Biomedical subjects
Publications and source records attributed to K Okamura.
In this study, we present our initial trials in the treatment of 6 cases of severe preeclampsia with thromboxane synthetase inhibitor (OKY-046). Following the treatment with OKY-046, maternal systolic blood pressure decreased significantly and umbilical artery waveforms were normalized. These data suggest that thromboxane synthetase inhibition might have a beneficial effect on preeclampsia.
Thyroid stimulation indices such as high thyroidal radioactive iodine uptake, increased estimated thyroid weight, presence of TSH-binding inhibitor immunoglobulin or thyroid-stimulating antibody, and elevated serum thyroglobulin level, were evaluated in 148 patients with Graves' disease who had been treated with antithyroid drugs for two years or more before the drugs were withdrawn. In all 19 patients in whom three or more indices were positive, early relapse, within 12 months, occurred after reducing the dosage of antithyroid drugs. Other 129 patients were followed after the drug was withdrawn and in 77 patients with one or two positive indices, early relapse occurred in 65-71% and late relapse, after 12 months or later, occurred in 2-11%. In 52 patients in whom none of the indices were positive, 86% remained in remission, but 10% developed an early relapse, and 4% a late relapse. We conclude that a combined analysis of thyroid stimulation indices is useful in predicting relapse in Graves' disease whereas it remains difficult to predict permanent remission.
The authors report malignant glioma occurring in two sibling cases. The elder brother presented with right hemiparesis and hemihypesthesia at 14-year-old. Computed tomographic (CT) scanning demonstrated a low-density area in the left frontoparietal lobe. The tumor was partially removed. Histologic diagnosis was glioblastoma multiforme. Radiation therapy was given postoperatively, but he died due to tumor recurrence 15 months after onset. The younger sister was admitted comatose due to intratumoral bleeding at 19-year-old. CT scans showed a high-density area in the right temporal lobe. The tumor was excised subtotally. Histological diagnosis was malignant astrocytoma (grade III). Radiation therapy, chemotherapy (ACNU), and immunotherapy (interferon) were given postoperatively, but she died due to recurrence 34 months after onset.
A study was made on treatment-related factors, notably prognosis, in 148 patients treated by surgical resection of the primary lesion among 170 consecutive patients who were admitted to the Department of Urology, Gunma University for the treatment of renal cell carcinoma during the period from September 1961 through August 1989. Operative procedures used in this series were radical nephrectomy in 100 patients, simple nephrectomy in 46, partial nephrectomy in 1 and tumor enucleation in 1, lymph node dissection being performed in 53 of the 100 patients treated by radical nephrectomy. The patients receiving surgical resection of the primary lesion were stratified according to sex, PS, disease stage, surgical procedure, lymph node dissection and weight of renal substance resected and comparisons were made on survival rate and recurrence rate among patients in different strata in an effort to observe if these factors are determinant of postoperative prognosis. No significant difference in survival rate was observed between sexes. Patients displaying a PS value of 0 had a significantly higher survival rate than those having a PS value of 1 or above. Whereas a significant difference in survival rare was noted between stage IIIA + IIIB + C disease patients, no significant difference was observed among stage I, II and III patients, thus stages up to IIIA being considered low stage. Radical nephrectomy was associated with a significantly higher survival rate than simple nephrectomy in low stage (stage I-II) disease patients. However, there was no significant difference in survival rate between stage I-II disease patients with vs. without lymph node dissection.(ABSTRACT TRUNCATED AT 250 WORDS)
Twenty-eight patients with a tumor thrombus 914 in the inferior vena cava and 14 in the renal vein), among a series of 170 renal cell carcinoma patients receiving hospital treatment at the Gunma University during the period from 1961 to 1989, were explored for clinical features, with the results leading to the following conclusions: 1) There were 19 male and 9 female with respective mean ages of 62.1 and 54.4 years. 2) The disease was right-sided in 16 patients and left-sided in the other 12, but there were no striking left-to-right difference in tumor location. 3) The most frequent chief complaint was symptoms arising from the urinary tract. Among symptoms and sings occlusion of the inferior vena cava or renal vein, proteinuria was most frequent, being present in 56% of patients with clinical evidence of occlusion, followed by tortuosity of veins of the abdominal wall and edema in the lower extremities noted in 3 patients. 4) Selective renal arteriography demonstrated tumor hypervascularity in all 22 patients (except for one with a hypovascular tumor mass) and A-V shunt at a high percentage. Profuse striated vascular pattern representing arterialization of an extensive tumor thrombus was also noted, particularly with intra-caval involvement. Venacavography demonstrated neoplastic thrombi in the inferior vena cava as filling defects, thus proving the diagnosis. CT also provided diagnostic evidence of a tumor thrombus in all cases except for one in which it failed to detect a tumor thrombus in the renal vein preoperatively, with an accurate diagnosis rate of 100% for intra-caval tumor thrombi and 83% for tumor thrombi in the renal vein.(ABSTRACT TRUNCATED AT 250 WORDS)
