Biomedical subjects
H Sugano
Publications and source records attributed to H Sugano.
Unusual features of thyroid carcinomas in Japanese patients with Werner syndrome and possible genotype-phenotype relations to cell type and race.
BACKGROUND: Werner syndrome (WS), an autosomal recessive disease characterized by premature aging, has a high frequency of association with six rare neoplasms in Japanese patients, and only four of these neoplasms also occur excessively in whites. Several differ from what is usual in their epidemiology and/or histology. Described in this article are peculiarities in the occurrences of follicular and papillary thyroid carcinomas among Japanese patients and the possible genotype-phenotype relations pertaining to cell types and the absence of excess thyroid carcinoma occurrence in whites with WS. METHODS: Epidemiologic features of 23 histologically diagnosed thyroid carcinomas from a series of 150 cancers in 845 Japanese patients with WS were compared with those of 19,446 tumors in a Japanese national registry of thyroid carcinomas from 1977-1991. Germline mutations had been determined by molecular studies of peripheral blood. RESULTS: The average age of patients with thyroid carcinoma was 39 years for those with WS and 49 years for the registry patients. The female-to-male ratios were 2.3:1 and 6.6:1, respectively. The rates of occurrence of papillary, follicular, and anaplastic carcinomas were 35%, 48%, and 13% for Japanese patients with WS and 78%, 14%, and 2% in the general Japanese population. All four cases of follicular carcinoma had germline mutations of the WS gene in the C-terminal region, and the germline mutation for the only papillary carcinoma was in the N-terminal region. CONCLUSIONS: This study suggests two possible WS genotype-phenotype relations. One concerns thyroid carcinoma histology; the other concerns frequent mutations that occur in the C-terminal region in Japanese patients, but not in white patients, with WS. These may account for the excess thyroid carcinoma occurrence among Japanese.
Real time observation of platelet adhesion to opaque biomaterial surfaces under shear flow conditions.
We developed a new system which enables direct observation of platelet adhesion on opaque biomaterials under shear flow conditions, by combining a thin quartz cone which produces laminar shear flows, with an upright epifluorescence microscope which visualizes stained platelets through the rotating cone. This is the first report on the observation of platelets adhered to opaque biomaterials in real time under shear flow conditions. The direct observation of platelet adhesion to expanded polytetrafluoroethylene (ePTFE) as an opaque biomaterial revealed that the kinetics of platelet adhesion to ePTFE depended greatly on shear stresses, showing that the shear stress of 5.0 dyne/cm2 induced higher adhesiveness of platelets to ePTFE than that of either 0.1 or 15 dyne/cm2. The observation also showed a difference in platelet adhesiveness among ePTFEs with different fibril lengths--0, 3.2, 18, and 35 microm--indicating that ePTFEs with shorter fibril length had lower adhesiveness of platelets under a shear stress of 5.0 dyne/cm2. It is indispensable for analyzing the phenomena of platelet adhesion to opaque biomaterials to observe in real-time rolling, adhesion, and detachment of platelets under shear stresses without disturbing shear flow conditions. The results showed that the mechanical and optical design of the system could serve this purpose.
Endothelin receptor antagonist preserves microvascular perfusion and reduces ischemic brain damage following permanent focal ischemia.
Synthesis and release of the potent vasoconstrictor peptide endothelin-1 (ET-1) increases following cerebral ischemia and has previously been shown to mediate the delayed hypoperfusion associated with transient global ischemia. In this study we assessed the impact of ET-1 on perfusion and infarct volume in a focal model of cerebral ischemia by use of the selective ET(A) receptor antagonist Ro 61-1790 (affinity for ET(A) receptor 1000 fold greater than ETB receptor). Control rats subjected to permanent middle cerebral artery occlusion (MCAO) showed extensive reductions in microvascular perfusion 4 h post-MCAO that were significantly attenuated by Ro 61-1790 pretreatment (10 mg/kg, i.v.). Ro 61-1790 concomitantly and significantly reduced the ischemic lesion volume in the same animals. This effect was maintained 24 h post-MCAO providing that the animals received additional i.v. injections of 5 mg/kg Ro 61-1790 at 5 h and 8 h after MCAO. These findings demonstrate that ET(A) receptor antagonism partially preserves tissue perfusion following focal ischemia and that this effect is associated with significant neuroprotection. The results also support the hypothesis that vasoactive mediators, and ET-1 in particular, are important contributors to the pathogenesis of cerebral ischemic injury.
