[The protein data bank: recent trends and developments].
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Computer Communication Networks↗
Biomedical subjects
M Kusunoki
Publications and source records attributed to M Kusunoki.
Anoabdominal rectal resection and colonic J pouch-anal anastomosis: 10 years' experience.
BACKGROUND: Coloanal anastomosis and radiotherapy for the treatment of lower rectal carcinoma have been receiving increasing attention. METHODS: Patients with rectal cancer were divided into two groups: anoabdominal rectal resection and colonic J pouch-anal anastomosis (CAA) plus preoperative intraluminal brachytherapy (IBT) (group 1; 68 patients) and CAA without IBT (group 2; 23 patients). Group 3, comprising 59 patients who underwent abdominoperineal excision (APE), was examined as a control group. Comparative results were reviewed. RESULTS: Postoperative complications occurred more frequently in group 1 than in group 2. Actuarial 5-year survival rates were 73 per cent in group 1, 64 per cent in group 2 and 63 per cent in group 3. Cumulative local recurrence rates at 5 years were 11 per cent in group 1, 38 per cent in group 2 and 21 per cent in group 3. Intestinal continuity breakdown was seen in 14 per cent of all patients at 5 years after initial operation. CONCLUSION: The combination of CAA and preoperative IBT resulted in decreased local recurrence. IBT followed by CAA can be a good restorative option for combating lower rectal cancer.
Adult↗
Use of transrectal ultrasonography to select type of surgery for villous tumors in the lower two thirds of the rectum.
OBJECTIVE: To determine the accuracy of transrectal ultrasonographic (TRUS) staging of rectal villous tumors when used to select a surgical procedure. DESIGN: Case series. SETTING: College hospital, Hyogo, Japan. PATIENTS: From 1988 to 1995, 24 patients were treated for villous tumors after diagnosis by TRUS, and were followed up for 0.5 to 7.5 years. MAIN OUTCOME MEASURES: Ultrasonographic tumor stage (u-T), pathologic tumor stage (p-T), biopsy findings, and surgical procedures were studied. RESULTS: Overall, 71% of the tumors were accurately staged by TRUS. However, 4 u-T1 and 3 u-T2 tumors were overstaged, with pathological examination showing 2 adenomas and 5 p-Tis tumors. Three of these 7 patients were overtreated surgically. The results of a biopsy predicted adenoma in 2 of the u-T1 tumors and 2 of the u-T2 tumors that were overstaged by TRUS. Pathological examination revealed that an enlarged lymphoid follicle in the mucosa had deformed the thin muscle layer of the rectal wall and abolished its continuity on TRUS imaging. The weakness of TRUS would seem to be in the accuracy of p-Tis staging. CONCLUSIONS: Transrectal ultrasonography had the advantage of predicting malignant infiltration in rectal villous tumors. The surgeon should know the limitations of TRUS diagnosis to select the most appropriate operation for each patient.
Adenocarcinoma↗
Defecographic assessment after colonic J pouch-anal anastomosis.
Colonic J pouch anal anastomosis is widely employed after rectal resection. In the 36 patients who participated in our retrospective study, although postoperative continence was retained/maintained in each individual, a survey questionnaire indicated some difficulties in neoanorectal function. Therefore, defecography was performed in 20 of these patients. Patients experiencing soiling were found to have an increased ano-pouch angle and pelvic floor descent. Loss of sensation and incomplete evacuation were also associated with an abnormally large pelvic floor descent. However, stool frequency, urgency, and the need for medication showed no correlation with any of the defecography parameters. These findings thus suggested that the puborectal muscle and the levator ani muscle played an important role in postoperative function. Defecography was also found to provide a dynamic assessment of the postoperative state of colonanal reconstruction.
Aged↗
Modification of the stapled functional end-to-end anastomosis for ileostomy closure.
