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Biomedical subjects

S Tokunaga

Publications and source records attributed to S Tokunaga.

At least 145 records · Page 8Linked to original sources
PubMed1989

Pharmacokinetics of cefpiramide in healthy volunteers, patients with various degrees of renal dysfunction, and patients on hemodialysis.

The elimination kinetics of cefpiramide, a parenteral semisynthetic cephalosporin derivative, were studied in 6 healthy volunteers and 31 patients with renal dysfunction after a single 500-mg intravenous injection. Cefpiramide concentrations in serum and urine were determined by an agar-well diffusion method. The serum levels in patients with renal impairment were slightly higher than those in volunteers during the period from 30 min to 24 h after the administration. The mean serum half-life during the beta-phase was 4.06 h in the volunteers and was slightly prolonged in the patients. The mean urinary recovery during 24 h amounted to 21.5% in the volunteers and decreased with reduced renal function. Hemodialysis did not enhance the clearance of cefpiramide.

Adult↗
PubMed1989

[Trisomy of chromosome 11 in a case of common ALL antigen-positive acute myeloblastic leukemia (FAB-M1)].

In February 1986, a 68-year-old woman was diagnosed as having acute myeloblastic leukemia (FAB-M1). At the time of diagnosis, 86.0% of the bone marrow cells were myeloblastoid, and 15% of these myeloblastoid cells were positive to myeloperoxidase. Surface marker analysis by flow cytometry disclosed granulocyte-associated antigen (MY7) and also lymphocyte-associated antigen (CALLA) on the leukemic cells. Chromosomal banding studies of bone marrow cells revealed trisomy 11 in 6 of 19 metaphases examined and normal karyotype in the others. Complete remission was attained after intensive combination chemotherapy, and has remained for 38 months. Only 19 patients with trisomy 11-associated acute nonlymphocytic leukemia (ANLL) including the present case have been reported. Morphologic analyses have revealed that the frequency of FAB-M1 is high. However, except for the present case, surface marker findings were apparent in only one M5a patient, in whom monocyte-macrophage-associated antigen was detected. Accordingly, careful surface marker studies will be needed to clarify the frequency of acute mixed lineage leukemia in such patients.

Aged↗
PubMed1989

[Cytogenetic studies of healthy HTLV-I carriers (Report 1): Cytogenetic studies of an ATL family].

The chromosome 14q11 anomaly has been reported to be specific to adult T-cell leukemia (ATL) and this anomaly has also been confirmed in preleukemic state of ATL (pre-ATL) patients though the frequency is low. In an attempt to clarify if the same chromosome aberrations could be found also at the stage of HTLV-I carrier and if there is any cytogenetic difference from non-HTLV-I carriers, a cytogenetic study of lymphocytes stimulated with phytohemagglutinin in three HTLV-I healthy carriers and three non-HTLV-I carriers in an ATL family was performed. The results were as follows. 1. In three HTLV-I carriers, 7 of 311 cells examined (2.3%) showed chromosome aberrations, and 4 cells (1.3%) had 14q11 anomaly. 2. In three non-HTLV-I carriers, 4 of 260 cells examined (1.5%) showed chromosome aberrations, whereas no cells had 14q11 anomaly. These findings suggest that 14q11 anomaly is already present at the stage of HTLV-I carrier and seems to be an important cytogenetic clue to the pathogenesis of ATL.

Adult↗
PubMed1989

Oriental blepharoplasty: single-stitch, nonincision technique.

The facial features of Orientals and Caucasians are different in many respects. In Orientals, the concept of beauty differs in each country depending on the cultural background. At present time, blepharoplasty in the Oriental eye is the most common aesthetic procedure performed in Korea and Japan. The objective should not be the caucasianization of the Oriental eye, where desired modifications are usually quite subtle. Generally, patients prefer more defined and invaginated folds, but not necessarily a very high fold, since the latter will often look unnatural or overdone in the Oriental face. We have found several different types of eyelids in the Oriental population. The purpose of this presentation is to present our nonincision technique to create aesthetically pleasing supratarsal folds. Seven-hundred and sixty-two patients were reviewed. We have found that our single-suture method is very reliable and allows the construction of a more even, smooth, and symmetrical fold.

