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Biomedical subjects

T Yasuda

Publications and source records attributed to T Yasuda.

At least 307 records · Page 17Linked to original sources
PubMed1997

[Successful pulmonary thromboendarterectomy in a patient with chronic pulmonary thromboembolism].

A 63-year-old patient had been diagnosed with angina pectoris for 5 months and came to us complaining of progressive exertional dyspnea. Echo cardiography showed remarkable pulmonary hypertension and we were prompted to do cardiac catheterization. The catheterization showed the pressure of the main pulmonary artery (PA) as 84/14 (36) mmHg and PA angiography showed a massive embolus in the right main PA. Chest computed tomography and lung perfusion scintigraphy were also compatible with pulmonary embolism. The patient had been treated with anticoagulant for 1 month, but he was not doing well. We decided to remove the embolus surgically. In a median sternotomy, a cardiopulmonary bypass was established with ascending aortic and two caval cannulae. During cooling, the right PA was mobilized within the pericardial reflection. An incision was made in the right PA. An organized thrombus was located at the central PA and extended to the distal segmental PA. Thromboendarterectomy was carried out carefully. To obtain a better operative view, circulatory arrest was introduced intermittently. The left PA was opened and the organized thrombus, located at the bifurcation between the upper and lower branch, was removed. Post-operative PA angiography showed remaining thrombus in the right lower PA, but the pressure of the main PA fell to 27/12 (18) mmHg. Pulmonary thromboendarterectomy by median sternotomy with the aid of deep hypothermia and circulatory arrest was useful to remove the thrombus in the bilateral PA, and to obtain good hemodynamic and symptomatic results.

Endarterectomy↗
PubMed1997

[PyNPase activity in primary and metastatic colorectal cancer].

5'-Deoxy-5-fluorouridine (5'-DFUR) is converted to 5-FU by the enzyme of Pyrimidine nucleoside phosphorylase (PyNPase). Its efficacy for lung metastases from colorectal cancer is known. So we investigated PyNPase activity in primary and metastatic lesions of colorectal cancer patients. The results revealed that PyNPase activity (microgram 5-FU/mg protein/hour) (mean +/- SD) was 122.1 +/- 61.1 (n = 48) in primary lesions, 91.6 +/- 48.3 (n = 4) in lymph node metastases, 135.2 +/- 56.4 (n = 10) in liver metastases and 168.2 +/- 79.8 (n = 11) in lung metastases. In non-cancerous tissues adjacent to the cancer lesions, PyNPase activity was 51.5 +/- 18.8 in normal colorectal mucosa, 61.8 +/- 24.7 in normal liver and 43.0 +/- 21.2 in normal lung. These results demonstrated that PyNPase activity in the cancer lesions reached significantly higher levels than in the non-cancerous tissues (p < 0.01); and the T/N ratio of PyNPase activity in lung was also significantly higher than in primary or other metastatic lesions (p < 0.05). It was surmised that the clinical response of colorectal cancer to 5'-DFUR had been influenced by PyNPase activity.

Adenocarcinoma↗
PubMed1997

[Heterogeneity in breakpoint location of duplication in Japanese Charcot-Marie-Tooth disease type 1A].

The crossover breakpoints for CMT1A are located in the CMT1A-REP repeat flanking a 1.5 Mb region of chromosome 17p11.2-12. We analysed the relationship between the breakpoint locations and clinical phenotypes in 21 Japanese patients with CMT1A duplication. The CMT1A-REP region was divided in 5 regions, A, B, C, D and E, based on restriction site differences between the proximal and distal CMT1A-REP repeats (Kiyosawa et al., HMG, 1995). The breakpoint location within the CMT1A-REP was heterogeneous, the frequency distribution of which was hightest in the B/C region and similar to that in Caucasian patients. The clinical phenotypes, such as foot deformity, muscular weakness and atrophy, sensory impairment and electrophysiologic finding, were extensively variable among the CMT1A patients with PMP22 gene duplication. The location of breakpoints was not related to the clinical phenotypes, suggesting that there is a factor other than the location of the crossover breakpoint, which influences phenotypic manifestation of CMT1A.

Adult↗
PubMed1997

[Locations of crossover breakpoints within the CMT 1 A-REP repeat in patients with hereditary neuropathy with liability to pressure palsy--detection by recombinant chromosome-specific polymerase chain reaction].

