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Biomedical subjects

M Tsugaya

Publications and source records attributed to M Tsugaya.

At least 37 records · Page 2Linked to original sources

Administration and dosage of iohexol, a nonionic contrast medium, for dynamic renal computed tomography.

We investigated the optimal method of administering iohexol, which contains 300 mg iodine/ml (Omnipaque 300), a nonionic contrast medium, to maintain adequate renal contrast while reducing artifacts during dynamic CT scanning. In this study, 76 patients with renal disease received 10-50 ml of iohexol as follows: group I (14 patients), 20 ml injected as an intravenous bolus for 5 sec, followed by 30 ml intravenous drip infusion for 5 min; group II (18 patients), bolus of 20 ml injected for 5 sec; group III (13 patients), 20 ml diluted with sterile water (total volume 40 ml), and injected as a bolus for 8 sec; group IV (15 patients), 20 ml injection for 5 sec followed by intravenous drip infusion of 200 ml of Hartmann-Ringer's solution given at maximum speed; and group V (14 patients), 10 ml diluted with sterile water (total volume 20 ml) injected as a bolus for 5 sec. We found that corticomedullary differentiation was most distinct on the images obtained from group IV. We concluded that a lower concentration of iohexol (150 mg iodine/ml) given by intravenous fluid loading can provide superior CT images.

Adult↗

Renal cortical scarring in acute pyelonephritis.

A series of 14 patients with acute pyelonephritis was evaluated for the formation of renal scarring by serial computed tomography (CT) and intravenous urography. Although the urography results were normal, CT showed renal parenchymal atrophy (cortical scarring) in 6 patients. Cortical scarring was observed to occur after 61 to 187 days, and it was slower to develop in the patients with recurrent fever lasting for 2 weeks or more in total than in those with fever for less than 2 weeks. Scarring was significantly more frequent in patients with severe renal involvement than in those with mild involvement, and scars developed at the sites of the most extensive lesions seen on the initial CT scans. Cortical scars were detected in 6 of the 7 patients in whom the lesions occupied 30% or more of the renal parenchyma. We conclude that the extent of the initial renal parenchymal involvement was the most important determinant of eventual scar formation.

Adolescent↗

[Monotherapy with extracorporeal shock wave lithotripsy for renal and ureteral stones].

We performed extracorporeal shock wave lithotripsy (ESWL) as a monotherapy using the Medstone STS lithotripter on 288 patients with renal and ureteral stones between June, 1989 and June, 1991. We compared our results with previous reports on ESWL as used in combination therapy. Our cases consisted of 121 patients with renal stones and 167 patients with ureteral stones. A total of 437 sessions of lithotripsy were performed on 288 patients, for an average of 1.52 sessions of lithotripsy per patient. The percentage of stones measuring less than 4.0 mm in diameter that were fragmented was 94.3% for renal stones and 87.6% for ureteral stones. The stone-free rates 3 months after ESWL were 60.3% and 90.4%, respectively. Our results of the monotherapy with ESWL did not differ from those reported on ESWL as used in combination therapy, in terms of the rate of stone destruction and stone-free rates. We studied the other reports carefully and determined that ESWL monotherapy could have been performed in most those cases. We concluded that ESWL monotherapy is an excellent therapeutic method in the light of fewer complications and side effects compared with those from combination therapy, and the fact that the rate of recurrence for renal and ureteral stones is high makes ESWL monotherapy very useful because the procedure can be repeated.

Adolescent↗

A new technique of ureteric catheterization.

Insertion of an indwelling stent catheter or ureteric catheterization using a new guide wire (the Radiofocus guide wire) was carried out in a total of 24 subjects. The subjects comprised 16 patients in whom insertion of a conventional guide wire and ureteric catheter was not possible due to previous use of an indwelling stent catheter for extracorporeal shock-wave lithotripsy (ESWL), 2 cases in whom a conventional guide wire could not be inserted due to post-ESWL formation of a stone street, 4 patients with ureteric stenosis and 2 patients with normal ureters in whom catheterization was impossible by the usual methods. Insertion of a Radifocus guide wire into the renal pelvis was successfully accomplished in all 24 cases and an indwelling catheter could be passed in 21 cases. These results suggest that the Radifocus guide wire should make a useful contribution to ESWL therapy. It can also be applied to retrograde pyelography, ureteric obstruction, and the dilation of ureteric stenosis.

