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Biomedical subjects

H Makuuchi

Publications and source records attributed to H Makuuchi.

At least 91 records · Page 5Linked to original sources
PubMed1999

Stromal expression of thrombospondin-1 is correlated with growth and metastasis of human gallbladder carcinoma.

Thrombospondin-1 (TSP1) is one of the extracellular matrix glycoproteins that affect cell adhesion, motility and growth. Based on its effects on tumors, TSP1 is thought to be a potential regulator of tumor growth and metastasis. In this study, we examined TSP1 expression in human gallbladder adenocarcinoma and its clinicopathological significance. TSP1 immunoreactivity was detected mainly in the cancer stroma and was observed infrequently in cancer cells. According to the TNM classification, 74.5% (29/39) of the T2 and T3 gallbladder cancers were TSP1-positive, while none (0/14) of the T1 cancers showed TSP1 expression (p<0.001). Lymph node metastasis and venous involvement were frequently found in the TSP1-positive cases (90.0% and 87.1%, respectively) of gallbladder adenocarcinoma (p<0.001). These observations suggested that TSP1 expression plays an important role in cancer cell growth and metastasis of human gallbladder adenocarcinomas, and that stromal TSP1 immunoreactivity is a good predictor of vascular involvement and lymph node metastasis.

Adenocarcinoma↗
PubMed1999

Small mucosal carcinoma of the stomach with para-aortic lymph node metastasis: a case report and review of the literature.

A 38-year-old woman presented with a mucosal gastric carcinoma measuring 0.7 x 0.5 cm and para-aortic lymph node metastasis. Radiographic and endoscopic studies showed a small depressed lesion on the anterior border of the gastric angle, which was classified as a type II c + III lesion. Histological examination of the biopsy specimen revealed a signet-ring cell carcinoma. Distal gastrectomy with wide lymph node excision was performed. Detailed study of the resected specimen revealed that the tumour was limited to the mucosa, but metastasized to both the perigastric and para-aortic lymph nodes. The patient received adjuvant immunochemotherapy postoperatively. However, multiple bone metastases developed at 3 years and she died 4 years after the operation.

Adult↗
PubMed1999

[Treatment of Barrett's esophageal cancer with special reference to endoscopic treatment].

Most cases of Barrett's esophageal cancer are discovered in the advanced stage, and therefore the principle treatment is surgical. Endoscopic treatment is employed for patients with early cancer and severe dysplasia discovered by endoscopic examination, accidentally or during follow-up of Barrett's esophagus. Among the endoscopic forms of treatment, photodynamic therapy (PDT) is the main procedure for early cancer and severe dysplasia in Barrett's esophagus. Recently argon plasma coagulation (APC) has been introduced for the treatment of severe dysplasia and early cancer, in addition to Barrett's epithelium itself. In Japan, endoscopic mucosal resection (EMR) has also been employed in 5 cases of mucosal cancer in Barrett's esophagus. It will be used more widely in Japan, because the number of reflux esophagitis and Barrett's esophagus cases will increase in the near future.

Adult↗
PubMed1999

Palpability of breast tumors--correlation with ultrasonic findings.

With the recent development of high-resolution real-time ultrasonic devices and their application to clinical examination and breast screening, small non-palpable breast lesions have frequently been detected and controversy has arisen concerning their diagnosis and treatment. In order to evaluate the relationship between ultrasonic B-mode images and palpability of breast tumors, 71 breast tumors including 21 cancers were analyzed. Five basic measurements on tumor size and location were performed followed by calculation of secondary parameters of palpability. Larger size (D and W), less distance from the skin surface (S-T), less embeddedness within or more protrusion from the mammary gland (G-T) and greater relative size of tumor with respect to whole breast thickness (D/(S-P)) were found to be significantly related to greater palpability of breast tumors. Among the qualitative diagnostic criteria for breast tumors, an irregular shape, rough border, thick boundary echoes, heterogeneous internal echoes and indirect signs were statistically more frequent in palpable than non-palpable tumors, and in malignant than in benign tumors. In cases of cancer, palpability was related significantly only to size and to heterogeneous internal echoes. For early detection of breast cancer, identification of breast cancer among small non-palpable breast lesions less than 1 cm in size in ultrasonic B-mode images is considered to be essential.

