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Biomedical subjects

T Numata

Publications and source records attributed to T Numata.

At least 37 records · Page 2Linked to original sources
PubMed2000

Successful treatment of malignant neurocardiogenic syncope with repeated tilt training program.

Recent reports have shown that repeated tilt-table testing or tilt training is a very effective therapy for the treatment of neurocardiogenic syncope induced by head-up tilt testing. The present patient experienced repeated syncopal or presyncopal attacks and had shown prolonged asystole on an electrocardiogram during syncope. The presyncope could be reproducibly induced by head-up tilt testing. Oral propranolol and/or disopyramide therapies failed to prevent his symptoms. Tilt training (2 sessions/day) was repeated every day for 4 weeks at home, and then head-up tilt testing was performed again. The syncope or presyncope was not induced by head-up tilt testing. The patient has continued with this training and has had no symptoms during the follow-up period of 1 year.

Electrocardiography↗
PubMed2000

Effect of a single oral dose of pilsicainide on pacing thresholds in pacemaker patients with and without paroxysmal atrial fibrillation.

A single oral dose of pilsicainide, a class 1c antiarrhythmic drug, is effective in terminating acute-onset atrial fibrillation (AF), but its effect on pacing thresholds in pacemaker patients is unknown. The present study measured atrial and ventricular pacing thresholds after a single oral dose of pilsicainide in patients with and without AF. Twelve patients with dual-chamber pacemakers were evaluated. Pacing thresholds as well as plasma pilsicainide concentration were measured prior to and then at 30, 60, 90, 120 and 180 min and 24h following a single oral dose of pilsicainide (150 mg). Six patients had paroxysmal AF and the remaining 6 did not. Pacing thresholds increased significantly (134+/-8%) in the atrium (p<0.05) and in the ventricle (155+/-11%; p<0.001) following pilsicainide administration in all 12 patients. Plasma concentrations of pilsicainide showed a positive liner correlation with pacing thresholds (R=0.62, p<0.0001 in the atrium; R=0.74, p<0.0001 in the ventricle). Atrial pacing thresholds in the patients with AF showed a significant increase at 90, 120 and 180 min compared with the patients without AF (p<0.05). There was no significant difference in either the ventricular pacing threshold or the plasma pilsicainide concentration in the patients with and without AF. It was concluded that a single oral dose of pilsicainide increases the pacing thresholds in both the atrium and ventricle in a selected group of pacemaker-implanted patients; that is, those who are aged and with AF. Thus, careful attention should be paid to pacemaker-dependent patients, particularly those with paroxysmal AF, when administering pilsicainide.

Administration, Oral↗
PubMed2000

Clinical surveillance of a thin bipolar pacing lead.

A total number of 415 co-radial, bipolar pacing leads (189 atrial leads; 226 ventricular leads) were implanted in 228 patients between November 1994 and July 1999. Mean pacing thresholds at the implantation were normal at 0.6 V in the atrium and at 0.4 V in the ventricle with a pulse duration of 0.4-0.5 ms. Lead impedance was relatively low (337-447 ohms for atrial leads; 369-459 ohms for ventricular leads) at the implantation and during the follow-up periods. No definite failure in lead materials was observed in either atrial or ventricular leads (mean follow-up of 19.7 and 19.2 months, respectively: up to 52.9 months for both leads). Predicted clinical surveillance up to 10 years calculated statistically showed that the upper 95% confidence limit was a constant of 100%. The lower 95% confidence limits at 5, 7, and 10 years were estimated to be 98.0%, 97.2%, and 96.0%, respectively. From the present study, the ThinLine lead is reliable for both sensing and pacing thresholds, and has excellent predicted lead longevity. Nevertheless, further observation is required regarding cost performance, such as early replacement of the pacemaker generator, because of the lower pacing lead impedance.

Aged↗
PubMed2000

Expression and mutational analysis of amino acid residues involved in catalytic activity in a ribonuclease MC1 from the seeds of bitter gourd.

