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Biomedical subjects

K Iwano

Publications and source records attributed to K Iwano.

At least 19 recordsLinked to original sources
PubMed1996

Infection with hepatitis GB virus C in patients on maintenance hemodialysis.

BACKGROUND: A recently discovered non-A-E hepatitis virus has been designated hepatitis GB virus C (HGBV-C), but little is known about its mode of transmission and its clinical manifestations. We studied 519 patients on maintenance hemodialysis to determine whether they were infected with HGBV-C. METHODS: HGBV-C RNA was identified in serum by a reverse-transcription-polymerase-chain-reaction assay with nested primers deduced from a non-structural region. A nucleotide sequence of 100 bp in the nonstructural region was determined on HGBV-C clones. RESULTS: HGBV-C RNA was detected on 3.1 percent of the patients on hemodialysis (16 of 519), as compared with 0.9 percent of healthy blood donors (4 of 448, P<0.03). None of the 16 patients had evidence of active liver disease, although 7 were also infected with hepatitis C virus. Eight patients with HGBV-C infection were followed for 7 to 16 years. In two patients the virus was present at the start of hemodialysis. One had a history of transfusion, and HGBV-C persisted over a period of 16 years; the other became free of HGBV-C after 10 years. In five patients, HGBV-C RNA was first detected 3 to 20 weeks after blood transfusion and persisted for up to 13 years. One patient with no history of transfusion was infected with an HGBV-C variant with the same sequence as in two of the patients with post-transfusion HGBV-C infections. CONCLUSIONS: Patients on maintenance hemodialysis are at increased risk for HGBV-C infection. This virus produces persistent infections, which may be transmitted by transfusions but may also be transmitted by other means.

Adult↗
PubMed1995

Cloning and sequencing of cellulase cDNA from Aspergillus kawachii and its expression in Saccharomyces cerevisiae.

The cDNA encoding the endo-beta-1,4-glucanase (carboxymethylcellulase; CMCase-I) from Aspergillus kawachii IFO 4308 was cloned. Nucleotide-sequence analysis of the cloned cDNA insert showed a 717-bp open reading frame that encoded a protein of 239 amino-acid residues. The predicted amino-acid sequence of the mature protein had considerable homology with the protein sequence of the FI-CMCase of Aspergillus aculeatus. The cDNA was introduced into Saccharomyces cerevisiae. The expressed enzyme had carboxylmethylcellulase activity, identified by clear zones on a CMC-agar plate after Congo Red staining.

Amino Acid Sequence↗
PubMed1995

Cholesterol emboli following percutaneous transluminal coronary angioplasty as speculated by toe skin biopsy.

A 55-year-old man required hemodialysis for acute renal failure 3 days after repeat percutaneous transluminal coronary angioplasty (PTCA). Bilateral acrocyanosis and necrotic lesions of the toes occurred 10 days after PTCA. Skin biopsy samples revealed needle-shaped cholesterol crystals of the intraluminal clefts in his small arteries. He was diagnosed with cholesterol emboli presenting as blue toe syndrome. The conditions improved with anticoagulation and vasodilation, but improvement in renal function was temporary. He later required maintenance hemodialysis. Cholesterol emboli following PTCA are life threatening because they are difficult to diagnose and can cause severe complications.

Angioplasty, Balloon, Coronary↗
PubMed1994

Cementless or hybrid total elbow arthroplasty with titanium-alloy implants. A study of interim clinical results and specific complications.

Twenty-six patients (32 elbows) with rheumatoid arthritis had a total elbow arthroplasty with insertion of a cementless prosthesis. The humeral component was made of titanium alloy and it was fixed without cement in all elbows. The patients were followed for an average of 3 years 1 month (range, 2 years 2 months to 4 years 4 months). A good result was seen in 25 elbows, a fair result in 2, and a poor result in 5. The reason for the poor results was a breakage of the humeral component at the junctional portion of its stem. In all five of these elbows a marked resorption of bone mass within the condylar portion of the humeral component was observed on the lateral radiograph. The five elbows with a poor result had a revision operation, and in each of these black staining of the soft tissues within the joint was seen. This tissue metallosis due to wear debris of the titanium alloy was responsible for the osteolysis within the condylar portion. It became clear from this study that even in a non-weight-bearing joint, such as the elbow, titanium alloy may wear and result in tissue metallosis when used as a bearing surface of the implant. However, it was also found that in the majority of the elbows an establishment of the biologic fixation of the porous-coated stem could be achieved by use of this alloy.

