Biomedical subjects

K Arima

Publications and source records attributed to K Arima.

At least 145 records · Page 8Linked to original sources

PubMed1996

Detection of subclinical disorders of the hypopharynx and larynx by gastrointestinal endoscopy.

BACKGROUND AND STUDY AIMS: It is believed that blind introduction of an endoscope into the esophagus causes less patient discomfort. The aim of this study was to evaluate the yield and usefulness of endoscopic screening of the hypopharyngeal and laryngeal regions. PATIENTS AND METHODS: A total of 1623 patients who underwent upper gastrointestinal endoscopy for gastrointestinal disease between 1987 and 1992 had the instrument introduced under visual guidance, and were retrospectively studied. RESULTS: We found 15 pathological conditions in the throat (0.92%): two small cancers (0.12%), one advanced cancer (0.06%), two hypopharyngeal polyps (0.12%), one cyst (0.06%), and eight cases of lymphoid hyperplasia (0.49%) in the hypopharyngeal region. A large Zenker's diverticulum was detected in one patient (0.06%). All of these cases could have been overlooked if the instrument had been passed blindly through the throat. CONCLUSIONS: In patients undergoing upper gastrointestinal endoscopy, the procedure of screening the hypopharyngeal and laryngeal region is justified to detect earlystage disease in these regions.

Adolescent↗

PubMed1996

A clinical profile of corticobasal degeneration presenting as primary progressive aphasia.

We report a patient with primary progressive aphasia who first presented with amnesic aphasia that developed over the course of 3 years into nonfluent aphasia with buccofacial apraxia, followed in the next year by cognitive impairment and parkinsonism. Pathological findings were typical for corticobasal degeneration except for the distribution of cortical atrophy. This case suggests that corticobasal degeneration should be included in the differential diagnosis of primary progressive aphasia, especially in association with parkinsonism.

Aphasia, Primary Progressive↗

PubMed1996

Prognostic factors of peripheral blood lymphocyte subsets in patients with renal cell carcinoma.

In 76 patients with renal cell carcinoma (RCC) we assessed the therapeutic effects of interferon-alpha (IFN-alpha) and the outcome of curative resection by analyzing changes in peripheral blood lymphocyte subsets to try to find prognostic indices. The percentage of activated CD8-positive cells present in blood samples before IFN-alpha therapy was significantly higher in progressive disease (PD) patients who died within 8 months than in PD patients who survived for more than 18 months. The high percentage of activated CD8-positive cells present in postoperative blood samples was the most remarkable characteristic in patients in which RCC recurred. Multivariate analysis showed that the percentage of activated CD8-positive cells in postoperative blood samples was the only predictor of recurrence (hazard ratio 1.29, p value 0.02). Thus, the high percentage of activated CD8-positive cells in postoperative blood samples is, therefore, a useful indicator of poor prognosis.

Antineoplastic Agents↗

PubMed1996

[A clinical study of renal cell carcinoma with extension into the inferior vena cava].

Nineteen patients with renal cell carcinoma with tumor extension into the inferior vena cava (IVC) were investigated between January, 1973 and March, 1994. The patients were between 50 and 78 years old with a mean of 65.9 years. The male to female ratio was 1.7 to 1. Thirteen tumors were on the right side and 6 on the left side. In 12 patients, both nephrectomy and removal of the tumor thrombus were performed. The survival rate in the operated group was 60% at 5 years. Histologically, 7 cases were diagnosed as clear cell subtype and 5 cases as granular cell subtype. From this study, an extended operative intervention such as radical nephrectomy combined with tumor thrombectomy of the IVC with or without cavectomy was suggested in the case of renal cell carcinoma without any other metastatic lesions and histopathologically of the clear cell subtype.

Aged↗

PubMed1996

[Effect of pamidronate and interferon-alpha on bone and lung metastases and hypercalcemia in a patient with renal cell carcinoma].

