Biomedical subjects
A Kondo
Publications and source records attributed to A Kondo.
Radiation-induced urothelial carcinoma.
Four cases of urothelial carcinoma following pelvic irradiation for carcinomas of the cervix uteri (n = 3) and the ovary (n = 1) are reported. The urothelial carcinomas developed 26.8 (mean) years after radiotherapy and invaded the bladder in 3 patients and the ureter in 1. Despite radical surgery, the patients died of metastatic cancer.
Effect of magnesium on the contraction of whole rabbit bladder in vitro.
Smooth muscle function, including that of the bladder, is mediated by changes in the intracellular concentration of calcium. Magnesium modulates the transport of calcium and may modify bladder function. This study was designed to investigate the effect of magnesium on the response of rabbit whole bladder to field stimulation in vitro. The response to field stimulation was decreased by magnesium in a concentration-dependent manner. Verapamil significantly enhanced the suppressive effect of magnesium, whereas BAY-K8644 decreased the effect of magnesium. The detrusor response to field stimulation was not changed by increased osmolarity. Results suggest that magnesium reduced the intramural nerve-stimulated contraction of rabbit whole bladder by a mechanism involving L-type calcium channels.
Establishment and evaluation of a new chemiluminescent enzyme immunoassay for carcinoembryonic antigen adapted to the fully automated ACCESS system.
We have established a new chemiluminescent enzyme immunoassay for carcinoembryonic antigen (CEA), designated ACCESS CEA, which is adapted to the fully automated ACCESS immunoassay analyzer. The assay is based on a one step sandwich-type method using two monoclonal antibodies, one of which is immobilized on micrometer-size paramagnetic particles and the other is conjugated to alkaline phosphatase. Ten microliters of calibrators or sera are incubated for 5 minutes at 37 degrees C with the particles and with the alkaline phosphatase conjugate. The particles are then magnetically separated and washed to remove unbound components. Time needed to obtain the first result is less than 15 minutes. The assay range was 0.04-1000 micrograms/l of CEA, and the possible high-dose hook effect was prevented at CEA concentrations up to 100000 micrograms/l in this working range. The coefficient of variation (CV) for intra-assay precision was 3.0 to 4.7%, and inter-assay CV was 3.4 to 5.6%. The sample carryover was less than 0.001%. The analytical recovery ranged from 98 to 104% and a dilution linearity was demonstrated. No interference was detected in any sample with levels up to 300 mg/l for bilirubin, 12000 mg/l for haemoglobin, 50000 mg/l for human serum albumin, 8500 mg/l for triacylglycerol, and 500000 IU/l for rheumatoid factor. The ACCESS CEA assay also showed very homogeneous reactivity with purified CEA preparations from different tumours and could discriminate CEA from four CEA-related normal antigens tested. Serum samples (n = 362) from patients with malignant or non-malignant disease, as well as from healthy individuals, were analyzed by the ACCESS CEA assay and by the established IMx CEA assay. The CEA values determined by the ACCESS CEA assay were in good agreement with those determined by the IMx CEA assay, and the ACCESS CEA assay significantly increased the sensitivity and specificity of tumour diagnosis as compared with the IMx CEA assay.
Focal dermal hypoplasia (Goltz syndrome): a decreased accumulation of hyaluronic acid in three-dimensional culture.
We report a 28-year-old female with focal dermal hypoplasia, (Goltz syndrome). We compared the growth kinetics and the production of type I collagen and glycosaminoglycans by fibroblasts from affected and unaffected skin. Fibroblasts were grown in conventional medium supplemented with ascorbic acid 2-phosphate, which makes fibroblasts from a tissue-like structure in vitro. The population doubling time of fibroblasts in affected skin was slightly shorter than that of unaffected skin. There was no difference in the levels of the carboxyterminal propeptide of type I procollagen liberated into the media between affected skin and unaffected skin. However, the cell layer of affected skin fibroblasts revealed a decreased amount of hyaluronic acid-derived disaccharide unit (delta Di-HA). The abnormal metabolism of glycosaminoglycan in the affected dermis might be involved in the development of skin changes in focal dermal hypoplasia.
[Cardiac impairment of elderly patients with diabetes mellitus as studied with non-invasive myocardial scintigraphy and signal-averaged electrocardiography].
