Biomedical subjects
Publications and source records attributed to K Yoshimura.
Infected urachal remnants in early childhood are occasionally seen. However, intraperitoneal penetration of an infected urachal remnant, resulting in acute peritonitis, is rare. We report a case of infantile granulomatous urachal abscess extending into the peritoneum and appendix. The diagnosis and treatment of urachal abscess in childhood are discussed.
A distinct clinical entity of uveitis associated with human T lymphotropic virus type 1 (HTLV-I) has been reported previously. During the period between January 1989 and April 1992, 93 patients were observed with HTLV-I uveitis and a significant correlation was found between Graves' disease and HTLV-I uveitis. Sixteen of the 93 patients with HTLV-I uveitis (17.2%) had a previous history of Graves' disease. Fifteen patients were female (15/60, 25.0%) and one was male (1/33, 3.0%). Interestingly, uveitis occurred after the onset of Graves' disease in all cases. On the other hand, none of 222 patients with idiopathic uveitis who were seronegative to HTLV-I had a history of Graves' disease. Although the mechanisms by which HTLV-I causes the correlation between uveitis and Graves' disease are unknown, the present data suggest that immune mediated or autoimmune mechanisms are involved in HTLV-I uveitis.
The effects of a competitive neutrophil elastase (NE) inhibitor, ONO-5046, and a recombinant human superoxide dismutase on leukotriene B4 (LTB4)-induced polymorphonuclear leukocyte (PMN)-mediated increase in microvascular permeability in isolated non-blood-perfused rabbit lungs were studied. Pulmonary microvascular permeability and lung edema were evaluated by use of the fluid filtration coefficient (Kf) and the wet-to-dry lung weight ratio (W/D), respectively. Pulmonary capillary pressure was estimated by the double occlusion technique. NE activity in the perfusate was determined using a spectrophotometric method. The PMNs (2-3 x 10(8) cells) were added into the perfusate in all groups of lungs. Injection of LTB4 (5 micrograms) increased Kf and W/D without affecting pulmonary arterial or capillary pressure. The LTB4-induced lung injury was closely associated with the increase in NE activity in the perfusate. Infusion of ONO-5046 (1 or 10 mg.kg-1 x h-1) inhibited the LTB4-induced increases in Kf, W/D, and perfusate NE activity in a dose-dependent fashion. Infusion of recombinant human superoxide dismutase (80,000 U.kg-1 x h-1) attenuated the LTB4-induced increases in Kf and W/D, although it did not influence the elevation of perfusate NE activity induced by LTB4. These results suggest that both NE and superoxide anion play important roles in the LTB4-induced PMN-mediated increase in pulmonary microvascular permeability.
To examine the hypothesis that the pathway of adaptation to high altitude in natives differs considerably from that in newcomers, we measured maximal O2 uptake (VO2max), minute ventilation, anaerobic threshold (AT), blood lactate, and blood gases during maximal exercise in 17 lifelong Tibetan residents and 14 acclimatized Han Chinese newcomers living at the altitude of 4,700 m. The two groups were similar in age, height, and weight, and the subjects were nonathletes. Although VO2max was significantly lower in the Tibetans than in the Hans (30.4 +/- 1.5 vs. 36.0 +/- 1.9 ml.min-1.kg-1 STPD; P < 0.05), at maximal exercise effort the exercise workload was greater (167.7 +/- 4.2 vs. 150.0 +/- 5.9 W; P < 0.05). The mean AT values (in % VO2max) in the Tibetan and Han subjects were 84.1 and 61.6%, respectively (P < 0.01). Minute ventilation at maximal exercise was significantly lower in the Tibetans than in the Hans (68.4 +/- 3.4 vs. 79.7 +/- 4.1 l/min BTPS; P < 0.05), whereas heart rate at maximal effort was equivalent in the two groups. The Tibetans showed lower blood lactate value than did the Hans both before and at the end of exercise. We conclude that the Tibetan natives have higher exercise performance and AT but lower VO2max and blood lactate concentration than do acclimatized Han newcomers. These results may reflect the effects of genetic or peripheral adaptation factors in the Tibetan natives.
We report a case of paratesticular myxoma. These tumors, which arise from mesenchymal tissues, occur in a variety of sites, the most common being subcutaneous tissues and skeletal muscles but they rarely have been reported to originate in the paratesticular region. The differential diagnosis of other mesenchymal neoplasms of the paratesticular area is discussed.
