Biomedical subjects
Publications and source records attributed to M Sugiyama.
OBJECTIVE: The purpose of this study was to evaluate the clinical performance of newly implemented dynamic MR dacryocystography. CONCLUSION: Dynamic MR dacryocystography, which requires neither ionizing radiation nor chemical contrast media with high viscosity, may be a useful tool for depicting nasolacrimal obstructions.
The injectable cephalosporin cefpirome (CPR) was launched in Japan in 1993. It has widely been used in the various infectious diseases. We therefore studied the clinical and bacteriological efficacy of CPR against infections caused by Bacteroides species, Prevotella species and Porphyromonas species frequently isolated from the obstetric and gynecologic infections. Thirteen institutions were involved in this study which ran from March 1994 to January 1999. The administration dosage of CPR was 2 to 4 gram per day administered by drip infusion or intravenous infusion. The duration of treatment was from 3 to 15 days. The evaluations were performed before and after the treatment. CPR was administered to 194 patients with obstetric and gynecologic infections, and 146 of 194 cases were acceptable for the evaluation of drug efficacy. Bacteroides species were identified in 102 patients. Clinical efficacy in 146 cases was excellent in 12 patients, good in 110, fair in 9 and poor in 15 patients. The eradication rate for Bacteroides species could be in 37 cases out of 54 evaluable cases; Prevotella species in 38 out of 49; and Porphyromonas species in 5 out of 5. The overall assessment of bacteriological efficacy was "eradicated" in 91 cases out of 133 (68.4%). Adverse reactions including abnormal findings in laboratory tests were seen in 8 patients (4.76%). Based on these results, CPR promises efficacy and safety in the treatment of obstetric and gynecologic infections due to Bacteroides species.
A 69-year-old man was referred to us because of severe pain in both girdles. A diagnosis of polymyalgia rheumatica was made, and low-dose prednisolone therapy (20 mg/d) was started. The patient's muscle pain disappeared after 3 weeks. After 5 months of therapy, pancytopenia became prominent. A marrow aspirate smear showed hypercellularity, trilineage dysplasia, and 7% blasts. The clinical diagnosis was myelodysplastic syndrome, subtype refractory anemia with excess of blasts. In elderly patients presenting with polymyalgia rheumatica, an underlying hematologic malignancy should always be looked for when the disease demonstrates clinical signs inconsistent with typical polymyalgia rheumatica.
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In Japan neurocysticercosis is a rare disease. We report a case of neurocysticercosis with a review of the literature. A 29-year-old man presented focal seizure on the left side. Physical and neurological findings on admission were unremarkable. CT and MRI showed a mass with ring-like enhancement and perifocal edema in the right frontal lobe, as well as multiple small masses with calcification. The main mass measuring 8 mm in diameter, was suspected as the eliptogenic focus, and was totally removed via the transcortical approach. Postsurgically seizures did not recur, and histological examination of the mass confirmed a cysticercus. A therapeutic course of albendazole and praziquantel administered postsurgically was effective for the multiple intraparenchymal masses.
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A 73-year-old woman was admitted with sudden-onset back and abdominal pain. Computed tomography scanning revealed type B acute aortic dissection with narrowing of the true lumen. We inserted an oximetric catheter into the right hepatic vein and started continuous measurement of ShvO2. The initial value was 20%. Consecutive aortograms showed an intimal tear in the thoracic descending aorta. Endovascular stent graft placement was performed to close the entry, and ShvO2 rose to more than 60% immediately after the stent graft expansion. ShvO2 is an excellent indicator of abdominal blood flow, not only for early diagnosis but also for the evaluation of treatment.
Bronchial asthma induced by contact with hamsters and other small rodents is receiving higher attention from the medical profession not only because of the problem of laboratory animal allergies (LAA), but also because of increasing household allergens for asthma, since keeping these pets has become more common in Japanese homes. The present report describes our studies on the backgrounds of nine patients with asthma who kept Dzungarian Dwarf hamsters as household pets. The following features were recognized among patients with bronchial asthma induced by contact with hamsters: 1) earlier onset of symptoms than for keeping other household pets, at an average of 14.7 months or within 12 months in 78% of the cases following the start of pet keeping; 2) adults ranging from their late 30s to 40s who have children of primary school age; 3) dwelling in apartments; 4) relatively high level of serum IgE and ECP; 5) positive for both immediate and late type asthmatic responses on an inhaling induction test; and 6) rapid remission after the cessation of pet keeping.
