Biomedical subjects
Publications and source records attributed to T Shirakura.
We report on a 74-year-old female patient with primary hemochromatosis complicated by hyperthyroidism. The serum ferritin level was reduced throughout a 217 day administration of deferoxamine (1 g/day). At the same time, the thyroid gland was changed from hyper- to hypo- functional proportionally.
A unique case of IgA kappa myeloma is presented. While the myeloma cells had secreted a large quantity of IgA kappa monoclonal protein, they were induced to stop secreting the monoclonal protein by cyclophosphamide and vincristine, in spite of a remarkable increase in tumor burden. The absence of intracytoplasmic IgA kappa was clearly evidenced by the immunofluorescence technique using anti-IgA and anti-kappa monoclonal antibodies.
We analyzed the blood cell counts and serum levels of total protein (TP), total cholesterol (TC) and triglyceride (TG) of 2,231 healthy subjects (1,295 men and 936 women) between age 20 and 99 years in order to clarify the following two subjects. (1) In the approximately 10 years since the report of Shirakura et al in 1978, eating habits have improved and the average life expectancy has extended in Japan. Is there any effect of such betterment on blood cell counts of the aged? (2) It has been pointed out that quality of everyday life, such as staying at home but not in an old-age home, working, traveling, and so forth, had an influence on the blood cell counts of aged. Is there any difference between the blood cell counts of people under 60 years and those of people older than 60 years who have a good quality of life as mentioned above? The hemoglobin concentration, red blood cell count, and hematocrit value began to decrease in men in their sixth decade and in women in their seventh decade and the change was more prominent with advancing age, especially in men. The white blood cell count and platelet count tended to decrease with advancing age. The serum levels of TP, TC, and TG also declined with age in those over 60 years of age. These results confirmed that the hemoglobin concentration, red blood cell count, and hematocrit value decrease in the elderly subjects as they grow older and it may be considered that reduced ingestion of protein is one of the causes of the phenomenon.
A 70-year-old man was admitted to our hospital because of fever and progressive dyspnea in December 1989. He was already diagnosed as having erythrocytosis secondary to pulmonary fibrosis 4 years previously and the values of his hematocrit (Ht) were maintained between 44.5 and 62.9% by repeated phlebotomy. Immediately after admission, severe diarrhea developed and the Ht value was 61.5%. Around 1:30 a.m. of the 3rd hospital day, he developed disturbance of consciousness. In addition, the serum levels of LDH, CPK, aldolase, and myoglobin of muscle origin increased markedly and the Ht value showed 78.5%. While the level of consciousness was gradually restored by 600 ml phlebotomy and 1,500 ml saline infusion, dysarthria and hemiplegia became evident. The Ht value early in the morning of the 3rd hospital day was reduced to 59.4%. Although cranial CT and MRI performed 74 days and 15 months, respectively, after the onset of the symptoms failed to reveal any abnormal shadow, he was clinically suspected to have cerebral infarction. These findings emphasize that abrupt increase in Ht or blood viscosity is a possible factor triggering cerebral infarction, and adequate control of Ht value is recommended for the prevention of such a condition in the aged.
A 60 year-old Japanese man having a 20-year history of diabetes mellitus presented with truncal neuropathy. The severe pain, especially its nocturnal exacerbation, prevented him from sleeping and eating, resulting in rapid emaciation. However, he recovered from the condition with oral mexiletine, which dramatically controlled the pain.
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The effect of green tea on iron absorption from tablets containing sodium ferrous citrate was investigated in four elderly patients with iron deficiency anemia and in eleven normal elderly subjects. In both groups, the serum iron level reached a maximum value from 2 to 4 hours after taking iron tablets and returned to the baseline value after 24 hours. No inhibitory effect of green tea on iron absorption was recognized.
A 60-year-old female, who was exposed to the Nagasaki atomic bomb at 18 years old, had renal cancer and subsequently was found to have multiple myeloma (IgG kappa). She underwent the left mastectomy for breast cancer at 43 years old but was not given chemotherapy and radiotherapy. The karyotype of bone marrow cells was 46, XX. The estimated radiation dose was under 10 rads. While the effect of such a low-dose of radiation is considered to be almost negligible, there would be a possibility that in this case the risk of carcinogenesis was enhanced as her age advanced.
A 43-year-old male patient with hypercalcemia and osteolytic lesions complicating chronic myelogenous leukemia is presented. Extramedullary myeloid blastic crisis was diagnosed by the histological finding of the specimen biopsied from a osteolytic lesion in the right femur. As the serum levels of parathyroid hormone, 1,25 (OH)2 vitamin D, prostaglandin E2 and interleukin 1, and the urinary excretion of cyclic AMP were all normal, it was considered that the hypercalcemia was attributed to the bone destruction by the invasion of leukemic myeloblasts.
Eighteen cases of mycotic lung disease, which included 17 pulmonary aspergillosis and one cryptococcosis, were treated surgically. Lobectomy was performed in 4, segmentectomy in 1, partial resection of lung in 4, cavernostomy in 2, open window thoracotomy in 4 and exploratory thoracotomy in 1. The authors would like to emphasize following points; 1) Of eighteen, cases, there were five patients over 70 years old and results of surgery in those were uneventful. 2) Two cases developed the postoperative empyema which was caused by the remnant lesion invaded with aspergillus fumigotus. From this experience it was considered that in the invasive aspergillosis the limited resection of the lesion was not recommended because of its local recurrence. 3) Omentopexy was effective for the treatment of mycotic empyema.
Warthin-Finkeldey-like giant cells were found in a lymph node specimen obtained from a 65-year-old Japanese woman with systemic lupus erythematosus. There were no clinical or laboratory findings indicating measles infection, which suggests that the appearance of Warthin-Finkeldey giant cells is not specific for measles, but is associated with reactive lymphatic proliferation.
A case of multiple aneurysm of superior mesenteric artery (SMA) branch is presented. A 54-year-old man with sudden onset of back pain was admitted to our hospital. Severe abdominal pain was developed and he fell into shock. Selective angiography of the SMA demonstrated aneurysm of the accessory middle colic artery to splenic flexure. Laparotomy disclosed much intraperitoneal blood and a large clot under the pancreatic body with a gushing hemorrhage. The bleeding vessel was ligated and sutured. The postoperative course was uneventful, but the subsequent angiography revealed another aneurysm of SMA branch, which was not able to be seen in the previous angiography because of overlapping with main SMA trunk. Resection of the aneurysm was done. The etiology of the latter aneurysm was suggested to be medial degeneration histologically. Fourty-nine cases of SMA aneurysm from the Japanese literature were reviewed and discussed. Emphasis is placed on early diagnostic laparotomy for appropriate management and the role of angiography in confirmation of bleeding site in case of spontaneous intraabdominal hemorrhage.
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A unique case of pernicious anemia is described. Initially, the percentage of OKT8-positive blood cells was markedly decreased, resulting in an increase in the OKT4/OKT8 ratio. The level of OKT8-positive blood cells was, however, returned to normal after vitamin B12 therapy. The finding may propose a possible role of the imbalance of blood lymphocyte subpopulations on the pathogenesis of pernicious anemia and also a responsibility of vitamin B12 for such a selective reduction in the OKT8-positive blood cells.
A case of chronic myelogenous leukemia in the chronic phase with erythrocytosis and a complex Ph translocation is described. The karyotype was 46,XY,t(9;11;22)(q34;q13;q11). The granulocytic and erythroid overgrowth was controlled by busulfan therapy.
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Explore the source record for details and available documents.
Explore the source record for details and available documents.