Biomedical subjects

S Aoyagi

Publications and source records attributed to S Aoyagi.

At least 37 records · Page 2Linked to original sources

PubMed2001

CD2- CD4+ CD56+ hematodermic/hematolymphoid malignancy.

BACKGROUND: CD2- CD4+ CD56+ lymphoid malignancy has been only rarely reported the last 5 years. It is characterized by a high incidence of cutaneous involvement, cytologically agranular cells, aggressive clinical course, and negative Epstein-Barr virus (EBV) involvement. OBSERVATION: We describe a Japanese patient with a unique hematolymphoid malignancy characterized by an involvement of skin, nasopharyngeal region, bone marrow, lymph node, and a CD4+ CD43+ CD56+ CD2- CD3- CD8- and terminal deoxynucleotidyl transferase phenotype. Clinically, the cutaneous eruptions were purplish, hard, multiple nodules. Histologically, a massive proliferation of atypical pleomorphic cells with medium-sized nuclei were observed throughout the dermis. No clonal rearrangement of T-cell receptor (TCR)-beta gene or immunoglobulin heavy chain J gene was found, and no positive identification of EBV by in situ hybridization for EBV-encoded small nuclear RNA was found. The patient underwent high-dose chemotherapy with autografting of peripheral blood stem cells; however, the tumors quickly relapsed. CONCLUSION: We gathered data from 17 cases of lymphoid malignancy from the literature sharing immunophenotypic and genotypic features similar to those of our case, including CD2- CD4+ CD56+ and germline rearrangement of TCR. Although the cellular origin could not be decided, this malignancy was found to have 100% affinity for skin, a short course, and poor prognosis.

CD2 Antigens↗

PubMed2001

Zosteriform and epidermotropic metastatic primary cutaneous squamous cell carcinoma.

The first case of primary cutaneous squamous cell carcinoma (SCC) to cause zosteriform and epidermotropic metastasis to skin is reported. The patient is a 72-year-old Japanese woman. A cutaneous SCC appeared on the lateral side of her right knee and was removed. After dissection of the right inguinal lymph nodes, which revealed metastases, and irradiation of the right inguinal region, the patient presented with slightly pruritic and painful erythematous papules on the right hip and small brownish papules and vesicles with crusts on the anterior side of the right thigh. The eruptions were in a zosteriform distribution along the right L1 to L3 dermatomes. Histologically neoplastic squamous cell nests were observed in the epidermis, below the epidermal-dermal junction, and within lymphatic vessels in the deeper reticular dermis. We postulate that neoplastic cells with the ability to fuse with adjacent squamous epithelium may have been carried beneath the basal lamina or to the epidermis via dermal lymphatic backflow, resulting in epidermotropic metastasis.

Aged↗

PubMed2001

Association of plasma free-3-methoxy-4-hydroxyphenyl (ethylene)glycol, natural killer cell activity and delirium in postoperative patients.

We measured and compared levels of plasma free 3-methoxy-4-hydroxyphenyl (ethylene)glycol (pMHPG), a major metabolite of noradrenaline, and natural killer (NK) cell activity in 26 patients prior to their undergoing an operation for cardiovascular diseases; 11 of whom expressed delirium and 15 who did not. In conclusion, we found that pMHPG levels before an operation were higher in patients with postoperative delirium than in the patients without, while NK cell activity showed no difference between the two groups. It is possible that hyperactivity of noradrenargic neurons is connected with the development of postoperative delirium. Furthermore, we considered that measurement of pMHPG level before operation might be a useful tool to predict the occurrence of postoperative delirium.

Aged↗

PubMed2001

Triple valve replacement with bileaflet mechanical valves: is the mechanical valve the proper choice for the tricuspid position?

