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Biomedical subjects

I Fukuda

Publications and source records attributed to I Fukuda.

At least 55 records · Page 3Linked to original sources
PubMed1998

Ultrasonographically assessed carotid intima-media thickness and risk for asymptomatic cerebral infarction.

Cerebral infarction (CI) is still a leading cause of death in Japan. Thus, the management of risk factors for CI as primary prevention is one of the most important tasks in multiphasic health testing and services. To determine whether carotid intima-media thickness (IMT) is a risk for CI, ultrasonographically assessed carotid IMT was compared between normal subjects (N) and subjects with asymptomatic CI (ACI) in 243 subjects who underwent human brain dry dock. ACI was found in 68 people (28.0%). Age, body mass index, and mean blood pressure were higher in ACI than in N. Also, atherogenic index was higher in ACI than in N. Carotid IMT was significantly thicker in ACI than in N. Furthermore, incidence of atherogenic plaque in ACI was significantly higher than that in N. In conclusion, not only aging, obesity, blood pressure, and plasma lipids, but also carotid IMT may be a risk for ACI.

Adult↗
PubMed1998

Endoscopic harvesting of radial artery graft for coronary artery bypass.

The radial artery is used frequently in cardiac revascularization and requires an average 23-cm forearm incision. With proper instrumentation (Tsukuba-West Virginia Endoscopic Radial Artery: TW-ERA series, Takumi Cardio Co., Chiba, Japan), the radial artery can be harvested utilizing two small transverse incisions. The authors report six cases of endoscopic harvest of a radial artery graft. Length of the endoscopic incision is 2 cm proximally and 3 cm distally. Operation time and tourniquet times were approximately 80 to 120 minutes. No complications such as hematomas, nerve damage, or delay in healing were observed at the donor sites. Plastic surgeons, with their expertise in radial forearm flaps, hand surgery, and subcutaneous endoscopic techniques, can contribute greatly to the minimally invasive harvesting of the radial artery, preventing associated morbidity and improving the aesthetic and functional outcome of the donor site.

Adult↗
PubMed1998

Serum high molecular weight form of insulin-like growth factor II from patients with non-islet cell tumor hypoglycemia is O-glycosylated.

Non-islet cell tumor hypoglycemia (NICTH) is one of major causes of fasting hypoglycemia. In some patients with NICTH, insulin-like growth factor II (IGF-II) produced by and secreted from the tumors is thought to be a hypoglycemic agent. In patients with NICTH, the major form of IGF-II is high molecular weight form of IGF-II, designated as big IGF-II. The generation of big IGF-II in the NICTH syndrome is unclear. It has been reported that in the patients with NICTH big IGF-II lacks normal E-domain O-linked glycosylation, suggesting that the patient's big IGF-II might be generated by abnormal processing of pro-IGF-II. However, we have found that the apparent size of big IGF-II varies in sera from the patients with NICTH, and that there is a possibility that slower migration pattern of IGF-II might be because of a different size of sugar moiety attached to pro-IGF-II. In the present study using the sera from 10 patients with NICTH, we investigated the effect of O-glycosidase digestion on migration of IGF-II and analyzed the results by Western immunoblot. By Western immunoblot analysis the big IGF-II was reduced in size to 9.5 kDa in the enzyme-treated sera of the 10 patients with NICTH. The migration pattern is similar to that observed in sera of normal subjects after O-glycosidase digestion. These data indicate that big IGF-II from patients with NICTH is O-glycosylated, and the sizes of the sugar moiety are larger than those from normal subjects suggesting abnormal glycosylation in NICTH.

Adult↗
PubMed1998

Serum insulin-like growth factor II in 44 patients with non-islet cell tumor hypoglycemia.

