Biomedical subjects
S Kamata
Publications and source records attributed to S Kamata.
[A prospective randomized trial of adjuvant chemotherapy with UFT for head and neck carcinoma. Head and Neck UFT Study Group].
A prospective randomized trial was performed in 67 institutions for the purpose to evaluate the efficacy of adjuvant chemotherapy after radical treatment of head and neck carcinoma. A comparison was made between the following two groups; one-year oral administration of UFT, 300 mg/day, after radical treatment (UFT group); and a non-treatment group. Patients were classified under the following three categories; 1) stage II-IV, receiving radical surgery; 2) stage II, receiving radical radiotherapy; and 3) nasopharyngeal cancer. The numbers of cases were 424, 111 and 25, respectively, and they were randomized into two groups. The numbers of eligible cases were 398, 105 and 25, respectively. Statistical analysis was performed in the cases receiving radical surgery and in those receiving radical radiotherapy. As the results, in cases receiving radical surgery no significant difference was observed in 3-year survival rates (77.9% for UFT group vs 72.9% for non-treatment group) or 3-year relapse-free rates (73.4% for UFT group vs 66.2% for non-treatment group) between the two groups. However, the distant relapse rate was significantly lower in the UFT group than in the non-treatment group (7.9% vs 14.6%; p = 0.034). In the cases receiving radical radiotherapy, no significant differences was observed in either 3-year survival rates or 3-year relapse-free rates. Thus it was suggested that UFT maintenance therapy might suppress the distant metastasis after radical surgery. We considered a further confirmative trial for patients at high risk of distant metastasis after radical surgery to be advisable.
[Coronary artery bypass grafting for a patient with single coronary artery].
A 47-year-old man was admitted with suddenly developed chest pain. Coronary arteriography could not identify the right coronary orifice at the right coronary sinus. Left coronary arteriography revealed that the right coronary artery originated from a proximal segment of the left anterior descending artery with subtotal obstruction at the segment just distal to the bifurcation of the right and anterior descending arteries. Coronary artery bypass grafting to the middle segment of the left anterior descending artery was carried out with satisfactory result. To our knowledge, only seven cases with a diagnosis of single coronary artery who underwent coronary artery bypass grafting have been reported.
[Congenital cystic adenomatoid malformation of the lung].
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Vitamin A status in biliary atresia: intestinal absorption and liver storage of retinol.
The vitamin A status of 19 patients with corrected biliary atresia was examined. They had been receiving 5,000 IU of oral vitamin A daily postoperatively. Plasma vitamin A levels in the nonjaundiced group were almost within normal range, whereas those in the jaundiced group were significantly low compared with the controls. In the oral vitamin A tolerance test, plasma vitamin A levels increased from 33.1 +/- 11.8 to 215.4 +/- 100.7 micrograms/dL in the nonjaundiced group, and from 23.1 +/- 10.3 to 209.8 +/- 154.2 micrograms/dL in the slightly jaundiced group, at 4 hours after the administration of vitamin A, showing no difference between both group and control. In the severely jaundiced group, plasma vitamin A levels increased from 13.5 +/- 3.5 to 30.0 +/- 14.6 micrograms/dL, a significantly smaller increase compared with controls. However, liver vitamin A levels were greater than 20 micrograms/g liver in all patients, irrespective of the presence of jaundice. This study suggested that nutritional support to facilitate the synthesis of retinol-binding protein may be an important factor in addition to vitamin A supplementation.
Anterior sagittal anorectoplasty as a redo operation for imperforate anus.
Based on the idea of transsphincteric approach by Peña, we applied anterior sagittal anorectoplasty (ASARP) as a redo operation in 10 patients, who present moderate to severe fecal incontinence postoperatively. Those patients exhibited anal opening located anteriorly to the center of contraction of external sphincter muscles. Operation is begun with making a circumferential skin incision in the mucocutaneous junction around the anal opening, extending posteriorly along the median line to the center of the external sphincter muscles. Upon confirming the vertical muscle and the external sphincter muscles, the rectal tube, being dissected free, is mobilized backward to be placed at the center of the vertical muscles and enclosed by the muscle. After the operation, an improvement was noted in either clinical symptoms or scores, being particularly marked for incontinence and staining scores. Anorectal manometry and barium enema studies also showed a significant improvement. These results provide ample justification of ASARP as a redo operation for imperforate anus being worthwhile trying in properly selected patients with poor anorectal function following the primary operation.
Indocyanine green test is a reliable indicator of postoperative liver function in biliary atresia.
