Biomedical subjects

N Kashiwagi

Publications and source records attributed to N Kashiwagi.

At least 19 recordsLinked to original sources

PubMed2001

Safety and efficacy of granulocyte and monocyte adsorption apheresis in patients with active ulcerative colitis: a multicenter study.

Active ulcerative colitis (UC) is characterized by activation and infiltration of granulocytes and monocytes/macrophages into the colonic mucosa. The infiltrated leukocytes can cause mucosal damage by releasing degradative proteases, reactive oxygen derivatives, and proinflammatory cytokines. The aim of this trial (conducted in 14 specialist centers) was to assess safety and efficacy of granulocyte and monocyte adsorption apheresis in patients with active UC most of whom were refractory to conventional drug therapy. We used a new adsorptive type extracorporeal column (G-1 Adacolumn) filled with cellulose acetate beads (carriers) of 2 mm in diameter, which selectively adsorb granulocytes and monocytes/macrophages. Patients (n = 53) received five apheresis sessions, each of 60 minutes duration, flow rate 30 ml per minute for 5 consecutive weeks in combination with 24.4 +/- 3.60 mg prednisolone (mean +/- SE per patient per day, baseline dose). During 60 minutes apheresis, 26% of granulocytes, 19.5% of monocytes and 2% of lymphocytes adsorbed to the carriers. At week 7, 58.5% of patients had remission or improved, the dose of prednisolone was reduced to 14.2 +/- 2.25 mg (n = 37). The apheresis treatment was fairly safe, only eight non-severe side effects (in 5 patients) were reported. Based on our results, we believe that in patients with active severe UC, patients who are refractory to conventional drugs, granulocyte and monocyte adsorption apheresis is a useful adjunct to conventional therapy. This procedure should have the potential to allow tapering the dose of corticosteroids, shorten the time to remission and delay relapse.

Adult↗

PubMed2001

Arthroscopic treatment for traumatic hip dislocation with avulsion fracture of the ligamentum teres.

Traumatic hip dislocation in children is a rare condition. Immediate closed reduction is a treatment of choice, but when incongruent reduction results, it can be due to interposition and requires open arthrotomy. We present a previously unreported technique of arthroscopic treatment that was used successfully for traumatic hip dislocation in a 10-year-old girl with impingement of the avulsed ligamentum teres. Arthroscopy was effective in confirming the exact nature of the interposition material and excising the fragment with minimal invasion.

Arthroscopy↗

PubMed2001

Bilateral humeral lengthening in achondroplasia.

Twenty humeral lengthenings were done on 10 achondroplastic dwarfs using the Ilizarov circular fixator. There were five female and five male patients from 6 years 11 months to 17 years 8 months of age (mean, 12 years 10 months) at the time of the operation. Mean length obtained was 7.8 cm (range, 3.5 cm-10 cm). External fixation time ranged from 105 days to 368 days (mean, 221 days). Healing index averaged 30 days/cm (27 days/cm when two patients with radial nerve palsy were excluded). Two half pins in one patient required replacement. Two humeral fractures occurred, one while in the fixator and the other after removal of the apparatus. Transient radial nerve palsy developed during lengthening in two patients, and lengthening was discontinued. Symptoms of radial nerve palsy resolved completely in both patients, but one patient required an additional surgery to explore the radial nerve for persistent paresthesia of the forearm. Although preexisting loose shoulders deteriorate during lengthening and sometimes cause pain and discomfort, they always resolve spontaneously as lengthening proceeds. Bilateral humeral lengthening was very effective for improving function and overall proportion in patients with achondroplasia.

Achondroplasia↗

PubMed2001

Sequential magnetic resonance imaging in slipped capital femoral epiphysis: assessment of preslip in the contralateral hip.

Thirty-three images using magnetic resonance imaging (MRI) in 10 patients with slipped capital femoral epiphysis were evaluated. The MRI of affected hips delineated typical widening of the physis. Sequential MRI demonstrated the process of premature closure of the physis developing from the posterior portion anteriorly. In 4 of the 10 asymptomatic contralateral hips, physeal widening was clearly observed in the center or posteromedial region of the physis on T1-weighted images. We performed prophylactic pinning for the four cases showing physeal widening on MRI, and none of the other cases developed a slip. MRI accurately documented detailed features of slips, as well as physeal changes, and may provide indicative information on prophylactic pinning for contralateral hips.

