Biomedical subjects

I Miyazaki

Publications and source records attributed to I Miyazaki.

At least 73 records · Page 4Linked to original sources

PubMed1995

Pathologic Assessment of Surgical Margins on Frozen and Permanent Sections in Breast Conserving Surgery.

The diagnostic value of frozen section was evaluated in the histologic assessment of surgical margins obtained by wide excision of breast tumors. There were 87 patients with unilateral breast cancer, and 5 with bilateral breast cancers. The periphery of the excised breast tissue was peeled like an orange and histologically examined by frozen and permanent section. If either in situ or infiltrating microscopic tumor was found at the margin, it was considered positive. Using frozen sections, the margin was judged histologically positive or suspicious in 30 tumors (31%) and negative in 67(69%) tumors. Positive surgical margins were histologically confirmed by permanent section in 20(67%) of the 30 tumors diagnosed as positive or suspicious on frozen section. Another 10 tumors had negative margins. In 4 tumors, however, while the initial or re-excised margin was negative on frozen section, the margins were positive by permanent section. These surgical margins were positive due exclusively to the presence of ductal carcinoma in situ (DCIS). Evaluation of surgical margins in breast cancer by frozen section, thus exhibited a diagnostic accuracy of 86&prtcnt;, a sensitivity of 83%, and a specificity of 86%. It is concluded that frozen sections are useful in the determination of involvement of surgical margins after the wide excision of breast cancer. It must be pointed out that frozen sections will ofter overestimate involvement of the surgical margins.

Journal Article↗

PubMed1995

Duodenogastric reflux and foregut carcinogenesis.

Epidemiologic cohort studies have established that after distal gastric resection, there is a higher risk of gastric carcinoma. It is likely that a main factor of this higher risk is the excessive duodenogastric reflux induced by surgery, because the incidence of stump carcinomas is higher in Billroth II than in Billroth I, and most of the stump carcinomas are located near the stoma. In addition, several groups of investigators have suggested that duodenogastric reflux per se induces stump carcinomas in rats. There is another human duodenogastric reflux, the primary duodenogastric reflux, through the pylorus. Experiments in animals have demonstrated that this type of duodenal reflux also induces gastric carcinomas in the antrum of the stomach that has not undergone surgery. Recent clinical attention has focused on the role of duodenogastric reflux in the pathogenesis of Barrett's esophagus and subsequent esophageal adenocarcinomas. Experimentally, reflux of duodenal contents into the esophagus can cause not only Barrett's esophagus and subsequent adenocarcinomas, but also squamous cell carcinomas. These findings suggest that duodenogastric reflux may be implicated in gastric and esophageal, that is, foregut carcinogenesis.

Adenocarcinoma↗

PubMed1995

T cell activation and anergy to islet cell antigen in type I diabetes.

Early exposure to cow milk proteins was linked to the development of type I diabetes by consistent epidemiology, and by feeding and tolerization studies in diabetes-prone rodents. Dietary BSA was suggested as the culprit because patients and relevant rodents have elevated anti-BSA Abs that precipitate the recently cloned protein, p69, from beta cell lysates. A total of 68 of 78 children with recent onset diabetes had BSA-reactive T cells at the time of diagnosis. Here we 1) map the fine specificity of these T cells, 2) delineate a homologous peptide sequence near the N-terminus of p69, and 3) demonstrate T cell recognition of this p69 sequence (T cell epitope p69, Tep69) by patient T cells. The Tep69 sequence is conserved in p69 of patients and diabetes-prone rodents. Whereas BSA triggers T cell proliferation, recombinant p69 and a synthetic Tep69 peptide induce early stages of T cell activation (IL-2R transcription) but insufficient IL-2 production and thus anergy. Exogenous IL-2 overrides anergy and allows proliferative expansion of p69-responsive T cells. In mixing experiments, p69 and Tep69 peptide prevented proliferative responses to BSA even at 100-fold smaller concentrations. These findings imply that high-affinity self-peptide triggers anergy, whereas low-affinity mimicry Ag triggers proliferative expansion of these T cells. This implies a disease model in which mimicry Ag would rescue autoreactive cells from ablation by self-Ag.

Adolescent↗

PubMed1995

Management of lymph node metastases in breast cancer and gastric cancer.

