Biomedical subjects

S Ishikawa

Publications and source records attributed to S Ishikawa.

At least 163 records · Page 9Linked to original sources

PubMed2000

[MRSA septicemia caused by an infected pacemaker lead: a case report with a review of Japanese literatures].

A 50-year-old woman was admitted to our hospital because of MRSA septicemia caused by a contaminated permanent pacemaker lead. A pacemaker system was successfully removed under cardiopulmonary bypass support. Postoperative antibiotics was administered for 7 weeks. Total removal of a pacemaker system under cardiopulmonary bypass support is the treatment of choice in a case with pacemaker infection associated with MRSA septicemia.

Aminoglycosides↗

PubMed2000

Postoperative oxygenation following coronary artery bypass grafting. A multivariate analysis of perioperative factors.

BACKGROUND: Pulmonary oxygenation is generally temporarily impaired following cardiac surgery. We studied the factors influencing postoperative oxygenation using multivariate analysis. METHODS: This study was retrospectively performed in University hospital. Fifty patients undergoing solitary coronary artery bypass grafting were included in this study. Patients were divided into two groups by mean age; older group (n=25) and younger group (n=25). Alveolar-arterial oxygen difference (A-aDO2) and respiratory index (RI) were measured at 3 hours after surgery and on postoperative day 1. Statistical analysis was performed using forward selection stepwise regression of 12 perioperative variables. RESULTS: In all patients, A-aDO2 and RI significantly (p<0.01) increased after surgery and remained high on POD1. In stepwise regression analysis, preoperative A-aDO2 and RI were significant factors in the equations for postoperative A-aDO2 and RI in general, which was the most important factor in the older group. In the older group, preoperative A-aDO2 or RI and water balance were significant (p<0.05) factors which were responsible for half the oxygenation impairment just after surgery, and PCWP showed a significant (p<0.01) negative correlation with both A-aDO2 and RI on POD1. In the younger group, PCWP was a significant (p<0.01) factor for A-aDO2 and CVP and CI were significant for RI on POD1. CONCLUSIONS: Postoperative oxygenation was mainly influenced by the preoperative respiratory condition, especially in old patients, indicating that preoperative management by a physiotherapist may be necessary. Pleurotomy also had a negative influence. Careful intraoperative and postoperative volume control is important in old patients.

Adult↗

PubMed2000

Postoperative splanchnic perfusion following the reconstruction of thoracoabdominal aortic aneurysm involving abdominal visceral branches. Report of a case.

A 58-year-old man with thoracoabdominal aortic aneurysm involving visceral arteries underwent graft replacement of the thoracoabdominal aorta and associated reconstruction of abdominal visceral branches. Femoro-femoral extracorporeal bypass, intermittent selective visceral arterial perfusion and a staging cross-clamping method of the aorta were utilized at surgery. The total cross-clamping time of the aorta was 165 minutes. The patient's postoperative course was uneventful with no incidence of hepatic and renal failure or paraplegia. Although postoperative systemic blood pressure and cardiac output recovered to normal values within 7 hrs after the release of aortic clamping, it took 18 hrs for hepatic venous hemoglobin oxygen saturation (ShvO2) to recover. Base excess in arterial blood, lactic acid in arterial and hepatic venous blood, and ketone body ratio in arterial blood (AKBR) and hepatic venous blood (HVKBR) recovered to within normal ranges after 18 hrs of the release of aortic clamping. ShvO2 monitoring is a simple and may be a useful parameter in evaluating postoperative splanchnic perfusion and predicting abdominal organ failure at the time of thoracoabdominal aortic reconstruction involving visceral arteries.

Aortic Aneurysm, Abdominal↗

PubMed2000

[Hyperbaric oxygen as an adjunctive treatment for descending necrotizing mediastinitis: report of a case].

We report a case of 59-year-old man of descending necrotizing mediastinitis (DNM) secondary to peritonsillar abscess. A 59-year-old man with diabetes mellitus was admitted to a local hospital because of cervical swelling related to a peritonsillar abscess. Despite administration of antibiotics, swelling of the neck, dysphagia and dyspnea deteriorated. Therefore he was urgently undergone a tracheotomy and transferred to our hospital by an ambulance. The surgery consisted with neck and anterior mediastinal drainage through neck and cervical collar incision. Culture of drainage fluid showed clostridium difficile. On postoperative day 5, we started hyperbaric oxygen therapy (HBOT). After lavage and HBOT, the patient improved by degrees, and discharged on postoperative day 82. DNM is a rare but serious complication of otopharyngeal and deep neck infection that spreads down to the mediastinum through the cervical-facial planes. Its mortality rate remains high even with aggressive surgical drainage and appropriate antibiotics. Our patient was successfully treated with urgent surgical drainage, antibiotics and HBOT. HBOT might be of great value as an adjunctive management to control this fatal infection.