Serum insulin-like growth factor II (IGF-II) was characterized by radioimmunoassay and Western immunoblot in 44 patients with non-islet cell tumor hypoglycemia (NICTH). 31 of 44 patients with NICTH had big IGF-II in sera. When the presence of IGF-II in tumors from 20 patients was investigated, IGF-II in tumors was detected in 18 patients and these patients had big IGF-II in sera. In two patients whose tumors did not contain IGF-II, big IGF-II in sera was not detected. In six patients with IGF-II in tumors, hypoglycemia disappeared and the big IGF-II decreased after successful removal of the tumors. These data indicate that the big IGF-II could be related to hypoglycemia, and that the increased serum big IGF-II suggests IGF-II-producing NICTH. Serum IGF-II levels in 31 patients with big IGF-II were greater than those in 13 patients without it (Mean +/- SEM: 723+/-54 vs. 326+/-31 ng/ml), but the elevated IGF-II levels were found in only 13 patients. Serum IGF-I levels were low in all patients with NICTH. In the 13 patients without big IGF-II, serum IGF-II levels were lower than those in the patients with big IGF-II, and serum IGF-I levels were also low. Serum IGF-II/IGF-I ratios in the patients with big IGF-II were elevated and greater than those in the patients without big IGF-II (35.0+/-2.2 vs. 11.5+/-2.4). The present data indicate that IGF-II-producing tumors are not rare in NICTH, and serum big IGF-II and IGF-II/IGF-I ratio are useful for screening patients with IGF-II-producing NICTH.

Adenoma, Islet Cell↗
PubMed1998

Combined carotid endarterectomy and coronary artery bypass graft.

Atherosclerosis is a generalized disease which afflicts a considerable number of patients in both the carotid and coronary arteries. Although the risk of stroke or death use to combined carotid endarterectomy (CEA) and coronary artery bypass graft (CABG) is thought to be higher than that of each individual operation, the combined procedure is generally preferred over staged operations to treat such patients. We performed the combined procedure safely with the aid of intraoperative portable digital subtraction angiography (DSA). This report describes our experience with the operative strategy of simultaneous CEA and CABG. Ninety CEA and 404 CABG were carried out between January 1989 and December 1997. A total of six patients received the combined procedure with the aid of intraoperative DSA; they were studied retrospectively. Postoperative mortality and morbidity after the combined procedure was 0%. In the combined procedure, neurological complications are difficult to detect after CEA because the patient must be maintained under general anesthesia and extracorporeal circulation during the subsequent CABG. However, intraoperative DSA can confirm patency of the internal carotid artery and absence of flap formation after CEA, and the CABG can be performed safely. Intraoperative portable DSA between CEA and CABG is helpful in preventing perioperative stroke in the combined procedure.

Aged↗
PubMed1998

[Duplex scanning of the internal thoracic artery for coronary artery surgery].

Ultrasonic duplex scanning was used to examine 77 internal thoracic arteries (ITA). The investigated vessels were classified as normal, stenosed (peak systolic velocity was faster than 150 cm/sec and doppler signals showed turbulent pattern), small (diameter measurements were smaller than 1.4 mm and mean flow velocities were slower than 20 cm/sec in distal part of the vessels), and occluded (no flow characteristics could be detected) by the doppler spectrum analysis and the two-dimensional B-mode images. The results of the duplex examination were compared with operative findings and angiograpic findings. Diameter measurements by duplex scanning compared with operative findings showed virtually no differences. One stenosed ITA, a 75% stenosis in the proximal part of the vessel, and two small ITAs were detected by duplex scanning. We performed coronary artery bypass grafting using distal part of the stenosed ITA as a free graft, and used small ITAs as individual bypass grafts. Two normal ITAs were misjudged as small, and one small ITA was misjudged as occluded. All normal ITAs of duplex examination showed normal findings of angiography. Duplex scanning is a reliable, sensitive, and noninvasive technique for the preoperative assessment of the ITA, and is a suitable screening for coronary artery surgery.

Coronary Artery Bypass↗
PubMed1997

Prohibitin expression is decreased in the regenerating liver but not in chemically induced hepatic tumors in rats.

