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Biomedical subjects

E Matsuyama

Publications and source records attributed to E Matsuyama.

At least 19 recordsLinked to original sources

Cardiomyopathy associated with the smoking of crystal methamphetamine.

The smoking of crystal methamphetamine, or "ice," is a growing drug abuse problem in the United States. The toxic effects of methamphetamine smoking have not been well described. We describe two patients with cardiovascular toxic effects associated with the smoking of crystal methamphetamine. In our first patient, the use of smokeable methamphetamine was associated with the subsequent development of pulmonary edema and a dilated cardiomyopathy. In our second patient, the smoking of crystal methamphetamine likely produced diffuse vasospasm that resulted in acute myocardial infarction, cardiogenic shock, and death. The recognition of potentially lethal cardiac complications associated with the smoking of crystal methamphetamine is of extreme significance and should be emphasized to potential abusers of this drug.

Adult

The third nationwide survey in Japan of vitamin K deficiency in infancy.

The occurrence of hemorrhagic disease due to vitamin K (VK) deficiency beyond the neonatal period has come under investigation in Japan. In 1980 the 1st nationwide survey was conducted in Japan by Nakayama and others, and was followed by the 2nd nationwide survey in 1985 by Hanawa. The present survey was designed to further monitor the incidence of this disease in Japan during the 3-year period from July 1985 to June 1988. Questionnaires were sent to 1,315 hospitals having more than 200 beds, located throughout Japan. Responses were received from 775 hospitals, for an answer rate of 58.9%. The total number of reported cases was 175, including 129 idiopathic type, 28 secondary type and 18 near-miss type. In this survey it was revealed that the incidence rate of the idiopathic type of vitamin K deficiency in infancy (VKDI) has decreased remarkably, to about one-fourth that reported in the first survey. The declining incidence rate of VK deficiency in Japan is considered to be the result of ever more widespread prophylactic administration of VK during the neonatal period, as most occurrences of VK deficiency in infancy are preventable by prophylactic administration of VK from the neonatal period. However, in 16 cases of the idiopathic type of VK deficiency found in the present survey, VK had been administered at least once during or after the neonatal period. This shows the heterogeneity of this condition.

Female

[Idiopathic enlargement of the right atrium with persistent superior vena cava].

A 69-year-old male, who had been found (during a routine roentgenogram of the chest at an annual check-up) to have cardiomegaly, had been asymptomatic until 63 years of age, when DOE and swelling of the legs appeared. He visited our hospital because these symptoms has become more severe. Physical examination revealed JVD, third heart sound and a grade 3 holosystolic murmur, hepatomegaly and edema in the lower legs. His ECG showed atrial fibrillation. His chest X-P showed marked cardiomegaly and rt pleural effusion. His echocardiography and MRI revealed a marked enlargement of the right atrium and a slight enlargement of the right ventricle. The latter also showed persistent left superior vena cava. The cardiac catheterization, angiocardiography and intracavitary electrocardiography revealed no organic cardiac disease which induced enlargement of the right atrium. The idiopathic enlargement of the right atrium is a rare disease. Patients suffering from this disease are asymptomatic in most cases. We reported the idiopathic enlargement of the right atrium with persistent left superior vena cava in this paper.

Aged

[A case of pulmonary nocardiosis diagnosed by percutaneous aspiration].

A 71-year-old man complained of mild dyspnea, and his chest X-ray showed a cavitating lesion accompanied by infiltrative changes in the right middle lobe. Percutaneous aspiration revealed numerous gram-positive and acid-fast branching rods. Morphological examination and biochemical tests of the colonies confirmed the diagnosis of pulmonary nocardiosis caused by nocardia asteroides. The patient was treated successfully with sulfamethoxazole-trimethoprim. It has been reported that approximately half of the patients with pulmonary nocardiosis have immunodeficiency, but our patient had no underlying disease. This disease has no characteristic clinical features, so diagnosis is difficult. As nocardia may involve the central nervous system leading to a poor prognosis, early diagnosis and prompt treatment are required to improve survival.

Aged

Multiple actions of recombinant activin-A in vivo.

