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Biomedical subjects

H Saisho

Publications and source records attributed to H Saisho.

At least 109 records · Page 6Linked to original sources
PubMed1997

Frequent detection of hepatitis A viral RNA in serum during the early convalescent phase of acute hepatitis A.

The diagnosis of type A hepatitis is performed mainly by immunoglobulin M (IgM) anti-hepatitis A antibody assay, but it has not been established whether there is a correlation between changes in viremia and the clinical course of type A hepatitis. We examined hepatitis A virus (HAV) RNA in the sera from type A and non-A, non-B, non-C acute hepatitis and analyzed the relation of HAV viremia with alanine aminotransferase (ALT) and IgM-HA levels. Two hundred sera from 38 patients with type A acute hepatitis and 20 patients with non-A, non-B, non-C acute hepatitis were examined for the presence of HAV RNA. HAV RNA was detected by nested reverse transcription-polymerase chain reaction (RT-PCR) with primers located at the 5' non-translated region of HAV. HAV RNA was detected in 35 of 38 (92%) type A hepatitis patients and in 60 of 156 (38%) serum samples. In contrast, it was detected in none of 44 serum specimens from 20 non-A, non-B, non-C acute hepatitis patients. In type A hepatitis, the mean ALT level in HAV RNA positive specimens was 1,481 +/- 2,042 (range, 20-10,370) IU/L and that in HAV RNA negative specimens 186 +/- 330 (range, 8-1,698). The positivity of HAV RNA was correlated with the level of transaminase at the time of sample collection. The mean duration from the onset of symptoms to disappearance of HAV RNA was 18 +/- 14 days. The mean titer of IgM-HA in HAV RNA positive cases was 5.0 +/- 1.4, in negative cases 5.7 +/- 1.1, with no statistical difference. Our results indicate that HAV RNA in serum is detectable in the majority of type A hepatitis cases in their early convalescent phase by nested RT-PCR.

Acute Disease↗
PubMed1996

Clinicopathologic features of small pancreatic adenocarcinoma. A collective study.

BACKGROUND: Early diagnosis and complete removal of pancreatic adenocarcinoma (PC) is essential to improve its poor prognosis. It is necessary to find PC when it is small and at an early stage if surgical treatment is to be successful. This is an investigation of the clinicopathologic features of small PC. METHODS: Thirty-one resected and histopathologically examined cases of small PC, 2 cm or less in greatest dimension, were collected from 7 institutions between 1989 and 1994, and their clinicopathologic features were analyzed in detail. RESULTS: Eighteen patients (58.1%) had some symptoms or signs at the time of diagnosis, however, the other 13 (41.9%) had no symptoms. There was no sensitive blood test for the detection of small PC. The detection rates of the pancreatic tumor mass on ultrasonography, endoscopic ultrasonography, and computed tomography were 64.5% (20/31), 73.7% (14/19), and 64.5% (20/31), respectively. Only 13 patients (41.9%) were in International Union Against Cancer (UICC) Stage I, and the other 18 were in Stage III or IV due to lymph node metastasis or peritoneal dissemination. The overall 4-year postoperative survival rate was 54.5% and that of patients in Stage I was 77.9%. CONCLUSIONS: To detect a small PC, a thorough examination may be required in patients with slightly abnormal findings on laboratory tests or imaging modalities, even if the patient is asymptomatic. PC 2 cm or less and belonging to Stage I may be regarded as an early carcinoma, because of its good prognosis.

Adenocarcinoma↗
PubMed1996

Elevated plasma levels of matrix metalloproteinase-9 (92-kd type IV collagenase/gelatinase B) in hepatocellular carcinoma.

