Biomedical subjects
Publications and source records attributed to K Gotoh.
An efficient method for the laparoscopic application of Avitene is presented herein. During laparoscopic operation, we cannot staunch bleeding points directly. Given such circumstances, the spray application of Avitene is a very effective method of hemostasis that should make laparoscopic operations even safer.
Concentration of amniotic fluid disaturated phosphatidylcholine (DSPC), factors related to cervical ripening, and histopathological evidence of chorioamnionitis were studied in 38 patients in preterm labour with intact membranes; all of them delivered spontaneously before 37 weeks. There was no correlation between the amniotic fluid DSPC level and gestational age at the time of amniocentesis. However, a significant inverse correlation was found between the amniotic fluid DSPC level and the interval between the onset of labour and delivery. The amniotic fluid DSPC level in cases with onset-delivery interval of less than 48 h was significantly higher than that in cases with an onset-delivery interval of 48 h or more. The gestational age in the former group was significantly lower than in the latter (28.6 vs 32.0 weeks). The amniotic fluid DSPC level in the patients with chorioamnionitis was significantly higher than that in the patients without chorioamnionitis, although the gestational age did not differ between the two groups. All 3 infants with RDS were associated with cervical incompetence. Patients in preterm labour with chorioamnionitis may be refractory to tocolysis and have higher amniotic fluid surfactant levels.
The production and secretion of multiple peptide hormones and tyrosine hydroxylase by the human neuroblastoma cell line NB-1 and the effects of dibutyryl cAMP (Bt2cAMP) and phorbol esters such as 12-O-tetradecanoyl-phorbol-13-acetate (TPA) on them were investigated. The presence of messenger RNAs (mRNAs) of vasoactive intestinal peptide (VIP)/peptide histidine methionine (PHM), preprotachykinin, and tyrosine hydroxylase was detectable in the cytoplasm of cultured NB-1 cells by in situ hybridization. Treatment with Bt2cAMP and TPA markedly increased the number of cells immunoreactive to VIP, PHM, neuropeptide Y, Met-enkephalin, substance P and tyrosine hydroxylase and also the contents of VIP and Met-enkephalin in the culture medium. Bt2cAMP and TPA induced morphological changes characteristic of endocrine differentiation, such as an increase in neuroendocrine granules and the development of rough endoplasmic reticulum and Golgi apparatus. The results indicated that treatment with Bt2cAMP and TPA induces the expression of multiple genes of peptide hormone and tyrosine hydroxylase and increases hormone production and secretion through morphological changes into endocrine cells.
Changes in serum myosin light chain I (MLCI) due to elective percutaneous transluminal coronary angioplasty (PTCA) were studied after PTCA (0, 8 and 48 hours) in 57 patients with old myocardial infarction (MI group) and 20 patients with angina pectoris (AP group). The AP group showed no increase after PTCA. In contrast, in the MI group there were 16 patients in whom MLCI at 48 hours was increased by 1.0 ng/ml or more (MI1 group) and another group of 41 patients who showed no increase in MLCI (MI2 group). The MI1 group had a significantly higher incidence of (1) non-Q wave myocardial infarction (62.5% vs. 17.1%, p < 0.01), (2) 99% stenosis of a coronary artery (50.0% vs. 12.2%, p < 0.01), and (3) redistribution in a hypoperfusion area found in the delayed image of resting thallium-201 (201Tl) myocardial scintigraphy (85.7% vs. 15.8%, p < 0.01). The left ventricular ejection fraction (LVEF) was significantly improved in the MI1 group, 3 to 4 months later (from 0.49 +/- 0.12 to 0.58 +/- 0.11, p < 0.01), in contrast to the patient of MI2 group who did not show any improvement. The AP group was not considered to have a bulk of myocardium impaired enough to show a release of MLCI due to PTCA-associated transient coronary occlusion. In the MI1 group, however, MLCI was probably released from the chronically under-perfused, but still salvageable, portion of the myocardium. This is consistent with the improvement in LVEF observed 3 to 4 months after the relief of severe coronary stenosis.(ABSTRACT TRUNCATED AT 250 WORDS)
To evaluate the accuracy and clinical utility of right ventricular volume estimated by a modified echocardiographic subtraction method versus Krebs' original subtraction method, an experiment was performed on hearts excised from 25 animals (dogs, pigs, and cows) followed by a clinical study of 41 patients with heart disease. Right ventricular volume was measured by subtracting the left ventricular volume from that of the whole heart based on echocardiographic apical two- and four-chamber views by means of the area-length method. In the animal heart study, the coefficient of variation between the right ventricular volume estimated by the modified method and the true volume was +/- 13%. The regression equation was y = 0.94x + 4.15 (r = 0.987, p less than 0.001) and showed good correlation, whereas the right ventricular volume obtained by the original method underestimated the true volume (coefficient of variation = +/- 25%, y = 0.59x + 1.11; r = 0.976, p less than 0.001). In the clinical study, the coefficient of variation between right ventricular volume estimated by the modified echocardiographic method and RV volume estimated by radionuclide ventriculography was +/- 15%. The regression equation was y = 0.80x + 13.3 (r = 0.935, p less than 0.001). This correlation was better than that obtained by the original method (coefficient of variation = +/- 16%), where the regression equation was y = 0.60x + 2.43 (r = 0.888, p less than 0.001). Thus the accuracy of the modified subtraction method was validated, and this method showed a better correlation than the original method both experimentally and clinically.
