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Biomedical subjects

K Nishimura

Publications and source records attributed to K Nishimura.

At least 559 records · Page 31Linked to original sources
PubMed1994

Oxitropium bromide improves exercise performance in patients with COPD.

Inhaled anticholinergics may be the first-line therapy for stable COPD. However, the effect of inhaled anticholinergic agents on exercise capacity is still controversial. Fourteen patients with stable COPD (age, 64.6 +/- 5.9 years) completed a randomized, double-blind placebo-controlled crossover trial. All the patients were studied by symptom-limited progressive cycle ergometry before and 90 min after the inhalation of either oxitropium bromide, 800 micrograms, or an identical placebo. Spirometry was assessed before and after each exercise test. While FEV1 averaged 0.85 +/- 0.34 L at 90 min after the inhalation of placebo, FEV1 was 1.01 +/- 0.41 L at 90 min after the inhalation of oxitropium, 800 micrograms (significant from placebo, p < 0.001). The maximal workload of 94.0 +/- 25.8 W after oxitropium administration was significantly greater than the 87.6 +/- 24.7 W measured after placebo (p < 0.01). The maximal minute ventilation was 40.2 +/- 12.3 L/min after oxitropium inhalation and 36.8 +/- 10.5 after placebo inhalation (p < 0.05). The differences in maximal oxygen consumption, maximal carbon dioxide production, and maximal heart rate between oxitropium and placebo inhalation also were statistically significant (p < 0.05, p < 0.05, and p < 0.01, respectively). There was a significant correlation between the change in maximal workload and the change in FEV1 before and after inhalation (r = 0.625, p < 0.01). The inhalation of oxitropium bromide, 800 micrograms, can improve the exercise capacity of patients with stable COPD. It is suggested that the effect is due to the bronchodilation induced by this drug.

Administration, Inhalation↗
PubMed1994

Lymphocytic hypophysitis presenting with diabetes insipidus: case report and literature review.

Lymphocytic adenohypophysitis is an autoimmune disorder of the anterior pituitary gland which usually occurs in a women in the postpartum period. It has been considered that lymphocytic hypophysitis is confined to the adenohypophysis sparing the neurohypophysis, and that diabetes insipidus is not a clinical feature of the disorder. Here we report the case of a 50-year-old woman with lymphocytic hypophysitis which presented with diabetes insipidus. MRI indicated homogeneous swelling of the whole pituitary gland, loss of the normal high intensity of the posterior pituitary, and thickening of the pituitary stalk. A biopsied specimen of the pituitary revealed diffuse lymphocytic infiltration. The diabetes insipidus was controlled by the administration of DDAVP. The anterior pituitary function was not greatly damaged, and no hormonal replacement therapy was necessary. We suggest that this case represents a variant of lymphocytic adenohypophysitis and/or lymphocytic infundibuloneurohypophysitis, in which the chronic inflammatory process involves the infundibulum, adenohypophysis and neurohypophysis.

Autoimmune Diseases↗
PubMed1994

Superficial cemental curettage: its efficacy in promoting improved cellular attachment on human root surfaces previously damaged by periodontitis.

This study was designed primarily to determine whether or not gingival fibroblasts attach to curetted cemental surfaces in periodontally-involved human teeth. Ten periodontally-involved human teeth were used. The superficial cementum from 5 teeth was removed by light mechanical curettage while no root treatment was performed on the remaining 5 teeth. Subsequently, the roots of all teeth were cut longitudinally to create 800 microns thick sections (slabs). Prepared slabs were then placed in 35 mm culture dishes, seeded with human gingival fibroblasts (HGF), and after 4 weeks processed for transmission electron microscopy (TEM). TEM results revealed flattened HGF on the noncuretted cemental surfaces that failed to attach. Fibrillar material was not seen between the HGF and cemental surfaces. In contrast, the HGF that grew on previously curetted cementum exhibited typical morphology of healthy, functional fibroblasts. Newly synthesized fibrillar material and collagen fibrils were noted, and both were apparently oriented towards the curetted cemental surface. Results strongly suggest that improved cellular attachment can be promoted on areas of root surface previously damaged by periodontitis if superficial cementum is first removed by mechanical curettage.

Cell Adhesion↗
PubMed1994

Fibrosis patterns of lesions developed by athymic and euthymic mice infected with Paracoccidioides brasiliensis.

