Biomedical subjects
Publications and source records attributed to H Komatsu.
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A male patient with acute meningoencephalitis and cerebellitis associated with Mycoplasma pneumoniae infection is described. T2-weighted MRI demonstrated a high-intensity lesion involving the deep white matter of the right cerebellar hemisphere, which was not enhanced on injection of gadolinium. Brain perfusion scintigraphy revealed hypoperfusion in the bilateral cerebellar hemisphere. Polymerase chain reaction analysis using M. pneumoniae-specific primers failed to reveal the existence of the M. pneumoniae genome in cerebrospinal fluid. Conversely, serum antibodies to gangliosides (GM1, GM2, and GT1b) were detected, suggesting a mycoplasma-related neurologic disorder mediated by an immunologic mechanism. These findings support the hypothesis that vasculopathy and demyelination caused by an immunologic mechanism play an important role in the pathogeneses of neurologic disorders associated with M. pneumoniae infection.
Valine-depleted amino acid imbalance, while having a suppressive effect on tumor growth, may induce fatty liver. We administered valine-depleted total parenteral nutrition (TPN) solution to rats subcutaneously transplanted with ascites containing hepatoma AH-109A and examined the time course of the development of fatty liver. An accumulation of fatty vacuoles was observed in hepatocytes on day 4. To prevent the development of fatty liver in tumor-bearing rats, we administered a small amount of valine in addition to the valine-depleted imbalance solution via the central vein. Such treatment, however, resulted in neither the prevention of fatty liver development nor the suppression of tumor growth. To supply valine to the liver, we administered a low concentration of valine via the portal vein simultaneously with central venous administration of valine-depleted TPN solution. As a result, the peripheral blood valine level of these rats was < 0.5 that of the control group, but the valine in the liver was maintained at the same level as that of the control group, and accumulation of triacylglycerols in the liver was slight. However, the suppressive effect on tumor growth was maintained, as the tumor weight was suppressed to almost the same degree as that of rats administered only the valine-depleted solution.
Incorporation of [3H-methyl] groups into phospholipids and prostaglandin E2 (PGE2) production in cultured rat mesangial cells were examined in the presence and absence of arginine vasopressin (AVP). In cells stimulated with AVP, a rapid increase in the incorporation of [3H-methyl] group into phospholipids was observed within 1 min after stimulation. The [3H-methyl] group present in the phospholipids began to decline 2.5 min after stimulation. The production of PGE2 increased with AVP treatment, and the decline in methylated phospholipids paralleled the release of PGE2 in AVP-stimulated cells. The inhibition of phospholipid methylation by treatment with adenosyl-S-isobutyl mercaptan (SIBA) resulted in a marked decrease in AVP-stimulated PGE2 production. In order to determine the identity of the methylated phospholipids, [3H-methyl] incorporation into phosphatidylethanolamine derivatives was examined. In AVP-stimulated cells, an increase of [3H-methyl] labeled phosphatidylcholine and lysophosphatidylcholine was observed after stimulation with AVP, followed by an apparent increase of [3H-methyl] labeled lysophosphatidylcholine. These findings indicate that AVP stimulates phospholipid methylation in cultured rat mesangial cells and phosphatidylcholine, synthesized by a transmethylation pathway, may be a source for PGE2 production.
In monkey cerebral cortex, color information is processed along the ventral visual pathway. This pathway starts in the primary visual cortex and ends in area TE of the inferior temporal cortex. Recent studies indicate that the transformation of cone signals occurs early in the pathway to form neurons selective to a narrow range of hues. In addition, it has become apparent that area TE plays a vital role in color discrimination.
A benign, transient proliferation of atypical lymphocytes and a monoclonal rearrangement of the T-cell receptor beta (TRB) locus was found in a 60-year-old woman who presented with low-grade fever, anorexia and fatigue. A marked and transient atypical lymphocytosis (white blood cell count 90.5 x 10(9)/l) with CD8 surface antigen improved without specific treatment. Although tests for IgM antibodies to hepatitis A, varicella zoster, Epstein-Barr virus (EBV), and cytomegalovirus (CMV) were all negative, a monoclonal gene rearrangement of TRB locus was observed in the DNA of the proliferated atypical lymphocytes by Southern blotting. The clonal rearrangement and the atypical lymphocytes disappeared after 14 d, and the patient has remained well for 7 years. These results suggest that monoclonal proliferation of CD8 lymphocytes can occur based on a non-neoplastic aetiology.
