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Biomedical subjects

S Tokunaga

Publications and source records attributed to S Tokunaga.

At least 73 records · Page 4Linked to original sources

Ventilatory responses to CO2: constant fraction vs. constant inflow administration.

The purpose of this study was to determine whether the transfer function characteristics of the respiratory CO2 control system differs according to whether the CO2 administration method is constant fraction (CF) or constant inflow (CFlow). Ventilatory responses to CO2 changes were measured in seven healthy subjects during random PETCO2 perturbation by the CF and CFlow administration methods in normoxia and hyperoxia. The transfer function from PCO2 to VE was estimated in the frequency domain from 0.002 to 0.02 Hz. The transfer function characteristics showed a low-pass filter character in both of CFlow and CF. The impulse responses to both the methods persisted for > or = 60 sec, while the maximum amplitude (hmax) of the CFlow response was statistically greater than that of the CF response in normoxic condition. The time required until the peak (tmax) of the CFlow impulse response was shorter than that of CF in normoxia. Hyperoxia retarded the tmax and reduced hmax in both CFlow and CF, with the result that significant differences in the normoxic impulse responses were not observed between CFlow and CF in hyperoxia. To characterize the CO2 control system quantitatively, we determined the static transfer gain, oscillatory frequency, damping factor, and pure time delay by applying a second-order delay model to the observed transfer function. The static gain was not significantly different between CFlow and CF responses in both normoxia and hyperoxia. The pure time delay and damping factor were significantly decreased for CFlow only in normoxia. We suggest that inhalation of CO2 by CFlow modifies ventilatory response, probably mediating through the peripheral chemoreceptor activity.

Adult↗

The effects of pulsatile and nonpulsatile systemic perfusion on renal sympathetic nerve activity in anesthetized dogs.

It is still controversial whether to pulse or not to pulse for the establishment of ideal extracorporeal circulation. We directly measured the renal sympathetic nerve activity in mongrel dogs (n = 10, weighing from 13 to 21 kg) to determine the effects of pulsatile and nonpulsatile systemic perfusion on the control of the sympathetic nerve activity during left ventricular assistance. Pulsatile perfusion was generated with an air-driven, diaphragm-type blood pump, and nonpulsatile perfusion was generated with a centrifugal pump. Renal sympathetic nerve activity and the blood flow of the descending aorta were then recorded during pulsatile and nonpulsatile systemic perfusion. Other variables, such as mean arterial pressure, central venous pressure, left atrial pressure, and blood gas levels, were kept constant. At the same mean arterial pressure, renal sympathetic nerve activity during pulsatile perfusion decreased significantly to 80% of renal sympathetic nerve activity during nonpulsatile perfusion (26.8 +/- 2.4 vs 33.4 +/- 2.9 spikes/sec, p < 0.01). Total systemic vascular resistance during pulsatile perfusion decreased significantly to 85% of that during nonpulsatile perfusion (5700 +/- 580 vs 6667 +/- 709 dynes.sec.cm-5, p < 0.05). These results suggest that pulsatile systemic perfusion, compared with nonpulsatile systemic perfusion, reduces sympathetic nerve activity and peripheral vascular resistance and thus may improve both microcirculation and organ function.

Animals↗

[Treatment and prognosis of renal cell carcinoma extending into the inferior vena cava].

Out of 173 patients with renal cell carcinoma diagnosed at our department between January 1984 and December 1994, 9 (5.2%) had an inferior vena caval tumor thrombus. They consisted of 6 men and 3 women between 43 and 74 years old with a mean age of 59.8 years. The tumors were on the right and left sides in 5 and 4 patients, respectively. According to the Novick's classification, 2, 1, 4 and 2 patients had level 1 (perirenal), level 2 (infrahepatic), level 3 (intrahepatic) and level 4 (suprahepatic) tumors, respectively. Five patients without distant metastases underwent nephrectomy and removal of the vena caval tumor thrombus. Although renal tumors and vena caval tumor thrombi were completely resected in all of the 5, 4 died of disease within 3 years. Only 1 patient without tumor invasion into the inferior vena caval wall survived over 5 years without disease. Since surgical treatment is the sole radical method for renal cell carcinoma, surgery is recommended for the patients even with a vena caval tumor thrombus unless there are metastases.

Adult↗

[Squamous cell carcinoma of the renal pelvis associated with renal stones in a patient with chronic renal failure: a case report and a review of the Japanese literature].

