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Biomedical subjects

Y Hino

Publications and source records attributed to Y Hino.

At least 55 records · Page 3Linked to original sources

Requirement for activation of the serine-threonine kinase Akt (protein kinase B) in insulin stimulation of protein synthesis but not of glucose transport.

A wide variety of biological activities including the major metabolic actions of insulin is regulated by phosphatidylinositol (PI) 3-kinase. However, the downstream effectors of the various signaling pathways that emanate from PI 3-kinase remain unclear. Akt (protein kinase B), a serine-threonine kinase with a pleckstrin homology domain, is thought to be one such downstream effector. A mutant Akt (Akt-AA) in which the phosphorylation sites (Thr308 and Ser473) targeted by growth factors are replaced by alanine has now been shown to lack protein kinase activity and, when overexpressed in CHO cells or 3T3-L1 adipocytes with the use of an adenovirus vector, to inhibit insulin-induced activation of endogenous Akt. Akt-AA thus acts in a dominant negative manner in intact cells. Insulin-stimulated protein synthesis, which is sensitive to wortmannin, a pharmacological inhibitor of PI 3-kinase, was abolished by overexpression of Akt-AA without an effect on amino acid transport into the cells, suggesting that Akt is required for insulin-stimulated protein synthesis. Insulin activation of p70 S6 kinase was inhibited by approximately 75% in CHO cells and approximately 30% in 3T3-L1 adipocytes, whereas insulin-induced activation of endogenous Akt was inhibited by 80 to 95%, by expression of Akt-AA. Thus, Akt activity appears to be required, at least in part, for insulin stimulation of p70 S6 kinase. However, insulin-stimulated glucose uptake in both CHO cells and 3T3-L1 adipocytes was not affected by overexpression of Akt-AA, suggesting that Akt is not required for this effect of insulin. These data indicate that Akt acts as a downstream effector in some, but not all, of the signaling pathways downstream of PI 3-kinase.

3T3 Cells↗

Successful treatment of anomalous origin of the left coronary artery from the pulmonary artery in a 5-week-old male infant.

A 5-week-old male infant who was referred to our hospital because of tachypnea and poor feeding. An electrocardiogram showed a deep Q wave in lead aVL, negative T waves in leads I, II, III, aVF and V6 and a positive T wave in VL. Echocardiography revealed severely impaired left ventricular function. Aortography confirmed with a diagnosis of anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA). Takeuchi's procedure was performed and the patient maintained postoperatively on assisted circulation for 7 hours even though sternal closure delayed until 7 days post operatively. His left ventricular function showed and marked improvement gradually.

Assisted Circulation↗

[Medical behavior after colo-rectal cancer screening--comparison with that after stomach cancer screening].

Medical behavior for intensive examination after colo-rectal cancer screening was examined in comparison with that after stomach cancer screening. Examinees who were positive in colo-rectal or stomach cancer screening, provided by an Occupational Health Organization from April 1993 to March 1994, were monitored for their medical behavior through notifications from physicians. The main results were as follows: 1. The proportion of those with the notification from a physician after colo-rectal cancer screening was half of that after stomach cancer screening. 2. Among those notified the rate of those who undertook intensive examination by the end of 12 weeks after the screening was 79.7% for a colo-rectal site and 87.0% for the stomach. The time interval from the screening to the intensive examination for the colo-rectal site was significantly longer than that for stomach. 3. For colo-rectal cancer screening, the proportion of those with the notification was lower in females than in males, and in those aged less than 50 than in those aged 50 or older. There were no differences in the proportion between those screened at the work site and those at the occupational health service center, and between those positive in the fecal occult blood test and those negative in the test but positive in the health interview. These results indicated, assuming that the probability of the physicians' notification was unrelated to the type of examination, a smaller proportion of the examinees positive in the colo-rectal cancer screening consulted a physician for the intensive examination later than those positive in the stomach cancer screening. It is therefore necessary to make colo-rectal cancer screening effective to establish a collaborating system which effectively facilitates the medical behavior of the screening positives.

Adult↗

[Two elderly patients with intestinal perforation caused by press-through package].

