[A male autopsy case of primary biliary cirrhosis associated with polymyositis and congestive cardiomyopathy].
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Biomedical subjects
Publications and source records attributed to J Takezawa.
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A 47-yr-old woman with low cardiac output and dyspnea due to pulmonary hypertension associated with rheumatoid arthritis was treated with two vasodilators. Although nicardipine, a Ca-channel blocking agent, reduced the pulmonary artery pressure (PAP), it reduced simultaneously the arterial BP, resulting in fluid retention with a low urine output and persistent high CVP. In contrast, prostaglandin E1 (PGE1) reduced successfully both the PAP and CVP. Although the BP decreased, a satisfactory urine output was maintained. The cardiac output increased from 3 to 4.5 L/min. PGE1 may help reduce reversible pulmonary hypertension of collagen disease.
A case of hepatocellular carcinoma (HCC) complicated with vascular invasion of the portal vein, hepatic vein, and pulmonary artery, accompanied by inferior vena caval and renal vein thrombosis, is reported. The patient was a 38-year-old female, positive in serum HBsAg and anti-HBe. Because portal trunk thrombosis was pointed out at the first diagnosis, incomplete transcatheter hepatic arterial embolization was carried out three times and one-shot therapy of anti-cancer agent given once. Four months after the first therapy, the patient died of oliguria and hypotension of sudden onset. The autopsy revealed not only intrahepatic vascular invasion but also tumor growth in the bilateral pulmonary arteries and thrombosis from the inferior vena cava to both renal veins unaccompanied by right atrial growth. Because the renal vein was thrombosed and HCC was accompanied by vascular invasion, especially pulmonary arterial invasion, the patient was thought to have become oliguric and hypotensive before severe hepatic failure. The metastatic tumor had grown in the pulmonary trunk without intra-atrial expansion because of the histological tight junction between the tumor and the wall of that vessel.
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A fully automated high-performance liquid chromatographic column-switching system is presented for the determination of cyclosporin A in whole blood. After blood proteins were precipitated with acetonitrile, the supernatant was automatically loaded on to a cyanopropyl column for initial separation, and then the fraction containing cyclosporin A was loaded on to a trimethylsilica column for final separation and quantitation. Cyclosporin A was detected by ultraviolet absorption at 205 nm. The minimum detectable concentration of cyclosporin A was 5 ng/ml in 100 microliter of blood. The coefficient of variation of the method was 1.755, 1.748 and 0.655% in whole blood when spiked at the 170, 425 and 850 ng/ml levels, respectively. One assay was completed in 15 min.
The effects of the d- and l-isomers of pentazocine were compared to that of racemic pentazocine on contractions of the mouse isolated vas deferens. L-pentazocine inhibited electrically evoked contractions of the mouse vas deferens (MVD) in a dose-dependent manner (ID50 0.37 +/- 0.04 microM). In contrast, d-pentazocine augmented field stimulated contractions dose-dependently; per cent increases in contractions at 10 and 30 microM were 57.8 +/- 18.0 and 98.0 +/- 15.1%, respectively. Racemic pentazocine produced an intermediate effect between the two isomers. The effect of 1-pentazocine was antagonized by naloxone, whereas that of d-pentazocine was not. L-pentazocine did not effect the response of the MVD to exogenous norepinephrine at any concentration tested, while d-pentazocine depressed the response of the MVD to exogenous norepinephrine at one dose (0.3 microM). These findings demonstrate that d- and l-pentazocine produce opposite effects on the MVD. The effects of l-pentazocine are opioid mediated, while those of d-pentazocine are not. In the racemic mixture the opposing effects of the two isomers modulate each other, resulting in a diminished effect.
Total lymphocyte count, lymphocyte cell-surface markers (OKT3, OKT4, OKT8, and B-1), serum complement factors (C3 and C4), immunoglobulins (IgG, IgA, and IgM), ceruloplasmin (Crl), and transferrin (Trf) were determined weekly for nine septic postoperative patients, all of whom had multiple organ-system failure. The peripheral blood total lymphocyte count, its subpopulation, T-cell subset, and proliferative responses of lymphocyte to phytohemagglutinin (PHA) and concanavalin A (Con A) decreased in all patients. OKT3 and B-1 decreased progressively in the four nonsurvivors compared with the five survivors. Although immunoglobulin levels were within the normal range in both groups, they tended to increase in survivors and decrease in nonsurvivors. Serial levels of C3, C4, Crl, and Trf increased in survivors but did not change in nonsurvivors. T-cell function and antibody-producing activity diminished progressively in nonsurvivors. These changes in cellular immunity may represent another manifestation of multiple organ-system failure during sepsis.
