Biomedical subjects

K Suemasu

Publications and source records attributed to K Suemasu.

At least 37 records · Page 2Linked to original sources

PubMed2000

Distinct mechanisms of loss of estrogen receptor alpha gene expression in human breast cancer: methylation of the gene and alteration of trans-acting factors.

We have previously shown that the distal promoter (promoter B) of the estrogen receptor alpha (ER alpha) gene is responsible for the enhanced expression of the ER alpha gene seen in human breast cancer and that a novel trans-acting factor, estrogen receptor promoter B associated factor 1 (ERBF-1), is required for transcription from promoter B in breast cancer cells. In development of breast cancer, loss of ER alpha gene expression is one of the most important steps in acquiring hormone resistance, though the mechanisms are poorly understood. Recent studies have reported that methylation of the ER alpha gene promoter A and exon 1 was inversely associated with ER alpha gene expression in human breast cancer and cell lines. The methylation status of the promoter B region, which is responsible for overexpression of ER alpha protein in cancer tissue, has not been investigated. In this report, we found that the methylation status of promoter B, as well as that of promoter A, was inversely associated with ER alpha gene expression in human breast cancer and cell lines. Specific methylation of ER alpha gene promoters in vitro directly decreased transcription of the ER alpha gene in a reporter assay. Demethylating treatment induced transcription of ER alpha mRNA from promoter B in ZR-75-1 cells, which showed no transcription from promoter B, despite weak ERBF-1 expression, but not in ER alpha-negative MDA-MB-231 and BT-20 cells, which lack ERBF-1. ZR-75-1 cells showed promoter activity equal to that of MCF-7 cells in a reporter assay. Our results indicate that methylation of promoter B of the ER alpha gene is important for loss of ER alpha gene expression in human breast cancer, and methylation of the promoters can directly modulate ER alpha gene expression. However, loss of critical transcriptional factors such as ERBF-1 may also be involved in some ER alpha-negative cases.

Base Sequence↗

PubMed2000

Multiple pulmonary infarctions associated with lung cancer.

We present a case of right lung adenosquamous cell carcinoma that had obstructed the main pulmonary artery and superior pulmonary vein, causing multiple pulmonary infarctions in the right upper and middle lobes. Multiple peripheral pulmonary nodules showed clinical features that are characteristic of pulmonary infarction: rapid appearance and gradual reduction in size, pleural-based parenchymal density with a truncated apex and a round nodular shadow with a blurred margin and a centrally directed linear shadow. The nodules were more intense than the primary tumor in both T1- and T2-weighted magnetic resonance imaging (MRI). We conclude that pulmonary infarction can look like a nodule when lung cancer invades both the pulmonary artery and vein and that such cases can be distinguished from pulmonary metastasis by MRI, computed tomography and a series of radiological examinations.

Aged↗

PubMed2000

Association of CYP1B1 genetic polymorphism with incidence to breast and lung cancer.

Cytochrome P450 1B1 (CYP1B1) participates in the metabolic activation of a number of procarcinogens including benzo[a]pyrene and the hydroxylation of 17beta-estradiol at the C-4 position. In this study, we investigated the association between CYP1B1 genetic polymorphism and breast or lung cancer incidence. The Ala-Ser polymorphism at codon 119 in presumed substrate recognition site 1 was significantly associated with the incidence of breast or squamous cell carcinoma of the lung. On the other hand, Leu-Val polymorphism at codon 432 did not show any association to the cancers. An allele containing both Ala and Leu simultaneously, comprised 75% of alleles among 315 Japanese healthy controls, was significantly inversely associated with breast cancer incidence. When expressed in a recombinant system, this CYP1B1 cDNA showed the lowest 17beta-estradiol 4-hydroxylase activity among four different variant forms of CYP1B1. Thus, inter-individual differences in activation of procarcinogens or metabolism of oestrogen originating from genetic polymorphisms of the human CYP1B1 gene may contribute to the susceptibility of human cancers.

Adenocarcinoma↗

PubMed2000

Granulation stenosis caused by a Dumon stent placed for endobronchial tuberculous stenosis.

