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Biomedical subjects

M Fukui

Publications and source records attributed to M Fukui.

At least 91 records · Page 5Linked to original sources

Response to hypercapnia in moyamoya disease. Cerebrovascular response to hypercapnia in pediatric and adult patients with moyamoya disease.

BACKGROUND AND PURPOSE: We have previously reported that cerebral blood flow decreased and oxygen extraction fraction and cerebral blood volume increased in pediatric patients with moyamoya disease, whereas these values did not change significantly in adult patients. In this study, we measured the cerebrovascular response to hypercapnia using 15O H2O positron emission tomography (PET) in each group of patients. These data were also compared with the oxygen extraction fraction and transit time (cerebral blood volume/cerebral blood flow) measured by 15O PET. METHODS: The subjects consisted of 20 patients with moyamoya disease (7 pediatric and 13 adult patients). Cerebral blood flow was measured by the 15O H2O bolus injection method at the resting state and during the inhalation of 5% CO2. Cerebrovascular CO2 response was estimated as the percentage change of cerebral blood flow per 1 mm Hg change of PaCO2. Oxygen extraction fraction and transit time were measured by the 15O steady-state method. RESULTS: Cerebrovascular response to hypercapnia severely decreased over the cerebral cortices in both pediatric and adult patients with moyamoya disease when compared with those of normal control subjects, and there was no significant difference between pediatric and adult patients. A significant correlation was observed between the CO2 response and transit time, whereas no significant correlation was seen between the CO2 response and oxygen extraction fraction. CONCLUSIONS: Our study revealed that the cerebral hemodynamic reserve capacity decreased to an equal degree in both pediatric and adult patients with moyamoya disease. This finding may thus help to explain the occurrence of transient ischemic attack in adult patients.

Administration, Inhalation

Degradation of a novel tripeptide, tert-butoxycarbonyl-Tyr-Leu-Val-CH2Cl, with inhibitory effect on human leukocyte elastase in aqueous solution and in biological fluids.

The stability of tert-butoxycarbonyl-Tyr-Leu-Val-CH2Cl (YLV) with inhibitory effect on human leukocyte elastase was investigated in aqueous solution, alpha-chymotrypsin solution and biological media. In all cases studied here, the degradation was observed as a pseudo-first order reaction. The half-life for the degradation of YLV in an aqueous solution of pH 7.4 at 37 degrees C was 35.9 h. YLV was most stable at about pH 3.8-5.8 and the effect of temperature was explained by the Arrhenius equation. The activation energies of the degradation in aqueous solutions at pH 2.0, 4.8, and 7.4 were 24.6, 22.1 and 23.4 kcal/mol, respectively. The degradation products in aqueous solution were analyzed by HPLC-MS and were estimated as Boc-Tyr-Leu-Val-CH2OH at pH 7.4 and H2N-Tyr-Leu-Val-CH2Cl at pH 2.0. In a bovine pancreas alpha-chymotrypsin solution at 37 degrees C, the half-life of YLV was 15 min at 25.6 micrograms/ml of alpha-chymotrypsin solution. In the rat plasma, the half-life of YLV was 42.4 min (YLV 26.7 micrograms/ml plasma), and in rat liver, lung and spleen homogenates, the degradation rate constants of YLV were 37.6, 10.3 and 23.5 times larger than that in plasma solution, respectively (all fluids containing 5 mg protein/ml). YLV was less stable than nafarelin acetate, secretin, adrenocorticotropic hormone (ACTH) and gonadorelin in an aqueous solution of pH 7.4.

Animals

Changes in the arterial PCO2 during a single night's sleep in patients with obstructive sleep apnea.

