Biomedical subjects

Y Maeda

Publications and source records attributed to Y Maeda.

At least 289 records · Page 16Linked to original sources

PubMed1999

Surgical treatment of internal carotid artery anterior wall aneurysm with extravasation during angiography--case report.

A 54-year-old female presented subarachnoid hemorrhage from an aneurysm arising from the anterior (dorsal) wall of the internal carotid artery (ICA). During four-vessel angiography, an extravasated saccular pooling of contrast medium emerged in the suprasellar area unrelated to any arterial branch. The saccular pooling was visualized in the arterial phase and cleared in the venophase during every contrast medium injection. We suspected that the extravasated pooling was surrounded by hard clot but communicated with the artery. Direct surgery was performed but major premature bleeding occurred during the microsurgical procedure. After temporary clipping, an opening of the anterior (dorsal) wall of the ICA was found without apparent aneurysm wall. The vessel wall was sutured with nylon thread. The total occlusion time of the ICA was about 50 minutes. Follow-up angiography demonstrated good patency of the ICA. About 2 years after the operation, the patient was able to walk with a stick and to communicate freely through speech, although left hemiparesis and left homonymous hemianopsia persisted. The outcome suggests our treatment strategy was not optimal, but suture of the ICA wall is one of the therapeutic choices when premature rupture occurs in the operation.

Aneurysm, Ruptured↗

PubMed1999

[Leucovorin and 5-FU for advanced gastrointestinal cancer].

During the last 40 years, 5-fluorouracil 5-FU) has been the drug of choice for treatment of patients with gastrointestinal cancer. However, its effectiveness is far from satisfactory. It has been determined that leucovorin (LV) potentiates the cytotoxic effect of 5-FU through prolonged inhibition of thymidylate synthase. A series of 10 trials comparing LV.5-FU with 5-FU alone were reported. A significantly higher objective response rate was seen with LV.5-FU, but there was no increase in survival. In randomized trials comparing low-dose and high-dose LV as modulates of 5-FU in treating advanced colorectal cancer, high doses of LV presented no advantage over low doses. Adjuvant LV.5-FU was compared to surgery alone in large group trials, demonstrated and a statistically significant decrease in disease and increase in overall survival. These data suggest that LV.5-FU is a very effective combination and most clinicians worldwide now regard it as the standard therapy for colorectal cancer.

Antineoplastic Combined Chemotherapy Protocols↗

PubMed1999

Size of lipid microdroplets effects results of hepatic arterial chemotherapy with an anticancer agent in water-in-oil-in-water emulsion to hepatocellular carcinoma.

We have initially prepared a new drug delivery system for hepatocellular carcinoma (HCC). Using sonication and a detergent, iodinated poppy seed oil (IPSO) can be mixed with an aqueous solution of epirubicin to make a water-in-oil emulsion. The water-in-oil emulsion is further passed through a microporous glass membrane and split into saline to make a long-term inseparable water-in-oil-in-water emulsion (W/O/W) that consists of IPSO microdroplets. To investigate the effect of the size of IPSO microdroplets on the efficacy of injection chemotherapy with W/O/W in patients with HCC, 32 HCC patients were randomly assigned and treated with W/O/W of small IPSO microdroplets (30 micrometers in diameter) containing 60 mg of epirubicin (n = 16, group A) or W/O/W of large IPSO microdroplets (70 micrometers) containing the same amounts of epirubicin (n = 16, group B). Effects were assessed by measuring the percentage of decline of the alpha-fetoprotein (AFP) level in a week from the AFP level immediately before the treatment. The decline was significantly larger in group B (50.5 +/- 19.8, mean +/- S.D.) compared with group A (18.9 +/- 33.1; p <.005). The size of IPSO microdroplets injected into the hepatic artery determines the decrease of serum AFP levels of the patients with HCC.

Alanine Transaminase↗

PubMed1999

Monitoring of human herpesviruses after allogeneic peripheral blood stem cell transplantation and bone marrow transplantation.

