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Biomedical subjects

J Kobayashi

Publications and source records attributed to J Kobayashi.

At least 253 records · Page 14Linked to original sources
PubMed1996

Serum KL-6 for the evaluation of active pneumonitis in pulmonary sarcoidosis.

KL-6, a mucinous high-molecular weight glycoprotein, expressed on type II pneumonocytes, is elevated in the serum of patients with active interstitial pneumonia. Forty-seven patients with histologically confirmed sarcoidosis were analyzed by chest radiography, CT, 67Ga scintigraphy, BAL fluid (BALF), and serum KL-6. Serum KL-6 level was significantly elevated in radiographic type II (945 +/- 725 U/mL; n = 13; p < 0.01) and type III (1,179 +/- 1,320 U/mL; n = 9; p < 0.01), as compared with type 0 (333 +/- 173 U/mL; n = 10) and type I (430 +/- 225 U/mL; n = 15). Serum KL-6 level was significantly elevated in patients with CT findings of irregular small opacities, ground-glass opacities, and thickened bronchovascular bundle (p < 0.01), as compared to those without these findings. Serum KL-6 level was significantly elevated in patients with positive pulmonary accumulation in 67Ga scintigraphy (1,108 +/- 1,044; n = 20; p < 0.001) as compared to those without accumulation (390 +/- 206; n = 27). Serum KL-6 level was elevated in patients with a higher CD4+/CD8+ ratio (> or =3) in BALF, as compared to those with lower ratios. These results suggest that serum KL-6 is a useful marker of sarcoidosis activity.

Adolescent↗
PubMed1996

Cloning of mRNA sequences for two antibacterial peptides in a hemipteran insect, Riptortus clavatus.

Escherichia coli injection rapidly induced bactericidal activity in the hemolymph of a hemipteran insect, Riptortus clavatus. This activity reached its maximum at 9 hr after injection and thereafter declined slowly. Two types of cDNA clones involved in this response were isolated by differential screening. The predominant type encoded for an open reading frame of 678 amino acids, which consisted of fourteen tandem repeats. Each repeat was rich in charged residues and had a proline-rich region which had striking sequence similarities to proline-rich antibacterial peptides from other insect species, indicating these clones encode a multipeptide precursor of antibacterial peptides. The other type encoded for a glycine-rich peptide similar to a known antibacterial peptide as well. Northern blot analyses revealed rapid induction of mRNAs corresponding to these clones after the injection. To our knowledge, this is the first report on the mRNA sequences of antibacterial peptides of hemimetabolous insects, and the second report on the occurrence of multipeptide precursor structure in insect antibacterial peptides.

Animals↗
PubMed1996

[Clinical studies on acute otitis media in infants less than one year old].

