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Biomedical subjects

H Komatsu

Publications and source records attributed to H Komatsu.

At least 163 records · Page 9Linked to original sources
PubMed1997

[Surgical treatment for patients with atypical mycobacteriosis].

We have been conducting surgical therapy for patients with atypical pulmonary mycobacteriosis (AM) since 1965 and have reported on the outcome of this approach to treatment. We have found that chemotherapy is not adequately efficacious against type III Mycobacterium avium complex (MAC), which suggests that surgical intervention may be the optimum approach for MAC. Among MAC patients who were treated surgically at our hospital in the period between 1966 and 1994, 74 cases on whom postoperative follow-up observation was possible served as the subjects of the present investigation. We report here on the outcome of treatment and related problems in these patients. Thirty-nine patients gave positive results for bacterial discharge on smear tests and all were positive on culture. Operation was performed on the right lung in 46 patients and on the left lung in 16. Pneumonectomy was conducted in 10 patients and lobectomy in 20. Other operative modes used included segmental resection in 9, pyothorax in 7, and thoracoplasty in 5 patients. Postoperative bacterial excretion was observed in 15 patients and was persistent bacterial discharge were advanced cases with lesions in another lobe, cases with a past history of tuberculosis, cases of cavitation with lesions on the contralateral side or cases with massive bacterial discharge prior to surgery. Postoperative death occurred in 5 patients: the cause of death was lung cancer in 1 case, serum hepatitis in 1 case, and respiratory failure evidenced by enlarged shadows in 3 cases. These findings pointed to a marked significance of surgical therapy for MAC patients. However, recurrent bacterial discharge has been observed occasionally in some patients even 5 years after surgery. This suggests the need for careful ongoing assessment of the efficacy of surgical therapy and long-term postoperative follow-up.

Adult↗
PubMed1997

[Pathology of bronchopulmonary aspergillosis].

This paper concerns the morphology of 3 types of bronchopulmonary aspergillosis: saprophytic aspergillosis (SPA), invasive aspergillosis (IVA) and allergic bronchopulmonary aspergillosis (ABPA)/allergic bronchopulmonary mycosis (ABPM). To know whether Aspergillus (ASP) in SPA only colonizes in preexisting cavities or presents significant pathogenecity, we examined 38 surgical specimens of SPA and 10 post-tuberculous open cavities (PT-OC). Macroscopically, SPA cavities had macroscopic ulcers (81.6%) and bronchi originating from the cavities (68.4%), in contrary to PT-OC that had neither of them. Microscopically, SPA cavities showed shallow ulcers (100%), coagulation necrosis (42.1%) and granulomatous reaction (52.6%), although ASP invasion to the viable lung tissue couldn't be discovered. The lung tissue around the SPA cavities showed various inflammation caused by transbronchial ASP dissemination from the cavities. We concluded that (1) SPA should be considered chronic destructive infection by ASP, but not colonization, (2) SPA couldn't be differentiated in quality from semi-invasive/chronic necrotizing pulmonary aspergillosis, and both should be categorized into secondary bronchopulmonary aspergillosis. Respecting IVA, we investigated 10 autopsy cases. In those cases, the disease was brought about in the lungs having no preexisting lesions. Three forms were distinguished; (1) 5 cases in that coagulation necrosis was a main feature (CN-IVA). (2) 2 cases having lung balls in cavitary lesions (LB-IVA), and (3) 3 cases showing suppurative lesions (SP-IVA). In CN-IVA and LB-IVA cases, ASP invaded to the viable lung tissue. But in 2 cases of SP-IVA, fungal hyphae were identified only in necrotic lesions but not in the viable tissue. Because the "invasive" was vague in definition, we should categorized these cases into primary bronchopulmonary aspergillosis. To determine the primary lesion of ABPA/ABPM, 5 lobectomy specimen were examined. All cases had hard or firm mucous plugs in the proximal bronchi, peripheral to which we found inflammation with tissue eosinophilia (bronchocentric granulomatosis with tissue eosinophilia : 5 cases, xanthogranuloma-like lesions : 2 cases, eosinophilic pneumonia : 2 cases and organizing pneumonia : 4 cases). Conglomerates of degenerated eosinophils, sometimes showing fir-structure, and fungal hyphae were recognized in both of mucous plugs and the peripheral lesions. We concluded that the mucous plug was the primary lesion of ABPA/ABPM.

Aged↗
PubMed1997

[Significance of postoperative elevation of urinary ulinastatin after open heart surgery under cardiopulmonary bypass].

To investigate the role of ulinastatin in perioperative stress, we measured the urinary levels of ulinastatin (UTI) in patients subjected to open heart surgery under cardiopulmonary bypass. The UTI levels began to increase on the first postoperative day and reached its maximum level on the third postoperative day. There is a good correlation between the maximum level of urinary UTI and cardiopulmonary bypass time. These results indicate that urinary UTI level can be an indicator of surgical stress.