The ribonuclease MC1 (RNase MC1) from seeds of bitter gourd (Momordica charantia) consists of 190 amino acids and belongs to the RNase T2 family, including fungal RNases typified by RNase Rh from Rhizopus niveus. We expressed RNase MC1 in Escherichia coli cells and made use of site-directed mutagenesis to identify essential amino acid residues for catalytic activity. Mutations of His34 and His88 to Ala completely abolished the enzymatic activity, and considerable decreases in the enzymatic activity were observed in cases of mutations of His83, Glu84, and Lys87, when yeast RNA was used as a substrate. Kinetic parameters for the enzymatic activity of the mutants of His83, Glu84, and Lys87 were analyzed using a dinucleoside monophosphate CpU. Km values for the mutants were approximately like that for wild-type, while k(cat) values were decreased by about 6 to 25-fold. These results suggest that His34, His83, Glu84, Lys87, and His88 in RNase MC1 may be involved in the catalytic function. These observation suggests that RNase MC1 from a plant catalyzes RNA degradation in a similar manner to that of fungal RNases.

Amino Acids↗
PubMed1999

[Procainamide-induced skin eruption associated with disseminated intravascular coagulation in a patient with sustained ventricular tachycardia].

A 70-year-old man, who had sustained ventricular tachycardias following a previous anterior myocardial infarction, suffered from skin eruptions and abnormal blood tests after 10 days following the oral administration of 1500 mg/day of procainamide. These abnormalities disappeared early after the discontinuation of oral procainamide. However, similar skin eruptions exhibited again when the procainamide was resumed. These results suggest that oral procainamide therapy induces skin eruptions and serious abnormal blood tests in the patient. No reports have suggested such a serious early complication by procainamide therapy. Careful follow-up is needed after the administration of oral procainamide therapy.

Aged↗
PubMed1999

Transsphenoidal reoperations for removal of pituitary adenomas: rhinological management and timing of reoperation.

Transsphenoidal reoperation of pituitary adenomas remain a difficult surgical procedure even with skilful microsurgical techniques. This paper retrospectively analysed how to overcome such difficult factors as absent normal surgical landmarks and an adhesive field. For residual or recurrent adenomas, transsphenoidal reoperations were carried out 14 times in 12 patients. Reasons for reoperations were intentionally multistaged operations in 10 cases, regrowth in three and apoplexy in one. In the first operation, we tried to preserve or restore as many anatomic landmarks as possible. Overly aggressive procedures causing cerebrospinal fluid leakage were avoided. In the three second reoperations within 3 months, a transnasal approach was used. In the other eight situations, between 4 and 119 months, transnasal approach in five, and transseptal approach in three, were used retrospectively. In two patients with fibrous adenomas, reoperations were carried out 4 and 12 months after the first. Magnetic resonance imaging (MRI) evaluation is essential to confirm the tumour descent toward or into pituitary fossa. Timing of the reoperation needs to be individualized depending on MRI findings. Trauma to the nasal mucosa and a narrower operative field became more frequent in reoperations 4 months or later. To obtain a surgical field wide enough to manipulate an ultrasonic aspirator for fibrous adenomas, removal of bony structures at the nasal cavity on the surgical corridor is useful. These rhinological preparations in the first and subsequent operations along with a selection of timing of reoperation are important to gain easier access for tumour removal and in avoidance of surgical complications. Copyright 1999 Harcourt Publishers Ltd.

Journal Article↗
PubMed1999

Bone window CT evaluation of the nasal cavity for the transsphenoidal approach.

