Biomedical subjects
Publications and source records attributed to O Ishikawa.
We describe a 15-month-old girl with Michelin tyre syndrome. She had hirsuties and marked skin folds. Histological examination showed fragmented elastic fibres in addition to smooth muscle hamartoma. On electron microscopy, decreased deposition of elastin was observed. We speculate that elastic fibre abnormalities may account for the characteristic skin changes in the Michelin tyre syndrome.
Bursitis is a common clinical entity usually induced by trauma and infection. It often occurs in inflammatory diseases such as gout and rheumatoid arthritis. We describe a patient with systemic sclerosis who developed multiple bursitis in the later stage of the disease.
The present article reviews previous reports on the systemic and regional chemotherapies for adenocarcinoma of the pancreas. When non-resectable pancreatic cancer was treated by the systemic chemotherapy, most reports showed that the mean or median survival periods were less than 6 months. Although the response rate to multi-drug chemotherapy was superior than that to single-drug chemotherapy, the survival period did net differ significantly between the two. In general, in terms of the patients, survival rates, the combination og chemo-therapy and radiation was slightly superior to either chemotherapy or radiation alone. On the other hand, regional chemotherapy seems to be more promising because our intra-arterial chemotherapy using angiontensin-II has succeeded in improving the mean survival period to 14 months for non-resectable pancreatic cancer. Likewise, liver perfusion chemotherapy via the hepatic artery and portal vein was effective in preventing the development of liver metastasis after pancreatectomy. Considering that the pancreatic cancer is a poorly vascularized tumor, it is essential to deliver a high dose of anti-cancer drug effectively into the cancer tissue. Secondarily, the selection of drug to which the pancreatic cancer cell is sensitive is also important.
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Transcatheter arterial embolization therapies (TAE) for multiple hepatocellular carcinomas (HCCs) were performed repeatedly, but had no effects on one or two of the tumors because of the development of collateral arteries. We report a case of which one of the tumors fed by collaterals showed good anti-cancer effects by microwave coagulation therapy (MCT) under mini-thoracotomy. The 70-year-old, male patient with HCC underwent two hepatic resections and one TAE before this admission. On the arteriogram, one of the tumors existing in S6, which was 2 cm in size, was supplied by the right 10th intercostal artery. We carried out MCT under mini-thoracotomy for the tumor in S6 two weeks after conventional hepatic embolization. First, two MCTs using a long electrode, 3 cm in size, were performed in the central area of the tumor, and eight MCTs by a short electrode, 2 cm in size, were done in the peripheral and surrounding area of the tumor. He was discharged 16 days after the therapy without any serious complications. On CT 3.5 months after therapy, no local recurrence of the tumor was recognized. MCT under mini-thoracotomy is a low-invasive, safe and effective therapeutic method for small HCC fed by collaterals.
A 71-year-old man with unresectable liver metastasis from colon cancer was treated by hepatic intraarterial infusion of low dose 5-FU (250 mg/body/day). The tumor measured 18 cm by ultrasonography and has reduced gradually to five cm during three years. Both serum CEA and CA 19-9 levels were as high as 49.9 ng/ml and 5,500 U/ml respectively, before treatment, but normalized. This case suggested that this hepatic intraarterial infusion of low-dose 5-FU might be effective to treat unresectable liver metastasis, especially with portal tumor thrombosis.
Intra-arterial infusion chemotherapy was given preoperatively to one patient with pancreatic head adenocarcinoma, in order to prevent local failure after surgery. Under an angiographic procedure, a catheter was placed in the gastroduodenal artery after embolizing the right gastric artery and gastroepiploic artery. Before surgery, 5-fluorouracil (250 mg/day) had been continuously infused for 2 weeks and bolus infusion of methotrexate (25 mg) with 5 micrograms of angiotensin-II had been performed every 3 days. As a results, the maximum diameter of the pancreatic tumor decreased from 3 cm to 2 cm on the CT-Scan. An extended pancreatoduodenectomy with portal vein reconstruction was performed. In histologic study, degenerative tumor cells were shown not only in the primary tumor but also in the extrapancreatic perineural invasion.
