[Respiratory insufficiency: discussion].
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Humans↗
Biomedical subjects
M Okayama
Publications and source records attributed to M Okayama.
The role of alcohol dehydrogenase 2 and aldehyde dehydrogenase 2 genotypes in alcohol-induced vasospastic angina.
Alcohol ingestion often provokes attacks in patients with vasospastic angina. Type 2 aldehyde dehydrogenase (ALDH2) deficiency, which is based on a single point mutation (Glu487Lys) of the ALDH2 gene, is common in the Japanese population, but rare among the Caucasian population. We investigated how the genotype of ALDH2 affects the characteristics of alcohol-induced vasospastic angina. Ninety-one patients with vasospastic angina who had ingested alcohol daily or occasionally were studied. Patients had been diagnosed as vasospastic angina by a provocation test with an intracoronary injection of ergonovine or acetylcholine during coronary angiography. The Glu487Lys mutation was detected by allele specific PCR. We interviewed the patients to obtain information concerning the relationship between alcohol ingestion and anginal attacks. Alcohol ingestion induced attacks in 16 of 66 patients without the Glu487Lys mutation, 8 of 22 in heterozygotes, and 1 of 3 in mutant homozygotes. The intervals between alcohol ingestion and the onset of anginal attacks were shorter in homozygotes (0.17 hours) and heterozygotes (1.5+/-0.6 hours) for ALDH2*2 than in normal homozygotes for ALDH2*1 (5.4+/-0.6 hours). The amount of ethanol which induced attacks was significantly greater in normal homozygotes than in homozygotes (11 ml) and heterozygotes (42.5+/-7.1 ml) for ALDH2*2 (96.1+/-13.4 ml in normal patients). The frequency of anginal attacks induced by alcohol ingestion did not differ between ALDH deficient and normal homozygotes. In ALDH deficient patients, however, anginal attacks were induced by a smaller amount of alcohol immediately after its ingestion. Thus, the ALDH2 genotype modifies the characteristics of the anginal attacks as a co-factor for the induction of vasospastic angina after alcohol ingestion.
Alcohol Dehydrogenase↗
A study of clinical features and treatment of acute bronchitis by Japanese primary care physicians.
OBJECTIVE: This study aimed to examine the factors affecting prescription of antibiotics for acute bronchitis in ambulatory care settings in Japan. METHOD: A prospective study was conducted on 92 physicians engaged in primary care regarding their prescription behaviour for a series of 20 new patients with acute respiratory diseases seen during November 1996 and the background factors affecting the behaviour. RESULTS: A total of 1755 patients were registered during the study period, 302 (17.2%) of whom were diagnosed with acute bronchitis and 1165 (66.4%) with upper respiratory tract infection. Independent background factors related to diagnosis of acute bronchitis included self-care prior to visit (odds ratio 1.93, 95% CI 1.33-2.80), complaints such as cough (8.80, 4.77-16.2), sputum (2.24, 1.59-3.14) and purulent sputum (6.47, 3.02-13.9). The odds ratio was high in patients with more severe findings of the chest (5.00, 3.64-6.85), given chest X-ray (2.68, 1.33-5.38) while it was low in those feeling cold (0.68, 0.48-0.96), and those with a sore throat (0.63, 0.45-0.90), nasal symptoms (0.75, 0.54-1.04) and more severe findings of the pharynx (0.74, 0.58-0.92). In those with an upper respiratory tract infection, the odds ratio was high for complaints such as feeling cold (1.51, 1.11-2.05) and nasal symptoms (1.39, 1.04-1.86), while it was low for complaints such as cough (0.67, 0.48-0.95), sputum (0.43, 0.30-0.62), purulent sputum (0.19, 0.08-0.44), wheeze (0.34, 0.13-0.92), in those with more severe findings of the tonsil (0.36, 0.29-0.44) and the chest (0.30, 0.19-0.47) and given chest X-rays (0.29, 0.12-0.66). For acute bronchitis, antibiotics were administered to 67.5% and symptomatic therapy concurrently given to 64.9%. As for independent background factors related to prescription of antibiotics for acute bronchitis, the odds ratio was higher in physicians denying the efficacy of antibiotics for treating a cold (4.58, 1.94-10.8), and the patients with complaints such as purulent sputum (22.9, 2.66-197.2), more severe findings of the pharynx (2.26, 1.34-3.79) and of the chest (2.73, 1.53-4.88), and those who had a body temperature measurement taken (4.42, 1.71-11.4) and a chest X-ray (6.11, 1.07-34.9), but was lower in those complaining of chills (0.16, 0.04-0.66) and diarrhoea (0.11, 0.01-1.11). CONCLUSIONS: A majority of patients receiving medical care for acute bronchitis are given an unnecessary antibiotic prescription. The result of this study may be useful for the finding of appropriate forms of intervention for changing physicians' prescription behaviour.
