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T Takishima

Publications and source records attributed to T Takishima.

At least 19 recordsLinked to original sources
PubMed2001

Declining trend in the in-hospital case-fatality rate from acute myocardial infarction in Miyagi Prefecture from 1980 to 1999.

The case-fatality rate from acute myocardial infarction (AMI) appears to have been declining in recent decades, so the present study reviewed the trend in in-hospital case-fatalities from AMI in Miyagi Prefecture, Japan, 1980-1999. The causes of death and the effects of gender and age on the trend were also analyzed. From the AMI registration database of the Miyagi Study Group for AMI, 12,961 cases of AMI were analyzed. The 30-day in-hospital case-fatality was calculated from the data for 1980-1999: data for causes of death were available for 1980-1997, and the data concerning primary percutaneous transluminal coronary angioplasty (PTCA) for AMI were available for 1997-1999. The in-hospital case-fatality rate declined from 17.0% in the early 80s to 7.3% in the late 90s (approximately 57% reduction). The in-hospital case-fatality rate was higher in female patients. Rhythm failure substantially decreased in the late 1980s. Pump failure is decreasing, but is still the biggest problem. The in-hospital case-fatality rate was significantly lower in patients received PTCA. The declining trend in the in-hospital case-fatality rate suggests the benefits of current therapeutic procedures, including primary PTCA, for AMI. Pump failure is an important target for further decreasing the trend.

Adult↗
PubMed2001

Case report: right subclavian artery pseudoaneurysm due to perforation of esophageal cancer.

A 51-year-old man presented with massive hematemesis. Perforation of upper esophageal cancer, which had already occurred at least six days earlier, progressed to upper mediastinitis. The mediastinitis contiguous to the right subclavian artery was considered to have caused a pseudoaneurysm. Rupture of the pseudoaneurysm into the esophagus resulted in massive hematemesis. Both enhanced computed tomography and angiography were diagnostic for the pseudoaneurysm. Transluminal endovascular stent-grafts placement was successful in preventing subsequent hemorrhage.

Aneurysm, False↗
PubMed2000

Pancreatographic classification of pancreatic ductal injuries caused by blunt injury to the pancreas.

BACKGROUND: In the treatment of patients with pancreatic injury, the focus of attention is usually on main ductal injuries. METHODS: To develop a classification system for pancreatic ductal injuries, we retrospectively analyzed blunt pancreatic injuries in 40 patients. We assessed the relationships between findings on pancreatography (36 endoscopic retrograde procedures and 4 transduodenal procedures), the treatment modality, and the clinical course. RESULTS: Patients with class 1 injuries (radiographically normal ducts, n = 13) could be treated nonsurgically without major complications. Patients with class 2 injuries (branch injuries, n = 7), in whom contrast medium from ductal branches did not leak from the pancreatic parenchyma (class 2a, n = 3), could be treated nonsurgically. Patients with leaks into the retroperitoneal space (class 2b, n = 4) required at least a drainage laparotomy. Patients with class 3 injuries (main duct injuries, n = 20), including two patients in whom conservative treatment resulted in severe complications, required laparotomy. CONCLUSION: This classification system for pancreatic ductal injuries may facilitate the selection of appropriate therapeutic modalities for patients with blunt pancreatic injury.

Adult↗
PubMed1998

Influence of sustained hypoxia on the sensation of dyspnea.

We assessed the effect of sustained isocapnic hypoxia (PCO2 = 40 Torr, SaO2 = 80%) on the sensation of dyspnea in 16 normal healthy males. Subjects rated the sensation of dyspnea (c) on 15 cm visual analog scales during 20 min of sustained hypoxia. Following this hypoxic period, 8 subjects undertook mild exercise (10-50 W on a bicycle ergometer for 3 min) under the continuation of hypoxia. During sustained hypoxia, psi increased initially with ventilation from 0.6 +/- 0.2 (n = 16, mean +/- SE) to 2.9 +/- 0.6 at peak ventilation, but it decreased with ventilatory depression to 1.6 +/- 0.4. Dyspnea intensity during hypoxic exercise was significantly smaller than that at peak ventilation in the resting hypoxic period (2.3 +/- 0.7 vs. 3.9 +/- 1.0), although the ventilation was greater during exercise (24.0 +/- 3.0 vs. 19.7 +/- 1.4 l/min). These results indicate that sustained hypoxia has a biphasic, i.e., initial stimulatory and delayed depressant, effect on dyspnea and on ventilation. It is suggested that the dyspnea sensing mechanism is suppressed during mild exercise under sustained hypoxia.

Adult↗
PubMed1997

Modification of human left ventricular relaxation by small-amplitude, phase-controlled mechanical vibration on the chest wall.