Mitotic index (MI), defined as the ratio (%) of the mitotic-phase-arrested cell number to the total cell number, is higher in the presence of colcemid than in its absence. MI is reduced by anti-tumor agents used in conjunction with colcemid. The ratio of MI, which is defined by the dose of colcemid to that of the supplement with etoposide as an anti-tumor agent and is designated MIR, was 10% at an exposure of 2 h, suggesting that etoposide blocks the cell cycle before 2 h of the mitotic phase. Thus, we established a convenient method to identify a target point in the cell cycle for anti-tumor agents using colcemid. RBL-2H3, a mammalian cell line, exhibited a large number of 2-fold swollen nuclear envelopes after exposure to etoposide. The G2-index, which is the ratio of the number of swollen nuclei to the total number of nuclei, was higher when the cells were incubated with etoposide than without it. In this study, we suggest that the measurement of the G2-index contributes to the screening of putative anti-tumor agents.
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We investigated the effect of reperfusion in patients with complete atrioventricular block within 6 hours after the onset of inferior wall acute myocardial infarction. Early reperfusion may promote the restoration of normal sinus rhythm and effectively reduce infarct size in these patients.
A gene, blmA, from bleomycin (Bm)-producing Streptomyces verticillus, encodes a Bm-binding protein, designated BLMA. The expression of BLMA conferred resistance to Bm in the Escherichia coli host, whereas a mutant protein, designated Pro-9/Leu, with the N-terminal proline 9 residue in BLMA replaced by leucine, did not. We created a fusion protein between the maltose-binding protein (MBP) and a mutant protein Pro-9/Leu/Leu with Met-94 in Pro-9/Leu replaced by leucine. Pro-9/Leu/Leu from the fusion protein, obtained by digestion with CNBr digestion, did not inhibit DNA-cleaving and antibacterial activities of Bm. Native-polyacrylamide gel electrophoresis (PAGE) and gel filtration column chromatographic analysis showed that the molecular size of Pro-9/Leu/Leu is roughly half of that of BLMA, suggesting that the mutant protein cannot form dimeric structure. Furthermore, Far-UV circular dichroism (CD) spectrum of Pro-9/Leu/Leu was quite different from that of BLMA and similar to the spectra obtained from unordered proteins [Venyaminov, S.Y. and Vassilenko, K.S. (1994) Anal. Biochem. 222, 176184], suggesting that the secondary structure of Pro-9/Leu/Leu is disrupted. These results indicate that the mutation abolishes not only dimer formation but also the secondary structure of BLMA, which results in the loss of its function as a Bm-resistance determinant.
High mobility group I(Y) [HMGI(Y)] proteins are architectural factors abundantly expressed during embryogenesis, and their overexpression is known to be closely associated with neoplastic transformation of cells. This study was performed to investigate whether determination of HMGI(Y) expression level could assist in (a) differential diagnosis between colorectal carcinoma, adenoma, and normal tissue and (b) determination of the prognosis of patients with colorectal cancer. To this end, HMGI(Y) expression was determined at both the protein and mRNA levels in 30 colorectal carcinomas, 26 adenomas, and 23 normal mucosa samples, and further correlations between the protein expression levels and various clinicopathological parameters, such as depth of tumor invasion, lymphatic and/or venous involvement, regional lymph node metastasis, and Dukes' stage, were determined in 30 carcinoma cases. The expression of HMGI(Y) proteins was significantly increased in carcinoma and adenoma with severe atypia compared with that in adenoma with less atypia and normal colorectal mucosa. This increase in HMGI(Y) protein expression was found to be because of an increase in its mRNA expression by RNA in situ hybridization analysis. Clinicopathological analysis revealed that the level of HMGI(Y) protein expression was significantly correlated with parameters known to be indicative of a poor prognosis in colorectal cancer patients. These findings indicate that the determination of the HMGI(Y) protein expression level could be a potential marker for the diagnosis of colorectal neoplasias and can be of great value in predicting the prognosis of patients with colorectal cancer.
The transposon Tn5 carries a gene, ble, which confers resistance to bleomycin (Bm) and gives a survival advantage to its host cell. We found that the ble gene product, designated BLMT, is a binding protein with a strong affinity for Bm. BLMT quenched both the antibacterial and DNA-cleaving activities of Bm, when incubated with the antibiotic. An electron spin resonance spin-trapping analysis showed that BLMT inhibits the generation of Bm-induced hydroxyl radical, by trapping Bm but not the hydroxyl radical. Western blot analysis using an anti-BLMT monoclonal antibody revealed that BLMT is immunologically distinct from Bm-binding proteins from Streptomyces verticillus, Staphylococcus aureus and Streptoalloteichus hindustanus. Escherichia coli, transformed with a mutant ble having leucine instead of proline at N-terminal amino acid position 7, lost resistance to Bm, although the cell maintained the survival benefit. This suggests that the Bm resistance mediated by ble is independent of its ability to give a survival advantage to the host bacterium.
