Biomedical subjects

T Todoroki

Publications and source records attributed to T Todoroki.

137 records · Page 8Linked to original sources

PubMedDate not supplied

Amputation neuroma mimics common hepatic duct carcinoma.

Most amputation neuromas of the biliary tract occur in the cystic duct stump after cholecystectomy and are asymptomatic. However, when they arise in the main hepatic duct and are associated with obstructive jaundice, it is difficult to distinguish them from carcinoma. We describe a case in which preoperative differential diagnosis was difficult. A 60-year-old man was admitted to the Institute of Clinical Medicine, University of Tsukuba, with a chief complaint of jaundice. Cholangiography showed an irregularly elevated nodular lesion on the lateral wall of the common hepatic duct and multiple floating stones in the choledochus. Ultrasonography and computed tomography revealed one-sided regional thickening of the common hepatic duct associated with dilatation of the intrahepatic and extrahepatic bile ducts. Carbohydrate antigen 19-9 level was markedly elevated to 11,200 IU/mL in the bile juice, but was only 38 IU/mL in the serum, below the limit of abnormality. Cholangioscopy showed papillary tumor with coarse granular surface mimicking papillary carcinoma, but biopsy revealed no malignancy. The patient underwent hepaticocholedochus resection. Although the macroscopic finding from the surgical specimens was papillary carcinoma of the common hepatic duct penetrating to the hepatoduodenal ligament, histopathological examination revealed an amputation neuroma consisting of hypertrophic nerve tissues and giant cells containing foreign bodies, probably as a consequence of a previous cholecystectomy. The postoperative course was uneventful and the patient has been living well for the 5 years since the resection.

Aged↗

PubMedDate not supplied

Chemotherapy for bile duct carcinoma in the light of adjuvant chemotherapy to surgery.

Chemotherapeutic regimens that markedly improve survival and quality of life in patients with bile duct cancer (cholangiocarcinoma) have not yet been developed. Currently, radical resection is the only potentially curative treatment modality for these patients. However, complete resection is often impossible and, even when achieved, is typically followed by metastasis and/or local recurrence. During the past 25 years, patients with cholangiocarcinoma have received chemotherapy in an attempt to improve their prognosis; effective methods are systemic administration, hepatic arterial infusion, and intraductal infusion. 5-fluorouracil, adriamycin, mitomycin C, and cisplatin remain the agents used most frequently (either singly or in combination) for treating cholangiocarcinoma. In particular, 5-fluorouracil has been a component of most chemotherapy regimens for bile duct cancer. However, regardless of the administration scheme, results from the use of 5-fluorouracil as a single agent have been disappointing. Recent phase II (albeit small-population) trials that addressed the biochemical modulation of 5-fluorouracil in combination with methotrexate, leucovorin, cisplatin, interferon, or mitomycin C yielded better results than did a classic (combination of 5-fluorouracil, adriamycin, and mitomycin C) FAM regimen. Hepatic arterial infusion chemotherapy was associated with the highest response rate and survival in patients with localized cholangiocarcinoma (localized in the liver, with no extra-hepatic metastasis); however, these results need to be confirmed in large, randomized trials. Studies regarding intraductal chemotherapy for patients with obstructive jaundice are still in the preliminary stages; therefore, no associated benefit could be ascertained. The present review discusses current chemotherapy regimens for bile duct cancer and outlines possible future clinical investigations.

Antineoplastic Agents↗

PubMedDate not supplied

Chemotherapy for gallbladder carcinoma--a surgeon's perspective.

Surgery is the only curative treatment for gallbladder cancer. However, because of frequent local-regional and distant recurrences, radical surgery during advanced stages of the disease is often unsuccessful. Despite potential improvements in patient survival and quality of life, alternatives such as chemotherapeutic regimens have not been fully developed for treatment of gallbladder cancer. The present paper reviews current publications that deal exclusively with the use of chemotherapy for treatment of gallbladder cancer, with particular attention to adjuvant chemotherapy including postoperative and preoperative systemic or regional hepatic arterial infusion chemotherapy. Treatment outcomes, including response rate, adverse effects, and survival are summarized.

