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Biomedical subjects

S Sugihara

Publications and source records attributed to S Sugihara.

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

[Visiting nurse for a terminal ALS patient].

The authors' hospital is a 585-bed hospital under the direct management of the National Health Insurance System. The hospital has been providing visiting nurses for the past 8 years, who work from local medical centers and the Visiting Nurses Department. Thirty-seven patients have received such home care, among whom 8 had intractable disease. Patient S was a 46-year-old woman who suffered from amyotrophic lateral sclerosis (ALS). The onset of the disease was in April, 1993, when the patient experienced muscular atrophy in both legs and deteriorating muscular strength. The diagnosis was definitive in 1995. On March 1, 1998, the patient received emergency hospitalization for breathing difficulties and aspiration pneumonia, and on March 5 underwent tracheotomy. A cannula had to be inserted for tubal feeding, and the physician in charge explained to her family that her prognosis was 3 months. Both the patient and her family desired home care, and the patient returned home on April 11. Respecting the wishes of the patient, the visiting nurse provided support so that home treatment could be continued. In the end, the patient lived at home while receiving home treatment for 7 months. Through the support provided by the visiting nurse, efforts were made to keep the patient's condition stable, and she was able to continue home treatment and living at home for a higher quality of life.

Amyotrophic Lateral Sclerosis↗
PubMed1999

[Rethinking the visiting nurse system at a major regional hospital].

The authors' hospital is a National Health Insurance System Hospital near four cities. It serves as the central hospital for a region with a population of about 330,000 people. The hospital has 585 beds and sees an average of 1,500 outpatients each day. The average number of hospitalized patients each day is 500. Its visiting nurse department is located in a regional medical center and functions as a "Visiting Nurse Center". The purpose of the present study was to review the visiting nurse system at our hospital that has been operating for the past 8 years. The motivation for this review was our intention to actively increase the number of people advantage of such services, and attempt to provide continuous care for each individual patient. By looking back on the system as it has been practiced, its procedures, and results during the 8 years from 1990 to 1997, we can consider points for improvement from among the problem points discovered. The problems uncovered in our practice of home nursing care are listed below. 1. It is difficult to present a list with an estimated period for the release from the hospital. 2. Instructions for leaving the hospital are not sufficiently detailed. 3. Arranging the schedule and actual visits for diagnosis and treatment is complex. 4. The system for cooperation with the activities that are done in the hospital is insufficient. 5. The system for cooperation with local public health nurses is insufficient. 6. The system for managing equipment is insufficient. 7. The 24-hour support system for terminal patients is inadequate.

Community Health Nursing↗
PubMed1998

Lumbar intervertebral disc involvement in chronic lymphocytic leukemia. A case report.

STUDY DESIGN: Report of a patient with a rare location of a solid chronic lymphocytic leukemic mass of an intervertebral lumbar disc. OBJECTIVES: To illustrate the previously undescribed discovertebral involvement of chronic lymphocytic leukemia and to discuss the diagnostic difficulties. SUMMARY OF BACKGROUND DATA: Chronic lymphocytic leukemia primarily involves lymph nodes, spleen, liver, and bone marrow. Bone lesions are rare in chronic lymphocytic leukemia and usually consist of areas of osteopenia. Spinal involvement in chronic lymphocytic leukemia is rare, and only two cases of spinal cord compression attributable to an extradural solid mass composed of leukemic cells have been reported. Intervertebral disc involvement in chronic lymphocytic leukemia has not been reported previously. METHODS: The clinical findings, radiographs, histology, treatment, and follow-up results are presented. RESULTS: Radiographs and magnetic resonance imaging studies showed partial collapse of vertebrae L2 and L3, with destruction and protrusion of the intervertebral disc L2-L3 with dura compression. Treatment consisted of radiotherapy followed by en bloc resection of vertebrae L2 and L3 stabilized with stackable cages and anterior fixation with Kaneda bars. Intervertebral disc infiltration with leukemic cells of B-cell origin was confirmed through histologic examination and immunohistochemical studies of a biopsy and resection specimen. Twenty months after treatment the patient was still in remission and fully mobilized. CONCLUSIONS: Intervertebral disc involvement in cases of chronic lymphocytic leukemia is rare. Its presence should be considered in patients with back pain and neurologic symptoms who had been treated for this form of leukemia in the past. Differentiation with infectious spondylodiscitis can be difficult. Histology is necessary to confirm diagnosis.

