Biomedical subjects

M Hirokawa

Publications and source records attributed to M Hirokawa.

At least 163 records · Page 9Linked to original sources

PubMed1993

[A case of benign mesothelioma of the tunica vaginalis testis].

A case of benign mesothelioma of the tunica vaginalis testis is described. A 56-year-old man with no history of asbestos exposure presented with a swelling of the left scrotal content. A physical examination revealed a hydrocele and an induration on the left epididymal head. A cytological examination of the hydrocele fluid demonstrated clusters of mesothelial cells without evidence of malignancy (class III). Left inguinal orchiectomy was performed because a 15 mm papillary pedunculated tumor was seen on the surface of the tunica vaginalis. A microscopic examination showed the papillary and glandular structures composed of cuboidal cells with no cytologic atypia, which were consistent with benign mesothelioma. The patient remains well and free of recurrent disease 10 years after operation.

Diagnosis, Differential↗

PubMed1993

[Idiopathic thrombocytopenic purpura (ITP) associated with renal injury: report of a case].

A 42-year-old woman with gross hematuria, left flank pain and vomit after being hit on her back admitted to our hospital. She has been under treatment for idiopathic thrombocytopenic purpura (ITP) with prednisolone for these last 14 years. Computerized tomographic (CT) scan revealed moderate laceration, subcapsular hematoma and perirenal hematoma of the left kidney. We tried treating her conservatively. The main treatment was absolute rest for two weeks, increase in the prednisolone dose and prevention from infection. On the 3rd day, the platelet count dropped to 4,000/mm3, but transfusion of platelets was not done to provide for emergency. The platelet count increased gradually and returned to normal on the 8th day. We decreased the prednisolone dose according to the platelet count. After 5 weeks, microscopic hematuria disappeared. Her clinical course was uneventful and she was discharged after 7 weeks.

Accidental Falls↗

PubMed1992

Human resting B lymphocytes can serve as accessory cells for anti-CD2-induced T cell activation.

Although resting B cells are poor accessory cells for signals transmitted through the TCR/CD3 complex, we report that these B cells can support T cell proliferation when T cell activating signals are delivered through CD2. This was first suggested when leucine methyl ester treatment of PBMC abolished proliferation induced by anti-CD3, but not by the accessory cell-dependent anti-CD2 mAb combination, GT2 and OKT11. Then we demonstrated that unstimulated, resting B cells could support the proliferation of both CD4+ and CD8+ T cells. Aggregated IgG inhibited proliferation, suggesting that anti-CD2 mAb bound to T cells were cross-linked by attachment to B cell FcR. Two lines of evidence suggested that lymphocyte function-associated Ag-1/intercellular adhesion molecule-1 interaction was crucial for anti-CD2-induced proliferation. First, proliferation was blocked by mAb against these adhesion molecules. Second, intercellular adhesion molecule-1 expression rapidly increased on resting B cells after the addition of anti-CD2, but not anti-CD3. This was of interest because fixed monocytes, but not fixed B cells, were able to support the proliferative response. In contrast to lymphocyte function-associated Ag-1/intercellular adhesion molecule-1, CD28/B7 interaction was not required for anti-CD2-induced proliferation, although ligation of these molecules provided important costimulatory signals for stimulation by anti-CD3. Finally, neutralizing antibodies against IL-1 alpha, IL-1 beta, and IL-6 showed only modest inhibitory effects on T cell proliferation. The addition of IL-1 and/or IL-6 to T cells failed to substitute for accessory cells and were only partially effective with fixed B cells. Further evidence of a linkage between CD2 and CD45 isoforms was obtained. Anti-CD45RA, but not anti-CD45RO, potentiated anti-CD2-induced T cell proliferation. These studies have revealed a novel role for resting B cells as accessory cells and have documented costimulatory signals that are important for this effect. Because Ag-presentation by resting B cells to T cells generally leads to T cell nonresponsiveness, it is possible that this tolerogenic signal may be converted to an activation signal if there is concurrent perturbation of CD2 on T cells.

