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Biomedical subjects

K Kaku

Publications and source records attributed to K Kaku.

At least 145 records · Page 8Linked to original sources
PubMed1984

Effects of dietary butter fat on fecal bile acid excretion in patients with Crohn's disease on elemental diet.

The excretion rate of fecal bile acids was determined by gas-liquid chromatography in nine patients with Crohn's disease and six healthy volunteers under two dietary conditions with different amounts of fat: during nasoduodenal tube feeding with a fat-restricted elemental diet containing approximately 1.5 g/day of fat, and during the addition of 50 g/day of butterfat by peroral administration. The fecal bile acid excretion rate on the elemental diet was significantly greater in the patients with Crohn's disease than in the healthy controls. With ingestion of the additional fat, the excretion rate was significantly increased in the patients with Crohn's disease, but not significantly changed in the healthy controls. The bile acid excretion rate in Crohn's disease correlated with fecal fat excretion, but not with either fecal weight or disease activity. These studies show that the amount of dietary fat represents an important consideration in the evaluation of bile acid malabsorption in Crohn's disease.

Adolescent↗
PubMed1984

In-vitro and clinical evaluation of cardiac valve substitutes.

One of the major causes of postoperative morbidity and mortality after valve replacement surgery is the prosthetic valve substitute itself. In this discussion, therefore, we make a fundamental evaluation of hydrodynamic valve function and present our clinical results following valve replacement with the Björk-Shiley valve prosthesis, the Hancock porcine xenograft and the Ionescu-Shiley bovine pericardial xenograft. In an experimental study using a mechanical simulator system, the pericardial xenograft displayed superior hydrodynamic characteristics compared to other two valve substitutes. Postoperative hemodynamic evaluation further indicated that the pericardial xenograft performed significantly better than the porcine xenograft regarding transvalvular pressure gradient, effective valve area and cusp opening. In addition, data from 387 patients with aortic, mitral or both types of valve replacement who had received one of the three kinds of valve substitute were analyzed. Systemic thromboembolic complications occurred in one patient with an aortic Björk-Shiley valve (0.6% per patient-year), six with mitral Hancock xenografts (2.8% per patient-year) and one with an aortic and mitral Hancock xenograft (2.2% per patient-year). The incidence of prosthetic valve endocarditis was 0.84% per patient-year for the Hancock xenograft and 1.84% per patient-year for the Ionescu-Shiley xenograft. It was concluded that the hemodynamic and antithrombogenic advantages of the pericardial xenograft proven by our mid-term follow-up study make it the valve substitute of choice. However, careful attention is required regarding prosthetic valve endocarditis tissue heart valves, which are more susceptible to infection than mechanical ones, and the long-term durability of the pericardial xenograft remains to be confirmed.

Aortic Valve↗
PubMed1984

Sequential changes of left ventricular function after cineangiography in normal heart and coronary artery disease.

To evaluate the effect of contrast material on left ventricular (LV) function, LV pressure and its first derivative were continuously monitored during and after LV cineangiography with Mikro-tip angiocatheters in 15 normal subjects (Group 1) and patients with coronary artery disease (CAD) without LV asynergy (Group 2, n = 10), with mild asynergy (Group 3, n = 12) and severe asynergy (Group 4, n = 13). In all 4 groups, systolic hypotension, decrease of negative dP/dt, and prolonged time constant of LV pressure fall (T) were observed in 30 seconds after dye injection, and all these parameters returned to the control value in 2 minutes. LV end-diastolic pressure (EDP) began to elevate at one minute, reached its peak at 2 minutes, and stayed elevated for 7 minutes. Although significant decrease in LV systolic pressure was seen, indexes of LV contractility, peak positive dP/dt and (dP/dt)/DP40, showed increase in all groups. No different directional changes of these parameters were observed among 4 groups. The degree of LVEDP elevation was parallel to the diastolic elastic stiffness constant (K) in Group 1 (r = 0.64, (p less than 0.05). It is concluded that systolic hypotension and prolonged relaxation are only transient, and elevation of LVEDP after the contrast material injection seems to be the effect of only acute volume overload.

Adult↗
PubMed1984

Tolbutamide stimulates fructose-2, 6-bisphosphate formation in perfused rat liver.

Effect of tolbutamide on liver fructose-2,6-bisphosphate (F-2,6-P2) was examined in isolated perfused rat liver in situ with a flow-through method. Tolbutamide (1 mM) gradually increased liver F-2,6-P2 level from 7.4 +/- 1.6 to 21.2 +/- 1.6 pmol/mg wet wt for 20 min perfusion. The increase of liver F-2,6-P2 induced by tolbutamide was dose dependent and was significantly observed at 10 min perfusion. The maximum plateau level of F-2,6-P2 induced by 16.7 mM glucose was further increased with 1 mM tolbutamide. Glucagon (10(-11) M) decreased the elevated level induced by 16.7 mM glucose, but this effect was completely inhibited with 2 mM tolbutamide. Cyclic AMP level of the liver throughout the perfusion with tolbutamide did not change. Carboxytolbutamide or gliclazide perfusion did not change significantly the liver F-2,6-P2 level; however, the results suggest that tolbutamide may increase the liver F-2,6-P2 level by affecting the phosphorylation state of fructose-6-phosphate, 2-kinase/fructose-2,6-bisphosphatase through cyclic AMP-dependent protein kinase, resulting in the stimulation of glycolysis and the inhibition of gluconeogenesis in the liver. Thus, the extrapancreatic action and the mechanism of action of different sulfonylureas may differ.

