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Biomedical subjects

H Shimada

Publications and source records attributed to H Shimada.

1,080 records · Page 60Linked to original sources
PubMedDate not supplied

Copper metabolism after living donor liver transplantation for hepatic failure of Wilson's disease from a gene mutated donor.

There is a genetic problem in living donor liver transplantation, involving Wilson's disease, because the majority of donors have a kinship relationship. Recently, it was reported that the serum ceruloplasmin level is insufficient in some persons with one allele mutation. The recipient was a 13-year-old male child, and the donor was a 22-year-old woman, who was his sister by a different father. The gene analysis for Wilson's disease (ATP7B gene) was preoperatively carried out by the amplification refractory mutation system-PCR. Homozygous and heterozygous deletion of 2871 cytosine (C) were detected in the recipient and donor, respectively, in the ATP7B gene. Serum ceruloplasmin level was sufficient in the donor. The right hepatic lobe graft was transplanted to the recipient. Immediately after the liver transplantation, the copper metabolism improved to increase the serum ceruloplasmin levels up to the normal range, and decrease the urinary copper excretion. However, the serum ceruloplasmin levels gradually decreased below the normal base line, although the urine copper levels continued to be low without any clinical symptoms. We should perform gene analyses and confirm the serum ceruloplasmin levels in donors before living donor liver transplantation for Wilson's disease, to screen for their impairment of copper metabolism. After living donor liver transplantation for Wilson's disease, we should carefully follow-up the transition of serum ceruloplasmin levels in the recipient.

Adenosine Triphosphatases↗
PubMedDate not supplied

Monocyte CD14 changes and endotoxemia after major hepatectomy.

BACKGROUND/AIMS: This study was designed to ascertain whether decreases in membrane CD14 (mCD14), the endotoxin receptor on the surface of the monocyte cell membrane, reflect the presence of endotoxemia, and whether endogenous endotoxemia is present after hepatectomy. METHODOLOGY: First, in cases with a definitive clinical diagnosis of endotoxemia, we determined the serum endotoxin level by the ES (Endospesy) method, from the percentage of cells positive for membrane CD14, from the CD14 fluorescence intensity (MFI-CD14), and from the quantification of soluble CD14 (sCD14); and calculated the diagnostic accuracy obtained with each. Next, in 13 cases of extended hepatectomy (in excess of lobectomy) the mCD14-positive rates were determined around the time of the operation, and compared with the clinical courses of infection foci, if any, and other findings. RESULTS: The diagnostic accuracy of endotoxemia obtained by ES, mCD14, MFI-CD14 and sCD14 were 77.3%, 95.5%, 86.7% and 66.7%, respectively, so that the highest was given by the positive mCD14 cell rate. Although no infectious complication was detected in any of the 9 patients in whom the mCD14-positive rates changed within the normal range, of the 4 patients in whom the mCD14-positive rates fell, 2 had cholangitis due to gram-negative bacilli, one who was infected by central vein catheterization, was thought to have exogenous endotoxemia; and the fourth, in whom no clear focus of infection was detected, ran a temperature of 38 degrees C (over 100 degrees F) of unknown origin for 16 days. In this last patient, gram-negative bacilli were detected in both the saliva and the gastric juice, and so endogenous endotoxemia was suspected. CONCLUSIONS: These results show that decrease in the mCD14-positive rate is more accurately diagnostic of endotoxemia than the endotoxin value obtained by the ES method, and was considered to be a definitive diagnosis of endotoxemia. In addition, from the reduction of the mCD14-positive rate after extended hepatectomy, it was considered that endogenous endotoxemia occurred in one case out of 13 (8%).

Endotoxemia↗
PubMedDate not supplied

Chemoradiation for patients with esophageal cancer aged 80 and older.

BACKGROUND: The objectives of this study were to evaluate the efficacy and toxicity of concurrent chemoradiation in patients with esophageal cancer aged 80 and older. PATIENTS AND METHODS: Seven patients with esophageal cancer, aged 80 or more were treated with chemoradiation. Five received a systemic combination of cisplatin and 5-fluorouracil while 2 received daily 5-fluorouracil, concurrent with radiotherapy. The total doses of radiotherapy ranged from 50 to 65 Gy. RESULTS: Complete response was obtained in 3 patients, and partial response and no change in 2 cases each. Esophageal passage improved in 4 patients. The treatment was well-tolerated. There was no death attributable to any adverse treatment effects. None of the patients experienced grade 3 or worse acute toxicities. CONCLUSION: This study demonstrated that advanced age per se is not a sufficient reason to exclude elderly patients from aggressive treatment.

