[Urology and internal medicine--correlation between pyelonephritis and vesicoureteral reflux].
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Biomedical subjects
Publications and source records attributed to K Miyazaki.
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The value of dynamic-contrast enhanced MR imaging using FLASH technique was studied in 13 patients with postoperative recurrent cervical cancer verified histopathology and in 9 patients without recurrence. Dynamic FLASH imaging and conventional spin-echo T1- and T2-weighted sequences were compared in a prospective fashion with regard to accuracy of the diagnosis of recurrent tumor using biopsy results as the gold standard. The contrast between the recurrent tumor and the surrounding pelvic tissues was also analyzed. The accuracy of depicting recurrent tumor or dynamic images (82%) was superior to that of pre- and postcontrast T1-weighted images and T2-weighted images (64%, 68%, and 64%, respectively). The contrast between the recurrent tumor and pelvic fat was greater on precontrast T1-weighted and dynamic images than on T2-weighted and postcontrast T1-weighted images. The dynamic images clearly showed involvement of the surrounding pelvic organs, because enhancement was observed exclusively in the tumor in the early dynamic phase. Accuracy regarding involvement of the urinary bladder or rectal wall on pre- and postcontrast T1-weighted images and T2-weighted images was lower than that on the dynamic images. Dynamic MR imaging has potential for use in the detection and evaluation of the extent of recurrent postoperative cervical cancer.
Balloon-occluded arterial infusion (BOAI) of bilateral internal iliac arteries produces high drug concentration as well as increased arterial flow of pelvic organs. Twenty-seven patients with primary and locally recurrent gynecologic malignancies were treated with BOAI of cisplatinum. Six of 10 patients with primary advanced uterine cancer and 5 of 11 patients with recurrent cancer showed clinical response. In 6 patients, BOAI was performed as an adjuvant therapy to radiation or other chemotherapy. Toxicity was similar to that seen with systemic treatment using cisplatinum, but its frequency and degree were less severe.
BACKGROUND: Analysis of unenhanced and contrast-enhanced magnetic resonance (MR) images of struma ovarii, a rare benign neoplasm of the ovary, is the aim of this study. METHODS: T2-weighted and Gd-DTPA-enhanced T1-weighted MR images of five histologically proven struma ovarii were evaluated retrospectively. RESULTS: In all patients, unenhanced and contrast-enhanced T1-weighted MR images showed complex cystic masses composed of multiple cysts and a solid component, indicating the presence of large and small thyroid follicles. In four patients, the cyst fluid was hypointense on T1-weighted images and hyperintense on T2-weighted images. In one patient, the fluid was hyperintense on T1-weighted images and hypointense on T2-weighted images due to hemorrhage. CONCLUSION: A complex mass composed of multiple cysts and a solid component, indicating the presence of large and small thyroid follicles, appeared to be a characteristic MR finding of struma ovarii.
Normal mouse vaginae and uteri regress following ovariectomy, whereas the vagina of mice given five daily injections of 3 micrograms diethylstilbestrol (DES) from the day of birth exhibit ovary (estrogen)-independent persistent stratification and cornification of the epithelium. Zymography indicated expression of four proteinases in both vaginae and uteri of normal mice after ovariectomy. Two proteinases detected in gelatin-containing gel and two others in casein-containing gel proved to be metalloproteinases and serineproteinases, respectively. The two metalloproteinases were identified as gelatinases A and B. Only gelatinase B was intensified 1 d after ovariectomy; however, all four proteinases showed an increase in expression 3 d after ovariectomy. In the uterus, the two gelatinases showed increased expression after ovariectomy. Progelatinase B and serineproteinase II were expressed in the vagina of normal mice at estrus; ovariectomy intensified expression and activation of gelatinases and serineproteinases II in the vagina. Vaginae of mice treated neonatally with DES exhibited a weak expression of proteinases. Ovariectomy changed neither the histology nor the expression of proteinases in these DES-exposed vaginae. Expression of gelatinases was inhibited by estrogen; progesterone stimulated expression and activation of gelatinase B. Serineproteinases found in the vagina and uterus of ovariectomized mice were also inhibited by estrogen but neither was affected by progesterone. These results suggest that gelatinase B and both gelatinases participate in vaginal and uterine regression, respectively, following ovariectomy. Estrogen negatively regulates expression of gelatinases and serineproteinases in the vagina, and of gelatinase A and serineproteinase II in the uterus.
