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Kazuo Shirouzu

Publications and source records attributed to Kazuo Shirouzu.

At least 55 records · Page 3Linked to original sources
PubMed2004

In vitro investigation of detectability of colorectal lymph nodes and diagnosis of lymph node metastasis in colorectal cancer using B-mode sonography.

PURPOSE: The aim of this in vitro study was to assess the feasibility of using high-frequency sonography to identify colorectal lymph nodes and to diagnose colorectal lymph node metastasis. METHODS: In part 1 of this study, resected colorectal tissues from 13 patients with colorectal cancer were scanned in a water bath using B-mode sonography performed at high frequency (10 MHz) to identify lymph nodes. The colorectal tissues were then carefully dissected to remove all lymph nodes. Detectability was calculated as the ratio of the number of sonographically detected nodes to the total number of histopathologically confirmed nodes. Student's t test was performed to compare sizes between these groups; a p value of less than 0.05 was considered significant. In part 2, 4 features of lymph nodes identified on B-mode sonography--size, shape, border, and echogenicity--and their combinations were evaluated for their ability to diagnose lymph node metastasis. Discriminant and receiver operating characteristic curve analyses were performed. RESULTS: In part 1, B-mode sonography performed in vitro detected 79 (48%) of the 165 histopathologically identified lymph nodes and 34 (87%) of the 39 histopathologically identified metastatic nodes. The mean size, or mean longest axis (+/- standard deviation), of the sonographically detected nodes (6.4 +/- 2.9 mm) was significantly larger than that of undetected nodes (3.6 +/- 1.7 mm; p < 0.01). In part 2, the most effective feature distinguishing metastatic from nonmetastatic lymph nodes was echogenicity, followed by size, shape, and border. However, a combination of at least 2 features (eg, echogenicity and size) provided better distinction of nodes than did any 1 feature. In the receiver operating characteristic curve of the 4-feature combination, an increase in sensitivity is accompanied by a decrease in specificity: at a sensitivity of 100%, specificities decreased to 60% or less. However, even with the optimal combination of features, the sensitivity and specificity did not both reach 85% at any operating point. CONCLUSIONS: The results of this node-by-node in vitro study show the current limitations and potential of sonography for assessing colorectal lymph nodes. High-frequency sonography may be insufficient for identifying lymph node metastasis in colorectal cancer.

Adenocarcinoma↗
PubMed2004

A case of benign bile duct stricture causing difficulty in differential diagnosis from bile duct carcinoma.

We report a patient with benign bile duct stricture causing difficulty in differential diagnosis from bile duct carcinoma. A 66-year-old woman consulted a local physician because of general fatigue. Blood biochemical tests showed increased levels of biliary tract enzymes. Abdominal ultrasonography (US) revealed tapering and blockage of the midportion of the bile duct and dilation of the intrahepatic bile ducts. Magnetic resonance cholangiopancreatography (MRCP) demonstrated obstruction of the midportion of the bile duct. Later, because a marked increase in biliary tract enzymes and jaundice appeared, percutaneous transhepatic biliary drainage (PTBD) was performed. Post-PTBD cytological examination of bile was negative for cancer. A third biopsy showed slight hyperplasia with no malignant findings. Recholangiography, performed through PTBD, suggested gradual improvement of bile duct stricture, but could not completely exclude the possibility of malignancy; thus, resection of the bile duct including the stricture site was performed, and the resected specimen was submitted for intraoperative frozen section examination. Histopathological diagnosis did not reveal malignant findings. After cholecystectomy and bile duct resection, hepaticojejunostomy (Roux-en-Y) was performed. Because only erosion and desquamation of the mucosal epithelium and mild submucosal inflammatory cell infiltration and fibrosis were observed, chronic cholangitis was diagnosed histopathologically. Surgical resection of the bile duct should be considered for potentially malignant stricture of the bile duct.

Aged↗
PubMed2004

Intraoperative ultrasonography is useful for diagnosing pancreatic duct injury and adjacent tissue damage in a patient with penetrating pancreas trauma.

