PubMed Health⌕ Search

Biomedical subjects

Kouhei Fukushima

Publications and source records attributed to Kouhei Fukushima.

At least 19 recordsLinked to original sources
PubMed2006

Pregnancy and delivery in patients with enterostomy due to anorectal complications from Crohn's disease.

BACKGROUND AND AIMS: Enterostomy is often undergone by patients with Crohn's disease (CD) due to severe anorectal lesions such as rectovaginal fistula (RVF). Reports of successful pregnancy and delivery, which are important determinants of quality of life for female CD patients with stoma, are limited. Thus, we investigated problems associated with pregnancy and delivery in female CD patients at our hospital. MATERIALS AND METHODS: Between 1985 and 2003, five female CD patients with enterostoma carried seven pregnancies and delivered eight babies in our hospital. For this study, we investigated CD activity, fetal growth, stoma complications, and the outcome of delivery in these seven pregnancies. RESULTS: Among the five patients, four underwent loop ileostomy and one loop sigmoidostomy for treatment of RVF or severe stricture of the rectum or sigmoid colon. Except for one case, no fertility treatment was done. During pregnancy, a flare-up was observed in one patient and was successfully treated with corticosteroids. Although home enteral or parenteral nutrition was required in two cases, fetal growth was within the normal range in all pregnancies. Preterm delivery occurred in one case with a twin pregnancy. The mean diameter of stoma increased during pregnancy (p<0.01), and a mucosal laceration of stoma by the edge of an ostomy appliance occurred in one case. All deliveries were safe, with six cesarean sections and one transvaginal delivery. After each delivery, the stoma returned to pre-pregnancy size. CONCLUSIONS: Pregnancy and delivery in CD patients with stoma is safe and should be encouraged. However, special attention to disease activity, nutritional support, and stoma-related complications is recommended.

Adult↗
PubMed2006

Assessment of the Japanese Inflammatory Bowel Disease Questionnaire in patients after ileal pouch anal anastomosis for ulcerative colitis.

BACKGROUND: The Inflammatory Bowel Disease Questionnaire (IBDQ) is the most widely used disease-specific health-related quality of life questionnaire for patients with inflammatory bowel disease. However, little has been reported about the validation of IBDQ for patients with ulcerative colitis after surgery. The aim of this study was to assess the validity and reliability of the Japanese version of IBDQ in patients with ulcerative colitis after total proctocolectomy and ileal pouch anal anastomosis (IPAA). METHODS: The validity and reliability of the Japanese IBDQ were assessed in patients with ulcerative colitis who had received IPAA in our hospital. We mailed them the Japanese IBDQ and a supplemental questionnaire on bowel function, which was developed at our institution. Internal consistency, discriminative validity, and factor validity were assessed. RESULTS: Of the 121 patients to whom we sent the questionnaires, 64 patients (53%) participated in this study. The Japanese IBDQ scores correlated well with Cronbach's alpha value (0.800 to 0.923) and daily life satisfaction score (Pearson's r, 0.492 to 0.700). The total IBDQ score and two subscale scores of the IBDQ, "bowel symptoms" and "systemic symptoms," correlated well with daily bowel-movement frequency (Pearson's r, -0.256 to -0.329). Factor analysis revealed a four-factor structure, and all correlations among factors were moderately positive (0.337 to 0.465). Although the factor distribution was not clearly divided into the four IBDQ subscales, these four factors showed a marked tendency to represent the IBDQ subscales independently. CONCLUSIONS: The Japanese IBDQ is a valid and reliable instrument for the assessment of Japanese patients with ulcerative colitis after IPAA.

Adult↗
PubMed2006

An approach to analyze mechanisms of intestinal adaptation following total proctocolectomy.

We hypothesized that epithelial cells of the remnant small intestine display "colonic" phenotype after total proctocolectomy. The aims of the present study were to identify preferentially expressed molecules in the colon or in the small intestine and to evaluate mRNA levels of those in the ileal pouch. Differential gene expression was investigated between the small intestine and the colon by using cDNA microarray and was confirmed by Northern blotting. Expression of three colonic mRNAs (3-hydroxy-3-methylglutaryl-coenzyme A synthase 2, deleted malignant brain tumors 1, carcinoembryonic antigen-related cell adhesion molecule 1) and one "small intestinal" (microsomal triglyceride transfer protein) mRNA were compared between the control and the ileal pouch mucosae by quantitative reverse transcriptase-polymerase chain reaction. Seventy-four clones were differentially expressed with more than a threefold difference. Differential expression was confirmed in all mRNAs examined, including 3-hydroxy-3-methylglutaryl-coenzyme A synthase 2 and microsomal triglyceride transfer protein. The mucosal expression of carcinoembryonic antigen-related cell adhesion molecule 1 mRNA in the ileal pouch was enhanced in humans. The remnant ileum develops some, but not all, colonic phenotype after total proctocolectomy. Comparative study of epithelial gene expression between the small intestine and the colon enables us to analyze mechanisms of intestinal adaptation after total proctocolectomy.