Secretory leukoprotease inhibitor (SLPI), a 12-kD nonglycosylated serine antiprotease, helps to protect the epithelial surface of the airways from the destructive capacity of neutrophil elastase. Based on the recognition that SLPI levels can increase in the presence of airway inflammation, we hypothesized that inflammatory stimuli should modulate the expression of the SLPI gene in airway epithelial cells. To evaluate this, the modulation of SLPI gene expression with various inflammatory stimuli was evaluated in the HS-24 human bronchial epithelial cell line. After preliminary studies showed that several inflammatory mediators enhanced SLPI messenger RNA (mRNA) levels, PMA was used as a model inflammatory stimulus. PMA significantly increased the level of 0.7-kb SLPI mRNA transcripts in HS-24 cells in a dose- and time-dependent fashion and increased the amount of SLPI protein in the culture supernatant. Nuclear run-on analyses showed that the SLPI gene transcription rate increased approximately twofold after PMA stimulation. Transfection studies using fusion genes composed of fragments of up to 1.2 kb of the 5' flanking sequence of the SLPI gene and a luciferase reporter gene demonstrated potent promoter activity in the 131-bp segment (-115 to +16 relative to the transcription start site), and all longer segments up to 1.2 kb, whereas smaller segments showed low promoter activity. An 18-bp element (-98 to -115), in a region with homology to PMA-responsive regions in the Moloney murine leukemia virus enhancer and the IL-8 gene, was shown to be of importance in the level of transcription of the SLPI gene. However, this element was not responsible for the upregulation of SLPI gene expression by PMA. Evaluation of HS-24 cells in the presence of actinomycin D demonstrated that SLPI mRNA transcripts were very stable and became more so in the presence of PMA. Thus, SLPI gene expression in airway epithelial cells can be upregulated by an inflammatory stimulus, and this modulation is regulated at both the transcriptional and posttranscriptional levels. These mechanisms of SLPI upregulation likely play a role in defending the epithelial surface in the local milieu of inflammatory lung diseases.
The change in the regional skin temperature of hand was investigated under two different clothing conditions. The skin temperatures at six points on the palm, dorsum, and middle finger of the hand, respectively, were measured by using thermister thermometers simultaneously. The measurements were performed in a climate chamber conditioned at 20 degrees C and 65% R.H.. The subjects were 10 healthy females aged between 20 and 24 years. Five out of the 10 subjects wore light clothing (ca. 0.36 clo) and the others heavy clothing (ca. 0.75 clo). They first rested sitting on a chair for 30 min in the climate chamber before the onset of measurement. The results are as follows: 1) The skin temperature of the palm was higher than that of the other parts. Data were rather scattered in the case of the middle finger. 2) The skin temperature of the middle finger dropped to about 3 degrees C within 20 min after the start of measurement. 3) The skin temperature of the middle finger was affected by the clothing condition. We imagine that the skin temperature of the middle finger closely relates to arteriovenous anastomoses (AVA) located in the finger. Clothing probably plays an important role in controlling the blood flow of the AVA vessels, and consequently the skin temperature of the middle finger changes more sensitively than other parts of the hand.
Evidence from in vivo studies supports the concept that growth factors are involved in the function of endocrine organs. We studied the effects of target endocrine organs (thyroid, adrenals, and gonads) on levels of basic fibroblast growth factor (FGF-2) messenger ribonucleic acid (mRNA) in the anterior pituitary and the hypothalamus of male rats using RNase protection assays. Castration significantly reduced the levels of FGF-2 mRNA in the anterior pituitary, but not in the hypothalamus. This decrease was restored by testosterone administration. The regulation of pituitary FGF-2 mRNA involves a specific hormone, i.e. testosterone, since neither adrenalectomy nor chemical thyroidectomy affects the expression of the gene for FGF-2.
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Castleman's disease (CD) is a lymphoproliferative disorder with resemblance in histopathology of thymoma. Here we describe a 48-year-old man with bloody sputum and a mass lesion of the right hilum on chest roentgenogram. He had undergone an incomplete surgical removal of a mediastinal tumor nine years earlier, which proved to be CD with characteristics of hyaline-vascular type pathology. The regrown mass lesion as well as the right upper and middle lobes were removed surgically. Histological examination of the tumor specimen revealed characteristics of hyaline-vascular type CD which were nearly identical to those of the tumor removed nine years earlier. Recurrence of CD as observed in the present report is very uncommon, since only 5 cases, including this one, have been reported. We suggest that in CD the primary tumor as well as regional lymph nodes should be completely removed, and the patients should be kept under long-term postoperative observation to check for recurrence.
We reported results of a clinico-encephalographic study using proposal for classification of epilepsies and epileptic syndromes (1989 ILAE). Fifty-three patients belonged to localization-related epilepsies (LE) and syndromes; forty-one patients belonged to generalized epilepsies and syndromes (GE); one patient belonged to epilepsies and syndromes undetermined, focal or generalized; and we could not classify 4 patients. No patients with the onset after 2 years of age belonged to idiopathic LE and no patients with the onset after 10 years of age belonged to symptomatic LE and GE. The rate of patients who had a past history of febrile convulsions was 38% in idiopathic LE and 35% in idiopathic GE. The rate of patients whose epileptic seizures were well controlled by medication was 83%. It was almost 100% in idiopathic LE, cryptogenic LE and idiopathic GE, but it was 60-70% in the other three groups. In seventeen patients their seizures were difficult to control. Six cases in this group had had frontal focus at least once. Although the patients who had had frontal foci at least once were 17 cases seizures could not be controlled in 6 of them. International Classification of Epilepsies and Epileptic Syndromes is convenient to clinicians, but some problems exist. One is unclearness of a definition differentiating cryptogenic from symptomatic LE. The other is the classification of patients with generalized seizures and interictal focal cortical epileptiform EEG activities. An agreement is necessary for these problems.
