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Biomedical subjects

M Hara

Publications and source records attributed to M Hara.

At least 397 records · Page 22Linked to original sources
PubMed1998

[Pneumoperitoneum with systemic sclerosis].

We report a case of systemic sclerosis (SSc) complicated with benign pneumoperitoneum without apparent pneumatosis cystoides intestinalis (PCI). A 43-year-old woman was admitted to our hospital because of prominent abdominal distension in April 1997. Raynaud's phenomenon has been detected since 1991. She was suffering from recurrent diarrhea, constipation, and subileus. The diagnosis of SSc was made in 1996 based on the sclerosis in her face, forearms, and chest, and hypomotility of the esophagus. On admission, she presented no signs of peritoneal irritation. The laboratory data revealed that white blood cell count was 7,400/mm3 and C-reactive protein was 0.1 mg/dl. Chest and abdominal roentgenograms showed massive free air under the diaphragm, dilatation of small and large intestine, and air-fluid level. PCI was not apparent. Pneumoperitoneum was improved after four weeks with intravenous hyperalimentation. But she presented recurrent severe diarrhea and high fever whenever she tried to take food orally. Klebsiella pneumoniae was proved in her jejunal juice by bacteriologic examination. Intravenous prostaglandin F2 alpha and oral fosfomycin calcium intake made her condition better. Benign pneumoperitoneum without PCI is rarely reported in the patients with SSc. In her condition, weakness of intestinal wall, hypomotility of intestine, unusual bacterial overgrowth, and elevated intraluminal pressure made intraluminal gas go through the wall of the fragile intestine of SSc. As operation of intestine of SSc usually cause miserable outcome, pneumoperitoneum accompanied with SSc even if PCI is apparent or not must be treated with conventional manner while there is no signs of peritoneal irritation.

Adult↗
PubMed1998

[A patient with acute sarcoidosis associated with fever, polyarthritis, and erythema nodosum: a typical of Löfgren's syndrome].

A 26-year-old female was admitted to Aoyama Hospital in February 1996, for evaluation of abnormal chest shadows and polyarthritis. She visited our clinic in December 1995 with complaints of fever, fatigue, and polyarthralgia which lasted for 3 weeks. Two weeks later she developed erythema nodosum on her lower legs with the exacerbation of polyarthritis. Erythrocyte sedimentation rate was 108 mm/hr and CRP 4.9 mg/dl. A chest radiograph showed hilar lymphadenopathy and multiple nodular shadows in both lung fields. On admission, she had arthritis of the shoulders and knees, erythema nodosum on her lower extremities, and keloid-like skin lesion on her left knee. Thoracoscopic lung biopsy of nodular lesion and skin biopsy of keloid-like lesion revealed noncaseating granuloma of epithelioid cells with lymphocytes, macrophages, and giant cells, confirming the diagnosis of sarcoidosis. She was cured in three months, and was well and free of the symptoms thereafter. Löfgren's syndrome is acute sarcoidosis, characterized by arthritis, erythema nodosum, and bilateral hilar lymphadenopathy. This syndrome is common in Europe and is closely related to HLA-B8 and DR-3. The frequency of HLA-B8 and DR-3 in Japanese is almost 0%, explaining the rare onset of this syndrome in Japan. Our case is the second report of typical Löfgren's syndrome in Japan, although the patient did not have these HLA loci.

Acute Disease↗
PubMed1998

[A combination chemotherapy with cytarabine ocfosfate, low dose etoposide, and G-CSF for the treatment of high risk MDS (RAEB, RAEBt)--a pilot study].

We evaluated a combination chemotherapy with cytarabine ocfosfate (SPAC), low dose etoposide and G-CSF for the treatment of high-risk MDS (RAEB, RAEBt). Seven patients with high-risk MDS were treated with a daily combination, 200 mg/day SPAC p.o., 50 mg/day etoposide p.o. and 75 micrograms/day G-CSF s.c. One patient achieved complete response, 2 achieved good response and one patient minor response. Although all of the patients developed severe marrow hypoplasia after chemotherapy, the nonhematologic adverse effects were mild enough to be tolerated. This combination chemotherapy should be useful in the clinical management of patients with high-risk MDS.

Aged↗
PubMed1998

Effects of gonadal steroids on ventricular repolarization and on the response to E4031.

