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Biomedical subjects

S Kitamura

Publications and source records attributed to S Kitamura.

At least 271 records · Page 15Linked to original sources
PubMed1998

Evaluation of bronchoscopic findings in patients with metastatic pulmonary tumor.

To clarify the bronchoscopic findings in metastatic spread to the bronchi, we analyzed the records of 65 cases of metastatic pulmonary disease in which fiberoptic bronchoscopy had been done. Forty-five patients (69.2%) had abnormal bronchoscopic findings. These patients could be divided into three groups, according to bronchoscopic findings and route of metastatic spread to the bronchi: endobronchial metastasis (n=15), bronchial involvement (that is, direct extension to the bronchi from adjacent metastatic foci, n=15), and lymphangitis carcinomatosa (n=15). Breast cancer and colon cancer were common in cases of endobronchial metastasis, and the bronchial tumor often presented as a polypoid or nodular lesion covered with necrotic material. Submucosal swelling with an irregular margin and narrowing of the bronchial lumen were seen in cases of bronchial involvement. In conclusion, each type of primary extrapulmonary tumor is associated with characteristic endobronchial findings of pulmonary metastases such as endobronchial metastasis and bronchial involvement, which should be discriminated if possible, because of their different metastatic process.

Biopsy↗
PubMed1998

Persistent primitive hypoglossal artery complicated by atrial septal defect and congenital intrahepatic shunts.

During early embryogenesis, anastomoses are formed between the carotid artery and the basilar or the vertebral artery, and subsequently, these anastomoses regress. In some cases, these anastomoses remain as persistent carotid-basilar or carotid-vertebral anastomoses. Atrial septal defect (ASD), a communication between the atria at the septal level, is a congenital heart anomaly. Intrahepatic venous shunts between the portal and hepatic veins are very rare and only some are considered congenital. We present the first case report of a patient with an ASD, a persistent primitive hypoglossal artery, and congenital portahepatic shunts.

Aged↗
PubMed1998

Effect of prostaglandin E1 on cerebral blood flow in patients with chronic cerebral infarction.

The effect of prostaglandin E1 (PGE1) on cerebral blood flow (CBF) was studied in 10 patients with chronic cerebral infarction. Regional cerebral blood flow (rCBF) was measured by single photon emission computed tomography before and after they received PGE1 120 microg daily for 2 weeks. The rCBF of the brainstem, cerebellum, and frontal, temporal, and parietal lobes increased significantly after PGE1 administration. PGE1 also significantly increased the rCBF of the non-infarcted area adjacent to infarction. The results indicate that PGE1 increases the CBF of patients with chronic cerebral infarction without causing the intracerebral steal phenomenon.

Aged↗
PubMed1998

[Indications for and limitations of minimally invasive cardiac surgery with the lower ministernotomy approach].

The chief benefits of small skin incisions are reduced patient discomfort, accelerated recovery, and cosmetic satisfaction without compromising the quality of surgery. Since April 1997, the lower ministernotomy approach without femoral cannulation has been performed in 43 patients in the authors' institutions. The indications for this approach were initial single valve surgery and secundum-type atrial septal defect. Cases of aortic valve regurgitation that could be repaired, and aortic stenosis that necessitated annular enlargement were excluded. Among patients with mitral valve disease, those with chronic atrial fibrillation were excluded frpm undergoing the Maze procedure and those reguiring chordal reconstruction for anterior leaflet were also excluded. Mitral valve repair for mitral regurgitation was performed in 8 patients, and open mitral commissurotomy in 2. Mitral valve replacement was performed in 3 patients and aortic valve replacement in 13. Closure of an atrial septal defect was carried out in 18 cases. An approximately 10-cm median skin incision was made, and a ministernotomy with a lower semitransverse division (inverted L-shape) was carried out. Cardiopulmonary bypass was initiated with ascending aortic cannulation and right-angled venous cannulae in the superior and inferior vena cava for mitral valve disease. Single venous cannulae from the right atrial appendage was used for aortic valve disease. Surgery was performed with mild hypothermia and intermittent tepid blood cardioplegia with diltiazem. A rigid 30-degree angle scope held by a videoscope holder with a flexible arm was used for mitral valve surgery. There were one hospital death due to perioperative myocardial infarction and pulmonary embolism. There was one reopening for bleeding which resulted in methicillin-resistant Staphylococcus aureus mediastinitis. However, the patients was discharged after rectal muscle flap repair. There was one reoperation for mitral valve repair due to hemolysis. The improvement of surgical instruments and materials will further facilitate this procedure.

