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Biomedical subjects

M Adachi

Publications and source records attributed to M Adachi.

At least 181 records · Page 10Linked to original sources
PubMed1999

Clinical and neuroradiological features of intracranial vertebrobasilar artery dissection.

BACKGROUND AND PURPOSE: We sought to determine the clinical and neuroradiological features of intracranial vertebrobasilar artery dissection. METHODS: The clinical features and MR findings of 31 patients (20 men and 11 women) with intracranial vertebrobasilar artery dissections confirmed by vertebral angiography were analyzed retrospectively. The vertebral angiography revealed the double lumen sign in 11 patients (13 arteries) and the pearl and string sign in 20 patients (28 arteries). RESULTS: The patients ranged in age from 25 to 82 years (mean, 54.8 years). Clinical symptoms due to ischemic cerebellar and/or brain stem lesions were common, but in 3 cases the dissections were discovered incidentally while an unrelated disorder was investigated. Headache, which has been emphasized as the only specific clinical sign of vertebrobasilar artery dissection, was found in 55% of the patients. Intramural hematoma on T1-weighted images has been emphasized as a specific MR finding. The positive rate of intramural hematoma was 32%. Double lumen on 3-dimensional (3-D) spoiled gradient-recalled acquisition (SPGR) images after the injection of contrast medium was identified in 87% of the patients. The 3-D SPGR imaging method is considered useful for the screening of vertebrobasilar artery dissection. CONCLUSIONS: Intracranial vertebrobasilar artery dissection is probably much more frequent than previously considered. Such patients may present no or only minor symptoms. Neuroradiological screening for posterior circulation requires MR examinations, including contrast-enhanced 3-D SPGR. Angiography may be necessary for the definite diagnosis of intracranial vertebrobasilar artery dissection because the sensitivity of the finding of intramural hematoma is not satisfactory.

Adult↗
PubMed1999

Analysis of the treatment of acute myocardial infarction using ambulance records in Japanese cities.

By means of ambulance records, the current state of medical services for the treatment of acute myocardial infarction (AMI) was investigated in Chiba City and Ichihara City, Japan. From all patients transported by ambulance personnel in 1992 (n=31,191), 388 patients who were admitted within 2 weeks after the onset were studied. Types of admitting institution, diagnoses, medical treatments and prognoses were investigated. According to medical records, 168 patients fulfilled the criteria of definite AMI and were admitted alive. Percutaneous transluminal coronary angioplasty (PTCA) and recanalization (PTCR) were performed on 54 and 6 patients, respectively. The hospital case-fatality rates were lower in the patients who underwent emergency PTCA or PTCR than in the others. Emergency PTCA or PTCR, and admission to coronary care units (CCU) or institutions equipped with coronary angiography, decreased the fatality risk, even after considering age, sex, and disease severity. These results show the importance of the selection of institutions for AMI patients. Because 40% of definite AMI patients were sent to institutions without CCU, it is essential that enough CCU are available through an improvement in cooperation between the various types of institutions, and in the proper transfer of AMI patients to CCU

Adult↗
PubMed1999

Relationship between serum biochemical values and marbling scores in Japanese Black steers.

In order to obtain available biochemical parameters related to the marbling score (MS), by which the meat was graded from 1 to 12 in Japan, serum biochemical values were examined in 13 Japanese Black steers during the fattening stages. The steers were divided into high MS (8-11) and low MS (4-5) groups and the fattening stage was also divided into 4 stages according to their feed contents; Stage I (11-13 month-old; 0-4 months after the fattening (af)), II (5-9 months af), III (10-14 months af), and IV (15-20 months af). High MS group showed significantly higher levels in glucose and urea nitrogen (at Stage I), albumin/globulin ratio (at Stage II), and magnesium (at Stage I and III), and lower level in vitamin A (at Stage III) than low MS group. These biochemical parameters, indicating conditions of steers during the fattening stages, are considered to have a possibility related to MS in fattening steers.

Animals↗
PubMed1999

A male patient presenting with major clinical symptoms of glucocorticoid deficiency and skeletal dysplasia, showing a steroid pattern compatible with 17alpha-hydroxylase/17,20-lyase deficiency, but without obvious CYP17 gene mutations.

