Biomedical subjects
S Tada
Publications and source records attributed to S Tada.
Extended intraarterial cisplatin infusion for treatment of gynecologic cancer after alteration of intrapelvic blood flow and implantation of a vascular access device.
PURPOSE: Twenty-two patients with advanced gynecologic cancer underwent extended intraarterial cisplatin infusion after alteration of the intrapelvic blood flow and implantation of a vascular access device (VAD). METHODS: To maximize concentrations of cisplatin at the target lesion, the superior and inferior gluteal arteries were embolized with steel coils. The tip of the catheter was inserted into the internal iliac artery; the opposite end of the catheter was connected to the VAD. RESULTS: Intensive radioisotope accumulation was demonstrated in the anterior division of the pelvis, seen by scintigraphy performed with technetium 99m macroaggregated albumin via the VAD. Local perfusion in the tumor was well seen by ultrasonographic angiography with CO2 microbubbles via the VAD. Continuous consecutive infusion of cisplatin at a rate of 12.5 mg/day via the VAD minimized the toxicity. The overall response rate was 73%. Radical surgery was possible in 16 of the 22 patients after this intraarterial infusion. CONCLUSION: This method was useful for treating advanced gynecologic cancer without significant toxicity.
Vascular access system for continuous arterial infusion of a protease inhibitor in acute necrotizing pancreatitis.
We used a vascular access system (VAS) for continuous arterial infusion (CAI) of a protease inhibitor in two patients with acute necrotizing pancreatitis. The infusion catheter was placed into the dorsal pancreatic artery in the first patient and into the gastroduodenal artery in the second, via a femoral artery approach. An implantable port was then connected to the catheter and was secured in a subcutaneous pocket prepared in the right lower abdomen. No complications related to the VAS were encountered. This system provided safe and uncontaminated vascular access for successful CAI for acute pancreatitis.
Endoscopic and biopsy findings of the upper digestive tract in patients with amyloidosis.
Endoscopic and biopsy findings of the esophagus, stomach, duodenum, and colorectum were studied in 37 patients with amyloidosis involving the gastrointestinal tract. Endoscopic examinations revealed fine granular appearance, polypoid protrusions, erosions, ulcerations, and mucosal friability in many cases. These findings were most marked and noticed most often in the second portion of the duodenum. The frequency of amyloid deposition in the biopsy specimens was as follows; 100% in the duodenum, 95% in the stomach, 91% in the colorectum, and 72% in the esophagus. The degree of amyloid deposition in the duodenum, which was the highest of the entire gastrointestinal tract, significantly correlated with the frequency of endoscopic findings such as fine granular appearance and polypoid protrusions. Therefore, the two endoscopic findings described above are characteristic of this disease and may reflect amyloid deposition in the mucosa or submucosa of the alimentary tract. Our results indicate that for a diagnosis of amyloidosis, it is important to examine the upper gastrointestinal tract, especially the duodenum, using endoscopy and biopsy techniques.
Minute non-polypoid adenoma of the colon detected by colonoscopy: correlation between endoscopic and histologic findings.
To characterize the endoscopic features of minute non-polypoid neoplastic lesions of the colon, we investigated the endoscopic, macroscopic, and histologic findings in 34 lesions detected by colonoscopy, which were smaller than 5 mm and were endoscopically recognized as flat or depressed lesions. The lesions were divided into two groups according to their endoscopic features; 8 lesions were completely flat and the remaining 26 lesions were flat-topped elevations with a central depression. Macroscopic examinations revealed that the center of the endoscopically flat lesion was slightly elevated, whereas the center of the flat-topped elevation was characterized by a central depression. All of the lesions were histologically diagnosed as tubular adenomas. The flat lesions were composed of flatly elevated adenomatous glands, while the flat-topped elevations with a depression were characterized by surrounding hyperplasia arising from normal glands. The whole thickness of the mucosa was replaced by adenomatous glands in the lesions with an obvious central depression, while the adenomas tended to spread superficially in the lesions with a shallow depression. These findings suggest that pre-cancerous lesions other than small polyps do exist in the colon and that colonoscopic examination provides some clue toward a prediction of the histologic architecture of the lesions.
