Biomedical subjects

T Yamamura

Publications and source records attributed to T Yamamura.

485 records · Page 27Linked to original sources

PubMedDate not supplied

Effects of the Na+/H+ exchange inhibitor cariporide (HOE 642) on cardiac function and cardiomyocyte cell death in rat ischaemic-reperfused heart.

1. Na+/H+ exchange has been implicated in the mechanism of reperfusion injury. We examined the effects of the cardiac-specific Na+/H+ exchange inhibitor cariporide (HOE 642) on postischaemic recovery of cardiac function and cardiomyocyte cell death (i.e. necrosis and apoptosis). 2. Rat isolated and buffer-perfused hearts were subjected to 25 min normothermic global ischaemia followed by 120 min reperfusion. Cariporide (10 micromol/L) or its vehicle (0.01% dimethylsulphoxide) was administered for 15 min before ischaemia and for the first 30 min after reperfusion. 3. Cariporide significantly improved the recovery of isovolumic left ventricular function (heart rate, left ventricular developed pressure and left ventricular end-diastolic pressure) and coronary flow throughout reperfusion. Creatine kinase release during reperfusion was significantly less in the cariporide-treated heart. In situ terminal deoxynucleotidyl transferase-mediated dUTP nick-end labelling (TUNEL)-positive cardiomyocytes were also significantly less in the cariporide-treated heart after 120 min reperfusion. Electron microscopy showed necrotic changes without typical apoptotic features in cardiomyocytes after reperfusion. Such necrotic changes were mitigated by cariporide. Simultaneous detection of necrotic and apoptotic cardiomyocytes using propidium iodide (PI) and Annexin V revealed that cardiomyocytes in the infarct area were stained with only PI or both PI and Annexin V. Cariporide did not alter the pattern of cardiomyocyte staining with PI and Annexin V, although the number of cardiomyocytes stained with PI or PI plus Annexin V was less than that in vehicle-treated hearts. 4. These results suggest that apoptosis is not a major manifestation of cardiomyocyte cell death in the ischaemic-reperfused myocardium and a cariporide-sensitive mechanism of reperfusion injury promotes both necrotic and apoptotic processes of cell death.

Animals↗

PubMedDate not supplied

Intrathyroid thyroglossal duct cyst simulating a thyroid nodule.

A case of intrathyroid thyroglossal duct cyst is reported. A 50-year-old woman presented with a right lateral neck mass that was clinically indistinguishable from a thyroid nodule. Ultrasound-guided fine-needle aspiration biopsy (US-FNAB) revealed normal-looking squamous cells. Right thyroid lobectomy was performed and microscopic examination revealed a cyst lined by squamous epithelium that was consistent with a thyroglossal duct cyst. The lesion was completely surrounded by normal thyroid tissue. Our experience suggests that intrathyroid thyroglossal duct cyst should be remembered in the differential diagnosis of a thyroid nodule. Detection of benign squamous cells by US-FNAB may be useful for ruling out the possibility of a cystic thyroid tumor.

Biopsy, Needle↗

PubMedDate not supplied

Ultrasound-guided fine-needle aspiration biopsy for breast tumors: needle guide versus freehand technique.

BACKGROUND: We retrospectively studied whether a needle guide is necessary when performing ultrasound-guided fine-needle aspiration biopsy (US-FNAB) in patients with breast tumors. METHODS: A total of 47 patients (50 lesions) with breast tumors underwent US-FNAB with a needle guide and 127 patients (143 lesions) underwent the procedure without a needle guide (freehand biopsy). The diagnoses obtained by US-FNAB were compared with the surgical findings. RESULTS: The sensitivity of freehand biopsy for tumors < 3 cm in diameter was significantly higher than that of the needle guide technique. CONCLUSIONS: We recommend performing US-FNAB without a needle guide (freehand biopsy) in order to maximize the correct preoperative diagnosis rate, especially in patients with tumors < 3 cm in diameter.

Biopsy, Needle↗

PubMedDate not supplied

The usefulness of pharmacokinetic modulating chemotherapy (UFT plus 5FU) in the treatment of unresectable colorectal carcinomas.

