[Case of Cushing's syndrome associated with empty sella syndrome and anterior pituitary hypofunction].
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Adult↗
Biomedical subjects
S Fujino
Publications and source records attributed to S Fujino.
Post-stenting enlarging false aneurysm of a saphenous vein graft.
Stenting seems to be a definitive procedure after failed balloon coronary angioplasty. This report describes a case of redo coronary bypass grafting and concomitant resection of enlarging false aneurysm of a saphenous vein graft that developed secondary to stenting for recurrent stenosis after serial percutaneous transluminal coronary angioplasty. It warns us of a pitfall in catheter intervention in an aged saphenous vein graft.
Aneurysm, False↗
Well-differentiated fetal adenocarcinoma of lung.
Well-differentiated fetal adenocarcinoma (WDFA) histologically resembles pulmonary blastoma, and is thought to be a subtype of pulmonary blastoma which has differentiated epithelial features resembling the fetal lung among its epithelial features and sarcomatous features. We recently encountered one patient who underwent surgery for WDFA. This case is reported with a discussion of the literature. A 33-year-old woman had a tumor shadow in the lower lobe of the right lung. The tumor was diagnosed as pulmonary blastoma as a result of echographic biopsy, and right total pneumonectomy was performed. No sarcomatous features were observed on postoperative histological assessment, and the patient was diagnosed as having WDFA. Its prognosis is believed to tend to be better than that of biphasic blastoma, in which sarcomatous features are mingled with epithelial features. However, it is reported that chemotherapy or radiotherapy has seldom been effective. Complete surgical resection is essential for long-term survival.
Adenocarcinoma↗
Evaluation of serum KL-6 levels in patients with pulmonary tuberculosis.
SETTING: KL-6, a human MUC-1 mucin preferentially expressed on type II pneumocytes, is a sensitive serum marker for evaluating alveolar damage of interstitial pneumonia and pulmonary fibrosis. Some patients with pulmonary tuberculosis develop severe respiratory dysfunction caused by extensive pulmonary fibrosis, compensatory emphysema and fibrous pleural thickening. OBJECTIVE: To evaluate the clinico-pathological significance of KL-6 in pulmonary tuberculosis. DESIGN: Serum KL-6 levels were measured in sera from 57 patients with active pulmonary tuberculosis and 38 healthy controls by a sandwich-type enzyme-linked immunosorbent assay. Immunohistochemistry was performed by an avidin-biotin-peroxidase complex method. RESULTS: KL-6 levels were significantly higher in the patients than in the healthy controls (518 +/- 693 [SD] vs 227 +/- 91 U/ml, P < 0.001) and increased significantly according to the extent of pulmonary lesions evaluated by chest X-ray (P < 0.001). There was a significant negative correlation between serum KL-6 levels and % vital capacity (VC) (r = 0.642, P < 0.05). KL-6 was strongly expressed on proliferated type II pneumocytes and cuboidal epithelial cells adjacent to thickened intralobular septa and pleura. CONCLUSIONS: In pulmonary tuberculosis, serum KL-6 originates from proliferated type II pneumocytes and cuboidal epithelial cells, and is a useful marker presenting the degree and extent of pulmonary fibroproductive lesions.
Aged↗
Evaluation of soluble IL-6 receptor concentration in serum and epithelial lining fluid from patients with interstitial lung diseases.
We measured soluble IL-6 receptor (sIL-6R) levels in serum and bronchoalveolar lavage fluids (BALF) from patients with interstitial pneumonia of unknown etiology (IP) (n = 17), sarcoidosis (n = 8) and normal control subjects (n = 10), to investigate its role in pulmonary diseases. Soluble IL-6R was determined by an ELISA. The volume of epithelial lining fluid (ELF) in BALF was estimated using an urea method. We found that levels of sIL-6R in serum, BALF, and ELF from patients with IP or sarcoidosis were significantly higher than those from normal subjects. Furthermore, levels of sIL-6R in BALF or ELF were significantly correlated with those of albumin, indicating that sIL-6R, together with albumin, may enter ELF as a result of the increased permeability caused by pulmonary inflammation. Thus most of the sIL-6R in ELF would be from serum, and relatively small amounts of it might be produced locally. However, sIL-6R levels in ELF, but neither serum nor BALF, were significantly correlated with levels of C-reactive protein in patients with IP. These results suggest that both systemic and local production of sIL-6R are increased, and raised sIL-6R is involved in the modulation of systemic and local inflammatory responses in patients with IP and sarcoidosis.
