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Biomedical subjects

M Kitamura

Publications and source records attributed to M Kitamura.

At least 307 records · Page 17Linked to original sources
PubMed1995

[Changes in CT-scan findings of liver metastases from gastric carcinoma treated by hepatic arterial infusion chemotherapy, especially after chemo-embolization and induced hypertensive chemotherapy].

The purpose of this study was to clarify the effectiveness of hepatic arterial infusion chemotherapy (HAIC) from not only the reduction rate but also the characteristic findings in CT-scan. Subjects were nine responders of HAIC for liver metastases from gastric carcinoma (chemo-embolization, 4 cases; induced hypertensive chemotherapy, 5 cases). Low density (LD), enhancement and indentation of the metastatic lesions were the characteristic findings. As the result, LD was more frequent in chemo-embolization cases (100%) than in induced hypertensive chemotherapy cases (60%). LD change, which was appeared in four cases before partial response, was one of the findings indicating the effectiveness. On the other hand, autopsy revealed severe LD to be necrosis or abscess of metastatic lesion. Therefore, we should pay attention to avoid complications such as rupture, and discontinue HAIC when severe LD appears.

Aged↗
PubMed1995

[Evaluation of intraoperative peritoneal cytology and intraperitoneal chemotherapy using CDDP combined with MMC for gastric carcinomatous peritonitis].

A cytological examination in the lavaged peritoneal fluid during operation was performed in 462 patients with gastric cancer. The incidence of positive cytology was 36% in serosal invasion cases. The prognosis of positive cytology cases without peritoneal dissemination was slightly better than the P (+) cases. The incidence of the positive cytology was 48% in patients with serosal invasion more than 16 cm2. The prognosis of patients with serosal invasion below 32 cm2 was significantly better than in the patients with above 32 cm2. Intraperitoneal repeated administration of MMC 10 mg/body and CDDP 40-50 mg/body was continued one a month via the drug delivery system. Negative change of cytology was observed in 7 out of 14 patients, and the prognosis of these patients was better than that of the unchanged cytology group. Side effects such as severe gastrointestinal symptoms and bone marrow toxicities were not observed. Further studies should be done to confirm the efficacy of the intraperitoneal chemotherapy in terms of the prolongation of life.

Adult↗
PubMed1995

[Intraperitoneal distribution of drug after gastric surgery].

To evaluate intraperitoneal distribution of drug after surgery, a radiographic study using peritoneography was performed. Five cases with positive intraoperative cytology of gastric carcinoma were studied. The tip of the subcutaneous injection catheter was located in the Douglas's fossa intraoperatively. As control group, 7 cases of inguinal hernia who underwent radical resection for gastrointestinal carcinoma and 2 cases who failed intraperitoneal chemotherapy through injection port, underwent peritoneography. The distribution of contrast medium in the peritoneal cavity was compared between groups. (Conclusion) The distribution of drug after gastric surgery was observed in all of the peritoneal cavity below the transverse colon. Distribution was not observed in the region where lymphadenectomy or bursectomy was done. The peritoneum has an important role in the distribution of drugs in the peritoneal cavity.

Cisplatin↗
PubMed1995

[A case of intrahepatic infusion chemotherapy with angiotensin II human for liver metastasis from early gastric cancer].

A 71-year-old woman underwent subtotal distal gastrectomy for II a+ II c type early cancer of the gastric antrum. Histological type was poorly differentiated adenocarcinoma with medullary proliferation, and the lesion invaded the submucosal layer. Two years and 6 months after the operation, multiple liver tumors were found on the CT scan. A surgical resection of the liver tumor was performed. Microscopically, the liver tumors were compatible with gastric cancer. The remnant liver metastases were treated by intrahepatic infusion chemotherapy with Angiotensin II human (Delivert) using a subcutaneous implanted pump. The liver metastases disappeared on the CT scan after 3 courses of chemotherapy, but bone metastasis occurred after 2 months. This mode of chemotherapy was therefore considered a useful treatment for liver metastasis in gastric cancer. We concluded that not only intrahepatic infusion chemotherapy with Angiotensin II human but also another systemic chemotherapy was necessary to treat patients with liver metastasis in gastric cancer.

Adenocarcinoma↗
PubMed1995

[Surgical results of aortic stenosis with or without left ventricular dysfunction--postoperative change of left ventricular function].

