Biomedical subjects
Publications and source records attributed to T Nakada.
Surgical atrial septostomy using a special atriotomy knife without cardiopulmonary bypass in patients with obstruction of the left-sided atrioventricular valve and complex cardiac anomalies is described. This procedure is effective, safe, and economical for patients in the acute stage after intracardiac repair, and available for patients with a closed fossa ovalis.
Although transaortic patch repair under cardiopulmonary bypass is a suitable procedure for aortopulmonary window, another method without cardiopulmonary bypass may be the only one for an infant with extremely low birth weight. We describe a successful repair of an infant with extremely low birth weight (758 g) by closing the window with a clip through a left thoracotomy. Cardiac catheterization 7 months after the operation showed no residual shunt and no stenosis of ascending aorta, pulmonary artery, or coronary arteries in the patient, whom we believe to be one of the smallest with successful repair.
PURPOSE: To discern whether the 3,4-dihydroxyphenylglycol produced in adrenal medulla is associated with altered urinary excretion, we compared the tissue and urinary levels of this catecholamine metabolite, epinephrine and norepinephrine in 23 patients with pheochromocytoma and 26 subjects with renal cell carcinoma. MATERIALS AND METHODS: Tissue and urine concentrations of dihydroxyphenylglycol, epinephrine and norepinephrine were determined by catechol-O-methyl-transferase-based radioenzymatic method and high performance liquid chromatography with electrochemical detection. RESULTS: Contents of dihydroxyphenylglycol, epinephrine and norepinephrine in pheochromocytomas were higher than those in normal adrenal medullae. Removal of pheochromocytomas lowered urinary excretion of these catecholamines and dihydroxyphenylglycol. Norepinephrine content correlated closely with dihydroxyphenylglycol content in normal adrenal medullae and pheochromocytomas but not with epinephrine content in either tissue. Contents of norepinephrine and dihydroxyphenylglycol correlated significantly with urinary norepinephrine excretion and dihydroxyphenylglycol excretion in patients with pheochromocytoma but not in subjects with renal cell carcinoma. The norepinephrine-to-dihydroxyphenylglycol ratio in a 24-hour preoperative urine collection from patients with pheochromocytoma was higher than that from subjects with renal cell carcinoma, which was almost similar to that of epinephrine dominant pheochromocytomas. CONCLUSIONS: Our study suggests that dihydroxyphenylglycol in urine in subjects with renal cell carcinoma is predominantly of a neuronal origin and urinary dihydroxyphenylglycol in patients with pheochromocytoma is of tumor origin. A high level of norepinephrine-to-dihydroxyphenylglycol ratio in urine can be used to determine the diagnosis of the norepinephrine dominant type pheochromocytoma. Measurement of at least a few markers is preferable for precise biochemical diagnosis of pheochromocytoma.
The present study demonstrates the clinical experience of pelvic floor stimulation using percutaneous implantable electrodes and implantable electrical stimulator for the treatment of reflex urinary incontinence in patients with spinal cord injury. Pelvic floor stimulation was carried out on six paraplegic patients who had urinary incontinence from an overactive bladder. After the percutaneous implantation of a pair of electrodes, chronic stimulation was carried out by employing an implanted receiver or an external pulse regulator. Within 4 to 16 weeks of electrical stimulation urinary incontinence was improved in four of the six patients. In two of these six patients, incontinence was completely abolished subjectively. Urodynamic investigations demonstrated an increased volume at the first unstable contraction (P < 0.01) in all of the patients. Inhibition of detrusor overactivity was obtained from this procedure. The stimulation effect appeared to be constant during chronic stimulation. This new procedure probably provides a stable and reliable stimulation effect for long term treatment, and may be an alternative treatment for previous external electrical pelvic floor stimulation.
The recurrence of interruption of aortic arch (IAA) in siblings is rare. According to previous reports concerning siblings with IAA, all cases were IAA type B according to the classification proposed by Celoria and Patton. In this report we present the first cases of brothers with IAA type A. The type of IAA was confirmed by autopsy findings in the elder brother and by operative findings in the younger brother. The etiology of IAA was unclear. Monogenic inheritance was thought unlikely because congenital heart disease was not recognized in other members of the family. It would seem prudent to separate recurrence risks for IAA type A from IAA type B when genetic counselling is provided, but it must be borne in mind that the recurrence of IAA type A can occur among siblings.
Recent research reveals that some patients with a normal coronary arteriogram present with myocardial ischemia in the late stages of Kawasaki disease (KD). The present paper reports a patient who developed ventricular arrhythmia and possible myocardial ischemia in the late stages of KD but whose coronary arteriogram was normal. The onset of KD was at 2 years of age but cardiac involvement including coronary arterial lesion was not detected during the acute stage. At 11 years of age, the Holter electrocardiogram showed both frequent ventricular premature contractions and ventricular tachycardia. The single photon emission computed tomogram demonstrated possible myocardial ischemia. Possible myocardial ischemia was considered to be one of the causes of the ventricular arrhythmia. Although the prognosis for the majority of patients without apparent coronary arterial lesion is excellent, regular follow up must be performed on patients with a history of KD.