This study was performed to improve the prognosis of unresectable (primary non-curative and recurrent) colorectal carcinoma by using pharmacokinetic modulating chemotherapy (PMC), a combination of oral UFT and continuous venous 5FU infusion. The subjects were 120 patients who were prospectively selected for this study. The patients selected PMC or alternative treatment. Fifty-six patients received PMC. The PMC group received 200-400 mg/body/ day UFT orally 5-7 days per week and 600 mg/m2/24 h 5FU infusion once a week. PMC markedly improved the median survival period (26.6 months vs. 9.2 months P<0.000001). This significant improvement as observed in unresectable primary colorectal carcinoma (P=0.0003), recurrent tumors (P<0.00001), local extension (P=0.01), lung metastases (P=0. 03), liver metastases (P=0.0001), and peritoneal seedings (P=0.02). One of 56 patients who received PMC developed grade 4 toxicity. PMC significantly improved the prognosis of unresectable colorectal carcinoma which has a low survival rate. PMC also indicated tolerable compliance and cost effectiveness.

Administration, Oral↗

PubMedDate not supplied

Massive pleural effusion and ascites resulting from esophagectomy with extensive lymphadenectomy for cancer of the abdominal esophagus.

Chylothorax is an uncommon but well recognized complication of esophagectomy. We present the case of a 57 year-old man with squamous cell carcinoma of the abdominal esophagus who underwent subtotal esophagectomy by right thoracotomy. Post-operatively, the volume of pleural effusion from the right chest was increased (1600-2000 ml/day). The effusion was straw colored, not changing to milky after meals. The characteristics and composition of the pleural fluid were similar to those of chyle. We therefore treated this patient using methods for treatment of chylothorax, conservatively, by administration of OK-432 and minocycline/hydrochloride into the pleural cavity from the chest tube with success. We discuss the pathophysiology of this unusual condition and its treatment.

Anti-Bacterial Agents↗

PubMedDate not supplied

Possible development of idiopathic sclerosing encapsulating peritonitis.

We report a rare case of idiopathic sclerosing encapsulating peritonitis (SEP). During a laparotomy before undergoing a distal gastrectomy with Billroth II reconstruction for early gastric cancer, the patient was found to have a membranous encapsulation wrapping each small bowel loop, unlike peritoneal encapsulation or typical SEP. He had complained of persistent heartburn, distension and diarrhea for 2 months in the post-operative course. The second laparotomy, which was performed to improve prolonged transit, revealed typical SEP with a thick and fibrotic membrane that encased the small bowel entirely. Stripping of the sclerosing encasing membrane, separation of the adherent loops of the proximal small bowel, and Braun's anastomosis were performed. The patient complained of epigastric fullness and diarrhea after he was relieved from the complete bowel obstruction for 45 days post-operatively. Trimebutine maleate was administrated 5 months after the second operation and this markedly improved his symptoms. This case might reflect the developmental process of idiopathic SEP. In addition, the use of a motility regulator may improve symptoms related to the abnormal intestinal motility by this disease.

Adenocarcinoma↗

PubMedDate not supplied

Acute acalculous cholecystitis in a patient on total parenteral nutrition: case report and review of the Japanese literature.

Acute acalculous cholecystitis (AAC) is a rare and dangerous complication of various medical and surgical conditions. We report on a male patient with bile panperitonitis caused by gangrenous AAC, which developed while he was on total parenteral nutrition (TPN) for ileus related to obstructive colon cancer. We also review the relevant Japanese literature on AAC associated with TPN. Our patient suddenly developed right hypochondrial pain after 3 days of TPN while waiting for colon cancer surgery. We diagnosed acute AAC by ultrasonography, and salvaged the patient by cholecystectomy plus left colectomy. Early diagnosis by ultrasound is important for this critical condition. Knowledge of the risk of acute gangrenous cholecystitis during TPN may allow the physician to provide an appropriate diagnosis and treatment.

Acute Disease↗

PubMedDate not supplied

Effects of elemental diet (ED) on surgical treatment in Crohn's disease.

BACKGROUND/AIMS: Patients with Crohn's disease are at risk of developing short bowel syndrome if they are treated with repeated operations. We examined the effect of preoperative nutritional therapy with elemental diet on the interval until and the outcome after surgical treatment in patients with Crohn's disease. METHODOLOGY: We reviewed the records for 73 patients with Crohn's disease who underwent intestinal resection in our department between January 1, 1974 and December 31, 1996. Thirty-two of them had not received elemental diet (No ED group) and 41 had received elemental diet therapy (ED group) before the first resection. RESULTS: The median interval between the onset and first resection was 19.3 months for the NoED group and 67.5 months for the ED group (P = 0.0005). All patients received ED therapy after the first resection. The incidence of second resection was significantly different between the ED and the NoED group after the first operation. (P = 0.045). CONCLUSIONS: Elemental diet therapy is effective in prolonging the interval between the onset and first resection and in reducing the incidence of second resection. The initial introduction of elemental diet therapy is useful in the management of the clinical course of Crohn's disease minimizing surgical intervention.

