Biomedical subjects

Masaru Suzuki

Publications and source records attributed to Masaru Suzuki.

At least 19 recordsLinked to original sources

PubMed2006

Association of hypoadiponectinemia in men with early onset of coronary heart disease and multiple coronary artery stenoses.

Adiponectin influences insulin sensitivity and lipid oxidation. Because low plasma adiponectin concentrations are suspected to promote atherosclerosis, we retrospectively assessed relationships of plasma adiponectin concentration to characteristics of coronary heart disease (CHD). Japanese men undergoing coronary angiography for CHD (n = 139) were grouped according to serum adiponectin concentration by enzyme-linked immunosorbent assay (low, <4.0; medium, 4.0-8; high, >8.0 microg/mL). Numbers of coronary arteries with at least 50% stenosis were determined. Serum adiponectin concentration correlated positively with age at onset of CHD (r = 0.285, P = .003). Age at CHD onset in the low-adiponectin group was younger than in the medium or high groups. Adiponectin was protective against CHD onset at ages younger than 58 years (relative risk, 0.778; P = .0047). Significantly more arteries were affected in low-adiponectin patients than in the medium or high group (each P < .01). Adiponectin concentration correlated positively with high-density lipoprotein cholesterol concentration and negatively with triglyceride concentration. Only in diabetic patients did serum adiponectin concentration correlate negatively with body mass index. Low plasma adiponectin concentrations were associated with early CHD onset and multiple atherosclerotic lesions in coronary arteries. Thus, adiponectin concentrations may influence risk of CHD and might serve as one of the screening tests facilitating early intervention.

Adiponectin↗

PubMed2006

Orthostatic decrease in cardiac chaos during the head-up tilt test in patients with vasovagal syncope.

BACKGROUND: Autonomic dysfunction contributes to orthostatic intolerance in vasovagal syncope (VVS), but as it has not been identified by spectral analysis of heart rate variability (HRV) in previous studies, the present hypothesis was that nonlinear analysis of HRV would identify the orthostatic intolerance in VVS. METHODS AND RESULTS: Twenty-six patients with VVS and 14 matched controls were subjected to 80-degree head-up tilt test (positive: 13 patients; negative: 13 patients and 14 controls). There were no differences in the orthostatic changes in the indices of spectral analyses of HRV among the 3 groups. The Lyapunov exponent (LE) was calculated from 200 consecutive RR-intervals to investigate chaotic behavior, and cardiac chaos was defined as the incidence of the presence of a positive finite LE. Orthostatic decreases in cardiac chaos were observed in the VVS patients (both the positive and negative groups), although there was no orthostatic decrease in the control group (ANOVA: p = 0.008). The receiver-operator characteristic curve indicated that cardiac chaos during the tilt identified VVS regardless of the results of the tilt (p < 0.001, sensitivity: 85.7%, specificity: 96.2%). CONCLUSIONS: The decrease in cardiac chaos during the tilt test was specific to patients with VVS, even if their response to the test was negative.

Adult↗

PubMed2006

[A case of steroid-resistant acute hypersensitivity pneumonitis successfully treated with an immunosuppressive drug].

A 28-year-old man complaining of cough and fever was hospitalized because of bilateral diffuse granular lung shadows. Hypersensitivity pneumonitis was diagnosed based on bronchoalveolar lavage fluid (BALF) and transbronchial lung biopsy (TBLB). Since antigen avoidance alone was not effective, steroid pulse therapy was started, and his symptoms and chest X-ray findings improved. After discharge, he moved to another residence. A few weeks later, fever and dyspnea recurred, then he was hospitalized on the suspicion of acute exacerbation of hypersensitivity pneumonitis. Steroid therapy resulted in no improvement on this occasion. Lung biopsy under video-assisted thoracoscopy was performed, and acute hypersensitivity pneumonitis was diagnosed pathologically. Although steroid therapy was continued, hypoxia still remained and a KL-6 level markedly increased. Combined therapy with steroid and cyclosporin A was started, and his symptoms, physical findings, laboratory data, and chest X-ray findings gradually improved. There has been no report in which cyclosporin A was used for acute hypersensitivity pneumonitis but this case indicates that cyclosporin A is efficacious for its treatment.

Adult↗

PubMed2005

Prognostic implications of inhalation injury in burn patients in Tokyo.

