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Biomedical subjects

K Shimada

Publications and source records attributed to K Shimada.

At least 127 records · Page 7Linked to original sources
PubMed2001

Urological management of cloacal anomalies.

BACKGROUND: A cloacal anomaly results from incomplete urorectal division and is frequently associated with genitourinary abnormalities. Experience of the urological reconstruction of this entity is reported. METHODS: Nine girls with cloacal malformation have been treated at the Osaka Medical Center in the past 9 years. Seven patients were detected by prenatal ultrasonography as having: megacystis (two patients); hydronephrosis (two patients); or hydrometrocolpos (three patients). Two patients underwent prenatal shunt placement between the enlarged bladder and the amniotic space. RESULTS: For neonatal urinary diversion, four patients received cystostomy. Six of seven patients with associated hydrocolpos required intermittent catheterization to decompress an enlarged vagina. Vesicoureteral reflux was detected in 12 ureters of seven patients. Antireflux surgery was indicated in four patients before definitive repair. Definitive reconstruction was performed on eight patients. The posterior sagittal approach was used in all patients. Vaginal reconstruction was done utilizing a perineal skin flap (one patient), a tubularized vaginal flap (three patients), distal rectum (three patients) and total urogenital mobilization (one patient). Postoperatively, urethrovaginal fistula was created in one patient and complete occlusion was seen in one patient. CONCLUSION: The anatomical variety of this entity determines the management options from in utero. It involves not only the creation of three perineal orifices, but also a continent, catheterizable urethra under the stabilization of renal function. Accomplishment of the definitive repair requires the combined expertise of experienced pediatric surgeons and pediatric urologists.

Clitoris↗
PubMed2001

Torsades de pointes ventricular tachycardia induced by mosapride and flecainide in the presence of hypokalemia.

We report a 68-year-old man who developed torsades de pointes ventricular tachycardia induced by combined use of mosapride and flecainide. He had a permanent pacemaker (DDD mode) implanted because of sick sinus syndrome (bradytachy syndrome) 6 years earlier. The patient had started taking mosapride for upper abdominal discomfort 2 weeks earlier. On admission, ECG showed prolongation of the QTc interval from 0.48 to 0.56 seconds and self-terminating torsades de pointes occurred. We considered that this proarrhythmia was induced by mosapride in combination with antiarrhythmic agents.

Aged↗
PubMed2001

Intraductal papillary components in invasive ductal carcinoma of the pancreas are associated with long-term survival of patients.

Most patients with pancreatic ductal carcinoma have a poor prognosis. However, in certain cases, 5-year survival can be achieved after surgical resection. Analysis of the pathologic findings associated with good survival rates will assist in identifying the optimum treatment. The clinicopathologic features of 67 patients who underwent surgical resection of ductal adenocarcinoma of the pancreas between 1990 and 1996 were reviewed and correlated with survival rates. There were 42 men and 25 women, with a mean age of 62.1 years (range, 44 to 82 years). The mean greatest diameter of the tumor was 4.3 cm (range, 1.5 to 11 cm). Nineteen patients (29.4%) survived more than 3 years, and 9 (13.2%) survived more than 5 years after surgical resection. The intraductal papillary component (IDPC) of the carcinoma was the main focus of the pathologic observations. IDPC was defined as intraductal papillary proliferative lesions seen in the tumor nodule with proliferative cells consistent with carcinomatous cellular atypia. IDPC was clearly present (++) in 24 patients and vaguely present (+) in 9 patients. Using the Mantel-Cox test, a statistically significant correlation was found between the presence of IDPC (either + or ++) and postoperative patient survival (P =.002). IDPC is a morphologic feature associated with longer patient survival and should be taken into consideration in assessing the pathway of tumor progression.

Adult↗
PubMed2001

Treatment strategy for small hepatocellular carcinoma: comparison of long-term results after percutaneous ethanol injection therapy and surgical resection.