We report two cases with interstitial pregnancy, which showed completely different MR appearances. In case 1, a gestational sac was demonstrated and the diagnosis of ectopic pregnancy was straightforward. In case 2, a hypervascular mass was shown without demonstration of a gestational sac, the findings usually seen in gestational trophoblastic disease (GTD). MR imaging may play some role in the diagnosis of interstitial pregnancy when sonography is insufficient or equivocal. If GS is visualized, diagnosis is easy. However, if not, the appearance may have a spectrum and can be similar to GTD.
The magnetic resonance (MR) appearances of three cases of atypical polypoid adenomyoma are reported. The signal intensity of the tumor was similar to that of adenomyosis on T2-weighted MR Imaging (MRI). On contrast-enhanced study, irregular enhancement was seen in hyperintense areas on T2-weighted images. Atypical polypoid adenomyoma can be characterized as a hypointense polypoid mass with hyperintense foci on T2-weighted MR images, resembling the appearance of adenomyosis.
Placental protein 5 (PP5) is a placenta-derived glycoprotein with serine proteinase-inhibiting activity. To date its physiological functions have not been well elucidated. Recently, cDNA sequence analysis revealed that PP5 belongs to the Kunitz-type proteinase inhibitor family and it is identical to tissue factor pathway inhibitor-2 (TFPI-2), homologous to TFPI. Northern blot analysis demonstrated that placental tissue is extremely rich in the transcripts. This study localized PP5/TFPI-2 mRNA in placental tissues at three different gestational periods using in situ hybridization. PP5/TFPI-2 mRNA was specifically detected in syncytiotrophoblast at any gestational period examined, suggesting that syncytiotrophoblast is the principal production site of PP5/TFPI-2 in developing placental tissues. This mRNA expression pattern of PP5/TFPI-2 is quite different from that of TFPI, which is mainly found in vascular endothelial cells. The results indicated possible roles of PP5/TFPI-2 in the trophoblast differentiation and in the maintenance of intervillous blood flow. Also, Northern analysis demonstrated no or little expression of PP5/TFPI-2 in four choriocarcinoma cell lines, in contrast to its abundant expression in syncytiotrophoblast.
The estrogenic activities of 13 Bisphenol-A (BPA)-related chemicals for development of new polymers by three in vitro bioassay have been examined in the presence and absence of a post-mitochondrial metabolizing system (S9 mix). BPA, Bisphenol-B (BPB), Bisphenol-F (BPF), Bisphenol-S (BPS), 4,4-ethylidenebisphenol (BP1), 4,4-dihydroxybenzophenone (BP2), 2,2-bis (4-hydroxyphenyl)-hexafluoropropane (BP3), 4,4-(1,4-phenylenediisopropylidene) bisphenol (BP4), 4,4-cyclohexylidenebisphenol (BP5), 4,4-dihydroxydiphenyl ether (BP6), 4-hydroxydiphenylmethane (BP7), 4-cumylphenol (BP8) and 4,4-dihydroxydiphenyl sulfide (BP9) were each diluted with dimethyl sulfoxide to final concentrations ranging from 10(-7) to 10(-3) M in both the yeast two-hybrid system and in a fluorescence polarization system. Dilutions of 10(-9) to 10(-4) M were assayed in the E-screen, respectively. Except for BPS and BP4, the chemicals tested showed estrogenic activity in the absence of cut S9 mix preparation and the activity was enhanced with S9 mix. BPS, which was initially negative, was active with S9 mix in the yeast two-hybrid system. BP2 was weakly estrogenic with or without S9 mix. Chemicals other than BP2 were positive in the competition binding assay. All chemicals tested showed estrogenic activity in the E-screen, the concentration level of which was 10(4) times lower than those of the other two assays.
The detection of adenocarcinoma of the cervix is difficult in clinical examination, leading to poor prognoses. We evaluated MR appearances of 23 patients with adenocarcinoma of the cervix and appearances of 65 patients with cervical SCCs were also evaluated for comparison. Both T2-weighted spin echo, dynamic and postcontrast Gd-DTPA enhanced techniques were obtained at a 1.5 Tesla MR unit. The results of our study showed that adenocarcinoma of the cervix have MR imaging features which may permit distinction from SCCs which include: large tumors with preservation of endocervical epithelium, lesser contrast enhancement, and greater enhancement of the tumor periphery. Understaging may be more problematic with adenocarcinoma than SCC.
