Biomedical subjects
Publications and source records attributed to K Okamura.
A strain of Streptomyces was found to produce new piericidins. The compounds were purified and separated into two substances named Mer-A2026A and B. These new piericidins exhibited vasodilating and depressor activities.
In the field of orthopedic surgery, arthroscopic surgery has become widespread since its first development by Dr. Watanabe in 1950. Arthroscopic surgery for the knee joint is now a common procedure, but this surgery is not so common when the procedure involves the shoulder joint. Although using arthroscopic surgery is not so common on the shoulder joint, there are several benefits by utilizing arthroscopy in such cases. Some of the benefits are; minimal scar formation, no functional limitation of the deltoid muscle, and a quick recovery time. So it is believed that due to these benefits, shoulder arthroscopy will become common in the future. The glenohumeral joint and subacromial bursa are the area of shoulder where arthroscopic surgery proves to be useful. In the glenohumeral joint, it is possible to see the biceps tendon, glenoid surface, humeral head, labrum, glenohumeral ligament, subscapularis tendon, supraspinatus tendon, infraspinatus tendon, teres minor, and rotator interval. In the subacromial bursa, it is possible to see the acromion, coracoacromial ligament, acromioclavicle joint, and the bursal side of the cuff. For recurrent anterior dislocation of the shoulder, Caspari's method is the arthroscopic Bankart repair. This is the multiple suture technique for a detached labrum-anteroinferior glenohumeral ligament complex from glenoid neck by using Caspari's suture punch. This is the anatomical repair for anterior instability. Superior labral injuries of the shoulder are usually caused by trauma or over use.(ABSTRACT TRUNCATED AT 250 WORDS)
Six cases of ureteral injuries were analyzed. Two cases were male and 4 cases were female. The right side was affected in 1 case and the left in 5 cases. The affected portion was the uretero-pelvic junction in 1 case and lower iliac vessels in the other cases. Five cases were iatrogenic injuries in surgical or gynecological pelvic operation, and the other was due to blunt trauma. Intraoperative diagnosis was made in 4 cases. Drain leakage led to diagnosis in one case and pyelonephritis in another. Ureteroureterostomy was performed in 2 cases, pyeloureterostomy in 1 case, ureteroneocystostomy with psoas hitch in 1 case, Boari bladder flap in 1 case and simple suture in 1 case. 4-0 or 5-0 Dexon with an atraumatic needle was used for all anastomoses. Except for case 1, who died of the recurrence of carcinosarcoma, renal functions were preserved in all patients during the follow-up period ranging from 5 months to 7 years 8 months.
To obtain new criteria for presuming the existence of chromosomally unbalanced progeny in reciprocal translocation carrier couples, the obstetrical histories of 57 couples were analysed. The chromosomally unbalanced progeny who had been prenatally or postnatally diagnosed were mainly partial trisomies. In contrast with partial trisomies, there were only a few cases of partial monosomies and there were only two cases of chromosomal imbalance derived from 3:1 segregation in gametogenesis. Moreover, the percentage of haploid autosome length (%HAL) of the maternal carriers whose progeny had suffered from chromosomal imbalance was significantly smaller than those of the maternal carriers who had not had progeny with chromosomal imbalance. Based on these results, the following criteria were obtained: 1) Partial trisomies tend to be maintained in pregnancy but partial monosomies do not; Most chromosomally unbalanced zygotes which were induced by 3:1 segregated gametes tend to be spontaneously selected in early pregnancy; 3) When interchanged segments of chromosomes are small in maternal reciprocal translocation carriers, chromosomally unbalanced fetuses tend to be maintained in pregnancy.
We evaluated the success rates of transplantation and growth conditions of 33 human tumor xenografts transplanted on the chorioallantoic membrane of chick embryos. Eleven out of 14 renal cell carcinomas (78.6%), 7 out of 9 urothelial carcinomas (77.8%), 2 out of 3 testicular tumors (66.7%), an adenocarcinoma of the colon and an adenocarcinoma of the ovary but none of the 5 prostatic carcinomas were transplanted successfully. Histologically, carcinoma cells survived on the chorioallantoic membrane forming organoids the structure of which was well preserved. Several regions of the grafts frequently became necrotized. However, the viability of carcinoma nests was not influenced by the inflammatory changes surrounding necrotic tissues. Renal cell carcinomas survived diffusely with prominent angiogenesis. Immunostaining with anti-bromodeoxyuridine (BrdU) and Ki-67 monoclonal antibodies demonstrated a strong correlation between the %BrdU labeling index of the cancer cells on the chorioallantoic membrane and %Ki-67 index of the original tumors. No difference in %BrdU indexes was found between small and large cancer nests. Growth conditions remained constant for 8 days after inoculation. The growth potential of cancer nests surviving on the chorioallantoic membrane, which was identical to that of the original carcinomas, appeared to be unchanged during incubation. However, it might be difficult to exploit the chorioallantoic membrane for anticancer chemosensitivity tests except for renal cell carcinoma since few cancer cell nests were produced in spite of the high transplantation success rates.
