Biomedical subjects
Publications and source records attributed to S Asai.
A 31-year-old man suffered burns to the forehead, alar grooves and forearms. Vascular island skin flaps, with the infraorbital vessels as the pedicle, were used to reconstruct the burned nasal alae. The case is reported here and the relevant literature is reviewed.
Four cases of pulmonary cryptococcosis were diagnosed by cytological detection of Cryptococcus neoformans in bronchial lavage. Three patients had underlying diseases, but not HIV infection. The chest X-rays showed 2 patients with nodular lesions and 2 with cavitary lesions. The cryptococcal antigen in the serum was positive in all four patients. In the cytology of bronchial lavage, Cryptococcus neoformans was detected after period-acid-Schiff (PAS) staining and was cultured in Sabouraud-dextrose agar. The cytology of bronchial lavage is useful for the rapid diagnosis of pulmonary cryptococcosis.
BACKGROUND: Despite identification of the pathophysiologic mechanisms of asthma and improvement in therapy, asthma mortality has not decreased in recent years. OBJECTIVE: The pathophysiology and asthma-related death preventive measures were investigated with a physician-based questionnaire survey. METHODS: Questionnaires were sent to physicians primarily involved in treating asthma in Nagasaki Prefecture, Japan. The clinical characteristics of 32 patients who died of asthma (fatal cases) from 1984 to 1992 were compared with those of 17 patients with severe asthma who survived as a result of treatment by mechanical ventilation (nearly fatal cases). RESULTS: The number of deaths due to asthma increased in the last 2 years. Fatal cases and nearly fatal cases included patients with severe asthma as well as patients with mild asthma. Analysis of the clinical histories of patients judged to have died suddenly revealed the presence of persistent wheezing in these patients for a few days prior to the fatal episode. Airway obstruction was more marked and bronchial hyperresponsiveness was greater in fatal cases compared with those of a group of 70 patients without a history of nearly fatal acute asthma. CONCLUSIONS: The following measures may help prevent asthma deaths. Both patients and physicians should realize that even mild episodes can lead to severe, even fatal acute asthma. The severity of asthma should be evaluated not only by symptoms and peak expiratory flow rates but also bronchial hyperresponsiveness. Treatment should include reduction of bronchial hyperresponsiveness using oral or inhaled corticosteroids.
We studied the usefulness of digital subtraction angiography for evaluating the pulmonary capillary bed. Four individuals underwent the procedure. One was a healthy volunteer and the others were patients with chronic pulmonary emphysema. During catheterization, an 8 F balloon catheter was manipulated into the right pulmonary artery. A total of 20 ml of contrast material was injected at a rate of 10 ml/sec at full inspiration. In the normal subject, the capillary bed filled homogeneously and no defect was seen. In the patients, the pulmonary artery was nearly normal, but severe defects were observed in the pulmonary capillaries. Contrast resolvability was greater with digital subtraction pulmonary angiography than with pulmonary perfusion scintigraphy or pulmonary arteriography. This technique makes possible the visual evaluation of the pulmonary capillary bed.
Six cases of allergic bronchopulmonary aspergillosis (ABPA) were evaluated. In four cases, diagnosis and steroid therapy were delayed, which resulted in irreversible pulmonary dysfunction. The important points for early diagnosis were: (1) Differentiation from pulmonary tuberculosis, (2) the presence of bronchial asthma was not essential for diagnosis, and (3) fungi other than Aspergillus fumigatus might cause this syndrome.
The immunohistochemical analysis using the monoclonal antibodies to the blood group antigens was performed on the tissues of 387 colorectal cancers and 307 normal colonic tissues, and the relation between expression of these antigens and prognosis of the patients with stage 2 was also investigated. La, Le(b), and CA 19-9 were used for type 1 antigens, and Le(x), Le(y), and Sialyl Le(x) for type 2, respectively. Expression of Ca 19-9 and Silyl Le(x) remarkably increased in cancers throughout the colorectum. Le(b) and Le(y) were expressed in only 0-17% of the normal distal colon, but in almost colonic tumors. Therefore CA 19-9 and Sialyl Le(x) are tumor-associated antigens in the whole colorectum, and Leb and Le(y) in the distal colon. Expression of CA 19-9 in primary tumor provided more prognostic information and risk of liver metastasis than other Lewis blood group antigens.