Two patients with cicatric tracheobronchial stenosis caused by tuberculosis who suffered granulation stenosis after placement of a Dumon stent are reported. Dumon stents, which were long enough to cover the stenotic sites, were placed in the trachea and left main bronchus of each patient. Granulation tissue grew at both edges of the stent 3 or 4 months after stent placement, which caused restenosis and necessitated removal of the stents. The authors conclude that a Dumon stent for treatment of tracheobronchial stenosis caused by tuberculosis can cause granulation stenosis at the edges of the stent.

Adult↗

PubMed1999

Intrathoracic light-assisted anterior limited thoracotomy in lung cancer surgery.

We recently developed an intrathoracic light-assisted anterior limited thoracotomy (ILAALT) for use in lung cancer surgery. A skin incision 12cm long is made below the breast, then the pectoral major muscle is divided, and the fourth intercostal space is opened with a disconnection of the anterior cartilagenous portion. The posterior skin, including the serratus anterior muscle, is drawn posteriorly using a retractor. To illuminate the posterior and apex portions of the thoracic cavity, a flexible fiber light is introduced into the thoracic cavity through the eighth intercostal space at the posterior axillary line. These techniques provided adequate exposure and sufficient illumination in the thoracic cavity, thus making surgery easy for most thoracic applications. Using this approach, we undertook 28 lung resections with a mediastinal nodal dissection for lung cancer (24 lobectomies, 2 bilobectomies, and 2 pneumonectomies) without difficulty. The mean intrasurgical blood loss was 217ml, the operative time 262min, and chest tube drainage duration 2.3 days. Except for one case, no patients required a blood transfusion. All patients underwent continuous epidural anesthesia until postoperative day (POD) 8. The mean time that other analgesic medication was required was 0.5 times per patient until POD 13, but none from POD 14 on. We thus conclude ILAALT to be low-invasive thoracotomy and is thus indicated for most types of lung cancer surgery, providing a reduction of pain as its main advantage.

Fiber Optic Technology↗

PubMed1999

Two-stage operation for endobronchial lipoma and lung cancer using bronchoscopy and thoracoscopy in an elderly patient with chronic obstructive pulmonary disease.

We present an 82-year-old man with chronic obstructive pulmonary disease with endobronchial lipoma, obstructing the right lower lobe bronchus, and lung adenocarcinoma in the peripheral lung of the right upper lobe (clinically T1N0M0). The endobronchial lipoma was thus first removed by bronchoscopic snaring forceps and laser therapy, resulting in an improvement of the pulmonary function. One month later, the lung adenocarcinoma was removed using thoracoscopy. The postoperative course was satisfactory, and the patient is now doing well without any tumor recurrence 11 months after surgery. For elderly chronic obstructive pulmonary disease patients with endobronchial lipoma and T1N0M0 lung cancer, a two-stage operation, consisting of bronchoscopic resection followed by a thoracoscopic resection for lung cancer, was found to be a safe and effective method of treatment while maintaining sufficient pulmonary function.

Adenocarcinoma↗

PubMed1999

Gelatin-resorcinol-formaldehyde-glutaraldehyde glue for sealing pulmonary air leaks during thoracoscopic operation.

BACKGROUND: Intraoperative pulmonary air leakage is one of the most troublesome complications in video-assisted thoracoscopic surgical procedures. We developed a sealing procedure using gelatin-resorcinol-formaldehyde-glutaraldehyde (GRFG) glue for pulmonary air leaks during such operations. METHODS: Formaldehyde-glutaraldehyde (FG) jelly is prepared by mixing FG fluid with 2.5% sodium carboxymethyl cellulose to make the FG fluid viscous. We performed an adhesion-strength test to determine the optimum ratio of gelatin-resorcinol mixture to FG jelly and then conducted an air leakage test on swine lung to compare the sealing effect between fibrin and GRFG glues. To study the histotoxicity of the GRFG glue, the sealant was applied to injured rabbit lung, and the rabbits were followed for 1 day to 188 days. For clinical studies, we developed an endosyringe to apply the GRFG glue on the target site during video-assisted thoracoscopic surgical procedures and used this technique in 21 patients with intraoperative air leaks. In addition, the side effects of GRFG glue application were studied in 52 patients in whom glue was used in several ways during lung operations. RESULTS: The results of the adhesion-strength test favored a 2:1 gelatin-resorcinol to FG ratio. The mean pressure required to produce air leakage was significantly higher with GRFG glue than with fibrin glue (p<0.001). No critical histologic damage was seen in the rabbit lung, and the glue persisted on the lung surface for 188 days after sealing. Clinical application of the glue in 21 patients resulted in complete stoppage of air leakage during operation and long afterward, except in 1 patient with a late-onset lung fistula. The FG jelly helped prevent glue spillage at the target site, regardless of angle. A transient rise in temperature up to 38.60C was observed as a side effect 7 days after operation in 5 (9.6%) of the 52 patients. CONCLUSIONS: A GRFG glue using FG jelly seals pulmonary air leaks effectively, simply, and safely during video-assisted thoracoscopic surgical procedures.

