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Biomedical subjects

I Takamatsu

Publications and source records attributed to I Takamatsu.

At least 19 recordsLinked to original sources
PubMed2001

Economic evaluation of universal BCG vaccination of Japanese infants.

BACKGROUND: The international controversy surrounding the use and effectiveness of the Bacillus Calmette-Guérin (BCG) vaccine and the low incidence of tuberculosis (TB) among Japanese children prompted this study. METHODS: We compared 'universal BCG vaccination' with 'no vaccination at all' using a cost-effectiveness analysis. The study population was a hypothetical cohort comprising a total of 1.2 million infants born in 1996 at locations all over Japan. A model was developed to calculate the number of TB cases prevented by the vaccination programme. Assuming 40-80% overall vaccine efficacy (64-86% for TB-meningitis) and 10 years of protection, we calculated the cost and number of immunizations required to prevent one child from developing TB, the total number of TB cases averted by vaccination and total costs required for the programme. RESULTS: Based on an assumption of flexible vaccine efficacy (40-80%), we estimated that 111-542 TB cases including 10-27 of TB-meningitis would be prevented during the 10 years after BCG vaccination among the cohort of infants born in 1996. About US$35 950-175 862 or 2125-10 399 immunizations would be required to prevent one child from developing TB. Sensitivity analyses covering a wide duration of protection, incidence of TB, vaccine coverage and discount rate, revealed that other than vaccine efficacy, the cost of preventing a single case of TB is highly sensitive to the duration of BCG protection and TB incidence. CONCLUSION: The cost per case of TB prevented is heavily dependent on vaccine efficacy and the duration of protection, and is high compared with the cost of treating one child who has developed TB.

BCG Vaccine↗
PubMed2001

Divergent renal vasodilator action of L- and T-type calcium antagonists in vivo.

OBJECTIVE: To assess the in-vivo action on the renal microvasculature of the calcium antagonists nifedipine (L-type blocker), efonidipine (L/T-type blocker), and mibefradil (predominant T-type blocker). DESIGN: An intravital needle-type charge-coupled device (CCD) camera videomicroscope was introduced to visualize the renal microcirculation directly in vivo. METHODS: In anesthetized mongrel dogs, nifedipine (0.01-1 mg/kg per min), efonidipine (0.033-0.33 mg/kg per min), or mibefradil (0.01-1 mg/kg per min) was infused intravenously after the insertion of a CCD probe into the kidney. Renal microvascular responses to calcium antagonists were directly evaluated, with concomitant observation of renal clearance. RESULTS: Each calcium antagonist caused modest vasodepressor action without affecting heart rate. Nifedipine (1 mg/kg per min, n = 9) increased renal plasma flow (RPF) (14 +/- 4%, P < 0.05) and glomerular filtration rate (GFR) (19 +/- 5%, P < 0.05), and tended to increase the filtration fraction (5 +/- 2% increment, P = 0.07). Efonidipine (0.33 mg/kg per min, n = 9), however, had no effect on filtration fraction, with 14 +/- 6% increments in RPF (P < 0.05) and 14 +/- 7% increments in GFR (P = 0.08). Rather, mibefradil (1 mg/kg per min, n = 9) elicited 6 +/- 2% decreases in filtration fraction (P < 0.05), with slight increments in RPF (6 +/- 3%) and no changes in GFR. In direct in-vivo microvasculature observations, nifedipine caused predominant (22 +/- 2%) dilatation of afferent arterioles (from 15.5 +/- 0.4 to 18.9 +/- 0.4 microm, n = 5), compared with that of efferent arterioles (10 +/- 2%; from 11.0 +/- 0.4 to 12.1 +/- 0.3 microm). In contrast, efonidipine caused a similar magnitude of vasodilatation (16 +/- 4%) compared with 18 +/- 2%; n = 6), and mibefradil caused greater dilatation of efferent arterioles (20 +/- 4%, n = 7) than that of afferent arterioles (13 +/- 4%). CONCLUSIONS: There exists marked heterogeneity in action of nifedipine, efonidipine and mibefradil on the renal microvascular in canine kidneys in vivo. Furthermore, our current observations suggest an important contribution of T-type calcium channel activity to efferent arteriolar tone in vivo.

Animals↗
PubMed2000

Evaluation of the cardiovascular responses to fiberoptic orotracheal intubation with television monitoring: comparison with conventional direct laryngoscopy.