Adult↗
PubMed1989

[Transesophageal Doppler echocardiography in the diagnosis of dissecting aortic aneurysm].

Transesophageal Doppler echocardiography (TEDE) was performed in three patients with proven or suspected DeBakey type I and type III aortic dissection. Case 1: A 66-year-old woman, with DeBakey type I aortic dissection. Clear images of a widened dissected aorta and an intimal flap were obtained in both the ascending and descending aorta, including the aortic arch. The site of an entry into the false lumen was identified by the defect of the intimal flap and the pulsatile entry flow through it. The reentry into the true lumen was also identified near the orifice of the celiac trunk. In this case, the observation was performed using this technique during the operation; i.e., replacement of the ascending aorta with an artificial graft. Case 2: A 77-year-old man, DeBakey type III aortic dissection. The study was performed after surgery which consisted of replacement of the descending aorta with an artificial graft. TEDE provided clear images of the artificial graft, the aorta, and their boundaries. The remaining intimal flap was clearly confirmed. Case 3: An 80-year-old man, DeBakey type III aortic dissection. In this case, though abdominal echography suggested aortic dissection, angiography and X-ray CT failed to facilitate the diagnosis. Only TEDE confirmed the diagnosis. The abnormal flow via the entry directing toward the false lumen was clearly demonstrated on the color Doppler images. We therefore conclude that TEDE is a useful and reliable means of diagnosing dissecting aortic aneurysm.

Aged↗
PubMed1989

[A case of multilocular renal cyst].

A case of multilocular renal cyst is presented. The patient, a 65-year-old female, who had had macroscopic hematuria since 1979, came to our hospital in 1986. Computed tomography demonstrated a cystic mass with septa enhanced by contrast medium. The lesion was located at the anterior aspect of the midportion of the left kidney. These findings suggested a multilocular renal cyst. Therefore, enucleation of the mass was performed after confirmation of the absence of malignant cells in the septum on the frozen slide. Histological diagnosis was the same as the clinical diagnosis. We reviewed 65 cases of multilocular renal cyst in Japan and discuss preoperative diagnosis and operative procedure.

Aged↗
PubMed1989

[Significance of the chromosomal findings in acute myeloid leukemia with maturation (M2)].

Chromosomal banding studies were performed on 13 patients with acute myeloid leukemia with maturation (M 2). Six patients revealed t (8;21) (q22;q22), five normal karyotype, and the remaining two +8 and inv (16) (p13 q22), respectively. Apparent pseudo-Pelger-Huët anomalies in mature neutrophils were observed in all the 6 patients with t (8;21), but in only one of the 5 patients with normal karyotype. Neutrophil alkaline phosphatase (NAP) score decreased in all but one in the former group while it increased in all the patients in the latter group. The former group had a median follow-up of 20.8 months or more, whereas the latter group had a median survival of 4.4 months or more. Accordingly, it was suggested that two major chromosome subgroups may be present among patients diagnosed as having M 2: one subgroup with t (8;21) and the other with normal karyotype. One patient with M 2 and inv (16) showed almost the same hematologic features as those observed in patients with acute myelomonocytic leukemia (M 4) and inv (16) except for a small population (6.8%) of monocytoid cells in the bone marrow.

Adolescent↗
PubMed1988

Significance of technetium-99m/thallium-201 overlap on simultaneous dual emission computed tomography in acute myocardial infarction.

