Biomedical subjects
Publications and source records attributed to H Sakata.
Stress fracture of the lateral tibial plateau is a rare occurrence. In this article we report a case of stress fracture of the lateral tibial plateau with a radiolucent fracture line in a 52-year-old man. To our knowledge, such a case has not yet been reported.
Recombinant interleukin 2 (rIL2) was administered to a patient with Wiskott-Aldrich syndrome for the treatment of an intractable facial herpetiform lesion. This treatment appeared to be effective in suppressing the virus activity. At the same time, a transient improvement of the chronic eczematoid dermatitis was observed. During rIL2 administration, the CD3+ and CD4+ subsets of peripheral blood lymphocytes increased in number. These changes might play an important role in the induction of anti-viral immunity and in the improvement of dermatitis.
A patient with liver cirrhosis who exhibited marked hypoxemia is presented. An abnormal dilatation of intrapulmonary capillaries was evidenced by perfusion lung scan, contrast-enhanced echocardiography, and histological examinations of lungs. Serial perfusion lung scan disclosed that the radioisotope uptake by extrapulmonary organs was significantly increased and uptake by both lungs was significantly decreased during the state of severer hypoxemia. Shunt quantification method revealed that intrapulmonary right-to-left shunt ratio also paralleled the extent of hypoxemia. The pathophysiology of hepatopulmonary syndrome appeared to involve a reversible intrapulmonary vascular dilatation. The perfusion lung scan could semiquantitate the severity of intrapulmonary vascular dilatation and could offer the efficient method to follow their progress.
In order to evaluate the systemic and neural factors on ornithine decarboxylase (ODC) activity of rat intestinal mucosa, ODC activity in duodenal mucosa, where blood flow did not decrease by superior mesenteric artery (SMA) occlusion, was compared to that of jejunal and ileal mucosa, where blood flow decreased to 90% of the initial value after SMA occlusion. Rats were allowed to recover after SMA occlusion before harvesting intestinal mucosa for measuring ODC activity. ODC activity in the jejunum and the ileum increased markedly 6 h after ischemia-reperfusion (I/R) and more than 72 h were required for ODC activity to return to normal. ODC activity in the duodenum did not change until 24 h after I/R, but the activity increased 48 h after I/R, and this increase continued for 2 days. Subdiaphragmatic vagotomy completely abolished the increase in ODC activity in the duodenum, whereas the same procedure had no influence on ODC activity in the jejunum or the ileum. These results indicate that a neural signal from the central nervous system via the efferent vagal nerve following I/R was an important factor in the increase in ODC activity of duodenal mucosa, where blood flow was not influenced by SMA occlusion.
A woman with recurrent Paget's disease of the vulva developed acute graft-versus-host disease (GVHD) 12 days after radical surgery and massive blood transfusion. Molecular diagnosis of lymphocyte chimerism in the peripheral blood was made by polymerase chain reaction (PCR) directed against a Y chromosome-specific sex-determining region Y (SRY) gene. PCR with skin biopsy after onset of GVHD also revealed infiltration of SRY-positive donor lymphocytes. The diagnosis was confirmed by HLA-DNA typing with PCR-sequence-specific oligonucleotide that revealed the presence of complex HLA-DR chimerism in the peripheral lymphocytes collected after onset of GVHD. The use of SRY-directed PCR is a rapid technique for the early diagnosis of acute posttransfusion GVHD in female patients.
Field isolates of measles virus (MV) during an 8-year period in four areas of Japan, i.e., Osaka, Nagoya, Tokyo and Akita, were classified into three types in regard to the electrophoretic mobility of the hemagglutinin (HA) proteins: S type with small (78K) HA, M type with intermediate (80 K) HA and L type with large (82 K) HA. The type of field isolates was closely related with the geographical location and the year of virus isolation. The S type strain was isolated only in an outbreak from 1983 to 1984, whereas the M and L type strains were isolated between 1983 and 1990. The HA genes of the M and L type strains of MV were found to have a nucleotide substitution which introduces a new potential glycosylation site. In addition, the matrix proteins of all field strains isolated after 1977 showed slower electrophoretic mobility of 42 K than 39 K of the Edmonston and Toyoshima strains. These results indicate that MV strains of different HA types existed concomitantly and that major populations of MV currently circulating in Japan are changing from those prevalent in 1983-1984.