Between January 1980 and December 1992, 82 patients with aortic stenosis underwent isolated aortic valve replacement at our institution. Age of the patients ranged from 26 to 72 (58 +/- 6.4) years, and 58 were men and 24 were women. The patients were divided into two groups according to preoperative left ventricular ejection fraction (LVEF): 23 patients (LVEF < 50%, mean 39.7%; Group D) and 59 patients (LVEF > or = 50%, mean 62.6%; Group N). By means of echocardiography, LV function were evaluated before and at one month after operation in terms of left ventricular fractional shortening (LVFS), left ventricular systolic internal diameter (LVIDs), left ventricular mass index (LVMI), and left ventricular end systolic wall stress (ESWS). Postoperative early mortality including hospital death was 8.7% in group D (2 cases; myocardial infarction 1, cerebral complication 1) and 3.3% in group N (2 cases; myocardial infarction 1, low output syndrome 1), and this difference was not significant (NS) between two groups. The 5- and 12-year actuarial survival rate were 87.8% and 87.8% in group D, 91.5% and 87.6% in group N, respectively (NS). LVFS (pre/post) was 0.25 %/- 0/08/0.24 +/- 0.10 in group D, 0.38 +/- 0.10/0.32 +/- 0.10 in group N. The difference were significant before (p < 0.0005) and after (p < 0.005) operation between two groups. LVIDs (mm; pre/post) were 39.0 +/- 7.9/35.0 +/- 9.6 in group D, 28.7 +/- 7.3/229.3 +/- 7.6 in group N. The difference were significant before (p < 0.0005) and after (p < 0.01) operation.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1995

[Retrospective study of sputum culture after esophagectomy].

We retrospectively investigated the sputum cultures of patients who underwent esophagectomy (n = 104) from just after operation to 11 postoperative days and evaluated the factors which influenced the cultures. We divided the 0-11 postoperative days into three periods (0-3 postoperative days (p.o.d.), 4-7 p.o.d., 8-11 p.o.d.). The sputum cultures were positive at a rate of 56.7% to 65.4% of patients during the period of observation (0-11 p.o.d.). Gram-negative bacillus was mostly detected. MRSA increased time-dependently. Diabetes mellitus, preoperative irradiation recurrent nerve palsy did not influence the positive rate of the sputum cultures. The positive rate of gram-negative bacillus and gram gram-positive coccus in the sputum of the patients who were given sefem-first generation antibiotics was lower than of patients who were given sefem-second generation antibiotics at 8-11 p.o.d. (p < 0.05). The positive rate of gram-negative bacillus in the sputum of patients who underwent esophagectomy with laryngectomy for cervical esophageal cancer was lower than that of patients who underwent esophagectomy without laryngectomy for thoracic or abdominal esophageal cancer at 4-7 p.o.d. (p < 0.05). The positive rate of gram-negative bacillus in the sputum of patients who underwent intraoperative tracheostomy was lower than that of patients who did not undergo intraoperative tracheostomy at 4-11 p.o.d. No patients had pneumonia during the period of observation except for the secondary lung complications. In conclusion, although we have done a good job of management, we should select the appropriate antibiotics with the patient's background in mind.

Aged↗
PubMed1995

[Clinical significance of diffuse vasoconstriction of coronary arteries--a study using hyperventilation thallium-201 myocardial imaging].

Hyperventilation Thallium-201 imaging was evaluated for the examination of the existence of ischemia in the cases of diffuse vasoconstriction under the ergonovine maleate provocative test for coronary artery. Transient myocardial perfusion defect (PD) was demonstrated in 14 patients with ergonovine induced vasospasm (group S), and 13 of these patients also demonstrated redistribution (RD) (92.4%). In 14 patients with diffuse vasoconstriction (group D), nine demonstrated PD, and all of them revealed RD. On the other hand, only one of ten (10%) patients demonstrated PD and RD in a group of patients without spasm or diffuse vasoconstriction (group N). In addition, the left ventricular myocardium was divided into nine segments on a SPECT image, and the mean minimum washout rate (WOR) of each segment was evaluated. These values were compared with the percent change of the lung/heart ratio between early and delayed images (delta L/H%). Both the mean minimum WOR mean and delta L/H% of group D were significantly smaller than that of group N (p < 0.001), and only approximated to group S. Thus, the possibility of myocardial ischemia of diffuse vasoconstrictive coronary artery is implicated and such patients are supposed to be treated medically as vasospastic angina.