L-Asparaginase has long been used in the treatment of acute lymphoblastic leukemia or malignant lymphoma in childhood. To determine cell type specific sensitivity to this drug, the L-asparaginase-mediated inhibition of blastogenesis of human peripheral T or B lymphocytes was compared. The rate of incorporation of [3H]-thymidine into the DNA of either T lymphocytes due to phytohemagglutinin (PHA) or B lymphocytes due to Staphylococcus aureus Cowan I (SAC) was measured by the addition of Escherichia coli L-asparaginase in the medium. The blastogenic response of either T or B lymphocytes was also determined in medium depleted of exogenous asparagine and/or glutamine, both of which are hydrolyzed by this enzyme. The in vitro blastogenesis of either human T lymphocytes due to PHA or B lymphocytes due to SAC was inhibited by the inclusion of asparaginase in the medium. The deprivation of exogenous asparagine did not have any inhibitory effect on the blastogenic response of both T and B lymphocytes to each mitogen. On the other hand, the glutamine concentration in the culture medium provided a critical influence on the proliferative response of T and B lymphocytes. The rate of incorporation of [3H]-thymidine into DNA was increased markedly as the concentration of glutamine was increased from 2(-7)-2 mmol/l. It is concluded that the mechanism of inhibition of PHA- or SAC-stimulated lymphocyte blastogenesis by L-asparaginase is not asparagine deprivation but glutamine deprivation. Glutamine, which is the most abundant amino acid, is thought to have an important role in the immune response of lymphocytes.
Life threatening mediastinitis as a complication of acute epiglottitis is very rare. A 38-year-old male in previously good health was admitted to our hospital in a state of unconsciousness. Seven days prior to admission he had complained of a sore throat, dysphagia, high fever and dyspnea. A chest X-ray on admission showed widening of the mediastinum, mediastinal emphysema, subcutaneous emphysema and left pleural effusion. Bronchoscopy showed the swelling of supraglottic structures. He was diagnosed as having acute mediastinitis and pyothorax as a complication of acute epiglottitis, but pathogens were not identified. The blood was hyperglycemic and insulin therapy was started. Though he gradually improved by massive antibiotic therapy, steroid therapy, tracheotomy and surgical drainage of both the left thoracic cavity and the mediastinum, he died suddenly of massive hemoptysis. Autopsy revealed that the acute mediastinitis had healed, but that the Aspergillus infection was present in both lungs and the pericardium. The Aspergillus infection was not lethal in the present case, and it seemed that death had resulted from arterial hemorrhage caused by erosion of the trachea. The present case suggests the need for antifungal therapy even in non-immunocompromised patients in particular when massive doses of antibiotics and steroids are administered.
Asthmatic symptoms are worsened after drinking small amounts of alcoholic beverages in Japanese asthmatic patients. Our previous results showed that the ingestion of pure ethanol caused a fall in FEV1.0 in about half of the Japanese asthmatics we studied. We studied the inhibitory effects of pretreatment with three kinds of anti-asthmatic agents on ethanol-induced bronchoconstriction in six Japanese asthmatic patients. We tested oral cyproheptadine hydrochloride (8 mg), which is an anti histamine agent, inhaled disodium cromoglycate (2 mg), which has an inhibitory effect on the release of chemical mediators from mast cells, and inhaled atropine sulfate (3 mg), which is an anti-cholinergic agent. Pretreatment with cyproheptadine significantly inhibited the fall in FEV1.0 120 minutes after ethanol challenge (p less than 0.05). Inhaled DSCG had significant inhibitory effects on the fall in FEV1.0 15 and 30 minutes after ethanol challenge (p less than 0.05). Inhaled atropine had no inhibitory effect. These results suggest that histamine, released from mast cells, plays an important role in ethanol induced bronchoconstriction in Japanese asthmatic patients.