We report the case of a 17-year-old boy with delayed puberty, who presented a complexity of clinical problems. An analysis of steroid hormones led to a diagnosis of 17alpha-hydroxylase/17,20-lyase deficiency (17OHD). Unlike typical cases of 17OHD, however, the patient had pubertal development without medical intervention. In addition, he never exhibited the symptoms of mineralocorticoid excess, showing instead the symptoms of glucocorticoid deficiency, including fatigability, emaciation, and weight-loss induced by minor infection. He also had dysmorphic features, which comprised marfanoid habitus, arachnodactyly and putative craniosynostosis. The combination of these malformations substantially resembled that of Shprintzen-Goldberg syndrome. Direct sequencing of the CYPl7 gene did not reveal any significant aberrations in the exons or exon-intron boundaries. We speculate that the association of partial combined 17OHD with the Shprintzen-Goldberg phenotype in the present patient may result from an aberration of a hitherto unknown gene that controls both steroid hormone synthesis and skeletal development.

Adolescent↗
PubMed1999

Rapid increase in circulating leptin in ventromedial hypothalamus-lesioned rats: role of hyperinsulinemia and implication for upregulation mechanism.

The mechanisms of marked increase in plasma leptin soon after ventromedial hypothalamus (VMH) lesions were investigated. Although rats did not gain body weight or parametrial fat-pad mass 24 h after the operation, the acute VMH-lesioned rats exhibited substantial five- and fourfold increases in plasma leptin levels compared with sham-operated control rats in fed (22.6 +/- 3.2 vs. 5.8 +/- 1.2 ng/ml) and fasted (8.8 +/- 2.0 vs. 2.3 +/- 0.3 ng/ml) states, respectively. Plasma insulin concentration was doubled in VMH-lesioned rats compared with sham-operated controls in both fed and fasting states. Northern blot analysis revealed that mRNA of ob gene was not increased in parametrial fat pad of animals 24 h after the creation of VMH lesions. However, leptin content in the fat pad was significantly increased in VMH-lesioned rats compared with sham-operated controls (32.2 +/- 4.7 vs. 17.4 +/- 2.3 ng/g wet tissue). The leptin content in parametrial fat pad was highly correlated with plasma leptin concentrations (r = 0.898, P < 0.001). To define the effect of hyperinsulinemia on their hyperleptinemia, a small dose of streptozotocin (STZ) (25 mg/kg body wt) was intravenously administered into rats 5 days before the creation of VMH lesions. Plasma insulin levels were not increased after VMH lesions in STZ-pretreated rats. Plasma leptin levels were halved in the absence of hyperinsulinemia, but still remained twofold higher than those in their sham-operated counterparts (9.9 +/- 1.3 vs. 4.8 +/- 0.7 ng/ml). These results indicate that the destruction of VMH rapidly promotes leptin production before obesity develops through an enhanced translational process in which hyperinsulinemia occurring after VMH lesioning plays an important role. The present study also suggests that there are other mechanisms that rapidly upregulate leptin production in adipocytes in VMH-lesioned rats in which the target organ of this hormone has been destroyed.

Animals↗
PubMed1999

Serum vascular endothelial growth factor in the course of transcatheter arterial embolization of hepatocellular carcinoma.

We previously reported that in vitro hypoxic condition enhanced VEGF level and its receptor expression in hepatic cancer cell line, HepG2. Transcatheter hepatic arterial embolization (TAE) therapy is one of the vasculo-occlusive and hypoxic challenges to hepatocellular carcinoma (HCC). Therefore, we examined the level of VEGF in sera of patients with HCC who underwent TAE during the course of the treatment. Thirty-eight patients with HCC and hepatitis C virus-positive cirrhosis were studied. Peripheral blood samples were taken before and 1, 3 and 7 days after TAE with informed consent. The serum levels of VEGF as well as hepatocyte growth factor (HGF), another hepatic remodeling factor, were measured. The molar ratio (BTR) of serum branched chain amino acid (BCAA) to tyrosine (Tyr), the serum levels of AST, ALT and LDH were also examined. Although the level of AST, ALT and LDH reached the peak value within 1 day after TAE, VEGF level increased significantly 7 days later. On the other hand, there were no significant alterations in the levels of HGF and BTR during the course of TAE. Although the level of HGF was significantly correlated with the level of VEGF before TAE, this correlation was no more observed after TAE. These data collectively suggest that VEGF may be secreted in response to clinical hypoxic intervention, TAE, independent of HGF or altered amino acid metabolism. VEGF may play a role as a sensitive marker for tumor ischemia.

