[The Japanese Nursing Association: observations on the organization of the Association, finishing the general meeting].
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Congresses as Topic↗
Biomedical subjects
M Fukuzawa
Publications and source records attributed to M Fukuzawa.
[Preoperative irradiation of gastric cancer--irradiation with or without concurrent drug therapy].
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Aged↗
Prenatal diagnosis of congenital diaphragmatic hernia and perinatal care: assessment of lung hypoplasia.
To assess the severity of lung hypoplasia, we have attempted to measure the lung thorax transverse area ratio (L/T) by using ultrasonic echography and to select immediate surgery after delivery by caesarean section. The evaluation of L/T for an index of lung hypoplasia was made by arterial blood gas data and clinical courses. Of 14 fetuses diagnosed, 13 had left sided CDH and one right sided case, from 11 to 38 weeks of pregnancy, 10 cases survived. The L/T in 14 fetuses with CDH was from 0.08 to 0.36 (mean 0.2 +/- 0.073) and was significantly lower than that of the controls. L/T was correlated best with data of arterial pH, PCO2, preductal A-aDO2 before operation and the duration of mechanical ventilation in survivors. Although L/T was also significantly low in the cases with severe grade, diaphragmatic patch closure and ECMO therapy, no significant differences were noted in L/T between survivors and non-survivors. These results indicated that L/T may predict the severity of lung hypoplasia in CDH and that the combination of perinatal management bases on prenatal diagnosis of CDH and ECMO support may improve the outcome of fatal CDH with severe lung hypoplasia.
Cesarean Section↗
Pseudoaneurysm of the superficial temporal artery.
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Aged↗
Total parenteral nutrition decreases luminal mucous gel and increases permeability of small intestine.
The distribution of fluorescein isothiocyanate dextran 70,000 (FITC-dextran) and mucous gel across the lumen of small intestine was observed as an investigation into the role of mucous gel on permeability in total parenteral nutrition (TPN). Thirty-two rats were randomly divided into two groups fed with either TPN or oral rat food. On day 4 or 7, FITC-dextran (750 mg/kg body weight) was given through the gastroduodenal tube. After 1 hour, blood samples were taken by aortic puncture to analyze plasma FITC-dextran by fluorescence spectrometry. Samples of small intestine with luminal contents were frozen and sectioned in a cryostat for fluorescence microscopy; the same sections were placed in a 0.2% celloidin solution for 3 minutes to preserve mucous gel and stained by periodic acid-Schiff reaction for light microscopy. The plasma level of FITC-dextran after 1 hour of this marker injection showed a significant increase (p < .01) in the TPN group compared with the rat food group on days 4 and 7. Morphologic findings on days 4 and 7 were similar in both the jejunum and ileum: The mucous gel filled the spaces between villi and FITC-dextran centered in the lumen in the rat food group, whereas the mucous gel decreased and FITC-dextran filled the spaces between villi in the TPN group. FITC-dextran and mucous gel showed complementary distributions in both groups. These data suggest that TPN decreases luminal mucous gel and increases permeability of small intestine in rats.
Animals↗
Developmental changes in distribution of the mucous gel layer and intestinal permeability in rat small intestine.
BACKGROUND: From the developmental aspects, the distribution of fluorescein isothiocyanate dextran 70,000 (FTTC-dextran) and mucous gel across the lumen of small intestine was observed as an investigation into the role of mucous gel on intestinal permeability. Furthermore, the effect of N-acetyl cysteine (NAC), a mucolytic agent, on intestinal permeability was examined. METHODS: In suckling and weaned rats, FTTC-dextran (750 mg/kg body wt) was gavage-fed. After 3 hours, blood samples were taken by cardiac puncture to analyze plasma FTTC-dextran by fluorescence spectrometry. Samples of small intestine with luminal contents were frozen and sectioned in a cryostat for fluorescence microscopy; the same sections were placed in a 0.2% celloidin solution to preserve mucous gel and were stained by periodic acid-Schiff reaction for light microscopy. In weaned rats, intestinal permeability was examined with different concentrations of intraluminally instilled NAC. RESULTS: The plasma level of FTTC-dextran showed a significant increase (p < .01) in suckling rats compared with the weaned rats. Morphologic findings were similar in both the jejunum and ileum: The spaces between villi were not entirely filled with mucus but filled with FTTC-dextran in suckling rats, whereas the spaces were filled with mucus and not filled with FTTC-dextran in weaned rats. Intestinal permeability in groups with NAC were significantly higher (p < .01) than that in group without NAC. CONCLUSIONS: These results suggest that an increase in the mucous gel layer that coats the epithelial lining according to the maturation of the gastrointestinal tract is one of the most important factors for a restriction in intestinal permeability.