Breast Neoplasms↗
PubMed1999

A case report: tumorectomy for brain metastasis of hepatocellular carcinoma.

Described here is a rare case of an operation for brain metastasis of hepatocellular carcinoma (HCC) after hepatectomy. We admitted a 45-year-old male patient complaining chiefly of a visual field disturbance and headaches. He had undergone a hepatectomy due to HCC one year prior to hospitalization. He was diagnosed with a brain metastasis with intratumoral hemorrhage. He underwent a tumorectomy and hemorrhage excision. After the surgery, his neurological symptoms improved, and he was temporarily rehabilitated. The decision to operate in this case could be questionable because the patient already had a pulmonary metastasis. Nevertheless, we concluded that local therapy for such a brain metastatic lesion would be effective in alleviating his discomforts and improving his quality of life as long as the primary lesion was under control.

Brain Neoplasms↗
PubMed1999

Autografting with peripheral blood CD34-positive cells following high-dose chemotherapy against breast cancer.

We report autologous CD34+ cell transplantation performed in 3 cases of recurrent breast cancer. The hematological recovery in these cases was assessed by comparing with that in the previous cases of autologous hematopoietic stem cell transplantation performed with the same high-dose chemotherapy regimen. Patient 1 was a 32-year-old woman with pulmonary and skeletal metastases; patient 2, a 55-year-old woman with pulmonary metastases; and patient 3, a 48-year-old woman with hepatic metastases. On day 1, cyclophosphamide 1000 mg/m2 and epirubicin 130 mg/m2 were administered concurrently with granulocyte colony-stimulating factor, and peripheral blood stem cells were harvested on days 14-16. These stem cells were processed using anti-CD34 monoclonal antibody and an immunomagnetic bead device, Isolex 300i. The high-dose chemotherapy regimen consisted of cyclophosphamide 2000 mg/m2/day, div, and thiotepa 200 mg/m2/day, div on day -5, -4, and -3. The harvested CD34+ cells numbered 3.9 +/- 2.8 x 10(6)/kg (range: 0.73-7.8/10(6)/kg), and the CFU-GM, 8.3 +/- 5.6 x 10(5)/kg (range: 1.2-15.1/10(5)/kg). After the separation, the percent of CD34+ cells was 81.9 +/- 11.6% (range: 65.8-96.4%), the CD34+ cell yield, 71.8 +/- 30.2% (range: 46.0-129.6%), and the CFU-GM yield, 48.9 +/- 9.1% (range: 35.3-62.0%). At the time of transplantation, the number of nucleated cells was 0.55 +/- 0.31 x 10(5)/kg, and that of CFU-GM, 31.2 +/- 17.8 x 10(5)/kg. Comparison of the hematological recovery in these three cases with that in patients receiving an identical high-dose chemotherapy regimen revealed recovery rates significantly faster than in patients having bone marrow transplants, and approximately identical with that in peripheral blood stem cell transplantation cases.

Adult↗
PubMed1999

A case of gastrointestinal stromal tumor of the stomach.

In a 55-year-old man, a tumor about 3 cm in diameter was detected in the upper abdomen by abdominal ultrasound screening during follow-up of chronic hepatitis C discovered in 1990. There were no symptoms and no abnormalities on physical examination. Tests for tumor markers were negative. By barium meal and gastroscopy, submucosal tumor was found on the lesser curvature of the stomach, with bridging fold in the absence of central ulceration. Biopsy revealed no tumor tissue. Under the diagnosis of submucosal tumor of the stomach, either a leiomyoma or leiomyosarcoma, partial resection of stomach was performed. Direct invasion of the surrounding organs, lymph node metastasis or distant metastasis was not observed grossly in the operation. Histologic examination of the resected specimen revealed proliferation of spindle cells and oval cells in an interlacing pattern. Immunohistochemistry for CD34, vimentin and c-kit protein was strongly positive, while smooth muscle actin, S-100 protein, desmin and p53 protein were negative. The proliferating cell nuclear antigen index was about 50%, while the MIB-1 index was < or = 1%. From these findings, this tumor was diagnosed as a gastrointestinal stromal tumor of the uncommitted type.

