Biomedical subjects

K Fujii

Publications and source records attributed to K Fujii.

At least 1,135 records · Page 63Linked to original sources

PubMedDate not supplied

Resection of liver metastases after pancreatoduodenectomy: report of seven cases.

There has been no English report of a long survivor after hepatectomy for metastasis from periampullary malignancies, who had previously undergone pancreatoduodenectomy (PD) for primary disease. Herein, we report 7 patients of liver metastases who underwent 8 hepatectomies after PD for peri-ampullary malignancies. One patient whose liver metastasis was neuroendocrine tumor, survived 2 years and 6 months without recurrence after hepatectomy. Another patient who had 2 hepatectomies for metastasis from duodenal leiomyosarcoma survived for 3 years and 20 days after the first hepatectomy. Procedure of hepatectomy comprised 4 limited resections (including 1 second hepatectomy) and 4 lobectomies at the first resection. Hepatic inflow clamp was used in 6 out of 8 hepatectomies and 4 out of 8 hepatectomies did not require allogeneic blood transfusion. Bacterial contamination of the drained discharge from the cut surface of the liver, mostly representative of enteric organisms, was identified in all but 2 patients who were not examined. Subphrenic abscesses developed in 2 patients after removal of the drains. Thus, prophylactic use of abdominal drain is indispensable after hepatectomy for the patients with bilioenteric anastomosis.

Adult↗

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Prognostic factors of advanced gastric carcinoma without serosal invasion (pT2 gastric carcinoma).

BACKGROUND/AIMS: The purpose of this study was to investigate the prognostic factors of advanced gastric carcinoma without serosal invasion (pT2 gastric carcinoma), for the planning of therapeutic strategy. METHODOLOGY: Prognostic factors were evaluated by univariate and multivariate analysis in a total of 304 curatively resected pT2 gastric carcinoma patients in whom the tumor invaded the muscularis propria or the subserosa. RESULTS: Macroscopic type, depth of invasion, lymph node metastasis and venous invasion were significantly related to outcome, using univariate analysis. Lesions resembling early gastric carcinoma had better prognosis than lesions belonging to one of the Borrmann types. Multivariate analysis (Cox's proportional hazards model) demonstrated that macroscopic type, lymph node metastasis and venous invasion, but not depth of invasion, were significant prognostic factors. CONCLUSIONS: Macroscopic appearance, lymph node metastasis and venous invasion were the important prognostic factors of pT2 gastric carcinoma. Extensive lymph node dissection and aggressive post-operative chemotherapy should be performed, especially in Borrmann type lesions with lymph node metastasis.

Female↗

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Kimura's disease with bilateral auricular masses.

We report an unusual case of Kimura's disease. An 81-year-old Japanese woman was shown to have bilateral auricular masses that had begun to enlarge 6 years before. On CT scans, slightly high-density masses with faint contrast enhancement were seen. The masses were heterogeneous and hypointense on T1-weighted MR images, were slightly hyperintense on T2-weighted MR images, and showed heterogeneous enhancement after the administration of contrast material. Kimura's disease should be included in the differential diagnosis of bilateral auricular tumors.

Aged↗

PubMedDate not supplied

Olfactory neuroepithelioma arising from the olfactory placode.

The patient was a 54-year-old man, who had lost his sense of smell 6 years previously and had started to become forgetful about 6 months prior to presenting at hospital. MRI admission showed a large multicystic tumor with Gd-DTPA enhancement extending from the anterior cranial fossa through the sphenoid sinus and into the nasal cavity. Histopathological examination revealed extensive proliferation of small round cells that were divided by connective tissue septae. The tumor cells occasionally formed tubular structures, although no basement membranes were present. On immunostaining, round tumor cells were positive for neuron-specific enolase, synaptophysin, and chromogranin A, while cells forming tubules were positive for AE 1 and CAM 5.2. Almost all of the tumor cells were positive for Ber-EP4, and some of the epithelioid cells surrounding the tubular structures were also positive for luteinizing hormone-releasing hormone (LH-RH). Electron microscopy demonstrated sporadic intercellular junctions, many microtubules in the tumor cell processes, and clear- and dense-cored vesicles in the cytoplasm. Based on the results, this case appears to be the first documented neuroepithelioma with Ber-EP4- and LH-RH-positive cells arising from the olfactory placode.

