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Biomedical subjects

Y Nimura

Publications and source records attributed to Y Nimura.

At least 487 records · Page 27Linked to original sources
PubMedDate not supplied

Clinicopathologic characteristics and postoperative outcome in Japanese and Chinese patients with thoracic esophageal cancer.

We evaluated the clinicopathologic findings and surgical results of 140 patients with thoracic esophageal cancer treated at Shinshu University, Japan (Shinshu group), and compared them with those from 1164 patients treated at Hebei Medical College, China (Hebei group) to determine if the two groups showed any differences. The Shinshu group had significantly higher incidences of elderly patients (>70 years of age), male patients, and tumors located at the lower esophagus (p < 0.01). In the Hebei group, although the depth of tumor invasion was more advanced, the incidence of nodal metastasis was significantly lower (p < 0.01). Operative death and postoperative complications were more frequent in the Shinshu group. Comparison of the postoperative survival curves revealed significantly longer survival of patients with pT2 or pT3 tumor in the Hebei group (p < 0.01), but there were no significant differences between the two groups when the lesions were classified by pTNM stage. This study demonstrated several differences between the patients in the two areas in regard to the clinicopathologic characteristics of thoracic esophageal cancer. The most important characteristic of the esophageal cancer in the Hebei group appears to be the low incidence of nodal metastasis.

Adult↗
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Pulsed Doppler echocardiography in the assessment of tricuspid regurgitation.

Pulsed Doppler echocardiography is a noninvasive method with high sensitivity and specificity for the assessment of tricuspid regurgitation. In patients with tricuspid regurgitation, pansystolic unusual Doppler signals are detected in the right atrial cavity, which are interpreted as tricuspid regurgitant flow signals. They distributed in a spindle-shaped area from the tricuspid orifice toward the right atrial posterior wall in parallel with the interatrial septum. The orientation of the range where the regurgitant Doppler signals are detected in the right atrial cavity shows the direction of the regurgitant jet. However, such a result is determined mainly in patients with functional tricuspid regurgitation. In regard to patients with organic tricuspid lesion, different considerations may be necessary. Semiquantitative grading of the severity of regurgitation is possible, based on the distance covered by the regurgitant signals from the tricuspid orifice. Tricuspid regurgitation is demonstrated also by contrast echocardiography. The severity is graded based on the distance reached by regurgitant curvilinear contrast echoes from the tricuspid valve in the M-mode echocardiography. If the ultrasound beam is adequately directed through the tricuspid orifice, the grade estimated by the contrast echoes are well correlated with that by the Doppler. However, if the M-mode is performed without the guide by the two-dimensional image, it may miss the most adequate beam direction for the observation, resulting in underestimating severity. The influences of tricuspid regurgitation are generally seen in the flow pattern of the major veins. However, they are more sharply reflected by the flow condition in the right atrial cavity than by the flows patterns in the major veins.

Blood Flow Velocity↗
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Effect of pericardium on left ventricular early filling assessed by pulsed Doppler echocardiography.

Pericardial effect on left ventricular early filling was studied in six dogs by use of pulsed Doppler echocardiography. Rapid dextran infusion was used to manipulate left atrial pressure. Left ventricular peak early filling velocities before and after pericardiectomy were measured at different levels of left atrial pressure with right atrial and left ventricular pressures. Peak early filling velocity correlated with mean left atrial pressure before and after pericardiectomy. Before pericardiectomy, when mean right atrial pressure exceeded 12 mm Hg, further increase of the velocity was not observed in spite of volume loading. After pericardiectomy, peak early filling velocity became higher and the slope of the relation line between mean left atrial pressure and the velocity became steeper than before pericardiectomy. When the filling pressure was denoted by the transmural mean left atrial pressure, the points on the relation line before pericardiectomy fell along the relation line after pericardiectomy. We conclude the pericardium exerts an external constraint on left ventricular early filling. Therefore we should not consider the absolute but the transmural filling pressure when estimating left ventricular early diastolic function with use of Doppler-derived left ventricular early filling velocity.

Animals↗
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Comparison of 5-fluorouracil, doxorubicin and mitomycin C with 5-fluorouracil alone in the treatment of pancreatic-biliary carcinomas.

In this multicenter randomized trial, the efficacy of combination chemotherapy using 5-fluorouracil, doxorubicin and mitomycin C (arm A) was compared with that of 5-fluorouracil alone (arm B) in 81 patients with nonresectable carcinomas of the pancreas or biliary tract. There were no significant differences between treatment arms regarding the median time to progressive disease, median survival time, palliative effects or toxicities. It was concluded that combination chemotherapy is feasible but cannot be recommended.

