[Follow-up study on post-transfusion hepatitis in the Kyushu University Hospital].
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Female↗
Biomedical subjects
S Inaba
Publications and source records attributed to S Inaba.
[Bronchospasms caused by intravenous hydrocortisone sodium hemisuccinate (Solu-Cortef) in an aspirin-sensitive asthmatic patient].
This is a report of a male patient who had an anaphylaxia-like reaction to hydrocortisone sodium hemisuccinate (Solu-Cortef). A 32-year-old male with aspirin sensitivity was treated for moderate wheezing with 200 mg Solu-Cortef given intravenously. After this treatment, his condition deteriorated acutely and he was admitted to our hospital. Intradermal skin tests revealed positive immediate reactions to Solu-Cortef, Saxizon, Solu-Medrol and Predonine. Challenge tests with 100 mg Solu-Cortef and Saxizon injection showed 34% and 27% decrease, respectively in FEV1 15 min after injection. These results suggest that succinylation of steroids resulted in allergic reaction to steroids in this patient.
Adult↗
[Histological study in renal grafts--macrophages population in renal grafts].
We studied about the histological findings of the kidneys including of the infiltrated macrophages in one hour post-transplantation kidney biopsies (one hour biopsies) and re-biopsies on 11 patients. They were transplanted at 4-28 (ave. 15.1 +/- 3.8) years of age. The periods from transplantation to this study were 1.0-7.3 (ave. 3.3 +/- 1.9) years. 6 patients had acute rejections, and their renal function became normal after treatments. At this study, all grafts survived, and the patients had no abnormal findings except two (one had proteinuria, another had proteinuria and mild elevation of serum creatinine level). But histologically, five patients had chronic rejections among the 8 patients who had re-biopsies more than one year after transplantation. And we experienced 6 patients whose kidney had mesangial IgA deposits in one hour biopsies and 3 patients who had de novo type glomerulonephritis in re-biopsies (IgA neuropathy in 2 patients, membranous nephropathy in one). In one hour biopsies, the populations of macrophages in the interstitium were 4.18 +/- 2.84/mm2 in the patients who would have acute rejections (6 patients), 1.38 +/- 1.13/mm2 in the cases who would not have. It was suspected that the increase of the infiltrated macrophages in the interstitium in one hour biopsies could predict acute rejections. In re-biopsies, many macrophages infiltrated in the interstitium (8.34 +/- 4.86/mm2), particularly on patients who had chronic rejections.
Adolescent↗
[Behavioral control of breathing and the effect of endogenous opiates in chronic obstructive pulmonary disease].
Dyspnea is a common symptom in patients with chronic obstructive pulmonary disease (COPD) but its mechanism is unclear. It is known that the opiate antagonist, naloxone, restores in some patients with COPD the ability to compensate for a flow-resistive load (N Engl J Med 1981; 304; 1190-5). We studied the effect of naloxone on the threshold of resistive load detection (RLD) and on sensation of breathlessness in patient with COPD. Naloxone (NLX, 2mg, IV) and placebo (P, Physiologic saline, 10ml) were administered in a randomized double-blind fashion, on separate days, to sixteen patients. The threshold for RLD was assessed by added resistance (delta R; 0.3-6.9cmH2O/L/sec) where the subject detected the load 50% of the time. This was analyzed in two ways; one by the ratio of added resistance divided by background resistance (Ro) and the other, by the mouth pressure (P) at the threshold. The patient squeezed a handgrip as ventilation increased and perception of breathlessness was assessed by a degree of squeezed handgrip (Gf; 0-100%). The threshold for breathlessness was estimated by Gf divided by ventilatory volume (Gf/VE) and P0.1 at the point of endtidal PCOz of 50mmHg (Gf/P0.1%/cmH2O), respectively. The threshold for RLD remained unchanged but Gf/VE increased significantly after NLX instillation (delta R/Ro: 0.55 +/- 0.28 during P vs 0.52 +/- 0.36 during NLX, NS. P: 0.89 +/- 0.44 during P vs 0.97 +/- 0.54 during NLX, NS. Gf/VE: 0.76 +/- 0.57 during P vs 1.38 +/- 0.62 during NLX, P < 0.01). FRC, VE, f, T1, TE and P0.1 did not significantly change after NLX.(ABSTRACT TRUNCATED AT 250 WORDS)
Adult↗
Clinical application of phosphoenolpyruvate (PEP) to autologous transfusion of patients with open heart surgery.