Animals↗

PubMed1999

Granulocyte colony-stimulating factor-producing primary pericardial mesothelioma.

A 54-year-old male patient presented with a granulocyte colony-stimulating factor (G-CSF)-producing primary pericardial mesothelioma, while showing symptoms of congestive heart failure, a fever of 38 to 39 degrees C, and marked leucocytosis of 52.7 x 10(3) cells/mm3. The histopathologic diagnosis was established after autopsy. G-CSF production was confirmed by the expression of G-CSF mRNA in the tumor extract and the patient's high serum G-CSF concentration. The expression of G-CSF by benign and malignant mesothelial cells has already been reported. However, this is the first case report of G-CSF production in a pericardial mesothelioma.

Fatal Outcome↗

PubMed1999

Minimally invasive thymoma with extensive intravascular growth.

A 70-year-old male with grossly non-invasive thymic tumor associated with myasthenia gravis was subjected to thymothymectomy. Microscopic examination showed extensive intravascular tumor extensions into veins of thymic tissue and surrounding muscles and a minute direct invasion of the thymic tissue. Histologically, the tumor showed mixed-type thymoma with polygonal epithelial cells. These pathological findings indicated that the tumor cells extended mainly into vessels beyond the tumor capsule via tumor drainage veins rather than invading neighboring structures. After chemotherapy and mediastinal irradiation, the patient is now in complete remission of myasthenia gravis and is recurrence-free 15 months after surgery.

Aged↗

PubMed1999

Pain-relieving posterior rod fixation with segmental sublaminar wiring for Pancoast tumor invading the vertebrae.

We describe the case of a 44-year-old male patient with Pancoast lung cancer invading the vertebrae. Because irradiation did not relieve his symptoms, we conducted tumor resection with posterior rod fixation with segmental sublaminar wiring of the vertebrae. This enabled the patient to walk and to discontinue morphine immediately after surgery. Although the tumor recurred within the region of the fixation 4 months after surgery, the patient complained of no pain until his death. Although Pancoast lung cancer with extensive vertebral invasion cannot be cured surgically, posterior rod fixation with segmental sublaminar wiring with tumor resection can improve a patient's quality of life by providing immediate, long-term pain relief.

Adult↗

PubMed1999

Dumon stent placement via endotracheal tube.

BACKGROUND: Dumon stent placement requires use of a technically difficult rigid bronchoscope. A recently developed technique for placing a Dumon stent introduced via a conventional endotracheal tube is detailed herein. METHODS: The conventional endotracheal tube is inserted beyond the stenosis site; this procedure is observed with the use of a flexible bronchoscope with the patient undergoing general anesthesia. The Dumon stent is folded and inserted into the endotracheal tube and is introduced into the stenosis site with the use of a cylindrical-tipped stainless steel wire as a pusher. The endotracheal tube is withdrawn while the pusher is positioned to expand the stent at the stenosis site. Dumon stents of 12 to 16 mm in diameter were put in place using the present method in 5 cases of tracheobronchial stenosis. RESULTS: The mean time from endotracheal tube insertion to stent placement was 181 s. The present method positioned the Dumon stent more easily and safely than the original rigid bronchoscope because the endotracheal tube used was flexible. One patient, however, required a tracheostomy and surgical forceps to remove the stent 3 months after placement. CONCLUSION: While Dumon stent removal may require a rigid bronchoscope or tracheostomy, stents can be introduced without difficulty via a conventional endotracheal tube.

Aged↗

PubMed1999

Anterior limited thoracotomy with intrathoracic illumination for lung cancer: its advantages over anteroaxillary and posterolateral thoracotomy.