Pamidronate is a second generation bisphosphonate used for treating tumor-induced hypercalcemia and for preventing the development of new bone metastasis. A 47-year-old man with renal cell carcinoma was admitted in our institution because of hypercalcemia with multiple metastasis in bone, lung and lymph nodes. After embolization of the right renal artery, the patient was treated with pamidronate and interferon-alpha. Intravenous pamidronate significantly reduced bone pain and normalized the serum calcium level. The pulmonary metastasis responded to interferon therapy after 2 months of therapy. Radical nephrectomy was then carried out. Paraaortic lymph nodes were found to be necrosed completely. Ossification of osteolytic lesions was observed after two months of therapy and metastatic lesions in the lung showed complete remission (CR) after six months of therapy.

Antineoplastic Agents↗

PubMed1995

Occupational hypersensitivity pneumonitis in Japan: data on a nationwide epidemiological study.

OBJECTIVES: Diagnostic criteria were prepared for hypersensitivity pneumonitis (HP) and a nationwide survey was conducted to investigate epidemiological and clinical characteristics of HP in Japan. The results are presented with special focus on occupational HP and on the key to the diagnosis of HP. METHODS: A questionnaire was completed by 185 doctors from 185 hospitals (response rate 89.5%). All cases were verified according to diagnostic criteria; 835 cases were classified as HP (653 definite and 182 probable). These 835 cases (total HP) and 99 possible cases of HP diagnosed during the 1980s were analysed and presented as a case series study. RESULTS: Occupational HP was noted in 115 cases (13.8%). 21 occupations, and 20 aetiological antigens were listed. Farmer's lung: 68 cases (59% of occupational HP) was the most prevalent diagnosis followed by 19 industrial workers who handled chemicals (for example, isocyanate) and 10 office workers. Unique cases of mushroom, greenhouse, and silkworm farmers, and a new type of bagassosis are also described. Adverse environmental conditions, immunological findings on examination, antigen challenge, and pathological findings were all significantly lower for possible than for total HP. This was not true for clinical findings. The differences in antibody analysis (6% positive of possible HP v 59% of total HP) and environmental challenge (3% v 74%) were notable. CONCLUSION: These data suggest that a careful interview about the environment and an antigen panel matched to variations in exposure are the key to the diagnosis.

Alveolitis, Extrinsic Allergic↗

PubMed1995

[Renal angiomyolipoma: diagnosis and treatment].

In 10 years the diagnosis of renal angiomyolipoma (RAML) was made in 14 patients (male-to female ratio 1:3.7) at our institution; 1 case was associated with tuberous sclerosis (TS) and 1 case had regional lymph node involvement. A statistical study was done on data taken from 739 cases of RAML in the Japanese literature, including our cases. The male to female ratio was 1 to 3. Twenty eight percent of the cases were associated with TS. The ratio of bilateral cases to the unilateral one was 1 to 3. The main clinical signs were flank pain, abdominal mass, hematuria and fever elevation. Recently the ratio of nephrectomy has decreased to 30%. The percentage of detecting the fat component by ultrasonography (US), computed tomography (CT) and magnetic resonance imaging were 88.1%, 86.5% and 80.8% respectively. The percentages of visualizing hypervascularity, aneurysms, absence of arterio-venous shunt and onion peel appearance by selective renal angiography were 77.3%, 71.4%, 48.1% and 4.9% respectively. Small (less than 3 cm), asymptomatic, simple lesions with adipose component may be observed annually by CT and US until more experiences is gained with surveillance of these patients. Embolization was useful for emergency cases or pre-treatment of nephron sparing surgery, but insufficient by itself. As there still remain problems in the diagnosis of RAML, especially in the case of very small tumors, in the case with almost no adipose component and in the case associated with renal cell carcinoma, the diagnosis of RAML should be made synthetically including angiography.

Adult↗

PubMed1995

[Intravesical instillation of pirarubicin for a patient with bladder cancer and chronic renal failure: a case report].

