Biomedical subjects

S Ohwada

Publications and source records attributed to S Ohwada.

194 records · Page 11Linked to original sources

PubMedDate not supplied

Short segment of left colon substitution following proximal gastrectomy.

For improved quality of life, limited surgery for early gastric cancer has been preferred over the standard operation with lymph node dissection. Therefore, we have developed a modified technique: the proximal gastrectomy is reconstructed with a short segment of the left colon. The anastomoses of both esophagocolonostomy and colono-gastric remnantstomy are made using stapling devices. A His' angle is formed to reduce reflux esophagitis. We described here the detail of an operative technique.

Colectomy↗

PubMedDate not supplied

Interferon-alpha potentiates the antiproliferative activity of CPT-11 against human colon cancer xenografts in nude mice.

Recently cytokines have been reported to potentiate the antiproliferative effects of chemotherapeutic agents against a variety of malignant tumors. We studied the antiproliferative effect of recombinant human interferon-alpha (rHuIFN-alpha) and CPT-11 on transplantable human colon cancer H-110 in nude mice. CPT-11 was administered to the H-110-bearing nude mice intraperitonealy every 4 days and rHuIFN-alpha was administered subcutaneously every day. The weight of the individual tumor was estimated by the tumor size. The cell cycle was analyzed by flow cytometry. The single administration of rHuIFN-alpha failed to show any antiproliferative activity. The antiproliferative effects of CPT-11 alone were observed in a dose and time dependent manner. This antiproliferative activity was markedly (p < 0.05) enhanced by combination with rHuIFN-alpha. Flow cytometric analysis revealed that treatment with rHuIFN-alpha accumulated cells in the S phase. rHuIFN-alpha can enhance the antiproliferative effects of CPT-11, probably through the accumulation of the tumor cells in the S phase.

Animals↗

PubMedDate not supplied

Multidisciplinary treatment with anthracyclines in inflammatory breast cancer.

Twenty-two patients with inflammatory breast cancer treated between 1962 and 1994 were analyzed. Before the introduction of multidisciplinary treatment with anthracycline agents between 1962 and 1981, 11 patients out of 14 were resected, however, a curative operation was performed for only 3 of these patients (29.3%). Ablative endocrine therapy, intraarterial infusion of anticancer drugs (mitomycin C or 5-fluorouracil), and radiation were carried out as the preoperative induction therapy for inflammatory breast cancer. All 14 patients died within 36 months. After the introduction of multi-disciplinary treatment with anthracycline agents between 1981 and 1994, preoperative induction chemotherapy or chemoendocrine therapy using anthracyclines was carried out on 7 out of 8 patients and the remaining patient received radiation. Of the former 7 patients, 6 (85.7%) underwent a curative operation. There was approximately a 35 percent cumulative survival rate observed 60 months after operation, and 3 patients out of the 7 lived for more than 5 years. To conclude, multidisciplinary treatment including systemic induction chemotherapy with anthracyclines was an effective treatment for inflammatory breast cancer.

Adenocarcinoma↗

PubMedDate not supplied

Breast conserving surgery with nipple resection.

Breast conserving surgery with nipple resection was carried out on 4 patients with early breast cancer because location of each tumor was very close to nipple. These consisted of 3 patients with state I invasive ductal carcinoma and 1 patient with stage II invasive ductal carcinoma. Cancer cells were not recognized histopathologically in the resection margins of each case and all cases underwent a curative resection with axillary dissection (up to level III). The rested areola in each case was made to be round-shaped by skin suture and the edge of the wound located in the center of areola looked like a small nipple. The cosmetic result of this operation were excellent in all patients. This operation may be effective both for these patients with early breast cancer locating under the nipple or areola and for those whose tumor was very close to nipple.

Adult↗

PubMedDate not supplied

Changes of cytokines and thyroid function in patients with recurrent breast cancer.

The hypothyroid state or nonthyroidal illness is often observed in patients with recurrent cancer. High levels of cytokines are frequently observed in critically ill patients. Recent studies have shown that interleukin (IL)-6 may be a cause of nonthyroidal illness. We reported the relationship between thyroid function and the prognosis of the patients with recurrent breast cancer. In this study, we measured the serum level of cytokines (IL-2, IL-6, IL-8) and thyroid function (free T3, free T4, and thyrotropin (TSH)) in 38 patients with recurrent breast cancer. All patients had received three or more different courses of therapy before they were entered the study. The patients were divided into three groups according to their response to therapy. There were 16 partial response (PR), 10 no change (NC) and 11 progressive disease (PD) patients. They did not receive any medication that influenced the thyroid hormone level other than medication for cancer. The IL-2 level was under the detectable limit in all groups. No abnormal levels of cytokines were observed in the PR group. IL-6 and IL-8 levels in the PD group were significantly higher than that in the NC group (p < 0.05). Significant negative correlation was observed between IL-6 and thyroid hormones (free T3, free T4). Patients whose IL-6 level was 20 pg/ml or more died within four months after the beginning of the treatment. We concluded that IL-6 may lead to a hypothyroid state in patients with recurrent breast cancer. A high level of IL-6 and IL-8 means the confusion of the defense system in hosts. Therefore, these cytokines will be predictive indicators of the therapeutic response and the prognosis of the patients with recurrent breast cancer.