The management of regional lymph node metastases in breast cancer and gastric cancer is reviewed. Regional lymph node metastasis is a critical prognostic factor in these diseases, but there is an apparent discrepancy in the efficacy of regional lymph node dissection between them. A number of prospective randomized clinical trials have demonstrated that regional lymph node dissection improves the regional control of breast cancer, but does not improve the survival. On the other hand, only retrospective or prospective comparative studies have shown that extended lymph node dissection significantly improves the survival in gastric cancer. Although the discrepancy in the regional lymph node dissection between breast and gastric cancers has been explained by differences in their biological behaviors, caution must still be exercised in drawing conclusions from these norandomized studies.

Breast Neoplasms↗

PubMed1995

Intraoperative histologic assessment of surgical margins and lymph node metastasis in breast-conserving surgery.

The diagnostic value of intraoperative histologic examination of frozen sections of surgical margins and axillary lymph nodes (AX) was investigated in 95 patients with breast cancer who underwent breast-conserving surgery. The periphery of the excised breast tissue was peeled like an orange and examined histologically by frozen section. The results were compared with examination by permanent section. Evaluation of surgical margins by frozen section resulted in a diagnostic accuracy of 87%, a sensitivity of 96%, and a specificity of 84%. Enlarged or hardened AXs were sampled from the axillary pad which was derived from a complete AX dissection. Histologic examination using frozen section was performed during surgery. After the operation, the remaining AXs were removed from the axillary pad by hand dissection and histologically examined on permanent section. A diagnostic accuracy of 97%, a sensitivity of 77%, and a specificity of 100% were achieved in the diagnosis of AX involvement on frozen section. It was therefore concluded that intraoperative histologic examination of frozen sections may be useful in the determination of involvement of the surgical margins and the AXs in patients with breast cancer.

Adult↗

PubMed1995

Anaplastic thyroid carcinoma producing the granulocyte colony stimulating factor (G-CSF): report of a case.

We report herein the unusual case of a 60-year-old woman with an anaplastic thyroid carcinoma which produced granulocyte colony stimulating factor (G-CSF). She presented with large neck masses, respiratory difficulty, and a high fever. Laboratory examinations revealed marked leukocytosis of 43,200/mm3 with 85% granulocytes and an elevated G-CSF level of 67 pg/dl. Total thyroidectomy with bilateral node dissection and tracheostomy was performed, and a histological diagnosis of large-cell anaplastic thyroid carcinoma was confirmed. Immunohistochemical examination with a polyclonal antibody against G-CSF stained the tumor cells. Although the respiratory difficulty, fever, and marked granulocytosis subsequently improved, she died 1 month after undergoing surgery due to metastatic mediastinal disease.

Carcinoma↗

PubMed1995

A new method of performing continuous intraabdominal drainage after pancreaticoduodenectomy.

Dehiscence of the pancreaticoenterostomy is one of the most feared, yet common, postoperative complications following pancreaticoduodenectomy (PD). We report herein a new technique we developed for performing continuous intraabdominal suction drainage (CISD) following PD. This method of CISD involves positioning an 18 Fr sump tube beside the pancreaticoenterostomy, with a continuous suction pressure of about -20cmH2O. The fluid obtained from the sump tube is also useful for monitoring amylase levels and providing bacterial cultures to enable the early detection of dehiscence of pancreaticoenterostomy. A study was conducted on 150 patients who underwent PD for periampullary carcinoma over a 20-year period. The patients were divided into two groups according to whether or not CISD was performed: group 1 comprised 71 patients who had CISD, and group 2 79 patients who did not have CISD. Although the frequency of anastomotic dehiscence did not differ between the two groups (32% in group 1 and 25% in group 2), the mortality rate of the patients with anastomotic leakage in group 1 was lower than that in group 2 (P = 0.07). Thus, we believe that our new technique for performing CISD could improve the surgical outcome of patients following PD.

Abdomen↗

PubMed1995

Oncologic and cosmetic outcome in patients with breast cancer treated with wide excision, transposition of adipose tissue with latissimus dorsi muscle, and axillary dissection followed by radiotherapy.

