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Biomedical subjects

N Usui

Publications and source records attributed to N Usui.

At least 19 recordsLinked to original sources
PubMed1998

Prolonged preoperative stabilization using high-frequency oscillatory ventilation does not improve the outcome in neonates with congenital diaphragmatic hernia.

Although delayed repair with preoperative stabilization using high-frequency oscillatory ventilation (HFOV) has been advocated in neonates with congenital diaphragmatic hernia (CDH), improved survival has not been reported. We compared survival between neonates undergoing delayed repair after prolonged stabilization for more than 48 h using HFOV and those undergoing immediate repair following short stabilization using HFOV in subjects with high-risk CDH. Patient selection was made by two criteria: fetuses with the lung/thorax transverse area ratio (L/T) below 0.26 and neonates who presented with respiratory distress significant enough to require intubation within 6 h after delivery. Selection of the strategies differed by era and medical center. Stabilization failed in 11 of 18 patients with delayed repair and only 7 patients (38.9%) in this group survived, but 18 of 23 patients (78.3%) in the immediate-repair group survived (P < 0.05). Although lower values of Apgar scores, best postductal PO2 (BPtDPO2), gestational weeks, and L/T and more frequent patch repair were observed in the delayed than in the immediate repair group, significant differences in survival among the subpopulations were also observed in the prenatally diagnosed group, including the group with L/T < 0.15 and the group that required ECMO, the group with the best preductal PO2 (BPrDPO2) >/= 100 torr, and the group with BPtDPO2 < 100 torr. These results indicate that prolonged stabilization for more than 48 h using HFOV does not improve survival in patients with high-risk CDH.

Combined Modality Therapy↗
PubMed1998

Successful laparoscopic cholecystectomy in a child with upper transverse scarring: report of a case.

Laparoscopic cholecystectomy (LC) was safely performed for cholelithiasis in a 4-year-old boy who had a long transverse operative scar in the upper abdomen as a result of intestinal surgery performed during the neonatal period. The adhesions beneath the scar were sharply divided and sometimes coagulated, and additional working ports were subsequently placed as the adhesiolysis proceeded. LC was performed in the usual fashion using 5-mm titanium clips, and his postoperative course was uneventful. This case report serves to demonstrate that laparoscopic surgery is feasible even for pediatric patients who have undergone previous major intraabdominal surgery.

Child, Preschool↗
PubMed1998

Decondensation of the mouse sperm nucleus within the interphase nucleus.

Sperm nuclei incorporated into the cytoplasm (ooplasm) of fertilised mouse eggs at the pronuclear stage remain condensed, whereas those injected into male or female pronuclei decondense. Similarly, sperm nuclei injected into germinal vesicles of immature oocytes or the nuclei of 2-cell embryos decondense, while those entering the cytoplasm of these oocytes/embryos do not. These facts seem to suggest that factors necessary for the decondensation of sperm nucleus are present in interphase nuclei and are released into the ooplasm during nuclear envelope breakdown. Nucleoplasmin, which is synthesised in the cytoplasm and accumulated within the nucleus, is likely a major candidate for these factors.

Animals↗
PubMed1998

Startle epilepsy with infantile hemiplegia: report of two cases improved by surgery.

PURPOSE: To study the effectiveness of surgical therapy on 2 patients with startle epilepsy with infantile brain damage (SEIBD), a rare but distinctive epileptic syndrome characterized by motor seizures resistant to antiepileptic drugs (AEDs). METHODS: The patients with SEIBD both had hemiplegia, due to gross contralateral hemispheric lesions, and suffered from tonic postural seizures, frequently provoked by sudden unexpected somatosensory stimuli on the paretic side of the body. These attacks occasionally caused the patients to drop to the floor, and mild-to-moderate injuries had been sustained; they were resistant to all currently available AEDs. Consequently, these daily drop attacks severely restricted the patients' social lives and school participation. Both patients underwent corpus callosotomy and resection of epileptogenic premotor and supplementary motor lesions. One patient also underwent additional multiple subpial transections of the primary sensorimotor area. RESULTS: Seizures, as well as quality of life, improved dramatically in both patients after surgery. CONCLUSIONS: Startle epilepsy with infantile hemiplegia is a distinct epileptic syndrome characterized by structural brain damage restricted primarily to one hemisphere, large ipsilateral epileptogenic lesions involving the perisensorimotor area, refractory startle-provoked drop attacks, and a good response to epilepsy surgery.

