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Biomedical subjects

K Fukushima

Publications and source records attributed to K Fukushima.

At least 361 records · Page 20Linked to original sources
PubMed1993

[A case of massive hemorrhage associated with the removal of longstanding intrabronchial foreign body].

A 46 year old male patient was admitted with fever and cough. A chest X-ray film revealed a foreign body shadow of a denture fragment in the right intermediate bronchus that he had swallowed one year and half ago. Rigid bronchoscopy was used to remove the foreign body under general anesthesia. During the procedure, massive hemorrhage occurred from bronchus, and the foreign body was not removed successfully and the patient sustained near cardiac arrest. Postoperatively, he recovered from the near fatal condition with support of mechanical ventilation in ICU for several days. After one month, pulmonary angiography was performed and it revealed the transfiguration of pulmonary artery and other vessels close to the foreign body. Granular tissue around the foreign body was observed by preoperative bronchoscopy. Disruption of such vessels and granular tissue by rigid and forced fiberscopy was suspected to have caused the massive bleeding. Later, the denture fragment was successfully removed by right thoracotomy. We should take this complication into consideration and preoperative fiberoptic bronchoscopy and pulmonary angiography may be beneficial to the anesthetic management of such patients.

Anesthesia, General↗
PubMed1993

[Long-term follow-up results of stage III and IV thymomas and thymic carcinomas invading the great veins].

A series of 24 patients with stage III and IV thymomas and thymic carcinomas were reviewed with respect to the invasiveness of the superior vena cava (SVC) and brachiocephalic veins (BCV). Masaoka staging revealed stage III disease in 14 patients and stage IV in 10. Follow-up ranged from 3 months to 12 years and 10 months. In 9 patients with stage III disease involving the great veins, 6 patients underwent total resection, 2 subtotal resection, and one exploratory thoracotomy. Reconstruction of SVC was done in 2 patients and of left BCV in 7 and angioplasty of SVC in one. Although there were 4 tumor deaths and one myasthenic death, 4 patients were alive and tumor free. The longest survival after total resection with SVC replacement was 11 years and 7 months. In 3 patients with stage IV disease invading the great veins, 2 patients underwent partial resection and one received radiotherapy alone. Although 2 patients died of generalized metastases and respiratory failure respectively, one remained alive 2 years and 2 months with carcinoma. Although long-term survivors were obtained in the patients with adventitial involvement, prognosis was poor in the patients with intimal invasion.

Adolescent↗
PubMed1993

[Changes of peripheral airways through mechanical ventilation in acute respiratory failure].

To evaluate the morphologic changes in the peripheral airways associated with positive pressure ventilation, fine fiberoptic bronchoscopy (1.8 mm outer diameter) was performed in 12 patients who had no history of prior pulmonary failure. In 19 examinations, the main morphologic findings were paleness and bronchial dilatation in the peripheral airways where increased secretions, pigmentation and stenosis or collapse were also observed. Patients with bronchial dilatation had longer periods of mechanical ventilation (17 +/- 8 days) compared to those without dilation (10 +/- 5 days). The structural destruction in the peripheral airways observed in patients on prolonged positive pressure mechanical ventilation suggests that barotrauma may be more widespread than previously recognized.

Acute Disease↗
PubMed1993

[Detection of HIV-1 proviral DNA in peripheral leukocytes by AMPLICOR HIV-1 test kit].

AMPLICOR HIV-1 test kits, which had been developed as an HIV-1 provirus detection test by PCR method, have been evaluated for its clinical diagnostic application. Sixty-six of HIV-1 antibody positive and 67 of HIV-1 antibody negative blood samples derived from hemophiliacs, who had received blood products, have been tested by AMPLICOR HIV-1. All of the results from AMPLICOR HIV-1 were consistent with those from antibody test and clinical aspects. Thirty-nine of HIV-1 antibody positive samples have been tested by AMPLICOR HIV-1 and virus isolation (culture method). Twelve of 39 (30.8%) were positive by virus isolation, and 39 of 39 (100%) were positive by AMPLICOR HIV-1. Two of new born infants from HIV-1 sero-positive mothers were tested by AMPLICOR HIV-1, and the result suggested that the kit would be useful for diagnosis of infants from sero-positive mothers. Based on these studies, AMPLICOR HIV-1 is considered as useful clinical diagnostic for HIV-1 proviral DNA detection.

