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Biomedical subjects

K Dan

Publications and source records attributed to K Dan.

At least 73 records · Page 4Linked to original sources
PubMed1998

Bactericidal activity of preservative-free bupivacaine on microorganisms in the human skin flora.

BACKGROUND: The rate at which the bactericidal activity of preservative-free bupivacaine develops at body temperature and at room temperature is not known. We studied the bactericidal activity of preservative-free bupivacaine on two strains of methicillin-resistant Staphylococcus aureus (MRSA), two strains of methicillin-susceptible S. aureus (MSSA), and each of Staphylococcus epidermidis and Escherichia coli. METHODS: The pathogen was exposed to 0.5% bupivacaine for 1, 3, 6, 12, and 24 h at 37 degrees C and room temperature. In addition, each strain of MRSA, MSSA, and S. epidermidis was exposed to distilled water, and 0.125%, 0.25%, 0.5%, and 0.75% bupivacaine at 37 degrees C. The inocula from the suspensions were cultured for 48 h at 37 degrees C. RESULTS: The 1- through 24-h exposures of 4 strains of S. aureus to 0.5% bupivacaine at room temperature reduced the colony count by 21.7%, 34.7%, 51.1%, 65.6%, and 81.1%, respectively, and the exposure at 37 degrees C reduced the count by 34.1%, 50.8%, 66.3%, 94.5%, and 96.0%, respectively. The differences were significant at all exposure times (P < 0.001, respectively). No organisms grew in the strain of E. coli after 24-h exposure and in the strain of S. epidermidis after 12- and 24-h exposures at 37 degrees C. The percent change from controls in the strains of E. coli and S. epidermidis was significantly higher than that in the strains of S. aureus at all exposure times at room temperature and 37 degrees C (P < 0.0001, respectively). Higher concentrations of bupivacaine were associated with lower colony count. CONCLUSION: Our results show that preservative-free bupivacaine possesses a temperature- and concentration-dependent bactericidal activity, and S. aureus is more resistant to the bactericidal activity of bupivacaine than are S. epidermidis and E. coli.

Anesthetics, Local↗
PubMed1998

[Clinical efficacy of fosfomycin in combination with sulbactam/cefoperazone in the treatment of severe infections complicated to blood dyscrasia. Working Group of Kanto Combination Therapy for FOM + SBT/CPZ].

In the treatment of severe infections complicated to blood dyscrasia, the efficacy and usefulness of fosfomycin (FOM) in combination with sulbactam (SBT)/cefoperazone (CPZ) were compared between patients receiving FOM in the first followed by SBT/CPZ (Group A) and those receiving both drugs simultaneously (Group B). The following results were obtained. 1. The efficacy rate was 56.3% for Group A and 47.9% for Group B, with no significant difference. 2. The efficacy for patients suspected of the presence of septicemia, the efficacy rate was 57.9% for Group A and 54.3% for Group B, with no significant difference. 3. As for underlying disease, patients with acute myelogenous leukemia were most prevailing. In these patients, the efficacy rate was 57.1% for Group A and 27.3% for Group B, with no statistically significant difference. However, the efficacy rate tended to be higher in Group A. 4. The administration of antibiotics was effective to restore the neutrophil count to 501/microliters or higher in 77.8% and 45.5% of the cases for Groups A and B, respectively, with significantly higher efficacy for Group A. 5. In the safety evaluation a total of 115 cases were included. Side effects and laboratory abnormalities were seen in 3 cases each, but none of them were serious in degree. From these results, it was confirmed that the combination therapy consisting of administration of FOM followed by SBT/CPZ with some interval is effective for severe infections complicated to blood dyscrasia.

Anti-Bacterial Agents↗
PubMed1998

Minimal residual disease in acute myelogenous leukemia with PML/RAR alpha or AML1/ETO mRNA and phenotypic analysis of possible T and natural killer cells in bone marrow.

