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Biomedical subjects

H Shigematsu

Publications and source records attributed to H Shigematsu.

At least 91 records · Page 5Linked to original sources
PubMed1999

Endovascular stent graft repair of aortopulmonary fistula.

Two patients who had aortopulmonary fistula of postoperative origin with hemoptysis underwent successful repair by means of an endovascular stent graft procedure. One patient had undergone repeated thoracotomies two times, and the other one time to repair anastomotic aneurysms of the descending aorta after surgery for Takayasu's arteritis. A self-expanding stainless steel stent covered with a Dacron graft was inserted into the lesion through the external iliac or femoral artery. The patients recovered well, with no signs of infection or recurrent hemoptysis 8 months after the procedure. Endovascular stent grafting may be a therapeutic option for treating patients with aortopulmonary fistula.

Anastomosis, Surgical↗
PubMed1999

Leiomyosarcoma of the heart and its pulmonary metastasis, both with prominent osteoclast-like multinucleated giant cells expressing tartrate-resistant acid phosphatase activity.

An autopsy case of cardiac leiomyosarcoma and its pulmonary metastasis, both with osteoclast-like multinucleated giant cells (OMGC) mimicking the so-called giant cell variant of malignant fibrous histiocytoma (MFH), is reported. The patient, a 70-year-old male, was admitted for sudden dyspnea. Extensive work-up established only a left atrial tumor mass. Three months after admission, the patient developed multiple intracranial and pulmonary metastases, followed by a worsening clinical course characterized by semicoma and dyspnea, and subsequently died 6 months after the onset of his symptoms. At subsequent autopsy, the left atrial polypoid tumor was found to have invaded destructively to the left half of the cardiac wall. Histology of the cardiac tumor revealed a bimorphic sarcoma in which a poorly differentiated leiomyosarcoma comfirmed by histologic and immunohistochemical findings was juxtaposed to a small nodule with features closely mimicking giant cell MFH. The pulmonary metastatic nodules exhibited features that were entirely indistinguishable from giant cell MFH except for the fact that a minority of polymorphic cells manifested myogenic differentiation. We believe that such a MFH-like pattern represents a pleomorphic form of leiomyosarcoma rather than a dedifferentiated one. The OMGC within the MFH-like component coexpressed CD68 and tartrate-resistant acid phosphatase activity.

Acid Phosphatase↗
PubMed1999

Primary liver carcinoma complicating membranous obstruction of the inferior vena cava.

A rare autopsy case of primary liver carcinoma complicating a pre-existing, incomplete membranous obstruction of the inferior vena cava (MOVC) is reported. The patient, a 67-year-old Japanese male, was admitted to hospital following a 2 year illness of a left chest wall tumor and a 3 month illness with progressive abdominal pain. Computed tomography scans of the abdomen displayed space-occupying lesions in the third and seventh hepatic segments, respectively. One month later, the patient developed edema of the lower extremities and marked venous dilatation of the abdominal trunk. At that time, Doppler examination revealed the presence of intrahepatic large venovenous collaterals. The patient subsequently succumbed 82 days after hospitalization. At subsequent autopsy, the inferior vena cava was completely obstructed by tumor thrombus, which was formed caudally and cranially to a thin membrane and mimicked the valve, with calcification and elastic lamina, at the phrenic portion. Intrahepatic large collateral pathways were found between submembranous and supramembranous hepatic veins. Anomalous absence of the ostia of the middle hepatic vein was found. In addition, the portal venous trunk was occluded by tumor thrombus. Histology of hepatic tumors revealed a combined hepatocellular and cholangiocellular carcinoma in the non-cirrhotic liver with severe acute centrilobular congestion. In MOVC patients such as the case presented, malignancy-induced thrombosis was deemed to be an important factor in prognosis.

Aged↗
PubMed1999

Renal involvement of thrombotic thrombocytopenic purpura: special reference to the glomeruloid structures.

We report the case of a 9-year-old girl with biopsy-proven renal thrombotic microangiopathy in thrombotic thrombocytopenic purpura (TTP), with particular reference to the glomeruloid structures. The renal biopsy sample from this TTP patient revealed platelet thrombus deposition, a glomeruloid structure and aneurysm with relative sparing of the glomeruli. The glomeruloid structure displayed a proliferation of mainly capillary-sized channels lined by Factor VIII-related, antigen-positive plump endothelial cells embedded in the edematous connective tissue. These glomeruloid vessels communicated with the aneurysmal segment at the end portion of the arteriolar branch. We believe that the glomeruloid structures in TTP represent not merely organization or recanalization of thrombus but rather active angiogenesis through aneurysmal dilation in the arteriolized vessel, probably initiated by platelet agglutination.