[Anesthetic management of a morbidly obese patient with intestinal obstruction].
We managed a morbidly obese patient [body weight 150 kg, body height 157 cm (body mass index, 61 kg.m-2)] with intestinal obstruction due to incarcerated postoperative ventral hernia. The trachea was intubated while applying cricoid pressure. The SpO2 decreased rapidly down to 30% during intubation, but increased to 100% after ventilation with oxygen. Potential problems in the anesthetic management of morbidly obese patients for emergency surgery are discussed.
The long-term results of ankle joint synovectomy for rheumatoid arthritis.
The clinical and radiological results of synovectomy for rheumatoid arthritis in the ankle joint were investigated in 20 ankles of 15 patients. The average follow-up period after synovectomy was 15 years, ranging from 10 to 25 years. The clinical evaluation at the time of follow-up, found that only two ankles showed recurrence of synovitis, and no patient complained of severe ankle pain disturbing the activities of daily life. During the period between the synovectomy and our investigation, no patients required further surgical procedures for their ankle joints. The radiological evaluation found that in approximately two-thirds of the cases, deterioration of the radiological grade, evaluated with Larsen's criteria, had continued after synovectomy. There was no considerable radiological deterioration in the less-erosive subset patients, classified according to Ochi's criteria (1). In the unilateral synovectomized cases, using the non-operated ankles as the natural-course control, osteoarthritic changes were predominant in the operated ankle joint, and the non-operated ankle demonstrated inflammatory disease changes. These results indicate that: (1) synovectomy for a rheumatoid ankle is still a preferred treatment, lessening the clinical symptom of persistent, marked synovial proliferation resistant to medical treatment. (2) Radiological deterioration continues after synovectomy in many cases. However, a radiogram demonstrates predominant osteoarthritic destruction, which indicates the natural course of rheumatoid destruction in the operated site could be altered by synovectomy.
[The second golden age of EB virus research].
Explore the source record for details and available documents.
Fluorometric determination of L-kynurenine with glycolaldehyde by high performance liquid chromatography.
Explore the source record for details and available documents.
Excess of rare cancers in Werner syndrome (adult progeria).
The association between genetic disorders and diverse cancers has provided clues for laboratory research into carcinogenesis. Such an opportunity now arises from studies of cancer in Werner syndrome (WRN). Soft-tissue sarcoma (STS) and benign meningioma have been associated with WRN, an autosomal recessive disorder characterized by premature aging, more commonly reported in Japan than elsewhere, in part because of inbreeding. In the literature we found 124 case-reports of neoplasia and WRN from Japan and 34 from outside Japan, 1939-August, 1995. They reveal a greater diversity of neoplasia in WRN than was previously known. In Japanese, there were 127 cancers, 14 benign meningioma, and 5 myeloid disorders, as compared with 30, 7 and 2 respectively in non-Japanese. The ratio of epithelial to non-epithelial cancers was about 1:1 for Japanese and for non-Japanese instead of the usual 10:1. Both series had excess of STS, osteosarcoma, myeloid disorders, and benign meningioma. In addition, the Japanese had an excess of thyroid cancer (20 versus 2 cases in non-Japanese) and melanoma (21 versus 3 cases), including 5 intranasal and 13 of the feet. STS, osteosarcoma, melanoma, and thyroid carcinoma accounted for 57% of all cancer in WRN as compared with 2% expected based on the Osaka population at 25-64 years of age. Multiple tumors were reported in 19 Japanese and 5 non-Japanese. In Japan, nine first-degree relatives had WRN and cancer, six of whom were concordant as to site and/or cell type. The WRN gene has been mapped to chromosome 8p. The high frequency of thyroid cancer and melanoma in Japanese, not found in Caucasians, may be related to a report of linkage disequilibrium with the WRN gene in Japanese but not in Caucasians and to haplotype differences within and between the two races, suggesting multiple independent mutations.
Frequent development of pancreatic carcinomas in the Rana nigromaculata group.