To investigate the relationship between hypercapnia during sleep and its influence on the PaCO2 during the morning after sleep in patients with obstructive sleep apnea syndrome (OSAS), the transcutaneous PCO2 (PtcCO2) was measured throughout the night, and the arterial blood gases (ABG) were also measured while awake before and after polysomnography in 30 OSAS patients with (n=13, hypercapnic group: HC) and without (n=17, normocapnic group: NC) hypercapnia. Significant differences were observed in the body mass index (p=0.03), the difference between the highest PtcCO2 during sleep and the PtcCO2 during awake before sleep (D-PtcCO2), (HC: 11.l+/-1.7 mmHg; NC: 6.3+/-0.5 mmHg; p=0.0057) and the lowest SaO2 during sleep (p=0.0007). In the HC, the PaCO2 on the morning after sleep (50.0+/-0.14 mmHg) was significantly increased (p=0.0029) compared with the PaCO2 on the night before sleep (47.4+/-1.1 mmHg). In the NC, this phenomenon was not observed. Severe hypercapnia (high D-PtcCO2) during a single night's sleep has a significant effect on the waking PaCO2 immediately following sleep in the HC.

Body Mass Index

Giant cell granulomatous hypophysitis manifesting as an intrasellar mass with unilateral ophthalmoplegia--case report.

A 62-year-old female presented with giant cell granulomatous hypophysitis manifesting as subacute unilateral ophthalmoplegia. Neuroimaging revealed a mass lesion expanding in the pituitary fossa. The mass was totally removed through the transsphenoidal approach. The histological diagnosis was giant cell granuloma. The oculomotor nerve paresis resolved completely 10 days after the operation. Giant cell granulomatous hypophysitis is symptomatically and radiologically indistinguishable from non-functioning pituitary adenoma, but is less likely to cause visual disturbance than pituitary adenoma. Giant cell granulomatous hypophysitis should be considered in the differential diagnosis of sellar and suprasellar lesions, particularly if oculomotor nerve paresis is observed without impaired visual field or acuity.

Diagnosis, Differential

Serum autoantibodies against sulfatide and phospholipid in NIDDM patients with diabetic neuropathy.

OBJECTIVE: We investigated the presence of antisulfatide and antiphospholipid antibodies and the relationship between these antibodies and the results of quantitative tests of nerve function in NIDDM patients with diabetic neuropathy. RESEARCH DESIGN AND METHODS: Antisulfatide and antiphospholipid antibodies were measured in serum samples obtained from 68 NIDDM patients with diabetic neuropathy by an enzyme-linked immunosorbent assay (ELISA). Each patient was classified into one of three groups based on the combined neuropathy score (determined by the symptom score, the results of autonomic nerve function tests, and the vibration perception test), as follows: mild (n = 26), moderate (n = 22), and severe (n = 20). Nerve conduction studies were performed in a subgroup of 37 patients. RESULTS: The antisulfatide antibody was detected in 1 (4%) of 26 patients in the mild group, 4 (18%) of 22 patients in the moderate group, and 8 (40%) of 20 patients in the severe group (P < 0.01 vs. mild group). The antiphospholipid antibody was detected in none of the patients in the mild group, 8 (36%) of 22 patients in the moderate group (P < 0.001 vs. mild group), and 6 (30%) of 20 patients in the severe group (P < 0.01 vs. mild group). The threshold amplitude, determined by the vibration perception test, was significantly higher in antibody-positive patients than in antibody-negative patients: antisulfatide antibody, 55.9 +/- 46.8 microns (n = 13) vs. 22.9 +/- 13.7 microns (n = 55), P < 0.001; antiphospholipid antibody, 47.2 +/- 32.5 microns (n = 14) vs. 24.5 +/- 23.2 microns (n = 54), P < 0.01. The conduction velocity of the sural nerve was slower in the antisulfatide antibody-positive group (37.9 +/- 11.1 m/s, n = 12) than in the antisulfatide antibody-negative group (45.2 +/- 6.0 m/s, n = 19) (P < 0.05). CONCLUSIONS: These results suggest that autoimmune nerve destruction may be involved in diabetic neuropathy in NIDDM patients.

Aged

Quantitative assessment of the spatial distribution of low attenuation areas on X-ray CT using texture analysis in patients with chronic pulmonary emphysema.

