Biomedical subjects

Toshio Hashimoto

Publications and source records attributed to Toshio Hashimoto.

At least 19 recordsLinked to original sources

PubMed2006

Hemostatic action of OC-108, a novel agent for hemorrhoids, is associated with regional blood flow arrest induced by acute inflammation.

Clinically, hemorrhoidal bleeding and prolapse disappeared immediately after injection of the sclerosing agent OC-108 into submucosa of hemorrhoids. The aim of this study was to elucidate the mechanism of action responsible for the immediate hemostatic effect of OC-108 using anesthetized rats. Subcutaneous injection of OC-108 in rats decreased blood flow at the injection site within 5 min. Aluminum potassium sulfate, one of the main ingredients of OC-108, reduced the skin blood flow. However, tannic acid, another main ingredient, did not. By perfusion of OC-108 on the mesenteric surface, microcirculatory blood flow was arrested without remarkable change in blood vessel diameter, accompanied by increased vascular permeability and venous hematocrit. These results indicate that OC-108 induces regional blood flow arrest with rapid onset, this effect being attributed to the action of aluminum potassium sulfate, and that hemoconcentration due to increased vascular permeability (plasma extravasation), an acute inflammatory reaction, is involved in the mechanisms of the immediate hemostatic action of OC-108.

Acute Disease↗

PubMed2006

Percutaneous CT-guided radiofrequency ablation of pulmonary malignant tumors: preliminary report.

OBJECTIVE: Radiofrequency ablation (RFA) is frequently used for hepatic malignant tumors, but few reports discuss its use for lung tumors. We report our pilot clinical study with RFA for the treatment of pulmonary malignant tumors. PATIENTS AND METHODS: Five patients with histologically-proven malignant primary and three metastatic lung tumors underwent a total of 11 RFA procedures. RFA was performed in two patients as palliative therapy to shrink the tumors and in six as radical therapy. All RFA was performed by the percutaneous CT-guided approach. RESULTS: Three tumors were completely ablated by one procedure. Contrast CT revealed cyst cavity formation or scar formation at these three tumors. Gd contrast-enhanced MRI revealed cystic lesions with ringlike enhancement or scar formation. Partial ablation after the first procedure was noted in six tumors including the two palliative cases. RF ablation was well tolerated in all patients. Intraprocedural complications included six cases of pneumothorax (one patient required chest tube placement), six cases of pleural effusion (two patients required chest tube placement), one case of pneumonia (improved immediately with antibiotics), three cases of bloody sputum (mild), and six cases of chest pain (all cases after the procedure). CONCLUSIONS: This pilot clinical study demonstrates that CT-guided RFA is a relatively safe and effective treatment option for malignant lung tumors. Additional trials are needed to determine the safety, efficacy, and optimal indications of RFA.

Aged↗

PubMed2005

[Postoperative intensive care of a patient with Cushing's syndrome accompanied with retroperitoneal abscess and massive subcutaneous emphysema].

A 60-year-old woman with Cushing's syndrome due to right adreno-cortical adenoma was referred to us because retroperitoneal abscess was found during surgical removal of the right adrenal gland. The diagnosis of Cushing's syndrome was made on the basis of elevated serum levels of cortisol. The abscess was accompanied with massive subcutaneous emphysema and pneumomediastinum. After operation the patient was admitted to ICU in the Medical Center for Emergency and Critical Care. PMX-DHP, continuous hemodiafiltration, and drainage were performed, and antibiotics were given. Nine days after the admission the patient recovered generally, and was transfferd to the Department of Urology. It was demonstrated that an opportunistic infection must be always considered in the condition like the present case.

Abscess↗

PubMed2004

Metabolic syndrome and new category 'pre-hypertension' in a Japanese population.

