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Biomedical subjects

S Koga

Publications and source records attributed to S Koga.

At least 253 records · Page 14Linked to original sources
PubMed1988

[Hyperthermia adjunct to surgery in the treatment of scirrhous carcinoma of the stomach].

In approximately 80% of patients with scirrhous carcinoma of the stomach, recurrence of cancers occurs even after potentially curative resection, and recurrence most frequently occurs in the form of peritoneal metastasis. Such recurrence may be attributable to possible intraperitoneal dissemination of malignant cells already present at the time of surgery. We performed intraoperative peritoneal cytology on patients with scirrhous carcinoma of the stomach. Free cancer cells were demonstrated in the Douglas cavity in 16 of 32 (50%) patients who underwent potentially curative gastrectomy. The postoperative 5-year survival rate was 23% in patients without detectable free cancer cells in the peritoneal cavity, compared with only 9% in patients with microscopic evidence of intraperitoneal free cancer cells. Therefore, we have applied hyperthermic continuous peritoneal perfusion (CHPP) on patients with scirrhous carcinoma of the stomach in order to develop a surgical adjuvant therapy effective for the prevention of recurrence of peritoneal involvement. The results obtained so far from our study have shown an increased 3-year survival rate of patients undergoing potentially curative gastrectomy, but no improvement of therapeutic outcome in terms of postoperative 5-year survival.

Adenocarcinoma, Scirrhous↗
PubMed1988

[Hepatic arterial chemotherapy combined with hyperthermia or arterial embolization in unresectable liver tumor].

Fifty-four patients with unresectable malignant liver tumors (14 of hepatocellular carcinoma, 40 of metastasis to the liver from gastric or colo-rectal cancer) were treated with intra-hepato-arterial (IHA) injections of cis-diamminedichloroplatinum (II) (CDDP) plus 5-fluorouracil (5-FU). In 32 of the patients, the liver tumors were detected synchronously with the diagnosis of the primary cancers, which were resected palliatively. Therapeutic schedules consisted of bolus injections of CDDP (50 mg/body/week) and 5-FU (250 mg/body/day) [Regimen I], and CDDP (50 mg/body/10-14 days) and 5-FU (100 mg/body/day) [Regimen II]. In 48 patients treated with IHA chemotherapy only, a partial response (PR) was obtained in 6 of 14 (43%) evaluable patients for Regimen I and in 11 of 30 (37%) patients for Regimen II. The dose-limiting factor for treatment with CDDP was bone marrow toxicity, but this toxicity was remarkably alleviated in Regimen II without any decrease in antitumor effectiveness. In 13 patients, other modalities, such as total-body hyperthermia (4 patients), radiofrequency capacitive local hyperthermia (5), and temporary arterial embolization (4), were combined with IHA chemotherapy. PR was obtained in 7 of 13 (54%) patients with the combined therapy. This combined therapy was efficacious in 7 patients in whom no desired results were obtained by IHA chemotherapy only. The survival rate was 50% at 12 months. IHA chemotherapy with CDDP plus 5-FU, especially when according to Regimen II, appears to be a strongly recommended strategy for treatment of unresected primary or metastatic liver tumor. Further, addition of the hyperthermia or the arterial embolization might enhance the antitumor effect of IHA chemotherapy.

Aged↗
PubMed1988

Oral contraceptives and intrahepatic biliary cystadenoma having an increased level of estrogen receptor.

We report a case of intrahepatic biliary cystadenoma in a young woman who had no prior history of liver disease and who had taken oral contraceptives for one year. A 27-year-old woman was admitted to our hospital with a firm epigastric mass. At laparotomy, a large cystic mass was resected from the left hepatic lobe, and diagnosed as biliary cystadenoma. In the tumor tissue, the estrogen receptor content was 14.0 fmol/mg cytosol protein, which was much higher than the 3.0 fmol/mg cytosol protein in the surrounding liver tissue. This is the first case of biliary cystadenoma in which the estrogen receptor content was increased.

Adult↗
PubMed1988

[Modified radical lymph node dissection in the treatment of gastric cancer invading the gastric serosa].

The improvement in prognosis for patients with advanced gastric cancer may be attributable to the success of the extensive lymph node dissection and adjuvant anticancer chemotherapy. In the present study, however, we found that the postoperative long-term prognosis for patients with gastric cancer invading the gastric serosa was not improved even by more extensive lymph node removal (R3-removal) than secondary lymph node removal (R2-removal). This difference indicates that serosal invasion by cancer, which is a source of exfoliating cancer cells and is closely related to peritoneal metastasis, is another factor influencing the prognosis of gastric cancer patients. Actually, in patients with gastric cancer who had serosal invasion, free cancer cells were frequently detected in the peritoneal cavity by means of pelvic lavage. We introduced continuous hyperthermic peritoneal perfusion (CHPP) with an anticancer drug as a prophylactic treatment for peritoneal recurrence after surgery for gastric cancer. In the randomized control study, the cumulative 5-year survival rate of patients in the CHPP group was better than that of the control group, although there was no significant difference. Based on the above, we suggest that in gastric cancer with serosal invasion, selective removal of Group 3 lymph nodes according to the location of the primary cancer lesion (modified radical lymph node dissection) and prophylactic treatment for peritoneal metastasis promise better outcome.

