Biomedical subjects

N Nishida

Publications and source records attributed to N Nishida.

195 records · Page 11Linked to original sources

PubMedDate not supplied

Transcatheter arterial chemoembolization (TACE) in the treatment of unresectable liver cancer.

Basis, techniques, and recent strategies and results of interventional treatments for hepatoma were reviewed. The basic experimental researches indispensable to justify clinical technique and dosage have been accomplished. A total of 1310 unresectable cases underwent transcatheter arterial chemoembolization (TACE) and/or related therapies. The related therapies are several modified or strengthened TACE such as Lipiodol-TACE and subsegmental TACE. The therapies for unembolizable cases are balloon occluded arterial infusion, Lipiodol-SMANCS infusion and percutaneous direct injection chemotherapy, that reinforces the effect of TACE. As for the resectable cases, postoperative TACE was proved to be beneficial because it increased survival rates; however, preoperative TACE was not beneficial. The TACE and related interventional radiologic therapies for the hepatoma can be an equal or superior therapy by virtue of targeting chemotherapy.

Chemoembolization, Therapeutic↗

PubMedDate not supplied

Post-TIPS hepatic encephalopathy treated by occlusion balloon-assisted retrograde embolization of a coexisting spontaneous splenorenal shunt.

A 51-year-old man with posthepatitis cirrhosis underwent a transjugular intrahepatic portosystemic shunt (TIPS) for bleeding of recurrent esophageal varices. The patient had a coexisting, spontaneous, splenorenal shunt. He subsequently developed hepatic encephalopathy, presumably due to excessive portosystemic shunting. Since medical management resulted in no significant improvement, the splenorenal shunt was embolized from the jugular vein approach via renal vein access during temporary balloon occlusion. Within a few days, the patient's hepatic encephalopathy resolved. Twelve months later the patient showed no recurrence of encephalopathy and had maintained a patent TIPS.

Catheterization↗

PubMedDate not supplied

Dependency of tissue necrosis on gelatin sponge particle size after canine hepatic artery embolization.

PURPOSE: To determine the optimal size of gelatin sponge particles (GSPs) to produce maximum tumor necrosis with minimum side effects after canine hepatic artery embolization (HAE). METHODS: GSPs were separated into four size ranges: A, up to 200 microns (mean 152) as Gelfoam powder; B, 200-500 microns (mean 336) as Gelfoam powder; C, 500-1000 microns (mean 649) as Spongel; and D, 1000-2000 microns (mean 1382) as Spongel. Three mongrel dogs were assigned randomly to HAE with each particle size. On day 7 after HAE, the livers were removed and subjected to pathological examination. RESULTS: The mean volume of liver necrosis was 11% after embolization, with particle size A, 36.3% with B, 0% with C, and 1% with D. Coagulation necrosis was found in all livers with particles of sizes A and B, and in 1 of 6 with sizes C and D. Bile duct injury was found in five of six dogs with sizes A and B and in none with sizes C and D. Gallbladder necrosis was found in one dog with size B and pancreas necrosis in one with size A. CONCLUSION: GSPs of 500 microns are considered optimally effective for tissue necrosis according to this model.

Animals↗

PubMedDate not supplied

Experimental TIPS with spiral Z-stents in swine with and without induced portal hypertension.

PURPOSE: To assess the suitability of spiral Z-stents for transjugular intrahepatic portosystemic shunt (TIPS) and the influence of portal hypertension on shunt patency in young swine. METHODS: TIPS were established using spiral Z-stents in 14 domestic swine. In 7 animals, the portal venous pressure was normal; in the other 7, acute portal hypertension was induced by embolization of portal vein branches. Follow-up portal venography and histologic evaluations were done from 1 hr to 12 weeks after TIPS. RESULTS: Follow-up transhepatic portal venograms showed progressive narrowing of the shunt, most prominent in the midportion of the tract. Ingrowth of liver parenchyma between the stent wires found after 3 weeks led to progressive shunt narrowing and shunt occlusion by 12 weeks. A pseudointima grew rapidly inside the stent, peaked in thickness around 4 weeks, and decreased later. Acutely created portal hypertension rapidly returned to normal and there was no difference in TIPS patency between the two groups of animals. CONCLUSION: Although the spiral Z-stent can be used as a device for creation of TIPS in patients with cirrhotic livers, it is associated with extensive liver ingrowth in swine that leads to rapid shunt occlusion. Portal hypertension was only transient in this model.

Animals↗

PubMedDate not supplied

A dedicated Z-stent for acquired saber-sheath tracheobronchomalacia.

The tracheobronchial lumen has a continuous horseshoe arch morphology. We formed Z-stents accordingly to support the weakened cartilagenous portions. With this type of stent we treated a patient with acquired saber-sheath type tracheobronchomalacia (TBM), Rayl's type II, Johnson's grade III, whose condition was aggravated even under positive end expiratory pressure (PEEP) therapy. The patient improved gradually. No immediate complication was observed. Bronchofiberscopic examination revealed that the tracheobronchial arcade was closely strut-braced and showed no expiratory collapse. Six months later, when the patient was intubated due to asthmatic attacks, tissue ingrowth through the stent was found and removed. There was no recurrence of TBM. The patient died 2 years later of pneumoconiosis.

