[Role of biochemical and fibrinolytic parameters on cardiac events associated with Hanshin-Awaji earthquake-induced stress].

Catastrophic stress induced by Hanshin-Awaji earthquake seems to promote rheological deterioration associated with high blood pressure, increased blood viscosity due to hemoconcentration and increased fibrinogen level. These changes lead to prolonged endothelial cell dysfunction demonstrating high levels of von Willebrand factor, tissue type plasminogen activator and plasmin.alpha 2 plasmin inhibitor complex, and accelerate fibrin turnover as the result of a high D-dimer level from the post earthquake period until 4-6 months later.

[Treatment and diagnosis of middle fossa arachnoid cyst: ventriculofiberscopy and cine-MRI].

The treatment of intracranial arachnoid cysts in controversial regarding its surgical indication and operative procedures. Conventional surgical approaches such as fenestration, membranectomy, and shunting operation are invasive. Also CT cisternography and/or RI cisternography are invasive, when it has been performed to evaluate the possible CSF communications between the arachnoid cyst and subarachnoid space.

Hemostatic activation and cardiac events after the 1995 Hanshin-Awaji earthquake.

Earthquake-induced stress seems to induce rheological deterioration associated with high blood pressure, an increase of blood viscosity due to hemoconcentration and an increase of the fibrinogen level. These changes lead to prolonged endothelial cell injury and accelerate fibrin turnover as the result of a high D-dimer level. An increase of these acute changes caused by mental and physical stress after an earthquake might trigger obstructive thrombus in coronary arteries in the elderly.

[The management of slit-like ventricle with the Medos programmable Hakim valve and the ventriculofiberscope].

A slit-like ventricle is one of the serious complications which can occur after a shunting operation. Low pressure valve systems are usually applied for hydrocephalus during infancy. As a result the shape of the ventricle often becomes slit-like after the operation.

ACE gene polymorphism in childhood IgA nephropathy: association with clinicopathologic findings.

A deletion polymorphism in the angiotensin-converting enzyme (ACE) gene has been reported to be a risk factor for progression to chronic renal failure in immunoglobulin A nephropathy (IgAN). In this study, we investigated the association between ACE gene polymorphism and clinical findings, early biopsy findings such as the extent of mesangial proliferation, focal lesions (capsular adhesions, glomerulosclerosis, and crescents), and the glomerular area in childhood IgAN. Genomic DNA was obtained from 97 patients and control subjects.

[Acute respiratory distress syndrome complicating imported Plasmodium falciparum malaria].

A 25-year-old male, who had returned from the Republic of Mali in Africa, was admitted to our hospital because of a 3-day history of high fever, on the first of October 1996. He was diagnosed as Plasmodium falciparum malaria by peripheral blood smear. From the admission day he was treated with quinine HCL, 1,500 mg per day, and sulfamethoxazole 2,400 mg trimethoprim 480 mg per day, but on October 2nd blood examination showed 35% parasite density and he was given mefloquine.

[Lung laceration caused by penetrating chest wall injury in Hanshin & Awaji earthquake: a case report].

A 36-year-old man having a left lower lobe laceration caused by penetrating chest wall injury was operated on 5 hours after Hanshin & Awaji Earthquake. At thoracotomy, significant destruction of the left lower lobe was observed. Therefore, we gave up repairing a lung, and performed left lower lobectomy, with a satisfactory outcome.

[Human fascioliasis: comparison of a fasciolicidal effect of bithionol and praziquantel].

There is no consensus about the optimal treatment for fascioliasis. Here we report 5 cases of fascioliasis and 12 cases of fascioliasis reviewed from the literature, and discuss the clinical characteristics and treatment of this parasitic disease. The diagnosis was made in 88% of all patients by the serological test and eggs in the feces were negative in all patients.

Hanshin-Awaji earthquake as a trigger for acute myocardial infarction.

On Jan. 17, 1995, the Hanshin-Awaji district was struck by the most destructive earthquake ever to occur in Japan. It is commonly believed that acute emotional stress such as that caused by an earthquake can trigger acute myocardial infarction (AMI).

[Diagnosis for dural arteriovenous fistulas based upon MR angiography].

Diagnosis of dural arteriovenous fistulas (DAVFs) has been traditionally based on cerebral angiography, which is still an invasive process. Recent advances of MR angiography have started to bring us into a new area of diagnosis for stroke patients. While using MRA at the out-patient clinic for screening patients with cerebrovascular disease, we have had a chance to diagnose DAVFs.

Application of argatroban, direct thrombin inhibitor, in heparin-intolerant patients requiring extracorporeal circulation.

This study describes the present knowledge regarding the clinical application of argatroban, a direct competitive thrombin inhibitor for heparin-intolerant patients, including those with congenital and acquired antithrombin III deficiencies, those with heparin-induced thrombocytopenia, and those with high levels of polymorphonuclear granulocyte elastase. These patients are often associated with intracircuit clot formation with heparin anticoagulation during extracorporeal circulation. Therefore, argatroban may be chosen as one of the alternate anticoagulants.

