[Therapeutic effect of adenovirus-mediated transfer of the wild-type p53 gene with cisplatin].
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Adenocarcinoma↗
Biomedical subjects
T Fujiwara
Publications and source records attributed to T Fujiwara.
[Surgical correction of total anomalous pulmonary venous drainage: an adult case of successful repair].
Total anomalous pulmonary venous drainage (TAPVD) is a rare congenital cardiac anomaly. It occurs in only 1.5% of children born with congenital heart defects. But, it is one of the most common lesions necessitating intracardiac operation in the neonatal period. We have experienced a 33-year-old man with supracardiac type TAPVD who was operated upon successfully. Cardiac catheterization showed 0.35 in Pp/Ps, 3.33 in Qp/Qs and 0.11 in Rp/Rs. The left to right shunt ratio was 77%, while the right to left shunt ratio was 23%. The operation was composed of anastomosis between the left atrium and the common pulmonary vein, patch closure of the atrial septal defect, ligation of the vertical vein and tricuspid annuloplasty. The posterior approach was adopted in anastomosis between the left atrium and the common pulmonary vein. The association of a normal pulmonary vascular resistance, a large interatrial communication and absence of a pulmonary venous obstruction was considered as factors of a favorable result.
Adult↗
[Evaluation of the clinical usefulness of super dynamic 99mTc-HM-PAO SPECT in ischemic cerebrovascular disease--detection of hypo- and hyperperfusion area].
The purpose of this study is to assess the clinical usefulness of super dynamic SPECT of 99mTc-HM-PAO. Six patients with unilateral occlusion of middle cerebral artery (MCA) or internal carotid artery (ICA) in the chronic phase, and 5 patients with subacute cerebral infarction were studied. We used a ring-type SPECT "HEADTOME." Two types of collimator were used: a high sensitivity (HS) collimator for super dynamic scan and a high resolution (HR) collimator for static scan. First, the intravenous constant infusion of 99mTc-HM-PAO (925-1480 MBq) for 1 minute was started. After 30 seconds from the beginning of the injection, we performed the 12 seconds/frame super dynamic SPECT for 2 minutes. Then, the static SPECT for 10 minutes was done. For semiquantitative analyses, differential percentage of regional activity between affected and non-affected hemispheres was calculated in the 6th frame image of super dynamic SPECT and static SPECT image. In all 6 patients with unilateral occlusion of MCA and ICA, super dynamic SPECT images showed the better contrast of low perfusion areas in comparison with the static SPECT images. In 5 patients with subacute cerebral infarction who showed focal hyperactivities on static SPECT, focal hyperactivities (hyperperfusion or hyperemia) were displayed in 3 cases, whereas, focal hypo- or isoactivities (hypo- or isoperfusion) were shown in 2 cases on super dynamic SPECT. However, all patients with subacute cerebral infarction showed hyperfixation on static SPECT as compared with super dynamic SPECT. Although the image quality on super dynamic SPECT is not as high as that on static SPECT, cerebral hemodynamics would be detected with less backdiffusion of 99mTc-HM-PAO from the brain to blood, and with less accumulation of hydrophilic components in subacute infarct region. In conclusion, super dynamic SPECT in early distribution of 99mTc-HM-PAO using dedicated SPECT device might be helpful to detect cerebral perfusion close to true cerebral blood flow distribution.
Aged↗
[Thickening of the GB wall].
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Diagnosis, Differential↗
[Underlying cardiac disease in infective endocarditis].
Underlying cardiac lesions in 39 adult cases with infective endocarditis were studied. 18 cases (46%) of the patients had no evidence of preexisting cardiac disease and infection frequently involved aortic valve. The patients without preexisting cardiac disease and 4 patients with an intracardiac substitute including pacemaker lead and aortic valve prosthesis required a surgery during an active infective endocarditis. All cases of active infective endocarditis accompanied with rheumatic valvular disease underwent surgery after a suppression of active inflammation by medical treatment.
Adult↗
[Long-term results of emergency coronary artery bypass grafting].
During a 20-year period, 364 patients underwent coronary artery bypass grafting (CABG) for the treatment of ischemic heart disease. Among these patients, 28 underwent emergency surgery. The reasons for performing emergency CABG were unstable angina in 15 patients, impending myocardial infarction in 12 patients, and congestive heart failure in 1 patient. Eleven patients died postoperatively. Eight variables were examined by univariate analysis for their influence on the occurrence of a hospital death. IABP and acute coronary occlusion were found to be predictors of hospital death and previous myocardial infarction was a predictor of hospital survival. Seventeen patients were followed up for 12 years. There was no cardiac death and actuarial survival at 12 years was 63%. The 14 survivors are now in NYHA functional class I or II. Although the operative mortality rate is high after emergency CABG, the patient's prognosis is good.
