Superficial esophageal carcinoma detected on extensive esophageal varices before endoscopic injection sclerotherapy.
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Adenocarcinoma↗
Biomedical subjects
M Takasaki
Publications and source records attributed to M Takasaki.
Epidural anesthesia enhances sympathetic nerve activity in the unanesthetized segments in cats.
To evaluate compensatory sympathetic excitation during epidural anesthesia, we measured cardiac and renal sympathetic nerve activity during thoracic or lumbar epidural anesthesia in cats. Thirteen cats were divided into three groups: five cats received thoracic epidural anesthesia, five received lumbar epidural anesthesia, and three received lumbar epidural anesthesia after the carotid sinus and vagoaortic nerves were severed (denervated lumbar group). Heart rate (HR), mean arterial pressure (MAP), and cardiac and renal sympathetic nerve activity were measured repeatedly after administration of a single dose of 0.1 mL/kg of 1% lidocaine via the epidural catheter. Epidural solution spread from a median of C-8 to T-6 in the thoracic epidural group, T-8 to L-3 in the lumbar epidural group, and T-7 to L-3 in the denervated lumbar group. During thoracic epidural anesthesia, HR, MAP, and cardiac sympathetic nerve activity decreased, while renal nerve activity increased. Similarly, HR, MAP, and renal sympathetic nerve activity decreased during lumbar epidural anesthesia, and cardiac activity increased. In the denervated lumbar group, HR, MAP, and renal sympathetic nerve activity decreased but cardiac activity remained unchanged. Sympathetic nerve activity in corresponding unanesthetized segments increased during thoracic or lumbar epidural anesthesia in association with significant decreases in MAP and HR. After severance of the carotid sinus and vagoaortic nerves, the absence of sympathetic excitation in the unanesthetized segments during lumbar epidural anesthesia suggests that the compensatory response is produced by the baroreceptor reflex response to anesthesia-induced hypotension.
Anesthesia, Epidural↗
The effect of hypothermic cardiopulmonary bypass on plasma adrenomedullin in adult cardiac surgical patients.
Cardiopulmonary bypass (CPB) can evoke a systemic inflammatory response, which is accompanied by an increase in plasma cytokines that may stimulate the production of adrenomedullin (AM), a potent vasodilator peptide. This study was undertaken to investigate whether CPB influenced plasma AM concentration in 10 patients undergoing cardiac surgical procedures. We found that the plasma AM concentration increased significantly after the commencement of CPB, with the greatest increase observed at weaning from bypass (P < 0.01). After CPB, plasma AM concentration declined but still exceeded baseline significantly 24 h postoperatively. The increase in the plasma AM concentration at weaning from CPB correlated significantly with aortic cross-clamp time (r = 0.74, P < 0.05). The authors conclude that the secretion of AM into circulation is augmented by CPB in patients undergoing cardiac surgery, which suggests a possible role of AM in cardiovascular regulation during and after surgery with CPB.
Adrenergic beta-Agonists↗
The effect of dopamine on hepatic blood flow in patients undergoing epidural anesthesia.
We studied the effect of dopamine on hepatic blood flow during epidural anesthesia with the infusion of hydroxyethyl starch (HES). Hepatic blood flow was measured noninvasively via indocyanine green (ICG) clearance (indices: K [ICG disappearance rate] and R15 [15-min ICG retention rate]). Group C (n = 7) received no epidural anesthesia, Group E (n = 14) received epidural anesthesia, and Group E + D (n = 7) received a dopamine infusion (5 microg x kg(-1) x min(-1)) during epidural anesthesia. Epidural blockade extended from a median of T5 (T4-7) to L4 (L3-5) in Group E and from T5 (T4-7) to L4 (L3-S1) in Group E + D. Mean arterial pressure was maintained at preanesthetic levels in Groups E and E + D. K decreased and R15 increased in Group E (P < 0.05). In Groups C and E + D, K decreased and R15 increased slightly, but not significantly. K was smaller and R15 greater in Group E than in Group C (P < 0.05). We conclude that hepatic blood flow is decreased by epidural anesthesia, despite normotension maintained by continuous infusion of HES, but that this decrease in flow is reversed by the addition of a dopamine infusion.
