A new endotracheal tube with a cuff impervious to nitrous oxide: constancy of cuff pressure and volume.
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Adult↗
Biomedical subjects
J Kawamura
Publications and source records attributed to J Kawamura.
[Respiratory disorders during sleep in Duchenne muscular dystrophy].
Respiratory disorders during sleep were studied in 42 patients with Duchenne muscular dystrophy (DMD) (mean age 18.4 years). Chest and abdominal movement, nasal airflow, snoring sounds, eye movement, and oxygen saturation were monitored during sleep. Three patterns of disorders were found: obstructive apnea, central apnea, and paradoxical respiration without upper airway obstruction (non-obstructive paradoxical respiration). Of these three patterns, obstructive apnea was the most common. Hypertrophy of the tongue and collapsibility of the upper airway seemed to be responsible for the obstructive apnea in these patients. The relationships between PaCO2 while breathing room air and the various indices of respiratory disorders were studied. The index of central apnea differed significantly between patients in whom PaCO2 was less than 50 Torr (early disease, n = 22) and those in whom PaCO2 was greater than or equal to 50 Torr (advanced disease, n = 20), but the indices of obstructive apnea and non-obstructive paradoxical respiration did not differ between those two groups. In conclusion, sleep disorders were common in patients with DMD, and the most common was obstructive apnea. In the patients with advanced DMD, blood gas analysis showed hypercapnia, and the index of central sleep apnea was high, probably because of respiratory muscle weakness or abnormalities in the respiratory center.
Adolescent↗
[Symposium (2). Diagnosis and treatment of renal parenchymal mass. Chairmen's comments].
Although renal cell carcinoma occupies clinically the majority of renal parenchymal mass lesions, indeterminate renal masses among renal cystic lesions and benign renal tumors have been frequently found with recent advances in renal imaging modalities. Renal mass lesions to be differentiated from renal cell carcinoma were focused on in the symposium and the points discussed were divided into four categories. 1. Indeterminate renal cystic masses, especially focused on multilocular cystic lesions and renal malignant lesions associated with acquired cystic disease of the kidney (ACDK) and von Hippel Lindau disease. 2. Angiomyolipoma and oncocytoma, as representative ones among a variety of benign renal tumorous lesions. 3. How to treat small renal masses serendipitously detected by abdominal CT and/or ultrasound, radical nephrectomy or renal parenchyma-preserving operation? 4. Feasibility of percutaneous ultrasound-guided fine needle biopsy for suspicious renal mass lesions. In this symposium, the diagnosis and treatment of various renal mass lesions other than renal cell carcinoma were mainly discussed and the important points to diagnose and treat patients with renal cell carcinoma have been clarified.
Carcinoma, Renal Cell↗
[Renal angiomyolipoma: diagnosis and treatment].
In 10 years the diagnosis of renal angiomyolipoma (RAML) was made in 14 patients (male-to female ratio 1:3.7) at our institution; 1 case was associated with tuberous sclerosis (TS) and 1 case had regional lymph node involvement. A statistical study was done on data taken from 739 cases of RAML in the Japanese literature, including our cases. The male to female ratio was 1 to 3. Twenty eight percent of the cases were associated with TS. The ratio of bilateral cases to the unilateral one was 1 to 3. The main clinical signs were flank pain, abdominal mass, hematuria and fever elevation. Recently the ratio of nephrectomy has decreased to 30%. The percentage of detecting the fat component by ultrasonography (US), computed tomography (CT) and magnetic resonance imaging were 88.1%, 86.5% and 80.8% respectively. The percentages of visualizing hypervascularity, aneurysms, absence of arterio-venous shunt and onion peel appearance by selective renal angiography were 77.3%, 71.4%, 48.1% and 4.9% respectively. Small (less than 3 cm), asymptomatic, simple lesions with adipose component may be observed annually by CT and US until more experiences is gained with surveillance of these patients. Embolization was useful for emergency cases or pre-treatment of nephron sparing surgery, but insufficient by itself. As there still remain problems in the diagnosis of RAML, especially in the case of very small tumors, in the case with almost no adipose component and in the case associated with renal cell carcinoma, the diagnosis of RAML should be made synthetically including angiography.
Adult↗
[Tubulointerstitial nephropathy--radionuclide imaging diagnosis].
There are many spectrums in renal diseases which induce tubulointerstitial nephropathy (TIN). Primarily, the renal tubule and interstitium are involved but glomerular and vascular lesions are found in the chronic course of TIN. Renal scintigraphy is poor for evaluating characteristic aspects of tubular function of TIN but demonstrate individual renal function as a whole. Particularly, measurement of the 99m-Tc-DMSA renal uptake rate is useful for evaluating a functioning tubular mass.
