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Biomedical subjects

H Nishida

Publications and source records attributed to H Nishida.

At least 199 records · Page 11Linked to original sources
PubMed1996

Double balloon catheter for concomitant augmentation of abdominal organ perfusion during intraaortic balloon counterpulsation.

A newly devised double balloon catheter to augment abdominal organ perfusion concomitant with original cardiac assist during intraaortic balloon counterpulsation provided satisfactory hemodynamics and urinary output around cardiac surgical procedures in 2 patients with coronary artery disease. Some optional advantages in clinical application and problems arising in the catheter design which need to be investigated are discussed.

Acetylglucosaminidase↗
PubMed1996

Recurrent exercise-induced acute renal failure in renal hypouricemia.

We describe a male patient with four episodes of acute renal failure after strenuous exercise occurring between the age of 14 and 25 years. He was found to have low serum uric acid (0.4 mg dl-1 after recovery) and high fractional excretion of uric acid. A benzbromarone/pyrazinamide test suggested that renal hypouricemia was due to defective proximal tubular reabsorption of uric acid at a presecretory site. A renal biopsy revealed acute tubular necrosis, a renal computer tomography scan showed patchy contrast enhancement and a treadmill exercise test induced an immediate fall in creatinine clearance. These findings suggest that the cause of acute renal failure was renal vasoconstriction rather than obstruction by uric acid crystals.

Acute Kidney Injury↗
PubMed1996

Renal denervation prevents intraglomerular platelet aggregation and glomerular injury induced by chronic inhibition of nitric oxide synthesis.

Nitric oxide (NO) inhibits platelet adhesion and aggregation in vitro. In vivo, chronic inhibition of NO synthesis induces nephrosclerosis and hypertension. Although the pathophysiological mechanism of this glomerular injury has not been clarified, sympathetic nerve activation, a potent procoagulant stimulus elicited by NO inhibition, may play a role. To investigate the role of renal sympathetic nerves in the development of renal injury induced by NG-nitro-L-arginine methyl ester (L-NAME), a specific NO synthesis inhibitor, we examined renal histological changes in four groups of Sprague-Dawley rats: (1) sham operated, vehicle treated; (2) sham operated, L-NAME treated; (3) denervated, vehicle treated, and (4) denervated, L-NAME treated. Following renal denervation or sham operation, L-NAME was administered orally for 4 weeks. Chronic NO inhibition induced platelet aggregation and erythrocyte stasis in the glomerular capillary lumen accompanied by electron-microscopic glomerular injury. Renal denervation abrogated platelet aggregation and glomerular injury in L-NAME-treated animals. Thus, chronic NO synthesis inhibition induced intraglomerular platelet aggregation and glomerular injury, which was attenuated by renal nerve denervation. These results suggest that intrinsic NO may have an antithrombotic effect in the glomeruli and may play a protective role in the progression of glomerular injury possibly mediated by renal sympathetic nerves.

Albuminuria↗
PubMed1996

Estimation of the optimal cut off point in a new immunological faecal occult blood test in a corporate colorectal cancer screening programme.

OBJECTIVE: To estimate the optimal cut off point in a new immunological method (OC-Hemodia) for faecal occult blood testing (FOBT). SETTING: A corporate colorectal cancer screening programme in Japan. METHOD - The screening programme targeted colorectal cancer and adenomatous polyps > or = 10 mm, and was conducted on 27 860 participants (age > or = 40 ) during 1991-92. The follow up consisted of diagnostic management by total colonoscopy on positive screened subjects exceeding the manufacturer recommended cut off level of 50 ng/ml faecal haemoglobin, and the identification of false negative cases by health insurance claims. The optimal cut off point was estimated by the positive predictive value, receiver operating characteristic (ROC) curve, and a cost effectiveness analysis. In this study evaluation was carried out only for cancer as the target disease. RESULTS: - At the current cut off level of 50 ng/ml the sensitivity and specificity were 86.5% and 94.9%. When the optimal cut off point was estimated the highest positive predictive value was obtained at 250-350 ng/ml. The ROC curve showed that the sum of sensitivity and specificity is maximised at 50 ng/ml, but evaluation of the ratio, change in sensitivity/change in false positive rate, pointed to higher optimal cut off points, showing marked changes occurring at about 200 ng/ml. The average cost per case was lowest at 250-300 ng/ml. Overall, the optimal cut off point was estimated to be about 200 ng/ml, at which the sensitivity and specificity of the test would be 77.5% and 98.9%, respectively. CONCLUSION: The optimal cut off point of the new immunological method of FOBT was estimated to be about 200 ng/ml, a value which, more than the current cut off value, favours specificity over sensitivity.

