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Biomedical subjects

T Shima

Publications and source records attributed to T Shima.

At least 145 records · Page 8Linked to original sources
PubMed1992

Wegener's granulomatosis with papillary adenocarcinoma of the thyroid.

A 59-year-old woman was admitted with scleritis, sinusitis, skin eruptions, nodular lesions of both lung fields in chest X-ray films and renal failure. Skin biopsy and elevation of the titer of anti-neutrophil cytoplasmic antibody confirmed Wegener's granulomatosis. A right nodular goiter was palpated and a diagnosis of thyroid cancer was made based on aspiration cytology. Although combined therapy with cyclophosphamide and corticosteroid was started and the Wegener's granulomatosis improved and disappeared except for the renal lesion, the renal failure worsened and she died. Apparently only 2 cases of Wegener's granulomatosis complicated with carcinoma as in this case have been reported.

Adenocarcinoma, Papillary↗
PubMed1992

Bilateral symmetrical cerebral arteriovenous malformations in the basal ganglia--case report.

A 21-year-old male presented with visual disturbance followed by severe headache. Computed tomography showed right thalamic hemorrhage entering the right lateral ventricle. Cerebral angiography revealed bilateral symmetrical arteriovenous malformations (AVMs) fed by the lenticulostriate, anterior choroidal, and lateral posterior choroidal arteries and draining into the vein of Galen. Partial removal of the right AVM induced bleeding on the left side, probably due to postoperative hemodynamic changes. Bilateral symmetrical cerebral AVMs are extremely rare, but provide serious problems for surgical intervention in the deep cerebrum.

Adult↗
PubMed1992

[The effect of preoperative oral administration of ranitidine on pH and volume of gastric juice].

The effect of ranitidine, administrated 2 or 4 hours prior to induction of anesthesia, on volume and pH of gastric juice was investigated in patients undergoing elective surgery. Three-hundred mg of ranitidine was administrated orally in 54 patients 2 hours prior to anesthesia and in 50 patients 4 hours prior to anesthesia. The volume and pH of gastric juice were measured immediately after induction of anesthesia. In more than 90% of patients of both groups, volume of gastric juice was smaller than 25 ml and its pH was more than 2.5. Ranitidine 450 mg was administrated orally in 7 patients, and its plasma concentration was measured 2, 4 and 6 hours after administration. In one patient, volume of gastric juice was larger than 25 ml and its pH was less than 2.5. Ranitidine concentration in this patient was below the effective level 2 hours after administration and it was above the level after 4 hours. We concluded that oral administration of ranitidine 300 mg, 4 hours preoperatively, could be more effective to prevent aspiration pneumonitis than when it is given 2 hours preoperatively.

Administration, Oral↗
PubMed1992

[A case of pulmonary adenocarcinoma in a young man with multiple metastasis to the nasopharynx and paranasal sinuses].

A 36-year-old man who complained of bloody sputum showed a mass-like shadow in the right upper lung field on chest X-ray, which was diagnosed as adenocarcinoma by sputum cytology in August, 1990. Since his clinical stage was too advanced for curative operation, chemotherapy was started on October 1, 1990. On October 26, he brought up a polyp-like mass, and was found to have polypoid tumors on the bilateral tonsils and nasopharynx, which were biopsied and diagnosed as poorly-differentiated adenocarcinoma. On November 21, CT of the face showed soft tissue density tumors in the bilateral paranasal sinuses. According to the clinical course, all tumors were thought to be metastatic lesions. Since he had suffered from epistaxis and nasal obstruction due to the enlargement of metastatic tumors, nebulization chemotherapy and palliative resection were performed. In February 1991, he developed severe headache due to brain metastasis. Despite irradiation therapy, he died from cerebral intra-tumorous hemorrhage on February 22. We reported a rare incurable case of lung cancer with metastasis to the nasopharynx and paranasal sinuses.

Adenocarcinoma↗
PubMed1992

[Anesthetic induction of children with high concentrations of sevoflurane].

The induction and intubation with high concentrations of sevoflurane (4% or 6.4%) were investigated in 180 children with ages ranging from 1 to 6yr 12m. Average induction time (duration between the start of induction and loss of consciousness) with 4% sevoflurane was 56 sec and that with 6.4% was 47 sec. Eight patients out of 90, to whom 4% sevoflurane was applied, could not be intubated due to closure of vocal cord, cough or closure of mouth. The most serious side effect was convulsion during induction, of which incidence was 6% of all patients, and occurred more frequently with 6.4% sevoflurane. The convulsion spread from hand on one side to all over the body, and disappeared spontaneously within 30 sec. There was no significant side effect in cardiovascular system, such as hypotension, arrhythmia or bradycardia. In conclusion, smooth intubation was possible without use of muscle relaxants with high concentrations of sevoflurane. This can be one of the choices for induction of children, though there is a possibility of occurrence of convulsion.