Athymic and euthymic mice with BALB/c background were used to study the patterns of fibrosis during ip infection with a virulent isolate of Paracoccidioides brasiliensis. Specimens from various organs were collected from the animals at 1, 4 and 7 weeks after infection and observed under light microscopy using various histologic staining methods. Lesions from the first week of infection, in both animal groups, presented a predominance of collagen III over I, carboxylated proteoglycans, and a tendency to encapsulation. From 4 weeks onward, the lesions of nu/+ mice tended to involute to macrophage-pseudoxanthomatous aggregates or to encapsulation with an increase of collagen I and sulfated proteoglycans. On the contrary, with the evolution of the infection, the nu/nu mice displayed permanently active lesions, rich in reticular fibers and carboxylated proteoglycans, with varied amounts of collagens III and I, without or with minimal encapsulation. However, independent of the type of mice, or of the type of lesions, the minimal P. brasiliensis-ECM unit was formed by a fibrillar cocoon of reticular fibers that encloses an individual yeast or a "family" composed of a mother cell plus one or various peripheral daughter cells, alone or engulfed by macrophages or giant cells. The overall difference of the lesions of nude and normal mice was not in isolated aspects of their components, but in the general architecture of the lesions. Those of nu/+ mice were either of involutive or of encapsulated type (slightly active), and those of nu/nu mice were of the sustained-expansive type (very active), without or with minimal encapsulation.

Animals↗
PubMed1994

[The effect of stellate ganglion block on the local and global cardiac uptake of 123I-metaiodobenzylguanidine].

To investigate the effect of stellate ganglion block (SGB) on the cardiac uptake of 123I-metaiodobenzylguanidine (MIBG), four patients without heart disease underwent SGB. Studies were done twice: once with SGB and once without SGB. Anterior planar images and myocardial SPECT images were taken at 10 minutes and 60 minutes after MIBG injection both with and without SGB. Cardiac uptake of MIBG on planar images estimated by heart/liver ratio was significantly higher with SGB at both imaging times (p < 0.01, p < 0.05) than without SGB. SGB had no effect on the local uptake of MIBG on SPECT images. In conclusion, SGB did not change the local cardiac uptake of MIBG, but it appeared to increase the global myocardial uptake of MIBG.

3-Iodobenzylguanidine↗
PubMed1994

[Lymphangioma of the penis: a case report].

We report a case of lymphangioma of the penis. A 45-year-old man presented with a painless mass on the dorsal penis. A soft and movable mass was excised under local anesthesia. Pathological findings demonstrated vast amounts of fluid, which did not involve any blood cells and confirmed it to be cavernous lymphangioma. After 2 years postoperatively, no evidence of recurrence was present. We review 22 reports of penile lymphangioma in Japan.

Humans↗
PubMed1994

[Effect of continuous infusion of flumazenil on unexpected postoperative resedation by midazolam].

Resedation after general anesthesia induced by midazolam is thought to be not an unusual problem for the anesthetists. We investigated the effect of continuous infusion of flumazenil on the patients who had general anesthesia using midazolam as an induction agent and had flumazenil for prolonged recovery after procedure. Fourteen of 54 patients were judged as prolonged recovery and were given 0.25 mg of flumazenil. Then, they were randomly divided into the following two groups. In the first group, another 0.25 mg of flumazenil was given 2 hours after the first flumazenil. In the second group, 0.25 mg of flumazenil in 250 ml of lactated Ringer's solution was given continuously for 2 hours after the first flumazenil. All the patients were fully awake after the first flumazenil but one case of resedation occurred in the first group and in none of the patients in the second group. We conclude that continuous infusion of 0.25 mg of flumazenil for 2 hours is effective and makes anesthetist free from anxiety of postoperative resedation by midazolam.

Adult↗
PubMed1994

[Bellini duct carcinoma treated with partial nephrectomy: a case report].

We report a rare case of collecting duct carcinoma of the kidney (Bellini's duct carcinoma). A 37-year-old woman visited our hospital with a chief complaint of asymptomatic hematuria. We suspected right renal pelvic tumor from the detection of round filling defects in the upper calyces of the right kidney by image diagnoses. A ureteroscopic biopsy revealed a low grade renal cell carcinoma. Therefore, she received right partial nephrectomy immediately. Histological examination of the surgical specimen showed a highly differentiated adenocarcinoma with papillary proliferation besides the collecting duct epithelium. With the results of the strongly positive patterns of immunohistochemical staining with high molecular cytokeratin and peanut aggulutinin, the tumor corresponded to the distal nephrons. Therefore we made the diagnosis of Bellini's duct carcinoma. She had been alive without evidence of metastases for one year after surgery.

