PubMed Health⌕ Search

Biomedical subjects

Y Fujino

Publications and source records attributed to Y Fujino.

At least 37 records · Page 2Linked to original sources
PubMed2001

Ampullary carcinoma developing after androgenic steroid therapy for aplastic anemia: Report of a case.

Sex steroids influence the development and course of human genital carcinomas including breast, testis, prostata, and ovarian cancers. (1) Other carcinomas such as hepatoma, cholangioma, and pancreatic cancer have also been reported to be related to sex hormones. (2-4) The existence of sex hormone receptors has been demonstrated immunohistochemically in specimens of these diseases. We recently encountered a patient in whom an ampullary carcinoma developed 39 months after the start of androgenic steroid therapy for aplastic anemia. Immunohistochemic analysis of resected tumor specimens of the patient suggested a possible hormonal effect on the tumor oncology.

Adenocarcinoma↗
PubMed2001

Performance of heated humidifiers with a heated wire according to ventilatory settings.

Delivering warm, humidified gas to patients is important during mechanical ventilation. Heated humidifiers are effective and popular. The humidifying efficiency is influenced not only by performance and settings of the devices but the settings of ventilator. We compared the efficiency of humidifying devices with a heated wire and servo-controlled function under a variety of ventilator settings. A bench study was done with a TTL model lung. The study took place in the laboratory of the University Hospital, Osaka, Japan. Four devices (MR290 with MR730, MR310 with MR730; both Fisher & Paykel, ConchaTherm IV; Hudson RCI, and HummaxII; METRAN) were tested. Hummax II has been developed recently, and it consists of a heated wire and polyethylene microporous hollow fiber. Both wire and fiber were put inside of an inspiratory circuit, and water vapor is delivered throughout the circuit. The Servo 300 was connected to the TTL with a standard ventilator circuit. The ventilator settings were as follows; minute ventilation (V(E)) 5, 10, and 15 L/min, a respiratory rate of 10 breaths/min, I:E ratio 1:1, 1:2, and 1:4, and no applied PEEP. Humidifying devices were set to maintain the temperature of airway opening at 32 degrees C and 37 degrees C. The greater V(E) the lower the humidity with all devices except Hummax II. Hummax II delivered 100% relative humidity at all ventilator and humidifier settings. When airway temperature control of the devices was set at 32 degrees C, the ConchaTherm IV did not deliver 30 mg/L of vapor, which is the value recommended by American National Standards at all V(E) settings. At 10 and 15 L/min of V(E) settings MR310 with MR730 did not deliver recommended vapor, either. In conclusion, airway temperature setting of the humidifying devices influenced the humidity of inspiratory gas greatly. Ventilatory settings also influenced the humidity of inspiratory gas. The Hummax II delivered sufficient water vapor under a variety of minute ventilation.

Equipment Design↗
PubMed2001

Optimal mean airway pressure during high-frequency oscillation: predicted by the pressure-volume curve.

BACKGROUND: A number of groups have recommended setting positive end-expiratory pressure during conventional mechanical ventilation in adults at 2 cm H2O above the lower corner pressure (P(CL)) of the inspiratory pressure-volume (P-V) curve of the respiratory system. No equivalent recommendations for the setting of the mean airway pressure (Paw) during high-frequency oscillation (HFO) exist. The authors questioned if the Paw resulting in the best oxygenation without hemodynamic compromise during HFO is related to the static P-V curve in a large animal model of acute respiratory distress syndrome. METHODS: Saline lung lavage was performed in seven sheep (28+/-5 kg, mean +/- SD) until the arterial oxygen partial pressure/fraction of inspired oxygen ratio decreased to 85+/-27 mmHg at a positive end-expiratory pressure of 5 cm H2O (initial injury). The PCL (20+/-1 cm H2O) on the inflation limb and the point of maximum curvature change (PMC; 26+/-1 cm H2O) on the deflation limb of the static P-V curve were determined. The sheep were subjected to four 1-h cycles of HFO at different levels of Paw (P(CL) + 2, + 6, + 10, + 14 cm H2O), applied in random order. Each cycle was preceded by a recruitment maneuver at a sustained Paw of 50 cm H2O for 60 s. RESULTS: High-frequency oscillation with a Paw of 6 cm H2O above P(CL) (P(CL) + 6) resulted in a significant improvement in oxygenation (P < 0.01 vs. initial injury). No further improvement in oxygenation was observed with higher Paw, but cardiac output decreased, pulmonary vascular resistance increased, and oxygen delivery decreased at Paw greater than P(CL) + 6. The PMC on the deflation limb of the P-V curve was equal to the P(CL) + 6 (r = 0.77, P < 0.05). CONCLUSION: In this model of acute respiratory distress syndrome, optimal Paw during HFO is equal to P(CL) + 6, which correlates with the PMC.