STUDY OBJECTIVE: We developed anterior limited thoracotomy (ALT) with intrathoracic illumination for curative resection of lung cancer. The present study evaluated the benefits of ALT by retrospective comparison with anteroaxillary thoracotomy (AAT) and posterolateral thoracotomy (PLT). DESIGN: Lung cancer patients, who underwent lobectomy via ALT (n = 28), AAT (n = 28), and PLT (n = 28), were matched by gender and age. Operating time, blood loss during operation, chest tube drainage volume 24 h after surgery, chest tube drainage duration, and vital capacity (VC) and chest pain from early to late postoperative period were studied for ALT, AAT, and PLT. Early postoperative chest pain was evaluated by a visual analog scale and analgesic requirements, and chronic pain was divided into five grades. RESULTS: No difference was observed in operating time among ALT, AAT, and PLT. ALT has the following advantages over PLT: (1) less blood loss during surgery (p < 0.05); (2) reduced postoperative drainage volume (p < 0.05) resulting in shorter chest tube drainage (p < 0.001); (3) diminished impairment of VC for 1 week to 6 months after surgery (p < 0.01 or p < 0.001); and (4) reduced pain from 1 day and 6 months after surgery (p < 0.001). ALT also has the advantage over AAT in reduced pain 5 days (p < 0.01) and 7 days (p < 0.05) after surgery and in decreased analgesic requirements during 14 days after surgery (p < 0.05). CONCLUSION: ALT is a sufficient and minimally invasive thoracotomy alternative to PLT or AAT for curative lung cancer resection.

Aged↗

PubMed1999

[Therapeutic efficacy of pirarubicin cyclophosphamide and doxifluridine in advanced and metastatic breast cancer].

Twenty-four eligible patients (23 of whom were evaluated) with advanced and metastatic breast cancer were treated at the Saitama Cancer Center every 4 weeks with pirarubicin (30 mg/m2 i.v., day 1 and 8), cyclophosphamide (200 mg/m2 div, day 1 and 8) and doxifluridine (800 mg/day po, day 1-14). The 23 evaluable patients had a median age of 49.7 years (range 35.3-72.1) and underwent a median number of 3 cycles (range 2-5). Grade 4 leukopenia (10/24 patients) was the dose-limiting factor and led to infection in one patient. Four complete responses and 7 partial responses with a median duration of 12.1 months (range 2.6-61.0) were achieved, resulting in an overall response rate of 47.8%. The 50% survival duration was 22.9 months.

Adult↗

PubMed1999

[Intrapulmonary hematoma surrounding the stapled line after video-assisted thoracoscopic bullectomy for spontaneous pneumothorax].

A 52-year-old man presented at our hospital with hemoptysis three months after undergoing a video-assisted thoracoscopic bullectomy for spontaneous pneumothorax. A chest X-ray showed a localized infiltrative shadow in the right upper lobe of the lung. The chest CT findings revealed a mass-like lesion surrounding the staple which had been used during the bullectomy. He therefore underwent a pulmonary resection including the lesion due to the continued hemoptysis that did not improve even after treatment by hemostatic agents and bronchial arterial embolization. The resected specimen revealed an intrapulmonary hematoma with severe inflammation. The late onset hematoma which was induced by the stapler may thus be a rare complication in video-assisted thoracoscopic surgery.

Endoscopy↗

PubMed1998

[Video-assisted thoracoscopic surgery in spontaneous hemopneumothorax].

We retrospectively studied the safety and utility of video-assisted thoracoscopic surgery (VATS) in the treatment of spontaneous hemopneumothorax. Of 128 cases of spontaneous pneumothorax operated on our hospital from April 1988 to October 1997, hemopneumothorax developed in 8 cases (2 cases treated by thoracotomy and 6 by VATS). In all 8 cases, bleeding points and pulmonary bullae were easily found and hemostasis and resection of pulmonary bullae conducted quickly and safely. Two cases of VATS involved elective surgery. Of surgical emergent cases, the duration from visit our hospital to operation and surgical duration in VATS were almost as long as those in thoracotomy. The mean duration of postoperative chest drainage and postoperative hospital stay in VAST were less than in thoracotomy except for a VAST case with persistent air leakage. Blood loss from onset to operation and blood transfusion for VATS were almost equal to thoracotomy. Postoperative duration of analgesic use for VATS were shorter than that for thoracotomy. The VATS case with persistent air leakage should be necessary to reinforce the pulmonary stapled line or to convert to thoracotomy. In all cases, residual hematoma was found in the thoracic cavity. We conclude that early surgical repair should be performed once spontaneous hemopneumothorax is diagnosed and confirmed, and that VATS may be the first choice of surgery because it provides a better view and more facilitated manipulation during surgery than thoracotomy, and is a safe, nonaggressive therapeutic option.