Patients undergoing surgery for cardiac valve replacement were autologously transfused after their cryopreserved blood was treated with phosphoenolpyruvate. Five patients received red cells treated on the day of operation with a solution containing phosphoenolpyruvate, the other 6 serving as a control group. None of the patients received homologous blood. The treated red cells had a normal adenosine triphosphate concentration; in the control group a 10% decrease was noted. The 2,3-bisphosphoglycerate concentration was 211% of normal in red cells of the treated group and 69% of normal in the control group. The P50 values (mmHg) were 31.1 +/- 3.5 (treated), 20.3 +/- 1.7 (untreated), and 26.1 +/- 0.6 (fresh, not cryopreserved), respectively. Both the 2,3-bisphosphoglycerate and P50 values of the circulating blood were significantly (p < 0.02) increased in the patients receiving treated red cells. The increase in the 2,3-bisphosphoglycerate and P50 remained for 6 hours after transfusion at which time the levels of the 2,3-bisphosphoglycerate were 14.5 +/- 2.2 mumol/gHb (treated group) and 10.5 +/- 0.8 mumol/gHb (control group). Those of P50 were 28.1 +/- 1.5 mmHg (treated group) and 25.9 +/- 0.9 mmHg (control group). The adenosine triphosphate levels were not significantly different. The postoperative values of pH and hematocrit did not differ between the two groups. It was estimated that the oxygen delivery capacity in the circulating blood was about 30% higher in the patients receiving phosphoenolpyruvate treated blood than in those receiving untreated blood.
Adult↗
Folinic acid does not mobilize hemopoietic progenitors following repeated consolidation chemotherapy for acute leukemia.
Folinic acid (FA) has been reported to expand the pool of peripheral blood stem cells (PBSC) after chemotherapy. We evaluated the efficacy of FA for harvesting PBSC following cytotoxic chemotherapy in 4 patients with acute leukemia. After achieving a complete remission (CR), 3 courses of chemotherapy for a consolidation of the CR were administered to the patients. Two successive cycles of leukapheresis were performed during the recovery phase from consolidation chemotherapy, which consisted of an intermediate dose of cytosine arabinoside. For the second cycle of leukapheresis, FA was administered intravenously at a dose of 50 mg/day following consolidation. The yields of either mononuclear cells or burst-forming units-erythroid (BFU-E) were not affected by FA administration. In contrast, the yields of colony-forming units-granulocyte/macrophage (CFU-GM) were significantly decreased in all patients compared to the CFU-GM yields after the first cycle of leukapheresis (P = 0.032). Thus FA is considered not to be effective in expanding the peripheral blood progenitor pool when given in a fashion different from the original report.
Acute Disease↗
Circulating CD34+ hematopoietic progenitors in the harvesting peripheral blood stem cells; enhancement by recombinant human granulocyte colony-stimulating factor.
