Diltiazem for tachycardiac orthostatic hypotension in NIDDM.
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Blood Pressure↗
Biomedical subjects
K Hashizume
Publications and source records attributed to K Hashizume.
[Two elderly cases of megacolon associated with cerebral infarction and diabetes mellitus].
The authors experienced two elderly patients of megacolon associated with cerebral infarction and diabetes mellitus. The first patient was a 66-year-old female who was admitted to our hospital for rehabilitation with a complaint of knee pain. She had suffered from diabetes mellitus since she was 30 years old and multiple cerebral infarction since age 62. Two months after admission, she had an episode of abdominal distension and obstructive symptoms. The roentgenograms of her abdomen showed diffuse dilatation of the colon. The second patient was a 78-year-old female admitted to our hospital with complaints of abdominal pain, distension of the abdomen and vomiting. Her abdomen was severely distended and plain roentgenograms of the abdomen, X-ray studies of the colon with the aid of contrast medium and CT scan of the abdomen showed striking dilatation of the colon. Megacolon may be congenital or acquired, and in acquired forms the conditions are secondary to organic diseases, smooth muscle atrophy, metabolic and neurological diseases, ulcerative colitis or psychogenic origin (idiopathic). The two patients in this series were suffered from cerebral infarction and diabetes mellitus. The mechanisms of megacolon seen in these two patients are not known, but involvement of the visceral autonomic innervation is presumed. Some elderly patients have chronic constipation, and dilatation of the colon may not be uncommon due to underlying diseases or drugs. Therefore, when examining elderly patients, careful attention should be paid to their bowel movement.
Aged↗
[Speech disturbance in acute stage of putaminal hemorrhage].
Speech disturbance was evaluated in the acute stage of 34 patients with left putaminal hemorrhage. Twenty-two patients were surgically treated and 12 were medically treated. Word cognition, naming, and obedience to verbal command were evaluated according to the STLA severity grade, and speech disturbance in the acute stage was classified as 10 severe cases, 13 moderate cases and 9 mild cases. Severity of speech disturbance was correlated to severity of hemiparesis, volume of hematoma and extension of hematoma. The cases with hematomas extending to the corona radiata showed severe speech disturbance. At the time of re-evaluation about one month after the initial evaluation, 13 cases showed improvement of the disturbance to some extent, but 19 cases showed no improvement. The improvement was related to severity of initial speech disturbance, type of hematoma and volume of hematoma. The hematomas whose volumes were over 30ml were related to poor recovery. However, the cases with hematomas extending to the posterior part of the corona radiata showed poor improvement even though the volume was less than 30 ml. In conclusion, these clinical factors, especially the degree of hematoma extension shown on CT scan, are useful for diagnosis and evaluation of speech disturbance in putaminal hematoma.
Acute Disease↗
[Radiation thyroiditis].
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Graves Disease↗
Elective surgery for cystic meconium peritonitis: report of two cases.
The cases of two infants with prenatally diagnosed cystic meconium peritonitis, who underwent minimal surgical procedure (drainage) first and elective surgery later, are reported. Just after birth tube drains were inserted under local anesthesia with ultrasonographic guidance. They underwent laparotomy, at 16 days in case 1 and at 20 days in case 2. The adhesions were quite easily dissected, ileal atresia was found, and the intestines were safely primarily anastomosed. In cystic meconium peritonitis, radical surgery in the early neonatal period is usually difficult, so many patients require second or third operations. We recommend cyst drainage just after birth and elective surgery later.
Combined Modality Therapy↗
[Bilateral chronic subdural hematoma with communication between the hematoma cavities: report of an adult case].
