Biomedical subjects

K Shirouzu

Publications and source records attributed to K Shirouzu.

At least 127 records · Page 7Linked to original sources

PubMed1997

Gastric cancer during pregnancy.

During the 27 years between 1966 to 1993, a total of 3,256 patients with gastric cancer were admitted to our institute. Among these patients, 3 (0.1%) cases of gastric cancer were associated with pregnancy. One cancer stage IVb patient died of peritoneal metastasis without any operation. Another stage IVb patient died of peritoneal metastasis 12 months after palliative gastrectomy. And the other stage IIIb patient is well, and the 8 years old child is also well, after synchronous extended total gastrectomy with cesarean section.

Adult↗

PubMed1997

Gastric cancer surgery in the octogenarian.

Seventy-seven octogenarian patients with gastric cancer (Group 1) were retrospectively investigated and compared with patients of age from 75 to 79 years (Group 2). The incidence rates for renal impairment, hepatic impairment, and hypoproteinemia, as preoperative complications, were higher in Group 1 than in Group 2 (each p < 0.05). The resectability rate was 83% in Group 1 and 89% in Group 2. D1 lymphadenectomy was performed for 45% of Group 1 and for 18% of Group 2 (p < 0.001). On the other hand, D2 lymphadenectomy was performed for 39% of Group 1 and for 71% of Group 2 (p < 0.001). A postoperative complication occurred in 25% of Group 1 and in 9% of Group 2 (p < 0.01). However, the postoperative mortality rate was zero in both groups. The t1 (early cancer) rate was 27% in Group 1 and 41% in Group 2 (p < 0.05). On the other hand, t2 was 31% in Group 1 and 19% in Group 2 (p < 0.05). The overall 5-year-survival rate was 38% in Group 1 and 48% in Group 2. When causes of mortality other than gastric cancer were excluded, the 5-year-survival-rate was 51% in Group 1 and 67% in Group 2 (p < 0.01).

Aged↗

PubMed1997

Thymolipoma associated with myasthenia gravis.

In a 29-year-old woman with myasthenia gravis and no visible mediastinal mass, the resected thymus was found to contain a small thymolipoma. Relief of the neuromuscular symptoms followed thymectomy. A very small thymolipoma may be associated with myasthenia gravis even if the content of though thymic tissue is low.

Adult↗

PubMed1997

In vivo detection of carotid plaque thrombus by ultrasonic tissue characterization.

The purpose of the study was to determine whether ultrasonic tissue characterization could detect carotid plaque thrombus in vivo. Patients undergoing carotid endarterectomy were examined preoperatively and the ultrasonic tissue characterization findings were compared to those of optical microscopy of the removed plaque specimens. Ten of 15 patients studied had plaque thrombus. Ultra-ultrasonic tissue characterization entailed an analysis of parameters obtained from the power spectrum of backscattered ultrasound signals. Data were obtained with a nominal 10 MHz sector scanning transducer with an effective bandwidth of 3 to 13 MHz. The parameters were the slope and intercept derived from the linear regression of the normalized spectrum and total power (log of the integrated power of the normalized spectrum over the effective bandwidth). The combined effect of the three parameters was determined by discriminant function analysis and showed a significant difference (P < 0.05) between nonthrombus and plaque thrombus in a small sample of patients with advance carotid atherosclerosis. These parameters applied singly could not provide such a distinction. Correct classification of carotid plaque thrombus using the multiple-parameter analysis revealed a sensitivity of 90%, specificity of 80%, and accuracy of 86.7%. This study demonstrates that analysis utilizing a combination of multiple spectral parameters was able to detect carotid plaque thrombus in vivo.

Aged↗

PubMed1997

Gastrectomy with combined resection of other organs for carcinoma of the stomach with invasion to adjacent organs: clinical efficacy in a retrospective study.

