Biomedical subjects

I Tsuji

Publications and source records attributed to I Tsuji.

At least 91 records · Page 5Linked to original sources

PubMed1997

Can the maze procedure be combined safely with mitral valve repair?

BACKGROUND AND AIMS OF THE STUDY: The safety of combining mitral valve repair with the maze procedure for chronic atrial fibrillation in the surgical management of patients with mitral valve disease is not well elucidated. We present our operative results regarding mortality and morbidity after such combined surgery. As a comparison, our operative results after mitral valve repair in patients without chronic atrial fibrillation are presented. METHODS: Between April 1993 and December 1994, 39 patients with chronic atrial fibrillation underwent mitral valve repair and concomitant maze procedure (group 1) at the Iwate Medical University. During the same period, 36 patients with sinus rhythm and one patient with DDD pacemaker underwent mitral valve repair (group 2). In order to evaluate the operative risk, morbidity, and mortality of adding the maze procedure to mitral valve repair, total cardiopulmonary bypass time, aortic cross-clamp time, intraoperative blood loss, intubation period, and duration of ICU stay were compared between the groups. RESULTS: Total cardiopulmonary bypass time and aortic cross-clamp time in group 1 were longer than in group 2 (174.0 +/- 38.8 min versus 150.1 +/- 54.4 min; p = 0.032, 122.5 +/- 30.7 min versus 95.8 +/- 38.2 min; p = 0.0012). However, the duration of ICU stay, intubation period, and intraoperative blood loss were not different between the groups. There were no hospital deaths in either group. Four patients in group 1, and two patients in group 2 required re-exploration for bleeding (p = NS). Two patients in group 1, and none in group 2 required pacemaker implantation postoperatively (p = NS). Two patients in group 2, and none in group 2 had minor cerebral infarction (p = NS). At hospital discharge, 28 patients in group 1 (72%) and 35 patients (97%) in group 2 were in sinus rhythm. CONCLUSIONS: The maze procedure can be combined with mitral valve repair without adding undue operative risk to patients. Those patients with chronic atrial fibrillation undergoing mitral valve repair may be advised for the possibility of concomitant maze procedure.

Aged↗

PubMed1997

[Intraocular neovascularization].

To investigate the mechanism of intraocular neovascularization, we studied how vascular endothelial growth factor (VEGF) and interleukin-8 (IL-8) are expressed in the ocular tissues under hypoxic conditions. Prior to proliferation of vascular endothelial cells resulting in neovascularization, the retinal tissues such as pericytes, retinal glial cells, ganglion cells, and ciliary epithelium react directly to hypoxia expressing VEGF and/or IL-8 and stimulate endothelial cell proliferation in a paracrine manner. We demonstrated that transcription factor activator protein-1 (AP-1) is activated for expression of VEGF messenger ribonuculeic acid (mRNA) and in a similar way nuclear factor kappa B (NF-kappa B) is activated for expression of IL-8 mRNA. However, hypoxia-induced expression of VEGF and/ or IL-8 is only one aspect of the complicated processes in intraocular neovascularization. We hope that further detailed analysis of the mechanism will make it possible to inhibit and treat clinically intraocular neovascularization in the near future.

Adult↗

PubMed1996

Circadian blood pressure variation related to morbidity and mortality from cerebrovascular and cardiovascular diseases.

