Biomedical subjects
K Iuchi
Publications and source records attributed to K Iuchi.
[Surgical treatment of elderly patients with bronchogenic carcinoma].
Explore the source record for details and available documents.
Artificial pneumothorax as a risk factor for development of pleural lymphoma.
An etiologically important role of chronic tuberculous empyema for development of pleural lymphocytic lymphoma of B-cell type has been suggested. To examine risk factors for development of pleural lymphoma in patients with chronic tuberculous empyema, a case-control study was carried out. Onset age of lung tuberculosis and empyema, presence of chemotherapy, surgical treatment, extent of empyema, presence of fistula, history of smoking, and height and weight of patients at first admission were compared in patients with empyema alone (70 controls) and empyema complicated with lymphoma (42 cases): the date of birth and sex were matched by group. The patients receiving artificial pneumothorax showed a significant increase in risk for development of pleural lymphoma (relative risk = 4.92, P < 0.05). We could not find any report describing development of pleural neoplasias in patients with chronic empyema receiving surgical resection of pleural pyogenic membrane. From these findings, it is suggested that artificial pneumothorax left chronic non-healing inflammation in the pleural cavity, which resulted in development of pleural lymphoma.
Effects of direct percutaneous transluminal coronary angioplasty treatment of acute myocardial infarction on plasma levels of haemostatic and fibrinolytic factors.
Although thrombolytic therapy is used widely for treatment of acute myocardial infarction (AMI), thrombolysis itself increases thrombin activity and may cause reocclusion of infarct-related vessels. Direct percutaneous transluminal coronary angioplasty (PTCA) is an effective treatment for AMI; however, it is not clear what effects PTCA has on coagulation and fibrinolysis. We investigated coagulation and fibrinolytic factor concentrations before and after direct PTCA. Plasma levels of thrombin-antithrombin III complex (TAT), D-dimer, plasmin-(alpha 2-antiplasmin complex (PAP), tissue-type plasminogen activator (t-PA) antigen and plasminogen activator inhibitor (PAI)-1 antigen were followed in twelve patients treated with direct PTCA for AMI. Before PTCA, only TAT concentrations were significantly elevated compared to normal controls. D-dimer, TAT, PAP and PAI-1 concentrations were similar before and after PTCA. Eleven patients had no recurrent ischaemia and no restenosis on follow-up coronary angiography. These data confirm that direct PTCA is less likely than thrombolysis to affect coagulation and fibrinolysis.
Reflex control of atrioventricular nodal refractory periods by cardiopulmonary receptors in humans.
The effects of selective cardiopulmonary receptor unloading on atrioventricular (AV) conduction were examined in 7 patients undergoing electrophysiologic testing. During -35 mmHg lower body negative pressure (LBNP) before autonomic blockade with propranolol and atropine, the AV-nodal conduction time (AH interval), the effective and functional refractory periods of AV node decreased at paced cycle length, when systemic arterial and central venous pressures decreased and heart rate increased. These responses to -35 mmHg LBNP except reductions in systemic arterial and central venous pressures disappeared after autonomic blockade. During -10 mmHg LBNP before autonomic blockade, both effective and functional refractory periods of AV node at paced cycle length decreased by 11 +/- 3% (mean +/- SEM) and 6 +/- 1% respectively with the reduction of central venous pressure while AH interval, systemic arterial pressure and heart rate remained unchanged. After autonomic blockade, -10 mmHg LBNP reduced central venous pressure but all the other parameters remained unchanged. These results suggest that cardiopulmonary baroreceptors participate in the reflex control of AV nodal refractoriness in humans.
[Two cases of coronary artery-left ventricular fistula associated with left ventricular hypertrophy].
Two cases of coronary artery-left ventricular fistula (AVF) associated with left ventricular hypertrophy were reported. The first patient was a 53-year-old man with chest pain. Selective coronary angiography (CAG) revealed bilateral coronary arteries draining into the left ventricle (LV). The second patient was a 46-year old man with electrocardiographic (ECG) abnormalities. CAG showed bilateral coronary artery which communicated via a maze of fine vessels into LV. In both cases, ECG showed ST depression and inverted T wave, and two-dimensional echocardiography revealed hypertrophic cardiomyopathy (HCM). Coexistence of coronary artery-left ventricular fistula and HCM seems to be a casual association.
