The importance of physical diagnosis in internal medicine.
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Biomedical subjects
Publications and source records attributed to J Takeuchi.
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To assess a possible direct tubular action of alpha-human atrial natriuretic peptide (alpha-hANP), we studied the effects of alpha-hANP on volume reabsorption (JV), transepithelial voltage (VT), and p-aminohippuric acid (PAH) secretion in the rabbit proximal straight tubules (PST) by in vitro microperfusion technique. In superficial PST (SFPST), addition of alpha-hANP at various concentrations (10(-7), 10(-9), 10(-11) M) to the bath solution did not alter JV significantly. Bath alpha-hANP (10(-7) M) did not change VT in SFPST, either. In juxtamedullary PST (JMPST), addition of alpha-hANP (10(-7) M) to the bath solution changed neither VT nor JV significantly. The alpha-hANP (10(-7) M) in the luminal fluid caused no changes in either VT or JV in SFPST. Furthermore, alpha-hANP (10(-7) M) in the bath did not change the rate of PAH secretion in SFPST. Thus, we could not obtain any evidence for direct tubular action of alpha-hANP in rabbit PST. Accordingly, alpha-hANP may increase solute excretion without directly affecting solutes transport in PST of the rabbit kidney.
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A 54-year-old man with hepatocellular carcinoma (HCC) of the typical trabecular pattern exhibiting unusual histologic features, both osteoid and bone formations, is reported. The tumor was associated with well-developed cirrhosis; thus, this may be different from mixed hepatic tumors of adults with bone formations because the latter are characterized by their prevalence in noncirrhotic livers and by the formation of myxoid connective tissue. Computed tomography of the current case revealed calcification within HCC.
In patients with alcoholic liver disease, serum proline and amino-terminal type III procollagen peptide levels were evaluated as a marker of hepatic fibrosis. Thirty-one patients with alcoholic liver disease (2 with nonspecific change, 3 with alcoholic hepatitis, 17 with hepatic fibrosis without cirrhosis, and 9 with cirrhosis) and 15 controls were investigated. Hepatic fibrosis was estimated in each liver biopsy specimen by morphometric analysis, and the ratio of fibrotic change to total area (AREA-F) was calculated by morphometric analysis. In patients with hepatic fibrosis, serum proline levels and routine liver function tests were not significantly correlated to AREA-F value, while serum peptide levels showed a significant positive correlation to AREA-F value (r = 0.733, P less than 0.001). These results suggest that the determination of serum amino-terminal type III procollagen peptide level may serve as a good marker for the diagnosis of liver fibrosis in the alcoholic.
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Proximal straight tubules (PST) has been shown to be an important nephron segment of renal ammonia production. To clarify the nature of glutamine (substrate of ammonia production) transport in PST, both luminal resorption and peritubular uptake of glutamine were measured in isolated rabbit PST. Luminal glutamine resorption (Jgln) was measured at various perfusate glutamine concentration (0.05 to 20 mM) at 38 degrees C and 12 degrees C. Jgln measured at 12 degrees C were proportional to mean luminal glutamine concentrations. This flux was thought to be a passive glutamine flux. The flux, which was obtained by subtracting passive glutamine flux from Jgln obtained at 38 degrees C, was thought to be active luminal resorption. This flux exhibited saturation kinetics (Vmax 20.9 pmol min-1 X mm-1, km 5.2 mM). When bath pH (HCO3) was lowered from 7.4 to 6.8, Jgln showed no change or a small decrease (12%) at perfusate glutamine concentrations of 0.05 or 5 mM, respectively. When perfusate pH (HCO3) was lowered from 7.4 to 6.8 Jgln showed a small decrease (10%) at 5 mM perfusate glutamine concentration. Peritubular glutamine uptake was determined in isolated nonperfused PST incubated for 5 to 50 min in [14C]-glutamine containing solution. When incubated in pH 7.4 HCO3 buffer solution, cell to medium 14C concentration ratio was higher than unity (3.83 +/- 0.34, P less than 0.001) at 5 min, and reached a maximum (11.37 +/- 1.13) at 30 min.(ABSTRACT TRUNCATED AT 250 WORDS)
