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Biomedical subjects

M Hara

Publications and source records attributed to M Hara.

At least 127 records · Page 7Linked to original sources
PubMed2001

Clinicopathological evaluation of surgical treatment for early gallbladder cancer.

We evaluated the therapeutic principles for early gallbladder cancer based on clinicopathological characteristics and outcomes in 27 patients encountered at the Kurume University Hospital between January, 1975 and December, 1999. Concerning the depth of wall penetration, 15 patients had mucosal cancers (m-cancers), and 12 patients muscularis propria cancers(mp-cancers). The gross patterns were lp (pedunculated) in 16 patients, ls (sessile) in 3 patients, IIa (flat elevated) in 4 patients, and IIb (flat) in 4 patients. The operative procedure used was cholecystectomy (C) in 12 patients, 4 of whom underwent lymph node dissection. Full-thickness cholecystectomy (FTC) was carried out in 3 patients, one of whom had lymph node dissection. Combination of C and gallbladder bed resection (GbBR) was performed in 7 patients, 6 of whom had lymph node dissection. Combination of C and bile duct resection (BDR), and lymph node dissection was performed in 1 patient. Combination of C and GbBR and BDR, and lymph node dissection was performed in 6 patients. All the patients who underwent lymph node dissection were negative for metastasis. Of the 27 patients, 2 underwent laparoscopic operation: one with m-cancer was 79 years old, and the other with mp-cancer 86 years old. In the m-cancers, no lymphatic, venous or perineural infiltration was observed. In contrast, in the mp-cancers, lymphatic and venous infiltration each were observed in 4 patients (33.3%), although no perineural infiltration was observed. A diagnosis of gallbladder cancer was made postoperatively in 6 patients, of whom 4 had the IIb pattern and all were complicated by gallstone, indicating the difficulty of diagnosing the IIb pattern. The 5-year survival rates for the m- and mp-cancers were as high as 90.9% and 80.8%, respectively. As a curative surgical technique for m- and mp-cancers, lymph node dissection should be performed in addition to FTC, GbBR, and BDR, in combination. When a postoperative histopathologic diagnosis of gallbladder cancer has been made, no second-look operation should be performed for m-cancers, but lymph node dissection of up to the second group should be performed for mp-cancers in a second-look operation.

Aged↗
PubMed2001

Consumption coagulopathy associated with aneurysms of the abdominal aorta and the bilateral femoral arteries. Report of a case.

The authors report a case of a 70-year-old man, with repeating episodes of systemic subdermal hematoma due to consumption coagulopathy associated with abdominal aortic aneurysm and the bilateral femoral arterial aneurysms. Prior to the first operation for abdominal aortic repair, anticoagulation therapy was applied to treat thrombocytopenia and hypofibrinogenemia. Five years following the first surgery, the same treatment was required before resection of the femoral lesions. Consumption coagulopathy is seen in approximately 1-4% population of aortic aneurysms, however, repeated appearance of symptomatic coagulopathy is rarely reported. Anticoagulation therapy was effective to normalize the coagulation and fibrinolytic system and followed by uneventful surgical resection of the aneurysms.

Aged↗
PubMed2001

Cricoarytenoid arthritis with rheumatoid arthritis and systemic lupus erythematosus.

A 56-year-old woman with rheumatoid arthritis (RA) suddenly developed severe respiratory distress and laryngeal stridor, which required endotracheal intubation. She had had RA for 12 years, which had been controlled well with prednisolone (3 mg/day) at the orthopedic clinic. Laryngoscopy revealed cricoarytenoid arthritis. She was finally diagnosed as having overlap syndrome with RA and systemic lupus erythematosus. She was given high dose corticosteroids that improved her clinical symptoms and laryngoscopic findings. She represents the first patient with overlap syndrome who developed an acute airway obstruction due to cricoarytenoid arthritis.

Arthritis, Rheumatoid↗
PubMed2001

[Mediastinal cystic lesions: CT and MRI findings].

In this article we describe various approaches to the evaluation of mediastinal cystic lesions using CT and MRI. Although cystic lesions generally appear to be uncomplicated and not difficult to diagnose, we consider that there are certain pitfalls in differentiating them from solid lesions. It is important to pay careful attention to the location (including ectopic occurrence), CT attenuation and/or MR intensity, thickness of the wall, tear-drop shape or alternation of shape owing to intrathoracic pressure, and pseudoenhancement. We suggest that MR be recommended when the findings of CT are equivocal, as they were in 32 of our cases.

