[Studies on poliomyelitis epidemic in Hokkaido in 1960. I. Clinical studies].
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Biomedical subjects
Publications and source records attributed to M Endo.
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A total of 211 patients with gastric cancer in the upper third of the stomach were clinicopathologically evaluated. Of the 211 patients, 82 had esophageal infiltration and 129 did not. These two groups were compared. The study on patients who had undergone resection and radioisotope (99mTc-phytate) uptake testing revealed that it was important to dissect the lymph nodes (predominantly nodes 7, 9, 11, and 16) during surgery in the patients with gastric cancer plus esophageal infiltration. When cancer infiltration of the esophagus exceeds 1 cm, the preferred surgical procedure is lower esophagectomy and total gastrectomy with abdominal and intrathoracic lymphadenectomy via the left thoracoabdominal approach. When residual cancer is suggested in the more proximal esophageal stump due to intramural metastasis from vascular invasion, rapid pathologic diagnosis should be made by frozen sections during surgery and then subtotal esophagectomy by blunt removal of the esophagus proximally from the aortic arch using a left thoracotomy considered.
A 12-year-old boy with a decrescendo diastolic murmur maximal at the lower right sternal border was suspected of having a coronary arteriovenous fistula. Cardiac catheterization and angiography revealed a right coronary artery to left ventricle fistula with marked dilatation of the right coronary artery. This is the thirteenth case of this anomaly reported in the literature. Characteristic two-dimensional echocardiographic features of this case are presented. A markedly dilated right coronary artery was revealed by two-dimensional echocardiography to take a normal right coronary artery course and empty into the posteromedial portion of the left ventricle. This case indicates the possibility of visualizing a dilated peripheral portion of the right coronary artery using two-dimensional echocardiography.
Endoscopic and histopathological findings were compared in 74 patients with gastric cancer infiltrating the lower esophagus who had undergone gastrectomy to evaluate mode of esophageal infiltration. There were no early cancers. Cancer infiltration modes were histopathologically broken down into three types: superficial, whole layer, and deep layer. Endoscopic findings were broken down into five types for proximal infiltration. Endoscopy used for histological evaluation frequently revealed the protruded type to be whole layer and had a highly accurate diagnosis rate (94%); it revealed the histology of the other four types to be primarily superficial. Extent of cancer invasion was underestimated in giant-rugae tumors (40%), as endoscopy could barely detect the small nest of esophageal infiltrations. Lugol staining was useful in preventing underestimation. For flat cancer, which is poorly demarcated and is often accompanied by vascular invasion, preoperative evaluation is very difficult, requiring preoperative examination of a frozen section taken from the proximal edge of resected specimen.
We devised a transparent anorectoscope for internal hemorrhoidal sclerotherapy. Using this scope the grade of hemorrhoids of the patients can be evaluated accurately through the transparent wall of the scope, and the device facilitates easier and safer sclerotherapy under clear direct vision, compared to the conventional free-hand-style treatment. We conclude that sclerotherapy using this anorectoscope represents a minimally invasive treatment for low-grade internal hemorrhoids and is recommendable for outpatient therapy of internal hemorrhoids.
In 57 cases with portal hypertensive disease, we investigated the intramural and extramural structure of the stomach and the esophagus by endoscopic ultrasonography (EUS). Variously developed intra- and extramural vascular structures had a relationship to the endoscopic variceal form, and communicating (inflow) vessels to varices were found in 28 of the 43 primary cases treated (65%). We then classified the esophagogastric varices into three types according to the vascular structure, such as the esophageal type, esophagogastric type, and solitary gastric type. Based on the analysis of these collateral structures, we selected the treatment as follows. In the esophageal type, which has a few inflow vessels, it is easy to eliminate the varices by obturating the inflow vessels by endoscopic injection sclerotherapy (EIS). In the esophagogastric type, which has many enlarged inflow vessels, the Hassab operation is effective in devascularizing the extramural inflow vessels, and the combination of EIS is necessary to sclerose the intramural varices. In the solitary gastric type, which is a part of the downward portosystemic shunt, the Hassab operation is recommended to prevent rupture of the varices for the subtype with intramural running vessels, but conservative therapy is enough for the subtype without.
This report describes five patients with cholecystolithiasis and choledocholithiasis who were treated by combination endoscopic extraction of common bile-duct stones with sphincterotomy (EST) and laparoscopic cholecystectomy (LC). Following this combination procedure the patients were relieved completely of obstructive jaundice and right upper quadrant pain, leaving only small trocar insertion scars made during the short course of hospitalization. The combination therapy of EST and LC will be recommended for this kind of patient as a minimally invasive procedure.
