Biomedical subjects
Publications and source records attributed to T Kano.
We experienced a case of hepatocellular carcinoma with adrenal metastasis that was effectively treated with ultrasonographically guided percutaneous ethanol injection. Effectiveness was proved by various imaging procedures and decreased serum alpha-fetoprotein. No complications during and after the treatment were deserved.
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The R-R intervals of an electrocardiogram, the coefficient variation of R-R intervals (CV-RR), and the power spectrum of heart rate fluctuation were studied just before surgical operations in a group of 10 patients who underwent high thoracic epidural anesthesia (TEA), and before anesthesia in a control group of 10 patients who were scheduled for general anesthesia without TEA. When TEA was performed, the CV-RR increased significantly (P less than 0.05). An increasing tendency (P less than 0.1) was also observed in the R-R intervals and the spectral analysis of the peak amplitude of the low frequency component (LFC) of 0.05 to 0.15 Hz. This tendency was found, too, in the band areas of the LFC and the high frequency component (HFC) of 0.15 to 0.4 Hz. These data indicate that the sympathetic innervation of the heart might have been interrupted by TEA and the vagal tone might have become dominant. Subsequent intravenous administration of atropine 0.5 mg reduced the R-R intervals, the CV-RR, the peak amplitude and the band areas of the LFC and HFC (P less than 0.01), as were seen in the control group. These evidences will show that the heart rate regulation of man in a supine position is dominantly influenced by the vagal tone, and it will become more prominent under TEA by blocking the cardiac sympathetic innervation at spinal level. Present study also suggests that a contribution of the cardiac sympathetic nerve on heart rate fluctuation, even on LFC, is only slight.(ABSTRACT TRUNCATED AT 250 WORDS)
Cardiopulmonary bypass (C-P bypass) was performed on two patients who had not responded to conventional cardiopulmonary resuscitation (CPR). The first patient, a 56-y-o male, with bilateral pulmonary thromboembolism repeatedly underwent cardiac massage and electric defibrillation for recurrent ventricular fibrillation. A veno-arterial bypass route was prepared during cardiac massage, and bypass circulation was started 3 hours after the onset of the first ventricular fibrillation. Soon after the initiation of C-P bypass, the physical status and EEG of the patient improved. The patient regained consciousness within a few hours and later underwent open chest pulmonary embolectomy. The second patient, a 44-y-o male, developed refractory cardiogenic shock near the end of aortocoronary bypass graft operation. Under closed chest massage, a femoro-femoral cardiopulmonary bypass operation was started. Soon after the initiation of the bypass circulation and IABP, peripheral circulation improved markedly, and consciousness returned within several hours. Though the first patient finally died from far advanced pulmonary embolism, he was conscious as long as the C-P bypass was continued for two days. In the second patient, the cardiac function gradually improved after the 3rd day. C-P bypass was tapered and discontinued on the 5th day. Emergency veno-arterial bypass for CPR is effective means to maintain life until the cardiopulmonary and cerebral functions are restored. Recent advances in emergency C-P bypass are introduced and a new acronym extracorporeal lung and heart assist, ECLHA, is proposed. Emergency ECLHA with veno-arterial cannulations through percutaneous puncture will become a promising adjunct of cardiopulmonary-cerebral resuscitation in the near future.
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The undetectable supernumerary and ectopic parathyroid glands have a high risk of persistent and recurrent hyperparathyroidism, especially in the patients with secondary hyperparathyroidism. Preoperative image diagnosis, CT scan, echogram and 201T1C1 scintigram were very useful for detecting supernumerary and ectopic parathyroid glands in our 132 patients who underwent parathyroidectomy for secondary hyperparathyroidism. Among these methods the scintigraphy showed the highest detection rate of the glands in the thymic tongue and in the upper mediastinum. CT scan showed the best detection rate of the glands located in the thyroid gland and those located between the thyroid gland and trachea. The echography was useful in detecting the glands in the thyroid gland, but could not offer easy visualization those located in the mediastinum. Even the ectopic parathyroid glands, weighing more than 500 mg were identifiable at about 90% when all the methods were applied routinely. In our experience, four patients had a supernumerary gland which was detected by the preoperative image diagnostic procedures at the initial surgery. One patient had a supernumerary gland in the mediastinum which was detected by image diagnosis after the initial operation and was removed at reoperation.