Expression of prohibition, a growing-regulatory protein, was immunohistochemically investigated in normal rat tissues, regenerating livers, and chemically induced preneoplastic and neoplastic hepatic lesions. Specific cell types including hepatocytes, striated and smooth muscle cells, salivary gland duct epithelial cells, chondrocytes, immature spermatocytes and oocytes were found to be positive. In regenerating livers, prohibitin protein disappeared as early as 3 h after two-thirds hepatectomy and returned to near the original level by 24 h, while its mRNA level did not markedly vary. The timing of the disappearance was coincident with the expression of c-myc, suggesting a relation to quiescent hepatocytes entering the cell cycle. However, no pronounced decrease was evident in the most hyperplastic hepatic nodules and hepatocellular carcinomas investigated. Examination of 9 rat hepatocellular carcinoma cell lines, 6 hyperplastic hepatic nodules and 5 hepatocellular carcinomas revealed a single case of a base substitution in prohibition cDNA, identified as a synonymous sense change. The observed abundant expression of prohibitin in quiescent hepatocytes and its rapid loss under conditions of regeneration indicate a growth-regulatory function, but our results do not suggest any critical role in rat hepatocarcinogenesis.

Animals↗
PubMed1997

[Constrictive pericarditis complicated with hepatic coma--a case report].

A 39-year-old man with pedal edema and icterus was admitted to our hospital. Laboratory findings revealed hyperbilirubinemia. Echocardiography and chest CT revealed the calcified mass front of the right ventricle. As cardiac catheterization showed dip and plateau in right ventricle, the diagnosis of constrictive pericarditis was established. Considering his condition and bleeding tendency with hepatic failure, plasma exchange was done for three days before operation. As the patient's condition deteriorated with hepatic coma, pericardiectomy was performed. The median sternotomy approach without cardiopulmonary bypass was selected. The calcified mass was removed, and the thickened pericardium was excised. Postoperative hemodynamic findings were improved, and the serum bilirubin returned to normal. In conclusion even in this case with severe hepatic failure due to constrictive pericarditis, surgical treatment should have be considered.

Adult↗
PubMed1997

[Perioperative management of a patient with severe anemia caused by rare Jr (a-) blood].

We experienced the anesthetic management of a patient with severe anemia as low as 1.8 g.dl-1 of hemoglobin and 6.5 per cent of hematocrit before surgery. His blood had been determined as type B, anti-Jra antibody positive and the proper blood was unavailable. We gave mainly colloid fluids and partially blood products of different blood groups to maintain the circulating volume with monitoring central venous pressure peri-operatively. The operation finished relatively uneventfully and the patient was transferred to the common ward from the intensive care unit on the fifth postoperative day. We conclude that maintaining the patient's circulating volume to avoid shock should be given priority in a case of severe anemia.

Aged↗
PubMed1997

[Surgical outcomes of transverse aortic arch replacement].

The surgical outcomes of transverse aortic arch replacement were analyzed for the cases of 33 consecutive patients who underwent operations during the seven years between July 1989 and March 1996. Sixteen patients were atherosclerotic aneurysm (group T), 17 patients were acute or chronic aortic dissection involving aortic arch (group D). As for brain protection during aortic arch reconstruction, selective cerebral perfusion was employed in 16 patients of group T and 11 patients of group D. In 6 patients of group D with acute type A aortic dissection or chronic type B dissection, deep hypothermic circulatory arrest at 18 approximately 20 degrees C of rectal temperature was employed. In 14 patients of group T, selective cerebral perfusion was simultaneously started when we begun cardiopulmonary bypass. There were one operative death in group T patients (operative mortality 6.2%) and two in group D patients (operative mortality 11.8%). Perioperative stroke was occurred in two patients of group T with complete recovery in one and with partial recovery in the other. The latter patient died of medistinitis and graft infection. There was no hospital death nor stroke in group D patients. Duration of selective cerebral perfusion was 157.8 +/- 54.4 minutes in group T patients, 140.1 +/- 66.5 minutes in group D patients (n = 11), duration of circulatory arrest was 49.5 +/- 11.4 minutes in 6 patients of group D patients, respectively. In 27 patients who underwent operation with selective cerebral perfusion, morbidity of stroke was 7.4% (two patients). These were caused by technical failure during arch vessel reconstruction and seemed to be avoidable. In conclusion, it is reasonable to employ selective cerebral perfusion for aortic arch reconstruction in atherosclerotic aneurysm of transverse aortic arch. In aortic dissection, either selective cerebral perfusion or deep hypothermic circulatory arrest is justified as cerebral protection during operation.

Adult↗
PubMed1997

[Methods of preoperative hemodilution to reduce homologous blood transfusion].

