A case of myelofibrosis with myeloid metaplasia with JAK2(V617F) mutation who developed fibrous tumours in multiple organs.
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Base Sequence↗
Biomedical subjects
T Tabuchi
Publications and source records attributed to T Tabuchi.
[Penetrating right ventricular trauma by stab injury; report of a case].
A 52-year-old woman, who had attempted to commit suicide with a kitchen knife, was admitted. Upon arrival, conscious level was II-30 and blood pressure was 76/46 mmHg. The knife with a blade 20 cm long penetrated the thorax from the 7th left intercostal space beside sternum toward the heart and synchronously moved with pulsation of the heart. The chest X-ray showed the left hemothorax and a computed tomography (CT) revealed the tip of the knife reached the right ventricle. After draining the pleural effusion from the left thorax, the median sternotomy and pericardiotomy were made. The knife was shown to be stuck in right ventricle as it grazed the left anterior descending artery and the right posterior descending artery through pericardium from the apex. The ST segments in II, III, aVF and chests leads were elevated in the preoperative electrocardiography (ECG), but any damage was not recognized in coronary arteries. Under the total bypass on extracorporeal circulation, the knife was removed. The wound at the right ventricle reached about 12 cm length from the apex to the inferior wall. Fortunately, papillary muscles, chorda, septum in the right ventricle and also the left lung were not injured. The wound of the right ventricle was closed with reinforced using felt-strips. The postoperative course was uneventful. This case suggested that the most important factor for survival in cardiac trauma would be to make the hemodynamics stable with the urgent treatment just after arrival and to perform the surgical repair immediately.
Electrocardiography↗
Abdominal stapled side-to-end anastomosis (Baker type) in low and high anterior resection: experiences and results in 69 consecutive patients at a regional general hospital in Japan.
OBJECTIVE: The technique of transanally introducing a circular stapled device to accomplish colorectal anastomoses has been widely used. However, the widespread popularity of this technique may have created the potential of anal sphincter injury during transanal insertion of the anastomosing stapler. Thus, to avoid the risk of anal sphincter injury during anal manipulation, we have been performing an abdominal approach, namely abdominal stapled side-to-end anastomosis (ASSEA) using a Purstring and premium curved EEA stapler in low and high anterior resection. This study will present our experience and results of consecutive resections. METHODS: ASSEA following a resection of the rectum and sigmoid colon for carcinomas was consecutively performed between October 1998 and May 2002. Age, sex, pre-operative anal function, the TNM classification by the UICC rules, operative methods, postoperative morbidity, mortality, anal function and bowel frequency were evaluated. RESULTS: Sixty-nine consecutive patients underwent a resection of the rectum and sigmoid colon with ASSEA. There were three (4.3%) clinical anastomotic leakages in the cases studied. Anastomoses that were located above the peritoneal reflection leaked in one (2.5%) of 40 cases, while anastomoses below the peritoneal reflection leaked in two (6.9%) of 29 cases. A diverting stoma was performed in five (17%) of the 29 cases with low anastomosis. Postoperative anal function was stable without soiling or faecal leakage and bowel frequency two months after surgery was less than four times in all 61 patients. There was no postoperative mortality related to the anastomosis. CONCLUSIONS: Abdominal stapled side-to-end anastomosis (Baker type) was found to be a safe and relatively easy method in both low and high anterior resection in association with a good quality of life.
Abdomen↗
Nitrogen removal from water containing high nitrate nitrogen in a paddy field (wetland).
Nowadays, it has become very common to find in Japan that nitrate nitrogen concentrations are very high in spring water and in well water where the land use of a watershed is agricultural. We have often observed around 50 mg/L of nitrate nitrogen in the spring water where we live. Crops produced in those fields are mainly vegetables such as celery, cabbage, lettuce, carrots, and so on. Green tea is also popular in Japan. In order to produce good quality green tea, farmers apply a great amount of nitrogen fertilizer. This amount can reach up to 1,000 kg/ha in some areas, although the average application amounts to 628 kg/ha in Japan. As a result, ground water that is rich in nitrate flows into the river, which results in a high nitrogen concentration in river water and ground water. Further, this causes a low pH in river water in some tributary rivers in Japan, though this kind of case is very rare. We knew from field tests that if water contained a high nitrogen concentration and was introduced into paddy fields, high nitrogen removal would be performed. This paper presents the outline and results of a system on how to remove nitrogen using paddy fields (wetlands). Further, this paper presents the evaluated results of the removal quantity at the watershed level.
