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Biomedical subjects

T Akasaka

Publications and source records attributed to T Akasaka.

At least 145 records · Page 8Linked to original sources
PubMed1996

[Value and limitations of valve resistance in assessing prosthetic aortic valve function: clinical study using dobutamine stress doppler echocardiography].

Hemodynamic resistance may be a useful index for the severity of valvular aortic stenosis, but little is known about the utility of valve resistance in assessing the prosthetic aortic valve function. This study investigated whether valve resistance is useful in assessing prosthetic valve function in 13 patients with normally functioning CarboMedics prosthetic aortic valves. Transvalvular pressure gradient, effective orifice area and valve resistance derived from two-dimensional and Doppler echocardiography were calculated before and after dobutamine infusion. Dobutamine was infused incrementally (3-12 micrograms/kg/min) under echocardiographic imaging. Transvalvular pressure gradient (24 +/- 7-->53 +/- 18 mmHg, p < 0.01) and valve resistance (102 +/- 32-->140 +/- 57 dynes.sec.cm-5, p < 0.01) significantly increased after dobutamine infusion. However, effective orifice area did not increase significantly (1.1 +/- 0.5-->1.2 +/- 0.5 cm2). These findings indicate that transvalvular pressure gradient and valve resistance are flow-dependent and should be treated with caution when assessing prosthetic valve function.

Adult↗
PubMed1996

[A case report of active infectious endocarditis caused by MRSA with chronic renal failure].

A 62-year-old female, who had chronic renal failure treated by HD, was admitted to our hospital with fever. MRSA was identified by blood culture examination. Echocardiography revealed vegetations attached to the mitral valve. Mitral abscess was detected during operation. Mitral valve replacement was performed. We used ECUM and HD for the chronic renal failure during peri- and postoperative days. The postoperative clinical course was uneventful.

Abscess↗
PubMed1996

[Intraoperative assessment of mitral valve plasty by transesophageal echocardiography].

Mitral valve repair offers many advantages over prosthetic valve replacement, especially in minimizing the risk of thromboembolism. Intraoperative evaluation of residual mitral regurgitation (MR) is important in this procedure. The present study assessed the usefulness of transesophageal echocardiography (TEE) for the intraoperative assessment of residual MR in patients undergoing mitral valve repair. Intraoperative TEE was performed in 102 consecutive patients before and after mitral valve repair in the operating room. The grade of MR was evaluated according to the maximum MR jet area detected by biplane color Doppler TEE (mild: <4 cm2; moderate: 4 < or = < 7 cm2; severe : 7 cm2 < or =). After the first repair, the manual regurgitant test was performed. Excellent results with no or mild MR assessed by the manual regurgitant test were obtained in 101 patients. However, moderate or severe MR was identified in eight of these 101 (7.9%) patients by TEE after weaning from the cardiopulmonary bypass. Consequently, six of these eight patients underwent repeat mitral valve repair and two patients received prosthetic valve replacement. Satisfactory final operative results were obtained in all 101 patients. The eight patients who needed additional operative procedures followed good clinical courses in hospital. TEE 1 month after operation demonstrated no or mild MR in these eight patients. Intraoperative TEE is useful in the evaluation of residual MR after mitral valve repair. This technique provides indications for immediate additional operative procedures, and can reduce the occurrences of congestive heart failure and reoperation in the early stage after mitral valve repair.

Adult↗
PubMed1996

Serial change of mitral regurgitation after mitral valve repair: comparison of anterior with posterior leaflet lesions.