Antigen-Presenting Cells↗

PubMed1992

[Pharmacokinetics of carboplatin after intraperitoneal administration and clinical effect in ovarian cancer].

The patients with ovarian cancer are apt to combine peritonitis carcinomatosa (PC). The effect of intraperitoneal (IP) administration of CDDP against peritonitis carcinomatosa was examined. Hydration was not necessary when CBDCA was injected, because nephrotoxicity of CBDCA was very low compared to CDDP. We studied pharmacokinetics of IP-CBCCA and its efficacy and safety. Four hundreds and fifty mg of CBDCA was dissolved in 1,000 ml of saline and administrated through the subcutaneously implanted Infuse-A-Port for 60 minutes. Complete response was 25%. The platinum concentration in the ascites (injected saline) decreased to 90.8 micrograms/ml at 2 hr after administration and to 3.8 micrograms/ml at 24 hrs, and 79.7 97.5% existed as free Pt. The concentration of serous Pt reached to 6.2 micrograms/ml at 15 min. and was kept at 6-8 micrograms/ml. and 52.4-92.7% existed as free Pt in serum. Pt was excreted to urine and reached to the peak concentration at 4 hr. Adverse effect was mainly myelotoxicity without renal toxicity and emesis. Leukocytopenia of grade 4 was 14.3%, thrombocytopenia was 25.0%. We tried IP administration to the outpatients. The doses were mainly 300 mg, but in some cases, it was escalated to 450 mg, Adverse effect of 300 mg was thrombocytopenia of grade 4 (4.8%). These results suggest that IP administration of CBDCA seemed to be a new method as locosystemic chemotherapy. We demonstrated new chemotherapeutic method to outpatients.

Adenocarcinoma↗

PubMed1992

[Retroperitoneal malignant lymphoma showing follicular type: report of a case].

We report a case of retroperitoneal follicular malignant lymphoma. A 59-year-old man visited the hospital with the chief complaint of a loss of body weight and left epigastric tumor. CT revealed a tumor, 9 x 6 cm, with non-homogeneous density in the left retroperitoneum. Since no clinical metastasis was identified, the tumor and the left kidney were resected en bloc with para-aortic lymph node dissection. Pathological diagnosis was non-Hodgkin follicular lymphoma of mixed small cleaved and large cell type with lymph node metastasis (2/23). The CHOP adjuvant chemotherapy (cyclophosphamide, adriamycin vincristine, Prednisolone) and the radiation therapy were performed after the operation. Recurrence in the mediastinal lymph node occurred 7 months after operation and radiation and the same adjuvant chemotherapy were performed and resulted in complete remission. The patient remained free of the tumor for 27 months at present.

Antineoplastic Combined Chemotherapy Protocols↗

PubMed1992

[Recurrent transitional cell carcinoma of the bladder in a young woman: report of a case].

A rare case of transitional cell carcinoma of the bladder in an 18-year-old female is presented. The chief complaint was gross hematuria and pain on urination. Transurethral resection was performed and pathological findings were low grade transitional cell carcinoma without invasion. During a 5-year follow up, she had relapse of the bladder tumor twice. Transitional cell carcinoma of the bladder in children and adolescents may be low grade, low stage and rarely recurrent, but the possibility of recurrence does exist. We emphasize the necessity of periodic cystoscopy for following up young adolescents with transitional cell carcinoma of the bladder.

Adolescent↗

PubMed1992

[Sick sinus syndrome in a patient with myeloma-associated amyloidosis].

