Minimal change lesion in congenital nephrotic syndrome. Two case reports and a review of the literature.
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Female↗
Biomedical subjects
T Matsubara
Publications and source records attributed to T Matsubara.
Application of mechanical restitution: variation of inotropic effects of vagal stimulation or verapamil administration during irregular cardiac rhythm.
The effects of verapamil administration or vagal stimulation on the mechanical restitution curve (MRC) were studied in order to better understand the modulation of left ventricular (LV) function by interventions that lower the ventricular rate of atrial fibrillation. The MRC and the postextrasystolic MRC were obtained in 11 dogs using peak single beat elastance (Emax). The MRC was fitted by a monoexponential curve. Vagal stimulation or verapamil administration decreased the peak of the MRC and right-shifted the MRC. The postextrasystolic MRC was located upward compared with the control MRC, and was shifted downward by vagal stimulation or verapamil administration. If interventions having a negative inotropic effect effectively slow a rapid heart rate, the net effect of the ventricular contractile state may not always be negative. It was concluded that the MRC is useful in understanding LV contractility during irregular rhythm, especially when assessing the net effect of the negative dromotropic and inotropic action of antiarrhythmic drugs.
Animals↗
Experimental study of catheter ablation using ultrasound energy in canine and porcine hearts.
UNLABELLED: We examined the efficacy and safety of ultrasound energy in eliminating the arrhythmogenic substrates of atrial as well as ventricular tissue using a newly developed instrument in both in vivo and in vitro experiments. Ultrasound (US) applicators were tested on 79 lesions created on a beating heart in canine cardiac tissue, and on 64 lesions in porcine heart specimens. US lesions were created by using transducers with frequencies around 5-10 MHz. In the in vivo study, we observed a significant decrease in the amplitude of the electrograms recorded from the tip of the ablation catheter during the US application (p < 0.01). In some sites transmural lesions could be created which were well demarcated. Blood coagulum formation was observed on the tip of the ablation catheter on several occasions. In one dog ventricular fibrillation was provoked by the delivery of ultrasound energy to the left ventricle. In the in vitro study, lesion depth increased significantly with a longer duration of energy delivery when the temperature was maintained table (p < 0.001), and the lesion depth increased significantly with higher temperatures of energy delivery when the duration of US application was maintained (p < 0.05). In both cases, no significant change in surface area was observed. The maximum depth of the lesion was 10.3 mm. CONCLUSIONS: An ultrasound energy system is relatively safe and effective for creating lesions large enough to eliminate arrhythmogenic substrates deep in the ventricular myocardium. Although the US system is free from pop phenomenon, the problem of blood coagulation on the catheter tip remains to be settled.
Animals↗
Progression to moderate or severe mitral regurgitation after percutaneous transvenous mitral commissurotomy using stepwise inflation technique.
Progression to moderate or severe mitral regurgitation (MR) was studied after Inoue balloon percutaneous transvenous mitral commissurotomy (PTMC) using the stepwise inflation technique, performed at increments of 1 mm of balloon diameter, in 49 consecutive patients with rheumatic mitral stenosis (aged from 32-73 years; 8 males, 41 females). The patients were classified on the basis of the degree of MR after PTMC, compared with that before PTMC, into either Group A, development of moderate or more severe (> or = grade 2) MR (n = 8) or Group B, no increase in MR or development of mild (grade 1) MR (n = 41). Progression to moderate or severe MR was significantly associated only with advanced age (60 +/- 8 vs 52 +/- 10 years, p < 0.05) and narrower mitral valve area (0.87 +/- 0.35 vs 1.11 +/- 0.29 cm2, p < 0.05), but other characteristics before PTMC were similar in both groups. There was no difference between the two groups in the total number and degree of balloon inflation. Immediately before the final inflation, the left atrial mean pressure and v wave pressure were decreased in smaller degrees in Group A compared with Group B (-2 +/- 2 vs -5 +/- 4 mmHg, p < 0.05; -2 +/- 2 vs -6 +/- 6 mmHg, p < 0.05, respectively). Thus, the stepwise inflations require careful monitoring of changes in the left atrial pressure and waveform to recognize the aggravation of MR, especially in older patients with severe stenosis. Patients who do not have a significant drop in left atrial mean pressure and v wave pressure during stepwise inflations of the balloon might be at risk of development of moderate or severe MR after further dilations.
