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Biomedical subjects

K Ohtomo

Publications and source records attributed to K Ohtomo.

At least 55 records · Page 3Linked to original sources

Estimation of 99mTc-MAG3 clearance by single-sample methods and camera-based methods.

We compared single-sample methods, proposed by Russell et al. and Bubeck et al., and camera-based methods in calculating 99mTc-MAG3 clearance, and determined camera-based methods that provide estimates comparable to those measured by the Russell method. Twenty-one patients underwent 99mTc-MAG3 renal scintigraphy, and clearance was measured by the Russell method and Bubeck method. Various renogram parameters were determined based on the slope of the renogram and area under the renogram, and correlated with the clearance measured by the Russell method. Camera-based clearance was calculated with the obtained regression equations and with equations determined previously using the Bubeck method as a standard. The Bubeck method provided lower measures than the Russell method in high renal function. Clearance measured by the Russell method was well correlated with renogram parameters, and clearance calculated with the obtained regression equation was comparable to that measured by the Russell method. When camera-based clearance was predicted with the previous equation, it was lower than the result obtained by the Russell method in high function. In conclusion, there are systematic differences in 99mTc-MAG3 clearance calculated by different methods. The camera-based methods obtained in this study appear to facilitate comparison of results obtained by the Russell method and camera-based method.

Adult↗

Three-dimensional computed tomography for reoperative minimally invasive coronary artery bypass.

We have been using three-dimensional computed tomography (3-D CT) in reoperative coronary artery bypass grafting performed by using a minimally invasive approach. Preoperative 3-D CT scanning can provide beneficial anatomical information about old patent grafts as well as the internal thoracic artery. Thus a mini-thoracotomy can be created at an optimal site, leaving the old graft untouched, and the length of the harvested internal thoracic artery, necessary for the bypass, can be assessed using this new modality.

Coronary Artery Bypass↗

Predictive value of gross classification of hepatocellular carcinoma on recurrence and survival after hepatectomy.

BACKGROUND/AIM: A new gross classification of hepatocellular carcinoma in which Eggel's nodular type is subclassified into type 1 (single nodular type), type 2 (single nodular type with extranodular growth), and type 3 (contiguous multinodular type) has been widely used in Japan. The aim of the study was to determine whether this classification is correlated with patient outcome. METHODS: Sixty-five resected hepatocellular carcinoma nodules (< or = 5 cm) were classified using this new classification. RESULTS: The 65 tumors were classified into 30 type 1 (46%), 20 type 2 (31%), and 15 type 3 (23%) hepatocellular carcinomas. The rate of microscopic vascular invasion significantly increased from type 1 to type 2, and to type 3 tumors (p=0.03). Kaplan-Meier estimates showed that type 1 was significantly associated with lower recurrence rate (type 1 vs. type 2, p=0.01; type 1 vs. type 3, p=0.004; log-rank test), and higher disease-specific survival (type 1 vs. type 2, p=0.02; type 1 vs. type 3, p=0.002). Cox's proportional-hazards model demonstrated that type 1 was an independent factor for low risk of recurrence (p=0.002) and low risk of disease-specific death (p=0.02). CONCLUSION: The gross classification of hepatocellular carcinoma is of clinical value in predicting patient outcome.

Aged↗

Different cortical activity in reading of Kanji words, Kana words and Kana nonwords.

We report a positron emission tomography study on reading of Japanese Kanji (morphograms) words, Kana (phonograms) words and Kana nonwords using statistical parametric mapping. Activity was more pronounced in the lateral fusiform gyrus (Area 37) in Kanji, in contrast to the greater activation in the middle and inferior occipital gyri (Areas 18 and 19) and the deep perisylvian temporo-parietal area (Areas 40/22 and 22/21) in Kana, suggesting that Kanji and Kana are processed differently.

Adolescent↗

Contrast-enhanced magnetic resonance imaging of the cranial nerves in patients with acoustic schwannoma: correlation with surgical findings.