BACKGROUND: Direct clinical manipulation to improve an impairment of left ventricular (LV) relaxation has not been reported. We investigated whether the LV relaxation rate in humans could be modulated by phase-controlled mechanical vibration applied to the patient's anterior chest wall and whether there are some quantitative differences in the responses of normal (N), hypertrophied (H), and failing (F) ventricle. METHODS AND RESULTS: In 46 patients (N, 10; H, 18 [hypertrophic cardiomyopathy]; F, 18 [heart failure]), the vibrator was attached to the precordium and a 50-Hz, 2-mm sinusoidal mechanical vibration was applied, with the timing restricted from the onset of isovolumic relaxation to end-diastole during cardiac catheterization. Heart rate and peak LV pressure showed no difference with vibration. However, in all patients, precordial vibration caused an acceleration of the LV pressure fall. The magnitude of the induced reduction of the time constant of LV pressure decay (delta T) was larger (P < .01) in H and F than in N (4.6 +/- 2.3, 4.0 +/- 1.6, and 0.6 +/- 1.5 ms for H, F, and N, respectively). Delta T correlated strongly with the magnitude of impaired relaxation and the magnitude of transmitted vibration to the ventricle. CONCLUSIONS: Phase-controlled, small-amplitude vibration on the chest wall can directly modulate LV relaxation rate, especially in those with hypertrophy or failing ventricle.

Adult↗
PubMed1997

Serum amylase level on admission in the diagnosis of blunt injury to the pancreas: its significance and limitations.

OBJECTIVE: The objective of this study was to elucidate the significance and limitations of serum amylase levels in the diagnosis of blunt injury to the pancreas. SUMMARY BACKGROUND DATA: Several recently published reports of analyses of patients with blunt abdominal trauma have indicated that determination of the serum amylase level on admission seemed to be of little value in the diagnosis of acute injury to the pancreas. Few previous reports have described clearly the significance and the limitations of the serum amylase level in diagnosing injury to the pancreas. METHODS: Retrospective analysis of 73 patients with blunt injury to the pancreas during 16-year period from February 1980 to January 1996 was performed. The factors analyzed in the current study included age, gender, time elapsed from injury to admission, hypotension on admission, type of injury to the pancreas, intra-abdominal- and intracranial-associated injuries, and death. RESULTS: The serum amylase level was found to be abnormal in all patients admitted more than 3 hours after trauma. Various comparisons between patients with elevated (n = 61, 83.6%) and nonelevated (n = 12, 16.4%) serum amylase levels showed the statistical significance solely of the time elapsed from injury to admission (7 +/- 1.5 hours vs. 1.3 +/- 0.2 hour, p < 0.001). The major factor that influences the serum amylase level on admission appeared to be the time elapsed from injury to admission. Determination of the serum amylase level is not diagnostic within 3 hours or fewer after trauma, irrespective of the type of injury. CONCLUSIONS: To avoid failure in the detection of pancreatic injury, the authors advocate determination of serum amylase levels more than 3 hours after trauma.

Abdominal Injuries↗
PubMed1996

Characteristics of pancreatic injury in children: a comparison with such injury in adults.

A retrospective study of eight pediatric patients (under 15 years of age) who had pancreatic injuries was undertaken. Comparisons were made with 59 adult patients who sustained pancreatic injuries over the same 15-year period. All the pediatric injuries and 96.6% of the adult resulted from blunt abdominal trauma. Bicycle accidents (children, 75.0%; adults, 0%; P < .001) and automobile accidents (children, 0%; adults, 61.0%; P < .01) were the most common causes of pancreatic injury in the two groups. There was no significant difference in the incidence of abdominal pain or peritoneal irritation between the groups. However, abdominal pain in the adults was poorly localized. Isolated pancreatic injuries were noted in 62.5% of the pediatric patients and in 15.3% of the adult patients (P < .05). Associated intraabdominal injuries were present in 25.0% of the children and in 69.5% of the adults (P < .05). The duodenum was injured in two (25.0%) pediatric patients and in 10 (16.9%) adult patients. Whereas the duodenal injuries in pediatric patients were intramural hematomas without perforation in both cases, all but one of these injuries in adults were perforations or transections (P < .05). There was a significant difference in the type of pancreatic injury between the two groups (P < .05). Surgery was performed in 12.5% of the pediatric cases and in 78.0% of the adult cases (P < .01). There were no deaths among the pediatric patients, but 8.5% of the adults died in the hospital. The difference with respect to clinical course might be related to the differences in cause of injury.

Abdominal Injuries↗
PubMed1996

Role of repeat computed tomography after emergency endoscopic retrograde pancreatography in the diagnosis of traumatic injury to pancreatic ducts.