Aged↗
PubMed1995

[A case of dermatofibrosarcoma protuberans who underwent chest wall reconstruction].

Dermatofibrosarcoma protuberans (DFSP) is a slowly growing tumor that occurs in the dermis, and it has a tendency to recur repeatedly. We reported a case, 50-year-old woman, who underwent chest wall reconstruction due to recurrence of DFSP. Since the first operation for the tumor 35 years ago, she had undergone surgical procedures 30 times. We had to resect parts of the rib cartilages and the sternum because we suspected the tumor had reached to the anterior mediastinum. There has been no recurrence for 8 months since this operation. Importance of extensive resection of the tumor to prevent a recurrence and long term follow-up should be stress.

Dermatofibrosarcoma↗
PubMed1995

[A case of deep neck abscess and acute mediastinitis, secondary to peritonsillar abscess].

A 60-year-old female visited a hospital complaining of fever and pharyngeal pain. She was diagnosed as peritonsillar abscess. Initial conservative treatment was not curative, and deep neck and mediastinal abscess developed. After cervical drainage, she was referred to our hospital. Drainage tube was inserted via epigastrium into anterior mediastinum upwardly under local anesthesia. Postoperative course was uneventful, and she was cured and discharged after about 1 month of hospitalization. We stressed the importance of recognition of the mediastinitis as a complication of cervical infections. And immediate drainage procedure is required as soon as the diagnosis is established.

Abscess↗
PubMed1995

Different functional recovery of the left ventricle after valve replacement for aortic regurgitation: correlation between grade of ventricular arrhythmia and long-term mortality.

Although aortic valve replacement for aortic regurgitation relieves left ventricular volume overload, ventricular size often remains abnormal after operation, particularly in the setting of marked or prolonged preoperative left ventricular dysfunction. The aim of this study is to assess the relationship between the grade of ventricular arrhythmias before operation and the recovery of left ventricular function after aortic valve replacement. Between January 1980 and August 1993, 229 patients with pure aortic regurgitation underwent aortic valve replacement at our institution. In this group, 50 patients (21.8%) who showed left ventricular end-systolic volume index (LVESVI) of 150 ml/m2 or greater received 24-hour ambulatory electrocardiographic recordings before and after operation. According to the preoperative grade of ventricular arrhythmias, the patients were divided into three groups. Group A included 20 patients with severe and frequent ventricular premature beats (VPBs). Group B included nine patients with severe and non-frequent ventricular premature beats (VPBs). Group C included 21 patients with non-severe and non-frequent VPBs. Left ventricular end-systolic dimension (LVDs), end-diastolic dimension (LVDd) and fractional shortening (LVFS) were measured in each echocardiogram before, and one year and five years after operation. LVDd significantly decreased at one year after operation in all three groups. At one year after operation, LVDs significantly decreased in group B (42.0 +/- 7.6 mm) and group C (42.6 +/- 8.6 mm), while LVDs showed no significant change in Group A (55.4 +/- 11.1 mm). After five postoperative years, further significant decrease of LVDs was found in group C (32.4 +/- 7.1 mm).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1995

Current strategy of circulatory support for profound heart failure.

The purpose of this study is to assess the current strategy of mechanical circulatory support for profound heart failure. In the last 10 years, 37 patients with profound heart failure underwent mechanical circulatory support after open heart surgery and 9 patients with non-cardiotomy cardiogenic shock received emergency circulatory support. All patients showed severe cardiac failure and/or fatal ventricular arrhythmia and required circulatory support as a life-saving measure. After cardiovascular surgery, 12 of those patients underwent venoarterial bypass (VAB), 13 had biventricular bypass (BVB), 8 had left ventricular bypass (LVB) and the remaining 4 patients received left ventricular assist device (LVAD). And 9 patients with non-cardiotomy cardiogenic shock received percutaneous cardiopulmonary support (or PCPS) as an emergency assist system. Weaning and discharge rates of the patients by the type of circulatory supports were 41.7% and 25.0% with VAB, 69.3% and 46.2% with BVB, 87.5% and 37.5% with LVB, 75.0% and 50.0% with LVAD, and 44.4% and 11.1% with PCPS, respectively. Clinical results of post-cardiotomy circulatory support (64.9% of weaning and 37.8% of discharge) were acceptable, but the patients with non-cardiotomy cardiac failure needed early application of more advanced circulatory support.

