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Biomedical subjects

N Kinukawa

Publications and source records attributed to N Kinukawa.

At least 91 records · Page 5Linked to original sources
PubMed1997

The current status of the treatment for hemorrhagic type moyamoya disease based on a 1995 nationwide survey in Japan.

The optimal treatment regimen for hemorrhagic type Moyamoya disease has yet to be clearly established. Furthermore, it remains unclear as to whether or not bypass surgery can help prevent future intracranial hemorrhaging in Moyamoya patients. In Japan, several treatment options, such as conservative, medical, and surgical intervention, have been employed for the treatment of hemorrhagic type of Moyamoya disease. In this study, 282 hemispheres with hemorrhagic onset were analyzed based on a 1995 nationwide survey by the Research Committee on Spontaneous Occlusion of the Circle of Willis (Moyamoya Disease) of the Ministry of Health and Welfare Japan to clarify the current status of treatment for hemorrhagic type Moyamoya disease. Questionnaires were distributed to the departments of neurology, neurosurgery, and pediatrics all over Japan asking about both treatment and rebleeding. As a result, 12.5% of the affected hemispheres were treated conservatively while 32.3% were medically treated. Ventricular drainage and/or hematoma removal was performed in 15.8%, and revascularization surgery in 38.3% of all hemorrhagic sides. Among the revascularization procedures used, 45.7% of the hemispheres underwent single indirect bypass surgery, such as EDAS while 22.2% of them received a direct (superficial temporal artery--middle cerebral artery: STA-MCA) bypass surgery. A combination of direct and indirect bypass surgery or a combination of different kinds of indirect procedures comprised 32.1%. Forty-nine out of 282 hemorrhagic hemispheres demonstrated rebleeding. An intracranial hemorrhage occurred in 15 hemispheres with ischemic onset even though nine of them had undergone bypass surgery prior to hemorrhaging. Nearly 18% of the patients with hemorrhagic type disease experienced rebleeding regardless of the treatment modalities. Based on these findings, there remains no clearly superior treatment plan for hemorrhagic Moyamoya disease to prevent rebleeding at this time. However, the selection of patients, treatment modalities, and the timing of the surgery might all play an important role in controlling rebleeding. The final outcome of the patients are therefore mainly considered to correlate with the initial severity of the clinical features.

Cerebral Hemorrhage↗
PubMed1997

Autologous peripheral blood stem cell transplantation for acute myelogenous leukemia.

The safety and efficacy of myeloablative therapy followed by autologous peripheral blood stem cell transplantation (ABSCT) for acute myelogenous leukemia (AML) were evaluated in 60 patients. Peripheral blood stem cells (PBSC) were collected during recovery after consolidation chemotherapy. High-dose chemotherapy consisting of busulfan (16 mg/kg), etoposide (40 mg/kg), and cytosine arabinoside (3 g/m2 x 4) (BEA regimen) was used for pretransplant conditioning in 13 patients. For the remaining 47 patients, granulocyte colony-stimulating factor (G-CSF) was administered concurrently with the BEA regimen during conditioning. Unpurged, cryopreserved PBSC containing a median number of 5.4 x 10(8) MNC/kg or 12 x 10(4) CFU-GM/kg were reinfused at transplantation. The median number of days to granulocytes exceeding 500/microl and last platelet transfusion were 15 (8-44) and 24 (0->180), respectively. The 3-year probabilities of disease-free survival (DFS) and relapse were 78.6 and 21.4% for patients transplanted in first remission, 29.6 and 64.4% for those in second or third remission, and 11.1 and 77.8% for those in relapse, respectively. There were no transplant-related deaths within 100 days of transplantation. Age, disease status at transplantation, and number of induction chemotherapies to first complete remission were risk factors affecting the outcome of ABSCT. These results of ABSCT for AML in first remission warrant a prospective study of ABSCT as post-remission therapy.

Acute Disease↗
PubMed1997

Gastrointestinal submucosal tumors: evaluation with endoscopic US.

