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Biomedical subjects

Y Shirai

Publications and source records attributed to Y Shirai.

At least 163 records · Page 9Linked to original sources
PubMed1996

Carcinoma of the ampulla of Vater: is radical lymphadenectomy beneficial to patients with nodal disease?

This study was undertaken to evaluate the effectiveness of radical lymphadenectomy in ampullary cancer with nodal disease. Thirty-five patients underwent the Whipple procedure with radical lymphadenectomy. The location and number of positive nodes was characterized. Eighteen patients (51%) had positive nodes. Patients without nodal disease (pN0 group) had an actuarial 5-year survival rate of 81%. Seven patients with metastasis confined to the pancreaticoduodenal nodes had a 5-year survival rate of 67%, which was comparable for the pN0 group (N.S.) and better than the 27% 5-year survival rate in patients with positive superior mesenteric nodes (P<0.05). Eleven patients with one to three positive nodes had a 5-year survival rate of 71%, which was also comparable to the pN0 group (N.S.) and better than the 0% 5-year survival rate in patients with four or more positive nodes (P<0.01). Radical lymphadenectomy is effective against a limited degree of nodal disease.

Actuarial Analysis↗
PubMed1996

Bile peritonitis due to a spontaneous perforation of the common bile duct: report of a case.

Spontaneous perforation of the extrahepatic bile duct is rare. We herein report the case of an 80-year-old woman who underwent emergency laparotomy for bile peritonitis due to a spontaneous perforation of the common bile duct. A 2-mm perforation was found in the posterior wall of the choledochus, and its wall was paper-thin. Three stones, 2mm in diameter, were removed from the common bile duct. She underwent T-tube decompression with intraoperative cholangiography demonstrating a swollen papilla of Vater. The swelling of the papilla disappeared 4 weeks after the operation. Her postoperative course was uneventful. It seems likely that the elevated intraductal pressure due to the swollen papilla following stone impaction caused the perforation in this patient. Furthermore, the excessive friability of the common bile duct of unknown etiology may also have contributed to the perforation. This experience along with a review of the literature indicate that biliary decompression is the treatment of choice for this condition.

Aged↗
PubMed1996

Hepatocellular carcinoma associated with precirrhotic primary biliary cirrhosis successfully treated by a right hepatic lobectomy: report of a case.

We report herein the case of a 69-year-old woman in whom hepatocellular carcinoma (HCC) arising in the precirrhotic phase of primary biliary cirrhosis (PBC) was successfully managed by a right hepatic lobectomy. The patient, who had never received a blood transfusion, had a 4-year history of asymptomatic PBC of Scheuer's histological classification stage II. Abdominal computed tomography (CT) revealed a mass measuring 4.0 cm in the right hepatic lobe, and a right hepatic lobectomy was performed in consideration of her good liver function and the deep location of the tumor in the right lobe. The patient has remained well without any evidence of recurrent disease for 4 years since her operation. A review of the literature revealed only two cases of successful partial hepatectomy, but none of major hepatectomy. Most of the reported cases had been treated with transcatheter arterial embolization (TAE) and were associated with poor survival. Our experience of this patient indicates the potential value of hepatectomy as an alternative to TAE in selected patients with resectable disease and good hepatic function.

Aged↗
PubMed1996

Simultaneous development of Crohn's disease and myelodysplastic syndrome progressing to acute myelocytic leukemia in a patient with a normal karyotype.

A 28-year-old man developed Crohn's disease and myelodysplastic syndrome concurrently. Chromosomal analysis of the bone marrow revealed a normal male karyotype. Subsequently, the myelodysplastic syndrome progressed to acute myelocytic leukemia. Several causes, including the medical treatment for Crohn's disease, chromosomal abnormalities, and a common underlying immune dysfunction, have been proposed as pathogenetic factors in the association with Crohn's disease of hematologic malignancies. This case suggests that neither medical treatment for Crohn's disease nor chromosomal abnormalities are inevitable causes of the development of hematologic malignancies associated with Crohn's disease. At present, the cause of the association remains unclear, although the idea of a common immune dysfunction is attractive.

Adult↗
PubMed1996

Outcome of radical surgery for carcinoma of the gallbladder according to the TNM stage.

BACKGROUND: The role of surgery in the treatment of gallbladder carcinoma (GBC) is controversial. The outcome after prospective radical surgery for GBC is discussed on the basis of the TNM stage of the tumor. METHODS: One hundred six patients who had undergone radical surgery were selected. The standard radical procedure consisted of a cholecystectomy accompanied by lymph node dissection, wedge resection of the liver, and resection of the extrahepatic bile ducts. The stage was determined by pathologic examination of resected specimens. RESULTS: Lymph node metastases were identified in no patients with T1 tumors (n = 15), 48% of patients with T2 tumors (n = 46), 72% of patients with T3 tumors (n = 25), and 80% of patients with T4 tumors (n = 20). One patient died within 30 days after radical surgery (mortality rate, 0.9%). There were 35 5-year survivors including 11 patients with nodal involvement, 10 with stage I tumors, 13 with stage II tumors, 10 with stage III tumors, and 2 with stage IV tumors. The cumulative 5-year survival rate in patients with stage I tumors was 91% (n = 15), 85% in patients with stage II tumors (n = 24), 40% in patients with stage III tumors (n = 28), and 19% in patients with stage IV tumors (n = 39). In patients with stage III and IV tumors the 5-year survival rate was 52% after curative resection (n = 35). This was significantly better than the 5% 5-year survival rate after a noncurative resection (n = 32). CONCLUSIONS: The presence of lymph node metastases is strongly influenced by the depth of invasion of the primary tumor. Accurate determination of the TNM stage is essential in comparing surgical results, predicting patient outcome, and planning additional treatment. Standard radical surgery contributes to patient survival and is recommended in patients with advanced GBC.

