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Biomedical subjects

H Makuuchi

Publications and source records attributed to H Makuuchi.

At least 127 records · Page 7Linked to original sources
PubMed1996

Multiple primary esophageal and concurrent upper aerodigestive tract cancer and the aldehyde dehydrogenase-2 genotype of Japanese alcoholics.

BACKGROUND: Multiple intraesophageal primary cancer and upper aerodigestive tract (UADT) cancer associated with esophageal cancer are common diseases, especially in heavy drinkers. They are often explained by the concept of field cancerization, which suggests a similar etiology. However, little is known about the nature of the hypothesized etiology. METHODS: Among 901 Japanese male alcoholics systematically screened by upper gastrointestinal endoscopy (with esophageal iodine staining), 33 had squamous cell carcinoma of the esophagus. The multiplicity of their esophageal carcinoma and their concurrent UADT cancer was compared with their genotype for aldehyde dehydrogenase-2 (ALDH2), the major determinant of blood acetaldehyde concentration after drinking. RESULTS: Of 17 patients with inactive ALDH2, 13 (76.5%) had multiple primary carcinoma of the esophagus, whereas 5 of 16 (31.3%) with active ALDH2 had multiple carcinomas (P < 0.01). The prevalence of concurrent UADT cancer was 29.4% in those patients with inactive ALDH2, compared with 6.3% in those patients with active ALDH2. CONCLUSIONS: Inactive ALDH2 is a risk factor for multiple carcinoma of the esophagus in alcoholics. Acetaldehyde, a recognized animal carcinogen, appears to play a critical role in field cancerization.

Alcoholism↗
PubMed1996

Use of metronidazole gel to control malodor in advanced and recurrent breast cancer.

Intolerable malodor emanating from ulcerated tumors as a result of anaerobic infection is a serious problem in the management of advanced and recurrent breast cancer. Metronidazole can control this malodor, but its oral use may cause adverse reactions. We therefore formulated a metronidazole gel, since no equivalent preparation is commercially available in Japan, and used it in five female patients (four with advanced cancer and one with recurrent cancer) admitted to our hospital between March 1994 and July 1995. The patients were aged between 47 and 71 (median: 59) years, and the duration of morbidity in the four patients with advanced cancer ranged from 10 months to four years. In three patients, the tumors were larger than 10 cm x 10 cm. Metronidazole gel was applied to the surface of ulcerated tumors once or twice daily. Independent assessments by the patient, doctor and nurse were unanimous, and revealed that the malodor was alleviated in one patient after three days, and removed in four patients after two to five (median: four) days of metronidazole gel treatment. Culture of swabs showed a decrease or disappearance of anaerobic colonies. Adverse reactions characteristic of metronidazole did not occur. The topical use of metronidazole in a gel form will improve the quality of life for patients with malodorous ulcerated tumors and facilitate intensive treatment of the underlying disease.

Administration, Topical↗
PubMed1996

Case report: lymphangioma of the oesophagus endoscopically resected.

Lymphangioma of the oesophagus is an extremely rare entity, with only nine cases having been reported worldwide. We report on a 52-year-old woman with oesophageal lymphangioma, diagnosed using endoscopic ultrasonography and endoscopically resected. No case of malignant transformation of the lymphangioma has been reported in the literature. Endoscopic resection seems to be a minimally invasive method that is appropriate both for the removal of the tumour and precise diagnosis.

Endoscopy↗
PubMed1996

Intermediate lymphocytic lymphoma massively involving the gastrointestinal tract.

A case is presented of intermediate lymphocytic lymphoma seen in a 53 year old male, which extensively infiltrated systemic organs, including the entire digestive tract from the esophagus to the rectum. Peyer's patch invasion was evident. Multiple intestinal perforations caused death 5 months later. Surface marker studies suggested the marginal zone origin for this CD20+ B cell malignancy.

Antigens, CD↗
PubMed1996

[Effect of endoscopic sclerotherapy with esophageal varices on esophageal motility].

We investigated esophageal motility in 12 patients with esophageal varices by esophagography, scintigraphy and manometry before and after endoscopic sclerotherapy. In the manometric study, the appearance rates of the primary wave and the deglutitive relaxation decreased gradually after sclerotherapy, and the former improved within 3 months after discharge, while the latter tended to have a prolonged recovery period. The pressure of the lower esophageal sphincter was not significantly different before and after sclerotherapy. The length of the lower esophageal high pressure zone was greater than normal range before sclerotherapy, but it gradually shortened after sclerotherapy and improved by 3 months after sclerotherapy. The inducing rates of gastroesophageal reflux by abdominal compression was significantly higher at 3 months after sclerotherapy than before. In radiologic study, the esophageal transit time tended to prolong early after sclerotherapy, and it improved only slowly. We concluded that we need contrive to prevent from motility disorder of esophagus at the time of endoscopic sclerotherapy for patients with esophageal varices.

