Objective To evaluate the diagnostic values of the detection of mRNAs of GA733 gene family in exfoliated cells of pleural and peritoneal effusions. Methods Sixty specimens of pleural and peritoneal fluids from 60 patients were collected. GA733-1 and GA733-2 mRNA in the exfoliated cells were detected by qualitative RT-PCR, and their diagnostic values were assessed. Patients Sixty patients with pleural or peritoneal effusions, from May 2003 and August 2004, aged 23-85 (average 56.5 years). Results GA733-1 and GA733-2 mRNA were positive in 5 (13.9%) and 27 (75.0%) of 36 malignant specimens, and in 1 and 7 of 11 cause-unknown specimens, respectively, but both of them were negative in all 13 benign specimens, and the difference of GA733-2 mRNA positive rates among the three groups was significant (P<0.005), but that of GA733-1 mRNA was not (P>0.05). GA733-1 and GA733-2 mRNA were positive in 4 (15.4%) and 22 (84.6%) of 26 cytological positive specimens, and in 1 and 6 of 6 suspicious specimens, and in 1 (3.5%) and 6 (21.4%) of 28 negative specimens, respectively and the difference of GA733-2 mRNA positive rates among the three groups was significant (P<0.005), but that of GA733-1 mRNA was not (P>0.05). Sensitivity, specificity and accuracy of detection for GA733-2 mRNA for diagnosis of malignant effusions were 75.0%, 100% and 81.6%, respectively. Conclusions The detection of GA733-2 mRNA by qualitative RT-PCR is sensitive and highly specific for the diagnosis of malignant pleural and peritoneal effusions, while the diagnostic value of GA733-1 mRNA needs to be further investigated.
Objective The purpose of this study was to compare the association of pulse pressure (PP) and mean arterial pressure (MAP) with stroke in uncontrolled hypertensive subjects. Methods A total of 9,901 uncontrolled hypertensive subjects were included in a cross-sectional study in 62 villages of Fuxin county of Liaoning Province, China. Results Among the 9,901, 406 cases of ischemic stroke and 145 cases of cerebral hemorrhage were identified. Older age, male gender, increased SBP, higher DBP, and history of hyperlipemia were positively associated with both ischemic stroke and cerebral hemorrhage by multivariate logistic regression analysis. However, the odds rations (ORs) of drinking for ischemic stroke and cerebral hemorrhage were 0.407 (95%CI: 0.304-0.544) and 0.595 (95%CI: 0.377-0.940), respectively. An increase of 10 mmHg of MAP had ORs of 1.430 (95%CI: 1.332-1.535) for ischemic stroke and 1.359 (95%CI: 1.220-1.514) for cerebral hemorrhage. The OR of PP (per 10 mmHg increase) for ischemic stroke was 1.085 (95%CI: 1.026-1.148). Subjects with the fourth quartile of PP and MAP had ORs of 1.555 (95%CI: 1.127-2.146) ischemic stroke and 5.127 (95%CI: 3.452-7.616) for cerebral hemorrhage, with the first quartile as the reference group. The OR of the fourth quartile of MAP for cerebral hemorrhage was 5.935 (95%CI: 2.932-12.012). There was no significant association between PP and cerebral hemorrhage. In sensitivity analysis, ORs of standard MAP for ischemic stroke were higher than those of PP in each stratified age subgroup. Conclusions Increased MAP and PP were significant markers of ischemic stroke and cerebral hemorrhage was only associated with increased MAP. MAP was more closely associated with stroke than PP in patients with uncontrolled hypertension.
