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Nantan, Japan

Ochi Y.,Research Institute for Production Development | Kajita Y.,Nantan General Hospital | Hachiya T.,Midorigaoka Hospital | Arata N.,National Center for Child Health and Development | Hamaoki M.,Yamasa Ltd.
Endocrine, Metabolic and Immune Disorders - Drug Targets

Previously, we reported the conversion phenomenon (CP) of thyroid blocking antibody (TBAb) to thyroid stimulating antibody (TSAb) by induced cAMP production during incubation of TBAb-bound porcine thyroid cells (PTC) with rabbit anti-IgG Ab. In the present experiment we examined the CP by TBAb-positive sera with high TSH binding inhibitor immunoglobulin (TBII) activity in primary hypothyroidism. Two patients with extremely high TBII patients; patient No.1 (35 yo male) with TSH 26.5μU/ml, TSAb negative, TBII 4,600 U/L, TBAb100% and patient No.2 (40 yo female) with TSH 4.5μU/ml, TSAb negative, TBII 1,620 U/L, TBAb 99.8% were examined. Cyclic AMP production was examined by 2nd incubation (3h) of anti-IgG Ab with TBAb-bound PTC that was made by 1st incubation (0.5h) of TBAbpositive serum and PTC. When sera (0.001-0.05 ml) of patient No.1 and No.2 were tested, cAMP production showed 980- 3,700% and 570-3,000% in a dose-dependent manner, respectively. Cyclic AMP production was also observed by anti- IgG fragments Ab [(Fab')2, Fab and light chain]. Cyclic AMP production by anti-F(ab')2 was higher than anti-Fab Ab, and cAMP by anti-κ Ab was significantly higher (>3 fold) than anti-λ Ab. Cyclic AMP production by TBAb-positive sera with high TBII activity (35-270 U/L) showed a correlation with serum TBII activity (R=0.76). The fact that all high TBAb-positive sera show the CP of TBAb to TSAb suggests that TSAb activity may be present in TBAb molecule and TBAb may be the precursor of TSAb. © 2013 Bentham Science Publishers. Source

Ochi Y.,Research Institute for Production Development | Kajita Y.,Nantan General Hospital | achiya T.,Midorigaoka Hospital | amaoki M.,Yamasa Ltd.
Endocrine Journal

There are several reports that sera from Graves' patients contain heterophilic antibody (Ab) to animal IgG such as human anti-mouse antibody (HAMA). We examined the binding of TSAb and TBAb with heterophilic Ab. The binding of animal IgG with patient's IgG was examined by the inhibition of animal IgG on the binding of labeled bovine (b) IgG with patient's IgG. The binding to labeled bIgG was detected in the serum of 5 patients (2.7%) among 185 patients with Graves' disease. The binding of the labeled bIgG with patient's IgG was inhibited by animal serum or the crude IgG (45% ammonium sulfate fraction of serum) (such as dog, horse, bovine, porcine, goat, ovine, rabbit, guinea-pig, rat, mouse) except human, monkey and chick. This heterophilic Ab which had cross-reaction with mammalian IgG (except human, monkey) was used as human anti-animal IgG Ab. TBII and TSAb activity of TSAb-positive serum, and TBII activity of TBAb-positive serum were neutralized by incubation with this Ab-bound column. Partial purifcation of TSAb- or TBAb-IgG from Protein A-purifed TSAb- or TBAb-IgG was possible using this Ab-bound column. TBII and TSAb activity of TSAb-IgG and TBII activity of TBAb-IgG were neutralized by incubation with rabbit anti-human (h) IgG Ab (having cross-reaction with animal IgG). Further purification of Protein A-purifed TSAb-IgG or TBAb-IgG by rabbit anti-hIgG Ab-bound column was impossible. The binding of TSAb and TBAb with heterophlic Ab means that TSAb-and TBAb-specifc IgG have immunological similarity with mammalian species IgG compared to human IgG. © The Japan Endocrine Society. Source

Kayano K.,Nantan General Hospital | Koida A.,Nantan General Hospital
Practica Oto-Rhino-Laryngologica

