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Biomedical subjects

T Fukuda

Publications and source records attributed to T Fukuda.

At least 595 records · Page 33Linked to original sources
PubMed1993

[Anesthetic management of a patient with polyarteritis nodosa who suddenly developed cardiac rupture after valve replacement].

We recently encountered a patient with mitral insufficiency, accompanied by PN (polyarteritis nodosa), who developed a cardiac rupture immediately after a mitral valve replacement. The patient was a 60-year-old woman. After she was diagnosed as having mitral stenosis and insufficiency in 1968, the patient developed congestive heart failure and underwent repeated hospital admissions and discharges. In 1989, she was diagnosed as having PN and began to receive a high-dose steroid therapy (prednisolone; total dose 5245 mg). Because of transient brain ischemia and exacerbation of the symptoms of heart failure, the patient underwent mitral valve replacement on December 19, 1991. For anesthesia, oxygen, fentanyl, midazolam and vecuronium were administered. During surgery, catecholamine, nitroglycerin and prostaglandin E1 were continuously infused intravenously. The patient was weaned smoothly from the cardiopulmonary bypass. The operation was completed in about 6 hours. Her postoperative course was satisfactory until she suddenly developed left ventricular rupture and died 6 hours after surgery. The rupture seemed to be attributable to a weakening of the myocardial wall following long-term, high-dose steroid therapy, and to myocardial degeneration caused by PN-associated necrotizing vasculitis of myocardial arterioles.

Female↗
PubMed1993

[Detection of IL-5 mRNA in bronchial biopsies from asthmatics by non-radioactive in situ hybridization].

To determine whether IL-5 is locally produced in the bronchial mucosa of asthmatics, and to ascertain the precise cell type producing this cytokine, we examined bronchial biopsies by non-radioactive in situ hybridization and immunohistochemistry. IL-5 cDNA probes were labeled with digoxigenin-dUTP and hybridized to frozen or paraffin tissue sections. Hybridization signals were visualized by an immunohistochemistry technique. An IL-5-producing T cell clone derived from a patient with adult T cell leukemia was used as a positive control. Specific hybridization signals for IL-5 mRNA were observed in the bronchial mucosa of symptomatic asthmatics. No hybridization signal was detected in the control subject in whom no underlying disease was found. Immunohistochemical staining of serial sections using a panel of monoclonal antibodies directed against lymphocyte subsets strongly suggested that cells expressing mRAN for IL-5 were T cells. These results suggest that a cell-cell interaction between T cells and eosinophils through IL-5 may play an important role in the airway inflammation in asthma.

Asthma↗
PubMed1993

[Role of eosinophils and lymphocytes in the pathogenesis of bronchial asthma].

Lymphocytes and eosinophils are the two major inflammatory cells in the airways of patients with asthma. We studied the phenotypic composition and activation status of eosinophils and lymphocytes in bronchial biopsies obtained from asymptomatic and symptomatic asthmatics and nonasthmatic controls. The number of EG2-positive cells (activated eosinophils), CD3- and CD4-positive cells, and CD25-positive cells (activated lymphocytes) were significantly increased in the symptomatic asthmatics. In addition, significant correlations were noted between the density of CD4- and CD25-positive cells and the degree of eosinophil infiltration and activation. These data suggest that activated eosinophils and lymphocytes are involved in the pathogenesis of asthma and that activated helper T-lymphocytes play a central role in eosinophil infiltration and activation in the airways of asthmatics. Recently, eosinophil infiltration has been though to induce airway hyperresponsiveness by damaging airway epithelium through eosinophil granule proteins. To test this hypothesis, we investigated whether the number of clusters of desquamated respiratory epithelial cells in sputum is related to the eosinophil granule proteins in sputum and whether the ultrastructural changes in the bronchial epithelium are related to the presence of eosinophils in the bronchial mucosa. The results of both studies supported the hypothesis.

Asthma↗
PubMed1993

[Anesthetic management for cesarean section of a patient with transient diabetes insipidus and acute severe liver dysfunction].

A 26-year old woman presented with acute hepato-renal dysfunction, coagulation abnormalities and diabetes insipidus associated with hypernatremia in the latter term of pregnancy (39 weeks). Such transient diabetes insipidus during pregnancy as in this case has been reported to be resistant to AVP, but to respond to DDAVP. Because of fetal compromise, an urgent cesarean section was performed. Spinal anesthesia was chosen because of the possible deleterious effects of general anesthesia on liver function. After delivery of twin babies, her symptoms recovered gradually. In conclusion, diabetes insipidus during pregnancy as in this case is transient and disappear after delivery. However, multiple organ dysfunction may become worse and cause fetal death, unless surgical procedure with appropriate anesthetic management is performed.

