[Inflammatory bowel diseases: diagnosis and physiopathology. 3. Endoscopy and diagnosis].
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Endoscopy, Gastrointestinal↗
Biomedical subjects
H Niwa
Publications and source records attributed to H Niwa.
Mediastinal abscess caused by a pyriform sinus fistula: report of a case.
A 13-year-old boy who originally presented with a left neck abscess rapidly developed a mediastinal abscess and empyema. Repetitive esophagography for the persistent mediastinal abscess revealed the existence of a pyriform sinus fistula. It was thought that infection of the pyriform sinus fistula precipitated a retropharyngeal abscess which continuously extended to the mediastinum. To our knowledge, no other such case has ever been reported and we present this unusual case herein, followed by a short review of the related literature.
Abscess↗
Surgical therapy for apical invasive lung cancer: different approaches according to tumor location.
Thirty-one patients with apical invasive lung cancer were reviewed. The tumor occupied the anterior portion of the lung apex in four, the middle portion in one, the posterior portion in 17, and the entire apex in nine. Nine patients were treated by irradiation alone. Twenty-two patients underwent en bloc resection of the apical chest wall and the lung. Seventeen patients were operated on by different approaches: anterior and hook, according to the location of the lesion. Nine patients were operated on by the anterior approach and eight by the hook approach. Another five patients were operated on by the conventional postero-lateral approach. Lesions of the sternum and subclavian vessels and ipsilateral supraclavicular lymph nodes were resected by the anterior approach. Lesions of the vertebrae, brachial plexus, subclavian vessels and ipsilateral supraclavicular lymph nodes could be resected by the hook approach. The anterior approach was suited for lesions in the anterior portion or middle portion and the hook approach for lesions in the middle or posterior.
Adult↗
An efficient gene-trap method using poly A trap vectors and characterization of gene-trap events.
New trap vectors (U1 and U2) have been developed to trap genes in murine embryonic stem (ES) cells. The polyA addition signal of the neomycin phosphotransferase II (neo) gene was removed from these vectors so that they needed to trap an endogenous polyA signal for expression of the neo gene. The frequency of gene-trap events of these vectors was about five times higher than with the vector containing the polyA signal, and only one copy of the trap vector was integrated in most cases. Four out of five 5'-flanking regions of the integrated vector in ES cell lines were found to be novel endogenous promoters, suggesting that this method is efficient for trapping genes in ES cells. In two cases analyzed, large deletions or rearrangements spanning more than 10 kb were found in the 3'-flanking region of the trap vector introduced by electroporation. This result suggests that phenotypes observed in homozygotes with a mutated allele could be due to the disruption of a gene adjacent to the trapped gene, but not of the trapped gene.
Animals↗
Negative regulation of mitosis by the fission yeast protein phosphatase ppa2.
To understand the role of the type 2A-like protein phosphatase in the cell division cycle, we investigated the mutant phenotypes obtained when the fission yeast ppa1+ and ppa2+ phosphatase genes (which encode polypeptides with approximately 80% identity to mammalian type 2A phosphatases) were either deleted or overexpressed. We also investigated the in vivo effect of okadaic acid, an inhibitor of protein serine/threonine phosphatases, on cell division. We show that ppa2+ interacts genetically with the cell cell regulators cdc25+ and wee1+, as a ppa2 deletion is lethal when combined with wee1-50 but partially suppresses the conditional lethality of cdc25-22 mutation. Evidence that ppa2+ negatively controls the entry into mitosis, possibly through the regulation of cdc2 tyrosine phosphorylation, is presented. ppa2 phosphatase is abundant in the cytoplasm, in contrast to the type 1-like phosphatase dis2, which is enriched in the nucleus. Overproduced ppa1 or ppa2 proteins accumulate in the cytoplasm near the nuclear periphery, and cells arrest in interphase. Okadaic acid-treated cells, like a ppa2 deletion, are short in length and display protein hyperphosphorylation. Cytokinesis is also inhibited, producing binucleated cells. We show that ppa2 is the genetic locus controlling okadaic acid sensitivity. The ppa2 deletion reveals the same hyperphosphorylated proteins as okadaic acid. When a strain deleted for ppa2 is treated with okadaic acid, cell size is reduced further to that of wee1-50 mutant strain or overexpressing the cdc25+ gene product, suggesting functional relationship of ppa2 with the cdc25 tyrosine phosphatase and/or the wee1 kinase in cell cycle control.
Base Sequence↗
Lupus anticoagulant (LAC) and its relation to pregnancy outcome: a report of five cases.
