Pharmaceutical University Hospital Research Articles

DNA hybridization study using Y-specific probes in an XX-male

A 30-year-old male attended the Toyama Medical and Pharmaceutical University Hospital with the chief complaint of infertility. Physical examination showed bilateral small testes and the semen contained no sperm. Hormonal studies revealed hypergonadotropic hypogonadism and cytogenetic studies showed a 46,XX karyotype. High-resolution banding showed no abnormalities in both of the X chromosomes. Histological examination of both testes showed germinal aplasia and the proliferation of Leydig cells. The diagnosis of XX-male was made from the above findings. A DNA hybridization study using 17 Y-specific probes revealed the presence of a major part of the short arm of the Y chromosome, which had presumably been translocated to the X chromosome. The translocated Y short arm had a small deletion within it.

Uveitis and Pseudouveitis Presenting for the First Time in Japanese Elderly Patients

Purpose: To evaluate the clinical characteristics of uveitis or pseudouveitis presenting de novo in Japanese elderly patients. Methods: We retrospectively examined 296 patients with uveitis or pseudouveitis who were treated at Toyama Medical and Pharmaceutical University Hospital. Patients were followed up for 1 week to 5 years (mean, 11 months). Results: Of 296 patients, 82 (38 men and 44 women, 120 eyes) presented with their first episode of uveitis or pseudouveitis at the age of ≧60 years. Forty patients had anterior uveitis, 2 had intermediate uveitis and the other 40 had posterior and/or pan-uveitis. Of 82 patients, 53 (64.6%) had idiopathic uveitis. The prevalence of Vogt-Koyanagi-Harada syndrome and Behçet disease in elderly patients was lower than that in younger patients. Complicated cataract was frequently seen in the eyes with uveitis. Most eyes with uveitis had poor visual acuity. Conclusions: The prevalence of Vogt-Koyanagi-Harada syndrome and Behçet disease in elderly patients was lower than that in younger patients.

Impact of Neuronavigation and Image-Guided Extensive Resection for Adult Patients with Supratentorial Malignant Astrocytomas: A Single-Institution Retrospective Study

Neuronavigation has become an effective therapeutic modality and is used routinely for intra-axial tumor removal. This retrospective study was conducted to evaluate the clinical impact of neuronavigation and image-guided extensive resection for adult patients with supratentorial malignant astrocytomas. Between 1990 and 2002, 76 adult patients with pathologically confirmed malignant astrocytomas underwent craniotomy and removal of the tumors at the Toyama Medical and Pharmaceutical University Hospital. Of these 76 patients, 42 were treated using neuronavigation with conventional microneurosurgery and the other 34 were treated with conventional microneurosurgery alone. Postoperative early MRI with contrast enhancement was done, and gross total resection was defined as the complete absence of residual tumor. Survival time was analyzed with the Kaplan-Meier method. Prognostic factors were obtained from the Cox proportional hazards model. In univariate analysis, age (< 65), grade 3, preoperative KPS (>/= 80), use of neuronavigation, and gross total resection were significantly associated with longer survival. However, when the data were submitted to multivariate analysis, grade 3, preoperative KPS (>/= 80), and gross total resection were independent prognostic factors. The median survival periods of patients receiving gross total resection (vs. partial resection) and neuronavigation (vs. no neuronavigation) were 16 (vs. 9) months and 16 (vs. 10) months, respectively. The percentage of a gross total resection was significantly higher in the neuronavigation group compared to that in the no-navigation group (64.3 % vs. 38.2 %, p < 0.05). Neurological deterioration occurred in 4 of 42 (9.5 %) and in 6 of 34 (17.6 %) patients after surgery with neuronavigation and surgery without neuronavigation, respectively, although this difference was not statistically significant. Our results showed that neuronavigation increases the radicality in the resection of malignant astrocytomas and is objectively useful for improving survival time.

Improved 1-h rapid immunostaining method using intermittent microwave irradiation: practicability based on 5 years application in Toyama Medical and Pharmaceutical University Hospital

Immunostaining depending on antigen–antibody specificity is the commonest approach for determining the localization of specific antigens in tissue sections. This procedure is applicable not only with frozen or specially fixed samples, but also has proved reliable with formalin-fixed paraffin-embedded tissue sections through improvement of antigen-retrieval. Immunostaining is thus firmly established as a tool for diagnostic pathology and in our institute multiple antibodies are applied for 13–15% of the cases examined, as well as H&E staining. With the standard approach, approximately 3 h is necessary from the beginning of deparaffinization till covering sections with the Envision system. We utilized intermittent microwave irradiation for 10 min during hybridization with primary and secondary antibodies in a special moist-chamber, to achieve all immunostaining steps within 1 h in 178 primary antibodies frequently used for diagnostic pathology. According to our 5 years experience, such microwave irradiation not only obtained significant specific staining for enhancing the specificity of antigen–antibody reactions, but also inhibited nonspecific binding. We present herein the details of the methodology and recommendations for its application with particular primary antibodies. This method can contribute to savings in time and energy, allowing pathologists to rapidly obtain diagnostic information.