The number of circulating progenitor cells increases during the period of hematopoietic recovery following myeloablative therapy. These progenitor cells were used for autologous transplantation in order to reconstitute hematopoiesis. As an indicator of the circulating progenitor cells, the number of granulocyte-macrophage colony forming units (CFU-GM), which is measured by means of a long-term cell culture, has been widely used. Recently, a cell surface marker, CD34, which can easily be measured by means of flowcytometry, was found to represent immature hematopoietic progenitor cells, which are very close to stem cells. Therefore, the relationship between the number of CD34 positive cells (CD34+ cells) and the number of CFU-GM in the peripheral blood following chemotherapy was studied in 9 patients selected to undergo autotransplantation. The number of peripheral blood CD34+ cells was found to be significantly correlated with that of CFU-GM (r = 0.81). When four out of 9 patients received recombinant human granulocyte-colony stimulating factor (rG-CSF) administration, a significant increase in the release of peripheral blood CD34+ cells as well as peripheral blood CFU-GM was observed (P less than 0.01). Thus, the measurement of CD34+ cells is useful for predicting the number of circulating CFU-GM.
Adolescent↗
The use of recombinant granulocyte-colony-stimulating factor for granulocyte harvest.
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Granulocyte Colony-Stimulating Factor↗
[Endocrine environment of benign prostatic hyperplasia--relationships of sex steroid hormone levels with age and the size of the prostate].
To determine the influence of endocrine factors on benign prostatic hyperplasia (BHP), the levels of three sex steroid hormones i.e., total testosterone (Total-T), free testosterone (Free-T) and estradiol (E2), were measured in serum of healthy 154 men. Their ages ranged from 18 to 91 years old. In 59 men, prostatic size was estimated by digital examination and was subdivided into three groups: smaller than or equal to walnut size, small hen's egg size and equal to or larger than hen's egg size. Firstly, relationships of sex hormone levels with age were studied. There was a slight decrease in Total-T over 60 years old, a significant decrease in Free-T, and no change in E2 with age. Thus, E2/Total-T and E2/Free-T ratio increased significantly after middle-age. Secondly, relationships of hormone levels with prostatic size were studied. In the larger prostate group, a significantly lower level of Total-T and significantly higher level of E2 were detected. But there was no difference in Free-T. Thus, the prostatic size was correlated positively with E2 level, E2/Total-T and E2/Free-T ratio. These suggest that the endocrine environment tended to be estrogens-dominant with age, in particular, after middle-age, and that patients with large prostates have more estrogens-dominant environments. We conclude that estrogens are key hormones for the induction and the development of BPH.
Adolescent↗
Cytotoxic drug and cytotoxic drug/G-CSF mobilization of peripheral blood stem cells and their use for autografting.
We analysed 99 courses of leukapheresis after the use of cytotoxic drugs or cytotoxic drugs plus G-CSF (cytotoxic/G-CSF) to mobilize peripheral blood stem cells (PBSC) in 68 patients with hematologic or solid malignancies. Mean yields of granulocyte-macrophage progenitor cells (CFU-GM) with cytotoxic/G-CSF mobilization were significantly higher than those with cytotoxic mobilization (18.6 vs 8.40 x 10(4)/kg). The optimal timing of collection was different between these two mobilizations; the mean number of days to a peak level of circulating CFU-GM after cytotoxic/G-CSF mobilization was less than that after cytotoxic mobilization (24.2 vs 27.7 days). The leukocyte level on the day of peak CFU-GM was significantly higher in cytotoxic/G-CSF mobilization than that in cytotoxic mobilization (mean 12.8 vs 2.7 x 10(9)/l), whereas the platelet level was not different (mean 132 vs 125 x 10(9)/l). Increasing patient age was not a major adverse factor for PBSC collection. Synchronous recovery of both leukocytes and platelets was critical for achieving a high CFU-GM yield in these two mobilizations. Following PBSC autotransplantation, the rate of trilineage hematologic reconstitution showed a significant correlation with the infused dose of CFU-GM, whether they were collected with cytotoxic or cytotoxic/G-CSF mobilization. These results suggest that G-CSF can expand the PBSC pool and that CFU-GM yield after cytotoxic/G-CSF mobilization may predict trilineage hemopoietic reconstitution after ABSCT, as well as cytotoxic mobilization.