A 62-year-old woman was admitted with general malaise and anorexia in September, 1988. Multiple myeloma (IgA-lambda, Stage IIIb) was diagnosed, and amyloidosis was also diagnosed by abdominal fat aspiration biopsy. A partial remission was achieved by MEVP combination chemotherapy, and she was discharged in December, 1988. She was readmitted because of dizziness and palpitation in April, 1989. A diagnosis of sick sinus syndrome was made, and a VVI permanent pacemaker (PPM) was implanted. She was able to walk to our outpatient clinic for 10 months after the PPM implantation. However, right hemiplegia and aphasia were recognized on April 19, 1990. CT scans revealed low density in the areas of the left anterior and middle cerebral artery. The symptoms of congestive heart failure worsened progressively, and the patient, who had been confined to bed, died on March 5, 1991. She was the fifth myeloma-associated amyloidosis patient who received a PPM implantation. Her survival time was one year and ten months, and was the longest among a small number of reported cases with PPM implantation.

Amyloidosis↗

PubMed1992

[A case of hemangiopericytoma in the pelvic retroperitoneum].

A case of hemangiopericytoma in the pelvic retroperitoneal space is described. A 54-year-old-male had a retroperitoneal mass which had been incidentally detected during evaluation of microscopic hematuria. The pelvic arteriogram revealed an extremely hypervascular mass at the arterial phase and intensive, longlasting and well-demarcated tumor stain at the capillary phase, which were characteristic of hemangiopericytomas. Resection of the tumor was difficult due to a well developed vessel mesh around the tumor and adhesion to the surrounding tissues. The tumor weighted 45 g. The patient has remained free of disease for 29 months postoperatively. Since histopathological malignant features of hemangiopericytoma are still obscure, long term and close follow up is important.

Hemangiopericytoma↗

PubMed1992

[A case of transitional cell carcinoma of renal pelvis with an extremely high serum carcinoembryonic antigen (CEA) level].

A case of urothelial tumor with extremely high serum carcinoembryonic antigen (CEA) levels is described. A 68-year-old female presented with macroscopic hematuria and left flank pain. Laboratory examination revealed an extremely high serum level of CEA (194 ng/ml) and elevated levels of serum CA 19-9 (235 U/ml) and squamous cell carcinoma (SCC)-Antigen (10.7 ng/ml), while urine CEA remained within normal limits. No abnormal findings were recognized in gastrointestinal and respiratory systems, but left renal pelvic tumor (T4N2M0) was discovered. Nephroureterectomy with regional lymph node dissection was done. The pathologic anatomy was infiltrating non-papillary transitional cell carcinoma (TCC, G2 = G3, pT4N2M0). More than 30% of the tumor cells were positive for CEA by ABC-peroxidase staining. Levels of tumor markers remained higher than normal after the operation and were normalized after M-VAC (methotrexate, vinblastine, adriamycin and cisplatin) chemotherapy. However, 6 months after the operation, levels of tumor markers rose again and lung metastases appeared. She died 10 months after the operation.

Aged↗

PubMed1992

[Primary ureteral tumor in the residual ureter: a report of two cases].

Two cases of primary ureteral tumor in the residual ureter are reported. One was in a 40-year-old woman who had undergone simple nephrectomy for renal tuberculosis 6 years earlier. The other was in a 59-year-old man 11 years after ureterostomy for hydronephrosis. They presented with hematuria. Cystoscopic examination revealed a ureteral tumor out of the residual ureteral orifice. Computed tomographic scan showed a perivesical mass attached to the urinary bladder. It is useful for examination of ureteral stump's condition. We performed ureterectomy. The pathological study revealed the former high grade transitional cell carcinoma with squamous cell carcinoma and lymph nodes metastasis and the latter low grade transitional cell carcinoma. They have been free of disease for 5.5 years and 1.75 years, respectively. These cases are the nine and tenth reports of primary ureteral tumor of the ureteral stump in the Japanese literature.

Adult↗

PubMed1991

Clinical study of infertile males with varicocele showing no typical radionuclide blood pooling on dynamic image of scrotal scintigraphy.

