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Biomedical subjects

S Iwabuchi

Publications and source records attributed to S Iwabuchi.

At least 73 records · Page 4Linked to original sources
PubMed1994

Use of the sandwich method with an ultra-high-molecular-weight polyethylene prosthesis and Marlex mesh in sternal reconstruction: report of a case.

A 52-year-old Japanese man with a slow-growing chondroma originating from the sternal bone was referred to our hospital. A subtotal resection of the sternum was performed, hereafter termed the "sandwich method," and an originally designed prosthesis made from ultra-high-molecular-weight polyethylene and Marlex mesh was used for reconstruction. The postoperative course was uneventful without any symptoms due to paradoxical movement of the chest or regional abscess, and no disturbance in the movement of the upper limbs, such as a surgical sequelae, was observed.

Bone Neoplasms↗
PubMed1994

[Serum levels of HCV-RNA determined by branched DNA (bDNA) probe assay in chronic hepatitis C: method and clinical significance on interferon (IFN) therapy].

Recently serum levels of HCV RNA (s-HCV RNA) in chronic hepatitis C has been regarded as one of an important indicator for the activity of disease and outcome of IFN therapy. Quantitative analysis by competitive RT-PCR, however, requires special skills and is too expensive for clinical use. We attempted to determine serial sample of s-HCV RNA and genotypes in 117 cases treated with IFN using bDNA probe assay which has lately been developed by Chiron corporation. Cases with complete response to IFN therapy showed 62% (49/79) in lower than 10(6) levels, 27% (8/30) in 10(6)-10(7) and only 5% (2/41) in higher than 10(7). Genotype III, IV had higher response than type II on the same level of s-HCV RNA. These data indicates that determination of s-HCV levels by bDNA assay may be useful for prediction of the outcome of IFN therapy and making adequate schedule of the therapy in each cases.

Chronic Disease↗
PubMed1994

[Study for relapse cases of chronic hepatitis C treated with interferon (IFN) and approach to more successful re-treatment of IFN].

It is well known that relapse of hepatitis develops in 30 approximately 40% cases of chronic hepatitis C after treatment of IFN. We assessed the background of those cases and investigated a scheme providing more successful re-treatment of IFN for those relapse cases. Cases developing complete response to re-treatment showed as follows. (1) During first IFN therapy, ALT sustained within normal. (2) Serum HCV-RNA levels before re-treatment demonstrated significantly lower than the levels of first therapy. (3) IFN dose of re-treatment was greater than first therapy. (4) Terms of initial daily IFN administration tended to be more longer (4W) than first therapy (2W).

Adult↗
PubMed1994

[Interferon therapy for acute hepatitis C; changes in serum markers associated with HCV and clinical effects].

In order to prevent the progression to chronicity of acute hepatitis C, we treated 22 patients with natural human alpha or beta interferon (IFN) in varying doses (3-6 megaunit) daily, for 4 weeks everyday or TIW for 8 weeks. 14 (63.6%) of the 22 patients was cured with IFN therapy. According to the level of serum HCV RNA, 5 (83%) of the 6 patients with more than 10(5) copies/ml were progressed to chronicity, while 10 (91%) of the 11 patients with less than 10(5) copies/ml were cured. Curative rate on each genotypes was 3/9 (33%) in type II, 2/3 (67%) in type III and 1/2 (50%) in type IV. Positive cases for anti C100-3 before IFN were cured only 2 (28.6%) of the 7 patients, but negative cases were cured in 12 (80%) of the 15 patients. This study reveal that IFN therapy for acute hepatitis C may contribute to prevent the progression to chronicity and that the determination of the level of serum HCV RNA, HCV genotypes and anti C 100-3 levels may be useful to predict that efficacy of IFN and also to make a schedule for successful IFN therapy.

Acute Disease↗
PubMed1994

[Long-term interferon (IFN), neominophagen C (SNMC) combination therapy of active liver cirrhosis type C].