Adult↗
Circulating interleukin-6 levels in patients with bronchial asthma.
Circulating interleukin-6 (IL-6) levels were determined using a sensitive enzyme immunoassay in adults with asthma in stable condition during naturally occurring attacks and before and after allergen inhalation tests. IL-6 was significantly elevated even in asymptomatic asthmatic subjects (n = 17) compared with normal control subjects (n = 17). During naturally occurring asthmatic attacks, serum IL-6 levels were significantly elevated in comparison with those in a symptom-free condition (4 wk interval; n = 8, p < 0.01). No significant difference was observed in serum IL-6 levels obtained from control asymptomatic asthmatic subjects during the period (n = 10). There was a significant elevation in circulating IL-6 levels in eight asthmatic patients following inhalation of allergen but not methacholine. These results suggest that IL-6 is involved in the pathophysiology of bronchial asthma.
Adult↗
An immunohistochemical study of the significance of a new 31.5-kD ouabain receptor protein isolated from cat cardiac muscle.
A new 31.5-kD ouabain receptor protein (NORP), which is independent of Na(+)-K+ ATPase, was recently isolated selectively from transverse tubule membrane-junctional sarcoplasmic reticulum (TTM-JSR) complexes of cat cardiac muscle. We investigated the role of this NORP in cardiac function with special reference to the positive inotropic effect (PIE) of ouabain, preparing and using a monoclonal antibody (MoAB, immunoglobulin) raised against the receptor protein. Electrically stimulated papillary muscles were immersed in a Tyrode solution containing the anti-NORP MoAB (40 microM), of which the binding potency was high enough for immunological use, for 60 min and then washed out. Thirty minutes after removal of the MoAB, both twitch and K-contracture were still inhibited, but both resting and action potentials and caffeine-induced contracture were unchanged, indicating that NORP plays a key role in excitation (E)-contraction (C) coupling. The intracellular localization of the protein was investigated by immunohistochemical electron microscopy, and the protein was shown to be located on the TTM, the location being probably its external surface and opposite to feet which occupy the TTM-JSR gap. These results indicate that E-C coupling of cardiac muscle cells is mediated through NORP and that ouabain-PIE occurs through the influence of ouabain on NORP in the E-C coupling process.
Animals↗
IgG and IgM rheumatoid factor levels parallel interleukin-6 during the vasculitic phase in a patient with Churg-Strauss syndrome.
A 43-year-old woman with a 10-year history of bronchial asthma developed marked peripheral blood eosinophilia and symptoms of vasculitis. A diagnosis of Churg-Strauss syndrome (CSS) was made, and her symptoms were successfully treated with low-dose prednisolone. Serum rheumatoid factors (RF) of both IgG and IgM, but not IgA or IgE, subclasses transiently appeared in accordance with the vasculitic phase. Serum interleukin-6 (IL-6) levels also transiently increased in this phase and the peak level was reached just prior to the maximum of RF elevation, suggesting the role of IL-6 as an inducer of RF. RF and IL-6 seemed to be involved in the pathogenesis of the vasculitis in this patient.
Adult↗
[A case of chylothorax caused by mesenteric panniculitis].
A 76-year-old female was referred to our hospital for examination of milky pleural effusion. We diagnosed her illness as chylothorax because of the high concentration of triglyceride in the effusion. There was neither obstruction nor damage of the thoracic duct. Systemic evaluation disclosed an abdominal mass in the umbilical region. Fasting with intravenous hyperalimentation followed by pleurodesis with minocycline successfully eliminated the effusion. On the other hand, the abdominal mass was diagnosed as mesenteric panniculitis by open biopsy. Since she also had chylous ascites, the tumor could have obstructed the intestinal lymphatics. Chylothorax was probably caused by damage to collateral lymph circulation.
Aged↗
Myocardial viability assessment with technetium-99m-tetrofosmin and thallium-201 reinjection in coronary artery disease.