Adult↗
PubMed1995

[Relation between preoperative ventricular arrhythmias and postoperative results in aortic valve regurgitation].

Sudden death is a well known complication of aortic valve regurgitation and remains a common cause of late mortality after aortic valve replacement. Although malignant arrhythmias have been suggested as the cause of these outcome, there has been little information concerning the frequency and severity of ventricular arrhythmias in patients with aortic valve regurgitation. In order to evaluate the relation between the severity and/or frequency of ventricular arrhythmias and late postoperative results in patients with pure aortic valve regurgitation, 24-hour ambulatory electrocardiographic recordings were obtained before surgery in 107 patients without coronary artery disease. Grading of ventricular arrhythmias was based on a Lown method and compared with hemodynamic data. Ventricular premature beats were observed in 101 patients (94.4%) before operation. Multiformity was found in 10 patients (9.3%) couplets in 19 patients (17.8%) and ventricular tachycardia in 32 patients (29.9%). Patients with severe ventricular arrhythmias (Lown grade 3 or 4: 57.0%) had a higher left ventricular end systolic volume index (LVESVI) 153.1 +/- 76.4 ml/m2 vs 96.5 +/- 35.0 ml/m2 (p = 0.0001); a higher left ventricular end diastolic volume index (LVEDVI) 257.0 +/- 85.4 ml/m2 vs 206.5 +/- 58.3 ml/m2 (p = 0.0009); a lower left ventricular ejection fraction (LVEF) 43.4 +/- 12.5% vs 54.2 +/- 9.8% (p = 0.0001). LVESVI was not related to the severity of ventricular arrhythmias, but was significantly related to the frequency (p < 0.05). All patients with late death were belonging to Lown grade 3 or 4 in severity and more than 30 beats per hour in frequency (28.6%). This study indicates that ventricular arrhythmias are common in patients with aortic valve regurgitation.(ABSTRACT TRUNCATED AT 250 WORDS)

Aortic Valve↗
PubMed1995

Membrane cofactor protein (CD46) in seminal plasma is a prostasome-bound form with complement regulatory activity and measles virus neutralizing activity.

Human seminal plasma contains 0.55 microgram/ml of membrane cofactor protein (MCP; CD46) of 60,000 MW. By ultracentrifugation, gel filtration and immunoelectron microscope methods, we found that the MCP in seminal plasma was associated with prostasomes. The functional properties of the prostasome-bound MCP were assessed in comparison with a recombinant soluble form, gamma MCP1, which is composed of four short consensus repeats (SCR), type C of the serine/threonine-rich domain (STC), and unknown significance (UK). The MCP in seminal plasma, although demonstrably bound to prostasomes, behaved more like the soluble form of MCP. In the absence of detergent it, together with factor I, degraded the fluid-phase ligand, methylamine-treated C3 [C3(MA)], which is insensitive under no-detergent conditions to the membrane form of MCP and factor I. Moreover, C3dg fragment was generated as a final product instead of C3bi during the incubation, indicating that the prostasomal MCP and proteases may be responsible for the C3dg generation. The prostasomes neutralized measles virus (MV) infectivity, while gamma MCP1, for the most part, did not. These results, taken together with the CD59 concentration on the prostasomes, suggest that the prostasomes are potential immunomodulators for complement activation, providing the C3- and C9-step inhibitors. The present report also reinforces the idea that there are two different forms of MCP in semen. One is located in the inner acrosomal membrane of spermatozoa, which appears through acrosomal reaction and spermatoon-egg interaction. The other is a prostasome-bound form maintaining activities sufficient to regulate complement activation and, probably, MV infection.

Antigens, CD↗
PubMed1995

[Surgical results of aortitis syndrome (Takayasu disease) combined with annuloaortic ectasia].