We evaluated the oncologic and cosmetic outcome in patients with breast cancer treated with wide excision, transposition of adipose tissue with latissimus dorsi muscle (LDM), and axillary dissection followed by radiotherapy. In this study, a wide excision of breast tissue was performed to obtain tumor-free margins. The subsequent breast deformity was not corrected in six patients in the early phase of the study (Group 1), and in 16 patients in the late phase (Group 2) in which the breast deformity was not remarkable at the time of operation. Breast deformity was corrected by transposing adipose tissue with LDM on a vascular pedicle in the remaining 51 patients (Group 3). Five year survival was 100%. Two patients developed distant metastases. None were found to have local recurrence. Fifty percent of the Group 1 patients, 69% of the Group 2 patients, and 67% of the Group 3 patients had an excellent or good cosmetic result. However, when the cosmetic results were evaluated in patients who underwent transposition and had small breasts, the results were excellent or good in 76%, compared to 38% in the patients who had reconstructions who had large breasts. The difference was statistically significant (p = 0.0309). Therefore, it was confirmed that wide excision and axillary dissection followed by breast radiation could provide adequate local control, but frequently resulted in breast deformity. However, transposition of adipose tissue may be useful to correct the breast deformity, especially in women with small breasts.

Adipose Tissue↗

PubMed1995

A case of macrocystic serous cystadenoma of the pancreas.

A case of macrocystic serous cystadenoma of the pancreas is presented, and literature is reviewed. A 35-yr-old woman presented with mild upper abdominal pain. Abdominal ultrasonography and an abdominal computed tomography revealed a multiloculated and calcified cyst in the body of the pancreas. A T1-weighted image, using magnetic resonance imaging, revealed a low-intensity multiloculated, pancreatic mass. In contrast, T2-imaging of the tumor showed a high-intensity mass. Endoscopic retrograde cholangiopancreatography showed no contact between the main pancreatic duct and the tumor. The preoperative diagnosis was a mucinous cystic neoplasm. Tumor enucleation was performed. Subsequent microscopic examination of this tumor suggested the diagnosis of a macrocystic serous cystadenoma of the pancreas.

Adult↗

PubMed1995

Effects of piroxicam and esculetin on the MDA-MB-231 human breast cancer cell line.

We investigated the effects of piroxicam, esculetin, prostaglandin E2 (PGE2) and leukotriene B4 (LTB4) on a human breast cancer cell line (MDA-MB-231). Both piroxicam and esculetin suppressed cell growth and thymidine incorporation, though esculetin was more active in inhibiting cell growth in the presence of linoleic acid (LA). Esculetin reduced the secretion of LTB independent of LA. Piroxicam reduced the secretion of PGE in the absence of LA but only at higher concentrations in the presence of LA. When the relationship between cell growth and PGE and LTB concentration was evaluated by multivariate regression analysis, cell growth was associated with the PGE and LTB concentration when the cells were treated with esculetin alone or with esculetin and LA. Cell growth was associated only with the PGE concentration when they were treated with piroxicam alone or with piroxicam and LA. Therefore, it appears that the growth of MDA-MB-231 cells in vitro is affected by both lipoxygenase and cyclooxygenase products, though lipoxygenase inhibition is more active than cyclooxygenase inhibition on suppression of cell growth in the presence of LA.

Breast Neoplasms↗

PubMed1995

Effects of indomethacin with or without linoleic acid on human breast cancer cells in vitro.

The effect of indomethacin (INDO) with or without the addition of linoleic acid (LA) was investigated in a cultured MDA-MB-231 human breast cancer cell line. It was found that INDO without LA suppressed cell growth and thymidine incorporation; however, with the addition of LA, INDO at low concentration promoted these factors, whereas INDO at higher concentrations suppressed them. On the other hand, INDO with or without the addition of LA reduced the secretion of prostaglandin E (PGE). However, INDO at a low concentration (1 microgram/ml) with the addition of LA increased the secretion of leukotriene B (LTB), while INDO without LA had no effect on the secretion of LTB. When the relationship between cell growth and PGE or LTB concentration was investigated, cell growth was associated with the PGE and LTB concentrations when the cells were treated with INDO and LA, whereas it was associated only with the PGE and LTB concentrations when the cells were treated with INDO and LA, whereas it was associated with the PGE concentration when they were treated with INDO alone.

Breast Neoplasms↗

PubMed1995

Surgical strategy for carcinoma of the pancreas head area based on clinicopathologic analysis of nodal involvement and plexus invasion.