Aged↗
PubMedDate not supplied

Micronuclei in esophageal cells of Chinese youths in a high-incidence area for esophageal cancer in China.

An epidemiologic survey among 538 young persons between 15 and 26 years of age in a high-risk area for esophageal cancer in the People's Republic of China revealed a high prevalence of esophagitis. Histologically confirmed very mild, mild, and moderate esophagitis was observed in 31.6%, 10.7%, and 1.1% of 354 male and 30.4%, 4.3%, and 1.1% of 184 female subjects. The prevalence of micronuclei in esophageal smears was assayed in a subsample to investigate its possible association with esophagitis and with risk factors for esophageal lesions. Of the 186 subjects, 2.7% had mild or moderate esophagitis, 19.9% had very mild esophagitis, and 77.4% were normal. The frequency distribution of micronucleated cells in the esophageal mucosa was similar for the three diagnostic groups. Mean percentages of micronucleated cells did not differ by diagnosis of esophagitis, household status, current smoking status, presence of oral leukoplakia, or consumption of burning hot beverages or fresh fruit. Higher mean percentages were observed in the older age group of both sexes, but the difference was not statistically significant. The results suggest that if esophagitis is considered an important precursor state in the development of esophageal cancer, the scoring of micronuclei does not appear to be an efficient test for mild forms of esophagitis.

Adolescent↗
PubMedDate not supplied

Pancreaticojejunostomy and pancreatic leakage after pancreaticoduodenectomy.

Some techniques of pancreaticojejunostomy have been introduced with reference to pancreatic leakage from the pancreaticojejunal anastomosis. Pancreatic leakage (+/- ) occurred in 21.4% of pancreaticojejunostomy patients and pancreatic leakage (+) in 9.5%. The frequency of pancreatic leakage tended to be higher in cases where the pancreatic duct was undilated and the remaining distal segment of the pancreas had a soft tissue. Pancreatic leakage led to secondary complication in none of the patients in our series, but further technical refinement of pancreaticojejunostomy is warranted to reduce the frequency of pancreatic leakage to zero.

Anastomosis, Surgical↗
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The micronucleus test of benzo[a]pyrene with mouse and rat peripheral blood reticulocytes.

The micronucleus test using peripheral blood reticulocytes (RETs) was evaluated in CD-1 and BDF1 mice and Sprague-Dawley rats treated with benzo[a]pyrene at two independent laboratories. The maximum incidence of micronucleated reticulocytes (MNRETs) appeared in both strains of mice 48 h after the treatment; interlaboratory differences were small. The incidence of MNRETs in BDF1 mice was higher than in CD-1 mice. In rats, significant increases of MNRETs with the maximum response at 72 h were detected when B[a]P was administered i.p.; slight but significant increases were observed at 24 h or later, with the maximum at 24-48 h, when it was administered p.o. These results suggest that the new method for the micronucleus test using circulating RETs will be useful in the detection of the clastogenicity of chemicals.

Animals↗
PubMedDate not supplied

Clinical significance of serum CEA protein and CEA mRNA after resection of colorectal liver metastases.

BACKGROUND: It is difficult to predict the recurrence of colorectal liver metastasis after curative hepatectomy. We investigated the relationship between subsequent metastasis and both CEA protein and CEA mRNA (TaqMan PCR) diachronic levels. PATIENTS AND METHODS: The subjects were 30 patients with colorectal liver metastases. Serum CEA protein and CEA mRNA assays were performed every month after hepatectomy. RESULTS: Metastasis recurred in 21 of the 30 patients. The CEA mRNA assay showed 26 cases with high (H) levels and 4 with low (L). Among the 15 patients whose protein levels were not elevated (NE group), 6 had recurrence; all 6 belonged to the mRNA H group. None of the 4 patients in the mRNA L group had recurrence. In the protein-elevated (E) group (DFI > 6 months) (n = 7), mRNA was elevated in 5 cases (71.4%) 6 months before recurrence, whereas protein was elevated in 1 case. The sensitivity, specificity and accuracy of CEA protein/mRNA for identifying recurrence were 71.4/100, 100/44.4, and 80/83.3%, respectively. CONCLUSION: CEA mRNA is more sensitive than CEA protein in detecting recurrence. CEA mRNA may be useful for identifying high-risk groups or detecting recurrence at an early stage, when the CEA protein level is still low.

