Biomedical subjects

Taijiro Sueda

Publications and source records attributed to Taijiro Sueda.

At least 91 records · Page 5Linked to original sources

PubMed2004

[Appropriate antibiotic prophylaxis and treatment in surgery--comparison of concepts in North America and Japan].

Three principles must be followed to maximize the benefits of antimicrobial prophylaxis (AMP): 1) use an AMP agent that is bactericidal with a spectrum that covers the most probable intraoperative contaminants; 2) the initial dose of AMP agents should be given no more than 30 min before the skin is incised: and 3) maintain effective levels of antibiotics throughout the surgery and until at most a few hours after the incision is closed in the operating room. These recommendations have become standardized in North America and Europe. A few controversies, however, persist in Japan, especially concerning the duration of AMP. Most practitioners recommend that prophylaxis be continued until postoperative day 3 to 4. However, some authors reported that the administration of AMP agents for 3 to 4 days causes the development of resistant strains. It is thus necessary to formulate national guidelines for appropriate AMP which are validated by the results of randomized, controlled trials conducted in Japan. In the treatment of postoperative infections, Gram-stain-based antibiotic selection is necessary and full knowledge of the interrelationships between pharmacokinetics and pharmacodynamics is important for determining effective regimens. The time that serum levels exceed the minimum inhibitory concentration is the most significant parameter determining the efficacy of beta-lactams, whereas the log area under the curve and peak serum level are the major parameters for aminoglycosides and new quinolones, respectively. Careful application of these concepts should allow surgeons to use more optimal dosing regimens in Japan.

Anti-Bacterial Agents↗

PubMed2004

[A case of recurrent gastric cancer with malignant ascites responding dramatically to chemotherapy with paclitaxel infused systemically and intraperitoneally].

We report a case in which chemotherapy with paclitaxel (TXL) infused systemically and intraperitoneally was effective for gastric cancer with malignant ascites. A 69-year-old man suffering from advanced gastric cancer with peritoneal dissemination underwent distal gastrectomy, a radical C operation. After chemotherapy with TS-1 and low-dose CDDP, TS-1 was administrated on an outpatient basis for 6 months. However, he complained of abdominal fullness and ascites, and received combination chemotherapy with paclitaxel infused systemically and intraperitoneally as second-line treatment. The ascites completely disappeared 5 weeks after administration. The only toxic event was anemia (grade 1), and no major adverse effects were observed.

Aged↗

PubMed2003

Expression profiling of favorable and unfavorable neuroblastomas.

Neuroblastomas show remarkable biological heterogeneity, resulting in favorable or unfavorable outcomes. To survey the differences in gene expression profiles between favorable and unfavorable neuroblastomas, we analyzed ten favorable neuroblastoma samples from patients whose tumors consequently regressed or matured and ten unfavorable tumor samples from patients who consequently died of disease using the microarray technique. In each sample, total RNA was labeled with Cy3 or Cy5 in reverse-trancriptase reaction and hybridized with our original microarray prepared with a cDNA library of human fetal brain. Microarray analysis revealed that 43 genes, including MYCN, hTERT, NME1 and cell cycle regulatory protein-coding genes, were highly expressed in unfavorable neuroblastomas, while another 80 genes were detected as highly expressed in favorable tumors, including neuronal differentiating genes and apoptotic inducing genes. Among favorable neuroblastoma samples, highly expressing genes in regressing tumors were different from those in maturing tumors. Expression profiling data revealed the existence of up-regulated and down-regulated gene clusters in favorable and unfavorable tumors. This cluster analysis is a powerful procedure to distinguish unfavorable tumors from favorable tumors as well as regressing tumors from maturing tumors among favorable tumors. The information obtained from expression profiling would clarify the key genes for cell growth, regression or maturation of neuroblastoma cells, and these genes will become diagnostic and therapeutic targets in human neuroblastoma in the future.

Apoptosis↗

PubMed2003

The effect of antibiotics and bismuth on fecal hydrogen sulfide and sulfate-reducing bacteria in the rat.

