Biomedical subjects
Publications and source records attributed to N Yoshimura.
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PURPOSE: The purpose of this study was to evaluate CT arteriography (CTA) using an implantable port system in the detection of perfusion abnormalities occurring during hepatic arterial infusion chemotherapy (HAIC). METHOD: In 51 patients with unresectable primary and metastatic liver tumors, who had implanted port systems for HAIC, CTA examinations through the infusion pump were performed. When perfusion abnormalities were found, selective angiography and/or digital subtraction angiography using the implantable port system were performed to determine the etiology. RESULTS: Forty-nine perfusion abnormalities were detected in 32 patients. Intrahepatic hypoperfusion was found in 24 cases. Of 11 patients in whom correction of the hypoperfusion was attempted, it was successful in 10. Of 13 patients in whom correction was not attempted, 6 patients showed progressive disease in nonperfused areas. Intrahepatic hyperperfusion was found in 14 cases, which showed no subsequent complication. Extrahepatic perfusion was found in 11 cases. CONCLUSION: We consider CTA to be useful in detecting perfusion abnormalities that may compromise HAIC.
PURPOSE: Our goal was to evaluate the role of electron-beam CT (EBT) in the diagnosis of patients with coronary artery anomalies with a shunt. METHOD: We performed EBT in seven patients with coronary artery anomalies with a shunt. Four cases were coronary artery fistula (CAF) and three were an anomalous origin of the left coronary artery from the pulmonary artery (ALCA from PA). Serial single volume mode scanning was performed at end-diastole to evaluate the anatomical course of the anomalous coronary arteries. Cine mode scanning was done in all but one to examine the ventricular wall motion and volumetrics. RESULTS: EBT could detect the course and drainage sites of all CAFs and ALCAs from PA. Cine mode scanning revealed reduced wall motion in one case with CAF and two cases with ALCA from PA. CONCLUSION: EBT serves a useful role in the assessment of coronary artery anomalies with a shunt.
We present a case in which MR arteriography (MRA) with an indwelling catheter was used in a perfusion study of intrahepatic arterial chemotherapy for liver metastases. After embolization of collateral vessels using platinum coils, CT imaging was disturbed by strong artifact. However, platinum coils produced no MR artifact. In addition, MRA had greater advantages in depicting perfusion defects than perfusion scintigraphy. We consider MRA useful in assessing perfusion abnormalities during intrahepatic arterial chemotherapy.
PURPOSE: To clarify whether loss of the retinal nerve fiber layer in normal-tension glaucoma (NTG) differs from that in chronic open-angle glaucoma (COAG). METHODS: Using a scanning laser polarimeter, retinal nerve fiber layer thickness (RNFLT) was measured in 21 patients with NTG, 21 patients with COAG and 21 normal controls. The three groups were matched for age, and the NTG and COAG groups were matched for visual field loss. RESULTS: The mean RNFLT was significantly less in the NTG than in the control group and less in the COAG than in the controls and NTG group. Although the correlations between the parameters of RNFLT and homotopic visual field measurements were significant in COAG, none of the correlations were significant in NTG. CONCLUSIONS: The present results suggest that loss of the retinal nerve fiber layer in NTG differs from that in COAG.
PURPOSE: To investigate a possible role of the nitric oxide (NO)-cGMP signal transduction system in phagocytosis of rod outer segments (ROS) by cultured retinal pigment epithelial (RPE) cells. METHODS: Primary cultures of RPE cells from 10-day-old Brown Norway rats were used to study the phagocytosis of ROS by these cells. Phagocytosis of ROS was evaluated with or without an inhibitor of nitric oxide synthase (NOS), N(G)-nitro-L-arginine (L-NNA), and the reverse effects of L-NNA by L-arginine and 8-bromo-cGMP on phagocytosis were also studied. NO-associated cGMP production by RPE cells was monitored during phagocytosis using L-NNA. NOS activity was assayed in RPE cells and ROS to locate the source of NO. RESULTS: Phagocytosis of ROS was inhibited by L-NNA but not by D-NNA. L-NNA inhibited the ingestion in a dose-dependent manner, but not the binding of ROS. The inhibition was reversed by L-arginine and also by an NO donor, SIN-1. RPE cells challenged with ROS showed increased cGMP activity, which was significantly reduced by L-NNA and again restored by an overdose of L-arginine. NOS activity was found in RPE cells but not in ROS. CONCLUSIONS: Our data show that cGMP plays a role in the ingestion phase of ROS phagocytosis by RPE cells via a cGMP second-messenger system.