Aged↗
PubMed1997

[Effects of ulinastatin on postoperative renal function in hepatectomized patients with liver cirrhosis].

Posthepatectomy patients with liver cirrhosis have a high incidence of multiple organ failure including renal failure. The depression of urinary ulinastatin (UTI) might be involved in renal derangements in the posthepatectomy patients with liver cirrhosis. We evaluated the relationship between the renal functions and the level of urinary UTI in perioperative period in the posthepatectomy patients with liver cirrhosis, and evaluated whether or not the renal function in the posthepatectomy patients with liver cirrhosis was protected by receiving synthetic UTI, Miraclid. In posthepatectomy patients with liver cirrhosis, the urinary UTI level was 26.3 +/- 13.0 IU. mg x Cr-1 on the first day and renal tubular dysfunction was noticed. On the other hand, in posthepatectomy patients with liver cirrhosis receiving Miràclid administered intravenously during the operation and postoperative three days, the urinary UTI level was 121.2 +/- 85.0 IU. mg x Cr-1 on the first day and renal function was maintained. These results indicate that in posthepatectomy patients with liver cirrhosis, an increase in urinary UTI level observed in response to surgical stress may not occur and this low level of urinary UTI may cause renal dysfunction in the postoperative period. The synthetic UTI, Miraclid, may have beneficial effects reversing the renal derangements resulting from the stress in posthepatectomy patients with liver cirrhosis.

Aged↗
PubMed1997

[Lung volume reduction surgery for pulmonary emphysema--report of two cases].

Lung volume reduction surgery (LVR) was practiced in 2 male patients with pulmonary emphysema to improve pulmonary function. On admission, they complained of exertional dyspnea (Grade III of the Hugh-Jones dyspnea scale). Computed tomographic scan (band display) revealed emphysematous changes throughout both lung fields, especially in bilateral upper lobes. Nuclear lung perfusion scintigraphy showed markedly diminished blood flow in both upper lobes. The bilateral upper lobes of each patient were excised through median sternotomy using the linear stapling device. The staple lines were buttressed with bioabsorbable polyglycolic acid fabric. At 1 month after LVR, the forced expiratory volume in 1 second improved, respectively, from 0.51 L to 1.27 L (Case 1) and from 0.68 L to 0.85 L (case 2). In conclusion, LVR was useful to improve pulmonary function of the patients with pulmonary emphysema.

Aged↗
PubMed1997

[Urinary excretion of ulinastatin and NAG after cardiopulmonary bypass].

Although urinary trypsin inhibitor (ulinastatin, UTI) is excreted into urine, its physiological function has not been clarified well. Administration of UTI during surgical procedure was reported to protect renal function from surgical stress. This result suggests participation of UTI excretion in renal tubular function. In this study, the amount of urinary excretion of UTI and that of N-acetyl-beta-D-glucosaminidase (NAG) after cardiopulmonary bypass (CPB) were measured. The urinary UTI excretion increased after surgery and reached the maximum on the third postoperative day. NAG also increased gradually and was three times greater than control on the seventh postoperative day. There was a good correlation between NAG and UTI on the first postoperative day. It is suggested that UTI might correlate with the renal tubular function after CPB.

Acetylglucosaminidase↗
PubMed1997

The role of lymphadenectomy in the treatment of transitional cell carcinoma of the upper urinary tract.

PURPOSE: We evaluated the efficacy of lymphadenectomy in conjunction with nephroureterectomy in patients with transitional cell carcinoma of the upper urinary tract. MATERIALS AND METHODS: Data were evaluated retrospectively in 21 consecutive men and 15 women (mean age 67 years) who underwent total nephroureterectomy with lymphadenectomy between January 1985 and December 1993. RESULTS: Of the 36 patients 11 (31%) had lymph node metastases. Of 20 patients with stages pT3 to 4 or pN+ tumors 12 received cisplatin based chemotherapy (11 postoperatively and 1 preoperatively). Followup ranged from 3 to 135 months (mean 55). Among 13 patients who died by May 1996 tumor was the cause of death in 8, while 5 died of unrelated causes. The probability of a cause specific survival at 5 years was 100% in patients with stages pTa to 1, 80% with stage pT2, 59% with stage pT3 and 0% with stage pT4 cancer. The probability of a cause specific survival at 5 years in patients with nodal metastasis was 21%. No patient without nodal metastasis died of tumor related causes. CONCLUSIONS: Lymphadenectomy may provide therapeutic benefit in select patients with lymph node metastasis. It also may be a useful indicator of candidates for adjuvant chemotherapy if an effective regimen is established because lymph node metastasis is common in patients with carcinoma of the upper urinary tract and is critical in establishing the prognosis.