PURPOSE: To describe the endoscopic ultrasound (US) features of benign versus malignant submucosal tumors throughout the gastrointestinal tract. MATERIALS AND METHODS: One hundred nine patients aged 24-81 years suspected to have submucosal tumors (11 esophageal, 41 stomach, 24 duodenal, and 33 colorectal tumors) at barium studies or endoscopy underwent endoscopic US. The layer of origin, internal echo pattern, and lesion margin were analyzed by means of consensus and independent interpretation by three radiologists. RESULTS: Endoscopic US findings revealed several distinct patterns among various submucosal tumors. Sixteen (94%) of the 17 homogeneous lesions with histopathologic findings of malignancy were hypoechoic, although 29 (43%) of the 68 homogeneous lesions with histopathologic findings of benignity were similarly hypoechoic. Homogeneous lesions that were anechoic, of intermediate echogenicity, or hyperechoic were almost exclusively benign (39 [98%] of 40). In contrast, 23 (96%) of the 24 malignant lesions were heterogeneous (n = 7) or homogeneously hypoechoic (n = 16). The sizes of benign and malignant lesions were significantly different (P < .05). There was no significant difference in the echo pattern (i.e., homogeneous versus heterogeneous), but there was a significant difference in the proportion of hypoechoic versus nonhypoechoic lesions (anechoic, hyperechoic, or of intermediate echogenicity; P < .001). CONCLUSION: The differential diagnosis of gastrointestinal submucosal tumors is assisted with endoscopic US.

Diagnosis, Differential↗
PubMed1997

A clinical comparison of definite moyamoya disease between South Korea and Japan.

BACKGROUND AND PURPOSE: The goal of the present study was to clarify whether South Korean patients with moyamoya disease have clinical features similar to those of Japanese patients. METHODS: From 26 South Korean neurosurgical institutes, 296 definite cases were collected and analyzed statistically. These cases were then compared with 731 Japanese definite cases registered to the Research Committee on Moyamoya Disease of the Ministry of Health and Welfare, Japan. RESULTS: The Korean age distribution patterns showed two peaks that were similar to those seen in Japanese patients. The incidence of adult moyamoya disease in South Korea, however, was 20% higher than that in Japanese patients. The family occurrence rate was 1.8% in Koreans. The incidence of cerebral infarction and bleeding in Koreans was statistically higher, whereas transient ischemic attack and seizure were less than those in Japanese subjects. The incidence of infarction in children and that of hemorrhage in both children and adults were also statistically higher in Koreans. The incidence of hemorrhage was higher in females than in males. Both the age at onset and sex affected the disease type. Although most Japanese patients underwent direct bypass surgery and/or combined indirect bypass procedures, single encephaloduroar-teriosynangiosis was performed on 87.6% of all surgical cases in Koreans. Despite the higher incidence of hemorrhagic type in South Korea, the outcomes of the patients were similar to those of the Japanese patients. CONCLUSIONS: This study suggests that the clinical background of moyamoya disease in South Korea is essentially similar to that in Japan.

Adolescent↗
PubMed1997

[A study of the clinical effect of hormone replacement therapy for patients with stress incontinence].

BACKGROUND: Our purpose was to clarify the effect of hormone replacement therapy (H.R.T.) for patients with stress incontinence. METHODS: We investigated 25 postmenopausal women, age 54-73 years, with a leakage volume is less than 15 g/day. In this study 0.625 mg of conjugated estrogen and 2.5 mg of medroxyprogesterone acetate were administrated for a total of 4 months. A clinical evaluation, measurement of volume of leakage per day and urodynamic evaluation (urethral pressure profile) were performed three times at pre administration, and at 2 months and 4 months after administration. RESULTS: Five of the 24 patients (20.8%) were improved significantly both clinically and urodynamically. Six patients (25.0%) improved clinically, and two patients (8.3%) improved urodynamically, the remaining 11 patients (45.8%) showed no change. Side effects occurred in eight cases. In one patient, it was necessary to stop administration due to severe irregular genital bleeding and leukorrhea, and in one patient the dosage was reduced due to swelling of breasts. The side effects of swelling of breasts and genital bleeding were relatively mild in the remaining six patients and they could continue H.R.T. administration. CONCLUSIONS: These results suggest that H.R.T. for patients with stress incontinence is not necessarily superior to the other non surgical methods. However, it may provide an alternative treatment method for incontinence.