A case of squamous cell carcinoma of the left renal pelvis associated with chronic renal failure on hemodialysis is reported. The patient, a 59-year-old man, had undergone bilateral nephrolithotomy, in 1966, followed by right ureterolithotomy and bilateral percutaneous nephrolithotripsy, but residual stones existed. He suffered from left flak pain and fever, and computed tomography (CT) and magnetic resonance imaging (MRI) revealed left perirenal abscess in July 1994. Percutaneous drainage and antibacterial chemotherapy were performed, but his symptoms did not improve. Three months later, CT and MRI revealed a mass in the left perirenal space and destruction of the 12th thoracic vertebra, which were considered to be infectious changes. On November 9, 1994, left nephrectomy was performed. Histopathological diagnosis was moderately differentiated squamous cell carcinoma, grade 2, INF-gamma, pT4, pR1, pL0 and pV1. In spite of irradiation therapy, he died on January 19, 1995.

Carcinoma, Squamous Cell↗

[The perinatal risk factors and periventricular leukomalacia (PVL) in premature infants--relationship between fetal heart rate decelerations and PVL].

Periventricular leukomalacia (PVL) has recently been recognized as an important risk factor of neurological impairment in premature infants. We studied 29 PVL cases on perinatal risk factors comparing with a non-PVL matched control group retrospectively. Variable decelerations were more frequently observed with statistical significance in the PVL group in the intrapartum period. Then another study was conducted to evaluate the relationship between fetal heart rate (FHR) decelerations and cystic PVL prospectively. Since January 1993 through December 1994 we studied 209 low birth weight infants (31.1 +/- 3.2 weeks, 1,424 +/- 419 g) who had been subjected to intrapartum FHR monitoring and postnatal sonographic intracranial examinations sequentially every 7 days until discharge. Cystic PVL was detected in 6 of 209 cases (2.9%) and occurred only in infants who had revealed severe variable deceleration or prolonged deceleration (6/37, 16%) in intrapartum FHR monitoring. We conclude that in low birth weight infants intrapartum severe variable deceleration or prolonged deceleration might play a causal role in cystic PVL.

Bradycardia↗

[Questionnaire of cryopreserved allograft valves in Kyushu and Yamaguchi area].

Japanese Society of Cryopreserved Thoracic Tissue Implantation was recently set up. Cryopreserved allograft valves are about to pervade in Japan. To clarify the interest, demands and supply of cryopreserved allograft valve in the area of Kyushu and Yamaguchi, we performed questionnaire investigation regarding this issue. Collection rate of this questionnaire was 87.5% (35/40 hospitals). Ninety-seven percent of the hospitals answered that they were interested in cryopreserved allograft. Ninety-four percent of the hospitals answered that they did not ethically hesitate to use cryopreserved allograft. Ninety-one percent of the hospitals hoped to perform cardiac surgery using allograft aortic valve if allograft is available. With respect to securing donors of allograft, two-third of the hospitals did not decide whether they could be involved in obtaining donors of allograft. As the number of the cadaver kidney donors is about 20 per year in the area of Kyushu and Yamaguchi, shortage of donors of allograft valve is anticipated.

Attitude to Health↗

D-arabinitol versus mannan antigen and candidal protein antigen as a serum marker for Candida pyelonephritis.

To evaluate serum markers for the diagnosis of Candida pyelonephritis, levels of D-arabinitol, candidal mannan antigen and candidal protein antigen were measured using an enzymatic fluorometric assay, an enzyme immunoassay and a latex agglutination assay, respectively. The study group comprised 36 patients with candiduria (11 disseminated candidiasis, 9 Candida pyelonephritis and 16 colonization) and 27 without candiduria. The D-arabinitol/creatinine ratio was the only marker that differentiated between Candida pyelonephritis and colonization (p < 0.01). Using the cut-off values (1.4 mumol/mg of D-arabinitol/creatinine ratio, 0.28 of mannan/creatinine ratio (x 10(4)) and 1:4 of protein antigen titer) D-arabinitol/creatinine ratio showed the highest sensitivity in Candida pyelonephritis (77.8%) as compared to mannan/creatinine ratio (55.6%) and protein antigen titer (11.1%) although there were no differences in specificity, positive predictive value or negative predictive value. These results suggest that D-arabinitol/creatinine ratio is the most useful marker of Candida pyelonephritis.

Aged↗

Refractory haemospermia: any predictive factors?

A total of 56 patients with haemospermia were reviewed. Twenty-four patients suffered from prolonged haemospermia for more than 1 month or recurrent haemospermia (refractory group). In 32 patients haemospermia disappeared within a month (non-refractory group). Patient age in the refractory group was significantly higher than that in the non-refractory group (p < 0.05). Clinical symptoms other than haemospermia, white blood cell counts in the semen, expressed prostatic secretion and urine after prostatic massage, and transrectal ultrasonography findings were studied in both groups, with no significant differences found in any of these parameters. We concluded that, among these clinical findings, only patient age is a predictive factor for refractory haemospermia.

