Biomedical subjects
Publications and source records attributed to Y Iijima.
Spontaneous rupture of the thoracic descending aorta is rare, and uniformly fatal without surgery. We report herein the case of a man in whom such a rupture was successfully treated with emergency surgery. We believe that the rupture in this patient was most likely associated with perforation through an atherosclerotic plaque of the descending aorta and was induced by sudden hypertension.
High level of urinary kallikrein excretion was observed in a 23-year-old man with primary aldosteronism. Unilateral adrenalectomy improved the clinical symptoms and normalized the urinary concentration of this vasoactive substance. Although plasma atrial natriuretic factor was not elevated, adrenal surgery lowered its concentration. Coexistence of an adrenal adenoma and lesions of nodular hyperplasia were detected in the removed adrenal gland. We summarize the clinical data of this patient and review the literature.
Proteins of Chlamydia pneumoniae immunodominant in humans were characterized with the sera of 13 patients who were not likely to have been exposed to C. trachomatis or C. psittaci. The serological responses among these patients were similar on a qualitative basis, but some differences were found quantitatively. However, the serological responses of the patients who were infected with C. pneumoniae differed markedly from those of two patients who were infected with C. trachomatis and two who were infected with C. psittaci and those of mice that were transtracheally infected with C. pneumoniae. Among proteins immunodominant in the patients who were infected with C. pneumoniae, a 40-kDa major outer membrane protein was genus specific and 53-, 46-, and 43-kDa proteins were species specific in their reactions with the majority of the human sera used. A few sera reacted strongly with a 73-kDa protein genus specifically. Some proteins with weak immunogenicity exhibited species specificity. An antigenic analysis with human sera and murine monoclonal antibodies against the 53-kDa protein showed that hte antigenicities were strictly conserved among the seven strains of C. pneumoniae tested. The genus-specific 73-kDa protein was solubilized with octylglucoside. All of the species-specific immunodominant proteins were solubilized with sodium dodecyl sulfate, but the genus-specific major outer membrane protein was not. These results suggest that a serological diagnosis of C. pneumoniae infection could be achieved species specifically by comparison of the serum responses to sodium dodecyl sulfate- and octylglucoside-soluble fractions.
Recently, human T-lymphotropic virus type I (HTLV-I) has been shown to cause endogenous uveitis, HTLV-I associated uveitis. To investigate the association of hereditary or environmental factors with the incidence of this uveitis, HTLV-I seroprevalence was studied in patients with undefined uveitis in central Japan, where HTLV-I infection has not been considered highly endemic. Of 129 patients with undefined uveitis, 6 (4.6%) were seropositive, and 4 of these 6 seropositive cases with undefined uveitis were born in southwestern Japan, where HTLV-I infection is highly endemic. As regards the incidence rate of uveitis, 4 of 9 (44.4%) seropositive cases from southwestern Japan developed uveitis, whereas only 2 of 21 (9.5%) seropositive cases from central Japan developed uveitis. The difference was statistically significant (P < 0.05). This results suggests that the incidence of HTLV-I associated uveitis could be influenced by environmental or hereditary factors including HLA.
We report a case of localized cardiac tamponade after aortic valve replacement. A 56-year-old man had an aortic valve replacement for his aortic valve steno-insufficiency. At 3-postoperative day, severe hypotension occurred, causing acute renal failure. There were no cardiomegaly, high central venous pressure, nor echo-free space. A mass shadow, appearing on chest X-ray at 37-postoperative day, was diagnosed as a localized tamponade by means of a computed tomography and a radioangiography at 38 postoperative day. After the spontaneous drainage of old bloody effusion from the partially opened wound in mid-line, his cardiac and renal failure improved rapidly. When the hematoma is localized, computed tomography is most diagnostic while conventional echo-cardiography often fails to show echo-free spaces.