A 56-year-old man was admitted with hemiparesis and shortness of breath. He was positive to human immunodeficiency virus (HIV) antibody and was diagnosed as acquired immunodeficiency syndrome (AIDS) with Kaposi's sarcoma and pneumocystis carinii pneumonia. He developed chronic photosensitivity and vitiligo preceding the onset of the AIDS-related complex (ARC). Association of the two skin lesions with HIV infection is very rare. Although the role of HIV infection in these skin lesions is not significant, the immunological responses in the early course of HIV infection may have contributed to the development of both of these skin lesions.
Although the administration of donor lymphocytes via portal vein (PV) on the day of transplantation significantly prolongs rat renal allograft survivals and the unresponsive state is mediated by an antigen-specific suppressor factor in the serum, significant variations exist among rodent models in terms of immunogenicity and mechanism of antigen presentation. The present studies sought to assess the effect of perioperative PV inoculation with donor lymphocytes on skin allograft survivals. Donor lymphocytes were prepared from Brown-Norway (BN, RT-1n) or third-party DA (RT-1a) rat spleens and lymph nodes and injected via PV or intravenously to Lewis (LEW, RT-1l) hosts on the day of skin grafting. Untreated LEW hosts rejected BN skin grafts at 9.0 +/- 1.4 days (n = 10). Intravenous administration of 1 x 10(8) BN cells into LEW hosts on day 0 did not prolong the skin graft survivals (MST = 8.6 +/- 1.2 days, n = 7, NS), whereas PV inoculation of 1 x 10(8) BN cells prolonged skin graft survival to 13.4 +/- 3.9 (n = 8, P < .01). PV administration of 1 x 10(8) DA cells to LEW hosts did not prolong the survival of BN skin grafts (MST = 8.6 +/- 1.5 days, n = 6). PV inoculation with BN cells inhibited the generation of anti-BN delayed-type hypersensitivity (DTH) response in the hosts, whereas untreated control hosts or hosts inoculated with third-party DA cells could not inhibit the anti-BN DTH response.(ABSTRACT TRUNCATED AT 250 WORDS)
We conducted a randomized controlled trial comparing oral regimen [doxifluridine, an intermediate metabolite of capecitabine, + medroxyprogesterone acetate (MPA) + cyclophosphamide (CPA)] (Method A) with a standard regimen (5-fluorouracil + adriamycin + CPA) plus MPA (Method B) as first line chemotherapy for metastatic breast cancer. Overall response rate was 55.8% for Method A, 46.3% for Method B. The total ratio of responder and long stable disease was significantly higher with Method A (p=0.006). Median time to progression and survival were not differences between Methods. Incidence of toxicity was 56.3% with Method A and 80.0% with Method B (p=0.014). Oral regimen is more useful than standard therapy.
The effects of ligustrazine on hepatic oxygenation in the isolated rat liver were investigated during prolonged perfusion and following the injection of norepinephrine. After injection of erythrocytes into the perfusate, the hemoglobin spectra in the liver were measured by Erlangen microlightguide spectroscopy, and the hemoglobin oxygenation (HbO2) in the liver was calculated on the basis of the Kubelka-Munk theory. During artificial perfusion, the HbO2 value was decreased from 59.3 +/- 6.4% (after one hour's perfusion) to 25.5 +/- 19.5% (n = 441; after six hours' perfusion). However, when ligustrazine was injected into the perfusate after six hours' perfusion, the HbO2 values recovered to 56.4 +/- 9.7% (n = 441). After injection of norepinephrine, HbO2 in the liver decreased from 48.8 +/- 10.4% to 25.2 +/- 18.4% (n = 961), while subsequent administration of ligustrazine caused a recovery to 62.9 +/- 6.0% (n = 961). Our results suggested that ligustrazine is a powerful hepatic vasodilator for improving hepatic oxygenation.