Anti-Bacterial Agents↗

PubMed2000

[Pulmonary cryptococcosis diagnosed by video-assisted thoracoscopic surgery with CT-guided localization: report of a case].

We report a case of pulmonary cryptococcosis diagnosed by video-assisted thoracoscopic surgery (VATS) with CT-guided localization. A 61-year-old man was admitted to our hospital for the precise diagnosis of a solitary mass in the left upper lung. Because the mass was too small to be detected under VATS, we tried CT-guided localization for surgery. One day before VATS, we placed a marking device besides the lesions after percutaneous puncture. We used a Naruke point marker as a marking device. After this procedure, the wedge resection was performed. The pathological diagnosis was cryptococcosis of the lung. The identification of small lesions in the lung has frequently been detected by helical and thin slice CT. Therefore, CT-guided localization procedure may be the most reliable technique to employ before surgery.

Biopsy↗

PubMed2000

The effect of short-term coronary perfusion using oxygenated diluted blood following cold storage for long-term heart preservation.

BACKGROUND: The aim of this study was to compare the results obtained from the use of both University of Wisconsin (UW) solution and diluted blood in short-term coronary perfusion following 12-hour cold storage. METHODS: Following coronary vascular washout of adult mongrel dogs with the UW solution, the heart was excised and immersed in a cold (4 degrees C) UW solution for 12 hours followed by 1-hour of coronary perfusion. Two different solutions were used for the coronary perfusion; a 4 degrees C oxygenated UW solution (Group U, n=7) and 15 degrees C oxygenated diluted blood (Group B, n=7). Myocardial high energy phosphate (HEP) levels, tissue water content (TWC), interstitial tissue space (ITS) rates and histological findings were evaluated at 0- and 12-hour cold storage and also following coronary perfusion. The preserved graft was then evaluated through orthotopic transplantation. The control group in this experiment consisted of seven hearts transplanted after 12-hour cold storage without coronary perfusion. RESULTS: Myocardial HEP levels significantly decreased after 12-hour cold storage. The recovery rate of myocardial HEP levels after coronary perfusion was significantly (p<0.05) higher in Group B than in Group U. The increase of myocardial TWC during coronary perfusion was significantly (p<0.01) higher in Group B than in Group U. After 1-hour coronary perfusion, the subendocardial ITS rate was significantly (p<0.01) higher compared with the value at 0-hour cold storage in Group U, whereas it demonstrated no significant change in Group B. PAS stain revealed the glycogen content of the subendocardial tissues was higher in Group B than in Group U. The recovery rate of hemodynamic parameters 2 hours after heart transplantation was higher in Group U and significantly (p<0.05) higher in Group B than in the control. CONCLUSIONS: Myocardial HEP levels recovered significantly after additional coronary perfusion. Though the UW solution prevented myocardial cellular edema, subendocardial perfusion was incomplete and the recovery rate of myocardial HEP levels was lower, suggesting that diluted blood may become the solution of choice as a perfusate.

Adenosine↗

PubMed2000

Long-term results after pulmonary resection in elderly patients with non-small cell lung cancer.

BACKGROUND: The number of elder by patients with lung cancer is expected to increase. But, there was no report that 10 years completely passed in surgically treated elderly patients (E-pts). This study assesses late results of surgery. METHODS: From 1981 to 1987, 160 patients with non-small cell lung cancer underwent lobectomy or pneumonectomy with mediastinal lymph node dissection. Of these, 37 (23%) were 70 years of age or older. The outcome of this group was compared with that of 123 non-elderly patients (NE-pts). RESULTS: There were no significant differences in the background between E-pts and NE-pts. Five- and 10-year survivals in the E-pts were 35.1%, and 24.3%, respectively. In outcome more than 5 years from operation, E-pts had a significantly poorer prognosis than NE-pts (p=0.04) by any causes of death, but a similar prognosis by primary death. E-pts died of nontumor-related death significantly more than NE-pts (p=0.6). CONCLUSIONS: This study showed that E-pts could consummate their lives completely. Additionally, when long-term prognosis of the postoperative E-pts was discussed, we should contemplate that E-pts had more deaths from nontumor-related causes.

Adolescent↗

PubMed2000

[Response to immunoadsorption and steroid therapies in a patient with carcinomatous Lambert-Eaton myasthenia syndrome accompanied by disturbed consciousness].

