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Biomedical subjects

K Kitamura

Publications and source records attributed to K Kitamura.

At least 1,675 records · Page 93Linked to original sources
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Hyperthermia combined with chemotherapy and irradiation for patients with carcinoma of the oesophagus--a prospective randomized trial.

From 1988 to 1990, 53 patients with squamous cell carcinoma of the thoracic oesophagus underwent subtotal oesophagectomy after either preoperative hyperthermo-chemoradiotherapy (HCR therapy) or chemoradiotherapy without hyperthermia (CR therapy), in a prospective randomized trial carried out to examine the effects of hyperthermia given preoperatively. The two groups (27 patients given HCR therapy and 26 given CR therapy) were found to be comparable with regard to prognostic factors of age, site of carcinoma, TNM stage, etc. Following preoperative evaluation by an upper GI series and endoscopy, a subtotal oesophagectomy was done for all 53 patients. All the resected specimens, including the lymph nodes, were histopathologically examined, and the effects of preoperative treatment were evaluated by findings in the upper GI series and endoscopy, as well as based on the histopathology of the excised tissues. There were no viable cancer cells in the resected specimens of seven patients in the HCR therapy group (26.9%) and of two patients in the CR therapy group (7.7%). In addition, no hyperthermia complications were observed. The study suggests that preoperative HCR therapy may be a more beneficial therapy than preoperative CR therapy in patients with squamous cell carcinoma of the oesophagus who undergo a subtotal oesophagectomy.

Aged↗
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A complete response of an advanced oesophageal carcinoma treated with hyperthermic chemotherapy: a case report.

A 56-year-old Japanese man with an advanced squamous cell carcinoma in the middle oesophagus was treated with a combination of hyperthermia, intravenous infusion of cisplatin (CDDP) and oral administration of oily bleomycin(BLM)-polyacrylate paste. After performing six sessions of hyperthermia treatment conducted at 42-45 degrees C for 30 min with 150 mg of CDDP and 180 mg of BLM, a subtotal oesophagectomy and lymph node dissection were performed. A histopathological study of the resected specimen showed no residual viable cancer cells either in the oesophagus or in the dissected lymph nodes. There were no side effects or perioperative complications and the patient is now healthy and leading a normal life 10 months after operation without undergoing any further treatment, at the time of writing. The effect of small amounts of CDDP and the oral application of oily BLM were thought to be strongly enhanced by hyperthermia in the treatment of oesophageal squamous carcinoma, and this regimen is therefore recommended as a safe and effective strategy, especially for preoperative treatment.

Antineoplastic Combined Chemotherapy Protocols↗
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Predictive value of intracellular ATP level for cell viability after heating in malignant cells.

An adenosine triphosphate (ATP) assay is known to be a useful chemosensitivity test, which correctly reflects cell viability. We investigated the usefulness of ATP assay as a thermosensitivity test by comparing two world-wide accepted assays which included a succinate dehydrogenase (SD) assay and a colony assay. We exposed KSE-1 and KSE-2 cell lines to various degrees of hyperthermia at 42, 43 and 44 degrees C for 0.5, 1, 2, 3 and 4 h, respectively. The ATP activity for the KSE-1 and KSE-2 cell lines was 2.0 and 0.7% in change of cell viability after heating at 44 degrees C for 4 h, respectively. Colony formation rates in the KSE-1 and KSE-2 cell lines were 0.9 and 0%, respectively, whereas the SD activity of each cell line was 24.1 and 22.8%. As a whole, the ATP assay showed a closer correlation to the colony assay than the SD assay because the latter revealed a more than 20% pseudo-viability due to the response between the base and residual enzyme even after the cells had died. Thus, the ATP assay was judged to be more sensitive than the SD assay; it was also quicker than the colony assay in evaluating cell viability after heating. We propose that the ATP assay should be included as another useful thermosensitivity test for malignant cells.

Adenosine Triphosphate↗
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Clinicopathologic features of patients with oesophageal cancer obtaining a histological complete response for preoperative hyperthermo-chemo-radiotherapy.

