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Biomedical subjects

J Hayashi

Publications and source records attributed to J Hayashi.

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

[Incidence and duration of febrile episodes in a hospitalized geriatric cohort].

Fever is a common and important clinical symptom observed among hospitalized geriatric patients. To investigate the frequency and duration of fever episodes, we surveyed fever episodes in a hospital where the frequency of patients over 60 years of age exceeds 90 per cent of the patients. Fever episodes with body temperature of over 37.5 degrees C were registered from May in 1991 to December in 1994, and 6809 episodes were subjected to analysis. The average incidences per month were 157.1, 165.3, 158.0, and 139.3 in 1991, 1992, 1993, and 1994, respectively. The numbers of episodes per month did not show any significant correlation with temperature or humidity. Average duration of the episodes were 8.0, 6.5, 7.6, and 6.7 days for 1991, 1992, 1993, and 1994, respectively. Episodes of one day duration were the most frequent in all months, and the frequencies of that ranged from 37.1% to 58.6% with a mean of 47.8%. The average duration of episodes and the frequency of one day episodes did not change significantly irrespective of a notable decrease in the total incidence. The high frequency of one day episodes and their consistency through the observed period suggest that fevers with one day duration are one of the characteristic features of the febrile symptoms in geriatric patients. Causality and prevention methods for these one day fever episodes should be investigated.

Aged↗
PubMed1996

[Serum albumin level as a predictor of incidence of febrile episodes and mortality in hospitalized geriatric patients].

To investigate the relationship between serum albumin level and incidence of febrile episodes and mortality in the elderly, we studied 748 patients hospitalized for over one year. The subjects included 123 males and 355 females with a mean age 81.2 years. The average serum albumin level was 3.79 g/dl and levels of serum albumin decreased with advancing age. The incidence of febrile episodes was 1.8 per year in patients with serum albumin levels over 4.1 g/dl, increasing with decline of serum albumin levels. The incidence of febrile episodes was 5.3 per year in patients with serum albumin levels under 3.0 g/dl. Patients with serum albumin levels under 3.0 g/dl displayed a high incidence of febrile episodes irrespective of age. Age adjusted in-hospital mortality was 40.4% during the observed period in patients with serum albumin levels under 3.0 g/dl, significantly higher than that of the patients with serum albumin levels over 3.1 g/dl. Relative risk of febrile episode and mortality calculated using the patients with serum albumin levels over 4.1 g/dl as a control was 2.9 and 2.1, respectively, in the patients with serum albumin levels under 3.0 g/dl. These results indicate that serum albumin level is a simple, but strong, predictor of susceptibility of febrile episode and death. Patients with serum albumin levels under 3.0 g/dl may constitute a high risk group for febrile episode and death.

Aged↗
PubMed1996

[Efficiency of combination chemotherapy and interferon-alpha therapy in a patient with AIDS-related cutaneous and gastrointestinal Kaposi's sarcoma].

A 40-year-old male was admitted to the hospital with acquired immunodeficiency syndrome (AIDS) and Pneumocystis carinii pneumonia (PCP). Two months before admission the patient had a high fever, general fatigue and mild epigastic tenderness. On admission, physical examination revealed numerous small tumors on the head, gingiva, neck, nasal ala, anterior forehead, anterior thoracic, bilateral sole and bilateral lower limbs. At that time, the CD4 cell count was 130/microliters. Upper GI endoscopy was performed because of sever epigastralgia and hematemesis. The gastric mucosa was diffusely nodular and erythematous with bleeding. This biopsy showed Kaposi's sarcoma, and the same findings were obtained from the duodenum, rectum and skin, AIDS with related cutaneous and gastrointestinal KS and PCP was diagnosed. We performed a combination of chemotherapy and Interferon-alpha therapy, and the KS almost completely disappeared within 3 months.

Acquired Immunodeficiency Syndrome↗
PubMed1996

[An outbreak of influenza A (H3N2) among hospitalized geriatric patients].