A 75 year-old man developed gait disturbance and somnolence over a period of three months. Electroencephalography indicated theta slowing and cerebrospinal fluid (CSF) examination showed an increased cell count of 23/microliter and IgG of 7.2 mg/dl. He showed fatigue-inducing muscle weakness and the Harvey-Masland test demonstrated a low M-wave amplitude of 0.6 mV which increased to 3 mV with 50 Hz high-frequency stimulations. The serum titer of P/Q type anti-voltage-gated calcium channel (VGCC) antibody was quite high at 11,901 pmol/L (< 20 pmol/L). The patient was diagnosed as Lambert-Eaton myasthenia syndrome (LEMS) although at first no carcinoma was detected. Immunoadsorption therapy with a phenilalanine absorber column resulted in a reduction in the titer of anti-VGCC antibody to half of the initial concentration, but it increased again within several days. Six repeats of immunoadsorption and concomitant administration of prednisolone at a dose of 40 mg daily succeeded in reducing the anti-VGCC antibody titer of to below 390 pmol/L. The patient's consciousness disturbance and muscle weakness improved simultaneously over the next month and the lumbar puncture and electroencephalography showed normal results. Prednisolone administration was maintained at a dose of 30 mg daily and one year after occurrence of the first symptoms, a small cell lung carcinoma was detected. There was no evidence of limbic encephalitis such as an elevation of anti-Hu antibody in his CSF and serum or abnormal signal intensities in the hippocampal formations on MR imaging. The etiology of his disturbed consciousness remained unclear, but, in the case of LEMS, it could be a manifestation of a paraneoplastic syndrome associated with small-cell lung carcinoma. It is noteworthy that the anti-VGCC antibody titer rose to 1,262 pmol/L 2 months before his tumor was detected and decreased to 286 pmol/L after chemotherapy. P/Q type anti-VGCC antibody could therefore be a useful tumor marker reflecting activity of small-cell carcinoma.

Aged↗

PubMed2000

[Cryoglobulinemia].

Explore the source record for details and available documents.

Central Nervous System Diseases↗

PubMed2000

[Bacteria isolated from surgical infections and their susceptibilities to antimicrobial agents. Special references to bacteria isolated between April 1997 and March 1998].

The annual multicenter studies on isolated bacteria from infections in general surgery and their antimicrobial susceptibility have been conducted in 19 facilities in Japan since July 1982. This paper describes the results obtained during the period from April 1997 to March 1998. The number of cases investigated as objectives was 215 for one year. A total of 420 strains (170 strains from primary infections and 250 strains from postoperative infections) were isolated from 174 cases (80.9% of total cases). In primary infections, the isolation rate of anaerobic bacteria was higher than in postoperative infections, while in postoperative infections, those of aerobic Gram-positive bacteria and Pseudomonas aeruginosa were higher than in primary infections. Among aerobic Gram-positive bacteria, the isolation rate of Enterococcus faecalis was the highest, followed by Staphylococcus aureus, which was frequently isolated from postoperative infections. Among anaerobic Gram-positive bacteria, Peptostreptococcus spp. and Streptococcus spp. were commonly isolated from both types of infections. Among aerobic Gram-negative bacteria, Escherichia coli was most predominantly isolated from primary infections, followed by P. aeruginosa, Klebsiella pneumoniae in this order, and from postoperative infections, P. aeruginosa was most predominantly isolated, followed by E. coli and K. pneumoniae. Among anaerobic Gram-negative bacteria, Bacteroides fragilis group was the majority of isolates from both types of infections. We found neither vancomycin nor arbekacin resistant strains of S. aureus, and found no vancomycin resistant strains of Enterococcus spp. The susceptibility of P. aeruginosa against carbapenems did not decline in the year 1997, while resistance of B. fragilis group against cephems advanced increasingly.

Anti-Bacterial Agents↗

PubMed2000

Determining appropriate small vessels for stenting by intravascular ultrasound.

To re-evaluate outcomes of stenting in small vessels, we studied 176 patients successfully treated with several types of stent by way of intravascular ultrasound (IVUS) and quantitative coronary angiography (QCA). These lesions were divided into 3 subgroups according to reference diameter (RD) by QCA, and vessel diameter (VD) by IVUS (group I: pre-RD 2.5 mm; group II: pre-RD < 2.5 mm and pre-VD 4.0 mm; group III: pre-RD < 2.5 mm and pre-VD < 4.0 mm). Post-procedure percent diameter stenosis (4 +/- 3%), post-procedure percent plaque area (42 +/- 3%), and loss index (39 +/- 11%) in group II were not significantly different from those in group I (7 +/- 2%, 37 +/- 2%, 45 +/- 5%, respectively). The rates of restenosis and target lesion revascularization in group II (24.0% and 16.0%, respectively) were not different from those in group I (25.9% and 21. 2%, respectively), and were significantly favorable compared to group III (66.7% and 39.4%, respectively; p < 0.05). By the use of IVUS, we not only identified those vessels which would normally go unstented when only using QCA, but also documented excellent long-term outcome in these patients.