The effects of exchange transfusion (ET) with a modified hemoglobin (pyridoxalated hemoglobin polyoxyethylene conjugate, or PHP) on endothelium-dependent relaxation of microvasculature were examined in rat mesenteric arterioles using image-splitter television microscopy. To examine the endothelium-dependent relaxation, we applied acetylcholine (ACh) to arterioles preconstricted with norepinephrine (NE) and measured changes in arteriolar diameter. Topical application of NE (6 x 10(-8) to 6 x 10(-6)M) decreased the diameter of the arterioles dose-dependently to a mean of 45% (SE +/- 4%, n = 6) of the control. Topical application of ACh (7 x 10(-8) to 7 x 10(-6)M) increased the diameter of the arterioles preconstricted with NE in a dose-dependent manner and almost fully reversed the NE-induced decrease in diameter. ET with 6% PHP solution (30 ml/kg) induced an increase in the mean arterial blood pressure (MABP) from 117 +/- 5 to 132 +/- 4 mm Hg (n = 6, p < 0.05), with a concomitant decrease in diameter of arterioles, from 22.6 +/- 2.5 to 19.8 +/- 2.7 microns (p < 0.05). The MABP and arteriolar diameter gradually returned to the control level within 30 min after ET. Arteriolar changes in diameter in response to NE and ACh examined 30 min after ET were similar to those of the control. ET with 6% stroma-free hemoglobin (SFH; 30 ml/kg) did not alter arteriolar changes in diameter in response to NE and ACh. Results suggest that circulating PHP and SFH moieties do not interfere with endothelium-derived relaxing factor(s) induced by ACh in rat mesenteric microvasculatures in situ.
We examined the effects of pyridoxalated hemoglobin polyoxyethylene conjugate (PHP) and stroma free hemoglobin (SFH) on vascular responsiveness to various vasoactive substances in isolated perfused rat lungs. The lungs isolated from rats were perfused with 6% PHP, 6% SFH, or 6% hydroxyethylstarch (HES) solution, and the effects of intrapulmonary arterial injection of norepinephrine (NE), angiotensin II (ANG-II), acetylcholine (ACh), and nitroglycerin (NG) were examined by measuring perfusion pressure. NE and ANG-II produced a dose-dependent increase in perfusion pressure in all groups. The NE response in the PHP- or SFH-perfused group was significantly larger than that in the HES-perfused one. ACh decreased perfusion pressure in both PHP- and HES-perfused groups but increased perfusion pressure in the SFH-perfused group. NG decreased perfusion pressure in all groups. Present results indicate that pulmonary arterial responses to endothelium-derived relaxing factor (EDRF) induced by ACh would not be affected in the presence of PHP.
A case of biliary cystadenocarcinoma that occurred in a 45-year-old woman is reported. Ultrasonography and computed tomography clearly revealed papillary projections in the cyst of the liver. Percutaneous transhepatic cystography showed connection between the cyst and the common bile duct. The tumor was surgically resected and proved to be a mucinous papillary adenocarcinoma arising from a biliary cystadenoma. The patient is doing well 4 years after surgery. Interestingly, this is the first reported case of a biliary cystadenocarcinoma in the liver with markedly diminished excretion of indocyanine green.
A rare case of primary retroperitoneal mucinous cystadenocarcinoma in a 44-year-old woman is reported. The cystic tumor was delineated by CT and echography. The tumor was removed intact in the presence of bilateral normal ovaries and demonstrated an infiltrating malignant process. This neoplasm may have arisen from a supernumerary ovary. The patient died of recurrence 4 months after surgery. A comparison of the known cases indicates that aggressive treatment by hysterectomy with bilateral salpingo-oophorectomy in addition to cyst extirpation may improve prognosis.