Mitral valve repair is an important operative procedure for correcting mitral regurgitation (MR). However, serial change of residual MR after operation has not been reported. Serial change of MR after mitral valve repair was evaluated by transesophageal color Doppler echocardiography (TEE). Twenty-six patients undergoing mitral valve repair for MR during 1987 to 1991 were examined by TEE just after operation, 6 months after operation, and late follow-up period (mean 3.7 years). Thirteen patients had a lesion of the anterior mitral leaflet before operation (group A). Thirteen patients had a lesion of the posterior mitral leaflet before operation (group P). The MR area was measured by TEE at each stage after operation. In group A, the MR area at late follow-up increased significantly compared with just after operation (1.1 vs 4.3 cm2, p < 0.001). In group P, the MR area at late follow-up did not increase significantly compared with just after operation (0.6 vs 1.3 cm2, p = NS). In conclusion, MR does not increase after mitral valve repair in patients with posterior mitral valve repair, but MR may increase at late follow-up after operation for anterior mitral valve prolapse.

Echocardiography↗
PubMed1996

Pseudoaneurysm and ventricular septal rupture complicated with inferior myocardial infarction diagnosed by two-dimensional and Doppler echocardiography: case report.

A 72-year-old woman with inferior myocardial infarction presented with both a pseudoaneurysm and a ventricular septal rupture detected by two-dimensional and Doppler echocardiography. The pseudoaneurysm originated from the junctional area between the inferior portion of the ventricular septum and posterior left ventricular wall. The short-axis view of two-dimensional echocardiography revealed an abrupt discontinuity of the junctional area and an echo-free space behind the left ventricular cavity. The communication orifice was 5 mm wide. Color Doppler echocardiography showed a left-to-right shunt flow from the pseudoaneurysm to the right ventricle was visualized. Combined use of two-dimensional and color Doppler echocardiography was useful for detecting a pseudoaneurysm resulting in rupture of the ventricular septum.

Aged↗
PubMed1996

[Automatic assessment of left ventricular cavity area by the automated contour tracking method].

Measurements of left ventricular cavity area by the manual tracing method from apical four-chamber views were compared with those using the automated contour tracking (ACT) method. Nine consecutive patients in whom clear images were obtained by two-dimensional echocardiography were studied, and left ventricular end-diastolic, end-systolic areas an fractional area changes were calculated using the ACT method. The ACT method slightly underestimated left ventricular cavity areas, but excellent correlations were obtained with left ventricular end-diastolic and end-systolic areas between the ACT and manual methods (r = 0.99, SEE = 1.5 cm2; r = 0.99, SEE = 1.2 cm2; respectively). Manual tracing fractional area change correlated well with that by the ACT method (r = 0.95, SEE = 3.4%). The ACT method provides accurate estimates of the area of the left ventricular cavity.

Cardiac Volume↗
PubMed1996

[Serial change of mitral regurgitation after anterior mitral valve repair using polytetrafluorethylene chordae: evaluation by transesophageal echocardiography].

The results of anterior mitral leaflet repair were evaluated by the serial change of mitral regurgitation (MR) using transesophageal echocardiography (TEE) in 24 patients undergoing mitral valve repair for anterior leaflet prolapse during 1988 to 1994, who were examined by TEE immediately after operation, 1 month after operation, and late after operation (mean 15 months). Chordal replacement using polytetra-fluorethylene chordae was performed in 15 patients (PTFE group), and not performed in 9 patients (non-PTFE group). MR jet area late after operation was significantly smaller in the PTFE group than in the non-PTFE group (2.2 +/- 2.3 vs. 4.6 +/- 2.3 cm2, p < 0.05). Moderate to severe MR was observed in four patients (27%) in the PTFE group, and six (67%) in the non-PTFE group late after operation. The thickness of the mitral leaflet before operation was more than 5 mm in all patients with more than moderate MR late after operation in the PTFE group. Chordal replacement using polytetrafluorethylene chordae showed better results compared with conventional mitral valve repair without polytetrafluorethylene chordae over the follow-up period of 15 months.

Aged↗
PubMed1996

[Prognostic value of serial Doppler echocardiographic follow-up of transmitral flow patterns in patients with congestive heart failure who presented with pulmonary edema].

