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Shibata T, Mitsuoka H, Iba Y, Hashizume K, Hongo N, Yasuhara K, Kuwada N, Katada Y, Hashiguchi H, Uzuka T, Murai Y, Nakajima T, Nakazawa J, Kawaharada N. Mid-term outcomes of physician-modified endograft therapy for complex aortic aneurysms. Interdiscip Cardiovasc Thorac Surg 2024; 38:ivae044. [PMID: 38490250 PMCID: PMC11001489 DOI: 10.1093/icvts/ivae044] [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] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Accepted: 03/13/2024] [Indexed: 03/17/2024]
Abstract
OBJECTIVES Our goal was to evaluate early and mid-term outcomes of physician-modified endografting for pararenal and thoraco-abdominal aortic aneurysms from 10 Japanese aortic centres. METHODS From January 2012 to March 2022, a total of 121 consecutive adult patients who underwent physician-modified endografting for pararenal and thoraco-abdominal aortic aneurysms were enrolled. We analysed early and mid-term postoperative outcomes, including postoperative complications and mortality. RESULTS The pararenal and thoraco-abdominal aortic aneurysm groups included 62 (51.2%) and 59 (48.8%) patients, respectively. The overall in-hospital mortality rate was 5.8% (n = 7), with mortality rates of 3.2% (n = 2) and 8.5% (n = 5) in pararenal and thoraco-abdominal aortic aneurysm groups, respectively (P = 0.225). Type IIIc endoleaks occurred postoperatively in 18 patients (14.9%), with a significantly higher incidence (P = 0.033) in the thoraco-abdominal aortic aneurysm group (22.0%, n = 13) than in the other group (8.1%, n = 5). Major adverse events occurred in 7 (11.3%) and 14 (23.7%) patients in pararenal and thoraco-abdominal aortic aneurysm groups (P = 0.074), respectively. The mean follow-up period was 24.2 months. At the 3-year mark, both groups differed significantly in freedom from all-cause mortality (83.3% and 54.1%, P = 0.004), target aneurysm-related mortality (96.8% and 82.7%, P = 0.013) and any reintervention (89.3% and 65.6%, P = 0.002). Univariate and multivariate regression analyses demonstrated that ruptures, thoraco-abdominal aortic aneurysms and postoperative type IIIc endoleaks were associated with an increased risk of all-cause mortality. CONCLUSIONS The mid-term outcomes of physician-modified endografting for pararenal and thoraco-abdominal aortic aneurysms were clinically acceptable and comparable with those in other recently published studies. Notably, pararenal and thoraco-abdominal aortic aneurysms represent distinct pathological entities with different postoperative outcomes.
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Affiliation(s)
- Tsuyoshi Shibata
- Department of Cardiovascular Surgery, Sapporo Medical University, 291, Minami 1-jo Nishi 16-chome, Chuo-ku, Sapporo, Hokkaido, 060-8543, Japan
| | - Hiroshi Mitsuoka
- Department of Cardiovascular Surgery, Shizuoka City Shizuoka Hospital, Shizuoka, Japan
| | - Yutaka Iba
- Department of Cardiovascular Surgery, Sapporo Medical University, 291, Minami 1-jo Nishi 16-chome, Chuo-ku, Sapporo, Hokkaido, 060-8543, Japan
| | - Kenichi Hashizume
- Department of Cardiovascular Surgery, Saiseikai Utsunomiya Hospital, Utsunomiya, Japan
| | - Norio Hongo
- Department of Radiology, Oita University, Oita, Japan
| | - Kiyomitsu Yasuhara
- Department of Cardiovascular Surgery, Isesaki Municipal Hospital, Isesaki, Japan
| | - Noriaki Kuwada
- Department of Cardiovascular Surgery, Kawasaki Medical School, Kurashiki, Japan
| | - Yoshiaki Katada
- Department of Radiology, Tokyo Medical University Ibaraki Medical Center, Ibaraki, Japan
| | - Hitoki Hashiguchi
- Department of Cardiovascular Surgery, Hokkaido Prefectural Kitami Hospital, Kitami, Japan
| | - Takeshi Uzuka
- Department of Cardiovascular Surgery, Sunagawa City Medical Center, Sunagawa, Japan
| | - Yuta Murai
- Department of Cardiovascular Surgery, Shizuoka Medical Center, Shizuoka, Japan
| | - Tomohiro Nakajima
- Department of Cardiovascular Surgery, Sapporo Medical University, 291, Minami 1-jo Nishi 16-chome, Chuo-ku, Sapporo, Hokkaido, 060-8543, Japan
| | - Junji Nakazawa
- Department of Cardiovascular Surgery, Sapporo Medical University, 291, Minami 1-jo Nishi 16-chome, Chuo-ku, Sapporo, Hokkaido, 060-8543, Japan
| | - Nobuyoshi Kawaharada
- Department of Cardiovascular Surgery, Sapporo Medical University, 291, Minami 1-jo Nishi 16-chome, Chuo-ku, Sapporo, Hokkaido, 060-8543, Japan
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Kuwada N, Akagi D, Watanabe Y, Kanaoka Y, Tanemoto K. Endovascular Stent Graft Placement and Coil Embolization for Splenic Artery Aneurysm with an Anatomical Variant. Int J Angiol 2023; 32:273-276. [PMID: 37927835 PMCID: PMC10624522 DOI: 10.1055/s-0042-1742588] [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] [Indexed: 10/19/2022] Open
Abstract
A 62-year-old woman with abdominal pain was diagnosed with a splenic artery aneurysm (SAA) and an anatomical variant in the splenic artery (SA) arising from the superior mesenteric artery (SMA) as its first branch. To treat the SAA, the draining artery and a small branch of the SAA were embolized, and then small-diameter stent grafts were deployed from SMA orifice, covering the aberrant origin of the SA and preserving the second branch of SMA. Intraoperative angiography confirmed successful exclusion of the SAA without endoleak or arterial dissection. The stent graft was patent and the aneurysm had shrunk 3.5 years after the operation.
