Biomedical subjects
Publications and source records attributed to J Wada.
Eighty-four epileptic patients, with seizures originating in either the left or the right hemisphere, were evaluated to determine the relations between lateralization of epileptogenic foci, gender, and depression. Our data suggest that male subjects, but not female subjects, with left-sided foci may be particularly vulnerable to depression.
Ninety-four epileptic patients who had undergone the carotid amytal test were evaluated in order to determine whether sex affects the pattern of hemispheric reorganization following cerebral injury. Our data suggest that the period during which hemispheric reorganization for speech can occur differs between the sexes. Females have a relatively short window, with reorganization most likely during the first year of life. The length of this window is more difficult to define for males but may extend until puberty. The period during which a shift to left-handedness can occur does not appear to be affected by gender. Here, both males and females seem to show a relatively short window.
Epileptic patients who had undergone the carotid amytal test were assessed on a variety of measures of verbal and nonverbal ability. All patients had left-hemisphere dysfunction early in life, before 1 year of age. In males, such damage results in generalized cognitive retardation regardless of the status of the cerebral speech pattern. In females, intellectual retardation is linked specifically to a shift in speech processes. This sex-related difference in behavioral outcome may reflect interruption at different maturational stages and/or the influences of the immediate hormonal milieu.
Cross-sectional survey on the prevalence of hepatitis B serological markers was performed in 2,411 residents who accounted for 74.4% of the population aged 40 and over and living in Hisayama Town, Japan, in 1983. Overall prevalences were 40.7% for both anti-HBs and anti-HBc, 6.1% for isolated anti-HBs and 5.4% for isolated anti-HBc. The condition with isolated anti-HBs was different from those with isolated anti-HBc and both anti-HBc and anti-HBs as follows. The titer of anti-HBs in isolated anti-HBs positive samples was significantly lower than that in both anti-HBs and anti-HBc positive ones (46.2 +/- 5.4 vs. 83.2 +/- 2.8, mean +/- SE, p less than 0.001). The presence of isolated anti-HBs was neither significantly more frequent in males nor related to the risk of liver damages in contrast with that of anti-HBc with or without anti-HBs. These findings suggest that isolated anti-HBs pattern with the absence of anti-HBc in general population was not due to prior HBV infection, but due to natural immunization with HBsAg.
The prevalences of hepatitis B surface antigen (HBsAg) carriers and liver damages were studied in 2,411 residents aged 40 and over and living in Hisayama, Japan in 1983. Hepatitis B virus (HBV) associated markers were all measured by radioimmunoassay. HBsAg carriers were found in 2.3 per cent of the residents. Hepatitis B e antigen and antibody to hepatitis B e antigen were positive in 8.9 per cent and 80.4 per cent, respectively, of HBsAg carriers. The prevalences of liver damages in HBsAg carriers were compared with 1095 who had none of HBV markers (neither anti-HBc nor anti-HBs). The prevalences of abnormal aminotransferase level in sera were not different between HBsAg carriers and those who had none of HBV markers. A history of jaundice and/or hepatitis was evident in 32.3 per cent of male carriers and 24.0 per cent of female ones, being significantly more than those without HBV markers (13.1 per cent and 5.8 per cent, p less than 0.05 and p less than 0.005, respectively). These results indicate that, among HBsAg carriers aged 40 and over, few have active clinical signs of hepatitis, although about 20 per cent of them have histories of symptomatic hepatitis due to hepatitis B.
Unicompartmental arthroplasty using the Marmor Modular knee was performed in 27 knees of 24 patients--three men and 21 women--aged 51-82 years (average age 68.9 years). The disease was osteoarthritis in 19 knees, steroid arthropathy in two knees, Charcot joint in three knees, and rheumatoid arthritis in three knees. Medial replacement was done in 24 knees and lateral replacement in three knees. Follow-up was from 2-7 years (average 4 years 9 months). Post-operatively, 14 knees were reported to be free of pain and 11 only occasionally mildly painful. Walking distance improved to more than 1 km in 17 patients. The knee score improved from 40.4 to 72.2 points (p less than 0.01). Complications included two knees with loosening due to postoperative limb malalignment; there were no instances of infection or fracture.
