Biomedical subjects

Toshio Onitsuka

Publications and source records attributed to Toshio Onitsuka.

At least 19 recordsLinked to original sources

PubMed2006

Adrenomedullin in mast cells of abdominal aortic aneurysm.

OBJECTIVES: Produced by vascular walls, adrenomedullin (AM) exerts antifibrotic actions in the process of cardiovascular remodeling. The purpose of this study was to examine the pathophysiological role of AM in the development of human abdominal aortic aneurysm (AAA). METHODS AND RESULTS: Immunohistochemical analyses revealed that vascular smooth muscle cells in the media were positive for AM in the early stage of atherosclerotic aorta. Intense immunoreactivity was observed in mast cells of the outer media and adventitia of AAA, and the number of mast cells was greater (p < 0.01) in AAA than in atherosclerotic aorta without any aneurysmal change. To determine the role of AM in mast cells, we examined cultured human mast cell leukemia line-1 (HMC-1) and fibroblasts isolated from AAA patients. Cultured HMC-1 cells were found to express preproAM gene and release AM peptide into the cultured media. When assessed by collagenase-sensitive [3H]proline incorporation and procollagen type I C-peptide secretion, collagen synthesis in co-culture of HMC-1 and the fibroblasts was reduced by 10(-6) mol/L synthetic AM, while conversely, it increased following blockade of the action of endogenous AM with 10 microg/mL anti-AM monoclonal antibody. CONCLUSION: The present study suggests an anti-fibrotic role for AM released from mast cells, providing new insight into the biological actions of mast cell-derived AM in the development of AAA.

Adrenomedullin↗

PubMed2006

Clinical analysis of acute type A intramural hematoma: comparison between two different pathophysiological types.

BACKGROUND: Type A intramural hematoma (IMH) has two different etiologies, which are rupture of vasa vasorum and penetrating atherosclerotic ulcer (PAU); however, it is difficult to know which is the initiating event. METHODS: Between January 1993 and August 2004, 28 patients of acute type A IMH were treated in our department and were divided into two groups, 20 patients with IMH probably caused by rupture of vasa vasorum (non-PAU group) and 8 patients with IMH probably caused by PAU (PAU group), according to pathologic specimen and atherosclerotic findings on computed tomography. Background factors, radiographic findings, and prognosis were analyzed retrospectively. RESULTS: Surgery was performed in 15 patients (75%) in non-PAU group and 4 patients (50%) in PAU group during the first admission. Late progression was noted in 3 patients, and operation was required. Finally, operation was performed in 22 patients (78.6%). The history of myocardial infarction (p = 0.026) and chronic renal failure (p = 0.026) were more associated with PAU group than with non-PAU group. Ascending aortic diameter at the onset was significantly larger in non-PAU group (50.3 +/- 6.6 mm) than in PAU group (43.9 +/- 9.0 mm; p = 0.046), and there were significantly more ulcer lesions in PAU group (1.9 +/- 0.4) than in non-PAU group (1.1 +/- 0.4; p = 0.0004). There was no significant difference in long-term survival rates between them. CONCLUSIONS: The PAU group patients have more coexisting atherosclerotic diseases and multiple aortic ulcer lesions with significantly mild ascending aortic dilatation compared with non-PAU group patients.

Age Factors↗

PubMed2006

Preoperative prognostic factors for pN2 non-small cell lung cancer.

PURPOSE: The prognosis of non-small cell lung cancer (NSCLC) with pathologic mediastinal lymph node involvement (pN2) is poor in general. The majority of previously reported prognostic factors of pN2 disease are not available preoperatively. When we perform preoperative induction chemotherapy, we should undertake therapeutic planning according to preoperative factors. METHODS: We focused on preoperative clinicopathologic factors, and investigated the prognosis in 78 patients with pN2 NSCLC who received complete resection. RESULTS: Age, gender, histologic subtype, tumor location, smoking status and cT status were not related to patients' survival. On the other hand patients with cN0 disease and normal serum carcinoembryonic antigen (CEA) level had a significant favorable survival (p = 0.038 and p = 0.019, respectively). In addition, comorbidity had a significant survival impact (p = 0.031). Despite there being no independent prognostic factors by multivariate analysis, the patients without all of cN1-2 disease, elevated serum CEA level and comorbidity had a significant favorable prognosis (p = 0.008). CONCLUSION: Among the preoperative factors examined, pN2 patients with all cN0 disease, normal serum CEA level and no comorbidities might have a favorable prognosis. Combined use of these might be a useful prognostic determinant, and even in the presence of pN2 disease, patients without these unfavorable 3 factors might have a favorable prognosis when treated with surgery alone.

