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Biomedical subjects

S Kusano

Publications and source records attributed to S Kusano.

At least 55 records · Page 3Linked to original sources
PubMed1999

Assessment of salivary gland dysfunction following chemoradiotherapy using quantitative salivary gland scintigraphy.

PURPOSE: To assess chemoradiotherapy-induced salivary gland dysfunction using quantitative salivary gland scintigraphy (QSGS), and whether QSGS is capable of predicting the grade of persistent salivary dysfunction after chemoradiotherapy. METHODS: From a time-activity curve using a stimulation test, the washout rate (WR) calculated was assessed. All glands (n = 155) were classified into four groups: a no-therapy group (n = 18), a chemotherapy alone group (n = 31), a radiotherapy alone group (n = 50), and a chemoradiotherapy group (n = 56). Subjective descriptions of xerostomia were recorded 1 year after the completion of the treatment period, and the 32 glands subjected to irradiation with or without chemotherapy were assessed. RESULTS: The WR values were significantly lower in glands that received chemoradiotherapy than in glands treated with radiotherapy alone (mean: 0.75 x 10(-3), n = 40 vs. 0.22, n = 36, p < 0.015), but there was no significant difference in the WR values between the no-therapy group and the chemotherapy alone group. The mean values of WR were lower in the chemoradiotherapy glands than in the radiotherapy alone glands in each of cumulative dose ranges of 1-20, 21-30, and 31-60 Gy. With regard to recovery from xerostomia, the WR values at a cumulative dose range of 20 to 40 Gy were significantly lower in the not improved group (-0.418, n = 16) than in the improved group (0.245, n = 16) (p < 0.0001). CONCLUSION: Chemotherapy per se has no or little adverse effect on salivary function, but combination chemotherapy can deteriorate radiation-induced injury of the salivary glands. QSGS appears useful in predicting the grade of persistent xerostomia following chemoradiotherapy.

Adolescent↗
PubMed1999

Preoperative embolization of meningiomas with pial supply: successful treatment of two cases.

BACKGROUND: The efficacy of preoperative embolization for hypervascular meningiomas fed by the pial branches of the internal carotid artery was evaluated. METHODS: Two cases of hypervascular meningiomas fed by the cortical branches of the internal carotid arteries are presented. In the first patient, the left anterior frontal internal artery was embolized with gelatin sponge (Gelfoam) as a preoperative treatment using a microcatheter. The tumor was totally resected with 1,000 ml of blood loss. In the second patient, the right sulcal artery was embolized with Gelfoam. The patient subsequently underwent surgical resection with 100 mL of blood loss. RESULTS: No neurological deficit appeared after the embolization or the surgery in either case. CONCLUSION: Preoperative embolization of hypervascular meningiomas, mainly fed by the cortical branches of the internal carotid arteries, may be possible and effective.

Carotid Artery, Internal↗
PubMed1999

Daily positioning accuracy of frameless stereotactic radiation therapy with a fusion of computed tomography and linear accelerator (focal) unit: evaluation of z-axis with a z-marker.

To evaluate quantitative positioning errors of frameless stereotactic radiation therapy with a fusion of computed tomography (CT) and linear accelerator unit, Z-type CT markers were attached to patients, and CT images were obtained before and after daily treatment. In 40 verification tests, geometrical errors were never more than 1 mm.

Brain Neoplasms↗
PubMed1999

Use of contrast-enhanced computed tomography to measure clearance per unit renal volume: a novel measurement of renal function and fractional vascular volume.

The iodinated contrast agents used for computed tomography (CT) have pharmacokinetics similar to inulin and can measure physiological indices, such as clearance per unit renal volume (alpha/V) and fractional vascular volume (fvv). Clinical experience with these techniques is, however, scanty, and the present study explored their potential in subjects with and without renal dysfunction. In a series of subjects, a single slice of kidney was scanned sequentially after the bolus injection of contrast material. Time-attenuation curves were constructed, and alpha/V and fvv were calculated using a Patlak graphic analysis. In the first part of the study, 50 normal kidneys in 35 subjects (aged 21 to 75 years) were studied. In the second stage, alpha/V was compared with glomerular filtration rate (GFR) measurements in 24 patients with diabetes (aged 28 to 84 years) with or without renal dysfunction. In normal kidneys, alpha/V averaged 0.49 +/- 0.11 mL/min/mL and fvv averaged 35% +/- 12%. These values agree with literature data obtained using other techniques. A negative correlation was seen between age and alpha/V (r = 0.66; P < 0.0001), but not fvv. In patients with diabetes, a strong correlation was observed between renal clearance values, calculated from CT and corrected for renal volume, and GFR (r = 0.87; P < 0.0001). Dynamic CT can provide quantitative renal physiological information on a regional basis noninvasively.

