Successful treatment of a recurrent large cystic hygroma in a child with intracystic injection of OK-432.
Explore the source record for details and available documents.
Antineoplastic Agents↗
Biomedical subjects
M Shimada
Publications and source records attributed to M Shimada.
Therapeutic effect of secretin in patients with jaundice; double-blind placebo-controlled multicentric trial.
Secretin, a gastrointestinal hormone, has been shown to have a potent choleretic effect. Having already obtained some beneficial effects with secretin in patients with intrahepatic cholestasis, we sought to confirm its effects in a double-blind placebo-controlled study in patients with mild jaundice after acute or during chronic hepatitis, where total bilirubin level was in excess of 4.0 mg/dl for 3 days or more. Patients with primary biliary cirrhosis (PBC), primary sclerosing cholangitis (PSC), and familiar hyperbilirubinemia were excluded from the study. Ninety-three patients were included in this analysis, but the final evaluation covered 69 of them. No statistically significant differences were found in the reduction of serum bilirubin levels between secretin and placebo groups. As a number of patients with liver cirrhosis had been included, the subjects were subdivided into one group with cholestasis in hepatitis and one with liver cirrhosis. In the subgroup of cirrhotic patients who received secretin, serum levels of AST were significantly increased compared with the placebo group. However, since the choleretic effect of secretin is unique, further studies seem to be warranted.
Adolescent↗
Usefulness of pulsatile bidirectional cavopulmonary shunt in high-risk Fontan patients.
BACKGROUND: A bidirectional cavopulmonary shunt has been performed for the high-risk Fontan patient. It is well known that in the presence of the bidirectional cavopulmonary shunt alone to secure pulmonary blood flow, the central pulmonary artery size decreases over time. We have performed pulsatile bidirectional cavopulmonary shunt (PBCPS), keeping pulmonary blood flow from the ventricle through the stenotic pulmonary valve, or a Blalock-Taussig shunt in patients who do not meet the criteria for the Fontan operation. METHODS: Eleven patients who underwent PBCPS between 1989 and 1993 were reviewed. We compared the results of cardiac catheterization immediately before PBCPS and during the postoperative observation period (310 +/- 257 days). RESULTS: Pulmonary blood flow and arterial oxygen saturation increased significantly after PBCPS (p = 0.01). Pulmonary artery area index showed a tendency to increase (p = 0.11). The mean number of risk factors for the Fontan procedure decreased significantly for 1.8 +/- 1.1 to 0.7 +/- 0.8 after PBCPS (p < 0.05). Overall, 5 of the 11 patients (45.5%) met the criteria for the Fontan procedure, and a fenestrated Fontan procedure was carried out in 4 of them. CONCLUSIONS: The PBCPS is useful for high-risk Fontan patients not only in the staged Fontan operation, but also as definitive palliation.
Child↗
Surgical treatment strategy for patients with stage IV hepatocellular carcinoma.
BACKGROUND: This study was conducted to identify the prognostic indicators for patients with stage IV hepatocellular carcinoma (HCC), as well as to clarify the strategy of surgical treatment for those patients. METHODS: Forty-six patients with stage IV HCC were included in this study. Prognostic factors were univariately and multivariately analyzed. Furthermore, the significance of intraoperative treatment for residual tumors was investigated in patients with an absolute noncurative operation. RESULTS: The poor prognostic factors were as follows: host factors, Child's classification of B and C and immunosuppressive acidic protein level of greater than 400 micrograms/ml; tumor factors, tumor diameter of greater than 5 cm, poorly differentiated histologic features, positive portal vein invasion, and intrahepatic metastases involving more than three segments; others, an absolute noncurative operation and no preoperative treatment. Tumor diameter of more than 5 cm was then suggested to be an independent prognostic indicator. Survival of patients with stage IV-A HCC who underwent a curative operation was similar to that of those with stages III HCC: Furthermore, the survival of patients with Stage IV-A who had an absolute noncurative operation but underwent either intraoperative microwave coagulation or ethanol injection to the residual HCCs was not statistically different from that of those with a curative operation. CONCLUSIONS: Therefore for stage IV-A HCC surgical treatment is considered to be both useful and the first choice of treatment when all the tumors in the liver can be removed or when the residual tumors can be treated during operation by either microwave coagulation or ethanol injection as a result of an incomplete removal of the tumors.
