Biomedical subjects

H Orita

Publications and source records attributed to H Orita.

At least 91 records · Page 5Linked to original sources

PubMed1992

Trends in survival rates in Japanese patients with advanced carcinoma of the stomach.

From 1965 to 1985, 1,150 patients underwent gastrectomy for carcinoma of the stomach invading beyond the submucosa. One thousand, one hundred and forty-one patients were studied for five years or longer. The patients were classified into two groups--those treated from 1965 to 1974 (n = 622) and those treated from 1975 to 1985 (n = 519). In the more recent group, there was a significant increase in the number of patients more than 70 years of age, in the number of female patients, of carcinomas present in the upper two-thirds of the stomach, in tumors exceeding 10 centimeters and diffusely infiltrative type and in early cancer-simulating type of advanced carcinoma in gross appearance and in undifferentiated type adenocarcinomas in histology. Although differences in the incidence of patients treated by radical procedures, such as extensive lymph node dissection and combined resection of adjacent organs, were not statistically significant, the incidence for those who underwent total gastrectomy was significantly increased. The over-all long term survival rate remained unchanged during 1965 to 1985 (five year survival rate of 31.3 versus 32.8 per cent). However, there was a significantly longer survival period for patients who underwent total gastrectomy (five year survival rate of 22.9 versus 28.3 per cent) (p less than 0.05). Much of the improvement can be attributed to an increase in the detection of relatively small advanced carcinomas and of advanced carcinomas of the stomach simulating early carcinoma in the upper one-third of the stomach. Therefore, we emphasize the need to diagnose advanced carcinoma of the stomach when the lesion is in an earlier stage of disease.

Adenocarcinoma↗

PubMed1992

Lower survival rate for patients with carcinoma of the stomach of Borrmann type IV after gastric resection.

Between 1965 and 1985, 194 of 1,113 patients (17.4 percent) with advanced carcinoma of the stomach who underwent gastric resection had Borrmann type IV carcinoma of the stomach, a macroscopically evident and diffusely spreading tumor. These patients tended to be younger and female and to have larger tumors that involved the entire stomach, as compared with patients with other types of carcinomas. Tissues were commonly undifferentiated, serosal invasion was prominent with infiltrative growth and high rates of metastasis to the lymph nodes and peritoneal dissemination were evident. In most instances, the disease was advanced; therefore, total gastrectomy was performed upon 82.0 percent of the patients and a palliative resection was done in 64.4 percent. The survival rate was lower than for patients with carcinoma of the stomach of other types (p less than 0.01). A multivariate analysis indicated that curative resection is an independent favorable prognostic event, while other factors are dependent covariates. Early detection of this carcinoma is crucial to extend survival time of patients with Borrmann type IV carcinoma of the stomach. Aggressive postoperative chemotherapy should be considered when a noncurative resection is done.

Female↗

PubMed1992

[A case of a primary neurofibroma of the left ventricle].

A neurogenic tumor of the heart is extremely rare, and previously only 8 cases of malignant schwannoma and 3 cases of neurilemmoma have been reported. The patient of this case was a seven year old boy and referred to our hospital by his school doctor for investigation of IRBBB on screening ECG. The chest-X-ray showed a bulging contour on left ventricular apex. Echocardiography and angiography showed a 4 x 4 cm solid mass in the anterior-lateral wall of the left ventricle near the apex. Thoracotomy was performed and during cardiopulmonary bypass the tumor was successfully removed without involvement of the endocardium. It was not encapsulated. The pathohistological findings of the specimen were compatible with neurofibroma, and S-100 protein was demonstrated immunohistochemically.

Child↗

PubMed1991

DNA ploidy is associated with growth potential in gastric carcinoma.

To correlate growth potential with DNA ploidy 109 patients with early gastric carcinoma and 132 patients with advanced gastric carcinoma were studied. Early gastric carcinomas were classified by growth potential into the small mucosal type, the superficially spreading (super) type, or the expansively penetrating (Pen A)/infiltratively penetrating (Pen B) types. Advanced gastric carcinomas were classified into funnel, column, or mountain types, each of which was divided further into expanding and infiltrative types. Cell nuclear DNA content was measured by microspectrophotometric study and classified as either low or high ploidy according to the degree of dispersion on the DNA histogram. Super type early and funnel type advanced carcinomas, characterized by superficially spreading growth, were more likely to have low DNA ploidy. In contrast, Pen A type early and column-expanding type advanced carcinomas, characterized by expansively penetrating growth, were more likely to have high DNA ploidy.