We examined the relation between the spontaneous remission and prednisolone-induced suppression of lupus anticoagulant (LAC) or anticardiolipin antibody (ACA) and pregnancy outcome in 5 LAC-positive women. Two women showed a spontaneous remission of LAC and ACA during the observation period. One of these 2 women became pregnant and delivered healthy twin infants at 36 weeks of pregnancy without any therapy. The other woman became LAC positive again after 1 year of remission, and experienced 2 more fetal losses. Two of the remaining LAC-positive women received prednisolone and aspirin. Only 1 woman, whose ACA was suppressed by medication, delivered a healthy newborn. The pregnancy of the other woman, whose LAC and ACA remained positive in spite of medication, terminated in an IUFD. These results suggest that the administration of prednisolone and aspirin is the first choice of therapy for LAC-positive women, and that encouraging such women to become pregnant while LAC is negative might be an alternative therapy.
Adult↗
Vasospastic angina induced by prostaglandin F2 alpha.
A 56 year old woman underwent cholecystectomy. Postoperative paralytic ileus was treated with an intravenous infusion of prostaglandin F2 alpha. During infusion she complained of oppressive chest pain. This was accompanied by ST segment depression, and was relieved by sublingual glyceryl trinitrate. Coronary arteriography did not show significant stenosis, but subsequent intravenous infusion of prostaglandin F2 alpha provoked multiple segmental spasm of both the right and left coronary arteries.
Angina Pectoris↗
The relationship between serum lipoprotein(a) and restenosis after initial elective percutaneous transluminal coronary angioplasty.
The purpose of this study was to elucidate the possible link between lipoprotein(a) (Lp(a)) and the occurrence of restenosis after initial elective percutaneous transluminal coronary angioplasty (PTCA). Serum lipids, including Lp(a), total cholesterol, triglyceride, HDL-cholesterol, LDL-cholesterol, apolipoprotein A-I (Apo A-I), and apolipoprotein B (Apo B), and the Apo B/Apo A-I ratio were examined in 63 consecutive patients (41 men and 22 women, average age 63 +/- 8 years) who underwent initial elective PTCA in our department. Forty two target lesions were in left anterior descending, 10 were in left circumflex and 11 were in right coronary branches. Restenosis was observed in 22 patients (35%) 6.4 +/- 2.6 months after PTCA. The serum Lp(a) level was significantly higher in the restenosis group than in the non-restenosis group (38.0 vs 19.9 mg/dl, p < 0.05). A significant correlation was observed between serum Lp(a) levels and the degree of % restenosis after PTCA (r = 0.557, p < 0.001). However, other lipids showed no significant relationship to restenosis. In addition, the % stenosis before PTCA was found to be related to the occurrence of restenosis after successful PTCA. We conclude that the serum Lp(a) level has a close correlation with the degree of % restenosis after PTCA, and may be a useful index for predicting the possibility of restenosis after PTCA, especially in patients with an Lp(a) level above 30 mg/dl.
Aged↗
Cerebral arterial blood flow velocity during induction of general anesthesia: rapid intravenous induction versus awake intubation.
Changes in middle cerebral arterial flow velocity (MCAV) during rapid intravenous induction and awake intubation using transcranial Doppler sonography were investigated. The study involved 20 patients without disorders of the central nervous or cardiovascular systems who were scheduled for maxillofacial surgery. In the intravenous induction group, anesthesia was induced with sodium thiopental, and orotracheal or nasotracheal intubation was facilitated with succinylcholine chloride or alcuronium chloride. In the awake intubation group, orotracheal or nasotracheal intubation was performed under intravenous sedation with diazepam and topical anesthesia with 4% lidocaine. Arterial blood pressures, heart rate, and MCAV were monitored at specific intervals. During intravenous induction, blood pressures decreased after the administration of thiopental and muscle relaxants and increased during endotracheal intubation. MCAV was remarkably slowed after the administration of thiopental and during mask ventilation. During awake intubation, blood pressures were increased by endotracheal intubation. MCAV was decreased from the administration of diazepam to the transtracheal injection of lidocaine, but returned to the control value from endotracheal spray to endotracheal intubation. These results suggest that smooth awake intubation may be the safest method of induction for patients with cerebrovascular disorders.
Alcuronium↗
Systemic management of Marfan's syndrome during dental treatment: a case report.