Adult↗

PubMedDate not supplied

Effects of 5'-DFUR and OK-432 on cytokines and thymidine phosphorylase in tumor tissue of gastric cancer patients.

BACKGROUND: The purpose of the study was to verify whether OK-432 in combination with 5'-DFUR induced thymidine phosphorylase (TdR Pase) and cytokines in gastric cancer patients as well as in vitro. MATERIALS AND METHODS: Fifty patients with invasive gastric cancer were randomly assigned, upon admission using by a closed-envelope technique, to either a group receiving 5'DFUR or OK-432 alone, to a group receiving both 5'DFUR and OK-432, or to a non- treated group up. Surgical specimens of the tumor and normal tissues were taken soon after gastrectomy to evaluate TdR Pase activity, IL-1 alpha and TNF-production. RESULTS: TdR Pase activities were several times higher in tumor than in normal tissues. In normal tissues, TdR Pase activities in the 5'-DFUR + OK-432 group were significantly higher than in the OK-432 group. TdR Pase activity in tumors, however, showed no significant difference between treated group. In the 5'-DFUR + OK-432 group, the level of IL-1 alpha production in tumor was significantly higher compared to the control group. In the 5'-DFUR + OK-432 group, the level of TNF alpha production in tumor was significantly higher than in normal tissue. TNF alpha production in tumor showed no significant difference in each treated group compared to the control. There was a significant correlation between TdR Pase activity and IL-1 alpha production levels in tumor. CONCLUSIONS: TdR Pase was induced by IL-1 alpha in tumor tissues of gastric cancer patients. OK-432 in combination with 5'-DFUR, however, did not induce TNF alpha and IL-1 alpha, and increase TdR Pase activity in gastric cancer tumors.

Antineoplastic Agents↗

PubMedDate not supplied

HLA antigen as predictive index for the outcome of breast cancer patients with adjuvant immunochemotherapy with PSK.

We demonstrated that the prognosis of breast cancer patients who received adjuvant immunochemotherapy with Krestin (PSK) showed a tendency to be better than that of breast cancer patients receiving chemotherapy only. We retrospectively investigated the usefulness of HLA typing for selecting patients to receive adjuvant immuno-chemotherapy with PSK. One hundred and thirty-four patients with operable breast cancer were typed as HLA-A, -B, -C by a lymphocytotoxicity test. Patients without vascular invasion had no adjuvant therapy (NA group). Patients with vascular invasion in the tumor and/or in the metastatic lymph node were randomized into two groups. In group 1 (FEMP only), a combination chemotherapy of 100 mg of 5-fluorouracil (F), 50 mg of cyclophosphamide (E), 2 mg of mitomycin C (M), and 5 mg of predonisolone (P) was orally administered daily for 28 days (one course). In group 2 (FEMP+PSK), FEMP and 3.0 g of PSK were orally administered for 28 days (one course). Two courses a year of these agents were given for five years in both groups. Each group (NA, FEMP, FEMP+PSK) was stratified by the presence of HLA B40 type (B40(+)) or not (B40(-)). Five- and 10-year disease-free survival (DFS) rates (93%, 80%, respectively) of patients with B40(+) seemed to be better than those (83% and 51%) of patients with B40(-). In the NA group, 5- and 10-year DFS were 100% and 71% in patients with B40(+), 92% and 76% in those with B40(-), respectively. In the FEMP group (chemotherapy only), 5- and 10-year DFS of patients with B40(+) were both 84%. These were not statistically significant compared with those (82% and 33%) of patients with B40(-). On the other hand, in the FEMP+PSK group, 5- and 10-year DFS of patients with B40(+) were both 100%, and those of patients with B40(-) were 76% and 55%, respectively. DFS of patients with B40(+) was significantly better than that of patients with B40(-). It is concluded that HLA typing may be a predictive index in determining the use of immunochemotherapy combined with PSK for patients with operable breast cancer.

