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Kazuo Shimizu

Publications and source records attributed to Kazuo Shimizu.

At least 73 records · Page 4Linked to original sources
PubMed2004

Adenolipoma of the thyroid gland: report of a case.

We report a case of adenolipoma of the thyroid gland, which is very unusual because thyroid adenoma rarely contains mature adipose tissue. A 55-year-old Japanese woman presented with a 1-month history of a neck mass. A blinded fine-needle aspiration biopsy showed benign follicular cells with no adipose cells, and we performed a left hemithyroidectomy. The specimen measured 7.0 x 4.4 cm and weighed 59.9 g. The cut surface of the tumor revealed a solid yellowish mass, and hematoxylin-eosin staining showed that the solid tumor was well separated from the adjacent thyroid tissue by a thin fibrous capsule. The tumor was found to be follicular adenoma composed of epithelial cells arranged in monotonous microfollicular patterns, intermingled with mature adipose tissue. No adipose tissue was found outside the tumor, and there were no signs of amyloid deposits in the tumor or adjacent thyroid tissue. The pathological diagnosis was adenolipoma of the thyroid gland. We discuss the pathogenesis of this entity and review the previously documented cases.

Adipose Tissue↗
PubMed2004

Prognosis after reoperation for local recurrence of papillary thyroid carcinoma.

PURPOSE: To investigate the factors associated with a favorable prognosis after reoperation for local recurrent papillary thyroid carcinoma (PTC), we reviewed 45 patients who underwent surgery for first local recurrence of PTC. METHODS: We divided the patients into two groups. Group A (n = 28) had no second recurrence, and group B (n = 17) had second local recurrence after surgery for recurrence. RESULTS: The mean follow-up period after reoperation was 56.9 months. The mean age at the time of reoperation in group A was significantly lower than that in group B, at 48.1 years versus 62.3 years, respectively (P = 0.0007). The mean age at the time of the initial operation in group A was also significantly lower than that in group B, at 40.1 years versus 55.1 years, respectively (P = 0.0006). Patients with recurrent tumors only outside the area dissected at the initial operation (n = 27) had a better outcome than those with recurrence within the dissected area (n = 18; P = 0.0127). Patients who underwent systematic partial or modified neck dissection (n = 36) had a better outcome than those who underwent only simple local resection (n = 9; P = 0.0169). CONCLUSION: For local recurrent PTC, systematic neck dissection is recommended over local resection of recurrent tumors.

Adult↗
PubMed2004

Successful thoracoscopic sympathectomy for primary erythromelalgia in the upper extremities.

Erythromelalgia is known as a rare syndrome of unknown etiology, characterized by redness with burning pain, edema associated with increased skin temperature in the upper and/or lower extremities. Various treatments such as drug therapies and sympathetic blockade were reported. We report two cases including a 57-year-old woman and a 64-year-old woman, showing the successful clinical outcome by bilateral thoracoscopic sympathectomy.

Erythromelalgia↗
PubMed2004

Large anomalous systemic arterial supply to basal segments of the left lung.

A 29-year-old man with a large anomalous systemic arterial supply to basal segments of the lower lobe was reported here. Pulmonary arteriography showed the absence of blood flow to basal segments. Aortography verified the anomalous artery from the descending thoracic aorta. Lobectomy was performed because the anastomosis between the anomalous and pulmonary arteries was anatomically difficult and segment 6 was small. The resected specimen showed that the anomalous artery had findings of pulmonary hypertension equivalent to grade V in the classification of Heath and Edwards. If the anastomosis between the anomalous and pulmonary arteries is anatomically feasible, pathological examination of open lung biopsy specimen is necessary to determine the operative procedures in this disease and two-staged operation is desirable.

Adult↗
PubMed2004

Metastasis to the thyroid from lung adenocarcinoma mimicking thyroid carcinoma.

