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Biomedical subjects

T Koh

Publications and source records attributed to T Koh.

At least 91 records · Page 5Linked to original sources
PubMed1991

Limited value of delayed radiothallium image in the diagnosis of nodular goiter.

To test whether delayed thallium image can improve the diagnostic accuracy of thyroid tumor, we have reviewed 35 patients with cold nodules of proven histopathology. Early and delayed images were taken 10-20 min and 3-4 hr postinjection, respectively. In this study, a thyroid nodule was interpreted as malignant if it had normal or increased uptake on early scan and more residual radioactivity than paranodular tissue on delayed scan. In the eighteen patients who had carcinoma, a disappointing 44% false negative rate was observed. No significant difference was seen between retention-positive and negative cases in tumor size or histological type of cancer. Nor could any demographic bias explain the low sensitivity. Of the six false negatives, macroscopic cystic degeneration was seen in two cases, but tumors in the other four were grossly solid. Considering the histological heterogeneity often seen within a thyroid tumor, the portion with increased retention of radiothallium may be too small to be detected in the false negative cases. Furthermore, 3 false positive readings were obtained in 17 patients with benign conditions. We conclude that the contribution of the delayed thallium image was quite limited in predicting or ruling out malignancy in nodular goiters.

Adult↗
PubMed1991

False aneurysm formation of the great arteries after arterial switch operation.

An infant with simple transposition of the great arteries underwent a two-staged arterial switch operation, after which mediastinal infection occurred. Continuous irrigation with povidone-iodine solution was performed for 10 days. After that, the patient experienced life-threatening hemorrhage three times. At the time of the second hemorrhage, greater omental transfer was performed. On postoperative day 109, false aneurysm was recognized, having developed from both great arteries. Successful repair was performed on postoperative day 110.

Aneurysm↗
PubMed1991

Investigations of origins of serotonergic projection to developing rat visual cortex: a combined retrograde tracing and immunohistochemical study.

The present study investigated whether the raphe neurons which give rise to the transient serotonergic fibers in the visual cortex of neonatal rats persist or disappear as the rats mature. Three experiments were performed employing the WGA-apoHRP-Au retrograde transport technique in conjunction with 5-HT or WGA-HRP immunohistochemical staining. WGA-apoHRP-Au was injected into the primary visual cortex of all rats 9 days postnatally. In the first experiment, the animals were examined after 2 days; retrogradely labeled cells were observed in the dorsal raphe nucleus (DR), the median raphe nucleus (MR), and in the B9 and B6 cell groups; the majority (82.5%) of the cells was serotonergic. In the second experiment, the examinations took place following a survival time of 8 weeks: virtually all of the original raphe-visual cortical serotonergic neurons were found to the present. In the third experiment, also performed after 8 weeks relabeling the raphe-visual cortical neurons by WGA-HRP, it was found that 37.2% of the raphe neurons which had projected to the neonatal visual cortex no longer possessed such projections.

Aging↗
PubMed1991

[Prediction of remission in Graves' disease after thionamide therapy by technetium-99m early uptake].

In the clinical management of Graves' thyrotoxicosis, one of the most important subject is when to stop antithyroid drugs after achieving an euthyroid state. T3 suppression test and other methods have been used to forecast the outcome after drug cessation, but the results were not always satisfactory. We have attempted to predict remission of Graves' disease by single measurement of early technetium uptake without administration of triiodothyronine. Drugs were discontinued in the seventy-five patients with Graves' disease on maintenance doses of either methimazole or propylthiouracil who showed normalized uptake (4.0% or less). Of 64 patients evaluable after twelve months, 55 (86%) remained euthyroid, 8 relapsed, and 1 became hypothyroid. With its accuracy in prediction of short-term remission comparable or superior to T3 suppression test, this rapid and simple method seemed suitable for routine use in clinical practice.

Adult↗
PubMed1991

Significant non-serotonergic raphe projection to the visual cortex of the rat. An immunohistochemical study combined with retrograde tracing.

