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Biomedical subjects

T Wada

Publications and source records attributed to T Wada.

At least 199 records · Page 11Linked to original sources
PubMed2000

[A case of intrasellar pure germinoma].

A 19-year-old male presented with progressive loss of vision and diabetes insipidus due to an intra- and suprasellar tumor. Transsphenoidal exploration revealed a pure germinoma. Seven days after the operation, bleeding from the residual tumor caused headache and right occulomotor palsy. The residual tumor and hematoma were removed using pterional approach. The residual tumor disappeared after postoperative irradiation. After 5 months of radiation, multiple lesions due to dissemination of the germinoma were discovered in the suprasellar region. Adjuvant chemotherapy and whole supratentorial irradiation were performed. All lesions regressed completely. Mid-sagittal magnetic resonance image was useful in our patient for differential diagnosis between intrasellar germinoma and pituitary adenoma. Before initiating an operation for intrasellar germinoma, awareness is needed for the fact of postoperative bleeding. We notice that transsphenoidal surgery should be selected for treatment of postoperative bleeding from intrasellar germinoma.

Adenoma↗
PubMed2000

[Fluid management after off-pump CABG in a patient receiving preoperative continuous ambulatory peritoneal dialysis].

Perioperative management of off-pump CABG in a patient receiving continuous ambulatory peritoneal dialysis (CAPD) was reported. Prior to the procedure, we considered that postoperative management could be performed by CAPD alone in the case of off-pump CABG. However, due to an unexpected increase in the circulating blood volume and dilution of blood after surgery, congestive cardiac failure developed and active dehydration was required for 3 days after the operation using CHDF and HD. Despite this treatment, the central venous pressure and the cardiothoracic ratio in the chest X-ray were elevated, and a state of volume overload continued. However, cardiac contractility was not disturbed as shown by echocardiography. A possible cause of this condition was that body fluid had accumulated in the third space such as the peritoneum and intestine due to long-term use of CAPD before surgery, and the fluid was mobilized after surgery.

Aged↗
PubMed2000

[Necessity of permanent anticoagulant therapy for isolated mitral valve replacement with bioprosthetic heart valve to prevent the postoperative thromboembolic complications].

One hundred fifty four patients underwent isolated mitral valve replacement with bioprosthetic heart valve at Hyogo Medical College Hospital from November 1973 to December 1998. A porcine bioprosthetic valve was replaced in 82 patients (Hancock 43, Carpentier-Edwards 26, Hancock II 13) and pericardial bioprosthetic valve in 72 patients (Ionescue-Shiley 39, Carpentier-Edwards 33) with a mean follow-up of 1,410 patients-years. Their thromboembolism rates were also analyzed in linear and actuarial term over the 15-year period. The incidence of thromboembolism rate was 2.5%/pt.yr. Thromboembolic free rates for patients with anticoagulant therapy were significantly decreased for patients without therapy. Thromboembolic free rates for patients with atrial fibliration were also were significantly decreased for patients with sinus rhythm because the patients with sinus rhythm were not on anticoagulant therapy. In conclusion, it is necessary for the all patients to be on anticoagulant therapy after mitral valve replacement with bioprosthetic valves, even though patients with sinus rhythm.

Adult↗
PubMed2000

Evaluation of radiological examination for sensorineural hearing loss.

The accuracy of radiological examinations has improved and their diagnostic ability has markedly increased. However, the cost of such examinations has also recently become an issue. In this study, the clinical significance of radiological examinations for sensorineural hearing loss (SNHL) was evaluated and the value of their utilization was reconsidered. A total of 1,276 ears of 724 patients who demonstrated unilateral or bilateral SNHL was studied retrospectively. Findings of radiological examinations such as plain X-ray (X-p), computed tomography (CT) and magnetic resonance imaging (MRI) of the brain or the temporal bone were investigated. Temporal bone X-p was usually performed to rule out acoustic tumors (AT). CT was further performed in 119 patients (16.4%) and MRI in 84 patients (11.6%) in total. The reasons or symptoms for further examination such as CT or MRI were X-p findings or auditory symptoms suspicious for AT or vertigo/dizziness suspicious for intracranial disease. Of five causes with AT, two with a small tumor exhibited normal findings for the internal auditory canal on temporal bone X-p. These small ATs were finally confirmed by MRI. MRI could also detect lacunar infarctions, cerebral atrophy and high jugular bulb which might be related to SNHL. These findings confirmed that MRI is very useful for detecting small ATs and suggested that MRI also reveals cerebral vascular insufficiency in patients with SNHL.

Adolescent↗
PubMed2000

[Adult Wilms' tumor: a case report].