From 1979 to 1993, 151 patients with resectable oesophageal cancer underwent preoperative hyperthermo-chemo-radiotherapy (HCR) followed by a subtotal esophagectomy. All resected specimens were histopathologically evaluated, and then were classified into two groups according to the efficacy of the preoperative HCR. Group A included 33 patients whose resected oesophagus was free of any cancer cells (grade 3). Group B included 118 patients, in which viable cancer cells remained in the resected specimens to various degrees (grade 1,2). The incidence of patients with well differentiated squamous cell carcinoma, node negative cases, or TNM stage I/II was significantly higher in group A than in group B (27.3% versus 9.3%, 72.7% versus 50.8%, 72.7% versus 50.8%, respectively). The recurrence rate was 33.3% (11/33) in group A, while it was 65.3% (77/118) in group B (p < 0.005). There was no case with any local recurrence in the former, while it was 8.5% (10/118) in the latter. The 1-, 3- and 5-year survival rates were 87.2%, 65.9% and 46.1% in group A, while they were 54.8%, 26.7% and 18.8% in group B (p < 0.005), respectively. Preoperative HCR may be expected of decreasing in the recurrence rate, including regional relapse when a grade 3 is obtained. Complete local control would further positively influence the prognosis.

Antineoplastic Combined Chemotherapy Protocols↗
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Relationship between the expression of HLA-DR antigen and the effectiveness of preoperative hyperthermo-chemo-radiotherapy in oesophageal cancer.

Based on the hypothesis that tumour cells expressing HLA-DR antigen would easily be damaged by the local immune response during preoperative treatments, the relationship was investigated between the expression of HLA-DR antigen in the oesophageal cancer and the effectiveness of the preoperative treatment. Immunohistochemical staining for the detection of HLA-DR antigen in cancer cells from biopsy specimens obtained before undergoing preoperative hyperthermo-chemo-radiotherapy (HCR therapy) in patients with oesophageal squamous cell carcinoma was performed, and the relationship between the expression of HLA-DR antigen and the effectiveness of HCR therapy was evaluated according to a histopathologic examination of resected specimen. A total of 35 cases were examined in which 14 showed strongly positive staining (+2), 14 weakly positive staining (+) and seven negative staining (-). No significant differences in the clinicopathologic factors between the groups were observed. In the 14 strongly positive HLA-DR antigen cases, nine were markedly effective (grade 3) (64.3%), four were moderately effective (grade 2) (28.6%) and one was slightly effective or ineffective (grade 1, 0) (7.1%). In the 14 weakly positive HLA-DR antigen cases, the markedly, moderately and slightly or ineffective cases numbered four (28.6%), eight (57.1%) and two (14.3%), respectively. On the other hand, in the seven patients showing no HLA-DR expression, the markedly, moderately and slightly effective cases numbered one (14.3%), two (28.6%) and four (57.1%), respectively. A statistical difference was observed between the cases of strongly positive and negative staining for HLA-DR antigen (p < 0.05). The expression of HLA-DR antigen in oesophageal cancer cells is thus considered to potentially be a valuable factor for predicting the effectiveness of preoperative treatment.

Aged↗
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Evaluation of surgical treatment for patients with gastric cancer who are over 80 years of age.

BACKGROUND/AIMS: The aim of this study is to evaluate whether super-elderly patients (> or = 80) with gastric cancer may be appropriate candidates for an R2/R3 (extended) gastrectomy. METHODOLOGY: The study evaluated 1334 patients with gastric cancer treated over the past 15 years, who were over 40 years of age. They were divided into three groups according to age: Super-elderly patients who were over 80 (group A; n=60), those aged 60-79 (group B; n=703) and those aged 40-59 (group C; n=571). RESULTS: The incidence of concomitant systemic disorders was higher in group A than in either group B or group C (65% vs. 53.2% vs. 34%) (p<0.0001). The resection rates were similar (88.3% vs. 93.7% vs. 96.1%), however, the incidence of a total gastrectomy, an R2/R3 dissection, or a combined resection of other organs was much lower in group A than those in the other groups (p<0.005). The survival curves of patients after a curative resection were not significant, however, 34.4% of the super-elderly patients died of other causes and the 5-year survival rates including other cause of death were poorer in groups A and B than those in group C (p<0.01). In group A, patients receiving an R2/R3 dissection had a two-fold higher incidence of post-operative complications over those receiving an R0/R1 (regional) dissection, however, they also had a better prognosis whether or not other causes of death were considered. CONCLUSIONS: We, therefore, conclude that an R2/R3 gastrectomy is basically appropriate for super-elderly patients, as long as they demonstrate a good risk. However, the short-term results should also be considered.

