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Biomedical subjects

N Nakano

Publications and source records attributed to N Nakano.

At least 55 records · Page 3Linked to original sources
PubMed1997

Renal effects of an angiotensin II antagonist in stroke-prone spontaneously hypertensive rat.

We evaluated the renal effects of the new angiotensin II type 1 (AT ) receptor antagonist, HR 720, in the stroke-prone spontaneously hypertensive rat. Rats were treated with either vehicle, HR 720, MK-954 (a selective AT1 receptor antagonist) or enalapril for 6 weeks. Blood pressure was decreased to a similar extent by HR 720, MK-954 and enalapril (203 +/- 4, 202 +/- 5 and 190 +/- 4 vs. 247 +/- 4 mm Hg for control). Urinary protein secretion was also decreased (5.2 +/- 0.3, 5.3 +/- 0.2 and 5.5 +/- 0.6 vs. 25.2 +/- 4.6 mg/100g/24h). The glomerular hypertensive change was improved in each drug-treated group (2.0 +/- 0.2, 3.3 +/- 0.3 and 1.6 +/- 0.1 vs. 17.6 +/- 1.5%; p < 0.0001). These results show that, in addition to its antihypertensive effect, HR 720 has a beneficial effect on renal function.

Angiotensin I↗
PubMed1997

Role of angiotensin II in the regulation of a novel vascular modulator, hepatocyte growth factor (HGF), in experimental hypertensive rats.

Hepatocyte growth factor (HGF) is a mesenchyme-derived pleiotropic factor that regulates cell growth, cell motility, and morphogenesis of various types of cells, and is thus considered a humoral mediator of epithelial-mesenchymal interactions responsible for morphogenic tissue interactions. We have previously reported that HGF is a novel member of endothelium-specific growth factors whose serum concentration is positively associated with blood pressure in humans. Therefore, we speculated that serum HGF secretion might be elevated in response to high blood pressure as a counter-system against endothelial dysfunction. However, it is difficult to elucidate the role of circulating and tissue HGFs in human hypertension. To address this issue, we measured circulating and tissue HGF concentrations in spontaneously hypertensive rats (SHR) and Wistar-Kyoto rats (WKY) at different ages. Serum HGF concentration in SHR was significantly higher than that in WKY at 6, 15, and 25 weeks of age (P<.01). Serum HGF concentration was also significantly positively correlated with blood pressure in SHR (P<.02, r=.455). In contrast, tissue HGF concentrations in heart, aorta, and kidney were significantly decreased in SHR as compared with WKY at 25 weeks of age, when these organs showed hypertrophic changes induced by hypertension (P<.01). Cardiac HGF mRNA was also decreased in SHR as compared with WKY at 25 weeks of age. Moreover, cardiac HGF concentration showed a significant negative correlation with left ventricular (LV) weight (P<.01), whereas serum HGF concentration showed a significant positive correlation with LV weight (P<.05). Interestingly, concentrations of cardiac and vascular angiotensin II, a suppressor of HGF, were increased in SHR as compared with WKY at 25 weeks of age (P<.01). Therefore, we examined the effects of angiotensin blockade on circulating and tissue HGF concentrations, to study the role of angiotensin II in HGF regulation. Administration of an angiotensin-converting enzyme inhibitor (enalapril) and angiotensin II type 1 receptor antagonists (losartan and HR 720) for 6 weeks resulted in a significant increase in cardiac HGF concentration, accompanied by increased cardiac HGF mRNA, and a significant decrease in serum HGF concentration, accompanied by lowered blood pressure and reduced LV weight (P<.01). Here, we demonstrated increased circulating HGF and decreased vascular, cardiac, and renal HGF in SHR as compared with WKY at the maintenance stage of hypertension. Decreased tissue HGF in target organs of hypertension may be due to increased tissue angiotensin II. These results suggest that decreased local HGF production may have an important role in the cardiovascular remodeling of target organs in hypertension, since HGF prevented endothelial injury and promoted angiogenesis. Blockade of angiotensin augmented local decreased cardiovascular HGF in hypertension, potentially resulting in the improvement of endothelial dysfunction.

Aging↗
PubMed1997

Influence of aging on progression of cardiovascular complications associated with insulin resistance in patients with essential hypertension.

