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Biomedical subjects

M Nishimura

Publications and source records attributed to M Nishimura.

At least 325 records · Page 18Linked to original sources

Treatment of neuroleptic malignant syndrome with direct hemoperfusion.

Neuroleptic malignant syndrome (NMS) is an uncommon but serious and fatal idiosyncratic reaction to neuroleptics. It is difficult to correct this abnormalities successfully. There has been several reports on the treatment of NMS with dantrolene and/or bromocriptine. But these therapy are not effective in every cases. We have experienced ten cases of NMS. Six of them were presented with respiratory distress. Seven patients were treated with direct hemoperfusion and the remainder were managed by dantrolene, bromocriptine and other drugs. Patients treated with direct hemoperfusion two to four times could got a good improvement within several days and recovered. As to the patients treated by drugs. One of them who was not serious recovered with bromocriptine after twenty days. Two patients needed hemodialysis. NMS is occur not only by the use of neuroleptics but also by the break of them. So, this syndrome is do not develop by the high concentration of neuroleptics merely. NMS differed from ordinary drug intoxication. The etiology of NMS has unknown. But two major theories are present. One is dopaminergic blockade theory the other is direct toxic effect on skeltal muscles. We speculate that direct hemoperfusion remove metabolites of neuroleptics or normalize the alteration in the central nervous system.

Adult

[A case report of mediastinal paraganglioma and a review of the literature in Japan].

Paraganglioma is a tumor arising from the extra-adrenal paraganglion system and is rarely observed in the mediastinum. The authors experienced a case of nonfunctioning paraganglioma of the upper posterior mediastinum. The patient was a 40-year-old female in whom abnormal shadows were noted in chest X-ray films taken in March, 1989. She was examined at our hospital with a diagnosis of mediastinal tumor in June of the same year. CT of the chest revealed a tumor in the upper posterior mediastinum and it was shown to be hypervascular by a DSA study. Urinary hormone levels were normal. The tumor was resected in May, 1990. The tumor, measuring 6.8 X 4.0 X 3.5 cm, was encapsulated, appeared dark red and had relatively clear borders. A histopathologic diagnosis of paraganglioma was made. The patient remains disease-free at present, 6 months after operation. Problems concerning diagnosis and treatment of mediastinal paraganglioma were evaluated with a review of cases reported in Japan.

Adult

[Clinicopathological and histochemical studies of linitis plastica type gastric cancer with special reference to early gastric cancer in the region of the fundic gland].

Early gastric cancer in the region of the fundic gland was found to occur predominantly in women. Many lesions of this type were identified in the posterior wall of the middle portion of the stomach. Histologically, the lesions were classified as poorly differentiated carcinomas in all cases of early cancer. In 9 patients with cancer of linitis plastica type having IIc lesions located in the region of the fundic gland, the tumor focus was also in posterior wall of the middle portion of the stomach. Giant folds were present diffusely in all other portions of the gastric mucosa in these latter cases. These cases also had diffuse infiltration of cancer cells into the submucosa, muscle layer and extraserosal regions. Histologically, the lesions were classified in all cases of linitis plastica type as poorly differentiated carcinomas including signet ring cells. Acid mucopolysaccharides (AMPS) and sialic acid were histochemically detected in the interstitial tissues of early gastric carcinomas and linitis plastica type gastric cancers. The AMPS digestion rates were higher for early cancer tissue. The present results support the hypothesis that early gastric cancer in the region of the fundic gland may occur in conditions favoring tumor growth and may develop into cancer of linitis plastica type.

Adenocarcinoma, Mucinous

Validity of salivary thiocyanate as an indicator of cyanide exposure from smoking.