BACKGROUND: The pattern of tumor spread, vis-à-vis nodal involvement and invasion of the extrapancreatic plexus (Plx), has not been thoroughly described for carcinoma of the pancreatic head area. METHODS: From 1973 to 1991, 110 patients (49 with carcinoma of the pancreatic head [Ph], 29 with distal bile duct cancer [Bi], and 32 with carcinoma of the papilla of Vater [Pv]) underwent pancreatectomy at Kanazawa University Hospital. Nodal involvement and Plx invasion were precisely evaluated by histopathologic examination. RESULTS: Thirty-seven (76%) of the 49 patients with Ph, 20 (69%) of the 29 with Bi, and 14 (44%) of the 32 with Pv had nodal involvement. The lymph nodes most commonly involved for Ph were the posterior pancreaticoduodenal lymph nodes (numbers 13a [superior] and 13b [inferior]), the superior mesenteric lymph nodes (number 14), the paraaortic lymph nodes (number 16), and the anterior pancreaticoduodenal lymph nodes (number 17) (13a, 51%; 13b, 47%; 14, 36.7%; 16, 18.4%; 17a, 33%; 17b, 22%). In patients with Bi, lymph nodes around the hepatoduodenal ligament (number 12) and lymph nodes numbers 13a and 14 were most commonly involved (12, 27.6%; 13a, 51.7%; 14, 34.5%). In patients with Pv, lymph node numbers 13b and 14 were most frequently involved (13b, 34.4%; 14, 15.6%). No significant correlation was noted between the tumor size and nodal involvement in these three lesions. Nodal involvement was an important prognostic factor for carcinoma of the pancreatic head area. Plx invasion in these three carcinomas was observed in 61% of patients with Ph, 29% of patients with Bi, and 3% of patients with Pv. CONCLUSIONS: Nodal involvement and Plx invasion differed significantly among carcinomas of the pancreatic head area. We believe that nodal dissection of at least group number 14 is needed for Ph, Bi, and Pv cancers. In addition, dissection of lymph nodes of number 16 and the Plx around the superior mesenteric artery and celiac axis are needed in Ph cancer. Plx dissection of the first portion of plexus pancreaticus capitalis is needed in Bi cancer.

Actuarial Analysis↗

PubMed1995

Expression of basic fibroblast growth factor and its receptor in human pancreatic carcinomas.

We examined the expression of basic fibroblast growth factor (FGF) and FGF receptor by immunohistochemistry in 32 human pancreatic ductal adenocarcinomas. Mild to marked basic FGF immunoreactivity was noted in 19 (59.4%) of the 32 tumours examined, and 30 (93.3%) of the tumours exhibited a cytoplasmic staining pattern against FGF receptor. The tumours were divided into two groups according to the proportion of positively stained tumour cells: a low expression group (positive cells < 25%) and a high expression group (positive cells > or = 25%). No statistically significant difference in tumour size, differentiation, metastases or stage was found between the low and high basic FGF expression groups. However, a significant correlation was found between FGF receptor expression level and the presence of retroperitoneal invasion, lymph node metastasis, and tumour stage. In addition, low FGF receptor expression was significantly associated with a longer post-operative survival as compared with high FGF receptor expression, whereas there was no significant difference in post-operative survival between the low and high basic FGF expression groups. Increased expression of FGF receptor is correlated with the extent of malignancy and post-operative survival in human pancreatic ductal adenocarcinomas. Thus, overexpression of FGF receptor may prove to be a more useful prognostic marker than basic FGF expression level in pancreatic cancer patients.

Adult↗

PubMed1995

Rationale for extensive lymphadenectomy in early gastric carcinoma.

The incidence of nodal metastasis in early gastric carcinoma (EGC) is 10-20%. However, the optimal nodal dissection for early gastric carcinoma has not been established. A retrospective study was conducted in 392 consecutive patients who underwent potentially curative distal gastrectomy for EGC between 1962 and 1990. Of these 295 patients treated after September 1972 were prospectively entered into an extensive lymphadenectomy protocol. These patients were compared with 97 patients with simple gastrectomy in respect of the causes of death after surgery and the 10 year disease-specific survival rate. The incidence of nodal metastasis in early gastric carcinoma patients was 13.0%. Operative mortality from extensive lymphadenectomy was almost the same as from simple gastrectomy (2.0% and 2.1% respectively). Extensive lymphadenectomy provided a significantly higher 10 year survival rate than limited lymph node dissection (97.9% vs 88.1% respectively; P < 0.005). Among patients with nodal metastasis, the survival rate following extensive lymphadenectomy was significantly higher than that after simple gastrectomy (87.5% vs 55.6%; P = 0.018). Among patients without nodal metastasis, there was no difference between the two groups in the survival rate (99.4% and 96.7% respectively; P = 0.12). Multivariate analysis using the Cox proportional hazards model disclosed two significant independent prognostic factors on disease-specific survival, the nodal involvement (risk ratio: 8.4; P < 0.0001) and the extent of lymph node dissection (risk ratio: 5.8; P < 0.005). Extensive nodel dissection appears to prevent recurrence and to improve the cancer-specific survival in EGC patients with nodal metastasis.

