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Biomedical subjects

J Yamagami

Publications and source records attributed to J Yamagami.

At least 19 recordsLinked to original sources
PubMed2005

The first case of cutaneous mucormycosis caused by Rhizopus azygosporus.

A rapidly enlarging leg ulcer appeared in a 54-year-old woman with systemic lupus erythematosus receiving aggressive immunosuppressive therapy. Skin biopsy revealed proliferation of hyphae in the midst of a neutrophilic abscess. Culture yielded Rhizopus azygosporus. As no organ involvement was detected by thorough examination, the patient was diagnosed as having primary cutaneous mucormycosis. Although intravenous amphotericin B therapy seemed to be very effective, it had to be discontinued due to nephrotoxicity. She unfortunately died of subsequent disseminated fungal infection and cerebral infarction in which the primary cause could not be determined. Minimum inhibitory concentrations of several antifungal drugs to the isolate were examined and amphotericin B proved to be the only agent that may potentially reach the effective plasma concentration. This is the first case report of cutaneous mucormycosis caused by R. azygosporus.

Amphotericin B↗
PubMed2001

Mathematical and optimal clustering of test points of the central 30-degree visual field of glaucoma.

PURPOSE: To determine a mathematically optimal sector pattern of the central 30 degree visual field for the follow-up of glaucomatous visual field change based on a large number of actual visual field test data of patients with glaucoma. METHODS: Visual field test data obtained from 1,039 eyes of 1,039 patients with open-angle glaucoma (OAG) using the 30-2 program of the Humphrey Field Analyzer were used for sectorization of the central 30 degree visual field. Of the 1,039 visual field data, 698 (modeling data) were used for determining the sector pattern and 341 (testing data) for checking the sector pattern. The modeling data were further divided into three groups according to the mean deviation (MD) (MD > or = -10 dB, -20 < or = MD < -10 dB, and MD < -20 dB), and the sector pattern was constructed from visual field data of each group using a clustering procedure called VARCLUS. The testing data were used for determining the optimal sector pattern. In a separate set of repeated visual field data of 303 patients with OAG, the fluctuation of MD, sector values of each sector determined, and total deviation of each test point were calculated and compared. RESULTS: The sector pattern constructed from visual field data of MD > or = -10 dB summarized the visual field performance most effectively. The fluctuation of the sector value of each sector was roughly 1.5 times smaller than the total deviation of each test point. CONCLUSION: The sector pattern determined may be useful in analyses of the visual field data of patients with glaucoma.

Glaucoma, Open-Angle↗
PubMed2001

[Pulmonary complications following laparoscopic cholecystectomy in patients with abnormal spirometry].

The purpose of this study was to determine the incidence of postoperative pulmonary complications (PPC) and the value of preoperative spirometry to predict PPC after laparoscopic cholecystectomy. Sixty-four of 1372 patients (8%) showed abnormal spirometry data. One out of 1372 patients developed aspiration pneumonia. The patient had high risk factors for serious PPC such as ASA physical status 4.84 y/o, longer anesthesia duration (230 min), multiple brain infarction and low albuminemia. Thirty to 39% of patients with abnormal spirometry showed less severe PPC such as atelectasis, lung collapse and pleural effusion, and incidence was the similar with normal lung function patients. Postoperative blood gas analysis showed a slight increase in arterial carbon dioxide tension during oxygen therapy. However, none of the patients with abnormal spirometry and less severe PPC developed manifest PPC (pneumonia, respiratory failure). Less severe PPC disappeared within second to third postoperative days. We conclude that laparoscopic intervention significantly reduced the incidence of severe PPC and the preoperative spirometry was not recommended in patients with no pulmonary symptoms.

Aged↗
PubMed2000

Changes in ocular surface caused by antiglaucomatous eyedrops: prospective, randomised study for the comparison of 0.5% timolol v 0. 12% unoprostone.

AIM: To study changes induced in ocular surface epithelia and the tear film by antiglaucomatous eyedrops. A beta blocker (0.5% timolol) and a novel prostaglandin F(2alpha) metabolite related drug (0.12% unoprostone) were examined in a prospective, randomised fashion. METHODS: 40 patients were randomly assigned to use either 0. 5% timolol (timolol group) or 0.12% unoprostone eyedrops (unoprostone group) twice a day for 24 weeks. In addition to routine ocular examinations, corneal epithelial integrity (vital staining tests, tear film break up time (BUT), anterior fluorometry, specular microscopy) and tear function (Schirmer's test, cotton thread test, tear clearance test (TCT)) were examined before and after the treatment. RESULTS: Both eyedrops caused significant reduction in intraocular pressure from the baseline levels. No significant changes were noted in corneal integrity in both groups, except a decrease in BUT at 20 weeks in the timolol group. The timolol group demonstrated significant decreases in Schirmer's test, tear clearance test, and tear function index (Schirmer's test value multiplied by clearance test); however, no such changes were noted in the unoprostone group. CONCLUSION: While unoprostone eyedrops caused no adverse effects on the corneal epithelial integrity and tear function, timolol caused significant impairments in tear production and turnover.