The authors present a case of bilateral chronic subdural hematoma with communication between the hematoma cavities. This 24-year-old male had hit his forehead while playing football and visited our hospital. An initial plain CT scan revealed extracerebral low density areas in the bifrontal region, which were considered to be post-traumatic subdural hygromas. The lesion was followed up with repeat CT scans. On plain CT scan performed seven weeks after the injury, the lesion had evolved into bilateral chronic subdural hematoma and the patient was admitted to our ward. He underwent burr hole drainage on the left side, because the hematoma volume on the left side was considerably larger than that on the right side. A plain CT scan on the day following the operation revealed complete resolution of the hematomas on both sides. A favorable re-expansion of the brain was confirmed on consecutive CT scan performed two months after the operation. In general bilateral chronic subdural hematomas in adults are considered to have no communication between the hematoma cavities and therefore they should be evacuated on both sides simultaneously. In our case, on the contrary, the operation revealed a communication between the hematoma cavities. The falx cerebri is narrow in front and this narrow anterior part is frequently perforated by one or more apertures. We attributed the communication to this anatomical feature of the falx cerebri. On preoperative CT scan, in addition, the inner surface of the bifrontal hematoma cavity demonstrated a smooth concave figure indicating retrospectively that the cavity on the left side was continuous with that on the right side.(ABSTRACT TRUNCATED AT 250 WORDS)
Adult↗
[Cardiac failure in endocrine diseases].
Several endocrine diseases show the symptoms of cardiac failure. Among them, patients with acromegaly show a specific cardiomyopathy which results in a severe left-sided cardiac failure. Hypoparathyroidism also induces cardiac failure, which is resulted from hypocalcemia and low levels of serum parathyroid hormone. In the cases of hypothyroidism, the patients with myxedemal coma show a severe cardiac failure, which is characterized by disturbance of central nervous system, renal function, and cardiac function. In the patients with thyroid crisis (storm), the cardiac failure comes from the great reduction of cardiac output with dehydration. The reduction of circulation volume, observed in the patients with pheochromocytoma easily induces cardiac failure (shock) just after the removal of adrenal tumor. In patients with malignant carcinoid syndrome, right-sided ventricular failure which may be occurred through the actions of biogenic amines is observed.
Acromegaly↗
[A case of primary intracranial T cell type malignant lymphoma, radiologically resembling germ cell tumor and presenting hypopituitarism].
A 21-year-old man was hospitalized with complaints of headache, nausea, polyuria, reduced body hair and reduced libido. Plain CT scan and MRI revealed multiple tumors in the pineal and suprasellar regions, and in the dorsal aspect of the medulla oblongata. Endocrinological examination showed hypopituitarism due to hypothalamic dysfunction. Replacement therapy with hydrocortisone was started preoperatively. Suprasellar tumor was explored. Postoperative CT scan and MRI showed marked diminishment of not only suprasellar tumor, but also tumors in the two other regions. These tumors were supposed to be sensitive to corticosteroid hormone. Histopathological diagnosis was T cell type malignant lymphoma. The patient was followed up for 10 months post-operatively with no recurrence on CT scan. Primary intracranial malignant lymphoma is not a rare disease today. However, primary intracranial T cell type lymphoma is extremely rare. Hypopituitarism due to suprasellar malignant lymphoma is also rare, and only 3 such cases have been reported previously. In our case, the tumor was located in the pineal and suprasellar regions, and the dorsal aspect of the medulla oblongata. Such disseminated malignant lymphoma as ours shows radiological resemblance to germ cell tumor. No such diseminated malignant lymphoma has been reported previously. We think that, in its radiological and clinical features, our case is very suggestive of primary intracranial malignant lymphoma.
Adult↗
[A case of radiculitis induced by spinal cord electrical stimulation by a percutaneously inserted needle].
Spinal cord electrical stimulation was performed by a percutaneously inserted needle for causalgia of the right upper limb. The end of electrode was positioned along a line extending down the 5th vertebral body in the vicinity of the right 6th cervical nerve root, after which it was permanently implanted following confirmation of desensitizing effects. Although the patient later returned to normal life without requiring any ancillary medication, beginning after a period of roughly six months, the pain suddenly began to increase when stimulated. When stimulated by extracting the electrode 1 cm under fluoroscopic guide, the irritation was relieved somewhat. As radiculitis of 6th cervical nerve was suspected, selective radicular block of 6th cervical nerve was performed. After selective radicular block, the patient's complaint diminished. Based on the above findings, we consider that the physical stimulation caused by the electrode in contact with the nerve root brought about inflammation of the 6th cervical nerve root. This patient was then treated by removing the causative stimulation and selective radicular block of affected nerve, the details of which are reported.