In 1979, 2 species of pond frogs (Rana nigromaculata and Rana plancyi plancyi) were imported from China, and hybrids were made between these and Japanese, Korean, and Taiwanese pond frogs (R. nigromaculata, Rana plancyi fukienensis and Rana brevipoda) that had been kept for a number of years in the Laboratory for Amphibian Biology of Hiroshima University. From 1982, development of tumors, especially in the peritoneal cavity, was noticed frequently in the hybrids and also later, although rarely, in the Japanese pond frogs. Such tumors had never previously been observed among pond frogs in the laboratory. Histological and immunohistochemical studies identified the i.p. tumors to be pancreatic carcinomas with occasional production of insulin and/or somatostatin. Ultrastructural investigation revealed both endocrine and exocrine secretion granules together with C-type retrovirus particles in the carcinoma cells. Other tumors included a retroperitoneal rhabdomyosarcoma, liver adenomas, and an unclassifiable mesenchymal tumor of the foot pad.
High K-ras mutation rates in goblet-cell-type adenocarcinomas of the lungs.
Adenocarcinomas of the lungs show a variable histology. We have subclassified such lesions into five cell types: hobnail, columnar, polygonal, mixed and goblet cell types, and investigated their relationships with K-ras mutations. Codons 12, 13 and 61 of the K-ras gene in 120 surgically resected pulmonary adenocarcinomas were examined by the mutation-allele-specific amplification method. Point mutations were observed in 10% of the adenocarcinomas limited to K-ras codon 12 and the commonest base substitution (nine cases) was a G to T transversion. Of the five types, goblet cell lesions demonstrated the highest mutation index, which at 100% (6/6) was significantly different from that of all other cell types. No relationship between K-ras mutation and cigarette smoking was observed. From these findings, it appears that development of goblet-cell-type adenocarcinomas of the lung may involve different carcinogenic mechanisms from adenocarcinomas of other subtypes.
[Endoscopic placement of self-expandable metallic stents (Wallstent) for malignant biliary stenosis, with special reference to preventive endoscopic nasal bile drainage against acute obstruction after stenting].
From December 1993 to December 1994, we inserted 14 biliary endoprostheses (Wallstent) endoscopically in 12 consecutive patients (5 men and 7 women; 55-91 years [mean 69.8 years] of age) with malignant biliary stenosis. Successful placement of Wallstent was achieved in all 12 patients. Procedure related death was encountered in one patient (8.3%) who was complicated with emphysematous cholecystitis, combined with a slipping migration of the stent. In 11 of the 12 patients, serum bilirubin levels reduced to less than 2.0 mg/dl. Acute obstruction, which was defined as the obstruction of the stent within 24 hours after the stent placement, occurred in 2 patients (16.7%). Endoscopic nasal bile drainage (ENBD) following stent placement was performed in 4 patients and acute obstruction was not developed in these cases. After endoprosthesis 8 patients were discharged with 6-47 hospital days and the average hospitalized period excluding a case with cerebral infarction was 12.7 days. Excluding one procedure related death, 6 patients died of primary malignancy 39-189 days (average 90.7 days) after endoprosthesis and in 2 cases recurrence of jaundice was observed. The other 4 patients have been alive for 60-174 days (average 102.5 days) without jaundice. The survival rate of the all patients was 64% for 3 months and 32% for 6 months, respectively. In conclusion, we suggested that the endoscopic Wallstent placement would contribute to the improvement of the quality of life for patients with malignant biliary stenosis. However, acute obstruction may be developed in some cases. For the purpose of managing acute obstruction, we recommend ENBD for a few days following the placement of a Wallstent.
[The relationship between genotypes of HLA-DRB1 alleles and progression of bony destruction changes of rheumatoid arthritis].
The relationship between genotypes of HLA-DRB 1 alleles and the progression of bone destruction of RA patients was assessed. The genotypes of the HLA-DRB 1 alleles were determined in 329 Japanese patients with seropositive RNA by polymerase chain reaction and allele-specific oligonucleotide probe techniques. We regarded HLA-DRB 1* 0101, 0401, 0404, 0405, 1001 and 1402 as susceptible alleles of RA and classified the patients into three groups. The s/s group consisted of those with susceptible factors in both of the HLA-DRB 1 alleles. The s/n group was made up of those having one susceptible factor and one non-susceptible factor. The n/n group consisted of those possessing two non-susceptible factors. The grading of radiographic change that was evaluated by Larsen's criteria compared with the genotyped results. In the result, the median years taken to development to grade III, IV and V were significantly shorter in the s/s groups compared with that in the s/n and n/n groups. Thus, genotyping of HLA-DRB 1 can be a useful prognostic market in the progression of bone destruction of RA.
[Lemmel's syndrome caused by a giant diverticulum in the third portion of the duodenum, report of a case].
Explore the source record for details and available documents.
[Factors affecting continuation of home medical care--based on the relationship between patient and caregiver status].
