Biomedical subjects

K Fukiyama

Publications and source records attributed to K Fukiyama.

At least 55 records · Page 3Linked to original sources

PubMed1998

Demographic study of first-ever stroke and acute myocardial infarction in Okinawa, Japan.

We performed a cross-sectional survey of stroke and acute myocardial infarction (AMI) in Okinawa, Japan with a census population of about 1.2 million. A total of 3,644 cases of first-ever stroke and 898 cases of initial acute myocardial infarction (AMI) were detected. The age-adjusted annual incidence rate for stroke was 105 per 100,000 standard population of Japan, and that of AMI was 26. The case-fatality rate of stroke within 28 days of onset was 12.8%, and that of AMI was 22.2%. Of the stroke cases, 51.4% were diagnosed as brain infarction, 38.7% as brain hemorrhage, and 9.3% as subarachnoid hemorrhage. The diagnosis of stroke subtypes were confirmed by computed tomography or magnetic resonance imaging in 98.4% of all stroke cases. In Okinawa, the incidence rate of AMI was still considerably lower than that in the Western population, and the rate of stroke was similar to that in the Western population.

Adult↗

PubMed1998

[A female case of Fournier's gangrene in a patient with lupus nephritis].

Infection is one of the common causes of death in patients with systemic lupus erythematosus (SLE). It is associated with the use of immunosuppressive agents, renal failure, and increased disease activity. Fournier's gangrene is a necrotizing fasciitis occurring in the genital region. It is rare, but can be crucial if surgical drainage is delayed. We report a female case of Fournier's gangrene occurring in a patient with lupus nephritis and chronic renal failure. The patient was a 21-year-old female with chronic renal failure due to lupus nephritis. She had suffered from watery diarrhea one month before admission. It improved after increasing the dose of prednisolone, but, she was complicated with Bartholin abscess. The vaginal pain rapidly spread to the left lower quadrant abdomen despite treatment with oral cephalosporin. Focal incision was performed and black fluid emerged with a foul smell. Pelvic computed tomography (CT) revealed many bubbles in that region. She was found to have septic shock on transfer to our hospital. Thereafter, emergency debridement was performed, followed by antibiotic therapy and hyperbaric oxygen therapy. Organisms were found to be 5 anerobes, such as Bacteroides species, and 3 aerobics, such as Morganella morganii. Fournier's gangrene was improved via these treatments, but she needed maintenance hemodialysis. Fournier's gangrene complication should be considered in SLE with urogenital infection.

Adult↗

PubMed1997

Role of ouabain-like compound in the rostral ventrolateral medulla in rats.

To determine whether ouabain-like compound (OLC) exerts modulatory influences on the activity of vasomotor neurons in the rostral ventrolateral medulla (RVLM), we examined the effects of microinjecting ouabain, digoxin-specific antibody Fab fragments, and mAb against ouabain on the rat RVLM. Microinjection of ouabain into the unilateral RVLM of anesthetized normotensive rats elicited dose-dependent increases in mean arterial pressure (MAP) and renal sympathetic nerve activity (RSNA). The pressor and sympathoexcitatory effects of ouabain in the RVLM were reversed by microinjections of an M2 muscarinic antagonist, gallamine, or digoxin-specific antibody Fab fragments. Furthermore, a prior microinjection in the RVLM of gallamine, digoxinspecific antibody Fab fragments, or kainic acid or intravenous injection of hexamethonium all prevented the pressor and sympathoexcitatory effects induced by a subsequent microinjection of ouabain. Microinjections of either digoxinspecific antibody Fab fragments or gallamine per se significantly decreased baseline MAP and RSNA. Injection of digoxin-specific antibody Fab fragments attenuated the effects of a subsequent injection of gallamine. Microinjection of mAb against ouabain, but not nonspecific IgG, also significantly decreased baseline MAP and RSNA. These results suggest that OLC in the RVLM contributes to the tonic activity of vasomotor neurons in anesthetized normotensive rats, and the action of OLC in the RVLM is at least partly mediated by M2 muscarinic mechanisms.

