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Biomedical subjects

K Hiroshige

Publications and source records attributed to K Hiroshige.

At least 37 records · Page 2Linked to original sources
PubMed1995

Postoperative prophylactic lipiodolization reduces the intrahepatic recurrence of hepatocellular carcinoma.

BACKGROUND: To determine a feasible postoperative adjuvant chemotherapy for patients with hepatocellular carcinoma, orally-administered chemotherapy (OC) and prophylactic lipiodolization (selective regional cancer chemotherapy using lipid contrast medium plus an anticancer drug) (PL) were compared prospectively. PATIENTS AND METHODS: Forty-eight patients who had undergone hepatic resection from 1989 to 1992 were divided into three groups: the control group (n = 19), given no chemotherapy; the OC group (n = 12), given 300 to 400 mg/d of 5-FU derivatives (either 1-hexylcarbamoyl-5-fluorouracil or uracil and tegafur, mean total dosage: 188 g, mean administrative duration: 18 months); and the PL group (n = 17), who underwent prophylactic lipiodolization 1.8 times on average using a 44-mg mean dose of epirubicin per treatment. RESULTS: No statistical differences were found either in the 25 variables studied as a background analysis, or among the survival curves of the 3 groups. Recurrence was found in 23 remnant livers of the 48 patients. The 3-year, disease-free survival rate was 15%, 50%, and 86% in the control, OC, and PL groups, respectively. The disease-free survival curve of the PL group was significantly higher compared to either the control (P = 0.001) or the OC group (P = 0.025). CONCLUSIONS: Prophylactic lipiodolization was found to be an effective treatment for patients with hepatocellular carcinoma for reducing intrahepatic recurrence after resection.

Administration, Oral↗
PubMed1995

Primary adrenal ganglioneuroblastoma in an adult.

We present here a case of adrenal incidentaloma in a 35-year-old male. Imaging technology including magnetic resonance imaging (MRI) clarified that the tumor was heterogeneous, and large in size (9x7 cm), and that it originated from the left adrenal gland. MRI scans on T1-weighted sequence showed the tumor with a low signal intensity followed by rapid contrast enhancement, whereas those on T2-weighted sequence showed markedly increased intensity. The tumor was surgically removed, and pathologic diagnosis was well-differentiated ganglioneuroblastoma. Ganglioneuroblastoma in adults is extremely rare, with only about 30 cases documented in people over the age of 20 years.

Adrenal Gland Neoplasms↗
PubMed1995

A dialysis patient with systemic calciphylaxis exhibiting rapidly progressive visceral ischemia and acral gangrene.

Systemic calciphylaxis is a rare, poorly understood syndrome of progressive peripheral ischemic necrosis and medial arterial calcification in patients with end-stage renal disease. We report a patient with this syndrome which developed following corticosteroid administration and who ultimately required amputation of the four extremities. Furthermore, cerebral, myocardial, splenic, and intestinal infarctions also developed in parallel with the increment of visceral arterial calcification. No evidence of noticeable hyperparathyroidism or elevation of serum calcium-phosphate product was observed. We speculated that, in addition to diabetes mellitus and chronic renal failure while undergoing dialysis therapy, the administration of corticosteroids might act synergistically to cause calciphylaxis.

Calciphylaxis↗
PubMed1994

Studies on the purine-pyrimidine metabolism (2)--Effects of sample preparation and diet on the concentrations of oxypurines in blood and urine.

The levels of pseudouridine (psi rd), uridine (Urd), hypoxanthine (Hyp), xanthine (Xan) and uric acid (UA) in both blood and urine samples were assayed by a reversed-phase high performance liquid chromatographic (HPLC) method. The evaluation of the sampling procedures showed that the levels of plasma oxypurines were overestimated by more than 15% for Hyp and 35% for Xan when heparinized plasma separation was delayed for 5 minutes after sampling. The fact that oxypurines levels of serum were significantly higher than those of plasma was also documented. Hence, for the accurate measurement of plasma oxypurines, plasma should be immediately separated from the blood with anticoagulants after it is collected. Physiological variation under a suitable sample preparation was also studied in 6 healthy male volunteers after their usual and a low purine diet for 4 days. The mean plasma levels for 6 male volunteers on a usual diet were 2.52 +/- 0.19 mumol/l for psi rd, 290.1 +/- 88.8 for UA, 49.4 +/- 1.24 for Urd, 0.82 +/- 0.30 for Hyp and 0.49 +/- 0.12 for Xan. On a low purine diet, the declines in the plasma oxypurine concentrations and the renal excretions of UA as well as oxypurine were demonstrated. When a dietary purine intake was restricted, the reference range of the Hyp level in plasma wa 0.48 +/- 0.26, and Xan was 0.36 +/- 0.17 mumol/l. Dietary influences on purine-pyrimidine metabolites should also be considered for the accurate measurement of their concentrations in blood and urine.

