Aeromonas hydrophila necrotizing fasciitis and gas gangrene in a diabetic patient on haemodialysis.
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Aeromonas hydrophila↗
Biomedical subjects
O Sasaki
Publications and source records attributed to O Sasaki.
Successful treatment with cyclosporine in a case of hemophagocytic syndrome manifesting as severe liver dysfunction.
Forms of hemophagocytic syndrome, which affects mainly children, vary from mild to very severe and often fatal. We describe an adult patient with hemophagocytic syndrome in whom severe liver dysfunction developed. The condition continued to deteriorate despite treatment with plasma exchange, high-dose gamma globulin, and corticosteroid therapy. Treatment with cyclosporine (2.3 mg/kg/day) dramatically improved the condition and normalized liver function. Cyclosporine reduced the serum levels of ferritin, interferon-tau, interleukin-6, and soluble interleukin-2 receptor. These findings suggest that hemophagocytic syndrome accompanied with severe liver dysfunction results from hypercytokinemia, and cyclosporine is useful in preventing a fatal outcome during the acute phase.
Adult↗
Detection of delayed cerebral vasospasm, after rupture of intracranial aneurysms, by magnetic resonance angiography.
OBJECTIVE: The goal of this study was to assess the value of magnetic resonance angiography (MRA), compared with conventional angiography, in the diagnosis and follow-up monitoring of delayed cerebral vasospasm after subarachnoid hemorrhage resulting from rupture of intracranial aneurysms. METHODS: For 32 patients undergoing examination by both MRA and conventional angiography during the period of risk for vasospasm, on the same day, the frequency and severity of and sequential changes in vasospasm were evaluated. The three-dimensional time-of-flight method was used. MRA was performed three times, i.e., before, during, and after the period of risk for vasospasm. Conventional angiography was performed twice, i.e., at admission and during the period of risk for vasospasm. Vasospasm was assessed at 22 regions of the cerebral arteries, including the bilateral anterior cerebral (A1, A2, and A3 segments), middle cerebral (M1, M2, and M3 segments), internal carotid (C1 and C2 segments), posterior cerebral (P1 and P2 segments), and posterior communicating arteries. RESULTS: Seven patients were excluded because of poor MRA images. Twenty-two of 25 patients (125 arteries) showed vasospasm in conventional angiograms. Nineteen of the 22 patients also showed vasospasm in MRA images; however, 57 arteries (45.6%) were diagnosed as showing vasospasm by MRA, and 59 (47.2%) could not be evaluated because of artifacts. For the remaining three patients (nine arteries, 7.2%), vasospasm could not be detected by MRA. Sequential changes in vasospasm could be well evaluated by MRA. CONCLUSION: MRA could be useful for management of cerebral vasospasm, although it cannot become a practical alternative to conventional angiography.
Adult↗
Plasmapheresis in the treatment of rapidly progressive glomerulonephritis.
The present study was carried out to examine the efficacy of plasma exchange in patients with rapidly progressive glomerulonephritis (RPGN). Seventeen patients with RPGN were treated with plasmapheresis as adjunct to immunosuppressive therapy. Of these, 4 had antiglomerular basement membrane (GBM) antibody-mediated glomerulonephritis (GN), 8 had immune-complex GN (5 SLE, 2 HSP, 1 cryoblobulinemia), 5 had pauci-immune GN (3 peripheral antineutrophil cytoplasmic antibody [P-ANCA], 1 cytoplasmic antineutrophil cytoplasmic antibody [C-ANCA], 1 other). Treatment of 10 of these patients with plasmapheresis within the first month of disease onset resulted in a stable renal function for a period extending from 1 to 3 years, except in 2 patients who had high baseline levels of serum creatinine. In the remaining patients, 2 were treated with hemodialysis 6 years later at the end of follow-up. We conclude that plasmapheresis, when used in combination with immunosuppressive drugs, is beneficial, leading to improved renal function.
Basement Membrane↗
Serial changes of hemostasis in aneurysmal subarachnoid hemorrhage with special reference to delayed ischemic neurological deficits.