Colonic bacteria produce the highly toxic thiol, hydrogen sulfide. Despite speculation that this compound induces colonic mucosal injury, there is little information concerning manipulations that might reduce its production. We studied the effect of antibiotics and bismuth on the production of hydrogen sulfide in rats. Baseline fecal samples were analyzed for hydrogen sulfide concentration and release rate during incubation and numbers of sulfate-reducing bacteria. Groups of six rats received daily doses of ciprofloxacin, metronidazole, or sulfasalazine for one week, and feces were reanalyzed. Bismuth subnitrate was then added to the antibiotic regimens. While sulfide production and sulfate-reducing bacteria were resistant to treatment with ciprofloxacin or metronidazole, bismuth acted synergistically with ciprofloxacin to inhibit sulfate-reducing bacteria growth and to reduce sulfide production. Combination antibiotic-bismuth therapy could provide insights into the importance of sulfide and sulfate-reducing bacteria in both human and animal models of colitis and have clinical utility in the treatment of antibiotic-resistant enteric pathogens.

Animals↗

PubMed2003

Adenosquamous carcinoma of the pancreas: preoperative diagnosis and molecular alterations.

Adenosquamous carcinoma of the pancreas is a rare tumor which has a less favorable prognosis than common ductal cell carcinoma of the pancreas, and a definite preoperative diagnosis of this tumor is quite difficult. We herein report two cases of this rare variant. The patients were a 41-year-old man (patient 1) and a 67-year-old woman (patient 2). Patient 1 had a hypoechoic mass measuring 3 cm in the uncus of the pancreas, while patient 2 had a huge mass, measuring 8 cm, in the tail of the pancreas. Patient 2 was successfully diagnosed preoperatively as having an adenosquamous carcinoma, by cytological examination of the pure pancreatic juice obtained by endoscopic retrograde pancreatic juice aspiration. A pylorus-preserving pancreatoduodenectomy was performed for patient 1, and a distal pancreatectomy with resection of the spleen and the left kidney was performed for patient 2. Subsequent pathological findings of these two tumors revealed adenosquamous carcinoma of the pancreas. K- ras point mutation, p53 overexpression, and telomerase activity in both tumor specimens were detected by the mutant allele specific amplification method, immunohistochemical staining, and telomeric repeat amplification protocol assay, respectively. The two patients died of recurrent disease 5 and 4 months, respectively, after surgery. Cytological examination of pure pancreatic juice is a useful modality for the preoperative diagnosis of this tumor, and frequent molecular alterations may be associated with the poor prognosis of adenosquamous carcinoma of the pancreas.

Adult↗

PubMed2003

Fate of aneurysms of the distal arch and proximal descending thoracic aorta after transaortic endovascular Stent-Grafting.

BACKGROUND: The purpose of this study was to evaluate the midterm results of transaortic stent-grafting for distal aortic arch aneurysms or proximal descending aortic aneurysms and the feasibility of this method for thoracic aortic aneurysm repair. METHODS: Twenty-three patients with true distal aortic arch aneurysms or proximal descending thoracic aortic aneurysms were repaired with the stent-graft introduced through the incision on the proximal arch aorta. Follow-up computed tomography was performed every 6 months in 21 surviving patients. The maximum dimension of the excluded aneurysmal space and the maximum aneurysmal diameter were measured and evaluated to determine whether the aneurysmal space decreased or disappeared after this alternative procedure. RESULTS: There was 1 hospital death (4.3%) due to cerebral embolism. Another patient died of pneumonia 1 year after surgery. Twenty-one patients (91%) survived during the follow-up period, but 1 patient (4.3%) suffered from paraplegia. The follow-up period ranged from 12 to 62 months (average, 34.3 +/- 15.2). There were no instances of aneurysmal rupture during the follow-up period. Postoperative serial computed tomography scans showed disappearance or significant shrinkage of the excluded aneurysmal space in 20 of 21 patients (95%), except for the one patient with endoluminal leakage. CONCLUSIONS: Transaortic endovascular stent-grafting was an effective alternative approach to treating distal aortic arch aneurysms or proximal descending aortic aneurysms. The excluded aneurysm disappeared or shrunk after successful placement of the stent-graft.