Pleomorphic adenomas occurring in the external auditory canal are very rare benign tumors, accounting for only 2-3% of benign tumors in this canal. A 29-year-old male visited our hospital with left ear fullness as the chief complaint. The left external auditory canal was filled with a tumor arising from the posterosuperior wall. Temporal bone CT showed a mass obstructing the left external auditory canal but no bone destruction or tumor extension to the middle ear cavity. Biopsy suggested a ceruminous or pleomorphic adenoma. The tumor was excised under local anesthesia using an endaural approach. The skin defect of the external auditory canal after the excision was covered with fibrin glue and a polyglycolic acid (PGA) sheet. The tumor (13 × 10 mm) was pathologically diagnosed as a pleomorphic adenoma originating from the ceruminous (apocrine) gland, and the surgical margin was negative. His postoperative course was favorable, showing epithelialization of the skin defect of the external auditory canal at about 1 month. There are two theories concerning the origin of pleomorphic adenomas of the external auditory canal: they originate from myoepithelial cells of the ceruminous (apocrine) gland or from aberrant parotid gland tissue. Since this patient showed ceruminous glands around tumor cells but no parotid gland structures, the tumor was considered to be of ceruminous gland origin. The first treatment choice is surgery. In this patient, the tumor could be excised using an endaural approach that is minimally invasive. A PGA sheet was useful for wound healing in the external auditory canal and the prevention of scar contracture after tumor excision. Source

Hayashi K.,Nantan General Hospital | Hayashi K.,Kyoto Prefectural University of Medicine | Mukai N.,Nantan General Hospital | Sawa T.,Kyoto Prefectural University of Medicine
Clinical Neurophysiology

Objective: The Poincaré plot is a two-dimensional state-space approach, where a timed signal is plotted against itself after a time delay, enabling determination of the dynamic nature of signals. Quantification of the Poincaré plot is a candidate for estimating anesthesia-dependent changes in the electroencephalogram (EEG). Methods: In 20 patients, at four different states of anesthesia (0.5%, 1%, 2% and 3% sevoflurane), frontal EEG signals (10. s) were used to construct Poincaré plots. The plot pattern was quantified by the standard deviation of the voltage dispersion along the line of identity (SD2), the standard deviation perpendicular to the line of identity (SD1) and their ratio (SD1/SD2), and compared using spectral EEG features. Results: A significant stepwise decrease in the SD1/SD2 ratio was observed with each stepwise increase in sevoflurane concentration (p< 0.001 for each). From 0.5% to 3% sevoflurane anesthesia, the ratio of relative β power to δ power (β/. δ) was highly correlated with SD1/SD2 (R= 0.92). Conclusions: The Poincaré plot of the frontal EEG can detect the significant changes in the depth of anesthesia induced by different sevoflurane concentrations. Significance: The Poincaré plot is a useful technique for detecting the EEG changes induced by anesthesia. © 2014 International Federation of Clinical Neurophysiology. Source

Hayashi K.,Nantan General Hospital | Hayashi K.,Kyoto Prefectural University of Medicine | Mukai N.,Nantan General Hospital | Sawa T.,Kyoto Prefectural University of Medicine
Clinical Neurophysiology

Objective: Occipital electroencephalogram (EEG) activity is known to be different from the frontal EEG during wakefulness and anesthesia. However, less is known about occipital non-linear dynamics analyzed by EEG-bicoherence, which can reflect the oscillatory features that are dependent on thalamocortical modulation. Methods: Forty patients were anesthetized using sevoflurane (1% or 3%) combined with remifentanil. Frontal and occipital EEGs were simultaneously collected, and bicoherence was analyzed before and after induction of anesthesia. Results: Occipital awake EEGs often demonstrate a bicoherence α peak, differing from frontal awake EEGs in the absence of bicoherence growth. With 1% sevoflurane, occipital α bicoherence disappeared and frontal α bicoherence peaks appeared. Although 3% sevoflurane caused an increase in occipital δ-θ normalized power, similar to the frontal region (peak relative δ-θ power, 13.1. ±. 2.2% vs. 12.2. ±. 2.7%, p>. 0.05), occipital bicoherence showed no growth in any frequency area, contrasting with the frontal bicoherence spectrum with a conspicuous peak in the δ-θ area (19.8. ±. 8.9 vs. 43.6. ±. 13.8, p<. 0.05). Conclusions: The occipital bicoherence spectrum in the peri-anesthesia period is quite different from the frontal bicoherence spectrum, which is not usually obvious in the power spectrum. Significance: Nonlinear regulation of the occipital EEG is different from the frontal EEG during every stage of anesthesia. © 2013 International Federation of Clinical Neurophysiology. Source

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