Futoshi Iida

Adjuvant radiotherapy after complete resection of thymoma

Seventy patients were studied after undergoing complete resection of thymoma to determine the effect of postoperative adjuvant mediastinal radiotherapy on prognosis, with regard to clinical stage, histological type, and pleural factor. Pleural factor was defined as follows: p0, no adhesion to the mediastinal pleura; p1, fibrous adhesion to the mediastinal pleura without microscopic invasion; and p2, microscopic invasion of the mediastinal pleura. Recurrence of thymoma after complete resection was observed in 13 patients, 12 (92%) with pleural dissemination, 6 (46%) with local recurrence, and 2 (15%) with distant metastasis (types of recurrence are overlapping). In stage I and stage II p0 patients, no recurrence was observed, regardless of mediastinal radiotherapy. Whereas mediastinal irradiation completely prevented recurrence in stage II p1 patients, 4 (36.4%) nonirradiated stage II p1 patients experienced recurrence. In stage II p2 patients, 75% had pleural dissemination even after radiotherapy. A high incidence of recurrence was also observed in stage III, nonirradiated (25%) and irradiated (30%) patients. The results suggest that mediastinal irradiation for stage I and II p0 patients is not always necessary, and that therapy for stage II p1 is essential and also expected to decrease the recurrence rate. On the other hand, in stage II p2 and stage III thymomas, mediastinal irradiation is not sufficient to prevent pleural recurrence even after complete resection. Our classification based on pleural factor is useful for better selection of appropriate postoperative treatment for thymoma patients.

Analysis of thyroid carcinoma based on material registered in japan during 1977-1 986 with special reference to predominance of papillary type

Background. As geographic differences have been observed in the characteristics of thyroid carcinoma, an analysis was made on thyroid carcinoma in the iodine rich country of Japan.

Photoinduced prevention of tissue adhesion.

Postoperative tissue adhesion causes retarded wound healing and the need for reoperation; it can even be life threatening. In this report, the authors present prototype materials and performance of newly developed tissue adhesion prevention technology based on photocurable polysaccharides. Polysaccharides used were hyaluronic acid and chondroitin sulfate, both of which were partially derived with photoreactive groups such as cinnamoyl, coumarin, and thymine. Photoreactive hyaluronic acids with low degrees of derivatization were soluble in water. Films of cinnamated hyaluronic acid or an aqueous solution of cinnamated chondroitin sulfate were photocured by ultraviolet irradiation, resulting in water adsorbable films or water swollen gels, respectively. Gelation was due to intermolecular dimerization between cinnamoyl groups. The authors provide two potentially applicable examples: 1) a photocured, water swollen hydrogel film, and 2) a photocurable chondroitin sulfate buffer solution. The authors used hydrogel films to cover the peritoneum after mechanically injuring its surface. Histologic examination showed neither tissue nor cell adhesion, and only a minimal inflammatory response. When tissues were coated with a photocurable chondroitin sulfate solution, the viscous solution was converted to a hydrogel upon ultraviolet irradiation, resulting in in situ tissue covering. Although an optimal molecular design has not yet been found, unique features of mucopolysaccharides (e.g., high water uptake; biodegradability and bioresorbability; and nontoxicity of photodimerizable groups) may result in the development of photoinduced tissue adhesion prevention technology.

Proliferative activity of human thyroid tumors evaluated by proliferating cell nuclear antigen/cyclin immunohistochemical studies

Background. To clarify the proliferative activity of human thyroid tumors, the labeling index of various thyroid tumors was evaluated by proliferating cell nuclear antigen (PCNA)/cyclin immunostaining.

Study of intraglandular dissemination of thyroid cancer

Pathohistologic studies were carried out for 186 nodules in 171 cases of thyroid cancer treated in the surgical clinic during the last 14 years. No definite relationship was found between the intraglandular dissemination and the size of cancer nodules. In the relationship between the intraglandular dissemination and histologic type of cancer, frequency of the intraglandular dissemination is definitely low in papillary adenocarcinoma. In the relationship between the intraglandular dissemination and the degree of histologic extension, advance in extension is accompanied by the increasing of the frequency of the intraglandular dissemination. In the cases with positive lymph node metastasis, the frequency of the intraglandular dissemination was higher than in the cases with negative metastasis. The intraglandular dissemination was definitely more frequent in the cases with recurrence or multiple occurrence than in the cases with single occurrence without recurrence. Based on these facts, recurrence is probably due to leaving the disseminated lesions in the remaining tissue, and the cases of multiple occurrence develop as die result of the growth of the intraglandular dissemination.

Gastric carcinoma and intestinal metaplasia. Significance of types of intestinal metaplasia upon development of gastric carcinoma.