An automated and quantitative assessment of the spatial distribution of low attenuation areas (LAA) on X-ray CT was performed using texture analysis in chronic pulmonary emphysema (CPE) patients. LAA was defined as those areas having a density less than the mean minus one SD of the control (-960 HU). The probability of change from non-LAA to LAA between a given pair of pixels with horizontal intervals of i pixels (RNi) was evaluated, because this reflects the interaction between LAA and non-LAA regions with different resolutions. The relationship between the percentage area of the LAA over the total area of the entire lung field (LAA%) was subsequently estimated. The RNi increased sharply as the i value increased from 1 to 5, but then almost became a plateau for i values larger than 5. This suggests that the fundamental structures in the LAA areas ranged from 1 x 1 to 5 x 5 pixels in size. RN1-LAA% and RN5-LAA% plots produced curves which were convex, with peak values at approximately 50 LAA% of 0.09 and 0.18, respectively. In the RN5/RN1-LAA% plot, the RN5/RN1 ratio remained constant at 2.0 regardless of the LAA%. A random process simulation was performed to determine the patterns of LAA proliferation if the spatial distribution of the LAA units was random. When the unit size was kept constant, the results of the simulation did not fit the empirical relationship between the LAA% and the three parameters (RN1, RN5 and RN5/RN1). The simulation provided the best-fitting curves when the unit size of the LAA increased in proportion with the LAA%, starting from a 1 x 1 pixel size increasing at a ratio 1 x 1/(5 LAA%). This suggested that the LAA units do not proliferate randomly in spatial orientation at a fixed unit size, but rather spread throughout the whole lung field in a congregated form whilst increasing their unit size. Thus, it may be concluded that healthy lung tissues near emphysematous lesions have a high probability of suffering from emphysema in the future. This may be due to a direct effect of the neighboring emphysematous lesion or due to a pathologic change in the larger bronchii which dominate both the healthy tissues and the emphysematous lesions.

Aged

[Potency of CPR without artificial breathing].

Recent experimental studies reported by several independent groups demonstrated that in the initial interventions of cardiopulmonary resuscitation (CPR), airway protection (A) and artificial breathing (B) are not essential for successful recovery from cardiac arrest. In this study, we reviewed and compared those reports to investigate individual effects of A and B on initial CPR. Airway protection: Spontaneous gasping during cardiac arrest is accompanied by upper airway protective reflexes such as head tilt and open mouth. Gasping promoted CO2 elimination from the nose in animals without A. Breathing: Gasping and precordial compression generated ventilation up to 150 and 100 ml.kg-1. min-1 respectively during cardiac arrest. Arterial blood gas analyses demonstrated that CPR without B developed hypercarbia, but maintained oxygen tensions in physiological levels. The frequency of chest compression is in the range of high frequency ventilation, which might allow for successful oxygenation regardless of limited tidal volumes. A series of experimental studies for CPR without A or B call for establishment of a simple CPR method for bystanders, namely "Just compress the chest".

Animals

Increased activity of the ipsilateral motor cortex during a hand motor task in patients with brain tumor and paresis.

PURPOSE: To look for changes in the motor cortex in patients with brain tumors. METHODS: Both cerebral hemispheres in seven patients with brain tumors were examined with functional MR imaging during a motor task performed by the hand opposite the site of tumor. The ratio of the activated area in the motor cortex ipsilateral/contralateral to the tested hand was calculated for each subject. Twenty healthy subjects were also examined in the same manner for comparison. RESULTS: The ratio of the ipsilateral/contralateral activated area was abnormally high in three patients with tumor-related paresis of the tested hand. The ratio was significantly greater in patients with paresis than in healthy subjects. CONCLUSION: This study demonstrated increased activity in the ipsilateral (unaffected) motor area during a hand motor task in patients with brain tumor and paresis, which was thought to reflect compensatory reorganization induced by the functional damage.

Adult

Cytokeratin subtyping in chordomas and the fetal notochord: an immunohistochemical analysis of aberrant expression.