Endoscopic features in amyloidosis of the small intestine: clinical and morphologic differences between chemical types of amyloid protein.
Thirty patients with amyloidosis of the small intestine were studied to determine the correlations between the chemical types of amyloid protein and endoscopic, histologic, or clinical features. Endoscopic examinations of the jejunum revealed various findings such as a fine granular appearance, erosions and mucosal friability, thickening of the valvulae conniventes, and multiple polypoid protrusions in 23 cases. Immunohistochemical study of the biopsy specimens identified the following chemical types of amyloid protein: amyloid A protein (AA) in 20 cases, light chain protein (AL) in 8, beta 2-microglobulin (AH) in 1, and prealbumin (AF) in 1. The fine granular appearance was found significantly more often in the AA cases (p < 0.001), whereas multiple polypoid protrusions and thickening of the valvular conniventes were observed only in the AL cases (p < 0.001). Histologically, wide granular amyloid deposits in the propria mucosae were seen significantly more often in the AA cases (p < 0.01), whereas massive amyloid deposits in the muscularis mucosae, submucosa, and muscularis propria were the more dominant findings in the AL cases (p < 0.001). Clinically, a more frequent occurrence of diarrhea, malabsorption, and occult blood in stools was present in the AA cases, whereas mechanical obstruction and chronic intestinal pseudo-obstruction were evident only in the AL and the AH cases. These results suggest that clinicopathologic differences between the amyloid proteins exist in small intestinal amyloidosis and that endoscopic appearance relates to the specific accumulation pattern of each type of amyloid protein.
Improved mechanical thrombolysis with the addition of recombinant tissue-type plasminogen activator: in vitro study with use of Cr-51-labeled clots.
PURPOSE: To explore the potential effect of infusion of recombinant tissue-type plasminogen activator (rt-PA) during mechanical thrombolysis. MATERIALS AND METHODS: Clots containing chromium-51-labeled platelets produced from blood from two donors were placed in a solution of rt-PA (1.25 micrograms/mL) or in saline solution and were pulverized with a mechanical thrombolysis catheter. The resultant slurry was passed through a filter with a pore size of 10 microns, and the radioactivity of the clot residue on the filter was measured. For each donor, the percentage of clot remaining was calculated from the residual radioactivity. RESULTS: The mean percentages of clot remaining were 72.0% for clots in saline (n = 10) and 44.4% for clots in rt-PA (n = 10) in donor 1 and 58.9% (n = 14) and 36.4% (n = 14), respectively, for donor 2. In both cases, the mean percentage of clot remaining was significantly lower when mechanical thrombolysis was performed in the presence of rt-PA. CONCLUSION: These results indicate the feasibility of combined pharmacologic and mechanical thrombolysis.
Insufficiency of the hip adductor after anterior obturator neurectomy in 42 children with cerebral palsy.
Forty-two children with cerebral palsy treated between 1970 and 1982 for correction of adduction and internal rotation of the hip were studied. According to the combined procedures and the effects of surgical manipulations, two groups were evaluated. The results of release of the adductor longus and gracilis without anterior obturator neurectomy were satisfactory when combined with proximal release of medial hamstrings. Hypertonicity in hip adduction was relieved. In cases of loss of function of the adductor brevis with anterior obturator neurectomy, the results were not satisfactory, and hyperabduction of the hip was inadequate. The adductor brevis plays an important role in stability of the hip.
An outbreak of human Leishmania (Viannia) braziliensis infection.
