Colon cancer after Bowen's disease.
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Adenocarcinoma↗
Biomedical subjects
M Sanaka
Publications and source records attributed to M Sanaka.
Spontaneous intramural hematoma localized in the proximal esophagus: truly "spontaneous"?
After a usual meal, a 57-year-old woman with normal hemostasis experienced a hematoemesis. She was then diagnosed endoscopically as having an intramural hematoma of the esophagus, which ranged from 18 cm to 24 cm from the incisors. The hematoma is considered to have developed not "spontaneously" but as a result of direct abrasive trauma by foodstuffs. The authors think it appropriate to use the term "spontaneous" only when the development of hematoma is unrelated to emetogenic events, impaired hemostasis, and food-induced injury.
Esophageal Diseases↗
No difference in seroprevalences of Helicobacter pylori infection between patients with pulmonary tuberculosis and those without.
A previous article reported a possible relationship between a history of tuberculosis and Helicobacter pylori infection. Epidemiologic similarities exist between the two infections: Mycobacterium tuberculosis and H. pylori are transmitted from person to person and the risk of acquiring them is elevated in underprivileged environment. This study was conducted to investigate the relationship between the two infections. Serum concentrations of anti-H. pylori IgG antibody were measured in 40 tuberculosis inpatients on antituberculosis chemotherapy for no more than 3 months (group I; 52.4 +/- 21.4 years of age), 43 tuberculosis inpatients on it for more than 3 months (group II; 57.3 +/- 16.3 years), and 60 nontuberculosis outpatients (control subjects; 55.9 +/- 16.7 years). H. pylori seropositivities were similar among control subjects (73.3%), group I (65%), and group II (69.8%). The difference in the antibody concentrations was significant between control subjects and group I (353.7 +/- 321.2 vs. 176.5 +/- 197.9 U/ml) but was not significant between control subjects and group II (353.7 +/- 321.2 vs. 229.9 +/- 249.5 U/ml). The seroprevalences may not be different between patients with pulmonary tuberculosis and those without, and antituberculosis therapy may not decrease the antibody concentrations.
Adolescent↗
Digoxin-like immunoreactive substance in the elderly patient and its impact on the TDx digoxin assay.
This study was undertaken to examine the impact of endogenous digoxin-like immunoreactive substance (DLIS) on the therapeutic drug monitoring of digoxin in elderly patients. Serum digoxin concentrations were detected by TDx digoxin assay in 220 patients 65 years of age and older who were not administered cardiac glycosides, spironolactone, or canrenone. The influence of clinical factors and laboratory parameters on the presence of DLIS was also evaluated. The concentration of DLIS averaged .07 ng/ml (range, 0-0.74 ng/ml), and in 25 subjects DLIS was observed over the detection limit of the assay. None of the parameters demonstrated a significant contribution to the presence of DLIS except one: continuous intravenous drip infusion therapy with a sodium-containing solution (DIV). The frequency of DLIS was significantly higher in the elderly subjects than in 121 control subjects younger than 35 years of age (p = 0.01). However, the difference became insignificant when subjects administered DIV were excluded from the analysis (p = 0.15). It was suggested that DIV may be clinically important in indicating the presence of DLIS.
Adult↗
Pharmacokinetic characteristics of cisapride in elderly patients.
We demonstrated pharmacokinetic characteristics of cisapride in elderly patients (85+/-6 years) who had suffered from constipation based on intestinal motility dysfunction. After a single p.o. dose of 2.5 mg cisapride tablet on the first day, plasma unchanged cisapride concentrations were detected at 9 points within 24 hours, using high-performance liquid chromatography method. Subsequently, the patients were treated with cisapride 3 times daily during next 26 days (from the day 2 to the day 27). On the 28th day, a cisapride tablet was given once in the morning and blood samples were obtained with the same procedure as that on day 1. The obtained elimination half-life averaged 21.8+/-10.6 hours, which seems to be considerably longer than those previously reported. The area under the time-concentration curve (AUC) on the day 28 was 2.7 times larger than AUC on the day 1, suggesting that plasma cisapride concentrations can become higher than expected by physicians when given 3 times daily to extremely elderly patients. Because cisapride sometimes induces fatal ventricular arrhythmias and sudden death in a concentration-dependent manner, this medicine should be administered once or twice per day to such patients.
Administration, Oral↗
Intestinal Behçet's disease associated with non-Hodgkin's lymphoma.