Adult↗
[Experimental study of intraperitoneal hyperthermic chemotherapy].
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Animals↗
[5-fluorouracil and low-dose leucovorin as surgical adjuvant therapy from viewpoint of long-term outcome].
Biochemical modulation of 5-FU by leucovorin (LV) has been demonstrated to increase the therapeutic effect compared to single agent 5-FU in the treatment of patients (pts) with advanced colorectal cancer. The purpose of this study was to determine the effectiveness of the 5-FU + LV combination as adjuvant therapy following surgery in pts with Dukes' B, C colon cancer. Pts were entered in a stratified clinical trial comparing two different combination chemotherapeutic regimens to single agent 5-FU, given orally as a control. This report summarized the result of treatment in 61 pts who were 5-FU oral alone and 32 pts who were 5-FU (375 mg/m2) and low-dose LV (20 mg/m2) intravenously for 5 days with 5-FU oral intake. 5-FU with LV regimen was associated with an improved survival compared with the single agent 5-FU oral intake (p < 0.05). 5-FU with LV regimen resulted in less recurrence in liver and lung compared with single-agent 5-FU oral intake.
Antineoplastic Combined Chemotherapy Protocols↗
[Results of treatment of cancer of the cardia].
Cancer of the cardia is traditionally discussed with cardiac cancer of the lower portion of the esophagus and upper gastric cancer invading the esophagus, and the specific characteristics of cancer of the cardia have never been clearly defined. We reviewed the outcome of 172 patients with adenocarcinoma of the cardia who had undergone radical surgery between 1949 and 1994 in the Division of Gastrointestinal Surgery of the Cancer Institute Hospital. The centers of the tumors were located within 2 cm above and below the boundary between the esophagus and the stomach, and their longitudinal diameter was less than 8 cm. We divided the patients into an early period (1949-1979; n = 79) and a late period (1980-1994; n = 93), and focused on the historical transition. There were no differences in patient gender or histology between the two periods. However, the late period was associated with fewer cases of esophageal invasion and shorter longitudinal diameter, as the age of the population advanced. The number of advanced cancers such as the localized and infiltrative type had decreased, and early cancer and early clinical stage had become more common, but despite the fact that the number of early cancers had increased, extended dissection, such as thoracic and paraaortic lymph node dissection, was performed more frequently. By clinical stage, the long-term outcome markedly improved in Stage I patient in the late period, and tended to improve in Stage II and III patients. This appears to have been attributable to the prevention of micrometastasis by extended dissection, although the number of early cancers is another major potential cause. There were no differences in the outcome of Stage IV patients between the two periods, and further advances in multimodality therapy must be awaited. The range of resection is basically proximal gastrectomy, and if there are adequate indications, the prognosis is favorable. In view of the status of lymphatic flow and lymph node metastasis, and long-term results, lateroaortic lymph node dissection is important. Since the number of early cancer patients has been increasing, if intraabdominal recurrence is prevented, intrathoracic lymph node dissection will contribute greatly to the outcome of such patients.
Adenocarcinoma↗
Mutation of the protein kinase C phosphorylation site on rat alpha1 Na+,K+-ATPase alters regulation of intracellular Na+ and pH and influences cell shape and adhesiveness.
The enzyme Na+,K+-ATPase creates the transmembrane Na+ gradient that is of vital importance for functioning of all eukaryotic cells. Na+, K+-ATPase can be phosphorylated by protein kinase A (PKA) and protein kinase C (PKC), and these sites of phosphorylation have been identified. In the present study, we have examined the physiological significance of PKC phosphorylation of rat Na+,K+-ATPase. In COS cells transfected with wild type rat Na+,K+-ATPase alpha1, intracellular Na+ was higher and pH was lower than in cells transfected with rat Na+,K+-ATPase alpha1 in which the PKC phosphorylation site, Ser-23, had been mutated into alanine. Phorbol dibutyrate inhibited Na+,K+-ATPase-dependent ATP hydrolysis and Rb+ uptake in cells expressing wild type Na+,K+-ATPase but not in cells expressing S23A Na+,K+-ATPase. Cells expressing the S23A mutant had a more rounded appearance and attached less well to fibronectin than did untransfected cells or cells transfected with wild type rat Na+, K+-ATPase alpha1. These results indicate a functional role for PKC-mediated phosphorylation of rat Na+,K+-ATPase alpha1 and suggest a connection between this enzyme and cell adhesion.