Marfan's syndrome is a dominantly inherited connective tissue disorder characterized by skeletal, ocular, and cardiovascular abnormalities, such as arachnodactyly, dolichostenomelia, kyphosis, scoliosis, pectus excavatum, ectopia lentis, aortic aneurysm and dissection, aortic valve incompetence, and mitral valve prolapse. This report describes the systemic management during dental treatment of a 26-year-old man with Marfan's syndrome. Blood pressure, electrocardiogram, echocardiography, systolic time intervals, and aortic pulse wave velocity were monitored. Nitrous oxide inhalational sedation was employed. In contrast to the vasopressin, felypressin (contained in prilocaine), epinephrine (contained in lidocaine) caused an acceleration of cardiac function--increased heart rate, cardiac output, 1/pre-ejection period (PEP), and aortic pulse wave velocity and decreased PEP and left ventricular ejection time. This experience suggests that the use of anesthetics containing epinephrine in dental patients with Marfan's syndrome needs to be carefully managed.
Adult↗
[Serial changes in QT interval during acute myocardial infarction: comparison of QT interval changes of reperfused cases and non-reperfused cases].
The serial changes in QT intervals during the course of acute myocardial infarction are of interest from the standpoint of the electrocardiogram itself, the development of ventricular tachyarrhythmias, residual cardiac function, and the prognosis of the patients. However, only sparse literature has dealt with this issue because it is difficult to obtain ECGs for analysis, and multiple factors influence the QT interval including the degree of reperfusion, electrolyte imbalance, hemodynamic changes and drugs which alter the QT interval. The ECGs of patients with acute myocardial infarction who underwent reperfusion therapy were analyzed: Sixteen consecutive patients were enrolled in this study, 9 with TIMI grade II and III (TIMI: the thrombolysis in myocardial infarction study group criteria) and 7 with TIMI grade 0, myocardial infarction with (9) and without (7) reperfusion. Patients with collaterals, TIMI grade I, hypertrophic cardiomyopathy, electrolyte imbalance, Ia antiarrhythmic drugs, beta adrenoreceptor blockades, atrial fibrillation, and intraventricular conduction disturbances were excluded from the study. Serial ECG recordings were performed at 3, 6, 9, 12, 24, 48, and 72 hours after the onset of myocardial infarction. One week after and one month after the onset, the ECGs were recorded. Patients who exhibited reocclusion on their arteriograms in the chronic phase were also excluded from the study. Measurements of the QT intervals were performed at the ischemic lead (II in the standard limb lead in inferior infarction and V2 in anteroseptal infarction), and values were averaged from 5 consecutive QRS complexes according to Lepeschkin's method and corrected using Bazett's method. The left ventricular ejection fraction (LVEF) and percent fractional shortening (FS) in segments 2, 3, 4 or 5 were calculated from the ventriculogram in the chronic phase. The QT interval revealed a lengthening with its peak within 12 hours after the onset and it became shorter thereafter in reperfused patients. In patients without reperfusion, the QT interval became progressively prolonged without showing a peak point, up to one month. LVEF and FS were significantly higher values in patients with reperfusion than in those without reperfusion. In conclusion, in patients with reperfusion, the QT interval was transiently prolonged and later shortened with improved LVEF and FS than in patients without reperfusion.
Adult↗
[Serum thyroid hormone levels correlate with cardiac function and ventricular tachyarrhythmia in patients with chronic heart failure].
The relationship between cardiac function and serum thyroid hormone levels was investigated in 41 patients with chronic heart failure (25 men and 16 women, mean age 63.7 +/- 11.1 years) and 15 normal subjects (5 men and 10 women, mean age 55.5 +/- 12.2 years). Patients with apparent thyroid disease were excluded from the study. All patients were evaluated according to the New York Heart Association (NYHA) classification using echocardiography, cardiothoracic ratios, mean daily heart rates calculated from ambulatory electrocardiograms (ECG), and ventricular tachyarrhythmias greater than triplets based on either Holter or ECG monitoring. The serum free triiodothyronine (FT3), free thyroxine (FT4), and reverse triiodothyronine (rT3) levels were measured. Decreased FT3 levels and FT3/FT4 ratios, and increased rT3 levels were associated with worse NYHA class. FT3/FT4 was positively and rT3 was negatively correlated with echocardiographical fractional shortening. FT3 and rT3 were negatively and positively correlated with mean daily heart rates, in contrast to known hypothyroid patients. Patients with ventricular tachycardia demonstrated significantly lower serum values of FT3 and FT3/FT4, and significantly higher values of rT3. Serum thyroid hormone levels can provide a quantitative index for evaluating the severity of chronic heart failure and predicting ventricular tachycardia.
Echocardiography↗
[A case of benign clear cell tumor of the lung--a review of 17 cases in the Japanese literature].
We experienced a case of benign clear cell tumor of the lung. It is a rare and most unusual pulmonary neoplasm. Only 40 cases have been reported in the foreign literatures and 16 cases in the Japanese literatures. A 30-year-old man, who revealed a coin lesion in the chest roentogenogram at the health screening, underwent resection of the right lower lobe. Microscopically, the tumor cells are similar to clear cell carcinoma of the kidney and have glycogen in the cytoplasm. Ultrastructually, fibrous banded collagen structures were found in the intercellular space. These findings suggest possibility of neural tissue origin of the clear cells.