One hundred and seventy one neonates were treated with flomoxef (FMOX) and the clinical efficacy and safety were evaluated. The ages of the patients ranged from 0 to 28 days, and their body weights from 450 to 4300 g. Dose levels were 12.4 to 24.9 mg/kg every 8 or 12 hours for 1 to 10 days. Fifty two patients who responded to the FMOX treatment included 5 neonates with sepsis, 17 with suspected sepsis, 9 with urinary tract infections, 12 with pneumonia, 8 with intrauterine infections, and 1 with omphalitis. The other neonates could not be retrospectively diagnosed as bacterial infections. Of 52 patients, clinical results were excellent in 15, good in 34, fair in 1, and poor in 2. And the FMOX treatment was effective in 13 out of 14 patients in which causative bacteria were identified. The drug was well tolerated, but 6 neonates out of 33 over 5 days old had diarrhea. From these results, empiric treatment with FMOX against neonatal bacterial infection was as clinically useful as that of combination with ampicillin and gentamicin or cefotaxime and ampicillin in our neonatal intensive care unit. But, as this study did not include neonate with meningitis, efficacy to meningitis was not evaluated.
A 5 years old girl is described with infection due to Mycoplasma genitalium causing brain stem encephalitis. The diagnosis was established by polymerase chain reaction assay of the cerebrospinal fluid which demonstrated DNA of Mycoplasma genitalium. She was somnolent, had left abducens nerve palsy, and aphasis. The T2 weighted scan showed high signal intensity of pontine in magnetic resonance imaging (MRI) of the central nervous system. She recovered and was discharged without any sequelae.
Auditory brainstem response (ABR) before and after the cessation of brainstem activity and postmortem histological findings in the temporal bone and auditory and vestibular pathways of two cases of brainstem death are reported. A brainstem death state of at least 48 h in Case 1 and of at least 24 h for the left side and several hours for the right side in Case 2 was demonstrated by neurological examination, flat EEG, and persistent absence of ABR. Postmortem examination was performed 3 h after death in Case 1, and 1 h after death in Case 2. Pathological studies of the entire length of the auditory and vestibular pathway revealed total autolysis of the organ of Corti and vestibular endorgans and swollen cochlear and vestibular ganglia in Case 1, and, in Case 2, on the right side, preservation of the organ of Corti and vestibular endorgans and mildly swollen cochlear and vestibular ganglia, but on the left side, destruction of the organ of Corti and vestibular endorgan and markedly swollen cochlear and vestibular ganglia. We believe that distinct pathological changes in auditory and vestibular endorgans, and other changes of the cochlear and vestibular ganglia as observed in these two cases, may develop if the duration of absent ABR is prolonged.
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We investigated pharmacokinetics and clinical effects of flomoxef sodium (6315-S, FMOX) in neonates and premature infants. These results are summarized as follows: 1. Pharmacokinetics (1) Plasma concentration (Ct) and half-lives (T1/2) were determined upon after intravenous one-shot injection (i.v.) of FMOX to neonates of different day-age groups (0-3 (n = 25), 4-7 (n = 18), 8-28 (n = 32) days of birth). At a dose of 10 mg/kg. i.v., mean C30 (30 minutes concentration) values were 21.2, 21.8 and 21.3 micrograms/ml, respectively, in the different groups mentioned above, and the mean T1/2 values were 3.37, 1.85 and 1.63 hours. At 20 mg/kg i.v., mean C15 (15 minutes concentration) values were 54.4, 51.4 and 50.7 micrograms/ml, and mean T1/2's were 2.99, 2.32 and 1.79 hours, respectively. At a dose of 40 mg/kg i.v., mean C15 values were 