A more durable mechanical valve may be a better choice for the tricuspid position than a bioprosthesis when the patient already has mechanical prosthesis in the left side of the heart. Eleven cases of triple valve replacement (total follow-up period, 49.5 patient years), all with mechanical valves, are reviewed to assess optimal valve selection. Nine patients had undergone a total of 12 previous cardiac surgeries. Three patients died in hospital (27.3%), but there were no late deaths among the survivors. Two cases of valve thrombosis in the tricuspid position occurred (linearized incidence: 4.04%/patient years) and 1 of these required reoperation. Because of this high incidence of valve thrombosis, the bileaflet mechanical valve is not considered to be the best choice. Even if mechanical valves are implanted in the left side of the heart, a bioprosthesis may be a better choice at the tricuspid position.

Adult↗

PubMed2001

Coronary artery bypass grafting in patients with mild renal insufficiency.

UNLABELLED: It is well known that dialysis-dependent renal failure increases the likelihood of a poor outcome following cardiac surgery. However, it is not known whether non-dialysis-dependent mild renal insufficiency also influences clinical outcome. Fifty-five patients with non-dialysis-dependent renal insufficiency undergoing coronary artery bypass grafting (CABG) (Renal group: serum creatinine level >1.5 mg/dl) were enrolled. These patients were then matched on prognostic variables to 148 patients with normal renal function ( CONTROL GROUP: serum creatinine level <1.5 mg/dl). The early postoperative clinical results showed that patients in the Renal group were more likely to develop postoperative renal failure (18% vs 1%: p=0.0002) and hemorrhage requiring re-exploration (11% vs 2%; p=0.01). Total morbidity was significantly higher in the Renal group (40% vs 22%; p=0.01). Multivariate analysis revealed that the Renal group was the second most important predictor of morbidity (odds ratio (OR) =2.2) behind left ventricular dysfunction (OR=2.9). The Renal group was also the second most important predictor of postoperative renal failure (OR=12.5). Therefore, non-dialysis-dependent mild renal insufficiency also increases the risk of morbidity following CABG.

Aged↗

PubMed2001

Repair of left ventricular rupture following mitral valve replacement concomitant with left atrial reduction procedure--intracardiac patch and extracardiac buttress suture.

Rupture of the posterior wall of the left ventricle after mitral valve replacement is a dire complication associated with a very high mortality. This study reports a successful repair of type I left ventricular rupture, which occurred after mitral valve replacement concomitant with a left atrial reduction procedure, by combination of an intracardiac patch and an extracardiac buttress suture. In a case such as this, in which hemostasis is quite difficult to establish, this combination technique is particularly effective.

Female↗

PubMed2001

Malignant fibrous histiocytoma of the heart: case report and review of 46 cases in the literature.

A rare case of cardiac malignant fibrous histiocytoma (MFH) is reported. A 55-year-old woman complained of palpitation due to atrial fibrillation. Echocardiography, magnetic resonance imaging, and angiography demonstrated a tumor arising from the posterior wall of the left atrium. At surgery, the tumor was almost entirely resected and histologically defined as MFH. Neither chemotherapy nor irradiation was administered. Echocardiography revealed a local recurrence two months after the surgery and the patient died of advanced cachexy and heart failure 2 years later. The details of this case are presented with a review of the literature.

Age Factors↗

PubMed2001

A case of ileus caused by implantation of cancer after surgical treatment of bile duct carcinoma.

We encountered a patient with an ileus caused by implantation of cancer cells after surgical treatment of bile duct carcinoma. The patient was a 55-year-old male diagnosed as having cancer in the lower bile duct who underwent pancreatoduodenectomy in March 1996. The comprehensive curability was B. The patient experienced nausea and vomiting and was diagnosed as having ileus in October 1998. The symptoms were alleviated by medical treatment. Because ileus symptoms recurred in December 1998 but were not alleviated by medical treatment, the patient was hospitalized in Kurume University Hospital for surgery. A mirror reflection was observed by plain radiography of the abdomen. Ultrasonography (US) revealed dilation of the intestinal duct and hypertrophy of the intestinal wall. An ileus tube was inserted but the symptoms did not improve, and therefore, the patient underwent surgery in February 1999. Upon laparotomy, a node of milk white color about 2 cm in size was found in the region coinciding with the enhancement on CT images, and part of the intestinal duct was found to be folded and adhered to the lower surface of the liver. No recurrence was observed in the liver, peritoneum, and lymph nodes. The tumor was excised together with part of the intestinal duct and liver to remove the ileus. At present, the patient is alive without recurrence. Because recurrence of cancer by implantation of cancer cells is often localized in a limited region, early diagnosis and excision are important.