Adolescent↗
[Effective continuous hemofiltration and plasma exchange for the treatment of subacute type fulminant hepatic failure].
By combination of continuous hemofiltration (CHF) with plasma exchange therapy we successfully treated a patient with subacute type fulminant hepatitis to keep her consciousness alert. The patient was a 55-year-old woman who admitted because of severe jaundice. On the 51st day after the onset she had consciousness disturbance and was transferred to our hospital. We started the therapy of CHF and plasma exchange at the patient's hepatic coma grade 4. On the 5th day her consciousness level recovered to grade 2 and we could keep the level for almost 2 weeks. This combination therapy seemed good not only for the improvement of consciousness of patients in hepatic coma but also to support the hepatic function of almost ahepatic patients.
Female↗
[Concentration of 5-fluorouracil in the blood and tissues of gastric and colo-rectal cancer patients after oral administration of UFT].
UFT is given to the patients with digestive cancer from the time before operation to prevent intra- and post-operative cancer dissemination and metastases. UFT (400 mg/day in terms of tegafur) was given preoperatively for 1-6 days in 6 patients with gastric cancer and 13 with colorectal cancer. The interval between the last administration and the beginning of the operation was 3.9 +/- 1.5 hours (mean +/- SD). The concentrations of tegafur, 5-FU, and uracil in the blood collected at the time of tumor resection were 9.68, 0.017, and 0.08 microgram/ml, respectively. In the patients with gastric cancer 5-FU concentration was 5.5 times higher in the normal mucosa, 3.3 times in lymph nodes, and 10.7 times in the tumor tissues than in the blood. In colorectal cancer patients, also, the 5-FU concentration was 5.6, 8.3 and 20.8 times higher in the normal mucosa, lymph nodes, and the tumor tissue, respectively, than in the blood. The 5-FU concentration in gastric cancer and colorectal cancer tissues decreased with time after administration of UFT but remained above the effective concentration 1.5-7 hours after administration of 200 mg. The tissue concentrations of FT-207, uracil, and 5-FU were correlated with each other.
Administration, Oral↗
[A case of hypersensitivity pneumonitis caused by a humidifier].
A 58-year-old woman was admitted complaining of dry cough and exertional dyspnea. Physical findings, chest X-ray films, chest CT scan and respiratory function tests were suggestive of interstitial pneumonia. Transbronchial lung biopsy showed specific findings of hypersensitivity pneumonitis. As a result of positive provocation test using her home humidifier, a diagnosis of humidifier lung was made. Many microorganisms including Flavobacterium meningosepticum were cultured from the water left in the humidifier for one week. As both complement fixation test and precipitation test were positive to humidifier water and to extract of Flavobacterium meningosepticum, the humidifier and Flavobacterium meningosepticum were suggested to be causative in this case.
Alveolitis, Extrinsic Allergic↗
[A water intoxication patient who showed remarkable ST depression and suspected ischemic heart disease].
A 63 year old female, who was admitted to a psychiatric hospital for schizophrenia, was referred to our emergency room because of sudden loss of consciousness and convulsions. On arrival, she was drowsy and hypoxemic. Her chest X-ray showed cardiomegaly with pulmonary edema. ECG showed marked ST depression in precordial leads and serum chemistry revealed marked elevation of CPK, GOT and LDH along with hyponatremia and hypochloremia. She was immediately admitted to CCU on suspicion of acute non-transmural myocardial infarction complicated with congestive heart failure. After fluid restriction and intravenous infusion of dopamine she passed large amount of urine, and her consciousness level, electrolyte imbalance and ECG change, improved gradually. Although serum CPK level increased as high as 32,307 IU/ml, there were no signs of left ventricular asynergy on UCG and CPK isozyme analysis performed later revealed more than 99% of serum cCPK was MM-type. We concluded that water intoxication was the cause of the ECG change and the elevated serum CPK, GOT and LDH levels. There are few reports on elevated CPK level in association with water intoxication, in which rhabdomyolysis is speculated as the cause of CPK elevation. But there is no report on ECG change complicated with water intoxication. In our case, electrolyte imbalance caused by water intoxication seemed to play a major role in ST depression and QT prolongation. Although water intoxication is a rare disorder in the general population, it is not infrequent among patients with psychiatric diseases. Care must be taken when such patients present ECG change and serum enzyme elevation mimicking ischemic heart disease.