Adult↗
[Development of simple on-line [oxygen-15]water infuser].
A [15O]water production and infusion system was newly developed for blood flow study with positron emission tomography. The system utilizes a electrostatic cooling unit to liquify [15O]vapor in a coiled plastic tube. Labeled [15O]water is collected into an infusion syringe by a wash of the trapping tube with saline. The system is simple and efficient; the recovery rate of [15O]water is over 90% at 10 degrees C of cooling temperature.
Cerebrovascular Circulation↗
[A case of tricuspid and mitral valve replacement for incomplete endocardial cushion defect].
A 56-year-old female who was diagnosed incomplete endocardial cushion defect, underwent closure of ostium primum defect and repair of mitral cleft 2 years ago. Mitral and tricuspid ring annuloplasty was done 9 months after the first operation because of an increment of mitral and tricuspid valve regurgitation. The Third operation, mitral valve replacement by mechanical valve and tricuspid valve replacement by bioprosthetic valve, was performed because of the gradually increased mitral stenosis and tricuspid regurgitation. Post-operative course was uneventful. Resected anterior cusp of mitral and tricuspid valve revealed hypertrophy and shortness macroscopically, and revealed fibrosis and calcification histopathologically. It was considered that remarkable regurgitation was due to secondary change of both valves. We concluded that valve replacement should be performed for case of secondary change of atrioventricular valve in adult patient.
Endocardial Cushion Defects↗
[Regional distribution of the muscarinic cholinergic receptor in the human brain studied with 11C-benztropine and PET using an anatomical standardization technique].
We measured regional distribution of the muscarinic cholinergic receptor in the normal human brain with 11C-benztropine (BZT) and positron emission tomography (PET) using an anatomical standardization technique. Seven normal volunteers who gave informed consents were involved in this study. Immediately after intravenous injection of 11C-BZT into the subjects, we started dynamic PET scanning and serial frequent arterial blood sampling. Analyses of plasma metabolites were also performed at selected time points and plasma time activity curves (TAC) of unmetabolized ligand were generated. From these PET and TAC data, we obtained Patlak plot slope calculation images. Using the HBA (human brain atlas) system, the Patlak plot slope calculation image of each subject was transformed into the shape of the standard brain. Mean and standard deviation (SD) calculation images were generated from those anatomically standardized images. On these mean and SD images, we placed regions of interest which were previously outlined on a MR image of the standard brain. From those data, we found the highest receptor distribution in the striatum and occipital cortex, as well as high distribution in the frontal, parietal, and temporal cortices, which were consistent with previous reports. These results suggested that anatomical standardization of PET receptor images with 11C-BZT will be useful for delineating the physiological or pathological alterations of the muscarinic cholinergic receptor in the human brain.
Adolescent↗
[Effect of aprotinin on endothelial cell functions during cardiopulmonary bypass].
Fourteen patients undergoing cardiac or great vessel surgery using cardiopulmonary bypass (ECC) were divided into two groups. Group A of 7 patients received 2 x 10(6) units of aprotinin (apr) 15 min before ECC and 0.5 x 10(6) unit immediately after the ECC. Group B of 7 patients received 0.5 x 10(6) unit of aprotinin 15 min before ECC and 2 x 10(6) units immediately after the ECC. Several physiological parameters were measured two hours before ECC, immediately after the cessation of the ECC and 4 hours thereafter. No difference was noted in coagulation time, which remained within normal range, and postoperative hemorrhage between the groups after ECC. Although thrombomodulin, ELAM-1 and ICAM-1 tended to decrease slightly in the two groups immediately after ECC, recovery of the thrombomodulin was much more rapid in the A group than in the B group. On the other hand, blood endothelin level and von Willebrand factor activity were elevated progressively after the ECC. Blood granulocyte-elastase activity and IL-8 increased markedly immediately after the ECC and then tended to decrease. These data indicate that no marked damage would be caused on the endothelial cells during ECC which was carried out using a relatively small dose of apr. However, the protective effect of apr remained to be clarified in the future.
Adult↗
[Optimum dose study of cefozopran in the pediatric field].