A case of acute thalamic hematoma not detected by computed tomography (CT) but unequivocally diagnosed by magnetic resonance imaging (MRI) is presented. A 79-year-old woman presented with acute left hemiparesis. The results of CT obtained on admission as well as on the seventh hospital day were negative for a hematoma. By contrast, serial MRIs exhibited chronological changes in the relaxation properties characteristics of acute hematoma in the thalamus. The case illustrates that contrary to widespread practice, CT cannot absolutely be relied on for the detection of acute intracerebral hematoma.
Indoor climate was assessed in an apartment in Isehara City, Kanagawa Prefecture, Japan, by use of a fungal index. The index represents the environmental (climate) capacity to allow fungal growth; it is determined by measuring the growth rate of a biosensor fungus, Eurotium herbariorum J-183. Differences in climate among various parts of the apartment (microclimate) and its changes could be clarified by using the index. The index in the entire apartment was high in summer, low in winter, and intermediate in spring and autumn. According to the part of the apartment, the index was high in water-associated areas and cool areas. This high fungal index in cool areas was caused by the air at the same absolute humidity showing an increase in the relative humidity with a decrease in temperature. Fungal contamination rapidly progressed in areas with a high fungal index in this apartment. A correlation was observed between the fungal index and fungal contamination. Therefore, areas susceptible to fungal contamination can be estimated by use of the fungal index.
Although hypothermia abolishes alveolar fluid clearance in the in situ goat lung and in the ex vivo human lung, it is unknown whether alveolar fluid clearance resumes in lungs that are rewarmed after severe hypothermia. An isosmolar albumin solution was instilled into resected human lungs that were rewarmed to 37 degrees C after hypothermia (7 +/- 3 degrees C), and then alveolar fluid clearance was measured by the concentration of albumin in the alveolar fluid sample after 4 h. In control experiments in lungs that had not been cooled and rewarmed, alveolar fluid clearance was 11 +/- 2% over 4 h. In separate experiments, hypothermia completely abolished alveolar fluid clearance. However, alveolar fluid clearance resumed to a normal level of 12 +/- 1% over 4 h in the lungs that were rewarmed after hypothermia. Amiloride decreased alveolar fluid clearance by 47% in the rewarmed lungs. Terbutaline increased alveolar fluid clearance by nearly 300% in 2-h experiments in the rewarmed lungs (P < 0.05). The results of this study indicate that alveolar sodium-channel transport mechanisms are preserved in resected human lungs that are exposed to rewarming after hypothermia.
We present a 17-year-old patient with a right testicular dislocation. In this case, dislocated testis had been considered as hematoma and therefore remained untreated for 4 months. The patient underwent right orchiopexy 4 months after the injury. Intraoperative testicular biopsy revealed impaired spermatogenesis and existence of many alternative Sertoli cells, but no atrophy of seminiferous tubules. Six months after the operation, semen analysis of the patient revealed the deformity of most sperms. Eight months after the operation, rebiopsy of the right testis disclosed slight improvement in the spermatogenesis of the testis. Damage of the testis appears to be not severe in dislocation and may be recovered by repositioning.
We report a case of spontaneous hemorrhage secondary to renal angiomyolipoma treated with percutaneous transcatheter arterial embolization. Fourteen and 18 months after the procedure, the patient showed repeated spontaneous hemorrhage during pregnancy. However, a healthy female infant was delivered at the 39th week of the pregnancy. We discuss the management of renal angiomyolipoma in young married women before pregnancy.
The objective of this study was to determine whether area densities of histological elements within prostatic adenoma affect objective and subjective parameters of patients with prostatic hyperplasia. Modified uroflowmetry parameters including Qmax/T100, TQmax/T100 and voiding efficiency were also measured. The area densities of histological elements did not affect uroflowmetry parameters. In addition, subjective symptom score was not correlated with morphometric findings. Our findings suggest that the degree of infravesical obstruction as measured by uroflowmetry parameters and symptom scores cannot be explained by the tissue compositions of adenomas alone.
We present a case of testotoxicosis diagnosed on the basis of immunohistochemical investigation of the testis. The patient was treated with the antiandrogen cyproterone acetate at a dose of 70-130 mg/m2/day. Clinical and biochemical features are consistent with the diagnosis of testotoxicosis. The long-term experience with cyproterone acetate had been generally satisfactory. There are, to our knowledge, no reports on cyproterone acetate treatment of testotoxicosis.
To clarify the effect of aging on the histological composition of established benign prostatic hyperplasia (BPH), quantitative morphometric analyses were performed. Specimens were obtained from 23 patients who underwent transurethral resection of the prostate due to symptomatic BPH. Smooth muscle cells, fibrous tissue, glandular cells, glandular lumen and vascular tissue were quantified. Stromal and glandular components of established BPH did not correlate with age, whereas the proportion of vascular tissue was inversely correlated with age (r = -0.572, p = 0.0046). In the present series, the main characteristic of BPH tissue of elderly men appeared to be decreased vascularity.
