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Biomedical subjects

S Morinaga

Publications and source records attributed to S Morinaga.

At least 55 records · Page 3Linked to original sources
PubMed1999

T-cell insulitis found in anti-GAD65+ diabetes with residual beta-cell function. A case report.

CASE HISTORY: We recently encountered a 65-year-old anti-GAD+ diabetic woman with residual beta-cell function who was proved to have T-cell insulitis. The proportion of CD4+ and CD8+ cells varied among individual islets, although CD4+ cells tended to be the predominant T-cell type in the islets examined. All of the islets examined still contained insulin, suggesting that beta-cell mass may have been preserved. DISCUSSION: It is well known that lymphocytic infiltration of pancreatic islets, a condition referred to as "insulitis," is seen in acute-onset type 1 diabetes at autopsy and in biopsy specimens. However, there have been no proven cases of insulitis in type 1 diabetes with residual beta-cell function. We believe that this is the first type 1 diabetic patient with residual beta-cell function who was proven to have T-cell insulitis. This novel evidence will contribute to the proper classification and treatment of diabetes and to a better understanding of the pathophysiology of type 1 diabetes.

Aged↗
PubMed1999

[Bronchial dilatation due to broncholithiasis mimicking lung abscess].

A 61-year-old man who had been treated for pneumonia several times was examined because radiographs and computed tomograms disclosed a mass-like shadow associated with a cavity in the left lingular segment. The lesion was resected by video-assisted thoracoscopic surgery because it was suspected of being a lung abscess that had caused repeated episodes of inflammation. The resected specimen revealed a severely dilated peripheral bronchus due to broncholithiasis. It is often difficult to diagnose a lesion as broncholithiasis on the basis of secondary changes or calcification without bronchoscopic data. We emphasize that broncholithiasis should be suspected when a shadow resembling a lung abscess associated with symptoms of recurrent infection is found.

Bronchial Diseases↗
PubMed1999

[Intrapulmonary hematoma surrounding the stapled line after video-assisted thoracoscopic bullectomy for spontaneous pneumothorax].

A 52-year-old man presented at our hospital with hemoptysis three months after undergoing a video-assisted thoracoscopic bullectomy for spontaneous pneumothorax. A chest X-ray showed a localized infiltrative shadow in the right upper lobe of the lung. The chest CT findings revealed a mass-like lesion surrounding the staple which had been used during the bullectomy. He therefore underwent a pulmonary resection including the lesion due to the continued hemoptysis that did not improve even after treatment by hemostatic agents and bronchial arterial embolization. The resected specimen revealed an intrapulmonary hematoma with severe inflammation. The late onset hematoma which was induced by the stapler may thus be a rare complication in video-assisted thoracoscopic surgery.

Endoscopy↗
PubMed1999

[Intraoperative radiation therapy (IORT) for locally unresectable pancreatic cancer].

To evaluate the therapeutic effect of IORT for unresectable locally advanced pancreatic cancer, 11 patients treated with IORT and 15 patients treated with palliative therapy only were retrospectively examined. The mean age of the IORT group was 61.9 years, 5 cases were classified into surgical stage IVa, and 6 into stage IVb. The mean age of the palliative therapy group was 69.1 years; 5 cases were classified into surgical stage IVa and 10 into stage IVb. The tumor size was measured in 6 cases in the IORT group, before and after IORT. The tumor was enlarged in 1 case, not changed in 4 cases, and reduced in 1 case. The serum CA19-9 level was measured in 8 cases of the IORT group. Serum CA19-9 was increased in 3 cases, not changed in 4 cases, and decreased in 1 case after IORT. ECOG pain scores were obtained in 9 patients who had complained of pain before IORT, and the score decreased in 7 cases. The median survival was 7.6 months in the IORT group and 3.0 months in the palliative therapy group. IORT may improve patients' QOL by decreasing their pain. However, further studies are necessary to confirm the efficacy of IORT for survival of locally unresectable pancreatic cancer patients, because the patient profile in this study was different in the two groups.

Aged↗
PubMed1999

[Clinical investigation of pulmonary tuberculomas diagnosed by video-assisted thoracoscopic biopsy].

