Biomedical subjects

Yoshihiro Nishimura

Publications and source records attributed to Yoshihiro Nishimura.

At least 37 records · Page 2Linked to original sources

PubMed2004

Does the lobectomy plus lymph node dissection still remain a standard surgical procedure for patients with cT1N0M0 adenocarcinoma of the lung?

OBJECTIVES: Controversies still exists regarding treatment for cT1N0M0 adenocarcinoma of the lung. The following topics need to be answered: 1) Should all patients undergo lobectomy plus lymph node dissection? and 2) Is there poor-prognostic subgroup that may need adjuvant therapy? METHODS: Between 1990 and 1999, 141 patients with cT1N0M0 adenocarcinoma of the lung underwent lobectomy plus lymph node dissection. Fifteen clinicopathological characteristics of the entire population were investigated with regard to survival. Forty-seven samples, which were possible to reexamine among 68 patients with small adenocarcinoma 2 cm or less in greatest dimension, were assessed according to Noguchi's classification. RESULTS: Nine of fifteen clinicopathological variables were significant in indicating poor prognostic factors in univariate analysis: gender, differentiation, p-T status, p-N status, pm, lymphatic invasion, vascular invasion, pleural invasion, and serum carcinoembryonic antigen (CEA) level. The p-N status and high serum CEA level were independent predictive variables in multivariate analysis. A five-year survival rate for patients with Noguchi's type A and B was 100%. However, six (8.8%) of 68 patients with small adenocarcinoma had lymph node involvement and four patients (5.9%) had pulmonary metastasis. CONCLUSIONS: It is inappropriate and inadequate to omit lobectomy or lymph node dissection only on the basis of tumor size. Therefore, it seems reasonable to conclude that lobectomy plus lymph node dissection still remains as a standard surgical procedure to treat cT1N0M0 adenocarcinoma of the lung. We must continue to search for new deciding factors in order to choose candidates for limited operation among patients with cT1N0M0 adenocarcinoma of the lung.

Adenocarcinoma↗

PubMed2004

Pulmonary metastases from uterine malignancies: results of surgical resection in 133 patients.

OBJECTIVE: The long-term results of the surgical treatment for patients with pulmonary metastases from uterine malignancies were clarified. METHODS: A total of 133 patients who underwent pulmonary metastasectomy for uterine malignancies were enrolled in the Metastatic Lung Tumor Study Group of Japan between March 1984 and February 2002. These patients constituted the study population, and their clinical, pathologic, and prognostic data were retrospectively analyzed. RESULTS: The morbidity and mortality rates related to the operation were minimal (1% and 1%, respectively). The 5- and 10-year survivals after the surgical resection in all cases were 54.6% and 44.9%, respectively. The 5-year survivals for each histologic type were estimated to be 46.8% for squamous cell carcinoma (n = 58), 40.3% for cervical adenocarcinoma (n = 13), 75.7% for endometrial adenocarcinoma (n = 23), 86.5% for choriocarcinoma (n = 16), and 37.9% for leiomyosarcoma (n = 11). In the univariate analysis, the following were shown to be associated with poor survival: primary tumor in the cervix, short disease-free interval (<12 months), large number of resected metastases (> or =4), and large tumor size (> or =3 cm). After mutual adjustment, short disease-free interval (<12 months) alone was related to risk of death (hazard ratio = 2.26, 95% confidence interval = 1.06-4.78) for 105 patients, excluding patients with choriocarcinoma and miscellaneous histologic types. CONCLUSION: Pulmonary metastasectomy for uterine malignancies is a safe and acceptable treatment to improve survival. Patients with a disease-free interval of 12 months or more are good candidates for this treatment if there is adequate control of the primary tumor without extrapulmonary metastasis.

Adenocarcinoma↗

PubMed2004

Cerebellar activation of cortical motor regions: comparisons across mammals.

