Biomedical subjects

N Masaki

Publications and source records attributed to N Masaki.

At least 19 recordsLinked to original sources

PubMed1998

Adjuvant radiotherapy after radical hysterectomy of the cervical cancer. Prognostic factors and complications.

AIM: To investigate prognostic factors and complications after radical hysterectomy followed by postoperative radiotherapy for carcinoma of the uterine cervix. PATIENTS AND METHODS: One hundred twenty-eight patients with T1b-2b carcinoma of the uterine cervix following radical hysterectomy with bilateral pelvic lymphadenectomy and postoperative radiation therapy were reviewed. Pathologic and treatment variables were assessed by multivariate analysis for local recurrence, distant metastases and cause specific survival. RESULTS: The number of positive nodes (PN) in the pelvis was the strongest predictor of pelvic recurrence and distant metastases. These 2 failure patterns independently affect the cause specific survival. The 5-year cumulative local and distant failure were PN(0): 2% and 12%, PN(1-2): 23% and 25%, PN(2 <): 32% and 57%, respectively (p = 0.0029 and p = 0.0051). The 5-year cause specific survival rates were PN(0): 90%, PN(1-2): 59% and PN(2 <): 42% (p = 0.0001). The most common complication was lymphedema of the foot experienced by one-half of the patients (5-year: 42%, 10-year: 49%). CONCLUSION: These results suggest that patients with pathologic T1b-T2b cervix cancer with pelvic lymph node metastases are at high risk of recurrence or metastases after radical hysterectomy with pelvic lymphadenectomy and postoperative irradiation.

Adult↗

PubMed1997

High-dose rate intracavitary irradiation for carcinoma of the uterine cervix. The adverse effect of treatment prolongation.

AIM: To investigate the adverse effect of treatment prolongation on the local control and survival of the cervical carcinoma of the uterus. PATIENTS AND METHOD: Two hundred and sixteen patients with stage IIB and III cervical carcinoma treated with a combination of external radiation and high-dose rate (HDR) intracavitary irradiation between 1978 and 1989 were retrospectively studied. A multivariate analysis was used to determine the effect of treatment time on local control and survival. RESULTS: Overall treatment time was the most highly significant factors for local control in the multivariate analysis (p = 0.0005). The 5-year cumulative relapse rates were significantly different with the treatment times 35 to 42 days: 9% versus 43 to 49 days: 19% versus 50 to 62 days: 42% (p = 0.001). The second most significant parameter was stage classification (p = 0.02). Concerning relapse-free survival, stage classification (p = 0.0001), overall treatment time (p = 0.0035) and hemoglobin level (p = 0.0174) were the 3 most important prognostic factors, although there was no relationship between treatment time and late complications. CONCLUSION: These results suggest that prolongation of treatment time is associated with decreased local control and survival in patients treated with external radiation and HDR intracavitary irradiation.

Adenocarcinoma↗

PubMed1997

Radiation therapy for early glottic carcinoma (T1N0M0). The adverse effect of treatment interruption.

PURPOSE: Clarification of the adverse effects of treatment interruption on the local control of early glottic carcinoma. PATIENTS AND METHODS: From May 1982 through February 1992, 273 patients with early glottic carcinoma (T1N0M0) were treated at this department. Of 253 patients administered 60 Gy in 30 fractions 77 patients had no treatment interruption and treatment was completed within 6 weeks (group I), overall treatment time was prolonged for 176 patients: 141 patients 43 to 49 days (group II) and 35 patients 50 to 62 days (group III). Treatment was interrupted due to public holidays (156 cases), patients convenience (13 cases) and severe mucosal reactions (seven cases). The major reason was public holidays, 91% in group II and 80% in group III. RESULTS: The 3-year recurrence-free survival rates were for group I 95%, group II 89% and group II 80%. Survivals for groups I and II, groups II and III and groups I and III were essentially the same. At 40 Gy tumor clearance was more than 50% in the 3-groups. For complete clearance cases at 40 Gy, recurrence-free survival was essentially the same for the 3 groups although for incomplete clearance cases, statistically significant difference for groups I and III (log-rank test p = 0.0004; Wilcoxon test p = 0.0004) and marginally significant difference for groups II and III (p = 0.0157, p = 0.0045) but no difference for groups I and II (p = 0.0669, p = 0.0853) were noted by adjusting the p-value. CONCLUSION: Prolongation of overall treatment time and tumor clearance at 40 Gy appeared to be a factor of the local control.

