Biomedical subjects
Publications and source records attributed to S Koga.
Treatment of 5-methylpyrimidine nucleosides and nucleotides with sodium peroxodisulfate in sodium phosphate buffer solution at pH 7.0 at 75 degrees C resulted in the selective oxidation of the methyl group. On the other hand, oxidation of thymidine by potassium peroxomonosulfate gave thymidine glycols.
To test the possible participation of activated leukocytes in the pathogenesis of gastric ulcer, plasma levels of polymorphonuclear leukocyte-elastase-alpha 1-proteinase inhibitor complex (PMN-EC), a discerning indicator for the activation of leukocytes, were determined in patients with gastric ulcer. Plasma levels of PMN-EC in patients with gastric ulcer (185.2 +/- 21.6 micrograms/l, mean +/- S.E.M.) were significantly higher than those in normal healthy subjects (67.6 +/- 4.4 micrograms/l, p less than 0.01). On the other hand, plasma levels of C-reactive protein and sialic acid increased in only 17.8% and 7.1% of patients with gastric ulcer, respectively. No significant correlation was observed between PMN-EC and the plasma levels of CRP or sialic acid. Plasma levels of PMN-EC decreased with the healing of the ulcerative lesion as judged by gastro-endoscopic observation. These findings suggested that activation of leukocytes might deeply be correlated with the pathologic mechanism of gastric ulceration and the measurement of PMN-EC might be useful for monitoring the patients with gastric ulcer.
Between April 1965 and March 1984, 659 patients (mean age 52.3 years) with chyluria were encountered (probably from filariasis) and 323 were followed for a mean period of 71.9 months (range 1 to 210 months). Of the 323 patients, chyluria was apparently exacerbated by another condition in 132 (40.8%), and often remitted with effective treatment of the coexistent condition. The findings suggest that chyluria is often accompanied by other physiologic or pathologic processes and treatment of these coexistent conditions should be the initial therapeutic approach.
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A prognostic study on 119 patients with primary liver cancer undergoing nonsurgical therapy was carried out to evaluate the relevance of hepatic functional reserve and tumor size to their cumulative survival rates. All patients were classified into the three groups of Child's classification (A, B and C) according to their hepatic functional reserve and were also divided into the five groups according to their tumor size. The cumulative survival rates of all patients at 1, 2, 3, 4 and 5 years after the diagnosis were 50.9, 28.3, 18.8, 13.5 and 6.7%, respectively. The cumulative survival rates of group V whose tumor occupied more than 40% of the liver area were significantly lower than those of the other tumor-size-groups. The survival rates of Child's group A were significantly higher than those of group B and C. But in those patients who were classified into group V according to their tumor size, there was no significant difference in their survival rates among the three groups of Child's classification. These results suggest that hepatic functional reserve as well as tumor size is an important prognostic factor in patients with primary liver cancer. But if the cancer once develops greater than 40% of the liver area, hepatic functional reserve diminishes in value as a prognostic factor.
To evaluate cerebral hemodynamics, 21 patients with chronic occlusion or severe stenosis of the internal carotid or middle cerebral artery with normal or only lacunar infarction on x-ray CT were studied using single photon emission computed tomography (SPECT). We measured rCBV with 99mTc erythrocytes after rCBF with 133Xe, and calculated rCBV/rCBF. rCBF and rCBV of the 25 affected hemispheres were classified as (a) patients with normal rCBF [type I (n = 7) and type II (n = 3)]; (b) patients with decreased rCBF [type III (n = 6) and type IV (n = 9)]. These two groups then could be subdivided according to findings of rCBV, normal, and increased blood volumes. rCBV/rCBF increased as the cerebral perfusion pressure dropped from type I to type III. In type IV, other situations but cerebral autoregulation could be assumed. rCBV/rCBF signifies vascular mean transit time. Type III (high rCBV/rCBF) assumed as the increased OEF, misery perfusion as reported in PET. We propose rCBF, rCBV and rCBV/rCBF using SPECT can be an index for cerebral circulatory reserve.
A brachytherapy of a choroidal melanoma using 198Au grains has been performed. Procedurally, the sclera was first incised, after which a pouch was constructed and the grains then arranged around the tumor in a circle so as to enclose it, said operative procedure according to the Manchester Technique. Total Gy dosage amounted to 120 Gy. Postoperatively, in due course, the disappearance of the tumor was clearly shown on MRI examination. The small size and the short half-life of the gold grains made it possible to insert the grains into the tissue permanently, and to give an adequate Gy dosage to eradicate the tumor while still preserving the eyeball.
