Bilateral hydronephrosis due to intramural ureteral involvement with systemic sclerosis.
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Adult↗
Biomedical subjects
T Nishimura
Publications and source records attributed to T Nishimura.
[Tumor seeding to the neck through percutaneous applicators of interstitial high-dose-rate brachytherapy for cancer of the tongue: a case report].
We report the case of a 46-year-old woman with cancer of the tongue. She underwent interstitial high-dose-rate brachytherapy of 50 Gy in 10 fractions for 5 days following telecobalt therapy of 20 Gy in 10 fractions for 2 weeks. Seven applicators were percutaneously implanted into the tongue. Radical neck dissection was carried out because a tumor rapidly developed on the neck 2.5 months after the treatment. Pathological examination revealed tumor seeding to the soft tissue of the neck where applicators were placed. To the best of our knowledge, there have been no reports presenting tumor seeding through percutaneous applicators of interstitial brachytherapy for head and neck tumor.
Brachytherapy↗
Classification system of complications in neuroleptic malignant syndrome.
Our group treated 13 cases of neuroleptic malignant syndrome (NMS) over a period of 8 years. Based on the clinical severity of complications, the cases were classified into three types: mild, with no complications; moderate, with only respiratory disturbance; and severe, with respiratory disturbance and renal failure. The major complications affecting the prognosis of NMS are respiratory disturbance and renal failure. Renal failure is also associated with the occurrence of disseminated intravascular coagulation and rhabdomyolysis. The proposed classification system for NMS patients is useful in selecting the appropriate therapeutic strategy for this disorder. The clinical data were analyzed to determine the factors in the process of deterioration in NMS.
Adolescent↗
Quantification of systolic count increase in technetium-99m-MIBI gated myocardial SPECT.
UNLABELLED: This study was performed to clarify the validity of quantification of myocardial wall thickening by the count increase method using electrocardiography (ECG)-gated SPECT. METHODS: We performed a phantom study to examine the quantification of this method and to clarify the relationship between the changes of relative counts and objective size (such as myocardial wall) under various conditions. In addition, in volunteers, the percent count increase (%CI) was analyzed in left ventricular segments based on circumferential profile curve analysis by ECG-gated SPECT with 99mTc-MIBI (methoxyisobutyl-isonitrile), and it was compared with the regional systolic wall thickness (%Th) assessed by echocardiography during low-dose dobutamine infusion. RESULTS: In our phantom study, the relative count changes were correlated linearly with the object size only within less than 20 mm. Recovery coefficient curves were influenced by acquisition parameters such as type of collimator, diameter of camera rotation, counts and photon scattering. In ECG-gated SPECT, the %CI value was increased gradually at each stage after dobutamine infusion, in relation to the increase of the %Th seen on echocardiography, although there are significant large deviations between these two parameters. CONCLUSIONS: In this study, quantitative analysis based on the %CI in ECG-gated SPECT may underestimate regional wall thickening. These data should be considered in the evaluation of the %CI as an index of myocardial function.
Adult↗
Intra-individual differences between technetium-99m-HMPAO and technetium-99m-ECD in the normal medial temporal lobe.
UNLABELLED: Regional distributions of 99mTc-hexamethyl propyleneamine oxime (99mTc-HMPAO) and 99mTc-ethyl cysteinate dimer (99mTc-ECD) were compared in the normal brain. METHODS: Six paid, healthy volunteers (mean age 26 yr) had high-resolution neuroperfusion SPECT using both 99mTc-HMPAO and 99mTc-ECD on separate days. RESULTS: Regional distribution of the two tracers differed. Technetium-99m-HMPAO accumulated more in the thalamus, frontal lobe, temporal lobe and cerebellum than 99mTc-ECD, which accumulated more in the occipital and parietal lobes. There was a considerable difference in the accumulation of the two tracers in the medial temporal lobe. The percent accumulations of 99mTc-HMPAO and 99mTc-ECD in the medial temporal lobe compared with the mean global cerebral cortical accumulation were 93.9% +/- 2.4% and 83.1% +/- 4.1% (mean +/- s.d.), respectively. CONCLUSION: The results suggest that 99mTc-HMPAO and 99mTc-ECD require specific and separate criteria for diagnosing temporal lobe pathologies, such as dementia and temporal lobe epilepsy.
