99 results on '"Koichi, Uchida"'
Search Results
2. Supplementary Methods and Materials from Loss of Hepatocyte Growth Factor/c-Met Signaling Pathway Accelerates Early Stages of N-nitrosodiethylamine–Induced Hepatocarcinogenesis
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Snorri S. Thorgeirsson, Valentina M. Factor, Elizabeth A. Conner, Luis E. Gomez-Quiroz, Koichi Uchida, Pal Kaposi-Novak, and Taro Takami
- Abstract
Supplementary Methods and Materials from Loss of Hepatocyte Growth Factor/c-Met Signaling Pathway Accelerates Early Stages of N-nitrosodiethylamine–Induced Hepatocarcinogenesis
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- 2023
3. Data from Loss of Hepatocyte Growth Factor/c-Met Signaling Pathway Accelerates Early Stages of N-nitrosodiethylamine–Induced Hepatocarcinogenesis
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Snorri S. Thorgeirsson, Valentina M. Factor, Elizabeth A. Conner, Luis E. Gomez-Quiroz, Koichi Uchida, Pal Kaposi-Novak, and Taro Takami
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Hepatocyte growth factor (HGF) has been reported to have both positive and negative effects on carcinogenesis. Here, we show that the loss of c-Met signaling in hepatocytes enhanced rather than suppressed the early stages of chemical hepatocarcinogenesis. c-Met conditional knockout mice (c-metfl/fl, AlbCre+/−; MetLivKO) treated with N-nitrosodiethylamine developed significantly more and bigger tumors and with a shorter latency compared with control (w/w, AlbCre+/−; Cre-Ctrl) mice. Accelerated tumor development was associated with increased rate of cell proliferation and prolonged activation of epidermal growth factor receptor (EGFR) signaling. MetLivKO livers treated with N-nitrosodiethylamine also displayed elevated lipid peroxidation, decreased ratio of reduced glutathione to oxidized glutathione, and up-regulation of superoxide dismutase 1 and heat shock protein 70, all consistent with increased oxidative stress. Likewise, gene expression profiling done at 3 and 5 months after N-nitrosodiethylamine treatment revealed up-regulation of genes associated with cell proliferation and stress responses in c-Met mutant livers. The negative effects of c-Met deficiency were reversed by chronic p.o. administration of antioxidant N–acetyl–l-cysteine. N–acetyl–l-cysteine blocked the EGFR activation and reduced the N-nitrosodiethylamine–initiated hepatocarcinogenesis to the levels of Cre-Ctrl mice. These results argue that intact HGF/c-Met signaling is essential for maintaining normal redox homeostasis in the liver and has tumor suppressor effect(s) during the early stages of N-nitrosodiethylamine–induced hepatocarcinogenesis. [Cancer Res 2007;67(20):9844–51]
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- 2023
4. A new therapeutic assessment score for advanced hepatocellular carcinoma patients receiving hepatic arterial infusion chemotherapy.
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Issei Saeki, Takahiro Yamasaki, Norikazu Tanabe, Takuya Iwamoto, Toshihiko Matsumoto, Yohei Urata, Isao Hidaka, Tsuyoshi Ishikawa, Taro Takami, Naoki Yamamoto, Koichi Uchida, Shuji Terai, and Isao Sakaida
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Medicine ,Science - Abstract
Hepatic arterial infusion chemotherapy (HAIC) is an option for treating advanced hepatocellular carcinoma (HCC). Because of the poor prognosis in HAIC non-responders, it is important to identify patients who may benefit from continuous HAIC treatment; however, there are currently no therapeutic assessment scores for this identification. Therefore, we aimed to establish a new therapeutic assessment score for such patients.We retrospectively analyzed 90 advanced HCC patients with elevated baseline alpha-fetoprotein (AFP) and/or des-gamma-carboxy prothrombin (DCP) levels and analyzed various parameters for their possible use as predictors of response and survival. AFP and DCP responses were assessed after half a course of HAIC (2 weeks); a positive-response was defined as a reduction of ≥ 20% from baseline.Multivariate analysis identified DCP response (odds ratio 16.03, p < 0.001) as an independent predictor of treatment response. In multivariate analysis, Child-Pugh class A (hazard ratio [HR] 1.99, p = 0.018), AFP response (HR 2.17, p = 0.007), and DCP response (HR 1.90, p = 0.030) were independent prognostic predictors. We developed an Assessment for Continuous Treatment with HAIC (ACTH) score, including the above 3 factors, which ranged from 0 to 3. Patients stratified into two groups according to this score showed significantly different prognoses (≤ 1 vs. ≥ 2 points: median survival time, 15.1 vs. 8.7 months; p = 0.003).The ACTH score may be useful in the therapeutic assessment of HCC patients receiving HAIC.
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- 2015
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5. Granulocyte Colony-Stimulating Factor and Interleukin-1β are Important Cytokines in Repair of the Cirrhotic Liver after Bone Marrow Cell Infusion: Comparison of Humans and Model Mice
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Yuko Mizunaga, Shuji Terai M.D., Ph.D., Naoki Yamamoto, Koichi Uchida, Takahiro Yamasaki, Hiroshi Nishina, Yusuke Fujita, Koh Shinoda, Yoshihiko Hamamoto, and Isao Sakaida
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Medicine - Abstract
We previously described the effectiveness of autologous bone marrow cell infusion (ABM i ) therapy for patients with liver cirrhosis (LC). We analyzed chronological changes in 19 serum cytokines as well as levels of specific cytokines in patients after ABM i therapy and in a mouse model of cirrhosis generated using green fluorescent protein (GFP)/carbon tetrachloride (CCl 4 ). We measured expression profiles of cytokines in serum samples collected from 13 patients before and at 1 day and 1 week after ABM i . Child–Pugh scores significantly improved in all of these patients. To analyze the meaning of early cytokine change, we infused GFP-positive bone marrow cells (BMCs) into mice with CCl 4 -induced LC and obtained serum and tissue samples at 1 day and as well as at 1, 2, 3, and 4 weeks later. We compared chronological changes in serum cytokine expression in humans and in the model mice at 1 day and 1 week after BMC infusion. Among 19 cytokine, both granulocyte colony-stimulating factor (G-CSF) and interleukin-1β (IL-1β) in serum was found to show the same chronological change pattern between human and mice model. Next, we examined changes in cytokine expression in cirrhosis liver before and at 1, 2, 3, and 4 weeks after BMC infusion. Both G-CSF and IL-1β were undetectable in the liver tissues before and at 1 week after BMC infusion but increased at 2 weeks and continued until 4 weeks after infusion. The infused BMCs induced an early decrease of both G-CSF and IL-1β in serum and an increase in the model mice with LC. These dynamic cytokine changes might be important to repair liver cirrhosis after BMC infusion.
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- 2012
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6. Vigorous Neuronal Differentiation of Amplified and Grafted Basic Fibroblast Growth Factor-Responsive Neurospheres Derived from Neuroepithelial Stem Cells
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Motoyuki Yamada, Koichi Uchida M.D., Takuro Hayashi, Yutaka Mine, and Takeshi Kawase
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Medicine - Abstract
Neuroepithelial stem cells (NESCs) have emerged as a possible donor material aimed at neural transplantation for the repair of damaged neural circuitry, particularly because of their propensity to differentiate into neurons. We previously ascertained in vitro that NESCs derived from rat early embryos could be amplified in culture containing basic fibroblast growth factors (bFGF), and that neurospheres grown for 7 days in the culture had a strong tendency to differentiate into neurons. In this report, we analyze immunohistochemically the biological nature of bFGF-responsive neurospheres derived from NESCs. We first succeeded in amplifying the number of NESCs from the mesencephalic neural plate of embryonic day 10 Wistar rats with the addition of bFGF. Grown neurospheres were labeled with bromodeoxyuridine (BrdU) in vitro and were stereotactically transplanted into the right striatum of the normal adult Wistar rat. Two weeks after transplantation, a viable graft in the host brain was observed. While many BrdU/Hu double positive cells were seen in the graft, and a few BrdU/nestin double positive cells were also seen, no BrdU/GFAP double positive cells could be identified. These results suggested that bFGF-responsive neurospheres derived from NESCs demonstrated a propensity to differentiate into neurons in the adult brain environment. Furthermore, following in vitro amplification of the original stem cell number with bFGF, the grown neurospheres preserved their propensity to differentiate vigorously into neurons. NESCs are thus suggested as a feasible candidate for intracerebral grafting donor materials aimed at reconstruction of damaged neural circuits.
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- 2004
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7. Feasibility of Using Early Mesencephalic Neural Plate for Intracerebral Grafting
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Takuro Hayashi, Koichi Uchida M.D., Yutaka Mine, Motoyuki Yamada, and Takeshi Kawase
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Medicine - Abstract
The purpose of this study was to elucidate the biological significance and the possibility of intracerebral grafting of neuroepithelial stem cells derived from the mesencephalic neural plate. Immunohistological studies of embryonic day 10.5 (E10.5) Wister rats revealed strong nestin expression in the mesencephalic part of the neural plate. Mesencephalic neural plates removed from E10.5 rats were processed to either tissue or cell dissociation culture. They were cultured in vitro under various conditions and were analyzed 7 days after the primary culture. When they were cultured as a tissue, cell proliferation and differentiation into neurons extending long neurites were obvious in a serum-free medium, in a medium containing 3% serum, and in a medium containing 20 ng/ml epidermal growth factor. On the other hand, in a medium containing 10 ng/ml basic fibroblast growth factor (bFGF), both vigorous cell proliferation and sphere formation were recognized. Furthermore, marked neurite growth was rarely seen in this culture. When they were plated in a dissociation culture, cell proliferation and neurosphere generation were also recognized only in a medium containing bFGF, depending on the initial cell concentration. The spheres, generated 7 days after the primary cell culture, were positively stained by nestin. These data suggested that bFGF was able to amplify the stem cell population present in the mesencephalic neural plate derived from early embryos. This might make it possible to obtain a large number of stem cells as donor material for neural transplantation on demand.
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- 2002
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8. Neurite Growth Capability of Rat Fetal Neuronal Cells against Matured CNS Myelin in Vitro
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Koichi Hara M.D., Koichi Uchida, Atsushi Fukunaga, Yoshiaki Kuroshima, Motoyuki Yamada, and Takeshi Kawase
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Medicine - Abstract
Reconstruction of neurocircuits by transplanted cells is expected to become an effective therapy for brain damage. In order to establish the transplantation therapy, it is necessary to find transplantable cells capable of reconstructing the lesioned neurocircuitry. We have reported that the younger neuronal cells such as neural stem cells are useful transplant materials because of their vigorous capacity for forming abundant neurites. On the other hand, it was reported that myelin-associated neurite growth inhibitor prevents neurite regeneration. In this study, we used rat fetal neuronal cells to examine the neurite growth capacity in the presence of mature CNS myelin. Crude CNS myelin was prepared from the brains of adult Wistar rats using previously described procedures. Testing wells were precoated with poly-L-lysine and additionally by overnight drying of a suspension containing 0, 5, 10, 15, or 20 μg/cm 2 of the crude myelin protein. On embryonic days 10, 12, 15, and 17 (E10, E12, E15, and E17) embryos were surgically removed, mesencephalic neural plates were dissected out from the E10 embryos, and midbrain cells were taken from the E12, E15, and E17 embryos. The neural plates and midbrain cells were placed on the myelin-coated wells. After 24 h of culture (72 h in the case of neural plates), the number of surviving cells and the length of the neurites were examined immunocytochemically using anti-neurofilament (NF) antibody. Neurite length was measured by image analyzer Luzex-F. The mesencephalic neural plate was able to grow neurites even on 20 μg/cm 2 central myelin. Almost the same number of midbrain cells attached themselves to the wells without myelin in every culture obtained from various stages of embryos. The number of cells attached on the myelin-coated wells decreased with the concentration of myelin. The number of NF-positive cells was higher in cultures of materials obtained from older embryos than in cultures obtained from younger embryos. The younger cells grew longer neurites than the older cells in the myelin noncoated wells. Neurite growth was inhibited strongly when the concentration of the central myelin was 10 μg/cm 2 or greater, but on the 5 μg/cm 2 myelin, the younger the cells were, the longer neurites they had. When the length of the longest neurites in one field of the image analyzer was further examined in the same way, the younger the cells were, the longer their axons grew on 0 and 5 μg/cm 2 myelin. Thus, CNS myelin was seen to be a significant inhibitor of the recovery of injured neural tissue of the adult CNS. Younger cells grew longer neurites than older cells on CNS myelin, and so it was suggested that neural stem cells or younger neurons may serve as tissue for transplantation therapy.
