A new action mechanism of intravenous immunoglobulin for idiopathic thrombocytopenic purpura.
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Biomedical subjects
Publications and source records attributed to H Natori.
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We attempted to detect cytomegalovirus DNA (CMV-DNA) and Pneumocystis carinii DNA (P. carinii-DNA) in sputum samples of 18 hematological neoplasm patients with pneumonia, using rapid cycle DNA amplification. A thermal cycler based on recirculating hot air was used for rapid temperature control of 10-microliters samples in this glass capillary tubes. After a total amplification time of 15 min, the amplified products were electrophoresed on agarose gels and visualized with ethidium bromide. In three cases, CMV-DNA was detected at about the time the pneumonia occurred. These patients were successfully treated with ganciclovir in the early stages of infection and CMV was not detected by the virus culture method. In four other cases, P. carinii-DNA was detected in their sputum samples but not detected by Grocott staining. These four cases of P. carinii were successfully treated with sulfamethoxazole-trimethoprim. For detection of CMV-DNA and P. carinii-DNA using the capillary polymerase chain reaction (PCR), a different temperature setting base on the primer difference was not necessary. Therefore, capillary PCR was performed at the same time for detection of CMV and P. carinii. We conclude that capillary PCR amplification is a valuable tool for rapid diagnosis and early treatment of pneumonia due to CMV and P. carinii.
From January to December 1991, 47 clinical cases in when methicillin-resistant Staphylococcus aureus (MRSA) strains were isolate were investigated at our internal medicine ward. The MRSA infection rate was 57.4% (27/47). The mortality due to MRSA bacteremia was 75.0% (9/12) and that due to MRSA pneumonia was 57.1% (4/7). We think that MRSA infections must be treated by multiple antibiotics. At out institution, most of the patients were given a combination therapy of imipenem + fosfomycin or imipenemt + mynocycline. Although in vitro the MICs of imipenem did not show excellent activity against MRSA strains, in vivo these combination therapy including imipenem showed excellent activity against MRSA infections. We think that this result was due to the additive effect of the two drug combination. We determined the MICs of single antibiotics against MRSA strains. Most of the MRSA strains were sensitive to minocycline and arbekacin. All MRSA strains were sensitive to vancomycin we think that vancomycin is a highly useful drug to combat MRSA infection.
We have developed a system of nodule detection interpretation experiment on personal computers. This system is composed of three subsystems: practice, experiment and check modes. In the practice and experiment modes, chest radiographic images, each with or without a nodule, are shown in a random order on the monitor. The reader is then asked to point a location of nodule and to give a confidence rating. In the check mode, a subsystem shows locations of the real nodules and false positive foci on a figure of a chest radiograph. It also shows receiver operating characteristics of each reader. This system can precisely and easily perform an interpretation experiment. Then reader performance in detection of nodules can be accurately and promptly evaluated. This system, therefore, is very useful to perform a large-scale interpretation experiment in a constant reading condition.
We attempted to detect cytomegalovirus DNA (CMV-DNA) and Pneumocystis carinii DNA (carinii-DNA) in urine, blood and sputum samples of 16 leukemia patients with pneumonia, using the polymerase chain reaction (PCR). Synthetic oligonucleotide primer pair were used to amplify DNA from the major immediately genes of CMV and genes for the large subunit of mitochondrial ribosomal RNA of P. carinii. Amplified products were detected by gel electrophoresis. In two cases, CMV-DNA was detected at about the time the pneumonia occurred, and in one of the two cases, CMV-DNA was detected in the sputum sample. This patient was treated immediately with ganciclovir. After ganciclovir treatment, clinical and biochemical signs of CMV pneumonia disappeared. In three cases, carinii-DNA was detected in their sputum samples. In their blood and urine samples, carinii-DNA were not detected. This three cases were treated with sulfamethoxazole-trimethoprim and successfully treated episodes of P. carinii pneumonia. We conclude that PCR amplification may be a valuable tool for rapid diagnosing CMV pneumonia and P. carinii pneumonia.
