Biomedical subjects

H Arai

Publications and source records attributed to H Arai.

At least 181 records · Page 10Linked to original sources

PubMed2000

Protein-losing enteropathy caused by mesenteric venous thrombosis with protein C deficiency.

A 64-year-old man presented with leg edema and hypoproteinemia. His alpha-1 antitrypsin clearance rate of 174 mL/day indicated the presence of protein-losing enteropathy (PLE). Computed tomographic scans demonstrated thickened ileal wall and mesenteric edema. Angiography revealed occlusion in a peripheral branch of the superior mesenteric vein. Furthermore, both the patient and his son had low protein C levels. The patient was treated successfully with partial resection of the ileum. Histologic examination of the resected ileum revealed multiple erosions and submucosal fibrosis with organized venous thrombi in the mesenteric veins. This is the first case report of PLE caused by mesenteric venous thrombosis, and our findings suggest that serum protein was lost through erosion of the ileum caused by ischemia due to mesenteric venous thrombosis.

Humans↗

PubMed2000

Oxidized-LDL and atherosclerosis. Role of LOX-1.

The accumulation of substantial numbers of monocyte/macrophages and activated T lymphocytes in focal areas of the arterial intima appears to be a hallmark of atherosclerosis. Our report demonstrated that lysophosphatidylcholine (lyso-PC), a polar phospholipid component that is increased in atherosclerotic lipoproteins, such as oxidized LDL and remnant lipoproteins in diabetic and Type 3 hyperlipidemia, can upregulate adhesion molecules for monocytes and T lymphocytes, and growth factors, such as heparin-binding epidermal growth factor-like growth factor and PDGF A and B chains. Recently, we identified the novel receptor for oxidized LDL, named LOX-1. We summarize the importance of the interaction between oxidized LDL and its receptor, LOX-1, in terms of early stage atherogenesis.

Animals↗

PubMed2000

Extraocular muscle responses to high dose intravenous methylprednisolone in myasthenia gravis.

Three patients with generalised myasthenia gravis and three with ocular myasthenia gravis received two to five courses of high dose intravenous methylprednisolone because of the failure of standard immunomodulating therapies. Changes in myasthenic signs were assessed using a four step system for grading muscle weakness and fatiguability in 10 test items. Although a brief and modest amelioration was found from day 1 to day 2 after the initial infusion in two patients with generalised myasthenia gravis, all three experienced a prolonged phase of worsening followed by improvement before the next course. Conversely, for two of the patients with ocular myasthenia gravis, a transient but dramatic improvement of ptosis and ocular immobility was noted from 90 minutes to 5 hours after initiating the first infusion, followed by mild or no exacerbation. This 3 hour improvement may be related not only to possible differences in the neuromuscular junction, but also to corticosteroids unmasking the central adaptation for the peripheral ocular muscle weakness by increasing the acetylcholine release.

Acetylcholine↗

PubMed2000

Postmortem study of ataxia with retinitis pigmentosa by mutation of the alpha-tocopherol transfer protein gene.

A new syndrome of ataxia and retinitis pigmentosa with vitamin E deficiency caused by the missense mutation of alpha-tocopherol transfer protein (alpha-TTP) gene was recently proposed. After studying the first postmortem case with this mutation pathologically and biochemically, whether the symptoms can be treated by supplementation of vitamin E or not is discussed. The major pathological findings were retinal atrophy; severe dying back-type degeneration of the posterior column; and massive accumulation of lipofuscin in neurons including dorsal root ganglion (DRG) cells, which were almost identical to those in vitamin E deficient animals and patients with fat malabsorption. Also, mild loss of Purkinje cells was noted. Because robust expression of alpha-TTP was detected in the cerebellum as well as in the liver and the tissue concentration of vitamin E in the cerebellum was still low even after oral supplementation, the mild Purkinje cell loss might be related to the mutant alpha-TTP in the cerebellum. By contrast, in the DRG, thought to be mainly responsible for ataxia, no expression of alpha-TTP was detected, and the tissue concentration of vitamin E increased to normal after supplementation. It is therefore considered that oral supplementation of vitamin E should effectively counteract the progression of ataxia.

Aged↗

PubMed2000

Induction of apoptosis in bronchial eosinophils: beneficial or harmful?