This comparative study was conducted to clarify the efficacy of percutaneous ethanol injection (PEI) and surgical resection in the treatment of small hepatocellular carcinomas (HCC). Thirty-nine patients treated by PEI and 58 who underwent hepatic resection for small HCC (smaller than 3 cm and 3 or less in number) during the same period were enrolled. The surgery group included more patients with large and multiple bilobar nodules than the PEI group. The histological differentiation of the treated tumors became worse in the surgery patients than in those treated by PEI. On the other hand, the PEI group included more patients with a poor hepatic reserve, according to Child-Pugh grading, the ICG test, and the serum total bilirubin value. The 1-, 3-, and 5-year overall survival rates were almost identical between the 2 cohorts (100%, 82.1%, and 59.0%, respectively, in the PEI group; 96.6%, 84.4%, and 61.5%, respectively, in the surgery group) (P =.96). During the follow-up period, 33 of 39 (85%) and 41 of 58 (71%) patients developed tumor recurrence after PEI and surgery, respectively. Cumulative 1-, 3-, and 5-year tumor-free survival rates in the PEI group were 63.4%, 30.3%, and 9.7 %, whereas those in the surgery group were 75.5%, 44.7%, and 25.7%, respectively (P =.10). Our overall findings show that local therapy can achieve an actual 5-year survival rate of around 60% for patients with small HCC with the proper selection of treatment. A prospective randomized comparative trial is required to settle this longstanding issue.

Adult↗
PubMed2001

Serum hepatocyte growth factor levels are increased in patients with congestive heart failure.

BACKGROUND: Hepatocyte growth factor (HGF) is a potent endothelial cell-specific mitogen. We investigated the clinical importance of HGF in congestive heart failure (CHF). METHODS AND RESULTS: Thirty-five patients with acute exacerbation of CHF and 7 control subjects were examined. Serum and peripheral blood mononuclear cells (PBMCs) were isolated from peripheral blood on days 1, 7, and 14 after admission. PBMCs were cultured at a density of 1 x 10(7) cells/mL for 24 hours. HGF levels in serum and the PBMC culture medium and serum interleukin 6 (IL-6) levels were measured by enzyme-linked immunosorbent assay. Serum HGF levels in patients with CHF were markedly increased at admission compared with those in control subjects and gradually returned to control levels during hospitalization. HGF levels in the PBMC culture medium were also significantly increased in CHF patients compared with control subjects. There was a positive correlation between HGF levels in serum or those in the PBMC culture medium and serum IL-6 levels. HGF levels in serum and the culture medium were not notably different between CHF patients regularly treated with and without angiotensin-converting enzyme inhibitors. CONCLUSIONS: HGF levels in serum are increased in patients with acute exacerbation of CHF.

Adult↗
PubMed2001

Estimating the prognosis of hepatic resection in patients with metastatic liver tumors from colorectal cancer with special concern for the timing of hepatectomy.

BACKGROUND: The effect of the time interval between colorectal and liver resection for metastatic lesions on the patient's survival remains controversial. Pretreatment classification for predicting the prognosis of this disease has not yet been reported. METHODS: Nine clinical factors revealed by preoperative examinations, intraoperative screening before liver resection, and resection margin were examined in 304 patients who underwent hepatic resections for metastatic colorectal carcinoma. The patients were divided according to the timing of hepatectomy and both tumor number and maximum diameter to devise a staging system. RESULTS: Tumor number and maximum tumor size were significant prognostic factors in the metachronous hepatectomy group, and resection margin was significant in the synchronous group. The following staging system was proposed: stage I, n < or = 3 and diameter < 5 cm in the metachronous hepatectomy group (n = 86); stage II, n < or = 3 and diameter > or = 5 cm in the metachronous hepatectomy group (n = 46); and stage III, n > or = 4 and diameter > 5 cm in the metachronous group and the synchronous hepatectomy group (n = 144). CONCLUSIONS: The current study revealed that the factors that influenced the patient's prognosis were different between the synchronous and metachronous groups. It may be useful to develop a staging system that considers this difference.

Adult↗
PubMed2001

Protein binding of glufosinate and factors affecting it revealed by an equilibrium dialysis technique.