The present study investigated the distribution of serotonergic and non-serotonergic raphe neurons with direct projections to the visual cortex. The study employed the WGA-apoHRP-Au retrograde transport technique combined with 5-HT immunohistochemical staining. Retrogradely labeled cells were observed in the dorsal raphe nucleus, the median raphe nucleus, and in the B9 and B6 cell groups. One notable finding was the great number of retrogradely labeled, non-5-HT immunoreactive cells. The average percentages of such cells in the various raphe regions were as follows: DR: 52% (n = 401); MR: 35% (n = 311); B9: 24% (n = 129); B6: 95% (n = 200). The present study demonstrated the presence of a significant proportion of non-serotonergic raphe region neurons projecting to the primary visual cortex in the rat. It is suggested that these neurons may complement the aminergic neurons as part of the ascending system which controls the functions of the visual cortex.

Animals↗
PubMed1991

[Mixed type cryoglobulinemia with discrepancy of platelet counts measured with an automated cell counter and by manual counting method].

We experienced an abnormal blood sample which showed larger numbers of white blood cells and platelets counted by the electric resistance system and of platelets in mechanical counting by the flow system, than those in manual counting. Many precipitates were observed in this blood sample at room temperature or 4 degrees C, but were not observed at 37 degrees C. The precipitates were clarified to be caused by the mixed type (IgA, IgG and IgM) cryoglobulin by using an immunofluorescence method and an ouchterlony method. These data indicate that precipitation of cryoglobulin at room temperature induce falsely high value of platelet count in mechanical counting systems.

Chemical Precipitation↗
PubMed1991

[A double-labeling study of serotonin neurons that project to the visual cortex of developing rat brain].

Immunohistochemical studies of developing rat brains revealed aggregation of serotonin terminal fibers in the visual cortex at from 7 to 14 postnatal days. This aggregation is transient, disappearing 2 weeks after birth. The cells of origin of these serotonin terminals were investigated using double-labeling with retrogradely transported WGA-apoHRP-Au and serotonin immunohistochemistry. WGA-apoHRP-Au was injected into the rat visual cortex on the 9th day after birth. The rats were allowed to survive for 2 days and sacrificed with perfusion. Cryostat sections of the brain were processed with silver-enhancement to develop the retrogradely transported WGA-apoHRP-Au, and then serotonin immunohistochemistry was performed. Double-labeled cells that were labeled with WGA-apoHRP-Au and serotonin-immunoreactive were found mostly in the raphe medianus and raphe dorsalis in rostral and caudal sections of the mesencephalon, respectively.

Animals↗
PubMed1991

[The early detection of metastatic differentiated thyroid cancer using 131I total body scan and treatment with 131I].

With the purpose of achieving early detection and performing 131I therapy for metastatic lesions of differentiated thyroid cancer, we studied the clinical findings in 132 patients who underwent 131I total body scanning (131I TBS) between 1981 and 1990. Metastatic lesions were detected only by 131I TBS in 24 (18%) of the 132 patients. Of the 49 patients treated with 131I for metastases, 27 (55%) underwent total thyroidectomy and then had their metastatic lesions treated by 131I less than one year later. In the remaining 22 patients (45%), the metastatic lesions were treated with 131I from 1 to 31 years (mean: 8.4 years) after the initial thyroidectomy. We determined the optimal timing of 131I TBS following radical thyroidectomy to be 3-4 weeks by sequential measurement of the serum thyroid hormones, TSH, and Tg, and determination of the 123I uptake in residual or metastatic cancer of the neck after thyroidectomy. 131I TBS with simultaneous serum Tg determination were performed in 52 patients with metastases. Scans were positive in 43 of the 52 (83%) and the serum Tg level was greater than 10 ng/ml in 46 of the 52 (88%). Serum Tg was elevated in 9 patients with negative scans, while low Tg levels were found in 6 patients with positive scans. 131I therapy was effective in 49 of the 65 treated patients (75%), including 5 cures. Two patients worsened and 6 died. These 8 patients were all older than 56 years of age. Post-therapeutic 131I TBS demonstrated unsuspected metastatic lesions in 7 patients and had a higher detection rate for metastatic lesions than diagnostic 131I TBS. We conclude that 131I TBS with simultaneous Tg determination should be performed to detect metastatic lesions in all patients following positively total thyroidectomy for differentiated thyroid cancer, and that 131I treatment should be given when positive 131I uptake is detected in metastatic or residual cancer.

Adenocarcinoma↗
PubMed1990

Thyrotoxic Graves' disease with normal thyroidal technetium-99m pertechnetate uptake.