We report two cases of intestinal perforation caused by accidental swallowing of Press-Through Packages (PTP). The first case occurred in a 90-year-old woman with moderate dementia. She was admitted to our hospital because of abdominal pain and intestinal obstruction. She showed symptoms and sign of peritonitis and underwent abdominal surgery. The postoperative diagnosis was diffuse peritonitis due to a perforated rectal ulcer caused by the sharp corners of an accidentally swallowed PTP. The second case occurred in an 82-year-old woman with recurrent symptoms and signs of intestinal obstruction. She underwent abdominal surgery and the operation revealed an ileal perforation due to penetration by the sharp edge of a PTP. Both patients were discharged in good condition. PTPs are rapidly becoming popular as packaging for tablets and capsules. However, reports of accidental swallowing of PTPs have recently been increasing. In most cases, the PTPs were found in the esophagus and removed endoscopically. Progression of accidentally swallowed PTPs to the intestines is rare. However, when this occurs, the patient's condition becomes more serious. We propose that drugs should not be dispensed in PTPs but rather handed to the patients, especially to elderly patients, or when impossible, the corners of PTPs should be rounded.

Aged↗

Improvement of bond strength in metal-ceramic systems using a gold intermediate layer.

The mechanism of bonding between metal and ceramic in systems using the functionally graded method with pure gold and gold mixture as a primer was examined. Four types of samples, porcelain, porcelain-gold, porcelain-metal and porcelain-gold-metal were prepared. The gold intermediate layer was fired at 1000 degrees C. For porcelain and metal, low-fusing opaque, body porcelain and palladium alloy were used. The intermediate layer was composed of three layers; pure gold, gold-palladium and gold-porcelain layer. During the bending test of each sample, the porcelain peeled away from the porcelain-metal system, while porcelain with the gold intermediate layer remained on the metal surface even after maximal loading. The bond strength of the porcelain-gold-metal system was much higher than that of the porcelain-metal system, and the toughness of the former was much greater than that of the latter. Laser microscopy and scanning electron microscopy (SEM) showed a smooth interface between the intermediate layer and the metal which suggested proper chemical bonding, and no gap was observed. At the interface between the porcelain and the gold intermediate alloy, a good mechanical anchor lock was observed. Electron probe microanalysis (EPMA) showed a clear distribution of each element (e.g. Si, Au and Pd) in the porcelain, gold intermediate layer and metal frame.

Dental Bonding↗

Silent myocardial ischemia in Kawasaki disease: evaluation of percutaneous transluminal coronary angioplasty by dobutamine stress testing.

BACKGROUND: Myocardial ischemia and myocardial infarction are the most serious complications of coronary artery lesions in children with Kawasaki disease (KD). Therefore, early detection and treatment of myocardial ischemia in patients with KD is essential. We studied the effectiveness of percutaneous transluminal coronary angioplasty (PTCA) in patients with silent myocardial ischemia detected by dobutamine stress 99mTc myocardial scintigraphy (TMS), body surface mapping (BMS), and signal-averaged ECG late potentials (ELP). METHODS AND RESULTS: Eight of 76 asymptomatic patients with a coronary stenosis >25% and a positive dobutamine stress test were considered to have silent myocardial ischemia. All eight patients had >95% stenoses demonstrated by coronary angiography (CAG) just before PTCA. After PTCA, CAG showed that all of the coronary artery stenoses had been reduced to <50%. Additionally, intravascular ultrasonography (IVUS) performed in five patients before and after PTCA demonstrated adequate dilation of the coronary stenosis after PTCA. All eight patients underwent dobutamine stress TMS, BMS, and ELP 2 to 3 months after PTCA, which demonstrated no regions of myocardial ischemia. Approximately 6 months later, CAG was performed in all eight patients, and only one patient had developed restenosis. CONCLUSIONS: PTCA effectively dilates stenotic coronary arteries in children with KD. Moreover, dobutamine stress TMS, BMS, and ELP are useful for detecting silent myocardial ischemia and estimating the effectiveness of PTCA. Furthermore, IVUS is useful for evaluating the severity of coronary artery lesions before and after PTCA in patients with KD.

Adolescent↗

[Parkinsonism and postoperative complications in the elderly].

