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Biomedical subjects

O Kobayashi

Publications and source records attributed to O Kobayashi.

At least 19 recordsLinked to original sources
PubMed1992

Adjuvant radiotherapy after complete resection of thymoma.

Seventy patients were studied after undergoing complete resection of thymoma to determine the effect of postoperative adjuvant mediastinal radiotherapy on prognosis, with regard to clinical stage, histological type, and pleural factor. Pleural factor was defined as follows: p0, no adhesion to the mediastinal pleura; p1, fibrous adhesion to the mediastinal pleura without microscopic invasion; and p2, microscopic invasion of the mediastinal pleura. Recurrence of thymoma after complete resection was observed in 13 patients, 12 (92%) with pleural dissemination, 6 (46%) with local recurrence, and 2 (15%) with distant metastasis (types of recurrence are overlapping). In stage I and stage II p0 patients, no recurrence was observed, regardless of mediastinal radiotherapy. Whereas mediastinal irradiation completely prevented recurrence in stage II p1 patients, 4 (36.4%) nonirradiated stage II p1 patients experienced recurrence. In stage II p2 patients, 75% had pleural dissemination even after radiotherapy. A high incidence of recurrence was also observed in stage III, nonirradiated (25%) and irradiated (30%) patients. The results suggest that mediastinal irradiation for stage I and II p0 patients is not always necessary, and that therapy for stage II p1 is essential and also expected to decrease the recurrence rate. On the other hand, in stage II p2 and stage III thymomas, mediastinal irradiation is not sufficient to prevent pleural recurrence even after complete resection. Our classification based on pleural factor is useful for better selection of appropriate postoperative treatment for thymoma patients.

Adolescent↗
PubMed1992

[Results of patients in stage I and II primary lung cancer with curative resection].

We analyzed 91 patients who had curative resection from 1982 to 1989 for stage I and II primary lung cancer. The 5-year survival rates were 71.4% for stage I and 44.7% for stage II. The 5-year survival rates were 86.6% for T 1 N 0 M 0, 47.3% for T 2 N 0 M 0, 56.3% for T 1 N 1 M 0, and 37.9% for T 2 N 1 M 0. There was no cancer death in patients with squamous cell carcinoma of T 1 N 0 M 0. For stage I, tumor diameter was significant factor to influence survival. Although there was a statistically significant difference between stage I and II in patients with adenocarcinoma, there was no significant difference in those with squamous cell carcinoma. Chemotherapy had no significant improvement in survival for stage I and II lung cancer.

Adenocarcinoma↗
PubMed1992

[A case of invasive broncho-pulmonary aspergillosis associated with influenza A (H3N2) infection].

A 49-year-old man with high alcohol consumption was admitted with fever, cough and progressive dyspnea after a one week history of influenza-like symptoms. Chest X-ray film on admission showed diffuse peribronchial shadows and patchy infiltration in the right lower lung field. Chest X-ray film the following day and chest CT film on the 4th day of admission showed multiple nodular shadows and cavity formation. At bronchoscopy the bronchial surface was covered by white plaque, and Asp. fumigatus was subsequently cultured from BAL fluid. On the basis of suspected invasive pulmonary aspergillosis, anti-fungal agents were commenced. However, the shadows on chest X-ray increased, and the patient died on the 10th day of admission of respiratory failure and septic shock. Histological examination revealed bronchial wall invasion by hyphae of aspergillus and abscess formation in the pulmonary parenchyma. The precipitin antibody against aspergillus antigen was positive in reserved serum. Anti-Influenza A virus antibody (CF) was positive (X 256), and hemagglutination inhibition test of Influenza A (H3N2) was positive (X 2048) in serum on admission. The suppression of cellular immunity and destruction of the mucociliary system of airways induced by Influenza A infection was suspected to have predisposed to aspergillus superinfection.

Aspergillosis↗
PubMed1992

[Epidural midazolam with bupivacaine--optimal dose for postoperative pain relief].

