Search PubMed⌕ Search

Biomedical subjects

T Yamanouchi

Publications and source records attributed to T Yamanouchi.

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

[Troglitazone].

There are good responders to troglitazone in whom sulfonylurea had failed to improve glycemia. The anti-diabetic effect of this agent seems to be partially composed of prolonged action. The action on different adipose tissue depots of troglitazone may be involved in this slow action. Significant decrease in fasting plasma glucose occurred. The effect may be related to reducing nocturnal hepatic glucose output by the drug. The efficacy of troglitazone is dependent on the levels of circulating insulin. Recent reports demonstrate the good therapeutic power of troglitazone in combination with a sulfonylurea or metformin, or insulin. Thus, we got a new approach of oral therapy to patients with type 2 diabetes in sulfonylurea failure before entering the insulin treatment. Because of low frequency of hypoglycemia, we can safely continue to use this drug in patients with euglycemia by the therapy for preventing return to hyperglycemia.

Blood Glucose↗
PubMed1999

Fetal stabilization for antenatally diagnosed diaphragmatic hernia.

BACKGROUND/PURPOSE: Infants with congenital diaphragmatic hernia have pulmonary hypoplasia resulting in persistent pulmonary hypertension of neonates (PPHN), which is the main contributor to both high mortality and morbidity. The pulmonary artery bed in patients with congenital diaphragmatic hernia (CDH) is underdeveloped and is very sensitive to slight stimuli. It is, therefore, vital to avoid any factors that might increase pulmonary vascular resistance during the perinatal treatment of these patients. Recently, fetal anesthesia for perinatal stabilization in patients with CDH has been reported. However, the efficacy of this method remains controversial. The aim of this study is to analyze the benefits of fetal stabilization using fetal anesthesia in patients with CDH. METHODS: The authors have seen 9 cases of antenatally diagnosed CDH and attempted fetal stabilization. The indication for fetal stabilization was a lung thoracic ratio of less than 0.2, without any severe associated anomalies. The protocol for fetal stabilization was (1) monitoring the fetal respiratory movement and heart beat by ultrasonography, (2) the administration of morphine (20 to 30 mg) and diazepam (5 mg) to the mother, (3) the confirmation of any interruptions in fetal movement followed by a cesarean section, (4) pancuronimum (0.5 mg) was given through the umbilical vessels, (5) intubation before clamping of the umbilical cord, and (6) high-frequency oscillatory ventilation (HFO) without bagging. RESULTS: The lung-thratic ratio (LTR) was between 0.06 to 0.17 (average, 0.10+/-0.04). Operation was performed in 7 of 9 patients at between 2.5 and 27 hours after birth. The overall survival rate was 66.7% (6 of 9). All of the patients who underwent operation within 5 hours after birth survived. CONCLUSIONS: Perinatal stabilization using fetal anesthesia was found to be effective in preventing PPHN and shortening the period of preoperative stabilization. It also improved the survival rate of patients with severe CDH.

Female↗
PubMed1999

Alterations of the intramural nervous distributions in a chick intestinal atresia model.

The postoperative intestinal dysmotility seen in intestinal atresia (IA) is usually found in association with a dilatation of the proximal intestinal segment, but the etiology of this disorder is not yet fully understood. A chick IA model was made by cutting the postumbilical midgut on d 11 in ovo. The operated chicks were euthanized 2 d after hatching. The samples were divided into two groups according to the extent of the dilatation of proximal ileal segments. Cryostat sections were processed for immunohistochemistry by the use of antisera to protein gene product 9.5, vasoactive intestinal polypeptide, substance-P, and alpha-smooth muscle actin and were also stained by NADPH-diaphorase. Tn highly dilated proximal segments, a decreased number of protein gene product 9.5-positive fibers was found in both the circular muscle and submucous layers. The number of nerve fibers positive for vasoactive intestinal polypeptide, substance-P, and NADPH-diaphorase also decreased in the circular muscle layer, particularly in the deep muscular plexus. Hypertrophy and an alteration of the staining intensities in the circular muscle layer were also revealed by a-smooth muscle actin staining. The nerve distribution of the distal segments was indistinguishable from that of the age-matched controls and the sham-operated group. Abnormalities in the intramural nerves are only found in the proximal ileal segment of the IA models. The abnormal nerve distribution of the proximal segment might thus be implicated in the postoperative dysmotility of the intestine in IA.

