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K Sasajima

Publications and source records attributed to K Sasajima.

At least 37 records · Page 2Linked to original sources
PubMed1998

Glucocorticoid attenuates a decrease of antithrombin III following major surgery.

BACKGROUND: Major surgery, such as esophagectomy, activates inflammatory responses and the coagulation system, and this activation is characterized by release of inflammatory cytokines and a decrease in antithrombin-III (AT-III), respectively. Preoperative glucocorticoid administration has been reported to suppress circulatory cytokine levels after major surgery. PATIENTS AND METHODS: A total of 28 patients underwent esophagectomy for esophageal carcinoma; 14 of them were given 10 mg/kg of methylprednisolone intravenously upon induction of anesthesia and 14 served as controls. Circulating levels of tumor necrosis factor-alpha (TNF-alpha), interleukin 6 (IL-6), polymorphonuclear (PMN) elastase, thrombin-antithrombin III complex (TAT), AT-III, and albumin were measured before and immediately after the operation and on postoperative days (PODs) 1, 3, 5, and 7. RESULTS: TNF-alpha, IL-6, and TAT levels significantly increased after esophagectomy in both groups. AT-III and albumin decreased to their minimum levels on POD 1 and POD 3, respectively. Methylprednisolone treatment effectively inhibited the increases in TNF-alpha and IL-6 and the decreases in AT-III and albumin, but did not inhibit the increases in PMN-elastase and TAT levels. There were significant correlations between AT-III, IL-6, and albumin levels. CONCLUSIONS: These results suggest that methylprednisolone pretreatment attenuates the decrease in AT-III by reducing IL-6 production postoperatively.

Aged↗
PubMed1998

Systemic and pulmonary responses of inflammatory cytokines following esophagectomy.

Inflammatory cytokines in plasma and bronchoalveolar lavage fluid (BALF) from 16 post-esophagectomy patients with and without preoperative methylprednisolone administration were studied. Interleukin-8 (IL-8), interleukin-6 (IL-6) and tumor necrosis factor-alpha (TNF-alpha) concentrations in plasma and BALF were measured by ELISA immediately after surgery (0-POD) and on the postoperative day 1 (1-POD). In patients without methylprednisolone treatment, IL-8 levels in BALF were 362 +/- 67 pg/ml on 0-POD and 948 +/- 359 pg/ml on 1-POD, and were approximately 10 times higher than those in plasma levels. IL-6 levels in plasma were significantly higher than those in BALF. The TNF-alpha concentration was similarly low in plasma and BALF. The patients with preoperative methylprednisolone treatment had significantly lower IL-8 levels in BALF and plasma compared with the patients without the treatment. Immunocytochemically, each cytokine was identified in the cytoplasm of bronchoalveolar macrophage. The percentage of polymorphonuclear cells (PMN) among BAL cells was significantly increased on 1-POD when compared with that of 0-POD, and tended to be decreased by preoperative methylprednisolone treatment. These results suggest that IL-6 was markedly increased in the peripheral circulation and that increased pulmonary IL-8 might be related to an accumulation of PMN in the lung under surgical stress. Further, methylprednisolone administration could possibly reduce postoperative cytokine responses at the local and systemic levels.

Adult↗
PubMed1998

[A case report of esophageal carcinoma with grade 3 response by preoperative chemotherapy using CDDP/5-FU/LV].

A 67-year-old man was diagnosed as having a type 3 advanced esophageal carcinoma by barium swallow and endoscopy. Biopsy specimens showed well-differentiated squamous cell carcinoma with positive immunostaining for p53, C-erb B-2 and negative for bcl-2. Two courses of chemotherapy using 5-FU, leucovorin and CDDP were performed before operation. Because no cancer cells were present in the surgical specimens, the effect was evaluated as grade 3. This neoadjuvant chemotherapy may be effective for esophageal carcinoma with a possible apoptosis mechanism.

Aged↗
PubMed1998

[Pathology of the cardia].