The risk factors for postoperative morbidity and mortality in elderly patients with Parkinsonism after gastrointestinal surgery were evaluated by univariate and multivariate analyses in comparison to those of patients with cerebrovascular disease and to those of patients with no comorbid condition. Data were obtained on 36 patients with Parkinsonism (PK), 77 with cerebrovascular disease (CVD) and 120 with no comorbid condition (ND). All data were adjusted for age, sex and operative procedure. The postoperative morbidity rate was highest in the PK group (77.8%), followed by the CVD group (70.1%), and both differed significantly from the rate of the ND group (32.5%). Gastrointestinal and pulmonary complications and delirium were the major postoperative complications, and were significantly more common in the PK group than in the ND group. Patients in the PK group had the longest postoperative hospital stay, followed by those in the CVD and ND groups; the differences were significant between the PK and ND groups and between CVD and ND groups. The PK group had the highest operative and hospital mortality rates, and they differed significantly from the ND group. Hayashi's second method of quantification was used to assess the risk factors for postoperative death. The highest partial correlation coefficient was that found for postoperative pulmonary complication. We conclude that we should pay close attention to postoperative respiratory management, particularly in elderly patients with Parkinsonism, to prevent pulmonary complications and reduce postoperative mortality.

Aged↗

[Components of decision-making among hemodialysis patients].

UNLABELLED: The purpose of this descriptive study was to identify the components of decision-making among the dialysis patients. Subjects were a Convenience sample of hemodialysis patients who agreed to participate this study. The data was collected through semi-structured interviews was recorded on the tape and transcribed. Decision-making episodes were picked and interpreted by researchers. Data was analysed based on the Grounded Theory Approach. RESULT: Subject were 21 patients from 4 hospitals. The mean age was 51.1 and the mean duration after the hemodialysis was 9.1 years. The number of episode of decision-making were 136. Six components of decision-making were extracted such as . The subject were making decision by examining and judging the situation and oneself, and then setting the goal. They were selecting situation and themselves. After all, the outcomes of decision-making were evaluating. Seven type of decision-making, erection type, reality-oriented type, elaborate type, dogmatic type, passive type, chance type, resistant type were extracted. DISCUSSION: The factors which were related to the quality of decision-making were discussed such as the ability to examine the reality and control own wishes and needs, and the commitment for the decision-making. The nursing approach to facilitate the patients to make the decision were mentioned.

Decision Making↗

[Re-expansion pulmonary edema after emergency thoracotomy for spontaneous hemopneumothorax: a case report].

A 44-year-old man was admitted to out hospital complaining of chest pain and increasing dyspnea. Chest X-ray on admission revealed a collapsed lung and an air fluid line in the left hemothorax. Following blood transfusion because of 2,000 ml hemorrhagic pleural fluid, emergent surgery was carried out. At operation, a bleeding artery originating from the apex of the thoracic cavity and a bulla on the upper lobe were noticed. After extubation of endotracheal tube, he offered severe dyspnea with hypoxia. The chest X-ray showed figure of pulmonary edema in the left lower lobe. Patient was managed by oxygen, steroid, and urinastatin. On the 3rd operative day, pulmonary edema was disappeared. It should be kept in the mind that the re-expansion pulmonary edema occurred in patients with spontaneous hemopneumothorax of less than 3 days of duration.

Adult↗

Evaluation of myocardial ischemia and infarction by signal-averaged electrocardiographic late potentials in children with Kawasaki disease.

We investigated myocardial ischemia and old myocardial infarction noninvasively using signal-averaged electrocardiographic late potentials (LPs) in patients with Kawasaki disease. Patients were divided into 4 groups: a noncoronary artery lesion group (n=136), a coronary artery lesion group (without myocardial ischemia and an old myocardial infarction; n=33), an ischemia group (n=16), and an old myocardial infarction group (n=13). Grouping was based on exercise thallium-201 myocardial scintigraphy, thallium-201 myocardial scintigraphy, exercise electrocardiography, coronary angiography, left ventriculography, and echocardiography. Signal-averaged electrocardiograms were recorded using a high-resolution system. Values of filtered QRS duration (f-QRSd), root-mean-square voltage, and duration of low-amplitude signal were judged using our own body surface area-related criteria (n=205) to determine positive rates of LPs and sensitivities and specificities to ischemia and infarction. These data were also interpreted using published criteria for adults and compared with those interpreted by our criteria. Positive rates by our criteria were 0% in the noncoronary artery lesion group, 9.1% in the coronary lesion group, 56.3% in the ischemia group, and 69.2% in the old myocardial infarction group. However, using the criteria for adults, these values were 0%, 3.0%, 25%, and 46.2%, respectively. Sensitivities to ischemia and infarction using our criteria were significantly higher (56.3% and 69.2%) than those using the criteria for adults (p < 0.05). Moreover, specificities to ischemia and infarction were very high (93.4% and 93.5%, respectively) using our criteria, and there were no significant differences from specificities using the criteria for adults. Also, we examined the reproducibility of values of LPs and LP parameters. The values of filtered QRS duration showed a high reproducibility in both LP-positive and -negative groups, followed by low-amplitude signal and then root-mean-square voltage. The results of LP presence or absence showed 100% reproducibility for both the LP-positive and -negative groups, supporting the utility of LPs for clinical applications. Thus, LPs provide useful information in a noninvasive manner for clarifying ischemia and infarction in patients with Kawasaki disease.

