Anorexia nervosa: an important cause of chronic tubulointerstitial nephropathy.
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Adult↗
Biomedical subjects
M Shinozaki
Publications and source records attributed to M Shinozaki.
Quantitative analysis of hyaluronan in the synovial tissues of patients with joint disorders.
Quantitative analysis of hyaluronan (hyaluronic acid; HA) in the synovial tissues of patients with joint disorders were performed. HA was found not only in the synovial intimal cells and matrices, but also especially in the alveolar lymphoid follicles and connective tissues surrounding blood vessels in the inflammatory granular synovium which formed the pannus. HA levels in the synovium of patients with rheumatoid arthritis (RA) (459.0+/-66.2 microg/g) where shown to be higher than those in patients with osteoarthritis (246.9+/-34.8 microg/g) and traumatic injury (227.7+/-35.4 microg/g). It follows from the present findings, HA in the synovium might contribute to the high amounts of serum levels of HA in patients with rheumatoid arthritis.
Adult↗
Differential diagnosis of dysplasia-associated lesion or mass and coincidental adenoma in ulcerative colitis.
PURPOSE: This study was undertaken to investigate factors that influenced differential diagnosis of dysplasia-associated lesion or mass and coincidental adenoma in patients with ulcerative colitis. METHODS: Among 346 patients with ulcerative colitis who underwent colonoscopy between 1979 and 1995, 27 patients had macroscopic neoplastic lesions and were divided into two groups: those with dysplasia-associated lesion or mass (16 patients) and those with adenoma (11 patients), each being categorized by the presence and absence of dysplasia in the flat mucosa adjacent to the elevated lesions, respectively. RESULTS: Thirteen of 27 patients had dysplasia-associated lesion or mass detected by colonoscopic biopsy; 10 of these patients underwent colectomy, and all had dysplasia-associated lesion or mass in the colectomy specimens. Two patients whose biopsy findings were adenoma had an unsuspected dysplasia-associated lesion or mass in the operative specimens. In the remaining 12 patients, the macroscopic lesions were excised during colonoscopy because of clinical and colonoscopic evidence of adenoma. One of them was proved to have dysplasia-associated lesion or mass, and the other 11 were confirmed as having adenoma in the polypectomy specimens. Patients with dysplasia-associated lesion or mass were significantly younger (P < 0.05), had longer duration of ulcerative colitis (P < 0.01), and had more extensive disease (P < 0.005) than those with adenoma. The colonoscopic appearance was plaque-like in 13, sessile in 13, and pedunculated in 2 of the 28 lesions with dysplasia-associated lesion or mass, whereas it was plaque-like in only 1 and sessile or pedunculated in 15 of the 16 lesions with adenoma (P < 0.001). The mean size of the lesions that were considered to be dysplasia-associated lesions or mass and adenoma was 1.8 and 0.5 cm, respectively (P < 0.0001). CONCLUSIONS: Colonoscopic biopsy for detection of dysplasia in the flat mucosa adjacent to macroscopic neoplastic lesions is an appropriate preoperative approach to distinguish dysplasia-associated lesions or mass from adenomas in patients with ulcerative colitis. The statistically significant variables that influenced the differential diagnosis were age, duration of disease, extent, tumor size, and tumor colonoscopic appearance.
Adenoma↗
Steroid complications and surgery in intractable ulcerative colitis.
The major operative indication for ulcerative colitis is intractability. Although steroid side effects appear to be closely associated with surgical indications for intractable ulcerative colitis, this relationship has yet to be analyzed in detail. To elucidate this relationship, we investigated 39 surgical patients with intractable ulcerative colitis, as defined by the Research Committee for Intractable Diseases of the Ministry of Health and welfare of Japan, and 66 conservatively treated patients with ulcerative colitis, of whom 6 had intractable disease. All patients with major steroid side effects and 17/24 (71%) patients with minor side effects underwent surgery. The median number of admissions was higher in patients with major side effects than in those with less severe or no side effects in the operative series, while this value was lower in the non-operative series than in the operative series. This tendency was similar for the total duration of hospitalization and the number of relapses. In the operative series, markedly higher steroid doses were administered to patients with side effects than to those without, and lower doses were given in the non-operative series. On multivariate regression analysis, the presence of steroid side effects, disease extent, and disease duration were significantly associated with surgery. Patients without side effects had a higher postoperative complication rate than those with minor side effects. We conclude that major side effects are a surgical indication for patients with intractable ulcerative colitis, and that even minor side effects should be taken as a surgical indication in view of the patient's quality of life.
Adolescent↗
Per anal suturing of a bleeding ulcer to achieve successful hemostasis of massive hemorrhage associated with ulcerative colitis: report of two cases.
