Biomedical subjects
I Hirata
Publications and source records attributed to I Hirata.
[Depressive condition with electroencephalographic abnormalities--contribution to differential diagnosis of endogenous depression].
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The Hanley cleat and the Ivy League: a progress report.
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[2 cases of aneurysmal bone cyst of the spine].
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Endoscopic evaluation of the therapeutic effect of sclerotherapy for esophageal varices.
The rebleeding rate after endoscopic injection sclerotherapy was studied in 237 patients with esophageal varices, and the optimal outcome of treatment was determined. Two new categories, RC(2-) and F0, were added to the classification scheme of endoscopic findings of varices in Japan. RC(2-) represents a state in which no veins, not even small vessels, are observed by endoscopy after endoscopic injection sclerotherapy, and F0 represents a state in which no localized venous dilations in the esophagus exist. The criteria for defining the other categories were not altered, and the R-C sign was expressed as RC(2-), RC(-), or RC(+); the degree of dilation was classified as F0 to F3. By combining the R-C sign and the F number, endoscopic findings were classified 1 to 4 weeks after endoscopic injection sclerotherapy into groups designated RC(2-)F0, RC(-)F0, RC(-)F1, and RC(+)F1-RC(+)F2. The four groups were observed to determine the incidence of esophageal stricture and rebleeding. In the RC(2-)F0 group, the incidence of stricture was high, but the rebleeding rate was low. In the RC(-)F0 group, both the incidence of stricture and rebleeding rate were low. We conclude that the optimal outcome of endoscopic injection sclerotherapy is RC(-)F0.
Characterization of a prolyl endopeptidase (kininase) from human urine using fluorogenic quenched substrates.
A prolyl endopeptidase (PE) was purified 83 times from human urine by DEAE-cellulose and Sepharose Mercurial chromatographies. In this work we studied the specificity of PE using different fluorogenics substrates. Further characterization of the enzyme was carried out using BK and it's analogue, Abz-RPPGFSPFRQ-EDDnp and Abz-FPQ-EDDnp, for measure of enzymatic activity of prolyl endopeptidase (Abz=ortho-aminobenzoic acid; EDDnp=N-[2, 4-dinitrophenyl]ethylenediamine). The substrate Abz-FPQ-EDDnp was considered as specific for PE. The endopeptidase PE, with a molecular weight of 45 kDa, was inhibited 100% by EDTA and pOHMB and resistant to PMSF, thyorphan, E64 and phosphoramidon, when we used the mentioned substrates. These results suggest that PE is a metallo endopeptidase that contains a thiol group important for it's activity. It was also able to hydrolyze in Abz-RPPGFSPFRQ-EDDnp the F-R peptide bound, differing from those obtained upon BK molecule, where the enzyme prefer the peptide bound located after double proline. In the substrate Abz-FPQ-EDDnp PE hydrolyzes the P-Q peptide bound. Furthermore the urinary PE is particularly unable to hydrolyze peptides with single prolines such as substance P, neurotensin and LHRH. The determined K(m) for Abz-RPPGFSPFRQ-EDDnp and Abz-FPQ-EDDnp were 0.74 and 0.65 uM, respectively. The optimum pH for the PE activity, using the substrate Abz-RPPGFSPFRQ-EDDnp was approximately 9.0, but using the specific substrate Abz-FPQ-EDDnp was 6.5 and 8.0. Endopeptidases, which are situated at brush border surface from proximal tubules, have an important role in kidney handling of many peptides, which are filtered by the glomerulus. The prolyl endopeptidase located at distal tubule could have an important physiological function in control of kinin formed in this portion. It's known that all components from kallicrein-kinin system like low molecular weigh kininogen and kallikrein are presents in this portion.
Effect of upper gastrointestinal endoscopy on circulation in the elderly.
BACKGROUND: Upper gastrointestinal endoscopy in the elderly is increasingly becoming more common, despite the possibility that a minimal load on the circulation can cause serious complications such as shock and cardiac arrest. OBJECTIVE: The effects of endoscopy on the heart and the possibility of predicting circulatory accidents were studied using natriuretic peptide levels. METHODS: The patients were randomly chosen according to their age and divided into an elderly group (over 60 years of age, 64 patients) and a young group (under 30 years of age, 20 patients). The patients in the elderly group were further subdivided into two groups based on the presence or absence of circulatory complications (46 patients with circulatory complications and 18 without complications). The load on the heart was evaluated by measuring human atrial natriuretic peptide (hANP) and human brain natriuretic peptide (hBNP) which are secreted by the myocardial cells in response to cardiac load. Specimens were obtained before and after endoscopy. RESULTS: The hANP level was significantly higher after endoscopy in the elderly group, regardless of the presence or absence of circulatory complications. No significant difference was observed in the hBNP level. No significant increase in hANP or hBNP levels was observed after endoscopy in the young group. CONCLUSIONS: These observations suggest an increased atrial load during endoscopy in the elderly. The increase in pulse rate during endoscopy is one possible cause of atrial load. Therefore, the risk of circulatory system damage must be recognized when endoscopy is performed in the elderly. The measurement of plasma hANP and hBNP levels may provide effective indices for evaluating cardiac load during endoscopy.