BACKGROUND: Prominent eosinophil infiltration takes place in asthmatic bronchi, and damages bronchial epithelial cells. AIM: This study was designed to investigate whether induction of apoptosis in infiltrated cells in the airways is beneficial or harmful. METHODS: A/J mice, which are genetically predisposed to be hyperresponsive to acetylcholine, were immunized with ovalbumin (OA) and alum. Thereafter, they were subjected to a 2-week regimen of OA inhalation, during which they were also administered either hamster anti-mouse Fas monoclonal antibody or hamster IgG (sham control) intranasally. Pulmonary function was then analyzed using whole-body plethysmography. RESULTS: Inhalation of OA increased both airway responsiveness to acetylcholine and infiltration of eosinophils. Administration of anti-Fas antibody induced apoptosis in the infiltrating eosinophils and abolished the increase in airway responsiveness to acetylcholine. CONCLUSION: Induction of apoptosis in eosinophils infiltrating asthmatic bronchi has a beneficial effect on airway hyperresponsiveness.

Acetylcholine↗

PubMed2000

Induction of intracellular interleukin-1 beta signals via type II interleukin-1 receptor in human gingival fibroblasts.

The type II interleukin-1 receptor (IL-1RII) has been thought to be incapable of transducing signals to cells because of its short intracellular domain, while type I IL-1 receptor (IL-1RI) does transduce signals. Since over-expression of IL-1RII has been demonstrated to inhibit cytokine production in the fibroblastic cell line, it has been proposed to use IL-1RII to prevent IL-1-induced inflammation in connective tissue. In this study, trace amounts of IL-1RII mRNA expression were detected in human gingival fibroblasts (HGFs), which are affected by cytokines in inflammatory periodontal disease. Cloning of the cDNA encoding IL-1RII expressed in HGFs revealed 3 amino acid substitutions in the extracellular domain, when compared with the 408 residues predicted from human B-cells. Over-expression of IL-1RII on HGFs by gene transfer down-regulated the expression of IL-1 beta mRNA and IL-6 mRNA in response to IL-1 beta stimulation, while the expression of IL-8 mRNA was not affected. In the IL-1RII-transfected HGFs, phosphorylation of 25- and 74-kDa proteins was up-regulated upon IL-1 beta stimulation in the transfected HGFs. The phosphorylation of these proteins was suppressed by the addition of a neutralizing antibody against IL-1RII. These results suggest that the IL-1RII may regulate HGFs expression of cytokine mRNA upon IL-1 beta stimulation, possibly by altering the IL-1RI-dependent signals.

Base Sequence↗

PubMed2000

Infantile arachnoid cyst compressing the sacral nerve root associated with spina bifida and lipoma--case report.

A 2-year-old boy presented with a rare sacral arachnoid cyst manifesting as gait disturbance. Neuroimaging revealed an intradural cyst in the sacral nerve root sheath associated with spina bifida occulta and a lipoma at the same level. At surgery, the conus medullaris was situated at the L-1 level and not tethered. The highly pressurized arachnoid cyst had exposed the dural sheath of the left S-2 nerve root and compressed the adjacent nerves. An S-2 nerve root pierced through the cyst. There was no communication between the cyst and spinal arachnoid space. We thought the one-way valve mechanism had contributed to the cyst enlargement and the nerve compression. Radical resection of the cyst was not attempted. A cyst-subarachnoid shunt was placed to release the intracystic pressure. Postoperatively, his gait disturbance improved and no deterioration occurred during the 4-year follow up. Both tethered cord syndrome and sacral arachnoid cyst in the nerve root sheath should be considered in pediatric progressive gait disturbance. Cyst-subarachnoid shunt is an alternative method to cyst resection or fenestration to achieve neurological improvement.

Arachnoid Cysts↗

PubMed2000

[A new interventional strategy for Alzheimer's disease by Japanese herbal medicine].

