[Intraoperative diagnosis. The reason of restricted indication and suggestion].
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Diagnosis↗
Biomedical subjects
M Kawamoto
Publications and source records attributed to M Kawamoto.
[Comparison of measuring an area with a planimeter and by rectangular dimensional methods].
We have developed a system that measures the volume of air cells in the temporal bone through computerized digital processing of high-resolution CT images. By using this method, the volume of pneumatization was measured, and the results were compared with the measured area of pneumatization obtained from two conventionally used simple ear X-ray methods (the planimeter and rectangular dimensional methods). A total of 57 ears, from 34 subjects, confirmed as normal by CT were examined. The average volume of pneumatization measured on CT images was 5.97 +/- 4.15ml, and the average areas of pneumatization measured by the planimeter and rectangular methods were 9.08 +/- 5.64 and 17.39 +/- 9.77 cm2, respectively. Graphically, when the volume of pneumatization was plotted on the Y axis and the planimeter-measured area of pneumatization on the X axis, a regression formula of Y = 0.651X + 0.054 was obtained, with a correlation coefficient of 0.89. With the volume of pneumatization plotted on the Y axis and the rectangular-dimensional-measured area of pneumatization on the X axis, the regression formula was Y = 0.375X - 0.559, with a correlation coefficient of 0.88. Both these correlation coefficients were considered high. Furthermore, 3D models of the air cells in the temporal bone were created and compared for patients with high and low correlations. In order to capture the morphological characteristics of these 3D models, they were examined from four different angles (lateral, upper lateral, anterior lateral and upper medial). The results showed that regardless of whether air-cell growth was present in the direction of the apex partise petrosae in patients with a low correlation coefficient, such growth played a major role in the degree of the correlatiton. Future studies will be required to clarify this point, though it can already be said that 3D models are indispensable for studying the air cells in the temporal bone. When we compared the volume and area of pneumatization in the temporal bone at different CT cross-sections, we found correlation coefficients in the vicinity of the canalis semicircularis lateralis of about 0.9 or higher. A statistical comparison of correlation coefficients for the CT, planimeter, and rectangular dimensional methods, made by using the CT cross-section with the highest coefficient, found a significant difference between the CT method and the other two methods (p < 0.05). In other words, the volume of pneumatization can be estimated more accurately with CT images than with simple ear X-rays.
Adolescent↗
[Immunohistochemistry and activities of thymidine phosphorylase in the tissues of uterine cervical and endometrial carcinomas].
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Aged↗
[Hemilateral hydrothorax and atelectasis during laparoscopic Nissen fundoplication].
A 57-year-old woman, weighing 75 kg, with gastroesophageal sliding hernia, received laparoscopic Nissen fundoplication under general anesthesia. Although artificial ventilation was carried out uneventfully when the surgery started, sudden decreases in SpO2 and thoraco-pulmonary compliance were noted after insufflation of CO2. Breath sound was not audible on the left lung. We suspected that inadvertent pneumothorax was produced, but chest X-ray and transesophageal echocardiography at the end of surgery revealed the presence of left hemilateral hydrothorax with pulmonary atelectasis. She was ventilated artificially and given diuretics and albumin solution for 3-days before extubation. We speculated on two reasons for the event: a possibility of perforation of the diaphragm manipulated by surgeons, and that of transition of fluid used for irrigation just below the diaphragm. Pulmonary atelectasis could be induced with hemilateral lung ventilation because cephalad shifting of the diaphragm might follow the intraperitoneal insufflation. We conclude that laparoscopic surgery with insufflation of gas and irrigation with fluid requires careful attention if the laparoscopic surgery is sustained with insufflation and irrigation.
Anesthesia, General↗
[Immunohistochemical localization of thymidine phosphorylase in primary lung cancer].
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Adenocarcinoma↗
[Serial changes of atrial natriuretic peptide and brain natriuretic peptide during cesarean section under spinal anesthesia].