Bile Duct Neoplasms↗

PubMed2001

Treatments of non-parasitic giant hepatic cysts.

This retrospective study presents the results of surgical treatments for large cyst of the liver over 10 cm in diameter in 9 patients diagnosed and treated at Kurume University Hospital. There were 8 women and 1 man, with an average age of 71.6 years. Although the chief complaints were abdominal pain or fullness, 1 had obstructive jaundice due to biliary compression by a large cyst. Cyst size ranged from 10 cm to 27 cm. There are several treatment modalities for giant hepatic cyst, such as cyst resection, unroofing, and sclerotherapy after cyst drainage. Operative procedures in the patients reported here were surgical resection of the liver cyst in 3 patients, unroofing with ethanol sclerotherapy in 1 patient and laparoscopic treatment in 2 patients. Sclerotherapy after percutaneous transhepatic cyst drainage was performed in 3 patients because their general condition was poor. There were no postoperative complications among these patients. Costs varied among the patients and depended mainly on the method of treatment and period of hospital stay. We discuss operative procedures and costs of treatment of each patient and review the literature.

Aged↗

PubMed2001

Evaluation of simultaneous excision of pancreatic cancer and the surrounding blood vessels.

Of the 139 patients who underwent excision for invasive cancer in the pancreatic duct at Kurume University Hospital between January 1965 and December 1998, the subjects were 38 patients in whom blood vessels around the cancer were simultaneously excised. The surgical methods were pancreatoduodenectomy (PD) in 31 patients, distal pancreatectomy (DP) in 5, and total pancreatectomy (TP) in 2. The excised blood vessels were the portal vein alone in 32 patients, the artery alone in 1, and both portal vein and artery in 5. Excision of the portal vein was performed by circumcision in 25 patients and by segmentectomy in 12. The range of circumcision was 1.0-7.0 cm (mean, 3.5 +/- 1.4 cm), and the blocking time of the portal vein was 8-36 min (mean, 19.5 +/- 8.8 min). Of the 25 patients who underwent circumcision, reconstruction was performed by end-to-end anastomosis in 23 and by transplantation of the autologous vein between the ends in 2. Of the 12 patients who underwent segmentectomy, direct suture was performed in 10, and transplantation of an autologous vein patch was performed in 2. Postoperative complications occurred in 14 of the 32 patients. In 5 of the 6 patients who underwent excision of the artery, reconstruction was performed by end-to-end anastomosis in 3 and by transplantation of the autologous vein between the ends in 2. Postoperative complications did not occur in the patient who had undergone excision of the artery alone, but 4 of the 5 patients who had undergone simultaneous excision of the portal vein and artery had postoperative complications, of whom 2 died during the period of hospitalization. Three patients with pv0, pv1 or pv2 survived for more than 3 years. Because some of the patients who had undergone excision of the portal vein alone survived for a long time and this method is relatively safe, this surgery can be generally applied, but simultaneous excision of the portal vein and artery should be carefully applied because the incidences of postoperative complications and death during the period of hospitalization are high. With the development of surgical techniques and postoperative control, simultaneous excision of pancreatic cancer and the surrounding blood vessels has become safe, but this method should only be applied to patients who have the potential to recover completely.

Hepatic Artery↗

PubMed2001

Xanthogranulomatous cholecystitis.