Adolescent↗
PubMed1998

Nephrotic syndrome associated with diffuse mesangial hypercellularity: is it a heterogeneous disease entity?

Diffuse mesangial hypercellularity (DMH) is a rare primary mesangial proliferative glomerulonephritis associated with idiopathic nephrotic syndrome (INS). We conducted this study on 15 patients, including 5 patients with repeated specimens, with a follow-up of 0.9-17.5 years and evaluated the clinical course and pathological findings. Seven patients were male. Ten patients were under 14 years of age. All specimens had INS and were diagnosed morphologically with primary diffuse mesangial proliferative glomerulonephritis at initial biopsy; 4 were diagnosed with focal segmental glomerulosclerosis (FSGS) within 3 years by the second biopsy. The remaining 11 patients included 8 initial responders and 3 initial nonresponders to 8 weeks' steroid therapy and had the histologic variant of the minimal-change nephrotic syndrome (MCNS). Ten of the 11 patients had normal renal function during the investigation period. One patient with the MCNS variant who was refractory to steroid therapy developed end-stage renal disease (ESRD) within 6 years. Four patient with the histologic variant of FSGS included 1 initial responder, 2 late responders, and 1 steroid-refractory case. One patient with the FSGS variant developed ESRD within 4 years. The follow-up biopsies documented that the severity of mesangial hypercellularity was associated with the severity of proteinuria or hematuria. We conclude that DMH may be divided into heterogeneous disease entities, whereas morphologic changes in initial biopsies were similar. Each variant as well as the degree of DMH should be recognized routinely by follow-up biopsy, because they are prognostic indicators.

Adolescent↗
PubMed1998

Role of daunorubicin in the induction therapy for adult acute myeloid leukemia.

PURPOSE: To evaluate the relationship of total-dose of daunorubicin (DNR) to the induction therapy and treatment outcome, we have administered individualized doses of DNR during induction treatment to patients with acute myelogenous leukemia (AML). PATIENTS AND METHODS: Ninety-two previously untreated adult patients with AML who entered our hospital were analyzed for the dose of DNR required to achieve complete remission (CR), the CR rate, disease-free survival (DFS), and overall survival (OS). Induction therapy consisted of DNR 40 mg/m2 daily intravenously from day 1 until the marrow was hypoplastic, cytarabine (Ara-C), prednisolone (PRD), and/or 6-thioguanine (6-TG). RESULTS: Eighty-three of 92 patients with adult AML were assessable for this study. Sixty-three (76%) patients achieved CR. Fifty-two of 63 CR patients achieved the CR in the first course of induction therapy, and 11 patients required the second course of induction therapy. The 5-year and 10-year DFS rates were 31.2% and 5-year and 10-year OS rates were 45.1% and 42.3%, respectively. The median total dose of DNR in the induction therapy was 280 mg/m2 (120 to 480 mg/m2). DNR dose did not influence the response to therapy and was not influenced by the initial WBC count or French-American-British (FAB) system classification. CONCLUSION: These results indicated that when the dose was linked to observed tumor response, the optimal dose of DNR in the induction therapy was approximately 280 mg/m2 (40 mg/m2 for 7 days), which is greater than the conventional dose of 40 to 60 mg/m2 for 3 days.

Adolescent↗
PubMed1998

[Evaluation of nasal obstruction with acoustic rhinometry: a simulated study with a nasal model].

The measurement of nasal resistance is important for understanding the pathophysiology of nasal obstruction. However, it is difficult to define the normal range of nasal resistance because of various physiological factors. Several authors have reported that nasal resistance is not correlated with the sensation of nasal obstruction. On the other hand, acoustic rhinometry was introduced by Hilberg et. al. (1989) to determine the geometry of the nasal cavity. The method based on sound reflection analysis provides an estimate of the cross-sectinal area of the nasal cavity as a function of the distance from the nostril. Recently, the measurement by acoustic rhinometry is becoming popular also in our country. However, the assessment by acoustic rhinometry may be different from that by measuring nasal resistance because the cross-sectional area is measured without studying the air flow. The aim of this study was to investigate the benefit of acoustic rhinometry using a nasal model. First, 4 pieces of nasal model LM005 (KOKEN, Co., Japan) made of silicone were coated with resinous putty. Then, the changes in the area-distance curve were measured with an acoustic rhinometer RHIN 2100 (SRE, Co., Denmark) in which this putty was scraped off gradually from anterior to posterior. In the next study, the quality of coated putty was increased at three points of the nasal area: anterior part, middle part, and posterior part. Thereafter the changes in the area-distance curve were observed in the same way. As a result, neither a decrease or an increase in the putty changed the area-distance curve at the posterior part. Therefore, it is suitable that the degree of the changing of nasal mucosa is defined as the change in the nasal volume between the top the I-notch and the end of the C-notch. In conclusion, acoustic rhinometry is useful to investigate nasal obstruction, especially the change in the nasal mucosa. Therefore, further clinical study is required for the different purpose of measuring nasal resistance.

