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H Yamabe

Publications and source records attributed to H Yamabe.

At least 145 records · Page 8Linked to original sources
PubMed1993

Quantitative histopathology in the prognostic evaluation of patients with transitional cell carcinoma of the urinary bladder.

BACKGROUND: Morphologic grading of malignancy is considered to be of prognostic value in patients with transitional cell carcinomas of the urinary bladder (TCC). This qualitative approach is, however, associated with low reproducibility. Grading of malignancy can be carried out on a reproducible, quantitative scale. METHODS: A retrospective, prognostic study of 110 patients treated for TCC in clinical Stages Ta-T4 (median follow-up time, 6 years) was performed, evaluating various grading techniques. Unbiased estimates of the volume-weighted mean nuclear volume (nuclear vV), nuclear volume fraction, estimates of nuclear mean profile area (aH(nuc)), nuclear profile density index (NI), and mitotic profile density index (MI) were obtained by stereologic and morphometric techniques. RESULTS: The T-stage and morphologic grade of malignancy were closely cross-correlated (+0.63 < Kendall tau < +0.71, 2P < 6.7 x 10(-16)). The estimation of nuclear vV was highly efficient, with more than 85% of the associated variation attributable to differences between tumors. A positive significant correlation between estimates of nuclear vV and aH(nuc) was detected (r = +0.79), whereas an inverse correlation was documented between nuclear vV and NI (r = -0.63). Estimates of nuclear volume fraction showed no correlation with nuclear vV. Comparisons between categorical and quantitative data revealed the following: a decrease in averaged estimates of NI for tumors in advanced T-stage and malignancy grade (2P < 0.0008); and nuclear vV and aH(nuc) increased on average, in tumors of high T-stage and malignancy grade. Estimates of MI were also positively correlated with the T-stage and the malignancy grade (+0.42 < Kendall tau < +0.49). Single-factor analyses showed prognostic effect of T-stage, grade of malignancy, and, apart from nuclear volume fraction, all quantitative histopathologic variables with regard to overall survival (2P < 0.03). None of the morphometric and stereologic parameters were of prognostic values with regard to recurrence-free survival (2P > 0.26). Multiple hazards regression analysis (Cox models) revealed that clinical stage of disease was the sole independent prognostic variable. Only estimates of nuclear vV added significant independent prognostic prediction with regard to recurrence-free survival in the 48 patients with Ta tumors (2P = 0.03). CONCLUSIONS: The results suggested that estimates of nuclear vV are prognostically superior to morphologic grading of malignancy in noninvasive TCC, whereas both morphologically and quantitatively based malignancy grading are without prognostic value in invasive TCC.

Adult↗
PubMed1993

A model of in vivo cell proliferation of adult T-cell leukemia.

We have made a model of in vivo cell proliferation of leukemic cells from adult T-cell leukemia (ATL) patients using severe combined immunodeficiency (SCID) mice. Peripheral blood mononuclear cells (PBMC) or lymph node cells (LNC) depleted of B cells and monocytes were intraperitoneally injected into SCID mice treated with antimurine interleukin-2 receptor (IL-2+) beta chain monoclonal antibody (MoAb)(TM-beta 1), followed by daily injection of human recombinant IL-2 until 60 days after cell injection. SCID mice injected with ATL cells from 6 of 8 ATL patients were found to have the tumor or leukemia 5 to 7 weeks after the inoculation of cells. Serum levels of soluble form of human IL-2R alpha chain (Tac) were markedly elevated in such mice. The cells recovered from the mice injected with leukemic cells from four different ATL patients had the same cell surface phenotype as that of original leukemic cells which were CD4+Tac+. Furthermore, we detected the same integration site of human T-cell leukemia virus type I (HTLV-I) provirus and the same rearrangement pattern of human T-cell receptor (TCR) beta chain gene as those of ATL cells by Southern blot hybridization, indicating that the cells proliferating in SCID mice were derived from the original ATL cell clone. Histologic examination showed that the pattern of the infiltration of ATL cells into various organs in SCID mice was similar to that of an ATL patient. Such a model of in vivo cell proliferation of ATL cells will be useful for the study of the mechanism of neoplastic cell proliferation and for the development of a new and effective treatment of ATL.