Adult↗
PubMed1999

The portal component of hepatic perfusion measured by dynamic CT: an indicator of hepatic parenchymal damage.

CT can measure absolute hepatic arterial and portal venous perfusion; pilot data suggests these are raised and lowered, respectively, in cirrhosis. This study examined the value of functional CT in assessing cirrhosis, using the prothrombin ratio (PTR) as a marker for hepatic parenchymal damage. Twenty subjects with viral-induced cirrhosis (11 men and 9 women; 55.41 +/- 7.86 years) and 14 controls (8 men and 6 women; 48.36 +/- 17.67 years) were studied. A single section through the liver was scanned after bolus intravenous injection of 40 ml ioversol 320 mgI/ml. Hepatic arterial and portal perfusion was measured using a previously described technique. Hepatic portal perfusion was decreased in patients (0.66 +/- 0.21 ml/min/ml) compared with controls (1.11 +/- 0.23 ml/min/ml; P < 0.0001). A strong correlation was seen between PTR and portal perfusion (r = 0.662, P = 0.0038) in cirrhotics. Hepatic arterial perfusion did not differ between patients (0.088 +/- 0.082 ml/min/ml) and controls (0.091 +/- 0.067), and did not correlate with PTR. In conclusion, portal perfusion is reduced in cirrhosis, and this reduction correlates with PTR. It could thus be used as a marker of hepatic parenchymal damage. This technique may be useful in the follow-up of chronic liver disease, potentially reducing the need for serial liver biopsy.

Adult↗
PubMed1999

Transient splenomegaly in acute pancreatitis.

Serial changes in splenic volume of 25 patients (18 men and seven women; 53.4 +/- 20.8 years old, range 25-83) with acute pancreatitis who underwent CT examinations were retrospectively studied. Abdominal CT was performed within 3 days after the onset and there was at least one follow-up CT examination after this time. The percentage changes of splenic volume in the first (4-30 days) and second (31-100 days) follow-up CT were calculated. Splenic volume increased in the first follow-up CT (mean +/- SD: 197.8 +/- 121.0 cm3) compared with the initial CT (124.8 +/- 70.0; p < 0.0001), and then decreased in the second follow-up CT (179.7 +/- 100.7; p < 0.002). The average splenic volume increased 65.5 +/- 88.7% (range -10.4-377.4%) between the initial and first follow-up CT examinations. Five of 25 cases (20%) in whom size of spleen increased more than twice had severe acute pancreatitis (p < 0.05), complicated pseudocyst requiring surgical drainage (p < 0.05), pleural effusion (p < 0.01), splenic vein thrombosis or compression (p < 0.05) and longer hospital stay (p < 0.02) compared with patients with a smaller increase in splenic volume. In conclusion, transient splenomegaly was commonly seen in acute pancreatitis, especially in severe or complicated cases. Congestive splenomegaly caused by obstruction or stenosis of the splenic vein and non-specified acute splenitis were suspected of contributing to the transient splenomegaly.

Acute Disease↗
PubMed1999

Transcatheter embolization of a superior mesenteric artery pseudoaneurysm. A case report.

A 61-year-old man, with pseudoaneurysm of the superior mesenteric artery presenting with gastrointestinal bleeding, was successfully treated by transcatheter embolization using interlocking detachable coils. During the following observation time of 10 months, the patient had no sign of gastrointestinal bleeding. We underline the importance and feasibility of transcatheter embolization as the first-line treatment in such pseudoaneurysms.

Aneurysm, False↗
PubMed1999

The evolution of cerebral blood flow in the developing brain: evaluation with iodine-123 iodoamphetamine SPECT and correlation with MR imaging.