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- 2000
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9. Differentiation and Angiogenesis of Central Nervous System Stem Cells Implanted with Mesenchyme into Ischemic Rat Brain
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Atsushi Fukunaga, Koichi Uchida, Koichi Hara, Yoshiaki Kuroshima, and Takeshi Kawase
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Medicine - Abstract
After cerebral infarction, necrosis in neural tissues is not usually repaired or reconstructed by the injured brain. We therefore examined the effects on postinfarction repair of implanting central nervous system (CNS) stem cells together with mesenchyme, because CNS stem cells can be expected to adapt and survive in the adult brain. Cerebral infarction was induced by the Koizumi-Longa method, using the adult male spontaneous hypertensive rat model. Reperfusion was performed an hour after middle cerebral artery occlusion. The rat mesencephalic neural plate at the early somite stage (embryonic day 10.5) together with the adjacent ventral mesenchymal tissues was dissected out under the microscope and immediately implanted into the ischemic rat striatum. One month later, the cognitive function was evaluated by the Morris water maze method. Histologic and immunohistochemical examinations of the graft were made with hematoxylin-eosin (H&E), neurofilament-200, and tyrosine hydroxylase (TH) stains. In the water maze study, mean latency times required to reach an escape platform in the implanted animals with surviving grafts were found to be shorter than in those without grafts, but longer than in normal animals. In the spatial probe trial, the number of animals seen to cross the area in the pool where the platform had been located was greater in the implanted rats with surviving grafts than in other groups. Multiple vascularization in the grafted area was observed histologically in H&E-stained tissues, and neurofilament-200-positive cells were recognized in the graft. TH staining revealed within the graft many immunoreactive neuron-like cell bodies with long dendrites. It was suggested that grafted CNS stem cells with mesenchyme may survive and differentiate into mature CNS tissue within the adult ischemic rat brain, constructing vessels in and around the grafts, and may therefore have the potential to be effective in the recovery of the cognitive function of the rat model.
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- 1999
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10. Implantation of Xenogeneic Transgenic Neural Plate Tissues into Parkinsonian Rat Brain
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Koichi Hara, Koichi Uchida, Atsushi Fukunaga, Shigeo Toya, and Takeshi Kawase
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Medicine - Abstract
Xenografting must be considered as a means of establishing neural transplantation therapy and of securing fetal neural tissues as donor material. The early stage (embryonic day 8.5, E8.5) embryonic mesencephalic neural plate (NP) from transgenic mice was examined for possible application in effective xenografting therapy. As recipients, Parkinsonian rats treated with 6-hydroxydopamine were used, and as donors, GT4-2 mice into which a β-galactosidase gene was introduced to allow brain tissue differentiation from the recipients by X-gal staining. Three microscopic pieces of E8.5 GT4-2 mice NP were injected into the striatum of the Parkinsonian rats. Some hosts were given immunosuppressants (cyclophosphamide and FK506) (IS group), others were not (non-IS group). Amphetamine-induced rotation was examined at days 11 and 21 after grafting (D11 and D21, respectively), and morphological investigations were performed using hematoxylin-eosin (H-E), X-gal, and thyrosine hydroxylase (TH) staining. The rotations were counted in 30 of the 38 transplanted rats before and after grafting. Histological data were obtained from 19 of these 30 rats. In 11 of them the grafts survived (survival group) and in the remaining 8, the grafts were unsuccessful (rejection group). In the survival group at D11, the mean number of rotations made by transplanted rats expressed as a percentage of the number before grafting (rotation percentage) decreased to 43.8% (n = 9), which, in comparison with the average of 125.9% (n = 6) in the rejection group, reveals significant behavioral recovery (p < 0.01). The rotation percentage at D21 was 23.8% in the survival group (n = 4) and 84.5% in the rejection group (n = 3). Behavioral recovery was thus seen to improve with time in the survival group. In the IS group (n = 19), the rotation percentages averaged 74.9% (D11, n = 15) and 51.1% (D21, n = 7), while the non-IS group averages were 136.7% (D11, n = 9) and 140.7% (D21, n = 9), indicating a tendency for better behavioral recovery in the IS group than in the non-IS group (p < 0.05). Fifteen IS group rats were studied histologically, 10 (sacrificed on D11, D21) from the survival group and 5 (sacrificed on D11, D21) from the rejection group. In the non-IS group (n = 4), there was a graft in only one rat sacrificed on D11. There were many X-gal positive and TH positive cells in the grafts, suggesting that mouse NP survived, and differentiated into TH positive neurons in the rat brain. Xenografted NP has the potential to cure central nervous system diseases.
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- 1997
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11. A temporofrontal fascia flap that penetrated temporal muscle for the reconstruction of an anterior skull base bone and dura: a technical case report
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Makoto Katsuno, Koichi Uchida, and Akira Matsuno
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medicine.medical_specialty ,Temporal Muscle ,Skull Base Neoplasms ,Temporal muscle ,Neurosurgical Procedures ,Surgical Flaps ,03 medical and health sciences ,0302 clinical medicine ,medicine.artery ,Sphenoid Bone ,Middle temporal artery ,medicine ,Humans ,Fascia ,Aged ,Anterior skull base ,Skull Base ,integumentary system ,business.industry ,General Medicine ,Anatomy ,Pedicled Flap ,Plastic Surgery Procedures ,musculoskeletal system ,Surgery ,Treatment Outcome ,medicine.anatomical_structure ,030220 oncology & carcinogenesis ,Skull base surgery ,Female ,Dura Mater ,Neurology (clinical) ,Meningioma ,business ,030217 neurology & neurosurgery - Abstract
During skull base surgery, reconstruction of the dura is a very important procedure. Here, the use of a temporofrontal pedicled fascia flap tunnelled between temporal muscle fibres is described. This technique is easily performed and has a low postoperative morbidity, including skin and temporal muscle complications.
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- 2017
12. A Case of Primary Hepatic Neuroendocrine Carcinoma Clinically Suggested
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Shogo Shiratsuki, Koichi Uchida, Isao Hidaka, Takahiro Yamasaki, Issei Saeki, Takuya Iwamoto, Isao Sakaida, Ryo Kawasato, Taro Takami, Shuji Terai, Tsuyoshi Ishikawa, and Yohei Urata
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Pathology ,medicine.medical_specialty ,business.industry ,Medicine ,General Medicine ,Primary hepatic neuroendocrine carcinoma ,business - Published
- 2014
13. Occlusion of portosystemic shunts improves hyperinsulinemia due to insulin resistance in cirrhotic patients with portal hypertension
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Takashi Matsuda, Takuya Iwamoto, Taro Takami, Takahiro Yamasaki, Koichi Uchida, Shogo Shiratsuki, Shuji Terai, Tsuyoshi Ishikawa, and Isao Sakaida
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Liver Cirrhosis ,Male ,medicine.medical_specialty ,Cirrhosis ,Esophageal and Gastric Varices ,Gastroenterology ,Impaired glucose tolerance ,Insulin resistance ,Hyperinsulinism ,Internal medicine ,Hypertension, Portal ,medicine ,Hyperinsulinemia ,Humans ,Insulin ,Aged ,Retrospective Studies ,Aged, 80 and over ,Glucose tolerance test ,medicine.diagnostic_test ,business.industry ,Balloon Occlusion ,Glucose Tolerance Test ,Middle Aged ,medicine.disease ,Glucose ,Hepatic Encephalopathy ,Portal hypertension ,Female ,Liver function ,Insulin Resistance ,Portosystemic shunt ,business - Abstract
Liver cirrhosis (LC) is often complicated by hyperinsulinemia due to insulin resistance (IR), which is considered to be closely related to shunt formation and impaired liver function. This study evaluates whether balloon-occluded retrograde transvenous obliteration (B-RTO) can affect glucose and insulin metabolism in patients with LC. Twenty-five cirrhotic patients (mean age = 69.6 years; female/male = 12/13; hepatitis C virus/alcohol/nonalcoholic steatohepatitis = 14/6/5; Child-Pugh’s class A/B = 10/15) with gastric varices and/or hepatic encephalopathy caused by portosystemic shunts (PSS) due to portal hypertension (PH) underwent B-RTO at our hospital. Testing was performed before and at 1 month after the procedure. Shunt occlusion resulted in a decrease in extrahepatic collateral blood flow and an increase in portal venous flow, as well as a dramatic improvement in hepatic function markers. In addition, B-RTO significantly decreased homeostasis model assessment (HOMA) of IR without a statistical decline of HOMA of β-cell function. The 75-g oral glucose tolerance test (75-OGTT) revealed that occlusion of PSS reduced both fasting immunoreactive insulin (IRI) levels and the area under the curve for IRI. However, no significant change in preprandial or postprandial plasma glucose levels was observed. Furthermore, according to the criteria of the American Diabetes Association, B-RTO led to an improved 75-OGTT profile in 58.3 % of patients who had impaired glucose tolerance or diabetes mellitus before the procedure. Shunt occlusion improves IR-related hyperinsulinemia through increased portal venous flow, ameliorated liver function, and consequent augmented hepatic insulin clearance in cirrhotic patients with PH.
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- 2013
14. Association of tyrosine with insulin resistance in hepatitis C virus-related chronic liver disease
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Issei Saeki, Takuya Iwamoto, Ichiro Kunitugu, Tsuyoshi Tanabe, Takahiro Yamasaki, Junichi Zaitsu, Isao Sakaida, Koichi Uchida, Makoto Segawa, Isao Hidaka, Yumiko Harima, Takashi Oono, Yoshio Marumoto, Taro Takami, Yohei Urata, Shuji Terai, and Tsuyoshi Ishikawa
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Prothrombin time ,medicine.medical_specialty ,Hepatology ,medicine.diagnostic_test ,Bilirubin ,business.industry ,Hepatitis C virus ,Albumin ,medicine.disease_cause ,Chronic liver disease ,medicine.disease ,chemistry.chemical_compound ,Infectious Diseases ,Endocrinology ,Insulin resistance ,chemistry ,Internal medicine ,Hepatocellular carcinoma ,medicine ,Tyrosine ,business - Abstract
Aim Insulin resistance (IR) increases during the early stages of hepatitis C virus (HCV)-related chronic liver disease and is a sign of poor prognosis as well as a risk factor for hepatic fibrosis and hepatocellular carcinoma. We aimed to determine the factors affecting IR in HCV-related chronic liver disease. Methods We retrospectively examined 71 patients with HCV-related chronic liver disease and analyzed various parameters, including amino acids, as possible predictors of IR. IR was assessed using the Homeostasis Model of Assessment – Insulin Resistance (HOMA-IR). Amino acids were assayed by examining branched-chain amino acids (BCAA), tyrosine level, and the ratio of BCAA to tyrosine level (BTR). Results HOMA-IR was significantly correlated with body mass index, platelet count, prothrombin time, hemoglobin, total bilirubin, total protein, albumin, total cholesterol, fasting glucose, BTR (r = −0.46, P = 0.0001) and tyrosine (r = 0.55, P
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- 2013
15. Serum transferrin as a predictor of prognosis for hepatic arterial infusion chemotherapy in advanced hepatocellular carcinoma
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Seiji Kaino, Shuji Terai, Tsuyoshi Ishikawa, Naoki Yamamoto, Isao Sakaida, Yoshio Marumoto, Toshihiko Matsumoto, Takuya Iwamoto, Yohei Urata, Taro Takami, Yohei Harima, Isao Hidaka, Issei Saeki, Koichi Uchida, Takahiro Yamasaki, Yumiko Harima, and Junichi Zaitsu
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chemistry.chemical_classification ,medicine.medical_specialty ,Hepatology ,business.industry ,Therapeutic effect ,Hazard ratio ,Cumulative survival ,medicine.disease ,Gastroenterology ,Confidence interval ,Surgery ,Deferoxamine ,Infectious Diseases ,chemistry ,Transferrin ,Hepatocellular carcinoma ,Internal medicine ,Hepatic arterial infusion chemotherapy ,medicine ,business ,medicine.drug - Abstract
Aim We recently reported that the iron chelator deferoxamine (DFO) is efficacious in advanced hepatocellular carcinoma (HCC) patients. Iron regulation may thus have an important impact in HCC therapy. Because transferrin is a native chelator that regulates iron homeostasis, it may act as an anticancer agent in a similar manner as DFO. The objective of this study was to evaluate serum transferrin as a prognostic predictor in advanced HCC patients undergoing hepatic arterial infusion chemotherapy (HAIC). Methods We retrospectively studied 44 patients receiving HAIC and analyzed various parameters for their possible use as prognostic predictors. Results The 1-, 2- and 3-year cumulative survival rates were 36.4%, 18.2% and 8.5%, respectively, and the median survival time (MST) was 7.0 months. The survival rates of patients who had serum transferrin of 190 mg/dL or more (MST, 12.0 months) were significantly better than those of patients who had serum transferrin of less than 190 mg/dL (MST, 4.9 months). Multivariate analysis identified serum transferrin of 190 mg/dL or more (hazard ratio [HR], 0.282; 95% confidence interval [CI], 0.132–0.603; P = 0.001) and Child–Pugh score B (HR, 1.956; 95% CI, 1.034–3.700; P = 0.039) as independent prognostic predictors. There was a significant correlation between serum transferrin level and therapeutic effect (P
- Published
- 2013
16. Loss of c-Met accelerates development of liver fibrosis in response to CCl4 exposure through deregulation of multiple molecular pathways
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Jens U. Marquardt, Mitsuteru Kitade, Snorri S. Thorgeirsson, Daekwan Seo, Matthew C. Gillen, Valentina M. Factor, Luis Enrique Gómez-Quiroz, Koichi Uchida, Pal Kaposi-Novak, and Elizabeth A. Conner
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CCl4 ,Liver Cirrhosis ,Cell signaling ,C-Met ,DNA Repair ,Transcription, Genetic ,Cell Communication ,Microarray ,Biology ,Article ,Mice ,chemistry.chemical_compound ,Fibrosis ,Conditional gene knockout ,Cell Adhesion ,Hepatic Stellate Cells ,medicine ,Animals ,Carbon Tetrachloride ,Molecular Biology ,Cell Proliferation ,Mice, Knockout ,Hepatocyte Growth Factor ,Proto-Oncogene Proteins c-met ,medicine.disease ,Liver regeneration ,Liver Regeneration ,medicine.anatomical_structure ,Liver ,chemistry ,Hepatocyte ,Hepatocytes ,Hepatic stellate cell ,Cancer research ,Molecular Medicine ,Female ,Signal transduction ,Transcriptome ,c-met ,Signal Transduction - Abstract
HGF/c-Met signaling plays a pivotal role in hepatocyte survival and tissue remodeling during liver regeneration. HGF treatment accelerates resolution of fibrosis in experimental animal models. Here, we utilized Metfl/fl;Alb-Cre+/− conditional knockout mice and a carbon tetrachloride(CCl4)-induced liver fibrosis model to formally address the role of c-Met signaling in hepatocytes in the context of chronic tissue injury. Histological changes during injury (4weeks) and healing phase (4weeks) were monitored by immunohistochemistry; expression levels of selected key fibrotic molecules were evaluated by western blotting, and time-dependent global transcriptomic changes were examined using a microarray platform. Loss of hepatocyte c-Met signaling altered hepatic microenvironment and aggravated hepatic fibrogenesis. Greater liver damage was associated with decreased hepatocyte proliferation, excessive stellate cell activation and rapid dystrophic calcification of necrotic areas. Global transcriptome analysis revealed a broad impact of c-Met on critical signaling pathways associated with fibrosis. Loss of hepatocyte c-Met caused a strong deregulation of chemotactic and inflammatory signaling (MCP-1, RANTES, Cxcl10) in addition to modulation of genes involved in reorganization of the cytoskeletal network (Actb, Tuba1a, Tuba8), intercellular communications and adhesion (Adam8, Icam1, Itgb2), control of cell proliferation (Ccng2, Csnk2a, Cdc6, cdk10), DNA damage and stress response (Rad9, Rad52, Ercc4, Gsta1 and 2, Jun). Our study demonstrates that deletion of c-Met receptor in hepatocytes results in pronounced changes in hepatic metabolism and microenvironment, and establishes an essential role for c-Met in maintaining the structural integrity and adaptive plasticity of the liver under adverse conditions.