Fecal bile acids (FBA) were analyzed by gas-liquid chromatography in 29 patients [17 with ulcerative colitis (UC) and 12 with adenomatosis coli (AC)] and 5 healthy volunteers. Seven UC and 9 AC patients had undergone total colectomy and J-shaped ileal pouch-anal anastomosis (JAA). The mean daily FBA output was similar for JAA and terminal ileostomy patients (approximately 370 mg/day), and was about 1.5 times that of healthy Japanese volunteers (approximately 235 mg/day). The output of unconjugated bile acids, secondary bile acids, and 7-dehydroxylated bile acid was higher in JAA patients with UC than in terminal ileostomy patients, but there were no significant differences between the groups. The total fecal bacterial count in JAA patients was 10 times that in terminal ileostomy patients but was 1/10 of that in healthy volunteers. In patients with defunctioning high ileostomy, FBA output increased markedly (maximum, 3054 mg/day), and serum cholesterol levels were also significantly lower (P less than 0.05). These results suggest that after JAA the bile acid metabolism and fecal bacterial flora undergo more normalization than after terminal ileostomy.
In a 72-year-old man with watery diarrhoea and leukocytosis the proliferation of abnormal cells was studied in specimens obtained by endoscopic biopsy of the gastrointestinal tract. Flow cytometry of leukaemia cells revealed a monoclonal expansion of "double-negative" (CD4-, CD8-) cells bearing T-cell receptor (TCR) alpha beta products. Southern blotting confirmed monoclonal integration of HTLV-I. A novel T-cell subset of double-negative TCR alpha beta cells in the gastrointestinal tract in adult man may be a target for HTLV-I infection.
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Relapsing polychondritis is a rare disorder of uncertain origin characterized by recurrent inflammation of cartilage. A case of myelodysplastic syndrome (MDS) associated with relapsing polychondritis is reported. A 60-year-old man who had been diagnosed as MDS was admitted because of pain and swelling in the bilateral preauricular regions and cheek. A diagnosis of relapsing polychondritis was made by coexistence of auricular chondritis, arthropathy, ocular inflammation and audio-vestibular disturbance. He also developed ocular palsies and optic neuritis. He was treated with prednisolone, azathioprine, dapsone, and then with steroid pulse therapy. Moreover, plasmapheresis and high dose gamma-globulin therapy were undertaken. However, all these treatments were unsuccessful and he died of respiratory failure.
We analyzed the effect of an unknown factor, which derived from serum, on platelet associated IgG (PA-IgG) and we established the novel immunofluorescence method to measure the level of PA-IgG. Blood samples were obtained from 20 patients with idiopathic thrombocytopenic purpura (ITP). After the treatment of platelets with neuraminidase, the value of PA-IgG positive platelets (%PA-IgG) were significantly increased in patients with ITP, but not in controls. When the platelets pretreated with neuraminidase were incubated with human serum, %PA-IgG was remarkably decreased in ITP patients. In healthy individuals, when platelets bound to aggregated human IgG pretreated with human serum, the binding of FITC-conjugated anti-human IgG was inhibited. And the value of mouse anti-GP II b/III a monoclonal antibody positive platelets was decreased, when the platelets preincubated with mouse serum. The binding of FITC-conjugated anti-human IgG and anti-mouse IgG antibody was apparently inhibited by some unknown factor in serum. Our results showed that this substance had species specificity. We called this substance "Serum Derived Blocking Factor (SDBF)".
A 22-year-old female was admitted to our hospital because of general fatigue. The lymph nodes, liver and spleen were not palpable. She was without cutaneous lesions. Haematological examinations revealed leukocytes 3,200/microliters with 44% blasts of myelomonocytic origin, and platelets 15,000/microliters. Bone marrow smears were hypercellular marrow with 51% blasts of myelomonocytic origin and focal involvement of mast cells. Serum histamine and vitamin B12 level was high. Mast cells were round with rounded or segmented nuclei. The nucleoli were inconspicuous and the cytoplasm contained a number of metachromatic granules. Cytochemically, mast cells stained positive for alpha-naphthol-AS.D-chloroacetate esterase and acid phosphatase, and negative for peroxidase, Sudan black B and alpha-naphthyl butylate esterase. In toluidine blue staining, mast cells had stained similarly with pH values from 2.5 to 6.5. She was diagnosed as acute myelomonocytic leukemia with benign mastocytosis, and treated with BH.AC-DNP. A complete remission was obtained, but mast cells in the marrow did not decrease. Relationship between leukemia and mastocytosis was not known, but it was suggested that mast cells responded to the proliferation of the leukemic cells.
