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Biomedical subjects

T Konishi

Publications and source records attributed to T Konishi.

At least 55 records · Page 3Linked to original sources
PubMed2001

Primary cardiac angiosarcoma detected by magnetic resonance imaging but not by computed tomography.

A 51-year-old man with a primary angiosarcoma of the right atrium is reported. The angiosarcoma was not detected by transthoracic echocardiography or computed tomography, but magnetic resonance imaging and transesophageal echocardiography did show the tumor of the right atrial free wall. We performed a transvenous endomyocardial biopsy of the tumor under the guidance of transesophageal echocardiography and made the pathological diagnosis. This case demonstrates the advantage of magnetic resonance imaging and transesophageal echocardiography for tumor detection over transthoracic echocardiography and computed tomography and the usefulness of transesophageal echocardiography for guiding the right atrial endomyocardial biopsy procedure.

Biopsy↗
PubMed2001

Relationship between papillary muscle size and benefit to cardiac function in mitral valve replacement with chordal preservation.

BACKGROUND AND AIM OF THE STUDY: Mitral valve replacement (MVR) with chordal preservation in patients with chronic mitral regurgitation (MR) has been reported to maintain systolic function of the left ventricle. However, the benefits of MVR with chordal preservation are not always predictable. The study aim was to ascertain the influence that papillary muscle (PM) size has on cardiac function after MVR with chordal preservation. METHODS: Postoperative regional shortening and its relationship with PM size were investigated by two-dimensional echocardiography in 18 patients who underwent MVR with chordal preservation, and nine patients without chordal preservation between 1986 and 1998 at Tenri Hospital. The PM cross-sectional area was measured in each patient, as well as postoperative fractional shortening (FS) of the septolateral, anteroposterior and vertical dimensions of the left ventricle. The technique of preserving all chordae tendineae involved reattaching the anterior leaflet chordae to the mitral annulus near each commissure. RESULTS: Postoperative FS of the septolateral and anteroposterior dimensions was better in patients with chordal preservation than in those without. In the former subgroup, a larger PM was associated with better FS of the left ventricle in the septolateral dimension (anterior PM, p <0.001, r = 0.78; posterior PM, p = 0.0010, r = 0.69), but not in the anteroposterior or vertical dimensions. This discrepancy in the relationship between PM size and functional benefits among the three dimensions may be related to the direction in which the PMs are suspended in our technique, or its effect on regional left ventricular function. CONCLUSION: The present study indicated that PM size may be used as a factor to better predict the outcome of MVR with chordal preservation.

Adult↗
PubMed2001

[Risk management and clinical path].

In the risk management of medical practice, developing an efficient system to prevent medical accidents and trouble is required. For this purpose it is important to promote a cooperative team practice, to clarify each staff member's role, for each staff member to accurately carry out that role, for each staff member to always try to understand the patient's condition, and for staff members to ask each other whenever in doubt as to a patient's condition or the medical practice itself. These points for risk management share the same goal as the clinical path. The introduction of a clinical path is useful from the viewpoint of risk management. Electronic medical records and computer ordering systems in the medical practice should be developed as tools to decrease medical accidents.

Critical Pathways↗
PubMed2001

[Partial sternotomy for off-pump coronary artery bypass grafting].

We performed off-pump coronary artery bypass grafting through a partial sternotomy. The sternum was spit like C-shape configuration from the second intercostal space down to the xiphoid junction. The left internal mammary arteries were mobilized and anastomosed to the left anterior descending arteries. Saphenous veins were grafted between the ascending aorta and the right coronary arteries or diagonal branches. After the surgery, excellent stability of the thorax with minimized incisions enhanced the early recovery. We believe that partial sternotomy approach may be useful in some cases of off-pump CABG.

Aged↗
PubMed2001

[Platinum compounds in cancer therapy--past, present, and future].