We present two cases of gastric toxicity related to hepatic arterial infusion chemotherapy (HAIC) for liver metastases. The gastric toxicity was caused by the inflow of infused drugs into the stomach via the left inferior phrenic artery arising from the celiac arterial trunk. The catheter hole was placed in the celiac arterial trunk with occlusion of the splenic and many gastric arteries. It must be kept in mind that perfusion of the stomach may occur through the left inferior phrenic artery in HAIC.
Histological changes that explain the mental symptoms of patients with myotonic dystrophy (MD) have not fully been demonstrated yet. Recently, the presence of Alzheimer's neurofibrillary changes (ANCs) in the brain have been reported in this disease. We studied the brain of a 61-year-old male with MD. The distribution of ANCs was investigated and mapped through careful histological examinations. The examinations disclosed that in MD, ANCs distributed along their preferential sites of the brain; a great number of ANCs were found in the parahippocampus, hippocampus, amygdaloid nucleus, fusiform gyrus, insula, and olfactory bulb, many in the nucleus basalis of Meynert, inferior temporal gyrus, hypothalamus, and brain stem, and a few in the cingulate, frontal and temporal gyri, neostriatum, and mammillary body. In the brain stem, ANCs were seen in the central gray, oculomotor nucleus, linear nucleus, substantia nigra, locus coeruleus, dorsal raphe nucleus, superior central nucleus, retriculotegmental nucleus, and reticular formation. From this result and the previous reports by others, it may be suggested that the presence of ANCs concentrated mostly in the limbic system is a regular and significant histological finding in the brain in MD. Therefore, this limbic lesion must be related to some of the mental symptoms unique to MD. In addition, diffuse and considerable neuronal atrophy and gliosis in the thalami in the absence of ANCs also may have played a causative role in some of the mental symptoms of the present case. Besides the more concentrated occurrence of ANCs within the limbic system, the minimal presence of senile plaques in the CNS may differentiate the brain in MD from that in Alzheimer-type dementia.
The olfactory bulbs and stalks were examined in a case of myotonic dystrophy that showed numerous Alzheimer's neurofibrillary changes (ANCs) in the brain. Typical ANCs were found in the cell body of many mitral cells and tufted cells and of a few outer and inner granule cells. In addition, massive ANCs were present in the anterior olfactory nucleus, where almost all the nerve cells were affected by ANCs. No senile plaque was detected anywhere in the bulb and stalk. Electron microscopy disclosed that the ANCs were composed of paired helical filaments and straight tubules. This implies that there was no ultrastructural difference between ANCs in the bulb and those in the parahippocampus or hippocampus in the present case, as well as in Alzheimer's disease. These data indicate that in myotonic dystrophy mitral cells, tufted cell and granule cells, as well as anterior olfactory nucleus cells can be affected by ANCs.
A case of Pick's disease with the onset at 51 years old and a 15-year clinical course was studied. The brain, weighing 740 g, showed striking atrophy limited to the frontal and temporal lobes and inferior parietal lobules of both sides. The topographic distribution of Pick bodies (PBs) was investigated; PBs were present most densely in the amygdaloid, hippocampus, innominate substance, posterior cingulate and insula, inferior parietal lobule, posterior inferior temporal gyrus, and fusiform and lingular gyri. They were present less densely in the anterior frontal and temporal gyri, occipital gyri, caudate, hypothalamus, claustrum, putamen, pallidum, and olfactory bulbs and tubercles. Their presence was sparse in the pre- and post central gyri and superior parietal lobule. The calcarine and cerebellum were spared. The tectum and central grey of the midbrain, red nuclei, substantia nigra, locus ceruleus, superior central nuclei, tegmental reticular nuclei, pontine nuclei, dorsal vagal nuclei, and arcuate nuclei, were also severely affected. This distribution pattern of PBs was very similar to that of Alzheimer's neurofibrillary tangles in Alzheimer's disease, except for the pontine and arcuate nuclei. Electron microscopy of PBs disclosed two component fibrils: smooth-surfaced straight tubular filaments with a diameter of 15nm +/- 3 and no periodic constrictions, and long-period (160nm) constricted fibrils. The morphology of these two fibrils of PBs, respectively resembled the straight filaments and paired helical filaments in Alzheimer's neurofibrillary tangles.
