Biomedical subjects

M Kayahara

Publications and source records attributed to M Kayahara.

At least 55 records · Page 3Linked to original sources

PubMed1995

Surgical strategy for carcinoma of the pancreas head area based on clinicopathologic analysis of nodal involvement and plexus invasion.

BACKGROUND: The pattern of tumor spread, vis-à-vis nodal involvement and invasion of the extrapancreatic plexus (Plx), has not been thoroughly described for carcinoma of the pancreatic head area. METHODS: From 1973 to 1991, 110 patients (49 with carcinoma of the pancreatic head [Ph], 29 with distal bile duct cancer [Bi], and 32 with carcinoma of the papilla of Vater [Pv]) underwent pancreatectomy at Kanazawa University Hospital. Nodal involvement and Plx invasion were precisely evaluated by histopathologic examination. RESULTS: Thirty-seven (76%) of the 49 patients with Ph, 20 (69%) of the 29 with Bi, and 14 (44%) of the 32 with Pv had nodal involvement. The lymph nodes most commonly involved for Ph were the posterior pancreaticoduodenal lymph nodes (numbers 13a [superior] and 13b [inferior]), the superior mesenteric lymph nodes (number 14), the paraaortic lymph nodes (number 16), and the anterior pancreaticoduodenal lymph nodes (number 17) (13a, 51%; 13b, 47%; 14, 36.7%; 16, 18.4%; 17a, 33%; 17b, 22%). In patients with Bi, lymph nodes around the hepatoduodenal ligament (number 12) and lymph nodes numbers 13a and 14 were most commonly involved (12, 27.6%; 13a, 51.7%; 14, 34.5%). In patients with Pv, lymph node numbers 13b and 14 were most frequently involved (13b, 34.4%; 14, 15.6%). No significant correlation was noted between the tumor size and nodal involvement in these three lesions. Nodal involvement was an important prognostic factor for carcinoma of the pancreatic head area. Plx invasion in these three carcinomas was observed in 61% of patients with Ph, 29% of patients with Bi, and 3% of patients with Pv. CONCLUSIONS: Nodal involvement and Plx invasion differed significantly among carcinomas of the pancreatic head area. We believe that nodal dissection of at least group number 14 is needed for Ph, Bi, and Pv cancers. In addition, dissection of lymph nodes of number 16 and the Plx around the superior mesenteric artery and celiac axis are needed in Ph cancer. Plx dissection of the first portion of plexus pancreaticus capitalis is needed in Bi cancer.

Actuarial Analysis↗

PubMed1995

Expression of basic fibroblast growth factor and its receptor in human pancreatic carcinomas.

We examined the expression of basic fibroblast growth factor (FGF) and FGF receptor by immunohistochemistry in 32 human pancreatic ductal adenocarcinomas. Mild to marked basic FGF immunoreactivity was noted in 19 (59.4%) of the 32 tumours examined, and 30 (93.3%) of the tumours exhibited a cytoplasmic staining pattern against FGF receptor. The tumours were divided into two groups according to the proportion of positively stained tumour cells: a low expression group (positive cells < 25%) and a high expression group (positive cells > or = 25%). No statistically significant difference in tumour size, differentiation, metastases or stage was found between the low and high basic FGF expression groups. However, a significant correlation was found between FGF receptor expression level and the presence of retroperitoneal invasion, lymph node metastasis, and tumour stage. In addition, low FGF receptor expression was significantly associated with a longer post-operative survival as compared with high FGF receptor expression, whereas there was no significant difference in post-operative survival between the low and high basic FGF expression groups. Increased expression of FGF receptor is correlated with the extent of malignancy and post-operative survival in human pancreatic ductal adenocarcinomas. Thus, overexpression of FGF receptor may prove to be a more useful prognostic marker than basic FGF expression level in pancreatic cancer patients.

Adult↗

PubMed1995

[Airborne Japanese cedar allergens studied by immunoblotting technique using anti-Cry j I monoclonal antibody--comparison with actual pollen counts and effect of wind speed and directions].