The use of stapling devices simplifies ileostomy closure; however, the original functional end-to-end anastomotic technique creates intersecting staple lines, generally causing disruption of the anastomosis at the intersections. Therefore, we modified the stapling technique to prevent the two staple lines from crossing. After the everted ileostomy spout is turned back, a stapled side-to-side anastomosis is made. Everting traction sutures are then placed around the ileostomy orifice prior to closure with a linear stapler, thus ensuring that this staple line does not cross the V-shaped staple line of the intestinal anastomosis. This modified technique was employed in the treatment of 20 patients, none of whom developed any signs of anastomotic leakage or intestinal obstruction.
Anastomosis, Surgical↗
Preoperative detection of distal intramural spread of lower rectal carcinoma using transrectal ultrasonography.
PURPOSE: Usefulness of transrectal ultrasonography (TRUS) for detecting distal intramural spread of rectal carcinoma was investigated. METHODS: Thirty-seven patients with advanced rectal carcinoma, who had not received preoperative adjuvant therapy, underwent TRUS before surgery. Distal intramural spread was evaluated by TRUS and by pathologic examination of resected specimens. RESULTS: Distal intramural spread was found in 7 of 37 patients (19 percent) by pathologic examination. Presence or absence of distal intramural spread was correctly diagnosed by TRUS in 86 percent of the 37 patients. Misdiagnosis by TRUS mainly occurred when distal intramural spread was 5 mm. Tumor penetration of muscularis propria, lymph node involvement, and a higher histologic grade of malignancy showed a significant relationship with the presence of distal intramural spread. CONCLUSION: TRUS was useful for detecting distal intramural spread > 5 mm in patients with lower rectal carcinoma and may be helpful for selecting appropriate surgery.
Adenocarcinoma↗
Clinico-physiological results after sphincter-saving resection for rectal carcinoma.
In this study, we evaluated the postoperative functional results after resection of rectal carcinoma. A questionnaire and anal manometry were used to evaluate the severity of the symptoms. The patients were divided into the three groups of anterior resection (AR, 38 patients), low anterior resection (LAR, 34 patients) and stapled colo-anal anastomosis (SCA, 20 patients). Manometric examination and questionnaire evaluation were performed 1, 3, 6, and 12 months after the operation. The SCA group showed by far the poorest outcome in terms of soiling and urgency at 12 months. Anal sensation was recovered by 12 months in each group. Incomplete evacuation was frequently observed in the SCA and LAR groups. Each anal manometric parameter recovered in the AR group, but the maximum tolerable volume of the neorectum did not recover in either the SCA or LAR group. The threshold volume of the SCA group was lower than those in the other two groups. The reservoir function of the neorectum, which is composed of the colorectal muscle layer and nervous components, plays a role in maintenance of bowel function.
Adult↗
[Chemotherapy of head and neck cancer].
Squamous cell carcinoma of the head and neck is a chemotherapeutically responsive tumor. Methotrexate, cisplatin, 5-fluorouracil and bleomycin in various combinations have achieved tumor regression, with complete or partial response, in 60-90% of previously untreated patients. The response to chemotherapy, however, is often short-lived, and conventional treatment has produced little impact on survival. To date, neo-adjuvant and/or adjuvant chemotherapy have also failed to demonstrate any impact on the survival rate, although subset analysis has indicated a possible survival benefit. Furthermore, larynx preservation and reduction in incidence of metastasis have been demonstrated. Concomitant chemoradiotherapy has some positive results in disease free survival and/or overall survival. In this report, we reviewed the literature on neoadjuvant chemotherapy, adjuvant chemotherapy, salvage chemotherapy and concomitant chemoradiotherapy for advanced head and neck cancer, and analyzed their efficacy.
Antineoplastic Combined Chemotherapy Protocols↗
Long-term effects of small bowel transplantation on intestinal motility.
