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Biomedical subjects

Y Yamazaki

Publications and source records attributed to Y Yamazaki.

At least 289 records · Page 16Linked to original sources
PubMed1997

Effects of Helicobacter pylori eradication therapy on hyperammonaemia in patients with liver cirrhosis.

BACKGROUND AND AIMS: Helicobacter pylori has strong urease activity. Ammonia produced by H pylori in the stomach can be a source of systemic ammonia in patients with hepatic dysfunction. The effect of the eradication of H pylori on hyperammonaemia was examined in patients with liver cirrhosis. SUBJECTS AND METHODS: Ammonia concentrations in blood and gastric juice were analysed in 50 patients with liver cirrhosis and hyperammonaemia. All patients were first treated with a low protein diet, kanamycin, lactulose, and branched chain enriched amino acid solution. Hyperammonaemia remained in 18 patients. These 18 patients were divided into three groups according to the status of H pylori infection; those with a diffuse distribution of H pylori in the stomach (group I), those with a regional distribution (group II), and those without H pylori (group III). These patients were given 30 mg iansoprazole, 1000 mg amoxicillin, and 400 mg clarithromycin or 500 mg metronidazole for two weeks to eradicate H pylori. RESULTS: In group I ammonia concentrations in blood and gastric juice were significantly reduced after H pylori eradication. The blood ammonia concentration at 12 weeks after the eradication was still significantly lower than that before eradication. In groups II and III the ammonia concentrations in blood and gastric juice were not significantly reduced after eradication therapy. CONCLUSIONS: The diffuse distribution of H-pylori in the stomach contributes partly to hyperammonaemia in patients with liver cirrhosis, and the eradication of H pylori is effective in patients with hyperammonaemia with diffuse H pylori infection in the stomach.

Adult↗
PubMed1997

Pradimicin, a mannose-binding antibiotic, induced carbohydrate-mediated apoptosis in U937 cells.

Pradimicin (PRM), a mannose-binding antifungal antibiotic, recognizes a D-mannoside in the presence of calcium. We demonstrated that BMY-28864, a semi-synthetic analog of PRM, induced apoptosis in U937 cells which had been incubated with 1-deoxymannojirimycin (DMJ). Characteristic morphological changes such as formation of apoptotic bodies and DNA fragmentation were observed in apoptotic cells.

1-Deoxynojirimycin↗
PubMed1997

A case of nonpenetrating traumatic aortic regurgitation detected by transesophageal echocardiography.

A 67-year-old man, who had fell 5 meters, landing on his back, one month before, was referred because of heart failure due to aortic regurgitation (AR). Transesophageal echocardiogram (TEE) confirmed injuries in the aortic valve and the Valsalva sinus of the aorta before the surgery: the intimal flap in the Valsalva sinus of right coronary cusp (RCC), the prolapse of the RCC, and the dissection by longitudinal length of 3 cm in the Valsalva sinus of noncoronary cusp (NCC), ending as a blind pouch. Postoperative TEE confirmed the dissection was not repaired in the Valsalva sinus of the NCC. In this instance, TEE was extremely useful, compared with transthoracic echocardiography, computed tomography and magnetic resonance imaging, to assess the mechanism of AR following a nonpenetrating trauma, and to know to what degree the aortic valve and the Valsalva sinus of the aorta were destroyed.

Aged↗
PubMed1997

Diffuse pulmonary amyloidosis with monoclonal IgG-kappa gammopathy.

A 62-year-old female with diffuse pulmonary amyloidosis developed abnormal radiographic findings while under observation for hyperimmunoglobulinemia over a ten-year period. Serum immunoglobulin G (IgG) was elevated (4,620 mg/dl), and associated with monoclonal gammopathy (M protein) of the kappa type, but no evident abnormalities were apparent in bone marrow. Chest radiograph and computed tomography showed a diffuse reticulonodular shadow in the bilateral lung. Thoracoscopic lung biopsy specimen revealed depositions of amyloid in the bronchus and pulmonary vessel. We emphasize that diffuse pulmonary amyloidosis should be considered a possible diagnosis in the presence of monoclonal immunoglobulin.

