Biomedical subjects
Publications and source records attributed to Y Hamada.
A 46-year-old female with mitral insufficiency complicated by hereditary hemorrhagic telangiectasia (Osler's disease) underwent successfully mitral valve replacement. The patient had a history of repeated large-volume nasal bleeding. Mitral valve replacement using a xenograft was safely performed with various attempts for preventing abnormal postoperative hemorrhage.
A case of a fresh type II fracture (Anderson & D'Alonzo) of the odontoid process treated with direct screw fixation is reported. A 52-year-old man complained of severe neck pain following a hit on his forehead incurred in a falling accident. Neurological examination was normal. Cervical spine x-ray films and axial CT scans revealed a fracture at the base of the dens. It was slightly oblique leftup and rightdown, and the dens fragment was displaced 3mm lateral to the right. One week after the injury, this odontoid fracture was directly fixed with a compression screw by an anterior cervical approach. Immediately after the operation, his neck pain disappeared. He had only 4 days of bed rest and 2 months of external immobilization with a simple neck collar. He returned to his previous job 2 months after surgery without any limitation of his neck movement. At follow-up examination 16.5 months after the operation, x-ray films demonstrated complete fusion of the fracture and no problem about the screw such as displacement or breakage. Direct screw fixation of an odontoid fracture via a transcervical approach was thought to be a reasonable method of treatment. For proper assembly of this method, the following two points are particularly recommended: a screw insertion perpendicular to the fracture plane and the use of an optimal screw with both the desired total and thread lengths.
The purpose of this study is to know the effects of Dobutamine (DOB) and Isoproterenol (ISP) on the systemic hemodynamics and myocardial metabolism in the acute phase after open heart surgery in children. Twelve patients with congenital heart disease were administered 5 and 10 micrograms/kg/min (gamma) of DOB, then 0.005 and 0.01 gamma of ISP, and the systemic hemodynamic and metabolic data were taken before and after the administration of the drugs. DOB: DOB increased HR and SVI, so CI rose up markedly. The systolic, diastolic and mean blood pressure also rose up after both doses. CVP and PCWP were depressed at both dosage levels. SVRI and PVRI did not show an appreciable change. ISP: ISP increased HR, CI and systolic blood pressures significantly. On the other hand, SVRI, PVRI and PCWP were decreased at both dosage levels. Myocardial metabolism: The two drugs tested did not exhibit any effect on the progress of anaerobic myocardial metabolism. The myocardial oxygen uptake rate was decreased with DOB and ISP. These phenomena probably suggest that DOB and ISP dilate the coronary vascular bed. From the above data, the following effects can be expected by the use of each drug after open heart surgery in children; 1) powerful inotropic and chronotropic action by DOB, and 2) chronotropic action and after-load reduction by ISP.
This is a report of two patients with extensive destruction of the mitral annulus due to active infective endocarditis. Patient 1 was a 66-year-old female and the patient 2 was a 59-year-old male. In both patients medical therapy had failed to control endocarditis and emergency mitral valve replacements were carried out. At the operation special surgical techniques were necessitated, since insertion of artificial valves in the annulus was impossible because of the lack of the annular tissue due to destruction and excision. On the posterior commissure side, mitral valve prosthesis were sutured to the left atrial wall just above the anatomical mitral ring. Furthermore, in patient 2, a bovine pericardium collar attached to the prosthetic valve was sutured to the left atrial wall to secure fixation of the prosthetic valve. The postoperative courses were uneventful in both patients. This technique seems to be useful in patients with mitral annular destruction.
This report describes two cases of aortic valve replacement which was warranted by the suddenly developed aortic regurgitation due to a congenitally bicuspid aortic valve. Aortic insufficiency was caused by the rupture of the strand which lifted a larger cusp to the aortic wall in one, and by the perforation of valvular aneurysm in another. Reviewing the literature these types of aortic insufficiency are rarely reported.
A simple and inexpensive sternal splint for delayed sternal closure was described. Sternal edges were splinted open using an edge-cut disposable syringe. This method has been employed successfully in 10 patients (one adult, 9 children). This syringe splint is a simple, inexpensive and effective method for delayed sternal closure.
