[A case of adult hemolytic-uremic syndrome associated with Escherichia coli O157 infections].
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Adult↗
Biomedical subjects
M Kawase
Publications and source records attributed to M Kawase.
[A study of minimally invasive direct coronary artery bypass (MIDCAB): comparison of low risk group and high risk group].
We started to perform MIDCAB for the cases of markedly low cardiac function from June, 1996 and obtained satisfactory results. So we expanded the indications to include only left anterior descending artery (LAD) lesion from June, 1997 and have since performed this operation on 14 cases. The 14 cases of MIDCAB were divided into two groups, Group L consisting of 6 low risk cases: 1 lesion alone without any complications involving other organ before operation and Group H made up of 8 high risk cases: multi branch lesion but rated as high risk because of the extracorporeal circulation being used. Both Group L and Group H were free of operation death and hospital death. In Group L, all the cases underwent operation without blood transfusion, the period of postoperative stay in ICU was not longer than 1 day, on catecholamine was required after operation and complications were not found either. The patency of the graft was 100 percent. The patients were discharged 13.7 days after operation. In Group H, 2 cases required blood transfusion and 3 cases required catecholamine after operation. Complication arising from operative wound were noted in 3 cases. One GEA graft to the right coronary artery and one LITA to the LAD buried in the muscle were occluded. After operation, hospital stay for 23.9 days was required. In Group L, the postoperative course was excellent, so MIDCAB was considered indicated well for this group. In Group H too, the selection of MIDCAB was considered adequate that the risk of conventional CABG is considered much higher.
Adult↗
[Coronary artery bypass grafting with arterial graft alone: radial artery and inferior epigastric artery used in combination].
UNLABELLED: We experienced 8 cases in which Coronary Artery Bypass Grafting (CABG) was performed by the arterial graft alone with radial artery (RA) and inferior epigastric artery (IEA) used in addition to internal thoracic artery (ITA) and right gastroepiploic artery (RGEA). All the patients were male ranging in age from 50 to 66 years (mean 57.5 year). The number of anastomosis was 3 to 5 branches (mean 3.6 branches). IEA was anastomosed with LITA and used as a composite graft in all cases. As for the proximal anastomosis of RA it was anastomosesd with ascending aorta. On postoperative radiography of graft, LITA, RITA, IEA and RA were all patent and RGEA was occluded only in one anastomosis where it was sequentially used (96.6%). All the patients followed a satisfactory postoperative course, and no case developed any major complications. CONCLUSION: The use of IEA and RA made it possible to perform CABG using only the artery with excellent postoperative results and early patency rate of the graft.
Aged↗
[Strategy in annuloplasty for a juvenile patient with asymptomatic mitral valve prolapse].
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Adult↗
[Pitfalls in echocardiographic diagnosis of mitral bileaflet prolapse].
Preoperative echocardiography provides good planning information for successful repair of mitral valve regurgitation, but identifying the prolapse of both the anterior and posterior leaflets is sometimes difficult. To clarify the cause of this problem, preoperative echocardiographic findings and intraoperative observations of the prolapse were analyzed in 124 patients with non-rheumatic pure mitral regurgitation. In 48 patients with final diagnoses of bileaflet prolapse, 16 (33%) were considered to have only single leaflet prolapse before the operation. Anterior leaflet prolapse was overlooked in 14, and prolapse of either of its commissural segments was the least detectable by echocardiography. Chordal rupture was seen more in the posterior leaflet than in the anterior leaflet. Movement of the anterior leaflet may be influenced by a prolapsed and hypermobile posterior leaflet and/or regurgitant jet flow caused by the posterior leaflet prolapse.
Chordae Tendineae↗
[Hemorrhage exerts different effects on variabilities of heart rate and blood pressure in dogs].
The aim of the present study was to evaluate the effects of hemorrhage on heart rate variability (HRV) and blood pressure variability (BPV) as indicators of autonomic nervous system (ANS) and hypovolemia. We induced hemorrhagic hypovolemia in 7 dogs by removing blood in graded stages (0%, 10%, 20%, 30%, 40% of the estimated blood volume; EBV). HR was unchanged during hemorrhage, while mean BP decreased significantly after 30% EBV hemorrhage. Low frequency component (LF: 0.04-0.15 Hz) of HRV significantly increased after 20% EBV hemorrhage but high frequency component (HF: 0.15-0.4 Hz) of HRV was not altered. LF of BPV increased significantly stepwise after 20% EBV hemorrhage and HF of BPV increased significantly after 30% EBV hemorrhage, showing that both LF and HF of BPV might indicate the degree of hypovolemia. During hemorrhage LF of HRV and BPV increased and HF of HRV was unchanged, indicating the shift of the autonomic balance toward sympathetic dominance. An excellent quantitative correlation between LF of BPV and the degree of hypovolemia was demonstrated during graded hemorrhage, while LF of HRV plateaued at its maximum value at 20% EBV hemorrhage. In conclusion, our study suggests that the spectral analysis of HRV and BPV during graded hemorrhage shows different characteristics in the quantitative evaluation of ANS and hypovolemia.