Defining the cardia as consisting of 2 cm of the distal esophagus and 2 cm of the proximal stomach, we describe the detailed histopathological features of the cardia and esophagogastric junction (EGJ). The distance between the EGJ and the squamocolumnar junction (SCJ) was 0-10 mm (mean: 3 mm) in 50 Japanese autopsy cases, but the SCJ was not located below the EGJ. It has been reported that pancreatic metaplasia, small leiomyomas, inflammatory EGJ polyps, carditis, and Barrett's epithelium are often recognizable in the cardia, and the literature on these conditions is reviewed. The relationship between leiomyomas and gastrointestinal stromal tumors is also reviewed, and the histopathology of short-segment Barrett's esophagus is described. In biopsy specimens obtained from Barrett's esophagus, the presence of ducts of esophageal glands proper in the metaplastic mucosa as revealed by microscopy can be used to establish the diagnosis, although only in a short-segment of Barrett's esophagus less than 3 cm in length. Finally, several English and Japanese textbooks on the pathology of the digestive tract containing descriptions of normal and diseased cardia are described for the convenience of authors writing scientific papers on diseases of the cardia.

Aged↗
PubMed1997

Telomerase activity in esophageal carcinoma.

BACKGROUND AND OBJECTIVES: Telomerase is a ribonucleoprotein that synthesizes telomeric DNA. Immortalized and carcinoma cells show no loss of telomere length during cell division. Telomerase activity has been demonstrated in carcinomas of various organs, but not in nonneoplastic tissues. In patients with esophageal carcinoma, no data have been reported concerning the relationship between telomerase activity and clinicopathological findings. MATERIALS AND METHODS: Esophageal carcinomas from 31 patients and normal esophageal mucosae from 92 patients were examined. Telomeric Repeat Amplification Protocol assay to detect telomerase activity and Southern blot analysis to examine telomere length were performed. RESULTS: Of the 31 carcinomas, 27 (87%) had detectable telomerase activity. Twenty-one (23%) of the 92 normal esophageal mucosae from autopsied patients also had detectable telomerase activity. There was no difference between stage and outcome and absence or presence of telomerase activity. No difference in terminal restriction fragment (TRF) length was observed between carcinomas with and without telomerase activity. CONCLUSION: Telomerase activity was demonstrated in a considerable number of normal esophageal mucosae. This suggests the possibility of a high frequency of false positivity if the presence of telomerase activity alone is used as a tumor-specific marker.

Adenocarcinoma↗
PubMed1997

Endoscopic dexamethasone injection following balloon dilatation of anastomotic stricture after esophagogastrostomy.

BACKGROUND: Anastomotic stricture is common after esophagogastrostomy. Recent advances in nonsurgical treatment include the silicon bougie and balloon dilatation. However, simple dilatation alone with a silicon bougie or endoscopic balloon dilator was repeated a mean of 4.7+/-5.4 times to control anastomotic stricture because of its temporary effect. METHODS: For 11 patients, endoscopic injection of dexamethasone (8 mg) around the anastomosis was done immediately after balloon dilatation (40 psi for 5 minutes). RESULTS: This method significantly reduced the number of the dilatations to 1.1+/-0.3 (P < 0.05). Ten of the 11 patients did not need any further treatment. There were no side effects or complications of dexamethasone injection. CONCLUSION: A combination of endoscopic balloon dilatation and dexamethasone injection provided an easy and safe method for preventing the recurrence of anastomotic stricture.

Anastomosis, Surgical↗
PubMed1997

The effect of preoperative high dose methylprednisolone in attenuating the metabolic response after oesophageal resection.

OBJECTIVE: To evaluate the effect of giving glucocorticoids preoperatively for the prophylaxis of surgical stress. DESIGN: Prospective randomised study. SETTING: University hospital, Japan. SUBJECTS: 30 patients undergoing resection of oesophageal carcinoma. INTERVENTIONS: 15 patients (group 1) were randomised to be given methylprednisolone (30 mg/kg) and 15 patients (group 2) to be given saline intravenously before operation. MAIN OUTCOME MEASURES: Outcome, length of stay in the intensive care unit (ICU), metabolic response, and oxygenation. RESULTS: Patients given methylprednisolone had a mean stay in the ICU of 5.1 +/- 1.0 days compared with 8.2 +/- 4.5 days in the saline group (p < 0.01). 5 patients in the saline group compared with 0 in the methylprednisolone group developed postoperative complications (p = 0.02). Plasma norepinephrine and arginine vasopressin levels in methylprednisolone group were significantly lower than those in the saline group (p < 0.05). The PaO2:FiO2 ratio in the saline group was significantly lower than that in the experimental group (p < 0.01). CONCLUSIONS: Preoperative methylprednisolone may facilitate the postoperative management of surgical patients.

Adult↗
PubMed1996

Changes in urinary nitrate and nitrite during treatment of ulcerative colitis.

