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A Okamura

Publications and source records attributed to A Okamura.

At least 109 records · Page 6Linked to original sources
PubMed1997

[Automated anesthesia record keeping system in in the United States].

We have implemented an automated anesthesia record keeping system (AARK) since 1992. The system stands in need of re-designing to function as a perioperative patient's information system. We discussed the issues with anesthesiologists who's institutes are implemented with AARK in the United States. We visited the following three institutes: St. Luke's Hospital (Kansas City, MO), University of Florida (Gainesville, FL), and Burbank Hospital (Fitchburg, MA). All of them are implemented with ARKIVE system. Dr. Edsall in Burbank Hospital stressed quality assurance (QA), and using ARKIVE's database for QA. University of Florida has a big anesthesia and engineering team to develop a new ergonomically sound AARK. Some of the members regarded ARKIVE as an "out of date" system. Dr. Tuohy in St. Luke's Hospital stressed cost/benefit of AARK. Taking their experience into account, we are designing a new perioperative patient's information system including AARK.

Anesthesia↗
PubMed1997

[A case of recurrent bronchogenic cyst 15 years after initial operation].

There are few reports on the postoperative recurrence of bronchogenic cysts. We conducted a re-operation on a 57-year-old man with a bronchogenic cyst 15 years after an initial operation. His history showed an earlier operation for a bronchogenic cyst at the age of 42 at another hospital. 15 years after this initial operation, he suffered from common cold like symptoms, and was referred to our hospital, because of an abnormal shadow on his chest X-ray. A chest CT and MRI revealed an oval tumor just under the right intermediate bronchus. We suspected it was a recurrence of the bronchogenic cyst, and an operation was performed. The cyst was firmly adhered to the lung, and at the upper site of the cyst, a region adjacent to the intermediate bronchus was adhered to the bronchial wall. The histological findings were similar to those of 15 years previously. The cyst wall lined with pseudostratified columnar ciliary epithelium with muscular layer, which led to a diagnosis of a bronchogenic cyst. Congenital cysts, including bronchogenic cysts, are considered to originate in abnormal primordia. If there are remaining abnormal primordia, a recurrence of the disease can occur.

Bronchogenic Cyst↗
PubMed1997

[Diabetic foot].

Explore the source record for details and available documents.

Diabetic Foot↗
PubMed1996

Involvement of N-methyl-D-aspartate receptor in the delayed transneuronal regression of substantia nigra neurons in rats.

The substantia nigra pars reticulata (SNr) receives both inhibitory GABAergic and excitatory glutamatergic afferents from diverse origins. Ischemic injury to the striatum and/or the globus pallidus causes delayed transneuronal death of the SNr neurons, in the course of which neuronal disinhibition induced by loss of GABAergic inputs is supposed to trigger a lethal hypermetabolic process. In the in vivo experiment presented herein, we clarified the role of glutamatergic action via the N-methyl-D-aspartate receptor in this cell death process. Continuous intraventricular infusion (0.5 microliter/h) of the N-methyl-D-aspartate receptor antagonist MK-801 (1000 micrograms/ml), or of saline (control group) was initiated 24 h after 2 h of transient middle cerebral artery (MCA) occlusion in rats, by which massive ischemic injury was produced in the striatopallidal regions. The measured rectal temperature was not significantly altered in the MK-801-infused and in the control rats throughout the time period examined. The rats were killed at 15 days after MCA occlusion. The volume of the focal ischemic infarction of the MK-801-infused group did not significantly differ from that of controls. Also, MK-801-infusion did not significantly ameliorate the nigral atrophy subsequent to MCA occlusion. In association with a marked depletion of GABAergic afferent fibers, neuronal cell number in the ipsilateral SNr was significantly decreased in the control group. In contrast, the neuronal cell loss in the nucleus was completely prevented in the MK-801-infusion group. The data suggested that withdrawal of GABAergic inputs may cause a severe imbalance between excitation and inhibition of the SNr neurons and may eventually result in neurotoxicity mediated by the N-methyl-D-aspartate receptor. Suppression of glutamatergic excitatory effects by suitable drugs may be a reasonable therapy for the transneuronal death of the SNr neurons.