Adult↗
[Recent clinical applications of MR medicine as functional medical imaging in the brain and heart].
This paper reviewed recent clinical applications of MR medicine as functional imaging in the brain and heart. Functional and metabolic imaging of brain and heart can be evaluated by the development of fast MR technique (fast SE, echo planar imaging, etc) and chemical shift imaging. The clinical applications of MR medicine to the brain are follows. 1. higher nerve activity assessment using functional MRI, 2. brain perfusion imaging by dynamic contrast MRI, 3. brain diffusion imaging and 4. brain metabolic function by 1H and 31P-MRS. Those of MR medicine to the heart are as follows. 1. left ventricular function assessment by snapshot and/or echo planar imaging. 2. regional wall motion assessment by magnetic tagging, 3. myocardial perfusion imaging by dynamic contrast MRI, 4. coronary flow reserve assessment and 5. cardiac metabolic function by 31P and 1H MRS. Most of these data are thought to be compatible with nuclear medicine technique such as PET and SPECT. In the future, MR medicine may be used as the tool of functional and metabolic diagnosis in addition to anatomical diagnosis in the field of cerebral and cardiac disorders.
Brain↗
[Brain functional MRI using 3D-SPGR pulse sequence].
We reported the effects of motor cortex stimulation of normal volunteers using conventional MR imaging techniques on standard 1.5 T clinical scanner. The imaging technique was an optimized conventional 2D and 3D spoiled GRASS. In the 3D-SPGR measurement, a slab of 96 mm with 32 partition was evaluated in sagital direction. The motor cortex stimulation was achieved by touching each finger to thumb in a sequential, self-paced, and repetitive manner. During stimulation, areas of increased signal intensity were identified in the sensorimotor cortex with both 2D and 3D SPGR method. The 3D-SPGR method in sagital direction is rather insensitive to inflow effects, thus signal increases with 3D-SPGR method is mainly due to the blood oxygenation level dependent effects.
Brain↗
[Prediction of postoperative pulmonary hemodynamics for the second lobectomy after the contralateral lobectomy].
We presented 7 cases who were performed the second lobectomy for the second lung cancer after the first successful lobectomy on the contralateral lung (3 cases for right upper lobectomy + left lower lobectomy and 4 cases for right upper lobectomy + left lower lobectomy). In 6 patients, the predicted postoperative FEV1 estimated by multiplying the preoperative FEV1 by the fraction of perfusion to the contralateral lung was less than 800 ml/m2BSA, which is our first cut-off for identifying lung resection candidates. Unilateral pulmonary arterial occlusion test (UPAO) revealed that total pulmonary vascular resistance (TPVRI) in 3 of those 6 patients was lower than 700 dyne.sec.cm-5/m2BSA, our second cut-off for lung resection. More precise postlobectomy pulmonary hemodynamics in another 3 of those 6 patients were then estimated by adapting selective pulmonary occlusion test (SPAO). Since TPVRI during SPAO was lower than the cut-off value, it was suggested that second lobectomy would be feasible with low incidence of post operative cardiopulmonary complication. There was no serious complications in all 7 cases during their postoperative course. We believe that more precise prediction of postoperative pulmonary hemodynamics by adapting UPAO and SPAO could be one of the tools to minimumize postoperative cardiopulmonary complications in those patients needed second lobectomy for the second lung cancer after the first successful lobectomy on the contralateral lung even though their impaired lung fung function.
Aged↗
[A case of sudden onset of toxic cholangitis].
A previously healthy 43-year-old male was admitted to the hospital because of the impared consciousness. Although a passage of the bile duct was good, the patient was in severe biliary sepsis and cardiac arrest occurred repeatedly. Plasma concentration of TNF increased markedly suggesting a pathogenic role of TNF in the course of the patient. Plasma exchange was effective for hemodynamic stabilization. Recent advances in treatment of acute cholangitis has been brought by early drainage of the obstruction in the bile duct using endoscopic or percutaneous drainage. However this case suggests that only drainage of the infection focus is not sufficient for the life saving in such a patient and other therapeutic approach such as an inactivation of TNF activity should be considered.
