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Biomedical subjects

T Maruta

Publications and source records attributed to T Maruta.

At least 19 recordsLinked to original sources

Status of patients with chronic pain 13 years after treatment in a pain management center.

This study describes the current vital, health, and employment status of 249 patients with chronic pain who were treated in a pain management center at the Mayo Clinic, on average, 13 years ago. These patients do not have an increased risk of mortality; their death rate is similar to that of the US white population. However, 68% of the patients reported worse-than-average or an abnormal level of bodily pain, with increased morbidity in their physical health, physical functioning, and social functioning. Emotional and mental health were claimed to be adequate. About half of the patients reported being gainfully employed.

Adolescent

Waddell's nonorganic signs and Minnesota Multiphasic Personality Inventory profiles in patients with chronic low back pain.

STUDY DESIGN: An analysis of clinical data gathered at an orthopedic outpatient clinic is presented. OBJECTIVE: To examine the relationship between Waddell scores and the Minnesota Multiphasic Personality Inventory response patterns. SUMMARY OF BACKGROUND DATA: Waddell's study of nonorganic signs of low back pain showed consistent correlations with Minnesota Multiphasic Personality Inventory scales 1 to 3. METHODS: A Waddell score was obtained from 507 consecutive patients with chronic low back pain to whom an Minnesota Multiphasic Personality Inventory also was administered. The sample was divided into those patients with a high Waddell score (high waddell score = 3 to 5) and those with a low Waddell score (low waddell score = 0 to 2); men and women were scored separately. RESULTS: Among male patients, statistically significant differences were found between the high Waddell score and low Waddell score groups on Minnesota Multiphasic Personality Inventory scales, 1, 3, and 8, but among females, differences were statistically significant only on scale 8. CONCLUSIONS: Correlations between the Waddell score and the first three scales of the Minnesota Multiphasic Personality Inventory were not fully replicated. The difference between the high Waddell and low Waddell groups on scale 8, however, was significant for men and women.

Adult

Electrogastrography after operative repair of esophageal atresia.

Esophageal atresia (EA) is a life-threatening disorder associated with operative complications. Postoperative gastric electrical control activity detected by a non-invasive electrogastrography (EGG) technique was investigated in 13 children aged 1-17 years to clarify whether gastric motility disorders were present. EGG abnormalities were present in 5 patients; persistent dysrhythmias were found in 3. Roentgenographic examinations showed mild gastroesophageal reflux in 3 (60%) of the dysrhythmic patients; 2 others had postprandial dysrhythmias. The mean spectral frequency (MSF) of EA cases with dysrhythmia was significantly higher than that of patients without dysrhythmia in both fasting and postprandial states (P < 0.05). The variability of the peak spectral frequencies (PSFV) in patients with dysrhythmia was significantly higher than in those without dysrhythmia in both fasting and postprandial states (P < 0.05). There were no significant differences in MSF and PSFV between EA patients without dysrhythmia and controls. These results suggest that gastric motor activity may be disordered in patients following operative repair of EA, although they remain asymptomatic. EGG may be a useful screening examination for postoperative gastric functional disorders.

Adolescent

[Histopathological study on acute poisoning of methamphetamine, morphine or cocaine].

Methamphetamine, morphine or cocaine was injected intraperitoneally into Wistar rats (male, 6 weeks old) at a dose of 50 mg/kg, 125 mg/kg, or 50 mg/kg body weight, respectively. These doses of drugs were determined to ensure that the rats would show signs of drug intoxication and survive for a day. Over the period from 5 min to 18 hr after injection, concentrations of the drugs and metabolites in blood were analyzed by the GC/MS method, and the histopathological changes of the heart, lungs, liver and kidneys were examined by light microscopy. The time of maximum drug concentration in the blood after injection was 5 min in the methamphetamine-treated group, 1 hr (total morphine) in the morphine group and 5 min in the cocaine group. These blood concentrations decreased with time. In the liver at 2.5 hr after injection of methamphetamine, centrolobular vacuolation and diffuse eosinophilic changes of hepatocytes appeared. At 6 hr this damage spread to the midzone of the liver and partial necrosis of the centrolobe was found. At 18 hr the liver damage became worse and necrosis was also found in the midzone of the liver. In the heart, from 2.5 hr, eosinophilic changes of the myocardium were observed diffusely. Furthermore, at 18 hr, partial inflammatory cell infiltration and contraction bands were observed. The degree of histopathological damage did not coincide with the time of maximum drug concentration. In the morphine group, centrolobular and midzonal vacuolation, diffuse fatty degeneration and eosinophilic changes were observed in the liver from 2.5 hr to 18 hr after the administration. No necrosis was found, perhaps because the rats did not suffer the hyperthermia observed in the methamphetamine group. The degree of histopathological damage became more serious with time, as it did in the methamphetamine group. In the cocaine group, no histopathological changes were observed, probably because the doses of cocaine were too small to cause histopathological damage, and because cocaine is more rapidly metabolized than methamphetamine or morphine. These results suggest that in histopathological investigations necessitated by drug intoxication, measuring drug concentrations in the blood might be useful in determining the causes of histopathological changes more clearly.