Aged↗
PubMed1993

Lymphocytic infundibuloneurohypophysitis as a cause of central diabetes insipidus.

BACKGROUND: Central diabetes insipidus may be familial, secondary to hypothalamic or pituitary disorders, or idiopathic. Idiopathic central diabetes insipidus is characterized by selective hypofunction of the hypothalamic-neurohypophysial system, but its cause is unknown. METHODS: We studied 17 patients with idiopathic diabetes insipidus, in whom the duration of the disorder ranged from 2 months to 20 years. Only four patients had been treated with vasopressin before the study began. All the patients underwent endocrinologic studies and magnetic resonance imaging (MRI) with a 1.5-T superconducting unit, and two patients had biopsies of the neurohypophysis or the pituitary stalk. RESULTS: Nine of the 17 patients had thickening of the pituitary stalk, enlargement of the neurohypophysis, or both and lacked the hyperintense signal of the normal neurohypophysis. In the remaining eight patients, the pituitary stalk and the neurohypophysis were normal, although the hyperintense signal was absent. The abnormalities of thickening and enlargement were seen on MRI only in the patients who had had diabetes insipidus for less than two years, and the abnormalities disappeared during follow-up, suggesting a self-limited process. In addition to vasopressin deficiency, two patients had mild hyperprolactinemia and nine had impaired secretory responses of growth hormone to insulin-induced hypoglycemia. The two biopsies revealed chronic inflammation, with infiltration of lymphocytes (mainly T lymphocytes) and plasma cells. CONCLUSIONS: Diabetes insipidus can be caused by lymphocytic infundibuloneurohypophysitis, which can be detected by MRI. The natural course of the disorder is self-limited.

Adult↗
PubMed1993

Radiofrequency catheter ablation of accessory pathway during entrainment of the atrioventricular reciprocating tachycardia.

Radiofrequency catheter ablation of the concealed atrioventricular (AV) accessory pathway was performed during entrainment of the AV reciprocating tachycardia. Right ventricular pacing at a rate 5 to 15 beats/min faster than the tachycardia rate was performed during the tachycardia, which resulted in transient entrainment. In 2 patients with a right-sided accessory pathway, constant fusion of the QRS complex was observed during entrainment, whereas in 2 with a left-sided pathway, no fusion beat was noted (concealed entrainment). Radiofrequency energy was applied to the accessory pathway while entraining the tachycardia. One to 4.5 seconds after initiation of energy delivery, ventriculoatrial conduction block occurred (i.e., the accessory pathway was ablated). This was associated with a change in the left ventricular activation sequence from orthodromic capture through the normal AV conduction system to antidromic capture through the right ventricle and with a change in the QRS morphology in patients with a right-sided accessory pathway. The left ventricular activation sequence and QRS morphology remained unchanged in patients with concealed entrainment. Radiofrequency energy was effectively delivered for 30 seconds with a stable ablation catheter position, and termination of rapid pacing resulted in sinus rhythm. Thus, radiofrequency ablation of the reentry circuit component during manifest entrainment fulfilled the third entrainment criterion defined previously. The results suggest that tachycardia entrainment can be used for continuous application of radiofrequency energy during tachycardia in selected patients, because it provides a constant ventricular rate during the procedure and thus maintains the catheter in a stable position.

Adult↗
PubMed1993

Membranoproliferative glomerulonephritis associated with hepatitis C virus infection.

