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Biomedical subjects

K Orii

Publications and source records attributed to K Orii.

At least 37 records · Page 2Linked to original sources

Early experience of minimally invasive valve surgery.

In this paper we report on our early results of minimally invasive cardiac valve surgery. A series of 6 consecutive patients with valvular disease underwent valve repair and valve replacement via a right parasternal incision; aortic valve replacement 3, mitral valve replacement 1, mitral valve repair 2. There were no intraoperative complications requiring median sternotomy. Five patients had no blood transfusion. There was only one postoperative event; this patient had a sudden massive bleeding from the chest tube after extubation of the endotracheal tube, an immediate re-suture of the aortotomy was performed. The reoperative course was uneventful. Minimally invasive cardiac surgery for aortic and mital valves is an excellent option for most patients affected by isolated valvular disease.

Adult↗

[Mantle cell lymphoma with multiple extranodal involvement].

A 79-year-old male was admitted to our hospital because of general fatigue and night sweat. Physical examination showed generalized superficial lymphadenopathy, marked splenomegaly, and tumors in the conjunctiva and the abdomen. Chest X-ray and computed tomography (CT) revealed pleural effusion and intrathoracic lymphadenopathy. Abdominal ultrasonography and CT showed hepatosplenomegaly and intraperitoneal tumors. Upper gastrointestinal fiberscopy revealed multiple polypoid lesions and ulcers in the duodenum and the stomach. Involvement of relatively small-sized lymphocytes with cleaved nuclei was identified in each biopsied specimen from a cervical lymph node, a tumor in the conjunctiva, gastrointestinal polypoid lesions, and the bone marrow. Surface marker analysis of abnormal lymphocytes in the bone marrow revealed that CD5, CD19, and CD20 were strongly positive, but CD23 was weakly positive. Although (11:14)(q13:q32) translocation was not identified by chromosome analysis of bone marrow cells, Northern blot analysis of bone marrow cells revealed overexpression of the PRAD1 oncogene. Diagnosis of mantle cell lymphoma (MCL) was made. Combination chemotherapy by cyclophosphamide and vincristine was not effective, but etoposide perorally given at a dose of 50 mg per day was effective. In MCL, extranodal involvement of a digestive tract and bone marrow is well known. This case suggests that involvement of multiple organs including lacrimal glands and pleura could be characteristic of MCL cells.

Abdominal Neoplasms↗

Mutation analysis of very-long-chain acyl-coenzyme A dehydrogenase (VLCAD) deficiency: identification and characterization of mutant VLCAD cDNAs from four patients.

Very-long-chain acyl-coenzyme A dehydrogenase (VLCAD) deficiency is a newly identified disease. A 105-bp deletion in the VLCAD cDNA in two patients has been reported, and detailed molecular characterization of this disease has remained to be done. We report here five mutations identified in four patients: a 135-bp deletion encompassing bases 343-477, a C-1837-to-T transition (R613W), 3-bp deletions at the nucleotide positions 388-390 (E130del) and 895-897 (K299del), and an A-1144-to-C transversion (K382Q). Sequencing of genomic DNA amplified by PCR revealed a 135-bp deletion caused by exon skipping due to a 1-bp deletion in a 3' splice site of an intron. In cDNA expression experiments using Chinese hamster ovary (CHO) cells, we found that each of the mRNAs derived from E130del and K299del clones were unstable and that translation products from R613W, E130del, K299del, and K382Q clones were labile. Each of R613W, E130del, K299del, and K382Q proteins expressed in CHO cells appeared abnormal in dimer assembly, as shown in gel-filtration analysis. VLCAD activity was not detected in mutants' transfectants. Thus, we verified that all five mutations identified in these four patients were disease-causing alterations.

Acyl-CoA Dehydrogenase, Long-Chain↗

Dependence of the thymidylate synthase inhibition rate on the interval after the last administration of tegafur in sigmoid colon cancer patients.

The thymidylate synthase (TS) inhibition rate was measured after tegafur (FT) administration (1.5 g/day, at least 10 days) in 7 sigmoid colon cancer patients. The TS inhibition rate decreased as the interval between the time of the last administration and the time of the tumor resection increased longer. This study provides basic data for considering methods of drug administration and assessment of modification, for example, by leucovorin.

Adenocarcinoma↗

[Histopathological evaluation of the radiosensitizing effects of an intratumoral injection of BrdU for rectal cancer].