OBJECTIVE: To examine whether insulin resistance and metabolic syndrome are associated with pre-hypertension, a new stage developed by the Joint National Committee on Prevention, Detection, Education and Treatment of High Blood Pressure (JNC-7). PATIENTS AND METHODS: Subjects included 506 Japanese taking no anti-hypertensive medication. Subjects were divided into three groups according to blood pressure status using the JNC-7 criteria. Normotension (NTN) was defined as a Systolic Blood Pressure (SBP) < 120 mmHg and a Diastolic Blood Pressure (DBP) < 80 mmHg, pre-hypertension (PHT) as a SBP 120-139 mmHg or a DBP 80-89 mmHg and hypertension (HTN) as a SBP > or = 140 mmHg or a DBP > or = 90 mmHg. The metabolic syndrome was defined according to the National Cholesterol Education Program Adult Treatment Panel III as modified for waist circumference criteria by the Regional Office for the Western Pacific Region of WHO. Insulin sensitivity was assessed by plasma glucose and insulin concentrations obtained at fasting or during a 75 g oral glucose tolerance test. RESULTS: There were no differences with respect to age, gender or glucose intolerance status among the three groups. The mean values of body mass index were similar between NTN and PHT, but were significantly higher in HTN than in other groups. The prevalence of the metabolic syndrome was 9.9% in NTN, 19.2% in PHT and 35.5% in HTN, respectively. The prevalence increased linearly with worsening of blood pressure status (p < 0.0001). An increase in the number of metabolic syndrome components (MS score) was also associated with a progress in blood pressure status. Even in the non-obese persons, the prevalence of the metabolic syndrome and the MS score increased linearly with worsening in blood pressure status. The homeostasis model assessment of insulin resistance (HOMA-R) was significantly higher in PHT and HTN than in NTN and increased significantly with worsening in blood pressure status. Furthermore, the quantitative insulin sensitivity check index (QUICKI) and the insulin sensitivity index proposed by Stumvoll et al. decreased significantly with worsening in blood pressure status. CONCLUSIONS: The metabolic syndrome is prevalent even in the pre-hypertensive stage in a Japanese population and insulin resistance contributes to the underlying mechanisms of these abnormalities.

Blood Pressure↗

PubMed2004

Primary seminoma in the middle mediastinum.

Primary mediastinal seminoma is a relatively rare tumor usually located in the anterior mediastinum. We report here an extremely rare case of a 66-year-old man with primary seminoma in the middle mediastinum. A physical examination showed lymphadenopathy in the right supraclavicular area. A chest CT confirmed the presence of a tumor occupying the retrotracheal space. A histological examination demonstrated metastatic seminoma from the open biopsy of the lymph node. Abdominal, pelvis, and cerebral CT scan and testicular ultrasound were negative. Thus, primary mediastinal seminoma in the middle mediastinum with supraclavicular lymph node metastasis was diagnosed.

Aged↗

PubMed2004

Subacute cor pulmonale due to tumor embolism.

We describe a patient wih subacute cor pulmonale caused by tumor emboli in the lungs. A 64-year-old female suffering from a subacute progressive cough and shortness of breathing died of severe pulmonary hypertension seven days after admission. Neither chest CT scans nor lung perfusion scintigraphy showed any abnormal findings. Microscopic examination after an autopsy revealed diffuse intravascular tumor emboli occluding not only the small pulmonary arteries and arterioles, but also the lymphatic vessels, which were suggested to be metastases of a breast carcinoma resected five years previously. Thus, pulmonary tumor embolism should be considered in the differential diagnosis of primary pulmonary hypertension, particularly in patients with a past history of cancers.

Autopsy↗

PubMed2004

[Lymphangioleiomyomatosis (LAM) causing chylothorax].

A 28-year-old woman was admitted to our hospital complaining of chest pain and dyspnea. Chest radiographs showed left pleural effusion. The effused fluid obtained by thoracocentesis was milky, and so chylothorax was diagnosed. A high-resolution chest CT (HRCT) scan demonstrated diffuse multiple cystic lesions, which were undetectable by conventional CT. An abdominal CT scan showed a retroperitoneal tumor. Since the effusion was resistant to conservative therapy, we performed clipping of the thoracic duct under the diaphragm. Since the effusion disappeared after continuous aspiration, 10 KE of OK-432 was administered into the pleural cavity, and the chylorrhea disappeared. The clinical diagnosis, based on the biopsy of the abdominal tumor, was lymphangioleiomyomatosis. Chylothorax developing from lymphangioleiomyomatosis is rare in Japan. However, we must consider the possibility of lymphangioleiomyomatosis in patients with chylothorax, and always perform chest HRCT.