Aged↗
PubMed1998

Presenilin 1 associates with glycogen synthase kinase-3beta and its substrate tau.

Families bearing mutations in the presenilin 1 (PS1) gene develop Alzheimer's disease. Previous studies have shown that the Alzheimer-associated mutations in PS1 increase production of amyloid beta protein (Abeta1-42). We now show that PS1 also regulates phosphorylation of the microtubule-associated protein tau. PS1 directly binds tau and a tau kinase, glycogen synthase kinase 3beta (GSK-3beta). Deletion studies show that both tau and GSK-3beta bind to the same region of PS1, residues 250-298, whereas the binding domain on tau is the microtubule-binding repeat region. The ability of PS1 to bring tau and GSK-3beta into close proximity suggests that PS1 may regulate the interaction of tau with GSK-3beta. Mutations in PS1 that cause Alzheimer's disease increase the ability of PS1 to bind GSK-3beta and, correspondingly, increase its tau-directed kinase activity. We propose that the increased association of GSK-3beta with mutant PS1 leads to increased phosphorylation of tau.

Adult↗
PubMed1998

Diffuse plaques associated with astroglial amyloid beta protein, possibly showing a disappearing stage of senile plaques.

To clarify whether senile plaques disappear, we examined amyloid beta protein (A beta) deposits in non-demented subjects, and found novel diffuse plaques associated with astroglial A beta. Formalin-fixed paraffin-embedded sections from cortical areas were immunolabeled with a panel of A beta antibodies, and astroglial and microglial markers. Cerebral A beta deposition was primarily found as diffuse plaques (DP) in these subjects. A subset of DP was associated with clusters of intensely A beta-positive small granules. The clusters, which were located just adjacent to astroglial nucleus, had the characteristics of lipofuscin granules and, therefore, were quite different from "small stellate deposits". Substantial amounts of A beta-positive granules were found inside astrocytes by dual labeling of A beta and glial fibrillary acid protein, and the majority of astroglial A beta immunoreactivity was located on lipofuscin granules. A beta-positive granules lacked immunoreactivity with antisera for the N-terminal region of A beta. These peculiar DP showed a much weaker staining than ordinary DP. The DP associated with astroglial A beta were found in about one third of the subjects, although the density varied widely among individuals. From these findings, we propose that DP, which are associated with the N-terminal truncated A beta in astrocytes, represent the disappearing stage of senile plaques.

Aged↗
PubMed1998

Total laboratory automation in Japan. Past, present, and the future.

The history of systematized automation in clinical laboratories in Japan started in 1981. At that time, about 12 laboratory technicians worked in a typical private University hospital laboratory (average size 1000 beds), whereas in national university hospitals (typical size 600 beds), the number of technicians was as low as 18-25. In 1981, the Kochi Medical School was founded as a new national school, and laboratory staffing was limited by the Ministry of Education to only 19 technicians for the first 3 years. Therefore, we started to develop a fully automated laboratory system by ourselves rather than accepting an intolerable shortage of technicians. The system was based on conveyor and robotic technology, and we called this approach systematization. Ten years later, systematized automation was introduced into the Japanese market. As a result, 72% of the national university hospitals in Japan installed commercial systems for systematization. There is a trend now in hospitals with sufficient numbers of technicians, to introduce fully automated systems in their laboratories as well, and even small hospitals with less than 100 beds are planning to introduce such systems. However, current technology is too expensive and not sufficiently standardized to meet the needs of these market segments in Japan. We recommend that companies agree on common shapes and sizes of racks and include more flexible robotic technology in their sample handling systems, to allow for plug and play systems and to make systematization affordable for every laboratory in the world.

Automation↗
PubMed1998

Pin force measurement in a halo-vest orthosis, in vivo.