Adult↗
PubMed1998

[Clinical and radiological study of pulmonary actinomycosis].

We clinically and radiologically examined 8 patients with pulmonary actinomycosis. Their clinical features were slowly progressive, and the most commonly occurring symptom was hemoptysis. Laboratory findings disclosed elevated ESRs, a sign of chronic inflammation. Roentgenographic films showed a higher percentage of lesions in the right lung and on the dorsal side. On chest CT images, the lesions appeared as nodular or consolidated shadows with atelectasis, and spread widely over the parietal pleura in the periphery of the lung fields. The margins of the nodules were irregular, and multiple blood vessels were involved. The internal density of the nodules contained either a low attenuation region or cavity. In relation to the pleural, local pleural thickening adjacent to the nodules was identified in all patients, and the thickened areas were thin and smooth. Although it was difficult to diagnose by transbronchial lung biopsy (TBLB), granulation tissue obtained by TBLB was considered an important finding suggestive of pulmonary actinomycosis. As diagnostic procedures, repeated TBLBs appear to be effective for lesions extending into the hilar region, and video-assisted thoracoscopic surgery, for small nodular lesions located in the periphery of the lung fields.

Actinomycosis↗
PubMed1998

[Anesthetic management involving difficult intubation in a child with Gaucher disease].

Gaucher disease is the most common of the glycolipid storage disorders caused by the deficiency of glucocerebrosidase, an enzyme which hydrolyzes glucocerebroside to glucose and ceramide. Accumulation of the substrate leads to multiorgan dysfunction involving the brain, spleen, liver, lymph node and bone marrow. In anesthetic management, gastroesophageal reflux leading to recurrent aspiration, pancytopenia and airway difficulties due to trismus, neck extension and upper airway infiltration with glucocerebroside must be considered. We report a case of a 9-year-old boy presenting developmental delay, mild pancytopenia, splenomegary gastroesophageal reflux. He was scheduled for measurement of intra-esophageal pressure, total splenectomy and Nissen fundoplication. Preoperative examination showed trismus and opisthotonic posturing. We predicted difficult airway maintenance and assessed his airway with airway radiograph. Airway narrowing was not shown. For this difficult airway, we made a special mask that has an introducer port for fiberbronchoscope. For the first time, we tried to insert a laryngeal mask, but the insertion was difficult due to trismus and narrowed oral cavity. Then, we used this special mask for the next time. Tracheal intubation was much safer by using this mask for fiberoptic intubation. In Gaucher disease, preoperative assessment of airway difficulties and preparation for this situation are necessary and anesthesiologist must be concerned about aspiration and airway difficulties.

Anesthesia, Inhalation↗
PubMed1998

[A case of convulsion induced by propofol].

A 71-year-old man was scheduled for laryngomicrosurgery under total intravenous anesthesia. Anesthesia was induced and maintained with propofol. Seven to eight minutes after induction of anesthesia, convulsion was observed first on his lower limbs and then on his all limbs and the head. This clonicotonic convulsion of a few minute duration lasted for 25 minutes. Later neurological examination revealed normal functions. Although the etiology of convulsion by propofol is controversial, the convulsion observed in our patient seems to be related to glycinergic as well as glutamate receptors. When we administer propofol to patients, we should be careful about the occurrence of convulsion.

Aged↗
PubMed1998

Synovial fluid cartilage metabolism marker concentrations in osteonecrosis of the femoral head compared with osteoarthrosis of the hip.

OBJECTIVE: Biochemical aspects of the etiology of articular cartilage degeneration in osteonecrosis of the femoral head have not been investigated extensively. We analyzed biochemical conditions in the hip joint cavity, regarding articular cartilage turnover in osteonecrosis of the femoral head (ONFH). METHODS: Cartilage metabolism markers in synovial fluid were measured. Synovial fluid (SF) samples were collected from 19 ONFH cases and 17 control hips with osteoarthrosis (OA). Concentrations of carboxy-terminal type II procollagen peptide (pCOL-II-C), matrix metalloproteinase-3 (MMP-3), and tissue inhibitor of metalloproteinase-1 (TIMP-1) were measured. In addition, concentrations of unsaturated disaccharides of hyaluronic acid (delta di-HA), chondroitin 4-sulfate (delta di-4S), and chondroitin 6-sulfate (delta di-6S) in SF were measured by high performance liquid chromatography. RESULTS: The mean SF concentration of pCOL-II-C was higher on ONFH than in OA. The mean SF MMP-3 level was higher in ONFH than in OA, while the mean SF TIMP-1 level was the same in the 2 groups. The SF concentration of delta di-HA and the delta di-6S/delta di-4S ratio were higher in ONFH than in OA. CONCLUSION: Higher concentrations of cartilage metabolism markers in ONFH compared with OA SF suggest elevated cartilage turnover in the former disease.