The purpose of this study was to evaluate the validity of salivary thiocyanate as an indicator of cyanide exposure from smoking. The salivary thiocyanate level showed wide variation, and the largest source of thiocyanate was hydrogen cyanide from cigarette smoke. Hydrogen cyanide in the mainstream of cigarette smoke was as high as 40-70 ppm, which is beyond the threshold limit value for occupational health (10 ppm). The hydrogen cyanide level in the sidestream smoke was lower less than 5 ppm. Thus the amount of cyanide intake was larger in active smokers than in passive ones. The correlation between the thiocyanate level in saliva and plasma was statistically significant. Thiocyanate levels in both plasma and saliva increased with the amount of cigarette smoke, and the discriminant powers (smoker versus non smoker) of thiocyanate levels in both plasma and saliva were quite similar. The smoker/non smoker ratio for salivary thiocyanate was 3.04 and that of plasma thiocyanate was 1.73. The result indicated that smoking status could be reflected more by the thiocyanate level in saliva than in plasma. The biological half life of salivary thiocyanate was estimated to be as long as 9.5 days from the changes salivary thiocyanate after stopping smoking. From the results of this study, it was concluded that salivary thiocyanate was a suitable indicator of habitual smoking exposure.

Humans

Possible role of the hormonal form of vitamin D3 in the granuloma-associated angiotensin-converting enzyme activity.

We studied effects of the hormonal form of vitamin D3 on the angiotensin-converting enzyme (ACE) activity of hepatic granulomas in mice infected with Schistosoma mansoni. During 7 to 11 weeks after infection, mice were given orally 0.1 or 1.0 microgram/kg of 1 alpha (OH)D3 or only medium solution every other day. Granulomatous livers were removed at 7, 9 and 11 weeks after infection, and ACE activity was measured in the granulomas isolated from each liver tissue using a fluorometric method. Oral administration of 0.1 or 1.0 microgram/kg/2 days of 1 alpha (OH)D3 for 4 weeks significantly enhanced ACE activity in the granuloma tissue. Since the DNA content relative to a unit weight of protein in the granulomas did not change with the 1 alpha (OH)D3 treatment, it is suggested that the elevated tissue ACE activity is due to an actual increase of the enzyme activity in each granuloma cell. The present observation may have relevance to sarcoid granulomas characterized by an increased tissue ACE activity, since macrophages from patients with sarcoidosis synthesize a biologically active hormonal form of vitamin D3. Namely hormonal form of vitamin D3 locally produced by macrophages is involved not only in systemic Ca++ metabolism but also in the stimulation of macrophages themselves to produce ACE in the granulomas.

Animals

[Immunohistochemical study of glial cytoplasmic inclusion in multiple system atrophy].

Recently, glial cytoplasmic inclusion (GCI) has been demonstrated to be argyrophilic cytoplasmic body by silver staining in the oligodendroglia of patients with multiple system atrophy. We observed such GCIs in all 20 cases of multiple system atrophy. No GCI was noticed in all 6 cases of hereditary spinocerebellar degenerations. Immunohistochemically, GCI was stained positively with antibodies to ubiquitin, alpha-tubulin, and beta-tubulin, of which characteristics is consistent with previous reports. In addition, GCI was first demonstrated to react with an antibody to microtubule-associated protein-1B(5), which is one of the proteins of cytoskeleton organization and a component of cross-bridges between microtubular assembly. The result suggests strong relationship between the formation of the OCI and immunohistochemical expression of MAP-1B(5).

Antibodies, Monoclonal

[A cohort study on deaths from SMON in Japan].

Causes and risk factors of deaths from subacute myelo-optico neuropathy (SMON) were studied in a prospective cohort of 4,329 SMON patients followed for 3 years and 7 months (Sept. 1985-March 1989) with the following findings: (1) Recent excess deaths of SMON patients was estimated as 4% from ratio of O/E (SMR = 104) and deaths due to SMON itself was 6.4%. (2) The ratio of O/E was significantly higher for deaths from cancer of colon/rectum in females, cancer of pancreas in males, hypertension in males, pneumonia/influenza in females, chronic obstructive pulmonary diseases in males, tuberculosis and intestinal obstructive disease in males and females. (3) The ratio of O/E was 1.8 times or greater for those SMON patients with complications of cerebrovascular disease, severe blindness, complete loss of ambulation, and who were bedridden, and who are unable to receive home care from family members or trained home helpers.