Adult↗

[Upper urinary tract obstruction diagnosis and treatment of congenital hydronephrosis in children].

Twenty nine children under 2 years old with congenital hydronephrosis have been treated in the last 14 years in our department. We report 4 cases which we found difficult to diagnose and treat. The diagnosis and the treatment of congenital hydronephrosis in children are discussed, especially concerning those patients under the age of 2 years. Pyeloplasty has been performed in 28 renal units out of 35 renal units. The results of the procedure were good in 82.1%, fair in 10.7%, no change in 3.6% and a lost case in 3.6%. The Aderson-Hynes dismembered technic was employed except for one renal unit in which the extrarenal pelvis was resected. Hydronephrosis in two renal units and one with nephrostomy for one year and one month improved spontaneously. Endopyelotomy was performed in 2 renal units and will be performed in one renal unit. Nephrectomy was carried out in one renal unit with renal dysplasia. A kidney with dysplasia excreted urine of several ml/day. Post-enhanced-X-ray computed tomography and T1-weighted image of magnetic resonance presented loss of function in the kidney. Degree of stenosis, position of stenosis and function of pelvis and ureter were different in each child. Children are constantly growing up and the condition of stenosis was changed in some cases. In conclusion, we should estimate the stenosis in children using several examinations.

Humans↗

Computerized tomography in acute pyelonephritis: the clinical correlations.

Computerized tomography was performed on 19 patients diagnosed as having uncomplicated acute pyelonephritis. The relationship was investigated among the laboratory findings, presence of flank pain, clinical course and severity of the lesions detected by computerized tomography. In patients febrile for less than 2 weeks healing as assessed by computerized tomography took an average of 76 days. However, in patients with repeated febrile episodes occurring for longer than 2 weeks healing was delayed until an average 232 days after onset. Computerized tomography findings generally correlated well with the erythrocyte sedimentation rate, C-reactive protein level, and presence of pyuria and flank pain. However, in patients with a prolonged course computerized tomography proved to be a more reliable indicator of progress than either the results of laboratory tests or the symptoms. In conclusion, computerized tomography was useful in the diagnosis, assessment of severity and evaluation of healing of acute pyelonephritis.

Blood Sedimentation↗

Various urinary properties in bladder tumor patients.

Urinary electrolytes, pH, urea nitrogen, creatinine, uric acid and osmolarity were measured in patients with bladder tumors and compared with those of a control group. There were 41 bladder tumor patients ranging in age from 29 to 87 (average 64) years with a male:female ratio of 32:9. According to histopathological classification of the bladder tumors, there were 34 transitional cell carcinomas (TCC) (21 G1, 10 G2, 3 G3), four squamous cell carcinomas, two adenocarcinomas and one inverted papilloma. The control group comprised 29 patients ranging in age from 35 to 80 (average 63) years with a male:female ratio of 26:3. Four urine samples were collected from each patient: early morning on the day of admission, just after admission, early morning on the day of return to hospital after temporary discharge, immediately after return to hospital after temporary discharge. The results indicated that the urinary Ca2+ and uric acid values were significantly lower in the bladder tumor group than in the control group. The urinary pH tended to be somewhat higher than in the control group, and the pH values tended to be especially high in the TCC G3 patients. There were differences in the various urinary properties between the TCC G1 and G2 and the TCC G3 patients.

Adult↗

[Clinical experiences of 35 cases with upper urinary tract stones by extracorporeal shock wave lithotripter (MEDSTONE 1000)].

