1
|
Suzuki Y, Nagase H, Toyota H, Ohyatsu S, Kobayashi K, Takeshita Y, Uehara Y, Hattori S, Ishizuka M, Sakasegawa H, Kuramochi M, Kohyama T, Sugimoto N. Questionnaire for diagnosing asthma-COPD overlap in COPD: Development of ACO screening questionnaire (ACO-Q). Allergol Int 2023:S1323-8930(23)00005-9. [PMID: 36868950 DOI: 10.1016/j.alit.2023.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 01/05/2023] [Accepted: 01/18/2023] [Indexed: 03/05/2023] Open
Abstract
BACKGROUND The considerable prevalence and worse outcomes of asthma-COPD overlap (ACO) in COPD have been reported, and optimal introduction of ICS is essential for ACO. However, diagnostic criteria for ACO consist of multiple laboratory tests, which is challenging during this COVID-19 era. The purpose of this study was to create a simple questionnaire to diagnose ACO in patients with COPD. METHODS Among 100 COPD patients, 53 were diagnosed with ACO based on the Japanese Respiratory Society Guidelines for ACO. Firstly, 10 candidate questionnaire items were generated and further selected by a logistic regression model. An integer-based scoring system was generated based on the scaled estimates of items. RESULTS Five items, namely a history of asthma, wheezing, dyspnea at rest, nocturnal awakening, and weather- or season-dependent symptoms, contributed significantly to the diagnosis of ACO in COPD. History of asthma was related to FeNO >35 ppb. Two points were assigned to history of asthma and 1 point to other items in the ACO screening questionnaire (ACO-Q), and the area under the receiver operating characteristic curve was 0.883 (95% CI: 0.806-0.933). The best cutoff point was 1 point, and the positive predictive value was 100% at a cutoff of 3 points or higher. The result was reproducible in the validation cohort of 53 patients with COPD. CONCLUSIONS A simple questionnaire, ACO-Q, was developed. Patients with scores ≥3 could be reasonably recommended to be treated as ACO, and additional laboratory testing would be recommended for patients with 1 and 2 points.
Collapse
Affiliation(s)
- Yuki Suzuki
- Division of Respiratory Medicine and Allergology, Department of Medicine, Teikyo University School of Medicine, Tokyo, Japan
| | - Hiroyuki Nagase
- Division of Respiratory Medicine and Allergology, Department of Medicine, Teikyo University School of Medicine, Tokyo, Japan.
| | - Hikaru Toyota
- Division of Respiratory Medicine and Allergology, Department of Medicine, Teikyo University School of Medicine, Tokyo, Japan
| | - Sho Ohyatsu
- Department of Internal Medicine, Teikyo University Mizonokuchi Hospital, Kanagawa, Japan
| | - Konomi Kobayashi
- Division of Respiratory Medicine and Allergology, Department of Medicine, Teikyo University School of Medicine, Tokyo, Japan
| | - Yuri Takeshita
- Division of Respiratory Medicine and Allergology, Department of Medicine, Teikyo University School of Medicine, Tokyo, Japan
| | - Yuuki Uehara
- Division of Respiratory Medicine and Allergology, Department of Medicine, Teikyo University School of Medicine, Tokyo, Japan
| | - Saya Hattori
- Division of Respiratory Medicine and Allergology, Department of Medicine, Teikyo University School of Medicine, Tokyo, Japan
| | - Mana Ishizuka
- Division of Respiratory Medicine and Allergology, Department of Medicine, Teikyo University School of Medicine, Tokyo, Japan
| | - Hirokazu Sakasegawa
- Division of Respiratory Medicine and Allergology, Department of Medicine, Teikyo University School of Medicine, Tokyo, Japan
| | - Michio Kuramochi
- Division of Respiratory Medicine and Allergology, Department of Medicine, Teikyo University School of Medicine, Tokyo, Japan
| | - Tadashi Kohyama
- Department of Internal Medicine, Teikyo University Mizonokuchi Hospital, Kanagawa, Japan
| | - Naoya Sugimoto
- Division of Respiratory Medicine and Allergology, Department of Medicine, Teikyo University School of Medicine, Tokyo, Japan
| |
Collapse
|
2
|
Ito A, Miyoshi S, Toyota H, Suzuki Y, Uehara Y, Hattori S, Takeshita Y, Sakasegawa H, Kuramochi M, Kobayashi K, Sugimoto N, Nagase H. [THE OVERLAPPING ELIGIBILITY FOR BIOLOGICS IN PATIENTS WITH SEVERE ASTHMA AND PHENOTYPES]. Arerugi 2022; 71:210-220. [PMID: 35569943 DOI: 10.15036/arerugi.71.210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
BACKGROUND Biologics are an important treatment option for patients with severe asthma. Four biologics are available in Japan, and an overlapping eligibility has been observed. The eligibility and availability of drugs depend on the local regulations of different countries. However, there is no precise information about the eligibility for biologics, including dupilumab, in Japan. The aim of the study was to investigate the overlapping eligibility and to analyze the phenotypes of patients with multiple eligibility. METHODS In this observational study, a retrospective chart review of patients was performed. The eligibility criteria for omalizumab were IgE 30-1500IU/mL and positive IgE for perennial aeroallergen. The eligibility criteria for IL-5-targeted biologics (mepolizumab and benralizumab) were eosinophil counts (Eos) > 150μL, while those for dupilumab were Eos > 150μL or fraction of exhaled nitric oxide (FeNO) > 150ppb or IgE > 167IU/mL. Severe asthma was defined by the severity criteria under treatment based on Japanese guidelines for adult asthma. RESULTS One hundred patients with severe asthma were identified. The eligibility for omalizumab, IL-5-targeted therapies, and dupilumab was 43%, 69%, and 82%, respectively. Thirty percent of the patients were eligible for all the four biologics and showed the lowest FEV1, frequent exacerbation history, and the highest levels of Eos, FeNO, and serum periostin. Only 11% of the patients were not indicated for any biologics. CONCLUSION A considerable portion of patients was eligible for all the biologics. Asthma control was poor, and type 2 inflammation was prominent in such patients.
Collapse
Affiliation(s)
- Ayaka Ito
- Division of Respiratory Medicine and Allergology, Department of Medicine, Teikyo University School of Medicine
| | - Shoki Miyoshi
- Division of Respiratory Medicine and Allergology, Department of Medicine, Teikyo University School of Medicine
| | - Hikaru Toyota
- Division of Respiratory Medicine and Allergology, Department of Medicine, Teikyo University School of Medicine
| | - Yuki Suzuki
- Division of Respiratory Medicine and Allergology, Department of Medicine, Teikyo University School of Medicine
| | - Yuki Uehara
- Division of Respiratory Medicine and Allergology, Department of Medicine, Teikyo University School of Medicine
| | - Saya Hattori
- Division of Respiratory Medicine and Allergology, Department of Medicine, Teikyo University School of Medicine
| | - Yuri Takeshita
- Division of Respiratory Medicine and Allergology, Department of Medicine, Teikyo University School of Medicine
| | - Hirokazu Sakasegawa
- Division of Respiratory Medicine and Allergology, Department of Medicine, Teikyo University School of Medicine
| | - Michio Kuramochi
- Division of Respiratory Medicine and Allergology, Department of Medicine, Teikyo University School of Medicine
| | - Konomi Kobayashi
- Division of Respiratory Medicine and Allergology, Department of Medicine, Teikyo University School of Medicine
| | - Naoya Sugimoto
- Division of Respiratory Medicine and Allergology, Department of Medicine, Teikyo University School of Medicine
| | - Hiroyuki Nagase
- Division of Respiratory Medicine and Allergology, Department of Medicine, Teikyo University School of Medicine
| |
Collapse
|
3
|
Morton CR, Rzechorzek NJ, Maman JD, Kuramochi M, Sekiguchi H, Rambo R, Sasaki YC, Davies OR, Pellegrini L. Structural basis for the coiled-coil architecture of human CtIP. Open Biol 2021; 11:210060. [PMID: 34129781 PMCID: PMC8205527 DOI: 10.1098/rsob.210060] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
The DNA repair factor CtIP has a critical function in double-strand break (DSB) repair by homologous recombination, promoting the assembly of the repair apparatus at DNA ends and participating in DNA-end resection. However, the molecular mechanisms of CtIP function in DSB repair remain unclear. Here, we present an atomic model for the three-dimensional architecture of human CtIP, derived from a multi-disciplinary approach that includes X-ray crystallography, small-angle X-ray scattering (SAXS) and diffracted X-ray tracking (DXT). Our data show that CtIP adopts an extended dimer-of-dimers structure, in agreement with a role in bridging distant sites on chromosomal DNA during the recombinational repair. The zinc-binding motif in the CtIP N-terminus alters dynamically the coiled-coil structure, with functional implications for the long-range interactions of CtIP with DNA. Our results provide a structural basis for the three-dimensional arrangement of chains in the CtIP tetramer, a key aspect of CtIP function in DNA DSB repair.
Collapse
Affiliation(s)
- C R Morton
- Department of Biochemistry, University of Cambridge, Cambridge CB2 1GA, UK
| | - N J Rzechorzek
- Department of Biochemistry, University of Cambridge, Cambridge CB2 1GA, UK
| | - J D Maman
- Department of Biochemistry, University of Cambridge, Cambridge CB2 1GA, UK
| | - M Kuramochi
- Graduate School of Frontier Sciences, The University of Tokyo, Tokyo, Japan.,AIST-UTokyo Advanced Operando-Measurement Technology Open Innovation Laboratory, National Institute of Advanced Industrial Science and Technology, Kashiwa, Japan
| | - H Sekiguchi
- Centre for Synchrotron Radiation Research, Japan Synchrotron Radiation Research Institute, Kouto, Sayo-cho, Sayo-gun, Hyogo 679-5198, Japan
| | - R Rambo
- Diamond Light Source, Didcot, Oxfordshire OX11 0DE, UK
| | - Y C Sasaki
- Graduate School of Frontier Sciences, The University of Tokyo, Tokyo, Japan.,AIST-UTokyo Advanced Operando-Measurement Technology Open Innovation Laboratory, National Institute of Advanced Industrial Science and Technology, Kashiwa, Japan.,Centre for Synchrotron Radiation Research, Japan Synchrotron Radiation Research Institute, Kouto, Sayo-cho, Sayo-gun, Hyogo 679-5198, Japan
| | - O R Davies
- Institute of Cell Biology, University of Edinburgh, Edinburgh EH9 3BF, UK
| | - L Pellegrini
- Department of Biochemistry, University of Cambridge, Cambridge CB2 1GA, UK
| |
Collapse
|
4
|
Toyota H, Sugimoto N, Kobayashi K, Suzuki Y, Takeshita Y, Ito A, Ujino M, Tomyo F, Sakasegawa H, Koizumi Y, Kuramochi M, Yamaguchi M, Nagase H. Comprehensive analysis of allergen-specific IgE in COPD: mite-specific IgE specifically related to the diagnosis of asthma-COPD overlap. Allergy Asthma Clin Immunol 2021; 17:13. [PMID: 33541385 PMCID: PMC7860183 DOI: 10.1186/s13223-021-00514-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Accepted: 01/11/2021] [Indexed: 12/15/2022] Open
Abstract
Background Although the relationship between allergic sensitization and increased respiratory symptoms of chronic obstructive pulmonary disease (COPD) has been suggested, which allergen has a significant effect on COPD pathology is unclear. This study aimed to identify the specific IgE related to clinical features of COPD and the diagnosis of asthma-COPD overlap (ACO). Methods We recruited 76 patients with COPD and analyzed 39 IgE using panel IgE test (View Allergy 39®). ACO was diagnosed according to the Japanese Respiratory Society Guidelines. Results As for perennial aeroallergens, the positivity for moth (31.5%), Candida (23.7%), Dermatophagoides pteronyssinus (22.4%) and house dust (22.4%), and concerning pollen, Japanese cedar (35.5%) and Japanese cypress (22.2%) exceeded 20%. Only the positivity of IgE for Dermatophagoides pteronyssinus and house dust was significantly higher in ACO compared with that in non-ACO COPD. Moreover, it contributed to the diagnosis of ACO in an IgE class-dependent manner. Patients with cockroach IgE exhibited higher residual volume, whereas those with Japanese cedar IgE exhibited better diffusion capacity than negative patients. The contribution for ACO diagnosis by the receiver operating characteristic curve analysis was comparable among total IgE (cutoff value: 158 IU/mL), blood eosinophil count (234/μL), and fraction of exhaled nitric oxide (31.0 ppb). Conclusions The prominent role of mite-specific IgE in the diagnosis and pathology of ACO and the potentially detrimental effect of cockroach sensitization on air trapping in COPD were suggested. The finding highlights the future development of a treatment targeting IgE as a treatable trait in COPD.
