[Franco-Japanese comparison in national schemes for international medical cooperation from a viewpoint of Medecins sans Frontieres].
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Disasters↗
Biomedical subjects
T Kondo
Publications and source records attributed to T Kondo.
[Neural control of tracheal smooth muscle during cough].
Contraction of tracheal smooth muscle during mechanically induced coughing was studied in dogs. Recordings of smooth muscle tension were obtained from the cervical trachea, which is not influenced by intrathoracic pressure. We observed that during breathing at rest, tracheal smooth muscle contracts and relaxes in synchrony with phrenic nerve activity. When cough occurs, the tracheal smooth muscle contracts continuously and tonically with no rhythmic correlation to phrenic nerve activity. Sometimes the contraction starts before the phrenic nerve activity increases. A neuromuscular blocking agent caused a significant decrease in phrenic nerve activity in response to mechanical stimulation. The correlation between phrenic nerve activity and tracheal smooth muscle tension during normal breathing was also observed after afferent inputs from pulmonary mechanoreceptors were interrupted. During coughing, however, this correlation was lost. From these results we conclude that the neural control of tracheal smooth muscle is at least partially independent of phrenic nerve activity during coughing. Because coughing was attenuated by neuromuscular blocking agents, we speculate that there is a positive feedback mechanism from receptors in the chest wall or airway, which increases the magnitude of coughing.
Animals↗
[Problems in chemosensitivity testing].
Although chemotherapy is promising as one form of treatment within its field, its therapeutic benefit has yet to be fully utilized because drug sensitivity tests have not been sufficiently used as predictors of response. The currently available prediction accuracy of drug effectiveness is said to be in the range of 60-69%, while the prediction of their ineffectiveness is reportedly 91-97%. The elimination of ineffective drugs is an issue of crucial importance because the side effects of carcinostatic agents are severe. It has been argued that in vivo effects cannot be accurately predicted on the basis of in vitro results for a variety of reasons. There are the roles played by the route of administration, intra-cellular distribution and clearance. In addition, there are also the roles of pharmacokinetics, structural factors related to spheroidal tumors, variations of the micro-cellular environment and so forth in the in vivo situation. To date, a short-time clinical usefulness of sensitivity tests has been reported, but whether there is predictive value for longer-term survival remains to be elucidated.
Animals↗
[Chemosensitivity test with endoscopic biopsy specimens].
In SDI test using tetrazolium salt, we compared MTT with XTT, which has been recently developed and is more sensitive than MTT. Further, a chemosensitivity test with endoscopic biopsy specimens using XTT was conducted. The reproducibility of the MTT assay was assessed under various conditions. The I.I of MTT assay did not vary according to type or concentration of anticancer drugs and the biopsy site of specimens. Then MTT and XTT assay were compared, revealing the results of these 2 assays were significantly correlated. Thus, XTT assay was performed with tissues from surgical specimens using biotome. Of the 16 specimens subjected to XTT assay, 6 showed an OD value of 0.100 or more, which was well within assessment. XTT assay was also performed in biopsy specimens from patients using a biotome manipulated under endoscopic guidance before operation. Three among 6 specimens showed an OD value of 0.100 or more. Our findings have demonstrated that the SDI test using XTT can be used for the chemosensitivity test, even when these specimens contain a relatively small number of cells collected using a biotome.
Animals↗
[Efficacy and assessment of patient education as related to morbidity from asthma].
Asthmatic patients are sometimes ignorant of their treatment and of the pathophysiology of their disease. In such patients, anxiety about the disease may worsen their condition. We studied the effects of an educational program for bronchial asthma. In 45 patients, the Severity of Asthma Scores before and after the program were measured. Sixty percent of the patients were assessed as "improved". On self-administered questionnaires concerned with asthma, most of the patients indicated that the program significantly improved their condition, reduced apprehension about the disease, and increased their trust in the hospital. In 24 patients, three psychological tests were done. Results of the comprehensive asthma inventory indicated that the program was useful for dependent and self-disciplined patients, but was not useful for resigned and depressed patients. The Y-G test showed that most of the patients who were helped by the program were introverted. Results of the Edwards Personal Preference Schedule revealed a difference in desire between the group that benefitted from the program and the group that did not. These results suggest that each group had a certain inclination toward psychogenic symptoms. Therefore, psychological tests are useful for predicting the effects of education. In conclusion, educational programs for patients with bronchial asthma may affect morbidity from asthma. Possible mechanisms include relief of anxiety about the disease and improvement in the patient's compliance with prescribed therapy.