Both atrial natriuretic peptide (ANP) and brain natriuretic peptide (BNP) are considered to play a role in regulation of body fluid volume and blood pressure. Serial changes of their plasma concentrations are known to reflect blood volume. In this study, we investigated the serial changes in maternal blood concentrations of ANP and BNP in those who underwent cesarean section under spinal anesthesia. Blood samples were obtained before anesthesia, before surgery, at the end of surgery, and on the next morning. Samples were also compared with those from normal pregnant women. Throughout the cesarean section, ANP did not show any significant changes, while BNP remained within normal ranges during anesthesia and increased on the next morning. We concluded that ANP and BNP were regulated differentially, and that BNP reflected blood volume significantly during and after spinal anesthesia.
Adult↗
Prediction of reversible ischemia after revascularization. Perfusion and metabolic studies with positron emission tomography.
BACKGROUND: Accurate noninvasive determination of myocardial viability is of paramount importance for the clinical identification of patients who will benefit most from revascularization. The preserved metabolic activity in the myocardium, as studied with positron emission tomography (PET), has been considered a gold standard for this purpose. However, recent reports show that moderate hypoperfusion or stress-induced ischemia may represent reversible ischemia. The present study was undertaken to compare the value of perfusion and metabolic studies with PET for predicting improvement in wall motion after revascularization. METHODS AND RESULTS: Of 61 patients who had regional asynergy and underwent PET before revascularization, 43 patients who had successful revascularization were included in the study. Each patient underwent rest-stress 13N-ammonia perfusion scans and 18F-fluorodeoxyglucose (FDG) scan at rest while in a fasting state. Reversible ischemia was considered to be present when the resting perfusion was > or = 50% of the peak value, stress-induced hypoperfusion was present, or an increase in FDG uptake was observed. Of 130 asynergy segments, 51 segments had improved wall motion after revascularization. The positive and negative predictive values for improvement in asynergy were 48% and 87% by the rest perfusion study, 63% (P = .05 versus the rest value) and 87% by the rest-stress perfusion study, and 76% (P < .01 versus the rest value) and 92% by the FDG study. CONCLUSIONS: FDG PET provided the best predictive value for improvement in wall motion after revascularization. On the other hand, 13N-ammonia PET is useful for predicting nonreversible myocardial scarring when it shows severe hypoperfusion at rest or hypoperfusion without stress-induced ischemia.
Adult↗
Distribution and characterization of immunoreactive adrenomedullin in porcine tissue, and isolation of adrenomedullin [26-52] and adrenomedullin [34-52] from porcine duodenum.
Using a sensitive radioimmunoassay which recognizes the carboxy-terminal region of porcine adrenomedullin, the distribution of immunoreactive adrenomedullin was widely distributed in porcine tissue, and its concentration was highest in adrenal medulla (126 +/- 32 fmol/mg wet tissue; mean +/- SD). Relatively high concentrations of immunoreactive adrenomedullin were found in the right atrium, lung, duodenum, and pituitary gland. The molecular form of immunoreactive adrenomedullin in all porcine tissues was found to be almost wholly porcine adrenomedullin itself by analysis with reverse-phase high-performance liquid chromatography coupled with radioimmunoassay. Minor molecular forms of immunoreactive adrenomedullin were found in the porcine duodenum. These were isolated and identified as adrenomedullin [26-52] and adrenomedullin [34-52].
Adrenomedullin↗
Sebaceous carcinoma of the vulva.
Extraocular sebaceous carcinoma (SC) is a rare tumor usually found on the head and neck. A 78 year old Japanese female who had an asymptomatic vulvar tumor is reported here. The excised specimen showed SC with metastasis to the inguinal lymph nodes. This is the fourth reported case of SC arising from female genitalia, and the second case that apparently arose from the labia minora. Contrary to the previously reported cases, tumor cells in the present case had abundant glycogen. Thus, differential diagnosis of SC from metastatic renal cell carcinoma is difficult morphologically because both of them have glycogen and lipid. Intraepidermal invasion of tumor cells has been reported in SC, but a suspected lesion of this phenomenon in the present case was proved to be histiocytic infiltration by immunohistochemistry using anti-CD 68 antibody.
Adenocarcinoma, Sebaceous↗
Bronchial epithelial cells regulate fibroblast proliferation.