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Affiliation(s)
- Noriaki Kuwada
- Department of Cardiovascular Surgery, Kawasaki Medical School, Kurashiki, Okayama, Japan
| | - Daisuke Akagi
- Department of Cardiovascular Surgery, Kawasaki Medical School, Kurashiki, Okayama, Japan
| | - Yoshiko Watanabe
- First Department of Physiology, Kawasaki Medical School, Kurashiki, Okayama, Japan
| | - Yuji Kanaoka
- Department of Cardiovascular Surgery, Kawasaki Medical School, Kurashiki, Okayama, Japan
| | - Kazuo Tanemoto
- Department of Cardiovascular Surgery, Kawasaki Medical School, Kurashiki, Okayama, Japan
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Kuwada N, Fujii Y, Nakatani T, Ousaka D, Tsuji T, Imai Y, Kobayashi Y, Oozawa S, Kasahara S, Tanemoto K. Diamond-like carbon coating to inner surface of polyurethane tube reduces Staphylococcus aureus bacterial adhesion and biofilm formation. J Artif Organs 2023:10.1007/s10047-023-01403-1. [PMID: 37227545 DOI: 10.1007/s10047-023-01403-1] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Accepted: 05/07/2023] [Indexed: 05/26/2023]
Abstract
Staphylococcus aureus is one of the main causative bacteria for polyurethane catheter and artificial graft infection. Recently, we developed a unique technique for coating diamond-like carbon (DLC) inside the luminal resin structure of polyurethane tubes. This study aimed to elucidate the infection-preventing effects of diamond-like carbon (DLC) coating on a polyurethane surface against S. aureus. We applied DLC to polyurethane tubes and rolled polyurethane sheets with our newly developed DLC coating technique for resin tubes. The DLC-coated and uncoated polyurethane surfaces were tested in smoothness, hydrophilicity, zeta-potential, and anti-bacterial properties against S. aureus (biofilm formation and bacterial attachment) by contact with bacterial fluids under static and flow conditions. The DLC-coated polyurethane surface was significantly smoother, more hydrophilic, and had a more negative zeta-potential than did the uncoated polyurethane surface. Upon exposure to bacterial fluid under both static and flow conditions, DLC-coated polyurethane exhibited significantly less biofilm formation than uncoated polyurethane, based on absorbance measurements. In addition, the adherence of S. aureus was significantly lower for DLC-coated polyurethane than for uncoated polyurethane under both conditions, based on scanning electron microscopy. These results show that applying DLC coating to the luminal resin of polyurethane tubes may impart antimicrobial effects against S. aureus to implantable medical polyurethane devices, such as vascular grafts and central venous catheters.
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Affiliation(s)
- Noriaki Kuwada
- Department of Cardiovascular Surgery, Kawasaki Medical School, 577 Matsushima, Kurashiki-City, Okayama, 701-0192, Japan
| | - Yasuhiro Fujii
- Department of Cardiovascular Surgery, Okayama University Faculty of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-Cho, Kita-Ku, Okayama-City, Okayama, 700-8558, Japan.
| | - Tatsuyuki Nakatani
- Institute of Frontier Science and Technology, Okayama University of Science, 1-1 Ridai-Cho, Kita-Ku, Okayama-City, Okayama, Japan
| | - Daiki Ousaka
- Department of Pharmacology, Okayama University Faculty of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-Cho, Kita-Ku, Okayama-City, Okayama, 700-8558, Japan
| | - Tatsunori Tsuji
- Department of Cardiovascular Surgery, Okayama University Faculty of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-Cho, Kita-Ku, Okayama-City, Okayama, 700-8558, Japan
| | - Yuichi Imai
- Institute of Frontier Science and Technology, Okayama University of Science, 1-1 Ridai-Cho, Kita-Ku, Okayama-City, Okayama, Japan
| | - Yasuyuki Kobayashi
- Division of Cardiovascular Surgery, Department of Surgery, Labatt Family Heart Centre, The Hospital for Sick Children, University of Toronto, 555 University Avenue, Toronto, ON, M5G 1X8, Canada
| | - Susumu Oozawa
- Division of Medical Safety Management, Safety Management Facility, Okayama University Hospital, 2-5-1 Shikata-Cho, Kita-Ku, Okayama-City, Okayama, 700-8558, Japan
| | - Shingo Kasahara
- Department of Cardiovascular Surgery, Okayama University Faculty of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-Cho, Kita-Ku, Okayama-City, Okayama, 700-8558, Japan
| | - Kazuo Tanemoto
- Department of Cardiovascular Surgery, Kawasaki Medical School, 577 Matsushima, Kurashiki-City, Okayama, 701-0192, Japan
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Goyama T, Fujii Y, Muraoka G, Nakatani T, Ousaka D, Imai Y, Kuwada N, Tsuji T, Shuku T, Uchida HA, Nishibori M, Oozawa S, Kasahara S. Comprehensive hemocompatibility analysis on the application of diamond-like carbon to ePTFE artificial vascular prosthesis. Sci Rep 2023; 13:8386. [PMID: 37225824 DOI: 10.1038/s41598-023-35594-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 05/20/2023] [Indexed: 05/26/2023] Open
Abstract
The aim of this study was to obtain comprehensive data regarding the hemocompatibility of diamond-like carbon (DLC)-coated expanded polytetrafluoroethylene (ePTFE). DLC increased the hydrophilicity and smoothened the surface and fibrillar structure, respectively, of the ePTFE. DLC-coated ePTFE had more albumin and fibrinogen adsorption and less platelet adhesion than uncoated ePTFE. There were scarce red cell attachments in in vitro human and in vivo animal (rat and swine) whole blood contact tests in both DLC-coated and uncoated ePTFE. DLC-coated ePTFE had a similar but marginally thicker band movement than uncoated-ePTFE with SDS-PAGE after human whole blood contact test. In addition, survival studies of aortic graft replacement in rats (1.5 mm graft) and arteriovenous shunt in goats (4 mm graft) were performed to compare the patency and clot formation between DLC-coated and uncoated ePTFE grafts. Comparable patency was observed in both animal models. However, clots were observed in the luminal surface of the patent 1.5 mm DLC-coated ePTFE grafts, but not in that of uncoated ePTFE grafts. In conclusions, hemocompatibility of DLC-coated ePTFE was high and comparable to that of uncoated ePTFE. However, it failed to improve the hemocompatibility of 1.5 mm ePTFE graft probably because increased fibrinogen adsorption canceled the other beneficial effects of DLC.
