[MR angiography in the diagnosis of intracranial vascular lesions].
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Biomedical subjects
Publications and source records attributed to T Aoki.
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We examined DNA from human saliva for usage as an individual discrimination material. The whole saliva included buccal cells at 17-500 cells/microliters. The DNA in the saliva was extracted with Chelex-100, and then subjected to PCR (polymerase chain reaction) treatment. The amplification site in the DNA was the D1S80 (MCT118) locus. One microliter of fresh saliva was enough for amplification of the DNA by PCR. The electrophoresis patterns of DNA from saliva were identical with those from blood. The extraction of DNA from saliva stains on cigarette papers was also examined. In most cases (more than 90% of all cigarette papers tested), analysis for DNA typing gave satisfactory results. DNA isolated from saliva stains on human skin also gave satisfactory results. This method is highly reliable and applicalle to legal medicine.
Although congestive gastric mucosal circulation has been suggested in patients with portal-hypertensive gastropathy, whether it is due to "active" (overflow) or "passive" (stasis) congestion is not known. To answer this question, we assessed regional gastric mucosal blood flow with laser Doppler flowmetry in 57 patients with portal hypertension and 30 controls. Twelve patients had portal-hypertensive gastropathy of the antrum: in eight it was mild and in four it was severe. Portal-hypertensive gastropathy of the corpus was seen in 32 patients: it was mild in 24 and severe in 8. Thus prevalence of portal-hypertensive gastropathy was higher in the corpus than in the antrum (p < 0.01). In the antrum, gastric mucosal blood flow was significantly lower (p < 0.05) in patients with severe portal-hypertensive gastropathy (0.54 +/- 0.27 V) than in controls (1.12 +/- 0.44 V), whereas the values in patients without portal-hypertensive gastropathy (0.90 +/- 0.35 V) and with mild portal-hypertensive gastropathy (0.91 +/- 0.31 V) were not significantly different from the values in controls (p < 0.05 on one-way analysis of variance). In the corpus, gastric mucosal blood flow was significantly lower in patients with mild (0.75 +/- 0.25 V) or severe portal-hypertensive gastropathy (0.42 +/- 0.22 V) than in controls (1.16 +/- 0.37 V) (p < 0.01 and p < 0.01, respectively) whereas the value in patients without portal-hypertensive gastropathy (0.99 +/- 0.37 V) was not significantly different from values in controls (p < 0.01 on one-way analysis of variance).(ABSTRACT TRUNCATED AT 250 WORDS)
Nonasbestos fiber concentrations and fiber size distribution in autopsied lung tissues of 53 urban residents (34 males and 19 females) were analyzed by low temperature ashing-analytical transmission electron microscopy. The following findings were obtained. 1. Pulmonary nonasbestos fibers were found in all samples. Fiber consisting mainly of aluminum and silicon represented 80.0% of the total nonasbestos fibers observed. 2. The geometric mean concentration of nonasbestos fiber was significantly higher in males (47.6 x 10(6) fibers/g dry lung) than in females (18.2 x 10(6) fibers/g dry lung) (p < 0.05). This may be caused by differences in occupational exposure to nonasbestos fibers between males and females. 3. In females, the geometric mean concentration of nonasbestos fibers of smokers (34.6 x 10(6) fibers/g dry lung) was higher than that of nonsmokers (11.4 x 10(6) fibers/g dry lung), while, in males, the geometric mean concentration of nonasbestos fibers was lower in smokers (53.9 x 10(6) fibers/g dry lung) than in nonsmokers (89.1 x 10(6) fibers/g dry lung). These differences were not statistically significant. 4. The mean value for the ratio of nonasbestos fiber to asbestos concentration which ranged from 2.3 to 268 in males, and from 1.3 to 52.0 in females, was 30.1 and 20.2 respectively. 5. The mean length, diameter and aspect ratio for nonasbestos fibers were 1.01 microns, 0.103 microns and 11.3, respectively. Although nonasbestos fibers were almost equal in length to asbestos, the mean diameter of nonasbestos fibers was almost one-half of that of asbestos. Most of nonasbestos fibers (99.0%) were too small to be visible by light microscopy.