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The relapsing process in the bone marrow was studied in those 77 patients with adult acute leukemia, diagnosed according to the FAB classification who achieved complete remission (CR) and then received intermittent multi-drug intensification treatment. Relapse occurred in most of the patients who exhibited Auer rods or Ph1 chromosomes in the bone marrow, or in whom blasts increased to 8% or more, but some patients remained in CR by subsequent treatment, that is, relapsing process was reversible. With our conventional treatment, the relapse or relapsing process occurred in most of the patients with L1, L2 and M1 subtypes within 6 months and was irreversible. It occurred mainly between 5 and 13 months in those with M2, M3 and M5 and was reversible in some cases. Patients with M4 subtype received intensified treatment due to the difficulty of achieving remission; relapse was seen in only 3 of 7 cases. To prevent relapse and attain a potential cure, the treatment should be intensive before the relapsing process with adequate supporting care. In view of the above-mentioned observations, our new treatment protocols for acute leukemia were designed to be more intensive than those conventionally employed, and to be discontinued within approximately 10 months in lymphoblastic leukemia and approximately 8 months in myeloid leukemia.
Cortical collecting ducts (CCD) and inner stripe of outer medullary collecting ducts (OMCD) of the rabbit were perfused in vitro and the electrical potential was measured with 0.5 M KCl-filled conventional microelectrodes. In CCD, the transepithelial potential (Vte) was -1.9 +/- 0.5 (S.E.) mV and the intracellular potential (Vb) was -74.5 +/- 1.3 mV, while in OMCD, Vte was +2.0 +/- 0.4 mV and Vb was -24.6 +/- 1.0 mV. Acute reduction of peritubular HCO3- concentration from 25 to 5 mM (from pH 7.4 to 6.9) decreased Vb slowly but markedly from -26.3 +/- 1.8 to -18.9 +/- 1.6 mV (p less than 0.001) in OMCD, while it depolarized Vb slightly in CCD (from -75.6 +/- 1.9 to -74.3 +/- 2.1 mV, P less than 0.05). Acute peritubular pH reduction with HCO3- -free HEPES-buffered solution also depolarized Vb of OMCD from -24.7 +/- 2.1 to -15.9 +/- 1.6 mV (p less than 0.001). Although the mechanism(s) of Vb depolarization in OMCD is unclear at the moment, this depolarization suggests that OMCD is responsive to peritubular pH alterations. The results of this study provide the evidence that the collecting duct is heterogeneous in Vb values and its response to the peritubular pH change.
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It is generally agreed that complete mixing of the indicator is one of the most important factors of the indicator dilution method, however, no clear definition of the mixing state has been established. We established a formula for the mixing rate of the indicator by the indicator dilution method, using the concept of entropy in the information theory, and compared the mixing rate of indocyanine green in one mixing chamber (left ventricle) with that in the two mixing chamber system (including the aortic system). The mixing rate of the indicator (M) is shown as M(%) = 100 H/Hcm = -100 (lk sigma ni = 1 Ci + log Ci + log k) (l & k: correction factors in each dye dilution curve, C: mean concentration of the indicator in the region). Left heart and aortic catheterizations by retrograde femoral and carotid artery approach were performed in five anesthetized dogs. Simultaneous dye dilution curves were recorded at the aortic root and at the bifurcation of the abdominal aorta, following the injection of indocyanine green (2.5 mg/1 ml of indocyanine green for each injection) by impulse into the left ventricle at the endsystole, triggered on the R wave of ECG, using the automatic injector devised by the authors. Twenty-five pairs of dye dilution curves were obtained by simultaneous recording in the aortic root and the abdominal aorta under several hemodynamic conditions, and the cardiac output, mean circulation time and the mixing rate of the indicator were determined.(ABSTRACT TRUNCATED AT 250 WORDS)