Acute Disease↗
PubMed1993

[Multicenter study of the effects of sulbactam/cefoperazone on bacterial infections in the fields of internal medicine focused mainly on respiratory infections in Tochigi Prefecture].

Clinical effects of sulbactam/cefoperazone (SBT/CPZ) was studied on variety of bacterial infections in the fields of internal medicine focused mainly on respiratory infections. The total 135 infections were consisted of 103 respiratory infections, 15 urinary tract infections, 4 sepsis, 7 biliary tract infections, and 6 other infections, of which 86 patients had underlying diseases. The daily doses of SBT/CPZ were 2 to 6 g divided into 2 to 3 times i.v. or d.i.v., and the duration of administration was from 3 to 35 days. The clinical effects were judged by the attending doctors based on the changes in fever, cough, rales, chest rentogenograms, white blood cell counts, CRP values, ESR, etc. The total efficacy rate was 76.9%, and 69.0% of the isolated organism was eradicated by SBT/CPZ. The side effect was noted in 1 case, and the abnormal laboratory findings were noted in 1 case, however it was difficult to determine whether they were due to SBT/CPZ. These results suggest that the clinical usefulness of SBT/CPZ for the infections in the fields of internal medicine.

Adult↗
PubMed1993

[Multiple myeloma associated with diffuse parenchymal amyloidosis of the lung].

A 58-year-old woman was hospitalized in March, 1991, with slight breathlessness on exertion. Laboratory investigations revealed M-protein (IgG lambda type, 7,575mg/dl) in serum, and Bence-Jones proteinuria. Osteolytic bone lesions were noted roentgeno-logically. Bone marrow aspiration showed the presence of 19% of atypical plasma cells, and the case was diagnosed as multiple myeloma. The chest X-ray film showed bilateral diffuse micronodules, which were found by a transbronchial lung biopsy to be diffuse parenchymal amyloid deposits. The patient was treated with melphalan, prednisolone and interferon-alpha for 6 courses. Clinical symptoms improved but no decrease of the level of M-protein was observed. The patient is still alive without changes of pulmonary shadows on X-ray films for the past 2 years.

Amyloidosis↗
PubMed1993

[A case of angiosarcoma of the heart with cardiac tamponade and repeated hemoptysis].

A 30-year-old man who died from brain metastasis of cardiac angiosarcoma is presented. His chest X-ray film showed cardiac tamponade and bilateral pleural effusion. His symptoms were improved only by drainage of the bloody pericardial and pleural effusion. During the course of the disease, multiple nodular infiltrates were seen on chest CT and hemoptysis occurred repeatedly. He presented to our hospital. On the first night of hospitalization, symptoms including headache, vomiting and disturbance of consciousness appeared and brain CT showed suspected brain metastasis. He died on the 20th hospital day with no definite diagnosis having been established. At postmortem examination, a hen's egg sized cardiac angiosarcoma was found infiltrating the right atrial wall. Metastatic foci were found in the epicardium and bilateral lungs. This case was considered to be angiosarcoma of the heart, manifesting various clinical symptoms because of bleeding from the metastatic foci.

Adult↗
PubMed1993

High serum soluble interleukin-2 receptor concentrations in elderly individuals and smokers.

The effects of sex, age, and smoking on the serum concentrations of soluble interleukin-2 receptor (sIL-2R) were investigated in 83 healthy subjects. No sex-related difference was found. The correlation between age and the serum sIL-2R concentration was weak, but significant, in the nonsmokers (r = 0.30, n = 50, p < 0.05). The serum sIL-2R concentration was significantly higher in smokers than in nonsmokers (41.0 +/- 2.8 pM (mean +/- SEM), n = 33, vs. 31.9 +/- 1.0, n = 50, p < 0.005). These results suggest that age and smoking habits should be taken into consideration when interpreting the serum sIL-2R concentration, although the mechanism by which sIL-2R concentrations are altered remains unknown at present.

Adult↗
PubMed1993

[Leukotriene levels of Helicobacter pylori-infected gastric mucosa].