Seven cases of xanthogranulomatous cholecystitis are presented, and their clinicopathological appearance is described. Three men and 4 women with xanthogranulomatous cholecystitis, aged 53-72 years old, were reviewed. Five patients had had previous attacks of acute cholecystitis lasting from 3 weeks to 6 months. Abdominal ultrasonography was performed in all patients, and computed tomography in 5 patients. Cholelithiasis and sludge were present in all patients. The gallbladder wall was thickened in all patients. On computed tomography, one patient showed no abnormal finding, and 4 patients had abnormal findings such as increased wall thickness and irregularity, and pericholecystic abnormalities. A diagnosis of gallbladder carcinoma was made preoperatively in 1 patient. During laparotomy, the gallbladders in all patients showed signs of chronic cholecystitis, and cholecystectomies were performed. Histological findings showed xanthogranulomatous cholecystitis, and 4 patients had stones in the gallbladder wall. Despite the characteristic histologic appearance of xanthogranulomatous cholecystitis, radiologic findings are nonspecific, varying from signs observed in other forms of cholecystitis to the appearance of a gallbladder neoplasm. We report here 7 cases of xanthogranulomatous cholecystitis and review the literature.

Aged↗

PubMed2001

A case of hepatocellular carcinoma rupturing after angiography.

We report a case of primary hepatocellular carcinoma (referred to as hepatocellular carcinoma below) apparently rupturing after angiography. The patient was a 62-year-old male who was admitted for the treatment of hepatocellular carcinoma. Ultrasonography (US) and computed tomography (CT) on admission showed a tumor occupying the entire left lobe of the liver and partly protruding outside the liver and a tumor embolus in the portal vein. We performed preoperative angiography, after which fever and abdominal discomfort appeared. Two days after the angiography, abdominal pain and a rapid increase in the size of the abdominal tumor were noted. US also revealed an unquestionable increase in the size of the tumor, leading to a diagnosis of intratumoral hemorrhage due to the rupture of hepatocellular carcinoma. Since child classification A, clinical stage I and ICG 11.7% indicated an adequate functional reserve of the liver, we performed an emergency operation. Laparotomy revealed that the tumor occupied almost the entire left lobe of the liver, partly protruded outside it, and was bleeding from part of its anterior surface. The volume of intra-abdominal hemorrhage was about 100 ml. A portal tumor embolus was present in the portal vein from the horizontal part to the trunk. We performed resection of the left and caudate lobes of the liver with removal of the portal tumor embolus. The resected specimens showed a hemorrhage in and around the tumor. We speculated that in a hepatocellular carcinoma that involves the surface of the liver and is complicated by tumor embolism of the portal vein, angiography could trigger the rupture of the carcinoma.

Angiography↗

PubMed2001

Carcinoma of the ampulla of Vater associated with other organ malignancies.

Because of its location with respect to the biliary system, carcinoma of the ampulla of Vater is considered to manifest earlier in its course of development than carcinoma of the pancreas. The most common physical finding is jaundice, which occurs in 93-100% of cases [1,2]. This retrospective study describes the results of the treatment and prognosis for double primary cancers in which cancer of the ampulla of Vater was associated with malignancies in other organs in 5 patients who were diagnosed and treated at Kurume University Hospital. The patients included 5 men with an average age of 72.8 years. There were 3 synchronous double and 2 metachronous double cancer patients. Regarding prognoses of these patients, 1 patient with associated lung cancer died because of postoperative complications after pneumonectomy, 1 patient died due to carcinomatosa peritonei developing from the ampulla Vater carcinoma, and 1 patient died because of metastatic liver tumors from the ampullary carcinoma. In multiple cancers including ampulla Vater carcinoma, gastrointestinal cancers such as gastric or colon cancer occur frequently. Therefore, a careful gastrointestinal examination should be done preoperatively. We report our experience with 5 cases of ampullary carcinoma associated with malignancies in other organs and review the literature.

Aged↗

PubMed2001

Clinicopathological evaluation of surgical treatment for early gallbladder cancer.