It has been reported that production of interleukin (IL)-4, a T helper (Th)-2-type cytokine, might play an important role in the pathogenesis of systemic lupus erythematosus (SLE). On the other hand, it is known that NK1.1(+) cells which belong to CD4, CD8 double-negative, or CD4(+) cells are associated with initial IL-4 production and Th2 differentiation in mice although human equivalent cells are unknown. In order to study the profile of IL-4-producing cells in SLE, cytoplasmic IL-4 and various surface antigens on peripheral mononuclear cells were analyzed. Peripheral mononuclear cells were stimulated for 5 h by phorbol ester and ionomycin in the presence of monensin, fixed, and permeabilized with paraformaldehyde and saponin solution. Then cytoplasmic IL-4 and various surface antigens were analyzed by flow cytometry. IL-4-producing cells in SLE were phenotypically the same as those which produce IL-4 normally and frequently bore activated T-cell (CD7, CD25, CD28, CD29) and NK-cell markers (CD56, CD57). Double-negative T cells and CD57(+) T cells were increased in number and were more frequently positive for cytoplasmic IL-4 in SLE compared with normal controls and various infectious diseases. It was suggested that T cells with NK cell markers, CD57(+) T cells, which are known to extrathymically differentiate, might be involved in the pathogenesis of SLE as a counterpart of mouse NK1.1(+) cells.
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BACKGROUND: The implication of the shape of ST elevation in the acute phase of myocardial infarction (MI) remains unclear. METHODS AND RESULTS: We examined the relation between the shape of ST elevation and infarct size in 77 patients who had a first acute anterior MI with successful reperfusion within 6 hours from symptom onset. A 12-lead electrocardiogram was recorded immediately before reperfusion confirmed by coronary angiography. The shape of ST elevation in lead V3 was classified into 3 types: concave type (n = 24), straight type (n = 41), and convex type (n = 12). For concave type, straight type, and convex type, a median value of peak creatine kinase was 2287, 4371, and 5322 mU/mL, and left ventricular ejection fraction measured by left ventriculography at discharge (14 days after MI) was 58%, 48%, and 41% (P <.05; concave type versus the other 2 types), respectively. A multivariate logistic regression model demonstrated that the concave type of ST elevation was a strong predicting factor for preserved left ventricular function (left ventricular ejection fraction >/=50% at discharge; odds ratio 6.2, 95% confidence interval 1.6 to 20.8, P =.019). CONCLUSIONS: In patients with reperfused acute anterior MI, left ventricular function was excellent in patients with concave type, intermediate in those with straight type, and relatively poor in those with convex type ST elevation at discharge. This simple classification is useful for predicting left ventricular function at discharge.
BACKGROUND: The optimal treatment strategy for treatment of bile duct stones first diagnosed during laparoscopic cholecystectomy has not been established. We prospectively treated unsuspected bile duct stones by means of intraoperative placement of a transcystic catheter followed by postoperative pharmacologic papillary dilation or endoscopic papillary balloon dilation. METHODS: In 17 patients with bile duct stones first found at laparoscopic cholecystectomy, a catheter was introduced via the cystic duct into the bile duct. If postoperative cholangiography via a transcystic catheter showed stones 5 mm or less in diameter, glyceryl trinitrate was infused via the catheter into the bile duct. Patients in whom medical dilation was unsuccessful or who had larger stones underwent endoscopic papillary balloon dilation. RESULTS: Stone diameter measured 3 to 11 mm (mean 6.4 mm). Postoperative cholangiography revealed spontaneous passage in four patients. After pharmacologic papillary dilation, two of five patients with stones 5 mm or less in diameter had stone clearance. The remaining 11 patients underwent successful endoscopic papillary balloon dilation with stone clearance. In two patients, a guidewire introduced via a transcystic catheter through the papilla facilitated selective biliary cannulation. One early minor complication occurred. All patients remained without symptoms for a mean follow-up of 13 months. CONCLUSION: For unsuspected bile duct stones (usually small ones), this strategy is a simple and effective alternative to laparoscopic bile duct exploration and postoperative sphincterotomy and may minimize early and late complications. Transcystic catheterization ensures access to the bile duct, thereby avoiding endoscopic treatment failures.