Chronic bronchitis frequently leads to irreversible airway obstruction. Alteration of airway architecture with abnormal airway connective tissue is thought to play an important role in this process. We hypothesized that the epithelial cells that line the airways modulate the development of peribronchial fibrosis and fixed airway obstruction by directing fibroblast proliferation. To assess this, we examined stimulatory activities for human lung fibroblast proliferation in bovine bronchial epithelial cell-conditioned medium. The conditioned medium stimulated the proliferation of fibroblasts in a serum-free culture system in a concentration-dependent manner. The fibroblast growth stimulatory activity was heterogenous, with molecular masses of > 50 and approximately 10 kDa. Bronchial epithelial cell-conditioned medium also contained fibroblast growth inhibitory factors, including both transforming growth factor (TGF)-beta and, based on indomethacin sensitivity, cyclooxygenase products. TGF-beta appeared to contribute to the morphological change of fibroblasts induced by the conditioned medium. Co-culture of human lung fibroblasts with bronchial epithelial cells resulted in a stimulation of fibroblast proliferation. In summary, airway epithelial cells appear to regulate fibroblast proliferation and may play a role in peribronchial fibrosis in chronic bronchitis.
Animals↗
Cigarette smoke inhibits lung fibroblast proliferation and chemotaxis.
Cigarette smoking is the most clearly recognized cause of pulmonary emphysema. Since loss of lung tissue, which characterizes emphysema, represents a balance between injury and repair, we hypothesized that cigarette smoke might contribute to the development of emphysema by inhibiting fibroblast proliferation and migration. To evaluate this, we examined the effect of cigarette smoke extract (CSE) on the proliferation and migration of human lung fibroblasts in vitro. CSE inhibited fibroblast proliferation and migration at noncytotoxic concentrations. When CSE was treated to remove volatile components, it showed less inhibitory activity on fibroblast proliferation. Therefore, we also examined acrolein and acetaldehyde, which are volatile components of cigarette smoke, Micromolar concentrations of acrolein and millimolar concentrations of acetaldehyde induced significant inhibition of fibroblast proliferation. In contrast, removal of volatile components did not eliminate the inhibitory activity of CSE for fibroblast migration, although acetaldehyde and acrolein alone were also capable of inhibiting chemotaxis. Cigarette smoke-induced inhibition of fibroblast proliferation and migration may impair lung repair following lung injury, and may thus contribute to the development of pulmonary emphysema.
Acetaldehyde↗
Modulation of fibroblast type I collagen and fibronectin production by bovine bronchial epithelial cells.
To elucidate bronchial epithelial cell (BEC)-fibroblast interactions with regard to extracellular matrix production, bovine BECs were cultured, and conditioned media were assayed for their effects on fibroblast extracellular matrix production. Bovine BECs were prepared by protease digestion and grown in serum-free medium. When confluent, 48-h conditioned medium (CM) was collected and added to confluent human fetal lung fibroblasts (HFL-1) with 10 micrograms/ml ascorbic acid every other day. Type I collagen and fibronectin production from fibroblasts were quantified by enzyme-linked immunosorbent assay. Fifty percent BEC CM caused an increase in type I collagen (582 +/- 92 pg/10(3) cells/h versus 220 +/- 42, P < 0.001) and in fibronectin (1,422 +/- 60 pg/10(3) cells/h versus 360 +/- 24, P < 0.001) production after 4 days. These observations were confirmed by sodium dodecyl sulfate-polyacrylamide gel electrophoresis followed by autoradiography in HFL-1 cultures labeled with [14C]proline. Dose-dependent stimulation was observed in response to BEC CM. Stimulation of macromolecule release was accompanied by increased steady-state fibronectin and alpha 1 (I) collagen mRNA levels. Sephadex G-150 column chromatography of BEC CM revealed two distinct peaks of activity at approximate molecular weights of 25 kD and > 66 kD. Transforming growth factor beta (TGF-beta)-neutralizing antibody blocked the activity of both peaks, suggesting that TGF-beta produced by the epithelial cells may drive fibroblast matrix production and that a TGF-beta binding substance may be present, or that TGF-beta aggregation may occur. Because some partially purified preparations had increased stimulatory activity compared to crude supernatants, potential inhibitors of matrix production were also sought.(ABSTRACT TRUNCATED AT 250 WORDS)
Animals↗
Effects of midazolam on heart rate variability during surgery under spinal anaesthesia.