Conditioning and training of the competitive athlete.
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Proper playing conditions.
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Effect of amogastrin on the release of various prostaglandins into gastric lumen in man.
The effect of amogastrin on the release of 5 types of prostaglandins (PGs) [PGE2, 6-keto-PGF1 alpha, PGF2 alpha, PGD2, and thromboxan B2 (TXB2)] into the gastric lumen was evaluated in seven healthy volunteers. Gastric juice was obtained under basal and amogastrin-stimulated conditions. The 5 types of PGs in the gastric juice were separated by high-performance liquid chromatography and then measured by radioimmunoassay. PGE2 was the major component in gastric juices among the PGs measured in this study. The release of 5 types of PGs increased after amogastrin administration. The rate of increase was high for PGE2 and 6-keto-PGF1 alpha (3.48 and 3.98 respectively), whereas it was low for PGD2 (1.54). It is suggested that endogenously synthesized PGs, especially PGE2 and PGI2 (assayed as 6-keto-PGF1 alpha), play important roles in the gastric mucosal protection and the regulation of acid secretion.
Report of a case of Crohn's disease associated with hyper-creatine phosphokinase-emia.
A young male patient with myositis associated with Crohn's disease is reported. His serum creatine phosphokinase (CPK) level was markedly elevated, but he had no muscle symptoms. The serum CPK level was not correlated with the activity of Crohn's disease. Muscle biopsy showed myositis with only degeneration of the muscle fibers and infiltration of inflammatory cells. The etiology of myositis in this case was not clear. Diagnosis of myositis based on a muscle biopsy in patients with Crohn's disease showing an elevated serum CPK level without any discernible cause has not been reported previously. Careful attention to the serum CPK and muscle symptoms in patients with Crohn's disease is suggested.
[The effects of upper gastrointestinal endoscopy on the circulatory system of elderly patients as evaluated by measuring hANP and hBNP].
Endoscopic examinations of the elderly have been increasing annually due to increase in the size of the elderly population, and due to the development and increased use of upper gastrointestinal endoscopy. The reserve potential of the circulatory system is frequently diminished in the elderly. Thus, a minimal load on the circulatory system can induce a critical status. Therefore, the effects of endoscopic examination on the circulation, most notably on the heart itself, was examined in the elderly (over 60 years old) and in younger (under 30 years old) individuals. Atrial and ventricular load were evaluated by measuring the concentration of human atrial natriuretic peptide (hANP) and human brain natriuretic peptide (hBNP), both before and after endoscopic examination. These peptides are secreted by myocardial cells in reaction to sharp increases in cardiac load. No significant difference was observed between the blood pressure of the elderly group (21 cases) and that of the young group (10 cases), either before or after endoscopic examination. However, the pulse rate was raised significantly after the examination in both groups. Furthermore, the hANP concentration was significantly higher after the endoscopic examination in the elderly group, although no notable difference in hBNP concentration was observed after endoscopy. In the younger group, the hANP concentration did not change significantly, but the hBNP concentration was notably lower after the examination. Increased atrial load during endoscopic examination of the elderly was indicated by these observations. Therefore, overall patients status must be correctly evaluated, with particular recognition of potential circulatory system damage, when endoscopic examinations are performed on the elderly.(ABSTRACT TRUNCATED AT 250 WORDS)
Immunohistochemical expression of vascular endothelial growth factor can predict response to 5-fluorouracil and cisplatin in patients with gastric adenocarcinoma.
The combination of 5-fluorouracil (5-FU) and cisplatin is used most commonly for gastric carcinoma. Recent studies have indicated that vascular endothelial growth factor (VEGF) is related to drug delivery through angiogenesis and vascular permeability. In this study, we evaluated the efficacy and toxicity of continuous infusion of 5-FU and low dose cisplatin infusion as first-line treatment in patients with unresectable gastric adenocarcinoma. We also examined the relationship between chemotherapy response and immunohistochemical expression of VEGF in the biopsy samples of gastric primary. All 30 patients enrolled in this study were assessable for response, adverse reactions, and VEGF expression. The regimen consisted of 5-FU (350 mg/m2/day every day by continuous venous infusion) and low dose cisplatin (7 mg/m2/day by drip infusion over 1 h on days 1-5 every week). This treatment was repeated weekly for 3 consecutive weeks. Four weeks after the second cycle, mesurable lesions were estimated for response. An overall response rate was 46.7% (14/30). Patients with intestinal histologic type (10/12) and good performance status ([PS], 13/18) showed good response rate (83.3%, and 72.2%, respectively) compared to patients with diffuse histologic type (4/18) and poor PS [(1/12) 22.2%, and 8. 3%, respectively]. The response rate of VEGF-positive cases and VEGF-negative cases was 75% (12/16), and 16.7% (2/14), respectively. Multivarite analysis revealed that VEGF-positive and good PS had a significant impact on chemotherapy response in this treatment. The most common garde 3 or higher toxicities were myelosuppression (30%) and diarrhea (13.3%). Continuous infusion of 5-FU and low dose cisplatin infusion is an effective treatment for patients with unresectable gastric carcinoma, and VEGF expression may be a useful predictor of chemotherapy response in this regimen.