BACKGROUND: Matrix metalloproteinase 9 (MMP-9), a 92-kd gelatinase/type IV collagenase, has been implicated as playing an important role in cancer invasion and metastasis. A previous study showed that serum type IV collagenase activity correlated with metastasis by hepatocellular carcinoma (HCC). The aims of this study were to determine the plasma levels of immunoreactive MMP-9 in patients with HCC and to compare the levels with the clinical features including vascular invasion. PATIENTS AND METHODS: This study included 100 patients with HCC, 21 patients with chronic hepatitis (CH), 24 patients with liver cirrhosis (LC), and 138 healthy control subjects. Plasma MMP-9 levels were measured with a specific one-step sandwich enzyme immunoassay. RESULTS: Plasma MMP-9 levels in HCC (62 [33 to 130 ng/mL] median [25%, 75%], 13 to 660 ng/mL, minimum, maximum) were significantly elevated compared with those in normal controls (36 [25 to 45], range, 2.8-70 ng/mL), in CH (28 [18 to 30], 13 to 66 ng/mL) and in LC (35 [26 to 58], 16 to 86 ng/mL) (P < .0000001; P = .0000003; and P = .00205, respectively). When the cut-off level was defined as 60 ng/mL from a receiver operating characteristic curve, plasma MMP-9 concentrations had a sensitivity of 53% and a specificity of 89% for the detection of HCC from CH and LC. The levels were significantly higher in HCC patients with macroscopic portal venous invasion (79 [36 to 160], 15-660 ng/mL) than those without the invasion (44 [27 to 80], 13 to 210 ng/mL) (P = .00726). Plasma MMP-9 levels in patients with HCC were not correlated with tumor number, size, volume, or serum alpha-fetoprotein levels. CONCLUSIONS: The present data suggest that plasma MMP-9 levels can be a candidate for a novel marker for HCC. The levels appear to reflect its potential and ongoing activity of vascular invasion. A long-term follow-up of the patients will be necessary to determine whether increased plasma MMP-9 levels are predictive of more invasive and metastatic HCC.

Adult↗
PubMed1996

Analysis of a germ line polymorphism of the p53 gene in lung cancer patients; discrete results with smoking history.

The p53 tumor suppressor gene is often mutated in various human cancers and a common polymorphism is known at codon 72 of exon 4, with two alleles encoding either arginine (CGC) or proline (CCC). Association of this polymorphism with any human cancer susceptibility has yet to be clarified. We have conducted a case-control study in Japan on the distribution of the three genotypes with 191 lung cancer patients, 152 control patients with non-cancerous pulmonary diseases and 115 colorectal cancer patients. The genotypes were examined by PCR using DNA samples from peripheral blood lymphocytes. Frequency distributions of the three genotypes were quite comparable with each other among groups, with allelic frequencies of approximately 60% for arginine and 40% for proline. The genotypic frequencies in lung cancer patients, however, were largely different between smokers and non-smokers (chi 2 = 13.5, df = 2, P < 0.001). Compared with the control and colorectal cancer patients a significant difference in genotypic frequency was observed only in non-smoker lung cancers (chi 2 = 10.9, df = 2, P < 0.01), with an excess of Arg/Arg homozygotes and a deficit of Arg/Pro heterozygotes. Our present data suggest that the p53 polymorphism affects the risk of lung cancer unrelated to smoking.

Arginine↗
PubMed1996

Detection of hepatocellular carcinoma after interferon therapy for chronic hepatitis C: clinical study of 26 cases.

The clinical findings in 26 patients in whom hepatocellular carcinoma (HCC) was detected after the start of interferon (IFN) therapy for chronic hepatitis C were analysed. Histological study before IFN therapy showed that 34.6% of patients were categorized as stage 3 (septal fibrosis with architectural distortion; the 0-4 scale) and 80.8% demonstrated at least some evidence of septal fibrosis or more advanced features. The AFP levels examined before IFN therapy were more than 20 ng/mL in 13 patients (84.6% of those studied). One of 26 patients had a complete response to IFN therapy, while six of 26 patients had only a partial response. HCC was detected within 1 year after the start of IFN therapy in 76.9% of patients. Thus, the possibility of the early occurrence of HCC or its existence at the time of therapy should be seriously considered when IFN therapy is contemplated. Patients with stage 3 or 3-4 histology may already have a small undetectable HCC before IFN therapy. Thus, for this reason, every patient treated with IFN should be examined at short regular intervals for the development of HCC during and after IFN therapy.

Adult↗
PubMed1996

Does gallstone formation after open cardiac surgery result only from latent hemolysis by replaced valves?

OBJECTIVES: To clarify the relationship between open heart surgery and gallstone formation. METHODS: Fifty-one patients without gallstones (Group A) underwent cardiac surgery using a heart-lung machine and were followed for 24 months by ultrasonography. Blood tests of hemolysis markers were examined before, immediately after, and 3, 6, and 12 months after surgery. And 52 healthy candidates without gallstone (Group B) also were followed for 24 months. RESULTS: The cumulative gallstone incidence in Group A was 15.7% at 3 months after surgery, 23.9% at 6 months, and 30.4% at and beyond 12 months and was significantly higher than that of Group B (p < 0.01). The stones showed a high dense pattern, indicative of pigment stones, in eight of the 10 patients assessed by CT. With respect to the type of surgery, latent hemolysis was seen only in patients who underwent mechanical valve replacement. However, there were no significant differences in the gallstone incidence between the patients who underwent mechanical valve replacement and those who underwent another cardiac surgery. The values of hemoglobin, haptoglobin, and lactate dehydrogenase showed abnormal values immediately after surgery, regardless of mechanical valve replacement or another cardiac surgery. CONCLUSIONS: The use of a heart-lung machine, which produces hemolysis, appears to have a close relation to gallstone formation after open cardiac surgery.

