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Biomedical subjects

N Koyanagi

Publications and source records attributed to N Koyanagi.

At least 73 records · Page 4Linked to original sources
PubMed1982

Induction of antitumor immunity by tumor cells treated with abrin.

Abrin is known as a cytotoxic lectin. Immunization with Meth-A tumor cells which were treated in vitro with abrin induced a strong antitumor immunity in syngeneic BALB/c mice. The immunizing effect was stronger than that produced by an irradiated Meth-A tumor cell vaccine. Studies on the mechanisms of the immunizing effect with the abrin-treated tumor cells demonstrated that abrin acts as an immunoadjuvant. Furthermore, the regression of a growing Meth-A tumor was observed after abrin was injected into the tumor, while the induction of a strong antitumor immunity also occurred. It appears, therefore, that the antitumor effects of abrin are attributable to two kinds of activity: cytotoxicity and adjuvant activity.

Abrin↗
PubMed1981

Prediction of variceal hemorrhage by esophageal endoscopy.

To assess the risk of variceal bleeding, endoscopic findings in 172 patients with esophageal varices were classified based on the "General Rules for Recording Endoscopic Findings on Esophageal Varices" prepared by the Japanese Research Society for Portal Hypertension. Among the factor which enabled an accurate prediction of bleeding were the red wale marking and cherry-red spot of the red color sign category and blue varices of the fundamental color category with large varices. Other factors in the "General Rules" such as the form and location were of minor significance in prediction of the bleeding. Each of these factors can be quantified and an assessment can be made of the likelihood of bleeding. By calculating the total score of these factors, the risk of bleeding in individual patients was accurately estimated.

Esophageal and Gastric Varices↗
PubMed1981

Decreased arteriovenous flow resistance in the left gastric venous area in cirrhotic patients.

To assess the relationship between the fluid mechanics in the left gastric venous area and the portal trunk, manometric measurements were made in patients with or without cirrhosis of the liver. In ten normal subjects, temporary portal vein occlusion produced comparable elevation in both the occluded left gastric venous pressure (OLGP) and the portal vein pressure (PVP); 152-429 mm of water in OLGP and 115-452 mm of water in PVP. In sixty cirrhotic patients, however, the portal vein occlusion resulted in far less increase in OLGP than that in PVP; 281-365 mm of water in OLGP and 281-540 mm of water in PVP. In other words, regarding pressure measurements, the relationship was 'separated' in cirrhotics, but 'continuous' in normal subjects. Mathematical analysis of the data using a modification of Wheat-stone bridge model suggested that the arteriovenous flow resistance in the left gastric venous area of cirrhotics was reduced to less than one fifth of that in the controls. It would appear that the increased flow capacity as a result of a reduced arteriovenous flow resistance is responsible for the functional 'separation' from the portal trunk.

Humans↗
PubMed1981

Hemodynamic and morphological changes in the stomach of portal hypertensive rats.

To determine hemodynamic and morphological changes in the stomach of portal hypertensive rats, male WKA rats were given CCl4 subcutaneously in order to induce liver cirrhosis. The portal venous pressure of cirrhotic rats was significantly higher (17.7 cm H2O) than that of controls (10.5 cm H2O). Mucosal blood flow of the stomach in the portal hypertensive rat was increased (+ 46%) compared with that of controls and the peripheral vascular resistance of the stomach was significantly low. Morphological studies revealed that capillaries, collecting, submucosal, serosal and portal veins were significantly dilated; however, there were no apparent alterations in the arterial system of the stomach of the portal hypertensive rats. These results suggest that in the stomach of the portal hypertensive rat there is an increased blood flow and decreased peripheral vascular resistance and that this hyperdynamic circulatory state may derive from the dilatation of microvascular systems.

Animals↗
PubMed1981

Immunological studies on the antitumor effect of sporamycin.

The role of immunological effects in the antitumor activity of sporamycin activity of sporamycin was studied mainly using the mouse syngeneic tumor, Meth-A. Sporamycin inhibited the growth of the Meth-A tumor and Balb/c mice, and 12 out of 19 mice were cured. The 12 survivors did not show any growth of reinoculated Meth-A cells. Enzymes-histochemical observations revealed marked activities of both acid phosphatase and alpha-naphthyl acetate esterase in lymphoid cells and macrophages which heavily infiltrated the tumor tissue. Pretreatment of mice with sporamycin produced a remarkable inhibition of tumor growth. A marked neutralization activity against tumor cells was observed by Winn's method using spleen cell of tumor-bearing mice which had been pre- or post-treated with sporamycin. However, this neutralization activity was depressed by anti-Thy 1.2 serum plus complement. The response of spleen cells to concanavalin A was increased by treatment with sporamycin in mice. All of these findings suggest that sporamycin may, at least partially, act by modulating the cellular immune response.

Animals↗
PubMed1977

Disseminated intravascular coagulation and refractory shock induced by splanchnic metabolic acidosis.