Aged↗

PubMedDate not supplied

Dose-dependency of hepatocellular necrosis in a canine model of chemoembolization.

PURPOSE: The degree of local tissue toxicity from hepatic arterial chemoembolization relative to the dose of anticancer drugs was evaluated in 13 dogs. MATERIALS AND METHODS: Animals were divided into four groups. Group 1 was the control group in which embolization was performed with gelatin sponge particles only (n = 4); group 2 animals underwent embolization with 0.4 mg/kg of Adriamycin (ADR) and 0.2 mg/kg of mitomycin C (MMC) (n = 4); group 3, with 0.8 mg/kg of ADR and 0.4 mg/kg of MMC (n = 2); and group 4, with 1.6 mg/kg of ADR and 0.8 mg/kg of MMC (n = 3). RESULTS: Animals were killed 1 week after embolization, and histopathologic evaluation was performed. The average percentage liver necrosis in the embolized lobe was 0% in group 1, 1% in group 2, 85% in group 3, and 92% in group 4. CONCLUSION: Hepatic arterial chemoembolization with high doses of anticancer drugs causes severe liver damage, but 0.4 mg/kg of ADR and 0.2 mg/kg of MMC is relatively safe, causing only minimal changes in this canine model.

Animals↗

PubMedDate not supplied

Hepatotoxicity in rat following administration of valproic acid.

Chronic injections of valproic acid (VPA), VPA with phenobarbital (PB), and PB were studied for their effects on liver mitochondrial morphology and carnitine metabolism in rats. Mitochondrial enlargement was induced by the administration of VPA (500 mg/kg/day) for a period of 7 consecutive days. The administration of VPA (500 mg/kg/day)-plus-PB (20 mg/kg/day) for 7 days, however, did not induce megamitochondrial formation, but in these livers an unusual increase was observed in the number of liver mitochondria, microvesicular steatoses, and myeloid bodies. VPA-treated rats had significantly lower levels of serum-free and total carnitine and higher levels of acylcarnitine and acyl to free ratio than those of the controls. The free carnitine concentrations in serum and liver of the rats treated with VPA-plus-PB were much lower as compared with those treated with either VPA or PB. These morphological and biochemical results, especially of carnitine metabolism, suggest that inhibition of beta-oxidation in liver mitochondria occurred in rats treated with VPA and PB and that, in particular, polytherapy with VPA-plus-PB could be clinically hazardous in causing hepatic injury.

Animals↗

PubMedDate not supplied

Hepatotoxicity in rat following administration of valproic acid: effect of L-carnitine supplementation.

The effect of prolonged administration (7 days) of valproate (VPA, 500 mg/kg/day), or VPA (500 mg/kg/day) with L-carnitine (200 mg/kg/day) on blood carnitine levels and the appearance of liver mitochondria were assessed in the rat. VPA-treated rats showed hypocarnitinemia and enlarged mitochondria when compared with saline-injected control rats. In rats treated with both VPA and L-carnitine, serum and liver carnitine levels were increased by the L-carnitine supplement and the liver mitochondria were not enlarged. L-Carnitine supplement in VPA-medicated patients seems to prevent hepatotoxicity, especially mitochondrial dysfunction.

Animals↗

PubMedDate not supplied

Angelman syndrome in three siblings: characteristic epileptic seizures and EEG abnormalities.

Neurologic findings in 3 siblings with Angelman syndrome (AS) with apparently normal karyotype but DNA deletion of 15q11-q12 deriving from their mother are described. Increased auditory brainstem response (ABR) thresholds were noted in all 3. Interictal EEG findings included periodic 2- to 3-Hz high-voltage slow wave bursts bioccipitally and sporadic slow spike wave complexes mainly bifrontally. EEG findings suggestive of minor epileptic status were apparent in the elder brother and may be a characteristic feature in young AS patients. Seizures suggestive of generalized epilepsy have been reported in 90% of AS patients. AS is considered a good model of symptomatic generalized epilepsy associated with chromosomal DNA deletion of the (GABA)A receptor beta 3-subunit gene.

Angelman Syndrome↗

PubMedDate not supplied

Cerebral artery thrombosis as a cause of striatocapsular infarction. a histopathological case study.

Striatocapsular infarction is a distinct form of stroke, but few histopathological studies have been performed concerning acute lesions. We report the postmortem findings of a patient with an infarct who died shortly after onset. A 72-year-old man died of acute myocardial infarction 6 days after the onset of left-sided striatocapsular infarction. Autopsy revealed thrombus formation of the left middle cerebral artery (MCA) trunk. The lateral striate arteries irrigating the area of the infarct branched off distal to the arterial segment occluded with a thrombus. The cortical vessels were perfused by leptomeningeal collaterals. This report histopathologically confirmed thrombus formation of the MCA resulting in striatocapsular infarction.

