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Biomedical subjects

K Kodera

Publications and source records attributed to K Kodera.

At least 19 recordsLinked to original sources
PubMed1992

[Left ventricular volume decrease during isovolumic relaxation period in gated blood pool scintigraphy: observations in patients with old myocardial infarction].

We studied left ventricular (LV) volume decrease, namely, the downward displacement of the LV volume curve, during the isovolumic relaxation period on the time-activity curves obtained from gated blood pool scintigraphy in patients with old myocardial infarction (OMI). To evaluate the mechanism and clinical significance of this phenomenon, 113 consecutive patients with OMI undergoing gated blood pool scintigraphy, left ventriculography, and Doppler echocardiography were studied. 1. This phenomenon was observed only in patients with anterior OMI (13 of 51 patients: 25%). Presence (Group I) or absence (Group II) of this phenomenon was examined. 2. On left ventriculography, dyskinetic or aneurysmal wall motion was observed in the anterior or apical region more frequently in Group I (11 of 13 patients: 85%) than in Group II (20 of 51 patients: 39%) (p < 0.001). 3. Doppler echocardiography showed that the presence of abnormal LV reversed flow over 20 cm/sec from the apex to the base during the isovolumic relaxation period is more frequent in Group I (7 of 13: 54%) than in Group II (4 of 51: 8%) (p < 0.001). These results suggested that this blood shift in the left ventricle is attributed to asynchronous LV relaxation occurring simultaneously with LV volume decrease on gated blood pool scintigraphy. In conclusion, this phenomenon suggests the presence of asynchronous LV relaxation.

Echocardiography, Doppler↗
PubMed1992

[A case of undifferentiated carcinoma of the thyroid with compression stenosis of the cervical and mediastinal trachea which was dilated by the expandable metallic stents].

The patient was a 64-year-old male with undifferentiated carcinoma of the thyroid which constricted the trachea. The radiation therapy did not reduce the size of the tumor, and did not improve the dyspnea. Bronchoscopy and tomography showed a compression stenosis of the cervical and mediastinal trachea. It was difficult to insert the T-tube because of the large mass of the neck. Therefore, three EMSs were inserted into the stenotic area of the trachea. Immediately after the insertion of the EMSs, the lumen of the trachea was dilated, and the dyspnea was improved. The patient died of the tumor 7 weeks after the insertion of the EMSs. Autopsy showed that the trachea was dilated by EMSs.

Bronchoscopy↗
PubMed1992

[A case report: an elderly patient surviving conservative surgical repair of ventricular septal perforation (VSP) with using Swan-Ganz catheter in order to close VSP temporarily].

A 81-year-old female was referred to our hospital for VSP. Preoperative catheterization showed that pulmonary arterial pressure (PAP) was 50 mmHg over in systole, and L-R shunt rate was 63.4%. In spite of any medications under intraaortic balloon pumping, hemodynamics was gradually worsened. And so Swan-Ganz catheter was inserted into right ventricle via VSP retrogradely in order to close VSP with the balloon of the catheter. PAP decreased to about 40 mmHg in systole and L-R shunt rate became to 49.7% by this method. This treatment could conserve the surgical repair for 5 days and the operation was performed on 22 days after the onset of VSP. It is very important to be able to conserve VSP operation by using Swan-Ganz catheter to close VSP temporarily.

Aged↗
PubMed1992

Randomized study of individualized induction therapy with or without VCR, and of maintenance of 4 or 12 courses in adult AML: JALSG-AML87. Japan Adult Leukemia Study Group (JALSG).

We asked 2 questions in this study. First was the additional effect of VCR in induction therapy, and the second was the duration of maintenance therapy. Adult AML were treated by an individualized response-oriented induction therapy with behenoyl Ara-C 200 mg/m2 daily + 6MP 70 mg/m2 daily + prednisolone 40 mg/m2 on days 1-4 + DNA 40 mg/m2 on days 1-3 and additionally on days 7, 8, 11, 12 (for M3, DNR 50 mg/m2 daily) (BHAC-DMP) until bone marrow became severely hypoplastic with less than 5% of blasts. Patients were randomized to BHAC-DMP or BHAC-DMP + VCR 0.35 mg/m2 on days 1-4. After obtaining CR, 3 courses of intensive consolidation therapy were given together with I.T. MTX+Ara-C+PSL. Maintenance intensification therapy was randomized to either 4 or 12 courses given every 2 months. Patients of age greater than or equal to 60 received about 2/3 reduced doses. From June 1987 to Sept. 1989, 265 consecutive adult AML were registered from 19 institutions and 258 were evaluable. Age ranged from 15 to 79 (med., 48). Out of 258, 200 (77.5%) achieved CR (80% in 209 of age less than 60 and 65% in 49 of age greater than or equal to 60). Unexpectedly, addition of VCR reduced the high CR rate of BHAC-DMP significantly (84% to 70%, p = 0.007). At the median follow-up of 37 mo., overall survival is 37%, and event-free survival (EVS) 27%. Survival, continuing CR and disease-free survival (DFS) rates of 200 CR cases are 45%, 40% and 35%, respectively. Patients received 12 courses of maintenance therapy showed better DFS (P = 0.0555). The VCR group had significantly worse EFS. By multivariate analysis, significant prognostic factors for the achievement of CR were age less than 60, PS 0-2 and no addition of VCR. Significant factors for longer DFS were induction of CR by one course, FAB M3 or M5 and age less than 50. The present multi-institutional study confirmed the high CR rates of the response-oriented individualized therapy reported from several centers in Japan, but failed to support an additional effect of VCR reported from one center.