Adult↗

PubMed2003

[Specific notch in early expiration region of a flow-volume curve in a case of Mounier-Kuhn syndrome].

A 75-year-old man presented at our hospital for evaluation of a chronic cough and sputa. Radiographic examination showed enlargement of the trachea and main bronchi. On chest radiography, the transverse diameter of the trachea was 39 mm at the level of the third thoracic spine. On bronchoscopy, the trachea and main bronchi were dilated on inspiration and were completely collapsed on expiration. A 3-D CT examination showed the trachea and main bronchi dilated, and the cartilage of the trachea and bronchi distorted. In pulmonary function testing, this disorder is characterized by the appearance of a specific notch in the early phase of expiration on the flow-volume curve.

Aged↗

PubMed2003

[Hematocrit as an indicator for coronary intervention in patients with acute myocardial infarction].

OBJECTIVES: Primary coronary intervention in patients with acute myocardial infarction complicated by persistent massive intracoronary thrombus is frequently difficult. Higher incidence of thrombus formation is associated with high hematocrit score. This study investigated the relationship between high hematocrit score and primary coronary intervention in patients with acute myocardial infarction. METHODS: Forty-five patients with acute myocardial infarction were divided into two groups according to hematocrit score on admission, the high hematocrit group (hematocrit > or = 48%, n = 8) and the low hematocrit group (hematocrit < 48%, n = 37). Time period required for coronary intervention (intervention time), number of balloon inflations, presence of persistent massive intracoronary thrombus, need for adjunctive intracoronary thrombolysis, need for intraaortic balloon pumping and achieved rate of Thrombolysis in Myocardial Infarction (TIMI) 3 were compared between the two groups. The relationships between hematocrit and intervention time or number of balloon inflations were also investigated. RESULTS: Intervention time (2.7 +/- 1.4 vs 1.4 +/- 0.7 hr, p = 0.0003), number of balloon inflations (12 +/- 9 vs 3 +/- 2 times, p = 0.0001), presence of persistent massive intracoronary thrombus (100% vs 5%, p < 0.0001), intracoronary thrombolysis (63% vs 3%, p = 0.0003), and intraaortic balloon pumping (63% vs 14%, p = 0.0092) were significantly higher in the high hematocrit group. However, the rate of TIMI 3 (25% vs 95%, p < 0.0001) was significantly lower in the high hematocrit group. The relationships between hematocrit and intervention time (r2 = 0.16, p = 0.0033), and hematocrit and number of balloon inflations (r2 = 0.19, p = 0.0015) showed positive correlations. CONCLUSIONS: Primary coronary intervention for patients with acute myocardial infarction showing high hematocrit score on admission is likely to be difficult due to the presence of persistent massive intracoronary thrombus. Therefore, coronary interventional strategy for intracoronary thrombolysis in patients with acute myocardial infarction should include measurement of hematocrit score.

Aged↗

PubMed2002

Primary systemic amyloidosis presenting as angina pectoris due to intramyocardial coronary artery involvement: a case report.

We describe a 76-year-old Japanese woman with primary systemic amyloidosis who presented with angina pectoris associated with ST-segment and T-wave abnormalities resulting from intramyocardial coronary artery amyloidosis. The patient was admitted to our hospital because of dyspnea and pretibial edema 7 years after the diagnosis of variant angina. A diagnosis of primary systemic amyloidosis (AL amyloid protein) was made after examination of gastric and endomyocardial biopsy specimens. The patient died of progressive, uncontrolled heart failure 3 months later. An autopsy study demonstrated only mild-to-moderate atherosclerosis in the epicardial coronary arteries. However, histological examination of the heart revealed diffuse stenoses and obstructions in the intramural coronary arteries by amyloid deposits. This patient had small-vessel coronary disease with ST-segment changes and angina caused by cardiac amyloidosis. A correct diagnosis of ischemic heart disease due to primary amyloidosis is important for estimation of the prognosis and for appropriate management.

Aged↗

PubMed2002

Transcardiac gradient of soluble adhesion molecules predicts progression of coronary artery disease.