Adult↗
Increased water diffusion in cerebral white matter in Alzheimer's disease.
We investigated the changes in water diffusion in the cerebral white matter in 19 patients with Alzheimer's disease (AD), including 11 without and 8 with periventricular hyperintensity (PVH) lesions, using diffusion-weighted magnetic resonance imaging (MRI). The apparent diffusion coefficients in the anterior and posterior white matter were significantly higher in the 19 AD patients than in the 10 age-matched controls. The apparent diffusion coefficients were higher in patients with PVH than in those without. The anisotropic ratios, defined as diffusion restricted perpendicular to the direction of the nerve fibers, were significantly higher in AD patients, even in those without PVH, than in the controls. Our results suggest that mild myelin loss occurs in AD patients even in the apparently normal white matter. A definite loss of myelin and axons, including incomplete infarction, occurs in the white matter, as seen on T2-weighted images as PVH. Studies with diffusion-weighted MRI may allow the characterization of different pathological processes and enable the demonstration of underlying white matter lesions in AD that cannot be visualized by conventional MRI.
Aged↗
Inhibitory effects of shouseiryu-to on two-stage carcinogenesis. II. Anti-tumor-promoting activities of lignans from Asiasarum heterotropoides var. mandshuricum.
Two lignans, asarinin (6) and xanthoxylol (7), were isolated from the radix of Asiasarum heterotropoides var. mandshuricum, which consist of a kampo prescription, Shouseiryu-to, as inhibitors of Epstein-Barr virus early antigen (EBV-EA) activation induced by 12-O-tetradecanoylphorbol-13-acetate (TPA). These lignans also exhibited remarkable inhibitory effects on a two-stage carcinogenesis test of mouse skin and pulmonary tumors. Furthermore, it was confirmed that these hydrophobic lignans dissolved in the water decoction of Shouseiryu-to, and these lignans might be among the active constituents of this kampo prescription in terms of its anti-tumor-promoting activity.
Animals↗
Anti-tumor promoting activities of isoflavonoids from Wistaria brachybotrys.
Eight minor isoflavonoids (3-10) isolated from the knot of Wistaria brachybotrys were tested for their inhibitory effects on Epstein-Barr virus (EBV) activation induced by the tumor promoter, 12-O-tetradecanoyl-phorbol-13-acetate (TPA), in Raji cells as a primary screening test for anti-tumor-promoters (cancer chemopreventive agents), and all the tested compounds showed inhibitory activity. Of these compounds, pendulone (3) was further examined on the cell cycle of Raji cells, and indicated strong inhibition on the effect of the cell cycle induced by TPA. In addition, the compound showed potent anti-tumor-promoting activity for an in vivo two-stage carcinogenesis test of mouse skin using 7,12-dimethylbenz[a]-anthracene and TPA. Consequently, it suggests that 3 could be a valuable chemopreventive agent in chemical carcinogenesis.
Animals↗
[Causes, diagnosis, and treatment of anemia in the elderly].