[A retrospective group study on post-thymectomy myasthenia gravis].
Retrospective group study on post-thymectomy myasthenia gravis (post-Tm MG) was carried out. Five hundred and twenty-seven resected thymoma cases (133 cases with MG and 394 cases without MG) were collected from 9 hospitals. Post-Tmx MG occurred in 18 out of 394 cases -4.6% of thymoma without MG-, and these 18 patients with post-Tmx MG were investigated retrospectively. As to surgical procedures, the mode of operation, either thymectomy or thymo-thymectomy was not thought to be an important factor in the pathogenesis of post-Tmx MG. These 18 patients could be divided into 7 with early onset and 11 with late onset. In the early onset group, post-Tmx MG occurred within 6 months after the operation, and these 7 patients may have had subclinical MG at the time of the initial operation. In the late onset group, post-Tmx MG was noted in 5 patients when recurrence of the tumor was confirmed, the latest being 11 years after operation. The pathogenesis of post-Tmx MG could not be clarified in the other 6 patients (33.3%). For further evaluation of these 6 cases, a prospective studies with large scale are needed.
[Pneumonectomy in a case of chronic hemodialysis].
A 60-year-old male was referred to our hospital due to a well-delineated tumor (4 x 4 x 3 cm) in the left hilar region demonstrated by chest X-ray examination. Bronchofiberscopic biopsy showed evidence of well moderately differentiated epidermoid carcinoma. Since the tumor infiltrated to a part of the pericardium, left pneumonectomy and partial resection of pericardium were performed. The disease was p-T2, N1, M0, and state II. Anemia was corrected with Erythropoietin, and hemodialysis was performed for 3 consecutive days before operation. Hemodialysis 3 times per week was initiated from 2 days after operation. Hyperkalemia was successfully treated by GI therapy (continuous intravenous infusion of glucose+insulin). His postoperative course was good without bleeding and infection. He was discharged 37 days after operation and has been observed on an outpatient basis. With an increased and aging patients on chronic hemodialysis, the operations for various malignant tumors have been increasing. However, there are few reports on operation for lung cancer and no report on pneumonectomy in such patients in Japan. We performed pneumonectomy for lung cancer detected in a patient on chronic hemodialysis for 4 years and obtained good results.
Soft tissue sarcoma of the pleural cavity.
Seventeen cases of soft tissue sarcoma (STS) developing in the pleural cavity were collected from Japanese hospitals, and their clinical and pathologic findings summarized. Eight of the 17 patients had a 15-year to 50-year (mean, 28.8) history of chronic pleural inflammatory disease (pleuritis, pyothorax, and pulmonary tuberculosis) before the onset of the pleural sarcoma. Histologically, malignant fibrous histiocytoma was the most common tumor type (11 cases), followed by angiosarcoma (four). The age at diagnosis of the sarcoma ranged from 15 to 74 years (mean, 58); the male-to-female ratio was 3.3:1. In the eight cases of sarcoma associated with chronic pleural inflammatory disease, male preponderance was more marked (7:1). The commonest presenting symptom was chest pain. A mass could be detected by chest roentgenograms in 13 patients and computed tomographic scans in 15 patients. No patient had distant metastases at first admission. Thirteen patients were treated by surgery, chemotherapy, and/or radiation therapy. Thirteen of the 17 patients died 1 to 87 months (mean, 14.2) after therapy for STS. The actuarial 1-year survival rate was 38.5%. These findings suggest that long-standing pleural inflammation might be an etiologic factor for development of pleural STS.
[The role of surgery in the treatment of chronic empyema].