We investigated community-based data of the Mini-Mental State Examination (MMSE) scores of elderly residents along with the effects of age and educational level. MMSE was planned for all residents over 65 years of age in a town in northern Japan. The number of elders who took the MMSE was 2,266 (90%). The score significantly declined with age and lower educational level, although no effect of sex was apparent. For the MMSE subitems, all the values except for that of naming showed effects of both age and educational level. Those screened by MMSE who fell in the range of cognitive impairment (< 24) accounted for 21.8% and those with severe cognitive impairment (< 18) constituted 6.0%. Despite the differences in language and culture, the mean scores are remarkably similar between Japan and other countries. This is the first normative, community-based study of MMSE among elderly adults in Japan.
UNLABELLED: To assess the analgesic efficacy and side effects of concurrent infusion in patient-controlled epidural analgesia (PCEA) after upper abdominal surgery, 40 patients undergoing elective gastrectomy under general anesthesia were allocated to two groups in this randomized, double-blind study: one received a 2.5-mL incremental bolus in a solution of 0.2% bupivacaine and 10 microg/mL fentanyl, and the other received the same bolus dose plus a 2.5-mL/h infusion of the same solution. The number of demands was smaller (P < 0.001) in the PCEA plus infusion group than in the PCEA alone group during the 48-h postoperative period. The average hourly fentanyl and bupivacaine doses were larger (P < 0.0001) in the PCEA plus infusion group than in the PCEA alone group. Visual analog scale pain scores on coughing in the PCEA plus infusion group were lower than in the PCEA alone group (P < 0.05). There was a greater incidence of pruritus in the PCEA plus infusion group (P < 0.05), but no serious side effects were observed in either group. In conclusion, a background infusion in PCEA with a mixture of fentanyl and bupivacaine decreases the incidence of postoperative pain and reduces the degree of pain associated with coughing without serious side effects after gastrectomy. IMPLICATIONS: A background infusion in patient-controlled epidural analgesia with a mixture of fentanyl and bupivacaine decreased the incidence of postoperative pain and reduced the degree of the pain associated with coughing without serious side effects in this randomized, double-blind study after gastrectomy.
BACKGROUND: Previously the authors found that a single post-training exposure to enflurane or isoflurane, but not halothane, enhanced memory storage in an active avoidance task, which is a behavior with underlying mechanisms that are poorly understood and still debated. In contrast, spatial tasks are known to depend on hippocampal functions. This study investigated the effects of repetitive post-training exposure to enflurane on spatial memory in mice. METHODS: Using an eight-arm radial maze, 80 mice were trained to eat a pellet placed on the end of each of the eight arms. Training occurred on four consecutive days with one trial per day. The number of errors in the first eight choices was recorded to determine performances for each day of training. Immediately after each training session, mice in the enflurane group received 1 h exposure to 0.5%, 1%, or 2% enflurane in air through a calibrated vaporizer. The performance ratios (the ratio of errors on each day compared with the first day of the 4 days) in the control and the enflurane groups were compared. RESULTS: The performance ratios (which equals the mean of the error in the fourth day/the error in the first day) in the control, and 0.5%, 1%, and 2% enflurane groups were 0.66, 0.65, and 0.32 (P < 0.01, vs. control), and 0.46 (P < 0.05, vs. control), respectively. CONCLUSIONS: Repetitive post-training exposure to 1% and 2% enflurane significantly enhanced spatial memory in the eight-arm radial maze task. Enflurane enhances consolidation of spatial memory, possibly by affecting hippocampal activity.
OBJECTIVE: This study was conducted to determine whether a ventriculoperitoneal shunt alone was effective in treating subdural effusion with hydrocephalus. METHODS: Using only a ventriculoperitoneal shunt, we successfully treated eight patients who had subdural effusion with hydrocephalus after ruptured intracranial aneurysmal clipping, despite ventricular deformity and midline shift. RESULTS: For all of the patients, both the subdural effusion and ventriculomegaly subsided and clinical symptoms lessened after surgery. CONCLUSION: Ventriculoperitoneal shunting alone is an effective and satisfactory procedure; no subdural peritoneal shunt is needed for patients with subdural effusion accompanied by hydrocephalus. To-and-fro communication between the subdural effusion and ventricles is considered to be present in these patients. When selecting the treatment for subdural effusion, it is important to consider whether hydrocephalus (disturbance of cerebrospinal fluid circulation) is present.