Animals↗
PubMed1996

Alternation in the coronary blood flow velocity pattern in patients with no reflow and reperfused acute myocardial infarction.

BACKGROUND: Experimental and clinical evidence indicates that myocardial ischemia often damages the coronary microvasculature ("no-reflow" phenomenon). In this study, we examined the effect of this phenomenon on the coronary blood flow velocity pattern in patients with reperfused acute myocardial infarction. METHODS AND RESULTS: We measured coronary blood flow velocity after coronary angioplasty in 42 patients with acute myocardial infarction using a Doppler guidewire. Myocardial contrast echocardiography (MCE) was also performed before and after angioplasty. Thirty-one patients showed good contrast reperfusion (MCE reflow), whereas the other 11 showed no reflow (MCE no reflow). Peak velocity and duration of systolic coronary flow were significantly less in patients with MCE no reflow than in those with MCE reflow (8 +/- 4 versus 17 +/- 10 cm/s and 207 +/- 79 versus 289 +/- 55 ms, respectively; P < .01). Early systolic retrograde flow was frequently observed in patients with MCE no reflow, whereas it was observed in only 1 patient among those with MCE reflow (95% versus 3%; P < .001). Although peak diastolic flow velocity was similar between the two subsets, diastolic deceleration rate was significantly higher in patients with MCE no reflow than in those with MCE reflow (107 +/- 76 versus 56 +/- 31 cm/s2; P < .01). CONCLUSIONS: The coronary flow velocity pattern in patients with the no-reflow phenomenon was characterized by the appearance of systolic retrograde flow, diminished systolic antegrade flow, and rapid deceleration of diastolic flow. Thus, the Doppler guidewire allows us to assess the presence of microvascular dysfunction in AMI.

Aged↗
PubMed1996

Myocardial perfusion patterns related to thrombolysis in myocardial infarction perfusion grades after coronary angioplasty in patients with acute anterior wall myocardial infarction.

BACKGROUND: Epicardial coronary flow is occasionally reduced even after coronary intervention despite the absence of vessel obstruction in patients with acute myocardial infarction. Our aim was to clarify the cause and outcomes of radiocontrast slow filling in patients with reperfused acute anterior myocardial infarction by assessing microvascular damage with the use of myocardial contrast echocardiography (MCE) and functional outcomes. METHODS AND RESULTS: We carefully reviewed the cineangiograms of 86 patients who achieved coronary revascularization within 12 hours of the onset and underwent MCE before and soon after recanalization with the intracoronary injection of sonicated microbubbles. Antegrade coronary flow after recanalization was graded by two observers based on Thrombolysis in Myocardial Infarction (TIMI) trial flow grades. Left ventricular ejection fraction was measured on the day of infarction and 1 month later. TIMI grade 2 was observed in 18 patients (21%), and the other 68 patients manifested TIMI grade 3 after recanalization. All patients with TIMI 2 showed substantial MCE no reflow, whereas only 11 patients (16%) with TIMI 3 showed MCE no reflow. Functional improvement was worse in patients with TIMI 2 than in those with TIMI 3 (TIMI 2, 38 +/- 8% versus 40 +/- 8%, P = NS [acute versus late]; TIMI 3, 44 +/- 13% versus 55 +/- 13%, P < .001). Among patients with TIMI 3, significant functional improvement was observed only in patients with MCE reflow (MCE reflow, 46 +/- 13% versus 57 +/- 12%, P < .001; MCE no reflow, 35 +/- 11% versus 45 +/- 12%, P = NS). CONCLUSIONS: Despite no obstructive lesion of the vessel, TIMI 2 is caused by advanced microvascular damage and is a highly specific, although not sensitive, predictor of poor functional outcomes in patients with acute myocardial infarction. TIMI 3 does not necessarily indicate myocardial salvage, and detection of MCE no reflow in these patients is particularly useful for the prediction of functional outcome.

Adult↗
PubMed1996

[Clinical characteristics and therapeutic strategy for acute myocardial infarction in the elderly].

