Biomedical subjects

K Kusakabe

Publications and source records attributed to K Kusakabe.

At least 19 recordsLinked to original sources

PubMed1995

Left ventricular dysfunction on exercise long-term after total repair of tetralogy of Fallot.

BACKGROUND: Excellent results regarding mortality are well recognized in the long-term period after intracardiac repair of tetralogy of Fallot. However, it is still unclear how postoperative sequelae affect cardiac performance during exercise. METHODS AND RESULTS: Twenty-nine patients with tetralogy of Fallot were studied 16 +/- 2 years after intracardiac repair by use of radionuclide first-pass ventriculography with an ultra-high-sensitive gamma camera at rest and at peak exercise on a semi-upright bicycle ergometer. The results were compared with those from 10 age- and sex-matched control subjects. Left and right ventricular ejection fraction and absolute ventricular volume were measured at rest and peak exercise. Regional right ventricular wall motion and diastolic function of the left ventricle were also assessed. Cardiac output of tetralogy was normally preserved both at rest and during exercise. Nevertheless, the incremental response of left ventricular ejection fraction during exercise was depressed in the patients. Left ventricular ejection fraction during exercise was inversely correlated with the right ventricular end-diastolic volume and the severity of pulmonary regurgitation. Regional wall motion at the right ventricular outflow tract was not decreased in the patients. Left ventricular diastolic function was not impaired in the patients compared with control subjects. CONCLUSIONS: Latent left ventricular dysfunction during exercise is related to an enlarged right ventricle due to pulmonary regurgitation after intracardiac repair of tetralogy. Careful follow-up is required in patients having significant pulmonary regurgitation.

Adult↗

PubMed1995

Surgical strategy for pheochromocytoma: emphasis on the pledge of flank extraperitoneal approach in selected patients.

BACKGROUND: Anterior transabdominal exploration has traditionally been advocated as the standard procedure for pheochromocytoma. However, some authors claim that a flank extraperitoneal approach with accurate unilateral localization is justifiable. METHODS: Retrospective analysis was performed on 87 patients with pheochromocytoma to determine the appropriateness of extraperitoneal exploration. RESULTS: There were 45 men and 42 women with a mean age of 44.7 years (range, 16 to 83 years). Fifteen patients (17.5%) had pheochromocytoma as a part of multiple endocrine neoplasia (MEN) type 2A, and four had familial pheochromocytoma, von Hippel-Lindau disease, or von Recklinghausen's disease. All tumors detected by preoperative localization studies were correctly identified and were resected through flank extraperitoneal (45 patients), transabdominal (28), thoracoabdominal (13), and posterior (1) approaches. Tumors were extraadrenal in 14, multiple in 22, bilateral in 12, and unequivocally malignant in 2 patients at the initial operation. Two patients died during the immediate postoperative period, giving an operative mortality of 2.3%. Two patients had persistent disease. During follow-up within a mean period of 5 years (range, 1 month to 13.7 years) 8 patients (9.1%) experienced recurrence or metastasis. Other than the patients with MEN 2, recurrence was not attributable to the operative approach. CONCLUSIONS: If a preoperative localization study is accurate, an extraperitoneal approach is justifiable for many patients with pheochromocytomas.

Adolescent↗

PubMed1995

[The characteristics of 123I-MIBG myocardial scintigraphy in patients with left ventricular pressure-overload diseases].

