Biomedical subjects

M Mishima

Publications and source records attributed to M Mishima.

At least 145 records · Page 8Linked to original sources

PubMed1992

[Emergent cardiovascular operation in patients older than 75 years].

From January 1988 through December 1990, 7 patients older than 75 years underwent emergent cardiovascular operation. We evaluated those operative results. The mean age was 80.1 years (range 77 to 85 years) and there were 5 men and 2 women. Coronary artery bypass grafting for 2 cases, closure of ventricular septal perforation for 1 case, graft replacement of ascending aorta and suspension of aortic valve in 2 cases, closure of left ventricular free wall rupture (LVFWR) in 1 case and closure of arch aneurysm rupture for 1 case were performed. Operative mortality was 14.3% (1/7). There was one hospital death. Five survivors had uneventful course in early postoperative term, but they needed long elaborate hospital care because of complications in noncardiac general organs in late postoperative term. They need nutritional support, rehabilitation for muscle weakness and so on. Their mean postoperative hospital period was 53 days. All of them were improved in New York Heart Association I or II. We concluded that we attained a good operative result in emergent cardiovascular operation in patients older than 75 years by effective operation as a result of long elaborate postoperative hospital care.

Aged↗

PubMed1991

Concentration of activated T lymphocytes in extracorporeal blood circulation for plasma separation.

To investigate whether the proportion of activated T lymphocytes changes in an extracorporeal blood flow, we compared paired samples collected at the inlet and outlet lines of an artificial circuit for plasma separation, using a dual-immunofluorescence flow cytometric technique. In our series of materials from patients with rheumatoid arthritis or systemic lupus erythematosus, the percentages of HLA-DR-positive cells in both CD4+ (P less than 0.01, n = 6) and CD8+ (P less than 0.05, n = 10) subsets were significantly increased in the outlet lines compared with the inlet lines, suggesting that activated T lymphocytes pass through an extracorporeal blood circuit more easily than resting T lymphocytes.

Adult↗

PubMed1991

Frequency characteristics of airway and tissue impedances in respiratory diseases.

We measured the frequency characteristics (at 10-40 Hz) of airway (Za) and tissue (Zt) impedances in cases of chronic obstructive pulmonary disease [asthmatic bronchitis (AB), chronic pulmonary emphysema (CPE)] and interstitial pneumonitis (IP) by use of an improved random noise oscillation and body box method. The results were then compared with those obtained for normal subjects. The real part of Za was markedly elevated in patients with AB but only slightly elevated in those with CPE. To interpret these data we used an electromechanical analogue including serial inhomogeneity with shunt impedance. From this model we concluded that AB causes both the central and peripheral airway resistances to increase, while CPE brings about a rise mainly in peripheral resistance. In IP patients, only the imaginary part of Zt decreased, which might reflect the decrease in both lung and chest wall compliance. In CPE patients, but not in AB patients, the real part of Zt fell. These data were consistent with the assumption that the decrease in mass per unit volume of lung tissue and hyperinflation of the chest wall in CPE patients might lower the tissue resistances.

Adult↗

PubMed1991

Serial transcardiac lactate metabolism in post-reperfused stunned myocardium in evolving myocardial infarction.

To elucidate the relationship between lactate metabolism following reperfusion and restoration of left ventricular (LV) function, we assessed serial changes in transcardiac lactate metabolism following reperfusion therapy in 67 patients admitted to hospital within 6 h of the onset of acute anteroseptal myocardial infarction. Left ventriculograms taken about 30 min after reperfusion therapy revealed marked dyskinesis in the anteroapical region in all subjects. According to the regional ejection fraction (rEF), determined 4 weeks later as an index of LV function, patients were divided into 3 group: 1) Restored LV group: 28 patients with reperfusion and restored LV function (rEF greater than 30%); 2) Poor LV group: 26 patients with reperfusion but poor LV function (rEF less than 30%); 3) Failure group: 13 patients with failed reperfusion and occluded left anterior descending coronary artery. Although there was no difference in elapsed time and time to peak creatine phosphokinase (CPK) between the former 2 groups, the Restored LV group demonstrated lower peak CPK values, suggesting that these patients had less myocardial injury. Immediately after reperfusion, both groups showed transcardiac lactate production. In the Restored LV group, aerobic lactate metabolism was restored early after reperfusion (at 6 h), while in the Poor LV group prolonged anaerobic lactate metabolism was observed. These results suggest that an early restoration of aerobic metabolism might be a sign of stunned and viable myocardium, and a sustained lactate production might relate to a sustained process of myocardial injury.