We herein report a case of metastasis to the thyroid from lung adenocarcinoma mimicking thyroid carcinoma. The thyroid tumor was palpated in the left lobe of the thyroid and diagnosed as primary thyroid carcinoma by fine-needle aspiration cytology. The patient also had a large pulmonary tumor and tiny pulmonary nodules, which were respectively diagnosed as moderately differentiated adenocarcinoma of the lung and intrapulmonary metastases from the main large lung carcinoma by the pathological examination of the biopsy specimens obtained by video-assisted thoracic surgery. Hemithyroidectomy with radical neck dissection was performed. The thyroid tumor was diagnosed as metastasis to the thyroid from lung adenocarcinoma, because it showed mucin production, positive immunoreactivity for carcinoembryonic antigen and negative immunoreactivities for thyroglobulin and calcitonin. The patient received systemic chemotherapy and died of the disease 1 year and 7 months after the diagnosis was made.

Adenocarcinoma↗
PubMed2004

Sternal resection for metastasis from thyroid carcinoma and reconstruction with the sandwiched Marlex and stainless steel mesh.

A case of 69-year-old woman with a solitary sternal bone metastasis from thyroid carcinoma undergoing surgical therapy was reported here. On admission, most part of the body of the sternum was destroyed by tumor. Subtotal sternectomy was performed and a part of the major pectoral muscles adherent to the sternal tumor was also resected. The chest wall defect was reconstructed with a sandwiched Marlex and stainless steel mesh. Pathological examination of the resected specimen revealed metastatic papillary carcinoma of the thyroid. Her postoperative course was uneventful. The reconstruction with Marlex and stainless steel mesh seemed to be an appropriate procedure to prevent paradoxical movement of the thorax and protect the intrathoracic organs. Stainless steel mesh compensated for limited resiliency of Marlex mesh and remained rigid in all directions.

Aged↗
PubMed2004

Atrial septal defect with borderline pulmonary vascular disease: surgery and long-term oral prostacyclin therapy for recalcitrant pulmonary hypertension.

The hemodynamic determination of operability in atrial septal defect (ASD) with severe pulmonary hypertension is problematic. Therefore, we perform an open lung biopsy prior to the corrective surgery in cases with pulmonary vascular resistance greater than 8 units x m2 and/or pulmonary arterial peak pressure greater than 70 mmHg. We present 4 cases showing occlusion of more than 70% of the small pulmonary arteries and arterioles by musculoelastosis, thromboembolism and mixed-type (musculoelastosis and plexogenic arteriopathy) which was considered borderline in terms of operability. After complete closure of the ASD and postoperative long-term oral prostacyclin (PGI2) therapy, pulmonary artery peak pressure decreased from 110-72 (mean 84) to 105-45 (mean 74) mmHg immediately after operation and 65-40 (mean 57) mmHg after PGI2 therapy. The New York Heart Association functional status of the patients improved from class II-III to class I with oral PGI2 only. Our cases demonstrate that despite more than 70% occlusion of the small pulmonary arteries and arterioles, surgery and long-term PGI2 therapy can reduce pulmonary artery pressure and improve the quality of life.

Adolescent↗
PubMed2004

Implementation of integrated medical curriculum in Japanese medical schools.

Recently, various integrated medical curricula, which can be defined as courses with subject matter classified by organ systems rather than according to departments such as surgery and internal medicine, are beginning to be introduced to bedside-learning in Japan. For example, in such an integrated medical curriculum, lectures in the course on neurological diseases would be given by a team that would include neurosurgeons, neurologists, and pathologists. Using medical education on neurological diseases as an example of an integrated medical curriculum, we analyzed the factors related to the neurological disease course as an example of an integrated medical curriculum in the clinical medicine course at our school. We also compared our course with those of all private medical schools in Japan, using the syllabuses of these private medical schools for the comparison, and considered elements that measured interdisciplinary participation in presenting the curriculum. For an integrated medical curriculum to gain interdisciplinary acceptance, the curriculum should be constituted using all medical disciplines related to the specific organ involved in the disease process under study, including both basic medicine and clinical medicine. In addition, teachers should be informed of the rationale for such a curriculum to promote their participation and a textbook on the integrated medical curriculum is needed. A curriculum committee should play an important role in promoting this type of medical education.

Curriculum↗
PubMed2004

Optimal time of surgical treatment for Kawasaki coronary artery disease.