Antineoplastic Agents↗

PubMedDate not supplied

Hepatic resection for metastatic tumors from noncolorectal carcinoma.

BACKGROUND/AIMS: The role of liver resection for hepatic metastases from noncolorectal carcinomas has yet to be clarified. The present study examines a single institutional experience of hepatic resection for noncolorectal metastases. METHODOLOGY: From January 1987 to March 1999, 14 patients underwent curative resection for liver metastases from noncolorectal carcinomas. Records of these patients were reviewed. RESULTS: Resections were performed for liver metastases from gastric cancers (n = 8), pancreatic cancers (n = 2), and cancers of bile duct, the papilla of Vater, kidney, and breast (n = 1, each). Six patients (5 with gastric cancers and 1 with pancreas cancer) presented with synchronous disease and 8 with metachronous disease. In the gastric cancer patients, there are 2 disease-free survivors (26 and 53 months) in the metachronous group, though all of the 5 patients with synchronous disease died within 29 months. All of the 4 patients with pancreatobiliary carcinomas died within 2 years. One case of breast cancer and another of renal cell cancer are alive without disease at 49 and 9 months, respectively. CONCLUSIONS: For metastases from gastric cancers, better survival after hepatic resection is expected in metachronous cases than in synchronous cases. Hepatic resection may afford little benefit for patients with liver metastases from pancretobiliary cancers.

Aged↗

PubMedDate not supplied

Retroperitoneal multiple lymphangioma with differential cyst contents causing hydronephrosis and biliary dilatation.

We report a 40-year-old woman with retroperitoneal multiple cystic lymphangioma. Multiple cystic lesions were found on both sides of the aorta in the retroperitoneal and right pelvic spaces. These thin-walled cysts gradually increased in size leading to left hydronephrosis and dilatation of the common bile duct with cholecystitis, requiring resection. Analysis of cystic contents revealed differences between the cysts. The right cyst contained high concentrations of amylase, 3429 U/L, while the left cyst contained high concentrations of triglyceride, 470 mg/dL. No reports of patients with idiopathic retroperitoneal cystic lymphangioma have described differences in cystic contents. Differences in cystic contents according to tumor location strongly suggest that the cause of retroperitoneal lymphangioma is a developmental malformation in which lymphangiectasia follows the failure of developing lymphatic tissue to establish normal communication with the remainder of the lymphatic system.

Adult↗

PubMedDate not supplied

Utility of serum CA 19-9 monitoring in preoperative radiotherapy for pancreatic cancer.

BACKGROUND/AIMS: Pancreatic cancer is extremely refractory even to aggressive treatments including surgery, resulting in early metastasis and/or local recurrence. We investigated changes in serum tumor marker CA 19-9 levels during preoperative radiotherapy in conjunction with initial treatment failure. METHODOLOGY: Twenty-three patients presenting with localized disease and an increased serum CA 19-9 level, who were slated to undergo pancreatectomy and/or intraoperative radiotherapy following preoperative radiotherapy were reviewed. CA 19-9 response, the ratio of post-radiotherapy level before laparotomy to pre-radiotherapy level, was analyzed in relation to disease-control time and survival. RESULTS: Eleven patients revealed metastasis at restaging or laparotomy; 12 patients (52%) completed aggressive treatments. Initial failure was identified at the liver (52%), peritoneum (52%), or local site (26%) with a median disease-control time of 91 days; 7 patients showed combined failure. All but 1 patient died of cancer with a median survival time of 264 days. CA 19-9 response (range: 0-1185%) did not correlate with disease-control time or survival; 8 progressive-disease patients (> 140% response), however, showed significantly shorter disease-control time than 15 nonprogressive-disease patients (< or = 140% response). CONCLUSIONS: CA 19-9 monitoring is useful in preoperative radiotherapy for identifying patients who will not benefit by succeeding aggressive treatments by predicting early metastasis.

Adult↗

PubMedDate not supplied

Evaluation of intraoperative radiotherapy for carcinoma of the pancreas: prognostic factors and survival analyses.

