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Biomedical subjects

Y Iwata

Publications and source records attributed to Y Iwata.

At least 163 records · Page 9Linked to original sources
PubMed1991

Giant metastatic VIPoma in the liver.

A case of giant metastatic liver VIPoma manifesting WDHA syndrome is described. The patient was a 33-year-old Japanese male who was admitted because of persisting watery diarrhea and weight loss. Laboratory examinations revealed marked hypokalemia, mild hypercalcemia and highly elevated plasma vasoactive intestinal peptide (VIP) and glucagon levels. Intensive imaging examinations disclosed two large tumors in the liver but not in other organs, including the pancreas. Laparoscopy disclosed a slightly elevated purplish-colored large tumor on the surface of the apparently normal liver. At operation, however, a small hard nodule was observed in the tail of the pancreas. Histologically, it was revealed to be a VIPoma resembling a carcinoid or an islet cell tumor, and was identical to the liver tumors. Thus, this neoplasm was considered to be a VIPoma of pancreatic origin, with metastatic lesions in the liver.

Adult↗
PubMed1991

Pathological and angiographic regression of coronary atherosclerosis by LDL-apheresis in a patient with familial hypercholesterolemia.

We present the case of a 42-year-old male with familial hypercholesterolemia (FH) who had received long-term low-density lipoprotein (LDL)-apheresis before death occurred, presumably from an arrhythmia. He had been treated with double filtration plasmapheresis (DFPP) for 4 years and selective LDL adsorbent plasmapheresis (LAPP) for 2 years and 7 months. During the period of treatment (6 years and 7 months) he had received a total of 129 sessions of LDL-apheresis. Serum total cholesterol of the patient before the treatment was 638 mg/dl and during the treatment, the time-averaged values ranged from 336 mg/dl to 411 mg/dl for the first 4 years (with DFPP) and from 257 mg/dl to 364 mg/dl for the sequential 2 years and 7 months (with LAPP). Coronary angiograms were analysed for 13 segments of the coronary arteries using a digitized processing system. Analysis documented regression by identifying a reduction in percent stenosis from 34% to 20% in the proximal left circumflex artery (LCX), from 78% to 61% in the proximal right coronary artery (RCA), and from 92% to 72% in the middle RCA. In the other 10 segments analysed no significant regression and no progression were observed. The autopsy findings of the step-wise serial sections of the native coronary arteries did not record the formation of new and/or typical atheroma. In addition, a thickened intima, and an eccentric thickened wall lesion rich in collagen fiber were observed, although an accumulation of foam cells in the thickened wall lesions was found in some segments. This observation suggested scarring of the atheromatous plaque. We confirmed that LDL-apheresis performed over a period of 6 years and 7 months induced angiographic regression of coronary atherosclerosis in the patient with FH, and found that most of the atherosclerotic lesions were changed pathologically into sclerotic lesions rich in collagen fiber.

Adult↗
PubMed1991

LDL-apheresis and improvement in the coronary atherosclerosis of familial hypercholesterolemia--correlation of computerized quantitative coronary angiography with autopsy findings.

We have evaluated the effects of LDL-aphereses performed over 15 to 62 months, involving both Double Filtration Plasmapheresis (DFPP) and LDL Adsorbent Plasmapheresis (LAPP), for 5 patients with familial hypercholesterolemia (FH) (1; homozygous, and 4; heterozygous) using computer image analysis by coronary angiography, (CAG). Results by CAG showed that in homozygous FH, 9 (75%) of 12 segments demonstrated no progression, 2 (16.7%) segments showed regression, and only 1 (8.3%) segment showed progression. In heterozygous FH, 27 (81.8%) of 33 segments showed progression, and 6 (18.2%) segments showed regression. Aorto coronary bypass was beneficial with obtained patency in 13 (93%) of the 14 grafts. We also performed an autopsy on one patient, with heterozygous FH who died suddenly probably due to fibrillation. The patient had received long-term LDL apheresis for 6 years and 7 months and had shown angiographic regression. The pathological findings showed no typical or new atheroma, significant cicatrization in the thickened intima and an eccentric thickened wall lesion. The serial angiographic findings together with the pathological findings very clearly support the use of LDL-apheresis for producing "true" regression in coronary atherosclerosis in FH.

