[Dialysis-associated ischemic heart disease].
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Angioplasty, Balloon, Coronary↗
Biomedical subjects
H Tagawa
Publications and source records attributed to H Tagawa.
Putative mechanisms of the impairment of endothelium-dependent relaxation of the aorta with atheromatous plaque in heritable hyperlipidemic rabbits.
Attenuation of acetylcholine-induced endothelium-dependent relaxation of thoracic aortas excised from Watanabe heritable hyperlipidemic (WHHL) rabbits linearly correlated with the percent area coated with atheromatous plaque. To elucidate mechanisms related to this reduced endothelium-dependent relaxation in the presence of atherosclerosis, the acetylcholine-induced release of endothelium-derived relaxing factor (EDRF) was assessed functionally as a percent relaxation of the precontracted detector strips obtained from the tunica media beneath the intact intima or the atheromatous plaque in the same aortic ring preparation. Relaxations of the normal detectors to effluents containing EDRF of thoracic aortas during stimulation by acetylcholine (3 x 10(-6) M) in heterozygous and homozygous WHHL rabbits were 73 +/- 5% and 59 +/- 9% (p less than 0.01) of the phenylephrine-induced precontraction, respectively. Relaxations of the atherosclerotic detectors to effluents (EDRF) through the aortas during stimulation by acetylcholine (3 x 10(-6) M) in heterozygous and homozygous WHHL rabbits were 16 +/- 4% and 14 +/- 5%, respectively--values significantly smaller than those seen in the normal detectors. When superoxide dismutase was added to the perfusate of the donors from homozygous and heterozygous WHHL rabbits, atherosclerotic detectors relaxed by effluents stimulated by acetylcholine to 73% and 65% (p less than 0.01 versus before the addition of superoxide dismutase) of the normal detector, respectively. Relaxations induced by sodium nitroprusside as well as the contractions by acetylcholine, phenylephrine, and KCl (118 mM) were comparable in detector strips from the normal and atherosclerotic portions. Thus, not only is the amount of EDRF released by acetylcholine reduced in the presence of atherosclerosis, the tunica media beneath the atheromatous plaque is also to some extent responsible for the superoxide-induced inactivation of EDRF.
Acetylcholine↗
Mechanisms of hypertension induced by erythropoietin in patients on hemodialysis.
To investigate the mechanisms of hypertension induced by recombinant human erythropoietin (rHuEPO) in patients on hemodialysis (HD), mean blood pressure (MBP), plasma renin activity (PRA), whole blood viscosity, blood volume (BV), cardiac index (CI) and total peripheral resistance index (TPRI) were measured before and after treatment with rHuEPO for 3 months in 9 patients on HD. Pressor responsiveness to exogenous norepinephrine (NE) and angiotensin II (AII) were also compared before and after treatment. Four patients were 'responders' (R) whose MBP increased by more than 10 mmHg, and 5 patients were 'non-responders' (non-R) whose MBP was unchanged or increased by less than 10 mmHg. Initial PRA and TPRI were significantly higher and BV was significantly lower in R than in non-R. After treatment, TPRI was increased in both groups, but CI was decreased in non-R. There was a significant correlation between changes in MBP and blood viscosity to rHuEPO. Pressor responsiveness to NE and AII were significantly enhanced after rHuEPO treatment in responders. These results suggest that inappropriate cardiovascular responses to the correction of anemia, increased blood viscosity, and enhanced pressor responsiveness may participate in the development of rHuEPO-related hypertension.
Adult↗
[Nutritional support and fluid therapy in elderly patients].
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Acidosis↗
Echocardiographic findings in hemodialysis patients treated with recombinant human erythropoietin: proposal for a hematocrit most beneficial to hemodynamics.