Antineoplastic Agents↗
PubMed1988

[Assessment of interaction between the left and right ventricles using pressure-volume loops in various heart diseases].

To assess the interaction and interdependence of left and right ventricular function, ECG-gated radionuclide angiocardiography was performed immediately after cardiac catheterization during right atrial pacing for 11 patients with old myocardial infarction (MI), two with non-obstructive hypertrophic cardiomyopathy, one with aortic stenosis (AS), two with pulmonary infarction (PI), and one with neurocirculatory asthenia (NCA). Absolute left ventricular (LV) volume curves were obtained by the count-based method with attenuation factor corrections. Biventricular pressure and volume curves were digitized and synchronized to end-diastole, and pressure-volume (P-V) loops were constructed throughout a cardiac cycle. The stroke work index (SWI), the work index per min (WI/M) and the contractility index (CNTI) were calculated from the P-V loops. In a patient with NCA, LV end-diastolic volume decreased during rapid pacing, but no significant change in the LV end-systolic P-V relation was recognized. However, the entire right ventricular (RV) P-V loop was shifted toward the left during rapid pacing. In a patient with AS, the LV P-V loop was markedly enlarged and every parameter of LV function was much greater than that of the right ventricle due to increased LV afterload. The areas of RV P-V loops in two patients with PI were larger than those of other patients, because RV pressure was relatively high, and RV volume was increased. It is suggested that RV pressure and volume overloads prevail in patients with PI. In four MI patients with three vessel disease and having collateral circulation, the LV end-systolic P-V relationship was shifted toward the lower right, and every parameter (SWI, WI/M, CNTI) of LV function decreased by rapid pacing. Myocardial ischemia may be induced by rapid pacing stress, causing decreased LV contractility. It was concluded that the P-V loops obtained by RNA and catheterization are clinically useful for estimating the interaction and interdependence between right and left ventricular hemodynamics.

Adult↗
PubMed1988

[Chronological trends in gastric cancer surgery in Japan].

The development of surgery for gastric cancer in Japan was reviewed. Recently, favorable long-term results have been obtained in surgically treated gastric cancer patients. This success has been mainly attributable to the performance of extended lymph node removal since the 1960s and of active total gastrectomy since the 1950s. Furthermore, gastrectomy combined with the resection of other organs since the 1960s, has resulted in an improvement of resectability. On the other hand, modified lymph node removal for early gastric cancer has been promoted in the 1980s. With the progress of anticancer chemotherapy since the 1970s, the concept of reduction surgery has been introduced into cancer surgery, and active palliative gastrectomy has been performed. Despite the advances made in gastric cancer surgery, however, there is a definite limit to the surgical treatment of gastric cancer. For this reason, multidisciplinary therapy combined with surgery should be considered.

Gastrectomy↗
PubMed1988

Hepatic encephalopathy and reversible cortical blindness.

We report a case of recurrent hepatic encephalopathy accompanied by transient cortical blindness. The patient with cryptogenic liver cirrhosis had six attacks of hepatic encephalopathy of grades II to III during 1 yr after admission. In the beginning of each episode of encephalopathy, when the patient was conscious, a complete loss of vision occurred, but with a normal pupillary reflex to light. At the same time, the visual evoked potential recorded the second negative wave with a prolonged latency and a diminished amplitude. His sight completely returned, and the electroencephalogram tracing and the visual evoked potential response normalized after treatment for the encephalopathy. The loss of vision was thought to be cortical blindness accompanied by hepatic encephalopathy. Thus, in rare cases of hepatic encephalopathy, the visual cortex may be affected, and cortical blindness may occur before the loss of consciousness.

Blindness↗
PubMed1988

[Clinical results and problems of total-body thermochemotherapy].

