Biomedical subjects
K Azuma
Publications and source records attributed to K Azuma.
[Metoclopramide, sulpiride, and chlorpromazine loading test].
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[L-dopa and dopamine loading test].
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[Bromocriptine loading test].
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[Thyroid function in patients with Yusho: 28 year follow-up study].
To evaluate chronic effect of polychlorinated biphenyl (PCB) on thyroid functions, thyroid hormone levels and thyroidal autoantibodies were studied in 81 patients with Yusho in 1996. Serum level of thyroid stimulating hormone (TSH) was elevated in 7 cases (8.6%). All of them showed normal triiodothyronine (T3), thyroxine (T4) and free T4 levels, and regarded as latent hypothyroidism. There were no significant correlations between blood PCB concentrations and TSH levels, T2 levels, T4 levels or free T4 levels. Thyroglobulin antibodies were detected in 8 cases (19.5%) of 41 Yusho patients with high PBC concentration (higher than 3.0 ppb), and in only one case (2.5%) of 40 patients with low PBC concentration (lower than 2.9 ppb). We conclude that thyroglobulin antibody in patients with Yusho is not frequent and it may be associated with blood PCB concentration.
[A case of retinochoroidal optic neuropathy].
The patient was a 59-year-old male with impaired left vision. Before he was referred to this hospital, he was diagnosed as having optic nerve injury due to the trauma of a severe bruise on his left eye caused by a traffic accident, and relative afferent pupillary defect (RAPD) was negative. On his first examination in this department, RAPD was negative and funduscopy of the left eye demonstrated hyperemia of the optic disc and mild opacification at the posterior pole. Fluorescein fundus angiography showed circular hyperfluorescence around the optic disc and transverse linear hyperfluorescence appearing above and below the macula. From these findings a diagnosis of choloidal rupture was made. The form of choloidal rupture suggested an early stage of evulsion of the optic nerve. The impairment of visual acuity seemed to be caused by choloidal circulatory disturbance. The patient was therefore, had traumatic retinocholoidal optic neuropathy complicated by the rupture of the choloidal around the optic disc, disturbance of the optic disc, and opacification of the retinochoroid.
Accumulation of Tc-99m HMDP in hepatic metastasis from colon carcinoma without detectable calcification.
A 51-year-old man was found to have hepatic metastasis from colon carcinoma. Bone scintigraphy with 99mTc-hydroxymethylene diphosphonate showed a ringlike accumulation corresponding to the hepatic mass, which was without calcification on computed tomography. Treatment with chemotherapeutic agents was started. After 4 months, computed tomography showed that the mass was smaller than before and that the margin was calcified. The extraosseous accumulation of the radionuclide may be evidence supporting earlier speculation on calcification that could not yet be detected by computed tomography.
Coronary artery fistula to bronchial artery on contralateral side of coronary atherosclerosis and myocardial insufficiency. A case report.
Among coronary vessels anomalies is the rare coronary artery fistula. Myocardial insufficiency resulting from fistula steal phenomenon can not be clinically distinguished from that of coronary atherosclerosis, if these conditions coexists in the same patient. The authors present a case of extracardiac left coronary artery fistula connecting the circumflex branch and left bronchial artery, with inferior wall myocardial insufficiency attributable to the right coronary artery atherosclerosis.
[Cesarean section under spinal anesthesia for a patient with chronic renal failure].
A 37-year-old primipara was scheduled for cesarean section under spinal anesthesia in the 38th gestational week because of cephalo-pelvic disproportion. She had suffered from chronic renal failure since 27 years of age, and had been undergoing hemodialysis three times per week. The frequency of hemodialysis was increased to 4-6 times per week during pregnancy to maintain blood urea nitrogen and serum creatinine concentration below 60 mg.dl-1 and 6.0 mg.dl-1, respectively. Since she had no bleeding tendency, spinal anesthesia with 8 mg of tetracaine was successfully performed after hemodialysis eliminating only solute but not water in the morning of surgery and after infusion of 500 ml of acetated Ringer solution. Blood pressure and heart rate were stable during surgery. Monitoring of central venous pressure was useful for fluid management. A baby weighing 2,575 g with an Apgar Score of 8 at one minute and 9 at five minutes was delivered five minutes after the beginning the surgery. The mother recovered uneventfully and returned to regular hemodialysis on the first postoperative day. These findings suggest that with careful fluid management, spinal anesthesia can be safely performed for cesarean section, for patients undergoing hemodialysis.
[Matured mediastinal teratoma with high levels of tumor markers in cystic fluid].