A 66-year-old male presented to our hospital in January 1990 with chief complaints of hemoptysis and cough. These symptoms had developed 10 months previously and had gradually increased. Fine crepitations were audible over the right lower lung field. There were no results suggesting an inflammatory process such as leucocytosis, elevation of ESR or positive CRP reaction. Chest X-ray film on the first visit showed fine nodular shadows in the right lower lung field, and chest CT revealed fine nodular shadows and mild dilatation of the right lower lobe bronchus. Transbronchial lung biopsy specimens showed granulomas with multinucleated giant cells, alveolitis and Masson bodies. The open lung biopsy specimens showed numerous macrophages and foreign body giant cells, and extensive organizing exudates in the bronchioles and alveolar spaces. Proliferation of smooth muscle and fibrosis around the dilated bronchioles were also seen. Thus, this patient demonstrated BOOP pattern, with granulomas and foreign body giant cells. His hemoptysis appeared to have resulted from inflammation of dilated bronchioles. His symptoms and abnormal shadows on chest X-ray improved without any therapy after admission. After treatment with corticosteroid, the diffuse fine nodular shadows disappeared. There has been no recurrence of symptoms to date, although this patient has continued living in the same environment as prior to admission. BAL findings during his prolonged follow-up revealed decrease in lymphocytes and elevation of CD4/CD8 ratio. Although the presence of granulomas suggests the possibility of an allergic reaction, no antigenic material could be identified in this case.(ABSTRACT TRUNCATED AT 250 WORDS)
Clinical and pathological investigations were performed in 58 cases of opportunistic pulmonary mycoses diagnosed at autopsy during the 10 years between 1979 and 1988 at Sasebo General City Hospital. The following findings were obtained. 1) The incidence of opportunistic pulmonary mycoses during the 10 years was 7.7%, with a significant increase in the incidence of fungal infections during the last 5 years of the study. The incidence of pulmonary mycoses was higher in patients with blood dyscrasia than in those with solid tumor or benign disease (p less than 0.001). 2) Administration of steroid hormone and anticancer drugs were suspected to be causative factors in the development of pulmonary aspergillosis and cryptococcosis, but not in candidiasis. 3) Characteristic radiographic patterns and clinical symptoms were absent in cases of pulmonary candidiasis due to the small size of the lesions and the high incidence of other complicating pulmonary infections and edema. 4) The most common initial roentgenographic pattern in opportunistic pulmonary aspergillosis was localized infiltrate, subsequently progressing to either multifocal infiltrates or cavitation. 5) The initial symptom in opportunistic pulmonary aspergillosis was usually high fever, and the radiographic abnormalities appeared later. The median duration between onset and death in 19 patients with pulmonary aspergillosis was 23.1 days. 6) Pulmonary aspergillosis should be suspected in the compromised host with high fever refractory to antibiotics and pulmonary infiltrates. Empiric antifungal therapy should be initiated at an early stage for the best chance for survival.
The culture fluids of various anaerobic bacteria induced the synthesis of early antigens (EA) in Epstein-Barr virus (EBV) carrying lymphoblastoid cells. The culture fluids of Corynebacterium butyricum and Fusobacterium nucleatum were the effective inducer on EA. The inducing activity was, to some extent, dependent on their n-butyric acid content, but appeared to be regulated by yet unidentified materials.