A clinical study was done of 19 patients in our male infertility clinic, who were diagnosed as having a varicocele and showed atypical radionuclide accumulation in the dynamic image of scrotal scintigraphy. The semen quality was good in 26 percent and poor in 42 percent. Patients with severe congestion in the varicocele tended to be small in number. The dynamic images of the varicoceles were classified into two groups: one group with no radionuclide accumulation, and one group with patchy radionuclide accumulations. Surgical treatment was performed in patients with poor semen quality or with a long infertility period. Neither improvement in the semen quality nor impregnation was achieved postoperatively in patients who had shown no accumulation of the radionuclide in the dynamic imaging. In patients who had shown patchy radionuclide accumulations, the postoperative results were good. We concluded that preoperative dynamic imaging of scrotal scintigraphy is a good means of estimating the postoperative prognosis of fertility.

Adult↗

PubMed1991

Necrotizing fasciitis rapidly diagnosed by aspiration cytology.

A case of necrotizing fasciitis caused by beta-hemolytic streptococci is reported. A 66-year-old man was admitted because of pain and swelling in the right buttock. Rapid application of aspiration cytology made it possible to diagnose necrotizing fasciitis with bacterial infection. Unfortunately, however, the patient died of cardiac arrest due to hyperpotassemia 11 h after admission. Mortality from this disease is most often related to failure in recognizing it early. Rapid diagnosis and early treatment is mandatory in order to save the patients' life. We emphasize the usefulness of rapid aspiration cytology, despite the unfortunate outcome in the present case.

Aged↗

PubMed1991

[Malignant fibrous histiocytoma of the urinary bladder: a case report].

A case of malignant fibrous histiocytoma (MFH) of the urinary bladder was presented. A 59-year-old man visited our hospital with a chief complaint of gross hematuria with clots. Intravenous urography revealed a filling defect on the left side of the bladder. CT scan demonstrated that the tumor invaded the bladder wall deeply. The histology of the biopsy specimens obtained by TUR was suspected to be transitional cell carcinoma. Bleeding from the bladder was so severe that a lot of units of blood transfusion were required in order to compensate for anemia before total cystectomy was performed. The tumor was hemispheric, moderately demarcated, measuring 5.5 cm x 4.0 cm x 5.5 cm, and located at the posterior wall. The histological diagnosis was malignant fibrous histiocytoma, inflammatory type, with venous invasion of tumor cells. Postoperatively, the patient received 5 courses of combination chemotherapy of adriamycin (100 mg/body, day 1) and dacarbazine (400 mg/body, day 1-5). He is alive with no evidence of local and metastatic disease 24 months after operation, in spite of the poor prognosis predicted from the histological findings. MFH of the urinary bladder is very rare. We also made a brief review of prior reports on this disease.

Antineoplastic Combined Chemotherapy Protocols↗

PubMed1991

[Bilateral renal metastases of lung adenoid cystic carcinoma].

A 79-year-old male was admitted for macroscopic hematuria and right back pain. A mass shadow in the right lower lung fields had been present for three years previously with unconfirmed diagnosis. Excretory urogram, ultrasonogram and computed tomographic scan revealed bilateral renal tumors. Selective right renal arteriogram demonstrated a slightly hypervascular mass in the upper pole of the right kidney. Chemotherapy was not effective. Slow but definite malignant progression developed and the patient died two and a half years later. Autopsy finally revealed the adenoid cystic carcinoma of the right lung with bilateral renal metastases. The renal metastasis of this tumor is the first case in Japan to our knowledge.

Aged↗

PubMed1991

[Clinical analysis of 35 patients with renal injury].

Because of the increase of abdominal trauma owing to traffic accident, the number of renal injury is increasing. Between May 1, 1986 and December 31, 1989, thirty-five cases with renal injury were treated in our hospital. The cases were classified as contusion, minor laceration, major laceration and vascular injury by the clinical findings and the radiographic evaluation. Contusion had 22 patients, who were treated conservatively except one with preexisting hydronephrosis. Four patients of minor laceration were all treated conservatively. In four cases of major laceration nephrectomy was performed, the other five cases were healed conservatively. There were two death cases caused by other organ injuries. The extent of associated injuries influenced the prognosis, rather than the degree of renal damage. Thirty-three cases except two survived with no complication. In cases of major injury same were managed conservatively, other required surgical treatment. Sometimes it is difficult to determine which treatment should be done. Indication for surgical treatment is discussed.