Cause of Death

[A case of chronic pulmonary emphysema with a past history of bilateral carotid body resection].

A 76-year-old man, whose carotid bodies had been resected for treatment of bronchial asthma 40 years previously was admitted for evaluation of abnormal arterial blood gases and exertional dyspnea. The case was diagnosed clinically as chronic pulmonary emphysema. His peripheral chemoreceptor function, estimated by hypoxic ventilatory and P0.1 response tests and withdrawal test was non-functioning. His PaCO2 value tended to rise over 50 Torr either after light exercise or during airway infection, though it was normal at rest. In addition his dyspnea had continued for 40 years in spite of carotid body resection. It was concluded that the effect of carotid body resection lasts more than 40 years and it does not have a good effect on COPD.

Aged

[Inferior vena caval resection for renal cell carcinoma: usefulness of renal venous pressure measurement].

Renal cell carcinoma with extended tumor thrombi densely adherent to the vena caval wall sometimes requires vena caval resection. If the tumor is on the right side and the collateral veins of the left renal vein are abundant, vena caval reconstruction may not be required. We recently performed radical nephrectomy and vena caval resection on 2 right renal cell carcinoma patients. To decide the necessity of vena caval reconstruction, left renal vein pressure was measured before and after clamping of the vena cava. In case 1, because the pressure was elevated from 21 cmH2O, to 61 cmH2O, total replacement with Gore-Tex graft was performed. In case 2, because the pressure change was from 22 cmH2O to 23 cmH2O, reconstruction was not performed. The most important test to decide the necessity of vena caval reconstruction is thought to be the change of renal venous pressure before and after clamping of the vena cava.

Aged

[Le Duc-Camey antireflux ureteroileal reimplantation for continent ileal reservoir].

Le Duc-Camey antireflux ureteroileal reimplantation was used on 15 patients with 30 ureters reimplanted into the ileum as part of a bladder substitution procedure (Kock pouch or ileal neobladder: U-bladder) or augmentation cystoplasty (Goodwin ileocystoplasty). In our experience, no reflux was observed, while hydronephrosis was identified in one ureter of ileal neobladder (4%). Le Duc-Camey antireflux ureteroileal reimplantation is suitable for reconstruction with the ileal reservoir.

Aged

[Histochemical and biochemical investigations of monoamine oxidase activity level in the brain of the brindled mouse].

In order to make clear the degree of brainstem affection in Menkes disease, it is important to investigate morphological and enzymatic changes of monoamine oxidase (MAO)-containing neurons in the brain in this disease. For this purpose, MAO activity levels in brain tissue from normal and brindled mice were examined histochemically and biochemically. A coupled peroxidatic oxidation method for the histochemistry and a rapid microfluorimetric method for the biochemical assay were adopted. Animals aged 3 days, 8 days, 13 days, 3 months and 12 months were used for the histochemical study. Three-, 7-, and 12-day-old mice were used for the biochemical study. Histochemical examinations showed no significant differences in the stainability, morphology and distribution of MAO positive neurons in the brain between normal and brindled mice at the same age. Biochemical assays revealed that MAO activity levels in the brain of the postnatal brindled mice rose with age as highly as those in the normal control mice. There were no significant differences in them between normal and brindled mice at the same age. The results indicate that in Menkes disease in mice the brainstem affection, if there is, is not so severe as to influence the morphology and enzyme activity of MAO-containing neurons.

Animals

[A study on thermal regulation disturbance in severely handicapped patients].

