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Biomedical subjects

M Kawashima

Publications and source records attributed to M Kawashima.

At least 91 records · Page 5Linked to original sources
PubMed1999

A new quadruple therapy for Helicobacter pylori: influence of resistant strains on treatment outcome.

BACKGROUND: There have been no reports concerning the efficacy and safety of a 1-week quadruple therapy regimen of omeprazole, amoxycillin, roxithromycin and metronidazole for Helicobacter pylori infections and the impact of primary resistance on the eradication rate. METHODS: One hundred and sixty-nine consecutive patients with peptic ulcer disease as well as gastritis with biopsy-proven H. pylori infection were entered into an open study of omeprazole 20 mg o.m., amoxycillin 500 mg t.d.s., roxithromycin 150 mg b.d., and metronidazole 250 mg t.d.s. Helicobacter pylori status was determined by urease test, histology and culture. Susceptibility to amoxycillin, metronidazole and roxithromycin was determined by the E-test. RESULTS: H. pylori was eradicated in 155 out of 169 (92%; 95% CI 88-96%) by intention-to-treat analysis, and in 155 out of 163 (95%; 95% CI 92-98%) by per protocol analysis. The prevalence of primary resistance against amoxycillin, roxithromycin and metronidazole was 2 out of 166 (1%), 16 out of 166 (10%) and 27 out of 166 (16%), respectively. H. pylori was eradicated in 25 out of 27 (93%) patients with metronidazole-resistant strains compared with 130 out of 136 (96%) in patients with metronidazole-sensitive strains of H. pylori. It was eradicated in 15 out of 16 (94%) patients with roxithromycin-resistant strains while in 140 out of 147 (95%) patients with roxithromycin-sensitive strains of H. pylori, and in two out of two (100%) patients with amoxycillin-resistant stains compared with 153 out of 161 (95%) in patients with amoxycillin-sensitive strains. H. pylori was eradicated in three out of four (75%) patients with double resistance against metronidazole and roxithromycin compared with 152 out of 159 (96%) patients with sensitive strains to metronidazole and or roxithromycin. None of these differences were statistically significant. Severe side-effects were found in only one out of 169 patients-anaphylaxis due to penicillin. CONCLUSIONS: The 1-week quadruple therapy with omeprazole, amoxycillin, metronidazole and roxithromycin was found to eradicate H. pylori in over 90% of all patients. This regimen was also found to be beneficial for patients with pre-treatment resistant strains to metronidazole, roxithromycin or amoxycillin, and was observed to be safe and well-tolerated.

Adult↗
PubMed1999

Local-regional control by conventional radiotherapy according to tumor volume in patients with squamous cell carcinoma of the pharyngolarynx.

BACKGROUND: To estimate the effect of tumor volume on local-regional control of pharyngolaryngeal cancer by radiotherapy (RT). METHODS: Definitive RT for 48 patients with squamous cell carcinoma of the lateral wall of the oropharynx, pyriform sinus and supraglottic larynx was reviewed. Tumor volume was estimated from computed tomography and it was expressed as the diameter of a sphere the volume of which is equal to the primary tumor (Td) and sum of the volumes of metastatic adenopathies (Nd). All patients received > or =60 Gy (median 66 Gy) to the gross tumor by conventional fractionation with or without chemotherapy. RESULTS: A median period of follow-up for survivors was 32.7 months (range, 12.4-68.6). The 2 year local control rate for T1/2 (n = 30) and T3/4 (n = 18) patients was 72 and 65%, respectively (P= 0.966), however, the rates for Td < 4 cm tumors (n = 37) and Td > or = 4 cm tumors (n = 11) were significantly different (80% vs 27%, P < 0.001). The 2 year regional control rates for Nd < 3 cm lesions (n = 29) and Nd > or = 3 cm (n = 19) lesions were 85 and 42%, respectively (P < 0.001). The 2 year ultimate regional control rates for N2/3 disease with Nd < 4 cm (n = 11) and Nd > or = 4 cm (n = 11) were 100 and 42%, respectively (P = 0.004). CONCLUSIONS: Conventional radiotherapy may allow organ preservation and ultimate local control in patients with Td < 4 cm and Nd < 4 cm disease, but larger volume tumors should be considered candidates for the most intensive chemoradiotherapy.