The patient was a 71-year-old woman. Two years ago right nephrectomy was performed by a general surgeon at the diagnosis of right renal cell carcinoma. However, the pathological report was transitional cell carcinoma (TCC) of the right renal pelvis, Grade II. She developed chronic renal failure and received hemodialysis once a week. The recurrence of bladder tumor was recognized and she was transferred to our hospital. Transurethral resection of bladder tumor (TUR-Bt) and right ureterectomy with a bladder cuff were performed. Also intravesical instillation of pirarubicin was done after the operation. No side effects or elevation of serum pirarubicin level were observed.

Administration, Intravesical↗

PubMed1995

[Partial status epilepticus developed 41 years after psychosurgery--an electroencephalographic and neuropathological study].

The authors report an 85-year-old man with schizophrenia, who had undergone bilateral frontal gyrectomy at the age of 44 and had a single series of convulsions 6 months after the psychosurgery. Forty-one years later, he had developed partial seizures with secondary generalized seizures, and died of partial status epilepticus. Ictal EEG showed generalized high-amplitude spikes or sharp waves spreading from the left frontal region. Interictal EEG showed slowing of background activity and high-amplitude paroxysmal discharges on the left frontal and central regions. Postmortem examination of the brain revealed tissue defects in the superior and middle frontal gyri caused by resection at the time of gyrectory and old cysts in the deep frontal white matter as late sequelae of the psychosurgery. There was fibrillary gliosis in the surrounding cerebral convolutions and the deep white matter. We considered that the glial scar in the frontal lobes, on the left side in particular, had developed the epileptogenic focus. The pathophysiological mechanism by which the intractable epileptic seizures appeared 41 years after psychosurgery is discussed.

Aged↗

PubMed1995

[Clinical study of prostatic cancer--statistical analysis of 184 cases in the latest 21 years].

One hundred and eighty-four patients with prostatic cancer were treated at Mie University Hospital from 1973 to 1993. They were between 47 and 90 years old, with an average age of 71.8 years old. One hundred and fifty-eight patients (85.8%) were in either stage C or D. Of the 146 cases histologically examined, 17.8% were well differentiated adenocarcinoma, and 47.9% and 34.2% were moderately and poorly differentiated adenocarcinomas, respectively. The overall 3-year, 5-year and 10-year survival rate were 64.2%, 44.9% and 24.2%, respectively. The patients with high stage and/or poorly differentiated adenocarcinomas revealed worse prognosis. Although the prognosis in the patients treated with estrogen and orchiectomy was better than that with estrogen alone, there was no significant difference between the 2 treatment groups. The prognosis of patients with prostatic cancer has been improved since 1988. A possible explanation is that prostate specific antigen has been introduced as a tumor marker, which might contribute to an accurate diagnosis in prostatic cancer and improve the prognosis of the disease. In conclusion, the diagnosis in lower stage and radical prostatectomy might bring favorable prognosis. In future, safer and more effective chemotherapy and endocrine therapy including LH-RH analogue are awaited, to obtain a better prognosis in the patients with advanced prostatic cancer.

Age Distribution↗

PubMed1995

[Slowly progressive memory impairment without generalized dementia--a clinical and radiological study].

We report a patient with a ten-year history of slowly progressive recent memory decline without additional cognitive impairment in presenility. A right-handed Japanese barber first experienced forgetfulness at the age of 59. Neurological examination at age 64 revealed no abnormality except for severe impairment in memorizing. Brain CT-scans were normal. In spite of gradually deteriorating memory, he was capable of organizing his work until the age of 67 years. At age 69, he showed intense recent memory defect and disorientation in time, but immediate memory span and remote memory beyond the retrograde gap were better preserved. Intelligence quotient (IQ) on the Wechsler adult intelligence scale-R remained 85 (verbal IQ, 88: performance IQ, 83). Neurological examination was negative. He showed no signs of aphasia, agnosia, or apraxia. Minimal organic personality changes were noticed. Brain CT-scans and MRI revealed mild atrophy of the temporal lobes and hippocampal formation on both sides. I123-IMP single photon emission computed tomography (SPECT) disclosed a decrease of cerebral blood flow in both the inferior temporal and superior frontal regions. SPECT after acetazolamide administration showed augmented accumulation in areas with decreased accumulation at baseline. Despite progressive memory impairment, the absence of aphasia, agnosia, or apraxia differentiates our case from more common Alzheimer's disease. A degenerative disorder of focal cerebral atrophy or "simple senile dementia" of presenile onset was suspected of causing the underlying pathophysiological changes.