Adult↗

PubMed1991

Coronary angioscopy: a monorail angioscope with movable guide wire.

A new angioscope was devised for easier visualization of the coronary artery. In its tip, the angioscope (Olympus) with an outer diameter of 0.8 mm had a metal lumen, through which a 0.014-in steerable guide wire passed. Using a 8F guiding catheter and a guide wire, it was introduced into the distal coronary artery. With injection of warmed saline through the guiding catheter, the coronary segments were visualized. In the attempted 70 vessels (32 left anterior descending [LAD], 10 right coronary [RCA], 28 left circumflex [LCX]) from 48 patients, 60 vessels (86%) were successfully examined. Twenty-two patients who underwent attempted examination of both LAD and LCX; both coronary arteries were visualized in 19 patients (86%). In the proximal site of the lesion, 40 patients have the diagonal branch or the obtuse marginal branch. In 34 patients (85%) the angioscope was inserted beyond these branches. In 12 very tortuous vessels, eight vessels (67%) were examined. In conclusion, the new monorail coronary angioscope with movable guide wire is useful to examine the stenotic lesions of the coronary artery.

Angioplasty, Balloon, Coronary↗

PubMed1991

[Phase difference between chest flow and mouth flow during rest breathing in cases of pulmonary diseases].

The phase difference between mouth flow and chest flow in cases of pulmonary diseases measured using a body box was compared with those in normal subjects. Phase differences in chronic pulmonary emphysema (CPE) and diffuse panbronchiolitis (DPB) patients increased compared to normal subjects, but remained normal in interstitial pneumonitis patients (Normal: 3.76 +/- 1.71, CPE: 10.70 +/- 4.93, DPB: 10.81 +/- 3.15, IP: 3.83 +/- 0.15 degrees). In addition, there was a good correlation with FEV1.0, FEV1.0% and RV/TLC (r: -0.634, -0.610 and 0.803). The analysis of phase differences during rest breathing is clinically useful because it is non-effort dependent and can evaluate the degree of airway disorders.

Adult↗

PubMed1991

Enzymatic hydrolysis of indometacin farnesil, a prodrug of indomethacin, by carboxylesterase in cultured synovial cells.

The hydrolysis of indometacin farnesil (IMF) in the synovial cells of rat and human and the subcellular fractions of rat liver were investigated in relation to the inhibition of prostaglandin E2 (PGE2) production in the synovial cells. The inhibition of PGE2 production in cultured human synovial cells by anti-inflammatory drugs was potent in the order of IND, IMF and acetyl salicylic acid. However, when the cells were pretreated with IMF, the inhibitory activity of IMF was retained even after the compound was washed out from the medium. No duration of the inhibition was seen in the pretreatment of the cells with IND or acetyl salicylic acid. These results suggest that IMF incorporated into the synovial cells was hydrolyzed gradually to IND. In fact, IMF was taken up by rat synovial cells in culture and considerable amount of IND, which increased with culture period, was found out in the cells. Furthermore, the IMF hydrolase activity was found in microsomal and lysosomal fractions of rat liver, and the hydrolase was identified as carboxylesterase by using bis-(p-nitrophenyl) phosphate, a specific inhibitor of carboxylesterase.

Animals↗

PubMed1991

[Analysis of factors of increased phase differences between chest flow and mouth flow at rest breathing in patients with obstructive disorders].

The factors which increase phase differences between mouth flow and chest flow in patients with obstructive disorders were analyzed. From airway resistance, thoracic gas volume and measured chest flow, phase difference was predicted by the Runge-Kutta (R.K.) method assuming respiratory system to be a single compartment model. The ratio of the measured phase differences to the predicted value by the R.K. method in normal subjects was 0.99 +/- 0.25. These results suggest that a single compartment model can be applied to normal respiratory system. In contrast, predicted phase differences were remarkably higher than measured values in patients with obstructive disorders (CPE: 1.83 +/- 0.63, DPB: 1.50 +/- 0.48). This phenomenon could be explained by the existence of parallel inhomogeneity of alveolar pressure.

