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Biomedical subjects

O Ishikawa

Publications and source records attributed to O Ishikawa.

At least 19 recordsLinked to original sources
PubMed1999

Phase II study of limited surgery for early gastric cancer: segmental gastric resection.

BACKGROUND: Endoscopic resection for treatment of early gastric cancer (EGC) is widely performed. Recently, however, surgeons began performing a limited operation for EGC when endoscopic resection was not indicated. This report discusses the surgical technique and the results of the limited operation, which is generally referred to as "segmental resection" (SR). METHODS: Since 1990, a total of 50 patients with intramucosal invasive EGC of the middle stomach underwent SR. The procedure included a limited gastrectomy, limited lymph node dissection, and preservation of the vagal nerve. We examined the surgical risk, postoperative complications, and patient survival rates and compared the results for the SR-treated patients (group A) with results for patients with EGC who underwent subtotal gastrectomy and systemic lymph node dissection (group B). RESULTS: Blood loss was less in group A (239 +/- 180 ml) than in group B (342 +/- 176 ml) (P < .05). The incidence of postoperative complications was also lower in group A (2.0%) than in group B (14.0%) (P < .05). The incidence of postoperative cholelithiasis was lower in group A (4.0%) than in group B (18.0%) (P < .05). All patients in both groups are alive without recurrence. CONCLUSIONS: Compared with distal gastrectomy, SR for EGC of the middle stomach decreased the surgical risk and postoperative complications without increasing the recurrence rate.

Female↗
PubMed1999

Cutaneous papules and nodules in the diagnosis of the antiphospholipid syndrome.

Of 11 patients with primary or secondary antiphospholipid syndrome (APS), four exhibited papules or nodules on the finger, sole or leg as the initial cutaneous manifestation. Histological examination demonstrated thrombosed vessels or vessels containing organized thrombi in the dermis or in the subcutaneous fat tissue. Cutaneous papules and nodules should be recognized as skin manifestations of APS. Screening tests for antiphospholipid antibodies and lupus anticoagulant are required in patients with cutaneous papules or nodules of unknown aetiology. In cases of positive antiphospholipid antibodies and/or lupus anticoagulant, histological examination is critical in the establishment of the diagnosis of APS.

Adolescent↗
PubMed1999

Clinical and immunological characterization of patients with systemic sclerosis overlapping primary biliary cirrhosis: a comparison with patients with systemic sclerosis alone.

Limited cutaneous systemic sclerosis (lSSc) or CREST syndrome is sometimes complicated by primary biliary cirrhosis (PBC). To characterize the clinical and immunological features of patients with SSc overlapping PBC (SSc-PBC), the clinical and laboratory data of 11 SSc-PBC were studied. Since all of the SSc-PBC were lSSc, the features of SSc-PBC were compared with those of 266 patients with lSSc alone. The sera from SSc-PBC showed a significantly higher positivity for anti-centromere antibody (ACA) (p < 0.0005) and higher reactivity to centromere protein-C. Although SSc-PBC more frequently exhibited calcinosis and telangiectasia (p < 0.05), there was no statistical difference in other features of CREST syndrome. There was no statistical difference in other scleroderma-related features either. SSc-PBC were more frequently complicated with Sjögren syndrome (p < 0.05). The most prominent feature of SSc-PBC was a higher incidence of ACA than in lSSc alone.

Adult↗
PubMed1999

Extended pancreatectomy and liver perfusion chemotherapy for resectable adenocarcinoma of the pancreas.

In order to increase the long-term survival after resection of pancreatic adenocarcinoma, it is essential to eradicate both locoregional recurrence and hepatic metastasis. We have added a wide range of lymphatic and connective tissue clearance to conventional pancreatectomy (extended pancreatectomy) and succeeded in improving the 5-year survival rate from 8 to 25% via decreasing the incidence of local failure. Among many procedures which together compose an extended pancreatectomy, connective tissue clearance seems to have played a more important role on patients' prognosis rather than wide range lymphadenectomy. Concomitant resection of the portal vein is recommended for selected patients, and it is important not to overlook a minute invasion even though it appears macroscopically intact. With regard to adjuvant therapy in combination with our extended pancreatectomy, the addition of preoperative irradiation failed to further improve the long-term survival rate because the cause of cancer deaths shifted from local recurrence to hepatic metastasis. When liver perfusion chemotherapy was added to this operation (without radiation), the 5-year survival rate was improved to 39% by decreasing the incidence of hepatic metastasis. In the future, a combination of extended pancreatectomy with chemoradiation plus liver perfusion chemotherapy is one of the promising approaches for this cancer.

Adenocarcinoma↗
PubMed1998

Prostaglandin E1 suppresses tumor necrosis factor-alpha and interleukin-10 production by lipopolysaccharides-stimulated mononuclear cells.

