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Biomedical subjects

K Niina

Publications and source records attributed to K Niina.

At least 19 recordsLinked to original sources

[Blue toe syndrome after coronary artery bypass grafting].

We report three cases of blue toe syndrome (BTS) after coronary artery bypass grafting (CABG). All patients were cyanotic and exhibited painful toes two to four weeks after CABG. They were treated with antiplatelet and anticoagulant agents, and one patient underwent replacement of the abdominal aorta. Thus, BTS may occur after CABG with coronary angiography, extra-corporeal circulation or intraaortic balloon pumping. For the treatment of BTS, surgery remains the most effective option.

Aged↗

[An autopsy case of neurogenic pulmonary edema due to suicide by hanging].

A 43-year-old man died of pulmonary edema after hanging himself. His cardiac function and renal function were normal. No aspiration, trauma, or overhydration was present, and high doses of catecholamine had not been administered. Autopsy findings revealed hypoxic brain damage, cerebral edema and pyknosis of nerve cells in the medulla oblongata. These findings resulted in a diagnosis of neurogenic pulmonary edema. To our knowledge, there have been no previous reports of neurogenic pulmonary edema due to airway obstruction.

Adult↗

L-asparaginase induced complete remission in Epstein-Barr virus positive, multidrug resistant, cutaneous T-cell lymphoma.

A 30-year-old man was admitted to our hospital with subcutaneous tumors and a high fever. Based on biomicroscopic findings of the tumor, the patient was diagnosed as having diffuse, medium, well-differentiated malignant lymphoma. Immunochemical analysis showed that CD3, CD4, CD25, and TCR beta were positive, and in situ hybridization revealed Epstein-Barr virus-encoded small RNAs in the nuclei of the lymphoma cells. Despite the patient's resistance to multidrug therapy, complete remission was achieved using L-asparaginase. This case is unique because of its peculiar clinical course and a possible association with the Epstein-Barr virus. L-asparaginase may be an important treatment in other patients who exhibit some of these characteristics.

Adult↗

[Multiple pulmonary nodules due to ticlopidine-induced pneumonitis].

A 54-year-old man had been treated with Ticlopidine for antithrombotic therapy after a myocardial infarction. Six months after the start of Ticlopidine, pruritic skin rash developed. After 8 months, chest X-ray films revealed multiple nodules, and the patient was admitted to our hospital. Laboratory data indicated liver dysfunction and sputum eosinophilia. Transbronchial biopsy specimens disclosed intraluminal organization and alveolar septal thickening with lymphocyte infiltration. After cessation of Ticlopidine, the cutaneous lesions quickly improved, and multiple nodules completely resolved within 4 months. These findings resulted in a diagnosis of Ticlopidine-induced pneumonitis. The radiographic pattern of multiple pulmonary nodules was very rare. Sputum eosinophilia may be helpful in the diagnosis of drug-induced pneumonitis. To our knowledge, there have been no previous reports of Ticlopidine-induced pneumonitis in Japan.

Humans↗

Secondary monocytic leukemia with rearrangement of the MLL gene occurring during the course of adult T-cell leukemia.

In June 1994, a 39 year-old male with adult T-cell leukemia was admitted to our hospital and received combination chemotherapy including epipodophyllotoxin for approximately 1 year. The monocyte count increased gradually beginning in April 1995, accelerating to 100 x 10(9)/l in January 1996, when he was diagnosed with acute monocytic leukemia. Inv(11)(q21;q23) x 2 was recognized at that time by chromosome analysis, and rearrangement of the MLL gene was shown by Southern blot analysis. From the clinical course and subsequent examinations, the case was regarded as epipodophyllotoxin-related secondary leukemia. Recently, epipodophyllotoxin has frequently been used as a treatment agent for adult T-cell leukemia. It is valuable to note that secondary leukemia may follow even such an aggressive leukemia as adult T-cell leukemia.

Adult↗

Actions of cyclic esters, S-esters, and amides of phenyl- and phenylthiophosphonic acids on mammalian and insect GABA-gated chloride channels.