Adenoma↗
PubMed1996

Vegetal egg cytoplasm promotes gastrulation and is responsible for specification of vegetal blastomeres in embryos of the ascidian Halocynthia roretzi.

An animal-vegetal axis exists in the unfertilized eggs of the ascidian Halocynthia roretzi. The first phase of ooplasmic segregation brings the egg cortex to the vegetal pole very soon after fertilization. In the present study, when 5-8% of the egg cytoplasm in the vegetal pole region was removed between the first and second phase of segregation, most embryos exhibited failure of gastrulation, as reported previously in Styela by Bates and Jeffery (Dev. Biol, 124, 65-76, 1987). The embryos that were deficient in vegetal pole cytoplasm (VC-deficient embryos) developed into permanent blastulae. They consisted for the most part of epidermal cells and most lacked the derivatives of vegetal blastomeres, such as endoderm, muscle and notochord. Removal of cytoplasm from other regions did not affect embryogenesis. The cleavage of the VC-deficient embryos not only exhibited radial symmetry along the animal-vegetal axis but the pattern of the cleavage was also identical in the animal and vegetal hemispheres. Examination of the developmental fates of early blastomeres of VC-deficient embryos revealed that the vegetal blastomeres had assumed the fate of animal cells. These results suggested that the VC-deficient embryos had been totally animalized. When vegetal pole cytoplasm was transplanted to the animal pole or equatorial position of VC-deficient eggs, gastrulation occurred, starting at the site of the transplantation and tissues derived from vegetal blastomeres formed. Therefore, it appears that vegetal pole cytoplasm specifies the site of gastrulation and the cytoplasm is responsible for the specification of vegetal blastomeres. It is suggested that during the second phase of ooplasmic segregation, cytoplasmic factors responsible for gastrulation spread throughout the entire vegetal hemisphere.

Acetylcholinesterase↗
PubMed1996

Basic fibroblast growth factor induces notochord formation and the expression of As-T, a Brachyury homolog, during ascidian embryogenesis.

The tadpole larva of an ascidian develops 40 notochord cells in the center of its tail. Most of the notochord cells originate from the A-line precursors, among which inductive interactions are required for the subsequent differentiation of notochord. The presumptive-endoderm blastomeres or presumptive-notochord blastomeres themselves are inducers of notochord formation. Notochord induction takes place during the 32-cell stage. In amphibia, mesoderm induction is thought to be mediated by several growth factors, for example, activins and basic fibroblast growth factor (bFGF). In the ascidian, Halocynthia roretzi, treatment with bFGF of presumptive-notochord blastomeres that had been isolated at the early 32-cell stage promoted the formation of notochord at a low concentration of bFGF (0.02 ng/ml), while activin failed to induce notochord differentiation. The effect of bFGF reached a maximum at the end of the 32-cell stage and rapidly faded at the beginning of the subsequent cleavage, the time for full induction of notochord being at least 20 minutes. The expression of As-T, a previously isolated ascidian homolog of the mouse Brachyury (T) gene, starts at the 64-cell stage and is detectable exclusively in the presumptive-notochord blastomeres. The present study showed that presumptive-notochord blastomeres, isolated at the early 32-cell stage, neither differentiated into notochord nor expressed the As-T gene. However, when the presumptive-notochord blastomeres were coisolated or recombined with inducer blastomeres, transcripts of As-T were detected. When presumptive-notochord blastomeres were treated with bFGF, the expression of the As-T gene was also detected. These results suggest that inductive interaction is required for the expression of the As-T gene and that the expression of the As-T gene is closely correlated with the determined state of the notochord-precursor cells.