Adult↗
PubMed1993

High carrier rate after hepatitis B virus infection in the elderly.

An outbreak of hepatitis B virus infection occurred in a nursing facility; it involved 31 patients with sequelae of cerebral vascular accidents (15 men and 16 women; mean age, 77.4 +/- 9.3 yr). HBsAg disappeared within 6 mo in 9 patients and persisted during an observation period of more than 6 mo in 13; the remaining 9 patients were lost to follow-up while they carried HBsAg. Thus 13 of 22 patients followed (59%) became HBsAg carriers. We amplified a part of the S gene (436 nucleotides) with polymerase chain reaction on hepatitis B virus DNA from 12 randomly selected patients. The sequences of nine patients were the same as that of a nursing assistant who was an HBsAg carrier and suspected as the source of infection; it differed by only 1 or 2 (< 0.5%) nucleotides from those of the remaining three patients. Between the group of nine patients with transient HBV infection and the 13 patients with persistent HBV infection, we found no differences in age or sex or in parameters of nutrition or immunocompetence. These results indicate a high incidence of HBV carrier state in the elderly.

Adolescent↗
PubMed1992

Hepatitis C virus infection in medical personnel after needlestick accident.

Hepatitis C virus infections in medical personnel after needlestick accidents have been documented generally by detection of seroconversion to a hepatitis C virus nonstructural region antigen, c100-3 (a marker of infection). We tested for hepatitis C virus core-derived antibodies and genomic RNA in addition to c100-3 antibody in 159 cases of needlestick exposure that did not involve patients positive for HBsAg. Of these we found 68 cases with index patients positive for both hepatitis C virus RNA and antibodies and members negative for antibodies to HCV core or c100-3 before the needlestick accidents. Seven of these medical personnel became infected with hepatitis C virus after the accidents. Their hepatitis was generally subclinical or self-limited and transient, except for one patient in whom liver enzyme elevation persisted along with the antibodies. In our study, the risk of hepatitis C virus transmission from a single needlestick accident with hepatitis C virus RNA-positive blood was 10%, considerably higher than the 4% estimated in a previous study. We found that donor blood with antibody to an hepatitis C virus core-derived peptide with enzyme-linked immunosorbent assay optical densities greater than 2.0 carried a significant risk of transmitting hepatitis C virus to needlestick victims. No hepatitis C virus seroconversions occurred in medical personnel exposed to hepatitis C virus antibody-negative or hepatitis C virus RNA-negative blood; however, one such exposure resulted in a very mild non-A, non-B, non-C hepatitis.

Health Personnel↗
PubMed1991

Surgical treatment of subaxial cervical myelopathy in rheumatoid arthritis.

Between 1978 and 1988 a total of 27 operations were performed on 26 patients for cervical myelopathy due to rheumatoid disease in the subaxial spine. Three different causes were recognised: the first group had cord compression due to subluxation of the cervical spine itself (6 patients); the second had cord compression occurring from in front, with rheumatoid lesions of vertebral bodies or discs (6); the third had compression from behind the cord due to granulation tissue within the epidural space (14). Group I was treated by closed reduction of the subluxation followed by surgical fusion either from in front or behind. Group II was decompressed by subtotal resection of the involved vertebral bodies and discs, followed by interbody fusion. The patients in group III were decompressed by laminectomy and excision of fibrous granulation tissue from the epidural space. Good recovery of neurological function was observed after 18 of the operations, fair recovery after five, poor recovery followed three, and one was worse. Myelopathy recurred in four patients, all of whom had had anterior interbody fusion.

Aged↗
PubMed1990

[Causes of death in patients with rheumatoid arthritis--analysis of 117 cases for 13 years].