Animals↗
Attenuation of nitric oxide synthase induction in IRF-1-deficient glial cells.
Nitric oxide (NO) produced by inducible nitric oxide synthase (iNOS) exerts inhibitory and cytotoxic effects on various cells including neuronal cells. Glial NO production, mediated via induction of iNOS, is thought to facilitate neuronal damage during cerebral ischemia. Recently, interferon regulatory factor-1 (IRF-1) has been reported to be an essential transcription factor for iNOS mRNA induction in murine macrophages. However, expression of IRF-1 and its role in the central nervous system have not been examined. In the present study, by using primary glial cell cultures from mice with targeted disruption of the IRF-1 gene, we investigated whether IRF-1 is involved in iNOS mRNA induction in glial cells. After stimulation with lipopolysaccharide and interferon-gamma, IRF-1 mRNA was strongly induced in wild-type (IRF-1 +/+) glial cells. iNOS mRNA induction and nitrite production in IRF-1 -/- glial cells were reduced as compared with those observed in IRF-1 +/+ glial cells. Diethyldithiocarbamate, a selective inhibitor of nuclear transcription factor kappa B (NF-kappa B), completely inhibited iNOS mRNA induction. These results suggest that not only NF-kappa B but also IRF-1 play important roles in iNOS mRNA induction in the central nervous system.
Animals↗
Effectiveness of fructose-modified chitosan as a scaffold for hepatocyte attachment.
Free amino groups of chitosan, a substance which has previously been shown to be a good scaffold for hepatocyte attachment, were covalently modified with fructose. The modification significantly increased the number of cells that could be attached on the surface of chitosan gel. Rat hepatocytes cultivated on fructose-chitosan behaved similarly to those on unmodified chitosan, i.e., they retained the spherical shape they have in vivo, and released much less lactate dehydrogenase than cells attached on a collagen-coated surface. The modification with fructose did not alter the important characteristics of chitosan for hepatocyte culture: liver-specific functions such as urea synthesis and drug metabolism were stably maintained for 5 d in the hepatocytes cultured on fructose-chitosan. In sharp contrast, hepatocytes attached on a collagen-coated surface underwent a severe morphological change, from spherical to flat, and lost almost all their lidocaine-removal activity within 5d. A very thin fructose-chitosan layer was also applied onto the collagen-coated surfaces of polystyrene plates and a dextran microcarrier by crosslinking free amino groups in the chitosan and collagen with glutaraldehyde to fix the thin layer. Hepatocytes on the fructose-chitosan-coated surface retained their spherical shape, masking the cell-flattening effect of the collagen layer. Perfusion culture was then carried out using a hollow-fiber cartridge in which hepatocytes attached on fructose-chitosan-coated microcarriers were suspended in the extracapillary space: the liver-specific functions were stably maintained during 4d of the culture. A fructose-chitosan-coated surface thus appears to be a very promising scaffold for hepatocyte attachment which can be used in cellular biological studies of liver functions, especially in relation to cytochrome P450, as well as in bioartificial liver support systems.
Animals↗
Application of glutaraldehyde-crosslinked chitosan as a scaffold for hepatocyte attachment.
The effectiveness of chitosan, a biocompatible polymer derived by the deacetylation of chitin, as a scaffold of hepatocyte attachment, was examined. Since chitosan gel was too fragile to use for cell culture, its free amino groups were crosslinked by glutaraldehyde to increase its strength. Rat hepatocytes seeded onto glutaraldehyde-crosslinked chitosan (GA-chitosan) gel could stably attach to the surface, retaining its spherical form, the same as in vivo, and then release a very small amount of lactate dehydrogenase during the 5 d culture period. By contrast, hepatocytes on a collagen-coated surface spread flat, and they released much more lactate dehydrogenase than those on the GA-chitosan gel. Hepatocytes on GA-chitosan also retained higher urea synthesis activity, a liver-specific function, than those on the collagen-coated surface. These results indicate that chitosan is a promising biopolymer as a scaffold of hepatocyte attachment, which can be applied to an effective bioartificial liver support system.