BACKGROUND AND PURPOSE: Although it is well established that brain maturation correlates temporally with the functions the newborn or infant performs at various stages of development, the precise relationship between function and anatomic brain maturation remains unclear. The purpose of this study was to investigate the developmental changes of regional cerebral blood flow (rCBF) in infants and children using iodine-123 iodoamphetamine (123I-IMP) and single-photon emission computed tomography (SPECT). These findings were correlated with the MR imaging appearance of the brain and with known developmental changes. METHODS: Twenty-one 123I-IMP SPECT examinations of 17 patients, ranging in age from neonates to 2 years, were reviewed retrospectively. All children had had transient neurologic events in the neonatal period that did not significantly affect subsequent neuropsychological development. MR studies were performed in 12 of these patients and the MR findings were correlated with the SPECT results. RESULTS: SPECT studies showed a consistent pattern of evolving changes in 123I-IMP uptake, most likely reflecting evolution of rCBF. From the 34th postconceptional week until the end of the second month after term delivery, there was predominant uptake in the thalami, brain stem, and paleocerebellum, with relatively less cortical activity. Radionuclide uptake in both the perirolandic and occipital cortices was well seen around the 40th postconceptional week and increased rapidly thereafter, with a predominance of parietal activity. By 3 months, radionuclide uptake in the cerebellar hemispheres and parietofrontal cortices increased. Frontal and temporal activity increased by age 6 to 8 months. Uptake in the basal ganglia increased by 8 months. By the beginning of the second year, rCBF showed a similar topographic pattern to that in adults. CONCLUSION: The time course of the changes in 123I-IMP uptake in the developing brain as detected by SPECT is similar to that of myelination and most likely reflects an overall topologic maturational pattern of the brain.

Amphetamines↗
PubMed1999

[Optimal dosage of contrast material in brain enhanced CT].

PURPOSE: To assess the optimal contrast dosage for brain enhanced CT. MATERIALS AND METHODS: A total of 150 patients were randomly assigned to two groups. The patients were also divided by body weight into three groups (< 50 kg, 50-59.9 kg and > or = 60 kg). A total of 100 ml (in 77 patients) or 50 ml (in 73 patients) of contrast material (iopamidol 300 mgI/ml) was intravenously administrated at a speed of 1 ml/sec. Three diagnostic radiologists evaluated image quality by five- or two-stage scoring systems with special attention given to enhancement of the anterior and middle cerebral arteries. CT values of the basilar artery were also measured. RESULTS: In visual evaluation by the five-stage scoring system, image quality with 100 ml of contrast material was better than that with 50 ml in all body-weight groups, although no difference was observed with the two-stage scoring system in patients weighing less than 60 kg. CT values of the basilar artery were higher in patients given 100 ml than in those given 50 ml regardless of weight groups. CONCLUSION: The image quality of brain CT using 50 ml of contrast material is sufficient for correct diagnosis in patients with a body weight of less than 60 kg.

Adolescent↗
PubMed1999

[Cost-effectiveness of exercise 201Tl myocardial SPECT in patients with chest pain assessed by decision-tree analysis].

To evaluate the potential cost-effectiveness of exercise 201Tl myocardial SPECT in outpatients with angina-like chest pain, we developed a decision-tree model which comprises three 1000-patient groups, i.e., a coronary arteriography (CAG) group, a follow-up group, and a SPECT group, and total cost and cardiac events, including cardiac deaths, were calculated. Variables used for the decision-tree analysis were obtained from references and the data available at our hospital. The sensitivity and specificity of 201Tl SPECT for diagnosing angina pectoris, and its prevalence were assumed to be 95%, 85%, and 33%, respectively. The mean costs were 84.9 x 10(4) yen/patient in the CAG group, 30.2 x 10(4) yen/patient in the follow-up group, and 71.0 x 10(4) yen/patient in the SPECT group. The numbers of cardiac events and cardiac deaths were 56 and 15, respectively in the CAG group, 264 and 81 in the follow-up group, and 65 and 17 in the SPECT group. SPECT increases cardiac events and cardiac deaths by 0.9% and 0.2%, but it reduces the number of CAG studies by 50.3%, and saves 13.8 x 10(4) yen/patient, as compared to the CAG group. In conclusion, the exercise 201Tl myocardial SPECT strategy for patients with chest pain has the potential to reduce health care costs in Japan.