Bone window CT findings sliced parallel to the transsphenoidal surgical route were evaluated preoperatively in 104 patients with pituitary lesions in order to assess their clinical significance. (1) The width and depth of the transsphenoidal operative fields were measured. The piriform aperture was 26.3 mm (SD 2.5) in maximum width, the origin of inferior nasal concha 27.0 mm (SD 2.5) and the origin of the middle nasal concha 26.8 mm (SD 3.8), respectively. The distance between the piriform aperture and the sellar floor was 61.6 mm (SD 3.6). The operative field was cylindrical in shape, approximating 26-27 mm in width and 62 mm in depth. (2) The width and length of bony nasal cavity were different by 2-3 mm in patients with and without acromegaly. (3) In re-operated patients, the location of thinned or atrophic nasal mucosa, residual bony septum and narrow sellar floor opening, which needed further bony removal were demonstrated. Bone window CT provides direct visualization of the nasal anatomy for the approach, and is useful in screening for patients with a narrow nasal cavity. It helps to determine rhinological manoeuvres for providing wide operative fields at the nasal cavity and sellar floor.

Acromegaly↗
PubMed1999

Adenocarcinoma with signet ring cells of the axilla showing apocrine features: a case report.

A 74-year-old Japanese man developed a reddish, indurated plaque composed of multiple nodules on his right axilla. Histopathologic examination showed a solid tumor that extended from the upper dermis into the subcutis, with both inter- and intracellular lumen formation, cellular arrangement in single files, a fibrotic reaction around the tumor cells, and the presence of mucinous material in the cytoplasm. There was both nuclear and cytoplasmic pleomorphism. Both lysozyme and GCDFP-15 were identified in the tumor cells. Electron microscopic examination showed periluminal condensation of the cytoplasm. Because thorough clinical and laboratory examinations were unremarkable, we regarded this to be a case of primary adenocarcinoma with signet ring cells of the axilla. The neoplasm might have differentiated toward the apocrine sweat glands or the mammary glands. Radiation therapy was effective to some degree. This seems to be the first reported case in which adenocarcinoma with signet ring cells of the skin affected a site other than the eyelids.

Aged↗
PubMed1999

Livedo vasculitis associated with regional cytophagic histiocytoses.

We report a 70-year-old woman who developed recurrent multiple ulcers and residual atrophic scars on her legs and feet. The histology showed fibrinoid material in the dermal vessel walls causing partial to complete occlusion of the lumina. Capillary tufting and dilatation were also noted in the dermis. There was no vasculitis or panniculitis. Extravasated red blood cells were seen throughout the dermis; these were engulfed by benign-appearing histiocytes around the dermal-fat junction. As she was generally well and there was no evidence of the presence of cytophagic cells in her extracutaneous organs, she was diagnosed with regional phagocytic histiocytoses supposedly triggered by extravasated red blood cells.

Aged↗
PubMed1999

Possible involvement of hypothyroidism as a cause of lithium-induced sinus node dysfunction.

Although several reports have stated that even therapeutic levels of lithium can induce sinus node dysfunction, the mechanism has not been fully elucidated. We present here two patients with sinus node dysfunction after long-term lithium therapy. Following lithium discontinuation, sinus node function recovered completely. After resuming lithium, however, irreversible sinus node dysfunction recurred and a permanent pacemaker was implanted in one patient. The serum concentration of lithium was within therapeutic levels. Nevertheless, hypothyroidism was associated with the sinus node dysfunction in both patients. Thus, thyroid function may play an important role in sinus node dysfunction induced by lithium.

Adult↗
PubMed1999

Pathophysiological features of the nasal mucosa in patients with idiopathic rhinitis compared to allergic rhinitis.

