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Biomedical subjects

Y Matsubara

Publications and source records attributed to Y Matsubara.

At least 199 records · Page 11Linked to original sources
PubMed1993

[A resected case of leiomyosarcoma of the esophagus--the diagnosis was supported with DNA content analysis].

A case of leiomyosarcoma of the esophagus was reported. The tumor was located in the lower esophagus. The esophagus was very stenotic, but the mucosa was clear. We thought the tumor had not invaded the mucosa. Enucleation was performed on the tumor. The tumor was encapsulated, so at the time of operation, the microscopic diagnosis was leiomyoma. However, after the operation, the diagnosis was changed to the leiomyosarcoma, because there are many spindle-shaped atypical cells, and many mitoses. We also analyzed the DNA content of the tumor. The DNA index of this tumor was 0.9 and 1.48, therefore, this tumor was DNA aneuploidy. The result of DNA content analysis showed that the tumor is malignant. DNA content analysis is helpful for diagnosis of this kind of sarcoma, because microscopic examination can not readily distinguish benign leiomyoma from malignant leiomyosarcoma. This patient was still alive one year after the operation. Thus, we thought that enucleation of the tumor is a good operational procedure to the leiomyosarcoma of the esophagus, if the tumor is polypoid type and encapsulated.

Aneuploidy↗
PubMed1993

[A case of neurinoma combined with testicular feminization syndrome].

A 23-year-old female was admitted to our hospital because of a mediastinal tumor. She complained of primary amenorrhea, and abdominal echosonography was therefore performed, revealing the absence of a uterus. Chromosome analysis revealed a 46 XY genotype, indicating the patient to be a male, not a female. Left renal venography demonstrated residual blood vessels originating in the Mullerian ducts. Thoracotomy and laparotomy were performed, and the mediastinal tumor and bilateral testes were resected. Postoperative pathology revealed that the mediastinal tumor was a neurinoma. There was no spermatogenesis, but hyperplasia of Sertoli cells in the testes was seen. Neither the neurinoma nor the testes were malignant. Bioassay of the testes showed no androgen receptors, leading to the diagnosis of testicular feminization syndrome with the complete form of androgen insensitivity. There have been many reports of an association between testicular feminization syndrome and malignant tumors of the testes, but few reports of an association between testicular feminization syndrome and benign tumors such as neurinoma. Accordingly, the present case was considered to be unusual and worth reporting.

Adult↗
PubMed1993

[Diagnosis of mediastinal neoplasms using mediastinoscopy and CT-guided needle biopsy supported by gene analysis].

Of 140 cases of mediastinal neoplasms in our hospital, histological diagnosis was confirmed in 129 cases. We examined the methods of preoperative biopsy with those 129 cases. Biopsy had been performed in 25 cases. Mediastinoscopy was performed in seven cases, needle biopsy in eight cases, lymph node biopsy in eight cases, esophageal biopsy using a gastrofiberscope in one case, transbronchial biopsy using a bronchoscope in one case. The true positive rates of those methods were 100% for both mediastinoscopy and lymph node biopsy, and 75% for needle biopsy. Preoperative misdiagnosis occurred in two cases of needle biopsy. The postoperative histological diagnosis was malignant lymphoma in both cases. We performed gene analysis of the immunoglobulin heavy chain gene, light chain kappa and lambda genes, and the T-cell receptor beta gene by use of biopsied specimens, and we found rearrangement bands of these genes in the cases of malignant lymphoma. Therefore, we summarize that gene analysis is a reliable method if malignant lymphoma is suspected. If a needle biopsy is performed under CT guidance, the needle is sure to puncture the tumor. We concluded, therefore, that if a tumor is located in the anterior mediastinum, CT-guided needle biopsy should be performed first of all. Mediastinoscopy is a useful method if the tumor is located in the mid-mediastinum.

Biopsy, Needle↗
PubMed1993

[An autopsy case of primary pulmonary malignant lymphoma associated with right pulmonary infiltrative shadow and macroglobulinemia].

We experienced a patient with two peaks of elevated monoclonal IgM and IgA in the serum, and lambda type Bence-Jones protein in the urine. Chest X-ray films showed right pulmonary infiltrative shadow and effusion. The results of the autopsy of this patient revealed infiltration of malignant lymphoma cells in both lungs, but in no other organs. The results of immunohistochemical staining for L26. UCHL-1, IgM, IgA and lambda chain in this case led to the diagnosis of diffuse small cell type. B-cell lambda, IgM type malignant lymphoma. Gene analysis using bone marrow did not reveal any rearrangement bands for the heavy chain, light chain kappa and lambda, or TcR beta genes. Therefore, we concluded that malignant lymphoma cells had infiltrated only the bilateral lungs, causing a rare case of primary pulmonary malignant lymphoma with two monoclonal peaks of increased serum IgM and IgA.

Aged↗
PubMed1992

Mutations in the medium chain acyl-CoA dehydrogenase (MCAD) gene.