Aged↗

PubMed1995

[Asymptomatic unilateral adrenal medullary hyperplasia with a cyst: case report].

A 45-year-old man was admitted with asymptomatic adrenal tumor. He had normal plasma and urinary catecholamine levels. The swelling of right gland was detected by CT scan and MRI. Selective venous samplings were performed and the level of catecholamine into the right adrenal vein were much higher than that into the left one. On July 15th, 1993, a right adrenalectomy was carried out and the right adrenal gland with a large cyst could be found. The ratio of cortical area to medullary area was about 4:1. Therefore, it was pathologically diagnosed as adrenal medullary hyperplasia with a cyst. There are relatively few reports of adrenal medullary hyperplasia. Before the operation, the patients were mostly diagnosed as pheochromocytoma by the results of laboratory studies and their symptoms. The condition of this disease is usually bilateral and often associated with type II multiple endocrine neoplasia (MEN II). We describe a case of asymptomatic unilateral adrenal medullary hyperplasia.

Adrenal Gland Diseases↗

PubMed1994

Corticonigral degeneration with neuronal achromasia presenting with primary progressive aphasia: ultrastructural and immunocytochemical studies.

We describe a clinico-pathological variant of a degenerative disorder involving Broca's, Wernicke's, and supplementary motor areas, which presented as primary progressive aphasia, dysarthria, bucco-facial apraxia, and hearing loss as initial symptoms, followed by organic personality changes. Postmortem examination revealed severe focal atrophy of the cerebral convolutions in the frontal operculum, superior frontal gyrus, and superior and transverse temporal gyri in addition to diffuse atrophy of the frontal and temporal lobes in both hemispheres. Microscopical examination revealed argyrophilic neuronal inclusions (ANIs) in the neuronal perikarya and presynaptic terminal throughout the central nervous system, as well as neuronal loss and swollen chromatolytic neurons in the affected cortices. Neocortical ANIs showed a positive immunoreaction with an anti-tau antibody but only a weak reaction with an anti-ubiquitin antibody immunohistochemically. Ultrastructurally, neocortical ANIs consisted of 15-nm thick smooth-surfaced tubules and tubules with constrictions at 120-150-nm intervals; thus they were different from the typical paired helical filaments of the 80-nm interval constrictions observed in the subiculum. ANIs were also found in the basal ganglia, brain stem nuclei, and cervical cord. Accordingly, ANIs appear distinct from neurofibrillary tangles (NFTs) of progressive supranuclear palsy, NFTs of Alzheimer-type dementia, and Pick bodies. The authors consider that this case fits the histopathological criteria of corticonigral degeneration with neuronal achromasia except for the unusual extension to the temporal lobes.

Aphasia↗

PubMed1994

Argyrophilic thread-like structure in corticobasal degeneration and supranuclear palsy.

Massive argyrophilic thread-like structures (ATS) are observed in corticobasal degeneration and, in varied degrees, in some cases of progressive supranuclear palsy. Immunohistochemically, ATS has a full length of phosphorylated tau epitopes without ubiquitin. Gallyas- and immuno-electron microscopic observation revealed that ATS is a cytoskeletal abnormality occurred in both the inner and outer loop of the oligodendroglia. tau-Positive oligodendroglial tangles were distributed in the same region as ATS.

Aged↗

PubMed1994

Purification and properties of a protease from the sarcocarp of bead tree fruit.

A protease was purified from bead tree fruit (Melia azedarach L. var. japonica Makino) in four steps, including HPLC gel-filtration. The M(r) of the enzyme, named melain, was estimated to be 25,000 on SDS-PAGE and on HPLC gel filtration. Melain contained a carbohydrate moiety. Using casein as a substrate, the optimum pH of the enzyme was 7.5-8.5 at 37 degrees. The enzyme was inhibited by iodoacetic acid, but was not inhibited by phenylmethanesulphonyl fluoride or EDTA. The enzyme had a wide specificity for peptide substrates such as oxidized insulin B-chain. All split sites (P1 and/or P'1) were hydrophobic or charged amino acid residues. The enzymatic properties of this protease were similar to those of phytolacain, an enzyme from the fruit of pokeweed, Phytolacca americana.

