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Biomedical subjects

K Yasuda

Publications and source records attributed to K Yasuda.

At least 181 records · Page 10Linked to original sources
PubMed2001

Preoperative disseminated intravascular coagulation associated with aortic aneurysms.

BACKGROUND: To report clinical experiences with disseminated intravascular coagulation (DIC) associated with aortic aneurysms (AA) and discuss therapeutic strategy. METHODS DESIGN AND SETTINGS: uncontrolled, observational study in a university hospital. PATIENTS: among 547 patients with AA treated between 1991 and 1999, 10 patients (7 males, 3 females, mean age 68.5+/-2.5) presenting a preoperative DIC score (defined by the Ministry of Health and Welfare in Japan) of 6 or higher were analyzed. The etiology was dissection for 5 and non-dissection for 5 patients. Six of 10 patients had a bleeding tendency. Eight patients received preoperative anticoagulant therapy. Prosthetic replacement was undertaken for 8 patients except for 2 patients in poor condition. RESULTS: There were no operative deaths in 8 surgical cases. One non-surgical case died of deteriorated bleeding tendency. The mean DIC score was 8.0+/-0.6 at admission, which was reduced to 4.4+/-0.5 at discharge (p<0.05). Prothrombin time, platelet counts, and fibrinogen levels tended to be normalized by the 7th postoperative day. Serum FDP levels decreased with surgery, but tended to increase at the time of discharge and the later follow-up period. Hematologic disturbances and bleeding tendency recurred in 2 patients in the follow-up period. CONCLUSIONS: In the majority of patients presenting DIC with aortic aneurysm, surgical treatment can be performed safely if adequately managed by anticoagulant therapy. Consumptive coagulopathy usually resolved after surgical intervention, but some patients developed DIC in the later period. If DIC recurs, it is essential to search for contributory causes.

Aged↗
PubMed2001

Effects of fibronectin bonding on healing of high porosity expanded polytetrafluoroethylene grafts in pigs.

BACKGROUND: We developed a new fibronectin bonding to expanded polytetrafluoroethylene (ePTFE) and previously reported that, in a dog carotid implant model, fibronectin bonding improves graft healing in high porosity ePTFE grafts. The purpose of this study was to further investigate the effect of the fibronectin bonding on graft healing in a pig carotid implant model. METHODS: Fifteen pigs received a high porosity ePTFE graft treated with the fibronectin bonding (fibronectin-bonded graft) on one side and an untreated graft (non-bonded graft) on the contralateral side. The grafts were explanted at intervals of 3 and 6 weeks and subjected to histological studies. RESULTS: At 3 weeks, the neointima of fibronectin-bonded grafts was better organized than that of non-bonded grafts. At 6 weeks, the morphologic features of the neointima were the same in fibronectin-bonded and non-bonded grafts. The neointima was completely organized. CONCLUSIONS: Together with the previous results with the dog model, fibronectin bonding could be expected to improve healing of the high porosity ePTFE grafts in humans.

Animals↗
PubMed2001

[A case of advanced non-small-cell lung cancer responding remarkably to weekly chemotherapy with paclitaxel].

We report a case of advanced non-small-cell lung cancer showing remarkable response to weekly administration of paclitaxel. The patient was a 63-year-old man who had IIIB advanced lung adenocarcinoma. Though he received one course of cisplatin and etoposide, the tumor was not reduced. In addition, because of his nauseous response, he no longer wanted to receive that chemotherapy. The chemotherapy regimen was therefore changed to weekly administration of vinorelbine, but this was not effective. Next, after changing the regimen to the weekly administration of paclitaxel, the tumor was remarkably reduced following 3 courses. This case shows that weekly administration of paclitaxel may be an effective chemotherapy for non-small cell lung cancer not responsive to first-line chemotherapy.

Adenocarcinoma↗
PubMed2001

[Laparoscopic surgery for gastric cancer: indications and limitations].

