Full-scale investigation into adverse reaction in Japan. Risk factor analysis. The Japanese Committee on the Safety of Contrast Media.
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Contrast Media↗
Biomedical subjects
H Katayama
Publications and source records attributed to H Katayama.
Hemodynamic effects of endothelin-1 in the newborn piglet: influence on pulmonary and systemic vascular resistance.
The aim of this study was to investigate the influence of endothelin-1 (ET-1) on the pulmonary and systemic circulations in newborn piglets. Twelve piglets (mean age of 6.8 days, range of 1-12 days) were anesthetized with chloralose-urethane and ventilated at FiO2 = 1.0. Animals were instrumented to measure cardiac output (CO), pulmonary artery pressure (PAP), aortic pressure (AoP), left atrial pressure (LAP), and right atrial pressure (RAP). Six piglets received a control saline injection into the pulmonary artery (PA), and six piglets received one injection of ET-1 (500 ng/kg) into the PA while PAP, AoP, LAP, RAP, CO, and heart rate (HR) were measured simultaneously at 20-s intervals with pulmonary vascular resistance (PVR) and systemic vascular resistance (SVR) calculated by computer. Administration of ET-1 into the PA led to (a) a transient decrease in mean PAP (delta max of -4 +/- 2 mm Hg, p less than 0.001); (b) a biphasic response (an initial decline followed by a substantial increase) in PVR (delta max of -760 +/- 460 dyn cm/s5, p less than 0.01, and delta max of +1,490 +/- 1,360 dyn cm/s5, p less than 0.05) and in AoP (delta max of -12 +/- 7 mm Hg, p less than 0.005, and delta max of +11 +/- 6 mm Hg, p less than 0.005); (c) an increase in SVR (delta max of +5,930 +/- 2,330 dyn cm/s5, p less than 0.05); and (d) an initial increase in CO (delta max of +0.06 +/- 0.03 L/min, p less than 0.05) followed by a decrease (delta max of -0.09 +/- 0.05 L/min, p less than 0.05). These responses have not been observed in adult species and may indicate a developmental difference in the response of the pulmonary circulation to ET-1 administration.
Animals↗
Polymorphonuclear leukocyte-induced detachment of cultured epidermal carcinoma cells from the substratum.
In an in vitro study, intended to develop tumoricidal therapy with the use of human leukocyte, an interesting phenomenon was found. Normal human polymorphonuclear leukocytes (PMN) plated on a cell line established from malignant trichilemmal cyst (DJM-1), a kind of squamous cell carcinoma, in a serum-free media and incubated for 48 h induced the detachment of DJM-1. The detachment was more extensive as the number of PMN increased. The detachment rate was 97.0% when the number of PMN and DJM-1 in a well was in a ratio 2.4:1 and the viability of detached DJM-1 was 96.5%. Two kinds of proteinase inhibitors, especially the inhibitor of neutrophil elastase, fetal bovine serum, and monoclonal anti-laminin antibody inhibited the detachment significantly. Furthermore, when PMN were seeded in a chamber with a filter membrane bottom to prevent direct contact with DJM-1, DJM-1 detachment decreased to 14.2%. In view of these results, the following mechanism was postulated. Activated by their adhesion to DJM-1, especially between laminin receptor on PMN and laminin on DJM-1, PMN secreted proteinases, resulting in DJM-1 detachment. This phenomenon might be an expression of cytotoxicity of PMN to cancer cells, because cultured cancer cells of epithelium origin such as DJM-1 can grow only after they are firmly attached to the substratum. This phenomenon, in turn, may explain the final step in the induction of epidermal-dermal separation in subepidermal bullous diseases with PMN infiltration such as bullous pemphigoid and dermatitis herpetiformis if we could regard DJM-1 as normal keratinocyte.
Carcinoma, Squamous Cell↗
Promoting effect of sodium chloride solution mist on the induction of papillomas on Syrian hamster tracheal mucosa following administration of diethylnitrosamine.