In patients more than 65-year-old with diabetes mellitus, positive late potentials on signal-averaged electrocardiograms were more common than in normal subjects (p < 0.05). This suggests that aged patients with diabetes mellitus are at risk for micromyocardial impairment. Myocardial scintigraphy with 123I-metaiodobenzylguanidine showed abnormally low uptake, in parallel with the data on SA-ECG. Thus, both methods may be clinically useful ways to noninvasively reveal micromyocardial impairment in aged patients with diabetes mellitus. Moreover, trimetazidine hydrochloride may be effective as therapy for micromyocardial impairment: the uptake of 123I-metaiodobenzyl guanidine had increased in some patients when measured 1 year after administration of trimetazidine hydrochloride (18 mg/day) and the late potential changed from positive to negative.
Trigeminal neuralgia and hemifacial spasm as false localizing signs in patients with a contralateral mass of the posterior cranial fossa. Report of three cases.
Trigeminal neuralgia and hemifacial spasm were false localizing signs in three patients with contralateral space-occupying mass lesions in the posterior cranial fossa. According to radiological observations, the brainstem was remarkably displaced and distorted toward the side contralateral to the mass in all three cases. In the two cases with trigeminal neuralgia, the fifth cranial nerve was embedded in a thick arachnoid membrane and strongly compressed and angulated between the brainstem and the petrous bone, but there was no apparent vascular involvement. In the case with hemifacial spasm, only the contralateral tumor was removed. Postoperatively, all three patients experienced complete cessation of the symptoms without recurrence. Based on the operative findings, the authors postulate that angulation and distortion of the axis of the cranial nerve due to the contralateral mass, accompanied by thickening of the arachnoid membrane around the nerve, play an important role in false localizing signs, particularly in patients with trigeminal neuralgia.
Solitary metastatic breast carcinoma in a trigeminal nerve mimicking a trigeminal neurinoma. Case report.
An unusual case of a metastatic adenocarcinoma located entirely within the trigeminal nerve is reported. The patient, with a history of breast cancer, presented with a pure trigeminal mononeuropathy. The neurological and neuroradiological findings in this patient were quite similar to those of a patient with trigeminal neurinoma. Surgery revealed that the tumor was located within the trigeminal nerve and its appearance was similar to that of a neurinoma. However, histopathological studies proved the tumor to be an adenocarcinoma that was related to the breast cancer treated earlier. A solitary metastatic tumor arising solely in a trigeminal nerve is quite rare; this is the first report of such a case metastasized from breast cancer.
[Diagnostic values and limitations of conventional urodynamic studies (uroflowmetry.residual urine measurement.cystometry) in benign prostatic hypertrophy].
PURPOSE AND METHODS: Diagnostic values and limitation of conventional urodynamic study (UDS) were assessed in 380 patients with benign prostatic hypertrophy (BPH), in terms of uroflowmetry, measurement of postvoid residual urine and cystometry. RESULTS: Maximum and average flow rate on uroflowmetry improved with increasing voided volume. Neither maximum nor average flow rate correlated with size of the prostate, subjective symptom (International Prostate Symptom Score) and bothersomeness for prostatism. Pre-TUR maximum flow rate did not predict outcomes on postoperative flow rate and surgical treatment failures. Uroflowmetry did not differentiate between obstruction and weakness of detrusor contraction. The intraindividual variation of postvoid residual urine was great and the volume of residual urine correlated poorly with subjective symptom, size of the prostate, maximum and average flow rate. On filling cystometry, although uninhibited detrusor contraction was much more frequently observed in patients with urge incontinence as compared with continent patients, there was no significant difference in other parameters between the two groups. Every parameter on cystometry did not correlate with nocturnal frequency. Postoperative persistence of urge incontinence did not correlate with the bladder volume at the first desire to void or at the maximum desire to void, an amplitude of uninhibited detrusor contractions, or bladder compliance. In some cases, evaluation of the intravesical pressure on voiding phase and uroflowmetry was diagnostic of apparent obstruction. CONCLUSIONS: In diagnosis of BPH, conventional UDS has limitation for certain and some caution showed be taken in interpretation of the data. However, since conventional UDS provides important and objective information on obstruction and detrusor function, which are independent of subjective symptom and prostate size, these should be necessary in diagnosis, determination of treatment options and evaluation of treatment outcomes in BPH.
Effects of luteinizing hormone-releasing hormone (LH-RH) analogue on the function of the isolated rabbit corpus cavernosum.