We made clinical trials of the extracorporeal shock wave lithotripter (MEDSTONE-1000) in patients with upper urinary tract stones. Thirty-five cases (total 40 trials) treated during the period of October 1987 through March 1988 were enrolled in this study. The ages of the cases ranged from 22 to 65 (average 43.9) years old, comprising 23 men and 12 women. The site of presence of urinary tract stones was the renal pelvis and calyx in 28 cases and the upper ureter in 7 cases. The size of the stone was smaller than 1 cm in 15 cases, 1 to 2 cm in 12 cases, 2 to 3 cm in 7 cases and larger than 3 cm in 1 case. 13 patients with renal stones were treated with double-J stent catheter and all patients with ureteral stones were treated with the ureteral balloon catheter or flexible-tip ureteral catheter as preoperative manipulation. In 26 cases epidural anesthesia was used and the others were treated under general anesthesia. Stone targetting was determined by two oblique radiographs from separate axes. The intensity of shock waves was mainly 24 KV and the maximum shock wave counts to break up stones were 6800 shots. The size of the broken stone fragments was less than 2 mm in 24 cases (68.5%) and 2 to 5 mm in 10 cases (28.6%), which indicated that the procedure was very effective. However, one case in whom the stone could not be broken was with cystinuria. After three months the fragments completely passed in 22 cases (64.7%) and the residual fragments larger than 5 mm were left in 2 cases (5.9%).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

[A clinical study and the diagnosis in magnetic resonance imaging of renal scarring].

Twenty-nine kidneys of seventeen patients (nine boys and eight girls) with vesicoureteral reflux and repeated urinary tract infection were studied by magnetic resonance imaging for diagnosis of renal scarring and correlation between clinical data and the degree renal scarring. Renal scarring is classified into three types according to findings in magnetic resonance imaging. The degree of renal scarring are classified into five grades according to traditional grading of intravenous pyelogram. If a fine deformity of calyx is shown on intravenous pyelogram, magnetic resonance imaging demonstrates renal scarring. Magnetic resonance imaging without irradiation is exceedingly valuable for the diagnosis of renal scarring. The appearances of magnetic resonance imaging were supported by X-ray computed tomography. There is a substantial correlation between serum creatinine and the grades of renal scarring by magnetic resonance imaging. There is a substantial correlation between fever attacks and the grade of renal scarring, and there is a significant reverse correlation between the age of the onset of upper urinary tract infection and the grade of renal scarring. It is suggested that upper urinary tract infection is the most significant factor in scar formation.

Adolescent↗

[A study on accumulation of cholesterol in rat prostate].

An experimental model of prostatic hypertrophy was created by freezing the urethra at the opening of the ventral prostate in rats and administering a cholesterol-rich diet to induce cholesterol accumulation. Four-week-old Fisher rats were divided into a control group, a cholesterol-rich diet group (by adding 1% cholesterol to the diet), a frozen group, and a frozen and cholesterol-rich diet group, and were reared for 5 months. The animals were killed, and the ventral prostate was removed, weighed, and the lipid was extracted. Cholesterol content was measured by an enzymatic method. A cholesterol-rich diet without freezing had no effects on the ventral prostate, and after freezing alone, the weight of the prostate was smaller than that of the control group. However, in the group cholesterol-rich diet after urethral freezing, the cholesterol content per mg of tissue increased. This indicates that cholesterol accumulation can be induced in the prostate by administering a cholesterol-rich diet after creating the proper secretory disturbance.

Animals↗

[Our experience with combined intravesical instillation therapy of superficial bladder tumor using Aclacinomycin-A (ACM) and cytosine arabinoside (CA)].

Thirteen patients with recurrent superficial bladder tumors were treated by combined intravesical instillation of Aclacinomycin-A (ACM) and cytosine arabinoside (CA). Prophylactic effects of this combined instillation therapy were studied in 7 patients. A solution of 200 micrograms/ml of ACM and 600 micrograms/ml of CA was instilled into the bladder. The instillation aimed for treatment was carried out once a week until ten treatments had been given. Complete response was attained in 2 patients and partial response in 3 patients, but tumor size increased by more than 50% in 6 of the 13 patients. No change was observed in the remaining 2 patients. Recurrence of the tumors was observed in 3 of the 7 patients who were treated by this prophylactic combined instillation therapy. Local side effects such as bladder irritability were found in 2 of the 20 patients. No systemic side effects were noted in any patients. Although the side effects were reduced, we were not satisfied with the results of this therapy.