Action Potentials↗

[A report of leiomyosarcoma of the esophagus].

Leiomyosarcoma of the esophagus is an uncommon disease of which only 97 cases including the present case have been reported in Japan. We report a case of the tumor which showed multiple hematogenous metastases after surgery. A 73-year-old male was admitted complaining of dysphagia and vomiting. Esophagography and endoscopy revealed a large protruding lesion in the lower esophagus. CT scanning revealed threefold-sized extramural mass. Boring biopsies failed to yield evidence of malignancy. However, we performed surgical treatment because of the uncommon size for a benign tumor. The excised tumor was 11 x 9 x 5 cm in size and was diagnosed histologically as leiomyosarcoma of the esophagus without any nodular involvement. Metastatic tumor in the right rib was found 14 months after the operation. Radiotherapy failed to decrease tumor size but eliminated pain. Bone metastases appeared successively and the patient died 3 years and 4 months after operation. Chemotherapy had no effect. Autopsy revealed metastases to the ribs, vertebrae, sternum, pelvic kidneys and diaphragm, but no local recurrence. There is a great need for the development of effective anti-cancer drugs for leiomyosarcomas, particularly in cases with extensive metastasis, such as presented here.

Adult↗

[Gastric cancer in the elderly].

Gastric cancer in the elderly was evaluated with regard to age-related pathomorphological changes. Resected gastric cancer was studied with regard to location, stage, morphology and histology in male young old (65-74 years old) which were 25 cases and 31 lesions, respectively male middle old (75-84 years old); 104 cases and 120 lesions, male very old (85 years-); 96 cases and 110 lesions, female young old; 22 cases and 31 lesions, female middle old; 91 cases and 106 lesions, female very old; 51 cases and 55 lesions. Multiple gastric cancers were more frequent in female older group. In early cancer the frequency of elevated type increased significantly and that of depressed type decreased in very old group. In advanced cancer Borrmann I type was not so common in very old group. Histologically the frequency of signet ring cell cancer decreased and of tubular adenocarcinoma and of papillary adenocarcinoma increased significantly in female very old group. Hepatic metastasis increased significantly in male very old group. Lymph node metastasis and peritoneal metastasis did not show any change in age-related frequency.

Age Factors↗

[Risk factors of operative death and prognosis following operations for esophageal cancer in the elderly].

Risk factors of operative death and prognosis in the elderly following operations for esophageal cancer were evaluated by multivariate analyses. Data were obtained from 45 operations over a 14-year period in patients of a mean age of 72.6 +/- 6.3 years. Using a multiple logistic model analysis, it was determined that the significant risk factor of death within 50 postoperative days was postoperative pulmonary complication. No other factors were significant as risk factors with regard to survival. Cox's proportional hazards model analysis was used to assess the prognostic factors of long-term survival following operations. Independent predictors were the stage of cancer and age. We conclude that two points are essential to improve the survival rate of elderly patients with esophageal cancer; first, postoperative special attention in order to prevent pulmonary complications and secondly, performing operations at as early a stage of cancer as possible.

Aged↗

[Experiences of the approaches to heart for a patient with a tracheostoma].

