Biomedical subjects

Tsutomu Tabata

Publications and source records attributed to Tsutomu Tabata.

28 records · Page 2Linked to original sources

PubMed2003

[Recent medication to renal osteodystrophy].

P control according to phosphorus (P) adsorbent by the medication to renalosteodystrophy (ROD) and the medical treatment by active vitamin D are main. Although the present calcium carbonate is used as P adsorbent, sufficient quantity to control P for hypercalcemia may be unable to be prescribed for the patient. The near future use of sevelamer hydrochloride under development which does not cause hypercalcemia will be attained at such a case. Although alphacalcidol and calcitriol are used for some time, the present clinical use of the vitamin derivatives which made calcitriol basic structure and made the action powerful, such as maxacalcitol and falecalcitriol, is developed and carried out. Thus, although the choice of vitamin D medical treatment increased by clinical use of much active vitamin D or its derivative having been attained and the adaptation range also spread, there is no view which now unified how such a medicine would be used properly. The validity to ROD, such as calcitonin, vitamin K, and bisphosphonates, is examined in addition to P adsorbent, or vitamin D and its derivative, and calcimimetics is developed as a new medicine.

English Abstract↗

PubMed2002

Treatment failure in vaginal cancer.

OBJECTIVE: The aim of this study was to analyze the pattern of treatment failure in patients with vaginal cancer. METHODS: Fifty-one patients with primary vaginal cancer (registered between 1957 and 1995) were reviewed. Primary treatment consisted of surgery in 12 patients and radiation in 39 patients. In these patients, the prognosis and treatment failure were analyzed in relation to clinicopathological factors. RESULTS: The 5-year survival rate was 100% in stage 0 (N = 5), 82% in stage I (N = 11), 70% in stage II (N = 23), 0% in stage III (N = 5), 14% in stage IV (N = 7), and 61% overall (N = 51). Although early disease had a relatively favorable prognosis, two of five patients with stage 0 disease developed local recurrence. There was no site-related difference in survival, but survival was better when the tumor occupied less than one-third of the vaginal wall compared with more than one-third. All relapses in stage 0-II patients were local recurrences, whereas treatment failure in stage III-IV patients was due to either persistent local disease or new distant metastasis. CONCLUSION: The present findings suggest that more intensive local therapy may achieve a better prognosis for patients with early disease. Conversely, suppression of distant metastasis along with aggressive local control is needed for advanced disease. Conventional radiotherapy alone is of little value for advanced disease.

Adult↗

PubMed2002

Advanced atherosclerosis in predialysis patients with chronic renal failure.

BACKGROUND: Atherosclerosis is advanced in hemodialysis patients as shown by increased intima-media thickness of carotid arteries (CA-IMT), although it is not established whether the advanced atherosclerosis results from hemodialysis treatment or from chronic renal failure. The purpose of this study was to evaluate the effects of hemodialysis and renal failure on CA-IMT in patients with chronic renal failure. METHODS: CA-IMT was measured by high-resolution B-mode ultrasonography in 110 patients with chronic renal failure before starting dialysis (CRF group), and compared with CA-IMT of 345 hemodialysis patients (HD group) and 302 healthy control subjects. They were all nondiabetic and the three groups were comparable in age and gender. RESULTS: As compared with the healthy control subjects, the CRF and HD groups had greater CA-IMTs, whereas CA-IMTs of the CRF and HD groups were not statistically different. There was no significant correlation between duration of hemodialysis and CA-IMT in the HD group. Multiple regression analysis in the total subjects indicated that presence of renal failure, but not being treated with hemodialysis, was a significant factor associated with increased CA-IMT independent of age, gender, blood pressure, smoking, high-density lipoprotein (HDL) and non-HDL cholesterol levels. CONCLUSIONS: These results demonstrate that thickening of arterial wall is present in patients with chronic renal failure before starting hemodialysis treatment, and support the concept that advanced atherosclerosis in hemodialysis patients is due not to hemodialysis treatment, but to renal failure and/or metabolic abnormalities secondary to renal failure.

Arteriosclerosis↗

PubMed2002

Antibody to oxidized low-density lipoprotein and cardiovascular mortality in end-stage renal disease.

BACKGROUND: Immune response to oxidized low-density lipoprotein (oxLDL) may modulate the process of atherogenesis and cardiovascular disease. METHODS: We performed a prospective, observational cohort study in 249 patients with end-stage renal disease (ESRD) to examine whether the serum titer of anti-oxLDL antibody can predict cardiovascular mortality. RESULTS: The median anti-oxLDL antibody titer was 320 mU/mL at baseline. During the follow-up (63 +/- 23 months), 72 deaths including 34 cardiovascular deaths occurred. When the subjects were divided into two groups by the median titer, the high titer group showed a lower risk for cardiovascular mortality (P = 0.040 by Kaplan-Meier analysis and log-rank test). Multivariate Cox proportional hazards model indicated that the lower risk of cardiovascular death in the high titer group remained significant (hazard ratio of 0.46, 95%CI 0.23-0.95, P = 0.037) and independent of age, presence of vascular complications, presence of diabetes mellitus, and elevated C-reactive protein. In contrast, anti-oxLDL antibody titer was not associated with non-cardiovascular mortality. CONCLUSIONS: These results demonstrate, to our knowledge for the first time, that serum anti-oxLDL antibody titer is an independent predictor of cardiovascular mortality in a cohort of patients with ESRD.

