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Biomedical subjects

K Inokuchi

Publications and source records attributed to K Inokuchi.

At least 199 records · Page 11Linked to original sources
PubMed1985

Improved results of surgery for esophageal carcinoma in 148 patients.

Since the late 1970's, there has been a remarkable decrease in the mortality of patients with esophageal cancer. Factors such as progress in pre- and post-operative management, operative technique, and anesthesia all play a contributory role in this improvement. Among 251 Japanese patients with esophageal carcinoma who underwent esophageal resection and reconstruction in our department of surgery since 1965, those treated from 1965-74 and others treated from 1975-1984 were investigated in detail. It became clear that pulmonary complications and anastomotic leakage were the two major complications related to operative mortality. The former has decreased by intensive postoperative care with strong emphasis on cough dynamics, and the latter because of the long gastric tube we devised and which has a good blood supply. These positive events make feasible early postoperative irradiation and cancer chemotherapy.

Adult↗
PubMed1985

Radiation-induced esophageal carcinoma responded well to hyperthermic chemotherapy--a case report.

A 66-year-old man with multiple malignant lesions of the esophagus, as apparently induced by irradiation of 60 Gy of 60Co for a mediastinal tumor at the age of 36 y.o., was a poor operative risk because of severe lung disease. This man was treated with a combination of hyperthermia, oral administration of oil Bleomycin-polyacrylate paste and intravenous infusion of cis-Platinum. During 20 administrations of hyperthermia conducted at 42-45 degrees C for 30 min, 600 mg of oil Bleomycin and 200 mg of cis-Platinum, no complications occurred and the heat treatments were completed with no side effects. Repeatedly performed esophagogram and endoscopy showed a complete disappearance of three of the four lesions and a marked regression in the other one. There has been no regrowth or distant spread of the carcinoma up to the present 10 months of follow up. This combination of hyperthermia and chemotherapy may prove to be the optimal strategy for treatment of unresectable esophageal cancer, particularly when radiotherapy is contraindicated.

Aged↗
PubMed1985

Prognostic study of intramucosal carcinoma of the stomach with DNA aneuploidy.

Cell nuclear DNA content was microspectophotometrically measured in 70 patients with a gastric carcinoma lesion of less than 4.0 cm in diameter and with mucosal or minimal submucosal invasion. Two groups were prepared; low ploidy and high ploidy, according to the degree of dispersion on the DNA histogram. Twenty-four cases of high ploidy were reviewed from the aspects of clinicopathology and prognosis and the findings compared with data on 46 of low ploidy. The high ploidy group was characterized by an elevated lesion and a differentiated carcinoma while the low ploidy group had a depressed lesion and an undifferentiated carcinoma Postoperative recurrence was confirmed in none of the low ploidy cases and 2/24 of the high ploidy cases. The five and ten-year survival rates of the patients with high ploidy were 100 per cent and 91.1 per cent, respectively. Compared to the findings that patients with submucosal carcinoma of high ploidy survived at a rate of only 64.8 per cent in the 5-year follow-up, efforts should be directed toward a higher detection of gastric carcinoma with aneuploidy at the stage limited to within the intramucosal layer. Endoscopic treatment for early gastric carcinoma is not recommended, especially for a differentiated carcinoma, even if the invasion is confined to the mucosa, since it may include aneuploid carcinoma.

Adult↗
PubMed1985

The role of prostacyclin in patients with portal hypertension.

The serum levels of prostacyclin in portal venous blood samples from patients with portal hypertension were measured by radioimmunoassay to assess the role of prostacyclin in this clinical entity. Portal venous prostacyclin activity exceeded peripheral venous activity 2-3 fold in both cirrhotics and non-cirrhotics. The size of esophageal varices showed an inverse relation to the concentration of portal venous prostacyclin in the cirrhotics. There was no significant difference between the portal vein pressure and the size of varices, and the portal vein pressure did not correlate with the concentration of 6 keto-PGF1 alpha. Thus, serum levels of portal venous prostacyclin may depend on the development of collateral circulation in cirrhotics and increased splanchnic blood flow probably accelerates the washout effect.

Adult↗
PubMed1985

Domains involved in osmoregulation of the ompF gene in Escherichia coli.