Anesthesia, Inhalation↗
PubMed1992

Increased concentrations of type IV (7 S) collagen in sera of hyperthyroid patients with Graves disease.

Serum concentrations of type IV collagen (7 S) were determined in 29 patients with untreated hyperthyroidism and 30 healthy subjects. Serum 7 S collagen was significantly higher (P less than 0.0001) in the hyperthyroid patients (6.3, SD 1.3, micrograms/L) than in the healthy control subjects (3.9, SD 0.6, micrograms/L). No difference in serum concentrations of 7 S collagen were observed between patients with normal liver function and those with abnormal liver function. Serum concentrations of 7 S collagen correlated positively with serum concentrations of free triiodothyronine (r = 0.41, P less than 0.05). In the hyperthyroid patients, 7 S collagen concentrations in serum gradually fell into the normal range as thyroid function became normalized. Thus, hyperthyroidism is one of the diseases in which serum concentrations of 7 S collagen are increased.

Adolescent↗
PubMed1992

Serum erythropoietin concentrations and iron status in patients on chronic hemodialysis.

We studied the relationship between serum erythropoietin (EPO) concentration and iron status in 67 patients undergoing chronic hemodialysis. Serum concentrations of EPO were measured by RIA with recombinant human EPO. The geometric mean of the serum EPO concentration was 10.9 int. units/L (mean +/- SD range = 7.8 - 15.3 int. units/L) in hemodialysis patients, considerably lower than that in normal subjects (12.9 int. units/L). We found no significant correlation between concentrations of serum EPO and hemoglobin in hemodialysis patients, but found a significant negative correlation between serum concentrations of EPO and iron in hemodialysis patients. Moreover, we also found a significant positive correlation between the EPO concentration and the unsaturated iron-binding capacity (UIBC) in serum, and a significant negative correlation between the serum concentrations of EPO and ferritin in hemodialysis patients. Several patients who had relatively high EPO concentrations for hemodialysis patients also had low iron concentrations, high UIBC values, and low ferritin concentrations. These findings suggest that iron was utilized even at these EPO concentrations, which were very low for the degree of anemia observed in the hemodialysis patients.

Adult↗
PubMed1992

[Perioperative management of uvulopalatopharyngoplasty for the obstructive sleep apnea patient].

The perioperative courses of 10 patients with obstructive sleep apnea syndrome who underwent uvulopalatopharyngoplasty were reported. No hypnotic was administered at night before operation. Premedication consisted of atropine 0.5 mg, meperidine 35 mg, given i.m. 1 hr prior to surgery. No patients developed respiratory depression after premedication. General anesthesia was induced with iv thiopental, and succinylcholine was given to facilitate tracheal intubation. Airway management was technically difficult in all patients. Anesthesia was maintained with N2O-O2-enflurane under controlled ventilation. At the end of the surgery the insertion of a nasopharyngeal airway was performed for the prevention of airway obstruction. In 8 patients it was possible to remove the airway in the next morning. Dexamethasone was administered 3 times to reduce pharyngeal edema during perioperative period. Trachea was extubated when the patient was fully awake and alert. Perioperatively the following points are important in the management of uvulopalatopharyngoplasty. 1. Assessment of airway and the method of airway control. 2. Reduction of pharyngeal edema. 3. Using caution against the postoperative hemorrhage. 4. Avoidance of sedation. 5. Close observation extending into the postoperative period.

Adult↗
PubMed1992

[The correct endotracheal tube size for infants and children].

The correct endotracheal tube size was assessed in 600 anesthetized infants and children. The correct tube size was determined by the airway pressure at which a gas leak around the endotracheal tube occurred, when the lungs were inflated with slowly increasing positive pressure. Endotracheal tube size correlated most with body length where the correlation coefficient was 0.973 (P less than 0.01), followed by body weight, tracheal size in X-ray photograph and age. But, there were four correct tube sizes for patients with the same body length.

Child↗
PubMed1991

Serum transferrin as a marker of bone growth in boys: correlation with serum alkaline phosphatase activity, plasma insulin-like growth factor 1 and rate of growth in height.