Activins↗
PubMed1996

[Assessment of cochlear functions of patients with acoustic neuromas].

Electrocochleographic cochlear microphonics (ECochG-CM) and Evoked Otoacoustic Emissions (EOAE) were recorded for 17 patients with acoustic neuromas to assess their cochlear functions. ECochG-CM was recorded by a transtympanic needle electrode technique. The acoustic stimuli of EOAE were short tone bursts and thresholds of detection of the slow components were determined. In 13 of the 17 patients, elevated detection thresholds of ECochG-CM and/or abnormal interaural differences in detection thresholds of the slow components of EOAE were observed. The patients with hearing loss and an elevated thresholds of CM were believed to have cochlear impairments. Those with hearing loss and a relatively low detection threshold of CM were thought to have cochlear nerve damage and a smaller degree of cochlear impairment. The correlation of ECochG-CM and EAOE was 0.799. Both ECochG-CM and EOAE were useful in evaluating the cochlear functions of patients with acoustic neuromas. Although EOAE was easier to apply clinically, ECochG was indispensable when detailed examinations of cochlear functions were necessary.

Adult↗
PubMed1996

[Surgical treatment for ischemic cardiomyopathy].

From June 1970 to Aug. 1995. We were experienced 2,235 coronary surgical patients at the Heart Institute of Japan. Among them, the ischemic cardiomyopathy (ICM) was defined as the elective, isolated CABG with the EF of less than 20%. Among the 1,640 cases of elective, isolated CABG, the cases with the EF of less than 20% were 29, 1.8% of the total. The hospital mortality was 2 cases (6.9%). The late mortality was 2 cases. The graft patency rate was 96.6%. An actuarial survival rates at 1 year, 3 years and 5 years were 93%, 93 and 87%. Operative mortality and 5-year survival rate of CABG for ICM are acceptable, and appear comparable to that achieved in similar patients after transplantation.

Adult↗
PubMed1996

[A case of saccular aneurysm of the coronary artery].

A 42-year-old man with chest oppression was diagnosed as having a saccular aneurysm of the coronary artery by cardiac catheterization. At the time of operation on April 26, 1993, the aneurysm, measured 15 mm in diamer, and arose from the proximal segment of the first septal branch of the left anterior descending coronary artery. Several coronary arteriovenous fistulae from the aneurysm to the pulmonary artery were also noted. The stem of the aneurysm and the coronary arteriovenous fistulae were ligated and the aneurysm was resected. We considered the etiology to be mainly arteriosclerosis on the basis of the aneurysm pathology. And this aneurysm was also considered to have congenital factors because of the existence of arteriovenous fistulae. There were no symptoms after the operation and he was discharged at 24th postoperative day. Now he continues to do well.

Adult↗
PubMed1996

Clinical application of a newly developed autoflow control system for the Terumo centrifugal pump: from external control to built-in direct control.

We have developed an autoflow control system for the Terumo Capiox centrifugal pump, the SP-101. First, we made an external control system regulated by a personal computer through a serial communications line. Although an in vivo experiment using a goat showed excellent performance in regulating the flow, a communication error that caused an abrupt and instantaneous flow fluctuation was noted occasionally. Therefore, we incorporated a check-sum function to solve this problem. After this improvement, 5 patients safely underwent cardiopulmonary bypass using a pump having this autoflow control. As the next step for more practical usage, we developed a built-in autoflow control system in which the control device is entirely incorporated into the console without a communications line. This system demonstrated better response and reliability than the external control system and was applied successfully in 3 patients. In conclusion, this autoflow mode will expand the usage of centrifugal pumps through improved handling.