A Japanese herbal medicine termed "Kami-Umtan-To (KUT)" was first described in Japanese literature in 1626, KUT consists of 13 different herbs, and it has been used for a long time in the treatment of a variety of neuropsychiatric problems including neurosis and insomnia. Recently, Yabe et al. have demonstrated that KUT increased both choline acetyltransferase (ChAT) and nerve growth factor at the protein and mRNA levels in cultured rat brain cells. Moreover, the same research group has reported that KUT improved mean latency on passive avoidance test in both basal for brain lesioned and aged rats. KUT significantly improved the survival rate, and increased the number of ChAT-positive neurons in aged rats. Here, we report a 12-month open clinical trial of KUT and combination of estrogen, vitamin E and NSAID to aim at slowing down the progression of Alzheimer's disease (AD). Twenty AD patients (MMSE score: 18.6 +/- 5.8) received extracts from original KUT herbs, and 7AD patients (MMSE score: 21.3 +/- 2.8) were placed on the combination therapy. Rate of cognitive decline as measured by change in MMSE score per year was significantly slower (p = 0.04, ANOVA) in the KUT group (1.4 points) and the combination group (0.4 points) as compared to 4.1 points in 32 control AD patients (MMSE score: 20.8 +/- 5.6) who received no medicines for AD. Any of CSF measures including tau. and A beta 1-42 did not differ significantly after KUT therapy. The efficacy of the KUT therapy was most obvious at 3 months. Our results suggest that traditional Japanese herbal medicine(s) may serve a new interventional strategy for AD.

Aged↗

PubMed2000

[Prediction of progression in patients with mild cognitive impairment using IMP-SPECT].

To examine the difference in functional brain imaging between mild cognitive impairment (MCI) and normal aging, we measured rCBF on functional brain imaging using 123I-IMP single photon emission computed tomography (IMP-SPECT) in 19 MCI patients who progressed to develop AD on follow-up and 23 probable Alzheimer's disease (AD) patients as well as 15 age-matched normal subjects. Baseline MMSE score was 25.3 (SD 1.2) in the MCI group and 17.5 (SD 3.3) in the AD group. The regions of interest (ROI) in the posterior cingulate gyrus, frontal, temporal and parietal cortices were drawn on the image of IMP-SPECT with reference to an individual MRI image. The rCBF ratio was calculated using ROI value in the cerebellum as a reference. Voxel-based analysis was also preformed using statistical parametric mapping (SPM). The rCBF ratio in the posterior cingulate gyrus was significantly reduced in the MCI group (mean 0.956, SD 0.080) and the AD group (mean 0.833, SD 0.118) compared to that in the normal group (mean 1.083, SD 0.084). In the frontal, temporal and parietal cortices, the rCBF ratio was significantly reduced only in the AD group compared to the normal group. At a fixed specificity of 80%, the diagnostic sensitivity in the discrimination between MCI patients and normal subjects was 80.5% when using rCBF ratio in posterior cingulate gyrus. In the SPM analysis, significant reduction of the rCBF in MCI group was observed only in the posterior cingulate gyrus, compared with normal subject group. Our results suggest that MCI patients presenting with a posterior cingulate hypoperfusion are at higher risk for transition from MCI to clinically recognizable AD.

Aged↗

PubMed2000

Possible origin of suprasellar arachnoid cysts: neuroimaging and neurosurgical observations in nine cases.

OBJECT: In this study the authors identify and investigate two new classifications of suprasellar arachnoid cysts. METHODS: The authors used computerized tomography cisternography, magnetic resonance (MR) imaging, and neuroendoscopy to investigate nine cases of suprasellar arachnoid cysts. A communicating cyst with early filling and early clearance of a radioopaque tracer was found in seven of nine cases; a communicating cyst with delayed filling and delayed clearance of the tracer was observed in one case; and a noncommunicating cyst was observed in the other. The MR findings indicated a variation in the position of the basilar artery (BA) bifurcation in relation to the ventral surface of the midbrain. A distance existed between the BA bifurcation and the ventral surface of the midbrain in a communicating cyst with early filling, whereas the BA bifurcation was posteriorly displaced in a communicating cyst with delayed filling and also in a noncommunicating cyst, leaving little space between the bifurcation and the ventral surface of the midbrain. Endoscopic observation revealed, in the case of communicating cysts with early filling and early clearance of tracer, that the BA bifurcation is located inside the cyst with no overlying membrane, whereas in a noncommunicating cyst, the BA and its branches can be observed through the transparent membrane of the lesion. CONCLUSIONS: The authors postulate two different types of suprasellar arachnoid cysts: a noncommunicating intraarachnoid cyst of the diencephalic membrane of Liliequist and a communicating cyst that is a cystic dilation of the interpeduncular cistern.

Arachnoid Cysts↗

PubMed2000

[A case of intrasellar pure germinoma].