The urinary excretion rates of nitrate (NO3) and nitrite (NO2) were monitored in 14 patients with active ulcerative colitis during treatment using hydrocortisone and sulfasalazine. During the active phase of the disease, the NO3 excretion was significantly higher in the patients than in healthy controls (n = 6, p < 0.05), although it varied considerably among the patients. During the healing phase, the NO3 excretion decreased concurrently with improvement of symptoms and colorectal ulceration, but the NO2 excretion increased. During the inactive phase of the disease, the NO3 and NO2 excretions were significantly lower than during the active phase, and the NO2/NO3 ratio resembled that in the healthy controls. In contrast, a patient who failed to respond to treatment showed continuously high NO3 and NO2 excretion rates. These results indicate that urinary NO3 and NO2 excretions vary with the disease state in ulcerative colitis.

Adult↗
PubMed1995

Increases in pulmonary artery pressure and cardiac output due to the inhibition of nitric oxide synthesis during operative stress.

Pulmonary artery pressure (PAP), cardiac output (CO), and urinary nitrate, a stable endproduct of nitric oxide (NO), were measured pre- and postoperatively in eight patients who underwent esophagectomy for squamous cell carcinoma of the thoracic esophagus. A significant elevation of PAP and CO on the day of operation (POD 0) was accompanied by a low concentration of urinary nitrate. A reduction in PAP and CO, and an increase in nitrate to the preoperative levels, were found on PODs 2 and 3, respectively, but urinary nitrate decreased again after POD 3. Consequently, the changes in PAP and CO were closely correlated with the nitrate concentration. These results suggest that operative stress inhibited NO synthesis with a transitory induction of endogenous NO synthesis postoperatively.

Aged↗
PubMed1993

Adenoma accompanied by superficial squamous cell carcinoma of the esophagus.

BACKGROUND: Adenoma of the esophagus is a rare type of esophageal submucosal tumor. METHODS: An immunohistochemical and histopathologic study is reported of specimen from a patient with adenoma of the esophagus. RESULTS: The eighth reported case of esophageal submucosal adenoma without Barrett epithelium is described. The patient was a 58-year-old man with an adenoma and carcinoma of the esophagus. The adenoma showed papillotubular structures lined with two layers of cuboidal cells within the submucosa and lamina muscularis mucosae, and the carcinoma was of the superficial squamous cell type confined to the submucosa. CONCLUSIONS: Morphologic findings suggested that this adenoma had originated from the duct of the esophageal gland proper.

Adenoma↗
PubMed1993

Multiple polyps of esophagus, stomach, colon, and rectum accompanying rectal cancer in a patient with constitutional chromosomal inversion.

BACKGROUND: It has been reported that colorectal carcinomas are caused by a multistage process. In patients with familial adenomatous polyposis, carcinoma of the colorectum frequently develops and occasionally polyps develop in the upper gastrointestinal tract. Chromosomal deletion often is found for chromosomes 5, 17, and 18, on which tumor suppressor genes are located. Furthermore, loss of the alleles of loci on chromosome 3 has been reported in renal cell carcinoma, small cell lung carcinoma, and mixed salivary gland tumor in hereditary and sporadic cases. These data support the concept of a recessive mechanism for the development of human tumors. PATIENTS AND RESULTS: The authors report the case of a 48-year-old woman with rectal cancer accompanied by multiple polyps in the esophagus, stomach, and colorectum. Histologically, the polypoid lesions in the esophagus, stomach, and colorectum showed a thickened mucosa, hyperplastic polyps, and mixed hyperplastic adenomatous polyps, respectively. Karyotype analysis showed 46, xx, inv(3)(p12.2q25.3) in all 20 inspected peripheral lymphocytes. By Southern blot with a c-raf probe, one allele of the c-raf-1 gene, which has been mapped on chromosome 3p25, was deleted from the rearranged chromosome 3 in the peripheral lymphocytes, intact colonic mucosa, and cancer tissue. CONCLUSIONS: These results suggest that the development of hyperplastic polyps and carcinoma of the rectum results from the allelic loss in chromosome 3p, as has been reported for solid tumors at other sites.

Chromosome Aberrations↗
PubMed1992

Leiomyosarcoma of the esophagus: report of a case and preoperative evaluation by CT scan, endoscopic ultrasonography and angiography.