We collected airborne particles of Japanese cedar pollen with Burkard's sampling tape in Toyama from February to April 1992. The tape was cut into two pieces in parallel to time axis. The one of piece of the tapes was stained with glycerin-jerry and stained pollens were counted with a microscope. The other piece was treated according to the immunoblotting technique. The airborne pollen allergens, reacting with anti-Cry j I monoclonal antibody, were stained as blue spots. The spots were classified by diameter into two groups, large spots (> 50 microns) and small spots (< 50 microns). There were significant correlations found between the airborne Cry j I allergen spots (in large and small) and actual pollen counts obtained with the Burkard's sampler and the Durham's sampler (r = 0.729, 0.586 in large spots and r = 0.676, 0.489 in small spots, p < 0.001). The counts of small spots stayed in high level even in April when actual pollen counts decreased. We concluded that this discrepancy was caused by allergenic crushed cedar pollen particles staying floating longer than actual pollens. Secondly we set a gauge of wind speed and direction at the same point as the samplers. The actual pollen counts and large spots counts were significantly larger in the wind (SE wind in Toyama city) from cedar trees blooming area than other areas. However small spots counts did not differ significantly according to wind directions. Wind speed did not effect on actual pollen counts, large spots counts and small spots count.

Air↗

PubMed1995

Evaluation of long-term survivors after pancreatoduodenectomy for pancreatoduodenal carcinoma.

Long-term survivors (> or = 5 years) of pancreatoduodenal carcinoma were evaluated. The absence of retropancreatic invasion seemed to be an important factor for long-term survival in carcinoma of the pancreatic head, carcinoma of the intrapancretic bile duct confined within the bile duct wall, and stage II papilla of Vater carcinoma. The mode of infiltration was INF alpha or INF beta, with a low infiltration tendency. Lymph node metastasis, when present, was confined to the pancreatic head. It is noteworthy that two of the patients with intrapancreatic bile duct cancer had perineural infiltration to the pancreatic head plexus. In patients treated by extended resection, postoperative malnutrition and diarrhea was severe, indicating the importance of long-term nutritional management.

Aged↗

PubMed1995

[Study of cockroach allergy in asthmatic children. The positive rates and antigenicity of cockroach allergen].

The specific IgE antibodies to 4 species of cockroach were measured in sera from 51 asthmatic children 6 to 16 years old by RAST and CAP system. Positive rates of RAST to Periplaneta fuliginosa, Blattela germanica, Periplaneta americana and Periplaneta japonica were 17.6%, 29.4%, 19.6% and 15.7%, respectively and those of CAP system to Periplaneta fuliginosa and Blattela germanica were 15.7%, respectively. Among those with positive RAST to 4 species of cockroach there were significant correlations. Significant correlations were observed also between the RAST titer for the whole bodies and feces of Periplaneta fuliginosa and Blattela germanica and immunoblotting analysis of sera obtained from two cockroach-positive patients revealed common sensitive fraction between whole body and feces. Immediate bronchial response was detected by bronchial provocation test. RAST inhibition study indicated no cross-reacting allergenicity between cockroach and mite. Collectively, cockroach is one of important inhalent allergens in asthmatic children.

Adolescent↗

PubMed1994

Clinical study of lymphatic flow to the paraaortic lymph nodes in carcinoma of the head of the pancreas.

BACKGROUND: At Kanazawa University, the authors have been developing an appropriate radical operation for the treatment of cancer of the head of the pancreas. As a result of previous research, it was believed that lymphatic metastasis of carcinoma of the head of the pancreas should be investigated more thoroughly to improve the surgical results. METHODS: Forty-two cases of carcinoma of the head of the pancreas were investigated to determine the distribution of lymphatic metastases. From among these cases, the authors injected activated carbon particles in 10 patients with pancreatic cancer and 111In colloid in seven patients with pancreatoduodenal cancer to investigate the lymphatic spread from the head of the pancreas to the paraaortic lymph nodes (area 16). RESULTS: The main lymphatic route from the head of the pancrease to lymphatic area 16 was found to pass through the nodes in the posterior part of the head of the pancrease (area 13) and around the superior mesenteric artery (area 14). Lymphatic metastases in area 16 were seen mainly in the lower segment of the middle region from the celiac artery to the inferior mesenteric artery (subarea 16b2). The carbon and 111In colloid flowed mostly to the same area 16 lymph nodes and toward the dorsal side of the renal artery rather than spreading superficially along the abdominal aorta. CONCLUSIONS: These results indicate that area 16 lymph node dissection should be extended toward the dorsal side of the renal artery rather than be performed widely along the abdominal aorta to make the radical operation for pancreatic cancer more extensive.

Abdomen↗

PubMed1994

Recurrence of intrahepatic stones after an end-to-side choledochojejunostomy.