Herpesviruses frequently cause serious complications after allogeneic bone marrow transplantation (allo-BMT). Recent studies have shown more rapid immune reconstitution after allogeneic peripheral blood stem cell transplantation (allo-PBSCT) compared with allo-BMT. However, it has not been clarified whether the improved immune reconstitution after allo-PBSCT is associated with a lower incidence of herpesvirus infections. We monitored the emergence of Epstein-Barr virus (EBV), cytomegalovirus (CMV), human herpesvirus 6 (HHV-6) and HHV-7 DNA by a nested-double polymerase chain reaction in peripheral blood leucocytes from 22 allo-BMT and 16 allo-PBSCT patients. Each virus had an unique temporal profile of detection. HHV-6 DNA was detected most frequently at 3 weeks after transplantation, whereas CMV and EBV DNA were detected later (2-3 months). Detection rates of HHV-6 DNA at 3 and 4 weeks after allo-BMT were significantly higher than those after allo-PBSCT (9/16 v 2/13 at 3 weeks, P < 0.01; 10/21 v 1/15 at 4 weeks, P < 0.01). Detection rates of the other three herpesviruses after the two types of allogeneic transplantation were not significantly different throughout observation period. Furthermore, detection of HHV-6 DNA within the first 4 weeks was associated with delayed platelet engraftment after both allo-BMT and allo-PBSCT (P < 0.01). These results suggest an advantage for allo-PBSCT over allo-BMT in terms of suppression of HHV-6 reactivation and prevention of subsequent complications.

Adolescent↗

PubMed1999

[Two cases of giant testicular tumor with widespread extension to the spermatic cord: usefulness of upfront chemotherapy].

The first case was a 55-year-old man with biopsy-proven seminoma of the left inguinal undescended testis. The tumor, 10 x 9 x 9 cm in size, with a calculated weight of 520 g invaded the left spermatic cord up to the level of the renal hilum and metastasized to the retroperitoneal lymph nodes (13 x 10 cm). The serum level of lactate dehydrogenase (LDH) and beta human chorionic gonadotropin (beta-hCG) was 3,669 U/l and 1.3 ng/ml, respectively. The second case was a 38-year-old man with non-seminoma of the left testis. The testicular tumor, 32 x 28 x 28 cm in size, with a calculated weight of 7,000 g invaded the left spermatic cord up to the level of the aortic-bifurcation and metastasized to the retroperitoneal and the left supraclavicular lymph nodes. The serum level of LDH, alphafetoprotein (AFP) and beta-hCG was 2,040 U/l, 240 ng/ml and 5.6 ng/ml, respectively. Both patients were initially treated with VIP chemotherapy (etoposide, ifomide and cis-platinum), 4 cycles for the 1st case and 3 for the 2nd, and followed by high orchiectomy and retroperitoneal lymph node dissection. Histologic section of all resected specimens revealed only necrosis and fibrosis. The patients have been free of recurrence for 15 and 13 months, respectively, after the operation. In the Japanese literature, 42 cases of giant testicular tumor (> 400 g) including these two cases have been reported. To our knowledge, our second case is the largest among the non-seminomatous tumors. For giant testicular tumor with extensive invasion to the spermatic cord, initial chemotherapy followed by surgical resection appears to be a better management.

Adult↗

PubMed1999

[Annual change of the pet in allergic patients home for ten years].

There are only few paper in Japan which reports the prevalence of pet keepers in the allergic population and also of the type of pets they keep. We made investigation on these points in 1337 allergic patients employing a questionnaire. Among 1337 patients, allergic conjunctivitis patients were found in 67, eczema patients in 118, allergic rhinitis patients in 368 and bronchial asthmatic patients in 1043. These number contained those who overlapped in symptoms. Approximately 43% of allergy patients are currently keeping the pet at present while 11.2% of the patient had kept the pet in the past. There were two peaks in the age when they began to keep a pet, 6 to 12 and 30 to 40 years of age. Trend in the past decade showed that both the dog and cat bred in foreign countries were increasing. About 80% of patients who own the foreign bred dogs keep them indoor. This ratio is increasing gradually. Another conspicuous change is the sharp increase in those who keep hamsters which occupied 20% of all the pet keeper in 1997. Percentages of the patient who recognizes the aggravation of their symptoms in eye, nose, skin and also as asthma often pet keeping is a about 10%. One out of 4 patients who keep the pet has a family member with rhinitis and/or asthma. We concluded that too many of the allergic patients keep the pet against their benefit and they must be informed that the pet could be the cause of allergy symptoms.