The purpose of this study was to clarify the clinical significance of 123I-metaiodobenzylguanidine (MIBG) myocardial scintigraphy in patients with left ventricular pressure-overload diseases. MIBG scintigraphy was applied to 10 pts with aortic valve stenosis (AS group), 11 pts with hypertrophic obstructive cardiomyopathy (HOCM group), 17 pts with hypertrophic non-obstructive cardiomyopathy (HCM group) and 6 control cases (C group). Mean pressure gradient in AS and HOCM groups was 62 +/- 21 mmHg and 38 +/- 18 mmHg, respectively. Initial myocardial uptake of MIBG (MU) was higher in the AS (1.92 +/- 0.46%) and HOCM (2.27 +/- 0.47%) groups than those in the HCM (1.61 +/- 0.29%) and C (1.50 +/- 0.23) groups. Myocardial clearance of MIBG (MC) was higher in the AS (39 +/- 11%), HOCM (37 +/- 19%) and HCM (28 +/- 17%) groups than that in the C (14 +/- 6%) groups. Heart/mediastinum count ratio (H/M) of AS, HOCM, HCM and C groups was 1.87 +/- 0.29, 2.09 +/- 0.19, 1.98 +/- 0.26, and 2.20 +/- 0.10, respectively. In the cases of AS, positive correlation was observed between mean pressure gradient and MU (r = 0.618, p < 0.05). In conclusion, MU was increased in the case of left ventricular pressure-overload state (AS and HOCM).

3-Iodobenzylguanidine↗

PubMed1995

[Usefulness of 123I-BMIPP myocardial imaging in patients with stable effort angina and unstable angina].

We evaluated the clinical significance of myocardial imaging using 123I-15-(p-iodophenyl)-3-methyl pentadecanoic acid (BMIPP) scintigraphy in patients with stable effort angina pectoris (SAP) and unstable angina pectoris (UAP). Thirty-three patients with SAP were studied using rest BMIPP and stress 201TlCl (Tl) myocardial scintigraphy, and 13 patients with worsening effort type of UAP were also examined using both rest BMIPP and Tl scintigraphy. We compared those BMIPP findings with myocardial perfusion images obtained with Tl and the regional wall motion determined by left ventriculography. In 45% of 282 segments of myocardial ischemia of SAP, the degree of myocardial uptake of BMIPP was concordant with that of stress Tl and the defect score of Tl was higher than that of BMIPP. On the other hand, in 32% of 62 segments of ischemia of UAP, the degree of myocardial BMIPP and Tl uptake was concordant and BMIPP defect score was higher than Tl score. In SAP, the decrease in regional wall motion agreed better with the decrease in myocardial uptake of BMIPP than that of Tl. These results suggest that myocardial ischemic regions decreased BMIPP uptake show the disturbance of fatty acid metabolism and lead to abnormal wall motions. Such ischemic regions may be clinically severe state in patients with angina pectoris.

Aged↗

PubMed1995

[Comparison of inferior myocardial defect between planar and SPECT image of 123I-metaiodobenzylguanidine cardiac scintigraphy].

Discordant findings of inferior MIBG defect between SPECT and planar images were sometimes observed in the clinical studies. In this study, we compared inferior myocardial findings between planar and SPECT image of 123I-metaiodobenzyl-guanidine (MIBG) cardiac scintigraphy in 29 patients. All patients were estimated as normal in anterior accumulation of MIBG. The patients were divided into 3 groups according to the visual finding of inferior defect in the planar and SPECT image; normal group (normal inferior accumulation of MIBG both in the planar and SPECT image, N = 10), discordance group (inferior MIBG defect was only observed in the SPECT image, but was not observed in the planar image, N = 7), inferior defect group (inferior MIBG defect was observed both in the planar and SPECT image, N = 12). Inferior/anterior count ratio of SPECT and planar image were 0.96 +/- 0.11 vs. 0.97 +/- 0.05 in normal group, 0.59 +/- 0.21 vs. 0.99 +/- 0.13 in discordance group, 0.46 +/- 0.13 vs. 0.82 +/- 0.04 in inferior defect group. Liver/heart count ratio was significantly higher in the discordance group (2.07 +/- 0.49) than that in the normal (1.14 +/- 0.15) and inferior defect group (1.45 +/- 0.39). In phantom study, it has been reported that increased liver accumulation of MIBG causes artifactual inferior defect adjacent to the liver. These data indicate that increased liver/heart count ratio may cause artifactual inferior defect on MIBG SPECT image in the clinical studies. Planar image evaluation may be helpful to distinct the artifactual inferior defect on SPECT image.

