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Biomedical subjects

K Shimada

Publications and source records attributed to K Shimada.

At least 667 records · Page 37Linked to original sources
PubMed1996

[Accessory scrotum with lipoma: a case report].

A newborn male infant was referred to our clinic because of anomalies of external genitalia. The infant was born at term after a normal pregnancy and delivery, and was appropriate for gestational age. A tumor mass covered with scrotum-like skin on its tip was noticed in the right side of perineum between the scrotum and anus. The raphe, which ran along the midline at the penis and the normal scrotum, circumscribed the right side of this structure. Both testes had descended into the scrotum. The condition was associated with incomplete penoscrotal transposition. There was no other urological anomaly including lower urinary tract. Histological findings of the tumor indicated perineal lipoma, and the scrotum-like portion was diagnosed as an accessory scrotum. Thirty-one report cases of the accessory scrotum including our own were reviewed and discussed.

Genital Neoplasms, Male↗
PubMed1996

[A case of breast cancer with metastasis of multiple organs showing marked efficacy of medroxyprogesterone acetate (MPA)].

The patient, a 55-year-old female, was diagnosed as having right breast cancer (T1aN2M1, Stage IV) with metastasis of multiple organs (lung, pleura, bone, mediastinal and unilateral axillary lymph nodes) when she underwent tumorectomy. Postoperative adjuvant therapy was performed using oral administration of MPA (800 mg/day). After 3 months of this treatment, metastatic lesions in the lung and pleura had disappeared. After 37 months, complete remission (CR) was evaluated in the multiple lesions of bone metastasis. She achieved a complete remission (CR) by this treatment lymph nodes metastasis in both mediastinum after 24 months and unilateral axillae after 15 months. Complete response time was 38 months in both lung and pleura, 15 months in bone metastasis, 15 months in mediastinal lymph nodes, 24 months in unilateral ones. Normalization of tumor markers was acquired after 7 months of this hormonal therapy. This CR condition continues at present without severe complications.

Antineoplastic Agents, Hormonal↗
PubMed1996

[Surgical treatment of small hepatocellular carcinoma].

Two hundred thirty-five patients with small hepato-cellular carcinomas (HCCs) (mixed hepatocellular and cholangiocellular carcinoma included) measuring no more than 3 cm in diameter treated by surgical resection between 1980 and 1990 were reviewed retrospectively. Ninety-nine percent of the patients also had chronic hepatitis and 73% were diagnosed histologically as having liver cirrhosis. The operative and hospital mortality rates were 0.4% and 1.3%, respectively. The number of tumors, intrahepatic metastasis and vascular invasion were significant prognostic factors. Overall the 1-,3-and 5-year survival rates (operative deaths included) were 93.2%, 72. 7%, and 49.7%, and those of 144 patients treated in the late 80s (1986-1990) were 93.6%, 76.3%, and 52. 1%, respectively. These results were appreciably better than those for percutaneous ethanol injection therapy (PEIT) and transcatheter arterial embolization therapy (TAE) reported previously. In particular, the survival of the patient with single tumor demonstrated a clear advantage of surgery. The selection of treatment modalities is discussed, and our present standard strategy for surgical treatment is described.

Carcinoma, Hepatocellular↗
PubMed1996

[Pulmonary typical carcinoid with metastases to pulmonary hilar, and mediastinal lymph nodes].

A 50-year-old woman was admitted to our hospital complaining of recurrent bloody sputum and hemoptysis. Chest X-ray films showed an infiltrative shadow in the left lower lung field. Chest computed tomograms showed a nodular tumor shadow near the left B8 and this tumor shadow was found between A8 and A9 by pulmonary arteriography. Bronchoscopic examination revealed a red coagulum in the left B8 and cytologic examination of broncho alveolar lavage fluid revealed atypical squamous cells. With a clinical diagnosis of squamous cell carcinoma of the lung, a left lower lobectomy with hilar and mediastinal lymph node dissection was done. A milk-white tumor was found in the lower lobe of the resected lung. The pathological diagnosis of the resected tissue specimen was carcinoid, accompanied by pulmonary, hilar, and mediastinal lymph node metastases. Reduced immunofluorescence by Chromogranin A and serotonin staining were further evidence that the tumor was atypical. This case is very interesting in that the tumor metastasized to the lung and lymph nodes, even-though it was pathologically typical.

Carcinoid Tumor↗
PubMed1996

Hypercoagulable state in patients with Takayasu's arteritis.