This study was undertaken to elucidate comprehensively the serial changes occurring in hemostatic systems after aneurysmal subarachnoid hemorrhage (SAH) and thereby to ascertain whether the examination of the integrity of these systems is helpful in predicting delayed ischemic neurological deficits (DINDs). The authors examined 117 patients admitted to the hospital within 24 hours after onset of SAH. Blood samples were collected from each patient on Days 0 (at admission), 3, 6, 14, and 30. A number of hemostatic parameters were examined in these samples, and the relationships between their changes and DINDs were assessed. Eighteen (15.4%) of the patients exhibited DINDs, and their frequency increased as the severity of subarachnoid clotting increased. Also, the frequency of DINDs was significantly higher in the patients with hydrocephalus on initial computerized tomography (CT) scans than in those without hydrocephalus. Regarding the hemostatic parameters at admission, there was no significant difference between the patients with and without DINDs. On Day 3, however, the fibrinogen and D-dimer levels were higher in the patients with than in those without DINDs. The fibrinogen and thrombin-antithrombin complex levels on Day 6 and the D-dimer level on Day 14 in the patients with DINDs were higher than the corresponding levels in those without DINDs. Multivariate analyses revealed that the following variables (in order of importance) were independent predictors of DINDs: the levels of D-dimer on Day 3, fibrinogen on Day 6, and the presence of hydrocephalus on admission. These data indicate that the levels of hemostatic parameters in concert with the CT findings may enable us to predict the appearance of DINDs.
Adult↗
[Analysis of DNA ploidy pattern and overexpression of p53 protein in cases of early gastric carcinoma with lymph node metastasis].
Twenty-one cases of surgically resected early gastric carcinoma with lymph nodal involvement (4 mucosal and 17 submucosal carcinomas) and 37 cases of that with no lymph nodal involvement (14 mucosal and 23 submucosal) were investigated by means of flow cytometry and immunohistochemical staining in order to clarify the correlation between lymph node metastasis and DNA ploidy pattern as well as overexpression of p53 protein. DNA aneuploidy was found to show a significantly higher frequency in submucosal carcinomas (60.0%) than in mucosal ones (22.2%), and also a significantly higher frequency in node positive cases (76.2%) than in node negative ones (32.4%). Meanwhile, the overexpression of p53 protein showed higher frequency in submucosal carcinomas (52.5%) than in mucosal ones (22.2%), and also higher frequency in node positive cases (47.6%) compared with that in node negative ones (40.5%). However there was no significant difference either in relation to the depth of tumor invasion or the lymph node metastasis. Thus, DNA aneuploidy showed a significant correlation to the depth of cancer invasion as well as lymph node metastasis, which was regarded as a useful indicator for the preoperative estimation of the depth of tumor invasion as well as lymph node metastasis.
Aneuploidy↗
Intraglomerular C3 synthesis in rats with passive Heymann nephritis.
Passive Heymann nephritis (PHN), a model of human membranous nephropathy, is an immune-complex-mediated glomerulonephritis characterized by the presence of complement-dependent tissue injury. Recent studies have confirmed the synthesis of C3, involved in both the classical and alternative pathways of complement, in injured human and animal renal tissues. However, there is little clear information on the role of local C3 synthesis in the pathogenesis of nephritides such as PHN. In the present study, using nonradioactive in situ hybridization and semiquantitative reverse transcriptase polymerase chain reaction, we examined C3 synthesis in the kidney and its contribution to tissue injury in a rat model of PHN induced by the injection of polyclonal anti-gp330 antibody. C3 mRNA was localized in mesangial cells, glomerular epithelial cells, and cells of Bowman's capsule. During the early stages of PHN, C3 mRNA expression was detected in mesangial cells and glomerular epithelial cells, whereas such expression was limited to mesangial cells during the late stages of the disease. Focal, weak C3 mRNA expression was detected in tubular epithelial cells and occasionally in the interstitium. Semiquantitative polymerase chain reaction demonstrated that the level of C3 mRNA expression correlated with that of proteinuria. Our results suggest that renal cells synthesize C3 mRNA in PHN in a site-specific manner and that locally produced C3 is associated with the development of proteinuria in this model.
Animals↗
Immunohistochemical expression of sialyl Tn, sialyl Lewis a, sialyl Lewis a-b-, and sialyl Lewis x in primary tumor and metastatic lymph nodes in human gastric cancer.