Child↗

PubMed2000

Preliminary traction and the use of under-thigh pillows to prevent avascular necrosis of the femoral head in Pavlik harness treatment of developmental dysplasia of the hip.

One hundred and sixty-one hips of 145 patients were treated with the Pavlik harness for developmental dysplasia of the hip. The patients were divided into two groups. Group A consisted of 65 patients (70 hips) who were treated between 1980 and 1987. The harness was applied immediately after the diagnosis. Group B consisted of 80 patients (91 hips) who were treated between 1988 and 1992. These patients received preliminary traction, and small pillows supported the lower extremities from just above the knee to the foot to prevent extreme abduction when the harness was applied. When the distance from the middle point of the proximal metaphyseal border of the femur to the Y-line (distance "a") was 8 mm or more on the initial X-ray picture, the rate of avascular necrosis in group A was 11% and that in group B was 0%; the difference was significant. However, when distance "a" was less than 8 mm, the rate of avascular necrosis in group A was 13% and that in group B was 12%, and there was no significant difference. Thus, we suggest that the Pavlik harness is indicated for developmental dysplasia of the hip in which distance "a" is 8 mm or more. Traction should precede application of the harness, and pillows placed under the thigh must be used during application.

Bedding and Linens↗

PubMed2000

Solitary subependymal giant cell astrocytoma: case report.

In this report, we describe a case of subependymal giant cell astrocytoma in a patient lacking clinical symptoms of tuberous sclerosis. The absence of any features of tuberous sclerosis initially dissuaded us from including subependymal giant cell astrocytoma in our differential diagnosis.

Adult↗

PubMed2000

Human T-cell receptor BV6 gene polymorphism in relation to expression level and CD4/CD8 skewness.

Using 50 samples of umbilical cord blood lymphocytes from Japanese donors, we analysed two human T-cell receptor beta variable (TCRBV) genes, BV6S4 and BV6S5, for their polymorphism, usage frequencies and CD4/CD8 skewness. They showed contrasting CD4/CD8 skewness, BV6S4 to CD8+ T cells and BV6S5 to CD4+ T cells. Genotyping of the BV6S4 alleles (A1, A2 and A3) revealed two of the six possible BV6S4 genotypes, A1/A2 and A2/A2. Among the two BV6S4 genotypes, no significant difference was detected in usage frequency or CD4/CD8 skewness. On the other hand, genotyping of the BV6S5 alleles (A1 and A2) revealed all three possible BV6S5 genotypes, A1/A1, A1/A2 and A2/A2, and the gene usage frequency was high, in the order A1/A1 > A1/A2 > A2/A2. These results indicate that the amino acid substitutions in BV6S5 (S36R and G70E) are in some way associated with the expression level of this gene. In the analysis of CD4/CD8 skewness, the three BV6S5 genotypes had similar skewness, indicating that A1 alleles are expressed more frequently than A2 alleles in both CD4+ and CD8+ T-cell populations. Although BV6S5 exhibits marked skewness to CD4+ T cells, our results indicate that the higher expression of A1 alleles is not associated with the increased ratio of CD4+ T cells.

Alleles↗

PubMed2000

[Novel extracorporeal granulocyte apheresis column inhibits myocardial reperfusion injury: future clinical applications].