Biomarkers, Tumor↗

PubMedDate not supplied

Factors influencing survival in 33 patients undergoing resection of hepatic metastases from colorectal cancer.

BACKGROUND/AIMS: To determine the factors influencing the prognosis of patients undergoing resection of hepatic metastases from colorectal cancer. METHODOLOGY: Between December 1981 and March 1998, 33 patients underwent potentially curative hepatic resection for metastatic colorectal cancer at the Kiryu Kousei General Hospital. We retrospectively examined 15 factors, including 3 clinical factors, 5 primary tumor characteristics and 7 metastatic tumor characteristics. Survival rates were estimated by the Kaplan-Meier method, and the weighting of each factor was compared by the log-rank test. We used univariate and multivariate analyses to assess any associations between the factors and mortality. RESULTS: The 30-day operative mortality was 0%. The 5-yr survival rate of the 33 patients was 43%. A significant survival advantage was noted in patients with 1 or 2 metastatic lesions (25/33, 76%), patients who underwent systematic anatomical resection (14/33, 42%) and male patients (16/33, 48%), compared with patients with 3 or more lesions (50% and 17%, P = 0.021), patients who underwent non-systematic resection (67% and 23%, P = 0.005) and female patients (65% and 20%, P = 0.011), respectively. No statistical influence on survival was found in the multivariate analysis of these 3 factors. Recurrence was identified in 24 patients (73%) and 19 of them died of recurrent cancer. CONCLUSIONS: Surgical resection of hepatic metastases from colorectal cancer is safe and potentially curative in appropriately selected patients.

Aged↗

PubMedDate not supplied

Primary intracerebral malignant melanoma with leptomeningeal spread, extradural extension and lung metastasis.

A rare primary intracerebral solitary malignant melanoma with extracranial metastasis is reported. The patient was a 66-year-old man who was revealed to have a tumor in the right temporal lobe by MRI. The tumor was totally resected and the histopathological diagnosis was malignant melanoma. Despite postoperative treatment with chemo-radiotherapy, tumor recurred with multiple subarachnoid dissemination. Complete autopsy showed marked leptomeningeal dissemination of tumor in the cerebro-spinal compartment. In the outside of the central nervous system, a microscopic metastatic nodule was found in the right lung. Metastatic tumor in the spinal cord showed the extradural extension which might have led to hematogenous metastasis to the lung.

Aged↗

PubMedDate not supplied

Resection of liver metastasis from gastric adenocarcinoma.

BACKGROUND/AIMS: To determine the factors influencing the prognosis of patients undergoing resection of liver metastases from gastric adenocarcinoma. METHODOLOGY: Over a 10-year period, at Kiryu Kousei General Hospital, 12 patients underwent potentially curative hepatectomy for metastatic adenocarcinoma of gastric origin. Two patients were excluded from this study, one because of postoperative death and one due to insufficient follow-up. We retrospectively examined the following factors: including TNM classification of the primary tumor, disease-free interval between gastric and hepatic resection, number and maximum diameter of the metastases, histological differentiation of the metastases, and the presence of lymphocyte aggregation enclosing the metastatic lesions. Survival rates were estimated by the Kaplan-Meier method and the weighting of each factor was compared by the log-rank test. RESULTS: The overall 5-year survival rate of the 10 patients was 10%. The median survival time after hepatectomy was 16.3 months, ranging from 3.1 to 245.7 months. Eight patients died of recurrent cancer and 1 died of unrelated septic shock with no evidence of cancer recurrence. Only one patient was alive without recurrence at the time of maximum follow-up. A significant survival advantage was noted in patients with disease-free interval > or = 1 year, and those with metastatic tumors < 5 cm in maximum diameter and/or enclosed by the aggregated lymphocytes, when compared with patients with disease-free interval < 1 year and those with metastatic tumors > or = 5 cm and/or directly infiltrated hepatic parenchyma. CONCLUSIONS: It was suggested that hepatectomy should be attempted in patients where the disease-free interval was > or = 1 year and with metastatic nodules < 5 cm. Lymphocyte aggregation around the metastatic tumor is a good prognostic sign for long-term survival.

