Objective: The aim of this study was to clarify whether a helicopter ambulance system (doctor helicopter system; DHS) could shorten the time interval to coronary intervention in the treatment of patients with acute myocardial infarction (AMI), in comparison with ground ambulance (GA). Methods: The time from the emergency call to coronary angiography (CAG time) or to percutaneous coronary intervention (PCI time), and the inhospital outcome were evaluated in 76 AMI patients. Twenty patients were transported by DHS, and the other 56 were by GA. Results: Both CAG time and PCI time were significantly shorter in the DHS (98.8+/-29.2 min, and 169.6+/-57.4 min) than those of the GA (126.6+/-48.7 min, and 203.2+/-57.0 min; p<0.05) group. Inhospital mortality was lower in the DHS (5.0%) versus the GA (10.7%) group. Conclusion: Use of DHS shortened the time interval to coronary intervention and also improved the inhospital prognosis of AMI patients.
Objective: The aim of this study was to assess the effects of hydrophilic pravastatin and lipophilic atorvastatin on glucose metabolism and lipid metabolism in nondiabetic patients with hypercholesterolemia. Methods: Fasting plasma glucose (FPG), hemoglobin A1c (HbA1c), total cholesterol (TC), lowdensity lipoprotein cholesterol (LDLC), highdensity lipoprotein cholesterol (HDLC), and triglyceride (TG) levels were determined before and after statin treatment. Patients: A total of 44 nondiabetic patients (FPG ≤125 mg/mL; HbA1c <5.8%) undergoing treatment with either pravastatin (n=21) or atorvastatin (n=23) for hypercholesterolemia were investigated. Results: FPG level in the pravastatin but not atorvastatin group was significantly lowered after vs before treatment. Accordingly, the HbA1c level in the atorvastatin but not in the pravastatin group was significantly increased. As expected, both TC and LDLC levels were significantly lowered in both groups. In particular, the TC level in the atorvastatin group was more remarkably and significantly improved than in the pravastatin group. On the other hand, the HDLC level in the pravastatin group but not in the atorvastatin group was significantly increased after the administration period. The TG level was unaffected in both groups. Conclusion: Pravastatin was suggested to act favorably, while atorvastatin adversely, regarding it's effects on glucose metabolism in nondiabetic hypercholesterolemic patients, although atorvastatin exerted more potent cholesterollowering effects compared with pravastatin.
Objective: To examine predictive values for the effect of the "Type 1" (hopeless and emotionsuppressive, cancer prone), "Type 4" (autonomous, healthy), and "Type 5" (rational/antiemotional, cancer prone) personalities proposed by GrossarthMaticek on the prognosis of lung cancer patients. Methods: 68 lung cancer patients were scored on the Types 1, 4, and 5 personality scales of the Short Interpersonal Reactions Inventory and were followed until the date of death or were censored at a maximum of 5.7 years after entry. Results: The stage at diagnosis tended to be higher in patients with a high Type 1 or a low Type 4 score. A univariate Cox proportional hazards model showed that a high tendency toward Type 1 or Type 5 was related to an increased hazard of death. Adjustment for age, performance status, and stage, however, attenuated the relation to Type 1, leaving only Type 5 as a significantly related personality factor. Conclusion: A high Type 5 tendency may predict poor survival in lung cancer patients, whereas Types 1 and 4 may not be independent predictors.
Objective: Radiofrequency ablation (RFA) is frequently used for hepatic malignant tumors, but few reports discuss its use for lung tumors. We report our pilot clinical study with RFA for the treatment of pulmonary malignant tumors. Patients and Methods: Five patients with histologicallyproven malignant primary and three metastatic lung tumors underwent a total of 11 RFA procedures. RFA was performed in two patients as palliative therapy to shrink the tumors and in six as radical therapy. All RFA was performed by the percutaneous CTguided approach. Results: Three tumors were completely ablated by one procedure. Contrast CT revealed cyst cavity formation or scar formation at these three tumors. Gd contrastenhanced MRI revealed cystic lesions with ringlike enhancement or scar formation. Partial ablation after the first procedure was noted in six tumors including the two palliative cases. RF ablation was well tolerated in all patients. Intraprocedural complications included six cases of pneumothorax (one patient required chest tube placement), six cases of pleural effusion (two patients required chest tube placement), one case of pneumonia (improved immediately with antibiotics), three cases of bloody sputum (mild), and six cases of chest pain (all cases after the procedure). Conclusions: This pilot clinical study demonstrates that CTguided RFA is a relatively safe and effective treatment option for malignant lung tumors. Additional trials are needed to determine the safety, efficacy, and optimal indications of RFA.
