Biomedical subjects
Publications and source records attributed to S Kitamura.
A patient with severe ulcerative colitis developed portal vein thrombosis. Intraportal infusion of plasminogen activators through a percutaneous transhepatic catheter produced an effective thrombolysis without increasing rectal bleeding. This is the first report in which portal vein thrombosis associated with active ulcerative colitis was treated successfully.
The frequency of chronic sinusitis among the family members of 26 patients with diffuse panbronchiolitis were analyzed, and were compared with the frequency in 127 control families. In the diffuse panbronchiolitis group, 50% of families suffered from chronic sinusitis, in contrast to 18.9% of families in the control group. The difference was significant. Analysis of HLA antigens in families of patients with diffuse panbronchiolitis revealed that family members with chronic sinusitis had the same HLA haplotype as these patients with diffuse panbronchiolitis in the same family. These results indicate that patients with chronic sinusitis only and those with diffuse panbronchiolitis have similar genetic background. They also suggest that the patients with chronic sinusitis may be seen as a mild or incomplete type of diffuse panbronchiolitis.
A 24-year-old woman who had suffered from pulmonary alveolar proteinosis for eight years was admitted to Jichi Medical Hospital with severe pneumonia. She was mechanically ventilated, and her condition markedly improved after repeated bronchoalveolar lavage with surfactant replacement therapy. This method was used because she had been resistant to the conventional unilateral lung lavage method for 12 months. During the bronchoalveolar lavage procedure, she became progressively hypoxic, but recovered immediately after the instillation of surfactant. The combination of bronchoalveolar lavage with surfactant replacement via a fiberoptic bronchoscope may be useful in treating other patients with pulmonary alveolar proteinosis.
Twenty nine patients with superior sulcus tumors (26 men and 3 women) were studied. The incidence was 2.1% of 1350 patients with lung cancer. The mean age was 66.2 years, and 27 patients (93.1%) had a history of smoking (B.I. = 1193.7). There were 10 adenocarcinomas, 9 squamous cell carcinomas, 5 large cell carcinomas 4 small cell carcinomas, and 1 that could not be classified. Fifteen patients (51.7%) had Stage IV disease on admission. Eight patients (27.6%) presented with symptoms outside the chest. Pancoast syndrome was recognized in 9 patients (31.0%). In 15 patients (51.7%) the diagnosis was made by transbronchial biopsy and in 10 patients (34.5%) it was made by echoguided needle biopsy. Tumors were located in a posterior lesion in 13 patients (44.8%). Twenty patients were given radiation therapy. Clinical staging, irradiation, and surgical treatment were related to the length of survival. The median survival time was 7 months.
The results of recent preclinical and clinical studies suggest that AO-90, a methionine-free intravenous amino acid solution (7.43%), potentiates the antitumor effect of 5-fluorouracil (5-FU). In the present multi-center, randomized, controlled study conducted at the internal medicine departments of 24 institutions between July 1991 and May 1993, patients with advanced gastric cancer were randomly allocated to receive either AO-90 (500-750 mL/day, AO/MF group) or Amiparen, a commercial intravenous amino acid solution (600-800 mL/day, C/MF group) by total parenteral nutrition for 14 days. Both groups received MF therapy which consisted of a continuous infusion of 5-FU at 350 mg/m2/day for 14 days and an i.v. push of mitomycin C 7 mg/m2 on days 7 and 14 (one course). Additional treatment courses were initiated after a withdrawal period when appropriate. Of the 53 subjects enrolled, 52 (98.1%) were eligible and 47 (88.7%) completed the scheduled treatment (AO/MF group: 23, C/MF group: 24). Although there were significant differences for age and sex between the groups, the Mantel-Haenszel test showed that these unevenly distributed characteristics did not affect the study results. The overall clinical response rates in the completed cases were 30.4% (7/23) in the AO/MF group and 16.7% (4/24) in the C/MF group. In particular, the response rate in the inoperable advanced cases with liver metastases, ascites or distant metastases was 45.5% (5/11) in the AO/MF group versus 16.7% (2/12) in the C/MF group. The treatment-related adverse reactions observed were mainly hematologic and subjective/objective symptoms, such as decreased leukocyte count, hemoglobin level and platelet count, nausea/vomiting, diarrhea, stomatitis, and fever. The differences in the incidence were not significant between the groups. These results show that AO-90 in combination with MF therapy is efficacious in the treatment of patients with gastric cancer.