3-Iodobenzylguanidine↗

PubMed1995

[High incidence of false positive results of thallium-201 myocardial stress scintigraphy for the evaluation of artery bypass graft patency after CABG].

We have often experienced false positive results of the stress Thallium-201 myocardial scintigraphy (TL) for the evaluation of artery bypass graft patency after coronary artery bypass surgery (CABG). The purpose of this study is to clarify the frequency and the clinical significance of this findings. Sixty-two patients undergoing coronary angiography (CAG) after CABG were studied. These patients had undergone at total of 156 bypasses (artery grafts 108, saphenous vein grafts 48, mean bypass grafts number 2.65/cases), and the mean period from CABG to TL was 41.6 +/- 34 days. The territories of stress induced ischemia were divided into 3 territories; left anterior descending (LAD), right coronary artery (RCA), and left circumflex (LCX) territories. Patency of the bypass grafts was estimated on the absence of transient perfusion defect (TPD) on TL images. The incidence of false positive results was higher in Dipyridamole TL (38%) than in Exercise TL (18%) and higher in LAD territories (38%) than in RCA (11%) and LCX (13%) territories. All false positive cases showed no evidence of chest pain and significant ST-T change during stress TL test. High incidence of false positive results of stress TL test was observed for the evaluation of artery bypass graft patency after CABG.

Aged↗

PubMed1995

[Two cases of dilated cardiomyopathy with the relationship between the effect of beta-blocker therapy and the changes of myocardial clearance of 123I-metaiodobenzylguanidine].

Two cases diagnosed dilated cardiomyopathy received beta-blocker therapy, and underwent 123I-metaiodobenzylguanidine (MIBG) myocardial scintigraphy before and after the treatment. In case 1, symptoms and cardiac function were improved in 1 month and 4 months after the treatment (LVEF increased from 19% to 32% and 40%), and myocardial clearance of MIBG decreased from 50% to 27% and 29%. In case 2, both symptoms and cardiac function were not improved in 1 month and 3 months after the treatment (LVEF was changed from 11% to 10% and 13%), and myocardial clearance was not significantly different between before (50%) and after (1 month: 46%, 3 months: 50%) the treatment. It was indicated that myocardial clearance of MIBG might depend on the extent of the improvement of cardiac function and symptoms, and might reflect the effects of beta-blocker therapy.

3-Iodobenzylguanidine↗

PubMed1995

[Identification of viable myocardium using 99mTc-tetrofosmin scintigraphy--comparison with 201Tl redistribution-reinjection images].

The purpose of this study was to clarify the diagnostic value of identifying viable myocardium using 99mTc-Tetrofosmin scintigraphy. Twenty-one patients with chronic coronary artery disease were studied using 201Tl exercise myocardial scintigraphy with reinjection and 99mTc-Tetrofosmin exercise myocardial scintigraphy. All patients had a history of old myocardial infarction. For 99mTc-Tetrofosmin scintigraphy, 222 MBq of 99mTc-Tetrofosmin was injected during exercise, and exercise images were obtained 20 min thereafter. There hours later, 666 MBq of 99mTc-Tetrofosmin was injected at rest, and images were obtained 40 min and 220 min later. Myocardial viability in the 99mTc-Tetrofosmin scintigraphy was estimated as fill-in findings (FF) or over 50% of %RI uptake (%TF) in the rest image. Myocardial viability in the 201Tl scintigraphy was estimated as redistribution (RD), fill-in findings in the reinjection image (FR) or over 50% of %RI uptake in the reinjection image (% TL). Sixteen of the 21 patients (76%) who underwent 201Tl scintigraphy (RD 10, FR 3, %TL 3 cases) and 15 of the 21 patients (71%) who underwent 99mTc-Tetrofosmin scintigraphy (FF 11, %TF 4 cases) had viable myocardium in the infarcted area. A comparison between the 99mTc-Tetrofosmin rest images obtained 40 min after the injection and that of 220 min revealed no redistribution findings. The %RI uptake of the infarcted area in the resting 99mTc-Tetrofosmin image (47 +/- 16%) was slightly lower than that in the 201Tl reinjection image (52 +/- 16%). In conclusion, viable myocardium was as clearly identified by 99mTc-Tetrofosmin, as by 201Tl scintigraphy.