We saw 24 thyrotoxic Graves' patients with normal thyroidal uptake of technetium-99m pertechnetate (99mTc) out of 201 untreated thyrotoxic Graves' patients seen over 4 years. The clinical and laboratory findings for these patients were studied and analysed. Thyroid uptake and scintigraphic examinations by means of 99mTc, TBII and TSab activity measurement clearly distinguished these patients from other thyrotoxic disorders (destruction-induced thyrotoxicosis and autonomously functioning thyroid lesions). Different from other disorders, these patients had not lower but normal thyroid uptake and also showed diffuse and discrete trapping into the enlarged glands. These patients had significantly smaller goiters, a lower serum thyroid hormone level, and lower TBII and TSab activity, when compared with other high 99mTc uptake groups with Graves' disease, and their condition could be easily controlled with small amounts of antithyroid drugs. Our study indicates that thyrotoxic Graves' disease with normal 99mTc uptake exists and 99mTc uptake study and TBII activity measurement is very useful for the diagnosis. The normal 99mTc uptake thyrotoxic Graves' patient might be early stage patients with general Graves' disease and their early discrimination from general Graves' patients is very advantageous for treatment and prognosis.

Adult↗
PubMed1990

Digoxin-like immunoreactivity in Chinese medicine.

Immunoreactive digoxin-like activity was observed in Chinese medicine, KYUSHIN tablet, taken popularly in Japan without prescription. The antibodies used in the assays of digoxin reacted with Chan-su, the major effective component of KYUSHIN, which contained cardiotonic steroids with similar chemical structure as digoxin. One tablet of KYUSHIN had digoxin-like immunoreactivity equivalent to 1.9, 1.5, and 72 micrograms of digoxin measured by three different commercial kits. These different equivalences may be attributed to differences in cross-reactivity of the antibody used in the immunoassays. Two healthy volunteers took two KYUSHIN tablets three times a day, a typical dose, and digoxin-like immunoreactivity reached almost 0.4 micrograms/L in 0.5 day. Therapeutic drug monitoring should be interpreted carefully in patients taking Chinese medicines, many of which contain the Chan-su component.

Cross Reactions↗
PubMed1990

Effects of repetitive administration of corticotropin-releasing hormone combined with lysine vasopressin on plasma adrenocorticotropin and cortisol levels in secondary adrenocortical insufficiency.

To examine the functioning of the hypothalamo-pituitary-adrenocortical axis in secondary adrenocortical insufficiency, we administered 100 micrograms synthetic human CRH, iv, plus 10 U lysine-8-vasopressin (LVP), im, three times daily for 3 consecutive days. The changes in plasma ACTH and cortisol levels during the administration and the response to an insulin tolerance test (ITT) conducted before and after the administration were determined. In three patients with isolated ACTH deficiency, basal plasma ACTH and cortisol levels were undetectablly low, and there was no response noted in the ITT or during CRH-LVP administration throughout the observation period. In four patients with adrenocortical insufficiency who had undergone successful transsphenoidal microadenomectomy for Cushing's disease and in six patients who had undergone curative unilateral adrenalectomy for Cushing's syndrome, basal plasma ACTH levels were low, but responded considerably to both stimulation tests. Along with the 3 days of CRH-LVP stimulation, however, neither the peak nor the time-integrated ACTH response was significantly enhanced, because of the variability of the responses among the patients. Compared with the ACTH response on the last day of CRH-LVP stimulation, the subsequent ITT tended to induce a lower ACTH response in the post-Cushing's disease patients and a higher response in the post-Cushing's syndrome patients. Regarding the plasma cortisol levels, the basal, peak, and integrated responses tended to increase daily during CRH-LVP administration. Conversely, the ITT after repetitive CRH-LVP administration induced a higher cortisol response than the test before CRH-LVP administration in the post-Cushing's disease patients. No serious complications were noted in any of the patients during or after the treatment. The present findings indicate that 1) repetitive administration of CRH in combination with LVP is a safe and valuable provocation test to examine the pituitary ACTH reserve and the integrity of the pituitary-adrenocortical axis; 2) isolated ACTH deficiency is usually due to a defect at the pituitary level; 3) with respect to adrenocortical responsiveness, post-Cushing's disease patients show a better accumulation of the provocative effect than do post-Cushing's syndrome patients; and 4) both hypothalamic and pituitary dysfunction are responsible for adrenal hypofunction in patients after hypercortisolemia, but post-Cushing's syndrome patients (especially those with a short period of hypercortisolemia) appeared to have less impairment of hypothalamic ACTH-releasing activity than post-Cushing's disease patients.

