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Biomedical subjects

Hiroyuki Ito

Publications and source records attributed to Hiroyuki Ito.

88 records · Page 5Linked to original sources

Chronic lupus peritonitis with massive ascites at elderly onset: case report and review of the literature.

A 77-year-old Japanese woman with massive painless ascites caused by chronic lupus peritonitis is reported. Peritoneal effusion had been resistant to the administration of steroids during the whole treatment period. It was characteristic that the titers of anti-DNA antibodies and the level of immune complex were elevated in the peritoneal fluid with suppressed levels of complements in ascites, although serum immunological markers reflecting the activity of SLE presented improvement after initiation of the treatment. Fifteen patients with chronic lupus peritonitis were reported previously. We reviewed the literature and suggest that chronic lupus peritonitis at elderly onset may demonstrate a poor response to the glucocorticoid therapy because of persistent inflammation in the peritoneum and the presence of impaired vascular circulation in addition to immunological mechanisms.

Age Factors↗

[Clinicopathological study of salivary duct carcinoma].

Salivary duct carcinoma (SDC) was first described by Kleinsesser in 1968 and was classified as an independent entity by the 1991 Revised World Health Organization. It is a rare but highly malignant tumor. We reviewed pathology in 49 cases of salivary adenocarcinoma, and diagnosed 6 cases as SDC. All had a rapidly enlarged mass in the parotid gland. All were men, and 4 involved facial palsy and metastasis to cervical lymph nodes. Fine needle aspiration biopsy was conducted in 3 cases, but none was diagnosed as SDC. Two had chemotherapy, but showed no effect. All underwent surgery, but only 1 survived more than 4 years. Immunohistochemically, none showed s-100 protein. Four showed PCNA and p53 protein. Highly positive cells of PCNA and p53 were found around comedo necrosis.

Adenocarcinoma↗

[Effect of central and surrounding gratings of test stimulus on appearance of motion aftereffect].

We conducted three experiments to examine the effect of spatial arrangement of test stimulus on the motion aftereffect (MAE). The adaptation and test stimuli were presented to subjects successively. Each adaptation stimulus consisted of a set of three gratings; a central stationary grating was located between the two surrounding gratings, one above and the other below respectively, which were arranged to move leftward for two minutes. The location and/or the shape of the test stimulus were varied to examine the effects of the spatial arrangement. The first and second experiments revealed that the MAE lasted longer when the surrounding gratings for the test were superimposed on those for the adaptation than when they were not superimposed. Further, the results of both experiments showed that the duration was not affected by the distance between the central grating and surrounding one. The results of the third experiment showed that the MAE lasted longer when the central grating for the test was identical with that for the adaptation than when not, and that the surrounding for the test need not to be identical with that for the adaptation. These results support Wade's hypothesis for explaining how MAE occurs.

Figural Aftereffect↗

[Two cases of intraoperative cerebral hemorrhage caused by undiagnosed metastatic brain tumors].

The authors report two cases of intraoperative cerebral hemorrhage caused by metastatic brain tumors. Delayed recovery from general anesthesia and neurological deficit were found in these patients. Brain CT in case 1 showed bilateral subdural hemorrhage and parenchymal massive hemorrhage in case 2. It is thought that the causes of hemorrhage are due to the changes in morphology of vessels, deterioration in cerebral circulatory regulated system, and increased intracranial pressure caused by tumors. Since the incidence of metastatic brain tumor has increased with prolonged survival time induced by progress in cancer therapy, preoperative brain examination and careful attention to vital signs during anesthesia are needed.

Aged↗

[Anesthetic management of MIDCAB with high dose diltiazem].

Precise management of blood pressure and heart rate is required during minimally invasive direct coronary artery bypass (MIDCAB). Previously, low dose diltiazem and beta-blokers have been employed for control of circulation during this procedure, but we report 2 patients whose blood pressure and heart rate were managed during MIDCAB by high-dose diltiazem. In both patients, anesthesia was induced with propofol, vecuronium and fentanyl, and maintained by continuous infusion of propofol and inhalation of oxygen and nitrous oxide. Fentanyl, midazolam, and sevoflurane were administered occasionally. Immediately after the induction, a continuous infusion of nicorandil (2 to 4 mg.hr-1) was started and diltiazem (4 to 15 micrograms.kg-1.min-1) was administered continuously from the beginning of the surgery. Following discontinuation of diltiazem administration, blood pressure and heart rate returned to their preoperative values. These results suggest that safe anesthetic management during MIDCAB can be performed with highdose diltiazem.

Aged↗

[Malignant fibrous histiocytoma of perirenal tissue: a case report].