Adult↗

PubMed1997

[Clinical features of acute hepatitis G].

Fifty-one patients with acute A, B, C, and non A-C hepatitis were studied. Alcoholic abusers and drug-induced hepatitis were excluded from non A-C hepatitis. Among 10 patients with acute non A-C hepatitis, 3 were positive for HGV-RNA by nested RT-PCR as primer of 5' non-coding region of HGV. Maximal s-ALT values in acute hepatitis G patients were significantly higher than those in acute hepatitis C(p < 0.05), but not different from those in acute hepatitis A and B. Although HGV-RNA was demonstrated after 9 years of onset of hepatitis in one patient, non of three patients took chronic course. In one patient, route of transmission was assumed to be blood transfusion.

Acute Disease↗

PubMed1997

Serum transforming growth factor-alpha level can be a parameter for evaluating liver regeneration after partial hepatectomy in patients with liver cancer.

Sensitive and reliable laboratory parameters are necessary to evaluate the degree of liver regeneration serially in patients after partial hepatectomy for liver cancer. We evaluated the serum levels of transforming growth factor-alpha (TGF-alpha) and hepatocyte growth factor (HGF), both of which are potent mitogens for hepatocytes, in 22 hepatectomized patients with liver cancer: 10 patients with hepatocellular carcinoma and 12 patients with metastatic liver tumors. Ten patients who underwent laparotomy for nonhepatic surgery were also studied as surgical controls. The serum TGF-alpha and HGF levels were measured by sandwich enzyme-linked immunosorbent assay techniques. Both the serum TGF-alpha and HGF levels increased after partial hepatectomy. However, there was no correlation between the levels of TGF-alpha and HGF. The maximal level of TGF-alpha achieved in each case correlated significantly with the resected liver volume and the increased volume of the remaining liver. Hepatocyte growth factor showed no such correlations. After nonhepatic surgery, the HGF level also increased significantly, while the TGF-alpha level did not. These results suggest that the serum TGF-alpha level varies depending on the regenerative stimulus to the liver, and that its increase corresponds with the degree of liver regeneration that occurs in patients after partial hepatectomy for liver cancer. In contrast, it is unlikely that the serum HGF level reflects liver regeneration. In conclusion, the serum TGF-alpha level can be used as a parameter for evaluating liver regeneration in patients who have undergone partial hepatectomy.

Carcinoma, Hepatocellular↗

PubMed1997

[Readmission among discharged psychiatric patients and it's correlates].

OBJECTIVE: This study investigated the incidence of readmission among discharged psychiatric patients and examined factors predicting early readmission. METHODS: A cohort of 343 patients, who had been hospitalized involuntarily to mental hospitals for medical care and custody, and who were discharged between April 1991 and September 1993, in two areas served by Fukuoka Prefectural Yamato Health Center (n = 163) and Tagawa Health Center (n = 180) were followed up until November 1994. RESULTS: The readmission rates within 6 months of discharge in Yamato Health Center and Tagawa Health Center were 17% and 22%, and within 1 year were 30% and 31% respectively. From Cox's proportional hazards model, alcohol/drug abuse, many of previous admission, long length of recent hospitalization, payment of medical care cost from public assistance, complication of physical disorders, living without a person responsible for custody after discharge, no request of health center's service by the hospital and discharge from a large-scale mental hospital were significantly related to increased risk of readmission. Not a few patients could not be followed up completely because of early drop-out of treatment. The drop-out rates within 1 month of discharge in Yamato Health Center and Tagawa Health Center were 10% and 26%, and within 1 year were 15% and 27% respectively. CONCLUSIONS: The rates of readmission and drop-out of treatment among discharged psychiatric patients were considerably high. This study clarified that rapid establishment of a mental health system supporting the mentally disabled in a community is an urgent need in Japan.

Adult↗

PubMed1996

Large spleno-caval shunt not accompanied by cirrhosis or encephalopathy.

