[A case of allergic gastroenteropathy provoked by mite in halation].
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Adolescent↗
Biomedical subjects
M Toyoshima
Publications and source records attributed to M Toyoshima.
[A case of eosinophilic pneumonia caused by inhalation of nickel dusts].
A 16-year-old male, an industrial high school student working at an ironworks, without a dust mask, began to complain of dry cough and fever several hours after inhalation of stainless steel dusts including 0.1% nickel. A chest X-ray film revealed ground glass shadows, patchy shadows and Kerley B lines in the right lung fields. A high resolution chest CT scan showed fusing panlobular densities, thickening of bronchial walls and thickening of interlobular septa. Blood cells counts revealed leucocytosis with eosinophilia. Arterial blood gas analysis revealed hypoxemia. A bronchoalveolar lavage fluid specimen showed a marked increase in the total cell count and in eosinophils. A transbronchial biopsy specimen showed eosinophilic and lymphocytic infiltration in the alveolar septa. Steroid therapy with methylpredonisolne (250 mg x three days) resulted in clinical remission. As we suspected nickel-induced eosinophilic pneumonia, an inhalation provocation test with 0.5% nickel sulfate solution was carried out with the patient's informed consent. Six hours after inhalation he developed a dry cough and fever with leucocytosis and A-aDo2 widening. The positive results of the inhalation provocation test provided a definite diagnosis of nickel induced eosinophilic pneumonia. A review of the world literature revealed three case reports of nickel induced PIE syndrome, all of whom were clinically diagnosed without biopsy however. We believe that this is the first case diagnosed by transbronchial biopsy-proven tissue eosinophilia and a positive nickel inhalation provocation test.
Adolescent↗
[A case of eosinophilic pneumonia, showing a positive environmental provocation test].
A 23-year-old woman was admitted to our hospital because of cough and fever. Coarse crackles were audible over her left chest. A chest X-ray obtained on May 5, 1989, showed consolidation in the left S10 and a nodule in the right S1. Clinical symptoms improved during the course of hospitalization. Neither antibody titers against mycoplasma and chlamydia nor viral titers were elevated in paired sera. BALF findings of the left B10 showed increased numbers of eosinophils and lymphocytes. We diagnosed this case as eosinophilic pneumonia (EP). Environmental provocation testing was carried out in her home and yielded a positive result. After clearing of the house, she was able to return and has since experienced no relapses. We suspect that environmental conditions influence the pathogenesis of EP.
Adult↗
[Percutaneous arterial prostheses of femoro-femoral bypass: using a new method of Modified Seldinger technique].
An experimental study of percutaneous arterial prostheses of femoro-femoral bypass was performed in 3 dogs using Modified Seldinger technique. Modified Seldinger technique with an arc needle was a newly designed method to penetrate the arterial wall due to introduce a bypass graft into the artery percutaneously. In all dogs, the bypass graft was successfully placed and proved to be effective in excellent blood flow. No significant complication was encountered. It is concluded that this method is feasible in the dog model.
Animals↗
[Evaluation of cross circulation in conjoined twins].
This report describes the evaluation of cross circulation in conjoined twins. Female thoracoomphalopagus conjoined twins were delivered by cesarean section after 37 week's gestation. CT, MRI and echography were performed. A partial communication of pericardium and sternum, and a union of the liver were found. For the preoperative evaluation of cross circulation, a bolus of indigo carmine was injected, and the pigment appeared in the urine of the other twin. RI angiography showed that radionuclides in one twin were similar to those in the other after 5-10 minutes. During the operation, an injected bolus of SCC to one twin was not effective for the other twin. Inhaled isoflurane in one twin did not appear in the expired gas of the other twin. After the intentional hemorrhage for 3 minutes from one twin, the hemoglobin concentration of one of the twin was the same as that of the other. This demonstrates that acute hemorrhage from one twin seems to result in a significant and rapid decrease of hemoglobin in both babies equally. However, intravenous infusion of drugs to one of the twins requires a relatively long time to take effect in the other baby. We must be careful in anesthetic management of the surgical separation of conjoined twins.
Anesthesia, Inhalation↗
[Amlexanox has an acute bronchodilator effect in patients with aspirin-induced asthma (AIA)].
Recently, we have reported that a nebulized solution of sodium cromoglycate (SCG) (Intal), a well known antiallergic agent, has an acute bronchodilator effect in patients with aspirin-induced asthma (AIA). Amlexanox is an antiallergic agent, with a structure similar to that of SCG. Therefore, we investigated the acute bronchodilator effect of amlexanox administered orally to adult asthmatics, focusing on a comparison between AIA and non-AIA patients. Fifteen patients participated, 8 having AIA and 7 non-AIA. After performing spirometry during remission, they were administered either amlexanox or placebo using a randomized double-blind protocol. Spirometry was then performed at 30, 60, 90 min, 2 h, and 3 h after administration. The placebo used was lactose. In the AIA group, FEV1 was significantly improved after administration of amlexanox. However, FEV1 was significantly decreased after placebo administration. On the other hand, in the non-AIA group, FEV1 was not changed after administration of either of the drugs. From these results, we conclude that amlexanox has an acute bronchodilator effect only in AIA patients.