Adolescent↗

Left ventricular-coronary sinus shunt through a septal aneurysm after mitral valve re-replacement.

We describe a case in which a left ventricular-coronary sinus communication through a dissecting ventricular septal aneurysm developed after a redo mitral valve replacement. The outlet orifice of the communication was located in the side wall of the ostium of the coronary sinus. Both the communication and the aneurysm were successfully dealt with by performing a right atriotomy and by opening the aneurysm from its outlet orifice.

Aged↗

[Bilateral synchronous renal cell carcinoma: a case report].

A case of bilateral synchronous renal cell carcinoma is reported. The patient was a 55-year-old man. A right renal tumor was pointed out by ultrasound during a health check in July, 1994. Enhanced CT scan and angiography revealed bilateral renal tumors. Right nephrectomy and left partial nephrectomy were performed on November 25, 1994. Both tumors were completely encapsulated. Histological examinations of these tumors revealed renal cell carcinoma, Expansive type, alveolar type, clear cell subtype, G2, INF alpha, pT1, pV0.

Carcinoma, Renal Cell↗

[A case of renal cell carcinoma extending into the inferior vena cava in a long-term hemodialysis patient].

We report a case of left renal cell carcinoma extending into the inferior vena cava associated with the acquired cystic disease of the kidney (ACDK). The patient was a 46-year-old man, who had been treated with hemodialysis for 12 years. In November 1992, ACDK was observed on computed tomography (CT) for routine check up, but no tumorous lesions were detected. He noticed bleeding from the urethra in May 1994. CT and magnetic resonance imaging (MRI) revealed left renal tumor with intrahepatic vena caval tumor thrombus. There were no findings of distant metastasis. Left radical nephrectomy and partial removal of vena cava were performed. Histopathologically, renal cell carcinoma, pT3b, pN0, stage III was diagnosed.

Carcinoma, Renal Cell↗

[Serial change of 123I-BMIPP SPECT imaging during recovery from stunned myocardium after acute myocardial infarction--correlation with 201Tl and two-dimensional echocardiography].

Using 123I-beta-methyl iodophenyl pentadecanoic acid (123I-BMIPP), we investigated changes in myocardial fatty acid metabolism at recovery from stunned myocardium after acute myocardial infarction (AMI), correlation with recovery of regional wall motion and thallium-201 (201Tl) distribution in particular. The subjects were 15 patients who underwent successful reperfusion therapy after the first onset of AMI. None of the patients had multi-vessel disease or ischemic episode during their clinical course. Patients underwent 123I-BMIPP scintigraphy, 201Tl scintigraphy and two-dimensional echocardiography during the acute and chronic phases. Then, we compared regional wall motion with distribution of 123I-BMIPP and 201Tl. Regional wall motion and SPECT were evaluated by the established 16 segment model. In patients, showing serial improvement in regional wall motion, there was 80.0% (8/10) showed normal 201Tl distribution during the acute phase or normalized during the chronic phase. However, distribution of 123I-BMIPP normalized only in 10.0% (1/10) of this group. In examination of each segment that showed serial improvement in regional wall motion, 92.3% (24/26) of these segments showed normal distribution of 201Tl during the acute phase or normalized distribution during chronic phase, despite distribution of 123I-BMIPP improved in only 3.8% (1/26) of these segments. These indicate that, in the process of recovery from myocardial stunning after AMI, abnormal distribution of 123I-BMIPP continued longer than abnormal distribution of 201Tl.

Decanoic Acids↗

Colovesical fistula due to sigmoid colon diverticulitis: a case report.

We present a case of colovesical fistula due to sigmoid colon diverticulitis. A 63-year-old woman was referred to our department with the complaints of dysuria, turbid and foul smelling urine. She was treated twice for acute cystitis at the referral hospitals. A diagnosis of colovesical fistula was confirmed on barium enema. She underwent partial resection of sigmoid colon with primary anastomosis and partial cystectomy with repair of bladder wall and covered with omentum. Retrograde cytography taken on the 20th post-operative day revealed no leakage of contrast medium. She was asymptomatic at 3 months of follow-up.

Diverticulitis↗

The efficacy of fluconazole in treating prosthetic valve endocarditis caused by Candida glabrata: report of a case.