Acute Disease↗
Continuous ambulatory radionuclide monitoring of left ventricular function: effect of body position during ergometer exercise.
UNLABELLED: We assessed the reliability of a continuous ambulatory radionuclide monitoring system (the VEST system, Capintec, Inc., Ramsey, NJ) for measurement of left ventricular performance during exercise in the upright and supine positions. METHODS: Sixteen healthy male volunteers (aged 32-46 yr; mean age 37 +/- 4 yr) were studied. All volunteers underwent ergometer exercise testing in both the upright and supine positions, and left ventricular performance was determined with the VEST system. RESULTS: The resting heart rate, systolic blood pressure, pressure rate product, relative end-diastolic volume, relative end-systolic volume and left ventricular ejection fraction (LVEF) all showed no differences between the upright and supine positions. At peak exercise, the heart rate, systolic blood pressure and pressure rate product showed no differences between the upright and supine positions. In the upright position at peak exercise the relative end-diastolic volume was increased (83% +/- 9% to 91% +/- 11%, p < 0.001); the relative end-systolic volume remained unchanged (34% +/- 3% to 33% +/- 15%), and LVEF was significantly increased from 58% +/- 6% to 66% +/- 11% (p < 0.01). In the supine position at peak exercise, the relative end-diastolic volume remained unchanged (85% +/- 5 to 83% +/- 7%), the relative end-systolic volume was increased (35% +/- 5% to 43% +/- 13%, p < 0.01), and LVEF was decreased from 58% +/- 5% to 48% +/- 17% (p < 0.01). These results indicated inferior data collection by the VEST system in the supine position. CONCLUSION: Since the detector of the VEST system may be too small, the data collection is impaired during exercise in the supine position by shifting the heart with deep respiration. The VEST system is very useful for determining left ventricular performance when applied in the sitting or upright position. However, in the supine position during exercise, the use of the VEST system should be avoided because it might indicate an artifactual deterioration of left ventricular performance.
Adult↗
Hemodynamic aspect of cerebral watershed infarction: assessment of perfusion reserve using iodine-123-iodoamphetamine SPECT.
UNLABELLED: The mechanism whereby watershed (WS) infarcts develop remains controversial, although a hemodynamic cause is usually assumed. The aim of this study was to investigate the relationship between the site of WS infarcts and the hemodynamic status of the cerebral circulation. METHODS: From among 96 consecutive patients with angiographically confirmed unilateral major cerebral artery obstruction (occlusion or > 70% stenosis), we investigated 29 patients with supratentorial WS infarcts on magnetic resonance imaging. The regional cerebral blood flow and perfusion reserve were quantified using the split-dose [123I]iodoamphetamine SPECT method, coupled with intravenous injection of 1 g of acetazolamide. Seven patients had a cortical WS infarct between the superficial branches of the anterior and middle cerebral arteries (MCAs) or between the middle and posterior cerebral arteries (Group C), and 22 had a deep WS infarct between the superficial branches and deep penetrating arteries of the MCA (Group D). Moreover, the patients in Group D were classified into two subgroups, i.e., Type A (n = 12), with lesions lying in the centrum semiovale above the level of the lateral ventricles, and Type B (n = 10), with lesions lying in the corona radiata adjacent to the lateral ventricles. RESULTS: Comparison of the Type of WS infarct with the clinical course of onset showed that sudden onset was more frequent in Group C than in Group D (p < 0.05). The perfusion reserve in the affected MCA territory in Group D (20.1% +/- 15.6%) was significantly lower than that in Group C (43.8% +/- 10.8%; p < 0.01) and that in 20 hemispheres (10 control subjects) without a major arterial lesion (54.7% +/- 16.4%; p < 0.01). Among the Group D patients, the patients with Type A infarcts showed a significantly lower perfusion reserve compared with those with Type B infarcts (p < 0.05). CONCLUSION: Patients with deep WS infarcts, especially Type A infarcts, showed severe hemodynamic impairment, whereas patients with cortical WS infarcts showed preserved perfusion reserve which appeared to be secondary to the embolism. The mechanism of development of WS infarcts is multifactorial, and distinguishing among these WS infarcts and from other types of infarct is important, because different pathogenic mechanisms require different therapeutic strategies.