Hyperinsulinemia or insulin resistance is suggested to play a role in the pathogenesis of hypertension and its target organ diseases. It is also well documented that aging is associated with a decline in glucose tolerance and insulin sensitivity, but there are few reports on the relationship between aging and insulin sensitivity or on the effects of aging on the progression of cardiovascular complications in patients with essential hypertension. To clarify these effects of aging in essential hypertension, 44 patients were examined by the euglycemic hyperinsulinemic glucose clamp test and ultrasonography of the heart and carotid arteries. There was a significant negative correlation between aging and insulin sensitivity (r = -0.37, p < 0.05). Significant increases in left ventricular mass index and carotid wall thickening accompanied by insulin resistance were seen in only non-elderly patients but not in elderly patients. These results suggest that aging decreases insulin sensitivity even in essential hypertensive subjects and that insulin resistance does not affect the progression of cardiac hypertrophy and atherosclerosis in elderly patients with essential hypertension.

Aged↗
PubMed1997

[The statistics of inpatients at Department of Neuropsychiatry in Sapporo Medical University Hospital (October, 1983 - March, 1996)].

The role of university hospitals should be re-examined considering the recent situation in psychiatrical health care. In this report, we investigated inpatients of neuropsychiatry in Sapporo Medical University Hospital from various aspects. Statistics were gathered on 1) age and sex, 2) address, 3) admission form based on the mental health law, 4) the number of admissions and discharges per year, 5) hospitalization term, 6) diagnostic group, 7) diagnosis, 8) rates of re-admission and re-admission within three months, 9) age and sex of schizophrenia patients and 10) age and sex of patients with affective disorders from October 31, 1983 to March 31, 1996. In our hospital, the rates of the inpatients with dementia and personality disorders are higher than those in other university hospitals. The reason for the high rate of personality disorders is elusive; however, most of the dementia patients enter our hospital mainly because we concentrate on a special research project about dementia. These data indicate that a specific function is required in university hospitals. In recent years, however, the surroundings of people with mental disorders have become more complicated, and the services for them have become diversified. However, it is very difficult for university hospitals to provide them with all such services, as the hospitals fulfill just one specialized function among the necessary services.

Adolescent↗
PubMed1997

[The disturbance of reversible operation in space in the early stage of Alzheimer's disease].

Constructional apraxia is one of the neuropsychological findings frequently observed in the early stage of the Alzheimer's disease, which may result from the visuo-spatial disturbances. The visual space consists of a variety of visual information processing, viewer-centered coordinate system, objects-centered coordinate system, integration of both coordinate systems, and verifying visual representation with the knowledge in the memory. The reversible operation in space, or mental rotation appears to play an important role in visuo-spatial functions, which refers to the operation of the visual representation at one orientation in viewer-centered coordinate system to construct the representation in object-centered coordinate system so that one can look like if it were presented at another orientation. To the present, little is known about reversible operation or mental rotation in patients with Alzheimer's disease. In this present paper, we attempted to investigate the ability of reversible operations in space so as to understand the mechanisms underlying constructional apraxia, or visuo-spatial disturbances in the early stage of Alzheimer's disease. The subjects were 12 patients with Alzheimer's disease in early stage (AD group), 12 patients with multi-infarcts dementia as disease control (MID group), 12 age matched persons as healthy control (HC group). In perspective taking tasks, that requires the subjects to imagine the spatial arrangement of the objects at the different view points from the subjects' one, AD group showed more severe deficits than MID group and HC group. Moreover, in a task that the subjects were asked to assume the photo-angle of the photograph taken of the model which was in front of them, AD group was imparied compared to the control groups. These disturbances were closely associated with deficits in Block Design test of WAIS. These results clearly demonstrate that the patients with Alzheimer's disease have disturbance in reversible operation in space and that the disturbance may be responsible for visuo-spatial dysfunctions, not only the constructional apraxia, but also a variety of performance deficits in the early stage of Alzheimer's disease.

Aged↗
PubMed1997

Serum deprivation-induced apoptosis accompanied by up-regulation of p53 and bax in human aortic vascular smooth muscle cells.