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- 2012
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17. A Case of Ruptured Duodenal Varices Treated by Combination Therapy of Endoscopic Variceal Ligation and Balloon-occluded Retrograde Transvenous Obliteration
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Yoshiteru Nakashima, Kouichi Hamabe, Atsushi Goto, Shuji Terai, Takahiro Yamasaki, Tsuyoshi Ishikawa, Isao Sakaida, Shinichi Hashimoto, Munemasa Okada, Takuya Iwamoto, Takashi Matsuda, Shigeyuki Suenaga, and Koichi Uchida
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medicine.medical_specialty ,Combination therapy ,business.industry ,Internal medicine ,Medicine ,General Medicine ,Duodenal varices ,Ligation ,business ,Balloon ,Gastroenterology ,Surgery - Abstract
57歳の男性.B型肝硬変・肝細胞癌に対して外来経過観察中,下血に対する精査加療目的で当科に緊急入院した.上部消化管内視鏡検査(EGD)で十二指腸下行脚に静脈瘤が認められたものの活動性出血および血液貯留の所見はなく,下部消化管内視鏡検査・カプセル内視鏡検査・経肛門的ダブルバルーン内視鏡検査においても回腸~結腸内に凝血塊の貯留が認められたのみで出血源の同定には至らなかった.腹部血管造影検査では十二指腸周辺に著明な門脈系-大循環系短絡路の発達が認められ,血管造影下CTで十二指腸下行脚付近に造影剤の血管外漏出が疑われた.直後の緊急EGDにより十二指腸静脈瘤破裂と診断し,内視鏡的静脈瘤結紮術(EVL)にて一次止血に成功した.しかしその2日後に出血性ショックに陥ったため,EVLで止血した上で引き続きバルーン閉塞下逆行性経静脈的塞栓術(B-RTO)を施行して完全止血を得た.十二指腸静脈瘤破裂は非常に稀な難治性消化管出血であるが,今回我々はEVL・B-RTO併用療法で止血し救命し得た症例を経験したので報告する.
- Published
- 2011
18. A case of liver metastasis from ocular melanoma with difficulty in distinguishing from hepatocellular carcinoma
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Takahiro Yamasaki, Junichi Zaitsu, Taro Takami, Yuhki Yamaguchi, Isao Sakaida, Shuji Terai, Tsuyoshi Ishikawa, Masako Tsuchiya, Koichi Uchida, and Yohei Harima
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Oncology ,medicine.medical_specialty ,Hepatology ,business.industry ,Internal medicine ,Hepatocellular carcinoma ,Ocular Melanoma ,medicine ,business ,medicine.disease ,Metastasis - Abstract
左脈絡膜悪性黒色腫に対する手術歴(2004年4月,左眼球摘出術)を有する79歳の男性患者が2009年10月に右季肋部痛を主訴に当院外来を受診した.血液検査にて軽度の肝機能障害と高度の凝固系異常が認められたため精査加療目的で同日当科に緊急入院となった.HBs抗原・抗HBs抗体・抗HBc-IgG抗体・抗HCV抗体はいずれも陰性であり,腹部超音波検査・CT検査・MRI検査・血管造影検査で肝両葉に多血性腫瘤が多数認められた.悪性黒色腫に特異的な腫瘍マーカーである5-S-cysteinyldopaが異常高値を呈したがPIVKA IIも著明に上昇していたため画像・血液検査所見からは悪性黒色腫肝転移と肝細胞癌の鑑別には至らなかった.超音波下肝腫瘍生検にて悪性黒色腫の確定診断を得た上で同病変に対してシスプラチンを用いた肝動脈化学塞栓療法を施行した.今回我々は「脈絡膜悪性黒色腫肝転移」という非常に稀な一例を経験したので報告する.
- Published
- 2011
19. Preventive effect of cyclosporin A on experimentally induced acute liver injury in rats
- Author
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Isao Sakaida, Kiwamu Okita, Kozo Kayano, Koichi Uchida, Teruaki Kimura, and Shuji Wasaki
- Subjects
Lipopolysaccharides ,Male ,Lipopolysaccharide ,medicine.medical_treatment ,Pharmacology ,Pathogenesis ,chemistry.chemical_compound ,Propionibacterium acnes ,Cyclosporin a ,medicine ,Animals ,Drug Interactions ,Rats, Wistar ,Liver injury ,Hepatology ,biology ,Macrophages ,medicine.disease ,biology.organism_classification ,Rats ,Cytokine ,Liver ,chemistry ,Alanine transaminase ,Immunology ,Cyclosporine ,biology.protein ,Tumor necrosis factor alpha ,Immunosuppressive Agents - Abstract
We examined the effect of cyclosporin A (CsA) on the pathogenesis of acute experimental liver injury in rats induced by injection of heat-killed Propionibacterium acnes (P. acnes) and subsequent injection of lipopolysaccharide (LPS). Pretreatment with CsA significantly reduced serum alanine aminotransferase (ALT), serum tumor necrosis factor-alpha (TNF-alpha) production, without changing the TNF-alpha mRNA level in the liver, and plasma interferon-gamma (IFN-gamma), following LPS injection in this model. Twenty-four-hour mortality was also markedly improved, from 100% in the P. acnes plus LPS group to 0% in the CsA-pretreated group. Although direct addition of CsA to isolated hepatic macrophages from P. acnes-pretreated rats did not prevent the production of TNF-alpha and active oxygen species, isolated hepatic macrophages from P. acnes plus CsA-pretreated rats significantly reduced their production in response to the addition of LPS. These results suggest that CsA protects against P. acnes plus LPS-induced acute liver injury, not by direct inhibition of hepatic macrophage activation, but by indirect prevention of hepatic macrophage activation, presumably related to the reduction in plasma IFN-gamma levels.
- Published
- 2008
20. Effects of a late evening snack combined with α-glucosidase inhibitor on liver cirrhosis
- Author
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Keiko Korenaga, Koichi Uchida, Takahiro Yamasaki, Masaaki Korenaga, and Isao Sakaida
- Subjects
medicine.medical_specialty ,Cirrhosis ,Evening ,Hepatology ,business.industry ,α glucosidase ,Branched-chain amino acid ,medicine.disease ,Impaired glucose tolerance ,Respiratory quotient ,chemistry.chemical_compound ,Infectious Diseases ,Endocrinology ,chemistry ,Internal medicine ,Concomitant ,medicine ,Medical nutrition therapy ,business - Abstract
AIM A late evening snack (LES) is recommended for protein-energy malnutrition in patients with liver cirrhosis. However, many cases of liver cirrhosis have accompanying impaired glucose tolerance and there are concerns that LESs might aggravate glucose intolerance. In this study, we concomitantly used an alpha-glucosidase inhibitor with a LES and examined the effects on glucose tolerance. In addition, we examined whether or not there was an improvement in energy metabolism by slowing glucose absorption with the concomitant use of the alpha-glucosidase inhibitor. METHODS The subjects were 11 patients with liver cirrhosis. From before the study, all the patients had been taking a LES supplementation with a branched-chain amino acid (BCAA)-enriched nutrient mixture. The patients were started on the concomitant use of alpha-glucosidase inhibitor (0.2 mg) taken just prior to the LES. The change of glucose tolerance and energy metabolism were examined using a 75-g oral glucose tolerance test and indirect calorimetry. RESULTS One week and three months after the start of the concomitant use of the alpha-glucosidase inhibitor, the area under the concentration curve for plasma glucose was significantly decreased. Three months after the concomitant use, the non-protein respiratory quotient was significantly improved. There were no serious side effects during the follow-ups. CONCLUSION The concomitant use of the alpha-glucosidase inhibitor use with LES showed the possibility of improving glucose tolerance and energy metabolism. In patients with impaired glucose tolerance, the concomitant use of an alpha-glucosidase inhibitor with LES might be a useful measure for nutritional management.
- Published
- 2008
21. Telmisartan prevents hepatic fibrosis and enzyme-altered lesions in liver cirrhosis rat induced by a choline-deficient l-amino acid-defined diet
- Author
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Naoki Yamamoto, Haiyan Jin, Koichi Uchida, Shuji Terai, and Isao Sakaida
- Subjects
Liver Cirrhosis ,Male ,medicine.medical_specialty ,Cirrhosis ,Biophysics ,Peroxisome proliferator-activated receptor ,Angiotensin-Converting Enzyme Inhibitors ,Biology ,L-Amino Acid Oxidase ,Benzoates ,Biochemistry ,Fibrosis ,hemic and lymphatic diseases ,Internal medicine ,medicine ,Animals ,Telmisartan ,Rats, Wistar ,Molecular Biology ,chemistry.chemical_classification ,Angiotensin II receptor type 1 ,Dose-Response Relationship, Drug ,Cell Biology ,medicine.disease ,Angiotensin II ,Choline Deficiency ,Rats ,Treatment Outcome ,Endocrinology ,chemistry ,Hepatic stellate cell ,Benzimidazoles ,Hepatic fibrosis ,medicine.drug - Abstract
Rennin-angiotensin system is involved in liver fibrogenesis through activating hepatic stellate cells (HSCs). Telmisartan (Tel) is an angiotensin II type 1 receptor antagonist, could function as a selective peroxisome proliferator-activated receptor gamma activator. Here we studied the effect of Tel on liver fibrosis, pre-neoplastic lesions in vivo and primary HSCs in vitro. In vivo study, we used the choline-deficient L-amino acid-defined (CDAA)-diet induced rat NASH model. The rats were fed the CDAA diet for 8 weeks to induce liver fibrosis and pre-neoplastic lesions, and then co-administrated with Tel for another 10 weeks. Tel prevented liver fibrogenesis and pre-neoplastic lesions by down-regulating TGFbeta1 and TIMP-1, 2 and increasing MMP-13 expression. Tel inhibited HSCs activation and proliferation. These results suggested that Tel could be a promising drug for NASH related liver fibrosis.
