A 52-year-old woman had a 14-year history of stridor attacks. Pulmonary function tests revealed reversible airway obstruction, and bronchial asthma was diagnosed. She also has bilateral ptosis, diplopia, and moderate weakness of all four limbs; a positive edrophonium test confirmed the diagnosis of myasthenia gravis. Although the parasympathetic system plays an important role in the regulation of bronchial tone, in this patient the edrophonium test did not provoke an asthmatic attack or exacerbate pulmonary function, except for increases in sputum production and in frequency of cough. The general weakness was usually worse in the afternoon. The decrease in grip strength and the shortening of arm elevation time also occurred after asthma attacks, which means that general muscle fatigue was caused by the work of breathing. Furthermore, dyspnea increased and pulmonary function worsened when an anti-cholinesterase inhibitor was discontinued, probably because of respiratory muscle weakness. Accordingly, the clinical status of bronchial asthma seemed to change in parallel with that of the myasthenia gravis.

Asthma↗

PubMed1996

[Pharmacokinetics of 99mTc-MAG3 and 131I-OIH: comparative study based on 2 compartment model analysis].

We studied 50 patients with mild to moderate renal dysfunction to compare pharmacokinetics of 99mTc-MAG3 with that of 131I-OIH. After simultaneous bolus injection of both 99mTc-MAG3 and 131I-OIH, 8-point venous blood sampling was performed from 2 to 44 min post injection. Aliquoted plasma samples were counted for radioactivity along with the injected standard to obtain % injected dose/ml plasma for each tracer. Using obtained time-concentration data, classical 2 compartment model analysis was performed for both tracers to obtain various pharmacokinetic parameters, including distribution volumes (Vds), inter-compartmental rate constants, and plasma clearance. In these parameters, Vd of central compartment, Vd at steady state, central to peripheral inter-compartmental rate constant, and plasma clearance were significantly larger for 131I-OIH. In all parameters, significant correlation was found between 99mTc-MAG3 and 131I-OIH. The best correlation was seen in plasma clearance (r = 0.891, p < 0.0001). Plasma clearance ratio (99mTc-MAG3/131I-OIH), however, showed weak but significant negative correlation with serum creatinine, although this correlation was not likely to affect the overall correlation of clearance between 131I-OIH and 99mTc-MAG3. From these results, we confirmed that 99mTc-MAG3 clearance could be used as an alternative to 131I-OIH clearance, although pharmacokinetic behavior of 99mTc-MAG3 was not exactly the same as that of 131I-OIH.

Adult↗

PubMed1996

[A comparative study on the efficacies of ritipenem acoxil and cefotiam hexetil in bacterial pneumonia by the double-blind method].

To objectively evaluate the efficacy, safety and usefulness of the newly developed penem oral antibiotic, ritipenem acoxil (RIPM-AC), against bacterial pneumonia, we conducted a multi-center double-blind comparative study using cefotiam hexetil (CTM-HE) as the control drug. Both RIPM-AC and CTM-HE were orally administered at 200 mg t.i.d. for 14 days, in principle. The results were as follows: The total number of patients enrolled in this trial was 208, of which 152 cases (RIPM-AC group: 73, CTM-HE group: 79) were evaluable for clinical efficacy. 1. The clinical efficacy rates (excellent + good) were 91.8% (67/73) in the RIPM-AC group and 94.9% (75/79) in the CMT-HE group. There was no significant difference between the two groups, and the clinical equivalency of RIPM-AC to CTM-HE was demonstrated. 2. In the patients enrolled in the evaluation of clinical efficacy, the eradication rates of the causative organisms were 84.6% (22/26) in the RIPM-AC group and 91.7% (22/24) in the CTM-HE group, with no significant difference between the two groups. 3. Side effects were noted in 9 cases (9.6%) of the RIPM-AC group and 5 cases (4.9%) of the CTM-HE group. Abnormal laboratory test findings were observed in 23 cases (26.7%) of the RIPM-AC group and 15 cases (15.6%) of the CTM-HE group. There was no significant differences between the two groups in the incidence of side effects nor of abnormal laboratory test findings. In the safety evaluation, RIPM-AC was judged to be safe in 64 cases (68.1%) and CTM-HE in 82 cases (80.4%), with no significant difference. 4. The usefulness rates (markedly useful+useful) were 86.5% (64/74) in the RIPM-AC group and 92.5% (74/80) in the CTM-HE group. There was no significant difference between the two groups. Since RIPM-AC showed clinical efficacy similar to those of CTM-HE and posed no particular safety problems, it is expected to be a useful antibiotic for the treatment of bacterial pneumonia.

Adolescent↗

PubMed1996

[Association of postoperative brain dysfunction and atherosclerosis, intraoperative rSO2 and CO2 reaction in open heart surgery].