Adult↗

PubMed2006

[Complete resection of the invasive thymoma combined with replacement of aortic arch and pneumonectomy].

A 68-year-old male was found an abnormal shadow on chest X-ray and was diagnosed as thymoma by computed tomography (CT)-guided needle biopsy. As the tumor invaded the aortic arch, left main pulmonary artery and the lung, thymectomy combined resection of the surrounding tissues was performed for the complete resection. The aortic arch was replaced with cardiovascular graft under cardiopulmonary bypass, with the aid of selective cerebral perfusion. The left pneumonectomy was performed because the tumor invaded to the left main pulmonary artery and to the lung parenchyma. Masaoka stage III and histologic type B2 were diagnosed according to the World Health Organization classification. The patient has been well without recurrence or metastasis after the surgery for 2 years. A complete resection of the thymoma invaded to great vessels should be performed to expect for the good curability and prognosis.

Aged↗

PubMed2005

Selective delayed management of blunt traumatic left common carotid artery injury using hypothermic circulatory arrest.

Most traumatic carotid artery aneurysms occur at or close to its bifurcation, and traumatic aneurysm of the intrathoracic carotid arteries are rare. We describe a case of false aneurysm at the origin of the left common carotid artery (LCCA) after blunt trauma. A 53-year-old man suffered a blow from a broken steel plate, which flew from a working concrete crusher over his neck when he looked down the machine. Chest computed tomography revealed aneurysm of the LCCA, and aortic arch arteriography demonstrated a false aneurysm of about 3 x 5 cm at the origin of the LCCA, with loss of arterial continuity and abnormal tortuosity above the aneurysm. An ascending aorta to LCCA bypass graft was placed during the cooling period of cardiopulmonary bypass, and mattress sutures were placed in the normal aorta to close the origin of the LCCA under hypothermic circulatory arrest because of the extreme danger of dissection. The LCCA was transected partially at its origin from the aorta. We speculated that the direct lifting force which caused the carotid artery to move upward might produce a tear at the junction of the LCCA and the aortic arch.

Accidents, Occupational↗

PubMed2005

Reinforcement of saphenous vein graft with ePTFE graft for axillocoronary bypass grafting.

Arteriosclerosis in the ascending aorta is widely accepted as a strong risk factor for the occurrence of stroke after coronary artery bypass grafting (CABG). The aortic no-touch technique, with a variety of modifications, has been used to reduce the risk of post-CABG stroke. Saphenous vein grafts (SVGs) have been used for axillocoronary bypass grafting, a modification of the aortic no-touch technique. However, kinking or compression often occurs with SVGs. We report here the successful application of an 8-mm expanded polytetrafluoroethylene graft, of the external bead support type, that was used to cover an SVG during axillocoronary bypass grafting.

Aged↗

PubMed2005

Prognostic significance of carcinoembryonic antigen level in pleural lavage fluid for patients with lung adenocarcinoma.