Airway Resistance↗
PubMed1998

[Cytomegalovirus retinitis].

Cytomegalovirus (CMV) retinitis is the most common intraocular infection in patients with Acquired immunodeficiency syndrome (AIDS). Approximately 25% of patients with AIDS will develop CMV retinitis during their life time. It is generally associated with CD4+ lymphocyte counts of less than 50 cells/microliter. Clinically, the most characteristic feature of CMV retinitis is a yellow-white lesion of retinal necrosis with a granular border extending into the surrounding retina. At present, ganciclovir and foscarnet have been approved for the treatment of CMV retinitis in patients with AIDS. Although both drugs arrest the progression of retinitis, relapse often occurs. More than ever, ophthalmologists have a special obligation to alleviate both the physical and psychological suffering of patients with CMV retinitis.

AIDS-Related Opportunistic Infections↗
PubMed1998

[EPOCH therapy for relapsed/refractory lymphoid malignancies].

Patients with refractory or relapsed non-Hodgkin's lymphoma (NHL), acute T-cell leukemia (ATL), ATL lymphoma and acute lymphocytic leukemia (ALL) received EPOCH therapy. All were previously treated with doxorubicin (DOX), vincristine (VCR) and other drugs. The EPOCH treatment schedule is consisted with DOX (10 mg/M2/day, 5 days c.i.v.), VCR (0.4 mg/M2/day, 4 days c.i.v.), etoposide (50 mg/M2/day, 4 days c.i.v.), cyclophosphamide (750 mg/M2/day, day 6 i.v.) and prednisolone (60 mg/M2/day, 5 days p.o.). Twenty-one patients (ALL:10, NHL:8, ATLL:2, ATL:1) were assessable for response and toxicity. Two patients with ALL and NHL, respectively, achieved a complete remission and 3 patients obtained partial remission (NHL:2, ATLL:1). The hematological toxicity (grade > 1) included neutoropenia, anemia and thrombocytopenia, which were observed in 83.3%, 76.7% and 76.7% respectively, of total 30 EPOCH courses. The major non-hematological toxicities were nausea/vomiting, constipation and infection, but most of the toxicity were tolerable with sufficient clinical supportive care. These results indicate that continuous infusion of DOX, VCR and ETP might be effective in patients who were treated with, and presumed to be resistant to the same drugs administrated by bolus infusion.

Adolescent↗
PubMed1998

[Primary cardiac non-Hodgkin's lymphoma].

A 69-year-old man who initially presented with lumbago developed heart failure during an MRI scan on the day of admission. A chest X-ray showed cardiomegaly and bilateral pleural effusion. Echocardiogram and computed tomography (CT) scan of the chest revealed a large tumor mass encompassing the heart with much pericardial effusion was demonstrated. The cytology of the effusion obtained by pericardiocentesis was consistent with non-Hodgkin's lymphoma, diffuse large B cell type. As CT scans of the abdomen and pelvis were negative, he was considered to have primary cardiac lymphoma. Although he responded remarkably to therapy with vincristine, cyclophosphamide and prednisolone and, he developed acute respiratory failure on the seventh month after admission. Although incidence of primary cardiac lymphoma is very low, it is necessary to investigate the mechanism of this disease in order to establish appropriate diagnostic and therapeutic approaches.

Aged↗
PubMed1998

[Prognostic significance of CD7 expression in adult acute myeloid leukemia].