Autoimmune bullous diseases, such as bullous pemphigoid or pemphigus vulgaris, occasionally develop in psoriatic patients. In addition, a novel subepidermal bullous disease with autoantibodies against a lower lamina lucida antigen of 200 kDa has recently been reported in association with psoriasis. We describe here a patient with psoriasis vulgaris who developed epidermolysis bullosa acquisita (EBA). Direct immunofluorescence revealed linear deposition of IgG and C3 at the basement membrane zone. The patient's serum bound to the dermal side of salt-split normal human skin. However, immunoblot analysis demonstrated that the patient's serum reacted with an EBA antigen of 290 kDa. EBA should be included in the list of autoimmune diseases associated with psoriasis vulgaris.
We report a 33-year-old Japanese man diagnosed as having hypocomplementaemic urticarial vasculitis at the age of 21, who subsequently developed Jaccoud's syndrome. Although Jaccoud's syndrome has been most frequently seen in patients with systemic lupus erythematosus, an association with other diseases has occasionally been described. Jaccoud's syndrome clinically shows joint deformities similar to rheumatoid arthritis, and needs to be differentiated from it. Patients with hypocomplementaemic urticarial vasculitis may develop Jaccoud's syndrome.
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A 74-year-old Japanese man presented with systemic lymphadenopathy, hepatosplenomegaly, and erythroderma in December 1991. A characteristic pattern of anti-EBV antibodies was suggestive of latent EBV infection. A skin tumor biopsied in April 1993 contained biclonal EBV genomes diffusely in the infiltrate of polyclonal T cells and monoclonal B cells. The clinical course was rather mild in contrast to that of classical EBV-associated disorders. Our case was considered a rare indolent type of EBV-associated T-cell-rich B-cell lymphoma of the skin.
The total amount of main disaccharide units of skin glycosaminoglycans was compared between sun-exposed (n = 12) and sun-protected skin (n = 14) of aged people using high performance liquid chromatography after labeling with 1-phenyl-3-methyl-5-pyrazolone. The total amount of main disaccharide units in sun-exposed skin was comparable to sun-protected skin presumably due to the diversity of individuals. Consequently, we compared sun-exposed skin with sun-protected skin in identical individuals (n = 6). The total amount of main disaccharide units in sun-exposed skin was significantly greater than that in sun-protected skin (P < 0.05). In addition, the ratio of delta Di-HA (hyaluronic acid, HA)/delta Di-4S (dermatan sulfate, DS) in sun-exposed skin showed a decreasing trend as compared with sun-protected skin in four of six individuals. These results are in agreement with our previous results obtained in animal experiments of photoaging, i.e., hairless mouse skin exposed to repeated UV irradiation showed an increase in total amount of main disaccharide units and a decrease in the ratio of delta Di-HA(HA)/delta Di-4S(DS). We could confirm similar changes in skin glycosaminoglycans both in human and murine photoaging supporting the appropriate rationale for using the hairless mouse as an animal model for photoaging. Again, disaccharide analysis should provide a useful method to examine the biochemical changes of skin glycosaminoglycans in human photoaging.
