A method of treatment for pseudoarthrosis of the femoral neck. A preliminary report.
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Biomedical subjects
Publications and source records attributed to T Mitsui.
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Virus associated adult T-cell leukemia/lymphoma (ATLL), which includes both adult T-cell leukemia (ATL) and its non-leukemic counterpart (NLATL) was studied clinically, histologically, and immunologically. The disease usually occurred in the sixth decade in both sexes equally. The patients had a rapid clinical course with frequent leukemic changes, lymphadenopathy, hepatomegaly, and occasional skin rash. Bone marrow involvement with mild infiltration and hypercalcemia were more frequent in ATL than in NLATL. Histologically the disease was categorized as malignant lymphoma, diffuse pleomorphic type with cerebriform nuclear giant cells. The lymphoma was characterized by diffuse proliferation of tumor cells with irregular nuclear configurations, varying in size and shape, and the presence of giant cells with highly convoluted cerebriform nuclei. The giant cells seemed to be a diagnostic marker. Immunologically, the tumor cells usually possessed the surface antigens recognized by OKT 3, 4, Leu 8 and anti-Tac antibodies, indicating that they were lymphomas of helper/inducer peripheral T-cells with the receptor for interleukin 2, but they demonstrated no helper/inducer functions. The patients often died of opportunistic infections due to T-cell dysfunction caused by the disease itself and strong chemotherapy.
We examined the hypothesis that recovery of high-frequency QRS potentials at reperfusion is influenced by the duration of myocardial ischemia during cardioplegic arrest in pediatric cardiac surgery. Signal-averaged electrocardiograms were recorded after induction of anesthesia (baseline data) and every 1 to 5 minutes after aortic declamping in 14 patients aged 2 months to 6 years. The signals were processed with a band-pass filter between 80 Hz and 300 Hz to obtain high-frequency potentials in the QRS complex. The high-frequency QRS potentials (80-300 Hz) were expressed as the root mean square voltage over the filtered QRS complex. The high-frequency QRS potentials at baseline were 33.9 +/- 4.4 microV. They decreased to 13.7 +/- 9.6 microV 1 minute after aortic declamping (p = 0.005). Subsequently they gradually increased and then returned to the baseline level. The time that the potentials were over 90% of baseline value ranged from 10 to 35 minutes after aortic declamping. The recovery time of this reduction in the high-frequency QRS potentials correlated with the duration of aortic cross-clamping (r = 0.80, p = 0.0009) and the value of postoperative MB isozyme of the creatine kinase (r = 0.81, p = 0.0042). This study demonstrated that the high-frequency QRS potentials decreased at early reperfusion following cardioplegic arrest and then returned to preischemic levels. The recovery time of the high-frequency QRS potentials significantly correlated with cardioplegic arrest time and postoperative MB isozyme of the creatine kinase values. Our results raise the possibility that changes in high-frequency electrocardiographic signals in the QRS complex may reflect myocardial ischemia during cardioplegic arrest.
An infant with right coronary artery to left ventricular fistula associated with left ventricular aneurysm successfully underwent a division of fistula under cardiopulmonary bypass. Follow-up angiogram showed the patency of the right coronary artery, no recurrence of fistula, and the regression of the left ventricular aneurysm. Because the lesion may progress with age, early diagnosis and surgical intervention are indicated to prevent later complications.
BACKGROUND: Intrapancreatic accessory spleens are frequently confused with primary pancreatic tumors, and differentiation from neoplastic lesions is important to avoid an unnecessary laparotomy. We present three cases of intrapancreatic accessory spleen evaluated by computed tomographic arteriography (CTA) and discuss the characteristic findings. METHODS: CTA was performed, followed by digital subtraction angiography, with an injection of contrast material through a 4-F catheter placed in the celiac artery. Single-level dynamic CTA was also performed in two patients with a 30-s continuous scan in one breath-hold. RESULTS: CTA clearly demonstrated early inhomogeneous enhancement of the lesion, similar to the splenic parenchyma. On single-level dynamic CTA, inhomogeneous enhancement of the lesion in the early phase was diminished in the late phase. Multiplanar reformatted images obtained in two cases showed the deep cleft between the lesion and the pancreas, which suggested that the lesion was originally extrapancreatic. CONCLUSIONS: These two findings on CTA, inhomogeneous enhancement of the lesion and the deep cleft between the lesion and the pancreas, may help to confirm the diagnosis of an intrapancreatic accessory spleen.