Possible effects of IFN and SNMC combination therapy for active liver cirrhosis were described. 28 patients with active liver cirrhosis were treated with natural IFN alpha 3-6 MU TIW for 3-17 months (mean, 8 +/- 6). 8 of 28 patients received combination therapy of SNMC (40 ml iv, TIW). 8 (29%) of 28 patients sustained normal ALT levels with no relapse (complete response) which involved 6 patients with persistent lack of serum HCV RNA sequences after IFN therapy. In those 8 patients, 4 had been received combination of SNMC. There were 4 (14%) patients with relative response. Patients with genotype III or IV had significantly higher response to IFN therapy than the patients with genotype II. In active liver cirrhosis, determination of HCV genotype and HCV RNA levels thought to be significant for the indication of IFN therapy, and that combination of SNMC may provide beneficial effect to IFN therapy for active liver cirrhosis.

Biomarkers↗
PubMed1994

[Coronary artery bypass with free arterial grafts].

Between October 1988 and October 1993, we experienced 15 cases of free arterial grafting for coronary artery bypass (11 men, 4 women: age range from 42 to 75 years). The bypass grafts were used 11 right internal thoracic artery (RITA), 4 right gastroepiploic artery (RGEA), and 1 left internal thoracic artery (LITA). There were no surgical complications by using free arterial graft. The patency rate at one month after operation was good (86.7%, 13/15 anastomoses). Sites of proximal anastomosis were ascending aorta in all patient. These results indicated that free arterial graft is usefull for multiple coronary artery bypass by arterial graft.

Abdominal Muscles↗
PubMed1994

[Acute disseminated encephalomyelitis presented with apnea in the acute stage].

A 33-year-old man was admitted to our hospital because of tetraplegia and dyspnea in November 4, 1991. He had been healthy until October 22, 1991, when he developed difficulty in urination, ascending paralysis, respiratory paralysis and oscillopsia. On admission, neurological examination showed transverse myelopathy below the level of fourth cervical cord segment, opsoclonus and respiratory paralysis, which developed apnea. Cell numbers and protein concentration in CSF were elevated 37/mm3 and 380 mg/dl respectively. MRI disclosed increased signal intensity area at the upper cervical cord and brainstem. From these findings, the patient was diagnosed as acute disseminated encephalomyelitis (ADEM). Cases of ADEM associated with respiratory paralysis in the acute stage are rare. An extended lesion of respiratory upper motor neuron descending from the medulla oblongata to the upper cervical cord may be involved, and resulted in respiratory paralysis in this case.

Acute Disease↗
PubMed1994

[Histological evaluation of the liver and response to interferon in chronic hepatitis C].

Liver histology was compared in patients with chronic hepatitis C to clarify the difference between responders and non-responders to interferon therapy. We have treated 50 patients with chronic hepatitis C by natural IFN-alpha 6.0 MU/day for 2 weeks, daily, followed by intermittent therapy for 3-6 months. The overall effect of IFN was a complete response (CR) in 16 (32%), transient response (TR) in 14 (28%), and no response (NR) in 20 (40%). According to the pre-treatment liver histology, CR had a lower total numerical scores than TR and NR. Histological difference between CR and TR appeared to be the degree of portal inflammation and piecemeal necrosis, though NR showed an increase in portal fibrosis compared of CR and also TR. Response to IFN may depend on the degree of liver fibrosis rather than other histological factors. To assess the degree of liver fibrosis is thought to be important for the prediction of the efficacy of IFN therapy.

Adult↗
PubMed1994

[Surgical management for atrial septal defect secundum in aged patients].

Between 1989 and 1992, atrial septal defect secundum (ASD) were closed in 8 patients aged 51 to 77 years with the use of cardiopulmonary bypass. The notable characteristics in our cases were; 1) All but one had slight or moderate left to right shunt ratios. Although pulmonary hypertension was present, the obstructive pulmonary vascular change had not progressed so far. 2) Atrial fibrillation was present in 6 patients (75%) and some other cardiac lesions (atrioventricular insufficiency, ischemic heart disease, intracardiac anomaly) coexisted with ASD in a high frequency. And surgical procedures other than ASD closure were required in 5 patients. 3) We must take care to prevent cardiac complications (i.e., arrhythmia) as well as extracardiac malfunctions in postoperative care, because aged patients had some organic dysfunctions of respiratory, renal and hepatic systems. 4) Post-operative courses were satisfactory and there was no operative mortality. All patients obtained improvements in their quality of life. Consequently, we concluded that surgical closure is recommended even for aged patients with ASD, except for Eisenmenger's syndrome.

