Ultrasound detection of diaphragmatic paralysis after cardiac operations.
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Heart Defects, Congenital↗
Biomedical subjects
N Yahagi
Publications and source records attributed to N Yahagi.
[A case of central sleep-apnea syndrome accompanied by bilateral paralysis of the diaphragma after pediatric cardiac surgery].
Sleep-apnea syndrome is a serious problem in respiratory care. Considerable attention has been paid to it, because it sometimes produces severe hypoxia and hypercapnia, and can cause death. We present a case of a six-year-old girl who showed sleep-apnea syndrome. She suffered from bilateral paralysis of the diaphragm after cardiac surgery and had to be managed under mechanical ventilation for three months. When weaning was tried from mechanical ventilation, she frequently showed apnea lasting over 15 seconds at night, and she was diagnosed as having sleep apnea. She was medicated with theophylline to stimulate the so-called respiratory center. Next day she was successfully weaned from mechanical ventilation. After she had been weaned from mechanical ventilation, hypoxia, hypercapnia, and tachycardia were detected by respiratory monitor at night. The respiratory monitor enabled us to identify the clinical appearance of sleep-apnea, and theophylline may have contributed to its improvement.
Cardiac Surgical Procedures↗
omega-Conotoxin GVIA and desipramine insensitive norepinephrine efflux from cardiac sympathetic nerve terminal.
Using dialysis technique, prominent accumulation of norepinephrine (NE) in the myocardial interstitial space was observed under local administration of a monoamine oxidase inhibitor (pargyline, 10 mM), and a vesicle uptake inhibitor (reserpine, 10 microM). Accumulation of NE in the myocardial interstitial space was associated with a reduction of dihydroxyphenylglycol levels. Pretreatment with omega-conotoxin GVIA (10 microM) or desipramine (10 microM) did not suppress this response. A brisk increase in dialysate NE levels might occur as a consequence of exocytotic or neurotransporter insensitive efflux of NE.
Adrenergic Fibers↗
Substratum-dependent and region-specific control of attachment and proliferation of gastrointestinal epithelial cells in primary serum-free culture.
A system for the primary serum-free culture of fetal rat gastrointestinal epithelial cells was used to examine the role of the extracellular matrix (ECM) in the attachment and proliferation of these epithelial cells. Forestomach epithelial cells (FSEC) were able to attach to and proliferate on plastic dishes without a substratum, while glandular stomach epithelial cells (GSEC) and duodenal epithelial cells (DEC) were unable to do so. The presence of a substratum promoted the attachment and proliferation of these epithelial cells. The effects of various components of the ECM differed depending on the type of cell. FSEC attached most efficiently to a substratum of fibronectin, while GSEC did so to laminin. DEC attached more efficiently to type I collagen and fibronectin than to any other substratum. FSEC proliferated most rapidly on laminin, while GSEC and DEC did so on collagen gels. These substrata induced the most efficient attachment and proliferation of FSEC, and they were effective in promoting the attachment and proliferation of GSEC and DEC in decreasing order of efficiency, indicating the existence of a head-to-tail gradient in the response of epithelial cells to substrata. The expression of c-myc mRNA in these cells differed depending upon the substratum on which they were cultured and the mRNA level was well correlated with the extent of the cell proliferation, indicating that the cell proliferation is mediated by c-myc gene expression, which is regulated by cell-ECM interactions. The results of the present study demonstrate that proliferation of gastrointestinal epithelial cells is regulated region-specifically not only by soluble factors but also by insoluble components of the ECM.
Animals↗
Cowden's disease with a defined genetic alteration--chromosomal duplication at 15q11-q13.
Cowden's disease, multiple hamartoma syndrome, is a dominantly inherited disorder characterized by multiple hamartomas of ectodermal, endodermal, and mesodermal origin and also by a high incidence of malignant tumors. Despite many efforts to identify the genetic alterations responsible for the syndrome, the molecular mechanism remains unclear. We report a case of Cowden's disease in which karyotype analysis revealed a small duplication (about 1 Mb) at 15q11-q13. This part of the genome is a region that is deleted in the Prader-Willi/Angelman syndrome and is a "hot spot" of chromosomal duplication.
Chromosome Aberrations↗
Apoptotic cell death in atherosclerotic plaques of hyperlipidemic knockout mice.
