Biomedical subjects
Publications and source records attributed to T Okuhara.
Heteropoly acids such as H3PW12O40 are exceptionally active catalysts in the synthesis of diphenylmethane from benzene and formalin (aqueous formaldehyde) in a biphasic system and can be recycled simply by drying the aqueous phase at room temperature.
We encountered 6 patients with bronchial asthma complicated by mediastinal emphysema. Their average age was 21 years. All were atopic and had histories of asthma in childhood. In 5 of the 6, mediastinal emphysema developed when the patients had upper respiratory infections. In 3, the mediastinal emphysema worsened. After insertion of subcutaneous drains to decrease intramediastinal pressure, the conditions of those 3 patients improved remarkably. The conditions of the other 3 improved after medication only. During the period of this study, 1.24% of all patients treated at Hiroshima Asa Citizen's Hospital for exacerbations of asthma had mediastinal emphysema.
A 50-year-old male with acute myelocytic leukemia (AML) achieved complete remission after combination chemotherapy. However, the AML recurred after six months. He did not respond to various treatments and his condition deteriorated after chemotherapy. After we attempted continuous administration of cytosine arabinoside (Ara-C), the number of leukemic cells was controlled for nine months. During this period, he could stay and receive treatment with Ara-C at home. In this case, the continuous administration of Ara-C at home was truly effective not only to control the number of leukemic cells but also to improve the quality of life.
Patients with pulmonary embolism may have no definitive predisposing factors for thrombi. The clinical entity of chronic pulmonary embolism is also uncertain. This study clarified the clinical characteristics of pulmonary embolism without definitive predisposing factors. During the last 10 years, 36 consecutive patients were diagnosed as having pulmonary embolism (mean age 61 years, female 75%). Twenty-four patients (67%) had definitive predisposing factors ("definitive" group). Patients without definitive predisposing factors had the following characteristics. The onset of symptoms was out-hospital and insidious. The main symptom was exertional dyspnea without acute episode compatible with an embolism. In four patients (33%) there was a delay of over 2 years form the onset of symptoms to the diagnosis. Three patients had been treated for depression. Thrombolytic therapy caused an inadequate fall in mean pulmonary artery pressure from 41 +/- 11 to 24 +/- 8 mmHg and in three patients it remained over 30 mmHg. Deep vein thrombosis were found in four of nine patients in whom venography were performed 10 days after thrombolytic therapy, but only one patient showed thrombus in the "definitive" group. During the convalescent stage, all patients were treated with prophylactic warfarin. Home oxygen therapy was indicated in three patients and an inferior vena caval filter was implanted in two patients. One third of patients with pulmonary embolism in our institute had no definitive predisposing factors. In these patients, even with thrombolytic therapy, recovery of pulmonary hypertension was often insufficient and deep vein thrombosis persisted. Clinicians should be aware of this disease to avoid undue delay in its diagnosis.
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Acute myocardial infarction (AMI) related to the right coronary artery (RCA) is associated with a lower reperfusion rate and higher reocclusion rate in the acute phase than AMI related to the left coronary artery. The greater susceptibility of the RCA to development of large thrombi makes successful reperfusion more difficult to achieve. This study investigated predictive factors for massive thrombus in the RCA before the selection of the treatment to achieve better rates of reperfusion. We classified 51 patients with AMI related to RCA into the massive (linear intraluminal radiolucency > 3 cm) thrombus group (9 patients) and the non-massive thrombus group (42 patients). 1) HISTORY: Patients in the massive thrombus group had a greater incidence of hypertension than the non-massive thrombus group, with more left ventricular hypertrophy (p < 0.05). There were no significant differences in other coronary risk factors. 2) RCA morphology: The maximum RCA diameter was significantly greater in the massive thrombus group than that in the non-massive thrombus group [proximal to the right ventricular branch, 4.2 vs 3.2 mm (median); distal to the right ventricular branch, 4.2 vs 3.4 mm, p < 0.05]. 3) Conditions of onset: The elapsed time was significantly longer in the massive thrombus group (15 hours) than that in the non-massive thrombus group (2.5 hours, p < 0.05). More massive thrombus cases were observed in summer (p < 0.05), but there was no evident correlation between massive thrombus formation and the onset time of day, weather, Hct and coagulation factor at the onset, left ventricular ejection fraction or left ventricular end-diastolic pressure.(ABSTRACT TRUNCATED AT 250 WORDS)
A case of Bence Jones kappa multiple myeloma with meningeal involvement in a 64-year-old woman is presented. Three years after the diagnosis of multiple myeloma, gait disturbances developed followed by visual disorders and impaired consciousness. A lumbar puncture revealed numerous atypical plasma cells in the cerebrospinal fluid. Craniospinal irradiation and intrathecal injections of methotrexate, cytarabine, and prednisolone were effective for a short period. At autopsy, the leptomeninges were infiltrated diffusely with atypical plasma cells. A review of the literature showed that multiple myeloma with meningeal involvement is accompanied frequently by circulating atypical plasma cells or plasma cell leukemia. Meningeal involvement is a rare complication and shows poor prognosis in cases of multiple myeloma.