We investigated the hemodynamic effects of the correction of anemia with recombinant human erythropoietin (rHuEPO) in 28 hemodialysis patients with severe anemia. Echocardiograms were recorded before the administration of rHuEPO (period I) with a hematocrit of 19.2 +/- 1.5% (mean +/- SD) and repeated twice (periods II and III) when the hematocrit was increased to 25.7 +/- 1.1% and to 30.0 +/- 1.0%. Left ventricular end-diastolic dimension (LVDd) decreased from 51.0 +/- 6.1 to 48.8 +/- 5.8 and to 48.3 +/- 7.1 mm, but no changes were observed in left ventricular end-systolic dimension. Cardiac output (CO) decreased from 5.89 +/- 1.46 to 5.00 +/- 1.44 and to 4.67 +/- 1.33 l/min. The thickness of the interventricular septum and the left ventricular posterior wall remained unchanged. Blood pressure was kept rather constant, although antihypertensive therapy needed to be adjusted to prevent the occurrence or aggravation of hypertension. Total peripheral resistance increased from 1481 +/- 359 to 1832 +/- 487 and to 1946 +/- 493 dynes.sec/cm5. The decreases in LVDd and CO were significant between periods I and II, without further changes between periods II and III. More antihypertensive therapy was needed in period III than in period II. Similar echocardiographic results were observed in 10 patients in whom antihypertensive therapy was not required throughout the study. In conclusion, an increase in hematocrit to 25% would be appropriate in order to obtain an effective hemodynamic improvement with rHuEPO therapy in dialysis patients although a higher hematocrit level might be desirable in order to improve working capacity.
Adult↗
[Contrast medium and renal dysfunction].
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Acute Kidney Injury↗
Smooth muscles from spastic coronary artery segments show hypercontractility to histamine.
An animal model of coronary spasm was produced in Göttingen miniature pigs by a selective endothelial denudation of the coronary artery. Five months after the denudation, intracoronary bolus administration of 10 micrograms/kg histamine reduced the luminal diameter angiographically by 57 +/- 16 and 17 +/- 10% (P less than 0.01) in the previously denuded and contralateral control coronary arteries. Muscle fibers of 0.08-0.1 mm wide were prepared from circumferential bundles of the medial smooth muscle in the spastic and nonspastic coronary arteries. Upward shifts of either dose-tonic contraction relationships in Ca2(+)-containing solution or dose-monophasic contraction relationships in Ca2(+)-free solution were noted in muscle fibers taken from the spastic site compared with those from the nonspastic site with no difference between the mean effective dose values. After skinning the muscle fibers with saponin, there was no significant difference in the Ca2+ concentration-tension relationships between the two fibers. These findings suggest that an increased number of histaminergic receptors and/or augmentation of signal transduction, but not Ca2+ sensitivity of the contractile proteins in the medial smooth muscle cells, cause histamine-induced coronary hypercontraction.
Animals↗
[Lipiodol-CT for the detection of small hypovascular HCC].
To evaluate the diagnostic value of Lipiodol-CT for small hypovascular HCC, we injected 3 ml or less Lipiodol into the hepatic artery of patients with chronic liver disease and small SOL in the liver detected on echogram but not on angiogram. About seven days after injection CT was used to check for accumulation of Lipiodol in the liver SOL. We found that the sensitivity of this method for detection of hypovascular HCC is only 25%. We assume that Lipiodol does not accumulate in small hypovascular HCC lesions because they have little vascular stroma. Lipiodol-CT has high diagnostic value for the detection of small hypervascular daughter HCC lesions, but this method should not be relied on for the detection of small hypovascular HCC.
Adult↗
[Two cases of amyopathic dermatomyositis with fatal rapidly progressive interstitial pneumonitis].
Two middle-aged women showed typical erythematous heliotrope eruption and Gottron's sign without any symptom of myositis. The patients were diagnosed as 'amyopathic dermatomyositis' because of normal serum CPK levels, normal EMG and no histological abnormality by muscle biopsy. Clinical manifestations improved by the treatment with corticosteroids. During tapering of corticosteroids, however, intersititial pneumonitis developed and rapidly progressed. The first patients was treated with methylprednisolone pulse therapy, azathiopurine and methotrexate. The second patients was treated with betamethazone, methlprednisolone pulse therapy and cyclosporin A. In spite of these extensive immunosuppressive therapies, both patients died of pulmonary insufficiency a few months after admission. In the literature there has been only several cases of amyopathic dermatomyositis and only one case with fatal rapidly progressive interstitial pneumonitis. A new approach to the treatment of this disease should be made.
