[Case of arachnoid cyst complicated by multiple cystic disease].
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Adult↗
Biomedical subjects
K Miyagi
Publications and source records attributed to K Miyagi.
Ventriculoarterial coupling during exercise in normal human subjects.
To examine the relative roles of ventricular contractility and loading conditions for cardiovascular adjustment during exercise, 10 normal human subjects were studied using a framework of ventriculoarterial coupling. Anaerobic threshold was evaluated to determine the work rates of aerobic and anaerobic exercise. Ventricular contractile properties were quantified by the slope of the end-systolic pressure-volume relationship (ventricular elastance) and arterial system properties were expressed by the end-systolic pressure-stroke volume relationship (arterial elastance). During aerobic exercise, left ventricular end-diastolic volume and stroke volume were increased by 14 and 33%, with plasma norepinephrine levels being doubled. Arterial elastance was reduced by 30%, but ventricular elastance did not change significantly. During anaerobic exercise, ventricular end-diastolic volume returned to the resting value, while stroke volume remained increased by 31%. In contrast to aerobic exercise, ventricular elastance rose substantially by 89% in association with about a 10 times increase in plasma norepinephrine. Arterial elastance remained the same as in aerobic exercise. Thus, the increase in stroke volume was primarily mediated by changes in loading conditions during aerobic exercise and by enhanced contractility during anaerobic exercise.
Adult↗
[Bacteriological study of traveller's diarrhoea. 4) Isolation of enteropathogenic bacteria from patients with traveller's diarrhoea at Osaka Airport Quarantine Station during 1984-1991].
During the last 8 years (1984 to 1991), 16,639,233 overseas travellers were quarantined at Osaka Airport Quarantine Station and 38,326 travellers reported that they were (or had been) suffering from diarrhoea. Bacteriological examination of stools from 12,573 persons revealed the following results. 1) Various enteropathogenic bacteria were isolated from 3,669 cases (29.2%) examined. The predominant species of bacteria isolated were as follows: Salmonella, 1049 cases; Plesiomonas shigelloides, 1030 cases; Vibrio parahaemolyticus, 789 cases; Shigella, 607 cases; enterotoxigenic Escherichia coli, 422 cases; Vibrio cholerae non-O1, 212 cases. 2) There were no apparent seasonal variations in the isolation rate of these pathogens. 3) The suspected regions for infection with these pathogens were as follows: a) Salmonella, Enterotoxigenic E. coli and Plesiomonas, mainly South-East and South-West Asia. b) Shigella, South-West Asia, especially India (59.8%). c) V. parahaemolyticus and V. fluvialis, mainly South-East and East Asia. d) V. cholerae non-O1, V. mimicus, almost restricted to Asia, mainly South-East Asia. 4) 22 strains of V. cholerae O1 were isolated and 19 were Ogawa, E1 Tor. Of these strains, 13 were cholera toxin-producing strains and 9 were non-toxigenic strains. 5) Several pathogens (mixed infection) were isolated simultaneously from 670 cases. 6) The 1247 Salmonella strains were identified into 98 serovars. 7) Of 624 Shigella strains isolated, 57.9% were S. sonnei, 29.2% were S. flexneri, 8.6% were S. boydii, 4.3% were S. dysenteriae. 8) The most predominant serovar of V. parahaemolyticus was O4:K8. Of 1,247 strains isolated, 9.8% were not producing thermostable direct hemolysin (TDH). 9) 570 (91.3%) of 624 Shigella strains and 409 (32.8%) of 1,247 Salmonella strains isolated were resistant to any one of the drugs tested (SM. CP. TC. KM. ABPC. NA. OFLX). The resistance rate and the number of multiple drug-resistance strains increased year by year. 10) Enterotoxigenic E. coli was isolated from 422 cases (10.7%) of 3,939 cases. Cases with enterotoxigenic E. coli strains producing ST (heat-stable), LT (heat-labile) or both ST and LT were 53.8%, 24.2% and 14.2% respectively. The others were cases with mixed types of enterotoxin production.
Asia, Southeastern↗
[The first cholera case diagnosed early in the clinical laboratory by DNA probe method].
An alkaline-phosphatase-labelled synthetic oligonucleotide probe was applied to detect the structural gene of cholera enterotoxin (ctx). This DNA probe has a complementary base sequence to 30 base of the CT-A subunit. This method was, for the first time, applied to diagnosis of a diarrheal patient. The probe detected ctx rapidly and simply as compared with reversed passive latex agglutination (RPLA) and Beads-ELISA. The cfu minimal dose for detection with the probe was about 10(6-7)/ml. This method can be easily performed in any clinical laboratory because the procedure is safe, simple and rapid (it can be completed within about 3 hours).
Adult↗
Serial reproducibility of conductance catheter volumetry of left ventricle in conscious dogs.