In eight dogs, acidosis was induced by the infusion of lactic acid into the superior mesenteric artery in a dose of 5.0 to 12.5 millimoles per kilogram during a 30 minute period. Four dogs out of five in which the lowest pH of arterial blood was lower than 7 developed a typical acute disseminated intravascular coagulation, accompanied by a sudden elevation of arterial and portal venous pressure. In these four dogs, refractory shock developed between 0.5 and five hours after lactic acid infusion. The other four without disseminated intravascular coagulation maintained a normal blood pressure and survived until sacrifice six hours after infusion. In two dogs, systemic infusion of 10 millimoles per kilogram was performed in the same interval as the former. Both died from cardiac failure without occurrence of disseminated intravascular coagulation before the infusion was completed. The dogs with disseminated intravascular coagulation revealed a marked deterioration of coagulative system and generalized thrombi in the intestine, liver, lung and kidney. Minimal changes in these parameters were observed in the dogs without disseminated intravascular coagulation. The results suggest that the infusion of lactic acid into the superior mesenteric artery is a convenient model for the production of disseminated intravascular coagulation and resultant shock.

Acidosis↗
PubMedDate not supplied

Prevention of recurrence of esophageal varices after endoscopic injection sclerotherapy with ethanolamine oleate.

Endoscopic injection sclerotherapy was given to 155 patients with esophageal varices mainly related to non-alcoholic liver cirrhosis. The formation of a superficial ulcer in the lower esophagus was achieved in 141 (91.0%) of the 155 patients, with an average of 4.1 sessions of endoscopic injection sclerotherapy during an average time of 4.9 weeks. The average volume of 5% ethanolamine oleate sclerosant used was 24.8, 19.2, 12.3 and 6.5 ml for the initial to fourth sessions of endoscopic injection sclerotherapy, respectively. For 14 patients, a sufficient number of sessions of endoscopic injection sclerotherapy could not be given: 10 early deaths (5 hepatoma, 4 liver failure and 1 gastric bleeding), and 4 refused further sessions. When the esophageal mucosa had been eliminated and a superficial ulcer had formed, episodes of recurrent bleeding or recurrence of esophageal varices were nil over a median follow-up of 14.6 months, with a range of 1 to 27 months. In seven patients, bleeding recurred before elimination of the mucosa could be achieved, but these bleeding episodes were well controlled with an additional session of endoscopic injection sclerotherapy. At the time of analysis, there were 36 deaths (20 hepatoma, 14 liver failure and 2 gastric bleeding) among these 155 patients. Thus, the mean follow-up was 16.3 months (range: 7 to 27 months) in the 119 survivors, with no recurrence of the varices. We propose that removal of the esophageal mucosa may well be the endpoint of repeated endoscopic injection sclerotherapy in the management of patients on injection sclerotherapy.

Endoscopy↗
PubMedDate not supplied

Successful treatment of early hepatocellular carcinoma and concomitant esophageal varices.

Twenty-two cirrhotic patients with hepatocellular carcinoma (HCC) and concomitant esophageal varices underwent aggressive hepatic resection accompanied by simultaneous devascularization, perioperative endoscopic injection sclerotherapy, or both (group A). To evaluate this treatment, 37 cirrhotic patients without esophageal varices who underwent hepatic resection for small HCC (2 cm or less) during the same period (group B) were studied to compare clinical data, preoperative laboratory data, pathologic findings, disease-free rates, and survival rates. The operative time, blood loss, and resected liver weight did not differ between the two groups; however, the tumor size of group A (2.7 +/- 1.6 cm, mean +/- SD) was significantly larger than that of group B (1.5 +/- 0.3 cm). The preoperative liver function of group A was also more severe than that of group B except for prothrombin time. Despite these disadvantages, the 1-, 3-, and 5-year disease-free rates of the two groups were 72% versus 94%, 48% versus 54%, and 38% versus 45%, respectively, and the 1-, 3-, and 5-year survival rates were 91% versus 97%, 79% versus 79%, and 54% versus 67% (group A versus group B), respectively, which showed no significant differences. Furthermore, there was no variceal bleeding in group A after treatment. Based on the above findings, for treatment of HCC and concomitant esophageal varices, aggressive hepatic resection accompanied by simultaneous devascularization, perioperative endoscopic injection sclerotherapy, or both is the preferred form of treatment.

Adult↗
PubMedDate not supplied

Endoscopic classification of gastric varices.

Endoscopic observations of gastric varices in 124 patients were classified according to form, location, and color. Form was classified into three types: tortuous (F1), nodular (F2), and tumorous (F3). Location was classified into five types: anterior (La), posterior (Lp), lesser (Ll) and greater curvature (Lg) of the cardia, and fundic area (Lf). Color was white (Cw) or red (Cr). Glossy, thin-walled focal redness on the varix was defined as red color spot (RC spot). Stepwise logistic regression analysis for multivariate adjustments was performed for all of the endoscopic covariates, and four risk factors (La, Lg, F2, RC spot) that affect bleeding from gastric varices were independently identified. This classification should aid in assessing gastric varices observed by fiberoptic endoscopy and help design appropriate treatment.