BACKGROUND AND METHODS: Hepatitis C virus (HCV) infection causes both acute and chronic liver disease and is also associated with mixed cryoglobulinemia. Whether HCV is also associated with renal disease, as is the hepatitis B virus, is not known. We describe the clinical, pathologic, virologic, and immunologic features of eight patients with HCV infection who were referred to nephrologists for glomerulonephritis. Four patients were treated with interferon alfa. RESULTS: All eight patients had proteinuria, and seven had decreased renal function. Renal biopsy in all patients revealed membranoproliferative glomerulonephritis, characterized by the deposition of IgG, IgM, and C3 in glomeruli. Electron microscopy of the biopsy specimens showed cryoglobulin-like structures in three of four patients. All eight patients had HCV RNA detected in their serum, elevated serum aminotransferase concentrations, and hypocomplementemia, and the majority had cryoglobulins and circulating immune complexes in their serum. Cryoprecipitates from the three patients who were tested contained HCV RNA and IgG anti-HCV antibodies to the nucleocapsid core antigen (HCVc or c22-3). IgM rheumatoid factors, present in all patients, bound anti-HCV IgG in all six patients tested. Four patients received interferon alfa for 2 to 12 months; all had evidence of decreased HCV replication and improvement of their renal and liver disease. CONCLUSIONS: Chronic HCV infection is associated with cryoglobulinemia and membranoproliferative glomerulonephritis. The pathogenesis is unknown, but may relate to deposition within glomeruli of immune complexes containing HCV, anti-HCV IgG, and IgM rheumatoid factors.

Adult↗
PubMed1993

A case of anti-nuclear antibody negative systemic lupus erythematosus associated with penile ulcer.

We report here an old male patient with anti-nuclear antibody (ANA) negative systemic lupus erythematosus (SLE) with active renal disease and penile ulcer. He revealed nephrotic syndrome, malar rash and oral ulcer. SLE was discussed, however both ANA and anti-DNA antibody were persistently negative. A penile ulcer was also observed. He died of acute respiratory distress. Autopsy findings including onion skin lesion in the spleen and haematoxylin body in the kidney resulted in the final diagnosis of SLE. To our knowledge, association of penile ulcer with SLE has not yet been reported. Therefore, the present case is thought to be extremely unusual.

Antibodies, Antinuclear↗
PubMed1993

Nuclear DNA content as a prognostic predictor in carcinoma of the pancreas.

Eighty-six patients with carcinoma of the pancreas were studied retrospectively. Paraffin-embedded specimens and flow cytometry were used to evaluate the accuracy of the measurement of nuclear DNA as a predictor of the postoperative prognosis. From the series of 86 patients, 72 with a diagnosis of tubular adenocarcinoma (Japanese classification) were selected, and their DNA ploidy pattern and clinical and pathological features were correlated; 52.3% of the 86 patients and 52.8% of the 72 tubular adenocarcinoma patients showed DNA aneuploidy. Histological examinations of the tubular adenocarcinomas showed 42.9% DNA aneuploidy in well differentiated, 56.8% in moderately differentiated, and 71.4% in poorly differentiated types. The DNA ploidy showed a statistically significant positive correlation with the T category. The presence or absence of retroperitoneal invasion was thought to be the most important prognostic factor. Cumulative survival rates showed that the prognosis for patients with retroperitoneal invasion and DNA aneuploidy was significantly worse than for those with DNA diploidy or those without retroperitoneal invasion.

Adenocarcinoma↗
PubMed1993

Increased deposition and serum level of type IV collagen in patients with extrahepatic biliary atresia.