Two cases of superior mesenteric vein thrombosis were examined with computed tomography. Prior to the operation the CT appearances of the disease were, as follows: focal thickening of the bowel wall, gas and fluid collection in the dilated bowel, mesenteric leaf, a little ascites and dilated superior mesenteric vein with central filling defect. We conclude that CT scan is very useful for an early diagnosis of the superior mesenteric vein thrombosis.
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The influence of bile acids on the development of remnant gastric carcinoma was examined by investigating the incidence of carcinogenesis in noninbred male Wistar rats treated orally with N-methyl-N'-nitro-N-nitrosoguanidine (MNNG; CAS 70-25-7; 1-methyl-3-nitro-1-nitrosoguanidine) and fed a diet containing 1% cholesterol. The high-cholesterol diet did not influence the incidence of carcinoma in the nongastrectomized, MNNG-treated groups of rats. However, in the gastrectomized groups, the incidence of carcinoma was significantly higher in the group given the high-cholesterol diet (60.6%) than in the group given a normal diet (35.5%). Histologically undifferentiated adenocarcinoma was recognized more frequently in the high-cholesterol-diet group. Three gastrectomized rats not treated with MNNG but fed the high-cholesterol diet developed remnant gastric carcinoma (13%), whereas none of the rats given the normal diet did. Because the fecal excretion of bile acids increased significantly in the rats fed the high-cholesterol diet and the gastroduodenal reflux of bile acids was probably accelerated, the increase in the incidence of carcinogenesis in the remnant stomach was considered to be the result of the increase in the reflux of bile acids evoked by a high-cholesterol diet.
Correlations between levels of tissue polypeptide antigen (TPA) in serum and histologic stage or progression of cancer were studied in 94 patients with gastric cancer. Levels of TPA in serum from patients with cancerous invasion into the vein of the stomach wall (v-invasion) were elevated in parallel to the progression of cancer by stage, and were significantly higher in each positive case than in each negative case of lymph node metastasis or of cancerous invasion into lymph vessels of the stomach wall (P less than 0.05 and P less than 0.01, respectively). There were no differences in levels of TPA in serum from patients without v-invasion when these cancers were classified by stage, progression, or histologic type. It appears that elevation of levels of TPA in serum is associated with v-invasion, and that a determination of the level of TPA in serum is useful for the prediction of hematogenic metastasis in cases of gastric cancer.
A retrospective analysis was undertaken of the association between blood transfusion and long-term results for 218 patients with stage III gastric cancer who were curatively treated by partial gastrectomy. One hundred and fifty-two patients received blood transfusion within the perioperative period. The postoperative 5-year survival rates were 49.3% for the transfused patients and 62.1% for the non-transfused patients (P less than 0.05). Furthermore, the postoperative survival of patients who had been transfused preoperatively was significantly lower than that of the non-transfused patients. The preoperatively transfused group of patients were found to have tumors that were larger than those of the non-transfused group. On the basis of the above data, it appears that the prognosis of patients with advanced gastric cancer is poorer when such patients receive preoperative blood transfusion than when patients do not receive transfusions, and that this adverse effect in the transfused patients is probably attributable to the larger size of their tumors, even though the stage of advancement of gastric cancer is the same in both groups of patients.
A 55-year-old woman presented to our hospital with abdominal fullness and edema of both legs. She had undergone a bypass operation by an ileotransversostomy for adhesive ileus following a drainage operation for acute appendicitis 35 years previously. We diagnosed the patient as having blind loop syndrome as a consequence of the side-to-side ileotransversostomy, and performed a right hemicolectomy and intestinal resection. The resected specimen of dilated ileal blind loop contained 15 crater-like lesions, proven histologically to be nodular proliferation of atypical lymphocytes. Lymph follicles had also proliferated in the mucosa of the blind loop and the histologically confirmed diagnosis of non-Hodgkins lymphoma of the diffuse medium-sized cell type was thus made. The etiology of such tumors is probably related to the alteration in intestinal environment caused by conditions such as fecal stasis, bacterial overgrowth, and bacterial toxins in the blind loop.