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Affiliation(s)
- Takashi Goyama
- Department of Cardiovascular Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama, Okayama, 700-8558, Japan
| | - Yasuhiro Fujii
- Department of Cardiovascular Surgery, Okayama University Faculty of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama, Okayama, 700-8558, Japan.
| | - Genya Muraoka
- Department of Cardiovascular Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama, Okayama, 700-8558, Japan
| | - Tatsuyuki Nakatani
- Institute of Frontier Science and Technology, Okayama University of Science, 1-1 Ridai-cho, Kita-ku, Okayama, Okayama, 700-0005, Japan
| | - Daiki Ousaka
- Department of Pharmacology, Okayama University Faculty of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama, Okayama, 700-8558, Japan
| | - Yuichi Imai
- Institute of Frontier Science and Technology, Okayama University of Science, 1-1 Ridai-cho, Kita-ku, Okayama, Okayama, 700-0005, Japan
| | - Noriaki Kuwada
- Department of Cardiovascular Surgery, Kawasaki Medical Hospital, 577 Matsushima, Kurashiki, Okayama, 701-0192, Japan
| | - Tatsunori Tsuji
- Department of Cardiovascular Surgery, Okayama University Faculty of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama, Okayama, 700-8558, Japan
| | - Takayuki Shuku
- Department of Civil Engineering, Okayama University Graduate School of Environmental and Life Science, 3-1-1 Tsushima naka, Kita-ku, Okayama, Okayama, 700-8530, Japan
| | - Haruhito A Uchida
- Department of Chronic Kidney Disease and Cardiovascular Disease, Okayama University Faculty of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama, Okayama, 700-8558, Japan
| | - Masahiro Nishibori
- Department of Translational Research and Drug Development, Okayama University Faculty of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama, Okayama, 700-8558, Japan
| | - Susumu Oozawa
- Division of Medical Safety Management, Safety Management Facility, Okayama University Hospital, 2-5-1 Shikata-cho, Kita-ku, Okayama, Okayama, 700-8558, Japan
| | - Shingo Kasahara
- Department of Cardiovascular Surgery, Okayama University Faculty of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama, Okayama, 700-8558, Japan
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Nakamura H, Kanki A, Watanabe H, Ono K, Kuwada N, Saisho S, Nishimura H, Yamamoto A, Tamada T. A case of primary aortic sarcoma with tumor infarction after stent graft placement. Acta Radiol Open 2021; 10:20584601211063360. [PMID: 34900342 PMCID: PMC8664319 DOI: 10.1177/20584601211063360] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 11/12/2021] [Indexed: 12/02/2022] Open
Abstract
Primary aortic sarcoma is a very rare disease, and most primary aortic tumors are
malignant mesenchymal tumors. We present the case of a 62-year-old man with
sudden epigastric and back pain. Contrast-enhanced computed tomography (CT)
revealed a mass lesion about 33.8 mm in diameter, in contact with the left side
of the abdominal aorta. Impending rupture of an abdominal aortic aneurysm was
suspected, so cardiovascular surgery for stent graft placement was performed the
same day. Symptoms immediately improved and CT at 3 months postoperatively
showed a marked decrease in lesion size, but the lesion subsequently grew again.
Fluorodeoxyglucose (FDG)-positron emission tomography/CT was performed due to
the possibility of malignant solid tumor, revealing markedly increased FDG
accumulation (maximum standardized uptake value, 36.95) in the mass lesion.
Primary aortic sarcoma was diagnosed from thoracoscopic biopsy. Here, we report
a primary aortic sarcoma that shrank due to tumor infarction after stent graft
placement, followed by tumor regrowth.