Human external urethral sphincters (n = 13) were studied histochemically, using ATP-ase staining. The proportions of constituent muscle fiber types (slow twitch type 1 fibers: 35.6-97.7%, mean 65.7%, SD 16.6) were different among the individuals. There were no significant relationships between the percentage of type 1 fibers and the sex or the age. As for the mean muscle fiber diameter of 13 cases, the sizes of type 2 fibers (19.2-42.4 um, mean 27.8 um) were significantly (p less than 0.05, t-test) larger than those of type 1 fibers (15.7-30.3 um, mean 22.3 um). In analyses of individual cases, 10 male cases had significantly larger type 2 fibers than type 1. Two of 3 female cases had no significant difference in diameter between the two fiber types and the remaining 1 female case, in contrast with male cases, had significantly larger type 1 fibers than type 2. There was no significant relationship between the proportions and the diameters of constituent muscle fiber types. Our study thus showed extreme interindividual variation and implicated the presence of sexual difference in human external urethral sphincter muscle.
We report our experience with the endourological treatment of 4 patients with 5 benign ureteroileal anastomotic strictures after ileal conduit urinary diversion. The treatment was successful in 4 of the 5 renal units without restenosis with a mean follow up of 10 months. The strictures were dilated by ureteral dilators and/or balloon dilation catheters using guide wires through percutaneous nephrostomies in an antegrade fashion. A 9 or 12 Fr. percutaneous splint catheter or a 12 Fr. double pig tail catheter was placed for 3-8 weeks after a successful dilation. Two renal units underwent repeated dilations. In 1 renal unit, a guide wire was hardly passed through the stricture and the treatment was unsuccessful. No serious complications were encountered. Percutaneous endourological managements of ureteroileal anastomotic strictures seemed to be quite versatile techniques which should be tried as the initial approach in many cases.
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Carbamyl phosphate synthetase deficiency (CPSD) is one of the enzyme defects of the urea cycle and inherited as an autosomal recessive. A definitive enzymatic diagnosis of CPSD can be made by biochemical assay of liver biopsy material, but not of cultured fibroblasts. In pregnancy at risk for CPSD, prenatal diagnosis was attempted by fetal liver biopsy, performed at 22 weeks of gestation. CPS activity was present and a healthy baby was delivered at term. The technique employed for fetal liver biopsy is described together with an evaluation of its possible role in prenatal diagnosis.
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Sixty-two patients with epithelial tumors of the renal pelvis and the ureter were studied with respect to 16 clinicopathological factors and their relationship to the patients survival. The cumulative survival curves are depicted by the Kaplan-Meier method and the statistical difference in the survival rates were detected in 11 factors, age, tumor number, multicentricity, tumor size, histological tumor type, stage, grade, growth pattern, infiltration pattern, lymphatic invasion and venous invasion. Cox's proportional hazard model was applied to evaluate the contribution of these 11 factors to survival. With the univariate analysis, lymphatic invasion showed the greatest hazard ratio followed by growth pattern, stage, venous invasion, age, and grade in this order. Stepwise selection of these factors based on the relative magnitude of their contribution to the survival with Cox's proportional hazard model revealed the most important factor for survival as the lymphatic invasion (hazard ratio 5.29), followed by growth pattern (hazard ratio 2.89). In conclusion, patients with tumor lymphatic invasion and tumor of non-papillary growth pattern showed poor prognosis, and adjuvant chemotherapy should be performed on them to improve their survival.
The expression of epidermal growth factor receptor (EGFR) was studied immunohistochemically in 92 colorectal carcinomas: 21 early and 71 advanced. EGFR immunoreactivity was detected in 15 cases (16.3%) of colorectal carcinomas. All EGFR-positive cases was advanced carcinomas, while no EGFR immunoreactivity was found in early carcinomas. EGFR-positive cases were macroscopically 3.4 type and more than 2 cm in diameter. No significant correlation of EGFR expression with tumor location, stage, lymph node metastasis, degree of differentiation, and prognosis was found. All EGFR-positive cases was synchronous positive for the expression of EGF. These results suggest that EGFR may play an important role in tumor progression in cooperation with EGF.