It is difficult to save a patient with acute cardiac free wall rupture due to blunt trauma; only 9 patients abroad and 2 patients in Japan are reported to have survived rupture of the left ventricle. A 30-year-old female was injured in a motor-vehicle accident. Distension of the neck vein, chest X-P and echocardiograms suggested cardiac tamponade due to cardiac rupture. After relieving the cardiac tamponade by left thoractomy, ruptures at the apex of the left ventricle and two sites in the right atrium could be repaired by median sternotomy, and the patient survived the injury. Cardiac rupture should be suspected in all cases of blunt trauma, and the early diagnosis of cardiac tamponade is a key to patient survival. Echocardiography is especially convenient and useful for the diagnosis of this condition. Repair should be performed by median sternotomy and the potential necessity for cardiopulmonary bypass should not be ignored.
The patient was a 50-year-old man who had an SLL-type corrected transposition of the great arteries (C-TGA) accompanied by significant regurgitation of the bilateral atrioventricular valves, atrial septal defect (ASD), persistent left superior vena cava, atrial fibrillation, and ventricular extrasystoles. The systemic tricuspid valve was repaired with a 28 mm Carpentier-Edwards ring (C-E ring) for the mitral valve, while the systemic mitral valve was repaired with a 32 mm C-E ring for the tricuspid valve. Simultaneously, the associated ASD was closed. Although mild tricuspid valve regurgitation persisted postoperatively, his general condition greatly improved. The report of valve repair for both atrioventricular valves in C-TGA is rare, and only 6 such cases have been reported in the Japanese literature.
The relationship between neonatal apnea following general anesthesia and serum ionized calcium (Ca2+) concentration was examined in 13 neonates who had received intraoperative hyperventilation. In all cases, preoperative serum Ca2+ concentration was within normal limits. The anesthesia was maintained by nitrous oxide and oxygen. At the end of anesthesia, the incidence of abnormal breathing such as apnea, periodic breathing or subcostal retraction and their activity were investigated. Five minutes after intravenous administration of 2% CaCl2 solution (16 mg.kg-1), the same parameters were compared with the values before CaCl2 administration. As we used only Ca2+ free solution for fluid therapy during operation, serum Ca2+ concentration decreased gradually under general anesthesia, but after CaCl2 administration, it increased and the incidence of abnormal breathing decreased. To determine the relationship between hyperventilation and the incidence of abnormal breathing, the data were analyzed by dividing the patients into two groups based on PaCO2 level, a lower PaCO2 group (intraoperative PaCO2 < 30 mmHg, n = 5) and a higher PaCO2 group (PaCO2 > or = 30 mmHg, n = 8). But there was no significant relationship between them. In conclusion, this study demonstrates that the Ca administration has a favorable effect on respiratory system and motor activity, but we cannot relate the incidence of postoperative abnormal breathing to the degree of hyperventilation.
