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Biomedical subjects

N Goseki

Publications and source records attributed to N Goseki.

At least 37 records · Page 2Linked to original sources
PubMed1995

Synergistic effect of methionine-depleting total parenteral nutrition with 5-fluorouracil on human gastric cancer: a randomized, prospective clinical trial.

Methionine-depleting total parenteral nutrition (Met-depleting TPN), infusing AO-90 amino acid solution (lacking both L-methionine and L-cysteine) as a sole nitrogen source, showed synergistic effects with 5-fluorouracil (5-FU) in tumor-bearing rats and in clinical trials with gastrointestinal tract cancers. In this study, the effect of Met-depleting TPN with 5-FU upon thymidylate synthase (TS) activity was examined, and the histological effect of this treatment on human gastric cancer was evaluated. Fourteen preoperative advanced gastric cancer patients were divided randomly into two groups. Seven cases were given Met-depleting TPN for 7 days before surgery with continuous intravenous administration of 5-FU (500 mg/body per day; total 4.0 g/body) (AO-90 group). The other 7 received conventional L-methionine-containing TPN with 5-FU (control group). All patients underwent gastrectomy without complications due to these treatments. Resected materials were examined for TS kinetics, and the anti-cancer effect was also assessed histopathologically. The specimens in the AO-90 group showed marked degeneration of cancer, while almost no effect was seen in the control group. The free TS activity of carcinoma tissue in the AO-90 group was decreased and the TS inhibition rate was increased in comparison with the control group (P = 0.0165 and P = 0.0243, respectively). Met-depleting TPN appears to play a role as a biomodulator of 5-FU in human gastric cancer.

Aged↗
PubMed1995

[Clinical evaluation of anticancer effect of methionine-depleting total parenteral nutrition with 5-fluorouracil and/or mitomycin C].

Methionine-depleting total parenteral nutrition (Met-deplete TPN), infusing AO-90 amino acid solution (lacking both L-methionine and L-cysteine) as a sole nitrogen source, showed synergistic effects with several antineoplastics including 5-fluorouracil (5-FU). In the recent multi-center, randomized, controlled study, advanced gastric cancer patients were randomly allocated to RT group and Control group. RT group received AO-90 amino acid solution, while Control group infused Amiparen (commercial methionine and cysteine containing amino acid solution) as protein source for 14 days' TPN with 5-FU and mitomycin C (MMC). The over all clinical response rate (PR+CR) in RT and Control groups were 26.3% and 8.1%, respectively, with significant statistical difference in both values at p = 0.015. Fourteen advanced gastric cancer patients allocated to RT and Control group randomly and received each amino acid as protein source for 7 days TPN with 5-FU administration. All cases were performed gastrectomy without waiting period, and resected material was examined the histological response. In the 7 cases of RT group, grade 2 was seen in 4 cases, grade 1-b in 1, grade 1-a in 1 and grade 0 in 1. In the 7 of Control, 3 cases were grade 1-a and the remaining 4 were grade 0. There were significant differences in both degree and incidence of the histological response at p = 0.016. A stage IV gastric cancer patient with marked liver metastasis received 2 times RT therapy with 5-FU and MMC for 14 days and undertaken gastrectomy after 22 day, waiting period. Resected gastric cancer showed grade 2 to 3 histological response, and the liver metastasis showed marked effect as PR to CR.

Amino Acids↗
PubMed1994

An approach to the hepatic hilus with marked fibrosis: a surgical technique for reconstruction of the bile duct with a benign stricture.

It is very difficult to approach the hepatic hilus safely in patients with common and/or hepatic bile duct strictures in which normal tissue has been replaced by scarred tissue with firm fibrous adhesions. In this report, we describe how eight patients with benign strictures of the bile duct underwent an operation which involved dividing the superior mesenteric and portal veins from the lower margin of the pancreas in a dorsal direction using a finger in a tunneling technique. The common bile duct, which was buried in scar tissue, was then explored, while the common and/or proper hepatic arteries in the hepatoduodenal ligament were confirmed, after transsection at the superior margin of the pancreas. Biliary reconstruction was successfully performed after resection of the constricted bile duct in all the patients, none of whom have experienced recurrence from 6 months to 5 years after the operation.

Aged↗
PubMed1994

Hepatic resection under the intermittent selective portal branch occlusion by balloon catheter.