An outbreak of influenza A (H3N2) in a hospital where almost 90% of the inpatients are aged over 70 years is described. An increase of febrile episodes was seen during the period from January 29th to March 17th, 1992 in two of six wards paired sera, at the onset of fever and more than two weeks later, were obtained from patients in sixty-five episodes. Serum antibody titer to influenza A (H3N2) elevated over four times in 39 (60%) of 65. Influenza A (H3N2) virus was also isolated from seven patients. These results indicated an outbreak of influenza A (H3N2) in this population. Maximum body temperature was over 39 degrees C in 18 patients (46.2%) with influenza, and were significantly higher than that of the non-influenza patients. The duration of fever in 12 patients of 39 was longer than 8 days in 12 patients, and significantly longer than that of non-influenza cases. Bronchopneumonia was found in ten patients (25.6%). These results suggest that the influenza infection causes a high grade fever in geriatric patients and lasts longer than is commonly seen in patients with fever not associated with influenza. Influenza infection also frequently induces bronchopneumonia and may contribute to increase mortality in the elderly, especially in patients over 70 years old.

Aged↗
PubMed1996

Soluble CD14 mediates lipopolysaccharide-induced intercellular adhesion molecule 1 expression in cultured human gingival fibroblasts.

Intercellular adhesion molecule 1 (ICAM-1) is involved in the accumulation and activation of leukocytes in inflammatory diseases such as periodontitis. As reported previously, ICAM-1 is up-regulated on cultured human gingival fibroblasts (HGF) by exposure to lipopolysaccharide (LPS), suggesting a specific LPS recognition mechanism. We therefore investigated the role of CD14, an LPS receptor, in stimulation of HGF by LPS. Cell surface CD14 antigen was not observed on HGF by flow cytometric analysis. In addition, expression of CD14 mRNA in HGF was not detected by reverse transcription-PCR analysis. Since HGF did not express endogenous CD14, we investigated the role of human serum-derived soluble CD14 (sCD14) in ICAM-1 induction on HGF by LPS. The serum-dependent ICAM-1 induction by LPS was observed in HGF. In medium containing human serum, anti-CD14 antibody inhibited ICAM-1 induction on HGF by LPS. Depletion of sCD14 from human serum markedly reduced ICAM-1 expression on HGF in response to LPS. Supplementation of the serum-free medium with sCD14 alone restored the capacity of HGF to respond to LPS. These results show that induction of ICAM-1 in HGF by LPS does not involve binding to cell surface CD14 but is mediated by serum-derived sCD14.

CD4 Antigens↗
PubMed1996

Probucol downregulates E-selectin expression on cultured human vascular endothelial cells.

Probucol, which inhibits monocyte adhesion, is a potent antioxidant to vascular endothelium in the cholesterol-fed rabbit. The accumulation of macrophages in the lesion is influenced by increased expression of specific adhesion molecules on vascular endothelial cells. We investigated the effect of probucol on the expression of cell adhesion molecules in cultured human umbilical vein endothelial cells (HUVECs). HUVECs were treated with lipopolysaccharide in the presence or absence of probucol (0 to 5 mumol/L) and assayed for the expression of adhesion molecules such as intercellular adhesion molecule-1 (ICAM-1) and E-selectin by cell-enzyme-linked immunosorbent assay. Probucol significantly downregulated the expression of E-selectin on HUVECs in a dose-dependent manner. In contrast, the expression of ICAM-1 was not affected. E-selectin but not ICAM-1 mRNA expression on HUVECs was also significantly inhibited by probucol in a dose-dependent manner. We also examined whether probucol affects cellular binding between the human monocytic cell line U937 and lipopolysaccharide-stimulated HUVECs by using an in vitro binding assay and found that probucol significantly suppressed their mutual binding in a dose-dependent manner. These data indicate a novel mechanism of action for probucol to reduce the development of atherosclerotic lesions in hyperlipidemic states.

Animals↗
PubMed1996

Right ventricular systolic performance before and after surgery for tricuspid regurgitation associated with mitral stenosis.

The reversibility of right ventricular function in patients with mitral stenosis associated with secondary tricuspid regurgitation (TR) is as yet undetermined. We assessed the right ventricular systolic performance by cardiac catheterization before and 19 months after surgery in 18 patients who underwent DeVega's tricuspid annuloplasty plus mitral valve replacement (MS plus TR group) and in 9 with mitral valve replacement for isolated mitral stenosis (MS group). After surgery, the right ventricular systolic pressure decreased significantly in both groups (both p < 0.01). In the MS plus TR group, the postoperative right ventricular end-diastolic and end-systolic volume indices (RVEDVI and RVESVI, respectively) were significantly decreased compared with the respective preoperative values (both p < 0.001). No significant difference was noted between the groups with regard to the right ventricular peak-systolic pressure/end-systolic volume index ratio (RVPSP/ESVI) either before or after surgery. Various left ventricular indices were comparable between the groups both before and after surgery. Linear regression analysis revealed significant correlations between RVEDVI and the RVPSP/ESVI, and between RVPSP and the RVPSP/ESVI both before and after surgery. These results indicate that right ventricular systolic performance in patients with MS plus secondary TR became comparable to those that in patients with isolated MS after surgery, and that this was probably due to nearly equivalent right ventricular contractility before surgery.