OBJECTIVES: Leukocyte infiltration is very important in myocardial ischemia/reperfusion injury. A new extracorporeal circulation therapy using a granulocyte-apheresis column (G-1) has recently been proved to be effective and safe in patients with rheumatoid arthritis and with ulcerative colitis. This study investigated whether this therapy would reduce myocardial ischemia/reperfusion injury. METHODS: Rabbits were subjected to 30 min ischemia followed by 180 min reperfusion with no treatment (control group: n = 12); or treated with extracorporeal blood circulation (2 ml/min) passing through the G-1 (G-1 group: n = 12), or sham column (sham group: n = 12). Infarct size was determined by tetrazolium staining and expressed as a percentage of the area at risk. RESULTS: Infarct size in the G-1 group (15.9 +/- 3.4%) was significantly (p < 0.01) smaller than in the control (34.7 +/- 3.9%) and sham (35.2 +/- 4.1%) groups. Granulocyte emigration into the ischemic myocardium assessed by histopathological score was significantly (p < 0.01) less in the G-1 group (0.58 +/- 0.17) than in the sham group (1.42 +/- 0.26). There was a significant (r = 0.78, p < 0.0001) positive correlation between this score and infarct size. Flow cytometry showed alterations in the adhesion molecule expression on granulocytes during the passage through the G-1, but not sham, columns as a low L-selectin and high Mac-1 form, which is associated with the inability to home to the inflamed site. CONCLUSIONS: Extracorporeal circulation with the G-1 column, a newly-developed clinically applicable therapy, appears to reduce infarct size at least in part by limiting the emigration capacity of granulocytes into the ischemic myocardium.

Animals↗

PubMed1999

Possible mechanisms of immunotherapy for maintaining pregnancy in recurrent spontaneous aborters: analysis of anti-idiotypic antibodies directed against autologous T-cell receptors.

We examined whether immunotherapy for recurrent spontaneous abortion (RSA) using paternal lymphocytes induces anti-T-cell receptor (TCR) idiotypic antibodies in RSA patients. The sera of these patients were assessed for inhibitory activity against mixed lymphocyte reactions (MLR) between maternal responder cells and paternal stimulator cells. Sera of four of the five women who maintained pregnancy successfully after immunotherapy showed significant MLR inhibition, whereas none of the five women who had unsuccessful pregnancies showed significant MLR inhibition. These sera inhibited the MLR of autologous responder T-cells, when stimulated with lymphocytes having the same HLA-DR antigens as the patient's husband, but not when stimulated with lymphocytes having unrelated HLA-DR antigens. This MLR inhibitory activity was absorbed by autologous maternal T-lymphoblasts induced by stimulation with lymphocytes having the paternal HLA-DR type but not by those induced by stimulation with lymphocytes having other HLA-DR types. The maternal serum inhibited the proliferation of autologous T-cells, but not of non-autologous T-cells, stimulated with paternal lymphocytes. These results indicate that anti-TCR idiotypic antibodies were induced in RSA patients by immunotherapy. These antibodies may contribute to maintaining pregnancy by negatively regulating maternal T-cells directed against HLA-DR antigens of the fetus.

Abortion, Habitual↗

PubMed1998

Granulocyte and monocyte apheresis suppresses symptoms of rheumatoid arthritis: a pilot study.

To investigate if granulocyte and monocyte apheresis mitigates the symptoms of rheumatoid arthritis (RA), and influences production of panmyelocytes (CD15+ CD16- cells) at the bone marrow level, 27 RA patients who had elevated granulocyte counts were recruited. The granulocyte and monocyte apheresis column (G-1 column) is an extracorporeal type device packed with 220 g cellulose acetate beads to which granulocytes and monocytes specifically adhere. Patients received apheresis of 1 hr duration twice per week, 8 times over a period of 4 weeks. To prepare CD15+CD16- cells, iliac bone marrow aspirate was obtained at baseline and at 2 weeks after completion of the apheresis course. Ex-vivo proliferation of bone marrow low density cells and production of IgM-RF were also investigated. Following granulocyte and monocyte apheresis, there was a suppressed tendency in the number of CD15+CD16- cells in patients with high bone marrow CD15+CD16- cell counts at baseline. Clinical assessments 2 weeks after the completion of apheresis therapy showed improvements in swollen joint count (P < 0.001), tender joint count (P < 0.001) and duration of morning stiffness (P < 0.005). The results suggest that granulocytes and monocytes/macrophages have a pathological role in RA and apheresis treatment to reduce or suppress these cells should benefit patients with RA.

Adult↗

PubMed1998

MR findings in three pituitary abscesses. Case reports.

We present MR findings in 3 surgically proved cases of pituitary abscess. All lesions were seen as a sellar cystic mass with a thin rim of enhancement. In addition, the pituitary stalk was thickened in 2 cases in which central diabetes insipidus developed. These findings may be suggestive of pituitary abscess.