Adult↗
PubMed1997

[TUR syndrome].

Explore the source record for details and available documents.

Humans↗
PubMed1997

[Changes in symptom and thermography images after lumbar sympathetic ganglion block].

In 35 lower limbs of 22 patients with peripheral circulation disturbance, we evaluated the effects of lumbar sympathetic ganglion block (LSGB) by skin temperature difference (delta T) between the two measured by thermography before and after LSGB. We divided the patients into two groups; ASO group (n = 15): patients with chronic arterial occulusive diseases, and nonASO group (n = 7): those with peripheral circulation disturbance partly due to decrease nervous function. After LSGB, we recognized a significant increase in delta T and remission of ischemic symptoms in all the patients of nonASO group and those in early stage of ASO group. This suggests that in ASO group LSGB should be applied as soon as possible to obtain good outcome, and thermography is useful to evaluate the effects of LSGB in patients with peripheral circulation disturbance of the lower limbs.

Adult↗
PubMed1997

Effects of the new angiotensin receptor antagonist dipotassium (Z)-2-[[5-ethyl-3-[2'-(1H-tetrazol-5-yl)biphenyl-4-yl] methyl-1,3,4-thiadiazoline-2-ylidene]aminocarbonyl]-1-cy clopentencarbox ylate on experimental cardiac hypertrophy and acute left ventricular failure.

The cardiovascular effects of dipotassium (Z)-2-[[5-ethyl-3-[2'-(1H-tetrazol-5-yl)biphenyl-4-yl] methyl-1,3,4-thiadiazoline-2-ylidene]aminocarbonyl]-1-cyc lopentencarboxylate CAS 169328-25-0, KRH-594), a new angiotensin II type 1 (AT1) receptor antagonist, on pressure-overload cardiac hypertrophy in rats and on acute left ventricular failure in dogs were investigated. In rats with a 2-week abdominal aorta constriction, left ventricular weight (LVW) and systolic blood pressure (SBP) were significantly greater than in sham-operated rats. Oral administration of KRH-594 (10 or 30 mg/kg/day for 2 weeks) reduced the increases in both LVW and SBP. Another AT1 receptor antagonist, candesartan cilexetil (1 or 3 mg/kg/day for 2 weeks), also prevented this type of cardiac hypertrophy. In anesthetized dogs with a 60-min coronary ligation, left ventricular end-diastolic pressure (LVEDP) and total peripheral resistance (TPR) were raised, whereas the maximum first derivative of left ventricular pressure and cardiac output were both decreased. Intravenous administration of KRH-594 (3 mg/kg) significantly attenuated the increases in both LVEDP and TPR after coronary ligation. These results suggest that KRH-594, by reducing the cardiac afterload, may ameliorate pressure-overload cardiac hypertrophy in rats and produce an improvement in the hemodynamic status of dogs with acute left ventricular failure.

Acute Disease↗
PubMed1997

[Efficacy of ring-shape cover in active skin surface warming in neonates--a retrospective comparative study with conventional methods].

UNLABELLED: Prevention of perioperative hypothermia is one of the most essential factor for neonatal anesthesia. Recently the forced-air warming system has been considered the most effective method in preventing perioperative hypothermia in adults, in children, and in infants during maxillofacial operations. However, its use for abdominal or thoracic surgery in neonates has not been examined. In the present study, we studied the effects of the forced-air warmer with a ring-shape cover, and compared this method with the conventional method retrospectively. PATIENTS AND METHODS: Sixteen neonates, 13 for abdominal and 3 for thoracic surgery were anesthetized with oxygen-air (nitrous oxide) sevoflurane (isoflurane or enflurane) in combination with/without fentanyl. They were divided into two groups; one for forced-air warming (F-group), and another for conventional methods (C-group). The patients' mean age, height and weight, the duration of anesthesia, infusion rate (ml.kg-1.hr-1), and urine output did not differ each other. Patients in F-group were placed in the center of the ring-shape cover and received heated air from their surroundings. We did not use any other warming equipment or means except for an artificial nose and a warming mattress. "Medium" heated air (38 degrees C) or unheated, room temperature air were used when necessary. The operating room temperature was kept around 25 degrees C. Patients in the C-group were placed on a warming mattress and under an infrared radiant heater with the room temperature of 30 degrees C. Their extremities were covered with aluminum-foil. Rectal, deep forehead, and deep sole temperatures were monitored throughout anesthesia. RESULTS AND CONCLUSION: In F-group, temperatures were well maintained, while C-group failed to maintain. In F-group, the mean value of base excess at the beginning of the operation was -1.8 mM, but it was restored to normal level without administration of sodium bicarbonate. No complications were found. Thus, compared to conventional methods, the forced-air warming system with a ring-shaped cover is an efficient method for body temperature management in neonatal anesthesia.