Thrombus formation is recognized pathologically in the affected arteries and is supposed to play a major role in the pathogenesis of Takayasu's arteritis; however, hemostatic conditions in this disorder have not been elucidated fully. We determined plasma levels of molecular markers for platelet activity (platelet factor 4; PF4, beta-thromboglobulin; beta TG), thrombotic status (thrombin-antithrombin III complex; TAT, fibrinopeptide A; FPA), fibrinolytic status (plasmin-alpha 2-plasmin inhibitor complex; PIC, D-dimer), and endothelial injury (von Willebrand factor antigen; vWF:Ag, thrombomodulin; TM) in 30 patients with Takayasu's arteritis and 20 age-matched control subjects. Plasma levels of PF4, beta TG, TAT, FPA and D-dimer, but not PIC, in patients with Takayasu's arteritis were substantially higher than those in normal control subjects. The levels of these markers were not different between the active and inactive stages of the disease. Plasma levels of vWF:Ag in patients with Takayasu's arteritis did not differ significantly from those in normal subjects, and plasma levels of TM were significantly lower than those in normal subjects. In patients with Takayasu's arteritis, platelet and coagulation activities are significantly increased, leading to hypercoagulable state and thrombus formation, although there is little, if any, endothelial damage.

Adolescent↗
PubMed1996

[Assessment of clinical utility of 111In-DTPA-IgG scintigraphy in the detection of inflammation/infection--a report of multicenter phase II clinical trials].

A Phase II clinical study was performed in patients with strongly suspected focal sites of inflammation/infection to investigate clinical utility of 111In-DTPA-IgG. Neither adverse effects nor abnormal laboratory changes were noted in the all cases. Out of 59 patients, the clinical utility was evaluated in 56 patients with a total of 67 suspicious sites (19 in thorax, 13 in abdomen and pelvis, 30 in musculoskeletal system, and 5 in other regions). True positive results were obtained in 100% of lesions in the thorax (13/13) and the musculoskeletal system (26/26). There were three false negative and five false positive results. Overall sensitivity and specificity was 94.0% and 70.6%, respectively. Most of the true positive scintigram with the best image quality was acquired at Day 1 or Day 2 post-injection. A dose of 80 MBq was considered to be a practical dose for imaging. Our study indicates that 111In-DTPA-IgG is a safe and promising imaging agent for the detection of inflammation/infection, and that it is reasonable to proceed with Phase III studies to further evaluate clinical utility of the agent.

Adult↗
PubMed1996

[Comparative study on serological diagnosis of entamoebiasis histolytica].

The practicability of four diagnostic methods for entamoebiasis histolytica including micro-gel diffusion precipitin test (MGDP), indirect immunofluorescent antibody test (IFA), indirect hemagglutination test (IHA) and enzyme-linked immunosorbent assay (ELISA) was evaluated. The serological test methods were compared by using sera obtained from 30 entamoebiasis histolytica patients and 130 normal health individuals. The highest sensitivity was obtained with the method of ELISA, followed by IFA and IHA : the lowest was obtained with MGDP. On the contrary, the high specificity was obtained with IHA, IFA, MGDP : the lowest was obtained with ELISA. Intensity of the antibody titers in IHA was correlated well with that of IFA. In addition, we studied antibodies nonspecifically reactive to Entamoeba histolytica in sera from E. histolytica-negative individuals with high CRP patients with regard to the sensitivity and specificity. Among 101 sera examined, six showed false positive results of which five were the sera with extremely high CRP.

Animals↗
PubMed1996

Endothelin-1 production in coronary circulation in a new canine model of coronary thrombosis.

OBJECTIVE: The purpose of this study was to investigate whether endogenous endothelin-1 (ET-1) production in coronary circulation is associated with acute coronary thrombotic events in vivo. To achieve this goal, we have designed a new experimental canine model of coronary thrombosis. METHODS: In vivo occlusive thrombus was induced by the intracoronary application of radiofrequency energy (660 kHz, 50 W) in closed-chest dogs. Pathological and immunohistochemical examinations of thrombosed coronary artery were performed. In 12 dogs, plasminogen activator was administered intravenously and serial measurements of ET-1, thromboxane B2 (TXB2) and thrombin-antithrombin III complex (TAT) levels in plasma from the coronary sinus, aortic root and inferior vena cava were examined. RESULTS: Occlusive platelet-rich thrombi were attached to the deeply injured intimal surface. TAT and TXB2 increased rapidly soon after the intimal injury and declined after successful thrombolysis. In contrast, ET-1 in the coronary sinus was elevated after reperfusion and was significantly higher than in the aorta. Net ET-1 production in the coronary circulation showed a significant positive correlation with the peak TAT levels (r = 0.69, P < 0.05), but not with TXB2 or total occlusion time as an index of ischemic severity. CONCLUSIONS: Deep intimal injury leads to occlusive coronary thrombus. Thrombus formation and its subsequent lysis is associated with the activation and deactivation, respectively, of the coagulation cascade and platelets. Thrombin generation may stimulate ET-1 production in the coronary endothelium in acute coronary thrombotic events.

