Search PubMed⌕ Search

Biomedical subjects

Y Fujino

Publications and source records attributed to Y Fujino.

At least 73 records · Page 4Linked to original sources
PubMed2000

Performance of transport ventilator with patient-triggered ventilation.

OBJECTIVES: Transport ventilators with inspiratory triggering functions and pressure support-control modes have recently become commercially available. We evaluated these ventilators in comparison with a standard ICU ventilator. STUDY DESIGN: Laboratory study with a mechanical lung model. METHODS: We compared the performance of four transport ventilators (model 740, Mallinckrodt, Pleasanton, CA; TBird, Bird Products Corp, Palm Springs, CA; LTV1000, Pulmonetic Systems, Colton, CA; Esprit, Respironics, Vista, CA) with a standard ICU ventilator (model 7200ae; Mallinckrodt) using a test lung that simulated spontaneous breathing (compliance, 46.8 mL/cm H(2)O; resistance, 5 cm H(2)O/L/s). The settings of ventilators were positive end-expiratory pressure (PEEP) of 0 or 5 cm H(2)O, and pressure support (PS) of 0 or 10 cm H(2)O. The settings of the test lung were inspiratory time of 1 s, respiratory rate of 10/min, peak inspiratory flow of 40, 60, and 80 L/min. To evaluate inspiratory function at each setting, we measured the inspiratory delay time (DT), inspiratory trigger pressure (P-I), and the time for airway pressure to rise from the baseline pressure to 90% of the end-inspiratory pressure (T(90%)); for expiratory function, supraplateau expiratory pressure (P-E) and the time constant (taue) for pressure decrease during exhalation were evaluated. Oxygen requirement was assessed as the time required to empty a 3.5-L oxygen tank. RESULTS: For inspiratory triggering, four transport ventilators had DT < 100 ms, which is considered clinically satisfactory, in all the settings except for PS 0 cm H(2)O, PEEP 0 cm H(2)O, and inspiratory flow of 80 L/min with LTV1000. P-I increased only in LTV1000 when PEEP was increased from 0 to 5 cm H(2)O. taue for the transport ventilators was > 50% shorter than for the ICU ventilator except for PS 0 cm H(2)O and PEEP 5 cm H(2)O with TBird. Oxygen requirement was lowest for the Esprit, followed by the 740, LTV1000, and TBird. CONCLUSION: The newer Food and Drug Administration-approved transport ventilators have performance indexes comparable to the ventilator currently used in ICUs and can probably be recommended for clinical use.

Equipment Design↗
PubMed2000

Anti-endometrial IgM autoantibodies in endometriotic patients: a preliminary study.

Japanese herbal medicines (Kampo medicines) are usually the third most popular choice among medicines for treatment of endometriosis in Japan. This traditional therapy is used to improve various signs and symptoms of endometriosis without decreasing serum estradiol levels or causing menstrual disorders. We used flow cytometry to examine and compare the effects of the Kampo therapy and danazol on anti-endometrial humoral immunity. Autoantibodies against endometrial epithelial cell lines and endometrial stromal cells were detectable in all the examined sera of men and women irrespective of the presence of endometriosis. Moreover, no significant increase in anti-endometrial antibodies was found in endometriotic patients. Anti-endometrial antibodies included Ig-gamma chain, Ig-mu chain, Ig-kappa chain, and Ig-lambda chain indicating polyclonal B cell activation in the endometriotic patients. Absorption tests of nonspecific antibodies with cervical cancer cells or ovarian cancer cells revealed that endometriotic patients had higher levels of endometrium-specific autoantibodies than did non-endometriotic healthy women. IgM fractions from endometriotic patients and healthy women differed in their effect on growth of endometrial adenocarcinoma cells. Therapy with the herbal compounds Keishi-bukuryo-gan but not danazol therapy, gradually decreased the tissue-specific anti-endometrial IgM antibody levels. These results indicate that tissue-specific anti-endometrial IgM may be a useful therapeutic marker for endometriotic patients treated with Keishi-bukuryo-gan and that endometrial tissue-specific immune disorders play specific roles in the pathogenesis or development of endometriosis.