Electric Stimulation Therapy↗
Regulation of rat hepatic peroxisomal enoyl-CoA hydratase-3-hydroxyacyl-CoA dehydrogenase bifunctional enzyme by thyroid hormone.
Rat hepatic t protein that is negatively regulated by thyroid hormone in nuclear globulin extract was characterized by the antibodies. The following evidence indicated that t protein is a peroxisomal enoyl-CoA hydratase-3-hydroxyacyl-CoA dehydrogenase bifunctional enzyme (bifunctional enzyme). 1. Both proteins had an identical molecular size, and were immunologically indistinguishable from each other. 2. The t protein was abundant in mitochondrial fraction which contained abundant peroxisomes. 3. The amount of the t protein was increased by a peroxisomal proliferator. 4. The activity of the peroxisomal bifunctional enzyme corresponded to the t protein in CM-Sephadex column chromatography. The amount of peroxisomal bifunctional enzyme was increased by thyroidectomy and decreased by 3,5,3'- triiodo-L-thyronine treatment in the whole homogenate of rat liver. These results indicate that the levels of peroxisomal bifunctional enzyme were regulated by thyroid hormone in vivo.
3-Hydroxyacyl CoA Dehydrogenases↗
Therapeutic significance of surgery in advanced neuroblastoma: a report from the study group of Japan.
The role of surgery was evaluated in 19 stage III and 102 stage IV neuroblastoma patients, all of whom were treated with intensive induction chemotherapy by the Study Group of Japan between January 1985 and March 1990. For stage III neuroblastoma, surgical intervention at the primary site was performed in 18 of the 19 patients, 9 during and 9 after the first three cycles of A1 regimen, consisting of high-dose cyclophosphamide, vincristine, THP-adriamycin, and cis-platinum. Gross complete resection of primary tumor and regional lymph nodes was feasible in 17 of the 19 patients (89%), and the survival rate for the 17 patients were 79%, 70%, and 70% at 2 years, 3 years, and 4 years, respectively. For stage IV, surgical intervention at the primary site was performed in 92 of the 102 patients (90%): 30 cases during the first 3 cycles of A1 chemotherapy and 62 cases after that, with gross complete resection accomplished in 81 of the 102 patients (79%). The 81 patients with gross complete resection achieved had a better prognosis than those 11 patients with partial resection (P less than .05). Overall survival rate was 62% at 2 years for 27 patients who underwent complete resection after 3 cycles of A1 when resolution of all metastases was obtained, whereas the survival was 52% at 2 years for 31 patients who similarly underwent complete resection but when evidence of persistent metastases was present. Patients in whom the ipsilateral kidney was preserved at surgery had an outcome superior to that of those with associated nephrectomy (P less than .05).(ABSTRACT TRUNCATED AT 250 WORDS)
Antineoplastic Combined Chemotherapy Protocols↗
Factors causing difference in force output among motor units in the rat medial gastrocnemius muscle.
