Biomedical subjects

K Miwa

Publications and source records attributed to K Miwa.

460 records · Page 26Linked to original sources

PubMedDate not supplied

Expression of insulin-like growth factor-2, c-MET, matrix metalloproteinase-7 and MUC-1 in primary lesions and lymph node metastatic lesions of gastric cancer.

BACKGROUND/AIMS: Lymph node metastases are thought to be formed as lymphatic flow, so the first metastasis is formed in the lymph node nearest the primary tumor and then further lymph node metastases are formed continuously down stream. In this study of gastric cancer, we evaluated whether IGF-2 (insulin-like growth factor-2), c-MET (hepatocyte growth factor receptor), MMP-7 (matrix metalloproteinase-7) and MUC-1, which are associated with nodal metastasis from primary tumor, are concerned with metastasis from nodal metastatic lesion to other nodes. METHODOLOGY: Tissue specimens were obtained from 146 patients who underwent gastrectomy at the Department of Surgery II of Kanazawa University between 1989 and 1997. We evaluated the expression of IGF-2, c-MET, MMP-7 and MUC-1 in 146 primary tumors and 66 metastatic lymph nodes by immunohistological staining. RESULTS: In primary lesions, these 4 factors had significant association with lymphatic vessel infiltration and MMP-7 and MUC-1 had significant association with nodal metastases. In nodal metastatic lesions, positive rates of MMP-7 and MUC-1 were higher than in primary lesions. Furthermore, 37 (73%) of the 51 cases with positive staining for MMP-7 in metastatic lesions in perigastric lymph nodes and 5 (33%) of the 15 cases without the staining had nodal metastases in group 2 or more, showing significant difference (P < 0.05). And 37 (76%) of the 49 cases with positive staining for MUC-1 in metastatic lesions in perigastric lymph nodes and 5 (29%) of the 17 cases without the staining had nodal metastases in group 2 or more, showing significant difference (P < 0.01). CONCLUSIONS: MMP-7 and MUC-1 were associated with not only nodal metastasis from primary tumor but also metastasis from nodal metastatic lesion to other nodes.

Adenocarcinoma↗

PubMedDate not supplied

Pancreaticoduodenectomy in combination with right hemicolectomy for surgical treatment of advanced gastric carcinoma located in the lower half of the stomach.

The results of surgical treatment of patients with gastric carcinoma infiltrating into the duodenum and the pancreas head and with N3 metastases are very poor. We have employed pancreaticoduodenectomy in combination with right hemicolectomy (PD + LH) with the aim of leaving no remnant of cancer cells in the vicinity of the primary lesion, in patients with carcinomas of the distal third of the stomach, associated with duodenal invasion, presence of fixity to the pancreas head or N3 metastases, in the last ten years. Twenty-six cases were treated with this technique (Group A). These cases were compared with 63 patients who underwent subtotal gastrectomy (Group B) in the same period. The operation time, amount of blood loss and numbers of operative complications were greater in Group A than in Group B. Operating mortality was found in 2 cases in Group B but was 0 for Group A. When the survival rates were compared, PD + LH can provide better long-term results than subtotal gastrectomy, especially in the patients with tumors infiltrating into the pancreas head or metastasizing to N3. The PD + LH is a rational and safe method for the treatment of gastric carcinoma infiltrating into the pancreas head or metastasizing to N3.

Carcinoma↗

PubMedDate not supplied

Surgical treatment of advanced gastric cancer with metastasis in para-aortic lymph node.

We have studied the incidence and prognosis of N4 node (para-aortic lymph node) metastases in gastric cancer in 434 patients who had been referred to our department for surgical treatment during the period between 1978 and 1988. N4 nodal involvement was found in 76 (17.5%) of 434 patients who had received a laparotomy with resection, and in 42 (10.5%) of 400 patients who had "curative" resection. When the surgeon assessed that the patients had metastasis in para-aortic lymph nodes, the para-aortic lymph nodes lying above and below the left renal vein were completely removed (R4 gastrectomy). During this period, 42 patients with N4 nodal involvement underwent "curative" resection by R4 gastrectomy. Their treatment results were compared with those of 32 patients who underwent subtotal or total gastrectomy (R2 or R3 gastrectomy) without resection of metastases of para-aortic lymph nodes ("palliative" resection). The operating time and the operative mortality rate were similar in both groups (R4 vs R2 or R3 gastrectomy). The patients who had undergone "curative" resection (R4 gastrectomy) had a significantly higher five-year survival rate than those who had received "palliative" resection. The R4 gastrectomy is a rational and useful surgical procedure for treating patients with N4 nodal involvement.