Adaptation, Physiological↗
PubMed2006

Molecular analysis of colonic transformation in the ileum after total colectomy in rats.

BACKGROUND: Colonic transformation is thought to be a phenotypic alteration in the ileum after total colectomy (TC) but has not been well addressed at the molecular level. We previously demonstrated roles of aldosterone in enhancement of ileal sodium absorption after TC. However, the significance of aldosterone in intestinal adaptation has been unknown. METHODS: Rat epithelial gene expression was compared between the ileum and distal colon by complementary DNA microarray. Genes were categorized into "colonic," "common," and "ileal" genes according to signal intensity. Ileal gene expressions in (1) the control and TC rats and (2) the control and aldosterone-infused rats were compared to detect altered genes or to assess the role of aldosterone in intestinal adaptation. Differential expression of MUC3 and lysozyme was confirmed by quantitative reverse transcriptase-polymerase chain reaction. RESULTS: A total of 6109 genes were categorized into "colonic," "common," or "ileal" gene pools. A comparison of the control and TC rats yielded 82 and 91 genes that were induced and suppressed in the ileum after TC, respectively. Thirty-five percent of them were associated with colonlike transformation (ie, the induction of colonic genes or the suppression of ileal genes). The expressions of MUC3 and lysozyme messenger RNAs were enhanced significantly in the TC ileum, compared with the control. In comparison, aldosterone infusion modulated a total of only 21 genes in the ileum. CONCLUSION: Those data demonstrate that altered gene expression after TC is, in part, characterized by colonlike transformation. Furthermore, circulating aldosterone appears to play a part in the altering and/or adapting of gene expression in intestinal epithelium.

Adaptation, Physiological↗
PubMed2006

[Results of hypotonic cisplatin treatment on seven patients with carcinomatous pleuritis].

Carcinomatous pleuritis frequently undermines the quality of life in advanced malignant disease patients. The traditional treatment for pleural effusion is intrapleural administration of a chemical agent, but its efficacy was not at all satisfactory. Ichinose et al.developed hypotonic cisplatin treatment for patients with carcinomatous pleuritis in 1993, and its therapeutic efficacy was assessed by the Japan Clinical Oncology Group. This treatment was performed on seven patients in our hospital since 2002: five patients with non-small-cell lung cancer, one with transverse colon cancer who had myocardial infarction (grade 4) after treatment, and another with gastric cancer who had grade 4 hemosputa. These patients, aged 52 to 88, complained of dyspnea before treatment, but all of them were able to be discharged with control of pleural effusion including the above-mentioned two patients. Although six patients had already died of disease, survival time after treatment of all patients ranged from 96 to 610 days, with an average of 346.7+/-228.2 days. The average time in five patients with non-small-cell lung cancer was longer than that in two with gastrointestinal malignant disease (not significant statistically). Hypotonic cisplatin treatment seemed to enhance the quality of life in lung cancer patients with carcinomatous pleuritis.

Adenocarcinoma↗
PubMed2005

Anal function during pregnancy and postpartum after ileal pouch anal anastomosis for ulcerative colitis.

PURPOSE: Total proctocolectomy and ileal pouch anal anastomosis (IPAA) is now a common procedure for ulcerative colitis (UC). Moreover, it has been reported that fertility is preserved in women who undergo this procedure, many of whom can experience normal delivery. METHODS: We assessed the perinatal outcomes and changes in anal function in four women, aged from 27 to 35 years, who gave birth after undergoing IPAA for UC. Pregnancies were confirmed 15-111 months after IPAA, three women had full-term pregnancies, and one gave birth after 31 weeks' gestation. RESULTS: Cephalic delivery with a vacuum extractor was used for one patient, and another underwent cesarean section. The other two patients experienced normal delivery. None of the patients needed artificial insemination and none had any symptoms of intestinal obstruction during their pregnancy. After delivery, two patients suffered a transient increase in bowel frequency and soiling, which gradually resolved. CONCLUSIONS: Although transient anal dysfunction occurred in the puerperal period, there were no changes in anal function during pregnancy. Therefore, there are no factors directly prohibiting pregnancy and vaginal delivery in women who undergo IPAA for UC.

Adult↗
PubMed2005

Renal expression of the essential genes associated with sodium transport following a total proctocolectomy in rats.