Adolescent↗

PubMedDate not supplied

Lymphangioma of the colon: a case report and review of the Japanese literature.

Intraabdominal lymphangiomas are rare, although these lesions can occur in the mesentery, omentum, retroperitoneum, or gastrointestinal tract wall. Here we report a case of lymphangioma of the transverse colon and review the other cases reported in the Japanese literature. Our patient presented with lower abdominal pain and barium enema revealed a filling defect in the transverse colon. Colonoscopy disclosed a submucosal tumor, which changed shape with alteration the patient's position and showed the cushion sign. This lesion was covered with normal-looking mucosa. A correct diagnosis was made from these findings. Knowledge of these endoscopic features may help physicians to provide appropriate diagnosis and treatment of colonic lymphangioma.

Biopsy, Needle↗

PubMedDate not supplied

The efficacy of whole gut irrigation with polyethylene glycol electrolyte solution in elective colorectal surgery for cancer.

Sixty-four patients undergoing elective operations for cancer of the colon and rectum were given mechanical bowel preparation in the form of whole gut irrigation with polyethylene glycol electrolyte solution. When their colonic cleansing scores were compared, it was found that the preparation was significantly less effective in the left colon (n = 49) than in the right (n = 15), the mean (SEM) scores being 3.8 (0.56) and 2.65 (1.01), respectively, p less than 0.001. We then compared the scores of 26 patients with stenosing lesions with those of 38 that were not: in the right colon the score for stenosing tumours was 3.9 (0.14) compared with 3.8 (0.25) for non-stenosing tumours. In the left colon, however, they were 2.3 (0.23) and 2.9 (0.18), respectively (p less than 0.01). We conclude that stenosis of the colon caused by malignant lesions reduces the efficacy of mechanical bowel preparation with polyethylene glycol electrolyte solution in the left colon but not in the right colon.

Colon↗

PubMedDate not supplied

Clinical features of familial hypercholesterolemia.

The clinical consequences of familial hypercholesterolemia (FH) result from its metabolic peculiarities that persist from very early childhood, leading to the accumulation of cholesterol in the form of xanthomas in skin and tendons and atheromatous lesions in the arterial wall, in particular, in the aorta and the stem of coronary arteries. Plasma cholesterol concentration markedly increases during the suckling period, soon attaining a level near 1000 mg/dl in homozygotes and 200 to 400 mg/dl in heterozygotes. By age 50, about 80% of FH males suffer from ischemic heart diseases, while only 20% to 30% of the females are moderately affected by coronary atherosclerosis. In addition to the low density lipoprotein (LDL) cholesterol level, higher triglyceride and lower high density lipoprotein (HDL) cholesterol levels correlate with an increased risk of ischemic heart diseases. A very important problem is that most of these patients do not feel themselves to be seriously ill until a severe myocardial infarction (often leading to sudden death) takes place during the third to fifth decades of life. Among the different types of receptor mutations, the incidence of ischemic heart diseases was much higher and more extensive among patients with the receptor-negative type than among those with the receptor-defective type with a residual receptor activity.

Age Factors↗

PubMedDate not supplied

Colonic J pouch-anal reconstruction with gluteus maximus transposition for a post-irradiation rectovaginal fistula.

A 44-year-old female with rectal cancer underwent anoabdominal rectal resection and colonic J pouch-anal anastomosis after preoperative intraluminal brachytherapy. Pelvic sepsis developed a rectovaginal fistula. We attempted to close the fistula and restore the anal function with coloanal re-anastomosis and bilateral gluteus maximus transposition. She regained good anal function without recurrence of the fistula.

Adult↗

PubMedDate not supplied

Hepatic artery-biliary fistula during infusion chemotherapy.

A 52-year-old man with rectal cancer and liver metastasis underwent tumor resection with hepatic arterial catheterization. During adjuvant chemotherapy, he developed epigastric pain, nausea, and melena. Digital subtraction angiography revealed a hepatic artery-biliary fistula and a pseudoaneurysm at the catheter tip. This rare complication of intra-arterial chemotherapy is reported in detail.