Carcinoma↗

PubMedDate not supplied

Human chorionic gonadotropin in gastric carcinoma. A useful marker for bone metastasis.

Twenty patients with bone metastases from gastric carcinoma resected during the 13 years from 1974 through 1987 were investigated in relation to the serum and tissue carcinoembryonic antigen (CEA), alpha-fetoprotein (AFP) and human chorionic gonadotropin (hCG). The incidence of bone metastases was 2.1% (20/933). The serum AFP, CEA and hCG positive rates were found to be 14.3, 42.9 and 69.2% for patients with bone metastases and 18.3, 19.4 and 14.1% for those without bone metastases, respectively. In addition, the tissue AFP, CEA and hCG positive rates were 11.1, 100 and 77.8% for such patients with bone metastases, and 8.0, 80.8 and 21.1% for those without bone metastases. Only the serum and tissue hCG positive rate was significantly higher for the patients with bone metastases than those without bone metastases. The bone metastatic lesions were investigated for tissue hCG in four cases, and found to be positive in all the four bone lesions. In four of the patients with metachronous bone metastases, serum hCG levels were elevated before or at the time when bone metastases were diagnosed. Furthermore, serum hCG levels fell in response to chemotherapy or tumor resection. On the contrary, the serum AFP or CEA levels did not correlate with the clinical course in patients with bone metastases. These results indicate that the measurement of the tissue and serum hCG in patients with gastric carcinomas could be of extreme value in the search for bone metastases and the serum hCG level could be a useful marker for the prediction of bone metastases in gastric carcinoma.

Adenocarcinoma↗

PubMedDate not supplied

The modified extended mastectomy using the trap-door method as a staging operation.

The choice of operation for breast cancer must be directed towards giving the best chance of local control of the disease. Extended radical mastectomy may be beneficial for patients with internal mammary lymph node metastases, although it has remained controversial. The anterior chest defect created by extended radical mastectomy should be avoided in patients with no metastasis in the internal mammary lymph nodes. This paper, proposes a new technique of modified extended mastectomy using the trap-door method as a staging operation and an intermediate operation between modified radical mastectomy and extended radical mastectomy. In this operation, the axillary dissection could be performed by reflecting the pectoralis major muscle and the internal mammary lymph nodes could be dissected by reflecting the parasternal chest wall in trap-door fashion. In cases in which the metastasis is histologically found in the internal mammary content, extended radical mastectomy by sternal splitting is preferred.

Breast Neoplasms↗

PubMedDate not supplied

[Increased HDL-cholesterol level improves the prognosis in patients with coronary vasospasm].

Cardiovascular events were analyzed in the subset of 49 consecutive patients with vasospastic coronary artery disease who underwent diagnostic coronary arteriography from December, 1987 to March, 1991 to confirm coronary artery spasm during anginal attacks. During the follow-up period (30 +/- 14 months, mean +/- SEM), seven patients had cardiovascular accidents including acute myocardial infarction, unstable angina, and stroke (group A), while the remaining 42 patients were event-free (group B). Current smokers at the end of the follow-up period were more common in group A (71%) than in group B (12%) (p < 0.01). Serum total-cholesterol, low density lipoprotein cholesterol, and triglyceride levels were not significantly different between the two groups before or after the follow-up period. The baseline high-density lipoprotein cholesterol (HDL-C) level also did not differ between group A (32.5 +/- 8.3 mg/dl) and group B (41.0 +/- 12.9 mg/dl). However, the HDL-C level significantly increased during the follow-up period in group B (delta HDL-C 6.1 +/- 9.4 mg/dl) (p < 0.01), but not in group A (delta HDL-C -3.3 +/- 7.2 mg/dl). The HDL-C level at the end of the follow-up period in group A (29.2 +/- 9.0 mg/dl) was significantly lower than in group B (47.1 +/- 11.5 mg/dl) (p < 0.01). Cardiovascular accidents were significantly more common in current smokers (50%) (p < 0.01) than in current nonsmokers (5%) after the follow-up.(ABSTRACT TRUNCATED AT 250 WORDS)

Body Weight↗

PubMedDate not supplied

Analysis of hepatic recurrence of colorectal cancer after resection of hepatic metastases.

