Importance of HLA-DRB1 molecular matching between recipient and donor in cadaveric renal transplantation.
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Alleles↗
Biomedical subjects
K Nishimura
Publications and source records attributed to K Nishimura.
[HLA antigens in patients with testicular germ cell tumors].
The role of HLA antigens in the etiology of testicular germ cell tumor has been suggested previously. Several attempts have been made to establish associations of HLA antigens in patients with testicular cancers, but have yielded inconsistent results. We studied the frequencies of HLA antigens by serological typing and DNA typing and examined the association between testicular germ cell tumors and HLA antigens. The serological expression of HLA-A, -B, -C, -DR and -DQ antigens was analyzed in 23 patients with germ cell cancers of the testis. The findings indicated a trend towards an increase in the antigen DQ4 (p < 0.05). The 13 patients were typed for HLA DRB1 and DQB1 allele by PCR-RFLP analysis. The findings revealed an increased frequency of DRB1 0405 (p < 0.01) and DQB1 0401 (p < 0.01).
Adult↗
[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↗
Point mutation in the alpha-galactosidase A gene of atypical Fabry disease with only nephropathy.
A point mutation in exon 6 of the alpha-galactosidase A gene (alpha-GAL A) was found in a Japanese hemizygous male without typical manifestations of Fabry disease other than renal involvement. This 45-year-old man developed moderate proteinuria and was diagnosed with Fabry disease on the basis of renal histologic findings and prominent decreases in alpha-GAL A activity in his plasma, urine, leukocytes, and skin fibroblasts. Determination of the cDNA sequence of his alpha-GAL A gene revealed substitution of a G to A in codon 301, resulting in a glutamine rather than an arginine residue. Our case is unique in that this patient only demonstrated renal manifestations while all other reported patients with atypical Fabry disease, including a case with the identical point mutation, present with a cardiomyopathy. Direct DNA sequencing of exon 6 and measurement of alpha-GAL A activity among the patient's family confirmed that the mutation was transmitted from his mother.
Biopsy↗
[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↗
Intracarotid blood pressure changes during contrast medium injection.
PURPOSE: To investigate changes in blood pressure during intracarotid injection of contrast material. METHODS: Two catheters were inserted into the ipsilateral common carotid artery of dogs. The proximal catheter was used for injection of contrast material and the other was positioned distally to monitor blood pressure. RESULTS: Distal intracarotid pressure rose significantly during injection of contrast material at all rates (5, 7, and 10 mL/s) and at all doses (0.2, 0.5, 0.7, and 1.0 mL/kg). In addition, these blood pressure elevations were shown to be correlated with injection rates and doses. Even when the pressure-monitoring coaxial catheter was advanced into smaller arteries, no decline in the impact of injection was observed. CONCLUSION: Intracarotid injection of contrast material causes a temporal elevation of cerebral blood pressure in dogs.
Animals↗
[Symptoms, FEV1/FVC, and peak flow as indices of the control of asthma].
In a cross-sectional study, we evaluated success in the control of asthma as defined by criteria for symptoms, for FEV1/FVC, and for peak flow rates. One hundred and three patients with chronic asthma who had been treated with inhaled steroids were studied. Chest tightness, dyspnea, wheezing, sputum production, and coughing were each scored from 1 (worst) to 5 (best). Symptoms were said to have been controlled if the symptoms scores for the preceding 4 weeks were greater than or equal to 20; FEV1/FVC was said to be under control if it was greater than or equal to 70% when measured in the clinic; peak flow was said to have been controlled if the lowest peak flow in the preceding 4 weeks was greater than or equal to 80% of the highest measured value. Symptoms were controlled in 72% of the patients, FEV/FVC was under control in 83%, and peak flow was controlled in 66%. The patients were grouped by severity of disease into four classes, and these percentages did not differ significantly among the classes. In 22 out of 74 (30%) patients in whom symptoms were controlled, peak flow was not controlled. Furthermore, in 18 out of 64 (28%) patients in whom symptoms and FEV/FVC were controlled, peak flow was not controlled. We concluded that in treating asthma, not should symptoms be controlled, but peak flow should also be measured each day to avoid undertreatment.
Adult↗
[Inverted papilloma of the posterior urethra: a case report].
A case of inverted papilloma of the posterior urethra is reported. A 59-year-old male was admitted with the chief complaint of difficulty in urination. Cystourethroscopy revealed a polypoid tumor with a smooth surface on the stalk arising from the prostatic urethra, concomitant with prostatic hypertrophy. Transurethral resection of the tumor and the prostate was performed. No evidence of recurrence has been noted in the 9 months after surgery. This is the 26 th case of inverted papilloma of the posterior urethra reported in Japan.
Humans↗
Predicting risk of embolization during anticoagulation for left atrial thrombus by transesophageal echocardiography: a case report.
