Biomedical subjects

S Kitano

Publications and source records attributed to S Kitano.

493 records · Page 28Linked to original sources

PubMedDate not supplied

Caffeine-assisted chemotherapy and minimized tumor excision for nonmetastatic osteosarcoma.

Osteosarcoma is usually treated with intensive preoperative and postoperative chemotherapy and wide tumor resection, resulting in a 60% to 70% 5-year survival rate. Caffeine has a DNA-repair inhibiting effect. We therefore investigated the impact of caffeine given in conjunction with chemotherapy and limb-sparing surgery on survival and local tumor control in patients with nonmetastatic, high-grade osteosarcoma. Twenty-two patients were given 3 to 5 preoperative courses of intra-arterial cisplatin (120 mg/m2, 1 to 2 hours) and caffeine (1.5 g/m2/day x 3 days) with or without doxorubicin (30 mg/m2/day x 2 days). Following this treatment, limb-sparing surgery was performed by means of intentional marginal excision aiming at preservation of important structures such as major neurovascular bundles, tendons, ligaments and the epiphysis. Three courses of cisplatin and doxorubicin combined with caffeine, and high-dose methotrexate with vincristine and citrovorum factor rescue were given intravenously as postoperative chemotherapy for 21 patients and three courses of high-dose methotrexate and combination of ifosfamide, etoposide and methotrexate for 1 patient. Following the preoperative chemotherapy, there were no viable tumor cells in 19 patients, only scattered foci of viable cells in 2 patients, and some areas of viable tumor cells in 1. The 21 patients with a good chemotherapeutic response on radiographs underwent minimized marginal excision. Functional evaluation of the affected limbs was excellent for 17 patients, good for 3, fair for 1, and poor for 1. No local tumor recurrence was seen in this series. Eighteen patients remain disease-free with a mean follow-up of 61 months. Two patients died of metastatic disease, 1 died of chemotherapy-related complications, and 1 died of unknown causes. The overall 5-year cumulative survival rate was 90%, and the 5-year event-free survival rate was 75%. Chemotherapeutic caffeine enhanced tumor necrosis and improved the success rate of limb-sparing surgery using marginal procedure without any adverse impact on survival. The results of our limited clinical trial appear to justify further prospective, multicenter randomized trials of the benefits of caffeine combined with chemotherapy for nonmetastatic osteosarcoma and other malignant neoplasms.

Adolescent↗

PubMedDate not supplied

Carcinoid somatostatinoma of the papilla of Vater: a case report.

A 57 year-old Japanese man with a carcinoid somatostatinoma of the papilla of Vater is presented. He was found to have cholecystolithiasis without any symptoms. Physical examination showed no abnormal findings. Routine laboratory data gave normal results, except for glucose intolerance and an elevated somatostatin concentration. A yellowish papillary tumor was found at the papilla of Vater, and histological examination suggested the diagnosis of carcinoid. He underwent a pancreatoduodenectomy in March 1992. The gallbladder contained a single pure cholesterol stone. Histological, immunohistochemical, and electron microscopic studies resulted in the diagnosis of a carcinoid somatostatinoma of the papilla of Vater, without regional lymph node metastases. Post-operative pancreatic juice output from the total pancreatic duct drainage increased to more than 1000 mL/day. Although an anastomotic leakage of the pancreatojejunostomy was noted, the pancreatic fistula closed 8 weeks later. His postoperative somatostatin value was normal. He has been well for 54 months following surgery, without any signs of recurrence.

Ampulla of Vater↗

PubMedDate not supplied

Glucagon and insulin metabolism in cirrhotic patients.

BACKGROUND/AIMS: The aim of this study was to investigate glucagon and insulin metabolism in order to clarify the mechanisms that lead to hyperglucagonemia and hyperinsulinemia in cirrhosis. METHODOLOGY: Splanchnic output and metabolic clearance rates were studied in 16 cirrhotic patients and 5 non-cirrhotic controls. Splanchnic glucagon and insulin output into the portal circulation were calculated by the difference between portal venous and systemic arterial concentration multiplied by portal plasma flow. The metabolic clearance rate was calculated as the ratio of output to systemic arterial concentration. Portal blood flow was measured by continuous local thermodilution. RESULTS: Arterial glucagon levels were higher in cirrhotics than in controls. Glucagon output was triple of that found in controls (52.4 +/- 7.0 vs 17.7 +/- 2.9 ng/min, p < 0.05). Both groups exhibited similar metabolic clearance rates of glucagon. Systemic arterial insulin values were higher in cirrhotics than in non-cirrhotics. Insulin output was not significantly different between the two groups. However, metabolic clearance of insulin in cirrhotics was reduced to one half of the rate found in controls (237.0 +/- 39.8 vs. 450.5 +/- 17.5 mL/min, p < 0.05). CONCLUSIONS: Hyperglucagonemia in cirrhotic patients results from increased pancreatic output, while hyperinsulinemia results from decreased insulin clearance.

