Ipsilateral truncal sensory deficit in a patient with ophthalmic zoster sine herpete.
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Bell Palsy↗
Biomedical subjects
S Tokunaga
Publications and source records attributed to S Tokunaga.
Correcting for measurement error in binary and continuous variables using replicates.
Measurement error in exposures and confounders leads to bias in regression coefficients. It is possible to adjust for this bias if true values or independent replicates are observed on a subsample. We extend a method suitable for quantitative variables to the situation where both binary and quantitative variables are present. Binary variables with independent replicates introduce two extra problems: (i) the error is correlated with the true value, and (ii) the measurement error probabilities are unidentified if only two replicates are available. We show that - under plausible assumptions - adjustment for error in binary confounders does not need to address these problems. The regression coefficient for a binary exposure is overadjusted if methods for continuous variables are used. Correct adjustment is possible either if three replicates are available, or if further assumptions can be made; otherwise, bounds can be put on the correctly adjusted value, and these bounds are reasonably close together if the exposure has prevalence near 0.5.
Bias↗
Successful staged-Fontan operation in a patient with ectopia cordis.
Ectopia cordis is a very rare and often fatal disease. We report a successful surgery case of thoracoabdominal ectopia cordis with univentricular heart. This patient underwent a three-stage Fontan procedure, a right-modified Blalock-Taussig shunt at the age of 1 month, bidirectional Glenn shunt and pulmonary arterioplasty at 2 years 8 months, and finally a total cavopulmonary connection at 4 years. This patient was discharged from the hospital in good condition and has been doing well since. Thus, ectopia cordis is not a contraindication for a Fontan operation.
Child, Preschool↗
Alcohol consumption and severity of angiographically determined coronary artery disease in Japanese men and women.
The relation of alcohol consumption to the severity of coronary atherosclerosis was examined among 323 men and 220 women who underwent coronary arteriography. Severity of coronary atherosclerosis was assessed by the number of vessels obstructed > or =75% in diameter and Gensini's severity score. Alcohol consumption was divided into 5 categories in men (never, past, 1-24, 25-49, and > or =50 ml per day) and 3 categories in women (never, past, and current). Among men, odds ratios of severe stenosis (multiple-vessel disease or Gensini's score >15) decreased substantially and significantly in all current drinking categories but without dose-response effect. There was a weak, inverse association of current alcohol consumption with one-vessel disease, but not with moderate stenosis in terms of Gensini's score (< or =15). Past drinkers showed a fairly large, but statistically nonsignificant, decrease in the odds ratios of not only severe stenosis but also of moderate stenosis. Among women, current drinkers showed a small, statistically nonsignificant decrease in the risk of severe stenosis in terms of Gensini's score. These associations with alcohol use did not change after adjustment for known coronary risk factors. The present findings add to evidence that alcohol drinking confers protection against coronary atherosclerosis.
Adult↗
Extraction of arsenic in a synthetic arsenic-contaminated soil using phosphate.
An environment-friendly and cost-effective extraction method has been studied for the removal of arsenic from contaminated soil. A yellow-brown forest soil was contaminated with arsenic(V) and used as a model soil. Among various potassium and sodium salts, potassium phosphate was most effective in extracting arsenic, attaining more than 40% extraction in the pH range of 6-8 with minimum damage to the soil properties. Exchange mechanism is proposed for the extraction of arsenic from soil by phosphate. Sequential extraction shows that phosphate is effective in extracting arsenic of Al- and Fe-bound forms. Arsenic of residual form was not extracted. Arsenic was efficiently extracted by phosphate solution of pH 6.0 at 300 mM phosphate concentration and at 40 degrees C.
Arsenic↗
Prevalence and mortality of the Brugada-type electrocardiogram in one city in Japan.