We previously found that the contractile motility of the jejunum was increased 4 weeks after transplantation, and that the dominant intrinsic neural component was changed from cholinergic to nonadrenergic, noncholinergic (NANC). The present study investigated the long-term effects of transplantation on jejunal motility using rats that survived for 2 years after surgery. Jejunal strips were harvested from various groups of rats, and intestinal motility was assessed by electrical transmural stimulation. Stimulation produced a similar increase of contraction at 4 weeks and 2 years after grafting. Pretreatment with atropine showed that the cholinergic component of contraction was 45%, 24%, 32%, and 24% in controls, rats 4 weeks after transplantation, 2-year-old controls, and rats 2 years after transplantation, respectively. The NANC component (obtained with atropine and guanethidine) in each group was, respectively, 56%, 73%, 60%, and 69%. The actual value of the tetrodotoxin-insensitive myogenic component was significantly increased at 2 years after transplantation. A substance P antagonist ([Arg6, D-Trp7,9, Mephe8], substance P 6-11), inhibited most of the NANC contraction after transplantation. These results suggested that substance P has a key role in the motility of transplanted small bowel throughout the life of the grafts.
Analgesics↗
Purification and characterization of recombinant hamster tissue complement C1s.
Hamster complement C1s cDNA was inserted into expression plasmid BCMGSNeo, and transfected to SEA7 cells, A31 mouse fibroblasts transformed by polyoma virus. The transfectant secreted a large amount of recombinant C1s that was activated in the serum free culture medium and hydrolyzed acetyl-Gly-L-Lys-naphthyl ester (AGLNE). C1s was purified to a homogeneity from the culture medium of the transfectant by DEAE-Sephadex, Dymatrex orange A and size-exclusion HPLC. Purified hamster C1s consumed human complement in hemolytic assay and hydrolyzed gelatin in enzymography. To investigate the enzymic action of C1s at molecular levels, several antibodies were prepared against hamster C1s. One peptide (amino-acid residues 379-391) and two peptides (amino-acid residues 478-496 and 560-583) corresponding to the heavy and the light chain, respectively, were synthesized. The amino-acid sequences of these regions is not conserved between hamster and human C1s. Antibodies against these peptides were raised in rabbits. The anti-peptide antibodies bound specifically to hamster serum and recombinant C1s but not to human C1s. They inhibited the esterase activity of recombinant C1s to varying degrees depending on each antibody's binding site.
Amino Acid Sequence↗
Water and electrolyte balance after ileal J pouch-anal anastomosis in ulcerative colitis and familial adenomatous polyposis.
The water and electrolyte balance was studied in 31 patients with ulcerative colitis (UC) and 22 with familial adenomatous polyposis (FAP) who underwent staged surgery involving colectomy and ileal J pouch-anal anastomosis (IAA), preoperatively, after terminal ileostomy, after high ileostomy, and after ileostomy closure. Serum electrolytes did not differ between each surgical stage. After terminal or high ileostomy, daily urine volume and urinary sodium loss was significantly lower, and daily fecal weight and fecal sodium loss was significantly higher than preoperatively. After ileostomy closure, urinary and fecal sodium loss became closer to preoperative value. Daily urinary potassium loss was significantly higher and fecal loss was lower after terminal and high ileostomy than preoperatively and did not show a significant change after ileostomy closure. The urinary sodium to potassium ratio after ileostomy closure was lower than preoperatively, but was higher than that after terminal and high ileostomy. Plasma aldosterone and renin levels were only significantly increased after high ileostomy. These findings indicate that high or terminal ileostomy caused chronic dehydration, which was compensated for by activation of the renin-aldosterone axis, while the water and electrolyte balance became closer to normal after ileostomy closure following ileoanal anastomosis.
Adenomatous Polyposis Coli↗
Correction of dorsi-flexed intercalated segment instability after restoration of scaphoid height in a cadaver model of scaphoid non-union.
