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Biomedical subjects

N Ishikawa

Publications and source records attributed to N Ishikawa.

At least 73 records · Page 4Linked to original sources
PubMed2001

Solitary infantile myofibromatosis in the lateral orbit floor showing spontaneous regression.

Infantile myofibromatosis is a rare benign tumour usually occurring early in infancy. We describe the case of a 10-year-old boy with solitary infantile myofibromatosis in the left lateral orbit floor which regressed spontaneously. Although our patient was older than previously reported cases and showed bony destruction confirmed by computed tomography (CT), this tumour was diagnosed as infantile myofibromatosis based on immunohistochemical findings. The tumour disappeared spontaneously six months after incisional biopsy, that also indicated this tumour was an infantile myofibromatosis.

Child↗
PubMed2001

Gastrointestinal stromal tumor of the stomach diagnosed preoperatively.

A case of gastrointestinal stromal tumor (GIST) of the stomach is reported. GIST has been applied to gastrointestinal submucosal tumors mainly composed of spindle shaped cells that represent neither typical features of myogenic nor neurogenic tumors, and immunohistochemical studies are necessary for the diagnosis of GIST. The patient was a 39-year-old man and was successfully diagnosed to be GIST (uncommitted type) preoperatively by immunohistochemical studies of biopsy specimens from an ulcerative submucosal tumor with bridging folds in the fundus, approximately 3.0 cm in size. Local excision of the stomach was performed. This is the 3rd case of GIST with a preoperative diagnosis to appear in the literature in Japan. For gastroenterological surgeons, it is critical to select the most suitable surgical procedure. In the present, because the number of papers reporting GIST of the stomach is small, it is impossible to review GIST clinicopathologically. We reviewed the surgical procedure for gastric leiomyosarcomas, because of including many cases with GIST in them. Therefore, we performed 54 cases of gastric GIST in the literature, compared with 92 cases of gastric leiomyosarcoma. As a result, it was thought that local excision for gastric GIST should be preferred.

Humans↗
PubMed2001

Coronary artery bypass grafting with cardiopulmonary bypass is safe and contributes to favorable long-term results.

The aim of this study was to determine the indication for minimally invasive direct coronary artery surgery based on the operative and long-term results of conventional coronary artery bypass grafting with cardiopulmonary bypass. Operative results: The subjects included 505 patients who underwent isolated elective coronary artery bypass grafting with cardiopulmonary bypass from January 1995 through August 1999. The mean age at the time of surgery was 61.9 and the mean number of grafts per patient was 2.6. Long-term results: From January 1984 to December 1995, a total of 907 patients received coronary artery bypass grafting with cardiopulmonary bypass using the internal thoracic artery to the left anterior descending artery with or without saphenous vein grafts to other coronary arteries. The rates of complete and incomplete revascularization were 69.3% (n = 629) and 30.7% (n = 278), respectively. Mean follow-up was 5.95+/-3.0 years. The operative results revealed low output syndrome occurred in 14 patients (2.8%), perioperative myocardial infarction with the appearance of new Q-waves in 5 (1.0%), renal failure requiring transient dialysis in 16 (3.2%), stroke with persistent sequelae in 5 (1.0%), and mediastinitis in 5 (1.0%). Two patients (0.4%) died in the hospital. The long-term results for the 907 patients revealed the 10-year actuarial survival, 10-year cardiac death free, and 10-year cardiac event free rates were 85.7%, 94.1%, and 77.3%, respectively. The 10-year survival rates was 88.4% among patients receiving complete revascularization and 79.3% among those receiving incomplete revascularization (p = 0.0334). The 10-year cardiac death free rate among patients undergoing complete revascularization was 96.3% and 88.7% among those receiving incomplete revascularization (p = 0.0016). The 10-year cardiac event free rates were 82.3% and 67.9%) among patients undergoing complete and incomplete revascularization, respectively (p = 0.0118). In view of the favorable operative and long-term results of conventional coronary artery bypass grafting, especially complete revascularization, we conclude that minimally invasive direct coronary artery grafting is an appropriate treatment for multi-vessel disease in carefully selected patients at a high risk for stroke and major comorbidities due to old age.

Adult↗
PubMed2001

Acute pericarditis associated with 5-aminosalicylic acid (5-ASA) treatment for severe active ulcerative colitis.

A 17-year-old male who had been diagnosed with ulcerative colitis was prescribed 80 mg prednisolone and 1,500 mg 5-aminosalicylic acid (5-ASA) per day. Two weeks after initiating therapy, he was referred to our hospital for evaluation of chest pain and high fever. Electrocardiography (ECG) showed ST elevation in limb and precordial leads. Chest pain with high fever and ECG changes were resolved after 5-ASA was discontinued. Three weeks later, the administration of a low dose of 5-ASA was associated with the immediate recurrence of pericarditis associated with chest pain, suggesting a hypersensitive reaction to 5-ASA in this patient.