Aged↗
PubMedDate not supplied

Colonic J-pouch decreases bowel frequency by improving the evacuation ratio.

BACKGROUND/AIMS: To compare the functional outcome of ultra-low anterior resection for rectal cancer with colonic J-pouch reconstruction with that of straight reconstruction. METHODOLOGY: Twenty-three patients who underwent ultra-low anterior resection with or without J-pouch reconstruction underwent bowel transit study, videodefecography, and answered a questionnaire survey 4 months and 1 year after surgery. Eleven healthy subjects underwent similar testing as controls. RESULTS: Patients with a J-pouch had less frequent stools than patients with straight reconstruction 4 months after surgery (p<0.05), but the two groups were similar at 1 year. Bowel transit time was similar at both study points. The evacuation ratio was higher after J-pouch than straight reconstruction 4 months after surgery (p<0.05). However, the ratio improved in the straight group, and no difference existed at 1 year. Colonic contraction was seen only near the anastomosis 4 months after surgery, but the contraction proximal to the anastomosis improved over the next 8 months. CONCLUSIONS: J-pouch reconstruction facilitates evacuation by improving the evacuation ratio. Although straight anastomosis caused excessive stool frequency 4 months after surgery, colonic function continued to improve and was comparable with J-pouch and straight reconstruction 1 year after surgery because the contraction ratio proximal to the anastomosis improved.

Aged↗
PubMedDate not supplied

The infiltration of bile duct carcinoma along the bile duct wall.

The infiltration of extrahepatic bile duct carcinoma along the bile duct wall was studied in 29 resection cases. Histologically, spreading took place by mucosal infiltration in one case, mucosal and transmural in three, and transmural in 25. The average microscopic infiltrating distance from the gross margin of the tumor (ID) was 16.8 mm towards the liver, 6.5 mm towards the duodenum. The ID of the infiltrating type in the gross appearance of the tumor and the ID of the tubular adenocarcinoma in the histological cellular type tended to be long. The severer the invasion of the carcinoma to the lymphatic vessels, the longer the ID. The result indicated that most bile duct carcinomas have a tendency for long infiltration along the wall. An exceedingly wide resection involving hepatectomy is advisable for treatment.

Adenoma, Bile Duct↗
PubMedDate not supplied

Experience with intrahepatic cholangiojejunostomy for unresectable carcinoma of the hepatic hilus.

An intrahepatic cholangiojejunostomy at segment III or segment IV (surgical bypass) was performed for 13 unresectable hepatic hilar carcinoma patients after reduction of jaundice. Compared with the result of external biliary drainage alone, the 30-day mortality rate was 1/13 in the surgical bypass group and 4/12 in the external biliary drainage group. The incidence of postoperative cholangitis in each group was 3/13, 6/17 and the mean survival rate was 155 days, 96 days. It was concluded that intrahepatic cholangiojejunostomy for unresectable hepatic hilar carcinoma, contributed to a temporary return to normal life, gave better results than external biliary drainage.

Adult↗
PubMedDate not supplied

"Seed" to "soil" is a return trip in metastasis.

A critical aspect in understanding and treating cancer progression and metastasis is the relationship of the host originating organ and metastatic "soil" organs that support the growth and progression of the cancer "seed". We have recently demonstrated that there is a great difference in seemingly similar visceral organs, the colon and the stomach to support the growth progression of transplanted human colon tumors in nude mice. To further understand the relationship of seed and soil in cancer, we transplanted the metastatic human colon tumor CO-3 on the liver of nude mice, which is a usual metastatic soil organ for this tumor if transplanted to the nude-mouse colon. The intrahepatically-transplanted CO-3 tumor grew extensively on the nude-mouse liver without intra-hepatic metastasis. However, cecal growth, peritoneal dissemination, and invasiveness were noted after extensive growth on the liver with no spread to other organs. This phenomenon suggested that the intra-hepatically transplanted tumor could "reversibly metastasize" to the orthotopic site and secondarily spread into the abdominal cavity. The observation reported here suggests that "seed" to "soil" is reversible in metastasis in that the tumor can spread in either direction between two "matched" organ "soil".