Follow-Up Studies↗
PubMed1998

Assessment of the proliferative activity of superficial esophageal carcinoma using MIB-1 immunostaining for the Ki-67 antigen.

BACKGROUND AND OBJECTIVES: Lymph node metastasis or vascular invasion may occur in superficial esophageal squamous cell carcinoma when it invades to or into the muscularis mucosae. Therefore, the correlation between histopathological characteristics and the proliferative activity of superficial esophageal carcinoma was investigated. METHODS: Thirty-eight cases of esophageal squamous cell carcinoma, including 14 cases of mucosal carcinoma and 24 cases of submucosal carcinoma, who underwent surgical resection without preoperative treatment, were studied using monoclonal antibody MIB-1 for the Ki-67 antigen immunohistochemically. The labeling index (LI) was calculated with a computed image analyzer. RESULTS: The LI of MIB-1 at the invasive tip of m3 carcinoma was significantly higher than that of m1 or m2 carcinoma (P < 0.01). The LI at the invasive tip was significantly higher than that at the core of sm2 (P < 0.05) and submucosal carcinoma overall (P < 0.01). The LI values at both the invasive tip and core of poorly differentiated carcinoma in submucosal carcinoma were higher than that of well or moderately differentiated carcinoma with a significant difference (P < 0.05). The LI at the invasive tip of submucosal carcinoma with lymph node metastasis or lymphatic invasion was significantly higher than that without them (P < 0.05). CONCLUSION: Proliferative activities of cancer cells in superficial esophageal squamous cell carcinoma, immunostaining with the MIB-1, were related to the depth of invasion, differentiation, lymph node metastasis, and lymphatic invasion with a significant difference.

Antibodies, Monoclonal↗
PubMed1998

[Assessment of saphenous vein graft wall characteristics with intravascular ultrasound imaging].

The wall characteristics of saphenous vein grafts (SVGs) after coronary artery bypass grafting (CABG) were assessed with intravascular ultrasound (IVUS) imaging. Twenty-seven SVGs in 25 patients who had undergone CABG were studied with IVUS in vivo. Ten SVGs excised from 6 patients who had undergone reoperation were studied with IVUS in vitro. The results were compared with the histopathologic findings. IVUS images of four SVGs studied within 1 month after CABG showed a thin and single-layer structure, which was almost identical to the IVUS features of a normal, fresh SVG. In five SVGs studied between 3 months and 1 year after CABG, the wall thickness was increased, and there were hypoechoic areas. In sixteen SVGs studied more than 2 years after CABG, two patterns were noted on IVUS imaging. One pattern was a triple-layer structure of alternating hyperechoic, hypoechoic, and hyperechoic bands seen in the angiographically normal sections of the SVGs. The second pattern was a heterogeneous, echogenic monolayer found in the angiographically irregular and diseased sections of the SVGs. Comparison of the in vitro IVUS images with the histopathology of the SVGs showed a strong correlation between the triple-layer structure and fibrointimal proliferation, and between the heterogeneous monolayer and atherosclerosis. In conclusion, IVUS is useful for assessing SVGs and for long-term qualitative monitoring of vein graft disease after CABG.

Coronary Artery Bypass↗
PubMed1998

[Pseudo-aneurysm of aortic arch and rupture into pericardium, a case report of successful surgical management].