Many problems arise from homologous blood transfusion in operative patients. The virtues include reduced likelihood of reactions to transfused blood and reduction or elimination of the risk of alloimmunization and transfusion transmitted diseases such as hepatitis C and the human immunodeficiency virus. Provided that skillful surgical technique is applied and the use of blood products is restricted, autologous transfusion techniques (predonation of autologous blood, preoperative plasmapheresis, acute normovolemic hemodilution, and intra- and postoperative blood salvage) can be performed with an acceptable risk for patients. Preoperative collection of blood with hemodilution is a simple method to allow autologous blood transfusion. To have recourse to apheresis techniques allows to increase the number of autologous transfused patients.

Blood Transfusion, Autologous↗
PubMed1997

[An adult case of aortic coarctation associated with two thoracic aneurysms].

A 57-year-old woman in whom an abnormality was detected on the chest X-ray presented with no signs or symptoms other than hypertension. Several examinations revealed that she had aortic coarctation of the isthmus with two aneurysm in the arch. One aneurysm was located in the root of the left subclavian artery, another was just distal of the first aneurysm. For prevention of rupture of the aneurysms and treatment of hypertension, aortic arch reconstruction was performed with the aid of selective cerebral perfusion. The postoperative course was uneventful and she was discharged 19 days after the operation with normalization of her blood pressure. At the operation in this case, the combination of the two approaches, median sternotomy and left 4th thoracotomy, was useful.

Aorta↗
PubMed1996

[Comparative study of the combined effect of HCFU and dipyridamole (DP) in colorectal carcinoma--TS inhibition rate. Kinki Cooperative Study Group of Chemotherapy for Colorectal Carcinoma].

In the forty-seven medical centers in the Kinki district, a comparative trial was conducted to investigate the enhancement of the efficacy of HCEU due to dipyridamol (DP), which is a biochemical modulator in patients with colorectal cancer who have had a curative resection. The trial consisted of two comparative groups: one group (Group A) received HCFU only for five days before operation and for two years from the second week, and the other group (Group B) was given HCFU + DP for the same trial period as Group A. The total number of patients collected was 653 (Group A: 327 patients; Group B: 326 patients) during the two-year trial period from October, 1991. Thymidylate Synthetase (TS) activity in the primary lesions, which is an index of proximity effect, was measured, and the TS inhibition rate (TSIR) was calculated from the activities. The results showed that the TSIR in the primary lesions for the HCFU + DP group (Group B: 0.33) was significantly higher than that of the HCFU group (Group A: 0.27) (p = 0.0006). There was no increase in the side effects of HCFU due to combined administration with DP. From the above results, the therapy with HCFU + DP is expected to be useful for patients with colorectal cancer who have undergone curative resection.

Adult↗
PubMed1996

[Carotid screening with duplex scanning before coronary artery bypass].

Seventy-one patients undergoing scheduled coronary artery bypass were preoperatively evaluated for the presence of carotid stenosis by duplex scanning. Prevalence of a moderate degree of stenosis (peak systolic flow velocity of internal carotid artery > 130 cm/sec) or a high degree of stenosis (peak systolic flow velocity > 250 or < 25 cm/sec) was 12.7% (nine patients). Predictive risk factors for carotid stenosis were diabetes mellitus and history of stroke. Compared with carotid angiogram, hemodynamically critical stenosis greater than 90% was found in three patients, severe stenosis (75-90%) in four, moderate stenosis (50-75%) in two. Bilateral carotid occlusion, complete occlusion of an internal carotid artery with contralateral 99% stenosis, was found in one patient. In the critical stenosis group (n = 3), simultaneous carotid endarterectomy and coronary artery bypass were performed in two and coronary artery bypass alone in one patient with unilateral complete occlusion of the internal carotid artery. There was neither operative death nor postoperative stroke in this series of patients. In conclusion, carotid screening with a duplex scan is very helpful to evaluate the presence of carotid occlusive disease in coronary artery bypass candidates. When significant carotid stenosis is detected, further examination should be done to clarify the carotid hemodynamics and brain protection during the operation should be employed.