Objectives We sought to determine the incidence of acute coronary events after coronary stenting in comparison to that after plain old balloon angioplasty (POBA). Background Although coronary stenting is proven to be effective in reducing the incidence of restenosis, the long-term outcome in terms of acute coronary events has not been clarified. Methods Study subjects were 1,507 patients with 2,780 native coronary artery lesions treated by POBA (n=1,400) or stenting (n=1,380). Lesion stabilization, which was defined as freedom from restenosis confirmed by follow-up angiography 3 months after POBA and 6 months after stenting, was achieved in all subjects. All patients were clinically monitored for symptoms for at least 1 year after angioplasty, and the incidence of angiographically confirmed acute coronary event was compared between groups. Results The clinical follow-up period was significantly longer in the POBA group than in the stent group (8.4 ± 5.0 years vs. 5.9 ± 3.0 years, p<0.0001). Acute coronary events occurred in association with 32 lesions (1.2% overall); the incidence was 1.1% (15 of 1,400) after POBA and 1.2% (17 of 1,380) after stenting. Freedom from acute coronary events related to the treated lesions was similar between the two groups. (p=0.0518 by log-rank test). Conclusion In terms of acute coronary events, the long-term clinical outcome of stenting is equivalent to that of POBA.
Background It has been shown that parathyroid hormone (PTH) influences cardiac abnormalities in dialysis patients. The purpose of this study was to evaluate the relationship between the plasma PTH level and cardiac abnormalities in these patients without overt cardiac disease. Methods A total of 81 of the 208 patients who received chronic dialysis treatment at our institution were included in this study. Plasma PTH level measurement, other blood examinations and echocardiography were performed in all patients. The subjects were divided into two groups based on plasma PTH level (<300 pg/ml: group A; ≥300 pg/ml: group B). Results There were no significant differences in echocardiographic parameters between group A and group B. The plasma PTH level was not significantly correlated with any echocardiographic parameter in any patient. In addition, we chose 10 patients with a plasma PTH level of more than 500 pg/ml from group B and 20 patients matched for various characteristics (excluding PTH level) from group A and compared the echocardiographic parameters between them. LVMI and intraventricular septum thickness (IVST) were significantly greater in patients with a plasma PTH level of greater than 500 pg/ml. Conclusion PTH was not strongly associated with cardiac abnormalities such as LVH or decreased left ventricular function in the overall group of patients. PTH may not play a major role in the pathogenesis of cardiac abnormalities in these patients. However, PTH could influence LVH in patients with remarkably elevated plasma PTH levels.
Aim To evaluate the clinical effects of switching from premixed human insulin to a premixed rapid-acting insulin analogue in type 2 diabetic patients. Research Design and Methods Thirty patients, who were treated with a twice-daily injection of premixed human insulin, were enrolled and randomized to (i) 50/50 premixed insulin lispro twice-daily at the same daily dose as premixed human insulin (analogue mix group), or (ii) continued premixed human insulin (control group). The doses of insulin were adjusted every month by registered diabetologists to achieve adequate blood glucose levels. At the beginning of the study, and again 4 months later, HbA1c and blood glucose levels were measured, and the amount of insulin required and BMI were recorded in both groups. Insulin therapy-related quality of life (ITR-QOL) and the diabetes treatment satisfaction questionnaire (DTSQ) were also assessed in the analogue mix group at the beginning of the study and again 4 months later. Results Although HbA1c levels did not change significantly over the duration of the study in the control group (7.33 ± 0.58 vs 7.29 ± 0.65%), HbA1c did improve significantly in the analogue mix group (7.59 ± 0.44 vs 7.24 ± 0.49%; p<0.05). The dose of insulin required in the analogue mix group did not change significantly (0.37 ± 0.11 vs 0.38 ± 0.14 U/kg/day), but increased in the control group from 0.34 ± 0.15 to 0.37 ± 0.16 U/kg/day (p<0.05). The switch to the premixed insulin analogue did not affect ITR-QOL and DTSQ scores. Conclusions This study showed that switching from premixed human insulin to 50/50 premixed insulin lispro improved blood glucose control without compromising QOL. This finding suggests that a premixed rapid-acting insulin analogue is more effective than human insulin for Japanese type 2 diabetic patients.