- Published
- 2007
22. The effect of supplementation with branched-chain amino acids in patients with liver cirrhosis
- Author
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Takahiro Yamasaki, Kosuke Okita, Isao Sakaida, Koichi Uchida, Yohei Urata, and Keiko Korenaga
- Subjects
chemistry.chemical_classification ,medicine.medical_specialty ,Creatinine ,Cirrhosis ,Hepatology ,business.industry ,Energy metabolism ,medicine.disease ,Amino acid ,Impaired glucose tolerance ,Respiratory quotient ,chemistry.chemical_compound ,Infectious Diseases ,Endocrinology ,chemistry ,Internal medicine ,medicine ,In patient ,Oral glucose tolerance ,business - Abstract
Aim: We investigated the effect of supplementation with branched-chain amino acids (BCAA) in patients with liver cirrhosis on the change of energy metabolism as well as glucose tolerance. Methods: Thirty liver cirrhosis patients underwent nutrient supervision by a dietician for one week. They were then prescribed oral supplementation with three packs of a BCAA nutrient (Livact 4.15 g/pack; Ajinomoto Pharma, Tokyo, Japan), taken three times a day: after breakfast, dinner and before sleep. The change in energy metabolism and glucose tolerance was examined using an indirect calorimeter and 75 g oral glucose tolerance test (75 g OGTT). Results: Non-protein respiratory quotient (npRQ) as well as branched-chain amino acid/tyrosine ratio (BTR) showed significant improvement, especially in patients with a creatinine height index (CHI) greater than 80. There was also a significant correlation between npRQ after one week of BCAA supplementation and the CHI. The patients with CHI greater than 80 and those with borderline pattern assessed by 75 g OGTT showed significant improvement in impaired glucose tolerance. Conclusion: Liver cirrhosis patients with CHI greater than 80 are the first candidates for BCAA supplementation. These patients showed improvement not only in energy metabolism and BTR, but also glucose tolerance.
- Published
- 2007
23. Deferasirox, an oral iron chelator, prevents hepatocarcinogenesis and adverse effects of sorafenib
- Author
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Isao Sakaida, Takahiro Yamasaki, Toshihiko Matsumoto, Naoki Yamamoto, Taro Takami, Issei Saeki, Shuji Terai, Koichi Uchida, and Koichi Fujisawa
- Subjects
Sorafenib ,Pathology ,medicine.medical_specialty ,Combination therapy ,hand-foot skin syndrome ,Clinical Biochemistry ,Medicine (miscellaneous) ,urologic and male genital diseases ,Gastroenterology ,liver cancer ,03 medical and health sciences ,0302 clinical medicine ,Fibrosis ,Internal medicine ,medicine ,heterocyclic compounds ,neoplasms ,liver fibrosis ,Nutrition and Dietetics ,business.industry ,Deferasirox ,medicine.disease ,female genital diseases and pregnancy complications ,digestive system diseases ,Deferoxamine ,030220 oncology & carcinogenesis ,Hepatocellular carcinoma ,030211 gastroenterology & hepatology ,Original Article ,sorafenib ,Liver function ,business ,Liver cancer ,deferasirox ,medicine.drug - Abstract
Although sorafenib is expected to have a chemopreventive effect on hepatocellular carcinoma (HCC) recurrence, there are limitations to its use because of adverse effects, including effects on liver function. We have reported that the iron chelator, deferoxamine can prevent liver fibrosis and preneoplastic lesions. We investigated the influence of administering a new oral iron chelator, deferasirox (DFX), on the effects of sorafenib. We used the choline-deficient l-amino acid-defined (CDAA) diet-induced rat liver fibrosis and HCC model. We divided rats into four groups: CDAA diet only (control group), CDAA diet with sorafenib (sorafenib group), CDAA diet with DFX (DFX group), and CDAA diet with DFX and sorafenib (DFX + sorafenib group). Liver fibrosis and development of preneoplastic lesions were assessed. In addition, we assessed adverse effects such as changes in body and liver weight, skin damage (eruption, dryness, and hair loss), which is defined as hand-foot skin syndrome, in the sorafenib and DFX + sorafenib groups. The combination of DFX + sorafenib markedly prevented liver fibrosis and preneoplastic lesions better than the other treatments. Furthermore, the combination therapy significantly decreased adverse effects compared with the sorafenib group. In conclusion, the combination therapy with DFX and sorafenib may be a useful adjuvant therapy to prevent recurrence after curative treatment of HCC.
- Published
- 2015
24. A new therapeutic assessment score for advanced hepatocellular carcinoma patients receiving hepatic arterial infusion chemotherapy
- Author
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Taro Takami, Naoki Yamamoto, Shuji Terai, Tsuyoshi Ishikawa, Takuya Iwamoto, Koichi Uchida, Takahiro Yamasaki, Issei Saeki, Toshihiko Matsumoto, Isao Hidaka, Isao Sakaida, Yohei Urata, and Norikazu Tanabe
- Subjects
Oncology ,Male ,medicine.medical_specialty ,Carcinoma, Hepatocellular ,medicine.medical_treatment ,Alpha interferon ,lcsh:Medicine ,Biomarkers, Pharmacological ,Metastasis ,Hepatic Artery ,Internal medicine ,Antineoplastic Combined Chemotherapy Protocols ,medicine ,Humans ,Infusions, Intra-Arterial ,Protein Precursors ,lcsh:Science ,Survival analysis ,Infusion Pumps ,Aged ,Neoplasm Staging ,Cisplatin ,Chemotherapy ,Multidisciplinary ,business.industry ,Liver Neoplasms ,lcsh:R ,Interferon-alpha ,Middle Aged ,medicine.disease ,Prognosis ,Thrombosis ,Survival Analysis ,Treatment Outcome ,Fluorouracil ,Research Design ,Hepatocellular carcinoma ,Multivariate Analysis ,Disease Progression ,Female ,Prothrombin ,lcsh:Q ,alpha-Fetoproteins ,business ,Biomarkers ,medicine.drug ,Research Article - Abstract
Background & Aims Hepatic arterial infusion chemotherapy (HAIC) is an option for treating advanced hepatocellular carcinoma (HCC). Because of the poor prognosis in HAIC non-responders, it is important to identify patients who may benefit from continuous HAIC treatment; however, there are currently no therapeutic assessment scores for this identification. Therefore, we aimed to establish a new therapeutic assessment score for such patients. Methods We retrospectively analyzed 90 advanced HCC patients with elevated baseline alpha-fetoprotein (AFP) and/or des-gamma-carboxy prothrombin (DCP) levels and analyzed various parameters for their possible use as predictors of response and survival. AFP and DCP responses were assessed after half a course of HAIC (2 weeks); a positive-response was defined as a reduction of ≥ 20% from baseline. Results Multivariate analysis identified DCP response (odds ratio 16.03, p < 0.001) as an independent predictor of treatment response. In multivariate analysis, Child-Pugh class A (hazard ratio [HR] 1.99, p = 0.018), AFP response (HR 2.17, p = 0.007), and DCP response (HR 1.90, p = 0.030) were independent prognostic predictors. We developed an Assessment for Continuous Treatment with HAIC (ACTH) score, including the above 3 factors, which ranged from 0 to 3. Patients stratified into two groups according to this score showed significantly different prognoses (≤1 vs. ≥2 points: median survival time, 15.1 vs. 8.7 months; p = 0.003). Conclusions The ACTH score may be useful in the therapeutic assessment of HCC patients receiving HAIC.
- Published
- 2015
25. Leptin enhances TNF-α production via p38 and JNK MAPK in LPS-stimulated Kupffer cells
- Author
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Jinhua Shen, Koichi Uchida, Kiwamu Okita, Isao Sakaida, and Shuji Terai
- Subjects
Leptin ,Lipopolysaccharides ,Male ,MAPK/ERK pathway ,medicine.medical_specialty ,Lipopolysaccharide ,Kupffer Cells ,p38 mitogen-activated protein kinases ,Stimulation ,p38 Mitogen-Activated Protein Kinases ,General Biochemistry, Genetics and Molecular Biology ,Proinflammatory cytokine ,chemistry.chemical_compound ,Internal medicine ,Animals ,Medicine ,General Pharmacology, Toxicology and Pharmaceutics ,Cells, Cultured ,Dose-Response Relationship, Drug ,Tumor Necrosis Factor-alpha ,business.industry ,JNK Mitogen-Activated Protein Kinases ,General Medicine ,eye diseases ,Rats ,Rats, Zucker ,Endocrinology ,chemistry ,Tumor necrosis factor alpha ,Signal transduction ,business ,Signal Transduction - Abstract
Leptin is now recognized as a proinflammatory cytokine and thought to be a progressive factor for non-alcoholic steatohepatitis (NASH). Here we showed the effects of leptin on the production of TNF-alpha (tumor necrosis factor-alpha) by Kupffer cells (KCs) with signal transduction. Leptin enhanced TNF-alpha production accompanied by a dose-dependent increase of MAPK activity in lipopolysaccharide (LPS)-stimulated KCs. SB203580 and JNK inhibitor I, specific inhibitors of P38 and JNK, inhibited TNF-alpha production in KCs but PD98059, an inhibitor of the ERK pathway, did not affect TNF-alpha production by KCs. Recombinant constitutively active adenovirus (Ad)-MKK6 and-MKK7 increased TNF-alpha production in KCs with activation of P38 and JNK without any change by Ad-MEK1 delivery. On the other hand, KCs isolated from the Zucker rat (fa/fa), a leptin receptor-deficient rat, showed reduced production of TNF-alpha on stimulation with LPS. The delivery of Ad-MKK6 and-MKK7, but not Ad-MEK1, increased TNF-alpha production in KCs of Zucker rats with activation of P38 and JNK. Addition of leptin to normal rats increased LPS-induced hepatic TNF-alpha production in vivo and leptin receptor-deficient Zucker rats showed reduced hepatic TNF-alpha production on addition of LPS in vivo. These findings indicate that P38 and JNK pathways are involved in the signal transduction of leptin enhancement of LPS-induced TNF-alpha production.
- Published
- 2005
26. Surgical treatment of temporal bone chondroblastoma
- Author
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Ryu Kurokawa, Koichi Uchida, and Takeshi Kawase
- Subjects
Adult ,Male ,medicine.medical_specialty ,Hearing Loss, Conductive ,Ear, Middle ,Chondroblastoma ,Middle cranial fossa ,Skull Base Neoplasms ,Neurosurgical Procedures ,Condyle ,Temporal bone ,medicine ,Humans ,Ear, External ,Cranial Fossa, Middle ,Temporomandibular Joint ,business.industry ,Mandibular Condyle ,Temporal Bone ,Middle Aged ,Temporomandibular Joint Disorders ,medicine.disease ,Magnetic Resonance Imaging ,Temporomandibular joint ,Surgery ,Radiography ,Skull ,Treatment Outcome ,medicine.anatomical_structure ,Primary bone ,Trigeminal Nerve Diseases ,Mandibular fossa ,Masticatory Muscles ,Female ,Neurology (clinical) ,Facial Nerve Diseases ,Neoplasm Recurrence, Local ,Otologic Surgical Procedures ,business ,Craniotomy - Abstract
Background Temporal bone chondroblastoma is a rare primary bone tumor that affects the floor of the middle cranial fossa. This tumor is known to have high recurrence rate after curettage, and wide resection is therefore recommended. However, the literature provides little information regarding long-term results after wide resection of temporal bone chondroblastoma. Methods Four cases of surgically treated temporal bone chondroblastoma underwent long-term follow-up. Results Four patients, 3 males and 1 female, with mean age of 34, were surgically treated at the neurosurgery department of Keio University Hospital. Two patients were treated for recurrent tumor and the other two for new disease. In all cases the tumor mainly involved the mandibular fossa with variable degree of infiltration into tympanic and petrous parts. The tumor was totally removed via zygomatic approach in all patients. In 3 patients, the mandibular condyle was removed to expose the tumor. These patients had temporary malocclusion and restricted motion postoperatively, which resolved within 3 to 12 months with conservative treatment. All patients have no recurrence to date with a mean follow-up period of 9 years. Conclusion Temporal bone chondroblastoma was removed totally with skull base surgical technique and no recurrence has occurred for 6 to 13 years postoperatively. We found that removal of the mandibular head does not cause permanent problems of mastication in patients with normal dentures.