Adult↗
PubMed1996

Effects of aprindine on ischemia/reperfusion-induced cardiac contractile dysfunction of perfused rat heart.

The present study was undertaken to determine whether aprindine, a class Ib antiarrythymic agent, exerts beneficial effects on ischemia/reperfusion-induced cardiac contractile dysfunction and metabolic derangement. Isolated rat hearts were subjected to 35-min global ischemia, followed by 60-min reperfusion, and functional and metabolic alterations of the heart were determined with or without aprindine-treatment. Ischemia induced a cessation of left ventricular developed pressure (LVDP), a rise in left ventricular end-diastolic pressure (LVEDP), and an increase in myocardial sodium content and a decrease in myocardial potassium content. When the hearts were reperfused, little recovery of LVDP and sustained rise in LVEDP and perfusion pressure were observed. Ischemia/reperfusion resulted in a release of ATP metabolites and creatine kinase from perfused hearts, an increase in myocardial sodium and calcium contents, and a decrease in myocardial potassium and magnesium contents. Treatment of the perfused heart with either 10 or 30 microM aprindine for the last 3 min of pre-ischemia improved contractile recovery during reperfusion and suppressed changes in myocardial ion content during ischemia and reperfusion. Treatment with the agent also attenuated the release of ATP metabolites and creatine kinase from the heart. However, treatment with high concentrations of aprindine (70 and 100 microM) improved neither cardiac contractile dysfunction, myocardial ionic disturbance nor the release of ATP metabolites and creatine kinase during reperfusion. Two possible mechanisms for the cardioprotection by the agent have been suggested: suppression of transmembrane flux of substrates and enzymes, and prevention of accumulation of myocardial sodium during ischemia.

Animals↗
PubMed1996

Cervical cemental tears in older patients with adult periodontitis. Case reports.

This communication reports 5 cases of cervical and 1 apical cemental tears. The diagnosis of the cervical tears was made by a characteristic feature which presented radiographically as a prickle-like body. The fragment of cementum could be detached by root planing or during periodontal surgery and uneventful healing was obtained following these procedures. The process of aging in addition to continuous occlusal strain may lead to this phenomenon. Cervical cemental tear may be one of the contributing factors in the progress of adult periodontitis.

Aged↗
PubMed1996

Long term survey of hepatitis C virus infection in hemodialysis units in Fukuoka, Japan.

To examine prevalence of hepatitis C virus (HCV) infection and liver dysfunction in hemodialysis units, we surveyed markers for HCV infection and serum alanine aminotransferase (ALT) in hemodialysis patients. 204 hemodialysis patients (111 men and 93 women; mean age, 53 +/- 12 years) in four hemodialysis units in Fukuoka, Japan were investigated. All serum samples were tested for antibody to HCV (anti-HCV) by second-generation enzyme-linked immunosorbant assay (ELISA). HCV RNA was detected to identify present HCV infection in the anti-HCV-positive patients by polymerase chain reaction (PCR) using primers deduced from the 5'-noncoding region. Liver dysfunction was defined as an elevated concentration of serum ALT (above 36 IU/liter) tested by a multiple autoanalyser. 105 patients (51.5 percent) were initially positive for anti-HCV, 95 (90.5 percent) of whom were also positive for HCV RNA. Ten became positive for anti-HCV in hemodialysis units during the observation, eight (80 percent) of whom had sustained HCV viremia. The route of transmission of HCV was not clear, but two of these patients had received blood transfusions. Of 95 patients with HCV viremia, 43 (45.3 percent) had had liver dysfunction at least once. In conclusion, HCV infection continues to occur in hemodialysis units not through blood transfusion and many of them become HCV carriers. Liver dysfunction was found in about a half of HCV-infected hemodialysis patients during the observation.

Adult↗
PubMed1996

[University education in geriatrics. Opinions of teaching staff on undergraduate education in gerontology and geriatric medicine].