Expression of the ompF gene, which is under the control of the OmpR protein, is regulated by the osmolarity of the medium. To study the mechanism of osmoregulation, plasmids carrying two different types of chimeric genes were constructed. In one type, the coding region of the ompF gene was linked to the trp promoter (trpPO) preceding ompF, and in the other type the ompF upstream region, mostly composed of the region for regulation by OmpR and the promoter region, was linked to the lacZ gene by protein fusion. Expression of beta-galactosidase by the lacZ chimeric gene was OmpR dependent and osmoregulated as sensitively as that of the intact ompF gene. In the ompR20 background the direction of osmoregulation was opposite that of normal osmoregulation, as was the direction of osmoregulation of the intact ompF gene. Osmoregulation was also observed with trpPO-ompF chimeric genes. However, the regulation was not as sensitive to the osmolarity of the medium as was regulation of the intact ompF gene and was independent of OmpR. These results suggest that OmpR-dependent osmoregulation played a primary role in the osmoregulation of ompF expression and that ompR-independent osmoregulation most likely did not play a crucial role. Studies with a series of trpPO-ompF chimeric genes also suggest that the untranslated leader region, about 100 base pairs in length, between the transcription initiation site and the initiation codon was not required for osmoregulation.

Bacterial Outer Membrane Proteins↗
PubMed1985

Increased blood flow in the stomach of cirrhotic patients as assessed by radionuclide angiography.

To assess the gastric hemodynamics of patients with cirrhosis of the liver, radionuclide angiography of the left gastric artery, using technetium-99m-labeled human serum albumin (99mTc-HSA), was performed in 13 cirrhotics and 4 control subjects. The half-life (T1/2) of radioactivity of the stomach was significantly shorter in cirrhotics than in controls, 7.1 +/- 2.2 s (+/- SD, n = 13) and 14.1 +/- 3.4 s (+/- SD, n = 4), respectively (p less than 0.001). Accordingly, the calculated blood flow per unit plasma volume of the stomach of cirrhotics was significantly increased compared with that of controls, 6.4 +/- 1.9 ml/min (+/- SD, n = 13) and 3.1 +/- 0.8 ml/min (+/- SD, n = 4), respectively (p less than 0.01). These results provide direct evidence that a hyperdynamic state exists in the gastric circulation of cirrhotic patients.

Angiography↗
PubMed1985

Randomly controlled study of chemotherapy versus chemoimmunotherapy in postoperative lung cancer patients.

A randomly controlled study of chemotherapy versus chemoimmunotherapy was performed in patients with operable lung cancer from November 1977 to June 1981. The immunotherapy consisted of an intrapleural instillation of Nocardia rubra cell wall skeleton (N-CWS) followed by serial intradermal N-CWS. A total of 119 patients were entered into this trial. There were 64 evaluable patients in the control group and 52 evaluable patients in the N-CWS group. N-CWS treatment was effective in terms of prolongation of duration of remission for all operable patients. Although significant improvement in the survival rate was not observed in patients at Stages I and II (p less than 0.10), it was observed in the curative operation group (p less than 0.05). The mode of recurrence was classified as local recurrence and distant metastasis in the curative operation group. The rates of distant metastasis were 34.0 and 18.9%, respectively, in the control and the N-CWS groups. The rate of local recurrence was 14.9% in the control group; however, no local recurrence was observed in the N-CWS group. These results indicate the clinical effectiveness of the N-CWS treatment, especially in curatively resectable lung cancer. No serious side effect was observed during this trial.

Adult↗
PubMed1985

[Randomized study of long-term adjuvant chemotherapy with Futraful and mitomycin C in gastric cancer. A second study (fourth report)].

In view of the usefulness of long-term adjuvant chemotherapy, the Cooperative Study Group of Surgical Adjuvant Chemotherapy for Gastric Cancer adopted as a second cooperative study a randomized controlled trial including three groups; MMC alone, Futraful alone and a combination of MMC and Futraful. In the groups given Futraful alone and the combination therapy, the survival and disease-free rate were improved at five years, in patients with stage III. Moreover, the survival and disease-free rate for the group given combination therapy were higher than those for the group given Futraful alone. Also, in the groups given Futraful alone and the combination therapy, toxicities probably due to the long-term Futraful therapy were minor, without serious side effects. Therefore, a long-term combined adjuvant chemotherapy with MMC and Futraful seems to be an effective chemotherapy regimen for resectable gastric cancer. A more potent regimen and cyclic therapy may be needed to improve the result of treatment.

Clinical Trials as Topic↗
PubMed1985

[A multi-institutional study on postoperative adjuvant immunochemotherapy of gastric cancer].

