Biomedical subjects

Takeshi Kojima

Publications and source records attributed to Takeshi Kojima.

6 recordsLinked to original sources

PubMed2004

[A case of Legionella pneumonia complicated with acute respiratory distress syndrome treated with methylprednisolone and sivelestat sodium in combination with intravenous erythromycin and ciprofloxacin].

A 64-year-old man was referred to us because of pneumonia refractory to panipenem/betamipron. His chest radiography showed patchy consolidations in the lower lobe of the right lung and in the middle field of the left lung, and severe hypoxia was present. He was diagnosed as having acute respiratory distress syndrome due to severe pneumonia, and was treated with pulse methylprednisolone and sivelestat sodium in combination with intravenous erythromycin and ciprofloxacin. The patient recovered with this treatment. Serological examination using blood samples collected on the 12th and 28th hospital days revealed elevation of anti-L. pneumophila serogroup I antibody. It is suggested that administration of methylprednisolone and sivelestat sodium in combination with intravenous erythromycin and ciprofloxacin in a case of severe Legionella pneumonia complicated with acute respiratory distress syndrome is effective, and may be of use in similar cases.

Anti-Infective Agents↗

PubMed2003

Mapping posterior vitreous detachment by optical coherence tomography in eyes with idiopathic macular hole.

PURPOSE: To determine the relationship between posterior vitreous detachment and idiopathic macular hole. DESIGN: Observational case series. METHODS: In a prospective study, the posterior hyaloid face was scanned from the posterior pole to the far periphery by optical coherence tomography in 25 eyes (22 patients) with an idiopathic macular hole (stage 1 = 1, stage 2 = 7, stage 3 = 10, and stage 4 = 7), and a map of the posterior vitreous detachment was constructed. RESULTS: One eye with a stage 1 macular hole had a posterior vitreous detachment confined to the vascular arcade, but attached to the fovea. In all seven eyes at stage 2, the detached posterior hyaloid enlarged upward beyond the superior vascular arcade, but stopped at the margin of inferior vascular arcade. In two cases, the posterior vitreous detachment also extended temporally and superonasally. In all cases, the vitreous face remained attached to the fovea. Six of the 10 eyes at stage 3 had larger partial posterior vitreous detachment that extended not only upward, but also beyond the inferior vascular arcade, while in the other four eyes, the size and position of the posterior vitreous detachment was similar to stage 2 macular holes. However, unlike stage 2, the posterior vitreous detachment included the fovea in all eyes. All seven eyes with a stage 4 macular hole had complete posterior vitreous detachment that extended to the far periphery in all directions. CONCLUSION: There is a close correlation between the stage of the macular hole and the degree of posterior vitreous detachment. This close correlation suggests that progression of idiopathic macular hole is related to enlargement of the posterior vitreous detachment.

Aged↗

PubMed2003

Changes in focal macular electroretinograms and foveal thickness after vitrectomy for diabetic macular edema.

PURPOSE: To evaluate the changes in the focal macular electroretinogram (FMERG) and foveal retinal thickness after vitrectomy for diabetic macular edema (DME). METHODS: FMERGs were elicited from 25 eyes of 21 patients (ages 29-75 years) who underwent vitrectomy for DME by a 15 degrees stimulus. A posterior vitreous detachment (PVD) was created during surgery in 19 eyes (group 1), and 4 eyes had a PVD before surgery (group 2). In the remaining 2 eyes, a PVD could not be created (group 3). FMERGs were recorded before and 3, 6, and 12 months after vitrectomy. The foveal thickness, determined by optical coherence tomography (OCT), and visual acuity were measured on the same day as the FMERG recordings. RESULTS: The postoperative visual acuity (logarithm of the minimum angle of resolution [logMAR]) improved gradually after the surgery and was significantly better at 12 months in eyes in group 1 (P = 0.0393). The postoperative mean foveal thickness was significantly less at 3 months after surgery in group 1 eyes (P = 0.0006), and there was a further decrease thereafter. In the 2 eyes in group 3, the decreased foveal thickness 3 and 6 months after surgery became thicker at 12 months. The mean b-wave amplitude of the FMERGs increased significantly at 12 months in group 1 eyes (P = 0.0297). The mean implicit time of a- and b-waves was more delayed at 3 months, and the change in a-wave was statistically significant in group 1 eyes (P = 0.0474). There was a wide range of changes in the b-wave amplitude at 12 months, however, the increase in the b-wave was correlated with the decrease in foveal thickness (r =.49, P = 0.012). CONCLUSIONS: A disparity in the time course and degree of recovery of the foveal thickness and macular retinal function was found in eyes with DME after vitrectomy. Part of the functional recovery could be attributed to decreased retinal thickness and the absorption of the subretinal fluid.

Adult↗

PubMed2002

Molecular bases for human complement C7 polymorphisms, C73 and C74.