Inhalation injury has recently emerged as the major cause of mortality in burn patients. However, the prognostic value of inhalation injury has not been thoroughly assessed in Japanese burn facilities. The aim of the present study was to evaluate the impact of inhalation injury on burn patients' mortality in Tokyo. Of 6416 patients admitted to 13 burn facilities of the Tokyo Burn Unit Association between 1984 and 2002; the 5560 eligible patients were included in this study (mean age, 40+/-20 years; male, 61.6%; mean partial- and full-thickness burn size, 10.7+/-13.0% and 9.6+/-20.5%). Of the 5560 patients, 1690 patients (30.4%) had experienced inhalation injury. The overall in-hospital mortality rate of the patients with inhalation injury was higher than that of those without inhalation injury (33.6% versus 8.1%, odds ratio, 5.72 [95% CI, 4.91-6.67]). The results of the multivariate analysis indicated that inhalation injury; full- and partial-thickness burn size, and age were independent predictors of outcome (relative risk, 2.58 [2.03-3.29], 1.10 [1.09-1.11], 1.06 [1.06-1.07], 1.05 [1.05-1.06], respectively). In conclusion, inhalation injury was the most important predictor of overall mortality among burned patients in Tokyo.

Adult↗

PubMed2005

Prognostic value of a qualitative test for heart-type fatty acid-binding protein in patients with acute coronary syndrome.

Heart-type fatty acid-binding protein (h-FABP) is a novel diagnostic marker for myocardial infarction, but its prognostic value has not been established in patients with acute coronary syndrome (ACS). We sought to determine the value of qualitative analysis of h-FABP for predicting 30-day adverse events in patients with ACS. A retrospective observational study was conducted on patients at a community hospital, and 130 patients admitted through the emergency room (ER) for ACS were identified among 12,077 patients who presented to the ER between January and June 2003. Of these 130 patients, 90 (mean age, 66.8 years, 67 males) who had ACS were eligible for this study. Qualitative tests for serum h-FABP and troponin T (cTnT) were performed on presentation. Follow-up information on adverse events within 30 days after admission, defined as cardiac death or recurrent ACS, was obtained from the medical records. The qualitative tests for h-FABP and troponin T were positive in 62.2% and 36.7%, respectively. The cumulative adverse event rate at 30 days was 14.8% in the h-FABP-positive group and 3.2% in the negative group. The adjusted relative risk of a positive h-FABP test for adverse events was 44.98 (95% CI: 1.48 to 1,364.88). A positive h-FABP test was an independent predictor of adverse events within 30 days in these patients.

Aged↗

PubMed2005

Pleural involvement of dialysis-related amyloidosis.

Two cases of pleural involvement of dialysis-related amyloidosis (DRA) with pleural effusion are presented. DRA is one of the most important complications in long-term dialysis patients and beta2-microglobulin is the principal protein component of DRA, but pleural deposition of beta2-microglobulin amyloid has not yet been reported. To the best of the authors' knowledge, this is the first case report of pleural involvement of DRA presenting with pleural effusion. This case study suggests that pleural involvement of DRA should be considered when exudative pleural effusion is observed in patients undergoing long-term dialysis.

Aged↗

PubMed2004

Long-term survival of Japanese patients transported to an emergency department because of syncope.

STUDY OBJECTIVE: Cardiovascular disease mortality is affected by ethnic differences and is lower in Japan than in Western countries. Although patients with cardiac syncope have significantly higher mortality than patients with noncardiac syncope in Western countries, no such phenomenon has been described in Japan. The aim of this study is to clarify the long-term mortality of patients with syncope who are brought to an emergency department (ED) in Japan. METHODS: This retrospective observational study was conducted on patients treated in the ED of Keio University Hospital in Tokyo. Nine hundred twelve consecutive patients who presented with syncope were identified. The patients were classified into 2 groups according to the cause of syncope: cardiac syncope and noncardiac syncope. Follow-up information about mortality was obtained from mailed questionnaires and medical records. Mortality data were analyzed using the actuarial life-table method and a Cox proportional hazards model. RESULTS: Follow-up information was obtained for 715 patients. The median follow-up period was 38 months, during which 63 patients died. At 5 years, the 23.1% (95% confidence interval [CI] 12.7% to 33.4%) mortality of the patients with cardiac syncope was significantly higher than the 8.2% (95% CI 5.5% to 10.9%) mortality of the patients with noncardiac syncope (P<.0001). The incidence of cardiac death among the patients with cardiac syncope was 17.2% (95% CI 7.8% to 26.5%) compared with 0.9% (95% CI 0% to 1.8%) in the noncardiac syncope group (P<.0001). Cardiac syncope was an independent predictor of overall mortality and cardiac mortality (relative risk 2.81 [95% CI 1.53 to 5.16], 18.74 [95% CI 5.90 to 59.52]). CONCLUSION: Cardiac syncope is associated with higher mortality than noncardiac syncope in this Japanese patient population.