STUDY OBJECTIVE: To evaluate and compare cardiovascular responses to a new method of orotracheal intubation incorporating TV monitoring, with conventional orotracheal intubation via rigid blade laryngoscopy. DESIGN: Prospective single-blind study. SETTING: Operating room of a medical college hospital. PATIENTS: 90 ASA physical status I and II surgical patients requiring general anesthesia and orotracheal intubation. INTERVENTIONS: Patients were randomly allocated to two groups, one for the new intubation method and the other for conventional intubation using a rigid laryngoscope. In the new method, an anesthesiologist inserted an endotracheal tube alone into the trachea via TV monitoring through the bronchoscope, which was inserted by an assistant through the mouth to the middle larynx. The patient's trachea was intubated without extreme stretching of laryngeal tissues or deep insertion of the tip of the bronchoscope. In the conventional method, orotracheal intubation was performed with rigid direct laryngoscopy. MEASUREMENTS: Noninvasive blood pressure (BP) and heart rate (HR) were measured before arrival at the operating room, and before and after orotracheal intubation. MAIN RESULTS: Although this method was expected to be a minimally invasive fiberoptic intubation technique, the patients showed significant increases in BP and HR. No significant differences between the two groups were observed in cardiovascular responses immediately after intubation: the systolic BP, 169.5 +/- 28.3 versus 167.0 +/- 23.1 mmHg, and HR, 100.2 +/- 18.2 versus 98.8 +/- 16.6 bpm. CONCLUSIONS: Insertion of an endotracheal tube may itself be the most invasive stimulus during intubation procedures.

Adult↗
PubMed2000

The effect on intracuff pressure of various nitrous oxide concentrations used for inflating an endotracheal tube cuff.

UNLABELLED: We sought to determine the optimal concentration of nitrous oxide (N(2)O) for inflating endotracheal tube cuffs, to avoid overinflation and air leaks. Female patients undergoing endotracheal intubation (inner diameter 7.5 mm) during anesthesia with 67% N(2)O were randomly assigned to five groups of 25 subjects each, in which cuffs were inflated with 0% (Air), 30% (N30), 40% (N40), 50% (N50), or 67% (N67) N(2)O. The cuff pressure and the N(2)O concentration in the cuff were measured. In an additional 15 patients (N40-a group), pilot balloons were replaced with metal tubes, and the mouths and noses of the patients were wrapped with tape, to minimize N(2)O efflux into the air. Postoperative sore throats were evaluated in double-blinded interviews. Cuff pressures increased significantly in the Air and N30 groups but decreased in the N67 group. Cuff pressures were <22 mm Hg in the N40 and N50 groups, but the N50 group had air leaks. The N(2)O concentration in the cuff in the N40 group was significantly smaller than that in the N40-a group, suggesting N(2)O rediffusion. The incidence of sore throats (40% in the Air group) was reduced significantly in the N40 and N50 groups. Therefore, 40% N(2)O is optimal for filling the cuff during anesthesia with 67% N(2)O. IMPLICATIONS: Nitrous oxide (N(2)O) diffuses into the cuff, equilibrating at a smaller concentration than the gas mixture with which patients are ventilated. Our data indicate that inflation of the cuff with 40% N(2)O is recommended to prevent both excessive endotracheal cuff pressure and air leaks during anesthesia with 67% N(2)O, reducing postoperative sore throats.

Adolescent↗
PubMed2000

[Decrease in serum propofol concentrations after acute autologous blood letting].

A change in serum propofol concentrations associated with acute autologous blood letting during anesthesia was investigated in seven scheduled surgical patients. Anesthesia was induced with propofol 2 mg.kg-1 and maintained with infusion of propofol 6 mg.kg-1.hr-1 at a constant rate. After achieving a stable anesthesia, about 10 g.kg-1 of autologous blood was withdrawn in about 15 minutes and 20 ml.kg-1 of acetated Ringer's solution was infused to manage the hypotension caused by withdrawal. A blood sample each 4 ml was taken before and 0, 5, 15, 30 minutes after blood withdrawing. Another 7 patients were anesthetized with the same procedure without blood letting to distinguishing the effect of blood letting from rapid infusion therapy of crystalloid. Assay of serum concentration of propofol was performed with HPLC-spectrofluorometry. Concentrations of propofol were significantly decreased from 2.8 micrograms.ml-1 to 2.3 micrograms.ml-1 just after blood letting, and remained at 2.3 micrograms.ml-1 after 30 minutes from letting. Rapid infusion therapy also decreased the concentrations of propofol from 2.4 micrograms.ml-1 to 1.7 micrograms.ml-1. Continuous infusions of propofol may become a major method of general anesthesia with target controlled infusion techniques (TCI) in clinical settings for the accuracy and reliability of prediction of blood concentrations. However, this study demonstrated unexpected decreases of concentration of propofol during acute autologous blood letting similar to surgical mass bleeding, which might be mainly caused by rapid infusion therapy. The rate of infusion of anesthetic should be readjusted to counteract the effect of acute blood loss or volume replacement.

