Biomedical subjects
Publications and source records attributed to K Tomoda.
We report a rare case of expansively growing angioleiomyoma in the proximal tibia of a 64-year-old woman. MRI revealed a well-defined area of low signal intensity on T1-weighted image and high intensity on T2-weighted image. Angiographs showed hypervascularity and vascular poolings. Microscopic examination after incisional biopsy showed an angioleiomyoma with bundles of nerve fibers.
Patients with diabetes mellitus (DM) show an increased susceptibility to bacterial infections due to the presence of neutrophil dysfunction. Susceptibility to tuberculosis has also been reported in such patients, however, the reason remains unclear. This study measured the production of interleukin-1 beta (IL-1 beta), tumor necrosis factor alpha (TNF alpha) and interleukin-6 (IL-6) by the peripheral monocytes of patients diagnosed with pulmonary tuberculosis accompanied by DM (TB+DM) and patients without DM complications (TB) using age-matched, healthy control subjects for comparison. Also examined was the relationship between cytokine production and DM control. The results were as follows: (1) The production of IL-1 beta, TNF alpha and IL-6 in TB patients was significantly higher than that observed in the healthy control subjects. (2) The production of IL-1 beta, TNF alpha and IL-6 in TB+DM patients was significantly lower than that observed in the TB patients. (3) The production of IL-1 beta and TNF alpha in TB+DM patients with poor control was significantly lower than that observed in the patients with good control. (4) The TNF alpha production had a significant inverse correlation to HbA1c in the TB+DM patients. This study demonstrated that the production of cytokines is impaired in TB+DM patients and suggests a close correlation between tuberculosis immunity and DM.
Three young adults advanced pulmonary tuberculosis due to delay of therapy were reported. In case 1 and 3, their delays resulted from difficulty in diagnosis, in case 2, from neglecting medical counseling. Each cases revealed bilateral diffuse shadows on chest roentgenograms on admission, which were typical shadows of advanced pulmonary tuberculosis. Malnutrition might contribute to the development of the diseases, which were improved by anti-tuberculosis therapy and hyperalimentation therapy. These cases were suggested some clinical problems characteristic of pulmonary tuberculosis of young adults.
The efficacy of transarterial immuno-embolization therapy (TIE) was investigated in 7 patients with multiple hepatocellular carcinoma (HCC). We administered OK-432 (10 KE), fibrinogen (30 mg/ml) and thrombin (1 U/ml) as a new treatment for HCC with intrahepatic metastasis. In all patients with a high level of AFP, the AFP level decreased promptly less than the pretreatment level after TIE therapy. High fever in all cases, epigastralgia in 6 cases and appetite loss in 3 cases were observed after TIE therapy. Our results indicate that this therapy may be a safe and effective method in HCC patients with intrahepatic metastasis.
Twelve of the patients with advanced (Stage III or IV) hepatocellular carcinoma who received transcatheter chemoembolization survived for more than 5 years. These survivors consisted of 6 Stage III cases and 6 Stage IV cases. Of the 6 Stage III cases, 5 had multiple tumors (larger than 2 cm) in one lobe of the liver, and 1 had tumor invasion into the second portal branch before treatment. Of the 6 Stage IV cases, 4 had had multiple tumors in both lobes, and 2 had had tumor invasion into the main portal branches. Before treatment, 9 of the 12 survivors had been rated as Child's class A. Lipiodol was used in all 12 cases. The results of the present study suggest the usefulness of Lipiodol in treating advanced hepatocellular carcinoma.
Nutritional status and its relation to respiratory function and respiratory muscle strength were assessed in patients with pulmonary emphysema. Energy metabolism was also examined in order to elucidate the mechanism of their malnutrition. BCAA/AAA ratio of plasma amino acid was positively correlated with FEV1.0%. Resting energy expenditure (REE) was negatively correlated with FEV1.0%, and REE/REEpred ratio was also negatively correlated with BCAA/AAA and PImax. These findings suggest that increased mechanical work load, associated with airway obstruction and reduced respiratory muscle efficiency, contribute to the increased energy expenditure and amino acid imbalance. Oral nutritional supplementation using BCAA enriched-elemental diet was found to be effective, as assessed by nutritional parameters, PImax, D.O.E., and QOL index, in malnourished emphysema patients.