Adult↗
Retrograde right hepatic trisegmentectomy.
Explore the source record for details and available documents.
Adult↗
Crystal-storing histiocytosis associated with lymphoplasmacytic lymphoma mimicking Weber-Christian disease: immunohistochemical, ultrastructural, and gene-rearrangement studies.
A case of crystal-storing histiocytosis associated with lymphoplasmacytic lymphoma is presented. Unlike previous cases, this patient presented with signs and symptoms suggestive of Weber-Christian disease. Biopsy of subcutaneous nodules showed numerous deposits of crystal-storing histiocytes with lymphoplasmacytic cells, the latter exhibiting light chain restriction (lambda-chain) with a predominance of immunoglobulin (Ig)G heavy chain. Polymerase chain reaction (PCR) analysis of CDR-II* region of the immunoglobulin heavy chain locus confirmed monoclonality of the lymphoplasmacytic cells in the nodule. Electron microscopy showed polygonal-shaped amorphous crystals, characteristic of immunoglobulin in the histiocytic cells. Crystal-storing histiocytosis should be examined by immunohistochemical and DNA analysis to confirm or exclude the possibility of lymphoplasmacytic lymphoma.
Adult↗
Elevation of plasma interleukin-6 level in patients undergoing oral and maxillofacial surgery.
OBJECTIVE: The purpose of this study was to evaluate the response of peripheral interleukin-6 associated with oral and maxillofacial surgery. STUDY DESIGN: Fifteen patients undergoing elective oral and maxillofacial surgery were studied. We investigated the change in plasma interleukin-6 level during and after surgery and the correlation between plasma interleukin-6 level and surgical procedure. Plasma interleukin-6 levels were measured by enzyme-linked immunosorbent assay. Statistical significance was determined by nonparametric methods. RESULTS: Elevation of plasma interleukin-6 level was detected at 2 to 6 hours after incision and observed to reach a peak level within 6 hours after the end of surgery. There were significant correlations between plasma interleukin-6 level and duration of surgery or response of C-reactive protein. CONCLUSION: The results suggested that interleukin-6 would be released by surgical injury and elevation of plasma interleukin-6 level would be associated with magnitude of tissue damage in oral and maxillofacial surgery.
Adult↗
Prognosis of recurrent hepatocellular carcinoma: a 10-year surgical experience in Japan.
BACKGROUND & AIMS: Little has been addressed on the characteristics and prognostic factors of recurrent hepatocellular carcinoma after undergoing a hepatic resection for primary hepatocellular carcinoma. The aim of this study was to clarify the aforementioned matters of recurrent hepatocellular carcinoma. METHODS: One hundred fifty-nine patients with recurrent hepatocellular carcinoma were studied retrospectively. Twenty-four clinicopathologic variables, including the period until recurrence (less than or more than 1 year), types of recurrence (intrahepatic nodular type, intrahepatic multiple type, and extrahepatic type), and types of treatment after recurrence (no treatment, lipiodolization, ethanol injection, or hepatectomy) were univariately and multivariately analyzed. RESULTS: The following three variables were finally selected as independent and prognostic indicators after recurrence: (1) period until recurrence, (2) type of recurrence, and (3) types of treatment after recurrence. CONCLUSIONS: The prognostic factors in patients with recurrent hepatocellular carcinoma were as follows: (1) period until recurrence, (2) types of recurrence, and (3) types of treatments received after recurrence. The establishment of a follow-up system, including an examination for extrahepatic recurrence, and the development of an effective method of adjuvant chemotherapy are required to obtain better treatment results.
Aged↗
Ultrasonographic detection of lymph-node metastases in superficial carcinoma of the esophagus.