Animals↗
Severe hemolysis due to artificial chordae displacement.
Hemolytic anemia is a well-recognized complication of mechanical heart valve prosthesis but, as yet, has not been reported after mitral valve repair with chordal replacement. We report a case of severe hemolytic anemia after mitral valve repair with chordal replacement and Carpentier-Edwards annuloplasty ring insertion. Progressive prolapse of the anterior leaflet due to the artificial chordae being too long caused recurrent regurgitation which was responsible for the hemolysis. The patient also had idiopathic thrombocytopenic purpura, but successful second mitral valve repair was performed after high-dose gamma-globulin therapy.
Anemia, Hemolytic↗
[Radial artery for coronary artery bypass graft].
Early postoperative results were studied in 50 cases of coronary artery bypass graft (CABG) using a radial artery (RA). The patients ranged in age from 37 to 81 years, with the mean age of 61 years. Of them, 49 were male. An average of RA was 17.6 cm at completion of detachment and 15.6 cm when the graft was cut for use. The internal diameter before anastomosis an average of 3.7 mm on the proximal side and an average of 2.8 mm on the distal side. RA was anastomosed with ascending aorta in 47 cases, with the left internal thoracic artery in 2 cases and with the right internal thoracic artery in one case on the proximal side. RA was anastomosed with the left anterior descending branch area in 6 cases, with the left circumflex branch area in 40 cases and with the right coronary artery area in 4 cases on the distal side. There was no case of operative death, but one patient died while in hospital. The cumulative patency rate of the RA grafts was 95% (n = 40). Early postoperative results of the RA graft were satisfactory, therefore the RA graft were satisfactory, therefore the RA graft was an excellent alternative conduit for myocardial revascularization.
Adult↗
Physiologic remodeling annuloplasty to retain the shape of the anterior leaflet: a new concept in mitral valve repair.
BACKGROUND AND AIMS OF THE STUDY: The Carpentier-Edwards (CE) ring was developed to restore the normal 3:4 ratio between the anteroposterior and transverse diameters of the mitral valve orifice during systole. It is difficult to use in patients in whom the ratio is more than 3:4. To overcome this problem, we developed an adjustable obturator, the ratio of which may be changed by sliding apart its two components. METHODS: Remodeling annuloplasty was performed using part of a flexible Duran ring or autologous pericardium and the adjustable obturator in 17 patients with severe MR, including two with high anterior leaflet. RESULTS: Physiologic remodeling annuloplasty was easily accomplished in all cases. Intraoperative echocardiography was performed in 14 patients, and it showed no regurgitant jet in 11 cases and only trivial jet in three. CONCLUSION: Physiologic remodeling annuloplasty to retain the natural shape of the anterior leaflet by using an adjustable obturator is a very useful technique that enables annuloplasty to be performed in all cases, irrespective of the shape of the anterior leaflet.
Adult↗
Inducible nitric oxide synthase following hypoxia in rat cultured glial cells.
Nitric oxide (NO) produced by inducible nitric oxide (iNOS) exerts inhibitory and cytotoxic effects on various cells including neuronal cells. In the present study, we examined the ability of rat glial cells to produce NO following hypoxia/reoxygenation in vitro by measuring nitrite. The levels of nitrite produced in the cultured media of glial cells significantly increased after 12-h hypoxia but not after 0- and 6-h hypoxia. The NOS inhibitor, NG-monomethyl-L-arginine, decreased hypoxia-induced nitrite formation. In glial cells after hypoxia/reoxygenation, the iNOS and mRNA and protein expressions were detected by reverse-transcription polymerase chain reaction and by immunocytochemical analysis, respectively. The present study provides the first evidence that hypoxia induces NO production from glial cells. This hypoxia-induced, glial cell-derived NO may play a critical role in the pathogenesis of cerebral ischemia in vivo.
Animals↗
Effects of age on levels of cysteine, glutathione and related enzyme activities in livers of mice and rats and an attempt to replenish hepatic glutathione level of mouse with cysteine derivatives.
There was a large statistically significant decrease in the hepatic level of cysteine and glutathione (GSH) in 24 month-old mice compared to young mice, while, cystine and glutathione disulfide (GSSG) contents in the liver did not differ between young and old mice. Activities of cystathionine gamma-lyase and beta-synthase in mouse liver of the 24 month-old group were significantly decreased. In rats, the hepatic levels of cysteine, cystine, GSH and GSSG exhibited no statistically significant change during aging to 30 month. As the rats matured, total hepatic activities of both cystathionine gamma-lyase and beta-synthase increased with maximum levels at 24 months of age and decreased to the same level found in 5 week old for the former and to 22% of that in 5 week old for the latter. Intraperitoneal administration of diethyl maleate to mice led to depletion of hepatic GSH. When N-acetylcysteine and a thiazolidine derivative were intravenously injected after diethyl maleate administration, the hepatic GSH level of mice was restored to the normal level.