Aged↗
PubMed1997

Xanthogranulomatous cholecystitis versus gallbladder cancer: clinical differentiating factors.

Xanthogranulomatous cholecystitis (XC) is occasionally difficult to differentiate from gallbladder cancer and mandates efforts to avoid extensive operations. We studied the clinical factors to differentiate XC from cancer. Subjects were a consecutive series of 10 patients with XC and 10 with carcinoma, all of whom radiologically showed thickened gallbladder walls. As opposed to cancer, XC was typified by invisible gallbladders on cholangiography (1), the presence of cholelithiasis (P = 0.01) (2), and, intraoperatively, an aspirate of pus or nothing (P < 0.01) (3). To diagnose XC against gallbladder cancer, (1) and (2) in combination and (3) demonstrated an accuracy of 82.4% and 85.0 per cent, respectively. Clinically, XC can be distinguished from gallbladder cancer by cholangiography, calculous findings, and a gallbladder aspirate of pus or nothing.

Aged↗
PubMed1997

p53 mutations in multiple urothelial carcinomas: a molecular analysis of the development of multiple carcinomas.

The purpose of this study is to assess whether the development of synchronous and/or metachronous multifocal urothelial cancers is due to field defect, intraluminal seeding and implantation, or both. We used a series of 42 cases of multiple urothelial cancers. We performed polymerase chain reaction single-strand conformation polymorphism, DNA sequencing, and immunohistochemical studies on p53 gene mutations in 84 multiple urothelial carcinomas (78 urinary bladder carcinomas and 6 ureteric or renal pelvic carcinomas) from 42 patients. p53 Mutations were detected in 42 (50%) of 84 cancerous tumors from 22 (52%) of the 42 patients and were strongly related to the tumor grade but not to the tumor stage. Nine patients had identical mutations with or without additional mutations in the multiple carcinomas, which suggests that the carcinomas had a common origin. Eleven patients, however, had discordant mutations, and two patients had a mutation in one tumor but not in another, a fact that strongly suggests independent origin. Double mutations were observed in 9 (21%) of 42 patients; in these types of mutation, transitions were clearly more frequent than transversions, a difference from previously reported spectra of urothelial carcinomas. The data indicate that multiple urothelial carcinomas seem to be either common or of independent origin. In addition, the different p53 mutational spectra in this series might reflect the presence of other possible mutagens in carcinogenesis of multiple urothelial carcinomas.

Aged↗
PubMed1996

Factors correlated with portal venous invasion by hepatocellular carcinoma: univariate and multivariate analyses of 232 resected cases without preoperative treatments.

BACKGROUND: The postoperative intrahepatic recurrence of hepatocellular carcinoma (HCC) is high. It is difficult to distinguish whether the recurrence is metastatic or new primary lesion. To determine the malignant potential of HCC itself, we analyzed the risk factors associated with portal venous invasion since this is direct evidence of tumor invasiveness. METHODS: Two hundred and thirty-two patients who underwent curative hepatectomy for HCC without preoperative treatments were included in this study, because preoperative treatment caused the tumor to undergo a variety of histologic change. We analyzed the risk factors linked to portal venous invasion by both univariate and multivariate analyses. RESULTS: In an univariate analysis, tumors larger than 3 cm, high histologic grade (III or IV), the presence of fibrous capsule, necrosis, mitotic rate of more than 4/10 high power fields, peliotic change, presence of tumor giant cells, high platelet count, low level of indocyanine green retention rate at 15 minutes, and the absence of cirrhosis were significantly correlated with portal venous invasion. In multiple stepwise logistic regression analysis, tumors larger than 3 cm, high histologic grades, and the presence of fibrous capsule were strong predictors of portal venous invasion by HCC. CONCLUSIONS: Because the blood vessels of the fibrous capsule were frequently invaded by cancer cells, it may have been possible to prevent postoperative metastatic recurrence if HCC were resected before becoming large enough to have a fibrous capsule.

