Biomedical subjects
Publications and source records attributed to K Shimada.
Liver-cell carcinomas generally occur in cirrhotic livers; their surgery is difficult when they are located in the caudate lobe. After an anatomical summary, the authors propose a topographic classification of these tumors and describe the surgical strategy to be implemented.
To elucidate the role of amyloid deposits in the pathogenesis of degenerative disorders of brain, we attempted to develop transgenic mice producing amyloidogenic human variant transthyretin (TTR) in the brain. A minigene, in which the promoter region of the mouse myelin basic protein (MBP) gene was ligated to the human mutant TTR cDNA, was used for microinjection. A transgenic mouse line expressing the human TTR mRNA specifically in the brain was thus derived. However, human TTR was not detected in the brain or in the serum of these mice. These data suggest that the human mutant TTR mRNA is not efficiently translated in the mouse brain.
From September 1973 to September 1989, 300 patients with bladder cancer were treated at the Department of Urology, Hyogo College of Medicine. They were 231 males and 69 females with an average age of 65.3 years old. The overall 5-year survival rate (Kaplan-Meier's method) was 64.7%. The 5-year survival rates were not different between male patients and female patients, or between patients with single tumor and patients with multiple tumors. Patients with vesical irritation symptoms had more unfavorable prognosis than patients with painless hematuria. Size and configuration of the tumors also affected the prognosis. Histological diagnosis was transitional cell carcinoma in 291 patients, squamous cell carcinoma in 7 patients, adenocarcinoma in one patient and undifferentiated carcinoma in one patient. In patients with transitional cell carcinoma, the 5-year survival rates according to histological grades were 93.5% for G1, 77.8% for G2 and 31.6% for G3. The 5-year survival rate according to clinical stage was 94.4% for Ta, 79.7% for T1, 66.7% for Tis, 46.1% for T2, 38.5% for T3 and 26.6% for T4. Transurethral resection of bladder tumor (TUR-b.t.) was performed in 208 patients as an initial operation and the 5-year survival rate in these patients was 78.6%. The 5-year survival rates for total cystectomy (52 patients), partial cystectomy (6 patients) and simple tumor resection (4 patients) were 51.9%, 25.0% and 37.5%, respectively. These findings suggest that superficial tumors (Ta, T1) can be controlled with TUR-b.t. but infiltrating tumors (T2, T3, T4) should be treated more vigorously with multidisciplinary approaches.(ABSTRACT TRUNCATED AT 250 WORDS)
A statistic analysis was made on urologic patients under 1 year of age operated at our Department between July, 1973 and December, 1989. The incidence of patients under 1 year of age was 2.7% of the total patients operated on during the same period. Prenatal diagnosis has been responsible for increasing frequency of perinatal urologic abnormalities. Congenital urinary tract obstruction accounted for the most important disorder encountered in this age group.
Advances and spread in ultrasonography in obstetrics have resulted in the increase in the number of reports of congenital anatomical anomalies that have been diagnosed prenatally. We present 56 patients with congenital urinary tract anomalies, which were found by prenatal USG. These anomalies included pelvi-ureteric junction stenosis in 19, multicystic kidney in 12, primary megaureter in 6, ureterocele in 4, posterior urethral valve in 3, polycystic kidney in 2, vesicoureteral reflux in 2, urogenital sinus anomaly in 2 and others in 4. There were 9 oligohydramnios: posterior urethral valve in 2, polycystic kidney in 2, bilateral multicystic kidney in 2, urogenital sinus anomaly in 2 and vesicoureteral reflux in 1. In the neonatal period, urological treatment was performed on 13 patients; indwelling catheter on 4, vesicostomy on 2, ureterocutaneostomy on 2, TUR cele on 2 and others on 3. Among the cases, 25 have been operated on after the various intervals of follow-up periods. Pyeloplasty was performed on 9 patients with pelvi-ureteric junction stenosis, total reconstriction on 4 with ureterocele, ureterocystoneostomy on 3 with megaureter and others on 9. There were 7 lethal cases; polycystic kidney in 2, multicystic kidney in 2, posterior urethral valve in 1, megaureter in 1 and urogenital sinus anomaly in 1. It seems likely that various kinds and increasing number of urinary tract abnormalities will be diagnosed through prenatal USG. It is now important to make a consensus for the timing and management of the therapy of these anomalies.