BACKGROUND AND STUDY AIMS: The presence or absence of lymph-node metastasis is the single most important factor in determining the strategy for treating superficial carcinoma of the esophagus. In this study, ultrasound (US) and endoscopic ultrasonography (EUS) were used in the diagnosis of lymph-node metastases, and the accuracy and limitations of these methods were assessed. PATIENTS AND METHODS: Prospectively, 37 patients with superficial esophageal cancer were studied by US and EUS before surgery, and the results were compared with the histological findings. Twelve of the patients had histologically confirmed lymph-node metastases. Ultrasonographic images of the lymph nodes were classified into three types, based on their boundaries and internal echoes. RESULTS: The sensitivity, specificity, and accuracy of predicting mediastinal lymph-node metastasis by EUS diagnosis were 80.0%, 87.5%, and 86.5%, respectively. The sensitivity, specificity, and accuracy of US in the assessment of cervical and abdominal lymph-node metastasis were 71.4%, 86.7%, and 83.3%, respectively. In cases in which there was a solitary metastatic lymph node, the detection rate was higher than in cases with two or more positive nodes. Most metastatic lymph nodes correctly diagnosed by US and EUS were larger than 6 mm and had tumor involving more than one-third of their cross-sectional area. CONCLUSIONS: In patients with superficial esophageal carcinomas, US is accurate in staging cervical and abdominal lymph nodes. EUS is accurate in staging mediastinal lymph nodes.
Carcinoma, Squamous Cell↗
Assessment of tumor invasion of the distal esophagus in carcinoma of the cardia using endoscopic ultrasonography.
BACKGROUND AND STUDY AIMS: Esophageal invasion by carcinoma of the cardia may affect the surgical approach. Accurate assessment of esophageal invasion is difficult using endoscopy, computed tomography, or barium contrast radiography. The aim of the present study was to evaluate the use of endoscopic ultrasonography (EUS) in the prediction of esophageal invasion by carcinoma of the cardia. PATIENTS AND METHODS: EUS (using a linear-array scanner) was carried out prospectively in 47 patients with carcinoma of the cardia who underwent subsequent surgical resection. The findings were correlated with the histopathological assessment of tumor infiltration in the esophagus in the resected specimen. RESULTS: An absence of esophageal invasion was correctly predicted by EUS in 12 of 13 patients. Histopathologically confirmed invasion of the esophagus was correctly predicted in 32 of 34 patients. With a margin of error of 10 mm, the accuracy of EUS in predicting or excluding histologically confirmed invasion of the esophagus was 85.1% (40 of 47 patients). False-positive results with EUS occurred in patients with prominent edematous or fibrous changes in the distal esophagus; false-negative results with EUS were seen in patients with scattered infiltration of a small number of tumor cells into the mucosal or submucosal layer. CONCLUSIONS: EUS can provide the surgeon with additional information on the extent of esophageal infiltration in patients with carcinoma of the gastric cardia, and can therefore assist in the selection of the surgical approach.
Adult↗
Hypertriglyceridemia, but not hypercholesterolemia, is associated with the alterations of fibrinolytic system.
Derangements of the blood coagulation-fibrinolytic system are thought to be associated with the development of cardiovascular disease. Previous studies have identified the alterations in patients with advanced atherosclerosis, however, studies on subjects without apparent cardiovascular complications are scarce. To evaluate the potential risk of thrombosis, we examined the serum lipid levels and fibrinolytic parameters in 54 subjects of different types of primary hyperlipoproteinemia (HL) and 18 normolipidemic controls. Plasma tissue-type plasminogen activator (t-PA) and plasminogen activator inhibitor-1 (PAI-1) antigen levels were significantly higher in type IV HL than in the controls. Serum triglyceride concentrations were correlated with t-PA (r = 0.537, p < 0.01) and PAI-1 (r = 0.249, p < 0.05) antigen levels, while serum cholesterol levels did not. The current study demonstrated that hypertriglyceridemia, but not hypercholesterolemia, is associated with the alterations of fibrinolytic system.
Adult↗
Eleven-year survey of safety and efficacy of endoscopic injection sclerotherapy using 2% sodium tetradecyl sulfate and contrast medium.
