Acta Medica Nagasakiensia
Print ISSN : 0001-6055
51 巻, 1 号
選択された号の論文の7件中1~7を表示しています
  • Shinichi SATO
    2006 年 51 巻 1 号 p. 1-7
    発行日: 2006年
    公開日: 2006/04/26
    ジャーナル フリー
    Systemic sclerosis (SSc) is a connective tissue disorder characterized by the fibrosis in the skin and internal organs. SSc is characterized by the presence of autoantibodies that are produced by B lymphocytes. Recently, the importance of B lymphocytes in immune response and autoimmunity has been recognized. CD19, which is a critical cell-surface signal transduction molecule of B cells, positively regulates signaling through B cell antigen receptor and controls autoantibody production. B cells from SSc patients exhibit CD19 overexpression that results in disturbed peripheral B cell homeostasis characterized by increased naive B cells and decreased but activated memory B cells. These findings indicate that B cells are potential therapeutic targets in SSc. Since SSc is a heterogeneous disorder, the subset classification of limited cutaneous SSc and diffuse cutaneous SSc (dSSc) is critical for predicting prognosis and selecting appropriate treatment. Although none of drugs have been proved to be effective for SSc by controlled studies, there are some therapeutic choices that may be effective for patients with early dSSc. Oral low-dose steroid is frequently effective for skin sclerosis, when it is used for early dSSc patients with edematous and rapidly progressing skin fibrosis. Many uncontrolled trials have shown that treatment with cyclophosphamide plus steroid may be effective for SSc patients with active alveolitis. Since it is difficult to remove fibrosis once established in SSc, it should be emphasized that early diagnosis and early treatment of dSSc are critical for management of SSc.
  • Viet Thang LE, Kazuto SHIGEMATSU, Yan ZHA, Arifa NAZNEEN, Mohammed S. ...
    2006 年 51 巻 1 号 p. 9-17
    発行日: 2006年
    公開日: 2006/04/26
    ジャーナル フリー
    Angiotensin II (Ang-II) and connective tissue growth factor (CTGF) are involved in various renal disorders that lead to end-stage renal disease. Here, we determined the role of Ang-II and CTGF in the progression of tubulointerstitial injury in the rat unilateral ureteral obstruction (UUO) model. Sprague-Dawley rats (n=16) were used; 10 rats underwent UUO, and 6 control rats underwent sham operation; and rats of both groups were sacrificed on days 7 or 14. Histomorphometric analysis was performed to quantitate tubulointerstitial injuries in the experimental group. Kidney sections were stained immunohistochemically for Ang-II, CTGF, transforming growth factor-β1 (TGF-β1), type III collagen and α-smooth muscle actin (α-SMA). Renal CTGF expression was studied using in situ hybridization and reverse transcriptase-polymerase chain reaction. Double staining for Ang-II with α-SMA and CTGF with α-SMA was performed to identify cells with enhanced expression of Ang-II and CTGF. Similar dual staining of Ang-II with type III collagen and CTGF with type III collagen was performed. The correlation between Ang-II and CTGF expression and tubulointerstitial injury was examined. In obstructed kidneys, there was a significant (p<0.001) increase in expression of Ang-II, CTGF, TGF-β1, type III collagen and α-SMA, compared with control kidneys. Tubular epithelial cells and interstitial cells were the main Ang-II- and CTGF-producing cells in the obstructed kidneys. A significantly (p<0.001) positive correlation was detected in obstructed kidneys between renal expression of CTGF and expression of TGF-β1 (r=0.91), type III collagen (r=0.87) or α-SMA (r=0.90). Similarly a significantly (p<0.001) positive correlation was found in obstructed kidneys between Ang-II expression and expression of TGF-β1 (r=0.88), type III collagen (r=0.79) and α-SMA (r=0.91). Finally, there were significantly positive correlations between CTGF /Ang-II expression and tubulointerstitial fibrosis in the obstructed kidneys (r=0.88, p<0.001). The results of our in vivo studies suggest that both Ang-II and CTGF, produced by intrarenal cells, coordinately regulate progression of renal tubulointerstitial injury, by facilitating increased accumulation of interstitial collagens in obstructed kidneys.
  • Hiroaki KAWANO, Katsusuke YANO
    2006 年 51 巻 1 号 p. 19-21
    発行日: 2006年
    公開日: 2006/04/26
    ジャーナル フリー
    We compared blood pressure lowering effects between imidapril of 5 mg and alacepril of 25 mg. The subjects were 11 hypertensive Japanese patients (6 males and 5 females) aged 51-87 years with the mean±standard deviation of 73±10 years, and their blood pressure had been controlled well by anti-hypertensive agents including imidapril of 5 mg. After we changed the administration of imidapril of 5 mg once a day to that of alacepril of 25 mg once a day, without any changes of other anti-hypertensive agents, the systolic blood pressure (mean±standard deviation) in patients significantly increased from 130±7.5 mmHg to 140±11 mmHg (p<0.0005). The present study suggests that imidapril of 5 mg is stronger than alacepril of 25 mg for lowering blood pressure in patients with hypertension.
  • Noriho SAKAMOTO, Hiroshi MUKAE, Hiroshi ISHII, Kanako SUGIYAMA, Tomoyu ...