Although the conductance catheter technique has been currently applied to in situ measurement of left ventricular volume, reproducibility of this method has not been examined within the same subject on separate days. Accordingly, serial catheter volumetries (mean 5 days apart) were performed in 10 normal conscious dogs, which were chronically instrumented with the conductance catheter, a micromanometer, and caval cuff occluders. Left ventricular end-systolic pressure-volume relationship was also determined during transient caval occlusion. All hemodynamic variables were compared at the same heart rate. There were no significant changes in blood resistivity (10 +/- 7 omega cm, 8%) and the parallel conductance of the surrounding tissues (7 +/- 6 ml, 10%). The mean difference was 3 +/- 2 ml (7%) for end-diastolic volume and 3 +/- 2 ml (11%) for end-systolic volume. Stroke volume and ejection fraction were also reproducible with mean difference of 2 +/- 1 ml (9%) and 3 +/- 2% (8%) respectively. The end-systolic pressure-volume relationships were nearly superimposable with the slope being 6.05 +/- 1.82 mmHg/ml on day 1 and 6.13 +/- 2.22 mmHg/ml on day 2. The difference averaged 0.63 +/- 0.42 mmHg/ml (11%). These results suggest that highly reproducible volume estimates by conductance catheter offer its feasibility of serial assessment of ventricular performance in vivo.
Analysis of Variance↗
New redistribution index of nutritive blood flow to skeletal muscle during dynamic exercise.
BACKGROUND: Cardiac output is effectively redistributed to working muscle by regional changes in vascular resistance. However, there has been no suitable method to quantify blood flow distribution to large working and nonworking muscles involved in ergometer or treadmill exercise. METHODS AND RESULTS: To quantify the redistribution of blood flow, we compared thallium activity in a bicycle pedaling leg with that in the contralateral resting leg in 10 normal subjects. The regional thallium activity was expressed as a percentage of the whole-body radioisotope activity. Comparison of thallium activity between legs was performed at rest and at the work rates of anaerobic threshold and peak exercise during one-leg exercise. Thallium distribution of both legs was essentially the same at rest. At the anaerobic threshold, thallium activity increased about threefold to fourfold in the exercising thigh and about twofold in the exercising calf. The thallium distribution in these muscles at peak exercise was the same as at the anaerobic threshold. In the nonexercising calf, thallium distribution during exercise decreased significantly, and it was unchanged in the nonexercising thigh. Consequently, the ratio of thallium activity between the exercising and nonexercising thighs increased from 1.1 +/- 0.1 to 4.0 +/- 0.9 at the anaerobic threshold and to 3.3 +/- 0.6 at peak exercise. Similarly, the ratio between the exercising and nonexercising calves increased from 1.0 +/- 0.0 to 3.8 +/- 1.3 at the anaerobic threshold and to 3.5 +/- 1.0 at peak exercise. The ratios at peak exercise, however, did not differ significantly from those at the anaerobic threshold. CONCLUSIONS: These findings suggest that the redistribution of blood flow occurs predominantly during mild to moderate exercise; therefore, blood flow in the leg during strenuous exercise would depend primarily upon an increased cardiac output. Thus, the thallium activity ratio of exercising and nonexercising legs reflects the difference in vascular tone of each leg and could provide a noninvasive and quantitative index of blood flow redistribution.
Adult↗
Lymphocytic adenohypophysitis with sudden onset of diabetes insipidus in menopausal female--case report.
A rare case of a postmenopausal (60-year-old) female with lymphocytic adenohypophysitis manifesting as a sudden onset of diabetes insipidus is reported. Magnetic resonance imaging with gadolinium-diethylene-triaminepentaacetic acid enhancement showed a spherical lesion, approximately 1 cm in diameter, in the sella turcica and a thickened, deviated pituitary stalk. The abnormal tissue was totally removed. Histological examination showed marked infiltration of lymphocytes and plasma cells. Postoperatively, the pituitary stalk became normal. Preoperative differentiation of lymphocytic adenohypophysitis from pituitary adenoma is extremely difficult, and biopsy is essential.
Adenoma↗
[A case of transient parkinsonism due to mesencephalic hemorrhage].
A 68-year-old man was admitted because of sudden onset gait disturbance and bradykinesia. He experienced left putaminal bleeding following mild right hemiparesis and emotional incontinence without any difficulties in his daily life since three years before admission. On neurological examination the patient was alert and oriented. He showed forced crying. Myerson's sign was positive. There were no abnormal findings in ocular movements, pupillary reflexes and other cranial nerves. Muscle tone was increased with cog-wheel phenomenon in bilateral upper extremities. Coordination was preserved. He showed severe akinesia and small steppage gait with stooped posture. Freezing phenomenon was observed in initiation of gait and turning. The deep tendon reflexes were increased in the right side with bilateral pathological reflexes. There was no definite weakness and sensory disturbance in all extremities. Brain CT revealed a small high density lesion in the medial side of right cerebral peduncle and a lens-shaped low density lesion in the left putamen. On T1 and T2 weighted images of MRI, right peduncular lesion showed low signal. It extended to the substantia nigra which was partially destructed. His parkinsonism was rapidly improved and completely disappeared within following two weeks. High density lesion of right peduncle on CT also disappeared. We discussed the mechanisms of parkinsonism following unilateral mesencephalic hemorrhage in this patient.
