Biomedical subjects
Publications and source records attributed to K Dohi.
A case of scleredema of Buschke associated with rheumatoid arthritis and Sjögren's syndrome is described. The onset of the skin changes and rheumatoid arthritis was almost simultaneous and the sicca syndrome developed 4 years later.
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We examined the clinical usefulness determined by polyacrylamide gel electrophoresis, followed by reaction with peroxidase-coupled lectins using urinary glycoproteins for diabetic nephropathy in 20 patients with diabetes mellitus. Lectins used were Triticum vulgaris (WGA), Phaseolus vulgaris (PHA-E4), Dolichos biflorus (DBA), and Lens culinaris (LCA), which have high affinity for beta 1----4N-acetyl-D-glucosamine (GlcNAc beta 1----4GlcNAc), N-acetyl-D-galactosamine (GalNAc), alpha-galactosamine (alpha-GalNAc), and alpha-mannose (alpha-Man) residues, respectively. Electrophoretic patterns of urinary glycoproteins clearly showed the presence of lectin-reactive glycoproteins with molecular weights lower than that of albumin. The molecular weight of the main bands reacted with WGA, PHA-E4 or LCA were 50,000 and 38,000, and increased with the progress of diabetic nephropathy. WGA reacted strongly with many glycoproteins having a wide range of molecular weights. LCA and PHA-E4 reacted preferentially with glycoproteins of molecular weights glycoproteins of molecular weights lower than 50,000, but no reaction was observed by DBA. These results suggest that low molecular urinary glycoproteins have abundant carbohydrate residues such as GlcNAc beta 1----4GlcNAc, GalNAc, and alpha-Man. The excretion of low molecular weight glycoproteins with high affinities for some lectins suggests functional impairment in diabetic nephropathy.
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Local resection of the lower rectum was performed for the treatment of malignant polypoid lesions in 22 patients. The clinical outcomes of the procedure are summarized as follows; 1. For IIa + IIc type malignant polyp, transanal wedge resection of the entire rectal wall or a transsacral tube resection of the rectum should be performed; as a minimal preventive measure against local recurrence. 2. Early invasive carcinoma (sm) has a metastatic potential on distant organs. 3. In the case of polypoid carcinoma invading the muscle layer (pm), local resection was conducted only in the patients with distant metastasis or with serious complications and in aged patients. 4. When postoperative histological examination reveals a mistake in operative strategy, the patient should be reoperated immediately.
Three cases presenting with systemic lupus erythematosus (SLE) and minimal change nephrotic syndrome (MCNS) are reported in this paper. All cases were female; they abruptly developed nephrotic syndrome at the age of 30, 11 and 23 years, respectively. In Case 1, the diagnosis of SLE was based on fever, butterfly rash, Raynaud's phenomenon, leukopenia, lymphopenia, hypocomplementemia, a high titer of anti-DNA antibodies, positive DNA and LE test, and the presence of anti-nuclear antibodies (speckled pattern). In Case 2, the diagnosis was based on butterfly rash, central nervous system involvement, lymphopenia, hypocomplementemia, a positive LE cell phenomenon, a high titer of anti-DNA antibodies and a positive DNA test. In Case 3, the diagnosis was based on photosensitivity, alopecia, lymphopenia, hypocomplementemia, a high titer of anti-DNA antibodies, a positive DNA test and a positive LE cell phenomenon. In these three cases, initial symptoms were puffy face and pretibial edema which occurred suddenly. These symptoms disappeared completely after either corticosteroid therapy or a combination therapy using corticosteroids and immunosuppressive drugs. These patients took a favorable course and no aggravation was noted in the findings of urinalysis and renal functions. In two of these cases, the diagnostic criteria for SLE were satisfied, but the remaining patient fulfilled only three criteria except for renal disorder. In each of these cases, minor glomerular abnormalities were disclosed by renal histology. It seems likely that SLE was complicated by MCNS in these cases. From these cases, it is suggested that there is a possibility of immunological abnormalities associated with SLE and MCNS.