In order to evaluate liver function in postoperative biliary atresia (BA) patients, the indocyanine green (ICG) clearance test was performed. Nineteen patients, ranging in age from 2 to 9 years, were classified into three groups. Group I were those who had no jaundice throughout the postoperative period (n = 9), Group II were those who had recurrent or intermittent jaundice (n = 7), and Group III were those who had persistent jaundice after hepatic portojejunostomy (n = 3). Forty-four volunteers of comparative age and sex served as controls to establish a normal range of ICG-K values in infants and children. The normal minimal ICG-K value in those 2-9 years of age was defined as 0.19. ICG-K values in BA patients were 0.262 +/- 0.073 (Group I), 0.150 +/- 0.060 (Group II), and 0.054 +/- 0.011 (Group III). All nine patients with ICG-K below the normal level had esophageal varices, and seven of nine had a history of gastrointestinal hemorrhage. Two patients with ICG-K values within the normal range had esophageal varices, and none had a history of gastrointestinal hemorrhage. Five of nine patients with ICG-K values below normal had low serum albumin levels, and all had low prealbumin levels. Of those with ICG-K within the normal range, none had low serum albumin or prealbumin levels. On the other hand, serum bilirubin and other liver function tests did not accurately reflect clinical findings. In conclusion, the ICG test using the ICG-K value was confirmed to be a reliable indicator of postoperative liver function in BA patients.
Dumbbell-shaped schwannoma of the jugular foramen.
A 49-year-old male patient with schwannoma of the jugular foramen is described. T1-weighted magnetic resonance imaging with gadolinium showed an enhanced dumbbell-shaped mass with its smaller part occupying the left cerebellopontine angle and its larger part in left parapharyngeal space. The mass was totally removed with a left mastoidectomy and suboccipital craniotomy. The dura mater was closed with anterior lamina of the rectus sheath, and the large defect of the neck was obliterated with free rectus abdominis muscular flap. The postoperative course was uneventful, except for some sputum aspiration and hoarseness. He underwent surgical mediation and cricopharyngeal myotomy for his left, paralyzed vocal cord, and both speech and swallowing function improved quite well. This paper reports our experience in managing this dumbbell-shaped neurinoma of the jugular foramen.
Characteristics of Staphylococcus aureus isolated from peracute, acute and chronic bovine mastitis.
Fifty-eight Staphylococcus aureus strains isolated from bovine mastitic milk at 27 dairy farms in Japan during the period from November 1988 to May 1989 were examined for their productivity of virulence associated factors. The positive rates of the total isolates for various virulence factors were as follows: toxic shock syndrome toxin-1 (TSST-1, 27.6%), staphylococcal enterotoxins (SEs, 34.5%), alpha-haemolysin (74.1%), beta-haemolysin (65.5%), delta-haemolysin (12.1%), DNase (100%), egg-yolk factor (25.9%), clumping factor (70.7%) and protein A (58.6%). All of S. aureus isolates from peracute mastitis produced TSST-1, SEC, alpha-haemolysin and beta-haemolysin. While none of clumping factor and protein A were detected among peracute isolates, these factors were produced at a relatively high frequency by isolates from chronic mastitis. In coagulase typing, the most predominant type was VI (36.2%), and types IV, V and VIII were not observed. TSST-1 positive isolates showed interesting characteristics which all of the isolates produce both SEC and coagulase type VI but lack egg-yolk factor, clumping factor and protein A except for one isolate. We could infer that TSST-1 and SEC contribute to bovine mastitis, especially to peracute mastitis from the present study.
[Multiple primary cancers in patients with head and neck cancer and history of tobacco smoking and drinking].
In a total of 2083 cases of hollow organ cancer of the head and neck region treated in our institute in the past 20 years, the relative risk of second primary cancers was statistically studied by the person-year approach. The organ association in multiple primary cancers and the relationship between tobacco and alcohol consumption and the development of second primary cancers were also reviewed. The incidence of second primary cancers was significantly (p < 0.05) higher in patients having a lesion at the tongue (n = 502), mesopharynx (n = 188), hypopharynx (n = 224) and larynx (n = 621) and in the oral cavity (n = 203) than in the general population. With regard to organ association in multiple primary cancers, cancers in the oral cavity, esophagus and at the pharynx were found to occur as second primary cancers of the tongue, oral cavity, meso-hypopharynx and larynx at significantly high rates in males. Male laryngeal cancer was related to the lung. No relation of female lingual cancer to the esophagus was noted. The incidence of second primary cancer was very high in persons who had been heavy smokers and/or heavy drinkers before the occurrence of their primary cancer in the head and neck region. In these people, second primary cancers were found to occur at high rates as cancers related to tobacco smoking and drinking. Otherwise, in cases with head and neck cancers less related to tobacco smoking and drinking, the incidence of second primary cancers was low. From the above results, tobacco smoking and drinking may be closely related to a high incidence of second primary cancer following the first primary cancer in the head and neck region.
Massive small bowel resection in neonates--is weaning from parenteral nutrition the final goal?
Eight surviving cases from an original 15 pediatric patients who underwent massive small bowel resection during their neonatal period were reviewed for a period of 2-19 years to assess long-term prognosis. the primary diseases were congenital intestinal atresia in 6 cases and midgut volvulus in 2. The length of the residual small intestine ranged from 27-75 cm and the ileocaecal valve had been resected in 3 cases. All cases were able to be weaned from parenteral nutrition and at present, 6 of the children can tolerate normal meals but 2 are still receiving enteral nutrition, in the form of a low residue diet at home. Near normal somatic growth was achieved in the most recent 5 cases who received intensive nutritional treatment in the immediate postoperative period, whereas 3 who did not receive nutritional management exhibited growth retardation. The D-Xylose absorption test revealed gradual improvement and finally normal absorption in all except one case with the shortest remaining intestine (27 cm). However, the fat absorption test revealed abnormal absorption in cases with a residual intestine of less than 45 cm. Late metabolic complications such as renal calculi, cholelithiasis and pathologic fractures were encountered in 3 cases.