BACKGROUND: The major complication of Kawasaki coronary disease is myocardial infarction caused by thrombus formation inside the aneurysm or by organic obstructive lesion following the regression of aneurysm, while the indications for surgical therapy remain controversial. We have adopted coronary artery bypass grafting (CABG) even in young children for giant coronary aneurysms (more than 8 mm diameter) with or without a stenotic region when myocardial ischemia is detected. We hypothesized that a shorter time-period from diagnosis of acute Kawasaki disease (KD) to CABG would lead to better postoperative results. To elucidate the validity of our strategy, we evaluated preoperative patient characteristics and long-term outcome. METHODS: Twenty-one patients (mean age: 12.0 years old) with Kawasaki coronary disease had undergone CABG during the last 12 years. The mean age at the time of acute KD was 2.7 years and the mean time range from diagnosis of acute KD to CABG was 8.1 years. The incidence of preoperative reduced ventricular function was 10 per 21 patients (47.6%). A multivariate logistic regression analysis using patient characteristics showed that the time range from acute KD to CABG was the only predictor for ventricular functional deterioration (p=0.03, odds ratio 1.55. 95%CI: 1.033 approximately 2.325). Based on these results, we divided the patients into two groups of short time range (mean: 3.7 years; group S) and long time range (mean: 13.9 years; group L). RESULTS: Preoperative left ventricular functional deterioration was recognized more frequently in group L (9/9, 100%) than in group S (1/12, 8.3%)(p<0.01). Myocardial infarction was documented significantly higher in the group L (6/9, 66.7%) than group S (1/12, 8.3%)(p=0.04). There was no surgical mortality in either group. The arterial grafts demonstrated good potential for growth and graft patency was 96.9%. Moreover, seven of the giant aneurysms proximal to the graft anastomosis showed complete thrombotic occlusion after CABG without development of myocardial infarction. The cardiac events free rate of group L and group S was 66.7% and 100%, respectively, during the postoperative follow up periods of 5.5+/-1.1 years (group L) and 4.7+/-1.1 years (group S). CONCLUSIONS: We successfully applied CABG for Kawasaki coronary disease. Based on our experience, a short interval after acute KD appears to be ideal for surgical treatment of Kawasaki coronary disease.

Child↗
PubMed2004

Video-assisted thoracic surgery for pulmonary aspergilloma in patients with anorexia nervosa.

We report a case of pulmonary aspergilloma in a 27-year-old woman with anorexia nervosa who underwent a video-assisted thoracic surgery (VATS) lobectomy. On admission, she had lost 38% of her original weight but the laboratory data were normal. She had refused treatment for anorexia nervosa for nine years ago and may have been predisposed to opportunistic conditions. The aspergilloma was developed in a simple bulla formed in the course of healing of a lung abscess and a VATS lobectomy was safely and cosmetically performed. Wedge resection was difficult due to the size of the lesion. The residual lobes expanded very well and the postoperative course was uneventful. VATS is considered to be an efficient method in the treatment of pulmonary aspergilloma in patients with better lung function and localized pulmonary disease.

Adult↗
PubMed2004

[Oncogenic emergency and treatment in thyroid disease].

The urgent treatment of thyroid disease is mainly considered to be that of thyroid neoplasia, especially malignant thyroid tumors. The clinical symptoms produced by malignant neoplasia are acute respiratory failure caused by tumor compression and/or invasion of the trachea. Massive bleeding caused by tumor invasion of the major vessels also requires emergency therapy. In general, thyroid cancer has a favorable prognosis in patients with well-differentiated papillary carcinoma, which makes up more than 90% of thyroid malignancies. However, anaplastic carcinoma, undifferentiated papillary carcinoma, and malignant lymphoma originating from the thyroid sometimes require urgent therapy to save lives. Anaplastic carcinoma that is basically transformed from well-differentiated papillary carcinoma shows rapid growth and invades the surrounding tissue to produce tracheal obstruction. Repeated postoperative recurrences in patient with papillary carcinoma suggest undifferentiated carcinoma that eventually becomes the same endostage as anaplastic carcinoma. Radical surgery is needed in such cases initially, although making a differential diagnosis between well- and undifferentiated carcinoma is extremely difficult. Urgent treatment of these diseases consists of ensuring that the airway remains open to improve quality of life, but does not include radical treatment. Stent insertion is one adequate method for the urgent treatment of respiratory disturbance caused by tumor compression. Malignant lymphoma frequently develops from Hashimoto's thyroiditis. Immediately after making an accurate pathologic diagnosis, chemotherapy and/or radiation therapy are effective in reducing enlarged goiters rather than surgical management.