Pulmonary vascular responsiveness to norepinephrine(NE), angiotensin-II (ANG-II), acetylcholine(ACh) and nitroglycerin (NG) was examined in isolated perfused rat lungs. The lungs were perfused with pyridoxalated hemoglobin polyoxyethylene conjugate (PHP), a newly introduced modified hemoglobin, stroma free hemoglobin (SFH) or hydroxyethyl starch (HES) at a constant flow rate. Perfusion pressure (PP) and intra-tracheal pressure (ITP) were measured. Effects of intrapulmonary arterial injection of NE, ANG-II, ACh and NG on PP were examined. NE and ANG-II produced a dose dependent increase in PP in all groups. The response to NE in PHP or SFH perfused group was significantly greater than that in HES-perfused group. ACh induced a dose dependent decrease in PP in HES and PHP groups, while in the SFH group, ACh produced a dose dependent increase in PP. NG produced a dose dependent decrease in all groups. Results showed that stroma free hemoglobin (SFH) inhibits relaxation induced by endothelium-derived relaxation factor (EDRF), but PHP dose not exert inhibitory action on vascular relaxation induced by EDRF.
A 22-year-old woman was admitted to our hospital complaining of productive cough and dyspnea even at rest, and marked cervical lymphadenopathy. Marked stridor and orthopnea were observed, and auscultation of the chest revealed widespread expiratory wheeze which was not relieved by bronchodilators administered intravenously. Chest X-ray and CT scan revealed hilar lymphadenopathy and invasive tumor of the mediastinum. Bronchoscopy demonstrated narrowing of the trachea anteriorly and posteriorly and a submucosal nodular tumor protruding from the right anterior wall, causing approximately 90% occlusion of the lumen of the lower third of the trachea, but distal bronchi were intact. Microscopic findings of inguinal lymph node biopsy specimen revealed mixed cellular lymphoma compatible with Hodgkin's disease. Systemic chemotherapy resulted in relief of symptoms, and two months later, the endotracheal tumor had disappeared bronchoscopically, with slight residual stenosis of the trachea. Before treatment, pulmonary function tests indicated markedly impaired forced volume in 1 second in both expiratory and inspiratory cycles, especially in the latter phase. After remission, however, obstructive ventilatory dysfunction was observed. The cause of prolonged air flow obstruction was thought to be marked infiltration and almost total involvement of the tracheal wall by tumor with a nodular appearance of the lumen. Endotracheal tumor in Hodgkin's disease is rare, and there are few reports on pulmonary function associated with intrathoracic involvement of malignant lymphoma.
A 47-y-o man had been suffering from cardiac failure due to refractory ventricular tachycardia (VT) after myocardial infarction. He underwent resection of the left ventricular aneurysm and cryocoagulation of the arrhythmogenic foci. On the 2nd post-operative day, VT often recurred in spite of repeated cardioversion and drug therapy, and threatened his life, even under IABP. Therefore, a veno-arterial bypass route was made and extracorporeal lung and heart assist, ECLHA, was started with a heparin bonded Maxima lung on the following day. Even under ECLHA, VT continued to recur. Cryocoagulation of the VT foci was tried again, without immediate success. A record high dose of beta-blockers, given under the circulatory support by ECLHA, stopped VT on the following day. The patient was weaned from the ECLHA circuit 12 days after the first operation, then from IABP on the 14th day. During the 10 day course of surgeries and ECLHA, the patient had almost 100 defibrillations. But for ECLHA, we may say that the patient couldn't have survived two open heart surgeries, administration of a great amount of beta-blockers, and repeated cardiac arrest without neurological sequelae.
In cases of acute and chronic pancreatitis, we measured the amount of polymorphonuclear neutrophil (PMN)-elastase. There was a significantly larger increase in PMN-elastase in patients with pancreatitis than normal adults. Especially, there was a particularly notable increase in amount of PMN-elastase in patients with severe pancreatitis. Furthermore, the peak of PMN-elastase increase throughout the course of the pancreatitis was seen to be 1-2 days after peak increase in pancreatic enzymes. In the experiment in which pancreatic juice and pig pancreatic kallikrein were added to granulocytes in vitro, we recognized a gradual release of PMN-elastase. From these data, we suggested that timely measurements of PMN-elastase are useful to marker of monitoring clinical changes in severe pancreatitis.