A 19-year-old male presented with progressive loss of vision and diabetes insipidus due to an intra- and suprasellar tumor. Transsphenoidal exploration revealed a pure germinoma. Seven days after the operation, bleeding from the residual tumor caused headache and right occulomotor palsy. The residual tumor and hematoma were removed using pterional approach. The residual tumor disappeared after postoperative irradiation. After 5 months of radiation, multiple lesions due to dissemination of the germinoma were discovered in the suprasellar region. Adjuvant chemotherapy and whole supratentorial irradiation were performed. All lesions regressed completely. Mid-sagittal magnetic resonance image was useful in our patient for differential diagnosis between intrasellar germinoma and pituitary adenoma. Before initiating an operation for intrasellar germinoma, awareness is needed for the fact of postoperative bleeding. We notice that transsphenoidal surgery should be selected for treatment of postoperative bleeding from intrasellar germinoma.

Adenoma↗

PubMed2000

[Renal inflammatory pseudotumor after embolization for arteriovenous malformation: a case report].

A 61-year-old man was admitted to our hospital with the chief complaint of asymptomatic macrohematuria. Because he was diagnosed with arteriovenous malformation of the right kidney by angiography, embolization was performed. However, 2 years and 3 months later, bleeding from the right kidney was detected. Computed tomography (CT) revealed a low density area (1.8 cm) in the right kidney protruding to the renal pelvic adjacent to the old embolized lesion. Since we could not make a conclusive diagnosis as malignant disease by ureteroscopy and angiography, we have decided to follow the case carefully. Nine months later, macroscopic hematuria worsened, and the low density area by CT in the right kidney expanded. Therefore, we finally decided to perform right total nephroureterectomy. The tumor was histologically diagnosed as renal inflammatory pseudotumor. This is the 14th case reported in Japan. We here report the renal inflammatory pseudotumor with a review of the Japanese literature.

Arteriovenous Malformations↗

PubMed2000

Rupture of infected pseudoaneurysms in patients with implantable ports for intra-arterial infusion chemotherapy.

Intra-arterial hepatic chemotherapy via implantable reservoirs is being used increasingly. In our department, five patients have undergone emergency surgery since 1991 because of rupture of an infected pseudo-aneurysm at the site of entry of the catheter. Surgical procedures included removal of the catheter and the reservoir, and closure of the affected artery with or without reconstruction. Of these patients, three (60%) died from uncontrollable sepsis. The poor prognosis emphasizes the need, in patients with carcinoma, for strict aseptic technique and hemostasis at the time of catheter placement, and for careful device maintenance.

Adult↗

PubMed2000

Low-dose cytarabine and aclarubicin in combination with granulocyte colony-stimulating factor (CAG regimen) for previously treated patients with relapsed or primary resistant acute myelogenous leukemia (AML) and previously untreated elderly patients with AML, secondary AML, and refractory anemia with excess blasts in transformation.

We used the CAG regimen (low-dose cytarabine [10 mg/m2 per 12 hours, days 1-14], aclarubicin [14 mg/m2 per day, days 1-4], and granulocyte colony-stimulating factor [200 micrograms/m2 per day, days 1-14]) for the treatment of patients with primary resistant acute myelogenous leukemia (AML) and previously untreated elderly patients with AML, secondary AML, and refractory anemia with excess blasts in transformation (RAEB-T) in addition to relapsed AML. Forty-three of 69 (62%) patients achieved complete remission (CR), including 29 of 35 (83%) patients with relapsed AML, 1 of 8 patients with primary resistant AML, 5 of 8 elderly patients with previously untreated AML, and 8 of 18 patients with previously untreated secondary AML or RAEB-T. Ten of 22 (45%) patients > or = 65 years old achieved CR. The patients who achieved CR received at least 1 course of modified CAG therapy as the first consolidation therapy, followed by various second consolidation and intensification therapies. The median disease-free survival and overall survival were 8 and 15 months, respectively, for relapsed AML; 11 and 8 months for the elderly patients; and 8 and 17 months for secondary AML and RAEB-T. Myelosuppression was mild to moderate, and other than fever, severe nonhematologic toxicity was rare. CAG as the induction therapy seems promising for the treatment of various categories of poor-prognosis AML.

Aclarubicin↗

PubMed2000

[Renocolic fistula: a case report].