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Percutaneous treatment of biliary disease was administered in 173 cases, mainly among high-risk or elderly patients. Diagnosis was acute cholecystitis in 32 cases, acute cholangitis in 16, hepatic abscess in five, gallbladder stones in 28, common bile duct stones in 11, intrahepatic stones in five, malignant obstructive jaundice in 61, and benign biliary stenosis in 15. The treatment was successful in 158 of 173 cases (91.3%). Complications were encountered in 17 (9.8%). Most of these occurred during the initial period and were mild and controllable with conservative treatments. There were two deaths (1.2% of patients); one was not related to the procedure. These data suggest that percutaneous treatments are safe and effective even among elderly or high-risk patients with biliary diseases.
For the purpose of studying the histological findings and prognosis of stomach cancer in atomic bomb survivors, a histological diagnosis of 600 cases of stomach cancer observed between 1964 and 1986 in three medical institutions in Hiroshima City was made by a single pathologist and, furthermore, analysis of 231 cases thereof was performed using the DS86 dose estimated by the Radiation Effects Research Foundation. 1) By histological type of stomach cancer, the frequency of poorly differentiated adenocarcinoma (poorly differentiated adenocarcinoma and signet ring cell carcinoma) was significantly higher in the 1 rad or more group (average stomach organ dose of 30.6 rad) than in the 0 rad group. 2) As for stromal type, the frequency of scirrhous type was significantly higher in the 1 rad or more group, but no difference in infiltrative behavior could be demonstrated. 3) Early cancer tended to be observed at a low rate in the 1 rad or more group. 4) As for average survival time, of the early cancers only well differentiated adenocarcinoma showed a significantly lower survival time in the 1 rad or more group when compared to the 0 rad group.
A 49-year-old man with a one-week history of general fatigue and several other symptoms, including hematuria, numbness of the mouth, anemia and thrombocytopenia, was admitted because of an episode of convulsions and unconsciousness after blood transfusion. A diagnosis of thrombotic thrombocytopenic purpura (TTP) was then made, and treatment with steroids, anti-platelet agents, transfusion of fresh frozen plasma was started. However, since no improvement was seen, on the third day of admission, treatment with plasma exchange was instituted (total plasma exchange volume was 18.1 iota), and his clinical and hematological conditions improved markedly. Since then, he has been in a remission state for about three years. Laboratory examinations during the acute phase showed increase of vWf: Ag, decrease of RCof/vWf: Ag, increase of vWf large multimers and a high endothelial cell injury activity by the patient's serum. In the next day following the plasma exchange therapy, RCof/vWf: Ag improved, but not to the normal range. One and a half years later, while in the remission phase, the vWf multimers and endothelial cell injury activity normalized. Thus, these findings show further evidence on the involvement of endothelial cell injury and vWf in the pathogenesis of TTP.
We have devised nonsurgical cholecystolithotomy for the extremely ill or elderly patients. Nonsurgical treatment of cholecystocholedocholithotomy is possible by combining our nonsurgical cholecystolithotomy with endoscopic sphincterotomy. The procedure is very useful for extremely ill or elderly patents because it is safe and noninvasive. This report describes the nonsurgical treatment of cholecystocholedocholithiasis.
A new method of nonsurgical removal of gallbladder stones is presented herein. The method consists of two parts: a, ultrasonically guided percutaneous transhepatic gallbladder drainage, and b, extraction of gallbladder stones using a choledochofiberscopic maneuver. The procedure is safe, less stressful than a surgical procedure and easy to perform. The method is useful for extremely ill or elderly patients and those who prefer not to undergo surgical treatment.
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A case of spontaneous rupture of the flexor tendons of a little finger due to projection of the hook of the hamate is reported. The projection seemed to be caused from Colles fracture ten years ago. A satisfactory result was obtained by free tendon grafting.
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In collagenase isolated rat pancreatic islets, CCK-PZ, SHG, secretin and glucagon stimulated the accumulation of cAMP, in physiological ranges. The resulting increment of cAMP showed a good correlation with insulin release stimulated by either glucagon or secretin, but not by SHG or CCK-PZ. In the same system, 14CO2 production from glucose-U-14C was significantly increased by either SHG or CCK-PZ. The results presented in this report are compatible with the hypothesis that insulin release by gastrointestinal hormones may be mediated by cAMP in the B-cell in the case of either glucagon or secretin; whereas, in the case of either SHG or CCK-PZ, it may presumably be mediated by an unknown mechanism in glucose metabolism, other than c-AMP.