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Biomedical subjects

K Kodama

Publications and source records attributed to K Kodama.

At least 469 records · Page 26Linked to original sources
PubMed1990

[Is emergency angioplasty following successful thrombolysis more effective than thrombolysis alone in acute myocardial infarction?].

This study clarified the effects of residual stenosis following successful thrombolysis in acute myocardial infarction on infarct size and cardiac function in the chronic stage. Subjects consisted of 24 patients with acute anteroseptal myocardial infarction within six hours after the onset of symptoms, in whom thrombolysis was performed, and additional coronary angioplasty was performed in 10 patients. Great cardiac venous flow (GCVF) at a point 30 min after thrombolysis and angioplasty was examined by continuous thermodilution, and the minimal cross-sectional area (MCSA) was determined at a stenotic lesion using an orthogonal angiographic view. As an index of infarct size, we measured abnormally contracting segments (ACS) and perfusion defects (PD) in 201T1 single photon emission computed tomograms four weeks after the onset. We determined anterior regional ejection fraction (rEF) as an index of left ventricular performance in the chronic stage. The patients with thrombolysis alone and the patients with angioplasty were comparable as to age, gender elapsed time, GCVF, MCSA, ACS, PD and rEF. In all the patients, MCSA did not correlate significantly with GCVF. In the patients with additional angioplasty, MCSA significantly increased (from 0.3 +/- 0.3 mm2 to 2.5 +/- 1.6 mm2). However, GCVF did not necessarily increase in all the angioplasty patients. In four patients having delays in angiographic flow, and MCSA less than 0.1 mm2, there was a significant increase in GCVF after angioplasty (41.3 +/- 32.0 vs 82.0 +/- 60.7 ml/min). GCVF correlated significantly with ACS, PD, and rEF, but MCSA did not correlate significantly with them. We concluded that in patients with successful thrombolysis but without angiographic filling delay, emergency angioplasty for residual stenosis has no effect on further limitation of infarct size.

Adult↗
PubMed1990

[Successful treatment of CML in accelerated phase with mithramycin].

The patient, an 18-year-old male, was admitted on May 17, 1988, because of high-grade fever, neuralgia and generalized lymphadenopathy. Bone marrow examination revealed a large number of small nests with myeloid blastic cells negative for both peroxidase and TdT activity. Ph1 chromosome and bcr rearranged fragment were positive. On a diagnosis of CML in the accelerated phase, treatment was started with standard BHAC-DMP and vincristine. However, fever still persisted and hematological improvement could not be obtained. From September 20, 1988, mithramycin was given at 25 micrograms/kg every three days. No fever was noted and the NAP score decreased. However, fever reappeared despite the continuing treatment. Combination use of vincristine (1.0 mg/week) and mithramycin (25 micrograms/kg/week) was then begun, and the fever immediately disappeared. After mithramycin administration, a transient marked increase of neutrophils appeared in the peripheral blood, suggesting the induction of differentiation. After then, a complete remission was obtained. A transient disappearance of Ph1 chromosome by the chemotherapy was noticed. He has remained in the chronic phase of CML for one year. In conclusion, combination use of vincristine and mithramycin may be useful in the treatment of the myeloid blast crisis.

Adolescent↗
PubMed1990

[Problems concerning the diagnosis and treatment of multiple primary carcinoma of the lung].

Data on 44 patients with multiple primary carcinoma of the lung are presented. Twenty had metachronous tumors, and 24 had synchronous tumors. Twenty-one patients had undergone complete resection for both tumors, and 14 had undergone resection for only one of two tumors. The remaining 9 patients underwent no operation and were treated with photodynamic, radiation and/or chemotherapy. Long-term survival of more than 3 years was achieved for 11 patients, nine of whom had synchronous lesions. Furthermore, they included 3 patients who underwent nonsurgical therapy for both lesions. On the other hand, the prognosis after resection of the second tumor in patients with metachronous lesions was poor. This was thought to be the result of failure to diagnose the second lesion due to incomplete long-term follow-up. We conclude that careful attention to the operative indications is necessary for patients with multiple lesions, particularly lesions such as early squamous cell carcinomas.