Models of scaphoid non-union with static dorsi-flexed intercalated segment instability were produced in five frozen arms from cadavers or subjects following accidents by repetitive mechanical loading of the wrist joints longitudinally after a bone defect has been made at the mid-portion of the scaphoid. We designed four models of reduction: anatomical reduction; reduction with a shortened scaphoid; anatomical reduction but with the radio-lunate ligament sectioned, and a shortened scaphoid with the radio-lunate ligament sectioned. Results suggested that anatomical reduction with rigid fixation with a Herbert screw was most effective for correction of malalignment with DISI. Preservation of the radio-lunate ligament during the palmar approach to the scaphoid seemed to be important to prevent ligamentous carpal instability.
Bone Screws↗
Induction chemotherapy with cisplatin, etoposide, and mitomycin-C (PEM) regimen in advanced cases with cancer of pharynx and oral cavity.
With the aim of improving survival rate in advanced head and neck cancer, we scheduled 26 patients to receive PEM regimen. This regimen consisted of cisplatin (CDDP)(P), etoposide (VP-16)(E), and mitomycin-C (MMC)(M) (CDDP 60 mg/ m2/2 hr infusion on day 1; VP-16 40 mg/m2/1 hr infusion on days 1-3; MMC 7 mg/m2 iv bolus on day 1). Of 25 patients evaluable for response, 8 complete response (CR), 14 partial response (PR) were achieved, with an overall response rate (RR) of 88%. Myelosuppression was major side effect and thrombocytopenia (23% greater than WHO grade) was dose limiting toxicity. Other adverse reactions including mucositis were all mild and transient. Since limited mucosal toxicity, full course of following treatment including radiotherapy and/or surgery could be done satisfactorily. We concluded that this regimen produced beneficial effect as the adjuvant setting in patients with cancer in pharynx and oral cavity because of limited mucosal toxicity.
Adult↗
Amelioration of high-fat feeding-induced insulin resistance in skeletal muscle with the antiglucocorticoid RU486.
Fat feeding produces whole-body insulin resistance and decreased glucose uptake in muscle tissue of rats. To examine the effect of glucocorticoid blockade on the insulin resistance caused by high-fat feeding, four groups of rats were fed diets high in starch (70% of calories) or fat (59% of calories) for 4 weeks with or without the antiglucocorticoid RU486 (69.8 mumol.kg-1.day-1) in the food. Whole-body insulin action was assessed by the euglycemic clamp technique at an upper physiological insulin level with bolus 2-[3H]deoxyglucose to determine individual tissue insulin-stimulated glucose uptake. Whole-body glucose utilization (clamp glucose infusion rate [GIR]) was decreased by high-fat feeding (GIR 68.3 +/- 12.2 vs. 182.6 +/- 12.8 mumol.kg-1.min-1 for the starch-fed group; P < 0.001). Addition of RU486 to the diet significantly improved (GIR 133.9 +/- 12.8 mumol.kg-1.min-1; P < 0.01), but did not fully reverse, the insulin resistance caused by fat feeding. RU486 was without effect in the starch-fed rats. In skeletal muscles, RU486 ameliorated 62 and 68% of the insulin resistance produced by fat feeding in red quadriceps and extensor digitorum longus hindlimb muscles, respectively, but had no effect in heart or white adipose tissue. These results suggest that glucocorticoids play, in a tissue-specific manner, a role in the maintenance and/or production of insulin resistance produced by high-fat feeding.
Animals↗
[Neurons in monkey parietal association cortex sensitive to axis orientation].
Patients with parietal lesions may fail to adjust the orientation of the hand to that of the target object or may make errors in judging the orientation of the bar. This suggests that the parietal cortex functions to discriminate the orientation of objects. Therefore, we studied orientation selectivity of the visual neurons of the posterior parietal association cortex of alert behaving monkeys. We recorded 23 neurons that showed selectivity in the axis orientation of visual stimulus in the lateral bank and fundus of the caudal part of the intraparietal sulcus (IPS). Almost all the neurons tested with a slit on the screen responded better to a longer or narrower stimulus. There were also neurons which responded only to three dimensional objects, such as a bar presented in the sagittal orientation tilted forward or backward. The majority of these neurons had wide receptive fields and their responses were position-invariant. These results suggest that the axis orientation selective neurons of the parietal cortex represent orientation of the longitudinal axis of objects in 3-dimensional space.