Adult↗
PubMed2001

Patch reconstruction of the mitral annulus for active infective endocarditis with annular abscess.

Active infective endocarditis is associated with high operative mortality and morbidity. The outcome may be improved by operating at the optimal time using the most appropriate surgical procedure. We describe a 15-year-old man with active infective endocarditis of the mitral valve associated with an annular abscess. Disseminated intravascular coagulation was associated with progressive decrease in the platelet count. The abscess was debrided, the mitral annulus was patch-reconstructed using bovine pericardium treated with glutaraldehyde, then the mitral valve was replaced. The patient was discharged from intensive care unit 3 days after operation with clinical and blood examination improvement. The patient is being observed carefully by periodic follow-up echocardiography, and there is no evidence of PVD, PVE or calcification of the patch during 14 months of follow-up period. Patch reconstruction of the annulus using bovine pericardium treated with glutaraldehyde reinforced the annulus and prevented local reinfection of the prosthesis in this patient.

Abscess↗
PubMed2001

[Simultaneous mitral and aortic valvuloplasty using rasping procedure for combined valvular disease: a case report].

We reported a case of successful simultaneous mitral and aortic valvuloplasty using rasping procedure. A 55-year-old woman with combined valvular disease received this operation. Postoperatively, the mitral valve area increased from 1.15 cm2 to 2.03 cm2. Mitral regurgitation improved. Aortic valve pressure gradient decreased from 21 mmHg to 0 mmHg. Aortic regurgitation also improved. Cardiac Index (CI) increased from 1.94 l/min./m2 to 2.59 l/min./m2. Ejection fraction (EF) also increased from 60% to 82%. The postoperative course was uneventful. Excellent postoperative results of this procedure may be expected, not only in single valvular disease but also in combined valvular disease.

Aortic Valve↗
PubMed2001

FXIIIA subtypes in Indonesians, Bangladeshis, Tibetans, South African blacks and South African whites.

The polymorphism of FXIIIA was investigated in 105 Indonesians, 141 Bangladeshis, 186 Tibetans, 101 South African Blacks and 100 South African Whites using isoelectric focusing followed by immunoblotting. These population data conformed to the Hardy-Weinberg equilibrium. A circum-pan-Pacific cline in the FXIII*1A (or FXIII*1B) allele frequency appeared to exist among the Mongoloids.

Adult↗
PubMed2001

[A case of recurrent hemophagocytic syndrome complicated with systemic sclerosis: relationship between disease activity and serum level of IL-18].

Hemophagocytic syndrome (HPS) is characterized by the activation of the mononuclear phagocytic system with prominent hemophagocytosis in the bone marrow and reticuloendothelial systems, and its occurrence is usually associated with variable disorders such as viral infections and malignant lymphoma. Recently, it was reported that HPS also occurred in association with underlying connective tissue disease, especially systemic lupus erythematosus. We report here a case of recurrent HPS complicated with systemic sclerosis. A 32-year-old woman had been diagnosed as systemic sclerosis since 1994. She was admitted due to unknown high fever and severe pancytopenia in 1997, and the diagnosis of HPS was determined because of hemophagocytosis in bone marrow and hyperferritinemia. Her symptoms were improved by immunosuppressive therapies including steroid pulse therapy and oral prednisolone (60 mg/day). She was followed by the treatment of oral prednisolone which was gradually tapered in our out-patient clinic. In August of 1999 high fever and severe anemia were recurred, and she was admitted again to our hospital because of the diagnosis as recurrent HPS. She had been treated with 40 mg/day of oral prednisolone and fever was immediately disappeared and hemoglobin was gradually increased. HPS is considered to be a rare complication with systemic sclerosis, and the etiology has been unknown. IL-18 is a novel cytokine which is a potent inducer of interferon-gamma, and its properties may be a proinflammatory regulation and activation of monocyte/macrophage and histiocyte through the expression of interferon-gamma. Therefore, the significance of IL-18 in the pathophysiology of HPS was recently reported. In this case, we investigated the significance of IL-18 and revealed the levels of serum IL-18 were well correlated with disease activity of HPS.

Adult↗
PubMed2001

[Allogeneic bone marrow transplantation for refractory multiple myeloma: presence of a graft-versus-myeloma effect].