This is a case report of 50 years old male suffering from pyrexia and epigastralgia 2 weeks prior to admission. On the 15th hospital day, he complained chest pain. Chest roentgenography revealed marked expansion of the mediastinum which was not existed upon admission. CT and MRI of the chest demonstrated a pseudoaneurysm of aortic arch at lesser curvature with extension into the pericardium. Exploration of the pericardium through median sternotomy disclosed fully filling with purulent effusion and blood clots. Following irrigation of the pericardial space and tube drainage, chest was closed. Repair of the aneurysm was postponded. Following continues irrigation of the pericardial space for 19 days, tube graft replacement of the aneurysm was performed under femorofemoral bypass and circuratory arrest through left thoracotomy. The aneurysmal space was filled with the omental pedicle to control infection. However, repeated bacteriological examination of the pericardium and aneurysm revealed no growth. Behçet disease was most suspected in report of the pathology.

Aneurysm, False↗
PubMed1998

[Successful management of aorto-esophageal fistula due to rupture of thoracic aortic aneurysm in an elderly patient].

Aorto-esophageal fistula due to ruptured thoracic aortic aneurysm is very rare but is associated with extremely high mortality. An 81-year-old woman was admitted due to repeated hematemesis. Endoscopic examination revealed ulceration with blood clot on the mid-esophagus and compression of an extra-esophageal mass. The thoracic CT scan revealed an aorto-esophageal fistula due to a ruptured descending thoracic aortic aneurysm. Surgery was performed on April 3, 1996. We report an aorto-esophageal fistula managed successfully in one stage by resection and replacement of the aortic aneurysm with a prosthetic graft and total esophageal resection. The esophagus was reconstructed using orthotopic gastric interposition with omentopexy around the prosthetic aortic graft. The postoperative course was uneventful and there have been no signs of mediastinal sepsis, graft infection or pyothorax 12 months postoperatively. We suggest that the resection of both the aneurysm and the esophagus as well as the immediate reconstruction of the esophagus by orthotopic gastric interposition to obliterate the retrosternal space are important technique in the management of intrathoracic infections.

Aged↗
PubMed1998

[Surgical treatment for chronic dissecting aneurysm (DeBakey type I)--a case using "elephant trunk" and "aortic tailoring"].

We present a surgical case of a 54-year-old man with chronic dissecting aortic aneurysm (Type I). At the first operation, ascending aorta and aortic arch were replaced with a tube graft under cardiopulmonary bypass and selective cerebral perfusion. Elephant trunk method was employed for the second operation. At the second operation, graft replacement of the proximal two-thirds of the descending aorta was performed, and the lower third of the descending aorta was tailored. Aortic tailoring consisted of the longitudinal aortomy and the removal of the initimal flap from the distal part of the descending aorta from the level of the 9th intercostal artery down to the diaphragm. The aorta was closed creating single channel 21 mm in diameter and containing the origins of the important intercostal arteries. He discharged the hospital without any complication including paraplegia or visceral ischemia, and his follow-up CT scan (1 year-later) did not show any dilatation of the tailored segment of the descending aorta and abdominal aorta.

Aortic Dissection↗
PubMed1998

[Postoperative compartment syndrome in a patient with acute aortic dissection (DeBakey type I)].

We report a case of compartment syndrome caused by femoral arterial cannulation during cardiopulmonary bypass. A 62-year-old man who had been diagnosed as acute aortic dissection (type I) received a operation of partial arch replacement with reconstruction of brachiocephalic and left carotid arteries. Compartment syndrome was noticed just after the operation, which was caused by long-term ischemia during femoral arterial cannulation combined with poor collateral circulation by the dissection of iliac arteries. The emergency fascitomy was performed, therefore, he could be discharged without any complications. It is concluded that in case of acute aorte aortic dissection, the back-flow of blood should be checked at the time of femoral arterial cannulation, and whenever the back-flow is poor, some procedures should be added to increase distal blood flow.

Acute Disease↗
PubMed1998

[Aortic root replacement by cryopreserved homograft for prosthetic valve detachment case due to aortitis].