Gastric cancer has been successfully treated by both endoscopic and open surgery, while early-stage gastric cancer with some risk of lymph node metastasis is managed with laparoscopic surgery. The principle of treatment of gastric cancer is to perform a complete resection of the lesion with safe and appropriate procedures based on disease stage. Three types of laparoscopic surgery have been reported: laparoscopy-assisted distal gastrectomy (LADG); laparoscopic local resection with the use of aT-fastener; and intragastric mucosal resection. In local resection, there is a possibility that past of the lesion or lymph node metastases may remain. D2 lymph node dissection requires a longer operative time and technical difficulties causing postoperative complications may be encountered. At present, LADG is the preferred choice of treatment in patients with early-stage gastric cancers due to the acceptable length of surgery and simple lymph node harvesting. For the wider application of minimally invasive surgery, numerous advances in operative procedures, including hand-assisted surgery and sentinel node navigation surgery, are required, along with technical developments for more accurate diagnosis to offer ideal treatment for each stage of gastric cancer.

Adult↗
PubMed2001

A case of intraoperative acute aortic dissection caused by cannulation into an axillary artery.

Severe atherosclerotic disease of the ascending aorta is one of the risk factors of dissection of the ascending aorta and cerebral embolism during cardiac operations with cardiopulmonary bypass. Aortic dissection is rare, but once it happens, the mortality rate is high. For the patient with severely atherosclerotic or strongly calcified aorta, we should avoid cannulation into the aorta or clamping of it. In this case, we experienced aortic dissection although we chose the arterial cannulations into the axillary arteries because of the strong calcification of the ascending aorta and the abdominal aorta. The dissection was caused by the cannulation into the axillary artery. Transesophageal echocardiography (TEE) showed the dissection during the operation and the ascending aorta was replaced soon. Early diagnosis and treatment saved the patient. This case showed the following points: 1) cannulation into an axillary artery is not always safe; 2) TEE is very useful to detect the complicated dissection during operation; 3) replacement of the ascending aorta alone can be one of the choices for the treatment of aortic dissection caused by cannulation into an axillary artery.

Aged↗
PubMed2001

Popliteal artery entrapment syndrome. Reconstruction of the transected medial head of the gastrocnemius muscle.

Popliteal artery entrapment syndrome (PAES) is an uncommon cause of arterial insufficiency, especially in younger, athletic patients. Surgical treatment should be performed in all cases of PAES whether the artery is occluded or not. Although transection of the compressing muscle or fascial band is required to obtain good results, controversy exists about reconstruction of the transected muscle or fascial band. We present a case of a young athlete with PAES for whom rapid recovery of the athletic activity was provided by reconstruction of the divided medial head of the gastrocnemius muscle.

Adolescent↗
PubMed2001

[Mixed type of total anomalous pulmonary venous return: a rare pattern of pulmonary venous drainage].

The occurrence of multiple drainage sites in total anomalous pulmonary venous return (TAPVR) has important implication in preoperative diagnosis and surgical treatment. We report a rare pattern of pulmonary venous drainage with the right upper pulmonary vein draining into the innominate vein and the other three pulmonary veins into the portal vein (Ib + III type). The preoperative diagnosis was made by echocardiography and confirmed by angiography. In operation, an anastomosis was made between the common pulmonary vein and the left atrium through posterior approach, but the right upper pulmonary vein was left uncorrected because the anomalously draining blood flow of a single pulmonary vein was about 20% of total pulmonary blood flow. The postoperative course was uneventful, however, the long-term follow-up is mandatory because of the right upper pulmonary vein being left uncorrected.

Anastomosis, Surgical↗
PubMed2001

Microsporum gypseum isolated from a feline case of dermatophytosis.

The 1- to 2-month-old female cross-breed cat presented with alopecia, erythema and many crusts were present on the tail. Microscopic examination of crusts from the tail disclosed epithelial debris, exudate, mycelium, and arthrospores. Microsporum gypseum which is rarely isolated from cats as a causative agent of dermatophytsis was cultured from the crusts on a 1/10 Sabouraud glucose agar at 27 degrees C for 1 week. The isolate of M. gypseum from the cat was examined by random amplification of polymorphic DNA (RAPD), chitin synthase 1 gene (CHS1) sequence and mating experiments. The RAPD band patterns of the clinical isolate of M. gypseum was identical to those of tester strains of Arthroderma gypseum. Nucleotide sequence analysis of the CHS1 gene fragments from the isolate and a tester strain of A. gypseum showed 100% similarity. The mating experiments on the clinical isolate of M. gypseum completely agreed with the results from RAPD and CHS1 gene sequence. The isolate from the cat was confirmed to be A. gypseum (-) mating type, which was consistent with the result of mycological examination by molecular analyses.

Animals↗
PubMed2001

A case of an ascending aortic aneurysm due to mesoaortitis complicated with idiopathic thrombocytopenic purpura.