Adult↗
PubMed1999

Downregulation of intercellular adhesion molecule-1 expression on human synovial fibroblasts by endothelin-1.

OBJECTIVE: To study the effect of endothelin-1 (ET-1) on the expression of intercellular adhesion molecule-1 (ICAM-1) by synovial fibroblasts derived from individuals with rheumatoid arthritis (RA) or osteoarthritis (OA). METHODS: The expression of ICAM-1 protein and the abundance of ICAM-1 mRNA in synovial fibroblasts derived from individuals with RA or OA, or healthy controls, was assessed by flow cytometry and Northern blot analysis, respectively. mRNA expression of ET type A (ETA) and ET type B (ETB) receptors was assessed by reverse transcription polymerase chain reaction. RESULTS: Tumor necrosis factor-alpha (TNF-alpha) increased the expression of ICAM-1 by RA and OA fibroblasts. While ET-1 alone had no significant effect on ICAM-1 expression by either cell type, it inhibited the TNF-alpha induced increase in ICAM-1 expression, and this effect was more marked in RA fibroblasts. TNF-alpha also increased the amount of ICAM-1 mRNA in both cell types, and ET-1 inhibited this increase to a greater extent in RA fibroblasts than in OA fibroblasts. This inhibitory effect of ET-1 was reversed by addition of specific antagonist of ETA receptor. mRNA expression of ETA and ETB receptors was significantly greater in RA fibroblasts stimulated with TNF-alpha or even medium alone than in OA fibroblasts. CONCLUSION: These results suggest that ICAM-1 expression by fibroblasts is regulated not only by proinflammatory cytokines such as TNF-alpha and interleukin-1beta, but also by the vasoactive peptide ET-1, and that ET-1 may play an important role in inflammatory responses, especially in rheumatoid synovitis.

Aged↗
PubMed1999

[Present situation of medical care for foreigners at medical facilities in Chiba City].

OBJECTIVE: The number of foreigners residing in Japan has increased during the past decade. The aim of this survey was to clarify the present situation and the disadvantages in the medical care for foreigners. METHODS: In October 1997, we mailed a questionnaire to all clinics and hospitals in Chiba City. The questionnaire included questions regarding the number of foreign patients who visited during the past three months, the proportion of patients who have any health insurance, procedures for handling foreign patients, and the disadvantages in medical care for them. RESULTS: Of the 210 respondents (183 clinics and 27 hospitals), 133 facilities (63.3%) provided medical care for foreign patients during the past three months, and 187 (89.0%) during the past year. In 102 facilities (76.7%), the number of foreign patients was fewer than 10 during the past three months. The mean number of foreign patients was 13.8 per facility (12.2 per clinic, and 23.5 per hospital). Of these foreign patients, 68.6% had any health insurance. In 172 facilities (81.9%), foreign patients were accepted in the same way as the Japanese. The main disadvantages in medical care for foreigners were difficulty in understanding because of communication problems, and default in payment of medical expenses for the foreigners with no health insurance. In 154 facilities (73.3%), no special preparation to communicate with foreign patients was provided, and few facilities could understand foreign languages except for English. In 20 facilities, fees for medical care had been left unpaid by foreign patients during the past year, and the total outstanding amount was about 23,800,000 yen. CONCLUSION: In Chiba City, many medical facilities provide medical care for foreign patients. This study suggests that support for communication with foreigners and compensation for default in medical expenses are necessary.

Communication↗
PubMed1999

[Tele-medicine system for high-risk asthmatic patients].

We have developed a tele-medicine system to monitor the airway status at home for patients with poorly controlled asthma, whereby a nurse provides instructions to individuals via the telephone to help them manage exacerbation under the supervision of their physicians. We examined the effectiveness of this system with a randomized control study. Patients with high hospitalization risk were enrolled in the study by screening patients for those with multiple previous emergency room visits and randomly assigned to either the tele-medicine or control group. After six months of participation in the program, the number of emergency room visits decreased significantly and the activities of daily living were improved in the tele-medicine group. Most of the patients in the tele-medicine group were able to continue measuring and transmitting peak expiratory flow (PEF) value successfully, and at six months had noticed an improvement in PEF. We therefore conclude that the system effectively contributes to the management of poorly controlled asthma. In addition, further consideration suggests that the reduction of emergency room visits may lead to reduction in hospitalization since we found a good correlation between number of emergency room visits and hospitalization from the studies published previously.