We delivered preoperative radiotherapy with intratumoral injection (ITI) of radiosensitizer, 5-bromodeoxyuridine for patients with locally advanced cancer originating in lower rectum. We identified immunohistochemically the tumor cells that incorporated BrdU, and evaluated the radiosensitizing effect of BrdU histopathologically. (1) BrdU-labeled nuclei of cancer cells were identified in twenty-three cases out of 24 (96%). Mean labeling index was 18.5%, and tended to decrease as time progressed. (2) The parameters representing volume of residual tumor nests (Tumor Nest Index) or degrees of tumor extension (Depth of Extramural Tumor and Depth of Extramural Fibrosis) for patients with ITI were compared to those for patients without ITI. Those parameters tended to decrease when ITI was combined with radiotherapy. However, the difference was not significant statistically. Intratumorally injected BrdU can incorporate with cancer cells, but a methodological invention is required for yielding clinically measurable radiosensitization.

Adenocarcinoma↗

[Computed tomographic evaluation of thickness of perirectal fascia in rectal cancer treated by preoperative radiotherapy--diagnostic value for prediction of local recurrence].

Perirectal fascia was examined by computed tomography before and after preoperative radiotherapy in thirty-six patients with rectal cancer. CT measurement showed that perirectal fascia tend to increase in thickness during preoperative radiotherapy in proportion to tumor extension into perirectal fat tissue. The fascial thickening more than 7 mm after preoperative radiotherapy was suggestive of local recurrence to develop. Preoperative or intraoperative boost irradiation would be recommended for such high-risk patients.

Adenocarcinoma↗

Recurrence factors studied by percutaneous transhepatic portography before and after endoscopic sclerotherapy for esophageal varices.

High recurrence and rebleeding rates have been reported when endoscopic sclerotherapy has been performed on patients with esophageal varices. We studied the relationship between embolization range and recurrence rate in 26 patients in whom percutaneous transhepatic portography was carried out before and after sclerotherapy. Patients were divided into complete and incomplete embolization groups. The complete embolization group consisted of 16 patients whose esophageal varices had disappeared and in whom embolization of the feeders to the varices had occurred. The incomplete embolization group consisted of 10 patients whose esophageal varices had disappeared, but no embolization had occurred. Recurrence rates within 2 yr after the treatment were compared between complete and incomplete embolization groups. The recurrence rates in the respective groups were 6.7% (1 of 15) and 70.0% (7 of 10), indicating a significant difference between the two groups (p less than 0.05) and indicating that embolization of both esophageal varices and their feeders is essential to lower the recurrence rate after sclerotherapy.

Adult↗

Effects of preoperative radiotherapy on rectal cancer. Preliminary report on combining radiation with intratumor injections of peplomycin and bromodeoxyuridine.

Between 1976 and 1983, 61 patients with advanced rectal cancer underwent Miles' operation at the authors' institution. All lesions were located 10 cm or less from the anal verge. Of these patients, 25 were treated by surgery alone and 36 were given preoperative radiotherapy. The total dose was 42.6 Gy, (30.6 Gy [1.8 Gy/fr x 5/week]) delivered to the entire pelvis plus an additional 12 Gy (3.0 Gy/fr x 4/week) delivered to the primary tumor. Of 36 patients, 21 were administered intratumor injections of peplomycin and bromodeoxyuridine at the time of boost radiation and 15 were treated without intratumor injections. During the follow-up period (3 to 9 years), in the groups of patients who underwent radiation, there was only one local failure (2.8 percent). In contrast, in the group of patients treated by surgery alone, eight local failures occurred (32 percent). The intratumor injection significantly enhanced the effect of radiation on tumor regression. The incidence of positive lymph nodes was higher in patients in the surgery alone group than it was in the groups treated with radiation. There was no difference in the rate of distant metastasis among the three treatment groups. The five-year survival rate for the radiation with intratumor injection group, radiation alone group, and surgery alone group, was 77.8, 69.2, and 56.0 percent, respectively. No severe complication was experienced.

Adenocarcinoma↗

Intense accumulation of indium-111 leukocytes in peritonitis carcinomatosa.

In order to detect the infectious foci in a case of terminal recurrent cancer of the sigmoid colon with intense inflammation, In-111 oxine leukocyte scintigraphy was performed. Leukocytes labeled with In-111 oxine quickly localized within the region of peritonitis carcinomatosa and could be imaged after 4 hours. With time, high activity appeared in this area. And 48 hours after injection, the large intestine was clearly seen. However, no activity was seen in the main recurrent tumor. This suggested that the labeled leukocytes had accumulated in regions of inflammation rather than in malignant tissue. When performing In-111 leukocyte scintigraphy for diseases in which tumor cells and inflammation are mixed, distinguishing the two components is particularly important, and time-sequential scanning is very useful.