Chest Pain↗
PubMed1998

Effocacu and Significance of Sentinel Lymph Node Identification with Technetium-99m-labeled Tin Colloids for Breast Cancer.

PURPOSE: The sentinel lymph node (SLN) is thought to reflect the metastatic status of the remaining axillary lymph nodes in patients with breast cancer. We used technetium-99m-labeled tin colloids to identify SLN. The efficacy and significance of SLN identification using this method were investigated in terms of number, size, location, and tumor metastasis. The efficacy of the emulsion charcoalinjection method for the intraoperative visible identification of SLN was also evaluated. METHODS: Twenty-five patients with invasive breast cancer were studied. Underultrasonographic guidance, technetium-99m-labeled tin colloid particles (3 ml) were injected into 3 sites around the tumor within 3 mm of the margin or into the wall of the excisional biopsy cavity 2 hours before surgery. At surgery, just before the incision, an emulsion of charcoal particles (2.5 ml) was injected into 3 sites of the breast parenchyma surrounding the tumor. All patients underwent mastectomy with axillary dissection to the infraclavicular region. The radioactivity of each dissected lymph node was measured. All axillary specimens were processed in individual blocks for permanent section histopathologic evaluation with H & E. RESULTS: SLN were defined as lymph nodes with 100, 000 or more counts per minute (cpm) in radioactivity after injection of labeled tin colloids. In all 25 patients, SLN were identified (mean, 1.9 SLN/patient; range,1-4). Since the mean uptake in SLN was 383 124 cpm, but only 884 cpm in non-SLN nodes, discrimination between SLN and non-SLN nodes was easy. Clearly visible lymph nodes with charcoalstaining accounted for 83.3% of all SLN, although 21.3% of non-SLN also stained. SLN were located only in the axillary region, but there were no other specific features in the location or size of SLN. The SLN were metastatic in 10 of the 25 patients: in 4, the SLN were the only metastatic nodes whereas in the remaining 6 patients, other axillary nodes were also positive. Fifteen patients with no metastasis in SLN had no tumor involvement in any other lymph nodes. There were no skip metastases. CONCLUSION: SLN identified with labeled tin colloids have clinical value in predicting the metastatic status of the remaining axillary lymph nodes in breast cancer.

Journal Article↗
PubMed1998

Use of Modern Radiation Therapy Following Surgery for Invasive Breast Cancer.

Radiation therapy has long been used in the treatment of breast cancer. However, it is still very difficult to state with certainty whether or not radiation therapy is truly beneficial for patients with breast cancer, mainly because breast cancers are very heterogeneous in their clinical behavior, and because radiation therapy has undergone significant change in the methodology. We extensively reviewed the literature, and determined that radiation therapy increases the survival of some patients, particularly in conjunction with surgery and systemic therapy. Although the total proportion of such patients seems to be small, appliedto the general population of breast cancer patients, the absolute number of women who might benefit from radiation therapy may be quite large.

Journal Article↗
PubMed1998

Focal, high dose, and fractionated modified stereotactic radiation therapy for lung carcinoma patients: a preliminary experience.

BACKGROUND: Stereotactic radiation therapy is highly effective in the treatment of small brain metastases, regardless of the histology. This suggests that small extracranial malignancies may be curable with similar radiation therapy. The authors developed a novel treatment unit for administering such therapy. METHODS: The unit consisted of a linear accelerator (linac), an X-ray simulator (X-S), computed tomography (CT), and a table. The gantry axes of the three machines were coaxial and could be matched by rotating the table. Patients were instructed to perform shallow respiration with oxygen. The motion of the tumor was monitored with the X-S. When the motion was slight enough, the table was rotated to the CT. To include all geometric movement on the CT images, each scan was made while the patient was performing shallow respiration. After the CT positioning, the table was rotated to the linac, and non-coplanar treatment was given. Beginning in October 1994, 45 patients with 23 primary or 43 metastatic lung carcinomas were treated. Radiation doses at the 80% isodose line were 30-75 gray in 5-15 fractions over 1-3 weeks with or without conventional radiation therapy. RESULTS: The treatment was performed with no or minimal adverse acute symptoms. The daily treatment time was short. During a median follow-up of 11 months, local progression occurred in 2 of 66 lesions. Interstitial changes in the lung were limited. CONCLUSIONS: With this unit and procedure, focal radiation therapy similar to stereotactic radiation therapy is possible for extracranial sites. The preliminary experience appeared safe and promising, and further exploration of this approach is warranted.