BACKGROUND: Measuring urinary beta 2 microglobin (B2M) and N-acetyl-beta-D-glucosaminidase (NAG) excretion is widely used as a valuable clinical tool in assessing renal tubular lesions. However, few data are available on normal values for urinary excretion of B2M and NAG in infancy. METHODS: Urinary B2M and NAG were measured in healthy infants. The logarithmic values of urinary B2M, NAG, B2M/creatinine ratio and NAG/creatinine ratio were distributed almost normally and reference ranges were calculated from the logarithms of the observed values. RESULTS: The levels of urinary B2M and B2M/creatinine ratio were highest in the 1-month-old group, followed by a decrease during the first 3 months. Urinary B2M excretions in the 3-month-old group showed rather lower levels than those of the 12-month-old and 36-month-old groups. Although urinary NAG excretions were almost constant throughout all groups, urinary NAG/creatinine ratio decreased gradually until 3 years of age. CONCLUSIONS: We suggest that these reference ranges are of importance in evaluating tubular damage due to a variety of renal diseases in infancy.
From the glycoside mixture with adjuvant activity obtained from the hyacinth bean, the seeds of Dolichos lablab L., six new oleanane-type triterpene bisdesmosides, lablabosides A, B, C, D, E, and F, were isolated together with chikusetsusaponin IVa. The structures of lablabosides A, B, and C were determined on the basis of chemical and physicochemical evidence as follows: 3-O-[alpha-L-rhamnopyranosyl (1-->2)-beta-D-galactopyranosyl (1-->2)-beta-D-glucopyranosiduronic acid]-28-O-(beta-D-glucopyranosyl) oleanolic acid (lablaboside A), 3-O-[alpha-L-rhamnopyranosyl (1-->2)-beta-D-galactopyranosyl (1-->2)-beta-D-glucopyranosiduronic acid]-28-O-(beta-D-glucopyranosyl) 24-epi-hederagenin (lablaboside B), 3-O-[alpha-L-rhamnopyranosyl (1-->2)-beta-D- galactopyranosyl (1-->2)-beta-D-glucopyranosiduronic acid]-28-O-[alpha-L-rhamnopyranosyl (1-->2)-beta-D-glucopyranosyl] 24-epi-hederagenin (lablaboside C).
In this communication, we summarized our recent experimental approaches to an unsettled issue, i.e., the nature and role of an acidic precursor in enamel mineralization. The objectives we specially focused our attention on are: the composition, structure and high resolution images of enamel crystals at various developmental stages, thermodynamic and kinetic consideration of octacalcium phosphate (OCP) vs hydroxyapatite (HA) precipitation in physiological media simulating the enamel fluid, reversible changes in the composition and structure of OCP, effects of fluoride at low concentrations and enamel proteins on OCP hydrolysis, and adsorption of enamel proteins onto OCP and fluoridated hydrolysates at neutral pH and room temperature. On the basis of all experimental evidence, we propose that enamel crystal growth comprises two events: the two-dimensional growth of an OCP-like precursor in a narrow outermost zone adjacent to the ameloblasts and the subsequent overgrowth of apatite units on the template under discrete fluid environment in the underlying region distant from the cell layer. The experimental data also support the concept that the whole process of enamel mineralization is modulated substantially through interaction between enamel proteins and crystals including the acidic precursor.
Therapy-related leukemia and myelodysplastic syndrome (TRL/MDS) in Japan were analysed in a multi-institution study to assess clinical, cytogenetic aspects, and prognostic factor. From 1985 to 1994, 405 cases of adult TRL/MDS were diagnosed and overall percentage of TRL/MDS in leukemia and MDS was 1.9%. Median age was 61 years old. The median latency from primary malignancies was 53.4 months, which latency was significantly shorter in the patients treated with chemotherapy. Primary malignancies were hematologic in 39%. Common symptoms were fatigue/ weakness and anemia. Chromosome 7,5, and 11 were frequently involved. MLL gene rearrangement were detected in 12 of 64 analysed cases. Overall median survival was 10.0 months. Body weight loss, neurologic abnormality, hypoproteinemia, hypofibrinogenemia, proteinuria, lack of Auer rods, and 5q-were prognostic factors in TRL/MDS. This large population study documented some datas useful for the prevention of TRL/MDS.
Excellent results of multiple burr-hole operation (MBHO) for child moyamoya disease are reported in this study. Three patients of moyamoya disease had MBHO. After MBHO, transient, ischemic attacks disappeared in a patient despite progressing stenosis of the major cerebral arteries, and remarkable neurological improvement was recognized in a patient who had encephaloduroarteriosynangiosis. Another patient slowly improved and became able to go to junior high school. N-isopropyl-p-[123I] iodoamphetamine (IMPSPECT) findings also improved in all patients. There was no mortality or morbidity, and no new neurological deficits or bleedings developed during the follow up period. The authors recommend the MBHO as the surgical treatment of choice for not only adult but also child moyamoya disease because of its safety and effectiveness, and also report the usefulness of MBHO for the patients who have already received other bypass operations.