Prostaglandin E1 has been clinically used in a variety of vascular occlusive diseases. We investigated the in vitro effect of prostaglandin E1 on the synthesis of tumor necrosis factor-alpha, interleukin-1, interleukin-6, interleukin-10 and transforming growth factor beta by human peripheral blood mononuclear cells stimulated with lipopolysaccharides. Prostaglandin E1 significantly suppressed both the mRNA expression and the production of tumor necrosis factor-alpha and interleukin-10 by lipopolysaccharides-stimulated peripheral blood mononuclear cells in a dose-dependent manner (1 x 10(-6)-1 x 10(-8) M). Since tumor necrosis factor-alpha is a potent proinflammatory cytokine involved in certain inflammatory diseases, our findings suggest the possibility to expand the clinical application of prostaglandin E1.

Adult↗
PubMed1998

Limited surgery for early gastric cancer in cardia.

BACKGROUND: Because there are some difficulties with the diagnosis of invasion or the endoscopic resection technique, almost all gastric tumors are resected surgically. Surgeons now are performing a limited operation for early gastric cancer of the upper stomach (EGCUS) without lymph node metastasis. This paper discusses and evaluates the surgical technique and the results of the limited operation for EGCUS. PATIENTS AND METHODS: Since 1988, a total of 34 patients with EGCUS, diagnosed as intramucosal invasion, have undergone a limited operation--fundectomy--which includes a limited proximal gastrectomy, a limited lymph node dissection, and a procedure preserving the vagal nerve. The surgical risk, postoperative complications, and survival rates of the fundectomy patients (group A) were compared with those of patients undergoing a total gastrectomy for EGCUS (group B). RESULTS: Blood loss was lower in group A (300+/-193 mL) than in group B (555+/-316 mL) (P <.05). The incidence of postoperative pancreatic fistula also was lower in group A (0%) than in group B (15.0%) (P <.05). All patients in both groups (except one who died of a cerebral infarction) are alive without recurrence. CONCLUSION: Compared to the results of a total gastrectomy, performance of a limited fundectomy for EGCUS decreased surgical risk and postoperative complications without decreasing the survival rate.

Adult↗
PubMed1998

Indications for hepatectomy for hepatocellular carcinoma - what stage of the disease is the best indication for surgery?

To determine the clinical and tumor stage of hepatocellular carcinoma (HCC) that is the best indication for surgery, the postoperative long-term outcomes of patients who underwent hepatic resection were examined retrospectively. Of 975 patients with HCC who underwent regional therapy, 384 patients (39%) received hepatic resection (HR), 534 (55%) had transcatheter arterial chemoembolization (TACE), and the remaining 57 (6%) received percutaneous ethanol injection (PEI) into the tumor. The criteria defined by liver Cancer Study Group of Japan was used for staging and liver functional reserve (i.e., clinical staging). In the 133 patients with stage I HCC, there were no significant differences among the survivals of the HR, TACE, and PEI groups. In the 314 patients with stage II HCC, the 5- and 7-year survival rates were 51% and 46% in the HR group, 23% and 10% in the TACE group, and 0% and 0% in the PEI group. The survival of the HR group was significantly better than the survivals of the TACE and PEI groups (P < 0.001). The 5- and 10-year survivals of the stage II HCC patients who had HR were 64% and 47% in the clinical stage I (i.e., good liver function) group, significantly better than the 5; and 10-year survivals (32% and 23%) in the clinical stage II (i.e., bad liver function) group (P < 0.0001). Patients with good liver function in stage II are expected to have better survival and are considered to be the most suitable for HR.

Aged↗
PubMed1998

Intraoperative cytodiagnosis for detecting a minute invasion of the portal vein during pancreatoduodenectomy for adenocarcinoma of the pancreatic head.

During pancreatoduodenectomy for adenocarcinoma of the pancreatic head, we frequently encountered cases in which the superior mesenteric-portal venous confluence (SMPVC) was involved with cancer. With regard to the indication of the concomitant SMPVC resection, as suggested by recent papers, a better long-term outcome would be expected if the cancer invasions were limited to the tunica adventitia or media of the SMPVC wall. Since this raised fears whether such a small SMPVC invasion was always detectable by macroscopic inspection alone, we have performed an intraoperative cytology on the touch smear of the exposed SMPVC wall for 23 patients with pancreatic head cancer. All of their SMPVCs were separated from the pancreatic head and appeared to be intact at a macroscopic level. As a result of the cytologic examination, however, 7 patients (30%) were newly diagnosed as having cancer cells on the SMPVC wall, and they received an additional resection of the SMPVC. Postoperative histology indicated that cancer invasion into the SMPVC wall was present in 6 of the 7 patients, and that the cancer invasions were limited in the tunica adventitia in 5 patients and to the tunica media in 1 patient. Thus, in order not to miss the chance of cure by SMPVC resection, our intraoperative cytology on the touch smear of the SMPVC is worth performing more actively on the macroscopically intact-looking SMPVC during resection of pancreatic cancer.

