Biomedical subjects
Publications and source records attributed to T Sakemi.
In rhabdomyolysis-related acute renal failure evidence of patchy renal vasoconstriction during the recovery phase was obtained by abdominal CT scan, which showed a wedge-shaped high-density area in the kidney.
A 51-year-old man was admitted 3 hours after ingesting approximately 50 ml of mixture of paraquat and organophosphate insecticide. His arterial oxygen pressure fell progressively to 44.6 mmHg. Diagnosed was paraquat-induced interstitial pneumonia. No improvement was observed after treatment with corticosteroid. The pneumonia, however, resolved after irradiation of both lungs and arterial oxygen pressure showed marked improvement. Radiotherapy to the lungs should be considered only in patients who showed progressive deterioration of respiratory function.
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1-Hexylcarbamoyl-5-fluorouracil (HCFU) was administered orally to 63 patients with hepatocellular carcinoma (HCC) at a daily dose of 200 to 600 mg. Twenty three of those patients who received HCFU over 4 weeks without any other therapies were studied for its antitumor effect. Eighteen patients were evaluated for tumor size. The results showed a response rate of 16.7% (3/18) based on the criteria of Koyama et al. Patients with minute hepatoma had an especially good response; the response rate being 40% (2/5), or 60% (3/5) including minor response. Tests showed no aggravation of liver function. HCFU was considered to be useful in the treatment of HCC. However, unexpected adverse neurological effects were encountered in 6 patients. They began with slurred speech, bradypragia and gait disturbance, and finally progressed to unconsciousness in 4 out of 6 patients, in which the clinical picture resembled hepatic encephalopathy. Though reversible, these symptoms necessitate immediate withdrawal of HCFU therapy.
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Carrageenan (CAR), a sulphated polygalactose having macrophage toxic properties, elicited a suppression of primary cytotoxic T lymphocyte (CTL) responses against allogeneic tumour cells in the spleen when the tumour cells (EL-4 tumour cells, H-2b) were administered subcutaneously to AKR mice. When the allogeneic tumour cells were administered intravenously to AKR mice, no CTL responses to the alloantigens were detected in the spleen, but were detected in the peritoneal exudate cells, and CAR treatment suppressed the responses. On the other hand, in vitro secondary CTL responses of cells from alloantigen-primed mice were markedly enhanced by the pre-treatment of such mice with CAR. These results may suggest that two steps, macrophage-dependent and independent, are involved in the development of CTL responses in vivo.
We herein report a very rare case of a patient suffering from simultaneous occurrence of three immune disorders, i.e. Hashimoto's thyroiditis, sarcoidosis and minimal change glomerular disease. A 66-year-old man was admitted to our hospital for evaluation of nephrotic syndrome. Six months before admission, he was pointed out as having positive proteinuria, hypoalbuminemia and associated pretibial pitting edema. Initial laboratory data showed high gammaglobulinemia, high titers of both antimicrosomal and antithyroglobulin antibodies with normal thyroid function. Chest X-ray and CT scan revealed bilateral hilar lymphadenopathy with interstitial shadow. Ga-citrate scan disclosed positive accumulation in the thyroid glands, the mediastinum, the lungs and the kidneys. The diagnosis of minimal change nephritic syndrome and pulmonary sarcoidosis was made, based on the findings of transbronchial lung biopsy and kidney biopsy. After one and a half months of admission, thyroid function had gradually deteriorated. The histological findings of the thyroid were consistent with the features of Hashimoto's thyroiditis. Treatment with prednisolone and cyclophosphamide resulted in a decrease in urinary protein excretion, reduction in the size of mediastinal lymphadenopathy and disappearance of positive findings of Ga-citrate scan in the thyroid glands and the kidneys. Simultaneous occurrence of minimal change-glomerular disease, sarcoidosis and Hashimoto's thyroiditis in our case suggests that similar immunological abnormalities may be involved in the pathogenesis of the diseases.
A 57-year-old woman who had had renal amyloidosis with nephrotic syndrome for five years was found to have the Fanconi syndrome and monoclonal lambda light-chain proteinuria. The amyloidosis of this patient was of primary type on the basis of the permanganate-resistant amyloid, the presence of monoclonal light-chain proteinuria, and the absence of clinical and histologic evidence of multiple myeloma. To best of our knowledge, this is the first case report in which primary amyloidosis with monoclonal lambda light-chain proteinuria was accompanied by adult Fanconi syndrome.
A case of crescentic glomerulonephritis associated with renal amyloidosis is reported. A 62-year-old woman with a 6-yr history of rheumatoid arthritis developed rapidly progressive glomerulonephritis associated with renal amyloidosis and crescent formation. Amyloid protein was positively stained with anti-AA antibody and its fibrils were demonstrated by electron microscopy. In connection with epithelial cell proliferation in the capsular space, destruction of the capillary basement membrane was observed at the sites where amyloid fibrils were accumulated, whereas glomerular deposition of immunoglobulin and complement was not detected. It is conceivable that the destruction of the glomerular tufts induced by amyloid deposition may be responsible for the crescent formation.