- Published
- 2005
27. Jugular foramen papillary meningioma: A case report
- Author
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Eiji Ikeda, Koichi Uchida, Takeshi Kawase, Ryo Ueda, and Masanao Tabuse
- Subjects
Adult ,Cancer Research ,medicine.medical_specialty ,Pathology ,Neurology ,Neurological examination ,Diagnosis, Differential ,Papillary Meningioma ,Meningeal Neoplasms ,otorhinolaryngologic diseases ,medicine ,Humans ,neoplasms ,Palsy ,medicine.diagnostic_test ,business.industry ,Magnetic resonance imaging ,General Medicine ,Immunohistochemistry ,Magnetic Resonance Imaging ,nervous system diseases ,medicine.anatomical_structure ,Oncology ,cardiovascular system ,Female ,Neurology (clinical) ,Neurosurgery ,Meningioma ,Jugular Foramen Meningioma ,business ,Jugular foramen - Abstract
Jugular foramen meningioma is very rare. Papillary meningioma, the histological aspects and clinical behavior of which are highly malignant, is also very rare. Only 55 cases of jugular foramen meningioma have been reported in the literature. To our knowledge, this is the first report of a jugular foramen papillary meningioma. A 25-year-old woman presented with hoarseness and right hearing disturbance. Neurological examination showed deficits of the right hypoglossal and vagus nerves with palsy. Magnetic resonance imaging (MRI) revealed a mass on the right jugular foramen extending intracranially and extracranially, with weak contrast enhancement. The intracranial tumor was removed via the right lateral suboccipital approach. Histopathological examination confirmed the diagnosis of papillary meningioma. We report here the first case of jugular foramen papillary meningioma. No completely effective treatment for papillary meningiomas exists at present, with the exception of surgery.
- Published
- 2004
28. Abducens schwannoma inside the cavernous sinus proper: case report
- Author
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Koichi Uchida, Mehmet Faik Ozveren, Toru Nakagawa, and Takeshi Kawase
- Subjects
medicine.medical_specialty ,Nerve fiber ,Postoperative recovery ,Schwannoma ,Abducens Nerve ,otorhinolaryngologic diseases ,medicine ,Humans ,Cranial Nerve Neoplasms ,Neoplasm Invasiveness ,Abducens nerve ,Sinus (anatomy) ,Trigeminal nerve ,Palsy ,business.industry ,Anatomy ,Middle Aged ,medicine.disease ,Magnetic Resonance Imaging ,Surgery ,medicine.anatomical_structure ,Cavernous sinus ,Cavernous Sinus ,Female ,Neurology (clinical) ,business ,Neurilemmoma - Abstract
BACKGROUND Only 2 cases of abducens nerve schwannoma solely inside the cavernous sinus have been reported. In both cases, abducens nerve palsy remained after operation. We report the first case of abducens nerve schwannoma inside the cavernous sinus proper with postoperative recovery from abducens nerve palsy. CASE DESCRIPTION The patient was a 47-year-old female who developed left abducens and trigeminal nerve palsies. Neuroradiological examination revealed left intra-cavernous sinus tumor. Total removal of the tumor was performed. The location of the tumor was confirmed intraoperatively inside the cavernous sinus itself, with no relation to the trigeminal nerve. Further, the relation of the tumor to one particular nerve fiber within the abducens nerve bundle was confirmed inside the cavernous sinus. After surgery, the patient had transient abducens nerve palsy. It had totally disappeared by 6 months. CONCLUSION When the tumor origin is just within the spacious cavernous sinus rather than more posterior in the narrow dural tunnel of Dorello's canal, successful preservation of the nerve function is possible postoperatively through a thorough knowledge of the membranous anatomy and careful preoperative study of the radiographic findings.
- Published
- 2004
29. Dural and Arachnoid Membraneous Protection of the Abducens Nerve at the Petroclival Region
- Author
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Takeshi Kawase, Koichi Uchida, M. Faik Ozveren, Bengu Cobanoglu, Ibrahim Tekdemir, Haluk Deda, and Ismail Akdemir
- Subjects
musculoskeletal diseases ,congenital, hereditary, and neonatal diseases and abnormalities ,Plexus ,Petrous Apex ,business.industry ,Dura mater ,Original Articles ,Anatomy ,nervous system diseases ,body regions ,medicine.anatomical_structure ,medicine.artery ,medicine ,Arachnoid Membrane ,Neurology (clinical) ,Internal carotid artery ,Subarachnoid space ,business ,Abducens nerve ,Petroclival Region - Abstract
The goal of this study was to determine the membranous protection of the abducens nerve in the petroclival region. The petroclival portion of the abducens nerve was studied in ten dissections from five cadaveric head specimens. One of the heads was used for histological sections. Four heads were injected with colored latex for microsurgical dissections. The histological sections were prepared from petroclival dura mater, embedded in paraffin blocks, stained, sectioned in the axial, coronal, and sagittal planes, and evaluated by light microscopy. The abducens nerve was covered by a dural sleeve and arachnoidal membrane during its course within the petroclival area. Following the petrous apex, the abducens nerve was fixed by a sympathetic plexus and connective tissue extensions to the lateral wall of the cavernous segment of the internal carotid artery and to the medial wall of Meckel's cave. Fibrous trabeculations inside the venous space were attached to the dural sleeve. The lateral clival artery accompanied the dural sleeve of the abducens nerve and supplied the petroclival dura mater. The arterioles accompanying the abducens nerve through the subarachnoid space supplied the nerve within the dural sleeve. The arachnoid membrane covered the abducens nerve within the dural sleeve to the petrous apex, and arachnoid granulations found on the dural sleeve protruded into the venous space. The extension of the arachnoid membrane to the petrous apex and the presence of arachnoid granulations on the dural sleeve suggest that the subarachnoid space continues in the dural sleeve.
- Published
- 2004
30. Leptin receptor-deficient Zucker (fa/fa) rat retards the development of pig serum-induced liver fibrosis with Kupffer cell dysfunction
- Author
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Shuji Terai, Kiwamu Okita, Shen Jinhua, Isao Sakaida, and Koichi Uchida
- Subjects
Lipopolysaccharides ,Male ,medicine.medical_specialty ,Kupffer Cells ,Swine ,Liver fibrosis ,Receptors, Cell Surface ,Biology ,Liver Cirrhosis, Experimental ,Procollagen Type I ,Collagen Type I ,General Biochemistry, Genetics and Molecular Biology ,Hydroxyproline ,chemistry.chemical_compound ,Internal medicine ,medicine ,Animals ,RNA, Messenger ,General Pharmacology, Toxicology and Pharmaceutics ,Leptin receptor ,Tumor Necrosis Factor-alpha ,Microarray analysis techniques ,Leptin ,Kupffer cell ,General Medicine ,Actins ,Rats ,Rats, Zucker ,medicine.anatomical_structure ,Endocrinology ,chemistry ,Hepatic stellate cell ,Receptors, Leptin - Abstract
The aim of this study was to investigate the role of leptin in the development of liver fibrosis with Kupffer cell function using leptin receptor deficient rats. Male Zucker (fa/fa) and control (fa/-) rats received pig serum for 8 weeks. Animals were sacrificed to estimate the degree of liver fibrosis and stellate cell activation with the expression of alpha smooth muscle actin (alphaSMA). Microarray analysis was performed. Isolated Kuppfer cells of Zucker and control rats were treated with LPS. LPS uptake and TNF-alpha production were examined. Stellate cells were also isolated from Zucker and control rats. The expression of procollagen type I mRNAs was examined. Control rats developed liver fibrosis 8 weeks after injection of pig serum and showed an increased liver hydroxyproline content of 348 +/- 34 microg/g (n = 10) compared with Zucker rats (225 +/- 13, n = 10, P0.01). The procollagen type I mRNA level and alphaSMA expression of Zucker rats were also significantly reduced. Microarray analysis indicated significantly reduced expression of TNF-alpha, LPS-binding protein, urokinase-type plasminogen activator (uPA), IGF, IGF-binding protein (IGFBP)-3,5, and increased expression of apolipoprotein IV. Isolated Kupffer cells of Zucker rats showed significantly reduced LPS uptake as well as TNF-alpha production compared with control rats. However, no significant change was observed in procollagen type I mRNA levels of isolated stellate cells after 4 days of culture on plastic dishes. These results suggest that leptin receptor deficiency retards the development of liver fibrosis due to the dysfunction of Kuppfer cells.
- Published
- 2003
31. Functional recovery after simultaneous transplantation with neuro-epithelial stem cells and adjacent mesenchymal tissues into infarcted rat brain
- Author
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Koichi Uchida, Atsushi Fukunaga, and Takeshi Kawase
- Subjects
Nervous system ,Pathology ,medicine.medical_specialty ,Mesenchyme ,Nervous System ,Brain Ischemia ,Brain ischemia ,medicine ,Animals ,Rats, Wistar ,Maze Learning ,Stem cell transplantation for articular cartilage repair ,business.industry ,Cerebral infarction ,Mesenchymal stem cell ,Epithelial Cells ,Cerebral Infarction ,medicine.disease ,Immunohistochemistry ,Rats ,Transplantation ,Treatment Outcome ,medicine.anatomical_structure ,Surgery ,Neurology (clinical) ,Stem cell ,Cognition Disorders ,business ,Stem Cell Transplantation - Abstract
Cerebral infarction results in impairment of motor and cognitive functions. We performed intracranial transplantation of multipotential neuro-epithelial stem cells with mesenchyme into experimentally large ischemic lesions to study their potential to relieve deficits.Wistar albino rats were subjected to transient middle cerebral artery occlusion for 60 minutes, producing an extensive ischemic lesion in the ipsilateral striatum and adjacent cerebral cortex. The rat mesencephalic neural plate at the early somite stage (embryonic day 10.5) together with adjacent ventral mesenchyme was used as donor material. We performed histological and immunohistochemical studies, with antibodies against tyrosine hydroxylase, and dopamine- and adenosine 3': 5'-monophosphate-regulated phosphoprotein 32 (DARPP-32; a striatal marker). Micro-angiograms were made by using Microfil silicone rubber. Morris Water-maze learning and treadmill task were employed to evaluate motor and cognitive functions.A viable non-tumoral mass was recognized in the rat striatum, up to as long as 156 days after transplantation. There were many cells positive for tyrosine hydroxylase or DARPP-32 in the graft. Some of the DARPP-32 positive cells within the graft had extended their dendrites into host tissues. In the micro-angiograms, many fine vessels were observed within the graft and dilated vessels meandered around the graft. Transplanted animals recovered significantly better in motor and cognitive functions than animals injected with only culture medium.Neuro-epithelial stem cells may follow several lines of differentiation; along the naturally genetically programmed line of differentiation, or along other cell lines depending on different environments. Grafting of neuro-epithelial stem cells with mesenchyme may merit a further study as a treatment for cerebral infarction.
- Published
- 2003
32. Anterior transpetrosal approach for petroclival tumors
- Author
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Takayuki Ohira, Koichi Uchida, Takeshi Kawase, and Kazunari Yoshida
- Subjects
Trigeminal nerve ,medicine.medical_specialty ,business.industry ,Petrous Apex ,medicine.medical_treatment ,Cranial nerves ,Brain tumor ,General Medicine ,medicine.disease ,Transpetrosal approach ,Surgery ,medicine.anatomical_structure ,Clivus ,Internal auditory meatus ,medicine ,business ,Craniotomy - Abstract
The petroclival or prepontine tumors originating medial to the trigeminal nerve include meningiomas, trigeminal neurinomas, laterally extended chordomas and prepontine epidermoids. They frequently show middle fossa or parasellar extension and have been one of the difficult tumors requiring a combined large craniotomy or multiple step surgery. Here, we will present a surgical method of tumor removal through a keyhole, epidurally created in a petrous apex. The technical points presented are based on my experience of 95 cases. This approach has the following advantages: (1) One-stage epidural surgery to the petroclival and dumbbell parasellar–clival lesions through a small craniotomy; (2) Minimal venous complications compared to the presigmoid approach; (3) Minimal facial and lower cranial nerves injury by jumping into the petroclival area medial to the internal auditory meatus; (4) Bloodless tumor removal being possible by detachment of the tentorial artery; (5) Hearing preservation by limited petrous resection.
