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Biomedical subjects

N Yoshimura

Publications and source records attributed to N Yoshimura.

At least 253 records · Page 14Linked to original sources
PubMed1997

Aromatase deficiency in a female who is compound heterozygote for two new point mutations in the P450arom gene: impact of estrogens on hypergonadotropic hypogonadism, multicystic ovaries, and bone densitometry in childhood.

We report on a female who is compound heterozygote for two new point mutations in the CYP19 gene. The allele inherited from her mother presented a base pair deletion (C) occurring at P408 (CCC, exon 9), causing a frameshift that results in a nonsense codon 111 bp (37 aa) further down in the CYP19 gene. The allele inherited from her father showed a point mutation from G-->A at the splicing point (canonical GT to mutational AT) between exon and intron 3. This mutation ignores the splice site and a stop codon 3 bp downstream occurs. Aromatase deficiency was already suspected because of the marked virilization occurring prepartum in the mother, and the diagnosis was confirmed shortly after birth. Extremely low levels of serum estrogens were found in contrast to high levels of androgens. Ultrasonographic follow-up studies revealed persistently enlarged ovaries (19.5-22 mL) during early childhood (2 to 4 yr) which contained numerous large cysts up to 4.8 x 3.7 cm and normal-appearing large tertiary follicles already at the age of 2 yr. In addition, both basal and GnRH-induced FSH levels remained consistently strikingly elevated. Low-dose estradiol (E2) (0.4 mg/day) given for 50 days at the age of 3 6/12 yr resulted in normalization of serum gonadotropin levels, regression of ovarian size, and increase of whole body and lumbar spine (L1-L4) bone mineral density. The FSH concentration and ovarian size returned to pretreatment levels shortly (150 days) after cessation of E2 therapy. Therefore, we recommend that affected females be treated with low-dose E2 in amounts sufficient to result in physiological prepubertal E2 concentrations using an ultrasensitive estrogen assay. However, E2 replacement needs to be adjusted throughout childhood and puberty to ensure normal skeletal maturation and adequate adolescent growth spurt, normal accretion of bone mineral density, and, at the appropriate age, female secondary sex maturation.

Adult↗
PubMed1997

[Bladder carcinoma presenting with hypercalcemia: a case report].

A 47-year old woman was referred to our hospital with nausea, vomiting and the loss of body weight. Pelvic computed tomography and magnetic resonance imaging revealed an invasive bladder tumor on the left lateral wall, accompanied with calcification. Laboratory examination revealed marked hypercalcemia (20.6 mg/dl) and elevated serum parathyroid hormone-related protein-intact (29.9 pmol/l), which was apparently produced by the tumor. Treatment with pamidronate and colloid infusion resulted in normocalcemia. Anterior pelvic exenteration was performed. Histopathological diagnosis was transitional cell carcinoma > adenocarcinoma, G3, pT4pN2M0, stage IV. She died of cancer 7 months postoperatively.

Carcinoma, Transitional Cell↗
PubMed1997

[Mitral valve replacement and closure of ventricular septal defect in the first two months of life].

A 2-month-old female infant weighing 4.2 kg was admitted with severe congestive heart failure and respiratory distress. The patient was operated upon under a diagnosis of severe congenital mitral regurgitation and ventricular septal defect. There was thickening of the anterior leaflet and short thickened chordae. The valve was judged not amenable to repair and it was replaced with a 17 mm St. Jude Medical valve. She was extubated on the 5th postoperative day. Post operative anti-coagulant therapy was initiated with warfarin potassium, dipyridamole and ticlopidine hydrochloride. The postoperative course was uneventful and the patient is doing well 9 months after the operation.

Female↗
PubMed1997

Role of P-selectin in endotoxin-induced uveitis.

