RESUMEN
To reveal clinicopathological features of narrow-band imaging (NBI) endoscopy and immunohistochemistry in ultraminute esophageal squamous neoplasms. If a lesion diameter was smaller or same compared with a width of closed biopsy forceps, a lesion was defined to be an ultraminute lesion. Twenty-five consecutive patients with 33 ultraminute esophageal lesions that were removed by endoscopic mucosal resection were included in the present study. We conducted two questionnaire surveys of six endoscopists by their retrospective review of endoscopic still images. The six endoscopists evaluated the endoscopic findings of the ultraminute lesions on still images taken by conventional white-light imaging endoscopy and non-magnified NBI endoscopy in the first questionnaire, and taken by magnified NBI endoscopy in the second questionnaire. An experienced pathologist who was unaware of any endoscopic findings made histological diagnosis and evaluated immunoexpression of p53 and Ki67. The 33 ultraminute lesions were all determined to be either 11 high-grade intraepithelial neoplasias (HGIENs) or 22 low-grade intraepithelial neoplasias (LGIENs). The tumor diameters were histologically confirmed to be <3 mm. All of the ultraminute tumors were visualized as unstained areas and brownish areas by real-time endoscopy with Lugol dye staining and non-magnified NBI endoscopy, respectively. All of the ultraminute IENs were visualized as brownish areas by real-time non-magnified NBI endoscopy. Three of the 25 patients with the ultraminute IENs (12%) had multiple brownish areas (more than several areas) in the esophagus on real-time non-magnified NBI endoscopy. All of the ultraminute IENs were visualized as unstained areas by real-time Lugol chromoendoscopy. Twenty of the 25 patients (80%) had multiple unstained areas (more than several areas) in the esophagus on real-time Lugol chromoendoscopy. The first questionnaire survey revealed that a significantly higher detection rate of the ultraminute IENs on non-magnified NBI endoscopy images compared with conventional white-light imaging endoscopy ones (100% vs. 72%, respectively: P < 0.0001). The second questionnaire survey revealed that presence rates of any magnified NBI endoscopy findings were not significantly different between HGIENs and LGIENs. Proliferation, dilation, and various shapes of intrapapillary capillary loops indicated remarkably high presence rates of more than 90% in both HGIENs and LGIENs. Six of 22 LGIENs (27%) and 3 of 11 HGIENs (27%) show a positive expression for p53. None of peri-IEN epithelia was positive for p53. A mean of Ki67 labeling index of LGIENs was 33% and that of HGIENs 36%. Ki67 labeling index was significantly greater in the LGIENs and HGIENs compared with that in the peri-IEN epithelia. There were no significant differences in p53 expression and Ki67 labeling index between the HGIENs and LGIENs. Non-magnified/magnified NBI endoscopy could facilitate visualization and characterization of ultraminute esophageal squamous IENs. The ultraminute HGIENs and LGIENs might have comparable features of magnified NBI endoscopy and immunohistochemistry.
Asunto(s)
Biomarcadores de Tumor/análisis , Carcinoma in Situ/patología , Carcinoma de Células Escamosas/patología , Neoplasias Esofágicas/patología , Antígeno Ki-67/análisis , Imagen de Banda Estrecha , Proteína p53 Supresora de Tumor/análisis , Anciano , Carcinoma in Situ/química , Carcinoma de Células Escamosas/química , Colorantes , Neoplasias Esofágicas/química , Esofagoscopía , Femenino , Humanos , Inmunohistoquímica , Yoduros , Masculino , Persona de Mediana Edad , Estudios RetrospectivosRESUMEN
Diphtheria tetanus acellular pertussis combined (DTaP) vaccines have been successfully used in Japan by controlling their potencies and toxicities with animal models. In accordance with the recent practical introduction of DTaP vaccines of various formulations, a question has been raised in other nations as to the efficacy of a quality control system based on animal tests and standard preparations. The World Health Organization issued its guidelines on the production and quality control of acellular pertussis vaccines in 1998 along with the concept of quality control by ensuring that production lots were consistent with clinical trial lots, rather than by comparing them with standard preparations in traditional laboratory tests. However, because it is not feasible to evaluate the combined use of vaccines from different manufacturers in a clinical study, the alternative trend of quality control may give rise to a difficulty in rationalizing the practical immunizations to use vaccines of different brands in a mixed consequence. A standardized national regulation system to ensure the equivalence of approved products would be essential for such an immunization practice. The success of the Japanese DTaP vaccination suggests the possibility of an effective quality control of DTaP vaccines by means of standardized test systems.