Animals↗
Reevaluation of postoperative radiotherapy for thoracic esophageal carcinoma.
PURPOSE: To reevaluate postoperative radiotherapy for thoracic esophageal carcinoma. METHODS AND MATERIALS: Reviewed were the outcome of 89 patients who underwent esophagectomy with systematic dissection of regional lymph nodes between 1988 and 1993. Of the 89 patients, 19 underwent no adjuvant treatment, 22 underwent adjuvant chemotherapy alone, and 48 underwent postoperative radiotherapy. Twelve of the 48 also underwent adjuvant chemotherapy. RESULTS: All patients who experienced local-regional recurrence had lymph node metastases at the time of surgery. The actuarial local-regional control rate at 2-year of follow-up was 94% for patients with lymph node metastases at the time of surgery who underwent postoperative radiotherapy alone or plus chemotherapy, and 74% for those who underwent adjuvant chemotherapy alone. The local-regional control rate was significantly better for those who had undergone postoperative radiotherapy (p < 0.01). CONCLUSIONS: Postoperative radiotherapy still plays an important role as adjuvant treatment.
Adult↗
Coronary artery perforation with subepicardial hematoma.
Coronary artery perforation is a relatively rare complication in coronary angioplasty. We report the case of a 71-year-old male, who was salvaged by emergency surgery, for cardiogenic shock due to subepicardial hematoma associated with balloon angioplasty. Such a case has not yet previously been reported.
Aged↗
Cardiac metastasis from squamous cell carcinoma of gallbladder.
A 65-year-old woman was admitted to our hospital with the diagnosis of gallbladder tumor. Right extended hepatic lobectomy plus lymph node dissection of the hepatoduodenal ligament and left hepaticojejunostomy with Roux-en-Y reconstruction was performed in July, 1993. The gallbladder tumor was histologically proven to be squamous cell carcinoma. Seventeen months later, the patient experienced dyspnea and pitting edema of the lower legs and was admitted, in December 1994, with a diagnosis of heart failure. Despite intensive cardiac support, she died 12 days after the second admission. Autopsy revealed multiple cardiac tumors in the left and right ventricles, left atrium, left coronary artery, and left diaphragm. Histologically, these tumors were shown to be squamous cell carcinoma, considered to have metastasized from the primary gallbladder carcinoma. As neither local recurrence of the gallbladder carcinoma nor any lymph node metastasis was found, the cardiac metastasis of the gallbladder carcinoma may have occurred via the hematogenous route. Although rare, this route of cardiac metastasis of gallbladder carcinoma may be an important aspect of distant metastasis, which should be monitored for during follow-up after resection of the primary tumor.
Aged↗
Resolution of protein-losing hypertrophic gastropathy by eradication of Helicobacter pylori.
UNLABELLED: There is as yet no consensus about the need for treatment of Helicobacter pylori infections, except for H. pylori-associated peptic ulcer. We present a 3-year-old boy with a 3-month history of oedema and hypoproteinaemia associated with hypertrophic gastropathy. Abdominal scintigram using intravenous 99mTc-labelled human serum albumin scintigraphy and direct measurement of protein in gastric juice proved that serum proteins were massively secreted in the stomach. Histological findings of mucosal inflammation were observed and H. pylori was isolated from the gastric mucosa. The protein loss promptly stopped within 2 weeks of the beginning of eradication therapy. CONCLUSION: Protein-losing hypertrophic gastropathy may be induced by Helicobacter pylori-associated gastritis and should therefore be carefully evaluated by histological and bacteriological examination to provide a basis for eradication of H. pylori.
2-Pyridinylmethylsulfinylbenzimidazoles↗
Surgical treatment for primary esophageal cancer developing after pharyngolaryngectomy for head and neck cancer.
