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Biomedical subjects

Y Takesue

Publications and source records attributed to Y Takesue.

At least 37 records · Page 2Linked to original sources
PubMed1999

Analysis of mec regulator genes in clinical methicillin-resistant Staphylococcus aureus isolates according to the production of coagulase, types of enterotoxin, and toxic shock syndrome toxin-1.

The intrinsic resistance of methicillin-resistant Staphylococcus aureus (MRSA) is frequently explained by the production of an additional penicillin-binding protein (PBP), which is encoded by the mecA gene. The mec regulator genes, mecR1 and mecI, was identified in mecA-carrying Staphylococcus aureus N315. Between February and March, 1993, 179 clinical MRSA isolates were collected from institutions in Hiroshima prefecture. According to serological types of coagulase, enterotoxins, and toxic shock syndrome toxin-1 (TSST-1) productions, these strains were classified into 6 groups. In 53 strains chosen from all groups, mec regulatory gene distributions were divided into two groups; one with whole regulatory genes and another with the lacking region, including 3'-partial region of the mecR1 gene and mecI gene. This same deletion was detected across the different groups, suggesting that the deletion occurred at the ancestral strain before branching according to coagulase or enterotoxin productions. The strains with this lacking region showed a high-level of resistance to methicillin, while the strains with whole regulatory genes consisted of low and high levels of resistant strains. The highly resistant strains with whole regulatory genes were found to harbor a point mutation in the mecI gene. The basal levels of mecA gene transcription were elevated in the strains with the lacking region or the mecI point mutations. These data suggest that deletion or mutation of the mecI gene, the repressor on the mecA gene, might play an important role in methicillin resistance in clinical isolates of MRSA.

Bacterial Proteins↗
PubMed1998

Prediction for the development of postoperative infections in the operation of esophageal cancer compared with gastric surgery.

The purpose of this study was to assess the point at which the postoperative infection has occurred in order to decide upon the proper duration of prophylactic antibiotic use. Another goal of this study was to determine whether prediction for the development of postoperative infections in major surgery such as esophagectomy should be the same as that in routine gastroenterological surgery. Twenty-five patients who underwent transthoracic esophagectomy and 127 patients who underwent gastrectomy were studied. On the third day after gastric surgery, the body temperature of patients who developed an infection was higher than that of the patients who did not develop an infection. The relative changes in peripheral white blood count (WBC), and C-reactive protein (CRP) concentration on the third and fourth days were more predictive of the development of infection than the absolute values. Almost all patients with systemic inflammatory response syndrome (SIRS) on the third day after gastric surgery developed an infection. On the other hand, the incidence of SIRS in patients who did not develop an infection was high on both the third and fourth days after esophageal surgery. It was nearly impossible to predict who would develop an infection in esophageal surgery. The high incidence of postoperative infections, and their significant consequences justify planned successive postoperative antibiotic use in esophageal surgery.

Antibiotic Prophylaxis↗
PubMed1997

Postoperative enteritis caused by methicillin-resistant Staphylococcus aureus.

We examined the clinical features of 14 men (mean age 72 years) with postoperative enteritis caused by methicillin-resistant Staphylococcus aureus (MRSA). The patients had all undergone surgery for the treatment of digestive diseases and had received antibiotic prophylaxis consisting of an extended-spectrum cephem. Diarrhea appeared a mean of 3.3 days postoperatively and lasted for 5 days on average. In severe cases organ insufficiency was involved. Coagulate-positive staphylococci were the predominant organisms isolated from watery diarrhea. In 13 of 14 patients, coagulase type II isolates producing enterotoxins A, C and toxic shock syndrome toxin-1 (TSST-1) with enterotoxin A, C, and 1st genes were isolated. These strains were sensitive to vancomycin and arbekacin; however, they were highly resistant to many other antibiotics. We also investigated the effects of a glucocorticoid hormone and gamma globulin on production of tumor necrosis factor-alpha (TNF-alpha) and interleukin-2 (IL-2) obtained from healthy volunteers. TNF-alpha and IL-2 production was enhanced by TSST-1 and the supernatant of Iscove-modified dulbecco medium, in which coagulase type II isolates producing enterotoxins A, C and TSST-1 with enterotoxin A, C were cultured for 24 h. Both glucocorticoid hormone and gamma globulin suppressed TNF-alpha and IL-2 production, thus suggesting that these drugs may be effective in treating postoperative MRSA enteritis.