Asunto(s)
Vacunas contra Difteria, Tétanos y Tos Ferina Acelular/efectos adversos , Vacunas contra Difteria, Tétanos y Tos Ferina Acelular/normas , Animales , Células CHO , Cricetinae , Difteria/prevención & control , Toxina Diftérica/inmunología , Toxina Diftérica/toxicidad , Humanos , Japón , Ratones , Control de Calidad , Tétanos/prevención & control , Toxina Tetánica/inmunología , Toxina Tetánica/toxicidad , Factores de Virulencia de Bordetella/inmunología , Factores de Virulencia de Bordetella/toxicidad , Tos Ferina/prevención & controlRESUMEN
The pyrogen test or the endotoxin test has been playing a crucial role in detecting endotoxin in parenteral drugs. The current test methods, however, have disadvantages such as requiring a relatively high number of animals or an inadequacy in direct evaluation of in vivo activity. We made an attempt to establish a new in vitro assay method that can overcome the shortcomings of the current assay methods. We standardized the system of tumor necrosis factor-alpha (TNF-alpha) induction from the peripheral blood of rabbits for assaying endotoxin activity. This in vitro assay showed a linear dose-response regression between 0.1 and 5.0 endotoxin units per milliliter of endotoxin and a definite homogeneity of variance by logarithmically transforming the endotoxin and TNF-alpha concentrations in the reaction mixtures at 5 h of incubation at 37 degrees C. The assay showed a definite correlation with the pyrogen test but not with the endotoxin test when endotoxins from various bacteria were tested.
Asunto(s)
Técnicas Bacteriológicas/métodos , Pruebas de Química Clínica/métodos , Endotoxinas/análisis , Animales , Técnicas Bacteriológicas/normas , Sangre , Pruebas de Química Clínica/normas , Ensayo de Inmunoadsorción Enzimática , Femenino , Conejos , Factor de Necrosis Tumoral alfa/análisis , Factor de Necrosis Tumoral alfa/biosíntesisRESUMEN
We evaluated applicability of the endotoxin test to DTaP vaccines. Although no DTaP vaccine batches showed immediate interference with the activating activity of spiked endotoxin on the clotting of Limulus amaebocyte lysate (LAL), a gradually progressing interference depending on the time after spiking was seen for some of the batches. The interfering DTaP vaccine batches, however, showed no significant effect onin vitro TNF-alpha induction in RAW264.7 cells and pyrogenicity in rabbits of spiked endotoxin. Aluminium hydroxide gel in the vaccines was suggested to be one of the causes of the interference. Accordingly, a careful evaluation of the interfering effect was assumed crucial for the effective application of the endotoxin test to check residual biological activity of endotoxin in DTaP vaccines.
Asunto(s)
Toxinas Bacterianas/análisis , Vacunas contra Difteria, Tétanos y Tos Ferina Acelular/farmacología , Lipopolisacáridos/análisis , Animales , Bordetella pertussis/química , Línea Celular , Cangrejos Herradura , RatonesRESUMEN
Fundamental conditions for applying the bacterial endotoxin test to antibiotic products were investigated so as not to affect the level of regulation by the rabbit pyrogen test. According to accuracy evaluation of test methods, the kinetic-turbidimetric and kinetic-colourimetric assays were shown to allow more accurate measurement and, therefore, more sensitive detection of interference to the bacterial endotoxin test than the gel-clot method. In total, 102 antibiotic products were evaluated on their interfering effect to show that the antibiotics could be categorized into three groups depending on intensity of the interference. Although the test was shown to be applicable even to the group showing the strongest interference, it was assumed to be crucial to use appropriate reagents and an accurate test method for avoiding approval of a pyrogenic product. Accordingly, lists of antibiotics are presented to provide limits of concentration for eliminating interference and endotoxin limits for approval to facilitate effective bacterial endotoxin tests.
