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Biomedical subjects

K Fujii

Publications and source records attributed to K Fujii.

At least 1,153 records · Page 64Linked to original sources
PubMedDate not supplied

Diagnosis and treatment of pituitary adenoma with adjacent carotid artery aneurysm.

We present three cases of pituitary adenoma with adjacent carotid artery aneurysm. The three adenomas are HGH-producing, prolactinoma and non-functioning tumors. Two of these 3 patients showed signs and symptoms of adenoma, while the other one showed a subarachnoid hemorrhage (SAH). The presence of the aneurysm adjacent to the pituitary adenoma was strongly suspected by the MRI finding, and the flow void signal sign just attached to the carotid artery in acromegalic patient. In a case of recurrent pituitary adenoma, development of the aneurysm was observed at a 17 year interval between angiography. Although the etiology of these lesion is not yet known, the change of hemodynamism seemed to have a major role in producing the aneurysm in all cases. The simultaneous treatment of the pituitary adenoma with aneurysm produced good results in all patients by the frontotemporal approach. MRI proved to be quite a useful tool in the management of cases of pituitary adenoma with adjacent carotid artery aneurysm. Cerebral angiography should also be performed without hesitation in such cases in which the MRI shows a significant finding of aneurysm. Simultaneous treatment of these lesions by a frontotemporal approach is recommended.

Aged↗
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Current concept of halothane hepatitis (review).

Clinically, halothane is still a useful volatile anesthetic, but since many cases of liver disorders considered attributable to halothane have been reported up to date, a number of studies have been made on the etiology and mechanism of halothane hepatitis. There are at least two possible mechanisms of halothane hepatitis; the first is the direct toxic reaction associated with free radical that is related to reductive pathway enhanced by hypoxia, and the other is the immune--mediated reaction in which the antigen is associated with the oxidative and/or reductive route. However, the etiology and mechanism of halothane hepatitis have yet to be elucidated, and clinically there is no obvious evidence that halothane can induce hepatic disorders. We have concluded at present that the use of halothane should be avoided in patients with liver disorders, in patients under long-term administration of drugs that may induce enzymes involved in halothane metabolism, in patients with high allergic sensitivity, and in patients undergoing operations in which liver circulation is reduced.

Adult↗
PubMedDate not supplied

Effects of multiple administration of halothane on the mixed function oxidase system in liver microsomes. Difference between guinea pigs and rats.

The effects of multiple administration of halothane on the mixed function oxidase system in liver microsomes were investigated and compared between guinea pigs and rats to clarify the difference in sensitivity to halothane. The mixed function oxidase system, except for NADPH-cytochrome P-450 recductase activity was increased in both animals. The inhibition in guinea pigs may have resulted from the microsomal membrane damage induced by the acceleration of lipid peroxidation.

Animals↗
PubMedDate not supplied

Clinical indication of digital subtraction angiography.

Intravenous subtraction angiography with Technicare DR 960 has been performed in the Department of Diagnostic Radiology and Nuclear Medicine, National Medical Center Hospital. All procedures are based on the non-invasive technique, i.e. with 5 cm length and 19 G. of cannula to the ante-cubital vein, and small amount of contrast material of half ml per kg of body weight kg as maximum dosage for pediatric patients. Image quality was evaluated by visual classification such as excellent, good, fair and poor. Among 335 procedures, 303 cases have brought useful diagnostic informations. 156 cases were excellent and good (47%). There were several specialized informations which might be worthwhile for DSA evaluation, i.e. 1. overlapping images, 2. static dynamic images, 3. density controlled image analysis, 4. three vessel visualized images and 5. well demarcated tumor images of extremities. Since the halo image around the true lumen of aneurysma suggested the outline of the false lumen, this phenomena might indicate the aneurysmal wall thickness. Poor risk patients and outpatients have been selected as our DSA candidates. The patient who is indicated for catheter technique angiogram were not examined by DSA.

Aged↗
PubMedDate not supplied

MR imaging compared with CT, angiography, and myelography supplemented with CT in the diagnosis of spinal tumors.