Adult↗

PubMed2002

Conjunctival and corneal calcification and bone metabolism in hemodialysis patients.

Conjunctival and corneal calcification is well recognized as a metastatic calcification in patients undergoing hemodialysis. In 44 male hemodialysis patients, we examined the relationship between the severity of conjunctival and corneal calcification and age; duration of hemodialysis; serum levels of calcium (Ca), phosphorus (P), intact parathyroid hormone (iPTH), alkaline phosphatase (ALP), and osteocalcin; and bone mineral density (BMD). The mean age was 58.3 years (range, 33-79 yr), and the mean duration of hemodialysis was 94.3 months (range, 25-258 mo). The serum level of Ca was 9.6 +/- 0.1 mg/dL, P was 5.9 +/- 0.1 mg/dL, Ca x P was 57.5 +/- 1.2, iPTH was 204.0 +/- 34.6 pg/mL, ALP was 173.8 +/- 11.8 U/L, and osteocalcin was 62.8 +/- 9.5 ng/mL. Lumbar BMD was 0.997 +/- 0.022 g/cm2 and radial BMD was 0.642 +/- 0.015 g/cm2. There was a significant positive correlation between the severity of conjunctival and corneal calcification and the duration of hemodialysis (P < 0.0001), the serum levels of P (P = 0.0035), the Ca x P (P = 0.0034), the iPTH (P = 0.0154), the ALP (P < 0.0001), and the osteocalcin (P = 0.0010), and was negatively correlated with radial BMD (P = 0.0008). However, the severity of conjunctival and corneal calcification was not significantly correlated with age (P = 0.986), serum Ca levels (P = 0.138), or lumbar BMD (P = 0.449). Based on these findings, we suggest that the conjunctival and corneal calcification developed by excessive serum levels of Ca and P associated with abnormal bone and mineral metabolism. This resulted in an increased bone turnover and decreased BDM after prolonged hemodialysis even though efforts were made to maintain the homeostasis of Ca and P metabolism in hemodialysis patients by using various therapeutic approaches.

Adult↗

PubMed2002

Insulin resistance as an independent predictor of cardiovascular mortality in patients with end-stage renal disease.

Insulin resistance is closely associated with atherosclerosis and cardiovascular mortality in the general population. Patients with end-stage renal disease (ESRD) are known to have insulin resistance, advanced atherosclerosis, and a high cardiovascular mortality rate. We evaluated whether insulin resistance is a predictor of cardiovascular death in a cohort of ESRD. A prospective observational cohort study was performed in 183 nondiabetic patients with ESRD treated with maintenance hemodialysis. Insulin resistance was evaluated by the homeostasis model assessment method (HOMA-IR) using fasting glucose and insulin levels at baseline, and the cohort was followed for a mean period of 67 mo. Forty-nine deaths were recorded, including 22 cardiovascular deaths. Cumulative incidence of cardiovascular death by Kaplan-Meier estimation was significantly different between subjects in the top tertile of HOMA-IR (1.40 to 4.59) and those in the lower tertiles of HOMA-IR (0.28 to 1.39), and the hazard ratio (HR) was 2.60 (95% confidence interval [CI], 1.12 to 6.01; P = 0.026) in the univariate Cox proportional hazards model. In multivariate Cox models, the positive association between HOMA-IR and cardiovascular mortality remained significant (HR, 4.60; 95% CI, 1.83 to 11.55; P = 0.001) and independent of age, C-reactive protein, and presence of preexisting vascular complications. Further analyses showed that the effect of HOMA-IR on cardiovascular mortality was independent of body mass index, hypertension, and dyslipidemia. In contrast, HOMA-IR did not show such a significant association with noncardiovascular mortality. These results indicate that insulin resistance is an independent predictor of cardiovascular mortality in ESRD.

Aged↗

PubMed2002

Effect of diabetes on uremic dyslipidemia.