Collapse
Affiliation(s)
- Hikaru Toyota
- Division of Respiratory Medicine and Allergology, Department of Medicine, Teikyo University School of Medicine, 2-11-1, Kaga, Itabashi-ku, Tokyo, 173-8605, Japan
| | - Naoya Sugimoto
- Division of Respiratory Medicine and Allergology, Department of Medicine, Teikyo University School of Medicine, 2-11-1, Kaga, Itabashi-ku, Tokyo, 173-8605, Japan
| | - Konomi Kobayashi
- Division of Respiratory Medicine and Allergology, Department of Medicine, Teikyo University School of Medicine, 2-11-1, Kaga, Itabashi-ku, Tokyo, 173-8605, Japan
| | - Yuki Suzuki
- Division of Respiratory Medicine and Allergology, Department of Medicine, Teikyo University School of Medicine, 2-11-1, Kaga, Itabashi-ku, Tokyo, 173-8605, Japan
| | - Yuri Takeshita
- Division of Respiratory Medicine and Allergology, Department of Medicine, Teikyo University School of Medicine, 2-11-1, Kaga, Itabashi-ku, Tokyo, 173-8605, Japan
| | - Ayaka Ito
- Division of Respiratory Medicine and Allergology, Department of Medicine, Teikyo University School of Medicine, 2-11-1, Kaga, Itabashi-ku, Tokyo, 173-8605, Japan
| | - Mariko Ujino
- Division of Respiratory Medicine and Allergology, Department of Medicine, Teikyo University School of Medicine, 2-11-1, Kaga, Itabashi-ku, Tokyo, 173-8605, Japan
| | - Fuminori Tomyo
- Division of Respiratory Medicine and Allergology, Department of Medicine, Teikyo University School of Medicine, 2-11-1, Kaga, Itabashi-ku, Tokyo, 173-8605, Japan
| | - Hirokazu Sakasegawa
- Division of Respiratory Medicine and Allergology, Department of Medicine, Teikyo University School of Medicine, 2-11-1, Kaga, Itabashi-ku, Tokyo, 173-8605, Japan
| | - Yuta Koizumi
- Division of Respiratory Medicine and Allergology, Department of Medicine, Teikyo University School of Medicine, 2-11-1, Kaga, Itabashi-ku, Tokyo, 173-8605, Japan
| | - Michio Kuramochi
- Division of Respiratory Medicine and Allergology, Department of Medicine, Teikyo University School of Medicine, 2-11-1, Kaga, Itabashi-ku, Tokyo, 173-8605, Japan
| | - Masao Yamaguchi
- Division of Respiratory Medicine and Allergology, Department of Medicine, Teikyo University School of Medicine, 2-11-1, Kaga, Itabashi-ku, Tokyo, 173-8605, Japan
| | - Hiroyuki Nagase
- Division of Respiratory Medicine and Allergology, Department of Medicine, Teikyo University School of Medicine, 2-11-1, Kaga, Itabashi-ku, Tokyo, 173-8605, Japan.
| |
Collapse
|
5
|
Tomyo F, Sugimoto N, Toyota H, Ito A, Ujino M, Sakasegawa H, Kobayashi K, Koizumi Y, Miyoshi S, Kuramochi M, Yamaguchi M, Yamamoto T, Nagase H. [PREVALENCE OF FUNCTIONAL DYSPEPSIA SYMPTOMS IN PATIENTS WITH ASTHMA]. Arerugi 2019; 68:1132-1140. [PMID: 31723110 DOI: 10.15036/arerugi.68.1132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Gastroesophageal reflux disease (GERD) is a common comorbidity among patients with asthma. In addition, functional dyspepsia (FD) is characterized by upper abdominal symptoms without organic disease manifestations. However, the prevalence of FD among patients with asthma remains uninvestigated; therefore, herein, we investigated the prevalence of dyspepsia symptoms in these patients. METHODS We recruited 156 patients with asthma from the outpatient clinic of Teikyo University Hospital and investigated the prevalence of dyspepsia symptoms using the modified Frequency Scale for the Symptoms of GERD. Further, the relationship between dyspepsia symptoms and clinical background of asthma was also investigated. RESULTS Certain digestive organ symptoms were exhibited by 83% of patients with asthma, dyspepsia symptoms by 44%, and reflux symptoms by 26%. The dyspepsia-dominant group showed significantly higher female ratio and numerically lower %FEV1 than the asymptomatic group. In the group with dyspepsia score >5 points, the ratio of patients undergoing step 4 asthma treatment and the ratio of those using long-acting muscarinic receptor antagonist were higher than those in the group with a score <5 points. Furthermore, endoscopic diagnosis was also made in 84 patients and the prevalence of FD was 21%. CONCLUSION A considerable proportion of patients with asthma exhibited dyspepsia symptoms, and the asthma severity in patients with dyspepsia was higher than those in asymptomatic patients. Based on the current findings, more attention should be directed to FD, in addition to GERD, as a comorbidity of the digestive system in patients with asthma.
Collapse
Affiliation(s)
- Fuminori Tomyo
- Division of Respiratory Medicine and Allergology Department of Medicine, Teikyo University School of Medicine
| | - Naoya Sugimoto
- Division of Respiratory Medicine and Allergology Department of Medicine, Teikyo University School of Medicine
| | - Hikaru Toyota
- Division of Respiratory Medicine and Allergology Department of Medicine, Teikyo University School of Medicine
| | - Ayaka Ito
- Division of Respiratory Medicine and Allergology Department of Medicine, Teikyo University School of Medicine
| | - Mariko Ujino
- Division of Respiratory Medicine and Allergology Department of Medicine, Teikyo University School of Medicine
| | - Hirokazu Sakasegawa
- Division of Respiratory Medicine and Allergology Department of Medicine, Teikyo University School of Medicine
| | - Konomi Kobayashi
- Division of Respiratory Medicine and Allergology Department of Medicine, Teikyo University School of Medicine
| | - Yuta Koizumi
- Division of Respiratory Medicine and Allergology Department of Medicine, Teikyo University School of Medicine
| | - Shoki Miyoshi
- Division of Respiratory Medicine and Allergology Department of Medicine, Teikyo University School of Medicine
| | - Michio Kuramochi
- Division of Respiratory Medicine and Allergology Department of Medicine, Teikyo University School of Medicine
| | - Masao Yamaguchi
- Division of Respiratory Medicine and Allergology Department of Medicine, Teikyo University School of Medicine
| | - Takatsugu Yamamoto
- Division of gastroenterology Department of Internal Medicine, Teikyo University School of Medicine
| | - Hiroyuki Nagase
- Division of Respiratory Medicine and Allergology Department of Medicine, Teikyo University School of Medicine
| |
Collapse
|
6
|
Maekawa T, Hagiwara A, Hori M, Andica C, Haruyama T, Kuramochi M, Nakazawa M, Koshino S, Irie R, Kamagata K, Wada A, Abe O, Aoki S. Effect of Gadolinium on the Estimation of Myelin and Brain Tissue Volumes Based on Quantitative Synthetic MRI. AJNR Am J Neuroradiol 2019; 40:231-237. [PMID: 30591507 DOI: 10.3174/ajnr.a5921] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Accepted: 11/12/2018] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE The effect of gadolinium on the estimation of myelin has not been reported. The aim of the current study was to investigate the effects of gadolinium on automatic myelin and brain tissue volumetry via quantitative synthetic MR imaging. MATERIALS AND METHODS The study included 36 patients who were referred for brain metastases screening, and quantitative synthetic MR imaging data before and after gadolinium-based contrast agent administration were analyzed retrospectively. Brain metastases were detected in 17 patients. WM volume, GM volume, CSF volume, non-WM/GM/CSF volume, myelin volume, brain parenchymal volume, myelin fraction (myelin volume/brain parenchymal volume), and intracranial volume were estimated. T1 and T2 relaxation times, proton density, and myelin partial volume per voxel averaged across the brain parenchyma were also analyzed. RESULTS In patients with and without metastases after gadolinium-based contrast agent administration, measurements of WM and myelin volumes, and myelin fraction were significantly increased (+26.65 and +29.42 mL, +10.14 and +12.46 mL, +0.88% and +1.09%, respectively), whereas measurements of GM, CSF, brain parenchymal, and intracranial volumes were significantly decreased (-36.23 and -34.49 mL, -20.77 and -18.94 mL, -6.76 and -2.84 mL, -27.41 and -21.84 mL, respectively). Non-WM/GM/CSF volume did not show a significant change. T1, T2, and proton density were significantly decreased (-51.34 and -46.84 ms, -2.67 and -4.70 ms, -1.05%, and -1.28%, respectively) after gadolinium-based contrast agent administration, whereas measurements of myelin partial volume were significantly increased (+0.78% and +0.75%, respectively). CONCLUSIONS Gadolinium had a significant effect on the automatic calculation of myelin and brain tissue volumes using quantitative synthetic MR imaging, which can be explained by decreases in T1, T2, and proton density.