Here we studied minimal residual disease (MRD) of patients with acute myeloid leukemia (AML) who have PML/RAR alpha or AML1/ETO as well as the phenotypic analysis of lymphocyte subsets involved in antitumor immunity. Eight patients in long-term (LT; 3 to 15 years) and 15 patients in short-term (ST; up to 3 years) remission were studied. Using the reverse transcription-polymerase chain reaction (RT) assay, the limit of detection was 10(-5) to 10(-6) for PML/RAR alpha transcript and 10(-4) to 10(-5) for the AML1/ETO transcript. Simultaneously, T lymphocyte subsets and NK cells from the peripheral blood (PB) and bone marrow (BM) were investigated by flow cytometric analysis. Four of the eight patients in LT and 7 of the 15 patients in ST remission were MRD-positive. Although all MRD-positive patients in LT remission are still until now event-free, 3 of the 7 MRD-positive (MRD+) patients in ST remission soon relapsed. The total populations of CD4+, CD8+ and CD56+ [possible T-cell and natural killer (T/NK) populations] in the BM of ST patients and MRD+/LT patients were significantly (p < .01) low. The CD8+ CD28+ population showed the same tendency (p < .01-.02). The T/NK subsets in the BM of MRD-negative (MRD-) LT (MRD-/LT) patients showed similar numbers of cells as normal volunteers. Basically, the total percentage of the CD4+, CD8+ and CD56+ cell populations in the BM was increased and in the following order: MRD-/LT patients, normal volunteers, MRD+/LT patients and MRD+ or -/ST patients. The percentages of the T/NK-cell subsets in the PB were not significantly different among these groups. Thus, the difference of the possible T/NK-cell phenotype in the BM may strongly influence clinical and molecular remission. These results still remain to be confirmed by further studies of the functional anti-tumor immunity of T/NK cells of AML in remission.

Core Binding Factor Alpha 2 Subunit↗
PubMed1998

Management of a patient with familial amyloid polyneuropathy type I with lumbar epidural anaesthesia.

Familial amyloid polyneuropathy (FAP) type I is a rare disease characterized by sensorimotor polyneuropathy, and autonomic nervous system and cardiac conduction system dysfunction. Severe bradyarrhythmia and hypotension may occur during anaesthesia and surgery in patients with the FAP type I. Only one report has been published of a patient with FAP type I who was managed with epidural anaesthesia. The present authors report a 38-year-old Japanese man with a permanent pacemaker because of advanced FAP type I who underwent rotation flap of the gluteus maximus muscle to cover a trophic ulcer in the sacral region under lumbar epidural anaesthesia. Ten millilitres of adrenaline (1:200,000) was injected around the ulcer prior to surgical manipulation. Neither bradycardia nor hypotension developed during the procedures. The haemodynamic changes under lumbar epidural anaesthesia in FAP type I are discussed.

Adult↗
PubMed1998

Lymphoblastic lymphoma of natural killer cell origin, presenting as pancreatic tumour.

AIMS: We describe the first case of lymphoblastic lymphoma (LBL) of natural killer (NK) cell origin initially presenting as a pancreatic tumour, and review this type of lymphoma. METHODS AND RESULTS: A 38-year-old woman with abdominal pain was found to have a pancreatic mass. Twenty days later, she developed diffuse lung infiltrates and leucoerythroblastosis of the peripheral blood, and her bone marrow was diffusely infiltrated with blasts. The blasts were positive for CD56, CD16 and P-glycoprotein, but lacked cytoplasmic azurophilic granules, T. B and myeloid cell markers on the cell surface, rearrangement of the genes for T-cell receptor and immunoglobulin, and the Epstein-Barr virus (EBV) genome. The diagnosis was LBL of NK cell origin. She received aggressive therapy, but died of the lymphoma. In contrast to ordinary NK-cell lymphoma, this case and reported cases of LBL of NK-cell origin showed the following common characteristics. The tumour cells often lack cell surface CD2, cytoplasmic CD3, cytoplasmic azurophilic granules, and EBV genome. The prognosis was extremely poor. CONCLUSIONS: LBL of NK-cell origin should be included in the differential diagnosis of pancreatic tumours. To fully characterize this type of lymphoma, further cases must be evaluated.

Adult↗
PubMed1997

Natural killer cells in the late decades of human life.

We examined the lymphocyte subsets and indices of natural killer (NK) cell activity (lytic unit (LU), index of absolute NK cell activity in vivo (ALU), and NK cell activity on a per-cell basis (PCNK)) in 82 people (age, 30-99 years) who were immunologically normal. Although the number of NK cells was maintained throughout the examined age range, the ALU and PCNK values correlated negatively with age. We then examined whether any of the various immunologic parameters, including the function and cell counts of NK cells, T cells, and neutrophils, related to past infectious episodes and death in the follow-up period in 44 elderly subjects (age, 63-98 years). Only low ALU and PCNK values correlated with a past history of severe infection, while low LU, ALU, and PCNK values were the only parameters which correlated with death due to infection during the follow-up period. We propose that human NK cells do not escape the aging process and that a low NK cell function relates to the development of severe infections, which may be fatal, in elderly subjects.

