Biomedical subjects
Publications and source records attributed to K Yabuta.
A very rare occurrence of adult granulosa cell tumor of the ovary (not of the juvenile type) causing precocious pseudopuberty in a six-year-old girl is described. An additional feature of interest was that the tumor appeared entirely cystic. To our knowledge, this condition in such a young premenarchal patient has not been reported previously.
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The peripheral blood mononuclear cell subsets in patients with Kawasaki disease and coronary artery lesions were investigated. Of the 106 patients 14 had lesions. Patients with Kawasaki disease and coronary artery lesions were found to have increased counts of CD14+ macrophages/monocytes compared with those of patients with Kawasaki disease without lesions. The absolute counts of CD14+ macrophages/monocytes form an important parameter to determine the severity of vascular damage during acute Kawasaki disease.
Concentrations of prostaglandin E1, E2, and F2 alpha (PGE1, PGE2, and PGF2 alpha) were determined in milk and plasma from mothers of 9 preterm and 11 term infants. The concentration of PGE1 in milk was similar to that in plasma, and the concentrations of PGE2 and PGF2 alpha were approximately 1.2-2 times higher than those in plasma. However, no significant differences in the levels of PGE1, PGE2, and PGF2 alpha were observed between the foremilk and hindmilk, among the colostrum, transitional milk, and mature milk, and between preterm and term milk. Further studies have to be performed to confirm that the stable levels of PGE1, PGE2, and PGF2 alpha in human milk found in this study play an important role in the gastrointestinal function of infants.
UNLABELLED: The purpose of this study is to report our experience regarding the acute and intermediate-term results of balloon pulmonary valvuloplasty (BPV) in various types of congenital pulmonary valve stenosis. METHODS AND RESULTS: Twenty-four consecutive patients with a median age of 6.6 years (ranging from 1 month to 24 years old) underwent BPV between January 1988 and September 1991. These patients were divided into 2 groups; Group 1 consisting of 13 patients with isolated pulmonary valve stenosis, and Group 2 consisting of 11 patients with complicated pulmonary valve stenosis (supravalvular, subvalvular, valved conduit and post-right ventricular outflow reconstruction). Mean peak systolic pressure gradients from the right ventricle to the pulmonary artery were as follows: In group 1, 48 +/- 21 (mean +/- SD) mmHg before BPV, 18 +/- 8 mmHg immediately after BPV and 13 +/- 5 mmHg at the longest follow-up based on catheterization or Doppler echocardiographic studies. The gradients in group 2 were 65 +/- 28 mmHg before BPV, 46 +/- 25 mmHg immediately after BPV and 47 +/- 21 mmHg at the longest follow-up. CONCLUSIONS: BPV provides both acute and intermediate-term gradient relief in patients with isolated pulmonary valve stenosis. In complicated pulmonary valve stenosis, on the other hand, the effect of BPV was unsatisfactory and appears to depend on the mechanism of associated obstruction. Therefore accurate evaluation of the anatomy of associated obstruction in the pulmonary valve region is needed to determine that BPV is indicated.
We report the case of a neonate with a rare association of tetralogy of Fallot and aortic valve stenosis, who died following percutaneous balloon valvuloplasty. Postmortem examination confirmed a tetralogy of Fallot morphology with a markedly hypoplastic pulmonary tree, hypertrophy of both ventricles, and a thickened and dysplastic aortic valve. Valvuloplasty was not effective despite the presence of a fissure in the cusp. The findings suggest that the left ventricular impairment and associated anomalies, with or without a dysplastic valve may contribute to the failure of balloon valvuloplasty in neonates with critical aortic valve stenosis.
We report a case of 10-year-old boy with chronic tubulo-interstitial nephritis (TIN). He had febrile convulsion and received sodium valproate (VPA) treatment. 18 months later, he had developed Fanconi syndrome. On admission, he also had evidence of tubular and glomerular dysfunction. Renal biopsy revealed interstitial nephritis with linear tubular-basement-membrane deposition of IgG and C3 and dominant infiltration of CD4 positive cells in interstitium. Although there is not a positive proof of the etiology in the relationship between TIN and VPA, it is likely that VPA is a possible cause of chronic TIN from his past history.
