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Biomedical subjects

Y Fujino

Publications and source records attributed to Y Fujino.

At least 91 records · Page 5Linked to original sources
PubMed1999

[Cataract surgery and intraocular lens implantation in patients with Behçet's disease].

PURPOSE: To evaluate the outcome of cataract surgery in patients with Behçet's disease. METHODS: The results of 27 eyes of 19 patients with Behçet's disease that had undergone cataract surgery with or without intraocular lens implantation from October 1993 to December 1996 were retrospectively analyzed. The postoperative follow-up period ranged from 13 to 50 months (average, 28 months). FINDINGS: Visual acuity improved postoperatively in 25 eyes, to 20/40 or better in 9 eyes. In 19 eyes, ocular attacks were seen within the preoperative 6 months in 2 eyes, and within the postoperative 6 months in 8 eyes. In 8 eyes, the first ocular attacks occurred within 2 months after the surgery. The frequency of ocular attacks increased after the surgery in 7 patients who received immunosuppressive a gents, with relatively short duration of the disease. CONCLUSION: These results suggest that the frequency of ocular attacks increases after cataract surgery in some patients who use immunosuppressive agents for controlling ocular attacks, even though they had no inflammatory history for a long period before the surgery.

Adolescent↗
PubMed1999

[Two cases of frosted retinal angiitis with central retinal vein occlusion].

BACKGROUND: Frosted retinal angiitis usually occurs in children, and has a good prognosis. We report two cases of unilateral frosted retinal angiitis in adults. They resulted in visual degradation because of associated central retinal vein occlusion and neovascular glaucoma. CASES: Case 1 was a 36-year-old female. Almost all retinal veins and some retinal arteries had vasculitis in her right eye, and the veins were slightly dilated and sheathed. Case 2 was a 23-year-old female. Angle hypopyon was observed in her left eye. Retinal veins were dilated, meandered, and sheathed. Retinal hemorrhages were also observed. In both cases, systemic steroid therapy gradually improved the retinal vasculitis, but central retinal vein occlusions gradually developed, and in spite of systemic administration of urokinase and panretinal photocoagulation, neovascular glaucoma developed, and visual acuity became degraded in both cases. CONCLUSION: Two cases of frosted retinal angiitis complicated by retinal vein occlusion were reported. Careful observation of retinal blood flow is necessary in frosted retinal angiitis in adults.

Adult↗
PubMed1999

[Neurological complications of ulcerative colitis].

Extraintestinal complications of ulcerative colitis(UC) affect various organ systems. However, there is a notable sparing of the nervous system. In this review, we describe the complications of nervous system dividing into some categories. Most frequently reported is cerebrovascular disease(CVD), which occurs in hypercoagulable state or vasculitis. Young patient with active UC seems to be a risk of CVD. Some authors suggest that the familial concurrence of multiple sclerosis and UC. However, there is only one report in Japan. Myopathy and neuropathy are rare diseases in a group of this review. The former are considered an overlapping occurrence of UC. The latter have various areas in peripheral nervous system. A detailed investigation of immunological back-ground is required to define the nature of their association.

Cerebrovascular Disorders↗
PubMed1999

[Evaluation of mortality of patients admitted to ICU for the last 12 years].

We evaluated mortality of 2689 patients admitted to the Intensive Care Unit, Osaka University Hospital from January, 1987 to December, 1998. The patients were divided into 3 groups. Group A consisted of 1408 patients who underwent cardiovascular surgery, group B, 1082 patients who underwent other surgical procedures and group C, 199 patients who were transferred from the department of medicine. We studied mortality rate, causes of death, correlation between length of ICU stay and mortality rate, and mortality rate among age groups for 12 years. The main causes of death were cardiac failure and sepsis in group A, and respiratory failure and sepsis in group B and C. Mortality rate in each group showed no significant change for the last 12 years. Those who stayed more than 2 weeks in ICU showed a significantly higher mortality rate (p < 0.0001). Thus, length of ICU stay and mortality rate showed a positive correlation (p < 0.0001). The youngest group (age 0-1) showed a significantly higher mortality rate than other age groups (p < 0.0001). As sepsis was the most important cause of death in all the groups, the prevention and treatment of infection are the most important issue in our ICU to reduce mortality rate.

Adolescent↗
PubMed1998

Nonfunctional paraganglioma of the pancreas: report of a case.