About 3 years after commencing hemodialysis for chronic renal failure, a 39-year-old man developed cutaneous lesions of the face and hands which were compatible with porphyria cutanea tarda (PCT) clinically and histologically. There was no evidence of familial PCT, excessive alcohol consumption, iron overload, chronic liver disease. It was impossible to measure urinary porphyrins because of anuria. Fecal and erythrocytic porphyrins were within normal limits. Plasma porphyrins, however, were markedly elevated, and in an assay using high performance liquid chromatography, uroporphyrin accounted for 72% and 7-carboxyl porphyrin for 24%. Review of past reports of PCT associated with hemodialysis revealed that the most characteristic feature was a significant increase of plasma porphyrins, mainly uroporphyrin. This increase is difficult to explain by accumulation due to failure of adequate clearance. Participation of factors affecting uroporphyrinogen decarboxylase activity seems likely.
Sympathetic excitement is not rarely accompanied by sweating over the palm or sole, and this sudatory reaction is often depressed by atropine. But, there was no simple way for quantitative expression of sympathetic activity. As an objective indicator of sympathetic activity, sympathetic skin response (SSR) was studied in 17 volunteers and 5 patients in the pain clinic. SSR was evoked by square wave electric stimulation through a pair of surface electrodes placed on the unilateral forearm. SSR recorded with a surface electrode was much larger than that was taken with a needle electrode inserted deep under the skin, and was markedly reduced by an intravenous administration of atropine sulfate 0.5mg for about 10 min. These findings support the hypothesis that the SSR is developed by an action potential of eccrine glands of a cholinergic nature. Unilateral stellate ganglion block abolished SSR in the ipsilateral palm indicating that the efferent impulse of palmal SSR is transmitted via cervical sympathetic ganglion. Inhalation of 0.1MAC halothane or enflurane in air reduced the height of SSR within 10 minutes. They obtunded SSR dose-dependently, and almost completely abolished at a concentration of 0.3 MAC. SSR may be useful to evaluate sympathetic activity under various conditions, such as under the effect of sedatives, analgesics and general anesthetics, and to evaluate the effects of a nerve block or other drugs which were used to obtund the nociceptive afferent stimuli to the sympathetic center of the brain.
[OBJECTIVES OF STUDY] This presentation deals with an analysis of factors to improve the survival of patients with ovarian cancer. Some 1051 patients with malignant ovarian tumors who were treated in this group, were divided into two groups for their period of treatment. Of these, 460 patients were treated 1974-1979 (retrospective group) and 591 patients treated 1979-1984, (prospective group) because chemo-immunotherapy was determined by a certain protocol in the group. [RESULTS] The survival rate of the two groups were compared, and the 5-year survival rate of prospective group was 20% higher than in the retrospective group. However, there were no significant differences of any clinical stages between retrospective group and prospective group, and the difference in 5-year survival rate was about 20% in any stages. The survival rate was also compared in accordance with histological types. The most dominant progression was seen in serous adenocarcinoma and when the cases were divided into two groups by their clinical stage; one was the early stage (Stage I) cases. The 5-year survival rate of serous ca, mucinous ca and embryonal ca (Higuchi, Kato) made remarkable progress in recent several years, but, mesonephroid ca made little progress. The other was the late stage (stage II, III, IV) cases, patients with mucinous ca when she had had surgery recurrently on relapse, resulting in prolonged survival period. As to the comparison of age groups, younger patients less than 40 years old showed a progression in their survival period, whereas patients in their sixties had no such progression. In order to evaluate the effect of treatment with due comparable counterpart of ovarian carcinoma, cases were quantified with 3 years survival prediction score which was calculated retrospectively by multivariate statistical analysis. The first evaluation was done with an MFC combination chemotherapy and a CAP combination. The results indicated that a CAP combination had improved the survival rate of ovarian cancer, and statistically significant differences were proved. Z value was 2.24 and P value was less than 5%. The second evaluation was done on the significance of second look operation. The prediction score of patients who underwent second look operation and matched pair control of prediction score without reoperation, were compared. The results indicated that second look operation improved the survival rate of ovarian cancer with statistically significant differences. Z value was 2.37 and P value was less than 5%. [CONCLUSION] According to the present study, the treatment of malignant ovarian tumors showed an improved survival rate of about 20%, regardless of the cl