Activin stimulates the secretion of FSH from cultured pituitary cells and enhances the differentiation of erythroid progenitors in vitro. The role of activin in the physiological regulation of either process, however, is unknown. We report here that systemic administration of recombinant human activin-A to immature female rats caused a marked increase in serum FSH levels. In addition, in ovariectomized estrogen-treated rats recombinant human activin-A induced a small but statistically significant increase in the circulating concentrations of red blood cells and hemoglobin. These data demonstrate the efficacy of activin in vivo, supporting the hypothesis that this protein is an important regulator of gonadotropic and erythroid function.

Activins

[Chronic neutrophilic leukemia associated with monoclonal gammopathy (IgA, kappa type)].

A 62-year-old woman with chronic neutrophilic leukemia (CNL) is described. She presented in February 1988 for evaluation of leukocytosis of 3 years' duration with no complaint. Physical examination was normal. The leukocyte count was 20,100/microliters with 70% segmented neutrophils and 12% band forms. A myelogram showed marked myeloid hyperplasia and plasmacytosis (5.9%). Neutrophil alkaline phosphatase score, serum lysozyme and vitamin B12 levels were elevated. Cytogenetic analysis of the marrow aspirate showed normal karyotype, with no Philadelphia chromosome. Total serum protein (TP) was 7.5 g/dl with increased beta-globulin (23.5%), identified as monoclonal IgA kappa (3.3 g/dl) on immunoelectrophoresis. No activity of G-CSF was detected in the serum. A retrospective study revealed that the beta-globulin level was normal (6.3%, TP 6.9 g/dl) in 1980 and that it was slightly increased (11.6%, TP 7.0 g/dl) without leukocytosis (5,900/microliter) in 1981. In 1985, when leukocytosis obviously existed (9,900/microliter), the percentage of beta-globulin was increased to 17.5% (TP 7.2 g/dl). The possibility that monoclonal gammopathy preceded the leukocytosis must be admitted. On the basis of our observation, it is assumed that CNL and monoclonal gammopathy may be blood dyscrasias derived from a common precursor cell or that the immunological abnormality associated with monoclonal gammopathy may be implicated in the development of CNL.

Female

[A case of hypereosinophilic syndrome associated with eosinophilic endocarditis].

A 66-year-old woman, who had had bronchial asthma, was admitted to our hospital because she suffered from fever, productive cough, wheezing, dyspnea, and chest pressure sensation. Her chest X-ray showed migrating infiltration and marked cardiomegaly. Her ECG at the admission revealed abnormal Q wave and T wave inversion, though that of 3 years before had been almost normal. Hematology showed leukocytosis and eosinophilia of 8,000/mm3 without abnormal cells. All immunological tests were negative and the specific cause of the eosinophilia was unknown. 2 weeks after admission, she complained of severe chest pain suddenly and her ECG showed ST elevation on V1-4 and serum CPK level was elevated to 290 IU/l. By the thrombolytic agent and anticoagulant therapy, her symptom was lightened immediately. 2 months later, we made her cardiac catheterization and myocardial biopsy. Her LVG showed a small aneurysm of the apex, though her CAG was normal finding. The biopsy revealed moderate fibrosis and cellular infiltration including a few eosinophils. We thought that eosinophilic endocarditis had existed first, and secondary embolism continued led to the small infarction. The hypereosinophilia was spontaneously normalized 2 months after admission, but the patient complained of myalgia and sensory disturbance of extremities. The biopsy of quadriceps muscle could prove neither infiltration of eosinophils nor vasculitis. But we diagnosed mononeuritis multiplex due to hypereosinophilia. Judging from various symptoms and laboratory findings, this case was included to the hypereosinophilic syndrome. We also thought allergic granulomatosis and angitis as one of the differential diagnoses, but histologically vasculitis was not proved. In this case, eosinophilia was disappeared without using corticosteroids.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged

The second nation-wide survey in Japan of vitamin K deficiency in infancy.