Adult↗
PubMed2000

[Effect of beclomethasone increment on airflow limitation in asthmatic children treated with high dose beclomethasone].

In order to evaluate the effect of higher dose BDP therapy (1200-1660 micrograms/day), we studied 12 asthmatic children (mean age 9.7 years-old) with airflow limitation on respiratory function test who were asymptomatic with high-dose BDP therapy (800 micrograms/day). After 4 weeks of higher dose BDP therapy, FVC, FEV1 and V50 were significantly improved, but those improvement were insufficient compared with those after salbutamol inhalation. The personal best values after salbutamol inhalation were not different in every parameter of respiratory function test between BDP 800 micrograms/day and 1200 micrograms/day. We conclude that less than 800 micrograms of daily BDP is generally adequate for prevention in most asthmatic children, because higher dose BDP therapy is no more effective on respiratory function in those treated with 800 micrograms of daily BDP, and that the best value of respiratory function after salbutamol inhalation is not always a goal of high dose BDP therapy.

Anti-Asthmatic Agents↗
PubMed2000

[Successful fiberoptic intubation for a patient with lingual tonsillar hyperplasia].

Hypertrophied lingual tonsils are rare, but may cause difficulty or inability in tracheal intubation during induction of general anesthesia. A 39-yr-old woman was scheduled for resection of symptomatic hypertrophied lingual tonsils. In this patient, we examined two methods of oro-tracheal intubation either with rigid laryngoscopy or flexible fiberoscopy using trans-nasal fiberopic monitoring. Direct laryngoscopy failed to expose the trachea because of large hypertrophied tissue, and fiberoscopic intubation was also difficult since a large mass hindered acquiring a suitable view. However, transnasal fiberoscopic monitoring could guide the orotracheal fiber into the trachea for intubation. When an anesthesiologist can predict the abnormality of lingual tonsils, this combination might be recommended for difficult airway and intubation.

Adult↗
PubMed1999

Effect of long-term treatment with inhaled beclomethasone dipropionate on growth of asthmatic children.

The effect of long-term inhaled steroid therapy on linear growth in asthmatic children is still a point of controversy. We tried to clarify the effect of long-term treatment with inhaled beclomethasone dipropionate (BDP) on linear growth and final height of asthmatic children. Height data measured annually from 12 years (beginning at age 10 years in most patients) to 20 years of age were retrospectively collected from clinical records in 97 moderate to severe asthmatics (49 boys, 48 girls) born in 1971-1975 who were observed regularly for more than 8 years at our outpatient clinic. Data were expressed as standard deviation scores and were compared between patients treated with BDP (30 boys and 31 girls, mean daily dosages were 300-800 microg) and without BDP. Growth delay in the early period of puberty and catch-up growth in the late period of puberty was found in both patients treated with and without BDP. The age of onset of treatment with BDP inhalation had no influence on linear growth, and asthmatic children receiving optimum treatment eventually attained standard final height for their age group. Long-term treatment with inhaled BDP in conventional doses does not significantly impair linear growth in asthmatic children.

Administration, Inhalation↗
PubMed1999

[A case of emergency caesarean section as a result of anaphylaxis to latex].

A 32-year-old woman was admitted with a diagnosis of impending premature delivery. In the 37th week of pregnancy, vaginal examination was performed. After ten minutes, vomiting, whole body flushing, and cold sweat appeared suddenly. Because fetal heart rate became 60-70 beats.min-1, emergency caesarean section was scheduled. When she arrived at the operating room, blood pressure was 75/45 and heart rate was 122 beats.min-1. Five minutes later, anesthesia was induced with thiopental and vecuronium, and operation was instituted concomitantly. After the delivery, pentazocine and midazolam were administered. During the operation, premature separation of normally implanted placenta or pressed cord was not observed. Hydrocortisone was administered for circulatory collapse. Gabexate mesilate was administered for the prevention of DIC. The scratch test, performed ten days later, revealed that latex was positive but lidocaine was negative. Therefore, it was concluded that anaphylaxis induced by latex gloves caused shock after internal examination.

Adult↗
PubMed1999

[The current situation and treatment of childhood tuberculosis].