A 40-year-old man with a large spleno-caval shunt through the azygos vein is described. This was considered a rare case, because the patient had no accompanying advanced liver disease, or episodes of hepatic encephalopathy. During checks after abnormal liver function test results, a shunt vessel was detected incidentally by ultrasonography. Computed tomography, magnetic resonance imaging, and angiography demonstrated that it was a large shunt between the splenic vein and superior vena cava through the coronary and azygos veins. The patient was a hepatitis B virus carrier and was positive for anti-HBe, and had a history of heavy drinking. However, on laparoscopic examination, the liver was not cirrhotic and the biopsy revealed only mild chronic hepatitis without bridging fibrosis. There were no esophageal varices or hepatosplenomegaly. On hemodynamic evaluation, the wedge hepatic vein pressure was slightly elevated and hepatic blood flow was reduced to half the normal value. Despite the large portal-systemic shunt, the patient had no history or signs of hepatic encephalopathy. The clinical features of this rare case are discussed.

Adult↗

PubMed1996

Radiation therapy for early glottic carcinoma (T1N0M0). The final results of prospective randomized study concerning radiation field.

PURPOSE: To investigate the effect of radiation field on the local control of early glottic carcinoma by prospective randomized study. PATIENTS AND METHODS: From May 1982 through February 1992, a total of 273 patients with early glottic carcinoma (T1N0M0) was treated at our department with a wedge filter technique using a shell to improve the dose distribution and immobilization during radiotherapy with 4 MV X-ray. Patients were randomly allocated to either treatment group A (radiation field size: 5 x 5 cm) or B (6 x 6 cm) using bilateral parallel opposed portals. Total radiation dose administered was 60 Gy in 30 fractions over a 6-week period. RESULTS: The 5-year recurrence-free survival rates were 88% in groups A and B (no significant difference). Minor chronic complication such as persistent arytenoid edema lasting more than 6 months or benign polypoid lesion of vocal cord was more frequently observed in group B (23%) than in group A (17%) (p = 0.038) while acute mucosal reaction and skin reaction showed no significant differences. CONCLUSION: A small field (5 x 5 cm) with an appropriate angle of wedge filter and shell fixing device is recommended to avoid adverse effect with keeping local control of early glottic carcinoma.

Actuarial Analysis↗

PubMed1996

Management for stage II glottic carcinoma: radiation therapy or surgery.

AIM: To analyze the results of stage II glottic carcinoma treated with radiotherapy or surgery. PATIENTS AND METHOD: One hundred thirty-four patients with squamous cell carcinoma of the T2N0M0 glottic carcinoma treated at the Osaka Medical Center for Cancer and Cardiovascular Diseases from 1979 through 1991 were reviewed. The 5-year disease-free survival and laryngeal preservation rate and prognostic factors were examined. Treatment was radiation therapy with salvage surgery for failure or surgery alone. RESULTS: The 5-year disease-specific survival rate for the radiotherapy group was 100% and for the surgery group, 93% (p = 0.055). In the surgery group 5-year disease-specific survival rate for the subgroup of cord mobility was 94% and that of impaired cord mobility, 89% (p = 0.5354). Concerning laryngeal preservation the radiotherapy group showed better preservation rate than the surgery group in the subgroup of cord mobility, i.e., 41/51 (80%) versus 6/55 (11%) (p < 0.001) although significant difference was not observed in the lesion with impaired cord mobility, 2/5 versus 4/22 (p = 0.171). CONCLUSION: We recommend radiation therapy for stage II glottic carcinoma with normal cord mobility, although further study is needed to improve the preservation rate of the larynx with keeping the disease-specific survival for the lesion with impaired cord mobility.

Adult↗

PubMed1995

Use of prostaglandin I2 analog in treatment of massive hepatic necrosis associated with endothelial cell injury and diffuse sinusoidal fibrin deposition.