BACKGROUND: Primary esophageal cancer developing after hypopharyngeal or laryngeal cancer is increasing in frequency, but operative treatment of such cases is not well established. The proximity of both cancers could produce interactive influence on surgical procedures and risk factors. There have been few reports focusing on surgical strategy for such cases. METHODS: We retrospectively investigated the most recent series of 18 patients who had previously undergone pharyngolaryngectomy for cancer and subsequently underwent esophagectomy for second primary cancer of the esophagus. At esophagectomy special care was taken to preserve the tracheal vascularity and to select adequate procedures for lymph node dissection and bowel reconstruction. RESULTS: Curative resection as confirmed macroscopically was achieved in all cases except one. Lymph node involvement was found in half of the patients. No major postoperative complication was observed except for partial necrosis of the trachea in two cases that were conservatively treated. No patient died during hospitalization. The 3-year survival rate was 64% overall and 55% in cases with lymph node involvement. CONCLUSIONS: Although increased operative risk was expected in esophagectomy after pharyngolaryngectomy, our operative results were acceptable. Most risk factors were controllable by selecting appropriate operation procedures. In patients with technically resectable cancer, esophagectomy with systematic lymph node dissection is recommended as in ordinary esophageal cancer.
Aged↗
Annual changes in serum vitellogenin concentrations in viviparous eelpout, Zoarces elongatus.
Vitellogenin of matrotrophic viviparous eelpout (Zoarces elongatus) was purified from estradiol-17 beta (E2) treated immature male sera by gel chromatography and anion exchange chromatography. Isolated vitellogenin has a molecular weight of 540 kDa estimated by gel chromatography. Serum levels of vitellogenin in females were measured during oocyte development and gestation by single radial immunodiffusion. Serum vitellogenin level was low (less than 0.2 mg/ml) during the early vitellogenic period, increased in the late vitellogenic period to a peak level (6.4 +/- 2.1 mg/ml) at the beginning of gestation. After that it rapidly decreased to a low level (0.1 +/- 0.1 mg/ml) during the early gestation period. Levels of vitellogenin remained low throughout the gestation period. Serum E2 levels in females showed increased from 1.3 to 3.0 ng/ml during the late vitellogenic period, and declined to 0.4 ng/ml during the early gestation period. Serum levels of E2 showed good correlation with serum vitellogenin levels, suggesting that the vitellogenin synthesis is controlled by E2 in this species. These results combined with the matrotrophic growth of embryo during gestation suggest that there is a shift in the synthesis of maternal nutritional products for embryos from the yolk to other nutrients.
Animals↗
Surgical treatment of cancer of the thoracic esophagus in association with a major pulmonary operation.
BACKGROUND: Pulmonary complications have been a major cause of mortality after operations for cancer of the thoracic esophagus. Although the risk involved in esophagectomy associated with a major pulmonary operation is expected to be high, it has seldom been evaluated on the basis of clinical experience. STUDY DESIGN: Of 408 patients who underwent esophagectomy, 8 had previously undergone major pulmonary operation (7 for tuberculosis and 1 for pulmonary cancer) and 10 underwent concurrent major pulmonary resection (7 for pulmonary invasion of esophageal cancer, 2 for synchronous pulmonary cancer, 1 for extensive bronchiectasia). All patients underwent systematic lymph node dissection for esophageal cancer, except one patient with mucosal cancer. To prevent postoperative complications, the operative approach and dissection procedures for esophageal cancer were modified according to the associated pulmonary operation and the extent of cancer invasion. All thoracotomies for esophagectomy were performed on the same side as the major pulmonary operation. Additional median sternotomy was performed when necessary. In the most recent 8 patients who underwent major pulmonary resection concurrent with esophagectomy, the bronchial stump was covered with a pedicle flap. RESULTS: Of the 18 patients who underwent pulmonary operation, postoperative complications developed in 13 of the 18 object patients, but none was fatal. The 3-year survival rate was 45%. All deaths were caused by esophageal cancer or another cancer. CONCLUSIONS: Aggressive esophagectomy associated with major pulmonary operation is not contraindicated in patients with fair risk conditions. The operative procedures for esophagectomy should be appropriately modified to minimize the effect of the associated pulmonary operation. Special care should be taken with respect to the approach for mediastinal dissection and closure of the bronchial stump.