The effects of chlorhexidine digluconate preadded to urine samples for a neuroblastoma-screening test in preventing the break-down of creatinine (Cre), vanillylmandelic acid (VMA), and homovanillic acid (HVA) by creatinine-cleaving bacteria and the influence of the added disinfectant on the HPLC determination of urinary Cre, VMA, vanillillactic acid (VLA) and HVA. Laboratory or field experiments showed that preadded disinfectant (0.02% volume) nearly completely inhibited the growth of the bacteria and satisfactorily protected urinary Cre, VMA, and HVA from bacterial decomposition. Chlorhexidine digluconate was comparable to benzalkonium chloride in its inhibitory effects on the growth and activities of creatinine-cleaving bacteria. Unlike benzalkonium chloride, chlorhexidine digluconate added to urine samples gave no troubles in subsequent analytical processes. Addition of the disinfectant (0.02% volume) to standard Cre, VMA, VLA, and HVA solution did not affect retention times and sensitivities in HPLC analyses. To estimate influences of the added disinfectant on the serial HPLC determinations of VMA, VLA, and HVA on a large number of urine samples (40, 80, 120, 160, 200, or 5, 500), HPLC analyses were performed on standard VMA, VLA, and HVA solution with repeated injection of the disinfectant in great amounts into a column. The results showed no appreciable changes in the retention times and sensitivities of VMA, VLA, and HVA, and almost complete elution of the disinfectant retained on the column were possible with water-methanol (1:1, 2:8) or methanol washing.(ABSTRACT TRUNCATED AT 250 WORDS)
The clinical and pathological aspects of two large arteriovenous malformations which were removed totally after preoperative embolization using ethylene vinyl alcohol copolymer (EVAL) were studied. The material, which is not adhesive, is handled easily during the procedure of embolization. However, it involves some risks because it might migrate to and occlude the normal branches of the brain and pass through the nidus to the venous system. Histopathological study of AVM nidus which was removed showed embolic materials within the vessels and inflammatory reaction of the vessel wall and its surrounding tissue. There were patchy hemorrhages within the AVM nidus and its surrounding brain tissue. Recanalization was also found within the occluded vessels. These findings suggest that preoperative embolization has some risk of causing intracerebral hemorrhage after the embolization. AVM should be removed surgically as a radical treatment if the patient is able to tolerate the operation.
Lymphocyte infiltration into a tumor has been regarded as an expression of host immunity against cancer, but tumor-infiltrating lymphocytes (TIL) have little or no cytotoxicity. This study examined two different approaches to augment this low cytotoxicity. Firstly, biological response modifiers (OK-432, PSK) were injected into gastric cancer intralesionally. Intralesional injection of OK-432 or PSK significantly augmented the cytotoxicity of TIL. By the injection of OK-432, the ratio of OKT8-, Leu7-positive cells were increased in the TIL subset. In the second approach, TIL of gastric or pulmonary cancer patients were cultured with interleukin-2 (IL-2) in vitro. Co-culturing with IL-2 augmented the low cytotoxicity of TIL, and broad-reactive lymphokine-activated killer (LAK) cells were generated from TIL.
Leflunomide is a new antirheumatic drug. It was evaluated, in comparison with azathioprine (AZA) and methylprednisolone acetate (MPA), for its therapeutic effects on the glomerulonephritis induced in rats by rabbit antiserum against the rat glomerular basement membrane. Its effect on body weight was also determined. Leflunomide (2 and 10 mg/kg/day, po), AZA (20 mg/kg/day, po), and MPA (2 mg/kg/day, sc) were administered for 28 days from 5 days after the intravenous injection of the rabbit antiserum. Leflunomide at both doses significantly decreased the urinary total protein, plasma total cholesterol, and plasma fibrinogen. On the other hand, neither AZA nor MPA affected the parameters except that they tended to reduce the urinary total protein. All three compounds decreased the plasma rat anti-rabbit IgG titer. Histologically, leflunomide at the high dose showed apparent therapeutic effects on the glomerulonephritis, as judged by light and electron microscopy and by immunofluorescence; the lesions were improved and deposits of rat IgG and C3 along the glomerular capillary wall decreased to a great extent. AZA and MPA exerted no therapeutic effects on the histological parameters except that MPA tended to reduce rat IgG and C3 deposits. Body weights increased favorably and slightly during leflunomide and AZA administration, respectively, but decreased during MPA treatment. Thus, leflunomide had more potent therapeutic effects on glomerulonephritis and less side effects than the already marketed drugs, suggesting that the compound is highly effective in improving immunologically mediated forms of glomerulonephritis, including membranous glomerulonephritis, at their early stages.
By the use of various Rhodococcus equi strains differing in the length of carbon chains of glycolipid, we examined whether the glycolipid, glucose monomycolate, was contributing to the virulence of R. equi for mice. R. equi strains with longer carbon chain mycolic acid showed a higher virulence as determined by lethality and granuloma formation in mice than those with shorter ones. When purified glycolipid was injected into mice, granuloma formation and liver damage were most prominent with the glycolipid having longer carbon chain mycolic acid. Only a representative strain with longer carbon chain mycolic acid persisted in the spleen of mice after intravenous injection, while a strain with shorter carbon chain mycolic acid was readily eliminated. These results suggested that glycolipid was at least one of the virulence factors of R. equi and that the carbon chain length of mycolic acid might be critical in the expression of virulence.