Biomedical subjects

Go Watanabe

Publications and source records attributed to Go Watanabe.

At least 55 records · Page 3Linked to original sources

PubMed2005

The technical aspect of the gastroepiploic artery graft skeletonization with the harmonic scalpel: the samurai technique.

A novel skeletonization technique using the scissors-type harmonic scalpel (Ethicon Endo-Surgery, Cincinnati, OH, USA) is presented. This "samurai technique," which uses the harmonic scalpel by frequently turning over the scissors, facilitates the handling of the gastroepiploic artery, enlarges the caliber size, and allows easy skeletonization without any vessel injury.

Coronary Artery Bypass↗

PubMed2005

A multipurpose arterial graft holder for coronary artery bypass grafting.

A multipurpose arterial graft holder designed for use during coronary artery bypass grafting is described. This new holder is atraumatic and holds the arterial grafts and saphenous vein graft securely during anastomosis. The use of this instrument facilitates the use of multiple arterial grafts for coronary artery bypass grafting.

Arteries↗

PubMed2005

A novel figure A-shape sternal retractor for off-pump coronary artery bypass grafting.

A novel figure A-shape sternal retractor was developed to avoid brachial plexus injury caused by sternal wide separation, and facilitate exposure of circumflex artery by elevating a rake and dropping the heart into the right pleural cavity during off-pump coronary artery bypass grafting. In addition, it has several notches to hold deep pericardial stitches in order to enhance the exposure.

Brachial Plexus↗

PubMed2005

Evaluation of esophageal peristalsis in patients with esophageal tumors: initial experience with cine MR imaging.

We evaluated esophageal peristalsis in patients with esophageal tumors by cine MR using steady-state free precession (SSFP) sequence and correlated the alteration of the esophageal peristalsis with clinical symptoms and tumor stages. Thirteen patients with pathologically proven esophageal tumors, including 12 esophageal cancers and one submucosal leiomyoma, underwent cine MRI using true fast imaging with steady precession (trueFISP) sequence, which is one SSFP sequence, after contrast-enhanced MR scanning for clinical purposes. A total of 120 serial images were obtained within 60 s through the plane along the long axis of the esophagus while patients chewed gum. The serial trueFISP images were evaluated for the presence, frequency, speed of progression, and passage of peristalsis through the tumor. The data from cine MRI were compared with clinical symptoms and tumor stages. Peristalsis was clearly identified in all patients. Seven patients with complete interruption of peristalsis had dysphagia; one with partially impaired peristalsis could intake solid foods with discomfort; and two with partially impaired peristalsis and three with preserved peristalsis remained asymptomatic. Patients with complete or partial interruption of peristalsis had Stage T3 or T4 esophageal cancer. In conclusion, trueFISP cine MR imaging enables direct visualization of esophageal peristalsis in relation to esophageal tumors. Complete interruption of peristalsis causes dysphagia, whereas partial interruption of and preserved peristalsis usually do not cause digestive problems. Interruption of peristalsis may indicate impaired muscle function caused by invasion of advanced esophageal cancers.

Esophageal Neoplasms↗

PubMed2005

The profile of hMLH1 methylation and microsatellite instability in colorectal and non-small cell lung cancer.

Microsatellite instability (MSI) is caused mainly by dysfunction of hMLH1, where aberrant hypermethylation (HM) of its promoter region is involved. Previously, we suggested that HM in the proximal region of the hMLH1 promoter plays a critical role in progression of gastric cancer with MSI and this specific region should be analyzed for diagnostic use of hMLH1 HM. We expanded the analyses of hMLH1 HM and MSI phenotype to sporadic colorectal cancer (CRC) and non-small cell lung cancer (NSCLC) to further evaluate the diagnostic value of hMLH1 HM. A total of 174 CRC and 94 NSCLC samples were used for hMLH1 methylation analysis by real-time methylation-specific PCR. Methylation levels were measured in three distinct regions of the promoter, designated as hMLH1-A, hMLH1-B, and hMLH1-C from distal to proximal. MSI phenotype was determined using five microsatellite markers, BAT25, BAT26, D2S123, D5S346, and D17S250. Methylation profile of the hMLH1 promoter varies between CRC and NSCLC. High methylation levels were observed in a group of CRC samples. Consequently, three patterns of methylation in the hMLH1 promoter regions were found: 1) low methylation level in all regions, 2) high methylation level in hMLH1-A with low methylation level in hMLH1-C, 3) high methylation level in all regions. In contrast, only one NSCLC showed high methylation level in hMLH1-A. Of the 134 CRCs examined, 14 (10.4%) showed MSI phenotype. No MSI phenotype was found in the initial 80 NSCLCs analyzed. Eight (57.1%) of 14 CRC with MSI showed HM in hMLH1-C, which was linked exclusively with MSI phenotype. However, the HM in hMLH1-A or -B was not sufficient for MSI. CRC with MSI phenotype was significantly more frequent in older patients and in the proximal colon, and was more evident in cases with hMLH1-C HM. The results suggested that hMLH1 HM cannot be used as an alternative diagnostic marker of MSI phenotype in sporadic CRC and NSCLC. CRC with MSI might have clinicopathologically distinct subgroups according to hMLH1-C HM status. The observed profiles of hMLH1 methylation and MSI in gastric cancer, CRC, and NSCLC were quite different from each other, facilitating the better understanding of the pathogenesis of these cancers.

