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Biomedical subjects

K Kodera

Publications and source records attributed to K Kodera.

At least 55 records · Page 3Linked to original sources
PubMed1995

[Obstructive sleep apnea syndrome associated with superior vena cava syndrome].

A 43-year-old man was admitted suffering from dyspnea on exertion and edema of the neck and face. Chest X-ray film and CT scan revealed a mediastinal tumor and a right pleural effusion. A biopsy of the tumor revealed poorly differentiated carcinoma. Severe snoring at night and excessive daytime sleepiness were noticed after admission. Nocturnal oxygen desaturation was documented with a pulse oximeter, and obstructive sleep apnea syndrome was diagnosed on the basis of results of respiratory inductive plethysmography. The severity of snoring and oxygen desaturation during sleep correlated well with the progression of facial swelling. Combination chemotherapy (carboplatin 300 mg/m2 day 1, vindesine sulfate 3 mg/m2 day 1 and 8) was started but no improvement was seen. An expandable metallic stent was inserted into the stenotic vena cava, and the facial swelling, snoring, and oxygen desaturation during sleep were promptly relieved. In this case, obstructive sleep apnea was caused by edema and vascular congestion in the upper airway, and by the decrease in pharyngeal inspiratory muscle function caused by superior vena cava syndrome.

Adult↗
PubMed1995

Partially implantable piezoelectric middle ear hearing device. Long-term results.

In accordance with the 1992-1993 Japanese government approval of production and implementation in the health insurance system of the partially implantable piezoelectric middle ear device (P-MEI), we are conducting follow-up studies on the implanted patients. This article reports the results of the 16 cases, which are regarded as successful implantations because these patients are using the device every day as long as they are awake. A successful case is presented to illustrate the efficacy of the device.

Adult↗
PubMed1994

[The effects of hearing aid frequency responses on speech discrimination score].

The effects of the frequency responses of hearing aids on speech discrimination scores were studied in 100 patients with sensori-neural hearing loss. Consonant discrimination scores of /s, z, m/ in frequency responses with high frequency amplification were better than those with low frequency amplification. On the other hand, consonant discrimination scores of /g/ were better in frequency responses with low frequency amplification. The discrimination scores of the other consonants were not affected by the frequency responses. In the fitting of the frequency response of a hearing aid, low frequency amplification is effective for improving sound quality through the hearing aid. However, there is a risk of decreasing the discrimination scores of /s, z, m/.

Adult↗
PubMed1994

[Computed tomography findings in middle ear anomaly].

The efficacy of computed tomography (CT) of the temporal bone was studied in 45 ears with a middle ear anomaly but whose tympanic membranes were normal. The plane of the film was 30 degrees oblique to the orbito-meatal line. Four otorhinolaryngologists made radiological diagnoses of the CT film without having any information about the patients. CT films of 40 normal ears were also evaluated and served as controls. The incudo-stapedial joint (I-S joint) and the stapes were visualized in all control group subjects. The percentage of correct diagnoses was 77.8% for separation of the I-S joint, and 75.6% for fixation of the stapes. The monopedal stapes was not visualized. Fixation of the malleus and the incus could not be diagnosed correctly. Abnormalities in the location of the facial nerve were visualized in a few ears. CT of the temporal bone was clinically useful for differentiating I-S joint separation and fixation of the stapes.

Adolescent↗
PubMed1994

[Cyst puncture and injection of contrast medium for diagnosis and treatment of pericardial cyst].

We present two cases of pericardial cyst diagnosed by cyst puncture and the injection of contrast medium. The first patient was a 48-year-old man. He was admitted for the evaluation of an abnormal chest X-ray which demonstrated a mass lesion inseparable from the right heart border. CT scan confirmed the mass in the anterior cardiophrenic angle. The mass was quite homogeneous, with an attenuation value of -0.3 HU. Under CT guidance a 21-G needle was inserted into the cyst and 3 ml of clear fluid was obtained, and then contrast medium was injected. A thin smooth walled cyst was outlined by the CT scan. A presumptive diagnosis of pericardial cyst was made. Surgery was performed and the diagnosis was confirmed. The second patient was a 24-year-old woman. An abnormal shadow was noted at annual check up. CT scan confirmed the mass in the anterior cardiophrenic angle. The mass was quite homogeneous, with an attenuation value of +10.4 HY. We made the diagnosis of pericardial cyst by cyst puncture and injection of contrast medium. The CT scan after three months showed no recurrence of the pericardial cyst. We consider that pericardial cyst can be diagnosed clearly by cyst puncture and the injection of contrast medium, and only percutaneous aspiration of the cyst fluid may be sufficient for the treatment.