Adenocarcinoma↗
PubMed1990

A case of nephrotic syndrome due to alpha-mercaptopropionyl glycine in a patient with familial cystinuria.

A 26-year-old male with nephrotic syndrome (NS) due to alpha-mercaptopropionyl glycine (MPG) is described. In March, 1988, he was diagnosed as having familial cystinuria after receiving urolithiasis treatment since December, 1985. Massive proteinuria and slight pedal edema were noted. Nephrotic syndrome was suggested and renal biopsy was performed. The renal pathological finding demonstrated membranous glomerulonephritis (MN) at stage I. This case was defined as NS clinically associated with MPG, and glucocorticoid intake was initiated. The response to the glucocorticoids was fairly good with no clinical problems after discontinuation of MPG, and the cystinuria was maintained with alkaline medication. The patient's parents and younger brother were suggested and confirmed to have cystinuria based on urinary aminogram analysis, but displayed no symptoms. We present a rare case of NS due to MPG therapy in a patient with familial cystinuria. However, the mechanism of onset remains unclear.

Adult↗
PubMed1990

[A case of extended myocardial infarction treated with the left ventricular assist device (LVAD) before and after the operation--the value and limitation of LVAD].

A left ventricular assist device (LVAD) was applied to a patient who had profound left ventricular failure following extended myocardial infarction caused by the left main trunk obstruction. The patient was a 61-year-old man, who had severe chest distress and was admitted 11 hours after the onset of the symptom. At the time of admission, he was already in cardiogenic shock. The emergent coronary angiography showed complete obstruction of the left main trunk and the intact right coronary artery which had no collateral flow to the left coronary artery. The intraaortic balloon pumping (IABP) was started bu could not maintain the satisfied circulation. Then a LVAD was applied to the patient 5 days after the onset. The LVAD maintained the normal circulation and prohibited exaspiration of organ failure. 19 days after the onset, scartectomy and A-C bypass to LAD was performed. The patient could not be weaned from LVAD and died of right ventricular failure following ventricular arrhythmia 20 days after the installation of LVAD. The use of LVAD for nonoperative cardiogenic shock is rare. Circulatory support with a LVAD in the treatment of a patient in cardiogenic shock following a acute myocardial infarction was considered useful.

Coronary Artery Bypass↗
PubMed1990

[A case of "interval" form of acute carbon monoxide poisoning--brain MRI and therapeutic effect of hyperbaric oxygenation].

A 43-year-old female who had suffered from paranoid reaction attempted suicide with city gas. She was admitted to an emergency hospital in a comatose state, regained consciousness the next day and was discharged 12 days after. However, on the 21st day after the poisoning, behavioral anomalies and staggering appeared. She was readmitted into another emergency hospital with the diagnosis of an "interval" form of acute carbon monoxide poisoning. She was performed hyperbaric oxygen therapy 42 times until the 53rd day after the accident. Nevertheless, her symptoms did not improve and remained in a state like an apallic syndrome. With little promise of improvement, she was moved to our hospital, and hyperbaric oxygen therapy further continued for 40 times which resulted in a remarkable recovery. Repeat EEGs were performed. On the 32nd day, EEG showed an abnormality consisting of generalized delta waves. On the 56th day, the abnormal EEG improved slightly with more alpha activity. EEG was normalized 126 days after. The X-ray CT scan on the 32nd day revealed low densities in the bilateral globus pallidus and the deep white matters adjacent to the frontal horns of the lateral ventricle and in the semioval centers. On the 57th day, these low density areas were depicted more clearly by the X-ray CT scan, which became less marked on the 73rd day. MRI was performed 3 times.(ABSTRACT TRUNCATED AT 250 WORDS)

Acute Disease↗
PubMed1990

[Key grafts in emergency aortocoronary bypass surgery].