Adult↗
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Esophageal hemangioma: a case report and review of the literature.

The patient, a 60-year-old man, was diagnosed as having a protruding lesion in the upper thoracic esophagus on a routine endoscopic examination. Endoscopy showed a polyp with a pedicle in the upper esophagus. A biopsy indicated the presence of hemangioma. Since endoscopic ultrasonography showed the tumor to be located within the mucosa and submucosa, we chose an endoscopic resection as the most appropriate treatment for the esophageal hemangioma. After endoscopic resection, the patient has remained free of any symptoms or recurrence. Although an esophageal hemangioma is a benign tumor, a risk of severe hemorrhaging does exist. We conclude that the first choice of the treatment for esophageal hemangioma should thus be an endoscopic resection if the tumor is located within the mucosal or submucosal layer. However, if it is impossible to resect endoscopically, then either endoscopic injection sclerotherapy (EIS) or a surgical resection should be considered.

Biopsy↗
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Immunohistochemical status of the p53 protein and Ki-67 antigen using biopsied specimens can predict a sensitivity to neoadjuvant therapy in patients with esophageal cancer.

BACKGROUND/AIMS: The prediction of an effective adjuvant therapy is essential in order to increase the number of esophageal cancer cases demonstrating an excellent response. Correlation of the immunohistochemical expression of p53 protein and Ki-67 antigen were studied using biopsied specimens of advanced esophageal cancer. The combined staining status of both can help predict the efficacy of neoadjuvant therapy in patients with esophageal cancer. METHODOLOGY: The overexpression of p53 protein and the Ki-67 labeling percentage were immunohistochemically investigated in 95 biopsied specimens of advanced esophageal carcinoma resected between 1988 and 1996. All patients preoperatively received 1 course of either chemoradiotherapy or hyperthermo-chemoradiotherapy. RESULTS: Thirty-nine specimens were positive for p53 protein staining (41.1%), and the treatment modalities were histopathologically effective in 71.8% of these 39 patients (28/39), while the efficiency rate was 58.9% (33/56) in patients with p53(-). On the other hand, the efficiency rate of patients with a high Ki-67 labeling percentage (> or = 30%) was 73.9%, which was significantly higher than that of those with a low Ki-67 labeling percentage (< 30%) (38.5%, P = 0.0013). The efficacy rate of the patients with both a high Ki-67 labeling percentage and p53(+) was 80%, while that of the patients with a low Ki-67 labeling percentage and p53(-) was only 35.3% (P = 0.0098). The combination of a high Ki-67 labeling percentage and p53(-) particularly showed a high sensitivity to hyperthermo-chemoradiotherapy since the efficiency rate of these patients with hyperthermo-chemoradiotherapy was 81.5%, while the rate for those with chemoradiotherapy was 41.7% (P = 0.0129). CONCLUSIONS: An immunohistochemical analysis of p53 and the Ki-67 labeling percentage using biopsied specimens was thus found to effectively predict the efficacy of neoadjuvant therapies in patients with esophageal cancer.

Adult↗
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Molecular detection of disseminated cancer cells in the peripheral blood of patients with gastric cancer.

This study was designed to determine whether circulating cancer cells in patients with gastric cancer can be identified by a RT-PCR method and to assess the clinical significance of the hematogenic dissemination of cancer cell in gastric cancer patients. A total of 41 patients with gastric cancer were enrolled in this study. Peripheral blood samples from 41 patients with gastric cancer were analyzed for CEA mRNA using RT-PCR. Of the 36 patients undergoing radical gastrectomy, eight had a positive CEA mRNA signal in their peripheral blood before the gastrectomy. In four patients, the CEA mRNA signal was negative, positive and then negative again, before, during and after the surgery, respectively. Of the five inoperable patients with peritoneal metastasis, four had positive CEA mRNA signals despite no metastasis in any other organs. The RT-PCR method is a useful diagnostic modality to determine patient selection for chemotherapy after surgery.

Adenocarcinoma↗
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Combined resection of the involved organs in T4 gastric cancer.