Our previous paper [(1999) Bioconjugate Chem. 10, 24-31] pointed out that hydrophobicity of substrates/inhibitors plays an important role in the recognition by an oligopeptide transporter (PEPT1) expressed in the human intestinal epithelial cell line Caco-2. To determine the significance of that hydrophobicity, we have now synthesized dipeptide analogues conjugating the epsilon-amino group of Lys in Val-Lys with aliphatic carboxylic acids: acetic acid (C2), propanoic acid (C3), pentanoic acid (C5), hexanoic acid (C6), and decanoic acid (C10). The affinities of these conjugates were estimated by their inhibition of the accumulation rate of Gly-Sar, a well-established substrate for PEPT1. With the increase in length of the hydrocarbon chain of the conjugates, i.e., in the hydrophobicity of the conjugates, the inhibition strengthened. Dixon-Webb plot analysis of the inhibition by the C10-conjugated dipeptide showed competitive inhibition. The trans-stimulation effect of Val-Lys conjugated to C10 or C5 on the uptake of Ceftibuten was observed using rat brush border membrane vesicles. This findings showed that these conjugates are transportable substrates. These results confirmed that the hydrophobicity of substrates/inhibitor is one of the factors in the recognition by PEPT1.
Immunohistochemical distribution of laminin gamma2 chain, a subunit of the basement membrane protein laminin-5, was examined in 19 cases of human embryos and foetuses ranging from 4 to 25 weeks of gestation. Laminin gamma2 was first detected in the basement membranes underlying ectodermal epithelial tissues, such as the skin and tooth, as early as 5-6 weeks of gestation. Between 6-7 and 12-13 weeks, laminin gamma2 was detected in the basement membranes of various endodermal epithelial tissues, such as the bronchus, oesophagus, stomach, intestines, urinary bladder, gallbladder and hepatopancreatic duct. The deposition of laminin gamma2 in basement membrane was associated with the process of morphogenesis. In the small intestine, laminin gamma2 first appeared in the basement membrane of the primitive short villi, and its level gradually increased in the villus region but decreased in the cryptic region during the maturation of the organ. In addition, non-basement membrane immunoreactivity for laminin gamma2 was detected in some mesoderm-derived tissues, such as the cartilage and skeletal and smooth muscle fibres. These results suggest a common role of laminin-5 and some specific roles of its gamma2 chain in the morphogenesis of human tissues.
Placental protein 5 (PP5)/tissue factor pathway inhibitor-2 (TFPI-2), a serine proteinase inhibitor, is homologous to tissue factor pathway inhibitor (TFPI) and commonly found in peripheral blood of pregnant woman. Although TFPI is well known to be synthesized primarily in endothelium and to play an important role in regulation of the extrinsic pathway of blood coagulation, the function of PP5/TFPI-2 remains unclear. Our previous report demonstrated that PP5/TFPI-2 expression is ubiquitous and extremely high in growing placental tissue. Using newly generated polyclonal anti-PP5/TFPI-2 antibody, and by immunohistochemistry and immunoelectromicroscopy, we examined precise localization of PP5/TFPI-2 in placenta especially in syncytiotrophoblasts, which had been shown to produce PP5/TFPI-2 mRNA by our previous study using in situ hybridization. Immunoelectromicroscopy revealed PP5/TFPI-2 localizing on the surface of the microvilli and the membrane of endoplasmic reticulum of syncytiotrophoblasts. To confirm the cell surface association of PP5/TFPI-2, placental villi were incubated with heparin and resultant soluble fraction was analysed by Western blotting. Heparin liberating PP5/TFPI-2 from villi suggested that PP5/TFPI-2 might be retained on the microvilli surface through the binding to membrane-anchored proteoglycans such as glypican and/or syndecan family members. We also examined the relationship between the presence of cell layer of syncytiotrophoblasts and the coagulation using clinical specimens, and revealed that the fibrin depositions were specifically observed on the regions lacking syncytiotrophoblasts cell layer in placental villi. Therefore, it is likely that during pregnancy PP5/TFPI-2 may be retained on the surface of placental villi via proteoglycans, and may play an important role to maintain intervillous blood flow and the patency of microvasculature in feto-maternal blood system mediated by the inhibition of serine proteinases involved in the blood coagulation.