BACKGROUND: Ninety-seven patients with small hepatocellular carcinomas (HCCs) measuring 3 cm or less in size and three patients with adenomatous hyperplasia who underwent radical hepatic resection were examined in this study. METHODS: The lesions were classified into four groups according to the following histologic grading criteria: group A, adenomatous hyperplasia (n = 3); group B, early HCC (n = 6); group C, well-differentiated HCC (wHCC) (n = 32); and group D, moderately or poorly differentiated HCC (n = 59). The involvement factors that seemed to be important or to characterize the progression of HCC and the survival rates were compared among the four histologic groups. RESULTS: The frequency of patients with tumors larger than 2.0 cm in size and that of patients with 200 or more ng/ml serum alpha-fetoprotein increased with the progression of histologic malignancy. Tumor staining on the angiogram, capsular formation, and extranodular invasion were never seen in groups A and B, but they began to appear in group C and increased remarkably in group D. The 5-year survival rates of the patients in groups B, C, and D were 100%, 60%, and 27%, respectively, and statistically significant differences were seen among them. In comparative evaluation of the group C patients the lesions that showed no tumor staining had no capsule, and those that had no capsule had no extranodular invasion. The 5-year survival rate of patients with wHCC without extranodular invasion (81%) was significantly higher than that of patients with extranodular invasion (35%) (p < 0.05). CONCLUSIONS: It may be recommended to provide the category of wHCC without extranodular invasion for pathologic classification of clinically early HCC (i.e., HCC of high curability).
The diagnostic accuracy of routine abdominal sonography for the detection of pancreatic cancer was examined. During the one-year period of 1994, sonographic examination of the upper abdominal region was performed 12,761 times on a total of 9410 patients for the screening of abdominal disorders. In 655 cases (7%) part of the pancreas could not be observed. Based on the "Diagnostic criteria for pancreatic cancer" published by the Japanese Society of Ultrasound in Medicine, sonographic finding was evaluated to be positive for pancreatic tumor in a total of 411 cases. At the end of 1995, 51 patients were proven to have pancreatic cancer, and 45 of these cases were ductal adenocarcinoma. In 26 cases the tumor was surgically resected. Fifty cases were true sonographic positives and one was a false negative. The sensitivity, specificity, overall accuracy, and positive and negative predictive values of sonography for pancreatic cancer were 98.0%, 95.9%, 95.9%, 12.2% and 100.0%, respectively. Among the 50 true positive cases, the tumor diameter was less than 1 cm in four (8%). In conclusion, the diagnostic accuracy of sonography for the detection of pancreatic cancer is sufficiently high. Therefore, a detailed study aimed at mass screening for pancreatic cancer using sonography as the main modality seems warranted as a countermeasure for the rapid increase of pancreatic cancer in Japan.
A 24-year-old women presented with multiple translucent papules on the periorbital and malar areas. Histological examination demonstrated cystic structures lined with a few layers of flattened epithelial cells. These cells were positive for carcinoembryonic antigen, confirming the histological diagnosis of eccrine hidrocystoma. Physical examination revealed a goiter along with finger tremor and hyperhidrosis. The diagnosis of Graves' diseases was established by endocrinological studies. The skin lesion as well as clinical symptoms disappeared as the thyroid function normalized with treatment. Graves' disease should be considered as one of the underlying diseases or conditions related to the development of the multiple eccrine hidrocystomas.
The expression of a negative regulator of the cell cycle, p21WAF1 protein, is trans-activated by wild-type p53, but not by the mutant protein. Therefore, mutations of the p53 and WAF1 genes may be complementary. We examined DNAs from 70 human primary lung (63 of NSCLC and 7 of SCLC) and 24 pancreatic cancers (19 primary cancers and 5 cell lines) for mutations of the WAF1 gene. No mutations were detected in any samples examined, regardless of the mutational state of the p53 gene. The results suggested that aberrations of the coding sequence of the WAF1 gene are not associated with carcinogenesis in lung and pancreatic cancers.
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BACKGROUND: The autocrine motility factor receptor (AMFR), a specific receptor for AME, is considered to be related to the metastatic potential of tumor cells. OBJECTIVE: We investigated whether AMFR is expressed on cutaneous malignant melanoma cells and has any relationship to clinical stage and metastatic ability. METHODS: We performed an immunohistochemical study on 20 cases of cutaneous malignant melanoma using anti-AMFR antibody. AMFR was expressed in 9 cases (45%), and its expression had a tendency to correlate with the clinical stage and the presence of lymph node metastasis. CONCLUSIONS: The expression of AMFR may have a possible association with the metastatic potential of malignant melanoma.