From March 1973 to December 1994, 8 patients (2 males and 6 females) aged 34.4 +/- 7.8 years, underwent composite graft replacement (CGR) for aortitis syndrome combined with annuloaortic ectasia (AAE) in our institute. Five patients showed active aortitis syndrome and steroid therapy was administrated to 2 of them. The mean value of the C-reactive protein (CRP) was 1.6 +/- 1.8 before the operation. The maximum diameter of the ascending aorta was 67.1 +/- 10.3 mm (range 53 to 85 mm). Stenosis and/or ectasia of the neck vessels were recognized in 5 cases, as well as the coronary artery in 2 cases. Isolated CGR was performed in 6 cases, and combined with single CABG to LAD in 1 case and with total arch replacement in 1 case. The enlarged ascending aorta was replaced with main graft using the exclusion method and interposed grafts for coronary arteries were sutured with pledgetted mattress sutures all around the coronary ostia. In patients with stenosis of neck vessels, oxygen saturation of the jugular vein was monitored during extracorporeal circulation for surveillance of cerebral ischemia. There was 1 early death due to pulmonary failure. Seven cases survived without any complications during 4-132 months (mean 83.4 months) of the follow-up period. After the operation, 3 cases required steroid therapy during 4-50 months. We concluded that preoperative control of active inflammation, selection of operative procedures, timing for the operation, and the long-term precise management of the intractable disease were essential for successful treatment of aortitis syndrome with AAE.

Adult↗
PubMed1995

[Comparison of exercise-stress single photon emission computed tomography with thallium-201 reinjection and postextrasystolic potentiation to assess myocardial viability in patients with myocardial infarction].

Myocardial viability was examined in 20 patients with myocardial infarction 24 +/- 3 (mean +/- standard deviation) days after onset. Postextrasystolic potentiation (PESP) was measured by left ventriculography and thallium-201 (Tl) single photon emission computed tomography (SPECT) redistribution was assessed after stress loading and reinjection of Tl. The results were compared with the improvement of left ventricular segmental wall motion after coronary revascularization which was performed successfully in all patients. The uptake of Tl was impaired initially in 41 segments, classified into three groups: normal group, 13 segments with smooth reversion to normal; new fill-in group, 15 segments with a new fill-in after reinjection of Tl; no fill-in group, 13 segments with no fill-in after reinjection. When evaluated by the PESP before coronary revascularization, segmental wall motion was significantly augmented in all segments in the normal group and new fill-in group (p < 0.001), but not in the no fill-in group. After coronary revascularization, left ventriculography revealed that segmental wall motion was significantly improved in normal group and new fill-in group, but not in the no fill-in group except for mild improvement in five segments. The sensitivity and specificity of PESP (90% and 93%) and Tl SPECT (80% and 100%) for improvement of segmental wall motion after the coronary revascularization were very high, with the accuracy of either method attaining 87%. This result indicates that both Tl SPECT and PESP are useful for detecting viable myocardium in patients with recent myocardial infarction.

Aged↗
PubMed1995

Long-term outcome of left ventricular dysfunction after surgery for severe aortic stenosis.

Thirteen patients with severe aortic stenosis and left ventricular dysfunction (ejection fraction < 0.50, Group A) received echocardiographic evaluation before, and early and late after isolated aortic valve replacement. The results were compared with those of 11 aortic stenosis patients without left ventricular dysfunction (Group B). Using two-dimensional echocardiography, left ventricular diastolic internal diameter (LVIDd), left ventricular systolic internal diameter (LVIDs), left ventricular wall thickness (interventricular septum + posterior wall: LVWT), left ventricular fractional shortening (FS), left ventricular mass index (LVMI) and left ventricular end-systolic wall stress (ESWS) were assessed before (Pre), at one month (Early) and 4-7.6 (mean 5.5 +/- 1.0) years (Late) after operation. In the early postoperative period in Group A, significant decrease was observed in LVIDd (5.4 +/- 0.8 to 4.5 +/- 1.0 cm, p = 0.010), LVWT (3.3 +/- 0.7 to 2.9 +/- 0.7 cm, p = 0.027) and LVMI (336 +/- 149 to 222 +/- 112 g/M2, p = 0.013). From the early to late postoperative period FS showed significant improvement in both groups (0.23 +/- 0.12 to 0.32 +/- 0.12 in Group A, p = 0.025 and 0.27 +/- 0.07 to 0.36 +/- 0.07, p = 0.014). However, changes of other parameters were not significant and LVMI in Group A remained twice as high as the normal value. It is concluded from the above results, that LV contraction in aortic stenosis patients with preoperative left ventricular dysfunction improved during the late postoperative period. Although LVMI in the early postoperative period significantly decreased as compared with the preoperative value, it showed no further improvement and remained at an abnormally high level. Therefore, early surgical treatment of severe aortic stenosis before appearance of LV dysfunction should be recommended for postoperative recovery from LV hypertrophy.

Aged↗