Acetylcysteine↗
Total parenteral nutrition increases uptake of latex beads by Peyer's patches.
BACKGROUND: Dysfunction of the intestinal barrier, as evidenced by increased intestinal permeability and bacterial translocation, has been reported under total parenteral nutrition (TPN). However, the role of Peyer's patches on the intestinal barrier in TPN is not well understood. We investigated whether TPN alters the uptake of microparticles by the follicle-associated epithelium of Peyer's patches. METHODS: Twenty rats were divided into two groups, a control group and a TPN group. Fluorescent polystyrene latex beads, 3.2 +/- 0.2 microns in diameter, were used as a probe for measuring the uptake by Peyer's patches. After 1 week of consuming either the control or TPN diet, rats were killed. On the day of killing, 0.1 mL of latex beads solution was injected into a 1-cm length of ileal loop, within 10 cm of the ileocecal valve. Samples were taken after 30 minutes of injection, sectioned by cryostat, and then viewed under a fluorescent microscope. Follicle-associated epithelial length and particles were counted using a confocal laser scanning microscope. The number of particles within each compartment was standardized per unit length of epithelium of Peyer's patches. RESULTS: Particle numbers within Peyer's patch dome of the TPN group were significantly increased compared with those of the control group (p < .01). CONCLUSIONS: These data suggest that dysfunction of the intestinal barrier in TPN might be associated with a change of uptake by Peyer's patches.
Animals↗
Immunohistochemical, electron microscopic, and immunoelectron microscopic features of plasmacytoma of the thyroid with amyloid deposition.
A rare case of primary plasmacytoma of the thyroid with amyloid deposition is reported. The tumor consisted of diffuse proliferation of atypical plasma cells showing IgG lambda-type monoclonal growth. Amyloid deposition with focal giant cell reaction was also observed. Bone marrow aspiration and systemic skeletal radiographic surveys revealed no evidence of multiple myeloma and myelomatosis. Radial arrangement of amyloid bundles was observed ultrastructurally. By immunoelectron microscopic examination, lambda chain was detected in the amyloid fibrils and rough endoplasmic reticulum of the tumor cells. Our findings suggest the following: amyloid fibrils originate from monoclonal light chains produced by tumor cells, and histiocytes contribute to amyloid deposition as well as to giant cell reaction in extramedullary plasmacytoma.
Amyloid↗
A case of carcinoma associated with the remained intrapancreatic biliary tract 17 years after the primary excision of a choledochal cyst.
Although the incidence of biliary carcinoma associated with choledochal cyst is high, there are extremely rare reports about cancer development in the remaining intrapancreatic biliary tract in patients who underwent primary excision of the choledochal cyst. The authors present a case of carcinoma associated with the remnant intrapancreatic biliary tract in a 39 year-old woman, 17 years after the initial excision of a choledochal cyst with Roux-en-Y hepaticojejunostomy. Long-term follow-up may be recommended even in patients who have undergone excisional surgery for choledochal cyst, because it is possible that cancer associated with the intrapancreatic biliary tract may develop.
Adenocarcinoma↗
Influence of the extent of hepatectomy on the portal hypertensive state in patients with hepatoma.