Aged↗
PubMed1994

[A case of lung cancer combined with ocular myopathy and idiopathic thrombocytopenic purpura which was presumed to be caused by heart catheterization].

A 61-year-old patient was admitted to our hospital because of a chest abnormal shadow. He was suffered from ocular myopathy for more than 4 years. A lab data on the admission showed only a slight thrombocytopenia. After the unilateral pulmonary arterial occlusion test for the preoperative evaluation of thoracotomy, the hemorrhagic tendency was appeared. A detailed examination proved idiopathic thrombocytopenic purpura which was presumed to be caused by the heart catheterization. We employed high-dose intravenous gamma-globulin infusion and concentrated platelet transfusion for 5 days for preventing hemorrhagic complications during the thoracotomy. The partial resection was undergone for the left upper lobe tumor, which was proved as large cell carcinoma. The postoperative hemorrhage was well controlled. We conclude that the high-dose intravenous gamma-globulin infusion and/or concentrated platelets transfusion should be positively employed for the patients with even slight thrombocytopenic purpura.

Carcinoma, Non-Small-Cell Lung↗
PubMed1994

[Sequential coronary artery bypass using right gastroepiploic artery].

Between January 1989 and March 1993, sequential coronary artery bypass grafting using the right gastroepiploic artery (RGEA) were performed in seventeen patients. Seven patients were anastomosed from left anterior descending artery to diagonal artery. Six patients were anastomosed from right coronary artery to left circumflex artery. Two patients were anastomosed from right coronary artery to left anterior descending artery. Two patients were anastomosed to two branches of left circumflex artery and one patient was anastomosed from right coronary artery to two branches of left circumflex artery. Postoperative angiograms were performed sixteen patients and patency rate was 93.9% (31/33 anastomoses). There were no early death, and all patients were free from angina. In situ anastomoses with the most of the coronary arteries could be performed, by using sequential RGEA grafting. These results indicated that sequential RGEA grafting is useful for multiple coronary artery bypass grafting by arterial graft.

Adult↗
PubMed1994

[A quantitative approach to the rCBF response to acetazolamide using 99mTc-HMPAO and graphical analysis].

A simple noninvasive method for a quantitative measurement of brain perfusion is presented using intravenous radionuclide angiography with 99mTc-hexamethylpropylene amine oxime (HMPAO). Graphical analysis was employed for the evaluation of the unidirectional influx constant (ku) of the tracer from the blood to the brain and the initial distribution volume (Vn) for the tracer, which is the volume of the exchangeable region plus the plasma space. The ku and Vn values were standardized to provide objective and comparable values, brain perfusion indices (BPI) and corrected Vn (Corr. Vn), between subjects by setting the size ratio of ROI(brain) to ROI(aorta) at 10 and 1, respectively. BPI and Corr. Vn of the whole brain were measured before and 20 min after injection of 1 g acetazolamide. After acetazolamide administration, BPI and Corr. Vn increased in all eight subjects with cerebrovascular diseases and one with a pituitary adenoma, by a mean of x 1.26 and 1.24, respectively. Increase of BPI showed a significant correlation with increase of Corr. Vn. This technique is easy to apply as an adjunct to SPECT and may be helpful in the measurement of brain perfusion changes in the acetazolamide test.

Acetazolamide↗
PubMed1993

Intrapleural rupture of a pulmonary arteriovenous fistula occurring just beneath the pleura: report of a case.