Adult↗
PubMed1993

Severe destruction of the neural integration mechanism for upward eye movements in bilateral internuclear ophthalmoplegia.

The visually elicited saccades and smooth pursuits of a 24-year-old man with bilateral internuclear ophthalmoplegia were recorded with an infrared limbus reflection technique. Although the amplitude-peak velocity relationship of saccades appeared to be normal, all the upward saccades were hypermetric and were followed by postsaccadic exponential drifts. The time constant of the postsaccadic exponential drifts was 248 +/- 19.5 ms (mean +/- SD). Upward pursuit eye movements were also severely disturbed, and only movements with a short duration (mean 113.8 ms) and low gain (mean 0.51) were frequently observed. Thus, the transformation of a pulse velocity signal for saccades and of a step velocity signal for smooth pursuits into step and ramp position commands, respectively, was almost completely lost for upward eye movements in this patient because of bilateral lesions of the medial longitudinal fasciculus.

Adult↗
PubMed1993

[The effects of anesthetic techniques and insufflating gases on ventilation during laparoscopy].

The present study was performed to clarify the influences of anesthetic methods and insufflating gases on arterial blood gas and ventilation during laparoscopy. Forty five women undergoing laparoscopy for gynecological procedure were studied after dividing into four groups; general anesthesia with control ventilation or epidural anesthesia with spontaneous breathing, plus insufflation with carbon dioxide (CO2) or nitrous oxide (N2O). After CO2 insufflation, PaCO2 increased significantly in the patients who were mechanically ventilated, but not in the patients breathing spontaneously. After N2O insufflation, the decrease in tidal volume (VT) and the increase in VD/VT were significant, but minute ventilation was well maintained by the compensatory increase in respiratory frequency during spontaneous breathing. On the other hand, after CO2 insufflation VE and VD/VT increased significantly without any change in VT. PaO2 decreased significantly after both insufflation and Trendelenburg tilt in all groups, probably secondary to the decrease in functional residual capacity. These findings suggest that during laparoscopy, ventilation could be well maintained by spontaneous breathing, although the increase in VD/VT and costal breathing indicate the increase in respiratory work load. We recommend that ventilation and oxygenation should be closely monitored during laparoscopy to avoid hypercapnia and hypoxia.

Adolescent↗
PubMed1993

[A case of Wernicke-Korsakoff syndrome caused by gastrojejunostomy--specific findings of MRI and SPECT].

A 63-year-old woman with Wernicke-Korsakoff syndrome, despite the absence of alcoholism and malnutrition, is reported. She had undergone gastrojejunostomy for ileus 30 years ago, and this operation was thought to be an important risk factor for her vitamin B1 deficiency. Brain MRI showed symmetrical high intensity areas on T2-weighted images in the periaqueductal region and bilateral dorsomedial nuclei of the thalamus. On single photon emission computed tomography (SPECT) using 99mTc-hexamethylpropyleneamine oxime, bilateral frontal perfusion was reduced, which was attributed to thalamo-cortical diaschisis due to injury to the dorsomedial nuclei of the thalamus. Presumably this phenomenon explains the Korsakoff psychosis. A history of gastrojejunostomy, even if normal intake is possible, is a risk factor for vitamin B1 deficiency, and should be considered in the differential diagnosis of Wernicke-Korsakoff syndrome.

Alcohol Amnestic Disorder↗
PubMed1993

Persistence of human papillomavirus type 6e in adult multiple laryngeal papilloma and the counterpart false cord of an interferon-treated patient.

Human papillomavirus (HPV) type 6e DNA was detected in a laryngeal papilloma, in a papilloma recurring after an interval of six years and in the counterpart clinically-normal false cord of the same patient. No detectable subgroup change of HPV DNA occurred during the clinical course, which included therapy by CO2 laser followed by intramuscular alpha-interferon injection. The data demonstrated a single subtype of HPV to have persisted, and the prevention of a recurrence of laryngeal papilloma during our patient's long clinical course to have failed, in spite of the interferon treatment.

Adult↗
PubMed1993

[Percutaneous transluminal angioplasty in atherosclerosis].

Percutaneous transluminal balloon angioplasty has achieved a dominant role in the interventional treatments of atherosclerotic peripheral, renal, and coronary artery disease. Improved operator's technique and equipment design have increased the primary success rate. Despite improved success rate and safety, acute closure, late restenosis and difficulty in treating chronic total occlusions or diffuse lesions remain as serious limitations of this procedure. To overcome these limitations of balloon angioplasty, new devices such as stenting, atherectomy or laser ablation have been developed. Although there are many problems for each device, these techniques appear to reduce the limitations in angioplasty.