A 75-year-old woman was admitted with transient left hemiparesis accompanied by diminished level of consciousness in September 1994. Holter electrocardiography showed transient atrial fibrillation, and transesophageal echocardiography (TEE) revealed an atrial septal aneurysm, spontaneous echo contrast, and a thrombus in the left atrial appendage. The patient received anticoagulant treatment with warfarin, and follow-up TEE showed thrombus resolution. However, after the warfarin was discontinued, symptoms recurred in October 1995 and TEE showed a club-like left atrial thrombus (21 x 40 mm) originating in the left atrial appendage and extending to the center of the left atrium. Follow-up TEE after warfarin therapy showed resolution at the neck of the thrombus but the head threatened detachment. The thrombus was subsequently excised surgically. Follow-up TEE was critical for detecting the risk of significant embolization during anticoagulant therapy.
Aged↗
A successfully treated case of multiple liver abscesses accompanied by portal venous gas.
A case with multiple liver abscess accompanied by massive portal venous gas is reported. A 61-yr-old male was admitted because of left lower abdominal pain, fever, and diarrhea. Abdominal x-ray examination demonstrated multiple branching lucencies in the liver. Computed tomography revealed multiple liver abscesses and massive gas in the portal system as well as a thickened wall of the sigmoid colon. Enema study using contrast medium revealed a perforation of the sigmoid colon with diverticulitis. The outcome was favorable after sigmoid colectomy in addition to intensive treatment with antibiotics. Bacteroides fragilis, which produces gas (H2 and NH3) by fermentation, was isolated not only from the resected specimen but also from blood samples. Although the presence of portal venous gas is a sign of poor prognosis in patients with intestinal infectious diseases, the sensitive detection of hepatic portal venous gas by computed tomography and the appropriate treatment may improve the patient's prognosis.
Anti-Bacterial Agents↗
[Effects of reducing or stopping inhaled beclomethasone dipropionate on airway hyperresponsiveness in stable chronic asthma].
Effects of reducing or stopping inhaled beclomethasone dipropionate (BDP) on airway hyperresponsiveness (AHR) were evaluated in stable chronic asthma. In 16 patients, after the best control (no symptoms, peak expiratory flow rate [PEF] > 80% best) was achieved for at least 3 months, the dose of BDP was reduced to 2/3 to 1/2. No differences were observed in the mean FEV1, PEF and AHR between before and 3 months after the reduction of BDP. In 7 patients, after the almost normal level of AHR was achieved, the dose of BDP was gradually reduced and then discontinued. Three out of the 7 patients had maintained the adequate level of AHR over 14 months, but in the other 4 patients AHR deteriorated below normal level and re-administration of BDP was needed due to worsening of symptoms and PEF. In conclusion, a gradual reduction of the dose of BDP is possible, if the best control is achieved for at least 3 months. The possibility of discontinuation of BDP may exist in some patients after achieving adequate AHR.
Administration, Inhalation↗
[Inhaled beta agonists as a bronchodilator are a mainstay of asthma therapy: focusing on inhaled beta agonists and oral theophylline].
In asthmaticus with relatively stable control, inhaled beta agonists are the primary drugs used to relieve symptoms which are mild and does not necessitate patients to visit emergency rooms. Global strategy for asthma management and prevention NHLBI/WHO workshop report gives inhaled beta agonists a specific position as a "reliever". Long-acting beta agonists such as salmeterol and formoterol were developed as a compensatory drug for "controllers". They have prolonged duration of bronchodilation effects with more than 12 hours. When asthmatic patients given high doses of inhaled corticosteroids do not enjoy best management, oral slow-releasing theophylline would be considered as one of next additional drugs of choice.
Administration, Inhalation↗
[Clinical studies on acute scrotum--focusing on torsion of the spermatic cord].
Surgical exploration was done on 50 patients with acute scrotum between June 1982 and October 1995. Of them, 24 (48%) had torsion of the spermatic cord, 9 (18%) had torsion of the appendage testis, 11 (22%) had intrascrotal hematoma, 4 (8%) had acute epididymitis, and 2 (4%) had bleeding of testicular tumor. The patients who had torsion of the spermatic cord were between 0 and 26 years of age (the mean: 14.6); 9 had torsion on the right side, and 15 on the left side. Infectious manifestations occurred in about 30%, and Prehn's sign developed in 37.5%. Of all cases, orchiopexy was performed in 10 cases and orchiectomy in 14. The testis was saved in 8 (88.9%) of the 9 patients who underwent surgery within 12 hours after onset. On the contrary, the testis was saved in only 2 (13.3%) of the 15 patients who underwent surgery more than 12 hours after onset. We concluded that early consultation, and exploration by a urologist are obligatory in the treatment of torsion of the spermatic cord.
Acute Disease↗
[Home oxygen therapy (HOT) in patients with pulmonary tuberculosis sequelae--comparison between patients medically treated and those surgically treated].