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Affiliation(s)
- Hiroki Nakamura
- Departments of Radiology, Kawasaki Medical School, Kurashiki, Japan
| | - Akihiko Kanki
- Departments of Radiology, Kawasaki Medical School, Kurashiki, Japan
| | | | - Kentarou Ono
- Departments of Radiology, Kawasaki Medical School, Kurashiki, Japan
| | - Noriaki Kuwada
- Department of Cardiovascular Surgery, Kawasaki Medical School, Kurashiki, Japan
| | - Shinsuke Saisho
- Department of General Thoracic Surgery, Kawasaki Medical School, Kurashiki, Japan
| | | | - Akira Yamamoto
- Departments of Radiology, Kawasaki Medical School, Kurashiki, Japan
| | - Tsutomu Tamada
- Departments of Radiology, Kawasaki Medical School, Kurashiki, Japan
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Honda T, Kanaoka Y, Furukawa H, Tamura T, Kuwada N, Yamasawa T, Watanabe Y, Yunoki Y, Tabuchi A, Tanemoto K. Intraoperative collection of autologous platelet-rich plasma from the cardiopulmonary bypass circuit upon initiation of extracorporeal circulation. J Cardiothorac Surg 2021; 16:17. [PMID: 33546696 PMCID: PMC7863431 DOI: 10.1186/s13019-020-01388-5] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 12/26/2020] [Indexed: 12/04/2022] Open
Abstract
Objectives The aim of this study is to evaluate the possibility of the autologous platelet-rich plasma (PRP) collection from the cardiopulmonary bypass (CPB) circuit and to evaluate its effect on the aggregative function. Methods For seventy-two patients undergoing cardiac surgery with CPB, an autologous PRP was prepared using the Haemonetics Component Collection System® by drawing blood from the CPB circuit immediately after CPB was established. The blood samples were taken at three points for examination, A: beginning of surgery, B: immediately after heparin reversal with protamine following discontinuation of CPB, C: after the collected autologous PRP was returned to the patient. Platelet count and platelet aggregation ability were analyzed. Results The mean platelet count in autologous PRP was 5.5 (range: 3–14) units. Platelet count decreased by 115.0 (±27.3) × 1000/μl from A to B and increased by 27.3 ± 17.2 (× 1000/μl) from B to C. When platelet aggregation was measured by Adenosine Diphosphate (ADP) 3.0 μM, it decreased by 42.6% ± 12.1% from A to B and increased by 8.7% ± 7.4% from B to C. Conclusions Autologous PRP can be safely collected by drawing blood from the CPB circuit, platelet count and aggregation ability significantly decreased after CPB including autologous PRP collection. Some improvement was detected in the number of the platelets count and platelet aggregation ability by administrating an autologous PRP even if autologous PRP is collected from CPB circuit. Trial registration UMI-CTR, UMIN000023776. Registered 1 October 2016.
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Affiliation(s)
- Takeshi Honda
- Department of Cardiovascular Surgery, Kawasaki Medical School, 577 Matsushima, Kurashiki, Okayama, Japan
| | - Yuji Kanaoka
- Department of Cardiovascular Surgery, Kawasaki Medical School, 577 Matsushima, Kurashiki, Okayama, Japan
| | - Hiroshi Furukawa
- Department of Cardiovascular Surgery, Kawasaki Medical School, 577 Matsushima, Kurashiki, Okayama, Japan
| | - Taishi Tamura
- Department of Cardiovascular Surgery, Kawasaki Medical School, 577 Matsushima, Kurashiki, Okayama, Japan
| | - Noriaki Kuwada
- Department of Cardiovascular Surgery, Kawasaki Medical School, 577 Matsushima, Kurashiki, Okayama, Japan
| | - Takahiko Yamasawa
- Department of Cardiovascular Surgery, Kawasaki Medical School, 577 Matsushima, Kurashiki, Okayama, Japan
| | - Yoshiko Watanabe
- Department of Cardiovascular Surgery, Kawasaki Medical School, 577 Matsushima, Kurashiki, Okayama, Japan
| | - Yasuhiro Yunoki
- Department of Cardiovascular Surgery, Kawasaki Medical School, 577 Matsushima, Kurashiki, Okayama, Japan
| | - Atsushi Tabuchi
- Department of Cardiovascular Surgery, Kawasaki Medical School, 577 Matsushima, Kurashiki, Okayama, Japan
| | - Kazuo Tanemoto
- Department of Cardiovascular Surgery, Kawasaki Medical School, 577 Matsushima, Kurashiki, Okayama, Japan.
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Furukawa H, Yamane N, Tamura T, Honda T, Kuwada N, Yamasawa T, Watanabe Y, Yunoki Y, Tabuchi A, Kanaoka Y, Tanemoto K. [Initial Clinical Experience of the Herbal Medicine Inchinkoto for Refractory Hyperbilirubinemia Following Open-heart Surgery]. Kyobu Geka 2019; 72:1049-1052. [PMID: 31879377] [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: 06/10/2023]
Abstract
We retrospectively assessed our initial clinical experience of the herbal medicine Inchinkoto for refractory hyperbilirubinemia following open-heart surgery. Six patients developed hyperbilirubinemia in an acute phase after surgery and their maximum total bilirubin levels were 6.4~26.4 mg/dl( mean:13.1± 8.2 mg/dl). They were initially treated with ursodeoxycholic acid and/or Stronger Neo-Minophagen C containing monoammonium glycyrrhizinate, glycine, aminoacetic acid, and L-cysteine hydrochloride hydrate. These treatments, however, were ineffective, and Inchinkoto was introduced at 5~34 day (mean:13.3±11.3 days) after surgery. Hyperbilirubinemia improved in all patients after the introduction of Inchinkoto:1 day after in 1 case, 2 days after in 2 cases, 3 days after in 2 cases, and 4 days after in 1 case. These results indicate the potential of Inchinkoto to attenuate refractory hyperbilirubinemia following cardiac surgery with cardiopulmonary bypass.
