Biomedical subjects

H Kuwano

Publications and source records attributed to H Kuwano.

At least 145 records · Page 8Linked to original sources

PubMed1994

Immunohistochemical detection of CEA, CA19-9, and DF3 in esophageal carcinoma limited to the submucosal layer.

The immunohistochemical expression of CEA, CA19-9, and DF3 was studied in 20 normal epithelia, 11 cases of dysplasia, 32 squamous cell carcinomas restricted within the submucosal layer (SM carcinoma), and 42 advanced squamous cell carcinomas of the esophagus. The modes of expression were grouped into three patterns, i.e., negative, focal, and diffuse patterns. No diffuse expression of CEA, CA19-9, or DF3 was found in the normal squamous epithelium and dysplasia. In the carcinomas (32 SM carcinomas and 42 advanced carcinomas) the diffuse expression of CEA and CA19-9 was found in four lesions, and only one of the four lesions was an SM carcinoma, while the diffuse expression of DF3 was found in 16 of the 32 SM carcinomas and 25 of the 42 advanced carcinomas. These results indicated that the diffuse expression of these tumor-associated antigens were characteristic of tumor tissue in the esophagus, and particularly DF3 was diffusely expressed earlier than CEA or CA19-9. The expression of DF3 in the esophagus may, therefore, be a marker of the early stage of tumor growth.

Antigens, Neoplasm↗

PubMed1994

Univariate and multivariate analyses of the prognostic significance of discontinuous intramural metastasis in patients with esophageal cancer.

A review of 167 cases of esophageal carcinoma without preoperative treatment revealed 24 (14.4%) to have intramural metastasis (IM) within the esophagus. Among the clinicopathologic factors, the length of the lesions (P < 0.01), lymph node metastasis (P < 0.001), and the depth of the invasion of the tumor (P < 0.0001) were found to be statistically significant different factors between the two groups of patients both with and without intramural metastasis. The survival curve for patients with IM was significantly lower than that for patients without IM (P < 0.0001). A univariate analysis revealed that the depth of invasion, lymph node metastasis, IM (P < 0.0001), and the length of the lesion (P < 0.001) all had a significant correlation with the prognosis. Moreover, in a multivariate analysis, the depth of the invasion (< 0.001), length of the lesion (0.001), and IM (0.049) were all determined to be significant prognostic factors. Therefore, IM is considered to be one of the independent significant prognostic factors for predicting a poor prognosis in esophageal cancer.

Adult↗

PubMed1994

Dipyridamole inhibits early wound healing in rat skin incisions.

In an effort to investigate the significance of platelet aggregation on early wound healing, the inhibitory effects of an antiplatelet drug (dipyridamole) on tensile wound strength was assessed. The breaking strength of the dorsal incisional wounds in Donryu rats both with and without the administration of dipyridamole was measured. In experiment I, the intraperitoneal administration of dipyridamole (100 mg/kg/day, Group A; 50 mg/kg/day, Group B) and saline (3 ml/day; Group C) was performed during the periods between the day of incision and the excision of the healing wound specimen in a 2.0-cm width on the third and seventh postoperative days (POD). The wound breaking strength was 229 +/- 44, 256 +/- 39, and 352 +/- 38 g/cm2 on POD 3 and 477 +/- 67, 578 +/- 60, and 764 +/- 31.9 g/cm2 on POD 7, in Groups A, B, and C, respectively. In experiment II, we performed the intraperitoneal administration of either dipyridamole (100 mg/kg) or 3 ml of saline as a control just before incision (Group a) as well as at 4 hr (Group b), and 12 hr (Group c) after incision, and the percentages of tensile strength compared with the control were 72 +/- 8, 89 +/- 13, and 103 +/- 23% in Groups a, b, and c, respectively. The administration of dipyridamole significantly inhibited the wound healing and, therefore, platelet aggregation would appear to play an important role in the early phase of wound healing.

Animals↗

PubMed1994

The clinical characteristics of patients with synchronous squamous cell carcinoma of the esophagus and hepatocellular carcinoma.