Sialyl Lewis Tn(STN), sialyl Lewis a(CA-9-9), sialyl Lewis a-b-(DU-PAN-2), and sialyl Lewis x(SLX) antigens were immunohistochemically examined in the primary tumor and metastatic lymph nodes in 35 patients with advanced gastric cancer. STN, CA-19-9, DU-PAN-2, and SLX were expressed in 91%, 60%, 31%, and 60% in the primary lesion, and 77%, 54%, 22%, and 51% in the metastatic lesion, respectively. In only four cases, (11%) were all four antigens expressed in both the primary and metastatic lesions. Three antigens were expressed in 49% of primary lesions and in 20% of metastatic lesions. Compared with expression in primary lesions, increased, unchanged and decreased expressions in metastatic lesions were noted in 23%, 37%, and 40% for STN, 20%, 40%, and 40% for CA-19-9, 17%, 57%, and 26% for DU-PAN-2, and 26%, 31%, and 43% for SLX, respectively. These results indicate that the tumor in the primary and metastatic lesions has a heterogeneous expression of sialyl-related antigens. However, metastases cannot be predicted based upon the expression of these antigens.
Adult↗
Application of agar-fill method to estimate compartment capacity of gastrointestinal tract in Syrian hamsters (Mesocricetus auretus).
In the present study we have developed the agar-fill method for the measurement of gastrointestinal-tract capacity (GTC) to replace the in vitro water-fill method. This would estimate GTC without using complex equipment and techniques, and can be applied to the measurement of GTC for small laboratory animals. We attempted to confirm the efficiency of the agar-fill method by investigating the relationship between dietary neutral-detergent fibre (NDF) content and GTC. The digestion trials were carried out using the Syrian hamster (Mesocricetus auretus). The trials were conducted using both sexes, two age-groups and three levels of dietary NDF with a cross-classified design. The size of each gastrointestinal organ was determined as tissue weight (TW) and GTC. The DM intake, digestible DM intake, DM digestibility, NDF digestibility, acid-detergent fibre (ADF) digestibility and digesta transit time were also measured. GTC increased with increasing NDF content of the diets. TW responded similarly to increasing NDF content, but the response was smaller than that of GTC. DM digestibility decreased with increasing NDF content of the diet. The digestible DM intake did not decrease with increasing NDF because DM intake increased with NDF content. Digesta transit time was not shorter of the high-NDF diet group but DM intake increased with increasing NDF content. NDF digestibility did not differ significantly between low- and medium-NDF diets. ADF digestibility was low in the low-NDF-diet group. The digestion characteristics were highly correlated with TW and GTC, except for TW of small intestine. These correlations were higher with GTC than with TW. The results of the present study confirm previous findings suggesting that the agar-fill method is a useful means of estimating GTC for small laboratory animals.
Agar↗
Ultra-early rebleeding in spontaneous subarachnoid hemorrhage.
To determine the incidence of, and risk factors for, the occurrence of rebleeding between admission and early operation (ultra-early rebleeding) in patients with spontaneous subarachnoid hemorrhage (SAH), the authors reviewed the cases of 179 patients admitted within 24 hours after their last attack of SAH. Thirty-one (17.3%) of these patients had ultra-early rebleeding despite scheduling of early operation (within 24 hours after admission). The incidence of rebleeding significantly decreased as the time interval between the last attack and admission increased. Patients with rebleeding before admission, high systolic blood pressure, intracerebral or intraventricular hematoma, those in poor neurological condition on admission, and those who underwent angiography within 6 hours of the last SAH were significantly more likely to have ultra-early rebleeding than those without these factors. The incidence of rebleeding also significantly increased as levels of enhancement of platelet sensitivity and thrombin-antithrombin complex increased. Multivariate analysis revealed that the following three factors were independently associated with ultra-early rebleeding: the level of enhancement of platelet sensitivity; the time interval between the last attack and admission; and the level of thrombin-antithrombin complex. On the basis of these findings, the authors suggest that many of the risk factors for ultra-early rebleeding are interrelated. A particularly high risk of ultra-early rebleeding was observed in those patients 1) who had platelet hypoaggregability; 2) who were admitted shortly after their last SAH; and 3) whose thrombin-antithrombin complex levels were extremely high and were thus in severe clinical condition.
Cerebral Angiography↗
[Correlation between intratumor DNA ploidy distribution pattern and prognosis by tumor stage in colorectal carcinomas].