Animals↗

PubMed1997

Sympathetic skin responses of the hand in normal subjects: shorter latency at distal phalanx.

We studied the conduction of the sympathetic skin response (SSR) in the hands of 35 normal subjects by simultaneous recording at five sites. The mean latency of the SSR in all subjects increased from the wrist (W) to the middle phalanx (M), but the SSR latency at the distal phalanx (D) was shorter than that at the middle phalanx. The mean conduction time and conduction velocity from W to M was 197.5 ms and 0.87 m/s, respectively, and that from W to D was 48.8 ms and 2.34 m/s, respectively. For evaluation of the cause of the shorter latency at D, digital nerve blocking was performed in two subjects. The blocking of the volar digital nerves at the proximal phalanx abolished SSR at M and D. It was postulated that the initiation or conduction of sudomotor nerve impulse to the distal phalanx would be facilitated compared with those to the other proximal sites in the hand. The SSR conduction time between W and M may be a means of detecting alteration of sympathetic sudomotor nerve activity.

Adult↗

PubMed1997

Risk factors of end-stage renal disease and serum creatinine in a community-based mass screening.

This study evaluated risk factors for end-stage renal disease (ESRD) and the prognostic significance of serum creatinine levels in a community-based mass screening. We used the registries of both community-based mass screening and chronic dialysis programs. In 1983, a total of 107,192 subjects over 18 years of age (51,122 men and 56,070 women) participated in a mass-screening program in Okinawa, Japan. Among them, serum creatinine data were available for 14,609 participants (5,613 men and 8,996 women). During 10 years of follow-up, we identified 60 dialysis patients (29 men and 31 women) among this group. Logistic regression analysis on the risk of ESRD was performed to determine the significance of serum creatinine levels in comparison with other clinical variables. The adjusted odds ratio (95% confidence interval) was 5.31 (3.39 to 8.32) in men and 3.92 (2.88 to 5.34) in women when compared to baseline serum creatinine levels of less than 1.0 mg/dl in women and 1.2 mg/dl in men. Diastolic blood pressure was not a significant predictor of ESRD. Results demonstrated the prognostic significance of serum creatinine in a community-based mass screening. Gender difference in the incidence of ESRD was explained, at least partly, by differences between clinical predictors and baseline serum creatinine levels.

Adolescent↗

PubMed1997

Low diastolic blood pressure, hypoalbuminemia, and risk of death in a cohort of chronic hemodialysis patients.

In a previous report, we showed that nutritional status and especially serum albumin had great predictive value for death in chronic hemodialysis patients, whereas blood pressure did not. In the present study, we analyzed the causes of death in consideration of the relationship between serum albumin and blood pressure. A total of 1,243 Okinawan patients (719 males, 524 females) undergoing hemodialysis in January 1991 were followed up through the end of 1995. Three hundred forty-two of the patients died, 45 received transplants, and 12 were transferred by the end of the follow-up period. The total duration of observation was 5,110.3 patient-years. Blood pressure as well as clinical and laboratory variables were determined immediately prior to the first dialysis session in January 1991. The crude death rate was 40.0% when the diastolic blood pressure (DBP) <70 mm Hg, 35.0% at 70 to 79 mm Hg, 25.0% at 80 to 89 mm Hg, 25.0% at 90 to 99 mm Hg, and 13.0% at >100 mm Hg. The death rate showed an inverse correlation with DBP. DBP showed a significant positive correlation with serum albumin (r = 0.137, P < 0.001) and age (r = -0.325, P < 0.0001). The adjusted odds ratio (95% confidence interval) of death was 0.84 (0.71 to 0.99) with 10 mm Hg increments in DBP when the reference DBP was less than 69 mm Hg. Low DBP may be a manifestation of malnutrition and/or cardiovascular disease in chronic hemodialysis patients. Target DBP levels may be higher levels in chronic hemodialysis patients than the general population.

Blood Pressure↗

PubMed1997

[Endogenous digitalis-like factor].