- Published
- 2002
33. Feasibility of Using Early Mesencephalic Neural Plate for Intracerebral Grafting
- Author
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Takeshi Kawase, Yutaka Mine, Takuro Hayashi, Koichi Uchida, and Motoyuki Yamada
- Subjects
Telencephalon ,0301 basic medicine ,Neurite ,Basic fibroblast growth factor ,Biomedical Engineering ,lcsh:Medicine ,Nerve Tissue Proteins ,Culture Media, Serum-Free ,Nestin ,03 medical and health sciences ,chemistry.chemical_compound ,0302 clinical medicine ,Intermediate Filament Proteins ,Fetal Tissue Transplantation ,Mesencephalon ,Culture Techniques ,Neurosphere ,Animals ,Brain Tissue Transplantation ,Rats, Wistar ,Cells, Cultured ,Transplantation ,Epidermal Growth Factor ,lcsh:R ,Cell Differentiation ,Cell Biology ,Immunohistochemistry ,Rats ,Cell biology ,Neuroepithelial cell ,Microscopy, Electron ,030104 developmental biology ,chemistry ,Cell culture ,Feasibility Studies ,Female ,Stem cell ,Neural plate ,030217 neurology & neurosurgery - Abstract
The purpose of this study was to elucidate the biological significance and the possibility of intracerebral grafting of neuroepithelial stem cells derived from the mesencephalic neural plate. Immunohistological studies of embryonic day 10.5 (E10.5) Wister rats revealed strong nestin expression in the mesencephalic part of the neural plate. Mesencephalic neural plates removed from E10.5 rats were processed to either tissue or cell dissociation culture. They were cultured in vitro under various conditions and were analyzed 7 days after the primary culture. When they were cultured as a tissue, cell proliferation and differentiation into neurons extending long neurites were obvious in a serum-free medium, in a medium containing 3% serum, and in a medium containing 20 ng/ml epidermal growth factor. On the other hand, in a medium containing 10 ng/ml basic fibroblast growth factor (bFGF), both vigorous cell proliferation and sphere formation were recognized. Furthermore, marked neurite growth was rarely seen in this culture. When they were plated in a dissociation culture, cell proliferation and neurosphere generation were also recognized only in a medium containing bFGF, depending on the initial cell concentration. The spheres, generated 7 days after the primary cell culture, were positively stained by nestin. These data suggested that bFGF was able to amplify the stem cell population present in the mesencephalic neural plate derived from early embryos. This might make it possible to obtain a large number of stem cells as donor material for neural transplantation on demand.
- Published
- 2002
34. Increased expression of tumor necrosis factor-α messenger RNA in the intestinal mucosa of inflammatory bowel disease, particularly in patients with disease in the inactive phase
- Author
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Kiwamu Okita, Isao Sakaida, Yoshitsugu Kubo, Akiko Akazawa, Shingo Higaki, and Koichi Uchida
- Subjects
Adult ,Male ,medicine.medical_specialty ,Adolescent ,Antigens, Differentiation, Myelomonocytic ,Disease ,Polymerase Chain Reaction ,digestive system ,Inflammatory bowel disease ,Pathogenesis ,Crohn Disease ,Intestinal mucosa ,Antigens, CD ,Internal medicine ,medicine ,Humans ,RNA, Messenger ,Intestinal Mucosa ,Colitis ,Aged ,Messenger RNA ,Tumor Necrosis Factor-alpha ,business.industry ,Gastroenterology ,Middle Aged ,Hepatology ,medicine.disease ,Immunohistochemistry ,digestive system diseases ,Immunology ,Colitis, Ulcerative ,Female ,Tumor necrosis factor alpha ,business - Abstract
Tumor necrosis factor-alpha (TNF-alpha), may be involved in the pathogenesis of inflammatory bowel diseases (IBDs). The aim of this study was to evaluate the effect of TNF-alpha on the inflammatory activity of IBD.TNF-alpha mRNA expression in intestinal mucosal biopsy specimens from IBD patients [ulcerative colitis (UC), n = 54; and Crohn's disease (CD), n = 11] was analyzed using a competitive polymerase chain reaction. The degree of macrophage infiltration was analyzed by immunohistochemistry, using an antihuman CD68 antibody.TNF-alpha mRNA expression was increased in UC patients, corresponding to the inflammatory activity. However, in CD, TNF-alpha mRNA expression was not correlated with the endoscopic findings.We clarified that TNF-alpha mRNA expression was responsible for the inflammatory activity in UC. However, TNF-alpha mRNA expression was not correlated with the mucosal injury in CD.
- Published
- 2002
35. Meningovenous Structures of the Petroclival Region: Clinical Importance for Surgery and Intravascular Surgery
- Author
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Felix Umansky, Bernard George, Mehmet Faik Ozveren, Koichi Uchida, Jeffrey S. Henn, Sadakazu Aiso, G. Michael Lemole, Robert F. Spetzler, and Takeshi Kawase
- Subjects
medicine.medical_specialty ,Cranial Sinuses ,Veins ,Meninges ,Abducens Nerve ,Clivus ,medicine.artery ,Cadaver ,Humans ,Medicine ,Abducens nerve ,Petroclival Region ,Aged ,Aged, 80 and over ,business.industry ,Petrous Apex ,Inferior petrosal sinus ,Anatomy ,Middle Aged ,Nerve injury ,Surgery ,medicine.anatomical_structure ,Cranial Fossa, Posterior ,Cavernous sinus ,Dura Mater ,Neurology (clinical) ,medicine.symptom ,Internal carotid artery ,business - Abstract
OBJECTIVE: The goals of this investigation were to perform a detailed analysis of petroclival microanatomic features, to investigate the course of the abducens nerve in the petroclival region, and to identify potential causes of injury to neurovascular structures when anterior transpetrosal or transvenous endovascular approaches are used to treat pathological lesions in the petroclival region. METHODS: Petroclival microanatomic features were studied bilaterally in seven cadaveric head specimens, which were injected with colored silicone before microdissection. Another cadaveric head was used for histological section analyses. RESULTS: A lateral or medial location of the abducens nerve dural entrance porus, relative to the midline, was correlated with the course and angulation of the abducens nerve in the petroclival region. The angulation of the abducens nerve was greater and the nerve was closer to the petrous ridge in the lateral type, compared with the medial type. The abducens nerve exhibited three changes in direction, which represented the angulations in the petroclival region, at the dural entrance porus, the petrous apex, and the lateral wall of the internal carotid artery. The abducens nerve was covered by the dural sleeve and the arachnoid membrane, which became attenuated between the second and third angulation points. The abducens nerve was anastomosed with the sympathetic plexus and fixed by connective tissue extensions to the lateral wall of the internal carotid artery and the medial wall of Meckel's cave at the third angulation point. There were two types of trabeculations inside the sinuses around the petroclival region (tough and delicate). CONCLUSION: The petroclival part of the abducens nerve was protected in a dural sleeve accompanied by the arachnoid membrane. Therefore, the risk of abducens nerve injury during petrous apex resection via the anterior transpetrosal approach, with the use of the transvenous route through the inferior petrosal sinus to the cavernous sinus, should be lower than expected. The presence of two anatomic variations in the course of the abducens nerve, in addition to findings regarding nerve angulation and tethering points, may explain the relationships between adjacent structures and the susceptibility to nerve injury with either surgical or endovascular approaches. Venous anatomic variations may account for previously reported cases of subarachnoid hemorrhage with the endovascular approach.
- Published
- 2002
36. Tentorial Vascularization in Solid Hemangioblastoma. Case Report
- Author
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Canan Tanik, Fatih Serhat Erol, Cahide Topsakal, Metin Kaplan, Koichi Uchida, and M. Faik Ozveren
- Subjects
medicine.medical_specialty ,business.industry ,medicine.medical_treatment ,Splenium ,Laminectomy ,medicine.disease ,Tentorium ,law.invention ,Surgery ,Intramedullary rod ,Lesion ,Hematoma ,law ,Hemangioblastoma ,medicine ,Cyst ,Neurology (clinical) ,medicine.symptom ,business - Abstract
A 40-year-old female was admitted to the hospital with complaints of headache worsening gradually over a 1-month duration. Her past history included surgery to treat a left cerebellar cystic lesion 3 years before, and an untreated small solid right supracerebellar lesion of 1 cm diameter. On admission, magnetic resonance imaging showed that the right cerebellar lesion had grown to approximately 4 cm diameter abutting the tentorium and causing obstructive hydrocephalus. She also had two more small lesions, a right supratentorial solid lesion with cystic component near the splenium and an intramedullary cystic lesion at the C-2 level. Right suboccipital craniectomy was done. The vascular attachments between the superior aspect of the tumor and the tentorium were coagulated and the tumor was totally removed. C1-2 laminectomy was also performed to drain the intramedullary cyst. The patient deteriorated and lost consciousness with respiratory arrest 6 hours postoperatively and was reoperated for intracerebellar hematoma due to oozing from the tentorial vessels. Histological investigation revealed hemangioblastoma. Dural tentorial vascular attachments in solid hemangioblastomas located subjacent to the tentorium may cause early postoperative complications of hematoma at the site of vascular attachment following the resection. Computed tomography study in the early postoperative period is helpful to identify this problem.
- Published
- 2001
37. Isolated Abducens Nerve Paresis Associated With Incomplete Horner's Syndrome Caused by Petrous Apex Fracture. Case Report and Anatomical Study
- Author
-
Koichi Uchida, Murat Tiftikci, Bengu Cobanoglu, Takeshi Kawase, Fatih Serhat Erol, and Mehmet Faik Ozveren
- Subjects
Trigeminal nerve ,medicine.medical_specialty ,Petrous Apex ,business.industry ,Horner syndrome ,Anatomy ,medicine.disease ,Surgery ,Ptosis ,medicine.artery ,medicine ,Neurology (clinical) ,Internal carotid artery ,medicine.symptom ,business ,Abducens nerve ,Petroclival Region ,Abducens Nerve Diseases - Abstract
A 17-year-old male presented with a wound on the right temporal region, oozing hemorrhagic necrotic brain tissue and cerebrospinal fluid, following a fall. Computed tomography showed temporoparietal and petrous apex fractures on the right. Neurological examination revealed abducens nerve paresis, ptosis, and myosis on the right side. The patient was treated surgically for the removal of the free bony fragments at the fracture site and to close the dural tear. The abducens nerve paresis, ptosis, and myosis persisted at the 3rd monthly postoperative follow-up examination. The anatomy of the abducens nerve at the petroclival region was studied in four cadaveric heads. Two silicone-injected heads were used for microsurgical dissections and two for histological sections. The abducens nerve has three different angulations in the petroclival region, located at the dural entrance porus, the petrous apex, and the lateral wall of the cavernous segment of the internal carotid artery. The abducens nerve had fine anastomoses with the trigeminal nerve and the periarterial sympathetic plexus. There were fibrous connections extending inside the venous space of the petroclival area. The abducens nerve seems to be vulnerable to damage in the petroclival region, either directly by trauma to its dural porus and petrous apex or indirectly by stretching of the nerve through the nervous and/or fibrous connections. Concurrent functional loss of the abducens nerve and the periarterial sympathetic plexus clinically manifested as incomplete Horner's syndrome in our patient.
- Published
- 2001
38. Spontaneous Cerebrospinal Fluid Rhinorrhea Associated With Chronic Renal Failure. Case Report
- Author
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M. Faik Ozveren, Koichi Uchida, Fatih Serhat Erol, Ismail Akdemir, Cahide Topsakal, Hüseyin Çeliker, Metin Kaplan, and Turgay Bilge
- Subjects
Pathology ,medicine.medical_specialty ,Fossa ,biology ,Pseudotumor cerebri ,business.industry ,medicine.medical_treatment ,Anatomy ,medicine.disease ,biology.organism_classification ,Hydrocephalus ,Osteopenia ,Cerebrospinal fluid ,medicine ,Surgery ,Arachnoid Membrane ,Neurology (clinical) ,Fibrin glue ,business ,Craniotomy - Abstract
A 39-year-old woman was admitted with complaints of headache and nasal discharge on the left for 3 months which was later on proved to be cerebrospinal fluid (CSF). Neurological examination found no abnormalities except bilateral papilledema. Neuroimaging demonstrated enlargement of the lamina cribrosa foramina through which the olfactory nerves pass, as well as empty sella and cerebral cortical atrophy. Bone mineral densitometry showed osteopenia. CSF Ca++ and blood parathyroid hormone levels were elevated. CSF pressure was 280 mmH2O. Bilateral frontal craniotomy was performed to expose the anterior fossa. Foraminal enlargement at the lamina cribrosa was confirmed, and islands of extra-osseous calcifications on the arachnoid membrane were identified. The base of the anterior fossa was repaired intradurally with fascial graft and fibrin glue on both sides. No CSF leakage was noted at 1-year follow up. Spontaneous CSF leakage probably resulted from enlargement of the foramina at the lamina cribrosa due to Ca++ mobilization from bones and pseudotumor cerebri not to the extent of hydrocephalus caused by poor CSF absorption at the arachnoid granulations obliterated by extra-osseous calcareous accumulation.