We have examined the correlation between the depth of venous invasion of the gastric wall and the occurrence of liver metastasis in cases of gastric cancer. In 244 patients examined, the incidence of venous invasion, and in particular of subserosal venous invasion, was appreciably high in cases of poorly differentiated adenocarcinoma of the medullary type. Synchronous and metachronous liver metastases were found in 13 and 18 patients, respectively. In these cases, poorly differentiated adenocarcinoma with a medullary growth pattern was the most frequent, and papillary adenocarcinoma was the next most frequent type of cancer. The incidence of liver metastases was appreciably higher in patients with subserosal venous invasion than in those with only submucosal venous invasion. Considering the above observations, we posit that subserosal venous invasion by cancer, especially by poorly differentiated adenocarcinoma of the medullary type, is indicative of the risk for development of liver metastasis in patients with gastric cancer.
Plasma samples from patients with disseminated intravascular coagulation (DIC) associated with acute promyelocytic leukemia (APL) exhibited higher levels of the D-fragment of fibrin and fibrinogen degradation products [FDP(D)], with relatively lower levels of cross-linked fibrin degradation products (XDP), than samples of DIC with non-APL. The difference between FDP(D) and XDP levels increased only when alpha 2-plasmin inhibitor (alpha 2-PI) fell below 60% of the normal level in APL patients. These findings suggest that fibrinogenolysis occurs in APL patients when the alpha 2-PI level has decreased significantly.
To examine the acquisition of voluntary control of a novel muscular activity from the initial stage to the self-control stage, the m. auricularis posterior, which had generally degenerated and had nearly lost its function of drawing an auricle backward in the human body, was selected as a target muscle to be studied. One female undergraduate student who could not move her auricles intentionally was required to activate her left m. auricularis posterior and underwent rest, pretest, training, and posttest sessions once a day for five days. At the subject's request, the electromyograph (EMG) from her left m. auricularis posterior on an oscillograph was provided for her as the feedback signal on each training trial. The picture of her left ear on television was handled in the same way. The EMG measures indicated that the subject could learn to activate her left m. auricularis posterior differentially. The number of training trials on which the subject requested the feedback signals suggested that EMG feedback signal was more useful to her than the video and that the usefulness of the feedback signals varied as the training sessions advanced. It was also concluded from analysis of the self-report data that the acquisition process of self-control of a novel muscular activity could be divided into at least four stages.
We have conducted a clinical trial to evaluate the effectiveness of continuous hyperthermic peritoneal perfusion with mitomycin C (CHPP-M) as prophylactic treatment of peritoneal recurrence of gastric cancer. Between January 1983 and October 1985, 82 patients with macroscopic serosal invasion but no macroscopic peritoneal metastasis undergoing potentially curative resection of gastric cancer, were divided into two groups by random sampling: 42 patients were scheduled to receive CHPP-M, while 40 would not receive such treatment. The CHPP-M was administered immediately after closure of the abdomen following gastric resection, while the patient was still on the operating table under general anesthesia. The 5-year survival rate (71.5% of the patients in the CHPP-M group was higher than that (59.7%) of those in the control group. Although postoperative follow-up periods are not long enough, the longer survival obtained in the patients treated with CHPP-M should be emphasized, since no effective means of preventing peritoneal recurrence of gastric cancer is so far available.
Postoperative intraportal anti-cancer chemotherapy was used for 51 patients with curatively resected colorectal cancer who were selected in the randomized controlled study to evaluate its inhibitory effect on liver metastasis from colo-rectal cancer. In cases of intraportal chemotherapy, 30 mg of Mitomycin-C (in 3 doses) and 5 mg/kg (B.W.)/day (1985-1986) or 3 mg/kg/day (1987-1988) of 5-FU was injected through the catheter inserted into the portal vein during postoperative 14 days. In cases of the control group (58 patients), the same doses of the drugs were injected into the peripheral vein during the same term. Six patients with recurrences were observed in the intraportal chemotherapy group, and 3 of them had liver metastases. In the control group, more liver metastases were observed (5 of 7 recurrences were liver metastases). Intraportally injected 5 mg/kg/day of 5-FU slightly disturbed the liver function. The averages of the serum GOT, GPT and gamma-GTP level of these cases were higher than those of the control cases. Three mg/kg/day of intraportally injected 5-FU had no influence on the liver function. There were no differences in the incidence of leukocytopenia or thrombocytopenia between the two groups.