The crossover breakpoints for hereditary neuropathy with liability to pressure palsies (HNPP) are located in the CMT 1 A-REP repeat flanking a 1.5 Mb region of chromosome 17p11.2-12. Three-unrelated HNPP patients have breakpoints in a 3.2 kb novel fragment of recombinant chromosome in the CMT 1 A-REP repeat. The fragment is detected by recombinant chromosome-specific polymerase chain reaction (PCR). Further analysis of PCR demonstrated a 1.2 kb novel junction fragment in the 3.2 kb region in all HNPP patients. The precise mapping of the breakpoints indicated that 2 patients were localized in a 700 bp interval of the 1.2 kb fragment 1.3kb telomeric to a marier transposon-like element (Kiyosawa and Chance, HMG 5: 745-753, 1996), suggesting that this region is a recombinational "hotspot" within the CMT 1 A-REP repeat for HNPP as well as CMT 1 A.

Adult↗
PubMed1997

[Perioperative risk factors and anesthetic management of patients for carotid endarterectomy].

Data from the records of 142 patients for carotid endarterectomy at Chugoku Rosai General Hospital between 1983 and 1995, were evaluated concerning perioperative risk factors and anesthetic management. As a preoperative anesthetic risk, the incidence of hypertension was the commonest (76%), and there was a significant incidence of ischemic heart disease (18%). Fentanyl and isoflurane have been used for anesthesia recently and the patients were closely observed and cared in the intensive care unit postoperatively. In order to prevent cerebral ischemia during the occlusion of the internal carotid artery, we measured somatosensory evoked potential as well as jugular venous oxygen saturation, and used near infrared spectophotometry. As a result, postoperative mortality and morbidity were 0% and 2%, respectively. The candidates for CEA have potentially high perioperative risks, and it is important to evaluate the coexisting diseases and to select proper anesthetic technic and monitors.

Adult↗
PubMed1997

[A case report on prosthetic valve dysfunction of the Carpentier-Edwards pericardial bioprosthesis in the tricuspid position associated with remarkable hypoproteinemia].

A 66-year-old woman underwent a second tricuspid valve replacement because of a malfunction of the Carpentier-Edwards pericardial bioprosthesis (CEP) in the tricuspid position 3.5 years after her first mitral and tricuspid valve replacement. The major symptom was lower leg edema and a serum albumin level ranging between 1.5 g/dl and 2.0 g/dl. The remarkable hypoproteinemia might have resulted from impaired albumin synthesis due to liver dysfunction, hemodilution, protein losing gastroenteropathy, and changes in albumin distribution due to edema. Although the explanted CEP showed neither dehiscence nor calcification of the leaflet, fibrous pannus mainly on the ventricular side restricted the mobility of the corresponding leaflet. Patients receiving a CEP in the tricuspid position should receive careful follow-up.

Aged↗
PubMed1997

Isolation, mapping and mutation analysis of a human cDNA homologous to the doc-1 gene of the Chinese hamster, a candidate tumor suppressor for oral cancer.

We have isolated a human cDNA encoding a 115-amino-acid polypeptide that revealed 97% identity to a candidate tumor suppressor gene for oral cancer in Mesocricetus auratus (deleted in oral cancer-1; doc-1). It also showed a high degree of homology to a gene induced by TNF-alpha in Mus musculus. To investigate its possible role in esophageal carcinogenesis, we examined genetic alterations and expression levels of the gene in 13 esophageal carcinoma cell lines and 10 primary esophageal carcinomas. No mutation nor reduction of expression was observed in any of the 23 cancer materials examined. These results imply that the human doc-1 homologue is unlikely to play a significant role in esophageal carcinogenesis, although its role in the TNF-alpha signaling pathway remains unclear. We mapped DOC1 to chromosome band 12q24.31 by fluorescence in situ hybridization.

Animals↗
PubMed1997

[Microwave coagulation therapy under mini thoracotomy for small recurrent hepatocellular carcinoma].