Aged↗

PubMed2000

[Jichi Medical School Social Support Scale (JMS-SSS) revision and tests for validity and reliability].

OBJECTIVE: To develop a perceived social support scale for the Japanese. METHODS: Participants consisted of a total of 2,150 residents who responded to a perceived social support scale questionnaire in four communities involved in the Jichi Medical School Cohort Study at the study baseline in 1992-1994 (Analysis I) and 380 residents of Akaike town who responded to a questionnaire survey with the revised scale in 1999 (Analysis II). The first analysis was performed to confirm cross validity of the perceived social support scale measuring the availability of functional support from the spouse, family, and friends. The factor structures estimated for each district were compared with each other. The second analysis was set to revise the scale, modified in terms of a 4-point scoring format. The correlation between each item and a social desirability scale score, Cronbach alpha, and correlation coefficients between the revised scale scores and the original scale scores were calculated. RESULTS: Cross validity was confirmed based on the similarity of the factor structures of the responses obtained from the four different communities. Four selected indices supported the constancy of the factor structures across the communities. For the revised scale, two items were removed from the original scale-items measuring spousal support because of their statistically significant correlations with the social desirability scale score. The first principal component accounted for 57.0% of variance for spousal support, 68.2% for family support, and 67.0% for friends support and uni-dimensionality of the scales was confirmed. Alpha coefficients of the scales were .89, .95, and .94, respectively. Social support levels were stable over a mean period of 6.2 years. CONCLUSIONS: On an empirical basis, we have been able to develop a perceived social support scale. Homogeneous data from three different sources were obtained which were free from social desirability response bias and thus applicable for Japanese adults.

Adult↗

PubMed2000

[Complications in home treatment of patients with severe disturbances of consciousness].

We have been providing home treatment for patients with severe disturbance of consciousness requiring various medical treatments for about 10 years. In the 65 cases we have encountered, we studied complications during the course of the home treatment. The proportions of infections, decubiti and convulsions were found to be very high. With infections in particular, conditions worsened rapidly in many cases, so we made it a principle to have the patients hospitalized early. We also investigated changes in serum albumin levels, peripheral blood lymphocyte count and prognostic nutritional index (PNI). Patients who develop infections repeatedly and succumb to early death often show low values for PNI and lymphocyte count. The low values are considered useful as one indicator of the general conditions of patients under home treatment. For the management of patients with severe disturbances of consciousness, it is important to keep a close liaison with other departments or hospitals and strengthen home nursing sections.

Adult↗

PubMed2000

[Leiomyosarcoma of the scrotum: a case report].

Leiomyosarcoma of the scrotum is a rare tumor. Up to 1999, only 29 cases have been reported in the literature worldwide. A 27-year-old man presented with a mass on the left side of the scrotum which had been painless and had gradually enlarged over the previous 10 years. During the following 3 months, however, it became painful and he was then referred to our hospital. Physical examination revealed a solid mass on the left side of the scrotum, measuring 7 cm in diameter, which was not adhering to the testis or to the vas deferens. The tumor was surgically resected. The histological examination confirmed the diagnosis of well differentiated leiomyosarcoma. Adjuvant therapy was considered unnecessary. The follow-up at 41 months revealed no local recurrence or distant metastasis.

Adult↗

PubMed2000

[Serum soluble interleukin-2 receptor levels in patients with renal cell carcinoma: a comparison of values before and after surgery].