Collapse
Affiliation(s)
- T Maekawa
- From the Department of Radiology (T.M., A.H., M.H., C.A., T.H., M.K., M.N., S.K., R.I., K.K., A.W., S.A.), Juntendo University School of Medicine, Tokyo, Japan
- Department of Radiology (T.M., A.H., S.K., R.I., O.A.), Graduate School of Medicine and Faculty of Medicine, University of Tokyo, Tokyo, Japan
| | - A Hagiwara
- From the Department of Radiology (T.M., A.H., M.H., C.A., T.H., M.K., M.N., S.K., R.I., K.K., A.W., S.A.), Juntendo University School of Medicine, Tokyo, Japan
- Department of Radiology (T.M., A.H., S.K., R.I., O.A.), Graduate School of Medicine and Faculty of Medicine, University of Tokyo, Tokyo, Japan
| | - M Hori
- From the Department of Radiology (T.M., A.H., M.H., C.A., T.H., M.K., M.N., S.K., R.I., K.K., A.W., S.A.), Juntendo University School of Medicine, Tokyo, Japan
| | - C Andica
- From the Department of Radiology (T.M., A.H., M.H., C.A., T.H., M.K., M.N., S.K., R.I., K.K., A.W., S.A.), Juntendo University School of Medicine, Tokyo, Japan
| | - T Haruyama
- From the Department of Radiology (T.M., A.H., M.H., C.A., T.H., M.K., M.N., S.K., R.I., K.K., A.W., S.A.), Juntendo University School of Medicine, Tokyo, Japan
- Department of Radiological Sciences (T.H., M.K.), Graduate School of Human Health Sciences, Tokyo Metropolitan University, Tokyo, Japan
| | - M Kuramochi
- From the Department of Radiology (T.M., A.H., M.H., C.A., T.H., M.K., M.N., S.K., R.I., K.K., A.W., S.A.), Juntendo University School of Medicine, Tokyo, Japan
- Department of Radiological Sciences (T.H., M.K.), Graduate School of Human Health Sciences, Tokyo Metropolitan University, Tokyo, Japan
| | - M Nakazawa
- From the Department of Radiology (T.M., A.H., M.H., C.A., T.H., M.K., M.N., S.K., R.I., K.K., A.W., S.A.), Juntendo University School of Medicine, Tokyo, Japan
| | - S Koshino
- From the Department of Radiology (T.M., A.H., M.H., C.A., T.H., M.K., M.N., S.K., R.I., K.K., A.W., S.A.), Juntendo University School of Medicine, Tokyo, Japan
- Department of Radiology (T.M., A.H., S.K., R.I., O.A.), Graduate School of Medicine and Faculty of Medicine, University of Tokyo, Tokyo, Japan
| | - R Irie
- From the Department of Radiology (T.M., A.H., M.H., C.A., T.H., M.K., M.N., S.K., R.I., K.K., A.W., S.A.), Juntendo University School of Medicine, Tokyo, Japan
- Department of Radiology (T.M., A.H., S.K., R.I., O.A.), Graduate School of Medicine and Faculty of Medicine, University of Tokyo, Tokyo, Japan
| | - K Kamagata
- From the Department of Radiology (T.M., A.H., M.H., C.A., T.H., M.K., M.N., S.K., R.I., K.K., A.W., S.A.), Juntendo University School of Medicine, Tokyo, Japan
| | - A Wada
- From the Department of Radiology (T.M., A.H., M.H., C.A., T.H., M.K., M.N., S.K., R.I., K.K., A.W., S.A.), Juntendo University School of Medicine, Tokyo, Japan
| | - O Abe
- Department of Radiology (T.M., A.H., S.K., R.I., O.A.), Graduate School of Medicine and Faculty of Medicine, University of Tokyo, Tokyo, Japan
| | - S Aoki
- From the Department of Radiology (T.M., A.H., M.H., C.A., T.H., M.K., M.N., S.K., R.I., K.K., A.W., S.A.), Juntendo University School of Medicine, Tokyo, Japan
| |
Collapse
|
7
|
Kojima S, Ogi M, Yoshitomi Y, Kuramochi M, Ikeda J, Naganawa M, Hatakeyama H. Changes in Bradykinin and Prostaglandins Plasma Levels during Dextran-sulfate Low-density-lipoprotein Apheresis. Int J Artif Organs 2018. [DOI: 10.1177/039139889702000310] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The negative charges of dextran-sulfate (DS) used for low-density-lipoprotein (LDL) apheresis initiate the intrinsic coagulation pathway in which plasma kallikrein acts on the high-molecular-weight kininogen to produce large amounts of bradykinin. This study was undertaken to assess whether bradykinin generated during DS LDL apheresis has any physiologic effects in vivo. The plasma levels of bradykinin, prostaglandins and cyclic guanosine monophosphate (cGMP) were compared, when either of two anticoagulants, heparin or nafamostat mesilate (NM), was used during DS LDL apheresis. Although anticoagulative action by NM depends on the inhibition of thrombin activity, this substance also inhibits the activity of plasma kallikrein. During apheresis using heparin, the plasma levels of prostaglandin E2 (PGE2) increased significantly (5.6 ± 1.2 (mean ± SE, n=4) pg/ml before apheresis and 33.4 ± 13.2 after apheresis, p < 0.05) in association with an increase in bradykinin levels (17.9 ± 2.6 pg/ml before apheresis and 470 ± 135 after apheresis, p < 0.01). Interestingly, these changes were suppressed during apheresis using NM. There were no appreciable changes in cGMP during DS LDL apheresis with either of the anticoagulants. This finding suggests that bradykinin generated during apheresis has some pathophysiological effects via activation of the prostaglandin system. Our results support the view that in patients taking angiotensin-convertingenzyme inhibitors, the anaphylactoid reaction occurring during apheresis may be caused by an excessive rise in the bradykinin levels.
Collapse
Affiliation(s)
- S. Kojima
- Department of Clinical Research and Department of Medicine, Tohsei National Hospital, City
| | - M. Ogi
- Department of Clinical Research and Department of Medicine, Tohsei National Hospital, City
| | - Y. Yoshitomi
- Department of Clinical Research and Department of Medicine, Tohsei National Hospital, City
| | - M. Kuramochi
- Department of Clinical Research and Department of Medicine, Tohsei National Hospital, City
| | - J. Ikeda
- Special Reference Laboratories City - Japan
| | | | | |
Collapse
|
8
|
Abstract
A simple method to calculate the amount of dietary (protein, sodium and potassium) intake in hemodialyzed patients was developed. In 8 nutritionally stable patients, the amount of dietary intake was monitored conventionally by a dietary record method. In contrast, assuming that the amount of dietary intake was equal to the amount of accumulation in the body, the former was calculated as the change in the product of serum concentrations and total body fluid volume, which was estimated based on the sex and body build of each patient. The urea accumulation was converted to the protein intake. The interdialytic dietary protein and sodium intake calculated by this method, 120 ± 10 g and 240 ± 40 mEq, respectively, was not significantly different from that obtained by the dietary record, while the interdialytic potassium accumulation, 60 ± 7 mEq, was significantly smaller than the dietary intake, 110 + 9 mEq, obtained by the record method, though the correlation was significant. Thus, the amount of protein and sodium intake can be calculated simply without diet research or body fluid volume measurements. Although potassium intake can not be calculated exactly because of intestinal loss, this simple method gives us a rough estimate. In addition, multiple regression analysis showed that the amount of energy intake obtained by the record method may be explained by the protein and sodium intake estimated by simple calculation.
Collapse
Affiliation(s)
- G. Kimura
- Division of Nephrology, National Cardiovascular Center Suita, Osaka - Japan
| | - S. Kojima
- Division of Nephrology, National Cardiovascular Center Suita, Osaka - Japan
| | - F. Saito
- Division of Nephrology, National Cardiovascular Center Suita, Osaka - Japan
| | - Y. Kawano
- Division of Nephrology, National Cardiovascular Center Suita, Osaka - Japan
| | - M. Imanishi
- Division of Nephrology, National Cardiovascular Center Suita, Osaka - Japan
| | - M. Kuramochi
- Division of Nephrology, National Cardiovascular Center Suita, Osaka - Japan
| | - T. Omae
- Division of Nephrology, National Cardiovascular Center Suita, Osaka - Japan
| |
Collapse
|
9
|
Kojima S, Harada-Shiba M, Toyota Y, Kimura G, Tsushima M, Kuramochi M, Sakata T, Uchida K, Yamamoto A, Omae T. Changes in Coagulation Factors by Passage through a Dextran Sulfate Cellulose Column during Low-Density Lipoprotein Apheresis. Int J Artif Organs 2018. [DOI: 10.1177/039139889201500309] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
To determine the extent of adsorption of coagulation factors by a dextran sulfate cellulose column used for selective removal of low-density lipoprotein (LDL), various coagulation factors were measured before and after application to the column during LDL apheresis. The column almost completely adsorbed many coagulation factors. Although the bradykinin concentration was markedly increased by passing the plasma through the column, this increment was suppressed by nafamostat mesilate which inhibits the initial contact phase of the intrinsic coagulation pathway. The von Willebrand factor, which forms a complex with factor VIII in plasma, is reduced in apheresis with nafamostat mesilate to the same extent as in apheresis without nafamostat mesilate. Thus, coagulation factors seem to be adsorbed by different mechanisms which include activation of the initial contact phase by the negative charges of dextran sulfate and concomitant adsorption with the phospholipid portion of lipoproteins containing apolipoprotein B or with von Willebrand factor.
Collapse
Affiliation(s)
- S. Kojima
- Department of Medicine National Cardiovascular Center Hospital, Osaka
| | - M. Harada-Shiba
- Department of Etiology and Pathophysiology, National Cardiovascular Center Research Institute, Osaka - Japan
| | - Y. Toyota
- Department of Etiology and Pathophysiology, National Cardiovascular Center Research Institute, Osaka - Japan
| | - G. Kimura
- Department of Medicine National Cardiovascular Center Hospital, Osaka
| | - M. Tsushima
- Department of Medicine National Cardiovascular Center Hospital, Osaka
| | - M. Kuramochi
- Department of Medicine National Cardiovascular Center Hospital, Osaka
| | - T. Sakata
- Department of Clinical Laboratory, National Cardiovascular Center Hospital, Osaka
| | - K. Uchida
- Department of Clinical Laboratory, National Cardiovascular Center Hospital, Osaka
| | - A. Yamamoto
- Department of Etiology and Pathophysiology, National Cardiovascular Center Research Institute, Osaka - Japan
| | - T. Omae
- Department of Medicine National Cardiovascular Center Hospital, Osaka
| |
Collapse
|
10
|
Nagase H, Sugimoto N, Nakase Y, Kamiyama A, Yoshihara H, Kuramochi M, Tashimo H, Arai H, Suzuki N, Yamaguchi M, Ohta K. The Comparison of Asthma Control Judgment Based on Japanese Guidelines for Asthma, GINA, EPR3, and ACT. J Allergy Clin Immunol 2012. [DOI: 10.1016/j.jaci.2011.12.743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
|
11
|
Toda T, Yamaguchi M, Nakase Y, Sugimoto N, Suzukawa M, Kamiyama A, Yoshihara H, Kuramochi M, Tashimo H, Arai H. Matsutake Mushroom-induced Anaphylactic Reaction: The Patient's Nonreleasing Basophils Showed Antigen-induced Histamine Release After 3-day Treatment With IL-3. J Allergy Clin Immunol 2011. [DOI: 10.1016/j.jaci.2010.12.931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
|
12
|
Tomita M, Kuramochi M, Iwata S. Superior: A Novel Repetitive DNA Element Dispersed in the Rye Genome. Cytogenet Genome Res 2009; 125:306-20. [DOI: 10.1159/000235937] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/06/2009] [Indexed: 11/19/2022] Open
|
13
|
Kuramochi M, Nakamura S. Effects of postnatal isolation rearing and antidepressant treatment on the density of serotonergic and noradrenergic axons and depressive behavior in rats. Neuroscience 2009; 163:448-55. [PMID: 19524023 DOI: 10.1016/j.neuroscience.2009.06.017] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2009] [Revised: 05/22/2009] [Accepted: 06/06/2009] [Indexed: 11/18/2022]
Abstract
The development of monoaminergic axons is affected by pharmacological and environmental manipulations during early periods of brain development. In addition, it has been proposed that changes in the density of monoaminergic axons are involved in the pathophysiology of depression. The present experiments examined the effects of neonatal treatment with antidepressants on the density of monoaminergic axons containing 5-HT or noradrenaline (NA) and depressive behavior in rats. In this study, clomipramine (CL) was used as an antidepressant, because a large amount of data has been accumulated on the effects of neonatal CL treatment on monoaminergic neurons and depressive behavior. It was also examined whether the effects of neonatal CL treatment could be further modified by environmental conditions. In the present experiments, postweaning isolation rearing (Iso) was examined as an environmental condition, because postweaning Iso is reported to change the density of 5-HT axons in the rat brain. Unexpectedly, neonatal CL treatment alone had no effect on the density of 5-HT or NA axons or depressive behavior. Postweaning social Iso rearing reduced the density of 5-HT axons in the central nucleus and basolateral nucleus of the amygdala and CA3 of the hippocampus. In the prelimbic area and infralimbic area of medial prefrontal cortex and the dentate gyrus of the hippocampus, the density of 5-HT axons was not affected by social Iso alone, but was reduced when animals were socially isolated after neonatal CL treatment. Postweaning Iso, but not neonatal CL treatment, increased immobility in the forced swim test in adolescence/early adulthood. These findings suggest that postweaning social Iso alters the density of monoaminergic axons, particularly 5-HT axons, and induces a possible model of depression, while neonatal CL treatment alone has no effect on the density of NA or 5-HT axons or depressive behavior in adolescence/early adulthood.