Emergencies↗
PubMed2004

Surgical treatment of lung cancer with vertebral invasion.

Vertebral body invasion by lung cancer has been problematic due to uncertainty regarding a clear surgical resection margin. Therefore, additional chemoradiotherapy has been performed to assist clearance of the surgical margin. We reviewed our experience of surgical treatment for lung cancer patients with vertebral invasion. Between 1982 and 2003, 1,070 patients underwent lung cancer surgery at the Nippon Medical School Hospital. Eight patients (0.74%) of this group underwent a combined vertebral body and chemoradiotherapy. Seven lobectomies and one pneumonectomy with mediastinal lymphadenectomy were performed. All patients underwent partial vertebrectomy. The percentage with vertebral tumor involvement was 15%. A defect of vertebral cortical bone was reinforced with implantation of rib in one patient. There was no postoperative mortality. Postoperative complications were pneumonia and arrhythmia. The median follow-up period was 19 months (range from 4 to 69.7 months). The overall actuarial survivals at 1-year, 3-year and 5-year were 68.6%, 22.9% and 22.9%. Local recurrence occurred in three patients and distant metastasis was evident in five. Even though the number of patients was small, partial vertebrectomy with chemoradiotherapy offer reduction of severe pain and an improved prognosis. However, a patient with further progressive disease should be treated with a multidisciplinary approach.

Aged↗
PubMed2004

Demonstration of human telomerase reverse transcriptase by in situ hybridization in lung carcinoma.

Telomerase activity is present in most malignant tumors and provides a mechanism for unlimited replication of neoplastic cells. This study was undertaken to investigate the expression of the gene encoding human telomerase reverse transcriptase (hTERT), the telomerase catalytic subunit gene in lung carcinoma, by in situ hybridization (ISH). hTERT is associated with telomerase activity, and overexpressed in most lung carcinomas. We assayed hTERT gene expression by ISH to study telomerase activity in lung carcinomas of 27 patients, and compared these results with those of telomerase activity by telomeric repeat amplification protocol (TRAP) assay. TERT gene expression by ISH was detected mainly in the nuclei of lung carcinoma cells. Some specimens showed a significant expression in only infiltrating lymphocytes. hTERT gene expression by ISH was found in 16 of 27 (59%) cases. On the other hand, telomerase activity by TRAP assay was detected in 21 of 27 (78%) cases. In 7 cases, TRAP assay detected telomerase activity, but ISH did not detect hTERT expression. TRAP assay might detect telomerase activity in not only carcinoma cells, but also in infiltrating lymphocytes. Our findings therefore suggest that ISH-based analysis of hTERT gene expression is superior to TRAP assay as a means of determining telomerase status during carcinogenesis.

Aged↗
PubMed2004

Surgical treatment of lung cancer combined with interstitial pneumonia: the effect of surgical approach on postoperative acute exacerbation.

UNLABELLED: Postoperative acute exacerbation of interstitial pneumonia (IP) is known to be a serious complication in the surgical treatment for primary lung cancer combined with IP. This retrospective study was conducted to investigate the influence of three different approaches to the thorax on postoperative acute exacerbation of IP in lung cancer patients. Forty-seven lung cancer patients who developed it underwent pulmonary resection between 1982 and 2003. Among them, approaches to the thorax consisted of posterolateral thoracotomy (PLT) (n=15), muscle-sparing thoracotomy (MST) (n=15), and video-assisted thoracic surgery (VATS) (n=17). Seven of 47 suffered from acute exacerbation of IP. Single variable analysis suggested that exertion dyspnea (Hugh-Jones classification), serum C-reactive protein, serum lactate dehydrogenase and total lung capacity were considered to be preoperative risk factors of acute exacerbation. As for the VATS patient, there was little frequency of postoperative complication in comparison with the other two approaches. However no significant difference was shown in the incidence of acute exacerbation between the three approaches. CONCLUSION: The use of VATS did not prevent acute exacerbation of IP. However, the incidence of postoperative complications in VATS seemed to be low, therefore further trials are required.