Asunto(s)
Antibacterianos/normas , Toxinas Bacterianas/análisis , Endotoxinas/análisis , Prueba de Limulus , Animales , Antibacterianos/química , Bioensayo/normas , Colorimetría/métodos , Contaminación de Medicamentos/prevención & control , Fiebre , Prueba de Limulus/normas , Nefelometría y Turbidimetría/métodos , Control de Calidad , Conejos , Análisis de Regresión , Reproducibilidad de los Resultados , Sensibilidad y EspecificidadRESUMEN
A saline-jet aspiration thrombectomy (JAT) catheter was used in a patient with acute myocardial infarction. A right coronary arteriogram showed complete thrombotic occlusion at the proximal segment. With this catheter the thrombus was removed without complications in 5 sec. The patient underwent percutaneous transluminal coronary angioplasty and placement of a Palmaz-Schatz stent after successful thrombectomy. Thrombectomy with a JAT catheter was very useful in this patient.
Asunto(s)
Cateterismo Periférico/instrumentación , Trombosis Coronaria/cirugía , Trombectomía/métodos , Anciano , Angiografía Coronaria , Trombosis Coronaria/diagnóstico por imagen , Diseño de Equipo , Femenino , Estudios de Seguimiento , Humanos , Succión/instrumentaciónRESUMEN
We conducted a prospective observational study to assess the effectiveness of "transradial primary stenting" in 33 patients with acute myocardial infarction, along with acute risk stratification and accelerated patient care. With use of adequate inclusion and exclusion criteria, the radial artery can be used as an access site for catheterization, and transradial primary stenting can be performed rapidly and successfully by trained coronary interventionalists.
Asunto(s)
Cateterismo Periférico , Vasos Coronarios , Infarto del Miocardio/terapia , Arteria Radial , Stents , Anciano , Femenino , Humanos , Masculino , Reperfusión Miocárdica/métodosRESUMEN
The temperature-dependence of the mechanical properties of a new esthetic orthodontic wire with fiber-reinforced plastic (FRP) structure was investigated. The new FRP wire, fabricated by a hot drawing method, is 0.5 mm in diameter and has a multiple fiber structure composed of biocompatible CaO-P2O5-SiO2-Al2O3 glass fibers of 20 microns in diameter and a polymethyl methacrylate matrix. The flexural load at a deflection of 1 mm and Young's modulus at 24, 37, and 50 degrees C under wet conditions showed similar fiber fraction dependence to those under dry conditions for a fiber fraction of 40-51%. The flexural load and Young's modulus tended to decrease slightly with increases in temperature. This tendency was larger for the lower fiber fraction. However, the difference in flexural load for a temperature difference of between 24 degrees C and 50 degrees C was at most 10 gf. This is negligibly small, and a constant orthodontic force regarding temperature change would be advantageous from a clinical point of view.
Asunto(s)
Vidrio/química , Alambres para Ortodoncia , Elasticidad , Ensayo de Materiales , Docilidad , Polimetil Metacrilato/química , Temperatura , Agua/químicaRESUMEN
We conducted a prospective study to investigate the relation between ST reelevation during primary angioplasty and improvement in left ventricular function. The duration, not the occurrence, of ST reelevation at reperfusion was associated with improvement in left ventricular function in patients with anterior wall acute myocardial infarction successfully recanalized by primary angioplasty.