Acute Disease↗
PubMed1991

P300 response to tones and speech sounds after cochlear implant: a case report.

P300 potentials evoked by tones and spoken words were recorded from a 20-year-old man with a House-3M single-channel cochlear implant. Three months after cochlear implantation, there was a slight appearance of P300 response to both pure-tone stimuli and spoken-word stimuli; 6 months later, clearly identifiable P300 response to both pure-tone stimuli and spoken-word stimuli were obtained. These results are consistent with an encoding improvement for re-establishment of information processing after auditory rehabilitation.

Adult↗
PubMed1991

The kidney disease of Crow-Fukase (POEMS) syndrome: a clinico-pathological study of four cases.

We studied four cases of Crow-Fukase syndrome with renal dysfunction. Kidney specimens obtained by needle biopsy showed glomerular lesions resembling those seen in conditions characterized by microangiopathy. Common glomerular findings by light microscopy were mesangial expansion and narrowing of the capillary lumina. An enlarged subendothelial space and mesangial area with deposition of amorphous material as well as swelling and vacuolization of endothelial cells were observed by electron microscopy. In an active phase, severe mesangial edema and segmental mesangiolysis, and in a late stage, mesangial cell interposition and sclerosis were seen. Tests by immunofluorescence microscopy for the presence of immunoglobulins A, M, G, lambda and kappa light chains, C3, and C4 were negative. Decay accelerating factor was found in glomeruli and in the vascular pole. Other findings included lymph node angiosclerosis, peripheral nerve microangiopathy and hemangioma formation with endothelial cell proliferation. These observations suggest that chronic endothelial injury constitutes the basic pathology of Crow-Fukase syndrome. Hemodialysis was required to manage anasarca in three of the patients although serum creatinine levels were below 5.0 mg/dl. Urinalysis revealed mild abnormalities and did not reflect the severity of the glomerular lesion. Corticosteroids given to three of the patients were effective in controlling fever and the lymphadenopathy; in two cases the corticosteroids induced a recovery of renal function. Thus Crow-Fukase syndrome may be due to chronic endothelial injury; the clinical symptoms and renal involvement respond to corticosteroid therapy.

Aged↗
PubMed1991

[Orthotopic heart transplantation with sinus venosus incision of right atrium in dogs--preservation of sinus node and original right atrium].

Orthotopic heart transplantation with sinus venosus incision of right atrium was aimed to preserve the sinus node, terminal crista, sinus node artery and whole right atrial muscle of the transplanted heart. This transplant procedure was performed in eight mongrel dogs and electrocardiogram was followed up to five postoperative months. Direct cross circulation technique was employed as an alternative of cardiopulmonary bypass. Donors and recipients were 6 to 8 kg mongrel puppies, and 19 to 25 kg adult dogs supported the cross circulation. Myocardial protection of the donor heart was carried out by low-flow continuous potassium cardioplegia and topical cooling. Right atrial incision of the donor heart was made longitudinally in the posterior wall of sinus venosus. After a median sternotomy, ascending aorta and superior and inferior venae cavae of the recipient were cannulated and connected respectively with carotid artery and jugular vein of the cardiopulmonary support dog. Electrocardiogram, arterial pressure and central venous pressure of the recipient were monitored, and an electro-magnetic flow meter was employed for measuring the blood flow of direct cross circulation. The native heart was resected after aortic cross-clamping, and left atrium and atrial septum were sutured continuously. Sinus venosus incision of the donor heart was anastomosed to the recipient's right atrium. Ascending aorta and pulmonary trunk were reconstructed in the standard fashion. Aortic cross-clamp time was less than one hour and sinus rhythm of the transplanted heart was continued in all cases. Five of the eight dogs were alive postoperatively for one week to five months.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1990

[Liver abscess as a complication of TAE--risk factors and prevention].

Transcatheter hepatic arterial embolization for not only hepatocellular carcinoma but metastatic liver cancers is nowadays prevalent. Gall bladder infarction, cholangitis, peptic ulcers, pancreatitis, and aneurysm are reported as complications of it. But the liver abscess following it is rare. We reviewed three cases of liver abscesses after transcatheter hepatic arterial embolization. Biliary tract congestion and inflammation, and iatrogenic contaminations are supposed to major factors that caused liver abscesses. We think we should refrain from the embolization until biliary tract disorders are resolved and take care not to contaminate the proceeding materials in addition to mixing antibiotics with embolus.