Agriculture↗
[A case of primary HIV infection with oral candidiasis not diagnosed by western blot].
Seroconversion to human immunodeficiency virus(HIV) associated with an illness characterized by fever, sore throat, and lymphadenopathy, sometimes with rash, diarrhea, and vomiting. Leukopenia and liver dysfunction also can occur in some patients. The antibody response associated with HIV infection is directed against a variety of viral proteins. Western blot analysis(WB) is used currently for determining HIV-1 infection. A 47-year-old man whose wife was infected with HIV was found to have contracted primary HIV infection. His first HIV antibody examination 4 weeks after speculated exposure was negative by particle agglutination(PA) method and WB. Approximately 2 weeks later he experienced fever, general fatigue, oral candidiasis. His second laboratory examination showed positive PA and indeterminate WB tests, an HIV-RNA PCR of 4.4 x 10(5) copies/ml, 223 CD4+ lymphocytes/microliter, and liver dysfunction. Two weeks later, all of his symptoms and the abnormal lab data had improved with antifungal therapy alone and no anti-HIV therapy. Subsequently, it took 16 more weeks before HIV infection could be diagnosed by WB. It is necessary to adopt an appropriate HIV-1 PCR method to shorten the diagnostic window in primary HIV infection.
Biomarkers↗
Transperitoneal drainage for a large cystic degeneration after regression of an intra-abdominal desmoid tumor.
A new technique is described for treating a large cystic degeneration after regression of an intra-abdominal desmoid tumors in patients with familial adenomatous polyposis. A cysto-peritoneal shunt is made for the relief of large cystic degeneration by creating a channel between the mesenteric cyst and the peritoneal cavity by means of a silicone tube to facilitate transperitoneal drainage.
Adenomatous Polyposis Coli↗
Granulocytapheresis as a possible cancer treatment. 1995.
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Breast Neoplasms↗
Multiple actin-related proteins of Saccharomyces cerevisiae are present in the nucleus.
An increasing number of actin-related proteins (Arps), which share the basal structure with skeletal actin but possess distinct functions, have been found in a wide variety of organisms. Individual Arps of Saccharomyces cerevisiae were classified into Arps 1-10 based on the relatedness of their sequences and functions, where Arp1 is the most similar to actin, and Arp10 is the least similar. While Arps 1-3 and their orthologs in other organisms are localized exclusively in the cytoplasm, Arp4 (also known as Act3) is localized in the nucleus and is involved in transcriptional regulation. Here we examined the more divergent Arps for possible nuclear functions. We show that Arps 5-9 are localized in the nucleus, but Arp10 is not. The nuclear export signals identified in actin are well conserved in the cytoplasmic Arps, Arps 1-3, but less conserved in the nuclear Arps. Gel filtration chromatography experiments show that the nuclear Arps are larger than monomer in size and thus are present in multi-protein complexes. Since nuclear protein complexes containing Arps are found to be responsible for histone acetylation and chromatin remodeling, it is suggested that most of the divergent Arps are involved in the !transcriptional regulation through chromatin modulation.
Actins↗
[Actual conditions of occupational health administration of small-scale enterprises in Japan: (II). Occupational health controls for hazardous and musculo-skeletally stressful working factors].