Angiography, Digital Subtraction↗

PubMedDate not supplied

The regrowth of rectal adenocarcinoma after pre-operative radiotherapy with a report of two cases.

To evaluate the factors that contribute towards the regrowth of rectal carcinoma after pre-operative radiotherapy. Of 120 patients, we pre-operatively treated with intraluminal brachytherapy or external beam radiotherapy since 1986, two showed regrowth of rectal carcinoma. For them, the case reports and findings for the resected specimen obtained using immunohistochemical staining for the P53 tumor suppressor gene (P53) and proliferating cell nuclear antigen (PCNA) were retrospectively evaluated. The regrowth of rectal carcinoma was observed 40 days after intraluminal brachytherapy in one patient, and 33 days after external radiotherapy in the other. Both P53 and PCNA staining was seen in the recurrent tumors or during the examination of the resected specimen. These results suggest that polypoid tumors with regrowth have a malignant potential. The interval between radiotherapy and operation reported in the literature varies widely. The potential for regrowth should be considered in the preoperative radiotherapy for rectal cancer.

Adenocarcinoma↗

PubMedDate not supplied

The relationship between stapling doughnuts: characteristics and functional results after total gastrectomy.

BACKGROUND/AIMS: The objective of this study was to determine whether the thickness of the esophageal doughnut is related to postoperative results in total gastrectomy. METHODOLOGY: Thirty-eight total gastrectomy patients were studied, including 18 who underwent jejunal pouch reconstruction and 20 who did not have pouch reconstruction. We used the Proximate-ILS circular stapler, with purse-string suturing at the cut end of the esophagus performing only the mucosal layer manually in all cases. We divided the esophageal doughnuts after stapling into two groups: Group A: doughnut involving muscle tissue of 0-25% of the esophageal circumference; Group B: doughnut involved muscle tissue of 25-100% of the esophageal circumference. Reflux scores and the scintigraphic reflux index were determined. RESULTS: No significant difference was found between the two groups in reflux score or scintigraphic reflux index. CONCLUSIONS: These findings indicate that the degree of postoperative reflux esophagitis was not affected by the amount of the muscular layer included in the esophageal doughnut. Continuity, and not variability of the degree of involved muscle in the esophageal doughnut, is an important factor at the time of stapling.

Aged↗

PubMedDate not supplied

Magnetic resonance imaging in the diagnosis of jejunal leiomyoblastoma.

We report a case of large leiomyoblastoma of the jejunum. The sagittal views in pre-operative magnetic resonance imaging (MRI) indicated that a cystic tumor with solid component was present, sequential from the small bowel. We suspected a smooth muscle tumor of the small bowel, but did not rule out the malignancy. The operative diagnosis was smooth muscle tumor of the proximal jejunum, and partial resection of the small bowel was performed. The pathological examination revealed benign leiomyoblastoma of the jejunum without metastasis. MRI contributed to the pre-operative diagnosis of the origin of this rare tumor, in a non-invasive fashion.

Aged↗

PubMedDate not supplied

The prediction of the prognosis for rectal carcinoma down-staged by pre-operative radiotherapy by transrectal ultrasonography.

BACKGROUND: We attempted to determine whether the results of transrectal ultrasonography (TRUS) could provide any prognostic information about patients with rectal carcinoma treated with pre-operative radiotherapy (RT). METHODS: Ninety-eight patients with rectal carcinoma were treated with pre-operative RT and radical surgery. We categorized the TRUS results with respect to TNM classification before the RT (Pre-RT staging), those after the RT (Post-RT staging), and the results of the pathological examination (Post-OP staging). We analysed the associations among these three stagings, and the survival time of the patients. RESULTS: The prevalence of under T2-stage (TNM classification) in the pre-RT staging was significantly lower than that in both the Post-RT and Post-OP staging. The number of tumours diagnosed as T4 stage in both the Post-RT and Post-OP staging was significantly lower than that before irradiation. The survival periods of the patients with tumours remaining as T4 after radiation were significantly shorter than those of the patients diagnosed as having T4 tumours at the Pre-RT staging (Pre-RT versus Post-RT, p = 0.019; Pre-RT versus Post-OP, p = 0.030). These results suggested that radio-insensitive residual cells might associate with the poor prognosis. CONCLUSION: We could predict the possible prognosis in rectal carcinoma patients treated with pre-operative radiotherapy before operation by TRUS.

Aged↗