The promoting effect of NaCl solution mist was studied in the induction of papillomas on Syrian hamster trachea following single subcutaneous injection of diethylnitrosamine (DEN). Sixty male hamsters were divided into three groups. Group A; Exposure to a 5% NaCl solution mist for 32 weeks following single subcutaneous injection of DEN at a dose of 3 mg/100 g body weight. Group B; Subcutaneous DEN injection alone. Group C; Exposure to the NaCl mist for 32 weeks alone. Total numbers of papillomas on the trachea in each group were 107 in group A, 64 in group B, and 0 in group C (P less than 0.05 between group A and B, P less than 0.01 between either groups A or B and C). Comparing the incidence of large papillomas with a diameter of more than 2 mm, that in group A hamsters was significantly greater than that of group B (22 large papillomas vs. 8 large papillomas, P less than 0.01). No difference in the effects on the epithelial cells of the nasal cavity, the bronchial or the alveolar cells in the lung was recognized between groups A and B. The hamsters in group C were not observed to have any changes in any of the respiratory organs. Inhalation of NaCl solution mist is considered to have a promoting effect on the induction of papillomas in the hamster trachea following DEN injection.
Adenocarcinoma↗
Prediction of severe adverse reactions to ionic and nonionic contrast media in Japan: evaluation of pretesting. A report from the Japanese Committee on the Safety of Contrast Media.
In a nationwide prospective study of adverse reactions to intravenous contrast media (CM), the Japanese Committee on the Safety of Contrast Media compared high-osmolar ionic CM with low-osmolar nonionic CM. A total of 337,647 cases were analyzed. The reliability of pretesting with an intravenous injection of a small amount of CM as a means of predicting severe or fatal reactions was also evaluated. The predictive values of the pretest were 1.2% for ionic and 0.0% for nonionic CM, and the sensitivity values were 3.7% and 0.0%, respectively. Such low values render this test meaningless for predicting which patients are at risk of a severe adverse reaction. A comparison of the incidence of severe adverse reactions between the nonpretested and pretested patients, as well as between the nonpretested and pretested patients with negative results, disclosed no statistically significant differences. Also, no beneficial effects of premedication in patients with a positive pretest were proved. The authors therefore conclude that pretesting with an intravenous injection of a small amount of CM is not useful in predicting severe reactions to ionic or nonionic CM.
Contrast Media↗
A quantitative analysis of hemodynamic effects of the right ventricle included in the circulation of the Fontan procedure.
BACKGROUND: Right heart hemodynamics were analyzed with a catheter-mounted velocity meter in seven patients after direct atrioventricular anastomosis for Fontan procedure (RV group) and were compared with those obtained in eight patients after direct atriopulmonary anastomosis (RA group). METHODS AND RESULTS: In the RV group, cardiac output was 2.7 +/- 0.6 l/min/m2; mean right atrial and pulmonary artery pressures were both 13 +/- 3 mm Hg; mean pulmonary artery wedge pressure was 7 +/- 5 mm Hg; left ventricular end-diastolic volume, determined angiographically, was 129 +/- 40% of normal; and its ejection fraction was 0.50 +/- 0.09. In the RA group, data were similar to those of the RV group except that right heart pressure were lower in the RV group, which was related to the preoperative condition of the pulmonary circulation. In the RV group, the fraction of ventricular forward flow of the total forward flow in the main pulmonary artery ranged from 0.21 to 0.46 and was not correlated with cardiac output or with any other parameter. The backward flow into the inferior vena cava at ventricular systole was greater than the atrial flow in two patients in whom cardiac output was less than 2.2 l/min/m2, whereas caval backward flow at atrial contraction was greater than ventricular flow in the other five patients, of whom four had a cardiac output greater than 3.1 l/min/m2. CONCLUSIONS: We conclude that the inclusion of right ventricle in the circulation of the Fontan procedure does not necessarily improve overall hemodynamics in most patients.
Adult↗
[Cytogenetic analyses of diesel engine exhaust by sister chromatid exchange and micronucleus tests with mouse fetal liver cells].