BACKGROUND: Prognostic indicators for non-small cell lung cancer patients traditionally include TNM staging, pleural lavage cytology, and serum carcinoembryonic antigen levels. This prospective study evaluates carcinoembryonic antigen levels in pleural lavage fluid as a potential determinant for patients with lung adenocarcinoma. METHODS: One hundred and fifty patients underwent thoracotomy. Pleural lavage fluid was collected, and pleural lavage cytology and lavage carcinoembryonic antigen levels were determined. The control group included 40 patients with nonmalignant disease. RESULTS: Sixteen patients (10.7%) had positive pleural lavage cytologies. These patients and those with elevated serum carcinoembryonic antigen levels generally had a poor prognosis. Thirty-seven patients (24.7%), however, showed elevated lavage carcinoembryonic antigen levels, and a significant correlation with patient survival was demonstrated. Multivariate analysis confirmed these results. We also found a correlation between positive pleural lavage cytologies and serum carcinoembryonic antigen levels and patient survival in patients with pN0 disease but not in those with pN1-2 disease. Elevated lavage carcinoembryonic antigen levels, however, correlated significantly with survival rates in patients with pN1-2 disease. CONCLUSIONS: An elevated lavage carcinoembryonic antigen level is an independent prognostic determinant for patients with lung adenocarcinoma, even with advanced disease, and may be a more useful marker of subclinical microdissemination than pleural lavage cytology.

Adenocarcinoma↗

PubMed2005

Predictor of neurologic dysfunction after elective thoracic aorta repair using selective cerebral perfusion.

OBJECTIVES: This study was undertaken to determine the factors that influence postoperative neurological dysfunction after selective cerebral perfusion (SCP). DESIGN: From 1995 to August 2004, 60 patients were evaluated for the presence of cerebro-vascular disease (CVD), and then underwent thoracic aortic operations using SCP. Perioperative factors were evaluated by multivariate analyses. RESULTS: Hospital mortality rate was zero. Sixteen patients (26.7%) proved to have CVD. Permanent neurological dysfunction (PND) appeared in three patients (5.0%) and transient neurological dysfunction (TND) in two (3.3%). Univariate analysis revealed superficial temporal artery (STA) pressure during SCP (p = 0.0410) to be a significant risk factor for PND. Variables that achieved values of p < 0.2 (aortic cross-clamp time, presence of CVD, old cerebral infarction, presence of clots or atheroma) were examined with multivariate analysis and the presence of CVD (p = 0.038) and STA pressure during SCP (p = 0.032) were independent risk factors for PND. Multivariate analysis for TND did not show any risk factor. CONCLUSIONS: The presence of CVD was indicated as an independent risk factor for PND after thoracic aortic operations using SCP.

Aged↗

PubMed2005

Neuroendocrine carcinoma of the posterior mediastinum arising from a foregut cyst.

Neuroendocrine carcinoma of the posterior mediastinum is extremely rare. Described here is a patient with neuroendocrine carcinoma of the posterior mediastinum arising from a foregut cyst. A paravertebral mass detected in the posterior mediastinum of a 64-year-old man was spherical, solid and yellowish white. Some cystic or cleft-like spaces were present. Microscopically, the lesion was composed of proliferating round or polygonal tumor cells in a diffuse, solid or trabecular fashion with extensive necrosis and high mitotic activity. Components of glandular epithelia and smooth muscle layers were evident in the cystic wall. Immunohistochemically, the tumor cells were positive for both epithelial and neuroendocrine markers, including pan-cytokeratin, chromogranin A and synaptophysin. Neuroendocrine marker-positive cells were also present in the glandular epithelium of the cystic walls. It was considered that posterior mediastinal neuroendocrine carcinoma arose from a foregut cyst. Malignant change within a foregut cyst is very uncommon. This is the first report of a neuroendocrine carcinoma of the posterior mediastinum arising from a foregut cyst.

Carcinoma, Neuroendocrine↗

PubMed2005

Vascular endothelial growth factor expression in pN2 non-small cell lung cancer: lack of prognostic value.