Amyloidosis↗
PubMed1997

Changes in regional cortical temperature and cerebral blood flow after cortical spreading depression.

Regional cerebral blood flow (rCBF) measurement by laser Doppler flowmetry and cortical temperature measurement using thermoencephaloscopy (TES) were performed to investigate the relationship between the changes in rCBF and cortical temperature after induced cortical spreading depression (CSD) in rats. TES showed a gradually expanding thermoresponse like an extending circular wave after CSD induced by application of KCl. Similarly, a transient increase in rCBF spread from the site of stimulation with a velocity of propagation of 2.5 mm/min. Simultaneous monitoring of rCBF and cortical temperature showed that the transient increase in rCBF was associated with an initial decrease in cortical temperature, followed by an increase in cortical temperature. We suggest that the cortical temperature is regulated mainly by neurogenic control of the pial microvascular blood supply that is precisely adjusted to the metabolic needs of the cerebral cortex. Non-injured cortex with the fine vascular architecture must be preserved during neurosurgery to allow heat transfer from deep areas of the cortex.

Animals↗
PubMed1997

[Pregnancy after augmentation cystoplasty. A case report].

A 31-year-old woman with a history of spina bifida occulta became pregnant after ileocystoplasty for her neurogenic bladder. During the pregnancy she had frequent episodes of febrile urinary tract infections, and progressive hydronephrosis appeared in the second trimester. At 25 weeks gestation she was complicated by severe pyelonephritis requiring the intervention with the placement of double pigtail ureteral stent. However, long term efficacy of ureteral stent was questionable and this indwelling catheter caused bacteriuria which was not eradicated by intravenous antibiotics. Classical cesarean section was performed at 32 weeks of gestation due to the fear of fetal distress. Neobladder and mesenteric blood supply were adherent to the anterior surface of the uterus. Urinary tract infection is extremely common during pregnancy after enterocystoplasty. The most important point is prophylactic antibiotics throughout the pregnancy. At the time of cesarean section, a reconstructive urological surgeon should be part of the operative team and take great care to avoid injury to the blood supply of cystoplasty.

Adult↗
PubMed1997

[Ascending aortic aneurysms operated through redo median sternotomy under selective cerebral perfusion].

Case 1: A 34-year-old man who had received ventricular septal closure at 4 years old was found to suffer from annuloaortic ectasia with severe aortic regurgitation and giant ascending aortic aneurysm accompanying with dissection. Median sternotomy was performed under selective cerebral perfusion to control bleeding when the aorta was injured. He was successfully replaced the ascending aorta and the aortic valve with the composite graft including an aortic prosthetic valve by modified Piehler's procedure. Case 2: A 44-year-old man received mitral valve replacement and tricuspid annuloplasty due to mitral regurgitation with tricuspid regurgitation. After surgery, he suffered from mediastinitis. Three months later, he was found to have pseudoaneurysm of the ascending aorta. During the sternotomy done under selective cerebral perfusion, the pseudoaneurysm was injured but bleeding was controlled easily. The defect of the aorta was closed successfully using a Dacron patch and covered with the right sternocleidomastoid muscle flap. Sternotomy under selective cerebral perfusion is very useful and safe for such patients as to have risks to injure the aorta or the heart during the sternotomy.

Adult↗
PubMed1997

[The effect of hypothermia on CSD propagation in rats].