BACKGROUND: During the development of atherosclerotic lesion, several types of cellular adhesion molecules (CAMs) are overexpressed on the surface of vascular endothelium. Some parts of these membrane proteins are proteolysed and are detected in blood as soluble forms. AIMS: The purpose of this study is to investigate the relationship between the transcardiac gradient of soluble cellular adhesion molecules (sCAMs) and the clinical characteristics of coronary artery disease (CAD). METHODS: We studied 46 patients with clinically stable CAD. Serum sCAM levels in both aortic sinus and coronary sinus were measured using enzyme-linked immunosorbent assay, and the transcardiac gradient of sCAMs was calculated. We also evaluated the angiographic severity of CAD, response of coronary artery to acetylcholine (Ach), as well as progression of coronary atherosclerosis over a 6-month period. RESULTS: The transcardiac gradient of sCAMs did not correlate to the angiographic severity of coronary atherosclerosis. The transcardiac gradient of sVCAM-1 was significantly higher in patients with vasoconstrictive response to Ach than patients without vasoconstrictive response to Ach (191.5+/-98.2 vs. -9.2+/-14.1 ng/ml, P<0.05). Furthermore, patients who exhibited progression of coronary atherosclerosis had a higher transcardiac gradient of sVCAM-1 at the initial study than patients without progression (47.8+/-24.5 vs. -6.4+/-12.3 ng/ml, P<0.05). CONCLUSIONS: An elevated transcardiac gradient of sVCAM-1 may represent the persistent activation of coronary artery that is accompanied by endothelial dysfunction, and may be a predictive index of progression of coronary atherosclerosis. Measurement of coronary circulating sVCAM-1 could provide important functional and predictive information about atherosclerosis.

Biomarkers↗

PubMed2002

Validation of simple indices to assess insulin sensitivity based on the oral glucose tolerance test in the Japanese population.

The homeostasis model assessment (HOMA) represents a simple index for evaluating insulin sensitivity, but clinical use is limited. Insulin sensitivity indices calculated from plasma glucose and plasma insulin concentrations after an oral glucose tolerant test (OGTT) have been proposed, but have not been validated in the Japanese population. We compared these indices with the euglycemic hyperinsulinemic clamp technique to evaluate the predicting insulin sensitivities in 77 Japanese subjects with varying degrees of glucose tolerance (normal glucose tolerance, n=40; impaired glucose tolerance, n=22; and type 2 diabetes mellitus, n=15). Insulin sensitivity was measured by the euglycemic hyperinsulinemic glucose clamp technique using an artificial pancreas, and expressed as the M-value. Weak inverse correlations existed between the HOMA index and M-values (r=-0.227, P=0.0468). An alternative index calculated by Matsuda's formula correlated with the M-value (r=0.450, P=0.0001). A second index calculated by Stumvoll's formula also correlated with the M-value (r=0.641, P=0.0001). Finally, a third index calculated by Gutt's formula also significantly correlated with the M-value (r=0.526, P=0.0001). All three indices are applicable for clinical use. The second index is the most sensitive measure of insulin sensitivity in the Japanese population.

Adult↗

PubMed2002

Transferrinuria in type 2 diabetic patients with early nephropathy and tubulointerstitial injury.

BACKGROUND: Transferrinuria is thought to be a marker for early stages of diabetic nephropathy. Transferrin has also been proposed as a mediator of tubular toxicity because the reabsorption of transferrin results in the release of reactive iron in proximal tubular cells, promoting the formation of hydroxyl radicals. We evaluated the role of urinary transferrin excretion in diabetic patients with early nephropathy by comparing tubulointerstitial injury in renal biopsy specimens. PATIENTS AND METHODS: 45 type 2 diabetic patients with normoalbuminuria (urinary albumin excretion <30 mg/24 h) or microalbuminuria (30-300 mg/24 h) were studied. All patients with microalbuminuria underwent renal biopsy, and the severity of the tubulo-interstitial lesions was determined by a semiquantitative estimate of interstitial fibrosis, tubular atrophy, and interstitial inflammatory infiltrates. Subjects were classified into group A (normoalbuminuria, n=25), group B (microalbuminuria without tubulointerstitial changes, n=11) or group C (microalbuminuria with tubulointerstitial changes, n=9). RESULTS: Urinary transferrin excretion (UTf), as well as UTf/creatinine clearance (Ccr), and transferrin clearance (CTf/Ccr), was significantly higher in groups B and C than in group A, and it was significantly higher in group C than in group B. There were no significant differences in urinary albumin excretion or mesangial expansion rate (MR% estimated by quantitative morphometric studies) between groups B and C. Although urinary beta2-microglobulin excretion was significantly higher in group C than in groups A and B, urinary N-acetyl-beta-D-glucosaminidase activity was significantly higher in groups B and C than in group A. CONCLUSIONS: Increased transferrinuria in the microalbuminuric stage may lead to the development of tubulointerstitial injuries in type 2 diabetic patients.