The mortality rate of stroke has decreased dramatically over the past 30 years in Japan, but the prevalence of cerebral infarction has increased, mainly because of the higher incidence of nonfatal cerebral infarction in the elderly. Significant advances in the development of antihypertensive drugs over the last 30 years have contributed to the decrease in stroke mortality, but antihypertensive treatment appears to relate to an increase in the prevalence of cerebral infarction in the elderly. We investigated the risks of low BP levels determined by ambulatory BP monitoring and home BP measurements to clarify the previously reported J-shaped relationships between the incidence of ischemic cardiovascular disease and BP levels after treatment. A long-term prospective study of all causes of mortality and cerebrovascular and cardiovascular mortality has been conducted in Ohasama, Japan, since 1987. Cox proportional hazard model after adjusting for age and sex demonstrated that during a 5-year follow-up period involving 893 of the subjects aged 50 years and over in this cohort, those with the lowest quintile of ambulatory BP levels exhibited a significantly high hazard ratio of cardiovascular as well as all causes of mortality. During the same follow-up period in 1,226 subjects aged 50 years and over, those with the lowest and highest quintiles of home BP levels demonstrated a significantly high hazard ratio of cardiovascular as well as all causes of mortality (i.e., J-shaped relationship). The amplitude of the fall in nocturnal BP obtained by ambulatory BP monitoring correlated positively with the severity of silent cerebrovascular lesions in elderly women, but not in elderly men. These results suggest the significantly high risk associated with low BP levels, which can be determined only by ambulatory and home BP measurements, but not by casual BP measurements.

Age Factors↗

PubMed1996

Effects of enalapril on tissue factor in patients with uncomplicated acute myocardial infarction.

In a randomized, double-blind, placebo-controlled study beginning 4 weeks after uncomplicated acute myocardial infarction, it was established that the baseline plasma tissue factor antigen level was significantly higher in patients with myocardial infarction than in control subjects, and enalapril therapy significantly reduced the elevated plasma tissue factor antigen level. This may be associated with the reduction in the risk of coronary thrombosis seen with the use of angiotensin-converting enzyme inhibitors.

Angiotensin-Converting Enzyme Inhibitors↗

PubMed1996

Seasonal variation in blood pressure in normotensive women studied by home measurements.

1. The factors influencing the seasonal variation in blood pressure measured at home in normotensive women were examined. 2. Sixteen female subjects (56.3 +/- 7.9 years old, mean +/- SD) measured their blood pressure and pulse rate at home each morning for more than 20 times per month for at least 1.5 years. Blood pressure and body weight were also determined in the office once or twice a month in that period. Monthly means of outdoor and indoor temperatures and daytime length were obtained from the Meteorological Observatory. The single cosinor method was used to evaluate circannual rhythm. 3. We observed a biphasic seasonal variation in self-recorded blood pressure measured at home, environmental temperature and daytime length but found no apparent seasonal variation in body weight and blood pressure measured in the office. The lowest levels of systolic and diastolic blood pressure measured at home were observed in July. The longest daytime length was recorded in June, while the highest outdoor temperature and indoor temperature were recorded in August, indicating that the longest daytime length preceded and the highest environmental temperature lagged behind the lowest level of blood pressure. The shortest daytime length is in December. The lowest outdoor and indoor temperature were observed in January, while the highest levels of self-recorded systolic blood pressure and diastolic blood pressure were in January and December, respectively. Half-amplitudes of self-recorded systolic and diastolic blood pressure were 2.6 +/- 1.0 mmHg and 2.0 +/- 0.8 mmHg, respectively. 4. These findings indicate the importance of a seasonal effect, i.e. daytime length and the environmental temperature, on the blood pressure of individuals.

Adult↗

PubMed1996

The independent association of smoking and drinking with serum beta-carotene levels among males in Miyagi, Japan.

BACKGROUND: Previous studies indicated that serum beta-carotene levels were low among smokers and drinkers. However these findings may result from the strong relationship between smoking and drinking. METHODS: Data were collected from 1902 males randomly selected from participants of a cohort study. The effects of smoking on serum beta-carotene levels were assessed according to drinking status (non-drinker, ex-drinker and current drinker), and those of drinking were assessed according to smoking status (ex-smoker and current smoker) using general linear model including other factors (age, intake of green-yellow vegetables, intake of carrot or pumpkin, body mass index serum cholesterol levels.) RESULTS: An inverse dose-response relationship between daily consumption of alcohol and beta-carotene levels was observed regardless of smoking status, and also between number of cigarettes smoked per day and beta-carotene levels regardless of drinking status. CONCLUSION: These results suggest that cigarette smoking and alcohol drinking reduce beta-carotene levels independently.