Endothelin-converting enzyme, a key enzyme in the production of a potent vasoconstricting peptide, endothelin, was purified to homogeneity from rat lung microsomes. A sensitive and convenient assay method using the 125I-endothelin-1 receptor binding assay was developed for purification studies. The enzyme was solubilized with Triton X-100 and was purified at high yield by sequential column chromatography on wheat germ agglutinin-agarose, zinc-chelating Sepharose, and Blue Bagarose. Electrophoretic analysis of the purified enzyme revealed one protein band with M(r) 130,000. High performance liquid chromatographic analysis of the enzyme reaction revealed that purified enzyme quantitatively converted big endothelin-1 to endothelin-1, indicating that the enzyme specifically cleaved the bond between Trp21 and Val22. The enzyme was inhibited by metal chelators and phosphoramidon, but not by thiorphan and captopril. Lung endothelin-converting enzyme preferred big endothelin-1 to big endothelin-2 or -3 as a substrate, and kinetic analysis revealed that the Michaelis constant and a maximal velocity for big endothelin-1 were 0.20 microM and 3.1 nmol/min.mg protein, respectively. Lung endothelin-converting enzyme is a typical neutral metalloproteinase and is similar to the enzyme from endothelial cells.
The morphology and antigenic property of elementary bodies (EBs) of new Chlamydia pneumoniae YK-41 strain isolated in Hiroshima, Japan, were compared with those of C. pneumoniae strains TW-183 and AR-39, C. trachomatis L2/434/Bu strain and C. psittaci Cal 10 and Budgerigar-1 strains by SDS-PAGE and immunoblotting techniques. In spite of a clear difference in EB morphology between the YK-41 and the other C. pneumoniae strains used, protein profile of the YK-41 strain in SDS-PAGE was similar to that of the other strains. However, some quantitative difference in 200 and 98 kDa peptides and a faint difference in SDS-PAGE pattern was also observed in the molecular masses from 42 to 50 kDa. Immunoblot analysis with the patient serum at the convalescent stage revealed the presence of genus-specific and species-specific antigens in YK-41 EBs: i.e., the major outer membrane protein and 73 kDa peptides were genus-specific and the peptides of 43, 46, 53, 60 and 98 kDa appeared to be C. pneumoniae-specific.
In this paper the acid resistance of hyper-remineralized dentine was quantified by means of fluoride and mineral measurements. Hyper-remineralization was achieved by demineralization of dentine in an acidic gel system (pH 5) for 3 weeks, followed by remineralization in a solution containing 1.5 mM Ca, 0.9 mM phosphate and 10 ppm F at pH 7 and 37 degrees C for 8 days. The samples were subsequently again demineralized in the gel system mentioned for 1, 2 and 3 weeks. Analysis for fluoride was done by means of the microdrill biopsy technique and to obtain information on the fluoride distribution by secondary ion mass spectrometry (SIMS); mineral was assessed by microradiography. The results showed that in hyper-remineralized dentine the original fluoride content was approximately 30,000 ppm F. This value was still in the same order after the acid challenge of 3 weeks at pH 5. These values were substantially higher than the baseline values in sound or in demineralized dentine being about 900 ppm F. The main microradiographic result was that there was no significant mineral change in the hyper-remineralized dentine due to the acid challenges. There was, however, a tendency for mineral redistribution deeper into the dentine lesion leading to lamination phenomena. The SIMS experiments on some of the samples showed a fluoride distribution in agreement with the microdrill fluoride data. Furthermore a fluoride redistribution took place in deeper parts of the lesion due to the acid challenges. The combined fluoride concentration and microradiographical data indicate that fluoride-enriched and highly mineralized hyper-remineralized dentine is more acid resistant than sound or demineralized dentine.
Two cases of acute focal bacterial nephritis (AFBN) are reported. The first patient was a 35-year-old man and the diagnosis was made by ultrasonography (US) and computed tomography (CT). The second patient was a 40-year-old man and was diagnosed by US, CT and renal biopsy. They were treated with antibiotics and showed rapid improvement in both clinical symptoms and renal masses.
We report a effective management of the Paget-Schroetter syndrome. A 23-year-old man was seen with a complaint of arm swelling and venous engorgement of the left arm. A first-rib resection was performed through a infraclavicular approach with removal of compressive elements including scalenus anterior and subclavius muscles. He became asymptomatic. But 2 months later, recurrent symptoms developed and venograms demonstrated the presence of restenosis of the subclavian vein with extensive collaterals. To relieve symptoms a percutaneous transluminal angioplasty (PTA) and a insertion and placement of the Gianturco's expandable metallic stents was carried out for the remaining stenosis of the subclavicular vein and a residual compression. Venograms, 7 months after operation, showed widely the patent subclavian vein. Trans-infraclavicular approach allowed exposure of the stenotic or obstructed segments of the subclavian vein. The PTA and stenting, especially after removal of compressive elements or during chronic phase, was a very useful and effective procedure for the treatment of the Paget-Schroetter syndrome.