Transcatheter arterial embolization therapies (TAE) for multiple hepatocellular carcinomas (HCCs) were performed repeatedly, but had no effects on one or two of the tumors because of the development of collateral arteries. We report a case of which one of the tumors fed by collaterals showed good anti-cancer effects by microwave coagulation therapy (MCT) under mini-thoracotomy. The 70-year-old, male patient with HCC underwent two hepatic resections and one TAE before this admission. On the arteriogram, one of the tumors existing in S6, which was 2 cm in size, was supplied by the right 10th intercostal artery. We carried out MCT under mini-thoracotomy for the tumor in S6 two weeks after conventional hepatic embolization. First, two MCTs using a long electrode, 3 cm in size, were performed in the central area of the tumor, and eight MCTs by a short electrode, 2 cm in size, were done in the peripheral and surrounding area of the tumor. He was discharged 16 days after the therapy without any serious complications. On CT 3.5 months after therapy, no local recurrence of the tumor was recognized. MCT under mini-thoracotomy is a low-invasive, safe and effective therapeutic method for small HCC fed by collaterals.

Aged↗
PubMed1997

[Evaluation of intra-arterial infusion chemotherapy for liver metastasis from gastric cancer].

We evaluated the result of intra-arterial infusion chemotherapy on liver metastasis from gastric cancer. Of 92 cases of metastatic liver tumor, 17 cases received intra-arterial infusion chemotherapy after primary resection. For comparison, we assigned the 17 cases to two groups according to the infused agents. One group was treated with the combination therapy of 5-FU, epirubicin and MMC (FEM group: n = 7), and another with other antineoplastic agents (non-FEM group: n = 10). In the FEM group, the response rate, 1-year survival rate and 50% survival period were 33.3%, 51.4%, 430 days, respectively, while those of the non-FEM group were 10.0%, 10.0%. 147 days. Although there was no significant difference (p = 0.0951), improvements in survival rate and survival period were observed. This implies the possibility that intra-arterial infusion chemotherapy, especially the combination therapy of FEM, is an effective treatment for liver metastasis from gastric cancer.

Aged↗
PubMed1997

[A case of huge liver metastasis from colon cancer successfully treated by hepatic intraarterial infusion of low-dose 5-FU].

A 71-year-old man with unresectable liver metastasis from colon cancer was treated by hepatic intraarterial infusion of low dose 5-FU (250 mg/body/day). The tumor measured 18 cm by ultrasonography and has reduced gradually to five cm during three years. Both serum CEA and CA 19-9 levels were as high as 49.9 ng/ml and 5,500 U/ml respectively, before treatment, but normalized. This case suggested that this hepatic intraarterial infusion of low-dose 5-FU might be effective to treat unresectable liver metastasis, especially with portal tumor thrombosis.

Aged↗
PubMed1997

[A case report of preoperative intra-arterial infusion chemotherapy for pancreatic head carcinoma].

Intra-arterial infusion chemotherapy was given preoperatively to one patient with pancreatic head adenocarcinoma, in order to prevent local failure after surgery. Under an angiographic procedure, a catheter was placed in the gastroduodenal artery after embolizing the right gastric artery and gastroepiploic artery. Before surgery, 5-fluorouracil (250 mg/day) had been continuously infused for 2 weeks and bolus infusion of methotrexate (25 mg) with 5 micrograms of angiotensin-II had been performed every 3 days. As a results, the maximum diameter of the pancreatic tumor decreased from 3 cm to 2 cm on the CT-Scan. An extended pancreatoduodenectomy with portal vein reconstruction was performed. In histologic study, degenerative tumor cells were shown not only in the primary tumor but also in the extrapancreatic perineural invasion.

Adenocarcinoma↗
PubMed1997

[Complication due to arterial infusion chemotherapy for liver metastasis from colorectal cancer].