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Affiliation(s)
- Hiroshi Furukawa
- Department of Cardiovascular Surgery, Kawasaki Medical School, Kurashiki, Japan
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Tabuchi A, Masaki H, Yunoki Y, Watanabe Y, Furukawa H, Yamasawa T, Takiuchi H, Honda T, Kuwada N, Kojima K, Tanemoto K. Positioning for Endovenous Laser Ablation: Comparative Study with Thigh Stripping. Ann Vasc Dis 2016; 9:154-159. [PMID: 27738455 DOI: 10.3400/avd.oa.16-00073] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 07/19/2016] [Accepted: 07/23/2016] [Indexed: 11/13/2022] Open
Abstract
We performed a comparative study of surgical outcomes and venous functions between endovenous laser ablation with a 980-nm diode laser (EV group) and thigh stripping (ST group). There were no severe complications and initial success rates were 100% in both groups. In the EV group, preoperative symptoms improved in 94.3% of cases, the venous occlusion rate was 98%, and endovenous heat induced thrombosis had occurred in 11.9% (Class 3: 0.7%) at 12 months after the operation. Although comparative study of postoperative venous function by air plethysmography showed significant improvement in both groups, there was less recovery of postoperative venous function in the EV than in the ST group. (This article is a translation of J Jpn Coll Angiol 2015; 55: 13-20.).
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Affiliation(s)
- Atsushi Tabuchi
- Department of Cardiovascular Surgery, Kawasaki Medical School, Kurashiki, Okayama, Japan
| | - Hisao Masaki
- Department of Cardiovascular Surgery, Kawasaki Medical School, Kurashiki, Okayama, Japan
| | - Yasuhiro Yunoki
- Department of Cardiovascular Surgery, Kawasaki Medical School, Kurashiki, Okayama, Japan
| | - Yoshiko Watanabe
- Department of Cardiovascular Surgery, Kawasaki Medical School, Kurashiki, Okayama, Japan
| | - Hiroshi Furukawa
- Department of Cardiovascular Surgery, Kawasaki Medical School, Kurashiki, Okayama, Japan
| | - Takahiko Yamasawa
- Department of Cardiovascular Surgery, Kawasaki Medical School, Kurashiki, Okayama, Japan
| | - Hiroki Takiuchi
- Department of Cardiovascular Surgery, Kawasaki Medical School, Kurashiki, Okayama, Japan
| | - Takeshi Honda
- Department of Cardiovascular Surgery, Kawasaki Medical School, Kurashiki, Okayama, Japan
| | - Noriaki Kuwada
- Department of Cardiovascular Surgery, Kawasaki Medical School, Kurashiki, Okayama, Japan
| | - Kenji Kojima
- Department of Physiological Laboratory, Kawasaki Medical School Hospital, Kurashiki, Okayama, Japan
| | - Kazuo Tanemoto
- Department of Cardiovascular Surgery, Kawasaki Medical School, Kurashiki, Okayama, Japan
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Watanabe Y, Masaki H, Kojima K, Tabuchi A, Yunoki Y, Furukawa H, Yamasawa T, Takiuchi H, Honda T, Kuwada N, Tanemoto K. Assessment of the characteristics and detectability of skin perfusion pressure measured using a thermostatic heating probe. Ann Vasc Dis 2013; 6:718-24. [PMID: 24386021 DOI: 10.3400/avd.oa.13-00062] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 07/02/2013] [Accepted: 10/10/2013] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES To assess the characteristics of skin perfusion pressure (SPP) measured using a thermostatic heating probe and whether a thermostatic heating probe improves SPP detection. METHODS We studied 8 feet of healthy young subjects and 31 feet of elderly patients suspected to have severe limb ischemia. We measured SPP at the dorsum and plantar aspects of each foot using a plain laser Doppler probe and a thermostatic heating probe heated at 44°C. Results were expressed as median. Comparisons were analyzed using a non-parametric test. RESULTS In the healthy subjects, the SPP values at both the dorsum and the plantar aspect were not significantly different after heating. The thermostatic heating probe did not improve the SPP detection rates. In the patients with ischemic limb, the SPP values at both the dorsum and the plantar aspect significantly increased after heating (p <0.001 for both). The SPP detection rate at the dorsum remained at 96.8%; however, it was improved from 87.1% to 100% at the plantar aspect after heating. CONCLUSION The thermostatic heating probe was shown to be useful for improving the detectability of SPP in the ischemic limbs. An SPP increase after heating may be considered as a parameter of limb ischemia.