PURPOSE: P-selectin is one of the early-reactive adhesion molecules that play a part in the rolling phase of leukocytes in cellular infiltration. The study objective was to determine whether P-selectin is involved in the development of endotoxin-induced uveitis (EIU). METHODS: Endotoxin-induced uveitis was initiated in male Lewis rats by injecting 200 micrograms lipopolysaccharide (LPS) into the foot pad. Expression of P-selectin in the iris-ciliary body was studied by immunohistochemistry using wholemounts and paraffin embedded sections of iris-ciliary body prepared at various time intervals. A monoclonal antibody (mAb) against P-selectin and a ligand for P-selectin, sialyl Lewis X oligosaccharide (SLeX-OS), was intravenously injected to evaluate the effects of selectin inhibition. The effect of treatment was evaluated by the number of infiltrated cells and protein concentration in the aqueous humor at 24 hours after LPS treatment. RESULTS: P-selectin immunoreactivities were observed in the vessels of the iris in whole iris-ciliary body mounts and on the surface of the microvascular endothelium in paraffin-embedded sections. Activity was most prominent at 15 minutes and at 5 to 7 hours after LPS treatment and was moderate from 1 to 4 hours after treatment. The selective inhibition of P-selectin significantly blocked the cellular infiltration into aqueous humor, but this infiltration was even more effectively inhibited by SLeX-OS. Protein concentration in the aqueous humor was not inhibited by selectin as much as was cellular infiltration. CONCLUSIONS: In the early phase of EIU, P-selectin may be expressed on the vascular endothelium in the iris in a biphasic pattern that modulates the rolling phase of leukocytes. The expression of this molecule may be essential for succeeding processes of cellular infiltration and may determine the subsequent states of ocular inflammation.

Animals↗
PubMed1997

[Surgical treatment of aortic dissection (Stanford type A) using hypothermic retrograde cerebral perfusion in patients older than 70 years of age].

Since 1991, 27 consecutive patients with aortic dissection (Stanford A) have been operated on using deep hypothermic retrograde cerebral perfusion (RCP). There were no differences in ECC time (247 +/- 15 vs 307 +/- 22 min), and RCP time (47 +/- 2 vs 47 +/- 3 min) between the aged (> or = 70 y.o., n = 11) and non-aged (< 70 y.o., n = 16) group. Although the aged group showed the higher incidences of postoperative neurological complications of prolonged emergence (2 cases) and delirium (3 cases), respiratory disorder (3 cases), and renal dysfunction (3 cases), there was no significant difference in hospital mortality (18% in the aged vs 13% in the non-aged). We concluded that RCP is well acceptable procedure for surgical treatment of the aged patients with aortic dissection.

Age Factors↗
PubMed1997

[Labor status of anesthesia in general hospitals in Japan Committee on Human Resources, the Japan Society of Anesthesiology].

AIMS: Investigating the labor by anesthetists in general hospitals with more than 600 beds during the month of September 1995. METHOD: Using MS/EXCEL spread sheet soft wear, we have analyzed daily OR anesthesia activities in 33 hospitals based on personal attendance of anesthesiologists. We defined anesthesia performing hours i.e. actual working hours as the time between the onset and the end of anesthesia for each anesthetist. RESULTS: An average number of monthly anesthesia cases was 961 in the first 10 hospitals we surveyed. We obtained two frequency graphs on weekly 5-day working 138 anesthetists whose anesthesia performed, and their occupied hours were as shown in fig. 1 and 2. for those who worked other less than 5 days per week, they showed the shorter hours on the frequency distribution graph as shown in fig. 3 to 7. The 5-day working anesthetists have spent more than 5 hours giving anesthesia in the 93.2% of all anesthesia times in the first 10 hospitals, while 28.1% of the times in the last 10 hospitals. There were an average of 11.6 operating tables, in the first 10 hospitals. And we have analyzed ratios of the number of 5 day working persons to the number of operating tables. The ratio was 0.86 in the first 10 hospitals, while 0.21 in the last 10 hospitals. CONCLUSIONS: There must be overwork of 5-day working anesthetists, who are working for too many hours for anesthesia. It is necessary to have better quality service in the OR.

Anesthesia↗
PubMed1997

Unifocalization and systemic-to-pulmonary shunt using internal mammary artery for tetralogy of Fallot and pulmonary atresia with diminutive pulmonary artery and arborization anomaly.

We report successful palliation of tetralogy of Fallot and pulmonary atresia with diminutive pulmonary arteries and arborization anomaly. Unifocalization and systemic-to-pulmonary artery shunt using an internal mammary artery were successfully performed. The internal mammary artery shunt provided a sufficient blood supply for a diminutive and fragile pulmonary artery, and brought a progressive improvement of exercise intolerance and polycythemia probably due to the growth potential.

Cardiovascular Surgical Procedures↗
PubMed1997

Long-term prognosis of renal transplant surviving for over 10 yr, and clinical, renal and rehabilitation features of 20-yr successes.