We evaluated the therapeutic principles for early gallbladder cancer based on clinicopathological characteristics and outcomes in 27 patients encountered at the Kurume University Hospital between January, 1975 and December, 1999. Concerning the depth of wall penetration, 15 patients had mucosal cancers (m-cancers), and 12 patients muscularis propria cancers(mp-cancers). The gross patterns were lp (pedunculated) in 16 patients, ls (sessile) in 3 patients, IIa (flat elevated) in 4 patients, and IIb (flat) in 4 patients. The operative procedure used was cholecystectomy (C) in 12 patients, 4 of whom underwent lymph node dissection. Full-thickness cholecystectomy (FTC) was carried out in 3 patients, one of whom had lymph node dissection. Combination of C and gallbladder bed resection (GbBR) was performed in 7 patients, 6 of whom had lymph node dissection. Combination of C and bile duct resection (BDR), and lymph node dissection was performed in 1 patient. Combination of C and GbBR and BDR, and lymph node dissection was performed in 6 patients. All the patients who underwent lymph node dissection were negative for metastasis. Of the 27 patients, 2 underwent laparoscopic operation: one with m-cancer was 79 years old, and the other with mp-cancer 86 years old. In the m-cancers, no lymphatic, venous or perineural infiltration was observed. In contrast, in the mp-cancers, lymphatic and venous infiltration each were observed in 4 patients (33.3%), although no perineural infiltration was observed. A diagnosis of gallbladder cancer was made postoperatively in 6 patients, of whom 4 had the IIb pattern and all were complicated by gallstone, indicating the difficulty of diagnosing the IIb pattern. The 5-year survival rates for the m- and mp-cancers were as high as 90.9% and 80.8%, respectively. As a curative surgical technique for m- and mp-cancers, lymph node dissection should be performed in addition to FTC, GbBR, and BDR, in combination. When a postoperative histopathologic diagnosis of gallbladder cancer has been made, no second-look operation should be performed for m-cancers, but lymph node dissection of up to the second group should be performed for mp-cancers in a second-look operation.

Aged↗

PubMed2001

Xanthogranulomatous cholecystitis mimicking gallbladder cancer: report of a case.

A 61-year-old woman was admitted to our hospital with abnormal findings of abdominal computed tomography. Whereas she had neither fever nor abdominal pain, a cholecystitis was suspected. Ultrasonography showed a mass in the gallbladder with several stones, and an unclear border between the gallbladder and liver. Computed tomography showed a large-mass in the gallbladder with findings that seemed to indicate hepatic invasion and para-aortic lymph node metastasis. On the basis of these findings, we made a diagnosis of gallbladder cancer associated with hepatic invasion and lymph node metastasis. We treated this gallbladder tumor by hepatic arterial infusion chemotherapy via catheter with cisplatin and 5-fluorouracil. Four weeks after administration of the anti-cancer drugs, the tumorous lesion of the gallbladder could not be detected by abdominal imagings, and the gallbladder wall revealed no irregular findings. During laparotomy, the gallbladder showed signs of chronic cholecystitis, and a cholecystectomy was performed. Findings of the resected specimens showed severe inflammation, fibrosis, and bleeding in the gallbladder wall with infiltration by many foamy cells. Histopathological diagnosis was xanthogranulomatous cholecystitis. We report here a case of xanthogranulomatous cholecystitis mimicking gallbladder cancer and review the literature.

Cholecystitis↗

PubMed2001

Diltiazem, a calcium antagonist, inhibits matrix metalloproteinase-1 (tissue collagenase) production and collagenolytic activity in human vascular smooth muscle cells.