Adult↗

PubMed1999

[Progress in the treatment of colorectal cancer].

The chemotherapeutic management of advanced colorectal cancer has been a challenge to oncologists for the last 30 years, with 5-fluorouracil (5-FU) being used as the core drug. However, its effectiveness is far from satisfactory, and there has been no evidence of improved survival. Recently, a method of biochemical modulation was used to enhance the effect of 5-FU. In colorectal cancer patients with recurrent or metastatic sites, survival was significantly prolonged for a group receiving LV.5-FU therapy, based on biochemical modulation, compared with a group receiving no chemotherapy (best supportive care). Still more, LV.5-FU therapy was proved to be beneficial for survival when it was used as a postoperative adjuvant. In this way, the most recent chemotherapy for colorectal cancer was proved to be effective.

Antineoplastic Combined Chemotherapy Protocols↗

PubMed1999

[A case of breast cancer with liver metastases responding remarkably to combination therapy of mitoxantrone (MIT), doxifluridine (5'-DFUR) and medroxyprogesterone acetate (MPA)].

A 60-year-old woman with her right breast cancer showing simultaneous and multiple liver metastases was initially treated with CEFT [cyclophosphamide (CPA), epirubicin (epi-ADM), 5-fluorouracil (5-FU), tamoxifen (TAM)]. After one treatment course the primary lesion did not decrease while tumor markers and liver lesion size increased. Therefore, the foul-smelling primary lesion was resected followed by treatment with mitoxantrone (MIT), 10 mg intravenously every 4 weeks as well as daily/oral administrations of doxifluridine (5'-DFUR) and medroxyprogester-one acetate (MPA). Following MIT administration, the tumor markers decreased markedly, so treatment was continued. After the third course, therapy was continued on an outpatient basis. During treatment WBC reduction to about 3,000/microliter was the only adverse reaction. After 10 courses, the tumor markers were normal, and after 15 courses there were no liver metastases on abdominal CT. Generally, patients with resistance to standard anthracycline chemotherapy are difficult to treat. Those with liver metastasis especially have a poor response which results in a poor prognosis. However, therapy with MIT, 5'-DFUR and MPA may be useful in previously treated, advanced and recurrent breast cancer. Furthermore, this therapy can be done on an outpatient basis, which presumably improves the quality of life (QOL).

Administration, Oral↗

PubMed1999

[Polymyositis and cutaneous vasculitis in a patient with myelodysplastic syndrome].

We report a 60-year-old man with myelodysplastic syndrome (MDS) who developed polymyositis and cutaneous vasculitis. He noticed difficulty in climbing up stairs 4 months before admission. On admission, he showed brownish skin pigmentation in the distal positions of the four extremities. Neurological examination revealed muscle weakness of the neck flexor and proximal muscles of four extremities. Serum myogenic enzymes including creatine kinase increased, and electromyography showed denervation potentials and MUPs were myogenic, which was compatible with polymyositis. Muscle biopsy indicated perivascular mononuclear cell infiltration and muscle fiber necrosis with cytoplasmic bodies and rimmed vacuoles in the muscle fibers. Complete blood cell counts revealed macrocytic normochromic anemia and bone marrow puncture disclosed marked hyperplasia of megakaryocytes, erythroblasts and myeloblasts, suggesting a refractory anemia type of MDS. In addition, skin biopsy showed chronic cutaneous vasculitis. Serum protein electrophoresis and immunoelectrophoresis revealed the presence of IgM gamma type monoclonal gammopathy. With immunosuppressive therapy, serum creatine kinase level was decreased. Since immunological abnormalities and the presence of autoimmune diseases have been reported in patients with MDS, both polymyositis and chronic cutaneous vasculitis in the present patient may be caused by the similar autoimmune mechanisms related to MDS.

Autoimmune Diseases↗

PubMed1999

Expression of cholesterol 7alpha-hydroxylase and delta(4)-3-ketosteroid 5beta-reductase genes in rat pancreatic hepatocyte-like cells.