Accidents, Traffic↗

PubMed1990

Reversible inhibition of keratinocyte thymidine incorporation by the calmodulin antagonist, W-7.

Although calmodulin has been suggested as an important regulator of keratinocyte proliferation, its precise role remains unknown. We employed a calmodulin antagonist, N-(6-aminohexyl)-5-chloro-1-naphthalenesulfonamide (W-7), to examine the role of calmodulin on keratinocyte proliferation. N-(6 aminohexyl-1-naphthalenesulfonamide (W-5), a chlorine-deficient analogue of W-7 with little anti-calmodulin activity, was used as the control. W-7 markedly inhibited thymidine incorporation of pig epidermis at concentrations close to its anti-calmodulin activity; W-5 had no effect on the thymidine incorporation. The inhibitory effect of W-7 was reversible; the removal of W-7 from the incubation medium resulted in the reinitiation of the thymidine incorporation, suggesting that W-7 is not a cytotoxic agent. These results are consistent with the view that calmodulin is an essential regulator of keratinocyte proliferation. The epidermal beta-adrenergic response, which is decreased in various hyperproliferative epidermal abnormalities, was increased in W-7-treated hypoproliferative epidermis. The epidermal SOD activity, which is also decreased in the hyperproliferative epidermis, however, was not affected by the W-7 treatment.

Adenylyl Cyclases↗

PubMed1990

Leukocytic fragments in blood smears.

We retrospectively reviewed blood smears from patients with septic shock and/or disseminated intravascular coagulation (DIC) in order to determine whether the appearance of leukocytic fragments on blood smears has any clinical significance. Leukocytic fragments were seen in six of twelve cases with septic shock but in none of three cases of DIC without sepsis. All six cases with leukocytic fragments also showed fragmented erythrocytes. The fact that five of these six cases died and that four were dead within two days after the leukocytic fragments were noted may indicate that this appearance heralds a severe and terminal condition of sepsis. Although the exact reason for the appearance of these fragments is unclear, it seems to be related either to mechanical shearing through microangiopathic fibrin strands, which may also cause erythrocytic fragments, or to a complex alteration in the cell membrane due to bacteria, endotoxin, or other factors. We would like to stress that the presence of leukocytic fragments on blood smears provides an important clue to the patient's prognosis.

Adolescent↗

PubMed1990

[Pure red cell aplasia induced by B19 parvovirus during allogeneic bone marrow transplantation].

We report a patient who had abrupt onset of pure red cell aplasia (PRCA) induced by B19 parvovirus during allogeneic bone marrow transplantation (BMT). A 14-year-old girl with APL in complete remission was admitted in February 1988, for the purpose of BMT. She was received marrow from HLA identical sister on March 17, 1988 (day 0). She received 120 mg/kg cyclophosphamide and 12 Gy total body irradiation for conditioning of BMT. For graft-versus-host disease (GVHD) prophylaxis she was given cyclosporine and short term methotrexate. She did not develop acute GVHD after BMT, but on the day 28 a bone-marrow aspirate revealed findings of PRCA. During this course the number of white blood cell and platelet favorably recovered. B 19 parvovirus DNA was detected in the serum of the day 30 and day 42. Antihuman B 19 parvovirus (HPV) antibody titers were increased: the values of anti-HPV IgM were suddenly elevated and those of anti-HPV IgG were elevated. Serum on the day 42 inhibited erythroid progenitors (CFU-E, BFU-E) but not inhibited myeloid progenitors (CFU-C). A reticulocyte count recovered on the day 50. As the patient was HPV-IgG negative prior to BMT and the donor was HPV-IgG seronegative, the source of infection may be platelet transfusion (day 7 through 14).

Adolescent↗