The genotoxic effect of maternal exposure to diesel engine exhaust was studied by analyses of sister chromatid exchanges (SCEs) and formation of micronuclei with fetal liver cells. Fetal liver cells were obtained from pregnant ICR/JCl mice at the 16th day of gestation. Diesel engine exhaust was generated by running a small engine (YANMAR NSA-40CE, used as an electric generator, displacement: 269 cc). The concentrations of pollutants in the inhalation chamber were as follows; CO: 40-100 ppm, NO2: 2-4 ppm, and particulates: 2-4 mg/m3. Maternal mice were divided into three groups: the long-term exposure group, the short-term exposure group and the non-exposed control. Mice of the long-term group were exposed to the exhaust 4 hours daily from day 0 to the 16th day of gestation. Mice of the short-term group were similarly exposed but only on the 15th and 16th days of gestation. The number of SCEs of fetal liver cells was significantly increased in both the exposed groups. The long-term exposure group showed a significant increase in the number of SCEs in comparison with that of the short-term exposure group. In the micronucleus test with fetal liver cells, no significant change in the frequency of micronucleated cells was induced by exposure to diesel exhaust.
Animals↗
Intraluminal pulsed Doppler evaluation of the pulmonary artery velocity time curve in a canine model of acute pulmonary hypertension.
The velocity pattern of the blood flow in the pulmonary artery was investigated in an animal model of acute pulmonary hypertension. Nine anesthetized, open-chest dogs were embolized with polystyrene microspheres, and the velocity pattern of the blood flow in the pulmonary artery was studied with use of an invasive pulsed Doppler technique. Phasic intraluminal velocity was recorded with use of a miniature piezoelectric crystal activated by 20-MHz Doppler pulses and mounted on the tip of a needle probe introduced into the pulmonary artery. The recorded Doppler quadrature signals were processed by spectral analysis. Significant increases occurred in mean, systolic, and diastolic pulmonary arterial pressures (p less than 0.0002), in pulmonary vascular resistance (p less than 0.005), and in negative velocity time (duration in milliseconds that the mean velocity was directed toward the pulmonic valve) (p less than 0.002). Significant decreases occurred in right ventricular ejection time (p less than 0.006) and in positive velocity time (duration in milliseconds that the mean velocity was directed away from the pulmonic valve) (p less than 0.005). A significant shortening in the time to peak velocity (acceleration time) was found (p less than 0.005). Second-order regression analyses demonstrated an inverse correlation between the ratio of positive velocity time to negative velocity time and the mean pulmonary artery pressure in all animals (r = 0.71). These findings should be compared with the velocity patterns of the blood flow in the pulmonary artery obtained under pulmonary hypertensive conditions due to various causes to facilitate interpretation and understanding of clinical investigations.
Animals↗
[Echocardiographic manifestations of excessive pulmonary artery banding in patients with transposition of the great arteries without ductal or ventricular shunt].
Recently, pulmonary arterial banding (PAB) and the Blalock-Taussig shunting operation (B-T) have been performed as a preparatory procedure for Jatene's operation for patients with complete transposition of the great arteries (TGA) without patent ductus arteriosus (PDA) or ventricular septal defect (VSD). We reviewed the echocardiographic findings of 29 patients after PAB and B-T. Four cases had abnormal catheterization data after PAB and B-T (Group 1). Twenty-five control cases with successful two-stage Jatene's operation exhibited normal data (Group 2). We studied 1) the grade of distortion of the interventricular septum as the a/b ratio on two-dimensional echocardiogram (2-DE), 2) the left ventricular (LV) shortening fraction (LVSF), 3) the thickening fraction (ThF), 4) the LV posterior wall thickness in diastole (LVPWTd) on M-mode echocardiogram, and 5) the LV inflow tract (LVIT) flow pattern on pulsed Doppler echocardiogram. In Group 1, all cases revealed LVSF less than 0.19 (control group: 0.40-0.56), ThF less than 0.18 (control group: 0.43-0.81), the a/b ratio higher than 0.88 (control group: 0.53-0.79), and LVPWTd thicker than 0.67 cm (control group: 0.45-0.59 cm). These data are markedly deviated from the range of the control data (p < 0.01). All cases in Group 1 had LVIT flow lacking the rapid filling phase, which was recognized in the control group. These abnormal echocardiographic findings suggest LV failure in adaptation against excessive after-load due to very tight PAB, and these figures are very different from the control group. These unusual postoperative cardiac abnormalities can be detected noninvasively using 2-DE and Doppler echocardiography.(ABSTRACT TRUNCATED AT 250 WORDS)
Echocardiography↗
[Recent advance in diagnostic imaging of bone tumors--how to read MRI].