Adenocarcinoma↗

PubMedDate not supplied

Resection of liver metastasis after a pancreatoduodenectomy for pancreatic cancer: a case report.

A case of resected liver metastasis from pancreatic cancer, in a 69-year-old woman who obtained a relatively long survival, is presented. Primary pancreatic cancer was found in a patient presenting with obstructive jaundice and a loss of appetite. A pylorus-preserving pancreatoduodenectomy was carried out on December 2, 1996. Eleven months later, a 1.5-cm mass was found in the right posterior segment of the liver. Although the tumor size had increased to 2.5 cm 5 months later, no other metastases were observed. Therefore, the right posterior segment of the liver was resected. Eleven months after the second operation, recurrence was found in the cut surface of the liver and the left caudate lobe. She died on May 1, 1999. This case demonstrated a relatively favorable prognosis in comparison to other common type of liver metastasis from pancreatic cancer. This study discusses the peculiarities of this case and emphasizes the necessity to carefully select the patients before attempting to resect the liver metastasis from pancreatic cancer.

Adenocarcinoma↗

PubMedDate not supplied

Recurrent bleeding from a duodenal diverticulum 8 years after endoscopic treatment: case report and review of the literature.

A 70-year-old woman presented with a 2-day history of tarry stool. She had a history of hemorrhage from a duodenal diverticulum of the 2nd portion 8 years previously that had been managed successfully by endoscopic hemostasis. Initial gastrointestinal endoscopy revealed ulceration of the diverticulum with no active bleeding; nevertheless the ulceration was presumed to be the source of the tarry stool. Despite medical treatment, bleeding started again, but endoscopic ethanol injection achieved hemostasis. When bleeding started yet again 8 days after the endoscopic therapy, the patient underwent diverticulectomy. Although duodenal diverticula are frequently found in the adult gastrointestinal tract, they rarely show hemorrhage. Recently, there has been controversy about whether bleeding diverticula should be managed surgically or endoscopically. We describe for the first time a rare case of recurrent hemorrhage of a duodenal diverticulum after an 8-year interval; the case was treated by surgical diverticulectomy as a definitive therapy for the recurrent bleeding ulcer. We also present a review of the literature.

Aged↗

PubMedDate not supplied

Improvement of the prognosis of gastric cancer with extensive serosal invasion using left upper abdominal evisceration.

BACKGROUND/AIMS: The prognosis of gastric cancer patients with serosal invasion is very poor. In this study, the effectiveness of the LUAE (left upper abdominal evisceration) procedure for these patients was evaluated retrospectively. METHODOLOGY: Thirty-seven gastric cancer patients who had serosal invasion but no massive peritoneal metastasis or hepatic metastasis, and underwent LUAE, were enrolled in this study (LUAE group). As a control, 66 gastric cancer patients who had the same disease conditions as the LUAE group, and underwent conventional total gastrectomy with the combined resection of the pancreatic body and tail and spleen (TPS group), were also investigated. RESULTS: The survival rate (5-year, 42.2%) of the LUAE group was significantly better than that (5-year, 21.2%) of the TPS group (P = 0.009). Although D4 super-extended lymphadenectomy and intraperitoneal chemotherapy during surgery was performed more frequently in the LUAE group than those in the TPS group, multivariate analysis demonstrated that the LUAE procedure was a better independent prognostic factor. CONCLUSIONS: The LUAE procedure in combination with D4 super-extended lymphadenectomy and intraperitoneal chemotherapy improved the prognosis of gastric cancer patients with extensive serosal invasion.

Aged↗

PubMedDate not supplied

Germinoma with a granulomatous reaction. Problems of differential diagnosis.

The patient was a 6 year-old girl with a progressive loss of visual acuity. Magnetic resonance imaging showed a suprasellar mass lesion with enhanced gadolinium which was resected. Histopathological study showed a remarkable granulomatous reaction, but a diagnosis was difficult. However, immunohistochemical study showed a few cells that were positive for placental alkaline phosphatase and it was diagnosed as germinoma. Intracranial germinoma with a remarkable granulomatous reaction is rare. However, when germinoma is suspected clinically, an immunohistochemical study is able to identify germinoma even if granulomatous disease is diagnosed histopathologically.