Autoimmune Diseases↗
[A case of tuberculous arthritis of shoulder].
A rara case of tuberculous arthritis of right shoulder was reported. Plain X ray and CT showed bone destruction in humerus and glenoid process and soft tissue swelling with calcification was also demonstrated. T2 weighted images showed extension of abscess clearly. And extension to bone marrow was showed on CT and T1 weighted MR images.
Arthritis, Infectious↗
[A case of Aspergillus empyema with bronchopleural fistula].
Pleural aspergillosis is not a common disease and we recently experienced a case of Aspergillus empyema with bronchopleural fistula. A 76 year-old man was admitted to our hospital with productive cough and fever. Chest X-ray films showed infiltration in the right lower and left middle field and rather lucent area (clearing) in the right lower lung. Antibiotic therapy was administered but no improvement was obtained. Chest CT scan and right bronchography revealed empyema in the right back portion and bronchopleural fistula in the right lower lobe. Needle aspiration biopsy was performed and Aspergillus fumigatus was isolated from pus. A diagnosis of Aspergillus empyema with bronchopleural fistula was made. We began intrapleural administration of miconazole and empyema was improved partially. For the complete treatment, right lower lobectomy and decortication were performed, but unfortunately he died of acute pneumonia 16 days after operation.
Aged↗
Regulatory mechanisms of erythropoietin levels in dialysis patients.
We described a radioimmunoassay system for measuring blood erythropoietin (Epo) levels using recombinant human Epo and evaluated the regulatory mechanisms of Epo in dialysis patients. A satisfactory dose-response relationship for Epo levels was observed within the wide range of 3-250 mU/ml with a sensitivity of approximately 5 mU/ml. The Epo levels were found to be 16.1 +/- 8.6 mU/ml (m +/- SD) in 422 uremic patients on maintenance dialysis and 17.1 +/- 7.2 mU/ml in 86 normal subjects. The Epo levels were not statistically different between the two groups, although the hematocrit was significantly lower in the dialysis patients. No correlation was observed between the Epo levels and hematocrit in the dialysis patients. Patients with polycystic kidneys had higher hematocrits and Epo levels than patients with chronic nephritis. No changes in Epo levels were observed with age and with the period of dialysis. Diurnal variations in the Epo levels revealed a significant increase after hemodialysis, and an acute reduction in hematocrit following massive hemorrhage raised the Epo levels up to 3,180 mU/ml. These findings indicate that the Epo levels in dialysis patients are inappropriately low for the severity of anemia and suggest that a negative feedback mechanism of the hematocrit on the Epo secretion may exist in uremic patients as well as in normal subjects and that the threshold for Epo secretion might be 'reset' at a low hematocrit level.
Erythropoietin↗
Clinical significance of cerebral aneurysm in renovascular hypertension due to fibromuscular dysplasia: two cases in siblings.
Two cases, in siblings, of renovascular hypertension caused by fibromuscular dysplasia (FMD) of the renal artery associated with cerebral aneurysms are reported. Both of the cases were found to have cerebral aneurysm, as well as multiple stenotic or occluded lesions in arteries such as renal, mesenteric, celiac, and internal carotid arteries. One case died of subarachnoid hemorrhage and the other case was successfully operated on for the aneurysm. This report suggests that FMD should be considered to be a systemic angiopathy including the cerebral artery, as well as the renal artery. Thus, cerebral angiography is recommended to detect the association with cerebral aneurysm, at least, in cases with multiple lesions of FMD. Occurrence of FMD in siblings also indicates that a genetic factor might be involved in the pathogenesis of FMD.
Adult↗
Synthesis and antileukemic activity of (+-)-20-deoxyaminocamptothecin analogues.
The camptothecin analogues (+-)-7-ethyl-10-methoxy-20-deoxyaminocamptothecin (2) and (+-)-7-ethyl-10-hydroxy-20-deoxyaminocamptothecin.HCl (3) were synthesized from indolizine compound 4 via Friedländer condensation to construct a pentacyclic ring system, and were tested in a P388 mouse antileukemia assay. Compounds 2 and 3 were more active and less toxic than (+)-camptothecin (1), and therefore had higher therapeutic ratios.