The petropharyngeal muscles were observed in 7 cadavers, 8 cases (1.4%) [both side: one case (0.3%), one side: 6 cases (1.9%)] in 614 Japanese cadavers. All cases of this supernumerary muscles of the stylopharyngeal muscle took origin from the petrous part of the temporal bone to inserted to the outer surface of the middle constrictor pharyngeal muscles. And also of its muscle bundles were innervated by the glossopharyngeal nerve and supplied from the ascending pharyngeal artery. The appearance of the sex differences male was much higher than female in Japanese.
Waste anesthetic gas concentrations were measured in areas corresponding to the breathing zones of the anesthetists and operating room nurses for personal exposure (n = 27, time-weighted values) and during special work practices (n = 65). Leaks related to anesthetic machines and high-pressure nitrous oxide components were investigated during (n = 60) and after anesthesia (n = 85). The effect of a local scavenging system on occupational exposure during inhalation induction of anesthesia in children was studied (n = 60). Concentrations of nitrous oxide, halothane, isoflurane, and enflurane were determined by using active dosimeters (SKC 222) and different infrared gas-analyzers. Factors that increase waste anesthetic gas concentrations in operating rooms can be divided into several categories, such as low air conditioning systems, anesthetists' work practices, equipment leakage, including leakage from high-pressure nitrous oxide systems, and inadequate scavenging devices. Equipment leakage is almost invariably present in low-pressure components of the anesthesia machine because so many seals and joints are necessary to permit disassembly for cleaning and replacement. Waste anesthetic gases are also distributed in the exhaled air of patients recovering from anesthesia. To restrict the levels, exposure must be as low as can be achieved with reasonable efforts. Thus, the anesthetic equipment should be designed to avoid leakage, leakage tests should be performed before the use of anesthetic machines, and waste anesthetic gases should be scavenged by central as well as by local systems. Regular and periodic use of a trace gas analyzer permits direct observation of gas leakage and enables anesthetists to modify their work technique in order to reduce avoidable leakage.
Studies of normal aging in the cardiovascular system in humans are affected by the study population. Besides intrinsic biological aging, extrinsic factors including overt or latent cardiovascular diseases as well as life style variables such as physical activity, diet, alcohol and smoking may influence the age-related changes of cardiovascular function. We have recruited "normal" elderly subjects from community-dwelling volunteers by extensive health screening procedures including treadmill maximum exercise tests. Some of their cardiovascular functions, such as various cardiovascular regulatory functions, were altered compared to normal young subjects, while others such as resting hemodynamics were not. Interrelationships among various autonomic functions in the elderly were not recognized. Although general effects of life styles on circulatory regulatory functions were not clearly indicated, variables such as sodium intake or body mass index appeared to affect some of the sympathetic nervous functions. Furthermore, hypertension in the elderly had much less impact on cardiovascular functions than is generally expected, based on the results from young or middle-aged subjects. To identify factors which either modify (accelerate) or do not affect the aging of the cardiovascular functions is important not only to achieve a good aging process but also to establish therapeutic goals in elderly subjects.
Ultrastructural changes of the left anterior descending coronary artery (LAD) by the presence of myocardial bridge (MB) were studied. In contrast with various atherosclerotic lesions in the intima both proximal to MB and in the whole length of the LAD having no MB, intimal thickness beneath MB was remarkably thin. Neither lipid deposition nor foam cells were present there even in the aged. The intima beneath MB consisted of only normal smooth muscle cells (SMCs) in some layers. Collagen fibrils loosely stuffed among SMCs showed a spiraled appearance. The intima distal to MB was thicker than that beneath MB. Modified SMCs were present along with normal SMCs, and foam cells were intermingled with them. By scanning electron microscopy, endothelial cells proximal to MB were arranged in a pavement-like appearance, and they were polygonal and flat. Endothelial cells beneath MB became spindle-shaped and regularly engorged along the direction of blood flow. Such regularity was lost in endothelial cells distal to MB. These endothelial changes indicate that the intima beneath MB is stressed by high shear and that intima proximal or distal to MB is stressed by low shear. It is, thus, suggested that alteration of hemodynamic factors that arise from contraction of MB greatly affects the evolution of atherosclerosis through the regulation of intimal lipid infiltration within the LAD.