Adjuvants, Immunologic↗

PubMedDate not supplied

Necrotizing granulomatous vasculitis of transverse colon and gallbladder.

A 52-year-old man suffering neither from allergies or asthma, with necrotizing granulomatous vasculitis (allergic granulomatosis) of the transverse colon and gallbladder is presented. During an emergency laparotomy, segmental necrosis of the mesenteric side of the mid-transverse colon, and a bulky enlarged gallbladder were found. The affected colon was resected and cholecystectomy was performed. Histological findings included necrotizing granulomatous vasculitis of the small- and medium-sized muscular arteries and adjacent veins with tissue infiltration by eosinophils and extravascular eosinophilic granulomas. These histological features were compatible with allergic granulomatous angitis described by Churg and Strauss (CSS). The patient had neither asthma nor involvement of two or more extra-pulmonary organs which is a key clinical criteria of CSS and fulfilled the criteria of eosinophilia alone. Although pulmonary vasculitis was not confirmed in this patient, the histological diagnosis of this patient was definitive CSS. Localised PAN with allergic granulomatosis or an isolated or limited form of CSS based on these clinical features may be an alternative entity.

Cholecystectomy↗

PubMedDate not supplied

Left trisegmentectomy for hepatocellular carcinoma with tumor thrombi extending to the third branches in the remnant liver.

BACKGROUND/AIMS: A successful left trisegmentectomy and tumor thrombectomy for hepatocellular carcinoma (HCC) of the right third branches in the remnant liver is described. METHODOLOGY: In this case, the hepatocellular carcinoma originated in the internal segment of an HBs- and HBe-Ag positive cirrhotic liver, involved the portal vein of the umbilical portion across the portal trunk to the contralateral third branches, and had many metastatic nodules in the anterior segment of the liver. To remove tumor thrombi by directly visualizing the lumen of the third branches of the portal vein, the portal trunk to the anterior branch of the portal vein was completely isolated by transecting the hepatic parenchyma along the intersegmental plane through a hilar approach. Tumor thrombi were removed by incising the portal trunk toward the anterior branch of the portal vein. Portal flow to the remnant liver was restored preceding liver resection to preserve hepatic function. After division of the anterior Glissonean code, the left trisegment and caudate lobes of the liver were resected. RESULTS: The patient was discharged 10 weeks after surgery and remained well for the first six months thereafter. Recurrent tumors, however, appeared in the remnant liver 7 months after surgery. CONCLUSIONS: This procedure may be applicable in cases of HCC with portal tumor thrombi extending into the third branches in the remnant liver.

Adult↗

PubMedDate not supplied

Does hypothermic perfusion have beneficial effects for ischemic liver during extended hepatectomy with hepatic inflow occlusion of canine liver? A comparative study with topical cooling.

BACKGROUND/AIMS: The present study was designed to elucidate the effect of topical cooling and hypothermic perfusion in extended hepatectomy under hepatic inflow occlusion. Hypothermic perfusion has provided to have a protective effect on the ischemic liver. However, it has not been determined whether hypothermia or perfusion had salutary effects on the ischemic liver. METHODOLOGY: Seventy-five percent of the liver was resected under hepatic inflow occlusion for 60 minutes in each adult mongrel dog. The animals were divided into three groups; no cooling group (n = 8), topical cooling group (n = 7) using ice slush and hypothermic perfusion group (n = 7). Blood from the hepatic vein was sampled for measurement of ALT, AST, LDH and purine nucleoside phosphorylase. RESULTS: The seven-day survival in topical cooling group and hypothermic perfusion group was better compared with that in no cooling group. ALT, AST and LDH levels showed no significant differences among the groups. PNP levels were significantly lower in topical cooling group (p < 0.01) and hypothermic perfusion group (p < 0.05) than in no cooling group, but no significant differences between topical cooling group and hypothermic perfusion group. CONCLUSIONS: In the hepatic ischemia for 60 minutes, hypothermic perfusion did not demonstrate markedly better effects compared with topical cooling.

Animals↗

PubMedDate not supplied

Jejunal pouch with nerve preservation and interposition after total gastrectomy.