Healthy elderly people are mildly anemic peripheral blood data on 3,583 healthy elderly people (1,590 men and 1,993 women aged 65 years or older) from among those undergoing medical examinations at our hospital in the 8 years from 1988 to 1995 were compiled into 5-year age groups. For both men and women the mean values of red blood cell count, hemoglobin, and hematocrit were slightly lower among older subjects. The main causes of this apparent reduction may be a decrease in the number of hematopoietic stem cells and regression of the hematopoietic microenvironment. Observation of arteries in specimens of hematopoietic bone marrow obtained from the spines of elderly people showed arteriosclerotic changes such as greater hypertrophy of the media than of the intima, and adventitial fibrous hypertrophy. The number of venous sinuses was low and the amount of adipose tissue was high compared to the bone marrow of younger people. The cell density and the ratio of hematopoietic tissue to fat tended to be lower in older subjects. The number of erythroid burst-forming units formed after 14 days in culture medium containing erythropoietin was 28 +/- 19 in 32 healthy elderly people, which was significantly lower than the number in 30 young people 54 +/- 30, (p < 0.005). The value for erythroid colony-forming units was 170 +/- 67 in eight healthy people, which was much lower than in young people, 276 +/- 54. In the elderly subjects, the plasma iron disappearance time (PIDT/2) was 60-80 min (mean: 71.9 min), which was similar to that in the young, but the percent red cell iron utilization was 67.6%-84.9% (mean: 79.7%), which was slightly lower than in younger people. When the diagnostic criterion for anemia in the elderly was set at a hemoglobin value of 11.0 g/ dl, about 13% of outpatients who came to our Geriatrics department were found to have anemia, and in most of them the anemia had resulted from another disease. In conclusion, anemia in the elderly is likely to be affected by reduction in the function of various organs and by the decreased reserves associated with aging. The causes of anemia are complex and diagnosis is often difficult. The present article gives a general outline of the diagnosis and treatment of common types of primary and secondary anemia in the elderly.
Aged↗
[Single photon emission computed tomography in the diagnosis of Alzheimer's disease].
Studies with single photon emission computed tomography (SPECT) have shown temporoparietal (TP) hypoperfusion in patients with Alzheimer's disease (AD). We evaluated the utility of this findings in the diagnosis of AD. SPECT images with 123I-iodoamphetamine were analyzed qualitatively by a rater without knowledge of the subject's clinical status. Sixty-seven of 302 consecutive patients were judged as having TP hypoperfusion by SPECT imaging. This perfusion pattern was observed in 44 of 51 patients with AD, in 5 with mixed dementia, 8 with cerebrovascular disease (including 5 with dementia), 4 with Parkinson's disease (including 2 with dementia), 1 with normal pressure hydrocephalus. 1 with slowly progressive aphasia. 1 with progressive autonomic failure, 2 with age associated memory impairment, and 1 with unclassified dementia. The sensitivity for AD was 86.3% (44 of 51 AD), and the specificity was 91.2% (229 of 251 non-AD). Next, we looked for differences in perfusion images between patients with AD and without AD. Some patients without AD had additional hypoperfusion beyond TP areas: deep gray matter hypoperfusion and diffuse frontal hypoperfusion, which could be used to differentiate them from the patients with AD. Other could not be distinguished from patients with AD by their perfusion pattern. Although patients with other cerebral disorders occasionally have TP hypoperfusion, this finding makes the diagnosis of AD very likely.
Adult↗
[Factors contributing to survival of elderly inpatients with chronic disease].
Clinical assessment and laboratory testing are important in predicting longevity and the outcomes of chronic diseases in the elderly. We therefore studied the prognostic utility of clinical and laboratory findings. A group of 168 elderly patients (70-97 years of age) with chronic diseases who were admitted to Kashiwazaki Kosei Hospital was studied. Data on 13 potentially prognostic factors were analyzed: dementia, being bedridden, anorexia, edema of the lower limbs, urinary incontinence, dyspnea fever, hepatic dysfunction, renal dysfunction, anemia, hypoalbuminemia, inflammation, and electrocardiographic abnormality. Kaplan-Meier survival curves were constructed, and either the log-rank or Wilcoxon method was used to look for significant differences in survival between patients with and without the factors listed above. Regression analysis was then done with the Coxproportional-hazards model to study the factors that contributed to the shortest survival. Patients lived longer if they were not bedridden, anorexic, incontinent of urine, hypoalbuminemic, or if they had no inflammation (p < 0.05): being bedridden, anorexia, urinary incontinence, hepatic dysfunction, hypoalbuminemia, inflammation, and electrocardiographic abnormalities. The survival curve obtained by using these factors as independent variables in the proportional-hazards model was similar to the Kaplan-Meier survival curve.