Forty-five severely handicapped patients were investigated on body temperature regulation. Poor regulation cases had CT scans showing severe third and lateral ventricle dilatation. Furthermore, in almost all poor regulation cases of perinatal and postnatal onset, CT scans showed extensive low density areas involving the frontal lobe. Electrophysiological studies (sSEP, ABR and blink reflex) could not show definite differences between poor regulation cases and good regulation cases. These findings suggest that hypothalamus, medial forebrain bundle and frontal lobe play important roles in body temperature regulation. On the other hand, perinatal or postnatal onset cases frequently had small body surface areas and low serum creatinine.

Adolescent

[Autosomal recessive oculopharyngeal "muscular dystrophy"--clinical features and association with reduced activity of myophosphorylase].

We reported two cases of brothers demonstrating oculopharyngeal muscular dystrophy (OPMD). The cases had consanguineous parents and five healthy siblings, which suggested the autosomal recessive inheritance. The initial symptom was slowly progressive blepharoptosis with onset in the third decade. On examination, total external ophthalmoplegia was observed in both patients. Additionally, the elder, a 57-year-old man, exhibited dysarthria, dysphagia and muscular weakness with atrophy of the face, bilateral proximal upper limbs and diffuse lower limbs. The younger brother, a 55-year-old man, displayed muscular weakness and atrophy distributed in the face and four limbs. Muscle biopsy of both cases revealed rimmed vacuoles and spheroid bodies in the atrophic and normal-sized fibers. Biochemical study of the biopsy specimens of the elder brother disclosed the myophosphorylase activity reduced to about 40% of the normal value, although in the younger brother, that activity was normal. OPMD is usually inherited in the autosomal dominant mode, and autosomal recessive OPMD is rare. The onset age of our cases was younger than that of the autosomal dominant OPMD. There were some differences in the clinical manifestation between the presented cases, which could be interpreted as phenotypic variation. The elder brother was thought to be associated with McArdle's disease.

Blepharoptosis

Clinicopathological and histochemical studies of linitis plastica type gastric cancer with special reference to early gastric cancer in the region of the fundic gland.

In this study, early gastric cancer in the region of the fundic gland was found to occur predominantly in women. Many lesions of this type were identified in the posterior wall of the middle portion of the stomach. Histologically, the lesions were classified as poorly differentiated carcinomas in all cases of early cancer. On the other hand, in 9 patients with cancer of linitis plastica type having IIc lesions (less than 2.0 cm in diameter) located in the region of the fundic gland, the tumor focus was also in the posterior wall of the middle portion of the stomach. Giant folds were present diffusely in all other portions of the gastric mucosa in these latter cases. These cases also had diffuse infiltration of cancer cells into the submucosa, muscle layer and extraserosal regions. Histologically, the lesions were classified, in all cases of linitis plastica type, as poorly differentiated carcinomas including signet ring cells. Acid mucopolysaccharides (AMPS) and sialic acid were histochemically detected in the interstitial tissues of early gastric carcinomas and linitis plastica type gastric cancers. The AMPS digestion rates were higher for early cancer tissue. The present results support the hypothesis that early gastric cancer in the region of the fundic gland may occur in conditions favorable to tumor growth and may develop into cancer of linitis plastica type.

Adult

Radiation-induced myeloid leukemia in C3H/He mice and the effect of prednisolone acetate on leukemogenesis.

We found that the incidence of spontaneous myeloid leukemia in C3H/He male mice was less than 1%, but it could be increased considerably by total-body X irradiation. The induction of myeloid leukemia was seen to increase after doses from 0.47 Gy (3%) to 2.84 Gy (23.9%), and then decrease after a dose of 4.73 Gy (13.6%). The administration of prednisolone acetate (synthesized glucocorticoid) after irradiation resulted in a significant increase in the incidence of myeloid leukemia from 23.9 to 38.5% after a dose of 2.84 Gy; however, corticosterone, a glucocorticoid secreted by cells, did not have such an enhancing effect.

Animals