Increased deposition of fibrous connective tissue has been demonstrated in extrahepatic biliary atresia (EHBA). We have focused on type IV collagen, a major component of the perisinusoidal wall of the liver. We attempted to localize tyep IV collagen in liver specimens with monoclonal antibodies. Ultrastructural changes of the liver were observed by electronmicroscopy. Serum amount of type IV collagen was estimated by a recently developed sandwich enzyme immunoassay (EIA) method. Serum laminin and prolyl 4-hydroxylase were also determined by EIA for comparison with type IV collagen. Increased deposition of type IV collagen in the perisinusoidal wall was evident in the area with so-called sinusoidal capillarization. Electronmicroscopy showed a basement membrane structure underlying the endothelial cells in Disse's space. Serum type IV collagen increased in EHBA patients before living-related liver transplantation (LRLT), and returned to normal within 5 weeks after LRLT, except for some patients with postoperative complications. Serum laminin and prolyl 4-hydroxylase showed the same propensity, although less prominently so. It is suggested that the immunoassay of serum type IV collagen adopted in this study has potential application in estimating collagen synthetic activity of the liver and in monitoring the postoperative states of patients after LRLT.

Biliary Atresia↗
PubMed1993

Chemotherapeutic effects of intra-arterial administration of ACNU in primary intracerebral non-Hodgkin's lymphoma.

The authors report five patients with primary intracerebral non-Hodgkin's lymphoma who were treated with several cycles of intra-arterial injection of 1-(4-amino-2-methyl-5-pyrimidinyl)-methyl-3-(2-chloroethyl)-3-nitrosourea hydrochloride (ACNU) at doses of 80 to 100 mg/m2/injection at several monthly intervals. There was no simultaneous use of steroids, and no patients had concomitant immunosuppression; no patient was human immunodeficiency virus positive. This therapy was initially used in four patients with advanced recurrent lymphoma. These patients experienced tumor progression despite our institutional standard therapy comprising cranial irradiation followed by repeated courses of systemic multi-agent chemotherapy (cyclophosphamide, vincristine, adriamycin, and prednisolone) more than 3 months previously. Based upon brain computed tomography scans and clinical neurologic examinations, three of the four cases showed partial responses ranging from 10 to 12 months in duration, whereas the other patient remained stable without worsening for 8 months. A fifth case was particularly noteworthy; this patient had no prior therapy and intra-arterial chemotherapy alone induced an 18-month, disease-free remission. No significant therapy-related complications nor neurotoxicity were seen. These results suggest that intra-arterial administration of ACNU may be a potential candidate for intracerebral lymphoma therapy.

Adult↗
PubMed1993

Tissue factor production by cultured rat glomerular epithelial cells.

It is well known that fibrin deposition in Bowman's space in association with crescent formation may play an important role in progressive glomerular injury in crescentic glomerulonephritis. Recent reports describe the presence of a procoagulant activity (PCA) in the glomeruli and its increased expression in human and experimental nephritis. The cells that synthesize PCA have not yet been identified. We attempted to determine if glomerular epithelial cells (GEC), one of the prominent cell populations in the crescent, can produce PCA. The PCA of cultured rat GEC was measured by clotting and amidolytic assays. The cultured GEC yielded PCA with the characteristics of a tissue factor, and this PCA was stimulated by interleukin 1, tumour necrosis factor-alpha, and lipopolysaccharide. We concluded that GEC produce tissue-factor-like PCA and thereby may contribute to fibrin deposition, which, along with macrophage or monocyte infiltration, leads to crescent formation in crescentic glomerulonephritis.

Animals↗
PubMed1993

Is ST/HR slope a predictor of coronary artery lesion in effort angina pectoris? A comparison of exercise hemodynamic variables.

This study evaluated the clinical value of the ST/HR slope and exercise hemodynamic variables for the severity of coronary artery lesions. Twenty-nine patients with effort angina pectoris underwent ergometer exercise during right side heart catheterization. The ST/HR slope failed to differentiate three groups stratified by the number of involved coronary vessels. The ST/HR slope was uncorrelated with the Gensini score (r = 0.24). By contrast, pulmonary capillary pressure (PCP), cardiac output index (CI) and CI/PCP at peak exercise correlated significantly with the Gensini score (r = 0.73, 0.53 and 0.69, respectively). We conclude that the ST/HR slope is not a useful predictor of the severity of coronary artery lesions, while exercise hemodynamic variables measured by right side heart catheter are useful.

