Biomedical subjects

K Miwa

Publications and source records attributed to K Miwa.

At least 253 records · Page 14Linked to original sources

PubMed1993

Comparative efficacy of thrombolytic therapy for acute myocardial infarction in patients with and without chronic preinfarction angina.

To resolve the question of whether coronary thrombolysis for acute myocardial infarction is more effective in patients with or in those without chronic preinfarction angina, we retrospectively analyzed cineventriculograms in 54 patients with the first anterior Q-wave myocardial infarction during the chronic stage of myocardial infarction. Patients were divided into 2 groups according to the presence (group A, n = 24) or absence (group B, n = 30) of chronic preinfarction angina. In group A, 16 had either intracoronary (n = 6) or intravenous (n = 10) coronary thrombolysis with urokinase within 6 h after the onset of acute myocardial infarction. In group B, 11 had either intracoronary (n = 4) or intravenous (n = 7) coronary thrombolysis within 6 h after the onset of acute myocardial infarction. Global left ventricular ejection fraction and regional wall motion in infarct areas were evaluated quantitatively. In group A, the percentage of systolic segment shortening in infarct areas was 20 +/- (SD) 16% in patients with thrombolytic therapy and 17 +/- 15% in those with conventional therapy (p = NS). By contrast, in group B, the regional wall motion in infarct areas was significantly (p < 0.01) better in patients with thrombolytic therapy compared to those with conventional therapy (13 +/- 10 vs. 3 +/- 8%). Thus, patients without chronic preinfarction angina might benefit from coronary thrombolysis, while in those with preinfarction angina the beneficial effect of thrombolytic therapy may be relatively limited.

Adult↗

PubMed1993

Comparative effects of early and late reperfusion of the infarct-related coronary artery and collateral circulation which develops after infarction on left ventricular size and function.

This study assesses the effects of early and late reperfusion of the infarct-related coronary artery and collateral circulation developed after infarction on left ventricular morphology and function in 22 patients with a first acute anterior myocardial infarction and without long-standing preinfarction angina. The patients were categorized into 4 groups: group A-5 patients with successful reperfusion within 6 h after the onset of infarction: group B-6 patients with late patency of the infarct-related coronary artery; group C-6 patients without recanalization of the infarct-related coronary artery who had good collateral circulation (collateral index (CI) = 2 or 3); and group D-5 patients without recanalization who had either poor or no collateral circulation (CI = 0 or 1). The left ventricular size and function were evaluated by means of contrast left ventriculography during the chronic stage of infarction. The left ventricular global and regional functions were preserved better (p < 0.05) in group A than in the other three groups. Although there was no difference in regional wall motion of the infarct area among groups B, C and D, the ejection fraction was greater (p < 0.05) and the percentage perimetric circumference was smaller (p < 0.05) in groups B and C than in group D. Among the 4 groups, the left ventricular end-diastolic volume index tended to be greater in group D. Thus, these results suggest that blood supply to the infarct area is essential for the preservation of left ventricular size and function regardless of the timing and route.

Adult↗

PubMed1993

Alternate coronary artery spasm with ST-segment "seesaw" phenomenon in variant angina.

Five patients with variant angina showed alternating ST-segment elevation and contralateral ST-segment depression between the precordial and inferior leads in electrocardiographic recordings made during sequential anginal attacks. This electrocardiographic "seesaw" phenomenon was observed during ergonovine-induced attacks in 3 cases and during spontaneous attacks in 1 case. Another patient showed ST-segment elevation in a spontaneous attack and in other leads during hyperventilation. In all cases, the first attack was accompanied by ST-segment elevation in the inferior leads. Coronary arteriography demonstrated that in all cases, coronary arterial spasm occurred during the attacks in both coronary arterial systems. Significant organic coronary arterial stenoses (> 50%) were found in both the left anterior descending branch and the right coronary artery in 2 patients. The remaining 3 patients showed no significant organic stenoses in any major coronary artery. However, pre-anginal coronary arteriography demonstrated that 13 of the 15 major coronary arteries, including all 9 of the major coronary arteries in the patients without significant stenoses, were already spastic. An exercise stress test performed in the morning induced attacks with chest pain and electrocardiographic ST-segment elevation in all 5 patients. The patients having an alternate ST-segment elevation in separate leads had vasospastic tendencies in both coronary arterial systems.