We present a case report of adult Wilms' tumor and reviewed from 1981. A 22-year-old woman with chief complaints of gross hematuria and right backache was introduced to our hospital in March 1998. Abdominal computed tomography (CT) revealed a solitary irregular mass (5.0 cm) at the lower pole of right kidney with no contrast medium enhancement. Angiography showed a hypovascular character, but irregular vascularization was found in the tumor. We performed a radical nephrectomy with a preoperative diagnosis of malignant renal tumor. Finally, adult Wilms' tumor (epithelial type) was diagnosed by pathological examination. We retrospectively studied the clinical and radiological features in 16 reported cases of adult Wilms' tumor from 1981. The average age was distinctly younger than that of renal cell carcinoma. Nearly half of the cases were at an advanced clinical stage (direct invasion or metastasis to other organs) at first consultation. Radiologically, Wilms' tumor tends to be visualized as a low density mass in the precontrast CT scan (75.0%) and hypovascular tumor by selective angiography (84.6%). Although this is not a definitive character to distinguish adult Wilms' tumor from renal cell carcinoma, it may be useful information for differential diagnosis.

Adult↗
PubMed2000

[Clinical statistics on patients and operations during a 20-year period (1978-1997) at Department of Urology, Jikei University School of Medicine].

A statistical analysis was made of diseases, patients, and operations at our department in the four affiliated hospitals of Jikei University School of Medicine from 1978 through 1997. Our findings were as follows. Newly diagnosed urogenital malignancies, except testicular tumors, have been increasing in the last two decades among both outpatients and inpatients. Urogenital infections, including tuberculosis, have gradually been decreasing in the last two decades. The treatment of urinary stone diseases was markedly altered by the induction of extracorponeal shock wave lithotripsy.

Female Urogenital Diseases↗
PubMed2000

Biomechanical diagnosis of atherosclerosis by ultrasound.

SETTING: Atherosclerosis causes structural changes in artery walls that alter their physical properties. The stiffness parameter beta is one quantitative index of the elastic properties of large arteries. beta can be calculated from the measurements of blood pressure and arterial diameter. We examined whether beta quantitatively evaluates common carotid atherosclerosis. METHODS: We measured the common carotid artery inner diameter and its pulsatile change with an ultrasonic instrument. The subjects were healthy persons, patients with atherosclerosis risk factors, patients with myocardial infarctions, and patients with cerebral infarction. RESULTS: The beta in healthy persons aged 40-59 years was 11.2. beta was 13.2 in patients with atherosclerosis risk factors, 13.4 in patients with myocardial infarction, and 13.5 in patients with cerebral infarctions. These data in each patient group were significantly higher than those in healthy subjects. CONCLUSIONS: This diagnostic method is inexpensive, noninvasive and easily performed. beta shows promise as a useful diagnostic indicator of atherosclerosis.

Adult↗
PubMed2000

[A case of posttraumatic severe ventriculitis treated by intraventricular lavage].

A 44-year-old male was admitted in a state of semicoma, tonic convulsion and elevated body temperature nine days after sustaining head injury. He had severe nuchal rigidity. Computed tomography revealed dilation of ventricles and swelling of the brain parenchyma. We performed cerebrospinal fluid (CSF) drainage of both lateral ventricles immediately. The fluid drained from both ventricles was just like pus. We diagnosed the patient's condition as posttraumatic ventriculitis and meningitis. We performed intraventricular lavage (IL) which was our ventricular irrigating technique. IL was repeated until the 7th day postoperatively. The CSF data improved immediately. Continuous spinal drainage (CSD) also was used for CSF drainage from the 7th day postoperatively. The patient recovered without the need for CSF shunt. Some authors have reported the usefulness of continuous intraventricular irrigation (CIVI) for treatment of severe ventriculitis. However, their patients required CSF shunt surgeries. Such shunts are likely to become infected more frequently than routine shunting. Our IL was able to drain pus and inflammatory products in the ventricles before the formation of septations in the ventricles. We emphasize that IL in combination with CSD is able to bring about good results for patients with severe ventriculitis.

Adult↗
PubMed2000

[Chromophobe cell renal carcinoma: a case report].

We report a case of chromophobe cell renal carcinoma. A 45-year-old woman with a chief complaint of macrohematuria and left backache was introduced to our hospital in October 1998. Abdominal computed tomographic scan (CT) revealed a solitary, solid mass (16 x 14 x 12 cm) at the upper pole of the left kidney. Angiography showed a hypervascular character but irregular neovasculizations were found. We performed a radical nephrectomy with a preoperative diagnosis of malignant renal tumor. The cut surface appearance of the tumor was homogeneous, grey-beige and solid. Light microscopic findings revealed voluminous cells with light, but not clear cytoplasm displaying a fine reticular pattern. Histochemical staining with Hale's colloidal iron stain demonstrated a distinctly positive cytoplasmic reaction. Since the ultrastructural study revealed numerous intracytoplasmic microvesicles, we finally reached the diagnosis of chromophobe cell renal carcinoma. We report our case here with reference to the relevant literature.