Cardiac Surgical Procedures↗
PubMed1996

[Recent progress in the diagnosis of gastroesophageal varices].

Recent advances in the diagnosis of gastroesophageal varices are reviewed in this paper. Endoscopy, angiography, ultrasound, and ultrasound Doppler are now employed in the diagnosis of varices. As for endoscopic diagnosis, new criteria for the evaluation of gastroesophageal varices have been applied. Angiography is now not only used to demonstrate the varices and collateral circulations in portal hypertension but also used in the embolization therapy for large gastric varices or intractable esophageal varices. Ultrasound and color Doppler are now widely used in the diagnosis of portal hypertension because of its noninvasiveness and conveniency. Furthermore, in its use in endoscopy, varical vessels and blood flow in the wall of the esophagus and the stomach can be directly demonstrated. Recent advances in these diagnostic modalities will made it possible to diagnose gastroesophageal varices and evaluate the pathophysiology in patients with portal hypertension more precisely.

Angiography↗
PubMed1996

[Present state and future of radiation therapy for pancreatic cancer].

According to a nation-wide annual report on pancreatic cancer patients in 1992, 70 percent of patients with pancreatic cancer underwent operations. Thirty percent of them, along with 10 percent of patients who did not undergo operations, underwent radiation therapy. The result of external radiation monotherapy for local advanced pancreatic cancer is so poor that the 2-year survival rate and the median survival time have been reported in some papers to be approximately 10% and at most 13 months, respectively. Our results indicated that the 1-, 2- and 3-year survival rates and the median survival time after external radiation monotherapy for local advanced pancreatic cancer were 21%, 11%, 5% and 11.3 months, respectively. The reasons for the poor results are thought to be as follows: pancreatic cancer is very malignant, invades the surrounding tissues and metastasizes distantly in its earliest stages; it is mostly adenocarcinoma resistant to radiation therapy; and the pancreas borders closely the stomach and duodenum, which are very sensitive to radiation. Therefore, charged particle radiotherapy, especially heavy ion radiotherapy, is expected to bring about advances in the field of radiation therapy for pancreatic cancer because of its excellent potential for dose distribution and biological effect.

Adult↗
PubMed1996

[Characteristic findings of endoscopic retrograde pancreatography in the diagnosis of chronic pancreatitis with inflammatory mass].

Chronic pancreatitis with inflammatory mass (CPM) is difficult to differentiate from pancreatic cancer. To clarify the characteristic findings of CPM, we performed endoscopic retrograde pancreatography (ERP) in 39 patients. The pancreatogram showed smooth stenosis at the site of the mass in 26/39 cases (66.6%), irregular stenosis in 6 (15.4%), obstruction in 4 (10.3%), and no stenosis in 3 (7.7%). In the case of stenosis on ERP, the length of the stenosis correlated with the size of the mass. The pancreatogram distal to the mass showed dilatation in 26/35 cases (74.3%), 18 (51.4%) of which were simple dilatation. A follow-up study of 5 cases showed that all the stenoses had remained, and that the pancreatitis was aggravated in 2 cases. These findings suggest that CPM causes local stenoses of the pancreatic duct in many cases, and consequently may aggravate the stage of chronic pancreatitis.

Adult↗
PubMed1995

Study of repeated arterial infusion chemotherapy with a subcutaneously implanted reservoir for advanced hepatocellular carcinoma.