Aged↗
PubMed1997

Surgical treatment for duodenal involvement in Crohn's disease: report of a case.

A 29-year-old woman was hospitalized with a 1-month history of postprandial epigastric pain, nausea, and vomiting. An upper gastrointestinal tract X-ray series showed a marked narrowing of the pyloric region. A histological examination of duodenal mucosal biopsy samples showed granulomatous inflammation, and thus a diagnosis of intrinsic duodenal Crohn's disease was made. A second upper gastrointestinal tract X-ray revealed a persistent gastric outlet obstruction. At laparotomy, the duodenal wall was found to be thickened over a distance measuring 3.5 cm in length from the pyloric ring. A longitudinal incision was made over the entire length, up to 5.5 cm beyond the pyloric ring on either side, while Finney-type anastomosis was also performed. A postoperative upper gastrointestinal tract X-ray showed an improvement in the gastroduodenal passage. Enteral nutrition therapy was provided postoperatively. Omeprazole was administered at a dose of 20 mg/day for 2 months. The patient currently remains on maintenance therapy with famotidine at 20 mg/day and is clinically doing well.

Adult↗
PubMed1997

Influence of ileal pouch capacity and anal sphincteric function on the clinical outcome after ileal pouch-anal anastomosis.

This study was designed to determine the influence of ileal pouch capacity and anal sphincteric function on the clinical outcome after ileal pouch-anal anastomosis. A total of 24 patients who had undergone ileal pouch-anal anastomosis (J pouch) for ulcerative colitis were studied. The 24-hour stool frequency was found to be inversely correlated with the sensitivity threshold volume (STV), maximal tolerance volume (MTV), and distensibility, but was independent of the maximal resting pressure and maximal squeeze pressure. Patients experiencing nocturnal fecal incontinence had maximal resting pressures that were significantly lower than those of nocturnally continent patients. Among the patients with fecal incontinence, those with frequent soiling had lower resting pressures, STV, and distensibility than the patients with intermittent spotting. In addition, the STV in patients needing nocturnal evacuation were lower than those of patients who did not evacuate after falling asleep. The conclusions are as follows. Both stool frequency and the need for nocturnal pouch evacuation correlated directly with pouch volume. Anal incontinence was more common in patients with low internal sphincteric function. In addition, frequent and gross nocturnal incontinent patients demonstrate a worse function in both the anal sphincter and reservoir than those with intermittent spotting.

Adolescent↗
PubMed1996

Purification and characterization of alpha-glucosidase complex from the intestine of the frog, Rana japonica.

The enzymes responsible for much of the isomaltase and maltase activities in the intestine of the frog, Rana japonica, were purified by detergent solubilization and affinity chromatography on Sephadex G-200 gel. The two activities paralleled each other during purification. The isomaltase, maltase and glucoamylase activities eluted in the same pattern on Sepharose 4B gel filtration as well as on Sephadex G-200 gel affinity chromatography. Anti-rabbit sucrase-isomaltase antibody inhibited the isomaltase activity but not the maltase or glucoamylase activity of the purified enzyme preparation, while the three activities were precipitated in parallel by the antibody. The isomaltase activity was more stable at 55 degrees C than the maltase and glucoamylase activities. On SDS-polyacrylamide gel electrophoresis under nondissociating conditions the purified enzyme preparation showed only one major band of 330 kDa, while under dissociating conditions it showed two bands of 116 and 212 kDa. These results suggest that isomaltase (apparently with no or minor maltase activity) is due to a protein domain (or protein) different from one which is responsible for maltase and glucoamylase activities. This implies that isomaltase is associated with maltase/glucoamylase to form alpha-glucosidase complex in the brush border membrane of the frog intestine.

Animals↗
PubMed1996

[Biodegradable controlled-release 5-FU implant in the surgery for glaucoma. Experimental study].

