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Biomedical subjects

M Koiwa

Publications and source records attributed to M Koiwa.

At least 37 records · Page 2Linked to original sources
PubMed1995

[Prognosis and outcome of rheumatoid arthritis--10 to 16 years of anti-rheumatic therapy].

One hundred twenty-eight rheumatoid arthritis (RA) patients were followed up over a long period of time (mean, 13.3 years; range, 10-16 years) in order to determine the role of pharmacotherapy in RA. Patients were aged 48.2 years on the average (23-79 years) and the mean RA duration was 7.8 years (0-58 years) upon initial visit to this unit. Although pharmacotherapy was effective in improving Lansbury's activity index and ESR, articular bone and cartilage destruction and functional impairment progressed gradually, resulting in the need for total hip, knee or ankle arthroplasty in 46 (96 joints) of the 128 patients. This finding indicates that current pharmacotherapy for RA has limitations in that it cannot completely prevent joint destruction and resulting functional impairment. This suggests that new therapeutic modalities, including new drugs, are necessary. Efforts were also made to determine factors which affect the prognosis of RA. The prognosis seemed pessimistic in RA patients with high activity and rheumatoid factor (RAPA) levels, long duration of illness, high Larsen scores and advanced functional impairment at the time of initial active therapy. It appeared necessary to maintain Lansbury's activity index at 30% or below in order to obtain a good prognosis.

Adult↗
PubMed1995

[Proton MR spectroscopy in patients with unilateral temporal lobe epilepsy].

The authors assessed proton magnetic resonance spectroscopy (1H-MRS) in patients with unilateral refractory temporal bole epilepsy. The subjects consisted of 20 patients (those with brain tumors, trauma, malformations or definite organic lesions were excluded) and 10 normal volunteers. 1H-MRS and MRI were performed using a 1.5 tesla machine. 1H-MRS was achieved using point-resolved spectroscopy (PRESS) or the stimulated echo acquisition mode (STEAM), and a 3 x 3 x 3 cm volume of interest was positioned at the hippocampus. N-Acetyl-aspartate (NAA) and choline-containing substance (Cho) signals were evaluated. The results showed decreased NAA and elevated Cho or asymmetry of both NAA and Cho in the epileptogenic focus in 19/20 cases. The reductions in NAA presumably reflect neuronal loss, while the elevation of Cho probably represents membrane break down within the lesion. These abnormalities were observed in 19/20 cases (95%), whereas abnormal magnetic resonance imaging was detected in only 6/20 (30%) of the patients. Thus, 1H-MRS appears to be a useful, non-invasive modality for evaluating metabolic changes in epileptogenic foci, and these metabolic changes can serve as a more sensitive indicator than magnetic resonance imaging.

Adolescent↗
PubMed1994

Cerebral metabolic changes in delayed carbon monoxide sequelae studied by proton MR spectroscopy.

The pathogenesis of delayed sequelae of carbon monoxide (CO) exposure is still unknown. We repeatedly examined a 55-year-old woman with the interval form of CO poisoning, using proton magnetic resonance spectroscopy (MRS). When the clinical picture was severe, MRS revealed markedly lowered N-acetyl-aspartate (NAA)/creatine and phosphocreatine (Cr) ratio and slightly increased choline containing compounds (Cho)/Cr ratio. Subsequently, NAA and Cho/Cr ratio tended to return to normal, reflecting clinical improvement. Proton MRS shows the previously unrecognised neuronal activity in CO poisoning and precisely reflects the severity of symptoms. We stress the superiority of proton MRS over the conventional radiological examinations in CO poisoning.

Brain↗
PubMed1994

Magnetic resonance angiography (MRA) of ruptured cerebral aneurysm.

The purpose of this study was to evaluate the high resolution magnetic resonance angiography (MRA) as pre-operative angiography for the detection of ruptured cerebral aneurysms. MRA was performed on 1.5 tesla system using the 3-dimensional time of flight (3D-TOF) method. The field of view was 16 cm or 20 cm and matrix size was 192 x 256 or 256 x 512. Twenty patients with ruptured cerebral aneurysms and 35 cases of non-ruptured aneurysms (incidental aneurysm) examined by both conventional angiography and MRA were included in this study. All the ruptured aneurysms were operated on based on the information obtained from conventional angiography and MRA. Aneurysms smaller than 3 mm in size were difficult to visualize on MRA. However, most ruptured aneurysms were clearly visualized because they were generally larger than 3 mm. The image quality of MRA was satisfactory for planning surgery. Screening for non-ruptured cerebral aneurysms using MRA is controversial. However, in ruptured aneurysms larger than 3 mm in size, MRA clearly revealed the aneurysm, and MRA findings were informative enough to plan surgery. It is concluded that this noninvasive examination can be selected as a first-choice examination especially in cases of ruptured aneurysm.