Brain Abscess↗

PubMed1998

Transition of the craniocaudal velocity of the spinal cord: from cervical segment to lumbar enlargement.

RATIONALE AND OBJECTIVES: The authors investigate the craniocaudal velocity of the spinal cord over its full length by using magnetic resonance imaging. METHODS: A spin-echo pulse sequence with velocity encoding gradients was used to examine five normal volunteers. Oblique-axial phase images at nine levels, from cervical spinal cord to lumbar enlargement, were obtained with prospective electrocardiogram gating. Time-velocity curves were then generated for these levels. RESULTS: Every part of the spinal cord moves first caudally after the R-wave of the electrocardiogram, then cranially. When compared with the cranial levels, peak velocity tend to occur later and their values tend to be smaller at the more caudal levels. CONCLUSIONS: Craniocaudal velocity is transmitted from cervical segment to lumbar enlargement.

Adult↗

PubMed1998

A role for granulocyte and monocyte apheresis in the treatment of rheumatoid arthritis.

Rheumatoid arthritis (RA) is an inflammatory condition, the etiology of which is not well understood. Recent reports indicate a major role of granulocytes in the pathogenesis of RA; arthritic joints are infiltrated with phagocytic leukocytes, granulocytes, and monocytes/macrophages, and it is believed that these cells, by releasing degradative proteinases, cytokines, and reactive oxygen species, contribute to joint destruction. Hence, the apheresis of granulocytes and monocytes may benefit patients with RA. Granulocyte and monocyte apheresis was carried out in 143 patients with RA using an apheresis column (G-1) packed with 220 g cellulose acetate beads, which selectively adsorb granulocytes and monocytes. Patients received 1 or 2 apheresis sessions, each of 1 h duration per week over a 4 week period at a flow rate of 30 ml/min. Apheresis significantly reduced swollen and tender joint counts and the duration of morning stiffness, and it increased grip strength, together with suppression of tumor necrosis factor-alpha and interleukin-1beta production by peripheral blood monocytes. It is concluded that this alternative treatment induces a kind of immunomodulation.

Adult↗

PubMed1998

Epidermoid tumor of the cerebellopontine angle: signal loss in the contralateral cistern.

We report a case of an epidermoid tumor of the right cerebellopontine angle (CPA) in which the contralateral CPA cistern showed abnormal, low signal intensity on T2-weighted fast spin-echo MR images. Diffusion-weighted images showed the epidermoid tumor of the right CPA extending to the prepontine cistern. The cause of the abnormal signal intensity was proved to be an artifactual signal loss due to cerebrospinal fluid flow by phase-contrast MR imaging.

Aged↗

PubMed1997

[Evaluation of the assay technique for detection of anti-chlamydial IgA and IgG antibodies in PID patients].

The purpose of this study is to evaluate the usefulness and limitation of Rapizyme CHLAMYDIA, enzyme-linked immunosorbent assay (ELISA) for qualitative detection of anti-chlamydial IgG and IgA antibodies, in the serum of 92 PID patients and 73 pregnant women, compared with those of Sero IPALISA CHLAMYDIA. The result of Rapizyme analysis was obtained within 10 minutes with no special devices. Overall agreements of Rapizyme and Sero IPALISA were 90.9% (IgG) and 90.3% (IgA) in the total patients, 88.0% (IgG) and 85.9% (IgA) in PID patients, and 94.5% (IgG) and 95.9% (IgA) in pregnant women. The positive rate of Chlamydia in PID was 17.4% (16/92). Positive agreement of Rapizyme in Chlamydia positive PID and pregnant women was 100% in both IgG and IgA, and negative agreement was also 100%. Positive agreement in Chlamydia negative PID was 100% in both IgG and IgA, and negative agreement was 90.0% (IgG) and 83.3% (IgA). The results of Rapizyme were in close agreement with those of Sero IPALISA. COI (cut off index) of Sero IPALISA clearly decreased in 3 of 6 PID patients during a 3 to 6 months period after chemotherapy, but those changes were not observed in Rapizyme. These results suggest that Rapizyme CHLAMYDIA is a useful diagnostic kit for Chlamydial PID of outpatients.

Antibodies, Bacterial↗

PubMed1997

Enhanced expression of CD14 antigen on myeloid lineage cells derived from the bone marrow of patients with severe rheumatoid arthritis.