Adult↗
PubMedDate not supplied

Comparative effects of 5% ethanolamine oleate versus 5% sodium morrhuate for sclerotherapy of oesophageal varices.

Forty-five cirrhotic patients with oesophageal varices were randomized to receive endoscopic injection sclerotherapy with either 5% ethanolamine oleate (EO), or 5% sodium morrhuate (SM). In the EO group, there was a statistically significant higher rate of disappearance of red colour signs on the varices a week after the initial session of sclerotherapy than in the SM group (91.3% vs 45.5%, P less than 0.05). A jet-like bleeding from injection sites at the second session of sclerotherapy occurred in three patients in the SM group and they experienced blurred vision. There was no such occurrence in the EO group. Oesophageal bleeding requiring blood transfusion during the course of repeated sclerotherapy occurred only in the SM group (five patients): bleeding was from a partly thrombosed varix and in four was from oesophageal ulcers. We found that EO administered intravariceally is more efficacious than SM for sclerotherapy of oesophageal varices.

Esophageal and Gastric Varices↗
PubMedDate not supplied

Prognostic value of combination assays for CEA and CA 19-9 in gastric cancer.

Preoperative serum CEA and CA 19-9 levels in 158 patients with gastric cancer were analyzed with respect to prognostic factors, using univariate and multivariate analysis. The incidence of high preoperative levels of both CEA and CA 19-9 was 10.1% (16/158). 13.9% (22/158) showed high CEA levels and normal CA 19-9 levels, whereas the reverse was true in 16.5% (26/158). Neither marker showed a high level in 59.5% (94/158). The multivariate analysis showed that in addition to tumor stage, the depth of invasion, liver metastasis and peritoneal dissemination, combination assays of preoperative serum CEA and CA 19-9 levels were an independent prognostic factor. Combination assays of preoperative serum CEA and CA 19-9 will allow us to conduct a more careful postoperative follow-up of high-risk patients, and also help determine the optimum adjuvant chemotherapy.

Aged↗
PubMedDate not supplied

The therapeutic strategies in performing emergency surgery for gastroduodenal ulcer perforation in 130 patients over 70 years of age.

BACKGROUND/AIMS: Gastroduodenal ulcer is a very common illness in Japan. As the number of elderly persons in Japan increases the same as in Europe and America, the number of such patients requiring a gastroduodenal emergency operation has also increased. Regarding the complications of peptic ulcer, a perforation remains the most important fatal complication. The aim of this study is to investigate the operative risk factors and the long-term recurrence rates and to define the optimal surgical procedures in emergency situations in elderly patients. METHODOLOGY: From April 1988 through March 1997, 130 patients over 70 years of age with a perforated gastroduodenal ulcer (a duodenal ulcer perforation in 50 patients and a gastric ulcer perforation in 80 patients) were operated on in an emergency situation in our clinic. We investigated the following items; medical illness, preoperative risk factor, optimal surgical procedure, postoperative organ failure and the cumulative recurrence-free rates after surgical treatment. RESULTS: A significant correlation with mortality was observed in patients with established comorbidity in the following organs: lung (P = 0.03), heart (P = 0.02), kidney (P = 0.04), and diabetes (P = 0.03). The highest postoperative mortality rate was recorded in patients who underwent a simple closure of a duodenal ulcer perforation (4 patients; 26.7%), while the lowest postoperative mortality rate was recorded in patients who underwent a simple closure and vagotomy of a duodenal ulcer perforation (3 patients; 12.5%). In gastric ulcers, the mortality rate in patients with a gastrectomy was significantly higher than in patients with a simple closure. The practical application of the three risk factors (preoperative shock, delay to surgery over 24 hours, and medical illness) was shown by the progressive rise in the mortality rate with the increasing number of risk factors. Based on the 5 postoperative years after treating a perforated duodenal ulcer, the cumulative recurrence rate after a simple closure (63.6%) was significantly higher than that after a simple closure and vagotomy (38.1%) (n = 0.02) or after gastrectomy (0%) (P < 0.001). At 5 years postoperatively, the cumulative recurrence rate after a simple closure (41.2%) was significantly higher than that after a gastrectomy (15.9%) (P < 0.01). CONCLUSIONS: In conclusion, in an emergency situation, elderly patients are in a highly unfavorable prognostic condition due to their advanced age, and comorbidity, which thus leads to poorer results, not only worldwide, but also in Japan. Based on our findings, in duodenal ulcer cases, a simple closure and vagotomy is recommended because of its low mortality and minimal stress, except for cases with a giant perforation measuring over 20 mm in diameter at the perforation hole or with severe duodenal stenosis. In stomach ulcer cases, a gastrectomy may be recommended because of its low recurrence rate.

Age Factors↗