Optimal dose of epidural midazolam with bupivacaine for postoperative pain relief was investigated. Forty seven patients for upper abdominal surgery were divided into 5 groups. Each group had either 0.25% bupivacaine 6 ml (control group), 0.25% bupivacaine 6 ml + midazolam 0.025 mg.kg-1 (0.025 group), 0.05 mg.kg-1 (0.05 group), 0.075 mg.kg-1 (0.075 group), or 0.1 mg.kg-1 (0.1 group) administered epidurally for complaint of first postoperative pain. Blood pressure (BP), heart rate (HR), respiratory rate (RR) and sedation score (SS) were monitored for 120 minutes, and the time interval for next analgesics (TNA) was checked. In each group, BP fell down 10 minutes after injection, HR was unchanged, and RR (except for 0.1 group) decreased, compared with the preinjection level. There was no difference between control group and others in BP, HR and RR. But 3 cases in 0.075 group and 4 cases in 0.1 group needed chin lift with a pillow under the shoulder for slight airway obstruction. The most optimal SS was obtained in 0.05 group. TNA was significantly longer in 0.025 and 0.05 groups than in the control group. It was concluded that the optimal dose of epidural midazolam with 0.25% bupivacaine 6 ml was 0.05 mg.kg-1 for postoperative pain relief after an upper abdominal surgery.

Abdomen↗
PubMed1992

[A case of stage IVb ovarian carcinoma successfully treated with intra-arterial infusion chemotherapy using implantable reservoir system].

A patient with liver metastasis from ovarian cancer was treated by intra-arterial infusion chemotherapy (well differentiated adenocarcinoma--CDDP 50 mg/body, ADR 30 mg/body, CPA 500 mg/body (iv)). After the chemotherapy, the metastatic tumor appeared remarkably smaller and could be resected successfully at the second reduction surgery. This patient is active 30 months after the first appearance and enjoying a favorable quality of life.

Adenocarcinoma, Papillary↗
PubMed1991

Differential intracardiac sympathetic and parasympathetic innervation to the SA and AV nodes in anesthetized dog hearts.

Stimulation of discrete intracardiac sympathetic nerves to the SA (SAS stimulation) or AV nodal region (AVS stimulation) increased the heart rate or decreased AV conduction time and caused an AV junctional rhythm, respectively, in anesthetized dogs treated with atropine. Topical application of tetrodotoxin (TTX) at the SAS or AVS stimulation locus totally inhibited the response to each stimulation, whereas each TTX treatment slightly attenuated the chronotropic response to the right ansa stimulation by 23 +/- 7.7% and the dromotropic response to the left ansa stimulation by 7 +/- 7.5%. TTX abolished AVS stimulation-induced one. Before atropine, topical application of hexamethonium at the locus for stimulation of intracardiac parasympathetic nerves to the SA (SAP stimulation) or AV nodal region (AVP stimulation) abolished almost totally negative chronotropic responses to SAP and cervical vagus stimulation or negative dromotropic responses to AVP and cervical vagus stimulation, respectively. These results demonstrate that activation of a very small population of intracardiac sympathetic nerves to target cells is enough to induced positive chronotropic and dromotropic responses in the heart in situ, and that SA and AV nodal pacemaker activity and AV conductivity are controlled multi-directionally by intracardiac sympathetic nerves in contrast with parasympathetic ones.

Anesthesia↗
PubMed1991

[An electron microscopic study of the pulmonary alveolar capillaries in idiopathic interstitial pneumonia and lungs of collagen vascular diseases].

The ultrastructure of pulmonary alveolar capillaries in idiopathic interstitial pneumonia (IIP) and collagen vascular diseases (CVD) were investigated. In IIP, the endothelial cells were only slightly swollen. The basement membrane (BM) was moderately thickened. In CVD, swelling of the endothelial cells and thickening of the BM were more severe than those of IIP. The injury of the endothelial cells seemed to be more severe than IIP. The patients with PSS and MCTD revealed degeneration of endothelial cells as well as lamellation of BM. The endothelial cell damage was most severe among CVD cases, and these changes were assumed to induce pulmonary hypertension. Microtubular structures were observed in the endothelium of SLE, dermatomyositis, polymyositis, PSS and MCTD patients. Weibel-Palade bodies and increase of pericytes were noticed in PSS and MCTD patients which seemed to be related to endothelial injuries. No electron-dense deposits were observed in any case.