BACKGROUND: In hepatic resection, it is important to control intrahepatic blood flow to minimize blood loss. Intermittent and selective vascular occlusion, if possible, are advisable. STUDY DESIGN: For this purpose, we created the double balloon catheter, which when introduced into a lobar or a smaller branch of the intrahepatic portal vein through a branch of the ileocolic vein, made it possible to occlude these branches temporarily during hepatic resection. The small balloon located at the tip of the catheter made it easy to introduce the catheter to the portal branch selectively, under the guidance of ultrasonography. Another balloon was inflated intermittently to occlude selective portal blood flow. Using this technique, hepatic resection was achieved in 18 consecutive patients: 13 with hepatocellular carcinomas (11 with cirrhosis, two with chronic hepatitis), one with cholangiocellular carcinoma, three with metastatic carcinomas, and one with intrahepatic calculi. RESULTS: In these cases, 19 hepatic resections were performed; two left hepatectomies, one extended right hepatectomy, one right hepatectomy, six segmentectomies, eight subsegmentectomies, and one partial hepatectomy. In each case, well demarcated hepatic tissue delineated by ischemic change was removed with minimal bleeding and little impairment to the residual hepatic tissue, resulting in a good postoperative course. CONCLUSIONS: This double balloon catheter can replace the dissection of the hepatoduodenal ligament for hepatic resection, which causes bleeding, especially in patients with cirrhosis, and results in less cell injury of the residual hepatic parenchyma.

Aged↗
PubMed1992

Antitumor effect of methionine-depleting total parenteral nutrition with doxorubicin administration on Yoshida sarcoma-bearing rats.

Methionine-depleting total parenteral nutrition (methionine-depleting TPN), which infuses an amino acid solution devoid of L-methionine and L-cysteine as the sole protein source, showed enhancement of the effect of several anti-cancer agents. In this study, the combined effect of the methionine-depleting TPN with the administration of doxorubicin was examined in Yoshida sarcoma (YS)-bearing rats with regard to effects on the primary tumor growth, the extension of metastasis, and the host animal's life span. In the first experiment, immediately after receiving methionine-depleting TPN for 8 days, the animals were killed. Pathologic findings evaluated tumor growth in the implanted site and extension of the metastasis. In the second experiment, the survival period was determined after animals received methionine-depleting TPN for 10 days, with subsequent oral feeding until they died naturally. Proliferation of YS was markedly suppressed. In particular, hematogenous metastasis, which is a characteristic of YS, was suppressed, and a longer survival period (42.7 +/- 15.6 days, mean +/- SD) was attained in rats in the group treated with the methionine-depleting TPN combined with the administration of doxorubicin.

Animals↗
PubMed1992

Histopathologic characteristics of early stage esophageal carcinoma. A comparative study with gastric carcinoma.

Unlike the stomach, the esophageal mucosal layer has abundant vessels. To study the histopathologic character of cancer of the esophagus in comparison with that of stomach, the histologic findings (such as vascular or lymphatic permeation and lymph nodal involvement of cancer) were surveyed in 52 lesions of superficial esophageal carcinoma in which carcinoma invasion was limited to the submucosal layer, 448 cases of so-called early gastric carcinoma in which the carcinoma invasion was limited to the submucosal layer, and 109 cases of gastric carcinoma invading the proper muscle layer (PM-carcinoma). With respect to lymph node metastasis and lymphatic and vascular permeation, there was a particularly high incidence of carcinoma extending to the submucosal layer (SM-carcinoma) of the esophagus and a similar high incidence of PM-carcinoma of the stomach. Carcinoma limited to the mucosal epithelium and mucosal layer of the esophagus (MM-carcinoma) has an incidence similar to carcinoma in the mucous membrane and SM-carcinoma of the stomach, respectively. Thus, the cases in which carcinoma invasion was limited to the muscle layer of the mucosa of the esophagus were shown to have a prognosis similar to that of so-called early carcinoma of the stomach.

Carcinoma↗
PubMed1992

Differences in the mode of the extension of gastric cancer classified by histological type: new histological classification of gastric carcinoma.

By combining two of the morphological characteristics of gastric cancer, the degree of differentiation of the glandular tubules and the amount of mucus in the cytoplasm, the histological type of the gastric carcinoma was categorised into four groups. Group I: tubular differentiation--well; mucus in cytoplasm--poor; group II: tubular differentiation--well; mucus in cytoplasm--rich; group III: tubular differentiation--poor; mucus in cytoplasm--poor; group IV: tubular differentiation--poor; mucus in cytoplasm--rich. A study of the relation between the types of primary lesion and the mode of extension and recurrence of gastric carcinoma in 200 autopsy cases was then undertaken. In group I, the frequency and extent of haematogenous metastasis such as in the liver was high, while in group IV, that of lymph node metastasis, direct invasion into surrounding organ, and peritoneal dissemination were higher. In group III, which showed the intermediate mode of extension in nature to those of group I and IV, although the frequency and severity of the bone marrow metastasis was the highest. There were significant differences in the modes of development and the extent of infiltration in all groups.

Bone Marrow↗
PubMed1992

[Therapeutic modality for esophago-gastric varices analyzed by endoscopic ultrasonography].

For 64 cases with portal hypertensive disease, we investigated the intramural and extramural structure of the stomach and esophagus by endoscopic ultrasonography (EUS). Variously developed intra- or extra-mural vascular structures had a relationship to the endoscopic variceal form, and the communicating (inflow) vessels to varices were found in 35 of 50 primary treated cases (70%). We classified the esophago-gastric varices into three types according to the vascular structure, such as the esophageal type, the esophago-gastric type and the solitary gastric type. From the analyses of these collateral structures, we should select a treatment as follows. In the esophageal type which has a few inflow vessels, it is easy to eliminate the varices by obturating the inflow vessels by endoscopic injection sclerotherapy (EIS). In the esophago-gastric type, which has many enlarged inflow vessels, the Hassab operation is effective to devascularize extramural inflow vessels, and the combination of EIS is necessary to sclerous the intramural varices. In the solitary gastric type which is a part of the downward porto-systemic shunt, Hassab operation is recommended to prevent the rupture of varices for the subtype with intramural running vessels, but conservative therapy is enough for the subtype without intramural running vessel.