We investigated the clinical characteristics of pulmonary tuberculomas and discussed strategies for their diagnosis. We compared a group of patients with lesions that had been diagnosed by bronchoscopy (the BF group: 15 patients, 17 lesions) with a group whose lesions had been diagnosed by thoracoscopy (the VATS group: 19 patients, 20 lesions). The VATS group included patients with lesions that could not be diagnosed by bronchoscopy alone. The 2 groups did not differ significantly in terms of patient age, gender, lesion size, number of bronchoscopic examinations, or tuberculin test findings. In both groups, the lesions always existed just below the pleural surface and were mostly located in the upper lobes of the lungs. Lesion locations in the middle lobe and lingular segment were observed only in the BF group, whereas locations in the lower lobes were observed only in the VATS group. Tuberculomas in 2 BF group patients (11%) and 10 VATS group patients (50%) were diagnosed on the basis of histopathologic findings in the absence of bacteriological evidence. No postoperative complications were observed in the VATS group, and all patients in this group were discharged from the hospital within 1 week. No relapse of tuberculosis was observed in either group following anti-tuberculous therapy. Video-assisted thoracoscopic biopsy is a reliable and minimally invasive diagnostic procedure, and should be performed on any solitary pulmonary lesion that cannot be diagnosed by bronchoscopy. It is important that tuberculomas be quickly and accurately diagnosed not only in order to distinguish them from lung cancer, but also to treat the patient's tuberculosis at an early stage and prevent it from spreading.

Adult↗
PubMed1998

Serum surfactant protein A levels in healthy individuals are increased in smokers.

Serum levels of surfactant protein A (SP-A) were studied in 237 healthy subjects in relation to sex, age, and smoking habits. SP-A values in male smokers were significantly higher than those in male nonsmokers (p < 0.001). The amount of cigarette smoking did not correlate significantly with SP-A values, however. SP-A values in young nonsmoking males and females were somewhat lower than those in older, but without significant difference. No significant difference in values was found between the sexes. We conclude that (1) smoking increases serum levels of SP-A, and (2) SP-A serum levels are not affected by age and sex.

Adolescent↗
PubMed1998

Primary malignant lymphoma of superior vena cava.

A 78-year-old woman suffered from superior vena cava (SVC) syndrome. Computed tomography and angiography revealed a mass within the SVC. The SVC was resected via median sternotomy, followed by reconstruction using an artificial graft. The resected specimen showed a polypoid tumor within the SVC that had invaded the wall of the SVC. Histologic diagnosis was diffuse large-cell non-Hodgkin's lymphoma. Most surrounding lymph nodes showed reactive swelling, but one showed a partial microscopic metastasis. These pathologic findings indicated that the tumor was an SVC-originating malignant lymphoma. The patient is now alive and tumor-free 65 months after the operation.

Aged↗
PubMed1998

De-epithelialization for esophageal cyst by video-assisted thoracoscopic surgery monitored by esophagoscopy.

In a 26-year-old male a congenital esophageal cyst was de-epithelialized using electro-cauterization via video-assisted thoracoscopic surgery (VATS) together with esophagoscopy. As the cyst adhered firmly to the esophageal muscle layer and mucosa, partial excision of the cyst and burning up of the cystic mucosa by electro-cauterization was performed to prevent esophageal mucosal perforation and postoperative esophageal dysmotility. Intraoperative video esophagoscopic monitoring enabled esophageal mucosal perforation to be avoided. Postoperative barium esophagography revealed good esophageal motility, and the patient showed no symptoms of esophageal dysmotility. We conclude that de-epithelialization for congenital esophageal cysts using VATS together with esophagoscopy is a minimally damaging and reasonable curative procedure without postoperative complications.

Adult↗
PubMed1998

Lung adenocarcinomas diagnosed by open lung or thoracoscopic vs bronchoscopic biopsy.