The water and electrolyte balance is regulated by the renin-angiotensin-aldosterone system in the kidney. We previously reported that the levels of circulating aldosterone dramatically increased following a total proctocolectomy in rats. However, there is no direct evidence regarding whether renal adaptation is accelerated by the induction of aldosterone-associated molecules. To explore this question, Sprague-Dawley rats underwent total proctocolectomies and then were killed 8 weeks later. We investigated the renal expression of 11beta-hydroxysteroid dehydrogenase type 2, the alpha-, beta-, and gamma-subunits of the epithelial sodium channel, and the alpha1- and beta1-subunits of Na+,K+-ATPase mRNAs because those molecules are responsible for the aldosterone specificity for mineralocorticoid receptor, amiloride-sensitive sodium absorption, and sodium extrusion from distal tubules, respectively. A Northern blot analysis demonstrated the kidney to exhibit mRNA induction for all of these molecules, thus supporting the idea that renal adaptation following a total proctocolectomy depends, at least in part, upon the molecular induction which is principally regulated by circulating aldosterone.

11-beta-Hydroxysteroid Dehydrogenase Type 2↗
PubMed2005

Comparative study of epithelial gene expression in the small intestine among total proctocolectomized, dietary sodium-depleted, and aldosterone-infused rats.

We previously demonstrated enhanced plasma aldosterone, ileal activation of epithelial sodium channel (ENaC), and induction of 11 beta-hydroxysteroid dehydrogenase type 2 after total proctocolectomies in rats. However, factors other than circulating aldosterone may cause molecular induction associated with sodium transport. Sprague-Dawley rats were treated with sodium-deficient diets or subcutaneous aldosterone infusion for 4 weeks. Rats also underwent total proctocolectomies as positive control. We extracted epithelial RNA from the distal small intestine and compared mRNA expression of the alpha, beta, and gamma subunits of ENaC, prostasin, sodium glucose transporter 1 (SGLT1), and the alpha1 and beta1 subunits of Na(+)/K(+)-ATPase among control, total proctocolectomized, dietary sodium-depleted, and aldosterone-infused rats by quantitative reverse transcription-polymerase chain reaction or Northern blotting. A significant increase in aldosterone was noted in sodium-depleted and aldosterone-infused rats. The induction of three subunits of ENaC and prostasin mRNA was observed in proctocolectomized, aldosterone-infused rats but not in dietary sodium-depleted rats. The levels of the alpha1 and beta1 subunits of Na(+)/K(+)-ATPase were similar among the experimental groups. SGLT1 mRNA was induced only in proctocolectomized rats. The molecular induction of ENaC, prostasin, and SGLT1 is unique for total proctocolectomized rats. Aldosterone infusion can induce several essential molecules for sodium absorption, as seen in total proctocolectomy.

Animals↗
PubMed2005

Induction of 11beta-hydroxysteroid dehydrogenase type 2 and hyperaldosteronism are essential for enhanced sodium absorption after total colectomy in rats.

BACKGROUND: Patients who undergo total colectomy with ileopouch anal reconstruction often have persistent diarrhea and frequent bowel movements. Analysis of the intestinal adaptation after total colectomy may lead to developing novel therapies for postoperative diarrhea. METHODS: Sprague-Dawley rats underwent total colectomy with ileoanal reconstruction and were sacrificed 4 and 8 weeks later. Mucosal response to aldosterone was evaluated with the use of ileal mucosa in an Ussing chamber by measuring short circuit current after in vitro stimulation with aldosterone. We investigated the expression of 11beta-hydroxysteroid dehydrogenase type 2 (11beta-HSD 2) in intestinal epithelial cells. To examine the role of hyperaldosteronism, we also evaluated rats treated with a sodium-deficient diet or subcutaneous aldosterone infusion. RESULTS: Aldosterone levels increased 80-fold after total colectomy. A comparable amount of aldosterone dramatically increased aldosterone-mediated, amiloride-sensitive short circuit current in the mucosa from colectomized rats, but not in control rats. We measured an increase in 11beta-HSD 2 messenger RNA and protein in the distal ileum from colectomized rats. Circulating aldosterone appears to be essential for these functional and molecular changes because similar results were obtained by using the mucosa from both dietary sodium-depleted and aldosterone-infused rats. CONCLUSIONS: Induction of 11beta-HSD 2 is essential for enhanced mineralocorticoid action in the remnant ileum after total colectomy in rats.

11-beta-Hydroxysteroid Dehydrogenase Type 2↗
PubMed2005

Aldosterone enhances 11beta-hydroxysteroid dehydrogenase type 2 expression in colonic epithelial cells in vivo.