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Affiliation(s)
- Yoshiko Watanabe
- Department of Physiology 1, Kawasaki Medical School, Kurashiki, Okayama, Japan
| | - Hisao Masaki
- Division of Cardiovascular Surgery, Department of Surgery, Kawasaki Medical School, Kurashiki, Okayama, Japan
| | - Kenji Kojima
- Vascular Laboratory of Kawasaki Medical School Hospital, Kurashiki, Okayama, Japan
| | - Atushi Tabuchi
- Division of Cardiovascular Surgery, Department of Surgery, Kawasaki Medical School, Kurashiki, Okayama, Japan
| | - Yasuhiro Yunoki
- Division of Cardiovascular Surgery, Department of Surgery, Kawasaki Medical School, Kurashiki, Okayama, Japan
| | - Hiroshi Furukawa
- Division of Cardiovascular Surgery, Department of Surgery, Kawasaki Medical School, Kurashiki, Okayama, Japan
| | - Takahiko Yamasawa
- Division of Cardiovascular Surgery, Department of Surgery, Kawasaki Medical School, Kurashiki, Okayama, Japan
| | - Hiroki Takiuchi
- Division of Cardiovascular Surgery, Department of Surgery, Kawasaki Medical School, Kurashiki, Okayama, Japan
| | - Takeshi Honda
- Division of Cardiovascular Surgery, Department of Surgery, Kawasaki Medical School, Kurashiki, Okayama, Japan
| | - Noriaki Kuwada
- Division of Cardiovascular Surgery, Department of Surgery, Kawasaki Medical School, Kurashiki, Okayama, Japan
| | - Kazuo Tanemoto
- Division of Cardiovascular Surgery, Department of Surgery, Kawasaki Medical School, Kurashiki, Okayama, Japan
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Otani S, Yamamoto T, Yamada Y, Kuwada N. [Coronary Artery Bypass Grafting (CABG) and simultaneous cardiac resynchronization therapy in a patient with left ventricular noncompaction repeating heart failure]. Kyobu Geka 2013; 66:1067-1070. [PMID: 24322314] [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: 06/03/2023]
Abstract
Noncompaction of the left ventricular myocardium (NCLV) is a rare congenital cardiomyopathy resulting from an arrest in normal endomyocardial embryogenesis, and has been known as a disease of infants. However, some cases of NCLV in adults have been recently reported. We experienced an adult NCLV case repeating heart failure, and controlled it by surgery. The patient was 75-year-old man with NCLV and he had repeated heart failure and hospitalization. His heart failure had been barely control by infusion of human atrial natriuretic peptide (hANP). Coronary angiography revealed double vessel disease( #2 100%, #6 90).We performed coronary artery bypass grafting(CABG) with intraoperative cardiac resynchronization therapy. The heart failure was dramatically improved and the patient was discharged on foot 32 days after operation. However, careful observation of cardiac function is vital because of the possibility of progression to heart failure of NCLV.
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Affiliation(s)
- Satoru Otani
- Division of Cardiovascular Surgery, National Hospital Organization, Iwakuni Clinical Center, Iwakuni, Japan
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11
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Otani S, Yamamoto T, Yamada Y, Kuwada N. [Combined surgical and endovascular treatment( hybrid-procedure) of thoracoabdominal dissecting aneurysm]. Kyobu Geka 2013; 66:379-382. [PMID: 23674035] [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: 06/02/2023]
Abstract
A 50-year-old man was admitted because of enlargement in diameter of the descending thoracoabdominal aorta. Seven years previously, he had undergone Bentall operation and graft replacement of the aortic arch due to an acute dissecting aneurysm, and he had also received graft replacement of the descending aorta due to a rupture of dissecting aneurysm 2 years before. The surgical stress of conventional repair under left lateral thoracotomy and laparotomy was considered to be excessive, and the 3-dimensional computed tomography (3D-CT) image revealed the reconstruction of intercostals artery was difficult. Hence, extra-anatomic bypasses were created to perfuse the visceral and renal vessels, and endovascular thoracic stent-grafts were deployed into the false lumen, because of the severe narrowing of the true lumen( hybrid-procedure). The postoperative course was uneventful and the patient was discharged on postoperative 30 days. Hybrid-procedure of aortic aneurysm is feasible, and may be an alternative to standard open procedures in high-risk patients and emergency cases.
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Affiliation(s)
- Satoru Otani
- Division of Cardiovascular Surgery, National Hospital Organization, Iwakuni Clinical Center, Iwakuni, Japan
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Kuwada N, Nagano K, MacLennan N, Havens J, Kumar M, Dipple KM, McCabe ERB. Gene therapy for murine glycerol kinase deficiency: Importance of murine ortholog. Biochem Biophys Res Commun 2005; 335:247-55. [PMID: 16105550 DOI: 10.1016/j.bbrc.2005.07.066] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [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] [Received: 07/10/2005] [Accepted: 07/13/2005] [Indexed: 10/25/2022]
Abstract
A glycerol kinase (Gyk) knock-out (KO) mouse model permits improved understanding of glycerol kinase (GK) deficiency (GKD) pathogenesis, however, early death of affected mice limits its utility. The purpose of this work was to delay death of affected males to investigate thoroughly their phenotypes. An adenoviral vector carrying the human (Adeno-XGK) or mouse (Adeno-XGyk) GK gene was injected into KO mice within 24 h of birth. Adeno-XGK did not change KO mouse survival time despite liver GK activity greater than 100% of wild type. However, Adeno-XGyk improved KO mouse survival time greater than two-fold. These investigations demonstrate that gene replacement therapy for Gyk KO mice is more efficacious using murine Gyk than human GK. These studies expand our understanding of GKD pathogenesis in the murine model, and show that while murine GKD is more severe than in humans, GKD mice have similar metabolic disturbances to affected humans with hypoglycemia and acidemia.