Acute Disease↗
Methacholine bronchial hyperresponsiveness in chronic sinusitis.
The coexistence of chronic sinusitis (CS) may deteriorate the clinical condition of lower airway diseases such as bronchial asthma (BA) or chronic bronchitis (CB). However, the bronchial hyperresponsiveness (BH) in CS without any apparent lower airway disease is not fully understood nor are the effects of treatment. We examined lower airway hyperresponsiveness to methacholine (MCh) in 42 subjects with CS but without allergic rhinitis (AR) who had normal lung functions without any pulmonary symptoms, comparing it with that of 50 subjects with stable BA, 50 subjects with simple CB and 40 subjects with AR, and further examined the effect of endoscopic sinus surgery in 7 CS subjects with BH. The BH to MCh was measured in terms of the minimum dose (Dmin), defined as the cumulative dose at the point where respiratory conductance began to decrease. A Dmin <50 units was defined as BH. Seventy-one percent of CS subjects showed BH without relation to the severity or duration of CS, or atopic status. BH in CS subjects, which was less than that in BA subjects, was similar to that in simple CB or AR in both its prevalence and degree. After the surgical treatment of CS, BH significantly decreased (p < 0.01) with improvements in both nasal symptoms and sinus lesions. These findings suggest that CS itself induces BH to a degree similar to simple CB and AR without any relationship to the clinical background, and that adequate treatment of CS reduces BH.
Adolescent↗
[A case of abdominal tuberculous lymphadenitis diagnosed by percutaneous US-guided needle biopsy].
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Abdomen↗
Risk factors for methicillin-resistant Staphylococcus aureus (MRSA) infection in a Japanese geriatric hospital.
A case control study on MRSA infection was carried out, with the purpose of evaluating the effect of age, gender, hypoalbuminemia, the limitation of activities of daily living (ADL), the administration of antibiotics and the use of the new cephems which include third generation cephalosporins and monobactam and carbapenems, on the occurrence of MRSA infection among the inpatients in a geriatric hospital. From April 1991 to March 1994, 285 patients underwent a bacterial culture in the various clinical aspects. 118 patients were positive for MRSA, who were then used as cases while 167 patients who were negative for MRSA were used as controls. The level of serum albumin and the ADL score were lower in the MRSA group than in the non-MRSA group (P < 0.01) while the number of antibiotics administered before bacterial culture was greater in the MRSA group than in the non-MRSA group (P < 0.01). The third generation cephems were more commonly used in the MRSA positive patients than the negative patients (P < 0.01). Even after controlling for the other factors, hypoalbuminemia (OR = 1.73, 95% CI = 1.27-2.36), the limited ADL (partially limited vs without limitation: OR = 1.88, 95% CI = 1.19-2.96, completely limited vs without limitation: OR = 2.50, 95% CI = 1.64-3.82), the use of antibiotics other than the third generation cephems (vs without antibiotics: OR = 1.73, 95% CI = 1.20-2.50) and the administration of the third generation cephems (vs without antibiotics: OR = 3.12, 95% CI = 2.16-4.50) increased the risk of MRSA infection.
Aged↗
An association of human T-cell lymphotropic virus type I infection with vascular dementia.
Subjects ranging in age from 50 to 89 years old, either with or without dementia were studied by both ELISA for anti-human T-cell lymphotropic virus type I (HTLV-I) gag 100-130 antibody and by cranial CT in order to clarify the relationship between HTLV-I infection and dementia. The frequency of anti-HTLV-I antibody was found to be significantly higher in the patients with dementia (24/130, 18.5%) than in those without dementia (11/139, 7.9%) (P=0.0169). Among the various types of dementia, HTLV-I seropositivity was found to be significantly associated with vascular dementia (11/48, 23%) (P=0.0087), but not with Alzheimer type dementia. In addition, HTLV-I seropositivity was also associated with Babinski sign, and the severity of cerebral infarction, ventricular dilatation and periventricular lucency on CT. The presence of HTLV-I therefore appears to be one of the risk factors for vascular dementia in HTLV-I endemic areas.
Adult↗
The case fatality rate of methicillin-resistant Staphylococcus aureus (MRSA) infection among the elderly in a geriatric hospital and their risk factors.
