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Biomedical subjects

J Oita

Publications and source records attributed to J Oita.

At least 19 recordsLinked to original sources
PubMed2000

Characterization of complex chromosomal abnormalities in B-cell lymphoma by a combined spectral karyotyping (SKY) analysis and fluorescence in situ hybridization (FISH) using a 14q telomere probe.

We report a case of non-Hodgkin's lymphoma of unknown origin with invasion into bone marrow and brain. This case showed complex chromosomal abnormalities, including five clonal marker chromosomes (mar) and four additional materials of unknown origin (add) that could not be identified by means of conventional G-banding. Spectral karyotyping (SKY) analysis could not only determine the origin and organization of all thus far unidentified structural chromosomal abnormalities but also detect two cryptic unbalanced translocations, which had been erroneously considered to be normal on the basis of G-banding analysis, and correct one abnormality misidentified by G banding. Among these abnormalities, we identified the new partner site of the 14q32 translocation, 22q13, and the jumping translocations involving 2p23 as a new donor chromosome. Furthermore, by using fluorescence in situ hybridization (FISH) with the probes specific for the 14q telomere, we could identify the unbalanced translocation of t(3;14)(q27;q32), which had been erroneously considered to be normal chromosome 3 on the basis of not only G-banding but also of SKY analysis. This translocation is one of the most frequent chromosomal abnormalities in B-cell lymphoma, especially diffuse large cell lymphoma. After SKY and FISH analysis, the original descriptions in the G-band karyotype were modified for a total of 13 chromosomes. The combination of SKY and FISH using the 14q telomere probe was therefore considered very useful for the characterization of complex cytogenetic cases in B-cell lymphoma.

Chromosome Aberrations↗
PubMed1996

Medial medullary infarction: analyses of eleven patients.

Of 2,130 consecutive patients admitted to two hospitals with acute brain infarction, we examined 11 patients (0.52%) with medial medullary infarction. The infarcts documented by MRI were unilateral in 9 patients and bilateral in 2 patients, and located in the anteromedial arterial territory of the upper or middle part of the medulla. Atherosclerosis of the vertebral arteries was the predominant vascular pathology. The vertebral artery was occluded at its terminal portion in 7 patients. Nine patients had hypertension, and 8 of these had additional risk factors. Male gender (10 patients) and smoking habits (7 patients) were more prevalent compared with patients with pontine infarction. One patient had a medial medullary infarction attributed to dissection of the vertebral arteries following blunt head injury. Limb weakness was the major symptom in all patients, and gaze-evoked nystagmus was also frequent (6 patients). Tongue weakness ipsilateral to the infarct, the classic sign of medial medullary syndrome, was evident in only 3 patients. The outcome was usually excellent.

Adult↗
PubMed1996

[Erythromycin-induced hearing loss in a patient with Listeria monocytogenes meningo-ventriculitis].

We report a 43-year-old woman who suffered from Listeria monocytogenes meningitis. She was admitted to our hospital because of headache, nausea, vomiting, and fever. On admission she had no abnormal neurological signs except for severe nuchal stiffness. Cerebrospinal fluid (CSF) examination on the day of admission revealed pleocytosis and increased total protein level. The CSF culture demonstrated Listeria monocytogenes. Because ampicillin therapy was not effective, erythromycin (8 g/day) was added. After 12 hours of erythromycin therapy, the patient complained of moderate hearing difficulty. Erythromycin was then stopped on the next day. Her hearing improved and became normal within 48 hours after discontinuation of erythromycin. Contrast MRI of the brain revealed enhancement of the ependyma of the lateral ventricle, suggesting the presence of ventriculitis. By parenteral administration of ampicillin and cephazolin, clinical symptoms improved quickly, and abnormal CSF and MRI findings were normalized. Listeria meningitis accompanied with ventriculitis has been reported in neonates and infants, but not in adults. In addition, this is the first case with erythromycin-induced hearing loss in the Japanese literature. Hearing should be regularly examined in patients who are treated with high-dose erythromycin (> or = 4 g/day), and the drug should be immediately discontinued when the patient develops hearing loss.

Adult↗
PubMed1995

Nocturnal blood pressure dip in stroke survivors. A pilot study.