Asthma↗
PubMed1999

Evaluation of the substantia nigra in patients with Parkinsonian syndrome accomplished using multishot diffusion-weighted MR imaging.

BACKGROUND AND PURPOSE: Although it is important to evaluate the substantia nigra in patients with parkinsonian syndrome, it is difficult to depict its anatomy, even by MR imaging. Using anatomic studies of the direction of nerve fibers around the substantia nigra, we attempted to depict this entity with multishot diffusion-weighted MR imaging to evaluate its topographic changes in patients with Parkinson's disease and secondary parkinsonism. METHODS: We measured the substantia nigra on 72 diffusion-weighted axial MR images obtained in 36 healthy control subjects, on 47 images obtained in 25 patients with Parkinson's disease, and on 10 images obtained in five patients with secondary parkinsonism. We considered the width of the minor axis of the substantia nigra as its "thickness," which appeared as a crescent-shaped region in the midbrain. RESULTS: Diffusion-weighted imaging portrayed the substantia nigra distinctly better than did T2-weighted imaging, because the surrounding white matter appeared as an area of high signal intensity. The mean (+/- SD) thickness values of the substantia nigra were 5.1+/-0.89 mm in control subjects, 4.8+/-0.75 mm in patients with Parkinson's disease, and 3.4+/-0.53 mm in patients with secondary parkinsonism. CONCLUSION: Multishot diffusion-weighted imaging is a better imaging technique than T2-weighted imaging for demonstrating a change in size of the substantia nigra in vivo. The substantia nigra is not reduced in size in patients with Parkinson's disease, but it is reduced in patients with secondary parkinsonism.

Adult↗
PubMed1999

[A study of factors influencing determination of discharge disposition of stroke rehabilitation patients].

PURPOSE: The purpose of this study is to statistically analyze medical and socioeconomic factors which influence discharge disposition from a stroke unit. METHODS: We investigated 126 stroke patients admitted to a community hospital within 30 days from the onset of the stroke. Mean age was 65.9 +/- 13.9 (SD) years old, profile of diagnosis was 89 infarctions was 37 hemorrhages, and mean length of stay was 79.7 +/- 45.1 days. Our rehabilitation team consists of doctors, nurses, physical therapists, occupational therapists and a medical social worker. Our stroke unit accepted the stroke patients from the time of admission and attempted to begin rehabilitation as soon as possible. The patients and their families were informed about their options after discharge from the hospital. Eight factors were analyzed using a multiple logistic regression model. RESULTS: 1) Ninety-eight patients (77.8%) could return home (home group) and 28 patients (22.2%) were discharged to another hospital or a long-term care facility (LTCF group). 2) Mean age of LTCF group (70.3 +/- 12.0) was significantly higher than the home group (64.8 +/- 14.2, p < 0.05). The home group showed milder leg paresis (p < 0.01), better Barthel index (p < 0.01), a higher number of family members (p < 0.05), and a better substantial care ability (p < 0.01) than LTCF group. 3) Three factors, higher Barthel index (odds ratio: 1.36), higher number of family members (1.84), and better substantial care ability (1.94), were found to facilitate discharge to home. Two other factors, hemorrhage (0.39) and public assistance (0.04), adversely affected the likelihood of discharge to home. CONCLUSIONS: This study suggests that a stroke unit could accelerate discharge home by improving the Barthel index. In addition, socioeconomic factors should be taken into consideration.

Aged↗
PubMed1999

[Effect of IL-17 on ICAM-1 expression of human bronchial epithelial cells, NCI-H 292].

Bronchial asthma is characterized as a chronic inflammation of the airway infiltrated by eosinophils, lymphocytes, and neutrophils. ICAM-1 expression on airway epithelium facilitates adhesion between these inflammatory cells and bronchial epithelial cells, and induces the activation of inflammatory cells. ICAM-1 expression was affected by various cytokines, such as IL-17. IL-17 is a novel cytokine released by CD4+ activated memory T cells. In this study, we examined the effect of IL-17 on ICAM-1 expression by RT-PCR and flow cytometry. Human bronchial epithelial cells, NCI-H 292 cells, were stimulated with IL-17 (100 ng/ml) and/or IFN-gamma (100 U/ml). ICAM-1 was expressed constitutively. IL-17 alone did not enhance ICAM-1 expression on NCI-H 292 cells. However, IL-17 synergistically enhanced ICAM-1 expression induced by IFN-gamma. These results suggest that IL-17 has an effect on ICAM-1 expression of bronchial epithelial cells in airway inflammation.