BACKGROUND: 5-Fluorouracil (5-FU) is useful as an adjunct treatment for glaucoma filtering surgery. However, efficacy depends upon maintaining sustained drug levels, currently achieved by repeated daily injections of the drug for several days. To overcome this limitation, we designed a biodegradable implant for the sustained release of 5-FU. MATERIAL AND METHODS: The implant (0.79 mm diameter, 6 mm long, 2.2 mg weight) contains 0.66 mg of 5-FU and is loaded in a needle coupled to a custom-made instrument to permit subconjonctival insertion of the implant through a 2 mm wide snip incision. The in vitro and in vivo pharmacokinetics as well as the biocompatibility studies of the implants were assessed in the rabbit. RESULTS: No infection, inflammatory reaction or extrusion occurred. The implant released the drug at a constant rate of 1.20 micrograms/hr for over 18 days and totally biodegraded in less than 86 days. CONCLUSION: Implantation of the device, after laser sclerostomy or conventional trabeculectomy shows great potential for the treatment of glaucoma. To determine the implant's efficacy, additional studies in the cat are underway.

Animals↗
PubMed1996

[Perioperative managements for postoperative severe infections in compromised host].

The incidence of postoperative infections, especially due to multi-drug resistant strains such as Pseudomonas sp., Enterococcus sp., and Methicillin resistant Staphylococcus aureus (MRSA), is high in compromised hosts. Among them, respiratory infection, catheter sepsis, and drug-associated enteritis are frequently observed and respiratory infection is liable to fall into serious illness. These infections have characteristics in causative organisms. Pseudomonas aeruginosa or MRSA are frequently isolated in respiratory infections and Candida or coagulase-negative staphylococcus are frequently isolated in catheter sepsis. G-test in addition to blood culture is necessary for early diagnosis of Candida sepsis, vancomycin should be administered in early phase of antibiotic-associated enteritis, since this infection is usually caused by MRSA or Clostridium difficile and frequently falls into serious illness. The patients with protein-calorie malnutrition, liver cirrhosis, renal failure, diabetes melitis, administration of anticancer drugs and/or radiation therapy, serious injury, or severe operative stress are considered to be compromised hosts in surgical field, and the adequate perioperative managements according to these disorders should be carried out against postoperative infections.

Bacterial Infections↗
PubMed1995

Severity and predicted outcome of postoperative Pseudomonas aeruginosa infections.

The severity and predicted outcome of postoperative Pseudomonas aeruginosa (P. aeruginosa) infections (PPAI) was evaluated using a severity scoring system based on a simplification and modification of the APACHE II system. A total of 86 patients in whom P. aeruginosa was isolated from various sources were examined. PPAI developed in 50 patients, resulting in an overall mortality rate of 24%. An increased severity score (SS) correlated with an increased risk of developing PPAI. Thus, PPAI developed in 33% of the patients with an SS of 0-1, in 66.7% of those with an SS of 2-3, and in 100% of those with an SS of 6 or higher. Moreover, the mortality rate of the patients with an initial score of 6 or higher was 50%. The mean (+/- SD) initial severity score was 5.4 +/- 2.9 for survivors and 2.9 +/- 2.6 for nonsurvivors (P < 0.01). In the patients who subsequently died, the SS remained high throughout the clinical course despite therapy, whereas in the survivors the SS decreased progressively, reflecting a favorable clinical course. These results suggest that our severity scoring system was useful for predicting outcome and monitoring the response of PPAI to therapy.

Adult↗
PubMed1995

Mac-1 expression and superoxide generation of the peripheral polymorphonuclear leukocyte following gastrectomy and esophagectomy.

The aim of this study was to evaluate the characteristics of the polymorphonuclear leukocyte (PMN) function after surgical stress. We investigated Mac-1 expression and superoxide generation by peripheral PMNs and serum granulocyte-colony stimulating factor (G-CSF) concentrations in 15 patients who underwent either gastrectomy (n = 8) or esophagectomy (n = 7). The serum G-CSF rapidly increased within 24 hours after operation. The maximum levels of serum G-CSF in the cases of esophagectomy were about 5-8 fold those of gastrectomy, although the increases in PMN counts within 24 hours of esophagectomy were lower than those after gastrectomy. Mac-1 expression and superoxide generation by PMN counts and serum G-CSF. After esophagectomy, Mac-1 expression on peripheral PMNs remained elevated through the 7th day after operation, while superoxide generation by PMNs in response to PMA declined to below preoperative levels after the 3rd day. These results suggest that, after major surgery such as esophagectomy, there is a discrepancy between Mac-1 expression and superoxide generation by the peripheral PMN despite a high level of serum G-CSF.