Adrenergic beta-Antagonists↗
PubMed2000

Trabeculectomy with mitomycin C for post-keratoplasty glaucoma.

AIM: To investigate the effect of trabeculectomy with and without mitomycin C in post-keratoplasty glaucoma. METHODS: A retrospective study was performed on patients who underwent trabeculectomy for glaucoma after penetrating keratoplasty. 34 eyes of 32 patients were included in this study. 26 eyes received trabeculectomy with mitomycin C and eight eyes without mitomycin C. The procedure was deemed successful if the intraocular pressure was maintained below 21 mm Hg with or without use of additional antiglaucoma medication (mean follow up time 22.3 (SD 10.3) months). RESULTS: At the last examination trabeculectomy was successful in 19 of 26 eyes (73.0%) with mitomycin C (+) and two of eight (25.0%) without (p=0.0219). When the prognosis was analysed by Kaplan-Meier curve, the mitomycin C (+) group showed a better prognosis (p=0.0182). Mean intraocular pressure and average number of glaucoma medications improved in the group with mitomycin C without severe side effects on the graft. Graft rejection after trabeculectomy was seen in two eyes in the mitomycin C group. Final graft clarity rate was 69.2% (18/26) in the mitomycin C (+) group and 37.5% (3/8) in the mitomycin C (-) group. Complications such as persistent epithelial defect, cystoid macular oedema, choroidal detachment, leakage from bleb were seen in four eyes in the mitomycin C (+) group and in one eye in the mitomycin C (-) group. CONCLUSIONS: Trabeculectomy with mitomycin C showed better results for glaucoma following keratoplasty.

Adult↗
PubMed1999

Effects of oral brovincamine on visual field damage in patients with normal-tension glaucoma with low-normal intraocular pressure.

PURPOSE: To prospectively study the effect of oral brovincamine, a relatively selective cerebral vasodilator, on further deterioration of visual field in patients with normal-tension glaucoma (NTG) with low-normal intraocular pressure (IOP). METHODS: Fifty-two patients with NTG (average age 57.7 years) with an IOP that was consistently less than 15 mmHg were randomly assigned to receive oral brovincamine (20 mg three times daily) or to an untreated control group. The groups were prospectively followed for 2 years with visual field examinations every 4 months, using the 30-2 Humphrey perimeter program. Changes in mean deviation (MD), corrected pattern standard deviation (CPSD), and total deviation (TD) at 74 test points were analyzed using regression analysis with linear mixed model. Data from one eye without media opacity of each subject were analyzed. RESULTS: There were no differences between groups in age; sex distribution; refraction; blood pressure; baseline IOP; MD, CPSD, or TD at each point. Changes in MD (standard error [SE]) during the study period were -0.778 (0.178) and -0.071 (0.195) dB/year in the control and brovincamine groups, respectively; change in the control group was significantly more negative than in the brovincamine group. Change in CPSD (SE) was 0.032 (0.015) and 0.004 (0.016) dB/year in the control and brovincamine groups, respectively. Change in the control group was significantly positive, but the intergroup difference was not significant. Change in TD was significantly negative at six test points in the control group, whereas no points showed a significant trend in the brovincamine group; the intergroup difference was significant. The average IOP was 13.2 mmHg and 13.1 mmHg in the control and brovincamine groups, respectively, and there was no significant intergroup difference. CONCLUSION: Oral brovincamine may retard further visual field deterioration in patients with NTG who have low-normal IOP.

Administration, Oral↗
PubMed1997

[Effect of non-surgical ocular hypotensive therapy in normal-tension glaucoma].

