[Show abstract][Hide abstract] ABSTRACT: Background: Left atrial (LA) contraction is an important parameter in hypertensive (HT) patients. However, it is difficult to evaluate LA contraction non-invasively. Recently, a Doppler echocardiogram derived left atrial ejection force (LAEF) method was introduced for evaluating LA contraction. We studied LAEF in patients with HT. Subjects: One hundred and twenty-four patients with HT were studied. There were 74 men and 50 women. Age ranged 35-77 years. Thirty-five normal subjects and 20 patients with congestive heart failure (CHF) or paroxysmal atrial fibrillation (PAF) were also studied. Principle: According to Newton's law of motion, LAEF is calculated as LA ejection volume acceleration of flow. LA ejection volume = mitral valve area (MVA) time velocity integral of mitral flow. Acceleration is the slope of atrial flow velocity. Methods: (1) MVA was calculated by 2-D echo. Mitral flow velocity was recorded by pulsed Doppler. (2) LAEF was calculated as 1/3 MVA A 2 , where A is the atrial flow velocity. (3) LAEF was compared with WHO stage and period of HT. (4) LAEF was compared between patients with and without CHF or PAF. Results: (1) In normal subjects, LAEF correlated with age (r = 0.74, p < 0.001). Therefore, age corrected %LAEF was used for analysis. %LAEF = (actual LAEF) / (normal LAEF) 100. (2) In patients with HT, %LAEF was 107.8 ± 5.7 % in WHO stage I, 111.6 ± 8.0 % in stage II and 105.7 ± 13.5 % in stage III (n.s.). %LAEF was higher in patients with WHO stage I and II than normal subjects. (3) %LAEF was 111.6 ± 6.0 % in patients with period < 9 years, 108.6 ± 9.0 % in period 10-20 years and 105.8 ± 11.2 % in period > 20 years. %LAEF had a tendency to decrease with period of HT (n.s.). (4) %LAEF was 50.5 ± 22.4 % in patients with PAF, and was 64.3 ± 31.8 % in patients with CHF. %LAEF was lower in hypertensive patients with CHF or PAF than without CHF or PAF (p < 0.001). Conclusions: LAEF may be compensated in mid stage of hypertension and decompensated in late stage of hypertension. LAEF is decreased in hypertensive patients with paroxysmal atrial fibrillation or congestive heart failure. J Clin Basic Cardiol 2002; 5: 237-40.
[Show abstract][Hide abstract] ABSTRACT: A case of carcinoma of the colon that metastasized to the lower gingiva is described. The patient who had carcinoma of the colon developed a proliferating lesion at the site of a recent tooth extraction. A few days later, the primary site of the malignancy appeared. The clinical features in such cases were reviewed in studies by others, most of which were of oral and dental surgery. Thus, because of our case, gastroenterologists should consider the possibility of gingival metastasis from malignant disease such as colorectal cancer.
Digestive Surgery 02/2001; 18(4):333-5. DOI:10.1159/000050166 · 2.16 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Lipiodolization, a selective regional cancer chemotherapeutic modality using lipiodol plus anticancer drugs, can prolong the survival time of patients with unresectable liver cancer. A preliminary study was conducted with adjuvant lipiodolization before a potentially curative hepatectomy for patients with metachronous colorectal liver metastases. The ultimate aim of this study was to improve the long-term survival after hepatectomy.
Twenty-one consecutive patients with colorectal hepatic metastases were included in this study. Seven patients underwent preoperative lipiodolization, while the remaining 14 patients did not receive any preoperative adjuvant therapy. The clinicopathological features and prognoses of these patients were investigated. The median follow-up period after a curative hepatectomy was 56 months.
The clinicopathological factors did not differ markedly between the 2 groups. However, the cumulative survival rate of the 7 patients receiving preoperative lipiodolization was significantly (P < 0.05) better than that in those not receiving any preoperative treatment.
Based on the above encouraging findings, we therefore propose that a prospective randomized trial should be carried out to confirm the beneficial effects of our adjuvant chemotherapeutic modality on patient survival following a curative hepatectomy for the patients with colorectal liver metastases.