Effect of serine protease inhibitor Camostat Mesilate (Foipan) on primary glomerulonephritis and it's mechanism were evaluated. Forty-two patients having primary glomerulonephritis (13 cases of IgA nephropathy, 11 cases of membranous nephropathy and others), aged 18 to 81 years were selected for this study. At the start of our study, twenty-one patients had received other drugs (13 cases of dipyridamole and 13 cases of prednisolone). A control period of four weeks was established to confirm that the levels of proteinuria and renal functions were stable. Patients were orally administered with 600 mg of Camostat Mesilate per day for four weeks. Effect of Camostat Mesilate was judged by urinary protein excretion, hematuria, serum total protein, albumin, Ccr, creatinine and BUN. In order to reveal the mechanism of the effect laboratory data such as granulocyte elastase, CH50, C3, C4, fibrinogen, platelate factor 4, beta-thromboglobulin, thromboxane B2 and prostaglandin F1 alpha were evaluated before and after the treatment. Parameters were analyzed by using paired t-test. Mean (+/- SEM) urinary protein excretion reduced from 4.31 +/- 0.91 to 2.80 +/- 0.43 g/day (p less than 0.05), and score of hematuria decreased from 1.8 +/- 0.16 to 1.5 +/- 0.15. A significant decrease in urinary protein excretion was seen in membranous nephropathy and a significant decrease in hematuria was seen in IgA nephropathy. In combination therapy (dipyridamole, prednisolone) urinary protein excretion markedly decreased (p less than 0.05) and in Camostat Mesilate therapy score of hematuria markedly decreased (p less than 0.05). Camostat Mesilate had no effects on renal function assessed by Ccr, creatinine and BUN.(ABSTRACT TRUNCATED AT 250 WORDS)
We report a case of 67-year-old woman with systemic lupus erythematosus presenting hyporeninemic hypoaldosteronism. She admitted because of anasarca in March, 1990. She manifested nephrotic syndrome, and hyperkalemia and hyperchloremic metabolic acidosis. The hyperkalemia was disproportionate to the degree of renal insufficiency. Basal levels of plasma renin activity and plasma aldosterone concentration were low. Renal tubular function studies revealed normal hydrogen ion secretion. Renal biopsy demonstrated diffuse proliferative lupus nephritis and prominent interstitial cell infiltration. There was no vasculitis of glomerular vascular poles. After treatment of lupus nephritis with prednisolone, levels of plasma renin activity and plasma aldosterone concentration were elevated. Hyperkalemia and metabolic acidosis were normalized and renal function improved. We conclude that the heperkalemia and metabolic acidosis could be attributed to hyporeninemic hypoaldosteronism.
Epileptic patients who had undergone the carotid amytal test were assessed on a variety of measures of verbal and non-verbal ability. All patients had left hemisphere dysfunction of early onset. Patients with atypical speech patterns performed as well as patients with left hemisphere speech on most, though not all, measures of language function. Transfer of language to the right hemisphere, however, occurred at a heavy cost. Patients with atypical speech patterns performed more poorly than their left hemisphere speech counterparts on a wide variety of non-verbal tests. These results are discussed in terms of the "crowding" hypothesis.
Asymmetry in the opening of the two sides of the mouth during speech has been suggested as an observable correlate of lateralization of cerebral speech motor control. For 24 epileptic patients who suffered speech disturbance only during left hemisphere carotid amytal anesthetization, 22 showed the expected greater opening of the right side of the mouth during a repetition task. However, all four of the patients who suffered speech disturbance following only right hemisphere anesthetization, and 8 of the 11 "bilateral speech" patients, also showed greater opening of the right side of the mouth. The speech dominant patients may, however, have genetic left speech dominance but a pathology-forced shift of some components of language to the right hemisphere. Basic mouth asymmetry, as measured here, may primarily reflect lateralization of a component of the motor/speech/language control system that may not be shifted by pathology in epileptic patients sustaining early brain insult. Relative change in mouth asymmetry as the speech task becomes more demanding may, however, be a more sensitive indicator or cerebral asymmetries for language in pathological cases.
