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Biomedical subjects

K Kihara

Publications and source records attributed to K Kihara.

At least 55 records · Page 3Linked to original sources
PubMed1999

Possible misinterpretation on computed tomography of left inferior vena cava as retroperitoneal lymph node metastasis: a report of two cases.

PURPOSE: We report on two cases of retroperitoneal lymph node metastasis of testicular cancer with left inferior vena cava. METHODS/RESULTS: A 25-year-old man with a left testicular cancer with pulmonary and retroperitoneal lymph node metastases received three courses of VIP (etoposide, ifosfamide and cisplatinum) chemotherapy. Subsequent abdominal computed tomography (CT) revealed round lesions enhanced with contrast agent on both sides of the aorta inside the degenerated lymphadenopathy. These lesions were regarded as a duplicated inferior vena cava (IVC) and this was confirmed at retroperitoneal lymph node dissection. The second case is of a 21-year-old man with a left testicular cancer with pulmonary, liver and widespread lymph node metastases. Subsequent to a course of VIP chemotherapy, super high-dose chemotherapy was administered. Abdominal CT revealed a round mass enhanced with contrast agent on the left side of the aorta adjacent to the degenerated lymphadenopathy, which was regarded as the transposed left IVC and this was confirmed at lymph node dissection. CONCLUSIONS: In both cases, initial CT failed to detect the lesions as the left IVC and there was a possibility for the misinterpretation of such venous anomalies with residual lymphadenopathy.

Adult↗
PubMed1999

Detection of disseminated urothelial cancer cells in peripheral venous blood by a cytokeratin 20-specific nested reverse transcriptase-polymerase chain reaction.

More than half of all patients with invasive urothelial cancer subsequently develop metastatic disease even after radical resection of the primary cancer. In these patients, neoplastic cells may be disseminated prior to or during the operation. A nested reverse transcriptase-polymerase chain reaction (nested RT-PCR) assay which amplifies cytokeratin (CK) 20 transcripts was used to detect cancer cells in the peripheral blood of urothelial patients. This assay was able to detect 10 bladder cancer cell line cells in a sample of ten million peripheral-blood mononuclear (PBMN) cells. CK 20-specific signals were detected in 9 (22.5%) of 40 PBMN cell samples prepared from 40 urothelial cancer patients in relation to the tumor stage, including 0/13 patients with a superficial tumor, 4/21 (19%) with a regionally invasive tumor and 5/6 (83%) with a metastatic tumor (P = 0.0002 in chi 2 test). No signals were detected in any of 25 healthy donor PBMN cell samples. The present results indicate that the CK 20 RT-PCR assay is applicable for detection of urothelial cancer cells in the peripheral blood. The assay also confirms that hematogenic dissemination occurs in invasive urothelial cancers but rarely in superficial ones.

Biomarkers, Tumor↗
PubMed1999

Late recurrence and progression after a long tumor-free period in primary Ta and T1 bladder cancer.

OBJECTIVE: To determine the probability and risk factors of recurrence and progression (to T2 or worse) after a long tumor-free period in patients with superficial (stage Ta and T1) bladder cancer. PATIENTS AND METHODS: A consecutive series of 100 patients with superficial bladder cancer who remained tumor-free for longer than 4 years after initial treatment were reviewed. The rates of recurrence and progression were statistically assessed and the significance of risk factors was determined. RESULTS: Of the 100 patients, 24 (24. 0%) recurred within 15 years after the initial treatment. The 10- and 15-year recurrence-free rates were 76.0 and 59.6%, respectively. Among the clinicopathological variables examined, intravesical chemotherapy was determined by a log-rank test to be a significant unfavorable risk factor for late recurrence (p < 0.001). Progression of the tumor occurred in 5 patients. Four variables including presence of multiple tumors, involvement of the bladder neck, positive urine cytology, and intravesical chemotherapy were found by a univariate analysis to be significant risk factors for late progression (p < 0.05). Among these factors, initial presence of multiple tumors (3 or more) was determined by a multivariate analysis to be an independent risk factor for late progression. CONCLUSION: Recurrence and progression continue to occur in patients with superficial bladder cancer even after long periods of dormancy. Regular follow-up urological assessments should be continued until at least 15 years of tumor-free existence, especially in patients treated by intravesical chemotherapy or those initially having multiple tumors.

Administration, Intravesical↗
PubMed1999

Morphological effects on in-stent restenosis assessed by intravascular ultrasound imaging.