Animals

[Molecular immunology of voltage-gated calcium channel and Lambert-Eaton myasthenic syndrome].

Lambert-Eaton myasthenic syndrome(LEMS), an autoimmune disease that is often associated with small cell lung carcinoma(SCLC), impairs the quantal release of acetylcholine by directing antibodies against voltage-gated calcium channels (VGCC) in the motor nerve terminal. We focused attention on the P/Q type VGCC, to which there are antibodies in LEMS patients in higher frequency than antibodies to other types of VGCC. To search for antigenic sites in the molecular structure of alpha 1A subuuit of P/Q type VGCC in LEMS, we synthesized 4 peptides corresponding to the extracellular region (S5-S6 linker) of each of 4 domains that form alpha 1A subunit of VGCC. Also, LEMS patients' sera were studied by immunoprecipitation assay using these antigens. Peptides corresponding to the extracellular region (S5-S6 linker) of domains II and IV were specifically reactive with LEMS antibodies; their titiers respectively correlated with those of anti-P/Q type calcium channel (omega-conotoxin MVIIC-sensitive human cerebellum extret). Lewis rats were immunized with the domain II S5-S6 linker peptides conjugated with KLH. The immunized rats showed LEMS features characterized by reduced acetylcholine quantum content of endplate potentials and antibodies reactive with P/Q type VGCC. Our observations suggest 2 potential epitopes of LEMS antibodies. Synaptotagmin is a Ca2+ and phospholipid binding protein integrated in synaptic vesicle membranes. It plays a crucial role in neurotransmitter release, probably as a Ca2+ sensor for exocytosis of synaptic vesicles. The extracellular region of synaptotagmin was found antigenic for the induction of a rat model of LEMS. A proportion of human LEMS antibodies reacted with the recombinant synaptotagmin in immunoblot.

Acetylcholine

Degos' disease: radiological and immunological aspects.

We present an 18-year-old patient with Degos' disease who manifested the sudden onset of paraplegia. Neurological examination revealed a rt-hemianopsia, paraparesis (with a sensory level at Th12), and a neurogenic bladder. Brain MRI showed multiple cerebral infarctions accompanied by small hemorrhagic areas and GdDTPA enhancement of the dura. A cerebral angiogram displayed stenosis, ectasia, and aneurysms involving the peripheral branch of arteries. Stenoses also were observed in the celiac artery and small arteries in the 1t-kidney. Skin biopsy exhibited hyperkeratosis, atrophy of the epidermis, and necrobiosis of the collagen layer. Laboratory examinations disclosed persistent elevations of the thrombin-antithrombin III complex (TAT), plasmin-alpha 2 plasmin inhibitor complex (PIC), and cytotoxic T cell subset (CD8+CD11-), illustrating the coagulative, fibrinolytic, and immunological implications of this disease.

Abdominal Abscess

[Successful surgical repair of tracheo-innominate artery fistula in a case of ALS patient with long-term mechanical ventilation].

A 59-year-old man with ALS developed dyspnea and was performed tracheostomy in September 1987. The cuff volume of a tracheostomy tube increased gradually in four years of mechanical ventilation. His chest X-ray in December 1992 showed a marked enlargement of the cuff. In March 1993, massive hemorrhage suddenly occurred through the tracheostomy site. This was controlled by hyperinflation of the cuff. He was diagnosed as tracheo-innominate artery fistula. An emergent operation was done by median sternotomy and right oblique cervical incision. The innominate artery, the subclavian artery and the common carotid artery were severed and occluded with sutures. The tracheal fistula was closed with a suture of monofilament. The postoperative course was satisfactory, however he died of respiratory failure ten months after the surgery.

