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Biomedical subjects

K Kodera

Publications and source records attributed to K Kodera.

At least 37 records · Page 2Linked to original sources
PubMed1999

Changes in serum leptin concentration during behavioral therapy in obese children.

To determine the pathophysiological implications of serum leptin level in obesity, we monitored the changes in serum leptin level during outpatient treatment with life style modification in children. Fifty-five obese Japanese children (34 boys and 21 girls; mean age, 9.64 years) were studied. The control children consisted of 42 nonobese subjects (27 boys and 15 girls). The serum leptin concentration was 4.35 +/- 0.46 ng/ml (mean +/- SEM) in the control girls and 2.93 +/- 0.21 ng/ml in the control boys. The serum leptin concentrations in the obese boys and girls were higher than those in their lean counterparts. The concentration in the obese boys (16.28 +/- 1.41 ng/ml) was similar to that in the obese girls (20.33 +/- 2.0 ng/ml). The logarithmic value of serum leptin concentration at the first blood sampling in obese children was correlated with percent overweight and percent body fat. In 36 obese children (24 boys and 12 girls) whose serum leptin concentrations were monitored serially during treatment of obesity, the percent overweight was significantly decreased after the initial sampling. In each individual, the changes in leptin concentration were roughly parallel to those in percent overweight. The ratio of the leptin concentration at the second blood sampling divided by the one at the first sampling in each individual was closely correlated with the respective delta percent overweight. These results suggest that the preceding course of obesity determines the serum leptin level of obese children on longitudinal basis, and that the leptin level reflects the degree of obesity on cross-sectional basis.

Behavior Therapy↗
PubMed1999

[Significance of atrial fibrillation, left atrial thrombus and severity of stenosis for risk of systemic embolism in patients with mitral stenosis].

The prognostic significance of atrial fibrillation, left atrial thrombus and the severity of mitral stenosis (MS) for systemic embolism was evaluated in 142 consecutive patients with MS (male 61, female 81; mean age 51 +/- 10 years) who were referred for cardiac catheterization. The relationships between systemic embolization, atrial fibrillation, left atrial thrombus and the size of mitral valve area obtained by the echocardiographic or Doppler method, or cardiac catheterization (Gorlin's formula) were studied. The effects of mitral regurgitation (MR) (Sellers II < or =) on systemic embolism or left atrial thrombus were also evaluated. Atrial fibrillation was observed in 117 patients (87%), 30 (28%) of whom had a history of systemic embolism. Four of 18 patients (22%) with sinus rhythm had a history of systemic embolism. Left atrial thrombus was observed in 63 patients (45%), including 17 (27%) with a history of systemic embolism. Seventeen (22%) of 76 patients without left atrial thrombus had a history of systemic embolism. Left atrial thrombus was detected in 17 of 41 (41%) patients with severe MS [mitral valve area (MVA) < or = 1.0 cm2], 8 of 25 (32%) patients with moderate MS (1.1 < MVA < or = 1.5 cm2), 2 of 14 (14%) patients with mild MS (MVA > or = 1.6 cm2), and embolization was complicated in 11% of cases of severe MS, 32% of cases of moderate MS and 21% of cases of mild MS. There was no significant difference between the 3 groups. Left atrial thrombus was more frequently observed in patients without MR than with MR (44% vs 13%, p < 0.05), but there was no significant difference in the incidence of embolism between the groups (28% vs 22%). Positive therapy intervention should be considered to prevent systemic embolism regardless of the presence or absence of sinus rhythm, MR, left atrial thrombus or severity of stenosis.

Atrial Fibrillation↗
PubMed1998

Effect of selenium deficiency on cellular and extracellular glutathione peroxidases: immunochemical detection and mRNA analysis in rat kidney and serum.