To examine the significance of technetium-99m pyrophosphate/thallium-201 scintigraphic overlap as an indicator of identifying early coronary reperfusion (less than or equal to 3 hours), 32 patients, in whom coronary recanalization was attempted for acute myocardial infarction (AMI), underwent myocardial imaging 3 days after the onset of AMI. The imaging was performed by simultaneous dual emission computed tomography, which allows simultaneous recording of technetium-99m pyrophosphate and thallium-201 images and comparison between both images in the same slice. The patients were separated into 3 groups: 9 patients in whom reperfusion was successful and showed scintigraphic overlap (group A), 12 with successful recanalization but no overlap (group B) and 11 with neither coronary reflow nor overlap (group C). No patient in whom reperfusion failed showed scintigraphic overlap (p less than 0.05). Groups A and B were comparable in age, infarct vessel, collateral circulation, residual coronary stenosis and cumulative release of creatine kinase-MB isoenzyme. However, compared with group B, group A had a shorter interval between onset of AMi and reflow (2.5 +/- 0.8 vs 4.8 +/- 1.3 hours, p less than 0.001). The presence of scintigraphic overlap identified early coronary reflow with a sensitivity of 80%, specificity of 91%, positive predictive accuracy of 89% and negative predictive accuracy of 83%. Thus, technetium-99m/thallium-201 overlap on dual emission computed tomography can be used as an index of documenting early recanalization and might reflect the presence of salvaged myocardium adjacent to the necrotic tissue.

Clinical Enzyme Tests↗
PubMed1988

Non-Q wave versus Q wave myocardial infarction: regional myocardial metabolism and blood flow assessed by positron emission tomography.

This study compared regional myocardial blood flow at rest and during supine exercise as well as regional myocardial glucose utilization in the fasting condition in 22 patients, 11 with antecedent non-Q wave and 11 with antecedent Q wave infarction. With use of N-13 (nitrogen-13) ammonia and F-18 (fluorine-18) deoxyglucose as tracers of blood flow and exogenous glucose utilization and positron emission tomography, hypoperfused areas were noted at rest and during exercise in all 11 patients (100%) with Q wave infarction. Among the 11 patients with non-Q wave infarction such areas were noted in only 5 (45%) at rest and in 8 (73%) during exercise. Furthermore, segmentally enhanced F-18 deoxyglucose uptake corresponding to the infarcted areas (identified electrocardiographically) was seen in 10 (91%) of the 11 patients with non-Q wave infarction but in only 4 (36%) of the 11 patients with Q wave infarction (p less than 0.01). In conclusion, segmental F-18 deoxyglucose uptake as a possible sign of myocardial viability was seen more frequently in non-Q wave than in Q wave infarction and, importantly, regionally enhanced F-18 deoxyglucose uptake occurred even in the absence of segmental rest or exercise blood flow abnormalities, or both, in 5 (45%) of 11 patients with non-Q wave infarction.

Adult↗
PubMed1988

[A case of bilateral testicular tumors showing remarkable regression of huge metastatic tumors after VAB-6 combined chemotherapy].

A case of bilateral testicular seminomas with abdominal huge metastatic tumors is presented. The patient is a 23-year-old male. An abdominal huge mass was found incidentally by a physician. CT scan and ultrasonography revealed the presence of the tumor in the left retroperitoneal space and biopsy specimen of the abdominal tumor was diagnosed as seminoma. On March 7, 1985, he was referred to our clinic. Bilateral testicular tumors were detected on palpation and ultrasonography. Bilateral orchiectomy was performed. Histological diagnosis was pure seminoma. After four sessions of VAB-6 combined chemotherapy, the abdominal tumor, 14.1 x 12.3 cm in size, decreased to 5.7 x 4.4 cm ( a regression rate of 85.5%). Retroperitoneal lymph-node dissection was undertaken, but the abdominal tumor could not be resected completely. Histological examination of the resected tumor revealed complete necrosis of the tumor tissue. After the operation, one session of the chemotherapy and irradiation were added. A total of 109 cases of bilateral testicular germ cell tumors in Japan was reviewed.

