Biomedical subjects
Publications and source records attributed to T Kinjo.
Cystic adventitial degeneration is an uncommon cause of arterial obstruction. Its etiology is debated. We report a case in which the left external artery was affected and the cystic mass communicated with the hip joint. The findings of this case support the embryonic theory that the articular synovium and adventitial cysts have the same mesenchymal origin.
A 49-year-old male patient was admitted to Ryukyu University Hospital complaining chiefly of progressive loss of mental activity for one year. He had a history of head trauma at the right retromastoid region when he was 24. Generalized convulsions developed three years later, and left exophthalmos, facial varix and impairment of visual acuity developed seven years later. Dural arteriovenous fistula of the posterior fossa was diagnosed at the age of 32, and feeding EC and tentorial arteries were successively ligated on the right several times without any effect. Angiography during this admission revealed tremendous collateral flows; a marked dilated tortuous occipital artery fed from the right vertebral artery, meningeal branches of VA and PICA, the marginal tentorial artery, and the posterior temporal artery from MCA, PCA were drained into the right transverse sinus. But transverse sinuses were occluded bilaterally, and venous outflows were directed to the superior sagittal sinus retrograde via the ascending cortical vein, Trolard veins, and sphenoparietal and cavernous sinuses. The final drainer was the superior ophthalmic vein on the left. Normal deep veins were not visible. In park bench position, the nidus was totally resected with a part of the transverse and thrombosed sigmoid sinus. Postoperative course was uneventful, and an angiogram showed complete disappearance of the AVF. Dural AVG in the posterior fossa with characteristics such as high flow, and which is rich in collaterals following palliative treatment indicates that total surgical resection should be undertaken.
Fifty-two cases of abdominal aortic aneurysms including common iliac aneurysms operated on during July, 1981 and December, 1989 have been studied. They were divided into the following three of elective operation (n = 34), impending rupture (n = 5), and ruptured (n = 13) groups. Cases with abdominal operations without aneurysms were randomly selected as the control group (n = 12). Overall operative mortality was 9.6%, consisted of 30.8% of the ruptured, 20.0% of the impending rupture and 0% of the elective operation groups. Respiratory functions including FEV1.0%, V75, V50, V25 and V25/Ht were significantly lowered in the ruptured group. PaO2 of the ruptured group was also significantly lowered in comparison with both the control and the elective operation groups. Leukocytic granular elastase, playing a role of destruction of the elastin component in the pulmonary alveoli and the aortic media, was increased in the patients with ruptured aortic aneurysms, though the difference was not significant. The data suggested the possibility of aneurysm rupture in case with elevated leukocytic granular elastase. Surgery for abdominal aortic aneurysm, even in cases with decreased pulmonary function, should be considered aggressively to elimination of ominous result of aneurysm rupture.
Eleven cases of chronic subdural hematoma (CSH) secondary to coagulopathy were experienced in our department in the last 5 years. They were classified into 4 groups, I: secondary to diffuse metastatic carcinomatosis of the bone marrow (4 cases), II: malignant hematological disease (acute lymphocytic leukemia and myelodysplastic syndrome 1 case each), III: postreplacement of cardiac valves or vein graft having been treated with anticoagulants (warfarin) (3 cases) and IV: chronic renal failure after having been hemodialyzed (2 cases). The outcomes were all good in group III, and there was one good outcome in group IV. However, death was the outcome in all the other cases. Conservative treatment (mannitol and steroid for 2 weeks) was carried out in 4 cases, all of which improved clinically with diminished hematoma. In 9 cases, surgical treatment was attempted by means of burr hole irrigation of the hematoma. Two of them developed intracerebral hematoma, and one developed acute brain swelling. In conclusion, treatment of CSH secondary to coagulopathy should be selected as follows. 1. Conservative treatment is to be the first choice, if conditions allow it. 2. Surgery can be performed by burr hole irrigation when indicated. Precautions should be taken not to injure the inner membrane of the hematoma or the brain proper, and the need for slow decompression should be kept in mind.