The purpose of this study was to evaluate the rupture and dissection of the vessel wall immediately after balloon dilatation by intravascular ultrasound (IVUS) imaging and to predict restenosis in patients who underwent subsequent coronary stent implantation. Stent implantation improves the long-term results of coronary angioplasty by reducing lesion elastic recoil and arterial remodeling. However, several studies have suggested that neointimal hyperplasia is the cause of instant restenosis. We recruited 60 patients in whom IVUS studies were performed immediately after successful balloon dilatation and just before stent implantation. We compared IVUS parameters with 6-month follow-up quantitative coronary angiography. This was performed in 51 lesions of 51 patients (85%). Qualitative analysis included assessment of plaque composition, plaque eccentricity, plaque fracture and the presence of dissection. In addition, minimal luminal diameter, percent diameter stenosis, percent area stenosis and plaque burden were quantitatively analyzed. Two morphological patterns after balloon dilatation were classified by IVUS. Type I was defined as absence or partial tear of the plaque without disclosure of the media to lumen (22 lesions). Type II was defined as a split in the plaque or dissection of the vessel wall with disclosure of the media to the lumen (29 lesions). At 6 months follow-up, angiographic restenosis occurred in 17 of the 51 lesions (33%). Restenosis was significantly (p < 0.05) more likely to occur in type II (13/29: 45% incidence) than in type I (4/22: 18% incidence). The assessment of plaque morphology immediately after balloon dilatation and before stent implantation provides important therapeutic and prognostic implications.

Aged↗
PubMed1999

Spacing effects on the memory for faces.

25 undergraduate women studied 12 stimulus pictures of female faces successively presented in spaced or massed conditions and made affective judgments for the pictures along a dimension of like to dislike. One week after the exposure (study) period, subjects were given an identification test comprised of photographs of the same female faces with different expressions. Analysis showed that the pictures presented in the spaced condition were more frequently and accurately identified than those presented under the massed condition and that affective judgment was unrelated to conditions of presentation.

Adult↗
PubMed1999

[A case of retroperitoneal hemangiopericytoma].

We report a case of a huge retroperitoneal tumor in a 67-year-old woman. When the patient was taken to another hospital by ambulance, she had lost consciousness because of hypertension and hypoglycemia and abdominal CT revealed a huge retroperitoneal tumor with deviation of the right kidney and inferior vena cava. After further examinations including ultrasonography, MRI and angiography in our hospital, the tumor was extirpated. The tumor, 22 x 17 x 10 cm in size and 2,580 g in weight was diagnosed as hemangiopericytoma histologically. She has remained well with no evidence of recurrence for 9 months since the operation.

Aged↗
PubMed1998

Spinal cord segments controlling the canine vas deferens and differentiation of the primate sympathetic pathways to the vas deferens.

This study was undertaken to explore the spinal cord segments controlling the canine and human vas deferens and differentiation of the mammalian sympathetic pathways to the vas deferens. Thoracolumbar white communicating rami (WCR) were electrically stimulated in the dogs. Stimulation of the 1st, 2nd, 3rd, and 4th lumbar WCR elicited an elevation of intraluminal pressure of the vas deferens in 2, 10, 16, and 14 of 20 dogs examined, respectively, whereas stimulation of sympathetic chain (between the 13th thoracic and 1st lumbar ganglia), 13th thoracic WCR, intermesenteric plexus, and 5th lumbar WCR showed no response in any of the 10, 2, 12, and 5 dogs examined, respectively. Anatomical study of the 118 human lumbar splanchnic nerves of 55 cadavers showed that almost all lumbar splanchnic nerves (96%) originated from L2 and/or L3 sympathetic chain ganglia (L1-2 spinal cord levels). Comparative anatomical study of the mammalian sympathetic pathways to the vas deferens showed that the caudal mesenteric plexus is not divided in rats, rabbits, cats, and dogs and is partially divided into two plexuses in monkeys and completely in humans and that separation of the sympathetic component in the pelvic nerve (isolation of the sacral splanchnic nerve) is in progress in the primate. These results indicate that spinal cord segments controlling the vas deferens are L1-4 in the dog and probably L1-2 in humans and that differentiation of the sympathetic nerve pathways is proceeding at both main and compensatory pathways to the vas deferens in the primate.

Animals↗
PubMed1998

Sympathetic efferent pathways projecting to the vas deferens.