An ongoing analysis of 762 patients with esophageal cancer revealed 4 (0.52%) male patients with synchronous hepatocellular carcinoma (HCC). A long history of habitual alcohol intake and heavy cigarette smoking was recognized in all four patients and, therefore, the possibility of these two factors being independent risk factors for this double cancer was suggested. Palliative treatment was undertaken since either one or both cancers were too far advanced, or because liver function was poor even in those patients with resectable cancers. The prognosis correlated more closely to the TNM stage of esophageal cancer rather than the HCC and the causes of death were related to the esophageal cancer in all four patients. These findings suggest that, in patients with this combination of double cancer, the state of the esophageal cancer may be a more reliable prognostic factor than that of the HCC and thus, the curability of esophageal cancer is of primary importance.

Aged↗

PubMed1994

A clinical analysis of multiple organ failure following elective surgery.

A retrospective analysis was made of 58 patients who unexpectedly developed multiple organ failure (MOF) following elective surgery, and the results were compared with those of 168 control patients who did not develop MOF. In 33 patients with liver cirrhosis, MOF was related to poor liver function, a low albumin level, excessive blood loss, many transfusions, and a high incidence of hypotension. MOF, rather than liver failure alone, was featured by postoperative bleeding and infection. In 15 patients with esophageal carcinoma, MOF was correlated with many transfusions, anastomotic leakage, and postoperative infection. In 10 patients who underwent surgery for an aortic aneurysm, poor renal function and extended anesthesia time were associated with MOF. These results indicate that to prevent MOF following elective surgery, it is important to: (1) Select patients for liver surgery according to their liver function, and minimize the risk of bleeding and infection, (2) avoid too many blood transfusions, and minimize the risk of leakage and infection in esophageal surgery, and (3) select patients for aortic surgery based on renal function and reduce the anesthesia time as much as possible.

Aortic Aneurysm↗

PubMed1994

Contact invasion by a polypoid pseudosarcomatous carcinoma of the esophageal wall: report of a case.

We present herein the interesting case of a 43-year-old man in whom a rapidly growing polypoid tumor of the esophagus was histologically proven to be pseudosarcomatous carcinoma. Of particular interest was the unusual type of invasion displayed by this tumor, whereby the head of the polyp came into contact with and directly invaded the esophageal wall at the distal end of the pedicle to the submucosal layer, while invasion near the stalk was restricted to the mucosa. This style of invasion is considered to be caused by the mechanical pressure produced by the rapid growth of the tumor in the narrow esophageal lumen.

Adult↗

PubMed1994

Pre-operative estimation of complete resection for patients with oesophageal carcinoma.

Three hundred and seventy-nine patients were studied retrospectively regarding the possibility of a complete resection of the oesophageal carcinoma based on the combined findings of pre-operative oesophagogoraphy and computed tomography (CT). One hundred and four out of 129 patients (96.1%) having lesions which did not demonstrate all three of the aforementioned factors (a lesion shorter than 8 cm, a normal oesophageal axis, and normal contact of the lesion with neighboring organs in CT) underwent a complete resection of the oesophageal lesion. Fifty-three percent of the patients (52/97) with a lesion showing only one of these factors had a complete resection. Whereas, on the other hand, a complete removal of the malignancy was only possible in 22% of the patients with two or all three of the findings. Moreover, as a result of further analysis limited for resected cases, the number of positive factors in these pre-operative findings correlated with the advancement of the surgical stage, which reflected a curability in surgery and a rate of postoperative complications. In order to make adequate plans for the treatment of patients with advanced oesophageal cancer, the finding of (i) the length of lesion, (ii) a deep ulceration and deformity of the oesophageal axis and (iii) any abnormal contact in CT, are considered to be very useful.

Adult↗

PubMed1994

Laparoscopy-assisted surgery: a new technique for transhiatal esophageal dissection.

Esophageal dissection under laparoscopic monitoring is performed during total esophagectomy to treat patients with cervical esophageal carcinoma. Using this technique, a safe esophageal dissection can be made from the surrounding mediastinal tissues. Some of the disadvantageous consequences of a blunt dissection, including the blind maneuver, may thus be prevented and various intraoperative and postoperative complications may be avoided.

Esophageal Neoplasms↗

PubMed1994

Polypoid carcinoma of the esophagus.