Adaptor Proteins, Signal Transducing↗

PubMed2005

Prognostic value of CD83-positive mature dendritic cells and their relation to vascular endothelial growth factor in advanced human gastric cancer.

Mature dendritic cells (DCs) play an important role as antigen-presenting cells in tumor immunity. The angiogenic factor, vascular endothelial growth factor (VEGF), inhibits DC maturation. In this study, 174 gastric cancer patients were assessed by immunohistochemistry using anti-S-100 antibody for total DCs, anti-CD83 antibody for mature DCs and anti-VEGF antibody for VEGF expression, and the relationships between total DC density (TDD), mature DC density (MDD), clinicopathological factors, VEGF expression and prognosis were examined. The MDD (count/cm(2)) was significantly lower in gastric cancer tissue (2.07, median value) than in normal gastric tissue (8.06) (p=0.0067), and also significantly lower in advanced stage gastric cancer tissue (1.55) than in early stage gastric cancer tissue (2.22) (p=0.0374). Among the 104 advanced gastric cancer patients, the MDD was significantly lower in older patients, and in those with a larger or histologically differentiated-type tumor or strong VEGF expression (p<0.05). The 5-year survival rate was significantly higher in the high TDD group than the low TDD group, and also significantly higher in the high MDD group than the low MDD group (p<0.05). By multivariate analysis, blood vessel invasion (p=0.0001, hazard ratio =3.464) and MDD (p=0.0171, hazard ratio =2.179) were revealed to be independent prognostic factors in advanced gastric cancer. These results suggest that the maintenance of MDD could prolong the survival of patients with advanced gastric cancer.

Adult↗

PubMed2005

A surgical case of lung cancer in a patient with the left superior and inferior pulmonary veins forming a common trunk.

The anatomical abnormalities of the pulmonary veins may have a serious impact on complications that may arise during pulmonary lobectomy. We present a surgical case of left lung cancer in a patient, who was a 69-year-old male, with the left superior and inferior pulmonary veins forming a common trunk outside the pericardium. In this present case, because of extensive adhesions, incomplete lobulation, and tumor infiltration of the main pulmonary artery, we could not identity the common trunk with certainty before excising the left upper lobe. Although this patient was fortunately discharged without complications, there was no choice but to perform pneumonectomy because of the interruption of the inferior pulmonary vein. Retrospectively, the preoperative CT films showed the anatomical anomalies involving the pulmonary veins. However, since the length of the common trunk outside the pericardium was short and the inferior pulmonary vein was thinner than usual and its venous distribution conformed to a normal structure, the anatomy appeared normal. In excising the pulmonary lobe, it is mandatory to ascertain the distribution of the vascular system prior to surgery.

Aged, 80 and over↗

PubMed2005

Long-term survival cases of lung cancer presented as solitary bone metastasis.

The prognosis of non-small cell lung carcinoma (NSCLC) with bone metastasis has been regarded as very poor. We report herein on two cases of NSCLC which presented as a solitary bone metastasis, were treated with surgical resection. Both these cases survived for over 5 years after their last operations. A 71-year-old-man was hospitalized with right crural pain. A diagnosis of squamous cell carcinoma of the left lower lobe with right fibula metastasis was made. A marginal resection of the right fibula was performed. After that, a left lower lobe lobectomy and systemic chemotherapy were carried out. He had a local recurrence in the right mediastinal lymph nodes eleven months after the operation. He received intraluminal and external radiation therapy and obtained complete remission. He has survived for 5 years without any other recurrence or metastasis. A 52-year-old-man was admitted to our hospital with left thigh pain. A diagnosis of adenocarcinoma of the right upper lobe with left thigh metastasis was made. A right upper lobe lobectomy and a resection of the left thigh tumor were performed. Three cycles of systemic chemotherapy were given after that. He has survived for 5 years since his last operation without any recurrence or metastasis.