To elucidate the clinical and epidemiologic features of HTLV-I associated uveitis (HAU), a multicenter case-control study was performed by collaboration of university hospitals throughout Kyushu and Okinawa and two university hospitals in the central metropolitan area. A total of 426 cases of endogenous uveitis were collected and studied between September 1992 and January 1993; about half of the cases were definable for etiology or clinical entity, and the remaining cases were unknown. Assessment of the serum antibodies to HTLV-I revealed that the group of entity-undefined uveitis had a significantly high prevalence of HTLV-I as compared with the age- and sex-matched control subjects, giving supportive evidence for HAU. The titer of serum HTLV-I antibodies was significantly higher in entity-undefined uveitis than in HTLV-carriers. Assuming that a collection of 50 cases of HTLV-I seropositive, etiology-undefined uveitis represents HAU, its clinical features consisted were: (1) middle-aged, otherwise healthy adults developed acute inflammatory uveal disease and presented with visual haze and/or floaters; (2) the disease showed granulomatous or nongranulomatous anterior uveal reactions accompanied by vitreous opacities and retinal vasculitis; (3) the lesions resolved in response to topical or systemic corticosteroids; (4) the visual outcome was usually favorable; (5) nearly half of the cases had recurrent disease; (6) the cases remained systemically unremarkable, except for two cases of HTLV-I associated myelopathy and eight cases of hyper thyroid disease.
Complete correction without external conduit repair by autologous pulmonary arterial flap was performed for the truncus arteriosus in one neonate and two small infants. In this study, we investigated advantages of postoperative hemodynamics and pulmonary artery growth from the data on truncus arteriosus repaired by the autologous flap technique. Patient in this study was classified as type I or II truncus arteriosus and age ranged from 19 days to 95 days after birth. One of the patients died of unexpected gastric bleeding 25 days after surgery. However, all showed excellent hemodynamics in the early postoperative period. The reconstructed pulmonary tract positioned rather left ward and posterior to the level of the systemic root than the technique with extra cardiac conduit repair. Compression did not occur at the created pulmonary tract and hemodynamics was fairly stable after closure of the chest. The postoperative RVP/LVP ratio ranged among 0.45 to 0.65 and the pressure gradient across the right ventricular out flow tract demonstrated only 10-15 mmHg. The size of the pulmonary arterial flap was sufficient even in type II truncus arteriosus to create right ventricle-to-pulmonary tract. However, the first patient underwent subsequent surgery 20 months after the initial surgery, because of left pulmonary artery stenosis due to intimal tissue overgrowth distal to the outflow patch. Surgical findings revealed that the posterior wall of the pulmonary tract was smooth and well developed. Traction of pulmonary arterial flap toward the right ventricular outflow tract shortens the distance between monocusp and left pulmonary arterial orifice than expected.(ABSTRACT TRUNCATED AT 250 WORDS)
A 59-year-old man underwent CABG with left internal thoracic artery (LITA) to the first diagonal branch and saphenous vein graft (SVG) to the right coronary artery (RCA). Pump off was quite uneventful, but re-anastomosis was done because bypass graft flow measured before the closure of chest was 6 ml/min, which was most likely due to sclerotic right coronary artery and technical error. After re-anastomosis, bypass flow of SVG to RCA was measured 95 ml/min. Root mean square total (RMST) immediately after aortic declamp for the first time was 39% compared with that measured prior to operation, but improved to 49% after aortic declamp at the second time. It recovered to 127% 2 days after operation, and 137% at 7th postoperative day. RMST indicates the total electropotential per unit time from the beginning to the end of QRS. It has the specificity to predict VT and postoperative pump failure. In this case, it is suspected that RMST may be a predictor that revascularization would be complete or incomplete in operations for ischemic heart disease.
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The clinical features of idiopathic uveitis were compared by the seropositivity for human T-cell lymphotropic virus type I. The statistical analysis of various clinical variables disclosed that the uveitis seen in seropositive patients (93 patients) had a significantly higher incidence of floaters, vitreous opacities, retinal vasculitis, and intermediate uveitis than that in seronegative patients (222 patients) (P < .05). The odds ratios of the virus infection for these clinical manifestations were high and statistically significant, suggesting that the virus infection has a role as a risk factor for the development of these clinical manifestations. Although visual acuity at the initial examination was almost equal between the two groups, after the therapy with topical or systemic corticosteroids, or both, visual acuity in seropositive patients was much better than that in seronegative patients. The surface phenotype of peripheral lymphocytes in the two groups was compared as follows: CD4-positive T lymphocytes (P < .05), CD4/8 ratio (P < .01), and CD25-positive T lymphocytes (P < .05) were significantly higher in seropositive patients than in seronegative patients.
Bacteriophage T4 was imaged by atomic force microscopy with the finest resolution to date with a clear image of tail fibers of an estimated diameter of 2-3 nm. T4 phages were spread on a clean surface of silicon wafer and dried under air before observation with an atomic force microscope. The head, tail and tail fibers were routinely imaged with somewhat distorted dimensions. The ease of imaging isolated phage particles with a good resolution raised our expectation for the further use of AFM in biomedical applications.