Adult↗
PubMed1997

Effects of alpha 2-adrenergic agonism, imidazolines, and G-protein on insulin secretion in beta cells.

It is well known that alpha 2-adrenergic agonism inhibits insulin secretion and stimulates glucagon secretion in both animal and human studies. Recently, alpha 2-adrenergic blockers (DG-5128, MK-912, and SL 84.0418) have been studied as antihyperglycemic agents in human subjects. To clarify the action mechanism(s) of these agents, we investigated the effects of alpha 2 agonists and antagonists (10(-10) to 10(-4) mol/L) and pretreatment by pertussis toxin (PTX) on glucose-stimulated insulin secretion using the hamster insulinoma cell line HIT-T15. The imidazoline-derivative alpha 2-adrenoceptor agonists clonidine and oxymetazoline at concentrations as low as 10(-8) mol/L significantly inhibited glucose-stimulated insulin secretion by 63% and 65%, respectively (P < .01 for both). These inhibitory effects were abolished by 20-hour preincubation of these cells with PTX 100 ng/mL. The imidazoline-derivative alpha 2-adrenoceptor antagonist DG-5128 at a concentration of 10(-4) mol/L doubled insulin secretion with or without pretreatment by PTX (P < .01 for both). Furthermore, both clonidine and oxymetazoline at a high concentration of 10(-4) mol/L stimulated insulin secretion with pretreatment of the cells by PTX (P < .05 for both). These results indicate that glucose-stimulated insulin secretion is inhibited by alpha 2-adrenoceptor agonists through PTX-sensitive G-protein in HIT-T15 cells. It is also suggested that imidazoline compounds at high concentrations directly stimulate insulin secretion.

Adrenergic alpha-2 Receptor Agonists↗
PubMed1997

Mexiletine-induced severe skin eruption, fever, eosinophilia, atypical lymphocytosis, and liver dysfunction.

A 64-year-old man developed a severe generalized pruritic morbilliform skin eruption, fever, eosinophilia, atypical lymphocytosis, and liver dysfunction 30 days after ingestion of mexiletine, a sodium channel blocker, prescribed to treat postherpetic neuralgia. Following intravenous dexamethasone, body temperature normalized the next day. However, the skin eruption did not disappear completely for 4 weeks. The patch test was positive for mexiletine. Clinical features and the result of patch test indicated that the patient developed hypersensitivity syndrome, a severe adverse cutaneous drug reaction, caused by mexiletine. We propose that mexiletine be added to the list of drugs that can cause severe adverse cutaneous drug reactions and that patients receiving mexiletine be warned to stop taking the drug immediately if a skin eruption occurs.

Anti-Arrhythmia Agents↗
PubMed1997

Rationale and hematologic target points in response-oriented individualized induction chemotherapy for acute myeloid leukemia.

Response-oriented individualized induction chemotherapy (ROIIC) has been reported to achieve a high complete remission (CR) rate in acute myeloid leukemia (AML). In ROIIC, drug dose is modified for each patient to achieve hematologic target points, based on the concept that this achievement, not a preset drug dose, increases the likelihood of attaining CR. However, the existing target points lack objectivity, therefore prohibiting worldwide use of ROIIC. In addition, the achievement of these target points does not statistically relate to CR, which contradicts the concept of ROIIC. To solve these problems, we evaluated various parameters of 117 AML cases treated by ROIIC to identify the factors relating to CR. Of 117 AML subjects, 75 achieved CR with ROIIC and most cases achieving CR did so with one ROIIC course. Not the administered dose of drugs but several hematologic parameters at the end of ROIIC correlated significantly with CR. A total of four parameters, all related to the leukemic cell mass, were independent predictive factors of CR. A formula consisting of these parameters predicted CR cases with high sensitivity (98%) and non-CR cases with high specificity (96%). Based on this formula, an objective target point (a bone marrow blast mass ratio between before and after ROIIC of below 0.15), valid for dose modification during ROIIC, was established. These results validate the concept of ROIIC and enable objective dose modification in ROIIC and universal application of this therapy. Further, the formula predicting non-CR cases at the end of ROIIC is useful for deciding early therapeutic intervention for such cases.