This chapter discusses the nature of mammalian cerebello-thalamo-cortical projections. These play an important role in motor control, but with species differences evident in the innervation patterns of thalamo-cortical (T-C) fibers relaying cerebellar inputs. A phylogenetic comparison of the mode of cerebellar activation of cortical motor regions reveals that cerebellar inputs are relayed by the deep and superficial T-C projections in the cat, but predominately by the latter in rat and monkey. Another difference across mammals is the nature of cerebellar activation of cortical neurons. Fast-conducting pyramidal tract neurons in the cat routinely receive fast-rising EPSPs from the deep cerebellar nuclei (CN). This tendency is not observed in rat and monkey, however. These findings suggest that the responsiveness of cortical output neurons also shows species differences, these having bearing on the development of species-specific motor skills. Common to all three species, however, are fast-rising and large CN-EPSP responses of layer III pyramidal neurons to CN input. It is argued that layer III pyramidal neurons modulate cerebellar input to layer V pyramidal neurons, which latter cells provide command signals from the motor cortex to the lower centers.

Animals↗

PubMed2004

High-grade neuroendocrine carcinoma of the lung presenting an unusual spread mimicking pleural mesothelioma associated with dermatomyositis.

Neuroendocrine tumors of the lung comprise a heterogeneous group of tumors that represents a spectrum of disease from typical carcinoid tumors to the high-grade neuroendocrine carcinomas (large-cell neuroendocrine carcinomas and small-cell carcinomas). The high-grade neuroendocrine carcinomas are characterized by early metastasis and poor prognosis. The peripheral location and especially the massive pleural spread are rare for a high-grade neuroendocrine carcinoma. We report a case in which a high-grade neuroendocrine carcinoma, associated with dermatomyositis, presented an unusual pattern of progression, mimicking malignant pleural mesothelioma on diagnostic imaging.

Carcinoma, Neuroendocrine↗

PubMed2004

Immunohistochemical study of Skp2 and Jab1, two key molecules in the degradation of P27, in lung adenocarcinoma.

To clarify the association of the P27 degradation pathway proteins, Skp2 and Jab1, with the development and progression of lung adenocarcinoma (AD), we immunohistochemically investigated Skp2 and Jab1 expression together with P27- and Ki-67-labeling in 110 lung AD and 11 atypical adenomatous hyperplasia (AAH) and analyzed the relationship between the expression of these proteins and the clinicopathological factors. High Skp2 or Jab1 expression was frequent in lung AD (52/110, 47%, and 59/110, 54%, respectively), and high expression of Jab1 was also frequent in AAH (4/11, 36%), while it was not observed in normal bronchiolar epithelium. The P27 labeling index (LI) was reciprocally correlated with high Skp2 and Jab1 expression, and a higher Ki-67 LI was significantly correlated with high Skp2 and Jab1 expression. However, low P27 expression did not correlate with a higher Ki-67 LI. High Skp2 lung AD showed significant correlation with blood and lymphatic vessel invasion, which low P27 expression did not correlate with. Furthermore, high Skp2 expression in lung AD was significantly correlated with a poor outcome for patients. Thus, Skp2 and Jab1 regulate P27 degradation, and might contribute to the development and progression of lung AD through P27-mediated and -unmediated mechanisms.

Adenocarcinoma↗

PubMed2004

Metastases in mediastinal and hilar lymph nodes in patients with non-small cell lung cancer: quantitative and qualitative assessment with STIR turbo spin-echo MR imaging.

