Objective Pulse wave velocity (PWV) correlates well with arterial distensibility and stiffness and is a useful non-invasive index to assess arteriosclerosis. The present study was conducted to evaluate the validity of noninvasive brachial-ankle PWV (baPWV) measurements in overweight young adults. Methods Three hundred and fifty-three students were voluntarily enrolled (mean age: 20±2, 93 women and 260 men). The subjects were divided into three groups: normal (18.5≤ body mass index (BMI) <25 n=120), overweight (25≤ BMI <30 n=164) and obese (BMI ≥30, n=69). The baPWV was measured using volume-plethymographic apparatus. Results Hypertension and hyperlipidemia were diagnosed in one-third of the subjects of the obese group and nonalcoholic fatty liver disease (NAFLD) was diagnosed in 64% of the obese group. The baPWV in male subjects was significantly higher in the obese group than in the overweight group and in the males with NAFLD than in those without NAFLD. The stepwise linear regression analysis showed that PWV was significantly associated with mean blood pressure (p<0.001) and γ-GTP (p=0.03). Conclusion Mean blood pressure was a powerful determination for baPWV in the university students. BaPWV may be useful to predict the initial stage of arteriosclerosis and conceivably NAFLD including nonalcoholic steatohepatitis (NASH) in obese young adults.
Objective Body fat percentage is commonly used for assessing body composition. We investigated the body fat percentage in Japanese subjects measured by air displacement plethysmograph (ADP) termed BOD POD®. Methods Cross-sectional clinical investigation study. Patients and Measurements We used data of 11,833 Japanese subjects aged 20-79 years [body mass index (BMI): 23.2±3.7 kg/m2]. Body fat percentage was evaluated by BOD POD®. Anthropometric parameters such as height, weight, BMI, waist circumference and hip circumference were also measured. Results Mean values of body fat percentage measured by BOD POD® were 24.5±6.6% in men and 31.1±7.1% in women, mean values were also calculated as classified into aged groups in normal weight subjects. Body fat percentage was significantly correlated with BMI and 25.1% of men and 34.6% of women corresponded to 25 kg/m2 in BMI. Conclusion Mean value of body fat percentage in normal weight Japanese subjects was revealed. In addition, the level of 25% in men and 35% in women corresponded to 25 kg/m2 of BMI.
Objective The purpose of this study was to investigate gouty arthritis in Japanese patients with end-stage renal disease (ESRD). Methods Questionnaires plus patient interviews and reviews of medical records were used to investigate gouty arthritis in 493 Japanese patients with ESRD receiving maintenance dialysis. Results The frequency of gouty arthritis was 4.1% for female patients and 15.4% for male patients greater than 2 years before the start of dialysis, and 0.6% for female patients and 7.7% for male patients less than 2 years before the start of dialysis. After the start of dialysis the frequency was 3.4% for the first 2 years and 1.2% thereafter in male patients, but no gouty arthritis appeared in female patients. Although the annual number of gouty attacks was 2.0±4.2 greater than 2 years before the start of dialysis, and 1.9±6.6 less than 2 years before the start of dialysis, the annual number of attacks decreased significantly after the start of dialysis to 0.2±0.7 in the first 2 years and 0.1±0.6 thereafter. Conclusions The frequency of gouty arthritis in Japanese patients with ESRD is similar to that of patients with hyperuricemia in the general population and it is decreased slightly before dialysis; however, the frequency decreases markedly after dialysis.