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The relation of pulmonary hemodynamics to pathological change in the pulmonary vasculature was examined in a model of unilateral pulmonary venous (PV) obstruction. The left upper pulmonary vein (A group, n=6) or both the left upper and left lower pulmonary veins (B group, n=6) of two-week-old piglets were banded; the control group (n=6) was sham operated. At eight weeks after PV banding, mean pulmonary arterial pressure was highest in the B group, intermediate in the A group and lowest in the control group. In all groups, the media of the pulmonary artery was equally thickened in both lungs, whereas the media of the pulmonary vein was thickened only in those lung lobes having stenotic pulmonary veins. For all animals from three groups, left pulmonary arterial wedge pressure (PAWP) correlated with medial thickness of the pulmonary arteries of the right lung (r=0.76, p=0.003), the left upper lobe (r=0.54, p<0.03), the left lower lobe (r=0.49, p=0.04). This finding suggests that the pathogenesis of PAWP-related medial thickening of the bilateral lung pulmonary artery begins with the sensing by the bilateral lung of PV pressure buildup in the unilateral lung.
We report a case of congenital ascending aortic aneurysm associated with double-outlet right ventricle that has been successfully repaired by graft replacement and extracardiac total cavo-pulmonary connection.
Hemodynamic changes induced by hypoxia and cold stress were examined on the model of pulmonary venous obstruction (PVO) to investigate the mechanism of pulmonary hypertensive crisis. Bilateral pulmonary venous stenosis was surgically created in 7 newborn piglets of the PVO group. Sham operations were performed on 6 piglets of the control group. Following the baseline hemodynamic measurement (FiO2 = 0.3) at 8 weeks after the operation, the piglets were exposed to hypoxia (FiO2 = 0.14) for 10 minutes, and were also exposed to cold stress for 20 minutes. Hypoxia significantly increased mean pulmonary arterial pressure in the PVO group. Hypoxia increased not only pulmonary arterial resistance, but also pulmonary venous resistance in the PVO group. Cold stress did not change pulmonary arterial resistance or pulmonary venous resistance in each group. In the lungs of the PVO group, the medial muscular layer of the pulmonary arteries and pulmonary veins were thickened. This probably accelerates hypoxia-induced vasoconstriction, which in turn increases pulmonary arterial and venous resistances.
Immunohistochemical localization of HLA antigens and placental proteins (alpha hCG, beta hCG CTP, hPL and SP1) in villous and extravillous trophoblast at various stages of normal human gestation were studied, using hysterectomy specimens. In the chorionic villi, the capacity for synthesizing placental proteins seemed to develop in parallel with the morphological change from mononuclear cells to multinucleated syncytiotrophoblast and no villous trophoblast expressed HLA antigens. In contrast, extravillous trophoblast, including the multinucleated trophoblastic cells at the deciduomuscular junction, expressed HLA-A, -B, and -C, and their capacity for synthesizing placental proteins did not seem to correspond with the degree of morphological change: the location of alpha hCG, beta hCG CTP and SP1 was restricted to mononuclear trophoblast in the superficial decidua, while hPL was present extensively in extravillous trophoblast. These findings strongly suggest that extravillous trophoblast possesses many distinctive biological features and differentiates in an independent manner. Mononuclear trophoblast forming the cell columns was also positive for HLA-A, -B, and -C, and no placental protein was demonstrated in these cells; this, together with previous morphological observations, may indicate the germinative nature of these cells.
The present paper describes a fluorometric assay for galactosaminoglycan-degrading endo-beta-xylosidase, utilizing glycosaminoglycan chains bearing a 4-methylumbelliferyl group at the reducing terminus as a substrate. This fluorogenic substrate is synthesized by human skin fibroblasts cultured in the presence of a fluorogenic xyloside, 4-methylumbelliferyl-beta-D-xyloside. The assay is based on measurement of the fluorescence of 4-methylumbelliferone, enzymatically liberated from the synthetic substrate by endo-beta-xylosidase. We examined the applicability of the assay for analysis of endo-beta-xylosidase activity.
The fluorescence labeling method (Takemoto, H. et al. (1985) Anal. Biochem. 145, 245-250) has been shown to have high sensitivity for measuring the sugar composition of glycoproteins. In the present study, its applicability for analysis of the reducing terminal sugars of glycosaminoglycans was investigated. The procedure involved coupling of glycosaminoglycans with 2-aminopyridine, followed by hydrolysis and N-acetylation, and then analysis by high-performance liquid chromatography on a reverse-phase column. The method was found to be useful for simultaneous determination of acidic, neutral and amino sugars at the reducing termini of glycosaminoglycan moieties.
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