BACKGROUND/AIMS: It remains controversial whether extended surgeries for gastric cancer can improve the postoperative survival rate. This study was designed to evaluate the effectiveness of a combined resection of the involved organs for improving the survival of gastric cancer patients. METHODOLOGY: Of the 1600 patients treated at our Department, from 1969-1993, 231 patients were found to have evidence of adjacent organ spread at laparotomy. Of the 231 patients, 174 underwent a combined resection of the adjacent organs with a gastrectomy due to direct invasion of these organs by the gastric cancer. The clinicopathological characteristics of 231 patients who had adjacent organ spread were compared retrospectively with 495 patients who had no adjacent organ spread. RESULTS: Although the postoperative survival rate of those patients who underwent a gastrectomy with a combined resection of the involved organs was poor, 14 patients survived for 5 years or longer after the surgery. The clinicopathologic factors characteristic of these 14 surviving patients were a lesser extent of lymph node metastasis and high operative curability. CONCLUSIONS: A combined resection of the involved organs with a gastrectomy should be performed when lymph node metastasis is not evident.

Adult↗
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Antiemetic effect of ramosetron during hyperthermo-chemo-radiotherapy for esophageal cancer.

BACKGROUND: The antiemetic effects of serotonin receptor antagonists during chemoradiotherapy for solid tumors have never been reported. We have developed hyperthermo-chemo-radiotherapy (HCR) for esophageal cancer. However, with this treatment, the more potent the chemotherapy was, the more frequently emesis was experienced. MATERIALS AND METHODS: Fifteen patients with esophageal cancer underwent HCR (6 courses of hyperthermia, cisplatin 20 mg/m2 x 6, 5-FU 300 mg/m2 x 15 and radiation 1.5 Gy x 30). Ramosetron was administered intravenously (0.3 mg x 15). The emesis inhibition rate was defined as the rate of patients having neither vomiting nor severe nausea. RESULTS: The incidence of patients without nausea gradually decreased to 60% at the end of chemotherapy. However, vomiting was completely avoided except in one patient for two days. The emesis inhibition rates of weeks 1, 2, 3 and 4 were 100.0, 93.3, 89.5 and 95.2%, respectively. The overall inhibition rate was 94.5% and the rate of "well inhibited" was 79.0%. There were no ramosetron-related adverse reactions. CONCLUSIONS: These findings suggest that ramosetron is a useful antiemetic agent for nausea and vomiting induced by chemoradiotherapy for solid tumors.

Aged↗
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Pathogenesis of esophageal squamous cell carcinoma with lymphoid stroma.

BACKGROUND/AIMS: Lymphocyte infiltration in esophageal cancer, especially when beneath intraepithelial carcinoma, is frequently seen. However, cases of esophageal cancer with a dense stromal infiltration of lymphocytes are rare and the pathogenesis of such cases has yet to be clearly demonstrated. The objective of this study is to clarify its pathogenesis. METHODOLOGY: Four cases of esophageal squamous cell carcinoma with lymphoid stroma were investigated by immunohistochemical staining for the detection of Epstein-Barr virus, human papillomavirus, human leukocyte antigen-DR, as well as T and B cells in cancer tissue. RESULTS: In these four cases, neither positive staining of Epstein-Barr virus nor human papillomavirus infection was detected. On the other hand, the expression of human leukocyte antigen-DR antigen was evident in all cases with dense T-cell infiltration in the tumor tissue and moderate B-cell infiltration around the tumor. CONCLUSIONS: The expression of human leukocyte antigen-DR antigen without Epstein-Barr virus or human papillomavirus infection could thus be one possible pathogenesis of patients demonstrating esophageal squamous cell carcinoma with a lymphoid stroma.

Aged↗
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Apoptosis and p53 overexpression in human rectal cancer; relationship with response to hyperthermo-chemo-radiotherapy.

Hyperthermo-chemo-radio (HCR) therapy has been found to be effective for rectal cancer. Biomarkers for predicting the effect of HCR therapy are important in determining optimum treatment regimens. Hyperthermo-chemo-radiotherapy (HCR therapy), consisting of hyperthermia at 42 degrees C to 45 degrees C for 40 minutes (twice per week for two weeks), a total of 60 Gy irradiation and administration of 1-hexylcarbamoyl-5-fluorouracil (HCFU) (total 8400 mg), were prescribed pre-operatively for 29 patients with rectal cancer, using tissue specimens collected at pre-treatment biopsy. Apoptosis and overexpression of p53 protein were investigated histopathologically and immunohistochemically. On termination of HCR therapy, all the tumors were surgically resected and effectiveness of the therapy was evaluated histologically. Spontaneous apoptosis was evident in the pre-treatment cancer tissues of 14 patients (48.2%). In this apoptosis-positive group, the positive rate of expression of the p53 protein (21.4%, 3 out of 14) was lower as compared to findings in the apoptosis-negative group (66.7%, 10 out of 15). The response to HCR therapy was better in the apoptosis-positive group than in the apoptosis-negative group. We propose that spontaneous apoptosis is closely related to the function of wild-type p53 protein and is also a predictive biomarker of the effect of HCR therapy for patients with rectal cancer.