A case of aneurysm of the mitral valve associated with aortic valve regurgitation is presented. The patient was 45-years-old female who complained of palpitation and underwent both aortic and mitral valve replacement. We could not detect the aneurysm by the transthoracic echocardiography because of it's small size (14 mm in diameter). The transesophageal echocardiography showed the aneurysm of the anterior mitral valve leaflet toward the left atrium clearly. This report describes that transesophageal echocardiography appears to be available for accurate diagnosis of the mitral valve disease, especially for the mitral valve aneurysm.
Among 361 consecutive patients who underwent open surgery from Jan. 1987 to Sept. 1991, risk factors and clinical courses were analyzed retrospectively in comparison between infants-children and adults. Seven mediastinitis (4.0%) occurred in 173 adult patients (20 to 75 y/o, mean: 54.4 y/o) and were not associated with age, sex, type of disease, and duration of operation or cardiopulmonary bypass. Postoperative mediastinitis significantly increased in the patients with low output syndrome (LOS) determined as use of IABP and/or assistant circulations (p < 0.001) and reexploration for bleeding or tamponase was associated with an increased risk for mediastinitis (p < 0.01). Five mediastinitis (2.7%) occurred in 188 infants and children (0 to 17 y/o, mean: 4.2 y/o). All patients involved with mediastinitis were less than 12 month old (2.6 +/- 3.3 month). None of the other factors was associated with an increased risk for this complication. Bacterial cultures of exudate were positive in 11 of 12 patients, and identified as MRSA in 10 and Staphylococcus epidermidis in one. In the seven of adult patients, two developed sepsis and four died with other organic failures or mediastinal bleeding. All five of infants healed after postoperative 33 to 145 days. The immature state of immune response might associate with postoperative mediastinitis in infants, whether LOS may be important in the immune suppression by surgical stress in adults, and the prognosis of mediastinitis might be effected by prolonged depression of postoperative cardiac function in adult patients.
Fourty-one patients (2-44 month old) underwent the closure of ventricular septal defect using moderate-hypothermic cardiopulmonary bypass (CPB). The respiratory index (RI) were monitored after CPB, as functional parameters of oxygenation capacity. At 15 min after CPB, there was the increased level in RI (2.22 +/- 0.45; normal value: 0.1-0.37). Thereafter, RI gradually decreased by 90 min after CPB (1.22 +/- 0.19), and again increased reaching peak levels by 12 hrs after ICU-entry (2.56 +/- 0.64). The patients who exceed 1.00 at 15 min after CPB (RI-15) remained higher levels in RI compared to less than 1.00 and had the prolonged controlled ventilation. The RI-15 correlated with pulmonary-systemic flow ratio (Qp/Qs) and pulmonary-left ventricular pressure ratio (PA/LV). There was no significant correlation between RI-15 and CPB factors including CPB time, dilution rate, rectal temperature, flow and perfusion pressure. These results suggest that pulmonary dysfunction following the CPB may not be simply occurred by CPB but also involved by preoperative conditions. An increased pulmonary blood flow might be one of important and predictive factor for the depression of oxygenation following the cardiac surgery in infants and children.
To remove regionally recurrent cancer of the rectum completely, more radical extensive resections were attempted than the conventional ones in 35 patients. Twenty-two patients underwent total pelvic exenteration. In 23, sacral resection was done, combined with other procedures including excision of the entire circumference of the lower pelvic ring. There were two hospital deaths. Delayed wound healing was seen in ten. Preoperative severe pain was alleviated in 18. Also, perineal ulcer, vaginal bleeding, bloody stools, and tenesmus disappeared. Of the four 5-year survivors (estimated rate, 23%), only one was disease-free. A second recurrence was seen in 27 patients, of whom 23 had regional failure. It was concluded that so-called local recurrence is a lesion more widespread than indicated by imaging and biopsy. Therefore, even the most radical resection rarely can cure this disease. However, such a surgical procedure can afford more effective palliation than other treatments and may prolong life in selected patients significantly.
