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Biomedical subjects

Y Okada

Publications and source records attributed to Y Okada.

At least 649 records · Page 36Linked to original sources
PubMed1997

[Open heart surgery without blood transfusion for complete atrioventricular septal defect associated with tetralogy of Fallot].

Open heart surgery without blood transfusion was successfully performed in two patients with complete atrioventricular septal defect associated with tetralogy of Fallot. The postoperative hemodynamics and respiratory status were uneventful in both patients (central venous pressure after ICU admission: 13.7 cmH2O and 11.5 cmH2O, intubation time after surgery: 9 hours and 11 hours). Autologous blood donation immediately after induction of anesthesia and minimization of bypass circuit were effective methods for open heart surgery without blood transfusion, particularly in cyanotic patients requiring prolonged cardiopulmonary bypass for intracardiac repair.

Blood Transfusion, Autologous↗
PubMed1997

A case of exophytic hepatic hemangioma mimicking adrenal tumor.

A rare case of exophytic hepatic hemangioma preoperatively diagnosed as a non-functioning adrenal tumor is reported. A 62-year-old man was admitted for treatment of primary hyper-parathyroidism and an incidental adrenal tumor. A 4.0 x 2.5 cm heterogeneous tumor located between the liver and the right kidney was detected by abdominal ultrasonography, computed tomography and magnetic resonance imaging. Color doppler images revealed no apparent blood flow. Since the tumor seemed to have originated from the liver under laparoscopy, an open partial hepatectomy was performed. Histopathological examination revealed cavernous hemangioma of the liver. When diagnosing non-functioning right adrenal tumor, it may be necessary to carefully rule out an exophytic liver tumor.

Adrenal Gland Neoplasms↗
PubMed1997

[Echocardiographic evaluation of cardiotoxicity induced by anthracycline therapy].

Echocardiographic reports on 144 adults receiving anthracycline therapy and 18 controls were reviewed for the possible relationship between dosage and ejection fractions. The cardiotoxicity of each anthracycline drug was evaluated as follows: Pirarubicin = 0.8, Mitoxantrone = 3.4, Daunorubicin = 0.5, Aclarubicin = 0, and Epirubicin = 0.6 with Doxorubicin = 1 as a control. As a whole, the ejection fractions, which decreased subsequently compared with increasing amount of dosage, showed a remarkable decrease at the dosage level of 600 mg/m2. However, the ejection fractions differed among individual patients. It was predicted that heart failure would not develop when the ejection fractions exceeded 55%. It is desirable to stop anthracycline therapy when the ejection fractions drop to 55%.

Aclarubicin↗
PubMed1997

Clinical experience of orthotopic urinary reservoirs in male patients with bladder cancer.

Between 1988 and 1996, 23 male patients with bladder cancer underwent bladder substitution after cystectomy, using either the hemi-Kock, Hautmann, and Reddy procedures. The mean postoperative follow-up period was 36 months, with a range of 3 to 85 months. There were no perioperative deaths, and early postoperative complications occurred in 7 patients (30%); transient urine leak from the pouch in 4, wound infection in 3 and pyelonephritis in 2 patients. Twenty-two of the 23 patients (96%) were continent during the day, while 7 (30%) had nocturnal incontinence. All 3 patients with the Reddy procedure had nocturnal incontinence. Complete continence was preserved in 70% of the patients. Dysuria was seen in 4 patients, including retention in 1 patient. Late complications included urethral stricture in 3, wound hernia in 2, metabolic acidosis in 1, stone in the pouch in 1, and gallbladder stone in 1 patient. However, reoperation was necessary in 1 patient for internal urethrotomy and 1 patient for removal of a stone in the neobladder. Mild degree of hydronephrosis and unilateral reflux were seen in 3 patients each, and followed up conservatively. No urethral recurrence has occurred and only 1 patient died of cancer. The need for reoperation was very low and the high reservoir capacity resulted in continence from the beginning in most patients. We considered the neobladder useful as an alternative form of urinary diversion in selected cases.

Adult↗
PubMed1997

[Hemo-lymphangioma of the scrotum: a case report].

A 3-year-old boy was referred because of a painless mass in the left scrotum. On palpation, the mass was discriminated from the testis, epididymis and spermatic cord and showed transillumination. A part of the mass was dark purple in color. Total surgical excision of the mass was performed. The lesion was multicystic (2-15 mm), adherent to the scrotal skin, and easily dissectable from the testicle. Pathological examination revealed lymphangioma as a major component and hemangioma as a minor part. He has been free of recurrent disease for 2 years. This is the 7th case of hemo-lymphangioma of the scrotum in the Japanese literature.

Child, Preschool↗
PubMed1997

[Open heart surgery without homologous blood transfusion for tetralogy of Fallot--use of hydroxyethyl starch diminishes the necessity of protein transfusion].

