Biomedical subjects

Y Itaoka

Publications and source records attributed to Y Itaoka.

8 recordsLinked to original sources

PubMed2000

Myopericarditis caused by cyclophosphamide used to mobilize peripheral blood stem cells in a myeloma patient with renal failure.

Cyclophosphamide (CPA) is widely used for peripheral blood stem cell mobilization, and a dose adjustment of CPA in the presence of renal failure has not been suggested. However, we describe a myeloma patient with renal failure (serum creatinine 4.2 mg/dl, creatinine clearance 11.2 ml/min) receiving CPA 2 g/m2 for 2 days, who developed unexpectedly severe toxicity, including myopericarditis and prolonged myelosuppression. The serial serum concentrations of CPA metabolites were persistently much higher than those in a myeloma patient with normal renal function. We consider, therefore, that the dose of CPA should be reduced in the presence of severe renal failure when used as high-dose therapy or to mobilize peripheral blood stem cells.

Adult↗

PubMed1992

[Efficacy of intracoronary thrombolysis versus percutaneous transluminal coronary angioplasty for treating acute myocardial infarction].

The usefulness of percutaneous transluminal coronary angioplasty (PTCA) in patients with evolving myocardial infarction remains controversial. We retrospectively assessed the efficacy of PTCA on myocardial salvage in acute myocardial infarction in comparison with the efficacy of intracoronary thrombolysis (ICT). Sixty-two patients with initial anteroseptal myocardial infarction who had been treated within 6 hrs after the onset of chest pain were categorized into 4 groups: 1) spontaneous recanalization: n = 14, 2) successful PTCA: n = 25 (this group was further subdivided into 2 groups: direct PTCA group, primary PTCA without prior ICT: n = 19; and rescue PTCA group, PTCA after unsuccessful ICT: n = 6), 3) successful ICT group (n = 12), and 4) unsuccessful recanalization group (n = 11). Left ventricular function in the chronic phase was assessed by contrast ventriculography using the global ejection fraction (EF) and regional wall motion (RWM) was assessed by the centerline method. Patients with recanalization had a significantly higher EF than did those without (62 +/- 12 vs 50 +/- 13%, p < 0.01). The mean EFs for groups with successful reperfusion were as follows: 65 +/- 8% for the spontaneous recanalization group, 61 +/- 14% for PTCA group (64 +/- 13% for direct PTCA group, 51 +/- 13% for rescue PTCA group) and 60 +/- 12% for the ICT group. The EFs for the spontaneous recanalization group and the direct PTCA group were significantly greater than that for the rescue PTCA group. The time to reperfusion and the thrombolysis in myocardial infarction (TIMI) flow grade before reperfusion did not affect the preservation of global left ventricular function. RWM of the infarcted area in patients with recanalization were less hypokinetic than that in patients without (p < 0.01). The mean RWM (SD/chord) in the successfully reperfused groups were -2.3 +/- 1.2 for the spontaneous recanalization group, -2.6 +/- 1.2 for the PTCA group (-2.3 +/- 1.1 for the direct PTCA group, -3.3 +/- 1.0 for rescue PTCA group) and -3.0 +/- 0.5 for the ICT group. Hypokinesis of the infarcted area was more severe in the rescue PTCA group than in the spontaneous recanalization group and the direct PTCA group (multiple comparison test p < 0.01, respectively), and hypokinesis was more severe in the ICT group than in the direct PTCA group (Student's t-test, p < 0.05).(ABSTRACT TRUNCATED AT 400 WORDS)

Adult↗

PubMed1991

[Long-term prognosis in patients with echocardiographic left ventricular dysfunction masquerading as dilated cardiomyopathy].