Adult↗
PubMed1991

[The significance of bacillus Calmette-Guerin in the therapy of carcinoma in situ of the bladder].

We treated ten patients with carcinoma in situ of the bladder (primary type, 6 and secondary type, 4) by intravesical bacillus Calmette-Guerin therapy. All patients received 8 weekly instillation, and among them 3 patients were followed by additional instillation monthly for 7 months. Complete regression (negative biopsies and cytology study) was observed after 8 weekly instillation in all patients. To elucidate the mechanism of action of BCG on carcinoma in situ, the biopsied specimens after BCG instillation were examined light and electronmicroscopically. It was speculated that BCG might act on cancer cells in two ways: one was sloughing and denudation of the cancer cells by acute tuberculous cystitis, and the other was a role of the macrophages through immune reaction. In our study, the toxicity and complications seemed to be much severer than previously reported. Vesicoureteral reflux was observed in 6 patients. Decreased bladder capacity noted in all patients, among them radical cystectomy and colocystoplasty were performed in 2 patients under the diagnosis of bladder contracture. Although complete regression was observed in all patients after 8 weekly BCG instillation, the duration being free from cancer cells was variable. And we also discussed on the additional therapy in such patients in the literature.

Administration, Intravesical↗
PubMed1991

A long-term follow-up study of unicompartmental replacement with a Marmor knee prosthesis and the introduction of a new ceramic prosthesis.

Unicompartmental replacement with a Marmor knee prosthesis was performed in 53 patients with unicompartmental osteoarthritis (OA). A five year or longer follow-up study of 15 joints in 13 of these patients was possible, three of which are now more than 10 years post-operative. All 13 patients reported absence of pain on weight-bearing and were able to flex the replaced knee more than 105 degrees. However, the postoperative femorotibial angle (FTA) appeared to be worsening with time, especially in those cases with an immediate postoperative FTA of more than 180 degrees. Since the needed size of the Marmor prosthesis is no longer available, we began using a ceramic prosthesis recently which we are introducing in this article.

Aged↗
PubMed1991

IgG-kappa type multiple myeloma in alcoholic cirrhosis--a case report.

Transition from polyclonal to monoclonal gammopathy resulted in myeloma in the course of cirrhosis is rare but of interest. We treated such a case of multiple myeloma of IgG-kappa type associated with alcoholic cirrhosis. The case was a 72-year-old Japanese male patient who was admitted because of ascites and edema. Physical examination and laboratory findings including liver histology were compatible with alcoholic cirrhosis. Serum electrophoresis revealed monoclonal hypergammaglobulinemia of IgG-kappa. Bence Jones protein in urine was positive. Bone scintigraphy and roentgenography revealed small punched out lesions in the skull. A bone marrow clot section showed marked infiltration of atypical plasma cells. From these findings multiple myeloma associated with alcoholic cirrhosis was diagnosed. On the basis of a review of the reported cases, the possible relationship between monoclonal gammopathy and chronic liver diseases was discussed.

Aged↗
PubMed1991

[A case of surgically treated simultaneous bilateral squamous cell carcinoma of the lung].

A case of simultaneous, bilateral squamous cell carcinoma of the lung was presented. One located in right basal bronchus had mediastinal lymph node metastasis even though primary lesion was localized within the bronchial wall. So right lower lobectomy with R 2 lymph node dissection was carried out. The left one located in the left basal bronchus was treated using laser preoperatively, which revealed its location and extension. Sequentially S6 segmental sleeve resection was carried out and preserved his residual lung function. Six months later, the third primary lung cancer was found in left B3. We discussed about diagnosis and treatment of the multiple lung cancer and emphasize that bronchoplastic procedures in segmental level is available for treatment of multiple lung cancer.

Aged↗
PubMed1991

[CT-guided stereotactic surgery of brain abscess].