We conducted a survey of 356 married couples and their 552 children living in Hisayama in Fukuoka prefecture in order to investigate the correlation between changes in obesity from adolescence to young adulthood. 1. A positive correlation between couples in weight and height could be found, but its coefficient was weak (r = 0.12, 0.10). There was no correlation between couples in BMI. 2. The correlation between parents and their children in height, weight and BMI was significantly positive (r = 0.18, 0.45), having a coefficient greater than that of the correlation between married couples. 3. The correlation coefficient between mother and child was greater than that of the correlation coefficient between father and child. 4. The BMI of a child with either parent obese was significantly greater than that of a child with neither parent obese. Obesity appeared more frequently in children whose BMI of parent was higher. 5. A positive correlation between the BMI of young adults and that of adolescents could be found, and the average BMI of the obesity group was higher than that of the non-obesity group even in the adolescent subjects. 6. Even after considering BMI during adolescence, the familial factor had a significant relationship to the BMI of young adulthood. These results suggest that obesity in adolescence will influence obesity in young adulthood, and that the appearance of obesity strongly correlates with the familial obesity factor. In conclusion, it is very important to take preventative measures, in cooperation with the family, early in a child's adolescent years in order to avoid obesity in adulthood.
Between 1980 and 1987, medical examinations and measurement of height, weight, and blood pressure were performed on 613 persons from among a cohort of 740 persons living in Hisayama town in Fukuoka prefecture who had attained the age of 19 to 20 by the end of the study. Of this group, 439 persons (215 males and 224 females) were further studied to determine the correlation between changes in blood pressure, height, weight and obesity that had occurred since age 14-15 years old, and their family history of hypertension and obesity. 1. A positive correlation was found between blood pressure levels and BMI. 2. There was a significant positive correlation between blood pressure levels at the age of 14-15 and those at the age of 19-20. 3. Those who maintained high blood pressure levels from the age of 14-15 through the age of 19-20 had high BMI. Many of these subjects had family history hypertension, but family history of obesity did not appear to have influenced the continuity of their high blood pressure levels during this stage of life. These results indicate that there was a weak tracking phenomenon for blood pressure from adolescence to young adulthood, and that family history of hypertension and continuity of obesity were detrimental factors contributing to continued high blood pressure levels. In conclusion, it is crucially important to take measures against obesity in early adolescence, especially in the presence of family history of hypertension, in order to prevent adulthood hypertension.
We performed cardiac valve replacement using the Wada-Cutter valve in 124 patients during the 9 years between 1966 and 1974: aortic valve replacement in 48, mitral valve replacement in 56, tricuspid valve replacement in 9, and multiple valve replacement in 11. Sixteen patients died within 30 days after operation, and 34 died in the late postoperative period, with a cumulative mortality rate of 40.3%. Postoperative complications included valve thrombosis in 9 patients, thromboembolism in 4, and mechanical valve failure in 5. The Wada-Cutter valve, first described at the Annual Meeting of The Society of Thoracic Surgeons on January 27, 1967, in a discussion on the paper by Cooley and colleagues on mitral valve replacement with a discoid valve, attracted attention for its unique design. Four of the Wada-Cutter valves were incorporated in Liotia's total artificial heart, which was implanted clinically for the first time in Cooley's second-stage heart transplantation. It may not only claim to be the origin of today's most popular tilting-disc heart valves but also has some original concepts with regard to bileaflet and tricuspid tilting-disc heart valves. However, at that time, cardiac valve replacement with this prosthesis resulted in a high incidence of thrombosis without systemic anticoagulation and in mechanical valve failure due to hinge wear of the Teflon occluder. For these reasons, its clinical use was discontinued in 1974. If Pyrolite carbon had been adopted in construction of the valve when it first became available, the valve design could have been useful even today.
