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Biomedical subjects

T Shoji

Publications and source records attributed to T Shoji.

At least 253 records · Page 14Linked to original sources
PubMed1991

Cost-effectiveness analysis of screening for colorectal cancer in Japan.

To clarify the best cost-effective screening strategy for colorectal cancer in Japan, the cost-effectiveness ratio was compared among six currently performed procedures. The analysis was made using a simulation model to estimate long-term cost and effectiveness of the screening programs. In the screening by the immunological fecal occult blood test (FOBT), a comparison between the one- and two-day fecal collection methods indicated that the latter was more cost-effective than the former. A comparison was also made on the four workup methods: barium enema (BE) alone, a combination of BE and sigmoidoscopy (BE + SIG), total colonoscopy (TCF) alone, and a combination of BE and TCF (BE + TCF). The cost-effectiveness ratio was the lowest in the method using TCF alone, followed by those based on BE alone and BE + TCF, and the highest in the BE + SIG method. The superiority of TCF alone strategy was stable over a range of estimates such as the sensitivity of diagnostic tests, the probability of complications due to TCF, etc. It is concluded that a combination of the two-day FOBT and TCF yields the best cost-effectiveness.

Barium Sulfate↗
PubMed1991

Cost-effectiveness analysis of screening for gastric cancer in Japan.

Cost-effectiveness analysis of gastric cancer screening in Japan was performed, and the cost-effectiveness ratio was compared with that of colorectal cancer screening. The analytical model was the same as that adopted in our previous study on colorectal cancer screening (Tsuji et al. 1991). The results indicated that the cost per case-fatality prevented by colorectal cancer screening was 5.5 and 2.7 times more expensive for males and females, respectively, than that by gastric cancer screening. The age of the population influenced the cost-effectiveness of screening programs. The cost-effectiveness ratio in gastric cancer screening became negative among males older than the age of 65 years, suggesting that the total cost for prevention and control of deaths by gastric cancer in these age populations is saved by the screening program.

Adult↗
PubMed1991

Lipoprotein metabolism in normolipidemic obese women during very low calorie diet: changes in high density lipoprotein.

We examined changes in high density lipoprotein (HDL) metabolism during a very low calorie diet weight reduction program in 6 massively obese normolipidemic women. The diet protocol consisted of a 1st low calorie diet (LCD; 1440, 1280, and 880 kcal daily for 1 week, each, in succession), a 1st very low calorie diet (VLCD; 420 kcal daily for 4 weeks, using Optifast 70), intermission (880 kcal daily for 1 week), the 2nd VLCD (4 weeks) and the 2nd LCD (880 and 1280-1440 kcal daily for 1 week, each). Mean body weight reduction was 18.9 kg. HDL-cholesterol, more specifically HDL2-cholesterol, reduced transiently during the 1st VLCD, intermission, and 2nd VLCD periods, and tended to increase in the 2nd LCD. Apolipoprotein (apo) A-I showed a similar change to HDL-cholesterol. However, apo A-II decreased persistently throughout the weight reduction program, and the apo A-I/apo A-II ratio increased significantly in the later part of the program. Serum triglyceride, apo B, and lipoprotein lipase (LPL) activity in post-heparin plasma did not change. These data suggest that the observed decrease in HDL-cholesterol was not due to a reduction in very low density lipoprotein-derived HDL production or to an LPL deficiency, but was consistent with reduction in chylomicron-derived HDL formation following dietary fat restriction.

Adult↗
PubMed1991

Obesity as a determinant of regional bone mineral density.

Total body and regional bone mineral density (BMD) and bone mineral content (BMC) in obese patients and healthy controls were assessed by dual-photon absorptiometry (DPA) in this study. In both men and women, BMD values in total body, pelvis, upper and lower extremities were significantly (p less than 0.05) higher in the obese group (body mass index greater than 28) than in the non-obese group (body mass index less than 23). These BMD values correlated significantly with body weights and with percentages of body fat. In the obese group, 8 massively obese women were treated with an 8-week very low calorie diet (VLCD), resulting in a 13.4 kg of mean body weight reduction. Although BMC in total body and in pelvis were maintained, significant decreases of BMC in the upper (from 275 +/- 30 to 255 +/- 26 g) and lower (from 871 +/- 47 to 805 +/- 31 g) extremities were observed following the 8-week VLCD treatment. These results suggest that body fat mass affects BMD and BMC preferentially in weight bearing bone, the changes of which are not always associated with changes in total body BMD or BMC.