Evidence suggests the existence of a Na,K-ATPase inhibitor, so called endogenous digitalis-like factor (EDLF), in plasma. This substance has been postulated to enhance renal tubular sodium excretion and to increase peripheral vascular resistance. Recently, plant ouabain or its isomer (ouabain-like compound, OLC) was purified from human plasma and bovine hypothalamic extract. The OLC is considered to be a candidate for the EDLF. The OLC has been implicated in the pathogenesis of sodium-dependent hypertension. Furthermore, accumulating evidence suggests central nervous system as a site of hypertensinogenic action of OLC.

Animals↗

PubMed1997

Predictors of end-stage renal disease and body mass index in a screened cohort.

The effect of body mass index (BMI) on the risk of developing end-stage renal disease (ESRD) has not been critically evaluated. To investigate this issue we used the registries of community-based mass screening and chronic dialysis programs. In 1983, a total of 101,516 subjects (47,901 men and 53,615 women) participated in a mass screening program in Okinawa, Japan. A total of 187 (101 men and 86 women) entered an ESRD program by March 31, 1994. Body mass index was calculated as weight in kilograms divided by the square of the height in meters. Subjects were categorized into six groups based on BMI: < 20.0, 20.0-21.9, 22.0-23.9, 24.0-25.9, 26.0-27.9, and > or = 28.0 kg/m2. The cumulative incidence of ESRD, per 100,000 subjects was calculated in each BMI subgroup for men and women. In men, the cumulative incidence of ESRD increased with BMI, except in the range of 24.0 to 25.9 kg/m2. In women, the association between the cumulative incidence of ESRD and BMI was not clear, but was lowest in the range of 24.0 to 25.9 kg/m2. The adjusted odds ratio (95% confidence interval) was 0.99 (0.92 to 1.13) in men and 0.83 (0.72 to 0.96) in women.

Adult↗

PubMed1996

Impact of the initial levels of laboratory variables on survival in chronic dialysis patients.

Besides the age at start of dialysis and the presence of diabetes mellitus, serum albumin has been shown to be a significant predictor of survival in prevalent dialysis patients. However, this was not evaluated in incipient dialysis patients. The initial biochemical variables were retrieved for a large dialysis population (N = 1,982) who were started on chronic dialysis in Okinawa, Japan from 1971 to 1990. Biochemical data that included blood urea nitrogen, serum creatinine, serum electrolytes (sodium, potassium, calcium, and phosphate), total cholesterol, triglyceride, total protein, serum albumin, and hematocrit obtained just before the first dialysis session were available for 1,491 (75.2%) patients. Six hundred sixty-four (43.2%) patients died by the end of 1993. Cox proportional analysis adjusted for sex, age, year of start of dialysis, presence of diabetes mellitus, and the laboratory variables was performed to examine the significance of the initial biochemical data on survival. The risk ratio was 0.577 (P = 0.0025) in serum albumin, 1.291 (P = 0.0138) in serum potassium, and 0.966 (P = 0.0202) in serum sodium. The study results support the notion that nutritional status is important for survival in chronic dialysis patients. Causes of hypoalbuminemia, hyperkalemia, and hyponatremia should be evaluated carefully at initiation of dialysis.

Adolescent↗

PubMed1996

Risk of developing end-stage renal disease in a cohort of mass screening.