Adult↗

PubMed1996

Nocturnal blood pressure and silent cerebrovascular lesions in elderly Japanese.

BACKGROUND AND PURPOSE: We conducted a cross-sectional epidemiological survey using ambulatory blood pressure monitoring and brain MRI in a cohort from northern Japan to determine whether an inappropriately low nocturnal blood pressure, or an excess fall in nocturnal blood pressure, might be responsible for silent cerebrovascular lesions in the elderly. METHODS: Untreated subjects over 55 years and under 64 years of age (late middle age; 24 men and 46 women, 60% of eligible people) and over 65 years and under 75 years of age (elderly; 29 men and 52 women, 91% of eligible people) participated in the study. We evaluated the relationship between the amplitude (Daytime Average-Nighttime Average) or the rate ([Daytime Average-Nighttime Average]/Daytime Average) of the fall in nocturnal blood pressure and the incidence of silent cerebrovascular lesions on MRI (number of lacunar infarctions or extent of periventricular hyperintensity). RESULTS: The amplitude or the rate of the fall in nocturnal blood pressure in elderly women with one or two lacunar infarctions was significantly higher than that in those without such infarctions. There was a significant positive correlation between the amplitude or the rate of the fall in nocturnal blood pressure and the extent of periventricular hyperintensity in the elderly women. This relationship was observed in women, but not in men, of late middle age; this was not seen in elderly men. CONCLUSIONS: Results indicate that an inappropriately low nocturnal blood pressure, or an excessive fall in nocturnal blood pressure, is associated with ischemic silent cerebrovascular lesions, at least in elderly women. Treatment of hypertension in such women should be administered with care and with regard to nocturnal blood pressure.

Age Distribution↗

PubMed1996

Ambulatory blood pressure monitoring in evaluating the prevalence of hypertension in adults in Ohasama, a rural Japanese community.

We estimated the prevalence of hypertension and evaluated the degree of blood pressure control on the basis of ambulatory blood pressure monitoring in patients receiving antihypertensive medication. A total of 969 adults (mean age +/- SD, 59.3 +/- 12.1 years old range: 20-79 yr) among 1,575 eligible persons (65.1%) recruited from a total adult population of 2,789 people living in a rural region of northern Japan underwent measurement of initial screening blood pressure; ambulatory blood pressure was measured subsequently. A total of 285 subjects (66.5 +/- 9.2 years old) were taking antihypertensive medication (treated group), while 684 (56.3 +/- 12.0 years old) were not (untreated group). The WHO criteria were used to categorize screening blood pressure. Ambulatory blood pressure levels were classified as follows: hypertension, systolic blood pressure > or = 144 mmHg and/or diastolic blood pressure > or = 85 mmHg; and normotension, systolic blood pressure < or = 133 and diastolic blood pressure < or = 78 mmHg. Of the 285 treated subjects, 49 (17.2%) were classified as hypertensive by screening measurements, while 36 (12.6%) were classified as such by ambulatory blood pressure monitoring. Only 12 (24.5%) of the former 49 subjects were also classified as hypertensive, while 20 (40.8%) were classified as normotensive by ambulatory blood pressure monitoring. Of the 684 untreated subjects, 34 (5.0%) were hypertensive by screening measurements and 43 (6.3%) were hypertensive by ambulatory blood pressure monitoring. Only 14 (41.2%) of the former 34 subjects were classified as hypertensive by ambulatory blood pressure monitoring. Of the 34 untreated subjects classified as hypertensive by screening measurements, ambulatory blood pressure monitoring showed 12 (35.3%) to be normotensive, suggesting that they were cases of "white coat" hypertension. The study first confirmed, based on community-derived data, that there are large discrepancies between screening (casual) blood pressure measurements and ambulatory blood pressure monitoring with respect to the recognition of hypertension and normotension. The determination of blood pressure levels by ambulatory blood pressure monitoring may result in a different prognosis of hypertension from that made on the basis of screening blood pressure measurements. The prognostic value of ambulatory blood pressure has to be further investigated.