Adult↗
PubMed1996

Evaluation of quantitative assay for antibody to hepatitis C virus core in patients treated with interferon.

We titrated antibody to hepatitis C virus (anti-HCV) core of serum samples from 57 patients with chronic HCV infection, in an attempt to clarify the relationship between the level of HCV RNA and the outcome of interferon treatment. The patients studied were positive for both anti-HCV, by second-generation assay, and HCV RNA, by polymerase chain reaction, and had been treated with interferon for six months. Of the 57 patients, HCV RNA was eliminated in 16 by the time of discontinuation of interferon treatment (CR); in 19 this elimination was transient (PR) and for 22 elimination was nil (NR). The low HCV RNA level was accompanied by high titers of anti-HCV core while high HCV RNA levels were accompanied by low titers of anti-HCV core, with an inverse correlation (r = -0.322, P < 0.05). The mean titer of anti-HCV core before interferon treatment was 324 units in CR, 205 in PR, and 168 in NR, with a correlation ratio of 0.382 (P < 0.05). A decreased titer (more than 50%) was found in 68% of the CR. At the time of six-month follow-up, the anti-HCV core titers of CR had decreased by more than 50%, compared to pretreatment titers, while in PR and NR, there was an increase to above the pretreatment titers, without increases in HCV RNA levels or worsening of the hepatitis. In conclusion, quantitative assay for anti-HCV core is useful to assess the status of HCV replication.

Adult↗
PubMed1996

Causal relationship between occlusive lesions of the coronary artery and myocardial fibrosis in arteriosclerotic rabbits--differences between cholesterol-fed and heritable hyperlipidemic rabbits.

To investigate the causal relationship between lesions of either the proximal large or the distal small coronary arteries and myocardial fibrosis, the hearts and the aortas of 99 cholesterol-fed rabbits with either intermittent or continuous hyperlipidemia for 8 months or more, 44 Watanabe-heritable hyperlipidemic (WHHL) rabbits and 20 normal rabbits were studied histologically. The size and location of the myocardial fibrosis correlated closely with the almost completely occlusive distal small coronary artery which mainly consisted of macrophages, necrosis and calcification but did not correlate with the maximum % stenosis of the large proximal subepicardial coronary arteries in the cholesterol-fed-rabbits. Myocardial fibrosis and almost completely occlusive lesions of the distal small coronary arteries were very rare in the WHHL rabbits, and the maximum % stenosis of the proximal coronary artery and aortic lesions in the WHHL rabbits tended to be greater than those in the cholesterol-fed rabbits. Thus, we are still not certain as to whether or not, the organic stenosis of the subepicardial coronary artery is responsible for myocardial fibrosis in WHHL-rabbits. In conclusion, a causal relationship was observed between myocardial fibrosis and the occlusive lesions of the distal small coronary arteries in cholesterol-fed rabbits, while the arteriosclerotic lesions of the small coronary artery in cholesterol-fed rabbits completely differed from those observed in WHHL-rabbit.

Animals↗
PubMed1996

Inverse correlation between the expression of bcl-2 and p53 proteins in primary gastric lymphoma.

