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Yuji Nimura

Publications and source records attributed to Yuji Nimura.

122 records · Page 7Linked to original sources
PubMed2002

P53 labeling index in cholangioscopic biopsies is useful for determining spread of bile duct carcinomas.

BACKGROUND: Preoperative biopsy specimens obtained by means of percutaneous transhepatic cholangioscopy are useful for planning curative resection of bile duct carcinoma in an effort to improve survival. However, tissue diagnosis is sometimes difficult. This study evaluated the usefulness of p53 immunostaining of cholangioscopic specimens for determination of tumor spread. METHODS: A total of 107 biopsy specimens from 28 patients with bile duct carcinoma was selected. Before surgery, these specimens were diagnosed histopathologically (hematoxylin and eosin staining) as positive or negative for carcinoma. After definitive surgery, specimens were immunostained with anti-p53 antibody. RESULTS: Eighteen of 28 cases (64%) were positive for p53. Among these, 86% obtained from the main carcinomatous lesion or an area of superficial spread of the carcinoma exhibited a p53 labeling index (LI) over 25% as opposed to a p53 LI under 25% for all specimens obtained from noncarcinomatous lesions. Twelve specimens from 8 cases were classified before surgery as indeterminate (hematoxylin and eosin staining). The criterion of p53 LI over 25% was applicable in 11 of the 12 specimens. CONCLUSION: The p53 immunostaining of biopsy specimens obtained by means of percutaneous transhepatic cholangioscopy is helpful in determining tumor spread in bile duct carcinoma.

Adenocarcinoma↗
PubMed2002

CD8 alpha-deficient mice are highly susceptible to 5-fluorouracil-induced lethality.

Intestinal intraepithelial lymphocytes (i-IEL) expressing CD8 alpha are located in the intestine and may confer protection against invasion of intestinal microflora. We found that mice rendered deficient in CD8 alpha molecules by homologous recombination were susceptible to 5-fluorouracil (5-FU)-induced lethality accompanied by translocation of members of the enterobacteria. The number of i-IEL was greatly reduced on day 6 after 5-FU administration in both CD8 alpha(+/-) mice and CD8 alpha(-/-) mice, whereas the recovery of the level of i-IEL thereafter was significantly impaired in CD8 alpha(-/-) mice compared with that in CD8 alpha(+/-) mice. The ability of i-IEL to produce gamma interferon in response to immobilized T-cell receptor (TCR) alpha beta or TCR gamma delta monoclonal antibodies was significantly lower in CD8 alpha(-/-) mice than in CD8 alpha(+/-) mice. Transfer of CD8(+) i-IEL conferred significant protection against 5-FU-induced lethality in CD8 alpha(-/-) mice. The results suggest that CD8(+) i-IEL play an important role in protection against 5-FU-induced lethality with translocation of Enterobacteriaceae.

Adoptive Transfer↗
PubMed2002

[Surgical treatment for advanced gallbladder cancer: indications and limitations].

We have aggressively performed extensive surgery including major liver resection for advanced gallbladder cancer since 1979. The 5-year survival rates for stage IVa and IVb patients after curative resection were 19% and 6%, respectively. Seven patients in the stage IVa group (n = 69) and one in stage IVb (n = 16) have survived for more than 5 years. The hospital mortality rate including all deaths within and over 30 days of curative operation for stage IV gallbladder cancer was 19%. Although radical resection is the only treatment of choice for advanced gallbladder cancer to obtain long-term survival, there are serious problems in extensive surgery. The most important issue is reduction of the hospital mortality rate. Elucidation of the clinical and molecular characteristics leading to potential long-term survival and development of new strategies for the treatment of recurrent tumors are also important issues.

Gallbladder Neoplasms↗
PubMed2002

[Biliary bacterial infection in liver surgery].

Hepatectomy for biliary tract carcinoma with obstructive jaundice is associated with a higher incidence of postoperative septic complications as compared with hepatectomy for hepatocellular carcinoma or metastatic liver cancer. Since most bacteria isolated from septic sites are identical to those found in the preoperative percutaneous transhepatic biliary drainage (PTBD) bile, bacterial colonization in bile appears to be responsible for posthepatectomy septic complications in patients with biliary tract carcinoma. Although it remains unclear how bile becomes contaminated after bile duct obstruction or why preoperative PTBD increases the incidence of biliary infection, bacterial translocation via the portal vein, resulting from loss of integrity of the intestinal mucosa and change in intestinal microflora, may in part account for the mechanisms. Moreover, impaired function of Kupffer cells and altered structure and function of hepatocyte tight junctions might also participate in the development of postoperative bacteremia in such patients. As septic complications and liver failure are profoundly associated with each other, it is important to take all measures before surgery to enhance liver function and to prevent postoperative septic complications.