Acetylcysteine↗
Differential response in the release of hydrogen peroxide between astroglial cells and endothelial cells following hypoxia/reoxygenation.
Hydrogen peroxide (H2O2) and lactate dehydrogenase (LDH) released from cultured astroglial cells (AGs) and brain endothelial cells (BECs) were measured following hypoxia/reoxygenation. AGs released H2O2 to the extracellular space from 8 h of hypoxia with the cellular injury indicated by LDH increase. In contrast, BECs released H2O2 at 4 h of hypoxia, prior to the LDH increase. These results suggest that AGs and BECs play different roles in production and metabolism of oxygen free radicals in the blood-brain barrier (BBB), and AGs may protect the BBB disruption from oxidative stress after hypoxia/reoxygenation.
Animals↗
Variability and phylogeny of the L1 capsid protein gene of human papillomavirus type 5: contribution of clusters of nonsynonymous mutations and of a 30-nucleotide duplication.
We analyzed the variability and established the phylogeny of the L1 capsid protein gene of 33 isolates of human papillomavirus type 5 (HPV5) obtained from epidermodysplasia verruciformis patients from different continents. By comparing the sequences of a 419-bp fragment with those published for two Japanese isolates, we found 12.9% variable nucleotide positions, defining 25 variants with mutation rates ranging from 0.2 to 8.8%. Such a high intratypic diversity is unusual among HPVs. Nine of the 139 encoded amino acids were variable and 12 protein variants were identified. Fifteen of the 16 substitutions observed were clustered in two short regions. A 9-amino-acid insert, already reported for the Japanese HPV5b isolate, was found within one of the regions in five isolates. Our data support that the insert arose from the duplication of a 30-nucleotide sequence. Phylogenetic trees distributed the DNA variants into three subtypes (a to c) with a divergence higher than 4.5% and allowed the recognition of European and African lineages. By contrast with the trees based on the HPV5 E6 gene, HPV5a DNA variants and the HPV5b variants lacking the insert constituted a single group in the L1 amino acid tree, probably reflecting different levels of structural constraints for the HPV5 L1 and E6 proteins. In that respect, the short variable L1 sequences should represent less constrained regions.
Amino Acid Sequence↗
Induction of brain-derived neurotrophic factor (BDNF) and the receptor trk B mRNA following middle cerebral artery occlusion in rat.
Middle cerebral artery (MCA) occlusion in halothane-anesthetized rats induced brain-derived neurotrophic factor (BDNF) and the receptor, trk B mRNA, in brain. In situ hybridization studies showed that BDNF and trk B mRNAs were induced in a widespread region of the ipsilateral cortex outside the infarct at 4 h following MCA occlusion. They were also induced in the bilateral hippocampi which are remote from the ischemic MCA region. These data show that changes in neurotrophic factor and receptor gene expressions can occur in the areas outside the infarct which could survive.
Animals↗
Astroglial cells inhibit the increasing permeability of brain endothelial cell monolayer following hypoxia/reoxygenation.
Blood-brain barrier (BBB) is known to be structured with astroglial cells (AGs) and brain endothelial cells (BECs), and it has been proposed that these cells play different roles in the BBB. We cultivated AGs and BECs from infant rats (2-week-old), and these cells were cultured on the opposing side of collagen membrane to produce a co-culture model of the BBB in vitro. Permeability of the cell layer was evaluated by the electrical resistance through the membrane. To clarify the role of AGs in the BBB disruption following ischemia/reperfusion, electrical resistance of the co-culture model was compared to that of BEC monolayer following hypoxia/reoxygenation. The electrical resistance through BEC monolayer showed 55.5 +/- 15.1 percent reduction at 4 h of hypoxia, and 93.3 +/- 5.4 percent reduction at 8 h of hypoxia (n = 8). However, the co-culture model showed attenuation of the reduction (24.8 +/- 14.2 percent) at 4 h of hypoxia (n = 8, P < 0.01), but not at 8 h of hypoxia (95.3 +/- 5.0 percent). These results indicate that AGs reduce the increasing permeability of the BEC monolayer following short duration of hypoxia/reoxygenation. It is suggested that AGs may have a protective effect to the BBB disruption following ischemia/reperfusion.
Animals↗