Autoantibodies↗
PubMed2000

Nitric oxide delivery during high-frequency oscillatory ventilation.

BACKGROUND: Inhaled nitric oxide (NO) is used increasingly in the care of infants with hypoxemic respiratory failure and is frequently combined with high-frequency oscillation (HFO). The aim of this study was to evaluate delivery of NO during HFO using titration into the ventilator circuit or using the INOvent Delivery System. METHODS: NO was delivered into the HFO circuit at three sites (pre-humidifier, post-humidifier, and after the bellows) by continuous titration using a rotameter. The target NO concentration ([NO]) was initially adjusted using a rapid-response chemiluminescence NO analyzer without oscillation at 5, 10, and 20 parts per million (ppm). During the study, gas was sampled 5 cm from the bellows (proximal), 35 cm from the bellows (middle), and at the distal end of the circuit (distal). The ventilator was set at frequencies of 5, 10, and 15 Hz, mean airway pressures of 15, 20, and 25 cm H(2)O, and amplitudes of 20, 30, and 40 cm H(2)O. Soft and hard circuits were evaluated. The fraction of inspired oxygen was 0. 90, the inspiratory time fraction was 33%, and the bias flow was 20 L/min throughout the study. An INOvent Delivery System was also evaluated with the same HFO settings. RESULTS: The fluctuation of [NO] was minimal with continuous titration pre-humidifier at all HFO settings. [NO] fluctuated with titration post-humidifier and after the bellows, especially at the proximal sampling site. At the lung model, however, fluctuation of [NO] was always < 1.5 ppm and usually < 1 ppm. Delivered [NO] was lower than target [NO] with injection after the bellows (> 5%). The soft circuit showed better mixing of NO than the hard circuit. The INOvent Delivery System delivered a stable and accurate [NO] at all settings. [NO(2)] was < 1 ppm at all settings. CONCLUSIONS: Mixing of NO during HFO was acceptable at all the injection sites evaluated, although injection pre-humidifier was preferable because of small fluctuations of [NO]. The INOvent Delivery System was simple to use and delivered an accurate and precise [NO] during HFO.

Administration, Inhalation↗
PubMed2000

[Mycosis fungoides terminating in acute myelocytic leukemia].

A 57-year-old woman was admitted to our hospital with suspected leukemia in September 1999. In 1990, systemic erythema had occurred, and mycosis fungoides (MF) had been diagnosed by skin biopsy. Interferon-gamma therapy had not been effective, and the erythema had disappeared after treatment with psoralen and ultraviolet A (PUVA) therapy (1.46 J/cm2). The patient had subsequently done well with a course of topical steroids. On admission this time, the WBC count was 1,600/microliter with 6% blasts. The total nucleated cell count in a bone marrow aspirate was 43.1 x 10(4)/microliter, of which 86.2% were peroxidase-positive blasts. Acute myelocytic leukemia (AML) was diagnosed. Chromosomal analysis demonstrated abnormalities of 48, XX, +4, +8, +add(10)(p11), add(11)(q23) in 10 of 20 cells, and 51, idem, +6, +8, +21, +mar in 8 cells with mixed-lineage leukemia gene rearrangement. Therapies (radiation, chemotherapy and PUVA) for MF, and the altered immune response seen in patients with this disease, especially in the more advanced stages, collectively termed cutaneous T-cell lymphoma (CTCL), suggest that such patients may be at increased risk of a second primary malignancy. To our knowledge, AML has been reported in 8 MF patients including the present one. Attention should be given to the possibility of MF terminating in AML.

Female↗
PubMed2000

[Extended spontaneous spinal epidural anterior hematoma over multiple spinal segments. A case report].