PURPOSE: To evaluate short inversion time inversion-recovery (STIR) turbo spin-echo (TSE) magnetic resonance (MR) imaging for detection of metastases in lymph nodes by using quantitative and qualitative analyses. MATERIALS AND METHODS: One hundred ten patients (68 men and 42 women) with non-small cell lung cancer who ranged in age from 36 to 82 years (mean age, 64 years) were examined with respiratory-triggered STIR TSE MR imaging. Ratios of signal intensity in a lymph node to that in a 0.9% saline phantom (lymph node-saline ratios [LSRs]) for all lymph nodes were classified into three groups according to nodal short-axis diameter. LSRs of each group were compared by using pathologic diagnosis as the standard of reference. For quantitative analysis, the LSR threshold value for a positive test was determined on a per-node basis and tested for ability to enable a correct diagnosis on a per-patient basis. For qualitative analysis, signal intensities of lymph nodes were assessed by using a five-point visual scoring system. Results of quantitative and qualitative analyses were compared on a per-patient basis with McNemar testing. RESULTS: In 110 patients, 92 of 802 lymph nodes were pathologically diagnosed as containing metastases, while 710 lymph nodes did not contain metastases. Mean LSR in the lymph node group with metastasis was higher than that in the group without metastasis (P <.05). When an LSR of 0.6 was used as the positive-test threshold at quantitative analysis, sensitivity was 93% (37 of 40 patients) and specificity was 87% (61 of 70 patients) on a per-patient basis. With a score of 4 as the positive-test threshold at qualitative analysis, sensitivity was 88% (35 of 40 patients) and specificity was 86% (60 of 70 patients) on a per-patient basis. There was no significant difference (P >.05) between results of quantitative and those of qualitative analysis. CONCLUSION: Quantitative and qualitative analyses of STIR TSE MR images enable differentiation of lymph nodes with metastasis from those without. Qualitative analysis can substitute for quantitative analysis of STIR TSE MR imaging data.

Adult↗

PubMed2004

Multiple endocrine neoplasia type 1 with unusual concomitance of various neoplastic disorders.

A patient with multiple endocrine neoplasia type 1 (MEN1) who manifested various MEN1-unrelated tumors was reported. The patient was a 43-year-old woman who manifested typical features of MEN1 including primary hyperparathyroidism, prolactinoma, adrenal adenoma and visceral lipomas. During the course, she also manifested chondrosarcoma, B cell lymphoma and mesothelioma. The patient had no apparent family history of MEN1 or any other neoplastic diseases. Genetic analysis of DNA from peripheral mononuclear cells of the patient revealed no germline mutations in MEN1 gene. Genetic instability due to yet unidentified cause is the possible explanation of occurrence of multiple tumors. Careful periodic screening of endocrine and other disorders for her siblings and children as well as for the patient is warranted.

Adenoma↗

PubMed2004

Dynamic perfusion MRI versus perfusion scintigraphy: prediction of postoperative lung function in patients with lung cancer.

OBJECTIVE: The purpose of this study was to determine the capability of dynamic perfusion MRI as an alternative to pulmonary perfusion scintigraphy for prediction of postoperative lung function in patients with lung cancer. SUBJECTS AND METHODS. Sixty patients with lung cancer (35 men, 25 women) underwent dynamic perfusion MRI, perfusion scintigraphy, and preoperative and postoperative pulmonary function tests (forced expiratory volume in 1 sec [FEV(1)]). Perfusion MRIs were obtained with a 3D turbo field-echo sequence (TR/TE, 2.7/0.6; flip angle, 40 degrees; matrix, 128 x 96) using a 1.5-T scanner. Regional blood flow was calculated from the signal intensity-time curves after bolus injection of contrast medium on MRI (Q(MRI)) and uptake ratios of radioisotope on perfusion scintigraphy (Q(PS)). Postoperative lung functions predicted by MRI (FEV(1,MRI)) and perfusion scintigraphy (FEV(1,PS)) were calculated from preoperative FEV(1) and regional Qs. To determine the capability of MRI as an alternative to scintigraphy, we evaluated correlations and the limits of agreement between predicted FEV(1,MRI) and postoperative FEV(1) and between predicted FEV(1,PS) and postoperative FEV(1). RESULTS: The correlation coefficient of postoperative FEV(1) with FEV(1,MRI) (r = 0.93, p < 0.0001) was better than that with FEV(1,PS) (r = 0.89, p < 0.0001). The limits of agreement between postoperative FEV(1) and predicted FEV(1,MRI) (0.9% +/- 10.4%) were smaller than those between postoperative FEV(1) and predicted FEV(1,PS) (2.1% +/- 13.2%). CONCLUSION: Dynamic perfusion MRI is a feasible alternative to pulmonary perfusion scintigraphy for predicting postoperative lung function in patients with lung cancer.