An adverse effect of the administration of luteinizing hormone-releasing hormone (LH-RH) analogue is impotence. The effects of LH-RH analogue injection on the function of the rabbit corpus cavernosum were investigated. Eighteen male rabbits were divided into three groups, i.e., LH-RH analogue injection, castration, and sham-operated control groups. After measurement of serum testosterone, the LH-RH analogue (1.5 mg/kg leuprolide acetate) was injected once in the LH-RH group, castration in the castrated group, and sham surgery in the control group. Four weeks later, the rabbits were maintained in the same circumstance and serum testosterone was measured once a week. Four weeks after preparation, all rabbits were used for in vitro experiments. At one week the serum testosterone level of the LH-RH and castrated groups decreased significantly from that in the sham-operated control group, which was sustained for the next 3 weeks. Although contractile strength of the corporal tissue taken from the castrated group was weakened in response to phenylephrine and KCl, corporal contractile strength of the LH-RH group was not. Under precontraction with 200 microM phenylephrine relaxation of the corpus cavernosum in response to field stimulation and sodium nitroprusside significantly decreased in both the LH-RH and castrated groups. However, there were no differences in the maximal relaxations induced by ATP and bethanechol between the three groups. In conclusion, the LH-RH analogue impaired the relaxation of the corpus cavernosum induced by field stimulation and sodium nitroprusside as much as castration did. Although the corporal contraction to phenylephrine and KCl was decreased by castration, it was not altered by the LH-RH analogue.
Endoscopic trigonoplasty in pediatric patients with primary vesicoureteral reflux: preliminary report.
PURPOSE: We investigated the preliminary surgical results of endoscopic trigonoplasty in pediatric patients with primary vesicoureteral reflux. MATERIALS AND METHODS: We performed endoscopic trigonoplasty in 6 pediatric patients (11 refluxing ureters). Reflux was grade II in 4 reno-ureteral units, grade III in 5, grade IV in 1 and grade V in 1 (international classification). Surgery was done using laparoscopic and endoscopic instruments. RESULTS: Vesicoureteral reflux disappeared 3 to 12 months postoperatively. Analgesics were administered postoperatively to 4 patients for 24 hours and to 2 for 48 hours. No bladder irritability or postoperative upper urinary tract dilatation was observed in the early postoperative period. CONCLUSIONS: Minimally invasive endoscopic trigonoplasty can be an effective surgical procedure for pediatric patients with vesicoureteral reflux.
[Death due to pulmonary tuberculosis--a comparison between 1984-88 and 1989-93].
Pulmonary tuberculosis (TB) remains the single leading cause of death from any single infectious agent in the world. We reviewed the case records and chest radiographs of patients with pulmonary tuberculosis who died between 1984 and 1993. Of 2333 patients discharged from National Nishi-Niigata Hospital, 86 (3.7%) died during that period. Comparison between the data for 1984-88 and for 1989-93 showed an increase in the number of elderly patients, TB-related deaths, and complication of TB by malignancy. Thirty-nine of the 86 patients died within 2 months of admission: a spread of TB over a wide region and low performance scores were noted in these patients. Multiple-drug-resistant Mycobacterium tuberculosis was often the cause of death. These results encourage us to pursue early detection in elderly people, to improve management during initial treatment such as with steroids, and to develop new and more effective drugs to treat TB.
Effects of Ischemia on the function of the isolated rat detrusor muscle.
Ischemia of vital organs causes various degrees of impairment. We studied the in vitro effects of ischemia on the function of the rat bladder. Ischemia was induced by ligation of the bilateral (bilateral ischemia) or right (unilateral ischemia) internal iliac arteries. Bladder weight increased significantly following 1 week of bilateral and unilateral ischemia. Passive tension was significantly higher in ischemic bladders than in control bladders at an increase in length between 6 and 12 mm. In both control and ischemic bladders, active tension was highest at a 16-mm increase in length. Bladders subjected to unilateral or bilateral ischemia for 1 or 2 weeks demonstrated impaired contractile responses to field stimulation, bethanechol, ATP and KCl. There were no differences in contractile strength between muscle specimens obtained from the ipsilateral or contralateral sides of unilateral ischemic bladders. Our findings showed that unilateral and bilateral ischemia inhibited the in vitro contractile strength of the detrusor muscle in response to intramural and pharmacologic stimulation.
Effects of in vivo Ischemia on the infusion cystometry and in vitro whole bladder contractility of the rat.
