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Biomedical subjects

M Okada

Publications and source records attributed to M Okada.

At least 937 records · Page 52Linked to original sources
PubMed1994

[A case of Langer-Giedion syndrome (tricho-rhino-phalangeal syndrome type II) associated with epilepsy].

We reported here a case of Langer-Giedion syndrome (tricho-rhino-phalangeal syndrome (TRPS) type II) associated with epilepsy. TRPS type II is an uncommon genetic disease characterized by sparse, slowly growing scalp hair, pear-shaped nose, multiple cartilagenous exostosis and mental retardation associated with delayed speech development. This patient displayed typical features of this syndrome. He also showed arachnoid cyst in the frontal area on computer tomography of the brain, and paroximal activities on EEG. Chromosomal analysis revealed a partial deletion of the long arm of chromosome 8. He had afebrile convulsion which is a rare complication of this syndrome.

Adult↗
PubMed1994

[Randomized controlled trial of amino acid based diet versus oligopeptide based diet in enteral nutritional therapy of active Crohn's disease].

This study compared the short-term effect of semi-elemental diet in treatment of active Crohn's disease with elemental diet which has been reported to be successful in inducing remission. The important differences between semi-elemental diet and elemental diet in composition are the form of nitrogen and fat content. Forty patients with active Crohn's disease were randomized to receive for 6 weeks either elemental diet (n = 21) which is composed of amino acid based with low fat content or semi-elemental diet (n = 19) which is oligopeptide-based and has higher fat content. Both groups showed similar improvement in Dutch-AI, Crohn's disease activity index (CDAI), erythrocyte sedimentation rate, C-reactive protein, serum albumin, body mass index and radiographic findings of bowel lesion. The present study suggests that semi-elemental diet is equal to elemental diet for treating active Crohn's disease. We conclude the compositional differences between the two diets did not affect the short-term effect of enteral nutritional therapy for active Crohn's disease.

Adult↗
PubMed1994

[Cardiac operations in nine patients aged 80 years or older].

Nine patients aged 80 years or older underwent cardiac operations with cardiopulmonary bypass. Seven patients underwent coronary artery bypass surgery, one modified Bentall's operation and another patch closure of ventricular septal perforation. One patient died soon after operation (11 POD) and operative mortality was 11%. One died 7 months after operation because of rupture of dissecting thoracic aortic aneurysm. Seven patients are still alive within physical status of New York Heart Association Classes I or II. We conclude that cardiac operations should not be excluded in octogenarians because of their chronological age alone.

Age Factors↗
PubMed1994

Effect of dynamic cardiomyoplasty on phasic coronary arterial flow velocity in canine hearts.

The usefulness of dynamic cardiomyoplasty has been demonstrated repeatedly, both experimentally and clinically. Although clinical applications of dynamic cardiomyoplasty to ischemic heart disease have been reported, its effect on the coronary blood flow has never been discussed. Therefore, we tested the hypothesis that dynamic cardiomyoplasty might adversely affect coronary arterial blood flow through compression of the coronary arteries during systolic skeletal muscular contraction and incomplete relaxation of the skeletal muscle flap during diastole. Dynamic cardiomyoplasty was performed in seven mongrel dogs with the use of a left latissimus dorsi-muscle flap, paced synchronously with the R wave of the electrocardiogram. A 3F Doppler catheter was placed in the left main trunk of the coronary artery to assess the instantaneous changes of coronary flow velocity by fast Fourier transformation analysis, We compared systolic and diastolic properties during assisted versus unassisted cardiac cycles by calculating the peak velocity and the time-velocity integral. During assisted cardiac cycles, a significant enhancement of coronary arterial blood flow velocity was demonstrated by significant increases in both systolic and diastolic peak velocity (26.9% +/- 6.5%, p < 0.005; 4.0% +/- 1.6%, p < 0.05, respectively) and time-velocity integral (20.9% +/- 4.8%, p < 0.05; 10.0% +/- 4.6%, p < 0.05, respectively). Enhancement of coronary arterial blood flow velocity was associated with an increase in mean aortic pressure (16.4% +/- 1.3%, p < 0.005) and descending aortic flow (67.5% +/- 5.3%, p < 0.005). Also, the improved systolic coronary arterial blood flow velocity was consistent with an increase in systolic aortic pressure (15.8% +/- 1.5%, p < 0.005), and enhancement of diastolic coronary arterial blood flow velocity was associated with an increase in diastolic aortic pressure (8.6% +/- 2.3%, p < 0.01). We concluded that coronary arterial blood flow velocity was increased by the enhancement of cardiac function as a result of dynamic cardiomyoplasty, leading to an increase of coronary perfusion pressure and cardiac output.

Animals↗
PubMed1994

Mucosal mast cell proliferation following normal and heterotopic infections of the nematode Nippostrongylus brasiliensis in rats.