Adult↗

PubMed1993

Determinants of beneficial effect of heparin exercise treatment on treadmill capacity and long-term efficacy of the therapy in patients with chronic effort angina.

The purpose of the present study was to evaluate the factors which influence the effect of heparin exercise treatment on treadmill capacity, and to examine the long-term efficacy of the treatment in 16 patients with chronic effort angina. Treadmill exercise was performed 20 times for 2 to 3 weeks according to standard Bruce protocol. A single intravenous dose of heparin (5,000 IU) was given 10 min before each exercise period. Exercise with heparin pretreatment increased the total exercise duration from 6.6 +/- 1.6 (SD) to 9.4 +/- 1.9 min (p < 0.05) and the maximal rate-pressure product from 19,200 +/- 4,700 to 24,700 +/- 5,900 mmHg.beats/min (p < 0.05). The rate-pressure product at the onset of angina was also increased by 32% (p < 0.05). The ST segment depression at the same exercise time as in control exercise was ameliorated from 0.16 +/- 0.05 to 0.12 +/- 0.06 mV (p < 0.05). Multivariate analysis of the determinants of the effect of the treatment on treadmill capacity indicated that the treatment is more effective in patients without previous myocardial infarction. All of the above-mentioned variables of treadmill capacity did not change significantly during a follow-up period of 13 +/- 7 months (range; 4-24 months). These findings lend further support to heparin exercise treatment as a possible therapeutic approach in patients with chronic stable effort angina, and particularly in those without previous infarction.

Aged↗

PubMed1993

Augmentation of smoking cessation education by urinary cotinine measurement.

Monitoring the current smoking status by an objective method may augment the effects of smoking cessation instruction. To quantitatively evaluate smoking status and its modification by smoking cessation instruction, urinary cotinine, a major metabolite of nicotine, was measured by radioimmunoassay in 64 patients with a smoking habit before and during smoking cessation instruction. Urinary cotinine levels were used to discriminate between smokers and nonsmokers (with 50 ng/ml used as a threshold). In 49 patients who claimed to have stopped smoking, urinary cotinine concentrations 1 month after instruction indicated that only 30 (61%) of them had actually stopped (before: 243 +/- 104, after: 1 +/- 3 ng/ml) (mean +/- standard deviation). In the remaining 15 patients who failed to stop smoking while reporting a reduction of cigarette consumption (before: 27 +/- 12, after: 7 +/- 5/day), there was no appreciable reduction in urinary cotinine levels (before: 298 +/- 140, after: 229 +/- 171 ng/ml). When the patients who had failed to stop smoking again received intensive smoking cessation instruction, the success rate increased from 47% (30/64) to 69% (44/64) (p < 0.05). Thus, urinary cotinine measurement may provide a useful and quantitative method for monitoring actual smoking habits and thus augment the efficacy of smoking cessation educational programs.

Cotinine↗

PubMed1993

Analysis of maxillary sinusitis using computed tomography.

Odontogenic maxillary sinusitis can be defined as sinusitis induced by a dental lesion. We examined the CT findings of 68 patients with maxillary sinusitis in order to differentiate between inflammation of sinus origin and inflammation of dental origin. Maxillary sinusitis was classified into four types according to clinical symptoms, history and conventional radiographic findings: type 1, simple sinusitis; type 2, odontogenic sinusitis; type 3, mixed sinusitis; type 4, slight sinus abnormality with a dental lesion. The relationship between the type of maxillary sinusitis and CT findings was analysed. Type 1 sinusitis exhibited severe pathological changes in both mucosa and bone which often extended into the nasal cavity and other paranasal sinuses. Type 2 sinusitis exhibited localized pathology on the unilateral antral floor. Type 3 sinusitis exhibited severe pathology characteristic of type 1 combined with type 2 sinusitis. Type 4 sinusitis could be differentiated by the CT findings into type 1 or type 2 sinusitis. The classification of sinusitis in this manner has implications for treatment planning, and CT should therefore be performed when conventional radiography does not provide sufficient information.

Female↗

PubMed1993

[Evaluation regarding effect and quality of life after distal pancreatectomy combining total gastrectomy].