UNLABELLED: Exercise-rest 99mTc-tetrofosmin myocardial perfusion images with a 2-day protocol was compared to exercise-redistribution-reinjection 201Tl images to assess the ability of 99mTc-tetrofosmin to detect viable myocardium. METHODS: We studied 25 patients with coronary artery disease and regional or global left ventricular dysfunction. Myocardial SPECT images with 99mTc-tetrofosmin were obtained 10 min after injection during exercise and 1 and 3 hr after rest injection. Within 1 wk of the 99mTc-tetrofosmin study, exercise-redistribution-reinjection 201Tl SPECT imaging was performed. RESULTS: Visual analysis demonstrated concordance between 201Tl and 99mTc-tetrofosmin imaging for defect reversibility in 126 of 209 segments (60%), with initial defects on both exercise 201Tl and 99mTc-tetrofosmin images. In the remaining discordant 83 segments (40%), 73 (88%) appeared nonreversible on 99mTc-tetrofosmin imaging but were reversible on 201Tl imaging. CONCLUSION: On the basis of defect reversibility by visual analysis, exercise-rest 99mTc-tetrofosmin imaging underestimates myocardial viability compared to 201Tl reinjection imaging. The identification of viable myocardium with both 99mTc-tetrofosmin and 201Tl can be greatly enhanced to a similar degree if the severity of reduction in activity within nonreversible defects is considered. These two agents may provide comparable information about myocardial viability by quantitative analysis of defect severity.
Coronary Disease↗
[A case report of prosthetic valve replacement for malfunction of the Hancock valve in mitral position associated with recurrent peptic ulcer and renal dysfunction].
A 62-year-old woman was admitted with malfunction of the Hancock valve in mitral position. She had been suffering from gastroduodenal ulcer for about ten years. She couldn't take warfarin after 5 years later of the initial operation due to recurrent gastrointestinal bleeding. Judging from her age and renal dysfunction, we preferred mechanical valve to avoid the risks for the reoperation. After confirming the healed ulcer with administering omeprazole, we performed prosthetic valve replacement with SJM 29 M successfully. Postoperative course was uneventful and recurrence of the ulcer was not observed.
Female↗
[Small cell lung cancer that appeared as a strange shape on chest X-ray films].
A 70-year-old man was admitted for diagnosis of an abnormal shadow on chest X-ray film. Chest X-ray films and chest tomograms showed a club-like shadow close to the pulmonary artery. The tumor was diagnosed as a small cell lung cancer, after transbronchial biopsy. The patient underwent chemotherapy and radiation therapy. This patient had small cell lung cancer that appeared on chest X-ray films to have a strange shape.
Aged↗
[Evaluation of myocardial fatty acid metabolism in the area of fill-in after thallium reinjection in patients with prior myocardial infarction].
Myocardial fatty acid utilization in the area with thallium fill-in after reinjection was assessed using 123I-labeled 15-(p-iodophenyl)3R,S-methylpentadecanoic acid (BMIPP). We studied 22 patients with prior myocardial infarction that revealed persistent defects on standard exercise-redistribution thallium imaging. In each patient, exercise-redistribution-reinjection thallium imaging was performed. Within two weeks of the thallium study, resting BMIPP imaging was performed 20 min after injection of BMIPP (148 MBq). Following qualitative analysis of the obtained thallium and BMIPP images, quantitative analysis was performed on the basis of relative regional uptake. Of 199 myocardial segments that showed persistent defects on exercise-redistribution images, 73 segments showed apparent fill-in on the reinjection images (fill-in positive), and the remaining 126 segments did not (fill-in negative). When BMIPP images were compared with the corresponding thallium reinjection images, reduced BMIPP uptake compared with thallium were frequently observed in the area of fill-in positive segments (65 of 73 segments, 89%). Quantitative analysis also showed decrease in BMIPP activity compared to thallium activity in the area of fill-in (49.7 +/- 16.1 vs. 65.8 +/- 16.0%, p < 0.001). In contrast, only 24 of the 126 fill-in negative segments (19%) showed lower BMIPP uptake than thallium. These results suggest that impaired fatty acid utilization in the area of thallium new fill-in after reinjection already exists at resting condition.(ABSTRACT TRUNCATED AT 250 WORDS)
Adult↗
Evaluation of viability of preserved lung by proton magnetic resonance imaging.
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Animals↗
[Immunohistochemical study of transforming growth factor-beta and central fibrosis in T1 adenocarcinoma of the lung].