Infections of intestinal nematodes induce the T cell-dependent proliferation of intestinal mucosal mast cells (MMC). To examine whether nematode-induced MMC proliferation is affected by the site of infestation, adult-stage nematode Nippostrongylus brasiliensis (NB) was transplanted into the normal infection site, the duodenum, or into heterotopic sites, the peritoneal cavity (i.p.) or subcutaneous tissue (s.c.), of rats. Two weeks after duodenal inoculation, MMC numbers in the small intestine had increased 6.5-fold. In contrast, i.p. and s.c. inoculation induced only slight increases of intestinal MMC. After i.p. inoculation, worm granulomas developed in the connective tissues adhering to stomach and duodenum, and large numbers of mast cells appeared around the granulomas. The majority of the latter mast cells showed histochemical features similar to MMC: they were formalin sensitive, berberine sulfate-, alcian blue+/safranine-, and rat mast cell protease (RMCP) II+. After s.c. inoculation, worm granulomas developed at the inoculation site, but the number of mast cells around the granulomas was not significantly increased. These results suggest that intense proliferation of MMC or MMC-like cells is induced only by the infections on mucosa or in mucosa-associated tissues.

Animals↗
PubMed1994

[Treatment of osteoporotic fracture in the aged].

Osteoporosis is defined pathologically as an absolute decrease in the amount of bone, leading to fracture after minimal trauma at the aged. Adults beyond the age of 60 years have higher incidence of fractures of the neck of the femur, the distal end of the femur, the proximal humerus, and the distal radius than adults of the races. In addition to the prolonged use of hospital beds, the complications are high and are mostly associated with long-term bed rest for elderly patients. Therefore, we should never be allowed to lie in bed at the aged. The goal of treatment must be to restore the patients to pre-traumatic status at the earliest possible time, and this can be achieved best through reduction and plaster-of-paris splint, internal fixation in a stable fashion that allows early ambulation.

Aged↗
PubMed1994

[Re-operation long after the Rastelli's procedures].

Secondary reconstructive operations were performed in six patients, who received Rastelli's procedure in their childhood. Six patients consisted of three tetralogy of Fallot with pulmonary atresia, two double outlet right ventricle, and one truncus arteriosus. The reoperations were undergone five to eleven years after the first operation. One patient received a replacement of a old valved conduit with a new larger one because of relative stenosis. The other five patients received reconstructive operations in which an old valved conduit was removed and a new conduit was constructed using the conduit bed as the posterior wall and a patch of xenograft pericardium. All operations performed successfully with no hospital or late cardiac death.

Adolescent↗
PubMed1994

[Redo valve replacement for primary tissue failure of bioprosthetic heart valve].

We evaluated long-term results of valve replacement with bioprosthesis in 59 patients. Freedom from primary tissue failure and reoperation declined more than seven years after valve replacement. Seven patients underwent repeat operations because of primary tissue failure in our hospital. Their ages ranged from 32 to 54 years, two cases were male and five were female. At repeat operation, mechanical valve prosthesis were implanted to mitral position in all seven patients, tricuspid annuloplasty was added in five patients, and aortic valve replacement was added in one patients. The New York Heart Association (NYHA) functional classifications were grade II for 1 patient, III for 1, and IV for 5 preoperatively. Five patients had severe pulmonary hypertension preoperatively, and three of them were died after operation. The removed bioprostheses showed tears, perforations or calcifications of cusps and commissural detachments.

Adolescent↗
PubMed1994

[Tissue blood flow of the sigmoid colon for safe anastomosis following ligation of the inferior mesenteric artery].

We examined the tissue blood flow (TBF) of the sigmoid colon to determine which level of inferior mesenteric artery. In 13 patients, TBF of the sigmoid colon was measured in the control state and the clamped state, in which the inferior mesenteric artery (IMA), left colic artery and the rectal were wall clamped. In the clamped state, means of TBF at 10 cm and 15 cm distal to the descend-sigmoid junction were 1.87 +/- 0.77 and 1.10 +/- 0.40, respectively. Mean of TBF at 15 cm was significantly lower than that at 10 cm. In conclusion, TBF which is enough for safe anastomosis reaches as far as 10 cm distal from the descend-sigmoid junction after ligation of IMA. Anastomosis at this level in anterior resection of the rectum is safe in concerning with TBF.

Adult↗
PubMed1994

[Results and operative indications of lobectomy with bronchoplasty for bronchogenic carcinoma].