A case of active prosthetic valve infective endocarditis (PVE) due to Candida glabrata was successfully treated by the systemic administration of fluconazole. A 66-year-old Japanese man with infective endocarditis of unknown etiology underwent aortic and mitral valve replacement to treat severe aortic and mitral regurgitation associated with multiple organ failure. Postsurgical cultures of arterial blood were repeatedly positive for C. glabrata, and therefore fluconazole was administered either intravenously or orally at a dose of 400 mg/day for 46 days. During that time the signs of inflammation including fever such as an elevated white blood cell count and the presence of C-reactive protein (CRP) all improved while the blood cultures became negative. Fluconazole is thus considered to be effective in treating PVE caused by C. glabrata. When administering this treatment, it is also important to monitor the patient's renal and liver function.

Aged↗

Crystal adherence to urinary catheter materials in rats.

Crystal adherence to the surfaces of indwelling urinary catheter materials was investigated by scanning electron microscopy and immunofluorescence method. Small sterile disks were inserted into the rat bladder transvesically. Crystals were frequently associated with fibrillar material, some of which was believed to be fibrin. Increases in fibrillar materials were paralleled by increases in crystal adherence. On the other hand, a decrease in the amount of fibrin adhering to the surfaces of heparinized material, resulting in a decrease in the quantity of encrusting deposits on these materials, was found as compared with other catheter materials, including latex, silicone and nonheparinized material. These findings suggest that early adherence of fibrin to the surfaces of indwelling urinary catheter materials plays an important role in the development of crystal adherence and encrustation on catheter materials. It is also suggested that heparin inhibits the adherence of fibrin, resulting in decreased encrustation on the surfaces of the heparinized material.

Adhesiveness↗

Erythrocytosis complicated by multiple paraganglioma.

We report the case of a 22-year-old woman with onset of erythrocytosis at the age of 9 years. Endocrinological and radiological examinations revealed an elevated catecholamine level and the presence of multiple abdominal tumors. After the removal of the tumors, the catecholamine level normalized, whereas erythropoietin remained at the same level and erythrocytosis persisted. The tumor lysate contained considerable amounts of catecholamine but not erythropoietin. Moreover, no erythropoietin mRNA was detected in the tumor by in situ hybridization. These data suggest that this paraganglioma did not produce erythropoietin. A review of the literature showed the existence of patients with early-onset erythrocytosis complicated with paraganglioma, whose erythrocytosis was not relieved even after the resection of paraganglioma.

Abdominal Neoplasms↗

Reproducibility of dietary and other data from a self-administered questionnaire.

This study examined the reproducibility of information obtained from a questionnaire covering dietary and other information by comparing the answers to the questionnaires with answers to the same questions one year later. Answers from 191 men and 220 women, aged 40 to 65, in Fukuoka prefecture, Japan were compared. The surveys were conducted in November 1989 and November 1990. In the second survey, 97.2% of the first respondents answered. The concordance between the two responses was high, and the differences between the mean intakes from the two surveys were within 5% for 7 food items and within 15% for 14 food items among the 20 items about which the respondents were asked. The intraclass correlation coefficients varied from 0.30 for eggs to 0.62 for milk, with 16 items greater than 0.4. The differences in reproducibility between the sexes and two age categories were not significant. Close values also were obtained for the estimated consumption of salt. A substantially high reproducibility was observed on items regarding drinking and smoking; most of the kappa statistics and the intraclass correlation coefficients were between 0.5 and 0.9. The above reproducibility on individual food items was comparable to or better than those reported from other studies. The results of the present study thus indicate that the self-administered semiquantitative food intake questionnaire used for our cross-sectional study is useful for epidemiologic studies to assess the association between diet and various diseases. In particular, the present questionnaire is highly dependable regarding the overall group intake of foods.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

Ultrastructural changes in cultured glomerular epithelial cells induced by puromycin aminonucleoside: a quick-freezing and deep-etching study.

The effects of puromycin aminonucleoside (PAN) on rat glomerular epithelial cells (GECs) in primary culture were studied using a quick-freezing and deep-etching method. On the 5th day after seeding, GECs were treated with PAN for 24 hours. The three-dimensional structure of the cell organelles, microtubules, and intermediate filaments were observed, primarily in the perinuclear areas of untreated GECs. Microfilaments were observed in marginal and basal areas. The GECs treated with PAN became rounded and partially detached from the substratum. Intermediate filaments formed bundled structures. A slight decrease in the number of microfilaments and a significant widening of their networks were observed in the basal areas of the GECs treated with PAN. These results suggest that PAN may affect the cytoskeletal components of GECs, such as the intermediate filaments and microfilaments, and may induce detachment of the cells from the substratum.

Animals↗