Hepatocyte-like cells have been observed in the pancreas of the rat. We examined the bile acid biosynthetic function of these cells to determine whether they were real hepatocytes. This study investigated the existence of two liver-specific enzymes involved in bile acid biosynthesis (cholesterol 7alpha-hydroxylase and delta(4)-3-ketosteroid 5beta-reductase) in the hepatocyte-like cells. We could demonstrate cholesterol 7alpha-hydroxylase activity and its circadian rhythm in the hepatocyte-like cells. Northern blot analysis demonstrated the expression of messenger RNA for the 7alpha-hydroxylase and delta(4)-3-ketosteroid 5beta-reductase in the pancreatic hepatocyte-like cells. To measure the amount of the messenger RNA, we used the competitive polymerase chain reaction method for the 7alpha-hydroxylase. This quantitation revealed the existence of a circadian rhythm of cholesterol 7alpha-hydroxylase messenger RNA in the hepatocyte-like cells. These results indicated that bile acid biosynthesis was performed in the pancreatic hepatocyte-like cells as noted as in the liver parenchymal cells.

Animals↗

PubMed1999

Two cases of methotrexate induced lymphomas in rheumatoid arthritis: an association with increased serum IgE.

We describe 2 patients with rheumatoid arthritis (RA) in whom non-Hodgkin's lymphomas developed during low dose pulsed methotrexate (MTX) treatment. The tumors regressed after discontinuation of MTX with no additional treatment. Serum levels of IgE increased concomitantly with the development of lymphoma, and decreased along with the regression of the lymphoma in both patients. These 2 cases and a review of the literature suggest that measuring serum IgE may have a predictive value for monitoring lymphoma in patients with RA treated with MTX.

Aged↗

PubMed1999

[A case with traumatic internal carotid artery dissection in which the extent of the pseudolumen was defined by MR angiography].

We report a 29-year-old male with traumatic internal carotid artery (ICA) dissection who presented with cerebral ischemia developed after removal of a left acute subdural hematoma and external decompression. CT scans 4 days after the operation showed infarctions of the distribution of the bilateral cerebral hemispheres. Cerebral angiography on the 11th hospital day demonstrated narrowing of the extracranial internal carotid artery at C1-C2 vertebral levels. Slight arterial dilatation and retention of the contrast medium were found just above the narrowing segment, which was suspected to be a pseudolumen. Three D time-of flight MRA showed an intramural hematoma corresponding to the narrowing on the angiography. Original axial MRA images showed that narrowing of the lumen was surrounded by a crescent hematoma and that two flow velocity areas were in the area distal to the narrowing. High flow seemed to be ordinary artery flow rate. The low flow area, including turbulent flow, led to the retention of contrast medium mimicking a pseudolumen. Precise MRA imaging will bring us an accurate diagnosis of extracranial carotid dissections.

Adult↗

PubMed1999

[Study of continuous arterial infusion chemotherapy with low-dose cisplatin and 5-fluorouracil for patients with hepatocellular carcinoma].

Seven patients with postoperative recurrence of hepatocellular carcinoma (HCC) and four patients who underwent absolute non curative resection for HCC were treated with continuous arterial infusion of low-dose cisplatin (CDDP) (10 mg/body/day) and 5-fluorouracil (5-FU) (250 mg/body/day). This infusion chemotherapy was continued for five days and discontinued for two days, repeated over four weeks as one course. The response rate in patients with postoperative recurrence was 42.9%, while that in patients who underwent reduction surgery for multiple HCC was 75%. Continuous arterial infusion of low-dose CDDP/5-FU may be effective in patients with multiple small intrahepatic metastases.

Aged↗

PubMed1999

[A case of multiple liver metastases from breast cancer successfully treated with intra-arterial administration of docetaxel].

Docetaxel is an excellent agent with a high antitumor effect for the treatment of advanced/recurrent breast cancer. A 55-year-old female with metastatic liver tumors from breast cancer showed a remarkable response to intra-arterial administration of docetaxel (20 mg/week, or 40 mg/2 weeks). Since CT and MRI imaging revealed multiple metastases in the liver, intra-arterial chemotherapy was selected. No critical side effect was found during this chemotherapy. A CT scan 3 months after chemotherapy showed a partial response. We conclude that this intra-arterial chemotherapy using docetaxel will be safe and useful for liver metastases from breast cancer.