Adult↗
Intravenous digital subtraction angiography of the internal jugular veins.
92 patients with various head-related symptoms were underwent study with IV-DSA. The width and density of the internal jugular veins were compared with the width and density of the common carotid arteries. The right internal jugular vein was more than twice as broad as the common carotid artery in 58 patients (63%), and was denser than the common carotid artery in 14 patients (15%). On the other hand, the left internal jugular vein was broader than the common carotid artery in 76 patients (83%) and more than twice as broad as the common carotid artery in 19 patients (21%). However, the left jugular vein was narrower than the common carotid artery in 12 patients (13%), and in 5 patients (5%) could not be demonstrated. If it is recalled that the internal jugular veins are sometimes congenitally aplastic or hypoplastic as developmental variations of the confluence of sinuses, the occurrence of complications associated with retrograde catheterization can be minimized.
Adolescent↗
[A case of sarcoidosis presenting as pulmonary nodules associated with pleural indentation fifteen years after onset].
A 65-year-old woman was admitted to our hospital because of pulmonary nodules, about 3 cm in diameter in the right upper lobe accompanied by pleural indentation, and 5 mm in diameter in the left middle lung field, revealed by chest X-ray. She had no clinical signs or symptoms except achalasia-like discomfort swallowing. Results of physical examinations were within normal limits. A specimen obtained from the nodule in right S2 by transbronchial biopsy showed noncaseating epithelioid granuloma containing asteroid bodies, and negative staining for acid-fast bacilli. No malignant cells were found in the specimen. Bacteriological examination of a bronchial lavage specimen was negative for pyogenic bacteria, mycobacteria and fungi. A PPD skin test was negative. BALF revealed an increase of lymphocytes and elevation of CD4/CD8 ratio. Fifteen years previously, the patient had been diagnosed as having sarcoidosis by scalene node biopsy, and had been treated with steroid therapy. Pulmonary nodules associated with pleural indentation in sarcoidosis is relatively rare, and is usually due to malignancy such as lung cancer. This possibility was ruled out clinically in the present case. Therefore, it was concluded that the pulmonary nodules in this case were due to the sarcoidosis itself.
Age of Onset↗
[A case of streptomycin-induced lupus].
A case of streptomycin-induced lupus occurring in a 48-year-old female is presented. She was admitted to our hospital in July 1990, complaining of productive cough and general fatigue. A chest roentgenogram showed cavitary lesions and infiltrative shadows in the bilateral upper and middle lung fields and a sputum smear tested positive for acid-fast bacilli. She was diagnosed as lung tuberculosis and antituberculous therapy with isoniazid, rifampicin and streptomycin was started. Ten days after starting the treatment, she began to complain of high fever and erythema on her face and forearms. Blood cell count revealed leucopenia. The antinuclear antibody and antihistone antibody were positive. The improvement of clinical findings and the lowering of antinuclear antibody titer seen after stopping streptomycin confirmed the diagnosis as streptomycin-induced lupus. Streptomycin-induced lupus is very rare.
Female↗
Partial anomalous pulmonary venous return showing anomalous venous return to the azygos vein.
Partial anomalous pulmonary venous return (PAPVR) is a congenital heart disease with a reported incidence of autopsied case. The location of the anomalous pulmonary venous return is usually the right atrium, superior vena cava (SVC), and sometimes the brachiocephalic vein, inferior vena cava (IVC) or coronary venous sinus. Recently we experienced a rare case of PAPVR showing anomalous right total pulmonary venous return to the azygos vein. Furthermore, downward translocation of the right upper lobe bronchus was evident. This rare case is reported along with a review of the related literature.
Azygos Vein↗
[Sodium cromoglycate nebulized solution has an acute bronchodilative effect in patients with aspirin-intolerant asthma (AIA)].
Sodium cromoglycate (SCG) (Intal) is a well-known anti-allergic agent which protects against allergen- and exercise-induced bronchospasms. The effect has been recognized non-acute, unlike that of bronchodilators. However, we have found that some patients with aspirin-intolerant asthma (AIA) show significant improvement soon after a single inhalation of SCG nebulized solution. In this study, we investigated the acute bronchodilator effect of SCG given by nebulizer in adult asthmatics, especially compairing AIA with non-AIA (aspirin-tolerant asthma) patients. Twenty patients with AIA and 11 with non-AIA participated in the study. After performing spirometry on remission, they inhaled either SCG via a nebulizer or 4 ml of placebo in a randomized double-blind fashion. After inhalation, spirometry was performed every ten minutes for one hour. The placebo used was a saline solution of the same osmolarity as that of the SCG nebulized solution. Placebo inhalation provoked asthmatic attacks in five of the patients with AIA and one with non-AIA, but SCG did not. In the AIA group, twelve out of the twenty patients also had improved nasal symptoms soon after inhalation of SCG. Forced expiratory volume in one second (FEV1) was significantly improved 10 minutes after inhalation of SCG. Fifty minutes after SCG inhalation, the percent degree of FEV1 improvement was approximately 17%. However, FEV1 was significantly decreased by approximately 14% after inhalation of placebo. In the non-AIA group, FEV1 was not increased after inhalation of SCG. V25 was not changed after inhalation of SCG in AIA and non-AIA groups.(ABSTRACT TRUNCATED AT 250 WORDS)
Administration, Inhalation↗
[A case of asthma relieved by aspirin--the first case in Japan and investigation of its mechanism].