Endothelial cell damage causes massive hepatic necrosis as a result of fibrin deposition in the hepatic sinusoids. When a stable analog of prostaglandin I2, beraprost sodium, was administered to rats given either dimethylnitrosamine, carbon tetrachloride, or endotoxin following Corynebacterium parvum administration, the hepatic necrosis produced in each was attenuated, but to a greater extent in the dimethylnitrosamine and endotoxin/Corynebacterium parvum models, where fibrin deposition in the hepatic sinusoids occurs, as compared to the carbon tetrachloride model, where such fibrin deposition does not occur. Beraprost sodium reduced the expected increase of portal venous pressure in the endotoxin/Corynebacterium parvum model without affecting plasma thrombin-antithrombin III complex levels. Beraprost sodium also significantly reduced cell killing of both isolated rat hepatocytes and hepatic sinusoidal endothelial cells exposed to tert-butyl hydroperoxide when compared to controls. Beraprost sodium could prove to be a therapeutic candidate for the treatment of hepatic necrosis, particularly in cases associated with fibrin deposition in the hepatic sinusoids because of its fibrin clot-clearing action.

Animals↗

PubMed1995

Prophylactic irradiation of para-aortic lymph nodes in carcinoma of the uterine cervix. A prospective randomized study.

PURPOSE: For assessment of the advantages and side effects of para-aortic lymph nodes irradiation under the evaluation by computer tomography, a prospective randomized study was started in 1986. The results for survival, local control and late complications are presented in the following. PATIENTS AND METHODS: From November 1986 to October 1990, 93 patients with cervical carcinoma were randomly allocated for treatment with either pelvic irradiation (pelvic group) or pelvic plus para-aortic lymph nodes irradiation (para-aortic group). Thirty-six patients underwent external irradiation and intracavitary therapy (RT arm) and 57 patients, extended radical hysterectomy and external irradiation (OP-RT arm). Para-aortic lymph nodes irradiation delivered 45 Gy in 1.8 Gy per day for 5 days per week through anterior-posterior fields. RESULTS: The 3-year cause specific survival rates were para-aortic group: 57% and pelvic group: 89% in RT arm group, and para-aortic group: 70% and pelvic group: 86% in OP-RT arm group. Differences for the 2 groups in each treatment arm were not significant. In pelvic failure, para-aortic lymph nodes metastases and distant metastases showed no statistically significant differences for the 2 groups in each treatment arm. In the para-aortic group, complications were more frequent than in the pelvic group (13/45 vs. 2/48, p < 0.025). As an enteric complication ileus was found in 7% (3/45) of the para-aortic group while 2% (1/48) in the pelvic group. Compression fractures of the lumber vertebral body were apparent in 9% (4/45) and 0%, respectively. CONCLUSION: Routine para-aortic lymph nodes irradiation delivered through anterior-posterior fields for high risk patients with cervical carcinoma is of limited value occurring to the high incidence of late complications and this treatment fails to improve no survival rates.

Adenocarcinoma↗

PubMed1995

Application of 198Au grains for carcinoma of oral cavity.

PURPOSE: The purpose of this study is to analyze the results of the treatment using gold grain implants over the past 9 years and to evaluate the usefulness of this treatment method. PATIENTS AND METHODS: From January 1985 through April 1993, a total of 45 patients with squamous cell carcinomas of the oral cavity and the oropharynx were treated with 198Au grain (gold grain) at the Department of Radiology, Osaka University Medical School. The initial activity of the grains supplied weekly by the Japan Radioisotope Association was usually 5 mCi (185 MBq), and single implants were usual. In case of combined external irradiation, telecobalt gamma-rays or 4 MV X-rays were used for treatment before implant. RESULTS: The local control rate for patients with T1 stages was 80% (20/25) and with T2 stages, 59% (10/17). The local control rate was 71% (10/14) for gold grain alone and 72% (13/18) for external irradiation combined with gold grain implants (combined therapy). In combined therapy, the median of the interval between external irradiation and gold grain implants was 21 days. The treatment interval for patients with recurrent diseases was 22 days, 22, 27, 39 and 46, respectively. The progression rate showed a tendency to increase in the patients with longer interval (more than 21 days), and with partial regression after external irradiation (p = 0.0085). CONCLUSION: Our findings show that the time interval between external irradiation and gold grain implantation is an important factor in combined therapy. Therefore, we emphasize that the time interval should be shorter than 3 weeks.

Adult↗

PubMed1995

[Autoimmune liver disease complicating Sjögren's syndrome].