Left atrial (LA) pressure-dimension curve was constructed and the area of A-loop (AAL, in mm.mmHg) which reflected LA stroke work was measured in 14 open-chest dogs before and after saline infusion, in 14 dogs before and after propranolol administration under fixed heart rate and in 12 dogs while atrial pacing rate was increased stepwise. The peak +dP/dt of LA systolic pressure (LA +dP/dt, in mm Hg/s) and LA percent fraction shortening (LA %FS) were obtained as indices of LA pump function. The peak -dP/dt of X descent in LA pressure (LA -dP/dt, in mm Hg/s) was measured as an index of LA relaxation. From pulsed Doppler mitral flow velocities, A-wave acceleration (AC, in cm/s2), LA pre-ejection period corrected by P-wave duration (LA PEPc), and LA ejection time (LA ET) were measured. AAL, LA +dP/dt, AC, LA %FS, and LA -dP/dt increased after saline infusion (AAL; 2.2 +/- 1.6 to 5.1 +/- 3.3 (p < 0.05), LA +dP/dt; 34 +/- 16 to 52 +/- 23 (p < 0.05), AC; 320 +/- 90 to 472 +/- 98 (p < 0.05), LA %FS; 9 +/- 4 to 12 +/- 4 (p < 0.05), and LA -dP/dt; 38 +/- 28 to 60 +/- 32 (p < 0.05)) and decreased after propranolol administration (AAL; 2.9 +/- 1.9 to 1.2 +/- 0.7 (p < 0.05), and LA +dP/dt; 42 +/- 19 to 28 +/- 11 (p < 0.05), AC; 332 +/- 92 to 254 +/- 102 (p < 0.05), LA %FS; 14 +/- 5 to 8 +/- 5 (p < 0.05), and LA -dP/dt; 36 +/- 19 to 26 +/- 18 (p < 0.05)), but did not change significantly during heart rate increments. LA PEPc decreased after saline infusion (114 +/- 11 to 104 +/- 14 (p < 0.05)) and increased after propranolol administration (108 +/- 8 to 129 +/- 13 (p < 0.05)). As pacing rate was increased, LA PEPc and LA ET showed no significant changes. Both AAL and LA +dP/dt correlated significantly with LA PEPc (r = -0.76 and -0.66), but not with LA ET (r = -0.08 and -0.04). In conclusions, LA pump function was augmented by volume loading and decreased by propranolol, but unchanged by heart rate increments. These changes in LA pump function were reflected by LA PEPc, but not by LA ET. LA PEPc is a useful index of LA pump function which is not heart rate dependent.
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We report on radiation-induced valvular dysfunction in a 41-year-old woman who developed aortic regurgitation with clinical symptoms, requiring aortic valve replacement seven years after mediastinal radiation therapy for carcinoma of the breast. She was treated with cobalt radiation therapy of 4000 rads to her left mediastinum. The excised three-cuspid aortic valve was edematous and densely fibrotic without commissural fusion. Histological examination strongly suggested that the aortic valve with diffuse fibrosis, destruction of elastic fibers and bizarre nucleus in fibroblasts had been induced by mediastinal radiation therapy. To our knowledge, symptomatic radiation-induced valvular dysfunction in the aortic position has been reported infrequently, with only eleven reported cases. In this case, symptomatic aortic regurgitation was diagnosed seven years after mediastinal radiation therapy. It is emphasized that long-term follow-up is important for patients receiving mediastinal radiation therapy.