DNA, Neoplasm↗

PubMed1991

Comparison of R1 and R2 gastrectomy for gastric cancer in patients over 80 years of age.

To evaluate the benefit of R2 gastrectomy for gastric cancer in Japanese patients over 80 years of age, data on 93 patients who underwent gastrectomy between 1967 and 1989 were collected retrospectively from charts filed in the Kyushu University Hospital and two affiliated national hospitals. Of 93 patients, 62 had a localized tumor without evidence of metastatic spread. These 62 patients were classified into two groups according to the procedures performed: 35 underwent R1 gastrectomy and 27, R2 gastrectomy. The clinical and pathological characteristics of the patients in the two groups were comparable at the time of surgery, except that the group who underwent R1 gastrectomy was older. R2 gastrectomy involved a significantly longer operation time (P less than 0.01) and greater intraoperative blood loss (P less than 0.05) when compared to R1 gastrectomy, but no patient undergoing this extensive surgery died. The difference in the morbidity rate between the two groups was not statistically significant. The 5-year survival rate was 55.8% in the R1 group and 65.4% in the R2 group. When gastric cancer invaded the serosa and/or secondary nodes, a substantial increase in survival time was gained with R2 gastrectomy when compared to an R1 operation. These findings suggest that an R2 gastrectomy is feasible, even for patients over 80 years, but is indicated mainly when the carcinoma had invaded the serosa and/or secondary nodes and the patients are at good risk for major surgery.

Aged↗

PubMed1991

Kinetic analysis of experimental post-operative peritoneal healing: the incorporation of proline and glucosamine by exudative and tissue repair cells.

The purpose of this study was to experimentally investigate the cellular composition of post-surgical peritoneal fluid and peritoneal tissue and determine the patterns of 14C-proline and 14C-glucosamine incorporation by the peritoneal exudative cells and peritoneal tissue repair cells (PEC and PTRC). One group of rabbits underwent resection (2.0 cm) and reanastomosis of their ileum, and another group underwent peritoneal wall abrasion. Postoperatively (1-28 days), the PEC and PTRC were collected and incubated for 5 days with 0.5 mu Ci 14C-glucosamine or 14C-proline, and the specific activity thereafter determined by beta counting. On the 1st postoperative day, the total cell number (TCN) has increased (7.7 x 10(7) cells/rabbit) to 770 per cent of the control values primarily as a result of the PMN influx (89.9 per cent). On day 3, the TCN was 6.1 x 10(7), 58.5 per cent of which comprised macrophages, which had become the principle cell type by day 5. The incorporation of proline and glucosamine into the PEC increased significantly peaking on day 7 then decreasing to the control value by day 21. Proline incorporation into the PTRC increased significantly, reaching a peak value on day 5, which decreased by day 10. Glucosamine incorporation reached a peak value on day 7 then decreased by day 10. In conclusion, the increase in glucosamine and proline incorporation into the PTRC parallels the increase in PEC, comprised principally of macrophages. These findings suggest that analysis of the metabolic activities in peritoneal activated macrophages may provide a useful tool to dissect the central mediation of postsurgical peritoneal re-epithelialization.

Animals↗

PubMed1991

Accelerated myocardial metabolic and functional recovery with terminal nicorandil-Mg cardioplegia in heart transplantation.

Cardiac reperfusion injury after heart transplantation or cardiopulmonary bypass has been difficult to control due to the variable degree of myocardial damage with respect to the length of ischemia and the complexity of the surgical procedure. Here, we evaluated the myocardial metabolic and functional recovery of hearts infused with a nicorandil vasodilator-magnesium (Mg) solution just prior to reperfusion (terminal cardioplegia). Donor hearts (20 dogs) were removed and immersed in a 4 degrees C water bath containing 20 mEq/l KCL-5% glucose for 6 hours, and then were transplanted to recipient dogs. Orthotopically transplanted dog hearts were either reperfused without any further treatment or received a terminal cardioplegic solution containing 8 mg/l nicorandil, 30 mEq/l Mg, and 50 g/l glucose, which was infused at a pressure of 75 cm H2O for 2 minutes. During the reperfusion period, myocardial tissue PCO2 (t-PCO2) and calcium ion (t-Ca) were continuously monitored by an ISFET (ion-sensitive field effect transistor) sensor. Myocardial oxygen consumption and lactate flux were calculated/monitored at 5, 10, 20 and 40 minutes of reperfusion. Thereafter, myocardial function was evaluated at 45 minutes of reperfusion using LVSWI. Just after reperfusion, the treatment group (group B, n = 10) had a significantly greater coronary flow than the control group (Group A, n = 10, 35.0 +/- 10.1; group B, 47.4 +/- 8.5 ml/100 g/min, p less than 0.025).(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗

PubMed1991

Lower survival rate for patients under 30 years of age and surgically treated for gastric carcinoma.