BACKGROUND: The literature on abnormality of vasomotor responses of the nasal mucosa to cold stimulation of the skin in idiopathic rhinitis is conflicting. The objective of this study was to elucidate pathophysiological features of the nasal mucosa in idiopathic rhinitis compared to allergic rhinitis. METHODS: The following were studied in patients with idiopathic rhinitis and allergic rhinitis and in normal controls: (1) threshold of the nasal reaction to histamine; (2) inflammatory cells in nasal lavage and scraped nasal mucosal epithelium, and (3) nasal vasomotor response to cold stimulation of the feet evaluated by acoustic rhinometry. RESULTS: Inflammatory cells were not found to be involved in idiopathic rhinitis. Nasal reactivity to histamine was significantly enhanced in patients with idiopathic rhinitis compared to normal controls, but was significantly lower compared to those with allergic rhinitis. The most prominent finding in idiopathic rhinitis was nasal mucosal swelling induced by cold stimulation of the feet. While in normal controls, cold stimulation of the feet caused mucosal contraction due to sympathetic excitation, sympathetic nasal vasomotor response in idiopathic rhinitis patients was significantly inhibited and caused mucosal swelling and enhanced nasal secretion. Mucosal reactions observed in allergic rhinitis were between those observed in idiopathic rhinitis and in normal controls. Cold stimulation of the feet increased systolic blood pressure by 5-15 mm Hg, but the degree of increase observed in the 3 groups was almost equal. CONCLUSIONS: The above findings indicate that patients with idiopathic rhinitis have abnormalities that inhibit sympathetic reactions and enhance parasympathetic vasomotor response at peripheral levels, possibly in the nasal mucosa.

Adolescent↗
PubMed1999

Comparative role of peptide leukotrienes and histamine in the development of nasal mucosal swelling in nasal allergy.

To evaluate the importance of histamine and peptide leukotrienes (LTs) in the development of nasal mucosal swelling in nasal allergy, H1 receptor antagonist (mequitazine, 6 mg, in 2 divided doses, Rhône-Poulenc Rorer, France) and LT receptor antagonist (ONO-1078, pranlukast, 450 mg, in 2 divided doses, Ono Pharmaceutical Co, Ltd, Osaka) were administered orally for 7 days to 16 subjects with perennial nasal allergy to house dust mites, and the effects of receptor blockers of these chemical mediators on the effective cross-sectional area of the nasal cavity (ECA) at rest, at exercise load, at antigen challenge, and at exercise load following antigen challenge were studied. After the administration of H1 receptor antagonist, ECAs at all measurement points slightly increased, but no statistical significance was observed. On the other hand, LT receptor antagonist inhibited ECAs 10 minutes after exercise load, just after the end of antigen challenge, 10 minutes later, and at exercise load following antigen challenge with statistical significance. These results suggest that LTs are involved markedly, and histamine slightly, in the development of nasal mucosal swelling in nasal allergy.

Adolescent↗
PubMed1999

A case in which stent insertion is considered to have triggered contrast medium-induced coronary vasospasm.

A Gianturco-Roubin II (GR-II) stent was inserted in a 75-year-old man who developed restenosis of the right coronary artery (RCA) after percutaneous transluminal coronary angioplasty (PTCA). Although the vessel became partially occluded after 7 months, it was redilated by PTCA. Follow-up angiography of the RCA and left coronary artery (LCA) was performed 3 months later. Chest pain with bradycardia and hypotension occurred immediately after this examination, and ST elevation appeared in ECG leads II, III, and aVF. Repeat angiography of the RCA confirmed complete occlusion due to a spasm at a site proximal to the GR-II stent. The spasm was resolved by intracoronary infusion of isosorbide dinitrate (ISDN), and PTCA was carried out for extensive recurrent restenosis of the RCA; however, vascular dissection developed at the distal end of the GR-II stent. Therefore, a Palmaz-Schatz (P-S) stent was placed such that its proximal end overlapped the distal end of the GR-II stent. Follow-up angiography 3 months later showed no restenosis, but an episode of vasospasm similar to the previous one occurred immediately after left ventriculography. The RCA was completely occluded proximal to the GR-II stent because of spasm. Although this spasm was gradually relieved by intracoronary infusion of ISDN, marked spasm was also observed distal to the P-S stent; complete relief was achieved by infusion of additional ISDN.

Aged↗
PubMed1998

Pirmenol hydrochloride-induced QT prolongation and T wave inversion on electrocardiogram during treatment for symptomatic atrial fibrillation.