Combined Modality Therapy↗
Effects of antihypertensive agents on circadian blood pressure in hypertensive patients with previous brain infarction.
To evaluate the effects of antihypertensive agents on the circadian blood pressure (BP) of patients with previous brain infarction, the ambulatory BP was measured non-invasively for 24 h before and after administration of antihypertensive agents. One hundred milligrams of acebutolol twice daily (n = 15) is effective in lowering the BP during the daytime, but has little effect during the night and the morning. Twenty milligrams of slow-release nifedipine twice daily (n = 14) produced a consistent reduction in the BP over the entire 24-h period and effectively blunted the rise in BP in the morning. Captopril (12.5 mg) twice daily (n = 15) produced a mild reduction in BP with little change in the circadian pattern. The slow-release nifedipine group had the greatest decrease in mean systolic and diastolic BP. The heart rate significantly increased after administration of slow-release nifedipine and decreased after administration of acebutolol. To reduce stroke recurrence, we should consider the effects of antihypertensive agents on circadian BP in hypertensive patients with previous brain infarction.
Acebutolol↗
Platelet-activating factor (PAF) and PAF acetylhydrolase activity in rat uterus and placenta during the late stages of pregnancy.
We evaluated the roles of platelet-activating factor (PAF) and PAF-acetylhydrolase (PAF-AH) activity in late pregnancy. Uterine and placental concentrations of PAF were determined by the washed rabbit platelet aggregation bioassay. Uterine, placental, and plasma PAF-AH activities were also assayed. PAF concentration in the uterus increased 4-fold between Days 15 and 21 of pregnancy. PAF was also determined in the placenta on Days 15 and 21. In contrast to findings in the uterus, the concentration in the placenta was decreased by 75%. Platelet aggregation caused by uterine and placental PAF was inhibited by the PAF receptor antagonists CV-3988 and TCV-309. Plasma and uterine PAF-AH activities decreased significantly between Days 15 and 21. In contrast, the placental PAF-AH activity significantly increased during this same time period. On the basis of these findings, it is suggested that the PAF concentration in the uterus and placenta may be regulated by intracellular PAF-AH and/or plasma PAF-AH activities. Increased PAF activity in the pregnant rat uterus may be related to the initiation of labor due to its known effect on myometrial contraction. Decreased PAF concentration in the placenta may contribute to the fetoplacental circulation due to its known hypotensive activity and the increase in vascular permeability.
1-Alkyl-2-acetylglycerophosphocholine Esterase↗
Increasing vasoconstrictor response to ergonovine with oxidative injury in canine coronary artery.
BACKGROUND: The effects of oxygen free radicals on coronary vasoreactivity remain unknown. OBJECTIVE: To examine whether oxygen free radicals increase coronary arterial tone and sensitivity to vasoconstrictor stimulation in closed-chest dogs. METHODS: Oxygen radicals were generated by the reaction of xanthine plus xanthine oxidase (XXO) and effects of these substances on the left coronary artery (the percentage diameter change) and on the constrictor effect of ergonovine were examined in vivo in 19 anesthetized, closed-chest dogs by selective coronary angiography. The effects of XXO solution and ergonovine were assessed in a cumulative fashion using 100, 200, and 300 ml XXO and 50, 100, 150, and 200 micrograms ergonovine, in 5 (group I) and 6 dogs (group II), respectively. The effects of XXO on the constrictor responses elicited by 50 micrograms ergonovine were examined in eight dogs (group III). Changes in the vascular endothelium were examined by postmortem electron microscopic examination. RESULTS: Oxidative injury alone produced slight constriction of the coronary artery, but the change was not significant. However, ergonovine-induced vasoconstriction was enhanced after administration of 100 and 200 ml (cumulative amount) XXO solution (P < 0.05, group II versus group III). The enhancement was no longer observed after administration of 300 ml (cumulative amount) XXO solution. Scanning and transmission electron microscopies revealed the formation of blebs and ulceration in the coronary endothelium after administration of XXO solution. CONCLUSION: These results suggest that oxygen radicals can enhance the ergonovine-induced coronary vasoconstriction in a concentration-dependent manner. There seems to be a critical level of oxygen radicals for the production of the effect.
Animals↗