Vascular remodeling, which plays an important role in atherosclerosis and hypertension, is determined in large part by the balance between cell growth and cell death by apoptosis. In this study, we studied the apoptosis of human aortic vascular smooth muscle cells (VSMC) induced by serum deprivation. Serum deprivation induced apoptosis of VSMC in a time-dependent manner. Serum deprivation resulted in the up-regulation of p53 protein, compared to treatment with 10% serum (P < 0.01), suggesting that apoptosis induced by serum deprivation may be due to the up-regulation of p53. Of importance, the protein of bax, a promoter of apoptosis, was significantly increased in VSMC treated by serum deprivation compared to treatment with 10% serum (P < 0.01). Overall, these findings demonstrated that serum deprivation induced apoptosis in human aortic VSMC, accompanied by the induction of p53 and bax, suggesting that apoptosis induced by serum deprivation may be mediated by the p53-bax pathway.

Apoptosis↗
PubMed1996

Prevention of adoptively transferred diabetes in nonobese diabetic mice with IL-10-transduced islet-specific Th1 lymphocytes. A gene therapy model for autoimmune diabetes.

Four pancreatic islet-specific CD4+ helper T (Th) 1 (Th1) clones and two Th1 clones transduced with an SRalpha promoter-linked murine IL-10 (mIL-10) cDNA of 2.0-6.0 x 10(6) cells were adoptively transferred to nonobese diabetic (NOD) mice at age 8 d. Cyclophosphamide (CY) was administered at age 37 d (plus CY), and the incidence of diabetes and the histological grade of insulitis were examined at age 47 d. After the adoptive transfer of IL-10-transduced Th1 cells, polymerase chain reaction (PCR) and reverse-transcription (RT)-PCR detected the neo gene and the retrovirus vector-mediated IL-10 mRNA in situ in recipient islets, respectively. RT-PCR detected the decrease of IFN-gamma mRNA relative to IL-10 mRNA in IL-10-transduced Th1 clones in vitro and also in recipient islets. All four wild type Th1 clones plus CY induced the insulitis grade of 2.75 and diabetes in 66% of recipient NOD mice. IL-10-transduced two Th1 clones plus CY induced periinsulitis with the grade of 1.43 and diabetes in 8.0%. The 1:1 mixture of wild type Th1 cells and IL-10-transduced Th1 cells plus CY induced periinsulitis with the grade of 1.85 and diabetes in 20%. The suppression of diabetes through decreasing IFN-gamma mRNA by the tissue-specific delivery of IL-10 to pancreatic islets with IL-10-transduced Th1 cells affords us the starting basis to develop the gene therapy for autoimmune diabetes.

Adoptive Transfer↗
PubMed1996

Insulin resistance and cardiovascular complications in patients with essential hypertension.

Hyperinsulinemia or insulin resistance is suggested to play a role in the pathogenesis of hypertension and its target organ diseases. We designed this study to evaluate the role of insulin resistance in cardiac function, cardiac hypertrophy, wall thickness of the common carotid artery, and endothelial function of the brachial artery in essential hypertensive patients without diabetes mellitus. Insulin resistance was evaluated by the constant glucose infusion rate (M value) during the euglycemic-hyperinsulinemic glucose clamp test. In correlation analysis for several indices of glucose metabolism, only M value correlated with left ventricular mass index (LVMI), ratio of peak velocity during atrial contraction to that during early left ventricular filling phase (E/A ratio) and intima-media complex (IMC). In stepwise regression analysis of various risk factors for cardiovascular diseases, only M value and age were dependent factors for LVMI, E/A ratio, and IMC. No indices of glucose metabolism or risk factors for cardiovascular diseases correlated with endothelium-dependent and -independent vasodilation. These results suggest that insulin resistance, but not glucose intolerance and hyperinsulinemia, partly accelerates cardiovascular complications such as left ventricular hypertrophy and wall thickening of the carotid artery in patients with essential hypertension.

Blood Flow Velocity↗
PubMed1996

A case of adenosine-sensitive ventricular tachycardia in a very elderly male.

The best-known type of adenosine-sensitive ventricular tachycardia is idiopathic and of right ventricular outflow origin; however, there is little information about other types of adenosine-sensitive ventricular tachycardia. Idiopathic adenosine-sensitive ventricular tachycardia is common in the young. An 87-year-old man with ventricular tachycardia was admitted to our hospital. His ventricular tachycardia was sensitive to adenosine triphosphate, edrophonium, verapamil, and Valsalva's maneuver. He had experienced no anginal episodes. His ventricular tachycardia was thought to be idiopathic. We report this very rare case of adenosine-sensitive ventricular tachycardia, which was not derived from the right ventricular outflow tract, in a very elderly male.