Ischemia induced by atherosclerosis is a common cause of organ failure in the elderly. We investigated the effects of in vivo ischemia created by ligation of the internal iliac arteries on the parameters of in vivo infusion cystometry under urethane anesthesia and on in vitro whole bladder contractility of the rat. Bladder weight significantly increased after ischemia for 14 days. Infusion cystometry demonstrated that in the ischemic bladders the capacity increased, the voiding pressure decreased, and the volume of residual urine increased, which resulted in deteriorated voiding efficacy. The in vitro whole bladder contractility to field stimulation, bethanechol, ATP, and KCl was reduced by ischemia. The passive pressure increased as the bladder volume enlarged and the bladder compliance once decreased by ischemia on the 7th day, but increased on the 14th day. In an active volume-pressure relationship study the peak response was decreased by ischemia. The volume at which response reached a peak value shifted to a larger volume 14 days after surgery. In conclusion, ischemia impaired in vivo rat detrusor power to empty. Since detrusor contractility in vitro decreased in response to various kinds of stimulation, this deteriorated bladder function was supposed to be caused by muscle degeneration.
[II. multidisciplinary analysis of chronic excretors of Mycobacterium tuberculosis bacilli].
For the most patients with pulmonary tuberculosis, treatment are successful and the chemotherapy can be finished within a year. Few patients, though receiving standard anti-tuberculous chemotherapy, expectorate tubercle bacilli continuously for more than a year. They are named "chronic excretors of mycobacterium tuberculosis bacilli" or "intractable tuberculosis patients". Being suspected that this phenomenon is produced by many factors, it is necessary to correspond suitably to these patients for eradication of tuberculosis. This symposium was organized to search for some factors on the bacterium and on the host, which caused patients to be the chronic excretors or intractable patients. We hope that our discussion may contribute to take the appropriate measures for such hard diseases. The main results are summarized as follows. 1) Dr. TSUCHIYA conducted a epidemiologic study by questionaire method to 33 Japanese national sanatoriums. The total number of tuberculosis patients admitted to these hospitals on a optimal day from September to October 1994 were 1,295. Numbers of patients who had expectorated bacilli continuously for more than 12 months were 85 (6.6%). The male/female ratio was about 3, their average age was 64. They had a tendency of thin-physique and most of them had past histories of tuberculosis, being the refractory cases. The average clinico-epidemiologic conditions of the patients came before our eyes. 2) Dr. OGATA analysed the results of drug sensitivity tests of mycobacterium tuberculosis bacilli from 2,630 pulmonary tuberculosis patients which contained 179 chronic excretors. The only 2.2% of bacilli from the chronic excretors were sensitive to RFP (50 gamma). The 99.4% of bacilli showed to be resistant to INH (0.1 gamma). The 39.1% of bacilli were sensitive to streptomycin (20 gamma). To EB (2.5 gamma) 34.1% of bacilli were sensitive. However, the ratio of chronic excretors in tuberculosis patients was not increased in these 17 years, and for many cases of these chronic excretors, they are all inexperienced in PZA, multi-sensitive-drug chemotherapy including PZA and OFLX were useful. Some of them underwent lobectomy combined for effective chemotherapy. The chronic excretors are likely to be affected multidrug-resistant bacilli, and it is important for such cases to treat intensively with several kinds of sensitive drugs. 3) Dr. FUJIWARA studied Interleukin-10 (IL-10) producing function of monocytes stimulated by Mycobacterium tuberculosis (M-TB). The IL-10 usually down-regulates a number of different macrophage functions, including microbicidal activity against intracellular bacteria such as Mycobacterium species. They found that the mean IL-10 production by peripheral blood mononuclear cells (PBMC) obtained from a healthy tuberculin-reactor stimulated with multidrug-resistant M-TB was greater than that with drug-sensitive M-TB. The IL-10 producing cells were monocytes, not T-lymphocytes. They moreover found that PBMC from intractable tuberculosis patients secreted greater amounts of IL-10 than those of healthy subjects. These data may give a hint for development of new immunotherapeutic methods for multi-drug-resistant tuberculosis patients. 4) Dr. HARA analysed clinical courses of 580 consecutive cases of bacilli positive pulmonary tuberculosis admitted in his hospital from a point of underlying diseases. All of dead 24 cases had some underlying diseases; diabetes mellitus 3, chronic liver diseases 4, others 17 (malignant neoplasms, central nerve vascular diseases, malnutritional condition, etc). (ABSTRACT TRUNCATED)
[Epidemiologic study of the actual investigation of chronic excretors of Mycobacterium tuberculosis bacilli].