Undergraduate education in gerontology and geriatric medicine has become more important because of a progressive increase in the aged population. To assess curricula in geriatric medicine and to survey the opinions of teaching staffs as to the ideal curriculum, a questionnaire was sent to professors of gerontology and geriatric medicine at 14 medical schools. Responses were obtained from all 14 professors. In all medical schools, students are given lectures in the fifth or sixth year, or both. The total number of hours for the lectures varied from a few hours to 40 hours, and contents of the lectures varied between schools. Medical staffs pointed out that little time is allocated to geriatric medicine. They also emphasized the importance of bedside teaching.

Curriculum↗
PubMed1996

[University education in geriatrics: medical students' understandings of gerontology and geriatric medicine].

With the rapid aging of Japan's population, medical professionals who specialize in geriatric medicine are in unprecedented demand. To meet that demand and to improve the curriculum for teaching geriatric medicine and gerontology in Japan, we surveyed medical students' understandings of these specialties. Students at 14 schools with classes in geriatric medicine and gerontology were surveyed. A questionnaire was sent to sixth-year medical students after their classes had ended. Questionnaires were collected from 849 students (60.1%) at ten medical schools (74.1%). One quarter (24.5%) of the students were satisfied with the contents of the classes in geriatric medicine and gerontology taught in their school, whereas 39.4% were not. These specialties encompass many fields of clinical and basic medicine, and many students found the lectures difficult to understand (41.4%). Inter-school comparisons of the results showed that students' strengths and weaknesses in the various areas of geriatric medicine reflected differences in the contents of the classes among the schools. Only 35.4% of students had ever visited hospitals or other health-related facilities for the elderly. Many students (58.8%) had never lived with elderly people. Most students (63.9%) wanted visits to health-care facilities for the elderly to be included in their regular curriculum. Medical students are conscious of the medical implications of the ageing of Japan's population; 13.2% had volunteered to work with the elderly.

Attitude of Health Personnel↗
PubMed1996

[University education in geriatrics: medical student's opinions on gerontology and geriatric medicine].

With the aging of Japan's population, physicians need to be aware of advances in geriatric medicine. To assess the status of geriatric medicine in undergraduate education, we surveyed of medical student's opinions on gerontology and geriatric medicine. A questionnaire was sent to six-year medical students at a total of 20 schools that did not include geriatric medicine in their curriculum. Responses were obtained from 950 students (47.6%) at 16 schools (80%). Almost half of the students (42%) had experiences in health care facilities for the elderly. Ten percent were content with their education in geriatric medicine education and 59% were not. A total of 41.4% felt that geriatric medicine is difficult because it involves many different subjects. Some students had experience as volunteers working with elderly people; they were aware of the aging of Japan's population, and felt that their training in basic geriatrics and in geriatric diseases was insufficient. A total of 56% agreed that all medical schools should have classes in geriatric medicine and 14% did not. Medical students in the schools without classes in geriatric medicine identified dementia (73%), cerebral vascular accidents (51%), cancer (24%) and osteoporosis (19%) as common in elderly people, with no differences between schools. The corresponding data for medical students in schools with classes in geriatric medicine were dementia (77%), cerebral vascular accidents (44%), osteoporosis (29%), and cancer (16%). Undergraduate medical students seem to be exposed to widely differing curricula with regard to geriatric medicine. We found a lack of uniformity in the teaching of gerontology and geriatric medicine to undergraduate medical students in Japan.

Education, Medical, Undergraduate↗
PubMed1996

[Undergraduate teaching of geriatric medicine in western countries--literature review].

To help plan for the future of undergraduate education in geriatric medicine in Japan, we reviewed the literature concerning undergraduate teaching of geriatric medicine in western countries. Undergraduate teaching in geriatric medicine in the UK is well developed: 22 of 25 universities have a full department of geriatric medicine. Training in geriatric medicine is mandatory in almost all universities. In contrast, geriatric medicine is an elective in most universities in the US. There is a shortage of geriatric medicine faculty in the US, which is similar to the situation in Japan. Clinical and basic research in geriatric medicine and gerontology should be encouraged to attract persons into this field.

Education, Medical, Undergraduate↗
PubMed1996

[University education in geriatrics--present status and future prospects of gerontology and geriatrics education in pathology].