Aged↗

PubMedDate not supplied

The hemodynamics of dysplastic nodules in the liver evaluated by CT angiography and immunohistochemistry.

BACKGROUND/AIMS: Dysplastic nodules diagnosed pathologically exhibit various hemodynamic patterns. To evaluate these differences in their hemodynamics, we observed basement membrane formation of sinusoids. METHODOLOGY: For 12 low-grade dysplastic nodules, 24 high-grade dysplastic nodules and 16 hepatocellular carcinomas, both computed tomography during arterial portography and CT arteriography were performed preoperatively. Resected specimens were examined immunohistochemically for COL IV (type IV collagen) and laminin to observe basement membrane formation. We compared their hemodynamics on computed tomography during arterial portography and CT arteriography with the expressions of COL IV and laminin. RESULTS: All of the low-grade dysplastic nodules were not hypervascular on CT arteriography, and negative for COL IV and laminin. All of the hepatocellular carcinomas were hypervascular on CT arteriography, and positive for COL IV and laminin. High-grade dysplastic nodules exhibit four hemodynamic patterns on CT during Arterial Portography/CT arteriography. All of 7 iso/iso and 5 iso/hypo nodules were negative for COL IV and laminin. Of the 9 hypo/hyper nodules, which exhibited hemodynamics similar to hepatocellular carcinoma, COL IV was identified in 7 and laminin identified in 8 nodules. Of the 3 hypo/hypo nodules, COL IV and laminin were identified in one. CONCLUSIONS: In high-grade dysplastic nodules, most cases exhibited a correlation between the hemodynamic patterns and the degree of the sinusoidal basement formation.

Aged↗

PubMedDate not supplied

Time courses of PIVKA-II and AFP levels after hepatic artery embolization and hepatic artery infusion against hepatocellular carcinoma: relation between the time course and tumor necrosis.

We examined 35 untreated patients with unresectable hepatocellular carcinoma who exhibited positivity for both plasma PIVKA-II and serum AFP, and studied the weekly course of these markers from the pre-TAE or -HAI period to the third week of treatment. We correlated changes in these markers with the tumor necrosis rate and the time course on X-ray CT images. One week after TAE, the tumor necrosis rate and the time course of PIVKA-II showed a significant correlation (r = 0.7), while the correlation was between the time course of AFP and the tumor necrosis rate was insignificant (r = 0.2). At two and three weeks after TAE, both the time course of AFP and PIVKA-II showed significant correlations with the tumor necrosis rate. In 16 patients with tumor necrosis rates of not less than 90%, the mean of the actual half-life (AHL) of PIVKA-II was 3.2 days, the shortest was 1.83 days, and 75% of all AHLs clustered from two days to four days, while the mean and shortest AHLs of AFP were six days and 2.98 days, respectively, exhibiting a broader distribution. On the other hand, in three out of the nine cases of hepatocellular carcinoma complicated with portal tumor thrombi, PIVKA-II increased after HAI in spite of a reduction in tumor size. It was suggested that the PIVKA-II level requires careful interpretation in cases of portal vein obstruction after intensive hepatic arterial infusion of anticancer agents.

Aged↗

PubMedDate not supplied

Clear cell sarcoma of the kidney in an adult.

A 25-year-old woman with clear cell sarcoma of the kidney (CCSK) underwent computed tomography (CT), angiography, and a surgical operation. The clear cell sarcoma showed a cystic lesion with solid components on CT and a hypovascular tumor and rat-tail occlusion of the left renal artery on angiography. These findings in our adult case of CCSK corresponded with those of CCSK in childhood.

Adult↗

PubMedDate not supplied

Transvaginal fallopian tube catheterization--diagnostic and therapeutic usefulness.

Fifty-two patients with 84 proximal Fallopian tube obstructions underwent Fallopian tube recanalization (FTR). The successful catheterization rate for Fallopian tubal ostia was 100%, and the successful recanalization rate was 64%. After FTR, hysterosalpingography or selective tubography showed no evidence of adhesion (without adhesion) in 31 tubes, perifimbrial adhesion in 17 tubes, hydrosalpinx in six tubes, and intratubal adhesion in 30 tubes (unsuccessful recanalization). Six patients (11%) achieved intrauterine pregnancies and two had extrauterine pregnancies. Follow-up studies in seven patients without adhesion showed patency in one patient and reocclusion in six patients who obtained repatency after a second FTR. Fallopian tube catheterization was useful for the exact diagnosis of Fallopian tube occlusion. The higher incidence of adhesion in patients' background caused the low incidence of pregnancy.

Adult↗

PubMedDate not supplied

Pitfall of superselective catheterization by 3F catheter for spinal arteriovenous malformation.

We experienced a case of subarachnoid rupture of a spinal arteriovenous malformation (AVM) following the injection of contrast medium through a 3F wedged catheter inserted into the feeding artery. If blood does not come through the catheter in the feeding artery of a spinal AVM, not even test injection should be done, to avoid rupture of the spinal AVM.

Angiography, Digital Subtraction↗