We investigated the protein binding of glufosinate ammonium (GLF) and several factors affecting this binding using human serum albumin (HSA) and human volunteer serum under various conditions. The mean ratios of the free GLF (RFr-GLF) to 4% HSA were examined in the sera of patients described elsewhere at GLF levels from 1 microg/mL to 500 microg/mL; the range was found to be only from 0.80 to 0.88. Neither the incubation temperature nor buffers containing different chloride ion concentrations had any effect on the RFr-GLF to HSA. Moreover, the addition of heparin, glycoprotein-alpha1-acid (AAG), and sodium azide had no effect on the RFr-GLF. However, pH of the isotonic phosphate buffer and the addition of palmitic or oleic acid were seen to have an effect. In this study, the mean RFr-GLF to healthy human serum was 0.99. This high value was evidenced that GLF was rapidly excreted through the renal route.

Adult↗
PubMed2001

Effects of Ca(2+) and calmodulin on the motile activity of characean myosin in vitro.

It is well known that the cytoplasmic streaming of characean cells is readily inhibited by Ca(2+). However, neither the actin-activated MgATPase nor the in vitro motile activity of purified characean myosin were inhibited by Ca(2+). Recently, amino acid sequence of characean myosin was determined in our laboratory and the sequence revealed that characean myosin contains six calmodulin binding sites in the neck region. We also detected calmodulin in quickly prepared characean myosin fraction. It is, therefore, possible that the insensitivity of characean myosin to Ca(2+) is due to the dissociation of some calmodulin molecules from the neck region during the course of protein purification. To determine strictly the Ca(2+) sensitivity of characean myosin, we intentionally used crude preparation of characean myosin to reduce the possibility of calmodulin dissociation and examined the motile activity of characean myosin in vitro in the presence of excess characean calmodulin. We could not observe any drastic inhibition of characean myosin activity by Ca(2+). The results suggest that the brief cessation of cytoplasmic streaming is not caused by the direct inhibition of myosin activity by Ca(2+).

Actins↗
PubMed2001

Phytoene desaturase, CrtI, of the purple photosynthetic bacterium, Rubrivivax gelatinosus, produces both neurosporene and lycopene.

Biosynthetic pathways for carotenoids in the purple photosynthetic bacterium, Rubrivivax gelatinosus, which synthesizes spirilloxanthin in addition to spheroidene and OH-spheroidene, were investigated by means of genetic manipulation. A phytoene desaturase gene (crtI) found in the photosynthesis gene cluster of this bacterium was expressed in an Escherichia coli strain that can produce phytoene. Both neurosporene and lycopene were synthesized in the recombinant, probably by three- and four-step desaturation reactions of CrtI. A mutant of RVI: gelatinosus lacking the crtI gene produced only phytoene, indicating that this organism had no other phytoene desaturases. When the crtI deletion mutant was complemented by the three-step phytoene desaturase of Rhodobacter capsulatus, spirilloxanthin and its precursors were not synthesized, although spheroidene and OH-spheroidene were accumulated. It was concluded that neurosporene and lycopene are produced by a single phytoene desaturase in RVI: gelatinosus resulting in the synthesis of spheroidene and spirilloxanthin, and that there are no pathways for spirilloxanthin synthesis via spheroidene.

Bacteria↗
PubMed2001

Molecular cloning of chicken vasoactive intestinal polypeptide receptor complementary DNA, tissue distribution and chromosomal localization.

Chicken vasoactive intestinal polypeptide receptor (VIPR) cDNA was cloned by the reverse transcription-polymerase chain reaction method using primers designed on the basis of other species of VIPR cDNA. The cDNA obtained was sequenced by the dideoxy-mediated chain-termination method. Of the 2227 nucleotides that were sequenced, 84, 855, and 1338 bases represent the 5'-untranslated region (UTR), the 3'-UTR, and the open reading frame that predicts a peptide of 446 amino acids. The cDNA of the chicken VIPR shows 65% and 60% homologies to human cDNA of VIP1 and VIP2 receptors, respectively. The clone had the expected similarity to highly conserved features of the other G protein-coupled receptors (GPCRs) such as six cysteine residues that are functionally important in the VIPR subfamily. In addition, the seven potential membrane-spanning domains characteristic of the family B group III GPCR superfamily and highly conserved motif within the third cellular loop between transmembrane regions 5 and 6. Northern blot hybridization analysis in this study indicated mRNA expression of VIPRs in the various tissues of the chicken. Strong signal was detected in the brain and anterior pituitary gland. High levels of VIPR mRNA in the brain was consistent with VIP-binding experiments and with the function of VIP in the brain as a neuroendocrine factor or neurotransmitter. Expression of VIPR was detected in the anterior pituitary gland of chick embryos. The expression of VIPR mRNA in the chick anterior pituitary gland may indicate a regulatory function of VIP on prolactin (PRL) production or PRL cell proliferation during embryogenesis. Chicken VIPR shows high homology with mammalian type I VIPR but, in some part, possesses similarity of amino acid sequence. Expression of VIPR in various tissues supports diverse functions for VIP in the chicken.