Adult↗
PubMed1993

[A case of inflammatory pseudotumor of the lung: relation to metastasizing leiomyoma].

A 61-year-old woman was referred to our clinic because of an abnormal shadow in the left lower lung field on an X-ray taken at a regular checkup. She had no subjective symptoms. Past history included myoma uteri at 47 yr and iatrogenic left pneumothorax subsequent to acupuncture for muscle pain in the shoulder. On CT, a solitary round lesion 2.5 cm in diameter and smooth margin was located at S5 just below the visceral pleura. Since we were unable to obtain a histological diagnosis by bronchofiberscopy, thoracotomy was carried out and the lesion was resected. The intraoperative pathological diagnosis was a benign lesion resembling leiomyoma. After surgery, re-evaluation of the myoma uteri specimen resected 14 years previously was done, as well as desmin immunohistochemical staining of the lung lesion, which demonstrated no evidence of a smooth muscle component in the latter. The final diagnosis was inflammatory pseudotumor.

Diagnosis, Differential↗
PubMed1993

High expression of the Epstein-Barr virus latent protein EB nuclear antigen-2 on pyothorax-associated lymphomas.

Pyothorax-associated lymphoma (PAL) is a rare tumor associated with long-standing tuberculous pyothorax. Most of these lymphomas are B-cell lymphomas of high-grade malignancy. Over 50 cases have been reported in Japan, but no cases have been described in Western countries. Its pathogenesis remains unknown. We studied immunohistologically the expression of Epstein-Barr virus- (EBV) encoded latent gene products, EB nuclear antigen-2 and LMP-1, in four cases of PAL. Fifty B-cell lymphomas unrelated to pyothorax, and five EBV-bearing lymphoblastic tumors produced in severe combined immune deficient mice (severe combined immune deficient-EBV+ tumors) were also studied as controls. Marked expression of EB nuclear antigen-2 was demonstrated on all four PALs. LMP-1 was also present in all cases, but both the staining intensity and the number of stained cells remained less than on severe combined immune deficient-EBV+ tumors. Neither EB nuclear antigen-2 nor LMP-1 was observed in the 50 control B-cell lymphomas. Additional molecular genetic analysis revealed that EBVs are incorporated into each PAL clonally. These results confirm the definite association of EBV with PALs, although the significance of weak expression of LMP-1 awaits further study.

Aged↗
PubMed1993

Epstein-Barr virus genome-positive tubulointerstitial nephritis associated with Kawasaki disease-like coronary aneurysms.

A patient with recurrent renal failure due to massive interstitial nephritis caused by Leu 3a + 3b-positive T-cell infiltration and associated with multiple thromboembolic attacks is reported. He died of gastrointestinal bleeding after treatment with anticancer agents. At autopsy, diffuse necrosis of the bilateral kidneys was noted as well as giant coronary aneurysms filled with thrombus that resembled those seen in Kawasaki disease and multiple old myocardial infarcts were also present. Among the various Epstein-Barr virus (EBV)-specific antibodies, the titers anti-viral capsid antigen (VCA) and anti-early antigen (EBEA) IgG antibody were always very high in contrast to the relatively low titers of anti-EB nuclear antigen (EBNA) antibodies. DNA extracted from kidney tissue obtained at autopsy was analyzed by Southern blot hybridization after the amplification of EBV-specific DNA by the polymerase chain reaction. In situ hybridization of kidney tissue obtained at biopsy was also performed using an enzyme-linked probe derived from the EBV-encoded RNA 1 (EBER1) gene. As a result, the EBV genome was found both at autopsy and in the biopsy tissue, which clearly revealed EBER1 in the interstitial cells. Taking account of the progressive ST-T changes of the electrocardiograms which were normal early in his course, multiple myocardial infarction associating multiple giant aneurysms probably occurred during this disease process. Thus, it could be concluded that chronic active EBV infection contributed massive interstitial nephritis mediated by the activation of Leu 3a + 3b-positive T cells.