An analysis of 3,630 gastric cancer cases from 412 institutions who were treated with 6 randomly-assigned protocols was carried out to study the effect of daily PSK and Futraful administration and the adjuvant effect of PSK and/or Picibanil (OK 5 KE) combined with MMC and FT. Evaluation of immunochemotherapy was made on the basis of three-year survival rates and immunoparameters. The most positive results were found in survival rates favoring the combined therapy (FT + PSK) over single administration (FT) to relatively early-stage patients (30%, difference), PSK, MMC and FT combination (10%), and PSK, OK, MMC and FT (22%), over single chemotherapy alone. Serum alpha-2 globulin levels, indicative of immunosuppression, were lower in PSK-administered cases. The overall findings indicated that PSK and/or OK with MMC and FT are effective in prolonging the lives of post-operative patients.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1985

Surgical treatment for carcinoma of the esophagus in the elderly patient.

There were 250 Japanese patients with carcinoma of the thoracic esophagus who had been admitted to the Second Department of Surgery at the Kyushu University Hospital from 1972 to 1982. Resection for carcinoma of the esophagus was performed upon 160 of these patients (64 per cent). These 160 patients were classified into three groups according to age, and preoperative examination, postoperative complications, mortality and late results were reported. In patients more than 70 years old, the incidence of abnormal findings at preoperative examination was high with a statistical difference and the incidence of postoperative complications was also high in elderly patients. Although the over-all mortality within one month after operation was seen in eight of 160 patients (5 per cent) surgically treated, the rate was 12.8 per cent when confined to those patients more than 70 years old. Thus, the indication for surgical treatment should be carefully determined for elderly patients with carcinoma of the esophagus. If the elderly patient can tolerate the surgical procedure, the five year survival rate is equal to that of younger patients. Since there is an increase in people more than 70 years old, the surgeon must be prepared for the challenge of treating elderly patients with carcinoma of the esophagus.

Aged↗
PubMed1985

Effect of wall shear stress on intimal thickening of arterially transplanted autogenous veins in dogs.

To determine whether or not changes in wall shear stress play a determinant role in the induction of hyperplasia of intimal tissue of arterially transplanted vein grafts, we developed two models of canine femoral arteries. Wall shear stress was defined by variation of wall shear stress (tau-variation) in the cardiac cycle, with the use of a newly designed computational flow waveform analyzer. In the group I model autogenous vein grafts were implanted under flow conditions of 79.7 +/- 3.2 ml/min of the normally high flow rate with 33.1 +/- 1.9 dynes/cm2 of low tau-variation. In the group II model grafts were implanted under conditions of 2.9 +/- 1.8 ml/min of low flow rate with 178.8 +/- 11.0 dynes/cm2 of normally high value of tau-variation. The intimal thickness of 259 +/- 36 microns 4 weeks after implantation in group I was statistically significant compared with that of 31 +/- 14 microns in group II (p less than 0.005). Our study revealed that change in wall shear stress and not the rate of blood flow is the essential hemodynamic factor related to intimal hyperplasia.

Animals↗
PubMed1985

[In vitro chemosensitivity of various human tumors evaluated by the SDI (succinate dehydrogenase inhibition) test].

In vitro chemosensitivity was evaluated by SDI test in various human tumors including 1 lymph node metastasis of esophageal cancer, 10 gastric cancers, 4 colo-rectal cancers, 1 hepatoma, 2 lung cancers, 2 breast cancers and 1 gallbladder cancer. Tumor fragments cut with scissors were exposed to twelve kinds of antitumor drugs at five to ten times peak plasma concentration. After 3 days at 37 degrees C, each tumor fragment suspension was washed with phosphate-buffered saline and assayed for succinate dehydrogenase (SD) activity using 3-(4,5- dimethyl-2-thiazolyl)-2, 5-diphenyl-2H tetrazolium bromide (MTT) as a hydrogen acceptor. When the SD activity of the drug-treated cells was reduced to below 50% that of control cells, the chemosensitivity to the antitumor drug was considered positive. The chemosensitivity of each tumor varied individually. Mitomycin C or 5-fluorouracil are regularly used to treat gastric cancer patients, but, some specimens of gastric cancer in this study showed a resistance to these drugs and an unexpected sensitivity to other drugs. Our results show that the SDI test is a convenient method for clinical use and gives significant information about drug sensitivity.

Antineoplastic Agents↗
PubMed1985

[Phase II study of (2''R)-4'-0-tetrahydropyranyladriamycin (THP) in gastrointestinal cancer].