Non-polypoid colorectal neoplasias: a multicentric study.
A total of 781 non-polypoid colorectal neoplasias harvested at 4 main Hospitals in Tokyo, Japan (n = 420) and at 4 different time-intervals at the Karolinska Hospital, Stockholm, Sweden (n = 361) were reviewed. By applying strict histologic definitions, the lesions were classified into adenomas with low grade dysplasia (LGD), with high grade dysplasia (HGD), intramucosal carcinomas (IMC) or submucosal carcinomas (SMC). Of the non-polypoid neoplastic lesions reviewed in Sweden, 82.8% (n = 299) had LGD. In Japanese patients only 42.6% (n = 179) had LGD (p < or = 0.001). On the other hand, as many as 42.4% (n = 178) of the non-polypoid lesions in Japanese patients had HGD, but only 14.1% (n = 51) of those in Swedish patients (p < or = 0.001). Whereas 15.0% (n = 63) of the non-polypoid neoplasias seen in Japan were IMC or SMC, only 3.0% (n = 11) of those seen in Sweden were IMC or SMC (p < or = 0.001). The cause(s) for these differences remains unclear. In Japan, however, a marked increased incidence of colonic cancer has been recorded in later years. Whether the "catching up phenomenon" by the Japanese with western colonic cancer incidence includes increased histologic aggressiveness of non-polypoid neoplastic polyps--as found in this survey--remains to be elucidated.
Breath and blood ammonia in liver cirrhosis.
BACKGROUND/AIMS: Hyperammonemia causes dysfunction of multiple organs in patients with cirrhosis, including hepatic encephalopathy. Blood ammonia concentrations are monitored with respect to disease progression and efficacy of treatment. Fetor hepaticus, the characteristic breath odor in hepatic encephalopathy has called little quantitative attention to breath ammonia. We studied the dynamics of ammonia metabolism in cirrhosis in terms of the relationship between breath and blood ammonia. METHODOLOGY: Breath and blood ammonia levels were measured simultaneously in 20 cirrhotic patients and in 10 healthy volunteers. Breath ammonia was measured using ammonia electrodes in collected expired air. Helicobacter pylori serum antibody titers were also measured, since the organism produces ammonia. RESULTS: Blood ammonia correlated positively with breath ammonia in patients with cirrhosis. Breath ammonia levels were significantly higher in cirrhotic patients (0.745 ppm) than in controls (0.278 ppm), and higher in cirrhotic patients with hyperammonemia (0.997 ppm) than in those without (0.558 ppm). Breath and blood ammonia decreased together with treatment of hyperammonemia. H. pylori seropositivity was 20% in controls, 27.3% in cirrhotic patients with normal blood ammonia, and 66.7% in those with hyperammonemia. CONCLUSIONS: Breath ammonia measurement may be useful in diagnosis, treatment assessment, and follow-up in hepatic encephalopathy.
Beneficial effect of fluorocarbon reperfusion on postoperative cardiac dysfunction of transplanted heart.
Fluosol DA 20% (Fluosol) perfusion was used to protect ischemic donor hearts of mongrel dogs from reperfusion injury. Fifteen orthotopically transplanted hearts, eight in the control group and seven in the Fluosol group, were studied for 3 hours after weaning from cardiopulmonary bypass. Donor hearts were arrested and immersed in 4 degrees C St. Thomas's Hospital Solution for 4 hours. The mean total ischemic time was 323 minutes (range, 298 to 345 minutes). In the Fluosol group, 200 ml of oxygenated Fluosol (37 degrees C; PO2 650 mm Hg; PCO2 35 mm Hg) was infused into the aortic root at approximately 100 ml/min just before aortic unclamping. Coronary sinus blood was analyzed for the MB fraction of creatine kinase, reduced glutathione, and oxidized glutathione. Hemodynamic and biochemical results were obtained at 30 minutes, 1 hour, and 3 hours after bypass. In the control group, during the second 30 minutes of the period after bypass, left ventricular end-diastolic pressure and stroke volume showed progressive deterioration, 54.8% increased (p less than 0.01) and 28.4% decreased (p less than 0.05), respectively. The MB fraction of creatine kinase and oxidized glutathione were increased, and reduced glutathione had declined, from 39.3 to 135.3 IU/L (p less than 0.01), from 28.0 to 33.4 micrograms/ml (p less than 0.05) and from 4.4 to 2.5 micrograms/ml (p less than 0.01), respectively. These parameters failed to recover during the next 2 hours, and massive mitochondrial degeneration was observed by electron microscopy. In the Fluosol group, these parameters maintained their baseline values, and electron microscopy showed well-preserved mitochondria. The data suggested that, in the control group, initial mitochondrial dysfunction was profound, persistent for at least 3 hours, and associated with membrane hyperpermeability, leading to cardiac dysfunction. Oxygenated Fluosol perfusion better preserved cardiac and mitochondrial function.