We analysed data on 38 patients with gastric cancer aged 30 years and younger who were surgically treated in the Department of Surgery II, Kyushu University Hospital, between 1965 to 1985. These younger patients comprised 2.6% of the total 1,470 patients treated for gastric cancer during this 21-year period. The durations and the kinds of symptoms in the preoperative period varied with the patient. In patients under 30 years of age, the female patients predominated, and in addition, undifferentiated lesions were more common than the differentiated type, tumours were larger, serosal invasion was more prominent, lymphatic involvement was more common, tumours showed infiltrative growth and the rate of peritoneal dissemination was higher. Consequently the survival rates for these younger patients were poor. Detection at an early stage of the disease is mandatory if the survival rates of younger patients with gastric cancer are to improve.

Adult↗

PubMed1991

Prophylactic administration of urinary trypsin inhibitor prevents postoperative hyperamylasemia after R2 gastrectomy in patients with gastric cancer. A prospective randomized trial.

The purpose of this prospective randomized study was to determine whether prophylactic administration of urinary trypsin inhibitor prevents postoperative damage to the pancreas caused by R2 gastrectomy in patients with gastric cancer, by analyzing related enzyme activities. Among the 22 patients who underwent distal partial gastrectomy together with R2 lymphadenectomy, 12 were given the drug for 3 days postoperatively, and 10 no therapeutic agent. These groups were otherwise comparable. Postoperatively, the control patients had significantly higher levels of total amylase activity in the serum and P-type amylase when compared to the preoperative data. These amylase activities almost remained at the preoperative level in those given the drug. When the ratio of increase in enzyme activities (postoperative value divided by preoperative value) were compared, on the 7th postoperative day, total amylase activity in the serum and P-type amylase were significantly different between the two groups (p less than 0.05). This difference was also evident when comparing total amylase activity in the urine (p less than 0.05). These findings indicate that prophylactic administration of urinary trypsin inhibitor would aid in preventing postoperative hyperamylasemia caused by R2 gastrectomy in patients with gastric cancer.

Adult↗

PubMed1991

[A role of postsurgical macrophage activation by peritoneal injury].

At a site of peritoneal injury after abdominal surgery, macrophages are thought to be a principle type of inflammatory cells. Therefore, we determined the metabolic activities of postsurgical peritoneal exudate macrophages using standardized rabbit model. Rabbits underwent midline laparotomy followed by resection and reanastomosis of the ileum. At various days after surgery, peritoneal exudate macrophages were recovered from lavage fluid. Postsurgical Day-5 macrophages expressed significantly high potential to produce superoxide anion even without PMA stimulation compared to non-surgical control macrophages, although an activity of Day-10 macrophages was similar to control. The conditioned media from postsurgical Day-1 macrophage culture strongly inhibited urokinase type plasminogen activator (PA) and this plasminogen activator inhibitor (PAI) activities decreased following the extension of postsurgical time. Conversely, PA activities of macrophage-conditioned media decreased by day 1 and then gradually increased reaching control levels by day 10. Elastase activities of macrophage-conditioned media gradually decreased until postsurgical day 10. These data suggest that surgical injury activates postsurgical exudate macrophages. However, a time course of metabolic activities of these cells was dependent upon each secretory products. This differential secretion might express the stage of activation and differentiation of postsurgical macrophages. Moreover, postsurgical activated macrophages may control the tissue repair through a digestion of injured matrix and fibrinolytic process.

Animals↗

PubMed1991

[Preventive effect of post-ischemic reperfusion injury by terminal Nicorandil-Mg cardioplegia].

