Biomedical subjects
Publications and source records attributed to S Kakimoto.
A 53-year-old man was found to have a mediastinal mass. Chest X-ray, CT scan, bronchofiber and superior vena vasography showed a left upper giant mediastinal tumor with invasion to left upper lobe and pericardium. And it was performed a surgical treatment and diagnosed a thymic carcinoma (sarcomatoid type) by histological examination. We reported a rare type of thymic carcinoma and added discussion.
Acid urease was purified to an electrophoretically homogeneous state, and the molecular weight was estimated to be 220,000. The enzyme consisted of three kinds of subunits, designated alpha, beta and gamma, with molecular weights of 67,000, 16,800 and 8600, respectively, in a (alpha 1 beta 2 gamma 1)2 structure. The isoelectric point of the enzyme was 4.8. The nickel content was found to be 1.9 atoms of nickel per alpha 1 beta 2 gamma 1 unit. The amino acid profile was different from those of known bacterial neutral ureases. The enzyme was most active at pH 2 and around 65 degrees C. It was stable between pH 3 and 9, and below 50 degrees C. The Km for urea was 2.7 mM at pH 2. The enzyme activity was inhibited by Ag+, Hg2+, Cu2+, p-chloromercuribenzoate and acetohydroxamate. The enzyme was separated into three subunits by reverse phase HPLC. The amino terminal amino acid sequences of the subunits alpha, beta and gamma were Ser-Phe-Asp-Met-, Met-Val-Pro-Gly- and Met-Arg-Leu-Thr-, respectively.
Ten cases were treated by partial cystectomy for bladder carcinoma (anterior wall 5 cases, dome 1 case, dome to anterior wall 2 cases, lateral wall 2 cases) and these defects were covered with lyophilized human dura (LHD). A few minutes before use, LHD was put into saline for rehydration and, for anastomosis, we used 2 zero plain catgut. In eight cases cardiovascular complications, DM and liver cirrhosis were found before operation. The mean operation time +/- SD was 109 +/- 26 minutes, and the indwelling catheter was left in place for 15 to 42 days. In three cases, prolonged urine leak from the wound continued after operation, and in one case temporal VUR was found without clinical significance. No severe urinary tract infection was found in all cases. The inner surface of dura was almost epithelialized after 8 weeks, 8 cases were in good clinical condition but one case was treated by TUR for recurrence of bladder tumor 1 year and 3 months after operation. Our results with LHD as a substitute for the bladder wall have been satisfactory. The main advantage of this technique is that large vesical segmental resection is possible to such an extent as to satisfy Prout's criteria (at least 3 cm of apparently normal bladder are available to be excised around the tumor).
A case of urethral diverticulum with calculus in a 53-year-old woman is reported. She was admitted to Isahaya General Hospital complaining of a localized swelling in the external genitalia. We found a urethral diverticular calculi by urethrography. Urethral diverticulectomy was carried out without any complications. The removed stones were in 2 pieces and they were composed of calcium phosphate and ammonium urate.
Between 1970 and 1987 valvular operations with cardiopulmonary bypass were performed on 636 patients, with an overall early mortality of 7.5%. To determine the critical indication for valvular surgery, preoperative clinical characteristics were examined by comparing 35 patients, who had died of surgery because of low cardiac output syndrome or multiple organ failure, with operative survivors. The multivariable logistic analyses demonstrated that NYHA functional class IV, multiple valvular disease, large CTR more than 70%, high left ventricular end-diastolic pressure more than 15 mmHg, depressed left ventricular ejection fraction less than 40%, and renal and hepatic dysfunction were powerful independent clinical characteristics concerning operative mortality. The mortality was highly significant when a patient was associated with more than three of the above factors in addition to being NYHA class IV. It should be emphasized, however, that there are three survivors among 11 patients with all six factors. On the other hand the prognosis of such patients without surgery was very poor, fifteen of 21 patients, medically treated during the same period, died within two years after reaching NYHA class IV condition. These results show that several predictors are useful for decision making regarding the indication for valvular surgery. Surgery, however, should not be denied because of the severity of the disease.
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We report a case of non-hormonal adrenocortical adenoma. The tumor was removed en block with the adrenal gland. The specimen was 5.0 X 4.5 X 3.0 cm, weighed 30 g and was solid. Histologically, this tumor had an oncocytoma-like appearance. However, as there is no concept of oncocytoma in connection with adrenocortical adenoma, this case was diagnosed as adrenocortical adenoma. A case with such histological findings has never been reported.
Histologic and immunochemical analyses were performed on 38 cases and 33 cases of malignant tumors of the peripheral nerve sheath, respectively. The histologic features consisted of either closely packed or loosely arranged interlacing fascicles of slender spindle cells that showed a wavy pattern. Although no characteristic findings indicative of neurogenic differentiation could be confirmed with anti-S-100-protein, a fair number of positive cells were seen in the area where the tumor cells were loosely arranged and displayed a wavy pattern. When anti-neuron-specific enolase (NSE) and anti-neurofilament antibody (68K, 200K) were applied, they were found to be positive in cells differentiating to ganglion cells and in epithelial cells. Since S-100-protein-positive cells indicate a differentiation to Schwann cells and NSE-positive cells and neurofilament-positive cells to nerve cells, it was concluded that immunohistochemistry can serve as an effective supplementary method for the diagnosis of malignant tumors of the peripheral nerve sheath.
Cefmenoxime (CMX) was intravenously administered to 106 patients with complicated urinary tract infection at a daily dose of 2-4 g for 5 days. An excellent response in overall clinical efficacy was seen in 15 cases (18.3%), a moderate response in 46 cases (56.1%) and poor response in 21 cases (25.6%). Pyuria was cleared in 20 cases (24.4%), decreased in 22 cases (26.8%) and unchanged in 40 cases (48.8%). Bacteriuria was eliminated in 41 cases (50.0%), decreased in 17 cases (20.7%), relapsed in 7 cases (8.5%) and unchanged in 17 cases (20.7%). Bacteriologically, 74 (76.8%) of the 95 strains isolated were eradicated by CMX, and 22 (23.2%) persisted. Side effects were observed in 3 (abdominal pain, diarrhea and elevation of trans amylase) of the 106 cases. Judging from the above results, CMX is considered to be a useful drug in the treatment of complicated urinary tract infections.
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A case of a 66 years old female who had a nephrogenic adenoma recurring three times during a 6 months course of her illness is reported. With each recurrence, the lesion moved toward the urethral orifice, suggesting an intimate relationship between the recurrent process and physical stimuli to the mucosa. Electron microscopy revealed merely non-specific morphological features of epithelial cells in the lesion. There were no positive morphological clues in the lesion for supporting the lesion to resemble mesonephric and/or mesodermal tissue. The diagnostic term of tubular metaplasia for the lesion is preferable instead of nephrogenic adenoma.
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