BACKGROUND/AIMS: Portal hypertensive symptoms, such as esophageal varices and hypersplenism, are frequently observed in patients with hepatocellular carcinoma (HCC). We investigated whether or not the extent of hepatectomy for HCC has an influence on the deterioration of the portal hypertensive state. METHODOLOGY: Fifty-four patients who underwent curative hepatectomy for HCC at our institute were retrospectively studied. The 54 patients were classified in two groups according to the extent of hepatectomy: Group A patients (n = 38) underwent minor hepatectomy (subsegmentectomy or less) and Group B patients (n = 16) underwent major hepatectomy (segmentectomy or more). On the basis of the endoscopic findings for the esophageal varices and the blood platelet counts, the alterations of portal hypertensive state were evaluated before and after hepatectomy. RESULTS: The number of patients whose esophageal varices deteriorated post-operatively, amounted to 9 (23.7%) in Group A and 1 (6.3%) in Group B (not significant). No significant differences were found in the platelet counts between pre- and post-operative states in each Group (A and B). In all of the 6 patients whose esophageal varices first came about after hepatectomy, the advent of the varices occurred more than 1 year after surgery. CONCLUSIONS: These results suggest that in the patients undergoing hepatectomy for HCC, the clinical deterioration of the portal hypertensive state in not caused by the extent of hepatectomy, but by the advance of the coexisting chronic hepatic diseases or tumor recurrence.
Carcinoma, Hepatocellular↗
Physiological studies on nitric oxide in the right sided colon of patients with diverticular disease.
BACKGROUND/AIMS: Previously, we reported that non-adrenergic non-cholinergic (NANC) inhibitory nerves are decreased in the left-sided colon of patients with diverticular disease, contributing to their intraluminal high pressure by segmentation (1). It is established that nitric oxide (NO) is released by stimulation of NANC inhibitory nerves. Among Oriental people, including the Japanese, right-sided diverticular disease has predominated more frequently than among Western people. In order to evaluate the function of NO in the right-sided colon of patients with diverticular disease, we examined the enteric nerve responses in colonic materials from patients with this disease, using the right-sided normal colon as a control. METHODOLOGY: Colonic tissue specimens were obtained from 8 patients with diverticular disease of the right-sided colon, and normal segments of the right-sided colon were obtained from 11 patients with localized diseases. A mechanograph was used to evaluate in vitro colonic responses to electrical field stimulation (EFS) of adrenergic and cholinergic nerves before and after treatment with various autonomic nerve blockers, N(G)-nitro-L-arginine (L-NNA), and L-arginine. RESULTS: 1) Cholinergic nerves were more dominant in the diverticular colon than in the normal colon (p<0.01). 2) NANC inhibitory nerves were found to act on the normal colon and to a lesser extent in the diverticular colon (p<0.05). 3) NO mediates the relaxation reaction of NANC inhibitory nerves in the normal colon and to a lesser extent in the diverticular colon. CONCLUSIONS: The intrinsic intestinal innervation contains excitatory and inhibitory nerves and the former, especially cholinergic nerves, are dominant in the right-sided colon with diverticula. In addition, reduction of the action of NANC inhibitory nerves by substances such as NO may be largely related to the tight intraluminal pressure by colonic segmentation observed in the right-sided colon with diverticula.
Adrenergic Fibers↗
The role of nitric oxide (NO) in the human pyloric sphincter.
BACKGROUND/AIMS: Nitric oxide (NO) has recently been shown to be a neurotransmitter in non-adrenergic non-cholinergic (NANC) inhibitory nerves in the gastrointestinal tract. To clarify the role of NO in the human pyloric sphincter, enteric nerve responses in pyloric tissue specimens obtained from patients with gastric cancer were investigated. METHODOLOGY: Fresh specimens of normal pylorus obtained from 18 patients with gastric cancer were used. The subjects consisted of 12 men and 6 women, aged from 45-74 years (average: 60.1 years). A mechanograph was used to evaluate in vitro pyloric sphincter muscle responses to electrical field stimulation (EFS) of adrenergic and cholinergic nerves before and after treatment with various autonomic nerve blockers, and N(G)-nitro-L-arginine (L-NNA) and L-arginine. RESULTS: Cholinergic nerves were mainly involved in the regulation of enteric nerve responses to EFS in the basal condition of the study, and NANC inhibitory nerves acted on human pylorus. L-NNA concentration dependently inhibited the relaxation in response to EFS in the human pylorus, and this inhibitory effect in the pylorus was reversed by L-arginine. CONCLUSIONS: These findings suggest that the cholinergic/adrenergic and NANC inhibitory nerves play important roles in regulating contraction and relaxation of the human pylorus, and that NO plays an important role as a neurotransmitter in NANC inhibitory nerves of the human pylorus.
