Biomedical subjects
Publications and source records attributed to M Tadokoro.
The case of a 49-year-old man with Sweet's syndrome (acute febrile neutrophilic dermatosis) is described, who had coincidently gastric cancer. The therapeutic effectiveness of colchicine is also presented as one treatment for Sweet's syndrome, because rapid regression of the lesions was noticed.
20 cases of coronary artery bypass graft (CABG) were divided randomly into 2 groups. 10 cases (Group I) received epidural catheterization between Th 6/7 at least 24 hours prior to the operation. After operation, these 10 cases were sedated with 3 mg of Morphine hydrochloride given through the epidural catheter. Other 10 cases (Group II) were sedated with 10 mg of Morphine given intravenously. Parameters of cardiorespiratory dynamics such as arterial blood pressure, pulmonary arterial pressure, pulmonary capillary wedge pressure, central venous pressure, oxygen saturation of mixed venous blood, cardiac index, doses of intravenous Nitroglycerin, Dopamine and Dobutamine, arterial blood gas analysis were measured and compared in two groups. No side effect caused by the epidural catheter was found in Group I. Parameters with significant difference in two groups were only doses of Dopamine and base excess from blood gas analysis, but these were not due to the method of sedation. Frequency of the sedation needed within 24 hours after operation was fewer, and the condition of the sedation was better in Group I. The course of postoperative management had no difference between both groups. Epidural Morphine was concluded to be an employable method of sedation after CABG.
A 42-year-old house wife had suffered from abnormal mass lesion in the right pulmonary hilum on her chest X-ray film. MRI showed another mediastinal mass between IVC and descending aorta with high T1 and T2 intensity. Thoracic CT done before MRI missed the latter lesion because only upper mediastinal scanning had been performed. At operation subcarinal and right paraesophageal cysts were successfully removed. Histological examination of the subcarinal cyst showed ciliated pseudostratified columnar epithelium lining, and its thin wall consisted of partly smooth muscle bundle, lymph node, calcification, inflammatory cell infiltration and hemorrhage. The paraesophageal cyst lined by a ciliated pseudostratified columnar epithelium, and the wall consisted of mostly fibrous connective tissue with partly smooth muscle bundle. Although the both cysts were diagnosed as bronchogenic origin, definitive bronchial glands and cartilage could not be recognized. The postoperative course was uneventful. This is the first case report of mediastinal double bronchogenic cysts appeared in the Japanese literature.
A patient with a cavernous hemangioma of the cavernous sinus was operated upon using the Cavitron Ultrasonic Surgical Aspirator (CUSA). Intracapsular subtotal removal of the tumor was accomplished efficiently with the CUSA. At the end of the procedure, however, the CUSA penetrated not only the capsule of the tumor, but also the wall of the internal carotid artery. Advantages and disadvantages of CUSA surgery for cavernous hemangiomas of the cavernous sinus are discussed.
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Aiming at radioimmunodetection of colorectal cancer, anti-CEA monoclonal antibodies (CEA102) were produced by immunization with purified CEA. CEA102 showed high specificity with colorectal cancer by mixed hemadsorption assay and immunoperoxidase technique. The antigen detected by CEA102 was confirmed to be carcinoembryonic antigen (CEA) and its molecular weight was estimated to be ca. 180,000 by biochemical analysis. The in vivo study using nude mice grafted a human colorectal cancer or a human malignant melanoma showed greater accumulation of 125I-labeled CEA102 in CEA-positive colorectal cancer than in nude mouse tissues and CEA-negative malignant melanoma. Moreover we successfully obtained scans with good localization of the grafted colorectal cancer on FCR (Fuji Computed Radiography). Using 131I-labeled CEA102 liver metastasis in the patient with colorectal cancer was successfully detected by external scanning with gamma-camera. These results suggest that radiolabeled CEA102 is useful for the detection of colorectal cancer.