This study was carried out in order to find out whether soluble interleukin II receptor (sIL-2R) levels were useful as a treatment biomarker in patients with renal cell carcinoma (RCC). The subjects consisted of 17 patients with RCC who had been scheduled for radical or partial nephrectomy. Serum levels of sIL-2R were measured before surgery and 1 and 3 months after surgery. We also analyzed the relationship of preoperative sIL-2R to pathologic TNM-stage, grading and presumptive tumor volume. The mean value of pre-operative sIL-2R in patients with RCC was 496.5 U/ml as compared with 302.7 U/ml in the control group (p = 0.056). Pre-operative sIL-2R values were 411.1 U/ml in stage I (n = 6), 481.4 U/ml in stage III (n = 11) and 1,330 U/ml in stage IV (n = 1). There was no significant difference between stage I and stage III. As compared with pathologic grading, pre-operative sIL-2R levels in patients with grade 2 were significantly higher than those with grade 1 (609.8 U/ml versus 288.7 U/ml, p = 0.016). There existed a significant correlation between preoperative sIL-2R and presumptive tumor volume (r = 0.61, p = 0.008). Three months after surgery, sIL-2R values were significantly higher than before surgery. Serum sIL-2R levels seemed to bear some relationship to the extent of disease in patients with RCC. Values of sIL-2R were significantly higher after than before surgery at least for a three-month postoperative period, suggesting a response to trauma of surgery. Further long term studies were required to clarify if sIL-2R could predict the progression of disease.

Adult↗

PubMed2000

Leydig cell hyperplasia and the maintenance of bone volume: bone histomorphometry and testicular histopathology in 29 male leprosy autopsy cases.

This study was conducted to determine if osteoporosis in male leprosy patients is caused by testicular atrophy. Bone volume (BV/TV), trabecular number (TbN), trabecular thickness (TbTh), and trabecular separation (TbSp) were measured in two areas in decalcified paraffin sections of lumbar bones from 29 male leprosy and 6 male nonleprosy autopsy cases. We found significant differences in the average BV/TV measurements among the 7 patients with nodular Leydig cell hyperplasia (BV/TV 12.24%) and the 22 patients without hyperplasia (BV/TV 7.35%) and 6 patients without leprosy (BV/TV 12.98%). Bone volume was maintained in patients with nodular Leydig cell hyperplasia, and we determined no clinical factor other than the Leydig cell hyperplasia that reflected the bone volume. The osteoporosis of male leprosy patients was attributed to secondary gonadal dysfunction due to testicular atrophy, and Leydig cell hyperplasia appears to preserve bone volume.

Aged↗

PubMed2000

Management of ipsilateral intrapulmonary metastases in the new TNM system for non-small cell lung cancer.

BACKGROUND: Recently, the Union Internationale Contre le Cancer and American Joint Committee on Cancer reclassified not only TNM staging but also ipsilateral intrapulmonary metastases (PM) as T4 in a same lobe or M1 in different lobes. To determine whether the new PM staging is appropriate, we studied the prognosis of PM. METHODS: From January 1981 to October 1997, we performed a lobectomy or pneumonectomy with mediastinal lymph node dissection, and had 42 patients with PM. We analyzed the postoperative prognosis of the patients with ipsilateral PM compared with the same stage group without PM (the non-PM). RESULTS: In the previous classification of PM (the old PM), 2 patients were categorized as stage IIA, 9 as IIB, 17 as IIIA, and 14 as IIIB. After reclassification (the new PM), 37 patients were categorized as stage IIIB, and 5 as IV. The old PM stage IIIA group had a significantly poor prognosis compared with the non-PM stage IIIA. However, the prognosis of the new PM group was compatible with that of the non-PM. None of the other staging group had a significant difference in the prognosis. CONCLUSIONS: The management of PM in the new TNM system for non-small cell lung cancer is appropriate.

Adenocarcinoma↗

PubMed2000

Na+/H+ exchange inhibitor reduces vascular injury caused by ischemia-reperfusion in the rat hind limb.

This study was designed to evaluate the effects of an Na+/H+ exchange inhibitor, SM-20550, on ischemia-reperfusion injury in the skeletal muscle. Male Sprague-Dawley rats were exposed to ischemia and reperfusion by clamping and releasing clamps both at the abdominal aorta and the bilateral femoral arteries. Rats were divided into three groups; the sham, the SM-20550 treated (SM), and the untreated control (Control) groups. In the SM and control groups, rats were exposed to 5-hr ischemia and 5-hr reperfusion. In the sham group, vessel isolation only was performed. SM-20550 (2.8 mg/kg/hr) in the SM group or vehicle in the sham and control group was continuously administered during ischemia and reperfusion periods. The wall thickness of the vessels were significantly (p<0.01) decreased in the control group than any other group. The internal diameter was significantly (p<0.01) higher in the control and SM group than in the sham group. The wall thickness/internal diameter ratio was significantly (p<0.05) lower in the control group than in the SM group. Thus, an Na+/H+ exchange inhibitor, SM-20550, ameliorated the morphological change due to ischemia reperfusion. These findings provide a clue into the mechanism of ischemia reperfusion injury.

Animals↗