Adolescent↗

PubMed2004

T cell cytokines: animal models.

Allergic asthma involves a complex series of reactions within the airways that lead to inflammation and bronchoconstriction. These phenomena are closely linked to the immune response to the allergenic protein mediated by T cells with specificity for the allergen. Antigen presentation by dendritic cells initiates the allergic response, triggering the activation of CD4+ T cells predominantly. These cells secrete Th2 type cytokines, of which IL-4 and IL-5 are best understood, that act on various cells including B cells, eosinophils, macrophages and epithelial cells. These cells mediate, in turn, immunoglobulin E synthesis, and promote an eosinophil rich inflammation through the concerted action of various chemoattractant substances, both lipid-derived and proteins. CD8+ T cells are also activated and may have either anti-inflammatory or pro-inflammatory effects, depending upon the particular experimental model studied. The T cell receptor (TCR) that these cells possess has an important influence on the role they play. TCRalphabeta cells appear more likely to be pro-inflammatory and have antigen specificity whereas TCRgammadelta cells can be either pro- or anti-inflammatory, depending on species and experimental conditions and are not antigen specific. In conclusion, the magnitudes of inflammatory responses and bronchoconstriction following allergen challenge of sensitised animals are T cell driven and are determined, at least in part, by the balance of the T cell subsets that are activated.

Animals↗

PubMed2004

Inhalation of tobramycin in a patient with aspiration pneumonia as a result of medullary stroke.

A 78-year-old man suffered from refractory aspiration pneumonia as a result of a minor medullary stroke. The only neurological symptom observed in this patient was difficulty in swallowing. He was managed with i.v. hyperalimentation with termination of oral intake, including water. However, he still experienced several episodes of aspiration pneumonia. As he was considered to have a bacterial infection because of silent aspiration of colonized oropharyngeal material, inhalation of tobramycin was introduced and successful control of airway infection was attained.

Administration, Inhalation↗

PubMed2004

Pulmonary Langerhans' cell histiocytosis presenting with an endobronchial lesion.

A 19-year-old man visited our hospital complaining of cough, sputum and low-grade fever. Chest radiograph and computed tomography findings suggested that he was suffering from pulmonary Langerhans' cell histiocytosis (PLCH). Bronchoscopy revealed a whitish elevated lesion at the bifurcation of the right upper lobe bronchus, and a specimen of this lesion showed the same pathological findings as pulmonary parenchymal lesions. Although there have been only a few reports of endobronchial LCH without pulmonary parenchymal lesions, this is, to our knowledge, the first case of PLCH with an endobronchial lesion, which was confirmed by bronchoscopy, and disappeared several months later.

Adult↗

PubMed2004

Immunohistochemistry for the differentiation of peritoneal disseminated carcinoma of unknown origin.

We report a woman with ascites, hydrothorax, pancreatic tumor, left cystic ovarian tumor, and an elevated serum cancer antigen 125 level. Exploratory laparotomy was performed to determine peritoneal disseminated carcinoma of unknown origin. Immunohistochemical analysis demonstrated positive staining for carcinoembryonic antigen, trypsin, and progesterone receptor and nonspecific or negative reaction for calretinin, estrogen receptor, amylase, lipase, Wilms tumor gene 1 protein, and inhibin or chromogranin A. These results together with the morphology of tubular structure suggested the pathological diagnosis of adenocarcinoma with pancreatic characteristics and contradicted ovarian cancer or mesothelioma. Immunohistochemistry is an adjunct tool to differentiate the primary site of carcinomatous peritonitis.

Adenocarcinoma↗

PubMed2004

Role of a critical pathway for door-to-CT-completion interval in the management of acute ischemic stroke patients in the emergency room.

OBJECTIVE: Door-to-CT-completion interval (DCI) for acute ischemic stroke patients is one of the clinical indicators of quality assurance in an emergency room (ER). The aim was to clarify whether the critical pathway improves the DCI for acute stroke patients in the ER. METHODS: The pathway describes each step in patient evaluation in sequence from the patient's arrival in the ER until the brain CT is completed. Whether to use the pathway when evaluating individual patients is left to the discretion of the physician. After excluding 8 cases with insufficient data, 52 cases diagnosed with acute stroke (29 males, 69.9 +/- 12.4 y/o) in the ER between January and February 2003 were retrospectively identified. A logistic regression analysis was used to assess the impact of application of the pathway on achievement of an acceptable DCI (<25 min). RESULTS: The pathway was applied in 21.2% of the cases included in the study, and the median DCI was reduced from 48 minutes to 22 minutes as a result (P=0.02). Comparing them with the DCI, the probability values for ambulance use, consciousness disturbance, history of stroke, and application of the pathway in univariate analyses were less than 0.10. These variables were entered into the logistic analysis, which that indicated application of the pathway was the strongest variable related to acceptable DCI (OR: 10.92, 95% CI: 1.22 to 97.96). CONCLUSION: Application of the pathway was associated with an improvement of the DCI. Use of the pathway will improve the quality of the process of care in the ER.