OBJECTIVES: We sought to study the prevalence and mortality of subjects exhibiting the Brugada-type electrocardiogram (ECG) in a community-based population in Japan. BACKGROUND: The Brugada syndrome has been associated with sudden death in subjects without structural heart disease. Hospital-based studies showed 11% to 38% annual fatal arrhythmic events in patients with the Brugada syndrome. METHODS: Prevalence and mortality of the Brugada-type ECG were studied in subjects who had ECGs during a health examination in Moriguchi, Osaka, Japan. Information about death and relocation from Moriguchi city was obtained prospectively. RESULTS: The Brugada-type ECG was found in 98 of 13,929 study subjects (0.70%, 95% confidence interval [CI]: 0.57% to 0.86%). The typical coved-type with an rsR' pattern in V(1) lead ("typical" Brugada-type) was found in 0.12% of subjects (95% CI: 0.07% to 0.20%). The prevalence for male subjects with the Brugada-type ECG (81%) was significantly higher than it was for those without (26%, p < 0.0001). In male subjects, the Brugada-type ECG was found in 2.14% (95% CI: 1.70% to 2.66%), and the "typical" Brugada-type was found in 0.38% (95% CI: 0.21% to 0.64%). After 2.6 +/- 0.3 years of follow-up, there was 1 death (1.0%, 95% CI: 0.03% to 5.6%) of a subject with the Brugada-type ECG, whereas there were 139 deaths (1.0%, 95% CI: 0.85% to 1.2%) of those without the Brugada-type ECG (p = 0.9943, log-rank test). CONCLUSIONS: A substantial number of the Brugada-type ECG were observed in subjects in a community-based population in Japan, especially in men. The total mortality of subjects with the Brugada-type ECG did not differ from the mortality of those without the Brugada-type ECG in a community-based population.
Aged↗
Obesity, body fat distribution and coronary atherosclerosis among Japanese men and women.
OBJECTIVE: To investigate the relation of the obesity and body-fat distribution with angiographically defined coronary atherosclerosis. DESIGN: Cross-sectional study in a clinical setting. SUBJECTS: Three hundred and twenty men (median age, 59 y) and 212 women (median age, 67 y) who underwent coronary angiography for suspected or known coronary heart disease at 5 cardiology departments between September 1996 and August 1997. Patients with disease duration >1 y were excluded. MEASUREMENTS: The body mass index (BMI) and the waist to hip circumference ratio (WHR) were used as main exposure variables, and either the presence of significant coronary stenosis or the Gensini's score (> or =10 vs<10) as an outcome variable, in a sex-specific multiple logistic regression analysis controlling for age, hospital, and other coronary risk factors. RESULTS: Among male patients, BMI was progressively higher with an increasing number of vessels involved (P trend=0.05); the adjusted odds ratios for the presence of significant stenosis across quartiles of BMI were 1.0 (reference), 1.1, 1.9 and 2.5 (P trend=0.02), and the positive association was more pronounced for younger patients. Among females, however, such associations were not evident. Employing the Gensini's score as an outcome gave similar results. WHR was not significantly associated with either outcome regardless of sex. CONCLUSION: These results suggested that BMI was predictive of coronary stenosis among male patients, but not among female patients. Unlike most previous studies, this study failed to detect a positive association with WHR.
Adipose Tissue↗
Role of hypertension, dyslipidemia and diabetes mellitus in the development of coronary atherosclerosis in Japan.
The present study evaluated the effect of hypertension (HT), dyslipidemia and diabetes mellitus (DM) on the development of coronary atherosclerosis in the Japanese population, using a cross-sectional study of 433 patients (254 men and 179 women) aged 30 years or older who underwent coronary angiography for suspected or known coronary heart disease angina at 5 cardiology departments in the Fukuoka area between September 1996 and August 1997. Patients with a disease duration of 6 months or more were excluded. The main outcome measure was angiographically defined coronary artery stenosis and was found to a significant degree in 146 patients (33.7%). HT, DM, low levels of high-density lipoprotein cholesterol (HDL-C) and hypertriglyceridemia remained as significant coronary artery disease (CAD) risk factors even after controlling for age, sex, hospital, smoking, alcohol use, body mass index and leisure time physical activity. However, hypercholesterolemia was not a significant risk factor after adjusting for these variables. After controlling for these variables, DM, low HDL-C and hypertriglyceridemia were significant CAD risk factors for men, but only DM was a significant CAD risk factor in women. These results indicate that in Japan DM, low HDL-C and hypertriglyceridemia may be more important CAD risk factors than hypercholesterolemia.