We reported a case of extended spontaneous spinal epidural hematoma over multiple spinal segment. A 68-year-old man presented with sudden onset of back pain. He rapidly developed tetraplegia within 15 minutes. On admission, he showed tetraplegia, sensory loss below C4 dermatome, right Horner's sign and bilateral Babinski's signs. These neurological signs gradually improved and disappeared completely within 5 hours. MR imaging showed extended hematoma in the anterior part of spinal epidural space. Spinal angiogram showed no vascular anomaly. The patient had nine years history of antiplatelet therapy, which would produce this episode of the spinal epidural hematoma. The hematoma located in the anterior part of the epidural space and extended over multiple spinal segments was characteristic features in this case. In the case which could have early neurological recovery, conservative therapy might be indicated.

Aged↗
PubMed2000

[Progressive cerebellar atrophy following acute antidepressant intoxication].

A 37-year-old woman presented with acute cerebellar atrophy after ingesting toxic doses of tricyclic antidepressants in an attempt of suicide. Two hours after ingestion, she was comatose and showed myoclonus of the limbs, and eventually developed status epileptics. The patient underwent general anesthesia with thiopental, she had hyperpyrexia with elevated muscle enzymes and leukocytosis. These clinical and laboratory features suggested that she had serotonin syndrome (SS). After recovery from coma and hyperpyrexia that had lasted for 7 days, she showed cerebellar ataxia, and progressive cerebellar atrophy of CT scan. As well as neuroleptic malignant syndrome, the SS may cause cerebellar degeneration, probably due to sustained hyperpyrexia.

Adult↗
PubMed2000

Nuclear matrix protein (NMP) levels in patients with acute pancreatitis.

Nuclear matrix protein (NMP) is an index of apoptosis. We measured NMP in 22 patients with acute pancreatitis and investigated the relationship between severity and NMP. We also measured tumor necrosis factor-alpha (TNF-alpha) and investigated the relationship between NMP and TNF-alpha. The NMP value increased significantly as the pancreatitis became more increasingly severe, and the NMP values were significantly higher in the group with multiple organ dysfunction syndrome (MODS) than in the group without MODS. A comparison of the NMP values in the group that survived and the group that died revealed higher NMP values in the former. A significant correlation was found between the NMP values and the TNF-alpha values, suggesting that apoptosis may contribute to the pathophysiology of acute pancreatitis.

Acute Disease↗
PubMed2000

Soluble Fas and soluble Fas L levels in patients with acute pancreatitis.

The FasL-Fas system is an apoptosis induction system and plays an important role in homeostasis and biophylaxis. The present study was conducted to investigate soluble Fas (sFas), soluble Fas ligand (sFasL), and tumor necrosis factor alpha (TNF-alpha) in patients with acute pancreatitis. As acute pancreatitis became severe, the levels of sFas in the serum increased significantly, while those of sFasL decreased significantly. A significant inverse correlation was observed between the serum levels of sFas and those of sFasL. Also, a significant positive correlation was observed between the levels of TNF-alpha and sFas. A greater increase in serum sFas and decrease in serum sFasL levels was observed in patients with complicating multiple organ dysfunction syndrome (MODS) than in those without it. The results of the study suggest that the pathological aggravation of acute pancreatitis could be related to changes in the Fas-FasL system.

Acute Disease↗
PubMed1999

Possible functions of oxytocin/vasopressin-superfamily peptides in annelids with special reference to reproduction and osmoregulation.

Annetocin is an earthworm oxytocin-related peptide that we previously isolated from the whole body of a lumbricid earthworm Eisenia foetida. We have reported that annetocin induces egg-laying-like behaviors in E. foetida and a gnathobdellid leech, Whitmania pigra, when it is injected into the respective animals. The present study was undertaken to probe physiological functions of invertebrate oxytocin-vasopressin-superfamily peptides with special reference to reproductive and osmoregulatory events in which vertebrate peptides of this superfamily are involved. Annetocin, Lys-conopressin (a leech vasopressin-related peptide) and two analog peptides, [Tyr(3)]-annetocin ((3)Y-annetocin) and [Phe(3)]-annetocin ((3)F-annetocin), were compared for their activities to induce egg-laying-like behavior and to change body weight as a measure of water balance in the leech W. pigra. Injection of annetocin, Lys-conopressin, and (3)F-annetocin caused both egg-laying-like behavior and reduction of body weight in the animals, but (3)Y-annetocin induced neither. Furthermore, leeches in the non-breeding season responded to peptides less conspicuously than those in the breeding season. Such a concomitant induction of egg-laying-like behavior and body-weight reduction suggests that these two phenomena are unitary and might be accounted for by the fact that egg-laying in leeches and earthworms is accompanied by secretion of a large quantity of mucus, which should significantly contribute to body-weight loss. J. Exp. Zool. 284:401-406, 1999.

