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Biomedical subjects

W Yamamoto

Publications and source records attributed to W Yamamoto.

At least 55 records · Page 3Linked to original sources
PubMed1997

Discordant splenic uptake of Tc-99m colloid and Tc-99m denatured RBC in candidiasis-endocrinopathy syndrome.

We report discordant splenic uptake of Tc-99m colloid and Tc-99m heat-denatured red blood cells (RBC) which occurred in a 21-year-old female with candidiasis-endocrinopathy syndrome. Tc-99m colloid liver-spleen imaging showed no splenic uptake, suggesting the presence of functional asplenia. A subsequent Tc-99m heat-denatured RBC study clearly revealed a small spleen with preserved sequestrating function. These results may demonstrate that the qualitative dissociation of splenic functions in processing colloid and denatured RBC in functional asplenia: the sequestration function remains while the reticuloendothelial system is impaired.

Adult↗
PubMed1997

Short-period-induced hypertension could improve tumor-to-nontumor ratios of radiolabeled monoclonal antibody.

This study was undertaken to find optimum period of hypertensive treatment for the improvement of tumor targeting of 111In-labeled monoclonal antibody. Angiotensin II was infused into tumor-bearing mice at an infusion rate of 2.0 micrograms/kg/min determined by the dose-finding study. The infusion was continued for up to 72 h, and biodistribution of 111In-DTPA-A7, a murine IgG1, was observed 72 h postinjection. Tumor-to-nontumor ratios were best improved with the infusion for 0.5-3 h. However, with the longer infusion, the effect deteriorated by the increase of nontumor uptakes, and body-weight loss became remarkable. It could be concluded that hypertensive treatment for a short period could be safely performed to benefit targeting of radiolabeled monoclonal antibody.

Angiotensin II↗
PubMed1997

The relationship between abdominal pain regions and specific diseases: an epidemiologic approach to clinical practice.

In order to evaluate the relationship between the patient-identified regions of abdominal pain and the disease diagnosis, a prospective study was conducted at General Medicine Outpatient Clinic, Saga Medical School Hospital. Four hundred eighty-nine outpatients complaining of abdominal pain at the first visit were classified into 10 groups according to the pain region complained of, i.e., whole abdominal, epigastric, right subcostal, left subcostal, right flank, left flank, periumbilical, right-lower, mid-lower, and left-lower, the clinic physicians and authors in joint-participation assigned the groups through studying the medical records. Comparisons were made in order to calculate sensitivity, specificity, and the positive and negative likelihood ratios between the pain regions and disease diagnoses. In general, the sensitivity of history-taking and physical examination is low, but specificity is, high in relation to epigastric pain and gastroduodenal diseases, right subcostal pain and hepatobiliary diseases, and mid lower pain and gynecological diseases (above 0.5). Comparative analysis between the pain regions complained of by the patient in the initial clinic visit and the medical diagnoses yielded clinically useful information as to the efficacy of medical history-taking and physical examination in the identification of abdominal diseases.

Abdominal Pain↗
PubMed1997

[Decision analysis and clinical laboratory test in general internal medicine].

OVERVIEW: We demonstrated the quantitative approach to evaluating laboratory test in a patient with hypercalcemia. CASE DESCRIPTION: 43 year-old-woman was referred to our department because of sustained hypercalcemia without subjective symptoms in the past 5 years. Physical examination showed no abnormality with laboratory tests unremarkable except for hypercalcemia (10.8 mg/dl). DIFFERENTIAL DIAGNOSIS AND PRE-TEST PROBABILITY SETTING: Based on history and physical examination, we hypothesized two possible cases of hypercalcemia; primary parathyroidism (PHP) malignant disease (MD). The pre-test probability of PHP was set at 1/3, and that of MD at 2/3. CALCULATION AND ASSESSMENT: The post-test probability using the likelihood ratio of "albumin > 4.0 g/dl", 5.1 was increased to 0.72. However, it was not considered above the test-treatment threshold. We then measured Intact PTH which has a likelihood ratio 14. Intact PTH was increased yielding the post-test probability of 0.97. We considered that this value exceeded test-treatment threshold. The patient was referred to a surgical department. CONCLUSIONS: In daily practice, we, internists have to make clinical decisions quantitatively based on test results. To make a rational and quantitative approach to diagnostic tests clinical routine, it is mandatory to determine sensitivity and specificity of all laboratory tests used in our country.