In an attempt to understand the roles of apoptosis in the development of atherosclerosis, we classified lesions developed in the aortas of apo E- and LDL receptor-deficient mice, murine models of atherosclerosis, and determined frequency, spatial distribution and cell types of apoptotic cells in each lesion. Terminal deoxynucleotidyl transferase-mediated dUTP nick end labeling (TUNEL) and nuclear staining with propidium iodide were used to demonstrate apoptotic cells. Mean frequencies of TUNEL-positive cells were as follows: 0%, in Type I, 0.3% in Type II, 0.05% in Type III, 0.06% in Type IV and 0.06% in Type V lesions. Most of the TUNEL-positive cells were filled with fat and distributed in close proximity to lipid pools. The TUNEL-positive cells in the intimal side of the lipid cores were macrophages, while some of those in the adventitial side were smooth muscle cells. In conclusion, apoptosis is involved in the active turn-over of foam cells of both macrophage- and smooth muscle cell-lineage especially in the early atherosclerotic lesions of the hyperlipidemic mice.
Age Factors↗
Proliferation, differentiation and morphogenesis of fetal rat glandular stomach transplanted under the kidney capsule of syngeneic hosts.
Undifferentiated glandular stomach tissue fragments from 16.5-day fetal rats were transplanted under the kidney capsule of syngeneic adult rats, and the proliferation, differentiation and morphogenesis of the transplanted tissues were investigated. Gastric epithelial cells began to invaginate 3-4 days after the transplantation and immature glands were formed after 1 week. During the period, there was a gradual increase in the expression of pepsinogen and cathepsin E, markers of cytodifferentiation of the stomach epithelia, both at protein and mRNA levels. Cathepsin E was weakly expressed in undifferentiated gastric epithelial cells at 16.5 days of gestation, and a higher level of the expression was observed in differentiated epithelia of the transplants. In contrast, the pepsinogen-producing cells first appeared around days 3-4 after transplantation and gradually increased in number to about 30% of the epithelial cells and became localized at the bottom of the gland. During the period of the experiment up to 1 month, the pepsinogen-producing cells were all positive for class III mucin and cathepsin E, indicating the immature character of these cells. In addition, no parietal cells were observed. When the tissue fragments were transplanted into adrenalectomized animals, the epithelial differentiation and morphogenesis was suppressed, but its proliferation was enhanced. The observed changes were reversed by hydrocortisone replacement. These results suggest that the development of the 16.5-day fetal stomach is regulated intrinsically to a certain extent by the genetic program of the cells involved and various gastric functions develop in the absence of luminal stimulation, stage-specific systemic hormonal change, neuronal regulation or other systemic influences, and that glucocorticoids modulate the developmental program of the fetal stomach tissues.
Adrenalectomy↗
Detection of tracheal stenosis by cineangiocardiography in infants with congenital heart disease.
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Child, Preschool↗
Effects of inhaled nitric oxide on postoperative pulmonary circulation in patients with congenital heart disease.
We studied 22 patients with residual pulmonary hypertension or symptoms of postoperative pulmonary hypertensive crisis. They received low-dose inhalation (10 ppm) of nitric oxide (NO), a selective pulmonary vasodilator, after total correction for congenital heart anomalies. Fifteen minutes of NO inhalation improved the pulmonary circulation and lessened the imbalance in the ventilation-perfusion ratio in both groups. Thus, NO inhalation is effective in the treatment of pulmonary hypertension and in the prevention of pulmonary hypertensive crises after total correction for congenital heart anomalies. All patients continued to receive NO therapeutically. The duration of such therapeutic NO inhalation was well correlated with postoperative Qp/Qs (p = 0.014) and Rp/Rs (p = 0.029).
Administration, Inhalation↗
Long-term sedation with isoflurane in postoperative intensive care in cardiac surgery.
After cardiac surgery, patients often require prolonged mechanical ventilation. We studied the effectiveness and potential toxicity of isoflurane sedation in 40 patients undergoing mechanical ventilation after cardiovascular surgery. All patients who received isoflurane (0.5-1.0 minimum alveolar concentration [MAC] were well sedated by it without significant adverse effects, such as renal, hepatic, or cardiovascular dysfunction. The highest serum inorganic fluoride concentration recorded was 45 mumol/L after 98 MAC h. Patients on isoflurane recovered more rapidly and were weaned from mechanical ventilation sooner than those sedated with intravenous drugs including fentanyl/midazolam. Patients who received intravenous sedatives, but not those on isoflurane, often showed tachyphylaxis in the early stages, and some exhibited an abstinence syndrome involving nonpurposeful movements. Patients sedated with isoflurane did not show these two side effects. In conclusion, isoflurane can provide effective long-term sedation for patients after cardiovascular surgery without significant adverse effects.