The prognostic significance of abnormal findings has not been demonstrated in a setting of mass screening. To evaluate the relative risk of end-stage renal disease (ESRD) indicated by various results of community-based mass screening, we utilized the registries of both community mass screening and chronic dialysis programs. In 1983, a total of 107,192 subjects over 18 years of age (51,122 men and 56,070 women) participated in dipstick urinalysis and blood pressure measurement in Okinawa, Japan. During ten years of follow-up, we identified 193 dialysis patients (105 men and 88 women) among them. Logistic regression analysis of clinical predictors of ESRD over 10 years was done and the adjusted odds ratio and 95% confidence interval were calculated in each of the predictors with adjustment to others. In the clinical predictors such as sex, age at screening, proteinuria, hematuria, systolic and diastolic blood pressure, proteinuria was the most potent predictor of ESRD (adjusted odds ratio 14.9, 95% confidence interval 10.9 to 20.2), and the next most potent predictor was hematuria (adjusted odds ratio 2.30, 95% confidence interval 1.62 to 3.28). Being of male gender was a significant risk factor for ESRD (adjusted odds ratio 1.41, 95% confidence interval 1.04 to 1.92). Diastolic blood pressure was also a significant predictor of ESRD (adjusted odds ratio 1.39, 95% confidence interval 1.17 to 1.64), but systolic blood pressure was not. In a mass screening setting, positive urine test, high diastolic blood pressure, and male sex were identified as the significant predictors of ESRD. Effect of glycosuria and other possible predictors of ESRD remained to be determined.

Adolescent↗

PubMed1996

Predictors of stroke in patients receiving chronic hemodialysis.

To identify the risk factors of stroke in patients receiving maintenance hemodialysis, we conducted a prospective study on patients in Okinawa, Japan. Patients with end-stage renal disease who were treated with maintenance hemodialysis before the end of 1990 and were alive on January 1, 1991 (N = 1,243) were studied. Medical records and pertinent data as of January 1, 1991 were compiled. All occurrences of stroke were recorded throughout the follow-up period, and until the end of 1995. The duration of observation was 5,110.3 patient-years. A total of 90 cases of stroke were observed, including 63 (70.0%) cerebral hemorrhage, 20 (22.2%) cerebral infarction, and 7 (7.8%) subarachnoid hemorrhage. Multiple logistic analysis identified hypertension as an independent predictor of stroke, with an odds ratio of 2.38 and a 95% confidence interval from 1.26 to 4.50. The present study demonstrates that the high incidence of stroke is at least partially explained by insufficient control of hypertension. Every effort to control hypertension is warranted in chronic dialysis patients.

Adolescent↗

PubMed1996

Seasonal variation in the incidence of end-stage renal disease.

The effect of ambient temperature (AMT) on the incidence of end-stage renal disease (ESRD) was examined in Okinawa, Japan, where there is a distinct seasonal variation in monthly AMT but constant intradiurnal temperature change throughout a year. Arbitral continuous and cyclic functions were examined using Fourier analysis and calculation of the cross-correlation coefficient. The calendar month of the start of chronic dialysis was regarded as the time of onset of ESRD. A total of 1,982 patients, 824 females and 1,158 males, was registered with ESRD between 1971 and 1990. The normalized monthly number of new ESRD patients, divided by days of each month, was smallest in August, n = 4.06, and largest in January, n = 6.45, and this pattern was well reproduced by the Fourier synthesized value. The cross-correlation coefficient showed that monthly mean AMT and the normalized number of ESRD patients correlated best with 6 months lag time. Taken together, our results showed that there was strong correlation between the normalized number of ESRD patients and AMT. Uremic symptoms leading to initiate dialysis, such as congestive heart failure, may be aggravated in lower AMT. We speculated a role of an inverse relation between AMT and the sympathetic nerve function. The public health implications of these findings warrant their further investigation.

Adult↗

PubMed1996

Increased risk of cardiovascular disease with erythropoietin in chronic dialysis patients.