Acute phase responses of vasoactive hormones to the rapid conversion of a systemic flow pattern from pulsatile or non pulsatile mode to the reverse were assessed in 20 goats weighing 45-69 kg. A total left heart bypass was instituted under general anesthesia, with pulsatile and non pulsatile pumps interposed in the circuit in parallel, and the systemic flow mode was rapidly and bidirectionally converted from the pulsatile mode or non pulsatile mode to the reverse. Vasoactive hormone levels and hemodynamics were evaluated before and after 5 min of conversion. No significant difference was observed between the modes either in blood flow or systemic vascular resistance, while the mean aortic pressure was significantly higher in the non pulsatile mode than the pulsatile mode (106.7 +/- 2.4 versus 99.9 +/- 3.5 mmHg). Among various vasoactive hormone levels evaluated, only norepinephrine showed a significant difference between the modes, where concentration in the non pulsatile mode was significantly higher than the pulsatile mode (391.0 +/- 60.7 versus 309.4 +/- 42.5 pg/ml). No correlation was found between the absolute values of mean aortic pressure and norepinephrine level, whereas a significant reciprocal correlation was detected between the magnitude of inter-mode differences in these two parameters. In conclusion, a non pulsatile systemic circulation does not exert significant influence on vasoactive hormone levels, except for slight increase in norepinephrine with a reciprocally correlated increase in mean aortic pressure. It is deduced that activity of the sympathetic nervous system represented by norepinephrine level is higher in the non pulsatile mode than the pulsatile mode, and the baroreceptor reflex functions in an acute phase after flow mode conversion.
Non pulsatile circulation is commonly applied to clinical cardiopulmonary bypass or circulatory assist. However, influences of non pulsatile circulation on sympathetic nerve activity, which plays an important role in circulatory control, have not been elucidated. In this study the renal sympathetic nerve activity (RSNA) was recorded for the first time in goats, whose heart rate and size are similar to humans', and the difference during pulsatile and non pulsatile circulation was evaluated. Total left heart bypass was instituted in eight adult goats under general anesthesia. A pneumatic pulsatile pump and a centrifugal non pulsatile pump were incorporated in parallel so that pulsatile circulation and non pulsatile circulation could be instantly converted to the other. The pumping rate was set at 90/min regardless of the native heart rate during pulsatile circulation and the mean aortic pressure was maintained constant at the conversion of circulatory mode. The original signals of RSNA were integrated and defined as the mean RSNA. The mean RSNA and the mean aortic pressure were averaged every 30 sec and quantified during pulsatile circulation and non pulsatile circulation. The pulse synchronized burst of RSNA during pulsatile circulation immediately disappeared and the mean RSNA significantly increased up to 120% of pre depulsation level after changing the circulatory mode to non pulsatile circulation. Reverse conversion of circulatory mode from non pulsatile circulation to pulsatile circulation decreased the mean RSNA to 79%. The results suggest that vasotonus may be affected in its periodicity as well as its quantity by the loss of pulsation during the initial phase after depulsation.
A novel cardiopulmonary support (CPS) system as a long-term total substitute for the natural heart and lung was designed and evaluated. The CPS system is composed of a ventricular assist device (VAD) and a newly developed compact artificial lung (AL). The pneumatic VAD was originally developed in the authors' institute and has proven durable and antithrombogenic in over 120 clinical uses. The AL, with 1.2 m2 membrane surface area and 140 ml priming volume, consists of a special gas exchange membrane where not only are micropores blind-ended to prevent serum leakage, but the blood contacting surface is treated with heparin binding to ease systemic anticoagulation. Chronic animal experiments of total CPS were carried out in three goats weighing from 28 to 36 kg. Venoarterial bypass was instituted with the CPS system in which all venous blood was drawn from both the right atrium and ventricle and returned to the aorta. No systemic anticoagulation was conducted except for heparin added fluid infusion from pressure lines. One animal survived for 2 weeks without any device related problems until electively euthanized. Blood flow rate ranged between 3.2 to 4.5 L/min, O2 transfer between 120 to 220 ml/min, and CO2 removal between 60 to 210 ml/min. No substantial changes were found in platelet count or other coagulation factors. These results indicate that the system has the ability to be used for long-term CPS, such as a bridge to lung or heart-lung transplantation.