Long-term mortality and morbidity was evaluated in 267 patients with a minimum follow-up of 10 yr and the physical status, graft function and quality of life in 15 patients with a functioning graft surviving for over 20 yr were reviewed. Actual patient and graft survival rates were 80.2% and 51.1% at 10 yr (n = 267) and 56.4% and 32.7% at 20 yr (n = 55), respectively. Although the rate of graft failure due to rejection was 4 times higher than that of patient death within 10 yr, it decreased to the level of patient death in the second decade. Dominant causes of death in patients with graft surviving for over 10 yr were hepatic failure due to viral hepatitis and malignancies. In 15 patients with graft currently surviving beyond 20 yr, while all patients have excellent graft function, malignancy occurred in 5, viral hepatitis in 3, aseptic necrosis in 3, and diabetes mellitus in one patient. No patient has suffered cardiovascular complications. Despite a high rate of morbidity, they show a satisfying status of rehabilitation (full time working 11/ 15, 73.3%). In order to attain more improved QOL in patients with long-term surviving renal transplant, close follow-up aiming at diminution of complications is required throughout the period after transplantation.

Adult↗
PubMed1997

[Selective transcatheter embolization for renal artery aneurysms: report of three cases].

Selective transcatheter embolization using an interlocking detachable coil (IDC) or detachable balloon was performed in three patients with renal artery aneurysms. All aneurysms were of the saccular type, located on segmental branches of the renal artery. After the embolization procedures, the levels of LDH, GOT, WBC and the body temperature were transitionally elevated in all patients. Complete occlusion of the aneurysms were achieved in all cases. Good clinical results were achieved in two of these patients without any renal dysfunction. However, local infarction of ipsilateral renal parenchyma occurred in one patient immediately after the embolization and a Tc-99m-DMSA renal scintigraphy study suggested renal dysfunction after infarction, and the level of serum renin activity was slightly elevated. Selective transcatheter embolization may constitute an acceptable therapeutic approach for renal artery aneurysms because beside avoiding surgery, it has a low risk of complications.

Aged↗
PubMed1997

[A case of bilateral renal infarction].

A 67-year-old woman was admitted with aching pain in her left flank and nausea. Bilateral renal infarctions were noticed by CT scan and arteriography. Selective intra-arterial thrombolytic therapy was performed. Urokinase (UK) was administered through a balloon catheter embedded into the occlusive segment of the left renal artery selectively. UK (20,000 units/hour) was continuously infused after short-term high dose UK (360,000) infusion. In spite of recanalization of the occluded artery, CT scan and renoscintigraphy image did not suggest recovery of renal function. Conservative intra-arterial thrombolytic therapy is considered to be the most effective treatment for renal infarction.

Aged↗
PubMed1997

Cerebral complications and distal false lumen in the repair of aortic dissection with retrograde cerebral perfusion.

BACKGROUND: In aortic dissection, patent distal false lumen at long-term follow-up leads to complications. We investigated the feasibility of an open distal anastomosis under retrograde cerebral perfusion. METHODS: During a 15-year period (1981-1995), 51 patients with type A dissection underwent 59 surgical repairs. In 1990, a distal open anastomosis with retrograde cerebral perfusion (group II) was introduced to replace the aortic cross clamp method (group I). Mean retrograde cerebral perfusion time was 50 minutes (range 22 to 65 minutes) with no neurologic sequelae in surviving patients. RESULTS: Operative mortality was 28.6% in group I, and 16.1% in group II. At long-term follow-up, dilatation of the false lumen (more than 50 mm in diameter) occurred in 56.2% (9/16) in group I, and 4 patients died of aortic rupture. There was no mortality in group II, and dilatation of the distal false lumen occurred in only 15.3% (p<0.05). CONCLUSIONS: Use of retrograde cerebral perfusion in aortic dissection allowed for adequate time to perform a safe, open, distal anastomosis. Intraoperative cerebral complications and enlarged patent false lumens decreased significantly.

Acute Disease↗
PubMed1997

[An elderly woman with chronic pigeon-breeder's disease].

A 64-year-old woman had been feeding more than 60 pigeons in a coop in her back yard for 35 years. Diffuse reticulonodular shadows were found on a chest radiograph obtained as part of an annual check-up eight years before admission to the hospital. She was given a tentative diagnosis of idiopathic pulmonary fibrosis and was observed. She was admitted to our hospital because she noticed dry coughing and shortness of breath. A chest CT scan revealed segmentally distributed honeycombing and bronchi-bronchioloectasis. Tests for IgA and IgG antibodies to extracts of pigeon droppings in serum samples and in samples of bronchoalveolar lavage fluid were strongly positive, as were tests for lymphocyte blastogenic responses to samples of pigeon serum Examination of lung-biopsy specimens obtained by video-assisted thoracoscopic surgery revealed bronchiolitis, alveolitis, and honeycombing in a centrilobular distribution. The patient was given a diagnosis of pigeon-breeder's disease. Chronic hypersensitivity pneumonitis without acute episodes might be misdiagnosed as idiopathic interstitial pneumonia or bronchiectasis, as happened in this case. The possibility of chronic hypersensitivity pneumonitis should be considered when patients are suspected to have pulmonary fibrosis. It is important to obtain the detailed information on past or current avian contact, working history, and the home environment.