Gonadal steroids are thought to be important determinants of gender-related differences in electrophysiology, such as the longer rate-corrected QTc intervals in women and the incidences of some clinical arrhythmias. We studied the chronic effects of gonadal steroids on cardiac action potentials (APs) using standard electrophysiological techniques. Papillary muscles were removed from the hearts of oophorectomized rabbits that had been treated with placebo, estradiol or dihydrotestosterone (DHT). The electrocardiograms of the three groups did not differ. Papillary muscle APs were studied during drive at cycle lengths of 330 to 5000 msec. The APD30 of the DHT group was significantly shorter than that of the others at cycle lengths of >500 msec. The APD90 of the estradiol group was significantly longer than that of the DHT group at cycle lengths of >1000 msec. The APD90 of the placebo group tended to be intermediate. The effects of the antiarrhythmic drug E4031 (10(-8)-10(-6) M) also were examined. E4031-induced prolongation of APD90 and magnitude of early afterdepolarizations was significantly greater in the estradiol-treated than the DHT-treated and placebo groups. In conclusion, in rabbit heart, gonadal steroids are important determinants of base-line electrophysiological properties and the proarrhythmic response to E4031.

Action Potentials↗
PubMed1998

Dilatation of sealed Dacron vascular prostheses: a comparison of Gelseal and Hemashield.

OBJECTIVE: Early postoperative dilation of a gelatin-impregnated knitted dacron prosthesis (Gelseal, Vascutek) and a collagen-impregnated woven Dacron prosthesis (Hemashield, Meadox Medicals) was studied. EXPERIMENTAL DESIGN: Prospective study. SETTING: Institutional clinical research. MATERIALS AND METHODS: A total of 30 patients who underwent aortic repair for abdominal aortic aneurysm with a Gelseal (n=15) or Hemashield (n=15) were studied. Prior to and immediately following implantation, the diameter of each graft was measured with slide calipers. The external diameter was examined by CT scan 4 weeks after surgery. Early dilation of Gelseal and Hemashield was estimated and compared. RESULTS: Prior to implantation, the external diameter of the Gelseal and Hemashield was 120% and 113% of the package size (PS), respectively, while the internal diameter was 103% and 102% of the PS, respectively. Following implantation, the external diameter of the Gelseal and Hemashield was 122% and 113% (immediately after) and 129% and 118% (4 weeks later) of the PS, respectively. CONCLUSIONS: The actual dilation rate for the first 4 weeks after implantation was estimated as 8% with the Gelseal and 4% with the Hemashield.

Aged↗
PubMed1998

[Clinical and bacteriological studies on panipenem/betamipron in pediatrics. Kanagawa Research Group for Infectious Diseases of Children].

Following its introduction into the market, PAPM/BP (panipenem/betamipron) was clinically studied in 188 evaluable cases out of 207 cases primarily of respiratory infectious diseases treated at the pediatric departments of 15 hospitals. In the clinical evaluation, the drug proved effective in three of three cases of sepsis; three of three cases of suppurative meningitis; nine of ten cases of laryngopharyngitis, six of seven cases of tonsillitis, 56 of 63 cases of acute bronchitis, 90 of 98 cases of pneumonia, and one of one case of phyothorax, all of which are respiratory infectious diseases; one of one case of secondary infection of a chronic respiratory disease; and two of two cases of lymphadenitis, which is a disease of the soft dermal structure. The overall efficacy rate was 91.0% (171/188 cases). In the bacteriological study, Gram-positive bacteria were eliminated in five of five strains of S. aureus, 30 of 31 strains of S. pneumoniae (96.8%), and three of three strains of S. pyogenes. Gramnegative bacteria were eliminated in 15 of 17 strains of H. influenzae (88.2%), three of four strains of M. catarrhalis, and two of two strains of K. pneumoniae. The overall elimination rate was 92.1% (70/76 strains). In the 23 strains of S. pneumoniae that were examined, penicillin-resistant strains accounted for 56.5%, showing an elimination rate of 100%. No serious adverse effects were observed, and the incidence of adverse effects was 1.45%. As for abnormalities in laboratory tests, levels of GOT and GPT increased in eight cases (3.88%), LDH increased in one case (0.48%), and neutropenia occurred in one case (0.51%). These results suggest that PAMP/BP could be considered the first choice in the treatment of infectious diseases in pediatrics, due to its effectiveness and high level of safety.

Adolescent↗
PubMed1998

Routine coronary angiography prior to abdominal aortic aneurysm repair: incidence of silent coronary artery disease.