Recent advances in molecular genetics have disclosed oncogenes playing a significant role in the development of malignant gliomas. Amplification of the c-erb gene which code EGFR and aberration of P53 oncogene play a significant role in the development of most malignant gliomas. Karyotype analysis of malignant gliomas revealed gains of chromosome 7, loss of chromosome 10, double minutes and loss of heterozygosity. The development of the tumors appear to result from the accumulation of those multiple genetic alterations. Although many cases of familiar malignant gliomas have been reported the role of hereditary factors in familial transmission still remains controversial. Chromosomal abnormalities seemed to be confined to the tumor cell, and no alteration in karyotype of peripheral blood, which indicated germ line mutation, was demonstrated. However, several authors indicated that the frequency of malignant gliomas in the relatives of patients was estimated more than ten times to the controls. Some hereditary factors might play a role in malignant gliomas.
Recently, computer systems including several delivery systems have been installed in the Central Clinical Laboratory of Kyoto University Hospital. As for the physiological examination system, we have introduced PRINS (Physiological-examination Result Information Network System) using an NEC computer and LAN. Utilizing Windows, this PRINS is connected to individual systems and equipment, and the data are sent to the host computer system (KING: Kyoto University Hospital Information Network Galaxy, which utilizes IBM). This system enabled us to greatly improve (1) the efficacy of examinations, (2) management and data-stock of huge volumes, (3) rapid data analyses and simplicity in handling, and (4) facility of reception and reservation business. As for the sample analysis system, we formerly developed computer systems using MUMPS independently in the subdivisions. At the time of delivery system installation, we decided to unify them and newly establish a general managing system using MUMPS Sumitomo Electric Industries. The purpose of these installations are briefly as follows; (1) to reduce human power and to simplify delivery of samples and related business, (2) to report the assay results rapidly, (3) to improve and automate the quality controls, (4) to prevent from infections, and (5) to make handling and work easier. This system is comprised of biochemistry, immunology, hematology and emergency examination subdivisions, and connects each part in a network system using LAN. This is further connected to KING, the host. Actually, 4 sample delivery lines from 3 industries were introduced: Hitachi for biochemistry, Sysmex for hematology, and Toshiba-IDS for coagulation and immunology. Monitoring and data analyses including quality controls are performed by a host system or individual systems (biochemistry and hematology). At present, such heterogeneous installations were considered to be most suitable for our purpose and these made it possible to continue assays of other lines even when trouble occurred in one of the lines. In addition to the general systems, we have introduced various software programs for statistical analyses. These have been effectively utilized already for detailed setting of the clinical reference values for hematology data, and also for a computer diagnosis trial for anemia related diseases. When effective operations of these newly installed systems is achieved, we would like to extend our efforts to establish an ideal laboratory which is able to assist the intensive medi-care system in the university hospital.
We studied 41 testicular germ cell tumors (TGCT) using DNA flow cytometry and argyrophilic (silver staining) nucleolar organizer region (Ag-NOR) quantitation to evaluate the proliferative characteristics of TGCT and the significance of those analytical techniques. In nonseminomatous germ cell tumor (NSGCT), the percentage of S + G2M phase cells (%S + G2M) in DNA aneuploid tumor was higher than in DNA of diploid tumors. Likewise, in NSGCT the aneuploid Ag-NOR sites per nucleus (Ag-NOR count) were significantly higher in DNA aneuploid than in DNA diploid tumors. There was also a significant linear correlation between % S + G2M phase cells and the Ag-NOR count in TGCT. However, the DNA ploidy pattern and the % S + G2M phase cells, and Ag-NOR counts, did not correlate significantly with the patient survival rate or clinical stage. In conclusion, our study suggests that Ag-NOR enumeration is an effective technique for assessing cellular proliferative activity that is somewhat less expensive than DNA flow cytometry.