A 75-year-old woman was admitted to our hospital with an extremely large retroperitoneal tumor that had been detected with ultrasound on a routine health check. She had no complaint except lumbar pain. Computed tomography revealed a heterogenous tumor located outside the right kidney which was enhanced gradually. Doppler ultrasound showed mild vascularity in the tumor. We performed tumorectomy and right nephrectomy because the tumor was adherent to the right kidney. The tumor was 16 x 11 x 7 cm in size and weighed 621 g. The histopathological diagnosis was malignant fibrous histiocytoma. The tumor was considered to have arisen from perirenal tissue.

Aged↗

Sick sinus syndrome disclosed by the successful radiofrequency catheter ablation of persistent common atrial flutter.

Sick sinus syndrome was disclosed in a 77 year-old man after a radiofrequency (RF) linear catheter ablation of cavotricuspid isthmus for persistent common atrial flutter. Prolongation of corrected sinus node recovery time, sinoatrial conduction time and AH interval, as observed after RF ablation, suggested binodal (sinus as well as atrioventricular node) dysfunction. Adams-Stokes syndrome due to sinus arrest was encountered on the day of RF ablation and a permanent DDD pacemaker was implanted consequently. Our experience indicates that careful observation is very important after the RF ablation when atrial flutter is associated with sick sinus syndrome. The present case suggests that binodal dysfunction underlies persistent atrial flutter and vice versa.

Aged↗

[Occlusion of endovascular stent-graft for abdominal aortic aneurysm three years after surgery].

A 79-year old man was admitted to our department with complaints of bilateral foot coldness, numbness and intermittent claudication. He underwent endovascular repair for abdominal aortic aneurysm three years before. An abdominal X-ray showed highly kinked endovascular stent-graft which indicated graft migration, and aortography showed occlusion of stent-graft and infrarenal aorta. An axillo-bifemoral bypass was performed and blood flow to the lower extremities was restored. Endovascular repair for AAA has been established worldwide as a less invasive treatment. Endovascular repair can be performed with low mortality and morbidity in the short period, however, in the long-term follow-up series, several late complications, such as late endoleaks, graft occlusion, AAA expansion, and even AAA rupture were encountered. Indication for endovascular repair for AAA still remains controversial because of these late complications, therefore, great attention must be paid for patient selection for endovascular repair.

Aged↗

Dynamical Cell Assembly Hypothesis - Theoretical Possibility of Spatio-temporal Coding in the Cortex.

This paper is an attempt to understand how knowledge and events are represented and processed in the brain. An important point is the question of what carries information in the brain - the mean firing rate or the timing of spikes? The idea we want to pursue is that, contrary to the traditional view, the brain might use higher order statistics, which means in essence that timing of spikes plays a critical role in encoding, representing, and processing knowledge and events in the brain.A recently revealed salient nature of cortical pyramidal cells, i.e., the high variability of inter-spike intervals suggests that a cortical neuron may function effectively as a coincidence detector. At the same time, non-classical experimental phenomena of task-related, short time-scaled dynamical modulations of temporal correlations between neurons suggest a non-classical view on the dynamics working in the brain. In response to contexts or external events, a group of neurons, a dynamical cell assembly, spontaneously organizes, linked temporarily by coincident timing of incident spikes, showing correlated firing with each other. This is an emergent property of neuronal populations in the cortex.We make a theoretical exploration on issues as (1) the description of such emergent dynamics of dynamical cell assemblies based on the working hypothesis that a cortica neuron functions effectively as a coincidence detector, and (2) the principle of spatio-temporal coding based on the hypothetical emergent dynamics. Note that the conventional rate coding hypothesis does not give satisfactory answers to fundamental questions on the representation and processing of knowledge or events in the brain, e.g., the questions of cross-modular integration of information or the binding problem, and representation of hierarchical knowledge etc.The first goal is to give a non-encyclopedic review on (1) the temporal structure of spike sequences, focusing on the question of the basic code in the brain; (2) the paradigms on representation of knowledge and events proposed from a theoretical or experimental basis. The classical paradigms of Hebb and Barlow with their experimental and theoretical critiques, and more recently proposed experiment-based paradigms are reviewed. Also a review is given on (3) the experimentally observed spatio-temporal structure of spike dynamics.The second goal is to give a description of the dynamical cell assembly - the central concept in this paper. Aside from the question of physiological basis, we make a theoretical study, under a working hypothesis that a cortical neuron functions effectively as a coincidence detector, on the emergent dynamics of cell assemblies, and also examine how the observed experimental data could be explained within this theoretical setting.We also try to give the principle of spatio-temporal coding based on the dynamical cell assembly framework. A key concept is the internal mechanism of "dialogue" among neuronal pools in the brain. This provides a dynamical foundation of bi-directional interactions for the linkage of distant modules to create integrated information. We present a simple model in order to illustrate the working principle of coincidence detector systems. Relations with other temporal coding paradigms are also discussed. Copyright 1996 Elsevier Science Ltd.