Effects of midazolam on the cardiac autonomic nervous system were studied by power spectral analysis of electrocardiographic R-R intervals in patients undergoing elective lower abdominal surgery under spinal anaesthesia. Patients were randomly assigned into two groups: 10 patients in group A received spinal anaesthesia only and 10 in group S received spinal anaesthesia and midazolam of 0.05 mg/kg when surgery started. In the frequency domain power spectra, low (Lo; 0.04-0.15 Hz) and high (Hi; 0.15-0.40 Hz) frequency components were integrated to ascertain sympathetic and parasympathetic activity, respectively. There was no intergroup difference in starting time of surgery, ventilatory frequency, arterial pressure, heart rate, mean and variance of R-R interval, and cephalad level of analgesia. In spectral component, Lo decreased (P < 0.05) and Hi/Lo ratio increased (P < 0.05) relative to their baselines in group S. These were also different from group A (P < 0.05). We concluded that intravenous midazolam depressed sympathetic activity to produce a vagotonic cardiac autonomic nervous system under spinal anaesthesia.
Abdomen↗
[Antibodies of IgM type against small cell lung carcinoma and 29 kD neuronal antigen of rat in a patient with paraneoplastic sensory neuropathy].
62-year old man who had small cell lung carcinoma (SCLC) with subacute sensory neuropathy had an antibody (IgM) recognizing the antigen on peripheral nerves. The antibody in the serum recognized cell surface antigen on small cell carcinoma cell lines and also reacted with peripheral nerves simultaneously, but not with central nervous system. Two months before admission, he felt difficulty in walking because of paresthesias in the extremities. He was found to have a tumor shadow in chest X-ray, and was diagnosed as SCLC by biopsy of right supraclavicular lymph node. Western blot analysis demonstrated that auto-antibody (IgM) in the serum recognizing the antigen on the neuronal axon with single band at 29 kD. Pathogenesis of carcinomatous neuropathy is still unexplained, but the findings presented here have given rise to the possibility that anti-SCLC antibody may cross-react with neuronal antigen, primarily resulting in neuronal disorder.
Animals↗
Decreased uptake of iodinated branched fatty acid analog indicates metabolic alterations in ischemic myocardium.
UNLABELLED: We previously reported that uptake of 123I-labeled 15-iodophenyl 3-methyl pentadecanoic acid (BMIPP) was lower than that of thallium in ischemic myocardium. Such discordant findings between BMIPP and thallium were compared with those of PET using 18F-deoxyglucose (FDG) and 11C-acetate to assess metabolic alterations in such segment. METHODS: Sixteen patients with coronary artery disease underwent both BMIPP SPECT and PET. Relative FDG uptake (% FDG uptake) and the clearance rate constant (% Kmono) of 11C-acetate from the myocardium were calculated as markers of glucose and oxidative metabolism, respectively. RESULTS: Relative FDG uptake of the myocardial segments with reduced BMIPP uptake and normal thallium uptake (discordant segments) was similar (85.3 +/- 10.3) to that of the normal segments (86.5 +/- 11.7) but higher than that of segments with reduced uptake of both BMIPP and thallium (67.5 +/- 19.9). Similarly, the discordant segments showed a higher % Kmono value (77.8 +/- 13.1 versus 70.0 +/- 19.1) and FDG-to-perfusion ratio (1.15 +/- 0.08 versus 1.01 +/- 0.22) than in the concordantly reduced segments. CONCLUSION: BMIPP uptake appears to provide metabolic information independent of thallium uptake. Combined imaging of BMIPP and thallium may potentially identify ischemic but viable myocardium.
Acetates↗
Myocardial oxidative metabolism in hyperthyroid patients assessed by PET with carbon-11-acetate.