Adult↗
Lower mortality in patients with the DD genotype of the angiotensin-converting enzyme gene after acute myocardial infarction.
OBJECTIVE: The angiotensin-converting enzyme (ACE) gene insertion/deletion (I/D) polymorphism has been associated with different serum ACE concentrations and cardiac ACE activity. We assessed whether the ACE gene I/D polymorphism influenced cardiac mortality in Japanese patients with acute myocardial infarction. METHODS AND RESULTS: The ACE gene I/D polymorphism was determined in 441 consecutive patients with a first myocardial infarction. There were 69 patients (16%) with the DD genotype, 194 patients (44%) with the ID genotype, and 178 patients (40%) with the II genotype. During a mean follow-up of 9.4 months, there were 49 cardiac deaths (DD, n = 4; ID, n = 26; II, n = 19). The DD genotype was significantly associated with a lower mortality than the other genotypes (p = 0.0363) by Cox regression analysis adjusted for age, sex, site of myocardial infarction, Killip functional class, reperfusion therapy during acute phase, ACE inhibitor use, and beta-blocker use. CONCLUSIONS: In a selected cohort of Japanese patients, the DD genotype was associated with a significantly lower cardiac mortality after a first myocardial infarction.
Female↗
Lupus anticoagulant in myasthenia gravis associated with IgM gammopathy.
The plasma of a patient with myasthenia gravis had strong lupus anticoagulant activity and his IgM paraprotein displayed non-specific inhibition to coagulation factors IX, XI, XII, prekallikrein, and high molecular weight kininogen. He was placed on prednisolone, which resulted in improvement in his myasthenic symptoms, but the prolongation of APTT and macroglobulinemia remained. Double filtration plasmapheresis successfully decreased the serum IgM level from 1,190 mg/dl to 375 mg/dl and APTT improved from 58 s to 38 s. Myasthenia gravis is frequently associated with other autoimmune diseases, but the association with lupus anticoagulant and IgM gammopathy is rare.
Humans↗
Xanthogranulomatous cholecystitis mimicking gallbladder cancer: report of a case.
A 61-year-old woman was admitted to our hospital with abnormal findings of abdominal computed tomography. Whereas she had neither fever nor abdominal pain, a cholecystitis was suspected. Ultrasonography showed a mass in the gallbladder with several stones, and an unclear border between the gallbladder and liver. Computed tomography showed a large-mass in the gallbladder with findings that seemed to indicate hepatic invasion and para-aortic lymph node metastasis. On the basis of these findings, we made a diagnosis of gallbladder cancer associated with hepatic invasion and lymph node metastasis. We treated this gallbladder tumor by hepatic arterial infusion chemotherapy via catheter with cisplatin and 5-fluorouracil. Four weeks after administration of the anti-cancer drugs, the tumorous lesion of the gallbladder could not be detected by abdominal imagings, and the gallbladder wall revealed no irregular findings. During laparotomy, the gallbladder showed signs of chronic cholecystitis, and a cholecystectomy was performed. Findings of the resected specimens showed severe inflammation, fibrosis, and bleeding in the gallbladder wall with infiltration by many foamy cells. Histopathological diagnosis was xanthogranulomatous cholecystitis. We report here a case of xanthogranulomatous cholecystitis mimicking gallbladder cancer and review the literature.
Cholecystitis↗
Fibrinogen Matsumoto V: a variant with Aalpha19 Arg-->Gly (AGG-->GGG). Comparison between fibrin polymerization stimulated by thrombin or reptilase and fibrin monomer polymerization.
Fibrinogen Matsumoto V (M-V) is a dysfibrinogen identified in a 52-year-old woman with systemic lupus erythematous. The triplet AGG encoding the amino acid residue Aalpha19 was replaced by GGG, resulting in the substitution of Arg-->Gly. Residue Aalpha19 has been shown to be one of the most important amino acids in the so-called 'A' site or alpha-chain knob. The thrombin-catalyzed release of fibrinopeptide A from M-V fibrinogen was only slightly delayed yet release of fibrinopeptide B was significantly delayed. Both thrombin-catalyzed fibrin polymerization and fibrin monomer polymerization were markedly impaired compared to normal fibrinogen. In addition, reptilase-catalyzed fibrin polymerization of M-V was much more impaired than thrombin-catalyzed fibrin polymerization. These results indicate 'B' and/or 'b' site of M-V fibrinogen play a more important role in thrombin-catalyzed fibrin polymerization than that of normal control fibrinogen.