Consumption of morphine preparations in Toyama Medical and Pharmaceutical University Hospital

Morphine is the dominant medication to control cancer pain. Morphine consumption has been increasing each year in many countries including Japan based on the understanding of the WHO report on the treatment of cancer pain. To evaluate the recent and current state of palliative medication for cancer patients in Toyama Medical and Pharmaceutical University (TMPU) Hospital, the amount of and trend in the use of morphine preparations from 1992 to 2001 were investigated. The amount used increased every year to 3.9-fold of that in 1992 at the end of this survey. In particular, the consumption of morphine sulfate sustained-release tablets and morphine hydrochloride injection increased markedly, because both total dose in individual patients and the number of patients treated with high-dose morphine increased. The distribution of the maximum daily dose in TMPU Hospital was similar to that in a specialist hospital in oncology. In conclusion, morphine consumption will increase to achieve better palliative care and to improve quality of life in cancer patients, and therefore appropriate use and regulation of narcotic preparations are necessary.

Laparoscopic ablation of peripelvic renal cysts

Recently, laparoscopic surgery has been reported for symptomatic renal cysts. A 60-year-old female was referred to Toyama Medical and Pharmaceutical University Hospital with a chief complaint of general fatigue and left back pain. CT demonstrated bilateral peripelvic renal cysts, and DIP demonstrated left hydronephrosis and a medical shift of the left renal pelvis. Laparoscopic ablation of bilateral peripelvic renal cysts was performed under general anesthesia and a round excision was made in the cyst wall via the peritoneum. After surgery, the left back pain disappeared and CT demonstrated resolution of peripelvic renal cysts. Laparoscopic ablation of peripelvic renal cyst is a highly effective and minimally morbid procedure.

Bacterial endophthalmitis after small-incision cataract surgery: effect of incision placement and intraocular lens type

Purpose To determine whether endophthalmitis after small-incision cataract surgery is affected by the incision site (superior sclerocorneal versus temporal cornea) or the foldable intraocular lens (IOL) material (silicone versus acrylic). Setting Multicenter study. Methods Patients who had small-incision cataract surgery at Toyama Medical and Pharmaceutical University Hospital and affiliated hospitals from March 1998 to March 2001 were examined prospectively. The patients were randomized into 3 groups. In Group A, an acrylic IOL (MA60BM, Alcon) was implanted through a temporal corneal incision. In Group B, an acrylic IOL (MA60BM) was implanted via a superior sclerocorneal incision. In Group C, a silicone poly(methyl methacrylate) IOL (SI-40NB, Allergan) was implanted via a superior sclerocorneal incision. Each patient was followed for more than 6 months. Results Initially, 7622 patients (12 317 eyes) agreed to participate in the study. The final study included 3831 eyes in Group A, 3901 eyes in Group B, and 3863 eyes in Group C. Postoperative endophthalmitis was diagnosed clinically in 11 eyes (0.29%) in Group A, 2 (0.05%) in Group B, and 2 (0.05%) in Group C. Endophthalmitis proven by culture was found in 9 eyes in Group A, 2 in Group B, and 2 in Group C. The incidence of endophthalmitis in Group A was higher than in the other groups. The incidence of endophthalmitis in Group B was similar to that in Group C. The relative risk of postoperative endophthalmitis proven by culture in Groups B and C was 4.6 times ( P = .037) lower than in Group A. Conclusion The findings suggest that a temporal corneal incision may lead to an increased risk of postoperative endophthalmitis and that the IOL material does not affect the incidence of this complication.

Can Kampo Medicines Eradicate Helicobacter Pylori in Clinical Situation?

Backgrounds and Aims : We examined the relationship between the existence of Helicobacter pylori (HP) and Kampo medicines used in patients. Methods : In Toyama Medical and Pharmaceutical University Hospital, we investigated HP infection in patients who were continuously administered Kampo medicines. During upper GI endoscopy, two specimens were obtained from the greater cavature of the antrum and upper body of the stomach, and then were processed for rapid urease test, the CLO-test. Results : Among 34 consecutively enrolled patients, CLO was positive in 18 patients (52.9%). Patients in HP-positive and -negative groups had taken various Kampo medicines for more than one month, and every Kampo medicine except one in both groups contained herbs that had been reported to have an in vitro anti-HP effect. Conclusion : Kampo medicine may not be indicated for eradication therapy for HP in clinical situations.