We investigated the graft-versus-myeloma effect (GVM) after allogeneic bone marrow transplantation (allo-BMT). Three patients with refractory multiple myeloma (MM) underwent related allo-BMT. Two of the patients showed disappearance of serum M protein 4 and 5 months after transplantation, respectively. One of them has remained in complete remission for more than 22 months after allo-BMT, with accompanying chronic GVHD. Two patients with relapse and disease progression after allo-BMT underwent donor lymphocyte infusion (DLI). Although one patient did not respond to DLI, the other developed acute GVHD after 4 weeks and achieved a 75% reduction in serum M protein. DLI did not produce severe acute GVHD or myelosuppression. These findings suggest the presence of a GVM effect. DLI may be an effective therapy for patients with MM who have relapsed after allo-BMT. Furthermore, non-myeloablative stem cell transplantation (mini-transplantation) for refractory MM should be investigated further as a potentially curative option.

Adult↗
PubMed2001

Tumor necrosis factor-alpha (TNF-alpha) converting enzyme contributes to production of TNF-alpha in synovial tissues from patients with rheumatoid arthritis.

OBJECTIVE: Expression and function of tumor necrosis factor-alpha (TNF-alpha) converting enzyme (TACE) in synovia of patients with rheumatoid arthritis (RA) were examined to investigate posttranslational regulation of TNF-alpha production by TACE in RA. METHODS: Expression of TACE protein was evaluated by immunohistochemistry. Cytokines and soluble cytokine receptors were measured by ELISA. TACE mRNA was detected by RT-PCR. The enzymatic activity of TACE was measured using TACE-specific fluorogenic substrate. RESULTS: Expression of TACE at protein level in synovial tissue (ST) of patients with RA was significantly stronger than that of patients with osteoarthritis (OA). In RA, TACE was mainly expressed in CD68+ macrophage-like synovial cells. ST from 9 of 9 RA and 3 of 8 OA patients expressed TACE mRNA. RA ST cells possessed significantly higher TACE-like enzymatic activity than OA ST. A synthetic TACE inhibitor significantly reduced the release of TNF-alpha and p75 TNF receptor from RA ST cells. CONCLUSION: TACE is an important regulator of the secretion of TNF-alpha from synovia of patients with RA.

ADAM Proteins↗
PubMed2001

Mature form of interleukin 18 is expressed in rheumatoid arthritis synovial tissue and contributes to interferon-gamma production by synovial T cells.

OBJECTIVE: To investigate the expression and function of interleukin 18 (IL-18) in synovial tissue (ST) of patients with rheumatoid arthritis (RA). METHODS: The localization of IL-18 in ST was analyzed by immunohistochemistry. IL-18 and IL-18 receptor (IL-18R) mRNA were detected by RT-PCR. Expression of IL-18 at the protein level was analyzed by Western blotting. Cytokines in culture supernatants were measured by ELISA. RESULTS: From immunohistochemical analysis, IL-18-producing cells were localized in the lining layer and sublining region of RA ST. Most of them coexpressed CD68 antigen. In ST from patients with osteoarthritis (OA), IL-18-producing cells were localized only in the sublining region and the numbers of these cells were small. From RT-PCR, RA ST expressed mRNA of IL-18, as well as alpha- and beta-chains of IL-18R. OA ST did not express or very weakly expressed mRNA of alpha- and beta-chains of IL-18R. ST from RA patients produced significantly larger amounts of IL-18 in vitro than OA ST. Western blotting revealed that RA ST expressed mature IL-18 more abundantly than OA ST. IL-12 alone stimulates interferon-gamma (IFN-gamma) production by RA synovial tissue cells, but IL-18 alone could not. In the presence of IL-12, however, IL-18 could synergistically stimulate IFN-gamma production by RA synovial tissue cells. OA synovial tissue cells responded to neither IL-12 nor IL-12 + IL-18. IL-18 showed synergistic effects with IL-12 on promoting the ability of synovial T cells from RA patients to produce IFN-gamma. CONCLUSION: These findings suggest that mature IL-18 is expressed in RA synovia and contributes to the production of IFN-gamma by infiltrating T cells.

Arthritis, Rheumatoid↗
PubMed2001

Reduced expression of p16 and p27 proteins in nasopharyngeal carcinoma.