Humans↗
[Proliferating cell nuclear antigen expression as a prognostic indicator for renal cell carcinoma: comparison with pathologic features and DNA content].
In the present study the prognostic value of proliferating cell nuclear antigen (PCNA) index and tumor DNA content were evaluated in 100 patients with renal cell carcinoma. The survival rate of patients with aneuploid tumors was not significantly different from that of those with diploid tumors. DNA ploidy could not be a prognostic factor. PCNA expression was determined by immunohistochemical staining using the PC10 clone. PCNA indices ranged from 2.6 to 33.6% with mean indices of 10.2, 15.7 and 27.9% for grades 1 to 3. There was a significant difference between the indices of each grade of tumor. Patients with a PCNA index of less than 13.6% had a longer survival time than the patients having tumors with a PCNA index of more than 13.6% (p < 0.05). Furthermore, within the group of grade 2 tumors, patients with a lower PCNA index had a significantly better prognosis (p < 0.05). Our findings demonstrated that the PCNA index provides significant prognostic information for renal cell carcinoma.
Adolescent↗
[Clinical study of prostatic cancer--statistical analysis of 184 cases in the latest 21 years].
One hundred and eighty-four patients with prostatic cancer were treated at Mie University Hospital from 1973 to 1993. They were between 47 and 90 years old, with an average age of 71.8 years old. One hundred and fifty-eight patients (85.8%) were in either stage C or D. Of the 146 cases histologically examined, 17.8% were well differentiated adenocarcinoma, and 47.9% and 34.2% were moderately and poorly differentiated adenocarcinomas, respectively. The overall 3-year, 5-year and 10-year survival rate were 64.2%, 44.9% and 24.2%, respectively. The patients with high stage and/or poorly differentiated adenocarcinomas revealed worse prognosis. Although the prognosis in the patients treated with estrogen and orchiectomy was better than that with estrogen alone, there was no significant difference between the 2 treatment groups. The prognosis of patients with prostatic cancer has been improved since 1988. A possible explanation is that prostate specific antigen has been introduced as a tumor marker, which might contribute to an accurate diagnosis in prostatic cancer and improve the prognosis of the disease. In conclusion, the diagnosis in lower stage and radical prostatectomy might bring favorable prognosis. In future, safer and more effective chemotherapy and endocrine therapy including LH-RH analogue are awaited, to obtain a better prognosis in the patients with advanced prostatic cancer.
Age Distribution↗
[Blood gas changes in Duchenne type muscular dystrophy].
We studied changes in blood gas data from 32 patients with Duchenne type muscular dystrophy (DMD), who were followed for more than 5 years. Regression lines for each blood gas variable were obtained by the least square regression method, from 276 observations. The mean change per year was calculated by averaging the individual slopes. All blood gas variables (PaO2, PaCO2, pH, and [HCO3-]) correlated significantly with age the regression lines were: PaO2 = 95.6-0.45x Age, PaCO2 = 34.7 + 0.70x Age, pH = 7.397-0.0023x Age, [HCO3-] = 20.7 + 0.28x Age. The rates of change were -0.74 Torr/year for PaO2, 1.07 Torr/year for PaCO2, -0.0028 per year for pH and 0.55 mEq/l/year for [HCO3-]. The slope of each regression line was within the average individual yearly change +/- one standard deviation. AaDO2 did not change significantly with age, but chronic respiratory acidosis worsened because of alveolar hypoventilation. As an index of the severity of DMD, PaCO2 was better than PaO2, because the former was more strongly correlated with age and the values of PaCO2 deviated less from the the regression line.
Adolescent↗
[Combined small cell and transitional cell carcinoma of renal pelvis: a case report].
Primary small cell carcinoma of the renal pelvis is rare. We report a case of combined small cell and transitional cell carcinoma of the renal pelvis. The patient was a 78-year-old man with macrohematuria. He was diagnosed with right pelvic tumor by right retrograde pyelography and computerized tomography. A right radical nephroureterectomy was performed. Histological sections of the tumor showed a mixture of small cell and grade 2 transitional cell carcinoma. Positivity for Grimelius was noted in the small cell component. Masson-Fontana, chromogranin A, serotonin, keratin, leucocyte common antigen (LCA), neuron specific enolase (NSE), adrenocorticotropic hormone (ACTH), growth hormone (GH) and somatostatin were negative. Ultrastructurally, the tumor cells were tightly packed and attached together by scattered desmosomes. There were no neurosecretory granules. Seven months after operation, the patient died with peritonitis carcinomatosa. At autopsy, a metastatic tumor was found in the liver and retroperitoneal lymph node. Other organs were not involved. Especially, there were no abnormalities in the lungs.