Chordoma is a well-known bone tumor that shows epithelioid features and in which the expression of cytokeratins (CKs) has been reported to appear very frequently. Numerous immunohistochemical analyses of CK expression have been conducted using such monoclonal antibodies as CAM5.2, which react with CK8, CK18, and CK19, and AE1/AE3, which react with CKs 1-8, 10, 14-16 and 19 in chordoma. No detailed analysis, however, of the expression of each component of CK has yet been conducted in chordoma; thus, the subsets of CK expressed there have yet to be clarified. With the use of immunohistochemical techniques with a panel of monoclonal antibodies against each subset of CK, the authors studied the expression of CKs in 16 specimens of classic chordoma and 14 specimens of the fetal notochord to clarify the subsets of CK expressed in chordoma and to evaluate the similarities and differences of CK expression between chordoma and the fetal notochord. All of the chordoma specimens showed a strong positive immunoreactivity for CK8 and CK19, whereas nine (56.3%) chordoma specimens showed a positive immunoreaction for CK18. In addition, four chordoma specimens were focally positive for keratin-903, which reacts with high molecular weight CKs such as CK1, CK5, CK10, and CK14; one specimen also showed a strong CK7 expression. All of the notochord specimens were also positive for CK8 and CK19, but none showed a positive immunoreaction for keratin-903, CK7, or CK18. In addition, none of the chordoma or notochord specimens showed immunoreactivity for CK20. The expression of CK8 and CK19, observed in all of the chordoma and notochord specimens, was thus considered to be maintained throughout the neoplastic transformation, although some aberrant CK expressions (CK7, CK18, and keratin-903) also occurred in the chordoma specimens examined in this study.

Adult

[A penetrating cranio-facial injury due to a nail-gun accident].

We report a case of a penetrating cranio-facial injury due to a nail-gun accident. An 18-year-old worker was admitted to our hospital as an emergency patient. He was working using a nail-gun when a nail ricocheted off a wall and pierced the right side of his face. Skull X-rays and a CT scan showed that a 9 cm nail had pierced his right frontal lobe through the right maxillary bone via the orbital space. The patient was alert without any neurologically abnormal findings. A small stab wound was recognized on his face. The nail was removed six hours after the injury through a sublabial approach and a fronto-temporal craniotomy. The nail was very tightly fixed in the maxillary bone and skull base bones, and a screw driver normally used in orthopedic surgery proved to be very useful for removing the nail. The patient returned home 14 days later without any neurological deficits. The technical problems associated with such a nail-gun injury in the face and skull are also discussed.

Adolescent

[Surgical management of intractable epilepsy in patients with ganglioglioma].

Long-standing intractable seizures are common manifestation of cerebral gangliogliomas. There is much controversy regarding the most appropriate surgical treatment (lesionectomy vs resection of the epileptogenic cortex with the lesion) for patients with intractable epilepsy associated with gangliogliomas. We reported 2 cases, in which the favorable seizure outcome was obtained following lesionectomy alone. (Case 1) Nine-year-old female developed attack of abnormal sensation in her left upper limb followed by motor seizure in her left limbs since 5 years old. MRI revealed hyperintense tumor in the right medial frontal lobe. Chronic invasive subdural recording showed that ictal onset zone was located in the hand motor area. Following lesionectomy alone, she became free from seizures. (Case 2) Eight-year-old girl had intractable generalized seizure since 6 years old. MRI revealed a cystic tumor in the right parietal lobe. She had multiple spike foci on electroencephalography and magnetoencephalography, and intraoperative electrocorticography failed to reveal the paroxysm. Following lesionectomy, she had good relief with less than one minor seizure per 1-3 months. Thus, lesionectomy, even without resection of the epileptogenic cortex, may improve seizure outcome in patients with ganglioglioma-associated epilepsy.

Brain Neoplasms

[An operated case of intractable occipital lobe epilepsy associated with calcification in the occipital lobe].