Adrenal Cortex↗
PubMed1990

A multipurpose dye laser photocoagulation system.

We modified a single argon/dye laser photocoagulator by adding two optical fibers so that it could be used with a slit-lamp microscope, an operating microscope, and with an endophotocoagulation probe. One fiber is attached to a nearby slit-lamp microscope; the other extends approximately 70 m and can be connected to either an operating microscope or an endophotocoagulation probe. An electrically-operated mirror inside the machine controls which of the two fibers the laser beam passes through. Separate control boxes for each fiber permit direct regulation of the photocoagulation process in all situations.

Argon↗
PubMed1989

[A case of congenital absence of the right coronary aortic cusp].

A 12-year-old boy with absence of the right coronary cusp underwent aortic valve replacement with a 21 mm St. Jude Medical prosthetic valve. He was known to have noncyanotic congenital heart disease at the age of 2 months. The diagnosis of aortic insufficiency was first made when he was 1 1/4 years old. Intensive medical treatment was continued while he was growing up. Cardiac catheterization was performed repeatedly at ages 3 1/2 and 7. The findings on the fourth cardiac catheterization at 12 years of age were pulmonary arterial pressure of 90/60 mmHg, left ventricular end-diastolic pressure of 25 mmHg and poor contraction of the left ventricle. Although IABP support was necessary for treatment of severe low cardiac output state in the early postoperative period, he was discharged at 1 month after operation, Now, he goes to school under anticoagulant therapy. Intensive medical care followed by elective aortic valve replacement may be a useful treatment for isolated congenital absence of the aortic valve cusp.

Aortic Valve↗
PubMed1989

[The use of omental pedicle flap for treatment in the field of thoracic surgery].

We present a series of 16 consecutive patients who underwent the omental pedicle flap method in the field of thoracic surgery. Fourteen of 16 patients were chronic empyema with bronchopleural fistulae and/or thoracic fistulae. A pedicle of omentum containing the right gastroepiploic artery was passed through a tunnel in the anterior diaphragm into the empyema cavity. It was fixed by mono-filament sutures on the bronchopleural fistulae. All but two patients were cured successfully by single-stage procedures. We also used a omental pedicle flap for mediastinal infection and reconstruction of the chest wall. We conclude that the use of omental pedicle flap is a promising method for treatment of serious infection in the field of thoracic surgery.

Adult↗
PubMed1989

[Single left coronary artery with a fistula to the right ventricle: report of a case with successful closure].

A 4-year-old boy of single left coronary artery associated with a fistula to the right ventricle was reported. Cardiac catheterization and selective coronary angiography revealed single left coronary artery with a fistula to the right ventricle. At operation, a single coronary artery arising from the left aortic sinus was present. A dilated and tortuous left circumflex branch passed to the right and anterior . This vessel terminated into the outflow tract of the right ventricle. The dilated vessel was doubly ligated at just distal portion of a acute marginal branch. The fistula to the right ventricle was directly sutured from arteriotomy. Then three small branches from the anterior descending artery terminating into the terminal portion of the dilated vessel were found and these were ligated respectively. After repair of arteriotomy, the remainder of the dilated and tortuous vessel was wrapped with a Dacron mesh for reinforcement. Postoperative course was uneventful and there were no complications.

Arteries↗
PubMed1989

[Surgical experience with a case of subaortic stenosis previously treated by patch closure of ventricular septal defect].

A patient who developed subaortic stenosis ten years after patch closure of perimembranous VSD was surgically treated. The subaortic obstruction could not relief sufficiently by the conventional transaortic maneuver. In this surgery, additional ventriculo-septoplasty (modified Konno's operation or Cooley's operation) was performed, preserving the patient's own aortic valve, because of the valve and the valvular ring diameter were almost normal. The postoperative course was uneventful. In this case, a posterior deviation of the infundibular septum and the ventricular septal patch seemed to have played an important role in the pathogenesis of the development of subaortic stenosis.

Adolescent↗