Aortic Dissection↗
PubMed1994

[Preliminary report of radical multiple synovectomy in rheumatoid arthritis].

We performed radical multiple synovectomy (RaMS) on rheumatoid arthritis (RA) patients who had multiple swollen joints in the mid or late course of RA. The objectives of this operation are to reduce the quantity of RA synovium as much as possible and to increase the efficacy of anti-rheumatic medication in order to achieve remission.2+ Nineteen RA patients who underwent RaMS were followed up for at least 15 months. In this series, anti-rheumatic medications were not changed after the operation, so that the effectiveness of the RaMS could be evaluated. The patients ranged in age from 44 to 73 years (mean: 55.8 years). The male to female ratio was 2:17. Duration after onset of RA ranged from 2 to 29 years (mean: 15.1 years). The swollen joint score according to Lansbury's evaluation of the RA activity index ranged from 7 to 24% (mean: 14.4%). The synovectomized joint score ranged from 7 to 22% (mean : 13.3%). The weight of the excised RA synovium ranged from 19.0 to 109.9 g (mean : 54.0 g). The number of operations was one in three patients, two in 15 patients and three in one patient. The postoperative results indicated that the modified Lansbury's index (morning stiffness, grip power, ESR, joint score), the values of ESR, CRP, Hb, TNF-alpha and IL-6 in the blood, and the peripheral lymphocyte CD4/CD8 ratio were improved, with a statistically significant difference. At 15 months after the operation, ten of the 19 patients (52.5%) satisfied the proposed criteria for clinical remission of RA.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1993

[Analysis of cerebral blood flow dynamics and evaluation of extracranial-intracranial arterial bypass function using magnetic resonance angiography with presaturation pulse sequence].

Magnetic resonance (MR) angiography was applied to the study of blood flow dynamics and evaluation of extracranial-intracranial arterial bypass function in patients who had received bypass surgery. Three-dimensional gradient-echo acquisitions with selective presaturation of individual vessels were used to determine the direction of blood flow. Presaturation causes signal loss within the territory supplied by the presaturated artery, without affecting vessels not coursing through the presaturation slab. The patency of arterial bypass graft could be demonstrated as properly with MR angiography as with conventional angiography. In addition to that, MR angiography with presaturation pulse clearly demonstrated the direction of blood flow and the territory supplied by arterial bypass graft. The results were correlated with those from transcranial Doppler sonography and conventional angiography. We concluded that MR angiography is a noninvasive useful method for the evaluation of dependency on post-surgical collaterals and bypass function.

Aged↗
PubMed1993

[Diagnosis of intracranial occlusive vascular disease and evaluation of extracranial-intracranial (EC/IC) arterial bypass using three-dimensional magnetic resonance angiography].

The three-dimensional time-of-flight (TOF) magnetic resonance angiograms (MRA) were studied to evaluate its accuracy in the assessment of the intracranial carotid occlusive lesions, collateral circulation and also the patency of extracranial-intracranial (EC/IC) arterial bypass surgery. All occlusive lesions of the intracranial major arteries seen in conventional angiograms were revealed clearly with MRA. However MRA had its practical limitation in the evaluation of the leptomeningeal anastomosis (collateral circulation) probably due to the deterioration of contrast in its slow flow and saturation effect of the magnetization. In addition to that, MRA often exaggerated the severity of the stenotic lesions, mostly in severe cases. The post-operative state of collateral flow and the patency of EC/IC bypass could be evaluated as properly with MRA as with conventional angiography, although MRA was limited in spatial resolution and evaluation of flow direction. In conclusion, MRA was considered t be a reliable non-invasive modality as a screening examination for the evaluation of the carotid occlusive disease and as the follow-up study of the post-operative patients with EC/IC bypass surgery.

Carotid Artery Diseases↗
PubMed1993

[Role of opioid peptide in rheumatoid arthritis--detection of methionine-enkephalin and leucine-enkephalin in synovial tissue].

A relationship between rheumatoid arthritis (RA) and endocrinological abnormality has been suspected for many years. In the present study, we immunohistologically identified the presence of methionine-enkephalin (Met-enk) and leucine-enkephalin (Leu-enk), in synovial tissues collected from RA patients and determined the amount of these peptides and interleukin 1 beta (IL-1 beta) in the culture supernatant of tissue explants by RI and ELISA. Synovial membrane samples obtained by biopsy during artificial joint replacement and plasma samples simultaneously collected from 11 RA patients (11 joint) diagnosed as having classic or definite RA according to the diagnostic criteria of the American Rheumatism Association were used. All 11 patients were females and aged between 36 and 64 years (mean: 45.8 years). As a result of immunohistological standing (ABC method), Met-enk was detected in vascular endothelial cells and Leu-enk in superficial cells, vascular endothelial cells and interstitial cells. Leu-enk concentrations (42.3 +/- 15.8 pg/ml) were higher in the culture supernatant of the synovial membrane than in the plasma (20.7 +/- 13.3 pg/ml). Furthermore, in the culture supernatant the concentration of Leu-enk was positively correlated with that of IL-1 beta (r = 0.789). These findings suggest that Met-enk and Leu-enk are locally produced by synovial tissues and may exert an immunological and/or inflammatory role in RA synovitis.