BACKGROUND: Carcinoma of the stomach invading one or more adjacent organs raises serious concerns over en bloc dissection because en bloc resection has an associated high risk and such advanced carcinoma is frequently associated with incurable factors. Thus, it is important to understand the efficacy of gastrectomy combined with other organ resection and to refine the indications for en bloc dissection. STUDY DESIGN: Seventy-seven patients with carcinoma of the stomach directly invading adjacent organs or structures were analyzed retrospectively to investigate the efficacy of en bloc resection. Forty-one patients underwent gastrectomy combined with resection of one or more invaded organs (combined resection group), while the other 36 patients underwent gastrectomy with palliative abrasion between the primary tumor and the invasion site (noncombined resection group). RESULTS: The five-year survival rate was 23 percent in the combined resection group and 0 percent in the noncombined resection group (p < .05). The 23 curative cases and 18 noncurative cases in the combined resection group had a survival rate of 41 percent and 0 percent, respectively (p < .05). The survival rate after a single organ resection was 29 percent, and after a multiple organ resection, 0 percent (p < .05). Cases of carcinoma invading either the pancreas or mesocolon had a slightly but not significantly better prognosis. In Borrmann type IV carcinoma there was no difference in survival between the curative and noncurative operation. Cases with P1 dissemination had a better prognosis than those of P2 and P3 dissemination. CONCLUSIONS: The best indication for an en bloc combined organ resection was an invasion limited to only one other organ, not more than N2, no incurable factor, and any type except Borrmann type IV. Additionally, an en bloc combined resection would be worth trying for any type of gastric carcinoma with not more than P1 dissemination and with no other incurable factor.

Carcinoma↗

PubMed1997

[The significance of p21 expression in gastric cancer].

We examined the expression of p53, p21, cyclin D1, E, and PCNA in 75 cases of gastric cancer by immunohistochemical study and the expression of p21 RNA in cases by in situ hybridization. The rate of stage III, IV cases of p53(+) p21(-) group was significantly higher than that of any other groups. The apportinately 3-year survival rate of p53(+) p21(-) group was significantly lower than either that of p21(+) p53(-) or p53(-) p21(-) group. The 3-year survival rates of positive cases were significantly lower than those of negative cases on both cyclin D1 and E. The positive rate of cyclin E of the p53(-) p21(+) group was significantly lower than that of the p53(+) p21(-) group. The average PCNA Labeling. Index (LI) of the p53(+) p21(-) group was significantly higher than that of the p53(-) p21(+) group. The 3-year survival rate of cases with expression of p21 RNA was higher than that of cases without p21 RNA. Average PCNA L1 of cases with expression of mutant-type p53 was high and the number of poor prognostic cases in cases with expression of mutant-type p53 was large. In contrast, the average PCNA LI of cases with expression of p21 was low and the number of good prognostic cases with expression of p21 was large. These results suggest that p21 suppresses synthesis of DNA via cyclin E and PCNA.

Cyclin D1↗

PubMed1997

Laparoscopic intervention to relieve small bowel obstruction following laparoscopic herniorrhaphy.

In this report, we present two cases of small bowel obstruction after laparoscopic herniorrhaphy (LH). One case involved incarceration of the small intestine into the port site, resulting in obstruction in an 80-year-old man on the third day after LH. The other case involved a 78-year-old man with bilateral inguinal hernia and a recurrent type on one side. In this case, a small bowel obstruction occurred due to intestinal herniation through the repaired peritoneum in the pelvic floor. In both cases, the location of the obstruction was diagnosed by means of a computed tomography scan. Subsequently, the trocar incision was extended to relieve obstruction with laparotomy in the first case, and the herniated intestinal loop was extracted followed by reclosure of the defective peritoneum under laparoscopic intervention in the second case. After the second operation, the clinical course of each patient was uneventful, and they were discharged from hospital at 10 days after the second surgery. In conclusion, (a) although patients can greatly benefit from LH, it must be kept in mind that problems can occur and (b) laparoscopic surgery to relieve small bowel obstruction following LH is the preferred procedure.

Aged↗

PubMed1996

Total pelvic exenteration for locally advanced colorectal carcinoma.