3' Untranslated Regions↗
PubMed2001

Lipophilic statins augment inducible nitric oxide synthase expression in cytokine-stimulated cardiac myocytes.

Nitric oxide production by inducible nitric oxide synthase (iNOS) may play an important role in the pathogenesis of cardiovascular dysfunction. We investigated the effects of statins on iNOS expression and subsequent nitric oxide synthesis in cardiac myocytes and the mechanism by which statins exert their effects. We measured the production of nitrite, a stable metabolite of nitric oxide, in cultured neonatal rat cardiac myocytes with the Griess reagent. iNOS mRNA and protein expression were assayed by reverse transcription polymerase chain reaction and Western blotting, respectively. The lipophilic statins fluvastatin and lovastatin significantly increased interleukin-1beta-induced nitrite production by cardiac myocytes, whereas hydrophilic pravastatin did not. Increased nitrite production by fluvastatin was accompanied by increased iNOS mRNA and protein accumulation. Exogenous mevalonate, but not squalene, significantly blocked the stimulatory effect of fluvastatin on nitrite production. Cotreatment with geranylgeranyl-pyrophosphate also reversed the effect of fluvastatin. Furthermore, both Rho inhibitor C3 exoenzyme and Rho kinase inhibitor Y-27632 significantly increased interleukin-1beta-induced nitrite accumulation in cardiac myocytes. These results demonstrated that lipophilic statins upregulate iNOS expression and subsequent nitric oxide formation in cardiac myocytes via inhibition of Rho.

Animals↗
PubMed2001

Abdominal pain in patients with resectable pancreatic cancer with reference to clinicopathologic findings.

Abdominal and/or back pain is one of the most common symptoms in patients with pancreatic cancer. However, the cause of the pain and the clinicopathologic features of patients with pain have not been fully elucidated. We retrospectively determined the factors related to preoperative abdominal and/or back pain in 95 patients with resectable pancreatic cancer. Pancreatic tumor size, invasion of the intrapancreatic nerves, invasion of the anterior pancreatic capsule, and lymph node metastasis were determined to be variables related to the pain. Pancreatic tumor size, invasion of anterior pancreatic capsule, and lymph node metastasis were also variables significantly correlating to pain intensity. Survival also correlated with pain intensity: the median survival periods were 29 months in patients without pain, 19 months in those with mild pain, and 9 months in those with severe pain who required analgesics. Larger pancreatic tumors, invasion of the intrapancreatic nerves, and invasion of the anterior pancreatic capsule may cause abdominal and/or back pain in patients with resectable pancreatic cancer. This study also suggests clinical implications of the pain intensity as a prognostic factor in patients with resectable pancreatic cancer.

Abdominal Pain↗
PubMed2001

Early morning surge in blood pressure.

Early-morning blood pressure is generally viewed as an important therapeutic target, for two reasons. First, for antihypertensive agents taken once daily in the morning, the timing of the trough plasma drug level, and thereby the lowest pharmacodynamic effect, often coincides with the early morning rise in blood pressure and heart rate. Evidence has been accumulated to suggest that blood pressure control throughout the 24 h period may be necessary to gain complete benefit from antihypertensive medication. In fact, in a longitudinal study, the regression of cardiac hypertrophy in patients with hypertension was more accurately predicted by treatment-induced changes in average 24 h ambulatory blood pressure than by clinic or home-monitored blood pressure readings. The other reason for the importance of morning blood pressure is that cardiovascular risk is heightened at this time of day. A morning surge in sympathetic activity alters haemodynamic forces and predisposes vulnerable coronary atherosclerotic plaques to rupture. At the same time as this risk of plaque rupture is greatest, circadian variations in haemostatic and fibrinolytic factors result in morning hypercoagulability and hypofibrinolysis, promoting the formation of intraluminal thrombi. We recently showed that, in older hypertensives, a greater morning blood pressure surge, mediated at least in part by an exaggerated alpha-sympathetic activity, is associated with more advanced silent cerebrovascular disease as well as a higher future incidence of stroke. The early morning surge in blood pressure could become a new therapeutic target for preventing target-organ damage and subsequent cardiovascular events in hypertension. Of greatest interest is the potential benefit of a chronotherapeutic approach, involving, for example, long-acting chronoformulations, which has not yet been extensively studied.