We report a case of pancreatic injury, caused by a stab wound, in which ductal injury and wound depth were clearly identified by intraoperative ultrasonography. A 65-year-old woman was emergently admitted to our hospital after stabbing herself in the abdomen in a suicide attempt. Preoperative computed tomography (CT) and laboratory examination revealed liver and pancreatic injury with massive abdominal bleeding and free air. Operative findings included injuries of the stomach, small bowel, colon, liver, and pancreas. The pancreatic lacerations were 1 cm in length, in the body. Intraoperative ultrasonography enabled the diagnosis of a lacerated main pancreatic duct with no damage to the major vessels posterior to the pancreas. Distal pancreatectomy; simple repairs of the liver, small bowel, and stomach; exteriorization of the injured colon; cholecystostomy; gastrostomy; and jejunostomy were performed. The patient recovered and was transferred to a psychiatric hospital 87 days after surgery. In this patient, intraoperative ultrasonography was successfully used to identify the degree of injury to the pancreatic duct, as well as the depth of the stab wound. In conclusion, intraoperative ultrasonography should be routinely performed to detect main pancreatic duct injury in penetrating pancreatic trauma.

Aged↗
PubMed2004

Preoperative spirometry versus expired gas analysis during exercise testing as predictors of cardiopulmonary complications after lung resection.

PURPOSE: As cardiopulmonary load increases with the amount of lung resected, to perform surgery safely it is important to be able to predict cardiopulmonary insufficiency. However, lung function testing with spirometry and blood gas analysis does not accurately measure cardiopulmonary reserve. We conducted this study to evaluate expired gas analysis during exercise testing for predicting postoperative complications after lung resection. METHODS: Expired gas analysis during exercise and spirometry were done 1 week preoperatively in 211 patients who underwent pulmonary resection for lung cancer. Patients were divided postoperatively according to whether cardiopulmonary complications were absent (group A) or present (group B). RESULTS: In group B there were more men than women (P < 0.01), and the mean age was greater (P < 0.05). There was no difference in disease stage, but more patients underwent pneumonectomy in group B than in group A ( P < 0.005). The results of expired gas analysis during exercise testing and of spirometry showed that maximum oxygen uptake/m(2) (P < 0.0005), anaerobic threshold/m(2) (P < 0.01), vital capacity (VC)/m(2) (P < 0.005), %VC (P < 0.0001), forced expiratory volume in 1 s (FEV(1.0))/m(2) (P < 0.0001), and FEV(1.0%) (P < 0.05) were lower in group B than in group A. CONCLUSIONS: The combination of expired gas analysis during exercise and conventional pulmonary function tests identified patients at risk for postoperative cardiopulmonary complications following pulmonary resection.

Aged↗
PubMed2004

Inhibition of acute rejection after skin or cardiac transplantation by administration of donor antigens in the rat.

PURPOSE: We examined differences in host immunologic changes induced by the intravenous or intraportal administration of donor antigens at engrafting and evaluated their contribution to graft survival using a rat transplantation model. METHODS: Lewis rat recipients were given either an intravenous or intraportal injection of donor splenocytes (1 x 10(8)) immediately after receiving skin grafts from Brown Norway donors. The immunologic responses were analyzed by mixed lymphocyte reaction (MLR) and profiles of interferon-Gamma, interleukin (IL)-2, and IL-10 in MLR supernatants. The effect on cardiac transplantation of perioperative administration of low-dose FK506 (0.1 mg/kg per day) was also examined. RESULTS: Mixed lymphocyte reactions using splenocytes and sera from recipients treated intraportally were greatly inhibited. Interferon-gamma, IL-2, and IL-10 levels were significantly higher after intraportal treatment compared with intravenous treatment (P < 0.05). When FK506 was injected from day 3, a significant enhancement of cardiac allograft survival was demonstrated by intraportal treatment (16.1 +/- 2.9 days) in comparison to the non-treatment (13.0 +/- 1.7 days, P < 0.05) and intravenous treatment rats (11.7 +/- 2.7 days, P < 0.05). CONCLUSIONS: The Th2 deviation induced with intraportal alloantigen administration immediately after engraftment was thus observed to produce a synergistic effect with immunosuppressant treatment to suppress acute rejection.

Animals↗
PubMed2004

Axillary lymph node recurrence of papillary thyroid microcarcinoma: report of a case.

