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H Iwama

Publications and source records attributed to H Iwama.

At least 37 records · Page 2Linked to original sources
PubMed2000

Refractory anemia with ringed sideroblasts with a low IPSS score progressed rapidly with de novo appearance of multiple karyotypic abnormalities and into acute erythroleukemia (AML-M6A).

We report here a case of refractory anemia with ringed sideroblasts (RARS) with a low risk group by the International Prognostic Scoring System (IPSS) at the time of diagnosis but had a rapid disease progression. Although the patient showed a normal male karyotype at the time of RARS diagnosis, his marrow cells had del(5)(q14) and add(17)(p12) abnormalities 2 months after the diagnosis, and later the marrow cells had multiple abnormalities and the patient expired 6 months after the initial diagnosis of RARS. The patient was diagnosed as having RARS with a low risk group by the IPSS classification, however, one should keep in mind that some patients with myelodysplastic syndromes with low risks by either the French-American-British (FAB) classification or the IPSS classification may have progressive disease and subsequential cytogenetic analysis could predict the disease progression.

Acute Disease↗
PubMed2000

Global brain ischemia produced by clamping left subclavian artery and bicarotid trunk in the rabbit.

Thirty-five rabbits were divided randomly into 5 groups: sham operation, 10 minutes clamping bicarotid trunk (partial ischemia, PI), and 3 groups of 5, 7, and 10 minutes clamping left subclavian artery and bicarotid trunk (global ischemia, GI). Systolic arterial pressure increased slightly in the PI group, but doubled in the GI groups during clamping. Heart rate did not change in the PI group, but decreased transiently in the GI groups during clamping. Brain temperature decreased gradually in the GI groups during clamping, but did not change in the PI group. Necrotic changes were present 96 hours later in approximately 50% of the hippocampal CA1 cells in the GI groups, but in none of the cells in the PI and sham operation groups. The present results may indicate that clamping left subclavian artery and bicarotid trunk in the rabbit brings about global brain ischemia.

Animals↗
PubMed2000

Propofol dosage achieving spontaneous breathing during balanced regional anesthesia with the laryngeal mask airway.

STUDY OBJECTIVE: To assess an anesthetic technique achieving spontaneous breathing through the laryngeal mask airway (LMA) during combined epidural block and propofol anesthesia. DESIGN: Prospective, consecutive case series study. SETTING: Operating room at a general hospital. PATIENTS: 112 ASA physical status I and II adult surgery patients; 32 patients for lower extremity surgery are enrolled into study 1, and 30 patients for lower extremity surgery and 50 patients for lower abdominal gynecology surgery are enrolled into study 2. INTERVENTIONS: In study 1, patients were given 1.5 to 2.0 mg/kg followed by a 3 mg/kg/h of infusion of propofol, after epidural block, and they were fitted with the LMA. Thirty minutes after induction, the dose of propofol was increased to 4, 5, 6, and 7 mg/kg/h every 15 minutes. In study 2, the patients were given 1.5 to 2.0 mg/kg and 5 mg/kg/h of propofol and the LMA insertion, after epidural block. MEASUREMENTS AND MAIN RESULTS: PaO(2)/FIO(2), PaCO(2), tidal volume or respiratory rate, blood pressure, heart rate, and eye opening and motor response scales in conformity with Glasgow coma scale were recorded. Study 1 suggested an induction dose of 1.5 to 2.0 mg/kg and an infusion of 5 mg/kg/h as an appropriate dose to preserve spontaneous breathing with the LMA and to maintain reasonable depth of anesthesia. Study 2 showed that respiratory and circulatory conditions, depth of anesthesia, and other data related to anesthesia were clinically acceptable. CONCLUSIONS: The best infusion dose of propofol to achieve spontaneous breathing with the LMA seems to be 5 mg/kg/h, and the present balanced regional anesthesia with the LMA, using propofol infusion at 1.5 to 2.0 mg/kg and 5 mg/kg/h combined with epidural block, may be useful in clinical practice for lower extremity and lower abdominal gynecologic operations.