OBJECTIVE: Although several previous studies have investigated the prognostic significance of vascular endothelial growth factor (VEGF) expression in non-small cell lung (NSCL) cancer, no previous study has concentrated on NSCL cancer with pathologically abnormal mediastinal nodes (pN2). METHODOLOGY: A total of 60 patients with pN2 NSCL cancer who had undergone a complete resection with a systematic mediastinal lymph node dissection were reviewed retrospectively. Immunohistochemical examination, using antibodies against VEGF, was conducted. The prognostic significance of VEGF expression and clinicopathological factors were analysed. RESULTS: The overall 5-year survival rate was 21.7%. With respect to clinicopathological factors, single N2 involvement and skip metastasis were significantly associated with patients' survival. Expression of VEGF was found in 35/60 (58.3%) patients. VEGF expression was not related to the clinicopathological parameters examined. There was no relationship between survival rates and patients positive and negative for VEGF. Multivariate analysis showed that single N2 disease was an independent prognostic factor, while VEGF expression was not. CONCLUSIONS: Although VEGF expression might be important for tumour development and maintenance, no prognostic significance of VEGF expression in pN2 NSCL cancer was found.

Adult↗

PubMed2004

Mycotic pseudoaneurysm of the brachiocephalic artery.

A 73-year-old woman with a history of hypertension and hyperlipidemia presented with a sharp pain ranging from the right shoulder to the upper limb. She had suffered a sharp pain at rest accompanied by general fatigue and nausea for about ten months prior to admission. Her white blood cell count was 12,800/microl, and her serum C-reactive protein was 17.5 mg/dl. A chest computed tomography scan revealed an aneurysmal change of the origin of the brachiocephalic artery. Pseudoaneurysm due to infection and aortic dissection was considered as a preoperative diagnosis. A total arch replacement was performed under cardiopulmonary bypass, deep hypothermia, and selective cerebral perfusion. Postoperatively, a bacteriologic culture of the contents of the aneurysm revealed Staphylococcus aureus. Perioperative administration of antibiotics was effective and the postoperative course was uneventful.

Aged↗

PubMed2004

Intrapleural hyperthermic perfusion with chemotherapy increases apoptosis in malignant pleuritis.

BACKGROUND: Previously, we reported on the effectiveness of intrapleural hyperthermic perfusion with chemotherapy, a new treatment we developed for patients with malignant pleuritis. The present study analyzes the mechanism of the effectiveness of this therapy by examining the induction ratio of apoptosis among tumor cells following the perfusion treatment. METHODS: This study included 11 consecutive patients with primary pulmonary adenocarcinoma and accompanying pleural seedlings and pleural effusions containing tumor cells but without distant metastasis. All patients underwent surgical resection of the primary lesion and then received sequential perfusion treatment. Tumor cells collected from the effusion both before and again at 24 hours following the perfusion treatment were subsequently examined using an immunocytochemical stain to determine apoptosis among tumor cells. The percentage of positively stained cells was expressed as the apoptotic index. We compared the survival rate of these 11 patients with the survival rate of a second group of 11 patients with malignant pleuritis who underwent surgical resection of the primary lesion but who did not receive the perfusion treatment (control group). RESULTS: The ratio of spontaneous apoptosis of untreated tumor cells was 2.8% +/- 2.0%. Following the perfusion, apoptosis among tumor cells was 25.2% +/- 4.6%, clearly a significant increase. While the median survival time for patients receiving the perfusion treatment was 20 months, the median survival time for the control group was 6 months. CONCLUSIONS: In patients with malignant pleuritis, intrapleural hyperthermic perfusion with chemotherapy induced potent apoptosis of tumor cells in the pleural cavity and also improved the survival rate of these patients as compared with patients who did not receive the perfusion treatment.

Adenocarcinoma↗

PubMed2004

Combined procedures for mediastinal staging in non-small cell lung cancer.

We investigated whether the combined use of computed tomography, thallium-201 single photon emission computed tomography and serum carcinoembryonic antigen level improves preoperative non-invasive mediastinal. 128 consecutive non-small cell lung cancer patients (85 adenocarcinomas, 31 squamous cell carcinomas and 12 others) who underwent a surgical resection were enrolled in this study. The results of the combined procedures were compared with the pathologic findings. Our results showed that the combined evaluation of mediastinal nodal involvement with the three procedures might increase underestimation, but decrease overestimation as compared to computed tomography alone. Thallium-201 single photon emission computed tomography for patients with enlarged nodes at computed tomography showed 81.3% and 100% of positive predictive value in overall and squamous cell carcinoma patients, respectively. The negative predictive value of thallium-201 single photon emission computed tomography for patients without enlarged nodes at computed tomography was highly accurate in adenocarcinoma (93.9%) as well as squamous cell carcinoma (94.4%). Combining computed tomography findings and serum carcinoembryonic antigen level had a poor predictive value. However, in patients with adenocarcinoma, a negative examination was highly accurate (95.2%). In conclusion, our results show a trend that combined use of the three procedures might improve non-invasive mediastinal staging in non-small cell lung cancer.