Anesthesia, General↗
PubMed1997

Mutations in the nonstructural protein 5A gene and response to interferon therapy in young patients with chronic hepatitis C virus 1b infection.

A region associated with sensitivity to interferon (IFN) has been identified previously in the nonstructural protein 5A (NS5A) of hepatitis C virus (HCV) genotype 1b. A study was undertaken to determine whether the presence of mutations in the NS5A2209-2248 sequence could serve as a predictor of response to IFN therapy in children and adolescents with chronic HCV-1b infection. Sixteen children (M/F ratio = 11:5; mean age 11.7 years, range 5 to 19 years) with chronic HCV-1b infection who received IFN-alpha for 6 months (total dose: 8 MU/kg) were enrolled in this study. Twelve of the children (75%) had an underlying malignant disease. Pretreatment NS5A gene sequences were detected by reverse transcription-nested polymerase chain reaction (RT-nested PCR). PCR products were subjected to direct sequencing by the dideoxy chain termination method. The amino acid sequences of NS5A2209-2248 were compared with the published NS5A2209-2248 sequences of HCV-J. The NS5A2209-2248 sequences were detected in 10(63%) of the 16 children. Eight patients had the wild-type sequences, with no amino acid changes; and two patients had the intermediate type, with only one amino acid change. Four (25%) of the 16 patients responded completely to IFN therapy. Three of the four patients had the wild-type sequences, while none of the patients with the mutant type had a complete response. Serum HCV RNA levels in children with the wild type did not differ from those in patients with the mutant type. This study shows that there is no significant correlation between response to IFN and mutations in NS5A2209-2248. The amino acid sequences in NS5A2209-2248 in young patients with chronic HCV-1b infection appear to be conserved.

Adolescent↗
PubMed1997

[Epinephrine Bitartrate Reference Standard (Control 951) of National Institute of Health Sciences].

The raw material for epinephrine bitartrate was tested for preparation of the "Epinephrine Bitartrate Reference Standard (Control 951)" of National Institute of Health Sciences. Analytical data obtained were as follows: melting point, 148.6 degrees C (decomposition); UV spectrum, lambda max = 279 nm; IR spectrum, the same as that of JP Epinephrine Bitartrate Reference Standard (Control 792); optical rotation, [alpha]20D = -52.8 degrees; thin-layer chromatography, one impurity was detected; high-performance liquid chromatography, no impurity was detected; loss on drying, 0.01%; assay, 99.6% by potentiometric titration, 100.3% by spectrophotometry. Based on the above results, the raw material was authorized as the Epinephrine Bitartrate Reference Standard (Control 951) of National Institute of Health Sciences (Japanese Pharmacopoeia).

Epinephrine↗
PubMed1997

[Riboflavin Reference Standard (Control 951) of National Institute of Health Sciences].

The raw material for riboflavin was tested for preparation of the "Riboflavin Reference Standard (Control 951)" of National Institute of Health Sciences. Analytical data obtained were as follows: melting point, 284.6 degrees C (decomposition): specific absorbance, E1cm1% = 857 (267 nm), 277 (373 nm), 326 (445 nm); IR spectrum, the same as that of JP Riboflavin Reference Standard (Control 921); optical rotation, [alpha]20D = -135.6 degrees; thin-layer chromatography, three impurities were detected; high-performance liquid chromatography, a small amount of 10 impurities were detected: loss on drying, 0.10%; assay, 100.4% by spectrophotometry. Based on the above results, the raw material was authorized as the Riboflavin Reference Standard (Control 951) of National Institute of Health Sciences (Japanese Pharmacopoeia).

Japan↗
PubMed1997

[Estradiol Reference Standard (Control 961) of National Institute of Health Sciences].

The raw material for estradiol was examined for preparation of the "Estradiol Reference Standard (Control 961)" of National Institute of Health Sciences. Analytical data obtained were as follows: melting point, 179.1 degrees C; UV spectrum, lambda max = 281 nm; IR spectrum, the same as that of the Estradiol Reference Standard of National Institute of Health Sciences (Control 931); optical rotation, [alpha]20D = +79.5 degrees; thin-layer chromatography, one impurity was detected; high-performance liquid chromatography (HPLC), a trace amount of three impurities were detected; loss on drying, 3.17%; assay, 99.4% by UV spectrophotometry and 99.0% by HPLC. Based on the above results, the raw material was authorized as the Estradiol Reference Standard (Control 961) of National Institute of Health Sciences.

Estradiol↗