Anterior sagittal anorectoplasty for rectovestibular and anovestibular fistula.
Rectovestibular (or anovestibular) fistula is the most common form of anorectal anomaly in female infants. In the surgical repair of these malformations, anal transplantation has been in widespread conventional use. Based on the idea of posterior sagittal anorectoplasty, we devised a new approach, anterior sagittal anorectoplasty, in which, in the lithotomy position, the anterior portion of sphincter muscles are cut through a median perineal skin incision and then the rectum is pulled through the center of these muscles to make its opening at the normal position. The operation has been performed in 12 patients with satisfactory results.
Injection of bleomycin as a primary therapy of cystic lymphangioma.
Forty-five patients (19 boys and 26 girls) with lymphangioma have been treated at Osaka University Hospital during the 10-year period from January 1978 to December 1987. Twenty-nine underwent initial bleomycin (BLM) therapy. These patients' lesions consisted of large cystic masses that were demonstrated by echography or computed tomography scans. BLM was administered as a solution of 1 mg/mL in saline, after aspiration of the cyst contents using a puncture needle. The total dose ranged from 3 mg to 32 mg (average, 10 mg) and was administered between 1 and 16 times. Of the 29 cases treated with BLM, 25 cases (86%) showed significant reduction of the mass and 16 (55%) showed complete disappearance. Recurrence occurred in 3 patients. One responded to further injection of BLM, and the other 2 required surgical resection. Thirteen patients required surgical resection; however, in those cases, the previous injection of BLM was found to minimize the extent of surgical resection required. There were no serious side effects with BLM injection. Injection of BLM as an initial treatment of cystic lymphangioma was found to be very useful. It can reduce the size of the mass and even result in complete disappearance; consequently, it can minimize the frequency and extent of surgical intervention.
Intrapancreatic duodenal duplication associated with pancreatic pseudocysts.
A rare case of intrapancreatic duodenal duplication causing pancreatitis is reported. At 2 years of age, the patient presented with a recurrent pancreatic pseudocyst. Intraoperative pancreatogram showed the presence of cystic duodenal duplication in the aberrant lobe of the pancreas communication with the pancreatic duct. Since the resection of the duplication, she has been free from recurrence of pancreatitis. In this case, intraoperative pancreatography was of great value.
A resected case of hepatoblastoma originating in the caudate lobe.
A very rare case of hepatoblastoma originating in the caudate lobe in an 18-month-old female infant is reported. Three years after surgical resection of the tumor, she is alive without signs of a recurrence.
The amygdaloid kindling in developing, adult and aged rats.
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Effects of synchronous pulsatile extracorporeal membrane oxygenation in an endotoxin-induced shock model: an experimental study.
A synchronous pulsatile venoarterial device for extracorporeal membrane oxygenation (ECMO) was designed to accomplish more effective circulatory support for neonates. The effect of this device was studied using an endotoxin-induced shock model, compared with conventional nonpulsatile ECMO. Twenty puppies weighing 1.6 to 4.0 kg were given endotoxin (5 mg/kg) intravenously. Thirty minutes after the administration of endotoxin, 10 were placed on pulsatile ECMO, and the others were placed on nonpulsatile ECMO, and they were studied for an additional 180 min. Peak blood pressure, arterial pH, base excess, and renal blood flow were significantly higher in the pulsatile group than in the nonpulsatile group. Serum lactate and serum noradrenaline were significantly lower in the pulsatile group than in the nonpulsatile group. These results indicate that pulsatile ECMO may provide more effective cardiopulmonary support in the treatment of neonates with serious circulatory failure that has failed to be supported by nonpulsatile ECMO.
A novel class of platelet activating factor (PAF) antagonists. I. Synthesis and structure-activity studies on PAF-sulfonamide isosteres.
New platelet activating factor (PAF) antagonists, 3 were synthesized by replacing the charged phosphate and trimethylammonium moieties with sulfonamide and heterocyclic quaternary ammonium functionalities, respectively (PAF-sulfonamide isosteres). Darmstoff phosphatidic acid analogues of this class (Darmstoff-sulfonamide isosteres), 6 were also synthesized. The activity of these compounds as PAF antagonists was evaluated from their in vitro inhibitory effect on PAF-induced platelet aggregation in rabbit platelet-rich plasma. Among the compounds tested, some of the 2-methoxypropane derivatives with an octadecylcarbamoyloxy or octadecylcarbamoylthio side chain at the 1-position and a propylsulfonamide function bearing a terminal polar substituent such as a quaternary quinolinium or substituted quinolinium group at the 3-position were found to be the most potent (IC50 = 0.3-0.6 microM).