Distal pancreatectomy combined with total gastrectomy for gastric carcinoma was evaluated in regard to the availability and quality of life for patients. We performed a question-naire survey of their daily life, especially regarding postpancreatectomy diabetes, for 67 patients passed 5 years after total gastrectomy inclusive of five cases without pancreatectomy as control. Eleven cases developed diabetes mellitus which needed insulin injection after distal pancreatectomy excluding three patients with glucose intolerance before operation. These were 19% of cases performed pancreatectomy, while there was no diabetes in cases without pancreatectomy. The incidence of postpancreatectomy diabetes was 60 per cent of the cases which underwent Appleby operation (65% pancreas resection), while it was 50 percent of the cases which underwent total gastrectomy combined with distal pancreatectomy (50% resection). There is significant difference at < 0.05 level. The incidence of postpancreatectomy diabetes was increased as passing of years after operation. These results suggest that distal pancreatectomy combining total gastrectomy improves the prognosis of patients with nodal metastasis. But considering the occurrence of postpancreatectomy diabetes, it should be emphasized the adequate indication is needed for the operation, and close and long-term follow up is essential for keeping QOL.

Diabetes Mellitus↗

PubMed1993

Correlation between DNA ploidy and clinical features in smooth muscle tumors of the gastrointestinal tract.

Paraffin-embedded tissue samples from 51 surgically resected, gastrointestinal smooth muscle tumors (10 leiomyomas, 5 leiomyoblastomas and 36 leiomyosarcomas) were assayed for nuclear DNA content, and the results were examined for correlation with clinico-pathological variables (tumor size, cellularity and mitosis) and prognosis. Twenty-four (47%) of the 51 tumors, consisting of 3 (30%) of the 10 leiomyomas, 2 (40%) of the 5 leiomyoblastomas and 19 (53%) of the 36 leiomyosarcomas, were identified as aneuploid. A close correlation was found between the mitotic index and the tumor size ( = 0.528; P < 0.001). The DNA ploidy pattern of the leiomyosarcoma was closely correlated with the patient survival periods (P = 0.06). The estimated median survival period was 73 months for patients with diploid tumors, and 51 months for those with aneuploid tumors. The 10-year survival rate for aneuploid tumors was lower than that for diploid tumors (P < 0.001). The measurement of DNA content may provide an index of prognostic value in gastrointestinal leiomyosarcomas.

Adult↗

PubMed1993

[Study of pre- and post-operative chemotherapy with oral 5-FU in patients with gastric cancer. Study Group of Pre- and Post-Operative Oral 5-FU in Gastric Cancer].

A cooperative study group consisted of 37 medical institutions evaluated the utility of pre- and post-operative chemotherapy with oral 5-FU by comparing with the historical controls of the patients treated with operation alone who were registered in Japanese Gastric Cancer List. Of 634 patients entered in this trial, 366 patients received curative operation at macroscopical stages II and III were studied as eligible cases. The relative 5-year survival at macroscopical stage II and III was 68.6% with 5-FU, significantly higher than 62.6% with operation alone (p < 0.05). Particularly, 5-year survival at macroscopical stage III was markedly different between 57.1% with 5-FU and 42.7% with operation alone. In order to make more effective comparison with the historical controls in this 1-arm trial, the background factors in 5-FU and control groups were matched in the ratio of 1:2 or 1:3 with respect to the following 4 factors: tumor site, S, N and macroscopical tumor type (by Kajitani's classification). As a result, the 5-year survival at macroscopical stages II and III was significantly higher with 5-FU (67.5%, 69.1%) than with operation alone (59.9%, 59.8%), and in particular this tendency was more marked at macroscopical stage III. These results suggest the usefulness of adjuvant chemotherapy in macroscopical stage III gastric cancer.

Administration, Oral↗

PubMed1993

[Preoperative prediction of gastric cancer development by in vitro labelling index of bromodeoxyuridine].

In vitro labelling index (L.I.) of bromodeoxyuridine (BrdU) was evaluated as a preoperative predictor of gastric cancer development. Biopsy specimens were obtained endoscopically from 187 gastric cancer patients preoperatively. Specimens were incubated in RPMI containing BrdU under carbogen gas at 3 times atmospheric pressure. They were fixed and embedded in paraffin. After slicing and dewaxing, they were denatured in 2N HCl. Then BrdU were stained by ABC method and labelling index was calculated. Patients with L.I. more than 10% had a significantly higher risk of lymph node involvement (p < 0.001) and venous invasion (p < 0.05). Those with L.I. more than 20% had a significantly higher risk of liver metastasis (p < 0.01), while patients with L.I. more than 25% had a significantly higher risk of submucosal invasion (p < 0.01). In conclusion in vitro BrdU labelling is a technique available as a preoperative predictor of node involvement, venous invasion, submucosal invasion and prognosis in gastric cancer.

