Biomedical subjects
Publications and source records attributed to H Inoue.
Experimental renal arterial embolization was undertaken with ethanol-iohexol solution in 17 mongrel dogs. Post embolization arteriography revealed that ethanol-iohexol solution and absolute ethanol were almost equal in embolic effect. With this solution, the interventional approach can be made much more easily and safely.
We present an unusual case of 30-year-old man who was admitted to our hospital with dysesthesia of the limbs and skin eruptions. Polyarteritis nodosa was diagnosed based on the histopathological examination of sural nerve and renal biopsies. A month after initiation of corticosteroid therapy, a small infiltrative shadow was detected in the right mid-lung field by chest X-ray. Aspergillus infection was suspected based on a culture of bronchial lavage fluid. Despite intravenous administration of the antifungal agents, miconazole and fluconazole, a thin-walled cavity with a fungus ball gradually formed in the infiltrative lesion. The patient's clinicopathological findings were consistent with a diagnosis of chronic necrotizing pulmonary aspergillosis, a rare aspergillus infection in the lung. Treatment with intracavitary instillation of amphotericin B proved effective.
The efficacy, safety and usefulness were evaluated for a combined antibiotic tazobactam/piperacillin (TAZ/PIPC) consisting of a new beta-lactamase inhibitor, tazobactam (TAZ), and a broad spectrum penicillin antibiotic, piperacillin (PIPC), in chronic respiratory tract infections with PIPC as the control in a multi-institutional comparative study. The drugs used were a preparation containing 0.5 g of TAZ and 2.0 g of PIPC per vial (TAZ/PIPC group) and a preparation containing 2.0 g of (PIPC group). The drugs were intravenously injected one vial at a time twice a day for 14 days as a rule. The following results were obtained: 1. Clinical effect There was no significant difference between TAZ/PIPC (86% or 76/88) and PIPC (81% or 69/85). 2. Bacteriological effect There was no significant difference between TAZ/PIPC (93% or 42/45) and PIPC (88% or 36/41) in terms of bacterial eradication rates. In 34 patients with beta-lactamase-producing pyogenic bacteria, there was no significant difference between TAZ/PIPC (77% or 10/13) and PIPC (88% or 15/17). 3. Degrees of improvement in clinical symptoms, signs and laboratory findings The TAZ/PIPC group was likely to show reductions in fever and the amount of sputum soon after administration. 4. Side effects Incidences of side effects were 7% (7/96) in the TAZ/PIPC group and 3% (3/89) in the PIPC group, showing no significant difference between the two groups. The main symptoms were allergic reaction and gastrointestinal symptoms. 5. Abnormal clinical laboratory test values The incidence was 17% (15/89) in the TAZ/PIPC group and 21% (18/87) in the PIPC group. The main symptoms were eosinophilia and hepatic dysfunction, and most of these symptoms were mild. 6. Usefulness The usefulness rates in the TAZ/PIPC group were 80% (71/89) and 78% (66/85) in the PIPC group, showing no significant difference. Thus, TAZ/PIPC exhibited excellent clinical effects and presented no troubles with safety. When comprehensively evaluated, TAZ/PIPC appears to be a very useful drug for the treatment of chronic respiratory tract infections.
Carbon dioxide (CO2) intraarterial subtraction angiography (IADSA) was performed in 31 patients with various hepatobiliary diseases. The injection sites of CO2 were proper hepatic artery (10/31; group A), segmental hepatic artery (18/31; group B), and peripheral inferior phrenic artery (3/31; group C), respectively. In group A, only the third order branches of the portal venous system were visualized anterogradely in 8 of 10 patients. In group B, the microcatheter was placed coaxially through a 5 French guiding catheter at the main arterial supply of the tumor in 7 patients and at the peripheral segmental branch of the hepatic artery in 11 patients. The portal venous system was visualized retrogradely in all of the patients regardless of the injection site. The injected CO2 may flow back into the portal vein through the anastomosis known as the peribiliary or periportal plexus. In group C, not only the portal vein but also the pulmonary artery or pericardial vein were visualized by this method. CO2-IADSA was useful to image the minute communications between the various vessels, which have been not hitherto visualized by iodinated contrast medium.