Adult↗
PubMed1997

[Clinical significance of 123I-MIBG myocardial scintigraphy in patients with hypertrophic cardiomyopathy].

We studied the abnormality of myocardial sympathetic nervous system in patients with hypertrophic cardiomyopathy using 123I-metaiodobenzylguanidine (MIBG) myocardial scintigraphy in comparison with the parameters of other clinical examinations. In 50 patients with HCM, the heart to mediastinum 123I-MIBG uptake ratio (H/M) was significantly low and washout rate (WR) of 123I-MIBG was significantly high respectively compared with normal subjects (n = 8). H/M was negatively correlated with serum norepinephrine level, wall thickness of left ventricle, left ventricular mass index, left ventricular end diastolic pressure respectively, and WR was positively correlated with those parameters respectively. On the other hand, LF/HF calculated by spectral analysis in holter electrocardiogram was positively correlated with H/M, and negatively correlated with WR. In HCM, H/M in patients with subjective symptoms was significantly lower than that without subjective symptoms, and WR in patients with paroxysmal atrial fibrillation was significantly higher than that without paroxysmal atrial fibrillation. This study revealed that H/M and WR reflected the severity and the difference of disease type in HCM. In conclusion, 123I-MIBG contributes to evaluating more details in diagnosis and pathophysiology of HCM.

3-Iodobenzylguanidine↗
PubMed1996

Estimation of the prevalence of non-insulin dependent diabetes mellitus in a rural area of Japan.

The objective of this paper is to describe a method of estimating the prevalence of non-insulin dependent diabetes mellitus (NIDDM) in a community. We first counted subjects with previously diagnosed NIDDM and those newly diagnosed by use of the 75-gram oral glucose tolerance test (OGTT). We then used the OGTT data to predict the prevalence of NIDDM at different levels of fasting plasma glucose (FPG) among the subjects who did not undergo the OGTT. Data were derived from 3,614 residents aged 20 years and older in a rural area where population-based screening for NIDDM was performed using FPG or post-prandial plasma glucose (PG). Of the 318 participants who underwent an OGTT in 1992, 35 (11.0%) were judged to have NIDDM by the 2-hour PG criterion. We applied the above-described method to the 1,179 subjects who had anFPG but failed to undergo the OGTT. The estimated prevalence of NIDDM, which included the previously diagnosed group, the newly diagnosed group and the expected group, was calculated. The estimated prevalence of diabetes in this population aged 20 years and older turned out to be 6.1% (95% CI: 5.3-6.9). As a validation study, the same method was applied to 220 subjects who did not undergo the OGTT in 1992 but did so in 1994. The actual prevalence of NIDDM among these subjects was compared to the prevalence expected from the 1992 data by our method. The actual value was within the 95% confidence interval of the expected value.

Adult↗
PubMed1996

[Pharmacokinetics of 99mTc-MAG3 and 131I-OIH: comparative study based on 2 compartment model analysis].