Curatively resected specimens of 124 cases of colorectal carcinoma, and 6 cases of colorectal carcinoma showing hematogenous metastasis were used in this study. Each carcinoma was cut out in stepwise section through the entire tumor. DNA ploidy for each section was determined by flow cytometry, and the intratumor DNA ploidy distribution pattern was decided, and divided into 5 types (Type A-E). These 5 types were broadly divided into 2 types; predominantly diploidy type (Type A, C) and predominantly aneuploidy type (Type B, D, E). A statistically significant difference was seen in the 5-year survival between 25 cases of the predominantly diploidy type (100%) and 99 cases of the predominantly aneuploidy type (76.7%). However, there was no statistically significant difference in survival between these 2 types in any Dukes stage. The intratumor DNA ploidy distribution pattern in 6 cases of colorectal carcinoma showing hematogenous metastasis comprised 3 cases of Type E, 2 Type D and 1 Type B. And that of 8 cases of curatively resected colorectal carcinoma showing hematogenous metastasis postoperatively comprised 5 cases of Type D, 2 Type E and 1 Type B. Thus, a close correlation between the aneuploidy predominant type, especially Type D as well as Type E, and hematogenous metastasis, was suggested.
Colorectal Neoplasms↗
[Correlation between intratumor DNA ploidy distribution pattern and clinicopathologic variables in large-bowel carcinoma].
Surgically resected specimens of 139 cases of large-bowel carcinoma were analysed in this study. Each carcinoma was cut out in stepwise section through the whole tumor, and flow cytometric DNA measurement was performed for each section. The intratumor DNA ploidy distribution pattern decided in this way was classified into 5 types (Type A-E). The 139 cases of carcinoma comprised 19 cases of Type A, 27 Type B, 11 Type C, 37 Type D and 45 Type E. The intratumor DNA ploidy distribution pattern showed a statistically significant correlation to tumor size, gross type, depth of invasion, growth pattern at the tumor margin, venous permeation of visceral wall, DNA Index and Dukes stage. Among these 5 types of carcinoma, carcinoma showing Type E was seen most frequently, even in the earlier stage, and found most frequently among the cases showing invasive growth pattern at the tumor margin, positive venous permeation in the visceral wall and DNA Index of more than 1.7. Therefore, the intratumor DNA ploidy distribution pattern seemed to reflect the degree of tumor malignancy as well as that of tumor advancement. Moreover, Type E pattern of carcinoma appeared to reveal the highest grade of malignancy, and early detection of this type seemed to be necessary in order to improve survival after surgery.
Colonic Neoplasms↗
Complete recanalization via fibrinolytic therapy can reduce the number of ischemic territories that progress to infarction.
PURPOSE: To clarify the clinical significance of fibrinolytic therapy for acute ischemic stroke. METHODS: We analyzed findings in 18 patients with occlusion of a major artery in respect to cerebral blood flow thresholds for infarction. Nine of these patients had shown complete recanalization just after the treatment, between 3.5 and 7.25 hours after symptom onset, and the other nine had shown no change. Cerebral blood flow was measured by single-photon emission CT using 99mTC-labeled hemamethylpropyleneamine oxime and assessed semiquantitatively: multiple regions of interest were placed on the section images and two parameters, the R/CL ratio and the R/CE ratio, were calculated (where R represents a mean count of the region of interest in the affected hemisphere, CL on the opposite side, and CE in the cerebellar hemisphere on the affected ischemic side). RESULTS: Reperfusion significantly reduced the development of infarction in the regions of interest with an R/CL ratio between 0.65 and 0.85 or an R/CE ratio between 0.55 and 0.75. No correlation was observed between the development of infarction and the duration of ischemia. The cerebral blood flow threshold in patients without recanalization was higher than that in patients with recanalization. CONCLUSION: Reperfusion achieved by fibrinolytic therapy in the acute stage can save ischemic brain within a limited cerebral blood flow value.
Aged↗
Direct evidence of the production of IgA by tonsillar lymphocytes and the binding of IgA to the glomerular mesangium of IgA nephropathy patients.