We performed repeated arterial infusion chemotherapy (RAIC) in 114 advanced hepatocellular carcinoma (HCC) patients, using a subcutaneous reservoir implanted under ultrasonic guidance. In 60 patients, this was the initial therapy for the primary tumor and the other 54 patients being treated for recurrent tumor. One hundred and seventy-one patients with advanced HCC who had been treated by transcatheter arterial embolization (TAE) or single bolus arterial infusion chemotherapy before RAIC was available served as historical controls. In 97 patients, anticancer agents (4'-epidoxorubicin or acurarubicin) and Lipiodol emulsion were used, and in 17, anticancer agents alone were given. The response rates were 39.2% in the Lipiodol group and 17.6% in the non-Lipiodol group. The dose of Lipiodol and the degree of liver invasion were the most important factors influencing the response rate. The 1-, 2-, and 3-year survival rates were 55.0%, 30.9%, and 21.2%, respectively. The long-termsurvival was compared in relation to Child's classification and the presence or absence of portal vein tumor thrombosis (PVTT). In non-PVTT patients, the results of initial therapy and therapy for recurrence were similar, but recurrent Child's C patients showed a poorer prognosis. In PVTT patients, initial therapy had a better prognosis than treatment for recurrence, but initial Child's C patients had a poor long-termprognosis. During the observation period, no severe complications were encountered, but in Child's C patients, hepatic function sometimes deteriorated. Compared with the results in the 171 controls, RAIC was more useful for advanced HCC as initial therapy, and it was also beneficial for the treatment of recurrence after TAE.

Aged↗
PubMed1995

Free combined thin wrap-around flap with a second toe proximal interphalangeal joint transfer for reconstruction of the thumb.

The combined thin wrap-around flap from the big toe and the proximal interphalangeal joint of the second toe is characterized by (1) a single vascularized joint, which is used to preserve the second toe with a free iliac bone graft, (2) a thin wrap-around flap, which allows the pulpal fatty tissue on the remaining bone of the big toe to be retained and accept a skin graft, (3) a wrap-around flap with a partial distal phalangeal bone, and (4) a microplate for firm fixation at the proximal bone union and early joint motion. The advantages of this method are (1) the cosmetic appearance is excellent with use of the thin wrap-around flap; (2) there is joint motion in the reconstructed thumb with strong pinch and vice pinch; (3) the vascularized joint with a microplate allows for early postoperative motion; (4) bone grafting from another donor site is unnecessary; (5) bone growth is possible in children with open epiphyses; and (6) the big and second toes are preserved with minimal donor-site morbidity. This method is indicated for thumb losses at a level distal to the metacarpophalangeal joint or at the level of the proximal phalanx.

Adult↗
PubMed1995

[Study of the changes in portal hemodynamics after endoscopic injection sclerotherapy with reference to the variceal recurrence].

Endoscopic injection sclerotherapy (EIS) combined with percutaneous transhepatic obliteration was performed in 63 cirrhotic patients with esophageal varices. In all patients, esophageal varices were completely disappeared after EIS. To investigate risk factors for recurrence of esophageal varices after EIS, hemodynamic changes in the portal system before and after EIS were studied by portal vein catheterization and ultrasonography. In patients in whom portal pressure rose after EIS, recurrence of varices was observed in high incidence (p < 0.05). Furthermore, variceal recurrence appeared frequently in patients with progressive splenomegaly after EIS (p < 0.05). During post-EIS course, new appearance or increase in size of non-variceal portosystemic collaterals was detected by ultrasonography in 22% of the patients. In these patients, variceal recurrence rate was low (p = 0.09). In patients with shunts around the splenic hilum, variceal recurrence rate was lower compared with the patients with paraumbilical vein (p < 0.05). Prognostic factors for variceal recurrence were analysed using multiple regression model. It was suggested that the absence of non-variceal portosystemic collaterals was the most risky factor. In conclusion, observation of portal hemodynamics is considered to be useful for the long-term management of patients with esophageal varices treated with EIS.

Adult↗
PubMed1994

A randomized trial of intrahepatic arterial infusion of 4'-epidoxorubicin with Lipiodol versus 4'-epidoxorubicin alone in the treatment of hepatocellular carcinoma.

We conducted a prospective randomized trial to evaluate the efficacy of Lipiodol in intrahepatic arterial infusion chemotherapy for patients with hepatocellular carcinoma (HCC). A total of 38 patients with unresectable HCCs and underlying cirrhosis were entered in this trial, and 36 of them were evaluable. Every 4 weeks, 17 patients received 70 mg of 4'-epidoxorubicin (epirubicin) alone (group A), whereas 19 patients received a Lipiodol emulsion containing the same dose of epirubicin (group B) through the hepatic artery. A tumor response (CR+PR) was observed in 12% of group A patients and in 42% of group B patients. The group B patients showed a significantly higher response rate than the group A patients. There was a tendency for an increased duration of survival (P = 0.09) in the group B patients. These results suggested that the infusion of the Lipiodol emulsion with epirubicin was more effective than epirubicin alone for the treatment of these patients with HCC.

Aged↗