Aged↗
[Aging and ultrasonographic findings of carotid atherosclerosis].
To establish the prevalence of carotid atherosclerosis and its relation to aging in Japanese population, 270 participants in voluntary health screening at our hospital were studied with 7.5 MHz B-mode ultrasonography and accelerated plethysmography (APG), and their levels of serum lipids were measured. The subjects consisted of 84 people in the fifth decade of life, 89 in the sixth decade, 67 in the seventh decade, and 30 in the eighth decade. Carotid lesions were deemed to be present when occlusion, atheromatous plaque, or both were found. Atheromatous plaque was defined as a thickened intima-media complex of 2.1 mm or more. Plaques were divided into two types based on morphometric criteria, and into three types based on echogenic criteria. Thickness of the intimamedia complex (IMT) was measured at two randomly chosen points along the common carotid artery. APG was obtained by double-differentiation of finger-plethysmograph record, and the APG index was calculated as (-b+c+d)/a, where the letters are the distances from the baseline to the peaks of each wave (a, b, c, and d waves) on the APG waveform. Carotid lesions were seen in 5% of subjects in the fifth decade of life, 7% of subjects in the sixth decade, 24% of those in the seventh decade, and 27% of those in the eighth decade. All the lesions were plaques, and neither plaque type nor size differed between young-adult and elderly subjects. Multiple regression analysis revealed that the thickness of the intima-media complex correlated significantly with age, but not with carotid lesions, sex, body weight, serum lipid levels, hemoglobin A1 level, or uric acid level. The APG index also decreased significantly with age, but no correlation was seen with carotid lesions or with the thickness of the intima-media complex. These findings indicate that people aged 60 or over could be at risk for plaque formation in the carotid arteries and their carotid arteries should be examined carefully even in the absence of risk factors for vascular disease. These findings also suggest that both increased thickness of the intima-media complex and a low APG index arise via pathophysiologic mechanisms different from those that lead to atheromatous plaque.
Adult↗
[Pleural-origin malignant lymphoma in an elderly patient with chronic empyema and infection with the Epstein-Barr virus].
A 73-year-old woman with a long-standing history of right-sided chronic empyema complained of lumbago. An artificial pneumothorax had been induced to treat pulmonary tuberculosis about 40 years previously. The year after she began to complain of lumbago, a tumor mass over the right anterior chest wall had grown rapidly. Pathologic examination revealed that it was a malignant lymphoma (Non-Hodgkin's lymphoma, diffuse large cell, B cell type). Chemotherapy with cyclophosphamide, adriamycin, vincristine, and prednisolone, and then radiation therapy were given. The patient responded very well. The tumor mass on the surface of the chest wall disappeared completely. She was alive and well and there was no evidence of recurrence at the seven-month follow-up examination. Analysis with the polymerase chain reaction showed that the tumor contained DNA of the Epstein-Barr virus. The chronic empyema and local infection with the Epstein-Barr virus might have been a factor in the development of the malignant lymphoma.
Aged↗
[Deterrent factors in rehabilitation training following cerebral vascular disease--comparison of elderly and non-elderly patients].