A case of a 60-year-old man associated with quadricuspid aortic valve and mitral regurgitation is reported. The aortic valve consisted of three larger cusps and a small accessory cusp situated between the right and the non-coronary cusps. The aortic regurgitation resulted from malcoaptation of the four cusps and the mitral regurgitation resulted from annulus dilatation and thickening of the anterior leaflet. The surgical treatment was performed successfully by the aortic and mitral valve replacements with St. Jude Medical valves. The patient is doing well fifteen months postoperatively. Sixteen Japanese cases of quadricuspid aortic valve which were corrected surgically are reviewed.
To decrease the incidence of ischemia in the lower limbs, we developed a new introducer sheath for IABP, which had 38 side holes (diameter; 1mm). Forty-five patients who received IABP counterpulsation support with this fenestrated sheath were compared with 108 patients in whom the ordinary nonfenestrated sheath was used. There was no significant statistical difference between these two study groups regarding age, height, weight and IABP insertion time. The frequency of ischemic episode of the lower limbs was 2.2% (one out of 45 patients) in the group with the fenestrated sheath, which was significantly lower than those with the ordinary sheath (18 out of 108: 16.7%) (p < 0.005). From these data, we deduced that this fenestrated sheath allowed more blood flow to the lower limb and was thus effective in preventing limb ischemia, particularly in patients with small caliber femoral arteries.
Magnetic resonance (MR) angiography was applied to the study of blood flow dynamics and evaluation of extracranial-intracranial arterial bypass function in patients who had received bypass surgery. Three-dimensional gradient-echo acquisitions with selective presaturation of individual vessels were used to determine the direction of blood flow. Presaturation causes signal loss within the territory supplied by the presaturated artery, without affecting vessels not coursing through the presaturation slab. The patency of arterial bypass graft could be demonstrated as properly with MR angiography as with conventional angiography. In addition to that, MR angiography with presaturation pulse clearly demonstrated the direction of blood flow and the territory supplied by arterial bypass graft. The results were correlated with those from transcranial Doppler sonography and conventional angiography. We concluded that MR angiography is a noninvasive useful method for the evaluation of dependency on post-surgical collaterals and bypass function.
The authors evaluated the cumulative dose response of pipecuronium under isoflurane anesthesia, and the efficacy as well as safety of priming principle in 52 patients who underwent elective surgery. The ED95 of pipecuronium was 34.24 +/- 5.34 micrograms.kg-1 in 10 patients and 70 micrograms.kg-1 (not equal to ED95 x 2) was used as total dose (T). The 42 patients were divided to receive either no prime or, 5%, 10%, 15% or 20% of T as a prime followed 5 minutes later by the remaining (intubating) dose. The muscle weakness in awake patients was determined after the priming doses by examining several clinical symptoms and by evaluating the effect of intubating doses on neuromuscular blockade. The priming using 10% of T provided rapid intubating conditions. However, the priming dose caused a significant incidence of symptoms of muscle weakness. Therefore, the priming principle should be used with caution.
D-penicillamine, an orally-administered chelating agent, is effective for Wilson's disease (WD). However 25% of WD patients showed serious adverse reactions to D-penicillamine cause this drug to be discontinued after months or years of treatment. For these cases, trientine-2HCl and trientine-4HCl, less toxic agents, are investigated. Three patients with WD, associated with neurological symptoms, were given either trientine-2HCl or trientine-4HCl. These patients had been on therapy with D-penicillamine. Severe adverse reactions had developed during the course of therapy, and D-penicillamine was discontinued, pancytopenia in case 1, nephrotic syndrome in case 2, and myasthenia gravis in case 3. Trientine-2HCl for case 1, and trientine-4HCl for cases 2 and 3 were instituted and continued. The neurological findings in all patients were extremely improved without side effects by trientine therapy. Though the chelating action on copper is weaker than that of D-penicillamine, it is efficient in improvement of the clinical neurological symptoms.