Actins↗
PubMed1999

[Insulin-sensitizing agent].

Troglitazone is a new oral insulin-sensitizing agent from the thiazolidinedione group of compounds that has been developed in Japan Thiazolidinediones improve the insulin sensitivity at muscle, adipose tissue and liver. The overall effectiveness of troglitazone seems to be less potent than is usually seen with sulfonylureas, however, there are good responders to troglitazone, in which sulfonylurea had failed to improve glycemia. It is frequently very effective for those who are very obese and show hyperinsulinemia. Recent reports demonstrate the good therapeutic power of troglitazone in combination with a sulfonylurea or metformin, or insulin. In future, a possibility that reduction of insulin resistance by troglitazone reduce cardiovascular risk will be discussed. Unfortunately, wider use has led to recognition of potential for serious liver damage. Until now, the mechanisms of the liver toxicity has not been known. We have to monitor GOT, GPT and LDH levels as recommended.

Chromans↗
PubMed1998

Acute glucosuria after continuous glucocorticoid loading in the rat in vivo.

We investigated the effects of the continuous infusion of various steroids in rats on renal tubular reabsorption of glucose in vivo to elucidate the pathogenesis of steroid-induced glucosuria. Urinary glucose excretion increased 60 min after administration of dexamethasone (2.38 mM). By 120 min, urinary excretion of glucose was three times higher in the dexamethasone group than in the control group (24.1 +/- 4.6 versus 72.4 +/- 16.7 micromol); the plasma level of glucose did not increase. Dexamethasone had no effect on the resorption of 1,5-anhydro-D-glucitol, which is a glucose-resembling polyol that is actively absorbed by the renal tubules as glucose. Neither estradiol nor progesterone increased urinary excretion of glucose. These findings suggest that continuous administration of a high-dose glucocorticoid selectively influences the glucose reabsorption system in the kidney.

Animals↗
PubMed1998

Non-protein energy overloading induces bacterial translocation during total parenteral nutrition in newborn rabbits.

The effect of energy intake provided by total parenteral nutrition (TPN) on the incidence of bacterial translocation and the relationship between TPN-induced cholestasis and bacterial translocation were investigated in newborn animals. Forty-six Japanese white newborn rabbits were divided into three groups: TPN-H group (high energy TPN; 280 kcal.kg-1.d-1), TPN-L group (low energy TPN; 180 kcal.kg-1.d-1), and a control group (breast fed). On day 8, they were all killed for investigation of the presence of bacterial translocation, for blood chemistry analysis, and for histological examination of the ileum. The incidence of translocation to any of mesenteric lymph nodes and liver and spleen was significantly higher in the TPN-H group (67%) than in both the TPN-L group (13%) and the control group (10%) (P < 0.01). No difference was seen in ileum morphology between the two TPN groups. Although the mean bilirubin level of the TPN-H group tended to be higher than the TPN-L group, whether or not bacterial translocation occurred was not found to be closely related to the degree of TPN-associated cholestasis. In conclusion, parenteral nonprotein energy overloadng increased the incidence of bacterial translocation in the newborn rabbit. However, bacterial translocation did not appear to be associated with the development of TPN-associated cholestasis.

Animals↗
PubMed1998

Relationship between normalization of negative T waves on exercise ECG and residual myocardial viability in patients with previous myocardial infarction and no post-infarction angina.

The usefulness of normalization of negative T waves in exercise ECG was investigated as an index of myocardial viability in patients with previous myocardial infarction with no symptoms or ischemic ST-segment change during exercise test. A total of 39 patients, 20 with T-wave normalization (POS group) and 19 without T-wave normalization (NEG group) on exercise ECG. were studied. Myocardial viability was evaluated by thallium-201 single-photon emission computed tomography (SPECT) during exercise or at rest. We also assessed left ventricular ejection fraction (LVEF) by contrast ventriculography before (n=39) and after percutaneous transluminal coronary angioplasty (PTCA) (n=17). SPECT detected myocardial viability in 16 (80%) of the 20 patients in the POS group and in 4 (21%) of the 19 patients in the NEG group (p<0.01). LVEF increased after successful PTCA in the POS group (from 53+/-13% to 63+/-8%, p<0.025), but fell in the NEG group (from 57+/-10% to 51+/-8%). It is concluded that normalization of negative T waves on exercise ECG is a useful, simple index of myocardial viability in patients with previous myocardial infarction with no symptoms or ischemic ST-segment change during exercise testing.