Amyotrophic Lateral Sclerosis

[A study of diagnostic scale in borderline personality disorder that was synthesis of symptomatic and personality structural element].

The diagnostic criteria for BPD such as the DSM-III(-R) and DCR, based on polythetic format for prototypal categories, has not always been able to result in accurate clinical diagnosis of BPD. Reasons posited for this were that DSM-III(-R) criteria consist of symptom items based on descriptive phenomenology, even for Axis II personality diagnosis, and that descriptions of the criteria were vague because of the standardization of vocabulary which aimed at improved inter-rater reliability. With the polythetic "yes/no" format, diagnosis was influenced by the determination of only one item; furthermore, different combinations of items yielding a heterogeneous membership might lead to the same diagnosis. It was, therefore, considered difficult to perform an accurate diagnosis of BPD in clinical practices using the existing general diagnostic criteria, and it was realized that the development of new diagnostic criteria for BPD was necessary. For those reasons, we generated a Clinical BPD Scale (CBS) as diagnostic evaluation scale of BPD with considering advantages for clinical use. This reconstituted some features of BPD which have been reported by many researchers, synthesizing symptomatic elements and personality structural elements. CBS is composed of four clusters, Two of these four clusters are evaluated by four grade anchor points which are provided for the rating of the severity of symptoms, and that are illustrated on the radarchart for comprehensive evaluation of the severity of the disorder. CBS was confirmed to have a high degree of validity, and achieved a satisfactory degree of inter-rater reliability by ANOVA ICC, and it has been found in application of CBS to several cases in the clinical practice that the degree of severity of each symptom could be clarified and differential diagnosis was possible with this diagnostic scale. Furthermore, the outcome of treatment could be confirmed at any time during the clinical follow up. In addition, through the dimensions, it is possible to grasp the severity, and further, through spectrum and hierarchy. We considered diagnostic area of BPD and its position by CBS correlating the other closely related disorders.

Borderline Personality Disorder

Keeping hostility in perspective: coronary heart disease and the Hostility Scale on the Minnesota Multiphasic Personality Inventory.

Three prospective studies from the early 1980s found that high scores on the Hostility (Ho) Scale of the Minnesota Multiphasic Personality Inventory (MMPI) were associated with an increased incidence of coronary heart disease (CHD) and mortality from CHD and other causes. In the current study, the association between the Ho score and subsequent health status was examined in a 20-year follow-up of 620 general medical patients who completed the MMPI between 1962 and 1965. Univariately, the Ho score from the MMPI was a significant factor for predicting the development of CHD, CHD-related mortality, and total mortality. When two simple risk factors for CHD--age and sex--were also considered, however, the MMPI Ho score was no longer a significant predictive factor.

Adult

[MR imaging of bone metastasis].

One hundred and three patients with known malignancy and suspected bone metastasis underwent magnetic resonance imaging. In 93%, the metastatic lesions, detected both on plain films and radionuclide bone scans, showed decreased signal intensity on T1-weighted images and increased signal intensity on T2-weighted images. All lesions, except one lesion showing much blastic change on plain films, showed contrast enhancement with Gd-DTPA administration. Although further investigation is needed, a correlation between the type of primary malignancy and the signal intensity of the metastatic lesion is suggested. Among 312 metastatic lesions detected by MR imaging, 272 lesions (87%) and 134 lesions (40%) were also detected by radionuclide bone scans and plain films, respectively. In five cases, MR imaging clearly revealed the lesion compressing the spinal cord, which helped us formulate a therapeutic plan. We conclude that MR imaging is the most sensitive examination for detecting bone metastasis and is necessary for planning treatment.

Bone Neoplasms

[SPECT images after intravenous injection of 99mTc-DTPA in lung tumors--comparison with delayed 123I-IMP lung scintigraphy].