Adenocarcinoma↗

PubMed2004

Association of thymidylate synthase polymorphisms with gastric cancer susceptibility.

We investigated in a case-control study a possible role of thymidylate synthase gene (TS) polymorphisms for gastric cancer susceptibility. Lymphocyte genomic DNA from 134 Italian gastric cancer patients and 139 controls was used for genotyping two polymorphisms in the TS 5'-untranslated region (5'-UTR); a double (2R) or triple (3R) 28-bp repeat and a G/C polymorphism within the triple repeats allele (3G allele). Samples were also genotyped at a 6-bp deletion/insertion (del6 or ins6) polymorphism at position 1494 in the TS 3'-untranslated region (3'-UTR). Unconditional regression with odd ratios (OR) and 95% confidence intervals (CI), haplotype and linkage disequilibrium analyses were used to investigate the association of the polymorphisms with the disease. The global allelic distribution was in Hardy-Weinberg equilibrium. Genotypes with the 3G allele (2R/3G, 3C/3G, 3G/3G) were significantly more frequent in patients than controls and were associated with gastric cancer risk (OR = 2.06; 95% CI = 1.26-3.35). A significant risk was also observed for carriers of the del6 allele in the 3'-UTR. Odds ratios for combined 3G-del6/ins6 and 3G-del6/del6 genotypes were 2.59 (95% CI = 1.36-4.94) and 2.81 (95% CI = 1.22-6.64), respectively. The 3G-del6 haplotype showed a significant association with the disease (p = 0.01). Polymorphisms in the TS gene may contribute to gastric cancer susceptibility and this finding deserve further investigation in the context of novel strategies for gastric cancer prevention. In vitro, 3G genotypes have been related to high TS mRNA expression, which may underlie one of the possible etiologic mechanisms.

3' Untranslated Regions↗

PubMed2004

Spontaneous regression of lung metastasis in the absence of tumor necrosis factor receptor p55.

In order to clarify the roles of tumor necrosis factor (TNF)-alpha in lung metastasis, we injected Renca cells intravenously into TNF receptor p55-deficient (TNF-Rp55 KO) and wild-type (WT) mice. Microscopic and macroscopic metastasis foci appeared in lungs at 7 and 14 days after the tumor injection, respectively. Moreover, metastasis foci expanded at similar rates in both WT and TNF-Rp55 KO mice until 21 days, and lungs were occupied with metastasis foci. However, later than 21 days after the injection, metastasis foci spontaneously regressed in TNF-Rp55 KO mice, whereas WT mice exhibited a progressive growth of metastasis foci. Moreover, metastasis foci remained reduced sizes in TNF-Rp55 KO mice even at 26 days, when all WT mice died with lungs filled with metastasis foci. Later than 21 days after the tumor injection, the number of apoptotic tumor cells was increased in TNF-Rp55 KO mice. In contrast, neovascularization was less evident in TNF-Rp55 KO than WT mice, with depressed hepatocyte growth factor (HGF) gene in TNF-Rp55 KO mice at 21 days after the tumor injection. Thus, TNF-Rp55-mediated signals can maintain tumor neovascularization at least partly by inducing HGF expression, and eventually support lung metastasis process.

Animals↗

PubMed2004

Prediction of lymph node metastasis with use of artificial neural networks based on gene expression profiles in esophageal squamous cell carcinoma.

BACKGROUND: The aim of the study was (1) to detect candidate genes involved in lymph node metastasis in esophageal cancers and (2) to investigate whether we can estimate and predict occurrence of lymph node metastasis by analyzing artificial neural networks (ANNs) using these gene subsets. METHODS: Twenty-eight primary esophageal squamous cell carcinomas were used. Gene expression profiles of all primary tumors were obtained by cDNA microarray. Lymph node metastasis-related genes were extracted with use of Significance Analysis of Microarrays (SAM). Predictive accuracy for lymph node metastasis was calculated by evaluation of 28 cases by ANNs with leave-one-out cross-n. The results were compared with those of other analyses such as clustering or predictive scoring (LMS). RESULTS: Our ANN model could predict lymph node metastasis most accurately with 60 clones. The highest predictive accuracy for lymph node metastasis by ANN was 10 of 13 (77%) in newly added cases that were not used for gene selection by SAM and 24 of 28 (86%) in all cases (sensitivity: 15/17, 88%; specificity: 9/11, 82%). Predictive accuracy of LMS was 9 of 13 (69%) in newly added cases and 24 of 28 (86%) in all cases (sensitivity: 17/17, 100%; specificity: 7/11, 67%). It was difficult to extract useful information for the prediction of lymph node metastasis by clustering analysis. CONCLUSIONS: ANN had superior potential in comparison with other methods of analysis for the prediction of lymph node metastasis. This systematic analysis combining SAM with ANN was very useful for the prediction of lymph node metastasis in esophageal cancers and could be applied clinically in the near future.

