Biomedical subjects
Publications and source records attributed to T Fujioka.
We report a rare case of systemic sarcoidosis involving the epididymis. An irregularly shaped heterogeneous lesion was identified with ultrasonography in the left caput epididymidis. Microscopically, a number of noncaseating epithelioid cell granulomas were found in the epididymal tissue.
A 40-year-old man developed slowly progressive muscle atrophy in his calf muscle. The patient became aware of asymmetry of his right big toe during in his teens; muscle atrophy was revealed at the age of 25 years. Multi-image examinations revealed "tethered cord syndrome" with spina bifida occulta. Spinal magnetic resonance image revealed a pathogenetic mechanism of asymmetry of muscle atrophy in the calf muscle. This suggested that spinal MRI imaging is one of the most useful diagnostic methods for this disease.
A total of 161 atherosclerotic plaques from 50 aortas in elderly autopsy cases were pathomorphologically investigated to clarify the pathogenesis of atherosclerotic plaque with central depression. Atherosclerotic plaques with central depression, with well defined borders were employed for this study, ulcerated plaques being excluded. Pathomorphological findings showed that plaques with central depression could be divided into four groups according to their derivation respectively; (a) fused lesion of multiple fibrous plaque, (b) regressing lesion of plaque, (c) healing lesion of ulcerated atheromatous plaque, (d) mixed type. Finally, it was suggested that atherosclerotic regression may cause some central depression in the atheromatous plaques.
A 31-year-old man came to our hospital complaining of severe voiding pain. He had inserted a fishing line made of nylon into his urethra at the age of eighteen, which was unable to be taken out and had been left there for 13 years. Preoperative ultrasonogram showed severe bilateral hydronephrosis and the serum BUN and creatinine level were as high as 45.2 mg/dl and 4.8 mg/dl, respectively. A huge bladder stone was demonstrated in X-ray film, the patient was admitted and vesicolithotomy was performed. The size of the stone was 10.5 x 7.5 x 7.5 cm and the weight was 360 grams. The fishing line was found inside the stone and the length was over 3 meters. The serum BUN and creatinine level after the operation were still high as 28.4 mg/dl and 4.1 mg/dl, respectively, and they did not improve even after six months following.
We evaluated transurethral resection of bladder tumor (TUR) for stage T1b & T2 bladder cancers by reviewing our long-term results from 181 patients. All were followed for a minimum of 5 years or until death. In 29 patients with a stage T1b tumor treated by TUR, the 5- & 10-year survival rates were 82.5 +/- 7.1 and 73.4 +/- 8.8. Bladders were successfully preserved in 16 patients, whereas seven patients died of cancer, all of whom experienced tumor recurrence and progression at the same site as the initial lesion (true local recurrence). Conservative treatment is supposed to be indicated for a stage T1b tumor because more than half could be treated successfully by TUR. However, considering the true local recurrence, for which incomplete resection of primary lesion seems responsible, we believe that re-TUR (a second resection of the primary lesion area) is essential to evaluate the residual tumor. Radical cystectomy should subsequently be considered after re-TUR proved residual tumor because conservative treatment no longer appears reasonable and places the patients at undue risk regarding serious disease progression. As for eight patients with a stage T2 tumor treated by TUR, only one had no recurrence. The others died of recurrence of invasive tumors. In contrast, the 5- & 10-year survival rates of the patients treated by cystectomy were both 63.6 +/- 14.5%. Based on these data, radical cystectomy should be required as initial treatment for a stage T2 tumor.