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Adult↗
[Evaluation of myocarditis using T1-201 myocardial scintigraphy with bull's eye functional map].
In order to evaluate myocardial damage in a patient with myocarditis, rest thallium-201 myocardial single photon emission computed tomography (SPECT) was performed in 15 patients with myocarditis. For qualitative and semiquantitative analysis, Bull's eye functional maps were made up with SPECT images. In the functional map, the abnormal area, where T1 uptake is less than mean-2SD of the T1 uptake of normal subjects, is generally distributed in the myocarditis group. But focal and sequential abnormal areas were recognized more often in the clinically severe cases. Abnormal area tended to be observed commonly at the antero-septal wall, but it was uncommon at the lateral wall. Extent score, i.e. degree of extension of abnormal area, and severity score, i.e. degree of abnormality, were in good negative correlation with left ventricular ejection fraction (r = 0.6, r = 0.7). Furthermore, existence of abnormal area was in good correlation with the left ventricular regional wall motion. Abnormal area existed 100% in the akinetic region, 71% in the region of severe hypokinesis, and 27% in the region of hypokinesis. Abnormal area occupied 30% of the normokinetic region in the myocarditis group, which was a higher rate than in the normal control group (p less than 0.05). It was suggested that latent myocardial damage existed in the normokinetic myocardium with myocarditis. Thus, rest T1-201 SPECT with Bull's eye map is useful for clinical diagnosis in patients with myocarditis.
Adolescent↗
[Preliminary study of pelvic CT with air enema].
In pelvic CT, several techniques (appropriate preparations) have been reported for the optimal diagnostic imagings. We demonstrated the usefulness and limitations of "Air Enema", which is one of preparations for hollow viscera in pelvic CT examination. From Oct. 1986 to Mar. 1987, 38 patients with gynecological abnormalities were evaluated by consecutive pre and post "Air Enema" CT. The patients aged 26-75 years with mean of 44.6 years. All patients were examined in prone position with 100 ml of 2% iopamidol in the urinary bladder and medical tampon in the vagina. Two consecutive scans were performed from the level of pubic symphysis to the 5th lumbar vertebra at 10 mm-15 mm intervals. The first scan was pre "Air Enema" CT, in which the rectum, entire colon and terminal ileum were not distended. The second scan was post "Air Enema" CT, in which the hollow viscera was distended by 1000 ml-1500 ml of air. Two images, each from pre and post "Air Enema" CT were evaluated on the efficacy for imaging diagnosis. In "Air Enema" CT, main useful effect was "replacement effect", which was that intrapelvic masses and/or intrapelvic paravascular spaces were clearly delineated by distended bowels. Detection and location of intrapelvic masses were correctly diagnosed when the masses were relatively small (5.3 cm in average diameter), but there were no advantages in cases in which the pelvic masses were large enough to occupy the pelvic cavity (12.7 cm in average diameter). Abdominal pain was the most common adverse reaction to this technique. But complaints usually disappeared in few hours after examination. Thus, "Air Enema" seems to be useful preparation for pelvic CT examination to detect relatively small intrapelvic masses and abnormalities.
Adult↗
[Bone changes in congenital biliary atresia--review of 42 cases after surgery].
Plain radiographs of forty-two infants with biliary atresia were reviewed to clarify the clinical significance of bone changes after surgery. The same surgical procedures (hepatoportojejunostomy with Suruga II enterostomy or choledochojejunostomy with Suruga II enterostomy) were performed in all cases except one at Juntendo University Hospital during 1977-1983. Bone changes were found in thirty-one patients during the 2 year period after surgery, and generalized osteopenia was the common radiological manifestation. In addition, sixteen patients were revealed to have rickets and/or fractures. The age of development of osteopenia ranged widely, but that of rickets and fractures ranged from 6 months to 2 years. It corresponded well to the age of recovering from physiological depression of bone mineral content in normal infants. Most rickets and fractures developed in association with other complications such as pulmonary infections. They were healed with treatment within 2-3 months after onset. But osteopenia persisted longer in most cases. Compared to cases without bone changes, jaundice was seen more frequently and the prognoses was worse in cases with bone changes. There was no relationship between rickets or fractures and prognosis. Biochemical data at the onset of bone changes included hypoalbuminemia and hypophosphatemia. Hypoalbuminemia, hypophosphatemia and hypocalcemia were seen in cases with rickets or fractures. But hypocalcemia was improved with treatment. From these observations, we considered that osteopenia reflected well the patients' general condition and prognosis, but most rickets or fractures which developed due to failure to meet the physiological high demand of calcium, did not play a major role for prognosis of biliary atresia.