Adult↗

PubMed2004

Extended thymectomy in patients with myasthenia gravis with high thoracic epidural anesthesia alone.

Successful extended thymectomy was performed in three patients with myasthenia gravis under only high thoracic epidural anesthesia with voluntary breathing. It was not necessary to intubate a tracheal tube during operation for any of the patients. Neither muscle relaxants nor volatile anesthetic agents were required. The mean operating time was 2.0 +/- 0.5 hours. The drainage tubes were removed the day after operation in all patients. In two patients the arterial oxygen saturation (SaO2) and the arterial partial pressure of carbon dioxide (PaCO2) and oxygen (PaO2) were stable; in the third patient the SaO2 was temporarily decreased to 92 mmHg when bilateral mediastinal pleura were opened. The right pleural defect was then covered with a large wet towel, which was pressed on the defect, and thoracic drainage was performed. The left pleural defect was repaired with 3-0 Vicryl after suctioning the air in the pleural space, after which the SaO2 recovered. All patients were able to drink water and walk within 1 hour after the operation. This procedure is advantageous in that the use of muscle relaxants and volatile anesthetic agents prevented the laryngeal injury that results from translaryngeal intubation; in turn we avoided causing postoperative respiratory insufficiency. This may be suitable for the operation of some patients with MG, but further studies are required to define the indication.

Adult↗

PubMed2004

The combination assay with circulating vascular endothelial growth factor (VEGF)-C, matrix metalloproteinase-9, and VEGF for diagnosing lymph node metastasis in patients with non-small cell lung cancer.

BACKGROUND: The aim of the present study was to evaluate the diagnostic utility of levels of circulating vascular endothelial growth factor (VEGF)-C, matrix metalloproteinase-9 (MMP-9), and VEGF and to verify that the combination assay of these circulating factors is a clinically useful indicator to predict the presence of lymph node metastasis in non-small cell lung cancer (NSCLC). METHODS: A series of 78 patients who underwent surgery for NSCLC was used in this study. Serum VEGF-C and VEGF and plasma MMP-9 levels were analyzed with enzyme-linked immunosorbent assay (ELISA) kits. Logistic regression models were used to analyze the influence of VEGF-C, MMP, and VEGF levels on the probability of presence or absence of lymph node metastasis. RESULTS: Patients with lymph node metastasis had higher serum VEGF- C, VEGF, and plasma MMP-9 concentrations than did those without metastasis (VEGF-C, P = .0004; VEGF, P = .001). Serum VEGF- C reached a sensitivity of 85% and specificity of 68% when a cutoff value of 1762.0 pg/mL was applied, while VEGF reached 80% sensitivity and 59% specificity at 316.8 pg/mL. MMP-9 reached a sensitivity of 63% and specificity of 75% when a cutoff value of 51.4 ng/mL was applied. In the ROC curve analysis, VEGF-C (0.761) had the biggest areas under the ROC curve, followed by MMP-9 (0.723) and VEGF (0.694). Combination assay of three markers had higher sensitivity and specificity for prediction than single-marker assays (AUC = 0.837). CONCLUSIONS: This study has confirmed that combination assay of three markers to determine VEGF-C, MMP-9, and VEGF expression in circulation detects lymph node metastasis in NSCLC with higher accuracy than single-marker assays.

Adult↗

PubMed2004

Intramyocardial CD34+ cell transplantation combined with off-pump coronary artery bypass grafting.

This report describes a new therapeutic approach for severe ischemic heart disease, intramyocardial transplantation of autologous bone marrow-derived CD34 + cells combined with off-pump coronary artery bypass grafting (CABG). CD34 is widely known as a cell surface antigen expressed on hematopoietic stem cells, and recent experimental studies have shown that CD34 + cells include endothelial progenitor cells. We used the Isolex 300i magnetic cell selection system to separate CD34 + cells from bone marrow cells. This report describes the first case treated with the combination of off-pump CABG and cell transplantation for therapeutic angiogenesis and myocardial regeneration. The transplantation of autologous bone marrow-derived CD34 + cells improved perfusion of the ungraftable ischemic area.