Recombinant human erythropoietin is widely used in chronic dialysis patients. However, the long-term effect, especially on the incidence of cardiovascular disease, has not been critically evaluated. We observed the annual incidence of stroke and acute myocardial infarction from April 1988 through March 1993 in Okinawa, Japan. Until April 1990, erythropoietin was not generally used. Therefore, we have two periods: pre-erythropoietin, April 1988 through March 1990, and post-erythropoietin, April 1990 through March 1993. Two thousand one hundred and sixteen patients (1,219 males and 897 females) were on chronic dialysis during the study period by March 31, 1993. Every case of stroke and acute myocardial infarction during the study period was registered. The odds ratio was calculated using the data of the general population in each sex and age class obtained in the same area. A total of 86 cases of stroke and 15 cases of acute myocardial infarction were registered during the study period. The annual incidence, per 1,000 patient-years, of stroke was 12.5 (1988), 10.5 (1989), 12.7 (1990), 14.0 (1991), and 17.5 (1992). The incidence of stroke was increased in the post-erythropoietin period compared to the pre-erythropoietin period, odds ratio 1.22 and 95% confidence interval (95% CI 1.06-1.41, p < 0.01). The annual incidence of acute myocardial infarction was 1.0 (1988), 1.8 (1989), 0.8 (1990), 2.9 (1991) and 4.7 (1992). The incidence of acute myocardial infarction was increased significantly in the post-erythropoietin period compared to the pre-erythropoietin period, odds ratio 1.87 (95% CI 1.66-2.10, p < 0.01). The odds ratio of stroke to the general population was 4.25 (95% CI 3.10-5.82) in the pre-erythropoietin and 4.58 (95% CI 2.14-9.80) in the post-erythropoietin period. In acute myocardial infarction, it was 2.98 (95% CI 2.84-3.12) and 3.81 (95% CI 3.18-4.56). The odds ratio of acute myocardial infarction was significantly increased (p < 0.01). The introduction of erythropoietin was associated with an increased risk of cardiovascular disease, especially acute myocardial infarction. Erythropoietin may unmask the sclerotic lesion in chronic dialysis patients.

Cardiovascular Diseases↗

PubMed1996

Epidemiologic analysis of diabetic patients on chronic dialysis.

We retrospectively surveyed all of the available medical records of 404 (191 females and 213 males) chronic dialysis patients, of whom 16 (4%) had insulin-dependent diabetes mellitus (IDDM) and 388 (96%) non-insulin-dependent diabetes mellitus (NIDDM). The patients were among 2,214 dialysis patients in Okinawa, Japan, of whom 443 were diabetic. The patients entered a large population-based dialysis registry. The mean duration from the diagnosis of diabetes mellitus (DM) to dialysis was 181.6 months in the IDDM patients and 150.4 months in the NIDDM patients. The NIDDM patients were classified into four subgroups according to their status when DM was first suspected. The duration from the diagnosis of DM until the onset of dialysis treatment was significantly shorter than in any other subgroup or in the IDDM subgroup with major vascular disease (131.9 months). Otherwise, the course of renal disease in NIDDM patients was similar to that in IDDM individuals. Most of our dialysis patients with DM had NIDDM. In most of the NIDDM patients, the diagnosis had been delayed for several years for unknown reason. However, if diagnosed early, NIDDM shows a clinical time course until dialysis similar to that of IDDM. Whether NIDDM patients contract chronic renal disease at an equal incidence to that of IDDM patients and the fraction of all diabetic patients accepted for chronic dialysis remain to be determined.

Adult↗

PubMed1996

Blood pressure and its regulation in spontaneously hypertensive rats bred on the lowest sodium diet for normal growth.

To investigate the effects of dietary sodium restriction from conception to adulthood on blood pressure and its regulatory mechanisms, male offspring were derived from inbreeding in spontaneously hypertensive rats fed a diet containing sodium of 175 mumol/g food (control) or 22 mumol/g (low sodium), which is the least sodium content for normal growth. While urinary sodium excretion was markedly less, the low sodium diet did not inhibit body growth and failed to blunt the development of hypertension. Neither plasma catecholamine concentration nor depressor response to hexamethonium was different between the two groups at any age examined (8, 12, and 20 weeks). Plasma renin concentration was not elevated, whereas urinary excretion of aldosterone was increased at any age in the low sodium group compared with that in the control group. Other sets of rats were fed a diet containing sodium of 175 mumol/g plus mefruside (a diuretic) of 0.001% in the same manner as in the other two groups. Urinary sodium excretion per creatinine was higher than in the other groups. The diuretic treatment inhibited body growth and suppressed adult blood pressure. While the sympathetic function was not affected, both plasma renin concentration and urinary excretion of aldosterone were elevated. These results indicate that dietary sodium restriction with the least sodium for normal growth from conception cannot blunt either the sympathetic nervous function or the development of hypertension in spontaneously hypertensive rats. Aldosterone appears to play an important role in maintaining sodium homeostasis under the dietary sodium restriction.