Sjögren's syndrome (SjS) has been well known to complicate autoimmune liver diseases such as autoimmune hepatitis (AIH) and primary biliary cirrhosis (PBC). In addition, it has been recently described that chronic viral hepatitis type C could be accompanied by a sialadenitis resembling SjS. Among 98 patients with SjS at our clinic, 7 AIH, 1 PBC, and at least 11 hepatitis C virus (HCV) infection were noted. However, occurrence of SjS was not always associated with the severity of chronic liver diseases. Our present study suggested that three mechanisms might contribute to the pathogenesis of HCV-related SjS: 1) direct infection and proliferation of HCV in salivary glands, 2) molecular mimicry between HCV and salivary glands, and 3) formation of immune complex containing HCV. Further investigation would be indispensable to elucidate immunological systems to regulate these phenomena.

Autoimmune Diseases↗

PubMed1994

[Radiation therapy for brain metastases from lung carcinoma: the second prospective randomized trial].

Since September 1980 we have been conducting a prospective randomized trial to determine the best treatment schedule for radiation therapy (XRT) of brain metastasis from lung carcinoma. The first trial (September 1980 to December 1984) used random allocation of two different time-dose radiotherapy schemes: 30 Gy/10 fractions/2 weeks versus 50 Gy/20 fr./4 wks. Treatment results showed no significant difference in neurological improvement or survival between the two arms or in lactate dehydrogenase (LDH) as the most important prognostic factor. The current study (January 1985 to April 1992) examined two sequential trials stratified according to the level of LDH and included 162 patients with brain metastasis from lung carcinoma. Whole brain doses were 30 Gy/10 fr./2 wks (group A, n = 46) or 50 Gy/20 fr./4 wks. (group B, n = 46) in the normal LDH group and 30 Gy/10 fr./2 wks (group C, n = 35) or 20 Gy/5 fr./1 wk. (group D, n = 35) in the high LDH group, while the treatment field was lessened to 30 Gy in group B if possible. The final results showed that 1) the most important prognostic factor as determined by Cox's multivariate analysis was also LDH in the second trial; 2) the incidence of acute side effects tended to depend upon a single dose, i.e., group A (3 Gy) 35% versus group B (2.5 Gy) 21% (p = 0.165), and group C (3 Gy) 23% versus group D (4 Gy) 46% (p = 0.044); 3) median survival time and 1-year survival rates were 5.4 months and 21% in group A, 4.8 months and 17% in group B; 3.4 months and 6% in group C; and 2.4 months and 4% in group D, respectively, and survival curves showed no statistically significant difference between the two treatment groups in each LDH group; 4) improvement in neurological function appeared to increase with total dosage escalation, i.e., 41% in group A versus 45% in group B, and 35% in group C versus 21% in group D (not significant). In conclusion, a short intensive course (30 Gy/10 fr./2 wks) is advantageous for XRT because of the short treatment time and minor acute toxicity in spite of stratification by the level of LDH.

Aged↗

PubMed1994

Results of combined external irradiation and chemotherapy of bleomycin or peplomycin for squamous cell carcinomas of the lower gingiva.

PURPOSE: In Japan, the role of radiotherapy for gingival carcinomas has not been considered as a radical treatment, but only a pre and/or postoperative treatment. This study was aimed to discuss a possibility of radiotherapy for a radical treatment. In this study, radiotherapy was given as an initial treatment for squamous cell carcinomas of the lower gingiva in simultaneous combination with chemotherapy of bleomycin or peplomycin (Tokyo, Japan). METHODS AND MATERIALS: When complete regression of the tumor was obtained, subsequent surgery was postponed with or without a booster of radiotherapy of about 30 Gy until a recurrent lesion was confirmed. RESULTS: Sixty-seven percent of 100 patients with T1 or T2 had complete regression, while only 22 (35.5%) of 62 patients with T3 or T4 had complete regression. The 5-year local control rate by T classification, including the results of secondary treatments (surgery and/or radiotherapy and/or chemotherapy) for recurrent lesions, was 91% for T1, 89% for T2, 76% for T3 and 61% for T4. The 5-year local control rate according to treatment methods was 95% in the group without surgery and 86% in the group with surgery for T1 and T2 patients. The rates were 54% and 71%, respectively for T3 and T4 patients. The cause specific 5-year survival rate by stage was 75% for Stage I, 87% for Stage II, 71% for Stage III, 51% for Stage IV and 70% overall. CONCLUSION: The combination of radiotherapy and chemotherapy could be a conservative radical treatment for T1 and T2 patients with lower gingival carcinoma.