Aged↗

PubMed1995

[Simultaneous evaluation of myocardial perfusion and fatty acid metabolism using dynamic SPECT with single injection of 123I-15-(p-iodophenyl)-3-methyl pentadecanoic acid (BMIPP)].

The purpose of this study is to clarify whether dynamic SPECT (DECT) immediately after the injection of 123I-15-(p-iodophenyl)-3-methyl pentadecanoic acid (BMIPP) may represent myocardial perfusion imaging. Ten patients with unstable angina pectoris (UAP), 11 patients with acute myocardial infarction (AMI) and 6 patients with non-ischemic heart disease (NIHD) were studied using BMIPP myocardial scintigraphy with DECT. DECT acquisition was started 2 minutes after the injection of BMIPP, and DECT images were obtained every three minute for 15 minutes with 3-headed gamma camera SPECT system. Additionally, static SPECT images were acquired 30 minutes after the injection of BMIPP. These SPECT images of BMIPP were compared with thallium-201 myocardial perfusion images at rest. In UAP group, early DECT images showed almost the same findings as thallium-201 images in 8 of 10 patients, and SPECT images at 30 minutes after the injection showed reduced accumulation of BMIPP compared with thallium-201 images in all patients. In AMI group, early DECT images showed the same findings as thallium-201 perfusion images in 9 of 11 patients, and SPECT images at 30 minutes after the injection showed reduced accumulation of BMIPP compared with thallium-201 images in 5 of 11 patients. These results indicate that myocardial perfusion can be evaluated in the early image using DECT, in addition to myocardial fatty acid metabolism in the delayed image.

Adult↗

PubMed1994

[Evaluation of usefulness of 99mTc-GSA scintigraphy in hepatitis C treated with alpha interferon].

To evaluate hepatic function before and after treatment with alpha interferon, 99mTc-GSA scintigraphy was performed in seven patients with hepatitis C. The ratios of HH 15 and LHL 15 in 99mTc-GSA scintigraphy were well correlated with the blood laboratory test(GPT) before and after treatment. The uptake of 99mTc-GSA depends on the number of hepatic cells. 99mTc-GSA scintigraphy was useful for evaluating potential liver function after treatment.

Albumins↗

PubMed1994

[Initial myocardial uptake and myocardial clearance of 123I-metaiodobenzylguanidine in patients with ischemic heart disease of left ventricular dysfunction and dilated cardiomyopathy].

We studied initial myocardial uptake and myocardial clearance of 123I-metaiodobenzylguanidine (MIBG) in patients with ischemic heart disease of left ventricular dysfunction and dilated cardiomyopathy. Eleven patients with ischemic heart disease of left ventricular dysfunction (IHD group), 6 patients with dilated cardiomyopathy (DCM group) and 7 control cases (control group) were studied. Heart to mediastinum activity ratio (H/M) of early and delayed image was significantly lower in the IHD and DCM groups than in the control group. Although initial myocardial uptake of MIBG showed no significant difference among three groups, myocardial clearance of MIBG was significantly higher in the IHD (35 +/- 11%) and DCM (48 +/- 13%) groups than that in the control group (19 +/- 10%). H/M of delayed image was related to the left ventricular size, initial MIBG uptake and MIBG myocardial clearance. Negative correlation was observed between MIBG myocardial clearance and left ventricular ejection fraction in all cases. In conclusion, initial myocardial uptake of MIBG were not decreased in patients with IHD and DCM. Enhanced myocardial clearance of MIBG was observed not only in patients with DCM but also in patients with IHD.

3-Iodobenzylguanidine↗

PubMed1994

[Therapeutic effectiveness of 131I-MIBG on malignant pheochromocytoma--results of long-term follow-up].

