Biomedical subjects

Akio Kimura

Publications and source records attributed to Akio Kimura.

At least 19 recordsLinked to original sources

PubMed2007

Electromyographic findings after different selective neck dissections.

OBJECTIVES: The objective was to compare electrophysiologic investigations of the upper trapezius muscle (UT) after different selective neck dissections (SND) and analyze the differences between types of SND and the preservation and excision of the cervical nerves (the C2-4 rami of the cervical plexus). STUDY DESIGN: Retrospective study of 54 patients (average age, 65.1 +/- 9.6 yr, 45 males) with 70 SND. METHODS: Patients underwent needle electromyography (EMG) of the UT by 4 months after surgery. The findings were rated according to the 5 point EMG scale system from 1 (total denervation: positive sharp wave or fibrillation potential at rest and electrical silence at voluntary contraction) to 5 (normal pattern). RESULTS: The average EMG scale was 1.7 +/- 1.1, 58.6% for score 1 and only 5.7% for score 5. There was not a significant difference in the EMG scale between the types of SND, whereas the group in which the cervical nerves were excised was significantly lower than in that in which it was preserved. The average EMG scales in the former and latter were 1.5 +/- 0.8 and 2.0 +/- 1.3, 68.8%. CONCLUSIONS: The study data confirm that complete or incomplete denervation of the UT was caused by axonal injury of the spinal accessory nerve, even though it was spared, because of traction of the nerve during neck dissection. Second, the excision of the C2 to 4 rami of the cervical plexus caused worse damage of the UT. It is suggested that it is important to preserve the cervical nerves to avoid denervation of the UT.

Accessory Nerve↗

PubMed2006

Association between metallothionein genes polymorphisms and sporadic amyotrophic lateral sclerosis in a Japanese population.

Amyotrophic lateral sclerosis (ALS) is a progressive, lethal neurodegenerative disease that selectively affects motor neurons. Reactive oxygen species (ROS) are assumed to be involved in the pathogenesis of ALS. Metallothioneins (MTs) are self-protective, multifunctional proteins that scavenge ROS. In particular, metallothionein-III (MT-III) has a strong scavenging effect on hydroxyl radicals. MTs have been suggested to have important roles in the pathophysiology of ALS. Therefore we investigated single nucleotide polymorphisms (SNPs) of the MT-III and the metallothionein-IIA (MT-IIA) promoter region in 37 Japanese SALS cases and 206 sex-matched healthy controls using polymerase chain reaction (PCR)-direct sequencing or PCR-temporal temperature gradient gel electrophoresis (TTGE). We detected no SNPs of the MT-III gene in SALS cases and controls, and no detectable association between SALS phenotypes and a SNP of the MT-IIA promoter region. We conclude that gene polymorphisms of MT-IIA promoter region and MT-III gene are not associated with SALS phenotypes in a Japanese population.

Amyotrophic Lateral Sclerosis↗

PubMed2006

Investigation of the therapeutic effects of edaravone, a free radical scavenger, on amyotrophic lateral sclerosis (Phase II study).

Amyotrophic lateral sclerosis (ALS) is a rare disease involving selective and progressive degeneration and disappearance of motor neurons. Oxidative stress is believed to contribute to its pathogenesis. We have investigated the efficacy and safety of edaravone, a free radical scavenger previously approved for treatment of acute cerebral infarction, in ALS patients. Within an open trial design, 20 subjects with ALS received either 30 mg (5 subjects) or 60 mg (15 subjects) of edaravone via intravenous drip once per day. Two weeks of administration was followed by a two-week observation period. This four-week cycle was repeated six times. The primary endpoint was the change in the revised ALS functional rating scale (ALSFRS-R) score, while the secondary endpoint was 3-nitrotyrosine (3NT) level in cerebrospinal fluid (CSF). Efficacy was evaluated in the 60 mg group. During the six-month treatment period, the decline in the ALSFRS-R score (2.3+/-3.6 points) was significantly less than that in the six months prior to edaravone administration (4.7+/-2.1 points); the difference between the two was 2.4+/-3.5 points (Wilcoxon signed rank test, p = 0.039). In almost all patients, CSF 3NT, a marker for oxidative stress, was markedly reduced to almost undetectable levels at the end of the six-month treatment period. Data from the present study suggest that edaravone is safe and may delay the progression of functional motor disturbances by reducing oxidative stress in ALS patients.