[Show abstract][Hide abstract] ABSTRACT: Combined hepatocellular carcinoma and cholangiocarcinoma is a rare tumor. In addition, both hepatocellular carcinoma and cholangiocarcinoma are rarely associated with cystic lesions. We herein present a 62-year-old Japanese woman with combined hepatocellular carcinoma and cholangiocarcinoma which was associated with a rapidly enlarging cystic lesion. Both abdominal ultrasonography and computed tomography revealed a cyst with a solid portion in the left hepatic lobe. A partial hepatectomy was performed on the basis of a tentative diagnosis of a cystadenocarcinoma of the liver, while the diagnosis based on immunohistochemical studies was combined hepatocellular carcinoma and cholangiocarcinoma with cystic formation. The patient died of tumor recurrence, such as intrahepatic metastases and extensive lymph node metastases, 6 months after the operation. The prognosis of this entity, which has never been reported in the English medical literature and is difficult to preoperatively differentiate from hepatic cystadenocarcinoma, therefore seems to be extremely poor.
[Show abstract][Hide abstract] ABSTRACT: Platelet aggregation is one of the most important mechanisms for acute myocardial infarction during exercise. We sought to evaluate the effect of ticlopidine (TP) on platelet aggregation (PA) during exercise in patients with ischemic heart disease (IHD). We studied 38 patients with IHD, 26 patients with effort angina pectoris, and 12 patients with a previous myocardial infarction. In protocol I, subjects were divided into two groups. Drugs altering platelet aggregation were withheld 2-4 weeks before the study in 25 patients (control group). TP (200 mg/day) was administered for 7 days in 13 patients (ticlopidine group). A symptom-limited modified Bruce protocol treadmill exercise test was performed. PA was measured at rest and after exercise by using optical densitometry induced by adenosine diphosphate (ADP). PA ratio (percentage of maximum) was compared. In protocol II, in 12 patients, treadmill exercise test and PA measurement were performed with and without TP. PA significantly increased after exercise in control (from 51.7+/-23.3% to 64.4+/-27.7%, p < 0.01) and ticlopidine (from 31.9+/-10.5% to 42.0+/-20.4%, p < .01) groups; however, its grade was lower in the ticlopidine group than in the control group. After exercise, PA was lower in the ticlopidine group than in control group (42.0+/-20.4% vs. 64.4+/-27.7%; p < 0.01). In the same patients, PA was lower with TP than without TP after exercise. Treadmill exercise-tolerance time was greater in the ticlopidine group than in the control group, but not statistically significant (762.3+/-139.2 vs. 711.6+/-169.6 s; NS). Exercise-tolerance time was significantly greater with TP than without TP in same patient (791.7+/-98.9 vs. 733.3+/-152.8 s; p < .05). TP suppressed the increase of PA during exercise and increased the exercise-tolerance time in patients with IHD.
[Show abstract][Hide abstract] ABSTRACT: A 65-year-old woman with hepatocellular carcinoma underwent right hepatic lobectomy. Her alpha-fetoprotein levels significantly dropped from 285,000 ng/ml to 3,100 ng/ml for one month without any preoperative treatment. The tumor thrombus in the portal vein showed complete necrosis, and lymphocytes infiltration around the main tumor were present microscopically. However, there was no necrotic area in the main tumor. This patient is living with no evidence of recurrence for 3 years and 6 months following hepatic resection.
[Show abstract][Hide abstract] ABSTRACT: We evaluated the diagnostic value of thoracoscopic examinations in eleven patients who had pleural effusion and were diagnosed as tuberculous pleurisy. The characteristic white or yellowish-white micronodules were observed by thoracoscopy in eight patients and all their biopsied tissue were compatible with tuberculosis. We had some cases which were not determined as tuberculous pleurisy from bacteriological examinations and were determined only from the thoracoscopic findings.
[Show abstract][Hide abstract] ABSTRACT: Laparoscopic cholecystectomy is widely accepted by patients and physicians despite the lack of controlled trials comparing this technology with conventional cholecystectomy. The cystohepatic ducts represent accessory bile ducts of variable size which frequently travel within the gallbladder fossa or in the posterior wall of the gallbladder. These ducts can be injured during laparoscopic cholecystectomy and can result in bile collection if transected. Recently, we have experienced two cases of injury to the bile duct during operation. One case was a transection of the accessory bile duct, the other one was an injury to the common hepatic duct. We present herein the clinical course of the two cases, in which biliary leakage, following laparoscopic cholecystectomy, was successfully managed by the end to end anastomosis of the bile duct.