104.0, 95.9 and 99.2 micrograms/ml, and the mean T1/2's were 3.40, 1.20 and 1.80 hours, respectively. (2) Plasma concentrations and T1/2 after intravenous one-shot injection of FMOX in premature infants in group (0-3 (n = 14), 4-7 (n = 10), 8-28 (n = 13) days of birth). Mean C15's at doses of 10, 20 and 40 mg/kg in the different groups of infants were 24.0, 28.6, 21.7 and 54.0, 54.6, 55.5 and 98.2, 93.0, 106.0 micrograms/ml, and T1/2's were 4.10, 2.53, 2.57 and 4.28, 2.27, 3.02 and 4.66, 2.86, 2.09 hours, respectively. Mean Cmax values were clearly dose dependent, and mean T1/2 values tended to be longer in premature infants compared to neonates. (3) Urinary recovery rate of FMOX after intravenous injection in neonates and premature infants. Mean urinary recovery rates of FMOX in the first 6 hours after i.v. (one-shot) at doses of 10, 20 and 40 mg/kg to neonates and premature infants were 38.9-62.8% in the neonates and 30.7-61.5% in the premature infants. (4) Plasma concentrations and urinary recovery rates upon 1 hour drip infusion of 20 mg/kg in the neonate groups (or the premature infant groups) as follows: Mean C50 values were 31.0, 32.7 and 23.4 micrograms/ml, and T1/2 were 2.94, 3.68 and 2.25 hours, respectively. The recovery rates were 35.2-52.9% in the first 6 hours after administration. 2. Clinical studies The number of clinically evaluable cases in the FMOX treatment of premature infants was 199, in which the causative pathogens were identified in 71 cases (A group) and not identified in 128 cases (B group).(ABSTRACT TRUNCATED AT 400 WORDS)
Cefditoren pivoxil (ME1207) in granules, a new oral cephalosporin, was pharmacokinetically and clinically evaluated in the pediatric field and the following results were obtained: 1. Pharmacokinetics In infants administered single oral doses of 3 mg (potency)/kg and 6 mg/kg, the Cmax was 1.54 +/- 0.68 and 2.85 +/- 1.03 micrograms/ml; Tmax, 2.27 +/- 1.08 and 2.06 +/- 1.16 hours; T 1/2, 2.22 +/- 1.95 and 1.68 +/- 0.66 hours; and AUC (0-infinity), 7.43 +/- 3.68 and 11.90 +/- 4.51 micrograms.hr/ml, respectively. These values have indicated that the drug has a dose-dependent pharmacokinetic behavior. Urinary concentrations peaked in 2-4 hours after administration. Urinary recovery rates in the first 8 hours were 19.4 +/- 6.6% at 3 mg/kg and 17.1 +/- 5.2% at 6 mg/kg. 2. Clinical results The clinical efficacy of the drug was evaluated in 445 patients with various infections. Cefditoren pivoxil was administered at daily doses of 9-18 mg/kg divided into 3 equal doses to most patients. Daily doses of > 7.5-10.5 mg/kg were given to 48.8% of the patients. The overall clinical efficacy rate was 97.3%, and this drug was effective in 97.5% of the 319 patients for whom the causative pathogens were identified and in 96.8% of the 126 patients with infections for whom the causative pathogens were unknown. The efficacy rate at daily doses of > 7.5-10.5 mg/kg was 97.2%, similar to that obtained at daily doses of > 10.5-19.5 mg/kg (97.0%). The bacteriological eradication rate was 90.4%. The efficacy and eradication rates for 66 patients who had not responded to previous chemotherapy were 95.5% (63/66) and 89.4%, respectively. Side effects occurred in 19 (4.2%) of 456 patients subjected to safety analyses. The primary side effect was diarrhea but no serious side effects were noted. As abnormal laboratory test results, moderate increases of the eosinophils and platelets counts as well as moderate elevations of the transaminases were observed. These abnormalities are also seen with other cephems and to a similar extent. No particular and serious problems were associated with administration of this drug. Based on the above results, cefditoren pivoxil is considered to be very useful at a dose level of 3 mg/kg t.i.d. against most infections encountered in the pediatric field.