OBJECTIVE: Routine coronary angiogram (CAG) was performed in patients prior to elective repair of abdominal aortic aneurysm (AAA) to estimate the incidence of coronary artery disease (CAD) and to compare with risk factors for CAD and resting electrocardiogram (ECG). METHODS: History of CAD, risk factors for CAD, resting ECG, and standard CAG were assessed in 50 consecutive AAA patients. RESULTS: Nine patients had a history of CAD. Risk factors included: smoking in 82%, hypertension in 58%, hypercholesterolemia in 42%, and diabetes in 18%. CAG revealed that 46% of the patients had severe CAD with greater than a 75% stenosis of one or more coronary arteries. There was no relationship between the number of risk factors and prevalence of CAD. Eleven patients who had severe CAD as detected by CAG had no history of CAD and displayed no ischemic findings on ECG. No perioperative myocardial infarctions or angial attacks were noted despite the absence of prophylactic coronary interventions or revascularizations. CONCLUSIONS: The prevalence of severe CAD was 46% and incidence of silent CAD was 22% in this AAA population. The numbers of coronary risk factors and resting ECG were not worthwhile for predicting silent CAD.

Aged↗
PubMed1998

Acute sympathetic hyperfunction in overlapping syndromes of systemic lupus erythematosus and polymyositis.

A 20-year-old woman with arthralgia, serositis, thrombocytopenia, proteinuria, muscle weakness, elevated creatinine kinase, and positive anti-Sm antibody was diagnosed as having polymyositis and systemic lupus erythematosus (SLE). She had persistent high temperature, sinus tachycardia, hyperhidrosis, mydriasis, visual disturbance, hallucination, and loss of consciousness. Levels of plasma adrenaline, noradrenaline, and dopamine and cerebrospinal fluid interleukin (IL)-6 and IL-8 were all high. A diagnosis of sympathetic hyperfunction accompanied by central nervous system (CNS) involvement in SLE was made parenteral. Pulse administration of high dose corticosteroid therapy was effective. This is the first reported case of a connective tissue disease with CNS involvement manifesting as sympathetic hyperfunction with high plasma catecholamine levels.

Acute-Phase Reaction↗
PubMed1998

[Alkaline phosphatase (ALP) activity in rheumatoid arthritis (RA): its clinical significance and synthesis of ALP in RA synovium].

Increased concentration of serum alkaline phosphatase (ALP) is a common feature in rheumatoid arthritis (RA), although its origin remains unclear. The aim of this study is to analyze the origin and clinical significance of the elevated ALP value in RA. In 123 RA and 63 age- and sex-matched OA (osteoarthropathy) patients, concentrations of total ALP and its isozymes in serum and synovial fluid were studied. Serum CRP, Fe, ferritin, and Cu values were examined, respectively. The expression of ALP as protein was also investigated by using an enzymehistochemical and an immunohistochemical staining methods. Serum ALP values were elevated in 37.4% of RA (245.2 +/- 91.2 IU/L), and significantly higher than those of OA (192.3 +/- 45.2 IU/L: P < 0.01, RA v.s. OA). The serum CRP, and ferritin values each had a relation with the serum ALP activity. Fluid ALP concentration of RA was 110.3 +/- 40.1 IU/L, and that of OA, 83.6 +/- 15.0 IU/L (P < 0.05), respectively. In RA, a predominant isozyme was liver-type one both in the sera (91%) and the synovial fluid (59%). However, this result means that bone-type one was more abundant in the synovial fluids (41%) than those in the sera (9%). An enzymehistochemical and an immunohistochemical studies revealed that ALP was positive in a perivascular area, sublining cells, and a part of vascular endothelium in RA. In contrast, the synovial tissue from OA and a healthy patient exhibited only a weak staining. In RA, a positive correlation between the elevation of serum ALP and the disease activity was confirmed. Furthermore, we elucidated that ALP is produced in RA synovium.

Adult↗
PubMed1998

[Lupus cystitis and peritonitis successfully treated with intravenous cyclophosphamide pulse therapy: a case report].