Adult↗
PubMedDate not supplied

A phase III randomized study comparing doxifluridine and 5-fluorouracil as supportive chemotherapy in advanced and recurrent gastric cancer.

We conducted a phase III randomized study to investigate effects of supportive chemotherapy with oral doxifluridine (group A, 75 patients) or 5-fluorouracil (group B, 75 patients) in advanced gastric cancer when intensive chemotherapy was not an option. Although there were no significant differences between the groups with regard to survival, hospital-free survival and time to progression, median values of 3 endpoints were superior in group A. Secondary analysis showed that group A patients with prior chemotherapy tended to have longer survival and hospital-free survival and significantly longer time to progression.

Adult↗
PubMedDate not supplied

Influence of vagal pyloric branches on gastric acid secretion and gastrointestinal motility in patients following a pylorus preserving pancreatoduodenectomy.

BACKGROUND/AIMS: The authors evaluated the influence of the vagal pyloric branches on the gastrointestinal function in patients who underwent a pylorus preserving pancreatoduodenectomy (PPPD). METHODOLOGY: Twenty-seven patients with pancreatobiliary and duodenal diseases underwent a PPPD between 1991 and 1994. We analyzed several variables including the daily volume of gastric juice, days of gastric suctioning, start of diet, gastric acid, and gastrin levels. In addition, a gastric emptying scintigram and gastrointestinal manometry were measured. These variables were compared between two groups, namely, those with retained superior pyloric branches of the vagus nerve (preserved group: n = 14), and those without these branches (non-preserved group: n = 13). RESULTS: There were no significant differences in basal acid output, maximum acid output, or plasma gastrin levels between the preserved group and the non-preserved group. In addition, a gastric emptying scintigram demonstrated no difference between the two groups. Finally, on gastrointestinal manometry, there was no significant difference between the two groups during gastric and jejunal phase III activity of migrating motor complex. CONCLUSIONS: Preservation of the vagal pyloric branches did not influence gastric exocrine and endocrine secretion, nor did it effect the gastric emptying of patients who underwent a PPPD.

Adult↗
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Serum alkaline phosphatase after extensive liver resection: a study in patients with biliary tract carcinoma.

BACKGROUND/AIMS: To clarify a correlation between serum alkaline phosphatase (ALP) levels and liver function and regeneration after major hepatectomy. METHODOLOGY: Post-operative changes in serum ALP levels were retrospectively examined in 91 non-cirrhotic patients with biliary tract carcinoma who underwent right hepatic lobectomy or more extensive liver resection. In addition, changes in liver volume after resection were assessed in 31 patients who underwent computed tomography before surgery and within 1 month after resection. RESULTS: Serum ALP levels reached its nadir on post-operative day 1, followed by a gradual increase until post-operative day 28. In patients with post-hepatectomy liver failure (n = 32), serum ALP levels were significantly lower on days 1, 7, 10, 14, 21, and 28 after resection than in those without such failure (n = 59). Unexpectedly, the volumetric study of the liver showed no significant difference between the two groups in the remnant liver volume after resection. CONCLUSIONS: Serum ALP levels can function as an indicator of liver function after hepatectomy, but not reflect morphological regeneration of the liver. Thus, increased ALP levels after hepatectomy may not reflect the cellular proliferation process itself.

Adult↗
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Histochemical study of vascular endothelial growth factor in squamous cell carcinoma of the esophagus.

BACKGROUND/AIMS: Vascular endothelial growth factor (VEGF) plays a key role in tumor angiogenesis. The aim of this study was to clarify the significance of VEGF expression in esophageal squamous cell carcinoma (SCC). METHODOLOGY: Tissues samples were taken from 52 patients with esophageal SCC after surgery. VEGF expression in these SCCs was examined immunohistochemically. Microvessels in the tumor stained for Factor VIII-related antigen were counted. Ki-67 antigen as a proliferative marker was immunostained with MIB-1, and terminal deoxynucleotidyl transferase-mediated deoxyuridine triphosphate biotin nick end labeling was performed for the evaluation of apoptosis. Ki-67 labeling index (LI) and apoptotic index were then calculated. RESULTS: VEGF expression was observed in 30 of the patients (57.7%). The microvessel count was significantly higher (p = 0.007), and the apoptotic index was significantly lower (p < 0.0001) in the SCC with VEGF expression than in the SCC without it, but no significant difference was observed in the Ki-67 LI between these groups. There was an inverse correlation between the microvessel count and the apoptotic index (p = 0.007). In the clinicopathologic factors, histologic venous invasion of cancer cells (p = 0.039) and lymph node metastasis (p = 0.049) were significantly correlated with VEGF expression. The survival rate after curative surgery was better in the patients without VEGF expression (p < 0.05), and distant organ metastasis after surgery was frequently observed in the patients with VEGF expression (p = 0.023). CONCLUSIONS: These results suggest that VEGF expression is associated with angiogenesis in esophageal SCC, and may be a prognostic factor in patients with esophageal SCC. Furthermore, apoptosis may be influenced by angiogenesis in esophageal SCC.