Adult↗
PubMed1998

Relationship between serum 1,5-anhydroglucitol and urinary excretion of N-acetylglucosaminidase and albumin determined at onset of NIDDM with 3-year follow-up.

OBJECTIVE: This prospective study was designed to elucidate the relationship between the serum level of 1,5-anhydroglucitol (1,5AG) and the urinary excretion of N-acetylglucosaminidase (NAG) and albumin in patients who were in the early stages of diabetes. RESEARCH DESIGN AND METHODS: A total of 1,062 male nondiabetic subjects with impaired glucose tolerance were monitored for blood glucose level once every 2-3 months, and the values were evaluated. Of these 1,062 subjects, 112 showed a worsening of glycemia during the observation period to the level seen in diabetes. We began to monitor the glycemia and parameters of renal damage in the 112 patients from the onset of diabetes. RESULTS: The urinary excretion of NAG and albumin were elevated even at the onset of diabetes. The abnormal excretion of NAG and albumin was associated with a change in serum 1,5AG and was quickly reversible when the serum 1,5AG improved. In the 3 years after the onset of diabetes, we obtained at least 18 measurements of one parameter for each patient and calculated the mean. Urinary NAG was found to be significantly correlated with the fasting plasma level of glucose (FPG; r = 0.512, P < 0.0001), the level of HbA1 (r = 0.351, P = 0.001), and the level of 1,5AG (r = -0.790, P < 0.0001). The urinary excretion of albumin was weakly but significantly correlated with levels of FPG (r = 0.383, P < 0.0001) and HbA1 (r = 0.337, P < 0.0001), but it was more strongly correlated with 1,5AG (r = -0.632, P < 0.0001). The level of 1,5AG was significantly correlated with FPG (r = -0.681, P < 0.0001) and HbA1 (r = -0.609, P < 0.0001). CONCLUSIONS: When the renal damage is not severe, the serum level of 1,5AG appeared to be an indicator of the reversible renal damage caused by hyperglycemia, as well as of the severity of the glycemia itself.

Acetylglucosaminidase↗
PubMed1998

EMG analysis of the lower extremities during pitching in high-school baseball.

I evaluated the contractions of the muscles of the lower extremities during baseball pitching using video imaging and simultaneous surface EMG. The subjects were 10 members of a high school baseball club and, for contrast, 10 students without any baseball club experience. I divided their pitching movements into two phases determined with respect to the landing of the non-pivot leg. The EMG signal intensities over the 2 seconds prior to landing, and over the 2 seconds after landing, were then integrated to give an EMG value to each phase. I then computed this value as the % MMT. The abductor and adductor of the hip muscles of both lower extremities in the players were strongly contracted, especially the adductor. This finding was consistent with the observation that pitching tends to lead to adductor muscle disorders. Strengthening the adductor and its antagonist abductor can therefore directly influence the capability for pitching, and can reduce the risk for the adductor disorders.

Adolescent↗
PubMed1998

[Recent advances in the nutritional management of pediatric surgical patients].

The prognosis of pediatric surgical patients is significantly improved by perioperative nutritional support. However, the morbidity and mortality rates from intestinal failure, including short gut syndrome and allied disorders of Hirschsprung's disease, remain high. Recent advance in nutrition support focus on the management of intestinal failure. A central venous catheter is commonly used for long-term total parenteral nutrition (TPN) in intestinal failure, although the incidence of catheter-related complications is still high. A nutrition support team approach might reduce such complications, with the exception of deep vein thrombosis, which is another serious problem in intestinal failure after long-term TPN on which more research is needed. A other serious complication in long-term TPN is liver dysfunction. It is postulated that bacterial translocation plays an important role in TPN-associated liver damage, although so far without evidence. Both cyclic TPN and enteral feeding are known to be effective in preventing liver damage. Since we are now familiar with methods of nutritional support little attention is paid to complications. Therefore nutritional management should be reevaluated from this standpoint.

Child↗
PubMed1996

Common reabsorption system of 1,5-anhydro-D-glucitol, fructose, and mannose in rat renal tubule.