The halo-vest is an orthosis commonly used to immobilize and protect the cervical spine. The primary complications associated with the halo-vest have been attributed to cranial pin loosening. However, the pin force history during day-to-day halo-vest wear has not previously been reported. This paper presents a new technique developed to monitor cranial pin forces in a halo-vest orthosis, in vivo. A strain gaged, open-ring halo was used to measure the compressive and shear forces produced at the posterior pin tips. The strain gages measured the bending moments produced by these forces without compromising the structural integrity of the halo-vest system. The prototype halo measured the compressive and shear force components with a resolution of +/- 15 and +/- 10 N, respectively. To test the feasibility and durability of the device, it was applied to one patient requiring treatment with a halo-vest orthosis. At the time of halo-vest application, the mean compressive force in the two posterior pins was 368 N. Over the 3 month treatment period, the compressive forces decreased by a mean of 88%. The shear forces were relatively insignificant. Using this technology future work will be aimed at determining the causes of pin loosening, optimizing vest and pin designs, and investigating the safety of more rapid rehabilitation.

Aluminum↗
PubMed1998

Treatment outcome of osteofibrous dysplasia.

The disease course of six tibial lesions in five patients with osteofibrous dysplasia who were followed longer than 10 years (average: 16.8 years) was analyzed retrospectively. Three patients had a lesion of the unilateral tibia; one patient had lesions of the unilateral tibia and fibula; and one patient had lesions of the bilateral tibiae and ulnae. Curettage and autogeneic bone graft were performed on two lesions, which then healed. Of four lesions on which curettage and xenogeneic bone grafts were performed, three lesions healed, and one developed local recurrence. Curettage and xenogeneic bone graft were performed on the recurrent lesion, which finally healed and the deformity stopped. Three lesions healed without surgical treatment. During the long-term follow-up, this disease showed a clear tendency of healing. Surgical treatment should be considered in patients with disease uncontrollable by conservative treatment or those who have a high possibility of impending fracture and progressing deformity.

Adolescent↗
PubMed1998

Systemic mast cell disease with splenic infarction: a case report.

An autopsy case of systemic mast cell disease (SMCD) without primary skin lesions in a 57-year-old Japanese male is described. Initially the patient was suspected of having liver cirrhosis or malignant lymphoma because of hepatomegaly and lymph node enlargement on admission. However, a lymph node biopsy and bone marrow aspiration conducted on his third admission indicated a SMCD because of the existence of metachromatic cell aggregates stained with toluidine blue. At autopsy, the diagnosis was confirmed because the proliferating cells were histochemically proven to be mast cells by naphthol AS.D chloroacetate esterase, Giemsa and alcian blue, in addition to toluidine blue staining. The intra-abdominal and retroperitoneal lymph nodes were replaced by mast cell aggregates, which caused the splenic infarction and bilateral hydronephrosis, with infiltration of mast cells into the spleen and kidneys also being apparent. Mast cell infiltration was similarly found in the bone marrow, liver, ileum and ascending colon. Immunohistochemically, the mast cells were positive for antibodies of alpha 1-antichymotrypsin, CD45 (LCA), CD43 (MT-1), CD45R (MB-1) and the oncoprotein c-kit. Electron microscopic examination using formalin-fixed tissue gave supportive evidence of a mast cell origin for the lesions.

Fatal Outcome↗
PubMed1998

[A case of acute empyema who underwent omentopexy and was found to have gastric cancer during operation].

A 76-year-old man had undergone omentopexy for empyema. He was found to have gastric cancer and revealed Borrmann III by gastroendoscopy intraoperative period. Segmental gastrectomy was performed without dissection of lymph nodes, because his general condition was poor. After operation, the patient showed septic shock, ARDS and hepato-renal failure but his condition was getting improved by conservative therapy. After 5 years later, he was examined gastro-endoscopy, abdominal and chest CT and revealed no recurrence sign.

Acute Disease↗
PubMed1997

Magnetic resonance chemical shift imaging in bone and soft tissue tumours.