The patient, a 35-year-old woman, had been diagnosed as SLE since she developed butterfly rash, arthritis and hair loss with positive antinuclear antibody, anti-DNA antibody, and LE cells in 1989, and treated with daily 20 mg prednisolone (PSL). She had been suffering from nausea, vomiting and waterly diarrhea since 1992. In June 1995, she noted pollakisuria and sense of residual urine, followed by dysuria and nocturia in October. She was admitted to our hospital in January 1996 with progressive gastrointestinal and urinary symptoms. Computerized tomography (CT) depicted thickening of the wall of intestine and bladder, diminished volume of bladder, and bilateral hydronephrosis and hydroureter. Biopsy of the bladder revealed erosion of mucosa and moderate infiltration with inflammatory cells. The diagnosis of lupus cystitis and peritonitis was made and she was initially given intravenous methylprednisolon pulse therapy (500 mg/day) for 3 days, and then switched to 100 mg of daily intravenous PSL. She responded partially to this regimen, but gradually developed gastrointestinal and urinary symptoms again when PSL was tapered down to 70 mg/day. Therefore, monthly intravenous cyclophosuphamide pulse therapy was started. With this therapy, her bladder and bowel symptoms improved, and then the thickness of her bladder and intestinal wall, and the bladder volume normalized. Five months after institution of therapy, PSL was successfully tapered down to 30 mg/day and she was discharged. Intravenous cyclophosphamidepulse therapy is a choice of treatment for steroid-resistant lupus cystitis and peritonitis.

Adult↗
PubMed1998

Successful treatment of aortoesophageal fistula resulting from aneurysm of the aortic arch.

Aortoesophageal fistulas from primary thoracic aortic aneurysms are almost always fatal. In the English literature we have found only four successfully managed cases, all descending thoracic aortic aneurysms. We report an elderly woman who developed an aortoesophageal fistula from an aortic arch aneurysm. She was successfully managed with graft replacement including reattachment of arch vessels and a staged esophagectomy which was accompanied by mobilization of the omentum into the space between the esophagus and the prosthetic graft. She was the first successfully treated patient with aortoesophageal fistula resulting from aortic arch aneurysm.

Aged↗
PubMed1998

Life-threatening reperfusion injury in skeletal muscle: a simple technique to control critical hyperkalemia.

A 55-year-old male suffering from acute abdominal aortic occlusion due to iatrogenic aortic dissection was urgently admitted to hospital. An axillo-bifemoral bypass was constructed 6 hours from the onset of dissection. Before and after revascularization, blood samples were repeatedly obtained from a systemic artery and femoral vein. The arterial potassium concentration gradually increased, reaching 7.3 mM/L. Oliguria and arrhythmias occurred, and the left lower limb became rigid 3 hours after reperfusion. The femoral artery and vein were clamped and within 30 minutes, the arterial potassium concentration fell to 4.8 mM/L. The urine output increased. The left lower limb was amputated, and the patient survived. Immediately following revascularization, hyperkalemia may occur. Clamping of the afferent and efferent vessels is recommended as a simple and practical technique to quickly control life-threatening hyperkalemia.

Amputation, Surgical↗
PubMed1997

Positive chronotropic actions of parathyroid hormone and parathyroid hormone-related peptide are associated with increases in the current, I(f), and the slope of the pacemaker potential.

BACKGROUND: The classic calciotropic hormone parathyroid hormone (PTH) and its paracrine factor parathyroid hormone-related protein (PTHrP) both increase heart rate. METHODS AND RESULTS: We used standard electrophysiological techniques to study the effects of PTH and PTHrP on isolated rabbit sinus node, isolated canine Purkinje fibers, and disaggregated rabbit sinus node myocytes. Sinus node maximum diastolic potential, activation voltage, and amplitude were unchanged by PTH or PTHrP (P>.05). However, the slope of phase 4 and the automatic rate were increased at PTH and PTHrP > or = 10 nmol/L (P<.05). Comparable results were seen in canine Purkinje fibers. We then used the perforated-patch technique to study the I(f) pacemaker current in sinus node. PTH 12.5 nmol/L and PTHrP 12.5 to 18 nmol/L increased I(f) at -65 mV by 68+/-41% (n=5) and 69+/-50% (n=5), respectively. Actions of both agents were reversible. The increase in I(f) appeared to result from a change in maximal conductance and not a shift in the voltage dependence of activation. CONCLUSIONS: These observations provide, for the first time, direct electrophysiological support for the chronotropic actions of PTH and PTHrP. They suggest that classic hormones and paracrine factors can have multiple functions and that in the case of PTH and PTHrP, a newly recognized action is to alter automaticity directly.

Action Potentials↗
PubMed1997

Resting B cells as tolerogens in vivo but only for minor histocompatibility antigens: evidence for activation of resting B cells in vivo.