Amino Acid Sequence↗
PubMed1999

Dynamic measurement of intrinsic PEEP does not represent the lowest intrinsic PEEP.

OBJECTIVE: Dynamic intrinsic PEEP (PEEPi-dyn) is the airway pressure required to overcome expiratory flow and is considered to represent the lowest regional PEEPi. However, there are few data to validate this assumption. We investigated if PEEPi-dyn represents the lowest PEEPi. SETTING: The animal laboratory at the Osaka University Medical School. MEASUREMENTS AND RESULTS: We compared static PEEPi (PEEPi-stat) and PEEPi-dyn in healthy animals. Five adult white rabbits (2.77+/-0.05 kg) were anesthetized, tracheostomized, and intubated with several different sizes of endotracheal tubes (ETT) (2.0, 2.5, 3.0, 3.5, or 4.0 mm i.d.). The animals were paralyzed and ventilated (Siemens Servo 900C). Baseline ventilator settings were at a rate of 50/min, inspiratory:expiratory (I:E) ratio of 2:1 or 4:1, and minute ventilation was manipulated to create 3 or 5 cm H2O PEEPi-stat. PEEPi-stat was measured using the expiratory hold button of the ventilator. PEEPi-dyn showed large variations. In all ventilator settings, PEEPi-dyn was higher than PEEPi-stat (p<0.001). The larger the ETT, the higher the PEEPi-dyn at an I:E ratio of 2:1 (p<0.05). The higher the minute ventilation, the greater the difference between PEEPi-stat and PEEPi-dyn. The tidal volume and the difference showed a significant correlation (r2 = 0.514, p<0.001). CONCLUSIONS: The value of PEEPi-dyn was dependent on ventilatory settings, and PEEPi-dyn does not necessarily represent the lowest regional PEEPi within the lungs.

Animals↗
PubMed1999

Effects of monoclonal antibodies directed at cell surface molecules on murine experimental autoimmune uveoretinitis.

BACKGROUND: To elucidate the immunopathogenic mechanism of endogenous uveitis, the effects of monoclonal antibodies to molecules involved in the immune response were studied in murine experimental autoimmune uveoretinitis (EAU). METHODS: Monoclonal antibodies to CD4, CD8, Ia(k), Ia(d), lymphocyte function-associated antigen-1 (LFA-1), and intercellular adhesion molecule-1 (ICAM-1) were used in this study. The monoclonal antibodies were added in the culture of lymph node cells from B10.BR mice(H-2(K)) immunized with interphotoreceptor retinoid-binding protein (IRBP) and the inhibition of proliferative response was measured. In vivo, IRBP-immunized mice were treated with a high dose of the antibody, and the EAU induction was examined both clinically and pathologically. RESULTS: Proliferative response of IRBP-sensitized lymph node cells was inhibited strongly by anti-CD4 or anti-LFA-1 monoclonal antibody and moderately by anti-Ia(k) or anti-ICAM-1 monoclonal antibody. In contrast, no inhibitory effect of anti-CD8 or anti-Ia(d) monoclonal antibody was observed. In vivo treatment with anti-CD4 monoclonal antibody inhibited development of EAU in a dose-dependent manner, while in vivo treatment with other monoclonal antibodies did not cause significant suppression of EAU. CONCLUSIONS: CD4, Ia, LFA-1, and ICAM-1 molecules play important roles in the antigen-specific immune response of lymphocytes. However, in in vivo treatment with monoclonal antibodies to these molecules, only anti-CD4 monoclonal antibody had a strong inhibitory effect on the development of EAU.