The clinical results and problems of extracorporeally-induced total-body thermochemotherapy (TBHT) for recurrent cancer are presented. A total of 127 hyperthermic treatments were performed in 45 patients who had undergone unsuccessful conventional systemic anticancer chemotherapy. Partial response was observed in 11 of 34 evaluable patients (32%). In analysing the anticancer effects of TBHT according to cancer site, a high efficacy was observed in patients with their main tumor in the lung, liver and lymph nodes. The anticancer effects were most enhanced when TBHT was performed in combination with cisplatin and 5-fluorouracil. In order to augment the anticancer effects of TBHT, the choice of combined agents and administration timing are important. A useful method for determining the thermochemosensitivity of individual cancer cells to agents selected for drug treatment is the human tumor clonogenic assay. Furthermore, the usefulness of angiotensin II-induced hypertensive chemotherapy during TBHT for augmenting selective drug delivery to cancer tissue is stressed.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1988

[Gastrointestinal carcinoma with skin diseases from the standpoint of surgery].

We encountered 21 patients with gastrointestinal carcinoma accompanied with skin diseases such as acanthosis nigricans, dermatomyositis, pemphigoid, erythrodermia, ichthyosis vulgaris, herpes zoster, Leser-Trélat's sign, Recklinghausen's disease and Gardner's syndrome. We have discussed such cases from the standpoint of surgery. There were 16 cases (76%) with gastric carcinoma, which were almost in the far advanced stage. Carcinomas of the other patients were seen in the esophagus, liver, pancreas, small intestine and rectum. Although skin lesions appeared before the onset of gastrointestinal symptoms in almost all cases, detection of carcinomas was very difficult until the symptoms emerged. In 6 of 21 patients (29%), carcinomas were detected by only skin manifestation, and they proved to be gastric cancer in all cases. Although the relationship of gastrointestinal carcinoma and skin diseases was unclear, we presented a 70-year-old woman with acanthosis nigricans accompanied with gastric cancer, whose skin manifestation was reduced by the therapy for gastric cancer. Therefore, some of these skin manifestation may be a symptom of the biological characteristics of the gastrointestinal carcinoma.

Acanthosis Nigricans↗
PubMed1987

Relationship between area of serosal invasion and prognosis in patients with gastric carcinoma.

We examined the relationship between the spatial extent of invasion of the gastric serosa in patients with gastric carcinoma and their postoperative 5-year survival rate. At the time of surgical resection of gastric cancer, intraperitoneal free cancer cells were detected by lavage of the Douglas cavity in 135 of 309 (44%) patients with gross evidence of serosal invasion. Examination of the relationship between the presence of intraperitoneal free cancer cells and serosal area invaded by the tumor revealed that only 22% of cases with an area of serosal invasion 10 cm2 or less were positive for free cancer cells, but such cells were found in 72% of cases with an area of serosal invasion greater than 20 cm2. The 5-year survival rate was 31% in patients with an area of serosal invasion of less than 10 cm2, whereas the rate was only 8% in patients with an area of serosal invasion greater than 20 cm2. Not only the presence of serosal invasion by a tumor but also the spatial extent of the invasion are significant factors that influence the prognosis of patients with gastric carcinoma.

Gastrectomy↗
PubMed1987

Clinical evaluation of total-body hyperthermia combined with anticancer chemotherapy for far-advanced miscellaneous cancer in Japan.

One hundred sixty-eight patients with miscellaneous far-advanced cancer received a total of 444 extracorporeally induced total-body hyperthermia (TBHT) treatments in seven Japanese hospitals. Overall, a regression of malignancy was observed in 39 of 132 evaluable patients (29.5%) and the most favorable results were obtained for patients with lung cancer. Irrespective of whether the tumors were primary or secondary lesions or recurrences, favorable results were obtained in patients whose tumors were in the lung, liver, lymph nodes, and soft tissue. No relationship was found between an objective response to TBHT and histologic types of the tumors. There was no clear relationship between an objective tumor response and the nature of the simultaneous chemotherapy during hyperthermia. Antitumor effects were not evaluable in 36 patients (21.4%). Of these 36 patients, 33 died before evaluation could be made; 24 died of various complications and 9 died of cachexia without complication. The mortality increased in proportion to the reduction of the performance status of patients before TBHT. These results indicate that TBHT should be used as therapy for patients whose tumors are in the lung, liver, lymph node, and soft tissue and then only on patients in generally good condition.

Adult↗
PubMed1987

Prognostic significance of lymph vessel involvement in gastric cancer.

We studied the prognostic significance of lymph vessel involvement in the gastric wall in 226 patients with advanced gastric cancer. There was no close correlation between the gross morphology of the cancer and the incidence of lymph vessel invasion. However, the more severe the degree of lymph vessel involvement, the higher was the incidence of lymph node metastasis. Severe lymph vessel invasion was found most frequently in poorly differentiated adenocarcinoma of the medullary type. Among patients with scirrhous carcinoma there were some in whom lymph vessel involvement was overlooked on routine histologic examination. Because the depth of lymph vessel invasion of the gastric wall was significantly related to the clinical course, we consider this to be of supplementary predictive value.

Carcinoma↗