Bleomycin↗

PubMed1994

Marked clinical improvement in patients with hepatocellular carcinoma by surgical removal of extended tumor mass in right atrium and pulmonary arteries.

Two patients with advanced hepatocellular carcinoma presented severe exertional dyspnea because of extension of a tumor into the right side of the heart. Removable of the tumor thrombus by open-heart surgery ameliorated the symptoms in each case, but their subsequent courses differed considerably. One patient survived for as long as 8 months thanks to successive multi-disciplinary treatments, whereas the other patient died suddenly 1 month after the surgery. The first patient's hepatocellular carcinoma was more differentiated, and the dyspnea was caused by a low cardiac output due to the intracardiac tumor mass, not by pulmonary embolism as in the second patient's case. We conclude that successive multidisciplinary treatments to control the growth of hepatocellular carcinoma is the most important approach and is indispensable for improving the prognosis.

Adult↗

PubMed1994

Regulating factors of liver regeneration after hepatectomy.

The factors regulating liver regeneration were studied by measuring changes in the liver volume and serum hepatocyte growth factor (HGF) levels after hepatectomy. Changes in the liver volumes were studied in 68 hepatectomized patients, including (A) hepatoma patients who had chronic hepatitis or liver cirrhosis (n = 44) and (B) metastatic liver cancer patients who had normal liver parenchyma (n = 24). The hepatic volume increased by 13.8% of the remnant hepatic volume in group A and by 49.1% in group B. The examined factors included the percentage of resected liver volume (%RLV) and the results of laboratory tests. Regression analysis showed that in group A, both %RLV (beta = 0.46) and the serum total bilirubin (T-Bil) level (beta = -0.33) correlated significantly with the extent of liver regeneration and that in group B, only %RLV (beta = 0.78) correlated significantly with the regeneration. Serum HGF levels after hepatectomy were studied in 21 hepatectomized patients, including 11 hepatoma patients and 10 patients with some types of metastatic liver cancer. Serum HGF levels increased significantly after surgery in all 21 patients. Regression analysis, however, showed that the change in HGF was related to liver cirrhosis (beta = 0.46) and to the maximal postoperative T-Bil level (beta = 0.51) but not to the extent of liver regeneration after hepatectomy. These results suggest that liver regeneration is regulated primarily by factors relating to the percentage of the resected liver parenchyma and that serum HGF levels do not directly relate to liver regeneration after surgery.

Aged↗

PubMed1994

Oxidative stress in hepatocytes and stimulatory state of Kupffer cells after reperfusion differ between warm and cold ischemia in rats.

Rat liver was kept at 4 degrees C or 37 degrees C in MEM, and reperfused through a closed circulation from the hepatic vein to the portal vein at 37 degrees C with the same solution. Although purine nucleoside phosphorylase and ALT activities were increased in the perfusate, depending on the duration of ischemia at both 4 degrees C and 37 degrees C, the ratio of the latter to the former was significantly higher after 37 degrees C-ischemia than after 4 degrees C-ischemia. The stimulation stage of Kupffer cells evaluated in situ by formazan deposition after liver perfusion with nitro blue tetrazolium and phorbol myristate acetate was elevated after 4 degrees C-ischemia longer than 1 h, but not after 37 degrees C-ischemia. In contrast, the degree of oxidative stress in hepatocytes assessed by formazan deposition after liver perfusion with nitro blue tetrazolium alone was greater after 37 degrees C-ischemia than after 4 degrees C-ischemia. These results suggest that oxidative stress in hepatocytes and the stimulatory state of Kupffer cells after ischemia-reperfusion may differ between 4 degrees C-ischemia and 37 degrees C-ischemia, probably leading to different development of liver damage.

Alanine Transaminase↗