Acute Kidney Injury↗
Helium/oxygen breathing improves hypoxemia after cardiac surgery.
The effects of helium/oxygen (He/O2) on oxygenation (respiratory index [PaO2/FiO2] and intrapulmonary shunt [Qs/Qt]) and on lung parameters (dynamic compliance [Cdyn] and peak inspiratory pressure [PIP]) were studied in 12 patients. After cardiac surgery, they had impairment of oxygenation without physiological findings and with normal chest radiographs despite having a positive end expiratory pressure of up to 10 cm H2O. After 90 min of inhalation of He/O2, oxygenation had improved significantly; that is, PaO2/FidO2 increased significantly (from 113 to 174 mm Hg; mean values are given; p < 0.01), and there was a significant fall in Qs/Qt (from 29 to 19%; p < 0.001) together with an increase in Cdyn (from 60 ml/cm H2O to 64 ml/cm H2O; p < 0.05). These results suggest that He/O2 may have improved oxygenation by recruiting previously obstructed small airways and alveoli.
Administration, Inhalation↗
Successful treatment of mediastinitis after cardiovascular surgery using electrolyzed strong acid aqueous solution.
Dilute povidone-iodine solution has been widely used as an irrigant for the treatment of mediastinitis. However, its use is not without adverse effects and often causes poor growth of granulation tissues. To avoid the problems seen with the use of povidone-iodine solution, we applied electrolyzed strong acid aqueous solution (ESAAS) to mediastinal irrigation in 4 patients (2 infants and 2 adults) who developed mediastinitis after cardiovascular surgery. According to the "open" method, the mediastinal wound was left open and irrigated with ESAAS 1 to 3 times a day until the infection was eradicated. Satisfactory growth of granulation tissues was observed in all patients treated with no evidence of adverse effects attributable to ESAAS. Delayed primary sternum closure was performed for 2 patients, and musculocutaneous transposition of rectus abdominis for 1. Our experience suggests that irrigation with ESAAS is a safe and effective method of therapy for mediastinitis.
Acids↗
[A case of fatal pneumonia caused by Legionella pneumophila serogroup 6 developed after drowning in a public bath].
A 57-year-old male was admitted to our hospital because of high fever, productive cough and dyspnea. Six days prior to admission he had an episode of drowning in a public bath. On admission chest X-ray showed wide-spread pneumonia causing severe respiratory distress for which mechanical ventilatory support was started. Despite chemotherapy including erythromycin and rifampicin his condition continued to deteriorate. Chemistry showed marked elevation of CPK and findings of acute renal failure. He eventually passed away with septic shock. During the course Legionellae remained negative with culture of broncho-alveolar lavage fluid. L. pneumophila serogroup 1 (SG1) antigen in the urine was not detected, and no elevation of serum antibody titer was noted. Culture of the material obtained from the lung abscess at autopsy revealed L. pneumophila SG6 and serum antibody titer against SG6 also was found to be extremely high. With this evidence we concluded that this case of pneumonia was caused by L. pneumophila SG6. We believe this is the first reported case of the SG6 pneumonia in Japan. Another remarkable feature of this case was massive rhabdomyolysis pathologically confirmed after autopsy. Although the pathogenesis of this process has not been clarified, there are several case reports of rhabdomyolysis complicated with Legionnair's disease in the past. Therefore, we should bear in mind and pay careful attention while coping with this disease.
Baths↗
Nitric oxide (NO) inhalation.
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Administration, Inhalation↗
Stage-specific elevated expression of the genes for hepatocyte growth factor, keratinocyte growth factor, and their receptors during the morphogenesis and differentiation of rat stomach mucosa.