We report herein a rare case of a 21-year-old man with Rendu-Osler-Weber disease, otherwise known as hemorrhagic teleangiectasia, in whom a spontaneous hemothorax occurred following the rupture of one of multiple pulmonary arteriovenous fistulae (PAVF). An emergency life-saving operation was performed which revealed the ruptured fistula lying just beneath the visceral pleura. This case demonstrates that patients in whom a pulmonary angiogram shows an arteriovenous fistula lying just beneath the visceral pleura should undergo prophylactic surgery to avoid a life-threatening emergency, whenever possible.

Adult↗
PubMed1993

Familial neurilemmomatosis: report of a case.

We report herein a case of familial neurilemmomatosis seen in a 16-year-old girl and her 38-year-old mother. The girl presented to us with an intrathoracic vagal neurilemmoma, as well as neurilemmomas on the right fifth intercostal nerve and in the serratus anterior muscle. Two years after these tumors were resected, bilateral acoustic neuromas and multiple brain stem tumors appeared. Her mother was being treated simultaneously at another hospital for multiple neurilemmomas, including bilateral acoustic neurilemmomas, suggesting the possibility that neurilemmomatosis is an autosomal dominantly inherited disorder.

Adolescent↗
PubMed1993

[Acetazolamide effect on vascular response in crossed cerebellar diaschisis as measured by 99mTc-HMPAO SPECT].

We studied the effect of acetazolamine (DIAMOXR) on vascular response in areas with crossed cerebellar diaschisis (CCD) using consecutive 99mTc-hexamethyl-propyleneamine oxime (HMPAO) SPECT studies before and after DIAMOX administration with a subtraction method. Regions of interest were drawn over the bilateral cerebellar cortices and interhemispheric asymmetry indices (IAI) were obtained. Eleven of 14 patients with CCD at baseline showed decrease of IAI after DIAMOX administration. Although there is a possibility of underestimation of increase in perfusion in unaffected cerebellar hemisphere, this result suggests a greater increase in perfusion in the affected cerebellar hemisphere as compared with in the contralateral unaffected one and suggests more dilatation of the arterioles in areas with CCD post-DIAMOX than in areas without CCD. However nonsignificant correlation between IAI at baseline and difference of IAI from baseline to post-DIAMOX did not support the hypothesis of more dilatation post-DIAMOX of more constricted arterioles.

Acetazolamide↗
PubMed1993

[Changes in right ventricular hemodynamic function by unilateral pulmonary arterial occlusion test].

We performed unilateral pulmonary arterial occlusion test (UPAO) for the preoperative evaluation of lung function in patients undergoing lung resection. In this test, the main pulmonary artery of either side is occluded to simulate postoperative functional status. In order to evaluate the right ventricular hemodynamic function, we measured right ventricular ejection fraction (RVEF) and right ventricular end-diastolic volume index (RVEDVI) throughout UPAO by thermodilution method. We investigated the relationships between changes in right ventricular hemodynamic function and postoperative complications related to cardiac functions, namely arrhythmias or heart failure. Thirty-four patients without heart disease prior to lung resection were examined by UPAO, and RVEF and RVEDVI were measured. Analyses demonstrated that changes in RVEF were inversely correlated with changes in RVEDVI. In 6 cases, RVEDVI increased from control by over 20% during UPAO. All of these patients had postoperative cardiac complications. The hypothetical ventricular function curves showed a large increase in RVEDVI relative to right ventricular stroke work index (RVSWI), suggesting a decrease in right ventricular function. In conclusion, these results suggest that changes in RVEDVI during UPAO may predict postoperative cardiac complications in patients undergoing pulmonary resection.

Adult↗
PubMed1993

[An adult case of secundum atrial septal defect with severe postoperative pulmonary hypertensive crisis].

We reported an adult case of secundum atrial septal defect with severe postoperative pulmonary hypertensive crisis. A 52 year-old female with secundum atrial septal defect and pulmonary hypertension underwent ASD patch closure. After the operation she experienced severe postoperative pulmonary hypertensive crisis. Only administration of PGE1 through the pulmonary artery was effective of hemodynamic improvement and reduction of pulmonary hypertension. Histological diagnosis of lung biopsy showed thromboembolism of small pulmonary artery. Pulmonary hypertension has not been evident during the 3 months since the cardiac catheterization was performed.

Alprostadil↗