Aged↗

PubMed2003

Relevance of antimicrobial agent-induced endotoxin release from in vitro cultured Escherichia coli and in vivo experimental infection with Gram-negative bacilli.

In vitro exposure of Gram-negative bacilli (GNB) to antimicrobial agents may induce endotoxin (ET) release, that may cause various reactions in vivo resulting in endotoxic shock. We used the antimicrobial agents, flomoxef (FMOX) and gentamicin (GM), to investigate the kinetics of ET released from in-vitro-cultured Escherichia coli and to examine the ET effect on tumor necrosis factor (TNF) production by macrophages. In a rabbit model of E. coli peritonitis, we measured plasma ET, TNF and blood bacterial counts under the administration of FMOX or GM. In our in vitro experiment, ET levels under FMOX were significantly higher than those under GM, and ET induced TNF production in a dose-dependent manner. However, in vivo, plasma ET, TNF, and blood bacterial counts under antimicrobial agents were significantly lower than those of the controls, and those under FMOX treatment did not differ from those under GM treatment. Thus, ET release may not be a critical problem in GNB infections if appropriate antimicrobial agents are administered.

Animals↗

PubMed2003

The snuffbox technique: a reliable color Doppler method to assess hand circulation.

OBJECTIVE: Although the Allen test is crude and subjective, an objective color Doppler method has yet to be established in the assessment of hand circulation before radial artery harvesting. Doppler studies so far have neglected the Doppler principle that the insonation angles should be less than 30 degrees and have not been compared with any standard except the crude Allen test. We therefore introduced the snuffbox technique, measuring the radial artery at the anatomic snuffbox, which is the most distal area after harvesting. Color Doppler methods were compared with the stump pressure as a criterion standard. METHODS: Maximal flow velocity and Doppler angles of the snuffbox, palmar artery, and ulnar artery were measured in 20 hands before and after radial artery harvesting. Stump pressure was measured during surgery. RESULTS: Maximal flow velocity in the snuffbox decreased with radial artery compression and after radial artery harvesting. All the flow patterns in the snuffbox technique showed simultaneous reversal. Maximal flow velocity in the ulnar artery increased with radial artery compression and after radial artery harvesting. Maximal flow velocity in the palmar artery did not change significantly with radial artery compression or after radial artery harvesting. Doppler angles were 20.9 degrees +/- 6.0 degrees in the radial artery of the snuffbox, 82.5 degrees +/- 6.1 degrees at the palmar artery, and 81.0 degrees +/- 7.6 degrees at the ulnar artery. The changes in the snuffbox technique were highly correlated with the stump pressure ratio (P <.001). CONCLUSIONS: Among various color Doppler methods, the snuffbox technique was precise and reliable.

Aged↗

PubMed2003

Retro-sartorius bypass in the treatment of graft infection after peripheral vascular surgery.

Extra-anatomic bypass is preferred for revascularization after removal of infected vascular grafts. The obturator canal technique has been used to bypass an infected field in the groin, although this method has not always been definitive because of several drawbacks. We present a unique method of extra-anatomic revascularization for use in such a situation. An autogenous graft is placed just below the sartorius muscle in the thigh and penetrates the iliacus muscle near the lateral end of the inguinal ligament. Limb loss and recurrent infection are prevented postoperatively. This retro-sartorius bypass technique may be a useful alternative to obturator bypass grafting in selected patients.

Aged↗

PubMed2003

Fluorescent-based BAT-26 analysis for distinct screening of microsatellite instability in colorectal cancers.