Polypoid carcinoma of the esophagus is rare and little is known about its clinical and histopathologic features. We reviewed 500 surgical cases of esophageal carcinoma and analyzed 12 polypoid carcinomas. Clinical records were reviewed. Histologic examination was done on an average of 68 sections in each tumor. Immunohistochemical examination for proliferating cell nuclear antigen (PCNA) was done in selected sections. No special findings were seen with respect to age, sex, symptoms, or tumor location. The tumors, however, had several interesting features: 1) the main histologic type was squamous cell carcinoma, but other histologic features such as so-called carcinosarcoma, adenoid cystic carcinoma, and verrucous carcinoma were occasionally seen, 2) bidirectional differentiation to squamous and adenocarcinomatous components was recognized, 3) intraepithelial spreading of the carcinoma was often present, 4) depth of invasion in the wall was often shallow, and 5) the prognosis was relatively good. The PCNA labeling index was well correlated with lymphatic or blood vessel permeation.

Adult↗

PubMed1994

Effect of digoxin on exercise performance in mildly symptomatic patients with idiopathic dilated cardiomyopathy and sinus rhythm.

The purpose of this investigation was to evaluate the effect of digoxin on aerobic performance in mildly symptomatic patients with congestive heart failure and sinus rhythm. Ten patients (8 men and 2 women) with idiopathic dilated cardiomyopathy (ejection fraction 17 to 33%, mean 27 +/- 4%) who were stable and mildly symptomatic with maintenance digoxin and diuretic therapy were studied. All patients underwent maximal symptom-limited ergometer exercise with analysis of respiratory gases during maintenance digoxin therapy, 4 weeks after digoxin withdrawal, and 4 weeks after digoxin readministration. Exercise capacity was assessed by peak oxygen uptake and anaerobic threshold. Serum digoxin concentration was 1.0 to 1.8 (mean 1.3 +/- 0.2) ng/ml during digoxin therapy, and less than the detectable level after digoxin withdrawal. No patients showed clinical deterioration after digoxin withdrawal. Peak oxygen uptake after digoxin withdrawal (23.7 +/- 3.0 ml/kg/min) did not differ significantly from that during maintenance digoxin therapy (23.8 +/- 2.5 ml/kg/min) or after digoxin readministration (24.1 +/- 2.9 ml/kg/min). The anaerobic threshold after digoxin withdrawal (14.9 +/- 2.5 ml/kg/min) did not differ significantly from that during maintenance digoxin therapy (15.0 +/- 2.1 ml/kg/min) or after digoxin readministration (14.9 +/- 2.2 ml/kg/min). No differences in heart rate and diastolic blood pressure were observed during exercise, but systolic blood pressure during exercise was significantly higher with digoxin therapy (p < 0.05). These results suggest that digoxin has no effect on aerobic performance in mildly symptomatic patients with idiopathic dilated cardiomyopathy and sinus rhythm.

Adult↗

PubMed1994

[Clinical evaluation of patients with right ventricular infarction detected by dual SPECT imaging of thallium-201 and technetium-99m pyrophosphate].

We evaluated clinical significance of dual-nuclide SPECT imaging (D-SPECT) of thallium-201 and technetium-99m pyrophosphate (PYP) in patients of acute inferior left ventricular infarction with PYP uptake in the right ventricle (PYP (+) group) in comparison with those without PYP uptake (PYP (-) group). There was no difference in coronary risk factors, history of angina, blood pressure, heart rate, and hemodynamics on admission between PYP (+) group and PYP (-) group. The duration from onset to admission was longer in PYP (+) group and coronary reperfusion therapies were carried out in few cases. In 7 of 8 PYP-positive patients, the diagnosis of right ventricular infarction was made only by D-SPECT. Four of 8 were complicated with shock within three days, and the duration of hospitalization was longer. Coronary angiography demonstrated many proximal lesions (50%) in PYP (+) group but few ones (18%) in PYP (-) group. D-SPECT was very useful for diagnosing acute right ventricular infarction, and it might contribute to the prevention of shock if performed within a few days.

Aged↗

PubMed1994

Epstein-Barr virus-associated carcinomas of the esophagus and stomach.