Aged↗
PubMed1994

Ultraviolet solid-state laser (213-nm) photorefractive keratectomy. In vivo study.

BACKGROUND: The pulsed ultraviolet 213-nm solid-state laser has been demonstrated as an alternative to the gas argon-fluoride 193-nm excimer laser for photorefractive keratectomy (PRK). The authors studied the clinical course and histopathologic changes occurring in rabbit corneas after PRK with a 213-nm solid-state laser. METHODS: The 213-nm output of neodymium:YAG frequency-quintupled laser was used to create 5-mm optical zone ablations in seven pigmented rabbit corneas. The radiant exposure was 250 mJ/cm2 delivered through a computer-controlled scanning delivery system with a spot size of 0.5 mm. The target ablation was 4.0 diopters with an estimated ablation depth of 40 microns. A clinical estimate of corneal epithelial healing and stromal haze was made at intervals over the 3-month study period. Animals were killed immediately after ablation, or at 10 days, 1 month, or 3 months after ablation. Corneal tissue was preserved for light microscopy and transmission electron microscopy at each study interval. RESULTS: All corneas re-epithelialized within 10 days postoperatively. Anterior stromal haze was clinically visible at 3 days, increased until approximately 1 month, and then gradually decreased over the succeeding 2 months. Residual subepithelial haze was visible at 3 months. Results of histopathologic study documented normal epithelium healing over time; the basement membrane retained its regular thickness and hemidesmosomes were abundant at 3 months. The anterior stroma had an increased number of fibroblasts at 10 days, many of which remained until 1 month. A mild, transient, cellular reaction occurred throughout the thickness of the stroma and the endothelium. CONCLUSION: Using the 213-nm ultraviolet solid-state laser with a scanning delivery system, PRK shows a similar clinical course and histopathologic findings to the 193-nm excimer PRK study in rabbits. It is a clinically viable procedure for refractive surgery and requires further human clinical trails to determine its efficacy.

Animals↗
PubMed1994

Susceptibility of methicillin-resistant Staphylococcus aureus clinical isolates to various antimicrobial agents. IV. Aminoglycoside-modifying enzyme AAC(6')/APH(2") is responsible for arbekacin-resistance enhanced by bleomycin.

Resistance patterns against various antimicrobial agents including beta-lactams, aminoglycosides, tetracyclines, fluoroquinolones, macrolides were examined for 58 strains of methicillin-resistant Staphylococcus aureus (MRSA) isolated at Hiroshima University Hospital from April to November 1992. All the MRSA strains produced type II-coagulase but not beta-lactamase. Regarding aminoglycoside-modifying enzymes, 7 strains (12%) appeared to be producing aminoglycoside 4',4"-adenyltransferase AAD(4',4") encoded by aadD without coproduction of bifunctional aminoglycoside 6'-acetyltransferase/2"-phosphotransferase AAC(6')/APH(2") encoded by aacA-aphD (referred to as tobramycin-resistant type, TOBr). The remaining 51 strains (88%) were phenotypically producers of both enzymes (i.e., mix-resistant type, Mixr). AAD(4',4"), encoded by aadD which was reported to be closely linked with bleomycin (BLM)-resistance determinant, could be seen in 100% MRSA strains and ca. 90% strains expressed AAC(6')/APH(2"). BLM endowed Mixr-type but not TOBr-type MRSA strain with enhanced resistance to arbekacin (ABK) dose-dependently, presumably by modifying the production of AAC(6')/APH(2"). The manifestation of ABK-resistant phenotype by Mixr-type MRSA required the coexistence of BLM. Therefore, ABK must be administered carefully to cure MRSA infection in patients who have been treated with BLM.

Acetyltransferases↗
PubMed1994

Defecation mechanisms in conscious dogs after total colectomy with ileorectal anastomosis.

To clarify defection mechanisms in those with total colectomy, we performed comparative studies of intestinal motility in two groups of straight and J-pouch ileorectal anastomosis. In the straight group, 98 percent of the interdigestive migrating contractions (IMC) reached the anastomosis and 48 percent of the defecations were affected by the contractions. In the J-pouch group, 16 percent of the contractions reached the anastomosis and only 8 percent of the defecations were related to the contractions. We conclude that transmission of IMC to the rectum is related to the frequency of defecation after total colectomy and that the disappearance of IMC in the J-pouch anastomosis reduced the frequency of defecations in those instances.