Extrinsic coagulation factors and tissue factor pathway inhibitor in end-stage chronic renal failure.

The relationship between extrinsic coagulation factors, tissue factor pathway inhibitor (TFPI) and activated factor XII (FXIIa) was examined in 71 patients with end-stage chronic renal failure. They had chronic stable uremia due to regular hemodialysis. The patients were divided into two age- and sex-matched groups with and without diabetes mellitus.

[Cerebral sinus thrombosis in a patient with protein S deficiency: a case report].

Cerebral sinus thrombosis associated with protein S deficiency is rare to the best of our knowledge. We report here a 22-year-old female who presented sudden onset of headache, vomiting and disturbance of consciousness. Neuroradiological studies including computed tomography scan, magnetic resonance imaging and cerebral angiography disclosed a huge cerebral sinus thrombosis in the territory of the superior sagittal sinus, torcular herophili, lateral sinus and straight sinus.

Development of argatroban, a direct thrombin inhibitor, and its clinical application.

Argatroban, a direct thrombin inhibitor, is used clinically because of its safe and effective antithrombotic action. This drug of low molecular weight shows reversible inhibition of thrombin irrespective of whether thrombin is fibrin-bound or soluble. Optimal anticoagulant effects can easily be attained by monitoring with the activated partial thromboplastin time or whole-blood activated clotting time when a therapeutic range of argatroban equivalent to that of heparin is used.

Early onset of immunological heparin-induced thrombocytopenia in acute myocardial infarction.

We studied five patients who developed a decrease in platelet count of more than 30000 x 10(6)/l within 24 h of heparin treatment and direct percutaneous transluminal coronary angioplasty and/or intracoronary thrombolytic therapy among 38 consecutive patients with acute myocardial infarction (AMI). Anti-platelet factor 4 (PF4)-heparin complex antibodies were detected in the sera of these five patients, although they had never previously been exposed to heparin. These patients might have had specific antibodies before heparin treatment.

Pharmacokinetics of carboplatin and etoposide in a haemodialysis patient with Merkel-cell carcinoma.

We present a Merkel-cell carcinoma patient with chronic renal failure requiring haemodialysis and evaluate the pharmacokinetics of carboplatin and etoposide during haemodialysis. The area under the concentration-time curve of carboplatin was increased by prolonging the interval between administration and haemodialysis. However, that of etoposide was not changed.

[Thrombotic thrombocytopenic purpura after administration of ticlopidine].

On June 29, 1995, a 49-year-old man was admitted with acute onset of fever, petechiae on his legs, and mental confusion He had suffered hypertension since 6 months previously and was on nicardipine (60 mg/day), ifenprodil (60 mg/day) and ticlopidine (300 mg/day). He had been on ticlopidine for 4 weeks and on the other drugs for 6 months. Soon after admission he had frequent grand mal seizures and needed mechanical ventilation.

Heparin-induced thrombocytopenia in hemodialysis patients.

This study was conducted to determine the incidence of heparin-induced thrombocytopenia (HIT), an important complication in heparin therapy, in 154 hemodialysis patients, with characterization of the subtypes using an enzyme-linked immunosorbent assay. The etiology of the immunologic type of HIT is suggested to involve the binding of a specific antibody for platelet factor 4-heparin complex to platelets and their consequent activation. The 154 consecutive patients were newly treated with hemodialysis due to chronic or acute renal failure between January 1993 and July 1995.

[Cesarean section in a patient with uncontrolled hyperthyroidism, preeclampsia, and congestive heart failure].

A case of a pregnant woman who underwent urgent cesarean section is presented. The patient had severe hyperthyroidism, preeclampsia, and congestive heart failure, which had not been treated until 36 weeks of gestational age. At 38 weeks, fetal distress occurred and an urgent cesarean section was performed successfully under epidural anesthesia with preoperative treatments using iodide, hydrocortisone and propylthiouracil.

[Successful combination chemotherapy including deoxycoformycin in a case of cutaneous T cell lymphoma].

A 44-year-old woman was admitted to our department because of fever and skin eruptions on August, 1991. Physical examination revealed superficial lymph node swelling, hepatosplenomegaly and generalized erythroderma. Laboratory findings were as follows; WBC 21,490/microliters with 67% lymphocytes including flower cells.

[Nineteen multiple primary cancer cases of 100 patients undergoing lung cancer resection].

In our department, half of 100 consecutive lung cancer resection cases were over the age of 70 years. In the same 100 patients, nineteen cases had multiple primary cancers. Sixteen cases had double, two cases had triple, one case had quadruple primary cancers.

An inappropriate erythropoietic response to iron deficiency anaemia in the elderly.

This study was carried out to clarify the features of iron deficiency anaemia in the elderly. Subjects were chosen from residents undergoing an annual health check in a home for the aged and the features of anaemia in the elderly were compared with those in middle-aged adults under 60 years old. The red cell count, red cell size and haemoglobin content in an elderly group with iron-deficiency anaemia did not differ from those in middle-aged adults.