Many randomized studies have revealed that reperfusion therapy is an epochmaking treatment for acute myocardial infarction (AMI). However, it is no clear whether it is equally beneficial in the elderly or not. In this study, we elucidated the clinical characteristics and effectiveness of reperfusion therapy and discussed the optimal treatment for AMI in the elderly. The study population comprised 1,891 consecutive patients with AMI. The reinfarction rates and the rates of Killip class III or IV on admission increased with age. The mortality was significantly higher in the older subgroups. In the patients with first AMI within 24 hours of the onset and who underwent emergency catheterization, those accompanied by hypercholesterolemia or with habitual smoking were significantly fewer in the older group. Although the Q-wave MI rate, the peak CPK level and the reperfusion rate were no different, the low cardiac output condition, multi vessel disease and short-term mortality were significantly greater in the older group. The patients over 80-year-old were subdivided into three groups; those treated conventionally (G-C), those treated with intracoronary thrombolysis (G-T) and those treated with direct PTCA (G-A). The overall mortality did not differ among the three groups. However, in patients hospitalized after 1990, the mortality in G-A was significantly lower than in G-C. The prevalence of bleeding complications between G-A and G-T did not differ. The patients in G-A showed greater improvement of the left ventricular wall motion and lower incidence of postinfarctional angina than other groups. Reperfusion therapy by direct PTCA appears to be the optimal strategy for treatment of elder patients with AMI.

Adult↗
PubMed1996

[Case of intralobar pulmonary sequestration with increased serum sialyl Lewis X-i (SLX)].

A 37-year-old male whose chief complaint was fever and back pain was admitted to our hospital because of a mass shadow in the left lower P3ng field found in X-ray examination. The level of serum SLX on admission increased to 1,338 U/ml. He was diagnosed intralobar pulmonary sequestration by angiography. The left lower lobe was resected 2 months after second admission. His general condition was steady, and he was discharged 18 days after the operation because the level of serum SLX decreased to 49.9 U/ml.

Adult↗
PubMed1996

[Serum eosinophil cationic protein in infants during first wheezing episode].

We measured serum ECP levels in infants during first wheezing episode. Serum ECP in these infants are significantly higher than in control infants, although much higher in children with asthma. Serum ECP in these infants with high serum IgE and/or positive RAST score are higher than in infants with normal serum IgE and negative RAST score. In children with bronchial asthma serum ECP is correlated with peripheral eosinophil counts, but in infants during first wheezing episode serum ECP is often elevated not associated with increased peripheral eosinophil counts. These suggest that activated eosinophils could be responsible for bronchoconstriction in wheezing patients with atopic diathesis even in very early phase and that these eosinophilic inflammations could contribute to formation of increased airway reactivity and bronchial asthma.

Asthma↗
PubMed1995

Lewis Y antigen expression in hepatocellular carcinoma. An immunohistochemical study.

BACKGROUND: The altered expression of the Lewis blood group-related antigens during malignant transformation can be used clinically as a tumor marker or as a prognostic indicator. The Lewis Y (LeY) antigen, which is one of the Type 2 human blood group-related antigens, also is thought to behave as an oncodevelopmental cancer-associated antigen. In this study, the authors examined the association between human LeY antigen expression and the clinicopathologic features of HCC, including its proliferative activity. METHODS: Forty-six histologically confirmed cases of HCC were studied retrospectively. Liver biopsy specimens from the main tumor of each case were obtained under ultrasonic guidance before treatment was initiated. The formalin fixed, paraffin embedded serial sections were immunostained using a modification of the avidin-biotin-peroxidase complex method, with a primary monoclonal antibody (MoAb) directed against the LeY antigen (BM-1/JIMRO). The relationship between LeY antigen expression and the HCC's proliferative activity was analyzed similarly by immunohistochemical methods using a primary MoAb directed against the Ki-67 antigen (MIB 1). In addition, to clarify the relationship between LeY antigen expression and the histologic heterogeneity within HCC, seven cases of surgically resected HCC also were immunostained. RESULTS: The LeY antigen was detected on the membrane and in the cytoplasm of the cancer cells. Of the 46 HCC cases, 20 (43.5%) expressed the LeY antigen in the tumor cells. There was no correlation between LeY antigen expression and the maximum tumor dimension or the Stage. However, the incidence of LeY antigen-positive cases in poorly differentiated HCCs was found to be significantly higher than that in well or moderately differentiated HCCs (P < 0.01). In resected HCC cases, LeY antigen expression within HCC nodules was frequently greater in the less differentiated tumor than in adjacent differentiated tumor. Moreover, the incidence of LeY antigen expression in alpha-fetoprotein (AFP)-positive (AFP > or = 200 ng/ml) HCC cases was significantly higher than that in AFP-negative (AFP < 200 ng/ml) HCC cases (P < 0.05). Furthermore, the mean value of the Ki-67 labeling index in LeY antigen-positive HCC cases (25.2 +/- 11.3%) was significantly higher than that in LeY antigen-negative HCC cases (9.4 +/- 4.1%) (P < 0.001). CONCLUSIONS: These results suggest that LeY antigen expression correlated closely to the dedifferentiation and proliferative activity of HCC.