For clarifying significance of subtypes of intestinal metaplasia upon the development of stomach carcinoma, 34 stomachs surgically removed for mucosal carcinoma were morphologically studied. Intestinal metaplasia was divided into incomplete and complete types by alcian blue‐PAS staining. The incomplete type has been understood as an immature stage of the development of the metaplasia as previously reported by us. In this study, it was revealed that the incomplete type of metaplasia showed more dysplastic features than the complete type. Analysis of the metaplasia of the gastric mucosa surrounding cancer tissue revealed that well differentiated adenocarcinoma frequently came into contact with the incomplete type of metaplasia in small cancer, less than 1 cm. This relationship became less evident as carcinoma became larger. In poorly differentiated carcinoma, however, any correlations between types of metaplasia and size of cancer were not demonstrated. From these results, it was suggested that well differentiated adenocarcinoma arises from the incomplete type of metaplasia.

Development of a hierarchically structured hybrid vascular graft biomimicking natural arteries.

A hierarchically structured hybrid vascular graft, resembling the layered structure of the intima and the media of a natural artery, is expected to exhibit structural stability and function similar to those of an artery. Two models of hybrid vascular grafts were constructed on knitted Dacron grafts (internal diameter, 4 mm; length, 6 cm; Golaski Laboratories, Inc., Philadelphia, PA) in vitro. The model I graft consisted of only an endothelial cell (EC) monolayer, and the model II graft was hierarchically structured with an EC monolayer and smooth muscle cell (SMC) multilayers embedded in a mixed gel of type I collagen and dermatan sulfate. Both models were implanted bilaterally in carotid arteries of 11 dogs for up to 12 weeks without anticoagulant. All grafts were patent after the implantation. There was a marked difference in the formation of the neomedia between the two models at 2 weeks: only a collagenous layer was observed beneath the EC monolayer in model I grafts, whereas the reconstructed neomedia consisting of proliferating SMCs and extracellular matrix was observed in model II grafts. In model I grafts at 2 weeks, the luminal surface with a wavelike form, along with crimps of the vascular graft, was almost endothelialized, but EC orientation was disorganized at the troughs of the crimps. Leukocyte adhesion on ECs and migration into their interstices were observed in some areas. Such events were infrequent in model II grafts at 2 weeks. Model II grafts at 12 weeks had an integrated neomedia comparable to that of a natural artery: SMCs exhibited dense accumulation and circumferential orientation.(ABSTRACT TRUNCATED AT 250 WORDS)

Histochemical Studies of Mucosubstances in Metaplastic Epithelium of the Stomach, with Special Reference to the Development of Intestinal Metaplasia

SummaryProcesses in the development of intestinal metaplasia of the stomach were investigated from the morphological and histochemical approaches using light and electron microscopic techniques. The specimens taken from 38 gastric carcinomas and 15 gastric and/or duodenal ulcers were subjected to this study. Morphological appearances of the intestinal metaplasia observed in routine examination with hematoxylin and eosin staining was able to be divided into complete and incomplete metaplasia by the light and electron microscopic histochemical stainings of the mucosubstances. The columnar cells at the area of the incomplete metaplasia had both the properties of the intestinal epithelia and the gastric foveolar epithelia. The incomplete as well as the complete metaplasia arose from the generative cells at the isthmus of the gland. The generative cells, however, sometimes gradually transformed to produce the complete metaplastic cells. The two processes of the development of the intestinal metaplasia were proposed and discussed.

Epidermal growth factor receptor on human thyroid neoplasms.