We conducted a retrospective 11-year survey to evaluate the post-treatment course in 285 patients with esophagogastric varices following administration of endoscopic injection sclerotherapy as an emergency, elective, or prophylactic procedure using freshly prepared 2% sodium tetradecyl sulfate not containing benzyl alcohol. These agents were injected into the varices and the supplying veins under fluoroscopic observation, usually in a single treatment. In all patients the variceal size was greatly reduced following one treatment. The amount of sclerosant necessary to fill the varices and the supplying veins varied widely among the patients. Acute variceal bleeding was controlled in 80 (96.4%) of the 83 patients, and the risk of rebleeding during the first month was 0.0548 in the emergency procedures. The serious complication of perforation was observed in one patient. The cause of death was established in the 122 patients who died and included esophageal variceal bleeding in eight (6.6%) and gastric variceal bleeding in one (0.8%). The overall 50% survival period was 5 years and 4 months. Multivariate analysis disclosed that the factors with the greatest negative effect on survival were poor hepatic status and the presence of hepatocellular carcinoma. The method of preparation and the procedure itself may be considered safe and effective in the treatment of esophagogastric varices.
Aged↗
Isolation and characterization of a new rat P450 (CYP3A18) cDNA encoding P450(6)beta-2 catalyzing testosterone 6 beta- and 16 alpha-hydroxylations.
A cytochrome P450 cDNA, encoding a new form of CYP3A protein, was isolated from a liver cDNA library of a male rat using anti-P450(6)beta-1 and anti-P450(6)beta-2 antibodies and the CYP3A2 cDNA. The cDNA (CYP3A18 cDNA) consisted of 1987 nucleotides, in which were contained an open reading frame of 1491 bp (corresponding to 497 amino acids), 5'-(59 bp) and 3'-noncoding regions (437 bp). The deduced amino acid sequence of CYP3A18 cDNA was completely identical in the first 27 N-terminal residues of P450(6)beta-2 previously isolated by us (Nagata et al. J Biochem 1990: 107, 718-725) from livers of rats treated with dexamethasone, and also shared higher extents of similarity with hamster CYP3A10 (78.5%) than with rat CYP3As previously sequenced (66.3-69.3%). Northern blot analyses indicated a male-dominant expression of this new CYP3A mRNA and enhanced expression in dexamethasone-or pregnenolone-16 alpha-carbonitrile (PCN)-treated, but not phenobarbital-or 3-methylcholanthrene-treated rats. Expressed CYP3A18 protein in COS-1 cells migrated at a position identical to that of purified P450(6)beta-2 on sodium dodecyl sulfate-acrylamide gel electrophoresis and catalyzed 16 beta- and 6 alpha-hydroxylations of testosterone. In contrast to CYP3A1 and CYP3A2, cytochrome b5 was not essential for maximal catalytic activities of recombinant CYP3A18 protein. These results, together with ontogenic profiles of CYP3A18 mRNA and P450(6)beta-2 protein, indicate that the newly isolated CYP3A18 cDNA encodes P450(6)beta-2 in rat liver.
Amino Acid Sequence↗
Bacterial changes in neonatal intensive care unit.
Organisms routinely cultured from throat swabs and infectious agents of sepsis and/or meningitis were reviewed. During the last 12 years, Klebsiella pneumoniae and Escherichia coli have been replaced by Staphylococcus aureus and Pseudomonas aeruginosa as the predominant isolates from throat swabs after admission. These change in the etiologic pattern of infectious agents of sepsis and/or meningitis, i.e., K. pneumoniae, E. coli, S. aureus, P. aeruginosa and staphylococcus epidermidis, were in agreement with the organisms isolated from the throat swabs after admission. The S. aureus isolated from throat swabs after admission showed a decrease in the bacterial activity of cloxacillin, cephazolin and cefotaxime since 1978.
Bacteria↗
Plasma concentration of granulocyte-colony-stimulating factor in neonates.
We determined the plasma concentration of granulocyte-colony-stimulating factor (GCSF) and the neutrophil count in 108 infants (gestational age 23-41 weeks; birthweight 478-4935g). The GCSF levels in the very low birthweight infants without infection were comparable to those in the full-term infants. Infants as premature as 23 weeks of gestation showed similar GCSF levels to mature neonates. GCSF levels decreased significantly by day 7 after birth. The levels were not significantly correlated with the neutrophil count. The mean plasma level of GCSF increased significantly when infection developed and was significantly higher in the infants with sepsis than in those with non-septic infections (p < 0.01). The results suggest that GCSF may be the major determinant of neutrophil kinetics both during fetal life and after birth.
Birth Weight↗
Inhibitory effect of TMK688 on skin tumor initiation caused by 7,12-dimethylbenz[a]anthracene in relation to inhibition of aryl hydrocarbon hydroxylase activity and Cyp1a1 mRNA induction.