Major categorical diagnosis by International Classification of Diseases and type-specific diagnosis for cardiovascular diseases in death certificates were compared to the diagnosis made at autopsy in 864 consecutive autopsy cases aged 20 or over, among the Japanese residents in Hisayama town. Cerebral stroke was correctly diagnosed in 84%, malignant neoplasms in 78% and cardiac disease in 66%. Cerebral stroke and cardiac disease tended to be overdiagnosed, while malignant neoplasms were underdiagnosed. The validation of certified diagnosis was less reliable in the aged population, and in type-specific diagnosis of cardiovascular diseases. Cerebral hemorrhage with false negative or false positive diagnoses was usually classified into type unspecified stroke or different categories of cerebral stroke, while those misdiagnosed as cases of cerebral infarction frequently had no significant lesions in the autopsied brain. Finally, the relationship between the validation of diagnosis on the death certificates and the secular trend in cardiovascular disease in the Japanese vital statistics was discussed.
Twenty-six first episodes of subarachnoid hemorrhage occurred among 1,621 Hisayama residents aged greater than or equal to 40 years during the 22-year follow-up of a prospective study. Subarachnoid hemorrhage was confirmed by both clinical and autopsy findings. The average annual incidence (96.1/100,000 population) was 3-13 times higher than any previously reported and steeply increased with age in both sexes, being 2.3 times higher for women than for men after adjusting for age. Nine patients (35%) died less than or equal to 8 hours after the onset of subarachnoid hemorrhage. None was correctly diagnosed on the death certificates, and four of the nine (44%) were misdiagnosed as intracerebral hemorrhage. We found the survival rate of patients suffering subarachnoid hemorrhage to be much lower than previously reported because we detected a large number of sudden deaths due to subarachnoid hemorrhage through the high rate of autopsy in our cohort (81.4%).
We performed surgical reconstruction on 1655 cases of deformed thoracic cage, we later operated again on 11 of these to repair postoperatively re-deformed anterior chest walls. Based on these experiences, we have concluded as follows. 1: Postoperative recurrence of funnel chest deforming is mainly due to insufficient resection of costal cartilages. In particular transection of the sternum at low levels during sternal turn-over procedure results in postoperative recurrence of depression in the upper anterior chest wall. 2: In young children who have undergone sternal turn-over procedure, the first and second costal bones and cartilages overgrow and protrude anteriorly, and in compensation their junctions to the sternum recess posteriorly. This results in a depression in the upper anterior chest wall. 3: We recommend sternal turn-over with overlapping of the sternum for repair of postoperative funnel chest deformity. Through this procedure, the extent of resection of costal cartilages can easily be determined and the depression of the anterior chest wall satisfactorily reconstructed. 4: In re-do surgery, we obtained pathological evidence confirming our clinical experience that our sternal turn-over technique does not interfere with blood circulation or development of the turned-over sternum even though the sternum is not connected to the rectus abdominus muscle pedicle, preserved internal mammary vessels, or anastomosis of the internal mammary vessels.
A case of a ten-day-old neonate weighing 3,867 g with the supracardiac type of total anomalous pulmonary venous return (TAPVR) is reported. The preoperative diagnosis was determined mainly by digital subtraction angiography. Surgical correction was carried out in this patient as an emergency operation. Under cardiopulmonary bypass on beating which required 3 hours and 7 minutes, anastomosis between the common pulmonary vein and the left atrium, ligation of both the anomalous vertical vein and the persistent ductus arteriosus, and closure of the atrial septal defects were successfully performed. Postoperatively cardiac failure was markedly improved, although 5 days were required for the weaning from the artificial respirator. The angiographic and hemodynamic examinations showed a complete repair of TAPVR. At present, 2 months after the operation, the patient shows an average development.
Surgical techniques were described on tibial osteotomy above the tuberosity, the fragments of which were fixed with a Koshino blade plate. Postoperative clinical results on 176 knees with medial compartment osteoarthritis of 138 patients with an average age of 62.1 years were excellent in 110 and good in 55 knees with an average of 5.5 years' follow-up. The best knee score was obtained in the knee with postoperative limb alignment of 6 to 15 degree valgus angulation (standing). The results were satisfactory, especially in postoperative management, which was much easier with the Koshino blade plate fixation than with other methods. The sinking of the osteotomy site was checked through observation of screw movement in the slot of the plate during postoperative management in 53 selected knees, and the averaged distance of sinking was 3.9 +/- 2.5 mm. The time of mechanical bone union judged by cessation of sinking averaged 12.9 +/- 6.2 weeks after osteotomy.