Journal Article↗

PubMed2002

Insulin secretion and sensitivity in non-obese and obese Japanese patients with coronary artery disease.

In a cross-sectional study of 240 patients with angiographically documented coronary artery disease (CAD), we investigated whether obese and non-obese subjects differed as to the influence of insulin deficiency and insulin resistance on glucose intolerance and cardiovascular risk. Patients were classified according to a 75-g oral glucose tolerance test as having normal glucose tolerance (NGT), impaired glucose tolerance (IGT), or diabetes mellitus (DM). We defined obesity as a body mass index (BMI) exceeding 25 kg/m(2). Early phase insulin secretion (insulinogenic index) declined with worsening glucose intolerance in non-obese (tau = -.216, P <.001; Kendall's correlation coefficient) and obese subjects (tau = -.392, P <.001). Total insulin secretion was higher in obese subjects with NGT or IGT than in controls and decreased in association with worsening glucose intolerance in obese subjects (tau = -.239, P <.001). Insulin sensitivity was calculated by 3 proposed indices. The first of these decreased in association with worsening in glucose tolerance in non-obese subjects (tau = -.137, P <.01). The second showed such a pattern in both groups (non-obese, tau = -.407, P <.001; obese, tau = -.311, P <.001), as did the third (non-obese, tau = -.512, P <.001; obese, tau = -.488, P < 0.001). Because even prediabetic Japanese subjects with CAD showed a latent insulin secretion defect in response to a glucose load, as well as impaired insulin sensitivity, compensatory hyperinsulinemia is not a sensitive indicator of coronary risk.

Aged↗

PubMed2002

Levels of MCP-1 and GM-CSF mRNA correlated with inflammatory cytokines mRNA levels in experimental autoimmune myocarditis in rats.

Infiltration of monocytes and T cells is known to be an essential trigger for the progression of experimental autoimmune myocarditis (EAM) in rats. Monocyte chemotactic protein-1 (MCP-1) and granulocyte-macrophage colony-stimulating factor (GM-CSF) were shown to mediate the migration of monocytes and T cells into inflammatory sites and to proliferate monocytes. Thus, we evaluated levels of MCP-1 and GM-CSF mRNA in the myocardium of EAM in rats using a real time quantitative PCR method. We also examined the correlation of MCP-1 or GM-CSF mRNA levels with those of inflammatory cytokines such as tumor necrosis factor-alpha (TNF-alpha), interleukin-1beta (IL-1beta) and interleukin-6 (IL-6) in the same lesion. Levels of MCP-1, GM-CSF, TNF-alpha, IL-1beta and IL-6 mRNA increased with the progression of myocarditis which was accompanied by the accumulation of ED-1 positive cells. The MCP-1 and GM-CSF mRNA levels were positively correlated with TNF-alpha, IL-1beta and IL-6 mRNA levels in the same lesion of EAM. We also demonstrated that serum MCP-1 concentrations were increased during the active stage of EAM, and were correlated with MCP-1 mRNA levels in the myocardium of each rat. These findings suggest that elevated MCP-1 and GM-CSF may associate with the migration and proliferation of monocytes/macrophages in EAM. Thus, MCP-1 and GM-CSF may play an important role in the progression of EAM.

Animals↗

PubMed2002

Is the site of thrombus formation in the left atrial appendage associated with the risk of cerebral embolism?

