Biomedical subjects
Publications and source records attributed to K Ueda.
A three-year-old girl suffering from ecchymoses developed severe epistaxis. The diagnosis of thrombasthenia was made on the basis of platelet aggregation studies, flow cytometric analysis with monoclonal antibodies and gel electrophoretic analysis. In addition, coagulation studies at the time of epistaxis repeatedly showed a transient deficiency of factor XIII activity and antigen.
A 26-year-old female patient complicated with PSS, SLE and Sjögren was treated by combination of medium doses of corticosteroid and cyclosporin A. On admission, she showed many abnormal laboratory findings such as increased serum gammaglobulin level, high anti-DNA antibody titer and low compliment level. This therapy improved not only these laboratory abnormalities but clinical symptoms including sclerosis of the skin and arthritis, without notable side effect due to either of these drugs for the following 10 months so far. On the other hand we haven't acknowledged the effect to internal involvement yet. Since there is no promising therapy to sclerosis of the PSS skin, it is suggested that cyclosporin A can be an effective agent for PSS and should be further evaluated.
Twelve patients with nephrotic syndrome (NS) in Henoch-Schoenlein (HS) nephritis were treated with a high dose of intravenous methylprednisolone (MP) on each of nine alternate days followed by oral prednisolone for 4 to 6 months. Renal biopsy was performed on 10 of the 12 patients. The glomerular change in 5 patients, which was accompanied by crescents and/or sclerosis, with NS and acute nephritic syndrome (ANS) at onset, was more severe than that of the other 5 patients with NS and hematuria at onset. The renal insufficiency or hypertension in these 5 patients with NS and ANS improved within 2 weeks on this MP therapy. After a mean follow-up period of 40.5 months, all patients except 2 revealed normal physical findings and renal function as well as urinary findings. Repeated biopsies in the 2 patients with NS and ANS at onset demonstrated an improved renal pathology in comparison with their initial biopsies. No severe side effects related to high-dose intravenous MP followed by oral prednisolone therapy were encountered in any of the patients. Our results suggest that high-dose intravenous MP therapy can lead to a favorable outcome in patients with NS in HS nephritis.
A 2-year-old girl developed fever, hepatosplenomegaly, jaundice, lymphadenopathy and pancytopenia. Bone marrow examination revealed increased immature histiocytes (5.5%) and mature histiocytes with hemophagocytosis. All the abnormalities were normalized in one month without any chemotherapy. It was suggested that the presence of immature histiocytes with benign features, even if their number exceeds that of mature histiocytes, does not favor the diagnosis of malignant histiocytosis.
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Three patients with pulmonary hypertensive crisis (PHC) after open heart surgery for ventricular septal defect are reported. These patients ranged in age from 2 to 47 months, with Rp from 7.0 to 10.6 U.m2, Pp/Ps from 0.67 to 1.0, and Qp/Qs from 1.6 to 1.79. Intraoperative lung biopsy showed pulmonary vascular obstructive disease of Health-Edwards grade 2 in each patient. Atelectasis or pleural effusion on their chest-XP films was found when PHC occurred. The PHC course of the last case was recorded continuously on ABP, PAP and LAP. Administration of prostaglandin-E1 directly through the pulmonary arterial catheter was effective on PHC. Continuous recording of ABP, PAP and LAP during the episode was useful to differentiate PHC from acute left heart failure and/or acute right heart failure.