Objective To evaluate severe community-acquired pneumonia (SCAP) patients in an intensive care unit (ICU) with regard to risk factors for mortality and to compare ICU patients with matched non-ICU patients to evaluate whether our judgement for ICU admission was appropriate or not. Materials and Methods During a 7-year period, all patients with CAP who were admitted to the ICU were examined. They underwent clinical and radiographic evaluations, and two commonly used severity of illness scores were also calculated using the Simplified Acute Physiological Score (SAPS) and the Acute Physiology and Chronic Health Evaluation (APACHE) II methods. To detect risk factors for ICU admission using existing guidelines, each study patient was matched with two patients hospitalized in a general medical ward. Results Seventy-two patients were identified during the study period. Their mean age was 72.9 years, and 35 patients (48.6%) subsequently died. For the univariate analysis, there were significant differences with the pulse rate ≥130/min, blood urea nitrogen ≥30 mg/dl, multilobar shadow, SAPS ≥13, APACHE II ≥23, and the occurrence of septic shock between the survivors and those who died. For the multivariate analysis, septic shock (p=0.0005, odds ratio of 26.6) and blood urea nitrogen ≥30 mg/dl (p=0.037, odds ratio of 5.38) were associated with mortality. Regarding the characteristics of different clinical predictions for ICU admission, the revised American Thoracic Society criteria might have been the most accurate. Conclusion Septic shock was associated with high mortality, which is a more accurate and higher predictor of mortality than was physical examination, laboratory or radiographic findings.
Objective Falls are common in patients with Alzheimer’s disease (AD). Identification of the potential risk factors and developing preventive strategies for falls will have a significant impact in maintaining the quality of life in AD. Patients Clinical follow-up of 124 (74.1±6.1 years, range 62-88) mild to moderate AD patients in an outpatient memory clinic. Methods Postural sway, cognitive function, use of neuroleptics, severity of periventricular and deep white matter lesions, and the presence or absence of silent brain infarctions on magnetic resonance imaging were assessed at baseline. Results A total of 104 patients (84%) completed the study. Fall events were confirmed in 42.3% (44/104). After adjustment for age, gender, and cognitive status, a high grade of periventricular white matter lesions (odds ratio 8.7 [95%CI 1.5 to 51.8], p=0.017) and neuroleptic drug use (odds ratio 3.5 [95%CI 1.2 to 10.5], p=0.027) were significantly associated with an increased risk of falls. Conclusion Our results suggest that periventricular white matter lesions and the use of neuroleptics may be related to falls in mild to moderate AD. A comprehensive risk management of brain ischemia as well as the use of the smallest efficacious dose of neuroleptics in the treatment of behavioral and psychiatric symptoms of AD should be recommended to help reduce the risk of unexpected falls.
We report a case of simultaneous percutaneous treatment of hypertrophic obstructive cardiomyopathy (HOCM) and coronary artery disease. Cardiac catheterization revealed a left ventricular outflow tract pressure gradient (LVOTPG) of 130 mmHg and a significant left anterior descending artery (LAD) stenosis at the site of the 1st major septal branch. The LVOTPG was eliminated by injection of ethanol into the branch. Subsequently, a coronary stent was implanted in the LAD. A coil stent was selected due to possibility of repeat septal ablation in the future. Simultaneous treatment of HOCM and LAD stenosis is considered safe and effective using a coil stent.
A 78-year-old woman was admitted to our hospital due to chest oppressive sensation. Admission electrocardiography revealed ST-segment elevation in I, II, III, aVF and V2-6 leads. Left ventriculography showed apical akinesis and basal hyperkinesis with a pressure gradient of 60 mmHg between the left ventricular apex and the base. Right ventriculography also showed similar abnormal wall motion with a pressure gradient of 28 mmHg. Follow-up cardiac catheterization after 16 days showed normal wall motion with no pressure gradients. However, dobutamine stress (10 μg/kg/min) caused a pressure gradient of 60 mmHg between the left ventricular apex and the aorta.
We report a case of Hermansky-Pudlak syndrome (HPS) with a novel mutation in the HPS1 gene. This case showed oculocutaneous albinism and lysosomal ceroid accumulation, however platelet dysfunction was not observed. Histopathological findings of the biopsied lung tissue were compatible with HPS. Sequencing analysis showed the insertion of C in the codon 178 (739 bp) of the HPS1 gene forming a stop codon at codon 181. To the best of our knowledge, this is a novel HPS1 gene mutation.