Animals↗
PubMed2001

Repetitive high-pressure recruitment maneuvers required to maximally recruit lung in a sheep model of acute respiratory distress syndrome.

OBJECTIVE: To compare the effects of two different recruitment maneuvers repeated multiple times on gas exchange lung injury, hemodynamic, and lung mechanics. DESIGN: Randomized prospective comparison. SETTINGS: Animal research laboratory. SUBJECT: Nineteen fasted Hampshire sheep. INTERVENTIONS: In 15 27-kg sheep with saline lavage lung injury, we compared the effects of two recruitment maneuvers: 40 cm H2O continuous positive airway pressure for 60 secs and 40 cm H2O positive end-expiratory pressure with 20 cm H2O pressure control, rate 10 breaths/min, inspiratory to expiratory ratio 1:1 for 2 mins. Each recruitment maneuver was repeated four times, every 30 mins after a 30-sec ventilator disconnection. An additional group received no recruitment maneuvers. Animals were assigned randomly to the three groups and ventilated with 20 cm H2O positive end-expiratory pressure, pressure control 15 cm H2O, rate 20 breaths/min, inspiratory to expiratory ratio 1:1, and Fio2 1.0 between recruitment maneuver periods. MEASUREMENTS AND MAIN RESULTS: Significant and marked increases in Pao2 were observed in the pressure control recruitment maneuver group but only after the second recruitment maneuver. In both the control group and continuous positive airway pressure groups, Pao2 did not significantly increase after any recruitment maneuver compared with baseline injury. There was a significant decrease in cardiac output immediately after some continuous positive airway pressure recruitment maneuvers and a significant increase in mean pulmonary artery pressure in both continuous positive airway pressure and pressure control groups immediately after recruitment maneuvers, but these changes resolved within 10 mins. There were no marked histologic differences between groups and no volutrauma. CONCLUSION: In this model, maximal lung recruitment was obtained with 40 cm H2O positive end-expiratory pressure and 20 cm H2O pressure control applied repetitively every 30 mins for 2 mins without physiologic or histologic harm. Multiple recruitment maneuvers in some animals were required for maximum effect.

Analysis of Variance↗
PubMed2001

Possible role of heat shock protein 60 in reducing ischemic-reperfusion injury in canine pancreas grafts after preservation by the two-layer method.

INTRODUCTION: Recently, results of the clinical application of the two-layer method have shown the morphologic quality of the human pancreas grafts after reperfusion to be excellent, although ischemia-reperfusion injury is related to early graft loss in pancreas transplantation. However, some reports have indicated that heat shock proteins (HSPs) have important functions in response to the stress-related events. AIM: To examine whether the two-layer method reduced ischemia-reperfusion injury in a canine pancreas autotransplantation model by investigating the expression of HSPs. METHODOLOGY: There were three experimental groups in which dogs received segmental autografts after preservation by the two-layer method using University of Wisconsin solution (UW) (group 1), simple storage in UW (group 2) for 24 hours, or no preservation (group 3). RESULTS: In group 1, pancreatic tissue perfusions were high, and pancreatic exocrine functions were well preserved after 1, 2, and 4 hours of reperfusion with low incidence of graft pancreatitis or vessel thrombosis compared with that in group 2. Moreover, ATP rapidly recovered, and HSP 60 was strongly enhanced after reperfusion in group 1. On the other hand, ATP recovery and the enhancement of HSP 60 were weak after reperfusion in group 2. CONCLUSION: The two-layer method reduced ischemia-reperfusion injury compared with UW simple storage in canine pancreas autotransplantation with a strong expression of HSP 60.

Adenosine Triphosphate↗
PubMed2001

Effort and work of breathing in neonates during assisted patient-triggered ventilation.