BACKGROUND AND PURPOSE: The influence of a nocturnal blood pressure dip on stroke recurrence has not yet been clarified. In this pilot study, we attempted to establish a correlation of the nocturnal blood pressure dip with stroke recurrence and development of new silent ischemic lesions in patients with chronic ischemic cerebrovascular disease. METHODS: We monitored circadian blood pressure patterns by use of a portable blood pressure monitoring device in 81 patients with chronic ischemic cerebrovascular disease and divided them into two subgroups according to levels of diurnal and nocturnal blood pressure (nocturnal blood pressure dippers and nondippers). The subgroups were prospectively followed up and compared for stroke recurrence and new silent ischemic lesions on magnetic resonance imaging. RESULTS: The average follow-up period was 27.2 +/- 11.3 months (mean +/- SD). Seventy-six patients completed the study; 43 (36 men and 7 women, aged 63.0 +/- 6.3 years) were being treated with antihypertensive agents and 33 (25 men and 8 women, aged 64.7 +/- 9.2 years) were not receiving treatment. In the treated group, recurrence was more frequent among the nocturnal dippers (5 of 18 patients, 12.5% per patient-year) than among the nondippers (1 of 25 patients, 1.5% per patient-year) (P < .05). All subjects who developed a recurrent attack during sleep had had a nocturnal blood pressure dip pattern before the attack. Furthermore, the increase in symptomatic (recurrence) and/or asymptomatic (silent) brain lesions was more frequent in the nocturnal dippers than in the nondippers (9 of 14 versus 2 of 18, P < .01). In the nontreated group, no clear difference was found between the two subgroups. CONCLUSIONS: This study indicated that the nocturnal blood pressure dip in patients treated with antihypertensive agents may accelerate the increase in ischemic brain lesions.

Aged↗
PubMed1995

[The pathogenesis of brain infarction in the posterior cerebral artery territory].

In order to clarify the etiology of brain infarction in the posterior cerebral artery (PCA) territory, we investigated 85 patients (29 women and 56 men, mean age: 63.6 years old) with PCA territory infarction confirmed by computed tomography or magnetic resonance imaging. Patients with thalamic infarction alone were excluded from the present study. Cerebral angiography was performed in 72 subjects. The diagnosis of the mechanism of brain infarction was made on the basis of cerebral angiographic and echocardiographic (presence of cardiac disease as a potential embolic source) findings. Embolism was inferred when the presence of the patent PCA ipsilateral to the infarction, reopening of the occluded PCA or intraluminal filling defect was demonstrated by angiographic studies. In addition, we divided these patients into three groups according to potential source of emboli; cardiogenic, atherothrombotic (so-called artery-to-artery embolism) and embolism of undetermined origin. We diagnosed the patient to have thrombotic mechanism, when an occlusion of the PCA was demonstrated without presence of an embolic source (heart diseases or stenotic arterial lesions proximal to the occluded PCA). When the mechanism (embolic or thrombotic) could not be clearly distinguished, we categorized them "unclassified". When other apparent mechanisms such as arterial dissection, moyamoya disease etc, were demonstrated, we classified them in "miscellaneous". According to the above criteria, 50 patients (59%) were diagnosed as having embolism, only two patients (2%) had definite thrombosis, 28 patients (33%) "unclassified", and five patients (6%) "miscellaneous" (2 arterial dissection, 1 radiation vasculopathy, 1 migraine, 1 moyamoya disease).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1994

The Japanese experience in hemorrhagic stroke.

AIM: To review current problems with hemorrhagic stroke in Japan and to explore possible explanations for a change not only in the incidence but also the severity of hemorrhagic stroke in recent years in Japan. METHODS: Mortality statistics, community-based registries and hospital records were used. RESULTS AND CONCLUSIONS: The age-adjusted stroke mortality rate in Japan has declined over the last 20 years by approximately 75%, a very strong decline compared with other countries. The reduction was much more marked for hemorrhagic stroke than for ischemic stroke. Community-based registries for recent years show that the incidence ratio of brain infarction to brain hemorrhage is 1.5-4.0; this is about one-half, or even less than one-half of the rates reported in Western populations. The incidence of subarachnoid hemorrhage in Japan is 7-12% of total strokes. The growing popularity of antihypertensive treatment and changes in lifestyle, including nutrition, are considered responsible for the marked change observed in the stroke figures. Furthermore, mild to moderate cases of brain hemorrhage have been seen more frequently in recent years than severe cases.

Adult↗
PubMed1994

[Valproate related syndrome of inappropriate secretion of antidiuretic hormone (SIADH)--a case report].