One hundred seventeen deaths of RA patients (30 males and 87 females) at National Sagamihara Hospital for 13 years (1975-1988) were analysed. The average duration of disease were 10.5 years in male patients and 17.7 years in female. The average life span of the patients with RA, revealing 65.8 years in male and 63.7 years in female, were much shorter than of general population. The causes of all deaths were investigated by ourselves and/or autopsy. The autopsy was performed in 56.6%. The most common causes of death in RA patients were infectious diseases (20.5%), respiratory diseases (16%, mainly interstitial pneumonia and chronic obstructive lung diseases), and gastrointestinal diseases (14.7% chiefly perforation or bleeding of peptic ulcer). The distribution of causes of death in RA patients was quite different from in general population. The gastrointestinal disease decreased from 20% in the early half (1975-1981) to 12.6% in the latter half (1982-1987). It seems likely that H2-receptor antagonist played a major role for preventing the death by perforation or bleeding of ulcer, because the drug has been used since 1982 in Japan. Renal insufficiency including amyloidosis increased markedly in the latter half (14.9%) compared with in the early half (6.7%). Frequency of infectious diseases, respiratory diseases, and basilar impression remain unchanged in all course. Although our study are case-analysis in only one institute and further study will be necessary, the accumulation of the data investigated by rheumatologist will be helpful to grasp correct cause of death in patients with RA.

Adult↗
PubMed1990

Total elbow arthroplasty with a non-constrained surface-replacement prosthesis in patients who have rheumatoid arthritis. A long-term follow-up study.

Thirty-seven elbows in thirty-six patients who had rheumatoid arthritis had a total elbow arthroplasty with insertion of a non-constrained surface-replacement prosthesis. The patients were followed for an average of nine years and six months, the longest follow-up being seventeen years. A good result was seen in twenty-nine elbows; a fair result, in one; and a poor result, in seven. The reasons for the poor results were gross posterior displacement of the humeral component in five elbows, persistent subluxation with pain in one, and recurrent ankylosis in one. Of the five elbows that had gross posterior displacement, four had a revision operation with a new humeral component, and a satisfactory result was eventually achieved. Radiographic examination revealed various degrees of proximal subsidence of the humeral component in 70 per cent of the elbows. However, in most of the elbows the subsidence was not progressive and was compatible with a good clinical result. In contrast, the rate of loosening of the ulnar component was low; loosening was seen in only 5 per cent of the elbows. Seventeen elbows were followed for ten years or more, and comparison of the clinical results in the intermediate period with those at the most recent review revealed that the results improved with time. Because of the number of elbows in which subsidence of the humeral component developed, we now use a humeral component with an intramedullary stem, and were no longer recommend the use of our Type-1 and Type-2 prostheses.

Adult↗
PubMed1989

Combined hepatitis B immune globulin and vaccine for postexposure prophylaxis of accidental hepatitis B virus infection in hemodialysis staff members: comparison with immune globulin without vaccine in historical controls.

Twenty-three staff members serving in a hemodialysis unit were exposed accidentally to needlestick contaminated with blood containing hepatitis B surface antigen and hepatitis B e antigen, as well as high levels of DNA polymerase activity (greater than 100 cpm). They received hepatitis B vaccine (20 micrograms) simultaneously with hepatitis B immune globulin (5 ml, 200 IU per ml) within 48 hr after the exposure, and the vaccination was repeated at 1 and 3 months. The protective efficacy was compared with that in a past study in the same unit in which 33 members were given hepatitis B immune globulin alone within 48 hr after the exposure to blood with similarly high levels of DNA polymerase activity. No differences were noted in age or sex between the staff members who were vaccinated and those who were not, nor were there any differences between their inocula in the titers of hepatitis B virus markers. During 12 months after the accident, only one (4%) of the 23 vaccinated members contracted hepatitis B virus infection, at a frequency significantly lower than 11 (33%) of the 33 members who did not receive vaccine (p less than 0.02). These results indicate that hepatitis B vaccine, when given in combination with hepatitis B immune globulin, is efficacious for postexposure immunoprophylaxis of accidental infection.

Adult↗
PubMed1988

[Intraarterial urokinase infusion therapy for the acute intracranial major artery occlusion].