Acetazolamide↗
[A case of successful treatment with ganciclovir for cytomegalovirus pneumonia after pulmonary lobectomy].
The premortem diagnosis of cytomegalovirus (CMV) pneumonia is usually difficult, and mortality of it is high. A case of successful treatment with ganciclovir for cytomegalovirus pneumonia after pulmonary lobectomy is reported. The patient was a 76-year-old man. Under diagnosis as lung cancer, the right lower lobectomy was performed. After operation, pneumonia occurred on the nonoperated side and in a few days reticular shadows rapidly spread to the whole lung. Although pulse steroid therapy was performed, the interstitial pneumonitis improved only a little. Then intranuclear inclusion body-bearing giant cells were found in sputum obtained by bronchoscopy. So we diagnosed the interstitial pneumonitis as CMV pneumonia and ganciclovir was administrated. CMV pneumonia had improved for two weeks and the patient has no recurrence. When interstitial pneumonitis develop in patients after operation or steroid therapy, the differential diagnosis should include the possibility of CMV pneumonia.
Aged↗
[Typical normal cases and normal cases with abnormal image pattern in every myocardial SPECT radiopharmaceutical].
Working group of cardiac nuclear medicine was made as a Japanese part of society of international cardiac nuclear medicine under the cooperation between Japanese society of nuclear medicine and Japanese society of cardiology. We investigated typical normal cases and normal cases with abnormal image pattern in every myocardial SPECT radiopharmaceutical as one of the research activity of working group. From 11 faculties, 16 T1 cases, 14 BMIPP cases, 8 MIBG cases, 8 MIBI cases and 14 tetrofosmin cases were submitted as typical normal cases, and 12 T1 cases, 5 BMIPP cases, 12 MIBG cases, 10 MIBI cases and 5 tetrofosmin cases were submitted as normal cases with abnormal image pattern. We summarized the condition of SPECT data acquisition of each faculties. And we added the discussion from literature about how to discriminate normal cases with abnormal image pattern from abnormal cases. In MIBG, patterns of typical normal cases and normal cases with abnormal image pattern were slightly different from other 4 pharmaceuticals. In other 4 pharmaceuticals, diaphragmatic attenuation, breast attenuation, apical thinning and others were presented as normal cases with abnormal image pattern.
3-Iodobenzylguanidine↗
[Results of vitreous surgery for proliferative vitreoretinopathy].
During the past four years, we performed vitreous surgery on 73 eyes with rhegmatogenous retinal detachments complicated with severe proliferative vitreoretinopathy (PVR). We analyzed the surgical outcome of PVR according to the revised classification of PVR Grade C (1991). After a mean follow-up period of 19 months, the retinas were successfully reattached in 62 of 73 eyes (85%). The reattachment rate in the eyes with only posterior proliferation was high (96%), regardless of the extent of posterior proliferation. However, the reattachment rate in the eyes associated with anterior proliferation was markedly low (57%), depending on the extent of anterior proliferation. Among 62 eyes with successfully reattached retinas, 39 eyes (63%) had an improved postoperative visual acuity. These results demonstrated that the eyes with anterior PVR have a worse reattachment rate than the eyes with only posterior PVR. Using the revised classification of PVR, we were able to analyze the surgical outcome of PVR which could not be classified by the old classification.
Adolescent↗
[Noninvasive measurement of a input function using beta camera for 15O-water injection method].