Adenocarcinoma↗

PubMed2004

Prognostic significance of preoperative serum carcinoembryonic antigen level in lung adenocarcinoma but not squamous cell carcinoma.

OBJECTIVES: Clinical significance of measurement of preoperative serum carcinoembryonic antigen (CEA) level in patients with non-small cell lung cancer was investigated. METHODS: Consecutive 271 adenocarcinoma and 112 squamous cell carcinoma patients of non-small cell lung cancer referred to our institute were included in this study. There were 214 men and 169 women, ages ranged from 19 to 90 years, with an average of 64.46 years. Curative resection was performed for 220 adenocarcinoma and 93 squamous cell carcinoma patients. Serum level of CEA was measured before staging or resection of cancer. RESULTS: There is a trend toward a correlation between serum CEA level and stage of the diseases, however, serum CEA level was not always related to tumor node metastasis (TNM) status. In patients with adenocarcinoma, survival rate of patients with an elevated serum CEA level was significantly lower than that with a normal serum CEA level. Multivariate analysis showed that prognostic significance of serum CEA level was TNM staging independent in patients with adenocarcinoma. On the other hand, serum CEA level was not related to patients' survival in patients with squamous cell carcinoma. CONCLUSIONS: Elevated preoperative serum CEA level is a TNM staging independent prognostic factor for patients with adenocarcinoma but not for those with squamous cell carcinoma.

Adenocarcinoma↗

PubMed2004

Micrometastasis and expression of nm23 messenger RNA of lymph nodes from lung cancer and the postoperative clinical outcome.

BACKGROUND: Based on the metastatic route in lymph nodes from lung cancer, we investigated micrometastasis in the dissected lymph nodes by genetic analysis of keratin 19 and nm23-H1 (the expression of a tumor-metastatic suppressor gene) and evaluated the postoperative outcomes. METHODS: Ten patients operated with lung cancer were 4 males and 6 females, who were stage IA; 2, stage IB; 3, stage IIA; 2, stage IIB; 1, and stage IIIA; 2, respectively. After total RNA extraction from the dissected lymph nodes, the expression of nm23-H1 and keratin 19 messenger ribonucleic acid (mRNA) were analyzed with reverse-transcripted polymerase chain reaction (RT-PCR). RESULTS: The confirmation of micrometastasis in lymph nodes was realized in seven of 10 cases (70%), in their 5-year follow-up term. In three patients there was recurrence (43%, 3/7), and the one of them had died from the mediastinal recurrence. On the expression of nm23-H1 mRNA in lymph nodes, there was no significant difference between the pathologically lymph-node metastasis positive group and the negative one, and between the group with a tumor size over 30 mm and the group with a tumor size under 30 mm, respectively. The expression ratio of nm23-H1 gene was significantly expressed in the group with micrometastasis in lymph nodes (47%, 9/19) as compared to those without micrometastasis (10%, 1/10) (p<0.05). On the all-positive expression of nm23-H1 in the examined lymph nodes (n=4), no patient had recurrence (0%, 0/4). However, in the rest of the six patients without the all-positive expression of nm23-H1 in those lymph nodes (n=6), four patients had recurrence (67%, 4/6). There was no significance between the recurrent ratio in the all-positive expression of nm23-H1 suggesting lower incidence as compared to that in patients without all-positive expression of nm23-H1. CONCLUSION: A detection of micrometastasis in lymph nodes could be a useful tool to identify the subpopulation of patients who might have a higher risk of recurrence and distant metastases. The nm23-H1 gene might be involved in a suppression role for micrometastasis in lymph nodes through the lymphatic route in lung cancer.