We report herein the case of a 61-year-old man found to have a rare nonfunctional paraganglioma of the pancreas. Interestingly, the preoperative data and images showed similar characteristics to neuroendocrine tumors of the pancreas. Both paragangliomas and neuroendocrine tumors of the pancreas belong to the category of Amine Precursor Uptake and Decarboxylation (APUD) tumors (APUDomas). Thus, it is important to examine the serum level of pancreatic endocrine hormones and a variety of peptides to differentiate paragangliomas of the pancreas from other pancreatic tumors. Paragangliomas of the pancreas grow slowly, so radical resection is recommended to achieve curability with a good prognosis.

Humans↗
PubMed1998

Laparoscopic repair of paraesophageal hiatal hernias.

BACKGROUND: Regardless of symptoms, paraesophageal hiatal hernias should be repaired in order to prevent complications. This study reports the University of California San Francisco experience with laparoscopic repair of paraesophageal hiatal hernias, emphasizing the technical steps essential for good results. PATIENTS AND METHODS: From May 1993 to September 1997, 55 patients, 27 women and 28 men, with a mean age of 67 years (range, 35-102 years) underwent laparoscopic repair of paraesophageal hernias at the University of California San Francisco. Symptoms, which had been present an average of 85 months before surgery, consisted mainly of pain (55%), heartburn (52%), dysphagia (45%), and regurgitation (41%). Of the four patients who presented with acute illness, two had gastric obstruction, one had severe dyspnea, and one had gastric bleeding. Endoscopy demonstrated esophagitis in 25 (69%) of 36 patients, and 24-hour pH-monitoring demonstrated acid reflux in 22 (67%) of 33 patients. Manometry detected severely impaired distal esophageal peristalsis in 17 (52%) of 33 patients. The preferred operation consisted of reduction of the hernia, excision of the sack and the gastric fat pad, closure of the enlarged hiatus without mesh, and construction of a fundoplication anchored by sutures within the abdomen. RESULTS: Of the 55 patients, the operations of 49 were completed laparoscopically using the following reconstructions: Guarner (270-degree) fundoplication (30 patients); Nissen fundoplication (10 patients); and gastropexy (9 patients). Five (9%) operations were converted to laparotomies. The average operating time was 219 minutes; the average blood loss was less than 25 mL; resumption of an unrestricted diet, 27 hours; and mean hospital stay, 58 hours. Intraoperative technical complications occurred in five (9%) patients. One patient died during surgery from a sudden pulmonary embolus. Two (4%) patients required a second operation for recurrent paraesophageal hernias. CONCLUSIONS: Laparoscopic repair of paraesophageal hiatal hernias is safe and effective, but the operation is difficult and good results hinge on details of the operative technique and the surgeon's experience. In this series, the crus could always be closed securely without using mesh. We realized early that a fundoplication should be a routine step, because it corrects reflux and is the best method to secure the gastroesophageal junction in the abdomen.

Adult↗
PubMed1998

Functional residual capacity measurement during tracheal gas insufflation.

OBJECTIVE: Tracheal gas insufflation (TGI) is considered an adjunctive method to enhance carbon dioxide elimination during permissive hypercapnia in patients with acute respiratory distress syndrome. Due to increasing tidal volume and/or expiratory resistance, TGI may cause intrinsic PEEP (PEEPi), and may lessen the advantages of permissive hypercapnia. There is no reliable method to measure PEEPi during TGI. Using an argon washout method to evaluate dynamic hyperinflation, we developed a method to measure FRC with TGI flow. METHODS: We measured FRC during TGI by washing out both the ventilator and TGI circuit with 100% oxygen (O2) previously equilibrated with 10% argon and 90% O2. To test the accuracy of our system, we measured the volume in a model lung composed of two flasks. The FRC of the model lung was changed by varying its volume of water, to active 500, 1000, and 1500 mL. The change of FRC (deltaFRC) of the model lung was measured at a flow of 0, 4, 8, and 12 L/min. Then the FRC of a bellows-type model lung was measured at the same TGI flow. PEEPi of the model lung was also recorded as the pressure inside the bellows at end-expiration. RESULTS: Our FRC measurements were accurate within 10% except for that of 500 mL without TGI (12.7%+/-1.1%). As inspiratory time (TI) and/or TGI flow increased, the FRC of the bellows-type model lung increased. PEEPi and deltaFRC showed a positive correlation (r = 0.843, p < 0.001). The higher the TGI flow, the greater was the deltaFRC with both continuous and expiratory-phase TGI. FRC during continuous TGI was higher than during expiratory-phase TGI especially during long TI and high TGI flow. CONCLUSIONS: The system developed in this study can be used as a method to detect air-trapping during TGI.

Functional Residual Capacity↗
PubMed1998

Effects of pressure-support ventilation on recovery from acute diaphragmatic fatigue in rabbits.