Animals↗
PubMed1984

Clinical significance of left ventricular hypertrophy in dilated cardiomyopathy: an echocardiographic follow-up of 50 patients.

To evaluate the significance of left ventricular (LV) hypertrophy in patients with dilated cardiomyopathy (DCM), 50 patients seen between 1976 and 1983 were studied echocardiographically. We categorized the patients as four groups according to the degree of LV dilatation or hypertrophy. Group consisted of 17 patients with mild to moderate LV dilatation without hypertrophy (LV end-systolic I dimension: Ds less than 60 mm, LV wall thickness at end-systole: WTs less than 15 mm). Group II, 12 with mild to moderate LV dilatation and hypertrophy (Ds less than 60 mm, WTs greater than or equal to 15 mm). Group III, eight with marked LV dilatation and hypertrophy (Ds greater than or equal to 60 mm, WTs greater than or equal to 15 mm), and Group IV, 13 with marked LV dilatation without hypertrophy (Ds greater than or equal to 60 mm, WTs less than 15 mm). Twenty patients had LV hypertrophy and 30 patients were without LV hypertrophy at the start of this study. New York Heart Association functional classes, cardiothoracic ratio and ECG findings at the first study did not show any statistically significant differences among the four groups. During the prospective follow-up of 2.7 years in average, eight patients died of congestive heart failure including five of Group IV, and three of Group I who had progressive LV dilatation. Three patients of Group I, II and III died suddenly. Ambulatory ECGs showed life-threatening ventricular arrhythmias in all 32 patients studied.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1984

[Regional myocardial contraction in ischemic heart disease: evaluation of regional myocardial thickening by two-dimensional echocardiography].

There were many studies concerning the evaluation of regional wall motion in ischemic heart disease by left ventriculography (LVG) and two-dimensional echocardiography (2DE), but only a few observations on the regional myocardial thickening have been reported. In a survey of 48 cases of old myocardial infarction, we selected 21 cases with adequate 2DE images for the evaluation of regional wall motion and thickening. In all cases the 2DE examinations were performed within seven days before or after LVG examinations. The left ventricular wall on 2DE was divided into 11 segments and wall motion and thickening in each segment were graded to three classes, i.e. none, reduced and normal. The results on 2DE were then compared with the grade of wall motion of the corresponding segment on LVG. The sensitivity and specificity of 2DE wall motion were 50% and 89% in none, 59% and 48% in reduced, and 89% and 84% in normal, respectively. The sensitivity and specificity of 2DE myocardial thickening were 81% and 93% in none, 82% and 70% in reduced, and 92% in normal, respectively. These results indicated that the regional myocardial thickening by 2DE has a higher sensitivity and specificity. Therefore, observation of both myocardial thickening and wall motion will be necessary for the proper evaluation of regional myocardial contraction in ischemic heart disease.

Adult↗
PubMed1984

[Three-dimensional evaluation of mitral regurgitation by pulsed Doppler echocardiography: analysis of the amount and direction of regurgitant flow].

Pulsed doppler echocardiography (PDE) was used to evaluate mitral regurgitation (MR) non-invasively and quantitatively in 156 patients including 51 of rheumatic valvular disease, 57 of mitral valve prolapse (MVP) or chordal rupture of the mitral valve (RCT), and 48 of ischemic heart disease (IHD) or dilated cardiomyopathy (DCM). The severity of MR was estimated three-dimensionally by a MR scoring system as follows: As an index of direction and extent of regurgitation, nine sampling sites were selected in the left atrium at the level of the mitral annulus. These include the anterior, mid, and posterior parts of each portion of the postero-medial, middle, and antero-lateral sides. The depth of regurgitation was graded by three degrees in the long-axis projection of the left ventricle; grade 1; MR signals localized within the level of the mitral annulus, grade 2; MR detected beyond the mitral annulus but not reaching the aortic valve level; and grade 3; MR detected beyond the aortic valve level in the left atrium. The MR score was comprised of the products of numbers of points at which MR signals were detected and the grades of the maximum depth. The MR scores correlated well with the severity of MR as determined by the left ventriculogram (LVG); the MR score was 4.0 +/- 1.6 (mean +/- S.D.) points in grade 1; 9.6 +/- 2.6 points in grade 2; 18.0 +/- 3.2 points in grade 3; and 23.0 +/- 1.7 points in grade 4 by LVG. Doppler mapping of the left atrium at the level of the mitral annulus suggested that the directions of MR varied with each disease and valvular lesion. Thus, these observations were helpful in the investigation of MR by PDE. We concluded that the above-mentioned MR scoring system proves a very useful method for quantitatively evaluating MR non-invasively.