OBJECTIVE: To clarify the efficacy of combination therapy with clarithromycin and sofalcone for eradication of Helicobacter pylori. DESIGNS: We studied 42 patients with H. pylori-positive gastroduodenal diseases, who were divided into two groups according to treatment period. Group 1 comprised 27 patients (seven with gastric ulcers, 14 with duodenal ulcers and six with gastritis) treated with a combination of clarithromycin (200 mg, three times a day) + sofalcone (100 mg, three times a day) for 3 weeks. Group 2 comprised 15 patients with chronic active gastritis treated with the same doses of clarithromycin + sofalcone but for only 2 weeks (group 2). The H. pylori status of all patients was assessed by culture, rapid urease test and histological examination at the end of treatment and 4 weeks after the end of treatment. The gastritis score, the index of intracellular periodic acid-Schiff-positive substance in the antral mucosa and the ammonia concentration in gastric secretions were also estimated before and after treatment. RESULTS: In group 1, with over half the patients excluded from the follow-up, H. pylori was eradicated in nine out of 13 patients (69.2%) compared with six out of the complete group of 15 (40.0%) patients in group 2, without serious side effects. In these patients, significant improvements were seen in the gastritis score (P < 0.025), the index of periodic acid-Schiff-positive substances in the antral mucosa (P < 0.025) and the ammonia concentration in gastric secretions (P < 0.02) after treatment. CONCLUSION: These results suggest that modification of the treatment regimen is needed, with higher doses of clarithromycin and combination therapy with proton-pump inhibition.
OBJECTIVES: To assess the suitability of an established experimental model for chronic gastritis associated with Helicobacter pylori for use in long-term observations. DESIGN: In a 3-year follow-up study of acute gastritis induced by H. pylori using an established experimental model with Japanese monkeys, we compared H. pylori-infected animals (n = 6) with a non-infected control group (n = 7). Colonization by H. pylori, gastritis scores, volume of intracellular periodic acid-Schiff-positive substances and the height of antral glands were investigated every 3 months for 3 years and compared with those of a control group. RESULTS: In the infected group, persistent colonization with H. pylori was demonstrated by culture and histological examinations. Gastritis scores were significantly higher than those of the control group, and the histological findings were quite similar to those of chronic active gastritis observed in humans. Simultaneously, significant decreases in the contents of periodic acid-Schiff-positive substances and in the height of antral glands were also demonstrated in infected animals. CONCLUSION: In Japanese monkeys, persistent colonization with H. pylori caused chronic gastritis quite similar to that observed in humans, thus providing a suitable animal model for evaluating the long-term prognosis of H. pylori infection.
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A 49-year-old man who had been suffering from poorly controlled diabetes mellitus for 20 years was admitted to our hospital with the chief complaints of diplopia and right ptosis. The onset of his symptoms was sudden. On admission, he had right palpebral ptosis, upward and left lateral gaze paresis of the right eye. Hess screen chart examination revealed paresis of the right superior rectus, inferior oblique and medial rectus muscles. T2 weighted magnetic resonance imaging (MRI) revealed high intensity area in the medial part of the right midbrain tegmentum where the oculomotor nucleus located, and diffusion weighted MRI demonstrated high intensity area which corresponded to the oculomotor fascicles of the midbrain. The latter represented Wallerian degeneration of the fascicles. The diagnosis of small infarction of the right oculomotor nucleus presenting ipsilateral external ophthalmoplegia was made. The superior rectus muscle is innervated by the neurons in the contralateral oculomotor nucleus, and the other external ocular muscles innervated by the third cranial nerve are conducted by the neurons in the ipsilateral oculomotor nucleus; therefore, unilateral oculomotor nuclear lesion generally causes ipsilateral ophthalmoplegia plus contralateral superior rectus palsy. Our case presented here shows that there may be such a case with oculomotor nuclear disturbance which masquerades with oculomotor fascicular or infranuclear disturbance; therefore, it is important to include these lesions in differential diagnosis.
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We studied the efficacy of the intra-lymph nodal injection of the activated carbon particle absorbed mitomycin C (MMC-CH40) for gastric cancer. Ninety-five patients with gastric cancer underwent gastrectomy with D1 or D2 lymph node dissection. Of these, 38 patients were treated with intra-lymph nodal injection of MMC-CH 40 (MMC-CH 40 group). The other 57 patients were classified into the control group. The survival of MMC-CH group was significantly higher than that of the control group using generalized Wilcoxon method. However, since the percentage of stage IV was higher in the control group than in MMC-CH 40 group, the survivals of subgroups of stage I-III were compared. Although the percentage of the early gastric cancer was higher in the control group of stage I-III (n = 35) than in the MMC-CH group of stage I-III (n = 38), the survival curves of MMC-CH group were higher than in the control group. The difference in survival between the two groups was significant at 8 months after surgery. These results indicate that this new therapy improves survival in patients with stage I-III gastric cancer.