Forty patients with history of resected hepatic metastases of colorectal cancer were examined for pattern of recurrence. The 5-year survival rate was 41.3% for 40 patients. Recurrences of the malignancy were seen in 25 of the patients, with hepatic recurrence in 42.5% of them. The hepatic recurrence rate did not correlate with the lobar distribution of metastases or surgical methods. The pathological margins of less than 1 cm, 3 or more liver metastatic lesions, and the metastatic lesions of greater than 5 cm were at increased risk of hepatic recurrence. The recurrence rate was high, or 56% for aneuploid tumors, while it was 18.5% for diploid tumors.

Aneuploidy↗

PubMedDate not supplied

Intrathoracic hyperthermochemotherapeutic perfusion for the intrathoracic malignancies in gastric cancer.

BACKGROUND/AIMS: We introduced intrathoracic hyperthermochemotherapeutic perfusion to two patients with intrathoracic lesions in gastric cancer, one patient with pleural dissemination and the other with left lung metastases. MATERIALS AND METHODS: Heated saline containing cisplatin, mitomycin C, and etoposide was circulated through the patient's thorax by a magnetic pump for an hour. RESULTS: The effects of this procedure were estimated complete respose in the former and no change in the latter. There were no complications. While the intrathoracic temperatures were stable between 42.0 and 42.5 degrees C, systemic temperatures measured at esophagus, urinary bladder, pulmonary artery, and tympanic membrane very gradually increased and peaked under 38.6 degrees C. The drug concentration in the perfusate was much lower than the peak plasma concentration, though concentration in the plasma was higher than the peak plasma concentration. CONCLUSIONS: This procedure is one of the preferable methods for treatment of intrathoracic lesions in gastric cancer because of easy temperature control, pharmacological advantage, and lack of side effects.

Adult↗

PubMedDate not supplied

Breast conserving treatment versus modified radical mastectomy in Japanese patients with operable breast cancer.

From January, 1988 to October, 1995, 96 patients with operable breast cancer were treated by breast conserving treatment (BCT) including wide excision and axillary dissection followed by breast radiation. During the same period, 188 patients were treated by modified radical mastectomy (MRM) with or without breast reconstruction. In order to compare the survival of BCT and MRM groups, univariate and multivariate analyses were performed in this retrospective study. Univariate analysis revealed that the 5-year survival rates in the BCT and MRM groups were 97% +/- 2% and 87% +/- 3%, respectively (p < 0.05 with the Cox-Mantel test). However, the baseline variables were different between the groups. The adjusted Cox regression analysis revealed that the results of BCT were almost equivalent with those of MRM. Moreover, no breast recurrence was found in the BCT group. Therefore, it is suggested that our technique of BCT is as effective as modified radical mastectomy in treating operable breast cancer in Japanese patients.

Adult↗

PubMedDate not supplied

Distal pancreatectomy--does it have a role for pancreatic body and tail cancer.

BACKGROUND/AIMS: Pancreatic resection is the only hope for clinical improvement for patients with carcinoma of the body and tail of the pancreas. However, it is unclear whether palliative pancreatic resection is effective or not for patients with carcinoma of the body and tail of the pancreas. METHODOLOGY: To determine the appropriate treatment for patients with pancreatic body and tail cancer, we analyzed the records of 74 patients with ductal carcinoma of the body or tail of the pancreas who were treated at Kanazawa University Hospital between 1970 and 1995. RESULTS: Using a multivariate Cox proportional-hazard model (factors: age, sex, chemotherapy, radiotherapy, hepatic metastasis, peritoneal dissemination, operative procedure), the presence of hepatic metastasis, peritoneal dissemination, and the type of operative procedures (resection or not) were found to be significant prognostic factors. Surgical resection was the most important prognostic factor. The patients with surgical resection had a significantly higher survival rate than those without resection (p < 0.0001). The survival rate of the patients with palliative resections was also significantly higher than that of the patients without resection, except for the patients with advanced liver metastasis (H3). The survival rate of the patients with palliative resections was also higher than that of the patients without resection, even in patients with peritoneal dissemination. CONCLUSIONS: Surgical resection prolongs the average survival for patients with carcinoma of the body and tail of the pancreas, except for the patients with multiple liver metastasis. These data support the role of palliative pancreatectomy in patients with carcinoma of the body and tail pancreas.

Adult↗