Adenocarcinoma, Scirrhous↗

PubMed1999

[A case of relapsing multiple sclerosis presenting with only autonomic symptoms including orthostatic hypotension, hiccups and vomiting].

A 49-year-old woman, with a two-year-history of multiple screlosis (MS), noticed postural dizziness, intractable hiccups and vomiting. On admission, she had mild quadriparesis, hypesthesia below the C5 level, and a girdle sensation at the T5 and L1 levels. A CSF examination showed slight increases in the protein level (48 mg/dl) and cell count (7/mm3). Brain MRI demonstrated no obvious lesion in the medulla oblongata. The head-up-tilting test showed a decrease in the blood pressure from 105/63 mmHg to 70/55 mmHg. The pulse rate, however, increased from 57/min to 72/min. The cold pressure test also revealed a mild impairement in her blood pressure response. The R-R interval variation (coefficient of variation: CVRR) during normal breathing was 2.58 (normal: > 1.66). The valsalva ratio was 1.84 (normal: 1.4-2.0). The Aschner eye-ball pressure test, the blood pressure response to the injection of epinephrine, and the sweating response to the injection of acetylcholine were all normal. She was thus administered domperidone and chlorpromazine. Only domperidone effectively improved the nausea and vomiting. All symptoms, including orthostatic hypotension, hiccups and vomiting, disappeared about one month after admission. The remission of her symptoms was considered to reflect the natural course of MS. The results of autonomic nervous system function tests and her clinical features suggest that an irritable lesion in the medullary tegmentum, including the nucleus tractus solitarii, most likely caused her symptoms. The above findings indicate that autonomic symptoms, such as orthstatic hypotension, hiccups and vomiting, may sometimes be the only symptoms observed in a relapse of MS.

Autonomic Nervous System Diseases↗

PubMed1999

How to manage patients with hard-to-recognize postnasal drip?

Postnasal drip (PND), commonly regarded as a phenomenon wherein nasal fluid drips into the pharynx, is one of the main symptoms of chronic sinusitis and other nasal lesions. This definition is controversial, however, because some patients have PND with no evidence of fluid either in the oropharynx or around the choanae. Among 220 patients in whom PND was diagnosed at the University of Tokyo Hospital between January 1996 and December 1997, 19 (8.6%) had hard-to-recognize PND on routine examination. Through careful observation, responsible lesions could be identified in all patients with hard-to-recognize PND. Seven patients had latent chronic sinusitis, 5 had nasopharyngeal lesions, such as Tornwaldt's cyst and inflammation, 3 had "old man's PND", 2 had "reflux PND", and 2 had polyps around the sphenoid ostium. Five patients received no treatment. In the other patients, medical therapy, mainly long-term treatment with low doses of macrolides, now regarded as a standard regimen for intractable chronic sinusitis in Japan, was effective in alleviating symptoms regardless of the cause.

Body Fluids↗

PubMed1999

Treatment of cholecystoduodenal fistula by laparoscopy.

We describe a patient with cholecystoduodenal fistula treated by a laparoscopic approach. Use of a flexible videoscope, flexible retractor, and endoscopic transecting stapler allows for laparoscopic treatment of cholecystoenteric fistulae.

Biliary Fistula↗

PubMed1998

Identification of PKD2L, a human PKD2-related gene: tissue-specific expression and mapping to chromosome 10q25.

Mutations in PKD2 cause autosomal dominant kidney disease (ADPKD). Polycystin-2, the PKD2 gene product, is an integral membrane glycoprotein of unknown function. We have identified PKD2L, another member of the PKD2 gene family. PKD2L is expressed in adult heart and skeletal muscle, brain, spleen, testis, and retina, and alternative transcripts of 2.4, 2.7, and 3.0 kb are seen. PKD2L shows 56% identity and 76% similarity with polycystin-2 over a 581-amino-acid span; however, the COOH-terminal 65 residues of PKD2L are unrelated to PKD2. PKD2L is localized to chromosome 10q25 and is excluded as a candidate gene for autosomal recessive polycystic kidney disease, autosomal dominant polycystic liver disease, and the third form of ADPKD. Given the high degree of homology between PKD2L and PKD2, it is likely that the respective functions of these proteins are also closely related.

Amino Acid Sequence↗