Object The present study was undertaken to evaluate the utility of low-dose spiral CT scanning, combined with single-slice high-resolution CT (HRCT), in the detection of pulmonary emphysema on CT (CTPE) together with screening for lung cancer. Subjects and Methods For 657 individuals who visited for screening of lung cancer, single-slice HRCT of the upper lung field was added on conventional low-dose spiral CT scanning in order to detect low attenuation area (LAA) visually. The individuals were classified into four groups according to the visual extent of LAA in bilateral upper lung fields: no LAA, subtle PE (0%<LAA%≤5%), mild PE (5%<LAA%≤25%) and moderate to severe PE (LAA%>25%), and compared spirometry among the four groups. Results LAA was detected in 23.3% of all subjects (subtle PE in 12.2%, mild PE in 9.9% and moderate to severe PE in 1.2%) by adding one HRCT slice whereas only in 6.4 % LAA was detected by conventional low-dose helical CT scanning at 10 mm slice alone. The airway obstruction (FEV1/FVC<70%) was observed only in 1.07%. The severity of emphysema was associated with older age, prevalence of having smoking history and Brinkman index. As the severity of emphysema, the FEV1/FVC, MMEF, and V25/HT showed lower values. Conclusions It is suggested that single-slice HRCT of the upper lung field combined with conventional low-dose spiral CT scanning for screening of lung cancer may also be useful for the detection of LAA, which may promote smoking cessation.
Objective There is growing interest in the use of transcranial sonography (TCS) of the substantia nigra (SN) in patients with Parkinson's disease (PD), as it has been reported that SN hyperechogenicity may be present in about 90% of PD patients. However, TCS of the SN has not been applied in Japanese patients, and its clinical potential has not been determined. Patients and Methods TCS of the SN was performed in patients with PD, progressive supranuclear palsy (PSP), multiple system atrophy (MSA), and essential tremor (ET), and age-matched controls. Ultrasound images of the SN were assessed using semi-qualitative estimation criteria by two investigators unaware of clinical diagnosis. Results SN hyperechogenicity was observed in approximately 83% of accessible SNs in Japanese PD patients. In comparison, SN hyperechogenicity was less frequently observed in healthy subjects or in patients with PSP, MSA, and ET. However, the rate of successful recording of the SN by TCS decreased prominently with advancing age, particularly in females. Conclusion The present study confirmed that TCS of the SN is potentially useful in the investigation of Japanese patients, and it provides a better differential diagnosis between PD and atypical parkinsonism. The recording failure of TCS in aged, particularly female subjects, may limit the clinical potential of TCS of the SN in Japanese patients.
Object To validate the cross-sectional and longitudinal use of the Medical Outcome Study Short Form 36 (SF-36) for measuring health-related quality of life (HRQL) in patients with idiopathic pulmonary fibrosis (IPF). Methods Patients were administered the SF-36 and concomitantly underwent laboratory and physiologic tests and high-resolution computed tomography (HRCT). Forty-six patients participated in the initial cross-sectional study, and 32 patients who were available more than one year later again underwent these studies under the same conditions. Results Patients with IPF had significantly lower scores across all 8 domains of the SF-36 when compared with the general population. Significant decline of HRQL was observed in 2 physical domains. There were significant differences in within-subject changes in a few domains according to worsening of the physiologic parameters. Vital capacity as percent of predicted was significantly correlated with the results of 6 subscales and its changes were significantly correlated with those of 4 subscales. The 6-min-walk distance was correlated significantly with 3 subscales and its changes were significantly correlated with those of 4 subscales. Changes in the HRCT ground-glass score were significantly correlated with those of 3 subscales. No significant correlations between changes in 3 domains and those of any clinical parameters were observed. Conclusion Patients with IPF had significantly impaired HRQL in both physical and psychological functions. This disease clearly decreased the physical aspects of HRQL over time. HRQL instruments should be incorporated into routine evaluations of IPF patients, since they measure dimensions not fully estimated by clinical assessment.