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A 71-year-old woman with unstable angina was admitted to our department. Upon admission, electrocardiography revealed a QS pattern in Leads V1-V3. Left ventriculography disclosed akinesis of the anterior wall and the septum. Myocardial scintigraphy with 99mTc-pyrophosphate (PYP) revealed marked accumulation (Parkey's grade III) in the anterior wall, septum and apical region. Coronary arteriography revealed stenosis (99% with delay) in the LAD #6. Based on these findings, we performed percutaneous transluminal coronary angioplasty (PTCA) on this patient. About 3 months later, the patient underwent PTCA again because stenosis had recurred. The resting 201Tl myocardial scintigram, taken immediately after the first PTCA, demonstrated complete defects in the anterior wall, septum and apical region. After the second PTCA, no stenosis was observed. About 1 year later, the wall motion returned to normal (except in part of the apical region), suggesting that this was a case of stunned myocardium. On the same occasion, the 201Tl uptake was normal except in the apical region. The present case was regarded as stunned myocardium which demonstrated marked radioactivity accumulation when examined by 99mTc-PYP myocardial scintigraphy. In the past, 99mTc-PYP has been thought to be incorporated into irreversibly impaired myocardium (e.g., in cases of acute myocardial infarction). The uptake of 99mTc-PYP into stunned myocardium has not been reported before. Thus, this case is rare and noteworthy.
Magnetic resonance (MR) images and MR angiograms (MRA) were studied in 20 childhood cases of moyamoya disease. Both MRI and MRA successfully demonstrated moyamoya vessels in the basal ganglia in all cases, with a positive but not definite correlation to the conventional angiographic findings. MRI depicted the stenotic and occlusive lesions of the carotid fork and horizontal portion of the middle cerebral artery effectively. MRA demonstrated some lesions which even MRI failed to prove, but it tended to overestimate the lesions. Post-operative state of collateral flow and the patency of EC-IC bypass graft could be evaluated as accurately with MRA as with conventional angiography, although MRA was limited in spatial resolution and evaluation of flow direction. In conclusion, MRI and MRA were considered to be useful in the diagnosis of moyamoya disease in stage 3 and 4, but less effective in the evaluation of its angiographical stage.
The three-dimensional time-of-flight (TOF) magnetic resonance angiograms (MRA) were studied to evaluate its accuracy in the assessment of the intracranial carotid occlusive lesions, collateral circulation and also the patency of extracranial-intracranial (EC/IC) arterial bypass surgery. All occlusive lesions of the intracranial major arteries seen in conventional angiograms were revealed clearly with MRA. However MRA had its practical limitation in the evaluation of the leptomeningeal anastomosis (collateral circulation) probably due to the deterioration of contrast in its slow flow and saturation effect of the magnetization. In addition to that, MRA often exaggerated the severity of the stenotic lesions, mostly in severe cases. The post-operative state of collateral flow and the patency of EC/IC bypass could be evaluated as properly with MRA as with conventional angiography, although MRA was limited in spatial resolution and evaluation of flow direction. In conclusion, MRA was considered t be a reliable non-invasive modality as a screening examination for the evaluation of the carotid occlusive disease and as the follow-up study of the post-operative patients with EC/IC bypass surgery.
Neoadjuvant chemotherapy with CDDP and UFT was performed on far advanced gastric carcinoma cases whose curative resection was impossible. These trials were carried out on 10 patients who had Borrmann 4 type carcinoma. PR was found in 6 cases, for an efficacy rate of 60% (6/10). The DNA content in gastric carcinoma was determined before and after treatment by flow cytometry. The relationship between the change of DNA ploidy pattern and effects of chemotherapy was investigated. Aneuploidy was found in 6 of 10 patients (60.0%). DNA ploidy patterns showed no correlation with effectiveness. In aneuploid cases, the group of responders showed seemingly the change of ploidy pattern, from aneuploid to diploid. In non-responders the percentage of aneuploid cells increased. In diploid cases, an accumulation of S-phase fraction was observed in the group of responders. These results suggested that DNA ploidy analysis may provide additional diagnostic criteria for better assessment of chemotherapeutic effects.