Eighteen patients with acoustic schwannoma were examined on a 1.5-T magnetic resonance imaging (MRI) unit with precontrast and postcontrast T1-weighted spin-echo sequences. Each abnormality was assessed in terms of the size, location, extensions and signal intensity of the lesions. If a nerve was enhanced and was involved by the tumor around the fundus of the internal auditory canal (IAC), the nerve was interpreted to be the originating nerve. The postcontrast T1-weighted images revealed enhanced masses of the cerebellopontine angle and/or the IAC in all cases. In 11 of the 19 operated patients with shwannomas, the site of tumor origin (or origin nerve) was confirmed by surgery. In 2 of the 11 cases (18%), surgical findings coincided with the T1-weighted image findings. Facial nerve enhancement on the ipsilateral side of the tumor was noted in 10 cases (53%) and the contralateral facial nerve enhancement was demonstrated in 7 (70%). The enhancement of facial nerve associated with acoustic schwannoma was not correlated to the degree of nerve compression by the tumor. These results demonstrate that it was possible, although infrequent, to predict the site of origin of acoustic schwannoma before surgery in some patients. Improvement of the imaging matrix or multiplanar reconstruction techniques with three-dimensional data acquisition may make it possible to overcome the limitations of MRI.

Adult↗

Temporal changes of the apparent diffusion coefficients of water and metabolites in rats with hemispheric infarction: experimental study of transhemispheric diaschisis in the contralateral hemisphere at 7 tesla.

The purpose of the present study was to clarify the temporal changes of the apparent diffusion coefficients (ADCs) of cerebral metabolites during early focal ischemia using stimulated echo acquisition mode with short echo time at a 7 T magnet to assess the pathophysiology of the reduction in diffusion properties observed both in the ischemic cerebral hemisphere and in the contralateral hemisphere. The ADCs of metabolites in the infarcted hemisphere 1 hour and 3 hours after the onset of ischemia decreased with 25% and 29% for choline containing compounds (Cho), 16% and 26% for creatine and phosphocreatine (Cre), and 19% and 19% for N-acetylaspartate (NAA), respectively, compared with the ADC values 2 hours later in the contralateral hemisphere. There were decreases in the ADC of Cho, Cre, and NAA with 21%, 7%, and 18% 8 hours later, respectively, in the noninfarcted hemisphere, which suggested transhemispheric diaschisis in rats with focal cerebral ischemia. The present study proposed that the diffusion characteristics of the brain metabolites might offer new insights into circulatory and metabolic alteration in the cerebral intracellular circumstance.

Animals↗

Enhancer-promoter activity of human papillomavirus type 16 long control regions isolated from cell lines SiHa and CaSki and cervical cancer biopsies.

Expression of human papillomavirus 16 (HPV-16) oncogenes is markedly higher in cervical cancer cells than in precancerous cells, and the elevated expression is believed to be required for the malignant phenotypes. We compared cancer cell lines CaSki (with 200 to 400 copies of HPV-16 DNA per cell) and SiHa (with one to two copies of HPV-16 DNA per cell) for the E7 expression in cells and the enhancer-promoter activity of the isolated viral long control region (LCR). Although these parameters per cell were 10-fold higher in CaSki than in SiHa, the levels of the E7 mRNA and protein per HPV DNA copy were 10- to 20-fold higher in SiHa than in CaSki. Characterization of the isolated LCRs showed that, whereas the LCR from CaSki resembled the prototype in structure and activity, the LCR from SiHa, with a deletion of 38 base pairs, enhanced transcription from P97 as assayed by using a plasmid capable of expressing luciferase. The upregulation appeared to be due to removal of one of the silencer YY1-binding sites. Furthermore, we isolated and characterized LCRs from 51 cervical cancer patients' biopsies. Among them, one with a deletion including YY1-binding sites and the other with a substitution in a YY1-motif were found to enhance the transcription. These findings suggest that mutation affecting YY1-motifs in the LCR is one of the mechanisms enhancing the viral oncogene expression in the course of progression of cancer cells.

DNA, Viral↗

Secondary infections of AIDS autopsy cases in Japan with special emphasis on Mycobacterium avium-intracellulare complex infection.