We evaluated relations with operative results of emergency aortocoronary bypass grafting to severity of residual stenotic lesion after surgery in patients with impending myocardial infarction or acute myocardial infarction. Mortality in patients with residual stenotic lesion whose score more than 15 is 66%. Mortality in patients with residual stenotic lesion whose score less than 15 is 5%, excluding patients died with noncardiac cause. Four of 6 patients (66%) with residual stenotic lesion whose score more than 5 have residual angina after the operation. None of fourteen patients with residual stenotic lesion whose score less than 5 has residual angina after the operation. In theory, we could save their lives with only one graft in 76% patients and cure their angina with less than 2 grafts in 72% patients. These grafts are key grafts.

Aged↗
PubMed1989

Development of postoperative intrathoracic chemo-thermotherapy for lung cancer with objective of improving local cure.

From April 1985 through March 1988, 24 lung cancer patients with carcinomatous pleuritis were treated with a new combined treatment modality consisting of pulmonary resection and postoperative intrathoracic chemo-thermotherapy (PICT). They consisted of 15 male patients and nine female patients. A majority of the patients (79%%) had adenocarcinoma. The PICT was started 10 to 14 days after the operation. Immediately after a bolus intrathoracic injection of cisplatin (CDDP) 50-100 mg, thermotherapy was carried out using 13.56-MHz or 8.00-MHz radiofrequency waves for 60 minutes. The peripleural temperature was precisely monitored in 20 patients. The temperature was successfully maintained above 42 degrees C for 40 minutes in each of two or three treatment courses in 13 patients, with no complications. However, in the other seven patients the therapy resulted in incomplete treatment because of development of a side effect. Cytologic examination of the pleural effusion, which was performed after the completion of PICT, gave a negative result in 16 of 20 patients examined. The median follow-up period was 16 months. Local relapse was recognized in only three cases who received incomplete treatment or in whom no temperature measurement was performed. The overall survival of the treated patients (n = 24) was significantly prolonged in comparison with a historical control group treated by surgery only (n = 17) or exploratory thoracotomy (n = 11). Of those 17 patients treated by surgery only, ten patients (59%) died of local relapse. These results suggest that this new treatment modality consisting of pulmonary resection and PICT is useful for the treatment of lung cancer patients with carcinomatous pleuritis, especially in the light of improved local control.

Adenocarcinoma↗
PubMed1989

Semiquantitative evaluation of aortic regurgitation by Doppler echocardiography: effects of associated mitral stenosis.

The accuracy of pulsed and continuous wave (CW) Doppler methods for evaluating aortic regurgitation (AR) was compared in patients with and without mitral stenosis (MS), with aortic root angiography as a gold standard. AR was diagnosed with pulsed Doppler echocardiography, by the detection of broad frequency spectral patterns in the isovolumic relaxation time. If these indications were present, AR was graded by examining the extent of diastolic turbulence in the left ventricular cavity (flow mapping method). With CW Doppler echocardiography, AR was diagnosed by the detection of a peak velocity of greater than 2 m/s; if this velocity was attained, AR was graded by measuring the time from the peak velocity to half the peak velocity (half-time method). The angiographic grade corresponded to that determined by the pulsed and CW Doppler methods in 37 and 37 of 46 patients without MS, respectively. Angiographic grade corresponded to the grade determined by the pulsed and CW Doppler methods in 13 and 17 of the 23 patients with MS, respectively. Eight of 10 discrepancies between pulsed Doppler and angiographic grades were due to overestimation of AR by the flow mapping method, apparently because the transmitral jet produces diastolic turbulence in the left ventricular cavity independent of AR. On the other hand, three of six discrepancies between CW Doppler and angiographic grades were due to the incapability of detecting signals of AR by CW Doppler echocardiography. Thus both the pulsed and the CW Doppler methods are useful to evaluate AR in patients without MS. In patients with MS, however, AR is most accurately diagnosed by the detection of AR signals in the isovolumic relaxation time by pulsed Doppler echocardiography, and the degree of AR is more accurately assessed by the CW Doppler half-time method.

Adult↗
PubMed1989

Right coronary artery occlusion: its role in the mechanism of precordial ST segment depression.