We report a case of axillary lymph node recurrence of thyroid papillary microcarcinoma (PMC) in a 51-year-old woman who had undergone thyroidectomy with lymph node dissection 5 years earlier. We performed residual thyroid resection with cervical and bilateral axillary lymph node dissection, and pathological examination revealed well-differentiated papillary carcinoma, with partial poor differentiation. Postoperative radioiodine therapy was ineffective, and the patient died of systemic dissemination of the recurrence 8 months after her second operation. The positive cell rates of proliferating cell nuclear antigen and Ki-67 were clearly higher in the recurrent lymph nodes than in the primary thyroid tumor, suggesting increased cell proliferation in the recurrent lymph nodes. Thyroid papillary carcinoma rarely recurs in the axillary lymph nodes, but its possibility must be kept in mind, especially in patients with remarkable cervical lymph node metastasis and those who undergo extensive lymph node dissection.

Axilla↗
PubMed2004

Amyloid tumor in the anterior mediastinum: report of a case.

A 33-year-old woman being treated for rheumatoid arthritis was referred to our hospital for investigation of a mediastinal mass. A chest computed tomography scan showed an anterior mediastinal mass, 8.5 x 7.0 cm in size, with a cystic lesion and calcification. These findings were suggestive of either a noninvasive thymoma or a mature teratoma. Therefore, we performed tumor resection and thymectomy. Histologically, the tumor consisted of diffuse deposits of massive eosinophilic amorphous material. The tumor was stained red-orange by Congo red, and the staining disappeared following potassium permanganate digestion. Based on these findings, a diagnosis of reactive amyloidosis of the amyloid A-protein-derived type was made. Amyloidosis in the mediastinum has rarely been described.

Adult↗
PubMed2004

Biological features of sporadic colorectal carcinoma with high-frequency microsatellite instability: special reference to tumor proliferation and apoptosis.

BACKGROUND: We evaluated the relationship between biological behavior and microsatellite instability (MSI) status, with or without p53 status, in sporadic colorectal carcinoma. METHODS: MSI was analyzed with regard to biological features such as cellular proliferation and apoptotic cell death, in addition to clinicopathological features, in 87 patients with sporadic colorectal carcinoma. RESULTS: Fourteen (16.1%) of 87 tumors showed instability at two or more of the five loci examined (high-frequency MSI [MSI-H]). Four demonstrated instability at one locus (low-frequency MSI [MSI-L]), and 69 showed no instability (microsatellite-stable [MSS]). The MSI-H tumors tended to be located in the proximal colon and more often were mucinous carcinoma. The MSI-H tumors also tended to be in patients with multiple colorectal carcinomas and to demonstrate, rarely, an infiltrating growth pattern or venous invasion. The incidence of p53 protein overexpression in the MSI-H tumors was significantly lower than that in the MSI-L/MSS tumors (21% vs 54%). There was no significant difference in the proliferating-cell nuclear antigen (PCNA) labeling index (PI) or apoptotic index (AI) between the MSI-H and MSI-L/MSS tumors. The AI in the MSI-H tumors with p53 overexpression was significantly lower than that in the MSI-H tumors without p53 overexpression, and was also significantly lower than that in the MSI-L/MSS tumors with p53 overexpression. In the MSI-H tumors with p53 overexpression, no expression of BAX protein was found, and there was high expression of bcl-2 protein, resulting in a low BAX/bcl-2 ratio. CONCLUSION: In sporadic colorectal carcinoma, an MSI-H tumor with p53 protein overexpression may display aggressive biological features.

Adenocarcinoma↗
PubMed2004

A clinical overview of familial adenomatous polyposis derived from the database of the Polyposis Registry of Japan.

The clinical situation of familial adenomatous polyposis (FAP) in Japan has changed in the period since the last analysis of data of the Japanese Polyposis Center. To reevaluate our data and elucidate the changes we analyzed the records of the 1390 FAP patients in 900 families registered with the Polyposis Committee of the Japanese Society for Cancer of the Colon and Rectum. In the 13-year period 1990-2003, clinical differences between men and women with FAP diminished. The postoperative prognosis was substantially better in patients without advanced colorectal cancer (stage > or = T2) than in those with early cancer or no cancer. Mean age at death improved from 42.5 years in the period before 1990 to 46.0 years, and it was a result of a decreased proportion of deaths from colorectal cancer. The distribution of colorectal cancer in FAP patients was similar to that in the general population. Desmoid tumors accounted for about 10% of deaths in the recent 13 years (1990-2003). The cumulative risk of rectal cancer in the preserved rectum was 12% at 10 years and 23% at 15 years. The registry system in Japan revealed a new clinical situation in FAP patients, and the findings of this study will be useful to improve the prognosis of patients with FAP.