Adolescent↗
PubMed2001

Gender difference in delays to diagnosis and health care seeking behaviour in a rural area of Nepal.

SETTING: Directly observed treatment for tuberculosis using a short-course regimen (DOTS) was introduced in a rural area of Nepal. All new patients assigned to DOTS from mid-December 1997 to mid-June 1999 were eligible for the study. OBJECTIVE: To examine delays in tuberculosis (TB) diagnosis and compare health care seeking behaviour between men and women. DESIGN: A cross-sectional analysis of patient interviews. RESULTS: Women were found to have a significantly longer total delay before diagnosis of tuberculosis (median 2.3 months for men, 3.3 months for women). When they visited traditional healers first, women had a significantly longer delay than men from the first visit to health care providers to diagnosis (median 1.5 months for men, 3.0 months for women). More women (35%) visited traditional healers before diagnosis than men (18%), and were more likely to receive more complicated charms from traditional healers. Men tended to visit the government medical establishment first if they knew that free TB treatment was available, but women did not. CONCLUSION: Women were more likely to visit and to believe in traditional healers; this might lead to the longer delays experienced before TB diagnosis.

Adolescent↗
PubMed2001

Prevalence of drug-resistant tuberculosis in an HIV endemic area in northern Thailand.

SETTING: Chiang Rai Province in Northern Thailand, where human immunodeficiency virus (HIV) infection has been prevalent since the 1990s. OBJECTIVE: To observe the prevalence of drug-resistant tuberculosis (TB) and investigate the factors related to the level of drug resistance in an HIV endemic area. DESIGN: Population-based surveillance study covering the whole province. METHOD: Drug susceptibility testing was performed at the Thai Ministry of Public Health laboratory for all sputum smear-positive TB patients diagnosed in hospitals in Chiang Rai Province over a 25-month period in 1996-1998. Patient characteristics were obtained through interview by trained personnel. HIV testing was performed with informed consent. RESULTS: Among the 1077 incident patients without previous history of treatment, the proportion of patients with resistance to isoniazid was 13.2%, 10.8% to rifampicin, 15.6% to streptomycin, and 5.8% to ethambutol. Multidrug resistance (MDR), i.e., resistance to at least both isoniazid and rifampicin, was observed in 6.3%. Factors associated with primary MDR-TB were HIV positivity (OR 2.2, 95%CI 1.3-3.9), age <50 years (OR 2.0), and treatment in the provincial hospital (OR 2.3), compared to patients treated in the community and private hospitals. Stratified analysis shows a significantly high prevalence of primary MDR-TB among HIV-positive patients treated in the provincial hospital against HIV-negative patients or HIV-positive patients in other hospitals. CONCLUSION: The prevalence of primary MDR-TB in this area was high. It is necessary to strengthen TB control activities in order to reduce the burden of MDR-TB.

AIDS-Related Opportunistic Infections↗
PubMed2001

[A case of lung adenocarcinoma showing diffuse air-space consolidation with idiopathic interstitial pneumonia].

Routine chest radiography demonstrated abnormal opacities in the right lower lung field of a 54-year-old man with idiopathic interstitial pneumonia. A high-resolution chest CT scan showed diffuse air-space consolidation in the right lower lung with replacement of a honeycomb area. The diagnosis was adenocarcinoma, and a right lower lobectomy was performed. Histopathologic examination showed moderately differentiated adenocarcinoma and the pathological stage was T3 N0 M0 (Stage IIB). About 1 year later, the cancer recurred with diffuse air-space consolidation in the whole of the right lung and the left middle and lower lung, which resulted in the patient's death. It was difficult to discriminate between an acute change for the worse of idiopathic interstitial pneumonia and a recurrence of lung cancer on the basis of the CT findings in this patient. It is important to elucidate the CT features of lung cancer associated with idiopathic interstitial pneumonia.

Adenocarcinoma↗
PubMed2001

Transapical aortic cannulation for acute aortic dissection to prevent malperfusion and cerebral complications.

We describe a technique for transapical cannulation in cases of acute aortic dissection. This method entails aortic cannulation via the apex of the left ventricle and the aortic valve. When this technique is used, retrograde perfusion prevents such fatal complications as malperfusion or cerebral embolism that can occur with femoral cannulation. Having found no disadvantage in this method, we recommend transapical cannulation as the best cannulation technique for acute aortic dissection.