Adult↗
PubMed1996

High levels of transforming growth factor beta 1 in patients with colorectal cancer: association with disease progression.

BACKGROUND & AIMS: Contribution of transforming growth factor beta 1 (TGF-beta 1) to tumor progression has been suggested. However, little is known about the role of TGF-beta 1 in colorectal cancer. Plasma TGF-beta 1 levels and its expression were analyzed in patients with colorectal cancer. METHODS: Plasma TGF-beta 1 levels were measured in 22 patients with colorectal cancer using a TGF-beta 1 enzyme-linked immunosorbent assay. Expression of TGF-beta 1 messenger RNA and immunohistochemical distribution of the protein in colorectal cancer tissues were examined. RESULTS: Plasma TGF-beta 1 levels in patients with colorectal cancer (14.8 +/- 8.4 ng/mL) were significantly higher than in normal controls (1.9 +/- 1.4; n = 22) (P < 0.001). After curative surgical resection, plasma TGF-beta 1 levels decreased in examined patients from 11.9 +/- 6.7 to 3.8 +/- 1.2 ng/mL (P < 0.01). TGF-beta 1 messenger RNA was about 2 1/2 times more abundant in colorectal cancer tissues than in control (P < 0.01). TGF-beta 1 was detected in the cytoplasm of colorectal cancer cells immunohistochemically. Both TGF-beta 1 messenger RNA expression in colorectal adenocarcinoma tissues and its plasma levels were associated with tumor stage of Dukes' classification (P < 0.05). CONCLUSIONS: These results suggest that plasma TGF-beta 1 levels may reflect overexpression of the gene in colon cancer tissues and are associated with disease progression.

Adenocarcinoma↗
PubMed1996

An endoscopic follow-up study of the development of diffuse antral vascular ectasia.

No endoscopic follow-up studies are available on the development of diffuse antral vascular ectasia (DAVE). We present here a ten-year follow-up study from discrete initial lesions to the full picture of DAVE. In a 72-year-old female patient with liver cirrhosis, the earliest findings of DAVE were several red spots, with or without a white halo, in the distal antrum. During follow-up, the spots increased in number, coalesced, and extended to the proximal antrum. Three years after the initial findings, latent hemorrhage occurred at a time when confluent lesions were formed. One year later, diffuse distribution of the antral lesions was observed, which led to the diagnosis of DAVE and developed to the full picture within three more years. Two years later, the patient presented with hematemesis, which confirmed the diagnosis of DAVE clinically. Treatment consisted of monopolar electrocoagulation, leading to a stable hemoglobin value for one year. This case study provides some substantial clues to the early detection and treatment of DAVE.

Aged↗
PubMed1996

Increased striatal glutamate transporter by repeated intermittent administration of methamphetamine.

We have examined the immunoreactivities of a glutamate (Glu) transporter, GLT-1, in rat brains treated with a single or repeated intermittent administration of methamphetamine (MAP). In the stratum of behaviorally sensitized rate induced by repeated intermittent MAP treatment, GLT-1 immunoreactivities were increased by 51%. There was no difference in the GLT-1 immunoreactivities in all regions examined between rate treated with a single administration of MAP and the control rats. These results suggest that hyperglutamatergic activity in the striatum is involved in the induction of behavioral sensitization caused by MAP.

ATP-Binding Cassette Transporters↗
PubMed1996

Suppression of ftsH mutant phenotypes by overproduction of molecular chaperones.

Decreased intracellular levels of FtsH, a membrane-bound ATPase, led to retardation of growth and protein export, as well as to an abnormal translocation of alkaline phosphatase that had been attached to a cytoplasmic domain of a multispanning membrane protein, SecY. The last phenotype is designated Std (stop transfer defective). In this study, we examined the effects of overproduction of some molecular chaperones on the phenotypes of ftsH mutants. The growth retardation was partially suppressed by overproduction of GroEL/GroES (Hsp60/Hsp10) or HtpG (Hsp90), although these chaperones could not totally substitute for FtsH. Overproduction of HtpG specifically alleviated the Std phenotype, while that of GroEL/GroES alleviated the protein export defect of ftsH mutants. These results suggest that FtsH functions can be somehow compensated for when the cellular concentrations of some molecular chaperones increase.