From 1976 to 1985, 277 cases of carcinoma of the esophagus were resected in the Second Department of Surgery, Tohoku University School of Medicine. Postoperative cardiocirculatory disturbances occurred in 114 cases (41.2%), arrhythmia being the disturbance most frequently observed (86.8%). Low cardiac output syndrome occurred in 8 cases and myocardial infarction occurred in 3 cases. The majority of the cases were treated successfully, but 5 patients died within one month after operation. Causes of death were as follows: myocardial infarction, constrictive pericarditis, cardiac tamponade, non-occlusive mesenteric ischemia and acute cardiac failure. Postoperative arrhythmia occurred mainly up to the third postoperative day. Low cardiac output syndrome occurred just after operation or on the first postoperative day. All cases of myocardial infarction occurred on the first postoperative day. The rate of occurrence of cardiocirculatory disturbances in aged patients (greater than or equal to 70) was significantly higher than other group (less than or equal to 69), (56.7%:38.1%, p less than 0.05). The rate of occurrence of cardiocirculatory disturbances in patients who had a history of hypertension or in patients with abnormal preoperative electrocardiographic findings were relatively higher than those in patients who had no history of hypertension or in patients with no abnormal preoperative electrocardiographic findings. The rate of occurrence of cardiocirculatory disturbances in patients who had undergone total resection of the thoracic esophagus was significantly higher than that in patients who had undergone partial resection of the thoracic esophagus (42.8%:23.8%, p less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)
In a study designed to determine the merit of preserving ovarian function and childbearing capability in women with unilateral malignant ovarian tumors, the results of radical surgery (n = 86) and conservative surgery (n = 106) were compared. The mean length of survival was slightly but not significantly shorter following conservative surgery. There were 15 recurrences (14%) and 11 deaths among the conservative surgery group. The incidence of metastasis to the preserved ovary was high. In the most cases restoration of normal menses was fairly rapid after initial treatment, but this appeared to depend on whether or not chemotherapy was given postoperatively, the specific agents used, and the duration of their administration. Hypergonadotropic hypogonadism was the most common finding among the anovulatory patients. Sixteen women experienced a total of 27 pregnancies and 18 normal infants were born. Abortion was induced when conception occurred during a course of chemotherapy. These findings are encouraging in terms of the feasibility of preserving childbearing capability in ovarian cancer patients. However, they also underscore the necessity for close, long-term follow-up, which will be improved as new technologies become available.
Endodermal sinus tumor (EST) arising in the endometrium is an extremely rare malignant neoplasm. To the authors' knowledge, this is only the second report of an EST arising in this location. The tumor was exophytic, 2.4 cm in diameter, and was located in the fundus uteri. It had infiltrated the circumambient endometrium slightly. Preoperative serum alpha-fetoprotein (AFP) levels were markedly elevated, 1580 ng/ml. The patient received a simple abdominal hysterectomy and bilateral salpingo-oophorectomy followed by combination chemotherapy consisting of vincristine, actinomycin D, and cyclophosphamide. To date, there has been no evidence of tumor recurrence, and serum AFP titers, which had returned to normal 7 weeks after surgery, continue to remain within normal limits. We believe this is the first successful treatment of a documented case of primary EST of the endometrium.
A 53-year-old Japanese man with a skin eruption characteristic of glucagonoma syndrome had had misdiagnoses for 10 years. The plasma glucagon level was not abnormally high on the first admission, and 4 years later the level was elevated as determined by the 30 gm arginine tolerance test. An alpha cell carcinoma detected in the tail of the pancreas was associated with a lymph node metastasis; the skin eruption cleared up 10 days after the partial pancreatectomy with lymphadenectomy. The clinical features of glucagonoma syndrome should be given attention.
