Biomedical subjects
Publications and source records attributed to T Negishi.
Recently, genital sclerosing lipogranuloma having no history of trauma and foreign body infusion are more common in Japan. We report three cases recently encountered in which tumors were diagnosed as sclerosing lipogranuloma on histological examination. In case 1, lipid analyses of the tissues by infrared absorption spectrometry proved that it was endogenous in origin.
Three cases of prostatic carcinoma with palpable metastatic lymph nodes are presented. In case 1, the intrapelvic lymph node metastases were recognized as an abdominal mass. In case 2 and 3, non-regional superficial lymph node metastases were palpable. Orchiectomy and anti-androgen therapy were effective in all cases.
The identification and diagnosis of thyroid metastases from renal cell carcinoma are rare in living patients in spite of more frequent incidence during autopsy. We reported two cases of thyroid metastases from renal cell carcinoma. In both cases, histological examination revealed metastasis from renal cell carcinoma and negative immunohistological stain for thyroglobulin ruled out primary thyroid carcinoma.
Clinical efficacy of sodium imipenem/cilastatin was studied on 45 patients with complicated urinary tract infections, on whom prior antimicrobial agents were ineffective. A 0.5g dose of IPM/CS was administered by drop infusion twice a day for 5 days. The clinical efficacy was evaluated according to the criteria of the Japanese UTI committee. Of a total of 65 strains, 29 strains of gram positive bacteria and 36 strains of gram negative bacteria, were detected as causative microbials. Bacteriologically, 23 strains of gram positive bacteria (79%) and 34 strains of gram negative bacteria (94%) were eradicated following the treatment. S. aureus, E. faecalis and Flavobacterium sp. were less sensitive to IPM/CS. Overall clinical effectiveness rate of IPM/CS in the present study was 87%. Adverse drug side effects were observed in six patients, namely they were eruption, headache and slight elevation of serum transaminase. These findings suggest that IPM/CS is an effective agent for the treatment of complicated UTI even when the prior medicine was ineffective.
We evaluated a newly developed quinolone agent, tosurofloxacin (TFLX), for its safety and clinical efficacy on patients with urinary tract infections (UTI). Among 138 cases satisfying the UTI criteria, 75 cases were acute simple UTI and 63 cases were chronic complicated UTI. In principle, a daily dose of 450 mg of TFLX was administered for 3 days and for 5 days for acute simple UTI and for chronic complicated UTI, respectively. Clinical efficacy of TFLX in these cases was evaluated according to the criteria of Japanese UTI committee. Bacteriologically, all 80 strains isolated from acute simple UTI were eradicated following TFLX administration. However, 2 gram positive strains and 1 gram negative strain, appeared following the treatment. In cases of chronic complicated UTI, 29 out of 32 gram positive strains and 29 out of 44 gram negative strains were eradicated. Among the isolated strains, P. aeruginosa and S. marcescens persisted, which suggests that they were less sensitive to TFLX. Overall clinical effectiveness rate of TFLX on acute simple UTI was 100%, while that on chronic complicated UTI was 73%. Adverse drug side effects were minimum, stomach discomfort and constipation was observed in one case each. These findings indicate that TFLX is a useful agent for the treatment of both simple and complicated UTI.
Two female patients with enterovesical fistula complicating Crohn's disease are presented. Case 1: A 40-year-old woman having a 10-year history of diarrhea presented with vesical irritability of a three months duration. Administration of antibiotics did not relieve her of the symptoms and then pneumaturia appeared. Cystoscopic examination revealed fistulous opening. Barium enema study depicted rectovesical fistula. After partial cystectomy and temporary colostomy, ileocecal lesion was shown by contrast study and resection of ileocecal segment was performed seven months later. Case 2: A 33-year-old woman presented with vesical irritability of 7 years duration and pneumaturia and fecaluria of 4 years duration. Cystoscopic examination revealed localized bullous edema but no apparent fistula. Cystography, as well as contrast studies demonstrated ileo-vesical, ileo-ascending colonic and ileo-sigmoidal fistulas. One-stage resection of diseased intestine and partial cystectomy were performed. In both cases, pathological diagnoses of Crohn's disease was made, and postoperative course was uneventful for over 10 months. Thirty eight cases of enterovesical fistula complicating Crohn's disease are reviewed.
A 23-year-old man presented with high fever and left abdominal pain. Ultrasonography, CT scan and angiography visualized a left adrenal cyst. Cyst fluid obtained preoperatively by percutaneous needle puncture under ultrasonographic guidance was purulent, and had a higher level of aldosterone, and lower level of amylase than the plasma. These findings suggested that this cyst originated from the adrenal gland. Histopathological examination of the surgically removed specimen confirmed the adrenal pseudocyst.