- Published
- 2001
39. [Untitled]
- Author
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Koji Hironaka, Kiwamu Okita, Koichi Uchida, and Isao Sakaida
- Subjects
chemistry.chemical_classification ,medicine.medical_specialty ,Pathology ,Physiology ,Gastroenterology ,Biology ,medicine.disease ,Amino acid ,chemistry.chemical_compound ,Type IV collagen ,Hydroxyproline ,Procollagen peptidase ,Endocrinology ,chemistry ,Fibrosis ,Internal medicine ,medicine ,Hepatic stellate cell ,Choline ,Hepatic fibrosis - Abstract
The aim of this study was to investigate the association of stellate cell activation with serum fibrosis markers in a rat model of hepatic fibrosis prepared using a choline-deficient l-amino acid (CDAA) defined diet. CDAA diet administration resulted in increased liver hydroxyproline contents in a time-dependent manner with activated stellate cells, expressing α-smooth muscle actin (α-SMA) as well as increased serum concentrations of amino-terminal procollagen type III peptide (PIIIP) and the 7S fragment of type IV collagen. Hydroxyproline content of the liver showed a closer correlation with the serum 7S (r = 0.75, P < 0.01) concentration than with the serum PIIIP (r = 0.51, P < 0.01) concentration. The percent area of α-SMA-positive cells showed stronger correlation with the serum PIIIP concentration (r = 0.85, P < 0.01) than with the 7S concentration (r = 0.50, P < 0.01). These results indicate that the serum PIIIP concentration reflects the activity of fibrogenesis, while the serum 7S concentration reflects the accumulation of collagen fibers in the liver.
- Published
- 2000
40. [Untitled]
- Author
-
Koji Hironaka, Koichi Uchida, Kozo Kayano, Kiwamu Okita, and Isao Sakaida
- Subjects
Chemotherapy ,medicine.medical_specialty ,Lipopolysaccharide ,biology ,Physiology ,business.industry ,medicine.medical_treatment ,Gastroenterology ,Inflammation ,Spleen ,biology.organism_classification ,Tacrolimus ,chemistry.chemical_compound ,Propionibacterium acnes ,medicine.anatomical_structure ,Endocrinology ,chemistry ,Internal medicine ,Immunology ,medicine ,Tumor necrosis factor alpha ,medicine.symptom ,business ,Saline - Abstract
The aim of the study was to investigate the effect of the immunosuppressant FK 506 (tacrolimus hydrate) on acute liver injury induced by Propionibacterium acnes and lipopolysaccharide (LPS). Acute liver injury was induced in male Wistar rats by injecting the animals with P. acnes (10 mg/rat), and administering LPS (10 μg/rat) seven days later. One group was given FK 506 (1 mg/kg) 24 and 2 hr before administration of LPS, and the other group was given the same dose of saline. The 24-hr survival rate, serum alanine aminotransferase (ALT) concentration, and tumor necrosis factor (TNF) -α mRNA and protein concentrations in the liver and spleen were then compared. Hepatic macrophages were also isolated from rats seven days after P. acnes injection, LPS, and FK 506 or saline were added to the culture supernatant, and TNF-α production was studied. The 24-hr survival rate was 100% in the FK 506-treated group, in contrast with 16.6% in the saline group. Four hours after LPS injection, the serum ALT concentration was 755 ± 401 in the saline group versus 119 ± 42 units/ml (P < 0.01) in the FK 506-treated group. The serum TNF-α concentration was lower in the FK 506-treated group (1419 ± 957 pg/ml) than in the saline group (9205 ± 2215) (P < 0.01). The mRNA and protein concentrations in the liver and spleen in the two groups did not differ significantly 1 hr after LPS injection but were significantly lower in the FK 506-treated group after 4 hr. FK 506 did not directly inhibit TNF-α production by isolated cultured hepatic macrophages. FK 506 is unable to inhibit initial TNF-α production by hepatic macrophages (or probably that by splenic macrophages either) stimulated by injection of LPS in P. acnes + LPS-induced acute liver injury. However, the immunosuppressant does limit hepatic damage by inhibiting subsequent aggravation of inflammation by the cytokine network.
- Published
- 2000
41. [Untitled]
- Author
-
Kiwamu Okita, Koji Hironaka, Koichi Uchida, and Isao Sakaida
- Subjects
Diminution ,medicine.medical_specialty ,Physiology ,Cell growth ,medicine.medical_treatment ,Gastroenterology ,Glutathione ,Biology ,Pathogenesis ,chemistry.chemical_compound ,Endocrinology ,medicine.anatomical_structure ,chemistry ,Internal medicine ,Hepatocyte ,Parenchyma ,medicine ,Saline ,Bromodeoxyuridine - Abstract
Injection of pig serum into rats twice a week for eight weeks induced transforming growth factor-β1 (TGF-β1) mRNA expression and protein production resulting in liver fibrosis without parenchymal cell injury. Eight-week treatment with pig serum reduced bromodeoxyuridine (BrdU) -positive hepatocytes 24 hr after 70% partial hepatectomy compared to that in the livers of rats treated with saline for eight weeks. Administration of a choline-deficient l-amino acid-defined (CDAA) diet for six weeks with pig serum coadministration, after pretreatment with pig serum for eight weeks, led to the development of preneoplastic lesions that were positive for the placental form of glutathione S-transferase (GSTP). Eight-week pretreatment with pig serum induced more GSTP-positive lesions and TGF-β1 mRNA expression and protein concentration in the livers of rats subsequently fed a CDAA diet for six weeks than in rats fed the CDAA diet with saline treatment. These results indicate that TGF-β1 induced by pig serum treatment inhibited hepatocyte proliferation but failed to prevent the development of preneoplastic lesions in a CDAA diet model.
- Published
- 2000
42. Management background, corporate governance and industrial restructuring: the Japanese upstream petroleum industry
- Author
-
Koichi Uchida and Gerald Pollio
- Subjects
Upstream (petroleum industry) ,General Energy ,Market economy ,Economy ,Restructuring ,Corporate governance ,Financial result ,Economics ,Audit ,Management, Monitoring, Policy and Law ,Industrial policy ,Private sector ,Financial market efficiency - Abstract
Japanese upstream companies have consistently underperformed private independents. A recent audit by the Ministry of International Trade and Industry (MITI) underlines the magnitude of financial losses and the necessity for sectoral restructuring. MITI's proposals involve refocusing rather than redefining upstream policy, including recognition that official intervention should be reduced in favour of greater control by the more successful local production companies. Some commentators claim the proposed reforms do not go far enough. The ultimate success of MITI's initiatives, it is claimed, depends upon changes in prevailing corporate governance arrangements and the progressive replacement of existing senior managers with those having superior professional or technical qualification. These changes have not been directly mandated by Japanese authorities. On the other hand, MITI's proposals do imply a redisrtribution of corporate oversight in favour of greater market control, a major step in the direction of increased operational and financial efficiency.
- Published
- 1999
43. Differentiation and Angiogenesis of Central Nervous System Stem Cells Implanted with Mesenchyme into Ischemic Rat Brain
- Author
-
Takeshi Kawase, Atsushi Fukunaga, Koichi Uchida, Koichi Hara, and Yoshiaki Kuroshima
- Subjects
Male ,0301 basic medicine ,Tyrosine 3-Monooxygenase ,Mesenchyme ,Central nervous system ,Biomedical Engineering ,Neovascularization, Physiologic ,lcsh:Medicine ,Morris water navigation task ,Arterial Occlusive Diseases ,Biology ,Brain Ischemia ,Mesoderm ,03 medical and health sciences ,Cognition ,0302 clinical medicine ,Fetal Tissue Transplantation ,Neurofilament Proteins ,Rats, Inbred SHR ,Reaction Time ,medicine ,Animals ,Brain Tissue Transplantation ,Spontaneous hypertensive rat ,Maze Learning ,Cerebral Cortex ,Neurons ,Transplantation ,Cerebral infarction ,Stem Cells ,Graft Survival ,lcsh:R ,Mesenchymal stem cell ,Age Factors ,Cell Differentiation ,Cerebral Infarction ,Cell Biology ,Anatomy ,medicine.disease ,Corpus Striatum ,Rats ,030104 developmental biology ,medicine.anatomical_structure ,Stem cell ,Neural plate ,030217 neurology & neurosurgery ,Stem Cell Transplantation - Abstract
After cerebral infarction, necrosis in neural tissues is not usually repaired or reconstructed by the injured brain. We therefore examined the effects on postinfarction repair of implanting central nervous system (CNS) stem cells together with mesenchyme, because CNS stem cells can be expected to adapt and survive in the adult brain. Cerebral infarction was induced by the Koizumi-Longa method, using the adult male spontaneous hypertensive rat model. Reperfusion was performed an hour after middle cerebral artery occlusion. The rat mesencephalic neural plate at the early somite stage (embryonic day 10.5) together with the adjacent ventral mesenchymal tissues was dissected out under the microscope and immediately implanted into the ischemic rat striatum. One month later, the cognitive function was evaluated by the Morris water maze method. Histologic and immunohistochemical examinations of the graft were made with hematoxylin-eosin (H&E), neurofilament-200, and tyrosine hydroxylase (TH) stains. In the water maze study, mean latency times required to reach an escape platform in the implanted animals with surviving grafts were found to be shorter than in those without grafts, but longer than in normal animals. In the spatial probe trial, the number of animals seen to cross the area in the pool where the platform had been located was greater in the implanted rats with surviving grafts than in other groups. Multiple vascularization in the grafted area was observed histologically in H&E-stained tissues, and neurofilament-200-positive cells were recognized in the graft. TH staining revealed within the graft many immunoreactive neuron-like cell bodies with long dendrites. It was suggested that grafted CNS stem cells with mesenchyme may survive and differentiate into mature CNS tissue within the adult ischemic rat brain, constructing vessels in and around the grafts, and may therefore have the potential to be effective in the recovery of the cognitive function of the rat model.
- Published
- 1999
44. Quantitative Analysis of Liver Fibrosis and Stellate Cell Changes in Patients With Chronic Hepatitis C After Interferon Therapy
- Author
-
Koichi Uchida, Atsuko Nagatomi, Koji Hironaka, Isao Sakaida, and Kiwamu Okita
- Subjects
Adult ,Liver Cirrhosis ,Male ,Pathology ,medicine.medical_specialty ,Biopsy ,medicine.medical_treatment ,Hepacivirus ,Hepatitis C virus ,Alpha interferon ,medicine.disease_cause ,Antiviral Agents ,Interferon ,Fibrosis ,Image Processing, Computer-Assisted ,medicine ,Humans ,skin and connective tissue diseases ,Hepatology ,biology ,business.industry ,Gastroenterology ,Interferon-alpha ,Muscle, Smooth ,Interferon-beta ,Immunotherapy ,Hepatitis C ,Hepatitis C, Chronic ,Middle Aged ,medicine.disease ,biology.organism_classification ,Actins ,Recombinant Proteins ,Microscopy, Electron ,Liver ,Case-Control Studies ,Interferon Type I ,Hepatic stellate cell ,Female ,sense organs ,business ,medicine.drug - Abstract
The proliferation and differentiation of stellate (Ito, or fat-storing) cells into myofibroblast-like cells is responsible for the development of liver fibrosis. Using computer image analysis, we evaluated the changes of alpha smooth muscle actin-positive stellate cells and liver fibrosis after interferon-alpha or -beta (IFN-alpha, beta) therapy in patients with chronic hepatitis C.Patients with chronic hepatitis C were treated with IFN-alpha or -beta and were divided into three groups on the basis of clinical criteria; a complete responder group (CR, 18 of 51), a partial responder group (PR, 17 to 51), and a nonresponder group (NR, 16 of 51). Liver fibrosis was assessed from specimens stained with Sirius red and was quantitated by computer image analysis. We also evaluated alpha-smooth muscle actin expression in the liver before and after IFN therapy by a semiquantitative scoring method (the alpha-smooth muscle actin index).Before IFN therapy, a large number of stellate cells expressing a-smooth muscle actin were present in the liver biopsy specimens. There was a significant correlation (r = 0.699, p0.05) between the change in the percent area of fibrosis and the alpha-smooth muscle actin index before and after IFN therapy in all groups. The complete responder group also showed a significant reduction of a-smooth muscle actin-expressing cells that was correlated with the reduction of serum ALT (r = 0.686, p0.05).These results suggest a-smooth muscle actin-expressing cells are responsible for liver fibrosis, and the elimination of factors stimulating matrix synthesis (e.g., hepatitis virus) may decrease liver fibrosis.