Tuberculin-active peptide-reactive T-cell lines were established from the popliteal lymph node of BALB/cA mice immunized with heat-killed Mycobacterium tuberculosis to investigate the cellular mechanisms in the protective immunity of tuberculosis. These T-cell lines, consisting mainly of L3T4 surface antigen-positive cells, were transferred intravenously into nude mice infected with M. bovis strain bacillus Calmette-Guérin (BCG). Four or 6 weeks after transfer, footpad swelling and hepatic granuloma formation were observed and viable counts in the liver were decreased. Reduction of viable counts in the liver was obviously preceded by the hepatic granuloma formation. An effect of Lyt-2+ T cells which might be included in the inoculum could be ruled out by the experiment using T-cell lines pretreated with anti-Lyt-2 monoclonal antibody and complement. These results indicated that T cells required for protective immunity in these experiments belong to the L3T4-positive TDTH subset. However, their protective activity was inferior to that of freshly prepared immune lymph node T cells. From the observation of migration patterns of 51Cr-labelled T cells in BCG-infected nude mice, a relatively high proportion of freshly isolated T cells, but only a small part of T-cell line, deposited in the spleen of infected nude mice. This difference in migration pattern of freshly isolated and cultured T cells could be one of the reasons for the less in vivo anti-bacterial activity of the latter.
We investigated the expression of Pre-S2 antigen (Ag) and antibody (Ab) in sera quantitatively using ELISA. Four patients with acute hepatitis B and 87 chronic HBV carriers were included in this study. We also investigated the expression of Pre-S2Ag in the liver tissues obtained from 26 chronic HBV carriers by direct fluorescent antibody method. There was a significant correlation between Pre-S2Ag titers and HBsAg titers in sera. Pre-S2Ag titers were higher in sera positive for HBeAg, HBV-related DNA polymerase or HBV-DNA than in sera negative for those markers. The ratio of Pre-S2Ag titers to HBsAg titers, however, was constant irrespective of virus replicative markers. Pre-S2Ag in the liver had almost same intracellular localization with HBsAg in the liver. It was suggested that Pre-S2Ag was expressed with an intimate relation to the expression of HBsAg and was not useful as a virus replicative marker. Pre-S2Ag titers/HBsAg titers tended to be high in patients with chronic active hepatitis and high serum GPT levels compared to patients with chronic inactive hepatitis. This may be explained by the release of Pre-S2Ag in the liver. In addition, all patients positive for Pre-S2Ag on the membrane of hepatocytes had chronic active hepatitis. The overproduction of Pre-S2-containing surface proteins in the liver may have some implication related to cell injury via the immune response to Pre-S2Ag etc. Pre-S2Ab was detected only in few cases of chronic HBV infected patients. The lack of immune response to Pre-S2 region may play a role in the persistence of HBV infection.
A case report of a traumatic dislocation of the testis is described. The patient was a 19-year-old man whose perineum received a high speed impact against the smooth wedge shape of the gasoline tank in a motor cycle accident. Immediate surgical replacement of the testis was successfully performed. Right testis was found between the Scarpa's fascia and the aponeurosis of external oblique in the superficial inguinal pouch. The testis was rotated through 180 degrees in its horizontal axis, such that the inferior pole was lying superiorly. Tunica vaginalis was ruptured, but testis had a normal appearance. Spermatic cord also showed normal appearance. Including our case, 50 cases (55 testes) of this entity have been reported in Japan. According to the classification of Alyea, 4 testes (7.3%) were in the pubic, 1 (1.8%) in the penile, 0 in the crural, 24 (43.6%) in the inguinal, 1 (1.8%) in the perineal, 4 (7.3%) in the inguinal canal, 4 (7.3%) in the abdomen, and 0 in the femoral canal. Seventeen (30.9%) testes had compound dislocation. Recent reports reveal an increased number of motor cycle accidents, and age distribution has its peak incidence at the ages of 20-29 (34%).
Recent progresses in DNA technology have made DNA diagnosis possible in clinical laboratories. The diagnosis is characterized by a potential to unveil genetic abnormalities and dispositions in the absence of symptoms, using any tissues not directly affected. Routinization of DNA diagnosis requires nonradioactive probes with sufficient sensitivities for detection and automated systems to use them. These requirements are being met by the latest technology such as polymerase chain reaction (PCR) and time-controlled temperature cyclers. Nonradioactive probes commercially available today, as tested in our laboratory, are not sensitive enough for practical use in single-copy gene analysis, unless combined with PCR. DNA diagnosis is extending to analyses of cDNA or mRNA. Our recent studies using a Northern blot technique and a ribonuclease protection assay indicated that the expression of mRNAs for those amyloid beta-protein precursors that harbor a protease inhibitor increases in the brain of Alzheimer's disease patients.