Biliary Atresia↗
Survey of safety of clinical contrast media.
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Contrast Media↗
Adverse reactions to contrast media. What are the risk factors?
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Contrast Media↗
Pretesting as a predictor of severe adverse reactions to contrast media.
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Contrast Media↗
Granulation tissue that developed after a minor trauma in a psoriatic patient on long-term etretinate therapy.
Synthetic analogues of retinoic acid, isotretinoin in particular, are known to cause granulation tissue in the nail sulcus and healing cystic acne. We observed granulation tissue that developed in a psoriatic patient on long-term oral etretinate therapy (30 mg/day for 3 years), another synthetic analogue of retinoic acid. In August of 1988, the patient, a 44-year-old male, hit his lower leg against a wooden stick, resulting in a laceration. At that time he had relatively limited patches of psoriasis, but his skin was generally thin with telangiectasia, even in areas without psoriasis, probably due to the long-term use of oral etretinate and topical steroid. In spite of treatment with topical disinfectants and oral antibiotics, the wound progressed into granulation tissue surrounded by erythema and multiple punctate erosions with marked secretion of a clear exudate. The histological findings of the granulation tissue included the presence of proliferating microvessels and a relatively dense cell infiltration with a predominance of plasma cells on the sparse edematous connective tissue. Based on these findings, the rash was considered to be retinoid-induced granulation tissue. As compared with previous reports, our case had the following characteristics: development of rash after minor trauma, rash on the lower leg, eosinophil infiltration into the rash. We believe that long-term users of oral etretinate should be cautioned about the potential for delayed wound healing and the formation of granulation tissue.
Adult↗
Coexistence of beta 1- and beta 2-adrenoceptors in the melanophore of the goby Tridentiger obscurus.
The effects of beta-adrenergic agonists and antagonists on the pigmentary state of denervated melanophores in isolated, split, caudal fins of the goby Tridentiger obscurus were examined to investigate the function and the subtype of the beta-adrenoceptors of the melanophores. Salbutamol, terbutaline, and dobutamine partially inhibited the pigment-aggregating response of melanophores to norepinephrine. The effects of these beta-agonists were inhibited by propranolol. It was confirmed that the melanophores possess both alpha- and beta-adrenoceptors, and that the activation of the beta-adrenoceptors induces the dispersion of pigment in the melanophores. Norepinephrine, epinephrine, isoproterenol, dobutamine, salbutamol, and terbutaline evoked the dispersion of pigment in the melanophores in which pigment had previously been aggregated by treatment with verapamil in the presence of phentolamine. The pigment-dispersing effects of two beta 1-selective agonists, norepinephrine and dobutamine, were effectively inhibited by metoprolol, a selective antagonist of beta 1-receptors. By contrast, the pigment-dispersing effects of two beta 2-selective agonists, salbutamol and terbutaline, were not inhibited by metoprolol. Both the effects of nonselective agonists, epinephrine and isoproterenol, were partially inhibited by metoprolol. The actions of all of the beta-agonists used were effectively inhibited by propranolol, and they were partially inhibited by butoxamine. These results suggest co-existence of beta 1- and beta 2-adrenoceptors in the melanophores. The relative numbers of beta 1- and beta 2-adrenoreceptors as a percentage of the total population of beta-adrenoceptors were estimated to be 18.6% and 81.4%, respectively, from analyses of Hofstee plots of the effects of the beta-agonists on the melanophores in the presence of butoxamine or metoprolol.
Animals↗