Objective To evaluate the usefulness of QuantiFERON TB-2G (QFT-2G) for detecting latent tuberculosis infection (LTBI) in a contact investigation of health care workers. Methods The investigated subjects were 190 subjects among the health care workers who were examined between January 2005 and June 2006. Background information, including a past history of tuberculosis (TB) or tuberculin skin test (TST) or BCG vaccination, and contact score (infectivity×contact duration) were investigated. The TST and QFT-2G test were performed on all subjects. Results In 109 subjects with a negative TST history, the TST results were converted to positive in 38 subjects. While the TST was positive in 48 subjects (25%), the QFT-2G test was positive in only five subjects (3%). The correlation of the QFT-2G with TST results was not significant. There was no relationship between contact score and the TST result. Twenty-nine subjects had TST positive responses (22%), but there were no QFT-2G positive responses in subjects with a mild contact score. Sixteen subjects had TST positive responses (31%), but two subjects showed positive QFT-2G results (4%) in the moderate contact score group. However, the positive response rate of the TST and QFT-2G test was the same percentage in the severe contact score group (33%). Conclusion The QFT-2G test showed a significant relationship with the contact score when compared with the TST. If the subjects with LTBI in the moderate contact score group were selectively excluded, the contact investigation in the mild contact score group may not be necessary. If there would have been many subjects with the QFT-2G positive responses in the moderate contact score group, we think that the QFT-2G test must be performed even in the mild contact score group.
We present a patient with chronic watery diarrhea and weight loss, in whom colonoscopic findings were consistent with microscopic colitis, but histopathological examination revealed granulomatous inflammation. A 67-year-old Japanese female with a several year history of chronic watery diarrhea and body weight loss was admitted to our hospital. Her laboratory data showed hypoalbuminemia and high levels of serum immunoglobulin G and C-reactive protein. Colonoscopic findings were grossly normal. Histopathology showed inflammatory cell infiltrates with non-necrotizing granulomas and multinucleated giant cells, indicating that this was not conventional microscopic colitis, lymphocytic colitis or collagenous colitis. After treatment with prednisolone her symptoms and laboratory data improved dramatically, and she went into remission without the necessity of further steroid treatment.
A 58-year-old male had been diagnosed as having autoimmune pancreatitis (AIP) from the results of serological examinations and image findings. He was treated with prednisolone (PSL) for 3.5 months. Fifteen months later, follow-up CT revealed the main pancreatic duct (MPD) dilatation in the pancreas body to tail and right hydronephrosis caused by complicated retroperitoneal mass. We diagnosed him as having recurrent AIP with retroperitoneal fibrosis, and restarted PSL treatment. After one month, Examinations indicated amelioration of the MPD dilatation and right hydronephrosis, but not the right renal failure. This case indicates the importance of maintenance of PSL treatment.
Intravascular large B-cell lymphoma (IVL) is a rare subtype of B-cell lymphoma presenting with neurological and dermatological lesions in addition to generalized symptoms such as fever and malaise. It may also be associated with variable manifestations of affected organs due to extranodal progression predominantly in the lumen of the small vessels. Here, we report a case of IVL with the syndrome of inappropriate secretion of antidiuretic hormone (SIADH) as the sole manifestation at the initial presentation. The present case suggests that hormonal disturbances may progress in advance in IVL, before generalized symptoms develop.
We report a case of diabetic mastopathy in an elderly woman with type 2 diabetes. The patient was a 69-year-old woman diagnosed with type 2 diabetes at the age of 33 years. She had been treated with insulin for 25 years, however, her blood glucose had been poorly controlled. She noticed bilateral breast lumps in September 2002. Mammography of the breast showed increased density in the glandular pattern and architectural distortion without focal mass and microcalcification. Ultrasonography of the breast showed an irregular-shaped hypoechoic mass with an acoustic shadow. As malignancy needed to be excluded, core needle biopsy was performed in the left breast and diabetic mastopathy was confirmed pathologically. Diabetic mastopathy is usually a complication of pre-menopausal type 1 diabetes and develops in a unilateral breast. This case developed in bilateral breasts in an elderly type 2 diabetic patient.
A 16-year-old girl presented with McCune-Albright syndrome associated with acromegaly and fibrous dysplasia. Brain MRI demonstrated a pituitary tumor. X-ray films showed bone deformities, and 99TmO4 bone scintigraphy revealed increased uptake of radioactivity in the affected bones. Although the serum FGF23 level was increased, the serum calcium, phosphate, and active vitamin D levels were all within normal limits. GNAS gene mutation was detected at neither codon 201 nor 227 by conventional PCR-based direct sequencing analysis. We performed a selective PCR with peptide nucleic acid (PNA) clamping to increase the sensitivity for gene mutation detection and identified the R201C GNAS mutation.