For the last ten years we had 56 patients operated for the empyema which occupied almost all the thoracic cavity. We evaluated their postoperative pulmonary functions and their sequelae. The pathological features of the resected lung and empyema wall were also examined. Surgical procedures consisted of 25 extraperiostal air plombage, 14 pleuropneumonectomy, 8 decortication, and 9 other procedures (lobectomy, muscle-flap, omental flap, and others). Preoperative %VC of patients with extraperiostal air plombage, those with pleuropneumonectomy, those with decortications and those with other procedures were 59.6 +/- 12.6, 46.4 +/- 11.1, 63.0 +/- 10.1, and 53.8 +/- 11.7 respectively. Of 11 patients who developed severe respiratory impairments (%VC less than 40 and/or FEV 1/VC predicted less than 30) post operatively, 4 had extraperiostal air plombage, 4 had pleuropneumonectomy, and 3 had other procedures. In general, degree of respiratory impairment was more severe in patients who underwent multiple surgical procedures. Of 18 patients who survived 5 years or more, %VC was under 50% in 9, and of those nine patients five had 30% decrease in VC compared to the preoperative values and there were 2 patients with extraperiostal air plombage in whom extreme shrinkage and deformity of hemithorax were observed though they had neither additional surgeries nor recurrences. Hemangioma was often seen on the walls of empyema and in some they became so large as to cause mediastinal shift. There were patients with round atelectasis, which, we thought, could have caused abscess or inflammatory granuloma.
Prognostic factors for pleural lymphoma patients.
Prognostic factors in 47 patients with pleural lymphocytic lymphoma developing in chronic tuberculous pyothorax were evaluated using Cox's proportional hazards model. There were 41 men and six women, aged 44-80 (median 61) years. Approximately 70% of the patients had localized disease in Stages I and II, and 30% advanced disease in Stages III and IV. Histologically, 27 patients had the diffuse large, immunoblastic type and 12 had others. In the other seven patients, histological subtyping of the lymphocytic lymphoma was impossible because of degenerative or necrotic changes in the histologic specimens. A diagnosis of lymphocytic lymphoma of B-cell type was made in one case using combined cytologic and surface maker findings on a cell suspension. In addition, immunologic and immunohistochemical studies revealed another 40 cases to be proven B-cell lymphomas. Poor performance status and elevated levels of BUN and GPT were significantly associated with shortened survival in a Cox's proportional hazards model. A poor performance status and high levels of serum BUN and GPT suggested a marked deterioration in a patient's condition. When compared with previous literature describing prognostic factors in patients with B-cell lymphomas and with lymphocytic lymphomas with unfavorable histologies or associated with long-standing inflammations, the only common prognostic factors was performance status. The significance of primary site in predicting survival from lymphocytic lymphoma is discussed.
Synthesis of antimicrobial agents. 3. Syntheses and antibacterial activities of 7-(4-hydroxypiperazin-1-yl)quinolones.
A series of novel pyridone carboxylic acids having a 4-hydroxypiperazinyl group at the 7-position of norfloxacin and ciprofloxacin were prepared. The in vivo antibacterial efficacies of these compounds were superior to those of corresponding piperazinyl derivatives. From the results of the studies on the pharmacokinetic profile and toxicity, the 4-hydroxypiperazinyl derivatives were confirmed to be pharmacologically superior to corresponding piperazinyl derivatives. Thus, a 4-hydroxypiperazinyl group was revealed to be a beneficial substituent for potential use in future quinolone antibacterials.
[Abnormal left ventricular flow during diastole in hypertrophic heart disease].