Adolescent↗
PubMed1991

[Epidural administration of midazolam with saline or bupivacaine for postoperative pain].

Postoperative pain relief and sedation with epidural midazolam-saline or midazolam-bupivacaine were studied in 46 patients after elective upper abdominal surgery. They were divided into 6 groups. In each group, 10 ml saline, 10 ml saline+midazolam 0.05 mg.kg-1, 10 ml saline+midazolam 0.1 mg.kg-1 (saline group), 0.25% bupivacaine 6 ml, 0.25% bupivacaine 6 ml + midazolam 0.05 mg.kg-1 or 0.25% bupivacaine 6 ml + midazolam 0.1 mg.kg-1 (bupivacaine group) was administered via epidural catheter for complaint of pain. For 120 minutes after epidural injection, blood pressure (BP), heart rate (HR), respiratory rate (RR), sedation score, and serum concentration of midazolam (conc midazolam) were evaluated. The time interval until next complaint of pain (pain relief time) was measured. In midazolam injected group, BP, HR, RR were not changed from preinjection value, but sufficient sedation was obtained and pain relief time was significantly prolonged compared with saline or bupivacaine injected group. Midazolam level was lower than that of sedation level. There were no significant differences between saline group and bupivacaine group, but the pain relief effect was slightly stronger in bupivacaine group. It is concluded that epidural saline - midazolam or 0.25% bupivacaine - midazolam is useful for postoperative pain relief after upper abdominal surgery.

Abdomen↗
PubMed1991

[Analysis of prognostic factors in high risk gestational trophoblastic disease with respect to remission and recurrence].

Sixty-nine patients with high risk gestational trophoblastic disease (excluding invasive mole) were treated at Chiba University from 1973 to 1988. The clinical features and results of treatment which influenced remission and recurrence in these high risk patients were analyzed statistically. The factors analyzed were (1) the height of pretreatment urinary hCG titer, (2) the type of antecedent pregnancy, (3) the time interval from pregnancy to treatment, (4) the metastatic site, (5) age, (6) the type of chemotherapy, (7) the time of operation and (8) the number of additional chemotherapy courses. With respect to the remission rate and the metastatic site, the type of chemotherapy was statistically significant. In addition, the factors related to the time of operation were significant in relation to recurrence.

Adult↗
PubMed1991

[A case of pulmonary arteriovenous fistula accompanied with marked polycythaemia].

A 67-year-old male was admitted with cyanosis, digital clubbing and exertional dyspnea. Laboratory data revealed severe polycythaemia with 26 mg/dl hemoglobin, red blood cell; 866 x 10(-4)/mm3, hematocrit 72.8% and PaO2 44.6 mmHg. Selective pulmonary angiography demonstrated a large arteriovenous fistula involving the right middle lobe. After venesection of 1,200 ml of blood, the middle lobectomy was performed safely. In a case of pulmonary arteriovenous fistula with such severe polycythaemia, preoperative venesection is useful to decrease perioperative complications.

Aged↗
PubMed1991

[A case of alveolar hemorrhage associated with mixed connective tissue disease].

A 52-year-old woman was admitted to our hospital because of anemia and abnormal lung shadow. She had Raynaud's symptom for 6 months, and recently developed cough and easy fatigability. She had thrombocytopenia, restrictive pulmonary dysfunction, and swollen fingers. ANF was positive (X1280), and anti-RNP antibody was also positive. Mixed connective tissue disease was diagnosed. Chest X-ray showed a diffuse alveolar pattern, and BAL revealed many hemosiderin-laden macrophages. Alveolar hemorrhage was suspected. The pulmonary shadow resolved spontaneously, and no recurrence occurred after steroid and immunosuppressant therapy.

Female↗
PubMed1990

Atrial natriuretic peptide in patients with the syndrome of inappropriate antidiuretic hormone secretion and with diabetes insipidus.