The authors report two cases of cerebellar infarction due to vertebral artery (VA) occlusion resulting from cervical spine trauma. In one patient with dens and C2 body fracture, the left VA was occluded, resulting in a left cerebellar infarction. The second patient, with a subluxation of C4 on C5, presented with cerebellar swelling and infarction along with acute hydrocephalus secondary to bilateral vertebral artery occlusion. Because vertebral artery injuries with cervical trauma are rarely symptomatic, they can be easily overlooked. Bilateral or dominant vertebral artery occlusion, however, may cause rapid and fatal ischemic damage to the cerebellum and brain stem. Rapid recognition and optimal treatment for this injury depends on early vertebral artery angiography.
A case of type III congenital cystic adenomatoid malformation of the lung was successfully diagnosed prenatally by fetal lung biopsy. We performed this procedure at 22 weeks of gestation, using a biopsy gun system under ultrasound guidance. The pregnancy was undisturbed by the procedure but as the condition was incompatible with life, an abortion was performed. The diagnosis was confirmed at post-mortem examination. Fetal lung biopsy appears to be a useful method for prenatal diagnosis of fetal lung disorders.
A total of 135 patients with superficial bladder cancer diagnosed as totally resectable were entered into a randomized multicenter trial to investigate the efficacy of early intravesical epirubicin instillation after resection in comparison with transurethral resection (TUR) alone. Epirubicin (40 mg/40 ml saline) was given within 24 h of TUR and once during the 1st week, weekly for 4 weeks and then monthly for 11 months. In all, 122 patients (90.4%) were eligible and 119 (88.1%) were evaluable. The interval to initial recurrence was significantly longer (P = 0.02) in the epirubicin group (36 months; 95% confidence interval, 32-40 months) than in the group receiving TUR alone (28 months; 95% confidence interval, 24-32 months). The recurrence rate per year in the epirubicin group was less than that in the TUR-alone group (0.13 versus 0.29 annual recurrences). Disease progression was observed in only one patient in the epirubicin-instillation group. The main toxicity encountered was bladder irritation (13.8%). These results demonstrate that early intravesical epirubicin instillation is efficacious in preventing local recurrence.
A new case of familial heterozygous paracentric inversion in the long arm of chromosome 14 [inv(14)(q22q32)] is presented. The rearrangement was first ascertained in a fetus examined due to advanced maternal age, and then detected in the father. The phenotypes of the newborn and the father were completely normal. The parents had no history of spontaneous abortion. With reference to previous reports, the risk of clinical abnormalities are discussed for both de novo and familial paracentric inversions of chromosome 14.
Four patients who developed intractable supraventricular tachycardia (SVT) after open heart surgery were treated using a new therapeutic method of creating a pharmacological atrioventricular block by the continuous infusion of verapamil with ventricular pacing. Both the initial dose and the effective dose, being the verapamil dose necessary to maintain pharmacological atrioventricular block to prevent the recurrence of SVT, were surveyed with clinical results. The verapamil-induced hemodynamic changes observed 4 h and 8 h after treatment, as indicated by systolic arterial blood pressure, mean arteral blood pressure, heart rate, cardiac index, and urine volume, were compared with the values 1 h before treatment. After an initial low dose infusion of 0.07 +/- 0.02 mg/kg.h had been given, an effective and safe dose of 0.11 +/- 0.05 mg/kg.h was determined. Good hemodynamic and clinical results were achieved in all four patients who are now leading an active life. These results therefore encourage us to apply this therapeutic method for treating patients with intractable and recurrent SVT after open heart surgery.
A heterozygous pericentric inversion of chromosome 12 (inv(12)) was prenatally diagnosed. The breakpoints were localized to p12.3 and q14, resulting in more than one-third of the total length of the chromosome being inverted. The inversions was transmitted from the father whose phenotype was completely normal. The newborn also showed normal phenotype and grew without any clinical problems. The parents had no history of infertility. Based on these facts, it is indicated that pericentric inv(12)(p12.3q14) does not affect phenotype.