The purpose of the present study was to clarify the deterrent factors for rehabilitation training (rehab) of chronic cerebral vascular disease (CVD) patients, and also to evaluate the influence of age on these factors. Sixty-five CVD impatients with sequelae treated at the Cerebral Vascular Center of Nanasawa Hospital were included in the study. Patients were classified into two groups using the Barthel index score: good effect group (n = 21) or no effect group (n = 22). The following factors were compared between the two groups in order to investigate which factor most affects the results of rehab: age, sex, the site of brain damage, extent of motor paralysis, character (Type A character or not), aphasia, hemispacial neglect, depression, and positive attitude toward training. A possible association between depression, and the site of brain damage and Type A character was investigated. Also, the difference in mood disorders was compared between elderly and non-elderly stroke patients. In the elderly group, hemispacial neglect, a negative attitude toward training, and depression all adversely affected the outcome of the rehab. In the non-elderly group, aging, hemispacial neglect, and a negative attitude toward training influenced the effect of the rehab, but there was no correlation with depression. Depression was seen in 64% of the patients (38/59). Of the 38 patients in a depressed state, 24 (63%) had right hemisphere brain damage, 13 (34%) had left hemisphere brain damage, and 1 (3%) had brain stem damage. Twenty-seven of the 38 depressed patients (71%) were Type A character, significantly more than in the non-depressed group (92/21, 43%). In addition, 14 of the 27 Type A patients were aged over 65 years (52%), which was more than in the non-depression group (11/38, 29%).
Adult↗
[Comparison of epidural versus intravenous administration of fentanyl during epidural block].
Effects of epidural anesthesia induced with bupivacaine alone (group C), bupivacaine and fentanyl (group E), or bupivacaine and intravenous fentanyl (group I) on the onset and spread of cold sensory block, the onset of analgesia and the degree of motor block were compared. Seventy-five patients undergoing lower limb or abdominal surgery were allocated to three groups of 25; patients of group C received 15 ml of 0.5% bupivacaine and 2 ml of 0.9% saline epidurally, patients of group E received 15 ml of 0.5% bupivacaine and 2 ml of fentanyl epidurally, and patients of group I received 2 ml of fentanyl intravenously and 15 ml of 0.5% bupivacaine and 2ml of 0.9% saline epidurally. The onset time of cold sensory block at T11 was significantly shorter in groups E (6.8 +/- 1.9 (SD) min) and I (7.3 +/- 1.7 min) than in group C (9.3 +/- 1.9 min). The onset time of analgesia was also significantly shorter in groups E and I than in group C. The segmental spread of cold sensory block at 20 min after initial injection was significantly larger in groups E and I than in group C. There was no significant difference in motor block at 20 min among the three groups. Respiratory depression appeared more frequently in group I than in groups C and E. These results suggest that epidural administration of fentanyl offers a clinical advantage over intravenous administration for analgesia during epidural block.
Adult↗
[Age-related changes of diffusional anisotropy in the cerebral white matter in normal subjects].
To investigate age-related changes of diffusional anisotropy in the cerebral white matter, we performed diffusion-weighted MRI studies in 21 normal subjects aged 25 to 96 years. The anisotropic rations (ARs), defined as the apparent diffusion coefficients perpendicular to the nerve fibers to those parallel to the nerve fibers, were significantly higher in elderly than in young subjects in the anterior and posterior white matter surrounding the lateral ventricle. Moreover, significant correlation between age and AR was found in the anterior white matter. The ventricular index (VI) measured on MRI, as a quantitative indicator of brain atrophy, was significantly higher in elderly than younger subjects, and significantly correlated with AR in the anterior white matter. Multiple regression analysis demonstrated that the VI showed the highest correlation for AR. On the other hand, there was no significant correlations between ARs in the corpus callosum and age. These results suggest that morphological changes in the myelin and axon in the white matter occur in elderly normal subjects, probably due to neuronal loss with aging.
Adult↗
[The effect of low-dose prostaglandin E1 on serum and urinary fluoride concentrations in patients anesthetized with sevoflurane].