We report herein the cases of two patients with ulcerative colitis complicated by massive hemorrhage who were successfully treated by per anal suturing of a bleeding ulcer. A 40-year-old woman and a 22-year-old man had suffered from extensive colitis for 8 and 2 years, respectively, and both followed a similar clinical course. They were admitted under emergency conditions and, despite treatment with intravenous high-dose prednisolone and thereafter with intraarterial injections of prednisolone, suffered several attacks of massive hemorrhage with hypovolemic shock. Emergency subtotal colectomy with ileostomy and rectal mucous fistula were performed, but recurrent massive hemorrhage occurred during the early postoperative period. Bleeding from a discrete ulcer in the rectum was subsequently located, and both patients underwent per anal suturing of the ulcer. No recurrent bleeding occurred thereafter, and an ileoanal anastomosis was performed several months later. Massive hemorrhage is a rare complication of ulcerative colitis which is most often resolved by subtotal colectomy without proctectomy. Although bleeding associated with ulcerative colitis usually occurs diffusely, these case reports serve to demonstrate that massive bleeding can also result from a discrete ulcer. We advocate that this condition be treated by an endoscopic or local hemostatic procedure.
Adult↗
Microsatellite instability is associated with the macroscopic configuration of neoplasms in patients with multiple colorectal adenomas.
BACKGROUND: The management of patients with multiple colorectal adenomas, 10-100 in number, is often troublesome clinically. To establish the reasonable management of such cases, genetic backgrounds should be made clear. METHODS: For a total of 19 adenomas and four carcinomas from four patients with multiple colorectal adenomas, we analyzed genetic instability at four selected microsatellite loci and screened exon 1-4 of the APC gene with special reference to macroscopic configurations of adenomas and carcinomas. RESULTS: RER-positive phenotypes were detected in none of 13 protruded type adenomas, two (33%) out of six superficial elevated type adenomas and two (50%) out of four carcinomas. We detected no mutation of exon 1-4 of the APC gene in any sample. In patients with multiple colorectral adenomas, the proportion of superficial elevated type adenomas exhibiting genetic instability was significantly higher than that of protruded type adenomas. CONCLUSIONS: The results suggested that RER-positive phenotype was an early event in tumorigenesis through superficial elevated type adenomas.
Adenoma↗
A premenopausal woman presenting with acute myocardial infarction of three different coronary vessels within 1 year: role of lipoprotein(a).
A premenopausal female patient presented with acute myocardial infarction of 3 different coronary vessels at different times within 1 year. These events were caused not by restenotic lesions after balloon angioplasty but by new lesions, which were successfully treated by primary angioplasty. Although she had a history of hypertension, type IIB hyperlipidemia, and diabetes, they had been well-controlled on medication. An elevated serum lipoprotein(a) level may have played a role in this rapid angiographic progression.
Angioplasty, Balloon↗
[Five cases of colorectal cancer complicated with ulcerative colitis].
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Adenocarcinoma↗
Induction of subcutaneous tissue fibrosis in newborn mice by transforming growth factor beta--simultaneous application with basic fibroblast growth factor causes persistent fibrosis.
To establish an appropriate animal model of skin fibrosis by exogenous application of growth factors, we investigated the in vivo effects of transforming growth factor-beta by injection into subcutaneous tissue of newborn mice. Histological examination revealed that TGF-beta1, beta2, and beta3 induced granulation tissue formation after 3 days of injection, while these changes had disappeared after 7 days. The changes after 3 days of injection were more pronounced in the tissue injected with TGF-beta2 or beta3 than that with TGF-beta1. In situ hybridization analysis indicated that connective tissue growth factor mRNA was strongly expressed in the fibroblasts at the site of TGF-beta injection, which suggested that fibroblasts were activated by TGF-beta. Next, we investigated the cooperative effects of TGF-beta and other growth factors including basic fibroblast growth factor (bFGF). The simultaneous application of TGF-beta and bFGF caused apparent tissue fibrosis which persisted for at least 2 weeks, while bFGF alone caused slight fibrotic changes after 7 days of injection. Thus, we succeeded in establishing an animal model of skin fibrotic disorders by the exogenous addition of growth factors, and this animal will be useful for future studies in this area.
Animals↗
Induction of subcutaneous tissue fibrosis in newborn mice by transforming growth factor beta-simultaneous application with basic fibroblast growth factor causes persistent fibrosis.