Animals↗
[Plasma beta-endorphin in patients on maintenance hemodialysis].
A sensitive and specific radioimmunoassay for beta-endorphin without gel filtration of plasma extracts has been developed by using newly raised antibody. The minimal detectable quantity was 5 pg, and ED 50 was 23 pg/ml. The crossreactivity of antibody with beta-lipotropin was 3.3%, but not showed crossreaction with other fragments of beta-lipotropin, beta-MSH and ACTH. The inter-assay coefficient of variation was 2.7% to 17.4%, and the intra-assay coefficient of variation was 4.5% to 26.4%, respectively. The mean recovery for unlabeled beta-endorphin added to plasma and extracted was 92.1% to 110.4%. Plasma levels of beta-endorphin in 40 normal subjects was 14.7 +/- 3.1 pg/ml and 14.8 +/- 1.1 pg/ml in 10 patients with chronic glomerulonephritis whose renal function was normal. There was no significant difference between the two groups. On the other hand, plasma levels of beta-endorphin in 16 patients on maintenance hemodialysis was significantly increased of 56.3 +/- 6.3 pg/ml than the other two groups. Physiological role of this high beta-endorphinemia in patients on maintenance hemodialysis still remains to be resolved.
Adult↗
[Pulmonary arterial input impedance in patients with chronic pulmonary diseases].
To evaluate pulmonary vascular lesions, input impedance of pulmonary arterial system was determined in 52 patients with chronic pulmonary diseases (CPD) by using a multisensor catheter. Mean values of impedance parameters in 14 subjects with normal mean arterial pressure (less than 15 mmHg) were 31 +/- 3 dyne.sec.cm-5 in characteristic impedence (Zo), 3.5 +/- 0.3 Hz in the frequency at which the first minimum of the impedance modulus occurs (fmin) and 0.85 +/- 0.3 in Zx oscillation (Zxos). In patients with CPD, Zo increased with an elevation of pulmonary arterial pressure (p less than 0.01) and fmin shifted to the right with that (p less than 0.05). These results show that stiffness of the proximal arteries in CPD is increased. In patients of interstitial fibrosis with pulmonary arterial hypertension, Zo was not significantly increased, but fmin shifted to the right. Pulse wave velocity correlated with fmin, but did not correlate with Zo. In conclusion, these results suggest that analysis of pulmonary arterial input impedance with a multisensor catheter provides useful information for patients with pulmonary hypertension.
Aged↗
Blood flow in the normal human retina.
The laser Doppler technique was used to measure the blood flow rate in 41 major vessels in ten eyes of healthy volunteer subjects. The specific relationship between blood flow rate, F, and vessel diameter, D, was determined for both retinal arteries and retinal veins. On average, F increased with increasing D at a power of 4.1, consistent with the presence of Poiseuille flow. In six eyes of six subjects, measurements on individual vessels were combined to yield the total retinal blood flow rate. The mean and standard deviation of the total retinal blood flow was 80 +/- 12 microliter/min. The blood flow rate per unit mass of retinal tissue was calculated and found to be in good agreement with that reported for macaque monkeys. Blood flow to the temporal side of the retina was approximately three times larger than to the nasal side. There was no significant difference between blood flow to the superior and the inferior retina.
Adult↗
Osteoclast-type giant cell tumor of the endometrium. An immunohistochemical study.
We present a rare case of a 55 year old female with an osteoclast-type giant cell tumor of the endometrium associated with leiomyoma and adenomyosis. Multinucleated giant cells and mononuclear stromal cells reacted with vimentin and alpha-1-antichymotrypsin (AACT) using the immunoperoxidase method. Epithelial membrane antigen (EMA), carcinoembryonic antigen (CEA), and keratin exhibited negative immunoreaction in these tumor cells. Our immunohistochemical results do not support the epithelial origin of an osteoclast-type giant cell tumor and mesenchymal derivation appeared more likely, suggesting histiocytic origin.
Female↗