We reported a case of Becker type congenital myotonia with myalgia. A 28 year-old woman admitted to our hospital because of right anterior chest pain and back pain. She was diagnosed as myotonic dystrophy by other university hospital when she was 16 years old. Physical examination revealed only myotonia and could not find muscle atrophy or cataracta which were usually found in myotonic dystrophy. The quadriceps muscle biopsy revealed complete absence of type IIB muscle fiber. We diagnosed her Becker type congenital myotonia by the clinical course and family history and the histopathological findings of quadriceps muscle. Myalgia which she complained seemed to have some connection with this disease. But we could not prove the pathogenesis of this myalgia.
The patient, a 28 year-old-man, was admitted to a hospital because of general fatigue and fever. He was pointed out renal dysfunction and was transferred to Nagasaki University Hospital. The laboratory data on admission showed moderate azotemia (BUN 43 mg/dl, Cr 5.4 mg/dl). A percutaneous renal biopsy on admission revealed a diffuse crescentic glomerulonephritis. A direct immunofluorescence of renal biopsy showed a linear pattern for IgG along the glomerular basement membrane. Radioimmunoassay of his serum for circulating anti-GBM antibody was strongly positive. Aggressive treatment with pulse therapy (methylprednisolone), plasmapheresis, and continuous heparin infusion was performed. He had markedly recovered from renal failure and escaped hemodialysis. The patient is making satisfactory process after 3 years.
We reported a case of syphilitic aortic arch aneurysm, which was examined by IADSA, X-ray CT and MR Imaging. A large aneurysm with the thick mural thrombus and central narrow lumen was clearly shown by MR Imaging. MR Imaging is an useful modality for the diagnosis of the aortic arch aneurysm with a very narrow lumen, which cannot be easily pointed out by IADSA.
In some cases of old myocardial infarction (OMI), left ventricular wall motion was improved after revascularization, though viability of the infarcted myocardium was not detected by left ventriculography (LVG) and exercise thallium-201 myocardial scintigraphy (EX-Tl). So to obtain more correct information of the viability, EX-Tl was performed again after ergometer rehabilitation for an OMI patient whose myocardial viability of the infarcted zone could not detected by LVG and EX-Tl. Incomplete fill in was showed in the EX-Tl after rehabilitation. So percutaneous transluminal coronary angioplasty (PTCA) was performed. Left ventricular wall motion was improved after three months. EX-Tl after rehabilitation is useful to evaluate the viability that could not detected by LVG and EX-Tl.
A 5-year-old girl with multiple pulmonary arterio-venous fistulae was reported. Both her mother and grandmother have been diagnosed as the same disease previously. Her grandmother was treated with resection of the right basal segment for arterio-venous fistulae. Her mother is well with fistulae for more than 20 years. The patient was operated upon to enucleate two larger fistulae in segments 3 and 6 of right lung. Her postoperative course was uneventful. She was discharged from the hospital on the 22nd postoperative day. Pulmonary arteriovenous fistulae are thought to be a part of the hereditary hemorrhagic telangiectasis. Enucleation of the larger fistulae of the lung are preferable even for multiple lesions.
The incidence of tuberculosis is very high in patients treated by hemodialysis particularly in the early stage of hemodialysis. The diagnosis of tuberculosis in dialysis patients was obscured as symptoms were nonspecific and extrapulmonary involvement was seen frequently. We investigated cell mediated immunity in dialysis patients in relation to the period of dialysis. The data indicate that dialysis patients show the following immunological impairments; 1) lymphopenia, 2) decreased B cell, 3) alteration of T cell subset, 4) decreased reaction of PPD skin test, 5) decreased T cell activity, 6) decreased IL-2 production, 7) decreased PHA induced lymphocyte blastogenesis, 8) decreased NK cell. Decreased immunologic host defence mentioned above may contribute to the high incidence of tuberculosis in the early stage as well as in the maintenance phase of dialysis.
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Malignant lymphoma of the left testis was seen in a 53-year-old man. Pathologically, the tumor cell showed malignant lymphoma of the diffuse, small cell type, especially, of lympho-plasmacytoid in LSG classification. Clinically, no other lesions were found. At 26 months following orchiectomy with chemotherapy (CHOP regimen: cyclophosphamide, hydroxydaunomycine, vincristine and prednisone) as well as post-operative irradiation (60Co, 30 Gy.), the patient has been doing well without any clinical evidence of recurrence generalization of the tumor.
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