Vasomotor nerves in human dental pulp were more closely related to arterioles than to venules. Most were composed of unmyelinated fibres, which were mainly adrenergic. They appeared close to arterioles that were surrounded by a few layers of contractile smooth-muscle cells. The smaller arterioles with a diameter of 10-15 microns received a more intimate innervation by vasomotor nerves than did the larger. These vessels occasionally showed much narrower neuromuscular junctions than previously reported. Most of these nerve fibres were identified as adrenergic by the presence of chromaffin-positive synaptic vesicles detected by ultrastructural enzyme histochemistry. Their function appeared to be to regulate the blood flow and/or the blood pressure by stimulating smooth-muscle cells, resulting in contraction and a change in the calibre of the vessels. Capillaries and venules, which have a higher permeability, received weaker innervation by the vasomotor nerves than did arterioles. The intimate relation between vasomotor nerves and arterioles is related to the function of dental pulp in normal and pathological conditions.
Carbamoyl phosphate synthetase deficiency is a type of an inborn error of metabolism with a poor prognosis. Carbamoyl phosphate synthetase is a liver-specific enzyme, and its deficiency can only be diagnosed by enzyme assay using liver biopsy specimens. A pregnant woman at risk for carbamoyl phosphate synthetase deficiency was evaluated for the purpose of prenatal diagnosis of the condition. Fetal liver biopsy was performed at the 22nd week of gestation. The results of enzyme assays on fetal liver biopsy revealed normal enzymatic activity and the diagnosis of carbamoyl phosphate synthetase deficiency was ruled out prenatally. Methods and safety of fetal liver biopsy are discussed. Measurements of activity of liver-specific enzymes were evaluated with respect to methodology and manner of assessment. Prenatal diagnosis of deficiencies in liver-specific enzymes, which have hitherto been considered difficult to detect before birth, has now become possible.
Umbilical venous blood pressure (UVP) was measured at fetal blood sampling using cordocentesis in 113 fetuses. Among these, both inferior vena cava (IVC) Doppler flow pattern, when the preload index was set as a parameter of reversed flow, and UVP were measured in 50 fetuses. We evaluated whether direct measurement of UVP, representing fetal central venous pressure, could be replaced by an assessment of reversed IVC blood flow. Normal mean UVP was 4.89 +/- 3.22 mm Hg, whereas no correlation was observed between UVP and gestational week. When the extent of reversed blood flow from the right atrium to the IVC was expressed as a preload index (PLI), there was a significant correlation between the index and UVP (r = 0.463; P < 0.001). When the abnormal range of PLI was set at 0.45, the sensitivity of an estimate of abnormal UVP (more than 1.5 SD plus the mean) was 0.54 and the specificity was 0.89. Measurement of UVP is necessary for the prediction of fetal cardiac function. PLI can be substituted for the UVP measurement. However, PLI should be supplemented with other parameters for an accurate fetal cardiac function evaluation.
Human T-lymphotropic virus type I (HTLV-I) is a causative retrovirus of adult T-cell leukemia lymphoma and HTLV-I associated myelopathy/tropical spastic paraparesis. HTLV-I is also associated with some forms of pulmonary alveolitis, chronic arthropathy, polymyositis, and uveitis. In this study, the possible role of HTLV-I infection in the pathogenesis of autoimmune thyroid diseases with positive antithyroid antibody (ATA) to microsomal antigen or thyroglobulin was evaluated. In Fukuoka Prefecture or the northern part of Kyushu Island located in the southwestern part of Japan, the prevalence of patients with HTLV-I antibody was screened using the particle agglutination test and then was further confirmed either by the indirect immunofluorescence method or the western blot method. The observed prevalence in patients with thyroid disorders and the estimated prevalence calculated considering the sex- and age-specific prevalence among healthy blood donors (n = 16,008) were as follows: 19 (7.4%) vs 7.8 (3.0%) (p < 0.001) for ATA-positive chronic thyroiditis (n = 257), 21 (7.0%) vs 6.6 (2.2%) (p < 0.001) for ATA-positive Graves' disease (n = 298), 4 (4.3%) vs 2.1 (2.2%) (ns) for ATA-negative Graves' disease (n = 94), 1 (2.9%) vs 1.1 (3.1%) (ns) in ATA-negative hypothyroidism (n = 35), and 3 (1.8%) vs 5.0 (2.9%) (ns) for ATA-negative nodular goiter (n = 170). These findings thus suggest that HTLV-I infection may have some relationship to ATA-positive thyroid disorders.