Adenocarcinoma↗
PubMedDate not supplied

Cancer seed and soil can be highly selective: human-patient colon tumor lung metastasis grows in nude mouse lung but not colon or subcutis.

The question remains as to whether metastatic cells (cancer seed) that eventually colonize a particular organ (cancer soil) have specific properties that distinguish them from the other cells of the primary tumor. However until recently there have not been model systems in which this question could be fully answered. To further understand the relationship between seed and soil we have developed an orthotopic-transplantation nude-mouse model that allows human tumors to essentially replicate their behavior they had in the patient. The patient-like behavior of the transplanted human tumor in the nude mouse depends on the use of intact tumor tissue for orthotopic transplantation. Here we report that a colorectal tumor lung metastasis surgically resected from a patient could grow in nude mouse lung, but not in either the colon or the subcutis after transplantation of intact tissue. The results were striking in that the human colorectal tumor lung metastasis grew in the lung of the animals and not in the colon or in the subcutis of the animals. The results described here suggest that the lung metastasis of the patient colon tumor is distinct in its soil requirement from the majority of the cells of the original colon tumor. In contract, in the intact-tissue orthotopic transplant model, primary human colon tumors grow when transplanted to the colon of the nude mouse. Thus the colorectal cancer "seed" which metastasized to the lung in the patients seems very selective for the "soil" of the lung of both the patient and the nude mouse.

Animals↗
PubMedDate not supplied

Diagnostic and therapeutic strategies of pyogenic liver abscess.

The infectious routes and etiologies of 26 cases with pyogenic liver abscess were portal spread in one, hematogenous in three, biliary in 12, transarterial embolization (TAE) in three, posthepatectomy in one and cryptogenic in five cases. Portal and hematogenous cases tend to show solitary and cystic pattern on echogram, and the majority of the bacteria detected was Klebsiella. While most biliary cases show multiple and cystic with tumor pattern on echogram, and an unhomogeneous low density in CT feature, anaerobic bacteria and candida were isolated only from the biliary or TAE cases. Most cases could be cured completely by the various kinds of abscess drainage, but two TAE cases with PTAD (percutaneous transhepatic abscess drainage) and two biliary cases with PTBD (PT-biliary drainage) and PTAD died due to a delay in establishing a diagnosis and to the severity of the condition. An early diagnosis followed by PTAD or PTBD were thought to be of prime importance.

Anti-Bacterial Agents↗
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Management of malignant tumor with intracaval extension by selective clamping of IVC.

BACKGROUND/AIMS: Malignant tumors with retrohepatic intracaval extensions are difficult to treat. We report five cases of intracaval tumor emboli (3 hepatocellular carcinoma, 2 renal cell carcinoma). MATERIAL AND METHODS: The tumor embolus is removed by the following methods according to site: in the right atrium, by open heart surgery after clamping of the inferior vena cava between the superior vena cava and the intrahepatic inferior vena cava and of the portal vein, in combination with a cardiopulmonary bypass using a pump oxygenator; above the confluence of the hepatic vein with the inferior vena cava, by inferior vena cava clamping between its suprahepatic and intrahepatic portions, shunting from the inferior vena cava and the portal vein to the axillary vein; below the inferior vena cava-hepatic vein confluence, by inferior vena cava clamping below the confluence and in the infrahepatic portion; and around the confluence, by side clamping of the inferior vena cava, maintaining both hepatic and systemic circulations. RESULTS: Pulmonary emboli were diagnosed in one patient. However, the patient's condition improved with anti-coagulant therapy. No major complication was observed in any other patient. All patients were discharged after a mean postoperative period of 32.8 days. One patient with HCC died of lung metastasis at 5 months and the other two, of recurrence in the residual portion of the liver at 4 and 16 months, and the two with RCC are still alive without recurrence of the carcinoma 9 and 14 months later. CONCLUSIONS: Preoperative recognition by ultrasonography, computed tomographic scanning, cavography and especially trans-esophageal endoscopic ultrasonography is important. Vascular exclusion may also be performed by various techniques depending on the site of the tumor embolus.