STUDY OBJECTIVES: To examine the characteristics of peripheral lung adenocarcinomas diagnosed by open lung or video-assisted thoracoscopic surgery (VATS) biopsy. DESIGN: We used retrospective analysis to compare tumor stage, pleural involvement, central tumor fibrosis, and the number of bronchi or vessels involved with tumors of small peripheral lung adenocarcinomas diagnosed by bronchoscopic biopsy. PATIENTS: Subjects had lung adenocarcinomas diagnosed by open lung or VATS (n=22) and those diagnosed by bronchoscopic biopsy (n=22), which were matched by tumor size. RESULTS: The T1N0M0 tumor was notably more frequent in the open lung or VATS group (77.3%) than in the bronchoscopic biopsy group (36.4%) (p<0.01). Tumors invading beyond the pleural surface were less frequent in the open lung or VATS group (4.5%) than in the bronchoscopic biopsy group (40.9%) (p<0.01). The grade of in-tumor central fibrosis--a malignancy factor and the cause of bronchi or vessel involvement with tumors-was significantly lower in the open lung or VATS group than in the bronchoscopic biopsy group (p<0.01). The number of bronchi or vessels involved with tumors was significantly fewer in the open lung or VATS group than in the bronchoscopic biopsy group (p<0.001). CONCLUSIONS: (1) Lung adenocarcinomas diagnosed by open lung or VATS biopsy were more frequently T1N0M0 than those diagnosed by bronchoscopic biopsy, which was caused by low grade of central tumor fibrosis rather than small tumor size. (2) They were infrequently diagnosed by bronchoscopic biopsy because few bronchi were involved by tumors due to the low grade of central tumor fibrosis. (3) Small pulmonary nodules not diagnosable by bronchoscopic biopsy should be diagnosed aggressively using VATS biopsy to detect early-stage lung cancer.

Adenocarcinoma↗
PubMed1998

Malignant insulinoma with extensive liver metastases presenting as disturbance of consciousness.

A 56-year-old man was referred to our hospital for evaluation of episodic disturbance of consciousness. Hypoglycemic symptoms were noted and Whipple's triad was satisfied. The 75 g OGTT and the glucagon test revealed a high baseline insulin level and hyperreactivity to glucagon. A pancreatic tumor and liver metastases were found by abdominal computed tomography (CT). Based on the finding of liver biopsy, the final diagnosis was malignant insulinoma with liver metastasis. He selected conservative treatment and no hypoglycemic crisis has occurred for one year since discharge. Early diagnosis and long-term follow-up is necessary since this tumor is slow growing.

Blood Glucose↗
PubMed1998

[Usefulness of marking with colored collagen to localize small pulmonary nodules for thoracoscopic biopsy].

We examined the usefulness of marking with colored collagen to localize small pulmonary nodules (less than 10 mm in diameter) for thoracoscopy. Before using colored collagen, 2 of 6 lesions (33%) could be localized. It was possible to localize 14 of 15 lesions (93%) for thoracoscopy after marking with colored collagen, a percentage that is significantly higher than localization without such marking (P < 0.01). Thus, marking using colored collagen is useful to localize pulmonary nodules less than 10 mm in diameter for thoracoscopy.

Collagen↗
PubMed1998

[A case of pulmonary epithelioid hemangioendothelioma diagnosed by video-assisted thoracoscopic biopsy].

A regular annual physical checkup for a 46-year-old man revealed multiple small nodules, which were less than 1 cm in diameter, in both lungs. Metastatic lung tumors were suspected, but no primary lesion was found in the general examination. Video-assisted thoracoscopic surgery (VATS) diagnosed multiple pulmonary epithelioid hemangioendothelioma (PEH), so no treatment was performed. Careful follow-up showed no significant change during 10 months. VATS is thus a certain, noninvasive procedure for the diagnosis of PEH.

Biopsy↗
PubMed1998

[Giant cell arteritis with bilateral obstruction of the internal carotid artery--report of an autopsy case].

Internal carotid artery involvement and dementia occur infrequently in patients with giant cell (temporal) arteritis. A 75-year-old woman admitted with progressive cognitive decline, drowsiness and headache was diagnosed as having giant cell arteritis by temporal artery biopsy (TAB). High dose corticosteroid improved inflammatory reaction but did not improve his cognitive function. Cerebral angiograms showed obstruction of both internal carotid arteries at the siphon. Brain MRI showed only small cerebral infarcts in the basal ganglia and corona radiata bilaterally. However, brain SPECT disclosed reduced cerebral blood flow in the frontal lobe bilaterally. A postmortem examination revealed bilateral parietal infarcts and isolated giant cell arteritis involving the both internal carotid arteries at the siphon. We speculated that perfusion insufficiency and multiple cerebral infarction due to bilateral internal carotid artery occlusion had caused this neurologic deterioration.