We report an 82-year-old retired man who developed syndrome of inappropriate secretion of ADH (SIADH) caused by sodium valproate (VPA). He had been taking VPA for treatment of symptomatic epilepsy due to cardioembolic stroke. Although he was clinically asymptomatic, he was found to have decreased level of serum sodium concentration (128 mEq/l). Association of hyponatremia, normal urinary sodium concentration, high urine osmolality and increased concentration of serum ADH strongly suggested the presence of SIADH. There were no underlying disorders which can cause SIADH, such as malignant neoplasm with autonomous ADH release, non-malignant pulmonary diseases and active disorders of the central nervous system. Eight days after discontinuation of VPA administration serum sodium level increased (142 mEq/l) to the normal level. Then, we started the administration of VPA again to confirm that VPA was responsible for developing hyponatremia. As a result, he developed SIADH with hyponatremia (128 mEq/l) again, which improved after discontinuation of the administration. Therefore, we concluded that the SIADH might have been caused by administration of VPA. This is the first report on adverse effect of VPA causing SIADH.

Aged↗
PubMed1994

[A case of cryptococcal meningoencephalitis, which damaged the medial part of the temporal lobe and caused gradually progressing memory disturbance].

A 71-year-old female was admitted to the National Cardiovascular Center, complaining of memory disturbance that had been gradually worsening for about two years. Neurologically, except for the memory disturbance, higher brain functions were almost normal and there were no signs of meningeal irritation. A cerebrospinal fluid examination showed lymphocytic dominant pleocytosis, elevated protein levels and decreased glucose levels. Furthermore, Cryptococcus neoformans was detected in the cerebrospinal fluid. A brain CT demonstrated a low density area at the medial part of the left temporal lobe. This lesion appeared as a low intensity area in the T1 weighted image, and as a high intensity area in the T2 weighted image in MRI, and was enhanced by the administration of Gadolinium-DTPA. After administration of fluconazole, improvements were observed in cerebrospinal fluid findings and the enhancement effect of Gadolinium-DTPA in MRI also became unclear on the lesion inside the left temporal lobe. No worsening of the memory disturbance was observed. It was presumed that the gradually progressive memory disturbance had been triggered by the cryptococcus-caused meningoencephalitis, in particular the damage at the medial part of the temporal lobe.

Aged↗
PubMed1994

[A case of Rendu-Osler-Weber disease with brain hemorrhages and portal-systemic encephalopathy].

A 64-year-old woman was admitted because of abnormal behaviors. She had previous histories of recurrent epistaxis for 20 years and brain hemorrhages at the age of 51 and 58 years old. Her elder sister had episodes of recurrent hematemesis and telangiectasias of finger tips. Physical examination revealed multiple small telangiectasias of the tongue and finger tips. Flapping tremor of the upper extremities was seen. Laboratory examinations demonstrated hyperammonemia and an electroencephalogram showed triphasic waves compatible with hepatic encephalopathy. Angiographic studies revealed dilated hepatic arteries with early filling of hepatic veins. We made a diagnosis of Rendu-Osler-Weber disease (ROW disease) based on cutaneous telangiectasia, her previous history of repeated epistaxis, and a positive family history. We speculated that hepatic encephalopathy in the present case was caused by porto-systemic shunt due to ROW disease, and that recurrent brain hemorrhages had resulted from rupture of telangiectasias of the brain vessels.

Cerebral Hemorrhage↗
PubMed1994

[Ataxic hemiparesis with ipsilateral cheiro-oral syndrome due to a single lacunar infarct at the border between the posterior limb of the internal capsule and the corona radiata].

A patient with ataxic hemiparesis and ipsilateral cheiro-oral dysesthesia (tingling) due to a single lacunar infarct at the border between the posterior limb of the internal capsule and the corona radiata is described. A 47-year-old hypertensive man was admitted because of weakness of the right upper and lower limbs with ipsilateral peri-oral and palmar dysesthesia, which developed during bathing in the morning. Upon admission, neurological examination revealed right hemiparesis with ipsilateral limb ataxia and ipsilateral peri-oral and palmar dysesthesia. Based on neurological finding, he was diagnosed as having ataxic hemiparesis with ipsilateral cheiro-oral syndrome. Brain computed tomography and magnetic resonance imaging demonstrated a small lesion at the border between the posterior limb of the left internal capsule and the corona radiata, which was enhanced with gadolinium-DTPA administration. It has been reported that the disturbance of the cortico-pontine tract causes ataxic hemiparesis and that of the thalamo-cortical projection causes cheiro-oral syndrome. These findings of the present case, therefore, suggest that both of these pathways run closely together at the border between the posterior limb of the internal capsule and the corona radiata.