- Published
- 1999
45. Neuropsychological evaluation and cerebral blood flow study of 30 patients with unruptured cerebral aneurysms before and after surgery
- Author
-
Takeshi Kawase, Koichi Uchida, Jun Hashimoto, and Atsushi Fukunaga
- Subjects
Adult ,Male ,medicine.medical_specialty ,medicine.medical_treatment ,Neuropsychological Tests ,Asymptomatic ,Aneurysm ,medicine.artery ,Preoperative Care ,medicine ,Humans ,Postoperative Period ,cardiovascular diseases ,Craniotomy ,Aged ,business.industry ,Intracranial Aneurysm ,Middle Aged ,medicine.disease ,Surgery ,Anterior communicating artery ,Treatment Outcome ,medicine.anatomical_structure ,Cerebral blood flow ,Cerebrovascular Circulation ,Middle cerebral artery ,cardiovascular system ,Female ,Neurology (clinical) ,Radiology ,Internal carotid artery ,medicine.symptom ,Cerebellar artery ,business - Abstract
We have recently had many opportunities to operate on patients who presented with no neurologic deficits and were incidentally detected to have unruptured cerebral aneurysms. Therefore, it is very important to know how craniotomy affects the normal brain when making decisions regarding surgery for asymptomatic cerebral diseases.Thirty patients with unruptured cerebral aneurysms were evaluated. Aneurysm sites were as follows: internal carotid artery (ICA) (eight cases), anterior communicating artery (ACoA) (seven), middle cerebral artery (MCA) (five), basilar artery-superior cerebellar artery (BA-SCA) (two), and multiple aneurysms (three) [bilateral MCA: (two), ICA + Basilar top: (one)]. These patients underwent neuropsychological examinations [the Mini-Mental State (MMS) test, the "Kana-hiroi" test, and the "Maze" test] and single photon emission computed tomography (SPECT) before and after surgery.The details of the 17 cases whose Kana-hiroi tests deteriorated 1 month after surgery are as follows: ACoA: seven, MCA: five, ICA: three, BA: two. SPECT showed a decrease in CBF in nine cases (ACoA: six, ICA: two, MCA: one). There was a statistically significant difference (p0.05) between patients with ACoA aneurysms and ICA aneurysms. Three months after operation, all of the patients with neuropsychological deterioration and four of the six low CBF patients recovered to preoperative levels.These results indicated that the operation for unruptured cerebral aneurysms is moderately safe and meaningful; such a study should be required to determine when those patients could return to normal life.
- Published
- 1999
46. [Untitled]
- Author
-
Koji Hironaka, Isao Sakaida, Koichi Uchida, and Kiwamu Okita
- Subjects
chemistry.chemical_classification ,Liver injury ,Iron Chelator ,Pathology ,medicine.medical_specialty ,Chemotherapy ,Physiology ,business.industry ,medicine.medical_treatment ,Gastroenterology ,Hepatology ,medicine.disease ,Amino acid ,Deferoxamine ,chemistry.chemical_compound ,Endocrinology ,chemistry ,Internal medicine ,medicine ,Hepatic stellate cell ,Choline ,business ,medicine.drug - Abstract
The aim of this study was to investigate wheThe ran iron chelator, deferoxamine (DFO) can prevent lipidperoxidation, resulting in reduced liver injury as wellas reducing preneoplastic lesions induced by a choline-deficient L-amino acid-defined(CDAA) diet. CDAA diet administration resulted in anincreased serum ALT level (367 ± 58) after twoweeks, but simultaneous DFO treatment for two weeksreduced this elevation of ALT as well asmalondialdehyde (MDA) production in the liver. Feedingrats a CDAA diet for 12 weeks led to the development ofsevere liver fibrosis and preneoplastic lesions detectedas enzymealtered lesions. DFO treatment preventedthe expression of activated stellate cells, resulting inThe reduction of liver fibrosis as well as reducing thedevelopment of preneoplastic lesions. These results indicate that iron chelation can reducethe development of preneoplastic lesions in a CDAA dietmodel.
- Published
- 1999
47. Fibrosis accelerates the development of enzyme-altered lesions in the rat liver
- Author
-
Koichi Uchida, Koji Hironaka, Isao Sakaida, Kozo Kayano, Chieko Suzuki, and Kiwamu Okita
- Subjects
Male ,medicine.medical_specialty ,Swine ,Biology ,Liver Cirrhosis, Experimental ,Choline ,Lesion ,chemistry.chemical_compound ,Hydroxyproline ,Fibrosis ,Malondialdehyde ,Internal medicine ,Parenchyma ,medicine ,Animals ,RNA, Messenger ,Amino Acids ,Rats, Wistar ,Glutathione Transferase ,Hepatology ,Liver Neoplasms ,Glutathione ,medicine.disease ,Actins ,Diet ,Rats ,Blood ,Endocrinology ,Liver ,chemistry ,Hepatic stellate cell ,medicine.symptom ,Precancerous Conditions - Abstract
Injection of pig serum into rats twice a week for 8 weeks induced stellate cell activation resulting in liver fibrosis without parenchymal cell injury. Administration of a choline deficient L-amino acid defined (CDAA) diet for 6 weeks with or without pig serum pretreatment led to the development of preneoplastic lesions that were positive for the placental form of glutathione S-transferase (GSTP). Pig serum pretreatment induced more activated stellate cells in the livers of rats subsequently fed a CDAA diet for 6 weeks compared with rats fed the CDAA diet alone. Activated stellate cells were detected as α smooth muscle actin (αSMA)-positive cells and by the expression of αSMA messenger RNA. These cells caused severe fibrosis as assessed by the hepatic hydroxyproline content. Pre-existing fibrosis induced by the activation of stellate cells with pig serum pretreatment increased hepatic malondialdehyde (MDA) level in parallel with GSTP-positive lesions. These results indicate that pre-existing fibrosis with the activated stellate cells accelerates the development of preneoplastic lesions in a CDAA diet model.
- Published
- 1998
48. Inhibitory effects of the herbal medicine Sho-saiko-to (TJ-9) on cell proliferation and procollagen gene expressions in cultured rat hepatic stellate cells
- Author
-
Kiwamu Okita, Koichi Uchida, Kozo Kayano, and Isao Sakaida
- Subjects
Liver Cirrhosis ,Male ,Pathology ,medicine.medical_specialty ,Cirrhosis ,Liver cytology ,Fibrosis ,Adipocytes ,medicine ,Animals ,RNA, Messenger ,Rats, Wistar ,Cells, Cultured ,Sho-saiko-to ,Hepatology ,Cell growth ,business.industry ,Cell Cycle ,Flow Cytometry ,medicine.disease ,Molecular biology ,Rats ,Procollagen peptidase ,Liver ,Cell culture ,Hepatic stellate cell ,business ,Cell Division ,Procollagen ,Drugs, Chinese Herbal - Abstract
It is of extreme importance to prevent liver fibrosis and subsequent progression to liver cirrhosis. The aim of our study was to elucidate in vitro whether Sho-saiko-to exerted inhibitory effects on hepatic stellate cells.Hepatic stellate cells were isolated from male Wistar rats. Water-soluble ingredients of Sho-saiko-to were obtained at concentrations of 10, 100, 250, 500 and 1000 microg/ml. Morphological transformation was observed under a phase-contrast microscope. Flow cytometric analysis was performed on day 4 after culture to evaluate the potential to proliferate of the stellate cells by analyzing cell cycles. Northern blot analysis was carried out on day 3 after culture to determine the expressions of type I and type III procollagen mRNAs.(i) Sho-saiko-to 500 and 1000 microg/ml inhibited morphological transformation of the stellate cells to myofibroblast-like cells. (ii) Sho-saiko-to 500 and 1000 microg/ml significantly (p0.0001) accumulated the cells in the G0/G1 phase (118.8+/-0.7%, 119.2+/-0.5%, respectively as compared with control) and significantly (p0.0001) decreased cell numbers subsequently in G2/M phase (47.5+/-8.1%, 48.9+/-2.0%, respectively). (iii) Sho-saiko-to 500 and 1000 microg/ml also significantly (p0.05 or p0.0001) suppressed procollagen mRNA expression of type I to 51.5+/-6.4%, 34.9+/-3.7%, respectively, and type III to 51.3+/-12.3%, 46.7+/-11.4%, respectively.We have clarified the inhibitory effects of Sho-saiko-to on hepatic stellate cells in vitro. Sho-saiko-to could be a potent inhibitor in the pathogenesis of liver fibrosis.
- Published
- 1998
49. Interferon γ- but not α-treatment prevents fibrosis by inhibiting procollagen and tissue inhibitor of metalloproteinase-1 gene expression in pig serum-induced rat liver fibrosis in vivo
- Author
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Kozo Kayano, Koji Hironaka, Koichi Uchida, Chieko Suzuki, Kiwamu Okita, and Isao Sakaida
- Subjects
Hepatology ,Biology ,Tissue inhibitor of metalloproteinase ,medicine.disease ,Molecular biology ,Procollagen peptidase ,Infectious Diseases ,medicine.anatomical_structure ,Fibrosis ,Interferon ,In vivo ,Hepatocyte ,Immunology ,medicine ,Hepatic stellate cell ,Interferon gamma ,medicine.drug - Abstract
The aim of this study was to investigate the effect of interferons- γ (IFN- γ ) and - α (IFN- α ) on the synthesis of matrix proteins such as collagens as well as the gene expression of tissue inhibitor of metalloproteinase-1 (TIMP-1) in vivo. We investigated the effects of IFN- γ and - α in a model of liver fibrosis induced by pig serum in male Wistar rats, which develop fibrosis without an increase in serum ALT (i.e. without hepatocyte injury). Rats were injected with 0.5 ml of pig serum twice a week for 8 weeks with or without 50 000 U of IFN- γ or 100 000 U of IFN- α . IFN- γ at the dose of 50 000 U day −1 prevented fibrosis, as indicated by reduced hydroxyproline content in the liver. IFN- γ at 50 000 U day −1 also reduced expression of type I procollagen as well as TIMP-1 in the liver. However, fibrosis was not reduced by IFN- α . Histologically, IFN- γ at 50 000 U day −1 also reduced the number of myofibroblast-like cells (activated stellate cells). These results indicate that IFN- γ , but not IFN- α , can prevent fibrosis by inhibiting the activation and proliferation of stellate cells, resulting in reduced expression of procollagen and TIMP-1 mRNA in pig serum-induced rat liver fibrosis in vivo.
- Published
- 1998
50. A Simple and Early Prognostic Index for Acute Renal Failure Patients Requiring Renal Replacement Therapy
- Author
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Hideyasu Kiyomoto, Hirohide Matsuo, Shigekazu Yuasa, Koichi Uchida, Hiroshi Fujioka, Mayuko Hashimoto, Norihiro Takahashi, Hirofumi Hitomi, Tetsuo Shoji, and Y. Fujita
- Subjects
Adult ,Male ,medicine.medical_specialty ,Adolescent ,medicine.medical_treatment ,Population ,Biomedical Engineering ,Medicine (miscellaneous) ,Bioengineering ,Biomaterials ,Risk Factors ,Oliguria ,Internal medicine ,medicine ,Humans ,Renal replacement therapy ,Child ,education ,Aged ,Retrospective Studies ,Aged, 80 and over ,Heart Failure ,Mechanical ventilation ,Univariate analysis ,education.field_of_study ,business.industry ,Mortality rate ,Acute kidney injury ,General Medicine ,Acute Kidney Injury ,Middle Aged ,Prognosis ,medicine.disease ,Respiration, Artificial ,Surgery ,Renal Replacement Therapy ,Heart failure ,Multivariate Analysis ,Cardiology ,Female ,medicine.symptom ,business ,Liver Failure - Abstract
Recent advances in technology have not substantially changed the high mortality rate associated with acute renal failure (ARF). To obtain a simple, valid prognostic index, we retrospectively evaluated the relative importance of demographic data, causes (acute insults) of renal failure, and comorbid clinical conditions for the outcome in 102 ARF patients who received renal replacement therapy with an overall mortality rate of 65% (66 of 102). There were no significant differences between survivors and nonsurvivors in age and gender. Mortality according to acute insults was similar to that of the whole population studied. Of the 10 clinical conditions at the time of the first renal replacement therapy, mechanical ventilation (p = 0.0002), cardiac failure (p = 0.0006), hepatic failure (p = 0.003), central nervous system dysfunction (p = 0.005), and oliguria (p = 0.04) were found to be significantly related to mortality by univariate analysis. Furthermore, multivariate analysis demonstrated that only mechanical ventilation, cardiac failure, and hepatic failure were significant risk factors. Survival was directly related to the number of significant variables in univariate analysis: zero, 89% (8 of 9); one, 62% (21 of 34); two, 19% (5 of 27); three, 10% (2 of 20); four, 0% (0 of 8); five, 0% (0 of 4). This simple and early prognostic index, derived from the assessment of clinical conditions which were easily determined at the patient's bedside, could be useful for outcome prediction in ARF patients requiring renal replacement therapy.
- Published
- 1998
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