Blood Pressure↗
PubMed2001

Task Force II: blood pressure measurement and cardiovascular outcome.

OBJECTIVE: To reach a consensus on the prognostic significance of new techniques of automated blood pressure measurement. METHODS: A Task Force on the prognostic significance of ambulatory blood pressure monitoring wrote this review in preparation for the Eighth International Consensus Conference (28-31 October 2001, Sendai, Japan). This synopsis was amended to account for opinions aired at the conference and to reflect the common ground reached in the discussions. POINTS OF CONSENSUS: (1) Prospective studies in treated and untreated hypertensive patients and in the general population have demonstrated that, even after adjusting for established risk factors, the incidence of cardiovascular events is correlated with blood pressure on conventional as well as ambulatory measurement. Ambulatory monitoring, however, significantly refines the prediction already provided by conventional blood pressure measurement. (2) White-coat hypertension is usually defined as an elevated clinic blood pressure in the presence of a normal daytime ambulatory blood pressure. Event-based studies in hypertensive patients have convincingly demonstrated that the risk of cardiovascular disease is less in patients with white-coat hypertension than in those with higher ambulatory blood pressure levels even after controlling for concomitant risk factors. Based on prognostic evidence, white-coat hypertension can now be defined as a conventional blood pressure that is persistently equal to or greater than 140/90 mmHg with an average daytime ambulatory blood pressure of below 135/85 mmHg. The issue of whether or not white-coat hypertension predisposes to sustained hypertension needs further research. (3) There is a growing body of evidence showing that a decreased nocturnal fall in blood pressure (<10% of the daytime level) is associated with a worse prognosis, irrespective of whether night-time dipping is studied as a continuous or a class variable. (4) Intermittent techniques of ambulatory blood pressure monitoring are limited in terms of quantifying short-term blood pressure variability. Proven cardiovascular risk factors such as old age, a higher than usual blood pressure and diabetes mellitus are often associated with greater short-term blood pressure variability. After adjusting for these risk factors, some - but not all - studies have nevertheless reported an independent and positive relationship between cardiovascular outcome and measures of variability of daytime and night-time blood pressure, for example standard deviation. (5) Reference values for ambulatory blood pressure measurement in children are currently based on statistical parameters of blood pressure distribution. In children and adolescents, functional rather than distribution-based definitions of ambulatory hypertension have yet to be developed. (6) Several studies of gestational hypertension have shown that, compared with office measurement, ambulatory blood pressure monitoring is a better predictor of maternal and fetal complications. Pregnancy is a special indication for ambulatory monitoring so that the white-coat effect can be measured and pregnant women are not given antihypertensive drugs unnecessarily. (7) Ambulatory pulse pressure and the QKD interval are measurements obtained by ambulatory monitoring that to some extent reflect the functional characteristics of the large arteries. The QKD interval is correlated with left ventricular mass, and ambulatory pulse pressure is a strong predictor of cardiovascular outcome. (8) Under standardized conditions, the self-measurement of blood pressure is equally as effective as ambulatory blood pressure monitoring in identifying the white-coat effect, but further studies are required to elucidate fully the prognostic accuracy of self-measured blood pressure in comparison with conventional and ambulatory blood pressure measurement. CONCLUSIONS: Ambulatory blood pressure measurement refines the prognostic information provided by conventional blood pressure readings obtained in the clinic or the doctor's office. Longitudinal studies of patients with white-coat hypertension should clarify the transient, persistent or progressive nature of this condition, particularly in paediatric patients, in whom white-coat hypertension may be a harbinger of sustained hypertension and target-organ damage in adulthood. Finally, the applicability, cost-effectiveness and long-term prognostic accuracy of the self-measurement of blood pressure should be evaluated in relation to conventional blood pressure measurement and ambulatory monitoring.