The predictive value of serial Doppler echocardiographic follow-up of transmitral flow patterns for the prognosis of patients with congestive heart failure who presented with pulmonary edema was evaluated in 80 consecutive patients with decreased left ventricular systolic function (ejection fraction < 40%). Restrictive patterns [peak early diastolic filling velocity (E)/peak late diastolic filling velocity (A) ratio (E/A) > 2 and/or deceleration time for E wave to decline to baseline (DcT) < 150 msec] were observed in 72 patients (90%) on admission. After intensive therapy, DcT showed a nonrestrictive pattern in 38 of 72 patients (53%). The survival rates at 1 year was 50% for the restrictive group, and 97% for the nonrestrictive group. E/A showed a nonrestrictive pattern in 37 of 56 patients (66%). The survival rates at 1 year was 86% for the restrictive group, and 58% for the nonrestrictive group. Serial Doppler echocardiographic follow-up of transmitral flow patterns is useful in predicting the prognosis in patients with congestive heart failure who presented with pulmonary edema.

Aged↗
PubMed1996

[Valvuloplasty for aortic insufficiency in a patient with bicuspid aortic valve].

A 20-year-old man with a bicuspid valve underwent aortic valvuloplasty for aortic regurgitation. Valvuloplasty was performed according to Cosgrove's method. Intraoperative transesophageal color Doppler echocardiography showed trivial aortic regurgitation after the repair. Peak pressure gradient across the repaired aortic valve was 9.3 mmHg at rest (cardiac output 4.2 l/min, stroke volume 49 ml) and 27.6 mmHg at dobutamine infusion (cardiac output 8.7 l/min, stroke volume 78 ml). The patient was in NYHA class I with no medication after surgery. Valvuloplasty for aortic regurgitation with a bicuspid valve is the surgical procedure of choice.

Adult↗
PubMed1995

Degradation of antenna chlorophyll-binding protein CP43 during photoinhibition of photosystem II.

When photosystem II (PS II) membranes from spinach were treated with Tris (0.8 M, pH 9.0) and illuminated with white light (5000 microE m-2 s-1) under aerobic conditions at 25 degrees C, not only were the reaction center-forming D1 and D2 proteins degraded but the antenna chlorophyll-binding protein CP43 was also degraded. Three products of the degradation of CP43, with molecular masses of 17.0, 15.5, and 14 kDa, respectively, were identified by sodium dodecyl sulfate/urea polyacrylamide gel electrophoresis and Western blotting with a specific antibody. Degradation products of another antenna chlorophyll-binding protein of PS II, CP47, were not detected under the same conditions. Concomitant with the damage to the D1 and D2 proteins and CP43, cross-linked products of the D1 protein, CP43, and CP47 were formed. These products were identified as slow-moving smeared bands in the higher molecular weight range of the gel during electrophoresis. Both the degradation and the cross-linking of these proteins were prevented by the addition of electron donors to PS II, a result that suggests that these processes were caused by the donor-side mechanism of photoinhibition. The photoinduced degradation of CP43 and the cross-linking among the D1 protein, CP43, and CP47 were less obvious in the PS II membranes that had been treated with hydroxylamine rather than Tris and in the membranes that had been treated with Tris and reconstituted by addition of an extrinsic 33-kDa protein (OEC33).(ABSTRACT TRUNCATED AT 250 WORDS)

Chloroplasts↗
PubMed1995

Flow capacity of internal mammary artery grafts: early restriction and later improvement assessed by Doppler guide wire. Comparison with saphenous vein grafts.