Collateral Circulation↗
PubMed1991

Endoscopic resection of early-stage esophageal cancer.

Early-stage esophageal cancerous lesions in four clinical cases were endoscopically resected via a newly developed procedure, endoscopic esophageal mucosal resection using a transparent tube (EMRT). In the complete resection of cancer-bearing mucosa, more than half of the circumferential mucosal resections did not involve major complications such as perforation or massive bleeding. Large ulcers artificially induced by this procedure disappeared within 3 weeks, exhibiting no stenotic changes. Resected specimens contributed well to microscopic examination for histological classification and determination of the depth of cancer invasion and possible vascular involvement. No signs of recurrence were observed during the 15-month follow-up period. We conclude that EMRT is a safe and minimally invasive local treatment for early-stage esophageal cancer that also provides specimens that are suitable for accurate histopathological diagnosis.

Adenocarcinoma↗
PubMed1991

Endoscopic resection of carcinoma in situ of the esophagus accompanied by esophageal varices.

A case of carcinoma in situ of the esophagus accompanied by esophageal varices was treated by endoscopic mucosal resection using a transparent tube (EMRT) following eradication of the varices via injection sclerotherapy (EIS). Intravariceal injection sclerotherapy was performed for esophageal varices, and after eradication of the varices had been achieved, half of the circumferential esophageal mucosal resection of the cancer lesion was carried out. No serious complication such as perforation or mass bleeding was observed. Cancer-involved mucosa was completely resected and all specimens contributed well to accurate histopathological study, being diagnosed as intraepithelial squamous-cell carcinoma. The artificial ulcer recovered completely, showing no stenotic changes. Our conclusion from this experience is that EIS + EMRT is a valuable and minimally invasive treatment for patients exhibiting this disease, providing an accurate histological diagnosis.

Aged↗
PubMed1991

Anti-tumor effect of L-methionine-deprived total parenteral nutrition with 5-fluorouracil administration on Yoshida sarcoma-bearing rats.

L-methionine-deprived total parenteral nutrition (methionine-deprived TPN), infusing amino acid solution devoid of L-methionine and L-cysteine by the method of TPN as an only protein source, showed enhancement of the effect of several anti-cancer agents. In this study the combined effect of the methionine-deprived TPN with administration of 5-fluorouracil (5-FU) was examined in Yoshida Sarcoma (YS)-bearing rats, from aspects of effects on the tumor metastasis and the host animal's life span, in the following four groups treated with: methionine-deprived TPN with administration of 5-FU, methionine-deprived TPN without administration of 5-FU, L-methionine-contained TPN plus 5-FU, and L-methionine-contained TPN without 5-FU. In the first experiment, TPN was continued for 8 days in the four groups, and the anti-cancer effect of methionine-deprived TPN and administration of 5-FU based on both the growth of the primary tumor at the implanted site and the tumor metastasis was studied from the view point of pathologic findings of animals killed immediately after these treatments. In experiment 2 the survival period was examined after these treatments for 10 days with subsequent oral feeding until death. The results were as follows: proliferation of YS, transplanted subcutaneously, was markedly suppressed; particularly hematogenous metastasis, characteristic in YS, was prominently blunted then obtained an apparent longer survival period in rats treated with the methionine-deprived TPN with administration of 5-FU.

Animals↗
PubMed1991

[Postoperative changes in immunoreactive plasma endothelin concentrations].

We investigated postoperative changes in immunoreactive plasma endothelin (ET-1) concentrations using a highly specific and sensitive radioimmunoassay developed for this purpose. The patients were divided into two groups: 10 patients underwent subtotal-esophagectomy by combined right thoracotomy and celiotomy (EC-group), and an other 10 underwent total gastrectomy via celiotomy only (GC-group). Before operation, plasma ET concentrations in both groups were within the normal range. After operation, the mean plasma ET-1 concentration in the EC group was significantly higher than the preoperative concentration (p less than 0.01). But in the GC-group, there were no significant change. A significant correlation existed between the change in plasma ET-1 concentration and the amount of intraoperative hemorrhage (p less than 0.05). Additionally in the EC group, a significant correlation existed between plasma ET-1 concentrations after operation and the change in the atrial-natriuretic-peptide (ANP) concentration during operation (p less than 0.05). There was no correlation between ET-1 concentrations and blood pressure. We believe that the increase in the ET-1 concentration was attributable to endothelial cell injury and may increase ANP secretion. We speculate that the plasma ET-1 concentration may be a reliable index of surgical stress.

Adult↗