Airway Resistance↗

PubMed1991

[A case of acute polyradiculoneuritis associated with autonomic involvement of the pupils].

Acute polyradiculoneuritis relapses rarely, and autonomic nerve involvement is less frequent than motor cranial nerve involvement. An 11-year-old boy exhibited acute relapsing polyradiculoneuritis associated with two types of autonomic dysfunction of pupils 6 months after the onset of the disease. Parasympathetic dysfunction of pupils with ocular palsies preceded neuropathy of limbs at the onset. Thereafter, sympathetic dysfunction of pupils without ocular palsies was revealed by pupillography at the 2nd attack of limb palsies.

Autonomic Nervous System Diseases↗

PubMed1990

Inhibitory effect of indomethacin farnesil, a novel antiinflammatory prodrug, on carrageenin-induced inflammation in rats.

Antiinflammatory effects of indomethacin farnesil (IMF), a novel prodrug of indomethacin, was examined after both oral and local administration. In the air pouch carrageenin-induced inflammation, an oral dose of IMF exerted dose dependent inhibitory effects on the accumulation of inflammatory exudate fluid and the migration of leukocytes into the exudate. Both the increased vascular permeability and the prostaglandin E2 levels in the exudate fluid were reduced by IMF. Significant levels of free indomethacin were detected in the pouch fluid. In spite of the inability of IMF to inhibit prostaglandin synthesis in a cell free cyclooxygenase system, IMF injected locally inhibited carrageenin paw edema, and the inhibitory effect was comparable to that of indomethacin itself. When injected locally into the paw together with carrageenin, 14C-IMF was effectively converted to its active metabolite, indomethacin. The indomethacin concentration in the paw tissue was comparable to that of indomethacin injected paws with the same molar dose of free indomethacin.

Animals↗

PubMed1990

Percutaneous transluminal coronary angioplasty using kissing balloon technique in the left main trunk.

This report describes the feasibility of the kissing balloon technique in the left main trunk in selected patients who had stenosis in the left main trunk involving bifurcation of the anterior descending artery and the circumflex artery and who also had enough blood flow to distal coronary to prevent left ventricular dysfunction during balloon occlusion or abrupt re-closure in the left main.

Aged↗

PubMed1990

Ia restriction specificity of KLH-specific T cells from allogeneic bone marrow chimeras is influenced by histocompatibility at the H-2 and minor histocompatibility loci.

Ia restriction specificity involved in T cell proliferative responses to keyhole limpet hemocyanin (KLH) has been analyzed using a variety of allogeneic bone marrow chimeras. The chimeric mice were prepared by reconstituting irradiated AKR, SJL, B10.BR and B10.A(4R) mice with bone marrow cells from B10 mice. When such chimeric mice had first been primed with KLH in complete Freund's adjuvant (CFA), T cells from H-2 incompatible fully allogeneic chimeras showed significantly higher responses to KLH in the presence of antigen-presenting cells (APC) of donor strain (B10) than APC of recipient strain. However, in H-2 subregion compatible chimeras, [B10----B10.A(4R)], which were matched at the H-2D locus and at minor histocompatible loci, the T cells could mount vigorous responses to KLH with antigen-presenting cells (APC) of either donor or recipient type. The same results were obtained as well with chimeras that had been thymectomized after full reconstitution of lymphoid tissues by donor-derived cells. A considerable proportion of KLH-specific T cell hybridomas established from [B10----B10.A(4R)] chimeras exhibited both I-Ab and I-Ak restriction specificities. The present findings indicate that the bias to donor Ia type of antigen specific T cells is determined by donor-derived APC present in the extrathymic environment but that cross-reactivity to the recipient Ia is influenced to some degree by histocompatibility between donor and recipient mice, even though the histocompatible H-2D locus and minor histocompatibility loci seem not to be directly involved in the I-A restricted responses studied herein.