The long-term prognosis and prognostic factors were assessed in patients with left ventricular dilatation with impaired function secondary to idiopathic dilated cardiomyopathy (DCM) or to heart diseases of various pathogeneses masquerading as DCM (DCM-like). The echocardiographic criteria for DCM-like disease were 1) left ventricular end-diastolic dimension exceeding 60 mm and 2) fractional shortening less than 15%. Those who showed improvement in either of these 2 parameters within 3 months were excluded from this study. One hundred and fifty-eight of 35,250 serially examined patients fulfilled the definitions. The pathogeneses of diseases were valvular heart disease (VHD) in 30 patients, ischemic heart disease (IHD) in 37, alcoholic cardiomyopathy (AC) in 12, hypertensive heart disease (HHD) in 31 and DCM in 48. All of the survivors were followed for more than 24 months; an average of 40 months. During this period, there were a total of 75 deaths, 18 (27%) of whom were judged as sudden death. Five-year survival rates calculated using the Kaplan-Meier method in AC and HHD were 86% and 77%, respectively, which were significantly higher than those in DCM (48%; p < 0.05); whereas, patients with VHD and IHD had lower values (60% and 46%, respectively) which were nearly equal to those in DCM. Factors that contributed to the increase in total cardiac mortality were advanced age, higher NYHA functional class, larger cardiac size on chest radiograph and history of heavy alcohol intake. Each of these factors were closely related to the specific pathogeneses as follows: age to IHD, cardiac size to VHD, and NYHA functional class to DCM. Long-term prognosis of DCM-like heart diseases, especially those of IHD and VHD, seemed to be as bad as those of DCM.

Adult↗

PubMed1990

Postoperative angiographic evaluation of gastroepiploic artery grafts: technical considerations and short-term patency.

Follow-up angiography was performed in 37 patients with right gastroepiploic artery (GEA) grafts at 27 +/- 32 days postoperatively. By the femoral approach, a 5F cobra or twist catheter was advanced selectively into the gastroduodenal artery (GDA) over a plastic-coated guidewire. In 29 patients, the GDA was successfully catheterized, and the GEA grafts were clearly visualized by the injection of 3-7 ml of contrast medium. GDA catheterization was unsuccessful in 8 patients, but in 4 of them the grafts were well visualized when 15-20 ml of contrast was injected. In the other 4 patients, visualization of the GEA grafts was poor, but the distal portions were outlined by retrograde perfusion from the native right coronary arteries. A total of 34 GEA grafts were patent (92%), and the diameters of these grafts were adequate when compared with respective recipient coronary arteries (2.8 +/- 0.9 and 2.3 +/- 0.6 mm, respectively; P less than .05). No complications were noted except for transient vasospasm (3 patients) in the GEA, hepatic artery, or both, which was relieved by the intra-arterial injection of isosorbide dinitrate (2.5 mg). Thus, the over-the-wire technique allows simple and safe GDA catheterization, which is essential for obtaining good visualization of GEA grafts.

Adult↗

PubMed1990

[Medical treatment of type III dissecting aortic aneurysms: influence of the shape of the false lumen assessed by X-ray CT as a factor in the long-term prognosis].

The future needs of surgical repair for type III dissecting aneurysms among medically-treated patients were estimated according to the influence of the shapes of false lumina assessed by contrast-enhanced CT scans and by the level of blood pressure control at the time of discharge on the long-term prognoses. Thirty-six patients, 30 males and six females, whose mean age was 61 years, underwent enhanced CT scans at their discharge. Events, including deaths and dissection-related surgery were analyzed by a nonparametric actuarial method of Kaplan and Meier. The changes in CT findings were also studied in 33 patients who underwent follow-up CT scans within a mean interval of 3.5 years. 1. Systolic blood pressure was maintained below 140 mmHg (good control group) in 15 patients, and above 140 mmHg (poor control group) in 18 controls. There were no significant differences between the two groups for event-free survival rates. 2. The shapes of false lumina assessed by enhanced CT scans at the time of discharge were categorized in three types; 21 patients (group A) without false lumina of the aorta, or with a small crescentic false lumen in the thoracic aorta (type a), six patients (group B) with intimal flaps and two contrast-material-filled lumina in the thoracic aorta (type b), and nine patients (group C) with expanded false lumina or a false lumen whose margin was convex towards a true lumen in the thoracic aorta (type c).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed1990

[A case of intrapleural rupture of pulmonary arteriovenous malformation with shock].