Animals↗
PubMed1996

Different types of Na+ and A-type K+ currents in dorsal root ganglion neurones innervating the rat urinary bladder.

1. Whole-cell patch-clamp recording in combination with axonal tracing techniques was used to examine the electrical properties of afferent neurones innervating the urinary bladder of the adult rat. Individual bladder afferent cells were labelled by Fast Blue (FB), injected into the bladder wall. 2. Passive and active electrical parameters at room temperature (20-22 degrees C) in FB-labelled bladder afferent neurones were comparable with those in unlabelled neurones. Unselected dorsal root ganglion (DRG) neurones as well as bladder afferent neurones exhibited two different types of action potential: high-threshold humped spikes in small-sized neurones and low-threshold narrow spikes in large-sized neurones. 3. The majority (70%) of bladder neurones which were small in size expressed high-threshold tetrodotoxin (TTX)-resistant Na+ channels and slow-inactivating A-type K+ channels (KA), which were available at the resting membrane potential, whereas large-sized DRG neurones had low-threshold TTX-sensitive Na+ channels and fast-inactivating KA channels, which were almost completely inactivated at the resting membrane potential. 4. Half-maximal conductances of activation of TTX-resistant and TTX-sensitive Na+ currents were obtained at -10.3 and -25.3 mV, respectively. The TTX-resistant and TTX-sensitive Na+ currents were half-inactivated at -25.3 and -56 mV, respectively. 5. In the TTX-resistant neurones, the transient outward K+ current (A-type current, IA) with half-maximal conductance at -40.8 mV was half-inactivated at -77.5 mV, and exhibited slower decaying kinetics (mean decay constant (tau), 240 ms) than the IA current recorded from the large-sized TTX-sensitive neurones (mean tau, 20 ms). 6. These results suggest that the majority of bladder afferent neurones have high electrical thresholds for spike activation due to the TTX-resistant Na+ current and the slow-inactivating IA current, which reflect the large population of unmyelinated high-threshold C fibre afferents that innervate the urinary bladder.

Action Potentials↗
PubMed1996

Spinal antinociceptive effect of substance P on the responses induced by intrathecally injected NMDA in mice.

Substance P (SP) has previously been shown to be involved in the transmission of nociceptive information in the spinal dorsal horn. In this study we investigated whether a functional interaction exists between SP and excitatory amino acids in the spinal cord of mice. Behavioral responses were observed after intrathecal co-administration of SP and N-methyl-D-aspartate (NMDA). The high dose (12 pmol) of SP potentiated NMDA (0.25 nmol)-induced behavior consisted of caudally directed licking and biting, while the low dose (1 pmol) of SP significantly reduced this behavior. This inhibitory effect of low dose of SP was blocked by intrathecal co-administration of opioid receptor antagonist naloxone (4 nmol). These results suggest that SP is also involved in the antinociception which is dependent on opioid mechanisms at the spinal level.

Animals↗
PubMed1996

Inducible nitric oxide synthase in retinal ischemia-reperfusion injury.

The purpose of this study was to determine whether inducible nitric oxide synthase (iNOS) was implicated in the pathogenesis of retinal ischemia-reperfusion injury. Semi-quantitative reverse transcription-polymerase chain reaction showed that the level of iNOS mRNA expression was markedly increased in rat retina following transient ischemia, with peak expression at 12 hr after reperfusion (15.7-fold increase over pre-ischemic levels). In situ hybridization showed that iNOS mRNA was expressed by resident retinal cells, most likely glial cells in the innermost retina, and also by the neutrophils that had infiltrated the retina. Intraperitoneal administration of NG-(1-iminoethyl)-L-ornithine (L-NIO), an inhibitor of iNOS, significantly increased the rate of b-wave recovery compared to that of control animals. The values (mean +/- S.E.M.) were 55.0 +/- 4.4% versus 40.1 +/- 5.1% (P < 0.05) at 1 day and 68.6 +/- 6.6% versus 45.8 +/- 3.5% (P < 0.05) at 3 days. This study shows that iNOS mRNA is highly expressed by non-neuronal cells of the inner retina during reperfusion following transient retinal ischemia. It also shows that L-NIO treatment provides some protection against ischemia-reperfusion injury. We suggest that nitric oxide produced by iNOS may mediate retinal ischemia-reperfusion injury.

Animals↗