[Treatment of benign esophageal strictures by means of balloon catheter dilatation].
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Biomedical subjects
Publications and source records attributed to M Kawabata.
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The pharmacokinetics of a new, potent H2-receptor antagonist, famotidine, 20 mg i.v. was studied in 7 subjects with normal renal function and in 24 patients with varying degrees of renal impairment. The volume of distribution at steady state was 1.141/kg in normal subjects and was not altered in renal failure. The half-life of elimination was 2.59 h in normal subjects and was unchanged in mild renal failure (creatinine clearance, CLCR 90-60 ml/min/1.48 m2) but was increased to 4.72 h in moderate renal failure (CLCR 60-30 ml/min/1.48 m2), and to 12.07 h in severe renal failure (CLCR below 30 ml/min/1.48 m2). The cumulative urinary excretion and renal clearance of famotidine were correspondingly reduced in patients with impaired kidney function. In normal subjects and in patients with mild to moderate renal failure, about 70% of famotidine was excreted through the kidney, mainly by tubular secretion. In patients with a CLCR above 60 ml/min/1.48 m2 the normal daily dose of famotidine can be employed, but in those with a CLCR between 60 and 30 ml/min/1.48 m2 the dose should be reduced by half, and in patients with a CLCR below 30 ml/min/1.48 m2 a reduction by three quarters of the normal dose is recommended.
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The biting patterns of Lutzomyia trapidoi and Lu. hartmanni, vectors of leishmaniasis, were studied using a human bait in an endemic area on the Pacific slope of the Andes in Ecuador. The results suggest that Lu. trapidoi is primarily an early biter at dusk, with the first peak at 20.00-21.00 hours and the second at 03.00-04.00 hours; and that Lu. hartmanni bites more constantly throughout the night, with a pronounced peak between 23.00 and 24.00 hours. The biting activity, however, shows a marked variation at each site and between different collections at the same site. The activity and the biting places on man are discussed in relation to human infection with leishmaniasis in the area and the location of lesions on patients.
A patient with hypertension is shown to have both a renal artery stenosis due to fibromuscular dysplasia and a hypoplastic contralateral kidney, a condition comparable to that of the one-kidney Goldblatt hypertension. Both blood volume and plasma renin activity were increased. Blood pressure was lowered either by an angiotensin II analog or by captopril. Secretion of excess renin was observed only from the stenotic kidney. A 4-week period of captopril treatment was accompanied by an acute, reversible deterioration of renal function. Transluminal angioplasty corrected the abnormalities in renin and in blood volume and has kept blood pressure and renal function normal for over 2 years.
Heterophile antibodies (Ab) against sheep red blood cells were shown to have developed in mice experimentally infected with Schistosoma japonicum (SJ). Incidence of the elevated Ab levels was markedly high in the period of 6-10 weeks following infection. By means of absorption tests, the heterophile Ab could be distinguished from classical human heterophile Ab of Paul-Bunnell, Hanganutzui-Deicher, and Forssman types. Antigen(s) cross-reactive with the heterophile Ab was found only in goat red blood cells (RBC) but absent on RBC of other species, in various tissue homogenates of syngeneic mice, or in SJ parasites and their eggs. The Ab activity seems to be mainly localized in immunoglobulin classes other than IgM.
In order to determine the vectors of leishmaniasis in Ecuador, 1,054 man biting sand flies from the Department of Cañar were dissected and examined for promastigotes. There were 2 man-biting species, Lu. trapidoi and Lu. hartmanni in this endemic area of the disease. The infection rates were 7.7% in the former and 3.9% in the latter species, demonstrating the different rates in various localities and altitudes of the study areas. There was an association between infection rates and the time of day, suggesting some connection with biting activity of sand fly species. In collections using human bait at 7 study areas in 5 Departments, 6 man-biting species were recognized, indicating different dominant species in each area. It was assumed that the dominant species would play an important role as the principal vector of leishmaniasis in each endemic area. As to species determination of the present Leishmania promastigotes, suffice it to say that the parasites are Leishmania sp., presumably L. braziliensis s.l., until the isolates have been typed.
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Severe renal impairment and massive proteinuria are rare in pheochromocytoma. We report the case of a patient with pheochromocytoma who repeatedly developed episodes of acute renal deterioration and transient, massive proteinuria. Each episodes followed hypotensive periods, two of which seemed to be induced by administration of metoclopramide. The pathogenetic mechanisms of acute renal deterioration and proteinuria are discussed.
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The possible presence of IgM Rheumatoid factors (RF) and anti-DNA antibodies was investigated in sera of patients with Guatemalan onchocerciasis. The mean value of IgM RF in the patients was found to be significantly higher than that in controls and 10 out of 57 patients had increased levels of IgM RF. In addition, serum IgM levels in those 10 patients with increased levels of IgM RF were significantly elevated. In contrast, no significant increase of serum anti-single-stranded (ssDNA) and double-stranded DNA (dsDNA) antibodies were found in the patients.
Sensitive methods of an enzyme-linked immunosorbent assay (ELISA) using red blood cells (RBC) have been developed and were applied to the detection of anti-sheep red blood cell (SRBC) heterophile antibodies (Ab) present in sera of Schistosoma japonicum (SJ)-infected mice. The indirect hemagglutination test (IHA) was used for the purpose as well. By these methods a significant increase in the heterophile Ab levels was demonstrated in the mice particularly after 6-10 weeks of infection. The heterophile Ab in SJ-infected mice were predominantly immunoglobulins resistant to 2-mercaptoethanol treatment and had temperature-independent reactivity. In an attempt to investigate the immunological specificity of the heterophile Ab, various absorption tests were performed; Davidsohn's differential absorption test revealed that the heterophile Ab were distinct from Forssman antibody, Paul-Bunnell antibody and heterophile agglutinins known to appear in serum sickness. The heterophile Ab were absorbed only with SRBC and goat red blood cells, not with other species of RBC such as human O Rh-, O Rh+, A Rh+, B Rh+, mouse, ox, chicken, horse, rabbit, guinea pig, and rat RBC, or syngeneic tissue homogenates including brain, lung, liver, spleen, kidney, muscle, and thymus. This heterophile antibody response is not a consequence of a specific immune response directed to the antigens of SJ parasites, since absorption of the heterophile Ab with SJ adult worms or an egg preparation did not reduce the heterophile Ab level.
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A number of reports of regional intraarterial infusion chemotherapy for malignant tumors have been published. Balloon occluded arterial infusion was newly developed by us. Balloon catheter is used for temporal occlusion of the hepatic artery during intraarterial infusion of anticancer drugs. Interruption of the arterial blood flow keeps the drugs at high concentration for a long time in the distal artery to the occluded portion. This procedure has been performed in 87 cases of hepatomas and metastatic liver cancers with the sufficiently good results.
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The effects of an anabolic steroid on the immune activity and clinical condition of patients with cancer of the uterine cervix were studied. The effects of the steroid on tumor growth were also studied in animals. The results obtained demonstrated that the anabolic steroid (1) enhanced the activity of macrophages and cell-mediated immune activity, (2) reduced the incidence of post-operative infection, (3) reduced pose-operative loss of weight of patients due to the intrinsic anabolic activity of the steroid, and (4) did not exert any influence on tumor growth. Judging from these results, administration of the anabolic steroid would appear to be effective for the improvement of the general condition of cancer patients following surgery or in terminal cases.