Antibodies, Monoclonal↗
PubMed1995

Immunohistochemically demonstrated expression of HLA-DR antigen in colorectal adenocarcinomas and its relation to clinicopathological features.

We studied 148 colorectal adenocarcinomas to clarify any correlation between HLA-DR antigen expression on tumor cells and histopathological features. Paraffin sections of formalin-fixed tissues were stained with HLA-DR antigen using the indirect immunoperoxidase technique. All the tumor tissues were divided into two groups, depending on the incidence of HLA-DR-positive cells (greater and lesser than 50%). Carcinoma tissues with a higher incidence showed less mural invasion, lymphoductal invasion, venous invasion, lymphonodular metastasis, and peritoneal metastasis. Tissues with a high HLA-DR reactivity were more often observed for Dukes' A and B stages, whereas those with a low HLA-DR positivity were frequently Dukes' C and D stages. As for the cumulative survival rate, the group with high HLA-DR expression demonstrated significantly better survival. We speculate that HLA-DR expression by colorectal cancer cells exerts a favorable influence on clinical course.

Adenocarcinoma↗
PubMed1995

Central neurocytoma with hemorrhagic onset.

A case of central neurocytoma with spontaneous intraventricular hemorrhage is reported. A 23-year-old man, 2 years after experiencing intraventricular hemorrhage, developed severe headaches. The magnetic resonance image showed a mixed intense mass in the lateral ventricle with associated hydrocephalus. The tumor mass was totally removed. The tumor was histologically diagnosed as central neurocytoma. Review of the computed tomography taken 2 years ago showed not only the hemorrhage but also a mass in the left lateral ventricle. This emphasizes that central neurocytoma should be considered in the differential diagnosis of patients with either intraventricular hemorrhage or hemorrhagic tumor.

Adult↗
PubMed1995

Diabetes impairs DRG neuronal attachment to extracellular matrix proteins in vitro.

Attachments of dorsal root ganglion (DRG) neurons from streptozotocin (STZ)-induced diabetic and normal C57BL mice to the following substrates were evaluated in vitro: a) poly L-lysine (PL), b) PL + type I collagen (CL-I), c) PL + type IV collagen (CL-IV), d) PL + laminin (LM) and e) PL + fibronectin (FN). After 6 h in culture, there was no significant difference in the average ratio of cells adhesive to PL between the diabetic (74.9%) and normal group of mice (75.6%). In the normal group, the addition of extracellular matrix (ECM) proteins such as CL-I, CL-IV, LM and FN to PL increased the ratios of cell attachment from 75.6% to nearly 90%. In the diabetic group, however, none of these proteins improved the attachment (the ratio changed from 74.9% to nearly 70%). Survival and neurite extension of attached cells after 48 h in culture were not different between the two groups. These results suggest that the cell-surface receptors, which enable DRG neurons to bind to the extracellular matrix proteins, are impaired by diabetes, resulting in being one of the causes of diabetic neuropathy.

Animals↗
PubMed1995

[A case of AIDS patient who was hard to diagnose from an initial symptom of interstitial pneumonitis].