Cyclic esters, S-esters, and amides of phenyl(thio)phosphonic acid were synthesized to probe the interaction between noncompetitive antagonists of ionotropic gamma-aminobutyric acid (GABA) receptors and their binding site. Some of these compounds competitively inhibited the specific binding of [3H]EBOB, a noncompetitive GABA antagonist, to rat-brain and housefly-head membranes. The trans isomer of the ester bearing a tert-butyl group at the 5-position and a bromine atom at the p-position (5t) was most potent in rat receptors with an IC50 value of 40 nM, while the trans isomer of the S-ester bearing the same substituents (10t) was most potent in housefly receptors with an IC50 value of 55 nM. In both cases, the corresponding amide analogue (12t) was less potent. The potencies of 5t and 12t tended to decrease in the presence of GABA, particularly in housefly receptors, while that of 10t remained unchanged. The rank order of activity in inhibiting [3H]EBOB binding to housefly-head membranes in the presence of GABA (10t > 5t > 12t) was in accord with that of insecticidal activity. S-Ester 10t depressed 10 microM and 300 microM GABA-induced 36Cl- influx into mouse cerebral synaptoneurosomes, whereas ester 5t depressed 10 microM GABA-induced 36Cl- influx but not 300 microM GABA-induced flux. Amide 12t was inactive at both GABA concentrations. These findings indicate that six-membered cyclic phenylthiophosphonic acid derivatives act as noncompetitive antagonists of GABA receptors and suggest that 10t is able to bind to the receptor in the open, desensitized, and closed states, whereas the affinity of 5t and 12t is lower in the open and desensitized states than in the closed state. The derivatives have similar structures except for the heteroatoms at the 1- and 3-positions, so that the heteroatoms may play a unique role when antagonists bring the open state of the GABA-gated channel to the desensitized or closed state.

Affinity Labels↗

[A case of tuberculous abscess in the chest wall close to the thickening pleural lesion following tuberculous pleuritis].

A 33-year-old woman with a history of right tuberculous pleuritis was successfully treated in December 1992 by administration of anti-tuberculous drugs, she demonstrated residual localized pleural thickening on chest computed tomography (CT) and gradually developed a subcutaneous mass in the right chest which became apparent in March 1993. In September, chest CT revealed a periocostal abscess in the right anterior chest wall close to the localized pleural thickening. The patient was diagnosed with tuberculous abscess in the right chest wall on confirmation of acid-fast bacilli in a needle aspiration material of the abscess, and was referred to our hospital. Anti-tuberculous chemotherapy was continued but the chest abscess grew, so on January 28, 1994 she underwent a resection of the abscess, the third costal cartilage and bone, and the parietal pleural lesion connected to the abscess. Histopathological examination showed that the abscess and parietal pleural lesion were compatible with tuberculosis, i.e. both lesions consisted of caseous necrosis and epitheloid cell granuloma, but acid-fast bacilli were not demonstrated in both lesions. After one year of postoperative anti-tuberculous chemotherapy, she was followed without any therapy for 3 years and there has been no recurrence to date. When a localized thickening pleural lesion remains after tuberculous pleuritis, complication of tuberculous abscess in the chest wall should be considered.

Abscess↗

[Pneumocystis carinii pneumonia in a HTLV-I carrier with monoclonal proliferation of HTLV-I infected lymphocyte].

A 63-year-old woman had Pneumocystis carinii pneumonia without any apparent underlying disease such as cancers or HIV infection. Although she reacted positively for HTLV-I antibody, hematological findings and clinical symptoms did not suggest that this patient had an ATL. Southern blot analysis revealed that HTLV-I infected lymphocytes had already proliferated monoclonally. The development of overt ATL should be carefully monitored in this type of patient as Pneumocystis carinii infection in HTLV-I carriers were reported to be a predictive sign of ATL and the monoclonal integration of a HTLV-I genome in the lymphocytes in this patient also suggests the presence of neoplastic clone.

Blotting, Southern↗

Human T-cell lymphotropic virus type-I (HTLV-I)-associated myelopathy/tropical spastic paraparesis with acute type of adult T-cell leukemia.

We report a 47-year-old Japanese woman with HTLV-I-associated myelopathy/tropical spastic paraparesis (HAM/TSP) combined with acute type adult T-cell leukemia (ATL). The susceptibility for HAM/TSP and acute type of ATL is hitherto explained by human leukocyte antigen (HLA) haplotype-linked immune responsiveness to HTLV-I. This patient's HLA (A24Cw1B54DR4DQ4/A24Cw3B51DR8DQ1) included a HAM-associated HLA haplotype. This suggests that HAM patients with HAM-associated HLA haplotype can also develop the acute type of ATL.

Adult↗

Histochemical and ultrastructural pathology of skeletal muscle in a patient with abetalipoproteinemia.