Bromodeoxyuridine↗

PubMed1992

Expression of p53 protein in colorectal cancer and its relationship to short-term prognosis.

BACKGROUND AND METHODS: The expression of p53 protein in 100 large bowel cancers was studied immunohistochemically by use of a monoclonal antibody (PAb1801). RESULTS: Immunoreactivity was found in 61.0% of specimens from 100 patients with colorectal cancer. The pattern of p53 expression was mainly detected in the nuclei of the cancer cells. There was no significant correlation between the expression of p53 and the histologic grade, tumor size, serosal invasion, lymphatic invasion, venous invasion, lymph node metastasis, or liver metastasis. However, patients with p53-positive tumors had a greater relative risk of death compared with those with p53-negative tumors. The p53 negative-tumors showed a recurrence rate of 5.9%; for the p53 positive-tumors, a recurrence rate of 23.8% was recorded. The 3-year survival rate was 96.7% of 39 patients with p53-negative carcinomas and 61.8% for the patients with p53-positive tumors; there was a significant difference in the rate between the two groups of patients (P < 0.05). The growth fraction of p53-positive tumors determined with a monoclonal antibody against DNA polymerase alpha (49.0%) was significantly higher than that of p53-negative tumors (40.7%, P < 0.01). CONCLUSIONS: These results suggest that the immunoreactivity of p53 may be a biologic marker of prognostic significance.

Analysis of Variance↗

PubMed1992

[CT features of chronic maxillary osteomyelitis in adults].

CT findings were reviewed in four adult patients with chronic maxillary osteomyelitis (CMO) that was histologically proved. The CT features of CMO included bone destruction and soft tissue mass, predominantly in the inferior portion of the maxillary antrum (all 4 cases), thickening of the antral wall (3 cases) and abnormal soft tissue around the antrum associated with or without bony wall destruction (3 cases). CMO could not be distinguished from cancer of the maxillary antrum on CT because of the similar findings. However, abnormal soft tissue around the antrum together with an undestructed bony antral wall may be useful for differentiating the two diseases.

Adult↗

PubMed1992

Effects of diltiazem and verapamil on (+)-PN 200-110 binding kinetics in dog cardiac membranes.

The effects of d-cis-diltiazem (diltiazem) and verapamil on 1,4-dihydropyridine binding to dog cardiac membranes were studied in competition, saturation and kinetic binding experiments with [3H](+)-PN200-110. Diltiazem increased [3H](+)-PN200-110 binding with an observed maximal effect at 50 microM, while verapamil decreased [3H](+)-PN200-110 binding in a dose-dependent manner. Scatchard analysis of saturation binding data revealed that diltiazem (50 microM) increased the maximal binding site density and verapamil (100 microM) increased the dissociation constant (KD) of [3H](+)-PN200-110 binding. The kinetic experiments demonstrated that diltiazem significantly reduced both the association and the dissociation rate of [3H](+)-PN200-110 binding, resulting in no significant change in the apparent KD. In contrast, verapamil accelerated dissociation and slowed down association of [3H](+)-PN200-110 binding. Diltiazem appears to alter both the number of [3H](+)-PN200-110 binding sites and the characteristics of [3H](+)-PN200-110 binding.

Allosteric Regulation↗

PubMed1992

Independent clinical and flow cytometric prognostic factors for the survival of patients with stage I gastric cancer.

Paraffin-embedded tumor samples from 151 patients with stage I gastric cancer were analyzed by DNA flow cytometry, and 80 patients received an infusion of bromodeoxyuridine (BrdU) to determine S-phase fraction. S-phase fractions of tumors were measured by the immunohistochemical method using anti-BrdU monoclonal antibody. Of the 151 patients, 81 (54%), and 70 (46%) showed diploid and aneuploid patterns. There was no significant association between DNA ploidy and wall invasion, histologic type, or lymphatic invasion. Aneuploid tumors were associated with positive-vessel invasion. When the DNA ploidy and clinicopathological parameters were simultaneously entered into the Cox regression model, DNA ploidy and wall invasion emerged as independent prognostic parameters. Aneuploid tumors had significantly higher values of BrdU labeling indices than diploid ones. These results indicate that the determination of DNA ploidy patterns may be an important prognostic factor in patients with stage I gastric cancer, and may be useful in deciding the therapeutic schedule of patients with gastric cancer.