The increase in the number and proportion of the elderly in Japan over the last 30 years has been faster than that in any other country. One of the measures we are compelled to take to deal with this drastic change in medicosocial circumstances is reform of the medical school curriculum. However, the necessary reforms are being implemented slowly and are still insufficient. We surveyed the present status of gerontology and geriatrics education in pathology, and the understanding, interest, and opinions on this matter among professors of pathology. Questionnaires were sent to 148 professors of pathology in 80 medical schools. Responses were received from 84 professors (57%) at 64 medical schools (80%). Of the 11 medical schools with a department of geriatrics 10(90%) included gerontology in the curriculum. In contrast, 43(80%) of the 53 remaining schools did not include gerontology in the curriculum, although education in geriatrics and gerontology has been given as part of pathology lectures in almost all medical schools. Many professors want to establish a department of geriatrics in their school, but feel it will be difficult because of lack of money and higher priority given to other fields. As other hindrances, most of the respondents noted the lack of money and higher priority given to other fields. As other hindrances, most of the respondents noted the lack of a good textbook of gerontology, ambiguity in the concept of the field, and the immaturity of gerontology as a science. Another major problem noted was uncertainty regarding the status of geriatrics as a clinical specialty. One professor mentioned that promotion of aging research would be the best way to solve these problems.

Education, Medical, Undergraduate↗
PubMed1996

Hepatitis C virus RNA levels determined by branched DNA probe assay correlated with levels assessed using competitive PCR.

OBJECTIVE: To search for comparative differences, levels of hepatitis C virus (HCV) RNA were examined by branched DNA (bDNA) probe assay and by competitive polymerase chain reaction (PCR). METHODS: The study population included 234 patients (chronic hepatitis 146, cirrhosis 36, hepatocellular carcinoma 52), all of whom were positive for HCV RNA, as determined by PCR. We quantified HCV RNA levels of all serum samples by both bDNA probe and competitive PCR. RESULTS: HCV RNA was detected in serum samples by bDNA assay in 142 (60.7%) of the 234 patients; this rate was significantly higher in 106 (73.6%) of the 144 patients in genotype II than in 20 (41.7%) of 48 of genotype III and in 16 (38.1%) of 42 of genotype IV (p < 0.001, respectively). The median HCV RNA levels by bDNA assay (x 10(6) eq/ml) were 0.1, 0.1, 0.4, 1.4, and 5.3 among patients with HCV RNA levels < 3, 4, 5, 6, and 7 respectively, by competitive PCR (logarithmic transformation copy numbers/50 microliters). A significant correlation was found between HCV RNA levels by bDNA and competitive PCR (r = 0.5747, p < 0.001). There was a correlation among patients of genotype II and genotype III but not genotype IV. CONCLUSION: We recommend bDNA assay for use in clinical practice because the procedure is not difficult and is less contamination-prone. The HCV RNA levels determined using this assay correlated with those examined by competitive PCR.

Base Sequence↗
PubMed1996

[Open heart surgery in patients with systemic diseases requiring steroid treatment].

Our surgical experiences in 9 patients who required steroid treatment for systemic diseases before, during and after the open heart surgery were reviewed. Subjects included 3 patients with systemic lupus erythematodes, 3 with aortitis syndrome, 1 with Behçet disease and 1 with rheumatoid arthritis. Cardiovascular lesion was aortic valve regurgitation in 2, Stanford A aortic dissection in 1 and ischemic heart disease in 3 patients. Duration of morbidity for systemic diseases before the surgery ranged between 0 nd 102 months, with a mean of 36 months. Steroid treatment was continued for 4 to 216 months (mean 70+/-76 months) before the surgery at a dose of 5-40 mg per day for conversion into prednisolone. In principal, methylprednisolone was given during the surgery, and the prednisolone was given at a dose of 20-140 mg per day on the day of operation or on the first postoperative day. Surgical procedures included a aortic valve prosthesis with Dacron cloth skirt implantation in 1 patient, surgical angioplasty of the left main coronary ostium in 1 and internal thoracic arteries grafting in 2 patients. Hospital mortality was 1 patient due to low cardiac output syndrome. Acute renal failure occurred in 2 patients with systemic lupus erythematodes, and wound complication was observed in 2 patients. In our experience, appropriate treatment for systemic diseases, timing of surgery and continuation of steroid treatment at an appropriate dose during and after the surgery seemed very important such as surgical procedure in order to prevent postoperative complications such as periprosthetic leakage and failure of anastomosis.

Aortic Arch Syndromes↗