The abdominal and pelvic sympathetic nervous system controlling the vas deferens has elaborate mechanisms to preserve its function against various injuries. The main sympathetic signals to the vas deferens proceed the common pathway in mammalians, which consists of the lumbar splanchnic nerve, caudal mesenteric plexus, hypogastric nerve, pelvic plexus and its branches. On the way of this common pathway, some signals cross to the other side of the body at the level of the caudal mesenteric plexus and/or the pelvic plexus. The preganglionic axons passing through the hypogastric nerve very likely provide a bilateral innervation to postganglionic neurons in the pelvic plexuses, which also exhibit crossing to the bilateral vasa deferentia. The sympathetic nerves originating from the thoracic spinal cord are of minor importance in contraction of the vas deferens but possibly influence it by the hormonal system consisting of the major splanchnic nerve and the adrenal medulla. When the common pathway is interrupted, various compensatory mechanisms are generated: enhancement of the remaining sympathetic pathways or reorganization of synaptic connection in the pelvic plexus. Surgical reconstruction of the transected hypogastric nerve is possible and cross-innervation mechanism via the hypogastric nerve can also be preserved. Elevation of intraluminal pressure at the cauda epididymis/proximal vas deferens induced by nerve impulse pushes the spermatozoa out to the ampulla and distention of the wall of the ampulla triggers its contraction to emit the content into the urethra. After seminal emission, a portion of the seminal fluid remaining in the vas deferens moves in a retrograde direction to the cauda epididymis for the next emission. It remains to be seen whether similar mechanisms in animals are at work in humans.

Adrenal Medulla↗
PubMed1998

A new criterion combining ST/HR slope and deltaST/deltaHR index for detection of coronary artery disease in patients on digoxin therapy.

We evaluated the clinical value of a new index combining deltaST/delta heart rate (HR) index and ST/HR slope for diagnosing coronary artery disease (CAD) in patients on digoxin therapy. Exercise treadmill tests were performed by 72 patients on digoxin therapy. Simple HR-adjusted indexes of ST-segment depression during exercise (deltaST/deltaHR index) and the decline calculated from the final 12 data points relating ST-segment depression to HR (ST/HR slope) were determined. A new index was obtained by subtracting the deltaST/deltaHR index from the ST/HR slope. On thallium scintigraphy, 37 of the 72 patients showed reversible perfusion defects related to the diseased coronary artery. The new index derived from this ST-HR relation was 4.1 +/- 3.6 microV/beats/min in the ischemic group and 1.3 +/- 1.0 microV/beats/min in the group of patients without ischemia (p <0.0001). An ST-HR relation > or = 1.5 was found in 33 of the 37 patients in the ischemic group, and in 7 of the 35 patients without ischemia (p <0.0001). The sensitivity of this criterion for prediction of myocardial ischemia was 89%, the specificity was 80%, and the predictive accuracy was 85%. Thus, this new ST-HR index is useful for detecting CAD in patients on digoxin therapy.

Aged↗
PubMed1998

Predicting the effects on patients with dilated cardiomyopathy of beta-blocker therapy, by using iodine-123 15-(p-iodophenyl)-3- R,S-methylpentadecanoic acid (BMIPP) myocardial scintigraphy.

We examined whether the iodine-123 15-(p-iodophenyl)-3- R,S-methylpentadecanoic acid (BMIPP) myocardial scintigraphy was useful for predicting the treatment response to beta-blocker in patients with dilated cardiomyopathy (DCM). Sixteen patients with DCM were studied. BMIPP single photon emission computed tomography (SPECT) was performed before beta-blocker therapy. The count ratio of the heart (H) to the upper mediastinum (M) (H/M ratio) was calculated. Several measurements including the BMIPP H/M ratio before the administration of metoprorol were retrospectively compared among the 10 "good responders" (showing improvement by at least one NYHA class or an increase in the ejection fraction of > or = 0.10, 6 months after the start of the drug therapy) and the 6 "poor responders." The bull's eye map of BMIPP was divided into 17 areas. Each segmental score was analyzed quantitatively by means of a two-point scoring system (good uptake > or = 67%, poor uptake < 67%). The total score was regarded as the uptake score. The H/M ratio was significantly higher in the good responders than in the poor responders (2.41 +/- 0.24 vs. 1.86 +/- 0.17 p < 0.01). There were no significant differences between the two groups in any other variable data at entry. The uptake score was also a good index for predicting the therapeutic effect. When a relative uptake of 67% or higher was scored as 1, uptake scores of 9 to 17 corresponded to good responses (sensitivity = 100%, specificity = 100%, accuracy = 100%, positive and negative predictive value = 100%). Although the number of patients studied is small, our results suggests that BMIPP myocardial scintigraphy can predict the response to a beta-blocker in patients with DCM.