Aneuploidy↗

PubMed1992

Effect of intra-hepatoarterial infusion of MMC and CDDP for gastric cancer patients with liver metastases.

The influence of operative treatment and chemotherapy on the prognosis in 93 gastric cancer patients with liver metastasis was studied. Chemotherapy included the systemic administration of mitomycin C (MMC) (39 patients), an intra-hepatoarterial infusion of MMC (MMC IAC group) (19 patients) and an intra-hepatoarterial infusion of MMC and cisplatin (CDDP) (MMC + CDDP IAC group) (24 patients). Either MMC or MMC and CDDP were given in 1-4 courses every 3-4 weeks from the first one to two post operative weeks. The response rate was 4 per cent (1/23), 29 per cent (5/17) and 73 per cent (17/23) for MMC systemic administration, MMC IAC and MMC + CDDP IAC, respectively, with a significantly high rate of effectiveness for the MMC + CDDP IAC. In addition, regarding the median survival period, the MMC + CDDP IAC group showed 11.8 months, as compared with 2.9 months for other chemotherapeutic treatments, indicating a good prognosis regardless of any possible resection of the primary lesion. A Cox proportional hazard model revealed the treatment by MMC + CDDP IAC alone to be a significant independent factor. These results indicated that MMC + CDDP intra-arterial chemotherapy is an effective approach to gastric cancer with liver metastasis.

Adult↗

PubMed1992

The succinate dehydrogenase inhibition test for evaluating biopsy specimens and resected tumors of advanced gastric cancer.

An in vitro chemosensitivity study of both biopsy specimens and surgically resected tumors of advanced gastric cancer from 12 patients was evaluated using the succinate dehydrogenase inhibition (SDI) test. A decrease in succinate dehydrogenase (SD) activity as an indicator of chemosensitivity was determined using cisplatin (CDDP), etoposide (VP-16), and mitomycin C (MMC). In this study, 29 of a total 36 experiments were evaluable (80.6%) and significant correlations were found in all three of the antitumor drugs (P < 0.03). This finding suggests that the SDI test using biopsy specimens may prove valuable for assessing the preoperative chemosensitivity of advanced gastric cancer.

Aged↗

PubMed1992

Is bile or are pancreaticoduodenal secretions related to gastric carcinogenesis in rats with reflux through the pylorus?

Male Wistar rats were subjected to one of three types of operative reflux procedure that allowed part or all of the duodenal contents to flow back into the stomach through the pylorus, thus producing models of bile reflux alone, pancreaticoduodenal reflux alone, and combined reflux. All surviving animals were killed 50 weeks after surgery and the development of gastric cancer was assessed. No cancer was seen in 16 animals with pancreaticoduodenal reflux or in 32 control animals with gastrotomy, whereas 2/8 animals with bile reflux and 11/29 animals with combined reflux had gastric carcinoma. Compared with the control group, the incidence of carcinoma in animals with bile or combined reflux was significantly higher (P less than 0.05 and P less than 0.01 respectively). All carcinomas developed in the antral area near the pylorus. Adenomas were observed only in the groups of animals developing carcinoma and occurred in the same region of the stomach. These results suggest that bile, and not pancreaticoduodenal secretions, is the component of the duodenal contents responsible for the development of gastric carcinoma.

Adenocarcinoma↗

PubMed1992

Intraperitoneal hyperthermic treatment for peritoneal dissemination of colorectal cancers.

Continuous hyperthermic peritoneal perfusion (CHPP) combined with administration of anticancer drugs was performed in eight colorectal cancer patients with peritoneal dissemination. An overall response rate of 50 percent was achieved in the eight patients. Two of three complete responders are long, recurrence-free survivors for 15 and 30 months. The two-year survival has been achieved in 18.8 percent of the patients receiving CHPP, and this rate is significantly higher than the rates in P2 and P3 patients who did not receive CHPP. The complications of CHPP with administration of anticancer drugs were mild bone marrow suppression in two (25 percent) of the eight patients and also a mild grade of renal dysfunction in one (12.5 percent), though not lethal. The results suggest that the combination of CHPP with the administration of anticancer drugs is a safe and effective therapy for peritoneal dissemination of colorectal cancers.

Adult↗