Adult↗
PubMed2000

Intermittent pneumatic compression on the calf improves peripheral circulation of the leg.

PURPOSE: The aim of this study was to examine whether intermittent pneumatic compression (IPC) increases peripheral circulation locally in order to assess the use of IPC for prevention of deep venous thrombosis. MATERIALS AND METHODS: Seventy adult patients receiving major gastrointestinal surgery were studied. On postoperative day 1, calf-length garments were fitted onto both calves and deep temperature thermometers were put on both plantae. The IPC was applied randomly to either the left or right calf under 40 mm Hg pressure for 150 minutes. Bilateral plantar deep temperatures, as a reflection of peripheral circulation in the lower extremity, the tympanic temperature, mean blood pressure, and heart rate were recorded at 15-minute intervals. RESULTS: IPC compression was applied to 31 left and 39 right calves. The plantar deep temperature in the compressed calf was higher than in the noncompressed calf, and increased significantly, whereas the noncompressed calf showed no temperature change. The tympanic temperature, mean blood pressure, and heart rate did not change during the experiment. CONCLUSIONS: The results suggest that IPC has the effect of improving peripheral circulation, which supports the use of IPC to prevent deep venous thrombosis.

Adult↗
PubMed2000

Measurement of soluble Fas antigen and ligand in circulating serum and intra-abdominal or cerebrospinal fluid during gastrointestinal or cerebrovascular surgery.

PURPOSE: Soluble Fas antigen (sFas) and ligand (sFasL), which are associated with apoptosis, have not been evaluated in gastrointestinal or cerebrovascular surgery. The aim of this study was to measure these substances in serum, intra-abdominal fluid, or cerebrospinal fluid, and to speculate a pathophysiologic role for Fas-FasL apoptosis in surgery. MATERIALS AND METHODS: Arterial blood and intraabdominal or cerebrospinal fluid were collected at intervals from 27 gastrointestinal surgical patients, 10 cerebrovascular surgical patients, and 10 spinal anesthesia patients. RESULTS: Serum sFas levels did not change during and after surgery. Intra-abdominal and cerebrospinal sFas levels were identical to and lower than those in serum. Serum sFasL levels did not change during surgery, but decreased after surgery. Intra-abdominal and cerebrospinal sFasL levels were higher than and identical to those in serum. In spinal anesthesia, cerebrospinal sFas and sFasL levels were lower than those in serum. CONCLUSIONS: Serum sFasL decreases after surgery, whereas intra-abdominal or cerebrospinal sFasL increases, although sFas in each site does not change, suggesting redistribution of activated lymphocytes into local surgical wounds and induction of apoptosis in this site.

Aged↗
PubMed2000

Continuous monitoring of lower thoracic epidural pressure.

PURPOSE: The aim of this study was to examine whether the epidural pressure (EPIP) can be monitored for a long period of time using the continuous epidural infusion via the lower thorax. MATERIALS AND METHODS: Twenty-one adult patients undergoing gastrointestinal surgery had an epidural catheter inserted via the lower thoracic interspace. After induction of general anesthesia, continuous infusion of local anesthetic at a rate of 4 to 5 mL/h was applied epidurally. A pressure transducer was connected to the epidural catheter and the EPIP was monitored. During surgery, changes in the EPIP were monitored at 0, 5, and 10 cm H2O of positive end-expiratory pressure (PEEP). On postoperative day 1, 2, and 3, the EPIP was measured in the supine position, the Queckenstedt test, and the 30 degrees head-up position. RESULTS: The EPIP was monitored continuously and stably during surgery and until postoperative day 3, it increased significantly at 5 and 10 cm H2O PEEP, and increased and decreased significantly in the Queckenstedt test and the head-up position, respectively. CONCLUSION: Continuous epidural infusion at a rate of 4 to 5 mL/h via the lower thorax allows stable monitoring of the EPIP over a long period of time.

Adult↗
PubMed2000

Detectable concentrations of urinary trypsin inhibitor in cerebrospinal fluid.