Biophysical profile (BPP) score was assessed immediately before fetal blood sampling by cordocentesis in 150 fetuses referred to our hospital, 95 after and 55 before 30 weeks of gestation. In 95 fetuses after 30 weeks of gestation, 39 fetuses were evaluated with BPP scores of 12, 35 were from 8 to 11 and 21 were less than 7. In 55 fetuses before 30 weeks of gestation, 8 fetuses were evaluated with BPP scores of 12, 27 were from 8 to 11 and 20 were less than 7. pO2, pH and pCO2 in fetuses with a score less than 7, either before or after 30 weeks of gestation, (with a score less than 7) did not significantly differ, in comparison to the other two groups. No variables in the biophysical profile precisely reflect fetal hypoxemia, acidemia or hypercarbia. Since even the fetus with a BPP score of greater than 8 may not always be assured of well-being and not all fetuses with a score of less than 7 are necessarily in a deteriorated condition, it is necessary to evaluate fetal condition on the basis of fetal blood gas data obtained by cordocentesis, especially when the fetus is additionally handicapped by prematurity or morbidities such as growth-retardation.
From September 1989 to March 1990, 6 male patients with invasive bladder cancer, 49 to 70 years old in age, underwent bladder replacement with the ileum (the urethral Kock pouch) after radical cystectomy. Follow up ranged between 3 and 9 months. Urodynamic evaluation showed the ileal bladder to be a low pressure reservoir with a capacity that increased to more than 250 ml. The ileal bladder was emptied by straining without significant residual urine in all patients except one who was performing intermittent self-catheterization. All patients were continent in the daytime. However, all patients required pads at night because of occasional loss of a little urine. Excretory urograms revealed excellent upper tract function. The procedure is suitable whenever the urethra can be preserved after cystectomy for cancer.
A 73-year-old female with bleeding from duodenal varices treated by percutaneous transhepatic obliteration (PTO) was reported. She was admitted to our hospital because of tarry stool and general malaise. Gastroduodenoscopy revealed tortous elevations in the descending part of the duodenum, and observed intermittent bleeding. Percutaneous transhepatic portography (PTP) was carried out. PTP revealed duodenal varices supplied via the inferior pancreaticoduodenal vein and drained to the inferior vena cava, and continuously obliterated by gelfoam. Duodenal varices disappeared after obliteration and we observed no recurrence of varices for a year endoscopically. In general, it is accepted that the causes of the upper gastrointestinal bleeding secondary to portal hypertension are esophagogastric varices, hemorrhagic gastritis, gastro-duodenal ulcer, and so on. However, we must keep in mind the case with duodenal varices in which bleedings are of unknown origin. We also reviewed duodenal varices reported in Japanese literature from 1968 to 1989.
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Severe preeclampsia in the second trimester presents a major challenge in management because it is associated with high perinatal mortality. One possible way to improve the perinatal outcome in these pregnancies is to predict the later development of preeclampsia and to start management of it early. To investigate the relationship between the timing of the rise in maternal mean arterial pressure (MAP) and the course of biparietal diameter (BPD) growth in the fetus, we reviewed seven women with preeclampsia diagnosed between 18 and 27 weeks' gestation. MAP increased slowly within the normal range three or four weeks before the onset of the disease. Slowing of the fetal BPD growth curve preceded the onset of preeclampsia by two to four weeks. Serial measurement of BPD from early pregnancy may prevent the onset of severe preeclampsia before 28 weeks' gestation.
We used male Wistar rats to determine the effects of lipopolysaccharide (LPS) on gastric secretion. After pylorus ligation, 24-h fasted rats received i.p. injections of different doses of LPS dissolved in sterile saline. The amounts of gastric acid and pepsin secreted were determined 2, 4 or 8 h after injection. Small doses of LPS (10-1000 ng/rat) significantly inhibited the release of both gastric secretants as compared with control animals, and this inhibitory effect of LPS on gastric secretion was dose-related. The gastric antisecretory effect of LPS was still evident 8 h after injection, indicating that this action of LPS was long-lasting. These results suggest that LPS might be involved in the regulation of gastric secretion under certain pathophysiological conditions such as acute bacterial infections.