Aldosterone↗

PubMed1996

Current status of antihypertensive therapy for elderly patients in Japan.

To assess how elderly Japanese hypertensive patients are treated by specialists, we conducted a cross-sectional survey. A total of 1,163 outpatients aged 50 years or older were studied. Hypertension was diagnosed in 939 of these patients, and 827 were receiving drug therapy. The average blood pressure during therapy was 143 +/- 16/81 +/- 10 mmHg. In patients aged 70 years or older, systolic blood pressure during antihypertensive therapy was significantly higher (p < 0.01) and diastolic blood pressure was significantly lower (p < 0.01) than the corresponding values in those aged 50 to 59 years or 60 to 69 years. The calculated mean blood pressures were similar in the different age groups. The rate of monotherapy in the patients aged 70 years or older was 58.8%, which was significantly higher (p < 0.01) than the rates of monotherapy in the other age groups. Calcium channel blockers were prescribed in about 80% of patients, irrespective of age or comorbidity. Of the patients receiving calcium channel blockers, 43.5% were treated with monotherapy. This rate significantly (p < 0.01) increased with advancing age. Diastolic blood pressures were significantly lower (p < 0.05) in patients with stroke and in those with ischemic heart disease, diabetes mellitus, or dyslipidemia, as compared with patients with no comorbidity. Among patients aged 70 years or older, the difference in systolic blood pressure between those with ischemic heart disease and those with no comorbidity was not significant. Blood pressure in elderly hypertensive patients was reduced to a level similar to that in younger patients. The target blood pressure was influenced by the presence of comorbidity. Furthermore, specialists showed a high preference for the use of calcium channel blockers in the management of hypertension.

Activities of Daily Living↗

PubMed1996

Insulin and cardiovascular diseases in Japanese work-site population with borderline to mild hypertension.

To clarify whether significant interrelations between hyperinsulinemia and cardiovascular diseases exist in Japanese, we analyzed serum insulin levels, fasting and after oral glucose load, in relation to blood pressure (BP), serum lipids, and incidence of acute myocardial infarction (MI) and stroke in 584 male employees of a railroad company with borderline to mild hypertension (age: 49 +/- 7 years, BP: 139 +/-13/90 +/- 8 mmHg, body mass index: BMI 24.0 +/- 2.8, mean +/- SD). Those who were taking antihypertensive drugs and/or hypoglycemic agents were excluded. The subjects were classified into five groups of comparable size according to sigma IRI (area composed by insulin levels at 0, 1, 2 hours post glucose load). Although averaged age, levels of fasting glucose and HbA1c were not significantly different among quintiles, the hyperinsulinemic groups had higher levels of fasting IRI and sigma glucose. Multiple regression analysis revealed that sigma IRI was associated positively with BMI, sigma glucose, systolic BP, total cholesterol, and negatively with HDL-cholesterol. During 7-year follow-up 7 cases with MI and 15 cases with stroke were registered. The subjects with MI, but not with stroke were involved in higher deciles of insulin levels. These results indicate that the insulin resistance syndrome exists in Japanese middle-aged men with borderline to mild hypertension. The association with cardiovascular morbid events appeared to be evident in coronary heart disease but not in cerebrovascular disease.

Adult↗

PubMed1996

Headache as a manifestation of myocardial infarction.

We report a 64-year-old man who complained of headache without chest pain at the onset of acute myocardial infarction (AMI). He had no history of chest pain or headache. Severe headache in this case was the first symptom of AMI. The headache was reproduced during stress test. During the angioplasty procedure, he also complained of headache without vasospastic change in the coronary artery. These findings suggest that the headache which accompanied AMI or myocardial ischemia in this case was due to referred pain rather than a generalized vasospastic disorder.

Angioplasty, Balloon, Coronary↗