Recently percutaneous transluminal coronary recanalization therapy (PTCR) with urokinase infusion has became one of popular technique for coronary arterial occlusion. This paper reported clinical experience of intraarterial urokinase infusion therapy for acute or superacute stroke patients. The procedure was followed by angiographical study which revealed the major intracerebral arterial occlusion in three cases. Case 1: A 74-year-old female had sudden onset of clouding of consciousness with complete left hemiplegia. The patient was in our urological ward because of treatment for her right ureter tumor, as the patient was immediately subjected to angiographical study and complete occlusion of the trunk of the right middle cerebral artery was revealed four hours after onset. Successively 240,000 IU of urokinase solution was injected through the arterial catheter after angiographical study. This procedure repeated two times with 10 minute intervals. So total amount of 720,000 IU of urokinase was given by intraarterial injection. Immediately after the last urokinase injection the patient started to recover her consciousness and weakness. Simultaneous angiogram demonstrated partial recanalization of the proximal branches of the middle cerebral artery. The following day, she had complete recovery from her neurological deficits although she had transient hemorrhagic tendency. The final angiogram showed no existence of obstructed cerebral arteries as well as no low density areas in computed tomographic images. Case 2: A 73-year-old female, with the left internal carotid occlusion at the site of C1-2 portion, was instituted infusion therapy of similar procedure with total amount of 960,000 IU oi urokinase ten to twenty hours after onset. However, no rewarding was obtained.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1986

Chondroblastoma of the sacrum. A case report.

Death due to a chondroblastoma of the sacrum is uncommon. We report the case of a 48-year-old man with this condition. During a 10-year period, the tumor spread into the retroperitoneal space and was an enormous mass after repeated radiotherapy. The patient died of renal failure. The tumor was histologically benign even at autopsy.

Chondroblastoma↗
PubMed1985

Factors influencing postexposure immunoprophylaxis of hepatitis B virus infection with hepatitis B immune globulin. High deoxyribonucleic acid polymerase activity in the inocula of unsuccessful cases.

Hepatitis B immune globulin was given intramuscularly to 102 staff members of a dialysis unit within 48 h after the accidental needlestick exposure to blood containing hepatitis B surface antigen (HBsAg). Hepatitis B virus (HBV) infection developed in 11 of 56 persons (20%) who had been exposed to blood containing hepatitis B e antigen (HBeAg). Among 56 HBeAg-positive inocula, HBsAg-associated deoxyribonucleic acid polymerase activity in the 11 inocula that transmitted HBV infection was significantly higher than that in the remaining 45 inocula that did not (log counts per minute 3.27 +/- 0.57 vs. 2.09 +/- 1.19, p less than 0.001). These 11 HBeAg-positive inocula revealed higher hemagglutination titers of HBsAg (geometric mean 13.5 +/- 1.4 vs. 11.2 +/- 3.2, p less than 0.001). The receptor for polymerized human serum albumin was detected significantly more often in the inocula that transmitted HBV infection than those that did not (10/11 vs. 24/45, p less than 0.05). Based on the results obtained, the failure in protecting all of those exposed to HBeAg-positive blood would be attributable to a high concentration of HBV in some HBeAg-positive inocula and the inability of intramuscular injection to raise a protective level of antibody in the circulation immediately.

DNA-Directed DNA Polymerase↗
PubMed1984

Cervical cord compression due to extradural granulation tissue in rheumatoid arthritis. A review of five cases.

Five patients with long-standing, severe rheumatoid arthritis who developed cervical myelopathy at the subaxial levels are presented. In each patient the myelopathy occurred in the absence of major subluxation. At laminectomy the cause of the cord compression was found to be a band-like mass of ligamentous and granulation tissue in the posterior half of the extradural space, extending to the underlying portion of the dura and forming a constricting ring. In three patients this constricting ring was released by longitudinal division of the dura followed by application of a fascial patch graft. This release seems to be essential for effective decompression of the cord and good neurological recovery was achieved in these three patients. Of the other two patients, the result was fair in one and poor in the other, this latter result being due to severe intra-operative bleeding with a massive wound haematoma.

Aged↗