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Gram-negative bacterial endotoxin (lipopolysaccharide) induces hepatic damage in mice caused by lipid peroxidation, and administration of antioxidants (coenzyme Q10 and alpha-tocopherol) suppresses this lipid peroxidation, preserves energy metabolism, and enhances the survival of endotoxin-administered mice. Therefore experiments were done to determine whether experimental endotoxemia in mice affected the levels of endogenous antioxidants and whether treatment with antioxidants altered these levels. Endotoxin produced decreases in hepatic endogenous antioxidants with time: reduced coenzyme Q9, alpha-tocopherol, and reduced glutathione were lowered to 29.9%, 27.1%, and 45.4% of the control levels, respectively, 24 hours after administration. Exogenously administered coenzyme Q10 (oxidized) accumulated in the liver and showed a maximal plateau between 8 and 16 hours after injection when 82% of coenzyme Q10 was converted to the reduced form. Coenzyme Q10 administered with endotoxin totally or partially prevented the decreases in these endogenous antioxidants, and furthermore, total coenzyme Q10 and the reduced form, both at levels of approximately 30 mg protein, were consumed during the period of elevated lipid peroxidation, 16 hours after endotoxin injection. These results indicate that coenzyme Q10 acts in vivo as an antioxidant after it has been converted to the reduced form. alpha-Tocopherol administered also showed an 84-fold accumulation in the liver 8 hours after injection, completely preventing any decrease in endogenous reduced coenzyme Q9 and partially preventing reduction of glutathione, which indicated an in vivo antioxidant action of alpha-tocopherol. These results support the assumption that administered coenzyme Q10 or alpha-tocopherol functions cooperatively with endogenous antioxidants to prevent tissue damage caused by lipid peroxidation in endotoxemia.
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One of the major problems accompanying liver transplantation is how to evaluate the viability of the grafted tissue at an early stage. The ability to assess immediate graft function would provide results useful in the determination of prognosis. The present study was undertaken to determine whether bile flow rates after liver transplantation were correlated with adenosine triphosphate levels and the survival of rats given transplants. In fresh-liver-transplanted rats, the one-week survival rate was 87%. The cellular ATP levels in the grafts decreased sharply prior to portal-venous declamping, but returned to nearly 80% of the normal level 4 hr after grafting, as did the total adenine nucleotide level and energy charge. When the grafts were subjected to warm ischemia for 15-min or 30-min periods prior to harvesting of the donor liver, the one-week survival rates decreased to 50% and 0%, respectively. In these cases, the levels of cellular ATP and bile secretion remained low and were proportional to the survival of the transplanted animals even 4 hr after transplantation. The relationship between the bile flow rates and the cellular ATP levels under various conditions revealed a good correlation, showing a saturation curve. The bile flow rates as well as the cellular ATP levels were therefore related to the survival rates of the transplanted animals. Thus it was shown in this experimental transplantation model that the monitoring of bile production after liver grafting is a useful indicator for assessing the extent of ischemic damage to the liver and for prognosis of the animal.
A new experimental model of chronic pancreatitis was produced by a combination of chronic ischemia and incomplete obstruction of the pancreatic duct. Ischemia was induced by ligation and separation of branches flowing into the left pancreatic lobe from the splenic artery. Incomplete ductal obstruction was achieved by ligation and separation of the minor pancreatic duct and placement of a polyethylene tube in the major pancreatic duct. Macroscopic examination at 6 months after model preparation showed that the pancreas was hard, with severe inflammatory change. In the secretin test, the flow rate of pancreatic juice, amylase output and bicarbonate concentration were significantly reduced as compared with the controls. Pancreatography revealed dilatation and meandering of the major pancreatic duct and poor visualization of its secondary and tertiary bifurcations. The histopathological findings consisted of a decrease in the pancreatic parenchyma, replacement of fat, severe inflammatory cell infiltration, extensive fibrosis and tubular complexes. This model most closely resembles human chronic pancreatitis, and is a very useful instrument.
We experienced a case of subclavian steal syndrome (SSS) with a specific form of obstruction of the right proximal subclavian artery. The patient was a 44-year-old man who complained of numbness of the right hand. Right carotid-subclavian artery anastomosis was performed under general anesthesia. The obstructed segment was a fibrous cord, 3.5 cm in length and 2.0 mm in diameter. Postoperatively, the patient was free from the symptom. In the Japanese literature, 73 cases of SSS were reported from 1965 to 1986, and the etiology was mentioned in 64 cases. In 28 cases the cause was aortitis syndrome (43.8%), in 22 cases arteriosclerosis (34.4%), in 13 cases congenital malformation (20.3%), and in 1 case iatrogenic lesion (1.6%). These data indicated that SSS caused by congenital malformation was not so rare as previously believed. Of 13 cases with congenital malformation, our case and 3 other cases had similar aspect in clinical features. All 4 patients were middle-aged men (aged 34, 26, 45 and 44 years) with a fibrous cord at the proximal portion of the right subclavian artery. None had any other cardiovascular anomalies.
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