Adult↗
PubMedDate not supplied

Visualization of the metastatic process by green fluorescent protein expression.

We demonstrate here the visualization of the cancer metastatic process in live tissue in vivo by green fluorescent protein (GFP) expression. The human lung adenocarcinoma cell-line Anip 973 was transfected with the humanized GFP-S65T cDNA and stable high-level GFP-expressing transfectants were established. GFP transfectants were initially inoculated subcutaneously in nude mice. Five weeks after transplantation, when the tumor had reached 1.2 cm in diameter, fragments of subcutaneously tumor were implanted onto the visceral pleura of nude mice by surgical orthtopic implantation (SOI) as a spontenous metastatic model. GFP expressing cells were injected intravenously in nude mice as an experimental hematogenous metastasis model. Mice were sacrificed four and eight weeks after treatment. At eight weeks, SOI-treated mice had lymphogenous (3/4 mice) and direct seeding (3/4) metastasis in the pulmonary hilum, cervical lymph nodes, the mediastinum and contralateral pleural cavity as detected by GFP expression in live tissue. All intravenously injected mice had metastases in the lung (4/4) and some of them had metastases in the brain (2/4) and other organs (1/4) as detected by GFP expression in fresh tissue. Some of the lung metastases produced by intravenous injection remained as dormant small colonies even eight weeks after treatment. These different metastatic patterns after SOI and intravenous injection visualized by GFP expression indicates that initial steps of the metastatic cascade influence the subsequent progression of metastasis.

Animals↗
PubMedDate not supplied

Cerebral black blood MR angiography with the interleaved multi-slab three-dimensional fast spin echo sequence.

To overcome the disadvantages of conventional three-dimensional time-of-flight MR angiography (3D-TOF), such as saturation or intravoxel dephasing, black blood MR angiography (BB-MRA) using an interleaved multi-slab 3D fast spin echo sequence was developed and evaluated clinically. In major branches, the contrast-to-noise ratio of the flow was not as good as 3D-TOF in BB-MRA. However, in-plane slow flow and large aneurysm were visualized better on BB-MRA than on 3D-TOF. Furthermore, BB-MRA could provide wider coverage than 3D-TOF. BB-MRA using interleaved multi-slab 3D fast spin echo is now feasible and complementary to 3D-TOF.

Cerebrovascular Circulation↗
PubMedDate not supplied

Continuous hyperthermic peritoneal perfusion for peritoneal dissemination of gastric cancer.

BACKGROUND/AIMS: We investigated the histological and clinical effectiveness of continuous hyperthermic peritoneal perfusion (CHPP) for treating peritoneal dissemination (therapeutic CHPP) and for the prevention of peritoneal recurrence (prophylactic CHPP). METHODOLOGY: In 5 patients with gastric cancer and peritoneal dissemination, the apoptosis index of the cancer cells on in situ end-labeling for detection of apoptotic cells was 3.0+/-1.2% before CHPP, and had increased to 52.9+/-8.3% after CHPP. The survival curve of the therapeutic CHPP group was significantly better than that of the control group. The therapeutic CHPP group was classified as miliary type or nodular type. The survival curve in the miliary type was significantly better than that in the nodular type. RESULTS: In prophylactic CHPP, there was no improvement in prognosis, but a prophylactic effect against peritoneal recurrence was demonstrated in the patients who were n4 negative when the mean intraperitoneal temperature during CHPP (MIT) was maintained above 42 degrees C. CONCLUSIONS: These results indicated that an improved prognosis can be expected after therapeutic CHPP in patients with peritoneal spread. The beneficial effects are especially marked in patients with the miliary type. Moreover, prophylactic CHPP exerts a prophylactic effect against peritoneal recurrence in patients with n4 negative, providing that the MIT can be maintained above 42 degrees C.

Apoptosis↗