Pathological examination was carried out of the skeletal muscle of an 8-year-old boy with abetalipoproteinemia. The patient complained of diarrhea, and showed a deficiency of betalipoprotein, decreased fat-soluble vitamins, acanthocytosis and a mild increase in serum creatine kinase. The prominent histochemical finding was punctate deposits of acid phosphatase activity in most fibers. Ultrastructural lesions revealed a number of giant lysosomes. Although these pathological findings seemed to be related to vitamin E deficiency, other pathological findings such as concentric laminated bodies or filamentous bodies were also observed. The clinical course and the changes in the pathological findings in our patient after long-term vitamin E therapy need to be observed.

Abetalipoproteinemia↗

[Clonal change of HTLV-1 infected lymphocytes before onset of adult T-cell leukemia/lymphoma].

A 73-year-old HTLV-1 infected male developed overt ATL following 3-years observation, and the clonality of HTLV-1 infected cells changed before overt ATL onset. 10 micrograms of DNA, extracted from mononuclear cells was digested with PstI, and the clonal proliferation of HTLV-1 infected cells was examined by Southern blotting with LTR probe. 4 bands were observed 3 years prior to ATL onset, and 2 different bands were detected 2 years and 6 months later. This suggests that in some ATL cases, the clonality of monoclonally proliferated HTLV-1 infected cells may be changeable before overt ATL onset.

Aged↗

Urinary excretion of parathyroid hormone-related protein as a predictor of hypercalcemia in patients with adult T-cell leukemia.

Hypercalcemia with adult T-cell leukemia (ATL) is chiefly caused by an excessive production by tumor cells of parathyroid hormone-related protein (PTHrP). We have previously reported hypercalcemic patients with solid tumors to excrete a large amount of the C-terminal fragments of PTHrP (C-PTHrP) into their urine. To elucidate whether PTHrP production correlates with or predicts the development of hypercalcemia, we studied the urinary excretion of C-PTHrP in 36 ATL patients. The urinary excretion of C-PTHrP was in the normal range (< 0.40 nmol equivalent to PTHrP (109-141)/g creatinine) in HTLV-1-positive carriers (n 3), ATL patients in complete remission (n 2) and chronic type ATL patients (n 2). It was marginally increased in seven patients in partial remission, and gradually increased as the disease progressed. In 20 patients who died without or with hypercalcemia, it was increased to 1.98 +/- 0.69 (n 9) and 7.6 +/- 2.1 nmol/g creatinine (mean +/- SD, n 11, P < 0.01), respectively. Urinary C-PTHrP excretion was significantly correlated with serum calcium and LDH levels as well as with CD25-positive cells in the peripheral blood. In four patients whose urinary excretion had been serially determined, it increased prior to the development of hypercalcemia. The findings suggest the urinary excretion of C-PTHrP to be of use as a predictor of the development of hypercalcemia in ATL patients. In ATL patients whose urinary excretion of C-PTHrP is progressively increasing, the serum calcium concentration should be carefully monitored to prevent hypercalcemic crisis.

Adult↗

Angiographic morphology of the posterior communicating artery and basilar in patients with ICA-PComA aneurysm.

The relationships between the angiographic morphology of the posterior communicating artery (PComA) and the basilar artery (BA) and saccular aneurysms at the internal carotid artery (ICA)-PComA junction were evaluated in 23 patients with ICA-PComA aneurysm and 46 controls. No significant differences were found in the height of the basilar top, the dislocation and inner diameter of the BA, and the distance between the basilar top and the ICA-PComA junction. However, the angle between the PComA and C2 portion of the ICA was larger and the PComA straighter in ICA-PComA aneurysm patients. Tension in the PComA and mechanical damage to the divergent angle of the PComA are probably important factors in the development of ICA-PComA aneurysms.

Basilar Artery↗

Type IIa hyperlipoproteinemia masquerading as cerebrotendinous xanthomatosis.

We describe an adult patient with type IIa hyperlipoproteinemia, presenting with Achilles tendon xanthomas, cataracts, dementia, ataxia, pyramidal tract signs, and peripheral neuropathy, which are commonly seen in cerebrotendinous xanthomatosis (CTX). However, the diagnosis of CTX was excluded on the basis of the cholestanol level and the normal cholestanol/cholesterol ratio in his serum and tendon. The pathomechanism for some of the clinical manifestations in type IIa hyperlipoproteinemia and CTX might be caused by a common biochemical disturbance.

Aged↗