Adult↗
PubMed1993

[Applicability to exercise test of thermodilution technique for right ventricular ejection fraction].

To assess the reliability of right ventricular ejection fraction (RVEF) during exercise measured by thermodilution technique using a modified Swan-Gantz catheter with a fast-response thermister, we measured RVEF under several conditions in 19 patients with cardiac disease. Measurements were repeated 5 times in each condition, and average RVEF and coefficient of variation (CV) were evaluated. 1) Injectate volume did not affect RVEF and CV. 2) A reduction in RVEF occurred with the thermister moved from proximal portion to distal portion within the pulmonary artery. 3) There were no differences in measurements of RVEF and CV between those during spontaneous breathing and those during apnea. 4) Postural change from supine to sitting decreased RVEF (38 +/- 8 to 35 +/- 9%; p < 0.05) and increased CV (7 +/- 2 to 13 +/- 5%). 5) Exercise increased RVEF (35 +/- 9 to 37 +/- 10%; p < 0.05) but did not change CV (13 +/- 5 vs 13 +/- 5%) compared with rest in the sitting position. 6) Cardiac rhythm (sinus vs atrial fibrillation) did not affect CV. 7) Average value of RVEF and CV during exercise were not different among 3, 4, 5 times repeated measurements. We considered that thermodilution technique for RVEF was applicable to exercise test, and 3 measurements were enough to determine the average value of RVEF during exercise.

Adult↗
PubMed1992

Flow cytometric analysis of nuclear DNA content of duct cell carcinoma of the pancreas.

BACKGROUND: This study was designed to evaluate the efficacy of nuclear DNA content analysis in determining the prognosis of carcinoma of the pancreas. METHODS: Resected and paraffin-embedded specimens from 72 patients with duct cell carcinoma of the pancreas were examined, and flow cytometry was used to explore the relationship between DNA ploidy and TNM classification or histologic grade. RESULTS: DNA aneuploidy was found histologically in 42.9%, 56.8%, and 71.4% of Grade 1, 2, and 3 tumors, respectively. DNA ploidy showed a statistically significant correlation with T category and retroperitoneal invasion. The cumulative survival rate of patients with retroperitoneal invasion was shorter than that of those without retroperitoneal invasion. Among the patients with retroperitoneal invasion, those with DNA aneuploidy had a significantly shorter survival time than did those with DNA diploidy. CONCLUSIONS: The DNA ploidy pattern, in combination with the presence or absence of retroperitoneal invasion, appears to be useful in predicting the prognosis for duct cell adenocarcinoma of the pancreas.

Adult↗
PubMed1992

Report of a patient with POEMS/Takatsuki/Crow-Fukase syndrome associated with focal spinal pachymeningeal amyloidosis.

The authors present the results of an autopsy of a 67-year-old Japanese man with POEMS/Takatsuki/Crow-Fukase syndrome (P/T/CFS) diagnosed in 1972. Each component of the syndrome was gradually recognized after the resection of lumbar vertebral solitary plasmacytoma in 1967. The patient died in 1989 of generalized infection and renal failure. Autopsy revealed in the vertebral canal between the fifth and seventh thoracic vertebrae dorsal pachymeningeal fibrosis, with prominent amyloid deposition that oppressed the spinal cord. This condition was consistent with the final neurologic manifestation of the patient, bilateral motor and sensory disturbance below the sixth thoracic level. Myelopathy remained clinically unnoticed because neurologic disturbance had begun as peripheral polyneuropathy. Normocellular marrow with heterogeneously scattered lambda light chain-positive plasma cells and degeneration of the myelinated fibers of sciatic nerve also were observed. This is the first report of focal spinal amyloidosis associated with P/T/CFS.

Adult↗