Urinary trypsin inhibitor (UTI) is a physiological protease inhibitor produced in the liver and excreted into urine. Urinary trypsin inhibitor-like antigen has been demonstrated on glial cells in the brain. This study measured cerebrospinal UTI levels in various conditions. Seven subjects in each of the following groups were studied: patients undergoing spinal anesthesia for minor surgery, spinal anesthesia for cesarean section, removal of meningioma, or at postoperative day 3 after ruptured intracranial aneurysm clipping. Cerebrospinal fluid was collected from a spinal needle, a needle puncturing the sylvian fissure, or a drainage tube from the optical carotid cistern. Urine was collected from a urinary catheter. Cerebrospinal and urinary UTI concentrations were measured by radioimmunoassay, and the urinary UTI concentration was divided by urinary creatinine concentration to give the systemic UTI concentration. The cerebrospinal UTI concentration in the brain tumor and postoperative state groups was significantly higher than in the spinal anesthesia and cesarean section groups. The systemic UTI concentration in the cesarean section and postoperative state groups was significantly higher than in the spinal anesthesia and brain tumor groups. The present results demonstrate that UTI can be detected in the cerebrospinal fluid, and suggest that cerebrospinal UTI increases in patients with a brain tumor or inflammation and is not affected by systemic UTI.

Adult↗
PubMed2000

Chronic lymphocytic leukemia complicated by plasmacytoma originating from different clones.

In a woman with chronic lymphocytic leukemia (CLL), a plasmacytoma developed on the back region after four years. CLL cases complicated with plasmacytoma are rare. In the present case, the plasmacytoma showed kappa cytoplasmic immunoglobulin (Ig), and the CLL showed gamma lambda surface Ig. To reveal the clonal origin of CLL and plasmacytoma, we analyzed Ig gene rearrangements in the patient's peripheral blood and plasmacytoma. Ig gene DNA analysis confirmed the presence of different rearrangements in the heavy and light chain genes of CLL and plasmacytoma. These findings suggest that in this patient, the two B cell malignancies arose from expansion of two phenotypically and genotypically distinct clones.

Blotting, Southern↗
PubMed2000

Telomere dynamics and genetic instability in disease progression of chronic myeloid leukemia.

Chronic myeloid leukemia (CML) is characterized by a Philadelphia (Ph) translocation creating a novel BCR-ABL oncoprotein, and CML patients have a chronic phase for several years followed by an intractable blast cell proliferation, called blast transformation. In the blast phase, more than 60% of patients show additional cytogenetic changes, e. g., double Ph, +8, i(17q). In this review, we would like to address genetic changes, including genome instability, cytogenetic changes, and telomere dynamics that relate to karyotypic instability. In the chronic phase, approximately 60% of CML patients show reduced telomere length without highly elevated telomerase activity or microsatellite alterations, indicating that telomere reduction may be linked to cell replication. Therefore, the Ph translocation might be a first event to immortalize cell proliferation. In the blast phase, 50% of CML patients have high levels of elevated telomerase activity and the same number of patients had microsatellite changes. Of note is that most patients with telomerase up-regulation in the blast phase had additional cytogenetic changes and >60% of them showed microsatellite changes at least at one locus. In contrast, most patients without telomerase activity did not show microsatellite changes. These findings may indicate that telomerase up-regulation in the blast phase of CML patients is closely associated with microsatellite changes (representative of genome instability), while blast cells in the remaining patients (30%) maintain their proliferative capability without microsatellite changes and telomerase up-regulation. This further suggests that there is also an unknown mechanism for genome stability without the process of telomerase up-regulation in some patients with CML in blast crisis.

Cell Transformation, Neoplastic↗
PubMed2000

[Rapidly progressive fibrosis and increased CD68-positive cells in the bone marrow at the terminal stage of adult T-cell leukemia accompanied by polycythemia vera].