Helicobacter pylori appears to cause chronic active gastritis, which is characterized by infiltration by neutrophils. Leukotrienes (LTs), which are both chemotactic and cytotoxic, are produced mainly by neutrophils. We studied LT levels, H. pylori infection and neutrophils infiltration in gastric mucosa of patients with non-ulcer dyspepsia. LT levels of mucosa infected with H. pylori were higher than that in non-infected mucosa. There was a correlation between LT levels and neutrophils infiltration in H. pylori infected mucosa. H. pylori was sensitive to lipoxygenase inhibitor, AA-861, both in vitro and in vivo. Treatment with AA-861 decreased the severity of neutrophil infiltration. LTs may therefore be important in chronic active gastritis associated with H. pylori.

Chronic Disease↗
PubMed1993

[Inhibitory effects of oral glucocorticoid therapy on T-lymphocyte infiltration in the bronchial mucosa of asthmatic subjects].

Although one of the mechanisms of glucocorticoid action in asthma is thought to be suppression of bronchial inflammation, there is little evidence to support this view. In the present study we have attempted to clarify the effect of oral glucocorticoid therapy on lymphocyte infiltration in the bronchial mucosa. Bronchial biopsies were obtained from 9 patients with asthma who had been taking oral prednisolone for at least the previous 18 days. They were stained immunohistochemically with a panel of monoclonal antibodies against: T cell subsets (CD3, CD4, CD8, CD57), and interleukin-2 receptor (CD25). The numbers of positive staining cells were counted for each antibody and compared with those in 11 patients with asthma who were symptomatic but had not been receiving glucocorticoid therapy for at least the previous one month. There was a significant decrease in the numbers of CD3- CD4-, CD8- and CD57-positive cells in glucocorticoid treated asthmatics compared with those of symptomatic asthmatics. Moreover, when one patient who showed glucocorticoid resistance was excluded from the analysis, there was a significant inverse correlation between the dose of prednisolone expressed as the total dose for the previous 2 weeks and the numbers of CD3- and CD4-positive cells. The number of CD25-positive cells (interleukin-2 receptor-bearing cells, presumed activated T-lymphocytes) also showed a tendency to decrease but the difference was not statistically significant. These results suggest that oral glucocorticoids exert an inhibitory effect on T-lymphocyte infiltration in the bronchial mucosa, which could be a mechanism of their beneficial action in asthma.

Administration, Oral↗
PubMed1993

Tumor necrosis factor alpha induces migration of human eosinophils.

In order to evaluate the role of tumor necrosis factor alpha (TNF alpha) in the recruitment of eosinophils and neutrophils into the tissues, we studied the effect of TNF alpha on the migration of those cells in vitro, employing a modified Boyden's chamber technique. TNF alpha induced a significant migration of human eosinophils in a dose-dependent manner, and the preincubation of eosinophils with TNF alpha enhanced platelet activating factor (PAF)-induced eosinophil migration. Checkerboard analysis revealed that the eosinophil migration induced by TNF alpha was mainly due to chemokinesis. On the other hand, TNF alpha induced neither neutrophil migration nor enhancement of PAF-induced neutrophil migration. These results indicate that TNF alpha possesses a chemokinetic effect on human eosinophils and that TNF alpha augments the migration of eosinophils by PAF.

Chemotaxis, Leukocyte↗
PubMed1993

[Safety of bladder irrigation and usefulness of BLADMAN for bladder training in the patients with spinal cord injury].

First, we used BLADMAN system for bladder irrigation on 47 outpatients with spinal cord injury. A syphon phenomenon of BLADMAN was applied to irrigation of the bladder. Irrigating liquid was a physiological saline solution and its volume was 500-1,000 ml. Bladder irrigation was done for 1 to 2 hours. As a result of bladder irrigation by this system, urine was clearer and the number of leucocyte in urine was decreased. There was no trouble and no side effects occurred while using this system. BLADMAN is safe and considered to be applicable to the patients with spinal cord injury. Secondly, we used BLADMAN for bladder training to the patients with spinal cord injury. Bladder training was done for 7 to 28 days on the patients with indwelling urethral catheter. The bladder function was compared before and after training. Bladder volume and compliance were significantly improved. There was no trouble while the patients used the BLADMAN system. We consider that the BLADMAN system is one of the best methods of bladder training for the patients with spinal cord injury.

Adolescent↗
PubMed1993

[Two-chambered right ventricle--a comparison of the methods of releasing stenosis in the right ventricle].