In order to study the frequency of secondary infections of AIDS autopsy cases in Japan, especially the frequency of Mycobacterium aviumintracellulare complex (MAC) infection, retrospective autopsy study was conducted between 1986 and 1997 at the affiliated hospital of Institute of Medical Sciences, University of Tokyo. Secondary infections of various organs from 43 AIDS autopsy cases were examined using histopathology, genetic diagnosis of tuberculosis, Ziehl-Neelsen stain for acid-fast bacilli and immunohistochemistry. Nontuberculous mycobacterial infection (Mycobacterium avium) was observed in 17 cases (40%) out of 43 using polymerase chain reaction (PCR), but M. tuberculosis infection was not observed. Ziehl-Neelsen staining showed a positive reaction in lung and spleen tissues of 7 AIDS autopsy cases. Immunohistochemistry using anti-BCG antibody revealed positivity in 7 AIDS autopsy cases. CD4 counts of 17 AIDS patients with mycobacterial infection were less than 18.7/microl. Other opportunistic infections were also examined by histopathology. Secondary infections were present in every case, and these included cytomegalovirus infection (32 cases), Pneumocystis carinii (15 cases), Candida (16 cases), Aspergillus (12 cases), Cryptococcus (6 cases), Toxoplasma (6 cases), methicillin-resistant Staphylococcus aureus (3 cases), herpes virus (1 case) and Entamoeba histolytica (1 case). Malignant lymphoma was recognized in 14 cases and Kaposi's sarcoma in 6. This is the systemic report on secondary infections of AIDS autopsy cases in Japan. In diagnosis of mycobacterial infections, PCR was more useful than staining for acid-fast bacilli and immunohistochemistry. Secondary infections (especially mycobacterial infection) were closely associated with the low CD4 count.

AIDS-Related Opportunistic Infections↗

Gamma knife radiosurgery as a primary treatment for prolactinomas.

OBJECT: The purpose of this study was to estimate the efficacy of gamma knife radiosurgery (GKS) in controlling tumor growth and endocrinopathy associated with prolactinomas. METHODS: Between 1993 and 1997, 164 of 469 patients with pituitary adenomas treated by GKS harbored prolactinomas. The dose to the tumor margin ranged from 9 to 35 Gy (mean 31.2 Gy), and the visual pathways were exposed to a dose of less than 10 Gy. The mean tumor diameter was 13.4 mm. The mean follow-up time for 128 cases was 33.2 months (range 6-72 months). Tumor control was observed in all but two patients who underwent surgery 18 and 36 months, respectively, after GKS. Clinical cure was achieved in 67 cases. Clinical improvement was noted with a decrease in the hyperprolactinemia after GKS. Nonetheless, in 31 (29%) of 108 patients who were followed for more than 2 years no improvement in serum prolactin levels was demonstrated, although this could be normalized by bromocriptine administration after treatment. Nine infertile women became pregnant 2 to 13 months after GKS and all gave birth to normal children. There was no visual deterioration related to GKS. Five women experienced premature menopause. In these patients there was subtotal disappearance of the tumor and an empty sella developed. CONCLUSIONS: Gamma knife radiosurgery as a primary treatment for prolactinomas can be safe and effective both for controlling tumor growth and for normalization of prolactin hypersecretion. A higher margin dose (> or = 30 Gy) seemed to be associated with a better clinical outcome. Gamma knife radiosurgery may make prolactinomas more sensitive to the bromocriptine.

Humans↗

Attenuation correction in evaluating renal function in children and adults by a camera-based method.

UNLABELLED: Correction for soft-tissue attenuation is required to evaluate absolute renal function by a camera-based method, and an estimate of renal depth and an attenuation coefficient are commonly used for attenuation correction. The first goal of this study was to develop formulas for the calculation of renal depth in both children and adults. The second goal was to optimize the attenuation coefficient for the estimation of renal accumulation of a 99mTc-labeled agent. METHODS: Renal depth was measured by CT in 74 children and 232 adults and compared with the depth calculated using previously published equations. Multiple stepwise linear regression analysis was conducted using data from children and adults together, and new formulas to calculate renal depth were derived. Using the resulting equations, percentage renal uptake at 2-2.5 min was computed from 99mTc-diethylenetriamine pentaacetic acid (DTPA) renography in 40 children and 92 adults. Percentage renal uptake was assessed using various values of an attenuation coefficient, and an optimized attenuation coefficient was determined to maximize the correlation coefficient between percentage renal uptake and glomerular filtration rate (GFR) measured from 2 blood samples. RESULTS: Although the previously published equations appeared to be acceptable in predicting adult renal depth, they substantially underestimated pediatric renal depth. Renal depth (D, cm) was shown by stepwise regression analysis to depend on the ratio of body weight (W, kg) to body height (H, cm) and was successfully calculated in both children and adults using the derived equations (right: D = 16.778 x W/H + 0.752; left: D = 16.825 x W/H + 0.397). The correlation coefficient between percentage renal uptake of 99mTc-DTPA and measured GFR varied substantially according to the attenuation coefficient used and was the highest (0.947) with an attenuation coefficient of 0.087/cm. CONCLUSION: The equations presented here enabled estimation of renal depth irrespective of the patient's age. Attenuation correction using these equations and the optimized attenuation coefficient appears to aid in evaluating renal accumulation and, consequently, renal function in both children and adults.