Amyotrophic Lateral Sclerosis↗

PubMed2006

Effects of alcohol consumption on cardiovascular events in male patients with healed myocardial infarction.

BACKGROUND: In Western countries, many studies have shown that among healthy people moderate drinkers have a lower incidence of cardiovascular events than abstainers and heavy drinkers. However, it is not clear whether this is true in patients with a healed myocardial infarction (MI). METHODS AND RESULTS: In the present study cardiovascular events were defined as cardiac events or strokes. Male patients only were included because the incidence of cardiovascular events is low in females. In patients younger than 65 years, the incidence of cardiovascular events was 34.6 persons per year (54 cases: 3.9%) of abstainers, 17.4 persons per year (20 cases: 1.9%) of moderate drinkers (p<0.01 vs abstainers) and 30.3 s persons per year (18 cases: 3.2%) of heavy drinkers. However, in those aged 65 years or older, the incidence was 47.8 persons per year (24 cases: 4.5%) of abstainers, 58.4 persons per year (14 cases: 5.6%) of moderate drinkers, and 314.8 persons per year (12 cases: 19.7%) of heavy drinkers. In this age group, cardiovascular events were significantly higher in heavy drinkers than in the other 2 groups (p<0.01), and the incidence was not lower in the moderate drinkers than in abstainers as shown in the younger group. CONCLUSIONS: In patients younger than 65 years with a healed MI, drinking limited less than 30 ml/day (moderate intake) reduces the incidence of cardiovascular events, but not in those aged 65 years or older.

Age Factors↗

PubMed2005

Usefulness of ST-segment elevation in the inferior leads in predicting ventricular septal rupture in patients with anterior wall acute myocardial infarction.

The ventricular septum receives its blood supply from the septal perforators of the left anterior descending (LAD) coronary artery and the right coronary artery. However, when the LAD artery extends to the inferior wall, beyond the apex (so-called wrapped LAD), the ventricular septum near the apex receives blood supply only from the LAD artery. As a consequence, ventricular septal rupture (VSR) would seem more likely in myocardial infarction with occlusion of this type of LAD artery. To test this hypothesis, we compared electrocardiographic findings in 21 patients who had anterior acute myocardial infarction that was complicated by VSR with those in 275 patients who had acute myocardial infarction that was not complicated by VSR. We observed ST-segment elevation in all inferior leads (II, III, and aVF) in addition to anterior leads in 42.9% of patients (9 of 21) who had VSR but in only 3.6% of those (10 of 275) who did not have VSR. Abnormal Q waves appeared in all 3 inferior leads in 44.4% of patients (8 of 18) who had VSR but in only 4.0% of those (10 of 250) who did not have VSR. Thus, the incidence of ST-segment elevation and abnormal Q waves in the inferior leads was significantly (p <0.001) greater in the VSR group. In addition, multivariate analysis of patient characteristics, including advanced age, female gender, and coronary morphology, showed VSR to be significantly correlated with ST-segment elevation (odds ratio 16.93, 95% confidence interval 4.13 to 69.30) and abnormal Q waves (odds ratio 13.64, 95% confidence interval 3.16 to 58.79) in the 3 inferior leads. In conclusion, these electrocardiographic findings can be useful predictors of complication by VSR.

Aged↗

PubMed2005

Plaque erosion in the culprit lesion is prone to develop a smaller myocardial infarction size compared with plaque rupture.