To clarify the significance of MR imaging and the present status of CT, angiography, and myelography supplemented by CT (M-CTM), the radiological findings of 50 spinal tumors were reviewed and analyzed. MR imaging was most effective for visualizing morphological features such as the margins and/or inner structures of the tumors. CT was also effective for imaging "dumbbell" neurinomas and extradural tumors. Angiography was necessary in one hemangioblastoma and in cervical extradural tumors. M-CTM visualized the morphology of intradural extramedullary tumors and extradural tumors, but provided no new information in most of these cases. It was concluded that when using MR the indications for CT, angiography, and M-CTM are limited and that CT or angiography should be performed only in selected cases. M-CTM appeared to be unnecessary.

Adolescent↗
PubMedDate not supplied

Case report: MR appearance of hemangiopericytoma of the thigh.

We report a case of hemangiopericytoma in the thigh of a 42-year-old woman. CT examination depicted a peripherally enhanced, multicystic mass without calcification. On T1-weighted images of MRI, the mass showed slightly high signal intensity relative to muscle, with the exception of the lower pole, which showed high signal intensity. On T2*-weighted images, the mass showed high signal intensity and cystic appearance. The lower pole showed low signal intensity on T2*-weighted images and was thought to be intratumoral hemorrhage. Low signal intensity structures on both T1- and T2*-weighted images were observed within and around the mass. They were thought to be dilated vessels, although this was not confirmed at surgery. Hemangiopericytoma should be considered in the differential diagnosis of a tumor in the thigh when MR images show the mass with slightly high signal intensity on T1-weighted images, intratumoral hemorrhage, and flow voids within or adjacent to the tumor.

Adult↗
PubMedDate not supplied

Ciliated craniopharyngioma indicates histogenetic relationship to Rathke cleft epithelium.

A case of ciliated craniopharyngioma is reported. The patient was a 36-year-old man who suffered from visual disturbance, and he was revealed to have a tumor in the suprasellar region by CT scan. At operation, the tumor was a solid mass accompanied by multiple small cysts. Histologically, the tumor consisted of papillary type of craniopharyngioma in which foci of ciliated columnar epithelial cells were observed. Electron microscopy revealed ciliated epithelium with scattered goblet cells. This uncommon type of craniopharyngioma seems to offer a clue to understand the histogenesis of craniopharyngioma.

Adult↗
PubMedDate not supplied

Histological evaluation of lymph node metastasis on serial sectioning in gastric cancer with radical lymphadenectomy.

BACKGROUND/AIMS: Lymph node metastasis is one of the most important prognostic factors in gastric cancer patients. To evaluate the real extent of lymph node metastasis from gastric cancer, histological examination by serial sectioning was performed. METHODOLOGY: Histological examination of serial sections of lymph nodes was performed in 111 gastric cancer patients who underwent radical gastrectomy, to evaluate methods of examining lymph node metastasis. A total of 58430 cross-sections of 3449 lymph nodes were examined. The extent of lymph node metastasis was evaluated by the routine one-section method, the 3-section method and the serial sectioning method for lymph node examination. RESULTS: The frequency of lymph node metastasis was 81.1% (90/111) and metastatic foci were detected in 23.0% of all lymph nodes by serial sectioning. Serial sectioning of distant lymph nodes showed metastasis in 23.8% by the 1 section method, and 8.4% by the 3-section method. Micrometastasis was detected in 10.5% of metastatic lymph nodes, and distant lymph nodes had a higher rate of micrometastasis. CONCLUSION: Serial sectioning resulted in more accurate evaluation of the extent of lymph node metastasis, and it was also shown that distant lymph nodes had a higher rate of micrometastasis.

Gastrectomy↗
PubMedDate not supplied

Protein exudation induced by manipulation of the intestines and mesentery during laparotomy in rat. A study of the mechanism of 'third space' loss.

BACKGROUND-MATERIALS: Much extracellular fluid administration is required during major surgery because of the functional loss of extracellular fluid. In the present study we investigated the effect of manipulation of the intestines and mesentery in a rat laparotomy model. METHODS-RESULTS-CONCLUSIONS: The results showed that manipulation significantly increased the amount of protein exudated into the peritoneal space and induced a marked histopathological inflammatory response including polymorphonuclear leukocyte infiltration and mast cell degradation. These findings suggest that the inflammatory response induced by manipulation may, at least in part, explain the underlying mechanism of 'third space' loss during abdominal intestinal surgery.

