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Biomedical subjects

Y Kamijo

Publications and source records attributed to Y Kamijo.

At least 37 records · Page 2Linked to original sources

Rabbit syndrome following phenol ingestion.

CASE REPORT: An elderly Japanese woman ingested a massive quantity of phenol in a suicide attempt. She was admitted to the Emergency Department in respiratory arrest and deep coma. Duodenogastritis was evident endoscopically. With the return of spontaneous respiration and consciousness, fine, rapid rhythmic perioral movements developed together with Parkinsonian findings. The abnormal movements were aggravated by administration of a neuroleptic and ameliorated by discontinuing the drug; they disappeared completely by hospital day 15. In addition to neuroleptic drugs, phenol intoxication may cause the rabbit syndrome by inducing cholinergic dominance with relative dopamine hypofunction in the central nervous system.

Aged↗

A case of serious organophosphate poisoning treated by percutaneus cardiopulmonary support.

We report a case of respiratory arrest, refractory circulatory collapse, and severe hypothermia following ingestion of an organophosphate insecticide. In addition to conventional management, including mechanical ventilation, administration of vasopressors, enteral lavage, charcoal hemoperfusion and administration of antidotes, extracorporeal cardiopulmonary support in the form of percutaneous cardiopulmonary support was successfully employed. Percutaneous cardiopulmonary support may be used for severe but potentially reversible pulmonary or cardiovascular toxicity induced by organophosphates as well as complicated severe hypothermia.

Extracorporeal Circulation↗

Severe rhabdomyolysis following massive ingestion of oolong tea: caffeine intoxication with coexisting hyponatremia.

A 36-y-o patient with schizophrenia, who had consumed gradually increasing quantities of oolong tea that eventually reached 15 L each day, became delirious and was admitted to a psychiatric hospital. After abstinence from oolong tea his delirium resolved. He was transferred to our hospital when he was discovered to have acute renal failure with hyponatremia (118 mEq/L) and severe rhabdomyolysis (creatine phosphokinase, 227,200 IU/L). On admission rhabdomyolysis had begun to improve despite a worsening of the hyponatremia (113 mEq/L). With aggressive supportive therapy, including hypertonic saline administration and hemodialysis, the patient fully recovered without detectable sequelae. The clinical course suggests that caffeine, which is present in oolong tea, was mainly responsible for the rhabdomyolysis as well as the delirium, although severe hyponatremia has been reported to cause rhabdomyolysis on rare occasions. We hypothesize that caffeine toxicity injured the muscle cells, which were fragile due to the potassium depletion induced by the coexisting hyponatremia, to result in unusually severe rhabdomyolysis. The possibility of severe rhabdomyolysis should be considered in a patient with water intoxication due to massive ingestion of caffeine-containing beverages.

Acute Kidney Injury↗

Fatal bilateral adrenal hemorrhage following acute toluene poisoning: a case report.

CASE REPORT: A 19-year-old woman was admitted to the emergency center with the development of quadriparesis after prolonged inhalation of lacquer thinner (67% toluene). Laboratory findings were compatible with a distal renal tubular acidosis manifest as metabolic acidosis, hypokalemia, and hyperchloremia. Despite potassium replacement, her condition deteriorated drastically 30 hours later. Blood pressure became refractory to vasopressors, temperature was persistently above 40 degrees C, and death occurred 56 hours later. At autopsy, adrenal insufficiency secondary to bilateral adrenal hemorrhage was diagnosed. Bilateral adrenal hemorrhage should be considered as a potential cause of sudden clinical deterioration during treatment of serious toluene intoxication.

Acidosis, Renal Tubular↗

Survival after massive arsenic poisoning self-treated by high fluid intake.

CASE REPORT: A 23-year-old male pharmacist ingested 1040 mg arsenic trioxide (788 mg trivalent arsenic, 13 mg/kg). After 7 asymptomatic hours, frequent vomiting and diarrhea occurred. Fearing death from shock, he drank 5 L of water over 5 hours. When he was brought to our hospital with chief complaint of constricted vision about 20 hours after ingestion, the major abdominal symptoms had already subsided. Despite a lethal plasma arsenic on admission, all toxic symptoms including hepatic dysfunction, erythematous dermal eruption, and peripheral neuropathy improved during his hospital stay with no treatment except for dimercaptopropanol.

Adult↗

[Infected emphysematous bullae in a patient with diabetes mellitus].

A 42-year-old woman with diabetes mellitus was admitted to our hospital because of fever, coughing, and dyspnea. Coarse crackles were audible and respiratory sounds were weak in the right lung field. Laboratory examination revealed a high erythrocyte sedimentation rate, a high level of serum C-reactive protein, a high blood sugar level, and hypoxemia. A chest roentgenogram revealed cystic lesions with fluid levels, and an infiltration shadow in the right lung field. A chest computed tomographic scan revealed many cystic lesions with fluid levels and an infiltration shadow. Our diagnosis was infected emphysematous bullae. A tube was inserted percutaneously for drainage and to allow injection of antibiotics into the cystic lesion. The cystic lesion then vanished. Percutaneous drainage and washing with antibiotics can be used to treat infected emphysematous bulla that have thick closed cystic walls.

Adult↗

[Pulmonary disease caused by Mycobacterium avium presenting as a solitary cavity with a thickened wall].