From April 1991 to March 1993, there were 49 elderly patients with methicillin-resistant Staphylococcus aureus (MRSA) infection in a geriatric hospital in Fukuoka, Japan. The retrospective study was carried out in order to evaluate the various factors which may influence the case fatality rate of MRSA infection among the elderly. Among them, 33 patients (67.3%) died while only 16 patients became culture-negative for MRSA and discharged after recovering from MRSA infection. A univariate analysis revealed that male sex (odds ratio [OR] = 12.25, 95% confidence interval [CI] = 2.80-53.55), hypoalbuminemia (OR = 3.83, 95% CI = 1.11-13.21) and an excessive usage of antibiotics (OR = 6.67, 95% CI = 1.70-26.09) were risk factors for death among the patients with MRSA infection. In a multivariate analysis, male sex and an excessive usage of antibiotics were still risk factors while hypoalbuminemia was not. However, hypoalbuminemina was more common in male patients than female patients (78.3% vs. 42.3%, p < 0.05). These findings suggest that the case fatality rate of MRSA infection may be high and also suggest that the elderly with MRSA infection who had hypoalbuminemia and/or received many antibiotics may have a poor prognosis.
Aged↗
[The efficacy of HFJV (high frequency jet ventilation) for ARDS (adult respiratory distress syndrome) following total arch replacement].
A 40-year-old man was admitted to the hospital with shock due to acute aortic dissection (type A of Stanford classification). The emergent total arch replacement was performed with the retrograde cerebral perfusion uneventfully. At the 3rd day after the operation, bilateral infiltrates were recognized on the frontal chest radiograph. The oxygenation was gradually decreased to less than 200 mmHg of PaO2/FiO2 in proportion with the growth of infiltrates and increase of LDH in blood. Steroid therapy was not effective. So then HFJV was introduced to improvement of hypoxygenation at the 16th day after the operation. HFJV made PaO2/FiO2 improve immediately to more than 300 mmHg and the inspiratrory pressure decrease to less than 30 mmHg. Bilateral infiltrates were diminished by HFJV. LDH in blood decreased apparently. HFJV had been used together during 15 days. The respirator was weaned at the 46th day after the operation. In this clinical course, the change of PaO2/FiO2 had the negative correlation with that of LDH in blood.
Adult↗
[Six patients in whom exacerbation of asthma was complicated by mediastinal emphysema].
We encountered 6 patients with bronchial asthma complicated by mediastinal emphysema. Their average age was 21 years. All were atopic and had histories of asthma in childhood. In 5 of the 6, mediastinal emphysema developed when the patients had upper respiratory infections. In 3, the mediastinal emphysema worsened. After insertion of subcutaneous drains to decrease intramediastinal pressure, the conditions of those 3 patients improved remarkably. The conditions of the other 3 improved after medication only. During the period of this study, 1.24% of all patients treated at Hiroshima Asa Citizen's Hospital for exacerbations of asthma had mediastinal emphysema.
Adolescent↗
[A case of thymic cyst differentiated from cardiac cyst with immunostaining].
This is a case of a 70-year-old woman with thymic cyst which was found by chance on admission for treatment of acute bronchial asthma and diagnosed by pathological examination. After remission of the asthma she was asymptomatic and no pathological physical findings were found except of cervical thyroid tumor of adenomatous goiter. Chest X-ray films revealed a large mediastinal mass with a sharp margin at the right cardiophrenic angle. Chest CT and MRI revealed that it occupied a space from upper anterior mediastinum to right cardiophrenic angle, and that it showed low density area without enhancement, suggesting a mediastinal cyst. A multilocular cyst, 15 cm in diameter, containing serous liquid was excised using thoracotomy. Pathological and immunohistochemical examination of the cyst revealed that its inner surface was lined with benign cylindrical epithelium and that thymic tissues existed in the walls of the cyst, resulting in a thymic cyst. The thymic cyst, of which reports have increased, should be considered in the differential diagnosis of anterior mediastinal cysts.
Aged↗
Phosphorylation of a membrane-intercalated proteoglycan, syndecan-2, expressed in a stroma-inducing clone from a mouse Lewis lung carcinoma.