Bacterial Infections↗
PubMed2001

Surgical stress reduces mortality from endotoxin shock.

BACKGROUND AND AIM: Surgical stress has been considered a preliminary to multiple organ failure through what has been termed a "two-hit" mechanism. Recent evidence, however, suggests that such stress has a beneficial influence in reducing endotoxin [lipopolysaccharide (LPS)]-mediated lethality. This study has been an effort to clarify whether and how LPS-mediated septic shock is prevented by a previous insult with mild (laparotomy) or severe (hepatectomy) surgical stress. METHODS: LPS was injected intraperitoneally into mice after two-thirds hepatectomy or laparotomy only. Survival rates, and protein and messenger RNA (mRNA) levels for tumor necrosis factor-alpha (TNF-alpha) and interleukin-6 (IL-6) were measured. RESULTS: Most of the unoperated control mice died within 3 days after the LPS challenge. Mortality following LPS injection was reduced after laparotomy only or hepatectomy (P<0.05). A significant reduction in the mortality was observed from 2 days to 7 days after laparotomy only, and from 2 days to 4 weeks after hepatectomy. Correspondingly, the increase in the serum levels of TNF-alpha and IL-6 induced by the LPS injection was partially impaired by either laparotomy only or hepatectomy at an early (2 days) postoperative stage (P<0.05). At a later (7 days) stage, however, the serum level of IL-6 and its mRNA level in the spleen were elevated after the LPS challenge more quickly in the hepatectomy group than in the unoperated control group ( P<0.05). CONCLUSION: Surgical stress reduces LPS-induced lethality through biphasically regulating the levels of TNF-alpha and IL-6 production.

Actins↗
PubMedDate not supplied

Percutaneous ethanol injection via an artificially induced right hydrothorax for hepatocellular carcinoma in the hepatic dome.

To evaluate the efficacy of sonographically (US) guided percutaneous ethanol injection (PEI) via an artificially induced right hydrothorax (transthoracic PEI) to treat US-invisible hepatocellular carcinoma (HCC) in the hepatic dome. Five cirrhotic patients with US-invisible HCC in the hepatic dome, who were poor surgical candidates, underwent transthoracic PEI. An artificial right hydrothorax was created by instilling 500 ml saline, and absolute ethanol was injected transhydrothoracically into the hepatic dome lesion under local anesthesia. The success and complications were assessed radiologically. The patients were followed up serologically and radiologically for 12-44 (mean 28.4) months. Twenty-five hydrothoraces were induced. All hydrothoraces enabled US visualization of the entire hepatic dome. Eight of the nine small lesions were treated successfully by the treatment. Two of the three local recurrences were eradicated by repeat transthoracic PEI. One large lesion was treated by a combination of transthoracic and regular PEI. The only complication was one clinically insignificant pneumothorax. Induction of a right hydrothorax is feasible and safe. The hydrothorax enables US visualization of the entire hepatic dome and permits US-guided PEI for HCC in the hepatic dome that otherwise would not be possible.

Aged↗
PubMedDate not supplied

Hydrogen sulfide as an endogenous modulator of biliary bicarbonate excretion in the rat liver.

Cystathionine gamma-lyase (CSE) is an enzyme catalyzing cystathionine and cysteine to yield cysteine and hydrogen sulfide (H(2)S), respectively. This study aimed to examine if H(2)S generated from the enzyme could serve as an endogenous regulator of hepatobiliary function. Gas chromatographic analyses indicated that, among rat organs herein examined, liver constituted one of the greatest components of H(2)S generation in the body, at 100 mumol/g of tissue, comparable to that in kidney and 1.5-fold greater than that in brain, where roles of the gas in the regulation of neurotransmission were reported previously. At least half of the gas amount in the liver appeared to be derived from CSE, because blockade of the enzyme by propargylglycine suppressed it by 50%. Immunohistochemistry revealed that CSE occurs not only in hepatocytes, but also in bile duct. In livers in vivo, as well as in those perfused ex vivo, treatment with the CSE inhibitor induced choleresis by stimulating the basal excretion of bicarbonate in bile samples. Transportal supplementation of NaHS at 30 mumol/L, but not that of N-acetylcysteine as a cysteine donor, abolished these changes elicited by the CSE inhibitor in the perfused liver. The changes elicited by the CSE blockade did not coincide with alterations in hepatic vascular resistance, showing little involvement of vasodilatory effects of the gas in these events, if any. These results first provided evidence that H(2)S generated through CSE modulates biliary bicarbonate excretion and is thus a determinant of bile salt-independent bile formation in the rat liver.