Batroxobin↗
Association between blood concentration of polychlorinated biphenyls and manifestations of symptoms and signs in chronic "Yusho" patients from 1986 to 1997.
To examine the association between blood PCB level and manifestations of symptoms and signs by Yusho patients, a cross-sectional study was conducted using the results of nationwide health examination for Yusho. The subjects were the officially identified Yusho patients who admitted the health examination from 1986 to 1997. The number of examinees with known blood PCB level was 334 in 1986, and decreased to 214 in 1997. The numbers of male and female patients were similar. The geometric mean (95% confidence interval) of blood PCBs concentration was 4.05 ppb (3.75 to 4.37) in 1986 and 2.85 ppb (2.63 to 3.08) in 1997. Multiple logistic regression analysis was carried out for the data of each year with log-transformed blood PCB level as an explanatory variable and a manifestation of a sign or symptom as a response variable. Sex and age adjusted odds ratio and significance level (P) were computed. Positive association of blood PCB level with manifestations of comedones on the trunk and acneiform eruptions on the genital and gluteal regions was statistically significant for five, eight and six times, respectively. No other symptoms or signs showed such strong associations. Associations between manifestations of these signs and blood PCB level, however, did not seem to diminish in the twelve years of observation. It is suggested that the positive association of these signs with blood PCB level will still be maintained.
Acneiform Eruptions↗
Depression among caregivers of elderly patients on chronic hemodialysis.
The present study was conducted to investigate depression in caregivers of elderly hemodialysis patients. Caregivers answered a self-administered questionnaire about various factors that may affect their depression, and also completed a Center for Epidemiologic Studies Depression Scale evaluation (CESD). The frail elderly who received regular nurse visits were used as controls. Compared with the caregivers of controls, those of hemodialysis patients spent less time on caregiving and had more time to go out unaccompanied by their patients. Males were numerous among hemodialysis patients than in the controls. Compared with the controls, hemodialysis patients were less likely to be older old (80 years old and more), diagnosed as demented or severely limited in activities of daily living (ADL). On the other hand, we did not find any significant difference between the two groups with regard to either the prevalence of depression, the rate of those who experienced any life event such as to cause depression within 6 months (e.g., death of family member), duration of caregiving or time looking after patients. Caregivers of hemodialyis patients may feel a heavy burden because they are obliged to play an important role in supporting patients on dialysis. They seem to need more social support regardless of whether or not their patients suffer from dementia.
Aged↗
A chromosomal locus encoding a phosphoserine phosphatase- and a truncated MinD-like protein affects differentiation in Streptomyces azureus ATCC14921.
We isolated BalA1, a representative transformant of thiostrepton-producing strain Streptomyces azureus ATCC14921, which carries an approximately 2.5-kb chromosomal DNA fragment on a high-copy-number plasmid. While strain BalA1 formed little aerial hyphae, its morphological defect was restored by cultivation with S. azureus, S. laurentii, etc. Strain BalA1 strongly inhibited the growth of Bacillus subtilis more than its parent strain, and also inhibited the development of its parent and some Streptomyces strains with thiostrepton resistance. Furthermore, it induced Streptomyces coelicolor A3(2) to produce undecylprodigiosin, at an early stage of growth. The 2.5-kb fragment contained two orfs, orf1 and truncated orf2. The deduced products were somewhat similar to phosphoserine phosphatase-like protein and the N-terminal region of MinD-like protein, respectively. The individual function of orf1 or the function of both orf1 and truncated orf2 seems to induce particular phenotypes or properties in strain BalA1.
Adenosine Triphosphatases↗
Extraction of heavy metals from MSW incinerator fly ashes by chelating agents.
