Abdominal insufflation pressure during laparoscopic cholecystectomy shifts the tracheal carina cephalad.
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Abdomen↗
Biomedical subjects
T Komatsu
Publications and source records attributed to T Komatsu.
Alterations in spectral characteristics of heart rate variability as a correlate of cardiac autonomic dysfunction after esophagectomy or pulmonary resection.
BACKGROUND: Both esophagectomy and pulmonary resection are associated with postoperative cardiac complications, partly because of autonomic perturbations involving the heart. This study was undertaken to determine whether heart rate variability (HRV), employed as an index of cardiac autonomic function, changes in patients undergoing esophagectomy or pulmonary resection. METHODS: Electrocardiographic RR intervals were measured in 20 esophagectomized patients, 10 undergoing right and 10 undergoing left pulmonary resection on the preoperative day as baseline data and on postoperative days 1, 3, 5, 7, 14, and 30. Instantaneous heart rate was calculated every 250 ms from 416-s data of RR intervals. Power spectra of HRV for 128 s were computed using a fast Fourier transform and normalized by squared mean heart rate. The average ten sets of normalized HRV power were obtained by integrating the following power spectral bands: the low-, (0.06-0.10 Hz), high- (0.15-0.40 Hz), and total-frequency regions (0.01-0.40 Hz). RESULTS: In the esophagectomy group, mean low-, high-, and total-frequency HRV power decreased after surgery to 17%, 6%, and 15% of their preoperative values, respectively, and these indexes remained suppressed for up to 30 days. After right pulmonary resection, low- and total-frequency HRV power decreased through 30 and 7 postoperative days, respectively. In the left pulmonary resection group, HRV remained unchanged. In the esophagectomy group, mean (+/- SEM) heart rate increased from 78 (+/- 3) bpm to more than 90 bpm throughout the study, and body temperature from 36.5 (+/- 0.1) degrees C to more than 37.0 degrees C through 14 postoperative days. Heart rate and body temperature remained increased for 3 days after pulmonary surgery. Mean arterial pressure remained unchanged in the three surgical groups. CONCLUSIONS: Reductions indicate HRV after esophagectomy or right pulmonary resection indicate a substantial and prolonged surgical injury to the autonomic nervous control of pulse rate.
Aged↗
Analytical study of the clinical response to two distinct adoptive immunotherapies for advanced hepatocellular carcinoma: comparison between LAK cell and CTL therapy.
To evaluate the effect of two distinct adoptive immunotherapies, tumor-specific cytotoxic T-cell (CTL) therapy and lymphokine-activated killer (LAK) cell therapy, the clinical responses of patients with stage IV primary hepatocellular carcinoma (HCC) treated with these therapies were studied. Of 18 patients treated with CTL, 3 had complete regression (CR), 2 had partial regression, and 3 had minor regression (MR). Their median survival was 21 months after the end of therapy, and 1 CR patient survived for > 6 years. On the other hand, in the LAK-cell-treated group of eight patients, four had MR and their median survival was only 2 months. No survival was observed 27 months after the end of LAK cell therapy. These results indicate that tumor-specific CTL therapy is more effective than LAK cell therapy and that it might be a promising therapeutic tool for advanced HCC patients.
Adult↗
Genomic and biological alteration of a human immunodeficiency virus type 1 (HIV-1)-simian immunodeficiency virus strain mac chimera, with HIV-1 Env, recovered from a long-term carrier monkey.
A macaque monkey infected with NM-3, a human immunodeficiency virus type 1 (HIV-1)-simian immunodeficiency virus strain mac (SIVmac) chimeric virus with env, rev, tat and vpu derived from HIV-1 and LTR, gag, pol, vif and vpx derived from SIVmac, became a long-term carrier (more than 2.8 years). This monkey produced neutralizing antibodies to the original NM-3 as well as to the parental HIV-1. The virus recovered at 116 weeks replicated more rapidly and productively in macaque peripheral blood mononuclear cells than the original virus. The recovered virus was not neutralized either by antibodies raised early in the monkey or by a neutralizing monoclonal antibody that recognizes the V3 loop of HIV-1 Env, whereas both the early antibodies and the monoclonal antibody neutralized the original NM-3. Analysis of the virus genomic population revealed a few common mutations in the V3 region that caused amino acid changes. These data are consistent with the hypothesis that the virus escaped from the early antibodies and that the observed mutations contributed to this, as with HIV-1-infected humans. The observed mutations could equally well be the result of adaptation to simian cells. These results suggest that the HIV-1-SIVmac chimeric virus will be useful for investigating genetic variation of HIV-1 env and alteration of biological properties in vivo in relation to the host immune response.
Amino Acid Sequence↗
Ascitic positive cytology and intraperitoneal metastasis in ovarian dysgerminoma.