Aneurysm↗
PubMed1999

Preexisting membranous nephropathy in allograft kidney.

A case of membranous nephropathy, preexisting in a donor kidney, will be reported. A 41-year-old man underwent a cadaver renal transplantation. An allograft biopsy specimen obtained during the operation showed spike formation on periodic acid-silver methenamine staining and deposition of IgG along the glomerular capillary loop on immunoperoxidase staining. Immunofluorescence staining for IgG remained in the specimens obtained on day 11 and after 4 weeks, but markedly decreased in the specimen obtained 7 weeks after transplantation. Electron-dense deposits also decreased in amount, but irregular thickening of the glomerular basement membrane with spikes, electron-lucent washout lesions, and small amounts of electron-dense deposits remained 20 months after the transplantation. These findings suggest that membranous nephropathy, as well as IgA nephritis and diabetic nephropathy, resolve after renal transplantation and that deposition of IgG markedly decreases within a few months after transplantation, but that complete histological restoration of the basement membrane needs at least a few years.

Adult↗
PubMed1999

[Leiomyoma of the lung: a case report].

An asymptomatic 43-year-old female was admitted to the Hospital because of an abnormal nodule in the left lung field on screening chest X-ray. Chest CT showed a tumor shadow mass (4 x 3 cm) in the left lower lobe. Bronchofiberscopy revealed an endobronchial polypoid mass obstructing the lower lobe bronchus at the orifice of left B10. Lt lower lobectomy was performed. Histopathological examination of the specimen showed the tumor (4.5 x 3.6 x 3.6 cm) developing not only within the tracheal lumen, but also in the lung tissue. Because immunohistochemical staining for desmin and alpha-smooth muscle actin was positive, we diagnosed leiomyoma. As MRI revealed multiple uterine masses after operation, we discussed the diagnostic problems in the relation to metastasizing leiomyoma of the uterus.

Adult↗
PubMed1999

Lupus nephritis in juvenile myelomonocytic leukemia.

A 13-year-old girl developed lupus nephritis and Hashimoto thyroiditis in the chronic phase of juvenile myelomonocytic leukemia (JMML). At age 7 months, she was diagnosed as having JMML based on the hepatosplenomegaly, leukocytosis, thrombocytopenia, increased levels of fetal hemoglobin, and spontaneous in vitro growth of granulocyte-macrophage progenitors. At the onset of JMML, she had hypergammaglobulinemia, antinuclear antibodies, rheumatoid factors and anti-smooth muscle antibody. She had been placed on oral 6-mercaptopurine for about 12 years, with clinical improvement. At age 13 years, she was found to have hematuria and proteinuria. She also developed arthritis and Raynaud's phenomenon as well. She had antinuclear antibodies, rheumatoid factors, LE phenomenon, beta-1C (C3) nephritic factor (C3NeF), antithyroid antibodies, and hypocomplementemia. The renal biopsy specimens revealed a diffuse increase in the mesangial cells and matrix by light microscopy, and intense staining of IgG, Clq and C3 by immunofluorescence microscopy. The hormonal study ultimately showed decreased thyroid functions. So she was diagnosed as lupus nephritis and Hashimoto thyroiditis. The patient is the first example to show close relationship between stem cell abnormalities in JMML and development of overt autoimmune disorders.

Adolescent↗
PubMed1999

Factors affecting the long-term outcome of Buerger's disease (thromboangiitis obliterans).

BACKGROUND: Although the age at onset in patients with Buerger's disease is relatively young, the life expectancy has been seldom reported in detail. The aim of this study is to study long-term results of Buerger's disease and factors affecting the ultimate outcome. METHODS: From 1965 to 1980, 682 patients with Buerger's disease were treated in our outpatient department. We studied their long-term status, including concomitant diseases, and the disease progression by mail. RESULTS: Of the 287 mail responders, 266 were male and 21 were female, with a mean age of 60 years. One hundred and fifty-five of these patients are currently suffering from clinical symptoms. Forty-eight patients underwent minor amputation and 30 and major amputation. Forty-six patients underwent sympathectomy, and only 17 bypass reconstruction. Although there was no significant difference in the continuation of symptoms between current smokers and ex-smokers, the amputation rate was higher in current smokers and continuous smoking is closely related to both minor and major amputations after sympathectomy and to minor amputations after drug therapy. Arteriosclerotic diseases were recognized in 57 patients, and gastroduodenal ulcer in 44. Thirty-three patients had died. Among 14 who died of neoplasm, three died of esophageal cancer and lung cancer, respectively, which were closely related to smoking. CONCLUSIONS: The natural history of the limbs in patients with Buerger's disease is not completely discouraging, and in order to obtain a favourable outcome for patients with Buerger's disease we recommend complete smoking cessation with drug-therapy and surveillance for neoplasm, especially of the upper gastrointestinal tract and lung.