A phase II study of a new anthracycline, (2''R)-4'-0-tetrahydropyranyladriamycin (THP) was performed on 37 patients with gastrointestinal cancer in 6 co-operative study institutions. Twenty-five patients out of 37 were evaluable for response according to the Koyama-Saito's criteria. THP was administered weekly at doses of 10 to 30 mg/body or every 3 to 4 weeks at doses of 40 to 60 mg/body intravenously. Of the 14 patients with gastric cancer, we obtained one complete response and 3 partial responses (response rate 28.6%), and of the 6 patients with rectal cancer, we obtained one partial response (16.7%). Leukopenia of less than 3 X 10(3)/mm3 and erythrocytopenia of less than 300 X 10(4)/mm3 were seen in 48% and 26% of cases. Neither cardiotoxicity nor hair loss were seen. These results suggest that THP is useful in the treatment of patients with gastrointestinal cancer.

Adult↗
PubMed1985

[The inhibitory effect of peptic ulceration on the growth of early gastric cancer].

The correlation between the growth pattern and peptic ulceration occurring in the cancer lesion was studied in early gastric cancer. Although the superficially spreading type (Super), which grows slowly, showed a high rate of being accompanied by peptic ulceration (74.0%), the deeply penetrating type (Pen), with rapid growth, had a lower such rate (Pen A- expansive type 9.7%; Pen B- infiltrative type 16.1%). Deep ulceration accompanied 32% of the Super cases, 12% of the small mucosal cases and no cases of the Pen type. The Super and small mucosal types located at the intermediate gland area had peptic ulceration more frequently than those at the other areas. The rate of the cases of peptic ulceration of undifferentiated adenocarcinoma was high in the Super and small mucosal types, and that of differentiated adenocarcinoma was 64.0% in the Super and only 33.3% in the small mucosal type. This study clarified that the growth of early gastric cancer was inhibitively influenced by peptic ulceration, which was modified by the localization and histologic type of the carcinoma.

Adenocarcinoma↗
PubMed1985

[Evaluation of splenectomy in total gastrectomy for gastric cancer].

It has been well accepted that extensive prophylactic lymphadenectomy is certainly effective for elevating cure rate after gastric cancer surgery, however, regarding to the prophylactic splenectomy the arguments are controversial. We studied the value of splenectomy in total gastrectomy for gastric cancer by examining the late survival rates, the accuracy of intraoperative judgement of splenic hilar lymph node metastasis and postoperative changes of serum immunosuppressive factors. In curatively resected stage III cases without splenic hilar lymph node metastasis, the nonsplenectomized group showed a significant better late survival rate than the splenectomized group, 5-year survival rate being 59.9% in the former and 30.8% in the latter. In cases with splenic hilar lymph node metastases, 2 of 9 splenectomized patients survived more than 10 years. In cases of noncuratively resection, splenectomy did not enhance the survival rate. Although further clinical randomized study is needed to draw a definitive conclusion, we had better take a splenic reserve operation for the patients without splenic hilar lymph node metastasis. On the other hand, splenectomy should be performed in cases with splenic hilar lymph node metastases.

Gastrectomy↗
PubMed1985

[Preoperative assessment of hepatocellular reserve by discriminant analysis of limited hepatic resection in cirrhotic patients with primary liver cancer].

We analysed various preoperative data of 32 cirrhotic patients with primary liver cancer to predict clinical course after limited hepatic resection. Out of 32 patients, postoperative course was uneventful in 26, however, the remaining 6 developed hepatic failure which led to death. The analysis of the preoperative data including liver function tests and age of patients to discriminate the two groups was carried out. It was shown that indocyanin green (ICG) test, prothrombin time (PT), lecithin cholesterol acyltransferase (LCAT), gamma-globulin, age of patients and total bilirubin appeared to be important factors to discriminate the subjected patients into two groups. An equation for prediction of hepatic failure after hepatectomy obtained in this study was: Y = 0.086726 X ICG(%), -0.054694 X PT(%), +0.102850 X LCAT(microgram/ml/h), +0.059758 X gamma-globulin(%), +0.077260 X age, +1.099958 X total bilirubin (mg/dl), -6.776657. When Y was over 0.5, patients are considered to be at high risk for postoperative liver failure, and satisfactory postoperative course could be expected when Y was less than 0.5. This equation can be used to determine operative indication for minimal hepatic resection in cirrhotic patients with impaired liver function.

Female↗