The Kurume Medical Journal 02/1998; 45(1):143-5. DOI:10.2739/kurumemedj.45.143
[Show abstract][Hide abstract] ABSTRACT: Straight back syndrome (SBS) is usually diagnosed by physical and chest radiographic findings. Radiographic computed tomographic (CT) findings are very useful for the diagnosis and the evaluation of its severity. The purpose is to evaluate the relationship between chest X-ray film and CT findings.
We evaluated 26 patients (SBS group) and 11 normal subjects (control group). SBS group consisted of 15 patients without structural heart disease (group I) and 11 patients with other heart disease (group II).
(1) On the chest X-ray film, antero-posterior diameter (APD) of the thorax, transthoracic diameter (TTD), and APD/TTD ratio were measured. (2) On the CT image, three parameters were calculated; APD of the left atrium (LA diameter), APD/transverse diameter ratio of the heart (flattening ratio) and left side shift ratio of the heart (shifting ratio). (3) CT parameters were compared with APD/TTD ratio in patients and control group.
(1) APD/TTD ratio was smaller in group I and II than control group (30.0 +/- 5.4, 30.5 +/- 4.0 v 44.6 +/- 2.7%, p < .001). (2) LA diameter was smaller in group I and II than control group (23.2 +/- 4.1, 26.0 +/- 8.6 v 30.0 +/- 6.5 mm, p < .01). Flattening ratio was also smaller in group I and II than control group (59.2 +/- 9.4, 61.8 +/- 8.6 v 75.4 +/- 13.2%, p < .01). Shifting ratio was greater in group I and II than control group (10.9 +/- 5.0, 11.9 +/- 4.5 v 8.4 +/- 4.0%, p < .01). (3) APD/TTD ratio correlated with LA diameter (r = .39, p < .05) and flattening ratio (r = .53, p < .001). APD/TTD ratio did not correlate with shifting ratio (r = -.27, NS).
APD/TTD ratio correlated with LA diameter and flattening ratio rather than shifting ratio. LA diameter and flattening ratio on the CT image were more useful for evaluating the severity.
American journal of cardiac imaging 10/1996; 10(4):228-34.
[Show abstract][Hide abstract] ABSTRACT: A case of primary splenic lymphoma in a patient with chronic hepatitis C is reported. A 69-year-old man with chronic hepatitis C was admitted to Fukuoka City Hospital for evaluation of an enlarging splenic tumour. In the spleen, ultrasonographic examination revealed a hypoechoic tumour and computed tomography demonstrated a non-enhancing low density area measuring 7 cm in diameter; coeliac angiography revealed a hypovascular tumour. Gallium scintigraphy showed uptake of the radioisotope in the splenic tumour. A splenectomy was performed and the morphological and immunohistochemical findings of this tumour were compatible with those of non-Hodgin's B cell lymphoma. Recently, cases of malignant B cell lymphoma associated with hepatitis C virus infection have been reported. Lymphotropism of hepatitis C virus may play a pathological role in the development of non-Hodgkin's lymphoma. We emphasize the importance of considering lymphoma in the differential diagnosis of extrahepatic disorders during the course of chronic hepatitis C virus infections.
Journal of Gastroenterology and Hepatology 09/1996; 11(8):724-7. · 3.50 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: A 62-year-old man was admitted to our hospital for treatment of HCC with a thrombus growing from the right branch to the trunk of the portal vein. His hepatic functional reserve was fairly good. Serum levels of AFP and PIVKA-II were elevated to 1,780 ng/ml and 27 AU-ml, respectively. The hepatic arteriogram showed a hypervascular tumor approximately 4 cm in diameter in the right anterior segment and many ill-defined small tumor stains around the main tumor. Portal phase of superior mesenteric arteriogram revealed filling defect in the portal trunk, and no visualization of the right branch of portal vein. SMANCS-Lipiodol was infused via right hepatic artery, and Spongel was infused via right anterior branch of hepatic artery. Three months after the first therapy, the tumor markers normalized. A computed tomography scan showed that the main tumor and the tumor thrombus were markedly decreased in size, whereas the hepatic angiogram revealed tumor stains around the main tumor. SMANCS-Lipiodol was again infused via proper hepatic artery. He has remained well for 16 months after the first treatment. The combination of the arterial infusion of SMANCS-Lipiodol with the selective TAE was very effective for this case, probably because his hepatic functional reserve was fairly good and the left branch of portal vein was patent. It was suggested that SMANCS-Lipiodol with the selective TAE could be one therapy to be considered for a patient like this case.