Twenty-four patients who underwent radical correction for two-chambered right ventricle from 1973 to 1990 were classified into 3 groups according to the method used for releasing the stenosis in the right ventricle; Group A (n = 7): resection of thickened fibrous tissue; Group B (n = 13): resection of the fibrous tissue and abnormal muscular bundles; and Group C (n = 4): resection of the fibrous tissue and abnormal muscular bundles with patch-enlargement of the right ventricular outflow tract. Postoperative cardiac catheterization was performed in the 22 patients. The pressure gradient between the right ventricle and pulmonary artery (RV-PA) at rest was 10 mmHg or less in 5 out of 7 cases in Group A, 7 out of 11 cases in Group B and all 4 cases in Group C. Isoproterenol stress test was performed in patients in whom the RV-PA pressure gradient at rest was low; the right ventricular inflow pressure increased above 50 mmHg in 3 out of 3 cases in Group A and 3 out of 4 in Group B, although it remained below 30 mmHg in 4 out of 4 cases in Group C. In conclusion, patch enlargement of the right ventricular outflow tract is the method of choice for releasing stenosis in the two-chambered right ventricle.

Cardiac Surgical Procedures↗
PubMed1993

[Successful anesthetic management of a patient with a giant mediastinal tumor].

Because of its anatomical location, mediastinal tumor is frequently accompanied by airway stenosis and signs indicating compression of the heart and large vessels. For this reason, a patient with this tumor often requires an urgent operation. We recently conducted such an operation on a girl 2 year and 7 month old in whom a giant tumor originating from the posterior mediastinum had caused dyspnea. In this case, anesthesia was induced with ketamine. Intubation was carried out while the girl was semiawake. No muscle relaxants were used, and spontaneous ventilation was partially preserved. During the operation, anesthesia was maintained with oxygen, nitrous-oxide and halothane, without using muscle relaxants. Although intratracheal bleeding, caused by manipulation of the tumor, aggravated the blood gas data, this could be coped with by elevating the oxygen concentration in the inspired gas. During the operation, respiratory control with 10cmH2O PEEP was carried out to cope with atelectasis from lung compression by the tumor. The postoperative course was excellent. From anesthetic management of this case we emphasize the following points: (1) preoperative assessment of the relationship between posture and dyspnea and assessment of the locational relationships of the tumor, heart, vessels and trachea, using CT, ultrasonography, bronchoscopy, etc; (2) utilizing a pulse oximeter, monitoring CO2 in expired gas and monitoring CVP during operation; (3) avoidance of the use of muscle relaxants before the improvement of the symptoms arising from tumor-caused compression; and (4) close respiratory care after operation.

Anesthesia↗
PubMed1993

[Advance in eosinophil chemotaxis assay method--automatic count of migrated cells by the image analyzing system in the Boyden method].

Eosinophils, which are prominent inflammatory cells in the asthmatic airway, are attracted to the airway by several chemoattractants. At present, eosinophil chemotaxis is studied employing the Boyden Millipore chamber system in vitro. In the Boyden method, the number of migrated cells are evaluated by direct microscopic observation of individual cells. This microscopic procedure usually requires much time and it is difficult to obtain objective results. Therefore, we have developed a new fractional measurement technique, using the image analyzing system connected with a color video camera and a computer for counting the eosinophils which have migrated into a filter. Using this system with the Boyden method, migrated cells were observed more objectively and quickly. Therefore, this image analyzing system with the Boyden method, may be a useful technique for the fractional measurement of migrated eosinophils in a sample mixture of eosinophils and neutrophils.

Cell Movement↗
PubMed1993

[The eosinophil and bronchial asthma].

Eosinophils have been observed in and around the wall of bronchi in bronchial biopsies and in bronchoalveolar lavage fluid from asthmatics. Early studies of eosinophils suggested that they might combat inflammation induced by type I hypersensitivity reaction. However, in the past two decades new information regarding the biology of the eosinophils has been obtained. There is now increasing evidence to suggest that eosinophils may play a key role in asthma by damaging respiratory epithelium, by generating LTC4 and PAF, and by releasing cytokines. This hypothesis is supported by the recent observations of a significant correlation between airway hyperresponsiveness and the magnitude of bronchial eosinophilia, and by the several observations of a coincident occurrence of late asthmatic response and bronchial eosinophilia.

Animals↗