In this study, we evaluated the postischemic myocardial tissue blood flow, specific enzymes, and functional recovery infused with a Nicorandil vasodilator-magnesium solution (Nico.: 8 mg/L, Mg: 20 mEq/L) given just prior to reperfusion (Terminal Cardioplegia, TCP). 27 patients undergoing valve replacement were divided into two groups; the hearts of group non-TCP (nTCP) (n = 15) were reperfused after ischemia without TCP, and in the other hearts of group TCP (n = 12), TCP was given for 2 min prior to reperfusion. During the reperfusion period, myocardial tissue blood flow (TBF) on the anterior wall of left ventricle were monitored by a laser blood flow-meter. Thereafter, serum CK-MB levels, MM3/MM1 values by CK-MM subbands (MM1, MM2, MM3) levels and LVSWI were measured until 24 hours after surgery. At 5 and 10 min of reperfusion, Group TCP had a significantly greater TBF than Group nTCP (5 min; G-TCP: 69.9 +/- 19.0 ml/100 g.min, G-nTCP: 47.5 +/- 20.9, p less than 0.05, 10 min; G-TCP: 74.9 +/- 22.8, G-nTCP: 56.1 +/- 23.4, p less than 0.05). At 3 hrs after surgery, an increase of MM3/MM1 values was significantly suppressed in Group TCP compared to Group nTCP (G-TCP: 2.6 +/- 0.6, G-nTCP: 3.4 +/- 1.0, p less than 0.05). Also, Group TCP had better recovery of LVSWI. These results indicate that the TCP might reduce the postischemic reperfusion injury by the improvement of myocardial TBF and metabolism.

Heart Arrest, Induced↗

PubMed1991

[Mechanical factors of a severe type of ventricular arrhythmia after Cabrol's operation].

Severe type of ventricular arrhythmia was noticed after Cabrol's operation more frequently than usual reperfusion arrhythmia. Nine patients received Cabrol's operation and 2 of Bentall's were divided into 2 groups according to the occurrence of postsurgical ventricular arrhythmia (Lown's classification grade 0-3: 5 cases, grade 4 A-5: 6 cases), and then the factors contributed to the arrhythmia were analyzed. There were no significant differences between the 2 groups on the point of the characteristics of the cases with or without emergent surgery for, such as ruptured or dissecting thoracic aortic aneurysms or other complicated lesions, the degree of surgical damage, or preoperative cardiac function. The only significant difference between the groups was the angle overheading to the central point of left coronary orifice anastomosed with intermediate tube from the extensive line of the prosthetic flange obtained in the left anterior oblique views on the angiography. The mean value of the angle of the severe group (grade 4 A-5) was 41 +/- 6.8 degrees (mean +/- SD) and significantly acute than the angle of the other group (grade 0-3: 57 +/- 6.4 degrees). This fact suggested that the main reason of the ventricular arrhythmia was coronary ischemia caused by compression of the intermediate tube after formation of massive hematoma within the aneurysmal capsule wrapped over the composite graft.

Adult↗

PubMed1991

Prognostic factors in adenocarcinoma in the upper one-third of the stomach.

From 1965 to 1985, 356 of 1,468 patients (24.3 per cent) with carcinoma of the stomach who underwent gastric resection had disease arising from the upper one-third of the stomach. Tumors in the upper one-third of the stomach were larger, and gross appearance of types 3 and 4 was frequent. Serosal invasion was prominent, and the rates of metastases of the lymph nodes and liver were higher in carcinoma in the upper one-third of the stomach compared with carcinoma in other regions of the stomach. Palliative resection was done for 43.8 per cent of the patients. Survival rate for patients with carcinoma in the upper one-third of the stomach was lower than for patients with lesions in other regions of the stomach (p less than 0.01). Multivariate analysis indicated that operative curability, hepatic metastasis, serosal invasion, lymph node metastasis, peritoneal dissemination and tumor size are significant prognostic factors for carcinoma in the upper one-third of the stomach. These events, except for peritoneal dissemination, differed between carcinoma in the upper one-third of the stomach and in other regions of the stomach, and the survival rate for patients with carcinoma of the upper one-third of the stomach was less favorable. Early detection is crucial for improving the survival time of patients with carcinoma in the upper one-third of the stomach. Aggressive postoperative chemotherapy should be considered when noncurative resection is done.

Adenocarcinoma↗

PubMed1991

[A successful case of double outlet right ventricle accompanied with complete endocardial cushion defect].

Surgical correction of a case of double outlet right ventricle accompanied with complete endocardial cushion defect was completed successfully. No other complicated anomaly existed in this case. Correction was done by using two patch method. The patch for VSD was designed to be comma-like shape. For ensuring the left ventricular out tract, the patch was sutured with bulging at the circumference of the aortic orifice and the suture line of the patch with atrio-ventricular valve was deviated to the right. There was no stenosis in the left ventricular out tract and tricuspid valve.

Child, Preschool↗

PubMed1990

Left ventricular function in the early postoperative stage--cardioplegic baneful effect is lost in the first 24 hours.