Animals↗
PubMed1999

Unilateral papilledema after bone marrow transplantation.

We describe a patient who developed unilateral papilledema after allogeneic BMT. This is a rare manifestation of pseudotumor cerebri, which results from elevated intracranial pressure caused by cyclosporin A. The papilledema usually involves the fundi bilaterally, but unilateral involvement has been described. Congenital anomalies, compression and adhesion of the optic nerve sheath are its causes. In this patient, the right optic fundus was spared although leukemic infiltration was present on this side and high-dose irradiation (72 Gy) was given. Although papilledema is a sensitive marker of elevated intracranial pressure, this sign may be masked by constriction of the optic sheath in patients who suffer from leukemic infiltration of the central nervous system and receive high doses of cranial irradiation.

Adult↗
PubMed1999

Randomized clinical trial of ultrasonic dissector or conventional division in distal pancreatectomy for non-fibrotic pancreas.

BACKGROUND: Resection of the non-fibrotic pancreas is prone to postoperative pancreatic fistula because of well preserved exocrine secretions and easily crushed soft parenchyma. The purpose of this study was to evaluate ultrasonic dissection for division of the non-fibrotic pancreas in distal pancreatectomy. METHODS: All pancreata included in this study were soft on direct palpation and their main ducts had no dilatation, at least proximally from the transection line. Fifty-eight patients with gastric cancer or pancreatic disease were randomly assigned to the two groups. In the ultrasonic dissection (UD) group (n = 27), all pancreatic ducts were identified and ligated securely. The stump was left open without parenchymal suturing. In the conventional (CV) group (n = 31), the pancreas was cut with a knife and the stump was oversewn in mattress fashion. The main pancreatic duct was ligated in all patients in both groups. Pancreatic fistula was defined as a pancreatic fluid discharge for more than 7 days after operation diagnosed according to amylase concentration in the drainage fluid. RESULTS: In the UD group, approximately 20-30 tubes including a mean(s.d.) 5.2(0.8) (range 4-6) pancreatic ducts were skeletonized and ligated per patient. There were nine pancreatic fistulas (16 per cent); one in the UD group and eight in the CV group (P = 0.020). CONCLUSION: In distal pancreatectomy for the non-fibrotic pancreas, ultrasonic dissection without suture closure of the stump reduced the incidence of pancreatic fistula compared with conventional division and suture, in this randomized trial.

Adult↗
PubMed1999

Evaluation of endoscopic ultrasonography as an indicator for surgical treatment of gastric cancer.

BACKGROUND AND METHODS: Clinicopathological analysis of 346 patients with gastric cancer was made retrospectively and new criteria for the indication of a limited operation using endoscopic ultrasonography (EUS) was developed. Suggested new criteria for selecting gastric cancer patients for the limited operation were: (i) the cancer is located in the mucosa and the lymph nodes are not involved as indicated by EUS examination; (ii) the maximum size of the tumour is less than 2.0 cm; (iii) there are no multiple gastric cancers or simultaneous abdominal cancers; and (iv) the mucosal cancer of elevated type less than 2.0 cm is excluded because there are good indications for endoscopic mucosal resection. RESULTS AND CONCLUSIONS: We applied these new criteria to 262 patients and found that the patients who had limited operation had the same prognosis and a better quality of life compared with patients who had the conventional operation.

Adult↗
PubMed1999

Role of the cytomegalovirus (CMV)-antigenemia assay as a predictive and follow-up detection tool for CMV disease in AIDS patients.

Forty-two patients were evaluated to determine the value of the CMV antigenemia (CMV-Ag) test as a follow-up marker as well as a prediction marker of CMV disease. Twenty patients were positive for at least one positive CMV-Ag assay and 9 of them developed CMV retinitis. With the threshold value (10 positive cells), sensitivity was 56% and specificity was 94%. The CMV-Ag assay, with the threshold value, produced high specificity, positive predictive value and negative predictive value but relatively poor sensitivity. Eight patients experienced CMV disease relapse a total of 16 times. At relapse, 8 of the 16 times showed negative for CMV-Ag assay; 7 underwent systemic maintenance while 1 underwent local maintenance. It is inferred that the CMV-Ag test is a poor follow-up marker to detect the relapse of CMV disease, particularly in patients undergoing systemic maintenance.