Previously, we discovered a binding site for the Fc region of IgG in human small intestinal and colonic mucosa. The binding site (Fc gamma IBS) appeared to be primarily associated with goblet cells, to consist of greater than 200,000 Da and 78,000 Da components, and to be distinct from leukocyte FcR. In the present work, we used mAb made to colonocyte IgG-binding material to more accurately define the molecular structure and cellular locations of the Fc gamma IBS. In immunoblot and fast protein liquid chromatography analysis, the mAb revealed that the Fc gamma IBS consists of a 110,000- to 140,000-Da component in addition to the two components previously recognized. The greater than 200,000 component may be the critical component for IgG binding, inasmuch as mAb to it but not to the other two components inhibited binding of IgG to colonic sections in vitro. Used in immunoelectron microscopy, the mAb documented that the Fc gamma IBS is present in the endoplasmic reticulum of goblet cells, in the cytoplasmic matrix separating secretory granules of goblet cells, and within the granules themselves; occasionally it has the appearance of being secreted into the intestinal lumen with mucus. The Fc gamma IBS could not be solubilized from colonocyte homogenates by three different detergents, which suggests that it exists in complex with cytoskeletal elements. We speculate that the Fc gamma IBS aids in immunologic protection of the intestine by facilitating interaction between intestinal mucus and antigenic material in the lumen.
In order to predict the residual stenosis in coronary thrombolysis, the factors easily obtained from clinical history--age, gender, history of angina before acute myocardial infarction (AMI), family history, hypertension, diabetes, hypercholesterolemia, smoking, and interval between onset of AMI and recanalization--were observed in 114 patients with successful coronary thrombolysis. In 55 patients with angina before AMI, 29 patients had residual stenosis greater than or equal to 75% and 26 patients had residual stenosis less than 75%. In 59 patients without angina before AMI, 15 patients had residual stenosis greater than or equal to 75%, and 44 patients had residual stenosis less than 75%. The presence or absence of angina before AMI was the main variable that discriminated the groups of residual stenosis of more or less than 75%, which was the only significant independent variable to predict the residual stenosis. These data suggest that the presence of angina pectoris before AMI is likely to be associated with a significant degree of residual stenosis after thrombolysis.
A 54-year-old man presented with symptoms of exertional syncope. Cardiac amyloidosis was diagnosed by endomyocardial biopsy. Exercise tolerance test revealed a failure of increased heart rate followed by sinus arrest, associated with syncope. Autopsy revealed amyloid deposits in the sinoatrial node.
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The morphological alteration of gut-associated lymphoid tissue (GALT) induced by long-term absence of dietary stimulation was investigated. Male Wistar rats weighing approximately 230 g were maintained with total parenteral nutrition (TPN). Control rats were allowed to have the same amount of the solution orally. After two weeks, the morphological alteration of GALT was examined. Although no significant difference in weight gain was noted between the two groups, the area comprised by Peyer's patches was decreased in TPN rats. The number of transported lymphocytes and the ratio of helper T (Th) cells to suppressor/cytotoxic T (Ts/c) cells in intestinal lymph were lowered after TPN treatment. In an immunohistochemical study of the rat ileum, the number of T cells and the Th/Ts/c ratio were decreased both in the intraepithelial spaces and in the lamina propria of TPN rats. The percentage of interleukin-2 receptor-positive cells and the number of IgA-containing cells in the lamina propria were significantly reduced in TPN rats. These results suggest that dietary stimulation might play a role in the maintenance of GALT function and morphology.
Serum IgG of CBA-K1Jms-lprcg/lprcg (lprcg/lprcg) mice with spontaneous systemic lymphadenopathy supported the proliferation of an IL-3-dependent cell line, FDC-P2/185-4. The lprcg/lprcg IgG induced IL-3 synthesis in FDC-P2/185-4 cells, and cells grew by an autocrine mechanism. There was virtually no time lag between the appearance of lymphadenopathy and an increase of IL-3-inducing activity in the sera. We have previously shown that serum IgG from other autoimmune mice with lymphadenopathy, MRL/Mp-lpr/lpr(MRL/lpr) and C3H/HeJ-gld/gld(C3H/gld), also induces IL-3 synthesis and cell growth in FDC-P2/185-4 cells. Furthermore, neither F1 (lprcg/+) mice between lprcg/lprcg and CBA(-)+/+ nor those (lpr-gld) between C3H-lpr/lpr and C3H/gld showed such IL-3-inducing activity, while those (lprcg-gld) between lprcg/lprcg and C3H/gld showed activity much lower than that of their parental strains but significantly higher than that of normal CBA(-)+/+ mice. This result is consistent with the incidence and degree of lymphadenopathy in these F1 mice. Our results suggest that expression of IgG(s) with cytokine-inducing activity might be controlled by these mutant genes, lpr, gld, and lprcg, and might be related to lymphadenopathy in these mice.