Adult↗
PubMed1988

[Dual energy emission computed tomography with 99mTc pyrophosphate and 201T1 in evaluating coronary reperfusion therapy in patients with acute myocardial infarction].

To evaluate the clinical significance of scintigraphic overlap of thallium-201 (201T1) and technetium-99m pyrophosphate (99mTc), we observed 28 patients with acute myocardial infarction (AMI) in whom coronary reperfusion was attempted. All patients underwent dual energy emission computed tomography (D-ECT) on the third post AMI day which facilitated comparing 99mTc and 201T1 images from identical slices simultaneously. The scintigraphic results of the 28 patients were as follows: (table, see text) In conclusion, (1) significant 201T1 and 99mTc overlap on D-ECT suggest very early and successful reperfusion, and (2) none of the patients with unsuccessful reperfusion exhibits overlap.

Diphosphates↗
PubMed1988

[Detection of penicillinase-producing Neisseria gonorrhoeae from male patients with urethritis].

Eighty-nine isolates of Neisseria gonorrhoeae from 89 male urethritis patients were studied for beta-lactamases (penicillinase) production, and their susceptibilities to benzylpenicillin, amoxicillin, piperacillin, clavulanic acid/amoxicillin (Augmentin), cephalexin, cefotaxime, spectinomycin and minocycline were determined by an agar plate-dilution method. Penicillinase activity was tested by a chromogenic cephalosporin method with nitrocefin as substrate (CefinaseTM discs, BBL, USA) and by a paper strip acidimetric method with benzylpenicillin as substrate (beta-Lactamase detection papers, Oxoid, UK). In addition, 60 of the 89 patients were examined for Chlamydia trachomatis, using fluorescein-labeled monoclonal antibodies (Direct specimen test; Micro TrakTM, Syva Co., USA). Penicillinase-producing N. gonorrhoeae (PPNG) were found in 12 of the 89 strains (13.5%). Although all these strains of PPNG were highly resistant to benzylpenicillin and amoxicillin, the minimum inhibitory concentrations (MICs) of Augmentin markedly decreased. Piperacillin was highly active against not only non-PPNG but also PPNG strains. More than half the isolates were resistant to cephalexin (MICs greater than or equal to 12.5 micrograms/ml) while all strains including non-PPNG and PPNG were fully sensitive to cefotaxime (MICs less than or equal to 0.20 microgram/ml). Spectinomycin and minocycline had MIC ranges of 6.25 to 25 micrograms/ml and 0.01 to 3.13 micrograms/ml, respectively; the ranges for non-PPNG and PPNG strains were fairly similar. C. trachomatis was detected in 11 (18.3%) out of 60 patients examined. The increasing incidence of PPNG and coexisting chlamydial infection should be taken into account in the treatment of gonococcal urethritis.

Adolescent↗
PubMed1988

[Autotransplantation of nipple-areolar complex in a modified radical mastectomy--indications and three-stage breast reconstruction].

Necessity of breast reconstruction after mastectomy has been increasing in recent years. For better reconstruction, we preserve a nipple-areolar complex (NAC) by transplanting it temporarily onto the lower abdominal wall and retransplant it to the restored breast mound in a subsequent operation. Indications for NAC preservation are as follows: (1) by palpation the tumor is found to be smaller than 3.0cm in diameter without apparent regional and distant metastasis, (2) neither abnormal nipple discharge nor nipple retraction is observed, (3) tumor is remote more than 3.0cm from the areolar margin, (4) no abnormal shadows are seen below the nipple and areola in the mammogram, (5) no microscopic extension of the cancerous cells is detected beneath the resected NAC. We have performed 18 transplantations using this procedure with good cosmetic results. There were no recurrent cases due to NAC preservation. It is concluded that this technique for preserving the NAC by autotransplantation is easy to perform and useful for breast reconstruction because of low risk of recurrence and better cosmetic results.

Adult↗