The risk factors for the recurrence of intrahepatic stones after an end-to-side choledochojejunostomy were investigated, along with the outcome following the treatment of such stones. Thirty-two patients with intrahepatic stones underwent an end-to-side choledochojejunostomy, and a complete lithotomy was achieved in 26 of them. The follow-up which ranged from 5-19 years after surgery revealed that eight patients developed a recurrence of intrahepatic stones, and their clinical and cholangiographic findings were thus reviewed. Recurrent stones were associated with onset of symptoms at a younger age and were predominantly located in the intrahepatic bile ducts. Recurrence was also associated with severe intrahepatic bile duct dilatation. Six of the eight patients developed recurrent stones more than 5 years after a complete lithotomy. One of these patients died of liver cirrhosis while two died of acute obstructive suppurative cholangitis. Five patients underwent cholangioscopic lithotomy through the jejunostomy for their recurrent stones, and a complete lithotomy was accomplished in three of them. These findings indicate the necessity of performing a hepatectomy in such patients whenever possible, and also emphasize the need for a long-term follow-up after a complete lithotomy with an end-to-side choledochojejunostomy. In addition, any recurrent stones should be treated promptly by a cholangioscopic lithotomy through a jejunostomy.

Adult↗

PubMed1994

Pancreatic resection for periampullary carcinoma in the elderly.

The effect of pancreatic resection for periampullary carcinoma in the elderly was studied by comparing the pre- and perioperative factors affecting survival in 102 patients less than 70 years of age (group A) with those in 28 patients 70 years and older (group B). Concomitant cardiac and pulmonary diseases were significantly more frequent in group B (P < 0.05), but the difference in routine laboratory data was not significant. The overall operative mortality was 7% (7/102) in group A and 18% (5/28) in group B, while the actuarial 5-year survival rates were 31% in group A and 23% in group B, these differences not being significant. A multivariate analysis using a logistic model showed that blood loss was the greatest risk factor for early postoperative death in the elderly patients, whereas anastomotic dehiscence and postoperative bleeding were significant factors in the younger patients. Thus, we conclude that age is not a contraindication to pancreaticoduodenectomy which offers the only hope for long-term survival in patients with periampullary carcinoma; however, meticulous dissection to minimize blood loss is especially important in elderly patients.

Actuarial Analysis↗

PubMed1994

Three-dimensional studies on the structure of the tissue surrounding the superior mesenteric artery.

The anatomy and topography of tissue surrounding the superior mesenteric artery were examined histopathologically, and the structure surrounding the superior mesenteric artery (SMA) was reconstructed with data from histologic examination and three-dimensional analyses. Specimens were obtained from three autopsy cases without abnormalities, two surgically resected cases of cancer of the pancreatic head, and one autopsy case of cancer of the pancreatic head. The endothelium or basal membrane of blood and lymph vessels were identified immunohistochemically, and the distribution of lymph nodes, blood vessels, lymph vessels, and collagen fibers was determined. The superior mesenteric plexus was found to be a relatively dense structure with a thickness of about 2 mm, composed of collagen fibers and connective tissue, which concentrically enveloped the small arteries, the superior mesenteric artery, nerve bundles, and capillaries. Lymph vessels larger than a few micrometers in diameter were often found outside of the plexus, and this plexus contained no lymph nodes in any sections. The three-dimensional study of the modes of spread along the superior mesenteric artery of pancreatic cancer revealed two types of spread: the tumor extends mainly by neural invasion, and the tumor extends mainly by lymph node metastases. These morphologic features suggest that lymphatic flow in the vicinity of the superior mesenteric artery passes primarily outside of the plexus, and complete excision of lymph nodes close to the superior mesenteric artery with preservation of the superior mesenteric plexus is feasible if there is no neural invasion into retropancreatic tissues.

Biomarkers↗

PubMed1994

Small pancreatic adenocarcinomas: efficacy of MR imaging with fat suppression and gadolinium enhancement.

PURPOSE: To compare the efficacy of fat-suppressed T1-weighted magnetic resonance (MR) imaging and dynamic MR imaging in the diagnosis of small pancreatic adenocarcinomas. MATERIALS AND METHODS: Pancreatic adenocarcinomas in 15 patients were evaluated with dynamic computed tomography (CT) and five MR imaging sequences that included fat-suppressed T1-weighted technique and dynamic multiplanar gradient-recalled acquisition in the steady state technique. RESULTS: The difference in contrast-to-noise ratios between tumor and normal pancreas was significantly different (P < .05) between the five MR imaging sequences used. In six patients, the combination of dynamic MR imaging and fat-suppressed imaging was superior to dynamic CT in the detection of tumors. Tumors accompanied by chronic pancreatitis were less distinct on fat-suppressed images but were clearly visible on dynamic MR images. Peripancreatic extension of tumors was better recognized on T1-weighted images and CT scans than on fat-suppressed images. CONCLUSION: Fat-suppressed T1-weighted images and dynamic MR images were useful in the detection of pancreatic carcinomas. T1-weighted images and CT scans were superior in the evaluation of tumor extension.