We evaluated the results and operative indications of bronchoplastic lobectomy in patients with bronchogenic carcinoma. From 1980 to 1992, 34 patients underwent lobectomy in combination with bronchoplastic procedure for lung cancer. In regard to histological typing, they consisted of 18 squamous cell carcinoma, 9 adenocarcinomas, 3 large-cell carcinomas, 2 combined types of adenocarcinoma and squamous cell carcinoma, 1 small-cell carcinoma, and 1 carcinosarcoma. Five-year survival rate of 18 cases of squamous cell carcinoma was 41.2%, whereas 9 cases of adenocarcinoma died within 3 years. We classified 34 cases into two groups according to the reason of indication for bronchoplasty. Group T (n = 19) was the case whose tumor was spreading to the major bronchus. Group LN (n = 14) was the case whose metastatic lymph nodes were invading to the major bronchus. Forty-two percent of Group T was stage III or IV, while 93% of Group LN was stage III or IV. Five-year survival rate was 54.7% in Group T, and 8.1% in Group LN. There were statistical differences between both groups (p < 0.05). In 73 patients who underwent pneumonectomy at the same period, 5-year survival rate was 31.7%. In conclusion, the bronchoplastic procedure is recommended to Group T in comparison with that of Group LN.

Adult↗
PubMed1994

[Surgical repair of aortic dissection associated with compression of true lumen during retrograde perfusion--report of two cases].

Two cases of acute aortic dissection which developed compression of the true lumen due to retrograde perfusion during cardiopulmonary bypass were reported. In the first case, coronary reperfusion could not be achieved when the aortic cross-clamping was removed after Collins' method of aortic dissection. There was no blood flow from the true lumen through the aortic root while the false lumen was distended by the retrograde perfusion. After completion of antegrade perfusion through the arterial cannula inserted into the anastomosed site of the ascending aorta, coronary reperfusion was established and the heart beating could be thereby obtained. In the second case, the false lumen was gradually expanded, and the true lumen was completely obstructed by it. Reexpansion of the true lumen was achieved by initiation of antegrade perfusion through the cannula inserted into the graft replaced in the ascending aorta. Fortunately cerebral and cardiac complications were not found in both cases postoperatively. Compression of the true lumen is rare, but fatal complication that may occur during retrograde perfusion in surgical repair for aortic dissection of Stanford type A. Therefore, it is very important to replace the perfusion cannula in the true lumen of the reconstructed aorta for preventing insufficiency of coronary and cerebral circulation.

Acute Disease↗
PubMed1994

[Clinical study of optimal bypass flow for temporary bypass with centrifugal pump in surgical treatment of aneurysm of the descending thoracic aorta].

Since 1987, 33 patients were operated on for aneurysm of the descending thoracic aorta using temporary bypass with a heparin-coated centrifugal pump and heparin-coated tubes at Kobe University Hospital. Sixteen patients had true aneurysms of the descending thoracic aorta, 7 had thoraco-abdominal aneurysms and 10 had aortic dissection (DeBakey's type III). Heat exchanger and oxygenator were not included in the bypass circuit in all cases. Perfusion time was from 42 to 205 minutes (average 90 minutes). Left heart bypass was established with 1 mg/kg of systemic heparinization in 5, 0.5 mg/kg in 5, and 0 mg/kg in 23 cases. There were no complications such as perioperative embolism, acidosis, or hypothermia. During aortic cross-clamping, the arterial pressure of the lower extremity was maintained over 70 mmHg, but there was no relationship between the distal perfusion pressure and bypass flow. The urine output during temporary bypass was significantly related to the distal perfusion flow by centrifugal pump (r = 0.455, p < 0.01). Seven out of 23 patients who were bypassed under 40 ml/kg/min of distal perfusion flow showed transient renal dysfunction postoperatively, and two developed postoperative renal failure, while the other patients bypassed over 40 ml/kg/min of pump flow stayed in the normal range of the renal function, where there were statistically differences (p < 0.05). Postoperative paresis occurred in 2 patients who were also perfused under 40 ml/kg/min of bypass flow. Therefore, it is concluded that temporary bypass with centrifugal pump is a safe and well acceptable circulatory support in the surgical treatment of aneurysm of the descending aorta.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1994

[Development of direct phlebography for surgical intervention of the varix cruris].

To determine the appropriate treatment for patients with varix cruris, we performed three different methods of phlebography including direct phlebography, and compared their findings by each phlebography. Conventional ascending phlebography was taken routinely and initially in all limbs (n = 120). "Direct phlebography" developed by us was then indicated, when the visualization of the deep vein system was unclear by conventional ascending phlebography. This method was useful for the clear opacification of the deep vein system, and also was able to visualize the deep femoral vein clearly. After the precise diagnosis of varix cruris, descending phlebography under the Valsalva maneuver at supine position was carried out for the evaluation of the deep vein insufficiency. According to these phlebographic findings, conventional stripping with or without sub- or suprafascial ligation of communicating vein was indicated to saphenous typed varix cruris. The valvuloplasty to the highest valve in superficial femoral vein was carefully added in eight limbs which showed the significant reflux by added in eight limbs which showed the significant reflux by the descending phlebography. This valvuloplasty was remarkably contributed to the immediate healing of the stasis ulcer without recurrence. And compression sclerotherapy was selected to some patients with branch typed varix cruris.