ATP-Dependent Proteases↗
PubMed1996

[Paraplegia following coeliac plexus block by anterior approach under direct vision].

We report here a case of paraplegia following coeliac plexus block by anterior approach under direct vision. Laparotomy was performed in a 62-year-old male patient with pancreatic cancer. Coeliac plexus block was undertaken in order to control his back pain, since the tumor was unresectable. The patient complained of numbness and weakness of his legs 14 hours later. The consequence of neurological events was diagnosed as ischemic infarct of the spinal cord by myelo-CT and MRI. He died of pancreatic cancer without recovery of neurological disturbances 4 months after the surgery. As demonstrated in this case, even when coeliac plexus block was performed by open anterior approach under direct vision, paraplegia might be a possible complication due to the anatomical proximity of coeliac plexus to the Adamkiewicz's artery.

Autonomic Nerve Block↗
PubMed1996

Junction of the cystic duct with the left hepatic duct: report of a case discovered during laparoscopic cholecystectomy.

We report a case of an anomalous junction of the cystic duct with the left hepatic duct found during laparoscopic cholecystectomy. Only five other patients with this anatomy have been reported. Two of these five patients had left-sided gallbladders, and the remaining patients (including ours) had their gallbladder in its normal location. Although the prevalence of this anomaly associated with left-sided gallbladders is 5.6 to 14.3%, this anomaly appears to be quite rare in patients with gallbladders in the normal position. In four cases, it was accompanied by left-sided gallbladder or low bifurcation of the common hepatic duct. This rare condition may accompany other biliary anomalies and should be kept in mind when performing cholecystectomy.

Bile Duct Diseases↗
PubMed1995

Blocking actions of BIDN, a bicyclic dinitrile convulsant compound, on wild-type and dieldrin-resistant GABA receptor homo-oligomers of Drosophila melanogaster expressed in Xenopus oocytes.

The receptor antagonist actions are described for a novel bicyclic dinitrile compound (BIDN, 3,3-bis-(trifluoromethyl)-bicyclo [2.2.1] heptane-2,2-dicarbonitrile) on a Drosophila melanogaster homo-oligomeric GABA receptor expressed in Xenopus oocytes. BIDN blocked the wild-type form of the receptor in a neither purely competitive, nor purely non-competitive manner, being dependent on the GABA concentration yet insurmountable, and block was independent of the membrane potential. BIDN was found to be less effective against a mutant (A(302) --> S) form of the receptor resistant to dieldrin and picrotoxinin. This cross resistance of dieldrin-resistant receptors to BIDN is of interest in the light of recent findings that BIDN binding to insect membranes is displaced competitively by dieldrin, but not by picrotoxinin.

Animals↗
PubMed1995

Hepatic metastases from carcinoma of the gallbladder.

BACKGROUND: The optimal hepatic resection margin for gallbladder cancer (GBC) is still debated. To explore this issue, the authors analyzed the mode of hepatic spread of GBC. METHODS: Of 85 patients undergoing radical cholecystectomy, 20 had hepatic metastases. The pattern of hepatic metastasis was examined grossly and histologically in specimens. RESULTS: Twelve patients had evidence of microscopic angiolymphatic portal tract invasion, with or without direct liver invasion. Four had direct invasion alone, and three had distant hepatic metastatic nodules. The distance (y axis) between the farthest angiolymphatic lesion and primary tumor (mm) correlated significantly with the gross depth (x axis) of direct invasion (mm): y = 1.3 + 0.33x (r = 0.88, P < 0.01). Three patients with metastatic nodules died of blood-borne disease within a year. Eight of the others obtained either long-term palliation or cure after potentially curative resection. Lymph node metastases were detected in 90% of patients. CONCLUSIONS: The extent of microscopic angiolymphatic portal tract invasion correlates well with the gross depth of direct invasion of the liver. This correlation may be useful for estimating adequate hepatectomy margins. A hepatectomy with an adequate margin combined with a radical lymphadenectomy provides benefit for selected patients with hepatic metastases.

Aged↗
PubMed1995

Actions of picrotoxinin analogues on an expressed, homo-oligomeric GABA receptor of Drosophila melanogaster.

The actions of picrotoxinin and four of its analogues were tested on a Drosophila melanogaster homo-oligomeric GABA (gamma-aminobutyric acid) receptor formed when RDL (resistance to dieldrin) subunits were expressed in Xenopus oocytes. In agreement with previously reported studies on native insect GABA receptors and native expressed vertebrate GABA receptors, acetylation of the bridgehead hydroxyl group (picrotoxinin acetate) greatly reduced the activity of the molecule, but surprisingly, substitution with flourine at the same position also reduced the activity. Conversion of the terminal isopropenyl group to an acetyl (alpha-picrotoxinone) or hydration of the double bond (picrotin) also reduced activity, in agreement with findings for native insect and mammalian receptors. The present results suggest that interactions of convulsants with homo-oligomeric and multimeric GABA receptors are qualitatively similar. Thus, the RDL homo-oligomer exhibits a pharmacological profile for picrotoxinin analogues resembling that of native GABA receptors.

Acetylation↗