The therapeutic response of 131I-MIBG was evaluated in 4 patients with malignant pheochromocytoma who had been treated with 131I-MIBG and followed-up over 5 years. The patients were 2 men and 2 women with ages ranging from 41 to 69 years old (mean 53 years). The primary tumors in 3 of 4 patients had been resected four to eight years before 131I-MIBG treatment. One patient was diagnosed as adrenal pheochromocytoma, and two were retroperitoneal paraganglioma. And in one patient, the resection of primary mediastinal tumor was not performed due to the adhesion to pericardium but the diagnosis of paraganglioma was obtained by biopsy of bone lesion. All patients showed the clear accumulation of 131I-MIBG in tumor on scintigraphy. The number of doses of 131I-MIBG ranged from one to three times with 3.7 GBq per administration and a cumulative activity from 3.7 to 11.1 GBq. Treatment effect was obvious in one patient with lung, bone, and lymph node metastases whose cumulated absorbed dose with 11.1 GBq of 131I-MIBG exceeded over 150 Gy. At the present time, the duration of survival since the beginning of initial 131I-MIBG therapy is over 5 yrs. The other three patients, however, showed little effects, and died with the disease in 2.6 to 4.1 years after the initial 131I-MIBG therapy. 131I-MIBG will become a promising agent for therapy in patients with malignant pheochromocytoma with high degree of accumulation.

3-Iodobenzylguanidine↗

PubMed1994

[Evaluation of myocardial uptake of beta-methyl-(123I)-iodophenylpentadecanoic acid (123I-BMIPP)].

To evaluate the myocardial uptake of beta-methyl-(123I)-iodophenylpentadecanoic acid (123I-BMIPP), nineteen patients with ischemic heart disease including left ventricular hypertrophy (mean age 63 +/- 7.8, 14 males and 5 females) underwent BMIPP myocardial scintigraphy. Myocardial uptake (MU) of BMIPP to the total injected dose was calculated from anterior view of the planar image in all subjects, and was compared with plasma glucose (BS), triglyceride (TG), and free fatty acid (FFA). It was also compared with left ventricular mass (LVM) calculated with echocardiography. MU was not related to BS, TG, and FFA, however had the positive correlation with LVM (r = 0.676, p < 0.01). Myocardial uptake per left ventricular mass (MU/LVM) had the negative correlation with LVM (r = -0.671, p < 0.01). Further studies for the significance of MU/LVM will be required.

Aged↗

PubMed1994

[Changes of thyroid hormone levels during ACTH therapy in epileptic children].

To investigate the effect of ACTH on thyroid function, thyroid hormone levels were measured in twelve patients with epileptic children who were treated with ACTH. One week after daily administration of ACTH, serum T3, T4, TSH, thyroglobulin and T3/T4 ratio showed significantly lower values compared with those of pretreatment values (p < 0.001-p < 0.05). Thyroid hormone levels respectively showed negative correlation with cortisol levels before and one week after ACTH treatment respectively. Tapering of ACTH brought a rapid recovery of T3, T4, TSH and thyroglobulin levels with concomitant return of plasma cortisol levels to the normal range. These results suggested that excess ACTH suppressed thyroid hormone secretion mainly through a decreased TSH secretion and a peripheral conversion of T4 to T3 by increased cortisol levels.

Adrenocorticotropic Hormone↗

PubMed1994

[Quantitative analysis of 123I-metaiodobenzylguanidine myocardial scintigraphy by myocardial uptake using a phantom].

To evaluate the quantitative analysis of 123I-metaiodobenzylguanidine (MIBG) myocardial scintigraphy, total injected dose measured by first pass (FP) method (TFP) was compared with that measured by phantom method using an acrylic phantom in 45 patients with cardiac disease. Heart per mediastinum ratio (H/M) was compared to myocardial uptake calculated with TFP. The total injected dose measured using the phantom in which the syringe was set in depth of 3.5 cm (Tpham) was correlated with TFP (r = 0.73, p = 0.0001). When Tpham was corrected by body weight (c-Tpham), c-Tpham showed better correlation with TFP. MU calculated by TFP (MU-FP) was well correlated with MU by c-Tpham (MU-pham) (r = 0.94, p = 0.001). These results indicate that phantom method is sufficient to substitute for FP method. Though H/M was correlated with MU-FP (p < 0.001), the interpatient variation was relatively large. Then the analysis by H/M is insufficient to substitute for the myocardial uptake. It is though to be enough to use the phantom method on daily routine work, since this method is accurate and easy to quantitate the myocardial uptake of MIBG taking a short time.