Medium chain acyl-CoA dehydrogenase (MCAD) catalyzes the first reaction of the beta-oxidation cycle for 4-10-carbon fatty acids. MCAD deficiency is one of the most frequent inborn metabolic disorders in populations of northwestern European origin. In the compilation of data from a worldwide study of 172 unrelated patients each representing an independent pedigree, a total of 8 different mutations have been identified. Among them, a single prevalent mutation, 985A-->G, was found in 90% of 344 variant alleles. 985A-->G causes glutamate substitution for lysine-304 in the mature MCAD subunit, which causes impairment of tetramer assembly and instability of the protein. Three of 7 rarer mutations have been identified in a few unrelated patients, while the remaining 4 have each been found in only a single pedigree. In addition to tabulating the mutations, the acyl-CoA dehydrogenase gene family, the structure of the MCAD gene and the evolution of 985A-->G mutation are briefly discussed.

Acyl-CoA Dehydrogenase↗
PubMed1992

Intestinal fatty acid-binding protein as a sensitive marker of intestinal ischemia.

Determination of the serum level of intestinal fatty acid-binding protein has been used to detect rat intestinal ischemia following ligation or 30-min occlusion of the superior mesenteric artery. The normal values were under the minimal detectable level of less than 2 ng/ml in all the 10 rats. The serum fatty acid-binding protein level increased rapidly, to 340.7 +/- 54.6, 438.5 +/- 40.1, 388.1 +/- 37.4, and 292.2 +/- 95.7 ng/ml (P less than 0.01) at 1, 2, 4, and 8 hr after ligation, respectively. It also increased, to 347.2 +/- 127.7 ng/ml (P less than 0.01) at 1 hr, after a 30-min transient occlusion and then returned to a normal level. Histological studies showed destruction of the villi, disappearance of the mucosa, and transmural necrosis with the progress of time after ligation, while no remarkable morphological change was observed following 30-min transient occlusion. These observations strongly suggest that the intestinal fatty acid-binding protein is a useful biochemical marker for intestinal ischemia, particularly in the early reversible phase.

Alkaline Phosphatase↗
PubMed1992

Medium-chain acyl-CoA dehydrogenase deficiency: molecular aspects.

Medium-chain acyl-CoA dehydrogenase (MCAD) deficiency is an autosomal recessive disorder which is known to cause Reye-like syndrome in children and sudden infant death. A point mutation of lysine329-to-glutamic acid329 substitution in the MCAD gene was recently identified as the most common mutation in patients with MCAD deficiency. This mutation is responsible for about 90% of mutant MCAD alleles in Caucasians. Patients with this type of mutation have a variety of symptoms, indicating that the clinical heterogeneity of MCAD deficiency may not be caused entirely by genetic heterogeneity. Screening for the mutation among newborns in England, Australia, and United States of America indicates the prevalence of carriers to be 1 in 40-107, suggesting the high incidence of the mutation. Since presymptomatic diagnosis and appropriate dietary management are important in MCAD deficiency to prevent life-threatening complications, the relatively high incidence of this disorder may warrant population screening. The most common MCAD mutation can now be detected by DNA diagnostic methods using Guthrie cards. This makes it possible to screen a population efficiently for this potentially fatal disorder.

Acyl-CoA Dehydrogenase↗
PubMed1992

Changes in the level of plasma cortisol, progesterone and total testosterone in developing hairless dogs.

Changes in the levels of plasma cortisol, progesterone and total testosterone were examined in developing hairless and haired dogs. Cortisol levels in the hairless dogs seemed to be higher than those in haired dogs within the age of 4-5 weeks. No apparent changes were seen in the level of plasma progesterone between the groups of hairless females and haired females. Total testosterone levels in hairless males showed to be significantly lower than those in haired males at the age of 13-21 weeks.

Animals↗
PubMed1992

The role of mediastinoscopic biopsy in preoperative assessment of lung cancer.

Between 1970 and 1989, mediastinoscopy and thoracotomy were performed on 619 patients admitted to our clinic with lung cancer. When mediastinoscopy was analyzed by lymph node location, the highest sensitivity (95.7%) was for the left paratracheal nodes and the lowest (64.0%) was for nodes at the bifurcation (p < 0.01). The 5-year survivals according to the results of mediastinoscopy were 47% for negative results, 14% for false-negative results, and 6% for positive results. The 5-year survival rate however, was significantly higher (28%) in patients (n = 13) with positive mediastinoscopic findings who underwent complete resection of the primary tumor and all involved nodes than in patients (n = 78) who underwent incomplete resection (p < 0.01). These data support our opinion that patients with positive mediastinoscopic results should not always be excluded from treatment by thoracotomy. The role of mediastinoscopy is not to select patients for thoracotomy but to evaluate lung cancer at the pretreatment stage.

Biopsy↗
PubMed1992

[Management of patients with impaired glucose tolerance following esophagectomy in carcinoma of the esophagus].