Platinum cytotoxics play an important role globally in the management of solid tumours. Cisplatin sets the standard for efficacy in both regions with careful administration to reduce nephrotoxicity. Carboplatin is associated with neurotoxicity, but has become the leading product in the US due largely to the easier to manage toxicity profile. Both agents have been widely used in both registered and non registered indications and are frequently combined with other cytotoxics. In Japan, cisplatin has been used successfully at low doses in combination with 5-FU based regimens and appears to achieve a synergistic effect, but controlled data are not yet available. More recently oxaliplatin (Europe) and nedaplatin (in Japan) have been introduced, but their clinical roles in therapy have yet to be established. One of the limiting features of the first generation of platinum compounds is that a significant proportion of tumours develop cross resistance to platins due to either changes in uptake or excretion, intracellular detoxification or accelerated DNA repair. The forum discussed the possibility for the development of better new platinum compounds, A new platin agent which had lower toxicity and higher efficacy across a wide range of cancers without the development of resistance would be a significant step forward. If the tolerability profile was suitable, an oral formulation may improve the quality of life for patients but this must not be at the expense of efficacy. Even after the introduction of new target based drugs, platinum cytotoxics are likely to be used to reduce the tumour mass and in some cases can be expected to potentiate the effects of the new agents. In preclinical studies, ZD0473 has been shown to by-pass some major mechanisms of resistance and has the potential to achieve these objectives and is now being evaluated in clinical studies in both Japan and the West.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed2001

[Two siblings with eyelid myoclonia with absences].

We report two siblings with eyelid myoclonia with absences. Patient 1, a 7-year-old boy, visited us because of eyelid blinking resembling a tic. He had experienced the movements since 2 years old. The diagnosis of a simple motor tic was initially made, however, the episodes worsened gradually. Patient 2, a younger brother of patient 1, was a 5-year-old boy. His eyelid blinking also began at age of 2 years. Additionally, the mother's aunt and her cousin had a history of grand mal on awakening, and the patient's cousin has febrile seizures. Their clinical features were as follows; (i) eyelid myoclonia, described as rapid, rhythmic eyelid fluttering with upward jerking of the eyes and head, lasting for 1-2 seconds; (ii) it occurred frequently each day; (iii) when it lasted for more than 2-3 seconds, it was associated with absences; (iv) both hyperventilation and photic stimulation on 18 f/c induced clinical seizures; and (v) ictal EEG revealed 3-4 c/s generalized irregular spike-waves with a duration of 1-3 seconds. Based on these characteristics, a diagnosis of eyelid myoclonia with absences was made. The present cases are the first sibling cases reported in Japan and, according to their family history, a genetic predisposition should be considered.

Child↗
PubMed2001

[Effect of arytenoid adduction operation for vocal function of laryngeal palsy patients].

OBJECTIVE: To evaluate the curative efficiency on vocal function of 56 laryngeal palsy patients underwent arytenoid adduction operation. METHOD: Voice analysis and laryngeal aerodynamical measurement were performed for the 56 laryngeal palsy patients to compare maximum phonation time (MPT), mean flow rate (MFR), voice intensity(SPL), and expiratory pressure(EP) before and after operation. Perceptual evaluation was also performed for comparison by using GRBAS system(G). RESULT: The postoperative average MPT increased by 3.1 times in males and 2.7 times in females. The average MFR decreased apparently from 827.3 ml/s in males and 477.1 ml/s in females before operation to 340.3 ml/s and 158 ml/s after operation, which was statistically significant (P < 0.01). The average SPL increased and the average EP decreased after operation. After operation the average G decreased from 2.8 to 1.7 (P < 0.01) and the percentage of improvement over one grade was 71%. CONCLUSION: From these results mentioned above, it can be concluded that the arytenoid adduction operation might be one of the most effective operative methods to improve glottal incompetence caused by laryngeal nerve paralysis.

Adolescent↗
PubMed2000

[Healing in the intestinal anastomosis--comparison of the Albert-Lembert and Gambee methods].

An experimental comparative histomorphological study was made on intestinal healing processes following an Albert-Lembert suture with approximation of the serosal surface and Gambee's layer to layer anastomosis of a dog. There was no obvious complications such as postoperative hemorrhage, anastomotic stenosis or anastomotic leakage. Although both anastomoses resulted in a good healing process, Gambee's layer to layer suture, which caused the submucosal layers to face each other, showed better wound healing at the anastomosis in terms of layer to layer attachment. As a conclusion, Gambee's layer to layer anastomosis seemed to be a better anastomotic technique in terms of wound healing for the intestinal anastomosis.

Anastomosis, Surgical↗
PubMed2000

Off-pump coronary artery bypass grafting via partial sternotomy. An alternative to left anterior small thoracotomy.