We previously reported that a mouse Lewis lung carcinoma-derived stroma-inducing clone, P29, highly expresses a syndecan-like proteoglycan exhibiting specific binding to fibronectin, a major constituent of the interstitial matrix formed by the induced stromal cells, via its heparan sulphate chains [Itano, Oguri, Nakanishi and Okayama (1993) J. Biochem. (Tokyo) 114, 862-873]. On metabolic labelling of the proteoglycan with [32P]Pi, followed by identification of the radiolabelled material using glycanases, almost all the isotope was found to have been incorporated into a core portion of molecular mass 48 kDa, which was generated by digestion with heparan sulphate lyase I plus chondroitin ABC lyase. Immunoblotting of the core protein with a monoclonal antibody, F58-6G12, demonstrated that the proteoglycan was mouse syndecan-2. CsCl-density-gradient centrifugation after mild treatment of liposome-intercalated 32P-labelled syndecan-2 with trypsin resulted in clear separation of the radioactivity into a bottom fraction containing all the glycosaminoglycans (accounting for 40% of the total radioactivity) and a top fraction containing liposome-associated peptides (60%). The former isotope was shown to be linked covalently to both heparan sulphate and chondroitin sulphate chains, probably at their bridge regions. The latter was mostly attributed to phosphoserine, the one and only phosphorylated amino acid released on acid hydrolysis of this proteoglycan, strongly suggesting that the phosphorylation occurs at a specific serine residue(s) in the cytoplasmic domain of the core protein.
Amino Acid Sequence↗
Incidence of methicillin-resistant Staphylococcus aureus (MRSA) isolation in a skilled nursing home: a third report on the risk factors for the occurrence of MRSA infection in the elderly.
A case control study was carried out in order to evaluate the various factors which may influence the occurrence of methicillin-resistant Staphylococcus aureus (MRSA) infections in a skilled nursing home. From April 1991 to March 1994, bacterial cultures were performed in 55 out of 102 residents in a nursing home based on various clinical aspects. We divided 102 residents into following three groups; (1) the MRSA group (n = 10), residents whose materials for bacterial culture were positive for MRSA, (2) the non-MRSA group (n = 45), residents whose specimens were negative for MRSA but positive for other bacteria, (3) the control group (n = 47), residents who did not have to undergo a bacterial culture because they were free from moderate and severe infectious diseases. Compared with the control group, the activities of daily living score and the serum albumin level were significantly lower in the MRSA group and the non-MRSA group at the beginning of the study. In contrast, the number of antibiotics used prior to the bacterial culture and the proportion of hospitalization within 6 months prior to the bacterial culture were significantly larger in the MRSA group than in either the non-MRSA group, or the control group. These results thus suggest that a low activities of daily living score, the use of many kinds of antibiotics and a recent previous hospitalization may be risk factors of MRSA infection in a nursing home environment.
Aged↗
Localization of histamine N-methyltransferase messenger RNA in human nasal mucosa.
BACKGROUND: Histamine is metabolized mainly by histamine N-methyltransferase (HMT) to N tau-methylhistamine in human nasal mucosa. Human HMT cDNA has been cloned and expressed in COS cells. The purpose of this study was to determine the localization of HMT METHODS: The fragment (nucleotide residues 430-1055) of human HMT cDNA was subcloned in a Bluescript vector (Stratagene, La Jolla, Calif.), and HMT sense anti-sense RNA probes were made with T7 and T3 RNA polymerases. In situ hybridization with digoxigenin-labeled RNA probes was performed on surgical specimens of human nasal turbinates. RESULTS: HMT mRNA was localized in cells in the epithelium and submucosa, and densely in endothelial cells of vessels. No HMT mRNA was identified in the submucosal glands. The presence of HMT mRNA was confirmed by Northern blot analysis, and HMT activities were also detected in nasal mucosa. CONCLUSION: Our study indicates that endothelium expresses HMT mRNA, whereas cells in the epithelium and submucosa, which remain unidentified, are an additional source of HMT mRNA.
Blotting, Northern↗
Effect of pilocarpine on propranolol-induced bronchoconstriction in asthma.
To investigate whether increased release of acetylcholine may be involved in propranolol-induced bronchoconstriction (PIB), the inhibitory effect of pilocarpine (Pilo), an agonist of M2-muscarinic receptors that in 11 stable asthmatic subjects. The bronchial responsiveness to Pilo was also measured in terms of Dmin, defined as the cumulative dose at the point where respiratory resistance (Rrs) began to increase. In PIB, the maximum increase in Rrs (Rrs max) after stopping inhalation for 1 min was measured. Atropine reversed PIB. After pilocarpine pretreatment at a dose equal to Dmin, Rrs max divided by baseline Rrs decreased significantly from 206.6 +/- 61.1 to 163.0 +/- 42.6% (mean +/- SD) (p = 0.001). The ratio of PIB (Rrs max/baseline Rrs) with Pilo to PIB without Pilo correlated inversely according to the pretreatment dose (Dmin) of Pilo (p < 0.05). These results suggest increased release of acetylcholine in PIB and that M2-muscarinic receptors are at least in part functioning in stable asthmatic airways.