Adenosine↗
PubMed1996

[A case of volatile solvent psychosis accompanied with multiple neurological and psychological symptoms].

A case of psychosis accompanied with variable symptoms induced by chronic volatile solvent inhalation is reported in this study. The patient was a 27-year-old male who had abused volatile solvents for 15 years, and was sent to the hospital because of a tonic-clonic seizure. Severe psychomotor excitement was observed on the first day and the 7th day after admission. After 10 days of admission, we observed visual transformation and hyperthermia, which suggested acute toxic symptoms due to a volatile solvent. Furthermore, symptoms such as incoherence, delusions of persecution, and catalepsy were also observed in this case. There have been few reports of multiple neurological and mental symptoms appearing in cases of volatile solvent psychosis. Although we sometimes experience cases of solvent abuse with acute mental symptoms and recurrent excitement after sedation, such symptoms are not always observed because of flashback in the strict sense. Therefore, careful early treatment should be employed to prevent 'secondary excitement'.

Adult↗
PubMed1996

[Relationship between SPECT and pathological alterations in Alzheimer's disease--a study of a case with left-hemisphere dominant lesions].

123I-IMP SPECT (SPECT) has been widely used in clinical neuropsychiatry for establishing the clinical diagnosis, and evaluating the course of the disease. However, little is known about the significance of alterations in SPECT. In this paper, we present comparative study between alterations in SPECT and neuropathological findings in the case of Alzheimer's disease (AD). The patient, a 59-year-old female, began to show memory disturbance and the left hemisphere disturbances, non-fluent aphasia, but right hemisphere disturbances, constructional apraxia, visuo-spatial dysfunctions were not notable at the early stage. The neuroimaging also revealed left-side dominant cerebral atrophy in MRI and left-side dominant hypoactive regions in SPECT (especially in parietal lobe). Memory disturbance and non-fluent aphasia gradually progressed after admission. Then, mirror phenomenon and Bálint's syndrome appeared at the age of 63 years. In the advanced stage, hypoactive regions in SPECT were expanded into temporal and frontal areas. The laterality observed at the early stage became unremarkable. The patient died from heart failure at 64 years. Pathological diagnosis was AD. Eleven ROI (region of interests) were determined on each hemisphere in transverse SPECT image. We calculated ROI% (each ROI count/ROI count at central cerebellum). Neuronal cell count (NCC) and amyloid beta protein deposited areas (BDA) were estimated using 3 serial sections stained with Nissl's method and immunostained for amyloid using monoclonal antibody raised against synthetic A beta, mcAb 90/12. Digitized images based on photographs were analyzed with NIH-image 1.45. NCC decreased in number in frontal, temporal, and parietal lobes. Significant asymmetrical reduction of NCC (lt. < rt.) was observed in orbital, superior temporal and angular gyri (p < 0.01). BDA in superior parietal lobule, superior temporal gyrus and superior, middle, inferior frontal gyri were larger than those in precentral gyrus and visual cortex. Asymmetry of BDA (lt. > rt.) was significant in middle temporal gyrus (p < 0.01). ROI% at the early stage was correlated with corresponding NCC (r = 0.49, p < 0.05) and BDA (r = -0.55, p < 0.01), but at the advanced stage was not significantly correlated with corresponding NCC (r = 0.26) and BDA (r = -0.20). It is evident that SPECT shows good correlation with clinical features and pathological alterations during the course of AD. Our observations imply that the changes in SPECT usually precede the appearance of the clinical symptoms. SPECT is very sensitive in detecting the functional decline in certain regions of the CNS. In the case of AD, the hypoactive regions in SPECT at the early stage may indicate functional decline of the neuronal cells, and at the advanced stage, these may indicate the degree of pathological changes, especially neuronal loss and amyloid beta protein deposition.

Alzheimer Disease↗
PubMed1995

The influence of invariant chain on the positive selection of single T cell receptor specificities.