We examined lung specimens that fulfilled the pathological criteria of Bosken and were obtained from 5, patients with allergic bronchopulmonary aspergillosis/mycosis (ABPA/M). A finding common to all 5 was the presence of hard mucous plugs containing numerous eosinophils and fungal hyphae in the bronchi, showing central bronchiectasis. Bronchocentric granulmatosis with tissue eosinophilia (4 cases), xanthogranulomatous lesions (3 cases), eosinohilic pneumonia (2 cases) and organizing pneumonia (3 cases) were recognized only in bronchi distal to the mucous plugs (BMP). Almost normal lung parenchyma could be seen in some areas distal to the BMP. We found clusters of degenerated eosinophils (CDE) showing a "fir-tree like structure" and fungal hyphae in both the mucous plugs and the peripheral lesions. Most CDEs were free in the exudate and were not engulfed by macrophages. The presence of fungi in the mucous plugs may have caused marked inflammation in the wall around the BMP, which may have made the walls fragile and caused central bronchiectasis. The fungi in the mucous plugs may have caused the peripheral lesions via aerogenous dissemination. For this reason, we conclude that ABPA/M is an infectious disease, and that the primary lesion in ABPA/M is the formation of mucous plugs. Therefore, the presence of mucous plugs containing fungi and many eosinophils is diagnostic of ABPA/M.
Thirty six cases with multidrug-resistant tuberculosis were retrospectively studied to define the causes attributable to the emergence of multidrug-resistant M. tuberculosis. All these tuberculosis cases were microbiologically confirmed and resistant to at least isoniazid and rifampicin. Data analysis using matched-pair sampling methods (1:3) demonstrated that the followings are the significant risk factors for the emergence of multidrug-resistant tuberculosis; incompliance to treatment (Odds ratio 21.0: 95% CI 4.10-107.63), alcohol abuse (Odds ratio 15.0: 95% CI 2.34-96.1) and the history of previous treatment (Odds ratio 5.0: 95% CI 2.04-12.21), while diabetes mellitus is not statistically significant. The incompliance to treatment which is primarily thought to be patient's responsibility results in non-optimal administration of antituberculous agents, leading to the multidrug-resistant tuberculosis. Other factors that may have contributed to the emergence of resistance included the unnecessary change of regimen before completion of chemotherapy. This is patient-unrelated situation where responsibility lies in the medical side. A clinical case presented here is an example. In this case RFP was replaced with ethambutol 3-months after the initiation of regimen including SM, INH and RFP because of abnormal elevation of GOT and GPT without any supporting evidence that RFP was causative. The readministration of RFP after 1-year cessation did not induce liver dysfunction, while the drug resistance was observed not only to RFP but also to INH. This case suggests unnecessary interruption of RFP could lead to the emergence of resistance to INH as well as RFP. One known mechanism of drug resistance is random mutation and the selection by drugs administered during the course of chemotherapy. The cases with advanced cavitary lesions would have a higher probability of the occurrence of mutation. The more the number of mutant bacilli, the higher the probability of emergence of multidrug resistance. Those cases in which longer period of time is needed for the negative conversion of M. tuberculosis should be treated with potent chemotherapy regimens under the intense supervision. Since both INH and RFP are the most potent among currently available antituberculous agents. It is crucial to preserve the potency of these essential agents before novel antituberculous are developed.
We surveyed 21 terminally-ill patients with cancer pain who received continuous injection therapy of morphine at home in the three years from 1995 to 1997. The period of home therapy was 179.3 +/- 257.5 (mean +/- SD) days. The period of morphine injection was 39.2 +/- 29.1 days. Morphine solution was injected intravenously via a catheter inserted in a central vein in all patients. The instrument used most frequently for injection was the seven-day type disposable balloon pump (n = 17, 81.0%). The maximum dosage of morphine in the period of home therapy was 57.3 +/- 30.6 mg per day. Nine patients (42.9%) seldom used supplemental analgesics, while 11 patients (52.4%) used them sometimes. Nine patients had some trouble with continuous injection therapy of morphine. The following were problems: accidents with the injection instruments (insufficient injection volume, delay of drug supply, etc.) and of the intravenous catheters (accidental removal of catheter, occlusion of catheter, etc.). Eleven patients (52.4%) died at home, and 10 patients (47.6%) were hospitalized again. Continuous morphine injection therapy is an effective strategy for cancer pain management at home.