Asunto(s)
Angioplastia Coronaria con Balón , Sistema de Conducción Cardíaco , Infarto del Miocardio/terapia , Reperfusión Miocárdica , Función Ventricular Izquierda , Anciano , Cineangiografía , Femenino , Humanos , Masculino , Persona de Mediana Edad , Infarto del Miocardio/fisiopatología , Estudios Prospectivos , Factores de TiempoRESUMEN
We evaluated the therapeutic efficacy of cilostazol, a novel potent inhibitor of phosphodiesterase, for the prevention of stent thrombosis following implantation of a Palmaz-Schatz stent guided by angiographic visual estimation alone in 71 patients with 84 lesions. Patients received 81 mg of aspirin 3 times daily and 100 mg of cilostozol twice daily after angiographic confirmation of optimal Palmaz-Schatz stent implantation. Of the 84 vessels stented, 65 (77%) were classified as type B2 or C lesions according to the modified American Heart Association/American College of Cardiology classification, and 51 (61%) were <3.0 mm in diameter. Multiple stents were used in 26 patients (31%). The final balloon inflation pressure was 18.3 +/- 1.5 atm. The balloon-to-vessel ratio was 1.18 +/- 0.16. No patient received heparin or warfarin after the procedure. There were no deaths, Q-wave myocardial infarctions, in- or out-of-hospital stent thrombosis, coronary bypass surgery, or serious side effects such as neutropenia and/or liver dysfunction during the 1-month follow-up period. These results indicate that cilostazol was a safe and effective antiplatelet agent with minimum side effects after Palmaz-Schatz stent implantation.
Asunto(s)
Trombosis Coronaria/prevención & control , Inhibidores de Fosfodiesterasa/uso terapéutico , Inhibidores de Agregación Plaquetaria/uso terapéutico , Stents/efectos adversos , Tetrazoles/uso terapéutico , Adulto , Anciano , Cilostazol , Angiografía Coronaria , Trombosis Coronaria/diagnóstico por imagen , Trombosis Coronaria/etiología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Inhibidores de Fosfodiesterasa/efectos adversos , Inhibidores de Agregación Plaquetaria/efectos adversos , Tetrazoles/efectos adversos , Resultado del TratamientoRESUMEN
BACKGROUND: Local inflammation within the coronary arteries is involved in the pathogenesis of acute coronary syndrome. However, the contribution of a systemic inflammatory response to the pathogenesis of this syndrome has not been well characterized. Accordingly, we investigated systemic inflammatory responses in patients with acute coronary syndrome. METHODS: A total of 83 patients with ischemic heart disease (15 with stable exertional angina and 68 with acute coronary syndrome) were studied. The luminol-dependent chemiluminescence (CL) response of polymorphonuclear leukocytes (PMNs), which reflects their ability to generate oxygen species, was used as a marker for PMN activation. Soluble interleukin-2 receptor (sIL-2R) levels were measured to assess T-lymphocyte activation. RESULTS: CL counts of whole blood from patients with acute coronary syndrome were twice those of patients with stable angina (2.38 +/- 0.22 vs 1.10 +/- 0.17 x 10(6) counts, P < 0.05). A comparison of CL counts between patients with unstable angina and those with acute myocardial infarction revealed no significant differences. T-lymphocyte activity, measured by serum sIL-2R, was significantly lower in patients with acute coronary syndrome than those with stable angina (214.3 +/- 11.5 vs. 358.3 +/- 115.7 U/ml, P < 0.05). CONCLUSIONS: This investigation shows that there is a systemic increase in PMN activity and a decrease in T-lymphocyte activity in patients with acute coronary syndrome. This contrasts with the pattern of cellular activation seen at sites of local inflammation within atherosclerotic plaques, suggesting that two independent inflammatory processes (local and systemic) may be involved in the pathogenesis of this syndrome.