The Epstein-Barr virus (EBV) is associated with nasopharyngeal lymphoepithelioma and certain types of lymphoma. We studied the presence of EBV in Japanese patients with esophageal and gastric carcinomas. The polymerase chain reaction was used for the detection of EBV DNA, in situ hybridization was used for the detection of latent EBV infection, and immunohistochemical studies were used for the detection of EBV-encoded latent membrane protein in formalin-fixed and paraffin-embedded surgical specimens. Positive reactions for EBV were shown in two of 31 cases of gastric carcinoma and in one of 30 cases of esophageal carcinoma; these reactions were detected by all of the above methods only in the carcinoma tissue specimens. The morphologic features of these three cases included undifferentiated carcinoma with a lymphoid stroma; these features were very similar to those of lymphoepithelioma in the nasopharynx. A negative reaction for EBV was demonstrated in each of the other 29 cases of gastric and esophageal carcinoma. The results suggest that EBV is associated with gastric or esophageal undifferentiated carcinoma with a lymphoid stroma, just as it is associated with nasopharyngeal lymphoepithelioma.

Adenocarcinoma↗

PubMed1994

Characteristics and sequence of the recurrent patterns after curative esophagectomy for squamous cell carcinoma.

BACKGROUND: A large number of patients with esophageal cancer experience recurrence, even when a curative operation is performed. The purpose of this study was to clarify the characteristics of recurrence after a curative esophagectomy. METHODS: The patterns and the time of recurrence after curative esophagectomy were examined in 187 cases of thoracic esophageal cancer. Ninety-five of these patients died of evident recurrence. The recurrence patterns were classified into lymphatic, hematogenic, mixed type (lymphatic and concomitant hematogenic), and intramural recurrences. RESULTS: The number of cases in each recurrence group were 46, 23, 22, and 4, respectively. The disease free intervals were fairly closely correlated with pTNM stage in the lymphatic and mixed type groups whereas they were within 2 years in all cases of the hematogenic group. Among the 22 cases of the mixed type, hematogenic recurrence preceded lymphatic recurrence in only one case. Furthermore, 17 of 20 cases with either cervical or mediastinal lymph node recurrence of the mixed type were accompanied with lung recurrence, whereas the remaining two cases with abdominal lymph node recurrence had liver recurrence. CONCLUSIONS: These findings suggest that most mixed type recurrences and most lymphatic ones are primarily caused by lymph node metastases; thus the importance of a radical lymphadenectomy was supported. On the other hand, a careful examination for hematogenic recurrence is essential soon after operation.

Carcinoma, Squamous Cell↗

PubMed1994

[Strategy for the treatment of esophageal carcinoma].

Esophageal carcinoma is classified as one of the most malignant neoplasms owing to the difficulty of early detection, frequent lymph node metastasis, and high incidence of recurrence even after curative resection of the lesion. According to the increase of early cases of esophageal carcinoma with the progress of the diagnostic technique, endoscopic mucosal resection and blunt resection of the esophagus have come to be performed in cases with quite early carcinoma or poor risk factors. Hyperthermo-chemo-radiotherapy (HCR) is extremely effective for esophageal carcinoma, especially for the advanced cases. The 1-, 3- and 5-year survival rates of the cases treated with preoperative HCR and chemo-radiotherapy (CR) were 64.6, 35.0 and 23.9%, against 46.9, 20.0 and 3.4%, respectively. The prognosis of the cases treated with HCR was significantly better than that for cases treated with CR. Moreover, for far-advanced esophageal carcinoma cases, palliative therapy such as intubation should be performed to assure quality of life (QOL). Strict follow-up including postoperative combined therapies is required for an improved prognosis in esophageal carcinoma.

Combined Modality Therapy↗

PubMed1994

[Multidisciplinary preoperative treatment of esophageal cancer].