The genotoxicities of a series of N-nitrosamines were assayed in the wing spot test and a new short-term test of Drosophila melanogaster. In the spot test, larval flies trans-heterozygous for the somatic cell markers mwh and flr3 were fed the test reagents and the wing hairs in adults were inspected for clones expressing the phenotypes of the markers. In the other test, larval stock consisting of meiotic recombination-deficient (Rec-) double mutant mei-9a and mei-41D5 males and repair-proficient Rec+ females were grown on feed containing the reagents and the DNA damages were detected with the preferential killing of the Rec- larvae as an endpoint. The carcinogenic nitrosamines tested, N-nitrosodimethylamine (NDMA), N-nitrosodiethylamine (NDEA), N-nitrosodi-n-butylamine (NDBA), N-nitrosomorpholine (NMOR), N-nitro-sopiperidine (NPIP) and N-nitrosopyrrolidine (NPYR), all showed clearly positive activities in both tests. The activities in the wing spot test were ranked in a sequence of NDMA much greater than NMOR greater than NPIP greater than NDEA greater than NPYR greater than NDBA. A similar ranking was obtained in the repair assay. The genotoxicity of N-nitrosodiphenylamine (NDPhA), carcinogenicity studies of which are inconclusive, was marginal in the spot test. The non-carcinogenic N-nitrosoproline (NPRO) and the non-mutagenic N-nitrosothioproline (NTPRO) were negative in the spot test. NDPhA and NPRO were negative in the repair test as well. The DNA-repair test is thus a convenient technique for estimating the mutagenicity of compounds because of its simplicity compared with the wing spot test. These Drosophila tests may be useful in predicting carcinogenic potentials of compounds.
Changes in activated T cell subsets in peripheral blood were examined during the course of experimental allergic neuritis (EAN), using two-color immunofluorescence flow cytometry. Both CD4+ and CD8+ activated T cells decreased transiently before the onset of clinical signs, and increased just around the time of onset of the disease. In contrast, during the recovery phase, the numbers of CD4+ activated T cells returned to the normal range, whereas CD8+ activated T cells continued to increase. These findings imply that activation of CD4+ helper/inducer cells contributes mainly to the evolution of EAN, and that of CD8+ suppressor cells are necessary for recovery.
From June 1989 to August 1990, 21 women with genuine stress urinary incontinence were treated with the Gittes procedure combined with transrectal ultrasonography. The urethrovesical junction was well pinpointed on an ultrasonographic image. The strength of suspension providing the optimal posterior urethrovesical angle was changed by each patient. Posterior urethrovesical angles averaged 89.3 +/- 9.5 degrees at operation and 93.6 +/- 9.5 degrees (mean +/- standard deviation) on a postoperative lateral cystourethrogram with the patient straining while in the standing position. An indwelling urethral catheter was removed on postoperative day 1. None of the patients had residual urine of more than 50 ml. by 4 days postoperatively. Furthermore, the average maximum urinary flow rates significantly increased from 21.0 +/- 7.1 ml. per second preoperatively to 26.1 +/- 9.8 ml. per second postoperatively (p less than 0.01). Therefore, application of ultrasonography during bladder neck suspension is simple and reliable for determination of the optimal suspension as well as identification of the suspension site.
From April 1985 to December 1989, 65 patients with advanced head and neck squamous cell carcinoma, underwent simultaneous bilateral neck dissection (SBND) at Saitama Cancer Center. Three and five year survival percentages were 53 and 42%, respectively. In patients without histologic involvement of cervical nodes, five year survival rate was 83%, whereas in those with nodal involvement five year survival fell to 32% (p less than 0.005). The conclusion were the following: (1) Of 38 patients diagnosed to have lymph node involvements on one side of neck before operation, 8 patients (22%) were found to have bilateral lymph node metastasis in clinicopathological study. Of 13 patients having no clinical lymph node metastasis on both sides of neck, 7 patients (54%) were found to have unilateral lymph node metastasis. Of 16 patients diagnosed to have bilateral lymph nodes involvement, 10 patients were found to have bilateral neck metastasis and 2 had unilateral neck metastasis. (2) Of 35 cases of hypopharyngeal canners, 19 cases had clinically positive lymph nodes on one side of neck. Of these 19 cases, 5 cases (26%) had histologically positive nodes on the opposite side. 14 (40%) of 35 cases had metastasis on the opposite side. In conclusion, SBND is a proper treatment for metastatic cervical cancer from a primary lesion of the head and neck, especially in hypopharyngeal cancers, because the rate of recurrence seems to be related more to the difficulty in controlling lymph node metastasis than to the failure in treatment of the primary cancer.
Forty-four patients with cancer in the hypopharynx and cervical esophagus underwent pharyngoesophageal reconstruction with a free jejunal graft after total removal of a tumor combined with resection of the circumferential tissues. The graft survival rate was 93.2% (41 of 44). Postoperative complications occurred in 16 patients (36.4%), which included postoperative death in one (2.3%), graft necrosis in 3 (6.8%), fistula formation in 4 (9.1%) and graft stricture in 3 (6.8%). All 3 cases of graft necrosis underwent successfully reimplantation. The mean interval time was 20.9 days until oral intake was possible. Thirty-two of 42 patients (76.2%) were able to take usual food. Esophageal speech was limited in the selected cases by this procedure. A cumulative survival rate of 5 years was 40.6% in this series. This method of reconstruction should be advocated as one of relatively safe and reliable procedures for patients with hypopharyngeal and cervical esophageal cancer.