Oral administration of TMK688 (1-([5'-(3"-methoxy-4"-ethoxycarbonyloxyphenyl)-2',4'-pentadien oyl] aminoethyl)-4-diphenylmethoxypiperidine: 30 mg/kg) at 6 h and 30 min prior to and at 30 min after a single topical application of 7,12-dimethylbenz[a]anthracene (DMBA) to dorsal skins of mice reduced both tumor incidence and number of tumors per mouse in the DMBA-initiated and 12-O-tetradecanoylphorbol-13-acetate (TPA)-promoted two-stage mouse skin carcinogenesis. TMK688 and its active metabolite TMK777 (1-([5'-(3"-methoxy-4"- hydroxyphenyl)-2',4'-pentadienoyl]-aminoethyl)-4-diphenylmethox y piperidine) inhibited 3-methylchol-anthrene (MC)-induced epidermal aryl hydrocarbon hydroxylase (AHH) activity in a concentration-dependent manner. IC50 of TMK688 and TMK777 was 0.18 and 0.01 mumol/l, respectively. Oral administration of TMK688 (30 mg/kg) almost completely suppressed Cyp1a1 mRNA levels in mouse epidermis induced by a topical application of MC (40 mg/kg) or benzo[a]pyrene (200 nmol) to mouse skin. Oral administration of TMK688 (30 mg/kg) also almost completely inhibited induction of epidermal AHH activity caused by a topical application of MC. These results indicate that oral administration of TMK688 inhibited DMBA-caused skin tumor initiation at least in part by inhibiting Cyp1a1 mRNA induction and epidermal AHH activity.
9,10-Dimethyl-1,2-benzanthracene↗
Nitric oxide and endothelin 1 during postnatal life.
Nitric oxide (NO) is a potent vasodilator produced by endothelial cells. Endothelin 1 (ET-1), another agent made by endothelial cells, is the most potent vasoconstrictor known to date. Endogenous NO and ET-1 may play a part in the normal physiological pulmonary vascular changes during the postnatal period. However, the changes of NO and ET-1 in healthy neonates have not been defined. We determined serum NO metabolites, i.e., nitrites and nitrates, and plasma ET-1 in 19 healthy neonates at birth (cord blood) and at ages 5 and 30 days. The sums of serum nitrite and nitrate (NOx) levels were 27.5 +/- 12.8, 53.8 +/- 14.2, and 38.3 +/- 13.2 mumol/l at birth, age 5 days, and age 30 days, respectively. The plasma ET-1 concentrations were 3.9 +/- 1.6, 1.1 +/- 0.2, and 1.1 +/- 0.2 x 10(6) mumol/l at birth, age 5 days, and age 30 days, respectively. These changes in healthy neonates suggest the presence of active physiological roles for NO and ET-1 in circulatory adaptation to extra-uterine life.
Aging↗
Sustained monomorphic ventricular tachycardia in a patient with Brugada syndrome.
We report a patient with Brugada syndrome who developed sustained monomorphic ventricular tachycardia (SMVT). The patient was a 29-year-old man who experienced recurrent episodes of palpitation and syncope after drinking alcohol. Electrocardiogram showed right bundle branch block and ST-segment elevation in precordial leads V1-3 without Q-Tc prolongation. Organic heart disease and coronary artery disease were excluded by noninvasive and invasive tests. Ventricular fibrillation was induced by the application of a single extra-stimulus to the right ventricular outflow tract. During isoproterenol infusion, SMVT of left bundle branch block morphology (240/min) was induced by the application of a single extrastimulus to the right ventricular apex. SMVT also developed spontaneously. Pace mapping disclosed that SMVT originated at the free wall of the right ventricular outflow tract. Head-up tilt test and an alcohol provocation test both induced similar SMVT that was associated with hypotension and near syncope. SMVT was not terminated by intravenous administration of lidocaine, procainamide or adenosine triphosphate (10 mg), but was terminated by propranolol. Thus, a beta-adrenoceptor-mediated mechanism appears to play an important role in SMVT in this patient. The site of origin of SMVT might be closely related to the lesion that causes ST-segment elevation.
Adult↗