Adult↗
PubMed1996

[The clinical value of BMIPP on the evaluation of myocardial ischemia and metabolism before and after CABG].

To evaluate the clinical usefulness of BMIPP (15-(p-[125I]-iodophenyl)-3-R, S-methylpentadecanoic acid), BMIPP and T1 imaging were underwent before and after surgery in 25 CABG patients. Preoperatively the demonstrated lesion on BMIPP scintigram is almost the same as that on rest-T1 scintigram. A month after CABG, the recovery on T1 scintigram was remarkable, however improvement on BMIPP was limited. These results suggest that on the evaluation of myocardial ischemia, the clinical value of BMIPP is almost the same as that of rest-T1 before CABG. The postoperative discrepancy between T1 and BMIPP scintigram suggests that the restoration of myocardial circulation does not directly improve myocardial metabolism.

Coronary Angiography↗
PubMed1996

[A case of left ventricular myxoma].

Left ventricular myxoma is very rare. To our knowledge, only 26 cases have been reported in the English and 7 cases in the Japanese literature. A 71-year-old man in our care was being followed due to angina pectoris. Two-dimensional echocardiography revealed a small mass in the left ventricular outflow tract. An operation was performed under cardiopulmonary bypass on July 14, 1992. A small mass located on the anterior wall of the left ventricle was excised en bloc via a transaortic approach. The gelatinous mass measuring 24 x 12 x 3 mm was determined histopathologically to be a myxoma. The postoperative course was uneventful and there has been no sign of recurrence so far. Because recurrent cases have been reported in the past, careful follow-up will be performed periodically.

Aged↗
PubMed1996

[A case report of concomitant carotid and coronary artery reconstruction].

We reported a case of a 70-year-old female who underwent simultaneous carotid endarterectomy and coronary artery bypass surgery. Preoperatively, cardiac catheterization demonstrated three vessel coronary artery disease. Her carotid angiogram revealed a 90% stenosis in the left common carotid artery. The cerebral blood flow scintigram on acetazolamide stress detected severely reduced cerebral blood flow on her left anterior and temporal lobe. Her postoperative course was uneventful. Postoperatively, no reduced cerebral blood flow was detected on the acetazolamide stress image. In patients with significant carotid artery stenosis, the cerearal blood flow scintigraphy on acetazolamide stress was a useful method for the simultaneous carotid endarterectomy and coronary artery bypass surgery.

Acetazolamide↗
PubMed1996

Acute emphysematous cholecystitis associated with pneumobilia: a case report.

This report describes a rare case of acute emphysematous cholecystitis with pneumobilia in the common bile duct. The patient was a 66-year-old woman with a part history of diabetes mellitus, and operations for gastric and breast carcinoma. The chief complaint was pain in the right hypochondrium with severe right hypochondrial tenderness and distention of the gallbladder detected on examination. Laboratory tests showed leukocytosis, marked elevation of CRP, jaundice, liver dysfunction, and hyperglycemia. Gas was detected in the gallbladder on plain abdominal X-rays and CT scans of the abdomen, and a small amount of gas was also observed in the common bile duct. On the day of admission, percutaneous transhepatic gallbladder drainage (PTGBD) was carried out under ultrasound guidance, and Clostridium perfingens and E. coli were detected in the bile. Imaging after PTGBD showed no cystic duct obstruction. On the 12th day after PTGBD, cholecystectomy and choledochotomy with primary closure were performed. The postoperative course was good and the patient was discharged on the 15th day after surgery.

Acute Disease↗
PubMed1996

A case of microhepatoma associated with schistosomiasis japonica diagnosed by enhanced ultrasonography after hepatic intraarterial injection of carbon dioxide gas.