Alkynes↗
PubMedDate not supplied

Expression of p73 gene, cell proliferation and apoptosis in breast cancer: Immunohistochemical and clinicopathological study.

p73 is a member of p53 tumor suppressor protein family. In spite of similarities of three meaningful domains between p53 and p73, the exact function of p73 protein is not established. To approach the relevance of p73 expression to a pathological parameter in human breast cancer, the apoptotic index (AI) and the mitotic index (MI) were examined for 75 patients with the breast cancer after mastectomies. We found that both of the AI and MI in p73-positive cases were significantly higher compared to the p73-negative cases, suggesting that the p73-positive cases in the breast cancer were in advanced grade. In six cases of breast cancer with distant metastasis, however, the p73 expression was slight and showing low AI but high MI. Advanced breast cancer with distant metastasis seemed to lose the p73 expression and gain the function of evading apoptosis. Altogether, these data demonstrate that p73 expression is well correlated with AI in breast cancer.

Adenocarcinoma↗
PubMedDate not supplied

Biliary stricture with hepatolithiasis as a late complication of retrograde transhepatic biliary drainage.

A 63-year-old man was admitted to a community hospital complaining of fever and epigastric pain. He had undergone cholecystectomy and choledocholithotomy with retrograde transhepatic biliary drainage 7 years previously. Referred to our hospital after demonstration of hepatolithiasis by computed tomography, he underwent further imaging that showed a dilated left lateral anterior segmental bile duct (B3) with hepatolithiasis. After he underwent percutaneous transhepatic biliary drainage via the B3 segmental bile duct, cholangiography performed through the drainage catheter revealed a biliary stricture at the confluence of B3 associated with intrahepatic stones. percutaneous transhepatic cholangioscopy showed a stricture and a cholangioscopic biopsy specimen contained no malignant cells. After performing cholangioscopic lithotomy, an endoprosthesis was inserted and connected to a subcutaneously placed reservoir. Repeat percutaneous transhepatic cholangioscopy 10 months later demonstrated a decreased degree of the stricture, so the endoprosthetic catheter could be removed. Retrospective review of computed tomography images obtained just after the first operation indicated that the retrograde transhepatic biliary drainage catheter had passed close to the B3, and that intrahepatic bile duct dilation was not present. Therefore, we suspect that biliary stricture was caused by an old bile duct injury due to retrograde transhepatic biliary drainage catheter placement. Percutaneous transhepatic cholangioscopy effectively managed this stricture and associated hepatolithiasis.

Bile Ducts, Intrahepatic↗
PubMedDate not supplied

Hepatectomy for proximal bile duct carcinoma in a patient with situs inversus; a case report.

Situs inversus is a rare condition which mandates a full understanding of all anatomic relationships prior to invasive procedures. A 76-year-old woman with situs inversus presented with fever and rigors. She had previously undergone endoscopic sphincterotomy and lithotomy for choledocholithiasis, and laparoscopic cholecystectomy for cholecystolithiasis. Laboratory examination revealed hyperbilirubinemia and transaminasimia. Percutaneous transhepatic biliary drainage, percutaneous transhepatic cholangioscopy, percutaneous transhepatic portography, percutaneous transhepatic portal embolization, and visceral angiography were performed without complications. She underwent right hepatic lobectomy, caudate lobectomy and extrahepatic bile duct resection for papillary adenocarcinoma of the proximal bile duct. Full investigation of the anatomical relationships between the biliary tree and the vascular system in the hepatic hilus enabled safe hepatectomy in a patient with situs inversus.

Aged↗
PubMedDate not supplied

Bile duct carcinoma arising in metaplastic biliary epithelium of the intestinal type: a case report.

We report herein a case of distal bile duct carcinoma showing intestinal differentiation diagnosed 3 years after endoscopic sphincterotomy for choledocholithiasis. The diagnostic problem in this case was that the granular mucosa, which is a typical finding of superficial mucosal extension of bile duct carcinoma in general, was interpreted as hyperplasia accompanying metaplasia in cholangioscopic biopsy. Discrimination of superficial mucosal cancer extension from hyperplastic mucosa with metaplastic changes was impossible using cholangioscopic examination. In our case, reflux and stasis of the duodenal and pancreatic juice into the biliary tract might have occurred because of abnormal function of the papilla of Vater following endoscopic sphincterotomy. It might be suggested that endoscopic sphincterotomy contributed to the metaplastic changes in the bile duct mucosa in our case.

Adenocarcinoma↗