BACKGROUND: Acute myocardial infarction (MI) stems from a disruption of the plaque in the coronary artery. Based on postmortem examinations, such plaque disruption has been classified as either a rupture or an erosion. Unfortunately, it has been difficult to clinically identify plaque ruptures and plaque erosions during the development of acute MI. To elucidate the relationships between clinical features and the morphological characteristics of the infarct-related lesions, we observed the culprit lesions in patients with acute MI by coronary angioscopy and intravascular ultrasound. METHODS: We examined culprit lesions in 107 patients with acute MI using coronary angioscopy and intravascular ultrasound immediately before performing percutaneous coronary intervention. The lesions were then classified as plaque ruptures or nonruptured erosions, and their clinical features were compared. RESULTS: Among the lesions studied, 44 were classified as plaque ruptures, 28 were classified as plaque erosions, and 35 were unclassified. Patients with nonruptured eroded plaques had more preinfarction angina before the onset of MI than those with ruptured plaques (53.6% vs 22.7%, P = .0074). They also had less ST-segment elevation MI (71.4% vs 93.2%, P = .0185), lower peak creatine kinase levels (2029 +/- 1517 vs 4033 +/- 2699 IU/L, P = .0009), less distal embolization after percutaneous coronary intervention (3.6% vs 36.4%, P = .0014), and less Q-wave MI 1 month after onset (40.7% vs 88.4%, P < .0001). CONCLUSION: Patients with eroded plaque lesions have smaller infarctions than those with ruptured plaque lesions, suggesting that an eroded plaque is less potently thrombogenic than a ruptured plaque.

Aged↗

PubMed2005

Effects of various lubricants on corneal surface regularity in rabbits.

The aim of this study was to establish a method for analysis of tear film stability and thereby to investigate the effects of lubricants on corneal surface regularity and corneal epithelial damage in anesthetized rabbits with the eye held open. Saline-instilled and noninstilled eyes manifested a time-dependent increase in the corneal surface regularity index (SRI). In contrast, 0.1% hyaluronic acid (HA) prevented the increase in the SRI for up to 20 min after instillation. Methylene blue uptake into the damaged cornea was significantly greater in eyes that received saline than in those treated with HA. Whereas eyes instilled with 0.5% methylcellulose (MC) or 0.35% sodium carboxymethylcellulose (CMC) manifested an increase in the SRI similar to that apparent in those that received saline, 1.0% chondroitin sulfate (CS) prevented the increase in the SRI for up to 10 min after instillation. In conclusion, we have established a method for analysis of tear film stability in rabbits. Our results suggest that tear film stability is closely related to corneal surface damage and that topical instillation of 0.1% HA or 1.0% chondroitin sulfate warrants further investigation as a potential treatment for patients with dry eye.

Animals↗

PubMed2005

Calcium antagonists for secondary prevention of myocardial infarction: is there a need to shift from short-acting to long-acting types?

BACKGROUND: Although short-acting nifedipine does not prevent myocardial infarction (MI), calcium antagonists with a long half-life may be effective. METHODS AND RESULTS: The present study was a retrospective analysis of the incidences of cardiac events among patients with a healed MI treated with 3 times-a-day type nifedipine (half-life 1.8 h; n=617), twice-a-day type nifedipine (half-life 4.0 h; n=527) and those not taking calcium antagonists (n=1,593) from 1986 to 1993, and the incidences of those on once-a-day type calcium antagonists (half-life 11.0 h; n=903) and those not taking calcium antagonists (n=2,788) from 1994 to 2001. Cardiac events included cardiac death and nonfatal recurrent MI. Single and multivariate analyses using the Cox-Hazard model were performed. From 1986 to 1993 cardiac events occurred in 38 patients with 3-times-a-day nifedipine (6.2%, hazard ratio and 95% confidence interval: 1.45 and 0.93-2.27), in 18 patients with twice-a-day nifedipine (3.4%: 0.68 and 0.39-1.20), 57 patients without calcium antagonists (3.6%). Cardiac events also occurred in 11 patients with once-a-day type nifedipine (1.2%: 0.72 and 0.37-1.42) and 48 patients without calcium antagonists (1.7%). Of the once-a-day type calcium antagonists, cardiac events were the lowest (2 patients, 0.6%: 0.32 and 0.08-1.31) in patients with amlodipine (half-life 39.0 h; n=334), which has the longest half-life. None of these drugs were a significant factor in the increase or decrease in the incidence of cardiac events. However, there was a good correlation between the half-life of the calcium antagonist and the hazard ratio for reducing cardiac events. CONCLUSION: Although there was a tendency toward a reduction in cardiac events using calcium antagonists with long half-life, none of these drugs could significantly reduce the incidence of cardiac events in patients with a healed MI.

Amlodipine↗

PubMed2005

Recent decline in hospital mortality among patients with acute myocardial infarction.

