Biomedical subjects
Publications and source records attributed to T Noji.
SUMMARY: We report a case of aorto esophageal fistula (AEF) with delayed esophageal reconstruction employing microvascular anastomosis. We demonstrate here that our method is useful for delayed esophageal reconstruction following AEF.
A 26-year-old woman presenting symptoms of rapid progressive heart failure consulted with our hospital. Two-dimensional echocardiography showed a large mass in the left atrium (LA) and severe pulmonary hypertension. Emergent operation was performed because of hemodynamic reason and the risk of embolism. The tumor (7 x 6 x 3 cm) which was lobulated and had a smooth surface was arising from posterior wall of LA extending into the ostium of right lower pulmonary vein. The portion of tumor located was excised. The defect was reconstructed by bovine pericardium. Postoperative histopathological diagnosis was leiomyosarcoma. Hemodynamics recovered after surgical treatment and there were no problems for 5 months. However, tumor recurrence in LA and pulmonary metastasis was found 5.5 months after surgery. The patient died two weeks later by progressive heart failure. Primary cardiac leiomyosarcoma is extremely rare. The current world literature is reviewed with respect to this rare tumor.
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Cord serum concentrations of the N-terminal propeptide of type-III procollagen(PIIIP), insulin-like growth factor I (IGF-I), thyroid-stimulating hormone (TSH) and free thyroxine were measured in 149 neonates, consisting of 22 small for gestational age, 95 appropriate for gestational age, 21 large for gestational age and 11 neonates of less than 24 weeks of gestation. Their gestational ages (GAs) ranged from 20 to 41 weeks. A significant negative correlation was found between PIIIP levels and GA (r = -0.83, p less than 0.001). No significant difference was found in PIIIP levels between SGA and LGA neonates, when there were no difference in their GAs, in spite of a significant difference in their birth body weights (p less than 0.01). The high concentrations of the cord serum PIIIP did not appear to be influenced by either IGF-I or thyroid hormones, nor was there any relationship between PIIIP and the birth body weight, but only with GA, suggesting that determining cord levels of PIIIP seems to provide a useful parameter for the assessment of newborn maturity.
In 37 infants, the blood levels of TSH were determined by the immunoradiometric assay (IRMA) and the relation between TSH and thyroid hormone was evaluated. The ranges of gestational age (weeks) and birth weight (g) of infants were 28-42 and 982-3,650, respectively. The birth weights of 19 infants were below 2,500 g. The free T4 levels in the low birth weight (LBW) infants were lower than those of the normal infants and significantly correlated to the birth weight (r = 0.64, P less than 0.01) and gestational age (r = 0.58, P less than 0.01). In addition, free T4 levels were significantly correlated to the levels of total T4 (r = 0.66, P less than 0.01). The concentrations of TSH measured by IRMA method were significantly correlated to those of free T4 (r = 0.51, P less than 0.01). From these data, we consider that the transient hypothyroxinemia observed frequently in LBW infants might be a physiological reaction regulated by hypothalamus and that thyroid hormone treatment should be avoided.
The levels of corticotropin-releasing factor (CRF) in the cord blood from 34 infants were determined by radioimmunoassay. All infants were born by vaginal delivery after an uneventful pregnancy. Levels of cortisol, dehydroepiandrosterone sulfate and ACTH were high in the cord blood. CRF levels (mean +/- SD) were 100.5 +/- 31.7 and 44.5 +/- 7.8 pg/ml, respectively, in cord blood and in controls (healthy prepubertal children, n = 10). Although the origin of CRF in peripheral circulation has not been clarified, we speculate that the high adrenocortical steroid synthesis of the fetus might be a consequence of high CRF levels in fetal circulation.