Animals↗
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Risk factors of esophagojejunal anastomotic leakage after total gastrectomy for gastric cancer.

BACKGROUND/AIMS: The purpose of this study was to investigate the incidence of esophagojejunal anastomotic leakage (EJAL) after total gastrectomy. METHODOLOGY: Four hundred and four consecutive gastrectomy cases were reviewed to determine the incidence of esophagojejunal anastomotic leakage. RESULTS: EJAL developed in 33 patients (8.2%). The rate of leakage was found to be significantly related to the preoperative lymphocyte count and serum albumin level. Cases of para-aortic lymph node dissection (D4) had a significantly higher rate (16.1%) of EJAL than in conventional lymph node dissection (D2,3: 5.3%). The left upper abdominal evisceration group demonstrated a significantly higher EJAL rate (20.0%) than the cases without combined resection (4.8%). CONCLUSION: Aggressive surgery for advanced gastric cancer increases the risk of esophagojejunal anastomotic leakage. When aggressive surgery is necessary for curative purposes, meticulous preoperative, intraoperative and postoperative care are indispensable.

Anastomosis, Surgical↗
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A case of enlarged cavernous sinus mistaken for petrous apex tumor.

We experienced a case of abnormally enlarged cavernous sinus extending into the petrous apex, which was confused with a petrous apex tumor or an enlarged Meckel cave. The CT and MR appearances were of expansile lesions in the petrous apex with water signal intensities on both T1- and T2-weighted MR images. Unfortunately, these findings were not specific. Cerebral angiography was only suggestive of enlarged cavernous sinus involving the petrous apex because of opacification of the petrous apex in the venous phase. Our case was confirmed by surgery as enlarged cavernous sinus involving the petrous apex.

Adult↗
PubMedDate not supplied

Carcinoid somatostatinoma of the papilla of Vater: a case report.

A 57 year-old Japanese man with a carcinoid somatostatinoma of the papilla of Vater is presented. He was found to have cholecystolithiasis without any symptoms. Physical examination showed no abnormal findings. Routine laboratory data gave normal results, except for glucose intolerance and an elevated somatostatin concentration. A yellowish papillary tumor was found at the papilla of Vater, and histological examination suggested the diagnosis of carcinoid. He underwent a pancreatoduodenectomy in March 1992. The gallbladder contained a single pure cholesterol stone. Histological, immunohistochemical, and electron microscopic studies resulted in the diagnosis of a carcinoid somatostatinoma of the papilla of Vater, without regional lymph node metastases. Post-operative pancreatic juice output from the total pancreatic duct drainage increased to more than 1000 mL/day. Although an anastomotic leakage of the pancreatojejunostomy was noted, the pancreatic fistula closed 8 weeks later. His postoperative somatostatin value was normal. He has been well for 54 months following surgery, without any signs of recurrence.

Ampulla of Vater↗
PubMedDate not supplied

Unilateral exophthalmos due to orbital metastasis from a contralateral intraocular melanoma.

Progressive, left exophthalmos developed due to a left, retrobulbar mass in a 76-year-old Japanese woman. An open tumor biopsy was carried out, and both macro- and microscopic findings of the mass confirmed that it was a malignant melanoma. Orbital melanomas usually result from distant metastasis of cutaneous melanomas or from secondary extension of ipsilateral intraocular melanomas. Thorough physical, laboratory, and radiological examination, however, did not disclose any primary cutaneous or visceral melanoma, nor had the patient any previous history of excision or spontaneous regression of a pigmented lesion. Histopathologically, the left retrobulbar melanoma was rich in sinusoidal vessels which were surrounded by melanoma cells, oriented in a perpendicular array, a histological feature more characteristic of uveal melanomas than of cutaneous ones. The ophthalmological examination excluded development of a primary intraocular melanoma on the left side. Fundoscopic examination of the right eye was not feasible because of the complete opacity of the right vitreous body which had resulted from previous episode of idiopathic vitreous hemorrhage. Unexpectedly, CT and MR studies depicted retrobulbar masses of non-homogeneous densities in the bilateral orbits. These radiologic studies indicated the metastatic nature of the left retrobulbar melanoma, while suggesting the development of a primary, intraocular melanoma on the right side, extension into the right orbit, and involvement of the right optic nerve. All these clinical, radiological, and histological data suggested the development of a primary melanoma in the right eye and subsequent metastasis to the left orbit producing exophthalmos. The mechanism of such a peculiar mode of metastasis remains entirely unknown. This is a rare case of metastatic orbital melanoma, without visceral involvement, which originated in the contralateral eye. Development of the right ocular melanoma remained unrecognized due to atrophic degeneration of the right eyeball and complete opacity of the right vitreous body, until the contralateral orbital metastasis grew massive enough to cause exophthalmos.