Aged↗

PubMed2003

Distribution of Mast Cells in Mediastinal Lymph Nodes from Lung Cancer Patients.

BACKGROUND: Mast cells have been documented to have several key functions with regards to malignant neoplasms. However, the functional significance of their accumulation is largely unknown. An analysis of the mast cell profile in mediastinal lymph nodes from lung cancer patients is reported here. METHODS: One hundred thirty-four, randomly selected lymph nodes (63 with positive pathological lymph node status) from 39 surgically treated lung cancer patients were examined. All cancer negative nodes were obtained from stage I patients. Mast cells were stained with Alcian blue and safranin O. Metastatic cancer cells were stained using anti-cytokeratin antibody. RESULTS: Immunohistochemical studies with cytokeratin revealed micro metastasis in 9/71 (12.68%) nodes previously diagnosed as histological negative. In tumor-free mediastinal lymph nodes, the mast cell count was significantly higher than in metastatic nodes. In all cases, mast cells were observed primarily in the T-cell area. CONCLUSIONS: An inverse relationship was observed between the number of mast cells and the amount of tumor tissue. The presence of mast cells primarily in the T-cell area implies a relationship between mast cells and the T-cell system. From the present study it is not possible to conclude whether mast cells in lymph nodes are for or against tumor spread.

Journal Article↗

PubMed2003

Protruding thrombus in the left atrium found 7 years after percutaneous transvenous mitral commissurotomy: report of a case.

A 50-year-old man was transferred to our hospital for investigation of cerebellar infarction, thought to have been caused by cardiac thromboembolism. We assumed that the cardiac thromboembolism had occurred as a late complication of a percutaneous transvenous mitral commissurotomy (PTMC) performed 7 years earlier. An echocardiogram and thoracic computed tomography revealed a protruding thrombus in the left atrium and an emergency operation was performed. The protruding thrombus was found to originate from the scar that penetrated into the intra-atrial muscular septum caused by the PTMC. After removing the thrombus, the scar was covered with normal endothelium and the mitral valve was replaced with a 27-mm St. Jude Medical prosthetic valve. We think that the thromboembolism was caused by mitral valve restenosis, atrial fibrillation, and endothelial injury in the interatrial septum during PTMC. Therefore, long-term follow-up and appropriate medication is recommended after PTMC, since restenosis and thrombosis are likely to occur.

Cerebral Infarction↗

PubMed2003

Influence of heparin dosage on hemostasis under combined use of Nafamostat mesilate during deep hypothermic circulatory arrest.

OBJECTIVE: Nafamostat mesilate (NM) is a guanidine acid derivative which is synthesized in Japan as an antifibrinolytic drug. It has been successfully used to decrease blood loss and blood product requirement in cardiac operations. As there have been some reports that insufficient heparinization might induce the coagulopathic state in aprotinin-treated patients undergoing deep hypothermia and circulatory arrest (DHCA), we have reviewed 16 consecutive patients who underwent total aortic arch replacement using DHCA and the associated use of NM. METHODS: The patients were divided into two groups; a Normal-dosage Group (n = 8) who received 3 mg/kg of heparin, and a Low-dosage Group (n = 8) who received 1.5 mg/kg of heparin. The Celite-activating clotting time was maintained at longer than 1,000 seconds in both groups. Blood loss, transfusion requirements and the volume of postoperative mediastinal tube drainage were compared between the two groups. RESULTS: We observed no adverse effects of NM and no significant difference in transfusion requirements between both groups. There was a significant difference in blood loss during the operation between the two groups (p < 0.05) (Low-dosage Group 1,973 +/- 959 ml vs Normal-dosage Group 1,059 +/- 704 ml). CONCLUSIONS: NM was a safe antifibrinolytic drug. Adequate heparinization was necessary to reduce hemorrhage in patients undergoing aortic arch replacement using DHCA and the associated use of NM.

Aged↗