One hundred twenty-eight patients with chronic renal failure and secondary hyperparathyroidism underwent total parathyroidectomy with forearm autograft. Postoperative clinical improvement was remarkable. In all cases, the grafted tissue functioned well, and reimplantation of the cryopreserved parathyroid tissues was unnecessary. Intact 1-84 parathyroid hormone was more sensitive than C-terminal parathyroid hormone in parathyroid hormone level (PTH) gradient assays of grafted and nongrafted forearm. The study of hypocalcemia was also helpful in obtaining more distinct PTH gradients. Five of 119 patients had supernumerary parathyroid glands (4.2%), which preoperative noninvasive image diagnosis of parathyroid glands was helpful in detecting.
The sex differences and regulation by sex steroid hormones in calcium channels were studied by using [3H]nitrendipine binding to cardiac and cerebral membranes in 15-week old spontaneously hypertensive rats (SHRs). The maximal number of binding sites (Bmax) in the hippocampus of female SHRs increased by 24.1% over that in male SHRs. In the females, the Bmax values in the cardiac, striatal, thalamic and hippocampal membranes from ovariectomized SHRs decreased by 34.7, 29.9, 29.3 and 26.9%, respectively, compared to normal SHRs. This phenomenon, except for the hippocampus, was inhibited by estradiol but not by testosterone. In the male, the Bmax values in cardiac and cerebral membranes showed almost no changes after orchidectomy or treatment with estradiol or testosterone. After gonadectomy, the Bmax values in the cardiac, striatal and thalamic membranes of females decreased by 30.2, 33.0 and 35.6%, respectively, compared to those in males. The changes in apparent dissociation constant (KD) values were less remarkable than those in the Bmax values. These findings suggest that sex differences exist in the calcium channels of the heart, striatum, thalamus and hippocampus, and they suggest that estradiol, but not testosterone, may play a part in the regulation of the calcium channels in female SHRs.
The long-term effect of endoscopic laser treatment for early gastric cancer as a local curative procedure was reported. Forty-seven patients with endoscopically diagnosed early gastric cancer whose surgical risk was critical or who refused surgery were treated by either photocoagulative Nd: YAG laser (YAG) or photodynamic therapy (PDT) with argon dye laser and hematoporphyrin derivatives (HpD) or both and followed-up for more than 3 years. Thirty-one patients were initially treated by YAG. One patient was lost to follow-up. Sixteen of 30 cases (53%) treated by YAG were negative for cancer on biopsy for 9 to 73 months (mean 3 years and 7 months) after the initial treatment. Sixteen cases were initially treated by PDT. Eight of 14 cases (57%) treated by PDT with argon dye laser were negative for cancer on biopsy for 19 to 35 months (mean 1 year and 7 months). Ten of 13 cases treated by combined laser therapy were negative for cancer on biopsy for 12 to 77 months (mean 3 years and 2 months). Curative effect of YAG and PDT was expected in lesions of superficially elevated mucosal cancer (type) IIa less than 20mm and well demarcated superficially depressed mucosal cancer (type IIc) less than 10mm. PDT was superior to YAG in treating early gastric cancer, particularly when the margin of lesion is unclear, and depth of cancer invasion is estimated to be submucosal. Risks of lymph node metastasis in these lesions are reportedly minimal as well. Quality of life scores did not decrease when the patients were treated by lasers, but did so statistically significantly in the surgically treated group of patients. Therefore, we conclude that the endoscopic laser is the treatment of choice of treatment for early gastric cancer as a local curative procedure in the aged if they have a curable lesion as mentioned above. As a palliative treatment, 34 patients with neoplastic obstruction of the esophagus and stomach were treated by dilators with or without intubation of prosthesis tube and laser recanalization. Functional efficacy (ability to eat solid or semi-solid diet which could not be eater before treatment) was noted in 64% of 11 cases treated by dilators alone, 75% of 12 cases treated by intubation of prosthesis tube and 45% of 11 cases treated by lasers. There was a greater complication rate in the intubation group also. Patients with malignant stricture due to mediastinal lymph node metastasis were at higher risk of perforation.
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