A thirty-six year old male was admitted to the hospital because of fever and dyspnea. On the eighth day the patient turned out to be HIV positive. Although aggressive therapy was performed, the patient died of HIV related disease such as Pneumocystis carinii pneumonitis and CMV infection which led to multiple organ failure seventeen days after admission. We reported a case of AIDS patient who was hard to diagnose from an initial symptom of interstitial pneumonitis.

Acquired Immunodeficiency Syndrome↗
PubMed1995

[A case of incarceration of a right femoral hernia in a very old female with a intriguing clinical course].

The patient was a 94-year-old woman. She was admitted on our hospital for ileus due to incarceration of a right femoral hernia on October 29, 1993. Although an emergency operation was necessary she refused, therefore we continued to have conservative therapy. After repeated persuasion, she agreed the operation which was performed under spinal anesthesia on November 17. The peritoneal cavity was opened through a transverse incision of the lower abdomen. Some bloody ascites was encountered. Part of the jejunum was incarcerated through right femoral canal and was completely obstructed, with ischemic but no necrotic changes. It was excised. She resumed oral intake on the 7th postoperative day and was discharged on the 77th postoperative day. Initially due to her opposition we could not perform the operation, but after persistent persuasion she agreed and survived. Good communications between the doctor and the patient, and of course informed consent, was very important in such cases.

Aged↗
PubMed1995

[Expression of Le(y) antigen in adenocarcinoma and its related lesions of the human uterine cervix].

The natural history and biological behavior of adenocarcinoma and related lesion of the uterine cervix remain controversial issues, but the dynamic alterations in glycosylation in the cancer cells are well known. Recently, it was recently documented that the Ley antigen might be correlated with apoptosis. Over the past eight years, we have encountered 12 cases of invasive adenocarcinoma (AD), 11 cases of early adenocarcinoma (early AD) including 6 adenocarcinoma in situ and 5 microinvasive adenocarcinoma, 16 cases of endocervical glandular dysplasia (EGD) and 10 patients with normal endocervix (control) among 2,165 postoperative cases. Immunohistochemical localizations of Le(y), sialyl Le(x) and epidermal growth factor receptor (EGFR) antigens were examined in serial sections. The localization of Le(y) antigen was predominant in the subcolumnar reserve cells in controls. The localization of sialyl Le(x) was predominant in the perinuclear portion of cells in cases of EGD. The localization of EGFR was presented in cases of tubal metaplasia, tubal type EGD, early AD and AD. These antigens were present in cases of EGD, early AD and AD, with AD cases showing the highest concentrations. To conclude, the presence of the Le(y) antigen might be correlated with differentiation, development and oncogenesis rather than with apoptosis in these lesions, EGD might indicate a precancerous lesion, and localization of the EGFR antigen indicates that tubal metaplasia, tubal type EGD, early AD and AD may have a common origin.

Adenocarcinoma↗
PubMed1995

[Angiocentric lymphoma associated with anemia secondary to parvovirus B19 infection].

A 50-year-old woman was admitted to our hospital in May 1993 because of papules, cervical lymphadenopathy and interstitial pneumonia. Oxygen inhalation and pulse therapy of corticosteroid were started. A biopsy of the left inguinal lymphnode showed T zone enlargement and marked vascularization with polymorphous atypical lymphoblasts, consistent with angiocentric lymphoma (immunohistochemically T cell type). In situ hybridization with EBER-1 did not show association of EB virus. She was subsequently treated with ProMACE-CytaBOM successfully, but anemia had progressed before that treatment showing a reticulocyte count 0/1000, LDH 870 U/l, positive direct Coombs test. Bone marrow aspiration revealed red cell aplasia and the existence of giant pronormoblasts. The hemoglobin dropped to the level of 4.7 g/dl, requiring anabolic steroid and frequent blood transfusion. Parvovirus B19-specific antibodies were negative initially by western blot assay, but IgM antibody appeared after 35 days and IgG after 71 days. In August anemia improved following a reticulocyte burst and recovery of bone marrow erythroblasts. This patient is the first reported case of angiocentric lymphoma complicated with severe anemia, perhaps resulting from autoimmune hemolytic process and parvovirus B19 infection.

Anemia↗