Aclarubicin↗

Morphological studies of Escherichia coli in the urine of patients with acute simple cystitis treated with aztreonam.

The effects of aztreonam (AZT) on the morphology of Escherichia coli in the urine of 5 patients with acute simple cystitis were studied by differential interference contrast microscopy. The urine specimens were collected via catheter before, 5, 15 and 30 minutes after intravenous administration of 1.0 gm AZT. The minimum inhibitory concentration of E. coli against AZT was 0.05 microgram/ml. The mean urinary concentrations at 5, 15 and 30 minutes after administration of AZT were 481.6 micrograms/ml, 1168.2 micrograms/ml and 993.4 micrograms/ml, respectively. In 4 patients, the urinalysis became normal within 30 minutes after the administration. Filamentous cells were observed at low and high urinary concentrations of AZT. They had vacuole-like formations. These findings were characteristic morphological changes caused by AZT. In the other patient, spheroplasts and ovoid cells were observed. AZT in the urine of patients with acute simple cystitis is suggested to have a high affinity for penicillin-binding protein (PBP) 3 and moderate affinity for PBP 1a.

Acute Disease↗

The treatment of bladder cancer by neothramycin.

Neothramycin (NTM), an anthramycin-group anticancer antibiotic, was used in the treatment of superficial carcinoma of the bladder. NTM was instilled into the bladder in the following dosages. Ten mg NTM in 20 ml of sterile distilled water was given first, and increased to 40 mg in 20 ml. This procedure was performed every second week to twice a day. Recently, in 2 patients, the treatment has been combined with 20 mg NTM intravenous administration. In 4 of the 11 patients (36%) the tumors disappeared completely, while in 6 patients (55%) there was partial disappearance of more than 50% and in one patient (9%) there was no effect. Three of the patients had irritable bladder symptom (temporarily). NTM was concluded to be effective for superficial carcinoma of the bladder.

Administration, Intravesical↗

[Fungal urinary infection: report no. 1].

Clinical studies were performed on 115 fungal strains isolated from the urine of 36 patients. The predisposing factors were fungal urinary tract infections, antibiotics and indwelling catheter. Forty five strains of the 115 strains were Candida albicans, the most prevalent, followed by 25 strains of C. tropicalis and 22 strains of Trichosporon beigelii. Species of Torulopsis were rare, only 5 strains were isolated. Sixty strains (56%) co-existed with bacteria in urine. The co-existing bacteria most frequently isolated were Pseudomonas and Streptococcus. The minimum inhibitory concentration (MIC) of 5-FU was measured using the Bact-Morphology Agar medium. C. albicans, C. guillermondii, and Torulopsis glabrata showed an excellent MIC (under 0.78 microgram/ml), C. tropicalis, C. parapsilosis, T. beigelii, and T. cutaneum showed a poor MIC (over 100 micrograms/ml).

Adult↗

[Silicone pig-tail catheter for the upper urinary tract].

Experience with pig-tail designed silicone rubber catheter for upper urinary tract is reported. There are several sizes of catheter: the small size (5, 6 F) is adequate for cystoscopic ureteral stenting, and the large size (8-14F) is suitable for the purpose of urinary diversion e.g. nephrostomy, cutaneostomy. In cases of long-term indwelling catheter like nephrostomy and cutaneostomy, there were some advantages; remarkably decreased frequency of catheter exchange, and prevention and/or treatment of dermatitis around the urostoma with Varicare system II. As a splint catheter after urinary tract surgery e.g. pyeloplasty, ureteroplasty, pyelolithotomy, the catheter was excellent.

Adult↗