A 61-year-old man with congenital bicuspid aortic valve associated with aberrant coronary artery origin is presented. His aortic valve was severely stenotic with marked calcification. At the aortic valve replacement, it was found that the valve was markedly calcified and the bicuspid valve and both coronary ostia were very close to each other in a posteriorly positioned sinus of Valsalva. There have been a few reports concerning the combination of the bicuspid aortic valve and aberrant coronary artery origin, and it is well known that the bicuspid aortic valve more frequently accompanies short left main trunk or left coronary arterial dominance than a normal aortic valve. Some genetic mechanisms surrounding the coronary artery, aortic valve and aorta are suggested to occur with such anomalies.
In order to know the adequate duration of the chemotherapy with two drugs (INH + RFP) for pulmonary tuberculosis with non-cavitary minimal radiological findings (minimal case), 278 cases with minimal lesion which had completed 9 months' chemotherapy, were observed for more than six months up to 5 years (mean duration = 54.4 months). Of them, 60 cases were bacteriologically confirmed by smear and/or culture examination. Many cases showed further improvement in radiological findings even after the end of the chemotherapy. Of 180 cases of initially infiltrative type (GAKKEN B type), 10 cases showed the enlargement of shadow radiologically, but were not regarded as relapsed cases, because they remained bacteriologically negative and the shadow improved in 1-2 months without additional chemotherapy. Only 3 cases (1.1%) were regarded as relapsed cases because of the positive bacteriological conversion and aggravation of the shadow. They were initially sputum negative. It can be concluded that for radiological minimal cases, nine months is enough for the duration of chemotherapy when the INH-RFP regimen is used.
Phenotypic characteristics of endothelial cells of blood vessels in renal cell carcinoma were studied immunohistochemically. Vascular endothelial cells in different compartments expressed surface antigens heterogenously. Sinusoidal capillary endothelial cells adjacent to carcinoma cells shared antigens with a monocyte/macrophage subset (OKM5 +, HLA-DR +, interleukin-1 +), but were only faintly positive or absent for factor VIII/von Willebrand factor antigen. Endothelial cells of larger vessels in fibrous septa were OKM5-, HLA-DR +, interleukin-1 +, factor VIII/von Willebrand factor antigen +. Renal cell carcinoma cells expressed HLA-DR and HLA-ABC antigens. These findings suggest that renal cell carcinoma cells are surrounded by blood vessels containing effector cells for immune responses, and that they have a high-potency response to immunopotentiators.
A 24-year-old male patient was admitted to our Ryukyu University Hospital, complaining of visual disturbance. He had had partial removal of a suprasellar region tumor in another hospital one year before the admission. Microscopical findings had shown two cell patterns of germinoma in the first operation. Following it, the patient received irradiation with a total dose of 54Gy. The tumor completely disappeared after these procedures. On this admission, plain CT scan revealed an isodensity mass in the suprasellar cistern extending to the right side of the third ventricle, which was enhanced homogeneously. In MRI, the mass showed low intensity in the T1-weighted inversion recovery sequence, and heterogeneously, high intensity in the T2-weighted spin echo sequence. By bifrontal craniotomy, the tumor was removed. Histologically, it consisted of granuloma containing fine cotton fibers. MRI findings of intracranial foreign-body granuloma were discussed.
To clarify the structural base of immune response occurring in the kidney, we investigated the antigenic and functional properties of vascular endothelial cells. Peritubular capillary endothelial cells exhibited the same immunohistochemical characteristics (OKM5-positive, HLA-DR-positive, Factor VIII/von Willebrand factor antigen-negative, Interleukin 1-positive) as a peripheral blood macrophage subset capable of presenting soluble antigens and triggering the autologous mixed lymphocyte reaction. On the other hand, endothelial cells of glomerular capillary loops, considered to be involved in blood coagulation, were OKM5-negative, HLA-DR-positive, Factor VIII/von Willebrand factor antigen-positive, Interleukin 1-positive. Thus the results of this study suggest that vascular endothelial cells in different anatomic compartments of the kidney express surface antigens heterogenously and may play different roles in the immune reaction.
Tension on the nylon loops in a Stamey endoscopic bladder neck suspension has been quantified for the first time by using a spring scale. Clinical data were compared between 14 patients with undetermined tension (control group) and 57 with tension of either 400, 600, 700, 800 or 1,000 gm. Experimental study during the operation demonstrated that changes in the posterior urethrovesical angle and distance that the bladder neck was elevated were not proportional to the tension: the lower the thread tension the larger the change in these 2 parameters. Compared to the control group a significant decrease in the period of suprapubic drainage was observed in patients with quantified tension. Operative success was obtained in 86 per cent of the control group and 91 per cent of those in whom tension was quantified. A tension of 400 to 600 gm. seemed to be most appropriate for a successful outcome. We conclude that quantifying the thread tension is useful to prevent either over-tightness of the nylon loops or insufficient suspension of the bladder neck, and that with a spring scale it is easy to instruct a beginner on how tightly to tie the threads.