We investigated the effects of the topical ocular hypotensives with or without half circumference argon laser trabeculoplasty (ALT) on intraocular pressure (IOP) of normal-tension glaucoma (NTG) eyes. Seventy-two NTG patients whose pretreatment mean IOP was > or = 15 mmHg at least in one eye were included and one randomly chosen eye from one patient were used for analysis. They were followed for at least 15 months after commencement of the therapy. The mean pretreatment IOP averaged 17.2 +/- 1.6 mmHg (mean +/- standard deviation, n = 72). All eyes were first treated with topical 2% carteolol. In eyes where IOP reduction was considered unsatisfactory, topical 1% pilocarpine or 0.04% dipivefrine was added. In eyes where IOP reduction was still unsatisfactory even with the two medications, half circumference ALT was performed. Mean IOP reduction was 1.5 mmHg in the eyes treated with topical medications alone and 2.5 mmHg in those treated by topical medications plus ALT. The mean outflow pressure reduction was 16 and 26%, respectively. In 40% of the all eyes, satisfactory IOP reduction was obtained by topical medications with or without additional ALT.

Carteolol↗
PubMed1995

Visual field damage proximal to fixation in normal- and high-tension glaucoma eyes.

To compare in more detail the central visual field damage in normal-tension glaucoma (NTG) and high-tension glaucoma (HTG) eyes, a pointwise inner-group comparison of the data obtained with the Humphrey 10-2 was carried out in 68 NTG cases with maximum intraocular pressure (IOP) of < or = 21 mmHg and 62 HTG cases with maximum IOP of > or = 25 mmHg. All eyes had the usual field defects, with a mean deviation of > or = -15 dB (MD, STATPAC). Age, refraction and MD were matched between the two groups. Total deviation (TD, STATPAC), the difference between the measured threshold and the age-corrected normal reference at each test point of the 10-2 program, was used for pointwise inter-group comparisons. The data were analyzed with Wilcoxon rank-sum test and logistic discriminant analysis. The latter method was also applied to the data of the 30-2 program to confirm the results obtained with the 10-2 program. The comparisons using the different methods and programs gave consistent results. For a given amount of overall visual field damage in the two types of glaucoma, a superior arcuate area extending down to the horizontal meridian just nasal to the fixation point was significantly more depressed and an area inferior to the horizontal meridian and inferior temporal to the fixation point significantly less depressed in NTG eyes. HTG eyes were significantly more diffusely damaged in the central 10-degree visual field. NTG and HTG may have unique patterns of central visual field damage. These differences may implications in following NTG patients and studying the pathogenesis of this glaucoma.

Fixation, Ocular↗
PubMed1995

Color vision deficit in normal-tension glaucoma eyes.

Color vision deficit in 26 eyes with normal-tension glaucoma (NTG) is compared with that in 21 eyes with primary open angle glaucoma (POAG) using the color perimetry method developed by Iijima et al. Subjects had visual field defects confined to either the upper or the lower hemifield as determined by conventional white-on-white perimetry, and the stage of disease was relatively early with an average mean deviation (MD) of -7 dB. Except for intraocular pressure, there were no significant differences between NTG and POAG subjects in age, refraction, MD, and mean total deviation for spared and damaged hemifield. In the spared hemifield, the incidence of blue-yellow abnormality was significantly different between the two diseases (P = 0.01); in only 11% of the present NTG eyes versus 52% of the POAG eyes in the present study. In the damaged hemifield, however, the blue-yellow abnormality was found in about 75% of the eyes, whether NTG or POAG. This finding may further shed light on the pathogenesis of open angle glaucoma.

Adult↗
PubMed1993

Visual field defects in normal-tension and high-tension glaucoma.

BACKGROUND: Differences in visual field characteristics between normal-tension glaucoma (NTG) and high-tension glaucoma (HTG) have not been established. This study re-examined the problem by pointwise between-group comparison of data obtained with the Humphrey 30-2 program. METHODS: Sixty-eight NTG cases with maximum intraocular pressure (IOP) of 21 mmHg or lower and 62 HTG cases with maximum IOP of 25 mmHg or greater with a mean deviation (STATPAC) greater than -10 decibels (dB) were included. Age, refraction, mean deviation, or sex ratio were matched between the two groups. Total deviation (STATPAC), the difference between the measured threshold and the age-corrected normal reference at each test point of the 30-2 program, was used for pointwise between-group comparisons. Another parameter, total deviation - mean total deviation, was introduced to normalize the total deviation by the overall visual field damage as an index of disease stage. Mean total deviation is the average of total deviations across the test field. Further, logistic discriminant analysis was applied to confirm that the difference at a questioned test point was due to the difference of disease type, but not disease stage, between the two groups. RESULTS: Comparison using total deviation and total deviation - mean total deviation gave similar results, which were collaborated by logistic discriminant analysis. For a given amount of visual field damage, an area just above the horizontal meridian was significantly more depressed in NTG, while HTG had significantly more diffuse visual field damage. CONCLUSION: Visual field defect of NTG differs from that of HTG, which may suggest that different regions of the optic disc are more susceptible to damage in NTG.