Adrenergic Fibers↗
Peptidergic nerves in the colon of patients with ulcerative colitis.
BACKGROUND/AIMS: The cause of impaired motility, such as diarrhea and toxic megacolon, in patients with ulcerative colitis is unknown. Neuropeptides have recently been shown to be a neurotransmitter in the non-adrenergic non-cholinergic inhibitory and excitatory nerves in the human gut. To clarify the physiological significance of vasoactive intestinal polypeptide, substance P and neurotensin in the colon of patients with ulcerative colitis, we investigated the enteric nerve responses on lesional and normal bowel segments derived from patients with ulcerative colitis and patients who underwent colon resection for colonic cancers. METHODOLOGY: Twenty-four specimens were obtained from the lesional colon of 6 patients with ulcerative colitis (4 male, 2 female; ages 14-51 years, mean: 40.3 years). The patients with ulcerative colitis had chronic disease (4 with moderate disease, 2 with severe disease). Seventy-two specimens were obtained from the normal colon of 10 patients with colonic cancer (8 men and 2 women; ages 40-56 years, mean: 51.2 years). A mechanographic technique was used to evaluate in vitro muscle responses to these peptides of adrenergic and cholinergic nerves before and after treatment with various autonomic nerve blockers. RESULTS: (1) Peptidergic nerves such as vasoactive intestinal polypeptide, substance P, and neurotensin nerves were found to act on both normal colon and ulcerative colitis colon; (2) the colon with ulcerative colitis was more strongly innervated by vasoactive intestinal polypeptide nerves than the normal colon; (3) Substance P and neurotensin nerves act more weakly in the UC colon that the normal colon. CONCLUSIONS: These findings suggest that peptidergic nerves play an important role in the impaired motility observed in patients with UC.
Adolescent↗
Role of nitric oxide in the left-sided colon of patients with diverticular disease.
BACKGROUND/AIMS: Non-adrenergic non-cholinergic inhibitory nerves are the most important nerves in the enteric nervous system of the human gut. Recently, it has been established that nitric oxide is released by stimulation of non-adrenergic non-cholinergic inhibitory nerves. Therefore, in order to evaluate the function of nitric oxide in the left-sided colon of patients with diverticular disease, we examined the enteric nerve responses in colonic tissues from patients with this disease, and also used the left-sided normal colon as a control. METHODOLOGY: Colonic tissue specimens (the diverticular bearing segments) were obtained from 9 patients with diverticular disease of the left-sided colon, and normal segments of the left-sided colon were obtained from 16 patients with ascending colon cancer. A mechanograph was used to evaluate in vitro colonic responses to electrical field stimulation of adrenergic and cholinergic nerve before and after treatments with various autonomic nerve blockers, NG-nitro-L-arginine, and L-arginine. RESULTS: 1) The diverticular colon was more strongly innervated by cholinergic nerves than the normal colon (P < 0.01); 2) Non-adrenergic non-cholinergic inhibitory nerves were found to act on the normal colon and to a lesser extent in the diverticular colon (P < 0.05). 3) Nitric oxide mediates the relaxation reaction of non-adrenergic non-cholinergic inhibitory nerves in the normal colon and to a lesser extent in the diverticular colon. CONCLUSIONS: These findings suggest that the intrinsic intestinal innervation contains excitatory and inhibitory nerves and that the former, especially cholinergic nerves, are dominant in the left-sided colon with diverticula. In addition, diminution of action of non-adrenergic non-cholinergic inhibitory nerves by substances such as nitric oxide may be largely related to the high intraluminal pressure by colonic segmentation observed in the left-sided colon with diverticula.