An in vitro comparison demonstrated that the concentration of NIK-247 that inhibited cholinesterase (ChE) activities to half the normal level (ID50) was 1.3 x 10(-6) M. This value was higher than those for both physostigmine (PHY; 1.2 x 10(-7) M) and tetrahydroaminoacridine (THA; 3.6 x 10(-7) M), which are used as cholinesterase inhibitors in the treatment of cholinergic deficits. Neither NIK-247 nor THA affected the activity of choline acetyltransferase (ChAT). These inhibitions of ChE by NIK-247 and PHY lasted for 2 h, while that by THA lasted for over 4 h. In the effects of NIK-247 and PHY, the concentrations of intrastriatal acetylcholine (ACh) were changed in relation to the inhibition of the ChE activity. However, THA caused a transient increase in the ACh level lasting for only 2 h instead of inhibiting the enzyme activity for over 4 h. These findings suggest that NIK-247 is a drug with a similar profile in its effect on cholinergic neurons to PHY, the prototype drug among ChE inhibitors. The data indicate that NIK-247 may be useful as a drug for the treatment of central as well as peripheral deficits of the cholinergic mechanism.
A 3 y.o. boy suffered cardiac arrest after submersion in a winter pond for more than fifteen minutes. He was transferred to our hospital and was successfully resuscitated. Although his neurological condition was severely damaged at the beginning, he started searching objects with his eyes on the 18th hospital day, speaking on the 65th hospital day and walking by himself on the 76th hospital day. His consciousness fully recovered eventually. The treatments consisted of "HYPER" as suggested by Conn AW, et al. and active anti-hypertensive therapy. These treatments and the cold temperature of winter time might have contributed to the good neurological recovery of the patient.
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A 15-year-old man with food-dependent exercise-induced anaphylaxis is reported. The patient had begun to run 4 hours after he had lunch on fried shrimps. When running about 2000 m, he suffered from general cutaneous erythema with itching, urticaria, angioedema of face and dyspnea. He had experienced the similar episodes associated with postprandial exercise before. Skin test and IgE-RAST were positive for shrimp. Exercise challenge test after having 20 g boiled shrimp was conducted, and the elevation of plasma histamine level was recognised. 25 cases with food-dependent exercised-induced anaphylaxis have reported in Japan. 13 of 25 cases were related with wheat, and 10 cases were related with shrimp. 14 of 25 cases had experienced the similar episodes. Exercise as part of planned health program has virtually mushroom world-wide. Therefore, the fact that anaphylaxis can be a complication of such exercise must be recognised if appropriate prevention and treatment are to be administered.
YM-09151-2, a novel benzamide derivative, significantly increased the concentrations of dopamine (DA) metabolites, both 3,4-dihydroxyphenylacetic acid and 3-methoxy-4-hydroxyphenylacetic acid (homovanillic acid). The maximum increase in such metabolites was about 4-fold the concentration in control animals, and was observed at 2 hr after oral administration. 3-Methoxy-4-hydroxyphenylethylene glycol, a metabolite of noradrenaline, was slightly increased in its concentration exhibiting a transient effect, but 5-hydroxyindoleacetic acid was not. YM-09151-2 antagonized the decreasing effects of apomorphine, a nonselective DA agonist, and LY-171555, a selective D2 DA receptor agonist, on the concentrations of DA metabolites in the brain. In contrast, SCH-23390, a selective D1 DA receptor antagonist, did not antagonize the effects of DA agonist. These results strongly suggest that YM-09151-2 is a selective antagonist of D2 DA receptor and a candidate as a new antipsychotic agent for clinical use.
Recently cases of tsutsugamushi disease have been reported in various areas in Japan. We met a case infected in a rural area, Sennan of Osaka prefecture. The patient suffered from high fever, left axillary lymphadenitis. At his left elbow an eschar was detected, so tsutsugamushi disease was suspected, despite no rash nor CRP elevation. By indirect immunofluorescence (IF) method, the diagnosis was confirmed. At an early stage (the fifth day after onset) he was followed by probable DIC, remitted successfully by administration of minocycline. For 20 years tsutsugamushi disease has not been reported in Osaka prefecture. This case is the second one and the first child case in Wakayama prefecture. Epidemiologic assessments may need to be investigated in Osaka and Wakayama Prefecture.