Aged↗
PubMedDate not supplied

Risk factors associated with intra-operative blood loss in hepatectomized patients with giant cavernous hemangioma of the liver.

BACKGROUND/AIMS: The aim of this study was to clarify risk factors associated with intra-operative blood loss in hepatectomized patients with giant cavernous hemangioma (GCH) of the liver. METHODOLOGY: Twenty patients with GCH of the liver were treated by hepatectomy. Eleven patients with intra-operative blood loss > 2000 ml (mean: 7145 +/- 7080 m; Group 1) were reviewed retrospectively and compared to 9 patients with intra-operative hemorrhage < 2000 ml (mean: 918 +/- 429 ml; Group 2). RESULTS: Although there were no significant differences in pre-operative AST, ALT, and ICG-15 or fibrinogen and platelets between the two groups, pre-operative total bilirubin and fibrin degradation product (FDP) in Group 1 was significantly higher than in Group 2. Mean operation time and intra-operative blood transfusion in Group 1 versus Group 2 were 433 min vs. 213 min (p < 0.0001) and 3036 ml vs. 422 ml (p = 0.0072), respectively. The weight of resected liver (r = 0.821, p < 0.0001), maximum diameter of tumor (r = 0.782, p < 0.0001) and operation time (r = 0.748, p < 0.0001) were the most highly correlated with intra-operative blood loss, followed by pre-operative total bilirubin (r = 0.605, p = 0.0038), FDP level (r = 0.576, p = 0.0068) and intra-operative blood transfusion (r = 0.561, p = 0.0089). CONCLUSIONS: These findings suggest that pre-operative management to reduce the tumor size, total bilirubin and FDP levels may be essential to minimize intra-operative hemorrhage and blood transfusion.

Adult↗
PubMedDate not supplied

Ten-year survival after pancreatoduodenectomy for advanced gastric cancer--report of two cases.

We performed pancreatoduodenectomy for 5 patients with gastric cancer, and here we present 2 who have survived for more than 10 years. Patient one had a large antral tumor tightly adherent to the head of the pancreas. Pancreatoduodenectomy with lymph node dissection was performed. Pathologic examination of the resected specimen revealed that the tumor was a well differentiated adenocarcinoma invading the duodenum, but not the pancreas. Patient two had an infrapyloric lymph node metastasis invading not only the pancreatic head, but also the duodenocolic ligament and the transverse mesocolon. Pancreatoduodenectomy and right hemicolectomy with lymph node dissection were performed. Pathological examination of the resected specimen revealed grade III lymph node metastasis, and invasion of the pancreas by the metastatic infrapyloric lymph node. These results indicate that complete resection of tumor by pancreatoduodenectomy may result in a long survival not only for the patients in whom pancreatic invasion and/or lymph node metastasis is limited, but also for some patients with tumor invading the pancreatic parenchyma and/or of grade III lymph node metastasis.

Adenocarcinoma↗
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Advanced adenosquamous carcinoma of the gallbladder with bilio-biliary fistula: an uncommon case treated by hepatopancreatoduodenectomy.

A 70 year-old female, who presented with jaundice and abdominal pain, was found to have an advanced gallbladder cancer involving the liver parenchyma, duodenum, and transverse colon. This was complicated by a bilio-biliary fistula between the gallbladder and both the right and left hepatic ducts. After obtaining an accurate pre-operative diagnosis, the patient underwent hepatopancreatoduodenectomy (HPD) with lymph node dissection around the hepatic pedicle, celiac trunk, aorta, and inferior vena cava. Histologic examination revealed adenosquamous carcinoma. This rare variant accounts for 3.5% of gallbladder cancers, and is associated with a worse prognosis than adenocarcinoma. The patient is in good condition without any signs of recurrence 42 months after the HPD. In this case report, we discuss the histological type and internal biliary fistula with regard to the literature, and the usefulness of an aggressive surgical procedure such as HPD with extended lymph node dissection which can improve survival and quality of life in selected patients.

Aged↗
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Effective treatment with chemotherapy and surgical resection for small cell carcinoma of the esophagus: report of a case.