Antineoplastic Agents↗
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Histopathological study of hypertrophied myocardium of known etiologies with special reference to correlation of ECG changes.

Sixty-two autopsied hearts, with left ventricular hypertrophy (LVH) caused by mitral regurgitation (MR), aortic failure (AR), combined valvular disease (CVD), hypertension (HHD), or ischemia (IHD), and 23 control hearts with normal left ventricles were studied morphologically for analysis of modes of hypertrophy and for ECG-pathology correlation. Basic disorders modify the mode of hypertrophy; that is, elongated AR-type LV makes muscle fiber orientation in the outer layer more vertical, and globular MR-type LV makes it more horizontal than normal. High-voltage QRS correlates with hypertrophy of the outer layer which is often associated with that of the inner layer. ST depression and T changes correspond to relative deterioration of the inner and median layers, respectively.

Cardiomegaly↗
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Hyperthermochemoradiotherapy for esophageal cancer (review).

Hyperthermia is effective for the treatment of cancer when applied concomitantly with chemotherapy and irradiation. However, it is difficult to heat deep portions of the body including the esophagus. Cancer of the esophagus still poses considerable treatment problems, with a poor 5-year survival rate after surgery, an even worse outlook after radiation and surgery, and a not very satisfactory response to chemotherapy. We, therefore, devised an electrode for radio frequency, and we have been successfully using this electrode in the treatment of esophageal cancer. The 5-year survival rates of patients with esophageal cancer, given either preoperative hyperthermochemoradiotherapy or chemoradiotherapy, were 43.2 and 14.7%, respectively. Immediate improvement of subjective complaints and decrease or elimination of the cancer lesion are so distinct that this treatment, by means of an endotract antenna, shows promise as a modality for esophageal lesions.

Esophageal Neoplasms↗
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MR and CT of tuberous sclerosis: linear abnormalities in the cerebral white matter.

A review of MR and CT images in five patients, 8 months to 22 years old, diagnosed as having tuberous sclerosis, revealed linear abnormalities in the cerebral white matter. A linear abnormality connecting a subependymal nodule to a subcortical lesion was shown in two patients as an area of hypointensity on T1-weighted MR images and as an area of hyperintensity on T2-weighted images. These appeared as faintly high-density areas on CT images. Seventeen linear abnormalities extending from the ventricle to the cortex with a subependymal nodule or subcortical lesion on each end were visible in all five patients as areas of hyperintensity on the T2-weighted images. On the T1-weighted images, only nine hypointense lines were noted. CT scans did not show these latter lines. Linear abnormalities in cerebral white matter are suggestive of lesions of demyelination, dysmyelination, hypomyelination, or lines of migration disorder. MR imaging, especially T2-weighted, is particularly sensitive in detecting these abnormalities.

Adolescent↗
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Improvement of T2-weighted images of central nervous system by motion artifact suppression technique (MAST).

Standard spin echo sequences of MRI with and without motion artifact suppression technique (MAST) were compared in 45 paired images of brain and 21 paired images of spine. The images were obtained on a Picker 1.5 T system with TR = 2 sec and TE = 100 or 120 msec. MAST is a method of refocusing transverse magnetization at echo time by modification of the gradient waveforms. Transverse, coronal, and sagittal planes of brain were compared in 10 paired images obtained from adults and five paired images from children. The spine was studied in sagittal images, 11 cervical images of adults, five lumbar images of adults, and five lumbar images of children. MAST was proven to be valuable not only for the detection of lesions but also for picturing anatomical details as in MR-cisternography and MR-myelography and the effects of iron ions. MAST improves significantly the quality of T2-weighted images, especially in children.

Brain↗