Epidemiological and bacteriological studies were made on 164 infants less than 1 year old with acute otitis media (OMA) treated at the Department of Otorhinolaryngology, Matsuyama Red Cross Hospital between January 1991 and December 1993. The patients consisted of 101 males (61.6%) and 63 females (38.4%). Compared with the general population in Matsuyama city, the preponderance of male patients with OMA is statistically significant at the level of P = 0.05. In infants less than 1 year old males are likely to be more susceptible to OMA than females. One hundred and four patients among the 164 (63.4%) were referred by pediatricians. Fever was the most common symptom (57.9%) and the next was otorrhea (19.5%). Between the patients younger than 6 months (younger group) and those 6 months old or older (older group) there were epidemiological differences which were statistically significant at the level of P = 0.05. The older group contained 128 patients (78.0%) and the younger group 36 (22.0%). The difference in incidence between the two groups indicates that infants 6 months old or older are more susceptible to OMA than those younger than 6 months. In the older group 76.6% of the patients had bilateral OMA, while in 38.9% of those in the younger group the OMA was bilateral. In infants 6 months old or older bilateral involvement and, in contrast, in infants younger than 6 months unilateral involvement was more frequent. The period needed to cure OMA was confirmed for 179 ears of 106 patients. For 80 (44.7%) of the 179 ears the period extended beyond 4 weeks. Seventy-five of the 80 ears were those of patients in the older group. OMA in the older group tended to be more resistant to treatment. The middle ear secretion of 117 ears was examined bacteriologically. Specimens were collected from middle ear effusion of 99 ears following myringotomy and from otorrhea in 18 ears. Cultures of 68 specimens were positive for one species of bacteria and 13 cultures yielded two species. Streptococcus pneumoniae, Staphylococcus epidermidis and Haemophilus influenzae were the three most common microorganisms in middle ear effusion. But it was considered that S. spidermidis was not pathogenic and was a result of contamination. In otorrhea S. aureus was frequently found. No difference in the results of bacteriological study was noted between the two groups. Transplacental IgG1 and IgG2 antibodies to S. pneumoniae and H. influenzae are known to decrease after birth and their serum levels are lowest between ages 6 months and 1 year. Then the serum levels of the immunoglobulins increase gradually with active production until age 4 years. The incidence and period of restitution of OMA in infants less than 1 year old in the present study seem to reflect the above Change in the serum levels of IgG1 and IgG2 mentioned. Based on the above results emphasis is placed on close cooperation between the otolaryngologist and the pediatrician in the treatment of OMA in an infant less than 1 year old. Particularly careful follow-up is important in patients in the older age group because they tend to be more susceptible to OMA and the disease is more resistant to treatment.

Acute Disease↗
PubMed1996

[Valvular surgery in the patients more than 70 years old].

One hundred twenty-eight valvular surgeries in patients over 70-year-old were reviewed (AVR:58, MVR:38, AVR and MVR: 11, mitral valvuloplasty (MVP): 11, AVR + MVP:11, mitral valvuloplasty (MVP): 11, AVR + MVP: 8, others: 2). Concomitant CABG was performed in 7, Maze in 6, TVR in 5 and Bentall in 3 cases. Early deaths occurred in 17 patients (13%). The early mortality was 5% in AVR, 21% MVR, 18% in AVR and MVR, 0% in MVP and 38% in AVR and MVP. Late death occurred in 16 patients. Forty-three percent of the late deaths were cardiac death. The actuarial survival at 10 years was around 50% in all groups. In the aortic position, a mechanical valve was implanted in 47 cases and a bioprosthetic valve was implanted in 33 cases. In the mitral position, the mechanical valve was implanted in 37 cases and the bioprosthetic valve was implanted in 12 cases. The event free rate after AVR at 10 years was 37% in patients with the mechanical valve (3 cerebral hemorrhage, 2 PVE, 1 thromboembolism and 1 sudden death) and 46% in patients with the bioprosthetic valve (2 PVE and 1 primary tissue failure). The event free rate after MVR at 10 years was 84% in patients with mechanical valves (1 perivalvular leak, 1 PVE and 1 sudden death) and 75% in patients with bioprosthetic valves (1 PVE and 1 sudden death). Between mechanical valve group and bioprosthesis group, no statistically significance was found in the event free curve after AVR nor MVR. There was no valve related event after MVP. Considering the better durability of bioprostheses in the aortic position than in the mitral position, the presence of atrial fibrillation and necessity of warfarin anticoagulation, we conclude that a choice of a bioprosthetic valve could be acceptable in the aortic position, but may not be recommended in the mitral position.

Aged↗
PubMed1996

[Anticoagulant related hemorrhage and thromboembolism after valvular surgery].