Adult↗
PubMed1991

[Malignant fibrous histiocytoma of the heart--a case report and review of the literature].

Malignant fibrous histiocytoma (MFH) has been rarely reported as a primary tumor of the heart. We present a case of a primary intracardiac MFH and review the 28 previous reports of this rare cardiac tumor. A 48-year-old woman underwent an operation for congestive heart failure (CHF) due to a left atrial tumor. A large multinodular tumor attached to the posterior wall of the left atrium and extended into the mitral annulus and the posterior leaflet of the mitral valve. The tumor was resected incompletely and mitral valve replacement was performed. Pathological diagnosis was MFH. The patient did well in the postoperative period, but she again presented with symptoms of CHF four months later. Chest CT and two-dimensional echocardiogram demonstrated a recurrent tumor of the left atrium. Since the tumor grew rapidly despite chemotherapy, a reoperation was performed to remove it. Nevertheless, as the tumor was found to have extended into the pericardial cavity and posterior mediastinum, only partial resection was possible. After a protracted operation, the heart failed to sustain the circulation and the patient died. The prognosis of intracardiac MFH was poor in spite of surgery, radiation and/or chemotherapy. However, repeated surgical treatments can relieve symptoms of CHF and may prolong the life of patients.

Female↗
PubMed1991

[The influence of left atrial cuff rejection on pulmonary hemodynamics after canine lung allotransplantation].

Several factors influence pulmonary hemodynamics after lung transplantation: reimplantation response, lung rejection reaction and imperfect anastomosis technique. In this experiment, five cases presented marked elevation of mean pulmonary artery pressure at the time or right pulmonary artery occlusion test performed two weeks postoperatively. Left atrial cuff rejection reaction arose in one case in which edema and stenosis of the pulmonary vein outflow tract were evidenced. This finding demonstrated that the changes in pulmonary hemodynamics after transplant suggest the possibility of inducement by left atrial cuff rejection reaction.

Animals↗
PubMed1991

Myocardial distribution of indium-111-antimyosin Fab in acute inferior and right ventricular infarction: comparison with technetium-99m-pyrophosphate imaging and histologic examination.

In a postmortem study of a 69-yr-old female patient who had suffered 2 yr previously a non-Q-wave anterior infarction and who had sustained just seven days earlier a left inferior and right ventricular infarction, the distribution of 111In-antimyosin Fab was compared to the results of 99mTc-pyrophosphate imaging and histologic examination. Indium-111-antimyosin Fab imaging could not be performed because of cardiogenic shock. However, postmortem gamma scintillation counting revealed increased activities of antimyosin Fab in the inferoapical and right ventricular infarcted regions in which 99mTc-pyrophosphate positive imagings were observed; in contrast, a histologically confirmed old subendocardial anterior infarction had no definite activity. Thus, the myocardial distribution of 111In-antimyosin Fab corresponded well to the results of 99mTc scintigrams and histologic examinations in a human heart, suggesting that this technique could be useful in vivo for detecting several-day-old myocardial infarction of the right ventricle as well as the left ventricle. Tissue from the 2-yr-old infarction was not identified by this technique.

Aged↗
PubMed1991

[Hematolymphoid system in the liver--restoring mechanism of hemopoiesis in the regenerating liver].