Hepatocyte growth factor (HGF) and keratinocyte growth factor (KGF) are two factors considered to be involved in the morphogenesis of several organs. To understand the role of HGF and KGF in the stomach development, we analyzed changes in the levels of expression of the genes for the two growth factors and their receptors in the fetal rat stomach by competitive RT-PCR. Resembling our previous results for HGF, the expression of the genes for KGF and its receptor was observed in the mesenchyme and epithelium of 16.5 day fetal stomach, respectively, indicating the possibility that KGF mediates the epithelial-mesenchymal interaction in the early stage of stomach development. The developmental profile of the expression of the genes for the two growth factors and their receptors were different, indicating a difference in their roles; the genes for HGF and c-met, the receptor for HGF, are expressed mainly during the morphogenetic period, while the genes for KGF and its receptor mainly after the morphogenetic period. Thus, it is probable that HGF controls the proliferation of epithelial cells during the morphogenetic process. The expression of the genes for KGF and its receptor is not correlated with epithelial proliferation during morphogenesis, but it does appear to be linked with epithelial differentiation. These results, together with the absence of significant mitogenic effect of KGF on the epithelial cells of the fetal rat glandular stomach in vitro, suggest a role for KGF as a differentiation factor. In addition, the expression profile of the genes for KGF and its receptor towards the end of fetal period appears to be closely correlated with that of mesenchymal cell proliferation, suggesting another role for the growth factor that is not regulated by the epithelial-mesenchymal interaction.
Animals↗
Complementary DNA cloning and sequencing of rat enteropeptidase and tissue distribution of its mRNA.
A cDNA clone encoding enteropeptidase (EC 3.4.21.9), a key enzyme for the conversion of trypsinogen to trypsin, was isolated from a rat duodenal mucosa cDNA library. Sequences of the 3585 base pair clone predicted that enteropeptidase is synthesized as a single-chain precursor form, proenteropeptidase, consisting of 1058 amino acid residues with an internal signal sequence (51 residues) and is then processed into the mature enzyme consisting of three different peptide chains, i.e., mini, light and heavy chains, not the previously reported two-chain enzyme. The structure of enteropeptidase is relatively conserved among different species and the rat enteropeptidase is 24 and 39 amino acids longer than the porcine and human ones, respectively. Northern blot analysis of rNAs from normal rat tissues revealed that the enteropeptidase mRNA of around 4.4 kb in size was expressed only in the duodenal mucosa, and high proteolytic activity of the enzyme was detected in the proximal small intestine. Additional analysis of the RNAs by RT-PCR revealed that a low level of the mRNA was also expressed in the other parts of the small intestine, i.e., jejunum and ileum. These results indicate that the biosynthesis of enteropeptidase takes place mainly in the proximal small intestine, the duodenum, and the importance of the region in the physiology of intestinal protein digestion regulated by the enzyme is suggested. Furthermore a faint signal of the mRNA was also detected in the stomach, colon and brain in which the existence of trypsin-like serine proteases were reported. The significance of the low level expression of the gene is unclear, but the potential peptide-processing function of the enzyme in these tissues is also suggested.
Amino Acid Sequence↗
The culture fluid of Isaira japonica yasuda augments anti-sheep red blood cell antibody response in mice.
Isaria japonica YASUDA was cultured in a liquid medium, and its culture fluid (IJCE) was tested for stimulatory activity to humoral antibody production. IJCE significantly enhanced the production of anti-sheep red blood cell (SRBC) plaque forming cells (PFC) by oral ingestions at 10 and 30 mg/kg/d for 4 consecutive days, either before or after SRBC challenge. It also recovered the reduction of anti-SRBC PFC response and number of spleen cells caused by treatment with 5-fluorouracil. It is suggested that IJCE is a promising source for an immunomodulating tool or medicine.
Adjuvants, Immunologic↗
Effects of long-term omeprazole treatment on adult rat gastric mucosa--enhancement of the epithelial cell proliferation and suppression of its differentiation.
Effects of long-term omeprazole treatment on the process of epithelial cell proliferation and differentiation in the adult rat gastric mucosa were investigated. Animals were treated with omeprazole (25 mg/kg body weight/day) for 28 days to induce anacidity in the stomach. The treatment induced a marked decrease in the number of chief cells in the gastric mucosa and at the same time an increase in that of immature pepsinogen-producing cells expressing class III mucin. This was accompanied by a decrease to 60% and 10% of the control values in the mucosal levels of pepsinogen and its mRNA, respectively. Moreover, the expression of cathepsin E in surface mucous cells was reduced. Cell proliferation studies revealed that the rate of bromodeoxyuridine-labeled cells was increased by omeprazole. The above-described changes were reversed by cessation of the treatment and they were not caused by the omeprazole-treatment at a dose which does not induce anacidity in the stomach. These results suggest that long-term omeprazole treatment reversibly increases the epithelial cell proliferation and suppresses its differentiation in the adult rate gastric mucosa probably by altering the acidic environment specific for the stomach.
Animals↗