Journal Article↗

Weight reduction decreases soluble cellular adhesion molecules in obese women.

1. Obesity is known to increase the risk for atherosclerotic diseases. Serum levels of cellular adhesion molecules are reported to be indices of atherosclerosis. The aim of the present study was to assess the effect of weight reduction on soluble intercellular adhesion molecule-1 (sICAM-1) and soluble E-selectin (sE-selectin). 2. Eighteen non-diabetic normotensive obese women participated in a 3 month lifestyle-modification programme (intervention group). The programme consisted of lectures on diet, exercise sessions and behavioural modification by weight charting. Fourteen women who did not enter the programme served as controls. Body fat mass (FM) was measured by dual-energy X-ray absorptiometry. Soluble ICAM-1 and sE-selectin were measured by ELISA. 3. After 3 months, sICAM-1 and sE-selectin, as well as body FM, decreased in the intervention group (P < 0.001), while no changes were observed in the control group. The baseline sE-selectin was positively correlated with total body FM, trunk FM and percentage body fat (r = 0.50-0.57; P < 0.01), but not with leg FM. The change in sE-selectin was also correlated with changes in total body FM and trunk FM (both r = 0.46; P < 0.01). Baseline sICAM-1 was not significantly correlated with these variables. The associations between changes in sICAM-1 and changes in total body FM or trunk FM were of borderline significance (both r = 0.34; P = 0.06). Linear regression analysis indicated that the change in sE-selectin was explained by the change in trunk FM (R2 = 0.18; P < 0.01). 4. Soluble ICAM-1 and sE-selectin were positively correlated with obesity, especially with central obesity. Weight reduction resulted in decreases in soluble adhesion molecules, which may suggest a downregulation of endothelial activation.

Adult↗

Prophylactic effects of an N- and L-type Ca2+ antagonist, cilnidipine, against cardiac hypertrophy and dysfunction in stroke-prone, spontaneously hypertensive rats.

To clarify the beneficial effects of cilnidipine, an L- and N-type calcium channel blocker, which were clinically observed against diastolic dysfunction in hypertrophied hearts of hypertensive patients, we investigated the effects of cilnidipine on cardiac remodeling and enhanced gene expression in stroke-prone, spontaneously hypertensive rats in comparison with that of captopril, a well-known angiotensin-converting enzyme inhibitor, at threshold doses with little blood pressure lowering effect. The expression of type III collagen and beta/alpha-myosin heavy chain as well as transforming growth factor-beta, and basic fibroblast growth factor were suppressed by both treatments, indicating the prevention or amelioration of cardiac dysfunction. Such beneficial effects were much more intense with cilnidipine treatment than in captopril. These results indicate that Ca2+ is a key factor in the pathogenesis of cardiac remodeling in hypertension. One possible beneficial effect of cilnidipine in the prevention of cardiac dysfunction may be due to the decreased amount of growth factors such as transforming growth factor-beta and basic fibroblast growth factor via direct action for Ca2+ influx and also via inhibition of local renin-angiotensin system in the myocardium.

Angiotensin-Converting Enzyme Inhibitors↗

Cholesterol embolization treated with corticosteroids--two case reports.

Cholesterol embolization (CE) is a potentially serious complication associated with invasive arterial maneuvers, in which standard therapy has not been established. We experienced two cases of CE in patients with severe atherosclerosis whose renal function deteriorated within a few months after invasive arterial maneuvers. CE was confirmed either by renal biopsy (case 1) or skin biopsy (case 2). Oral administration of prednisolone at a daily dose of 30 mg (0.4 mg/kg) was effective to improve their renal function. Our observation suggests that corticosteroid therapy may be beneficial in some patients with CE.

Aged↗

Expression of vascular endothelial growth factor and basic fibroblast growth factor in small adenocarcinomas.

The expression of two angiogenetic factors, vascular endothelial growth factor (VEGF) and basic fibroblast growth factor (bFGF), in small adenocarcinomas (</=2 cm in greatest dimension) in relation to pathological features and survival was determined. Tumor specimens were obtained from lungs of 80 patients who underwent curative operations with systematic nodal dissection. The median follow-up period was 47.7 months. Expression of VEGF and bFGF was assessed by immunohistochemical staining. The percentage of VEGF-positive tumors was 40.0%, and that of bFGF-positive tumors was 52.5%. VEGF-positivity was significantly associated with vessel invasion (p=0.03) and pathological stage (p=0.04). There was no significant statistical difference with respect to relapse (p=0.08), but a tendency to a lower disease-free survival rate was seen. bFGF-positivity was significantly associated with differentiation (p<0.01) and vessel invasion (p<0.01). The survival curves of bFGF were similar to those of VEGF. Even in small adenocarcinomas, VEGF and bFGF were significantly associated with histological features and survival.