We report a case of a 59-year-old male who suddenly developed massive right hemothorax and shock due to pulmonary arteriovenous malformation (AVM). He was admitted as an emergency case because of severe back pain, cyanosis and cold sweat. Although shock with massive right hemothorax was found, echocardiographic and X-ray computed tomographic examination showed no dilatation of the aorta, no intimal flap in the aorta and no pericardial effusion which suggested aneurysm. Pulmonary arteriography, performed subsequently, disclosed intrapleural rupture of the right pulmonary AVM. The patient recovered successfully from the state of shock. The pulmonary AVM was removed by segmentectomy of the right lung (S4). He was discharged following an uneventful postoperative course. Intrapleural rupture with shock is a very rare complication of pulmonary AVM. Pulmonary AVM should be considered as one possible cause in patients with massive hemothorax and shock.

Arteriovenous Malformations↗

PubMed1990

[A case of right-sided infective endocarditis in a drug addict].

A 49-year-old man was admitted to Mitsui Memorial Hospital because of fever of unknown origin. Since one year ago, he had often used intravenous narcotic drugs. Ten months before his admission, he had his first experience of fever and a chill. Four months later, he was admitted to a hospital under the diagnosis of pneumonia and he was treated successfully. After his discharge, he began to use drugs again, which resulted in the repetition of fever and chills during four months prior to his admission to our hospital. On admission, physical findings concerning the patient were unremarkable, except for mild hepatomegaly. ECG and chest X-ray were normal. Laboratory data revealed marked inflammatory changes and severe liver injury. Blood culture disclosed Campylobacter fetus and two dimensional echocardiography showed a large vegetation on the anterior tricuspid valve. He was diagnosed as isolated tricuspid infective endocarditis accompanied with acute hepatitis due to drug abuse. Moreover pulmonary perfusion scintigraphy showed decreased perfusion in the right lower lung field, which suggested that pneumonia of six months ago was due to septic pulmonary emboli from the infected tricuspid valve. The combined antibiotics therapy was successful. By the follow-up echocardiographic studies, the size of vegetation was observed to decrease progressively.

Campylobacter Infections↗

PubMed1989

[The relationship between mitral regurgitation and asynergy of the left ventricle in old myocardial infarction].

To elucidate the mechanism of mitral regurgitation (MR) in patients with old myocardial infarction, two-dimensional (2D) and 2D Doppler echocardiographic examinations were performed in 92 patients. According to the sites of asynergy in the short-axis view of the left ventricle at the papillary muscle level, the patients were classified in three groups; i.e., anteroseptal (AS) group (49 cases), inferoposterior (IP) group (29 cases), and the AS + IP group (14 cases). The existence and severity of MR were evaluated by 2D Doppler echocardiography and the presence of mitral valve prolapse (MPV), by 2D echocardiography. The mitral valve ring diameter was also measured. The incidence of MR was significantly higher in the IP group (41%) and AS + IP group (43%) than in the AS group (20%) (p less than 0.05, respectively). In the IP group, 21 patients had left ventricular asynergy at the base of the posterior papillary muscle; eight did not. In the former 21 patients with asynergy, MR was detected in 12 (57%) and MVP in nine (43%), whereas neither MR nor MVP was detected in the eight patients without asynergy. The grade of MR assessed by 2-D Doppler echocardiography was significantly more severe in patients with MVP than in those without MVP (MR distance: 23 +/- 6 mm with MVP vs 11 +/- 1 mm without MVP; p less than 0.05, MR area; 312 +/- 217 mm2 with MVP vs 64 +/- 29 mm2 without MVP; p less than 0.05). MR appeared at the mitral orifice between its middle portion and the posteromedial commissure, which coincided with the site of MVP in the majority of cases. In the AS and AS + IP groups, however, such close relationships between MR and MVP were absent. In these groups, mitral valve ring diameters were significantly larger in patients with MR than in those without MR (AS group: 32 +/- 3 mm with MR vs 24 +/- 2 mm without MR; p less than 0.01, IP group: 26 +/- 2 mm with MR vs 25 +/- 2 mm without MR; NS, AS + IP group: 30 +/- 3 mm with MR vs 24 +/- 1 mm without MR; p less than 0.05). Mitral valve ring diameters in the IP group with MR (26 +/- 2 mm) were smaller than in those in the AS and AS + IP groups with MR, and did not differ from those in the IP group without MR (25 +/- 2 mm). In conclusion, posterior papillary muscle dysfunction was mainly responsible for MR in the inferoposterior infarction and the dilatation of the mitral valve ring in the infarction involving the anteroseptal wall.

Aged↗