To examine a possible role for atrial natriuretic peptide (ANP) in water and sodium metabolism disturbances associated with abnormal vasopressin (AVP) secretion, we measured plasma ANP concentrations in 15 patients with the syndrome of inappropriate antidiuretic hormone secretion (SIADH) and in 17 patients with central diabetes insipidus (DI). The mean plasma ANP concentration (30.2 +/- 10.4 pmol/L) in SIADH patients who had hyponatremia, plasma hypoosmolality, hyperosmolar urinary compared to plasma sodium levels, and increased plasma AVP levels relative to plasma osmolality was significantly higher than that in normal subjects (12.6 +/- 4.9 pmol/L), although there was a considerable individual variation in plasma ANP ranging from normal to clearly elevated levels (15.1-47.0 pmol/L). When hyponatremia was corrected by water restriction or demeclocycline administration, plasma ANP levels decreased significantly and fell into the normal range (12.5 +/- 4.3 pmol/L). DI patients who complained of polyuria and polydipsia and had hypoosmolar urine, normal or elevated plasma sodium concentrations, and decreased plasma AVP levels relative to plasma osmolality, on the other hand, had a significantly lower mean plasma ANP level (7.6 +/- 2.9 pmol/L) than normal subjects. There was, again, a considerable overlap between plasma ANP levels in individual DI patients (4.2-13.9 pmol/L) and those in normal subjects. Treatment with 1-desamino-8-D-arginine vasopressin resulted in a significant increase in the mean plasma ANP level (18.6 +/- 8.0 pmol/L). There were no significant correlations between plasma ANP and AVP levels in either group of patients. The results indicate that ANP secretion is modulated by changes in plasma volume consequent to abnormal AVP secretion, which may have a pathophysiological significance in maintaining volume homeostasis.

Adolescent↗
PubMed1990

Interaction of sevoflurane, isoflurane, enflurane and halothane with non-depolarizing muscle relaxants and their prejunctional effects at the neuromuscular junction.

The interaction of four inhalational anesthetics (sevoflurane, isoflurane, enflurane and halothane) with pancuronium and vecuronium and also their prejunctional actions at the neuromuscular junction were quantitatively studied using rat phrenic nerve-hemidiaphragm preparations. To investigate the prejunctional effects of inhalational anesthetics, a train-of-four ratio (T4/T1) and the tetanus ratio (the ratio of the final response to the initial response during tetanus) were evaluated. All four inhalational anesthetics markedly potentiated the neuromuscular blockade of twitch response caused by either pancuronium or vecuronium with halothane and enflurane being the most potent both on a % concentration basis and on a MAC (minimum alveolar concentration) basis. Although none of the four inhalational anesthetics had any effects on the T4/T1 ratio, they produced variable effects on the tetanus ratio. Sevoflurane had little effect on the tetanus ratio, whereas 1 and 2% isoflurane and 1, 2 and 3% enflurane increased the tetanus ratio and 5% halothane and 5% enflurane significantly reduced the tetanus ratio. Halothane and enflurane had the most potent depressant action of the four inhalational anesthetics both on the % concentration basis and on the MAC basis. These results indicate that the main site of action of inhalational anesthetics is a postjunctional site at the neuromuscular junction and that they do not seem to act on prejunctional sites at the concentrations used in clinical situations.

Anesthetics↗
PubMed1990

[A clinicopathological study on gestational trophoblastic disease comparing with high risk criteria and diagnostic score of choriocarcinoma].

In the past 15 years, 274 patients with the gestational trophoblastic disease have been treated at Chiba University and the diagnosis of 125 patients was confirmed pathologically. There were 55 cases (44%) in the high risk and 70 cases (56%) in the low risk group with the following criteria: (1) the urinary hCG titer was more than 100,000 IU/L; (2) the duration between antecedent pregnancy and the start of treatment was more than 1 year; (3) antecedent pregnancies were full-term or abnormal pregnancies except hydatidiform mole. These pathologically confirmed patients were evaluated with the choriocarcinoma diagnostic score. From this study, the following results were obtained: (1) The overall remission rates in high risk and low risk patients were 79.1%, 100%, respectively. (2) Out of 55 patients with high risk diagnosed pathologically, 49 (89.1%) patients had choriocarcinomas. On the other hand, 65 (92.9%) patients with low risk had invasive moles. (3) The discrepancies between the pathological and the clinical diagnosis chiefly depended on the inadequate evaluation of recurrent cases and the pretreatment urinary hCG. (4) Compared with our criteria, the choriocarcinoma diagnostic scoring system more closely corresponds to the pathological diagnosis but this system is more complex and inadequate than our criteria for older up patients that have not been adequately followed up.