Twenty-six patients who underwent total pelvic exenteration for locally advanced colorectal cancer were studied retrospectively. The operative mortality rate was 8 per cent (two deaths). In patients with stage II primary disease the recurrence rate after curative surgery was three of seven, although the mean survival time was 58 months and the 5-year survival rate 71 per cent. Patients with stage III primary disease had a shorter mean survival time regardless of supposed curability (curative 14 months versus non-curative 9 months). Patients with stage IV disease had a mean survival time of 5 months. In patients who underwent curative surgery for recurrent disease the mean survival time was 33 months and 5-year survival rate 25 per cent, although in those receiving non-curative surgery the survival time was significantly shorter at 10 months (P < 0.05). Total pelvic exenteration is warranted for patients with stage II locally advanced colorectal carcinoma and is an option for those with recurrent carcinoma when performed with curvative intent.

Adenocarcinoma↗

PubMed1996

Effect of fentanyl citrate analgesia on glucose production following trauma in rats.

The postoperative hormonal milieu enhances glucose production. The objectives of this study were to determine whether fentanyl plus pentobarbital anesthesia reduced the excretion of stress hormones and whether this resulted in decreased glucose production following trauma. Male Sprague-Dawley rats were assigned into control and trauma. The trauma group was further subdivided into three groups according to the methods of anesthesia: T-1, pentobarbital (PB) alone; T-2, pentobarbital plus fentanyl (FE); and T-3, given PB during surgery and FE at the end of surgery. Glucose production was measured by a primed constant infusion of 3-3H-glucose. Fentanyl plus pentobarbital anesthesia prevented an increase in corticosterone levels in the plasma compared with in T-1 and T-3, 0.5 hr after the surgery. Fentanyl plus pentobarbital, anesthesia caused reductions of insulin and glucagon levels in the plasma and a decrease in catecholamines excretion in the urine. Glucose production was lower with FE+PB anesthesia than with PB alone (PB: 4.6 +/- 0.1 mg/kg/min vs PB+FE: 3.6 +/- 0.2 mg/kg/min, P < 0.05). However, fentanyl given at the end of surgery did not alter hormonal milieu and glucose production compared with pentobarbital alone. Blocking afferent neural stimuli from the wound and injury during the surgery is one approach to prevent an enhancement of postoperative glucose production.

Analgesia↗

PubMed1996

Effect of fentanyl citrate anesthesia on protein turnover in patients with esophagectomy.

The objectives of this study were to determine whether high doses of fentanyl anesthesia reduced the surgical stress level and to elucidate the effect of fentanyl anesthesia on protein turnover after esophagectomy. Seventeen male patients with esophageal cancer were divided into two groups, conventional anesthesia (CA) and fentanyl anesthesia (FA). The FA patients received 134.0 +/- 15.3 microg/kg fentanyl citrate and the CA patients 15.7 +/- 7.4 microg/kg fentanyl during the surgery. Protein turnover was measured by the method of bolus infusion of [15N]glycine (1 g). High dose of fentanyl anesthesia reduced cortisol levels during the surgery (CA 38.0 +/- 13.8 pg/ml vs FA 13.5 +/- 2.4, P < 0.05) and interleukin-6 levels in the plasma after the surgery (P < 0.02). The postoperative nitrogen retention was greater with fentanyl anesthesia than with conventional anesthesia. Both protein synthesis and breakdown rates were increased with fentanyl anesthesia, while they were unaltered in CA patients. Postoperative fibrinogen synthesis rate was greater with FA than with CA (CA 51.1 +/- 9.2%/day vs FA 100.9 +/- 14.0, P < 0.01). The protein turnover and fibrinogen synthesis data suggested a shorter duration of shock phase in FA patients than in CA patients. We concluded that a high dose of fentanyl anesthesia reduced surgical stress levels and shortened the postoperative shock phase, resulting in a nitrogen-sparing effect.

Acute-Phase Proteins↗

PubMed1996

Evaluation of the cell kinetics of MNNG-treated rat gastric mucosa based on AgNOR and ODC activity.