Complement C7 is one of the components of membrane attack complex (MAC) generated by the terminal complement cascade. C7 protein is polymorphic and most of its polymorphisms have been identified using isoelectric focusing (IEF), which detects protein charge differences. To date, the molecular bases of the polymorphisms detected by IEF have not been determined. In this paper, we describe the structural bases of two C7 IEF-detected polymorphisms, C7*3 and C7*4, both of which are common in Asian populations. C7*3 resulted from substitution of cysteine (Cys) at amino acid residue 106 by charged arginine (Arg; C106R), while charged lysine (Lys) at amino acid residue 398 was replaced by neutral glutamine (Gln; K398Q) in C7*4. As C7*3 is hypomorphic, it is important to study its possible associations with diseases such as immunological disorders and infections. We present genetic bases for this C7 polymorphism, which we determined using polymerase chain reaction (PCR)-based genotyping, a simple and accurate method suitable for large-scale studies.

Base Sequence↗

PubMed2002

Loss of stereopsis with optic chiasmal lesions and stereoscopic tests as a differential test.

OBJECTIVE: To identify and characterize the loss of stereopsis observed in patients with lesions of the optic chiasm. STUDY DESIGN: Cross-sectional study. PARTICIPANTS: Forty-three patients who had good visual acuity with orthophoria and without strabismologic histories were divided into two groups. Group 1 consisted of 13 patients with lesions involving the optic chiasm (regardless of their visual field loss) diagnosed by magnetic resonance imaging findings. Group 2 (control group) consisted of 30 patients who had large absolute visual field defects as a result of other causes, including 11 intracranial disorders other than optic chiasmal lesions, 11 cases of open-angle glaucoma, and 8 patients with lesions of the retina. METHODS: The stereoacuity and visual field in each case in group 1 (before and after surgery) and group 2 were assessed, and the results were compared. MAIN OUTCOME MEASURES: Stereoacuity was assessed by the Titmus stereo test (normal value for circle, 6/9; 80 seconds of arc) and by Lang-stereotest (normal value for circle, 3/3; 350 seconds of arc). Visual field was evaluated by Goldmann and Humphrey perimetry (conventional perimetry), the starlight test (binocular visual field test), and scanning laser ophthalmoscopic microperimetry (microperimetry). RESULTS: Before surgery, 11 of 13 cases (85%) in group 1 failed stereo tests, and after surgery, 5 of 13 cases (38%) in group 1 failed stereo tests. Before surgery, four patients who failed stereo tests showed no absolute scotoma by Humphrey or Goldmann analysis; after surgery, one patient who failed stereo tests showed no absolute scotoma by Humphrey or Goldmann analysis. However, starlight testing showed complete bitemporal hemianopsia only under binocular conditions, and microperimetry demonstrated a relative bitemporal hemianopsia at the fixating point. No patient failed in the Titmus circle test, but one patient in group 2 failed the Lang test (3%). The patients with chiasmal lesions significantly lost the ability of stereopsis compared with other diseases (group 1 [before or after surgery] vs. group 2, P < 0.001, Fisher's exact test). Conventional perimetry was unable to measure scotomas within 3 degrees of the fixation point, which is the key area for acute foveal stereopsis, because of an attached observational mirror. CONCLUSIONS: The difficulty with stereopsis in patients with lesions of the optic chiasm is most likely caused by the compression of the decussating optic nerve fibers resulting in the loss of an overlapping visual field at the fixation point. Stereo tests were demonstrated to be simple and effective adjunctive tests for suspected chiasmal compression.

Adolescent↗

PubMedDate not supplied

Vitrectomy for diabetic macular edema: effect of glycemic control (HbA(1c)), renal function (creatinine) and other local factors.

AIMS: To determine the effect of preoperative factors on the foveal thickness following vitrectomy for diabetic macular edema. METHODS: Fifty-eight eyes of 47 patients underwent vitrectomy for diabetic macular edema. In all eyes, no clear, visible vitreomacular traction was present. Twelve eyes were pseudophakic before vitrectomy, and 31 eyes underwent concurrent phacoemulsification and intraocular lens (IOL) implantation. Multiple logistic regression analysis was used to assess the independent effect of age, history of photocoagulation, diabetic retinopathy status, preoperative posterior vitreous detachment, HbA(1c) and serum creatinine levels within 2 weeks before surgery, lens status after surgery and follow-up period on the foveal thickness determined by optical coherence tomography. RESULTS: The median preoperative visual acuity was 20/100 (range from 20/500 to 20/20), and the median postoperative visual acuity was 20/70 (range from 20/500 to 20/13). The preoperative visual acuity (logarithm of minimal angle of resolution; logMAR) was 0.73 +/- 0.36 (mean +/- SD; 20/107 Snellen acuity), and the mean postoperative logMAR visual acuity was 0.60 +/- 0.39 (20/80), which was significantly better than the mean preoperative value (Wilcoxon signed rank test, p = 0.011). The mean +/- SD of preoperative foveal thickness was 475.9 +/- 172.5 micrometer, and the mean postoperative foveal thickness was 277.3 +/- 171.9 micrometer. The mean postoperative foveal thickness was significantly thinner than the preoperative thickness (Student's paired t test, p < 0.0001). Multiple logistic regression analysis showed that a preoperative low HbA(1c) and postoperative pseudophakia were independently associated with the decrease in foveal thickness (p = 0.01, p = 0.04, respectively). CONCLUSIONS: The greater reduction in foveal thickness in eyes with an IOL probably resulted from a relatively larger amount of vitreous being removed during the vitrectomy. Because the decrease in foveal thickness may be related to the preoperative glycemic control and the amount of vitreous, these factors should be considered in the planning for vitrectomy.