We reviewed anticoagulant related hemorrhage (ACRH) and thromboembolism (TE) in 84 patients after valvular surgery. There were 45 females and 39 males with a mean age of 51.8 years (range 30.5-71.2 years), who underwent valvuloplasty in 14, bioprosthetic valve replacements in 17, mechanical valve replacements in 13. A mean period from the operation to the event were 2.7 years (range 0.01-12.3 years). There were 25 ACRH events after one valvuloplasty, 4 bioprosthetic valve replacements, 20 mechanical valve replacements. About half of them, the prothrombin time were less than 25%, which was considered the effect of warfarin is high, and 8% of them had infective endocarditis (IE) previously. There were 59 TE events after 13 valvuloplasties, 13 bioprosthetic valve replacements, 33 mechanical valve replacements. In the patients with atrial fibrillation, TE occurred irrespective of operative procedures. And in the patients with mechanical valve, severely impaired left ventricular function and past history of IE, thrombi of left ventricule were caused of TE. It was suggested that past history of IE was a risk factor ACRH and TE, and severely depressed left ventricular function and atrial fibrillation were for TE.

Adult↗
PubMed1996

The mode of rabbit platelet shape change and aggregation induced by theonezolide-A, a novel polyketide macrolide, isolated from the Okinawan marine sponge Theonella sp.

Theonezolide-A (TZ-A), a novel polyketide macrolide, isolated from the Okinawan marine sponge Theonella sp., caused a marked platelet shape change at low concentrations (0.2-0.6 microM). Increasing concentrations of TZ-A to 6 microM or more caused shape change followed by a small but sustained aggregation. In a Ca(2+)-free solution, TZ-A-induced aggregation was markedly inhibited, although the marked shape change was still observed. Aggregation stimulated by TZ-A increased in a linear fashion with increasing Ca2+ concentrations from 0.1 to 3.0 mM. Furthermore TZ-A markedly enhanced 45Ca2+ uptake into platelets. Aggregation induced by TZ-A was inhibited by Arg-Gly-Asp-Ser, an inhibitor of fibrinogen binding to glycoprotein IIb-IIIa, H-7 and staurosporine, protein kinase C inhibitors, or genistein and tyrphostin A23, protein tyrosine kinase inhibitors, whereas shape change was blocked by genistein and tyrphostin A23. H-7 or staurosporine did not affect the TZ-A-induced shape change. These results suggest that TZ-A-induced platelet shape change is not dependent on external Ca2+, whereas TZ-A-induced aggregation is caused by an increase in Ca2+ permeability of the plasma membrane. It is also suggested that both aggregation and shape change induced by TZ-A are associated with protein phosphorylation by protein kinase C and tyrosine kinase.

Adenosine Diphosphate↗
PubMed1996

[Use of the the ED046 kit to analyze serum KL-6 in patients with pneumonitis].

KL-6 is a mucinous glycoprotein expressed on Type 2 pneumonocytes, and serum levels of KL-6 are reported to be abnormally high in patients with interstitial pneumonia. A new assay kit for serum KL-6 (ED046) was used in the evaluation of patients with pneumonitis. To clarify whether KL-6 is a useful marker of pneumonitis activity, 649 subjects were studied, including 185 healthy controls, 187 patients with 3 types of interstitial lung diseases, and 277 patients with 4 types of non-interstitial lung diseases. The serum KL-6 level was significantly higher in the patients with pneumonitis (1285 +/- 1196 U/ml) than in the patients without pneumonitis (307 +/- 232 U/ml). The KL-6 level was also significantly higher in patients with clinically active pneumonitis (1708 +/- 1338 U/ml) than in those with inactive pneumonitis (820 +/- 796 U/ml) (p < 0.0001). Serum KL-6 levels correlated significantly with serum c-reactive protein, lactic dehydrogenase, and PaO2 values. These results suggest that the ED046 assay is useful for measuring KL-6 as a marker of pneumonitis activity.

Adult↗
PubMed1996

[Establishment of reference intervals and cut-off value by an enzyme immunoassay for KL-6 antigen, a new marker for interstitial pneumonia].