Adolescent↗
PubMed1998

Functional outcome after hip fracture in Japan.

One thousand one hundred sixty-nine elderly Japanese patients who sustained a hip fracture were observed prospectively. Ninety-two percent had operative fracture treatment. Hospital length of stay averaged 67 days; 81% of patients were discharged to their place of residence where they resided before sustaining the fracture. Mortality rates at 120 days, 1 year, and 2 years after injury were 6%, 11%, and 19%, respectively. At 1-year followup, ambulatory status was recovered to that of the level experienced before injury in 67% of patients.

Activities of Daily Living↗
PubMed1998

Disposition of a new nonsteroidal anti-inflammatory agent, S-2-[4-(3-methyl-2-thienyl)phenyl]propionic acid, in rats, dogs and monkeys.

The disposition of S-2-[4-(3-methyl-2-thienyl)phenyl]propionic acid (CAS 155680-07-2, S-MTPPA, code: M-5011) was studied after oral administration to rats, dogs and monkeys using the 14C-labeled drug. After oral dosing, S-MTPPA was well absorbed from the gastrointestinal tract, to the extent of 97.7% in rats. The concentration of S-MTPPA in rat plasma reached a peak (Cmax: 13.07 micrograms/ml) at 15 min (tmax) after dosing and declined with a half-life (t1/2) of 2.5 h. The values of the parameters tmax, Cmax and t1/2 for dogs were 30 min, 26.2 micrograms/ml and 7.0 h, and those for monkeys were 15 min, 12.8 micrograms/ml and 3.0 h, respectively. The radioactivity was widely distributed in tissues and almost completely excreted in urine and feces within 48 h after oral administration to rats. The excretion of radioactivity in bile, urine and feces within 48 h after oral administration of 14C-S-MTPPA to bile duct-cannulated rats amounted to 75.0, 18.6 and 1.4% of the dose, respectively. The drug was metabolized mainly by oxidation of the thiophenyl moiety and by glucuronidation of the carboxyl group in rats and monkeys. The major urinary and fecal metabolite in dogs was identified as the taurine conjugate of MTPPA.

Animals↗
PubMed1998

[A case report: inhaled nitric oxide improves respiratory function in an infant with pulmonary hypertension].

Nitric oxide (NO) was administered to an infant in a near fatal crisis of pulmonary hypertension after total correction of double outlet right ventricle. Inhaled NO of 4 parts per million reduced pulmonary arterial pressure (PAP) and increased tidal volume during pressure limit ventilation. Both respiratory system compliance and resistance were improved with NO inhalation. There was a significant negative correlation between mean PAP and respiratory system compliance. We speculated that a reduction in PAP with NO inhalation resulted in the improvement of respiratory function. He was successfully weaned from mechanical ventilation.

Double Outlet Right Ventricle↗
PubMed1998

[A case of lung abscess caused by Eikenella corrodens].

We report a case of lung abscess caused by Eikenella corrodens and reviewed the literature. A 51-year-old man was hospitalized because of an infiltrative shadow in the left upper lung on chest X-ray. The patient was intravenously given CEZ (2 g/day) followed by CEZ (4 g/day) and AMK (200 mg/day). We nevertheless deteriorated and was subsequently treated with CTM (4 g/day) and LCM (6 g/day), and the shadow improved but remained. Only Eikenella corrodens was isolated from aspiration materials obtained from the resected lung. We examined the susceptibility of 60 strains of Eikenella corrodens to various antimicrobial against. The organisms were very susceptible to PCG, ABPC, PIPC, CTM, CTX and LMOX, but were all resistant to LCM, CLDM, GM and AMK.

Aminoglycosides↗
PubMed1998

Total hip arthroplasty for failed rotational acetabular osteotomy: a report of three cases.