Adenocarcinoma↗
PubMed1998

Cardiorespiratory endurance in people with cerebral palsy measured using an arm ergometer.

OBJECTIVE: To determine whether cardiorespiratory endurance, a component of physical fitness, in people with cerebral palsy (CP) is lower than that in able-bodied people, and whether the difference in locomotion of CP patients affects their cardiorespiratory endurance. DESIGN: Nonrandomized control trial. SETTING: Referred care center. SUBJECTS: Twelve men with CP who were independent in daily life and 7 able-bodied control volunteers. INTERVENTION: Cardiorespiratory endurance of the subjects was measured with an arm ergometer. MAIN OUTCOME MEASURES: Oxygen consumption (VO2), heart rate (HR), and physical working capacity (PWC) measured during arm ergometer rotation. RESULTS: The 75%VO2max and 75%HRmax did not differ significantly between CP subjects and control subjects, or between ambulatory CP subjects and wheelchair-bound CP subjects. However, the PWC at 75%HRmax of the CP subjects was significantly lower than that of the control subjects. CONCLUSION: Cardiorespiratory endurance does not differ significantly between people with CP and able-bodied people. Type of locomotion does not affect cardiorespiratory endurance. However, the highest PWC performed by the CP subjects was significantly lower than that of the control subjects.

Activities of Daily Living↗
PubMed1998

Hepatic perfusion changes after transcatheter arterial embolization (TAE) of hepatocellular carcinoma: measurement by dynamic computed tomography (CT).

We observed the hemodynamic changes at the level of the hepatic parenchyma induced by transcatheter arterial embolization (TAE) for hepatocellular carcinoma in 22 patients. TAE was performed by administration of a mixture of iodized oil, adriamycin, and mitomycin C, followed by injection of gelatin sponge particles (1-mm pieces). Perfusion measurements (arterial and portal) were done by dynamic computed tomography (CT). Arterial perfusion was increased two to six days after TAE (0.146 +/- 0.073 ml/min/ml, P < 0.0002) compared with that before TAE (0.064 +/- 0.039), but decreased again one month after TAE (0.086 +/- 0.038). Portal perfusion was decreased two to six days after TAE (0.541 +/- 0.180, P < 0.001) compared with that before TAE (0.733 +/- 0.263) and was grossly unchanged one month after TAE (0.651 +/- 0.214). We suspected that these perfusion changes were due to acute inflammatory responses. Quantification of tissue perfusion by dynamic CT was useful for studying hemodynamic changes after TAE.

Aged↗
PubMed1998

The ftsQ1p gearbox promoter of Escherichia coli is a major sigma S-dependent promoter in the ddlB-ftsA region.

The most potent promoters in the ddlB-ftsA region of the dcw cluster have been analysed for sigmaS-dependent transcription. Only the gearbox promoter ftsQ1p was found to be transcribed in vitro by RNA polymerase holoenzyme coupled to sigmaS (EsigmaS). This dependency on sigmaS was also found in vivo when single-copy fusions to a reporter gene were analysed in rpoS and rpoS+ backgrounds. Although ftsQ1p can be transcribed by RNA polymerase containing either sigmaD or sigmaS, there is a preference for EsigmaS when the assay conditions include potassium glutamate and supercoiled templates, a property shared with the bolA1p gearbox promoter. The rest of the promoters assayed, ftsQ2p and ftsZ2p3p4p, similarly to the control bolA2p promoter, were preferentially transcribed by EsigmaD, the housekeeper polymerase. The ftsQ1p and the bolA1p promoters also share the presence of AT-rich sequences upstream of the - 35 region and the requirement for an intact wild-type alpha-subunit for a proficient transcription, allowing their joint classification as gearboxes.

Bacterial Proteins↗