A study was carried out in 14 patients to assess the location and differential diagnosis of bone and soft tissue tumours with a 0.5 Tesla scanner, using water and fat images obtained by the three-point Dixon technique. We compared the magnetic resonance imaging findings obtained with this technique with conventional MRI, T1-T2-weighted images, and gadalinium-diethylenetriamine penta-acetic acid enhanced T1-weighted images. Localisation was better with the three-point Dixon technique than with conventional magnetic resonance imaging. Differentiation between the fat and water component around the tumour was possible. The gadalinium-diethylenetriamine penta-acetic acid enhanced water images were very sensitive to enhancement of the tissue. The three-point Dixon technique is useful when the tumour area is difficult to detect by conventional magnetic resonance imaging and information about its components is needed; these images can be made at the low magnet field.

Adipose Tissue↗
PubMed1997

Microglial activation in early stages of amyloid beta protein deposition.

The present study was undertaken to investigate the relationship of microglial activation to amyloid beta protein (A beta) deposition, particularly at the early stage. Using single and double immunostaining methods with a panel of microglia markers and antibodies against A beta and amyloid beta protein precursor (APP), we examined the cerebrum and cerebella of both Alzheimer's disease (AD) and non-demented subjects obtained at autopsy. In nondemented, middle-aged subjects that had small amounts of cerebral A beta deposits, approximately 70% of the diffuse plaques contained ramified microglia. However, no evidence of microglial activation was found in diffuse plaques in any of the non-demented subjects. Dual immunostaining of sections of cerebral cortex using antibodies against A beta and major histocompatibility complex class II antigen showed that in AD subjects, approximately 20% of total diffuse plaques contained a few, activated microglia. Most of these plaques were defined as a transitional from between diffuse and primitive plaques. Both primitive and classic plaques in the cerebral cortex of AD subjects consistently contained clusters of activated microglia. Subpial A beta deposits without neuritic changes lacked microglial activation. In the cerebellum, all of the diffuse plaques lacked microglial activation, and activated microglia in the compact plaques were not as hypertrophic as those in cerebral primitive/classic plaques. Our findings indicate that microglial reactions are absent in the early stages of A beta deposition, and it occurs during the transition from diffuse to primitive plaques, when amounts of A beta deposits and the degree of neuritic changes increase.

Aged↗
PubMed1997

Anaplastic Ki-1-positive large cell lymphoma of the pancreas: a case report and review of the literature.

A case of Ki-1-positive anaplastic large cell lymphoma of the pancreas is presented. The patient complained of abdominal pain and was jaundiced. Examination of a biopsy specimen obtained by duodenal endoscopy revealed malignant lymphoma, and surgery confirmed a large mass located in the region from the intra-pancreatic tissue around the lower common bile duct to the peri-pancreatic lymph nodes. Histologically, this tumor was composed mainly of large and giant neoplastic cells. Immunohistochemically, these cells were diffusely positive for Ki-1 and CD45RO antigens, indicating the features of Ki-1 anaplastic large cell lymphoma with a T-cell phenotype among non-Hodgkin's lymphoma. The histologic types of the majority of malignant lymphomas of the pancreas reported previously were considered to be diffuse-type non-Hodgkin lymphoma (probably with predominance of the B-cell phenotype), except for a single Japanese lymphoma case with a T-cell phenotype. This is therefore the first known case of Ki-1 anaplastic large cell lymphoma of the pancreas.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1997

Imaging assessment of the response of bone tumors to preoperative chemotherapy.