This study was performed to investigate the characteristics of isovolumic relaxation flow velocity (IRFV) in the mid-portion of the left ventricle. Doppler examinations were performed at rest in 20 subjects with normal heart and 18 with hypertrophic heart disease. To assess the left ventricular flow conditions in hyperdynamic states, 10 healthy subjects underwent exercise Doppler echocardiography. From the apical transducer position, left ventricular filling velocities were obtained at the mitral valve orifice level and at the mid-ventricle, and the changes of peak velocities in the rapid filling (R0, R1) and atrial contraction phases (A0, A1) were measured [%R = (R1-R0)/R0, %A = (A1-A0)/A0]. There was a good correlation between IRFV and %R (IRFV = 0.69 X %R + 25.9, r = 0.75, p less than 0.001). However, there was no correlation between IRFV and %A. Prominent IRFV (greater than or equal to 30 cm/sec) was demonstrated in 13 subjects, including 10 with hypertrophic heart disease. During exercise, IRFV, %R and %A did not increase. It was concluded that a prominent IRFV was associated with the acceleration of rapid filling velocity at the mid-ventricle. This phenomenon may be caused by regional and asynchronous hyperdynamic states demonstrated in hypertrophic heart disease.
Sustained inotropic effects of a new cardiotonic agent. OPC-8212 in patients with chronic heart failure.
OPC-8212, a newly synthesized noncatecholamine, nonglycosidic, orally effective inotropic agent, has been shown to exert a potent cardiotonic action in acute administration to patients with heart failure. However, its long-term effect has not yet been established. Eight patients with dilated cardiomyopathy (New York Heart Association functional class II-III) were given a single dose of 60 mg of OPC-8212 daily for 4 to 8 weeks. OPC-8212 produced symptomatic improvement in four patients. Though there were no detectable changes in arterial pressure and left ventricular end-diastolic dimension, heart rate and end-systolic dimension significantly decreased after administration of OPC-8212. Baseline fractional shortening rose significantly and depression of shortening in response to acute pressor stress (afterload mismatch) was corrected after OPC-8212. The end-systolic pressure-dimension relation was shifted to the left with a steeper slope. These findings indicate that the inotropic state was substantially enhanced by the drug. No adverse effects were observed in any patient. Thus, the drug appears to hold promise for the chronic treatment of patients with moderate congestive heart failure who are essentially asymptomatic at rest, but develop severe impairment of cardiac function in a stressed state.
Non-Hodgkin's lymphoma of the pleural cavity developing from long-standing pyothorax. Summary of clinical and pathological findings in thirty-seven cases.
Our previous study suggested a close relation between a preceding chronic tuberculous pyothorax and the development of non-Hodgkin's lymphoma (NHL) in the pleural cavity. To confirm this further, 37 cases were collected from Japanese hospitals, and their clinical and pathological findings summarized. The age at first admission for lymphoma of patients ranged from 46 to 81 (mean 63) years, the male to female ratio being 5.2:1. All patients were admitted after a 22-55 (mean 33) year history of pyothorax resulting from artificial pneumothorax for the treatment of pulmonary tuberculosis (29 cases) or tuberculous pleuritis (seven cases). The most common presenting symptom was chest pain. The main tumor mass, detected by chest roentgenogram and computed tomographic scans, was situated in the pleura (28 patients), the lung near the pleura (five patients) and the pleura and lung (four patients). The diagnosis of pleural NHL was made by biopsy for 31 of the patients and at autopsy for the other six. Histologically 30 (81%) of the 37 cases were of the diffuse large cell type, and of these the immunoblastic type was the most common (22 cases). Immunological and immunohistologic studies revealed a B-cell nature of the proliferating cells in all but one tumor. Thirty-two patients received chemotherapy and/or radiotherapy. Twenty-seven patients died between one and 144 (median eight) months of diagnosis. Autopsies carried out in 23 cases revealed the disease to have been localized to the thorax in 11 patients. These findings indicated that malignant B-cell lymphoma arose as a monoclonal growth from a pool of proliferating polyclonal B lymphocytes in tissues affected by the chronic tuberculous pyothorax.
Synthesis of N-acyl-gamma-D-glutamyl peptide derivatives containing a C-terminal small fragment of cholecystokinin and their effects on gastric secretion.
Explore the source record for details and available documents.
Synthesis and effect on gastric secretion of several di- or tripeptides related to proglumide.
Explore the source record for details and available documents.
Synthesis and analgesic activity of cholecystokinin-heptapeptide analogs with N-terminal substitution.
Explore the source record for details and available documents.