Dynamic images of positron distribution in artery were measured for noninvasive measurement of input function using beta camera. The beta camera was attached from the skin surface on the artery of arm during the PET measurement using the 15O-water injection method. Beta camera used had a field of view of 20 mm in diameter. After injection of 15O-water, time sequence images of the artery of 10 sec interval 15 frames were obtained. Regions of interest (ROIs) were set on the artery and on the adjacent area of the artery. By subtracting average counts in the latter ROI from in the former ROI, time activity curve similar to input function was noninvasively obtained.
Arteries↗
[The results of questionnaire on quantitative assessment of 123I-metaiodobenzylguanidine myocardial scintigraphy in heart failure].
This study was done by working group under the cooperation between Japanese Society of Nuclear Medicine and Japanese Circulation Society. We evaluated the usefulness of quantitative assessment of 123I-metaiodobenzylguanidine (MIBG) myocardial scintigraphy in heart failure by the results of questionnaire. Forty-nine (72.1%) of 68 selected institutions participated in this study. The incidence of MIBG myocardial scintigraphy used in heart failure was 41.1%. The imaging protocol was mostly done by both planar and SPECT at 15 min and 3.6 hr after intravenous injection of 111 MBq of MIBG. The quantitative assessment was mostly done by heart/mediastinum (H/M) ratio and washout rate analysis based on planar imaging. The mean normal value of H/M ratio were 2.34 +/- 0.36, and 2.49 +/- 0.40, at early and delayed images, respectively. The normal value of washout rate was 27.74 +/- 5.34%. On the other hand, those of H/M ratio in heart failure were 1.87 +/- 0.27, and 1.75 +/- 0.24, at early and delayed images, respectively. That of washout rate was 42.30 +/- 6.75%. These parameters were very useful for the evaluation of heart failure. In conclusion, MIBG myocardial scintigraphy was widely used for not only early detection and severity assessment, but also indication for therapy and prognosis evaluation in heart failure patients.
3-Iodobenzylguanidine↗
Effects of adenosine on cholinergic transmission in mammalian vesical parasympathetic ganglia.
Intracellular recordings were made from mammalian vesical parasympathetic ganglia. A fast excitatory postsynaptic potential (EPSP) was abolished by hexamethonium (200 microM) in rabbit and feline ganglia. A slow inhibitory postsynaptic potential (IPSP) and a following slow EPSP were abolished by atropine (1 microM) in the feline ganglia. Bath application of adenosine (300 microM) depressed the amplitude of nicotinic fast EPSP by 48 +/- 4% in the rabbit ganglia. The action of adenosine was dose-dependent. An antagonist of A1-purinoceptors, 8-cyclopentyltheophylline (1-10 microM), inhibited the adenosine-induced depression but not the amplitude of fast EPSP. Adenosine (2-3 mM) did not significantly affect either the muscarinic slow IPSP, or the slow EPSP, in the feline ganglia. Adenosine also caused a hyperpolarization (1-5 mV) in 40% of the rabbit neurons and 66% of the feline neurons. However a purinergic IPSP was not recorded from either species. These data suggest diverse actions of adenosine in modulating cholinergic transmission in rabbit and feline vesical ganglia.
Adenosine↗
Convulsions in hemodialysis (HD) patients with elevated polymorphonuclear leukocyte elastase (PMNE) levels.
Eight hemodialysis (HD) patients with convulsions of unknown cause were monitored for serum levels of uremic toxins such as methylguanidine(MG), and polymorphonuclear leukocyte elastase (PMNE). Twenty HD patients without convulsions served as controls. In the convulsion group, MG and PMNE were high. In 2 patients, convulsions subsided after daily hemodiafiltration (HDF). Although PMNE was thought to be a mediator of injury in the present series, no significant correlation was found between PMNE and either neutrophil numbers or endotoxin levels. PMNE may indicate the over production of cytokines not associated with serious infection or septicemia. In patients with renal failure and complications of unknown cause, intensified dialysis therapy such as frequent HDF may be useful when combined with treatment of the underlying disease producing the toxins. PMNE measurement is useful in assessing the uremia caused by high cytokine levels and, together with methylguanidin (MG) serum levels, can indicate the severity of the convulsion.
Aged↗