For the study of immunological phenomena peculiar to liver transplantation, it would be important to know well hematolymphoid system in the liver. In this paper, we report the restoring mechanism of hemopoiesis in the murine regenerating liver. 1) We found hemopoietic stem cells (HSC) and wheat germ agglutinin positive cells (WAG-PC) in both fractions of peripheral blood lymphocytes (PBL) and intrahepatic lymphocytes (IHL) from untreated C3H/He mice. The numbers of HSC and WGA-PC in each fraction gradually increased after partial hepatectomy. This change was remarkable in the population of IHL, associated more strongly with the liver. Colonies, which were generated from IHL in a fibrin clot culture system, are mainly composed of granulocytes, macrophages and mast cells. 2) We found colony-stimulating activity not only in the culture supernatant of normal nonparenchymal liver cells but in that of normal parenchymal liver cells. Furthermore, we clarified that one of colony-stimulating factors in both culture supernatants is GM-CSF. This result suggests parenchymal liver cells also release cytokines such as GM-CSF. These facts show that hematolymphoid system in the liver is a complicated network, composed of parenchymal liver cells, nonparenchymal liver cells, hemopoietic stem cells, and other cell populations.

Animals↗
PubMed1991

[Clinical experience of intramediastinal injection therapy via mediastinoscope for lung cancer].

As local treatments other than surgery, radiation therapy, bronchial artery infusion and intrabronchial injection of anti-cancer drugs have generally been administered to inoperative lung cancer cases. Together with these local therapies, we experienced six cases of intramediastinal injection. Indication of this therapy has been fundamentally limited to the inoperative cases in which patient performance status has deteriorated. Histologically, three cases were squamous cell carcinoma and three cases were adenocarcinoma. Injection therapy was effective in four cases where we noted alleviation of atelectasis and obstructive pneumonia brought on by the tumor, and a tendency of the tumor and swelling lymph nodes to be reduced. No side effects nor complications were evidenced. This therapy is characterized by a wider injection area in which intrabronchial injection is incapable of reaching the upper mediastinum, the bifurcation and the upper side of the hilus. The results suggest that this therapy should be used alone or together with other local therapies and prior to operation.

Adenocarcinoma↗
PubMed1991

Arrhythmogenic right ventricular dysplasia with massive involvement of the left ventricle.

A 30-year-old male died suddenly after two years of clinically progressive episodes of recurrent ventricular tachycardia. In spite of recurrent episodes of palpitation, the patient had never shown signs or symptoms of heart failure before death. Post mortem examination revealed massive left ventricular involvement in addition to complete absence of myocardial tissue in the right ventricle, replaced by adipose tissue. This case illustrates that patients with arrhythmogenic right ventricular dysplasia may die of arrhythmia before failure of the left ventricle.

Adult↗
PubMed1991

[Prediction of postoperative exercise capacity in lung resection candidates].

The relation between submaximal oxygen consumption (MVO2) before and after lung resection was studied, and the possibility to predict postoperative MVO2 was investigated. Thirty four patients (19 lobectomies, 9 bi-lobectomies, 6 pneumonectomies) performed exercise tests one week before operation and at the time when they were able to resume work daily after operation (in two to eleven months). Predicted postoperative MVO2 was calculated from preoperative MVO2 as follows: 0.8 x resection rate x age index x preoperative MVO2 + 183. In this formula the resection rate means [the number of total lung segments--the number of non-working segments]. The age index is 1.5 for patients under 50 years, 1.0 for those between 50 to 69, and 0.8 for those over 70. This predicted MVO2 had strong correlation with actual postoperative MVO2 (r = 0.94, t = 13.4, y = 1.08x - 83) in twenty five patients. Correlation was low in the remaining nine patients, however. The nine had old myocard infarction, postoperative cerebral infarction, marked wet lung, anticancerous chemotherapy within ten days or marked reduced exercise capacity (below 3 METS at maximal exercise). From these results, we concluded it is possible to predict the postoperative MVO2 using preoperative MVO2 except in cases which have some exercise limiting factors or whose exercise capacity is very small.

Adult↗
PubMed1991

[Arterial graft anastomosis in coronary artery surgery: some technical points].

To facilitate surgical technique, we describe some devices on arterial graft anastomosis in coronary artery surgery. Prior to anastomosis, the graft is positioned closely just parallel to the coronary artery by fixing surrounding endothoracic fascia or other connective tissues to the epicardium with 5-0 monofilament sutures. Stitching around the heel of the anastomosis is best performed by "a single stroke continuous suture" with the graft kept in position parallel to the coronary artery. This technique provides simple and secure anastomosis of an arterial graft.

Anastomosis, Surgical↗