Adult↗
PubMed1999

A case of a malignant melanoma with late metastases 16 years after the initial surgery.

We report a case of a pulmonary metastasis 16 years after the initial surgery for a malignant melanoma. The patient was a 58-year-old Japanese man. In 1976, he had a pigmented skin lesion with a diameter of 8 mm on his right third finger. He received an amputation of the finger and a dissection of the right axillary. Histological examinations of the tumor revealed a feature of a malignant melanoma with infiltration of the papillary layers of the dermis, 1.5 mm in thickness. The histological subtype was considered to be an acral lentiginous melanoma with a mixed spindle-epithelioid cell pattern. There was no regional lymph node metastasis. In December 1992, when he was 74-years-old, a round tumor in the left lower lung was discovered by chest radiography. In February 1993, he received a left lower lobectomy of the lung. Histological examination revealed a feature of a malignant melanoma with predominantly epithelioid cells and this was considered to be a metastasis from the initial skin lesion. Five months after the lobectomy, he died from a hemorrhage of a metastatic brain tumor. This case indicated the importance of periodic, life-long follow-up in treating malignant melanomas.

Amputation, Surgical↗
PubMed1999

Preliminary results of pelvic autonomic nerve-preserving surgery combined with intraoperative and postoperative radiation therapy for patients with low rectal cancer.

BACKGROUND: In Japan, lateral lymphadenectomy was widely performed for patients with stage II-III rectal tumors because it was thought to contribute to good local control, but the pelvic autonomic nerves were thus sacrificed. Although autonomic nerve-sparing surgery with lateral lymph node dissection has been tried from around 1987, the type of nerve sparing varied and the indications were not established. To examine the possibility of expanding the indications for total pelvic autonomic nerve preservation for patients with low rectal cancer, we conducted a pilot study. METHODS: Between 1993 and 1997, a total of 50 patients with low rectal cancer underwent pelvic autonomic nerve preservation with lateral lymphadenectomy of both sides and intraoperative radiation therapy followed by postoperative radiation therapy. RESULTS: The median follow-up period for surviving patients was 41 months. The 3-year local control rates for all patients, with stage I-II and stage III tumors were 88% (95% confidence interval, 78-97%), 97% (90-100%) and 73% (52-94%), respectively. The site of local recurrences was not near or within the preserved plexus. CONCLUSIONS: The preliminary results showed good local control rate for patients with stage I-II tumors. For patients with stage III tumors, the local control rate was unsatisfactory, but nerve sparing was not the cause of local recurrence. Further investigation of function-preserving surgery without decreasing curability is needed.

Adult↗
PubMed1999

Identification of an androgen receptor within the uterus of the domestic fowl.

Cytosolic and nuclear fractions of the uterus (shell gland) of the hen's oviduct were found to contain a specific [17alpha-methyl-3H]-methyltrienolone ([3H]R1881; a synthetic androgen) binding component having properties of an androgen receptor; i.e., binding specificity, high affinity, and limited capacity. The value of the equilibrium dissociation constant (Kd) was of the order of 10(-9), and did not differ between laying and nonlaying hens. The maximum binding capacity (Bmax) per gram of tissue of both fractions was greater in laying hens than in nonlaying hens. When 5alpha-dihydrotestosterone was administered exogenously, the Bmax of the cytosolic fraction decreased and that of the nuclear fraction increased without any change in Kd. The specific binding in both fractions was at an increased level from 4 to 11 h before oviposition, suggesting that androgen binding may be related to certain events during an early stage of shell formation in the uterus of laying hens.

Animals↗
PubMed1999

Prostaglandin F concentration in serum of hens and cocks.

Prostaglandin F (PGF) concentrations in the serum of laying and nonlaying hens and of cocks at various times during a day were measured by radioimmunoassay. The serum concentration of PGF was higher in laying hens than in nonlaying hens or cocks without regard to time of day. In all birds, the concentration showed a peak at 2 h after onset of light (0700 h). In laying hens on the day of laying the fourth egg of a sequence, two peaks were found: one at 2 h after onset of light and another at the time immediately after oviposition. The results suggest that the serum concentration of PGF in both male and female chickens shows a daily change and that in laying hens it also shows a change associating with oviposition.

Animals↗
PubMed1999

Influence of deflated and anaerobic conditions during cold storage on rat lungs.