A 45-year-old man with intestinal Behçet's disease noticed an enlarged right cervical lymph node, and was diagnosed with diffuse large cell type, non-Hodgkin's lymphoma. The intrapelvic lymph tract was markedly deformed because of recurrent ileocecal ulceration, and conventional lymphoscintigraphy with a common tracer did not abolish the suspicion that lymphoma cells may have invaded the lymph nodes. Dynamic lymphoscintigraphy with a new tracer, 99mtechnetium-diethylene triamine pentaacetic acid-human serum albumin, because of its high detection sensitivity, was very useful for excluding this suspicion, and for determining the clinical stage of lymphoma. Combination induction chemotherapy led to complete remission without any adverse effects, but subsequent supportive therapy with same protocol could not be completed because of progression of the intestinal lesions. Special management for the intestinal lesions, such as bowel rest, may be essential with chemotherapy for patients with intestinal Behçet's disease.
Antineoplastic Combined Chemotherapy Protocols↗
A case of type-1 diabetes mellitus formerly diagnosed as maturity-onset diabetes of the young (MODY) carrying suggestive MODY3 gene.
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Adult↗
A simple assessment of the renal function in geriatric patients.
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Aged↗
Angiotensin II-induced pulmonary edema in a rabbit model.
We conducted the present study to propose a rabbit model of pulmonary edema (PE) induced by angiotensin II (AII) and to test the preventive effect of losartan on this form of PE. AII was administered to rabbits intravenously at 50, 100, 150 or 300 microg/kg, either by continuous infusion (10 min) or by bolus injection (30 sec). Continuously administered AII (150 microg/kg) induced PE in most cases, while a bolus injection of the same dosage did not. Additionally, the incidence of PE increased with higher dosages of AII when it was infused continuously. A newly established parameter, the area under the systolic blood pressure-time curve corrected by baseline (cAUC), was prone to rise as the incidence of PE increased. Moreover, cAUC signficantly correlated with the wet-dry lung weight ratio (r=0.66, P<0.05). Subsequently, 0.5 or 3.0 mg/kg of losartan was given before continuous infusion of 150 microg/kg of AII. The higher dosage of losartan prevented PE completely, while the lower one did so moderately. We concluded that intravenous administration of AII induces PE, probably as a result of increasing afterload. Furthermore, an adequate dosage of losartan can prevent PE because it reduces the pressor effect of AII.
Angiotensin II↗
A reliable and convenient parameter of the rate of paracetamol absorption to measure gastric emptying rate of liquids.
The rate of paracetamol absorption represents gastric emptying rate (GER) of liquids. Thus, the liquid GER is assessed by conventional pharmacokinetic parameters such as the maximum concentration and the time to maximum concentration after oral administration of paracetamol. However, the conventional parameters are subject not only to the rate but also to the extent of absorption. For the reliable assessment of GER we have proposed a new parameter, the C0.5/C0.25 ratio, for the rate of paracetamol absorption without being affected by the extent of absorption. Of 15 healthy male volunteers, 9 orally received 10 mg/kg of paracetamol with 200 ml of water as the "normal" GER group, and the other 6 took 10 mg/kg of paracetamol with 200 ml of a liquid nutrient (200 kcal/200 ml), which delays GER, as the "delayed" GER group. Blood samples were obtained at t = 0 (pre-dose), 0.25, 0.5, 0.75, 1.0, 1.5, 2.0, 3.0, 4.0, 6.0, and 8.0 hours (post-dose). In each subject, GER was assessed by the conventional parameters, the C0.5/C0.25 ratio, and the Wagner-Nelson method which provides an accurate estimate of the drug absorption rate. Using the C0.5/C0.25 ratio and the Wagner-Nelson method we could more clearly differentiate the delayed GER group from the normal GER group than by using the conventional parameters. This suggests that the C0.5/C0.25 ratio and the Wagner-Nelson method may be more reliable than the conventional parameters in detecting a delay in GER. Further, it should be noted that the C0.5/C0.25 ratio can be calculated from only 2 blood samples while the Wagner-Nelson method requires repeated blood sampling.
Acetaminophen↗
Serum albumin for estimating creatinine clearance in the elderly with muscle atrophy.
The present study was conducted to develop a special formula to predict creatinine clearance (CCr, ml/min) in the elderly with chronic muscle atrophy using serum albumin (Alb, g/dl). We obtained 90 data sets including actual body weight (BW, kg), urinary creatinine excretion (UCr, mg/24 h), serum creatinine (SCr, mg/dl), and Alb from 90 inpatients aged 60-92 years. Regression equations were determined between the dependent variable of UCr/BW and the explanatory variable of Alb as follows: For males Ucr/BW = 2.695 Alb + 4.665 For females Ucr/BW = 1.827 Alb + 4.146. Then, the new predictive formula was derived from the equations: For males CCr = (19Alb + 32)BW/(100 x SCr) For females CCr = (13Alb + 29)BW/(100 x SCr). Evaluations for the predictive error (predicted CCr- measured CCr) showed that the new formula could provide more accurate and less biased estimates of CCr than the Cockcroft and Gault formula could, even in patients with renal insufficiency and in those with Alb < or = 2.8 g/dl.