In order to clarify the actual condition of occupational health management for hazardous and musculo-skeletally stressful work factors in small-scale enterprises (SSEs) in Japan, a questionnaire survey was conducted in an area near Osaka city. The hazardous work factors examined were dust, organic solvents, lead, specified chemical substances, anoxia, noise, hand-arm vibration, ionizing radiation, high and low temperatures, and high air pressure. The musculo-skeletally stressful work factors examined were VDT work, prolonged standing, unnatural postures, handling of heavy weights, and stress on neck, shoulders and arms. The number of SSEs that replied to the questionnaire was 765 (recovery rate: 69.3%). Enterprises with noise, dust, hand-arm vibration and organic solvents numbered 14.0%, 10.7%, 6.9% and 6.4%, respectively, and those with other hazardous factors numbered less than 3%. Special medical examinations and working environment measurements for hazardous factors were conducted in 0.0% to 26.7% and 0.0% to 13.3%, respectively, of the enterprises. Working environment controls were conducted in 0.0% to 40.2%. Enterprises with prolonged standing and VDT work, were 42.0% and 35.8%, whereas those with other stressful factors were approximately 30%. Special medical examinations for musculo-skeletally stressful factors were conducted in 3.0% to 5.1% of the enterprises, and work controls were conducted in 20.4% to 25.3%. Non execution of the special medical examinations and working environment measurements were mainly due to "lack of knowledge of the law (19.7% and 30.2%)" and "lack of time to perform (16.0% and 23.3%)". Non execution of the controls for the hazardous work factors was due to "lack of knowledge as to how to control (9.0%)", "high costs (7.4%)", "lack of time to perform (6.4%)" and "absence of a suitable adviser (5.9%)". Non execution of the controls for stressful work factors was due to "lack of knowledge as to how to control (15.6%)" and "lack of time to perform (10.2%)". Consequently, as a result of the survey, it was suggested that it is necessary to enlighten the employers of SEEs as to the importance of occupational health controls. It is also necessary to propose low-cost, feasible control methods.
Computer Terminals↗
Significance of late diastolic potential preceding Purkinje potential in verapamil-sensitive idiopathic left ventricular tachycardia.
BACKGROUND: Verapamil-sensitive idiopathic left ventricular tachycardia (VT) is due to reentry with an excitable gap. A late diastolic potential (LDP) is recorded during endocardial mapping of this VT, but its relation to the reentry circuit and significance in radiofrequency (RF) ablation remain to be elucidated. METHODS AND RESULTS: Sixteen consecutive patients with this specific VT were studied (12 men and 4 women; mean age, 32 years). In all patients, sustained VT was induced and during left ventricular endocardial mapping, LDP preceding Purkinje potential (PP) was recorded at the basal (11 patients), middle (3 patients), or apical septum (2 patients). The area with LDP recording was confined to a small region (0.5 to 1.0 cm2) in each patient and was included in the area where PP was recorded (2 to 3 cm2). The relative activation times of LDP, PP, and local ventricular potential (V) at the LDP recording site to the onset of QRS complex were -50.4+/-18.9, -15.2+/-9.6, and 3.0+/-13.3 ms, respectively. The earliest ventricular activation site during VT was identified at the posteroapical septum and was more apical in the septum than the region with LDP in every patient. In 9 patients, VT entrainment was done by pacing from the right ventricular outflow tract while recording LDP. During entrainment, LDP was orthodromically captured, and as the pacing rate was increased, the LDP-to-PP interval was prolonged, whereas stimulus-to-LDP and PP-to-V interval were constant. In 3 patients, the pressure applied to the catheter tip at the LDP region resulted in conduction block between LDP and PP and in VT termination. RF energy application at the LDP recording site successfully eliminated VT. CONCLUSIONS: LDP was suggested to represent the excitation at the entrance to the specialized area with a conduction delay in response to the increase in the rate within the critical slow conduction zone participating in the reentry circuit of this VT. LDP can be a useful marker for successful RF ablation for this VT.
Action Potentials↗
Granulocyte apheresis as a possible new approach in cancer therapy: A pilot study involving two cases.
Patients with advanced cancer often develop immunodeficiency which may be associated with granulocytosis. The granulocytes have the potential to deplete cytotoxic T cells, resulting in accelerated tumor growth and metastasis. To study the elimination of excess granulocytes using granulocyte apheresis in patients with elevated granulocyte to lymphocyte ratios, 2 patients with recurrent metastatic tumors, were selected. Granulocyte apheresis was performed by extracorporeal vein-to-vein circulation with the G-1 granulocyte and monocyte/macrophage apheresis column filled with cellulose acetate beads, each 2 mm in diameter to adsorb granulocytes and monocytes/macrophages. The patients received 1 or 2 apheresis of 30 to 50 min duration per week, at a flow rate of 30-50 ml/min, with 15 sessions constituting one therapeutic course. Apheresis markedly reduced tumor size and prolonged patient survival time without causing any serious adverse events. The results of the present study suggest that granulocyte and monocyte/macrophage apheresis may be beneficial in patients with metastasizing tumors.