To determine the effect of selenium (Se) deficiency on expression of glutathione peroxidase (GSH-Px) 1 and 2, we measured GSH-Px activity in rat serum, liver and kidneys, serum immunoreactive GSH-Px 2, and the mRNAs of kidney GSH-Px 1 and 2. We purified rat GSH-Px 2 and raised polyclonal antibodies. Immunoreactive GSH-Px 2 was measured by rocket immunoelectrophoresis. GSH-Px 2 was purified 1470-fold with a specific activity of 250 units/mg. Immunoblotting detected only GSH-Px 2 in rat serum, and much less GSH-Px 2 than GSH-Px 1 in kidney. Immunoblot signal of kidney GSH-Px 1 and 2 decreased progressively in Se deficient rats. Serum GSH-Px activity in Se deficient rats at 1, 2, 3, and 4 weeks declined to 33, 20, 10, and 9% of the control, while the serum level of immunoreactive GSH-Px 2 was 58, 24, 15, and 10% of the control, suggesting the presence of an inactive protein at week 1. GSH-Px activity declined to 4 and 11% of the control in the liver and kidney at 4 weeks. The mRNAs of kidney GSH-Px 1 and 2 showed similar decreases, and were 24 and 23% of the control at 4 weeks. GSH-Px mRNA levels were better preserved than GSH-Px activity, suggesting that GSH-Px expression was regulated at both pre-translational and translational levels.

Animals↗
PubMed1998

Relationships between an index of body fat distribution (based on waist and hip circumferences) and stature, and biochemical complications in obese children.

OBJECTIVE: To determine the clinical utility of a new age-adjusted measure of body fat distribution (based on waist and hip circumferences) and stature, in relation to biochemical complications in obese children. DESIGN: Cross-sectional, clinical study. The formula to calculate the common standard deviation score (SDS) of waist-to-hip ratio/height (WHR/Ht) was obtained from the data of control children. The relationship between WHR/Ht SDS, as the age-adjusted measure, in obese children and their clinical laboratory data was evaluated. SUBJECTS: Outpatient obese Japanese children (102 boys and 75 girls) and control children (508 boys and 549 girls), ranging in age from 6-15 y. MEASUREMENTS: Height, body weight, waist girth, hip girth, triceps and subscapular skinfold thicknesses, as anthropometric measures. Percent overweight, percent body fat, waist girth, WHR and WHR/Ht SDS as criteria for obesity. Clinical laboratory analyses for fasting blood samples of obese children. RESULTS: The WHR/Ht SDS closely correlated with age in obese children, thus reflecting the progress of abdominal obesity during growth. The obese boys were more hyperlipidaemic than the girls were, although the percent overweight was similar in both genders. The percent overweight, percent body fat, waist girth and WHR/Ht SDS all correlated well with triglyceride (TG), alanine aminotransferase (ALT) and insulin in boys, whereas only waist girth and WHR/Ht SDS showed a close correlation with TG and insulin in girls. The obese subjects were subdivided according to the number of abnormal values observed in TG, ALT and insulin. For obese boys, all five indices of obesity were higher in the groups with complications than in the group without. In the girls, only the WHR/Ht SDS constantly differed between subgroups. WHR/Ht SDS most obviously distinguished the groups with complications from the other group with a wide margin of difference (2-fold in boys and > 2-fold in girls) in the mean values. CONCLUSION: The WHR/Ht SDS can serve as an index predicting the occurrence of biochemical complications in obese children ranging from the age of 6-15 y.

Adipose Tissue↗
PubMed1998

Effect of a balanced biventricular bypass system on left ventricular energies.

Left dominant biventricular failure is a common type of heart failure after cardiac surgery. We developed a biventricular bypass (BVB) system for treatment of postcardiotomy ventricular failure, and we previously reported that the clinical results of the BVB system were superior to those obtained with venoarterial bypass (VAB). The purpose of this study was to evaluate the effect of the BVB system on left ventricular (LV) performance in comparison to that of VAB by means of the LV pressure-volume relationship (PVR). Eight adult mongrel dogs (14-21 kg) underwent VAB with right atrial and aortic cannulation. Left atrial cannulation was added for BVB, and both atrial drainage tubes were joined with a Y-shaped connector. The bypass flow was maintained at half of the baseline cardiac output (0.7-1.0 L/min), and the hemodynamic parameters were monitored. A high fidelity microtip catheter and a conductance catheter were used to evaluate LV function. The slope of the LV end-systolic pressure-volume relation (Emax), the slope of the LV end-systolic pressure-stroke-volume relation (Ea), the LV stroke work (SW), LV potential energy (PE), LV pressure-volume area (PVA), the slope of the SW end-diastolic volume relation (PRSW), and an index of the LV energizing charge (ratio of PE/PVA) were assessed during transient occlusion of the inferior vena cava. LV contractility (Emax) showed no significant change during each experiment. Standardized LV work (PRSW) was reduced by BVB in comparison to the baseline and in comparison to VAB. The rate of LV energy charge (PE/PVA) significantly increased only during BVB. These results suggested that the BVB system might be an effective circulatory support for reducing LV work and improving the LV energizing charge in patients with severe heart failure after cardiac operation.