We performed a retrospective analysis of 394 patients who were treated for active tuberculosis (TB) at our hospital from 1976 to 1997. The diagnosis criteria for establishing TB were history of direct contact with TB patients, tuberculin skin test reactivity, positive bacteriology and radiographic findings compatible with TB. There were 192 males and 202 females (age range 1 month to 18 years of age, mean 6.3 years of age). Fifty-four percent of the cases were under 5 years of age. Primary pulmonary TB was presented in 200, post primary pulmonary TB in 97, pleural effusion in 53, endbronchial TB in 4, TB meningitis (TBM) in 28, miliary TB in 28 and other extra-pulmonary TB in 31. A history of contact with the patients was obtained in 72.8% of cases. Two hundred and thirty (58.4%) had received BCG, 134 (34%) no BCG, 30 (7.6%) were unclear. Especially, under 5 years of age, only 29 (13.6%) had received BCG. TBM is not disappeared in Japan and there were 28 cases with TBM. Fifteen patients out of them recovered completely, 8 patients recovered with severe neurological sequelae which included mental retardation, motor weakness, seizures and hydrocephalus and 5 patients died. Twenty-six had no BCG. Particularly in 1990s, we had experienced 4 dead TBM cases, 1 multi-drug resistant (MDR) TBM case and 1 TBM case due to nosocomial infection. Children with TBM should received 12-month regimen using initial daily treatment with isoniazid, rifampin, pyrazinamide, and streptmycin, followed by isoniazid and rifampin administered daily. Pulmonary TB in children is successfully treated with 6-month standard chemotherapy using isoniazid, rifampin, and pyrazinamide daily for 2 months, followed by isoniazid and rifampin daily for 4 months. In order to promote TB control and eliminate childhood TB, especially in infants, the following is necessary; 1) early detection and treatment of adult TB patients, source of infection, 2) prompt and appropriate contact examination and chemoprophylaxis, 3) BCG vaccination during early infancy, 4) protection from MDR TB are most important in Japan.

Adolescent↗
PubMed1999

[Tuberculosis outbreak among inpatients].

The Index case, 22 year-old pregnant woman, was admitted for threatened abortion among obstetric ward in X Hospital for 17 days. Two months later, she was admitted for delivery among perinatal ward in another Y Hospital for 5 days. She produced persistent cough and sputum, when she had diagnosed pulmonary tuberculosis (TB) with sputum smear-positive and cavity on 2nd Y hospital day. By 2 years after the detection, 15 TB patients were newly diagnosed. Seven of 15 TB patients were culture positive cases and RFLP analysis of the 7 Mycobacterium TB strains demonstrated an identical banding pattern, thus confirming the spread of a unique strain. Of the 15 TB patients, seven were patients on the obstetric ward. Three were visitors. Two were infants with TB meningitis and miliary TB were not confirmed direct contact with the index case. Another two were family member and one was employee. The present outbreak emphasizes the high risk of TB transmission on obstetric and perinatal ward when the diagnosis of smear-positive pulmonary TB was delayed.

Adult↗
PubMed1999

[Factors for the onset of and the exacerbation of tuberculosis. 3. Clinical factors for the development and the exacerbation of active tuberculosis. a. Children, young adult].

We reviewed the reports about the development and the exacerbation of active tuberculosis and performed a retrospective analysis of 394 patients who were treated for active tuberculosis (TB) at our hospital from 1976 to 1997. The factors for the development and the exacerbation of active tuberculosis were the bacteriological status of the source, the age of the person infected, the degree of tuberculin sensitivity, BCG non-vaccination, non-chemoprophylaxis, the medical condition that increases the risk for tuberculosis, the presence of other infection, poor nutrition.

Adolescent↗
PubMed1999

[Commemorative lecture of receiving Imamura Memorial Prize. Studies on prevention and treatment of childhood tuberculosis].

We performed a retrospective analysis of 394 patients who were treated for active tuberculosis (TB) at our hospital from 1976 to 1997. We had started early BCG vaccination campaign in Osaka Prefecture from 1995 and the coverage of BCG vaccination in infants rose up to about 90%. From that experience, we studied the current situations and measures on prevention and treatment of childhood tuberculosis. Pulmonary TB in children is successfully treated with 6-month standard short-course chemotherapy using isoniazid, rifampin, and pyrazinamide daily for 2 months, followed by isoniazid and rifampin daily for 4 months. Prognosis of childhood tuberculous meningitis (TBM) is poor, early diagnosis and prevention of TBM is important. In order to promote TB control and eliminate childhood TB, especially in infants, the following is necessary; 1) early detection and treatment of adult TB patients, source of infection, 2) prompt and appropriate contact examination and chemoprophylaxis, 3) BCG vaccination during early infancy, 4) protection from MDR-TB are most important.