Early postoperative left ventricular function was investigated in 42 patients with left ventricular volume overload caused by valvular regurgitation. Preoperatively, left ventricular contractile function, stroke work and stress relations were all evaluated. Anoxic index (AnI) was considered as an index of myocardial preservation. Postoperatively, the cardiac function was estimated as the left ventricular stroke work index (SWI) after 3, 6, 24 and 48 hours of post-cardiopulmonary bypass. The release of CK-MB isoenzyme was also measured at the same time as an indication of myocardial injury. AnI and the postoperative SWI3 and SWI6 showed negative correlations in 6 hours, while preoperative SWI0 and postoperative SWI24 and SWI48 showed positive correlations after 24 hours, and SWI0 showed positive or negative correlations to the preoperative 8 parameters. It was observed that ejection fraction, end-systolic wall stress to end-systolic volume index ratio and tension volume ejection showed positive, while left ventricular end-diastolic pressure showed negative correlations to SWI48. However, none of these indexes showed any significant correlations during the first 24 hours following surgery. On the other hand, AnI and the total release of CK-MB isoenzyme showed a positive correlation. These data suggest that the cardioplegic baneful effect on cardiac function might be lost in the first 24 hours after surgery.

Female↗

PubMed1990

Adjuvant mitomycin-C prolongs survival time of patients undergoing extensive en bloc resection of carcinoma of the stomach invading the adjacent organs.

We retrospectively examined the long-term results of adjuvant chemotherapy with mitomycin-C (MMC) in 50 patients with gastric carcinoma invading the adjacent organs. All patients underwent gastrectomy and en bloc multiple resection of the invaded organs, with the intent of a potential cure. Evidence of direct invasion was confirmed histologically. These patients were classified into 3 groups, according to the dose schedule of MMC: 12 received prolonged, intermittent administration of the drug, in a total dose of 40 mg or more (group A); 19 were given a bolus injection at the time of surgery and/or on the following day, in a total dose of less than 40 mg (group B), and 19 were given no anticancer drugs (group C). These 3 groups were comparable with regard to various prognostic factors. The 5-year survival rates were 50, 32 and 17% in groups A, B and C, respectively. There was a statistical difference in survival between groups A and C (p less than 0.05). These results indicate that extensive en bloc resection plus intensive adjuvant chemotherapy prolong the survival time for those with gastric carcinoma invading the adjacent organs.

Antineoplastic Agents↗

PubMed1990

[A case of isolated congenital diverticulum of the left ventricule].

Congenital diverticulum of the left ventricule is rare congenital cardiac malformation and is classified as muscular and fibrous. Muscular diverticula are usually accompanied with other cardiac and extracardiac malformations. 8 years old boy involved with muscular left ventricular diverticulum with no other congenital anomalies underwent resection of diverticulum. The cardiopulmonary bypass was required because it was not feasible to apply a clamp, to the neck of the diverticulum. Congenital diverticulum of the heart should be resected as soon as possible because of crisis of spontaneous rupture and systemic embolization. However, the assessment of cardiac arrhythmias and hemodynamic changes caused by clamping of the diverticulum during operation is necessary.

Cardiopulmonary Bypass↗

PubMed1990

Brain tissue pH, oxygen tension, and carbon dioxide tension in profoundly hypothermic cardiopulmonary bypass. Pulsatile assistance for circulatory arrest, low-flow perfusion, and moderate-flow perfusion.

The brain tissue pH, oxygen tension, and carbon dioxide tension were experimentally examined during profoundly hypothermic cardiopulmonary bypass with core cooling and core rewarming. Sixty-minute circulatory arrests (n = 28, group I), 120-minute low-flow perfusions (25 ml/kg/min; n = 16, group II), and 120-minute moderate-flow perfusions (50 ml/kg/min; n = 16, group III) were accomplished with and without pulsatile flow. In group I, progressive brain tissue acidosis and hypercapnia were recovered with pulsatile assistance. In group II, brain tissue acidosis and hypercapnia were recovered completely with pulsatile assistance but incompletely without it. In group III mild acidosis was eliminated with pulsatile assistance where the pH was significantly higher than in groups I and II, and brain tissue carbon dioxide pressure was significantly lower than in groups I and II with and without pulsatile assistance. Brain tissue hypoxia was severe in group I, slight in group II, but not found in group III. We concluded that a perfusion flow rate will decide the safe period, and a pulsatile assistance will promote brain protection at any flow rate in profoundly hypothermic cardiopulmonary bypass.

Acidosis↗