Energy depletion closely correlates with ischemia-reperfusion (I-R) injury in solid organs, but there has been no conclusion about the lungs that contain air. We investigated the alveolar state during cold storage and its relation to energy metabolism and I-R injury in an ex vivo rat lung model. The lung was deflated (DEF group) or inflated with either room air (RA group) or nitrogen (N(2) group) for 6 h at 4 degrees C, and reperfusion samples of buffer and bronchoalveolar lavage fluid (BALF) was collected (n = 6, each). Furthermore, the static lung compliance, the intrapulmonary high-energy phosphates, lactate, and pyruvate were measured. The pulmonary functions of the DEF and N(2) groups were significantly worse than those of the RA group. In the N(2) group, the intrapulmonary levels of energy charge and pyruvate/lactate ratio were significantly lower than those in the DEF and RA groups, whereas there were no significant differences between the DEF and RA groups. In the DEF group, total protein and lactate dehydrogenase (LDH) in the BALF were significantly higher whereas the static lung compliance was significantly lower compared with the N(2) and RA groups. We concluded that aerobic metabolism would be essential for attenuating I-R injury of the lung, and inflation of the alveoli would be necessary for avoiding mechanical damage during reexpansion.

Air↗
PubMed1999

[A case of Takayasu's arteritis with ulcerative colitis diagnosed by carotodynia and MRI findings].

We experienced a case of Takayasu's arteritis (TA) with ulceritive colitis (UC) having the onset of carotodynia, not accompanied by ischemic symptoms. MRI findings of the neck demonstrated a thickening of the bilateral carotid artery walls. The patient was treated by prednisolone with a marked improvement in both clinical symptoms and MRI findings. The patient had a unique HLA haplotype reported to correlate with both TA and UC. Carotodynia is an early but pathognomonic symptom of TA and MRI is helpful for the early diagnosis of TA.

Adult↗
PubMed1998

Radiotherapeutic Management of Brain Metastases from Breast Cancer.

We have reviewed the medical records of 28 breast cancer patients with brainmetastases who were treated with radiotherapy at our clinic from 1980 through 1994(4 patients, postoperatively; 24 patients, radiotherapy alone). Radiotherapy was delivered as whole brain irradiation using lateral opposed 10 MV X-rays. Tenpatients received an additional boost to a reduced field. One patient was treated with localized stereotactic irradiation alone. The radiation dose for tumorsranged from 32 Gy to 60 Gy(mean, 49 Gy)in 2 or 3 Gy daily fractionated doses. The brain was the first site of metastatic involvement in only two patients. In the 26 evaluable patients, neurologic functional improvement was achieved in 24 patients(92%)with complete response(CR)in 12 patients(46%)and partial response(PR)in 12 patients(46%). The survival rates from the initial treatment were 39% at 5 years and 16% at 10 years(median survival time, 50 months), and those after treatment of brain metastases were 29% at one year and 18% at 2 years(median survival time, 6 months). Performance status tended to be associated with survival(p=0.10), and the presence of liver metastasis was the most important risk factor concerning survival(p=0.056). Two patients suffered severe chronic complications.One patient developed severe dementia after whole brain irradiation with a total dose of 45 Gy in 3 Gy daily fractionated dose, and another patient developed widespread brain necrosis after combined radiotherapy with intrathecal local infusion of methotrexate. Radiotherapeutic management is useful for breast cancer patients with brain metastasis, and long-term survival may also be possible even if patients have preexisting extracranial metastases, except for hepatic involvement. Radiation-related complications should therefore be avoided in these patients.

Journal Article↗
PubMed1998

Flow cytometric single-cell analysis of cytokine production by CD4+ T cells in synovial tissue and peripheral blood from patients with rheumatoid arthritis.