Animals↗
PubMed1998

A new mutation in the POU3F4 gene in a Japanese family with X-linked mixed deafness (DFN3).

OBJECTIVE: The molecular defect in patients with X-linked mixed deafness showing a perilymphatic gusher at stapedectomy (DFN3) has been attributed to mutations in the POU3F4 gene. This study aimed to clarify an allelic variant of this gene. STUDY DESIGN: This was a genetic study of a single Japanese family with DFN3. METHODS: Products of a polymerase chain reaction (PCR) were subjected to single-strand conformation polymorphism (SSCP) analysis. Direct sequencing of PCR products from patients and carriers showing SSCP variants was performed using the fluorescent dideoxy termination method and a sequencer. RESULTS: Sequencing of the PCR product revealed a 6-base deletion (TTCAAA) at nucleotides 601 to 606, resulting in a two-amino-acid deletion in the POU3F4 protein, (phenylalanine and lysine at amino acid residues 201 and 202). The deletion was adjacent to the site of a nonsense mutation previously described. CONCLUSION: Microdeletions at a previously undescribed location account for some clinically important POU3F4 mutations.

Asian People↗
PubMed1997

[A case of anastomotic aneurysm-enteric fistula].

We successfully performed circulation reconstructive surgery and repair of a small intestine resection, primarily at an anatomical position, for perforation of a pseudoaneurysm in the small intestine, which occurred in an anastomosis site of the right leg of a Y graft of an artificial blood vessel and internal iliac artery graft on a patient, at the remote time of 18 years after she had received a Y-type artificial blood vessel. The patient's life was saved. The results suggest that it is important to make a definitive diagnosis quickly after the occurrence of symptoms and to select an appropriate surgical technique according to the findings of infection adjacent to the perforation site.

Aged↗
PubMed1997

[A report of two cases of Carpentier-Edwards pericardial mitral valve malfunction due to neointimal overgrowth expanding to valve cusps].

Two cases of Carpentier-Edwards pericardial mitral valve malfunction due to neointimal overgrowth were reported. Case one was a 51-year-old female undergone redo mitral valve replacement at nine years after first operation. Removed valve showed remarkable overgrowth of neointima expanding to the valve cusps. Case two was a 67-year-old male. A valve removed at nine years after first operation and at 1.5 years after recovery of prosthetic valve endocarditis. Removed valve also showed neointimal overgrowth expanding to the valve cusps. Although we experienced only two cases of neointimal overgrowth, these findings were considered being important in durability of Carpentier-Edwards pericardial valve.

Aged↗
PubMed1997

[Stenosis of Carpentier-Edwards pericardial bioprosthesis in the tricuspid position caused by adhesion of native valve cusps to the bioprosthesis].

We experienced a case of dysfunction of Carpentier-Edwards pericardial bioprosthesis in the tricuspid position. Explanted bioprosthesis showed overgrowth of neointima from ring to cusps and adhesion to remnants of native cusps. This restricted the motion of the pericardial leaflets resulting in orifice stenosis. Care must be taken in such valve replacement by this prosthesis leaving native valve tissue.

Aged↗
PubMed1997

[A case report of chronic dissecting aortic aneurysm (Stanford type A) with circumferential detachment of the intima].

A 57-year-old man underwent Bentall's procedure (Piehler's modification) and partial aortic arch replacement for Stanford type A chronic aortic dissection. Circumferential detachment of intima with intimal intussusception into the aortic arch was found at the time of operation. Preoperative findings did not show the intimal tear involving entire circumference of the ascending aorta. He was asymptomatic but coughing before consulting our hospital. He was discharged from the hospital 26 days after operation.