The patient was a 58-year old man whose complaints were generalized malaise and right epigastralgia. He had liver cirrhosis and schistosomiasis japonica, previously diagnosed by laparoscopy. Computed tomography (CT) showed a high density funicular shadow in the liver. However no tumorous lesions in the liver were visualized. Ultrasonography (US) of the liver showed a reticulate or scaly pattern, but no images of tumorous lesions. Hepatic angiography showed a single, deeply colored image about 1cm in diameter, in the segmentum anterosuperior. Preoperative and intraoperative enhanced US with hepatic intraarterial injection of carbon dioxide gas was performed. It showed a hyperechoic tumor shadow about 1cm in the segmentum anterior. The segmentum anterosuperior including the tumor was partially resected. Pathologically, the tumor was found to be a hepatoma of Edmondson type II, caused by cirrhosis and schistosomiasis japonica. The patient's postoperative course was uneventful. Enhanced US with hepatic intraarterial injection of carbon dioxide gas was useful for the diagnosis and treatment of the microhepatoma associated with schistosomiasis japonica.

Angiography↗
PubMed1996

Endoscopic screening for esophageal cancer in 788 patients with head and neck cancers.

Esophageal cancer has a poor prognosis because it is difficult to detect in its early stages and, even if an operation is possible, the postoperative quality of life is much impaired. An early diagnosis can lead to a good prognosis and enables treatment by endoscopic mucosal resection (EEMR), contributing to a postoperative good quality of life. As head and neck cancers are known to have a high risk of concomitant esophageal cancer, endoscopic screening with iodine staining was performed on 788 patients with head and neck cancers. Among them, 93 cases of esophageal cancers (11.8%) and 23 cases of gastric cancers (2.9%) were detected. Seventy-two cases (77.4%) of the 93 esophageal cancers were superficial cancers limited to the submucosal layer. Twenty cases, treated by EEMR, had a good postoperative course without local recurrence. We suggest that endoscopic screening for esophageal cancer should be performed on all patients with head and neck cancers, because it allows early detection and a good prognosis, and the treatment can be completed by endoscopic maneuver.

Aged↗
PubMed1995

Successful screening for early esophageal cancer in alcoholics using endoscopy and mucosa iodine staining.

BACKGROUND: Epidemiologic studies have provided evidence that alcohol abuse is an important risk factor for esophageal carcinoma. However, no systematic screening program has been established yet in the early detection of esophageal cancer in high risk populations of heavy drinkers. METHODS: A cohort of 629 male alcoholics (54 +/- 8 years old) were consecutively and systematically screened by endoscopy combined with iodine staining and targeted biopsy at the National Institute on Alcoholism (Kanagawa, Japan). For mucosal carcinomas, endoscopic esophageal mucosal resection (EEMR) was used to serve confirmatory diagnostic and therapeutic purposes. RESULTS: Iodine-unstained lesions, distinctly demarcated, white, and 5 mm or larger in greatest dimension, were observed on the esophageal wall in 162 patients (25.8%). Thirty-six such unstained lesions in 21 of 629 patients, with an unexpectedly high rate of 3.3%, turned out to be squamous cell carcinomas of the superficial type. According to some established criteria, EEMR was performed in 17 of these patients, 3 of whom were given additional irradiation. Esophagectomy was performed in two patients, chemotherapy combined with irradiation in one, whereas still another was followed endoscopically. The cancer invasion was confined within the epithelium in eight patients, to the proper mucosal layer in nine, and to the submucosa in four. Multiple logistic regression revealed that the risks for distinct iodine-unstained lesions and superficial esophageal carcinoma increased independently for users of stronger alcoholic beverages, i.e., whiskey or shochu (odds ratio [OR] = 1.47 and 2.94, respectively) compared with lighter beverages, i.e., sake or beer and 30+ cigarettes/day (OR = 1.68 and 3.85, respectively). CONCLUSION: Routine application of this program for these high risk individuals yielded an unusually high rate of detection of esophageal carcinoma.

Adult↗
PubMed1995

Immortalisation of human oesophageal epithelial cells by a recombinant SV40 adenovirus vector.

We introduced the origin-defective SV40 early gene into cultured human oesophageal epithelial cells by infection of a recombinant SV40 adenovirus vector. The virus-infected cells formed colonies 3-4 weeks after infection in medium containing fetal calf serum. When the cells derived from 'serum-resistant' colonies were then maintained in the serum-free medium with a low calcium ion concentration, some of them passed the cell crisis and kept growing for over 12 months. These cells, regarded as immortalised cells, resembled the primarily cultured oesophageal epithelial cells in morphology and had some of their original characteristics. Treatment of the cells with a high calcium concentration induced phenotypic changes. These cells still responded to transforming growth factor beta. When the immortalised cells were injected into severe combined immunodeficient mice, they transiently formed epithelial cysts, although the typical differentiation pattern of the oesophageal epithelium was not observed. These cysts regressed within 2 months without development into tumours. The results indicated that human oesophageal epithelial cells were reproducibly immortalised by infection with a recombinant SV40 adenovirus vector at relatively high efficiency. The immortalised cells should be useful in studies on oesophageal carcinogenesis and in assessing the cooperative effects with other oncogene products or carcinogens.