Adult↗

PubMed2004

[A case of pneumocystis carinii pneumonia associated with low dose methotrexate treatment for rheumatoid arthritis and trimethoprim-sulphamethoxazole induced pancytopenia].

A 64-year-old man was admitted to our hospital complaining of dyspnea and fever. He had been treated with low-dose methotrexate for rheumatoid arthritis. Chest radiography showed diffuse ground-glass attenuation in both lung fields, and hypoxia was detected. Pneumosystis carinii pneumonia was demonstrated on transbronchial lung biopsy, and the serum beta-D glucan level was high. We started treatment with trimethoprim-sulphamethoxazole, but respiratory failure worsened, and drug-induced pancytopenia occurred. Although trimethoprim-sulphamethoxazole was stopped, pancytopenia persisted and the patient required ventilatory support. After we changed the medication from trimethoprim-sulphamethoxazole to pentamidine, respiratory failure improved. It was thought that pneumocystis carinii pneumonia was associated with low-dose methotrexate and that trimethoprim-sulphamethoxazole interacted with methotrexate to induce severe pancytopenia.

Anti-Infective Agents↗

PubMed2004

Superimposed display of coronary artery on gated myocardial perfusion scintigraphy.

UNLABELLED: Fusion of images of vascular anatomy and of myocardial perfusion images might be helpful for understanding the relationship between ischemia and the responsible vessels. The aim of this study was to develop a simple means of superimposing the images obtained from coronary angiography and gated myocardial perfusion SPECT. METHODS: Right and left oblique views from conventional coronary angiography and left ventriculography (LVG) were stored as 512 x 512 x 8-bit digital datasets and combined. We reconstructed images from routine gated myocardial perfusion imaging (MPI) by using (99m)Tc-tetrofosmin to match the oblique positions between the image from MPI and combined angiographic images. We then generated a 3-dimensional (3D) surface map by using the quantitative gated SPECT (QGS)/quantitative perfusion SPECT (QPS) program. Both the combined angiographic images and the 3D surface map were rescaled and unified by registering the internal landmarks between the 2 images. After subtraction of the LVG image, the coronary angiogram and the 3D surface map were fused into 1 image. All processes were performed with the QGS/QPS program and commercially available graphic software. We applied this method to datasets from a cardiac phantom and from several patients with coronary artery disease. RESULTS: In the phantom study, our technique could obtain a 3D surface map in which the oblique angle was identified as that of radiography and could realize image registration and superimposition of radiography on scintigraphy. The preliminary results from the patients indicated that the markedly stenotic vessels showed good coincidence with the regional myocardial perfusion abnormalities on the unified images. In addition, these images could show the relationship between the coronary artery and regional wall motion in the gated mode. CONCLUSION: We developed a simple method of superimposing the image of the coronary artery tree on images from gated MPI. The technique yielded useful information about myocardial perfusion and function as well as the supplying coronary artery.

Adolescent↗

PubMed2004

[An operative approach of extrapleural pneumonectomy].

We present a case of breast cancer with pleural metastasis and empyema treated with extrapleural pneumonectomy. We showed the some of technically important points for this operation. The careful preparation was needed to prevent hemorrhage from such as great vessels, bronchial arteries and intercostal arteries. Especially in this surgical procedure, we should select the best approach method to have enough surgical field for complete tumor resection. We suggest that we should make additional thoracotomy and skin incision immediately when we feel the surgical field is not wide enough during the operation. The extrapleural pneumonectomy is one of the most highly invasive operation in general thoracic surgery, so careful perioperative managements should be required.

Breast Neoplasms↗

PubMed2004

Imbalance of matrix metalloproteinase-9 and tissue inhibitor of matrix metalloproteinase-1 is associated with pulmonary emphysema in Klotho mice.