Aortic Dissection↗
PubMed1996

[Use of an expandable metallic stent in patients with superior vena cava syndrome--comparison of angiographic findings and autopsy findings].

To evaluate the usefulness of expandable metallic stens (EMS) in patients with superior vena cava (SVC) syndrome, we compared venographic findings obtained before EMS insertion with findings at autopsy. Stents were inserted into the SVC in 10 patients. An autopsy was done in 7 of the 10 patients. At autopsy, the lumen of the SVC was patent in 4 patients; in those 4 patients venography before EMS insertion showed that the SVC was obstructed by extramural compression. These results suggest that extramural compression without direct invasion of the tumor is the best indication for insertion of an EMS. At autopsy, the lumen of the SVC was obstructed by direct invasion of a tumor in 2 patients; in those 2 patients venography showed wall irregularity and lumen narrowing caused by tumor invasion. However, in those 1 patients SVC syndrome either did not recur or recurred in only a mild form after EMS insertion. The results in these 2 patients suggest that if collateral circulation does not develop, insertion of an EMS is indicated also in patients in whom the SVC is obstructed by direct invasion of a tumor. In the remaining patient, the lumen of the SVC was found at autopsy to be obstructed by a thrombus. SVC syndrome developed in this patient 430 days after EMS insertion. In 1 of the 7 patients, an EMS was inserted into the left innominate vein and also into the SVC. Venography before EMS insertion showed that the vein was obstructed by extramural compression without direct invasion of the tumor, but the EMS was found at autopsy to be completely obstructed by a thrombus. This suggests that insertion of an EMS into the left innominate vein is not indicated this vein is easily obstructed by thrombi because of its anatomical location.

Adult↗
PubMed1996

Biventricular bypass with oxygenation for postcardiotomy ventricular failure.

Between January 1984 and March 1995, biventricular bypass (BVB) with oxygenation was used in 17 patients for postcardiotomy ventricular failure at the Heart Institute of Japan, Tokyo Women's Medical College. Of the 17 patients, 12 (70.6%) were weaned from the circulatory support, and 8 (47.1%) were discharged from the hospital. The time interval from the endo of cardiopulmonary bypass to the start of BVB was significantly shorter in weaned patients than in unweaned patients. The duration on support also has been shortened significantly in the last 6 years, compared with the earlier 6 years. Causes of death were severe heart failure or ventricular arrhythmia in 6 patients and multiple organ failure in 3 patients. These results suggest that early application and timely weaning from biventricular bypass with oxygenation might be the effective circulatory support of choice for treatment of postcardiotomy ventricular failure.

Adult↗
PubMed1996

[A case report on graft replacement of ruptured aneurysm of the arch and the descending thoracic aorta associated with dense pulmonary adhesion].

A 73-year-old patient had been followed for aortic arch aneurysm of 54 mm in diameter. He was hospitalized complaining of chest and back pain. A chest CT scan showed ruptured aortic arch aneurysm extending to mid-descending thoracic aorta, and an emergent operation was decided. The trachea was intubated with a univent tube providing a movable blocker (System Corporation) which was directed to the left bronchus for differential lung ventilation. The descending thoracic aorta was exposed through the left 4th intercostal thoracotomy just at the site intending to anastomose a prosthetic graft because of dense pulmonary adhesion. The ascending and arch aorta was approached via median sternotomy. Under deep hypothermia and retrograde cerebral perfusion, total arch and descending aortic replacement was performed using an arch graft providing four branch grafts for neck vessels reconstruction and pump perfusion. The patient showed moderate pulmonary bleeding during and after cardiopulmonary bypass, but improved gradually. He was weaned from the respirator on the 13th post-operative day. During extensive thoracic aortic surgery using left thoracotomy combined with median sternotomy, left lung deflation using a univent tracheal tube with a blocker, and circulatory arrest during distal aortic anastomosis, are useful in preventing lethal pulmonary bleeding caused by lung injury under the fully heparinized condition. However, in cases associated with dense pulmonary adhesion, it is important to dissect carefully just a small area necessary to anastomose a graft, and to take elaborate assistant measures.

Aged↗
PubMed1995

[Repeat open heart surgery in a case associated with persistent left superior vena cava: a method of simple occlusion of L-SVC using an alternative extra-pericardial approach and retrograde cardioplegia].