Adenocarcinoma↗

PubMed1994

Variable loading cholangiomanometry and clinical applications.

We have designed a variable loading cholangiomanometric method, which permits a precise and objective evaluation of distal bile duct function. Normal resistance (R) values (1-7 units) and residual pressure (P) values (50-150 mm H2O) have been defined by this method. We have performed this procedure on 138 patients with cholelithiasis, and have found that 13 patients with cholecystolithiasis and 14 patients with choledocholithiasis have elevated R and P values in the distal bile duct. These patients also had morphological abnormalities in the distal bile duct. There was a high percentage of patients with abnormal pressure/flow curves at high flow rates among patients with morphologically dilated bile ducts. Division of pressure/flow curve patterns at low flow rates into three types made it possible to differentiate between functional and structural abnormalities. Patients in whom the residual P values were high and morphological defects of the distal bile duct. The possible application of these measurements in determining the need for additional surgery on the inferior bile duct, particularly papilloplasty, is discussed.

Bile Ducts↗

PubMed1994

[Bronchial hypersensitivity and development of bronchial asthma in children with atopic dermatitis].

Using histamine inhalation tests, we followed changes in bronchial hypersensitivity in 48 children with atopic dermatitis (AD) who were nonasthmatic on their initial visit. Twenty-three of these subjects became asthmatic during the follow-up period. The respiratory thresholds to histamine RT-Hist) of children with AD were widely distributed, ranging from 156 to more than 5000 micrograms/ml. There was a statistical difference in RT-Hist, as those who became asthmatic showed lower levels (< or = 625 micrograms/ml) at 2-6 yr of age. The percentage of peripheral eosinophil counts and IgE level was significantly elevated in those who became asthmatic. Subjects who developed asthma were more likely to have had positive D.p. RAST when they were less than 2 yr of age. The development of asthma in children with AD showed no significant relationship with family history of bronchial asthma.

Age of Onset↗

PubMed1994

[Bronchial hypersensitivity to histamine in asthmatic children longitudinal study from first visit to remitted state].

In order to examine the changes in bronchial hypersensitivity, histamine inhalation tests were evaluated in 27 asthmatic children who remitted. The respiratory threshold to histamine (RT-Hist) 2-3 yrs after remission was higher than in the initial test, in their worst periods of the asthma and just before remission (p < 0.001, p < 0.001, p < 0.005, respectively). Eleven subjects (40.7%), showed no improvement of bronchial hypersensitivity 2-3 yrs after remission (RT-Hist was 1250 micrograms/ml or lower). In this group, the asthma score per year two and three years before symptom-free state was higher than in the group with improved bronchial hypersensitivity (p < 0.05). There was no significant difference between % fall of FEV1.0 in RT-Hist in the worst periods of the asthma and 2-3 yrs after remission. FEV1.0/VCP, %V50, %V25 and V25/Ht 2-3 yrs after remission were higher than those in the worst periods of the asthma.

Adolescent↗

PubMed1994

Neural invasion and nodal involvement in distal bile duct cancer.

Nodal status and neural plexus invasion are important prognostic factors in pancreaticobiliary cancer. The relationship between neural invasion and nodal involvement is evaluated, and its significance for therapy discussed. During the last 20 years, 29 patients with distal bile duct cancer underwent pancreaticoduodenectomy at our institute. An accurate evaluation of the relationship between nodal involvement and plexus invasion was done by histological examination. Twenty of the 29 patients had nodal involvement (68.9%) including 11 patients (37.9%) with nodal involvement of the third group of lymph node (n3). None of these 11 patients had tumors confined to the bile duct wall (panc0 disease). Eight patients (27.6%) had plexus invasion. None of these patients had panc0 disease. The most frequent site of extrapancreatic plexus invasion was the first portion of the plexus pancreaticus capitalis. Nodal dissection around the superior mesenteric artery, and plexus dissection in the hepatoduodenal ligament, around the hepatic artery, and at the first portion of plexus pancreaticus capitalis is necessary in the treatment of distal bile duct cancer, except in patients with no evidence of pancreatic invasion.

Adult↗

PubMed1994

[A case of anaphylaxis caused by sunflower seed].

A 14 years old boy experienced an anaphylactic reaction of dyspnea, vomiting, urticaria and hypotension after he ate sunflower seeds. Specific IgE-mediated hypersensitivity to sunflower seen extract was demonstrated by skin tests and radioallergosorbent test (RAST). By immunoblotting test analysis (SDS-PAGE, Western blotting method), the allergenic activity of sunflower seem were shown to be in the MW range of 13.5 Kd.