Adenocarcinoma↗
PubMed1998

Differential effect of etretinate on proliferation and extracellular matrix metabolism of human dermal fibroblasts from elderly and young individuals in a novel three-dimensional culture.

The effect of etretinate on proliferation and biosynthesis of collagens and glycosaminoglycans (GAGs) were investigated using human dermal fibroblasts in a novel three-dimensional culture supplemented with L-ascorbic acid 2-phosphate. Fibroblasts from two young and two elderly individuals were studied at different concentrations of etretinate, 0.25, 1.0 and 2.5 microg/ml. Collagens (hydroxyproline) and GAGs (disaccharide units) extracted from the cell layer were analyzed and quantified biochemically by high-performance liquid chromatography (HPLC). Etretinate showed no significant effect on fibroblast proliferation either in the monolayer or the three-dimensional culture. Etretinate increased the collagen or GAGs content in the cell layer, which was prominent at etretinate concentrations of 1.0 and 2.5 or 0.25 microg/ml, respectively in fibroblasts from the elderly (P < 0.05). This effect was not seen in dermal fibroblast from the young. These results suggest that etretinate may have the differential effect on collagen and GAG metabolisms depending on the donor age of the cultured fibroblasts.

Aged↗
PubMed1998

Immunohistochemical distribution of epimorphin in human and mouse tissues.

A novel protein epimorphin has been identified as a mesenchymal signal factor. We reported previously ubiquitous expression of epimorphin in normal skin and a significant increased expression in diseased human skin. The present immunofluorescence study was conducted to determine systematically the distribution of epimorphin in adult human organs with an anti-epimorphin monoclonal antibody. Epimorphin was found to be widely distributed in all human organs examined. It was present in the connective tissue adjacent to or around various epithelial tissues, muscles and vessels. In particular, strong staining was present on the endomysium of muscles, the adventitia of blood vessels, along the sinusoidal lining of hepatocytes and connective tissue around epithelial cells, exocrine and endocrine glands. The results suggest that epimorphin may play a key role in maintaining normal tissue structure and interaction between mesenchymal tissue and epithelial tissue in vivo.

Animals↗
PubMed1998

Down-regulation of focal adhesion kinase, pp125FAK, in endothelial cell retraction during tumor cell invasion.

Although endothelial cell retraction is required before tumor cell invasion, its molecular mechanism still remains obscure. We previously demonstrated that conditioned medium (CM) derived from a human pancreatic cancer cell line, PSN-1, induced endothelial cell retraction and facilitated tumor cell invasion. To investigate the molecular change of events in the transduction of extracellular signals during endothelial cell retraction, we examined the effect of the CM derived from PSN-1 cells on the tyrosine phosphorylation in endothelial cells. Immunoblot analyses revealed that the PSN-1 CM decreased tyrosine phosphorylation of a 120-130 kD protein, and induced the concomitant down-regulation of focal adhesion kinase, pp125FAK, during endothelial cell retraction in time- and dose-dependent fashions. These changes preceded endothelial cell retraction and were reversible after removal of the CM. Further quantitative densitometric analyses demonstrated that the extent of decrease in tyrosine phosphorylated 120-130 kD protein during the endothelial cell retraction was likely to be proportional to that of the down-regulation of pp125FAK. A tyrosine phosphorylated 120-130 kD protein immunoprecipitated by anti-phosphotyrosine antibody immunoreacted with anti-pp125FAK antibody. These results suggested that decreased amount of a tyrosine phosphorylated 120-130 kD protein probably due to the down-regulation of pp125FAK might be associated with the signal transduction pathway in the endothelial cells during their retraction. Furthermore, these findings were also observed in the CM from another four human cancer cell lines, suggesting the down-regulation of pp125FAK in endothelial cells during tumor cell invasion.

Animals↗
PubMed1998

Opposite effects of tumour necrosis factor-alpha on type I and III collagen gene expression by human dermal fibroblasts in monolayer and three-dimensional cultures.

We have recently established a novel fibroblast culture system supplemented with L-ascorbic acid 2-phosphate. The addition of L-ascorbic acid 2-phosphate enables human dermal fibroblasts to organize a three-dimensional dermis-like structure by accumulating collagens and extracellular matrices. The purpose of this study was to examine the effects of tumour necrosis factor-alpha (TNF-alpha) on collagen gene expression by human dermal fibroblasts in this culture system in comparison with monolayer culture. TNF-alpha suppressed the expression of pro alpha 1 (I) and pro alpha 1 (III) collagen mRNA in monolayer culture. In contrast, their expression was elevated in the three-dimensional culture system. TNF-alpha increased the mRNA expression of matrix metalloproteinase-1 and tissue inhibitor of metalloproteinase-1 both in monolayer and three-dimensional culture. These data suggest that responses of human dermal fibroblasts to TNF-alpha are distinct under the different culture conditions. Extracellular matrices may modulate the responsiveness of fibroblasts to TNF-alpha.