To determine whether myocardial changes in patients with supraventricular tachycardia (SVT) are primary or secondary to persistent tachycardia, 11 patients with SVT were studied. These patients were divided into 2 groups with respect to the type of SVT. Group I consisted of 5 patients with incessant SVT and one with multifocal atrial tachycardia, while group II consisted of 4 patients with paroxysmal supraventricular tachycardia and one with short-run supraventricular premature contraction. All of the patients underwent electrophysiological study and endomyocardial biopsy from the right ventricle following routine cardiac catheterization. In group II, there were no significant abnormalities in the clinical and hemodynamic parameters. In group I, 3 patients had clinical features of dilated cardiomyopathy including abnormal ECG, chest X-ray and hypokinesis on left ventriculography. Induction and termination of SVT were possible in 2 patients in group I and in 4 of the 5 patients in group II. The only significant histologic difference between group I and group II was fibrosis. A high incidence of histopathological abnormalities, such as hypertrophy, degeneration, interstitial fibrosis and disarray was observed in both groups. The incidence of significant pathology was higher in group I than in group II. Almost all of the patients were given antiarrhythmic drugs. One patient underwent a successful surgical procedure and normal cardiac function returned after resection of the foci of the right atrium. Our present results suggest that patients with SVT who have incessant or recurrent SVT should undergo not only intracardiac electrophysiologic study but also endomyocardial biopsy for the evaluation of myocardial damage, since SVT might be the initial sign of cardiomyopathy.
A thermostable maltooligosyl trehalose synthase was purified from a cell-free extract of the thermoacidophilic archaebacterium Sulfolobus acidocaldarius ATCC 33909 to an electrophoretically homogeneous state by successive column chromatography on Sepabeads FP-DA13, Butyl-Toyopearl 650M, DEAE-Toyopearl 650S, Ultrogel AcA44, and Mono Q. The enzyme had a molecular mass of 74,000 by SDS-polyacrylamide gel electrophoresis and a pI of 5.9 by gel isoelectrofocusing. The N-terminal amino acid of the enzyme was methionine. The enzyme showed the highest activity from pH 5.0 to 5.5 and at 75 degrees C, and was stable from pH 4.5 to 9.5 and up to 85 degrees C. The enzyme activity was inhibited by Hg2+ and Cu2+. The Kms of the enzyme for maltotetraose, maltopentaose, maltohexaose, maltoheptaose, and short chain amylose (DP 18) were 41.5 mM, 7.1 mM, 5.7 mM, 1.4 mM, and 0.6 mM, respectively.
A thermostable maltooligosyl trehalose trehalohydrolase from the thermoacidophilic archaebacterium Sulfolobus acidocaldarius ATCC 33909 was purified from a cell-free extract to an electrophoretically pure state by successive column chromatographies on Sepabeads FP-DA13, Butyl-Toyopearl 650M, DEAE-Toyopearl 650S, Toyopearl HW-55S and Ultrogel AcA44. The enzyme had a molecular mass of 59,000 by SDS-polyacrylamide gel electrophoresis and a pI of 6.1 by gel isoelectrofocusing. The N-terminal amino acid of the enzyme was methionine. The enzyme showed the highest activity from pH 5.5 to 6.0 and at 75 degrees C, and was stable from pH 5.5 to 9.5 and up to 85 degrees C. The activity was inhibited by Hg2+, Cu2+, Fe2+, Pb2+, and Zn2+. The Km values of the enzyme for maltosyl trehalose, maltotriosyl trehalose, maltotetraosyl trehalose, and maltopentaosyl trehalose were 16.7 mM, 2.7 mM, 3.7 mM, and 4.9 mM, respectively.
A novel enzyme, trehalose synthase, was purified from a cell-free extract of Pimelobacter sp. R48 to an electrophoretically homogeneous state by successive chromatographies on DEAE-Toyopearl 650, Butyl-Toyopearl 650, and Mono Q HR5/5 columns. The molecular weight of the enzyme was estimated to be 62,000 by SDS-polyacrylamide gel electrophoresis, and the enzyme had a pI of 4.6 by gel isoelectrofocusing. The enzyme catalyzed the conversion of maltose into trehalose by intramolecular transglucosylation. The enzyme also converted into maltose but was inactive on other saccharides. The N-terminal amino acid of the enzyme was serine. The optimum pH and temperature were pH7.5 and 20 degrees C, respectively. The enzyme was stable in the range of pH 6.0-9.0 and up to 30 degrees C for 60 min. The rate of conversion of maltose into trehalose was independent of the maltose concentration. The maximum yield of trehalose from maltose were 81.8%, 80.9%, and 76.7% at 5, 15, and 25 degrees C, respectively. The activity was inhibited by Cu2+, Hg2+, Ni2+, Zn2+, and Tris.