Assessment of the response of bone tumors to preoperative chemotherapy is of clinical importance. The authors determined the value of 3 imaging techniques (digital subtraction angiography, thallium scintigraphy, and dynamic magnetic resonance imaging) in guiding patient management by assessing the response of 17 bone sarcomas to preoperative chemotherapy compared with histologic evaluation of the resected specimens. Digital subtraction angiography showed a sensitivity of 87.5%, specificity of 57.1%, and accuracy of 73.3%. Thallium scintigraphy (sensitivity, 85.7%; specificity, 85.7%; accuracy, 85.7%) was superior to angiography in predicting tumor responses. The results of dynamic magnetic resonance imaging were analyzed on the basis of the value of slopes, which represents the percent increase in signal intensity per minute. The differences in slope before and after chemotherapy and the postchemotherapy slope values correlated with the histologic responses. The assessment by dynamic magnetic resonance imaging showed a sensitivity of 100%, specificity of 85.7%, and accuracy of 90.9%. Thallium scintigraphy and dynamic magnetic resonance imaging were considered noninvasive, reliable techniques that had about equal ability to assess the response of bone sarcomas to preoperative chemotherapy. Dynamic magnetic resonance imaging offers major advantages in the spatial resolution and can be more readily quantitated when compared with thallium scintigraphy.

Adolescent↗
PubMed1997

Optimum conditions for iron colloid enhanced fast spin echo imaging in hepatocellular carcinoma.

The optimum conditions for iron colloid enhanced fast spin echo (FSE) in the detection of hepatocellular carcinoma have not been clearly established as yet. MRI was performed on 14 patients with hepatocellular carcinoma (45 nodules) before and after administration of chondroitin sulphate iron colloid (CSIC). One type of conventional spin echo (CSE) (TR/TE = 1800/80) was then quantitatively and qualitatively compared with three types of FSE (FSE 1800 (TR/effective TE/echo factor = 1800/90/7); FSE 7 (3500/90/7); and FSE 11 (3500/99/11)). The liver signal-to-noise ratio (SNR) was significantly decreased after CSIC administration in all sequences, while the tumour-to-liver contrast-to-noise ratio (CNR) was significantly increased. Although the decreased ratio of the liver SNR was smaller on the three FSE sequences compared with CSE, the increased ratio of the tumour-to-liver CNR was higher on the FSE sequences. The highest increase of the tumour-to-liver CNR was on the FSE 7 sequence. The number of detectable tumours, both before and after the administration of CSIC, was largest on FSE 7. In conclusion, FSE with longer TR and TE, and decreased echo factor, was especially useful for CSIC enhanced liver MRI.

Adult↗
PubMed1997

Preoperative multidisciplinary treatment with hyperthermia for soft tissue sarcoma.

We report the results of phase I/II studies of preoperative multidisciplinary treatment of 14 patients with soft tissue sarcoma using hyperthermia from November 1990 to April 1995. The preoperative treatment was conducted with thermo-radio-chemotherapy in 11 cases of stage III, and with thermo-radiotherapy as well as thermo-chemotherapy in three cases of stages I and II. Hyperthermia was carried out twice a week with totals ranging from 4 to 14 times (average: 8.4 times); each session lasted 60 min. Radiotherapy was administered four or five times per week, and the dose was 1.8 2Gy/fraction, with a total of 30-40 Gy in a four week period. Chemotherapy was mainly in the form of MAID regimen (2-mercaptoethanesulphonic acid (mesna), adriamycin, ifosfamide and dacarbazine). The tumors were surgically resected in all patients after completing the preoperative treatment. The efficacy rate, as expressed by the percentage of either tumors in which reduction rate was 50% or more, or tumors for which post-treatment contrast enhanced CT image revealed low density volumes occupying 50% or more of the total mass, was 71% (ten of the 14 tumors). The mean tumor necrosis rate in the resected specimens was 78%. The tumor necrosis rate was significantly high (P < 0.05) in patients whose Time > or = 42 degrees C was of long duration. Postoperative complications were observed in six patients; among these, two patients developed wound infection that required surgical treatment as a complication of surgery performed in the early stage following the preoperative treatment. After a mean postoperative follow-up of 27 months, distant metastasis occurred in four patients resulting in three fatalities. The three-year cumulative survival rate was 64.3%. No local recurrence was observed in any patient during the follow-up, thus confirming our hypothesis that preoperative multidisciplinary treatment has an excellent local efficacy. We think that it would be valuable to conduct, at many facilities, phase III studies on the treatment of soft tissue sarcoma by a combination of surgery and preoperative multidisciplinary treatment using hyperthermia, paying close attention to the interval between these two modalities.

Adult↗