Acute Disease↗
PubMed1996

Expression of plasminogen activator inhibitor 2 in the adult and embryonic mouse tissues.

We have studied the expression of plasminogen activator inhibitor 2 (PAI-2) in the adult mouse and during embryonic development using immunohistochemistry and the polymerase-chain reaction. Mouse PAI-2 mRNA was mainly expressed in the skin, bone-marrow, spleen, lung, thymus, and urinary bladder. Immunohistochemical studies suggested that PAI-2 was synthesized in macrophages and epithelial cells such as skin epithelial cells, transitional cells of the urinary bladder, and mesothelial cell of peritoneum and pleura. PAI-2 mRNA and antigen expression was observed only in the skin of 15 day-old mouse embryos. These data suggest that PAI-2 may play a role in protecting the mouse embryo from the protease attack in the amniotic fluid and also in maintaining and/or protecting the structure of various surfaces in the mouse.

Aging↗
PubMed1996

Study of the repairing process of gastric ulcer using multivariate analysis of bFGF-positive cells, haemodynamics, PAS-positive mucus amount and glandular index in the gastric mucosa.

To investigate pathophysiological diversities in the repairing process of gastric ulcer, distribution density of basic fibroblast growth factor (bFGF)-positive fibroblasts and myofibroblasts and vascular endothelial cells, mucosal haemoglobin content, PAS-positive mucus amount and glandular index were compared in the peripheral region of an open ulcer (the unhealed group; n = 17), the central region of a red scar (the red scar group; n = 32) and the central region of the white scar (white scar group; n = 32). Density of bFGF-positive fibroblasts and myofibroblasts and vascular endothelial cells was highest in the unhealed group, followed by the red scar group, while the white scar group showed a low value close to control. Mucosal haemoglobin content was high in the red scar and unhealed groups. PAS-positive mucus amount in the unhealed and red scar groups showed lower values compared with that in the white scar group. Glandular index in the unhealed group was the lowest, followed by the red scar group, while the white scar group neared control values. Statistically significant correlations were observed between the density of bFGF-positive "fibroblasts and myofibroblasts' and density of bFGF-positive vascular endothelial cells, between the density of bFGF-positive vascular endothelial cells and mucosal haemoglobin content and between the PAS-positive mucus amount and glandular index. Discriminant analysis demonstrated that the unhealed group could be distinguished from the red and white scar groups, based on glandular index, density of bFGF-positive "fibroblasts and myofibroblasts', mucosal haemoglobin content and PAS-positive mucus amount, while the red scar group could be discriminated from the white scar group based on the density of bFGF-positive "fibroblasts and myofibroblasts', density of bFGF-positive vascular endothelial cells, glandular index, haemoglobin content and PAS-positive mucus amount. The white scar group was difficult to discriminate from control. Our present results show that the recovery of glandular formation and mucus production continues throughout the repairing process, whereas the acceleration of angiogenesis and granulation formation is observed only in unhealed ulcers and at the red scar stage.

Biopsy↗
PubMed1996

[Coronary artery bypass grafting under the beating heart in a patient with insufficient cardiopulmonary bypass].

Coronary artery bypass grafting in a 64-year-old male with a severe calcified ascending aorta was performed under the beating heart, because of insufficient cardiopulmonary bypass. The patient suffered inferior and anterolateral myocardial infarction with moderate mitral regurgitation. Computerized tomography showed a severely calcified ascending aorta. During the operation, cardiopulmonary bypass was conducted with femoral arterial cannulation and bicaval cannulation. Adequate perfusion flow, however, could not be achieved. Anastomoses of left internal thoracic artery-left anterior descending artery and right gastroepiploic artery-right coronary artery were performed under a beating heart supported by cardiopulmonary bypass. The patient made an uneventful recovery and postoperative angiography revealed patent grafts. Mitral regurgitation remained unchanged, but the postoperative lifestyle has been stable for the last 15 months.

Aortic Diseases↗
PubMed1996

[Indication and result of hypothermic fibrillatory arrest in coronary artery bypass grafting].