Case-Control Studies↗

PubMedDate not supplied

Laparoscopic cholecystectomy using the abdominal wall lift in a cardiac patient.

We present a case report of a patient with impaired cardiac function after aortic valve replacement and open mitral commissurotomy who underwent a laparoscopic cholecystectomy for cholecystolithiasis. In preventing reduced cardiac output due to pneumoperitoneum, the laparoscopic operative procedure was performed using the abdominal wall lift. Cardiac function was continuously evaluated by transesophageal echocardiographic examination and remained stable during the surgery. Because of the patient's co-existing chronic atrial fibrillation and prosthetic aortic valve, perioperative anticoagulation management was carried out. The patient's post-operative course was uneventful, and he was discharged on the 7th post-operative day.

Cholecystectomy, Laparoscopic↗

PubMedDate not supplied

The pattern of lymphatic spread in carcinoma of the distal bile duct.

From 1995 to 1996, 20 patients with carcinoma of the distal bile duct (Bi) and 16 with carcinoma of the pancreatic head (Ph) underwent pancreaticoduodenectomy or total pancreatectomy with systematic extended lymphadenectomy. Histopathological specimens were examined with special reference to nodal metastases. Pancreatic parenchymal invasion was present in 10 of 20 patients with Bi. The frequency of nodal involvement in Bi with pancreatic invasion and Ph was significantly greater than in Bi without pancreatic invasion (p<0.05 and p<0.01, respectively). Metastasis to nodes around the superior mesenteric artery or abdominal aorta in Bi with pancreatic invasion occurred more frequently than in Bi without pancreatic invasion (p<0.05), though was not different from the frequency observed in Ph. The pattern of lymphatic spread in distal bile duct carcinoma with pancreatic invasion was practically equal to the mode in carcinoma of the pancreatic head.

Adult↗

PubMedDate not supplied

Delayed massive intraperitoneal hemorrhage after pancreatoduodenectomy.

Of 144 cases of pancreatoduodenectomy we treated 6 patients (4.2%) with delayed massive bleeding. Massive hemorrhage occurred 14 to 38 days later. Leakage of the pancreatojejunostomy was confirmed in all patients. A "sentinel bleed" was evident in five patients with arterial bleeding. One patient with hemorrhage of the superior mesenteric vein was successfully treated conservatively. One patient with bleeding from the left gastric artery stump survived emergency re-operation. Two of four patients with hemorrhage from the gastroduodenal artery stump were successfully treated with selective embolization of the common hepatic artery. The remaining two patients died of uncontrollable re-bleeding or hepatic failure following hemostasis. Angiography and selective embolization are effective for identification and control of the bleeding site when delayed hemorrhage occurs after pancreatoduodenectomy. Intensive treatment is necessary to compensate for reduced hepatic arterial blood supply in cases requiring surgical or radiological interruption of the common hepatic artery.

Aged↗

PubMedDate not supplied

Para-aortic lymph node metastasis in carcinoma of the distal bile duct.

BACKGROUND/AIMS: Lymph node dissection plays an important role in radical surgery for pancreaticoduodenal carcinomas. The aim of this study was to identify the critical areas of lymph node dissection in carcinoma of the distal bile duct. METHODOLOGY: Between January 1995 and December 1996, 20 consecutive patients with distal bile duct cancer underwent pancreaticoduodenectomy with extended lymph node dissection (including the para-aortic nodes). Histopathologic findings were examined with special reference to lymph node metastasis. RESULTS: Histological evidence of lymph node metastasis was found in 11 patients (55%). The areas with frequent metastases were the posterior pancreaticoduodenal lymph nodes (35%), and the nodes around the hepatoduodenal ligament (35%) and around the common hepatic artery (30%). Para-aortic lymph node involvement was identified in 5 patients (25%). Most of these existed in the inter-aorticocaval space. Pancreatic parenchymal invasion was present in 10 patients. Half of the patients with pancreatic invasion had para-aortic nodal involvement. Para-aortic lymph node metastasis was significantly associated with pancreatic parenchymal invasion (p<0.05). CONCLUSIONS: In carcinoma of the distal bile duct with pancreatic parenchymal invasion, extended lymph node dissection (including para-aortic nodes) should be undertaken because of the relatively high incidence of metastasis.

Adult↗