Adolescent↗

Coronary microangiopathy in type 2 diabetic patients: relation to glycemic control, sex, and microvascular angina rather than to coronary artery disease.

UNLABELLED: Coronary microangiopathy is a major complication in diabetics. However, the presence of independent factors in association with coronary microangiopathy in patients with non-insulin-dependent diabetes mellitus (NIDDM) or the difference in coronary microangiopathy between diabetics with coronary artery disease (CAD) and those with microvascular angina is unclear. METHODS: Nineteen patients with NIDDM and microvascular angina, 18 patients with NIDDM and CAD, and 17 age-matched control subjects were studied. Myocardial segments that were perfused by angiographically normal coronary arteries were studied. The baseline myocardial blood flow (MBF) and the MBF during dipyridamole administration were measured using PET and 13N-ammonia, after which the myocardial flow reserve (MFR) was calculated to assess coronary microangiopathy. RESULTS: The baseline MBF was comparable among NIDDM patients with microvascular angina, NIDDM patients with CAD, and control subjects. However, the MBF during dipyridamole administration was significantly lower in NIDDM patients with microvascular angina (126 +/- 42.7 mL/min/100 g) than that in either NIDDM patients with CAD (210 +/- 70.1 mL/min/100 g; P < 0.01) or control subjects (293 +/- 159 mL/min/100 g; P < 0.01), as was the MFR (NIDDM with microvascular angina, 1.90 +/- 0.73; NIDDM with CAD, 2.59 +/- 0.81 [P < 0.01]; control subjects, 3.69 +/- 1.09 [P < 0.01]). Multivariate stepwise regression analysis showed that, among the factors considered, glycemic control was independently related to the MFR (r = 0.838; P < 0.05). CONCLUSION: Glycemic control appears to be essential for coronary microangiopathy in NIDDM.

Adult↗

Computed tomographic scan of the chest, latex agglutination test and plasma (1AE3)-beta-D-glucan assay in early diagnosis of invasive pulmonary aspergillosis: a prospective study of 215 patients.

BACKGROUND AND OBJECTIVES: Blood and radiologic tests are frequently used for diagnosis of invasive pulmonary aspergillosis, but it remains unknown which is more useful for its early diagnosis. Aim of the study was to compare usefulness of computed tomographic (CT) scan of chest, latex agglutination (LA) test and determination of plasma (1-->3)-beta-D-glucan (BDG) levels for early diagnosis of invasive pulmonary aspergillosis (IPA). DESIGN AND METHODS: We treated 215 consecutive patients who underwent cytotoxic chemotherapy. From initiation of chemotherapy until death or discharge, blood samples were taken weekly and subjected to LA and BDG tests. We performed chest CT scans when patients had any signs of pulmonary infection or an antibiotic-resistant fever. RESULTS: Of the 215 patients, 30 (14. 0%) were diagnosed as having IPA. In sixteen cases the diagnosis was definite and in 14 it was suspected. In patient-based analysis, sensitivities of LA and BDG were 44% and 63%, respectively. Sensitivity tended to be lower in patients with IPA localized to the lung than those with disseminated invasive aspergillosis. Specificities were 93% and 74%, respectively. Either a halo or an air-crescent was observed in 7 of the 16 patients with IPA, and all of the IPA patients showed some abnormal signs on chest CT scans. On average, CT scan signs preceded a positive LA test by 7.1 days and a positive BDG assay by 11.5 days. In 6 of the 11 patients who became positive for either LA or BDG assay, CT scan signs preceded the positive results by more than seven days. INTERPRETATION AND CONCLUSIONS: Chest CT scan is more beneficial than the blood tests and X-ray for early diagnosis of IPA.