We studied the relationship between postoperative brain dysfunction and the state of atherosclerosis in the patients of open heart surgery, by analyzing the intraoperative cerebral oxygen saturation (rSO2) and the CO2 reaction. The subjects were 143 patients with average age of 64 years. The patients with low postoperative Hasegawa's Dementia Score were categorized as brain dysfunction group. rSO2 was utilized to monitor cerebral blood flow, and AI and stiffness parameter beta were used for evaluation of systemic atherosclerosis. Postoperative brain dysfunction was confirmed in 12%. There were significantly high values of AI and beta as well as low rSO2, in elder age with low cardiac index and no correlation was observed between rSO2 and PaCO2 in the brain dysfunction group. The results suggested that a higher level of atherosclerosis is associated with the postoperative brain dysfunction with resultant decreased cerebral blood flow and disturbed reaction to CO2 of cerebral blood vessels.

Aged↗

PubMed1996

[Clinical analysis of embolism with left atrial myxomas].

We conducted a retrospective analysis examining the relationship between the tumor quality and the occurrence of systemic embolization in 16 patients who underwent surgical excision of the left atrial myxoma. Systemic embolization occured in 10 patients (63%) before surgery, in 5 of whom embolic episodes were the first manifestation of the tumor. Cerebral infarction had developed in 7 patients, TIA in 2, myocardial infarction in 2, limb ischemia in 2, and multiple infarctions in the kidney, adrenal gland, spleen and bone marrow in one. A permanent deficit remained in 6 patients (60%). Myxoma was a lobulated and gelatinous type in 9 (90%) of these patients with embolization and a solid type only in one case. When the dignosis of the left atrial myxoma with soft and fragile quality is made by echocardiography, surgical excision should be performed without delay to prevent systemic embolization.

Adolescent↗

PubMed1996

The role of two endogenous proteases of the stratum corneum in degradation of desmoglein-1 and their reduced activity in the skin of ichthyotic patients.

We investigated the role of stratum corneum (SC) trypsin-like and chymotrypsin-like serine proteases in the degradation of desmoglein-1 (DSG-1) in the SC sheet. DSG-1, whose presence in the SC sheet was confirmed by Western blot analysis, was degraded completely during incubation of the SC sheet in Tris buffer. The degradation of DSG-1 was inhibited by the addition of protease inhibitors, such as aprotinin or a mixture of leupeptin and chymostatin. Either leupeptin or chymostatin alone did not inhibit its degradation. These results indicated that both trypsin-like and chymotrypsin-like serine proteases are involved in the degradation of DSG-1. We further examined the activities of the two proteases in the SC obtained from patients with ichthyosis vulgaris, in whom SC desquamation is abnormal. The enzymatic activities measured using synthetic substrates were significantly decreased in these ichthyotic SC samples. This result supports the idea that these proteases play an important role in normal SC desquamation.

Adolescent↗

PubMed1996

Clinical significance of serum levels of soluble interleukin-2 receptor in patients with localized scleroderma.

Localized scleroderma has been reported to be accompanied by abnormal immune reactions, including autoantibody production and lymphocyte activation. Lymphocyte activation can be quantitatively detected by measuring soluble interleukin-2 receptor (sIL-2R) in serum samples. In this study, serum sIL-2R levels were assayed by a sensitive enzyme-linked immunosorbent assay, in 48 patients with localized scleroderma, in 20 with systemic sclerosis (SSc) and in 20 healthy controls. Serum levels of sIL-2R were significantly higher in patients with localized scleroderma than in healthy controls. The serum levels of sIL-2R were correlated with the number of sclerotic lesions, the number of involved areas, the levels of anti-ssDNA, and the levels of antihistone antibody immunoglobulin M. Moreover, sIL-2R levels in sera from patients with SSc were also significantly higher than in healthy controls. Elevated serum levels of sIL-2R in localized scleroderma suggest that lymphocyte activation is one of the early processes in the development of this disease.

Adolescent↗

PubMed1996

Spontaneous mutation of p53 gene in human papillomavirus type 16 E7-immortalized human laryngeal epithelial cells.

The E7 gene is one of the principle transforming genes of human papillomavirus type 16 (HPV 16). In this study, we show that HPV 16 E7 gene could immortalize in vitro primary human laryngeal epithelial cells (HLEC cells) without cooperation of the viral E6 gene. The HPV 16 E7-immortalized HLEC cell line had acquired a mutation of a tumor suppressor gene, p53, during the immortalization process. Using immunofluorescence assay, nuclear accumulation of p53 protein was found in the cell line. These results suggest that HLEC cells can be immortalized in vitro by the cooperative activities of HPV 16 E7 gene and a spontaneous mutation of the endogenous p53 gene.

Antibodies, Monoclonal↗

PubMed1996

[Traumatic thoracic aortic rupture--diagnosis and surgical repair].