Of 1,295 patients with tuberculosis who were admitted in 33 Japanese national sanatoriums from September to October, 1994, actual investigation of patients with persistent expectorate tubercle bacilli continuously for more than 12 months was carried out by questionnaire. From the result, numbers of patients who had persistently expectorated bacteria were 85 (6.6% of inpatient). The rate of male and female was 3:1, and mean age was 63.5 years old. Many slim type patients (less than 90% of the standard body weight) were observed at the rate of 55.8%. The rate of the inpatient whose admission period was for more than 10 years were found in 22%. The past history of the tuberculosis and surgical therapy were existent at the rate of 83.3% and 18.8% respectively. The chief complications such as diabetes mellitus (12.4%), pyothorax (10.1%), alcoholism (10.1%) and hepatic dysfunction (6.7%) were observed at the respective rate. As chest X-ray findings on admission, severe cases with cavity of I or II 3 by the classification of the Japanese society for tuberculosis were found in 32.2%, and many cases with much amount persistently excreted bacteria such as more than number 7 of Gaffky scale (24.7%) or 3+ by culture (55.8%) were detected by sputum-test on admission. From the result drug-resistance, resistance of the main drugs early found from initial medication, and high degree resistance of isonicotinic acid hydrazide (INH; 80%), rifampicin (RFP; 94.4%), ethambutol (EB; 85.6%) and streptomycin (SM; 76.4%) was found. As intractable causes which were indicated by doctor in charge, drug-resistance, drug allergy, disorder of life, unfavorable medication-compliance and unsuitable treatment were considered.
Effects of ethanol on in vivo cystometry and in vitro whole bladder contractility in the rat.
PURPOSE: It is known that acute ethanol intoxication can produce urinary retention in patients with benign prostatic hyperplasia. We evaluated the effects of ethanol on rat bladder function in vivo and in vitro. MATERIALS AND METHODS: Infusion cystometry was performed under urethane anesthesia with or without intravenous injection of ethanol. Voided volume, maximum voiding pressure, residual urine, bladder capacity, the pressure at which micturition was induced and voiding efficacy were compared. Subsequently, the in vitro whole bladder pressure generated by field stimulation, bethanechol, adenosine triphosphate and KCl in the presence of ethanol 0 to 5.0% was investigated. RESULTS: Intravenous administration of ethanol changed the in vivo cystometrogram. Bladder capacity and residual urine volume were significantly increased, and voiding pressure was decreased. Contractility of the isolated whole bladder to various kinds of stimulation in vitro was suppressed by ethanol in a dose-dependent manner. Washing the bladder and incubating it in normal Krebs' solution following exposure to 5% ethanol restored detrusor contractility. CONCLUSION: Ethanol significantly impairs detrusor contractility in the rat in vivo and in vitro.
An intensive programme for pelvic floor muscle exercises: short- and long-term effects on those with stress urinary incontinence.
Pelvic floor muscle exercises for the treatment of stress urinary incontinence were reported 45 years ago. However, few studies have been made on the long-term outcome and clinical effects in elderly people. We put 123 incontinent women on an intensive exercise programme for 8 weeks and followed them for more than 12 months; 15 patients were over 65 years old and 108 under 65 years old. Self-reported success rates, i.e., cure or a reduction of > 50% of the original severity, were prospectively assessed in the 2 groups immediately and a mean of 28 months (12-52) after the training. Predictive parameters for an immediate and a long-term success were assessed. The intensive programme depended on patients being motivated, patient education, correct muscle contractions, and the keeping of treatment diaries for 8 weeks. Urine loss evaluated objectively and bothersome scores in 6 activities assessed subjectively improved only in the younger adult group. However, vaginal contractile strength increased in both groups. The immediate success rate was 20% and 40% for the elderly and the adults, respectively. Twenty eight months later, the success rate was 27% for the aged and 40% for the adults with 6 patients becoming continent by surgery. Both the short- and long-term success rates were similar in the 2 groups (p < 0.05). 95% of the patients stated that the intensive training was valuable and that they would recommend the training to friends suffering from stress incontinence. Contractile strength of the vagina can be used to predict the immediate treatment outcome, but there are no parameters for predicting the long-term success. In conclusion, the intensive programme of pelvic floor muscle exercises is an effective treatment option for not only for the young adults but also for elderly people suffering from stress incontinence.