OBJECTIVE: [corrected] 11beta-hydroxysteroid dehydrogenase type 2 (11beta-HSD2) metabolizes glucocorticoids, thus enabling aldosterone to bind to the mineralocorticoid receptor. However, little is known about the regulatory mechanism of epithelial 11beta-HSD2 expression in the gut. MATERIALS AND METHODS: Sprague-Dawley rats were maintained on a sodium-depleted diet or subjected to continuous aldosterone infusion for 4 weeks. Plasma aldosterone and arginine-vasopressin (AVP) levels were measured by radioimmunoassay. Expression of 11beta-HSD2 in colonic epithelia was evaluated by Northern blotting and immunohistochemistry. T84 and Caco2 cells were stimulated with aldosterone, dexamethasone and AVP alone or in combination, and 11beta-HSD2 mRNA was measured by quantitative reverse transcription polymerase chain reaction (RT-PCR). RESULTS: Sodium-depleted and aldosterone-infused rats showed an increase of plasma aldosterone and AVP. Both treatments resulted in induction of 11beta-HSD2 in the colonic epithelia at mRNA and protein levels. Positive immunoreactivity was detected in the cytoplasm of the surface epithelia in control rats. In contrast, epithelial cells in the crypt also showed immunoreactivity for 11beta-HSD2 in the proximal colon of dietary sodium-depleted and aldosterone-infused rats. Induction of 11beta-HSD2 mRNA was observed when T84 cells were stimulated with corticosteroids plus AVP. CONCLUSIONS: Aldosterone has a pivotal role by increasing expression of 11beta-HSD2 in epithelial cells of the colon. AVP may act as a synergistic hormone in aldosterone-mediated 11beta-HSD2 induction.

11-beta-Hydroxysteroid Dehydrogenase Type 2↗
PubMed2004

New reconstructive procedure after intestinal resection for Crohn's disease: modified side-to-side isoperistaltic anastomosis with double Heineke-Mikulicz procedure.

Although side-to-side isoperistaltic anastomosis is a useful strictureplasty technique when long segments of intestinal stenosis complicate Crohn's disease, concerns have been raised regarding disease recurrence adjacent to the anastomosis. We performed side-to-side isoperistaltic anastomosis without spatulated intestinal ends as a method of reconstruction after intestinal resection for Crohn's disease; both intestinal ends were transversely closed like a Heineke-Mikulicz-type strictureplasty. With this procedure, the luminal diameter proximal and distal to the anastomosis became wider than the original diameter of the intestine. This new procedure, which we refer to as the "modified side-to-side isoperistaltic anastomosis with double Heineke-Mikulicz procedure" could become an alternative operation after intestinal resection in persons with Crohn's disease, although long-term outcome analysis is necessary.

Anastomosis, Surgical↗
PubMed2004

Change in relative mobility of M protein following neuraminidase treatment in patients with multiple myeloma and monoclonal gammopathy of undetermined significance.

The aim of this study was to clarify the relationship between the relative mobility of M protein in various disease states using cellulose acetate membrane electrophoresis. To examine the carbohydrate chain of the M protein, sera from patients with multiple myeloma (MM), various cancers, and benign disease were treated with neuraminidase. The relative mobility in benign disease and MM patient sera following neuraminidase treatment varied among individuals, while that of IgG M protein in sera from cancer patients was from 0.2 to 0.3. Thus, the relative mobility in cancer patients was narrower than in those with MM or benign disease.However, after neuraminidase treatment, there was no significant difference between relative mobility in cancer patient's sera and those in other disease patients.

Adult↗
PubMed2004

Outcomes after pylorus-preserving gastrectomy for early gastric cancer: a prospective multicenter trial.

The aim of the present study was to compare in a prospective, multicenter trial the results early and late after pylorus-preserving gastrectomy (PPG) versus conventional distal gastrectomy (CDG) with Billroth I anastomosis for early gastric cancer. Eighty-one patients with early gastric cancer were randomized and then underwent either PPG or CDG. Duration of operation, intraoperative blood loss, days until removal of the nasogastric tube, days until start of oral intake, and decrease in body weight were studied as parameters for outcomes early after the surgery. Late results were studied in patients followed for longer than 3 years. Change in body weight, status of oral intake, symptoms suggesting early dumping syndrome, and overall satisfaction were addressed in the questionnaire. The presence of gallstones was examined with ultrasonography. There were no differences in early results between PPG and CDG. The incidence of early dumping syndrome was lower in PPG (8%) than in CDG (33%). Other late results including the incidence of gallstones were not different between the 2 groups. These results indicate that PPG is as safe as CDG and has an advantage in terms of early dumping syndrome.

Female↗