3-Iodobenzylguanidine↗

PubMed1994

[Artifactual defect of inferior myocardium on 123I-metaiodobenzylguanidine myocardial SPECT: characteristic findings and preventive method on phantom study].

Discordance between planar and SPECT image of inferior myocardial defect on 123I-metaiodobenzylguanidine myocardial scintigraphy (MIBG) was occasionally observed in the clinical studies. The purpose of this study is to clarify the existence of artifactual myocardial defect on MIBG SPECT image. Phantom study was performed in various kinds of situation using triple gamma camera. Artifactual defect adjacent to the liver was significantly observed in the case of increased liver/heart uptake ratio more than 2:1. Artifactual defect was markedly observed in the 180 degrees than that in the 360 degrees SPECT acquisition. To avoid artifactual defect during SPECT acquisition, liver phantom was moved down to the foot direction (vanishing liver position). In this phantom position, artifactual defect adjacent to the liver was not observed on reconstructed myocardial SPECT image. The vanishing liver position was also applicable to human study. Human body was inclined to right side at an angle of 15 degrees, artifactual defect could be avoided. Further study is needed to analyze the cause of this artifactual defect and to conform the preventive method with vanishing liver position in the routine myocardial SPECT examination.

3-Iodobenzylguanidine↗

PubMed1994

Accumulation enhancement of human monoclonal antibody HB4C5 to lung tumor xenografts by N-deglycosylation.

UNLABELLED: The fractional uptake of intact monoclonal antibodies by tumors is relatively low. Various methods to alter the molecular structure have been used to augment tumor uptake. These chemical manipulations, however, may alter the specificity of antibody binding. METHODS: Comparative studies of biodistribution, radioimmunoimaging and macroautoradiography in LC-6 xenografted mice were conducted with the 125I-labeled intact and N-terminal deglycosylated monoclonal antibodies to evaluate the effect on deglycosylation on antibody binding. RESULTS: The removal of N-glycosyl residues from this monoclonal antibody significantly enhanced specific localization of the radioactivity to the tumor, especially to its necrotic fraction. Nonspecific accumulation of radioactivity to the necrotic fraction of the tumor was excluded by biodistribution studies demonstrating selective accumulation of 125I-labeled monoclonal antibody after coadministration of 125I-monoclonal antibody (intact or N-deglycosylated) with 131I-labeled control IgM. CONCLUSION: The lung cancer-associated human monoclonal antibody HB4C5, which recognizes histone H2B as the antigen, accumulates specifically to the necrotic fraction of tumor. The uptake is enhanced by removal of N-terminal glycosyl residues from the antigen-binding site of the light chain.

Animals↗

PubMed1993

[Maternal and cord blood thyroid hormones in Graves' disease and fetal states].

Serum concentrations of thyroid hormones (T3, T4, fT3 and fT4), TSH and TRAb in 14 mothers with Graves' disease at 1-4 weeks before delivery were comparably studied with cord blood hormone levels and various fetal states. Twelve mothers were on anti-thyroid drugs and 2 were drug-free, with 8 being euthyroid and 6 being hyperthyroid. Serum concentrations of T3, T4 and fT3 in cord blood were all the same regardless of maternal thyroidal function. Though cord blood TRAb levels correlated with maternal levels, cord fT4 levels were low in those who given antithyroid drugs. TSH levels in cord blood were low in Cesarean section delivery and babies with low birth weight. Birth weight and gestational weeks were both inversely correlated with maternal T4, fT4, fT3 and TRAb concentrations. Thus, maternal hormone levels at late stage of pregnancy in Graves' disease could be useful indices for perinatal risk.

Adult↗