Aspartate Aminotransferases↗
[A case of idiopathic aneurysm of the inferior vena cava].
Congenital aneurysms of the inferior vena cava (IVC) are very rare, and to our knowledge, only 4 cases have been previously reported. We describe the fifth case of fusiform aneurysm and briefly review the literature. A 62-year-old woman was admitted to our hospital for investigation of a mass shadow on the right hemidiaphragm on a chest roentgenogram. CT, MRI, and DSA examinations revealed an aneurysmal dilatation of the IVC measuring 51x50x38 mm inferior to the right atrium, and the diagnosis of fusiform aneurysm of the IVC was made. The newer imaging techniques of CT, MRI, and DSA have facilitated the diagnosis of this abnormality.
Aneurysm↗
[A case report of AML M0:CD7, 33 (+) AML M0 case initially presented with cervical lymphadenopathy].
A 59-year-old man was admitted because of generalized lymphadenopathy with fever and vomiting. His peripheral blood showed leukocytosis with a WBC of 93,500/microliters, and the bone marrow picture revealed a predominance of blast cells. The blasts were negative for peroxidase, alpha-naphthyl butyrate esterase and PAS, and had the phenotype of CD 7, 13 and 33 positive. A diagnosis of AML M0 was made, based on the criteria of the NCI-sponsored workshop in 1988. His initial status had been compromised by acute renal failure which necessitated hemodialysis. He responded partially to chemotherapy consisting of daunorubicin, cytarabine and prednisolone. However leukemia recurred and the patient suffered from various episodes of infection and died six months after admission. The Southern blotting showed the germ line configuration for TCR-beta chain and immunoglobulin heavy chain genes. No messenger RNA was detected for myeloperoxidase, c-myc and c-jun, while c-fms, c-fos and c-myb were expressed on Northern blotting. It is intriguing to detect c-fms and c-fos expression in these poorly differentiated leukemic cells.
Antigens, CD↗
Continuous haemoperfusion for fulminant hepatic failure.
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Acute Kidney Injury↗
Isolation and characterization of a thermolabile beta-2 macroglycoprotein ('thermolabile substance' or 'Hakata antigen') detected by precipitating (auto) antibody in sera of patients with systemic lupus erythematosus.
A novel thermolabile beta-2 macroglycoprotein ('thermolabile substance' (TLS) or 'Hakata antigen' (HA], which was detected by the precipitating (auto) antibodies of patients with systemic lupus erythematosus, was isolated and characterized. The purification procedure entailed the following steps: isoelectric precipitation in the range between pH 5.2-6.1, hydroxyapatite absorption chromatography, 35% saturated ammonium sulfate precipitation, Sephadex G-200 gel filtration, Pevikon block electrophoresis, lentil lectin affinity chromatography and immobilized rabbit anti-human whole serum IgG column chromatography. Utilizing these procedures, 0.1 mg of HA was purified from 3 1 of pooled human serum. The molecular mass of HA was determined as 650 kDa by Sepharose 4B gel filtration. On SDS-PAGE analysis, HA showed a single band at 35 kDa under reduced conditions and numerous ladder bands between 35 kDa to more than 300 kDa under nonreduced conditions. On analytical ultracentrifugation, HA gave a molecular mass of 520 kDa with a single meniscus and a sedimentation constant of 12.0. The amino acid and carbohydrate analysis of reduced and S-pyridylethylated HA revealed that it contained five residues of hydroxyproline and an N-linked type sugar chain.
Adult↗