OBJECTIVES: The purpose of this study was to assess flow dynamics and flow capacities of internal mammary artery and saphenous vein grafts to the left anterior descending coronary artery. BACKGROUND: The postoperative flow capacity of internal mammary artery grafts to the left anterior descending coronary artery has been reported to be restricted compared with that of saphenous vein grafts in studies using radionuclide angiography. A recently developed Doppler guide wire has been used to analyze the flow dynamics of bypass grafts and to clarify the mechanism of this limited flow capacity. METHODS: Phasic flow velocity recordings were obtained in the midportion of the bypass graft and within the native left anterior descending artery, using a 0.018-in. (0.046-cm) 12-MHz Doppler guide wire, in 53 patients: 27 patients with an internal mammary artery graft (16 with a new graft assessed 1 month postoperatively and 11 with an old graft assessed at 1 year) and 26 patients with a saphenous vein graft (13 with a new graft assessed 1 month postoperatively and 13 with an old graft assessed at 1 year). All patients were studied at baseline rest and during hyperemia induced by intravenous infusion of dipyridamole, 0.56 mg/kg body weight, over 4 min. RESULTS: In the left anterior descending artery itself, systolic and diastolic peak velocities, the time average of the instantaneous spectral peak velocity (time-averaged peak velocity), vessel diameter and the calculated flow volume did not differ significantly among the four graft groups. The time-averaged peak velocity was significantly greater for new than for old arterial grafts or for new or old vein grafts (mean +/- SD 27 +/- 9 vs. 19 +/- 6, 11 +/- 5 and 12 +/- 6 cm/s, respectively, p < 0.01). However, because the diameter of new arterial grafts was significantly smaller than that of the other three grafts (2.4 +/- 0.1 vs. 2.9 +/- 0.2 [p < 0.05], 3.6 +/- 0.6 [p < 0.01] and 3.4 +/- 0.5 mm [p < 0.01], respectively), there was no difference in calculated flow volumes at rest (62 +/- 17 vs. 58 +/- 15, 61 +/- 18 and 58 +/- 19 ml/min, respectively, p = NS) between new arterial grafts and the other grafts. Although the maximal time-averaged peak velocity during hyperemia was significantly greater in new than in old arterial grafts or new or old vein grafts (47 +/- 17 vs. 40 +/- 7, 31 +/- 8 and 34 +/- 12 cm/s, respectively, p < 0.01), the flow reserve of new arterial grafts was significantly smaller than that of the other three groups (1.8 +/- 0.3 vs. 2.6 +/- 0.3, 2.8 +/- 0.5 and 3.0 +/- 0.6, respectively, p < 0.01) because the baseline time-averaged peak velocity of these new grafts was far greater than that of the other groups. CONCLUSIONS: Internal mammary artery graft flow early after operation is characterized by a higher rest velocity than that of vein graft flow. This high velocity maintains flow volume at baseline condition in compensation for the smaller diameter. Although flow reserve does not differ significantly between new and old vein grafts, that for internal mammary artery grafts is significantly reduced soon after bypass surgery. This restricted flow capacity improves late postoperatively because of an increase in diameter and a decrease in flow velocity from baseline levels.

Adult↗
PubMed1995

Postoperative flow characteristics of left internal thoracic artery grafts.

Twenty patients whose left internal thoracic artery (LITA) was anastomosed to the left anterior descending artery (LAD) underwent postoperative coronary angiography and Doppler ultrasound velocimetry. During angiography, the diameter of the LITA conduit was measured at three points: proximal, mid, and distal. The degree of left anterior descending artery stenosis proximal to the anastomotic site was evaluated by densitometry. The LITA flow velocity pattern was obtained at the three points to calculate the total, systolic, and diastolic flow volume. There were significant differences in the total LITA flow among the three points (proximal, 36.0 +/- 17.2 mL/min; mid, 29.9 +/- 15.2 mL/min; distal, 27.2 +/- 14.0 mL/min; p < 0.001 between the proximal and the mid or distal portions). The degree of left anterior descending artery stenosis affected the distal LITA flow and diameter (r = 0.823 and 0.811, respectively). There were significant differences in the systolic LITA flow among the three points (proximal, 13.2 +/- 6.5 mL/min; mid, 8.1 +/- 4.7 mL/min; distal, 5.6 +/- 3.4 mL/min; p < 0.001 between the proximal and the mid or distal portions). However, there was no statistically significant difference in the diastolic LITA flow among the three points (proximal, 22.9 +/- 11.0 mL/min; mid, 21.7 +/- 10.8 mL/min; distal, 21.6 +/- 10.8 mL/min). We conclude that a lower degree of LAD stenosis significantly reduces the LITA flow, inducing the string phenomenon. Additionally, during the diastolic phase, the LITA graft transports the blood primarily to the coronary artery but not to the side branches. Therefore, the steal phenomenon might not apply in the setting of an LITA graft.