Twenty-four monoclonal antibodies (MAbs) against rinderpest virus (RPV) were established and characterized by several serological tests. Of the 24 MAbs. 10 recognized the nucleoprotein (NP), six the phosphoprotein (P), four the haemagglutinin (H), and two the fusion (F) protein as determined by radioimmunoprecipitation assay. The specificities of the remaining two MAbs could not be determined. From a competitive binding assay using MAbs against each structural protein, at least five, four and two separate antigenic sites were identified on the NP, P and H proteins, respectively. MAbs against the H protein neutralized the infectivity of the virus, but those against the F protein were only neutralizing in the presence of guinea-pig complement. The reactivities of each of the MAbs for other strains of morbillivirus were tested using an indirect immunofluorescent antibody assay. The MAbs against four out five antigenic sites on the NP showed cross-reactivity amongst all the strains of morbillivirus tested whereas the fifth antibody reacted only with RPV. Of the antibodies specific for the P protein, the antibody against one site was cross-reactive with all the strains of RPV, measles virus (MV) and canine distemper virus (CDV), the antibody against another site was reactive with RPV and MV but not with CDV, and the antibodies against the other two sites were specific for RPV.
One hundred female patients with stress incontinence have been operated on by means of modified stamey's endoscopic bladder neck suspension procedure, i.e. quantifying the thread tension for bladder neck suspension. Twelve patients had 1,000 grams in the nylon loop, 5,800 grams, 9,700 grams, 25,600 grams and 49,400 grams. A follow-up period varied from 10 to 32 months (mean: 20.5 months). A 60-min pad-weighing test revealed urinary loss of 1.0 to 196.0 grams/hour (mean: 36.0) prior to operation. 1. The modified Stamey's procedure was successful in 95 patients (95%). The appropriate thread tension for bladder neck suspension was 400 grams. 2. Various complications were encountered: removal of unilateral nylon suture was necessitated in 2 patients, bleeding from operative wound in 2, bladder tamponade in 2, and clean intermittent catheterization for more than one month in 4. 3. Micturition parameters, i.e. maximum and average flow rates, temporarily got worse post-operatively. Maximum urethral closure pressure decreased and functional profile length elongated which were significantly different from those of pre-operative values. 4. Questionnaire sent to the patients revealed that 89 percent of them were satisfied with the operative results but 11 percent were not. 5. The modified Stamey's procedure is simple to perform and prevents over-tightness of nylon loops. We conclude that this operative method is the treatment of choice for correction of stress incontinence.
A 28-year-old man visited our hospital with a complaint of left testicular pain and swelling. Left orchiectomy was performed, and its pathological finding was embryonal carcinoma (seminoma in a small portion). Though no sign of metastasis was detected and the serum tumor markers, alpha-fetoprotein, and beta-human chorionic gonadotropin (HCG) decreased in value as expected, he has undergone two courses of chemotherapy (PVB regimen). Twenty months after operation the patient found contralateral testicular induration, and serum beta-HCG was abnormally high, 36.0 ng/ml. We performed right orchiectomy. The pathology revealed pure seminoma. He has been followed up without adjuvant therapy.
Twelve monoclonal antibodies against ibaraki virus (IbV) were established and preliminarily characterised by indirect immunoperoxidase (IIP), haemagglutination inhibition (HI) and neutralisation (NT) tests. Five antibodies reacted in the IIP test with all IbV and epizootic haemorrhagic disease virus (EHDV) strains tested, and five antibodies reacted with IbV and Alberta strain (serotype 2) but not with New Jersey strain (serotype 1) of EHDV. Two of 12 antibodies showed both HI and NT activities. Viral proteins with molecular weights of about 24,000 daltons (24KD) and 78KD were determined by two monoclonal antibodies in Western blot analysis. One of two antibodies with the ability of both HI and NT recognised a viral protein with a molecular weight of about 78KD.