Endoscopic retrograde pancreatography (ERP) is performed on patients with pancreatic injury after abdominal trauma. To delineate pancreatic ductal injuries more accurately, we performed repeat computed tomography (CT) shortly after completion of ERP. We describe our experiences with six patients to demonstrate the feasibility and utility of this method. In our cases, the diagnosis of pancreatic ductal injury was made with certainty on the basis of the presence of extravasated contrast medium. This protocol is useful for reaffirmation of injuries noted on ERP, for diagnosis of injuries not noted on ERP, and for exclusion of injuries in patients with equivocal results of ERP. Moreover, the protocol is easy to implement because it involves only the transfer of the patient from the endoscopy to the CT suite. The technique can be used to clarify potentially confusing situations.

Abdominal Injuries↗
PubMed1996

Surfactant apoprotein-A concentration in airway secretions for the detection of pulmonary oedema.

Patients with cardiogenic pulmonary oedema expectorate foamy sputum containing surfactant, which might be expected to include surfactant apoprotein A (SP-A). SP-A is specific for lung surfactant. We have measured the SP-A concentration in airway secretions to determine whether it is useful in distinguishing pulmonary oedema from other disorders. Samples of sputum and of aspirated airway secretion were obtained from 11 patients with cardiogenic pulmonary oedema, seven patients with clinically stable congestive heart failure, five patients with adult respiratory distress syndrome (ARDS) and 20 control patients (10 intubated) with other respiratory diseases. The samples were used for the measurement of SP-A concentration by a two-site simultaneous immunoassay with monoclonal antibodies against SP-A. SP-A concentrations, measured in samples of sputum and aspirated secretions, depended on the diagnosis of the patients from which they had come. In descending order these samples came from patients with: cardiogenic pulmonary oedema (1324 +/- 197 micrograms.mL-1; n = 33); ARDS (311 +/- 47 micrograms.mL-1; n = 23); clinically stable congestive heart failure (78 +/- 10 micrograms.mL-1; n = 21); and control conditions (3.0 +/- 0.6 micrograms.mL-1; n = 30). Concentrations from disease samples did not overlap with controls. In samples from patients with cardiogenic pulmonary oedema, the SP-A concentration correlated with mean pulmonary capillary wedge pressure (PCWP) (p < 0.001; n = 39). These findings indicate that the measurement of the surfactant apoprotein A concentration in airway secretions may be useful for the detection of pulmonary oedema.

Aged↗
PubMed1996

A new method for evaluating right ventricular dimensions and volume by cineangiography.

The aim of the present study was to establish a new method to evaluate the right ventricular dimensions and volume. Biplane right ventriculography of steep left anterior oblique view (LAO) and right anterior oblique view perpendicular to LAO were performed in 32 patients. The right ventricular volume and ejection fraction calculated from the three axial dimensions of the right ventricular cavity (the septum-free wall dimension, the anterior-posterior dimension, and either the long axis dimension or the tricuspid valve-apex dimension at end-diastole and end-systole) were well correlated to those from Simpson's method. In conclusion, we developed a new method for estimating right ventricular dimensions and volume.

Adolescent↗
PubMed1996

Role of macrophages in pulmonary late-phase reaction in guinea pigs.

To examine the role of macrophages in pulmonary late-phase reaction (LPR), macrophages were reduced in sensitized guinea pigs by an intravenous injection of liposome-encapsulated dichloromethylene diphosphonate (Cl2MDP). Macrophage reduction was evaluated by bronchoalveolar lavage (BAL) fluid analysis. In Cl2MDP liposome-treated animals, the number of macrophages in BAL fluid significantly decreased by 56% compared with PBS liposome-treated animals (1.6 +/- 0.1 vs. 3.6 +/- 0.4 x 10(6) cells, p < 0.01). The number of neutrophils, eosinophils, or lymphocytes in BAL fluid showed no significant changes in these two groups. Both PBS and Cl2MDP liposome-treated sensitized guinea pigs were challenged with an inhalation of antigen, and respiratory resistance (Rrs) was measured. PBS liposome-treated animals (control) exhibited both immediate (IPR) and late (LPR) increases in Rrs. The maximal increases in Rrs at IPR and LPR were 217 +/- 19 and 187 +/- 20% of baseline values, respectively (n = 9). On the other hand, Cl2MDP liposome-treated animals showed an immediate increase in Rrs (IPR); however, the late increase in Rrs (LPR) was significantly suppressed (p < 0.05). The maximal increases in Rrs at IPR and LPR were 200 +/- 13 and 134 +/- 11% of baseline values, respectively (n = 8). In Cl2MDP liposome-treated animals, the numbers of macrophages and neutrophils in BAL fluid 4 hr after antigen challenge decreased by 45% and 54%, respectively, compared with PBS liposome-treated animals (p < 0.05). In Cl2MDP liposome-treated animals, neutrophil chemotactic activity in BAL fluid 4 hr after antigen challenge decreased by 59% compared with PBS liposome-treated animals (p < 0.05). These results suggest that macrophages play an important role in the development of pulmonary LPR through the induction of neutrophil accumulation in the airways.