Adrenergic beta-Antagonists↗
PubMed1998

A newly developed on-line monitoring system for the determination of serum electrolytes and urea during hemodialysis.

Continuous monitoring of serum solute concentrations throughout a dialysis session could be beneficial for the prevention of intradialytic morbidity such as hypotension and for the confirmation of dialysis adequacy. In this paper, we introduce a new on-line monitoring system for use during hemodialysis sessions, a system developed for the continuous observation of serum biochemical data. Using this system, we also show the possibility of clinical applications. Intradialytic hypotension could be prevented by the observation of filtrate sodium concentration and the control of dialysate sodium concentration. The termination of a dialysis session could be decided by the observation of the filtrate urea nitrogen, on the basis of the Kt/V urea ratio. Because monitoring for other solutes such as calcium and creatinine is theoretically available, clinical applications will continue to increase in the future.

Adult↗
PubMed1998

Advanced testicular germ cell tumor in a hemophilic patient with human immunodeficiency virus infection.

A stage IIIB anaplastic seminoma which occurred in an HIV-infected hemophilia is reported. The patient with hemophilia A was 36 years old and had been seropositive for HIV antibody for 3 years. Inguinal orchiectomy and subsequent chemoradiotherapy for retroperitoneal lymphadenopathy were performed and a marker negative partial response was obtained. In spite of a low initial CD4+ lymphocyte count (90/microliter), the patient tolerated the treatment well without life-threatening opportunistic infection. Although factor VIII supplement was performed, continuous bleeding from the operative wound made postoperative care difficult.

Acquired Immunodeficiency Syndrome↗
PubMed1998

Chromophobe cell renal carcinoma in childhood.

We report the first case of chromophobe cell renal carcinoma in childhood. A 12-year-old boy presented gross hematuria following minor trauma. He was diagnosed as having a left renal tumor 45-mm in diameter. Radical nephrectomy was performed. One year later the boy was well.

Carcinoma, Renal Cell↗
PubMed1998

Significance of bladder neck involvement on progression in superficial bladder cancer.

OBJECTIVES: To determine the significance of bladder neck involvement in predicting disease progression in superficial (stage Ta and T1) transitional cell carcinoma (TCC) of the urinary bladder. PATIENTS AND METHODS: A series of 277 patients with newly diagnosed superficial TCCs of the bladder was reviewed, and disease progression (to T2 or worse) was considered. The significance of several risk factors including bladder neck involvement was assessed in univariate and multivariate analysis. RESULTS: Progression occurred in 28 (10.1%) of 277 patients during a median follow-up period of 7.7 years. Nineteen died of bladder cancer. The following variables were found to be statistically significant at the univariate analysis (p < 0.05): irritative symptoms, urine cytology, tumor stage, involvement of the bladder neck, and tumor grade. Indeed, only involvement of the bladder neck, tumor stage, and grade retained their value as independent factors for progression at multivariate analysis. Patients were divided into three groups according to the number of independent risk factors they had. Groups having none, one, and two or three risk factors included 129, 99, and 49 patients with 5-year progression rates of 0.8, 4.6 and 27.5%, and 15-year rates of 4.0, 20.1 and 42.7%, respectively. CONCLUSION: Involvement of the bladder neck is a significant and independent risk factor for progression of superficial TCCs in addition to the histologic grade and stage. The combination of these three risk factors offers better prediction of progression in an individual patient.

Adolescent↗
PubMed1998

Cosmetic orchiectomy using pedicled fibro-fatty tissue graft for prostate cancer: a new approach.

OBJECTIVE: To preserve the appearance of a normal scrotum at orchiectomy, a pedicled fibro-fatty tissue graft was inserted in the lumen of the tunica vaginalis. METHODS: 42 testes of 21 patients with metastatic prostate cancer were treated. A pedicled fibro-fatty tissue graft prepared from the region between the spermatic cord and the scrotal septum was inserted in the lumen of the tunica vaginalis following epididymis-sparing orchiectomy under local or spinal anesthesia. RESULTS: A pedicled fibro-fatty tissue graft which reached the epididymal tail was prepared in all instances. The average postoperative volume of the scrotal content was 18 ml (range 5-30 ml). Postoperative complications were scrotal edema, sensation of traction at the inguinal region and epididymitis. All but 1 patient were satisfied with the appearance of the scrotum and achieved sufficient androgen ablation. Mean follow-up was 8 (3-11) months. CONCLUSION: This cosmetic orchiectomy is a safe, simple and economical procedure to preserve the appearance of a normal scrotum; it also achieves the reliable result of androgen deprivation.

Aged↗