Collapse
Affiliation(s)
- M Kuramochi
- Department of Neuroscience, Yamaguchi University Graduate School of Medicine, 1-1-1 Minamikogushi, Ube, Yamaguchi 755-8505, Japan
| | | |
Collapse
|
14
|
Hara A, Nagase H, Hayashi H, Kuramochi M, Ishida H, Adachi T, Suzuki N, Ohta K. [Case of allergic bronchopulmonary aspergillosis complicated with lung abscess which developed into a bronchopleural fistula]. Nihon Kokyuki Gakkai Zasshi 2009; 47:432-437. [PMID: 19514508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
We report a case of bronchopleural fistula in a patient with allergic bronchopulmonary aspergillosis. A 25-year-old man was admitted with high fever and chest pain. Although his chest CT in a previous hospital showed pulmonary infiltrate suggesting the existence of a mucous plug, a mass shadow in the right upper lobe was recognized on admission to our hospital. Based on the presence of eosinophilia, elevated levels of total IgE and Aspergillus-specific IgE, positive precipitating antibody to Aspergillus, and detection of A. fumigatus in bronchial washing fluid, we diagnosed this case as ABPA complicated with lung abscess. Although we treated by antibiotics and antifungal drugs, the lung abscess did not improve and led to bronchopleural fistula. After addition of nebulised liposomal amphotericin B, his symptoms improved and treatment was successful.
Collapse
Affiliation(s)
- Asae Hara
- Department of Medicine, Teikyo University School of Medicine
| | | | | | | | | | | | | | | |
Collapse
|
15
|
Abstract
Simultaneous formation of the thrombi in two different coronary arteries is a very rare event. We present a 34-year-old man with acute myocardial infarction due to simultaneous occlusion of the two major coronary arteries. His only risk factor was smoking 40 cigarettes daily. Emergency arteriography revealed a total occlusion of the proximal left anterior descending artery (LAD) and the left circumflex coronary artery (LCx). We performed primary angioplasty to the LAD and instituted thrombolytic therapy to the LCx. During intra-aortic balloon pumping and medical treatment, the patient had no symptoms of angina. He underwent a second catheterization 4 weeks after primary angioplasty. After intravenous ergonovine provocation, coronary arteriography revealed diffuse vasospasm of the LAD and the LCx. These data suggest that habitual heavy smoking and coronary spasm may have been causatory factors for myocardial infarction in this case.
Collapse
Affiliation(s)
- Y Yoshitomi
- Division of Cardiology, Tohsei National Hospital, Shizuoka, Japan
| | | | | |
Collapse
|
16
|
Hara A, Nagase H, Kojima Y, Suzukawa M, Kuramochi M, Ishida H, Adachi T, Suzuki N, Ohta K. The Relationships between the Levels of Cytokines and Chemokines In Exhaled Breath Condensate and the Control Status of Asthma. J Allergy Clin Immunol 2009. [DOI: 10.1016/j.jaci.2008.12.994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
|
17
|
Nagase H, Takano H, Inoue K, Hara A, Kojima Y, Suzukawa M, Kuramochi M, Ishida H, Adachi T, Suzuki N. The Effect of Diesel Exhaust Particles on Pathogen-associated Molecular Patterns-induced Cytokine Generation from Bronchial Epithelial Cells. J Allergy Clin Immunol 2009. [DOI: 10.1016/j.jaci.2008.12.516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
|
18
|
Maekawa F, Fujiwara K, Kohno D, Kuramochi M, Kurita H, Yada T. Young adult-specific hyperphagia in diabetic Goto-kakizaki rats is associated with leptin resistance and elevation of neuropeptide Y mRNA in the arcuate nucleus. J Neuroendocrinol 2006; 18:748-56. [PMID: 16965293 DOI: 10.1111/j.1365-2826.2006.01470.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The present study aimed to examine whether hyperphagia, which is frequently observed in type 1 diabetic patients and model animals, also occurs in type 2 diabetic Goto-Kakizaki (GK) rats and, if so, to explore underlying abnormalities in the hypothalamus. GK rats at postnatal weeks 6-12, compared to control Wistar rats, exhibited hyperphagia, hyperglycaemia, hyperleptinemia and increased visceral fat accumulation, whereas body weight was unaltered. The ability of leptin to suppress feeding was reduced in GK rats compared to Wistar rats of these ages. In GK rats, leptin-induced phosphorylation of signal transducer and activator of transcription 3 was significantly reduced in the cells of the hypothalamic arcuate nucleus (ARC), but not of the ventromedial hypothalamus, whereas the mRNA level of functional leptin receptor was unaltered. By real-time polymerase chain reaction and in situ hybridisation, mRNA levels of neuropeptide Y, but not pro-opiomelanocortin and galanin-like peptide, were significantly increased in the ARC of GK rats at 11 weeks, but not 26 weeks. Following i.c.v. injection of a NPY Y1 antagonist, 1229U91, the amount of food intake in GK rats was indistinguishable from that in Wistar rats, thus eliminating the hyperphagia of GK rats. These results demonstrate that young adult GK rats display hyperphagia in association with leptin resistance and increased NPY mRNA level in the ARC.
Collapse
Affiliation(s)
- F Maekawa
- Department of Physiology, Division of Integrative Physiology, Jichi Medical University School of Medicine, Shimotsuke, Tochigi, Japan
| | | | | | | | | | | |
Collapse
|
19
|
Yamashita N, Tashimo H, Nakajima M, Ishida H, Kuramochi M, Kaneko F, Kawashima R, Horiuchi T, Ohta K. Attenuation of allergic inflammation by neutralization of IGF-I in murine asthmatic models. J Allergy Clin Immunol 2003. [DOI: 10.1016/s0091-6749(03)81251-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
|
20
|
Yamaoka K, Iguchi E, Kubota S, Tashimo H, Kuramochi M, Wakabayashi H, Nakajima Y, Nakano J, Yamashita N, Ohta K. [Usefulness of patient education and quality of life (QOL) evaluation in asthma patients]. Arerugi 2002; 51:1170-6. [PMID: 12522321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 07/24/2002] [Accepted: 10/15/2002] [Indexed: 02/28/2023]
Abstract
Achieving successful treatment of bronchial asthma depends on its control by the patient. We implemented a program of educating asthma patients and conducted a QOL survey to objectively evaluate the patients'conditions. Thirty-nine asthma patients who were receiving treatment with an inhaled corticosteroid [beclomethasone dipropionate (BDP) ] on an outpatient basis at our hospital, received instructions on proper drug administration in cooperation with the Pharmacy department of our hospital. The QOL survey (SF-36 and Marks et al. AQLQ) was conducted at the initial education session and again two months later. Thirty-two patients (82.0%) responded that they would like to continue to receive instructions on the administration of drugs. Significant improvements in Social, Concerns, Marks, and Scales were observed after the education. In addition, even those patients who stated that they did not want to receive instructions showed significant improvements in their QOL scores. The usefulness of patient education can be assessed by the change in the patients' QOL scores.
Collapse
|
21
|
Yamashita N, Tashimo H, Ishida H, Kuramochi M, Nakajima M, Kaneko F, Nakano J, Ohta K. An essential role for endogenous GM-CSF in induction of airway hyperresponsiveness in a murine asthma model. J Allergy Clin Immunol 2002. [DOI: 10.1016/s0091-6749(02)81152-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
|
22
|
Yoshitomi Y, Kojima S, Yano M, Sugi T, Matsumoto Y, Saotome M, Tanaka K, Endo M, Kuramochi M. Does stent design affect probability of restenosis? A randomized trial comparing Multilink stents with GFX stents. Am Heart J 2001; 142:445-51. [PMID: 11526357 DOI: 10.1067/mhj.2001.117321] [Citation(s) in RCA: 44] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
BACKGROUND Experimental studies have revealed that stent configuration influences intimal hyperplasia. The purpose of this study was to evaluate clinical outcomes for 2 stent designs in a randomized trial with quantitative coronary angiography (QCA) and intravascular ultrasonography (IVUS). METHODS We randomly assigned 100 patients with 107 lesions and symptomatic coronary artery disease to deployment of a Multilink stent (Advanced Cardiovascular Systems, Guidant, Santa Clara, Calif) or a GFX stent (Applied Vascular Engineering, Santa Rosa, Calif) with IVUS guidance. QCA and IVUS studies were performed before and after intervention and at follow-up (4.2 +/- 1.0 months). RESULTS There were no significant differences in baseline characteristics and QCA and IVUS parameters before and after intervention between the 2 groups. However, minimal lumen diameter at follow-up was significantly larger in the Multilink group (2.46 +/- 0.59 vs 2.08 +/- 0.79 mm, P <.05). Maximal in-stent intimal hyperplasia was significantly larger in the GFX group (2.9 +/- 1.7 vs 1.8 +/- 1.2 mm(2), P <.01). The restenosis rate differed between the 2 groups (Multilink 4% vs GFX 26%, P =.003). In multiple stepwise logistic regression analysis, the only predictor that significantly correlated with restenosis was stent type (P <.01). The odds ratio for the GFX stent-treated vessels was 18.65 (95% confidence interval 2.10-165.45). CONCLUSIONS With deployment of the GFX stent, a thicker neointima develops within the stent. Stent configuration may affect clinical outcomes.