Ménière's Disease and Delayed Endolymphatic Hydrops in Children

In order to study the characteristics of pediatric patients (≤ 15 years at onset) with endolymphatic hydrops disorders, we selected 5 patients with Ménière's disease (MD) and 3 patients with delayed endolymphatic hydrops (DEH) from 7418 patients who had visited the Neurotological Clinic of the Toyama Medical and Pharmaceutical University Hospital between 1979 and 1999. Clinical features were characterized as follows: (i) pediatric MD patients were rare, comprising ≈ 1.5% of all the 337 MD patients in the sample; (ii) a fluctuating hearing loss, strong positive response in glycerol test, high SP/AP amplitude ratio in electrocochleography and moderate positive response in furosemide vestibulo-ocular reflex test were recorded; (iii) in 2 of the 5 pediatric MD patients, vertiginous attacks had persisted for a long period and they had undergone surgical procedures (sac operation and vestibular neurectomy); and (iv) the ipsilateral type of DEH was observed in 2/3 children, and contralateral DEH in 1/3.

Clinical study of elderly patients with Meniere’s and related diseases

In order to study the characteristics of elderly patients (70 or over at onset) with endolymphatic hydrops disorders, we selected six patients with Meniere’s disease (MD), five patients with delayed endolymphatic hydrops (DEH), and two patients with syphilis of the labyrinth (SL) from 7112 patients who had visited the Neurotological Clinic of the Toyama Medical and Pharmaceutical University Hospital during 1979–1998. Clinical features were characterized as follows: (1) Since 1990, the proportion of elderly patients increased as lifespans lengthened. (2) A narrow fluctuation in hearing, low positive rate on glycerol test, high positive rate of dominant-SP in EcochG, and the moderate abnormal rate of the oculomotor system tests were found. (3) The prognosis was relatively good. From these neurotological observations, it could be concluded that elderly patients with endolymphatic hydrops disorders were characterized by the multipathological finding of the endolymphatic hydrops and the complications of CNS disorders.

院内製剤「抱水クロラールシロップ」に関する検討

We investigated the stability of “Chloral Hydrate Syrup” by 1H-NMR spectrometry and spectrophotometry.“Choloral Hydrate Syrup” is composed of 4%(w/v) chloral hydrate, 50%(w/v) simple syrup and 2%(w/v) pineapple flavor. When “Chloral Hydrate Syrup” was kept in the dark and cold conditions, chloral hydrate was found to be stable for at least 2 weeks. No changes in the smell and taste of “Chloral Hydrate Syrup” were observed. However, the color was fugitive, and 80% of original color was lost within a week even in the dark and cold conditions.The Pharmacological effects of “Chloral Hydrate Syrup” given for 25 infant patients, who had been hospitalized in Toyama Medical and Pharmaceutical University Hospital between September and November 1997, were evaluated clinically. “Chloral Hydrate Syrup” showed a certain, hypnotic effect in 24 out of 25 patients. These results suggest that “Chloral Hydrate Syrup” is useful as a hospital hypnotic preparation.

Is smoking behaviour in patients with coronary heart disease influenced by whether their attending physician smokes?

Objective -To examine the association between the smoking status of attending physicians and that of their patients. Setting - Cardiology division of the Toyama Medical and Pharmaceutical University Hospital and two affiliated hospitals in Toyama District, Japan. Subjects -A total of 259 patients with known ischaemic heart disease who con sulted our outpatient clinic in September 1992, and their attending physicians at the clinic (n = 17). Thirty eight attending physicians who cared for 100 of these patients during a previous admission of the University Hospital were also in cluded in the study. Design and main outcome measures Smoking status of patients was deter mined by urinary cotinine radioimmuno assay using 125I-cotinine. Patients with urinary cotinine concentration above 50 ng/ml were classified as smokers. Smoking status of physicians was de termined by self report. Results - Smoking was found to be sig nificantly more prevalent (p < 0.05) in outpatients whose attending physicians smoked (20/94, 21.3%) than in those with

Influence of a Cold Front on the Onset of Meniere's Disease 2dn Report

We investigated the influence of a cold front (CF) on the onset of Meniere's disease (MD) and concluded that the onset of MD was influenced by the passing of a CF. But it was not clear whether patients with MD were stressed by the passing of a CF or the passing of a CF directly influenced the inner ears. Among the patients with MD who visited the Neuro-Otological clinic of the Toyama Medical and Pharmaceutical University Hospital from 1987 to 1992, 67 were sure of the date of the first attack and were chosen for the study. In 36 the first attack was on a day when a CF was passing or on the next day, so they were studied epidemiologically.1) Age: more of these 36 patients were over 40 years of age than in the group of 31 patients with no definite relationship between CF and MD.2) Hearing: in the 36 patients hearing was poorer than in the others.