To evaluate the prognostic significance of CD7 expression in de novo acute myeloid leukemia (AML), we studied 63 patients with AML who had been admitted to our hospital between September 1989 and January 1996. Even of the patients were later eliminated from the study (9 due to insufficient surface marker analyses, and 2 due to early death). The remaining 52 patients (median age: 42.5 years) were evaluated for morphologic subtype, immunophenotypic classification, complete remission (CR), disease-free survival (DFS) and overall survival (OS). All 52 patients were grouped by the French-American-British classification system: 10 as M1, 16 as M2, 11 as M3, 8 as M4, 5 as M5, and 2 as M6. Ten of the patients expressed CD7 on their leukemia cells (positive rate > or = 25) and were classified as CD7(+)AML, with morphological subtypes as follows: 3 as M1, 6 as M2, and 1 as M3. Thirty-three of the 42 patients with CD7 + AML (78.6%) and 6 of the 10 patients with CD7 + AML (40%) achieved CR. DFS and OS rates for the patients with CD7(+)AML were 22.1% and 35.4%, respectively; those for the CD7(+)AML patients were 53.3% and 44.4%, respectively. No significant differences in gender hematological findings, clinical manifestations such as hepatosplenomegaly, lymphadenopathy, or incidence of central nervous system involvement, CR rate, and DFS distinguished patients with CD7(+)AML from those with CD7(+)AML. These suggest that CD7 expression is unlikely to be a prognostic factor in AML.

Adolescent↗
PubMed1998

[Chemotherapy for non-Hodgkin's lymphoma].

This review highlights the role of chemotherapy for intermediate grade non-Hodgkin's lymphoma (NHL) including immunoblastic large cell lymphoma and low grade NHL. The combined modality treatment (CMT) consisting of chemotherapy including adriamycin (ADM) and involved-field irradiation (IFI) is considered standard therapy for localized intermediate grade NHL since a superior outcome (long-term disease-free survival rate is about 80%) can be obtained by CMT. However, developing dose-intensified regimens in initial chemotherapy will change the role of IFI. The phase II study using second and third generation regimens for advanced intermediate grade NHL showed a better outcome than first generation regimen CHOP. Unfortunately, the recent phase III intergroup trial concluded that none of the second or third generation treatment was superior to CHOP, and this regimen is now considered to be standard chemotherapy. However, the cure rate of the CHOP regimen (about 30%) is not satisfactory, and efforts should be underway to develop promising regimens with significantly increased dose intensity. While radiotherapy such as IFI, extended-field irradiation and total lymph node irradiation for localized low grade NHL obtained a more than 50% disease-free survival rate, the role of chemotherapy remains controversial. To date, many randomized trials of single agent chemotherapy regimen, combination chemotherapies with or without ADM, and CMT have shown no overall survival benefit for advanced low grade NHL, so there is no standard therapy for it.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1997

CD95 ligand (FasL)-induced apoptosis is necessary for corneal allograft survival.

Although anatomical barriers and soluble mediators have been implicated in immune privilege, it appears that the apoptotic cell death of Fas+ cells by tissue-associated CD95 ligand (Fas ligand, FasL) is an important component. One clinical example of the function of an immune privileged site is the success of human corneal transplants, where a very high percentage of transplants accept without tissue matching or immunosuppressive therapy. Since the mouse cornea expresses abundant Fas ligand and immune privilege has been implicated in the success of these transplants, we examined the role of FasL in corneal transplantation. Our results show that human corneas express functional FasL capable of killing Fas+ lymphoid cells in an in vitro culture system. Using a mouse model for corneal allograft transplantation, FasL+ orthografts were accepted at a rate of 45%, whereas FasL- grafts, or normal grafts transplanted to Fas- mice, were rejected 100% of the time. Histological analysis found that FasL+ grafts contained apoptotic mononuclear cells indicating the induction of apoptosis by the graft, while rejecting FasL- corneas contained numerous inflammatory cells without associated apoptosis. Taken together our results demonstrate that FasL expression on the cornea is a major factor in corneal allograft survival and, thus, we provide an explanation for one of the most successful tissue transplants performed in humans.

Actins↗
PubMed1997

Effects of endotoxin on intestinal hemodynamics, glutamine metabolism, and function.