Bronchi↗
PubMed1999

[A case of fetal valproate syndrome with intractable wheezing due to submucosal tumor below the vocal cord].

A full-term baby was born to an epileptic mother treated with two anti-epileptic drugs, sodium valproate and phenobarbital, throughout the pregnancy. She was given no information about the risk of teratogenesis of these drugs. At birth the patient was hypotonic and had clinical features specific for the fetal valproate syndrome. After a viral infection at three months of age, he had intractable and persistent wheezing. Suspecting the presence of congenital respiratory tract abnormality, we performed tracheobronchoscopy, which revealed a relatively big submucosal tumor on the left trachial wall below the vocal cord. Dyspnea and wheezing were remarkably improved by tracheolaryngotomy, but he died suddenly and unexplainedly at seven months of age.

Abnormalities, Drug-Induced↗
PubMed1999

Incidence of histamine release after the administration of midazolam-ketamine in allergic patients.

OBJECTIVE: We examined the effects of midazolam-ketamine which was used during the induction of anesthesia against histamine release, skin reactions and hemodynamic changes in patients with a history of allergy. SUBJECTS: Forty allergic patients and 40 non-allergic patients undergoing oral surgery were examined. METHODS: Midazolam ketamine was used for the induction of anesthesia in 40 patients with a history of allergy (M-K group) and thiamylal was used for the induction of anesthesia in 40 patients without any history of allergy (BARB group). Venous blood samples were obtained before induction as a control and 0.5, 1, 3, 5 minutes after the administration of each drug in order to measure the plasma histamine level. In addition, any observed hemodynamic changes were simultaneously recorded. The plasma histamine level was measured using the HPLC (high performance liquid chromatography) post-label system. RESULTS: The incidence of histamine release, skin reactions and hemodynamic changes were 37.5%, 10.0% and 7.5%, in the M-K group, and 40.0%, 12.5% and 12.5%, in the BARB group, respectively. Although the mean basal plasma histamine level in the M-K group (0.46 +/- 0.23 ng/ml) who had a history of allergy was much higher than that in the BARB group (0.28 +/- 0.17 ng/ml) (p < 0.001), the incidence of histamine release and clinical symptoms were similar between the two groups. CONCLUSIONS: The induction of anesthesia with midazolam-ketamine was thus found to be a valuable method for allergic patients, because the incidence of histamine release, skin reactions and hemodynamic changes in allergic patients were similar to those in non-allergic patients induced by thiamylal and no significant changes were observed in the plasma histamine level after the administration of midazolam-ketamine in spite of the high level of basal plasma histamine.

Adolescent↗
PubMed1999

The basal plasma histamine level and eosinophil count in allergic and non-allergic patients.

OBJECTIVE: The basal plasma histamine level and eosinophil count in the peripheral blood in patients with a history of allergy (allergic patients) were examined and compared with those in patients without any history of allergy (non-allergic patients). SUBJECTS: We preoperatively examined 70 allergic patients and 70 non-allergic patients who were all scheduled to undergo oral surgery. METHODS: The basal plasma histamine level and eosinophil count in the peripheral blood were measured preoperatively. The high performance liquid chromatography (HPLC) post label system was used to measure the plasma histamine level. RESULTS: The mean basal plasma histamine level in non-allergic patients and allergic patients were 0.31 +/- 0.27 ng/ml and 0.47 +/- 0.30 ng/ml, respectively (p < 0.01). The mean eosinophil counts in non-allergic patients and allergic patients were 3.3 +/- 3.0% and 5.3 +/- 3.4%, respectively (p < 0.01). The patients who had asthma, atopic dermatitis or a food-induced allergy showed a high level of basal plasma histamine compared to that in non-allergic patients. The patients with asthma, allergic rhinitis or atopic dermatitis all demonstrated a higher eosinophil count than non-allergic patients. In addition, the correlation between the plasma histamine level and the eosinophil count was statistically significant (p < 0.05). CONCLUSIONS: The allergic patients had both higher basal plasma histamine levels and eosinophil counts than non-allergic patients (p < 0.01).

Adolescent↗