Alkaline Phosphatase↗

PubMedDate not supplied

Suppressive effect of vitamin E on lipid peroxidation in halothane-administered guinea pig liver.

The effect of vitamin E on halothane-induced liver damage was studied in guinea pig halothane hepatitis. Twenty animals were divided into 3 groups, consisting of a control group, a halothane group and a vitamin E + halothane (H) group. The animals in the control group (n = 6) were allowed to inhale air only. The animals in the halothane group (n = 6) and the vitamin E + H group (n = 8) were allowed to inhale 1% halothane with air. Animals in the vitamin E + H group were additionally injected with 30 mg kg-1 of vitamin E 30 minutes prior to inhalation of halothane. Blood was aspirated from the heart immediately after sacrificing to measure the serum activity of glutamic oxaloacetic transaminase (GOT) and glutamic pyruvic transaminase (GPT). A microsomal suspension was prepared from the excised liver. Then the amount of thiobarbituric acid (TBA) reactive products in the microsomes were measured. The amount of tissue TBA-reactive products was increased by inhalation of halothane. The increase in the amount of TBA-reactive product was inhibited by the administration of vitamin E. The serum GPT activity was increased by halothane inhalation. Increased serum GOT and GPT activity were inhibited by the administration of vitamin E. These results demonstrated that vitamin E suppressed halothane-induced liver damage in the guinea pig by inhibiting lipid peroxidation.

Alanine Transaminase↗

PubMedDate not supplied

Invasive meningioma is associated with a low expression of E-cadherin and beta-catenin.

Invasive meningioma shows benign histological features (WHO grade 1) and the brain expansion at the tumor-brain interface, and recurs more frequently than common meningiomas. To determine the mechanism of brain expansion, we studied the relationship between invasive meningioma and cell adhesion molecules. Immunostaining for E-cadherin (E-CH), N-cadherin (N-CH), beta-catenin, and Ki-67 was performed in 103 meningiomas that consisted of 61 meningothelial meningiomas, 25 fibrous meningiomas, 12 invasive meningiomas and 5 anaplastic meningiomas. All tumors were negative for N-CH. All the 61 meningothelial meningiomas, 10 of 12 invasive meningiomas, and 3 of 5 anaplastic meningiomas were positive for both E-CH and beta-catenin, while these were both negative in all of the fibrous meningiomas. In invasive meningiomas, the expansive part of the tumor showed a lower rate (4/12 tumors) of E-CH and beta-catenin positivity, while the central part showed a higher rate (10/12 tumors). The Ki-67 labeling index was higher in invasive and anaplastic meningiomas than in meningothelial meningiomas. These results suggest that a reduction in cell adhesion molecules and increased proliferative activity may be related, which may lead to a better understanding of the mechanism of meningioma expansion in the future.

Cadherins↗

PubMedDate not supplied

Asymmetric appearance of intracranial vessels on routine spin-echo MR images: a pulse sequence-dependent phenomenon.

PURPOSE: To determine the cause of right to left signal intensity differences arising from intracranial vessels during routine spin-echo axial MR imaging of the head. METHODS AND RESULTS: Using a normal imaging sequence in which the default directions of the frequency and phase axes were horizontal and vertical, respectively, differences in signal intensity arising from the vertebral arteries were observed in a healthy subject. With the exchange of the frequency and phase axes relative to the normal sequence, no signal intensity differences between the vertebral arteries were recognized. Other pulse sequence modifications, ie, the use of motion-compensating gradients and the reversed polarity of the frequency-encoding gradient, also resulted in variable appearances of the vertebral arteries, indicating that the right-to-left signal asymmetry of the vertebral arteries observed on the normal spin-echo image results from a pulse sequence dependent phenomenon. CONCLUSIONS: Frequency-encoding and slice-selection gradients both produce motion-induced phase shifts. These phase shifts depend on the angle between the direction of flow and that of the effective vector sum of these gradients. The asymmetric appearance of the vertebral arteries during normal spin-echo imaging was found to result from the angle dependence of motion-induced phase shifts. Awareness of this artifactual phenomenon is important to avoid confusing it with conditions such as stenosis/occlusion, dissection, or slow flow.

Artifacts↗

PubMedDate not supplied

Neuromas and meningiomas: evaluation of early enhancement with dynamic MR imaging.