    2006 年 51 巻 1 号 p. 23-26
    発行日: 2006年
    公開日: 2006/04/26
    ジャーナル フリー
    Pneumothorax and pneumomediastinum sometimes occur in patients with idiopathic interstitial pneumonias (IIPs). Although steroid treatment is commonly used for IIPs, some reports indicated that this treatment could cause pneumothorax (PT) or pneumomediastinum (PM) in patients with IIPs. The aim of the present study was to evaluate the clinical features of PT and PM in patients with IIPs, and to assess their association with steroid treatment. We enrolled 77 patients with IIPs and divided them into four groups: (1) idiopathic pulmonary fibrosis (IPF) patients without PT and PM [IPF PT/PM(-) group, n = 38]; (2) IPF patients with PT and/or PM [IPF PT/PM(+) group, n = 6]; (3) non-IPF patients without these complications [non-IPF PT/PM(-) group, n = 29]; and (4) non-IPF patients with PT and/or PM [non-IPF PT/PM(+) group, n = 4]. We reviewed and compared the clinical, radiological and laboratory findings among the four groups. We also focused on the above 10 IIPs patients with PT and/or PM to describe the details of their clinical features. Resultingly, IPF PT/PM(+) and non-IPF PT/PM(+) groups showed low percentage of vital capacity (%VC) compared with IPF PT/PM(-) and non-IPF PT/PM(-) groups, respectively. Six of the 10 cases with PT/PM were treated with steroids about 2 weeks before the development of PT and/or PM. We concluded that PT and PM could arise in patients with IIPs, especially in cases with severe restrictive ventilatory impairment. Our results further suggest that clinicians should be aware of these complications after starting steroid treatment for interstitial lung diseases.
  • Atsushi NANASHIMA, Yorihisa SUMIDA, Takafumi ABO, Hiroaki TAKESHITA, K ...
    2006 年 51 巻 1 号 p. 27-30
    発行日: 2006年
    公開日: 2006/04/26
    ジャーナル フリー
    The Tokyo score, a new prognostic staging system consisting of albumin, bilirubin, and size and number of tumor has recently been proposed. To evaluate its usefulness, we examined the survival of 213 patients of hepatocellular carcinoma who had undergone hepatectomy. Disease-free and overall survival rates were calculated and difference in these rates between patients with different Tokyo scores was tested for significance using log-rank test. Regarding disease-free survival, there was a significant difference in survival between patients with Tokyo score of 0 and 1 (p<0.05); however, there was no significant difference among patients with Tokyo score of 1, 2, 3 and 4. Regarding overall survival, there were a significant difference between patients with Tokyo score 0 and 1 (p<0.01); however, there was no significant difference among patients with Tokyo score of 1, 2, 3 and 4. The 3- and 5-year disease-free survival rates in patients with Tokyo score of 0 were 61% and 46%, respectively, and the 3- and 5-year overall survival rates in them were 97% and 81%, respectively. Survival in patients with Tokyo score of 0 was significantly better than in those with Tokyo score of 1. The Tokyo score, a simple staging system that combines tumor factors and hepatic function, might be a good predictor of prognosis for patients of early-stage hepatocellular carcinoma with hepatectomy.
  • Koh ABE, Yasumasa DOUTSU, Masaomi YAMAMURA, Takushi YAMAO, Masaki YAMA ...
    2006 年 51 巻 1 号 p. 31-34
    発行日: 2006年
    公開日: 2006/04/26
    ジャーナル フリー
    An abnormal shadow was detected on chest radiograph in a 28-year-old male on a routine medical check. The chest radiograph showed a solitary mass-like opacity in the right upper lung field. The patient attended our hospital for further examination on May 22, 2002. High-resolution computed tomography showed an aggregate of micronodular opacities consistent with the "pseudo-alveolar" pattern described in recent reports. The final diagnosis was pulmonary sarcoidosis as confirmed by the presence of epithelioid granulomas in specimens from transbronchial lung biopsy. Pulmonary sarcoidosis with a pseudo-alveolar pattern is unusual, particularly in the absence of bilateral hilar lymphadenopathy. Therefore, this case might be instructive for the diagnosis of pulmonary sarcoidosis.
  • Tetsuro HONDA, Masahiro ITO, Daisuke NIINO, Makoto SASAKI, Yojiro MATS ...
    2006 年 51 巻 1 号 p. 35-38
    発行日: 2006年
    公開日: 2006/04/26
    ジャーナル フリー
    Autoimmune pancreatitis is a recently proposed disease entity. It is sometimes associated with other inflammatory diseases such as Sjögren's disease and sclerosing cholangitis. We report here a case of autoimmune pancreatitis associated with sclerosing cholangitis. The patient was a 74-year-old Japanese male who presented with obstructive jaundice and mild epigastric pain. Computed tomography scan and magnetic resonance cholangiopancreatography showed a diffuse swollen pancreas and poor visualization of the main pancreatic duct. The distal bile ducts were stenotic with marked dilatation of the main and intrahepatic bile ducts. Consequently, a pylorus preserving pancreatoduodenectomy was performed because bile duct carcinoma could not be ruled out. Pathological findings of the removed tissues showed fibrosis with lymphoplasmacytic infiltration in both the choledochus and pancreas head, destruction of pancreatic acinar tissues and obliterative phlebitis. Postoperative laboratory studies showed elevated serum IgG and detection of antinuclear factor. Scattered IgG4-positive plasma cells detected by immunohistochemistry appeared in the pancreas and in the periductal region of the bile duct. This case was finally diagnosed as autoimmune pancreatitis associated with sclerosing cholangitis.
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