The immunohistochemical expression of bcl-2 and p53 proteins was evaluated in formalin-fixed, paraffin-embedded surgical specimens from 212 patients with primary gastric lymphoma. bcl-2 protein was found to be expressed in 145 specimens (68%). Among the 179 specimens with B-cell lymphoma of mucosa-associated lymphoid tissue (MALT), bcl-2 positivity decreased significantly as the histological grade advanced; bcl-2 was expressed in 93% of low-grade tumors, 88% of mixed-grade (low-grade with a focal high-grade component) tumors, and 44% of high-grade tumors (Cochran's linear trend test; P<.001). p53 protein expression was detected in 43 of 212 cases (20%). Among the B-cell MALT lymphomas, p53 positivity increased significantly as the histological grade advanced; p53 was expressed in 6% of low-grade tumors, 12% of mixed-grade tumors, and 31% of high-grade tumors (Cochran's linear trend test; P<.001). An inverse correlation was observed between the expression of bcl-2 and p53 in all 212 lymphomas (gamma = -0.531; P<.05) as well as in all 179 B-cell MALT lymphomas (gamma = -0.671; P<.01). Although the bcl-2 expression did not correlate with the patient survival, the p53 positive cases showed a significantly poorer prognosis compared with the p53 negative cases (log-rank test; P<.05). These results suggest that the expression of bcl-2 and p53 may, therefore, be associated with the transition from low-grade to high-grade tumors in primary gastric lymphoma.

Adolescent↗
PubMed1995

Risk factors for intrahepatic recurrence in human small hepatocellular carcinoma.

BACKGROUND/AIMS: Postoperative intrahepatic recurrence of human hepatocellular carcinoma is high. Recently, the relationship between proliferating cell activity in the cirrhotic liver and occurrence or recurrence of hepatocellular carcinoma has been reported. METHODS: One hundred two resected cases of small hepatocellular carcinoma of < 3 cm in diameter without venous invasion or intrahepatic metastasis were examined to ascertain the factors affecting postoperative intrahepatic recurrence. RESULTS: Cumulative intrahepatic recurrence rates at 1, 3, and 5 years after surgery were 12.0%, 57.2%, and 67.6%, respectively. The log-rank test indicated that serum albumin levels of < 3.7 g/dL, alanine aminotransferase levels of more than 54 IU/L, active inflammation in the nontumorous portion, and high proliferating cell nuclear antigen labeling index in the nontumorous portion (> 23.2%) were significant risk factors for recurrence. Tumor factors, including tumor size, histological grade, or alpha-fetoprotein level, were not significant risk factors. Cox's proportional hazard model identified that serum albumin level and alanine aminotransferase level were independently associated with intrahepatic recurrence after hepatectomy. CONCLUSIONS: This study suggests that the principal cause linked to either a recurrence or a second new growth of hepatocellular carcinoma in the remnant liver after hepatectomy was the state of the underlying liver parenchyma as well as other tumor factors per se.

Adult↗
PubMed1995

Cellular immunity in hemodialysis patients: a quantitative analysis of immune cell subsets by flow cytometry.

Immune cell subsets, when measured by two-color flow cytometry in a population of 129 hemodialysis patients, showed significant variance from normal values. Lymphopenia, decreased absolute counts, and altered percentage values of immune cells were found. Increased proportions of CD3+, T cell receptor (TCR) alpha beta + cells and CD4+ T lymphocytes were present. An abnormally high percentage of a subset of activated TCR alpha beta + cells (alpha beta + DR+) was also seen in hemodialysis patients. The proportion of B lymphocytes was found to be significantly lower as compared with controls. Relative values for TCR gamma delta+cells, both for activated (gamma delta + DR+) and nonactivated (gamma delta + DR-) subsets, as well as for CD8+ lymphocytes and natural killer cells did not vary from those of normal controls. Also, the CD4+/CD8+ ratio showed no significant change. Analysis of absolute counts of the investigated immune cell populations revealed significantly decreased numbers for the majority of subsets, as a result of the preexisting lymphocytopenia, characteristic of end-stage renal disease. We conclude that profound quantitative alterations of immune cells, including TCR+T cells subsets, exist in hemodialysis patients. These account, at least in part, for the immune dysregulation associated with chronic renal failure.

B-Lymphocyte Subsets↗
PubMed1994

Microsoft Excel Program for creating attractive survival curves.

This paper describes the design of a Microsoft Excel Program which interactively creates attractive and outstanding survival curves. This program enables medical researchers to easily create quality presentation graphs of survival curves and obtain high quality slides and prints, which can be inserted in papers or used directly at medical meetings. Through the use of vertical bars, this program can display the exact points where censored cases occur on survival curves, making it possible to monitor censoring patterns between groups. Furthermore, this program can also create survival curves based on the proportional hazards model for specific patterns of covariate values, given estimated regression coefficients and baseline survival function. This program may be a most useful and effective tool in creating medical research papers containing survival analysis.