Adult↗
PubMed1992

Papillary craniopharyngioma of the third ventricle--case report.

A papillary craniopharyngioma localized in the third ventricle occurred in a 45-year-old male. The clinical presentation was unusual and the neuroradiological appearance resembled a choroid plexus papilloma of the third ventricle. The tumor originated from the right anterolateral wall of the third ventricle, forming a discrete mass with prominent papillae formation. The tumor was totally removed by a transcallosal approach without neurological or endocrinological sequelae.

Cerebral Ventricle Neoplasms↗
PubMed1992

[Role of opioid peptide in rheumatoid arthritis--detection of beta-endorphin in synovial tissue].

The presence of beta-endorphin (beta-end) was immunohistologically identified in synovial tissue samples biopsied from patients with rheumatoid arthritis (RA) and osteoarthritis (OA). The amount of beta-end in culture supernatants of synovial tissue explants was also determined by RIA. beta-end was strongly detected in mainly superficial synovial cells, vascular endothelial cells and a few synovial interstitial cells in RA patients, but not in OA patients. In RA patients the beta-end concentration was significantly higher in the supernatants of tissue explants (26.4 +/- 8.3 pg/ml) than in the plasma of the same patients (15.3 +/- 2.5 pg/ml) (p < 0.01). Using isolated synovial cells, the beta-end concentration in the culture supernatants of non-adherent cells (19.4 pg/ml) was higher than that of adherent cells (4.0 pg/ml). It is suggested that beta-end is produced by non-adherent cells such as lymphocytes and neutrophils in addition to synovial lining cells and endothelial cells and may play some role in the pathology of RA synovial inflammation.

Adult↗
PubMed1992

[Evaluation of cerebral blood circulation using fast magnetic resonance imaging (turbo-FLASH)].

In its initial stage of development, poor time resolution was supposed to be inevitable for magnetic resonance imaging (MRI). The development of the gradient echo technique, however, has made an opening for a breakthrough to a fast MRI technique. However, conventional gradient echo technique is not fast enough to disclose the cerebral blood circulation. A new technique (turbo-FLASH), which combines gradient echo and preparation pulse, has opened the door to a true dynamic (high time resolution) MRI. The authors performed a basic study of this new fast imaging technique (Turbo-FLASH) for the evaluation of cerebral blood circulation. Using this dynamic MRI, the conventional Gd-DTPA administration (0.1mmol/kg, intravenous manual administration) has produced sufficient contrast to reveal a difference of the extent of enhancement between normal gray matter and white matter. In patients of cerebral infarction, the infarcted brain does not show any significant increase of signal intensity after the administration of contrast medium, whereas the normal brain shows a sharp increase of signal intensity after the administration of contrast medium. Indeed, many puzzling questions remain to be solved for clinical application of this new dynamic MRI. For example, the optimal quantity of contrast medium and optimal parameters for this sequence (T1 weighted or T2 weighted?) are still unknown. But, in any case, this dynamic MRI is expected to be a clinically powerful tool for the evaluation of cerebral blood flow.

Brain↗
PubMed1992

[A case report of rheumatoid arthritis patient with thoracic myelopathy].

The authors report a 39-year-old woman with rheumatoid arthritis associated with myelopathy at the thoracic level. X-ray films of thoracic spine showed scoliosis which had its apex at T6. Myelography demonstrated incomplete block at the level of T6. Computerized tomogram revealed destruction of left pedicle of the sixth thoracic vertebra and dislocation of the sixth rib into the spinal canal which compressed cord at T6 level. Hemi-laminectomy at T5-T7 level and decompression were performed. Pathological investigations of soft tissue around the cord and dura mater showed infiltration of small round cells. We concluded that the synovitis of costo-transverse joint or costovertebral joint led to the destruction of the pedicle. As a result, dislocation of the rib, scoliotic deformity and thoracic myelopathy occurred.

Adult↗
PubMed1992

[Psychosomatic medicine in rheumatoid arthritis].