A 38-year-old woman developed slowly progressive gait disturbance. At age 39 years she was admitted to our department because she could not walk without assistance. On neurological examination she was alert with normal mental functions. Horizontal nystagmus on both sides, minimal clumsiness in the left upper extremity on the finger-to-nose test and moderate degree of spasticity in bilateral lower extremities without evident motor weakness were present. The gait was spastic with small steps on a wide base. There was no sensory abnormalities. The deep tendon reflexes were hyperactive on both sides, on the lower extremities, with positive Babinski's sign. The sphincter functions were intact. During the following 5 years she gradually deteriorated and pseudobulbar palsy, emotional incontinence and the progressive dementia appeared in addition to severe spastic paraplegia. At age 45 years she was admitted to our nursing home and she died 3 months later, of pneumonia, on 6 years after the onset of her illness. Two elder sisters of her 7 siblings had the similar neurologic illness. The brain weighed 1,060 g. There was mild atrophy of cerebrum, cerebellum and brainstem. There were neuronal loss and gliosis in layers IV-VI of cerebral cortex with no evidence of the spongy state. Cerebellar cortex, cerebellar peduncles and spinocerebellar tracts were preserved. There was marked degeneration of corticospinal tract from cerebral peduncle to lateral funiculus of lumbar spinal cord. The most prominent feature was appearance of numerous multicentric amyloid plaques, which were marked in layers I-III of cerebral cortex and to a lesser extent in corpus striatum, hippocampus and the white matters of cerebrum and cerebellum.(ABSTRACT TRUNCATED AT 250 WORDS)
A 46-year-old man presented at Kasukabe City Hospital because of urinary retention. Digital rectal examination revealed soft distended mass in the retrovesical space. Transrectal ultrasonography and computed tomography showed a retrovesical cystic lesion of 14 x 11 x 10 cm in size and a mass protruding into the cyst from posterior lobe of the prostate. The cyst and the mass were removed suprapubically. The cyst was filled with 400 ml of clear yellowish fluid containing acid-phosphatase and prostate-specific antigen in a high concentration, but no spermatozoa. The mass protruded posteriorily from the prostate. The wall of the cyst was partly lined with double layer of columnar epithelium. The histological examination of the mass showed marked nodular hyperplasia and dilated acini of the prostate gland was seen around the cyst. A diagnosis of retention cyst of the prostate and nodular hyperplasia of the prostate were made. Cysts of the prostate are uncommon and retention cysts protruded by markedly hyperplastic prostatic tissue are extremely rare.
An 83-year-old male presented in October, 1988, with pigmented tumor lesions on the penis. The main tumor mass accompanied with necrotic bleeding, measuring 5 cm in diameter was located on the fore skin and glans penis. On the proximal shaft of the penis, there were three other black tumors, measuring from 0.5 to 3 cm in diameter. The distal urethra of the penis was clinically involved in the tumor mass and bilateral inguinal lymph nodes were palpable. Chest X-ray and liver scan both revealed multiple metastases. Tumor biopsy confirmed malignant melanoma. Phallectomy and bilateral inguinal lymph node biopsies were performed in October, 1988. Pathological findings revealed that a malignant melanoma had developed from the fore skin and glans penis, extended into the penile urethra and metastasized to bilateral inguinal lymph nodes. The patient gradually deteriorated in general condition and died of cancer 28 days later. The prognosis of malignant melanoma of the penis seems to be extremely poor.
A comparative clinical study examined the preventive effect of ticlopidine hydrochloride (hereinafter referred to as ticlopidine, anti-platelet drug) on Peplomycin sulfate (hereinafter referred to as Peplomycin) pulmonary fibrosis. In clinical evaluation, pulmonary function (PaO2, DLco) and biological fibrosis markers (angiotensin I converting enzyme, type III procollagen peptide, phospholipid) were measured. PaO2 and DLco using ticlopidine showed improvement, but statistical significance was not observed. Changes in biological fibrosis markers due to Peplomycin administration were observed in accordance with earlier experiments. Importantly however, the variance of type III procollagen peptide in the ticlopidine group was significantly suppressed (p less than 0.10). As a result, ticlopidine has the potential to prevent Peplomycin pulmonary side effects during clinical use.
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Ten patients with urinary stress incontinence were treated by suburethral sling procedure using a polytetrafluoroethylene tube as the sling. The tension of suspension was determined by the post-urethrovesical angle measured by transrectal ultrasonography in each patient. In nine patients, the post-urethrovesical angle ranged from 90 to 110 degrees, and urinary continence of the patients was completely obtained. The remaining one patient whose post-urethrovesical angle was determined as 120 degrees could not obtain complete continence. None of the patients had subjective post-operative disturbance in urination and the peak flow rate of post-operative uroflowmetry hardly decreased in 7 patients in whom this was performed. Although post-urethrovesical angles reduced as the tension which suspended the bladder neck increased, the tension reforming the post-urethrovesical angle was various in each patient. Since one of the aims of suspension of the bladder neck for patients with stress incontinence is reform of the post-urethrovesical angles, correct and reasonable tension of suspension is to be obtained by measuring the post-urethrovesical angle.