The performance of open heart surgery in a patient with a tracheostoma can present difficult problems, including postoperative mediastinitis and inadequate operative exposure. Recently, we experienced two cases in which tracheostomy had been done preoperatively due to heart failure and reported the satisfactory results in this paper. Case 1; A 59-year-old woman who had mitral stenosis and massive regurgitation received mitral valve replacement and left atrial raphy. The approach to heart was performed in according to the following. A transverse submammary skin incision was made from right anterior axillar line to left mammary line and then a bilateral thoracotomy was made at the fourth intercostal space. Case 2; A 73-year-old man who had old myocardial infarction and postinfarction angina received coronary artery bypassgrafting to right coronary artery and left anterior descending branch, using saphenous vein grafts. A skin incision was placed at the second intercostal space in the fashion of "collar skin incision" and then made from the center of collar skin incision to the xiphoid process. The sternum was transected at the second intercostal space and divided longitudinally to the xiphoid process. These two approaches provided the adequate operative field. The cannulation of the ascending aorta, the superior vena cava and the inferior vena cava presented no difficulty and the operative procedure could be performed easily in a routine manner. We think that in a case of open heart surgery of a patient with a tracheostoma the approach in which the skin incision is distant from the area of a tracheostoma and no dissection near a tracheostoma is necessary have to be selected in order to decrease the risk of postoperative wound infection and mediastinitis.

Aged↗

Preferential heme transport through endoplasmic reticulum associated with mitochondria in rat liver.

The transport of de novo synthesized protoheme into the conventional microsomal fraction and endoplasmic reticulum associated with mitochondria (MAER) was studied by injecting amino[14C]levulinic acid (ALA) into phenobarbital-treated rats to evaluate the role of MAER in the trafficking of heme between mitochondria and endoplasmic reticulum. In mitochondria, the specific radioactivity of the radiolabeled heme reached a maximum level at 4 min after the injection of 14C-ALA. The specific radioactivity in cytosol was about 2-fold lower than that in microsomes, suggesting that the cytosolic pathway of the heme transport from mitochondria to endoplasmic reticulum is not predominant, because the specific radioactivity of heme in cytosol should be higher than that in microsomes if heme is transported mainly through cytosol. MAER showed higher specific radioactivity than the conventional microsomal fraction up to 4 min and thereafter the specific radioactivities in MAER and the conventional microsomal fraction became nearly the same. The extents of decrease in cytochrome P-450 and the radioactivity in microsomes by the treatment with allylisopropylacetamide which destroyed cytochrome P-450 but not cytochrome b5, were essentially the same, suggesting that most of the radiolabeled heme in microsomes was incorporated into cytochrome P-450. These results suggest that MAER is a preferential site for the protoheme transport from mitochondria to endoplasmic reticulum.

Animals↗

Cerebellar hemorrhage complicating cervical durotomy and revision C1-C2 fusion.

STUDY DESIGN: A case of cerebellar hemorrhage complicating cervical durotomy and revision C1-C2 fusion is reported. There has been only one report on cerebellar hemorrhage after cervical durotomy. SUMMARY OF BACKGROUND DATA: The patient became comatose approximately 16 hours after surgery. According to a review of the recovery room records, the patient's cerebellar hemorrhage probably occurred some time within the first 10 hours after the procedure and not during the operation. METHODS: The authors reviewed reports on complicated cerebellar hemorrhage, and the causative factors were studied. CONCLUSION: Postoperative drainage of cerebrospinal fluid, especially when negative pressure is applied, may play a role in the occurrence of cerebellar hemorrhage.

Aged↗

Hypertrophic spinal pachymeningitis.

A patient with idiopathic hypertrophic spinal pachymeningitis (HSP) with predominant involvement of the cervical and thoracic dura is reported. Serial magnetic resonance (MR) images detected isolated thickening and ridges of the dura mater. There has been no report describing the serial changes of MR images in idiopathic HSP. According to a review of the English and Japanese literature on idiopathic HSP, the prognosis of patients with positive inflammatory signs is worse than that of those with no inflammatory signs. Idiopathic HSP is a rarely reported disease that can resemble other disorders associated with dural compression. MR imaging can help to differentiate it from other disorders, and enables the diagnosis of the disease in its early stage. The prognosis of idiopathic HSP with positive inflammatory signs may be worse; the authors stress the significance of early surgical treatment.

Dura Mater↗

Neurogenic bladder in Hunter's syndrome.

We encountered a rare patient with Hunter's syndrome who exhibited urinary retention as a result of a neurogenic bladder, uninhibited detrusor contractions, and detrusor-sphincter dyssynergia. Neurological findings were consistent with cervical myelopathy and cervical MR imaging showed very narrow segments at the cord level C2-4. We speculate that this Hunter's syndrome patient has cervical myelopathy and that this neurological dysfunction causes the neurogenic bladder.

Adult↗