AbstractMorphological observation of epidermal growth factor receptor (EGF-R) was attempted for human thyroid neoplasms, and the results were evaluated compared with the various histological types. Thirty-four malignant tumors, 24 benign tumors, 7 adenomatous goiters, and 7 normal thyroid tissues obtained at surgery were subjected to this study. They were fixed in 10% formalin solution, embedded in paraffin. After sectioning at 4μm, immunohistochemical staining by avidin-biotin-peroxidase complex technique was performed employing anti-human EGF-R monoclonal antibody. Both normal thyroid tissues and benign adenomas showed no apparent immunoreactive staining. The majority of the malignant tumors, however, demonstrated dark brown reaction products indicating location of EGF-R on the cell surface, cytoplasm, and nuclear envelope. Medullary and anaplastic carcinomas were stained more intensively than papillary and follicular carcinomas. In adenomatous goiter, the immunoreactive products were occasionally observed on the follicular cells of some limited areas, whereas its staining pattern was different from the malignant neoplasms. The correlative study between UICC classification of thyroid tumors and EGF-R staining in the papillary carcinoma revealed a higher frequency of positive staining in cases of multifocal metastasis.RésuméDans cette étude, on a mis en évidence le récepteur du facteur de croissance épithélial (R-FCE) dans les tumeurs de la thyroïde. Les caratéristiques immunohistologiques ont été étudiés dans les différentes variétés histologiques.On a donc étudié 34 tumeurs malignes, 24 tumeurs bénignes, 7 goitres adénomateux, et 7 pièces comportant du tissu normal, prélevés lors de la chirurgie de la thyroïde. Tous les tissus ont été fixés au formol à 10% et inclus dans de la paraffine. Après des coupes de 4μm, on a effectué une coloration immunohistochimique par la technique du complexe avidine-biotineperoxydase en utilisant des anticorps R-FCE humains monoclonaux.La coloration des tissus normaux et des adénomes bénins était apparemment immunonégative. La plupart des tumeurs malignes cependant ont montré des substances marron foncé, indiquant la présence de R-FCE sur la surface cellulaire, dans le cytoplasme et sur la membrane du noyau. Les cancers anaplasiques et médullaires ont présenté une coloration plus intense que celle des cancers papillaires et folliculaires. Dans le goitre adénomateux, on a mis en évidence, par endoit, des substances immuno-réactives dans quelques cellules folliculaires, mais les résultats de coloration différait de ceux obtenus dans les tumeurs malignes.Une étude de corrélation entre la classification UICC des tumeurs thyroïdiennes et la coloration R-FCE des cancers papillaires, a démontré une fréquence accrue de coloration positive en cas de métastases multifocales.ResumenEl factor de crecimiento epidermal (FCE) es un subgrupo de diversos polipéptidos de crecimiento involucrados en la regulación del crecimiento y diferenciación celulares. El FCE se liga a receptores específicos (FCE-R) de la membrana celular de sus órganos blanco (target organs); es considerado como un oncogen por su homología con el oncogen transformador v-erb B del virus de la eritroblastosis de las aves. Se ha demostrado la presencia de FCE-R en algunos tumores del esófago, estómago, seno, vejiga, pulmón, cerebro, ovario, y útero. La identificación del FCE-R es esencial en la yaloración del comportamiento biológico de los tumores sólidos. Este trabajo demuestra la reactividad de un anticuerpo monoclonal anti FCE-R con células de neoplasmas tiroideas así como la ubicación de FCE-R.El estudio tuvo como propósito la observación morfológica de FCE-R en neoplasmas tiroideos y su comparación con los diversos tipos histológicos.Treinta y cuatro tumores malignos, 24 tumores benignos, 7 bocios adenomatosos, y 7 tejidos normales obtenidos durante la cirugía fueron sometidos a estudio. Los especímenes fueron fijados en solutión de formol al 10% incluídos en parafina. Una vez seccionados a un espesor de 4μm, se realizó la coloración inmunohistoquímica con la técnica del complejo de avidinabiotina-peroxidasa empleando un anticuerpo monoclonal murino contra FCE-R humano.Tanto los tejidos tiroideos normales como los adenomas benignos exhibieron ausencia de coloración inmunorreactiva. Sin embargo, la mayoría de los tumores malignos demostraron la presencia de productos con una reacción marrón oscura indicativa de la ubicación de FCE-R en la superficie celular, el citoplasma, y la envoltura nuclear. Los carcinomas medulares y anaplásicos aparecieron con coloraciones más intensas que los carcinomas papilares y foliculares. En el bocio adenomatoso los productos inmunorreactivos fueron ocasionalmente observados en las células foliculares de áreas limitadas, al tiempo que su patrón de coloración fue diferente del de los neoplasmas malignos.El estudio correlativo entre la clasificación de la UICC (Union International Contra el Cáncer) de los tumores tiroideos y la coloración de FCE-R en el carcinoma papilar demostró una mayor frecuencia de coloración positiva en casos con metastasis multifocales.De los resultados del estudio se puede concluír que: (a) el carcinoma tiroideo puede poseer mayor cantidad de FCE-R y mayor afinidad de ligazón que el tumor benigno, (b) la presencia de FCE-R puede correlacionarse con los diversos grados de malignidad en el carcinoma tiroideo, (c) el bocio adenomatoso puede poseer algún potencial de malignidad.

Calcium regulating hormones and bone mineral content in patients after subtotal gastrectomy

Twenty-nine men who had undergone Billroth I gastrectomy and 19 men who had undergone Billroth II gastrectomy were studied to examine the changes in their calcium regulating hormones and bone mineral content following surgery. The serum calcium and phosphate concentrations in the patients with Billroth I and Billroth II were normal. The Billroth II group had an elevated level of serum alkaline phosphatase and reduced bone mineral content. The 24,25(OH)2D concentration was reduced (P<0.01) and 25(OH)D and 1,25(OH)2D concentrations were increased (P<0.01,P<0.05, respectively) in the Billroth II group. It was suggested by our study that the Billroth II patients had a reduced bone mineral content and an elevated 1,25(OH)2D concentration. Therefore, the pathophysiology of postgastrectomy bone metabolic disease is not due to vitamin D deficiency, but may instead be due to reduced calcium absorption in the intestine.