Adult↗
PubMed1995

Class switch recombination of the immunoglobulin heavy chain gene frequently occurs in B-cell lymphomas associated with rearrangement of the BCL2 gene.

B-cell lymphomas, mainly follicular lymphomas, carrying a t(14;18) chromosomal translocation associated with rearrangement of the BCL2 gene and the immunoglobulin heavy chain (IGH) gene, share many similarities with germinal center B cells in the secondary lymphoid follicle. In the germinal center, antigen-stimulated B cells proliferate and differentiate while undergoing isotype class switching of their immunoglobulin heavy chains. To examine whether BCL2-positive lymphoma cells show class switch recombination similar to that in the germinal center B cells, we studied the genomic configurations of the IGH gene loci in 38 patients with B-cell lymphomas. Sixteen (80%) out of 20 patients with BCL2-positive lymphomas showed class switch recombination on translocated and/or productive IGH gene loci. Lymphoma cells from 7 of the 16 patients expressed the gamma-heavy chain on their surfaces, indicating functional class switching to the gamma-constant gene on the productive allele. By contrast, 6 (33%) of the 18 patients lacking the BCL2 rearrangements exhibited class switch recombination. Statistical analysis revealed that the BCL2-positive lymphomas underwent switch recombination on either allele at a significantly higher frequency than the BCL2-negative lymphomas (P = 0.0099). This indicates that follicular lymphoma, not only morphologically but also functionally, recapitulates the germinal center. We propose that the up-regulated BCL2 expression itself is capable of playing an important role in immunoglobulin class switching.

Gene Rearrangement↗
PubMed1995

Synchronous presentation of Epstein-Barr virus-associated Hodgkin's disease and adult T-cell leukemia/lymphoma (ATLL) in a patient from an endemic area of ATLL.

We report a patient from an endemic area of adult T-cell leukemia/lymphoma (ATLL), who developed lymphoma with features characteristic of Hodgkin's disease (HD). Large atypical Reed-Sternberg/Hodgkin's cells (RS/H cells) had a CD3-CD15+CD20-CD30+CD45RO- immunophenotype. Epstein-Barr virus (EBV) latent membrane protein and EBV-encoded small RNA were detected in the RS/H cells. The patient received C-MOPP/ABVD chemotherapy for the HD resulting in a partial response. However, relapse occurred and he died of disease progression associated with serious bacterial infection. Although serial lymph node biopsies revealed consistent presence of the EBV-positive RS/H cells, the background small lymphocytes showed progressive increase in pleomorphism and nuclear irregularity. The lymphocytes had the T-cell phenotype, CD3+CD4+CD7-CD8-. Southern blot analysis using DNA probes for the human T-cell lymphotrophic virus-I (HTLV-I) and the T-cell receptor beta-chain gene demonstrated expansion of the HTLV-I infected monoclonal T-cells with the disease progression. We concluded that the patient synchronously presented two independent lymphoproliferative disorders; EBV-associated HD and ATLL resulting from HTLV-I infection.

Antigens, CD↗
PubMed1995

TCR repertoire in early fetal mouse thymus.