Aged↗
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Malignant meningioma with a new intracytoplasmic inclusion body.

A 55-year-old man presented with a frontal mass lesion, which histologically consisted of pleomorphic tumor cells with necrotic foci and abundant mitotic figures, showing a meningothelial pattern focally. In addition, many eosinophilic round- or irregular-shaped bodies were seen not only in tumor cell cytoplasm but also in between the tumor cells. By electron microscopy, the tumor cells showed a minimal adherence to each other and the intercellular spaces were wide. Tumor cells had numerous branching cytoplasmic processes and some of them were united by desmosomal junctions. These features suggested that the tumor was a malignant variety of arachnoid trabecular cell meningioma. The inclusion bodies consisted of homogeneous fine granular material and were not surrounded by microvilli. This type of inclusion body has not been reported in meningiomas in the past. The significance and possible pathogenesis of the inclusions are discussed.

Cell Division↗
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Imaging of large early and early advanced hepatocellular carcinomas of more than 5 cm in diameter: report of two cases.

In an attempt to clarify the imaging characteristics of large early and early advanced hepatocellular carcinoma (HCC), we present two such cases which were greater than 5 cm in diameter. One case had four early HCCs and the other had early advanced HCC which was followed for five years and nine months. Multiphasic CT, CT arteriography (CTA), CT arterial portography (CTAP), and MR imaging were performed. Early HCC was shown as a low density mass by multiphasic contrast CT, CTAP and as a hyperintense mass on a T1-weighted image (WI) and isointense on T2WI. Early advanced HCC was demonstrated as a hypodense mass with hyperenhancing interior nodules on CTA, and isodense with hypodense internal foci on CTAP. One follow-up case showed a multi-step progression from early to early advanced HCC, and finally to overtly advanced HCC. Despite the unusually large size of these two tumors, the findings of multiphasic CT, CTA, CTAP, and MR imaging were consistent with those seen in common-sized (less than 2 cm) early and early advanced HCCs. Multi-step progression of hepatocarcinogenesis was observed in one case.

Aged↗
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Surgical treatment for advanced carcinoma of the gastric remnant.

BACKGROUND/AIMS: Carcinoma of the gastric remnant has increased in recent years, but a therapeutic strategy for this disease has not been established. This retrospective study was performed to determine the most appropriate surgical procedure for carcinoma of the gastric remnant. METHODOLOGY: A total of 25 patients who underwent operation for advanced carcinoma of the gastric remnant that had developed after distal gastrectomy (13 for benign gastric diseases, B group; 12 for gastric carcinoma, M group) were studied. Clinicopathological features, as well as the status of lymph node metastasis, were investigated in the B and M groups. RESULTS: There were more patients with carcinoma invading other organs, stage IV disease, and with N2 or more lymph node metastasis (especially, with a high metastatic rate to lymph nodes along the splenic artery) in the M group than in the B group. Forty percent of patients in the M group were treated by left upper abdominal evisceration (LUAE), but only 8% in the B group. The survival rate (5-year, 46.0%) of the B group was significantly higher than that (5-year, 11.9%) of the M group. When we compared the survival rate of carcinoma of the gastric remnant with that of primary carcinoma of the upper third of the stomach, there was no difference between the two groups in the curative resection cases. CONCLUSIONS: Almost the same surgical strategy can be adopted for the B group as for primary gastric carcinoma. On the other hand, for the M group, a radical surgical procedure, LUAE, should be recommended.

Aged↗