To investigate the process of carcinogenesis in gastric cancer, we studied the histological features and cell kinetics in the gastric mucosa of N-methyl-N'-nitro-N-nitrosoguanidine (MNNG)-treated rats. Samples of gastric mucosa from both MNNG-treated and control rats were histologically examined by staining with nucleolar argylophilic nonhistone (AgNOR) proteins, and their ornithine decarboxylase (ODC) activity was determined every 2 months for 10 months. In 40% of the MNNG-treated rats, atrophy of the gastric mucosa was observed after 2 months, followed by adenomatous proliferation. More AgNOR-positive granules were found in the pyloric glands than in the fundic glands, and the total number of positive granules increased over time. Cancerous and hyperplastic lesions preferentially developed in the pyloric glands and showed significantly more AgNOR-positive granules than the normal mucosa. After 6 months the ODC activity in the MNNG-treated rats was significantly higher than that in the control rats. These results thus suggest that the pyloric glands have a high growth activity, while in addition, adenomatous proliferation is a characteristic pathological feature of precancerous lesions in the stomach in MNNG-treated rats.

Adenocarcinoma↗

PubMed1996

Leiomyosarcoma of the small intestine presenting as a pelvic mass.

We present a challenging case of differential diagnosis of leiomyosarcoma of the small intestine in a patient presented with a pelvic mass. This 43-year-old Japanese woman complained of hypermenorrhea and was diagnosed as myoma uteri. She underwent partial resection of the ileum with a primary end-to-end anastomosis, omentectomy, and appendectomy, as well as a simple hysterectomy and bilateral salpingo-oophorectomy. CT and MRI indicated an intestinal tumor at the gaseous site. The histological diagnosis was leiomyosarcoma of the small intestine and leiomyoma of the uterus. Although such leiomyosarcomas are rare, they can appear as pelvic masses and must be differentiated from gynecologic disease. Preoperative CT and MRI of the abdomen were useful in obtaining the diagnosis.

Adult↗

PubMed1996

Expandable metallic stents for tracheobronchial stenoses in esophageal cancer.

BACKGROUND: Tracheobronchial stenosis in patients with esophageal cancer can be life threatening. Few reports have discussed use of expandable metallic stents for central airway stenoses in patients with esophageal cancer. METHODS: Twelve patients with esophageal cancer underwent placement of expandable metallic stents for respiratory distress caused by tracheobronchial stricture. Single or double metallic stents were placed in the stenotic airways under fluoroscopic guidance. Improvement in respiratory symptoms and clinical outcome were assessed. RESULTS: Most stenoses were located in the trachea or the left main bronchus. From one to four expandable metallic stents were placed in each stricture site, with immediate relief of respiratory symptoms in 8 patients. One patient with tracheomalacia in alive 3 years after stent placement and another is alive 6 months after stent insertion. The other 10 patients lived from 10 to 70 days (mean; survival, 35 days) after stent placement. Death was due to progression of disease. CONCLUSIONS: Although metallic stents are useful for relieving respiratory distress in patients with advanced esophageal cancer, additional therapies should be considered.

Aged↗

PubMed1996

A case report of rectal schwannoma.

We experienced a case of rectal schwannoma which was diagnosed before surgery. In this paper we have described this rare case and have discussed a number of similar cases reported in the literature.

Aged↗

PubMed1996

Remnant-stump early gastric cancer following partial gastrectomy.

Eight rare cases of remnant-stump early gastric cancer (RS-EGC) were investigated, retrospectively. The incidence of RS-EGC was 0.9% (8/845) of all resected early gastric cancers. The macroscopic cancer type was elevated in 75% and mucosal in 88%. All were the differentiated type with no lymph node metastasis. The initial reconstruction involved a Billroth II in 75% of the patients. The RS-EGC was usually found during a periodic endoscopic follow-up. All patients are still alive with no postoperative complications and no cancer recurrence.