We demonstrated the effectiveness of the "sliding scale" insulin infusion in diabetic patients undergoing esophagectomy. Fifty-eight patients were followed after esophagectomy to clarify differences in energy expenditure and caloric contributions of substrates. Energy expenditure was measured by indirect calorimetry on the 1st, 3rd, 5th, and 7th days after esophagectomy. Out of 58 patients, 7 were divided into diabetic (D), 30 into borderline (B), 21 into normal (N), according to a 75 g oral glucose tolerance test, preoperatively. Forty-four patients underwent esophagectomy by means of right thoracotomy, and blunt esophagectomy was done on 14 patients. The results were as follows: 1) No relation was found between postoperative morbidity and severity of glucose intolerance. 2) There was no significant difference in changes in energy expenditure following operation among groups D, B, and N. No difference was found in ratio of caloric intake to energy expenditure among groups D, B, and N. Caloric contributions of substrates seemed to be comparable among groups D, B, and N. These results suggest that "sliding scale" insulin infusion with total parenteral nutrition enable us to control not only blood glucose level but energy metabolism following esophagectomy in diabetic patients.

Diabetes Complications↗
PubMed1992

[Diagnosis, incidence, clinicopathology and surgical treatment of acquired tracheobronchomalacia].

We report our recent findings on the diagnosis, incidence, appearance of the trachea at autopsy, and surgical treatment of acquired trachobronchomalacia. In the diagnosis of this disease, continuous dynamic CT scanning (1 slice/0.6 second) from inspiration to deep expiration was better than X-ray cine recording. It is difficult to observe the most collapsed airway on coughing using bronchofiberscopic recording, because its duration time was estimated to be 1/10 second by X-ray cine recording, whereas the findings at one instant were easily recorded by video-bronchoscopy on coughing. The degree of severity of this disease was classified into three groups. 1st degree 0-50% narrowing of airway caliber, 2nd degree 50-75%; and 3rd degree 75-100%. Severity of 2nd or 3rd degree was present in 542 (12.7%) of 4283 patients suffering from chest disease who underwent bronchoscopy. Seventy-two percent of patients were aged 50 to 80 years. Third degree tracheomalacia was found in 131 patients with an incidence of 3.1%, which increased from 2.2% at 50 years to 6.2% at 80 years. The autopsy findings of the trachea consisted of fragmentation of the tracheal cartilage and extension of the membranous portion. The pathogenesis may be varied with different types of collapse of the airway, including the saber sheath type and the crescent type. Surgical treatment consists of prevention of the airway collapse by wrapping the airway with Marlex mesh and bonding Lyodura (lyophilized dura mata) with fibrin glue, which is more reliable than the span plasty proposed by Nissen.

Adolescent↗
PubMed1992

[Chest wall reconstruction using polyester mesh].

Using polyester, we prepared a new material for chest wall reconstruction. The polyester mesh has the same rigidity and elasticity as Marlex tracheal mesh. From January 1987 through July 1991, we performed chest wall reconstruction using the polyester mesh in 8 patients with lung cancer, 9 with empyema after open drainage, 2 with metastatic chest wall tumors, 1 with a primary osteogenic giant cell tumor originating from the rib and 1 with radiation dermatitis and costal chondritis. Three or more ribs were resected in 17 patients. The defects of the chest wall were reconstructed with the polyester mesh covered with a GORE-TEX soft tissue patch to achieve air tightness. Fifteen cases have passed at least one year with no sign of infection. In conclusion, the polyester mesh prevents flail chest and seems to be a satisfactory material for chest wall reconstruction.

Adult↗
PubMed1992

[Preoperative nutritional support in patients with esophageal cancer].

Major surgery is essential in the treatment of esophageal cancer. Nutritional depletion may play some role in a high likelihood of postoperative complication following esophagectomy. The aim of this study was to determine whether preoperative nutritional support could restore the nutritional status and reduce the incidence of postoperative pneumonia in malnourished patients with esophageal cancer. Fifty-one malnourished patients undergoing transthoracic esophagectomy were studied (group I: 19 patients, 70 years of age or older; group II: 32 patients, 69 years of age or younger). All of them received nutritional support of 30 kcal/kg/day or more by either the parenteral or enteral route for a week or more. These patients were followed for postoperative pneumonia. The relationship between response to preoperative nutritional support and postoperative pneumonia was examined. Sixteen out of 51 patients (31%) demonstrated a loss in weight and rise in serum albumin following the institution of nutritional support, i.e., good response. Out of 11 patients in group II who exhibited a good response to nutritional support, only one (9%) developed pneumonia postoperatively. By contrast, out of 14 in group I who showed a poor response to nutritional support, five (36%) developed pneumonia following esophagectomy. From these results, it is concluded that nutritional support can benefit malnourished esophageal cancer patients. However, further points remain to be elucidated to improve the nutritional status of patients more than 70 years old.

Enteral Nutrition↗