AIDS-Related Opportunistic Infections↗
PubMed1999

The effect of mode, inspiratory time, and positive end-expiratory pressure on partial liquid ventilation.

Partial liquid ventilation (PLV) has been shown to be an effective means of improving oxygenation in the injured lung. However, little is known about how approach to ventilation during PLV affects gas exchange and pulmonary mechanics. We hypothesized that gas exchange and pulmonary mechanics would be best with positive end-expiratory pressure (PEEP) set above the lower inflection point (LIP) of the pressure-volume (P-V) curve regardless of mode of ventilation or inspiratory to expiratory time (I:E) ratio and that the efficiency of ventilation would be greatest with volume-controlled ventilation (VCV) compared with pressure-controlled ventilation (PCV) and with long inspiratory time as compared with short inspiratory time. Lung injury was induced in 14 sheep by lavage, 10 of which were studied. Sheep were then assigned to high-PEEP (Group H, n = 5) and low-PEEP (Group L, n = 5) groups. In Group H applied PEEP was set at the LIP and in Group L applied PEEP was set at 5 cm H2O after the lung was filled with perflubron (PFB). We randomly compared VCV and PCV with I:E ratios of 1:2, 1:1, and 2:1. Peak inspiratory pressure and VT were adjusted to maintain a constant end-inspiratory plateau pressure (Pplat) of about 25 cm H2O in both groups and a constant total PEEP of about 5 cm H2O in Group L and about 12 cm H2O in Group H. There were no differences in oxygenation among modes in Group H. In Group L VCV 2:1 and all of the PCV modes in Group L had a lower PaO2 than VCV 1:1 (p < 0.05). PaCO2 and VD/VT were significantly different (p < 0.05) among modes. VD/VT was highest during PCV 1:2 with PEEP of 5 cm H2O (p < 0.05). Quasi-static compliance in Group H was higher than in Group L (p < 0.05). We conclude that during low PEEP gas exchange deteriorated in VCV with long inspiratory time and in PCV. Oxygenation was enhanced during VCV 1:1 when compared with VCV at longer I:E ratios or PCV at any I:E ratio. With PEEP set at the LIP, adequate gas exchange and improved lung mechanics could be obtained in all modes assessed.

Animals↗
PubMed1999

Pressure-release tracheal gas insufflation reduces airway pressures in lung-injured sheep maintaining eucapnia.

Although tracheal gas insufflation (TGI) has proved to be a useful adjunct to mechanical ventilation, end-inspiratory as well as end-expiratory pressures may increase. We investigated the ability of continuous-flow TGI to maintain eucapnia while reducing airway pressure (Paw) and tidal volume (VT). Seven sheep (36 +/- 2 kg) were ventilated using the Dräger Evita 4 in the pressure control plus mode where flow is released via the expiratory valve to maintain constant inspiratory pressure. To avoid TGI-generated positive end-expiratory pressure (PEEP), a prototype reverse flow TGI tube was used. Two TGI flows (5 and 10 L/min) were investigated pre- and postsaline lavage-induced lung injury. Inspiratory pressures and VT were significantly reduced as TGI flow increased. At 10 L/min TGI flow the carinal pressures (Pcar) and VT were reduced pre- and postinjury by 15% and 20%, and by 28% and 34%, respectively. Tidal volume to dead space ratio (VD/VT) decreased preinjury from 0.49 +/- 0.1 to 0.18 +/- 0.2 and postinjury from 0.62 +/- 0.1 to 0.33 +/- 0.1 at a TGI flow of 10 L/min. The combination of the reverse flow TGI tube and a ventilator with an inspiratory pressure relief mechanism kept set end-inspiratory and end-expiratory pressures constant. This TGI system effectively reduced set Paw and VT while maintaining eucapnia.

Airway Resistance↗