Adenoma↗
PubMed2004

Incidental partial anomalous pulmonary venous connection in left lung cancer.

We present the case of a 79-year-old woman with partial anomalous pulmonary venous connection (PAPVC), discovered incidentally during upper left division segmentectomy for primary lung cancer. The left superior pulmonary vein originated from the hilum of the upper left lobe and flowed into the left brachiocephalic vein. The left inferior pulmonary vein was connected normally, and neither atrial septal defect nor other anomalous condition was present. Upper left lobectomy with ligation of the anomalous connected vein was performed, as the lingual segment was anatomically difficult to retain. Although this type of PAPVC is extremely rare, it is advisable to exercise caution when performing lung resection with the potential for PAPVC in mind.

Aged↗
PubMed2004

Evaluation of an aortic stent graft for use in surgery on esophageal cancer involving the thoracic aorta: experimental study.

OBJECTIVE: The purpose of this experimental study was to investigate whether aortic stent grafting can be applied to the treatment of an esophageal cancer involving the thoracic aorta. METHODS: The canine thoracic aorta was partially resected without aorta being clamped after emplacement of an endovascular stent graft. Study I; The aortic whole layer of 1 cm in length and 1/4 of the circumference was resected and was covered by a free fascia patch of the abdominal rectal muscle immediately after stent graft placement. Study II; The aortic adventitia and the outer half of the media of the same size was resected on day 3, 7, 14, 21, and on day 28, after the stent graft placement. The resected portion was covered by the free fascia patch in half experimental dogs, and was uncovered in the others. Study III; The aortic adventitia and the outer half of the media of 1 cm in length and 1/2 of the circumference was resected and was uncovered on day 7 after stent graft placement. Histological examinations were performed on day 28 and at one year after aortic resection. RESULTS: The aortic wall could be resected in all cases with no complication, except in resection of 1/2 the circumference where the aorta had become narrow. There was no difference in healing of the resected portion of the aorta between with and without fascia covering. CONCLUSION: An aortic endovascular stent graft could be applied to surgery for an esophageal cancer involving the aorta.

Animals↗
PubMed2004

Fixation of silicone stents in the subglottic trachea: preventing stent migration using a fixation apparatus.

Silicone stents are widely used to treat benign or malignant airway stenosis. However, since straight silicone stents placed into the subglottic trachea to treat stenosis display a high risk of migration, novel approaches are required. The present report outlines our method of external fixation for silicone stents in the subglottic trachea. This technique utilizes a fixation apparatus, is readily performed, and may help to overcome the hesitation seen in placing silicone stents for subglottic tracheal stenosis.

Bronchoscopy↗
PubMed2004

CD9 expression in gastric cancer and its significance.

BACKGROUND: The tetraspanin transmembrane protein CD9 is known to be involved in cell adhesion, proliferation, and cell motility. Previous studies have reported that reduced expression of CD9 is related to aggressive behavior of cancer cells. However, the cause-and-effect relationship between the CD9 expression level and the state of malignancy remains unclear. Here, we investigated the connection between the CD9 expression level and the state of malignancy in gastric cancers. MATERIALS AND METHODS: The expression of CD9 was examined in primary and metastatic gastric carcinoma tissues. In total, specimens from 78 patients were used for immunohistological staining and specimens from 57 patients were subjected to Northern blotting. Paired samples of tumor/normal tissues obtained from five cases of gastric cancer were used for Western blotting. RESULTS: CD9 expression was observed at both the message level and the protein level in primary gastric carcinoma tissues, lymph node metastatic tissues, and peritoneal dissemination tissues. Contrary to previous reports for other cancers, CD9 expression was intensified in cancerous areas of gastric cancers in comparison with noncancerous areas in the same patient. When analyzed by the malignancy status based on the clinicopathological diagnosis, there was a tendency that CD9 expression was observed in severe vessel invasion, active lymph node metastasis, and advanced stage. CONCLUSIONS: CD9 expression was rather intensified in gastric cancer tissue in comparison with normal tissues. CD9 expression was more prominent in advanced gastric cancer.