We studied 50 patients with mild to moderate renal dysfunction to compare pharmacokinetics of 99mTc-MAG3 with that of 131I-OIH. After simultaneous bolus injection of both 99mTc-MAG3 and 131I-OIH, 8-point venous blood sampling was performed from 2 to 44 min post injection. Aliquoted plasma samples were counted for radioactivity along with the injected standard to obtain % injected dose/ml plasma for each tracer. Using obtained time-concentration data, classical 2 compartment model analysis was performed for both tracers to obtain various pharmacokinetic parameters, including distribution volumes (Vds), inter-compartmental rate constants, and plasma clearance. In these parameters, Vd of central compartment, Vd at steady state, central to peripheral inter-compartmental rate constant, and plasma clearance were significantly larger for 131I-OIH. In all parameters, significant correlation was found between 99mTc-MAG3 and 131I-OIH. The best correlation was seen in plasma clearance (r = 0.891, p < 0.0001). Plasma clearance ratio (99mTc-MAG3/131I-OIH), however, showed weak but significant negative correlation with serum creatinine, although this correlation was not likely to affect the overall correlation of clearance between 131I-OIH and 99mTc-MAG3. From these results, we confirmed that 99mTc-MAG3 clearance could be used as an alternative to 131I-OIH clearance, although pharmacokinetic behavior of 99mTc-MAG3 was not exactly the same as that of 131I-OIH.

Adult↗
PubMed1996

[Influence of smoking on medical care expense of middle-aged workers].

An analysis was made to elucidate influence of smoking habits on medical care expense. Subjects were 4,795 male workers aged 40 to 73 who participated in the routine medical check-up in 1988 at a health insurance society in Tokyo. Their daily habits including smoking habit were also surveyed. Data on medical care utilization were derived from the medical records for 1989 provided by the health insurance society. The data on medical care fees were examined, and hospitalization costs analyzed separately. Compared to other subjects, ex-smokers had a higher frequency of having a history of medical care. Ex-smokers showed higher and current smokers lower values of both visiting (percentage of subjects utilizing medical facilities at least once a year) and monthly rate of receiving examinations when compared to non-smokers. Current smokers had the lowest average number of days utilized for medical services, lowest average medical care fee per visit and annual medical care fee per person. The average number of days utilized and annual medical care fee per person was weakly correlated to smoking index. Ex-smokers had the highest average medical care fee per visit. There was a weak correlation to smoking index. Annual medical care fees per person decreased with age in non-smokers, but not in current smokers whose total fees were generally already low. In ex-smokers, fees increased until age fifties. From these results it would be difficult to identify on increase of medical care fees in middle-aged current smokers, especially in active businessmen. While the effect of smoking on health were still subclinical, average medical care fee per visit relate to and reflect the health effects of smoking.

Adult↗
PubMed1995

[Characteristics of medical institutions visited by patients with 26 intractable diseases who are residents of Saitama Prefecture (comparison of the data for 1984 and 1988)].

To obtain basic data concerning the availability of medical care for intractable diseases in a large city and its environs, we analyzed the data of Saitama Prefecture. These data were selected from a nationwide survey conducted by the Epidemiology of Intractable Diseases Research Committee of the Ministry of Health and Welfare in Japan. The characteristics of medical institutions visited by patients with 26 intractable diseases were analyzed. The patients were receiving financial aid for treatment. The subjects were 4234 patients in 1984 and 6804 patients in 1988. In addition, we compared the data of 1984 with those of 1988. The results are as follows: 1) In both years, the characteristics of medical institutions which were visited varied in terms of the individual disease. The proportion of patients who visited medical institutions in the same medical service area and in the same prefecture were both very low. The percentage of patients who visited medical institutions in Tokyo was more than 30% of the total, and was more than 50% for the disease with the highest proportion of patients. The dependency on Tokyo for medical institutions was inversely proportional to the distance from Tokyo. Most patients were highly dependent on a large hospital, but the proportion of patients with SMON and ulcerative colitis who visited a large hospital was markedly lower than that for other diseases. 2) A comparison of the data of 1984 with those of 1988 showed that in most of medical service areas, the proportion of patients who visited medical institutions in the same medical service area and in Saitama Prefecture increased, but in Tokyo Prefecture the proportion decreased. We continuously observed a high dependency on a university hospital located about 60km distance from downtown Tokyo, but the dependency slightly decreased in 1988. When a new branch of a university hospital opened, many intractable disease patients then depended on that branch. These results suggest that the self-sufficiency levels of medical services for intractable diseases gradually rose in Saitama Prefecture. The illness behavior of intractable disease patients in Saitama Prefecture did not show any remarkable changes, therefore those results in Saitama Prefecture might indicate a universal characteristic of medical institutions visited by intractable disease patients who live in the envirous of a large city (Tokyo).