We studied 15 patients with renal cell carcinoma invading adjacent organs (stage T4) between January 1980 and December 1991. Such invasion was four times more frequent in males than in females. The patients were between 41 and 78 years old, with a mean age of 63.9 years. The tumor was on the right side in 4 cases, and on the left side in 11 cases. Six patients (40%) presented with flank pain. The pancreas was the organ involved most frequently. Eleven patients had regional lymph node involvement or distant metastasis. Most patients had an increased erythrocyte sedimentation rate (ESR), elevated alpha-2 globulin levels, and positivity for c-reactive protein (CRP). In 6 patients, nephrectomy was extended to the abdominal or retroperitoneal structures that seemed to be invaded by tumor. Patients with T2 or T3 tumor had a significantly longer overall survival than patients with a T4 tumor. However, there was no significant difference in survival between T2/T3 tumors and T4 tumors in nephrectomized patients. Two patients who survived longer than 3 years showed no abnormalities of ESR, alpha-2 globulin and CRP. They also had no nodal or distant metastases, and had a good initial performance status. These findings suggest that extended local resection can improve the survival and quality of life for selected patients with T4 tumors.
Very frequent loss of heterozygosity (LOH) on chromosome 3p has been found in human renal cell carcinoma (RCC). In the present study, we examined LOH at the retinoblastoma (RB), mutated in colorectal cancer (MCC) and adenomatous polyposis coli (APC) tumour suppressor genes loci, and mutations of the H-, K-, and N-ras oncogenes. We performed these studies using the polymerase chain reaction (PCR) method followed by restriction fragment length polymorphism (RFLP) and single-strand conformation polymorphism (SSCP) analyses. LOH was detected in 2 of 11 (18.2%), and 2 of 14 (14.3%) informative cases at the MCC and APC loci, respectively, and in none of 15 informative cases at the RB locus in 25 RCCs. LOH at the MCC was accompanied by LOH at the APC locus in two RCCs. No mutation was detected in H-, K-, and N-ras genes in 39 RCCs. Thus, alterations of the known tumour suppressor genes and the ras oncogenes were infrequent events in RCC. The results suggest that the genetic pathway in the genesis of RCC differs considerably from that of other common human carcinomas.
We had an opportunity to treat a rare case of foreign body in the corpus cavernosum in a patient with cleft glans penis. The foreign body was a 13 cm wire, which was inserted by the patient himself for masturbation, and was removed surgically. To our knowledge, such a case has never been reported in the literature.
A-48-year-old male was admitted to our hospital with a right renal tumor. He received radical nephrectomy immediately. Histological examination of surgical specimen revealed renal liposarcoma, which consisted of mixed type of pleomorphic and well differentiated subtypes. Multiple tumorous lesions were scattered in the renal parenchyma. He has been alive without disease for 2 years and 7 months after surgery. Only 23 cases of renal liposarcoma have been reported in Japan.
A solitary hepatic tumor in a 50-year-old woman, which was observed as a hemangioma, ultimately was resected because it increased in size. The tumor volume doubling time was 28.8 months over the observed period of 30 months. The histologic diagnosis was carcinoid tumor. Immunohistochemical staining showed strong focal reactivity for gastrin and diffuse reactivity for pancreatic polypeptide, vasointestinal polypeptide, calcitonin, and parathormone. Preoperative gastric hyperacidity with diarrhea and a body weight loss of 7 kg, moderately controlled by cimetidine on admission, suggested high serum gastrin levels produced by the tumor. Her symptoms resolved after surgery, and she had a normal serum gastrin level with negative secretin stimulation test results. A review of six cases of hepatic gastrinoma suggests that surgical resection, if feasible, would be the treatment of choice.