Biomedical subjects
Publications and source records attributed to S Oba.
The rectus abdominis muscle flap, combined with the external oblique fascia, were utilized in cranial-base reconstruction. In a wide defect caused by resection of a giant meningioma, the dura was reconstructed with the external oblique fascia and anterior sheath, and the cranial-base defect was reconstructed with the rectus abdominis muscle flap.
We performed in total 528 kidney transplantations from Feb. 1983 to Dec. 1988 in Kidney Center of Tokyo Women's Medical College. Of the 528 kidney transplantations, 450 were living related kidney transplantations. The living related renal transplant recipients treated with CYA were divided into 3 groups: high dose CYA double drug therapy group (group 1), high dose CYA triple drug therapy group (group 2) and low dose CYA triple drug therapy group (group 3). Group 1 (n = 263) was treated with CYA (initial dose 12 mg/kg) and methylprednisolone (MP). Group 2 (n = 106) was treated with CYA (initial dose 10 mg/kg), MP and azathioprine (AZ) (1 mg/kg). Immunosuppression of group 3 (n = 81) consisted of CYA (initial dose 6 mg/kg), MP and AZ (2 mg/kg) (or mizoribine (MZ) (3-5 mg/kg). CYA serum trough level (polyclonal) was lowered according to the initial dose of CYA, and in particular trough level in group 3 was controlled at a low level (50-150 ng/ml in induction phase) to reduce CYA nephrotoxicity. However, even if strict control of serum trough level was accomplished, we could not get improvement of renal function in Group 3. Group 3 had more frequent and severe accelerated acute rejections (AAR) than the other groups. These data showed that inadequate immunosuppression in group 3 caused more frequent and severe rejection episodes. Also, renal biopsy revealed CYA nephrotoxicity even in group 3 and this nephrotoxicity may have been caused by ischemic damage by severe rejections.(ABSTRACT TRUNCATED AT 250 WORDS)
The clinical state of bacteriuria and its correlation with pyuria and symptomatic genitourinary tract infection (GUTI) were studied in 42 renal transplantation recipients who were followed up in the Kidney Center of Tokyo Women's Medical College over 6 months and who showed bacteriuria more than 3 times between January and December in 1987. The results were as follows. 1) Of the 42 recipients, bacteriuria was found less than 5 times in 19 patients, 6 to 10 times in 18 patients and more than 11 times in 5 patients. There was a tendency for the same bacteria to be isolated several times from the same patient. The most commonly isolated bacterias were Enterobacter, Enterococcus, Serratia and E. coli. 2) Bacteriuria was accompanied by pyuria in 33 patients (79%) and by symptomatic GUTI in 12 patients (29%). Bacteriuria without pyuria was shown in 9 patients (21%) without symptomatic GUTI and it was suggested that bacteriuria did not result in graft hypofunction after two years. 3) Of 16 patients with bacteriuria accompanied by pyuria, symptomatic GUTI occurred in 9 patients (56%). Of these, one patient was found to have VUR of the transplanted kidney, another was found to have VUR of the native kidney, and a third patient died due to interstitial pneumonitis presumably as a result of overimmunosuppression. Transplantation recipients with bacteriuria accompanied by pyuria develop symptomatic GUTIs frequently and should be treated with proper antibacterial agents. When bacteriuria continues, further examination should be performed for an organic disease of the urinary tract or an overimmunosuppressed state. When a patient shows bacteriuria without pyuria, chemotherapy is not needed and it is sufficient to observe the course carefully.
More than 100,000 uremic patients have been maintained by various blood purification modalities in Japan. However, their quality of life is far from satisfaction not only in terms of physical problems related to the complications specific to long-term dialysis treatment, but also the restriction in social activities by spending much time for hospital dialysis. A graft functioning rate in kidney transplantation has been remarkably improving after introduction of Cyclosporine A as an immunosuppressant and is presently approximately 90% one year after transplantation. As long as the transplanted kidneys function, further extensive social activities and highly-graded quality of life is warranted compared to artificial kidney treatment. On the other hand, patients in end-stage renal diseases and with rejected transplants are expected to undergo safe kidney transplantations as being maintained by dialysis therapy. Furthermore, recent development in blood purification technology has made the specific kidney transplantations successful in recipients with the preformed antibody (-ies) and the incompatible ABO blood type antibody (-ies). Nowadays, relation between blood purification and kidney transplantation is not competitive, but mutually supplementary as a matter of realism.
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The postoperative duration of pyuria was studied in 35 patients who underwent transurethral resection of the prostate (TUR-P). The average postoperative duration of pyuria was 58.0 +/- 23.6 days. The age over 70 years, preoperative indwelling of urethral catheter and the preoperative urinary tract infection did not make the duration of pyuria longer. The volume of resected prostatic tissue over 20 g and the existence of diabetes mellitus make it significantly longer. It is effective and safe to use a low-dose antibacterial agent such as NFLX which has a broad spectrum and hardly develops bacterial resistance after TUR-P. It is suggested unnecessary to change the anti-bacterial agent even when pyuria continues.
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The common tumors originating in the jugular foramen are chemodectoma and schwannoma. Jugular foramen meningioma is extremely rare. Review of the literature revealed only seven reported cases of this tumor. The authors present a child case of jugular foramen meningioma with intra and extracranial extension. A 9-year-old boy was admitted to the Department of Neurosurgery, Hiroshima University School of Medicine on March 20, 1985. Since the age of 3, the patient had hoarseness and was found to tilt his neck when he shouted. Since the age of 6, he was found to nod when he swallowed. At the age of 8, he developed swallowing difficulties. On admission, his general condition was unremarkable except for his lean build (126 cm in height and 23 kg in weight). An elastic hard and immobile mass was palpable in the left upper neck deep in the atrophic sternocleidomastoid muscle. Neurological examination revealed involvement of the ninth, tenth, eleventh, and twelfth cranial nerves. A plain skull roentgenogram and laminogram revealed hyperostosis around the left jugular foramen, and narrowing of the canal. CT with contrast enhancement revealed a high density mass in the left cerebellopontine angle extending through the jugular foramen to the left parapharyngeal space. Cerebral angiography did not show any abnormal findings except for complete blockage of the left sigmoid sinus. On April 4, 1985, subtotal removal of the intracranial tumor was performed using suboccipital craniotomy. Then, on July 3, 1985, the left parapharyngeal tumor was excised through a cervicofacial incision. Finally the residual tumor in the jugular foramen was excised using suboccipital approach on August 18, 1986.(ABSTRACT TRUNCATED AT 250 WORDS)
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