Adult↗

PubMed1996

Factors affecting death at home in Japan.

Despite the wish of the Japanese people to spend their final moments at home, the percentage of deaths at home among elderly is decreasing. Moreover, large variations in this rate were observed over the country. The present ecological study analyzed the relationship between the percentage of deaths at home for decedents aged 70 and over, and demographic, medical and socioeconomic characteristics. The data published in 1990 by the Japanese National Government were analyzed by correlation, principal-component, and multiple linear regression analyses. The results showed that the percentage of deaths at home for decedents aged 70 and over was positively associated with the number of persons per household, and the area of floor space per house. The divorce rate, the national tax per capita, and the mean length of hospitalization for stroke showed a negative association with the percentage of deaths at home. In the prefectures where the crude death rates of stroke and senility were high, elderly were more likely to die at home. These results suggested the importance of the number of family caregivers, and the housing conditions for terminal care at home. This research may lead to improve home medical assistance which is still underdeveloped in Japan.

Aged↗

PubMed1996

Prevalence of hypertension and rate of blood pressure control as assessed by home blood pressure measurements in a rural Japanese community, Ohasama.

A cross-sectional community survey using home blood pressure measurements was performed in northern Japan to estimate the prevalence of definite hypertension, white coat hypertension and the success of blood pressure control in patients receiving antihypertensive drugs. A total of 1334 subjects (mean age +/- SD, 53.8 +/- 17.3 years; 8-91 years) participated in the screening and home blood pressure measurement program. They measured blood pressure at home at least 3 times (mean measurement frequency, 20.8 +/- 8.3 times). Of these 1334 subjects, 314 (65.1 +/- 8.9 years) were taking drugs (treated group) while 1020 (50.3 +/- 17.8 years) were not (untreated group). The WHO criteria were used to categorize screening blood pressure. Criteria for diagnosis of hypertension by home blood pressure measurements were as follows: definitely hypertensive (systolic blood pressure > or = 144 mmHg and/or diastolic blood pressure > or = 89 mmHg) and normotensive (104 < systolic blood pressure < or = 131 mmHg and 60 < diastolic blood pressure < or = 79 mmHg). Of the 1018 subjects identified as normotensive on screening measurements, home measurements indicated that 73 (7.2%) were hypertensive and 765 (74.7%) were normotensive or lower. Of the 112 subjects identified as hypertensive on screening measurements, home measurements showed that 42 (37.5%) were hypertensive and 30 (26.8%) were normotensive or lower. Of the 314 treated subjects, 45 (14.3%) were identified as hypertensive by screening measurements and 88 (28.0%) as hypertensive by home measurements. Only 20 (44.4%) of the former 45 subjects were also defined as definitely hypertensive by home measurements. Of the 1020 untreated subjects, 67 (6.6%) were hypertensive by screening measurements and 84 (8.2%) by home measurements. Only 22 (32.8%) of the former 67 subjects were classified as hypertensive by home measurements. Of the 67 untreated subjects identified as hypertensive by screening measurements, 20 (29.9%) were normotensive or lower by home measurements, suggesting that these subjects were "white coat" hypertensives. The study first confirmed based on the large community data that there are large discrepancies between screening (casual) blood pressure and home blood pressure measurements for recognition of hypertension and normotension. Determination of blood pressure levels by home blood pressure measurements may predict prognosis of hypertension differently from that by screening blood pressure measurements. Further prospectively study is needed to validate the prognostic value of home blood pressure measurements.

Adolescent↗

PubMed1996

Predictive power of screening blood pressure, ambulatory blood pressure and blood pressure measured at home for overall and cardiovascular mortality: a prospective observation in a cohort from Ohasama, northern Japan.