Animals↗
PubMed1995

Comparison of long-term efficacy of medical treatment versus coronary artery bypass grafting (CABG) in multivessel coronary artery disease.

The long-term results of medical therapy and coronary artery bypass grafting (CABG) were compared in patients with multivessel disease. All patients were confirmed to have > or = 75% luminal narrowing of major coronary arteries by coronary arteriogram. When multivessel disease was stratified into double- and triple- vessel disease, the outcomes varied. In triple-vessel disease, the outcome with CABG was good, but the outcome was unfavorable in those employing medical therapy, particularly in patients with decreased left ventricular (LV) function. In patients with double-vessel disease with good LV function, the long-term results with medical therapy were just as favorable as those with CABG. However, double-vessel disease complicated by reduced LV function (ejection faction < or = 40%) had a clearly less favorable outcome when treated with medical therapy than with CABG. Thus, it is important for patients with multivessel disease to undergo revascularization if indicated, to improve their prognosis. On the other hand, the incidence of cardiac events arising from vein graft occlusions tended to increase in CABG patients after 5 years or more following surgery.

Aged↗
PubMed1995

[Clinical usefulness of FUT-187 (sepimostat mesilate) on reflux esophagitis and gastritis after gastrectomy].

The efficacy and safety of the proteolytic enzyme inhibitor FUT-187 were evaluated in postgastrectomy reflux esophagitis and gastric remnant inflammation. FUT-187 was administered orally in a dose of 50 mg four times daily, after meals and bedtime, for periods of 4 to 8 weeks. The subjects consisted of 4 patients with postgastrectomy reflux esophagitis and 9 patients with gastric remnant inflammation. In the endoscopic classification of lesions, postgastrectomy reflux esophagitis was classified as erosive or ulcerative and gastric remnant inflammation as superficial. The general improvement rating, general improvement rating of endoscopic findings, and final global improvement rating were 85% (11/13), 82% (9/11), and 85% (11/13), respectively. Neither adverse reactions nor abnormal laboratory findings due to the test drug were noted. Based on the results of this study, it may be concluded that FUT-187 is an effective drug with a wide margin of safety for postgastrectomy reflux esophagitis and gastric remnant inflammation.

Administration, Oral↗
PubMed1995

[The clinical value of MIBG myocardial spect before and after CABG--comparison with TI myocardial spect].

To evaluate the clinical usefulness of MIBG scintigraphy, 25 CABG patients underwent myocardial imaging using MIBG and TI. The result of this study indicated that the sensitivity of the MIBG was equivalent to that of the stress TI in detection of ischemic lesions. In spite of successful recanalization, only 14 patients showed improvement of MIBG uptake, indicating that MIBG is not useful for detecting myocardial ischemia just after CABG. The decreased postoperative uptake of MIBG suggests that the CABG procedure may have caused denervation of the region.

3-Iodobenzylguanidine↗
PubMed1994

[Surgical treatment of acute Stanford Type-A aortic dissection].

Twelve cases of Stanford Type-A aortic dissection were operated in an acute phase. The male vs female ratio was 3:9, and their ages ranged from 47 to 79 (mean 61.3) years old. Most of them complained of chest and/or back pain, and four of them complained of syncope. Eight patients had the history of hypertension. As to the complications of aortic dissection, cardiac tamponade was seen in two cases, myocardial infarction in one, and transient hemiplegia and paraplegia in one case each. In five cases, moderate to severe aortic regurgitation was also noted. All but one case were operated within twenty-four hours after admission. The replacement of the ascending aorta with a tube graft was performed in all cases including the two cases whose entries were located in the aortic arch. CABG was done concomitantly in three cases, and aortic valve replacement and CABG in one case. The open distal anastomosis was carried out under the systemic circulatory arrest combined with the retrograde cerebral perfusion. The systemic perfusion was reinstituted after the distal anastomosis was completed. In cases whose dissecting pseudo-lumen of the distal aorta was not thrombosed, the arterial cannulation site was shifted from the femoral artery to the tube graft. All but two cases were discharged from the hospital in good condition. One case, who had been transferred to the operating room under cardiac massage due to myocardial infarction, was lost by severe LOS three weeks postoperatively.(ABSTRACT TRUNCATED AT 250 WORDS)

Acute Disease↗