The appearance of peptide-loaded major histocompatibility complex (MHC) class II molecules at the cell surface depends critically on the invariant chain (Ii). We have studied the influence of Ii on the positive selection of CD4+ T cells, mediated by class II molecules expressed on thymic stromal cells. Invariant chain-deficient mice (Iio) were crossed with different T cell receptor (TcR) transgenic strains and the emergence of mature CD4 single-positive thymocytes measured in Iio/TcR transgenic offspring. Positive selection was nearly absent in Iio/2B4 mice, which display receptors specific for a moth cytochrome c (MCC) peptide in the context of Ek. In addition, no T cell response was elicited when nontransgenic Iio animals were injected with this peptide, even though antigen-presenting cells (APC) from such mice were perfectly capable of presenting it, suggesting that selection of the entire anti-MCC 88-103 repertoire depends on Ii. Positive selection also appeared strongly reduced in another line of Iio/TcR transgenic mice (Iio/BDC2.5). However, in sharp contrast, a third line (Iio/3A9) exhibited almost normal positive selection of thymocytes displaying the transgene-encoded receptor. These thymocytes were exported to the periphery: peripheral T cells could respond normally to the appropriate peptide in vitro. The most likely interpretation of these findings is that selection of most CD4+ T cells depends on MHC class II complexes loaded with peptide in an Ii-dependent pathway, but some can be selected on class II complexes that are either loaded along an alternative, Ii-independent, route or are empty. This is consistent with the involvement of peptide in positive selection of CD4+ T cells, for which there exists little prior evidence.

Animals↗
PubMed1995

Phorbol ester induces the rapid processing of cell surface heparin-binding EGF-like growth factor: conversion from juxtacrine to paracrine growth factor activity.

Vero cell heparin-binding epidermal growth factor-like growth factor (HB-EGF) is synthesized as a 20- to 30-kDa membrane-anchored HB-EGF precursor (proHB-EGF). Localization and processing of proHB-EGF, both constitutive and 12-O-tetradecanoylphorbol 13-acetate (TPA)-inducible, was examined in Vero cells overexpressing recombinant HB-EGF (Vero H cells). Flow cytometry and fluorescence immunostaining demonstrated that Vero cell proHB-EGF is cell surface-associated and localized at the interface of cell to cell contact. Cell surface biotinylation and immunoprecipitation detected a 20- to 30-kDa heterogeneous proHB-EGF species. Vero H cell surface proHB-EGF turned over constitutively with a half-life of 1.5 h. Some of the 20- to 30-kDa cell surface-associated proHB-EGF was processed and a 14-kDa species of bioactive HB-EGF was released slowly, but most of the proHB-EGF was internalized, displaying a diffuse immunofluorescent staining pattern and accumulation of proHB-EGF in endosomes. Addition of TPA induced a rapid processing of proHB-EGF at a Pro148-Val149 site with a half-life of 7min. The TPA effect was abrogated by the protein kinase C inhibitors, staurosporine and H7. Kinetic analysis showed that loss of cell surface proHB-EGF is maximal at 30 min after addition of TPA and that proHB-EGF is resynthesized and the initial cell surface levels are regained within 12-24 h. Loss of cell surface proHB-EGF was concomitant with appearance of 14- and 19-kDa soluble HB-EGF species in conditioned medium. Vero H cell-associated proHB-EGF is a juxtacrine growth factor for EP170.7 cells in coculture. Processing of proHB-EGF resulted in loss of juxtacrine activity and a simultaneous increase in soluble HB-EGF paracrine mitogenic activity. It was concluded that processing regulates HB-EGF bioactivity by converting it from a cell-surface juxtacrine growth factor to a processed, released soluble paracrine growth factor.

1-(5-Isoquinolinesulfonyl)-2-Methylpiperazine↗
PubMed1995

[Persistent reactive airway dysfunction syndrome after exposure to chromate].

A 42-year-old man was admitted to the hospital because of wheezing and dyspnea that began 20 minutes after accidental exposure to irritant gas containing chromate at a chrome pellet manufacturing plant. The patient had a positive skin reaction to chromite (Cr2O3). Reduction of FEV1.0 was observed 120 minutes after Cr2O3 inhalation challenge. By 150 minutes after Cr2O3 inhalation, FEV1.0 had decreased by 32%. Chest X-ray film revealed no abnormalities. Histological findings of the lung tissue obtained by open lung biopsy revealed bronchospasm and peri-bronchial inflammatory cell infiltration without bronchiolar obstruction, and thus bronchiolitis obliterans was ruled out. This patient fulfilled the criteria of reactive airway dysfunction syndrome (RADS) proposed by Brooks; onset of symptoms very soon after a single exposure to an irritant, persistence of asthmatic symptoms, obstructive pulmonary dysfunction, and the presence of airway hyperreactivity to methacholine. During the initial hospital stay, asthmatic symptoms were relieved by intensive anti-asthmatic treatment including oral and parenteral corticosteroids. However, the patient's asthmatic symptoms have lasted for eight years and necessitate the use of systemic steroids, and regular use of inhaled steroids and bronchodilators. We know of no previous reported case of RADS after chromate exposure.