Familial cases of HTLV-I-associated myelopathy (HAM) and adult T-cell leukemia (ATL), developing in a daughter and father, respectively, are reported. The coexistence of both diseases in a family has not been reported before. This supports the recent findings that ATL and HAM may be brought about by an identical virus on an apparently different immunogenetic background.
Since 1978, J. Utsunomiya has performed total colectomy, mucosal proctectomy and ileoanal anastomosis (IAA) in 105 patients and analysed their results in 97 patients consisting of 61 of familial polyposis (FP) and 36 of ulcerative colitis (UC) those who have been observed for two months to 10 years after operation. The operative procedures were classified in the three modalities. I. the "end to end-long cuff", II. "J-pouch-long cuff" and III. "J-pouch-short cuff" procedure. The success rate has been improved to 93.0% in the procedure III. compare with 74.1% in the II and 61.5% in the I. This improvement was achieved by preservation of reservoir continence, reduction of pelvic sepsis and less damaging of the internal sphincter during operation. Through a series of evolutional modification, the surgical technique has been established to the present method which is constructed with the four principal components: direct anastomosis of J-ileal pouch to the anus, short rectal cuff mucosectomy, anoabdominal approach at prone jack-knife position and routine use of defunctioning ileostomy. With this technique, both FP and UC patients enjoyed excellent or good function in 90% of the cases. Sex of the patient did not influence the functional result, but older patients showed poorer results compared with the younger patients. This procedure can provide a function comparable with ileorectal anastomosis with a technical difficulty similar to that of the abdominal pouch. All patients with FP or UC who require colectomy are candidates for IAA unless they are 60 years or older. For UC a three stage surgical procedure of IAA proceeded by open rectal excluding colectomy could improve the result.(ABSTRACT TRUNCATED AT 250 WORDS)
A 61-years old woman who had been healthy without history of abnormal bleeding, developed widely spread ecchymosis and intramuscular bleeding in March, 1987. She was hospitalized for this hemorrhagic diathesis in May, 1987 and the following laboratory data were revealed: activated partial thromboplastin time (APTT), 76.7 seconds; factor VIII procoagulant activity, 2%; factor VIII inhibitor, 27 Bethesda units/ml. The inhibitor was an immunoglobulin of IgG type. Her clinical data of the blood were normal, and tests for antibodies, such as RA test, LE test and thyroid test were negative. Physical examination revealed ecchymosis over her right arm and swelling and pain in the right arm. She was first treated with a large dose of factor VIII concentrates, but the effect was insufficient. Then prednisolone was given, which resulted in decreasing of the inhibitor and improvement of the coagulation profiles. This treatment appeared to offer effective control on severe hemorrhage in patients with factor VIII inhibitors.
88 cases of bacterial spontaneous pneumothorax, 20 cases, occurred same time and 68 cases, occurred different time, were treated in our Department of Thoracic Surgery from 1975 to July 1987, and represented 16.6% of all cases of spontaneous pneumothorax. The characteristics of bilateral spontaneous pneumothorax, occurred same time, were as follows; 1) frequent in teens, 2) often occurred with history of unilateral spontaneous pneumothorax, 3) slightly collapsed. For the treatment of bilateral spontaneous pneumothorax, occurred same time, bilateral thoracotomy was necessary. The characteristics of bilateral spontaneous pneumothorax, occurred different time, were as follows; 1) frequent in the twenties, 2) often occurred the other side after unilateral thoracotomy within a year. For the treatment of bilateral spontaneous pneumothorax, occurred different time, if the patient is under 20 thoracotomy must be carried out, but if the patient is over 20 at the side of pneumothorax must be operated.
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