Adjuvants, Immunologic↗

Evaluation of renal function with 99mTc-MAG3 using semiautomated regions of interest.

UNLABELLED: The need to draw regions of interest (ROIs) manually may reduce the convenience and reliability of estimating renal function from renal scintigraphy. We developed a semiautomated method to define ROIs for renal scintigraphy with 99mTc-mercaptoacetyltriglycine (MAG3) and evaluated the clinical applicability of the method to the estimation of renal function by camera-based methods. METHODS: Dynamic renal scintigraphy with 99mTc-MAG3 was performed on 21 patients. An operator placed a large rectangular ROI over each kidney, a circular ROI within the liver, and a rectangular ROI between the kidneys. Using these ROIs, semiautomated renal ROIs were determined on the basis of the temporal changes in counts, in addition to the absolute counts, and a subrenal background ROI was automatically assigned for each renal ROI. Background-subtracted renograms were generated using these renal and subrenal ROIs, and renogram parameters were derived from the slope of the renogram and the area under the renogram. Clearance was calculated using the renogram parameters and equations determined previously with manual ROIs and correlated with clearance measured by a single-sample method. The relative function of the right kidney determined by the semiautomated method was compared with that determined by the manual method. Data processing was performed independently by another operator to assess interoperator reproducibility. RESULTS: ROIs defined by the semiautomated method were visually judged to be acceptable for clinical use in all patients with a wide range of renal function. Clearance was successfully predicted with the semiautomated ROIs (r = 0.968 using the slope of the renogram; r = 0.934 using the area under the renogram), and relative function calculated with the semiautomated ROIs was almost identical to that calculated with manual ROIs. There was almost complete concordance in absolute and relative function between the two operators. CONCLUSION: The semiautomated method can define ROIs for 99mTc-MAG3 renal scintigraphy with limited operator intervention. Camera-based methods using the semiautomated ROIs allow estimation of renal function with high accuracy and little interoperator variability and are suggested to be suitable for clinical use.

Adult↗

Improvement of impaired myocardial vasodilatation due to diffuse coronary atherosclerosis in hypercholesterolemics after lipid-lowering therapy.

BACKGROUND: Diminished myocardial vasodilatation (MVD) in hypercholesterolemics without overt coronary stenosis has been reported. However, whether the diminished MVD of angiographically normal coronary arteries in hypercholesterolemics can be reversed after lipid-lowering therapy is not known. METHODS AND RESULTS: A total of 27 hypercholesterolemics and 16 age-matched controls were studied. All patients had >1 normal coronary artery, and those segments that were perfused by anatomically normal coronary arteries were studied. Myocardial blood flow (MBF) was measured during dipyridamole loading and at baseline using positron emission tomography and 13N-ammonia, after which MVD was calculated before and after lipid-lowering therapy. Total cholesterol was significantly higher in hypercholesterolemics (263+/-33.8) than in controls (195+/-16.6), and it normalized after lipid-lowering therapy (197+/-19.9). Baseline MBF (ml. min-1. 100 g-1) was comparable among hypercholesterolemics (both before and after therapy) and controls. MBF during dipyridamole loading was significantly lower in hypercholesterolemics before therapy (189+/-75.4) than in controls (299+/-162, P<0.01). However, MBF during dipyridamole loading significantly increased after therapy (226+/-84.7; P<0.01). MVD significantly improved after therapy in hypercholesterolemics (2.77+/-1.35 after treatment [P<0.05] versus 2. 02+/-0.68 before treatment [P<0.01]), but it remained significantly higher in controls (3.69+/-1.13, P<0.01). There was a significant relationship between the percent change of total cholesterol and the percent change of MVD before and after lipid-lowering therapy (r=-0. 61, P<0.05). CONCLUSIONS: Diminished MVD of anatomically normal coronary arteries in hypercholesterolemics can be reversed after lipid-lowering therapy.