Anxiety↗
[A 65-year-old woman with dysarthria, dysphagia, weakness, and gait disturbance].
We report a 65-year-old woman with progressive dysarthria, dysphagia, weakness, and gait disturbance. The patient was well until 59 years of age (January of 1986) when she noted bilateral ptosis. One year later, she noted a gradual onset of difficulty in speech (articulation). Her speech slowly deteriorated and she noted weakness in chewing power and difficulty in swallowing in addition. In October 1987, she developed emotional incontinence. In January of 1988, she started to drag her left foot. She was admitted to our hospital on June 13 of 1988. On admission, she was alert and general physical examination was unremarkable. Neurologic examination revealed no dementia; her higher cerebral functions appeared intact. Ptosis was present bilaterally more on the right. She showed difficulty in opening her eyes on command; no contraction of the frontal muscles was seen upon attempted eye opening. There was a moderate limitation in the vertical gaze. Forced laughing and crying were seen. Facial muscles were moderately weak without apparent atrophy. The movement of the soft palate was very weak, and swallowing disturbance was more prominent for liquid staff. The tongue appeared somewhat small, however, no fasciculation was noted. Her step was small and the posture was stooped. Retropulsion was present, however, Romberg's sign was absent. No muscle atrophy was apparent, however, diffuse mile to moderate muscle weakness was noted in all four limbs. Cerebellar sign was absent. Deep tendon reflexes were exaggerated bilaterally, and Babinski sign was present on the left side. Sensation was intact. Routine blood tests were unremarkable as was a cranial CT scan. Her ptosis did not improve after 10 mg of edrophonium injection. CSF was also normal. She was transferred to another hospital but her neurological disabilities further progressed. In 1989, she was totally unable to move her limbs; she could only move her eyes; still consciousness was clear without dementia. She developed respiratory difficulty and expired on July 25, 1992. She was discussed in a neurological CPC, and the opinions were divided into ALS and primary lateral sclerosis (PLS). The chief discussant arrived at the conclusion that the patient might have had the pyramidal form of ALS. Postmorten examination revealed marked myelin pallor in the anterior as well as lateral corticospinal tracts. Pyramidal tract degeneration was prominent starting at the level of the cerebral peduncle and was continued to be seen until the level of lumbar cord. The number of anterior horn cells showed only slight decrease in the cervical level, however, it was normal in the lumbar cord.(ABSTRACT TRUNCATED AT 400 WORDS)
Aged↗
[Cost benefit analysis of care of low-birth-weight infants].
A model for cost-benefit analysis of medical care of low-birth-weight infants was proposed in order to evaluate its economic efficiency using the notion of an expected value, routinely used in economics. The expected cost and benefit when a low-birth-weight infant is born were calculated and compared. Cost includes the hospital charges and the charges for long-term care of a handicapped survivor. Benefit includes the present value of lifetime earnings. Benefit/Cost Ratio was selected as a criterion to determine efficiency, with values exceeding 1 representing the case where the expected benefit exceeds the expected cost, meaning a net economic gain. Actual values were substituted in the model for cost-benefit analysis of care of very-low-birth-weight infants. Benefit/Cost Ratios corresponding to various birth weights were calculated, and the break-even point was found to be about 800 g, which was consistent with several former reports. However sensitivity analysis indicated that Benefit/Cost Ratio was affected greatly when either the discount rate or charges for long-term care of a handicapped survivor was changed. A net economic loss would be attributable to the higher incidence of sequela corresponding to very-low-birth-weight, which would suggest that to enhance economic gain investment in care for increasing the rate of intact survivals is essential. Further study is required to define adequate values, and to determine the grade of handicap as well as lifetime earnings.
Cost-Benefit Analysis↗
[Clinical characteristics and outcome of 508 patients with hyperventilation syndrome].