BACKGROUND: Small, resting B cells (rB cells) express major histocompatibility complex (MHC) class II molecules but not the putative costimulatory molecules, B7-1 (CD80) and B7-2 (CD86); they are classified as nonprofessional antigen-presenting cells. rB cells have been shown to be capable of anergizing T cells in vitro and inducing the prolonged survival of skin grafts mismatched for a single minor histocompatibility (miH) antigen, H-Y. The aim of this study was to investigate ability of rB cells to induce unresponsiveness to multiple miH and MHC antigens. METHODS: Mice were pretreated with 1 x 10(7) donor rB cells 14 days before transplantation of cardiac grafts mismatched for either a single or multiple miH and/or MHC antigens in vivo. RESULTS: rB cells induced indefinite prolongation of cardiac grafts mismatched for H-Y antigen (C57BL/10 male to female). Moreover, 50% of grafts mismatched for multiple miH antigens (C3H to CBA) were accepted indefinitely in recipients treated with donor rB cells. In marked contrast, when grafts were mismatched for either a single MHC class I antigen, Kb (CBK to CBA), or multiple MHC and miH antigens (C57BL/10 to C3H), pretreatment with rB cells did not prolong graft survival. To investigate why rB cells were ineffective tolerogens for grafts mismatched for MHC antigens, we examined the fate of the cells in vivo. We demonstrate that, after intravenous injection of rB cells, expression of B7-2 was induced within 24 hr. CONCLUSIONS: These data suggest that rB cells may be less effective at inducing specific unresponsiveness to MHC antigens because of their rapid activation in vivo.

Animals↗
PubMed1997

Advanced glycation endproducts stimulate mitogen-activated protein kinase and proliferation in rabbit vascular smooth muscle cells.

Advanced glycation end products of bovine serum albumin (AGEs-BSA) exhibited biphasic effects on the proliferation of cultured rabbit vascular smooth muscle cells (VSMCs) in terms of [3H]thymidine incorporation and cell number count; a stimulatory effect was observed at 1-10 micrograms/ml and an inhibitory effect at more than 20 micrograms/ml, while it inhibited [3H]thymidine incorporation even at 1-10 micrograms/ml in cultured bovine vascular endothelial cells (VECs). Transient activation of p42 mitogen-activated protein kinase (MAPK) with a peak at around 5 min and a subsequent sustained phase was induced by AGEs-BSA in VSMCs, but not in VECs. The dependence of MAPK activation on AGEs-BSA dose was correlated with that of VSMCs proliferation.

Animals↗
PubMed1997

Molecular studies on the voltage dependence of dihydropyridine action on L-type Ca2+ channels. Critical involvement of tyrosine residues in motif IIIS6 and IVS6.

The interaction site(s) of dihydropyridine (DHP) antagonists and agonists have been identified by site-directed mutagenesis and localized on motifs IIIS5, IIIS6, and IVS6 of L-type voltage-gated calcium channels. In this study, we investigated the voltage-dependent action of DHPs with mutants of the IIIS6 and IVS6 segments of a cardiac calcium channel. Tyrosine residues in both motifs (Tyr1178 and Tyr1489) strongly contributed to the action of DHP agonists and antagonists. When these two sites were mutated, the communication between the voltage sensor and the DHP interaction site(s) was substantially impaired. In contrast, mutants of a nearby Ile (Ile1182) had much less influence on DHP agonist and antagonist interaction, and the voltage dependence of DHP antagonists was very similar to that of the wild type. The effect of a mutating of Ile1182, on agonist or antagonist action, however, depended strongly on the type of amino acid change. When Ile1182 was substituted with alanine, small changes were noted for DHP agonist and antagonist action. Changing this site into phenylalanine, however, significantly decreased the action of the DHP antagonist. These data show that Ile1182 can preferentially interact with DHP antagonists, but has a lesser contribution in agonist interaction. Thus, even though the agonist and antagonist interaction sites for DHPs with L-type calcium channels may overlap, some amino acids in this site may exhibit a preference for either DHP enantiomers.

Animals↗
PubMed1997

Increase in serum leptin and uterine leptin receptor messenger RNA levels during pregnancy in rats.

Pregnancy is a physiological state associated with significant changes in appetite, thermogenesis, and lipid metabolism, functions which are regulated in part by a hormone, leptin, secreted by adipocytes. Leptin has also been shown to have a role in reproduction, promoting centrally-regulated maturation of the reproductive system and signaling the presence of adequate maternal energy stores for fertility. Here we demonstrate that serum leptin levels are modulated during normal rat pregnancy with a 1.8-fold increase during pregnancy followed by a decrease just before parturition. Leptin receptor mRNA levels in the uterus are also regulated with an increase about 2.7-fold during this same period, whereas there is no change in other tissues examined. The results suggest that leptin may play a role during pregnancy, perhaps regulating energy utilization.

Animals↗