OBJECTIVE: To determine the cytokine profile of CD4+ T cells in the synovial tissue (ST) of rheumatoid arthritis (RA) patients at the single-cell level. METHODS: Unseparated ST cells and paired CD4+ T cells separated from the peripheral blood (PB) and ST of RA patients were stimulated for 4 hours with phorbol myristate acetate (PMA) plus calcium ionophore A23187, or for 6 hours with immobilized anti-CD3 plus anti-CD28, in the presence of brefeldin A. Cells were stained for intracellular cytokines such as interferon-gamma (IFNgamma), interleukin-2 (IL-2), IL-4, IL-10, and IL-13, in combination with cell surface markers. The percentages of cytokine-producing T cells were analyzed by flow cytometry. RESULTS: When ST cells were stimulated with PMA plus A23187 in bulk culture, IFNgamma-producing T cells were more frequently detected in the CD8+ subset, but cells producing other cytokines were found in the CD4+ subset. Purified ST CD4+ T cells, after stimulation with PMA plus A23187, were able to produce higher levels of IFNgamma but lower levels of IL-4 and IL-13, by analysis at the single-cell level, as compared with the PB CD4+, CD45RO+ T cells. The majority of IL-4- or IL-13-producing ST CD4+ cells produced IFNgamma, although PB CD4+ T cells rarely showed this cytokine pattern. IL-10-producing CD4+ T cells were more frequently found in the ST than in the PB. Of interest, most of the IL-10-producing ST CD4+ T cells were able to produce IFNgamma. IL-2-producing CD4+ T cells were similarly present in both compartments. Similar intracellular cytokine patterns were observed with anti-CD3 plus anti-CD28 stimulation, although the number of detected cells was lower. CONCLUSION: These data indicate that CD4+ T cells present within the inflamed synovium have apparently distinct cytokine profiles from those of memory CD4+ T cells in the PB, as typified by their ability to secrete both IFNgamma and IL-10.

Aged↗
PubMed1998

An important role of tumor necrosis factor-alpha in the induction of adhesion molecules in psoriasis.

Recent studies have suggested that cell adhesion plays an important role in the development and regulation of inflammation. To elucidate the mechanisms of regulation of adhesion molecule expression by cytokines in psoriatic lesions, we compared the expression of intercellular adhesion molecule-1, vascular cell adhesion molecule-1, E-selectin, and P-selectin immunohistochemically in involved and uninvolved psoriatic skin with the expression of these molecules in normal skin, and measured the amounts of tumor necrosis factor-alpha, interferon-gamma, interleukin-1alpha, and interleukin-1beta in the supernatant of freeze-thawed skin specimens using an enzyme-linked immunosorbent assay. There was strong staining for P-selectin on endothelial cells from involved skin. There was also strong staining for intercellular adhesion molecule-1 on keratinocytes, dermal infiltrates, and endothelial cells from involved skin and on endothelial cells from uninvolved skin, and strong staining for vascular cell adhesion molecule-1 on dermal dendritic cells and fibroblasts and for E-selectin on endothelial cells from involved skin. Large amounts of tumor necrosis factor-alpha were detected in six out of ten specimens of involved skin, but not in uninvolved or normal skin, although interferon-gamma was detected in both involved and uninvolved skin to the same extent. Neither interleukin-1alpha nor interleukin-1beta was detected in involved skin. There was strong staining for tumor necrosis factor-alpha on keratinocytes and endothelial cells from involved skin. These findings suggest that tumor necrosis factor-alpha might play an important role in the induction of vascular adhesion molecules in psoriatic lesions.

Adolescent↗
PubMed1998

Chicken lutropin acts like follitropin in rat ovarian follitropin receptor: an isoelectric focusing study.

This study investigates whether chicken lutropin (LH) specifically binds to rat ovarian follitropin (FSH) receptor and exerts FSH-like bioactivity. Glycoprotein fraction, prepared from the chicken anterior pituitary gland, was fractionated using isoelectric focusing within a pH range of 3.5-11. Analysis of the focused fractions, by a radioreceptor assay (RRA) specific for FSH in rats using rat ovarian homogenate as receptor source, and 125I-labeled rat FSH as radioligand, detected a large component having an isoelectric point of 10.25. This focusing profile obtained by RRA was quite similar to that obtained by a specific radioimmunoassay (RIA) for chicken LH, but clearly different from that obtained by a specific RIA for chicken FSH, indicating this RRA specifically recognizes chicken LH. Chicken LH fraction prepared from the electrofocused material was used for further studies. The chicken LH preparation was three times more potent than rat FSH in the RRA in displacing the radioligand bound to rat ovarian receptor, while chicken LH facilitated an 8-fold less production of estradiol in dispersed rat granulosa cells than rat FSH. These results suggest that chicken LH acts like rat FSH in rat ovarian FSH receptor, but receptor-binding activity is much higher than biological activity.

Animals↗