The purpose of this study was to investigate the intestinal hemodynamics and gut glutamine metabolism during endotoxemia, and their correlation with altered intestinal absorptive capacity and permeability. Seventeen Sprague-Dawley rats were used in the study. The endotoxin group (ENDO) received endotoxin (10 mg/kg intraperitoneally, n = 9), while the control group (CONT, n = 8) received saline injection. Twelve hours later, D-xylose (0.5 g/kg) and fluorescein isothiocyanate-dextran (FITC-dextran, 750 mg/kg) were given by oral gavage. One hour later abdominal aortic (AA) blood flow, superior mesenteric venous (SMV) flow, mean arterial pressure (MAP), central venous pressure (CVP), and SMV pressure (SMVP) were also measured. The MAP, AA, and SMV blood flow decreased (P < 0.05), while the CVP and SMVP increased (P < 0.05) in the ENDO group as compared with the CONT group. The ENDO group showed significant decreases for both intestinal glutaminase activity and net intestinal glutamine uptake (P < 0.05). The D-xylose concentration in SMV decreased significantly (P < 0.05) in the ENDO group as compared with the CONT group. However, the plasma FITC-dextran concentration showed no significant difference between the groups. Endotoxin produced a hypodynamic effect in rats 12 h after intraperitoneal administration in association with both a decreased intestinal glutamine metabolism and an absorptive capacity.

Animals↗
PubMed1997

Hyaluronic acid of wound fluid in adult and fetal rabbits.

Fetal wound healing proceeds without fibrosis or scar formation in contrast to adult wound healing. The mechanisms responsible for this remarkable process are mediated in part through a fetal wound extracellular matrix rich in hyaluronic acid (HA). Polyvinylalcohol sponge (PVA) wound implants were placed pervertebrally at 24 days' gestation in fetal (N = 118) rabbits and in adult (N = 44) rabbits, and then harvested at 1, 2, 3, 4, 5, and 7 days postwounding. To analyze the fetal and adult wound matrix, the HA concentration of wound fluid within the PVA sponge was quantitated using a newly developed assay. A significantly increased (P < .05) HA deposition on days 1 through 7 in the fetal wounds was found compared with the adult wound. These observations may suggest an important physiologic role in fetal wound healing by providing a more fluid and malleable matrix. These results, coupled with earlier findings of the lack of an acute inflammatory response in the fetus, further support the hypothesis that fetal response to injury is significantly different from adult response in this prescience of an implanted PVA sponge.

Aging↗
PubMed1997

Experience in tracheobronchial reconstruction with a costal cartilage graft for congenital tracheal stenosis.

Although successful surgical management of congenital tracheal stenosis has been reported, it is still controversial as to the best operative procedure. Eleven infants with congenital tracheal stenosis were evaluated to confirm the efficacy of tracheobronchial reconstruction with costal cartilage graft. Symptoms ranged from recurrent respiratory infection to severe respiratory failure. All infants had other congenital anomalies in addition to tracheal stenosis. Notably, five infants had pulmonary artery sling and four infants had patent ductus arteriosus. Definitive diagnosis was made by bronchoscopy, results of which showed complete tracheal rings in all patients with severely compromised tracheobronchial lumens. Five infants had elongated stenosis involving nearly the whole length of the trachea, and five infants had segmental stenosis involving nearly one half the length of the trachea. One infant had bilateral stenosis of the main bronchi. Early experience included two deaths from problems related to the repair. The involvement of the carina and the distal portion of the trachea was associated with increased complications and a higher mortality rate. Currently, our preferred technique facilitated by extracorporeal membrane oxygenation (ECMO) includes carinal reconstruction with a thin-wall intraluminal stent. Bronchoscopy is essential for accurate intraoperative incision of the trachea, post-operative airway management for several weeks, and removal of the intraluminal stent.

Bronchi↗
PubMed1997

Nitric oxide inhalation therapy for an infant with persistent pulmonary hypertension caused by misalignment of pulmonary veins with alveolar capillary dysplasia.

Misalignment of pulmonary veins with alveolar capillary dysplasia (MPV) has been reported to be a rare cause of persistent pulmonary hypertension of the newborn (PPHN) and to be fatal despite extracorporeal membrane oxygenation (ECMO). A full-term female neonate with PPHN was brought to the hospital for ECMO therapy at 2 days of age. On the 14th day of life, she was extubated early after the second run of ECMO, and underwent nitric oxide (NO) inhalation therapy in the incubator. She died of catheter-related sepsis on the 61st day of life. After autopsy findings revealed MPV, the longest survival with this disease was documented. NO inhalation therapy in the incubator may provide time for lung transplantation.

Administration, Inhalation↗