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61.
Atsushi Nakahira Hitoshi Ogino Hiroaki Sasaki Nobuyuki Katakami 《European journal of cardio-thoracic surgery》2007,32(2):388-390
Malignant pulmonary artery tumors represented by sarcomas are rare, but fatal. Early diagnosis and radical surgical resection offer the only chance for survival. However, surgical intervention has some challenging aspects, and prognosis is poor even after tumor resection. We report a case of a pulmonary artery sarcoma between the right ventricular outflow tract and the pulmonary artery branches. The tumor was aggressively extracted with reconstruction using a cryopreserved pulmonary valved allograft, followed by adjuvant chemoradiotherapy. At 56 months after surgery, the patient is well without any evidence of recurrence, demonstrating that aggressive surgical resection with adjuvant chemoradiotherapy can prolong survival. 相似文献
62.
Hiroaki Yoshikawa 《Clinical neurology》2007,47(11):880-882
MGTX Study is a multi-center, international, single-blinded, randomized trial to determine whether extended transsternal thymectomy (ETTX) for patients with myasthenia gravis receiving the prednisone protocol confers added benefits to the prednisone protocol alone. The aims of the study are answering following three questions. 1) Does ETTX combined with prednisone result in a greater improvement in myasthenic weakness, compared to prednisone alone? 2) Does ETTX combined with prednisone result in a lower total dose of prednisone, thus decreasing the likelihood of concurrent and long-term toxic effects, compared to prednisone alone? 3) Does ETTX combined with prednisone enhance quality of life by reducing adverse events and symptoms associated with the therapies, compared to prednisone alone? Primary outcome measure is consists with 1) Comparison of the prednisone protocol alone to prednisone protocol plus ETTX, based on the clinical response to therapy measured over the 3 year trial period by the Area Under the Quantitative Myasthenia Gravis (QMG) Weakness Score (AUQMG), and 2) Testing the difference in the total prednisone used over the 3 year trial period measured by pill count from blister packs (Area Under the Prednisone Dose Time Curve, AUDTC), conditional on the results of comparing AUQMG. 相似文献
63.
Yusuke Narita Katsuhiko Naoki Naoya Hida Hiroaki Okamoto 《Nihon Kokyūki Gakkai zasshi》2007,45(1):13-20
A 78-year-old woman was admitted with dyspnea. She had caught a cold and took an over-the-counter drug (Nospole G) for 2 weeks before admission. Chest radiography and CT scanning showed bilateral diffuse and interstitial shadows, and arterial blood gas analysis demonstrated severe hypoxemia. Withdrawal of Nospole and treatment with both corticosteroid and sivelestat sodium resulted in improvement of clinical findings and successful recovery from mechanical ventilation. A drug lymphocyte stimulation test for Nospole G was positive. Based on these findings, we determined that this patient had drug-induced pneumonitis caused by Nospole G. Finally, she died of sepsis caused by multidrug-resistant Staphylococcus aureus (MRSA) infection. In summary, we report here an elderly case of drug-induced pneumonitis successfully weaned from mechanical ventilation by early treatment with corticosteroid and sivelestat sodium, monitored by changes of markers for interstitial pneumonitis (KL-6, SP-A, SP-D). 相似文献
64.
Masaaki Kohta Hiroaki Minami Kazuhiro Tanaka Keiichi Kuwamura Takeshi Kondoh Eiji Kohmura 《Journal of clinical neuroscience》2007,14(2):167-170
A 52-year-old man fell from standing and a computed tomography (CT) scan revealed traumatic intracerebral haematoma and subarachnoid haemorrhage in the temporal cortex. He was treated without surgery and discharged. On day 30 after the accident, he had no neurological deficit. On day 37 he complained of headache and urinary incontinence, and on day 39 he was hospitalized due to progressive neurological deterioration (reduced conciousness, dilated pupils, and left hemiplegia). A CT scan revealed a diffuse low-density in the right cerebral hemisphere with marked midline shift. Emergency decompressive craniectomy and right temporal lobectomy were performed. Angiography after surgery revealed moderate vasospasm in the right middle and anterior cerebral arteries. The patient remained severely disabled. Delayed onset neurological deterioration can be caused by brain oedema and vasospasm after traumatic brain injury, despite an intervening period of improvement. 相似文献
65.
Y Nakamura K Fukamachi M Masuda T Asou Y Toshima M Oe A Mitani K Kinoshita Y Kawachi J Tanaka 《The Journal of thoracic and cardiovascular surgery》1990,99(2):335-344
Retrograde administration of cardioplegic solution via the right atrium with continuous cooling of the right ventricular cavity (right atrial perfusion cooling) was assessed for its protective effect in 12 dogs with occlusion of the right coronary artery subjected to global ischemia for 60 minutes. After an initial administration of 4 degrees C crystalloid cardioplegic solution by antegrade aortic perfusion, myocardial protection was established either by right atrial perfusion cooling (group I; n = 6) or by antegrade aortic perfusion alone (group II; n = 6). The right ventricular temperature was approximately 15 degrees C in group I and 20 degrees C in group II. After ischemia for 60 minutes, the adenosine triphosphate content of the right ventricular free wall was significantly higher in group I than in group II (24.4 +/- 1.45 versus 13.8 +/- 2.34 mumol/gm dry weight, p less than 0.05). The percent recovery of right ventricular contractility, which was evaluated by end-systolic pressure-volume relationships, was significantly better in group I at each reperfusion period (30 minutes: 130.0% +/- 9.6% versus 86.1% +/- 11.8%, p less than 0.05; 60 minutes: 159.6% +/- 12.9% versus 96.5% +/- 20.1%, p less than 0.05). Postischemic right ventricular stiffness (reciprocal value of compliance) increased in group II compared with group I, although the difference was not statistically significant. There were no major differences in percent recovery of the left ventricular end-systolic pressure-volume relationships between the two groups. The evidence suggests that the right atrial perfusion cooling method produces excellent right ventricular protection. 相似文献
66.