Biomarkers, Tumor↗
Atrial ectopy originating from the posteroinferior atrium during radiofrequency catheter ablation of atrioventricular nodal reentrant tachycardia.
Atrial ectopy sometimes appears during RF ablation of the slow pathway in patients with atrioventricular nodal reentrant tachycardia (AVNRT). However, its origin, characteristics, and significance are still unclear. To examine these issues, we analyzed 67 consecutive patients with AVNRT (60 with slow-fast AVNRT and 7 with fast-slow AVNRT), which was successfully eliminated by RF ablation to the sites with a slow potential in 63 patients and with the earliest activations of retrograde slow pathway conduction in 4 patients. During successful RF ablation, junctional ectopy with the activation sequence showing H-A-V at the His-bundle region appeared in 52 patients (group A) and atrial ectopy with negative P waves in the inferior leads preceding the QRS and the activation sequence showing A-H-V at the His-bundle region appeared in 15 patients (group B). Atrial ectopy was associated with (10 patients) or without junctional ectopy (5 patients). Before RF ablation, retrograde slow pathway conduction induced during ventricular burst and/or extrastimulus pacing was more frequently demonstrated in group B than in group A (9/15 [60%] vs 1/52 [2%], P < 0.001). Successful ablation site in group A was distributed between the His-bundle region and coronary sinus ostium, while that in group B was confined mostly to the site anterior to the coronary sinus ostium. In group B, atrial ectopy also appeared in 21% of the unsuccessful RF ablations. In conclusion, atrial ectopy is relatively common during slow pathway ablation and observed in 8% of RF applications overall and 22% of RF applications that successfully eliminated inducible AVNRT. Atrial ectopy appears to be closely related to successful slow pathway ablation among patients with manifest retrograde slow pathway function.
Adult↗
[Actual conditions of occupational health activities in small-scale enterprises in Japan: system for occupational health, health management and demands by small-scale enterprises].
In order to clarify the real conditions of occupational health services (OHS) in small-scale enterprises (SSEs) in Japan, we analyzed questionnaires recovered from 765 SSEs in the area of a city neighboring Osaka City (recovery rate, 69.3%). The SSEs included 358 SSEs with 1 to 4 workers (46.8% of total SSEs), 203 with 5 to 9 (26.5%), 163 with 10 to 29 (21.3%) and 41 with 30 to 49 (5.4%). The main types of businesses were manufacturing (374, 48.9% of total SSEs), wholesale/retail trade/restaurants (153, 20.0%), community, social and personal services (132, 17.3%) and construction (72, 9.4%). Health examinations were performed in 47.7% of SSEs. The reason for the lack of examinations were "shortage of time" (33.3% of SSEs lacking health examination) and "employees do not want to be examined" (28.1%). Some health promotion measures were conducted in 29.2% of SSEs. Health examination (59.0% of SSEs), health promotion (36.5%), measure of mental health (25.9%) and information service for employers and employees (25.5%) were demanded by SSEs as OHS. Financial subsidies and economical incentives were demanded by 46.4% and 28.8% of SSEs, respectively. Regional occupational health center in this area was poorly known among SSEs (8.2%), but health examination (48.4%), information service (37.5%), assessment of work method and advice to improve (19.8%) and environment measurement (12.4%) are demanded of the center by SSEs.
Female↗
Tumor staging of pancreatic adenocarcinoma using early- and late-phase helical CT.
OBJECTIVE: We compared early-phase CT with late-phase CT in the evaluation of pancreatic adenocarcinoma. MATERIALS AND METHODS: Both early- and late-phase CT images of 25 pancreatic adenocarcinomas were compared with surgical-pathologic findings. We evaluated tumor detectability, tumor size, and local tumor invasion. RESULTS: Tumor detectability was 96% on early-phase CT imaging and 64% on late-phase CT imaging (p < .01). Sensitivity for anterior serosal invasion, retroperitoneal invasion, and arterial invasion on early-phase CT exceeded sensitivity on late-phase CT (p < .05). However, specificity for all factors on early-phase CT was less than or equal to specificity on late-phase CT. The grade of local tumor invasion on early-phase CT achieved better agreement with the surgical-pathologic results than did late-phase CT, especially for tumor size and retroperitoneal invasion. CONCLUSION: Early-phase CT was better than late-phase CT in revealing tumors, tumor size, and retroperitoneal invasion.