Aged↗
[A case of colonic vascular ectasia with hypertrophic cardiomyopathy manifested by massive rectal bleeding].
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Aged↗
Heparin exercise treatment following percutaneous transluminal coronary angioplasty in a patient with effort angina.
A 63-year-old female with chronic stable effort angina underwent percutaneous transluminal coronary angioplasty (PTCA) for a donating coronary artery of the collateral circulation to the jeopardized region. Because of the inefficacy of the procedure in increasing the collateral flow reserve, the patient was then put on an exercise regimen and also received heparin pretreatment. Her exercise tolerance improved remarkably with the development of improved collateral circulation.
Angina Pectoris↗
Increased interleukin-1 production by peripheral blood mononuclear cells in patients with multiple sclerosis.
The production of interleukin-1 (IL-1) by peripheral blood mononuclear cells (MNC) was assessed in patients with relapsing multiple sclerosis (MS) in both the active and inactive phase, in chronic progressive MS patients, in other neurological diseases, and in healthy subjects. Production was determined by measuring the IL-1 concentration in cultures with MNC supernatants using enzyme-linked immunosorbent assay (ELISA). IL-1 in sera of MS patients and healthy subjects also was investigated. MNC IL-1 alpha production was significantly higher in MS patients (180.2 +/- 177.5 pg/ml) than in healthy subjects (66.2 +/- 66.0 pg/ml) (P less than 0.05). Relapsing MS patients in the active phase had significantly higher MNC IL-1 alpha concentrations (360.1 +/- 130.0 pg/ml) than normal subjects (P less than 0.001), but MNC IL-1 alpha production in patients with relapsing MS in the inactive phase (65.3 +/- 52.8 pg/ml) or chronic progressive MS (80.9 +/- 71.9 pg/ml) was not increased significantly. MNC IL-1 beta production in MS patients was not elevated significantly. IL-1 alpha and -1 beta were not detected in sera of MS patients. The correlation between increased IL-1 alpha production and the clinical course of MS suggests that activated MNC may play a role in the pathogenesis of MS.
Adult↗
Tumor necrosis factor and interleukin-1 in the CSF and sera of patients with multiple sclerosis.
Serum and cerebrospinal fluid (CSF) from 31 patients with multiple sclerosis (MS) were examined to determine the levels of tumor necrosis factor (TNF) and interleukin (IL)-1 alpha (or IL-1 beta) by an enzyme-linked immunosorbent assay. TNF was detected in 29 (93.5%) of CSF from 31 cases of MS. TNF was also detectable in 100% of CSF from patients with acute relapsing MS in exacerbation. Patients with acute relapsing MS in exacerbation showed significantly higher CSF levels of TNF as compared with either those in remission or the controls (P less than 0.001 and P less than 0.0001, respectively). Increased levels of TNF were also detected in 35.5% of the MS sera, and especially in those with acute relapsing MS in exacerbation. Increased TNF levels were also frequent in the CSF and sera of patients with Guillain-Barré syndrome (GBS), which is also a demyelinating disease. No IL-1 alpha (or IL-1 beta) was detected in either CSF or sera of 31 MS patients. It is considered likely that TNF CSF levels may reflect disease activity in MS.
Adult↗
Soluble CD4 and CD8 in the peripheral blood of patients with multiple sclerosis and HTLV-1-associated myelopathy.
We evaluated the presence of soluble (s) CD4 and sCD8, released from activated T cells, in the sera of patients with multiple sclerosis (MS) and human T lymphotropic virus type 1 (HTLV-1)-associated myelopathy (HAM) using an enzyme-linked immunosorbent assay (ELISA). In addition, peripheral blood T cell subsets in patients with MS and HAM were analyzed by single and two color flow cytometry. The serum level of sCD8 was significantly elevated in MS patients as compared with controls (p less than 0.001). Sera from patients with an exacerbation of acute relapsing MS showed a higher sCD8 level than the patients in remission or controls (p less than 0.01 and p less than 0.001, respectively). The serum levels of both sCD4 and sCD8 were also significantly elevated in patients with HAM (p less than 0.001 and p less than 0.001, respectively). In addition, a significantly increased serum level of soluble interleukin-2 receptor (sIL-2R) was found in patients with HAM as compared with that of controls (p less than 0.001). These observations suggest that CD8 cells may be activated in the peripheral blood of patients with MS and sCD8 may be related to clinical activity, but that both CD4 and CD8 cells may be activated in the peripheral blood of patients with HAM.