Adult↗
PubMed1993

Diurnal variation in intraocular pressure of normal-tension glaucoma eyes.

BACKGROUND: The nature of intraocular pressure (IOP) in normal-tension glaucoma (NTG) has not been studied in detail, although the information on the IOP is indispensable for diagnosis and treatment of NTG. METHODS: After at least six IOP measurements at daytime clinic, diurnal IOP was measured at 10:00 AM, 12:00 noon, 2:00, 4:00, 6:00, 8:00, 10:00 PM, 12:00 midnight, and at 3:00, 6:00, 8:00, and 10:00 AM by 1-day hospitalization in 118 NTG suspects. Four subjects with peak IOPs exceeding 21 mmHg were diagnosed as primary open-angle glaucoma (POAG) whose eyes all had mean clinic IOPs above 16 mmHg. The remaining 114 patients were diagnosed as having NTG, and their right eye data were used for analysis. RESULTS: The rhythmic nature of the diurnal IOP of NTG was analyzed by fitting the data to a cosine curve. In 54.4% of the eyes, the correlation between the measured IOP and the values predicted from the cosine curve was significant (r > 0.60, P < 0.05), and the equation, diurnal IOP = 13.9 + 1.7 cos 2 pi (t/24-0.40) mmHg, which was similar to that reported in normals, was obtained. Multiple regression analysis showed that the mean diurnal IOP was best predicted with the mean of the six clinic IOPs and systolic blood pressure (R2 = 0.67), and the peak diurnal IOP with the mean of six clinic IOPs (R2 = 0.50). The estimate fell within +/- 1 and +/- 2 mmHg of the actual value in 83% and 96% of the left eyes for the former and in 69% and 93% for the latter, respectively. No eyes with peak diurnal IOP exceeding 21 mmHg were overlooked with the cutoff IOP of 16 mmHg. CONCLUSION: The mean and peak diurnal IOP could be predicted with the mean of clinic IOPs.

Blood Pressure↗
PubMed1993

[The central visual field defects in low-tension glaucoma. A comparison of the central visual field defects in low-tension glaucoma with those in primary open angle glaucoma].

To discover if there is difference in central visual field damage between low-tension glaucoma (LTG) and primary open angle glaucoma (POAG) eyes, the data obtained with the 10-2 threshold program of the Humphrey visual field analyzer were analysed using logistic discriminant analysis. One hundred and four LTG eyes from 65 case (maximum IOP < or = 21 mmHg) and 48 POAG eyes from 34 cases (maximum IOP > or = 25 mmHg) with early to moderately advanced visual field damage were included. There was no significant difference in mean deviation (MD, STATPAC), refraction, or age between the 2 groups. The analysis demonstrated that an arcuate area in the upper central 5-10 degrees of the visual field was significantly more depressed in LTG than in POAG eyes.

Aged↗
PubMed1993

[A comparative study of visual field damage in low-tension and primary open-angle glaucoma].

We compared the results of visual field examination obtained with a Humphrey 30-2 program between 57 eyes of 57 low-tension glaucoma (LTG) and 57 eyes of 57 primary open-angle glaucoma (POAG; max IOP > or = 25 mmHg) cases, whose mean deviation (MD) given by STATPAC was > -10 dB. MD, age, and refraction showed no differences between the two groups. Corrected pattern standard deviation (CPSD) was significantly higher in the LTG group (p < 0.01). The total deviation (TD), deviation from the age-corrected normal reference, was found to be significantly lower by about 5 dB in the LTG group at two test points nasal-superior to the fixation point (Wilcoxon rank sum test, p < 0.01). Logistic discriminant analysis carried out to exclude a subtle difference in the distribution of the stage of disease between the two groups confirmed a significant between-group difference at the above-mentioned points. Furthermore, to compare the unevenness of visual field in the two groups, [TD-mean TD] was calculated, where mean TD was the average of 70 points of TD excluding the uppermost four points, and the same two points obtained above were found to decrease significantly in LTG, while all points were diffusely damaged in POAG. These results may imply a difference in the mechanism of visual field damage between LTG and POAG.

Adult↗
PubMed1993

[A study of para-foveal color vision in normal-tension and primary open angle glaucoma eyes].