KL-6 antigen is a novel marker for interstitial pneumonia. In a similar manner as the protocol developed in serum protein standardization project, reference intervals for KL-6 was established using a newly developed enzyme immunoassay. The cut-off value was thus determined by ROC curves. Reference interval for a total of 273 subjects was 94.9-458.2 U/ml (median , 181.1 U/ml), with the age-dependent elevation. Sex-difference was observed over 40 years of age, being higher in males than in females (p < 0.01). Although no statistical difference, smokers showed higher levels than non-smokers did. The KL-6 value was 133.0-527.0 U/ml in 23 cases with diseased controls and 225.0-6740.0 U/ml in 54 cases with the group of interstitial pneumonia. In the latter, the value in active cases was significantly higher than that in inactive cases (p < 0.0001). Based on above results, the optimal cut-off value was established as 500 U/ml by the ROC curves. By using the cut-off, serum KL-6 antigen can be used as a powerful diagnostic and prognostic marker for interstitial pneumonia.

Adult↗
PubMed1996

[Hypersensitivity pneumonitis monitored with serum KL-6, a marker of interstitial pneumonia].

A 44-year-old man was hospitalized because of exertional dyspnea that had progressed for one month. A chest X-ray film showed bilateral small nodular and reticular shadows. The patient presented with a positive inflammatory reaction and hypoxemia. Bronchoalveolar davage fluid had a high lymphocyte fraction and a low CD4/CD8 ratio. Trichosporon cutaneum antibodies were detected, and a specimen obtained by transbronchial lung biopsy showed alveolitis with granuloma formation. The patient reacted positively on a provocation test that was done by having him stay home for 5 days. Summer-type hypersensitivity pneumonitis was diagnosed, and a steroid was administered because of the prolonged abnormal chest roentgenographic findings. KL-6, a mucinous high-molecular-weight glycoprotein that is expressed on Type II pneumonocytes, was retrospectively used as a marker of pneumonitis. A new kit for enzyme-linked immunoassay (ED046) was used to measure the serum KL-6 level. The serum KL-6 level peaked approximately 10 days after the patient was admitted to the hospital and was thus kept away from antigens, and also after the provocation test. The steroid treatment was started, the KL-6 level decreased gradually. Within 2 months after steroid treatment began, the dose of the steroid was reduced and the KL-6 level decreased below the upper limit of normal. The KL-6 level remained low thereafter; it was not influenced by liver dysfunction or other inflammatory processes. However, the C-reactive protein level decreased rapidly after provocation and thereafter immediately returned to almost zero. The lactate dehydrogenose level peaked 8 days after provocation and decreased rapidly after steroid treatment. These results suggest that the serum KL-6 level provides new information regarding the clinical course and treatment of interstitial pneumonia. In addition KL-6 may be useful form monitoring disease activity, especially while tapering the dose of steroids in patients with interstitial pneumonia.

Adult↗
PubMed1996

Aortic and mitral valve replacement with the Carpentier-Edwards pericardial bioprosthesis: 10-year results.

BACKGROUND AND AIM OF THE STUDY: This report reviews our experience with single aortic and mitral valve replacement using the Carpentier-Edwards pericardial valve in a population younger than those of other reports. METHODS: Between 1984 and 1993, 106 patients underwent single aortic or mitral valve replacement using a Carpentier-Edwards pericardial valve. There were 49 aortic and 57 mitral implants. The mean age was 56.7 +/- 14.3 years. The follow up was 100% complete; total follow up being 273.3 patient-years in the aortic (AVR) and 348.0 patient-years in the mitral valve replacement (MVR) group, with a mean of 5.6 and 6.1 years, respectively. RESULTS: The rates of thromboembolic complications for AVR and MVR were 0.37% and 0.58% per patient year respectively. There were no cases of non-structural dysfunction or anticoagulant-related hemorrhage. The incidences of prosthetic valve endocarditis for AVR and MVR were 0% and 0.86% per patient year respectively. Structural deterioration (calcification and sclerosis) occurred in one patient after AVR and in six patients after MVR, all younger than 60 years of age. Freedom from structural deterioration at five years and 10 years was 100% and 92.9% +/- 6.9% for AVR, and 100% and 76.9% +/- 8.6% for MVR. CONCLUSIONS: In conclusion, the Carpentier-Edwards aortic valve has a low incidence of valve-related complications at 10 years. Although late results of this valve in the mitral position were excellent in the elderly, leaflet degeneration is still a problem in patients under the age of 60 years.