Biliary Tract Diseases↗
PubMed1990

[Two cases of solid and cystic tumor of the pancreas (including one case of MRI)].

Solid and cystic tumor of pancreas is an uncommon neoplasm which is histologically low grade malignant but amenable to cure by surgical excision. It tends to occur in young women. US and CT depict a well circumscribed mass that can be solid, mixed solid and cystic and largely cystic. Their ratio depends on the degree of hemorrhage and necrosis. Angiography shows a mildly to moderately vascular mass which corresponds to solid parts. MRI is useful to detect the hemorrhage which is common in this tumor.

Adolescent↗
PubMed1989

[Percutaneous placement of the inferior vena caval filter--a clinical experience with the Günther vena caval filter].

A new inferior vena caval filter (Günther vena caval filter) was used in seventeen patients with pulmonary embolism. The filter is a basket filter which consists of twelve stainless-steal wires, and can be inserted percutaneously through a 10 F angiographic catheter. The filter was easily and safely placed in every case. No significant complications were encountered. In a follow up period of up to twenty seven months, the filter was well tolerated. One patient had a recurrence of pulmonary embolism. The author believe that the filter will be suitable for prophylactic placement for pulmonary embolism, and it will take over another filters that require surgical venotomy.

Adult↗
PubMed1989

Further clinical experiences with middle-ear implantable hearing aids: indications and sound quality evaluation.

Since 1983, when the 5-year project on the middle-ear implantable hearing aids (MEI) was completed, we have been concentrating our studies on the clinical application of the partially implantable MEI (PMEI). The study was on the indication of implantation, improvement of the implantation operation, follow-up of the implanted patients, minor modification of the MEI, preparation of necessary surgical tools, and so on. Clinical study was also necessary for our team to finally confirm the clinical usefulness of this device. The present report is focussed mostly on the problem of indication for the application of PMEI.

Adult↗
PubMed1989

[Cardiac involvement of alcoholics and the effect of total abstinence].

Echocardiographic features of 221 alcoholics after total abstinence were investigated. At the time of admission, none demonstrated left ventricular (LV) enlargement. Noticeably, 26% patients out of the total showed LV wall thickening more than 1.4 cm in the interventricular septum. On the other hand, 19% of the alcoholics illustrated hypokinetic LV wall without chamber dilatation which was either less than 55% in ejection fraction or 30% in fractional shortening. Three months later, the LV wall thickness reduced significantly from 1.6 to 1.4 cm in average and the LV wall motion improved significantly from 27 to 31% in fractional shortening. In the cases with wall thickening, the change was well correlated with a decrease both in heart rate and in LV muscle volume, but not with a decrease in systemic blood pressure. No significant correlated factors could be detected in the hypokinetic cases.

Adult↗
PubMed1988

[Myocardial involvement in female Fabry's disease: evaluation by thallium-201 myocardial scintigraphy].

Fabry's disease is characterized by an inherited X-linked disorder of glycosphingolipid catabolism, and heterozygous women affected with this disease who show overt symptoms including cardiac manifestations have rarely been reported. To elucidate the features of myocardial involvement in female patients, noninvasive techniques including exercise stress thallium-201 myocardial scintigraphy were performed. Three female patients, Cases 1-3, 26, 29 and 50 years of age, were documented low leucocytic alpha-galactosidase activities of less than 48% of normal (67.92-16.2 nmol/mg protein/h). They were examined using ECG, two-dimensional echocardiography (2-D Echo), Holter ECG, treadmill test and stress scintigraphy. On the ECG, negative T waves were shown in leads III and aVF in Cases 1 and 2. Left ventricular high voltage, giant negative T waves and short PR intervals were seen in Case 3. The 2-D Echo revealed neither valvular change nor left ventricular hypertrophy. On the Holter ECG, monofocal ventricular premature beats were occasionally observed in Cases 1 and 3. The treadmill test showed positive ST changes only in Case 2. On the exercise stress scintigraphy, uptake of thallium-201 was enhanced in the apex of the heart in Cases 2 and 3. Low uptake areas of thallium-201 were observed in Case 3. The ventricular angiogram revealed slight hypertrophy of the wall of the apical portion. In endocardial biopsies from the right ventricle, myelinoid lamellar inclusions were demonstrated in myocardial cells electron microscopically. Increased uptake of thallium-201 in the apex was noted in two of the three patients, but no apical thickening was noticed in any of the three cases by 2-D Echo. From the result of the biopsy of Case 3, the increased apical uptake of thallium-201 seems to reflect thickening caused by the deposition of glycosphingolipid. It was concluded that myocardial involvement in female Fabry's disease may occur early in the third decade and that the lesions could be detected with high sensitivity by thallium-201 myocardial scintigraphy.

Adult↗