In recent years it has gradually become possible to have some control over the medical condition of the end-stage cancer patient. However, there are various problems involved in the continuation of home care. In order to clarify how the mutual relationship between patient and caregiver effects the continuation of home care, we conducted a study on 28 end-stage cancer patients who made the transition from our hospital to home care by means of our HOme Care Service. Using the Kaneda Assessment Score, we obtained information from patients' charts, added reasons for rehospitalizations and analyzed the data. The results showed that the group of patients who remained on home care, despite the fact that their condition was significantly poorer than that of the group who discontinued home care, showed a significantly higher proportion of "wishing to be cared for at home to the last," in the view of the caregiver, a joint commitment of the caregiver together with the family, and a suitable response to changes in the patient. As a direction for forthcoming support in this area, there is a need for sufficient assessment in order to evaluate the balance between caregiver and family. It was suggested that guidance in each case and the use of community resources will be very important.
[The effectiveness of discharge planning (DSP) in home care--comparison of conditions of cancer patient shifted to home treatment before and after DSP introduction].
We developed a discharge planning (DSP) procedure as a method to assess the family and cancer patient situation when making the shift to home care, and we herewith report its significance. DSP is intended to sustain the patient's quality of life (QOL) and improve it; for a smooth transition to treatment at home, the family and patient situation must be assessed from various perspectives. The prospective illness conditions, needed medical treatment and care should be appropriately planned, with due recognition of the roles to be played and the requisite pooling of professional information in order to handle emergencies and the like when such arise. In the present study, in order to clarify issues dealing with DSP effectiveness, we compared 34 patients on home care, 17 before DSP and 17 thereafter. The results indicated that following the introduction of DSP, the home care increased for patients with gastroenterological problems such as pain, general debilitation, poor appetite, constipation, diarrhea and the like and those impulsiveness, vomiting and mental symptoms overlapping. With the proper assessment at the time of the transition to home care, this care could be continued. Moreover, with patient satisfaction, there was the need for assessment over the course in order to evaluate treatment and care. In the days to come, there is the need to improve this approach with a scoring system in the evaluation.
"Hot spots" of chromium accumulation at bifurcations of chromate workers' bronchi.
To investigate the mechanisms underlying respiratory tract carcinogenesis in chromate workers, we measured the concentration of chromium in samples of tissues from 50 bronchial bifurcations and other bronchial tissue obtained at autopsy, or during surgical procedures, from 9 exchromate workers known to be at risk of developing lung cancer. The mean duration of exposure was 21 years and the average time between cessation of exposure and death/surgery was 15 years. The area of the tissue samples was measured by image analysis and the chromium concentration determined by neutron activation analysis. Chromium concentrations ranged from 0.04 to 39 x 10(-10) g/microns tissue thickness/mm2 and in 80% of the cases the concentrations were greater at bifurcations than in neighboring epithelial tissue. The mean concentration ratios between bifurcations and adjacent areas were 1.5 (n = 1) in the trachea, 3.0 (n = 9) in the main bronchi, 3.6 (n = 22) in lobar bronchi, and 10.9 (n = 3) in subsegmental bronchi. Our results demonstrated long-term retention of chromium in the bronchial walls of chromate workers and also that chromium concentrations were higher at airway bifurcations than elsewhere, thus providing solid evidence for a deposition "hot spot" concept.
[The effect of the odour of mother's milk and orange on the spectral power of EEG in infants].
Few studies have been found on the EEG responses to odours in infants. Most of the studies done regarding infants up until now have focused only on the psychological and behavioral reaction of infants to odours. The purpose of the present study is to investigate whether or not relative differences in EEG response are seen before and during the odour presentation of mother's milk and orange in infants, and if they do respond to these odours, are there any differences in the EEG responses? EEG responses to these two odours were studied in 11 healthy mixed fed infants aged from 3.3 to 4.2 months during sleep. Changes in the sleep stage 2 and slow wave sleep EEG's were analyzed by the fast Fourier transformation method. While the mother's milk was presented, a significant decrease in the amplitude of EEG was observed in the delta and theta bands in the bilateral frontal and central regions of the brain, but on orange odour presentation, an increase of delta bands was seen in the central and right parietal regions. Detailed statistical analysis (ANOVA) revealed that the EEG responses to the two odours were significantly different from each other in the delta and theta bands. The present results suggest that these two odours seem to cause a different psychophysiological change in infants.