Angioplasty, Balloon, Coronary↗
PubMed1993

Human papillomavirus DNA in squamous cell carcinomas of the respiratory and upper digestive tracts.

The prevalence of human papillomavirus (HPV) types 16 and 18 in clinical samples of squamous cell carcinomas from respiratory and upper digestive tracts was studied. HPV DNA of types 16 and/or 18 was detected using the polymerase chain reaction (PCR) method in 16 out of 121 cases (13.2%). By Southern blot hybridization, however, only the DNA from a laryngeal and a tonsillar carcinoma was found to hybridize with the whole HPV 16 DNA probe (two out of 16 HPV DNA-positive cases by PCR, 12.5%). None of the DNAs hybridized with the whole HPV 18 DNA probe. The discrepancy in the results of PCR and Southern blot hybridization methods seemed to reflect their sensitivity. The possible relation between prevalence of HPV DNA and carcinogenesis in respiratory and upper digestive tract is discussed.

Adult↗
PubMed1993

[Effect of succinylcholine on serum potassium concentration in children with chronic renal failure].

Serum potassium (K+) levels were measured after intravenous injection of succinylcholine (SCh) in 10 children with chronic renal failure, 10 normal children aged 1 to 10 years and 10 children with chronic renal failure after pretreatment with pancuronium prior to SCh. Arterial blood gas was maintained within normal ranges. The serum K+ level increased significantly during 10 minutes after SCh in normal children. There was no significant difference between serum K+ levels in normal children and those in children with chronic renal failure. Administration of pancuronium in small doses (20 micrograms.kg-1) prior to SCh (1 mg.kg-1) was not effective to prevent serum K+ elevation completely. Our results indicate that the administration of SCh in children with chronic renal failure might be possible without increasing serum potassium level.

Child↗
PubMed1993

[A case of superior vena cava syndrome caused by adenocarcinoma of the mediastinum--the significance of pulsed Doppler echocardiography in the SVC reconstruction].

We report a case of SVC syndrome caused by adenocarcinoma of the mediastinum, in which brachiocephalic vein flow was recorded by pulsed Doppler echocardiography before and after the SVC reconstruction. A 46-year-old man was admitted to the hospital with the chief complaints of edema of the face and the upper extremities. Although chest X-ray film showed no abnormalities, chest CT and SVC-graph demonstrated the obstruction of SVC and bilateral brachiocephalic veins. It was found that bilateral brachiocephalic vein flow displayed characteristic one-peak shaped pattern and the peak flow velocity was decreased. We removed SVC and bilateral brachiocephalic veins with the surrounding tissue, and SVC and tributaries were reconstructed with 10 mm ringed ePTFE grafts. Histological examination revealed carcinoma cell infiltration in the wall of SVC. Postoperative phlebography showed well patent grafts, and bilateral brachiocephalic vein flow pattern normalized and the peak flow velocity remarkably increased.

Adenocarcinoma↗
PubMed1993

[Blood gas changes during hypotensive anesthesia induced by prostaglandin E1].

The influence of prostaglandin E1 (PGE1) on PaO2 at doses that produced slight hypotension was evaluated in 176 patients scheduled for surgery. When systolic blood pressure was stabilized after induction of anesthesia, PGE1 infusion was started until 20% reduction of systolic blood pressure was achieved. Arterial blood gases were analyzed before infusion of PGE1 and 30 min after the completion of this hypotensive level respectively. The reductions in both PaO2 [from 177 +/- 64 mmHg to 164 +/- 65 mmHg (mean +/- SD) (P < 0.01)] and PaO2/FIO2 [from 486.5 +/- 144.4 to 437.6 +/- 121.6 (P < 0.01)] were observed with PGE1 infusion of 0.079 +/- 0.068 micrograms.kg-1.min-1. The results of this study show that PaO2 decreases during induced hypotension with PGE1 infusion, but this decrease is not clinically significant.

Adult↗
PubMed1993

[Effect of enflurane on human somatosensory evoked potentials: differences between specific and nonspecific responses].