Gan to kagaku ryoho. Cancer & chemotherapy 08/1996; 23(8):1073-6.
[Show abstract][Hide abstract] ABSTRACT: Nisoldipine is a second generation dihydropyridine calcium antagonist having characteristics of strong coronary artery dilating effect and less negative inotropic action. The purpose of this study was to evaluate the effect of nisoldipine on the cardiac function (systolic and diastolic) and the exercise tolerance, in patients with hypertrophic cardiomyopathy (HCM).
Twenty-three patients with HCM were studied.
We measured the following indices using M-mode and pulsed wave Doppler echocardiography before and after nisoldipine therapy; left ventricular fractional shortening (LVFS), isometric relaxation time (IRT), deceleration half-time (DHT) of early diastolic mitral (E) flow, late diastolic mitral (A) flow and A/E ratio. Symptom-limited treadmill exercise test was performed. Exercise tolerance (EX) time was measured. Nisoldipine of 10 mg/day was orally administered. Same tests were repeated on day 14 and after 6 months.
1) Short-term effects; LVFS did not change (55.9 +/- 5.9%-->57.0 +/- 7.4%, NS) after 2 weeks. However, LV diastolic function significantly improved (IRT; 92.1 +/- 7.7 ms-->85.2 +/- 11.6 ms, p < 0.05, DHT; 70.7 +/- 16.2 ms-->63.3 +/- 3.7 ms, p < 0.05). EX time increased (8.9 +/- 2.6 min-->10.0 +/- 3.3 min, p < 0.05), 2) Long-term effects; LV diastolic function had a tendency toward improvement, but is statistically not significant (IRT; 91.1 +/- 7.6-->83.8 +/- 11.6 ms, DHT; 73.1 +/- 23.4-->61.0 +/- 11.4 ms, A/E; 1.26 +/- 0.29-->1.11 +/- 0.36) after 6 months. EX time was significantly increased (9.4 +/- 1.7--> 10.1 +/- 1.7 min, p < 0.05).
Nisoldipine improved LV diastolic dysfunction and exercise tolerance in patients with HCM. These effects were similar to the first generation calcium antagonists. LV diastolic dysfunction may be improved due to the reduction of intracellular calcium concentration and the relief of myocardial ischemia by strong coronary artery dilating effect. However, nisoldipine did not affect the LV systolic function because of its less negative inotropic effect.
Archiv für Kreislaufforschung 07/1996; 91(4):329-36. DOI:10.1007/BF00789305 · 5.41 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: A 33-year-old woman had been on hemodialysis since she was 25 years old. In September, 1993, she had cough, which gradually increased in severity, and was accompanied by slight fever. No abnormality was observed on the chest radiography taken on November 2. However, bilateral diffuse miliary shadows were observed on the radiograph taken on November 30. Tubercle bacilli were detected by the examination of sputum smear. As she was pregnant 20 weeks, therapeutic abortion was done on December 8. A case of miliary tuberculosis occurring during pregnancy in a patient on hemodialysis has not been documented in Japan to date, and the first case in Japan was reported with a review of the literature.
[Show abstract][Hide abstract] ABSTRACT: We report unique features of computed tomography (CT) and magnetic resonance (MR) imaging in the metastatic lesion of the liver in a case of gastric leiomyosarcoma. A CT scan and MR image demonstrated presence of a huge multilocular cystic lesion in the liver, of which finding were unlike to those of usual smooth muscle tumors, but mimicked to those of cystadenomatous tumors. In addition, this case had an extremely long elapsing time over ten years from the radical operation for the primary site.