A 78-year-old woman had disregarded pneumaturia since April 1998. In March 1999, computed tomography and barium enema were done to examine anemia and positive fecal occult blood, revealing a left renocolic fistula and bilateral renal stones. Intravenous pyelography revealed a left staghorn calculus, non-functioning kidney, and right partial staghorn calculus. Urinalysis showed pyuria and the culture grew Proteus vulgaris and Klebsiella oxytoca. Smear and culture of the urine were negative for acid-fast bacilli. In consideration of the patient's age and conservation of right renal function, right pyelolithotomy was performed first. Three weeks later, left nephrectomy and partial colectomy were done. The postoperative course was uneventful. A renocolic fistula is relatively rare and to our knowledge there have been 37 cases reported in Japan, including our case. Surgery is the main therapy and was performed in 31 patients. Among them, surgery was not curative in 1 and 5 died of postoperative complications. Thus, surgery is not safe in all cases. However, despite her age and bilateral renal dysfunction, our patient was successfully operated on.

Aged↗

PubMed2000

[A case of urinary stone in ureterocele extracted transurethrally after ESWL].

A 66-year-old man was referred to our hospital with chief complaints of difficulty in urination and terminal micturition pain. Ureteroceles were identified bilaterally, and a ureteral stone (19 x 12 mm) existed in the right ureterocele. After crushing the stone by extra corporeal shock wave lithotripsy (ESWL), we removed the stone transurethrally with a small incision in the right ureterocele. The vesicoureteral reflux (VUR) was not detected postoperatively. Now, we recommend the combination of ESWL and a small transurethral incision of the urelerocele for the treatment of ureteral stones in a ureterocele in order to prevent postoperative VUR.

Aged↗

PubMed2000

[Autopsied case of an extracranial internal carotid artery dissecting aneurysm].

An autopsy case of extracranial internal carotid artery (ICA) dissecting aneurysm due to atherosclerosis was reported. A 74-year-old man was admitted to our hospital with the chief complaints of hoarseness and a pulsatile mass below the left mandibular angle. Neurological examination showed no obvious deficits except left recurrent laryngeal nerve palsy. Angiography revealed narrowing of the original segment of left ICA with dissection and aneurysmal dilation at the level of C3 vertebra. Seven days after admission, the patient had a sudden onset of consciousness disturbance. The second angiography showed no obvious changes compared with the first findings except slight narrowing in the distal portion above the aneurysmal dilation. The possible mechanism was thought to be recanalization following transient occlusion of the left ICA caused by extension of dissection or intracranial embolism due to a thrombus within the aneurysm. He was managed conservatively, but unfortunately he died of pneumonia. Macroscopic autopsy showed that the aneurysm was fusiform. Histologically, it demonstrated dissection of the hematoma between the media and adventitia layer. Hemorrhage in the atheromatous plaque with disruption of the elastic lamina were observed along with severe degenerative changes of the intima, media and, in part, adventitia layer due to atherosclerosis. In addition, a dissecting aneurysm of the right iliac artery and severe arteriosclerosis were observed in the systemic arteries. On the basis of these findings, the dissecting aneurysm presumably developed after disruption of a weak portion of the atherosclerotic wall, where intraplaque hemorrhage occurred earlier. We suggest that atherosclerosis be regarded as one of the pathogenic factors capable of causing dissecting aneurysm of the extracranial ICA in elderly patients.

Aged↗

PubMed2000

[A case of superomedial cerebellar astrocytoma completely removed, using the occipital transtentorial approach].

The occipital transtentorial approach (OTT) is showed to be effective not only for pineal body tumors, but also for superomedial cerebellar tumors. We satisfactorily removed a superomedial cerebellar astrocytoma in a 3-year-old infant using OTT. The magnetic resonance images showed a tumor located in the left superomedial cerebellum, and the distance between the midline and the outer margin of the tumor was 2.5 cm. OTT was performed on the left side, and the tumor was removed completely. Herein, relying on own experiments and some reports, we discussed some helpful techniques and the indications for OTT for superomedial cerebellar tumors. In brief, an arch shift of the superior sagittal sinus to the contralateral side by tracting the dura, a long incision of tentorium, and aspiration of CSF were very useful measures for avoiding occipital lobe injury. We emphasized that a preoperative estimation of possibilities for these techniques is very important.

Astrocytoma↗