OBJECTIVES: To examine the effects of pressure-support ventilation on recovery from acute diaphragmatic fatigue. DESIGN: Prospective laboratory trial. SETTING: Experimental laboratory. SUBJECTS: Twenty-one healthy, adult New Zealand white rabbits. INTERVENTIONS: Diaphragmatic fatigue was induced with 50-Hz phrenic nerve stimulation for 30 mins. Recovery was compared between pressure-support ventilation 0 cm H2O (SB), 10 cm H2O (P10), and 20 cm H2O (P20) for 90 mins immediately after the end of the fatigue inducing procedure. MEASUREMENTS AND MAIN RESULTS: After the fatigue-inducing procedure, pressure-support ventilation reduced transdiaphragmatic pressure and integrated diaphragmatic electromyogram both at P20 and P10, but not in SB. Recovery was assessed by airway occlusion pressure (Poccl) generated by high- (100 Hz) and low- (20 Hz) frequency phrenic nerve stimulation. Poccl at 100 Hz was lower in P10 and P20 than in SB (74.6 +/- 6.2 [SEM] %, 66.9 +/- 3.3%, and 94.8 +/- 3.6% of the baseline at 90 mins for P10, P20, and SB, respectively), while those at 20 Hz showed no differences between the three groups. CONCLUSION: Recovery from acute diaphragmatic fatigue might be disturbed with pressure-support ventilation.

Animals↗
PubMed1998

Circadian secretion patterns of melatonin after major surgery.

Biorhythms, such as regular variation in core body temperature and the pattern of the secretion of melatonin, are thought to be mediated by the same biological clock. Core body temperature is affected by the inflammatory response to major surgery. Apart from the well-known inhibitory effect of bright light on its secretion, melatonin is an exceedingly good marker of one of the central generating systems of circadian rhythms. We sequentially measured the plasma melatonin concentration pattern in patients who had undergone esophagectomy with thoracotomy to elucidate the circadian rhythm after major surgery. From seven patients who had received esophagectomy with thoracotomy for esophageal cancer, plasma concentrations of melatonin were measured using an RIA method. Blood samples were collected via each patient's arterial line at 00.00, 02.00, 04.00, 06.00, 08.00, 12.00, 16.00, 20.00, and 24.00 hr on the first postoperative day for six of the patients, and, for one patient, every 2 hr until the third postoperative day and every 4 hr thereafter until the sixth postoperative day. Four patients out of seven had melatonin concentrations of over 30 pg/ml (mean 34 pg/ml) at 24.00 hr on the first postoperative day. Five patients showed circadian secretion patterns of melatonin during the first postoperative day. One patient whose melatonin concentrations were measured consecutively for 6 days showed a regular circadian secretion pattern through the 6 days of the study. Even the stress caused by extremely invasive surgery did not significantly disturb the melatonin secretion pattern.

Aged↗
PubMed1998

Suppression of natural killer cell activity and interleukin-2 concentration of serum obtained from in vitro fertilization-embryo transfer patients.

PROBLEM: The effect of serum obtained from in vitro fertilization-embryo transfer (IVF-ET) patients on healthy volunteers' natural killer (NK) cell activity was evaluated. We also measured interleukin (IL-2) concentration with IVF-ET patients' serum and clarified the relationship between IL-2 levels and the suppressive effect on NK cell activity. METHOD OF STUDY: A retrospective nonrandomized clinical study was performed. The suppressive effect on NK cell activity and IL-2 concentrations was measured with serum obtained from 30 pregnant and 30 nonpregnant women during an IVF-ET procedure. The suppressive effect of the serum on NK cell activity was evaluated by the formula that we defined in our previous study. RESULTS: The suppression of NK cell activity was significantly higher in the nonpregnant women than in the pregnant women (P < 0.05); however, IL-2 concentration did not differ. There was a positive correlation between the suppression of NK cell activity and IL-2 levels in the pregnant women, but no significant correlation in the nonpregnant women. CONCLUSIONS: These results suggest that the suppression of NK cell activity may be one of the prognostic factors for IVF-ET. In addition, we speculate that an unidentified humoral factor other than IL-2, which could increase NK cell activity, might exist in the serum of the nonpregnant patient.

Adult↗
PubMed1998

Development of pyothorax-associated pleural lymphoma in relation to focal cytokinemic condition and Epstein-Barr virus infection.