Postoperative liver failure following major hepatectomy is a frightened complication. In order to increase safety of major hepatectomy, a study evaluating preoperative portal embolization (PE) was performed. Between 1983 and 1990, PE was performed in 71 patients (41 with hepatocellular carcinoma (HCC), 8 with other liver tumors, and 22 with biliary carcinoma), in 63 cases to the main branch, prior to hepatectomy. Out of these 63 patients 42 (extended) hemihepatectomies were performed. For comparison 77 patients with the same extent of hepatectomy, but without PE, were studied. Liver volume was evaluated by CT examination. Portal venous pressure was elevated by 73 mmH2O just after embolization of the main portal branch. However, no complications were associated to the PE procedure except for temporary elevation of transaminases. Volume of the unembolized lobe increased by 8.8% in average following PE. Prominent volume gain was observed in the patients with prior arterial embolization and long observation period. In patients with PE prior to major hepatectomy, postoperative bilirubin values were significantly lower (p less than 0.01). In the group with PE, no fulminant liver failure was seen and no operative mortality was encountered, as compared to 11.7% (9/77) in the control group. Preoperatively performed PE was a safe procedure decreasing postoperative liver failure and mortality.
To analyze the pathologic processes of amyloid deposition in type I familial amyloidotic polyneuropathy (FAP), mice were made transgenic by introducing the human mutant transthyretin (TTR) gene. In these transgenic mice, amyloid deposition started in the gastrointestinal tract, cardiovascular system, and kidneys 6 months after birth and extended to various other organs and tissues with advancing age. At age 24 months, the pattern of amyloid deposition was similar to that observed in human autopsy cases of FAP, except for its absence in the choroid plexus and in the peripheral and autonomic nervous systems. Amyloid deposition was shown to be composed of human mutant TTR and, in addition, mouse serum amyloid P component. These results clearly indicate that human variant TTR produced in transgenic mice deposits is a major component of amyloid fibrils in various organs and tissues. Thus this animal model is useful for analyzing how amyloid deposition initiates and proceeds in FAP.
5-fluorouracil (5-FU) was orally administered before surgical operation to two groups of patients, one treated at 300 mg for 7 days and the other treated at 400 mg for 5 days, to examine the change of TSIR in gastric patients. Tumor tissue, lymph node and normal lesions were collected from removed specimens immediately frozen. As a result, there were no differences in FdUMP volumes of various tissues between 300 mg and 400 mg groups. TSIR tended to be higher in the order of normal tissue, lymph node and tumor lesions. TSIR was significantly higher in 400 mg group than 300 mg group. We believe that further studies on TSIR will provide a useful information as to various studies, including efficacy reinforcement by combination therapy, problems in resistance, histological efficacy and sensitivity tests.