Adenocarcinoma↗
Effects of pilsicainide and propafenone on vagally induced atrial fibrillation: role of suppressant effect in conductivity.
The effects of pilsicainide on vagally induced atrial fibrillation and on electrophysiological parameters were compared with those of propafenone in alpha-chloralose-anesthetized dogs. Conduction velocity, effective refractory period, wavelength, averaged atrial fibrillation cycle length and activation sequence in the right atrial free wall were determined before and after drug administration. Pilsicainide (2 mg/kg/5 min and 3 mg/kg/h)(n=10) or propafenone (2 mg/kg/15 min and 4 mg/kg/h)(n=10) was intravenously infused during stable atrial fibrillation sustaining > 30 min. Pilsicainide terminated atrial fibrillation in nine dogs, while propafenone did so in three (p < 0.01). After the drug, conduction velocity was suppressed more in the pilsicainide than in the propafenone group(p < 0.01). There was no difference in effective refractory period after drug between the two groups. Mean wavelength was prolonged from 46.0 to 70.4 mm in the pilsicainide group and from 45.0 to 110.8 mm in the propafenone (p < 0.01 vs. pilsicainide). Activation mapping during atrial fibrillation showed Type II or III atrial fibrillation as previously defined [Konings, K.T.S., Kirchhof, C.J.H.J., Smeets, J.R.L.M., Wellens, H.J.J., Penn, O.C., Allessie, M.A., 1994. High-density mapping of electrically induced atrial fibrillation in humans. Circulation. Vol. 89, pp. 511-521.] before the drug, and changed to Type I before atrial fibrillation termination. Thus, pilsicainide was more effective to terminate vagally induced atrial fibrillation than was propafenone despite a greater effect of propafenone than of pilsicainide on wavelength. In this canine atrial fibrillation model, the suppression of conduction velocity may play an important role in changing the activation pattern of atrial fibrillation and thus, terminating atrial fibrillation.
Animals↗
Desmoplastic response in biopsy specimens of early colorectal carcinoma is predictive of deep submucosal invasion.
PURPOSE: The aim of this study was to evaluate the role of histopathology of biopsy specimens in predicting depth of infiltration in early colorectal carcinomas before treatment. METHODS: Early colorectal carcinomas that had been resected surgically or endoscopically between 1984 and 1995 were analyzed. Histopathologic findings, including differentiation of adenocarcinoma and a desmoplastic response were investigated. RESULTS: One hundred nine early colorectal carcinomas consisted of 73 lesions of carcinoma in situ, 13 submucosal carcinomas with minimum invasion, 8 lesions with moderate invasion, and 15 lesions with deep invasion. Of 73 carcinoma in situ lesions, 72 (approximately 99 percent) showed well-differentiated adenocarcinomas and no desmoplastic response. Twelve (92 percent) of 13 submucosal carcinomas with minimum invasion also revealed well-differentiated adenocarcinoma without a desmoplastic response. Sixty-three percent (5/8) of lesions with moderate invasion revealed well-differentiated adenocarcinoma. None of the lesions had a desmoplastic response. Among lesions with deep invasion, 73 percent (11/15) demonstrated moderately differentiated adenocarcinoma, and 11 lesions had a prominent desmoplastic response (73 percent; P < 0.01). CONCLUSIONS: These results suggest that if histopathologic findings of biopsy specimens taken from them before treatment demonstrated adenocarcinoma associated with a desmoplastic response, the lesions had at least deep invasion carcinomas. These lesions should be resected surgically. Submucosal carcinomas with minimum invasion, which have no desmoplastic response, could be treated endoscopically.
Adenocarcinoma↗
Effects of variation in exposure to airborne acetone and difference in work load on acetone concentrations in blood, urine, and exhaled air.