1,5-Anhydro-D-glucitol (AG) is a major polyol, 99.9% of which is reabsorbed by the kidney. However, such reabsorption is inhibited by competition with glucose excreted in excess, i.e., glucosuria. Under such conditions, AG is excreted into the urine. We administered various types of sugars to rats by continuous intravenous infusion for two hours to evaluate the competition between AG and these sugars for renal reabsorption in vivo. The reabsorption of AG was significantly inhibited by competition with fructose and mannose. The excretion of AG in the 120 min after a load of 3.64 mmol of fructose was 1.99 +/- 0.33 mumol, that after 3.64 mmol of mannose loading was 2.34 +/- 0.43 mumol. These levels were comparable to the AG excretion observed after the administration of the same amount of glucose (3.87 +/- 0.61 mumol). No competition was observed with sucrose, xylose, myoinositol or galactose. The reabsorption of fructose and mannose was significantly inhibited by the presence of AG (P < 0.001) after a mixed load. Results suggest that AG is reabsorbed in the renal tubule by an AG/fructose/mannose-common transport system that is distinct from the major glucose reabsorption system. These findings may help to clarify the specific transport systems for various sugars in the renal tubule, as well as their physiological importance.

Absorption↗
PubMed1996

Clinical usefulness of serum 1,5-anhydroglucitol in monitoring glycaemic control.

BACKGROUND: To evaluate prospectively the clinical value of measuring serum concentrations of 1,5-anhydroglucitol (1,5AG) in monitoring glycaemia in patients with newly diagnosed non-insulin-dependent diabetes mellitus (NIDDM), we measured serum 1,5AG in 56 such patients. METHODS: 28 patients (group A) were started on, and continuously received, an oral hypoglycaemic agent for at least 6 weeks. The other 28 patients (group B) were given such agents for 4 weeks, and then stopped taking them for at least 2 weeks. All patients were then followed for an additional 10 weeks. Serum 1,5AG, fructosamine, glycated haemoglobin (HbA1c), and self-monitoring of blood glucose were monitored every 14 days for 16 weeks. FINDINGS: When sudden worsening of glycaemia occurred within 2 weeks, entailing withdrawal of oral treatment, 1,5AG accurately detected the slight change in glycaemia whereas HbA1c and fructosamine both failed to detect it. Although the change was detected by measurement of fasting plasma glucose (FPG) concentrations, FPG was less sensitive than 1,5AG. In patients with "near-normoglycaemia" (HbA1c about 6.5%) in the preceding 8 weeks, those who showed a lower concentration of 1,5AG (<10.0 micrograms/mL) manifested a higher mean daily plasma glucose concentration even though HbA1c measurement suggested good control of glycaemia. Results of 1,5AG were correlated more strongly with the FPG (r=0.790) and mean daily plasma glucose (r=-0.835) estimated on the same day than those estimaoffted in the preceding 2, 4 and 8 weeks, and with a fall in the Spearman correlation coefficient at any preceding time interval. INTERPRETATION: Because 1,5AG accurately detected a slight change in glycaemia without delay, it is suitable for use in monitoring for strict control of glycaemia, an important clinical goal.

Biomarkers↗
PubMed1996

Effect of percutaneous transluminal coronary angioplasty on exercise ventilation in patients with coronary artery disease and normal left ventricular function.

We evaluated the ventilatory response to exercise before and after percutaneous transluminal coronary angioplasty (PTCA) in 22 patients with coronary artery disease (CAD) and normal left ventricular systolic function to determine the effect of exercise-induced myocardial ischemia on the ventilatory response. Subjects performed a symptom-limited maximal ergometer exercise test in the sitting position. The ventilatory response was evaluated in terms of the slopes of minute ventilation (VE) and carbon dioxide production (VCO2) during exercise (slope 1 and slope 2, defined as below and above the respiratory compensation threshold, respectively). Slope 1 of the correlation between (VE) and (VCO2) was significantly greater in patients with CAD (27.3 +/- 2.6) than in the age-matched control group (23.7 +/- 2.6; p < 0.01). Slope 2 was also significantly greater in patients (41.0 +/- 4.8) than in the control group (29.7 +/- 2.9; p < 0.01). Slope 1 of the correlation between (VE) and (VCO2) decreased significantly in the 14 patients in whom PTCA was successful but did not decrease in the 8 patients in whom PTCA failed. Our results suggest that myocardial ischemia increases exercise ventilation in patients with CAD and normal left ventricular systolic function and that its effect is reversible.

Adult↗