Griseolic acid (GA) is a potent cyclic AMP (cAMP) phosphodiesterase (PDE) inhibitor that has an adenine base and two carboxyl groups in its molecule (Nakagawa F, Okazaki T, Naito A, Iijima Y and Yamazaki M, J Antibiot 38: 823-829, 1985). GA analogues were synthesized in which the adenine group was substituted with guanine (6-deamino-2-amino-6-hydroxygriseolic acid, G-GA) or hypoxanthine (6-deamino-6-hydroxygriseolic acid, H-GA). Their inhibitory activities to cyclic GMP (cGMP) PDE and cAMP PDE were compared with GA. For cGMP PDE from rod outer segments of bovine retina, the IC50 values of GA, G-GA and H-GA were 18, 0.040 and 0.12 microM, respectively, with 0.25 microM cGMP as substrate. For type IV PDE isozyme from mouse 3T3 fibroblast cells, the IC50 values of GA, G-GA and H-GA were 0.021, 15 and 11 microM, respectively, with 0.25 microM cAMP as substrate. Thus, GA and G-GA were found to be base-selective inhibitors of type IV PDE of 3T3 cells and type V PDE of bovine retinas, respectively. Esters of carboxylic acids of GA were synthesized in order to increase permeability into cells, and their efficacy was tested by measuring the accumulation of cAMP in 3T3 cells. The dipivaloyloxymethyl ester of GA was found to increase cAMP levels at 0.1 microM, while GA and 3-isobutyl-1-methylxanthine were active only above 100 microM, and the dimethyl ester of GA was inactive. The dipivaloyloxymethyl ester of GA seems to exert its activity after conversion to GA in the cell, since the pivaloyloxymethyl ester was easily hydrolysed by the enzyme action and the dipivaloyloxymethyl ester of GA itself was much less potent an inhibitor of PDE. The dipivaloyloxymethyl ester of GA inhibited thrombin-induced aggregation of platelets and stimulated lipolysis of adipocytes at low concentrations.
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The noncompetitive NMDA receptor antagonist MK-801, (+)-5-methyl-10,11-dihydro-5H-dibenzo-[a,d]-cyclohepten-5,10-imine , increased ambulatory activity in the mouse at doses over 0.1 mg/kg (IP). The effect was enhanced when 0.3 mg/kg MK-801 was repeatedly administered at intervals of 3-4 days. In contrast, a reduction of the effect was induced with repeated doses of 0.1 and 1 mg/kg. The mice that had repeatedly experienced 1 mg/kg MK-801 exhibited a decrease in the sensitivity to methamphetamine (2 mg/kg SC). In addition, the repeated co-administration of 1 mg/kg MK-801 with methamphetamine induced a decrease in the sensitivity to methamphetamine. No modification of methamphetamine sensitivity was elicited by 0.1 and 0.3 mg/kg MK-801 in both the single and co-administration schedules. On the other hand, established sensitization to methamphetamine was hardly affected by repeated treatment with 0.1-1 mg/kg MK-801. These results indicate that the mechanism of the inhibitory action of MK-801 on the development of methamphetamine sensitization is different from that of dopamine D2 antagonists, which may act to decrease the effective unit dose of methamphetamine and reduce ambulation-increasing effect of methamphetamine.
We measured penile blood flow during physiological erection using the Xenon-133 clearance method in order to diagnose the exact cause of impotence. In 16 patients, in whom complete erection was obtained after visual sexual stimulation, the mean penile blood flow during erection was apparently higher than that in the flaccid state. On the contrary, in 6 patients whose reaction to visual stimulation was poor, penile blood flow did not change before and after stimulation. We considered that increased arterial flow was indispensable, but complete venous outlet obstruction was not necessary to produce a rigid erection. In addition, in the flaccid state the mean penile blood flow in the poor response group was apparently higher than that in the response group. This means that some patients who fail to obtain sufficient erection after visual sexual stimulation have increased venous outflow from the corpus cavernosum in the flaccid state. Based on these findings, the main cause of erectile dysfunction in such cases is probably attributed to disorders of the venous outlet system in the cavernous body.