Tonsils were obtained by tonsillectomy from a 33-year-old woman with IgA nephropathy. Hetero-hybridoma cells of human tonsillar B-lymphocytes with mouse myeloma cells (NS-1) were made, and cultured in HAT medium supplemented with 10% fetus bovine serum and hybridoma cloning factor. The culture medium was analyzed by Western blot analysis using anti-human IgA antibody, and both IgA1 and IgA2 were demonstrated to be produced. The specimens of the biopsied kidney tissue of IgA nephropathy were washed with 0.02 M citrate buffer (pH 3.2) to remove deposited IgA from glomerulus. The specimens were then incubated with the culture media of hybridoma cells, and immuno-fluorescence analysis using FITC-conjugated anti-human IgA antibody was performed. IgA deposit was efficiently removed by washing with citrate buffer and was recovered after incubation with the culture medium of hybridoma cells. Direct evidence of binding of IgA produced by tonsillar B-lymphocytes to the glomerular mesangium of IgA nephropathy was demonstrated.
Adult↗
Surgical experience with massive lobar haemorrhage caused by cerebral amyloid angiopathy.
Nineteen patients with massive lobar haemorrhage without angiographic lesions received direct or stereotactic surgery, and biopsy specimens were examined histologically. Ten patients (53%) were found to have vessels positive for Congo-red staining, and demonstrating amyloid angiopathy. In the patients with amyloid angiopathy, CT scan and surgical findings were investigated. Subarachnoid haemorrhage (9/10), irregularly shaped haematoma (9/10) and fluid-blood density level in the haematoma cavity (7/10) were frequently found on CT scan. The characteristic surgical findings in patients treated by direct surgery were subarachnoid haemorrhage adjacent to intracerebral haematoma (8/8) and the existence of a tangle of vessels in the haematoma cavity (4/8). Evacuation of haematomas was relatively easy, and difficulty of haemostasis was not encountered during surgery.
Aged↗
Preliminary report of tumor metastasis during liver regeneration after hepatic resection in rats.
In an attempt to ascertain possible facilitation of tumor metastasis during liver regeneration after hepatectomy, a series of experiments in rats was carried out using the RBT-1 carcinoma. WKA rats were separated into three groups: Group A received a sham operation; Group B underwent one-third hepatectomy; and Group C underwent two-thirds hepatectomy. Three groups had viable tumor cells injected into the tail vein after treatment. Survival period and lung metastases were analysed 14 days after initial injection of tumor. When comparisons were made between all groups, survival was shown to be significantly shorter in Group C than Group A (P < 0.05). The number of metastatic nodules in the lungs was significantly increased in Group B (P < 0.05) and C (P < 0.01), compared to Group A and in Group C, compared with Group B (P < 0.05). These results suggest that facilitation of tumor metastasis during liver regeneration may be proportional to the extent of liver resection.
Animals↗
The incidence of chromogranin A defined endocrine cells decreases with tumour progression in gastric adenocarcinoma.
The immunohistochemical expression of chromogranin A (CGA) was investigated in 60 normal mucosas, 95 primary tumours and 38 metastatic lymph nodes. CGA was expressed in 100% of the normal mucosas, 61% of the primary tumours that were restricted within the submucosal layer, 21% of the primary tumours that invaded beyond the submucosal layer, and 11% of the metastatic lymph nodes. The 5-year survival rates in patients with negative and positive expression of CGA in primary tumours were 60.4% and 74.6%, respectively. These results indicate that endocrine cells occupy an integral part of gastric adenocarcinoma with regard to tumour progression.
Adenocarcinoma↗
Immunohistochemical expression of tenascin in normal stomach tissue, gastric carcinomas and gastric carcinoma in lymph nodes.
The immunohistochemical expression of tenascin was examined in the normal adult mucosa of the stomach, primary tumours and lymph node metastases of gastric cancer patients. In normal gastric tissue tenascin was expressed in the muscularis mucosae, muscularis propria and vessel walls, however it was not expressed in either the mucosal connective tissue or the stromal tissue in the submucosal layer. In gastric cancer, tenascin was expressed in 35 of 85 primary tumours, and in 8 of 25 metastases in lymph nodes. Tenascin was located in the fibrous stroma surrounding foci of cancer. The expression of tenascin in the primary tumour did not correlate with the depth of invasion, lymph node metastasis or prognosis. Tenascin appears during the process of either malignant transformation or tumour progression in gastric cancer, and the positive expression of tenascin may be useful as a stromal marker for the early detection of gastric cancer.
Adult↗