UNLABELLED: Hyperthyroid patients often complain of cardiovascular symptoms because of increased metabolism. This study was designed to quantitatively evaluate myocardial oxidative metabolism in these patients. METHODS: Dynamic PET with 11C-acetate was performed in 19 patients who had not undergone treatment for hyperthyroidism. Eight were restudied 2 wk after oral administration of propranolol. The clearance rate constant of 11C-acetate (Kmono) was calculated with monoexponential fitting of tracer washout from the myocardium as a marker of myocardial oxidative metabolism. The results were compared with those in nine normal subjects both at rest and during dobutamine infusion. RESULTS: Kmono in our patients (0.109 +/- 0.028 min-1) was significantly increased compared to normal subjects (0.066 +/- 0.016 min-1) (p < 0.05). After propranolol treatment, Kmono decreased (0.082 +/- 0.014 min-1) but remained significantly higher in eight patients than normal subject levels (p < 0.05), while the rate pressure product decreased significantly (7500 +/- 1700) toward the normal range (7900 +/- 1500). CONCLUSION: These results suggest the possibility of excessive myocardial oxygen consumption in hyperthyroid patients. The clearance rate of 11C-acetate is a new and valuable index to assess myocardial oxidative metabolism not closely related to the pressure rate product or thyroid hormones in these patients.
Acetates↗
[Pulmonary infarct hardly differentiated from lung cancer--a case report].
A 64-year-old woman experienced high grade fever, chest pain, and hemosputum. She was admitted to a hospital for evaluation of the infiltrate on an chest X-ray. She was diagnosed as having lung cancer by sputum cytology and transferred to our hospital for operation. The tumor was obscure on palpation during thoractomy, but malignancy could not be ruled out based on analysis of frozen sections. Therefore, a right lower lobectomy and mediastinal lymph node dissection were performed. Pulmonary infarct was not suspected until thrombi were observed in the dissected pulmonary artery. Urokinase and heparin were intravenously administered soon after the operation, but the patient died of pulmonary thromboembolism of the sixth postoperative day. Examination of the operative specimen revealed pulmonary thromboembolism with infarction and no evidence of malignancy. Atypical cells observed in sputum cytology seemed to be derived from basal cell hyperplasia in the area of infarction. Type II alveolar epithelial cell hyperplasia was observed in the periphery of the infarction. These findings seemed to make accurate analysis of frozen sections difficult. An increasing number of cases of pulmonary thromboembolism is being reported in Japan. Therefore, pulmonary infarct with false positive cytology may be encountered more frequently in the future.
Diagnosis, Differential↗
[Myocardial uptake ratio of iodine-123 labeled beta-methyl iodophenylpentadecanoic acid (123I-BMIPP) in relation to the concentration of the substrates of energy].
Iodine-123 beta-methyl iodophenylpentadecanoic acid (BMIPP) has been used for evaluating myocardial fatty acid metabolism in vivo. The whole body BMIPP imaging was acquired in 26 patients (11 with HCM, 11 with CAD and 4 with DCM) to calculate % uptake in the myocardium and to correlate its uptake with biochemical data, including blood sugar (BS), nonesterified fatty acid (NEFA) and insulin in the blood. BMIPP was administered at rest with overnight fasting state, and the anterior and posterior whole body imaging was performed one hour later. The background corrected whole myocardial counts were calculated to obtain %BMIPP uptake. In addition, the heart to mediastinum count ratio (H/M ratio) was calculated from the mean counts in the heart and the upper mediastinum in the anterior view. The %BMIPP uptake was 3.70 +/- 1.22% and H/M ratio was 2.30 +/- 0.23. The patients with DCM showed higher %BMIPP uptake values (DCM = 5.58 +/- 0.67% vs. CAD = 3.09 +/- 0.97% and HCM = 3.63 +/- 0.86%, both p < 0.01), but similar values of H/M ratio with other patients (DCM = 2.43 +/- 0.20, CAD = 2.22 +/- 0.25 and HCM = 2.32 +/- 0.20). Although the biochemical data varied at the time of the tracer administration, they were not significantly correlated with the %BMIPP uptake or H/M ratio. However, there was a significant correlation between %BMIPP uptake and H/M ratio with the correlation coefficient of 0.80 (p < 0.001). We conclude that the myocardial uptake of BMIPP is not influenced by the plasma substrate level under the fasting state.
Blood Glucose↗