Animals↗

PubMed1990

The interaction of neuromuscular relaxants with rabbit lung muscarinic receptors.

The interaction of muscle relaxants with airway muscarinic receptors of rabbit lung was investigated in vitro by the [3H]QNB binding technique. Pancuronium, vecuronium, alcuronium and succinyl choline chloride (SCC) inhibited the binding of [3H]QNB to rabbit lung muscarinic receptors in a dose-dependent manner. The values of IC50 (the concentration giving 50% inhibition) of pancuronium, vecuronium, alcuronium and SCC were 1.54 x 10(-5), 2.52 x 10(-5), 8.40 x 10(-5), and 4.00 x 10(-3) mol/l respectively. As the values of Kd increased with minimal change in the value of Bmax, while not influencing the number of receptors, these muscle relaxants had an inhibitory action on the affinity of muscarinic receptors to [3H]QNB in the order: pancuronium greater than or equal to vecuronium greater than alcuronium greater than SCC. Applying IC50 values to human conditions, clinical doses of these muscarinic relaxants are unlikely to exhibit any significant vagolytic action in lung tissue.

Alcuronium↗

PubMed1990

Metabolic fate of indometacin farnesil, a prodrug of indomethacin: characteristic biotransformation of indometacin farnesil in rats.

1. Hydrolysis of indometacin farnesil (IMF), a farnesyl ester of indomethacin, was higher in plasma and pancreatic juice than in liver and kidney homogenates of rats. Plasma hydrolytic activity was extremely low in beagle dog, monkey and human. 2. Orally administered 14C-IMF was absorbed mainly via the throacic lymph duct and distributed into tissues such as liver, adrenal and spleen as the unchanged from; the 14C in rat plasma was present mainly as indomethacin released from IMF. 3. The concentration ratios of indomethacin in carrageenin-induced inflamed paw to blood after 14C-IMF administration were significantly greater than those after 14C-indomethacin dosing. 4. These results indicate that absorbed IMF might be transported as the unchanged drug into tissues, including the site of inflammation and then hydrolysed to indomethacin in the tissues.

Animals↗

PubMed1990

[Is emergency angioplasty following successful thrombolysis more effective than thrombolysis alone in acute myocardial infarction?].

This study clarified the effects of residual stenosis following successful thrombolysis in acute myocardial infarction on infarct size and cardiac function in the chronic stage. Subjects consisted of 24 patients with acute anteroseptal myocardial infarction within six hours after the onset of symptoms, in whom thrombolysis was performed, and additional coronary angioplasty was performed in 10 patients. Great cardiac venous flow (GCVF) at a point 30 min after thrombolysis and angioplasty was examined by continuous thermodilution, and the minimal cross-sectional area (MCSA) was determined at a stenotic lesion using an orthogonal angiographic view. As an index of infarct size, we measured abnormally contracting segments (ACS) and perfusion defects (PD) in 201T1 single photon emission computed tomograms four weeks after the onset. We determined anterior regional ejection fraction (rEF) as an index of left ventricular performance in the chronic stage. The patients with thrombolysis alone and the patients with angioplasty were comparable as to age, gender elapsed time, GCVF, MCSA, ACS, PD and rEF. In all the patients, MCSA did not correlate significantly with GCVF. In the patients with additional angioplasty, MCSA significantly increased (from 0.3 +/- 0.3 mm2 to 2.5 +/- 1.6 mm2). However, GCVF did not necessarily increase in all the angioplasty patients. In four patients having delays in angiographic flow, and MCSA less than 0.1 mm2, there was a significant increase in GCVF after angioplasty (41.3 +/- 32.0 vs 82.0 +/- 60.7 ml/min). GCVF correlated significantly with ACS, PD, and rEF, but MCSA did not correlate significantly with them. We concluded that in patients with successful thrombolysis but without angiographic filling delay, emergency angioplasty for residual stenosis has no effect on further limitation of infarct size.

Adult↗

PubMed1990

[Dermal patch anesthesia to prevent pain from dermal puncture--10% lidocaine aqueous gel with 3% glycyrrhetinic acid 3-0 hemiphthalate disodium].