Adult↗
Relationship between gastroduodenal interdigestive migrating motor complex and quality of life in patients with distal subtotal gastrectomy for early gastric cancer.
A total of 40 patients (28 males, 12 females; mean age, 56.6 years; range, 41-72 years), 1-1.5 years (mean, 1.4 years) after subtotal gastrectomy for early gastric cancer (Billroth I, D2 lymph node dissection, curability A) were divided into 2 groups according to the occurrence of interdigestive migrating motor complex (IMMC), phase III from the duodenum, and their postoperative quality of life was compared. Results were as follows: (i) patients in the IMMC, phase III positive group (28 patients) had evidently more appetite and ate more food, with less decrease in body weight compared with the IMMC, phase III negative group (12 patients); and (ii) patients in the IMMC, phase III positive group had clearly less symptoms, such as early dumping symptoms (systemic symptoms), symptoms of reflux esophagitis (e.g. heartburn, feeling of regurgitation, difficult swallowing), nausea, abdominal pain, diarrhea, abdominal distention, and borborygmus, compared with the negative group. These results showed more satisfactory quality of life in the IMMC, phase III positive group compared with the negative group.
Adult↗
Prognostic studies on gastric cancer with concomitant liver metastases.
BACKGROUND/AIMS: The aim of this study was to clarify prognostic factors after surgical treatments in gastric cancer patients having synchronous liver metastases. METHODOLOGY: Clinicopathological features and prognosis were retrospectively reviewed in 43 surgical patients with gastric cancer with concomitant liver metastases from 1984 to 1998. RESULTS: More than half of the patients (51.2%) had numerous liver metastases (H3). Rates of peritoneal metastases (P1, P2, P3: 34.9%), tumor serosal invasion (T3 or T4: 73.8%) and widespread lymph node metastases (N3, N4: 69.8%) were also high. Although the gastric resection was performed in 29 patients (67.5%), concomitant hepatectomy resection was performed in only 3 patients (7.0%). Univariate analysis revealed that the grade of liver metastases (H1, H2, H3) was only a statistically significant prognostic factor (P = 0.008). Concerning surgical treatments, the resection group had tendency to better survival than the nonresection group (P = 0.074). Eight cases survived more than 1 year. Seven of the 8 cases (87.5%) were patients with gastrectomy. All of the 5 two-year survivors were patients with gastrectomy. CONCLUSIONS: In patients with gastric cancer with concomitant liver metastases, the grade of liver metastases indicate prognosis. In addition, there is possibility of palliative gastrectomy increasing the survival rare to more than one year.
Adult↗
A novel operative technique on proximal gastrectomy reconstructed by interposition of a jejunal J pouch with preservation of the vagal nerve and lower esophageal sphincter.
BACKGROUND/AIMS: This article describes the surgical techniques and postoperative status for proximal gastrectomy reconstructed by interposition of a jejunal J pouch with preservation of the vagal nerve and lower esophageal sphincter. METHODOLOGY: We have performed a new technique for reducing postgastrectomy sequelae such as reflux esophagitis, early dumping syndrome, and microgastria in early gastric cancer located in the proximal third of the stomach. The technique consists of proximal gastrectomy with preservation of the hepatic, pyloric, celiac branch of the vagal nerve, and abdominal esophagus (lower esophageal sphincter), and reconstruction by interposition of a jejunal J pouch. To reserve pyloric function, pyloroplasty can be omitted by preservation of the pyloric branch from the vagal nerve. To restore loss of reservoir function, the reconstruction is performed with an interposed jejunal J pouch. Sacrifice of the mesenteric arcades is kept to a minimum to preserve the autonomic nerve and blood flow in the mesentery. RESULTS: All of the patients who underwent this operation were able to eat an adequate amount of food at 6 months after surgery and they were satisfied with their postoperative status. And that, we have not experienced postgastrectomy disorders such the dumping syndrome and reflux esophagitis. CONCLUSIONS: Therefore, this method is useful for preventing the postoperative disorders in patients with early gastric cancer located in the proximal third of the stomach.
Adult↗