OBJECTIVE: To investigate the risks of high and low blood pressure levels determined by ambulatory blood pressure monitoring and home blood pressure measurements. METHODS: A long-term prospective study of all-cause mortality and cardiovascular mortality has been conducted in Ohasama, Japan since 1987. RESULTS: The Cox proportional hazards model after adjusting for age and sex demonstrated that, during a 5-year follow-up period involving 893 of the subjects aged 50 years or more in this cohort, those with the lowest quintile of ambulatory blood pressure levels exhibited a significantly higher hazard ratio for cardiovascular and for all-cause mortality. During the same follow-up period, of 1226 subjects aged 50 years and more, those with the lowest and highest quintiles of home blood pressure levels demonstrated a significantly higher hazard ratio with respect to cardiovascular and all-cause mortality (i.e., a J-shaped relationship). CONCLUSION: These results suggest that there is a significant risk associated with low blood pressure levels, which can be determined by ambulatory and home blood pressure measurements, but not by casual blood pressure measurements.

Journal Article↗

PubMed1995

The evaluation of screening for gastric cancer in Miyagi Prefecture, Japan: a population-based case-control study.

Although a screening program for gastric cancer, using barium X-ray examination, has been carried out widely in Japan for the past 3 decades, there is insufficient evidence to confirm its effectiveness in terms of reducing mortality. To evaluate the effectiveness of the screening, a population-based case-control study was carried out in Miyagi Prefecture, Japan. Case subjects, who had died from gastric cancer (198) and control subjects matched in age, sex and residence (577) were selected from among members of the National Health Insurance. Their screening histories during 5 years before the cases were diagnosed were surveyed on the basis of records of the regional cancer registry and the cancer-detection center. The odds ratio (OR) of death from gastric cancer for the persons who participated in the screening at least once during 5 years was 0.41. For those who participated only once during 5 years the OR was 0.43, and for those whose last participation was 5 years earlier it was 0.30. Our data suggest that screening for gastric cancer at 5-year intervals might reduce mortality by 60%, and that the effect might remain for at least 5 years.

Adult↗

PubMed1995

Active life expectancy among elderly Japanese.

BACKGROUND: This study estimated the active life expectancy (ALE) among the elderly in a Japanese urban society to determine whether or not the Japanese live long lives at the expense of life quality. METHODS: Survival and ability to perform activities of daily living (ADLs) were followed up on a probability sample (n = 3,459) of the aged people living in Sendai City, Japan, between 1988 and 1991. ALE was calculated by an increment-decrement life table method. RESULTS: At age 65, ALE was 14.7 years for men and 17.7 years for women. The duration of active life occupied 91% of the total life expectancy for men and 87% for women. These values were further compared with those reported for the elderly in the United States. ALE among the Japanese subjects was longer than that among the American elderly. The percentage of remaining life that was active was comparable with that in the United States. However, the interpretation of the results requires caution because of the difficulty in comparing self-reported disabilities across cultures. CONCLUSION: The authors conclude that it is premature at this time to judge which country is better in terms of functional status among the elderly. An international comparison of ALE would create an opportunity to evaluate and promote health and function of the elderly population worldwide. For this purpose, an international standardization of ALE measurement is urgently needed.

Activities of Daily Living↗

PubMed1995

Predictors of nursing home placement in community-based long-term care.

OBJECTIVE: To identify predictors for nursing home placement among a group of frail older patients receiving formal home care services. DESIGN: Retrospective chart review. SETTING: A geographically defined catchment area of southeast Baltimore, Maryland. PATIENTS: A total of 334 homebound patients who started using the Elder Housecall Program (EHP), a multidisciplinary team providing in-home care and housed at the Johns Hopkins Geriatrics Center, between 1986 and 1989. MEASUREMENTS: Independent variables, based on the chart review, were age, sex, diagnosis, functional status, and caregiver conditions at entry into EHP. Dependent variable was nursing home placement until December 31, 1991. MAIN RESULTS: Cox proportional hazards analysis indicated that significant predictors were diabetes mellitus, bowel incontinence, and three caregiver characteristics: living separate from the patient, having time conflicts because of a job, and being stressed by caregiving. CONCLUSION: Among this group of frail older people, caregiver problems were significant predictors of nursing home placement, but functional disabilities generally were not. These results suggest the need for geriatricians to be alert to the psychosocial aspects of patients and their caregivers.