We report an initial case of pyothorax-associated pleural lymphoma (PAPL) in which the level of interleukin 6 (IL-6) was remarkably high in the pleural fluid contaminated with tumor cells; at the same time Epstein-Barr virus (EBV)-encoded small RNAs (EBERs) were detected in the lymphoma cells by in situ hybridization. These findings suggest the possibility that EBV-transformed B cells proliferated in the focal cytokinemic condition caused by long-standing chronic inflammation of the pleura and give us a clue to the lymphoma genesis of PAPL.

Aged↗
PubMed1998

Positive end-expiratory pressure improves gas exchange and pulmonary mechanics during partial liquid ventilation.

Partial liquid ventilation (PLV) with perflubron (PFB) has been proposed as an adjunct to the current therapies for the acute respiratory distress syndrome (ARDS). Because PFB has been also referred to as "liquid PEEP," distributing to the most gravity-dependent regions of the lung, less attention has been paid to the amount of applied positive end-expiratory pressure (PEEP). We hypothesized that higher PEEP levels than currently applied are needed to optimize gas exchange, and that the lower inflection point (LIP) of the pressure-volume curve could be used to estimate the amount of PEEP needed when the lung is filled with PFB. Lung injury was induced in 23 sheep by repeated lung lavage with warmed saline until the PaO2/FIO2 ratio fell below 150. Five sheep were used to investigate the change of the LIP when the lung was filled with PFB in increments of 5 ml/kg/body weight to a total of 30 ml/kg/body weight. To evaluate the impact of PEEP set at LIP +1 cm H2O we randomized an additional 15 sheep to three groups with different doses (7.5 ml, 15 ml, 30 ml/kg/body weight) of PFB. In random order a PEEP of 5 cm H2O or PEEP at LIP +1 cm H2O was applied. The LIP decreased with incremental filling of PFB to a minimum at 10 ml (p < 0.05). Increasing PEEP from below LIP to LIP +1 cm H2O at 15 and 30 ml/kg resulted in an improvement in PaO2 from 152 +/- 36 to 203 +/- 68 (NS) and 193 +/- 57 to 298 +/- 80 (p < 0.05), respectively. Pulmonary shunt, and ratio of dead space volume to tidal volume (VD/VT) decreased, and static lung compliance increased with PEEP at LIP +1 cm H2O (p < 0.05). No changes were observed in hemodynamics. We conclude that increasing the dose of PFB shifts the LIP to the left, and that setting PEEP at LIP +1 cm H2O improves gas exchange at moderate to high doses of PFB.

Analysis of Variance↗
PubMed1998

Quantitative differentiation of both free 3'-OH and 5'-OH DNA ends between heat-induced apoptosis and necrosis.

Cell death is roughly categorized as either apoptosis or necrosis. For better understanding of the differences in DNA cleavage between them, we performed quantitative analysis of both the 3'-OH and the 5'-OH ends of DNA strand breaks via in situ nick-end labeling (ISEL) combined with transmission electron microscopy (TEM) of both heat-induced apoptosis and necrosis in mouse B-cells derived from a lymphoma cell line. To detect the 5'-OH ends, the 3'-P ends located on the opposite side holding the 5'-OH ends were dephosphorylated into 3'-OH ends with alkaline phosphatase. As assessed by statistical analysis of both the 3'-OH and the 5'-OH ends, their labeling densities were significantly higher in both the apoptotic and the necrotic cells in the early stage than in control cells. The labeling densities increased during the apoptotic and necrotic processes, except for a decrease in the density of the 3'-OH ends in necrotic cells in the late stages. Therefore, DNA degradation in both necrosis and apoptosis provides early evidence for these processes, and both apoptosis and necrosis may share at least the first steps of DNA degradation pathways.

Animals↗
PubMed1998

High frequency oscillatory ventilation attenuates the activation of alveolar macrophages and neutrophils in lung injury.

BACKGROUND: Recent investigations have shown that leukocyte activation is involved in the pathogenesis of ventilator-associated lung injury. This study was designed to investigate whether the inflammatory responses and deterioration of oxygenation in ventilator-associated lung injury are attenuated by high-frequency oscillatory ventilation (HFO). We analyzed the effects of HFO compared with conventional mechanical ventilation (CMV) on the activation of pulmonary macrophages and neutrophils in 10 female rabbits. RESULTS: After surfactant depletion, the rabbits were ventilated by CMV or HFO at the same mean airway pressure. Surfactant-depletion followed by 4 h mechanical ventilation hindered pulmonary oxygenation in both groups. Impairment of oxygenation was less severe in the HFO group than in the CMV group. In the HFO group the infiltration of granulocytes into alveolar spaces occurred more readily than in the CMV group. Compared with CMV, HFO resulted in greater attenuation of beta2-integrin expression, not only on granulocytes, but also on macrophages. CONCLUSIONS: In the surfactant-depleted lung, the activation of leukocytes was attenuated by HFO. Reduced inflammatory response correlated with decreased impairment of oxygenation. HFO may reduce lung injury via the attenuation of pulmonary inflammation.