We have previously reported the marked increase in plasma levels of endothelin-1 in patients with acute myocardial infarction (AMI). To investigate the effects of severe myocardial ischemia on the production of endothelin-1, plasma concentrations of endothelin-1 were measured by a sandwich-type enzyme immunoassay that we developed recently in both the coronary sinus and the aorta of dogs with artificially induced AMI. Dogs were anesthetized and chests were opened. The proximal left anterior descending coronary artery was completely occluded by ligation for 1 h and then was reperfused for 1 h. Throughout the experiment (at the end of occlusion for 1 h, at the beginning of reperfusion, at the end of reperfusion for 1 h), plasma endothelin-1 levels were not significantly altered either in the coronary sinus or in the aorta. The present findings indicate that severe myocardial ischemia itself does not affect the production of endothelin-1 in the coronary circulation of dogs.
PURPOSE: To clarify the effectiveness of transcatheter arterial embolization (TAE) for hepatocellular carcinoma (HCC) in the caudate lobe of the liver. MATERIALS AND METHODS: Thirteen patients with HCC in the caudate lobe underwent TAE. TAE was performed by injection of the mixture of anticancer drugs (mitomycin C and doxorubicin or epirubicin) and iodized oil, followed by gelatin sponge particles. Arterial anatomy of the caudate branch, local recurrence rate, and survival rate were evaluated. RESULTS: From 31 TAEs for the caudate lobe, 22 subsegmental TAEs were successfully performed (71%). Local recurrence in the caudate lobe was seen in 10 patients (77%). Subsegmental TAE for the caudate lobe was repeated one to five times. Cumulative local recurrence rates were 33% and 75% within 3 and 6 months, respectively. Survival rates after first TAE for HCC in the caudate lobe were 89% and 74% for 1 and 3 years, respectively. CONCLUSION: Local recurrence rate after subsegmental TAE for HCC in the caudate lobe was high. However, repeated subsegmental TAE possibly improves the prognosis of HCC in the caudate lobe.
Oligonucleotide 15-mers containing one or two anthraquinonylmethyl groups at specified sugar residues have been prepared on an automated DNA/RNA synthesizer by using 5'-O-dimethoxytrityl 2'-O-(2-anthraquinonylmethyl)uridine 3'-O-(2-cyanoethyl)-N, N-diisopropylphosphoramidite. The purification of the modified oligonucleotides was done with denaturing polyacrylamide gel electrophoresis. The base compositions and the presence of anthraquinone group(s) in the oligonucleotides were verified with enzymatic digestion (snake venom phosphodiesterase and alkaline phosphatase) analysis and UV-vis spectral measurements. The UV melting behaviors indicate that all the oligonucleotides with anthraquinone group(s) can bind to both their complementary DNA and RNA in a manner similar to that of the unmodified oligonucleotide. All the oligonucleotides possessing anthraquinone group(s) have higher affinity for both DNA and RNA segments when compared with the unmodified oligonucleotide. The oligomer containing two anthraquinone substituents at sites separated by four nucleotides instead of six exhibits the highest affinity for both the complementary DNA and RNA. The stabilizing effect can be translated into a free energy cost of 7.1 kcal/mol for the DNA hybrid and 3.6 kcal/mol for RNA. It has been shown through mismatch/Tm studies that modification of the oligonucleotide by anthraquinone groups does not alter the sequence specificity in binding to a RNA segment.
PURPOSE: The genetic basis of Bernard-Soulier syndrome (BSS) was studied to clarify a relationship between severe clinical manifestations and gene abnormality. PATIENT AND METHODS: A patient with BSS had a severe bleeding tendency that was sometimes life threatening. Flow cytometric analysis of the patient's and normal control platelets was performed to study which glycoprotein (GP) was impaired in glycoprotein Ib/V/IX complex. The genes encoding GPIbalpha from the patient's and control genomic DNA were amplified and directly sequenced. RESULTS: Flow cytometric analysis revealed a defect of GPIbalpha on the surface of the patient's platelets. A homozygous single base pair deletion was identified in seven repeats of adenine at positions 1932 to 1938 in the GPIbalpha gene. This mutation, which has been previously reported, results in a frameshift and predicts a premature stop codon leading to a truncated peptide that cannot fix on the platelet membrane. CONCLUSION: This patient's severe clinical phenotype would be explained by this mutation in the GPIbalpha gene.
A 19-year-old man with cervical myeloradiculopathy is reported. He was admitted to our hospital because of acute muscle weakness of upper limbs, which developed two weeks after respiratory tract infection. Neurologic examination revealed prominent muscular weakness of upper limbs. Deep tendon reflexes showed hyporeflexia in upper limbs and hyperreflexia in lower limbs. Serum IgG anti-GT1a antibody was detected by thin-layer chromatography and immunoblotting. Neck MRI revealed T2-weighted high intensity legions and swelling in spinal cord at third to sixth cervical segment. The muscular weakness and the cervical legion in MRI improved two weeks after steroid treatment. These findings indicate the involvement of cervical pyramidal tract as well as that of cervical roots in the patient. Neurological symptoms of the present case differed from those of pharyngeal-cervical-brachial variant (PCB) of Guillain-Barré syndrome, although serum anti-GT1a antibody was positive.