Adult↗
PubMed1998

Dermal mast cells in scleroderma: their skin density, tryptase/chymase phenotypes and degranulation.

To determine the distribution, tryptase/chymase phenotypes and degranulation of mast cells (MCs) in the dermis of patients with scleroderma, we examined MC density in the skin of 22 patients with systemic sclerosis (SSc) and 11 with localized scleroderma (LSc). We used antitryptase and antichymase antibodies after Carnoy's fixation. Detailed reports of two representative patients with SSc and LSc are included. In the scleroedematous stage (grade 1) showing oedema in both papillary and reticular dermis with variable homogenization of collagen bundles in the reticular dermis, MC skin density was variable in each specimen although MC skin density, as a whole, was significantly increased as compared with normal skin (P < 0.05). In the sclerotic stage (grade 2) characterized by homogenization of collagen bundles in the entire dermis, MC skin density was significantly decreased as compared with normal skin (P < 0.005). LSc showed changes similar to those in SSc. The ratio of MCTC cells (both tryptase- and chymase-positive MC) to MCT cells (tryptase-positive but chymase-negative MC) was variable in SSc and LSc. MCT cells were exclusively dominant in three patients with SSc and two with LSc. In a patient with SSc (patient 1) showing remarkable perivascular and interstitial oedema in the upper dermis, MC skin density was increased in the oedematous portion and tryptase-positive granules were distributed in extracellular locations. In another patient with LSc (patient 2), tryptase positivity increased and chymase positivity decreased in both number and intensity as the skin sclerosis progressed. MCs must have variable interactions with the lesional skin in SSc and LSc. The present study suggests that MCs are involved in the development of interstitial oedema.

Adult↗
PubMed1998

Distinct patterns of collagen gene expression are seen in normal and keloid fibroblasts grown in three-dimensional culture.

The purpose of this study was to examine collagen gene expression in various types of scar fibroblasts as well as normal fibroblasts in a novel three-dimensional culture system and to compare them with those in a monolayer culture system. Cells in three-dimensional culture formed multiple layers within the self-produced dense extracellular matrix and formed a dermis-like structure. In monolayer culture, both normal and scar fibroblasts continued to express high levels of mRNA for pro alpha 1(I) and pro alpha 1(III) collagens. However, in three-dimensional culture, the mRNA levels gradually declined in normal fibroblasts. In contrast, mRNA levels remained high in keloid and hypertrophic scar fibroblasts. Atrophic scar fibroblasts demonstrated similar changes to normal fibroblasts in three-dimensional culture. When we compared mRNA expression in fibroblasts from the centre and the edge of hypertrophic scar, cells from the centre showed a persistently decreased level of collagenase mRNA expression. These results suggest that the mRNA expression pattern of pro alpha 1(I) and pro alpha 1(III) collagens varies depending on the culture system. Fibroblasts from keloids and hypertrophic scar may have a defective system of down-regulation in extracellular matrix metabolism.

Adult↗
PubMed1998

Linear cutaneous lupus erythematosus following the lines of Blaschko.

We describe two Japanese girls with discoid lupus erythematosus (DLE) in whom the condition showed a linear configuration following the lines of Blaschko. The clinical appearance was unusual but histological examination established the diagnosis. After reviewing the previous reports, we found that in six of eight patients with linear 'discoid' lesions, the age at onset was under 14 years; no patient has progressed to systemic lupus erythematosus. Patients with 'linear' DLE may compose a certain clinical subset. We propose the term 'linear cutaneous lupus erythematosus' which may be more suitable for the linear lesions of DLE.

Adolescent↗
PubMed1998

Creeping eruption caused by a larva of the suborder Spirurina type X.

We report a 40-year-old Japanese man with a creeping eruption caused by a larva of the nematode suborder Spirurina type X. He had eaten raw small squid (hotaruika) 4 weeks before the serpiginous erythematous eruption appeared on his abdomen. Routine laboratory tests revealed only slight eosinophilia in his peripheral blood. Although we could not find the larva in an excised skin specimen, an indirect immunofluorescence test confirmed the presence of antibodies against larvae of the suborder Spirurina type X. We review 28 reported cases in Japan which showed that creeping eruption caused by larvae of the suborder Spirurina type X has the following clinical characteristics: an incubation time of 1-4 weeks; a migratory, well-defined, narrow, serpiginous erythematous eruption; and only slight peripheral blood eosinophilia. Excision of the advancing end of the track was curative in our patient.

Adult↗