Adult↗

PubMed1995

Physical status and dementia risk: a three-year prospective study in urban Japan.

A three-year prospective study of 3,180 non-dementia persons in Sendai City, Japan was conducted to examine the effects of physical status and diseases diagnosed on dementia incidence. This cohort had been made at the initial survey in 1988 and the evaluation for incident dementia was performed on 2,461 respondents (77.4%) in a follow-up survey in 1991. Regarding physical status, the logistic regression including sex, age, health status, ambulatory activity and activities of daily living indicated that the poor health status and the limitation of ambulatory activity were significantly associated with an increased risk of dementia. The significant positive association with dementia was observed on stroke, respiratory disease and depression. This study identified the high risk population for dementia in the aspect of physical status.

Activities of Daily Living↗

PubMed1995

Dementia and physical disability as competing risks for mortality in a community-based sample of the elderly Japanese.

To examine whether an excess mortality due to dementia is independent of coexisting physical disability, a probability-sample of the non-institutionalized elderly (n = 3,308) living in Sendai City, Japan was followed between 1988 and 1991. Of those, 128 were diagnosed as dementia in 1988 by psychiatrists, using Diagnostic and Statistical Manual of Mental Disorders, Third Edition-Revised as a diagnostic standard. Information on the ability to perform activities of daily living (ADL) was collected by self-report of the study subjects in 1988 baseline survey. The survival status was investigated three years later. The risks of dementia and co-existing ADL disability for mortality was examined by Cox proportional hazard models. The results indicated that the relation between dementia and mortality was two-fold, depending upon the physical functions. Dementia increased the risk for mortality among those without ADL disability, but it did not so among those with ADL disability, rather ADL function was a stronger predictor for mortality among the latter individuals. Prevention and treatment of physical disability would be important for improving the survival of the demented people.

Aged↗

PubMed1995

The secular trend in the incidence of subarachnoid hemorrhage in Miyagi, Japan: 1979-1990.

Since 1978, a stroke registry has been carried out in Miyagi Prefecture (2.2 million in population), Japan. Approximately 2,000 cases of stroke were annually registered through 16 hospitals which have cerebrovascular disease units. The incidence of subarachnoid hemorrhage was 17.4 per 100,000 population in 1990. The incidence increased gradually during early 1980's and reached plateau during late 1980's. Further, the trend in the incidence of subarachnoid hemorrhage is compared with those in other communities in other countries as well as Japan.

Adolescent↗

PubMed1995

Extended coverage for preventive services for the elderly: response and results in a demonstration population.

OBJECTIVES: This study was undertaken to test the acceptability of preventive services under Medicare waivers to a community-dwelling population aged 65 and over and to examine the effect of such services on health. METHODS: Medicare beneficiaries and designated primary care providers were sampled, and beneficiaries were screened and surveyed. A total of 4195 individuals were then randomized into intervention or control groups. Those in the intervention group were offered free preventive visits (under waivers) to their physicians. A follow-up survey of the entire group was administered after completion of the intervention. RESULTS: Sixty-three percent of the intervention group made a preventive clinical visit, and about half of them a counseling visit. For men, being married and having a solo practitioner were positively associated with accepting the intervention services, while for women, having had a mammogram, having a confidant, having a high school education, and having a female practitioner were so associated. The intervention group showed a greater health benefit than did the control group and had a significantly lower death rate: 8.3% vs 11.1%. CONCLUSIONS: Older individuals will respond to preventive programs, and such services will result in modest health gains.

Aged↗