Adult↗
PubMed1999

Hepatic heme metabolism in rats with fever induced by interleukin 1beta.

We have recently reported that the content of hepatic cytochrome P450 (CYP) apparently decreased in fever model rats, which were created by repeated injection of recombinant human interleukin-1beta (rhIL-1beta) into the cerebroventricle. To make clear the biochemical mechanism of the decreased CYP content, we examined the effect of fever on the activities of hepatic enzymes involved in the biosynthetic and degradative pathways of heme. The activities of delta-aminolevulinic acid synthase, a rate-limiting enzyme in the heme biosynthesis, and porphobilinogen synthase in the liver of rhIL-1beta-induced fevered rat were significantly lower than those in the control, whereas the activity of heme oxygenase, a key enzyme in the heme-degradative pathway, markedly increased in the fevered rat. Moreover, the heme saturation of tryptophan 2,3-dioxygenase in the fevered rat liver was decreased to 43% of the control. These results indicate that fever diminishes the hepatic heme content by decreasing the heme biosynthesis and by accelerating the heme degradation. The deficiency of hepatic heme pool may be one of the main mechanisms that cause the impairment of CYP synthesis.

5-Aminolevulinate Synthetase↗
PubMed1999

Comparison of near-infrared spectroscopy with air plethysmography in detection of deep vein thrombosis.

BACKGROUND: As a noninvasive screening test, air plethysmography (APG) is a reliable and frequently used modality in the detection of deep vein thrombosis (DVT). Although APG is highly sensitive for the diagnosis of proximal DVT, its sensitivity for identifying calf DVT is poor. Near-infrared spectroscopy (NIRS) is a new modality which can be used to evaluate venous retention during walking. The purpose of this study was to investigate the diagnostic value of NIRS for the detection of DVT, particularly isolated calf DVT, in comparison with APG. METHODS: Fifty limbs of 39 consecutive patients with clinically suspected DVT were studied. All patients were examined by venography and APG. Patients also underwent a treadmill-walking test with simultaneous NIRS. Deoxygenated hemoglobin was continuously measured by NIRS during exercise. The ambulatory venous retention index obtained from serial DeoHb changes was calculated in each patient. RESULTS: Venography demonstrated DVT in 35 limbs, confined to the calf in 9 limbs, and with the involvement of a proximal deep vein with thrombi in 26. The overall sensitivity of NIRS and APG was 97% (34/35) and 80% (28/35), respectively. NIRS was more sensitive than APG for detecting isolated calf DVT (89% [8/9] and 22% [2/9], respectively), while both tests identified proximal DVT in all limbs. CONCLUSIONS: NIRS is a highly sensitive method for the diagnosis of haemodynamically significant DVT. NIRS may become a useful screening test because of its reliability in detecting calf vein thrombi that cannot be identified by APG.

Female↗
PubMed1998

EDG1 is a functional sphingosine-1-phosphate receptor that is linked via a Gi/o to multiple signaling pathways, including phospholipase C activation, Ca2+ mobilization, Ras-mitogen-activated protein kinase activation, and adenylate cyclase inhibition.

In Chinese hamster ovary (CHO) cells transiently transfected with an expression vector for EDG1, but not an empty vector, sphingosine-1-phosphate (SP) at a concentration as low as 10(-10) M caused an increase in the intracellular free Ca2+ concentration ([Ca2+]i) as a result of mobilization of Ca2+ from both intracellular and extracellular pools. In a CHO clone stably expressing EDG1 receptor (CHO-EDG1 cells), SP induced increases in the production of inositol phosphates and the [Ca2+]i and inhibited forskolin-induced increase in the cellular cAMP content, all in a manner sensitive to pertussis toxin. SP also activated mitogen-activated protein kinase in CHO-EDG1 cells in pertussis toxin-sensitive and Ras-dependent manners. To evaluate the spectrum of agonists for EDG1, we used human erythroleukemia (HEL) cells, which at naive state do not respond to SP or structurally related lipids with an increase in the [Ca2+]i. In HEL cells stably expressing EDG1 receptor (HEL-EDG1 cells), SP dose-dependently increased the [Ca2+]i with half-maximal and maximal concentration values of 10(-9) and 3 x 10(-7) M, respectively; sphingosylphosphorylcholine at exclusively high concentrations, but not sphingosine at all, also increased the [Ca2+]i. HEL-EDG1 cells bound 32P-labeled SP, which was displaced dose dependently by unlabeled SP. These results indicate that EDG1, a member of the EDG family G protein-coupled receptors, is a specific, high-affinity SP receptor.