Adult↗
PubMed1996

[Reduction of homologous blood in elective cardiac surgery with miscellaneous autologous blood transfusion--especially with short-term predonation method].

The efficacy of homologous blood reduction in consecutive elective cardiac surgery by four different autologous transfusion methods was described. One hundred forty patients were divided into five different groups. No autologous blood transfusion in group A (22 cases), intraoperative autotransfusion with Cell Saver in group B (24 cases), additional intraoperative hemodilution method in group C (25 cases), additional preoperative predonation two weeks before operation in group D (15 cases), and predonation one week before operation with recombinant human erythropoietin administration in group E (55 cases) were performed. In group E, the criterion for patient selection of predonation was widely indicated (hemoglobin > 10 g/dl, body weight > 40 kg) and the period of the predonation technique was shorter compared with previous reports. The total homologous blood transfusion volume and the rate of the patients without homologous blood in each groups was 2216 +/- 1888 ml, 14.3% in group A, 2297 +/- 1789 ml, 4.2% in group B, 774 +/- 1043 ml, 36% in group C, 399 +/- 683 ml, 64.3% in group D, 135 +/- 276 ml, and 76.3% in group E, respectively. There were significant differences between group A, B or C and group D (p < 0.01), group A, B or C and group E (p < 0.001), and group D and group E (p < 0.05) with total homologous blood volume and between group A or B and group D (p < 0.01), group A or B and group E (p < 0.001), group B and group C (p < 0.05), and group C and group E (p < 0.01) with the rate of the patients without homologous blood. The reduction of homologous blood volume by patients was 1500 ml by the intraoperative hemodilution method, 370 ml by the preoperative prodonation technique, and 260 ml with predonation using erythropoietin. Ten of the thirteen patient (76.9%) who required homologous blood transfusion in group E had anemia (Hb < 12 g/dl) at preoperative blood pooling or postoperative massive bleeding (total mediastinal drainage > 1000 ml). Elongation of the predonation period before operation or postoperative autotransfusion of mediastinal shed blood and intraoperative aprotinin administration in such patients should be considered to reduce homologous blood transfusion.

Aged↗
PubMed1996

Absence of p53 mutations in methylnitrosourea-induced mammary tumors in rats.

Administration of methylnitrosourea (MNU) to female rats during or before puberty induces a high incidence of mammary tumors, most of which contain a G to A transition at the second base of H-ras codon 12. However, this mutation alone is presumably not sufficient for normal mammary epithelial cells to develop into neoplastic cells, because it can be detected in mammary tissues prior to the appearance of tumors. To clarify whether p53 genetic changes may complement the H-ras mutation in mammary carcinogenesis, we investigated nine MNU-induced mammary tumors of F344 rats by polymerase chain reaction-mediated denaturing gradient gel electrophoresis (DGGE). However, no mutations were identified in p53 exons 5 through 8, which include the known mutational hot spots. Our data thus indicate that p53 mutations are not involved in MNU-induced rat mammary carcinogenesis.

Animals↗
PubMed1996

[Survival of a patient with postinfarction ventricular septal defect following venoarterial bypass with centrifugal pump and reoperation for residual shunt].

A 61-year-old man was hospitalized because of circulatory collapse due to postinfarction ventricular septal defect. As his hemodynamic condition deteriorated despite intraaortic counterpulsation, he underwent patch closure of VSP and patch reconstruction of the anterior left ventricular wall concomitant with coronary artery bypass grafting to the circumflex lesion immediately after admission. Femorofemoral circulatory assist with centrifugal pump was necessitated to wean from cardiopulmonary bypass because of severe left ventricular dysfunction. Circulatory assist was controlled to maintain mixed venous oxygen saturation of more than 70% under mild hypothermia. On the second postoperative day (POD), increased oxygen saturation from right atrium to pulmonary artery developed (Qp/Qs = 2.1). Further surgery was performed on an emergency basis for additional patch closure of VSP. Then he was successfully weaned from cardiopulmonary bypass successfully. The patient was extubated on the 14th POD and was ambulatory when he discharged on the 56th POD. Immediate surgical intervention should be performed for the patient with postinfarction ventricular septal defect when the hemodynamic state deteriorates under intraaortic counterpulsation.

Assisted Circulation↗