Antigens, CD↗
PubMed2004

Increased expression of a Myc target gene Mina53 in human colon cancer.

Mina53 is a novel Myc target gene that we previously demonstrated to be involved in cell proliferation. We studied, here, the expression of Mina53 in colon cancer to examine its possible role in carcinogenesis. We generated a specific monoclonal anti-human Mina53 antibody and found that colon tumor cell lines expressed Mina53 highly. We also found that expression of Mina53 was elevated in colon tumor tissues by immunoblotting analysis. Tissue sections of 23 surgical cases of adenocarcinoma and 1 case of adenoma were stained immunohistochemically, and the expression of Mina53 was found to be elevated in all of the adenocarcinomas compared to adjacent nonneoplastic tissues, which showed little staining. Deeply invading tumors as well as tumors that have invaded lymphatic vessels showed strong immunoreactivity against anti-Mina53 antibody. Mina53 was expressed in all pathological grades of cancer as well as in the adenoma. Staining patterns of Ki-67, a biomarker for cell proliferation, were similar to those of Mina53 in most cases, but the percentage of tumor cells stained by anti-Mina53 was higher. Although anti-Ki-67 antibody strongly stained some well-proliferating nonneoplastic cells including cells in the deeper part of the crypts and in lymphoid germinal centers, antibody to Mina53 rarely stained those cells. Suppression of mina53 expression severely suppressed proliferation of colon tumor cells in vitro. Together, our results indicate that the elevated expression of Mina53 is a characteristic feature in colon cancer, one that may have therapeutic applications.

Adenocarcinoma↗
PubMed2004

Clipless hand-assisted laparoscopic total colectomy using Ligasure Atlas.

Hand-assisted laparoscopic total colectomy for ulcerative colitis has allowed less invasive operations in acute severe colitis and poor risk, and has not yet been widely applied for the reason of prolong the operating time in comparison with open surgery. We present the advantages of the use of the LigaSure Atlas vessel sealing for vascular control during laparoscopic surgery. A retrospective study was conducted to compare 15 patients who underwent hand-assisted laparoscopic total colectomy using an ultrasonic coagulator from January 1988 to September 2002 (US group) with 18 patients who were operated using LigaSure Atlas (LS group) from October 2002 to December 2003. There was no significant difference in the background factors of patients between both groups. The operating time was 225 +/- 58 min in the LS group and less than 280 +/- 105 min in the US group. Intraoperative blood loss was 91 +/- 22 ml in the LS group and less than 212 +/- 178 ml in the US group. Postoperative bleeding did not occur in the LS group, but occurred in 1 patient in the US group (6.6%) and this patient required re-operation. Postoperative seroma formation in the abdomen was found in 3 patients of the US group (20%). The procedure using LigaSure Atlas reduced the operating time, intraoperative bleeding and operator's stress in comparison with standard ultrasonic coagulation.

Adult↗
PubMed2004

The fungal DNA examination is useful as a sensitive parameter for the initiation and the quit of antifungal therapy in immunocompromised pediatric patients after surgery.

The purpose of this study is whether the fungal deoxyribonucleic acid (DNA) examination is useful as a sensitive parameter for pediatric surgical patients with mycosis. The eleven episodes of five cases (4 cases; progressive liver disease after biliary atresia operation, 1 case; short bowel syndrome and long term total parenteral nutrition with megacystis microcolon intestinal hypoperistalsis syndrome) with mycosis were divided into two groups according to the difference of therapeutic protocols. The sensitivity of fungal DNA examination, serum Candida antigen level, plasma beta-D glucan level, and blood culture were evaluated at the onset of infection and at the quit of antifungal medication under the protocols respectively. The duration of medication and the medication free interval in two groups were compared. The 6 episodes (3 cases) were diagnosed and treated under the protocol not including fungal DNA examination, while the 5 episodes (2 cases) under the protocol including fungal DNA examination. The occurrence rate was not significant. The sensitivity of fungal DNA examination was complete, but others were not. Using the fungal DNA examination, the duration of medication became significantly short. We conclude that the fungal DNA examination could be a sensitive parameter not only to start but to quit antifungal medication in pediatric patients with mycosis.

Antifungal Agents↗