In the cortical zone surrounding an ischemic or traumatic focus, CSD is a transient phenomenon involving interstitial ions, blood flow and metabolism and is believed to be completely reversible. However, it may extend to secondary brain injuries because CSD releases excitatory amino acids into the extracellular space. In order to prevent secondary brain injuries, it may be effective to block repeated CSD. This study was designed to determine whether hypothermia can block CSD propagation and whether this study is a potentially useful means for preventing secondary brain injuries. Male wistar rats weighing 270 g on average were used for the experiments. The animals were divided into two groups: hypothermic rats (33.5-34 degrees C, rectal temp.) and normothermic rats (37-37.5 degrees C). The changes in rCBF (regional Cerebral Blood Flow) were monitored in order to observe CSD. LDF (Laser Doppler Flowmetry) was used to measure rCBF. The two LDF probes were placed on the parietal cortex (4 mm apart). To elicit CSD, a needle stab injury was made on the cortex or a piece of paper soaked with 10% KCl was applied on the cortex. The velocity of CSD propagation was more prolonged in the hypothermic rats than in the normothermic rats (p < 0.01). There were smaller numbers of repeated CSD in the hypothermic rats than in the normothermic rats. Histological examination of the cerebral cortex revealed shrinkage neurons more distinctly in the normothermic rats than in hypothermic rats. From these results, we can speculate that hypothermic may block CSD propagation and that hypothermic therapy has the potential to prevent secondary brain injuries.

Animals↗
PubMed1997

[Mitrofanoff procedure with bladder-sparing urethrectomy in female urethral carcinoma: report of a case].

A 60-year-old woman with urethral carcinoma treated by bladder sparing surgery is reported. A tumor of Grabstald's clinical stage C2 arose from the anterior urethra infiltrated into the distal wall of vagina with invasion of vaginal mucosa. Pathological findings revealed poorly differentiated squamous cell carcinoma. She underwent a wide local excision of the urethra and the anterior vaginal wall with preserving the bladder. An appendicovesicostomy (Mitrofanoff procedure was selected for the urinary diversion. This technique provided a small stoma, appropriate continence, normal bladder sensation and preseving renal function. Bladder-sparing urethrectomy could be an alternative treatment for female urethral tumors.

Appendix↗
PubMed1997

Reliability of 99mtechnetium dimercapto-succinic acid uptake 2 hours after injection in hydronephrosis.

PURPOSE: The accumulation of radioactivity in the dilated collecting system potentially influences the calculation of differential renal function on the radionuclide test. We focused on this reservoir effect in unilateral hydronephrosis and assessed the reliability of calculating differential renal function by dimercapto-succinic acid (DMSA) uptake 2 hours after injection. MATERIALS AND METHODS: Unilateral partial ureteral obstruction was created in 8-week-old rats. Four weeks after surgery the animals were sacrificed 2 and 24 hours after the injection of tracer. The DMSA uptake rates of the renal parenchyma and collecting system were measured separately by autowell gamma counter. Differential function was calculated according to renal parenchymal and whole kidney (parenchyma and collecting system) uptake. RESULTS: There was a higher accumulation of DMSA in the dilated renal pelvis at 2 than at 24 hours. However, DMSA uptake in the collecting system was extremely small in comparison to that in the parenchyma. As a result; differential renal function calculated using parenchymal uptake was similar to that calculated using whole kidney uptake measured 2 and 24 hours after injection. CONCLUSIONS: Our data suggest that the pure reservoir effect of DMSA uptake at early measurement is much smaller than reported in previous experimental animal studies. Further clinical studies are needed to reexamine this reservoir effect in children with unilateral hydronephrosis.

Animals↗
PubMed1997

[Farmer's lung complicated by bilateral pneumothorax and mediastinal emphysema].