Pirmenol hydrochloride is a new orally effective, long-acting antiarrhythmic agent currently used in patients with supraventricular and ventricular tachyarrhythmias. We report on a 56-year-old female who exhibited drug refractory paroxysmal atrial fibrillation, in which marked prolongation of the QT interval and T wave inversion on electrocardiogram was demonstrated reproducibly shortly after the administration of oral pirmenol therapy. The plasma concentration of pirmenol was at a subtherapeutic level and the lymphocyte stimulation test was positive in this patient. Thus, an immunological mechanism might be involved in the mechanism of pirmenol-induced QT prolongation and T wave inversion on the electrocardiogram.

Anti-Arrhythmia Agents↗
PubMed1998

Analysis of long-term results of our combination therapy for squamous cell cancer of the maxillary sinus.

Seventy-four patients between 1971 and 1982 in Period I and 32 patients between 1982 and 1987 in Period II with maxillary sinus squamous cell cancer were treated by combination therapy consisting of preoperative LINAC X-ray irradiation with 5-flourouracil intra-arterial chemotherapy followed by maxillectomy and primary reconstruction. In Period II, 21 patients received preoperative cisplatinum (CPPP) microcapsule chemoembolization and pepleomycin (PEP) i.m. and or postoperative CDDP i.v. with PEP i.m. in addition to the combination therapy administered in Period I depending on systemic conditions, tumor stage and histopathological type. Five and 10-year crude survival rates were 68.9% and 55.4%, respectively, for Period I and 71.9% and 56.3% for Period II, with no significant difference between the two trials. In 21 selected patients in Period II, who had additional chemotherapy with preoperative CDDP chemoembolization and/or postoperative i.v. infusion of CDDP with pepleomycin i.m., 5 and 10-year survival rates were 85.7% and 61.9%, respectively.

Antineoplastic Agents↗
PubMed1998

Analysis of factors affecting long-term treatment results of adenoid cystic carcinoma of the nose and paranasal sinuses.

At Akita University Hospital (from 1971 to 1987) and at Chiba University Hospital (from 1983 to 1988), 17 patients with adenoid cystic carcinoma of the nose and paranasal sinuses were treated by en bloc tumor resection followed by primary reconstruction of the maxilla. Pre- and postoperative radiation was combined in 5 and 6 patients, respectively. Ten-year cancer-free survival rates were 59.3% in the 12 patients with maxillary sinus tumors and 50% in the 4 patients with nasal tumors. One patient with a sphenoid sinus tumor died within 5 years. Ten-year cancer-free survival was affected markedly by grade of tumor extension. Among T1N0M0 and T2N0M0 patients (of which there were 1 and 7, respectively), only 1 died of unrelated causes, and 6 patients survived cancer-free for more than 10 years. However, 4 of the 6 T3N0M0 patients died, and the cause of death was distant metastasis in 2, intracranial tumor extension in 1, and unrelated causes in 1. All 3 T4N0M0 patients died, 2 due to intracranial tumor extension and 1 of unrelated causes. The cause of death was distant metastasis in 3, local recurrence in 3, 2 of whom had intracranial tumor extension, and unrelated causes in 2. Prevention of distant metastasis and intracranial tumor extension was considered to be crucial for improving treatment results after en bloc tumor resection. Preoperative radiation was thought to decrease incidence of distant metastasis. In 5 patients who had preoperative radiation. 4 survived cancer-free for more than 10 years, and only 1 patient died of unrelated cause. However. of the 6 patients who had postoperative radiation, 2 died of distant metastasis and another 2 died of intracranial tumor extension. Of the 6 patients who did not have radiation therapy, the causes of death were local recurrence in 1, distant metastasis in 1 and unrelated causes in 1. Preoperative radiation in 5 patients showed histopathologically moderate or marked degeneration and necrosis of tumors in all patients. Although the number of patients in this study is too small to allow statistical analysis of the data, our present modality of treatment for adenoid cystic carcinoma of the nose and paranasal sinuses is routine combination of preoperative full dose radiation, en bloc tumor resection and primary reconstruction, including en bloc resection of the cranial base in selected T4 patients.

Antineoplastic Agents↗