Adult↗
Afferent connections of the neurons in the Forel's field of H in cat.
An anatomico-physiological analysis was made to elucidate afferent connections of the neurons in the Forel's field of H (FFH) by horseradish peroxidase retrograde tracing technique and by evoked potential technique. 1) The FFH neurons receive fibers from the neocortex (layer V) and brainstem reticular formations. 2) Physiological projections from the mesencephalic reticular formation to the FFH as well as to the motor cortex were ipsilateral, but those from the pons and medulla oblongata were bilateral. 3) These data will suggest that the FFH neurons are in junction of the cortico-reticular connections and play an important role in the maintenance of an epileptic excitability of the neocortical system as suggested by Jinnai and Mukawa.
Afferent Pathways↗
Treatment of metastatic brain tumor from esophageal carcinoma--report of four cases.
Metastasis to the brain from esophageal carcinoma is rare. Recently we had four cases, all treated by tumor removal. Three received postoperative whole or local brain irradiation. Anticancer pellets were implanted in two. The postoperative 1-year survival rate was 37.5%, which suggests the prognosis is not worse than for other metastatic brain tumors.
Aged↗
[Total removal of hypothalamic glioma 15 years after irradiation of right optic glioma].
Hypothalamic glioma was found in a 17 year old male patient 15 years after irradiation of right optic glioma. It was totally removed by surgery. He was first admitted to Ryukyu University Hospital at the age of 1 year and 11 months, with right exophthalmos and visual disturbance. Diagnosis was anterior type of right optic glioma. This was treated by irradiation (47 Gy). Follow-up CT scans revealed no regrowth in intraorbital and intracranial regions. At the age of 17 years, CT scan and MRI showed an enhanced mass in the hypothalamus above the suprasellar cistern. Total removal was performed by bifrontal interhemispheric trans-lamina terminalis approach. Histological diagnosis was pilocytic astrocytoma. Postoperatively, consciousness remained disturbed for 3 weeks because of infarction in the bilateral medial nucleus of the thalamus. Radical excision of hypothalamic glioma was reviewed in the literature. We concluded that such excision has a potentially good outcome, and should be attempted when circumstances indicate its feasibility.
Adolescent↗
[A case of chondrosarcoma in the cavernous sinus].
A 24-year-old female patient complained of headache and right abducens nerve paralysis. No abnormality was found in plain CT scan, but a ring-like enhanced mass was disclosed behind the right posterior clinoid process in enhanced CT scan. MRI revealed a low intensity mass in T1-weighted image and a ring-like enhanced mass in gadolinium-DTPA enhanced image. It was a circumferential high intensity mass in T2-weighted image and an isointensity mass in proton image. Cerebral angiography indicated that it was avascular. Preoperative diagnosis was trigeminal neurinoma or petroclival meningioma. The tumor was removed almost completely by orbitozygomatic infratemporal approach. Histologically, it was low grade chondrosarcoma. Postoperatively, neither radiation therapy nor chemotherapy was added. Differential diagnosis and treatment was discussed. It was suggested that MRI was the most useful diagnostic tool to distinguish chondrosarcoma from other skull base tumors.
Adult↗
[A case of successfully removed posttraumatic high flow dural arteriovenous fistula in the posterior fossa].
A 49-year-old male patient was admitted to Ryukyu University Hospital complaining chiefly of progressive loss of mental activity for one year. He had a history of head trauma at the right retromastoid region when he was 24. Generalized convulsions developed three years later, and left exophthalmos, facial varix and impairment of visual acuity developed seven years later. Dural arteriovenous fistula of the posterior fossa was diagnosed at the age of 32, and feeding EC and tentorial arteries were successively ligated on the right several times without any effect. Angiography during this admission revealed tremendous collateral flows; a marked dilated tortuous occipital artery fed from the right vertebral artery, meningeal branches of VA and PICA, the marginal tentorial artery, and the posterior temporal artery from MCA, PCA were drained into the right transverse sinus. But transverse sinuses were occluded bilaterally, and venous outflows were directed to the superior sagittal sinus retrograde via the ascending cortical vein, Trolard veins, and sphenoparietal and cavernous sinuses. The final drainer was the superior ophthalmic vein on the left. Normal deep veins were not visible. In park bench position, the nidus was totally resected with a part of the transverse and thrombosed sigmoid sinus. Postoperative course was uneventful, and an angiogram showed complete disappearance of the AVF. Dural AVG in the posterior fossa with characteristics such as high flow, and which is rich in collaterals following palliative treatment indicates that total surgical resection should be undertaken.
Arteriovenous Fistula↗