One hundred and sixty one patients with upper urinary stones were examined for antimicrobial prophylaxis following extracorporeal shock wave lithotripsy (ESWL). They were divided into two groups, the low-risk group (n = 133) and high-risk group (n = 28), according to the risk factors of urinary tract infection. The patients in the low-risk group were further randomized into two groups which were orally given ofloxacin for 7 days after ESWL (Group A, n = 66), no antimicrobial (Group B, n = 67). The patients in the high-risk group were randomly subdivided into three groups which were given flomoxef intravenously for 2 or 3 days and ofloxacin for 4 or 5 days thereafter (Group C, n = 10), flomoxef only for 2 or 3 days and no drugs later (Group D, n = 10), ofloxacin for 7 days (Group E, n = 8). In all of the patients in the low-risk group, during the 7 days after ESWL, fever elevation was observed in only 1.5% of patients, and bacteriuria in 10.0% on the 7th day. There was no difference in frequency of fever elevation and bacteriuria following ESWL between Group A and Group B. These findings indicate that prophylactic antimicrobial after ESWL treatment is not necessary for low risk patients with urinary tract infections. In the high-risk group, the over-all rates of fever elevation and bacteriuria were 21.4% and 24.0% respectively. The difference of effectiveness among the prophylactic regimens of the three groups (Group C, D, E) was not shown.(ABSTRACT TRUNCATED AT 250 WORDS)
A left ventricular assist system (LVAS, Toyobo CO., LTD., Japan) was used to provide life support for 190 days in a 44-year-old male patient with end-stage dilated cardiomyopathy. Before LVAS implantation, heart failure and cardiogenic shock with multi-organ dysfunction progressed despite the use of intra-aortic balloon pumping (18 days), mechanical ventilatory support (15 days), continuous veno-venous hemofiltration (two days) and intravenous administration of catecholamines. Before LVAS implantation, the patient had marked hepatic and renal dysfunction (total bilirubin 6.1, BUN 73 and serum creatinine 3.1 mg/dl). Those functions returned to normal (total bilirubin 1.2, BUN 11 and serum creatinine 0.6 mg/dl) one month after implantation. He was complicated by multiple cerebral embolisms occurring on the 9th, 57th and 175th postoperative days and died 190 days after surgery. Autopsy showed thrombi attaching to the diaphragm of the blood pump and multiple embolisms in the kidney and the spleen. By scanning electron microscopic examination, initial thrombi with attached erythrocytes were seen on the diaphragm surface without intimal lining formation. In conclusion, LVAS support can be useful for patients with end-stage heart disease complicated by multi-organ dysfunction. However, the LVAS may cause thromboembolic complications over the prolonged use.
The patient was 38-year-old male. His chief complaint was persistent cough. He had been diagnosed at an another clinic as tuberculosis by positive sputum culture. Laboratory findings at the first examination were as follows: ESR was 10 mm/1 hr and CRP was 0.920 mg/dl and other data were within normal limits. Chest X-ray showed infiltrative shadow in the left lower lobe. Bronchoscopic findings before treatment were as follows: there were ulcers on bilateral vocal cords, small white nodules with reddness in trachea and red nodules and white coated ulcers in left main bronchus. He was treated with combination chemotherapy (INH, RFP, EB) and the steroid inhalation was added 1 month later after the initiation of chemotherapy. Bronchoscopic findings at 2 months after starting chemotherapy were as follows: lesions of vocal cords and trachea were improved and lesion of left main bronchus was scarred without stenosis. Bronchial stenosis as sequelae of endobronchial tuberculosis deteriorates the patients' quality of life. Therefore it is important to diagnose endobronchial tuberculosis early and to start treat with chemotherapy as soon as possible, and the follow up by bronchoscopy should be done during treatment.
A 64-year-old woman complained of multiple blisters in 1990. She had had a productive cough since 1975. Immunofluorescence study of a specimen obtained from a skin biopsy showed staining in a linear pattern for both IgG and C3 in the epithelial basement membrane zone (BMZ) of the dermal-epidermal junction, and a high titer of anti-BMZ antibody. These findings led to the diagnosis of bullous pemphigoid. Corticosteroid therapy was started, and resulted in some stabilization of the skin lesion. Exertional dyspnea and a productive cough developed gradually, and the patient was referred to our department in 1992. Chest X-ray film and CT findings revealed a diffuse granular shadow and bronchiectatic change, predominantly in the lower lung fields. Laboratory tests showed a high titer of cold hemagglutinin and a high level of serum immunoglobulin A. Pulmonary function tests showed a combined destructive-restrictive defect and hypoxemia (PaO2 = 58.5 Torr). From these findings diffuse panbronchiolitis was diagnosed. A low dose of erythromycin alleviated the patient's pulmonary symptoms and improved the chest radiographic findings.
A 33-year-old man was admitted complaining of a fever, dyspnea, and a dry cough almost every night since December of 1992. He had been using an ultrasonic humidifier at home. The chest CT scan and roentgenogram showed bilateral reticulonodular shadows. After admission, the symptoms resolved spontaneously. These findings were suggestive of hypersensitivity pneumonitis. After analysis of fluid obtained by bronchoalveolar lavage and of a specimen obtained by transbronchial biopsy, "humidifier lung" was diagnosed. Ten species of microorganisms were isolated from the water left in the patient's humidifier. On precipitation and complement fixation tests of the patients serum, the results were positive for three of those microorganisms: Flavobacterium multivorum, Yersinia pseudotuberculosis, and Aureobacterium liquefaciens. The titer on the complement fixation test increased immediately after a provocation test. The laboratory results suggest that at least one of these three microorganisms was the causative antigen in this case.