Adult↗
PubMed1996

[Contralateral lung contusion].

A 47-year-old man was admitted to the emergency room in November 1994 with left-sided chest pain. Two days before admission, he had fallen two meters and hit the left side of his chest. A chest roentgenogram showed patchy infiltrative shadows and a pleural effusion confined to the right lung field. Bloody fluid was obtained from the right B3b by bronchoalveolar lavage. Specimens obtained from the right lung by transbronchial lung biopsy revealed deposition of hemosiderin and precipitation of fibrin, which were consistent with lung contusion. The abnormal shadows on the chest roentgenogram disappeared spontaneously within one week. Review of the literature suggests that contra coup pulmonary contusion is rare, and that the mechanism might involve injury of small vessels by high-speed vibration of the contralateral part of the mediastinum.

Accidents, Occupational↗
PubMed1996

[Unresectable gastric cancer followed by remarkably effective tumor disappearance and good quality of life for 10 months after CDDP/5'-DFUR combination chemotherapy--a case report].

A 40-year-old woman was admitted to the hospital because of dysphagia and severe anemia (Hb 4.5 g/dl). She was diagnosed as having an advanced gastric cancer, which was unresectable because of liver metastasis, esophageal invasion and paraaortic lymph node metastasis. Combination chemotherapy with CDDP/5'-DFUR was started. CDDP of 80 mg/m2 was administered twice every 4 weeks by a 24-hour drip infusion method, and oral 5'-DFUR of 1,400 mg/m2 was administered for 4 days prior to the first administration of CDDP. Then, 5'-DFUR of 500 mg/m2 was given every day except for 7 days after the first administration of CDDP. Her performance status before the chemotherapy was 3, and improved to 1 a month after the first administration of CDDP. The patient was discharged very much improved on the 45th day after the first administration of CDDP. The side effect was nausea but tolerable. Six months after the first administration, her cancer disappeared on X-ray films, endoscopic and CT examinations. Her PS improved to 0, and she has remained alive with a good QOL for 10 months after the second administration of CDDP.

Adult↗
PubMed1996

Calcific degeneration of bioprosthetic aortic valves in patients receiving steroid therapy.

BACKGROUND AND AIMS OF THE STUDY: Calcification of glutaraldehyde-preserved bioprosthetic valves is a frequent long-term complication of valve replacement, although the mechanism responsible for such degeneration is not clearly understood. In the current study, we investigated the calcific degeneration of bioprosthetic aortic valves in patients who had been given steroid treatment for aortitis in order to evaluate the immune response to glutaraldehyde-preserved bioprostheses. METHODS: Ten patients who had undergone aortic valve replacement with bioprosthetic valves were studied. Their mean age was 48.4 years (range: 27 to 64 years). Aortitis was due to Takayasu disease in eight patients and to Behcet aortitis in two. The bioprosthetic valves used included bovine pericardial xenografts (n = 8) and porcine aortic valves (n = 2). The mean daily dosage of prednisone was 10.1 mg (range: 2.5 to 60 mg); mean duration of therapy was 8.0 years. The mean patient follow up, using echocardiography, was 11.5 years (range: 8.5 to 16 years). The total follow up period was 115 patient-years. RESULTS: During follow up, three reoperations were required because of valve detachment, aortic insufficiency due to perforation of the aortic cusp, and aortic insufficiency with coronary orifice stenosis, respectively. No reoperations were required for stenotic degeneration of the bioprosthetic valves. Seven bioprosthetic valves were still functioning between 8.5 and 16 years after implantation. Calcific degeneration in two of three bovine pericardial valves that required replacing was surprisingly minimal; separation of collagen fibers in the valves by infiltration with plasma proteins was also minimal. CONCLUSIONS: These results suggest that the calcific degeneration of bioprosthetic valves may be decreased by concomitant steroid therapy for aortitis, though further research will be required to confirm this effect and to determine the mechanism(s) involved.

Adult↗