Journal Article↗
PubMed1998

Cloning, sequencing, and expression of an endoglucanase gene from the rumen anaerobic fungus Neocallimastix frontalis MCH3.

A cDNA clone encoding an endo-1,4-beta-glucanase from a rumen fungus, Neocallimastix frontalis MCH3, was isolated. The nucleotide sequence showed that the gene, celA, encoded a multidomain enzyme containing a family 5 catalytic domain and a reiterated sequence that is involved in the association of a multienzyme complex, the cellulosome. The enzyme expressed in Escherichia coli showed the highest activity against carboxymethylcellulose at 40 degrees C and pH 8.5.

Amino Acid Sequence↗
PubMed1998

Delivery of inhaled nitric oxide using the Ohmeda INOvent Delivery System.

OBJECTIVES: We evaluated the Ohmeda INOvent Nitric Oxide Delivery System, which uses an inspiratory flow sensor to inject a synchronized and proportional nitric oxide (NO) flow into the mechanical ventilator circuit. This system should deliver a constant NO concentration independent of ventilator mode, minute ventilation, fraction of inspired oxygen, or ventilator brand. It should also minimize nitrogen dioxide (NO2) formation. METHODS: NO delivery by the INOvent and a premixing NO delivery system were compared using two ventilators (Puritan-Bennett 7200 and Servo 900C). NO concentration was measured within the trachea of an attached lung model using a fast-response chemiluminescence NO analyzer. NO concentration was also measured in the inspiratory limb using the electrochemical analyzer of the INOvent. For three NO concentrations (2, 5, and 20 ppm), the ventilators were set for constant flow volume control ventilation, pressure control ventilation, and spontaneous breathing with pressure support ventilation or synchronized intermittent mandatory ventilation. Different tidal volumes (300, 500, 750, and 1,000 mL) and inspiratory times (1 and 2 s) were evaluated. NO2 formation for both ventilators and delivery systems were evaluated at 20 ppm and 95% O2-. RESULTS: Regardless of ventilatory pattern, both systems delivered a constant NO concentration. The error between the target and the delivered NO dose for the INOvent was -1.3+/-3.6% with the Puritan-Bennett 7200 and -3.9+/-4.3% with the Servo 900C. For the premixing system, the error was -5.5+/-4.8% with the Puritan-Bennett 7200 and -6.7+/-6.2% with the Servo 900C. NO2 concentrations were 0.5+/-0.1 ppm during NO delivery by the INOvent, 5.8+/-1.6 ppm when NO was premixed with air, 0.3+/-0.1 ppm when NO was premixed with N2. CONCLUSION: The INOvent provides a constant NO concentration independent of the ventilatory pattern, and NO2 formation is minimal.

Administration, Inhalation↗
PubMed1998

Lipoteichoic acid as an inducer of acute uveitis in the rat.

PURPOSE: To examine the capacity of lipoteichoic acid (LTA) to induce intraocular inflammation in the rat. METHODS: LTA obtained from Staphylococcus aureus and three different streptococcal species were suspended in saline solution in various concentrations and were injected into one footpad of female Lewis rats. The uveitic changes were assessed by conventional clinical and histopathologic procedures, whereas the intensity of inflammation in the anterior chamber (AC) was evaluated by the measurement of protein concentration and cell density in the aqueous humor (AH). RESULTS: LTA from S. aureus induced a strong intraocular inflammation between 24 and 30 hours after injection. The inflammatory reaction was observed in a dose-dependent manner. At a dose of 15 mg/kg LTA, the protein concentration and cell counts in the AH were 5.6 +/- 0.5 mg/ml and 4075 +/- 1193 cells/microl, respectively. When LTAs of streptococcal origin were used, cells were undetected in the AH and protein concentration increased only two- or threefold compared with the control group. In pathologic examination, inflammatory cells were found in the AC and posterior chamber only after the injection of S. aureus LTA. In systemic evaluations of the liver, kidney, spleen, heart, lung, gut, brain, joint, and eye performed 6, 24, and 48 hours after the challenge, inflammatory lesions were found only in the eye. CONCLUSIONS: LTA, especially of S. aureus origin, induces anterior uveitis in the rat. This model may be useful for investigation of Gram-positive bacterial infection and uveitis.

Acute Disease↗