Three cases of chronic subdural hematoma (CSH) following advanced cancer are reported. Case 1. A 54-year-old male patient was referred to our clinic in a semicomatose state. Bilateral CSH was evacuated through a pair of burr holes, and consciousness was recovered. However, subependymal hemorrhage occurred at the third ventricle 6 days after the operation. Hematological examination revealed thrombocytopenia. He died 12 days after operation because of hemorrhage in the lung. Postmortem examination disclosed metastatic adenocarcinoma of unknown origin to the dura mater, lymph nodes, lung and bone marrow. Case 2. A 50-year-old male patient who was diagnosed as having gastric cancer was referred to our clinic in a state of deep coma. CT scan revealed CSH and putaminal hemorrhage at the left side. Hematological examination revealed disseminated intravascular coagulation (DIC). After the subdural hematoma was evacuated, the putaminal hematoma enlarged and hemorrhagic infarction at the left temporo-occipital lobes occurred. He died 2 days after operation. Autopsy was not carried out, but histological examination revealed poorly differentiated malignant cells in the outer membrane of the subdural hematoma. Case 3. A 53-year-old female patient who had a history of gastric cancer operated on 4 years ago was admitted to our clinic complaining of headache and vomiting. CT scan revealed bilateral subdural hematoma. Following a pair of burr-holes and irrigation of the hematoma, hemorrhage recurred alternatively at the left side on the 6th and at the right side on the 27th day after the operation. Hematological examination revealed DIC, and bone marrow puncture disclosed metastasis of the adenocarcinoma.(ABSTRACT TRUNCATED AT 250 WORDS)
To evaluate the diagnostic value of radiographic examinations in renal trauma, 30 patients treated between April, 1985 and March, 1988 were examined. The 25 male and 5 female patients ranged in age from 10 to 74 years, with 17 (57%) less than 30 years of age. Causes of injuries were traffic accidents in 19 patients (63%), falls in 5 (17%), sports in 2 (7%), and others in 4 (13%). Twenty-nine patients (97%) had hematuria and 3 (10%) had shock due to renal injury. The presence of shock indicated severe renal injury, but the degree of hematuria did not correlate to severity of injury. Of the 30 patients, 18 (60%) had renal contusions, 7 (23%) had minor lacerations, 4 (13%) had major lacerations and one had vascular injury. One patient had penetrating trauma and the other 29 had blunt trauma. Two patients (7%) had pre-existing renal anomalies. Associated injuries were present in 16 patients (53%). The presence of associated injuries had no relation to the severity of the renal injury. Computerized tomography (CT) with contrast medium was more sensitive to abnormal findings, especially subcapsular and perirenal hematoma, than excretory pyelography. Findings of renal angiography provided additional anatomical information for deciding immediate surgical treatment and for selecting operative methods for salvage of the kidney.(ABSTRACT TRUNCATED AT 250 WORDS)
The authors report their experience with the surgical treatment of carotid-ophthalmic aneurysms in 29 cases, and describe their surgical technique. The technique can be summarized as follows. When dissecting the aneurysm, temporary vascular occlusion of the common carotid artery and external carotid artery is done in the neck under the administration of cerebral protective substances. Through a bifrontal craniotomy, wide dissection of the Sylvian fissures and the interhemispheric fissure is performed. When necessary, the anterior clinoid process and the roof of the optic canal are removed. This approach allows for observation of the neck of the aneurysm from various angles, thus facilitating clipping of the neck. There have been no previous reports of direct surgery on carotid-ophthalmic aneurysms using an interhemispheric approach, but this approach provides a much larger operative field and a better exposure of the aneurysm than other surgical approaches.
Avian rotaviruses were isolated from feral pigeon faeces treated with trypsin using roller tube cultures of mammalian cells. Two pigeon strains, designated as strains PO-8 and PO-13, produced a marked cytopathic effect (CPE), small intracytoplasmic inclusion bodies and high titres of infectious particles in infected MA-104 and MDBK cell lines without cell adaptation and roller drum apparatus. The pigeon rotaviruses shared a common group specific antigen with the Lincoln strain of bovine rotavirus by indirect immunofluorescence, but differed from both the Lincoln strain and the Wa strain of human rotavirus in neutralization tests. The RNA segment profile of this virus on polyacrylamide gel electrophoresis differed from that of group A mammalian rotaviruses. The results of a serological survey suggested that antibody to pigeon rotaviruses was widespread in avian species in Japan.