Immune complex solubilizing capacity (ICSC) of sera obtained from patients with insulin-dependent diabetes mellitus (IDDM) was assayed by the spectrophotometric method. In 17/32 IDDM sera, ICSC was significantly low. The value of ICSC was only weakly correlated with serum CH50 (r = 0.42). Six sera out of 28 showed a high serum immune complex level and low ICSC. The results with these 6 cases suggest the possibility that circulating antigen-antibody complex might be insoluble in vivo. The precise characterization of these 6 patients' autoantibodies was obtained with immunofluorescence tests. Interestingly, 2 of these sera were positive for islet cell surface antibodies (ICSA) and AtT-20 cell (ACTH secreting cell) surface antibodies.
The beta-adrenergic receptors were investigated in partially purified mononucleal leukocytes (MNL) plasma membranes from 18 patients with IDDM in pediatric period, 9 healthy children and 8 normal adults. The decreased beta-adrenergic receptor number was seen in patients with IDDM (Bmax = 27.6 +/- 8.3 fM (125I) IHYP/mg protein) compared with normal children (Bmax = 40.4 +/- 10.4 fM (125I) IHYP/mg protein) and normal adults (Bmax = 36.9 +/- 6 fM (125I) IHYP/mg protein). MNL beta-receptor binding affinities (apparent Kd = 109.8 +/- 26.1 pM in IDDM, 102.8 +/- 46.6 pM in normal children, 130.0 +/- 43.1 pM in normal adults) did not differ. We divided the patients with IDDM into two groups based on their level of blood glycosylated hemoglobin (HbA1) when samples were taken. Group A IDDM (consisted of 9 diabetic patients with below 10% of HbA1) had markedly decreased beta-receptor numbers compared with group B IDDM (consisted of 9 diabetic patients with more than 10% of HbA1), whereas Kd was not significantly different. Also, there was negative correlation between Bmax and level of blood sugar or HbA1 in IDDM. This is the first report concerning the beta-adrenergic receptor in IDDM in pediatric period. We suggest that decreased Bmax in group B is a homeostatic response to restore the poorly-controlled hyperglycemic state to normoglycemia because the group B patients had high level of HbA1 and blood sugar.
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Epidermal growth factor (EGF) in human milk, cow's milk and 10 different milk formulas was measured by radioreceptor assay (RRA) using human placental membrane as an EGF receptor. The raw and pasteurized cow's milk contained 324.2 ng/ml and 155.0 ng/ml of RRA-EGF, respectively. These values were almost the same as that found in human milk, when the concentration was expressed as the proportion of protein contents in the samples. On the other hand, no trace of RRA-EGF was detected in 9 different milk formulas, and only one contained a very small amount of it.
In order to evaluate the mechanism of high growth hormone (GH) secretion in perinatal life, the levels of GH and growth-hormone-releasing factor (GRF) in cord blood were determined. Plasma-immunoreactive GRF was measured by a double antibody RIA method. The levels (mean +/- SD) of GH, GRF and somatostatin (SRIF) were 23.4 +/- 10.2 ng/ml, 49.5 +/- 11.7 and 41.5 +/- 10.4 pg/ml, respectively; they were remarkably higher than those of healthy adults. In statistical analysis, there were no significant relationships among the levels of GH, GRF or SRIF. We speculate that a high GRF release from the hypothalamus might increase the secretion of GH in the perinatal period.
The observation that N alpha,B1-biotinylinsulin binds firmly to resins in which succinoylavidin is covalently attached to AH Sepharose 4B and can be retrieved by exposure of the resins to 20 mM biotin provided the basis for the present investigations. Solubilized, partially purified insulin receptor from human placenta binds to affinity resins in which N alpha,B1-biotinylinsulin is noncovalently attached to AH Sepharose 4B-immobilized-succinolylavidin. Exposure of the receptor loaded resin to 20 mM biotin results in liberation of a high molecular weight material containing bound 125I-biotinylinsulin, which precipitates with polyethyleneglycol and cross reacts with human insulin receptor antibodies. The technique is biospecific and appears to be applicable to the purification of insulin receptors on a preparative scale. Crude solubilized insulin receptor from human placenta is contaminated with "insulinase" which is inhibited by N-ethylmaleimide. HPLC provides a tool to assess "insulinase" activity that is more sensitive than the TCA precipitation method.
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