The occurrence of acute cutaneous leishmaniasis among inhabitants of 10 farms within 10 Km of the hamlet of Corte de Pedra, Bahia, Brazil was studied prospectively from 1984-1989. A mean population of 1,056 inhabitants living in 146 houses were visited every 6 months and the number of skin ulcers recorded. A leishmanin skin test survey was done people with suggestive skin scars or active disease in 1984. The incidence of skin ulcers due to Leishmania (Viannia) braziliensis (Lvb) reached 83/1,000 inhabitants but declined sharply in the subsequent 2 years. Retrospective data shows that leishmaniasis is a sporadic endemic disease. Although the reasons for this epidemic are unclear some possible aetiological factors are discussed.
A case of deep soft tissue leiomyoma: CT and MRI findings.
A 25-year-old man presented with a firm tissue mass of the right elbow and intermittent pain. CT showed a dumbbell-shaped soft tissue mass with foci of dense calcification in the muscular layer of the triceps brachii muscle and subcutaneous tissue. The tumor showed slightly higher signal intensity on T1-weighted images and markedly higher intensity on T2-weighted images compared with the surrounding muscle. Prominent enhancement was present after the intravenous injection of Gd-DTPA. Histopathological examination of the resected specimen revealed a deep soft tissue leiomyoma.
Serum leptin levels in patients with nonalcoholic chronic liver disease.
BACKGROUND/AIMS: The elevated serum leptin level of patients with alcoholic cirrhosis has been reported, however, the precise mechanism is still unknown. Leptin expression and protein synthesis have also been detected in activated hepatic stellate cells in cell cultures, which play a major role in hepatic fibrosis. We evaluated the serum leptin levels of patients with nonalcoholic liver diseases including cirrhosis and chronic hepatitis. We also investigated the hepatic clearance of leptin by determining the serum leptin level in blood samples obtained from the portal and hepatic veins. METHODOLOGY: The serum leptin level of 44 patients with nonalcoholic chronic liver disease (male/female = 21/23, cirrhosis/chronic hepatitis = 30/14) and 40 control subjects (male/female = 20/20) was determined in blood samples obtained from the antecubital vein by enzyme-linked immunosorbent assay. We also assessed the relationship between the leptin level and various biochemical tests of liver function. Additionally, we determined the leptin levels in the portal and the hepatic venous blood (nonalcoholic cirrhosis = 10, nonhepatic disease = 4). RESULTS: There were positive correlations between the serum leptin level and body mass index among males and among females in the liver disease group and in the control group. However, the serum leptin level of the liver disease group and control group did not differ significantly. Among the 44 liver disease patients, only the serum cholesterol level was significantly correlated with the serum leptin level after adjusting for sex and body mass index by multiple regression analysis. Furthermore, the leptin level in hepatic venous blood was significantly lower than that in portal venous blood. However, the ratio of [leptin level in hepatic venous blood]/[leptin level in portal venous blood] in the cirrhosis group, and that in the nonhepatic disease group, did not significantly differ. CONCLUSIONS: The serum leptin level of patients with nonalcoholic liver diseases is not elevated. On the other hand, the serum leptin level of patients with alcoholic cirrhosis has been reported to be elevated. The difference in the serum leptin level of patients with nonalcoholic liver disease and that of patients with alcoholic cirrhosis may be due to a difference in factors such as the levels of cytokines or sex steroids, and/or nutrition. Furthermore, it is likely that leptin is cleared in part by the portosystemic circulation through the liver.
The micronucleus test of benzo[a]pyrene with mouse and rat peripheral blood reticulocytes.
The micronucleus test using peripheral blood reticulocytes (RETs) was evaluated in CD-1 and BDF1 mice and Sprague-Dawley rats treated with benzo[a]pyrene at two independent laboratories. The maximum incidence of micronucleated reticulocytes (MNRETs) appeared in both strains of mice 48 h after the treatment; interlaboratory differences were small. The incidence of MNRETs in BDF1 mice was higher than in CD-1 mice. In rats, significant increases of MNRETs with the maximum response at 72 h were detected when B[a]P was administered i.p.; slight but significant increases were observed at 24 h or later, with the maximum at 24-48 h, when it was administered p.o. These results suggest that the new method for the micronucleus test using circulating RETs will be useful in the detection of the clastogenicity of chemicals.