Recent studies have shown that neuropeptides, such as substance P, are responsible for arthritis. We therefore studied opioid peptides (beta-endorphin, Methionine-enkephalin, Leucine-enkephalin) in order to confirm our belief that mental status may have some influence on the activity of rheumatoid arthritis (RA). We examined opioid peptides, lymphocyte subsets, psycologic test (Cornell Medical Index-Health questionnaire (CMI), the Face scale) and clinical data in patients with RA. Plasma Leu-enk, % Leu2a+ Leu15- cells,% Leu3a+ Leu8- cells and % Leu11+ Leu7- cells were higher in patients with a larger number of psycologic complaints in CMI. Plasma Leu-enk concentration was higher while % Leu11+ Leu7- cells was lower in proportion to the degree of neurosis, as indicated by the descrimitive chart of CMI. Plasma Met-enk concentration, % Leu2a+ Leu15- cells, and Lansbury's index were significantly higher in the group of patients whose facial expression was more severe. These findings suggest that mentala status have some relationship with the plasma level of opioid peptides (enkephalins) and immunologic functions, and that it may exert indirect effects on RA.

Arthritis, Rheumatoid↗
PubMed1992

[Intraoperative monitoring of facial electromyographic responses during neurovascular decompressive surgery for hemifacial spasm].

UNLABELLED: In this paper, we reported our experience of intraoperative facial electromyographic recordings obtained during microvascular decompression for hemifacial spasm. MATERIALS AND METHODS: Intraoperative electromyographic recordings from the mentalis muscle during stimulation of the temporal branch of the facial nerve has been attempted in 31 patients. No muscle relaxants were used except for those before intubation. Of 31 patients, 22 were female and 9 were male. The age on admission ranged from 31 to 60 years with a mean of 54 years. RESULTS: 1. Abnormal response appeared with a latency of about 10 msec after stimulation. This response disappeared in 30 out of 31 patients at the end of operation. In 4 patients, the abnormal response disappeared prior to decompression of the nerve. 2. 30 patients in whom the abnormal response disappeared were free of spasm immediately after surgery. Hemifacial spasm has been relieved in 28 patients with a follow up period of 6 months to 2 years and 7 months. The remaining two patients had mild spasm. The one patient in whom the abnormal response did not disappear had persistent hemifacial spasm. CONCLUSION: The authors think that intraoperative facial electromyographic recording is useful to identify the blood vessel that is causing the spasm and to ensure that decompression of the nerve has been accomplished.

Adult↗
PubMed1991

Effects of dihydroheptaprenol on the neutrophil function of postpartum dairy cows.

Neutrophil responses were evaluated in dairy cows at parturition and on 1, 2, 3, 5 and 7 days after they were given dihydroheptaprenol (DHP) (0.5 mg/kg body weight) at parturition. The chemiluminescent index increased significantly (P less than 0.05) from parturition to 1 day after parturition in cows injected with DHP. No significant differences were observed in the number of neutrophils between untreated and DHP-treated groups of dairy cows during the immediate postparturient period.

Animals↗
PubMed1991

[Longitudinal change of H-1 spectroscopy in cerebral infarction].

Longitudinal change of the proton spectroscopy was observed in 2 cases of cerebral infarction. Proton spectra was acquired utilizing stimulated echo acquisition mode (STEAM). In acute stage, the increase of lactic acid and decrease of N-acetyl-aspartic acid (NAA) was observed prior to the appearance of abnormality in imagings such as magnetic resonance imaging and computer tomography. The increase of lactic acid was observed in subacute stage and chronic stage (in severe case). The decrease of NAA persisted in chronic stage. The increase of lactic acid and decrease of NAA indicate a damage of the ischemic tissue. The degree of the decrease of the NAA seems to be a reasonable indicator of the viability of the damaged tissue. The proton spectroscopy is a powerful modality for the evaluation of the extent of tissue damage caused by the ischemic insult.

Aged↗
PubMed1991

[Two autopsied cases of radiation-induced gliosarcoma].

Two autopsied cases of radiation induced gliosarcoma are presented in detail with a review of the literatures. Case 1 was that of a 36-year-old female who was found to have a metastatic choriocarcinoma in the right occipital lobe and received radiation therapy of 45 Gy. Four years later CT scan showed a new enhanced tumor in the cerebellum within the previously irradiated field. Total removal was performed and histological diagnosis of the tumor was a gliosarcoma. She died 12 months after the operation. Case 2 was that of a 63-year-old male who had a protoplasmic astrocytoma in the left temporal lobe and received radiation therapy of 60 Gy after surgery. The tumor recurred in the left temporal base after 9 years. Histological finding of the surgical specimens showed gliosarcoma. The patient died 2 months after he was operated on. The tumors had obviously two defined neoplastic components. One was gliomatous features with anaplastic glial cells which stained for glial fibrillary acidic protein. The other was malignant mesenchymal features with spindle shaped fibrosarcoma cells which contained numerous reticulin fibers. Postmortem examination revealed these similar features. Criteria for identifying a tumor as a radiation induced neoplasm have been proposed by Fajado. The main criterion is that the induced tumor should occur in the previously irradiated field. Secondly, it should appear after a latent period. Thirdly, the pathology should be different from the initial neoplasm. Our cases fulfil these criteria.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