Seven patients with brain abscess underwent CT-guided stereotactic aspiration using Iseki's stereotactic apparatus. Three of them were under the age of fifteen and four were older than thirty. The lesions were single and round in four cases, multilobular in two and multiple in one patient. Operations were performed after systemic administration of antibiotics for more than two weeks and after capsule formation was confirmed on CTs. Preoperative volume of the abscesses was estimated from CTs. The target point chosen was the center of the ring of the largest diameter in the enhanced lesion. Abscess was aspirated under monitoring with intraoperative CT scan. No continuous drainage was performed and no antibiotics were given directly into the abscess cavity. In all cases the center of the abscess was punctured with a single trial. Average volume of the preoperative brain abscesses was 18.8ml. Aspirated volume at the time of the operation averaged 16.9ml and all the abscesses decreased to unmeasurable size on CTs. In five of seven patients abscesses were cured after a single aspiration, and in one case after the second operation. One case required extirpation of the lesion. During the follow-up period of four months to five and a half years six patients showed no recurrence. One patient died of unrelated cause four and a half years after the operation. No operative complication was noted. There was no operative morbidity or mortality. Using a CT guided stereotactic method, brain abscess is punctured so accurately, regardless of its location and size, that damage to the surrounding brain during operation can be minimized. Therefore it is highly possible to aspirate abscesses completely.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1990

Clinical applications of a new Fujinon operating fiberoptic hysteroscope.

A soft and rigid operating fiberoptic hysteroscope (4.8 mm outer diameter) was developed by Lin et al., with the support of a Fuji Photo Optical Company. The functional part of the telescope consists of three sections: a soft, flexible front section, a rigid rotating middle section, and a semirigid, self-retaining rear section. With these features, the intrauterine target can be approached easily, directly, and closely, usually without cervical dilation or anesthesia and with the operator in a comfortable position. Clinical applications were divided into four groups: (1) directed biopsy, (2) transcervical tubocornual recanalization for the management of cornual occlusion, (3) hysteroscopic chorionic villus sampling, and (4) the removal of lost IUDs. Experience with 153 procedures is presented. No complications were encountered. The authors conclude that this new hysteroscope is a very useful tool for the treatment of intrauterine lesions, used easily in the office and the operating room alike.

Adult↗
PubMed1990

Pulmonary aspergillosis with bronchocentric granulomas.

A 56-year-old Japanese man without asthma was admitted with cough, excessive sputum, and abnormalities on the chest X-ray film. The lung biopsy material showed necrotizing granulomas centered upon bronchioles. Serial sections of the material revealed a mass of well-oriented, uniform, viable-appearing aspergillus hyphae in the center of the granulomas. There was no evidence of blood eosinophilia, tissue infiltration of eosinophils, or deposition of immunoglobulins or complement in the granulomatous lesion. Thus, we obtained no direct evidence of an allergic reaction. After treatment with the antifungal drug, 5-flucytosine, the patient is in good health. This may be the first documentation of pulmonary aspergillosis showing predominantly bronchocentric granulomas in a nonasthmatic patient who was not immunocompromised.

Aspergillosis, Allergic Bronchopulmonary↗
PubMed1990

[A serous cystadenoma of the ovary of borderline malignancy with a fifteen-year history. A case report].

A case of a serous cystadenoma of a ovary of borderline malignancy is reported. Sixteen years earlier, the patient had undergone an exploratory laparotomy because of ovarian tumor, and the histologic diagnosis had been a serous cystadenocarcinoma. Postoperative chemotherapy was not effective and drainage of the tumor fluid had been performed for 15 years, with the estimated drainage volume estimated to have reached, 1,000 1. Gradual malnutrition and marked tumor growth then become apparent. A reevaluation of the initial histologic slides and her clinical course strongly suggested a serous cystadenoma of borderline malignancy. Thus a tumor resection, a bilateral salpingo-oophorectomy, and a hysterectomy was performed. A histologic diagnosis of a resected specimen confirmed a serous cystadenoma of borderline malignancy and the histologic features were quite similar to those of the initial biopsy specimens. The patient is living well postoperatively for 8 months without postoperative chemotherapy.

Adult↗
PubMed1990

The Fujinon diagnostic fiber optic hysteroscope. Experience with 1,503 patients.

A soft and rigid diagnostic fiber optic hysteroscope (outer diameter, 3.7 mm) was developed. A total of 1,503 women underwent panoramic, televised fiber optic hysteroscopy without cervical dilation. No anesthesia, analgesia or tenaculum was required. No complication was encountered during or after the operation. The procedure is simple, easy and safe, with the operator in a relaxed and comfortable position even when the patient has acute flexion of the uterus. Our clinical results prove that the soft and rigid structure of the fiberscope offers advantages over rigid scopes or conventional fiberscopes with full-length soft, malleable parts.

Evaluation Studies as Topic↗