Enlisting the help of various research institutions across the nation, Ikemoto et al. have been pooling cultures of clinical isolates of respiratory tract infections and mapping out the correlations between patient backgrounds and the causative bacteria and the changes in the sensitivity spectra of the bacteria to various antibacterial and antibiotic agents annually since 1981. The following is a report of the 1986 findings. During the period from September, 1986 to March, 1987, 558 cases of respiratory infections were reported at 17 institutions across the nation and a total of 657 apparent causative strains were isolated from sputum samples. Of these strains, 75 strains of Staphylococcus aureus, 108 of Streptococcus pneumoniae, 150 of Haemophilus influenzae, 107 of Pseudomonas aeruiginosa (non-mucoid production type), 21 of P. aeruginosa (mucoid production type), 32 of Klebsiella pneumoniae, 8 of Escherichia coli, and 55 of Branhamella catarrhalis were subjected to MIC determination of various antibacterial and antibiotic agents to map drug sensitivities. In addition, diagnoses, age distributions by diagnoses, frequencies of infectious diseases, types of isolated bacteria, and usage statuses of the antibacterial and antibiotic agents the times of at isolation were also investigated. MIC determinations were carried out to investigate susceptibilities of causative organisms of respiratory tract infections to various antibacterial and antibiotic agents. From the 558 cases of respiratory tract infections, 657 strains were detected at concentrations not less than 10(4-6)/ml and identified to be the causative organisms. Of these strains, 603 could be used for MIC determination. An overwhelming majority of major causative bacteria, inclusive of H. influenzae and S. pneumoniae, showed sensitivity patterns similar to the sensitivity patterns found a year earlier, P. aeruginosa alone, however, showed some increase in its susceptibility to penicillin and cephem antibiotics. Regarding patient backgrounds, the age distribution was heavily biased towards the higher end of the scale, which patients with ages of 50 or higher accounting for 77.9%, compared to 73.5% in 1985. When the patients were classified by diagnoses, chronic bronchitis, bacterial pneumonia and bronchiectasis accounted for the majority of the infections: 28.7%, 23.3%, and 19.0%, respectively. The percentages of chronic bronchitis and bacterial pneumonia 28.7% and 23.3%, respectively, were somewhat higher in 1986 than in 1985. The disease which was comparatively frequent in all age groups was bronchiectasis, which accounted for 44.0% in patients with ages 29 years or lower, 18.4% in patients between 30 years and 69 years, and 16.7% in patients with ages 70 years or higher. The next most frequent infection was bacterial pneumonia.(ABSTRACT TRUNCATED AT 400 WORDS)
Two cases of intrauterine depressed fracture are presented. In each case, the mother had no history of abdominal trauma during pregnancy, the children were delivered normally without the use of forceps, but a round depression was present in the left frontal bone at time of delivery. CT scans demonstrated a depressed fracture of the left frontal bone and stagnation of cerebrospinal fluid around the fracture. Elevation of the depression was therefore made through a small incision along the rear edge of the frontal bone using a periosteal elevator. A review of intrauterine depressed skull fracture is made and the concept, mechanism, surgical indications and operative methods of this rare fracture are discussed.