The clinical efficacies of 10% lidocaine aqueous gel with and without 3% glycyrrhetinic acid 3-0 hemiphthalate disodium (GAHPh) applied as a skin patch for reduction of pain from venous cannulation were evaluated in a double blind study. Twenty-four adult patients, who were scheduled for surgery under general anesthesia, gave informed consent to participate in this study. The patients were allocated randomly into two groups: one for a dermal patch GAHPh (GAHPh group) and the other for a dermal patch without GAHPh (plain group). Approximately 0.3g of either gel with or without GAHPh, soaked in a round sponge (25mm in diameter, 1mm in thickness), was applied over the selected vein on the arm and was covered with an adhesive plastic film (Tegaderm). Pain score was graded by the number of painful spots out of the 5 tests in the treated skin area. In patients with a pain score under 1, venous cannulation was carried out without an intradermal injection of a local anesthetic and pain associated with the cannulation procedure was graded by patients on a scale of 5, where 0 = no pain, 1 = little pain, 2 = moderate pain, 3 = painful, 4 = very painful. The mean application time periods were 59.3 min for the GAHPh group and 60.3 min for the plain group. Transient local redness was observed in 8 patients after removal of the gels; 3 in the GAHPh group and 5 in the plain group. The mean pain score (1.3 +/- 1.5) in the GAHPh group, was significantly lower than that (2.5 +/- 1.7) in the plain group (P less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

Administration, Cutaneous↗

PubMed1990

[A case of extended myocardial infarction treated with the left ventricular assist device (LVAD) before and after the operation--the value and limitation of LVAD].

A left ventricular assist device (LVAD) was applied to a patient who had profound left ventricular failure following extended myocardial infarction caused by the left main trunk obstruction. The patient was a 61-year-old man, who had severe chest distress and was admitted 11 hours after the onset of the symptom. At the time of admission, he was already in cardiogenic shock. The emergent coronary angiography showed complete obstruction of the left main trunk and the intact right coronary artery which had no collateral flow to the left coronary artery. The intraaortic balloon pumping (IABP) was started bu could not maintain the satisfied circulation. Then a LVAD was applied to the patient 5 days after the onset. The LVAD maintained the normal circulation and prohibited exaspiration of organ failure. 19 days after the onset, scartectomy and A-C bypass to LAD was performed. The patient could not be weaned from LVAD and died of right ventricular failure following ventricular arrhythmia 20 days after the installation of LVAD. The use of LVAD for nonoperative cardiogenic shock is rare. Circulatory support with a LVAD in the treatment of a patient in cardiogenic shock following a acute myocardial infarction was considered useful.

Coronary Artery Bypass↗

PubMed1990

[Dermal anesthesia: comparison of the analgesic effects of 2% and 10% lidocaine gel patch].

The analgesic effects of aqueous gel containing 2% or 10% lidocaine with 3% glycyrrhetinic acid mono 3-0 hemiphthalate sodium as an absorption promoter were compared in two volunteer groups of 12 persons each. A round sponge (25 mm in diameter and 1mm in thickness) filled with approximately 0.3g of either gel was applied on the volar surface of the forearm and kept covered with an adhesive plastic film (Tegaderm) for two hours. The analgesic effect was assessed every 30 min by pin-prick method at five places under the coverage for two hours, and after the gel was wiped away. The result from each place was scored 0 (no pain) or 1 (needle pain). The mean pain scores at 1 hr and 1.5 hr in the 10% group were 1.0 and 0.7, and significantly lower than 2.2 and 1.3 of the 2% group (P less than 0.05). Two hour application of the gel, five volunteers in the 2% group and eight volunteers in the 10% group produced a pain score under 1.0. In these subjects, a 26 gauge needle was stuck into the skin for further pain analysis. Four of the 5 subjects in the 2% group and 7 of the 8 subjects in the 10% group did not complain of any pain. Transient local redness under the coverage was observed in 3 subjects in each group. They were all known to be sensitive to alcoholic beverages. No other side effects were found. The plasma concentration of lidocaine was lower than 0.01 microgram.ml-1 at all times.

Adult↗