A 56yearold woman was admitted to our hospital for treatment of nonspecific interstitial pneumonitis (NSIP). The patient started prednisone treatment, but one month later treatment with voglibose, an αglucosidase inhibitor (αGI), was started because of prednisoneinduced diabetes mellitus. One week later, a massive volume of free air below the diaphragm was detected by a chest Xray examination. An abdominal CT examination demonstrated pneumatosis coli and the patient was diagnosed with pneumatosis cystoides intestinalis (PCI). Voglibose was discontinued and parenteral nutrition and oxygen inhalation were initiated. Radiographic findings of PCI disappeared within 7 days. We encountered a rare case of PCI, that was associated with αGI treatment.
Two patients with lifethreatening episodes of ventricular fibrillation (VF) showed typical ST elevation in V1V3 leads. Both had spontaneous clinical episodes of resting angina. Intracoronary injection of acetylcholine provoked coronary vasospasm and ST elevation was the same as Brugadatype ST elevation in 1 case but not in the other. Calcium channel antagonist was prescribed to prevent coronary vasospasm but Brugadatype ST elevation and the occurrence of VF could not be prevented. The symptoms accompanied both cases. Considering these cases, the pathogenesis of Brugada syndrome should differ from that of coronary vasospasm because it could not be prevented by calcium channel antagonist.
Thymic carcinoid in multiple endocrine neoplasia type 1 (MEN 1) is previously reported as a nonACTH producing tumor. The present case is a 39yearold man with mortal outcome from thymic carcinoid and Cushing's syndrome with high plasma ACTH. The symptom was first observed at age 29 and was relieved after extended thymectomy, with reduction of ACTH level. The tumor was positive for ACTH, Grimelius silver staining and Chromogranin A. The finding of primary hyperparathyroidism, pituitary adenoma, and a novel germline nonsense mutation (W423X) established the diagnosis of MEN 1. Cushing's syndrome due to ACTH producing thymic carcinoid should be also considered as one phenotype of the MEN 1 spectrum.
We report a case of successfully treated acute thrombocytopenia associated with preexisting ulcerative colitis (UC). The patient had typical symptoms of UC, and colonoscopy showed pancolitis. During treatment with sulfasalazopyridine (SASP) and steroids, thrombocytopenia was observed. Despite the cessation of drugs, severe thrombocytopenia was noted. Immune thrombocytopenic purpura (ITP) was suspected based on a normal bone marrow megakaryocyte count, positive autoantibody to platelet membrane antigen, and the absence of splenomegaly. Medical treatment, including increased dosage of steroids, failed to control UC and acute thrombocytopenia in this patient. Moreover, acute severe pancreatitis developed and abdominal computed tomography showed toxic megacolon. Platelet count recovered after urgent total colectomy without splenectomy. When patients with UC develop thrombocytopenia, particularly in the presence of extensive and significant colonic inflammation, a diagnosis of ITP should be considered. In such patients, preexisting UC might be involved in the immunological causal mechanism of ITP. In this situation, colectomy might cure both UC and resistant thrombocytopenia. Steroidrefractory and lifethreatening UC complicated by thrombocytopenia presumably caused by ITP is therefore a possible indication for colectomy.
A 63yearold man developed bilateral peroneal nerve palsies after a craniotomy for a craniopharyngioma. It is believed that the primary etiology of the nerve palsies was intermittent pneumatic compression, which was used to prevent deep vein thrombosis and pulmonary embolism during the surgery. Physicians should take care to avoid compressing the fibula head when using pneumatic devices.
A 48yearold man with systemic lupus erythematosus developed organic brain syndrome. Highdose prednisolone was ineffective, and somnolence without focal signs rapidly developed. Electroencephalogram (EEG) demonstrated a slow basic rhythm (3 Hz), but brain magnetic resonance imaging was normal. Somnolence resolved soon after performing plasma exchange (two sessions). However, memory dysfunction persisted, with EEG demonstrating mild abnormalities (78 Hz basic rhythm). Doublefiltration plasmapheresis (three sessions) was done, followed by intravenous cyclophosphamide. Immediately after the first plasmapheresis session, memory dysfunction began to improve. After the second dose of cyclophosphamide, intellectual function resolved completely and EEG findings also normalized (basic rhythm of 10 Hz waves). Serial EEG findings precisely reflected the neurological condition and therapeutic efficacy in this patient. In contrast, protein levels in cerebrospinal fluid remained high and did not seem to appropriately reflect the neurological condition in this patient.
A 27yearold man who had a history of bronchial asthma, eosinophilic enteritis, and eosinophilic pneumonia presented with fever, skin eruptions, cervical lymphadenopathy, hepatosplenomegaly, atypical lymphocytosis, and eosinophilia two weeks after receiving trimethoprim (TMP)sulfamethoxazole (SMX) treatment. After the withdrawal of TMPSMX and the administration of highdose steroid, these systemic symptoms gradually resolved. During the disease course, the patient showed a transient increase in antihuman herpesvirus (HHV)6 antibody titers and HHV6 DNA in the peripheral blood, indicating the reactivation of a latent HHV6 infection. This is the first case of TMPSMXinduced hypersensitivity syndrome associated with the reactivation of a latent viral infection.