We measured the cord serum levels of thyroid-stimulating hormone (TSH), thyroxine (T4) and triiodothyronine (T3) in 922 neonates delivered by mothers who had no thyroid disorders. The T4 and T3 levels increased progressively from the 27th to the 40th week of gestation. However, the TSH levels varied widely and had no correlation with gestational age, because they were affected by the mode of delivery. The mean cord serum TSH level in neonates delivered by vacuum extraction was 16.3 +/- 10.0 microU/ml (n = 30), which was significantly higher than the level following normal vaginal delivery (9.5 +/- 6.0 microU/ml, n = 622) (p less than 0.005). The mean cord serum TSH level following elective caesarean section was 6.5 +/- 3.1 microU/ml (n = 79), and this was significantly lower than after normal vaginal delivery (p less than 0.005). TSH levels in high-risk neonates were significantly higher than in neonates without risk factors. A significant positive correlation was found between the duration of the second stage of labor and the cord serum TSH level (r = 0.45, n = 412, p less than 0.01). However, there was no correlation between the cord serum TSH level and the congenital hypothyroidism screening TSH level (r = 0.01, n = 468). We conclude that the cord serum TSH level reflects delivery stress and that an elevated level does not influence the congenital hypothyroidism screening TSH test in which blood is obtained at five days of life.
Elevated erythrocyte sorbitol levels have been demonstrated in diabetic patients. In order to explain the enhanced sorbitol formation, it has been suggested that aldose reductase might be activated by hyperglycaemia. Although aldose reductase activity has been reported to be increased in some tissues of diabetic patients, the effects of varying concentrations of glucose on the enzyme activity in vivo are unknown. To determine whether or not erythrocyte aldose reductase activity is increased in diabetic patients and is affected by glucose levels, we collected blood samples from 10 Type 1 diabetic patients while fasting and 2 h after a standard meal. We measured the activity of erythrocyte aldose reductase after partial purification by column chromatography. The results showed that erythrocyte aldose reductase activity was significantly increased in diabetic patients as compared with non-diabetic subjects (7.3 +/- 0.7 (+/- SE) vs 5.2 +/- 0.3 u l-erythrocytes-1, p less than 0.05). No correlation, however, was observed between fasting plasma glucose levels and the enzyme activity, and acute elevation of the blood glucose level did not affect the enzyme activity.
It is known that long-standing volume overload on the left ventricle due to mitral regurgitation eventually leads to contractile dysfunction. However, it is unknown whether or not correction of the volume overload can lead to recovery of contractility. In this study we tested the hypothesis that depressed contractile function due to volume overload in mitral regurgitation could return toward normal after mitral valve replacement. Using a canine model of mitral regurgitation which is known to produce contractile dysfunction, we examined contractile function longitudinally in seven dogs at baseline, after 3 mo of mitral regurgitation, 1 mo after mitral valve replacement, and 3 mo after mitral valve replacement. After 3 mo of mitral regurgitation (regurgitant fraction 0.62 +/- 0.04), end-diastolic volume had nearly doubled from 68 +/- 6.8 to 123 +/- 12.1 ml (P less than 0.05). All five indices of contractile function which we examined were depressed. For instance, maximum fiber elastance (EmaxF) obtained by assessment of time-varying elastance decreased from 5.95 +/- 0.71 to 2.25 +/- 0.18 (P less than 0.05). The end-systolic stiffness constant (k) was also depressed from 4.2 +/- 0.4 to 2.1 +/- 0.3. 3 mo after mitral valve replacement all indexes of contractile function had returned to or toward normal (e.g., EmaxF 3.65 +/- 0.21 and k 4.2 +/- 0.3). We conclude that previously depressed contractile function due to volume overload can improve after correction of the overload.
The synthesis and antibacterial activity of the 1-methylcarbapenems, 2-heteroaromatic-thiomethyl and 2-carbamoyloxymethyl derivatives having a 6-[(R)-1-hydroxyethyl] side chain, are described. The introduction of a methyl substituent at the C-1 position was accomplished by a newly developed procedure using crotyl halides and zinc dust. The 2-hydroxymethyl carbapenems as key intermediates allowed an easy entry into the preparation of title carbapenems.
The title compounds (4b, d-f, h-j) were prepared from 1-[4-(p-substituted phenyl)-2-chloro-n-butyl]-1H-imidazoles and the corresponding thiophenols or mercaptopyridines. Acyloxy compounds (5a-e) were prepared from alcohol (2b) and the corresponding acyl chlorides. In the antifungal activity test, p-tolyl compounds (4e, f) showed as good activity as butoconazole (4c).
Cyclic peptides from marine organisms constitute a growing class of naturally occurring cytotoxic substances. A general synthetic method for thiazole amino acids, common components of these cyclic peptides 1-7, has been developed and total syntheses of 1-7 have been achieved. In the process, dolastatin 3 with the proposed structure has been disclosed to differ from the natural material and the real structure 2 has been confirmed by its total synthesis. Patellamides with the proposed structures has been revised to be 6 by their total syntheses. Absolute configuration of ascidiacyclamide has been determined to be 4 and the structure of ulithiacyclamide has been confirmed. Ulicyclamide has been efficiently prepared in combination with solid and liquid phase syntheses. Didemnins A and B, cyclic depsipeptides with potent antitumor activity, have been prepared by condensation of the key eastern and western fragments.