Collapse
Affiliation(s)
- Y Yoshitomi
- Division of Cardiology, Tohsei National Hospital, Shizuoka, Japan.
| | | | | | | | | | | | | | | | | |
Collapse
|
23
|
Kojima S, Shida M, Takano H, Inami S, Yodogawa K, Yokoyama H, Kuramochi M. Effects of losartan on blood pressure and humoral factors in a patient who suffered from anaphylactoid reactions when treated with ACE inhibitors during LDL apheresis. Hypertens Res 2001; 24:595-8. [PMID: 11675956 DOI: 10.1291/hypres.24.595] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
In a patient who was taking an angiotensin-converting-enzyme inhibitor, low-density lipoprotein (LDL) apheresis with dextran-sulfate cellulose provoked hypotension accompanied by lacrimation and blurred vision. Hypotension was eliminated by changing the anticoagulant from heparin to a protease inhibitor, nafamostat mesilate. A study was undertaken to clarify whether an antagonist of angiotensin type 1-receptor, losartan, could be safely used in the same patient during LDL apheresis treatment. Blood pressure and humoral factors were compared between the apheresis sessions with losartan and those without. Although angiotensin II and bradykinin plasma levels during LDL apheresis were significantly greater with losartan than without, blood pressure reduction by losartan was mild and unpleasant symptoms were not induced. Losartan was thus safely used for this patient during treatment by LDL apheresis. The greater rise in bradykinin levels during apheresis with losartan might be ascribable to angiotensin type 2-receptor stimulation.
Collapse
Affiliation(s)
- S Kojima
- Department of Clinical Research, Tohsei National Hospital, Shizuoka, Japan.
| | | | | | | | | | | | | |
Collapse
|
24
|
Fukuhara H, Kuramochi M, Nobukuni T, Fukami T, Saino M, Maruyama T, Nomura S, Sekiya T, Murakami Y. Isolation of the TSLL1 and TSLL2 genes, members of the tumor suppressor TSLC1 gene family encoding transmembrane proteins. Oncogene 2001; 20:5401-7. [PMID: 11536053 DOI: 10.1038/sj.onc.1204696] [Citation(s) in RCA: 57] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2001] [Revised: 05/28/2001] [Accepted: 05/31/2001] [Indexed: 11/08/2022]
Abstract
We have recently identified the TSLC1 gene as a novel tumor suppressor in human non-small cell lung cancers. TSLC1 encodes a membrane glycoprotein with an extracellular domain homologous to those of immunoglobulin superfamily proteins. Truncation of TSLC1 in the cytoplasmic domain in a primary human tumor suggests that this domain is important for tumor suppressor activity. Here, we report the isolation of two TSLC1-like genes, TSLL1 and TSLL2, based on their structural homology with the sequences corresponding to the cytoplasmic domain of TSLC1. Significant similarity was also observed in the extracellular domain as well as in the overall gene structure, indicating that these three genes form a unique subfamily (the TSLC1-gene family) in the immunoglobulin superfamily genes. In contrast to the ubiquitous expression of TSLC1, TSLL1 is expressed exclusively in adult and fetal human brain, while TSLL2 is expressed in several specific tissues including prostate, brain, kidney and some other organs. Expression of TSLL1 and TSLL2 was lost or markedly reduced in many human glioma cell lines or some prostate cancer cell lines, suggesting that loss of expression of these genes might be involved in some human cancers.
Collapse
Affiliation(s)
- H Fukuhara
- Tumor Suppression & Functional Genomics Project, National Cancer Center Research Institute, 5-1-1, Tsukiji, Chuo-ku, Tokyo 104-0045, Japan
| | | | | | | | | | | | | | | | | |
Collapse
|
25
|
Pletcher MT, Nobukuni T, Fukuhara H, Kuramochi M, Maruyama T, Sekiya T, Sussan T, Isomura M, Murakami Y, Reeves RH. Identification of tumor suppressor candidate genes by physical and sequence mapping of the TSLC1 region of human chromosome 11q23. Gene 2001; 273:181-9. [PMID: 11595164 DOI: 10.1016/s0378-1119(01)00592-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Loss of heterozygosity for a locus on human chromosome 11q22-23 is observed at high frequency in non-small cell lung carcinoma (NSCLC). Introduction of a 1.1 Mb fragmented yeast artificial chromosome (YAC) mapping to this region completely suppresses the tumorigenic properties of a human NSCLC cell line, A549. Smaller fragmented YACs give partial but not complete suppression. To further localize the gene(s) responsible for this partial suppression, a bacterial artificial chromosome (BAC) and P1-based artificial chromosome (PAC) contig was constructed, completely spanning the candidate region. End sequence generated in the construction of the BAC/PAC contig identified a previously unmapped EST and served to order genomic sequence contigs from the publicly available Celera Genomics (CG) and Human Genome Project (HGP) efforts. Comparison showed that CG provided larger contigs, while HGP provided more coverage. Neither CG nor HGP provided complete sequence coverage, alone or in combination. The sequence was used to map 110 ESTs and to predict new genes, including two GenScan gene predictions that overlapped ESTs and were shown to be differentially expressed in tumorigenic and suppressed A549 cell lines.
Collapse
Affiliation(s)
- M T Pletcher
- Department of Physiology, Johns Hopkins University School of Medicine, Baltimore, MD 21205-2105, USA
| | | | | | | | | | | | | | | | | | | |
Collapse
|
26
|
Kojima S, Shida M, Tanaka K, Takano H, Yokoyama H, Kuramochi M. Renal macrostructure and cortical circulation in hypertension assessed by dynamic computed tomography. Am J Hypertens 2001; 14:516-23. [PMID: 11411730 DOI: 10.1016/s0895-7061(00)01281-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
The aim of this study was to assess the macrostructure of the kidney and the grade of heterogeneity in renal cortical circulation in the early stages of essential hypertension. The subjects consisted of 84 patients (<50 years old) who underwent dynamic computed tomography (CT) because of various abdominal diseases and who had no serious hemodynamic abnormalities. The volumes of the whole kidney, cortex, and medulla were measured with the program installed in the CT instrument. In dynamic CT under appropriate conditions, the CT number of each pixel (image element) reflects the blood volume in the pixel. The means and standard deviations were calculated from the CT numbers within the renal cortex. The coefficient of variation (CV) of CT numbers was used as the index of the heterogeneity of renal cortical circulation. The volume ratio of cortex/medulla was significantly (P < .01) smaller in the hypertensive patients (0.80 +/- 0.03 (mean +/- SE)) than in the normotensive subjects (0.92 +/- 0.03). The CV was significantly (P < .01) greater in the hypertensives (n = 23, 0.124 +/- 0.008) than in the normotensives (n = 61, 0.106 +/- 0.003). There was a significant correlation (r = -0.391, P < .001) between the CV of CT numbers and the volume ratio of cortex/medulla, and the relationship between the two variables was independent of other variables. These results suggest that the heterogeneity of renal cortical circulation is increased in the early stages of essential hypertension and is related to changes in renal macrostructure.
Collapse
Affiliation(s)
- S Kojima
- Department of Clinical Research, Tohsei National Hospital, Shizuoka, Japan.
| | | | | | | | | | | |
Collapse
|
27
|
Abstract
The authors report a 47-year-old man with Becker-type muscular dystrophy presenting with dilated cardiomyopathy. Left ventriculography showed diffuse severe hypokinesia: left ventricular end-diastolic volume index 193 mL/m2, left ventricular end-systolic volume index 143 mL/m2, and left ventricular ejection fraction 26%. Skeletal muscle biopsy demonstrated a dystrophic process. Genetic analysis revealed a deletion of exon 4. There was a difference in immunostaining pattern between skeletal muscles and cardiac muscles. Severe cardiac dysfunction in this case may be associated with the damage in dystrophin-deficient fibers.
Collapse
Affiliation(s)
- M Saotome
- Division of Cardiology, Tohsei National Hospital, Shizuoka, Japan
| | | | | | | |
Collapse
|
28
|
Kuramochi M, Fukuhara H, Nobukuni T, Kanbe T, Maruyama T, Ghosh HP, Pletcher M, Isomura M, Onizuka M, Kitamura T, Sekiya T, Reeves RH, Murakami Y. TSLC1 is a tumor-suppressor gene in human non-small-cell lung cancer. Nat Genet 2001; 27:427-30. [PMID: 11279526 DOI: 10.1038/86934] [Citation(s) in RCA: 349] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
The existence of tumor-suppressor genes was originally demonstrated by functional complementation through whole-cell and microcell fusion. Transfer of chromosome 11 into a human non-small-cell lung cancer (NSCLC) cell line, A549, suppresses tumorigenicity. Loss of heterozygosity (LOH) on the long arm of chromosome 11 has been reported in NSCLC and other cancers. Several independent studies indicate that multiple tumor-suppressor genes are found in this region, including the gene PPP2R1B at 11q23-24 (ref. 7). Linkage studies of NSCLC are precluded because no hereditary forms are known. We previously identified a region of 700 kb on 11q23.2 that completely suppresses tumorigenicity of A549 human NSCLC cells. Most of this tumor-suppressor activity localizes to a 100-kb segment by functional complementation. Here we report that this region contains a single confirmed gene, TSLC1, whose expression is reduced or absent in A549 and several other NSCLC, hepatocellular carcinoma (HCC) and pancreatic cancer (PaC) cell lines. TSLC1 expression or suppression is correlated with promoter methylation state in these cell lines. Restoration of TSLC1 expression to normal or higher levels suppresses tumor formation by A549 cells in nude mice. Only 2 inactivating mutations of TSLC1 were discovered in 161 tumors and tumor cell lines, both among the 20 primary tumors with LOH for 11q23.2. Promoter methylation was observed in 15 of the other 18 primary NSCLC, HCC and PaC tumors with LOH for 11q23.2. Thus, attenuation of TSLC1 expression occurred in 85% of primary tumors with LOH. Hypermethylation of the TSLC1 promoter would seem to represent the 'second hit' in NSCLC with LOH.
Collapse
Affiliation(s)
- M Kuramochi
- Tumor Suppression & Functional Genomics Project, National Cancer Center Research Institute, Tokyo, Japan
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
29
|
Kojima S, Shida M, Tanaka K, Takano H, Yokoyama H, Kuramochi M. Acute changes in plasma levels of hepatocyte growth factor during low-density lipoprotein apheresis. Ther Apher 2001; 5:2-6. [PMID: 11258604 DOI: 10.1046/j.1526-0968.2001.005001002.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Hepatocyte growth factor (HGF) is a mesenchyme-derived pleiotropic factor, and angiogenesis is included in a variety of its functional effects. HGF levels were measured in 5 sessions of low-density lipoprotein (LDL) apheresis in 3 patients with severe hypercholesterolemia. Blood was collected at the start (T0) and at 1,000 ml (T1), 2,000 ml (T2), and 3,000 ml (T3) plasma treatments. During LDL apheresis, HGF levels increased from 1.59 +/- 0.78 (mean +/- SE, n = 5) ng/ml at T0 to 6.64 +/- 0.97 at T1, 6.28 +/- 0.97 at T2, and 5.20 +/- 0.94 at T3. In one apheresis session, HGF increased immediately at the 100 ml plasma treatment stage. HGF was adsorbed completely by a dextran-sulfate (DS) column. Despite the adsorption by the DS column, HGF in the patient blood increased to the levels with functional effects. The improvement of ischemic symptoms due to LDL apheresis may be related to the angiogenic activities of HGF.