Adult↗
PubMed1994

Sound evaluation of partially implantable piezoelectric middle ear implant: comparative study of frequency responses.

Two comparative studies were performed in six subjects using partially implantable middle ear implants (MEI). The sound quality was evaluated by speech discrimination tests and sound evaluation tests. In the first experiment, the performance of the output transducer of the MEI and an ear phone of a conventional hearing aid was compared. The MEI showed better results than the hearing aid in both the speech discrimination tests and sound quality rating. In the second experiment, four kinds of frequency responses for the external component of the MEI were compared. Sound quality evaluation in a wide frequency response with a peak at 4000 Hz were superior to those with the frequency response of the present MEI model. In conclusion, improvement of the external component in the frequency response can provide better performance of the MEI.

Audiometry↗
PubMed1993

Indications for an expandable metallic stent for tracheobronchial stenosis.

An expandable metallic stent was used in 9 patients with tracheobronchial stenosis. Of the 8 patients with malignant stenosis, 6 had extrinsic compression and 2 had intraluminal tumor invasion. The 1 patient with nonmalignant stenosis had postreconstruction bronchomalacia and granulation tissue affecting different parts of the tracheobronchial tree. The expandable metallic stent successfully dilated tracheobronchial stenosis due to extrinsic tumor compression and malacia. However, it was not effective for stenosis due to intraluminal tumor invasion or granulation tissue because of the growth of tumor or granulation tissue between the wires of the stent. However, an expandable metallic stent covered with Dacron mesh was effective in 1 patient with intraluminal tumor invasion because tumor growth was blocked by the mesh. We conclude that an expandable metallic stent is effective for tracheobronchial stenosis due to extrinsic tumor compression, but not for stenosis due to intraluminal tumor invasion or granulation tissue.

Adult↗
PubMed1993

[Study on consonant confusion in Japanese patients with sensorineural hearing loss].

The speech discrimination scores of a 57S word list were analyzed in 180 patients with sensorineural hearing loss. Confusion matrices were made on consonant groups of voiceless, voiced and nasal consonants. In succession, the incidence of consonants was compared between the 57S word list and Japanese conversation. Consonants with high incidence in Japanese conversation were t, h, d, g, m, and n. Patients with sensorineural hearing loss are apt to confuse t and h to k, d to b or r, g to b, d or r, m to n or r, and n to m or r. It is effective to correct these instances of consonant confusion, for improving conversational ability in Japanese patients with sensorineural hearing loss.

Hearing Loss, Sensorineural↗
PubMed1993

[Measurement of cardiac output by Doppler echocardiography: clinical validation in pediatric patients after open heart surgery].

We compared the cardiac output obtained by pulsed Doppler echocardiography (COPW) with simultaneous thermodilution measurements (COTD) in 13 children for 33 times after open heart surgery. Good correlation (r = 0.84, slope = 1.15) of cardiac output was obtained when direct measurements of aortic diameter during operation were used in the calculations. Cardiac output was overestimated (r = 0.89, slope = 1.42) when 2 DE measurements of aortic diameter were used. Nineteen measurements of 8 VSD patients revealed good correlation (r = 0.89, slope 0.85) using direct measurement of aortic diameter, whereas 14 measurements of TOF patients showed somewhat overestimation of cardiac output (r = 0.90, slope = 1.31). In serial determinations, percent change change in COPW well correlated with COTD (r = 0.75, slope = 1.08). We conclude that accurate cardiac output can be obtained by pulsed Doppler echocardiography after pediatric cardiac surgery by measuring aortic diameter directly in operation room. Accuracy in percent change in cardiac output proved that COPW is useful especially in hemodynamically unstable patients after pediatric cardiac surgery.

Age Factors↗
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↗