To avoid any blood or protein transfusions, we employed 6% hydroxyethyl starch in 0.9% saline (saline HES) during cardiopulmonary bypass (CPB) for intracardiac repair in 24 consecutive patients with Tetralogy of Fallot (TF). The postoperative course has been satisfactory (central venous pressure 9.5 +/- 1.2 cmH2O, duration of intubation after surgery 4.4 +/- 1.5 hours), and all patients but one did not require transfusion therapy during their hospital stay. We conclude that intracardiac repair without transfusions is feasible in almost all patients with TF, when substituting saline HES for blood or proteins.

Blood Proteins↗
PubMed1997

Membrane-type matrix metalloproteinases (MT-MMPs) in cell invasion.

Activated gelatinase A is reportedly associated with tumor spread. We identified a novel matrix metalloproteinase that localizes on the cell surface and mediate the activation of progelatinase A. Thus, this progelatinase A activator was named membrane-type matrix metalloproteinase (MT1-MMP). Following the first-discovery of MT1-MMP, two other MT-MMPs which can activate progelatinase A were identified (MT2- and MT3-MMP, respectively). Among these three MT-MMPs, MT1-MMP is most often overexpressed in malignant tumor tissues, including lung and stomach carcinomas that contain activated gelatinase A. This suggests that MT1-MMP is most closely associated with the activation of progelatinase A in these tumor tissues. The expression of MT1-MMP also induced binding of gelatinase A to the cell surface by functioning as a receptor. The cell surface localization of proteinases has advantages over pericellular proteolysis. MT1-MMP and its family may play a central role in the cell surface localization and activation of progelatinase A and via this mechanism, tumor cells use exogenous progelatinase A to mediate the proteolysis associated with invasion and metastasis.

Chromosome Mapping↗
PubMed1997

[Clinical outcome of bladder preserving therapy for superficial high-grade bladder cancer].

Clinical outcome of bladder preserving therapy for superficial high-grade bladder cancers (pTa-pT1b, G3) was retrospectively studied. Twenty-six patients initially received bladder preserving therapy ('preserved' group), while 19 underwent radical cystectomy as the initial treatment ('cystectomized' group). Tumor recurrence was accompanied by a progression in the tumor grade in 9 patients with low-grade tumors ('grade-up' group). The 5-year survival rate was 87% and 100% in the preserved and cystectomized groups, respectively, with no significant difference. However, the grade-up group had a significantly worse rate of 57%. Failure in bladder preserving therapy was unrelated to the size or number of tumors. Our findings suggest that bladder preserving therapy is a reasonable treatment option for superficial high-grade tumors although a careful followup is mandatory. On the other hand, radical cystectomy should be considered for recurrent, grade-up G3 tumors.

Aged↗
PubMed1997

Expression of membrane-type 1 matrix metalloproteinase and activation of progelatinase A in human osteoarthritic cartilage.

Matrix metalloproteinases (MMPs) are expressed in osteoarthritic (OA) cartilage and are thought to be involved in the degradation of cartilage extracellular matrix (ECM). Among these proteinases, MMP-2 (gelatinase A) demonstrates a wide range of substrate specificity against the ECM present in cartilage. Although MMP-2 expression increases in OA cartilage, the activation mechanism of the corresponding zymogen (pro-MMP-2) in cartilage is unknown. In this study, we examined the expression pattern of membrane-type 1 MMP (MT1-MMP) in human OA articular cartilage and its correlation with the activation of pro-MMP-2. Immunohistochemical studies demonstrate that MT1-MMP localizes to the chondrocytes in the superficial and transitional zones in all of the samples examined directly correlating with cartilage degradation. Reverse transcription polymerase chain reaction confirmed the predominant expression of MT1-MMP mRNA in the OA cartilage. In situ hybridization revealed the site of expression of MT1-MMP in OA cartilage to be the chondrocytes. Through gelatin zymography and a sandwich enzyme immunoassay it was demonstrated that OA cartilage explants secrete significantly higher levels of pro-MMP-2 than normal samples. Pro-MMP-2 activation was enhanced in the OA cartilage samples and correlated with MT1-MMP expression in the cartilage. Plasma membranes prepared from cultured chondrocytes with MT1-MMP expression and those directly isolated from OA cartilage could activate pro-MMP-2. MT1-MMP gene expression in cultured chondrocytes was induced by treatment with interleukin-1 alpha and/or tumor necrosis factor-alpha. These data suggest that cytokine-induced MT1-MMP in the chondrocytes may play a key role in the activation of pro-MMP-2 in the OA articular cartilage, leading to cartilage destruction through ECM degradation.

Aged↗
PubMed1997

[The use of low dose midazolam for the management of spinal anesthesia].

The purpose of this study was to evaluate the effects of low dose midazolam (MZ) on memories and ease of management of spinal anesthesia. The low doses of MZ were administered to 70 patients (ASA 1-2), of whom 37 patients were premedicated with atropine sulfate 0.5 mg and pethidine hydrochloride (group P), with 33 patients receiving no premedication (group N). Double blind randomized trials were conducted with the doses of MZ (0, 0.03, 0.06 mg.kg-1), and MZ was administered i.v. to patients just prior to spinal puncture. The short-term and long-term memories were impaired after administration of MZ in both groups. We conclude that MZ appears to be a suitable replacement for other benzodiazepines for relieving anxiety of patients during surgery.