OBJECTIVES: To verify the pattern of the spread of tumors in ovarian dysgerminoma, with special reference to intraperitoneal metastasis, and to assess clinicopathologic factors for predicting tumor extension. METHODS: Detailed data regarding ascitic cytology, macroscopical findings at surgery, and the histopathology of the surgical specimens were retrospectively reviewed in 12 patients with dysgerminoma who were treated at Kyoto University Hospital. The relationships between the tumor extension and the period of symptoms, the serum lactic dehydrogenase (LDH) level, and the operative findings also were analyzed. RESULTS: Ascitic cytology revealed a high incidence of positivity in 6 of the 10 (60%) cases examined. Extraovarian metastases were present in 4 of the 6 (67%) cases with positive cytology, and in 1 of the 4 (25%) cases with negative cytology. Intraperitoneal metastatic nodules were detected in 5 of the 12 (42%) patients either by inspection during surgery or by postsurgical histological examination. In addition, these metastatic lesions were 5 or fewer in number and 7 mm or less in diameter, except in 1 patient with widespread disease. The presence or absence of extraovarian spread of the tumor was not significantly correlated with the period of symptom, the serum LDH level, the size of the primary tumor, or the volume of the ascitic fluid. CONCLUSION: The incidence of intraperitoneal spillage and/or metastases of dysgerminoma cells might be higher than previously reported. These findings indicate the importance of ascitic cytology and careful inspection at the time of operation, as well as the rationale of postsurgical chemotherapy for dysgerminoma of an apparently early stage.
Adolescent↗
Adnexal masses: transvaginal US and gadolinium-enhanced MR imaging assessment of intratumoral structure.
PURPOSE: To evaluate the accuracy of transvaginal ultrasound (US) and gadolinium-enhanced magnetic resonance (MR) imaging in the assessment of the intratumoral structure of an adnexal mass. MATERIALS AND METHODS: The population comprised 82 patients with an adnexal mass who underwent both transvaginal US and gadolinium-enhanced MR imaging and had surgical confirmation. The findings from both modalities were compared retrospectively with those of surgery. RESULTS: The sensitivity, specificity, and accuracy were 100%, 98%, and 99% with MR imaging and were 97%, 46%, and 68% with transvaginal US for the identification of solid tissue in the masses. Transvaginal US exhibited many (n = 25) false-positive results, especially in evaluation of lesions filled with blood or fatty tissue and small echogenic excrescences adherent to the wall, such as blood or fatty tissue. CONCLUSION: Both transvaginal US and gadolinium-enhanced MR imaging were highly sensitive in identification of solid components within an adnexal mass. Gadolinium-enhanced MR imaging was specific, whereas transvaginal US was nonspecific.
Adnexal Diseases↗
Spermatogenic cycle in the testis of the Japanese black bear (Selenarctos thibetanus japonicus).
Spermatogenic cycle in the testis of the japanese black bear (Selenarctos thibetanus japonicus) was studied by light and transmission electron microscopy. By light microscopy, spermatids were allocated into eleven steps based on morphological changes in the nucleus and the acrosome of spermatids. Cellular associations of the seminiferous epithelium were allocated into eight stages based on the changes in the nucleus and acrosome of spermatids, appearance of meiotic figures and time of spermiation. Cross-sections of the seminiferous tubule seldom contained more than one type of stage. Spermatids at steps 1-2 had the well-developed Golgi complex. The crescent-shaped Golgi complex was accompanied by the acrosome extending over the nucleus at steps 3-5. At step 6, spermatids faced the base, and the outer membrane of the acrosome converged upon the plasma membrane of spermatids. The acrosome projected into the cytoplasm of Sertoli cells at step 9. At step 11, most of the cytoplasm was phagocytosed by Sertoli cells, and spermatids were released in the lumen to become spermatozoa.
Acrosome↗
[A case of superior vena cava syndrome treated with combination radiation and CRE (CBDCA and VP-16) therapy].
Carboplatin and etoposide were reported to be excellent radiation sensitizers. We encountered a patient with SVC syndrome due to lung cancer who was successfully treated by combination carboplatin, etoposide and hyperfractionation radiotherapy. A 72-year-old man was admitted to our hospital because of remarkable face edema. Computed tomography revealed a huge lung tumor and compressed SVC due to tumor growth. Acute tumor regression was essential for this case. We performed combination chemotherapy and radiation. The regime consisted of CBDCA 300 mg (day 1 1 hr drip infusion) and etoposide 50 mg/day for 21 days by oral administration. Two daily fractionations of 1.4 Gy were delivered 5 days-a-week, with a 4 h interval between fractions (total dose 49.8 Gy). Complete response of huge tumor was attained in this case. The major side effect associated with the therapy was myelosuppression. The patient's quality of life has been remarkably improved with this therapy.