BACKGROUND: This study examined the long-term clinical outcome of patients with focal atrial tachycardia who were treated surgically. Focal atrial tachycardia is a relatively rare arrhythmia that is often difficult to control with conventional medical therapy. Therapeutic modalities are not well defined because of the scarcity of long-term data of treated patients, including pathologic findings. STUDY DESIGN: Nine patients, six men and three women, ranging in age from 16 to 50 years (mean of 34 +/- 14 years), underwent operative treatment for focal atrial tachycardia. The average rate of tachycardia was 167 +/- 22 beats per minute. All patients were treated with antiarrhythmic drugs (mean 2.9 drugs per patient). Concomitant operative procedures were performed upon four patients, including division of the accessory atrioventricular pathway for the Wolff-Parkinson-White syndrome in two patients, plication of the right atrium for idiopathic right atrial dilatation in one patient, and a closure of the atrial septal defect in one patient. Focal ablation was performed in all instances. RESULTS: There was no early or late death nor postoperative complications. Atrial tachycardia disappeared and there were no episodes of recurrent tachycardia postoperatively during the mean follow-up period of 67 +/- 38 months. Histopathologic findings from four patients revealed a sinus node-like structure, diffuse chronic epimyocarditis, focal myocarditis, and fascicular disarray lesions. CONCLUSIONS: Excellent long-term result were obtained in patients with focal atrial tachycardia who were treated operatively. Early operative intervention is preferable before the occurrence of impaired ventricular function. From the histopathologic findings, operative therapy should be selected in patients with diffuse atrial lesions.
Limited surgery, esophagectomy without thoracotomy or endoscopic mucosal resection (EMR), is indicated for mucosal cancer of the esophagus without lymph node metastasis. Mucosal cancer less than 2 cm in size or less than a third of the circumference of the esophagus, is suitable for EMR. However, mucosal cancer invasive to the muscularis mucosa is excluded. As for postoperative complications, a small fissure, two cases of stenosis and 3 cases of oozing bleeding, were experienced. Conservative treatment was performed for all patients except one. The 5-year survival rate of EMR was 95%-100% in several institutions in Japan. Recurrence was observed in 3%-7%, however, it was cured by means of local treatment of esophageal cancer.
A 57-year-old woman was admitted with a chief complaint of difficult urination on June 7, 1993. A filling defect and a large diverticulum were revealed on the cystogram. Cystoscopy showed a tumor, obstructing the internal urethral orifice at the bladder neck and a diverticulum at the right posterior wall of the bladder. Under the preoperative diagnosis of a benign bladder tumor with a diverticulum, resection of the tumor and transvesical diverticulectomy were performed by a suprapubic approach. The resected tumor was smooth-surfaced, elastic soft and was measured 2.0 by 1.5 by 1.0 cm in size. Histologically, the tumor was diagnosed as a benign fibroma of the urinary bladder. The postoperative course was uneventful. Non-epithelial benign bladder tumors are rare. To our knowledge, this is the 18th case of bladder fibroma in the Japanese literature. The characteristics of bladder fibroma are briefly described.
Operation of esophageal cancer accompanies a big surgical stress and postoperative pulmonary complications such as respiratory failure are observed at high frequencies. On the other hand, when a big stress is added to a body, a state of hypercoagulation in which blood coagulation mechanism is abnormally enhanced appears and this state is closely related to organ failures but has many unknown points. So, we examined 39 patients given excision of esophageal cancer with respect to occurrence of postoperative respiratory failures, participation of coagulopathy in aggravation and their degrees before and after the operation to find out the relationship between postoperative respiratory failure and the state of hypercoagulation. We gave a diagnosis of respiratory failure to the patients whose respiratory index exceeded 1.5 on the day after operation but did not show atelectasis or hydrothorax. As a result, respiratory failures were observed in 7 out of 39 cases (17.9%). When a risk score (RS) of postoperative respiratory failure was determined using multivalent analysis (quantification type II) with preoperative factors such as age and function of heart, lung, liver, and kidney as well as preoperative blood coagulation factors, RS = 2.87 (antithrombin-III (AT-III) less than 75%) +1.89 (age over 70 years) +1.78 (respiratory index over 0.15) +1.44 (serum albumin less than 3.0 mg/dl) +1.28 (cardiac index less than 3.0 l/min/m2) was obtained and a drop in preoperative AT-III was considered a risk for occurrence of post operative respiratory failure. In contrast, referring changes in postoperative value of blood coagulation factors, a distinct rise in fibrinogen (FBG) appeared in early stage after operation in the respiratory failure group compared to the control group (p < 0.01). Moreover, recovery in AT-III of blood coagulation factors and in plasminogen and antiplasmin of fibrinolytic factors was delayed (p < 0.05) indicating promotion of postoperative hypercoagulation state and delay in recovery of coagulation-fibrinolysis factors. However, participation of platelet factors was absent.