For easy screening of genetic instability in colorectal cancers, we tried BAT-26 and BAT-25 mononucleotide repeats using fluorescent analysis and evaluated their usefulness and problems compared with other markers: D5S346, D17S250, D2S123, and D2S391, D4S392 (located near BAT-26 and BAT-25 respectively). The high-frequency of MSI (MSI-H) tumours, defined as tumours having instability in more than two markers, were detected in 8/146 (5.5%). These MSI-H cases were younger ages at diagnosis, and showed significantly higher incidences of right side location, and poorly differentiated histology than other cases (p<0.05). Four cases (2.7%) showed a 1 bp size shift in BAT-26 and 2 of them showed loss of heterozygosity (LOH) at D2S391 near BAT-26 locus. Among 9 cases with a 1 bp size shift in BAT-25, 6 cases showed LOH at D4S392 near the BAT-25 locus (p=0.035). In all 4 cases, non-cancerous DNA had two analogous peaks of BAT-26, indicating the heterozygosity of BAT-26 in constitutional DNA. This phenomenon was also detected in the peaks of BAT-25 in some cases, in whose constitutional DNAs, 1 bp size shift was also detectable in three other markers. To elucidate the reasons for the alterations of the 1 bp size shift of peak of these markers, we examined by microsatellite analysis mixed samples of tumour DNA with complete loss of the one allele at the 1p loci and each constitutional DNA sample of neuroblastoma patients. One base shift of the peak signal of the microsatellite marker was clearly obtained in proportion to the ratio of cancerous DNA and constitutional DNA. Fluorescent-based analysis of BAT-26 or BAT-25 was easy and useful for detection of MSI-H in colorectal cancers without analyzing non-cancerous DNA. A 1 bp size shift in BAT-26 or BAT-25 was considered to be affected by LOH at these loci. Thus, it is important to distinguish MSI from LOH to evaluated MSI using these markers.

Adult↗

PubMed2003

[A case of advanced gastric cancer with abdominal paraaortic lymph node swelling successfully resected following neoadjuvant chemotherapy of TS-1 and low-dose cisplatin].

A 63-year-old man who had suffered from anorexia and body weight loss was admitted to the hospital. Upper GI series and an endoscopic examination revealed type 3 cancer in the posterior wall of the cardia. Abdominal CT scan showed enlargement of No. 16 lymph nodes. Preoperative diagnosis was stage IV gastric cancer (T3 (SE) H0 P0 N3), and we considered a curative operation impossible. Therefore, neoadjuvant chemotherapy with TS-1 and low-dose cisplatin (CDDP) was planned. After 4 weeks of administration, the primary lesion was reduced in size and the No. 16 lymph nodes were shrunken remarkably. Therefore, a total gastrectomy with a splenectomy, a distal pancreatectomy, and D3 lymph node dissection was performed. Histological findings demonstrated the degeneration of cancer cells and fibrosis in the primary tumor and metastatic regional lymph nodes. There were no viable cancer cells in the No. 16 lymph nodes. The histological changes against neoadjuvant chemotherapy were judged to be Grade 1b for the main tumor and Grade 3 for the No. 16 lymph nodes. Neoadjuvant chemotherapy with TS-1 and low-dose cisplatin is so effective in a short period that can be adapted to advanced gastric cancer for downstaging.

Adenocarcinoma↗

PubMed2003

[Bacteria isolated from surgical infections and its susceptibilities to antimicrobial agents--special references to bacteria isolated between April 2001 and March 2002].

Isolated bacteria from infections in general surgery during the period from April 2001 to March 2002 were investigated in a multicenter study in Japan, and the following results were obtained. In this series, four hundred and twenty strains were isolated from 175 (79.2%) of 221 patients with surgical infections. One hundred and eighty-six strains were isolated from primary infections, and 234 strains were isolated from postoperative infections. From primary infections, anaerobic Gram-positive bacteria were predominant, while from postoperative infections, aerobic Gram-positive bacteria were predominant. Among aerobic Gram-positive bacteria, although the isolation rate of Staphylococcus aureus was the highest, followed by that of Enterococcus faecalis from primary infections, the isolation rate of E. faecalis was the highest from postoperative infections. Among anaerobic Gram-positive bacteria, the isolation rate of Peptostreptococcus spp. was the highest from both types of infections. Among aerobic Gram-negative bacteria, Escherichia coli was the most predominantly isolated from primary infections, followed by Klebsiella pneumoniae and Pseudomonas aeruginosa in this order, and from postoperative infections, P. aeruginosa was the most predominantly isolated, followed by Enterobacter spp., E. coli and Klebsiella spp. Among anaerobic Gram-negative bacteria, the isolation rate of Bacteroides fragilis group was the highest from both types of infections. The isolation rate of aerobic Gram-negative bacteria from primary infections and that of aerobic Gram-positive bacteria from postoperative infections were high in the last several years. We noticed no vancomycin-resistant Gram-positive cocci.