Aged↗
[A case of severe hypertension caused by stellate ganglion block in a patient with facial palsy].
We report a case of severe hypertension following stellate ganglion block. A 61-year old woman received the left stellate ganglion block with 5 ml of 1% mepivacaine for her left facial palsy. Before the stellate ganglion block, blood pressure was 120/68 mmHg and heart rate was 62 b.p.m. Seven minutes after the left stellate ganglion block, blood pressure increased to 230/140 mmHg, but heart rate was unchanged. Systolic blood pressure remained above 190 mmHg for 60 minutes following the stellate ganglion block. We suggest that the extreme increase in blood pressure was due to the vagal nerve block associated with the left stellate ganglion block.
Anesthetics, Local↗
[Appearance of cytoplasmic processes of megakaryocytes in the peripheral blood in a Munchausen syndrome with factitious anemia].
Many cytoplasmic processes of megakaryocytes were seen in a 45-year-old male patient of Munchausen syndrome with sustained severe anemia due to repeated self-blood drawing. He had a past history of repeated infection and removal of skin-graft transplanted for giant congenital melanocytic nevus due to self-infliction (later confessed by the patient). On the admission, he presented with high fever (39 approximately 40 degrees C) and severe sustained anemia refractory to repeated blood transfusions. Any specific clinical data indicating bleeding or hemolysis were not found. Self-blood drawing was discovered by a nurse on his 27th hospital day. Syringes and needles for blooddrawing were also found. He recovered from anemia under intensive watching without any specific treatment. He confessed that the high fever was artificial. It was of interest that cytoplasmic processes of megakaryocytes were seen in the peripheral blood film until he recovered from anemia for one month. The serum level of erythropoietin was elevated (1540 mU/ml), but not significantly was that of thrombopoietin (1.54 fmol/ml). This case was considered to be valuable to understand the mechanism of platelet-production by megakaryocytes at persistent bleeding.
Anemia↗
[Surgical stress and nervous systems].
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Anesthesia↗
IL-12 promotes enhanced recovery from vesicular stomatitis virus infection of the central nervous system.
To investigate the role of a cytokine in host defense against the vesicular stomatitis virus (VSV) infection of the central nervous system (CNS), IL-12 was injected i.p. into groups of 10 BALB/c mice on days -1, 0, 1, 2, and 3 postinfection. Four days postinfection, mice were examined. IL-12 strongly enhanced immunity to VSV infection in the CNS as demonstrated by 1) decreased VSV titers in brain homogenate of IL-12-injected mice compared with those of controls; 2) increased expression of inducible nitric oxide synthase in the CNS; 3) enhanced expression of both MHC class I and class II Ags in the CNS; 4) increased T cell infiltration in the CNS, especially in the olfactory bulb; and 5) diminished VSV-induced apoptosis in olfactory bulb. No detrimental effect was observed even with the 200 ng/mouse dose of IL-12. Protective effects of IL-12 were dose dependent. Collectively, these results demonstrate that exogenously added IL-12, even when injected peripherally, significantly enhances recovery from VSV infection of the CNS.
Animals↗
Cloning of a new cytokine that induces IFN-gamma production by T cells.
The mechanism underlying the differentiation of CD4+ T cells into functionally distinct subsets (Th1 and Th2) is incompletely understood, and hitherto unidentified cytokines may be required for the functional maturation of these cells. Here we report the cloning of a recently identified IFN-gamma-inducing factor (IGIF) that augments natural killer (NK) activity in spleen cells. The gene encodes a precursor protein of 192 amino acids and a mature protein of 157 amino acids, which have no obvious similarities to any peptide in the databases. Messenger RNAs for IGIF and interleukin-12 (IL-12) are readily detected in Kupffer cells and activated macrophages. Recombinant IGIF induces IFN-gamma more potently than does IL-12, apparently through a separate pathway. Administration of anti-IGIF antibodies prevents liver damage in mice inoculated with Propionibacterium acnes and challenged with lipopolysaccharide, which induces toxic shock. IGIF may be involved in the development of Th1 cells and also in mechanisms of tissue injury in inflammatory reactions.
Amino Acid Sequence↗
[A case of lipoprotein glomerulopathy associated with retinal artery occlusion].
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Adult↗
Altered expression of nm23-H1 and c-erbB-2 proteins have prognostic significance in adenocarcinoma but not in squamous cell carcinoma of the uterine cervix.