Adult↗
PubMed1998

[Tuberculosis in children].

Newly registered active tuberculosis in children is under 300 persons a year in Japan, now. In order to lessen further and exterminate childhood tuberculosis in near future, physician have to make effort to find the infected children by good-timing thorough surveillance when he find an adult tuberculosis patient. Chemoprophylaxis could prevent the infected children from progressing to active disease. BCG vaccination in infantile period is still important in Japan, especially to protect young children from disseminated tuberculosis. Pulmonary tuberculosis in children is successfully treated with 6 months standard multi-drugs therapy.

Child↗
PubMed1998

[The effects of low-doses of fentanyl, buprenorphine and pentazocine on circulatory responses to endotracheal intubation].

This study evaluates the effects of low-doses i.v. fentanyl, buprenorphine and pentazocine on circulatory responses of endotracheal intubation in 70 scheduled surgical patients. Patients were allocated to 5 groups randomly and 2 (n = 11) or 4 (n = 13) micrograms.kg-1 of fentanyl, 0.5 mg.kg-1 of pentazocine (n = 13), 5 micrograms.kg-1 of buprenorphine (n = 10) and saline as a control (n = 23) were administered 5 minutes before the administration of thiopental, respectively. Then, patients were intubated with 0.1 mg.kg-1 of vecuronium. Blood pressure and heart rate were recorded. Only 4 micrograms.kg-1 of fentanyl diminished circulatory responses of systolic blood pressure on the stimuli of endotracheal intubation.

Adjuvants, Anesthesia↗
PubMed1996

CD4 T-lymphocyte activation is associated with peak expiratory flow variability in childhood asthma.

BACKGROUND: Asthma has been recognized as a chronic inflammatory disorder of the airway. We have investigated the relationships among the activation markers on lymphocytes, eosinophils, their serum products in the peripheral blood, and the variability of airway obstruction in childhood asthma. METHODS: Twenty-two patients with atopic asthma (mean age, 12 years) were treated regularly and asked to measure their peak expiratory flow (PEF) twice daily for 7 days, Peripheral venous blood was obtained on day 8. RESULTS: The absolute counts of CD4 T lymphocytes expressing the activation marker CD25 in the peripheral blood on day 8 correlated significantly with the values of the coefficient of variation (CV) of both morning PEF (p < 0.01) and night PEF (p < 0.05) obtained over 7 days, but those of CD8+/CD25+ T lymphocytes, those of CD23+ B lymphocytes, and the serum concentrations of soluble CD25 did not. The absolute counts of peripheral blood eosinophils also demonstrated a significant correlation with the CV values of both morning PEF (p < 0.01) and night PEF (p <0.05). CONCLUSION: CD4 T-lymphocyte activation and increased counts of eosinophils in peripheral blood correlate with CV of PEF in patients with asthma, suggesting that CV of PEF is a good marker for assessing not only the variability of airway obstruction but also the degree of airway inflammation.

Adolescent↗
PubMed1996

[Bilateral vocal cord paralysis in children].

Eighteen infantile cases with bilateral vocal cord paralysis were treated at our hospital from 1970 to 1993. All cases were diagnosed using a flexible fiberscope to examine the larynx. Direct laryngoscopy was performed under general anesthesia for the definite diagnosis and differential diagnosis from laryngomalacia, subglottic stenosis, tracheal stenosis, or laryngeal web. Bilateral vocal cord paralysis in children is a rare disease, there have been few and reported cases. Eight cases were male and 10 cases were female. Thirteen cases were congenital, 4 cases acquired and 1 case was unknown. The characteristic symptoms of bilateral vocal cord paralysis include normal or near normal phonation with inspiratory stridor which may progress to complete respiratory obstruction. Associated anomalies and diseases included 3 cases of immature infant, 2 of myelomeningocele, and single cases of Arnold-Chiari malformation, cerebral palsy, hydrocephalus, laryngomalacia, William's syndrome, Wiedemann-Beckwith syndrome, hypoxia, esophageal hiatus hernia, gastroesophageal reflex, spina bifida, COFS syndrome, and cerebral atrophy. Laryngeal function was completely recovered in seven cases following growth of the children incompletely recovered in five cases, and 2 cases retained right vocal cord paralysis. Tracheostomy was performed in 2 cases. One case died from the original disease, and the other one case was unknown. Swallowing function, phonation and development were good. Our experience suggests that the airway with bilateral vocal cord paralysis in children can be managed well without the need for tracheostomy.

Female↗