Algorithms↗
PubMed1996

A new supportive method of aortic aneurysm surgery: centrifugal left heart bypass combined with an oxygenator and a heat exchanger.

A new supportive method of centrifugal left heart bypass with oxygenation was performed in 25 patients and compared with standard left heart bypass in 45 patients. Femoro-femoral bypass was selected in another 6 patients because of the presence of a left atrial adhesion. Intraoperative complications related to standard left heart bypass, hypoxia, hypothermia, and ventricular fibrillation, were eliminated by using this method. This supportive method maintained good hemodynamics and improved the surgical result of extended thoracoabdominal aortic replacement. Hospital deaths decreased from 6.7% to 3.2%.

Adult↗
PubMed1996

Less blood damage in the impeller centrifugal pump: a comparative study with the roller pump in open heart surgery.

A centrifugal pump with an impeller (Nikkiso Centrifugal Pump, Model HPM15; Nikkiso Co. Ltd.) was applied to cardiopulmonary bypass (CPB) in 14 patients who underwent elective coronary artery bypass grafting. Serum hemoglobin level, platelet count, and serum beta-thromboglobulin (beta TG) level were measured during CPB. The results were compared with those obtained in a comparative roller pump (RP) group (n = 10). There was no difference in the time on CPB between the NP (109 min) and RP (121 min) groups. The serum beta TG level (ng/ml) was lower in the NP group than in the RP group (obtained 90 min after the initiation of CPB). The plasma-free hemoglobin level also was lower in the NP group than in the RP group (obtained 90 min after the initiation of CPB, 120 min after the initiation of CPB, immediately after the termination of CPB, 3 h after termination of CPB; p < 0.01). There was no significant difference in platelet depletion. The HPM15 pump showed excellent hemodynamic performance with less blood trauma compared with the roller pump in its clinical application to open heart surgery.

Adult↗
PubMed1996

[Emergency coronary artery bypass in an 84-year-old patient with severe left main disease and cardiogenic shock].

An 84-year-old male was admitted to pur hospital because of unstable angina. The patient presented in cardiogenic shock with a cardiac index of 1.3 l/min/m2 associated with hypotension (systolic blood pressure < 80 mmHg) and oliguria, and in ventricular fibrillation after an acute broad anterolateral infarction due to severe left main coronary disease. The patient received an intra-aortic balloon pumping (IABP) and underwent emergency CABG. After completion of CABG, left ventricular contractility was markedly diminished to maintain systemic circulation. Because the patient could not be weaned from cardio-pulmonary bypass (CPB) in spite of IABP and high-dose of catecholamines, we decided to continue CPB. It was continued for 163 minutes and the patient was successfully weaned from CPB. In spite of the high risk of operative mortality with CABG for left main shock syndrome in elderly patients, CABG could be performed safely. The patient ran an uneventful postoperative course and is now doing well.

Aged↗
PubMed1996

[Cardiac surgery in patients on chronic hemodialysis].