Adenocarcinoma, Clear Cell↗
ANCA associated vasculitis allergica cutis (VAC) and mild proliferative necrotizing glomerulonephritis.
We report here the case of a 69-year-old male with vasculitis allergica cutis (VAC) accompanied by a nephrotic syndrome associated with serum perinuclear-staining anti-neutrophil cytoplasmic antibody (P-ANCA). Renal biopsy specimens showed mild proliferative glomerulonephritis with crescentic and necrotizing lesion in the glomeruli, while lesional skin biopsy specimens showed leukocytoclastic vasculitis in the deep dermis. Pauci-immune deposits were evident (deposits of immunoglobulins and complements were absent) by immunofluorescence microscopy in both tissues. The appearance of weakly positive P-ANCA associated with skin lesions and renal dysfunction occurred twice in this patient. Following corticosteroid administration, renal dysfunction was remarkably diminished and proteinuria decreased. P-ANCA titer were decreased, reaching the normal level. ANCA associated glomerulonephritis complicated by VAC has not been reported previously. In the present case, the vasculitis cutis and glomerulonephritis is assumed to be associated with the appearance of weakly positive P-ANCA.
Aged↗
[Tumor-node-metastasis classification for thymic epitherial tumors].
We applied the tentative TNM classification of thymoma to 24 cases of IV b thymoma, 59 cases of thymic carcinoma, and 26 cases of thymic carcinoma (109 cases in total). This classification was useful in these cases because cases could be divided into different grades (e.g. N 0, N 1, N 2, N 3) of the factor N (lymph node metastasis) without any shift to particular grades. Based on this finding, we hereby propose a TNM classification of thymic epitherial tumors which was prepared by slightly modifying the tentative TNM classification of thymoma.
Carcinoid Tumor↗
Mutational analysis of the structure and function of the xeroderma pigmentosum group A complementing protein. Identification of essential domains for nuclear localization and DNA excision repair.
We showed previously that the xeroderma pigmentosum group A complementing (XPAC) protein involved in the DNA excision repair pathway contains a zinc-finger motif and is localized in the nucleus of normal human cells. For detailed structural and functional analyses of the XPAC protein, we constructed various XPAC cDNAs by site-directed mutagenesis and isolated permanent cell lines expressing mutant proteins. Immunofluorescent analysis of these lines indicated that the nuclear localization signal is located in the region encoded by Exon 1, especially centered at amino acids 30-42. A UV survival study showed that regions from Exons 2 through 6 were essential for DNA repair function, but that Exon 1 was not. Interestingly, deletion of the glutamic acid cluster in the region encoded by Exon 2 resulted in a dramatic loss of DNA repair activity. Furthermore, replacements of each of the 4 cysteines supposed to form a zinc-finger structure in the region encoded by Exon 3 by serine or glycine resulted in similar levels of loss of repair activity. These results suggest that all 4 cysteines forming a zinc-finger structure and also the glutamic acid cluster are important for DNA repair function.
Amino Acid Sequence↗
[Mass screening of stomach polyps by gastroscopy].
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Aged↗
QT interval shortening and ST elevation in intracoronary ECG during PTCA.
Percutaneous transluminal coronary angioplasty (PTCA) can provide a unique model of transient and reversible myocardial ischemia. The aim of this study was to assess the serial changes in QT interval during elective PTCA-induced transient ischemia. The serial changes in QT interval before, during, and after PTCA of the left anterior descending artery (LAD) were measured in patients who showed ST elevation in intracoronary electrocardiogram. Twelve consecutive patients who showed ST-segment elevation during PTCA-induced ischemia anterior precordial leads of the electrocardiogram (ECG) were enrolled in the present study. Target lesions for PTCA were all in the LAD. There were six patients with angina pectoris, two with non-Q-wave infarction, and four with Q-wave myocardial infarction. During balloon inflation, QTc interval shortened in both intracoronary ECG (ic-ECG) (0.472 +/- 0.013 vs 0.436 +/- 0.014) and surface ECG (0.462 +/- 0.012 vs 0.438 +/- 0.011). However, a significant shortening of the QT interval was more rapidly observed in the ic-ECG (20 s) than in the surface ECG (40 s). We conclude that the QT interval in both ic-ECG and surface ECG becomes shortened in PTCA-induced myocardial ischemia, and that the ic-ECG might be a good probe for detecting survived viable myocardium in the infarcted zone.
Aged↗