Twelve years ago, we reported a method of extrapericardial approach to the L-SVC. Since then we have used this approach and performed simple occlusion of L-SVC during cardiopulmonary bypass without any cerebral complications. We have been expecting for a long time and have believed that this method will be very valuable especially in repeat open heart surgery. A case of 49-year-old man successfully underwent a redo operation for mitral and tricuspid valve replacement using extrapericardial occlusion of the L-SVC and retrograde cardioplegia. Although there was a pitfall for retrograde cardioplegia in the persistent L-SVC and a possibility of steal of cardioplegic fluid through a branch of the accessory hemiazygos vein during retrograde cardioplegia for a case with persistent L-SVC, sufficient cardiac protection was obtained in the case presented.

Aortic Valve↗
PubMed1995

[A case of Von Recklinghausen's disease associated with a hemothorax due to a rapidly growing malignant schwannoma].

A 17-year-old man with Von Recklinghausen's disease was admitted to our hospital because of progressive dyspnea on exertion. A chest X-ray film showed a massive left pleural effusion. Thoracentesis revealed dark blood. Hemothorax was diagnosed, and digital subtraction angiography (DSA) was done. DSA revealed a large mass that was supplied with blood via the inferior phrenic artery, but revealed no active bleeding. An intercostal tube was inserted and 1700 ml of dark blood was drained. A chest X-ray film taken after drainage revealed a giant mass showing an extra-pleural sign in the left lung field. A thoracotomy was done to determine the source of bleeding. A giant tumor with hypervascular tissue was seen, and was diagnosed as a malignant schwannoma. No spontaneous hemorrhage from the artery was seen. The source of the hemothorax was believed to be hemorrhage from the tumor vessels. The tumor was treated conservatively, but it continued to grow rapidly and the patient died of respiratory failure. Five other patients have been reported to have hemothorax associated with Von Recklinghausen's disease. The sources of the hemothorax were reported to be hemorrhage from tumor vessels, or spontaneous rupture of the subclavian artery, an intercostal artery, or an intercostal vein.

Adolescent↗
PubMed1995

[Cavernostomy and muscle plombage with the pedicled latissimus dorsi and serratus anterior flap for recurrent large bullae with infection: a case report].

A 70-year-old male, who suffered from infection by MRSA and Aspergillus of the recurrent large bullae, was operated on cavernostomy for space sterilization. About three months later he underwent muscle plombage with the pedicled latissimus dorsi and serratus anterior flap. These muscles are ideal to place in open wound in the thorax because of the following reasons: These have the ability to eliminate local infection, a sufficient length and volume to obliterate an open cavity. And transposition of these muscles cause minimal functional upper extremity disability. Therefore, we considered that this technic was useful for the case of an infectious intrathoracic cavity with many bronchial fistulas.

Aged↗
PubMed1995

Current strategy of circulatory support for profound heart failure.

The purpose of this study is to assess the current strategy of mechanical circulatory support for profound heart failure. In the last 10 years, 37 patients with profound heart failure underwent mechanical circulatory support after open heart surgery and 9 patients with non-cardiotomy cardiogenic shock received emergency circulatory support. All patients showed severe cardiac failure and/or fatal ventricular arrhythmia and required circulatory support as a life-saving measure. After cardiovascular surgery, 12 of those patients underwent venoarterial bypass (VAB), 13 had biventricular bypass (BVB), 8 had left ventricular bypass (LVB) and the remaining 4 patients received left ventricular assist device (LVAD). And 9 patients with non-cardiotomy cardiogenic shock received percutaneous cardiopulmonary support (or PCPS) as an emergency assist system. Weaning and discharge rates of the patients by the type of circulatory supports were 41.7% and 25.0% with VAB, 69.3% and 46.2% with BVB, 87.5% and 37.5% with LVB, 75.0% and 50.0% with LVAD, and 44.4% and 11.1% with PCPS, respectively. Clinical results of post-cardiotomy circulatory support (64.9% of weaning and 37.8% of discharge) were acceptable, but the patients with non-cardiotomy cardiac failure needed early application of more advanced circulatory support.

Adult↗