To evaluate the development of the fetal behavioral state with reference to the association of the fetal parameters we selected, we simultaneously monitored fetal heart rate (FHR), fetal movement (FM), fetal eye movement (FEM) and fetal breathing movement (FBM). These various parameters were monitored with 2 ultrasonographic real time scanners and a doppler device to monitor fetal movement. We assessed the convergence and integration of these four parameters to evaluate the association rate (AR). FHR with a variation in excess of 3 min. was interpreted as the active phase (A), and reduced variation in excess of 3 min. as the inactive phase (I). When FM and FEM were observed in the 1 min. window of A, we labeled this A3, and when FBM was present in more than 10% of the 1 min. window, we labeled it A4. A3/A = AR-A3% and A4/A = AR-A4% was calculated. A similar calculation was done for I, without FM and FEM in the 1 min. window of I (I3) and when FBM was present less than 10% of 1 min. (I4), allow derivation AR-I3% and AR-I4%. A discrete separation of synchrony in A and asynchrony in I can be seen to develop as the fetus matures, and we feel that this may be a valuable tool in the evaluation of fetal central nervous system development in utero.
The representation of perceptual space in the posterior parietal cortex can be divided into at least two categories: far space, beyond arm's reach, and peripersonal space, within arm's reach. These are encoded by different groups of neurons that are closely related to the control of gaze and the guidance of arm and hand movement, respectively.
Over a 14 year period, there were 20 patients who presented with staphylococcal empyema from whom methicillin-resistant Staphylococcus aureus (MRSA) was isolated. Twelve cases were community-acquired and 8 were hospital-acquired infections. Patients were treated with penicillinase-resistant penicillin, cephalosporin or carbapenem in combination with or without aminoglycoside. They were also treated with drainage or thoracentesis. However, they were refractory to treatment and 7 patients, 6 of whom were suffering from bacteremia, died. One bacteremic patient was treated with vancomycin and was cured. In an area of endemic MRSA, vancomycin may be the first choice in the initial treatment of staphylococcal empyema until antimicrobial susceptibility can be determined.
We determined the characteristics of group A streptococci isolated from 29 sporadic cases with non-suppurative complication or severe infection during a 15-year period from 1977 to 1991. The clinical diagnoses of children included 4 patients with rheumatic fever, 2 with reactive arthritis, 2 with central nervous system complication, 5 with glomerulonephritis, 11 with Honoch-Schölein purpura, 4 with sepsis and 1 with empyema. Twenty-four strains were isolated from throat swabs, 4 from blood specimens and one from pleural fluid. M/T-serotypes and the number of isolates were as follows; 1/1:10, 3/3:1, 3.3R/3:3, 4/4:7, 5/NT:1, 12/12:3, 18/18:2, 62/12:1, NT/13:1. All 29 isolates had productivity for at least one of streptococcal pyrogenic exotoxins (SPEs) A, B and C. Two strains were positive for A, 2 for A and B, 3 for A, B and C, 9 for B and 13 for B and C. Of 11 isolates from patients with Henoch-Schönlein purpura, 7 and 2 strains were serotyped in M1 and M4, respectively, but none was in M12. Ten of 11 isolates were positive for SPE B or SPEs B and C.
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The level of immunoreactive lung surfactant apoprotein A (SP-A) was determined with a newly developed one-step ELISA kit (TDR-20) in 217 samples obtained by transabdominal or transvaginal amniocentesis from 217 pregnant women with high risk pregnancy. The lecithin/sphingomyelin ratio (L/S ratio) by two-dimensional thin layer chromatography, disaturated phosphatidylcholine (DSPC) values, shake test and the stable microbubble method were done simultaneously to compare diagnostic reliability in estimating fetal lung maturity. Amniotic fluid SP-A levels increased with advancing gestational age and correlated well with the values obtained by the other methods. When the cut-off SP-A value for the assessment of lung maturity was set at 1,700ng/ml in the amniotic fluid obtained within 24h before delivery, the true-negative rate for RDS was 71% and the true-positive rate for non-RDS was 83%. The sensitivity, specificity and accuracy were 100%, 83% and 88%, respectively. These results are comparable with those for the L/S ratio, DSPC determination and the stable microbubble method, and were slightly better than those for the shake test. In conclusion, this newly developed ELISA kit for the measurement of amniotic fluid SP-A is more effective than other methods currently available for the evaluation of fetal lung maturity, when it is considered that it requires only 0.2ml of amniotic fluid and provides results in only 2h without technical difficulties.