Recurrence of superficial bladder tumours after transurethral resection.

From 1979 to January 1990, 48 patients with newly diagnosed superficial bladder tumours were treated by transurethral resection (TUR) at Toyama Medical and Pharmaceutical University Hospital. The relationship between tumour recurrence and the stage, grade, number, or size of the tumours was investigated. The 1-, 2-, 3-, 4- and 5-year non-recurrence rates were 72%, 63%, 47%, 40%, and 40%, respectively. Non-recurrence rate for pTa tumours was significantly higher than that for pT1 tumours (p < 0.05). There was no relationship between tumour grade and recurrence. The rate of recurrence of multiple tumours was higher than that of single ones. There was no difference in non-recurrence rate between tumours smaller than 1 cm and those of 1 cm or larger. Non-recurrence rate in the instillation therapy group was significantly higher than in the non-instillation group (p < 0.05). It was concluded that patients with multiple or high-stage tumours have the risk of a high rate of recurrence and that intravesical chemotherapy is effective in preventing local recurrence in some patients.

泌尿器悪性腫瘍における尿中 Epidermal growth factor の検討

We measured epidermal growth factor (EGF) in the urine of 54 untreated patients with malignant tumors (7 prostatic cancer, 11 renal tumor, 31 bladder cancer, 3 renal pelvic tumor, 2 ureter tumor) in the Toyama Medical & Pharmaceutical University Hospital. We also measured EGF in the urine of 77 normal subjects (43 males, 34 females). Urinary concentration of EGF in normal subjects decreased with increasing age. It was significantly higher in females than males (p less than 0.05). Urinary concentration of EGF in patients with prostatic cancer or renal tumor was similar to that in normal subjects. The patients with prostatic cancer controlled by estrogen showed a slightly high level of EGF in the urine. In patients with renal tumor, urinary concentration of EGF decreased after nephrectomy. Patients with bladder cancer showed a significant decrease of EGF in the urine compared with normal subjects (p less than 0.05), and urinary concentration of EGF in the patients with bladder cancer of high stage was remarkably low. Low concentration of EGF in the urine was recognized in patients with renal pelvic tumor or ureter tumor. However, the relationship between the decrease of urinary concentration of EGF in these urothelial tumors and the growth of these tumors remains to be elucidated.

Transsarcolemmal Ca 2+ influx via Na+/Ca2+ exchange may be responsible for abnormal intracellular Ca 2+ transient documented in myocardium from patients with end-stage heart failure : Yasuki Kihara, and James P. Morgan. The Second Department of Internal Medicine, Toyama Medical and Pharmaceutical University, Toyama, Japan, and Cardiovascular Division Beth Israel Hospital, and Harvard Medical School, Boston, MA

Transsarcolemmal Ca 2+ influx via Na+/Ca2+ exchange may be responsible for abnormal intracellular Ca 2+ transient documented in myocardium from patients with end-stage heart failure : Yasuki Kihara, and James P. Morgan. The Second Department of Internal Medicine, Toyama Medical and Pharmaceutical University, Toyama, Japan, and Cardiovascular Division Beth Israel Hospital, and Harvard Medical School, Boston, MA

Studies on Criteria for Diagnosis of Meniere's Disease

In 1974, the Meniere's Disease Research Commitee in Japan designated the criteria for the diagnosis of Meniere's disease. However, there was little consideration of the objective neuro-tological findings in this disease.During 1987, 451 patients with vertigo and/or dizziness, who visited the Neurotological Clinic of Toyama Medical & Pharmaceutical University Hospital, were tested neurotologically. There were 27 definte and 30 suspected cases of Meniere's disease diagnosed according to the Committee's criteria.However, seven patients with vertigo and cochlear symptoms, who had subjectiverly satisfied the cirteria, were excluded because of other CNS findings, such as abnormal hyperexcitatory caloric response, abnormal OKN findings and abnormal image findings (CT-scan, VAG).These clinical observations lead us to conclude that the criteria for the diagnosis of Meniere's disease should include objective findings, especially tests for endolymphatic hydrops, such as the glycerol test, electrocochleography (ECoG) and the furosemide VOR-test.

富山医科薬科大学歯科口くう外科におけるがく骨骨折症例の臨床統計的観察

富山医科薬科大学歯科口くう外科におけるがく骨骨折症例の臨床統計的観察

Investigation of air born bacteria and aseptic management in the operating department of Toyama medical and pharmaceutical university hospital : from out experience in a little over one year

Investigation of air born bacteria and aseptic management in the operating department of Toyama medical and pharmaceutical university hospital : from out experience in a little over one year