The aim of this study was to assess the efficacy of SPECT imaging of the thorax with 99mTc-DTPA, which accumulates at sites of increased capillary permeability and expanded extracellular space, by comparing it with delayed 123I-IMP lung scintigraphy. We have previously reported that increased uptake on delayed 123I-IMP lung scintigraphy was associated with atelectasis and inflammation. Thirteen patients with lung cancer (4 with atelectasis and 3 with pleurisy), one patient with malignant lymphoma complicated by pneumonia and pleurisy, and one patient with pneumonia were studied. 99mTc-DTPA scintigraphy was performed twice, 20-160 minutes and 2-4 hours after the intravenous administration of 370 MBq of 99mTc-DTPA. 123I-IMP scintigraphy was performed 24 hours after the intravenous injection of 111 MBq of 123I-IMP. SPECT images were obtained with both types of scintigraphy. 99mTc-DTPA scintigraphy was compared with 123I-IMP scintigraphy for its ability to detect atelectasis and pneumonia. All patients showed increased accumulation corresponding to the lesions on both 123I-IMP and 99mTc-DTPA scintigraphy. 123I-IMP scintigraphy showed a defect corresponding to the tumor with increased accumulation around the tumor, whereas 99mTc-DTPA scintigraphy showed accumulation corresponding to the tumor. Ten of 11 tumors showed accumulation of an intensity equal to that of the soft tissue of the chest wall on 20-60 min 99mTc-DTPA images. The 2-4 hr images showed that 99mTc-DTPA leaked from the periphery of the tumor toward its center. All the patients with pleurisy showed increased accumulation in effusion on 2-4 hr 99mTc-DTPA scintigraphy.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged

[Clinical results of N0 tongue cancer treated with interstitial brachytherapy and management of occult cervical node metastases].

One hundred patients with T1-2NO squamous cell carcinoma of the oral tongue were treated with interstitial brachytherapy at the Hyogo Medical Center for Adults between 1962 and 1983. These patients were followed for more than two years. The cumulative five-year survival rate was 89% in T1N0 and 66% in T2N0. The relapse-free survival rate was 88% in T1N0 and 51% in T2N0. The two-year local control rate in the primary site was 100% in T1N0 and 73% in T2N0. Cervical node metastases developed in 41% (T1N0: 33%, T2N0: 43%) of the patients. The five-year survival rate of the patients with subsequent cervical node metastases was 42%, while that of patients without subsequent cervical node metastases was 92% (p less than 0.001). Twenty-seven patients also received prophylactic neck irradiation (average dose: 33.8 Gy). In patients treated with prophylactic neck irradiation, the rate of subsequent cervical node metastases was 37% and the cumulative five-year survival rate was 62%. In the patients without prophylactic neck irradiation, these figures were 41% and 73%, respectively. There was no statistically significant difference between the two groups. Between 1984 and 1986, 28 patients with T1-2 N0 squamous cell carcinoma of the oral tongue were treated with interstitial brachytherapy. These patients were prospectively examined for the ability of chemotherapy to prevent the development of cervical node metastasis. In 13 patients treated with chemotherapy (CDDP 80 mg/m2 + PEP 6 mg/m2 x 5 days), the two-year local control rate was 90%, the incidence of cervical node metastases was 38% and the incidence of distant metastases was 15%.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult

[Clinical value of Gd-DTPA enhanced MRI of pulmonary and mediastinal tumors].

Gd-DTPA (Gd) enhanced Magnetic Resonance (MR) early images and delayed images of 28 patients with pulmonary or mediastinal tumors were analyzed and compared with the computed tomography scans and the plain MR images. Numbers of relative signal intensity of the tumors, secondary lesions (adjacent pneumonia or collapse) and pleural effusions were calculated and graphed on time intensity curves. Gd-enhanced MR early images were more useful than other methods in delineating viable areas from necrotic areas. However, Gd-enhanced MR delayed images better delineated margins of necrotic areas than Gd-enhanced MR early images did in some cases. In distinguishing tumors from secondary lesions, Gd-enhanced MR early images were the most useful, too. We considered Gd gradually penetrated into pleural effusions after intravenous administration, just in the same way into necrotic areas. Therefore pleural effusions showed very high intensity on Gd-enhanced MR delayed images. Time intensity curves of the tumors and pleural effusions showed characteristic patterns, but those of secondary lesions showed different patterns among the individual cases. We presumed this was due to the variances of the water and fibrous components among them.

Adenocarcinoma

[A case of increased 123I-IMP uptake in adenocarcinoma of the lung].