To investigate the mechanism of precordial ST segment depression during right coronary artery occlusion, precordial ST segment shifts and myocardial lactate metabolism were evaluated during coronary angioplasty in 10 patients with (group A) and 7 patients without (group B) precordial ST segment depression during balloon occlusion of the right coronary artery, and in 17 patients with precordial ST segment depression during balloon occlusion of the left anterior descending artery (group C). A 12 lead electrocardiogram was continuously recorded in each patient. Blood lactate in the aorta and great cardiac vein was measured during the procedure, and the lactate extraction ratio in the anterior wall was determined both before and during balloon occlusion. Eight of the 10 patients in group A and 1 of the 7 patients in group B had a dominant large right coronary artery. There were no significant differences in summed ST segment elevation in leads II, III and a VF between group A (0.56 +/- 0.26 mV) and group B (0.46 +/- 0.19 mV) during balloon occlusion of the right coronary artery, and no significant differences in summed ST segment depression in leads V1 to V6 during balloon occlusion between group A (0.44 +/- 0.26 mV) and group C (0.38 +/- 0.14 mV). Lactate extraction ratio before balloon occlusion was similar among the three groups. Patients in group A had a higher lactate extraction ratio during (38 +/- 11%) compared with before (30 +/- 11%) (p less than 0.05) balloon occlusion despite precordial ST segment depression.(ABSTRACT TRUNCATED AT 250 WORDS)

Angina Pectoris↗
PubMed1989

Effects of blood pressure changes on development and regression of electrocardiographic left ventricular hypertrophy: a 26 year longitudinal study.

At the Radiation Effects Research Foundation, medical examinations have been conducted biennially since 1958 on a fixed population of approximately 20,000 individuals. Blood pressure measurements and electrocardiographic (ECG) recordings are available for 6,569 individuals who were monitored for at least 11 of the 13 2 year intervals between 1958 and 1984. Data from 601 individuals who had satisfied the Foundation's ECG diagnostic criteria of left ventricular hypertrophy ("Kagan-Yano code") on at least one occasion were reviewed. Both the development and the regression of ECG left ventricular hypertrophy were ascertained in 61 subjects (17 men and 44 women). During the course of development of ECG left ventricular hypertrophy, hypertension (including borderline cases) was noted in 83.3% of the subjects. The most common pattern of ECG left ventricular hypertrophy development was high voltage, followed by ST-T changes. In about half of these cases, the condition of hypertrophy regression was associated with lowering of blood pressure, marked by the disappearance of high voltage ECG readings.

Blood Pressure↗
PubMed1989

Computed tomographic findings in children with spastic diplegia: correlation with the severity of their motor abnormality.

Computed tomographic findings of 46 children with spastic diplegia examined at nine months to three years of age corrected for preterm births were analyzed. Both the size of the lateral ventricles measured by the width of the anterior horns, and the volume of the extracerebral low-density areas were enlarged in some patients. Both enlargements did not, however, correlate to the severity of the motor abnormality in the patients. The low-density areas of the periventricular white matter, especially adjacent to the trigone, were reduced in many children, probably due to the atrophy of the cerebral white matter having periventricular leukomalacia. The anterior expansion of the white matter reduction from the trigone corresponded to the severe motor abnormality in the children with spastic diplegia.

Atrophy↗
PubMed1989

Motoscopic analysis of gross motor patterns in athetotic cerebral palsied children.

Rolling, sitting, and crawling patterns were motoscopically analyzed in 51 athetotic cerebral palsied children. In rolling, rotation of the trunk and support on the elbows were difficult in some subjects. When sitting, most of the subjects had a "W" sitting pattern in which the hips were adducted and the knees were flexed. As for crawling, reciprocal movements of the four extremities were disturbed. The reciprocal hip movements were insufficient and accompanied the lateral bending of the trunk in many of the children. The hips supported the weight in flexion, and the synchronized extension of the hips, with or without lateral bending of the trunk, propelled the body in some. Creeping on the elbows was shown only in the younger children.

Adolescent↗
PubMed1989

Effects of atrioventricular interval on left ventricular diastolic filling assessed with pulsed Doppler echocardiography.