BACKGROUND: Many patients with acute myocardial infarction will still die after admission. Recent trends in hospital mortality were analyzed to identify aspects that need improvement. METHODS AND RESULTS: A total of 1,247 patients admitted to Kinki University School of Medicine within 24 h of the onset of infarction were analyzed between 1975 and 2001. The percentage of patients discharged with 100% occlusion decreased gradually from 31.3% during 1975-1982 to 2.1% during 1998-2001, while those with 50% stenosis or less gradually increased from 12.5% to 82.5% during the same period (trends: p < 0.01). The cardiac death rate was 17.1% in 1975-1982, and 7.7% in 1998-2001, showing a significant decrease with time (p < 0.01). This decrease was particularly marked among those admitted within 6 h of the onset of infarction. Death due to cardiac rupture decreased significantly with time (p < 0.001). In contrast, the non-cardiac death rate, amounting to 2.2% on average, did not decline. CONCLUSIONS: Cardiac deaths due to acute myocardial infarction have decreased markedly of late. However, patients must be admitted within 6 h of the onset of infarction to benefit from this improvement. More effort should be made to improve the general care of patients in order to reduce the incidence of non-cardiac death.

Aged↗

PubMed2005

Clinical electromyography and electrodiagnosis course at Keio University Hospital--a 7-year experience.

Although electromyography and electrodiagnosis (EMG-EDX) is one of the most fundamental skills in rehabilitation medicine, the number of residency programs that can provide comprehensive postgraduate EMG-EDX training is still limited in Japan. Under these circumstances, we started a 2-day primer course in EMG-EDX at Keio University Hospital in 1998. To review our 7-year experience with the course, we analyzed the number and specialty of the participants, their appraisal of the lectures and practical sessions, and the score distribution of the final examination. The number of participants totaled 288 during the past 7 years, and the mean number for each year was 41. The distribution by specialty for the whole period was 64.0% for rehabilitation medicine, 25.4% for orthopedic surgery, 5.1% for neurology, 1.0% for pediatrics, 0.5% for gerontology and 4.1% for physical therapists and occupational therapists. The difficulty levels of the lectures were judged as appropriate by 81 to 95.5% of the participants, and the presentation was judged as good by 34 to 67% of them. For the practice sessions, the difficulty levels were judged as appropriate by 88% of the participants, and the quality of the supervisors was judged as good by 64% of them. The mean score for the final examination was 56.0 (SD 15.2, median 60). In conclusion, our course has played an important role to promote EMG-EDX in our country by providing compact introductory exposure to EMG-EDX for beginners. A follow-up system for the course graduates is planned to support their EMG-EDX practice.

Diagnostic Techniques, Neurological↗

PubMed2005

[A case of non-herpetic acute encephalitis with autoantibodies for ionotropic glutamate receptor delta2 and epsilon2].

We report a 45-year-old woman admitted to our hospital due to fever, consciousness disturbance, and severe seizures. Based on her signs and symptoms and clinical course, a diagnosis of non-herpetic acute encephalitis was made. She received antibiotic drugs, acyclovir, gamma-globulin, and steroid pulse therapy (methylprednisolone 1 g/day, 3 days). The patient's signs, symptoms and severe seizure showed marked improvement, but she still showed monthly seizure attacks and both anterograde and retrograde amnesia Viral infection and autoimmune response after viral infection may have been involved in non-herpetic acute encephalitis in our patient. Recently, autoantibodies to GluRepsilon2 and VGKC were reported in cases of non-herpetic acute limbic encephalitis (NHALE). In our patient, we detected IgM type autoantibody to GluRdelta2 and epsilon2 in both the CSF and serum, and these antibodies normalized in the CSF with the clinical course. Autoantibodies to GluRdelta2 and epsilon2 may be involved in the clinical symptoms and pathogenesis of non herpetic acute limbic encephalitis. This is the first report of MRI-positive non-herpetic acute encephalitis with autoantibodies to GluRdelta2 and epsilon2.

Acute Disease↗

PubMed2004

Spinocerebellar degeneration with negative electroretinogram: dysfunction of the bipolar cells.