A 46-year-old man was admitted for evaluation of a solitary pulmonary cavity in the apey of the left lung. Because two transbronchial biopsies followed by brushing and washing and sputum cytology did not yield any diagnostic findings, the patient was treated with INH, RFP and SM under a tentative diagnosis of pulmonary tuberculosis. The shadow decreased over two months with combination therapy, but increased again after the dose of SM was decreased. We performed a left upper lobectomy to diagnose either multi-drug-resistant pulmonary tuberculosis or lung cancer. Pathological examination of the resected lung revealed epitheloid cell granulomas with areas of caseous necrosis. Smooth chromophoric colonies were isolated on an Ogawa egg medium, and were identified as M. avium by PCR and DDH. A diagnosis of pulmonary M. avium was made. A chest X-ray film taken two years later was normal. Pulmonary M. avium disease developed in this patient, who had no predisposing lung pathologies.

Diagnosis, Differential↗

Is there an energy conservation "system" in brain that protects against the consequences of energy depletion?

A poorly understood marked decrease (circa 50% of control) in local cerebral glucose utilization is caused by sublethal doses of NaCN. The decrease is global, occurring in essentially all brain regions and is entirely reversible within hours, leaving no obvious pathology. This event is not unique to NaCN in so far as a strikingly similar pattern of decreased glucose utilization occurs with some other toxins. Nor can it be attributed to a direct action of NaCN since local application by microdialysis to the striatum produces a global depression. These results imply that some widely distributed "system" or substance is involved. We speculate the existence of a "system" possibly related to the reticular activating system that senses a fall in energy production and acts globally to make cells quiescent and thus would give some protection from excitotoxic driven damage.

Analysis of Variance↗

Arterial baroreflex attenuation during and after continuous propofol infusion.

The reduction of arterial blood pressure produced by propofol may be, in part, attributable to impaired baroreflex integrity. The purpose of this study was to investigate arterial baroreflex sensitivity during and after continuous propofol infusion. In urethane anaesthetized rabbits, left renal sympathetic nerves were exposed and placed on a bipolar silver electrode to record renal sympathetic nerve activity (RSNA). Mean arterial pressure (MAP) via a femoral artery and heart rate (HR) by electrocardiogram were continuously recorded. The rabbits were divided into two groups of eight each: Group 1, propofol 5 mg.kg-1 bolus followed by infusion 0.5 mg.kg-1 x min-1; Group 2, propofol 2 mg.kg-1 bolus followed by 0.2 mg.kg-1 x min-1. Phenylephrine pressor and sodium nitroprusside (SNP) depressor tests were carried out before propofol was started (control), at 15 and 30 min during 30 min infusion, and at 15, 30 and 60 min after its discontinuation. The change of RSNA was plotted with respect to every 5 mmHg increment and decrement of MAP to construct sympathetic baroreflex sigmoid curves, and to evaluate baroreflex sensitivity. The baroreflex sensitivity was also evaluated by calculating the ratio of maximum increase of RSNA or HR to SNP-induced maximum decrease of MAP (delta RSNA/delta MAP, delta HR/delta MAP). Despite the same decreases or increases in MAP, RSNA was attenuated after 15 and 30 min of propofol infusion in both groups compared with control (P < 0.05). Decreased delta RSNA/delta MAP gradually returned to the control level 60 min after discontinuation of propofol in Group 1.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗

Thrombosed aneurysm of the middle cerebral artery with occlusion of the distal parent artery--case report.

A 54-year-old female presented with subarachnoid hemorrhage due to rupture of a small middle cerebral artery aneurysm, found to be thrombosed at surgery and not visualized on the preoperative angiograms. One major branch of the middle cerebral artery was found to be occluded near the trifurcation. The lumen of the branch proximal to the occlusion had appeared as the aneurysmal opacification on the preoperative angiograms.

Aneurysm, Ruptured↗

[Clinical use of prostaglandin E1 during intracranial surgery].

Prostaglandin E1 was administered to 19 patients to induce hypotension during intracranial surgery. Urine volume during the operation and after the first day was well maintained, and serum BUN and creatinine were within normal ranges after the surgery. Serum GOT and GPT increased significantly on the 7th and 14th day after the operation compared with the control, but this did not seem to be the results of PGE1 administration. LDH and ALP showed no significant change. Thirty minutes and two hours after the administration of PGE1, arterial blood oxygen tension decreased significantly. These results suggest that PGE1 does not adversely affect the liver and kidneys, and it can be used safely and is useful to control blood pressure during intracranial operation.

Adolescent↗

[Efficacy and adverse effects of beta-interferon in the treatment of malignant glioma].

Sixteen patients with malignant glioma were treated by the intravenous administration of beta-interferon together with chemoradiotherapy. Five of the cases were recurrent gliomas. Seven of the 11 fresh cases were treated with beta-interferon, more than two months after cessation of the radiotherapy. Of the 16 cases, 12 cases showed partial regression of tumors, or no regrowth of tumors on CT scan, 2 cases showed no improvement, and 2 cases were unevaluable due to the short follow-up periods. IFN-beta is often administered, in combination with antineoplastic agents and radiotherapy, to patients with malignant glioma. Some patients have shown sufficient suppression of the growth of the malignant glioma only through administration of IFN-beta 1 x 10(6) IU once or twice a week. Some patients, however, have developed severe bone marrow suppression due to the combination therapy of IFN-beta and antineoplastic agents. Therefore, the blood of patients should be tested twice a week, and the data should be analyzed within the same day to determine the subsequent treatment. IFN-beta administration should be stopped if the platelet count drops below 1.0 x 10(5)/mm3 or half of the initial figure, and the course of disease of the patient should be carefully observed.

Adult↗