BACKGROUND: The reduced expression of nm23-H1 protein and/or overexpression of c-erbB-2 protein reportedly is associated with a high incidence of lymphatic metastasis or poor prognosis of the patient in a variety of human malignant tumors. METHODS: The expression patterns of nm23-H1 and c-erbB-2 proteins were analyzed by immunohistochemical staining using formalin fixed, paraffin embedded sections of 88 cases of invasive carcinoma (39 matched pairs of adenocarcinoma and squamous cell carcinoma, 8 cases of adenosquamous carcinoma, and 2 cases of undifferentiated carcinoma) and 31 cases of preinvasive lesions of the uterine cervix. RESULTS: Expression of nm23-H1 was detected in 46% of adenocarcinoma and in 36% of squamous cell carcinoma of the uterine cervix, whereas c-erbB-2 expression was evident in 49% and 38%, respectively. Negative expression of nm23-H1, positive expression of c-erbB-2, and a combined nm23-H1-negative and c-erbB-2-positive expression were associated with a high incidence of lymph node involvement (P = 0.36, P = 0.0015, P = 0.0055, respectively) and with poor prognosis of patients (P = 0.034, P = 0.014, P = 0.00008, respectively) with adenocarcinoma of the uterine cervix, but not in those with squamous cell carcinoma. Multivariate analysis using the Cox's proportional hazard model also revealed that these three factors significantly contributed to the prognosis of patients with cervical adenocarcinoma. CONCLUSIONS: Reduced expression of the nm23-H1 protein, increased expression of the c-erbB-2 protein, and a combined nm23-H1-negative and c-erbB-2-positive expression have prognostic significance in patients with adenocarcinoma, whereas they may not be associated with the prognosis of squamous cell carcinoma of the uterine cervix, nm23-H1 and c-erbB-2 proteins may have different functions according to the subtype of cervical carcinoma.
Adenocarcinoma↗
Peritoneal papillary serous carcinoma arising in an infertile woman during ovulation-induction therapy: immunohistochemical expression of LH/hCG receptors.
A case of peritoneal papillary serous carcinoma arising in an infertile patient during ovulation-induction therapy is presented. A 34-year-old woman with past history of ovulation-induction therapy for infertility again received fertility drugs. During the use of gonadotropic hormones, massive ascites developed and an exploratory laparotomy revealed serous papillary carcinoma on the surface of bilateral ovaries, pelvic peritoneum, and omentum. Immunohistochemical analysis showed the tumor cells to be positive for luteinizing hormone/human chorionic gonadotropin receptors and negative for sex steroid receptors. A possible relationship between the use of gonadotropic hormones and cancer development is discussed.
Adult↗
Minimal deviation adenocarcinoma of endometrioid type may arise in the isthmus: clinicopathological and immunohistochemical study of two cases.
Clinicopathological and immunohistochemical features of minimal deviation adenocarcinoma (MDA) of endometrioid type which may have arisen in the isthmus are presented. Hysterectomy specimens from two women, one 39 years of age and the other 64 years of age, showed the presence of endometrioid-type adenocarcinoma with minimal atypia and without back-to-back arrangement of the glands, which was consistent with a histological diagnosis of endometrioid MDA. However, the tumorous glands were most abundant in the isthmus, and extensively infiltrated into the cervical stroma, vagina, parametrium, and corpus in one case, and the tumor was confined to the isthmus in the other. Immunohistochemically, the tumorous glands were CEA-positive and vimentin-negative in both cases. p53 protein expression was found in one case. Histogenetic origin of MDA of endometrioid type is discussed.
Adult↗
Immunohistochemical analysis of p53 protein and 72 kDa heat shock protein (HSP72) expression in ovarian carcinomas. Correlation with clinicopathology and sex steroid receptor status.
Mutations of the tumour suppressor p53 gene have been reported in a variety of human malignant tumours, and are frequently associated with overexpression of p53 protein. To examine the significance of p53 gene alteration in malignant epithelial tumours of the ovary, we studied the immunohistochemical reactivity with a monoclonal antibody against p53 (PAb 1801) in 6 ovarian tumours of low malignant potential (LMP) and 32 ovarian carcinomas. The existence of any correlation of p53 overexpression with the clinicopathological features and with the immunohistochemical expression of 72 kDa heat shock protein (HSP72) and sex steroid receptors (oestrogen receptors; ER, progesterone receptors; PR) was also analysed. Expression of p53 was found in 2 of the 6 (33.3%) LMP tumours and in 15 of the 32 (46.9%) carcinomas. Strong expression of HSP72 was observed in 11 of the 17 (64.7%) p53-positive tumours, but only in 2 of the 21 (9.5%) p53-negative ones. Histologically, p53-positivity was observed in 7 of the 10 (70%) serous carcinomas, 4 of the 6 (66.7%) mucinous, 4 of the 10 (40%) endometrioid, and none of the 4 clear cell and 2 transitional cell carcinomas. Distribution of p53-positive cells in the tumour sections was homogenous in serous tumours, but heterogenous in mucinous lesions. All of the 4 carcinomas arising in endometriotic cysts were p53-negative. These differences support the thesis of heterogeneity in ovarian carcinogenesis.(ABSTRACT TRUNCATED AT 250 WORDS)
Adolescent↗