Aged↗
Insulin-like growth factors (IGFs) and IGF-binding proteins (IGFBP-1, -2 and -3) in diabetic pregnancy: relationship to macrosomia.
To evaluate the role of insulin-like growth factors (IGFs) and IGF-binding proteins (IGFBPs) in excessive fetal growth (macrosomia) in diabetic pregnancy, 84 insulin-treated diabetic mothers and their infants were tested for serum concentrations of IGF-I, IFG-II, and IGFBP-1, -2 and -3. These parameters were correlated with the birth weight of neonates and placental weight. IGF-I and II levels were determined by specific radioimmunoassays (RIAs) after serum samples were extracted with aid-ethanol. IGFBPs were measured by Western immunoblot with specific antibodies to the respective IGFBP species. Serum concentrations of both IGF-I and IGF-II in mothers with either IDDM or NIDDM increased with the gestational period, reached a plateau at the third trimester, and returned to non-pregnant levels within 7 days after delivery. These values were not different from those in normal mothers before and throughout pregnancy. As previously reported, IGF-I concentrations in cord serum of neonates born to diabetic mothers were (P < 0.01) higher than those of newborns of normal mothers. Likewise, cord blood IGF-II levels were 2-fold higher in babies of diabetic mothers (P <0.001). Fetal IGF-I and IGF-II correlated with each other and with maternal HbA1C, and they positively correlated with either birth weight or placental weight. Cord IGFBP-3 concentrations were significantly higher in diabetic pregnancy, but IGFBP-2 concentrations were not different from those in normal pregnancy. Cord IGFBP-1 concentrations were significantly higher only in babies of mothers with IDDM. None of these cord IGFBP concentrations correlated with birth weight or placental weight. The data suggest that fetal IGF-II, like IGF-I, is involved in fetal and placental growth in diabetic pregnancy. The role of IGFBPs remained to be determined.
Adult↗
Expression of messenger RNA of insulin-like growth factors (IGFs) and IGF binding proteins (IGFBP1-6) in placenta of normal and diabetic pregnancy.
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Female↗
Mutation in the mitochondrial tRNA(leu) at position 3243 and spontaneous abortions in Japanese women attending a clinic for diabetic pregnancies.
Mitochondrial DNA is exclusively maternally inherited. We recently found the prevalence of diabetic patients with an A to G transition at position 3243 of leucine tRNA (3243 base pair (bp) mutation) to be nearly 1% in randomly selected Japanese subjects. Here, we report the higher prevalence of diabetic patients with the 3243 bp mutation in a specific Japanese population of women attending a diabetic pregnancy clinic. Of 102 patients with non-insulin-dependent diabetes mellitus 6 (5.9%) were positive for the mutation, 1 (8.3%) of 12 patients with gestational diabetes and 2 (5.9%) out of 34 borderline diabetic patients. In contrast, none of 64 patients (0%) with insulin-dependent diabetes mellitus had the 3243 bp mutation. Moreover, there was a difference in the prevalence of spontaneous abortions between patients with and without this mutation (27.3 vs 12.4%). Among nine probands with the mutation, four had a history of one spontaneous abortion (p = 0.0518) and two had a history of two abortions (p = 0.0479). Two probands had a spontaneous abortion even while under strict diabetic metabolic control. The 3243 bp mutation thus may cause spontaneous abortion during pregnancy.
Abortion, Spontaneous↗
Rapid and accurate estimation of creatinine clearance in the muscle-wasted elderly by computed tomography.
To develop a new method for accurately predicting creatinine clearance (Ccr) in the debilitated elderly without urine collections, the total muscle volume of both thighs (MV thigh), as a new predictive parameter, was calculated using computed tomography in 68 debilitated patients aged 61-92 years. A regression line between 24-hour urinary creatinine excretion and MV thigh was divided by serum creatinine (Scr), and then the following formula was derived: Ccr (ml/min) = 9 x [MV thigh (cm3) - 100]/[1,000 x Scr (mg/dl)] Predicted Ccr by the new method more closely correlated with measured Ccr (r = 0.862) than did predicted Ccr by Cockcroft and Gault's method (the C-G method) (r = 0.727). Statistical analysis of prediction error (= predicted Ccr-measured Ccr) suggested that the new method could provide more accurate and less biased estimations of Ccr than did the C-G method, even in patients with renal insufficiency. By using computed tomography, we have proposed a more accurate method for predicting Ccr of the debilitated elderly than the C-G method, although the new method has inherent disadvantages of radiation exposure and high cost.