Effects of changes in atrioventricular interval on left ventricular diastolic filling were studied using pulsed Doppler echocardiography in 14 patients with programmable dual chamber pacemakers. Peak early diastolic filling velocity (E) and peak atrial filling velocity (A) were measured from the transmitral flow velocity pattern at three different atrioventricular intervals under the same pacing rate of 80 beats.min-1 in each patient. When the atrioventricular interval was switched from intermediate [148(SD10) ms] to short [68(11) ms], stroke volume did not change significantly [60(14) to 58(13) ml], but E increased from 39(12) to 44(11) cm.s-1 (p less than 0.05), and A decreased from 48(8) to 38(9) cm.s-1 (p less than 0.05). At the short atrioventricular interval, incomplete atrial emptying by the atrial contraction seemed to cause a reciprocal increase in the early diastolic filling. When the atrioventricular interval was switched from intermediate to long [234(16) ms], stroke volume, E and A did not change significantly [57(14) ml, 37(13) cm.s-1, 51(8) cm.s-1 respectively]. At the short and long atrioventricular intervals, atrial filling always changed in the direction opposite to that of early diastolic filling. Changes in stroke volume as well as peak early diastolic filling velocity caused by altering atrioventricular interval were pronounced in aged patients and patients with decreased early diastolic filling. In conclusion, left ventricular diastolic filling patterns can be affected by atrioventricular interval even without any concomitant pathological changes in the left atrial or ventricular function. These effects should not be taken lightly, especially in patients with decreased left ventricular early diastolic filling.

Adolescent↗
PubMed1989

Antitumor activity and pharmacology of 1-beta-D-arabinofuranosylcytosine-5'-stearylphosphate: an orally active derivative of 1-beta-D-arabinofuranosylcytosine.

The antitumor activity of 1-beta-D-arabinofuranosylcytosine-5'-alkylphosphates (CnPCAs) against L1210 leukemia in mice after oral administration was demonstrated. The optimum length of the alkyl group on the phosphate moiety of CnPCA for exhibiting a high antitumor activity was found to be between tetradecyl (C14) and tricosyl (C23). The most active alkyl derivative in this system was found to be 1-beta-D-arabinofuranosylcytosine-5'-stearylphosphate (C18PCA). The optimum and minimum effective doses of C18PCA were 100 and 6.25 mg/kg/day (q1d, day 1 to day 5), respectively. The maximum T/C% of C18PCA was approximately 220. The antitumor activity of C18PCA was not greatly dependent on the treatment schedule and route. Plasma concentration of 1-beta-D-arabinofuranosylcytosine (ara-C) remained in the range of 0.4 to 0.75 nmol/ml [corrected] for 24 h after oral administration of 100 mg/kg (170 mumol/kg) of C18PCA. These results indicate that C18PCA administered per orally is absorbed intact through the gastrointestinal tract and area-C is released of long period of time. C18PCA is regarded as an orally active depot form of ara-C.

Administration, Oral↗
PubMed1989

Choice of anticoagulant in a congenital antithrombin III (AT III)-deficient patient with chronic renal failure undergoing regular haemodialysis.

We describe a 43-year-old male patient with congenital antithrombin III deficiency requiring haemodialysis due to extension of venous thrombus from recurrent deep vein thrombosis. During dialysis with adequate heparinization, the patient often revealed clot formation in the extracorporeal circuit resulting in unexpected discontinuation of dialysis. When either a combination of antithrombin III concentrate plus heparin or the newly developed synthetic antithrombin preparation, MD805, was infused during dialysis, he could be uneventfully dialysed with either of the two regimens. The functional antithrombin III activity with MD805 increased to the same level as that obtained with antithrombin III concentrate, and it was possible to achieve an antithrombotic effect, as measured from the APTT and thrombin-antithrombin III complex with MD805 during and after dialysis. We thus found that MD805 could be used as an anticoagulant drug when an AT III-deficient patient required anticoagulation in the extracorporeal circulation.

Adult↗