Adolescent↗

PubMed1994

[Progress of preoperative diagnosis of pancreatic tumor--with special reference to extension of pancreatic cancer].

Preoperative diagnosis of the extension of pancreatic cancer is very important for determining the range of resection. We evaluated the preoperative imaging diagnosis of the tumors and compared it with the pathological diagnosis. Out of 68 pancreatic head cancers, the percentage of correct diagnosis of serosal invasion was 69.1%, that of over-estimate was 23.5% and that of under-estimate was 7.4%. In the case of retroperitoneal invasion, a correct diagnosis had been made in 79.1%, over-estimate in 4.5% and under-estimate in 16.4%. In the case of portal vein invasion, these percentages were 52.8%, 39.6% and 7.5%, respectively. In the case of lymph node involvement, these percentages were 85.3%, 2.9% and 11.8%, respectively. The percentage of preoperative over-estimate was higher for serosal invasion and that of preoperative under-estimate was higher for retroperitoneal invasion. In the case of portal vein invasion, the percentage of preoperative over-estimate was relatively high. Of the 12 patients who had paraortic lymph node metastases, 6 patients had a single metastatic node in the paraortic area. The minimum size of these nodes was 2 x 2 mm. Only 5 cases could be diagnosed preoperatively. We evaluated the usefulness of abdominal CT scan and superior mesenteric arteriography for the diagnosis of superior mesenteric arterial wall invasion. In both methods, the over-estimate rate was 0%, but the under-estimate rate was relatively high. Conclusively the preoperative diagnosis of the extension of the pancreatic cancer by conventional imaging methods has some limits.

Humans↗

PubMed1993

Lymphatic flow in carcinoma of the distal bile duct based on a clinicopathologic study.

BACKGROUND: Nodal status is one of the most important prognostic factors for distal bile duct cancer. The pattern of lymphatic spread of distal bile duct cancer was analyzed by determining the frequency of involvement of various lymph nodes. MATERIALS AND METHODS: From 1973 to 1991, 29 patients with distal bile duct cancer underwent pancreaticoduodenectomy at Kanazawa University Hospital. A precise evaluation of their nodal involvement and the relationship among the lymph nodes was determined by histopathologic examination. RESULTS: Twenty of the 29 (68.9%) patients had nodal involvement. The lymph nodes with a high metastatic rate were those around the lower portion of the hepatoduodenal ligament (number 12abp2), the superior posterior pancreaticoduodenal lymph nodes (number 13a), and the superior mesenteric artery (number 14) (12abp2, 24.1%; 13a, 51.7%; 14, 34.5%). At least one para-aortic lymph node was involved with cancer in two (6.9%) patients. All of the patients except one who had one or more positive number 14 lymph nodes also had positive number 12abp2 or 13a lymph nodes. CONCLUSIONS: Lymph nodes number 12abp2 and 13a are important in lymphatic metastasis to superior mesenteric lymph node for distal bile duct cancer. Nodal dissection around the superior mesenteric artery should be performed in all patients except those without pancreatic invasion.

Adult↗

PubMed1993

An evaluation of radical resection for pancreatic cancer based on the mode of recurrence as determined by autopsy and diagnostic imaging.

BACKGROUND: To determine the extent of dissection in curative resection for cancer of the pancreatic head, the mode of recurrence was determined at autopsy and by radiographic examinations. MATERIALS AND METHODS: Records of 45 patients who had undergone macroscopically curative resection of carcinoma of the head of pancreas were analyzed to determined the mode of recurrence. The mode of recurrence was divided into four types: hepatic metastasis, peritoneal dissemination, retroperitoneal recurrence, and distant metastasis. Retroperitoneal recurrence was subdivided into lymph node metastasis and local recurrence, primarily neural invasion and lymphatic invasion. RESULTS: Thirty patients experienced disease recurrence. Patients with Stage I or II disease experienced recurrence significantly less often than did patients with Stage III or IV disease (P < 0.05). Local retroperitoneal recurrence was discovered in 12 of 15 (80%) postmortem examinations, hepatic metastasis in 10 (66%), peritoneal dissemination in 8 (53%), and lymph node recurrence in 7 (47%). In 15 antemortem studies, retroperitoneal recurrence occurred most frequently (87%), followed by hepatic metastasis (53%). Almost all patients with liver metastasis also had local retroperitoneal recurrence. CONCLUSIONS: The frequency of retroperitoneal recurrence of carcinoma of the head of the pancreas suggests that retroperitoneal resection, including nerve plexi and lymph nodes, should be included in curative resections for patients with Stage I or II pancreatic cancer.

Adenocarcinoma↗