Elevated intermediate-density lipoprotein (IDL), a remnant lipoprotein, is an independent risk factor for atherosclerosis in patients with end-stage renal disease (ESRD). Since the presence of diabetes mellitus further increases the risk of cardiovascular mortality in ESRD, we examined the effect of diabetes on IDL among ESRD patients. The subjects were 330 healthy control subjects and 287 patients with end-stage renal disease including 80 patients with type 2 diabetes. As compared with the healthy subjects, the nondiabetic ESRD patients had increased plasma triglyceride and IDL cholesterol. Diabetic patients with ESRD showed a further increase in plasma triglyceride and IDL cholesterol compared with the nondiabetic group. However, the difference in IDL levels between the ESRD groups was no longer significant when subjects were stratified by plasma triglyceride. Plasma triglyceride was correlated with IDL cholesterol. Increased hemoglobin A(1c) was significantly associated with IDL cholesterol in a multiple regression model including age, gender, and the presence of ESRD. Such an association was no longer significant in another model including plasma triglyceride as an additional covariate. Further analysis indicated the positive effects of diabetes and hyperglycemia on plasma triglyceride. These results indicate that increased IDL in ESRD is further deteriorated in the presence of diabetes, and that the adverse effect is accounted for at least partly by hypertriglyceridemia associated with chronic hyperglycemia.

Cholesterol↗

PubMed2002

[Phosphate control in vitamin D pulse therapy for hemodialysis patients].

The efficacy of PTH suppression of oral 1,25 (OH) (2)D(3) pulse therapy was greater in the group with well-controlled phosphate levels (mean serum P<6.0 mg/dl) in hemodialysis patients with secondary hyperparathyroidism. The restriction of dietary phosphate can decrease the level of serum phosphate without increasing the dose of phosphate binders and continue the treatment without increasing Ca x P product. The dietary phosphate reduction is important in oral 1,25 (OH) (2)D(3) pulse therapy.

English Abstract↗

PubMed2001

Diabetes mellitus, aortic stiffness, and cardiovascular mortality in end-stage renal disease.

Cardiovascular mortality is elevated in patients with end-stage renal disease (ESRD), especially in those with diabetes mellitus. Although the higher cardiovascular death rate in diabetic ESRD patients may be the result of more advanced atherosclerotic changes of the arterial wall, this has not been documented previously. Aortic stiffness was compared between ESRD patients with and without diabetes, and the impact of aortic stiffness on cardiovascular mortality was examined in a prospective, observational cohort study. The cohort consisted of 265 ESRD patients on hemodialysis, including 50 diabetic patients studied between June 1992 and December 1998. At baseline, the diabetic ESRD patients had significantly higher aortic pulse wave velocity (PWV), a noninvasive measure of aortic stiffness, than the nondiabetic patients. During a mean follow-up period of 63 mo, 81 deaths, including 36 cardiovascular deaths, were recorded. Kaplan-Meier analysis revealed higher all-cause or cardiovascular mortality rates in the diabetic as compared with the nondiabetic patients and also in those with higher aortic PWV than those with lower aortic PWV. The effect of diabetes on cardiovascular death was significant in the Cox model, including age, years on hemodialysis, gender, smoking, C-reactive protein, hematocrit, and body mass index as covariates. However, when aortic PWV was included as a covariate, the impact of diabetes was no longer significant, whereas aortic PWV was a significant predictor. In a model including 13 covariates, aortic PWV remained a significant predictor for cardiovascular and overall mortality but not for non-cardiovascular death. These results demonstrate that the increased aortic stiffness of the ESRD patients with diabetes mellitus contributed to the higher all-cause and cardiovascular mortality rates.

Aorta↗

PubMedDate not supplied

A randomized study of primary bleomycin, vincristine, mitomycin and cisplatin (BOMP) chemotherapy followed by radiotherapy versus radiotherapy alone in stage IIIB and IVA squamous cell carcinoma of the cervix.

BACKGROUND: To determine whether neoadjuvant chemotherapy would improve disease control and clinical outcome of patients with locally advanced cervical cancer undergoing radiotherapy. MATERIALS AND METHODS: Sixty-one patients with primary invasive squamous cell carcinoma of the cervix of stage IIIB or IVA were randomized to receive either three courses of chemotherapy followed by radiotherapy (CT + RT) or radiotherapy alone (RT). The chemotherapy regimen consisted of bleomycin, vincristine, mitomycin and cisplatin (BOMP). The radiotherapy was carried out by the use of a combination of external beam radiation and intracavitary brachytherapy. RESULTS: The response rate of the chemotherapy (complete or partial response) in the CT + RT group was 72% (3 + 20 out of 32). The 5-year survival rates were 52% in RT group and 43% in the CT + RT group with no significant difference. Recurrence outside the irradiated field occurred in 17% (5 out of 29) in the RT group, whereas it was 25% (8 out of 32) in the CT + RT group. CONCLUSION: Despite the high response rate of BOMP chemotherapy, the combination (CT + RT) failed to improve the survival of patients with locally advanced cervical cancer when compared with radiotherapy alone. It was also noteworthy that the incidence of distant metastasis was not reduced by the use of neoadjuvant chemotherapy.

Adult↗