Journal of The Showa Medical Association
Online ISSN : 2185-0976
Print ISSN : 0037-4342
ISSN-L : 0037-4342
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Volume 71, Issue 1
Displaying 1-16 of 16 articles from this issue
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Feature Articles: Minimally Invasive Surgery for Malignant Tumors of Digestive Organs
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  • EFFECTS OF PREOPERATIVE AMINO ACID INFUSION ON INTRAOPERATIVE TEMPERATURE AND BLOOD SUGAR LEVEL DURING SURGERY?
    Reon KOBAYASHI
    2011 Volume 71 Issue 1 Pages 56-63
    Published: February 28, 2011
    Released on J-STAGE: September 01, 2011
    DOIhttps://doi.org/10.14930/jsma.71.56
    JOURNAL FREE ACCESS
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    Although amino acid infusion during operations could prevent intraoperative hypothermia, it is possible that the serum insulin level will increase. The purpose of this study was to evaluate the effects of preoperative amino acid infusion on intraoperative temperature and blood sugar during hip surgery. Twenty-nine patients were divided into three groups. Ten of the patients (group A) had amino acid infusion of 5 ml·kg-1·h-1 and eight patients (group B) had amino acid infusion of 2.5 ml·kg-1·h-1 one hour before induction of anesthesia. Eleven control patients (group C) had corresponding volumes of a Lactated Ringer's solution. Esophageal temperature was measured for 120 minutes after induction of anesthesia. Blood sugar, insulin, adrenaline and noradrenaline levels were determined at 7 defined times: before amino acid infusion, immediately after induction of anesthesia, and 15, 30, 60, 90 and 120 minutes after induction of anesthesia. Temperatures decreased after induction of anesthesia in all three groups. The degree of decline in group A was smallest. In addition, the temperature in group A was significantly higher than in group C. Although group A and group B serum insulin levels transiently increased immediately after treatment, severe hypoglycemia was not observed in any group. Preoperative amino acid infusion, therefore, was shown to be effective in reducing hypothermia and it did not cause hypoglycemia during hip surgery.
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  • HISTOLOGICAL AND MORPHOMETRICAL INQUEST INTO ESOPHAGEAL INTRAEPITHELIAL NEOPLASIA AND SUPERFICIAL ESOPHAGEAL CANCER
    —Search for the histopathological factors reflecting endoscopic features—
    Hiromi DATE, Nobuyuki OHIKE, Koji SAITO, Kai MATSUO, Yasuo OCHIAI, Koj ...
    2011 Volume 71 Issue 1 Pages 64-70
    Published: February 28, 2011
    Released on J-STAGE: September 01, 2011
    DOIhttps://doi.org/10.14930/jsma.71.64
    JOURNAL FREE ACCESS
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    According to recent, advances in endoscopic technology, including magnification and image-enhanced endoscopy, it is possible to view the surface vascular structures in esophageal squamous cell tumors and early stage esophageal cancers, so called superficial neoplastic lesions of the esophagus (SNLsE), including intraepithelial neoplasms and superficial carcinomas. The authors therefore focused on characteristic findings in capillaries in SNLsE, and considered the possible histological factors that may reflect the endoscopic findings. Using surgically resected SNLsE obtained from a total of 16 cases, the authors quantitated the metrics of the form of these factors and looked for a relationship between histological grade and invasion depth. The non-tumor components and tumor lesion components were classified into seven groups (G0-G6) on the basis of histological grade and invasion depth. Epithelial thickness, vessel caliber, and the position of most shallow vessel were measured under an optical microscope using a micrometer and the mean values were calculated; the mean of those measurements and the histological factors were compared. Epithelial thickness measurements showed a statistically significant tendency to increase. Regarding vessel caliber, the mean diameter increased and showed a positive relationship as grade of intraepithelial lesions, and invasion depth of invasive lesions increased. In SNLsE, epithelial thickness and vessel caliber of the capillaries tended to increase with histological grade and invasion depth. These results were consistent with the change in the images of vascular structures obtained using NBI for the diagnosis of invasion depth. The above suggests that the trend in the capillaries is associated with changes in the epithelium, and the degree of endoscopic findings of rubefaction and extension of vascular-like structures may reflect endoscopic findings.