The objective of this study was to assess the regression of vascular structural changes seen in essential hypertension after long-term monotherapy with a calcium antagonist and to clarify the relations to cytosolic free calcium and neurohumoral factors. Blood pressure, minimal vascular resistance (MVR) by strain-gauge plethysmography, cytosolic free calcium in platelets ([Ca2+]i) by Quin 2 method, plasma renin activity (PRA) and plasma aldosterone concentration (PAC), plasma noradrenaline (PNA) and parathyroid hormone (PTH) were measured in 14 essential hypertensives during a placebo period and 2 and 6 months after anti-hypertensive treatment with nilvadipine. Blood pressure decreased from 174 +/- 10/104 +/- 8 mm Hg during the placebo period to 154 +/- 13/93 +/- 14 mm Hg 2 weeks after nilvadipine, and the hypotensive effects were found throughout the 6-month period. Although increased MVR seen in hypertensives did not change after 2 months (from 2.1 +/- 0.7 to 1.9 +/- 0.6 mm Hg/ml/min per 100 ml tissue (PRU), NS), MVR decreased significantly at 6 months (1.6 +/- 0.4, PRU, P < 0.05). Elevated [Ca2+]i seen in hypertensives during the placebo period decreased significantly 2 months after nilvadipine treatment (156 +/- 26 and 140 +/- 27 nM, P < 0.01). The changes in MVR were associated with those in [Ca2+]i 6 months after nilvadipine (r = 0.56, P < 0.05). However, the changes in MVR did not correlate with those in PRA, PAC, PNA or PTH.(ABSTRACT TRUNCATED AT 250 WORDS)
Our objective was to clarify the DNA-binding activity of transcription factor NF-kappa B as related to cytokine induction in the synovium of patients with rheumatoid arthritis (RA) and osteoarthritis (OA). Synovial membranes were obtained during arthroplasty of the knee from 7 patients with RA and 4 patients with OA. Nuclear extracts obtained from the synovial membranes were examined by electrophoretic mobility shift assay to determine the DNA-binding activity of NF-kappa B. Markedly high DNA-binding activity of NF-kappa B was detected in the synovial membranes of RA patients, while virtually no activity was observed in those of OA patients. These results suggest that the high induction of NF-kappa B in the nuclear extracts may be relatively specific to synovial membranes in RA. NF-kappa B may regulate the production of cytokines at the site of synovial inflammation.
BACKGROUND: The occurrence of various arthropathies including carpal-tunnel syndrome (CTS) in dialysis-associated amyloidosis, a condition caused by the deposition of beta 2 microglobulin (beta 2MG), has been emphasized for several years. We attempted to analyse the pathogenesis of CTS in haemodialysis-associated amyloidosis (HA). METHODS: The expression of cell adhesion molecules and inflammatory cytokines in tenosynovial tissues was determined by using both reverse-transcriptase polymerase chain reaction (RT-PCR) and immunostaining. RESULTS: There was a marked expression of ICAM-1, VCAM-1, E-selectin mRNAs together with increased mRNA expression of inflammatory cytokines (IL-1 beta, TNF alpha, IL-6 and MCP-1) in proliferating synovial tissues. ICAM-1 was expressed not only on vascular endothelial cells, but also on synovial cells. In contrast, both VCAM-1 and E-selectin were exclusively expressed on endothelial cells. Mononuclear cells bearing CD13, CD14, CD33 and HLA-DR with macrophage-like morphology were accumulated in the perivascular area and expressed VLA-4, LFA-1 and Mac-1. Moreover, synovial lining cells, vascular endothelial cells and infiltrated mononuclear cells expressed chemokines such as MCP-1 and MIP-1 alpha. CONCLUSIONS: These data suggest that upregulated expression of inflammatory cytokines and adhesion molecules promotes activation and infiltration of macrophages causing CTS in haemodialysis-associated amyloidosis patients.
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In the present study, patients with asthma ware evaluated in order to find out if the emotional stress itself causes their asthmatic attack or not, and to elucidate the mechanisms underlining it. 41.8% of the 55 patients demonstrated asthmatic attack during hypnosis evaluated their symptoms and significant decrease in their air flow. The non-responders showed significant increase ind the serum DBH level (p < 0.05) during the hypnosis compared with their baseline value, while the responders did not show any significant change in the serum concentration. However, the responders shows significant increase in serum histamine concentration during (p < 0.01) and 40 min (p < 0.05) after the hypnosis. These data suggest that the increased sympathetic nerve activity during the hypnosis suppresses the release of chemical mediators from inflammatory cells and autonomic nerve terminals in the airways.