Acute Disease↗
PubMed2001

[Inflammatory endotracheal polyp associated with lung cancer treated by high-power diode laser].

A 74-year-old man was admitted to our department for surgery of light lung cancer (c-T1N0 M0 stage IA). Preoperative bronchoscopy revealed a smooth-surfaced polypoid lesion about 3 mm in diameter in the left main bronchus. Pathological findings of the biopsied specimen revealed inflammatory granulation tissue. Right upper lobectomy and lymph node dissection was performed and the pathological diagnosis was squamous cell carcinoma of the lung with no lymph node metastasis (p-T1N0M0 stage IA). Bronchoscopy after 2 and 5 month revealed no change of the polypoid lesion and the biopsied specimen revealed no malignancy. The polypoid lesion was identified microscopically as inflammatory polyp. Therefore, the polypoid lesion was treated with a new high power diode laser system (DIOMED 25, OLYMPUS). Bronchoscopy after 10 month showed complete disappearance of the polypoid lesion.

Aged↗
PubMed2001

[Coronary risk appraisal for primary prevention of coronary heart disease in a community].

PURPOSE: In discussion on application of "National Health Promotion Toward 21st Century in Japan" in Kanagawa prefecture, it was noted that the age-adjusted mortality rate of death from ischemic heart disease in this part of Japan was higher than that for the whole nation in 1996. To facilitate development of a strategy for primary prevention of coronary heart disease (CHD), the present study was conducted to predict 2-yr incidence of CHD and decrease with simulations assuming improvement in CHD risk factors. METHODS: Using CHD risk prediction algorithm; the Weibull accelerated failure regression model based on the Framingham Heart Study, a 2-yr incidence of CHD was predicted for 1652 residents (515 male, 1137 female) on the basis of results of a health check up in 1998. We then estimated the probable decrease in CHD recalculated assuming decrease in total cholesterol (TC), increase in HDL-cholesterol (HDL-C), decrease in systolic blood pressure (SBP), or quitting the smoking habit. RESULTS: 1. The 2-yr probability of developing CHD for men free of heart disease was 2.79 +/- 2.17%, and that for men who had heart disease was 10.25 +/- 2.17%. The 2-yr probability for women free of heart disease was 16.80 +/- 14.40%, and that for women who had heart disease was 3.66 +/- 1.09%. As the reported probability of developing CHD in the U.S.A. is remarkably higher than in Japan, the fact that the present model was based on American data explains why these predicted probabilities are higher than values reported from Japanese cohort studies. 2. For men free of heart disease, a strategy for high risk case such as a decrease in TC and an increase in HDL-C, or quitting the smoking habit, was more effective than a population-based strategy. For women free of heart disease, the population-based strategy was more effective. 3. Women more than 60-yrs old who had a high 2-yr probability of developing CHD were divided into three groups; high, middle, and low risk. The mean body weight, mean body mass index, mean diastolic blood pressure, and mean blood glucose in the high risk group were significantly higher than the values in the other groups. Decrease in systolic blood pressure was a more effective strategy for decrease in CHD incidence in the high risk group than in the other groups. CONCLUSIONS: CHD risk prediction of this type may be considered useful for setting target CHD risk factors and for focusing interventions to prevent CHD effectively.

Adult↗
PubMed2001

[Intracardiac repair of tetralogy of Fallot with an anomalous coronary artery crossing the right ventricular outflow tract].

Between may 1993 and march 2001, 2 patients with tetralogy of Fallot and an anomalous coronary artery crossing the right ventricular outflow tract underwent intracardiac repairs. The anomalous coronary arteries included the left anterior descending from the right coronary artery (case 1), and the right coronary artery from the left coronary artery (case 2). In case 1, we turned down a flap of anterior wall of the main pulmonary artery, sutured it to the edge of the right ventriculotomy and placed a bicusped patch to the anterior aspect. In case 2, we underwent transpulmonary-transatrial repair and placed a transannular patch along by the left coronary artery. Right ventricular outflow tract reconstruction was successful in 2 cases.

Cardiac Surgical Procedures↗
PubMed2001

Hemorrhagic shock due to intrathoracic rupture of an osteosarcoma of the rib.

A 13-year-old girl presented with dyspnea and chest pain. Chest radiography showed a massive left pleural effusion. Computed tomography revealed a tumor of the fourth rib. A large bloody effusion was drained. Her anemia worsened (hemoglobin: 4.8 g/dl), and hemorrhagic shock ensued. An emergency thoracotomy was performed. Bleeding from the ruptured tumor was identified. The fourth rib, the tumor, and the adjacent tissues were resected. Histopathologic examination revealed a ruptured primary osteosarcoma of the rib with pleural dissemination.