The characteristics of hyperventilation syndrome (HVS) were studied in 508 patients who visited our hospital over 11 years. Information regarding symptoms and laboratory data was collected from the clinical records, and outcome was surveyed with a questionnaire mailed to all patients. Patients with acute HVS ranged in age from 5-85 years, and acute HVS was particularly prevalent among women in their late teens. Triggers of HVS included anxiety, nausea & vomiting, and fever due to the common cold. The primary symptoms were dyspnea and numbness, but these differed from the symptoms that appeared during a provoked attack, Half of the patients had no underlying disorder, but the others were suffering from neurosis, cardiovascular disorders, or other diseases. These characteristics of acute HVS did not differ from those seen in patients in whom the diagnosis of HVS was confirmed with arterial blood gas analysis. Half of the patients recovered without treatment, and the others underwent paper-bag rebreathing or intravenous infusion of sedatives. The prevalence of chronic HVS was 2% and almost all those patients were middle-aged women. In contrast, the questionnaire revealed that half of the patients had repeated HVS attacks. In 10% of the patients, these attacks persisted for more than 3 years. Many of these patients reported that they sighed frequently and felt air hunger while in remission. These findings were compatible with the criteria for chronic HVS. Therefore, it may be possible to diagnose HVS from symptoms alone, without hyperventilation provocation tests. In conclusion, these data underscore the importance of clinical symptoms in the diagnosis of HVS.
Adolescent↗
[Long-term analysis of hypertension in men by job type].
Health education intervention for hypertension require the assessment of hypertension. Risk factors for developing hypertension in Japanese workers were evaluated by the type of occupation: manager, office worker, salesperson, blue-collar worker, and engineer. A cohort of 2,257 male subjects, aged 21 through 63 years, who were normotensive, diastolic blood pressure less than 90 mm Hg and systolic blood pressure less than 140 mm Hg in the initial year, were followed for 15 years to observe the occurrence of hypertension. Hypertension was defined as a systolic blood pressure (SBP) of 160 mm Hg or higher and/or a diastolic blood pressure (DBP) of 95 mm Hg or higher, or the initiation of antihypertensive therapy. Eight risk factors related to hypertension (age, body mass index, cigarette smoking, job characteristic, alcohol consumption, stress, SBP, and DBP) were selected for analysis using Cox proportional hazards models. Stepwise model was utilized to incorporate risk factors for each type of occupation (p < 0.05). The following results were obtained: 1. The incidence of hypertension over 15-year analysis was 29.3% for the total male subjects. 2. Each type of occupation had a different pattern of risk factors for hypertension. 3. Blood pressure at baseline showed a significant association in all types of occupation, indicating a stronger relationship with hypertension than other factors. 4. Stress and age were significantly associated in managers, salespersons, and blue-collar workers. 5. Body mass index and alcohol consumption were significantly associated in salespersons. 6. Cigarette smoking was significant in managers and blue-collar workers, with the hazard ratio in managers being greater than 1 (1.66, 95%CI 1.06-2.60) but less than 1 in blue-collar workers (0.31, 95%CI 0.15-0.67). 7. In all types of occupation, job characteristic failed to reach statistical significance. Work-site primary prevention of hypertension should be performed specifically considering type of occupation. Individual risk assessment and lifestyle modification are potentially important tools for health education in the work-site and by applying this model to primary preventive care, appropriate preventive activities specific to an individual may be developed and provided.
Adult↗
Relationship between coronary angioscopic and intravascular ultrasound imaging and restenosis.
In order to investigate the relationship between restenosis and the morphology detected by coronary angioscopy (CASC) and introvascular ultrasound imaging (IVUS), 17 patients were detected by CASC and IVUS immediately and 3 months after percutaneous transluminal coronary angioscopy (PTCA). The results showed that the dilation index by IVUS (DIu) was significantly lower in restenosis patients than in non-restenosis patients (0.42 +/- 0.08 versus 0.78 +/- 0.16, P < 0.01) and that the elastic recoil (ER) was higher in restenosis patients than in non-restenosis patients (4.51 +/- 1.42 mm2 versus 1.63 +/- 1.20 mm2, P < 0.01), and that the elastic recoil rate (ERR) was also higher in restenosis patients than in non-restenosis patients (57.3 +/- 8.07% versus 21.80 +/- 16.84% P < 0.01), and that coronary dissection, atheromatous plaque and calcification as well as the colour of inner coronary artery had no relation with chronic restenosis. In conclusion, the elastic recoil is one of the important factors of chronic restenosis after PTCA.