To obtain a better prognosis, multidisciplinary treatment is essential for esophageal cancer. We prescribed hyperthermia combined with irradiation and chemotherapy (HCR) preoperatively for patients with resectable esophageal squamous cell carcinoma. The local effect of the HCR therapy was better than that of chemotherapy and radiotherapy (CR), showing 19.3% of the complete response rate. The five-year survival rate of stage III and IV patients given preoperative HCR was 18.5%, compared with 10.4% in the CR therapy group and 10.5% in the preoperative no treatment group. Moreover, preoperative HCR therapy improved prognosis of cases with far advanced cancer which invades the neighboring organs, showing 20.1% of 3-year survival rate. To evaluate the effectiveness of hyperthermia more objectively, we started a prospective randomized trial from 1988, comparing HCR therapy and CR therapy. The local effect is better in HCR therapy. When treated with cisplatin, the rate of complete response (Grade 3) in HCR therapy was 35.3%, which is as high as for the multi-drug combined treatment reported from other institutes previously. More effective multidisciplinary treatment together with basic research are necessary for a better therapeutic outcome.

Adult↗

PubMed1994

Recent advances in the diagnosis and surgical treatment of patients with carcinoma of the esophagus.

Five hundred and eighty-five patients with carcinoma of the thoracic esophagus underwent resection of the esophagus in the surgical department in which we work since 1965. The postoperative 30 day mortality rate was 11.9 percent during the early period, from 1965 to 1974, whereas it has decreased to 1.3 percent in the period since 1985. The most common cause of mortality was pulmonary complications (45.8 percent). The five year survival rate of patients who underwent a curative resection between 1975 and 1984 was only 29.1 percent, whereas it has remarkably increased to 49.9 percent since 1985, at which time cervical thoracic and abdominal lymph node dissection began to be regularly performed. There were three patients with intraepithelial carcinoma and 17 with mucosal carcinoma, respectively; none of these patients died within five years postoperatively. However, the five year survival rate of 73 patients with submucosal carcinoma of the esophagus was only 52.6 percent. Thus, it is clear that the prognosis substantially worsens when carcinomatous invasion reaches the submucosal layer. From the results of this study, it can be concluded that a combination of early detection and resection of the esophagus with three field lymph node dissection offers the best chance for long term survival in patients with carcinoma of the esophagus.

Adult↗

PubMed1994

[DNA heterogeneity and its significance in colon carcinoma].

We performed DNA flow cytometry analysis of colon carcinomas from the viewpoint of DNA heterogeneity. The materials were 25 colon carcinomas and 17 metastatic lymph nodes. Four different regions were examined in each primary tumor. The DNA index (DI) was classified into four groups. We classified the primary tumors into homogeneous and heterogeneous group according to the DI of the four regions of each case. Ten of 25 (40%) were classified as homogeneous and 15 (60%) as heterogeneous. The heterogeneous group tended to show more aggressive clinicopathologic characteristics. The corresponding rate between the maximum DI in the primary tumor and the DI in the metastatic lymph node was 65% (11/17). The maximum DI of the primary tumors was mostly seen in the metastatic lymph nodes, suggesting high metastatic potentiality of the higher DI clones. The examination of DNA heterogeneity may be useful for detecting the more precise character of the colon carcinomas. In heterogeneous cases, the higher corresponding rate of DI between primary and metastatic lesions suggested that metastasis occurred frequently in primary lesions containing gathering larger DI cells.

Adenocarcinoma↗

PubMed1993

Squamous epithelial dysplasia associated with squamous cell carcinoma of the esophagus.

To investigate the relationship between dysplasia and carcinoma of the esophagus, 159 cases of esophageal carcinoma without any preoperative treatment were reviewed retrospectively. There were 75 dysplastic lesions in 32 cases (20.1%). The incidence of co-existence of dysplastic lesions was 0, 58.3, 31.3, 20.8 and 11.4% in intra-epithelial, mucosal and submucosal cancers and those invading the proper muscular layer and adventitia, respectively. Thus, excluding the cases of intra-epithelial carcinoma, the less advanced the lesion, the higher the incidence of dysplasia. Epithelial dysplastic lesions were classified as 12 with mild, 33 with moderate and 30 with severe degrees of dysplasia. Although the continuity of dysplastic lesions to the areas of carcinoma was not so frequent (48.0%), it was more often encountered in severe dysplasia rather than in moderate or mild dysplasia, which suggested some relationship between the severity of dysplasia and carcinoma. In the cases with a dysplastic lesion the multiplicity of squamous cell carcinoma and the intra-epithelial spread of the main lesion were more frequently seen (P < 0.001), suggesting a multicentric occurrence of dysplastic lesions and carcinomas.

Carcinoma, Squamous Cell↗