Ataxia↗
PubMed1993

Clinical features of recurrent embolization in acute cardioembolic stroke.

BACKGROUND AND PURPOSE: Recurrent embolization is a serious problem in acute cardioembolic stroke. However, the clinical features and predisposing factors of recurrent embolization have not been fully elucidated. METHODS: Subjects were 227 consecutive patients (128 men and 99 women, aged 68.6 +/- 13.2 years) with acute cardioembolic stroke who did not receive anticoagulant therapy during the first 14 days after stroke onset. We assigned the subjects to two groups according to the occurrence or nonoccurrence of recurrent attacks within 14 days of the stroke onset. We assessed their clinical features, coagulation study results, and underlying heart disease. RESULTS: Recurrent brain or systemic embolization during the first 14 days after onset was noted in 46 patients (20.3%, group A) but not in the other 181 (group B). Recurrent embolization was more frequently noted at an early phase than at a late phase during the initial 14 days. Mortality was higher in group A (19.6%) than in group B (8.8%). The mean plasma level of antithrombin III (77.8 +/- 19.5%) at admission in group A patients was significantly lower than that in group B patients (87.9 +/- 15.5%). After admission, hematocrit decreased in group B patients but slightly increased in group A patients, in whom diuretics were more commonly used. Rheumatic heart disease and prosthetic valves, in addition to the presence of intracardiac thrombi, were seen more commonly in group A patients, whereas atrial fibrillation without organic heart disease and myocardial infarction were more frequent in group B patients. CONCLUSIONS: Low plasma levels of antithrombin III, dehydration, the use of diuretics, and the presence of rheumatic heart disease, prosthetic valves, and intracardiac thrombi seem to be predisposing factors for recurrent embolization. Immediate anticoagulation may be considered in acute cardioembolic stroke patients if such predisposing factors are demonstrated.

Aged↗
PubMed1993

[Warfarin therapy for secondary prevention of cardioembolic stroke with nonvalvular atrial fibrillation--a retrospective study].

In order to evaluate the efficacy of warfarin for the secondary prevention of cardioembolic stroke due to nonvalvular atrial fibrillation (NVAF), we retrospectively investigated the frequencies of recurrent brain embolism and hemorrhagic complications in 68 subjects (62 +/- 9 years old, 54 men and 14 women), who had experienced at least one cardioembolic stroke prior to the study period. The follow-up period was 39 +/- 27 months. Paroxysmal and persistent atrial fibrillation were seen in 37 and 31 subjects, respectively. We assigned the subjects to three subgroups according to types of the events during the follow-up; recurrence group, hemorrhage group, and non-accident group. Prothrombin time (international normalized ratio, INR) was assessed as mean value during the follow-up period. The prothrombin time at the time of recurrence and hemorrhagic complication was also taken into consideration for data analysis. Recurrent brain embolism was observed in three patients (1.4%/yr). Major bleeding occurred in 12 patients (5.5%/yr) and three of them were fatal (subarachnoid hemorrhage, brain hemorrhage, and acute subdural hematoma). The mean value of INR in the hemorrhage group (3.0) was higher than that in the recurrence group (2.2) and in the non-accident group (2.3) (p < 0.001, vs. non-accident group). The lowest mean value of INR in the hemorrhage group was 2.5. The prothrombin time in the recurrence group did not differ from that in the non-accident group. The death rate in the hemorrhage group (4/12, 33.3%) was higher than those in the recurrence group (0) and in the non-accident group (4/53, 7.5%) (p < 0.01, vs. non-accident group).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1993

[Herpetic simplex encephalitis followed by myelopathy].

A 48-year-old male was admitted to our hospital because of fever, headache and vomiting. At admission, the level of consciousness was depressed (drowsy) with slight confusion. Extremely miotic pupils, nuchal stiffness, ataxia and myoclonic movements of both upper limbs were observed. The eye movements were almost normal and there was no definite limb weakness or sensory impairment. A few days after admission, his level of consciousness further decreased, and opsoclonus, ataxic breathing and intestinal paralysis appeared. The body temperature fluctuated remarkably ranging from 33.0 degrees C to 39.0 degrees C. The cerebrospinal fluid (CSF) examination revealed lymphocytic dominant pleocytosis, increase of protein and decrease of glucose. Enzyme-linked immunosorbent assay (ELISA) showed increased antibody (IgG) to herpes simplex virus (HSV) in both serum and CSF. The antibody in CSF further elevated at the later examination. Magnetic resonance imaging (MRI) demonstrated high signal intensity areas mainly in the cerebellum and sporadically in the supratentorial subcortical white matter on T2-weighted images. Administration of Gadolinium-DTPA also revealed an additional lesion in the pons. From these findings, he was diagnosed as herpetic encephalitis involving the brainstem and the cerebellum, and acyclovir was administered. Although his initial symptoms and signs started to recover three weeks after admission, he newly developed complete flaccid paraplegia, dysuria and sensory disturbance with the spinal cord level of the 4th thoracic segment. The oligoclonal IgG bands were detected in the cerebrospinal fluid of the convalescent stage.(ABSTRACT TRUNCATED AT 250 WORDS)