We report the characteristics of three patients with spinocerebellar degeneration (SCD) with negative-type electroretinograms (ERGs). None of the patients showed retinal degeneration, but all had severe cerebellar ataxia, and brain MRIs showed cerebellar atrophy. Negative-type ERGs have been implicated in the selective functional impairment of the inner retinal layer, but few studies have reported dysfunction of the inner nuclear layer in SCD patients. Our subjects may be the first reported SCD cases with negative-type ERGs. Our results suggest that an etiologic relationship exists between cerebellar ataxia and negative-type ERGs. Further investigation of ERGs in patients with SCD could potentially lead to the identification of an increased number of SCD patients with negative-type ERGs and retinal pathogenesis.

Adult↗

PubMed2004

Twenty-seven years of complication-free life with clean intermittent self-catheterization in a patient with spinal cord injury: A case report.

Currently, clean intermittent self-catheterization (CISC) is the most prevalent method of bladder management in patients with spinal cord injury (SCI) at discharge from rehabilitation centers. However, half of the patients discontinue using CISC and change to other methods of bladder management several months postdischarge despite the fact that it the best way to prevent urinary tract complications. Few studies, however, report the long-term consequences of CISC. In this case, we present a woman in her early fifties who had sustained thoracic SCI and had continued using CISC for 27 years without developing any complications. The possible reasons for her success were absence of incontinence because of underactive and normal capacity bladder; normal upper-extremity functions and absence of marked spasticity of lower extremities that facilitated CISC technique; and absence of sociovocational problems, enabling her to keep proper intervals between catheterizations each day. This case indicates that CISC is useful for long-term bladder management in patients with SCI, even for 25 years or more. Long-term outcomes of CISC and factors leading to success need to be delineated in future studies with larger samples.

Female↗

PubMed2004

Beta-blockers prevent cardiac events in Japanese patients with myocardial infarction.

BACKGROUND: Although the favorable effects of beta-blockers in the treatment of myocardial infarction (MI) have been repeatedly demonstrated in Western countries, administration of this drug has been limited in Japan. METHODS AND RESULTS: The study group of 1,896 patients with MI was retrospectively divided into 1,029 patients treated by beta-blockers and 867 not treated by beta-blockers, and the incidences of cardiac events, consisting of recurrent MI, death because of worsening heart failure, and sudden death, and cardiovascular events, comprising cardiac events and stroke, were compared in both groups. There were 45 cardiac events (4.4%, 30.1 patients/1,000 patients. year) among the beta-blocker group, which was significantly less than the 56 cardiac events (6.5%, 52.3 patients/1,000 patients. year) among the no-beta-blocker group (p<0.05). The total mortality was 92 (8.9%, 61.6 patients/1,000 patients. year) and 124 (14.3%, 115.8 patients/1,000 patients. year), respectively, and cardiac death occurred in 42 (4.1%, 28.1 patients/1,000 patients. year) and 53 (6.1%, 49.5 patients/1,000 patients. year), respectively, indicating that both these events occurred significantly less in the beta-blocker group (p<0.01 and p<0.05). CONCLUSIONS: Beta-blockers prevent cardiac events in Japanese patients with MI. However, a placebo-controlled, double-blind, multicenter, clinical trial conducted on a large scale in Japan would further contribute more precise information of the useful effects of beta-blockers.

Adrenergic beta-Antagonists↗

PubMed2004

Identification of the Cryptosporidium isolate from chickens in Japan by sequence analyses.

The Cryptsosporidium isolate from chickens in Japan by Itakura et al. is not yet accurately identified because of several discrepancies in phenotypic features. We attempted to identify this isolate by analyzing the partial sequences of the 18S rRNA, COWP and HSP70 genes. The chicken isolate showed nearly 100% homology in each gene with C. baileyi, but less than 91% homology with C. meleagridis. In addition, these genes were classified into the same cluster with C. baileyi other than C. meleagridis by phylogenetic analysis. From these results, the Cryptosporidium isolate from chickens in Japan is considered to be one of the strains of C. baileyi.

Animals↗

PubMed2004

[Diagnosis of vascular complications at the puncture site after cardiac catheterization].