Chromatography, High Pressure Liquid↗
PubMed1994

Pharmacologic evaluation of the renal handling of uric acid and oxypurines.

The effect of drugs that alter the renal tubular transport of urate in the renal excretion of the oxypurines, hypoxanthine (Hx) and xanthine (X), was used to analyze the tubular mechanisms involved in oxypurine excretion in normal subjects and in patients with idiopathic renal hypouricemia. In healthy subjects, administration of the drugs, benzbromarone (Bb) and probenecid (Pb), brought a marked uricosuric effect, but did not alter oxypurine excretion. One of 2 hypouricemic patients exhibited no uricosuric effects with Bb and the other showed a slight uricosuric effect with the drug. Bb administration, however, produced no increase in oxypurine excretion in either patient. In healthy subjects, administration of pyrazinamide (PZA) suppressed the excretion of urate and oxypurines to varying degrees: relative to the baseline values, the fraction excretion of urate was reduced by 95% or more, that of Hx by about 24%, and that of X by about 64%. In patients with hypouricemia, the effects of PZA on urate and oxypurine excretion were impaired. According to these findings, we can speculate that the oxypurines have the same renal secretory mechanism as uric acid. However, the reabsorptive mechanisms of oxypurines at the postsecretory site are likely to differ from that of uric acid.

Adult↗
PubMed1994

The re-evaluation of sex steroids metabolism in patients with non-alcoholic liver cirrhosis.

We examined the serum levels of testosterone (T), androstenedione (delta 4-A), estrone (E1), estradiol (E2), and dehydroepiandrosterone sulfate (DHEA-S) in the non-alcoholic cirrhotic male patients when divided into compensated or decompensated state. Serum level of T was significantly elevated in compensated cirrhotic patients (9.63 +/- 1.00 ng/ml, mean +/- SE) compared to that in decompensated cirrhotic patients (5.63 +/- 0.69 ng/ml, p < 0.01) and in aged-matched normal controls (4.95 +/- 0.38 ng/ml, p < 0.01). Serum levels of E1, E2 and delta 4-A tended to be increased in decompensated cirrhotic patients, while there was not a significant difference decompensated cirrhosis compared to those of normal controls. Serum concentration of cholinesterase, indicative one of the representative residual liver function, showed a good positive correlation to T (r = 0.53, p < 0.01), and a negative correlations to E1 (r = -0.67, p < 0.01), E2 (r = -0.77, p < 0.01), delta 4-A (r = -0.57, r = p < 0.01). Also, we examined the relationship of the serum levels to gynecomastia or esophageal varices. The cirrhotics with gynecomastia showed significantly higher serum levels of E1, E2, and delta 4-A, and lower level of T than those without gynecomastia. And the cirrhotics with esophageal varices showed the greater level of T than those without esophageal varices. Our study suggests that low serum testosterone level of men with nonalcoholic cirrhotic is not a common finding, especially in compensated state.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1994

Unique imagings of CT and MR in liver metastasis from gastric leiomyosarcoma.

We report unique features of computed tomography (CT) and magnetic resonance (MR) imaging in the metastatic lesion of the liver in a case of gastric leiomyosarcoma. A CT scan and MR image demonstrated presence of a huge multilocular cystic lesion in the liver, of which finding were unlike to those of usual smooth muscle tumors, but mimicked to those of cystadenomatous tumors. In addition, this case had an extremely long elapsing time over ten years from the radical operation for the primary site.

Aged↗
PubMed1994

Possible multicentric occurrence of hepatocellular carcinoma: a clinicopathological study.