Adenocarcinoma↗

Expression of survivin correlated with vessel invasion is a marker of poor prognosis in small adenocarcinoma of the lung.

The purpose of this study was to investigate the possible association between expression of survivin, pathological findings in the tumor and survival in patients with small adenocarcinoma of the lung. Seventy-nine patients with resected tumors <2 cm in diameter were entered into the study. There were 33 males and 46 females, with a median age of 64 years (range 26-83 years). The pathological stage of the tumors was recorded as stage I, II, III and IV in 72, one, five and one case, respectively. Each patient underwent curative surgical resection for lung cancer between July 1992 and November 1999. The resected tumors were subjected to immunostaining for survivin. Thirty-eight patients had tumors with < or = 10% survivin-positive cells and 41 patients had tumors with >10% survivin-positive cells. When survivin expression and pathological findings in the resected tumors were analyzed, the frequency of venous invasion was significantly higher in the survivin-positive group (36.6% vs. 13.2%; p=0.0167). In contrast, the overall survival of survivin-positive patients (n=41) was significantly worse than that of individuals whose tumors were negative for survivin expression (n=38; log-rank test, p=0.014; Wilcoxon test, p=0.021). It can be concluded that the expression of survivin in tumor cells is a factor of poor prognosis in patients with small adenocarcinoma of the lung.

Adenocarcinoma↗

Increased expression of integrin beta1 is a poor prognostic factor in small-cell lung cancer.

The purpose of this study was to investigate the possible association between the expression of integrin beta1 and response to chemotherapy and survival in patients with small cell lung cancer (SCLC). One-hundred and four patients with SCLC, who had received an initial course of chemotherapy between February 1989 and July 1999, were entered into the study. There were 91 males and 13 females, with a median age of 65 years (range 40-85 years). The clinical stage of the tumors was recorded as limited disease in 43 patients and extensive disease in 61. Each patient received a full-dose of combination chemotherapy. Transbroncheal biopsy specimens of tumors obtained before chemotherapy were subjected to immunostaining for integrin beta1. Twenty-nine patients could not be evaluated for integrin beta1 immunostaining, because the tissue samples had been crushed during the biopsy procedure. Fifty-three patients had tumors with < or = 25% integrin beta1-positive cells and 22 patients had tumor with > 25% integrin beta1-positive cells. Among 75 patients whose biopsy specimens were evaluable for integrin beta1, the overall response rate to chemotherapy was 87%. When the relationship between integrin beta1 expression and tumor response to chemotherapy was considered, 17 out of 22 patients with high expression of integrin beta1 and 48 out of 53 patients with low expression of integrin beta1 showed tumor response, although the resistance rate in patients with high expression of integrin beta1 was over twice that of patients with low expression of integrin beta1 (23% vs. 9%, respectively). By comparison, the overall survival of patients with high expression of integrin beta1 (n = 22) was significantly worse than that of individuals whose tumors had low expression of integrin beta1 (n = 53; log-rank test, p=0.043; Wilcoxon test, p=0.049). The association between survival and prognostic factors was examined by multivariate regression analysis; clinical stage and integrin beta1 were found to be independent factors (p = 0.018 andp = 0.041, respectively). In conclusion, the high expression of integrin beta1 in tumor cells is a poorprognostic factor in patients with SCLC.

Adult↗

Expression of cyclin D1 but not of cyclin E is an indicator of poor prognosis in small adenocarcinomas of the lung.

We investigated the significance of cyclin D1 and cyclin E expression in resected tumors on the survival of patients with small adenocarcinomas of the lung. Seventy-two patients with resected tumors <2 cm in diameter and of pathological stage I were entered into the study. There were 29 males and 43 females, with a median age of 64 years (range 26-83 years). The patients underwent curative surgical resection for lung cancer between July 1992 and November 1999. The resected tumors were subjected to immunostaining for cyclin D1 and cyclin E expression. Twenty-six patients had tumors with >20% cyclin D1-positive cells, but only 1 patient had a tumor with >20% cyclin E-positive cells. When the survival of 72 patients was compared in relation to their oncogene expression, the overall survival of patients with positive expression of cyclin D1 was significantly worse than that of individuals whose tumors had negative expression of the gene (log-rank test p=0.0049). Increased expression of cyclin D1 but not of cyclin E is an indicator of poor prognosis in patients with small adenocarcinomas of the lung.

Adenocarcinoma↗