A 42-year-old woman was admitted to Gifu Municipal Hospital because of an abnormal mediastinal shadow on a chest X-ray film. The serum CA125 level was slightly high 38 U/L, normal: < 35 U/L. Preoperative examination of fluid from a cyst revealed a high level of carcinoembryonic antigen (550 ng/ ml). The tumor resected was 11 x 9 x 5 cm. Microscopic examination revealed a matured teratoma containing pancreatic cells, collagenous tissues, squamous epithelia, and hair follicle-like tissues. Biochemical analysis of the cystic fluid revealed high levels of eight tumor markers: carcinoembryonic antigen, CA125, CA19-9, SLX, Ferritin, NSE TPA, and elastase 1. Samples stained positively for the tumor markers carcinoembryonic antigen CA125, CA19-9, and NSE by ABC immunohistochemical staining. The serum carcinoembryonic antigen levels had decreased to the normal level within two weeks after the surgery. The high levels of tumor markers and materials in the cystic fluid may have been related to the biological characteristics of the various cell components in this matured teratoma.
[Experimental study on early detection of alloxan-induced pulmonary injury by magnetic resonance imaging].
We studied the early detection of alloxan-induced pulmonary injury by magnetic resonance imaging in vivo. Permeability edema was induced in ten rats by intravenous injection of alloxan at 100 mg/kg. T1-and T2-weighted images were acquired in five rats every 30 min for 120 min after alloxan injection. Five rats served as controls. The rats were sacrificed immediately after imaging and examined microscopically. CT images were also acquired in five rats every 30 min for 120 min after alloxan injection. Five rats served as controls. The rats were sacrificed immediately after imaging, and the wet-to-dry ratio of the lung was measured. In T1-weighted images, relative signal intensity from the lung with permeability edema rose from 30 min to 120 min, and was greater than that from normal lung every time. In T2-weighted images, there was no statistically significant difference in relative signal intensity of the lung between permeability edema and the control during 120 min. In CT images, there was also no statistically significant difference in lung density between permeability edema and the control during 120 min. There was no statistically significant difference in the wet-to-dry lung ratio between edematous lung and normal lung. In histological study, mild congestion and interstitial edema were observed in edematous lung. These results suggest the potential capability of MR imaging in detecting the early phase of permeability pulmonary edema.
[Coronary artery bypass grafting in cases with the atherosclerotic ascending aorta].
Among 172 cases of coronary artery bypass grafting, 9 cases (5%) revealed severely atherosclerotic ascending aorta. In 3 of the 9 cases, total aortic cross-clamping in the distal anastomoses of saphenous vein graft (SVG) and partial aortic clamp in the proximal anastomoses of SVG were performed. In 1 case with this technique, cerebral infarction was occurred. In 4 cases, total aortic cross-clamping in the distal and proximal anastomoses of SVG was performed. In 2 of these cases with this technique, cerebral infarctions were occurred. Hypothermic circulatory arrest was performed in 2 of the rest. In one case that was predicted to have atherosclerosis of ascending aorta prior to operation, the left internal thoracic artery was anastomosed to the left anterior descending, and SVG to the right coronary artery with hypothermia and ventricular fibrillation. And during the proximal anastomoses of SVG, hypothermic circulatory arrest without aortic clamping was initiated. In another case, atherosclerosis of ascending aorta was noted after aortic cross-clamping. Then the aorta was declamped, hypothermic circulatory arrest was established, the aorta was opened, the diseased segment was resected, and proximal anastomoses of SVG was performed to Dacron patch which was implanted for aortic wall. There were no cerebral infarction in last two patients.
Screening of patients with ischemic heart disease by transesophageal atrial pacing and the selection of surgical therapy: in patients with arteriosclerosis obliterans and aortic aneurysm.
This study evaluated (1) a screening method for ischemic heart disease (IHD) using transesophageal atrial pacing (TEP), and (2) the appropriate surgical therapy for patients with concomitant IHD which was evaluated on the basis of the coronary score (CS) by Leaman. Thirty-nine patients with arteriosclerosis obliterans of the lower extremities (ASO) and 35 with aortic aneurysm underwent TEP and coronary angiography (CAG). Coexistent IHD was diagnosed in 25 patients (64%) with ASO and in 14 (40%) with aortic aneurysm. Screening for IHD by TEP was 96% sensitive, 71% specific, and 87% accurate in patients with ASO, and 79% sensitive, 90% specific, and 86% accurate in patients with aortic aneurysm. Coronary artery bypass grafting (CABG) and peripheral arterial revascularization (PAR) were performed by one stage surgery in 3 patients with a CS of 16 or more. In 18 patients with a CS of 5.5 or less, only PAR was performed. One stage surgery was performed in 6 patients with aortic aneurysm. Four patients had a CS of 9.5 or more, and 2 patients with coexistent stenosis of the left anterior descending branch (LAD) had CS of 3.5 and 8, respectively. Repair of the aneurysm was undertaken in 5 patients with a CS of 8 or less without LAD disease. In patients with ASO showing a CS of 5.5 or less and in those with aortic aneurysm showing a CS of 8 or less (and without LAD disease), the only surgical procedure performed was either PAR or repair of the aneurysm. There were no complications attributable to IHD observed in these patients during the perioperative period.