Adenylate Cyclase Toxin↗
PubMed1998

Cloning and characterization of the CYP2D1-binding protein, retinol dehydrogenase.

A CYP2D1-binding protein, 29 k-protein (p29), has been isolated and its N-terminal amino acid sequence has been reported (Ohishi et al. (1993) Biochim. Biophys. Acta 1158, 227-236). In this study, p29 cDNA was isolated by PCR with oligonucleotide probes designed from the N-terminal amino acid sequence and p29 was found to be a microsomal retinol dehydrogenase, a member of the short-chain alcohol dehydrogenase family which metabolize hydroxysteroids and prostaglandins. CYP2D1 and p29 were expressed in Saccharomyces cerevisiae to characterize these proteins. CYP2D1 had an absorption maximum at 448 nm in a CO-reduced form. Expressed p29 in yeast cells was detected with anti-p29 antibody. Solubilized CYP2D1 and p29 from yeast microsomes were mixed and applied to an anti-CYP2D1 antibody-binding column. Both proteins were retained in the column and eluted with glycine buffer (pH 2.8). However, when applied alone, p29 was not retained in the column. The findings indicated that CYP2D1 bound tightly with p29. Catalytic activities of p29 expressed in yeast were investigated. p29 had retinal reductase activity in the presence of NADPH. Addition of CYP2D1 and NADPH-P450 reductase increased the retinal reductase activity of p29. These findings suggest that the complex of CYP2D1, p29, and NADPH-P450 reductase has an important role in the metabolism of retinoids.

Alcohol Oxidoreductases↗
PubMed1998

Satigrel, a new antiplatelet agent, inhibits platelet accumulation in prosthetic arterial grafts.

BACKGROUND: Early and late vascular obstruction are both related to platelet adhesion and aggregation in the grafts. We assessed the effect of satigrel, a new oral antiplatelet agent, on the accumulation of indium-labeled platelets in knitted Dacron grafts inserted proximal to the femoral artery. METHODS: Nine patients with arteriosclerosis obliterans receiving grafts were treated with satigrel, and 10 others were enrolled as untreated controls. Scintigraphy was performed in postoperative weeks 2 and 4, and the ratio of the scintillation count of the graft to that of the native artery was calculated to assess platelet accumulation. RESULTS: In both weeks 2 and 4, the ratio was significantly smaller in the satigrel group than in the control group for the whole graft, the proximal anastomosis, and the distal anastomosis. CONCLUSIONS: Satigrel significantly inhibited platelet accumulation in vascular grafts and thus may be useful for preventing postoperative graft occlusion.

Aged↗
PubMed1998

Self-limited spontaneous dissection of the main trunk of the superior mesenteric artery.

Spontaneous dissection of the splanchnic arteries is rare and reportedly carries a high risk of mortality. Two cases with spontaneous dissection of the main trunk of the superior mesenteric artery followed by a self-limited clinical course are presented. Current management strategies, including bypass operation, patch angioplasty, and conservative treatments, are discussed. Emphasis is placed on the role of nonsurgical management with careful follow-up with the use of new technologies such as duplex and computed tomography scanning.

Aortic Dissection↗
PubMed1998

Autoreactive antibodies following autologous peripheral blood stem cell transplantation.

A 35-year-old woman diagnosed with multiple myeloma (IgG, lambda type, stage IIIA) received an autologous peripheral blood stem cell transplant (PBSCT). She was euthyroid without autoreactive antibodies prior to the transplant. The patient complained of malaise, weight loss and low grade fever 1 month after transplant, despite rapid haematopoietic recovery. Thyroid function tests on day 34 revealed hyperthyroidism associated with anti-thyroid peroxidase antibody. Antinuclear antibody was also detected, and platelet-associated immunoglobulin was increased. These findings disappeared spontaneously by day 62 without treatment. Autoimmune diseases may occur transiently after autologous PBSCT.

Adult↗
PubMed1998

Early viral complications following CD34-selected autologous peripheral blood stem cell transplantation for non-Hodgkin's lymphoma.

A patient with non-Hodgkin's lymphoma who received a CD34-selected autologous peripheral blood stem cell transplant (PBSCT) developed cytomegalovirus retinitis, adenovirus-associated haemorrhagic cystitis (HC) and fatal herpes simplex virus pneumonia. Depletion of mature T cells from the graft and a persistent decrease in CD4+ lymphocytes following PBSCT may have predisposed this patient to such viral infections. Infusion of cryopreserved autologous PBSC (containing mature T cells) was effective for adenovirus-associated HC. Immunosuppression and resultant viral infections may affect patients receiving CD34-selected autologous transplantation.

Adenoviridae Infections↗