Klotho mice, which exhibit multiple phenotypes resembling human aging, develop pulmonary emphysema. In this study, to clarify the mechanism of their emphysematous change through development, we evaluated the expression of matrix metalloproteinase (MMP)-2, 9 and the tissue inhibitors of matrix metalloproteinase (TIMP)-1, 2 in the lungs of Klotho mice and wild type mice. Klotho mice showed obvious air space enlargement at 5 weeks of age, but not at 2 weeks of age. Immunohistochemical analysis revealed that expression of MMP-9 was increased in Klotho mice compared with wild type at 5 weeks of age. Western blot analysis and gelatin zymography also revealed that the expression and the gelatinolytic activity of MMP-9 were increased in the lungs of Klotho mice. The expression of TIMP-1 decreased in the lungs of Klotho mice. MMP-2 and TIMP-2 showed no significant differences at 5 weeks of age. At 2 weeks of age, there were no significant differences in the expressions of MMP-9 and TIMP-1 between Klotho and wild type mice. These findings suggest that imbalance of MMP-9 and TIMP-1 is associated with the development of pulmonary emphysema in Klotho mice.

Animals↗

PubMed2003

Modulation of voltage-dependent potassium currents by opiates in facial motoneurons of neonatal rats.

We examined the modulation of rat facial motoneurons (FMNs) by opiates in a slice preparation (7-15 days old) using whole-cell patch clamp techniques. Although application of methionine enkephalin (ME) did not change the peak value of the transient outward current (A-current, IA), it reduced the persistent voltage-dependent K(+) currents (IKs) in a dose-dependent manner. The reduction was antagonized by naloxone (40 microM). IKs were reduced only by mu-selective agonist [D-Ala(2),N-Me-Phe(4),Gly(5)-ol]enkephalin (DAMGO, 2-121.6 microM). This reduction was antagonized by naloxone (40 microM) or the mu-selective antagonist, D-Phe-Cys-Tyr-D-Trp-Orn-Thr-Phe-Thr-NH(2) (CTOP, 1 microM). Agonists for other opiate receptors (delta- and kappa-opiate receptor) showed no effect on IKs. In accord with the effects on IKs, DAMGO (100 microM) prolonged the duration of the action potential evoked in Ca(2+)-free external solution containing 4-aminopiridine (1mM). These results suggest that the activation of mu-opiate receptors contributes to signal transduction in FMNs primarily by modulating action potential duration.

Animals↗

PubMed2003

Airway remodeling of murine chronic antigen exposure model.

Airway remodeling is one of the most important features of bronchial asthma. However, there are few studies that have used repeated antigen exposure in murine models. We designed a murine chronic antigen exposure model necessary for studying airway remodeling. Two different strains of mice, BALB/c mice and C57BL/6 mice, were sensitized and challenged for 3-7 weeks with ovalbumin (OVA). Bronchoalveolar lavage (BAL) and histology study were conducted in each phase. Morphometry was performed, and the epithelial area ratio (Ae ratio) and subepithelial area ratio (As ratio) were calculated. The Ae ratio and As ratio of BALB/c mice were significantly increased in sensitized mice compared with non-sensitized mice at 3 and 5 weeks, but not at 7 weeks. In C57BL/6 mice, the Ae ratio showed no significant changes, whereas the As ratio maintained high from 3 to 7 weeks. This thickening of the subepithelial layer consisted of collagen fibers with elastica van-Gieson (EVG) stain. Lymphocytes of the BAL showed a significant increase at 3 and 7 weeks in C57BL/6 mice, but not in BALB/c mice. A murine chronic OVA exposure model in C57BL/6 mice revealed subepithelial layer thickening consisting of collagen fibers and increased lymphocytes until 7 weeks. C57BL/6 mice are useful to elucidate the mechanism of airway remodeling.

Animals↗

PubMed2003

[A multicenter evaluation of seven commercial ML-EM algorithms for SPECT image reconstruction using simulation data].