Anti-Bacterial Agents↗

PubMed2003

Surgical treatment of aortic coarctation associated with multi-vessel brachiocephalic involvement in takayasu's arteritis.

In Takayasu's arteritis (TA), both atypical coarctation (CO) and brachiocephalic involvement are common features that occasionally require operative correction. A combination of these abnormalities could duplicate underlying illness in patients, posing an increased risk of operative morbidity. We present, herein, two TA patients in which hypertensive heart disease secondary to CO was surgically corrected. Both patients had multi-vessel brachiocephalic disease. One patient who showed occlusion of all brachiocephalic arteries underwent aorto-aortic bypass, while another with two-vessel lesion underwent axillo-bifemoral bypass grafting. Subclavian reconstruction was supplemental to each procedure, resulting in relief of neurologic stigmata. Strategies to avoid intraoperative cerebral ischemia played an important role in the surgical repair of such TA-related extensive vascular lesions.

Aortic Coarctation↗

PubMed2003

[Antiinfective host defense mechanism: toll-like receptors and innate immunity].

The innate immune system has evolved as the first line of defense against invading microorganisms. The recent discovery of the toll-like receptors(TLRs) has rapidly expanded our knowledge of molecular events that initiate host-pathogen interactions. The TLRs, which are expressed on the surface of cells, involved in innate immune recognition, including macrophages and dendritic cells, have a crucial role in the detection of microbial infection. Signals initiated by the interaction of TLRs with pathogen-associated molecular patterns (PAMPs) induce activation of the inflammatory and antimicrobial innate immune response. Ten members of the TLR family have been identified, and they appear to recognize PAMPs, including lipopolysaccharide, peptidoglycan, and bacterial DNA. There has been considerable interest in how adaptive immune responses are controlled by the innate immune system. Recent studies have suggested that TLRs may control the induction of Th1 responses and that a separate system of recognition regulates the Th2 response. Thus TLR signaling represents a key component in the innate immune response to microbial infection.

Animals↗

PubMed2003

Trans-vertebral regional cooling for spinal cord protection during thoracoabdominal aortic surgery: an experimental study.

We developed a simple cooling method for spinal cord protection against ischemic injury during aortic surgery. The neuroprotective effects of our method were investigated using an animal study. Selective spinal hypothermia was produced by means of originally-designed cooling pads placed over the lower thoracic and lumbar vertebral column. Spinal cord ischemia was induced by cross-clamping the thoracic aorta for 60 min in beagle dogs. The neuroprotective effects were evaluated by a multi-modal study. The motor-evoked potentials of the spinal cord resulting from transcranial electric stimulation (MEPs) were recorded during both the ischemic and reperfusion periods. Hindlimb motor function was graded with the Tarlov score, and a histologic examination of the spinal cord injury was performed, at 24 hours after ischemia in animals undergoing hypothermia (hypothermia group: n = 7) or a sham (control group: n = 7). The spinal cord temperatures at the lower thoracic (T10) and lumbar (L3) levels decreased by -9.1 degrees C per hour and -8.1 degrees C per hour, respectively. The amplitude of the MEPs decreased during ischemia in both groups of animals, and significantly recovered during the early phase of aortic reperfusion in the hypothermia group. The Tarlov scores in the hypothermia and control groups were 3.3 +/- 1.0 and 1.1 +/- 1.5 (mean +/- SD, p = 0.015), respectively. Histopathologic study revealed that ischemic injury of the lumbar cord was reduced in the animals undergoing hypothermia. Trans-vertebral regional cooling reduced ischemic spinal cord injury in a canine study. The current method is potentially feasible for clinical use, especially in view of its technical simplicity and few procedure-related complications.