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Affiliation(s)
- N Kuwada
- Department of Pediatrics, David Geffen School of Medicine at UCLA and Mattel Children's Hospital at UCLA, Los Angeles, CA 90095, USA
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Nishida T, Suzuki K, Kuwada N, Nakamura Y, Motoyoshi K, Kamakura K. Hemophagocytic syndrome and adult Still's disease associated with meningoencephalitis and unconsciousness. Intern Med 2001; 40:1037-40. [PMID: 11688830 DOI: 10.2169/internalmedicine.40.1037] [Citation(s) in RCA: 23] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
We describe a 19-year-old woman with hemophagocytic syndrome and adult Still's disease who showed rare features of central neurological involvement, including cerebellar symptoms and the sudden onset of unconsciousness with pleocytosis in the cerebrospinal fluid during the early course of the illness. As this patient's serum showed a high level of interferon-gamma and soluble interleukin 2 receptor, this might play a pathologic role in the development of central nervous system symptoms. Intensive treatment consisting of methylprednisolone pulse therapy followed by the oral administration of methylprednisolone and cyclosporine, as well as plasma exchange, was found to achieve good results.
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Affiliation(s)
- T Nishida
- Department of Internal Medicine III, National Defense Medical College, Tokorozawa, Saitama
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14
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Ikeda T, Sato K, Yamashita T, Kanai Y, Kuwada N, Matsumura T, Nakamura Y, Kimura F, Motoyoshi K. Burkitt's acute lymphoblastic leukaemia transformation after myelodysplastic syndrome. Br J Haematol 2001; 115:69-71. [PMID: 11722413 DOI: 10.1046/j.1365-2141.2001.03098.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [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: 11/20/2022]
Abstract
We describe a patient with myelodysplastic syndrome (MDS) that transformed to Burkitt's acute lymphoblastic leukaemia (ALL). The leukaemic blasts were negative for peroxidase staining, and expressed CD10, CD19, CD22, CD38, human leucocyte antigen (HLA)-DR and surface immunoglobulin (sIg) M, but neither sIgD nor sIgG were expressed. Chromosomal study during the ALL phase showed t(8;22)(q24;q11) in addition to the karyotypes determined during the MDS phase. Furthermore, overexpression of c-myc mRNA was confirmed in ALL blasts. These findings indicate that MDS transformed to Burkitt's ALL through multiple cytogenetic evolutions, the final event of which seems to be overexpression of the c-myc gene.
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Affiliation(s)
- T Ikeda
- Third Department of Internal Medicine, National Defence Medical College, Saitama, Japan
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15
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Kuwada N, Kimura F, Matsumura T, Yamashita T, Nakamura Y, Wakimoto N, Ikeda T, Sato K, Motoyoshi K. t(11;14)(q23;q24) generates an MLL-human gephyrin fusion gene along with a de facto truncated MLL in acute monoblastic leukemia. Cancer Res 2001; 61:2665-9. [PMID: 11289145] [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] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Abstract
More than 20 different partner genes with MLL have been cloned from leukemia cells with translocations involving chromosome 11 band q23 (11q23). All reported partner genes fused in-frame to MLL and the fusion cDNA encode chimeric MLL proteins with a significant portion derived from the partner genes. We analyzed one patient with de novo acute monoblastic leukemia with t(11;14)(q23;q24) and identified that a human homologue of gephyrin (human gephyrin) fused with MLL. Gephyrin is a rat glycine receptor-associated protein, which forms submembranous complexes and anchor glycine or gamma-aminobutyric acidA receptors to microtubules. Alternative splicing of human gephyrin gene created two different forms of fusion cDNA. In one form, human gephyrin gene fused in-frame to MLL exon 9, and the chimeric product had COOH terminus of human gephyrin protein, including the tubulin binding site. In the other, the reading frame terminated shortly after the fusion point. As a result, only seven amino acids with no known function were attached to the NH2 terminus of MLL protein. The functional significance of this de facto truncated MLL gene product is not clear.
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MESH Headings
- Aged
- Animals
- Artificial Gene Fusion
- Base Sequence
- Blotting, Southern
- Carrier Proteins/genetics
- Chromosomes, Human, Pair 11
- Chromosomes, Human, Pair 14
- Cloning, Molecular
- DNA, Complementary/genetics
- DNA, Neoplasm/genetics
- DNA-Binding Proteins/genetics
- DNA-Binding Proteins/metabolism
- Female
- Histone-Lysine N-Methyltransferase
- Humans
- Leukemia, Monocytic, Acute/genetics
- Leukemia, Monocytic, Acute/metabolism
- Membrane Proteins/genetics
- Molecular Sequence Data
- Myeloid-Lymphoid Leukemia Protein
- Oncogene Proteins, Fusion/genetics
- Oncogene Proteins, Fusion/metabolism
- Proto-Oncogenes
- Rats
- Reverse Transcriptase Polymerase Chain Reaction
- Sequence Homology, Nucleic Acid
- Transcription Factors
- Translocation, Genetic
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Affiliation(s)
- N Kuwada
- Third Department of Internal Medicine, National Defense Medical College, Saitama, Japan
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Wakimoto N, Kimura F, Sato K, Kuwada N, Matsumura T, Yamashita T, Nakamura Y, Yoshida M, Nakamura Y, Motoyoshi K. [Marked hematologic improvement despite deterioration of marrow cell dysplasia in a refractory anemia patient treated with vitamin D3]. Rinsho Ketsueki 1999; 40:408-13. [PMID: 10390890] [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: 02/13/2023]
Abstract
A 69-year-old man was admitted to our hospital due to pancytopenia and a marked bleeding tendency. On admission, he had a white cell count of 2.8 x 10(9)/l, hemoglobin level of 6.0 g/dl, and a platelet count of 3 x 10(9)/l. He was given a diagnosis of refractory anemia on the basis of bone marrow aspiration findings, which disclosed trilineage myelodysplasia. After discharge, the patient remained dependent on blood transfusions. The sole administration of an active form of vitamin D3 (calcitriol) was started in July 1997, and one and a half years later, the patient's transfusion dependency disappeared. However, bone marrow aspiration findings at this point disclosed marked cell dysplasia of erythroid lineage and a prognostically unfavorable chromosomal abnormality (monosomy 7) that had not been found during the initial examination. Nonetheless, the patient's hemoglobin level and platelet count increased to more than 9 g/dl and about 1.0 x 10(11)/l, respectively. The finding in this case suggested that vitamin D3 therapy is useful for refractory anemia even if aggravated marrow cell dysplasia and cytogenetic anomalies develop.