In Japan there are about 40,000 patients under home oxygen therapy (HOT), of whom about 30 to 40% are pulmonary tuberculosis sequelae (TBS). These patients can be divided into three groups depending on the treatments they had, Group 1: those who had medical treatments only, Group 2: those who had artificial pneumothorax, and Group 3: those who had thoracoplasties or other surgical treatments. The purpose of this study was to observe the distributions and possible differences in the survival rates among these groups. The study included 1537 patients with TBS under HOT followed at National Hospitals and Sanatoriums nationwide in Japan. In 819 patients the treatments were specified and of those 354 were in Group 1, 29 in Group 2, and 436 in Group 3, so that the proportion of surgically treated patients in PTS was estimated between 28.4% (436/ 1537) to 53.2% (436/819). The ages at the onset of tuberculosis, at the start of HOT and the intervals in between were 36.6, 66.2 and 29.8 in Group 1, and 26.8, 65.5, and 38.1 in Group 3 respectively. Though the ages at the start of HOT were the same, those at the onset of tuberculosis were about ten years younger in Group 3 than in Group 1. Comparing Group 1 and 3, the survival rates after the initiation of HOT (Kaplan-Meier method) was better in Group 2 (surgically treated) than in Group 1 (medically treated). It is speculated that the reason could be a better preservation of the function of the remaining lung in the surgically treated and a higher incidence of obstructive impairments in the medically treated patients.
Adolescent↗
[Successful electroconvulsive therapy of Cotard syndrome with bitemporal hypoperfusion].
A case study is presented to illustrate a rare condition described by Cotard as "délire de négation". The central symptom is a nihilistic delusion with denial of one's own existence of oneself and that of the external world. In the present case, the syndrome became manifest as an escalation of a recurrent depressive disorder late in life. After initial resistance to therapy, the syndrome was successfully treated with electroconvulsive therapy. For the first time, we report the regional cerebral blood flow measured by 99mTc-HMPAO-SPECT before and after therapy. Before treatment, significant bitemporal hypoperfusion relative to the cerebellum was found, which was no longer demonstrable on remission.
Aged↗
[Pharmacologic therapy for patients with stable chronic obstructive pulmonary disease--emphasis on inhaled agents].
One dose of an anticholinergic agents has about the same bronchodilatory effect as one of a beta 2-agonist. Anticholinergic agents may be used first in patients with stable chronic obstructive pulmonary disease, because of the possible adverse effects of beta 2-agonists. One puff of a metered-dose inhaler will not cause a maximal bronchodilatory effect. Both anticholinergic and beta-adrenergic drugs cause dose-dependent bronchodilation when given as aerosols from metered-dose inhalers, and a combination of the two can provide better results. If the response to a single agent is unsatisfactory, use of higher doses is advised and the use of a combination of anticholinergic agents and beta-agonists is recommended. With regard to inhaled corticosteroids, a high dose of inhaled beclomethasone dipropionate (1,500 micrograms per day) can be a effective as oral corticosteroids. Step-by-step pharmacologic therapy with the drugs mentioned above should be used in outpatient management of patients with chronic obstructive pulmonary disease.
Administration, Inhalation↗
Partial inhibition of protein synthesis accelerates the synthesis of porphyrin in heme-deficient mutants of Escherichia coli.
Mutants of Escherichia coli defective in the HemA protein grow extremely poorly as the result of heme deficiency. A novel hemA mutant was identified whose rate of growth was dramatically enhanced by addition to the medium of low concentrations of translational inhibitors, such as chloramphenicol and tetracycline. This mutant (H110) carries mutation at position 314 in the hemA gene, which resulted in diminished activity of the encoded protein. Restoration of growth of H110 upon addition of the drugs mentioned above was due to activation of the synthesis of porphyrin. However, this activation was not characteristic exclusively of cells with this mutant hemA gene since it was also observed in a heme-deficient strain bearing the wild-type hemA gene. The activation did not depend on the promoter activity of the hemA gene, as indicated by studies with fusion genes. It appears that partial inhibition of protein synthesis via inhibition of peptidyltransferase can promote the synthesis of porphyrin by providing an increased supply of glutamyl-tRNA for porphyrin synthesis. Glutamyl-tRNA is the common substrate for peptidyltransferase and HemA.
Aldehyde Oxidoreductases↗
The human protoporphyrinogen oxidase gene (PPOX): organization and location to chromosome 1.
We determined the structure of the human protoporphyrinogen oxidase (PPOX) gene after isolation and characterization of lambda phage clones mapping discrete regions of the cDNA. Southern blotting of human genomic DNA showed that there is a single copy of the PPOX gene, and fluorescence in situ hybridization to metaphase chromosomes mapped the gene to region 1q22. The gene has 13 exons and about 8 kb. The exon/intron boundary sequences conform to consensus acceptor (GTn) and donor (nAG) sequences, and exons in the gene appear to encode functional protein domains. Primer extension analysis revealed two major transcriptional initiation sites in a region with sequence motifs characteristic of a promoter. The promoter region contains multiple Sp1 elements, CCAAT boxes, and potential GATA-1 binding sites. Mapping of the 5' end PPOX mRNA by polymerase chain reaction indicated that there are the same transcripts in erythroid and nonerythroid cells.
Bacteriophage lambda↗