Resting energy expenditure (REE) was assessed and its relationship to nutritional status, pulmonary function and respiratory muscle function was studied in 25 patients with pulmonary emphysema. The mean value of REE was 1413 +/- 251 Cal and the ratio of REE/REEpred was 1.398 +/- 0.23, suggesting the existence of a hypermetabolic state in these patients. REE/REEpred ratio was inversely correlated with plasma amino acid BCAA/AAA ratio and body muscle mass; and PImax. REE was inversely correlated with FEV1.0%. REE in the patient subgroup with severe hyperinflation (%RV > or = 200) was significantly higher than that in the subgroup with moderate hyperinflation. Malnourished patients showed significantly more severe hyperinflation than well-nourished patients. These findings suggest that augmented REE contributes to malnutrition in patients with emphysema, and that the increase in REE was related to the increase in mechanical work load on the basis of airway obstruction, respiratory muscle weakness and hyperinflation.
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Axial three-dimensional volume scans obtained by magnetic resonance (MR) imaging were used to evaluate meniscal lesions of the knee in 28 knees of 26 cases. Axial 0.7 mm thin-sliced images with volume scan outlined the overall meniscal appearance for the first time. Axial volume scan was essential to the diagnosis of discoid lateral meniscus because only it could depict the characteristic elongated appearance of discoid lateral meniscus. Radial meniscal tears were depicted only by this technique: conventional sagittal and coronal views could not detect this type of meniscal tear. Volume scan could detect the precise extent of lesions with horizontal meniscal tears and meniscal degeneration. These MR findings obtained by axial volume scans were confirmed by arthroscopy in all cases. We concluded that volume scans were extremely useful in the evaluation of meniscal lesions because they offered axial views that provided much information on menisci located horizontally in the knee.
We retrospectively reviewed the MR examinations of 10 patients (17 knees) with surgically documented discoid lateral meniscus of the knee joint. As MRI of the knee is being used more often, the criteria for diagnosis of this entity with MRI need to be established. We tried to define MRI criteria for the detection of discoid menisci by performing numerical measurements of MR images on a display screen. The transverse diameter of the midbody of a discoid lateral meniscus averaged 21.9 mm (normal control: 8.6 mm), and its proportion to the transverse width of the tibia averaged 29.4% (normal control: 12.0%). The measurable difference in height between the discoid and the medial meniscus was negligible. The number of sagittal sections on which the anterior and posterior horns connected varied from two to five in cases of discoid lateral meniscus, and from zero to two in normal controls. Among these parameters, the transverse diameter and its proportion of the transverse width of the tibia proved to be the most reliable. We concluded that a discoid meniscus is indicated if a transverse diameter of a lateral meniscus exceeds 15 mm (proportion to the tibia: 20%).
An axial 3D volume scan with MRI was applied to the evaluation of discoid lateral meniscus of the knee. By 0.7 mm-thick thin-sliced and gapless images with volume scan, characteristically elongated appearance of discoid lateral meniscus was clearly depicted. These MR findings completely accorded with those on arthroscopy. Our conclusion is that an axial 3D volume scan was essential to the diagnosis of discoid lateral meniscus.
Acetylcholine (ACh) and choline (Ch) in cerebrospinal fluid from 29 normal volunteers and 7 patients with Alzheimer-type dementia (DAT) were examined using high-performance liquid chromatography with electrochemical detector coupled with liquid cation-exchange method. In normal volunteers, ACh concentration was decreased significantly from 40-50 years and Ch concentration was increased significantly from 50-60 years. CSF from patients with DAT revealed high Ch concentration and the increase was statistically significant while ACh concentration in CSF of DAT did not show a significant difference with that of normal volunteers. This Ch augmentation may suggest a disturbance in utilization of Ch for ACh synthesis and may become an useful indicator for organic changes in central cholinergic system.
The palatine tonsil is the only lymphoid organ directly exposed to the outside environment. This characteristic anatomical feature appears to be immunologically significant with the defence activity primarily directed against exogenous antigens. However, the palatine tonsil is also often the site of secondary diseases, such as focal infections. This study investigated how the tonsil responds to horseradish peroxidase (HRP) dropped into the crypts and the effects of this response on the regional lymph node and the kidney as a distant organ. HRP entered through the microcrypts was phagocytosed by macrophages, gathered mostly around the vessels and emigrated to the regional lymph nodes. Anti-HRP antibody-producing cells were observed not only in the tonsil but also in the regional lymph node. In this long-term study with repeated immunization, fusion of the epithelial foot process and reduction of the anionic charge in the glomerulus were often found electron microscopically. This investigation suggests that the tonsil has important roles in the defence activity in relation to the general immune system; otherwise it becomes a primary site for focal infections.