Selective lengthening of the psoas and rectus femoris and preservation of the iliacus for flexion deformity of the hip in cerebral palsy patients.
Between 1978 and 1983, 52 Japanese patients with cerebral palsy underwent operative correction of flexion deformity of the hip. The results of lengthening of the psoas, rectus femoris, and proximal hamstrings were satisfactory. The iliacus was left intact. Improvement in gait and activities of daily living was attained. Concentric reduction was obtained in 27 of 33 dislocated or subluxated hips. Sitting and perineal care were facilitated, and pain was alleviated. We conclude that preservation of the iliacus is important.
Magnetic resonance imaging of the normal pituitary gland and pituitary adenoma: preliminary experience with a resistive magnet.
Magnetic resonance (MR) imaging was performed in fifty normal pituitary glands, ten pituitary microadenomas, and twelve adenomas with extrasellar extension using a 0.15 Tesla resistive magnet. The average height of normal glands was 5.6 +/- 1.2 mm, whereas that of microadenomas was 6.8 +/- 1.0 mm. The superior surface and internal texture of these conditions were well delineated. Adenomas that showed extrasellar extension together with surrounding structures were well demonstrated on sagittal and coronal scans. It can be expected that with further technical developments MR imaging will play an important role in the clinical management of pituitary adenomas.
Computed tomographic features of renal tuberculosis.
Computed tomograms (CT) in twenty cases of renal tuberculosis (TB) were reviewed in comparison with intravenous urograms. CT findings were calyectasis, low parenchymal density, parenchymal retraction, and calcification. The main CT feature of renal TB was the simultaneous appearance of these findings in combination. Three of these findings were seen in two-thirds of the cases in the present series. Total renal volume was grossly normal in 10 of 24 affected kidneys and decreased in only seven. Global enlargement of the affected kidney occurred when calyceal dilatation surpassed parenchymal retraction. In our series, affected kidneys tended not to be small in size when renal TB was active. Non-functioning kidneys depicted by intravenous urography were successfully evaluated by CT.
Thoracic tissue core biopsy by Surecut: a preliminary report of 42 cases.
Percutaneous thoracic tissue core biopsy was performed in forty-two cases using modified Menghini needle with a 1-mm outer diameter (19-gauge Surecut). The tissue core for histological analysis was obtained in 32 out of 42 cases (76%). No serious complication was encountered. It is suggested that the Surecut is a desirable thin needle for obtaining histological material with minimal risk to the patient.
Computed tomographic evaluation of hydronephrosis in uterine carcinoma.
By using computer tomography (CT) hydronephrosis was discovered in 13 cases (18 sides) of previously treated uterine carcinoma. Local tumor recurrence was found to be responsible in six cases, para-aorta nodal masses in three cases and intrapelvic nodal masses in two others. One case was considered to be due to vesicoureteral reflux resulting from radiation cystitis. It was difficult to distinguish increased fibrous tissue as radiation sequelae from tumor infiltration. A variety of causes of hydronephrosis in uterine carcinoma can be clarified by CT.
Nodular lesions in renal tuberculosis.
We retrospectively studied the CT findings of renal tuberculosis in 27 cases (32 kidneys). As a characteristic CT finding, nodular lesions were recognized in 20 kidneys. Low density nodules were found in three kidneys, isodensity nodules in seven, and high density nodules in 10. In a case examined by follow-up five years later, the low and isodensity nodules changed to high density nodules with decreasing volume. Ultrasound demonstrated the high density nodules as low-echo mass lesions. These nodular lesions corresponded with the localized foci in the renal parencyma and/or pyocalyx. We consider that the density differences in nodular lesions reflect the process of water absorption from the caseous necrotizing materials of tuberculosis.