From March 1993 to February 1993, 36 patients with chronic renal failure underwent cardiac surgery with intraoperative hemodialysis (HD). We examined and compared the medium term results of those patients cased upon the time periods of operation and types of heart disease. With respect to the time periods of operation, the 1st term (n = 12) was between March 1985 and February 1989, and the 2nd term (n = 24) was between March 1989 and February 1993. Concerning types of disease, Group A was comprised of 24 patients with ischemic heart disease, and Group B was comprised of 12 patients with valvular or congenital heart disease. Only one early death was observed in the 1st term (8.3%: LOS). As for late death, 5 cases were observed in the 1st term (45.3%), and 2 cases were observed in the 2nd term (8.3%). The actuarial survival rate (post 3 years) was 72.7% in the 1st term and 91.3% in the 2nd term. In each case, the survival rate of the 2nd term was significantly better than the that of the 1st term (p < 0.025). When compared cased upon the types of disease, the actuarial survival rate (post 6 years) was 84.6% in Group A, and 45.5% in Group B, respectively. This difference was statistically significant (p < 0.05). Causes of late death were cerebral hemorrhage in 5 cases, sudden and unknown in one and DIC in the remaining one patient. There were many postoperative complications in this series in addition to the above stated fatal ones. The majority of them, however, were successfully treated, if early diagnosis of them was obtained. During the perioperative period through the long-term period, incidents of fatal hemorrhage among patients on chronic dialysis were reduced by 1) strict management of hypertension; 2) HD without use of Heparin; and 3) with respect to patients who required Warfarin after valve replacement, through the careful anti-coagulant therapy which maintained the thrombo-test (TT) value at precise levels.

Adult↗
PubMed1996

Coronary artery bypass grafting with both internal thoracic arteries and the right gastroepiploic artery.

From July 1989 to March 1995, 83 patients (79 men, 4 women, mean age 58.3 years, range 35 to 76 years) underwent coronary artery bypass grafting with the both internal thoracic arteries (ITAs) and the right gastroepiploic artery (RGEA). Postoperative follow-up ranged from one to 69 months with a mean of 31 months. Seventy-eight patients (94%) had either triple vessel disease or left main disease. A total of 264 distal anastomoses with arterial grafts were constructed; 90 with the left ITA, 73 with the right ITA, 90 with the RGEA and 1 with the inferior epigastric artery (IEA). An additional saphenous vein graft was constructed in 13 patients including 4 sequential bypass grafting. The mean number of distal anastomoses was 3.4. Postoperative angiography was performed in 80 patients (96%) 3 to 4 weeks after the operation. There were no operative deaths or hospital deaths. No patients developed perioperative myocardial infarction. Graft patency in arterial grafts was 96% (242/253), 95% (80/84) in the left ITA, 100% (82/82) in the right ITA and IEA (1/1), and 93% (80/86) in the RGEA. Graft patency in vein grafts was 99% (84/85) and overall patency rate was 96% (326/338). Four patients (5%) died during follow-up period but all were non-cardiac deaths. Six postoperative percutaneous transluminal coronary angioplasties (PTCA) (7%) and two reoperations (re-CABG) (2%) were required, but no patients developed myocardial infarction (MI). The 5-year actuarial survival rate and cardiac event (cardiac death, MI, PTCA, and re-CABG) free rate was 90.1% and 86.6% respectively. In conclusion, the clinical outcome of the coronary artery bypass grafting with the both ITAs and RGEA was satisfactory in terms of low operative risk, high patency rate, and excellent long-term results.

Abdominal Muscles↗
PubMed1996

[One possible classification of the delusional misidentification syndromes and its developmental, regressive understandings].

In recent years, misidentification syndromes have attracted much attention, and various types of these syndromes have been recognized. However, misidentification syndromes tend to be discussed as case reports or as a whole, and yet there is no established classification. This is primarily due to a small number of cases encountered by each researcher. We propose a new classification of misidentification syndrome based on more than 70 patients with these syndromes, who have been treated at one psychiatric hospital during 20 years. First, delusional misidentification syndromes were classified into two types: misidentification of human relationships represented by descent delusion (relational misidentification), and misidentification of identity itself represented by Capgras symptom and Fregoli symptom (identical misidentification). Next, identical misidentification was subclassified into 3 types: division of identity (divided type), union of identity (unionized type), and transformation of identity (transformed type). Various misidentification syndromes and associated signs and symptoms were evaluated in detail from the aspect of descriptive psychiatry and were compared with our new classification. In addition, this typological study on misidentification was analyzed based on the regressive theory and Jacksonism, and we proposed a hypothesis that there is correspondence between misidentification syndromes and the development of person identification in infants.

Capgras Syndrome↗