OBJECTIVES: Arterial infusion chemotherapy is considered to be an extremely effective treatment for liver metastasis from colorectal cancer in terms of its tumor reduction and preventing recurrence in residual liver after resection. However, there still remain some unclear points as to the influence on hepatic artery and bile duct when this treatment is used over the long term. We report some conclusions obtained by examining cases of hepatic arterial occlusion (stenosis) and biliary complication who received this treatment. MATERIALS AND METHODS: Thirty-six cases who received this treatment over 3 months were the objects of this study, with the aim of direct effect against metastatic focus (21 cases) and prevention of recurrence in residual liver (15 cases). The ages were from 27 to 81; 22 cases were male and 14 were female. Indwelling routes of catheter were gastroduodenal artery (GDA) in 28 cases and femoral artery (FA) in 8 cases. Intermittent high-dose infusion (WHF: 5-FU 1,000 mg/m2/5 hrs qw) was adopted as the method. RESULTS: Hepatic arterial occlusion or stenosis was observed in 12 cases (GDA: 10; FA: 2). There seemed to be no correlation with the total dosage of 5-FU or the number of administrations. Even when hepatic arterial occlusion or stenosis occurred, no change was observed in liver function, and there no death was caused by this. However, CT showed a low-density area followed by atrophy in the right lobe in one case with right hepatic arterial stenosis, despite normal portal blood flow. Of the 6 cases which developed obstructive jaundice, 4 were due to the increase of metastatic focus or lymph nodes, and 1 case without dilatation of bile duct died from suspected sclerosing cholangitis. In this case, ALP had been increasing since 1 month before the onset of jaundice. Another case which developed biloma accompanied by the increase of serum bilirubin improved by discontinuance of chemotherapy. CONCLUSION: Since arterial infusion chemotherapy for liver metastasis from colorectal cancer causes hepatic arterial occlusion (stenosis) at a high rate, early detection of abnormalities by liver function test and imaging diagnosis which leads to early treatment is important.

Adult↗
PubMed1997

[A case of antiphospholipid syndrome associated with myasthenia gravis].

We report a 40-year-old Japanese woman with antiphospholipid antibody syndrome (APS) associated with myasthenia gravis (MG). She had a history of miscarriage at the age of 27 followed by pulmonary embolism 3 weeks later. At the age of 40, she developed diplopia, bilateral ptosis and easy fatigability. Serum anti-acetylcholine receptor antibody and tensilon test were positive. She was diagnosed as having MG. The laboratory test revealed mild thrombocytopenia, prolonged activated partial thromboplastin time (aPTT) and positive findings for both beta 2-glycoprotein I-dependent anticardiolipin antibody and lupus anticoagulant. She fulfilled the diagnostic criteria of APS, but did not the criteria proposed by American Rheumatism Association for SLE. An extended total thymectomy was performed after administration of oral prednisolone and low-dose aspirin. This is a patient who had APS associated with MGs: both are known to result from autoimmune abnormality. The clinical and laboratory manifestations of APS were ameliorated after removal of the thymus, suggesting that thymectomy alleviates APS symptoms.

Adult↗
PubMed1997

[A case of adult meningitis with bilateral sensorineural hearing loss at the onset].

Here we report a case of pneumococcal meningitis with bilateral sensorineural hearing loss at the onset. The patient was a 60-year-old man who a few days before visiting our hospital experienced common cold-like symptoms, and then he suddenly developed bilateral hearing loss. Examination of the cerebrospinal fluid (CSF) on the day of admission revealed pleocytosis and his CSF culture demonstrated pneumococci. Otorhinolaryngological examinations disclosed bilateral severe sensorineural hearing loss due to cochlear impairment. Many cases of bacterial meningitis concomitant with hearing loss have been reported, but a case of meningitis starting with sudden hearing loss is rare.

Hearing Loss, Sensorineural↗
PubMed1997

[Clinical effect of high-flow pulsatile cardiopulmonary bypass in coronary artery bypass grafting].

The effect of high-flow pulsatile cardiopulmonary bypass was evaluated in 36 patients undergoing coronary artery bypass grafting in our unit. The patients were divided into two groups, based on cardiopulmonary bypass (CPB) flow; high (3.0 +/- 0.2 l/min/m2), or moderate (2.4 +/- 0.2 l/min/m2). Multidose cold crystalloid cardioplegia was administered for myocardial protection. Pulsatile flow during CPB was used and systemic perfusion pressure was maintained between 50 and 80 mmHg. Preoperatively, there were no differences between groups in left ventricular ejection fraction or extent of coronary artery disease. The times required for CPB and weaning from CPB were significantly shorter in high-flow group than moderate-flow group. The urinary output during CPB was significantly higher in high-flow group than moderate-flow group. Postoperatively, there were no significant differences in the incidence of myocardial infarction, stroke, or 30-day mortality between groups. In conclusion, high-flow pulsatile CPB shortens the length of CPB and does not differ significantly from moderate-flow with respect to mortality and morbidity.

Aged↗