Biomarkers, Tumor↗
PubMed1990

[A case of chondrosarcoma arising from the left first rib].

A 46-year-old female was admitted to our hospital because of a left supraclavicular tumor. The chest CT scan and MR imaging revealed that the tumor arose from the left first rib and developed into the supraclavicular region. In this case, we tried to resect the tumor using the so-called "trap-door" thoracotomy. Although removal of subclavian vessels and brachial plexus from the tumor was easily performed, we could not enough treat the vertebral side of the first rib through this thoracotomy without the T1 nerves injury. In cases of superior sulcus tumors developing into the posterior chest wall, a posterior incision combined with an anterior one will be useful to remove these tumors safely.

Chondrosarcoma↗
PubMed1990

[Extended radical mastectomy using preoperative local injection of activated carbon particle adsorbing aclarubicin (ACR-CH)].

ACR-CH was injected prior to surgery of breast cancer. Incidence of black staining of regional lymph nodes and concentration of ACR in the nodes were examined in order to evaluate the usefulness of preoperative local injection of ACR-CH. 1) In 13 cases of extended radical mastectomy, black staining was seen in nodes of all the regions. Especially, in parasternal, retromanubrial, anterior mediastinal and supraclavicular nodes, 46% or more of the nodes were stained and ACR concentration of 6-7 micrograms/g was obtained. 2) When incidence of black staining of the metastasis-free nodes was compared with that of the nodes with metastasis, it was 79% in the metastasis free nodes and 42% in the nodes with metastasis. The average ACR concentration was 54.16 +/- 123.16 in the stained nodes and 2.58 +/- 3.59 in unstained nodes, the former being significantly higher than the latter. 3) Majority of the stained nodes with metastasis had only very small metastatic foci and nodes with significant metastasis were only very rarely stained. 4) In conclusion, we believe that anticancer effect of ACR-CH can be expected to small metastatic foci in the parasternal lymph nodes and more distal nodes, dissection of which tends to be incomplete at extended radical mastectomy, as well as to free cancer cells in the lymph vessels.

Aclarubicin↗
PubMed1989

Presynaptic effect of muscle relaxants on the release of 3H-norepinephrine controlled by endogenous acetylcholine in guinea pig atrium.

The influence of nondepolarizing muscle relaxants (MR) on the resting and electrically evoked release of tritiated norepinephrine (3H-NE) was investigated, in the absence and presence of 10(-4) mol/l cocaine, in the in vitro right atrium preparation of guinea pigs (g.p.) preloaded with 3H-NE. In the absence of MR both resting and stimulated 3H and 3H-NE release remained relatively constant throughout the experiment and the ratios of the evoked release of 3H during consecutive stimulation periods (i.e. S2/S1, S3/S2) were close to unity. None of the MR had any effect on resting 3H release. Atropine (3 x 10(-7) mol/l), gallamine (7 x 10(-5) mol/l), and pancuronium (2 x 10(-6) mol/l), but not d-tubocurarine (5 x 10(-6) mol/l) significantly increased stimulated release of 3H-NE. The effect of MR on resting or evoked release of 3H-NE was not influenced by 10(-4) mol/l cocaine. In the presence of atropine gallamine and pancuronium did not affect the release of 3H-NE. This finding indicates that the effect of MR was mediated via presynaptic muscarinic receptors. Muscle relaxants and atropine inhibited these receptors and removed the tonic inhibitory effect of acetylcholine (ACh) released from the parasympathetic nerve endings on the release of NE from the sympathetic nerve. This was substantiated by the finding that in the present of cholinesterase inhibition, when the effect of endogenous ACh was amplified and thereby the cholinergic tone was dominant, the total release of 3H-NE evoked by stimulation was much lower and muscle relaxants and atropine were much more effective to enhance 3H-NE release. Gallamine and pancuronium also increased the force of contraction of the electrically stimulated atria. These findings indicate that the acceleration of the heart rate observed with gallamine and pancuronium in anesthetized man is due to increased release from, and not the inhibition of reuptake of NE by the sympathetic nerve endings of the right atrium.

Acetylcholine↗