To establish an appropriate animal model of skin fibrosis by exogenous application of growth factors, we investigated the in vivo effects of transforming growth factor-beta by injection into subcutaneous tissue of newborn mice. Histological examination revealed that TGF-beta1, beta2, and beta3 induced granulation tissue formation after 3 days of injection, while these changes had disappeared after 7 days. The changes after 3 days of injection were more pronounced in the tissue injected with TGF-beta2 or beta3 than that with TGF-beta1. In situ hybridization analysis indicated that connective tissue growth factor mRNA was strongly expressed in the fibroblasts at the site of TGF-beta injection, which suggested that fibroblasts were activated by TGF-beta. Next, we investigated the cooperative effects of TGF-beta and other growth factors including basic fibroblast growth factor (bFGF). The simultaneous application of TGF-beta and bFGF caused apparent tissue fibrosis which persisted for at least 2 weeks, while bFGF alone caused slight fibrotic changes after 7 days of injection. Thus, we succeeded in establishing an animal model of skin fibrotic disorders by the exogenous addition of growth factors, and this animal model will be useful for future studies in this area.
Animals↗
Cytomegalic colitis after total colectomy in ulcerative colitis: report of a case.
A 58-year-old man with ulcerative colitis underwent total colectomy and ileorectal anastomosis. Steroid suppositories were administered postoperatively, and he had had no exacerbation in the residual rectum for 12 years. He suddenly presented with frequent bloody stools and anal pain. An intensive intravenous regimen of prednisolone was ineffective. Cytomegalic inclusion bodies were identified in biopsy specimens. Administration of ganciclovir reduced the ulcers remarkably. The clinical course suggested that this deterioration was caused by cytomegalovirus infection from the beginning. Cytomegalovirus colitis should be recognized as an exacerbating factor, even in ulcerative colitis patients who have undergone surgery, especially when the residual bowel inflammation is resistant to steroid therapy.
Colitis↗
Excess glutamine exacerbates trinitrobenzenesulfonic acid-induced colitis in rats.
BACKGROUND: Although the pathogenesis of Crohn's disease remains unclear, an elemental diet has been shown to be clinically effective. Glutamine is an energy source for many cell types including colonocytes. PURPOSE: This study was designed to assess the potential clinical effects on colitis of changing the dietary quantity of glutamine. METHODS: Colitis was induced by intrarectal administration of 30 mg of trinitrobenzenesulfonic acid with 50 percent ethanol vehicle in Sprague-Dawley rats. Rats were randomly allocated into three dietary groups: Group 1, a commercial elemental diet-based diet without glutamine; Group 2, a commercial elemental diet (glutamine: 12 percent of amino acid content); Group 3, elemental diet with 24 percent glutamine. Diets were started one week before colitis induction and continued until sacrifice. Rats were killed at one, three, and five weeks after colitis induction, and colons were excised. Damage evaluation was based on the percentage of rats with ulcer, macroscopic damage score, average ulcer area, and microscopic damage score. RESULTS: Group 2 rats weighed more than Group 1 rats at three weeks because of their higher dietary intake. At one week after colitis induction, all groups had comparable damage. At three weeks, the macroscopic damage score was higher in Group 3 than in Groups 1 and 2. At five weeks, rats in Group 3 had significantly more severe damage than those in Groups 1 and 2 in terms of all four indexes. CONCLUSION: We conclude that excess glutamine has a deleterious effect on ulcers in trinitrobenzenesulfonic acid-induced colitis.
Animals↗
Unusual cerebral complication associated with ulcerative colitis.
A case of ulcerative colitis complicated with convulsive seizure is reported. Magnetic resonance imaging studies strongly suggested cerebral vasculitis was the main cause of this episode.
Adult↗
Case report: congenital absence of the portal vein associated with nodular hyperplasia in the liver.
Congenital absence of the terminal portion of the portal vein with visceral venous return to the suprahepatic inferior vena cava, a rare malformation, was demonstrated in an 18-year-old Japanese woman. She had nodular hyperplasia in the liver and a non-functioning pancreatic endocrine tumour. It is generally believed that reduction of portal venous flow causes atrophic changes and, subsequently, nodular hyperplasia occurs in a well-perfused area in the liver. However, the liver was not perfused by the portal vein in this case. It is suggested that nodular hyperplasia can occur without portal blood flow.
Adolescent↗
Analysis of extracellular matrix proteins in malignant chicken cell lines.
The adherent chicken cell line, MDCC-MSB1-41C, was highly transplantable and metastatic in vivo, compared with the parental non-adherent cell line MDCC-MSB1 from Marek's disease (MD) lymphoblastoid tumor. For clarification of differences in extracellular matrix proteins in MSB1-41C and MSB1 cells, examination was made of various components of extracellular matrix proteins. A detachment experiment indicated the protein(s) recognizing the Arg-Gly-Asp (RGD) sequence, the minimum structure required for recognition by the cell-surface receptors, is essential for the adherent character. Immunoblot assay using antibodies showed increased expression of fibronectin, fibronectin receptors, and vinculin on MSB1-41C cell lines. RGD-directed integrins mediate important cell-cell adhesive interaction and these interactions with extracellular matrix proteins may thus possibly be requisite for migration, proliferation and metastatic dissemination of MDCC-MSB1-41C cells. The RGD-containing peptide in the culture medium could cause detachment of cultured adhesive lymphoid leukosis LSCC-1104X5 cells from the dish too.