A 35-year-old woman was admitted to the hospital because of severe coughing and right-sided chest pain. She had worked on a farm for 13 years. For the preceding 2 years, she noticed a productive cough, a mild fever, and dyspnea after working in a barn for longer than 6 hours. Chest radiological examinations revealed low lung volumes, especially in the right upper lobe, and diffuse small granular shadows in both lung fields. Pathological examinations of lung specimens, which were obtained by transbronchial lung biopsy, showed alveolitis and granulomas in the interstitium. Micropolyspora faeni organisms were detected in hay from the barn. A M. faeni serum precipitation test revealed that her serum had antibodies against that organism. From these findings, we gave her a diagnosis of chronic farmer's lung. Prednisolone was given because her dyspnea and hypoxemia had increased. During the steroid treatment, bilateral pneumothorax and mediastinal emphysema developed. Bullae were removed surgically because she did not respond well to medical treatment. Although steroid administration may have caused these complications, bilateral pneumothorax and mediastinal emphysema are rare in patients with chronic farmer's lung.

Adult↗
PubMed1997

[Congenital antithrombin III deficiency associated with pulmonary thromboembolism].

A 42-year-old man was admitted to the hospital because of sudden left-lateral chest pain and dyspnea. The chest roentgenogram on admission showed a string-like shadow and pleural effusion, and analysis of arterial blood gases revealed hypoxemia. Many bilateral segmental defects were seen on a radioisotope perfusion scan of the lungs, and the chest CT scan showed a low-density area in the trunk of the pulmonary artery. From these findings, pulmonary thromboembolism was diagnosed. The serum antithrombin III (ATIII) activity and the antigen value were low, and the patient's son's serum ATIII level was also low. Both the patient and his son were given the diagnosis of congenital ATIII deficiency. Gene analysis revealed two point mutations in exon 6 of the ATIII gene, so we classified this case as type IIc. The patient was treated with intravenous urokinase and heparin, and was then given warfarin. The arterial blood gas tensions improved, and the low-density area of the pulmonary artery on the CT scan disappeared, as did the pulmonary perfusion defect on the radioisotope scan. The clinical manifestations of members of 28 families with congenital ATIII deficiency reported in Japan were reviewed. Patients in whom many point mutations were detected in the ATIII gene were rare.

Adult↗
PubMed1997

[Infected emphysematous bullae in a patient with diabetes mellitus].

A 42-year-old woman with diabetes mellitus was admitted to our hospital because of fever, coughing, and dyspnea. Coarse crackles were audible and respiratory sounds were weak in the right lung field. Laboratory examination revealed a high erythrocyte sedimentation rate, a high level of serum C-reactive protein, a high blood sugar level, and hypoxemia. A chest roentgenogram revealed cystic lesions with fluid levels, and an infiltration shadow in the right lung field. A chest computed tomographic scan revealed many cystic lesions with fluid levels and an infiltration shadow. Our diagnosis was infected emphysematous bullae. A tube was inserted percutaneously for drainage and to allow injection of antibiotics into the cystic lesion. The cystic lesion then vanished. Percutaneous drainage and washing with antibiotics can be used to treat infected emphysematous bulla that have thick closed cystic walls.

Adult↗
PubMed1997

[Effects of pimobendan on pulmonary hypertension in patients with chronic pulmonary emphysema].

Pimobendan is a positive inotropic agent that dilates blood vessels and sensitizes the myocardium to calcium. We studied the clinical usefulness of single oral doses of pimobendan (2.5 mg) in 8 patients with pulmonary hypertension caused by chronic pulmonary emphysema. We measured the short-term effects of pimobendan on pulmonary hemodynamics and gas exchange. Pimobendan significantly decreased mean pulmonary artery pressure from 23.4 +/- 3.4 to 18.5 +/- 2.5 mmHg, and total pulmonary resistance from 383 +/- 111 to 281 +/- 81 dyne.sec.cm-5, while oxygen delivery and cardiac output increased significantly (oxygen delivery: from 81.8 +/- 10.2 to 93.5 +/- 16.2 ml O2/min. cardiac output: from 4.98 +/- 0.76 to 5.77 +/- 1.49 l/min, means +/- SD). Systemic vascular resistance was not significantly reduced. The ratio of pulmonary to systemic vascular resistance was reduced, but not significantly. Arterial oxygen tension (PaO2) and arterial carbon dioxide tension (PaCO2) did not change significantly. These results indicate that pimobendan may be useful in the treatment of patients with secondary pulmonary hypertension.