To assess the features of multicentric occurrence in hepatocellular carcinoma, we analyzed 10 of 72 patients (14%) who had undergone hepatic resection for hepatocellular carcinoma from May 1989 to October 1992 both clinically and pathologically. The multicentric occurrence of hepatocellular carcinoma was defined among the simultaneously detected small tumors as (a) at least one tumor consisting of extremely well-differentiated (grade I) hepatocellular carcinoma growing in a replacing pattern or (b) one of a group of hepatocellular carcinomas growing in an area of adenomatous hyperplasia. Of the 10 patients, the tumors in 9 were diagnosed as synchronous multicentric hepatocellular carcinomas, whereas the tumor in 1 was considered metachronous. All patients had cirrhosis; one of them had hepatitis B virus infection and nine patients had HCV infection. The inflammatory findings in the parenchyma were determined on the basis of serum enzyme values (AST, 89 +/- 27 IU/L; ALT, 96 +/- 43 IU/L). One or two tumors in 9 of 10 patients had thin trabecular or trabecular patterns showing replacing growth. In addition, one of the two tumors in two of nine patients was observed growing in areas of adenomatous hyperplasia. Recurrences were found in 4 of 10 patients. The 3-yr disease-free survival rate was 23%. Multiple recurrences were recognized in the two patients, and in the patients who underwent repeat surgery, grade I tumors were also found. Even though these tumors were small and well-differentiated, the recurrence rate was high. Therefore to detect the recurrence of metachronous multicentric hepatocellular carcinoma at an earlier stage, careful follow-up after surgery should be carried out.

Carcinoma, Hepatocellular↗
PubMed1993

High plasma concentration of myeloperoxidase in cirrhosis: a possible marker of hypersplenism.

Plasma myeloperoxidase levels in patients with cirrhosis were compared with those in patients with chronic hepatitis and healthy controls by means of a specific radioimmunoassay for myeloperoxidase. The mean concentration of plasma myeloperoxidase in cirrhotic patients (309.1 +/- 17.2 ng/ml, n = 41) was markedly higher than that in chronic hepatitis patients (222.6 +/- 17.2 ng/ml, n = 21) (p < 0.01) and normal controls (219.5 +/- 5.7 ng/ml, n = 50) (p < 0.01). Plasma myeloperoxidase showed good negative correlations with neutrocyte count (r = -0.32, p < 0.01), thrombocyte count (r = -0.40, p < 0.01), red blood cell count (r = -0.32, p < 0.01), serum albumin (r = -0.35, p < 0.01), and cholinesterase (r = -0.32, p < 0.02) and positive correlations with serum alkaline phosphatase (r = 0.49; p < 0.01) and lactate dehydrogenase (r = 0.31, p < 0.01) in patients with cirrhosis or chronic hepatitis. Among lactate dehydrogenase isozymes, a good positive correlation was seen between plasma myeloperoxidase and lactate dehydrogenase-2 (r = 0.40, p < 0.01) and lactate dehydrogenase-1 (r = 0.03, p < 0.02). Plasma myeloperoxidase was significantly higher in the cirrhotic and chronic hepatitis patients with splenomegaly (341.1 +/- 19.4 ng/ml, n = 31) than in those without splenomegaly (217.4 +/- 12.2 ng/ml, n = 29) (p < 0.01). We also examined the difference between plasma levels of myeloperoxidase in the portal and peripheral blood.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1993

Diabetes mellitus-associated glycogen storage hepatomegaly: report of a case and review of the Japanese literature.

A huge hepatomegaly was seen in a 30-yr-old female diabetic who was treated with high dose of insulin for her uncontrollable food ingestion. The liver function at the peak of the hepatic enlargement showed a moderate increase of transaminases, alkaline phosphatase, and gamma-glutamyl transpeptidase. The histology of the enlarged liver revealed PAS-positive granules in enlarged hepatocytes, indicating the presence of massive glycogen storage. On admission, she was maintained under a calorie-restricted diet and received approximately 15 to 20 units per day of insulin supplement. At one month after admission, a marked shrinkage of her enlarged liver and restoration of normal liver function were observed concomitantly with the return of fair control of her blood sugar levels. One year later, she had an episode of diabetic ketoacidosis which subsequently was treated with a continuous low-dose infusion of insulin; however, she showed neither hepatomegaly nor liver dysfunction during this episode. There have been 20 cases reported of Japanese diabetics with marked hepatomegaly, in whom the vigorous treatment of diabetic ketoacidosis with insulin seemed to be a trigger of the enlarged liver. This has occurred mostly in patients with insulin-dependent diabetes mellitus. We present a case of non-insulin-dependent diabetes mellitus with glycogen storage hepatomegaly, presumably due to excessive insulin supplements. This suggests that glycogen storage hepatomegaly in diabetics may not be only due to an acute restoration from diabetic ketoacidosis, but may also be due to an overinsulinization in an attempt to maintain a euglycemic condition in spite of excess food intake.