Animals↗
Ileoanal anastomosis and ileoanal canal anastomosis in Japan: comparative retrospective study.
A questionnaire survey of ten institutions in Japan revealed that restorative proctocolectomy accounted for 81.8% of the surgical procedures performed in patients with UC in the last 5 years (1989-1993); ileoanal anastomosis (IAA) and ileo-anal canal anastomosis (IACA) were performed in 63% and 33% of these patients, respectively. Comparison of the two series showed that IACA was technically simpler and yielded better continence, but that it entailed a potential risk of recurrence of the disease in the remaining anal canal mucosa. Although IACA seems to be a useful surgical option for UC, until the long-term outcome of the procedure can be elucidated. It may be better regarded as a very low variation of IRA rather than as an improved technical version of IAA.
Adult↗
Tumorigenicity of BALB3T3 A31 cells transfected with hamster-complement-C1s cDNA.
Hamster-complement-C1s cDNA was inserted into an expression plasmid BCMGSNeo (BCMGSNeoHACS). BALB/c mouse fibroblast A31 cells, which do not produce C1s, were transfected with BCMGSNeoHACS and the transfectants were selected with G418. Normal C1s production by the transfectants was confirmed by Northern and immunoblot analysis and by an esterase assay. To examine the tumorigenicity of the transfectants, 1 x 10(6) cells were injected s.c. into 6-week-old BALB/c nu/nu mice. Three C1s cDNA transfectants (A3CS9, A3CS12, A3CS13) formed tumors whereas both A31 and A31 transfected with the vector alone (A3BCM1 and A3BCM3) did not. The tumors derived from the transfectants showed invasive growth, and many capillaries were observed in the tumors. A tumor derived from A3CS13 was examined immunohistochemically and found to be reactive with an anti-C1s monoclonal antibody. Tumor cells were cultured in vitro again and C1s secreted into the culture medium was examined by immunoblot analysis. C1s synthesized by the tumor cells derived from A3CS13 maintained its biological functions. Tumor cells derived from A3CS9 and A3CS12 cells, however, produced C1s having abnormal disulfide bonds.
3T3 Cells↗
Changes of intestinal motility after small bowel transplantation in the rat.
Small bowel transplantation disturbs the enteric neural network as a result of complete extrinsic denervation, but few data are available on the status of the intrinsic neurons in intestinal grafts. This study assessed intestinal motility and the intrinsic innervation of jejunal longitudinal muscle after transplantation in rats using electrical transmural stimulation. Syngeneic total small bowel transplantation was performed in male Lewis rats using microsurgical techniques. The rats were divided into four groups-i.e., a control group and groups examined at one (G1), two (G2), and four (G4) weeks after transplantation. Jejunal strips were mounted in a superfusion apparatus for examination. Functional innervation was assessed by comparing contraction and relaxation following stimulation at 10 Hz with or without various drugs. All grafts showed increased contractile motility when compared with the control group. The cholinergic excitatory components in the control, G1, G2, and G4 groups were 45%, 73%, 66%, and 24%, respectively, while nonadrenergic noncholinergic-excitatory components were 56%, 53%, 57%, and 78%. Thus, there was a marked change in excitatory innervation after transplantation. However, the tetrodotoxin-insensitive (myogenic) component showed no changes in active tone after transplantation. Adrenoceptor antagonists had a decreased effect on all grafts except for yohimbine (an alpha 2 blocker). The contractile motility of transplanted jejunum was increased compared with that of the control bowel. However, the dominant intrinsic component varied with the time after transplantation.
Adrenergic alpha-Antagonists↗