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Affiliation(s)
- N Wakimoto
- Third Department of Internal Medicine, National Defense Medical College
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17
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Wakimoto N, Mukai Y, Kuwada N, Yamashita T, Matsumura T, Nakamura Y, Kimura F, Sato K, Nagata N, Motoyoshi K. Dual rearrangement of immunoglobulin and T-cell receptor genes in a case of Philadelphia chromosome-positive acute leukemia. Jpn J Clin Oncol 1998; 28:396-400. [PMID: 9730156 DOI: 10.1093/jjco/28.6.396] [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: 11/12/2022] Open
Abstract
A 48-year-old patient was admitted to our hospital for leukocytosis. The blast cells were positive for peroxidase and he was tentatively diagnosed as acute myeloid leukemia according to the French-American-British criteria. By flow cytometry, the bone marrow cells were positive for CD10, CD13, CD33 and HLA-DR, but two-color analysis revealed that most of the CD13- and CD33-positive cells did not express CD10. The marrow cells had Philadelphia chromosome with no additional abnormalities. Major bcr-abl fusion gene was observed by the reverse transcriptase-polymerase chain reaction method. Southern blot analysis disclosed rearrangement of both immunoglobulin heavy chain and T-cell receptor beta chain genes. He received combined chemotherapy for myeloid lineage and lymphoid lineage, but the response was quite poor. He died 64 days after admission due to pulmonary bleeding. Although the association of Ph1 with multilineage differentiation is unclear, our case has significant implication for further investigation of the relationship between Ph1-positive cells and lineage selection.
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MESH Headings
- Acute Disease
- Bone Marrow/immunology
- CD13 Antigens/analysis
- Fusion Proteins, bcr-abl/analysis
- Gene Rearrangement, T-Lymphocyte
- Genes, Immunoglobulin
- Genes, T-Cell Receptor beta
- HLA-DR Antigens/analysis
- Humans
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/genetics
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/immunology
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/pathology
- Male
- Middle Aged
- Neprilysin/analysis
- Polymerase Chain Reaction
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Affiliation(s)
- N Wakimoto
- The Third Department of Internal Medicine, National Defense Medical College, Tokorozawa, Saitama, Japan
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Wakimoto N, Yokoyama A, Mukai Y, Kuwada N, Yamashita T, Matsumura T, Nakamura Y, Kanatani Y, Nagata N, Okabe-Kado J, Honma Y, Motoyoshi K. Elevated expression of differentiation inhibitory factor nm23 mRNA in monoblastic crisis of a patient with chronic myelogenous leukemia. Int J Hematol 1998; 67:313-8. [PMID: 9650453 DOI: 10.1016/s0925-5710(97)00116-3] [Citation(s) in RCA: 5] [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: 11/29/2022]
Abstract
Differentiation inhibitory factor nm23 gene has been found to be expressed in high quantities in acute myelogenous leukemia (AML), especially in acute monocytic leukemia (AML-M5) and is suggested as a new prognostic factor in AML-M5. We report an example of elevated expression of nm23 mRNA in a patient with chronic myelogenous leukemia (CML) who developed monoblastic crisis. Relative levels of nm23-H1 and -H2 mRNA extracted from the patient's peripheral blood mononuclear cells and bone marrow mononuclear cells were measured by quantitative reverse transcriptase polymerase chain reaction. The level of nm23-H1 mRNA in CML cells at the chronic phase was as high as that in bone marrow cells from healthy volunteers. The mRNA level of nm23-H2 was slightly below the normal level. At blastic crisis, however, expression of both nm23-H1 and -H2 mRNA was elevated to about three to nine times of that at the chronic phase. Proliferated blastic cells were positive for non-specific esterase, and the serum lysozyme level was elevated and diagnosed as monoblastic crisis. The patient received combined chemotherapy but response was partial. These findings are compatible with our previous report that nm23 gene is overexpressed in monocytic leukemia.
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MESH Headings
- Antigens, Neoplasm/biosynthesis
- Female
- Humans
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/blood
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/pathology
- Leukocytes, Mononuclear/metabolism
- Leukocytes, Mononuclear/pathology
- Middle Aged
- Monomeric GTP-Binding Proteins
- NM23 Nucleoside Diphosphate Kinases
- Nucleoside-Diphosphate Kinase
- RNA, Messenger/biosynthesis
- Transcription Factors/biosynthesis
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Affiliation(s)
- N Wakimoto
- Third Department of Internal Medicine, National Defense Medical College, Saitama, Japan
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Suzumura M, Honma T, Kuwada N. [Drug therapy of abortion (excluding hormone preparations), with special reference to uterine relaxants]. Sanfujinka No Jissai 1966; 15:982-92. [PMID: 6015130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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