We report a case of asthma that was relieved by aspirin and other cyclooxygenase inhibitors. The patient, a 51-year-old man, was admitted to our hospital because of an asthmatic attack. Onset of asthma had occurred at the age of 40 years, after a flu-like infection, and was preceded for several years by perennial rhinitis and loss of the sense of smell. The course was perennial, and unrelated to the seasons. These clinical features resembled those of aspirin-induced asthma (AIA). Therefore, suspecting AIA, we performed a aspirin-DL-lysine iv challenge test. After aspirin-DL-lysine injection, FEV1 was increased by about 30% and nasal obstruction was improved. Other cyclooxygenase inhibitors (indomethacin, mefenamic acid, ketoprofen) also improved FEV1 by more than 30%. Hydrocortisone sodium succinate (HCs) improved FEV1 about 20%. Lipoxygenase inhibitor (AA861) produced an evident attack, but continued administration did not result in complete tolerance. On the other hand, seven other AIA patients showed no reaction to AA861. DSCG had an acute bronchodilative effect similar to that of AIA. Paraben and chloramphenicol sodium succinate (CMs) produced an asthmatic attack. The present patient showed a marked improvement in response to cyclooxygenase inhibitors and HCs, in contrast to the situation in AIA, and developed an evident asthmatic attack in response to lipoxygenase inhibitor. He showed marked improvement in the response to DSCG and developed an asthmatic attack in response to paraben and CMs, as in AIA. Our results suggest an abnormality of Arachidonic acid metabolism not only in AIA but also in asthma relieved by aspirin.(ABSTRACT TRUNCATED AT 250 WORDS)
Aspirin↗
Waldenström's macroglobulinemia associated with amyloidosis and crescentic glomerulonephritis.
An unusual case of Waldenström's macroglobulinemia associated with amyloidosis and crescentic glomerulonephritis is described. At autopsy, crescent formation was present in 80% of the glomeruli, and the breaks in the glomerular basement membranes were found at the same place as the deposition of amyloid.
Aged↗
Cobalamin derivatives in subcellular fractions of porcine ileal enterocytes.
The distribution of cobalamin derivatives in porcine enterocytes was studied using thin-layer chromatography and bioautography. Compared with the original homogenate, adenosyl-cobalamin (Ado-Cbl) was concentrated 5-10 times in the mitochondrial fraction. Cyanocobalamin was found in the lysosomal fraction, but was not detected in the mitochondria. Methyl-cobalamin (Me-Cbl) was found only in the sap fraction and could not be detected in the total homogenate. Hydroxocobalamin was the main form of Cbl in the lysosomal fraction. These results provide indirect evidence that in enterocytes methylmalonyl-CoA mutase, the coenzyme of which is Ado-Cbl, is located in the mitochondrial fraction and that methionine synthetase, the coenzyme of which is Me-Cbl, is located in the sap fraction. These enzymes thus appear to be distributed in the same way as in liver cells.
Animals↗
[Treatment of occlusive cerebrovascular disease with a selective thromboxane A2 synthetase inhibitor].
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Acrylates↗
[A case of jargon aphasia--a clinicopathological study].
An autopsied case of jargon aphasia by multiple cerebral infarction was reported. A 75-year-old right-handed woman developed a Wernicke's aphasia with the first attack of cerebral infarction in the left hemisphere in July 1980. With the second attack of infarction in October 1980, she developed a neologistic and semantic jargon aphasia, in which her speech consisted of neologisms, literal paraphasias, empty phrases and so-called "misused words". CT-findings showed two low density areas; one was in the left hemisphere and the other in the posterior region of the right hemisphere. Her jargon aphasia persisted for about one year. In November 1981, she suffered a third attack of infarction and developed an apallic syndrome. Neuropathological examination confirmed that the lesion of the right hemisphere played a decisive role in the outbreak of jargon aphasia in this case.
Aged↗
[Key points in nursing. Nursing of a patient with tumor of the common bile duct--care of the patient before and after excision of the tumor, anastomosis of the common hepatic duct and jejunum, and cholecystectomy].
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Adolescent↗