Adult↗

PubMed1998

Serum surfactant protein A levels in healthy individuals are increased in smokers.

Serum levels of surfactant protein A (SP-A) were studied in 237 healthy subjects in relation to sex, age, and smoking habits. SP-A values in male smokers were significantly higher than those in male nonsmokers (p < 0.001). The amount of cigarette smoking did not correlate significantly with SP-A values, however. SP-A values in young nonsmoking males and females were somewhat lower than those in older, but without significant difference. No significant difference in values was found between the sexes. We conclude that (1) smoking increases serum levels of SP-A, and (2) SP-A serum levels are not affected by age and sex.

Adolescent↗

PubMed1998

Limited axillary thoracotomy vs video-assisted thoracoscopic surgery for spontaneous pneumothorax.

BACKGROUND: Video-assisted thoracoscopic surgery (VATS) has been reported to have a higher pneumothorax recurrence rate than limited axillary thoracotomy (LAT). We investigated the cause of pneumothorax recurrence after VATS by comparing surgical results for VATS and LAT. METHODS: Ninety-five patients with spontaneous pneumothorax underwent resection of pulmonary bullae by VATS (n = 51) or LAT (n = 44). Operating duration, bleeding during surgery, number of resected bullae, duration of postoperative chest tube drainage, postoperative hospital stay, postoperative complication, and pneumothorax recurrence were analyzed to compare VATS and LAT in a retrospective study. RESULTS: The duration of surgery, postoperative chest tube drainage, and postoperative hospital stay was significantly shorter in VATS than in LAT cases (p < 0.0005 and p < 0.005). Bleeding during surgery was significantly less in VATS than in LAT cases (p < 0.005). Numbers of resected bullae were significantly lower in VATS (2.7 +/- 2.1) than in LAT cases (3.9 +/- 2.7) (p < 0.05). Postoperative pneumothorax recurrence was more frequent in VATS (13.7%) than in LAT cases (6.8%), but there was no significant difference. CONCLUSIONS: VATS has many advantages over LAT in treating spontaneous pneumothorax, although the pneumothorax recurrence rate in VATS cases was double that in LAT cases. The lower number of resected bullae in VATS than in LAT cases suggests that overlooking bullae in operation could be responsible for the high recurrence rate in VATS cases. We recommend additional pleurodesis in VATS for spontaneous pneumothorax to prevent postoperative pneumothorax recurrence.

Adolescent↗

PubMed1998

Multidrug-resistant recurrent breast cancer which responded to medroxyprogesterone acetate showing a remarkable improvement in the quality of life: report of a case and the role of team medical care.

We herein report the case of a patient with recurrent breast cancer who showed a remarkable improvement in her quality of life (QOL) as a result of a good response to medroxyprogesterone acetate (MPA). A 43-year-old Japanese woman developed bone metastases 3 years after surgery. Subsequent radiotherapy and chemoendocrine therapy with CAF (cyclophosphamide, adriamycin, 5-fluorouracil) and tamoxifen all failed, and she could not sit up because of bone metastases. The performance status (PS) on admission was grade 4. After admission, delirium accompanied with sensory and visual hallucination caused by intense anxiety occurred, and a continuous consultation by psychiatrists was necessary. MPA treatment at the dose of 1200 mg/day alleviated the bone pain, thus improving her PS to grade 1. Her appetite also improved, while her mental state stabilized. A bone scintigram revealed an improvement of bone metastases, and the tumor markers also returned to normal values. The patient thus showed a pronounced improvement in her QOL due to both MPA treatment and team medical care. The role of the medical staff as well as the importance of their cooperation in achieving an improvement in the QOL of cancer patients is also discussed.

Adult↗