Acute Disease↗
PubMed2003

Impaired vascular endothelium-dependent relaxation in Henoch-Schönlein purpura.

Few reports have focused on vascular endothelial function in children with Henoch-Schönlein purpura (HSP). The purpose of the present study was to assess endothelial function and to follow serial changes from the acute to convalescent phases in children with HSP. Forearm flow-mediated vasodilation was evaluated in 21 patients with HSP, aged 4.0-10.3 years (median 6.2 years), and in 14 control subjects. Vascular dimension, mean velocity, and flow volume were measured by ultrasonography in brachial artery before and after hyperemia, and during incremental infusions of nitroglycerin (0.5, 1.0 microg/kg per min). In the controls, significant increases in dimension, mean velocity, and flow volume were observed in reactive hyperemia ( P<0.01). In contrast, patients in the acute phase of HSP showed a flow velocity profile indicating a highly resistant forearm circulation, and significantly attenuated responses after hyperemia ( P<0.01 vs. control), whereas the responses to nitroglycerin were well preserved. In addition, the impaired hyperemic responses recovered in the convalescent phase, with no significant differences compared with controls. These results clearly suggest that forearm vascular endothelium-dependent relaxation was attenuated in patients with acute HSP.

Acute Disease↗
PubMed2003

In vivo priming of natural killer T cells by dendritic cells pulsed with hepatoma-derived acid-eluted substances.

Many murine tumor cells express not only individual haplotype-matched class I MHC molecules, but also species-specific CD1d molecules. The former class I MHC molecules generally present internally synthesized tumor-derived peptide antigens to highly specific CD8(+) cytotoxic T lymphocytes (CTLs) in acquired immunity. In contrast, the latter CD1d molecules may present tumor-associated glycolipid antigens to broadly crossreactive natural killer T (NKT) cells, which might correlate with controlling tumor metastasis. Here, we showed that murine hepatoma cell line Hepa1-6-derived acid-eluted substances might contain both D(b) class I MHC-restricted antigens and CD1d-restricted substances, which could sensitize not only syngeneic bone marrow-derived DCs (BM-DCs), but also allogeneic BM-DCs expressing haplotype-mismatched class I MHC and species-specific CD1d molecules. To our surprise, intravenous (i.v.) immunization of C57BL/6 mice with the former syngeneic BM-DCs carrying acid-eluted materials primed both CD4(-)CD8(-) and CD8(+) NKT cells in the spleen, whereas immunization with the latter allogeneic BM-DCs loaded the tumor-derived substances primed CD4(-)CD8(-), but not CD8(+) NKT cells. The findings shown in the present study will open a new area for cancer immunotherapy using allogeneic DCs and tumor-derived acid-eluted substances.

Acids↗
PubMed2003

Asian perspective on endoscopic thyroidectomy -- a review of 193 cases.

Endoscopic surgery has become widely used, so much so that recent technical and mechanical advances have led to "endoscopic surgery" being synonymous with "minimally invasive surgery". In particular, endoscopic thyroid surgery has developed rapidly and been increasingly refined in recent years. The incidence of thyroid diseases is markedly higher in women than in men, and operations for these diseases result in a scar on the anterior neck that is exposed when open-necked clothing is worn. Therefore, a technique for endoscopic endocrine neck surgery that results in a better cosmetic appearance is desirable. We have developed a totally gasless endoscopic surgical technique using an anterior neck-skin lifting method for thyroid and parathyroid diseases. This technique is called the video-assisted neck surgery (VANS) method. Since our original report, we have treated more than 200 cases of thyroid and parathyroid disease using this technique. In cases of benign thyroid tumours, near total lobectomy was the most common procedure followed by total lobectomy. The maximum resected tumour size was 7.4 cm in diameter. For malignant tumours, the indication for the VANS method was limited to thyroid papillary microcarcinomas measuring less than 1 cm in diameter. Total lobectomy and prophylactic neck dissection were performed in all 10 of these cases. A subtotal thyroidectomy was performed for only a few cases of Graves' disease. The operating time and the amount of bleeding were statistically significantly reduced, as the surgeon gained experience with the technique. In conclusion, the VANS method is a feasible, practical and safe procedure, with excellent cosmetic benefits.

Carcinoma, Papillary↗