Adult↗
PubMed2001

Aberrations of the p14(ARF) and p16(INK4a) genes in renal cell carcinomas.

The INK4a / ARF locus on chromosome 9p21, which encodes two distinct genes, p14(ARF) and p16(INK4a), is frequently altered in human neoplasms. To investigate the potential roles of p14(ARF) and p16(INK4a) genes in human renal cell carcinomas (RCCs), we analyzed 6 human RCC cell lines and 91 primary RCCs for homozygous deletion, promoter hypermethylation and expression of the p14(ARF) and p16(INK4a) gene products using differential PCR, methylation-specific PCR, and immunohistochemistry, respectively. Five cell lines showed homozygous co-deletion of both genes and one demonstrated promoter hypermethylation of the p16(INK4a) gene only. Eight of 91 RCCs showed aberrations of p14(ARF) or p16(INK4a) status and six of these featured gross extension into the renal vein. The results suggest that p14(ARF) and p16(INK4a) aberrations may play roles in the relatively late stage of renal tumorigenesis associated with tumor progression.

Carcinoma, Renal Cell↗
PubMed2001

[Isolation and incidence of Cryptosporidium and Giardia from river water].

A study was conducted during the period from July to October in 1999, surface water samples were collected from 13 rivers in Hyogo Prefecture serving as tap water sources and examined for Cryptosporidium oocysts and Giardia cysts using the immunomagnetic separation method. In 9 (69%) of the 13 rivers, Cryptosporidium oocyst was detected. Giardia cyst was detected in 5 (38%) of the 13 rivers. The Cryptosporidium oocyst positive rate was comparable to that of fecal bacteriological indicators, which was also examined and detected in 10 (77%) of 13 rivers. Water samples were collected at 69 points in the 13 rivers. Cryptosporidium parvum oocyst was detected at 38 (55%) of the 69 points, demonstrating widely spread contamination. Comparing 3 areas which were divided on the basis of agricultural circumstance as well as geographical locating, the Cryptosporidium positive rate varied widely according to the area, ranging from 37% to 100%. To elucidate the reason for these differences, the relationship between positive rate and the species and number of livestock animals raised in each respective region was investigated. The results showed a strong correlation (r = 0.91) between the number of raised cattle and contamination with the rate of Cryptosporidium in each area. Furthermore, genetic analysis by PCR-restriction fragment length polymophism method revealed that C. parvum oocyst detected in the rivers studied was the bovine type, probably indicating that the oocyst was excreted from the cattle in the river basins. The degree of contamination with Cryptosporidium in river water was comparable to that of fecal bacteriological indicators, suggesting the possibility that fecal bacteriological indicators examination might be used as a criterion of Cryptosporidium contamination.

Animals↗
PubMed2001

Lesion characteristics of acute myocardial infarction: an investigation with intravascular ultrasound.

OBJECTIVE: To use intravascular ultrasound (IVUS) to compare plaque morphology in acute myocardial infarction and stable angina pectoris. DESIGN: Retrospective study. SETTING: Primary care hospital. PATIENTS: 59 consecutive cases of acute myocardial infarction and 50 consecutive cases of stable angina pectoris. METHODS: IVUS was used before coronary intervention. MAIN OUTCOME MEASURES: Plaque morphology (incidence of eccentric plaque, subtle dissections, low echoic thrombus, calcification, echolucent areas, and bright speckled echo material), assessed visually using IVUS. RESULTS: There were no significant differences in plaque eccentricity or calcification between the two groups, but low echoic thrombus (acute myocardial infarction 15% v stable angina pectoris 0%), subtle dissections (37% v 4%), echolucent areas (31% v 0%), and bright speckled echo material (90% v 0%) were more common in the infarction group than in the stable angina group (p < 0.001 for all). There was a longer time between the onset of symptoms and the IVUS examination in patients with low echoic thrombus than in those without (p < 0.03). CONCLUSIONS: Low echoic thrombus, subtle dissections, echolucent areas, and bright speckled echo material are morphological characteristics associated with plaque at the time of acute myocardial infarction. These findings correspond pathologically to ruptured plaque.

Angina Pectoris↗