Adenocarcinoma, Papillary↗

[Electrophysiological monitoring of the brainstem function in impending brain death--serial changes of blink reflex and brainstem auditory evoked potential].

Serial changes of EEG, BR and BAEP recordings were obtained over a period of two days on two patients who had suffered massive cerebral hemorrhage while their clinical condition evolved from coma with evidence of preserved cerebral and brainstem functions to a state meeting the criteria of brain death. As clinical evidence of deteriorating brainstem function became apparent in case 1, first wave IV and V components of BAEP disappeared while waves I to III were normal. Finally, when clinical criteria of brain death were fulfilled, the BAEP response was restricted to wave I with small amplitude to stimulation of left ear only. These serial changes were likely consistent with gradual dissolution of brainstem function in a rostrocaudal direction. By contrast, in case 2, the BAEP response was restricted to waves I and II and was stationary in the whole process of impending brain death in no association with some preservation of cerebral and brainstem function. The changes of BAEP was not parallel to the progressive deterioration of EEG and BR. After meeting clinical criteria of brain death, complete abolition of waves II and I was sequential in that order, and then Babinski sign besides withdrawal and deep tendon reflexes may revive in the extremities. Monitoring of serial electrophysiological changes is helpful in the course of impending brain death to determine whether revival of Babinski sign is due to recovery of cerebral-brainstem dysfunction or due to establishment of spinal autonomy.

Aged↗

[Electrophysiological study of congenital facial paralysis].

The common cause of neonatal facial asymmetry is facial nerve paralysis or "asymmetric crying facies syndrome". In the not uncommon later the lower lip, symmetrical at rest, becomes tilted to the so-called normal side when the patient is smiling or crying, as the congenital hypogenesis of sublabial muscles fail to pull down the lower lip in the opposite side. The electrophysiological differentiation between the two diseases has been performed by orbicularis oculi and oris reflexes with mechanically glabellar and supralabial tapping stimulation, respectively, in addition to needle and/or surface EMG recording. In the facial nerve paralysis of the case 1, R1 and R2 were absent in the orbicularis oculi and oris reflexes. EMG activity was completely lacking over the M. orbicularis oculi and oris innervated by facial nerve. On the contrary, the orbicularis oculi and oris reflexes were normal in the asymmetric crying facial of the case 2. EMG activity was absent only in the sublabial muscles including M. depressor anguli oris and/or M. depressor labii inferioris. Furthermore, needle EMG disclosed no spontaneous activity at rest, which was suggestive of no denervation in the sublabial muscles. It was, however, not possible to determine exactly which muscle the needle was inserted, the M. deprossor anguli oris or the M. depressor labii inferioris. The case 3 might be a variant of asymmetric crying facies with hypogenesis of M. orbicularis oris and/or oculi as well as the sublabial muscle, since the latency was normal but the amplitude was significantly attenuated in the components of orbicularis oculi and oris reflexes.(ABSTRACT TRUNCATED AT 250 WORDS)

Diagnosis, Differential↗

Villous adenoma in the large bowel following ureterosigmoidostomy: a case report and review of the pertinent literature.

This report presents a case of colonic adenoma which developed after ureterosigmoidostomy. A 71-year-old man was initially treated by total cystectomy and ureterosigmoidostomy for transitional cell carcinoma of the bladder in 1970. In 1983, a routine checkup revealed urinary occult blood. A barium enema x-ray showed a polypoid lesion in the sigmoid colon. Colonoscopy confirmed the presence of the polyp adjacent to the ureteral stoma. The biopsy findings were interpreted as villous adenoma with severe atypia. This tumor was removed endoscopically. This is the seventh case report of neoplasia occurring in the sigmoid colon after ureterosigmoidostomy in Japan. Review of the pertinent literature indicates that patients who have undergone this type of urinary diversion have an increased risk of development of large bowel neoplasia. Adequate and regular surveillance of these patients has been suggested in order to help in early detection.

Adenoma↗

Lithotomy of intrahepatic and choledochal stones with Yag laser.

Eight patients with intrahepatic bile duct stones and three with choledochal stones were treated by Yag laser using a choledochofiberscope. A choledochoscope was inserted through a T-tube fistula in five patients or a percutaneous transhepatic cholangiodrainage fistula in six patients. In one patient, right partial lobectomy of the liver was performed after most of the stones were withdrawn, since some stones in the extremely narrow bile duct had not been removed. Most of the intrahepatic bile duct stones and choledochal stones will be withdrawn using the Yag laser and a choledochofiberscope, when they were bilirubin stones.

Adult↗