Aged↗
Retrospective investigation of medico-legal autopsy cases involving mentally handicapped individuals.
Mentally handicapped individuals were involved in some way in 64 (17.7%) of the total of 362 medico-legal autopsy cases during the past 13 years. Among these 64 cases, 32 were suicides committed by mentally handicapped persons (18 males and 14 females). The most common method of suicide was drowning (65.6%). Five cases were homicides suddenly and unexpectedly committed by mentally handicapped persons. In four of the five cases, the victim was a member of the assailant's family; this was considered to be a characteristic of homicides committed by mentally handicapped persons. On the other hand, there was only one case in which a mentally handicapped person was victimized, that of a 34-year-old female with schizophrenia who was strangled by her mother. In 19 cases, infanticide was committed by mentally handicapped mothers ranging in age from 17 to 40 years old; approximately 80% of the infanticide victims were infants of less than 6 months, and this was the age range most at risk of victims. There were two cases involving either double suicide or murder followed by suicide; in one case, the 45-year-old mother of a mentally handicapped 18-year-old son with congenital hydrocephalus set fire to her own house, and both perished in the fire, and in the other, a 65-year-old schizophrenic female fatally stabbed her neighbor, a 68-year-old female, and then she also cut herself fatally. There were three cases in which mentally handicapped individuals died due to freezing, and one in which an epileptic died suddenly due to status epilepticus. In order to prevent these tragic events, at first, it is necessary to much better understand the circumstances of the mentally handicapped individuals and their families without prejudices against them. The authors propose that a more comprehensive psychiatric medical care including the following systems should be established in Japan: 1) Day care for the mentally handicapped person, especially after the discharge as well as during admission, and support for their relatives, 2) Therapeutic drug monitoring to assess the effective level of psychotropic drugs and to suppress the side effects in the patients receiving the psychotropic drugs for a long time.
Adolescent↗
A case of Fabry's disease with granulomatous interstitial nephritis.
A 15-year-old boy with proteinuria and hematuria is reviewed in this study. He was first found to have urinary abnormalities at the age of 13 years, and his renal function was exacerbated for a short duration. Renal biopsy was performed to make a histological diagnosis and to establish adequate therapy. Light microscopy showed marked tubulointerstitial inflammation with granulomatous changes, and electron microscopy revealed that numerous osmiophilic inclusions were present in podocytes, mesangial cells, and endothelial cells of the glomeruli and in epithelial cells of the tubules. The alpha-galactosidase activity of lymphocytes from the patient was measured, and the results of this assay indicated that the patient's lymphocytes had a low level of alpha-galactosidase activity. Therefore, the patient was diagnosed as having Fabry's disease with renal dysfunction. This study demonstrated that the onset age of renal insufficiency in Fabry's disease may be earlier than that described previously, and that when granulomatous interstitial nephritis is developed, renal function may deteriorate progressively.
Adolescent↗
[Evaluation of drug sensitivities to gastric cancers by SDI test--study of quality control of SDI test by simulation test].
For the purpose to evaluate the feasibility of SDI test, a drug sensitivity test, against resected gastric cancer, a multiinstitutional study consisted of multiple institute, the 16th specified study was planned by Japanese Foundation for Multidisciplinary Treatment of Cancer. SDI test was performed individually in 15 institutes in Japan using surgically resected specimens from the patients with gastric cancer. The strict quality control was necessary to unify the method and the technique of this test in 15 institutes. Tumor bearing nude mice were delivered to each institute and the test was performed simultaneously. The data of test were sent by personal computer to Department of Surgery II Nagoya University. These data were estimated by two factors. One is the deviation of data in one institute and the other is the deviation of data among 15 institutes. This simulation test was continued through this study, 4 institutes could not pass this simulation test but the data from other three institute indicated excellent uniformity.
Animals↗
[Effect of surfactant replacement therapy on neonatal mortality rates in Japan].
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Humans↗