Acute Disease↗
PubMed1997

Heterogenous expression of bcr-abl fusion mRNA in a patient with Philadelphia-chromosome-positive acute lymphoblastic leukaemia.

We performed molecular and cytogenetic analysis on a 56-year-old woman with Philadelphia chromosome (Ph1)-positive acute lymphoblastic leukaemia (ALL) having two types of major and minor bcr-abl (M-bcr-abl, m-bcr-abl/fusion mRNA at diagnosis. In the course of her disease, unexpected heterogenous bcr-abl fusion mRNA was detected by sequential analysis using the reverse transcription and polymerase chain reaction (RT-PCR). The RT-PCR analysis showed both M-bcr-abl (b2-a2 type) and m-bcr-abl at diagnosis. Although b2-a2 type M-bcr-abl disappeared after complete remission (CR) was achieved with intensive induction chemotherapy, expression of both m-bcr-abl and a new type of M-bcr-abl mRNA (b1-a2 type), which may have been produced through splicing out of exon b2, was detected in the early stage of CR. The leukaemic cells contained these heterogenous bcr-abl mRNAs in both the CR and relapsed state, and showed more stable expression of the m-bcr-abl type mRNA than that of the b2-a2 type. These findings of heterogenous bcr-abl mRNA due to alternative or missplicing during the disease course in the present ALL case may provide important evidence of disease progression.

Alternative Splicing↗
PubMed1997

Rupture of the left main-stem bronchus by the tracheal portion of a double-lumen endobronchial tube.

We report a rupture of the left main-stem bronchus following the insertion of a left-sided double-lumen endobronchial tube in a 76-yr-old woman with a short trachea. A fiberoptic bronchoscope was not used during the initial insertion of the tube and the depth of insertion resulted in approximately 5 cm in excess of the optimal level for this patient. The rupture had been caused by the tracheal portion of the double-lumen tube. This damage may have been avoided if a fiberoptic bronchoscope was used routinely as an introducer and for positioning of the endobronchial tube under direct vision.

Adenocarcinoma↗
PubMed1997

A comparative analysis of the transplant potential of umbilical cord blood versus mobilized peripheral blood stem cells.

Human umbilical cord blood (UCB) is currently considered as a third source of hematopoietic stem cells for transplantation, following the bone marrow and growth-factor-mobilized peripheral blood (MPB). To evaluate the potential benefits of UCB, we performed a comparative study of the properties of the stem cells in UCB and MPB samples. CD 34+ cell determination and CFU-GM colony assay showed a lower frequency of committed progenitors in UCB than in MPB. In contrast, a higher of the CD 34+ CD 38- subset in UCB suggested that more primitive, multipotent progenitors are enriched in UCB than in MPB. Phenotypic analysis of UCB lymphocytes revealed a reduced level of T cell subsets, especially cytotoxic CD 8+ lymphocytes, which might minimize graft versus host disease in clinical practice. In conclusion, UCB is an attractive alternative source for stem cell transplantation, but ex vivo expansion of stem/progenitor cells could be effective for attaining rapid and safer hemopoietic reconstruction.

Blood Cell Count↗
PubMed1997

Relation between stable glycated hemoglobin A1C and plasma glucose levels in diabetes-model mice.

In an IDDM model mouse which was inoculated with a diabetogenic variant, DK-27, of encephalomyocarditis (EMC) virus, the relation between a stable glycated hemoglobin A1C (St-HbA1C) level and plasma glucose level (PGL) in the progress of diabetes was studied. The St-HbA1C level and PGL were examined every 2 weeks for 10 weeks in normal male DBA/2 and IDDM-onset mice. PGLs of normal control mice did not change, but their St-HbA1C levels were slightly increased by 0.52 to 1.03%. On the other hand, in IDDM mice, their PGLs were greatly increased (> 400 mg/dl) and hyperglycemia was maintained throughout this observation period, with their St-HbA1C noticeably increased to 3.8% according to the progress of diabetes for 10 weeks. A highly significant correlation between St-HbA1C levels and averaged PGLs for the past weeks was found in IDDM mice. To examine the reflection of St-HbA1C levels to delicately varied PGLs, we also estimated both values in IDDM mice which were treated with insulin at a minimal effective dose once a day for 4 weeks. The St-HbA1C levels in insulin-injected IDDM mice were significantly lower than those in control IDDM mice. These findings suggest that the estimation of the St-HbA1C level is useful in following up blood glucose control in a long-term therapeutical study with small laboratory animals.

Animals↗