Nasopharyngeal carcinoma (NPC) is a malignant tumor with a high incidence in east Asian countries. Inactivation of cyclin-dependent kinase (CDK) inhibitors (CKIs) and overexpression of G1 cyclin has been thought to be important for tumor development. To determine whether reduction of CKI (p16 and p27) expression was associated with NPC development, we performed immunohistochemical staining of NPC specimens from 20 patients. We found that p16 and p27 proteins were negative in 8 of 20 and 16 of 20 cases, respectively; that either p16 or p27 proteins were negative in 17 of 20; and that both p16 and p27 were negative in 7 of 20. Excepting the cases in which both CKIs were negative, negativity of p27 alone was statistically higher than that of p16 (9/20 versus 1/20, P = .022), suggesting that the reduction of p27 protein is an important event for the multi-step process of NPC development.

Carcinoma, Squamous Cell↗
PubMed2001

[Usefulness of enhanced ultrasonography after administration of intravenous contrast agent in the evaluation of therapeutic effect in treatment of hepatocellular carcinoma, and efficacy of percutaneous ethanol injection therapy (PEIT) for residual tumor].

PURPOSE: To investigate the usefulness of enhanced ultrasonography after the administration of intravenous contrast agent in the evaluation of therapeutic effect in the treatment of hepatocellular carcinoma (HCC) comparison with dynamic CT, and to examine the efficacy of percutaneous ethanol injection therapy (PEIT) for residual tumor. MATERIALS AND METHODS: Thirty patients (22 men, 8 women; age range, 42-76 years; mean age 60 years) underwent enhanced ultrasonography with the intravenous ultrasonographic agents Levovist, after transcatheter arterial embolization (TAE) (n = 15, size range 23-35 mm, mean 25.3 mm) or PEIT (n = 15, 15-35 mm, mean 24.5 mm), to compare the therapeutic effect with dynamic CT. If residual lesions were detected by enhanced ultrasonography, we performed additional PEIT. RESULTS: The evaluation of enhanced ultrasonography correlated almost completely with that of dynamic CT. Two residual lesions could not be detected by dynamic CT due to lipiodol, but enhanced ultrasonography and dynamic MRI showed them clearly. In total, eight residual tumors (3-15 mm, mean 8.3 mm) were seen. We performed PEIT on seven lesions and obtained good control for six months. CONCLUSION: Enhanced ultrasonography with Levovist could be performed to evaluate the therapeutic effect of treatment for HCC, and could serve as be a good marker for additional US-guided therapy.

Adult↗
PubMed2000

Islet allograft rejection can be mediated by CD4+, alloantigen experienced, direct pathway T cells of TH1 and TH2 cytokine phenotype.

BACKGROUND: It is widely believed that Thl cells that secrete interferon-gamma are primarily involved in the rejection of allografts whereas Th2 cells [interleukin(IL) 4 and IL-10] are thought to be protective of this process. However, the exact role and specificity of these helper T lymphocytes in mediating allograft damage is presently unknown. METHODS: Th0, Th1, and Th2 cell lines specific for the class II MHC molecule H2IAb were adoptively transferred into T cell deficient, syngeneic, diabetic mice before transplantation of fully allogeneic C57BL/10 (H2b) or (CBKxBALB/c)F1 (H2k/d+Kb) islet grafts. T cells were 5-(and-6-)-carboxyfluorescein diacetate succinimidyl ester- (CFSE) labeled to allow detection, immunohistochemistry was performed, and IL-4 transcripts within the rejected islet grafts were quantified by reverse transcriptase polymerase chain reaction (RT-PCR). RESULTS: Adoptive transfer (IV) of Th0-, Th1-, and Th2 IAb-specific T cells resulted in rejection of H2b islet allografts. CFSE-labeling demonstrated that these T cells were able to home to the graft site. CD4+ T cells and CD11b+ macrophages were present within the graft after adoptive transfer of both Thl and Th2 cells. Interestingly, CD8+ T cells and B cells were absent from these rejecting grafts. Even when Th2 cells were introduced directly at the graft site, prompt rejection was still observed despite the presence of increased IL-4 mRNA expression within the islet allografts. CONCLUSIONS: Th2 and Th0 alloreactive CD4+ T helper cells can reject islet grafts with similar efficiency to Th1 cells. These results suggest that deviation of the immune response from a Th1 to Th2 phenotype will not be sufficient to allow successful engraftment of allogeneic organs or tissues.

Animals↗