Adult↗
PubMed1995

[Bupivacaine-fentanyl continuous infusion is superior to morphine bolus injection in postoperative epidural analgesia].

We compared bolus injection of morphine 51 +/- 9 micrograms.kg-1 (M-S group) with 48 h-continuous infusion of bupivacaine and fentanyl mixture (BF-C group) for postoperative epidural analgesia in 100 patients who had undergone upper abdominal laparotomy. The epidural analgesia was started about 60 min before completion of surgery. The mixed solution, consisting of bupivacaine 48 ml (240 mg), fentanyl 24 ml (1.2 mg) and 0.9% saline (24 ml), was administered at a rate of 2 ml.h-1 by using a 100 ml balloon infuser. Analgesic effects (determined by visual analogue scale, verbal pain scores at rest and with movement, additional requests of other analgesics), comfort and side effects of the epidural analgesia were examined. The evaluation based on postoperative analgesia and comfortable feeling rated higher in the BF-C group compared with the M-S group (P < 0.01 to of 0.05). There were fewer requests for other postoperative analgesics in the BF-C group (P < 0.01 to 0.05). There was no significant difference in side effects between the two groups. The plasma fentanyl concentration in the BF-C group (n = 5) was maintained almost constant for the period from 24 to 49 hours after the start of infusion and was approximately 1.6 ng.ml-1. We conclude that continuous infusion of bupivacaine (2.5 mg.ml-1) and fentanyl (12.5 micrograms.ml-1) at a rate of 2 ml.h-1 is superior to bolus injection of morphine for postoperative analgesia.

Adolescent↗
PubMed1994

Outcomes of 116 patients with hepatocellular carcinoma.

We studied the outcomes of 116 patients with hepatocellular carcinoma (HCC) diagnosed in our hospital between January 1980 and August 1992. The patients were divided into groups according to the principal treatment procedure. The 3-year survival rates in the patients treated by percutaneous ultrasonically guided ethanol injection (PEI), operation (hepatic resection), and transcatheter hepatic arterial embolization (TAE) were 90.9%, 53.6%, and 29.0%, respectively. None of the patients treated by one-shot injection of an anticancer agent into the hepatic artery and chemotherapy survived for more than 2 years. The outcomes of the patients treated by PEI and hepatic resection were significantly better than those of the patients treated by the other procedures. There was no significant difference when the patients were stratified according to the year of detection. The 3-year survival rate was 57.3% for 19 patients in whom HCCs were detected during clinical follow-up for chronic liver disease and 17.3% for the other 97 patients. We concluded that hepatic resection in patients with good liver function and PEI for early HCC yielded significantly better survival rates than the other procedures. Moreover, for early detection and treatment of HCC, we recommend clinical follow-up of patients with chronic liver disease.

Adult↗
PubMed1994

Mediastinal ultrasonography for the assessment of mediastinal lymph node metastases in lung cancer patients.

Using an ultrasonic probe inserted into the mediastinum during cervical mediastinoscopy, mediastinal ultrasonography (USM) was performed on 63 patients with lung cancer. The patients with a small peripheral mass of less than 2 cm in diameter, according to the chest X-ray results, and with mediastinal lymph nodes smaller than 1 cm in their short axes as determined by computed tomography (CT), were excluded from this study. An analysis of the areas under the receiver operating characteristic curves derived from CT and USM showed that USM was superior (P = 0.043) to CT in terms of the diagnosis for mediastinal lymph node metastases, when the short axis dimension of mediastinal lymph nodes was employed for the diagnosis of metastases. The reason for this is that 97% of the mediastinal lymph nodes imaged by USM were located vertically along the body axis of the patient, and hence USM imaged the true short axis of the node in many cases. Our results indicate that USM is useful for performing a safe biopsy of lymph nodes during mediastinoscopy as well as for obtaining a clear imaging of the subcarinal nodes, which are inaccessible by normal cervical mediastinoscopy.

Adult↗