Aged↗
[Asymptomatic unilateral adrenal medullary hyperplasia with a cyst: case report].
A 45-year-old man was admitted with asymptomatic adrenal tumor. He had normal plasma and urinary catecholamine levels. The swelling of right gland was detected by CT scan and MRI. Selective venous samplings were performed and the level of catecholamine into the right adrenal vein were much higher than that into the left one. On July 15th, 1993, a right adrenalectomy was carried out and the right adrenal gland with a large cyst could be found. The ratio of cortical area to medullary area was about 4:1. Therefore, it was pathologically diagnosed as adrenal medullary hyperplasia with a cyst. There are relatively few reports of adrenal medullary hyperplasia. Before the operation, the patients were mostly diagnosed as pheochromocytoma by the results of laboratory studies and their symptoms. The condition of this disease is usually bilateral and often associated with type II multiple endocrine neoplasia (MEN II). We describe a case of asymptomatic unilateral adrenal medullary hyperplasia.
Adrenal Gland Diseases↗
[Two cases of squamous cell carcinoma of the ureter].
Herein, we report two cases of squamous cell carcinoma of the ureter. The first case was in a 56-year-old-male. Total cystectomy and ileal conduit were performed because of bladder tumor suspected to be accompanied by carcinoma in situ and atrophic urinary bladder induced by chronic cystitis in December, 1993. Pathological examination revealed transitional cell carcinoma (TCC) > squamous cell carcinoma (SCC), G2 > G1, INF beta, pT1, 1y1, v1. He complained of back pain under medical observation in December, 1994. Left hydronephrosis was found and antegrade pyelography showed leakage from the left pelvic ureteral junction. Urinary cytology revealed class V and suggested TCC. He received left nephroureterectomy, and pathohistological examination of resected specimen revealed SCC, INF gamma, pT3, pRo, pLx, pVx, pNo, pMo. CABO chemotherapy (cisplatin, methotrexate, bleomycin, vincristine) was performed postoperatively. The second case was in a 61-year-old female. She complained of macrohematuria in the course of observation of pyelonephritis. Drip infusion pyelography showed right hydronephrosis and retrograde ureterogram revealed stenosis of the right lower ureter. Urinary cytology revealed class V. Nephroureterectomy and bladder cuff were performed. The tumor was histologically diagnosed as SCC > TCC, INF beta, pT3, pRo, pLo, pVo, pNo, pMo. Postoperatively, CABO chemotherapy was performed. So far, no recurrence has been observed. Fifty five cases of squamous cell carcinoma of ureter were collected from the Japanese literatures including our cases.
Carcinoma, Squamous Cell↗
[Coronary artery spasm as a cause of perioperative myocardial infarction and stunned myocardium].
We report a male patient who had recurrent coronary artery spasm on withdrawal from cardiopulmonary bypass, which led to myocardial infarction and stunned myocardium. The spasm responded to conventional medication. Transesophageal echocardiogram showed no remarkable asynergy during the operation. However, MB fraction of creatine kinase was 132 IU.l-1 and electrocardiogram showed new Q waves. After stopping intravenous catecholamines, hypokinesis of the anteroseptal segment appeared in the echocardiogram. Spotty myocardial necrosis and stunned myocardium might have resulted from recurrent coronary artery spasm.
Aged↗
[Respiratory failure: respiratory disorder during sleep in patients with myotonic dystrophy].
Myotonic dystrophy (MyD) patients have been reported to show severe nocturnal desaturation related to sleep respiratory disorders. However, the reason of respiratory failure in MyD has remained unclear. In this study, ten patients with MyD underwent overnight polysomnography to evaluate the mechanisms which would cause respiratory failure, compared with Duchenne muscular dystrophy (DMD) patients in these three views: 1) sleep-related nocturnal desaturation, 2) histopathological evaluation of respiratory muscles, and 3) abnormalities of respiratory center. Nocturnal desaturation was more prominent in MyD rather than DMD. Apnea-hypopnea index (AHI) was higher in MyD than DMD. Type of respiratory disorder during sleep was mainly central apnea-hypopnea pattern, including Cheyne-Stokes respiration. In histopathological findings, central core change in respiratory muscle related to respiratory muscle fatigue was found less frequently in MyD than DMD. In respiratory center function, MyD showed hyporesponse to both alveolar hypercapnic and hypoxic stimulation. However, DMD showed normal response to both stimulations. We concluded that respiratory failure in patients with MyD would be attributed to respiratory center disorder rather than respiratory muscle weakness, which is the main cause of respiratory failure in patients with DMD.