Currently, cardioplegic arrest is used for almost all coronary artery bypass grafting (CABG). However, there are some cases in which aortic occlusion or the cardioplegic infusion is not desirable. In this paper, we discussed the indications and the usefulness of hypothermic fibrillatory arrest for CABG. From April 1992 to March 1995, CABG with hypothermic fibrillatory arrest was performed in 6 patients (3.9% of total CABG cases). The reasons of employing hypothermic ventricular fibrillation were as follows; calcified ascending aorta in 2 patients, coronary aneurysm associated with Behçet's decrease in 1, revascularization to the totally obstructed branches with poor left ventricular function in 2, and collateral circulation from bronchial artery with total obstruction of left main trunk in 1. The age range was 48 to 68 years with a mean of 59.0 +/- 7.8 years. Five patients had a history of myocardial infarction and 2 of them had a left ventricular ejection function less than 0.25. Surgical procedures consisted of elective ventricular fibrillation without aortic cross-clamp, systemic hypothermia and local pericardial cooling, left atrial or pulmonary artery venting, and local vessel isolation during distal anastomosis. Average number of grafts was 2.0 +/- 0.6, and 5 left internal thoracic arteries, 2 gastroepiploic arteries and 5 saphenous vein were used. Mean duration of ventricular fibrillation was 74.0 +/- 17.5 min. Postoperative angiography confirmed all bypasses patent. Only 1 patient, whose preoperative left ventricular ejection function was 0.20, died of heart failure 5 months after the operation. All other patients survived asymptomatically. Hypothermic fibrillatory arrest is useful and reliable technique in coronary artery bypass grafting when aortic occlusion or cardioplegic arrest is not desirable.

Aged↗
PubMed1996

Recurrence of hepatocellular carcinoma after surgery.

A total of 386 patients who underwent complete resection of hepatocellular carcinoma over an 8-year period were assessed retrospectively for tumour recurrence. Some 219 (56.7 per cent) of the patients developed recurrence. Patients with a greater degree of cirrhosis showed a longer interval to recurrence; the median (range) interval until recurrence was 7.9 (1.8-84.2) months in patients with a normal liver, 13.4 (2.0-79.5) months in those with chronic hepatitis and 16.7 (1.5-73.1) months in those with cirrhosis. Intrahepatic recurrence was observed more frequently in either the same (26.4 per cent) or the adjacent (24.8 per cent) Healey segment than in the lobe contralateral to the primary tumour (17.8 per cent). The presence of portal venous invasion and/or intrahepatic metastasis, underlying liver cirrhosis and perioperative blood transfusion were determined to be independent predictors of recurrence by multivariate analysis. Because intrahepatic spread of hepatocellular carcinoma occurs in a segment-by-segment manner, surgeons should use an anatomically wide resection within the hepatic functional reserve.

Adult↗
PubMed1996

[Three cases of coronary to pulmonary arterial fistulae combined with valvular disease].

Three cases of coronary to pulmonary arterial fistulae (CAF) combined with valvular disease are reported. The first case was 53-year-old male admitted with mitral stenosis (MS) and left atrium thrombus. CAF originating from both coronary artery and draining to pulmonary artery were found by coronary angiography. Open mitral comissurotomy (OMC), thrombectory and ligation of CAF were performed. Case 2 was 52-year-old female suffered from CHF due to MS. Abnormal communication from left coronary artery to pulmonary artery was demonstrated. OMC and ligation of CAF were performed. Case 3 was 65-year-old male with combined valvular disease. MS, aortic regurgitation and CAF from right coronary artery to pulmonary artery were revealed. Mitral and aortic valve replacement and ligation of CAF were done. Diffusion of coronary angiography increase chance to reveal coronary artery fistulas during examination of acquired cardiac disease. Coronary artery fistulas draining into pulmonary artery were completely ligated by double ligation at both the arising point from coronary artery and the draining point to pulmonary trunk.

Aged↗
PubMed1996

[Ectopic ureter opening in the vestibulum without urinary incontinence: a case report].

A case of ectopic ureter without urinary incontinence despite its ureteral orifice in the vestibulum is reported. A 2-year-and-9-month-old female was referred to our hospital with the pain of external genitalia, pollakisuria and macroscopic hematuria. Examination revealed a complete double system of the left upper tract with vestibular opening from the upper moiety. She did not show any signs of ureteric incontinence after the establishment of voiding habits. Because radioisotope (RI) scintigram showed apparent uptake in the upper half of the left kidney we performed left ureterocystoneostomy with psoas hitch procedure. We postulate that the incontinence mechanism is maintained when the running course of the ectopic ureter is through some portion of the urethral sphincter musculature. This is the 10th case reported in Japan.

Child, Preschool↗