We report on a patient with small cell carcinoma of the esophagus treated with effective combination chemotherapy followed by surgical resection. A 69 year-old male had an ulcerated tumor in the middle part of the esophagus, which was microscopically diagnosed as small cell carcinoma of the esophagus. After combination chemotherapy, endoscopy showed that the esophageal tumor had changed into a shallow ulcer. No cancer cell was found in the biopsy specimen of the ulcer. A subtotal esophagectomy with regional lymph node dissection was performed. Histological examination showed that a few cancer cells remained in a microvessel of the submucosal layer in the removed esophagus and no cancerous lesion was found in regional lymph nodes. The patient was well and was able to remain at home. However, he eventually died 21 months after first detection of the carcinoma due to progression of multiple lung and mediastinal lymph node metastases. After complete or partial remission is achieved by the combination chemotherapy, surgical resection may be recommended as the second therapy that occasionally produces long-term remission and possibly long-term survival for patients with small cell carcinoma of the esophagus, such as the present case.

Aged↗
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Primary carcinoid tumor of the gallbladder: resection of a case metastasizing to the liver and analysis of outcomes.

Gallbladder carcinoid tumor is a rare and aggressive neoplasm, usually lacking specific symptoms, as they typically are unassociated with the carcinoid syndrome, despite frequent hepatic spread. The patient was an 81-year-old man with right upper quadrant pain who underwent radical surgery for carcinoid tumor of the gallbladder with liver metastasis (preoperative diagnosis, carcinoma). We analyzed the outcome of previously reported cases of gallbladder carcinoid. Increasing tumor size and depth of invasion progressively compromised the 2-year survival. These findings underscore the importance of early detection.

Aged↗
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Resection of a hilar cholangiocarcinoma in a patient with absent portal bifurcation.

Absence of the bifurcation of the portal vein is an extremely rare anomaly and the misled ligation of the portal vein would result in the lethal hepatic failure. In this paper, a resected case of hilar cholangiocarcinoma with this anomalous portal venous system is first presented. Preoperative percutaneous transhepatic portography disclosed an absence of portal bifurcation and a transversely running portal vessel from the right anterior segment to the left lateral segment. The patient underwent left hepatic lobectomy with caudate lobectomy, in which the portal trunk was successfully preserved.

Bile Duct Neoplasms↗
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Hepatopancreatoduodenectomy for squamous cell carcinoma of the gallbladder.

Herein we present a case of a 57-year-old woman with squamous cell carcinoma of the gallbladder, with an advanced, large tumor infiltrating the liver and duodenum, but curatively resected by hepatopancreatoduodenectomy. She has been doing well without any sign of recurrence more than 5 years after operating. Hepatopancreatoduodenectomy is an adequate procedure for en bloc resection of advanced squamous cell carcinoma of the gallbladder because it often grows expansively. No residual tumor cells owing to hepatopancreatoduodenectomy shall fortunately result in a good prognosis.

Carcinoma, Squamous Cell↗
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Cytokine response to human liver ischemia-reperfusion injury during hepatectomy: marker of injury or surgical stress?

BACKGROUND/AIMS: The aim of this study was to evaluate the inflammatory or antiinflammatory cytokine response to ischemia-reperfusion during hepatectomy and to find a useful marker of injury or surgical stress during hepatic ischemia-reperfusion. METHODOLOGY: In 9 patients with liver disease who underwent hepatectomy using the Pringle maneuver, serum cytokines, including alanine transaminase, aspartate transaminase, and hyaluronic acid, were measured just prior to vascular occlusion; 5, 10 and 15 min after initial clamping; and 3 min after initial declamping. RESULTS: The mean concentrations of aspartate transaminase and alanine transaminase did not significantly differ before and after ischemia-reperfusion during hepatectomy. However, mean concentrations of hyaluronic acid after ischemia-reperfusion were significantly (P < 0.03) higher than before clamping. Although there were no significant differences in the mean concentrations of IL-1 beta, IL-6, IL-8, IL-10 and TNF-alpha among, before and after ischemia-reperfusion, the mean concentrations of granulocyte colony-stimulating factor after ischemia-reperfusion and macrophage colony-stimulating factor after reperfusion were significantly (P < 0.05) higher than before clamping. CONCLUSIONS: Although hepatic parenchymal cell function was maintained after ischemia-reperfusion during hepatectomy, sinusoidal endothelial cell dysfunction was found. Release of granulocyte colony-stimulating factor and macrophage colony-stimulating factor after ischemia-reperfusion were also found. These cytokines and hyaluronic acid may be useful indicators in the early phase of human ischemia-reperfusion injury during hepatectomy.

Aged↗