Adult↗
PubMed1994

[The accuracy and side effects of pharmacologic stress thallium myocardial scintigraphy with adenosine triphosphate disodium (ATP) infusion in the diagnosis of coronary artery disease].

The diagnostic accuracy and side effects of pharmacologic stress thallium myocardial scintigraphy with ATP infusion were studied in 172 patients with or without coronary artery disease. ATP was infused for five minutes at a rate of 0.16 mg/kg/min (group A) or 0.18 mg/kg/min (group B) via antecubital vein. One hundred and eleven (67 of group A, 44 of group B) of 172 patients underwent coronary arteriography (CAG). In 111 patients received CAG, overall sensitivity, specificity and accuracy of this method were 88%, 84% and 87%, respectively. In 67 patients of group A, these were 92%, 81% and 90%. In 44 patients of group B, 79%, 87% and 82% were documented (NS, between group A and B). Chest pain, flushing, bradycardia and ST depression were included in side effects caused by ATP infusion. At least one of these side effects were observed in 84% of the all 172 patients, 89% of group A and 75% of group B (NS). But, all of the side effects were spontaneously alleviated within two minutes without any therapy. In conclusion, pharmacologic stress myocardial scintigraphy with ATP infusion is very accurate and safe, and infusion rate of 0.16 mg/kg/min is optimal for this purpose.

Adenosine Triphosphate↗
PubMed1994

[Assessment of myocardial viability by thallium-201 reinjection imaging with sublingual nitroglycerin].

Although thallium-201 (201Tl) reinjection imaging improves the detection of myocardial viability compared to standard 3-4-hr redistribution (RD) imaging, it still underestimates the extent of viable myocardium. We examined whether 201Tl reinjection SPECT with sublingual nitroglycerin (NTG) had a higher sensitivity for viability detection than reinjection alone. Eighty patients with coronary artery disease were studied, 38 of them with an old myocardial infarction. At the peak of exercise, 111 MBq 201Tl was injected and the initial and the delayed SPECT images were obtained. Then, all patients were divided randomly into two groups, and in each group, SPECT data were obtained again after the injection of 37 MBq 201Tl with (NTG(+) group) or without 0.6 mg of sublingual NTG (NTG(-) group). Among 50 segments showing fixed defects on the delayed image in the NTG(+) group, 21 (42%) were found to be reversible on the reinjection image, as compared to 16 of 51 (31%) in the NTG(-) group. Twenty-two of 44 (50%) segments showing incomplete RD were found to be reversible in the NTG(+) group, while 17 of 42 (41%) segments in the NTG(-) group. Moreover, the ratio of reversible segments seen in the reinjection images was significantly higher in the collateralized regions of the NTG(+) group than in those of the NTG(-) group (20/26 vs. 14/28, p < 0.05). Thus, 201Tl reinjection SPECT with sublingual NTG improves the detection of ischemic but viable myocardium as compared to SPECT with reinjection alone.

Administration, Sublingual↗
PubMed1994

[Left heart bypass with the bio-medicus centrifugal pump by the use of an antithrombin agent, argatroban].

Seventeen adult patients who underwent surgery for the thoracic or thoracoabdominal aortic disease by the use of left heart bypass with the Bio-Pump were divided into untreated, low-dose heparin treated and argatroban treated groups so as to evaluate the effects of systemic infusion of a newly synthesized antithrombin agent, argatroban, for the prevention of platelet loss and consumption coagulopathy. ACT reached 150 to 250 seconds at doses 0.5-7.5 micrograms/kg/min of argatroban and maximum ACT prolongation was limited to around 250 seconds. ACT spontaneously recovered below 150 seconds within 60 minutes following the end of bypass during which no excessive blood loss developed. In argartoban group, platelet loss during and immediately after surgery was effectively prevented as compared to other groups with significance. Fibrinogen was also preserved to some extent by argatroban treatment without evidence of systemic embolization. Argatroban, as an antithrombotic agent, is worthy of further trial of clinical use in bypass with a centrifugal pump.

Adult↗
PubMed1994

[A case of primary hyperparathyroidism associated with marked hypercalcemic crisis].