Aged↗
PubMed1997

Serum Clara cell protein levels in lung cancer patients: an assessment of preoperative values and postoperative changes.

Serum levels of protein 1 (P1), a Clara cell protein known to have an antiinflammatory effect, were studied in 33 patients with lung cancer before surgery, and 3, 7, 14, 21 days, and 2 months after surgery. The preoperative P1 values of the lung cancer patients were compared with those of 66 healthy controls matched by sex and age. The postoperative changes in P1 which occurred in the lung cancer patients were compared with those in 16 patients who underwent laparotomy for gastric or colon cancer. There was no significant difference in the P1 values between the lung cancer patients and the healthy controls; however, the postoperative P1 values showed a significant decrease 3, 7, (P < 0.001), and 14 days (P < 0.05) postoperatively, recovering to normal within 2 months after surgery. One patient who died of postoperative pneumonia showed decreasing serum P1 levels until death. None of the laparotomy patients showed any decrease in P1 serum levels. Thus, we conclude that: (a) serum P1 levels do not differ between lung cancer patients and healthy individuals; (b) serum P1 levels significantly decrease in the early postoperative period, but recover within 2 months after lung resection; and (c) the postoperative changes that occur in serum P1 levels could provide important information about recovery from intraoperative lung damage.

Female↗
PubMed1997

Contacting metastasis of a fibrous tumor of the pleura.

A 26-year-old female with a fibrous tumor of the pleura that metastasized to the other site of the pleura due to contact is reported. The primary lesion was a 6-cm pedunculated tumor originating from the diaphragm; the metastasis was a broad-based 1-cm tumor located on the parietal pleura of the lateral thoracic wall, within an area in contact with the primary tumor. The surrounding pleura around the small tumor and the diaphragm-the area that contacted the large tumor-was resected with both of the tumors under a thorascope. Despite a benign pathologic finding, a localized fibrous tumor of the pleura can then metastasize to the pleura due to contact. It was concluded that, because localized fibrous tumors of the pleura can occasionally metastasize to the area in contact with tumors, the intrathoracic cavity should be thoroughly observed using a thoracoscope.

Adult↗
PubMed1997

Haemophagocytic lymphohistiocytosis in association with granular lymphocyte proliferative disorders in early childhood: characteristic bone marrow morphology.

Five paediatric cases of haemophagocytic lymphohistiocytosis (HLH) which showed proliferation of granular atypical lymphocytoid cells in bone marrow are reported. All cases were girls aged 8 months to 4 years who had marked hepatosplenomegaly. Marker analysis on peripheral blood mononuclear cells revealed an increase in the CD3+HLADR+ subset in three cases and the CD3- CD56+ subset in one case. An Epstein-Barr virus genome was detected in three cases, and monoclonality was confirmed in two cases. A characteristic morphology of large granular lymphocytes (LGL) was identified, with elongated bizarre features that resembled horsetail-, tadpole-, cucumber- or shooting star-type configurations on the bone marrow smear. Serum concentrations of soluble interleukin-2 receptor and interferon-gamma were elevated in all cases. All five cases required multi-agent chemotherapy which resulted in two complete remission, two partial remissions and one no response. Refinement of treatment is required for these paediatric GLPD cases which probably comprise a specific high-risk subgroup among secondary HLH patients which had previously escaped notice.

Bone Marrow Diseases↗
PubMed1997

Massive hemoptysis from an endobronchial metastasis of thyroid papillary carcinoma.

A 68-year-old female was admitted to our hospital with massive hemoptysis. She had undergone total thyroidectomy and postoperative radioisotope therapy for thyroid papillary carcinoma associated with multiple lung metastases one year before the present disorder. The right middle lobe was resected because of lethal airway bleeding from the lobe. Pathological examination showed an endobronchial metastasis 30 mm in size at the segmental bronchi. Other numerous small metastatic lesions exhibited two growth patterns: subepithelial endobronchial metastasis at the peripheral bronchi and visceral pleural metastasis. Endobronchial metastasis is an extreme type of lung metastasis of thyroid carcinoma, and can cause massive hemoptysis as the lesion increases in size.

Aged↗