Amino Acid Sequence↗

PubMed1994

What are parents of obese children concerned about in their children?

We retrospectively examined the issues that concern parents of obese children to determine the most effective means of motivating them to seek treatment for obesity in their children. Children with an obesity index > or = 40%, aged six to 12 years, were screened in Kagoshima City in 1992. Parents were notified if their children needed an evaluation that included a family history and measurements of the blood pressure, total cholesterol, high density lipoprotein (HDL)-cholesterol, atherogenic index (ASI), triglycerides, aspartate aminotransferase (AST) and alanine aminotransferase (ALT). Parents were informed of the results of the evaluation and invited to attend a lecture on the treatment of obesity in children. A total of 378 obese children were evaluated. However, the parents of only 39 children attended the lecture. Children whose parents attended had higher mean total levels of cholesterol (190 +/- 25 vs 175 +/- 28, P < 0.01) and ASI values (3.2 +/- 0.9 vs 2.7 +/- 0.9, P < 0.02) than those whose parents did not attend. There were no significant differences in other factors. Only 4.2% of parents whose children showed no abnormal values, except for obesity, attended the lecture, compared with 20.3% (P < 0.01) or 16.9% (P < 0.05) of parents whose children had abnormal levels of cholesterol or abnormal ASI. Parents may be more concerned about hypercholesterolemia or arteriosclerosis than obesity per se. We should perhaps use the total cholesterol or ASI values, not just the severity of obesity, to motivate parents to enter their children into treatment programs for obesity.

Adult↗

PubMed1994

[Case report: infective endocarditis caused by Streptococcus agalactiae].

A 42-year-old male was admitted to our hospital because of high grade fever on October 6, 1992. He had no history of cardiac and underlying disease. For the past 10 days, he had complained of high grade fever and noticed arthralgia on his left shoulder. Physical examination on admission revealed that there was a body temperature of 39.0 degrees C and tenderness in the left shoulder. There were no abnormal findings for the chest or abdomen. On the second hospital day, he developed a diastolic murmur which had not been present on admission. And blood culture was positive for Streptococcus agalactiae. Ultrasonic-cardiogram indicated the presence of vegetation. He was diagnosed as infective endocarditis and treated with PCG 20 million units/day, IPM/CS 2 g/day and ISP 400 mg/day. But he was not responding to the chemotherapy. Aortic valve replacement was done on 22nd, October. Valve surgery succeeded and he became well after that time. Endocarditis caused by S. agalactiae is extremely rare, and is an important condition which carries a high mortality. Only seven cases of S. agalactiae endocarditis have been reported in Japan. It is difficult to treat these cases with antibiotic therapy alone. Therefore, we suggest that early surgery should be considered in infective endocarditis caused by S. agalactiae.

Adult↗

PubMed1994

[A case report of atypical tuberculous spondylitis].

A 22-year-old male was admitted to our hospital because of progressive weakness of bilateral lower limbs on October 29, 1992. He also complained of cough, sputum and back pain for 6 months. He had no history of underlying disease. His family history disclosed that his elder brother had tuberculous peritonitis. Chest radiogram on admission showed an abnormal shadow around the right first arch. Computerized tomogram revealed osteolytic lesions of the vertebral corpus and posterior elements at the level of C3, Th5, and Th11. Metastatic bone tumor was strongly suspected and surgical decompression was done on November 12. Histologic findings of the bone showed caseation and Langhans's giant cells, and acid fast bacilli were isolated. He was treated with anti-tubercular chemotherapy and showed remarkable relief of his symptoms over a period of 6 months therapy. This was a case of atypical tuberculous spondylitis. The main locus existed at the posterior elements of the vertebra and the distribution of vertebral lesions was multiple including cervical spine.

Adult↗