The maximum likelihood expectation maximization (ML-EM) algorithm has become available as an alternative to filtered back projection in SPECT. The actual physical performance may be different depending on the manufacturer and model, because of differences in computational details. The purpose of this study was to investigate the characteristics of seven different types of ML-EM algorithms using simple simulation data. Seven ML-EM algorithm programs were used: Genie (GE), esoft (Siemens), HARP-III (Hitachi), GMS-5500UI (Toshiba), Pegasys (ADAC), ODYSSEY-FX (Marconi), and Windows-PC (original software). Projection data of a 2-pixel-wide line source in the center of the field of view were simulated without attenuation or scatter. Images were reconstructed with ML-EM by changing the number of iterations from 1 to 45 for each algorithm. Image quality was evaluated after a reconstruction using full width at half maximum (FWHM), full width at tenth maximum (FWTM), and the total counts of the reconstructed images. In the maximum number of iterations, the difference in the FWHM value was up to 1.5 pixels, and that of FWTM, no less than 2.0 pixels. The total counts of the reconstructed images in the initial few iterations were larger or smaller than the converged value depending on the initial values. Our results for the simplest simulation data suggest that each ML-EM algorithm itself provides a simulation image. We should keep in mind which algorithm is being used and its computational details, when physical and clinical usefulness are compared.

Algorithms↗

PubMed2003

[The diagnosis and treatment of the thymic carcinoma].

Thymic carcinoma was indistinct for criteria of clinicopathological diagnosis. Recently it gets easier to diagnose thymic carcinoma, because of progression of WHO classification and immunohistochemical technique. Commonly, patients are men and in sixties. Common symptoms are chest pain and dyspnea. Most cases are advanced, over Stage III of the Masaoka's classification. Combined therapies e.g. operation, chemotherapy and radiation were done, but complete resection is difficult. Prognosis is poor, the 3- and 5-year survival is 48.7% and 40.6%.

Adult↗

PubMed2003

[Pulmonary thromboembolism associated with familial protein C deficiency type I].

A 66-year-old man was admitted to our hospital because of progressive dyspnea on effort. Arterial blood gas analysis showed severe hypoxemia, and a chest radiograph revealed reticular shadows in both lower lungs and an increase of the cardiothoracic ratio. Echocardiography demonstrated mild indentation of the interventricular septum toward the left ventricle, moderate pericardial effusion and pulmonary hypertension. From these data, we diagnosed pulmonary thromboembolism and started anticoagulation therapy. After the addition of the administration of warfarin and oxygen therapy, his symptoms disappeared. However, we could not obtain more supporting evidence of thromboembolization by methods of ventilation-perfusion scanning, digital subtraction angiography of the pulmonary artery, or venography. Blood coagulation analysis demonstrated that the patient's plasma protein C antigen levels and its activity were depleted. The patient's son had a history of thrombophlebitis and pulmonary embolization, and his data of protein C antigen levels was also decreased. Therefore, this patient was found to have a character of familial protein C deficiency type I. We could not get the conclusive proof of pulmonary thromboembolism, but we considered that the presence of familial protein C deficiency may cause exacerbation of pulmonary hypertension.

Aged↗

PubMed2003

[A case of malignant lymphoma associated with diffuse pulmonary involvement successfully treated with rituximab].

A 66-year-old man was admitted to our hospital with a chief complaint of fever. Histopathological examination of the inguinal lymph nodes revealed follicular B-cell non-Hodgkin's lymphoma (NHL). In spite of 9 cycles of chemotherapy (CHOP/COP), progression of the disease was seen. Fever and dyspnea developed. The chest radiograph revealed diffuse pulmonary infiltrates. Transbronchial biopsy revealed pulmonary involvement of diffuse B-cell lymphoma. The tumor cells showed positive staining for CD20. Salvage chemotherapy (ESHAP, EPOCH) was not effective. We decided to perform mono-immunotherapy with the monoclonal CD20 antibody rituximab. One month later, the patient was in almost complete remission without adverse events. It is suggested that rituximab may be effective for refractory NHL with pulmonary involvement.

Aged↗