The effect of enflurane on somatosensory evoked potentials (SEP) was investigated in nine gynecological patients under nitrous oxide-enflurane anesthesia. SEPs were obtained from electrodes placed on the scalp C4 and earlobes by median nerve stimulation contralateral to the recording site. SEPs taken in a control study without enflurane consisted of six components; P12, N17, P23, N31, P50, and N65. Components N17, P23, N31, and P50, thought to be specific SEP responses, showed a dose-dependent increase in latencies under enflurane while P12, the initial SEP components, did not show any significant changes throughout the experiment. The longer the latency for a given response component, the greater was the increase in latency seen under enflurane anesthesia. On the other hand, N65, assumed to be a nonspecific SEP response, was completely lost with inhalation of 0.5 MAC or more of enflurane. However, the peak-to-peak amplitude between P23 and N31 was enhanced dose-dependently with enflurane up to 1.5 MAC. These results suggest that, at clinically effective doses, enflurane may inhibit nonspecific projection pathways while enhancing the primary cortical sensory area, and this enhancement may be responsible for provoking convulsive seizures under enflurane anesthesia.

Adult↗
PubMed1992

De novo glucan synthesis by mutants streptococcal glucosyltransferases present in pellicle promotes firm binding of Streptococcus gordonii to tooth surfaces.

Adherence of 3H-labelled cells of Streptococcus gordonii and Streptococcus milleri to artificial pellicles prepared from saliva supplemented with glucosyltransferases from mutants streptococci was examined using a new assay for sucrose-dependent cell-to-pellicle attachment. Results indicate that S. gordonii, but not S. milleri, could attach tightly to hydroxylapatite surfaces through de novo glucan synthesis by mutants streptococcal glucosyltransferases present in the experimental salivary pellicles.

Bacterial Adhesion↗
PubMed1992

Light and electron microscopic immunolocalization of endothelial leucocyte adhesion molecule-1 in inflammatory bowel disease. Morphological evidence of active synthesis and secretion into vascular lumen.

Endothelial leucocyte adhesion molecule-1 (ELAM-1) is a rapidly inducible adhesion molecule for neutrophils in vascular endothelial cells. We investigated its immunohistochemical localization in 17 cases of inflammatory bowel disease. ELAM-1 was preferentially expressed in venules in actively inflamed mucosa and granulation tissue. Most capillaries were negative for ELAM-1. In areas with mild inflammation its expression diminished markedly and in normal mucosa of the colon and small intestine its expression was sparse. Electron microscopically, venules in active inflammation had swollen endothelial cells with well-developed rough endoplasmic reticulum. Immunoelectron microscopy revealed ELAM-1 localization along the luminal plasma membrane and in rough endoplasmic reticulum and round granules, findings suggestive of active production in endothelial cells. Furthermore, exocytosis of immunoreactive substance into the lumen was confirmed. Our study suggests that venules in actively inflamed area play an important role in eliciting and/or maintaining acute inflammatory processes by active permeation of neutrophils from the blood stream into the tissue, and that ELAM-1 may be a secretory protein as well as a transmembrane receptor protein.

Adult↗
PubMed1992

Improved PCO2 monitoring during high frequency jet ventilation.

During high frequency jet ventilation (HFJV), it has been shown that Pa(CO)(2) can be predicted by capnography when the frequency was temporarily reduced to obtain a steady expiratory CO(2) tension (P et(CO)(2)). The influence of the sampling site of expiratory gas in the airway and the driving pressure of the ventilator on the difference between Pa(CO)(2) and P et(CO)(2) was investigated in ten adult patients who underwent general anesthesia. During HFJV (frequency: 100 bpm, inspiratory duty cycle; 30%), its frequency was temporarily reduced to 10 bpm in twelve different condition; i.e., 3 different driving pressures (Pd; 20, 30, and 40 psi) at 4 different sampling sites (d; 0, 2, 5, and 10 cm in the endotracheal tube). Both P et(CO)(2) and Pa(CO)(2) were measured simultaneously, and their difference was evaluated by using Student's t-test. The difference between Pa(CO)(2) and Pmax(CO)(2) (the maximum P(CO)(2) value in the airway during exhalation) was minimal, when Pd was greater than 30 psi, and d was greater than 5 cm. The present study suggests that better prediction of Pa(CO)(2) can be done by P et(CO)(2) during HFJV, when d and Pd were set as large as possible to obtain stable expiratory P(CO)(2) curve.

Journal Article↗