A high incidence of inflammation and carcinoma of the biliary tract in patients with anomalous pancreaticobiliary ductal junction has been well documented. The change in biliary phospholipids as a result of the reflux of pancreatic juice into the biliary tract through anomalous pancreaticobiliary ductal junction may be responsible for it. We developed a new method of analysis of phospholipid classes using aminopropyl Bond Elut cartridge for extraction and high-performance liquid chromatography for separation. Satisfactory recovery was achieved (i.e., more than 95% for both phosphatidylcholine and lysophosphatidylcholine). With this method, the bile of 11 patients with anomalous pancreaticobiliary ductal junction was examined. The concentration and proportion of lysophosphatidylcholine in bile were much higher in the presence of anomalous pancreaticobiliary ductal junction than in controls (3.44 +/- 1.50 mmol/L vs. 0.52 +/- 0.25 mmol/L, 60.0% +/- 31.0% vs. 2.3% +/- 1.4% in gallbladder bile; p less than 0.001). In contrast, the concentration of phosphatidylcholine and the sum of phosphatidylcholine and lysophosphatidylcholine in gallbladder bile significantly decreased (p less than 0.001), but in hepatic bile they did not. An inverse correlation was found between the proportion of lysophosphatidylcholine and phospholipid concentration in gallbladder bile. Phospholipase A2 and amylase activities in bile were markedly high. Increased total fatty acid concentration and proportion of unsaturated fatty acid in bile were found. Total bile acid concentration in gallbladder bile was significantly lower than in controls. These results suggest that a considerable amount of lysophosphatidylcholine, which is known to have a cytotoxic effect, isp reduced by phospholipase A2 in refluxing pancreatic juice, and an increased concentration of lysophosphatidylcholine gives rise to cell damage causing mucosal hyperplasia and metaplasia.(ABSTRACT TRUNCATED AT 250 WORDS)
Cholera toxin B subunit (CTB) has been shown to augment the antibody responses to influenza virus haemagglutinin (HA) in BALB/c mice immunized with HA vaccine together with CTB. In this study, mouse strain differences in the adjuvant effect of CTB on anti-HA antibody responses were investigated along with those in the antibody responses to CTB or HA, using various inbred and H-2 congenic strains. The antibody responsiveness to CTB depended on the H-2 haplotype of the strain: strains with the H-2b haplotype were high responders, those with H-2a, H-2k and H-2s were low responders, and those with H-2d were intermediate. The responsiveness to HA was also related to the H-2 haplotype: H-2a and H-2k strains were high responders, H-2b and H-2s strains were low responders, and H-2d strains were intermediate. However, the degree of the adjuvant effect of CTB on anti-HA antibody responses was almost constant, regardless of the H-2 haplotype or other genetic backgrounds of the strain. The lack of genetic restriction of the adjuvant effect would be favourable for application of CTB-combined HA vaccine to humans, who are genetically diverse. Moreover, these results suggest that the immunogenicity and adjuvanticity of CTB differ essentially in their mechanisms.
The purpose of this study was to improve tumor effects and to reduce side effects caused by one shot bronchial arterial infusion therapy for pulmonary malignancies. The catheter-in catheter replacement technique in proper bronchial artery was introduced for infusion therapy for several hours for this purpose. Three kinds of combination of catheters were selected and the duration of replacement in bronchial artery was either eight or 24 hours. In eight patients of 12 patients with pulmonary malignancies superselective bronchial arterial infusion was carried out through the inner small catheter. No significant complications developed either at the time of replacement or during continuous infusion.
Survival rates and several effective factors for the postoperative course of 10 advanced cases of small sized lung cancer (ASLC) were evaluated. Followings were considered as characteristics of these patients: 1) ASLC were observed at the rate of 4.0% of whole lung cancers, 2) ASLC were more often seen in relatively young patients, females and adeno carcinomas than ordinary lung cancer, 3) as factors concerned to postoperative prognosis, stage III A (especially T1N2M0), few numbers of metastatic lymph nodes in N2, and performance of relative curative operation may predict good prognosis, but adenosquamous type will be a sign of poor prognosis. Satisfactory result was obtained even in a case of stage IV when complete resection of metastasis was carried out. There was no significant difference of survivals between 2 cm and 3 cm of diameter of the tumor. In conclusion, above mentioned points should be considered when operative indication of ASLC is evaluated.
An 8-year-old boy with infected urachal cyst presenting with macroscopic hematuria, pain on urination and high fever attack is reported. He had recurrent episodes of cystitis. At admission, a quail-egg sized solid tumor was palpated in the midline of his lower abdomen. The urine was infected. Ultrasonographic examination revealed an oval tumor 2 x 2.7 cm in diameter at the dome of the bladder with a thin funicular structure running toward the umbilicus. Cystoscopy revealed a round tumor covered with hyperemic epithelia. Transurethral biopsy revealed no malignant lesions of the epithelia. Partial cystectomy with excision of the funicular urachal ligament was performed. The pathological findings were consistent with persistent urachus with chronic inflammation. We reviewed 210 cases of infected urachal cysts reported in the Japanese literature.
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