We present a surgical case of a 35-year-old man with aortitis. He had been performed the reconstruction of the right common carotid artery with a saphenous vein graft at 23 years old for his ruptured aneurysm by aortitis. The aortic valve replacement and CABG (LITA to LAD, SVG to D1 and SVG to RCA) were performed for aortic regurgitation and aneurysms of coronary arteries two years ago. The diastolic murmur was first heard at 18 months after the operation. The echocardiography on admission showed an abnormal movement of the prosthetic valve with perivalvular leakage. At the second operation, the valve dehiscence was observed. Although the tissues around the dehiscence was friable and edematous, there were no signs of vegetation nor abscess formation. His aortic root was replaced with a cryopreserved aortic allograft conduit. His postoperative course was uneventful and aortography revealed neither aortic regurgitation nor stenosis of the coronary artery or SVGs. We think the softness of the allograft valve ring is favorable in valve detachment cases due to not only infection but also aortitis, to prevent redetachment.

Adult↗
PubMed1998

Immunotherapy and combined assay of serum levels of carcinoembryonic antigen and acute-phase reactants.

Our previous studies have revealed that gastric and esophageal cancer patients with abnormal sialic acid levels had a better response than those with normal levels if they received polysaccharide K (PSK), a nonspecific immunomodulator. Serum levels of carcinoembryonic antigen (CEA) and acute-phase reactants (APR) such as immunosuppressive acidic protein, acid-soluble glycoproteins, alpha1-antichymotrypsin, and sialic acid were analyzed in 872 gastric cancer patients who had undergone resection from March 1979 to September 1993 at the Department of Surgery of Tokai University. The patients were categorized into four groups according to the preoperative serum levels: group A had normal levels of both CEA and APR, group B had abnormal CEA and normal APR levels, group C had a normal CEA level and normal levels of one or more APR, and group D had abnormal levels of both CEA and of one or more APR. Patients in group D who received PSK showed significantly better survival than those without PSK (29.3% versus 6.9%; log-rank test, P = 0.0015; Breslow test, P = 0.0042). CEA-positive patients receiving PSK therapy exhibited a significantly better survival rate than those without PSK (38.1 % versus 18.6%; log-rank test, P = 0.0136; Breslow test, P = 0.0125). Cox's regression analysis showed that PSK therapy was significantly related to survival in group D, but not in the other groups. We conclude that the combined assay of tumor-associated factors (such as CEA) and various nonspecific reactants to the presence of cancer (such as immunosuppressive acidic protein, alpha1-antichymotrypsin, acid-soluble glycoproteins and sialic acid) provides a good set of preoperative indicators on which to base the selection of treatment for individual gastric cancer patients.

Acute-Phase Proteins↗
PubMed1998

Anemia in patients with colorectal cancer.

Although anemia is one of the signs of colorectal cancer, the relationships between histological findings and hematological findings other than hemoglobin level have not been adequately investigated. We investigated the relationship between hematological findings, serum iron, and histological findings in 358 patients (207 men and 157 women) with colorectal cancer. Their mean (+/-SD) ages were 64.3 +/- 12.4 and 63.8 +/- 13.3 years. A hemoglobin level of less than 10 g/dl was the criterion for anemia, and 20.8% of the men and 25.8% of the women met this criterion. Univariate analysis showed that carcinoma of the cecum, ascending colon, and transverse colon; large-size carcinoma, invasion beyond the proper muscle layer; positive lymph node metastasis: and clinical stage (Dukes' B, C, and D) were factors associated with high incidence of anemia. Histological type did not affect the hematological findings. Multivariate analysis showed that age, tumor site, and tumor size were significant factors related to anemia. Depth of invasion, the presence or absence of lymph node metastasis, and Dukes' classification were not significant factors. In the presence of these factors, mean corpuscular volume and mean corpuscular hemoglobin concentration values were low, and red blood cells were microcytic and hypochromic. The incidence of a low serum iron level was about twice the frequency of a hemoglobin level of less than 10 g/dl. The results of the multivariate analysis showed that none of the factors were significantly related to iron deficiency.

Adenocarcinoma↗