An extraction process has been studied on a laboratory scale for the pretreatment of municipal solid waste (MSW) incinerator fly ash to remobilize Cr, Cu, Pb, and Zn. Five different types of fly ashes were treated with HCl, nitrilotriacetic acid (NTA), ethylendiaminetetraacetate (EDTA), or diethylenetriaminepentaacetate (DTPA) in a batch process in the pH range 2.5-10. The extraction of heavy metals by HCl was dependent on pH, increasing with increasing acid concentration. The efficiency of the chelating agents was independent of pH. By the treatment with 3.0% EDTA or DTPA, 20-50% of Cr, 60-95% of Cu, 60-100% of Pb, and 50-100% of Zn were extracted in the pH range 3-9. NTA was also effective in extracting Cr, Cu, and Zn. The maximum extraction of Cr, Cu, Pb, and Zn was obtained at 0.3-1.0% concentration of the chelating agents. NTA was effective in extracting Pb at a concentration as low as 0.1%. Extraction behavior of other elements during the treatment was also studied. The leaching test on the residues after the treatment with chelating agents showed that the fly ashes were successfully detoxified to meet the guideline for landfilling.
Air Pollution↗
Mild mitral regurgitation was associated with increased prevalence of thromboembolic events in patients with nonrheumatic atrial fibrillation.
Although several studies demonstrated that the presence of significant mitral regurgitation was associated with reduced occurrence of thromboembolism, little data is available concerning the effect of mild mitral regurgitation on the occurrence of thromboembolic events. To evaluate the association between mild mitral regurgitation and thromboembolic events, we reviewed 232 patients' records between January 1996 and September 1997 who had nonrheumatic atrial fibrillation. There were 59 patients (25%) with mitral regurgitation > or = grade 2, 69 patients (30%) with grade 1 mitral regurgitation, and 104 patients (45%) with no mitral regurgitation. Patients with grade 1 mitral regurgitation had significantly higher prevalence of thromboembolic events (28%) than those with mitral regurgitation > or = grade 2 (8%, P=0.006) or those with no mitral regurgitation (11%, P=0.007). A history of previous thromboembolic events were compared between 173 patients with grade 1 mitral regurgitation and those with no mitral regurgitation using the logistic regression analysis adjusted for age, sex, administration of warfarin, and presence of hypertension, diabetes mellitus, structural heart disease, enlarged left atrium (> or = 40 mm), chronic atrial fibrillation, and grade 1 mitral regurgitation. Grade 1 mitral regurgitation (odds ratio=2.689, 95% confidence interval=1.039-7.189, P=0.0434) and no warfarin administration (odds ratio=0.045, 95% confidence interval=0.002-0.242, P=0.0036) were significantly associated with the history of thromboembolic events. The presence of mild mitral regurgitation in nonrheumatic atrial fibrillation was associated with higher prevalence of thromboembolic events.
Aged↗
Early experience of off-pump coronary artery bypass using Octopus Tissue Stabilizer.
OBJECTIVE: The Octopus Tissue Stabilizer stabilizes segments of the beating heart using a series of suction cups that do not damage myocardial tissue or compromise hemodynamics. This allows the heart to be positioned with the arterial target on a stable platform. In this study we present our early experience of off-pump coronary artery bypass using the Octopus Tissue Stabilizer. METHODS: Between October 1997 and June 1998, 50 patients underwent off-pump coronary artery bypass using the Octopus Tissue Stabilizer (7.5% of all coronary artery bypass cases; average age: 67.0 +/- 12.2). Preoperative ejection fraction was 15-70% (43.0 +/- 14.0%). Median sternotomy was used for all operations. RESULTS: The average number of grafts per patient was 2.5 +/- 0.9. The average operating time was 191 +/- 47 minutes. No patients returned to the operating room for postoperative bleeding or tamponade. Average intraoperative blood loss was 297 +/- 190 ml. No patient experienced perioperative myocardial infarction. There were five hospital deaths and one late death. All patients were free of angina at discharge. No patients returned with angina or required clinical restudy. CONCLUSIONS: Off-pump coronary artery bypass offers the surgeon another tool to apply for appropriate patients. The Octopus Tissue Stabilizer allows the surgeon access to all parts of coronary circulation, extending the range of off-pump coronary artery bypass procedures, when the anatomy is appropriate.
Aged↗