A perimetric color vision test developed by Iijima et al. for evaluating parafoveal color vision provides information regarding local retinal function which can not be evaluated by other color vision tests. Using this method, we investigated para-foveal color sensitivity in normal-tension glaucoma (NTG) and primary open angle glaucoma (POAG) eyes whose glaucomatous visual field change determined with the central 30-2 program of the Humphrey visual field analyzer was confined to either the upper or the lower hemifield. The examined eyes had no abnormalities in ocular media with best corrected visual acuity of 1.0 or higher, and age, refraction, mean deviation, and extent of visual field loss were matched between NTG and POAG eyes. In the para-foveal area of the spared hemifield, acquired blue-yellow dyschromatopsia was detected in 52.3% of the POAG eyes and in 11.3% of the NTG eyes (p < 0.02, chi 2-test), and in damaged hemifield, it was found in 76.1% of the POAG eyes and 80.7% of the NTG eyes. We suggest that visual function is more diffusely damaged in POAG than in NTG and that the perimetric color vision test is useful for detecting glaucomatous damage which cannot be detected with conventional light threshold measurements.

Adult↗
PubMed1993

[Combined posterior chamber intraocular lens implantation and trabeculectomy--a life-table analysis of postoperative clinical course].

Postoperative courses of 68 eyes of 58 glaucoma patients who underwent posterior chamber intraocular lens implantation combined with trabeculectomy were studied retrospectively. The visual acuity was 0.5 or better in 66% of the eyes at 3 months postoperatively. The average intraocular pressure (IOP) was below 15 mmHg till 16 months postoperatively. An analysis of the postoperative course using the life-table method of Kaplan-Meier revealed that the probability of successful IOP control with medication was 83% at 18 months and 47% without medication. The subjects aged 75 years or older showed significantly higher success probability than those younger than 75 years, while types of glaucoma, the preoperative IOP control, location of conjunctival or sclerocorneal incision, postoperative 5-fluorouracil (5-FU) injections or surgical intervention on the iris had no significant effects on the probability of successful IOP control. The probability of subsistence of functional filtering bleb was 24% at 18-month follow-up, on which postoperative administration of 5-FU of 35 mg or more had a favorable effect.

Aged↗
PubMed1992

A comparative study of optic nerve head in low- and high-tension glaucomas.

The disc and rim areas in 15 eyes from 15 selected low-tension glaucoma (LTG) patients were compared with those in 15 eyes from 15 selected high-tension glaucoma (HTG) patients. In all patients, visual field defects (VFD) were at an early stage (mean deviation greater than -5 dB, program 30-2 of Humphrey Visual Field Analyzer, STATPAC) and were confined to either the upper or lower hemifield. There were no significant differences in the degree of VFD between LTG and HTG, and the peak intraocular pressure averaged 18.9 and 29.2 mmHg for LTG and HTG eyes, respectively. The disc and rim areas were determined from stereoscopic disc photographs using the method of Littman. The half rim area corresponding to the upper or lower hemifield without VFD was significantly smaller for LTG than HTG (LTG 0.26 +/- 0.08 mm2, HTG 0.31 +/- 0.08 mm2, mean +/- SD, n = 15, P less than 0.005). The rim area corresponding to the upper or lower hemifield with VFD was also significantly smaller for LTG than HTG (LTG 0.19 +/- 0.08 mm2, HTG 0.24 +/- 0.08 mm2, P less than 0.01). On the other hand, there was no significant difference in the disc area between LTG and HTG (LTG 1.96 +/- 0.57 mm2, HTG 2.03 +/- 0.45 mm2, P greater than 0.4). It was suggested that the differences in rim area were already present prior to the manifestation of the VFD.

Glaucoma, Open-Angle↗
PubMed1992

[Relationship of the office intraocular pressure (IOP) to diurnal fluctuation of IOP in low-tension glaucoma: a multivariate analysis].

In 288 eyes of 114 low-tension glaucoma (LTG) patients, the mean, peak, trough and magnitude of the diurnal fluctuation of the intraocular pressure (IOP) determined over a period of 24 hours (diurnal IOP) were correlated with the IOPs recorded at the daytime office (office IOP), refraction, extent of visual field loss, age, sex, blood pressure and obesity index by the method of multivariate analysis. Only the mean office IOP was found to have a statistically significant contribution for estimating the mean, peak and trough of the diurnal IOP with the proportion (R) of 0.71 0.67 and 0.68 respectively. Furthermore, an analysis of the IOP data obtained from 118 LTG suspects using the receiver operating characteristics (ROC) curve showed that a patient whose peak diurnal IOP exceeds 21 mmHg could be detected with a sensitivity of 100% and a specificity of 46% if around-the-clock IOP measurements were carried out in patients whose mean office IOP are above 16 mmHg at least in one eye. In view of high prevalence of LTG in Japanese, estimation of mean diurnal IOP from mean office IOP and exclusion of primary open angle glaucoma using the mean office IOP of 16 mmHg as a cutoff IOP level are thought to be clinically useful.

Adult↗