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We examined clinical characteristics of patients with primary lung cancer associated with clubbing of the fingers or pulmonary hypertrophic osteoarthropathy. Clubbing was observed in 12.5% of patients with lung cancer. Squamous cell carcinoma was frequently associated with clubbing. Clubbing was found in all clinical stages. PaO2 and PaCO2 were normal in patients with lung cancer, which suggests that neither hypoxemia nor hypercapnia caused the clubbing in these patients. Pulmonary hypertrophic osteoarthropathy was found in three patients with lung cancer (two men and one woman, mean age 49 years). The incidence was 2.9% among lung cancer patients with clubbing, 0.22% in all lung cancer patients, and was apparently lower than those in reports from outside Japan. One of these patients has stage IIIA squamous cell carcinoma, one had stage IV large cell carcinoma, and one had stage IV adenocarcinoma. In all cases bone scans were useful for diagnosis and for following the clinical course.
Seventy-seven children for minor surgery of less than 90 minutes in duration were divided into two groups; one group received midazolam syrup and the other received bromazepam suppository. The sedative effect before or after the induction of the anesthetic, the effect on the circulatory system, and the prolongation of the sedative effect after surgery were studied. Regarding the sedative effect before or during the induction of anesthesia, both medications were effective with no significant difference between the two groups. However, the bromazepam suppository had a significantly better sedative effect 1 or 2 hours after the surgery. In children under 4 years of age, the sedative effect during the induction was obtained by administering midazolam syrup before the surgery. It is indicated that midazolam syrup is superior to the bromazepam suppository in children under 4 years of age.
The present study demonstrated a significant variation of liver aldehyde oxidase activity in twelve strains of rats. The highest activity was found with Sea:SD rats and the lowest one with WKA/Sea rats. When assayed using benzaldehyde as a substrate, the difference in the activity between the two strains was 63.5-fold. Little significant differences in Km values of the enzyme were observed among several strains. On the other hand, Western blot analysis for the enzyme suggested that the strains possess different quantities of the enzyme, which are roughly parallel to aldehyde oxidase activity observed in the strains.
To investigate the patients with language disorder and to detect the activated areas in language processing, we measured the changes in the regional cerebral blood flow (CBF) during speech task (¿counting¿ task) using O-15 water PET activation technique in six normal subjects (age 58.3 +/- 8.1), mean +/- SD), ten fluent aphasics (age 60.3 +/- 12.5) and six nonfluent aphasics (age 50.5 +/- 8.3). In ¿counting¿ task, the subjects were instructed to count the number aloud from 1 to 10 and repeat the sequence over and over in the native language (Japanese) at the rate of one number per 2.5 sec. The data were analyzed with stereotactic intersubject averaging analysis for the normal subjects. Apart from it, the regions of interest (ROI) analysis (a circular ROI of 12 mm diameter) was performed in the language-related areas: posteroinferofrontal areas (PIF), posterosuperotemporal area (PST), and Rolandic areas (related to the mouth and lips) were significantly activated bilaterally in the ¿counting¿ task. PIF were activated with a dominance in the left side. In the resting state, rCBF in the left PIF and left PST were activated with a dominance in the left side. In the resting state, rCBF in the left PIF and left PST was reduced in both fluent and nonfluent aphasics. In nonfluent aphasics, the magnitude of activation in the right PIF by ¿counting¿ task was significantly greater than normal subjects and patients with fluent aphasia (ANOVA). It suggests the importance of the right PIF in the simple language processing in the nonfluent aphasia. In the sixteen aphasic patients, the increase in rCBF in the right PST during the ¿counting¿ task was negatively correlated with the score of comprehension (WAB) in the Spearman ranked correlation (p < 0.05). It suggests that, while the activity of the right PST is minimal for the ¿counting¿ in normal subjects, it plays an important and compensatory role in aphasic patients.