Aged↗
PubMed1997

[Two patients with summer-type hypersensitivity pneumonitis in Nagano Prefecture].

We encountered two patients with summer-type hypersensitivity pneumonitis that developed in Nagano Prefecture. Patient 1 was a 61-year-old man who had worked in warm and humid environments as painter. He was referred to our hospital because of fever, coughing and exertional dyspnea. Respiratory symptoms developed during work but were gone within in few weeks. Patient 2 was a 50-year-old housewife who was admitted to our hospital because of persistent coughing and a low-grade fever. In both patients, chest roentgenograms and computed tomograms showed bilateral, small, nodular and reticular shadows. Examination of a specimen obtained from patient 2 by transbronchial lung biopsy revealed alveolitis. In both patients, bronchoalveolar lavage fluid had low CD4/8 ratios, but in patient 1 the lymphocyte fraction was high and in patient 2 the neutrophil fraction was high. A steroid drug was given to patient 1 because of the patients symptoms and prolonged abnormal roentgenographic findings. Patient 2 reacted positively on a provocation test when returned to her house. Serum from both patients contained antibodies to Trichosporon mucoides and T. asahii. We know of no previous reports of summer-type hypersensitivity pneumonitis that developed in Nagano prefecture.

Alveolitis, Extrinsic Allergic↗
PubMed1997

[Aortic arch replacement performed in emergency in a short-term after grafting for abdominal aortic aneurysm].

Two cases of successful staged replacement of multiple aortic aneurysms are reported. Case 1: A 65-year-old man was found to have abdominal aortic and aortic arch aneurysms. He underwent abdominal aneurysmectomy and Y-grafting in the first stage. A month after his discharge, he was transferred to our hospital because of abrupt chest pain. Two days later, he fell into shock and emergent aortic arch replacement was performed successfully. Case 2: A 46-year-old man was transferred to our hospital because of abrupt abdominal pain and shock. CT scan revealed the rupture of the abdominal aneurysm. He received emergent abdominal aneurysmectomy and Y-grafting successfully. Three months later, he was readmitted because of back pain. CT scan revealed DeBakey Type I dissecting aneurysm. After three days, PaO2 of blood gas analysis fell to 46 mmHg, and absent femoral pulsation and oliguria were also observed. Therefore, aortic arch replacement was performed in emergency. The intimal tear was found in the distal aortic arch. The both of cases are doing well 24 months and 10 months after surgery respectively. It is important to scrutinize the order of surgery for multiple aortic aneurysms and to control blood pressure properly after aneurysmectomy.

Aged↗
PubMed1997

[A case of rapidly progressive IgA nephropathy with transient hypocomplementemia at onset].

We present a case of IgA nephropathy (IgAGN) which developed rapidly progressive glomerulonephritis and showed marked clinical improvement with treatment. The patient was a 7-year-old boy who initially presented with acute nephritic syndrome with hypocomplementemia. Although the renal function improved with normalization of the serum complement level, it deteriorated again progressively. The first renal biopsy revealed cellular crescents in about 70 percent of 43 glomeruli. Immunofluorescent microscopy demonstrated deposits of IgA, C3 and IgG in the mesangium; they were also deposited along the glomerular capillary walls. He was treated with plasma exchange associated with hemodialysis and methylprednisolone pulse therapy, followed by oral administration of prednisolone, cyclophosphamide and warfarin. Renal function recovered to the normal range about two months after the initiation of treatment. The second biopsy demonstrated a marked decrease in histological activity. In this case, transient hypocomplementemia at onset may indicate that acute glomerulonephritis caused exacerbation of clinically silent IgAGN. Aggressive therapy may be effective in patients with rapidly progressive IgAGN if treated at an early stage.

Child↗