The ventilation mechanism of the middle ear is very important as regards the pathogenesis of middle ear disease, but its mode of function is still obscure. Therefore, we tried to measure the ventilation and clearance of the middle ear using radio-isotope imaging techniques and 133Xe in order to gain a clearer picture of the ventilation mechanism. In normal Eustachian tube cases, approximately 10% of the initially insufflated gas immediately entered into the middle ear cavity and mastoid air cells. The gas introduced into the middle ear diminished at a rate of 8% of volume per hour in the normal resting state. Two hours after the first procedure, air was insufflated, and gas volume in the middle ear cavity immediately diminished by 30%. In stenotic tube cases, it proved difficult to insufflate the gas into the middle ear, however, its diminishing rate with the passage of time was slightly faster than in normal tube cases. From this data, it was evident that air could easily and quickly enter into even the periphery of the mastoid air cells by insufflation via the Eustachian tube, despite the fact that the middle ear and mastoid air cells form a closed cavity. In the resting state, moreover, the air in the middle ear was thought to be absorbed mainly into the middle ear mucosa at a regular rate. It was confirmed that the insufflation procedure as a therapy for tubal stenosis and OME is very useful for the ventilation of the middle ear.
We have devised a non torque, supple and flexible catheter with a Ball-tip and have applied this catheter (combined) with the plastic coated guide wire in a superselective angiography to a total of 43 patients, namely, 41 hepatic and 2 renal tumor patients. Since the pulling forces of the arterial blood flow carries the Ball-tip supple catheter to the distal part of the desired artery, the new system seldom causes spastic change and subintimal injury. We have achieved successful catheterization and embolization in all but one cases, even when there are extensive curves in the arteries leading to the affected site. Our conclusion is that cases which cannot be embolized by the conventional method due to the extensive curves of the artery can be safely treated by using this catheter system.
A new catheter was developed for hepatic angiography and embolization: a non-torque control supple catheter with a ball tip combined with a small guide wire. The catheter was used successfully in 47 of 49 patients with hepatocellular carcinoma or hepatic metastases. It seldom causes spasm or intimal damage of distal arterial branches and is useful even when there are extensive curves in the arteries leading to the affected site.
Changes in action potential (AP) and summating potential (SP) were investigated in guinea pigs immunized with type II collagen through the stylomastoid foramen. Endolymphatic hydrops could be induced in four of 11 guinea pigs. The striking feature of the electrocochleographic waveform in guinea pigs with endolymphatic hydrops was the negative SP recording in response to high frequency tone bursts. Furthermore, abnormal changes in AP were observed in three of four hydropic guinea pigs. Morphologic study of the cochleas in these three guinea pigs with light microscopy revealed spiral ganglion cell degeneration in addition to endolymphatic hydrops and almost normal sensory hair cells. These results suggest that guinea pigs with hydrops as produced by our procedure can serve as a useful model of Meniere's disease, that autoimmune response may play an important role in the etiopathogenesis of Meniere's disease, and that spiral ganglion cell degeneration together with endolymphatic hydrops seems to contribute to abnormal changes in AP.
Quantitative evaluations of histamine and histamine H1 receptor were carried out in nasal mucosa of toluene diisocyanate (TDI) sensitized guinea-pigs at specific points in time during a pre-determined sensitization period. Histamine content is significantly increased at 1 week and definitely elevated after 2 weeks of sensitization. This increase was maintained throughout the sensitization period. It decreased to normal by four weeks post-sensitization. Also the relatively low histamine content immediately after TDI challenge indicated that a certain amount of histamine was released by TDI challenge. On the other hand, the density and affinity of the histamine H1 receptor was not found to be altered during TDI sensitization. These results suggest that enhanced histamine has a role in the development of nasal allergy, whereas the relevance of quantitative-alteration of the H1 receptor to histamine hypersensitivity observed in nasal allergy has not been demonstrated.