Aged↗
Pulmonary edema induced by angiotensin II in rats.
We performed this study to demonstrate the experimental procedure for inducing pulmonary edema by angiotensin II (AT II) in rats and to determine the mechanism of hemodynamic pulmonary edema. In the pilot study, 10 micrograms/ml of AT II was found to be adequate as the edematogenic dose for inducing pulmonary edema. The edematogenic dose of AT II was intravenously given to rats pretreated with 20 mg/kg of an AT II-receptor antagonist, E 4177 (3-[(2'-carboxybiphenyl-4-yl)methyl]-2-cyclopropyl-7-methyl-3H- imidazo[4,5-b]pyridine), and to rats given 10 mg/kg of an alpha-adrenergic blocker, phentolamine. Similarly, pulmonary edema was induced by 25 micrograms/ml of adrenaline in rats pretreated with E 4177 (20 mg/kg) and rats with no pretreatment. E 4177 completely suppressed the development of AT II-induced pulmonary edema, whereas phentolamine could not. On the contrary, E 4177 could not suppress the development of adrenaline-induced pulmonary edema. We concluded that AT II-induced pulmonary edema will develop via the specific AT II receptor without the indirect action of adrenaline.
Angiotensin II↗
Accumulation of phosphatydilcholine-hydroperoxide in dialysis patients with diabetic nephropathy.
Plasma lipid peroxidation in noninsulin dependent diabetes mellitus (DM) patients were evaluated in DM patients undergoing hemodialysis (HD) by means of a chemiluminescence-HPLC for the specific determination of phosphatidylcholine hydroperoxide (PCOOH). Thirty-three uremic patients with DM nephropathy, undergoing 12 hours HD a week using polymethylmethacrylate membrane, were studied. Of them 22 DM patients on HD were divided into 2 age and sex matched groups treated and conventional group in order to clarify therapeutic effect of 500 mg alfa-tocopherol and 600 mg probucol daily. Fifty DM patients without end-stage renal disease (ESRD) who were age-, period of diabetes-, and sex-matched, were selected as positive control of the subjects. Plasma PCOOH levels were significantly elevated in both DM patients, while the plasma PCOOH in normal controls were 227.0 +/- 68.7 pmol/ml. Plasma PCOOH levels of DM patients undergoing HD were significantly higher than that of patients without ESRD (1,330.8 +/- 642.7 pmol/ml vs. 756.6 +/- 431.9 pmol/ml, p < 0.025). Partial correlation coefficient of plasma PCOOH level demonstrated PCOOH and period of HD in DM patients were highly significantly positively correlated (p < 0.01), although single session of HD was not found to produce significantly increased lipid-peroxidation. Plasma PCOOH roughly remained within similar levels as base lines by medication with anti-oxidant compared to that of conventional group. From these results we conclude that HD intensifies lipid peroxidation and such accumulation of hydroperoxide could account for accelerated progress of atherosclerosis in DM patients with renal insufficiency. It is worthwhile to try an administration of free radical scavenger in order to reduce PCOOH and slow down the progression of atherosclerotic vascular disease.
Adult↗
Insulin-receptor kinase is enhanced in placentas from non-insulin-dependent diabetic women with large-for-gestational-age babies.
The function of insulin receptor and IGF-1 receptor was investigated in placentas from 10 healthy control mothers, 8 diabetic mothers with appropriate-for-gestational-age babies (AGA group) and 9 diabetic mothers with large-for-gestational-age babies (LGA group). None of the diabetic mothers were obese before pregnancy; their blood glucose was well controlled during pregnancy and glycosylated HbA1c was 6.52 +/- 0.71% (M +/- S.E.). Insulin and IGF-1 receptors were partially purified from placentas using wheat germ agglutinin chromatography. The insulin-binding capacity was significantly increased in both the AGA and the LGA groups compared to the control, whereas the IGF-1 binding capacity was similar in the three groups. Autophosphorylation studies were performed with partially purified receptors equalized for similar binding capacity, then immunoprecipitated with anti-insulin receptor antibody or anti-IGF-1 receptor antibody. Insulin-stimulated 32P-incorporation into the insulin receptor beta-subunit was increased by 133% in the LGA group versus the control, whereas incorporation in the AGA group was equivalent to the control. Insulin-stimulated tyrosine kinase activity of the receptor preparation for histone H2B phosphorylation was also significantly increased in the LGA group compared to the control. 32P-incorporation into beta-subunit IGF-1 receptor and IGF-1-stimulated tyrosine kinase activity did not show any significant differences among the three groups. The data in the present study suggest that elevated insulin receptor kinase might be involved in fetal overgrowth in diabetic mothers.
Adult↗