Adolescent↗
PubMed1994

[Severe obstructive necrotizing enterocolitis associated with carcinoma of the sigmoid colon: report of a case].

A 68-year-old male diagnosed as carcinoma of the sigmoid colon developed shock and cardiac arrest just 8 hours after the onset of ielus. After resuscitation, exploratory laparotomy was carried out and it revealed gangrene spreading from the sigmoid colon over the distal 150cm of the terminal ileum, separated from the carcinoma by a normal segment of the colon 13cm in length. All the mesenteric vessels were pulsating normally. The whole necrotic lesion including the carcinoma was resected and an ileostomy was constructed. This is a noteworthy report of severe obstructive necrotizing enterocolitis with critical condition and wide involvement of the colon and intestine associated with carcinoma of the sigmoid colon.

Adenocarcinoma↗
PubMed1994

[MECHOP-BM chemotherapy in the treatment of non Hodgkin's lymphoma].

Twenty patients with previously untreated advanced aggressive or relapsed or refractory non-Hodgkin's lymphoma were treated with the MECHOP-BM regimen (MCNU, etoposide, cyclophosphamide, adriamycin, vincristine, prednisolone, bleomycin and methotrexate). Of the 18 patients treated with the MECHOP-BM, the response rate was 78% and complete response (CR) was attained in 33%. Among these CR patients, one patient relapsed, but the other patients continued to show CR (59-243 days, medium 178 days). The most serious toxicity attributed to MECHOP-BM therapy was leukopenia. The mean white blood cell count dropped to 1,300/microliters, and only therapy could be useful in the treatment for patients with untreated aggressive and advanced stage of non-Hodgkin's lymphoma as well as salvage therapy of relapsed cases.

Adolescent↗
PubMed1994

Right ventricular dysfunction after major pulmonary resection.

Right ventricular performance was assessed by thermodilution in 20 patients at rest and during exercise before and after lobectomy or pneumonectomy. The right ventricular ejection fraction was significantly decreased on the first postoperative day (0.36 +/- 0.34), the second postoperative day (0.34 +/- 0.04), and the third postoperative week (0.37 +/- 0.06) relative to the preoperative right ventricular ejection fraction value (0.43 +/- 0.07, p < 0.05). The right ventricular end-diastolic volume index was significantly increased by the second postoperative day (130 +/- 24 ml/m2) compared with the preoperative value (112 +/- 20 ml/m2). A significant decrease in the right ventricular stroke volume index was observed after operation, with a significant increase in heart rate considered necessary to maintain cardiac output. Pulmonary arterial pressure, the pulmonary vascular resistance index, and central venous pressure were unaltered over time. Indices of left ventricular function (that is, cardiac index, arterial pressure, and pulmonary arterial wedge pressure) were also preserved throughout the postoperative period. To explain the right ventricular dysfunction, ergometric exercise values were compared and the heart rate, pulmonary arterial pressure, central venous pressure, pulmonary vascular resistance index, and right ventricular end-diastolic volume index were all higher and the right ventricular ejection fraction lower during exercise after the operation. However, indices of left ventricular function remained unchanged. Significant elevations in pulmonary arterial pressure and the pulmonary vascular resistance index only during exercise occurred. These findings indicate that changes in right ventricular function at rest compensate for the increase in right ventricular volume, but adequate compensation does not occur during exercise, with a resultant increase in pulmonary arterial pressure and the pulmonary vascular resistance index. This suggests that a change in afterload may be the main determinant of the deterioration in right ventricular pump performance during exercise. We speculate that the main cause of right ventricular dysfunction after major pulmonary resection might be the changes in right ventricular afterload. The right ventricle may play an important role serving as a "reservoir" for afterload.

Aged↗
PubMed1994

[Calculation of normal range using a nonlinear least squares method].

We developed a method to calculate the normal range of laboratory tests using nonlinear least squares method. Our method decomposes a histogram of laboratory test into constituent distributions assuming these constituents to be gaussian distributions. The proposed method has been applied to the histograms of serum total protein and serum lactate dehydrogenase, and good fittings were obtained assuming the histograms consist of 2 and 3 constituents respectively. Accuracy and precision were calculated for the stimulated data of known distribution pattern with contamination of abnormal values to examine the robustness of our method. With the contamination rate of 10%, accuracy less than 1% and precision less than 3% have been shown for the sample size more than 2,000. And the estimation was not markedly affected by the contamination rate up to 50%. Based on the parameters estimated by our method, we proposed a new measure for laboratory tests named abnormality index, which gives a probability to be abnormal.

Clinical Laboratory Techniques↗