PURPOSE: To investigate the role of dynamic MR imaging in the differentiation of neuromas and meningiomas. METHODS: Eleven patients with neuromas and 15 patients with meningiomas underwent dynamic contrast-enhanced MR imaging using a short TE FLASH sequence and a bolus injection of Gd-DTPA. RESULTS: There was no significant difference between these tumors in the signal-enhancement increment at the late phase, which corresponds to the signal-enhancement increment between pre- and postcontrast images in conventional spin-echo imaging. However, the signal enhancement at the vascular phase, ie, the phase where the first passage of Gd-DTPA was recognized both in the arteries and veins, was approximately four times as high in meningiomas as in neuromas. The difference was statistically significant. Furthermore, meningiomas had a wider range of early signal enhancement than did neuromas, reflecting the histologic varieties: two angioblastic meningiomas had the highest values, and three fibroblastic the lowest values comparable with those of neuromas, while meningiomas with other subtypes had intermediate values. CONCLUSIONS: The results of this study indicate that the evaluation of early enhancement with dynamic MR imaging is helpful in the differentiation of neuromas and meningiomas, and possibly in the crude prediction of pathologic subtypes of meningiomas.

Contrast Media↗

PubMedDate not supplied

Ciliated craniopharyngioma may arise from Rathke cleft cyst.

OBJECTIVE: The histogenesis of craniopharyngioma is not fully understood. We encountered a ciliated craniopharyngioma, the details of which may shed light on the histogeny of craniopharyngioma in general. PATIENT: A 74-year-old man presented with visual disturbance. Computed tomography showed an intra-suprasellar cyst including a solid tumor. Transsphenoidal surgery was performed. During surgery, the cyst was found to contain mucoid milky-white fluid and a solid tumor 1 cm in diameter. Histologically, the tumor was shown to be a papillary type craniopharyngioma with foci of ciliated columnar epithelial cells. Ciliated craniopharyngioma was diagnosed. CONCLUSION: Our findings in this case together with findings in other reported cases suggest that the basal cells of Rathke cleft cyst transform to papillary type craniopharyngioma after squamous metaplasia, explaining the presence of the cilia and goblet cells.

Aged↗

PubMedDate not supplied

Atypical teratoid/rhabdoid tumor arising from the spinal cord--case report and review of the literature.

Spinal atypical teratoid/rhabdoid tumor (AT/RT) is extremely rare. We report this rare case and review the literature of spinal AT/RT. A 10-month-old girl presented with rapidly progressive paraplegia. Magnetic resonance images revealed an intramedullary tumor occupying the entire spinal canal below Th10. An urgent operation, consisting of decompression by laminectomy and biopsy, was performed. Histologically, the tumor specimen had many rhabdoid cells with prominent nuclei and eosinophilic cytoplasmic inclusion. It showed mitosis and necrosis. The tumor cells were immunoreactive for vimentin, desmin, smooth muscle actin, neuron-specific enolase, neurofilament, epithelial membrane antigen, and CAM5.2. Despite chemotherapy and radiotherapy, she died 3 months after admission. The present case is only the third detailed report of spinal AT/RT. Spinal AT/RT carries a poor prognosis, and therefore should be distinguished from other embryonal tumor.

Diagnosis, Differential↗

PubMedDate not supplied

Diffusion imaging of the human brain: a new pulse sequence application for a 1.5-T standard MR system.

We developed a new pulse sequence and investigated whether the anisotropic diffusion in the human brain can be detailed with a standard whole-body MR imager. Apparent diffusion coefficient maps were produced by the proposed sequence using a 1.5-T MR unit. The sequence employed simultaneous application of three orthogonal gradients to achieve an optimal signal attenuation for imaging the brain without any increase in echo time. The orientation of the effective diffusion-encoding gradient was off-axis. On the in vivo apparent diffusion coefficient maps of four healthy volunteers, white matter tracts (the internal capsule and the corpus callosum) and the cortical and deep white matter showed anisotropic diffusion. In the gray matter, such as basal ganglia and thalami, anisotropic diffusion was not observed. A typical whole-body imager can provide in vivo human brain diffusion images of clinical quality. This technique has promising implications for the evaluation of brain development and the diagnosis of degenerative diseases.

Adult↗