1. The isometric contractile properties and morphological characteristics of the muscle unit portion of motor units were investigated in the medial gastrocnemius (MG) muscle of Fischer 344 rats. Individual motor units were functionally isolated by stimulating single MG axons in finely dissected ventral root filaments. 2. To study the mechanical properties of the motor units in the rat MG muscle, ninety-six motor units in five animals were classified into three categories (type FF, FR and S units) using two physiological criteria: presence or absence of the 'sag' property and fatigability. The relative distribution of the different motor unit types in the sample was 35.4% for type FF, 47.9% for type FR, and 16.7% for type S units. 3. There was little overlap in the distribution of twitch contraction time between type F (including types FF and FR) and type S units. The mean value was 17.1 ms for type FF, 15.7 ms for type FR, and 28.0 ms for type S units. Type FF units produced the largest tetanic tension (mean +/- S.D.; 201 +/- 75 mN). Tension output of type S units was the smallest (15 +/- 6 mN), and that of type FR units was intermediate (100 +/- 45 mN). These values were significantly different. 4. A muscle unit portion of twenty-three motor units (8 FF, 6 FR, and 9 S units) was depleted of its glycogen through repetitive stimulation after characterization of its mechanical properties. Cross-sectional areas of units fibres and innervation ratio were directly measured in sections stained for glycogen using a periodic and acid-Schiff (PAS) reaction. Specific tension of unit fibres was calculated by dividing the maximum tetanic tension of a unit by its total fibre area. 5. The number of unit fibres ranged from 44 to 77 for type S, 116 to 198 for type FR, and 221 to 356 for type FF units, and differences among their means (66, 154 and 271, respectively) were significant. Tetanic tension was correlated with innervation ratio for all of the twenty-three units, or units within a particular type. 6. Mean fibre area for type S units (1983 microns2) was significantly smaller than that for type FF units (3489 microns2). Fibres belonging to type FR units had an intermediate size (2648 microns2). Correlation between tetanic tension and fibre area was significant for either all units or units within a particular type. 7. Total cross-sectional area was significantly different among the motor unit types, and was highly correlated to the maximum tetanic tension.(ABSTRACT TRUNCATED AT 400 WORDS)
Animals↗
Heat shock decreases nuclear transport of 3,5,3'-triiodo-L-thyronine in clone 9 cells.
Thyroid hormone, T3, enters cells through an energy-dependent, saturable process and/or passive diffusion. Although the nucleus is the primary site of T3 action, exact mechanisms by which T3 is transported to nucleus are uncertain. In this report, initial cellular and nuclear uptake of T3 was determined using a rat liver cell line (clone 9), in which energy-dependent cellular T3 uptake was demonstrable. One to 5 mM sodium butyrate enhanced cellular T3 uptake with a concomitant increase in nuclear T3 uptake after 30 h. Increased cellular T3 uptake was associated with the increase in the maximum velocity of saturable cellular T3 uptake systems without affecting the Michaelis-Menten constant. Sodium butyrate, however, elicited a reduction in nuclear thyroid hormone receptor levels. On the other hand, heat shock (42 C for 60 min) reduced nuclear T3 uptake without affecting the Michaelis-Menten constant and maximum velocity of saturable cellular T3 uptake. Although nuclear receptor levels were reduced transiently after the heat shock, decreased nuclear T3 transport was not caused by the changes in the receptor levels. NADPH-dependent cytosolic T3 binding protein was undetectable in clone 9 cells before and after butyrate treatment or heat shock. In conclusion, sodium butyrate enhanced nuclear T3 uptake through the increase in cellular T3 uptake that is prerequisite to nuclear T3 transport. However, nuclear T3 uptake mechanisms independent of the cellular uptake system exist and are sensitive to heat shock. Nuclear receptors and cytosolic T3 binding proteins do not seem to be involved in the alteration of nuclear T3 uptake after sodium butyrate or heat shock. These findings suggest intracellular regulatory mechanisms of thyroid hormone transport.
Animals↗
Effect of administration of thyroxine on the risk of postpartum recurrence of hyperthyroid Graves' disease.
In our previous study, we reported that the administration of T4 to patients with Graves' disease who were under treatment with methimazole (MMI) decreased the level of antibodies to thyroid-stimulating hormone (TSH) receptors and the rate of recurrence of hyperthyroidism. In this study, the effect of T4 administration on the rate of postpartum recurrence of hyperthyroidism was examined. Seventy-eight patients with Graves' disease had been treated with MMI for 1-3 yr before pregnancy, and MMI was discontinued 5-6 months after the onset of pregnancy because the levels of antibodies to TSH receptors decreased during early pregnancy. The patients were then divided into two groups. Group A (n = 40) was given T4 (100 micrograms/day) and group B (n = 38) was not given any drugs from 5 months after the onset of pregnancy until 1 yr after delivery. The levels of the antibodies to TSH receptors and serum concentrations of thyroxine-binding globulin (TBG) and T4 were not different between the two groups before and during pregnancy, although a transient increase in serum T4 and TBG concentrations were observed during the pregnancy in both groups. After delivery, levels of antibodies to TSH receptors increased in both groups. The rate of increase, however, was more rapid in group B than in group A. The levels were significantly higher in group B than A at 3, 6, 9, and 12 months after delivery. Serum T4 and TBG concentrations decreased after delivery in both groups. Serum concentrations of T4 increased after delivery in group B but not in group A. The concentration of T4 was significantly higher in group B than in group A at 9 and 12 months after delivery. Postpartum recurrence of hyperthyroidism was 5.0% in group A and 31.6% in group B, respectively, during the first year after delivery. These results suggest that administration of T4 during pregnancy and after delivery is effective in decreasing the level of antibodies to TSH receptors and to prevent the postpartum recurrence of hyperthyroidism.