Acyclovir↗
PubMed1992

Bilateral medial medullary infarction with oculomotor disorders.

BACKGROUND AND PURPOSE: We describe the first case of bilateral medial medullary infarction demonstrated by magnetic resonance imaging. We discuss the relation between this lesion and the oculomotor signs that were observed clinically. CASE DESCRIPTION: A 71-year-old man initially presented with pure motor hemiparesis, which progressed to complete quadriplegia. He also developed nearly complete vertical and horizontal ophthalmoplegia. Magnetic resonance imaging revealed upper medial medullary infarctions bilaterally that extended to the pontomedullary junction. CONCLUSIONS: We propose that the vertical oculomotor disorders resulted from involvement of the oculomotor system in the caudal brain stem, especially the caudal paramedian pontine reticular formations on both sides.

Aged↗
PubMed1991

[A case of central pontine and extra-pontine myelinolysis demonstrated by magnetic resonance imaging].

A 74-year-old woman was admitted because of disturbed consciousness due to iatrogenic hyponatremia. At admission, her serum level of sodium was 88 mEq/l. The hyponatremia was carefully corrected with physiologic saline for three days at a rate of 0.75 mEq/h until the serum sodium concentration of 135 mEq/l was achieved. Her neurologic state gradually improved to respond to painful stimuli with her left hand during the first week of treatment, but further improvement was not noted after that. On the 16th hospital day, seizure developed on her face and left upper extremity. Although abnormal lesions were not detected by MRI of the brain at admission, those performed on the 15th hospital day revealed multiple uncommon lesions with Tl and Gd enhanced images. On Tl images areas of low signal intensity were found in the central pons and left putamen, which were more clearly demonstrated by Gd enhanced MRI images. These lesions were considered to be consistent with central pontine and extra-pontine myelinolysis (CPEM). In addition, a part of the right temporal cortex was enhanced clearly by Gd-DTPA, which was also thought to be an extra-pontine myelinolysis. These lesions were responsible for the development of neurological signs due to CPEM. To our knowledge, this is the first case in which a lesion in the cerebral cortex was revealed as an extra-pontine myelinolysis by Gd enhanced MRI images. Gd enhanced MRI is useful for detecting the extra-pontine myelinolysis as well as central pontine myelinolysis.

Aged↗
PubMed1991

[Isolated nuclear oculomotor nerve palsy due to mesencephalic infarction].

A patient with unilateral nuclear oculomotor palsy due to midbrain infarction is described. A 46-year-old man was admitted because of difficulty in opening right eye and double vision noticed when he awoke in that morning. On admission, neurological examination revealed total right oculomotor palsy with slight impairment of left upward gaze. There were no other neurologic abnormalities at all. Brain CT and cerebral angiograms were also normal. Magnetic resonance imaging (MRI) performed on the ninth day, however, demonstrated high signal intensity in the right tegmentum of the mesencephalon on T2-weighted images, which was shown more clearly after the administration of Gadolinium-DPTA. He was diagnosed as nuclear third nerve palsy caused by midbrain infarction. The majority of isolated oculomotor nerve palsy has been reported to be caused by extraaxial lesion. When the oculomotor palsy is caused by intraaxial ischemic lesion, it is usually accompanied by other brain stem signs, because abundant nuclei and fibers are present adjacent to the oculomotor nucleus and nerve in the mesencephalon. The present case clarified that such a small infarct disclosed only by MRI can cause isolated oculomotor nerve palsy. It is emphasized that the intraaxial ischemic lesion should be ruled out by using the sophisticated diagnostic aid before making diagnosis of peripheral lesion. This is the first report of the isolated third nerve palsy resulting from mesencephalic ischemic lesion in the Japanese.

Cerebral Infarction↗