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Biomedical subjects

K Kitamura

Publications and source records attributed to K Kitamura.

At least 1,207 records · Page 67Linked to original sources

Hypereosinophilic syndrome with extensive myocardial involvement and mitral valve thrombus instead of mural thrombi.

A 68-year-old woman complained of repeated signs of congestive heart failure during the last 10 years. Clinical examination revealed persistent marked eosinophilia of the peripheral blood. Postmortem examination of the heart revealed multiple thrombo-embolic materials of the small vascular lumina throughout the myocardium, associated with marked perivascular and stromal infiltration of eosinophils, many foci of myocardial necrosis, and diffuse myocardial fibrosis. There was also an organizing thrombus in the posterior mitral valve. Neither subendocardial fibrosis, overlying mural thrombi in the endocardium, pulmonary infiltration of eosinophils nor systemic granulomatous or healed vasculitis in the lungs and other organs were found. The disease is preferably consistent with a diagnosis of hypereosinophilic syndrome of Hardy et al., a group of ill-defined and overlapping conditions, and best descriptively termed as eosinophilic interstitial myocarditis.

Aged↗

Evidence that ionic channels associated with the muscarinic receptor of smooth muscle may admit calcium.

1 The actions of carbachol on the membrane potential and conductance of smooth muscle of the guinea-pig intestine were investigated using microelectrode recording and the double sucrose-gap method in solutions in which calcium was the only cation creating an inwardly-directed electrochemical gradient.2 In a calcium chloride solution containing a small amount of potassium but no sodium and buffered to physiological pH (Ca Locke) the membrane was hyperpolarized to more than -80 mV. Carbachol (2 x 10(-7)-10(-4)M) depolarized the membrane and increased the membrane conductance.3 By passing current the membrane potential of the smooth muscle cells could be varied. In Ca Locke the depolarization produced by carbachol was shown to be reduced if the membrane was depolarized. The relationship between the size of the carbachol depolarization and the membrane depolarization was linear, giving an apparent reversal potential for carbachol depolarization some 20 mV positive to the resting membrane potential, as measured by extracellular electrodes in the sucrose gap.4 Carbachol depolarization was reduced if the calcium concentration was reduced below 2.5 mM by replacing calcium with Tris, but the depolarization in 2.5 mM Ca and in Ca Locke (100 mM Ca) were of similar size. In Ca-free Na-free solution with EGTA, carbachol depolarization was soon abolished.5 In the sucrose-gap when the chloride gradient across the cell membrane was reversed by replacing the chloride of Ca Locke by an impermeant anion the membrane depolarized. Carbachol now contracted the muscle but produced a hyperpolarization.6 These results are consistent with the hypothesis that activation of muscarinic receptors opens ionic channels which at least in the solutions used, can admit sufficient calcium ions to depolarize the cell and cause tension development.

Animals↗

Roles of extrajunctional receptors in the response of guinea-pig mesenteric and rat tail arteries to adrenergic nerves.

Studies of the electrical response of isolated guinea-pig mesenteric and rat tail arteries to perivascular nerve stimulation were made by micro-electrodes inserted from the outer surface of the vessels. Membrane potential of both arteries was -68 to -69 mV and usually stable, though with occasional miniature excitatory junction potentials (m.e.j.p.s). Perivascular nerve stimulation produced excitatory junction potentials (e.j.p.s) which usually increased in size with repetitive stimulation, particularly in the mesenteric artery, but rarely triggered a spike or other regenerative response. Phentolamine and yohimbine in low concentrations increased the size of the e.j.p.s in both arteries, and increased the mechanical response of the mesenteric artery, probably by blocking prejunctional alpha 2 receptors which depress release of noradrenaline by the nerves; they reduced the mechanical response of the tail artery, probably by blocking alpha 2 receptors of the smooth muscle. Prazosin in low concentration had no effect on the e.j.p.s but inhibited contraction in both arteries, probably by blocking alpha 1 receptors of the smooth muscle. In the tail artery, but not the mesenteric artery, e.j.p.s produced by repetitive perivascular nerve stimulation were followed by a slow depolarization reaching a maximum at about 20 s and then decaying over 1-3 min; it did not reach the threshold for contraction, assessed by K depolarization. Yohimbine reduced the size and duration of the slow depolarization. High concentrations of noradrenaline (10(-5) M) caused depolarization and contraction of the mesenteric artery, both of which were blocked by prazosin and little affected by yohimbine. In the tail artery, yohimbine did but prazosin did not block the depolarization produced by any concentration of noradrenaline, although yohimbine was almost as effective as prazosin in blocking the contraction produced by low concentrations of noradrenaline. Extrajunctional adrenoceptors in the mesenteric artery therefore included high sensitivity types of alpha 1 receptor, and in the tail artery high sensitivity types of alpha 1 and alpha 2 receptor. Some of the extrajunctional receptors, as well as the junctional receptors responsible for e.j.p.s in both arteries, produced depolarization. Most of the contraction induced by either nerves or exogenous noradrenaline was produced by the extrajunctional receptors, and was not dependent on the depolarization which some of these receptors induced.