OBJECTIVE: This study compares patient-ventilator synchrony, work of breathing and patient effort in neonates during different modes of patient-triggered ventilation. DESIGN: Clinically stable neonates received intermittent mandatory ventilation (IMV), synchronized intermittent mandatory ventilation (SIMV), pressure assist/control ventilation (A/C), and pressure support ventilation (PSV) in a random order for 20 mins. With each mode patient-ventilator synchrony, work of breathing, and patient effort were evaluated. SETTING: Neonatal level III intensive care unit of a university hospital. Measurements and RESULTS: Seven clinically stable neonates (31.4 +/- 2 wks gestation, weighing 1.49 +/- 0.38 kg) were randomly ventilated with the above four modes using a Bird VIP ventilator. Esophageal pressure, airway pressure, and flow were measured using a CP-100 neonatal monitor (Bicore). Data for five consecutive breaths in each mode were analyzed. Patient effort and work of breathing differed significantly among modes of ventilation. The inspiratory pressure time product was least with A/C (0.54 +/- 0.29 cm H(2)O.sec) and increased with PSV (0.60 +/- 0.39 cm H(2)O.sec), SIMV (1.46 +/- 0.55 cm H(2)O.sec), and IMV (2.74 +/- 1.05 cm H(2)O.sec) (p <.05). A similar trend was observed for work of breathing, with work least during A/C (0.07 +/- 0.04 joules per liter [J/L]), followed by PSV (0.17 +/- 0.14 J/L), SIMV (0.33 +/- 0.13 J/L), and IMV (0.41 +/- 0.16 J/L) (p <.05). Marked dyssynchrony between patient-initiated and ventilator-initiated inspiration occurred only during IMV. CONCLUSION: Asynchrony can be avoided by the use of assisted, patient triggered modes of ventilation and, of the available modes, pressure A/C results in the least effort and work of breathing for clinically stable neonates.

Journal Article↗
PubMed2001

Prediction of pulmonary complications after a lobectomy in patients with non-small cell lung cancer.

BACKGROUND: Although the preoperative prediction of pulmonary complications after lung major surgery has been reported in various papers, it still remains unclear. METHODS: Eighty nine patients with stage I-IIIA non-small cell lung cancer (NSCLC) who underwent a complete resection at our institute from 1994-8 were evaluated for the feasibility of making a preoperative prediction of pulmonary complications. All had either a predicted postoperative forced vital capacity (FVC) of >800 ml/m(2) or forced expiratory volume in one second (FEV(1)) of >600 ml/m(2). RESULTS: Postoperative complications occurred in 37 patients (41.2%) but no patients died during the 30 day period after the operation. Pulmonary complications occurred in 20 patients (22.5%). Univariate analysis indicated that the factors significantly related to pulmonary complications were FVC <80%, serum lactate dehydrogenase (LDH) level > or =230 U/l, and arterial oxygen tension (PaO(2)) <10.6 kPa (80 mm Hg). In a multivariate analysis the three independent predictors of pulmonary complications were serum LDH > or =230 U/l (odds ratio (OR) 10.5, 95% CI 1.4 to 77.3), residual volume (RV)/total lung capacity (TLC) > or =30% (OR 6.0, 95% CI 1.1 to 33.7), and PaO(2) <10.6 kPa (OR 5.6, 95% CI 1.4 to 22.2). CONCLUSIONS: The above findings indicate that three factors (serum LDH levels of > or =230 U/l, RV/TLC > or =30%, and PaO(2) <10.6 kPa) may be associated with pulmonary complications in patients undergoing a lobectomy for NSCLC, even though the patient group was relatively small for statistical analysis of such a diverse subject as pulmonary complications.

Adult↗
PubMed2001

Involvement of phenotypes and serum levels of haptoglobin in the outcome of in vitro fertilization and embryo transfer.

Haptoglobin (Hp) possesses many functions in the immune system and angiogenesis as well as scavenging released hemoglobin, and thus it is speculated that Hp may also play a critical role in the reproductive process. To investigate the possible involvement of Hp in the outcome of in vitro fertilization and embryo transfer (IVF-ET), the serum Hp of 50 patients who underwent IVF-ET was analyzed by the Western blot method. The results showed a higher pregnancy rate in the patients with the Hp2-2 phenotype (38%) than in those with the Hp2-1 phenotype (16%) (p = 0.08), and the serum alpha 2 subunit levels in the patients who achieved pregnancy within four attempts at IVF-ET were higher than in the others (p < 0.05). The results of this study suggest that Hp is involved in the outcome of IVF-ET.

