Biomedical subjects
Publications and source records attributed to A Takami.
We encountered an unusually severe case of intra-abdominal lymphangiomatosis associated with protein-losing enteropathy and intestinal bleeding. A low-fat diet effectively raised the patient's serum levels of hemoglobin and the total serum protein, perhaps by inducing a reduction in intestinal lymph flow and pressure.
We present a 74-year old woman who was hospitalized because of typical spiking fever, evanescent rash, polyarthralgia, lymphadenopathy, and marked elevation of serum transaminases and lactate dehydrogenase (LDH) due to adult-onset Still's disease (AOSD) with submassive hepatic necrosis. All of the symptoms and abnormal laboratory findings were dramatically improved after treatment with prednisolone. The clinical course of this patient indicates that AOSD with severe hepatic necrosis can successfully be treated with early administration of corticosteroid, although it remains unknown whether the disease can remain in remission with no or minimal treatment.
Six patients with hematologic diseases who received bone marrow from an unrelated donor (URD) from 1992 through 1993 and survived for more than 100 days after bone marrow transplantation (BMT) were assessed for the incidence, time of onset, and extent of chronic graft-versus-host disease (cGVHD). Five patients (83%) developed cGVHD, compared with 41% of a control group consisting of 34 patients who received bone marrow from a related donor during the same period. In 4 (80%) of the 5 patients, cGVHD occurred within 70 days after BMT. This early occurrence of cGVHD was observed in only 7% of the control group (P = 0.006). cGVHD tended to involve more organs in the URD-BMT patients than in the control group. In two patients with cGVHD, an allele mismatch in HLA-DRB1 gene between the patients and donor was disclosed by DNA typing. These findings indicate that it is important to strengthen post-transplant immunosuppression, to initiate screening tests from the early post-transplant period, and to select a suitable donor matched with HLA-DRB1 alleles for the prevention of cGVHD in the URD-BMT patients.
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We report a case of chylothorax in a 51-year-old male with non-Hodgkin's lymphoma. Combination chemotherapy reduced the size of mediastinal lymph nodes dramatically, but retroperitoneal lymph nodes remained almost the same, and chylothorax subsequently developed. Lymphangiogram showed reticular spread of contrast material from the thoracic duct downwards but not above the diaphragm. These findings suggest that an obstruction of the infra-diaphragmatic but not the supra-diaphragmatic thoracic duct caused development of collateral lymphatic channels penetrating the diaphragm into the thoracic cavity, with subsequent formation of chylothorax.
The relation between myocardial bridges (MB) and atherosclerosis in the left anterior descending coronary artery (LAD) was explored using morphometric methods in 642 hearts. The location of myocardial bridges in the LAD was classified according to distribution as proximal, middle and distal. Myocardial bridges were found in 48 per cent of males and 36 per cent of females. When proximal myocardial bridging was present intimal thickening and macroscopic raised lesion were increased just before the bridge as compared with the corresponding site in the other two categories. Underneath bridges eccentric plaques and raised lesions are absent although there is often concentric intimal thickening. The overall frequency of myocardial infarction was the same in patients with and without myocardial bridges. However, when infarction occurred in the patients having bridges, it was almost confined to those in the proximal group despite this being infrequent in the general distribution of myocardial bridges in the left anterior descending artery. It is postulated that hypertension may enhance infarction in the case of myocardial bridges in the very proximal left anterior descending artery. It is concluded that the location of myocardial bridges greatly alters the distribution of physical force against the arterial wall and influences the extent of atherosclerosis.
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