Animals↗

PubMed2002

Long-term results of seton drainage on complex anal fistulae in patients with Crohn's disease.

BACKGROUND: The aim of this study was to assess the long-term (greater than 2 years) results of seton drainage on anal fistulae in patients with Crohn's disease. METHODS: Between September 1990 and September 1999, 32 patients with Crohn's disease underwent seton drainage for complex anal fistulae. The median follow-up time in these patients was 62 months (range, 25-133 months). In 10 patients (31.3%), recurrent perineal abscesses occurred with inlying seton drainage, and these were drained by re-insertion of the seton. A Malecot catheter was also inserted in 8 patients with recurrence. RESULTS: The overall success rate of long-term seton usage was 87.5%. The subsequent associated procedure was simple seton removal ( n = 9), secondary core-out fistulectomy ( n = 7), or lay-open fistulotomy ( n = 4). Eleven patients still had the seton in place. Recurrence developed in 3 patients (33%) who underwent simple seton removal and in 2 patients (18.2%) who underwent the secondary core-out procedure or fistulotomy. At the last follow-up examination, continence had not changed in 28 (87.5%) of the 32 patients. No change in continence was experienced by 10 of the 11 patients who underwent secondary fistulotomy or the secondary core-out procedure. CONCLUSIONS: Long-term seton drainage for complex anal fistula in Crohn's disease is efficacious in both treating sepsis and preserving anal sphincter function. A relatively good result was achieved by the secondary core-out procedure or fistulotomy at the time of seton removal.

Adolescent↗

PubMed2002

Changes in the intestinal flora after the administration of prophylactic antibiotics to patients undergoing a gastrectomy.

PURPOSE: Changes in the intestinal flora were investigated in patients administered antibiotics for 4 days after a gastrectomy. METHODS: Twenty-four patients were divided into each of the following groups: cefazolin, 1 g every 8 h; cefozopran, 0.5 g every 8 h; flomoxef, 1 g every 8 h. All drugs were administered intravenously for a 4-day period. RESULTS: Antibiotic prophylaxis caused no major change in the total number of anaerobes because of the preservation of the Bacteroides fragilis group. However, the number of Bifidobacterium, Lactobacillus, Eubacterium, and Veillonella spp. decreased by an average of 100-fold. These changes were accompanied by an overgrowth of Enterococcus spp. and Pseudomonas aeruginosa. CONCLUSIONS: Four days of antibiotic prophylaxis after surgery caused a suppression of colonization resistance in the intestinal flora. Certain genera of anaerobes may thus play an important role in preventing overgrowth of antibiotic-resistant organisms after surgery. Surgeons should decide the duration of antibiotic use after carefully considering its influence on the intestinal flora.

Adult↗

PubMed2002

Bacterial translocation in patients with Crohn's disease undergoing surgery.

PURPOSE: Much evidence, derived from experimental studies, suggests that bacterial translocation indeed occurs, yet its clinical significance is still a matter of controversy in humans. The aims of this study were to determine the prevalence of bacterial translocation in patients with Crohn's disease undergoing laparotomy and to identify any association with postoperative septic complications or systemic inflammatory response syndrome. METHODS: Mesenteric lymph node and peripheral blood samples from 42 patients with Crohn's disease undergoing laparotomy were collected for bacteriologic assessments. RESULTS: Bacterial translocation to mesenteric lymph node was identified in 20 patients (48 percent). The most common organism was (27 percent). Blood cultures were positive in 2 of 20 patients in whom translocation to lymph node was identified. Bacterial translocation was associated with a greater than two-fold increase in the incidence of postoperative septic complications (35 14 percent), but this difference was not significant. In the analysis of the occurrence of systemic inflammatory response syndrome, a significantly higher incidence continued until the third postoperative day in patients with those without bacterial translocation. In a logistic regression analysis, bacterial translocation had a significant effect on the occurrence of systemic inflammatory response syndrome, even though septic complications were taken into account. CONCLUSIONS: Bacterial translocation to mesenteric lymph node predisposed patients with Crohn's disease undergoing laparotomy to systemic inflammatory response syndrome.

Adolescent↗