Atrial fibrillation (AF) is a risk factor for cerebral embolism, with the left atrial appendage (LAA) being considered as the source of emboli. However, the relationship between the histologic properties of LAA thrombi and the occurrence of cerebral embolism is not known. Seventy-six hearts from patients who died within 1 month after cerebral embolism were studied at autopsy. Patients were grouped according to the presence of AF and the presence of valvular disease (VD). We determined whether the LAA thrombi adhered to the trabecular region or the remainder of the LAA. LAA thrombi were grouped into three stages: a fresh stage in which thrombi consisted of fibrin and platelets, an organizing stage in which angiogenesis was observed in the thrombi, and an organized stage in which endothelial cells covered the surface of the thrombi. The AF+/VD- group included 19 patients (25.0%), the AF+/VD+ group 8 (10.5%), the AF-/ VD- group 37 (48.7%), and the AF-/VD+ group included 12 patients (15.8%). LAA thrombi were observed in 15 patients (78.9%) in the AF+/VD- group, and all of the thrombi adhered to the trabecular region. Thrombi in the fresh and the organizing stages were observed in 10 patients (66.7%). Patients in the AF+/VD- group accounted for about 25% of the cases of cerebral embolism. All of these thrombi were attached to the trabecular region, and about 70% of them could represent an embolic source.

Adult↗

PubMed2002

Oxidative DNA damage and tubulointerstitial injury in diabetic nephropathy.

BACKGROUND: Oxidative stress is an important pathogenetic factor in underlying diabetic complications. Recently, 8-hydroxy-2'-deoxyguanosine (8-OHdG) has been reported to serve as a new sensitive biomarker of the oxidative DNA damage in vivo. We studied the relationship between oxidative DNA damage and tubulointerstitial injury in patients with diabetic nephropathy. METHODS: Type 2 diabetic patients (n = 25) and healthy control subjects (n = 20) were studied. The urine concentrations of 8-OHdG were measured by a competitive ELISA. The severity of the glomerular changes was graded using Gellman's criteria, and the severity of the tubulointerstitial lesions was determined by a semiquantitative estimate of the space occupied by the fibrous tissue and/or interstitial infiltrates. RESULTS: The urinary 8-OHdG excretion were significantly higher in the diabetics than in the healthy controls, and tended to increase with severity of the glomerular diffuse lesion, but it was not significant. The urinary 8-OHdG excretion significantly increased with severity of the tubulointerstitial lesion. CONCLUSIONS: Oxidative stress may contribute to the progression of tubulointerstitial injury in patients with diabetic nephropathy.

8-Hydroxy-2'-Deoxyguanosine↗

PubMed2002

Validation of simple indices to assess insulin sensitivity and pancreatic Beta-cell function in patients with renal dysfunction.

BACKGROUND/AIMS: Insulin resistance and hyperinsulinemia has been reported in patients with chronic renal failure. However, usefulness and validation of new indices for assessment to insulin sensitivity and pancreatic beta-cell function were unknown. METHODS: We evaluated insulin sensitivity and pancreatic beta-cell function in 61 normal glucose tolerant (NGT) and 60 diabetic (DM) subjects; both groups were subdivided as normal renal function (NRF; C(cr) >/= 70 ml/min) and impaired renal function (IRF; C(cr) <70 ml/min). Insulin sensitivity were assessed by homeostasis model assessment of insulin resistance (HOMA-IR) and plasma glucose and insulin concentrations obtained at fasting or during a 75-gram oral glucose tolerance test (insulin sensitivity index), and pancreatic beta-cell function were assessed by insulinogenic index, first-phase insulin secretion index, and area under the response curve for plasma insulin (insulin-AUC(0-180)). RESULTS: There was no evidence of insulin resistance in NGT-IRF group. No differences in both insulinogenic index and first-phase insulin secretion index between NGT-NRF and NGT-IRF, but these were significantly decreased in DM-NRF and DM-IRF. There were inverse linear correlations between the insulin sensitivity index and insulin-AUC(0-180) in patients with NGT and DM, respectively. These correlations were similarly robust in NRF subjects and IRF subjects. CONCLUSIONS: New indices for assessment of insulin sensitivity and pancreatic beta-cell function calculated from plasma glucose and plasma insulin concentrations after OGTT are applicable for clinical use even in patients with renal dysfunction.

Aged↗