We reported a 20-year-old female of intractable occipital lobe epilepsy associated with calcification in the left occipital lobe. She developed seizures since 2 years old and electroencephalography showed paroxysmal activities on the left occipital area. At 8 years old, partial resection of the lesion and interictal spike focus under intraoperative corticography guidance was performed, but the favorable seizure outcome was not obtained. At the age of 20 years old, the frequency of her seizures has increased and admitted to our department. Preoperative evaluation with chronic invasive subdural recording showed that the ictal zone was located in the inferior (tentorial) surface and convexity of the left occipital lobe. Functional mapping involving cortical stimulation and cortical recording of pattern-reversal visual evoked potentials demonstrated that the ictal onset zone was not in the visual area. Following cortical resection of the ictal onset zone and multiple subpial transection on the surrounding cortex, she had good relief with less than one minor seizure per 1-3 months. Histological findings of the resected specimen were consistent with those of Sturge-Weber syndrome. Thus chronic invasive subdural recording may improve seizure outcome in patients whose epileptogenic area was located near the visual field.

Adult

[Radiation-induced leiomyosarcoma of the dura mater: a case report].

A 31-year-old man underwent total resection for a fibrillary astrocytoma in the right frontal lobe followed by 6MV x-ray radiotherapy. The portal field size was a square of 8 cm x 7 cm, and the total dose of irradiation was 50Gy, with single fractions of 2Gy. For the next 6.5 years there was no recurrence of the astrocytoma. At 38 years of age, the patient noticed a subcutaneous mass in the scar of the previous operation and developed generalized convulsive seizures. MRI revealed a dural tumor within the previous radiation field, and the tumor was partially removed. Histologically, it was diagnosed as a leiomyosarcoma. This dural sarcoma satisfies the widely used criteria for definition of radiation-induced malignancies first described by Cahan et al. Both the clinical features and the possible histogenesis of this secondary tumor are briefly discussed.

Adult

Inhibition of a medium chain acyl-CoA synthetase involved in glycine conjugation by carboxylic acids.

Molecular characteristics of carboxylic acids were investigated for the ability to inhibit a purified medium chain acyl-CoA synthetase, using hexanoic acid as a substrate. Salicylic acid, 4-methylsalicylic acid, 2-hydroxynaphtoic acid, and 2-hydroxyoctanoic acid, which do not act as substrates for the medium chain acyl-CoA synthetase, were potent as inhibitors. Valproic acid was not an inhibitor. Salicylic acid, 2-hydroxynaphthoic acid, and 2-hydroxyoctanoic acid inhibited the medium chain acyl-CoA synthetase with Ki values of 37, 5.2, and 500 microM, respectively. 4-Methylsalicylic acid was more potent than salicylic acid. The inhibitory carboxylic acids were competitive with respect to hexanoic acid. The distance of the hydroxyl group from the carboxylic acid group of the benzene ring influenced the inhibitory activity. The hydroxyl group on the carbon adjacent to the carboxylic acid group was required for inhibitory activity. In addition, there was a good correlation between the lipophilicity of the carboxylic acids and the Ki values, suggesting that the lipophilicity of the carboxylic acids is a major determinant for inhibition of the medium chain acyl-CoA synthetase.

Animals

Formation of crossline as a fluorescent advanced glycation end product in vitro and in vivo.

Crossline is one of the major advanced glycation end products resulting the reaction mixture of free amino group(s) such as epsilon-one in lysine with D-glucose in vitro. To study crossline formation on proteins in vitro and in vivo, polyclonal antiserum to the crossline hapten was prepared. This antiserum reacted with bovine and human serum albumin that had been modified by prolonged incubation with glucose as well as with crossline itself. Antisera did not react with unmodified serum albumin or the other Maillard-related compounds. Crossline was formed in a time-dependent manner when a mixture of six different proteins was incubated with glucose at pH 7.2 or 9.0. Crossline levels could be measured in rat lens proteins and the levels increased with age. The crossline content of lens proteins in diabetic rats was more than two-fold higher than that of age-matched controls. Results of this study suggest that most proteins containing advanced glycation end products have crossline-like structures. Measurement of crossline-like structures in biological specimens may provide an index of aging and of the development of diabetic complications.

Animals