Animals↗
PubMed1994

[Results of a 2-year animal experiment with reticulated polyethylene oxide intrastromal rings].

Gel Injection Adjustable Keratoplasty (GIAK) is a technique previously described by G. Simon for the correction of myopia. Following pachometry, a 0.8 mm wide, 80% deep linear incision is performed 2.5 mm from the apex. Using a guide, a 1 mm wide, 5 mm diameter annular spatula is introduced to dissect an interlamellar canal and the crosslinked polyethylene oxide hydrogel is injected with a modified 23 gauge needle. The biocompatibility to 13 PEO batches was studied on 21 albino rabbits (Follow up 15 to 135 days). In nineteen, the cornea remained perfectly transparent. Two animals presented an infection at POD 1. Histopathology showed no endothelial deterioration, no anomaly of the thickness or of the cellular morphology around the injected zone. However some mononuclear cells were noticed surrounding the hydrogel in some rabbits together with thinning of the corneal epithelium anterior to the injected zone. A pilot refractive study was conducted on 5 cats using 2 PEO gels. One cat developed an infection following surgery. A second developed an inflammatory response with corneal neovascularization at POD 8. Thus, these animals were not included in the follow-up study which ranged from 6 to 28 months. Immediately after surgery, the refractive effect, measured with the Canon SK-1 digital autokeratometer, was 5.22 +/- 0.46 D (SD) of flattening. The long term effect (26 months) of the GIAK procedure appears to be stable and safe when using sterile PEO gels made of highly purified materials.

Animals↗
PubMed1994

[A study of nosocomial infections by the comparison of methicillin-resistant Staphylococcus aureus and Pseudomonas aeruginosa].

The objective of this study was to investigate nosocomial infections by the comparison of methicillin-resistant Staphylococcus aureus (MRSA) and Pseudomonas aeruginosa. We made a serological classification of 262 strains of Pseudomonas aeruginosa between 1983 and 1991. Group E strains were prevalent in 1987 and group F strains after 1990. Both these groups strains were resistant to several antibiotics, and were scarcely detected from the appendix contents in appendicitis that originated outside the hospital. Therefore we presumed these were nosocomial pathogens. With the countermeasures to nosocomial infections from 1987 on the isolation rate of enterotoxin type B and C MRSA strains decreased. Following this MRSA change, almost group E strains disappeared in Pseudomonas aeruginosa. Whereas type AC MRSA began to isolated abruptly from 1990, and the isolation of group F strains increased simultaneously. Type B and C strains still remained high sensitivity to minocycline. Type AC which have already gotten resistance to minocycline took the place of type B and C and prevalented. Similarly group F in Pseudomonas aeruginosa took the place of group E as soon as the former acquired resistance to carbapenem.

Cross Infection↗
PubMed1993

A study on postoperative enteritis caused by methicillin-resistant Staphylococcus aureus.

We investigated the production of staphylococcal enterotoxin (SE) with respect to coagulase types by methicillin-resistant Staphylococcus aureus (MRSA). A total of 138 strains of MRSA, which were isolated from clinical materials in the surgical ward between 1983 and 1990, were studied. Coagulase type IV strains produced SE A only, whereas coagulase type II strains were classified into four groups by SE production: SE B producing strains (32.7%), SE C producing strains (29.8%), SE B and C coproducing strains (12.5%), and SE A and C coproducing strains (25.0%). Almost all of the organisms (nine of ten) which were isolated from the feces of patients with MRSA enteritis were SE A and C coproducing strains. The coincidence in time of the prevalence of MRSA enteritis and the isolation SE A and C coproducing strains also demonstrated that these strains caused MRSA enteritis. Although SE C producing strains and SE A and C coproducing strains were simultaneously prevalent in 1990, the former tended to be sensitive while the latter tended to be resistant to minocycline. Considering the variety of antibiotic sensitivity in coagulase type II strains, it is thus considered to be of critical importance for epidemiologic purposes to further characterize isolates by SE typing.

Aged↗