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We review the validity of balloon occlusion aortography (BOA) on the basis of our personal experience with 18 patients with congenital heart disease (mean weight 4.55 g, including 8 neonates). Four of the 18 patients underwent aortic arch angiography using balloon occlusion of the descending aorta. Pulmonary angiography was also performed in 9 patients via a patent ductus arteriosus and in 3 patients via a Blalock-Taussig shunt. The remaining 2 patients underwent coronary arteriography by balloon occlusion of the ascending aorta. The information obtained was satisfactory in 17 of the 18 patients. However, in one patient with a double-outlet right ventricle and pulmonary stenosis, the pulmonary arteries were not clearly visualized because of dominant antegrade flow from the right ventricle. BOA is a safe and useful procedure which can be used to image the aortic arch, pulmonary artery, and coronary arteries in infants with congenital heart diseases. In children over 3 years of age, however, the balloon may not be able to occlude the appropriate site of the aorta, so selective angiography is required to obtain precise information.
A 31-month-old boy developed right coronary artery stenosis after Kawasaki disease for which he underwent percutaneous transluminal coronary angioplasty (PTCA). The narrowing of the right coronary artery was successfully dilated by angioplasty without apparent complication. This case suggests that PTCA may have a potential advantage as a temporary method to postpone the aortocoronary bypass surgery in a child with coronary artery stenosis due to Kawasaki disease. However, strict patient selection is recommended for coronary angioplasty.
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The levels of soluble CD4 (sCD4) and sCD8 in serum correlate with the T cell subset activation and may be important in monitoring and characterizing disease processes during immunological diseases. We compared acute Kawasaki disease (KD) with anaphylactoid purpura (AP) and acute febrile viral infections, such as measles and infectious mononucleosis (IM), in terms of serum sCD4 and sCD8 levels. The levels of serum sCD4 and sCD8 were measured by a sandwich enzyme immunoassay. In addition, peripheral blood mononuclear cell subsets were analysed by single and two-colour flow-cytometric analyses in KD and IM patients. The levels of serum sCD4 and sCD8 were significantly elevated in patients during acute stages of KD, measles and IM, but not AP. Peripheral blood CD4+, CD8+ and also HLA-DR+ T cells count did not increase during the acute stage of KD; however, peripheral blood CD8+ and HLA-DR+ T cell counts were increased during the acute stage of IM. Our results suggest that there is a low level of activation of peripheral blood T cells during acute KD, or that infiltrated T cells in some local tissues of KD patients contribute to the elevated levels of serum sCD4 and sCD8.
A review of our previous immunological studies on Kawasaki disease (KD) was undertaken. The results showed that peripheral blood macrophages/monocytes, T-cells and B-cells become activated during acute KD in terms of numerical changes in immunocompetent cells, expression of activated antigens on the cell surfaces and cytokine production. Also, during acute KD with coronary artery lesions (CALs) the numbers of macrophages/monocytes are increased. In addition, both the increased levels of tumor necrosis factor-alpha and shed intercellular adhesion molecule-1 in serum are more evident in KD patients with CALs than in those without. Our results further suggest that the main characteristics of the pathogenesis of KD are increased numbers of peripheral blood macrophages/monocytes with the secretion of monokines by these activated cells, and the expression of adhesion molecules on immunocompetent cells. These immune responses develop more vigorously in KD patients with CALs.
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We analyzed the expression of Fc epsilon R2/CD23 on the peripheral blood B lymphocytes of 10 patients with Kawasaki disease (KD) using a fluorescence-activated cell sorter. The absolute count of CD23-positive B lymphocytes and the ratio of CD23-positive B lymphocytes to B lymphocytes were high during the acute stage of KD in comparison to those during the convalescent stage and in control subjects. In addition, both the increased number of CD23-positive B lymphocytes and the increased serum IgE levels appeared during the latter part of the acute stage. These results suggest that the increased number of CD23-positive B lymphocytes during the latter part of the acute stage in KD reflect the activation of B lymphocytes and have an important role in IgE-mediated immunity.
A 13-year-old boy with unresectable pulmonary metastatic osteosarcoma, which was refractory to high dose methotrexate, adriamycin, cisplatin and combination of bleomycin, cyclophosphamide and actinomycin D, was treated by aggressive chemotherapy including the combination of ifosfamide (1 g/m2 x day 1-4), Carboplatin (100 mg/m2 x day 1-4) and Vindesine (4 mg/m2 x day 1). After 5 courses of the treatment, pulmonary metastasis regressed, respiratory symptoms resolved completely, and in this regimen no severe toxicity was observed. Thoracotomy for pulmonary metastatic osteosarcoma is an accepted treatment, but treatment for patients with unresectable disease has not been established. It is suggested that this regimen is relatively safe and very effective for refractory and unresectable osteosarcoma.