Action Potentials↗

Clinical and experimental results with focused ultrasound.

Focused ultrasound was applied at the lateral semicircular canal in 19 patients and at the round window in 12 patients, all of whom had intractable vertigo caused by Meniere's disease. Postoperatively, the vertigo was relieved or diminished in 75% of the lateral canal cases and in 25% of the round window cases. The results indicate that the lateral canal approach may have some therapeutic value, but the treatment is arduous for the patient and the risk of facial palsy is always nettlesome. Utilizing similar techniques, ultrasound irradiation was given to the lateral canals of 6 squirrel monkeys and to the round windows of 15 cats. After survival times of up to 3 months, light microscopic studies of the temporal bones of these animals show no morphological changes which can be attributed to the ultrasound irradiation. In general, these findings are in concert with the reports of other investigators and show that selective ablation of the vestibular sense organs cannot be achieved by current techniques of ultrasound irradiation. It seems doubtful that prolonged relief of vertigo can be expected to occur without a more complete morphological ablation of the vestibular sense organs than is possible with the current methods of ultrasound treatment.

Adult↗

Coronary neovascularity related to a left ventricular mural thrombus.

Thirty-six patients with the angiographic diagnosis of left ventricular mural thrombus were reviewed. All had a history of myocardial infarction. In 9 of these patients (25%), coronary neovascularity was related to a left ventricular mural thrombus. Although no relationship was found between either the size of the mural thrombus or the duration of illness and the neovascularity, the incidence of neovascularity was low in a group taking anticoagulants. Arteriographic characteristics of the neovascularity in the present cases are: 1) In all cases, the neovascularity arose from the left anterior descending coronary artery. 2) The neovascularity consisted of a hypervascular region in the same location as the mural thrombus. It was observed as a dense mass of small vessels penetrating the left ventricle in a form resembling a toothbrush. 3) The neovascular region had no veins and it extended through the narrow gap of the thrombus to communicate with the left ventricle. Histological studies were consistent with coronary arteriography. The demonstration of neovascularity by coronary arteriography suggests either that the thrombus is relatively new or that a new thrombus is further organized on the old thrombus. This seems to be useful information from a therapeutic viewpoint.

Coronary Angiography↗

Thigh and calf blood flows after isometric contraction in untrained and trained subjects.

The present study was undertaken to examine whether or not there were any differences between untrained and trained subjects in the changes of blood flow in the ipsilateral and contralateral lower limbs after isometric exercise. Blood flow of the thigh and calf in both right and left legs were measured simultaneously before and after isometric contraction with mercury-in-silastic strain gauge venous occlusion plethysmography. In the present study, the main pattern of blood flow responses in the active and non-active limbs was strikingly similar in all subjects: a significant fall in blood flow immediately after isometric contraction at a force of about 50% of maximal muscle strength for 15 sec was observed in the non-active lower limbs. Peak blood flow of the exercised thigh in the trained group was significantly higher than that in the untrained ones. From these results, it was suggested that higher blood flow after isometric exercise in the trained subjects may be due to the improvement of degree of vasodilation in the lower limb as a result of physical training.

Adult↗

Statistical studies on evaluation of mild disturbance of consciousness. Study of a simpler scale for clinical use.