Animals↗
PubMed1996

[Standard range of peak expiratory flow in normal, healthy Japanese subjects].

The measurement and analysis of the standard range of peak expiratory flow (PEF) in normal, healthy Japanese is necessary at any cost to facilitate bringing the Japanese Guidelines for Bronchial Asthma smoothly into effect. In a study as part of The Bronchial Asthma Group of the Comprehensive Research Project (Terumasa Miyamoto, Chairman of the Planning and Evaluation Committee) under the auspices of the Ministry of Health and Welfare, we measured PEF in 2,785 healthy Japanese volunteers (1,407 males aged 15-84 years and 1,738 females aged 15-80 years) who had no history of smoking, respiratory and/or thoracic diseases, or wheezing with four different peak flow meters (e.g., mini-Wright, Assess, Personal Best and Vitalograph). As a result of comparing PEF measured by the four meters in the same subjects over a short interval of time, we noted significant differences on analysis of variance. Accordingly, the equation for prediction should account for variables in gender and the type of peak flow meter used. A comparison of cubic equations for prediction suggests that the PEF of both Japanese men and women is similar to that of the British but is different from that of the Chinese.

Adolescent↗
PubMed1996

[Effectiveness of PEF monitoring in chronic management of asthma patients].

Whether PEF monitoring introduced by the guidelines (NIH/WHO, International Consensus Report and Japanese Allagology Society Report) is effective or not was discussed in chronic management of patients with asthma. It was stressed to improve usefullness of PEF monitoring in the management of asthma patients that the full understanding of physiological basis of PEF as a lung function test and an augmentation of sensitivity and compliance of the PEF monitoring which includes an improvement of accuracy of devices, and automatic registration of recordings and systems to check the maneuvers of patients to perform PEF is necessary and important.

Animals↗
PubMed1995

Diversity of early afterdepolarizations in guinea pig myocytes: spatial characteristics of intracellular Ca2+ concentration.

We classified early afterdepolarizations (EADs) into subgroups according to the spatial features of the intracellular Ca2+ concentration ([Ca2+]i). Myocytes were enzymatically isolated from guinea pig ventricles. When fura-2 salt was applied through a whole cell patch pipette after the formation of a gigaohm seal, the membrane potential was measured using the current, clamp technique. When myocytes were loaded with fura-2 AM, the membrane potential was recorded with a conventional microelectrode technique. Spatio-temporal changes in fura-2 fluorescence and cell length were recorded simultaneously, using a digital TV system. EADs were induced after superfusion with potassium-free Tyrode solution. Irrespective of the fura-2 loading procedure, EADs could be classified into those with spatially synchronous fluorescence changes (n = 26 from eight hearts) and those with heterogeneous changes (n = 20 from three hearts). EADs with synchronous features took off from a higher membrane potential (> or = -34 mV) than EADs with heterogeneous features (< or = -57 mV). These results suggest that EADs have at least two constituents.

Animals↗
PubMed1995

Effect of intramedullary procaine injection on tracheal tone and phrenic neurogram.

To map the superficial locations which are involved in the control of respiration and tracheal smooth muscle tone in ventrolateral medulla, we examined the effects of local anesthesia on phrenic activity and tracheal tone in twelve anesthetized, paralyzed, and artificially ventilated dogs. 0.5 microliter of 5% procaine was injected 0.3 to 0.5 mm below the surface unilaterally to the ventral superficial layer (from the rostral part of the trapezoid body to the caudal hypoglossal rootlets and lateral from the pyramids to 5.5 mm from the midline), which included rostral, intermediate and caudal areas, and the area lateral to the hypoglossal rootlets. The peak amplitude of the integrated phrenic neurogram was decreased by procaine injection to the intermediate area and the area lateral to the hypoglossal rootlets. Tracheal tone decreased only by procaine injection to the intermediate area. In the intermediate area, some injections decreased either phrenic output alone or tracheal tone alone. These results suggest that the two ventral medullary areas, i.e. the intermediate and caudolateral parts, contain neural structures which are involved in the shaping of phrenic output, but only the intermediate area is involved in the regulation of tracheal tone. It is also suggested that, in the intermediate area, the structures responsible for the maintenance of respiration and tracheal tone are, at least in part, separable.

Animals↗