Throughout Japan a total of 543 cases of vitamin K deficiency occurring in infants over 2 weeks of age were reported from January 1981 to June 1985. Of these cases, 427 showed no obvious reasons for vitamin K deficiency; this sort of case is known as "idiopathic vitamin K deficiency in infancy". Another 57 cases had bleeding episodes due to vitamin K deficiency associated with obvious hepatobiliary lesions, chronic diarrhoea, long-term antibiotic therapy, etc; this sort is called "secondary vitamin K deficiency in infancy". The third group, consisting of 59 cases, was made up of the so-called "near miss" type, in which a haemorrhagic tendency, without any obvious clinical haemorrhage, was discovered by Normotest, at the time of mass screening in most cases. In the idiopathic group, 269 cases (63.0%) developed bleeding episodes between the 1st and 2nd months of age, and 387 cases (90.0%) were entirely breast-fed. Intracranial haemorrhage was observed in 353 cases (82.7%) of this group. Moreover, slight elevation of serum transaminase and direct type bilirubin levels were observed in the idiopathic group. Liver dysfunction of unknown origin may play some role in the onset of vitamin K deficiency in infancy.

Alanine Transaminase

A case of Wolff-Parkinson-White syndrome: conduction through the Kent bundle seems to depend on the serum potassium level.

A 72-year-old man with Wolff-Parkinson-White syndrome and sick sinus syndrome had colon cancer, suggesting that the conduction of the Kent bundle depends on the serum potassium level. Because of severe diarrhea or furosemide administration, the serum potassium level in this patient was sometimes low. When it was less than 3.0 mEq/l delta wave or re-entrant tachycardia via the Kent bundle occurred. These were suppressed by the administration of potassium. On the other hand, when the serum potassium level was normal or high, neither effect was noted, and electrophysiological studies, done when the level was 3.2 mEq/l, showed no evidence of conduction by the accessory pathway. This suggests that conduction through the Kent bundle depends on the serum potassium level.

Aged

Comparative effects of three calcium antagonists, diltiazem, verapamil and nifedipine, on the sinoatrial and atrioventricular nodes. Experimental and clinical studies.

Diltiazem, verapamil and nifedipine suppress sinoatrial (SA) nodal function in the excised rabbit heart. Clinically, however, their suppressive effect on the SA node is modified considerably by the reflex increase in sympathetic tone as a result of the fall in blood pressure caused by the vasodilating action of the calcium antagonists. Diltiazem, verapamil and nifedipine suppress atrioventricular (AV) nodal conduction and prolong refractory periods in the excised rabbit AV node. Clinically, diltiazem and verapamil exert a similar suppressive effect on the AV node and are useful for treating and preventing AV nodal reentrant tachycardia. Nifedipine, in clinically practical doses, has no antiarrhythmic properties, probably because of reflex activation of the sympathetic system secondary to its hypotensive effect, which is greater than that of the other two calcium antagonists. Diltiazem and verapamil may sometimes worsen AV conduction, especially in patients with conduction disturbances. Nifedipine, on the other hand, can be used as a coronary vasodilator with the least untoward effect on AV conduction.

Adolescent

Combined effect of verapamil and disopyramide on induction of circus movement tachycardia in patients with pre-excitation.

By means of intracardiac recordings and programmed electrical stimulation of the heart, the combination effect of verapamil and disopyramide on induction of circus movement tachycardia was studied in 8 patients with anomalous extranodal atrioventricular (A-V) pathway. In 4 of 6 patients who manifested reproducible circus movement tachycardia, verapamil, 0.2 mg/kg intravenously administered, prevented the induction of tachycardia by increasing the A-V nodal refractoriness. Disopyramide in a dose of 2 mg/kg was injected 30 minutes after the start of verapamil administration, when prolongation of the A-V nodal conduction time (A-H interval) had continued in most of the patients. Disopyramide lengthened the effective refractory period of the anomalous pathway in all patients in whom this could be determined. The A-H interval, which had been prolonged by verapamil, was shortened in 4 patients and about unchanged in the remaining 4. After addition of disopyramide, sustained tachycardia could be induced in 2 patients who had lost the ability of initiating circus movement tachycardia after verapamil administration. Thus, disopyramide, when administered together with verapamil, may block the effect of verapamil on the A-V node by its anticholinergic action. A concomitant prescription of disopyramide with verapamil in expectation of the depression of both the anomalous pathway and the A-V node may have an untoward outcome.

Adolescent