Transforming growth factor-beta (TGF-beta) is known as the growth factor that stimulates the multiplication and accumulation of extracellular matrix. Recently, TGF-beta also has been found to have the ability to control the growth and metastatic potential of cancer cells. It is known that central fibrosis frequently occurs in pulmonary adenocarcinoma and the prognosis becomes poorer as fibrosis become more hyalinized. To estimate the role of TGF-beta in the formation of central fibrosis in pulmonary adenocarcinoma and its influence on the prognosis of patients with pulmonary adenocarcinoma, we performed an immunohistochemical study of TGF-beta in 51 cases of T1 pulmonary adenocarcinoma. Positive stain for TGF-beta was shown in 31 cases, and negative stain was shown in 20 cases. In patients with Stage I, T1 pulmonary adenocarcinoma, the post operative survival curve was compared between positive and negative cases of TGF-beta, and the result showed a tendency toward poorer prognosis in positive cases of TGF-beta. Twenty-four of 51 cases of T1 pulmonary adenocarcinoma had central fibrosis. Twenty of 24 cases with central fibrosis showed positive stain for TGF-beta. It was proven that the appearance of central fibrosis was significantly related to positive stain for TGF-beta in T1 pulmonary adenocarcinoma. According to these results, it is suggested that TGF-beta plays some role in the formation of central fibrosis in pulmonary adenocarcinoma and TGF-beta is possibly a prognostic factor for patients with pulmonary adenocarcinoma.
Adenocarcinoma↗
Difference in sero-diagnostic values among KL-6-associated mucins classified as cluster 9.
KL-6 classified as Cluster 9 (MUC-I) is a circulating high-molecular-weight mucin-like molecule. Serum level of KL-6 was measured by a sandwich assay using KL-6 antibody as not only a catcher but also as a tracer. We established 2 additional monoclonal antibodies (MAbs), LISA 101 and EH-123, reacting with KL-6 epitopes different from the epitope recognized by KL-6 antibody. The KL-6-associated mucins detected by the sandwich assay using LISA 101 or EH-123 antibody as a catcher and KL-6 antibody as a tracer were designated as LISA 1-6 and CAM 123-6 respectively. The diagnostic values as the serum markers of KL-6, LISA 1-6 and CAM 123-6 were evaluated measuring their levels in the same serum from healthy individuals and from patients with pulmonary, pancreatic and breast adenocarcinomas. KL-6 was increased abnormally at high rates of more than 50% in pancreatic cancer and in benign lung diseases, LISA 1-6 only in pancreatic cancer, and CAM 123-6 only in pulmonary adenocarcinoma. In benign lung diseases, however, LISA 1-6 and CAM 123-6 were increased abnormally at the rates of only 5.3% and 0% respectively. These observations clearly indicate that LISA 1-6 and CAM 123-6 constitute a part of KL-6, but that they are superior to KL-6 as tumor markers for pancreatic cancer and for pulmonary adenocarcinoma respectively, because of their much lower false-positive rates.
Adenocarcinoma↗
Posterior mediastinal endodermal sinus (yolk sac) tumor in a female patient.
Primary endodermal sinus tumor (yolk sac tumor) of the mediastinum is uncommon. Most patients are young and male, and the great majority of tumors are found in the anterior mediastinum. We report a case of primary posterior mediastinal endodermal sinus tumor occurring in a female patient. Surgical excision was performed and three courses of combination chemotherapy were subsequently given. The serum alpha-fetoprotein level returned to normal.
Adolescent↗
Chest wall and mediastinal invasion by lung cancer: evaluation with multisection expiratory dynamic CT.
PURPOSE: To assess the utility of multisection expiratory dynamic (ED) computed tomography (CT) in evaluation of tumor invasion in the chest wall or mediastinum. MATERIALS AND METHODS: Fifteen patients with lung cancer underwent multisection ED CT. At each section level, 10 images were obtained at an interval of 1 second during a single expiratory maneuver. These images were evaluated in cine mode to assess tumoral movement along the chest wall or mediastinum. RESULTS: ED CT showed that the tumors in five patients were fixed to the chest wall (n = 2) or mediastinum (n = 3); free movement of tumor along the peripheral (n = 7) or mediastinal (n = 3) pleura was proved in the 10 other patients. At pathologic examination, the ED CT findings were proved correct in all patients. In six patients, ED CT provided additional information about tumor invasion that could not be obtained with conventional criteria. CONCLUSION: Multisection ED CT may improve the accuracy of CT in prediction of chest wall or mediastinal invasion of lung cancer.
Aged↗