Acute Disease↗

PubMed2004

[A case of pulmonary embolic metastasis of choriocarcinoma presenting with multiple pulmonary infiltrative shadows].

A 34-year-old woman visited our hospital complaining of dry cough. Chest radiography and computed tomography showed bilateral multiple infiltrative shadows over the lung field. After an initial diagnosis of pneumonia, antibiotics were administered, but the therapy failed to improve the symptoms and abnormalities observed on the chest radiograph. The patient was then admitted to our hospital. The bronchoalveolar lavage fluid (BALF) was slightly bloody, but we were not able to make any specific findings in BALF. In order to confirm the pathological diagnosis, video-assisted thoracoscopic lung biopsy was performed aiming at the right middle and lower lobes. There were bleeding pulmonary infarctions in a biopsy specimen from the right middle lobe. Atypical cells positive for human chorionic gonadotropin (hCG) proliferated in the pulmonary arteries, and so a diagnosis of pulmonary embolic metastasis of choriocarcinoma was made. After the diagnosis, it became clear that urine and serum hCG values were very high. The patient has since received systemic chemotherapy in the gynecology unit at our hospital. Pulmonary embolic metastasis of choriocarcinoma diagnosed by video-assisted thoracoscopic lung biopsy has never been reported in the literature. However, early hCG measurement may have detected this syndrome in the earlier stages, and pulmonary metastasis of choriocarcinoma should be considered in the differential diagnosis of women with past pregnancy presenting with intractable multiple pulmonary shadows.

Adult↗

PubMed2003

Extension of ductal carcinoma in situ: histopathological association with MR imaging and mammography.

The purpose of this study is to evaluate the capability of breast MRI (magnetic resonance imaging) and mammography in determining tumor extent and the detectability of ductal carcinoma in situ (DCIS) in association with histopathological features. Thirty women with breast cancer underwent 3D dynamic MRI. Twelve women had pure DCIS and 18 women had DCIS with microinvasion. We analyzed the results of preoperative MRI and mammography with histopathologic results, retrospectively. The mean lesion size was 55.1 mm from the histopathologic results. Twenty-six lesions were detected through the MRI (a sensitivity of 86.7%). MRI depicted eight lesions without mammographically detected microcalcification. In seven cases, MRI showed tumor extent accurately compared with mammography, and the combined diagnosis improved the accuracy of evaluating tumor extent. MRI can complement mammography in guiding surgical treatment of DCIS by providing better assessment of the extent of the lesion.

Adult↗

PubMed2003

Role of vagal control in vasovagal syncope.

The vasovagal reaction is thought to be caused by sympathetic withdrawal and vagal augmentation. While measurements of muscle sympathetic nerve activity support sympathetic withdrawal in tilt induced syncope, the results of previous attempts to quantify vagal control using spectral analyses of heart rate variability (HRV) remain controversial. The sampling period used in the HRV studies is related to the discordant results. In the present study, HRV was computed every second using wavelet transformation to clarify the role of vagal control in tilt induced syncope during the 80-degree head-up tilt test (positive: 10 patients with vasovagal syncope; negative: 10 patients with vasovagal syncope, and 10 control subjects). Autonomic modulations were assessed using the absolute power of the low frequency (LF) (0.04-0.15 Hz) and high frequency (HF) (0.15-2.00 Hz) oscillatory components of R-R variability. Although the LF did not change during the tilt procedure, a decrease in the systolic arterial pressure (SAP) and increases in the R-R interval and HF were observed for the last 30 seconds before the tilt induced syncope in the tilt-positive group. Analyzing the hemodynamic measurements and spectral indices for the last 5 minutes preceding the tilt induced syncope, the study found that the SAP, R-R interval, and HF changed simultaneously during the 30-second period immediately before the tilt induced syncope. Further, the HF was positively correlated with the R-R interval and negatively correlated with the SAP. In conclusion, continuous spectral analysis of the R-R interval demonstrated increased vagal influence on the heart in tilt induced syncope.

Adult↗

PubMed2003

Risk stratification of adult pneumonia in a tertiary emergency center in Japan.