Adult↗
PubMed2001

[Usefulness of routine ophthalmologic examination for cytomegalovirus retinitis in acquired immunodeficiency syndrome patients].

PURPOSE: To evaluate the usefulness of routine ophthalmologic examinations for cytomegalovirus retinitis in acquired immunodeficiency syndrome (AIDS) patients. METHODS: Clinical symptoms of cytomegalovirus (CMV) retinitis in patients with AIDS who had circulating CD4+ T lymphocytes 50/microliter or less and received monthly ophthalmological examinations (examined group) were compared with those of the patients detected by non-routine ophthalmological examinations (unexamined group). RESULTS: The patients in whom early CMV retinitis was detected by monthly ophthalmological examinations had no subjective symptoms or iritis. The size of CMV retinitis was smaller than 2 disc diameters and it did not extend to the papillomacular area in a majority of the patients. On the other hand, the size of CMV retinitis in the unexamined group was larger than 10 disc diameters and it extended to the papillomacular area in most cases. The visual prognosis of the examined group was better than that of the unexamined group. CONCLUSIONS: To protect visual acuity, it is important to conduct monthly ophthalmological examinations in patients with AIDS whose serum CD4+ T lymphocyte counts are 50 cells/microliter or less.

AIDS-Related Opportunistic Infections↗
PubMed2001

[Preparation of a manual for treatment of patients refusing blood transfusion].

We prepared a concise and simple manual for the treatment of a patient refusing blood transfusion. In this manual, we present the idea that our medical staff will respect the intention of adult patients but not the intention of juveniles below 18 years of age. If an unconscious adult patient is carrying a blood refusal card, we would regard the card as a document indemnifying the hospital from responsibility and we would treat the patient without blood transfusion. However, we would treat a juvenile patient below 18 years of age with blood transfusion if necessary, even if they and their parents refused blood transfusion. By following the manual, we can cope with the patient who refuses blood transfusion, promptly and precisely and we are rarely prosecuted by them. We respect the right of patients to make decisions regarding medical treatment and to resolve problems regarding medical expenses. We recommend that all medical institutions prepare a manual for the treatment of the patient refusing blood transfusion and officially announce the institution's policies on this matter.

Adult↗
PubMed2001

Arsenic contamination of groundwater and prevalence of arsenical dermatosis in the Hetao plain area, Inner Mongolia, China.

An investigation was carried out on arsenic contamination of groundwater and prevalence of arsenical dermatosis in the Hetao plain of Inner Mongolia Autonomous Region, China. Based on the screening of water samples from 96 randomly selected wells in this Region, two areas (Wuyuan and Alashan) were chosen as highly contaminated areas because arsenic in the water samples was higher than 50 microg/l. Arsenic was measured using an arsenic silver diethyl dithiocarbamate method for 326 water samples from all the wells in these areas. The results show arsenic contaminated groundwater from tubule-type wells of depths about 15-30 m was serious compared with open-type wells where depth is about 3-5 m. In the Wuyuan area, 96.2% of water samples from tubule-type wells contained arsenic above 50 microg/l and 69.3% in Alashan area; the highest value was 1354 microg/l and 1088 microg/l, respectively. In these two areas, a health survey was carried out for arsenical dermatosis. The results show the prevalence of arsenical dermatosis in the Wuyuan area was 44.8%, higher than 37.1% prevalence of arsenical dermatosis in the Alashan area. The prevalence of arsenical dermatosis was highest in the over 40-year-old age group. There was no sex difference in the prevalence. Further investigation is needed to clarify the actual situation of arsenic pollution of groundwater in Inner Mongolia, China in order to reduce the adverse health effect among residents exposed to arsenic.

Adolescent↗
PubMed2001

Interleukin 18 levels reflect the severity of acute pancreatitis.

The serum interleukin 18 (IL-18) levels were significantly increased in cases of acute pancreatitis, corresponding to the severity of the disease. The IL-18 levels were also significantly correlated with the serum tumor necrosis factor alpha (TNF-alpha) and bilirubin levels. The possible involvement of IL-18 in the development of liver dysfunction in acute pancreatitis is suggested.

Acute Disease↗