Calcium antagonists (CAs) are widely prescribed for patients with cardiovascular diseases. CAs have been reported to inhibit smooth muscle cell (SMC) proliferation in addition to their effects on vascular tone. To determine whether CAs potentially affect vascular remodeling, we measured the expression of matrix-degrading enzymes in growth factor-stimulated SMC. Human cultured SMC were stimulated with 10 ng/ml of platelet-derived growth factor (PDGF)-BB with or without a calcium antagonist, diltiazem. In the cell counting assay, diltiazem (10-5 M) alone had no effect on the proliferation of quiescent SMC, however 10-6-10-5 M of diltiazem dose-dependently inhibited PDGF-stimulated SMC proliferation. The inhibitory effects of diltiazem on SMC proliferation were further confirmed by a 5-bromo-2'-deoxyuridine (BrdU) incorporation assay and flow cytometry. In Western blotting, matrix metalloproteinase (MMP)-1 (tissue collagenase) but not MMP-2 (72-kDa gelatinase) expression was upregulated by PDGF and phorbol ester (TPA), which were reduced by diltiazem in a dose-dependent manner. The downregulation of MMP-1 expression was consistent with the reduction of collagenolytic activity measured by a FITC-conjugated type I collagen breakdown assay. PDGF-stimulated c-Jun/AP-1 expression, a major transcriptional factor for MMP-1, was not affected by diltiazem. In contrast, intracellular calcium ions measured with a fluorometric assay of Fluo-3AM-loaded cells revealed that the PDGF-stimulated increase in the intracellular calcium content was dose-dependently reduced by diltiazem. Our data suggest that diltiazem inhibits not only proliferation but also MMP-1 expression and collagenolytic activity in PDGF-stimulated SMC. The administration of CAs potentially influences the process of vascular remodeling, and this possibility should be further verified in vivo.

Blotting, Western↗

PubMed2001

Germline mutation of the PTEN gene in a Japanese patient with Cowden's disease.

Cowden's disease (CD) is an autosomal dominant disorder which confers a high susceptibility to diverse benign and malignant tumors. The PTEN (phosphatase and tensin homologue deleted in chromosome ten) gene has been identified as a tumor suppressor gene responsible for cancers of the endometrium, ovary, prostate, and glioblastomas. Recently, germline mutations of this gene were also found in patients with CD, and it is now recognized as a gene responsible for this disease. We identified a germline nonsense mutation at codon 130 in exon 5 of PTEN in a 56-year-old Japanese woman with CD. The patient had adenoid facies and mucocutaneous lesions including multiple facial papules, acral keratoses on neck and shoulders, palmoplantar keratoses, multiple oral papillomas, scrotal tongue, mucosal and cutaneous hemangiomas, and a sclerotic fibroma on the arm. She also had benign and malignant polypoid neoplasms throughout the entire digestive tract, including adenocarcinoma of the colon and submucosal lipomas of the rectum, as well as bilateral breast carcinomas, multinodular goiters, an ovarian cyst with a fibroma-like nodule, hepatic hemangiomas, and abdominal hernia. We searched CD cases with the same genotypic PTEN mutation as the present case and compared their phenotypes. Further studies will disclose a better understanding of the role of mutation in the PTEN gene in the course of tumorigenesis of both benign and malignant tumors developed in patients with CD.

Codon, Nonsense↗

PubMed2001

[A case of gastric cancer with liver metastases successfully treated with combination therapy of systemic and hepatic arterial infusion chemotherapy].

A 67-year-old man was admitted to our hospital because of advanced gastric cancer associated with metastases to the liver, the lymph nodes along the lesser curvature and the infradiaphragmatic lymph nodes. As we considered the primary lesion and the liver metastases to be unresectable, we treated him with combination therapy of systemic and hepatic arterial infusion chemotherapy. The regimen of systemic chemotherapy consisted of cisplatin (CDDP) and UFT. Hepatic arterial infusion chemotherapy included 5-fluorouracil (5-FU), doxorubicin (DXR) and mitomycin C (MMC). We repeated this therapy six times. The size of the primary lesion and the lymph node metastases decreased significantly after the chemotherapy. The size of the liver metastases did not change, but they appeared to necrotize. The patient maintained a good quality of life during the therapy. He finally died of peritonitis carcinomatosa 18 months after the diagnosis. This case indicated that combination therapy of systemic and hepatic arterial infusion chemotherapy was effective in cases of unresectable gastric cancer associated with liver metastases.

Administration, Oral↗