Collapse
Affiliation(s)
- S Kojima
- Department of Clinical Research, Tohsei National Hospital, Sunto-gun, Shizuoka, Japan
| | | | | | | | | | | |
Collapse
|
30
|
Yoshitomi Y, Kojima S, Yano M, Sugi T, Matsumoto Y, Kuramochi M. Long-term effects of bisoprolol compared with imidapril on left ventricular remodeling after reperfusion in acute myocardial infarction: an angiographic study in patients with maintained vessel patency. Am Heart J 2000; 140:E27. [PMID: 11100000 DOI: 10.1067/mhj.2000.110934] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
BACKGROUND Although angiotensin-converting enzyme inhibitor attenuates ventricular enlargement, whether beta-blocker therapy induces regression of left ventricular remodeling is not known. The purpose of this study was to compare the effects of bisoprolol therapy with those of imidapril therapy on left ventricular remodeling after acute myocardial infarction (AMI). METHODS Sixty patients with AMI who underwent reperfusion therapy were randomly assigned to an imidapril group (20 patients), a bisoprolol group (20 patients), or a control group (20 patients). Administration was started within 24 hours. Left ventricular function on admission and 3 months and 1 year after AMI was investigated. RESULTS Baseline characteristics on admission were similar in the 3 groups except for sex distribution. Mean pulmonary capillary wedge pressure and left ventricular end-diastolic pressure in the bisoprolol group were higher than those in the imidapril group 1 year after admission (pulmonary capillary wedge pressure: 12 +/- 7 vs 8 +/- 2 mm Hg, left ventricular end-diastolic pressure: 17 +/- 8 vs 11 +/- 4 mm Hg, P <. 01). Left ventricular end-diastolic volume index (EDVI) increased in the bisoprolol group throughout the 1-year period (P <.01), whereas EDVI in the imidapril group decreased (P <.01). The increases in EDVI during 1 year in the bisoprolol group were greater than those of the other 2 groups (bisoprolol: 12 +/- 10, imidapril: -9 +/- 7, control: 4 +/- 11 mL/m2, P <.01). CONCLUSIONS Early treatment with bisoprolol in AMI cannot prevent left ventricular remodeling, whereas imidapril attenuates left ventricular dilation by decreasing preload.
Collapse
Affiliation(s)
- Y Yoshitomi
- Division of Cardiology and the Department of Clinical Research, Tohsei National Hospital, Suntoh-gun, Shizuoka, Japan.
| | | | | | | | | | | |
Collapse
|
31
|
Yoshitomi Y, Kojima S, Yano M, Matsumoto Y, Sugi T, Saotome M, Tanaka K, Endo M, Kuramochi M. Relation between stent expansion and arterial remodeling: a serial intravascular ultrasound study. Catheter Cardiovasc Interv 2000; 50:282-9. [PMID: 10878623 DOI: 10.1002/1522-726x(200007)50:3<282::aid-ccd4>3.0.co;2-u] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Previous studies suggested that stent area (SA) did not change after the Palmaz-Schatz stent implantation. Whether these findings apply to other types of stent, however, is unknown. This study assessed vascular response to stent implantation using intravascular ultrasound (IVUS) studies. Serial (pre-intervention to follow-up) IVUS imagings were used to study 57 native coronary lesions after the GFX stent or the Multilink stent implantation. The vessel area (VA) at lesion site increased at follow-up (16.92 +/- 3.67 mm(2) after intervention to 18.17 +/- 4.66 mm(2) at follow-up, P < 0.01). The SA also increased from 8.39 +/- 1.90 mm(2) after intervention to 8.80 +/- 2.08 mm(2) at follow-up (P = 0.02). Thirty-two percent of lesions showed late stent expansion. The stent expansion [Delta (after intervention to follow-up) SA] correlated significantly with the VA growth [Delta (after intervention to follow-up) VA] (r = 0.59, P < 0.0001). In conclusion, some lesions reveal late stent expansion after both the GFX stent and the Multilink stent implantation. Adaptive vessel remodeling may be followed by stent expansion.
Collapse
Affiliation(s)
- Y Yoshitomi
- Division of Cardiology, Tohsei National Hospital, Shizuoka, Japan.
| | | | | | | | | | | | | | | | | |
Collapse
|
32
|
Kojima S, Yoshitomi Y, Yano M, Saotome M, Tanaka K, Endo M, Kuramochi M. Heterogeneity of renal cortical circulation in hypertension assessed by dynamic computed tomography. Am J Hypertens 2000; 13:346-52. [PMID: 10821334 DOI: 10.1016/s0895-7061(99)00202-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022] Open
Abstract
The aim of this study was to assess the grade of heterogeneous disturbance in the renal cortical circulation using dynamic computed tomography and to investigate the relationship between the heterogeneity of renal cortical circulation and hypertension. We studied 125 patients who underwent dynamic computed tomography (CT) for various abdominal diseases and had no serious hemodynamic abnormalities. In dynamic computed tomography under appropriate conditions, each pixel (image element), less than 1 mm2, has a CT number that is in proportion to the concentration of contrast media, which reflects the blood volume in the pixel. The image was constructed at the hilus level about 50 s after the start of a continuous infusion of contrast medium. The mean and standard deviation were calculated from the CT numbers in the renal cortex. The coefficient of variation, ie, the standard deviation divided by the mean value, was used as the index of the heterogeneity of renal cortical circulation. The coefficient of variation was significantly (P < .001) greater in the hypertensive patients (n = 48, 0.174 +/- 0.006 [mean +/- SE]) than in normotensive subjects (n = 77, 0.140 +/- 0.004). The coefficient increased in parallel with the patient's age and with the grade of renal surface irregularity. In the patients whose serum creatinine levels were normal, this parameter also had a significant relationship (r = 0.367, P < .0001) with serum creatinine. These results suggest that the heterogeneity of renal cortical circulation is increased in hypertension and is also associated with aging. This parameter may become a sensitive indicator to detect slight deterioration in the renal cortical circulation.
Collapse
Affiliation(s)
- S Kojima
- Department of Clinical Research, Tohsei National Hospital, Shizuoka, Japan.
| | | | | | | | | | | | | |
Collapse
|
33
|
Yano M, Yoshitomi Y, Kojima S, Sugi T, Matsumoto Y, Kuramochi M. Long-term follow-up of primary stenting with coil stent in acute myocardial infarction. Angiology 2000; 51:107-14. [PMID: 10701718 DOI: 10.1177/000331970005100203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The authors evaluated clinical and angiographic outcomes for 1 year after primary stenting using coil stent for acute myocardial infarction. Twenty-eight patients underwent primary stenting with coil stent. Follow-up coronary arteriography at 3 months and 1 year was planned in all patients. Procedural success was achieved in 96%. There was no acute or subacute thrombosis. Minimal lumen diameter (MLD) was increased from 0.08 +/- 0.19 to 2.73 +/- 0.49 mm after stenting. MLD had decreased significantly for 3 months (MLD at 3 months: 2.03 +/- 0.86 mm, p = 0.001). On the other hand, MLD did not differ between 3-month; and 1-year follow-up (MLD at 1 year: 2.26 +/- 0.73 mm, p = NS). Only one patient manifested reocclusion at 3-month follow-up. The cumulative restenosis rate and target lesion revascularization rate at 1-year follow-up were 25.9% (7/27) and 11.1% (3/27). Primary stenting using coil stent is safe and feasible in patients with acute myocardial infarction and may improve clinical outcome and decrease restenosis and target lesion revascularization rate.
Collapse
Affiliation(s)
- M Yano
- Division of Cardiology, Tohsei National Hospital, Shizuoka, Japan
| | | | | | | | | | | |
Collapse
|
34
|
Yoshitomi Y, Kojima S, Umemoto T, Hosoi Y, Kuramochi M. A retrospective study of late outcome in patients with peripheral arterial occlusive disease: an association between prosthetic vascular graft and cancer death? Angiology 1999; 50:1007-15. [PMID: 10609767 DOI: 10.1177/000331979905001206] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The authors assessed the relationship between cause of death and treatment modality in patients with peripheral arterial occlusive disease. A total of 273 patients were treated with percutaneous transluminal angioplasty, surgical reconstruction, amputation, or medical therapy. We evaluated the outcome in various patient subgroups divided by treatments with a mean follow-up of 4.9 years. Most patients died because of cardiovascular or cerebrovascular events, and cancer was the second most frequent cause of death. Furthermore, there was a significant difference in cancer deaths between patients who received prosthetic vascular grafts and those with other types of treatment (9.3% vs. 2.8%, p<0.01, odds ratio = 3.34). It is noteworthy that patients with peripheral arterial occlusive disease succumbed to cancer, especially the patients with prosthetic vascular grafts.
Collapse
Affiliation(s)
- Y Yoshitomi
- Division of Cardiology, Tohsei National Hospital, Suntoh-gun, Shizuoka, Japan.
| | | | | | | | | |
Collapse
|
35
|
Abstract
The negative charges of dextran sulfate cellulose (DSC) used for low-density lipoprotein (LDL) apheresis activate the intrinsic coagulation pathway, accompanied by bradykinin production. This study was undertaken to see whether an antagonist of angiotensin receptor (AT1), losartan, could be safely used in a patient treated by DSC-LDL apheresis. Losartan (50 mg/day) was given to a patient with coronary heart disease who had been treated by DSC-LDL apheresis and had experienced an anaphylactoid reaction by administration of an angiotensin converting enzyme inhibitor. The effects of losartan on blood pressures and humoral factors were examined by comparing these parameters between apheresis with and without losartan. Blood pressures and plasma levels of bradykinin, renin, and aldosterone were measured before and at 1,000, 2,000, and 3,000 ml of plasma treatment. Bradykinin levels during LDL apheresis tended to be higher with losartan than without losartan (without versus with, 529 +/- 121 [n = 4, mean +/- SE] pg/ml vs. 1,058 +/- 49 at the 2,000 ml stage, p < 0.01). The rise of plasma renin activity with losartan (221 +/- 26% at the 3,000 ml stage) was significantly greater than that without losartan (144 +/- 2.4%). Mean blood pressure decreased by 7% during apheresis with losartan, but blood pressure reduction was not accompanied by any complaints. These results suggest that AT1 receptor antagonists are safely used in patients treated by DSC-LDL apheresis.