Among 145 patients with carcinoma of the pancreas who had been admitted to three institutions between 1976 and 1985, 117 were entered into a prognostic factor analysis system according to Cox's proportional hazards model. The treatment was classified into four modalities: bypass surgery, single-dose intraoperative radiotherapy (IOR), IOR combined with external irradiation, and resection with or without various radiations. The most important prognostic factors for treatment were identified as location of tumor, TNM stage, and relief of back pain. Adjusting the imbalances among the treatment groups using Cox's model, the superiority of IOR with external irradiation was confirmed for both bypass and single-dose IOR. With this adjustment, the survival rates proved to be more meaningful than the simple Kaplan-Meier estimates.

Adenocarcinoma↗

PubMedDate not supplied

Suppression of Fc Receptor and C4.C3 receptors of the granulocytes from patients with systemic lupus erythematosus.

The suppressive functions of Fc receptor and complement (C4.C3) receptors were studied in the granulocytes from patients with systemic lupus erythematosus (SLE). The inhibition of complement receptors was mainly due to immune complex bearing C4 or C3 fragments and to complement fragments in part, because 1. the inhibitory activity was present mostly in macromolecular fraction of SLE serum on gel filtration, and 2. the inhibitory activity was precipitated by 4% polyethylene glycol. The suppression of the complement receptors correlated with SLE disease activity.

Arthritis, Rheumatoid↗

PubMedDate not supplied

Radiation therapy for primary gallbladder cancer.

This paper presents a survey into the role of radiation therapy in the treatment of advanced gallbladder cancer and provides information on the radiobiological aspects for combining surgery and radiation therapy. This treatment modality has resulted in improved median survival time even in patients with stage IV disease when it was applied to microscopic post-resection residue.

Animals↗

PubMedDate not supplied

Laser scanning cytometry (LCS) allows detailed analysis of the cell cycle in PI stained human fibroblasts (TIG-7).

We have demonstrated a method for the in situ determination of the cell cycle phases of TIG-7 fibroblasts using a laser scanning cytometer (LSC) which has not only a function equivalent to flow cytometry (FCM) but also has a capability unique in itself. LSC allows a more detailed analysis of the cell cycle in cells stained with propidium iodide (PI) than FCM. With LSC it is possible to discriminate between mitotic cells and G2 cells, between post-mitotic cells and G1 cells, and between quiescent cells and cycling cells in a PI fluorescence peak (chromatin condensation) vs. fluorescence value (DNA content) cytogram for cells stained with PI. These were amply confirmed by experiments using colcemid and adriamycin. We were able to identify at least six cell subpopulations for PI stained cells using LSC; namely G1, S, G2, M, postmitotic and quiescent cell populations. LSC analysis facilitates the monitoring of effects of drugs on the cell cycle.

Cell Cycle↗

PubMedDate not supplied

Protecting the viability of hepatic allografts procured from non-heart-beating donors by blockade of endothelin and platelet activating factor in porcine liver transplantation.

PROBLEM: The function of hepatic allograft from non-heartbeating donors (NHBD) is significantly affected by warm ischemic injury before harvesting. MATERIALS AND METHODS: The effects of the endothelin (ET) antagonist TAK-044 and the platelet activating factor (PAF) antagonist E5880 on the function of grafts from NHBD were evaluated in a porcine orthotopic liver transplantation. The liver grafts were subjected to 90 min of warm ischemia and 4 hours cold preservation. Group 1 (n = 4; n is the number of donor/recipient pairs) was used as a control (untreated). In group 2 (n = 4), donors and recipients were treated with TAK-044 (3 mg/kg). In group 3 (n = 4), pigs were treated with E5880 (0.3 mg/kg). In group 4 (n = 4), pigs were treated with TAK-044 and E5880. RESULTS: The 7 day survival rate of the recipients in groups 1, 2, 3 and 4 was 0, 25, 25 and 100%, respectively (p<0.05, group 1 versus 4). The increases of the serum concentrations of aspartate transaminase, lactate dehydrogenase and arterial lactate 1-4 hours after transplantation were significantly inhibited in the treated groups. CONCLUSION: The blockade of ET and PAF has protective effects on the function of hepatic grafts from NHBD.

Animals↗