We studied the role of nitric oxide and inhibitory non-adrenergic, non-cholinergic (i-NANC) nerves in the regulation of airway responsiveness in anesthetized and mechanically ventilated cats. Vagal stimulation caused marked bronchodilation in the cats with sustained bronchoconstriction in the presence of atropine and propranolol. The bronchodilation evoked by vagal stimulation was completely abolished by hexamethonium (2 mg/kg). L-NG-nitroarginine methyl ester (L-NAME; 8 mg/kg + 2 mg/kg/min) significantly suppressed the relaxation evoked by vagal stimulation; the effect was particularly noticeable soon after the stimulation. Hexamethonium significantly increased airway responsiveness to serotonin: the PC200 decreased from 0.346 mg/ml (GSEM 1.23) without hexamethonium to 0.44 mg/ml (GSEM 1.63) with hexamethonium (p < 0.05). L-NAME shifted the dose-response curve to serotonin significantly to the left: the PC200 decreased from 0.261 mg/ml (GSEM 1.,40) without L-NAME to 0.056mg/dl (GSEM 1.38) with L-NAME (p < 0.05). Inhalation of citric acid (20%) caused marked bronchodilation during serotonin-induced bronchoconstriction. This bronchodilation occurred in the presence of atropine and propranolol and was inhibited by hexamethonium, therefore it was probably caused by a reflex mediated by i-NANC nerves. Furthermore, the bronchodilation induced by i-NANC nerves was significantly suppressed by L-NAME. These results suggest that nitric oxide is an important i-NANC transmitter that can modulate airway responsiveness.
We report a patient who developed acute cerebellar ataxia, delirium, disseminated intravascular coagulation (DIC), and acute renal failure following typhoid fever. After treatment his general conditions improved except for cerebellar ataxia. Brain magnetic resonance imaging (MRI), before and after intravenous gadolinium administration, showed slight atrophy of the cerebellar vermis. 1-123 iodoamphetamine single photon emission computed tomography (IMP-SPECT) images showed markedly reduced radioisotope (RI) uptake in the cerebellum, and strongly implicated dysfunction of the cerebellum. Our report suggests that severe typhoid fever can produce persistent cerebellar dysfunction.
The effects of leukotrienes C4 and D4 on ciliary activity of human paranasal sinus mucosa were investigated in vitro. Normal mucosa was surgically obtained from human paranasal sinuses and incubated in the form of tissue culture. Ciliated cells were magnified under an inverted microscope, and ciliary activity was photoelectrically measured. LTD4 progressively inhibited ciliary activity, and showed a more potent effect on ciliary activity compared to LTC4. The concentrations of LTC4 and LTD4 in the incubation medium were determined by radioimmunoassay when the mucosa was incubated with 10(-8) M LTC4. The concentration of LTD4 gradually increased and after 90 min reached the maximum of 0.71 x 10(-8) M, while that of LTC4 was reduced to about 10% of its initial concentration within 60 min. These results suggested the possible conversion of LTC4 to LTD4 on the mucosa, and that LTC4 can inhibit ciliary activity by means of LTD4.
Glutathione S-transferase (GST) was purified from Escherichia coli K-12, and its N-terminal sequence was determined to be MKLFYKPGAXSLAS. The gene encoding this sequence was cloned and mapped at 1731-1732 kilobases on the E. coli gene map. It encoded a polypeptide of 201 amino acid residues with a calculated molecular weight of 22,860. The overexpressed product of the gene was confirmed to have GST activity toward 1-chloro-2,4-dinitrobenzene and ethacrynic acid and GSH-dependent peroxidase activity toward cumene hydroperoxide. The relative molecular mass of the gene product was determined to be 40,000 by gel chromatography and 25,000 by SDS-polyacrylamide gel electrophoresis, indicating a homodimeric structure. The deduced amino acid sequence was 54% identical with that of Proteus mirabilis GST. Although the homologies between the GSTs from E. coli and mammals were low, many of the residues assigned to be important for the enzymatic function or structure in mammalian cytosolic GSTs were found to be conserved in E. coli GST. Therefore, E. coli GST is considered to have diverged from the same ancestor with other cytosolic GSTs. A specific tyrosyl residue in the vicinity of the N terminus is conserved in all of the known cytosolic GSTs and has been shown to function as a catalytic residue in alpha, mu, and pi class GSTs from mammals. Although Tyr5 in E. coli GST appeared to be the counterpart of the catalytic residue, its replacement with phenylalanine did not significantly affect the enzymatic activity. Therefore, this apparently conserved tyrosyl residue is not essential for catalytic activity in E. coli GST.
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