Critical Illness↗
PubMed1994

Hyperproinsulinemia in Japan.

Four families with hyperproinsulinemia found in Japan were described. The details of the first case, who was investigated by Kanazawa et al., were reported and the similarity of the first case to the following cases was shown. Arginine 65 of the proinsulin molecule might be a hot spot of the insulin gene. A possible abnormality of insulin release in affected individuals was disclosed by investigation of the family members of the first case.

Arginine↗
PubMed1994

[Relationship between insulin resistance and blood pressure].

A study designed to analyze the relationship between blood pressure and insulin resistance was conducted on 353 subjects who received medical health examinations, and who did not have obvious diabetes. Fasting plasma insulin (IRI), fasting plasma glucose (FPG), body mass index (BMI), waist hip ratio (WHR), body fat percentage, total cholesterol (TC), triglyceride, and urine sodium concentrations were measured or calculated. After analysis of the correlation's between each value, multiple regression analyses were performed. The results were as follows: 1) hypertensive subjects were significantly higher than non-hypertensives in with age, value of IRI, FPG, WHR, TC and BMI. 2) The values of IRI, WHR, and BMI were correlated each other. 3) After adjusted for age and sex by multiple regression analyses, IRI, WHR, and BMI were shown to have significant relationship to mean blood pressure. From this study, it is concluded that IRI is an indicator for insulin resistance and is related to blood pressure.

Adolescent↗
PubMed1993

Effect of social factors on metabolic improvement in type II diabetic patients.

Psychological and social factors can profoundly influence a patient's success in adhering to a prescribed self-care regimen. A total of 34 inpatients with type II diabetes who attended the diabetes education program at a single clinic were studied as a retrospective cohort, beginning between 6 and 12 months after discharge. At the start of the study, the patients were classified into two groups, those with good control and those with poor control of diabetes, based on the rate of change of the glycosylated hemoglobin (HbAlc) value relative to the value at admission. Data for each patient were collected retrospectively from their medical records. Patients' family function was assessed by the adaptability, partnership, growth, affection, and resolve (APGAR) scoring system. Multiple regression analysis was used to determine the effect of demographic, medical, and social factors on metabolic improvement. The family APGAR score was higher in the good control group than in the group with poor control.

Adult↗
PubMed1992

[A case of Candida albicans endocarditis with impaired lung function].

A 53-year-old male was admitted to the hospital because of Candida albicans endocarditis. He had had a thoracoplasty due to pulmonary tuberculosis and showed severe restructive lung function. In 1987 and '89, trachiostomy was made because of respiratory failure. The patient was well until nine months earlier, when he consulted a physician because of fever. The investigations failed in finding the cause of the fever. He was administered antituberculosis agents and antiinflammatory drugs but had a fever every day. Two months before admission, a cardiac ultrasonographic study showed evident vegetations with mitral regurgitation. From the above course and examinations, a diagnosis of Candida albicans endocarditis was made. Infusions of CEZ, TOB, PIPC and miconazole for more than one month was ineffective. In November, 1990, he was referred to our medical center for the purpose of operation. A blood culture proved Candida albicans infection. An intravenous administration of fluconazole 400 mg/day was begun. However, there was pulmonary bleeding probably due to heparin used for prevention of atrial thrombosis and he developed fever, hypoexemia, ventricular tachycardia, and hyponatremia. He underwent mitral-valve replacement with a SJM valve. Culture of the vegetated mitral valve again proved Candida albicans. After operation, hypoexemia, ventricular tachycardia, hyponatremia were improved gradually. However he had an eosinophilia, eruption, and dyspnea. We suspected a drug eruption of fluconazole. Lymphocyte stimulating test of fluconazole proved positive. After the episode, he had no symptoms and was discharged.

Candidiasis↗