Adult↗

PubMed1995

[Presence and future in neoadjuvant chemotherapy against gastric cancer].

The present state and a future of neoadjuvant chemotherapy (NAC) was reviewed. Gastric cancer is classified as a cancer which is resistant against anti-cancer drugs. Consequently, surgery is the only method that offers hope of cure. Candidates for NAC are patients with stage IV disease, especially with T4 disease having no distant metastases. NAC is carried out for an increase of the resectability rate and the judgement of the in vivo chemosensitivity. Regimens with high fractional kill should be used, and and the tumor burden must be periodically estimated by CT scan, endoscopy and the serum levels of tumor markers. If the used regimen showed no response, a new protocol should be tried. Since a histological CR is very rare, not only primary tumor but metastases should be resected as much as possible. A completeness of the cytoreduction is a major factor for a long term survival. Surgery is carried out for the elimination of the drug-resistant cancer cells. Furthermore, early postoperative chemotherapy is very important for the improvement of survival after NAC.

Chemotherapy, Adjuvant↗

PubMed1995

Evaluation of long-term survivors after pancreatoduodenectomy for pancreatoduodenal carcinoma.

Long-term survivors (> or = 5 years) of pancreatoduodenal carcinoma were evaluated. The absence of retropancreatic invasion seemed to be an important factor for long-term survival in carcinoma of the pancreatic head, carcinoma of the intrapancretic bile duct confined within the bile duct wall, and stage II papilla of Vater carcinoma. The mode of infiltration was INF alpha or INF beta, with a low infiltration tendency. Lymph node metastasis, when present, was confined to the pancreatic head. It is noteworthy that two of the patients with intrapancreatic bile duct cancer had perineural infiltration to the pancreatic head plexus. In patients treated by extended resection, postoperative malnutrition and diarrhea was severe, indicating the importance of long-term nutritional management.

Aged↗

PubMed1995

[Correlation of DNA ploidy, c-erB-2 protein tissue status, level of PCNA expression and clinical outcome in gastric carcinomas].

One-hundred and sixty-four patients with gastric carcinomas, who underwent gastrectomy during 1979-1985, were studied. The nuclear DNA contents were measured by cytofluorometry, and immunohistochemical study on the expression of c-erbB-2 protein was performed using a monoclonal antibody against the c-erbB-2 oncogene product. Furthermore immunohistochemical detection of proliferating cell nuclear antigen (PCNA) was performed using a monoclonal antibody against the PCNA. The patients with aneuploid tumor had a significantly worse prognosis than those with diploid tumor. The group with positive staining for c-erbB-2 had a significantly worse prognosis than negative one. The higher group of PCNA indices had a worse prognosis. The patients with tumor showing both aneuploid and positive staining for c-erbB-2 tissue status and PCNA indices. But no correlation was formed between c-erbB-2 tissue status, PCNA indices and DNA contents. From these results, it can be concluded that DNA ploidy, c-erbB-2 protein, and PCNA may reflect the malignant potential of gastric carcinoma.

Aneuploidy↗

PubMed1995

Decreased E-cadherin expression correlates with poor survival in patients with gastric cancer.

E-cadherin, Ca(2+)-dependent intracellular adhesion molecule, is known to be an invasion suppressor gene. To elucidate the correlation between E-cadherin expression and invasion or metastasis in gastric cancer, we examined E-cadherin tissue status immunohistochemically. Ninety-eight primary gastric cancer, prepared by AMeX method, were retrospectively analyzed with anti-E-cadherin monoclonal antibody. In normal gastric epithelium, E-cadherin is expressed homogeneously with a typical membranous staining at cell-cell borders. Decreased and heterogeneous expression is found in 70 of 98 tumours. Tumours with decreased E-cadherin expression had a tendency to infiltrate more deeply in stomach wall, and metastasize in lymph nodes or peritoneal surface. More importantly, decreased E-cadherin expression correlates with shorter survival (z = 3.98, P = 0.00086). These results may indicate that E-cadherin tissue status is a powerful prognostic indicator in gastric cancer. The high malignant potential of tumours with decreased E-cadherin expression may be associated with high potential of lymph node metastasis and peritoneal dissemination.

Cadherins↗