Adolescent↗
PubMed1984

[A clinical study on cefoperazone in serious infections associated with hematological malignancy].

Clinical and bacteriological efficiencies of cefoperazone (CPZ) in 19 serious infections associated with hematological malignancy were studied. CPZ was clinically effective in 13 cases (68.4%). Excellent effects were obtained in 3 cases (15.8%), good effects in 7 cases (36.8%) and fairly good effects in 3 cases (15.8%). The rate of clinical effectiveness by CPZ was not dependent on neutrophils number in peripheral blood. Bacteriological effectiveness to isolated organisms in 15 cases was obtained in 9 cases (60%). Clinically significant serum concentrations of CPZ persisted over 6 hours after injection (1 g/l hour, d.i.v.). In comparative study of MIC against clinically isolated P. aeruginosa, CPZ was superior to other cephalosporins. Adverse reactions were not significant except for 3 cases with abnormalities of hepatic function.

Adult↗
PubMed1983

Myonephropathic-metabolic syndrome as a complication of cardiopulmonary bypass.

We encountered eight rare cases of myonephropathic metabolic syndrome (MNMS) which developed as a complication of the femoral arterial cannulation (FAC) during cardiopulmonary bypass (CPB). Seven were boys ranging in age from 4-17 years, and all had undergone open heart surgery using CPB with a hemodilution technique. These eight corresponded to 1.9 per cent of the 420 patients treated with CPB before June, 1974. The pump priming fluid used was either Ringer's lactate solution alone or that containing a small amount of colloidal solution. Duration of CPB ranged from 52 min to 2 hrs and 42 min, but the FAC period was more than 3 hrs in each case. Acute renal failure occurred in 3 and 2 required peritoneal dialysis. Severe respiratory insufficiency occurred in 2 and one died 3 months after the operation. The most effective means to prevent the development of MNMS seems to be the local cooling of the cannulated limb during FAC. MNMS did not occur in 444 cases of CPB with FAC after July 1974, and here local cooling was applied in all cases.

Adolescent↗
PubMed1983

[Hypertrophic cardiomyopathy with dilatation of the left ventricle and congestive heart failure: comparison with postmyocarditis cardiomegaly and hypertensive heart failure].

In a total of 114 cases of hypertrophic cardiomyopathy (HCM), four cases were regarded to have dilated left ventricle and congestive heart failure. History of myocardial infarction was not present, and significant narrowing of coronary arteries was not detected in each case. The clinical manifestations were analyzed in the light of the differentiation from postmyocarditis cardiomyopathy (PMC: three cases) and hypertensive heart disease ( HHD : five cases). Representative case was a 47-year-old man with HCM, who showed congestive heart failure developed gradually over the last 20 years. The cardiothoracic ratio increased from 57% to 64% and high voltage of the precordial leads noted initially decreased gradually with normalization of ST-T changes. Meanwhile, a new abnormal Q wave appeared in aVL. The echocardiographic findings at the age of 47 were asymmetric septal hypertrophy and left ventricular enlargement. Myocardial biopsy of the right ventricle done at the same period revealed the marked progression of interstitial fibrosis as compared with that of 15 years ago. Clinical pictures demonstrated that PMC patients were younger than HCM or HHD patients. Abnormal Q waves were observed in three cases of HCM. In the remaining one, the Q wave was not discernible due to superimposed complete left bundle branch block. No abnormal Q waves were observed in cases of PMC and HHD . A high voltage of the left precordial leads with marked ST-T changes suggesting left ventricular hypertrophy was not seen in HCM with dilated left ventricle and HHD . Echocardiographically, the systolic anterior motion was absent in all cases. The left ventricular posterior wall in PMC and HHD was equally hypertrophied both at the apex and base, whereas in three of four cases of HCM, the apical region of the posterior wall was disproportionately hypertrophied. All cases of HCM and PMC showed asymmetric septal hypertrophy, while all the HHD cases except one showed concentric hypertrophy. In HCM, left ventricular end-diastolic dimension and left atrial dimension were increased to 60.0 +/- 6.1 mm and 45.3 +/- 9.4 mm, respectively, which were not different from those of PMC and HHD . Isometric relaxation time was prolonged to 100 msec or more in all cases of HCM, while in only one case of PMC it was prolonged and no prolongation was observed in HHD . Left ventricular wall motion revealed asynergy mainly at the hypertrophic apical area in HCM and PMC, whereas asynergy was found at the hypertrophic area, which was mostly apical, and also in the area without hypertrophy in HHD .(ABSTRACT TRUNCATED AT 400 WORDS)

Aged↗