Collapse
Affiliation(s)
- S Kojima
- Department of Clinical Research, Tohsei National Hospital, Sunto-gun, Shimizu-cho, Japan.
| | | | | | | | | | | |
Collapse
|
36
|
Yoshitomi Y, Kojima S, Kuramochi M. Long-term effect of a new oral prostacyclin analogue, beraprost sodium, in isolated peripheral pulmonary artery stenosis in the adult. J Intern Med 1999; 246:227-30. [PMID: 10447792 DOI: 10.1046/j.1365-2796.1999.00532.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
A 20-year-old woman was admitted with increasing breathlessness on exertion. A diagnosis of isolated peripheral pulmonary artery stenosis (PPS) was confirmed by right-sided cardiac catheterization and pulmonary angiography. We tried treatment with a newly developed oral prostacyclin analogue, beraprost sodium. Her symptoms gradually improved 1 month after treatment. After 1 year, we observed a decrease in pulmonary arterial pressure (from 118/16 [mean 59] to 87/13 [mean 40] mmHg) and systolic right ventricular pressure (from 125 to 90 mmHg). This is the first report to describe the chronic effect of oral prostacyclin analogue on isolated peripheral pulmonary artery stenosis.
Collapse
Affiliation(s)
- Y Yoshitomi
- Division of Cardiology, Tohsei National Hospital, Shizuoka, Japan.
| | | | | |
Collapse
|
37
|
Yoshitomi Y, Kojima S, Umemoto T, Kubo K, Matsumoto Y, Yano M, Sugi T, Kuramochi M. Serum hepatocyte growth factor in patients with peripheral arterial occlusive disease. J Clin Endocrinol Metab 1999; 84:2425-8. [PMID: 10404815 DOI: 10.1210/jcem.84.7.5826] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Hepatocyte growth factor (HGF) is a multifunctional protein implicated in tissue regeneration, wound healing, and angiogenesis. We measured serum HGF concentrations in 37 patients with peripheral arterial occlusive disease (PAOD). Among them, 36 patients underwent arteriography. Serum HGF concentrations were also measured in 40 control subjects who remained free of vascular, liver, kidney, or lung disease. Patients with PAOD showed elevated serum HGF concentrations compared with control subjects (0.40+/-0.02 vs. 0.19+/-0.01 ng/mL; P<0.001). Serum HGF concentrations were significantly higher in smokers compared with nonsmokers (0.45+/-0.03 vs. 0.35+/-0.02 ng/mL; P = 0.003). The serum HGF concentrations in patients with collaterals tended to be higher than those in patients without collaterals (0.43+/-0.03 vs. 0.35+/-0.02 ng/mL; P = 0.06). Moreover, in patients who underwent bypass surgery or angioplasty, serum HGF concentrations decreased from 0.41+/-0.03 to 0.21+/-0.04 ng/mL after treatment (P<0.001). Serum HGF may be an useful marker for the diagnosis of PAOD. HGF may play an important role in angiogenesis and collateral vessel growth in PAOD.
Collapse
Affiliation(s)
- Y Yoshitomi
- Division of Cardiology, Tohsei National Hospital, Shizuoka, Japan.
| | | | | | | | | | | | | | | |
Collapse
|
38
|
Yoshitomi Y, Kojima S, Yano M, Sugi T, Matsumoto Y, Kuramochi M. Benefit of intravascular ultrasound in Wiktor stent implantation. Catheter Cardiovasc Interv 1999; 47:28-35. [PMID: 10385154 DOI: 10.1002/(sici)1522-726x(199905)47:1<28::aid-ccd5>3.0.co;2-o] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The goal of this study was to evaluate retrospectively the efficacy and safety of intravascular ultrasound (IVUS) during Wiktor stent implantation. Until 1996, the success of stent implantation was assessed by angiographic criteria only, but in 1997, the procedure was expanded to include pre- and postprocedural IVUS imaging. Sixty-six patients were included, 28 treated in 1996 (group A) and 38 treated in 1997 (group B). Stent size was larger in group B than in group A (3.6+/-0.4 vs. 3.1+/-0.2, P < 0.001). Acute gain was greater in group B than in group A (2.58+/-0.61 vs. 2.11+/-0.56, P < 0.001). Restenosis rate was 31% in group A and 14% in group B. No major acute complications due to IVUS examination occurred. IVUS is helpful in choosing optimal stent size.
Collapse
Affiliation(s)
- Y Yoshitomi
- Division of Cardiology, Tohsei National Hospital, Shizuoka, Japan
| | | | | | | | | | | |
Collapse
|
39
|
Nagaya N, Nishikimi T, Uematsu M, Yoshitomi Y, Miyao Y, Miyazaki S, Goto Y, Kojima S, Kuramochi M, Matsuo H, Kangawa K, Nonogi H. Plasma adrenomedullin as an indicator of prognosis after acute myocardial infarction. Heart 1999; 81:483-7. [PMID: 10212165 PMCID: PMC1729034 DOI: 10.1136/hrt.81.5.483] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To elucidate whether prognosis after acute myocardial infarction can be predicted by measuring plasma adrenomedullin, a novel vasorelaxant peptide. PATIENTS AND DESIGN Plasma adrenomedullin concentrations on day 2 after myocardial infarction were measured in 113 patients with myocardial infarction with other clinical and haemodynamic variables related to mortality. RESULTS During a mean follow up period of 25 months, 16 patients died of cardiac causes. Plasma adrenomedullin concentrations on day 2 increased significantly in patients with myocardial infarction compared with controls (mean (SD), 12.3 (8.8) v 4.9 (1.0) pmol/l, p < 0.001). Plasma adrenomedullin correlated negatively with left ventricular ejection fraction on admission (r = -0.47, p < 0.001), although it did not significantly correlate with any other haemodynamic variable. By univariate Cox proportional hazards analysis, plasma adrenomedullin, age, coronary reperfusion, maximum creatine kinase concentrations, pulmonary congestion, pulmonary capillary wedge pressure, cardiac index, and left ventricular ejection fraction were all significantly related to mortality. Among the non-invasive variables, only plasma adrenomedullin was an independent predictor of mortality after myocardial infarction (p < 0.05). The Kaplan-Meier survival curves based on the median plasma adrenomedullin concentration (10.3 pmol/l) showed that patients with high plasma adrenomedullin had a higher mortality than those with low plasma adrenomedullin (p < 0.01). CONCLUSIONS Plasma adrenomedullin on day 2 after myocardial infarction is strongly associated with long term mortality, and thus may complement standard prognostic indicators.
Collapse
Affiliation(s)
- N Nagaya
- Department of Internal Medicine, National Cardiovascular Centre, 5-7-1 Fujishirodai, Suita, Osaka 565, Japan
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
40
|
Abstract
Antemortem diagnosis of hepatocellular carcinoma with a tumor thrombus extending into the right atrium has been rarely observed. Although echocardiography allows easy detection of the intracardiac mass, reports of echocardiographic descriptions of a right atrial mass associated with hepatocellular carcinoma are few. Herein, we describe two cases of hepatocellular carcinoma with a tumor thrombus in the right atrium detected by transthoracic echocardiography. In one of the patients we also performed transesophageal echocardiography. Neither patient had cardiac symptoms or signs. Thus, echocardiographic examination is very important in patients with hepatocellular carcinoma, with or without cardiac symptoms and signs.
Collapse
Affiliation(s)
- Y Yoshitomi
- Division of Cardiology, Tohsei National Hospital, Shizuoka, Japan
| | | | | | | | | | | | | |
Collapse
|
41
|
Mori K, Murata S, Yoshioka H, Michishita N, Kuramochi M, Oda T, Saida Y, Itai Y. Transcatheter embolization of celiac artery pseudoaneurysm following pancreatico-duodenectomy for pancreatic cancer. A case report. Acta Radiol 1998; 39:690-2. [PMID: 9817043 DOI: 10.3109/02841859809175498] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
A case of transcatheter embolization of a celiac artery pseudoaneurysm in a 70-year-old man is reported. The pseudoaneurysm was considered to be the result of pancreatic anastomotic leakage and an intra-abdominal abscess following pancreaticoduodenectomy with irradiation of 66 Gy for pancreatic carcinoma. To avoid recanalization of the pseudoaneurysm due to retrograde blood flow, first all branches of the celiac artery were embolized with metallic coils, and then the celiac trunk was also occluded. Hepatic arterial flow was preserved by the right hepatic artery arising from the superior mesenteric artery. After the procedure, the patient had no noticeable complications associated with the embolization nor any recurrence of the pancreatic cancer, and he achieved a 2-year survival.
Collapse
Affiliation(s)
- K Mori
- Department of Radiology, Tsukuba University Hospital, Japan
| | | | | | | | | | | | | | | |
Collapse
|
42
|
Kojima S, Yoshitomi Y, Sugi T, Matsumoto Y, Yano M, Kuramochi M. Changes in plasma levels of cyclic nucleotides during low-density lipoprotein apheresis. Ther Apher 1998; 2:263-7. [PMID: 10227752 DOI: 10.1111/j.1744-9987.1998.tb00119.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The negative charges of dextran sulfate (DS) used for low-density lipoprotein (LDL) apheresis activate the intrinsic coagulation pathway, accompanied by the production of bradykinin. This study was undertaken to see whether cyclic nucleotide plasma levels are affected by DS LDL apheresis. Previously, we showed the rise in plasma levels of prostaglandins and nitric oxide derivatives accompanied by the rise in bradykinin levels. The physiologic effects of prostaglandins and nitric oxide become manifest through the intracellular signal of cyclic nucleotides. The plasma levels of the cyclic nucleotides (cyclic adenosine monophosphate [cAMP] and cyclic guanosine monophosphate [cGMP]) were examined when either of 2 anticoagulants, heparin or nafamostat mesilate (NM), was used during DS LDL apheresis. The plasma levels of cAMP during LDL apheresis using heparin were 9.2 +/- 0.3 (mean +/- SE) 12.4 +/- 0.6, 12.0 +/- 0.5, and 12.1 +/- 0.3 pmol/ml, respectively, at the 0, 1,000, 2,000, and 3,000 ml stages. The rise in cAMP levels was suppressed during apheresis using NM. There were no significant increases in cGMP during apheresis with heparin or with NM. There were significant negative correlations between changes in cAMP and those in the blood pressure. These findings suggest that bradykinin generated during apheresis exerts some physiologic effects via activation of the adenylate cyclase dependent pathway.
Collapse
Affiliation(s)
- S Kojima
- Department of Clinical Research, Tohsei National Hospital, Shizuoka, Japan
| | | | | | | | | | | |
Collapse
|
43
|
Abstract
OBJECTIVES To evaluate the efficacy of cilostazol, a new synthetic inhibitor of phosphodiesterase, in preventing stent thrombosis after successful implantation. DESIGN Preliminary prospective study. SETTING A single coronary care unit in Japan. PATIENTS Elective, bailout, or primary stents were implanted in 85 consecutive patients with 93 lesions. Primary stent implantation was performed in 18 patients with acute myocardial infarction. Patients received 200 mg cilostazol and 243 mg aspirin after stenting. MAIN OUTCOME MEASURES Stent thrombosis, major and minor complications, and side effects were assessed in the six months after stenting. RESULTS Gianturco-Roubin stents were implanted in 37 lesions, Wiktor stents in 55, and Palmaz-Schatz stents in 27. Multiple stents were used in 26 lesions. There was no mortality, stent thrombosis related Q wave myocardial infarction, emergency bypass surgery, repeat intervention, or vascular complications in the six months of follow up. Acute or subacute closure did not occur after stenting. There were no serious side effects such as leucopenia and/or abnormal liver function for three months. Cilostazol was withdrawn in one patient because of skin rash. Patients who underwent primary stenting had no clinical events, such as acute or subacute thrombosis, or side effects. CONCLUSIONS Cilostazol is an effective antiplatelet agent with minimum side effects after elective, bailout, or primary stent implantation.