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  • IMMUNOHISTOCHEMICAL ANALYSIS OF IMMUNOPHENOTYPES OF ADULT T-CELL LEUKEMIA/LYMPHOMA AND PERIPHERAL T-CELL LYMPHOMA, NOT OTHERWISE SPECIFIED
    Satomi ISHIHARA, Hirotsugu ARIIZUMI, Toshiko YAMOCHI-ONIZUKA, Eisuke S ...
    2011 Volume 71 Issue 1 Pages 71-78
    Published: February 28, 2011
    Released on J-STAGE: September 01, 2011
    DOIhttps://doi.org/10.14930/jsma.71.71
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    Distinguishing adult T-cell leukemia/lymphoma (ATLL) from peripheral T-cell lymphoma, not otherwise specified (PTCL-NOS) is pathologically difficult in the absence of clinical findings of monoclonal cells infected with human T-cell lymphotropic virus type-1 (HTLV-1). However, if the immunophenotypic difference between ATLL and PTCL-NOS is clearly identified, the pretest probability of ATLL will increase even without clinical information of HTLV-1, when distinguishing ATLL from PTCL-NOS. We clinicopathologically studied paraffin-embedded tissues of 37 patients who were diagnosed with ATLL or PTCL-NOS according to the WHO classification, 4th edition, at Showa University Hospital from November 1983 to September 2009. We analyzed the immunophenotypic differences between ATLL and PTCL-NOS by using immunohistochemistry. Significant differences between ATLL and PTCL-NOS were observed for CD7, CD25, CD56, CCR4, and TIA-1. Loss of CD7 was observed in all ATLL cases. CD25-positive cases represented 72% of the ATLL cases, i.e., more than in PTCL-NOS cases (P = 0.005). Similarly, CCR4-positive cases constituted 72% of the ATLL cases, i.e., more than in PTCL-NOS cases (P < 0.001). CD56- and TIA-1-positive cases were significantly more frequent in patients with PTCL-NOS than in patients with ATLL (CD56, P = 0.01; TIA-1, P = 0.03). Immunophenotypic evaluation for CD7, CD25, CD56, CCR4, and TIA-1 using immunohistochemistry is useful for distinguishing ATLL from PTCL-NOS. Therapies with anti-CD25 and anti-CCR4 antibodies are expected to be effective in ATLL treatment, because of high CD25- and CCR4-positive rates in ATLL patients.
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  • SALIVARY GLAND FUNCTION AFTER CONCURRENT CHEMORADIOTHERAPY
    Kenichiro IKEDA, Toshikazu SHIMANE, Aya UZUKI, Akane SUGIMOTO, Tomoaki ...
    2011 Volume 71 Issue 1 Pages 79-83
    Published: February 28, 2011
    Released on J-STAGE: September 01, 2011
    DOIhttps://doi.org/10.14930/jsma.71.79
    JOURNAL FREE ACCESS
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    Concurrent chemoradiotherapy for cancer of head and neck is becoming more and more prevalent. In fact, it is considered to better maintain QOL of patients than operative treatment in terms of preserving the functions, organs, and structures, but recently I seems that it does not maintain the QOL of patients better than operative treatment because its complications after therapy disturb daily life. We previously conducted a questionnaire survey that investigated the complications experienced by patients who received concurrent chemoradiotherapy, and reported that xerostomia was markedly reduced QOL in these patients. In this study, we divided patients who were exposed to radiation in both major salivary glands into two groups: 20 patients who received a 36 Gy dose of radiation (36 Gy group) and 15 patients who underwent radiation therapy alone at a dose of 40 Gy (RT group). The gum test was conducted with the following results (mean volume of saliva): 11.2 ml in the 36 Gy group, 6.0 ml in the RT group. There was no significant difference between the 36 Gy group and RT group. Our findings suggest that there is no significant difference in the extent of salivary gland dysfunction even after chemotherapy is carried out concurrently with radiotherapy.
