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Biomedical subjects

H Yoshitomi

Publications and source records attributed to H Yoshitomi.

84 records · Page 5Linked to original sources
PubMed1980

Binding of several loop diuretics to serum albumin and human serum from patients with renal failure and liver disease.

The binding of the new diuretic piretanide and two other diuretics (furosemide and bumetanide) to serum proteins (especially albumin) was studied using the in vitro equilibrium dialysis method. Piretanide and bumetanide, similar to each other in chemical structure, were almost equal in the binding constant to purified albumin, while the binding constant of furosemide was greater than that of the other two diuretics. The binding of these loop diuretics in the dilutions of the sera from healthy adults and patients with renal failure or liver disease was also studied by the same method. Protein binding of the drugs was markedly reduced in patients with renal failure. The cause could only partly be explained by some structural changes in the serum albumin molecules of these patients and influences of endogeneous substances present in serum.

Adult↗
PubMedDate not supplied

Left atrial thrombus formation immediately after cardioversion of atrial fibrillation despite adequate anticoagulant therapy.

We observed a patient who exhibited de novo left atrial thrombus formation after cardioversion, despite administration of adequate anticoagulant therapy. Preexisting atrial thrombus was excluded by transesophageal echocardiography. Preexisting severe left atrial mechanical dysfunction may be considered as a risk factor for de novo thrombus formation after cardioversion, as well as the poor outcome of cardioversion.

Adult↗
PubMedDate not supplied

Sublingual nifedipine in elderly patients: even a low dose induces myocardial ischaemia.

1. Low doses of sublingual nifedipine are still used for the treatment of hypertensive crises, although recent studies have raised concerns that sublingual nifedipine may cause serious dose-dependent adverse effects. The present study was performed to test the safety of low-dose sublingual nifedipine administered to elderly hypertensive patients. 2. Systemic blood pressure measurements and electrocardiographic (ECG) examinations were performed before and 45-60 min after a 5 mg dose of sublingual nifedipine in 93 consecutive hypertensive patients, 65 years of age or older, who were without coronary artery disease. In 33 patients, the effects of nifedipine on myocardial lactate metabolism were studied during cardiac catheterization. 3. In all patients, following nifedipine administration, blood pressure (BP) decreased significantly, while heart rate (HR) increased, and symptoms associated with elevated BP disappeared. However, changes consistent with myocardial ischaemia appeared on the ECG in six of 55 patients with left ventricular hypertrophy (LVH) and in one of 38 patients without LVH, although only two of these seven patients experienced angina-like precordial tightness. Sublingual nifedipine decreased myocardial lactate extraction from 52 +/- 13 to 38 +/- 19% in 20 patients with LVH (P = 0.02), but myocardial lactate extraction remained stable in 13 patients without LVH (49 +/- 7 to 50 +/- 5%; NS). The change in lactate extraction was significantly correlated with the percentage change in diastolic arterial pressure (r = 0.77, P < 0.001). 4. These results suggest that sublingual nifedipine, even at the low dose of 5 mg, may cause myocardial ischaemia in some elderly patients with LVH that is associated with a marked reduction in coronary perfusion pressure.

Administration, Sublingual↗
PubMedDate not supplied

Does aggressive surgical resection improve the outcome in advanced gallbladder carcinoma?

BACKGROUND/AIMS: Patients with advanced gallbladder carcinoma have usually been considered nonresectable, leading to a very poor outcome. This study was aimed to evaluate the results of our aggressive surgical approaches in certain cases of advanced gallbladder carcinoma. METHODOLOGY: Ninety-one patients with advanced gallbladder carcinoma of stages pT3 and pT4 who underwent surgery at our institution were the subjects of this study. Fifty-eight of 91 patients had surgical excision; 44 by hepatic resection and 14 by hilar resection. Post-operative outcome was evaluated. Advanced gallbladder carcinomas were classified according to our previously reported classification: type I hepatic; type II biliary; type III hepatobiliary; type IV others. RESULTS: Curative resection was obtained at a more increased rate in type I tumor patients than in types II and III (91% vs. 29%, p < 0.01). The surgical mortality rate was 17%. Survival rates of resected patients were significantly higher that those of nonresected patients: 45%, 31%, 22%, 17%, 13% at 1, 2, 3, 4, 5 years vs. 9%, 9%, 0% at 1, 2, 3 years (p < 0.01). Survival rates of type I tumor patients after curative resection were remarkably higher than those of type II and III tumor patients, (69%, 64%, 56%, 48%, 39% at 1, 2, 3, 4, 5 years vs. 17%, 17%, 0% at 1, 2, 3 years). CONCLUSIONS: Aggressive surgical approaches might bring about improved prognosis in advanced gallbladder carcinoma, especially for patients with type I tumors.

Adult↗