Two patients with dermatomyositis complicated with Sjögren's syndrome (SjS), are reported. Both patients exhibited sensory-dominant polyneuropathy, compatible with neurologic involvement in SjS. Vascular endothelial growth factor (VEGF) levels were increased in their plasma. Histological examination demonstrated vasculitic changes in biopsied specimens of muscle and salivary glands from the patients, and VEGF was overexpressed in the vasculitic lesions. These findings suggest that VEGF overexpression was associated with the development of vasculopathy in skeletal muscle and salivary glands and possibly in the peripheral nervous system.
We report a 50-year-old Japanese woman with dermatomyositis in whom an anti-mitochondrial antibody was detected. Muscle biopsy demonstrated periodic acid Schiff- (PAS) positive vacuoles in addition to infiltrates of mononuclear cells. Histochemical analysis showed reduced phosphorylase activity. An aerobic exercise test demonstrated that the concentrations of serum lactate and pyruvate were elevated before corticosteroid therapy but decreased after the therapy. On the other hand, in forearm ischemic exercise tests, the responses of serum lactate and pyruvate were attenuated before corticosteroid therapy but recovered after the therapy. These findings indicate that an inflammatory mechanism interfered with myophosphorylase activity and muscle aerobic function.
OBJECTIVE: To ascertain whether clinically diagnosed rheumatoid arthritis (RA) patients having antibodies to enterobacterial common antigens (ECA) in synovial fluid (SF) have a histological appearance characteristic of RA synovitis. METHODS: Twenty-five RA patients for which synovial biopsy specimens were preserved, were selected from 58 patients with RA tested for antibodies to ECA in SF The synovial tissue specimens were examined histologically using a semiquantitative scoring system with quantitative counts. The correlation of anti-ECA antibody levels with total scores for synovitis and laboratory markers in three RA patient groups (markedly positive, moderately to slightly positive, and negative according to anti-ECA antibody levels) was analyzed statistically. RESULTS: Histologic examination in the markedly positive RA group (total score for synovitis, range 18-20 points) revealed typical histological features of rheumatoid synovitis. Total scores for synovitis were significantly higher in both the markedly positive and moderately to slightly positive RA groups than in the negative RA group. A comparison of anti-ECA antibody levels with total scores for synovitis revealed a strong and significant correlation. Furthermore, levels of anti-ECA antibodies were also correlated with rheumatoid factor and C-reactive protein. CONCLUSION: Clinically diagnosed RA patients having anti-ECA antibodies in SF showed typical or characteristic histological features of RA synovitis. Our data suggest that a group of RA patients with an entrobacterial etiology exists in larger groups of patients with RA which is thought to be a heterogeneous disease.
We report a 53-year-old Japanese woman who had recurrent orbital myositis for 14 years. She exhibited mild muscle weakness in proximal limbs 13 years after the onset of orbital myositis. An electromyogram revealed myopathic potentials and denervation potentials in proximal limb muscles. Quadriceps biopsy showed infiltrates of mononuclear cells around intramuscular vessels and mild degenerative changes in muscle cells. These findings indicate that the present case belongs to the spectrum of localized nodular myositis.
A valveless, single-orifice counterpulsation device powered by skeletal muscle was applied to the pulmonary artery for right heart assist. Latissimus dorsi muscles of six dogs had been electrically conditioned for four months in advance (Group 1); the muscles of eight dogs were not preconditioned (Group 2). A polyvinyl chloride balloon was placed beneath the latissimus dorsi muscle and connected to the left pulmonary artery using a noncollapsing graft. Latissimus dorsi muscle was paced synchronously to the cardiac cycle to produce pulmonary artery diastolic augmentation. Percent changes in diastolic augmentation pressure (% DAP) in the main PA was measured. Percent DAP after 180 min assistance was 91 +/- 10% in Group 1, whereas it decreased to 17 +/- 12% in Group 2 (p less than 0.001). These results demonstrate that electrically conditioned skeletal muscle is effective as a power source in right heart assist.
Progressive left ventricular hypertrophy was observed following operations in which long bypasses were inserted from the ascending aorta to the abdominal aorta for aneurysm exclusion in cases of thoracic aortic aneurysm. This effect was not observed after operations in which there was grafting with a short prosthesis for abdominal aortic aneurysm, wrapping and trans-section of the dissecing aneurysm. Clinical and experimental studies of the hemodynamic aspects suggest that the left ventricular hypertrophy was caused by an increase in systolic blood pressure at the aortic root due to the low distensibility of the long graft, a decrease in the Windkessel effect by exclusion of the proximal aorta and energy loss by turbulence formation of the proximal anastomotic area. Therefore, the distensibility or compliance at the long prosthesis seems to be very important in cases with long grafts of the aorta.