Bone Marrow Cells↗

PubMed2004

Gastroepiploic artery graft angiography via brachial approach using a Yumiko catheter.

We report here our initial experience in angiography of gastroepiploic artery (GEA) grafts via a brachial approach using the Yumiko catheter regarding technical aspect. Good-quality GEA angiography was obtained in 12 (86%) of 14 patients using our technique. GEA graft angiography can be performed using the Yumiko catheter via a brachial approach. This technique may be less stressful for patients receiving coronary catheterization, including GEA graft angiography.

Aged↗

PubMed2004

Enhanced proliferation of hepatic progenitor cells in rats after portal branch occlusion.

It is known that hepatic progenitor cells increase in number after liver injury caused by carcinogens, but this injury cannot be reproduced in humans. In order to create a practical source of hepatic progenitor cells, changes in the number of liver epithelial cells (LECs), a type of hepatic progenitor cell, were examined following partial interruption of the portal flow. Efficiency in this isolation procedure was investigated, and isolated LECs were transplanted into livers to demonstrate their differentiation into hepatocytes in vivo.A volume of 70% of Sprague-Dawley rat's livers was exposed to portal vein ligation. LECs, identified as alpha-fetoprotein (AFP)-positive and albumin-negative cells, were counted and LECs isolated from the portal vein ligated-lobe were characterized by immunostaining and Western blotting. Isolated cells were subjected to a 1-week-culture, and the number of colonies formed on dishes was counted. The cells were then transplanted to the livers of genetic analbuminemic rats and identified by immunohistochemistry. The number of LECs in the portal ligated-lobes on day 7 was 14.7 +/- 6.5 cells/1,000 hepatocytes: 18 times higher than numbers in a normal liver. A significant increase was noted from day 3 until day 28. Isolated LECs were AFP-positive, albumin-negative, and cytokeratin-19-positive cells. The number of colonies on the 7th day following portal vein ligation was 42 times higher than in a normal liver. After transplantation of the LECs to the analbuminemic rat, a cluster of albumin-producing cells was present until day 56, suggesting that they differentiate into hepatocytes. We conclude that after portal vein occlusion, the liver can be a good source of hepatic progenitor cell. These results open up the possibility of cellular transplantation for liver functional support in clinical settings.

Animals↗

PubMed2004

Acinic cell carcinoma of the trachea: report of a case.

Acinic cell carcinoma (ACC) is a very rare primary tracheal carcinoma. We report a case of primary ACC of the trachea, which represents, to the best of our knowledge, only the fifth such case ever documented. Pharyngolaryngoesophagectomy was necessary for complete resection because the tumor invaded the trachea widely, up to the cricoid cartilage and involving the cervical esophagus. Although invasion of the upper aerodigestive tract by neoplasma is rare, to achieve complete resection and an acceptable prognosis, even a tumor with low malignancy requires wide resection.

Carcinoma, Acinar Cell↗

PubMed2004

Skeletonized radial artery graft with the St. Jude Medical Symmetry Bypass System (aortic connector system).

BACKGROUND: We report our initial experience with an automatic anastomotic device using skeletonized radial artery in patients requiring off-pump coronary artery bypass grafting (CABG). METHODS: St. Jude Medical, Inc, Symmetry Bypass System (aortic connector system [ACS]) (St Jude Medical, St. Paul, MN) was used in ten patients. Ten consecutive patients who underwent off-pump CABG and who received at least one radial artery graft proximal anastomosis using the ACS were evaluated. The radial artery (RA) was harvested in a skeletonized fashion and applied to the ACS in the same manner as applying saphenous vein graft. The creation of the anastomosis lasted no longer than a few seconds. RESULTS: Our attempt to use the ACS for proximal anastomosis of the RA was successful in all ten patients. Mean operating time was 3.2 +/- 0.6 minutes and an average of 3.0 +/- 0.9 bypass grafts (range, 2 to 5 grafts) were performed. There was no postoperative fatal complication. Postoperative angiographic control showed that all grafts were widely patent including grafts other than the RA. During the mean postoperative follow-up of 10.3 +/- 2.9 months, there was no cardiac-related event in any patient. CONCLUSIONS: The St. Jude Medical Symmetry aortic connector system allows the construction of uniform and widely patent anastomoses in RA graft and does not require aortic side biting. Skeletonization of the RA is a safe and effective technique for applying ACS in off-pump CABG using multiple arterial grafts.

Aged↗