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  • GENETIC ANALYSIS OF STEM CELL-SPECIFIC MARKERS IN PITUITARY ADENOMAS
    Atsuuji KUWAJIMA, Takumi ABE, Daisuke TANIOKA TANIOKA, Akiko SASAKI, T ...
    2011 Volume 71 Issue 1 Pages 84-91
    Published: February 28, 2011
    Released on J-STAGE: September 01, 2011
    DOIhttps://doi.org/10.14930/jsma.71.84
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    Stem cells have the ability to self-renew and to differentiate into hormone-producing cells, and have been reported to possibly be involved in the formation of pituitary adenomas. In the present study, we analyzed the properties of stem cells in pituitary adenomas by analyzing the expression of stem cell-specific markers in pituitary adenomas. Frozen sections were prepared from surgically resected pituitary adenomas, and adenoma cells were then isolated using laser microdissection. Following total RNA extraction, cDNA was synthesized using the RT2 Profiler PCR Array System and PCR was performed using the ABI PRISM®7000 Sequence System. Specific markers were detected with the PAHS-405A array plate and analyzed using the ΔCT method following correction in reference to RNA data for normal pituitary tissue. Cyclin D1, which is involved in the cell cycle, was detected in all pituitary adenomas. The NEUROG2 gene, which is involved in neurogenesis, was more highly expressed in functional pituitary adenomas than in non-functioning pituitary adenomas. SOX2, a transcription factor and cofactor specific to the pituitary gland, was detected in functional pituitary adenomas but not non-functioning pituitary adenomas. ISL1, a gene involved in differentiation from embryonic cells, was detected in non-functioning pituitary adenomas but not in functional pituitary adenomas. More undifferentiated cells were present in non-functioning pituitary adenomas compared to functional pituitary adenomas, suggesting that more stem cells are present in the former, which does not involve hormone secretion.
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  • A CLINICAL STUDY ON THE INVESTIGATION OF THE CAUSE OF A PATIENT'S DEATH AFTER CARDIOPULMONARY ARREST ON ARRIVAL
    Akihito KATO, Keizo SATO Keizo SATO, Masaya FUJISHIRO, Susumu NITTONO, ...
    2011 Volume 71 Issue 1 Pages 92-101
    Published: February 28, 2011
    Released on J-STAGE: September 01, 2011
    DOIhttps://doi.org/10.14930/jsma.71.92
    JOURNAL FREE ACCESS
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    The investigation of the cause of a patient's death after cardiopulmonary arrest (CPA) on arrival usually requires an autopsy. In most areas in Japan, however, such an autopsy is rarely performed, except for those areas with a medical examiner system. No reports demonstrating how to investigate the cause of the patient's death after CPA on arrival were found to our knowledge. From September 1, 2007 to August 31, 2010, 1121 CPA patients died in spite of cardiopulmonary resuscitation in the Emergency and Critical Care Center at Showa University Fujigaoka Hospital. In this paper, causes of their death were reexamined using medical records, roentgenograms of their chest and abdomen in addition to computed tomography (CT) films when taken. Further, the means by which to investigate the cause of death was studied. The detailed reexamination resulted in the estimation for causes of 652 (58.2%) patients' death as follows: 67 cardiac, 61 aortic, 75 respiratory, 44 cerebral, 25 alimentary, 20 renal, 57 systemic diseases and 303 external deaths. Causes of 469 (41.8%) patients' death were unknown. Although CT examination was performed for 219 patients (26.0%), the cause of 75 patient deaths could not be estimated. Reexaminations of medical records revealed 379 prodromes of 300 CPA patients (26.8%), but no prodromes indicated any specific disease. Anamneses were partly useful for specifying causes of their death. On the other hand, CT examinations were highly useful for not only diagnosing the specific disease but also denying it. Even when causes of their death could not be specified, reexaminations of both CT findings and other clinical data resulted in possible diagnoses of the disease for most cases. The spread of a medical examiner system throughout Japan is the most desirable for investigating causes of CPA patients' death. The postmortem CT examination seems to be preferable for such an investigation.
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