In an effort to express the grades of mild disturbance of consciousness (MDOC), or clouding of consciousness, 25 items were selected for application in clinical examination. Factor analysis of the 25 items revealed that MDOC has a two-factor structure; namely, the performance factor (F1) and the verbal factor (F2). This structure was maintained in the sequential examinations. Guttman's scale analysis showed that the scale using the 25 items may be considered to approximate a unidimensional scale. By item selection according to communality, the 25 items could be reduced to 12 items without losing the two-factor structure or the usefulness and reliability of the examination. The principal component analysis (PCA) score, the F1 score, and the F2 score, calculated from the 12 items, were found to be good scales to describe an overall picture and characteristics of the F1 and the F2 of MDOC, respectively. Furthermore, by means of the characteristic curve (ogive) method, it was revealed that MDOC consisted of four clusters of items, the F2 factor (mild), F1 factor (mild), F2 factor (moderate), and F1 factor (moderate), according to the MDOC severity, so that a simpler scale composed of a representative item from each cluster could be constructed which exhibited a high correlation coefficient with the original PCA score.

Brain Diseases↗

Brain abscess in congenital cyanotic heart disease.

Sixty-two cases of brain abscess with congenital cyanotic heart disease are reviewed. A sharp peak in the age distribution was seen at 4 to 7 years of age. Of 62 cases, 38 (61.2%) had a tetralogy of Fallot, and six had a transposition of the great vessels. The majority of these abscesses were supratentorial and 76% of abscesses were found in the frontal, temporal, and parietal lobes. Multiple abscesses were present in 19.4% of cases. Sterile cultures were obtained in 61% of the abscesses, and the increasing percentage of sterile cultures seems to be the result of broad-spectrum antibiotic therapy. The overall mortality rate was 37% but there were no deaths after surgical excision secondary to aspiration. Since the introduction of computerized tomography, aspiration without total excision has produced good results, and therefore it is believed that the number of cases which are cured with aspiration therapy alone will gradually increase in the future.

Adolescent↗

[Clinical effect of new alpha-adrenergic blocker on micturition disturbance of neurogenic bladder and lower urinary tract obstruction].

E-643, a newly developed alpha 1-adrenergic blocker with a postsynaptic action, was tried on 17 subjects, 10 patients with neurogenic bladder and 7 patients with lower urethral obstruction. The results of treatment were excellent in 5, good in 7, and poor in 5 of them, the rate of effectiveness therefore being 70.6%. The inhibitory effect of E-643 on the contractility of the detrusor was no stronger than that of other alpha-blockers. The rate of effectiveness for neurogenic bladders was as high as 80% whereas that for lower urethral obstruction was much lower: 57%. Concerning benign prostatic hyperplasia (B.P.H.) alone, this agent was markedly beneficial. In the case of B.P.H the urethra pressure in the prostatic urethra tends to drop and urination is facilitated even without a change in maximum urethral closure pressure, which reduces the amount of residual urine, this sequence of events taking place on condition that the contractility of the detrusor is adequate. According to urodynamic criteria, the underlying causes of the so-called bladder neck contracture can be classified into organic and functional obstruction, but it is mistaken to use this term for functional disturbance of the bladder neck. It seems worthwhile to determine the clinical effect of alpha-blockers on functional urethral obstruction. E-643 produced few if any appreciable signs or symptoms of side effects either subjectively or objectively.

Adrenergic alpha-Antagonists↗

[Histographic analysis of computed tomography of cerebral hemispheric tumors].

The aim of this report is to assess the possibility of digital processing of computed tomography for histological diagnosis of brain tumors. For this purpose, percent histograms of x-ray attenuation value of lesions were analysed in 113 cases of histologically verified hemispheric tumors. Sixteen histograms obtained from normal brain parenchyma served as controls. Histograms were made from the same slices before and after contrast enhancement. The result were as follows; Histograms of benign tumors such as meningiomas and low grade astrocytomas characteristically showed similar pattern with normal subjects, whereas histographic patterns of the more malignant tumors such as malignant astrocytomas, metastases and glioblastomas were more heterogeneous with lower peak and wider curve. Displacement of the histogram to the higher density following contrast material administration was important clue in histographic analysis. The most prominent displacement was observed in meningiomas, followed by metastases with nodular type enhancement and malignant astrocytomas. Displacement in low grade astrocytomas and oligodendrogliomas was very slight and less than that of normal brain. Tumors showing ring enhancement such as glioblastomas and brain abscesses had wide histogram curve with twin peaks. Conclusively, it is possible to detect histological nature of cerebral tumors through CT scanning, using histographic analysis of the digital data.

Astrocytoma↗