Four patients, who were considered to be inappropriate candidates for left anterior small thoracotomy, underwent off-pump coronary artery bypass grafting via partial sternotomy. Under a median skin incision over the lower half of the sternum, the sternum below the second rib was cut in an "inverted L" (or "C") shape. Without cardiopulmonary bypass, the left internal thoracic artery was anastomosed to the left anterior descending artery in all patients, and a saphenous vein graft was anastomosed to the right coronary artery in one of them. Partial sternotomy has some advantages as an alternative to left anterior small thoracotomy, in that it enables multiple-bypass grafting without cardiopulmonary bypass and conversion to cardiopulmonary bypass, should it be come necessary, would be relatively uncomplicated.

Aged↗
PubMed2000

Partial sternotomy ("C" incision) as standard access for full range of adult cardiac operations.

OBJECTIVE: In our institute, partial sternotomy has been adopted for standard access in the full range of adult cardiac operations, including coronary artery bypass grafting. In this study, our clinical experience is reviewed. METHODS: Since April 1998, of 100 cardiac surgical patients, 64 underwent partial sternotomy, while 36 patients had the traditional full sternotomy because of high surgical risk factors or anatomical reasons. Most of the patients having minimal access had a "C" incision, that is, a left lower partial sternotomy. RESULTS: The procedures performed with the "C" incision were coronary artery bypass grafting, valve surgery, aortic root replacement, closure of atrial septal defect, and so on. There were two hospital deaths after partial sternotomy. Compared with full sternotomy patients, partial sternotomy patients had a shorter hospital stay, while their bypass times were longer. Their skin incisions were 11.7 cm on average. CONCLUSION: The "C" incision can provide satisfying results and can serve as the standard approach in the full range of cardiac operations.

Adult↗
PubMed2000

Intraoperative map guided operation for atrial fibrillation due to mitral valve disease.

BACKGROUND: This study was designed to determine if intraoperative atrial activation mapping facilitates operations for chronic atrial fibrillation associated with mitral valve disease. METHODS: Surgical treatment guided by intraoperative electrophysiologic mapping was performed in 12 patients with chronic atrial fibrillation associated with isolated mitral valve disease. In 10 of 12 patients, regular and repetitive activation (cycle length ranged from 118 to 210 msec) originated in the left atrial appendage and/or orifice of the left pulmonary vein. In the remaining 2 patients, dominant repetitive activation and sporadic complex activation were alternately observed in the left atrium. However, the activation sequence of the right atrium was extremely complex and chaotic. RESULTS: On the basis of intraoperative mapping, surgical procedures, including resection of the left atrial appendage and/or cryoablation of the orifice of the left pulmonary vein, were applied on the breakthrough site of the repetitive activation. No surgical procedure was performed on the right atrium in 11 patients. Ten of 12 patients (83%) have maintained sinus rhythm for 6 to 40 months (average 24.8 months) after operation. CONCLUSIONS: In the majority of the patients with isolated mitral valve disease, the left atrium acts as an electrical driving chamber for chronic atrial fibrillation. Computerized intraoperative mapping should guide surgeons in determining the appropriate surgical procedure for chronic atrial fibrillation.

Aged↗
PubMed2000

Excoecarins D, E, and K, from excoecaria agallocha.

Three novel diterpenoids, excoecarins D, E, and K (1-3), were isolated from Excoecaria agallocha. The structures of 1-3 were established as 3alpha,18-dihydroxy-3beta,20-epoxybeyer-15-ene, (15R, 16S)-ent-15,16-epoxybeyeran-3-one, and ent-3beta-hydroxykaur-16-en-2-one, respectively, on the basis of extensive NMR experiments and, in the case of 1, by X-ray analysis.

Diterpenes↗
PubMed2000

Congenital ureteral diverticulum coexistent with hydronephrosis caused by vascular compression involving the uterine artery and umbilical ligament: report of a case.

Coexistence of congenital ureteral diverticulum and hydronephrosis caused by vascular compression is a rare entity. The authors experienced a case of congenital ureteral diverticulum coexistent with hydronephrosis caused by aberrant vascular compression by uterine and umbilical arteries in a 14-year-old girl. The authors could not diagnose accurately this abnormality preoperatively by 3-dimensional computed tomography. After partial ureterectomy, including resection of the saccular lesion and ureteroneocystostomy, the frequency of urinary tract infection decreased.

Adolescent↗
PubMed2000

The lactate-dependent enhancement of hydroxyl radical generation by the Fenton reaction.