Adolescent↗
PubMed2001

A surgical intervention using percutaneous cardiopulmonary support for contralateral pneumothorax following pneumonectomy.

We here, describe a 63-year-old man presenting with a contralateral pneumothorax following pneumonectomy. After setting up a percutaneous cardiopulmonary support (PCPS) system in advance in preparation for hypoxemia during the operation, resection of bullae was performed. His oxygen saturation and hemodynamic status were stable intraoperatively and we achieved a successful and safe operation swiftly. He had no complications and was discharged on the 10th postoperative day.

Carcinoma, Squamous Cell↗
PubMed2000

Role of anti-A/B antibody titers in results of ABO-incompatible kidney transplantation.

BACKGROUND: Our previous studies showed that the incidence of humoral rejection was extremely high in ABO-incompatible living kidney transplantation. This result suggests that anti-A/B antibody titers directly influence the graft survival of ABO-incompatible kidney transplantation. In this study, we examined the impact of preoperative anti-A/B antibody titers on the results of ABO-incompatible living kidney transplantation. METHODS: Sixty-seven patients underwent ABO-incompatible living kidney transplantation at our institution between January 1989 and December 1995. The mean age was 34.9 years with 38 males and 29 females. Sixty-one of the 67 recipients were included in an analysis of the impact of anti-A/B antibody titer in long-term graft survival. The remaining six patients were excluded because of death with a functioning graft (three patients) and withdrawal of immunosuppression due to nonimmunological reasons (three patients) within 1 year after renal transplantation. RESULTS: The graft survival rate for the level of less than 1:16 in maximum IgG antibody before transplantation (n=21) at 1, 5, and 8 years was 81.0, 66.8, and 66.8%, respectively. The corresponding values for the level of 1:32-1:64 (n=33) and higher than 1:128 (n=7) were 93.9, 90.5, and 79.7%, and 42.9, 28.6, and 28.6%, respectively (log-rank test, P=0.0007). There was no significant association between maximum anti-A/B IgM titers, minimum anti-A/B IgM titers, minimum anti-A/B IgG titers, and graft survival. CONCLUSIONS: Preoperative maximum anti-A/B IgG titers correlated with the long-term graft survival in ABO-incompatible living kidney transplantation. Thus, preoperative maximum levels of anti-A/B IgG titers are one of the good predictors of the results of ABO-incompatible living kidney transplantation.

ABO Blood-Group System↗
PubMed2000

Quantitative Evaluation of Nystagmus by an Image-analysis System.

Purpose: We attempted to apply a newly developed image-analysis system for measurement and analysis of nystagmus.Method: Eye movements were recorded by digital video through a head-mounted charge coupled device (CCD) camera. The recorded movie was converted into black and white in order to detect the area of the pupil. Horizontal and vertical eye positions were determined by calculating the centroid of the pupil. Torsional angle was calculated using the iris striate pattern around the pupillary margin.Results: The parameters (amplitude, cycle, etc.) of nystagmus were calculated easily by the new image-analysis system from the recorded images. As examples, the foveation period was measured accurately in a case of jerky-type congenital nystagmus. Very regular cycles of intorsional attack period were revealed in a case of superior oblique myokymia. A case of cork-screw-like nystagmus showed a characteristic combination of large and small cycles unassociated with torsion.Conclusion: This image-analysis system was useful for quantitative analysis of nystagmus, and especially for measurement of torsion. Detailed waveforms and specific rhythms of nystagmus, which could not be recognized by observation, were demonstrated by this system.

Journal Article↗
PubMed2000

Glutathione S-transferase-pi gene expression and platinum drug exposure in human lung cancer.

We examined the association between the gene expression levels of glutathione S-transferase-pi (GST-pi) and platinum drug exposure in human lung cancer. First we monitored GST-pi gene expression levels in two lung cancer cell lines and in peripheral mononuclear cells of ten previously untreated lung cancer patients after platinum drug exposure. Next we examined GST-pi gene expression levels in 40 lung cancer autopsy specimens. The GST-pi gene expression levels were assessed by the quantitative reverse transcription-polymerase chain reaction or Northern blot analysis. The GST-pi gene expression was not induced by platinum drugs either in vitro and in vivo within 24 h of exposure. In contrast, GST-pi gene expression levels in lung cancer tissues of patients who had been exposed to platinum drugs at least 1 month before death were significantly higher than that in those of patients who had not been exposed. These results suggest that GST-pi gene expression is associated with chronic exposure to platinum drugs in lung cancer and/or the stress response to xenobiotics.

Antineoplastic Agents↗