Transferrin (TF) has a growth promoting activity in cell culture. The aim of this work was to study possible relationships between serum TF, alkaline phosphatase activity (ALP), plasma insulin-like growth factor 1 (IGF-1) levels and rate of height increase in boys. 149 boys aged 13-15 yrs were studied. TF levels were measured using turbidimetric method. The serum levels of ALP could be used as a biochemical marker for bone formation. Significant correlation was found between serum TF levels and ALP levels (r = 0.31, P less than 0.0005). The TF levels are higher in iron-deficiency anemia. The hemoglobin (Hb) and serum ferritin were measured in all boys. Thirty-one of 149 boys had no iron-deficiency anemia (Hb 14.0 g/dl and serum ferritin 23 ng/ml). The rate of growth in height was estimated over a 5 month period. In these boys, the rate of growth in height was significantly correlated with serum TF levels (r = 0.37; P less than 0.05). A significant correlation was found between serum TF levels and plasma IGF-1 levels (r = 0.45; P less than 0.05). These data indicate that serum TF levels may be a marker of skeletal growth in normal boys.

Adolescent↗
PubMed1991

[The effect of oral administration of roxatidine acetate hydrochloride 3 hours prior to the operation on pH and volume of gastric juice].

The effect of roxatidine acetate hydrochloride, administered 3 hours prior to induction of anesthesia, on pH and volume of gastric juice was investigated in preoperative patients. In fifty patients, who were scheduled to undergo elective surgery, 150 mg of roxatidine acetate hydrochloride was administered orally 3 hours before the induction of anesthesia. The volume and pH of gastric juice were measured immediately after the induction of anesthesia. In 46 patients out of fifty, pH of gastric juice was more than 2.5, and its volume was below 25 ml. In another 4 patients, pH of gastric juice was more than 2.5, or its volume below 25 ml. We conclude that, oral administration of 150 mg roxatidine 3 hours preoperatively could be effective for the prevention of an aspiration pneumonitis.

Administration, Oral↗
PubMed1991

[An X-ray study of catheters abnormally placed in the epidural space].

We investigated the roentgenogram of the epidural catheter in 82 patients in whom the injection of local anesthetics had no effect. Contrast medium 0.5 ml was injected through the epidural catheter and antero-posterior roentgenogram was taken. The roentgenograms were categorized into three patterns, according to the relationship of the catheter to the pedicle of lamina, or to the spread of contrast medium. In 43 cases, the catheter passed through the intervertebral foramen. The tip of the catheter was located outside the foramen, and the contrast medium spread outside the vertebra. In 4 cases, the tip of the catheter was located laterally in the vertebral column, and only the catheter itself was contrasted but no spread of medium was observed. The catheter was thought to be misinserted intravascularly. In other 35 cases, catheter ran laterally on the pedicle of lamina, or the spread of medium 2 mins after the injection was indicated by a dumpling-shape even when the tip was in the vertebral column. In these cases, the catheter was thought not to be outside the epidural space.

Anesthesia, Epidural↗
PubMed1991

[Chronic lymphocytic leukemia with bilateral exophthalmos and visual disturbance].

A 61-year-old male was admitted to our hospital because of progressive bilateral exophthalmos and visual disturbance. He was diagnosed as chronic lymphocytic leukemia (CLL) with stage I of Rai system. Ophthalmologic examinations suggested that CLL cells might have invaded diffusely to bilateral orbits. Radiation to orbital lesions might result in other ophthalmologic complications such as cataract, therefore we tried to treat him with chemotherapy alone. As a result, combination chemotherapy consisting of vincristine, cyclophosphamide, prednisolone and doxorubicin (VEPA) and additional daily oral administration of cyclophosphamide were effective enough for his ophthalmologic recovery.

Exophthalmos↗
PubMed1990

Unusual trihydroxy bile acids in the urine of patients treated with chenodeoxycholate, ursodeoxycholate or rifampicin and those with cirrhosis.

Urinary bile acids from 20 patients treated with chenodeoxycholate, 18 treated with ursodeoxycholate, 15 treated with rifampicin and 8 patients with advanced cirrhosis were analyzed by gas-liquid chromatography and gas-liquid chromatography-mass spectrometry. Occurrence rates and amounts of three so-called unusual trihydroxy bile acids, hyocholate, ursocholate and omega-muricholate, were increased in patients treated with chenodeoxycholate, ursodeoxycholate or rifampicin and decreased in cirrhotic patients as compared with those in untreated healthy adults. These data suggest that chenodeoxycholate and ursodeoxycholate are hydroxylated to produce unusual trihydroxy bile acids in bile acid-loaded humans and that this metabolism may be related to the induction of hepatic microsomal enzymes by rifampicin. In contrast, the hydroxylation of chenodeoxycholate and ursodeoxycholate may be impaired by severe hepatic damage. Because the urine is a secretory pathway for internal bile acids, the occurrence of unusual trihydroxy bile acids in the urine may be used as an indicator of hepatic ability to metabolize "hydrophobic" dihydroxy bile acids to their secretory forms.

Bile Acids and Salts↗