BACKGROUND/AIMS: In this paper, we describe operative technique details and our results with a modified technique for jejunal pouch formation and interposition after total gastrectomy, with an overall aim to achieve results superior to jejunal pouch and Roux-en-Y reconstruction, as reported in the literature. METHODOLOGY: Following total gastrectomy, the jejunum was divided approximately 20 cm distal to the ligament of Treitz. Marginal vessels were not divided in order to preserve the nerves in the 50 cm of distal jejunum which would be used for pouch construction. The pouch was constructed using a linear stapler (Endo GiA, United States Surgical Corp., Norwalk, Conn). A total of 15 gastric cancer patients underwent construction of a nerve-preserving jejunal pouch and interposition following total gastrectomy. RESULTS: None of the patients experienced postoperative complications due to pouch construction. Additionally, discomforts such as dumping or stagnation were not observed. Mild reflux esophagitis occurred in five of the 15 patients and was resolved by oral administration of camostat mesilate. Six months after surgery, the average patient's diet volume and body weight had gradually increased to 79% and 86%, respectively, of the presurgical levels. A dual phase, dual isotope radionucleid pouch emptying study was also performed six months after surgery. The intra-pouch RI retention rate was 47% for liquid food and 53% for solid food 120 minutes after intake. The emptying rate was slower for both solid and liquid food, as compared with healthy individuals. CONCLUSIONS: The pouch-emptying test demonstrated a satisfactory retention capacity and an acceptable emptying time as a gastric substitute. The patients who underwent gastric reconstruction with a nerve-preserving jejunal pouch with interposition have experienced a reasonably good quality of life.

Female↗

PubMedDate not supplied

Metastasis and invasion of hepatocellular carcinoma mimicking a right adrenal tumor.

A 60-year-old man presented with a large right adrenal mass. Adrenal primary carcinoma invading the liver and retrohepatic inferior vena cava was suspected after preoperative imagings, which included ultrasonography, computed tomography, selective hepatic and adrenal angiography, and magnetic resonance imaging. An en bloc resection of the right kidney, right adrenal gland, posterior hepatic segment, and laterodorsal of the vena cava was performed using an active veno-venous bypass. The defect of the inferior vena cava was closed using a 6 x 10 cm patch of horse pericardium. The cut surface of the resected specimens revealed a smaller necrotic intrahepatic tumor as well as a large extrahepatic tumor which involved the right adrenal gland and extended continuously to the liver, mimicking an adrenal tumor. As the histological features of the two tumors disclosed the same moderately differentiated hepatocellular carcinoma with a trabecular or pseudoglandular pattern, a huge mass of the right adrenal gland with invasion into the right lobe of the liver, which mimicked a primary adrenal tumor, was diagnosed as metastatic hepatocellular carcinoma from a primary hepatic tumor.

Adrenal Gland Neoplasms↗

PubMedDate not supplied

Hepatic vein reconstruction at inferior vena cava confluence using left renal vein graft.

BACKGROUND/AIMS: To preserve remnant liver function, extended left hepatectomy combined with middle hepatic vein reconstruction using a left renal vein graft was performed in resection of liver metastasis from sigmoid colon cancer, involving the confluence of the middle and left hepatic veins. METHODOLOGY: The tumor, 5 cm in size, occupied the superior part of segment 4, and involved the confluence of the middle and the left hepatic veins. An extended left hepatectomy, including the left lobe, left caudate lobe and part of segment 8, together with the middle hepatic vein trunk, was performed. The left renal vein was resected as a graft from the confluence of the inferior vena cava just distal to the branches of the gonadal vein, renal-azygos, splenorenal communications and vertebral veins. The middle hepatic vein was reconstructed using the left renal vein 3 cm in length. RESULTS: Impaired values of liver function tests were normalized by the third postoperative day. Renal function was good throughout the postoperative period. The patient was discharged two weeks after the surgery. The reconstructed middle hepatic vein was patent, which was evaluated by a color Doppler ultrasonography, computed tomography and magnetic resonance imaging 60 days after the surgery. The patient remained well in the eight months thereafter. CONCLUSIONS: Hepatic vein reconstruction using a left renal vein graft is a new and preferable addition for the selection of an optimal graft.

Female↗

PubMedDate not supplied

Traumatic biliary stricture successfully treated by percutaneous transhepatic bile duct dilatation: a case report.

A 24 year-old woman complained of obstructive jaundice 24 days after blunt abdominal trauma due to a traffic accident. Endoscopic retrograde cholangiopancreatography (ERCP) revealed a stricture, 15 mm in length, at the common bile duct associated with upper bile duct dilatation. Jaundice was reduced by percutaneous transhepatic cholangio-drainage (PTCD). A 7 Fr-sized PTCD tube was exchanged for a larger-sized catheter for percutaneous transhepatic cholangioscopy expecting gradual dilatation of the stricture. Following the confirmation of satisfactory dilatation of the stricture, the catheter was removed. There was no recurrence of jaundice 16 months later in a follow-up study.

Abdominal Injuries↗