An 80-year-old man was referred to our hospital for the surgical treatment of an ascending aortic aneurysm. The diagnosis of idiopathic thombocytonenic purpura was also made by hematological studies which included the examination of the aspirated bone marrow. Preoperative chest computed tomography showed an ascending aortic aneurysm with a maximum diameter of 80 mm. Echocardiography demonstrated mild aortic regurgitation. The platelet count increased by intravenous administration of immunoglobulin. A prosthetic graft replacement of the ascending aorta and aortic valve repair were carried out with the aid of cardiopulmonary bypass, selective cerebral perfusion and hypothermic circulatory arrest. No difficulty was encountered in hemostasis and the postoperative course was uneventful. Histological examination of the aneurysmal wall showed chronic mesoaortitis with patchy destruction of musculo-elastic medial tissue and adventitial focal lymphocytic infiltrates that were similar to syphilitic mesoaortitis, although serological treponemal tests were all negative. Perioperative administration of gamma-globulin is useful to minimize the hemorrhagic complication in a patient undergoing cardiovascular surgery with idiopathic thrombocytopenic purpura.

Aged↗
PubMed2001

[Propofol anesthesia combined with thoracic epidural anesthesia for thymectomy for myasthenia gravis--a report of eleven cases].

We report 11 cases of thymectomy for myasthenia gravis using propofol and thoracic epidural anesthesia. Considering the influence of nitrous oxide to environment and muscular relaxation of volatile anesthetics, we selected this anesthetic method. By proper sedation with propofol and sufficient analgesia with epidural anesthesia, the hemodynamics during operation was stable and the emergence was rapid. The patients were extubated early after operation except in one case in which oxygenation was not good because of sputum. We conclude that our anesthetic method is useful. Moreover, we applied Fuchu hospital scoring system for prediction of the need of postoperative mechanical ventilation in patients with myasthenia gravis to the present 11 cases. These predictions corresponded well with the results. Therefore Fuchu hospital scoring system is useful for managing these patients by our anesthetic method.

Adult↗
PubMed2000

A novel low-density lipoprotein receptor-related protein mediating cellular uptake of apolipoprotein E-enriched beta-VLDL in vitro.

We report here the identification of a novel member of the low-density lipoprotein receptor (the LDL receptor) family through signal sequence trap screening of a mouse lymphocyte cDNA library. The protein was termed LDL receptor-related protein 9 (LRP9). LRP9 is a type I membrane protein predicted to contain 696 amino acids with a calculated molecular mass of 74 764 Da. The NH(2)-terminal half of LRP9 contains two CUB domains separated by a single ligand-binding repeat. The second CUB domain is followed by a cluster of three additional ligand-binding repeats and a transmembrane domain. The COOH-terminal intracellular region contains a proline-rich region. LRP9 mRNA was expressed in the liver, kidney, lung, and heart at high levels, and in the spleen and brain at low levels. In situ hybridization analysis of mouse liver, kidney, and brain detected LRP9 transcripts in hepatocytes, sinusoidal lining cells, peritubular capillaries, choroid plexus, ependyma of the third ventricle, pia matter, and hippocampus. In particular, high levels of expression were observed in the vascular walls. Apolipoprotein E (apoE)-enriched beta-VLDL stimulated cellular cholesteryl ester formation in ldl-A7/LRP9. These results raise the possibility that this newly identified receptor, which is expressed in the liver, may play a physiological role in the uptake of apoE-containing lipoproteins.

Adult↗
PubMed2000

Comparative study of the effects of magnetic versus electrical stimulation on inhibition of detrusor overactivity.