A 37-year-old woman with a history of transphenoidal surgery and gamma knife treatment for prolactinoma was admitted because of pneumoniae with hyponatremia (Na 109 mmol/l). After the careful correction of the serum sodium level within 15 mmol/l/day, the patient developed parkinsonism. MRI of the brain disclosed a signal increase in the bilateral basal ganglias on T2-weighted images, a finding consistent with extrapontine myelinolysis (EPM). Interestingly, the parkinsonism fully disappeared after the replacement therapy of hydrocortisone for adrenal insufficiency due to hypopituitarism, and MRI 5 months later showed complete disappearance of the lesions, indicating the patient had ameliorated from the EPM.
Pseudomigraine with pleocytosis (PMP) is an uncommon disease in Japan. The diagnostic criteria include at least one episode of transient neurological deficit accompanied or followed by migraine-like severe headache, cerebrospinal fluid (CSF) lymphocytosis, and normal neuroimaging. Both the etiology and the pathophysiology of PMP is not yet well defined. We report a 40-year-old man with a PMP-like syndrome. He came to our clinic because of severe throbbing headache and amnesia, and the examination showed CSF lymphocytosis of 23/mm3, a transient decrease of cerebral blood flow in the left thalamus. All the symptoms were completely resolved within 2 months.
A 27-year-old woman was admitted to our hospital with tetraparesis, dysesthesia and hypoesthesia of all regions below the breasts, urinary disturbance, and difficulty in breathing. Since age 21 idiopathic thrombocytopenic purpura (ITP) was diagnosed and steroid therapy was continued. At age 26, she had splenectomy for her ITP. On admission, steroid pulse therapy was administered with a tentative diagnosis of transverse myelitis. Symptoms gradually ameliorated. At age 29, she gradually lost her left vision, and multiple sclerosis was diagnosed and steroid therapy was administered, and her left vision gradually ameliorated. There are several reports describing other autoimmune disorders that arise after splenectomy. Since the spleen acts as a major pool of type 2 helper T cells, it is plausible that peripheral type 1 helper T cell activity may increase after splenectomy, promoting the development of autoimmune disorders. We considered there would be a close relation between splenectomy for ITP and multiple sclerosis in this case.
Wegener’s granulomatosis with eosinophilia both in blood and tissue samples has been rarely reported. A 25-year-old woman developed fever, granulomatous inflammation of nasal mucosa, pulmonary hemorrhage, suprascleritis, and cutaneous vasculitis. She showed eosinophilia in blood and biospy samples of skin, nasal mucosa, and lung. She was positive for proteinase 3-antineutrophil cytoplasmic antibody. She had no history of asthma. We diagnosed her as Wegener’s granulomatosis with eosinophilia rather than Churg-Strauss syndrome. Her mucocutaneous and pulmonary lesions were successfully treated with high-dose corticosteroid and methotrexate, but her suprascleritis required pulsed cyclophosphamide.
We report a patient with chronic lung abscess due to Pasteurella multocida infection that may be caused by the contact with cows in his workplace. Despite its apparent rarity, chronic abscess due to P. multocida should be considered in the differential diagnosis of solitary pulmonary masses. This case report suggests that P. multocida infection can be potentially caused from saliva of cows as well as dogs or cats.
We report a patient with acquired immunodeficiency syndrome dementia complex (ADC) that presented human immunodeficiency virus infection as an initial manifestation. A 34-year-old man developed disturbance of consciousness and severe abulia over 3 months. The CD4 lymphocyte count was 7.9/μl, while human immunodeficiency virus RNA in blood amounted to 4.2×104 copies/ml. T2-weighted magnetic resonance imaging showed diffusely high signal intensity in the deep white matter of both cerebral hemispheres. On the 20th hospital day, the patient died of sepsis caused by methicillin-resistant Staphylococcus aureus. Autopsy findings in the brain included increased glial cells and multinucleated giant cells in cerebral white matter and subcortical gray matter. These features were compatible with ADC.