67.
Nobuo Wakata Hidenari Fukuya Masamichi Niizuma Tetsuro Ishida Masao Kinoshita 《Clinical neurology and neurosurgery》1992,94(4):303-306
We report 4 cases of myasthenia gravis in which myasthenic symptoms developed after a thymoma was known to be present. They include 3 invasive thymomas and one thymoma. In 3 of them, myasthenic symptoms developed 2–7 months after removal of the thymoma; in 1 case, myasthenic symptoms developed 11 years after the thymoma was known to be present. We also discuss here the possible pathogenetic mechanism of post-thymomectomic myasthenia gravis, and propose that it is due to the natural course of the disease. 相似文献
68.
A rare case of pituitary metastasis of thyroid follicular adenocarcinoma occurred in a 62-year-old female manifesting as left retro-orbital pain and diplopia. Computed tomography and magnetic resonance imaging revealed a tumor in the pituitary fossa extending to the left cavernous sinus, sphenoid sinus, and prepontine cistern, destroying the upper portion of the clivus. An asymptomatic thyroid mass, probably malignant, was also found. She also had an incidental small meningioma in the posterior fossa. The pituitary tumor was partially removed, and the thyroid and posterior fossa tumors were totally removed in two operations. Both pituitary and thyroid tumors were verified to be follicular adenocarcinoma. Postoperatively, she developed panhypopituitarism for which cortisol and thyroxine replacement therapy was necessary. Three years after first therapy, she was alive but her symptoms did not improve. 相似文献
69.
M. Higashima Hiroya Kinoshita Nariyoshi Yamaguchi Yoshifumi Koshino 《Psychopharmacology》1997,131(4):394-398
It has been reported that the clinical and electroencephalographic profiles of zolpidem, a non-benzodiazepine drug which
binds preferentially to the ω1 benzodiazepine recognition sites located within the GABAA receptor complex, are different from those of benzodiazepine drugs, which bind non-selectively to the ω1 and ω2 sites. In order to clarify the electrophysiological mechanism underlying the unique profile of zolpidem, the present study
compared the enhancing effects of zolpidem and two benzodiazepine drugs, triazolam and diazepam, on recurrent inhibition.
This inhibition was expressed as suppression of the orthodromically induced population spikes by the preceding antidromic
stimulation of the alveus in the CA1 region of rat hippocampal slices. The rank order of potency for enhancing recurrent inhibition
was triazolam > diazepam > zolpidem. From the present results and previously reported findings that zolpidem has a lower affinity
for the ω2 sites than diazepam while both have the same affinity for the ω1 sites, we concluded that the hippocampal recurrent inhibition appears to be enhanced mainly by activation of the ω2 sites, but not by that of the ω1 sites. Furthermore, the lower potency of zolpidem for enhancing recurrent inhibition may underlie its unique profile in terms
of its clinical and electroencephalographic effects.
Received: 1 November 1996/Final version: 22 January 1997 相似文献
70.
Hiroaki Nakamura Marie Yamada Makoto Fukae Hidehiro Ozawa 《Journal of bone and mineral metabolism》1997,15(4):184-192
We investigated the immunohistochemical localization of CD44, hyaluronate receptor, and moesin, of the ezrinradixin-moesin
(ERM) family, in osteoclasts after calcitonin adminstration using confocal laser scanning microscopy and transmission electron
microscopy to clarify the role of CD44 and moesin in their cytoskeletal organization and cell polarity. We also elucidated
the localization of osteopontin (OPN) to confirm its possible role in cell-matrix recognition via CD44. In untreated mice,
intense immunoreactivities for CD44 and moesin were detected on the basolateral plasma membrane of osteoclasts. Rhodamine-phalloidin
reactivity was seen in a bandlike pattern on the region of contact between osteoclasts and bone and was also detected moderately
along their basolateral plasma membrane. At 30 min after calcitonin administration, osteoclasts did not show either clear
zones or ruffled borders. The bandlike reactivity of rhodamine-phalloidin in the contact region was diminished, although labeling
was seen along osteoclasts. CD44 and moesin were colocalized along their plasma membranes, including the region facing the
bone surface. Electron microscopic observation revealed that the microvillus processes in the contacting region with bone
surface, as well as the basolateral plasma membrane, showed immunoreactivities to CD44 and moesin. At 60 min, some osteoclasts
attached to bone and showed a bandlike pattern of rhodamine-phalloidin. On the other hand, OPN was localized under CD44-positive
cytoplasmic processes and the clear zone of osteoclasts. These findings suggest that calcitonin effects on the cell polarity
of osteoclasts and the CD44-moesin-actin filament system in osteoclasts plays an imporant role in cell polarity and cell-matrix
recognition. 相似文献