Using a physiologically based pharmacokinetic (PBPK) model, the effects of variation of exposure concentration of acetone on three biological indicators--acetone concentrations in blood, urine, and exhaled air--were investigated. The effect of the difference in work load was also examined. It was confirmed that the model could be used to estimate acetone concentrations during fluctuating exposure by comparing simulated acetone concentrations with the corresponding values observed in field surveys. By inputting the exposure situations into the PBPK model, the variabilities of the biological indicators were simulated. The variation of acetone exposure was expressed by seven 1-hour time-weighted averages (CEXPs). The arithmetic means of the CEXPS were 200 and 750 ppm. The geometric standard deviations (GSDs) were 1.5, 2.0, and 3.0, representing low, moderate, and high variations, respectively. Work loads were set at 15 and 50 W. Consequently, there were 12 exposure situations. The acetone concentrations in venous blood (CB) and exhaled alveolar air (CA) at 1 minute after the end of the work shift were selected as biological indicators of exposure because they were predicted to decrease rapidly at the end of exposure and become relatively stable after 1 minute. The acetone concentration in urine excreted during the last 2 hours of the work shift (CU) was also used as a biological indicator. Simulation was repeated 100 times with randomly permuting CEXPs for each situation. The mean values of CB, CU, and CA showed almost no variation regardless of the difference in the GSD of CEXPs. The coefficients of variation increased with the GSD of CEXPs but were less than 0.2. Consequently, these variables were acceptable as biological indicators of daily average exposure for the same work load. However, the difference in work load greatly changed the mean values of CB, CU, and CA, thus making it difficult to use these variables as indicators of daily average exposure for different work loads.
Acetone↗
Slow potential-guided radiofrequency catheter ablation in atrioventricular nodal reentrant tachycardia: characteristics of the potential associated with successful ablation.
To examine the characteristics of Haïssaguerre's slow potential (SP) specific to effective catheter ablation of the slow pathway in AV nodal reentrant tachycardia, the properties of SP and its recording site were analyzed in 52 patients who underwent successful SP-guided ablation. The properties of SP included the ratio of the amplitude of SP to that of atrial potential (A)(SP/A), the SP duration, the interval between His-bundle potential (HP) and SP (HP-SP), the interval between A and SP (A-SP), the interval between SP and ventricular potential (V) (SP-V), and the ratio of A-SP to the interval between A and the V (A-SP/A-V). The SP recording site was determined by the ratio of the amplitude of A to that of V (A/V) and by the relative position of the ablation catheter on X ray (right anterior oblique projection), expressed as the ratio of the distance between the coronary sinus ostium and SP site to that between the coronary sinus ostium and HP recording site (relative SP position). Twenty-eight slow pathways were ablated with a single energy application, while the other 24 required applications > or = 2. In all successful applications, SP/A, SP duration, HP-SP, A-SP, SP-V, A-SP/A-V, A/V, and relative SP position were 51% +/- 25%, 28 +/- 5 ms, -11 +/- 9 ms, 57 +/- 25 ms, 68 +/- 13 ms, 46% +/- 9%, 15% +/- 13%, and 51% +/- 13%, respectively. A significant correlation was observed between the relative SP position and A-SP, and between the relative SP position and A-SP/A-V (r = 0.60 and 0.37, respectively), while it was not between the relative SP position and HP-SP, nor between the relative SP position and SP-V. When the characteristics of SP were comparatively analyzed between the effective and ineffective applications in 24 patients in whom applications > or = 2 were required, there was no difference observed in HP-SP, A-SP, SP-V, A-SP/A-V, and A/V. However, SP/A, SP duration, and the relative SP position in the effective applications were all greater than those in the ineffective ones (56% +/- 20% vs 35% +/- 18%, P < 0.001; 29 +/- 4 vs 26 +/- 5 ms, P < 0.01; and 52% +/- 15% vs 33% +/- 11%, P < 0.001, respectively). These results indicate that SP with an amplitude over a half of A amplitude and recorded at the mid-septum of the tricuspid annulus can be a marker for successful slow pathway ablation. Although the local atrial electrogram appears late as the SP recording site shifts to the lower position, the timing of SP relative to HP and V remained unchanged, suggesting that SP is independent of the local atrial activation.
Action Potentials↗