Fifteen cases of traumatic thoracic aortic rupture (TAR) were treated at St. Marianna University Hospital from December 1980 to July 1995. Causes of TAR were due to vehicle accidents in 14 patients and fall in one patient. On diagnosis, contrast-enhanced CT scan was routinely performed in the patients with blunt chest trauma associated with superior mediastinal widening, loss of the aortic knob or right shift of the trachea on the initial roentgenogram. When CT scan demonstrated specific signs for TAR, pseudoaneurysm formation and/or extravasation of the contrast dye, aortography was eliminated before operation. As a role, operation was performed on an emergency basis as soon as the diagnosis was confirmed. Four cases died due to intrapleural rupture before or immediately after thoracotomy. Nine (82%) of the 11 patients in whom operation was completed survived and are doing well. In one of the 4 patients who underwent operation with simple aortic cross-clamping; paraplegia developed after 30 minutes of spinal ischemia. Left heart bypass with the Bio-Pump without heparin or with an antithrombin agent, argatroban, was used in recent 6 patients. Use of left heart bypass with the Bio-Pump without anticoagulant or with argatroban appears to be promising as a safe adjunct in the repair of TAR, preventing fatal bleeding of other injured organs.

Adolescent↗

PubMed1996

[Responses of cytokines, acute phase proteins, and polymorphonuclear cell elastase to surgical stress in the patients with esophageal cancer].

The serum levels of cytokines (interleukin-1 beta; IL-1 beta, interleukin-6; IL-6, tumor necrosis factor alpha; TNF alpha), and acute phase proteins (CRP, alpha 1-antitrypsin; alpha 1-AT, alpha 1-acid glycoprotein; alpha 1-AG, fibrinogen; FBG, pancreatic secretory trypsin inhibitor; PSTI), and the plasma concentration of polymorphonuclear cell elastase; PMN-E and white blood cell counts were measured in 18 patients with esophageal cancer who underwent radical esophagectomy through right thoracotomy and reconstruction with gastric tube. Peripheral venous blood samples were obtained before and just after operation, and on the 1st, 2nd, 3rd, 7th and 14th post-operative day. The serum concentrations of IL-6 just after operation were significantly correlated with volume of blood loss during operation and duration of thoracotomy. Plasma PMN-E levels just after operation seemed to be correlated with those factors, but its correlation was not statistically significant. Serum IL-6 levels began to increase markedly just after operation, and reached the maximum by the 1st post-operative day. This elevation preceded that of acute phase proteins, indicating that IL-6 may induce the production of acute phase proteins in vivo. Furthermore, peak serum values of IL-6 after operation were correlated with volume of blood loss and duration of thoracotomy. These results suggest that elevation of IL-6 and PMN-E levels may reflect the degree of surgical stress, and the measurement of IL-6 and PMN-E is useful for the early detection of an inflammatory response.

Acute-Phase Proteins↗

PubMed1996

[Recanalization of dural sinus occlusion following the disappearance of dural arteriovenous fistula: report of a case].

A 73-year-old female was admitted to our hospital because of disturbed consciousness and left-sided motor weakness. Computed tomographic scans demonstrated a hemorrhagic infarction in the right parietal region. Right carotid angiograms showed both the posterior portion of the superior sagittal sinus (SSS) and the entire left transverse sinus simultaneously occluded. Left carotid angiograms revealed an enlarged occipital artery, which had direct communications to the left sigmoid sinus and the superior petrosal sinus. These findings were consistent with dural arteriovenous fistula (D-AVF). The laboratory examinations yieled normal results. The patient was managed conservatively with glyceol and anticonvulsants for four weeks and eventually recovered with complete resolution of hemiparesis. Follow-up angiography carried out 6 weeks later showed the SSS, partially stenotic, but recanalized with no evidence of venous congestion. The D-AVF still remained opacified, but there was a marked reduction in retrograde flow to the sigmoid sinus. Further repeated angiograms obtained at 10 months after the onset confirmed complete recanalization of the SSS and disappearance of the D-AVF. From the timing of the angiographies, we considered that the sinus occlusion was caused by the high arterial flow to the fistula and its disappearance made recanalization of SSS possible.

Aged↗

PubMed1996

Urinary albumin excretion in short children treated with recombinant human growth hormone.

The urinary levels of albumin, beta 2-microglobulin (BMG) and beta-D-N-acetyl glucosaminidase (NAG) were studied in 30 children with short stature due to partial or complete growth hormone (GH) deficiency under treatment. All 30 children had a normal urinalysis and no clinical evidence of renal disease. They were treated with recombinant GH in a dose of 0.5 IU/kg/week given subcutaneously. The mean albumin excretion rate (9.13 +/- 8.33 micrograms/min/1.73 m2) of these children was significantly higher than that (4.2 +/- 2.27 micrograms/min/1.73 m2) of 30 age-, sex- and pubertal status-matched normal children (p < 0.01). BMG and NAG excretion was normal in both groups. There was no correlation between the urinary albumin excretion rate and the duration of GH treatment. Among the GH-treated children, the urinary albumin excretion rate was correlated significantly with circulatory insulin-like growth factor I (IGF-I) (r = 0.65, p < 0.01). In 7 other children analyzed before and three months after start of GH treatment, the mean urinary albumin excretion rate increased significantly from 4.71 +/- 3.95 micrograms/min/1.73 m2 to 8.29 +/- 2.70 micrograms/min/1.73 m2 (p < 0.03). These results suggest the possibility of functional glomerular alterations during GH therapy.

Acetylglucosaminidase↗