The portal blood flow of a 70-yr-old man with suspected massive mesenteric infarction was measured using duplex scanning. The main portal flow was 109 ml/min, while cardiac output was 4.2 L/min. Laparotomy revealed a massive mesenteric infarction from proximal jejunum to rectum. Duplex scanning may be a useful method for studying the course of mesenteric infarction.
The efficacy of gabexate mesilate (FOY), a synthetic serine proteinase inhibitor, was compared with that of heparin in preventing the acceleration of bleeding after hemodialysis. Transfused blood volume (TBV) was measured 24 h before and after 24 dialyses in 14 bleeding patients with impaired hemostatic function. The predialysis TBV did not differ significantly between heparin and FOY groups; however, TBV was significantly (p less than .05) larger after heparin dialysis than after FOY dialysis. After dialysis, TBV was increased in eight of nine heparin patients, compared to only three of 15 FOY subjects (p less than .01). FOY is an effective agent and may decrease postdialysis bleeding complications in certain high-risk patients.
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The effects of driving pressure (DP) and respiratory rate (RR) on mean airway pressure (Paw), PaCO2, and other respiratory variables were studied during high-frequency jet ventilation (HFJV) in anesthetized rabbits. The animals were tracheotomized and paralyzed, and various combinations of RR (4, 8, 12, and 16 Hz) and DP (0.5, 1.0, and 2.0 kg/cm2) were applied randomly with an inspiratory/expiratory ratio of 1.0. HFJV was delivered via a 2.5-Fr catheter through a T-attachment, using 100% oxygen, and a hot-wire flowmeter was connected to the outlet of the T-attachment for measurement of the minute volume (MV). Heart rate, arterial BP and CVP, respiratory variables, and arterial blood gases were monitored during the study. There were no direct correlations between PaCO2 and DP, MV, or RR. However, there was an inverse correlation between PaCO2 and tidal volume, and linear correlations were found between Paw and DP, and between DP and MV. It is concluded that HFJV over an RR range of 4 to 16 Hz depends mainly upon tidal volume. When the desired PaCO2 and Paw are determined, DP and RR can be calculated following the equations established in this study.
Varying concentrations of lipopolysaccharide (LPS) and mannan suspensions were mixed with either saline or plasma from normal volunteers, heated to 100 degrees C for 10 min, and then subjected to the limulus amebocyte lysate test (LAL). A positive LAL in saline required minimum LPS and mannan concentrations of 10(-11) and 10(-5) g/ml, respectively, while the minimum concentrations premixed with plasma were 10(-13) and 10(-9) g/ml, respectively. Thus, use of plasma instead of saline increased assay sensitivity 100-fold for LPS and 10,000-fold for mannan. In the second part of the experiment, normal plasma was separated into lipid and nonlipid phases by Folch's method. LAL analysis of each phase revealed equal sensitivity for LPS and mannan in the nonlipid phase, but no sensitivity in the lipid extract. Subsequently, 200 ml of a fat emulsion (Intralipos) was administered to the normal volunteers, and LAL and lipid analyses were performed. The LAL turned positive in all volunteers. When LAL was positive, triglycerides (TG), chylomicron (Chyl), and very low-density lipoprotein (VLDL) increased significantly compared with when LAL was negative. It is concluded that plasma lipids increase the sensitivity of LAL and directly activate LAL when TG, Chyl, and VLDL concentrations are high. This effect of plasma lipids on LAL can be eliminated by extracting LPS and mannan in the nonlipid phase.
Morphological changes of interlobular bile ducts in asymptomatic or symptomatic primary biliary cirrhosis (PBC) and chronic hepatitis with ductal lesions were investigated. It was supposed that bile duct lesions found in PBC and chronic hepatitis could be distinguished histologically. There were identical epithelial changes between symptomatic PBC and asymptomatic one, but granulomas were more often found in asymptomatic PBC than in symptomatic PBC. Numbers of interlobular bile ducts per portal tract and the rates of portal tracts without interlobular duct in asymptomatic PBC were intermediate between symptomatic PBC and chronic hepatitis. Serial sections revealed that some bile ducts were able to be followed by ductules in asymptomatic PBC. From these results, numbers of interlobular bile ducts are undoubtedly decreased in asymptomatic PBC but not so much as in symptomatic one. This observation may be attributable partially for taking asymptomatic course.