OBJECTIVE: We previously reported the accumulation of abnormal myeloid cell populations reacting with CD14 (MY4) monoclonal antibody in the iliac and epiphyseal bone marrow of patients with severe rheumatoid arthritis (RA). Therefore, we investigated in vitro production and modulation of CD14+ myeloid cells from iliac bone marrow cells. METHODS: Mononuclear cells were prepared from iliac bone marrow aspirates from patients with RA. The presence of unusual myeloid cells was assessed by 2 color flow cytometry of cells cultured under various conditions. RESULTS: Cultured iliac bone marrow cells of patients with severe RA produced 14.7% of CD14+ CD15+ cells on average. Cultures derived from healthy donors and from patients with a milder form of RA produced fewer CD14+ CD15+ cells (< 10%). The production of CD14+ CD15+ cells was enhanced by granulocyte macrophage colony stimulating factor and interleukin 1beta, but inhibited by T lymphocytes. CONCLUSION: Production and modulation of CD14+ myeloid cells were observed in iliac bone marrow of patients with severe RA.

Adult↗

PubMed1996

T-cell receptor diversity expressed by CD4+ T cells activated by primary allogeneic HLA-DR stimulation: estimation of the degree of CDR3 diversity.

In order to analyse the diversity of T-cell receptors (TCRs) expressed by the T-cell population activated by allogeneic HLA-DR stimulation, TCR beta cDNA was synthesized from mRNA of human CD4+ T cells that had been stimulated in a primary mixed lymphocyte reaction (MLR). The TCR beta cDNA was amplified by the polymerase chain reaction (PCR), subjected to bacterial cloning, and sequenced from V beta through J beta. Twenty-six different V beta and 10 different J beta segments were detected among 56 randomly selected cDNA clones. Occurrences of V beta 17.1 and J beta 1.5 were higher than those found in the CD4+ T-cell population activated with a CD3-specific antibody. A total of 53 different CDR3 sequences, two of them occurring more than once, were detected among the 56 cDNA clones. In order to estimate the degree of CDR3 diversity, amino acid similarity in the CDR3 region of the cDNA was calculated and compared with those of the anti-CD3-activated T-cell sequences as well as those of various published T-cell clone sequences, each directed to either alloantigens or single antigenic peptides. It was found that the similarity score among CDR3 sequences obtained from the MLR (56.4 +/- 10.3) was comparable to those of anti-CD3-activated T cells (55.7 +/- 10.7) and those of T-cell clones directed toward alloantigens (range, 48.4 +/- 12.4-59.4 +/- 13.1), but significantly smaller than those of T-cell clones directed toward single antigenic peptides such as those derived from myelin basic protein (75.6 +/- 17.9) and cytochrome c (76.9 +/- 20.5). These results provide quantitative proof that TCRs of T cells activated by primary allogeneic HLA-DR stimulation have a larger diversity than those recognizing single antigenic peptides.

Amino Acid Sequence↗

PubMed1996

Avascular necrosis and the Pavlik harness. The incidence of avascular necrosis in three types of congenital dislocation of the hip as classified by ultrasound.

We analysed the incidence of avascular necrosis in 101 hips of 90 infants with congenital dislocation treated with Pavlik harness and followed up for more than one year. Using ultrasonography in the flexed-abducted position the hips were classified as type A when the femora head was displaced posteriorly, but within the socket and making contact with the posterior inner wall of the acetabulum; type B when it was in contact with the posterior margin of the acetabulum, with its centre at this level or anterior to it; and type C when it was displaced out of the socket, with its centre posterior to the posterior rim of the acetabulum. Eighty-seven hips were reduced by the harness (86%), and seven of these developed avascular necrosis (8%). All 69 hips with type-A dislocation were reduced and only one (1.4%) showed slight avascular necrosis. Eighteen (78.3%) of 23 hips with type-B dislocation were reduced, and six developed avascular necrosis (33.3%). In one hip, the femoral head was severely damaged. None of the nine hips with type-C dislocation was reduced in the harness. We concluded that the Pavlik harness is indicated for type-A but not for type-B or type-C dislocations.

Contraindications↗