OBJECTIVES: To perform a randomized comparative study investigating the urodynamic effects of functional magnetic stimulation (FMS) and functional electrical stimulation (FES) on the inhibition of detrusor overactivity. METHODS: Thirty-two patients with urinary incontinence due to detrusor overactivity (15 men, 17 women; age 62. 3 +/- 16.6 years) were randomly assigned to two treatment groups (15 patients in the FMS group and 17 in the FES group). Stimulation was applied continuously at 10 Hz in both groups. For FMS, the magnetic stimulator unit was set on an armchair type seat and had a concave-shaped coil, so that the patients could sit during stimulation. For FES, a vaginal electrode was used in the women and a surface electrode on the dorsal part of the penis was used in the men. Cystometry was performed before and during the stimulation. RESULTS: The bladder capacity at the first desire to void and the maximum cystometric capacity increased significantly during stimulation compared with prestimulation levels in both groups (P = 0.0054 and 0.0026, respectively, in the FMS group and P = 0.0015 and 0.0229, respectively, in the FES group). However, the increase in the maximum cystometric capacity was significantly (P = 0.0135) greater in the FMS group (114.2 +/- 124.1 mL or an increase of 105. 5% +/- 130.4% compared with the pretreatment level) than that in the FES group (32.3 +/- 56.6 mL or an increase of 16.3% +/- 33.9%). Detrusor overactivity was abolished in 3 patients in the FMS group but not in any patient in the FES group. CONCLUSIONS: Although both treatments were effective, the inhibition of detrusor overactivity appeared greater in the FMS group than in the FES group.

Adult↗
PubMed2000

The role of atypical and conventional PKC in dehydroepiandrosterone-induced glucose uptake and dexamethasone-induced insulin resistance.

We have reported that both dehydroepiandrosterone (DHEA) and dexamethasone (Dexa) directly activate PKC. In this study, we investigated the effects of these hormones on conventional PKC (cPKC) and atypical PKC (aPKC). DHEA and Dexa directly activated PKCbeta and PKCzeta to the same degree. In rat adipocytes, DHEA and Dexa activated endogenous immunoprecitable PKCzeta to 246 and 164%, respectively, from basal level (100%). In adipocytes, 5 min treatment with DHEA increased phosphatidylinositol 3-kinase (PI 3-kinase) activity in immunoprecipitate with anti-phosphotyrotyrosine antibody to 235%. Preincubation with wortmannin, myristoylated PKCzeta pseudosubstrate, but not with Go6976, abolished DHEA-induced 2-deoxyglucose (DOG) uptake. cPKC inhibitors prevented Dexa-induced insulin resistance. Moreover, DHEA and Dexa increased DOG uptake to 330 and 220%, respectively, in adipocytes overexpressed with wild-type PKCzeta, but not in those overexpressed with dominant negative. These results indicate that DHEA and Dexa activate both cPKC and aPKC, and Dexa-induced cPKC activation may lead to insulin resistance. In contrast, DHEA may mimic or enhance insulin action via PI 3-kinase and aPKC.

Adipocytes↗
PubMed2000

Pathology and prognosis of gastric carcinoma: well versus poorly differentiated type.

BACKGROUND: The most important parameters predicting outcome of patients with gastric carcinoma are the depth of wall invasion and the status of lymph node metastasis, but the prognostic significance of histologic type is unclear. The aim of this study was to clarify the prognostic value of two major histologic types of gastric carcinoma, that is well and poorly differentiated types. METHODS: Histopathologic findings and outcomes of 504 patients with gastric carcinoma were evaluated by well and poorly differentiated types. Well differentiated gastric carcinoma (WGC) included papillary and tubular adenocarcinomas, poorly differentiated medullary carcinoma, and well differentiated mucinous carcinoma; whereas poorly differentiated gastric carcinoma (PGC) included poorly differentiated scirrhous carcinoma, signet ring cell carcinoma, and poorly differentiated mucinous carcinoma. RESULTS: Patients with WGC were characterized by old age, male predominance, tumor location in the lower third of the stomach, small tumor size, and liver metastasis; whereas patients with PGC were distinguished by their tumor location in the middle third of the stomach, serosal invasion, lymph node metastasis, advanced stage, and peritoneal dissemination. The overall 5-year survival rate for patients with WGC was higher than that for patients with PGC (76% vs. 67%; P = 0.058), especially for patients with >/= 10 cm tumors (42% vs. 14%; P = 0.017). The 5-year survival rate for patients with serosa positive but node negative tumors was higher in WGC patients than in PGC patients (83% vs. 59%; P = 0.086); whereas the 5-year survival rate for patients with serosa negative but node positive tumors was lower in WGC patients than in PGC patients (63% vs. 88%; P = 0.008). Multivariate analysis indicated that among pathologic variables of the tumor, histologic type (WGC vs. PGC) was one of the independent prognostic factors. CONCLUSIONS: Histologic type is important for estimating the tumor progression and outcomes of patients with gastric carcinoma. In addition to the depth of wall invasion and status of lymph node metastasis, histologic type, including well or poorly differentiated type, should be evaluated in the management of gastric cancer.

Adenocarcinoma↗