Aged↗

Determination of the site of disulfide linkage between heavy and light chains of silk fibroin produced by Bombyx mori.

The analysis of fibroin secretion-deficient 'naked-pupa' mutant silkworms has suggested that the disulfide linkage between heavy (H) and light (L) chains of fibroin, produced by the silkworm, Bombyx mori, is essential in its efficient large-scale secretion from the posterior silk gland cells. However, the site of disulfide-linkage between H- and L-chains has not been determined. In this study, cysteine residues involved in the single disulfide linkage between H- and L-chains were identified as the twentieth residue from the carboxyl terminus of H-chain (Cys-c20) and Cys-172 of L-chain by sequencing of genomic clones and peptide analysis. Furthermore, Cys-c4 (fourth residue from the carboxyl terminus) and Cys-c1 at the carboxyl terminus of H-chain were shown to form an intramolecular disulfide bond.

Amino Acid Sequence↗

Evaluation of gadobenate dimeglumine in hepatocellular carcinoma: results from phase II and phase III clinical trials in Japan.

To evaluate the clinical efficacy of gadobenate dimeglumine (Gd-BOPTA)-enhanced magnetic resonance imaging for hepatocellular carcinoma (HCC), we reviewed the results of clinical phase II and III trials in Japan. Gd-BOPTA was administered at a dose of 0.1 mmol/kg to 139 patients who were suspected to have HCC. Dynamic phase images [breath-hold T1-weighted gradient echo (GRE)], spin-echo (SE) images obtained within 10 minutes of injection, and delayed breath-hold GRE images obtained 40-120 minutes after injection were evaluated. All post-contrast images were compared with T1- and T2-weighted pre-contrast images. The contrast efficacy for the dynamic study was classified as ( ) or (++) in 92.1% (128/139), in 43.1% (59/137) with SE within 10 minutes of injection, and in 43.2% (60/139) with breath-hold GRE at delayed phase. The increase in lesion-liver contrast-to-noise ratio was best at the arterial phase of dynamic breath-hold GRE. Liver signal-to-noise ratio showed a mean 52.3% increase in delayed phase. Additional information at delayed phase compared with images acquired within 10 minutes of injection (including the dynamic study) was classified as ( ) or (++) in 28.1% (39/139). With regard to safety, the overall incidence of adverse reactions was 5.0% (7/141) of the patients who were suspected to have HCC, all of whom recovered within 12 hours without any sequelae. No clinically important changes were observed in the blood and urine laboratory tests. It was concluded that Gd-BOPTA was well tolerated and effective in both dynamic study and delayed static imaging for the diagnosis of HCC.

Adult↗

Accurate preoperative evaluation of liver mass lesions without fine-needle biopsy.

Fine-needle biopsy (FNB) is associated with problems, such as tumor seeding, which are probably underestimated. The aim of this study was to validate prospectively the accuracy of our diagnostic work-up without FNB, for defining indications for surgery in a cohort of patients with focal liver lesions (FLLs). Between January 1997 and December 1998, 160 consecutive patients carrying 225 FLLs admitted to our department were evaluated prospectively. Preoperative diagnoses were established by means of clinical histories, serum tumor marker levels, ultrasonography, and spiral computed tomography (CT). Angiography, magnetic resonance imaging (MRI), and Lipiodol-CT were performed when it was considered necessary to plan the surgical strategy. All the patients underwent surgery and results of pathological examinations were obtained for all of them. The preoperative diagnoses of 221 of the 225 lesions (98.2%) were confirmed, and the indications for liver resection in 156 of the 160 patients (97.5%) were correct. The respective accuracy, sensitivity, specificity, and positive and negative predictive values were 99.6%, 100%, 98.9%, 99.3%, and 100% for diagnosis of hepatocellular carcinoma (HCC); 99.1%, 100%, 98.8%, 96.9%, and 100% for metastases; 99.6%, 100%, 99.5%, 91%, and 100% for cholangiocellular carcinomas (CCCs); all 100% for mixed HCC-CCCs; and 98.7%, 57.1%, 100%, 100%, and 98.6% for benign tumors. In view of these results, the fact that the real risks of FNB have yet to be established and the possibility that tumor seeding has a major impact on patient prognosis, the use of FNB should be drastically limited.

Angiography↗