The metabolites of fentanyl (l), which has been widely used as a neuroleptic analgesic agent, were identified in urine of rats by gas chromatography-mass spectrometry combined with a stable-isotope tracer technique. After the oral administration of an equimolar mixture of l and deuterium-labeled l (l/l-d5), the urinary metabolites were extracted with chloroform at pH 9.0. Extracts were derivatized and analyzed by GC/MS. Metabolites were identified by the presence of doublet ion peaks separated by 5 amu, and chemical structures were established from analyses of fragmentation pathways. The metabolites were identified as 4-N-(N-propionylanilino)-piperidine, 4-N-(N-hydroxypropionylanilino)piperidine, 4-N-(N-propionylanilino) hydroxypiperidine, 1-(2-phenethyl)-4-N-(N-hydroxypropionylanilino)piperidine and 1-(2-phenethyl)-4-N-(N-propionylanilino)hydroxypiperidine. These metabolites, together with unchanged l, were also detected in urine of rats receiving l/l-d5 intravenously, by selected-ion monitoring of the specific cluster ions.
Neurites in senile plaques in the cerebral cortex from an autopsied case of Alzheimer's disease were examined by electron microscope. Swollen axons containing vastly increased numbers of neurofilaments (NF) together with paired helical filaments (PHF) were common. In some of these axons the continuity of NF with PHF was frequently discernible. In one, there were numerous figures of continuity in a bundle, indicating transition from NF to PHF. Moreover, some of these figures showed that two NF seemed to join to form one PHF. No straight 15 nm filament was noted anywhere in the sectioned plane of this axon. Instead, NF appeared to have contacts with many coated vesicles here and in the other swollen and/or degenerated axons that showed the coexistence of PHF with NF. These observations suggest not only that PHF originate from NF but that individual NF can be converted simultaneously and directly into PHF, possibly by a chemical modification without their first forming straight filaments.
An autopsy case of dementia beginning with right hand muscle atrophy was reported. A 42-year-old woman with no family history of neurologic disease developed weakness of the right hand at age 30, and was diagnosed as having amyotrophic lateral sclerosis (ALS). The weakness and atrophy spread to the four extremities subsequently. At age 36, she could not walk without assistance. At age 38, she was first noted as having dementia with forced crying, and she also showed generalized muscle weakness and atrophy. She rapidly developed akinetic mutism, and died of respiratory failure at age 42, 12 years after the onset of the symptoms. Macroscopically, the brain showed fronto-temporal atrophy. Microscopic examination revealed numerous intracytoplasmic inclusions throughout the central nervous system (CNS) including anterior horn of the spinal cord. The inclusions were stained moderate to dark brown with silver stain. Electron microscopically, they consisted of fibrils covered along most of the length with granular and fuzzy materials. This case was thought to be difficult to categorize in any known neuro-degenerative diseases. We proposed the case to be "atypical Pick's disease" with ALS features. This case might be a new entity of neuro-degenerative disease.
The effects of halogenated inhalational anesthetics, viz. halothane, enflurane, isoflurane and sevoflurane, on ischemic rat kidneys were studied through the response of renal gamma-glutamyl transpeptidase in the brush border of proximal tubules to monoclonal antibodies. Brush border staining characteristics were evaluated as follows: a) continuous (normal), b) discontinuous (damaged) and c) indistinct (necrotic). The isoflurane group had significantly fewer damaged and/or necrotic proximal tubules compared to the other groups. These results suggest that isoflurane is the most appropriate inhalational anesthetic when renal circulation is impaired.