Cefozopran (SCE-2787, CZOP) was administered to patients with pediatric infections three to four times daily by intravenous injection or 30-minute intravenous drip infusion, and investigations were made in individual cases, on relationships among doses, pharmacokinetics, effects on pathogenic bacteria and MIC against them, and clinical effects. The following results on optimal doses of CZOP were obtained. 1. Clinical cases in which CZOP was administered at a dose of 10 mg (potency)/kg The subjects were 7 patients including 4 patients with pneumonia. Severities of the diseases were severe in one of the patients with pneumonia, and moderate in the other patients. The MIC against pathogenic bacteria (4 strains) isolated from these cases ranged from 0.2 to 1.56 micrograms/ml. The serum concentrations were in a range between 1.4 and 7.6 micrograms/ml at 4 hours after administration. In some cases, the serum concentrations were lower than the MICs, though slightly. In the clinical evaluation, CZOP was excellent in 3 cases, good in 2 cases and fair in 1 case. The evaluation was impossible in 1 case. The efficacy rate was 83.3% (5/6). In bacteriological evaluation, 3 out of the 4 strains disappeared. Adverse reactions and abnormal laboratory test values were not observed. 2. Cases in which CZOP was administered at a dose of 20 mg (potency)/kg The subjects were 5 patients including 2 with pneumonia, and severities were severe in one of the patients with pneumonia, and moderate in the other patients. The MICs against the pathogenic bacteria (3 strains) isolated from these cases ranged from 0.1 to 1.56 micrograms/ml. While, serum concentrations at 4 hours after administration were in a range between 3.0 and 7.7 micrograms/ml sufficiently exceeding the MICs. In the clinical evaluation, CZOP was excellent in 1 case and good in four cases, with an efficacy rate of 100% (5/5). In the bacteriological evaluation, all the 3 strains disappeared. No adverse reactions were observed, but an abnormal laboratory test value showing eosinophilia was noted in one case. 3. Cases in which CZOP was administered at a dose of 40 mg (potency)/kg The subjects were 5 patients including 3 with pneumonia. The severity was moderate in 2 of the pneumonia patients, and severe in the other three cases. The MICs against the pathogenic bacteria (4 strains) isolated from these cases were in a range between 0.1 and 0.78 micrograms/ml. The serum concentrations at 4 hours after administration ranged from 6.5 to 21.9 micrograms/ml, sufficiently exceeding the MICs. In the clinical evaluation, CZOP was excellent in 4 cases and good in 1 case, with an efficacy rate of 100% (5/5). The efficacy rate in the bacteriological evaluation was also 100%. As adverse reaction, red urine was observed in one case. Eosinophlia was noted in one case in the laboratory tests. When CZOP was administered to patients with pediatric infections at a dose of 10 mg (potency)/kg, the clinical effect of the drug was insufficient in a case in which serum concentration of CZOP at 4 hours after administration was lower than the MICs against the pathogenic bacteria. When CZOP was administered at a dose of 20 mg (potency)/kg, sufficient concentrations were obtained, and the drug efficacies were found to be excellent or good in all cases. Therefore, the effective dose normally used is considered to be 20 mg (potency)/kg. When CZOP was administered at a dose of 40 mg (potency)/kg, the drug was found to be excellent or good in all of the cases although the severities were high in more than half of the cases tested. In addition, the rate of excellent efficacies was 80% (4/5). Furthermore, no severe adverse reactions were observed. It was, therefore, confirmed that CZOP should be administered at a dose of 40 mg (potency)/kg in severe or intractable cases.
Bacterial Infections↗
[Molecular aspects of pulmonary surfactant in neonatal respiratory distress syndrome and surfactant replacement therapy].
A success in surfactant therapy for neonatal respiratory distress syndrome in Japan in 1980 has led to the introduction of scientific randomized controlled trials on the one hand, and a great interest in the constituents of the exogenous surfactant on the other. It contains 2% hydrophobic surfactant proteins B and C that are now known to be critical components in surface-active properties of lung surfactant. The application of molecular biology has fostered rapid progress in the elucidation of the structure, function and metabolism of the surfactant. The introduction of surfactant therapy has had a major impact on neonatal mortality and morbidity. Although various surfactant preparations are already in the market and a new generation of totally synthetic surfactant is under clinical evaluation, further studies are required to address the issue regarding optimization of surfactant therapy.
Biological Products↗
[Analysis of proliferating cell nuclear antigen (PCNA) expression in brain tumors].
The expression of PCNA in brain tumor cells was measured in vitro and in situ by using an electrophoretical immunoblotting method and an immunohistochemical staining method. In synchronized C6 rat glioma cells, PCNA were almost parallel to the S phase, although the small amounts of PCNA were expressed in G1 and G2 x M phases. In astrocytic tumors from operative tissues, immunohistochemical PCNA positive rate increased significantly with increasing tumor grade. PCNA positive rate of recurrent meningiomas was also significantly higher than that in nonrecurrent meningiomas. These findings suggest that the PCNA is associated with the cell cycle, especially the S phase and immunohistochemical staining of PCNA is useful to evaluate the proliferating activity of a brain tumor. Immunoblotting method would also be helpful for the exact analysis of proliferating activity in brain tumor cells.
Animals↗
PET study of cerebral glucose metabolism and fluorodopa uptake in patients with corticobasal degeneration.