The effect of lactic acid (lactate) on Fenton based hydroxyl radical (*OH) production was studied by spin trapping, ESR, and fluorescence methods using DMPO and coumarin-3-carboxylic acid (3-CCA) as the *OH traps respectively. The *OH adduct formation was inhibited by lactate up to 0.4 mM (lactate/iron stoichiometry = 2) in both experiments, but markedly enhanced with increasing concentrations of lactate above this critical concentration. When the H2O2 dependence was examined, the DMPO-OH signal was increased linearly with H2O2 concentration up to 1 mM and then saturated in the absence of lactate. In the presence of lactate, however, the DMPO-OH signal was increased further with higher H2O2 concentration than 1 mM, and the saturation level was also increased dependent on lactate concentration. Spectroscopic studies revealed that lactate forms a stable colored complex with Fe3+ at lactate/Fe3+ stoichiometry of 2, and the complex formation was strictly related to the DMPO-OH formation. The complex formation did not promote the H2O2 mediated Fe3+ reduction. When the Fe3+ -lactate (1:2) complex was reacted with H2O2, the initial rate of hydroxylated 3-CCA formation was linearly increased with H2O2 concentrations. All the data obtained in the present experiments suggested that the Fe3+-lactate (1:2) complex formed in the Fenton reaction system reacts directly with H2O2 to produce additional *OH in the Fenton reaction by other mechanisms than lactate or lactate/Fe3+ mediated promotion of Fe3+/Fe2+ redox cycling.

Coumarins↗
PubMed2000

Structure analysis of regenerated cellulose hydrogels by small-angle and ultra-small-angle x-ray scattering.

Absolute intensities Deltai(q) of small-angle x-ray scattering (SAXS) and ultra-small-angle x-ray scattering (USAXS) were measured in a wide range of scattering vector q from 2x10(-4) to 0.5 A(-1) for transparent (VI-P) and translucent (VI-L) cellulose hydrogels prepared by coagulation and regeneration of viscose in acid solutions with and without acetone, respectively. We obtained the scattering intensities at very small q conveniently by desmearing the combined data measured by SAXS and USAXS. The plot of Deltai(q)q(2) versus log(10) q showed a peak at -2.5<log(10) q<-1.0. By assuming a two-phase model with the high-density phase (phase 1) composed of only cellulose and with the low-density phase (phase 2) composed of cellulose dispersed in water, volume fractions of phase 1 in VI-P and VI-L were determined to be 0.18 and 0.09, respectively, from the mean-square fluctuation of electron density determined as integral of (Deltai(q)q(2)dq). By fitting the observed scattering profile with the theoretical particle scattering functions of spheres, the average diameter of the high-density region including crystallite was determined to be 120 A for VI-P and 80 A for VI-L. Similar analyses were applied also to freeze-dried VI-P. These results were consistent with those obtained by the wide-angle x-ray-diffraction measurement and also with the observation by scanning probe microscopy.

Cellulose↗
PubMed2000

Effect of age on the relationship between gastric cancer and Helicobacter pylori. Tokyo Research Group of Prevention for Gastric Cancer.

Helicobacter pylori is thought to be involved in the pathogenesis of gastric cancer, but the time point at which it produces its effects (critical time) is unknown. We measured the serum level of H. pylori antibody in 787 gastric cancer patients and 1007 controls aged 20 to 69. Odds ratios for different gastric cancer types and stages were determined for each 10-year age class. The overall odds ratio for gastric cancer decreased with age, being 7.0 for those aged 20 - 29, 14.5 for those aged 30 - 39, 9.1 for those aged 40 - 49, 3.5 for those aged 50 - 59, and 1.5 for those aged 60 - 69 (trend in odds ratios: P < 0.01). However, there was no such age-dependent trend for early diffuse-type cancer; the odds ratios were 12.6, 4.0, 7.2, 6.5, and 18.5 respectively (P = 0.29). Early cancer tended to show higher seroprevalence than advanced cancer, especially in older subjects. No significant difference in seroprevalence was observed between diffuse and intestinal cancers within each age-class. Seroreversion must have occurred in the time interval between the critical time and the diagnosis of the cancer, especially in older patients. The age-dependent relationship between H. pylori and gastric cancer may be due to seroreversion, which itself may be independent of age. This age-independence indicates that prolonged exposure to H. pylori does not increase the magnitude of its influence on gastric carcinogenesis. Possible mechanisms through which H. pylori exerts pathogenic effects are continuous inflammation in adulthood and / or irreversible damage to gastric mucosa in childhood or the teenage years.

Adult↗