Adult↗
PubMed1993

High plasma concentrations of endothelin-like immunoreactivities in patients with hepatocellular carcinoma.

The plasma levels of endothelin-like immunoreactivities (ET-IR) of patients with hepatocellular carcinoma (HCC) were compared with those of patients with liver cirrhosis (LC), using a specific radioimmunoassay for endothelin-1. The mean concentration of plasma ET-IR of 21 HCC patients (30.3 +/- 8.5 pg/ml, n = 21) (means +/- SD) was markedly higher than those in LC (22.1 +/- 4.7 pg/ml, n = 16) (p < 0.01), which were also elevated compared with those in normal subjects (9.4 +/- 1.6 pg/ml, n = 91). Moreover, the level of plasma ET-IR reflected the tumor size of HCC patients, which was estimated by the ultrasonic and computed tomographic examinations. Although there was no relation to other biochemical parameters indicating liver function or tumor markers such as alpha-fetoprotein, a good positive correlation was obtained between plasma ET-IR and C-reactive protein (CRP) concentrations of HCC patients (r = 0.805, p < 0.01). We measured the tissue contents of ET-IR in HCC and its adjacent LC tissue, but failed to find any significant difference between the mean content of HCC (0.50 +/- 0.38 ng/g) and LC (0.44 +/- 0.28 ng/g). The endothelial cell damage due to cancer growth may not be responsible for the high concentrations of plasma ET-IR of HCC, because plasma thrombomodulin concentrations were not correlated with plasma ET-IR levels in HCC patients. Our study implies that the high plasma concentration of ET-IR is pathogenomonic to HCC, although the site of production is still debatable.

Aged↗
PubMed1993

[A study on uric acid excretion in patients with hypouricemia].

We studied four patients with hypouricemia and almost normal renal function. Two patients are idiopathic renal and familial. The other two cases are secondary to diabetes mellitus. The study of the uricosuric mechanism with pyrazinamide (PZA) and benzbromarone (Bb) test shows that two patients have a defect of pre-secretory reabsorption of urate, the other one a incomplete combined defect of pre-and post-secretory reabsorption, and the other one a enhanced secretion of urate. The fact that two patients have the history of acute renal failure (ARF) suggested that strenuous exercise or dehydration would be responsible for ARF in patients with renal hypouricemia.

Acute Kidney Injury↗
PubMed1992

[Studies on purine-pyrimidine metabolism (1)--Quantitation of purine-pyrimidine metabolites and allopurinol-oxipurinol in biological fluids].

A reversed-phase high-performance liquid-chromatography method for determining simultaneous quantitation of purine-pyrimidine metabolites, allopurinol and oxipurinol in plasma and urine samples was studied. Separation was optimal with phosphate buffer (10 mmol/l, pH 5.0) containing 1% methanol as an eluent and mu Bondapak C18 as a column. An isocratic separation of a standard mixture of 13 compounds was achieved within 40 minutes with adequate reproducibilities (coefficient of variation: 2.49% for 1.63 mumol/l orotidin-0.12% for 50 mumol/l uridine). A simple ultrafiltration of plasma yielded quantitative recoveries (uric acid: 101.7-107.5%, hypoxanthine: 90.4-102.8%, xanthine: 95.9-99.5%, oxipurinol: 104.4-107.1%, allopurinol: 97.4-103.4%). Compounds were identified by their retention times, absorbance ratios, co-elution with standards and enzymic shifts. In addition to the above compounds, simultaneous quantitation of pseudouridine, uridine, adenine and inosine in the plasma would be possible under the same conditions.

Allopurinol↗
PubMed1992

Endoscopic ultrasonography findings in acute gastric anisakiasis.

To clarify the components of the thickened gastric wall in acute gastric anisakiasis, we evaluated endoscopic ultrasonography (EUS) findings of acute gastric anisakiasis. Ten patients with acute gastric anisakiasis underwent endoscopic ultrasonography immediately after anisakiasis was diagnosed by endoscopy. In the acute phase of gastric anisakiasis, endoscopic ultrasonography (EUS) detected a thickening of the gastric wall made of mainly thickened third layer with low echoic changes. When EUS was performed 7 to 11 days later in seven patients, the EUS findings had normalized. We made clear EUS findings in acute gastritis due to gastric anisakiasis. Consequently, we found, by EUS, that the main inflammatory lesion in anisakiasis was in the submucosal layer of gastric wall.

Acute Disease↗