Age Factors↗
PubMed1994

The organization of statistical activities at medical research institutions.

In this paper, we discuss the organizational structure for the conduct of statistical activities at medical Colleges and Universities. Here, we have particularly focused on two significant statistical activities, i.e., statistical consultation and research. The consulting service for medical researchers consists of practical statistical analysis, instruction on computer manipulation and software, response to reviewer's comments and statistical design of prospective studies. From our various experiences, we describe the actual implementation of statistical consultations for medical researchers. It has played an important role in supporting medical research. In addition, we also outline some research, with respect to new ways of applying statistics in medical science. This paper concludes that it may be practical for the existing computer center or department of medical informatics, in charge of the computing service, to conduct statistical activities until formal organizations are established at the academic institution. To realize the conduct of statistical activities by Department of Medical Informatics, it needs a team of biostatisticians, data analysts and computer personnel.

Computer Systems↗
PubMed1994

Inverse correlation between the titre of antibody to hepatitis C virus and the degree of hepatitis C viraemia.

We titrated 277 hepatitis C virus (HCV) antibody-positive serum samples from 235 volunteer blood donors as well as from 42 outpatients of a hospital for elderly people and studied the relation of the titre of HCV antibody to the presence of HCV RNA, of antibody to C100 protein (anti-c100) and of antibody to GOR epitope (anti-GOR). Liver dysfunction was measured also. Of 177 HCV RNA-positive serum samples, 87 were tested for the degree of HCV viraemia by means of a competitive assay. Among the 277 samples, prevalences of HCV RNA, anti-c100, anti-GOR and liver dysfunction were 63.9%, 71.8%, 75.7% and 17.5%, respectively. The prevalence of HCV RNA became higher as the titre of HCV antibody increased. The titre tended to increase with age but the tendency was not statistically significant. The mean titre was higher in females (2(10.4 +/- 1.8)) than in males (2(9.4 +/- 2.2)) (P < 0.01). In the HCV RNA-positive serum samples, the HCV antibody titre was significantly higher in the anti-c100-positive samples than in the negative ones. This difference between the positive and negative samples, however, was not statistically significant for anti-GOR and liver dysfunction. Low degrees of HCV viraemia were accompanied by high titres of HCV antibody while high degrees of HCV viraemia went with low titres of HCV antibody. The study revealed that titres of HCV antibody were higher in females and the degree of HCV viraemia correlated inversely with the titre of HCV antibody.

Adolescent↗
PubMed1994

A statistical analysis of predictive factors of response to human lymphoblastoid interferon in patients with chronic hepatitis C.

OBJECTIVE: To determine markers predictive of effective interferon treatment for patients with chronic hepatitis C virus (HCV) infection, we studied 80 Japanese patients treated for 6 months with natural interferon-alpha. METHODS: Serum samples were tested for HCV RNA by two-stage polymerase chain reaction (PCR). HCV RNA were grouped into four genotypes by amplification of core-gene sequences by PCR with type-specific primers, and the level of HCV RNA was measured by competitive PCR. HCV RNA was detected in all patients before the interferon treatment. For the purposes of this study, a complete response was defined as the elimination of HCV RNA for at least 6 months after termination of the treatment. RESULTS: HCV RNA was eliminated from the sera of 27 patients (33.8%) at the termination of the interferon treatment, and the elimination was sustained throughout a 6-month follow-up (complete response). Four of eleven variables proved to be associated with a complete response when assessed by univariate analysis. With multiple logistic regression analysis assessment, however, only two variables (HCV RNA level (p < 0.001) and genotype (p = 0.048)) were significant. CONCLUSION: These results suggest that factors associated with the HCV infection are more important than patient characteristics for effective interferon treatment of patients with chronic HCV infection and that a low level of HCV RNA and HCV of genotype III are useful predictors of a complete response.

Adult↗