Three female patients with osteoarthrotic hips received total hip replacement arthroplasties after failed rotational acetabular osteotomies (RAO) were reported. In the first case, there was necrosis of the thin acetabular fragment and a collapse of the large grafted iliac bone because of technical problems. The second case had residual development dislocation of the hip preoperatively which resulted in pseudoarthrosis and instability of the pubic bone postoperatively. This patient was considered to be a bad candidate for rotational acetabular osteotomy. The last case was 65 years old, too old to treat by osteotomy. Deterioration of the articular cartilage was expected. All of them were successfully treated with total hip arthroplasties. The ages of the patients, the stage of osteoarthrosis, the thickness of the osteotomized acetabular fragment, and the size of the grafted bone seemed to be factors influencing the outcome of the RAO.

Acetabulum↗
PubMed1998

[Surgical treatment for prosthetic valve endocarditis].

From April 1993 to May 1997, 21 patients underwent surgical treatment for prosthetic valve endocarditis (PVE). There were 13 males and eight females aged from 46 to 79 years old (mean 62 years). There were four cases of early PVE (onset of PVE within 60 days from previous valve replacement), and 17 cases of late PVE (after 60 days). The predominant organisms were Staphylococcus epidermidis (eight cases), Staphylococcus aureus (two cases), MRSA (one case), streptococcal species (three cases), Candida (two cases), Pseudomonas cepacia (one case) and Enterococcus (one case). The predominant organisms were identified in 16 of 20 cases by preoperative blood culture, and in 11 of 20 cases by intraoperative tissue culture, and in 19 cases in all. There were four cases of preoperative cerebral complications, and three cases resurged. The hospital mortality rate was 24% (five patients). Reoperation was required in four patients for recurrence of PVE. Autopsy was performed in four of five patients. Intramyocardial abscess was detected in three patients. Earlier diagnosis and earlier surgical treatment could prevent emboli due to vegetations, which might cause catastrophic results, and could achieve better outcomes. Identification of the predominant organisms, especially from operative tissue cultures, is required.

Aged↗
PubMed1998

Morphometric study of skin grooves of the head and neck.

The skin surface contains furrows called wrinkles, Langer's lines, and skin grooves that are characteristic ultrastructures of the skin. When a skin incision line is determined, these features should be considered. Many studies have examined skin wrinkles, the number of which increases with age. Langer's lines have also been studied extensively in cadavers. However, these studies may not consistently reflect Langer's lines in living individuals. Most of the studies of skin grooves have examined dermatoglyphics such as fingerprinting, palm printing, and sole printing. Very few studies have examined skin grooves in other areas or quantified their characteristics. The present study analyzed skin grooves of the head and neck in relationship to age, sex, and region. Subjects consisted of 50 nursery school children aged 6 years, 50 college students aged 20 years, and 50 adults aged over 60 years. Impressions were obtained from: 1) forehead, 2) root of the nose, 3) lateral ocular angle, 4) cheek, and 5) neck. The samples were cut into cubes (5.0 x 5.0 x 1.0 mm) and ion-coated with Au-Pdin by a cool sputter coater. Then scanning electron micrographs (x 50) were taken and analyzed by computer morphometry CB-TASPER. Densities of skin grooves and the specific length representing the complexity of grooves per unit area were analyzed using computer morphometry CB-TASPER software. The density of skin grooves differed according to the area, especially among samples taken from the forehead, root of the nose, and the neck. Females had more grooves than males, particularly in the neck region. Skin grooves decreased with age; they appear to change and be absorbed by increasing wrinkles, thus becoming indistinct.

Adult↗
PubMed1998

[Late results of extended Stanford type A acute aortic dissection].

From 1978 to July 1997, 140 patients with extended Stanford type A aortic dissection underwent surgical treatment. There were 77 acute and 63 chronic aortic dissections. The follow-up period of the 61 surviving patients in acute aortic dissection ranged from 2 to 164 months (mean, 56 months). During follow-up periods, 6 patients died of no dissection-related causes. The actuarial survival ratios in 77 patients were 77.2% at 3 years, 72.2% at 5 years and 62.6% at 10 years, respectively. There was no significant difference between acute aortic dissection and chronic aortic dissection in actuarial survival ratio. The ratio of the clotted false lumen in the distal aorta was lower and subsequent surgery was more frequent in patients with Marfan syndrome than those with non-Marfan syndrome. In extended type A aortic dissection, the observation of the residual false lumen using body CT scan was very important after surgery, especially in Marfan syndrome. If the false lumen is dilated, a subsequent surgery is needed to get good late results.

Adult↗