Humans↗
Age-related changes of the prostate gland in the senescence-accelerated mouse.
Aging is of utmost importance in the pathogenesis of the prostate gland (i.e., benign prostate hyperplasia or prostatic carcinoma). The object of this study was to examine the morphological and histological changes of the aging prostate of the so-called senescence-accelerated mouse (SAM). Ventral and dorsolateral lobes of prostate glands of SAM were microdissected into two-dimensional ductal arrays. Gross morphology, ductal branching patterns, and histology were examined in these microdissected specimens. Wet weight and numbers of ductal tips in ventral and dorsolateral prostate glands in senescence accelerated-prone (SA-P) mice were significantly smaller than those of senescence accelerated-resistant (SA-R) mice, although the changes of patterns of gross ductal morphology were virtually identical in these groups. High incidence of stromal hyperplasia with fibrosis and inflammation was observed in the dorsal lobe of the aged SA-P mouse. Atypical glandular epithelial cells and cribriform glandular deformity were observed in the dorsal and lateral lobe of aged SA-P mice. Marked heterogeneity in age-related pathological changes was observed between prostatic lobes. These data suggest that the aging process occurs heterogeneously within the prostate gland, and that SA-P mice may be an important model for the study of age-related changes in the prostate gland.
Aging↗
Waveform changes of compound muscle action potential (CMAP) with muscle length.
Changes in finger positions influence the waveform of CMAP recorded from the muscle that moves that finger. The present study suggested that the muscle length, dependent on the finger position, was a main factor affecting the waveform. On shortening the muscle length, the amplitude of CMAP increased with concomitant reduction in the duration, and on lengthening, the amplitude decreased with concomitant increase in the duration. These changes are considered due to changes in propagation velocities of muscle fibers dependent on the muscle length. In nerve conduction studies, it is important to carefully monitor the finger position to distinguish the waveform changes with muscle length from those due to nerve lesions.
Action Potentials↗
[Radionuclides in urology].
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Adrenal Glands↗
[Endorectal magnetic resonance imaging of the prostate and bladder].
Endorectal magnetic resonance imaging (MRI) using an endorectal surface coil has been evaluated basically and clinically. This new modality obtained increased resolution magnetic resonance images of the pathologic conditions of the prostate and bladder. Compared with images obtained with a body coil, the surface coil images clearly demonstrate prostatic intraglandular zonal anatomy. The clear images of prostatic capsule and neurovascular bundle seen on the surface coil may contribute to the local staging of prostate cancer. The staging diagnosis of bladder tumor located in the bladder neck will be the best candidate for endorectal MRI. Enhancement with gadolinium may improve the ability to differentiate superficial from deep bladder-wall tumors. We concluded that endorectal MRI is safely performed and is extremely useful for the local staging of prostate cancer and bladder neck tumor. Further studies will be required to evaluate the clinical significance of this new modality.
Humans↗
[Initial chemotherapy followed by orchiectomy and retroperitoneal lymphadenectomy--a case of seminoma with a testicular tumor and enlarged regional lymph nodes].
A 43-year-old male visited our hospital with complaints of right scrotal swelling and lower abdominal mass. Computed tomographic (CT) scan showed the right testicular tumor and regional enlarged lymph nodes. However, there were no metastasis in lung, brain, liver, and bone. First, we performed chemotherapy of modified PVB regimen (cisplatinum, vinblastine, peplomycin) prior to the right orchiectomy, because a tumor lump was palpable from the right testis to the lower abdominal mass. After three courses of modified PVB chemotherapy, beta-HCG, HCG and LDH values became within normal limits and all tumors were necrotic on the CT scan. Then, we performed the right orchiectomy and retroperitoneal lymphadenectomy simultaneously. After operation, two courses of VIP chemotherapy (etoposide, ifosfamide, cisplatinum) were performed since viable cells in one of the obturator lymph nodes were pathologically noticed. The patient has been free of recurrence of the tumor for 15 months after the treatment. In the particular case, in which the primary testicular tumor was not extirpated en bloc, the initial chemotherapy followed by orchiectomy was found to be feasible.
Adult↗