Adolescent↗
PubMed1997

[The efficiency of a new porous type leukocyte removal filter for red cell blood components, Terumo Imuguard III-RC, in the rapid transfusion conditions].

We evaluated the efficiency of a new porous type leukocyte removal filter for red cell blood components, Terumo Imuguard III-RC, in the rapid transfusion conditions. One leukocyte removal filter was used for 2 units of RC-M.A.P (red cell mannitol-adenine-phosphate). Filtration methods employed were gravity infusion, high pressure infusion (300 mmHg), pumping infusion and 20 ml.min-1 infusion under high pressure (300 mmHg). Blood samples were taken before and after the filtration to measure white blood cell (WBC), red blood cell (RBC) and platelet content. Blood samples before filtration and after filtration with WBC excluded, were examined by automated hematology analyzer (Coulter counter STKS-Retic). WBC after filtration was counted by the hemacytometer method using Nageotte Chamber. The removal rate of WBC was found to be more than 99.99% and residual WBC content was less than 4 x 10(4) with every method. The recovery rate of RBC was not significantly decreased in all filtration methods. The removal rate of platelet was equal in all filtration methods. In conclusion, Imuguard III-RC could be useful for effective homologous blood transfusion.

Blood Transfusion↗
PubMed1997

[Angiographical evaluation of extracranial carotid artery: comparison between Japanese and Hungarian].

We investigated the cervical level of carotid bifurcation, diameter of common carotid artery (CCA) and internal carotid artery (ICA) in 147 Japanese patients (150 arteries, range of age 31-79) and in 490 Hungarian patients (517 arteries, range of age 12-77). The cervical level of carotid bifurcation was determined by comparison with cervical vertebra. The carotid bifurcation of Japanese was most frequent at the lower part of 3rd cervical vertebra but in Hungarian the bifurcation was most frequent at the middle part of 4th cervical vertebra. Japanese carotid bifurcation was high-positioned compared with Hungarian. The mean CCA diameter in Japanese was 7.47 mm in male and 7.07 mm in female, in Hungarian 9.24 mm in male and 7.80 mm in female. The mean ICA diameter in Japanese was 4.96 mm in male and 4.83 mm in female, in Hungarian 8.56 mm in male and 7.66 mm in female. CCA and ICA diameter were larger in male than in female. The diameter of CCA had a significantly positive correlation with age (p < 0.002) but ICA had no similar correlation.

Adolescent↗
PubMed1997

[Clinical results of left ventricular free wall rupture following acute myocardial infarction].

We studied 19 cases of Left Ventricular Free Wall Rupture (LVFWR) following acute myocardial infarction, admitted to our CCU between 1987 and 1996. We were able to treat 15 patients and diagnosed 4 cases as LVFWR at postmortem after sudden deaths. Of the treated 15 patients, 11 survived: 1 out of 2 repaired under cardiopulmonary bypass (CPB), 5 out of 7 repaired without CPB, and 5 out of 6 non-surgically treated. Although the survival rate for those able to be treated was 73%, overall rate was 58%. There were 7 cases of blow-out type: 4 of which were sudden deaths, and 3 were operated. Thoracotomy and direct closure of rupture without CPB was done at bed-side in 2 cases. Even though hemostasis was successful, they did not survive. The 3rd case survived with the patch closure under CPB. In this case, the circulation was maintained pre-operatively with the pericardial-central venous bypass drainage method. This method seems to be extremely effective in saving blow-out cases. There were 12 subacute patients. Although 2 cases were lost, total of 10 patients were saved, including 2 direct suture closures of rupture without CPB, 3 median sternotomy and fibrin-glue fixations, 1 where only pericardial drainage was done, and 4 in whom percutaneous intrapericardial fibrin-glue fixation therapy was utilized. Since the risk of secondary damage to the fragile infarcted are from direct suturing of ruptured myocardium exists in LVFWR, we changed to the Infarction Exclusion Technique under CPB during surgical repair, based on our experiences with ruptured intraventricular septum. In general, the only treatment believed to be available for LVFWR has been surgical. However, our experiences suggest that other treatments may also be effective. If the best suitable method could be chosen from various therapies, it may contribute to improving outcome statistics. The reduction of left ventricular pressure in the treatment is extremely important, being the key to improving survival rate.

Aged↗
PubMed1997

[The case of left atrial myxoma originating from posterior leaflet of mitral valve].

We experienced the case of left atrial myxoma originating from posterior leaflet mitral valve. Mitral valve repair was performed in that case, because of the presence mitral leaflet defect due to removal of the myxoma. Transesophageal echocardiography was a useful tool for perioperative evaluation of the mitral valve and precise localization of the origin of the myxoma.

Adolescent↗