Collapse
Affiliation(s)
- Y Yoshitomi
- Division of Cardiology, Tohsei National Hospital, Shizuoka, Japan
| | | | | | | | | | | |
Collapse
|
44
|
Takeda T, Kuramochi M, Sato M, Wu J, Itai Y. Tc-99m diethylenetriamine pentaacetic acid (DTPA)-human serum albumin (HSA) radionuclide lymphography for detecting the location of chyluria. Ann Nucl Med 1998; 12:205-7. [PMID: 9795706 DOI: 10.1007/bf03164846] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The cause of chyluria cannot be easily detected by CT scan or other imaging methods, except conventional lymphography, but Tc-99m diethylenetriamine pentaacetic acid radionuclide lymphography clearly revealed the location of chyluria in the left renal pelvic area. Radionuclide lymphography is one of the choices in investigating chyluria due to its noninvasive and simple technique.
Collapse
|
45
|
Yoshitomi Y, Kojima S, Sugi T, Matsumoto Y, Yano M, Kuramochi M. Coronary vasoreactivity to ergonovine after angioplasty: difference between the infarct-related coronary artery and the noninfarct-related coronary artery. Coron Artery Dis 1998; 9:105-11. [PMID: 9647411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND The vasoreactivity after direct percutaneous transluminal coronary angioplasty (PTCA) in patients with previous myocardial infarction remains unknown. We examined the constrictor response to ergonovine of the infarct-related coronary artery in comparison with that of noninfarct-related coronary artery after angioplasty. METHODS Ergonovine was administered intravenously to 17 patients with previous myocardial infarction (group I) and to 21 patients with stable angina (group II) 1 year after PTCA. The effects of ergonovine on lumen diameter were analysed quantitatively at the PTCA segment, nonPTCA segment (proximal to the PTCA segment), and nonPTCA artery. RESULTS The ergonovine-induced decrease in minimal lumen diameter at the PTCA segment was significant in group I (decrease from 2.12 +/- 0.56 to 1.39 +/- 0.74 mm, P < 0.01), but not in group II (decrease from 1.60 +/- 0.35 to 1.43 +/- 0.33 mm, NS). Patients in group I showed a constrictor response at the nonPTCA artery (decrease in diameter from 2.54 +/- 0.90 to 1.94 +/- 0.77 mm, P < 0.01), and a tendency to constrict at the nonPTCA segment (2.56 +/- 0.67 to 2.11 +/- 0.66 mm, P = 0.06), whereas those in group II showed no significant constrictor response to ergonovine at any of the three segments examined. The changes in diameter at the three segments in patients in group I were significantly greater than those in group II (all P < 0.01). Subtotal coronary spasm at the PTCA segment was provoked only in three patients in group I (18%). CONCLUSIONS The constrictor response to ergonovine of the infarct-related coronary artery was enhanced compared with that of the noninfarct-related coronary artery. This difference in coronary vasoreactivity at the angioplasty segment may be due to previous hypersensitivity of the smooth muscle.
Collapse
Affiliation(s)
- Y Yoshitomi
- Division of Cardiology, Tohsei National Hospital, Shizuoka, Japan
| | | | | | | | | | | |
Collapse
|
46
|
Abstract
We report a 27-year-old Japanese man who developed acute renal failure associated with cold water immersion. The clinical course was consistent with that of acute renal failure attributable to acute tubular necrosis. A renal biopsy specimen showed patchy and focal loss of tubule cells, necrotic epithelium, interstitial edema, and arterial lumina obstructed by diffuse and severe intimal thickening. Endothelin increased more than five times in the early phase of the clinical course. Vasoconstriction and ischemia induced by cold exposure seem to lead to endothelin release. Endothelin may be related to the development of acute renal failure and intimal thickening.
Collapse
Affiliation(s)
- Y Yoshitomi
- Department of Clinical Research, Tohsei National Hospital, Shizuoka, Japan
| | | | | | | |
Collapse
|
47
|
Yoshitomi Y, Nishikimi T, Kojima S, Kuramochi M, Takishita S, Kangawa K, Matsuo H. Plasma natriuretic peptides as indicators of left ventricular remodeling after myocardial infarction. Int J Cardiol 1998; 64:153-60. [PMID: 9688434 DOI: 10.1016/s0167-5273(98)00026-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
To investigate the relationship between natriuretic peptides and left ventricular remodeling after acute myocardial infarction, left ventriculography and blood sampling were performed on admission, after 1 month and after 3 months in 33 patients with acute myocardial infarction (15 anterior and 18 inferior). Plasma atrial and brain natriuretic peptide concentrations at 1 and 3 months were higher than those of controls (P<0.01). Brain natriuretic peptide concentrations correlated with changes in left ventricular end-diastolic volume index after 1 and 3 months (1 month: r=0.57, P=0.003; 3 months: r=0.47, P=0.006). Atrial natriuretic peptide concentrations also correlated with changes in left ventricular end-diastolic volume index after 1 and 3 months (1 month: r=0.40, P=0.02; 3 months: r=0.61, P<0.001). Our results indicate that natriuretic peptide concentrations increase in the chronic phase of acute myocardial infarction and may relate to left ventricular remodeling. Thus, atrial natriuretic peptide as well as brain natriuretic peptide concentrations may be useful biochemical markers in identifying asymptomatic patients at risk for heart failure or sudden death after acute myocardial infarction.
Collapse
Affiliation(s)
- Y Yoshitomi
- Department of Clinical Research, Tohsei National Hospital, Shizuoka, Japan
| | | | | | | | | | | | | |
Collapse
|
48
|
Yoshitomi Y, Nishikimi T, Kojima S, Kuramochi M, Takishita S, Matsuoka H, Miyata A, Matsuo H, Kangawa K. Plasma levels of adrenomedullin in patients with acute myocardial infarction. Clin Sci (Lond) 1998; 94:135-9. [PMID: 9536921 DOI: 10.1042/cs0940135] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
1. Adrenomedullin, a newly identified vasorelaxant peptide, participates in the regulation of the cardiovascular system. To investigate the pathophysiological significance of adrenomedullin in patients with acute myocardial infarction, we measured plasma levels of adrenomedullin. 2. Cardiac catheterization was performed on admission, after 1 day, and after 4 weeks in 36 patients with acute myocardial infarction. We measured plasma levels of adrenomedullin, atrial natriuretic peptide and brain natriuretic peptide in the right atrium, pulmonary artery and aorta. 3. Plasma levels of adrenomedullin in the right atrium (mean +/- SEM) were significantly increased on admission (4.2 +/- 2.6 h) in patients with acute myocardial infarction (10.6 +/- 1.0 pmol/l) compared with controls (5.2 +/- 0.3 pmol/l, P < 0.01). In addition, plasma levels of adrenomedullin were further elevated in patients with congestive heart failure (12.3 +/- 1.4 pmol/l) compared with patients without congestive heart failure (7.8 +/- 0.6 pmol/l, P < 0.01). In patients with congestive heart failure, plasma adrenomedullin on admission significantly correlated with atrial natriuretic peptide and brain natriuretic peptide. 4. These results suggest that plasma adrenomedullin increases in the early phase of acute myocardial infarction and that volume expansion may be one of the additional stimuli for the release of adrenomedullin in patients with acute myocardial infarction complicated by congestive heart failure.
Collapse
Affiliation(s)
- Y Yoshitomi
- Department of Clinical Research, Tohsei National Hospital, Shizuoka, Japan
| | | | | | | | | | | | | | | | | |
Collapse
|
49
|
Abstract
Fluid retention develops relatively early in the renal insufficiency of patients with diabetic nephropathy. The objective of this study was to clarify the effect of postural change on urine volume and urinary sodium excretion in diabetic nephropathy. Subjects consisted of 16 patients with non-insulin-dependent diabetes mellitus (five with diabetic nephrotic syndrome [DNS], five with nonnephrotic overt diabetic nephropathy [NNODN], and six without overt diabetic nephropathy [ODN]) and 11 patients with nondiabetic renal diseases (five with nondiabetic nephrotic syndrome [NDNS] and six without nephrotic syndrome). Patients were studied during 60 minutes of recumbency, followed by 60 minutes of standing. Mean blood pressure decreased in the standing posture only in patients with DNS and nondiabetic renal diseases. Urine volume decreased in the standing posture in the three groups of diabetic patients. Urine volume showed no changes in the standing posture in nondiabetic patients with and without nephrotic syndrome. The decreases in mean blood pressure and urine volume and the percentage decrease in creatinine clearance were significantly larger in patients with DNS than in those with NDNS and NNODN. The increase in free water clearance was significantly smaller in patients with DNS than in those with NDNS and NNODN. Urinary sodium excretion decreased in the standing posture in diabetic and nondiabetic patients, while no differences in the magnitude of changes were noted among patients with NDNS, NNODN, and DNS. It is concluded that the standing posture causes a greater decrease in urine volume due to orthostatic hypotension in patients with DNS compared with those with NDNS and NNODN, and that the presence of orthostatic hypotension in patients with DNS is likely responsible for the greater fluid retention of this group compared with other nephrotic patients with similar degrees of hypoalbuminemia.
Collapse
Affiliation(s)
- M Ogi
- Department of Internal Medicine, Tohsei National Hospital, Shizuoka, Japan
| | | | | |
Collapse
|
50
|
Kojima S, Ogi M, Yoshitomi Y, Sugiyama A, Katayama M, Kuramochi M. A close association between brain lacuna infarction and renal surface irregularity. Am J Hypertens 1997; 10:1378-83. [PMID: 9443773 DOI: 10.1016/s0895-7061(97)00300-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
This study was undertaken to examine the association between brain lacunae examined by magnetic resonance imaging (MRI), and the severity of renal ischemia, evaluated by computed tomography (CT). We reviewed 114 cases, out of 1694 brain MRI studies and 2861 kidney CT studies undertaken between May 1994 and March 1996 in which both brain MRI and kidney CT were examined. Brain lacunae were defined as low intensity areas between 5 mm and 10 mm in diameter with the T1-weighted image. The severity of irregularity of the renal surface was classified as one of three grades: absent, mild, or severe. The prevalence of brain lacunae in cases with the renal surface irregularity classified as absent, mild, or severe was six of 45, 14 of 45, and 17 of 24, respectively. There was a highly significant relationship (P < .001) between the prevalence of brain lacunae and the severity of the renal surface irregularity. This relationship persisted, even when the subjects were restricted to include hypertensive patients > 60 years old. The irregularity of the renal surface is mainly caused by ischemia due to arteriosclerosis in the renal arteries. The results reported here suggest that brain lacuna infarcts are closely associated with renal ischemia, implicating a causative role of renal ischemia for brain lacunae.
Collapse
Affiliation(s)
- S Kojima
- Department of Clinical Research, Tohsei National Hospital, Japan
| | | | | | | | | | | |
Collapse
|