Amino Acid Sequence↗
Expression of LH-alpha and -beta subunit mRNAs in the rat placenta.
Gonadotropic activity is present in the placenta of various mammals including humans. Human and equine chorionic gonadotropin (CG) are well characterized and known to be glycoprotein hormones, as are pituitary LH, TSH and FSH. In the rat, however, the placental gonadotropin molecule has not been identified, and in fact the existence of CG in the rodent is still controversial. In the present study, the placental expression of mRNA for CG-like molecules was investigated by PCR with mixed primers designed for the CG-beta subunit based on the amino acid sequences common to the rat LH-beta, human LH-beta, equine LH-beta and human CG-beta subunits and for the alpha subunit designed from the rat LH-alpha subunit. PCR with mRNA extracted from the placenta (day 10 of pregnancy) amplified several bands including cDNA identical to part of rat LH-alpha and -beta. Furthermore, expression of these genes was confirmed in the placenta on days 10, 12, 14, 16, 18 and 20 of pregnancy by PCR with another set of primers specific to rat LH-alpha and -beta and by Southern hybridization with 32P-labeled cDNAs for LH-alpha and -beta. The specific bands for these subunit mRNAs were amplified in the placenta, as well as in the positive control i.e. the anterior pituitary gland, but were not detected in other tissues including decidual tissue, liver, spleen, intestine, brain and kidney. Expression of the mRNAs was observed in both the junctional and labyrinth zones of the placental tissue. The rat choriocarcinoma cell line Rcho-1 also expressed LH-alpha but not LH-beta regardless of the stage of differentiation in vitro. Here we show the expression of LH-alpha and -beta mRNAs in the rat placenta.
Amino Acid Sequence↗
[Preservation of anal transitional zone in restorative proctocolectomy].
Since 1980, restorative proctocolectomy has been established for surgical therapy to ulcerative colitis. The crucial points of this procedure are mucosectomy of the anorectal mucosa and pouch anal anastomosis. Mucosectomy is often difficult due to long standing acute and chronic inflammation and incomplete microscopically and leakage of pouch anal anastomosis is relatively high probably due to steroid given prior to surgery or direct effect of anorectal mucosal inflammation. Regards to postoperative bowel function, nocternal soiling is frequently recognized in the patients who received this operation. To overcome these technical and functional disadvantages, anal transitional zone preservation without mucosectomy and stapled anastomosis between pouch and the upper rim of the puborectalis muscle has been performed. Our series of 84 cases with this modified method, anastomotic leakage was significantly decreased and nocternal soiling was completely disappeared within 7 months postoperatively. And one stage procedure became possible unless severe, or high doses of steroid given prior to surgery. Only one case of mild dysplasia was experienced in the remaining rectal mucosa which was disappeared at the next examination. Medical treatment to the remaining lesion was not necessary in the most of cases. Anal canal preservation is superior to mucosectomy in the points of bowel function and minimizing postoperative complications.
Anal Canal↗
[A successful Konno's operation for subaortic stenosis progressed after total correction of partial atrioventricular septal defect associated with polysplenia].
Konno's operation was successfully performed on a small infant, weighing 3.8 kg. She underwent pulmonary artery banding on the 29th day of life under the diagnosis of partial atrioventricular septal defect with a small left ventricle, associated with polysplenia. Intracardiac repair was subsequently performed on the 45th day of life, which included atrial partition and mitral valvuloplasty. Eleven months after the second operation, wedge resection on the narrow subaortic fibrous lesion was done concomitant with mitral revalvuloplasty. However, repeated echocardiac study disclosed progression of subaortic stenosis. Cardiac catheterization performed at 2 years of age showed the pressure gradinet of 90 mmHg between the aorta and the LV. The aortic annulus and the subaortic lesion measured 10 mm and 4 mm in diameter respectively. Severe subaortic stenosis was created by protrusion of abnormal mitral tissue to the LV outflow, in addition by secondary circumferential fibrous tissue growth and hypertrophy of the ventricular septum. Konno's operation using on 18A Carbomedics valve was chosen for the certain relief of the subaortic stenosis. Although the operation required extensive ventriculotomy and septostomy because of the small aortic annulus, the postoperative course was uneventful. Two months after the operation echocardiography showed good LV function and low RV pressure of about 40 mmHg.
Aortic Valve Stenosis↗