OBJECTIVES: Cardiac catheterization is increasingly used for the diagnosis or treatment of coronary artery disease. Previous studies that revealed the incidence of complications such as arteriovenous fistula and pseudoaneurysm were based on retrospective analysis of cohorts referred to vascular surgery. This study was designed to determine the incidence of arteriovenous fistula and pseudoaneurysm after percutaneous transluminal angiography. METHODS: All 557 consecutive patients undergoing cardiac catheterization were examined by ultrasonography from March 1, 2001 to April 1, 2002, to investigate the occurrence of arteriovenous fistula and pseudoaneurysm at the puncture site. RESULTS: Pseudoaneurysm was found in 16 patients (2.9%), and arteriovenous fistula in 12 patients (2.2%). Pseudoaneurysm in 7 patients (43.8%) and arteriovenous fistula in 6 patients (50.0%) were diagnosed only by ultrasonic examination. There were more female patients (9 patients, 56.3%) than male with pseudoaneurysm (p < 0.01). The puncture site was located after the division of the deep femoral artery and superficial femoral artery in all patients with complications. CONCLUSIONS: Ultrasonic examination was useful for diagnosis of complications such as arteriovenous fistula and pseudoaneurysm after cardiac catheterization.

Aged↗

PubMed2004

[Diagnosis of adult type of Niemann-Pick disease (type C) in two brothers by filipin staining of bone marrow smears].

Niemann-Pick disease, type C (NPC) is a neurometabolic genetic disorder that is distinguished from other types of Niemann-Pick disease by its later onset, more insidious progression, variable visceromegaly, and abnormalities of intracellular cholesterol metabolism. We report cases in 18-year-old and 20-year-old brothers who presented with disinhibition and involuntary movement of their hands. Both brothers presented various signs such as dementia, vertical supranuclear ophthalmoplegia (VSO), dysarthria, axial and limb dystonia, hyperreflexia, pathologic reflex, cerebellar ataxia, as reported. They also presented startle response. Brain MRI showed diffuse cerebral atrophy and abdominal CT reveals hepato-splenomegaly in both patients. These cases were suspected to be NPC based on dementia, VSO, cerebellar ataxia, hepato-splenomegaly and foam cells in the bone marrow. Generally, the diagnosis of NPC is based on deficient cholesterol esterification and excessive lysosomal filipin staining in cultured skin fibroblasts. However, culture of fibroblasts obtained from a biopsied skin samples is slow. We have rapidly made the diagnosis of NPC in our patients by filipin staining of foam cells from bone marrow. This diagnostic process using a bone marrow smear is more convenient and rapid than previous methods using cultured skin fibroblasts.

Adolescent↗

PubMed2003

Pravastatin reduces the incidence of cardiac events among patients with myocardial infarction.

We retrospectively compared the incidence of cardiac events in myocardial infarction (MI) patients treated in our departments between 1990 and 1999 with pravastatin or without cholesterol-lowering agents. Our aim was to evaluate the efficacy of pravastatin in the secondary prevention of MI. Cardiac events--defined as fatal or nonfatal recurrent MI, sudden cardiac death, and death from congestive heart failure--occurred in 8 (2.2%) of 356 MI patients treated with pravastatin (17.1 cases/1.000 person x year) and in 39 (5.6%) of 700 MI patients not treated with cholesterol-lowering agents (54.3 cases/1000 person x year), which represented a significant decline among those taking pravastatin (P < 0.05, odds ratio: 0.39, 95% (CI: 0.18-0.84). Likewise, total mortality was significantly lower among patients treated with pravastatin (18 cases, 5.1%; 38.4 cases/1,000 person x year vs 77 cases, 11.0%; 107.2 cases/1,000 person x year, P < 0.01, odds ratio: 0.43, 95% CI: 0.25-0.73). Subgroup analysis revealed a significantly lower incidence or cardiac events in the pravastatin group for 6 of the items among 53 patient characteristics, and was lower but not significant for 45 items and was greater but not significant only for 2 items. Furthermore, multivariate analysis confirmed pravastatin to be a useful factor for preventing the occurrence of cardiac events in MI patients (P < 0.05, odds ratio: (0.44, 95% CI: 0.20-0.95), and Kaplan-Meier curves also showed pravastatin to significantly reduce the incidence of both cardiac events and total mortality. These findings are consistent with those previously reported by several large-scale clinical trials carried out in Western countries, and demonstrate that pravastatin is useful for secondary prevention of MI in Japanese patients.

Aged↗