We investigated the effects of low-dose prostaglandin E1 (PGE1) on serum and urinary concentrations of inorganic fluoride in 39 adult patients undergoing upper abdominal surgery. Anesthesia was maintained with a combination of N2O-O2-sevoflurane and thoracic epidural anesthesia. Twenty-two patients received infusion of PGE1 at a rate of 0.02 micrograms.kg-1.min-1 throughout surgery. Seventeen patients served as control by not receiving PGE1. Serum inorganic fluoride concentrations (FB) were determined before the induction of anesthesia and 0, 2 and 24 hours after the end of anesthesia. Urinary inorganic fluoride concentrations (FU) were determined before the induction of anesthesia, and 0, 24 and 48 hours after the end of anesthesia. These was no difference between PGE1 group and control group in anesthetic dose (MAC hours) of sevoflurane. In both groups, FB peaked at the end of anesthesia. In PGE1 group, UB peaked at the end of anesthesia, while in control group, it peaked 24 hours after anesthesia. There were differences between groups neither in FB nor in FU throughout the study period. The relationships between anesthetic dose and fluoride concentrations, however, differed significantly between the groups. In control group FB values of 0, 2 and 24 hours after anesthesia correlated positively with MAC hours, respectively, while in PGE1 group they did not. Similarly in control group, FU values of 24 and 48 hours after anesthesia correlated positively with MAC hours, respectively, while in PGE1 group, they did not. Thus in patients receiving high-dose sevoflurane, FB and FU tended to be lower in PGE1 group than in control group. In contrast, in PGE1 group, urinary excretion of fluoride during surgery correlated positively with MAC hours, while in control group, it did not. Urinary fluoride excretion during surgery was significantly greater in PGE1 group than in control group. These results suggested that PGE1 might prevent elevation of serum and urinary fluoride concentrations in patients receiving high-dose sevoflurane. This effect might result from enhanced urinary excretion of fluoride with PGE1.
Abdomen↗
[An autopsy case of multiple myeloma with pineal body and spinal cord dura mater infiltration].
An autopsy case of multiple myeloma (IgD lambda type) with pineal body and spinal cord dura mater infiltration is reported. The 63-year-old man was diagnosed as multiple myeloma (IgD lambda type). He was treated with melphalan and prednisolone. Extra bone marrow masses developed 1 year after the onset. He died with renal failure. At autopsy there were many extra bone marrow masses including pineal body and dura mater of the thoracic cord. Microscopic examination revealed that those mass lesions consisted of neoplastic plasma cells. Myeloma cells also infiltrated perivascular space near the pineal body, subdural space of the cerebrum and brain stem. The cells were labeled VS 38 c immunohistochemically. We discussed routes of the metastasis to the central nervous system of the multiple myeloma. This case suggests that the way of myeloma cells infiltration to the pineal body is hematogenous metastasis, because pineal body have no blood brain barrier.
Dura Mater↗
[Intravenous neostigmine enhances the analgesic effect of epidural anesthesia].
A single-blind trial of the intravenous neostigmine on epidural anesthesia was carried out on 75 patients undergoing lower limb or lower abdominal surgery. They were allocated to three groups of 25: patients of group C received 2 ml of 0.9% saline, patients of group AN 1 ml (0.5 mg) of atropine and 2 ml (1 mg) of neostigmine, and patients of group N 2 ml (1 mg) of neostigmine, intravenously 5 min before epidural injection of 15 ml of 2% mepivacaine solution without epinephrine. We assessed the onset and spread of cold sensory block and analgesia, and the degree of motor block and sedation. The onset time of analgesia at T 11 was significantly shorter in group N [6.2 +/- 2.0 (SD) min] than in groups C (8.5 +/- 2.6 min) and AN (8.7 +/- 2.4 min). The segmental spread of analgesia 10 and 20 min after epidural injection was significantly larger in group N (10.8 +/- 3.9 and 15.4 +/- 2.7 seg, respectively) than in groups C (7.6 +/- 3.4 and 12.8 +/- 3.5 seg, respectively) and AN (7.8 +/- 3.6 and 13 +/- 3.4 seg, respectively). There were no differences in the onset and spread of cold sensory block, and the degree of motor block and sedation among the three groups. The incidence of bradycardia and fecal incontinence was significantly higher in group N than in groups C and AN. These results demonstrate that intravenous neostigmine potentiates the analgesic effect of epidural anesthesia mediated by a cholinergic muscarinic mechanism. However, in clinical practice, it does not seem to be useful, because of the side effects.
Adolescent↗