We measured cerebral glucose utilization and fluorodopa metabolism in the brain of patients with corticobasal degeneration using position emission tomography. The clinical pictures are distinctive, comprising features referable to both cerebral cortical and basal ganglionic dysfunctions. Brain images of glucose metabolism can demonstrate specific abnormalities with a marked asymmetry in the parietal cortex (the primary motor and sensory cortex and the lateral parietal cortex), the thalamus, the caudate nucleus and the putamen of the dominantly affected hemisphere related to clinical symptoms in six patients. [18F]dopa uptake also reduced in an asymmetric pattern, both the caudate nucleus and the putamen in four patients. This unique combination study measuring both cerebral glucose utilization and fluorodopa metabolism in the nigrostriatal system can provide efficient information about the dysfunctions which are correlated with individual clinical symptoms.
Aged↗
Impact of antibodies to leukocyte function-associated antigen-1 and intercellular adhesion molecule-1 on fetal bowel allo- and xenotransplantation in mice.
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Animals↗
[Result of surgery for aneurysms of distal aortic arch and proximal descending aorta].
We examined the surgical result for non-dissecting aneurysm of distal aortic arch and proximal descending aorta, for which aneurysm, proximal aortic clamp cannot be set at descending aorta because of the proximal progression of aneurysm. In 25 cases out of all 46 cases for 18 years, before 1990, aortic arch was clamped for proximal aortic control with the aid of temporary bypass, femoral artery-vein bypass or left heart bypass (clamp group). In 10 cases proximal aortic clamp was set between innominate and left common carotid artery and in 15 cases between left common carotid artery and left subclavian artery. In the former, temporary or permanent bypass was made to left common carotid artery. After 1990, in 21 cases, aortic arch was not clamped with the aid of separate cerebral perfusion (no clamp group). In the comparison of surgical result between two groups, no clamp group showed less postoperative complication rate in brain damage (28% vs 14%) and bleeding (16% vs 5%) and showed better operative mortality (20% vs 14%) and better hospital mortality (32% vs 19%). Now, in the surgery for non-dissecting aneurysm of diatal aortic arch and proximal descending aorta, it is preferable not to clamp aortic arc, employing separate cerebral perfusion.
Adult↗
[Surgical treatment for tetralogy of Fallot with pulmonary atresia right ventricular outflow tract reconstruction with autologous pulmonary tissue and concomitant extensive pulmonary angioplasty].
Eight consecutive patients with tetralogy of Fallot associated with pulmonary atresia successfully underwent corrective surgery without using an extracardiac conduit at a mean age of 2 years 4 months. Each of these patients had undergone a classical or modified Blalock-Taussig shunt at a mean age of 55 days. In 6 cases, central PA was fully mobilized and pulled forward. An autologous flap was made from the rudimentary PA trunk or right PA, then it was anastomosed to the endocardium of RV infundibulum as a posterior wall of the outflow tract. In 7 cases, concomitant extensive pulmonary angioplasty was performed on stenotic and under-developed lesions which were caused by tissue contraction of the PDA. During follow up period from 11 to 25 months, all patients have remained in good condition without restenosis of the RVOT. The mean pressure ratio of RV over LV measured 0.42 in 5 patients who underwent catheterization after operation. We conclude that these procedures are useful for early corrective surgery of tetralogy of Fallot with pulmonary atresia.
Angioplasty↗
Ischemic and reperfused myocardium detected with technetium-99m-nitroimidazole.
UNLABELLED: To evaluate the utility of 99mTc-labeled nitroimidazole (BMS) in the detection of ischemic or reperfused myocardium, we performed dual-tracer autoradiography with BMS and [125I]iodoantipyrine (IAP). METHODS: In open-chest rats, the left coronary artery was ligated to produce 15- or 60-min ischemia followed by reperfusion or 60-min ischemia without reperfusion. BMS was injected just before ligation, 1 min before reperfusion or 15 min after reperfusion. RESULTS: In the area at risk, regional myocardial blood flow (rMBF) evaluated by IAP recovered to the level in the nonischemic septum in all hearts, except in 60-min occlusion without reperfusion. In myocardium reperfused after 15-min ischemia (stunned), normalized BMS uptake (%BMS) in the area at risk was significantly increased only when BMS was injected before ischemia. When BMS was injected before 60-min ischemia or just before reperfusion, %BMS was significantly higher at the marginal zone of infarction than in the infarcted area. In contrast, %BMS was significantly lower in the infarcted area when BMS was injected during reperfusion. After 60 min of occlusion without reperfusion (permanent occlusion), rMBF in the area at risk was significantly decreased as was %BMS. In the peripheral zone of the area at risk, rMBF was significantly reduced, but %BMS was significantly increased. CONCLUSION: BMS images stunned myocardium only when it is injected before ischemia, while it images the area at risk subjected to prolonged ischemia when it is injected up to the time of reperfusion. The infarcted area can be negatively visualized when BMS is injected after reperfusion.
Animals↗