Adenocarcinoma↗
PubMed2000

Atherosclerotic aneurysm of the intrathoracic segment of the subclavian artery: a case report.

True aneurysms of the intrathoracic segment of the subclavian artery are extremely rare. Atherosclerosis is the most common etiology. The surgical approach and timing of repair remain controversial. We successfully treated a patient with a large proximal subclavian artery aneurysm which was secondary to atherosclerosis. The patient was asymptomatic for 30 years as the aneurysm enlarged. Three-dimensional computed tomography provided the most useful information regarding anatomy of the cervical vasculature. The patient underwent closure of the inlet port of the aneurysm and repair using a 6-mm Dacron bypass graft (Gelsoft , VASCTEK, Scotland) via a minimally invasive surgical approach.

Aged↗
PubMed2000

[Percutaneous endoscopic gastrostomy (PEG) for the management of dysphagia: experiences in the neurosurgical care unit].

This report concerns percutaneous endoscopic gastrostomy (PEG) administered in the neurosurgical care unit to a patient with dysphasia. This reliable nutrition route has the major advantage of minimal surgical invasion and can be expected to become a standard nutritional method. Since patients with neurological disorders account for the majority of those who need PEG, neurosurgeons need to be aware of the importance of PEG.

Aged↗
PubMed2000

[Transitional cell carcinoma of urachus: a case report].

We report a case of transitional cell carcinoma of urachus in a 72-year-old man. At follow up cystoscopy for past history of bladder cancer, we found a papillary tumor in the right orifice that came out to the bladder cavity intermittently. Although there was no cancerous lesion on the surface of the bladder mucosa, a submucosal eminence at the dome of bladder was observed. Sagittal magnetic resonance imaging (MRI) revealed an extravesical tumor (2 cm) at the position of urachus. Under the diagnosis of right ureteral cancer and urachal cancer, we performed right distal ureterectomy, ureteral reimplantation and total resection of urachus. Pathological examination revealed transitional cell carcinoma in the urachus and right ureter. The urachal cavity was isolated completely from the bladder cavity. Tumor infiltrated to the muscularis of the bladder dome from the urachal cavity, but there was no cancerous lesion on the surface of the bladder mucosa. Therefore, our diagnosis was urachal transitional cell carcinoma and right ureteral carcinoma.

Aged↗
PubMed2000

[A case of effective endotoxin adsorption therapy for septic shock due to acute pyelonephritis].

Although septic shock has a high mortality rate of 43%, recently the endotoxin adsorption column was established and its efficacy is interesting. We report a very effective case of endotoxin adsorption the rapy for septic shock due to acute pyelonephritis. A 59-year-old man with chief complaints of pyrexia and right backache was referred to our hospital with a small right ureteral stone (4 mm) associated with a low degree of right hydronephrosis. Since it was diagnosed as right acute pyelonephritis, antibiotics were administered; and then septic shock occurred on the day of hospitalization. Endotoxin adsorption therapy was performed for two days and hemodynamic stability was achieved. The concentration of blood endotoxin was reduced remarkably and the efficacy of endotoxin adsorption therapy was suggested.

Acute Disease↗
PubMed2000

[A case of high-age minimal change nephrotic syndrome relapse after 18-year remission and effective treatment with steroid and cyclosporin combined therapy].

We describe the clinical course of a 69-year-old woman, who suffered from minimal change nephrotic syndrome(MCNS) after long-term remission. In 1979, she was admitted to Kanazawa University Hospital due to MCNS verified by renal biopsy and was treated with oral prednisolone(initially 40 mg/day) for two years. She suffered from edema again in 1999 with massive proteinuria. Renal biopsy revealed minor glomerular abnormality without any deposition of immunoglobulins or complements. Electron microscopic findings showed extensive foot process effacement. Therefore, we diagnosed this case as a recurrence of MCNS. She was treated with the combination of methylprednisolone pulse therapy(500 mg, 3 days), oral prednisolone(20 mg/day) and cyclosporin(CyA, 3 mg/kg/day), which could induce earlier complete remission. These results suggest that recurrence after long-term remission could occur in adult-onset MCNS and that the combination therapy of prednisolone and CyA may be effective for the induction of early remission in MCNS.

Administration, Oral↗