Asunto(s)
Enfermedad Coronaria/patología , Neutrófilos/patología , Linfocitos T/patología , Enfermedad Aguda , Anciano , Angina Inestable/sangre , Angina Inestable/inmunología , Angina Inestable/patología , Enfermedad Coronaria/sangre , Enfermedad Coronaria/inmunología , Femenino , Humanos , Inflamación/sangre , Inflamación/inmunología , Inflamación/patología , Mediciones Luminiscentes , Masculino , Persona de Mediana Edad , Infarto del Miocardio/sangre , Infarto del Miocardio/inmunología , Infarto del Miocardio/patología , Isquemia Miocárdica/sangre , Isquemia Miocárdica/inmunología , Isquemia Miocárdica/patología , Receptores de Interleucina-2/sangre , SíndromeRESUMEN
The relationship between ST reelevation at reperfusion and the occurrence of late potentials (LPS) in 35 patients with a first anterior infarction who had single vessel disease was investigated. All patients underwent a successful primary angioplasty and had a patent infarct related artery confirmed angiographically 4 weeks later. Patients were classified into groups based on changes in the ST level at reperfusion: patients with ST reelevation (group A, n = 22) and patients without ST reelevation (group B, n = 13). Signal-averaged ECG was performed 4 weeks after primary angioplasty to detect LPS. Cineventriculography was performed to measure left ventricular ejection fraction (LVEF) and evaluate regional wall motion of the infarct area (SD/chords). LPS were present in eight of the 22 group A patients (36%) and in none of the 13 group B patients (P < 0.05). Left ventricular function was impaired in patients in group A compared with patients in group B (LVEF: 5 1 +/- 12 vs 63 +/- 10, P < 0.01; SD/chords: -2.7 +/- 0.9 vs -1.9 +/- 1.1, P < 0.05). These data suggest that ST reelevation and myocardial damage at reperfusion are associated with the occurrence of LPS in patients with successfully recanalized infarct related arteries after acute anterior infarction.
Asunto(s)
Potenciales de Acción/fisiología , Angioplastia Coronaria con Balón , Electrocardiografía , Infarto del Miocardio/terapia , Cateterismo Cardíaco , Volumen Cardíaco , Cinerradiografía , Angiografía Coronaria , Enfermedad Coronaria/diagnóstico por imagen , Enfermedad Coronaria/fisiopatología , Enfermedad Coronaria/terapia , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Infarto del Miocardio/diagnóstico por imagen , Infarto del Miocardio/fisiopatología , Procesamiento de Señales Asistido por Computador , Volumen Sistólico , Resultado del Tratamiento , Grado de Desobstrucción Vascular , Disfunción Ventricular Izquierda/fisiopatología , Función Ventricular IzquierdaRESUMEN
The purpose of this study was to investigate the significance of ST re-elevation at reperfusion using strict criteria for patient inclusion and exclusion. Twenty-nine patients who had a first anterior infarction with single-vessel disease, successful recanalization by intracoronary thrombolysis (ICT) with urokinase, and an angiographically confirmed patent infarct-related artery after 4 weeks, were divided into three groups according to the deviation of the ST segment at reperfusion: Group A, 10 patients with sustained ST re-elevation; Group B, 10 patients with transient ST re-elevation; and Group C, 9 patients with ST reduction. Left ventricular (LV) function was evaluated from cineventriculograms performed in the 30 degrees right anterior projection 4 weeks after ICT. LV ejection fraction and regional wall motion of the infarct area, evaluated by the centerline method (SD/chords), were significantly lower in Group A (44 +/- 10%, -3.2 +/- 0.4) than in Group B (61 +/- 9%, -1.9 +/- 0.7) and Group C (60 +/- 5%, -2.0 +/- 0.4) (p < 0.01). Peak creatine kinase (CK) activity was significantly higher in Group A (5848 +/- 2112 IU) than in Group B (2485 +/- 1254 IU) and Group C (1889 +/- 1525 IU) (p < 0.05). These data suggest that a sustained ST re-elevation at reperfusion was strongly associated with marked LV dysfunction and higher peak CK activity. It was concluded that sustained, not transient, ST re-elevation associated with successful reperfusion indicates extensive myocardial damage.