We investigated the rearrangement and expression of TCR genes in mouse fetal thymus organ culture, a system that avoids subsequent entry of hematopoietic precursor cells. The first observable rearranged TCR gene was homogeneous V gamma 2-J gamma 2, detectable as early as fetal day 11 (d11) in the thymic primordia. The productive TCR was homogeneous V gamma 5-J gamma 1, first detectable in d13 thymocytes, followed by adult-type TCR gamma (V gamma 4 and V gamma 7). Sequence analysis of TCR revealed five types of V-J junctional sequences. In the very early stage, a homogeneous V-J junction is generated via a short homology sequence in the coding region (Type I), while a short homology sequence in the P-nucleotide rather than the coding region is used in the following stage (Type II). In the later embryonic stages, diverse V-J junctions are generated by well-known mechanisms, such as P-nucleotide (Type III), N-region insertion (Type IV) or trimming of the coding ends (Type V). These findings suggest that the generation of homogeneous TCR gamma (V gamma 2 and V gamma 5) in the early fetal stages is due to the intrinsic rearrangement mechanisms and is in stage specific manner.

Animals↗
PubMed1995

Mechanisms of 4-quinolone resistance in quinolone-resistant and methicillin-resistant Staphylococcus aureus isolates from Japan and China.

Ninety-two and 33 methicillin-resistant Staphylococcus aureus (MRSA) strains were isolated in Japan and China respectively. They were categorised as ofloxacin-susceptible (MIC < 12.5 mg/L), moderately (MIC 12.5-25 mg/L) or highly (MIC > or = 50 mg/L) ofloxacin-resistant. 4-Quinolone concentrations required to inhibit purified DNA gyrase from the moderately and highly quinolone-resistant MRSA were at least 20 times higher than those required to inhibit the equivalent enzyme from quinolone-susceptible strains. Reconstitution assays demonstrated that the 4-quinolone-resistant MRSA had a mutation in subunit A of DNA gyrase. A portion of the gyrA gene from amino acids codons 40-115 was sequenced. Four moderately resistant and seven highly resistant MRSA contained a Ser-->Leu substitution at amino acid 84; one moderately and one highly resistant MRSA and one moderately resistant methicillin-susceptible S. aureus (MSSA) strain contained a Glu-->Lys substitution at amino acid 88. Eight MRSA, including one quinolone-susceptible strain and one MSSA contained a silent mutation at amino acid 86. Uptake of ofloxacin in moderately resistant strains was almost the same in the presence or absence of carbonyl cyanide m-chlorophenylhydrazone (CCCP), whereas in highly resistant strains, uptake increased when CCCP was added. Restriction fragment length analysis of the norA gene with the restriction endonuclease SfcI showed a mutation of nucleotide position 1085 in all MRSA strains tested except for one highly quinolone-resistant strain. Thus the mechanisms of 4-quinolone-resistance in these MRSA isolates involved alterations in both DNA gyrase and antimicrobial uptake and efflux.

Anti-Infective Agents↗
PubMed1995

Focal adhesion kinase (p125FAK) expression correlates with motility of human melanoma cell lines.

Focal adhesion kinase (p125FAK), a recently characterized protein localized within focal adhesion plaques, is believed to play a role in extracellular matrix-integrin-mediated signal transduction involving cytoskeletal proteins. We studied p125FAK expression, distribution, and relation to cell migration in six human melanoma cell lines. Western blot analysis detected differential expression of p125FAK among these lines that was directly proportional to the amount of phosphorylated p125FAK. Time-lapse image analysis of the cell lines exhibited 10-fold differences in the mean migration rates on fibronectin-coated substrates. Regression analysis revealed that p125FAK expression correlated significantly with mean migration rate in the six melanoma lines tested. Double immunofluorescent labeling for p125FAK and actin in these lines demonstrated p125FAK plaques that were localized to actin stress-fiber termination sites in the periphery of cells. The number of p125FAK plaques in the melanoma cell lines was heterogeneous, but the cell lines with more p125FAK plaques per cell exhibited significantly higher mean migration rates on fibronectin as compared with cell lines with fewer p125FAK plaques per cell. The findings support the hypothesis that focal adhesion tyrosine kinase modulates cytoskeletal function during melanoma cell migration on fibronectin.

Cell Adhesion Molecules↗