Acetylcholine↗
Temporal frequency deficit in patients with senile dementia of the Alzheimer type: a visual evoked potential study.
To study the temporal aspect of visual processing of senile dementia of the Alzheimer type (SDAT), we recorded the steady-state visual evoked potentials (VEPs) to LED goggle stimulation at five different temporal frequencies in 14 patients with SDAT and 14 control subjects. For comparison, we also studied 14 patients with vascular dementia (VD). All subjects were women, and their ages were closely matched. Temporal frequencies were 5, 10, 15, 20, and 30 Hz. The steady-state VEPs were Fourier analyzed, and both the amplitude and phase of the first and second harmonic responses were obtained. There was a significant difference in the amplitude across the three groups for stimulation at 15, 20, and 30 Hz, but no difference at a stimulation of 5 and 10 Hz. Multiple comparison tests revealed that patients with SDAT had a significantly smaller amplitude than normal controls. Patients with VD had lower amplitudes than normal subjects, but this was not statistically significant. In the phase data, there were also no statistically significant differences across the three groups for any of the temporal frequencies. These results indicate that a temporal frequency deficit exists in SDAT. This phenomenon may be explained by the pathology that affects the early stage of visual signal processing.
Aged↗
Differential fibrotic stromal responses of host tissue to low- and high-metastatic cloned Lewis lung carcinoma cells.
BACKGROUND: The relationship between host stromal responses and tumor invasion and metastasis is poorly understood. To gain new insights into this relationship, we compared the stromal response in tumor tissues formed by low- and high-metastatic murine lung carcinoma cell lines. EXPERIMENTAL DESIGN: Mouse Lewis-lung-carcinoma-derived cloned cell lines with different metastatic potentials (P29, LM12-3, and LM60-D6 cells with low-, medium-, and high-metastatic potentials, respectively) were subcutaneously injected, and the resultant tumor tissue was analyzed immunohistochemically for the localization of type I collagen, fibronectin, and tenascin, and biochemically for the levels of glycosaminoglycans. The activities of conditioned media of cultured tumor cells to stimulate DNA synthesis in BALB/c 3T3 cells in vitro were also examined. RESULTS: In the subcutaneous low-metastatic P29 tumor, fibrillar extracellular matrices and fibroblast-like cells surrounding tumor cells were stained strongly for type I collagen, fibronectin, and tenascin, but only weakly stained in the more highly metastatic LM12-3 and LM60-D6 tumors. Implantation of these cell lines into cerebrum, which does not normally contain interstitial stroma, gave same results. Morphometric analysis of the subcutaneous tumor tissues revealed significantly more fibroblast-like cells and mast cells in the P29 tumor than in the more highly metastatic tumors. Quantitative analysis of glycosaminoglycans present in tumor tissues showed that the hyaluronic acid content of the P29 tumor was more than 5 times that in the more highly metastatic tumors. Furthermore, serum-free conditioned medium prepared from the culture of P29 cells exhibited about 10 times higher mitogenic activity toward BALB/c 3T3 cells than the conditioned medium from the more highly metastatic cells. CONCLUSIONS: We found an inverse relationship between the host stromal response and spontaneous lung metastasis. The stromal response in the P29 tumor may be induced directly by tumor cells and/or indirectly via mast cell activation. This metastasis model should be useful in understanding the role of stromal response in tumor metastasis.
Animals↗
Difference in blood flow volume of the common carotid artery between vascular and non-vascular dementia detected by colour duplex sonography.
Using colour duplex sonography, blood flow volume in the common carotid artery was measured in 72 demented patients and 28 normal controls. Thirty-five patients with a Hachinski's ischaemic score of 7 or above and marked ischaemic lesions on CT were assigned to the vascular dementia (VD) group. Thirty-three patients with probable Alzheimer's disease according to the NINCDS-ADRDA criteria, 2 patients with Parkinson's disease, 1 patient with spinocerebellar degeneration, and 1 patient with Pick's disease were assigned to the non-vascular dementia (nonVD) group. The sum of blood flow volume in the bilateral common carotid arteries (CCA flow) in the nonVD group and in the VD group was lower than that in the control group. The CCA flow in the VD group was lower than that in the nonVD group. Comparison of patients matched for both age and the Hasegawa's dementia rating scale also revealed lower CCA flow in the VD group than in the nonVD group. Linear discriminant function analysis showed that nearly 90% of the demented patients were correctly diagnosed as having VD or as having nonVD. These results show the usefulness of colour duplex sonography in the differential diagnosis of patients with dementia.
Aged↗