We measured urinary levels of i-TXB2, 2,3-dinor TXB2 and NAG following cardiopulmonary bypass (CPB) and studied their clinical significance. Subjects studied were 8 patients undergoing cardiac surgery. In the CABG group, urinary i-TXB2, 2,3-dinor TXB2 and NAG level increased significantly (P less than 0.05) 3hrs after CPB, but decreased on and after the 1st postoperative day. In the DVR group, these levels showed similar changes, but i-TXB2 and NAG levels were significantly (P less than 0.05) higher than those of the CABG on the 1st or 3rd postoperative day. A significant correlation (r = 0.84, P less than 0.05) was observed between NAG and i-TXB2 on and after 2nd postoperative day. The results suggest that urinary i-TXB2 during the period immediately after CPB is derived from platelets and reflects the functional changes in renal urinary tubules, while urinary i-TXB2 level on and after the 2nd postoperative day reflects the function of the renal urinary tubules.
Three infants with type A interrupted aortic arch, VSD and PDA underwent staged operation. Aortic arch reconstruction with Blalock-Park's method, PDA division, and PA banding were performed as the first operation. Subsequently all patients were underwent the second operation, consisting of VSD closure and PA debanding, and are doing well now. Pressure gradient at the anastomosis site, the diameters of the anastomosis site and the left subclavian artery, and the diameter ratios of the anastomosis site and the left subclavian artery to the ascending aorta were evaluated after the first and second operation. Two patients with good size of the left subclavian artery at the first operation showed excellent growth of the reconstructed aortic arch and trivial pressure gradient at the anastomosis site. The other patient, whose preoperative left subclavian artery was small (2.5 mm in diameter) resulted in residual stenosis at the anastomosis site. The development of the left subclavian artery was satisfactory in all patients. These data suggest that the aortic arch reconstructed with Blalock-Park's method can grow if the diameter of the anastomosis site has adequate size at the first operation.
A 76-year-old woman, who had suffered from liver cirrhosis, was referred to our hospital because of pancytopenia. Her peripheral leukocyte count was 2,500/microliters with 43% myeloblasts, hemoglobin at 9.0 g/dl and platelet count of 0.9 x 10(4)/microliters. Aspirate from bone marrow showed hypercellular marrow with 52% myeloblasts. No chromosomal abnormality was detected. She was diagnosed as acute myelogenous leukemia (AML, M2). The diagnosis of liver cirrhosis was confirmed by laboratory data and findings of abdominal sonography. Moreover, she had valvular aortic stenosis. These complications made it difficult to treat her with combined chemotherapy containing anthracycline antibiotics, so she was given a small dose of cytosine arabinoside (Ara-C, 10 mg/body/12 hr) for 18 days. After severe myelosuppression, complete remission was achieved. The highest serum concentration of Ara-C was obtained at 15 min after subcutaneous injection of Ara-C; thereafter the Ara-C concentration decreased immediately within 60 min in a pattern similar to that observed in patients without liver cirrhosis. Thus, low-dose Ara-C regimen might be a useful treatment for aged patients with AML, even complicated with liver cirrhosis.
Seventeen cases of pediatric malignant neoplasm with pulmonary and/or pleural lesions shown by chest radiography at initial diagnosis were reviewed and analyzed. Respiratory symptoms such as dyspnea, tachypnea, and chest pain were observed on admission in approximately one-half of them. The initial chest radiography showed pleural lesions in 7 of the 17, pulmonary lesions in 8, and both pulmonary and pleural lesions in 2. Unilateral or bilateral pleural fluids were observed in all of the seven patients with pleural lesions, and malignant cells were confirmed in the pleural fluid of all patients. The radiographic patterns of the eight patients with pulmonary lesions were solitary nodule in two, multiple nodules in two, diffuse miliary nodules in three, and diffuse honeycomb in one. Histological examination of the pulmonary lesion was performed in six patients at the initial diagnosis or after death, while in the remaining two primary or other metastatic sites were examined. The two patients with both pulmonary and pleural lesions showed multiple nodules or infiltrates with pleural fluid on chest radiography. Increased malignant cells were detected in the pleural fluid of both patients. In all cases, the lesions gradually or rapidly disappeared with multidrug chemotherapy. The review confirms the need for a combination of complete radiographic and pathological analysis at the time of initial diagnosis of malignant neoplasm in children to distinguish other causes such as infectious complications.