OBJECTIVE: To determine whether the guidelines for community-acquired pneumonia published by the Infectious Disease Society of America (IDSA) and the Japanese Respiratory Society (JRS) are applicable to stratifying the mortality risk of patients visiting a tertiary emergency center in Japan. METHODS: Patients were categorized into three risk groups (low, intermediate and high) based on the IDSA guidelines and three severity groups (mild, moderate and severe) using the JRS guidelines. The mortality rates among each set of groups were then compared using 30-day follow-up data. PATIENTS: Ninety-seven consecutive patients with pneumonia who visited the emergency room and were admitted to our hospital were retrospectively identified. RESULTS: Based on the IDSA guidelines, the patients were categorized into a high, intermediate, or low-risk group (38.1%, 51.5% and 10.3%, respectively). Cumulative mortality rates were 18.9% for the high-risk group and 4.0% for the moderate-risk group (p=0.02); no deaths occurred in the low-risk group. Based on the JRS guidelines, the patients were also classified into a severe, moderate, or the mild-severity group (69.1%, 25.8% and 5.2%, respectively). The mortality rate was 13.4% in the severe group, whereas no deaths occurred in the moderate or mild-severity groups. CONCLUSION: The IDSA and JRS guidelines allow short-term mortality risks to be recognized at a tertiary emergency center in Japan.

Adult↗

PubMed2003

A randomized controlled trial of postoperative adjuvant immunochemotherapy for colorectal cancer with oral medicines.

Postoperative adjuvant chemotherapy reportedly improves advanced colorectal cancer patients' survival, however, it is necessary to assess what regimens are useful. Doxifluridine (5'-DFUR) is an intermediate of capecitabine approved in Europe and USA to treat metastatic colorectal cancer. 5'-DFUR is metabolized to 5-fluorouracil (5-FU) by thymidine phosphorylase existing in tumor at high concentrations, suggesting high 5-FU levels in tumor tissues and lesser complications. Present study compared usefulness of 5'-DFUR to that of oral 5-FU. Patients were enrolled at 38 centers from April 1993 to September 1996. They had diagnosed colorectal cancer of TNM stages II and III, and underwent macroscopic curative resection. Patients were prestratified into colon or rectum cancer and allocated into either 5'-DFUR (5'-DFUR 460 mg/m(2)/day + PSK 3 g/day) or 5-FU (5-FU 115 mg/m(2)/day + PSK 3 g/day) group by dynamic randomization (stratification factors such as depth of tumor, degree of lymph node metastasis, and location of tumor). Drugs were orally administered daily from postoperative week 2 to 54, with 6 mg/m(2) mitomycin C at operation and following days. Subjects for analysis were 277 in 5'-DFUR and 281 in 5-FU groups. Median follow-up was 6.5 years. Although no differences in overall survival curves were detected, multivariate analysis showed that 5'-DFUR + PSK regimen was a significantly better prognostic factor in patients with Dukes B or C (risk ratio, 1.451; p=0.048); with tumor depth of pT3 or pT4 (risk ratio, 1.568; p=0.020). For patients with advanced colorectal cancer, 5'-DFUR + PSK therapy may possibly be more useful than 5-FU + PSK, but further study is required.

Adjuvants, Immunologic↗

PubMed2002

The immunomodulatory actions of prostaglandin E2 on allergic airway responses in the rat.

PGE(2) has been reported to inhibit allergen-induced airway responses in sensitized human subjects. The aim of this study was to investigate the mechanism of anti-inflammatory actions of PGE(2) in an animal model of allergic asthma. BN rats were sensitized to OVA using Bordetella pertussis as an adjuvant. One week later, an aerosol of OVA was administered. After a further week, animals were anesthetized with urethan, intubated, and subjected to measurements of pulmonary resistance (R(L)) for a period of 8 h after OVA challenge. PGE(2) (1 and 3 micro g in 100 micro l of saline) was administered by insufflation intratracheally 30 min before OVA challenge. The early response was inhibited by PGE(2) (3 micro g). The late response was inhibited by both PGE(2) (1 and 3 micro g). Bronchoalveolar lavage fluid from OVA-challenged rats showed eosinophilia and an increase in the number of cells expressing IL-4 and IL-5 mRNA. These responses were inhibited by PGE(2). Bronchoalveolar lavage fluid levels of cysteinyl-leukotrienes were elevated after OVA challenge and were reduced after PGE(2) to levels comparable with those of sham challenged animals. We conclude that PGE(2) is a potent anti-inflammatory agent that may act by reducing allergen-induced Th2 cell activation and cysteinyl-leukotriene synthesis in the rat.

Adjuvants, Immunologic↗