Evidence for an immunological pathogenesis of thrombocytopenia in chronic liver disease.
OBJECTIVES: To elucidate the role of platelet-associated IgG (PA-IgG) in the mechanism of thrombocytopenia associated with chronic liver disease. METHODS: Platelet count in blood, PA-IgG, and scintigraphic spleen/liver ratio as a marker of splenomegaly was examined in 214 individuals, including 16 controls showing nonspecific reactive change in liver biopsy and 198 patients with chronic liver disease. RESULTS: The mean blood platelet count decreased significantly according to severity of liver disease, from control to liver cirrhosis. PA-IgG levels increased significantly in relation to severity of liver disease, as did spleen/liver ratio. In chronic hepatitis or liver cirrhosis, an inverse correlation was found between platelet counts and PA-IgG levels. An inverse correlation was also observed between platelet count and spleen/liver ratio in liver cirrhosis. The splenic embolization resulted in a significant rise in platelet count and a significant fall in PA-IgG in the 14 cirrhotic patients. CONCLUSIONS: These results may give support to evidence for an immunological mechanism mediated by PA-IgG for the thrombocytopenia occurring in chronic liver disease. In the case of liver cirrhosis, this mechanism would act in addition to platelet pooling in the spleen on thrombocytopenia. PA-IgG may also have an important role in thrombocytopenia associated with chronic hepatitis, in which splenic platelet pooling is less marked.
[Intratumoral LPD deposition within hepatocellular carcinoma without arterial tumor staining].
The dissociation of intratumoral LPD deposition and arterial tumor staining was investigated in 20 cases of hepatocellular carcinoma (HCC) without arterial tumor staining. The intratumoral deposition of LPD injected from the hepatic artery was observed in nine cases of HCC and coincided with the decrease in tumor vascular bed evaluated by photomicroscopic study and arterial portography. LPD deposition was not observed within the 11 other tumors, which were diagnosed as well differentiated HCC. Infusion angiographic CT revealed that the arterial and portal vascular beds were separated from each other. Therefore, arterial tumor staining was insufficient for accurate evaluation of the tumor vascular bed. The vascular bed in cancerous and noncancerous tissue was accurately evaluated by the addition of the contrast enhancements from the hepatic artery and the portal vein.
Diffusion anisotropy of cerebral ischaemia.
Focal cerebral ischemia was produced by occlusion of the middle cerebral artery with a silicone cylinder in Wistar rats. Diffusion-weighted echo-planar images (DW-EPIs) using the motion-probing gradient (MPG) method were acquired at 1-3 hours and 24-48 hours after occlusion. Apparent diffusion coefficients (ADCs) were calculated from these images in ischemic lesions and in normal unoccluded regions. Results were as follows. 1. Ischemic lesions could be detected on the DW-EPIs at 1 hour after occlusion. 2. The ADC of water in the brain tissue was smaller than that of free water as a result of restricted diffusion. 3. Anisotropic diffusion that probably can be attributed to the myelin sheath was observed in the normal deep white matter. 4. In the ischemic lesions, the ADC decreased rapidly within 1-3 hours after occlusion and then slightly further declined after 24-48 hours. In the ischemic deep white matter, diffusion anisotropy disappeared at 24-48 hours after occlusion. Diffusion-weighted imaging may have applications in the examination of pathophysiological mechanisms in cerebral ischemia by means of evaluation of ADC and diffusion anisotropy.
Another approach for aortic valve replacement through left thoracotomy.
We report a 54-year-old man with a history of esophagectomy and retrosternal esophagogastric anastomosis for esophageal cancer through right thoracotomy in whom cardiac failure developed due to aortic regurgitation. He underwent aortic valve replacement through a left thoracotomy with division of two great arteries and their strong traction toward the surgeon by stay sutures. He has been well for 3 years postoperatively in New York Heart Association class I.