It has been reported that delayed 123I-IMP lung scintigraphy shows a defect corresponding to the tumor with increased accumulation around the tumor, and that an increased accumulation is associated with atelectasis and inflammation. We presented a case of increased uptake of 123I-IMP in lung cancer. None of the other reported case of increased uptake in lung cancer, to our knowledge, occurred. A 55-year-old man had a 6 cm mass in the lower lobe of the right lung. Cytologic examination with a small curette diagnosed the case as an adenocarcinoma. The 123I-IMP scintigraphy was performed 24 hours after intravenous injection of 111 MBq of 123I-IMP. The 123I-IMP SPECT lung images showed an area of increased 123I-IMP concentration corresponding to the tumor mass. The patient's subsequent course was characterized by massive pleural effusion caused by extensive invasion to the pleura despite chemotherapy. He died about 2 months after the 123I-IMP scintigraphy. The right lung removed at necropsy confirmed that the area of high 123I-IMP concentration corresponded to the mass, which proved a poorly differentiated adenocarcinoma. One should note that there is an unusual case with high 123I-IMP uptake in lung cancer.

Adenocarcinoma

[Evaluation of delayed I-123 IMP lung studies in atelectatic and inflammatory diseases in comparison with Ga-67-citrate scintigraphy].

We have previously reported that increased tracer accumulation on delayed 123I-IMP scintigraphy is associated with atelectasis and inflammation. The purpose of this study was to evaluate the diagnostic values of delayed 123I-IMP lung scintigraphy, compared with gallium scintigraphy. Ten patients with atelectasis caused by lung cancer and 7 patients with inflammatory diseases were studied. Inflammatory lung disease included 4 cases of pneumonia, 2 of interstitial pneumonitis, and 1 of diffuse panbronchiolitis. Delayed 123I-IMP scintigraphy was performed 24 hours after intravenous injection of 111 MBq of 123I-IMP. In 14 patients, the SPECT images were obtained. Gallium scintigraphy was done within 7 days of 123I-IMP scintigraphy and the images were obtained 72 hours after the administration of 111 MBq of 67Ga-citrate. 123I-IMP scintigraphy was compared with gallium scintigraphy for its ability to detect atelectasis. The degree of uptake by the collapsed lobes was judged visually on planar images and rated using four grades: negative, slight, moderate and heavy. All the cases showed moderate or intense uptake on the 123I-IMP images, whereas with gallium scintigraphy there was no change corresponding with lobar collapse in 8 out of 10 cases. Of the remaining 2 cases, one had tumor in the collapsed lobe and the other had obstructive pneumonia. In inflammatory lung diseases, the correlation of 123I-IMP and gallium images regarding degree of change shown on chest X-ray film was studied. The degree of correlation was classified using four grade: poor, fair, good and excellent.(ABSTRACT TRUNCATED AT 250 WORDS)

Adenocarcinoma

[Clinical evaluation of radiotherapy for endocrine ophthalmopathy].

Ten patients with severe endocrine ophthalmopathy were treated by radiotherapy at Hyogo Medical Center for Adults from May 1984 to February 1988. All but one of the patients had poorly responded to previous systemic or topical corticosteroid therapy. The target of the radiotherapy was both retrobulbar tissues. The radiation field used was about 4 x 4 cm, excluding the pituitary gland and the brain, and was angled 5 degrees posteriorly to avoid the contralateral lens. A total of 2000 cGy was given to each patient over a 2 week-period. Eight of the ten patients showed some response, with 5 of them (50%) having a good to excellent response. Treatment was more effective for soft tissue changes, proptosis and keratopathy, while myopathy was less responsive. As for the duration of the eye signs and symptoms, those of a shorter duration (less then 12 months) responded better. It was also noted that the degree of the eye muscle enlargement on the pre-treatment orbital CT scan was directly correlated to the results of the treatment. Although three of the patients experienced transient headache, there were no serious acute reactions or long term complications. In conclusion, retrobulbar radiotherapy is a well-tolerated, safe and effective treatment for severe endocrine ophthalmopathy.

Adult

Prevalence of sexual abuse, physical abuse, and concurrent traumatic life events in a general medical population.

A normative sample of 100 patients (59 women and 41 men) from the city of Rochester, Minnesota, and the surrounding rural area who came to the Mayo Clinic for a general medical examination were interviewed in a semistructured format by using a list of questions about childhood life events. Sexual abuse was reported by 16.9% of women and 0% of men, frequencies that are near the lower end of the spectrum of reported values from recent studies. Physical abuse was reported by 5% of the entire group. No association was observed between the two types of abuse. Physical abuse was associated with a significant degree of traumatic life events, but sexual abuse was not. Use of face-to-face interviewing, matched sex and ethnicity of the interviewer, and a high compliance rate substantially increase the probability that the female respondents in the current study were both representative and reliable.

Adolescent