A case of esophageal leiomyosarcoma, for which CT scan, endoscopic ultrasonography (EUS) and angiography were employed for preoperative diagnosis is reported. CT scan identified an exophytic mass which had no rim-enhancement in the lower end of the esophagus. EUS revealed a homogeneous mass originating from the muscularis propria. Angiography showed a mildly hypervascular tumor. Histologically, the resected specimen was a leiomyosarcoma. These results suggest that the evaluation by EUS combined with CT scan and angiography is useful in differentiating smooth muscle tumors from other submucosal tumors.

Angiography↗
PubMed1992

Hyperbilirubinemia after esophagectomy. A possible role of lipid peroxidation.

Postoperative hyperbilirubinemia was investigated in 18 patients who underwent a single-staged esophagectomy and reconstruction. The total serum bilirubin (TSB) concentration increased progressively after surgery without any evidence of sepsis and reached a peak on day 5 from 0.5 +/- 0.1 to 2.4 +/- 0.4 mg/dl (p less than 0.01), and then decreased by day 14. The TSB concentration rose above 2.5 mg/dl on days 5 or 7 in 8 patients (44%). Alkaline phosphatase and SGOT showed a mild increase during the postoperative period. The increase in the serum lipid peroxide (LPO) concentration, which was measured as malondialdehyde, after surgery correlated closely with the change in the TSB concentration. The LPO concentration was significantly elevated only in the patients with postoperative hyperbilirubinemia, and showed a correlation with the TSB concentration (r = 0.81, p less than 0.01). The level of serum alpha-tocopherol decreased after surgery, but did not differ between the patients with or without postoperative hyperbilirubinemia. These results suggest that lipid peroxidation reactions play a role in the development of hyperbilirubinemia after esophagectomy, which may be due to benign intrahepatic cholestasis.

Aged↗
PubMed1991

Double muscularis mucosae in Barrett's esophagus.

To clarify the histology and morphogenesis of the double muscularis mucosae in Barrett's esophagus, eight specimens resected from patients with Barrett's esophagus were compared histopathologically with 352 specimens resected from patients without Barrett's esophagus. A double muscularis mucosae was observed in seven (87.5%) of the eight cases with Barrett's esophagus, but in none of the 352 cases without Barrett's esophagus. The mucosa in the segment of Barrett's esophagus consisted of columnar epithelium, a superficial lamina propria, a superficial muscularis mucosae, a deep lamina propria, and a deep muscularis mucosae. The distal end of the superficial muscularis mucosae was connected to the deep muscularis mucosae at the esophagogastric junction, and its proximal end was located in fibrous tissue below the squamocolumnar junction of the mucosal epithelium or the distal edge of the erosive lesion. The deep muscularis mucosae in the portion with Barrett's esophagus was continuous with the original muscularis mucosae of the proximal esophagus and muscularis mucosae of the stomach. Barrett's esophagus is considered to be not merely a metaplastic lesion within the epithelium, but a newly developed lesion containing columnar epithelium, lamina propria, and a superficial muscularis mucosae on the lamina propria of the esophageal mucosa.

Barrett Esophagus↗
PubMed1991

[Zinc concentration in the central nervous system in a case of multiple sclerosis--comparison with other neurological diseases].

The possible role of trace elements in a pathogenesis of central nervous system (CNS) on degenerative and demyelinating diseases has been suggested. Simultaneous measurements of Zinc (Zn) and iron (Fe) concentration in CNS were undertaken by neutron activation analysis in CNS tissues: a patient with multiple sclerosis (MS), five patients with amyotrophic lateral sclerosis (ALS), five with spinocerebellar degeneration (SCD), and five with cerebral infarction (CVD) in non-invasive area of CNS as control. Although Zn and Fe concentration were present in white matter and gray matter of CNS in each disease, 1) Zn concentration showed no special pattern in gray matter among four diseases, but decreased more in white matter of MS and ALS than that of CVD (p less than 0.05); 2) Fe concentration in gray matter of SCD increased more than that in CVD (p less than 0.05), but Fe concentration in white matter of CVD was increased more than that of ALS (p less than 0.05); 3) Fe concentration of CNS in a patient with MS was not notable except for high Fe concentration in caudate nucleus and globus pallidus. The demyelinated pathological area in CNS of MS showed a decrease in Zn level but no change in Fe level. These results indicate that low Zn concentration in CNS tissues of MS seemed to be responsible for CNS demyelination, but not for undernutrition due to poor conditions of a patient with MS. It seems that Zn might be one pathogenetic factor of MS, but the action of Fe in MS can not be ruled out.

Adult↗