Adolescent↗
Recognition of a 56 kDa protein in partially purified rat hepatic nuclear thyroid hormone receptor by anti-human c-erb A beta antibody.
Human beta thyroid hormone receptor (c-erb A beta protein) produced by an Escherichia coli expression system was purified by sequential column chromatography followed by electroelution from an electrophoresis gel and an antibody was prepared. The antibody recognized a 56 kDa protein band in a partially purified rat hepatic nuclear thyroid hormone receptor fraction on Western blotting. Although multiple bands appeared on Western blotting of crude rat hepatic receptor preparations, a 56 kDa band was the most prominent and preadsorption of the antibody by purified c-erb A protein resulted in almost complete disappearance of the 56 kDa band, indicating that the 56 kDa band was formed by a specific antigen-antibody interaction. Furthermore, the 56 kDa protein appeared to co-elute with 3, 5, 3'-triiodo-L-thyronine binding activity in hydroxylapatite, Sephacryl S-200, and DNA-cellulose column chromatography of rat hepatic nuclear receptor, and sequential column purification resulted in selective enrichment of the 56 kDa band. These results suggest that the 56 kDa protein may be the major component of the rat hepatic thyroid hormone receptor.
Animals↗
A case of autoimmune insulin antibody syndrome associated with polymyositis, empty sella and apparent high urinary output of immunoreactive insulin.
Patients with autoimmune insulin antibody are characterized by hypoglycemic attacks and antibodies to insulin in serum without prior insulin administration. In the present report, a patient with hypoglycemia due to autoimmune insulin antibody associated with primary empty sella syndrome and polymyositis appeared to have high urinary immunoreactive insulin (IRI) in the face of normal urinary C peptide. Consequently, the urinary IRI/C peptide ratio was apparently high. The amelioration of hypoglycemic attacks and polymyositis by prednisolone treatment was accompanied by the disappearance of the antibodies and complete normalization of the urinary IRI and IRI/C peptide ratio. No comparable rise in the urinary IRI and IRI/C peptide ratio was observed in the patients with other disorders studied. Glucose clamp and glucose tolerance study showed decreased sensitivity to exogenous or newly secreted insulin, prolonged half disappearance time of serum insulin, and normal disappearance of blood glucose. These results were consistent with the idea that autoantibodies buffered the effect of exogenous or newly secreted insulin and maintained a relatively constant level of serum free insulin which was not high enough when a large amount of glucose was loaded, but was too high after prolonged fasting, which eventually caused hypoglycemic attacks.
Autoantibodies↗
Giant aneurysm of the azygos anterior cerebral artery associated with acute subdural hematoma--case report.
A ruptured giant aneurysm of the azygos anterior cerebral artery (ACA) associated with an acute subdural hematoma (SDH) occurred in a 67-year-old male with two episodes of sudden severe headache and transient loss of consciousness. Neurologically, he had mild weakness of the left lower extremity. Computed tomography showed an elliptical heterogeneous hyperdense mass in the interhemispheric fissure in front of the corpus callosum and an acute SDH on the right. Angiography disclosed a giant aneurysm (2.8 x 2.0 cm) at the distal end of the azygos ACA. Removal of the SDH and aneurysmal neck clipping achieved a good outcome. Successive small bleedings may allow the aneurysmal dome to develop adhesions to the arachnoid membrane, and the final rupture will occur into the subdural space, resulting in a SDH.
Acute Disease↗