A 41-year-old woman was referred to our hospital with complaints of general fatigue, appetite loss, nausea and vomiting. Blood examination revealed high serum calcium level (21.6 mg/dl) and high serum parathyroid hormone level. Although enlarged parathyroid glands could not be clearly detected via ultrasonography, computed tomography and scintigraphy, we diagnosed her with hypercalcemic crisis due to primary hyperparathyroidism and performed parathyroidectomy after conservative therapy. A parathyroid tumor measuring 1.9 x 1.1 x 1.0 cm, and weighing 1,100 mg was found at the upper right pole of the thyroid gland, and three thyroid tumors were found in the bilateral lobes of the thyroid gland. Histological diagnosis was adenoma of the parathyroid gland and follicular adenomas of the thyroid gland. Following removal of the parathyroid tumor, the serum calcium level rapidly dropped and the symptoms rapidly improved. Hypercalcemic crisis has a high mortality, and the only treatment is surgical removal. Therefore, in patients with hypercalcemic crisis due to primary hyperparathyroidism, surgical removal should be done immediately, unless the serum calcium level has dropped and symptoms of crisis have disappeared after conservative treatment.

Adenoma↗
PubMed1994

[Effect of left heart bypass on right ventricular function in normal and acute heart failure dogs--an application of the conductance catheter to the right ventricle].

We investigated right ventricular function during left heart bypass (LHB) with 18 mongrel open-chest dogs, in normal and acute heart failure (AHF) dogs which underwent aortic cross clamp. Left ventricular unloading was completely accomplished with a centrifugal pump. For more accurate evaluation of right ventricular volume, conductance catheter was employed to assess right ventricular function. Analysis were performed with right ventricular pressure-volume curve which was changed by transient volume loading on right ventricle. And right ventricular properties with and without LHB were compared by the use of load independent parameters as follows. Right ventricular systolic property was evaluated by maximum elastance (Emax) and stroke work-end-diastolic volume relation (SW/EDVR), and its diastolic function was evaluated by end-diastolic pressure-volume relation (EDP/VR). Overall right ventricular performance was assessed by stroke work-end-diastolic pressure relationship (SW/EDPR). In the normal heart, only a parallel shift to the right in EDP/VR and SW/EDVR was noted without any significant changes in slope with LHB. On the other hand, in AHF dogs, the slope of SW/EDVR and SW/EDPR were increased from 0.14 +/- 0.08 to 0.18 +/- 0.08 (p < 0.05), from 0.22 +/- 0.15 to 0.34 +/- 0.19 (p < 0.01), respectively, and the curve of EDP/VR was shifted right and downward. These result suggested that decompression of the left ventricle and septal shifting by LHB provided good diastolic compliance and afterload unloading of the right ventricle, and these effects had a more significant role in acute heart failure than in the normal heart.

Acute Disease↗
PubMed1994

[A case of nontraumatic rupture of ascending aorta].

A 34-year-old man became shock caused by nontraumatic ascending aortic rupture. He was urgently operated. The aortic annulus was mildly ectatic and right coronary cusp was aneurysmal but not perforated. There was a small laceration in the anterior aortic wall without dissection. Cabrol operation was performed.

Adult↗
PubMed1994

[Leiomyoma of the kidney: a case report].

A case of leiomyoma of the kidney is reported. A 57-year-old man with the chief complaint of right back pain was consulted to our hospital. Abdominal computed tomography (CT) demonstrated a right renal tumor. Right renal angiography revealed a hypovascular lesion. Under the diagnosis of right renal tumor, right radical nephrectomy was performed. Gross evaluation revealed a well encapsulated solid mass. The tumor was 48 x 43 x 42 mm in diameter and a hemorrhagic region was present. Microscopically, the tumor was composed of interlacing bundles of spindle cells. Diagnosis was leiomyoma of the kidney. We reviewed 42 cases of renal leiomyoma reported in Japanese literature.

Humans↗
PubMed1994

[A case of IgA nephropathy associated with psoriasis vulgaris].

Nephrotic syndrome due to IgA nephropathy was found in a 45-year-old man with psoriasis vulgaris. He was first diagnosed as psoriasis vulgaris at 20 years age and had exhibited proteinuria since 37 years of age. Recently, he developed nephrotic syndrome with unfavorable progression of psoriasis. The conditions of psoriasis and nephrotic syndrome were consistently parallel, and both diseases responded to corticosteroid therapy. The specimens from renal biopsy showed mesangial proliferative glomerulonephritis and sclerosis with mesangial deposition of IgA. Therefore, we diagnosed this case as IgA nephropathy. Twelve cases with chronic glomerulonephritis associated with psoriasis vulgaris have been published. All biopsied specimens from these cases showed mesangial deposition of IgA. Immune abnormalities have been reported in both diseases. The pathogenesis of psoriasis vulgaris and IgA nephropathy may be related through an immune mechanism.

Adult↗