Aged↗

PubMed1996

Immunohistochemical localization of vascular endothelial growth factor in esophageal cancer.

We have studied the expression of vascular endothelial growth factor (VEGF) in esophageal cancer using immunohistochemistry. A total of 101 specimens of esophageal cancer tissue were fixed by formalin, embeded in paraffin wax, and examined in 3 microns sections by avidin-biotin peroxidase complex method. VEGF was noted in the cytoplasm of normal esophageal glandular cells, monocyte-macrophages, squamous carcinoma cells and of the vascular endothelial cells themselves. VEGF expression by monocyte-macrophages was observed in all cases, in contrast the incidence of VEGF expression in the tumor cells was relatively low at 26.7% of all specimens. However, in the cases where the tumor cells were positive for VEGF, it was discovered that the main source of the VEGF production was the tumor cells themselves. In the cases with proper mucosal invasion the incidence of VEGF expression by the tumor cells was quite low at 7.6%. However, when the tumor invaded the submucosal layer the expression increased to 33.3%. There was also a significant correlation in those with the submucosal invasion between the expression of VEGF in the tumor cells and that VEGF may play an important role in tumor progression and in the angiogenesis via auto-crine and para-crine mechanisms in esophageal cancer.

Endothelial Growth Factors↗

PubMed1996

A clinicopathological study of distal advanced gastric carcinoma with duodenal invasion.

We studied retrospectively the clinicopathological features of gastric cancer with duodenal invasion and compared these with those with non-invasion, to investigate the prognostic significance of duodenal invasion. The patients were grouped into two groups of Group A (65 patients) with duodenal invasion and Group B (197 patients) without invasion who underwent gastrectomy for advanced distal gastric carcinoma according to histological findings. In Group A, many were at high age and with symptoms of pyloric stenosis. Group A (91%) had a significantly higher incidence of serosal invasion and infiltration into the pancreas head than did Group B (76%) (p < 0.01). In N3 metastasis, there was a significant difference between Group A (60%) and Group B (36%) (p < 0.01). The five-year-survival rate in Group A was 14.0% and in Group B was 43.3% (p < 0.001). In cases of duodenal invasion, patients with symptoms of pyloric stenosis demonstrated a poorer prognosis than those without. Those with longer than 20 mm invasion had a significantly higher incidence of N3 metastasis than those with less than 10 mm (p < 0.05). Lymphangitic type had longer invasive length to duodenum, and N3 metastasis of the lymphangitic type was frequent comparing to localized type (42%) and invasive type (47%) (p < 0.001) (95%) (p < 0.01). These results showed that duodenal invasion was a significant prognostic factor in cases of distal gastric carcinoma. In the therapeutic strategy for advanced gastric carcinoma with duodenal invasion, it is necessary to perform gastrectomy with regional lymph nodes dissection and with combined resection of adjacent organs.

Aged↗

PubMed1996

Remnant-stump gastric cancer following partial gastrectomy-clinicopathological studies.

Forty-five cases of remnant-stump (R-S) gastric cancer were investigated retrospectively, comparing those which were initially benign (Group 1: 31 cases) with those which were initially malignant (Group 2: 14 cases). The incidence of R-S gastric cancer over all gastrectomy cases from 1967 to 1994 was 1.4% (45/3,282). The mean period until development of the R-S gastric cancer following partial gastrectomy was 21.6 years in Group 1 and was 15.8 years in Group 2 (p < 0.05). Of those R-S cases that underwent resection, total gastrectomy was selected for 82% in Group 1 and for 85% in Group 2. The incidence of negative lymph nodes was only 25% in Group 1 and 62% in Group 2 (p < 0.05). The pathological stage I was 21% in Group 1 and 54% in Group 2 (p < 0.05). The 5-year-survival rate was 32% in Group 1 and was 62% in Group 2 (p < 0.05). To improve the prognosis for R-S gastric cancer, periodic endoscopic follow-up examinations to find any R-S cancer at the earliest stage is most important, especially in cases of a partial gastrectomy for an initially benign case.

Aged↗