We report a case of adult T-cell leukemia (ATL) accompanied by polycythemia vera (PV) in which rapid development of myelofibrosis and clinical features of hemophagocytic syndrome (HPS) were observed at the terminal stage. The patient, a 53-year-old man who was born in Oita Prefecture, Japan, was diagnosed as having PV in 1996. He had undergone venesection but had not received any chemotherapy. In June 1997, he showed systemic lymphadenopathy with positivity for serum HTLV-1 antibody (x 10,240). Pathological findings and Southern blotting analysis for detection of monoclonal integration of HTLV-1 provirus DNA in a lymph node biopsy sample revealed that he also had acute-type ATL. Although several courses of chemotherapy were transiently effective, high fever, pancytopenia, increased serum LDH, hypoproteinemia and hyperferritinemia appeared, all of which were compatible with the clinical features of HPS. In addition, cytomegalovirus infection became evident. He died of multiple organ failure with rapid progression of myelofibrosis in May 1998. Detection of both increased CD68-positive histiocytes by immunohistochemistry and iron-stained phagocytic cells in marrow biopsy specimens appeared to be helpful for diagnosis of HPS in this patient, whose marrow showed myelofibrosis with hypocellularity.

Antigens, CD↗
PubMed1999

Time course of activated coagulation time at various sites during continuous haemodiafiltration using nafamostat mesilate.

OBJECTIVE: To determine the adequate site of activated coagulation time (ACT) measurement during continuous haemodiafiltration (CHDF) using nafamostat mesilate. DESIGN: Prospective, consecutive, clinical study. SETTING: An intensive care unit of a general hospital. PATIENTS: Ten patients with acute organ failure including kidney, lung and liver, caused by sepsis after major surgery. INTERVENTIONS: A CHDF circuit with a haemofilter made of polymethylmethacrylate membrane was primed with 50 mg nafamostat in 500 ml saline, and was started at a circuit flow rate of 100 ml/min. Continuous injection of 0.5 mg/kg per h nafamostat, 700 ml/h of dialysis fluid and 1000 ml/h of filtrate fluid was set. MEASUREMENTS AND RESULTS: The circuit pressure at the inlet and outlet of the circuit were monitored, and ACT was measured every 2 h at the site of nafamostat injection, outlet, patient's artery and inlet until 24 h. A value of standard deviation of ACT at each site was regarded as the variation value of ACT. The circuit pressure did not change significantly. The ACT did not change significantly at any measurement site. The variation value of ACT at the inlet of the circuit was significantly lower than that at the site of nafamostat injection. CONCLUSIONS: The ACT value at the inlet of the circuit may be adequate to monitor anticoagulation during CHDF using nafamostat.

Aged↗
PubMed1999

Epidural block during general anesthesia attenuates urinary trypsin inhibitor excretion in lower abdominal surgery.

PURPOSE: The aim of this study was to elucidate whether urinary trypsin inhibitor excretion differs between general anesthesia (GA) and epidural block during general anesthesia (EPI) in lower abdominal surgery. METHODS: Sixteen women undergoing abdominal total hysterectomy were assigned to the GA and EPI groups. The GA group received propofol induction and maintenance with isoflurane, nitrous oxide, and vecuronium. The EPI group received epidural block, followed by propofol induction and maintenance with isoflurane and nitrous oxide. The levels of adrenocorticotropic hormone and cortisol during anesthesia and on postoperative days 1, 2, and 3, and the levels of urinary trypsin inhibitor in 12-h urine from the day of surgery to postoperative day 3, were measured. RESULTS: As compared with the EPI group, the GA group had a higher level of adrenocorticotropic hormone at the completion of anesthesia, higher levels of cortisol at the completion of anesthesia and postoperative day 2, and higher excretion of urinary trypsin inhibitor on the day of surgery and postoperative days 1 and 2. CONCLUSION: The present results suggest that excretion of urinary trypsin inhibitor into the urine under epidural block during general anesthesia is lower than that under general anesthesia alone in lower abdominal surgery. This is probably due to the difference in endocrine response to surgery between the two types of anesthesia.

Journal Article↗