Systemic capillary leak syndrome is characterized by recurrent hypovolemic shock attributable to increased systemic capillary leakage. A 26-year-old woman was admitted because of recurrent episodes of hypovolemic shock. Hemoconcentration, hypoalbuminemia, and monoclonal gammopathy were observed. We diagnosed systemic capillary leak syndrome. Three years later, she again had an attack of systemic capillary leak syndrome complicated with pretibial compartment syndrome. This case emphasizes the importance of muscle compartment pressure monitoring during volume resuscitation in patients with systemic capillary leak syndrome.
Extramedullary hematopoiesis predominantly occurs in the liver, spleen, and lymph nodes with hemolytic anemia. Occurrence with osteopetrosis tarda in the paravertebral region is very rare. We discuss the examination of the third known case of paravertebral extramedullary hematopoiesis arising with osteopetrosis tarda.
A 37-year-old woman presented with a cough and discomfort in the chest. Computed tomography revealed the right pleural effusion and a number of cysts in the lungs. Thoracentesis revealed LAM cell clusters (LCC) in chylous pleural effusion, confirmed by immunocytochemical examinations showing that the cells at the center of cluster were LAM cells positive for α-smooth muscle actin and HMB45 and the outer layer was lymphatic endothelium cells. When LCC were cultured in vitro, the loss of heterozygosity of TSC2 markers was detected. This case illustrates that LAM can be diagnosed by the identification of LCC without an invasive biopsy if complicated with chylous effusion.
We report the rare case of a 38-year-old man who suffered from aseptic meningitis. Brain magnetic resonance imaging showed an ovoid lesion with a high signal intensity on T2- and diffusion-weighted images in the splenium of the corpus callosum that completely disappeared within a week. There were no symptoms or signs associated with the lesion, and the prognosis was good. Although rare in adult patients, awareness of a reversible splenial lesion in meningoencephalitis is important.
Neurosarcoidosis is generally expressed by various symptoms; it is exceptionally revealed by hydrocephalus. We report a 27-year-old African man hospitalized with acute neurological deterioration due to hydrocephalus. The treatment consisted of ventriculostomy and corticosteroid therapy; however a permanent shunt was not required. After six months of follow-up, the patient had fully recovered. Clinical presentation, neuroimaging findings and treatment modalities are discussed.
A 79-year-old woman with progressive systemic sclerosis (PSS) presented with acute pulmonary edema, hypertension and renal failure. Administration of angiotensin-converting enzyme (ACE) inhibitor under suspicion of PSS renal crisis resulted in worsening of the renal function, which necessitated hemodialysis. Magnetic resonance arteriogram (MRA) demonstrated stenosis of the right renal artery, and ischemic nephropathy was diagnosed. Renal function improved after the discontinuation of ACE inhibitor. ACE inhibitor/angiotensin II receptor blocker (ARB), which is recommended for PSS renal crisis, should be avoided in ischemic nephropathy. In elderly PSS patients, careful exclusion of ischemic nephropathy is warranted before the administration of ACE inhibitor/ARB.
We report a patient who developed lacunar syndrome due to left upper pons infarction after performing leg exercises associated with paradoxical brain embolism. A 32-year-old man developed right arm weakness and moderate dysarthria following leg exercise. Brain MRI showed a paramedian pontine infarction of the left upper pons, and contrast transesophageal echocardiographic examination indicated that the patent foramen ovale was the embolic source. Simultaneous RI venography examination of the lower limbs identified deep venous thrombosis in the right leg as a paradoxical emboligenic source. We concluded that the presence of lacunar syndrome suggests that this mechanism was responsible for the paradoxical brain embolism.
We report an 85-year-old man with Hashimoto's encephalopathy (HE) who showed spontaneous complete remission. The autoantibody against the amino (NH2) terminal region of α-enolase was positive in our patient. Neuropsychological manifestations, such as personality change and progressive cognitive impairment, gradually improved over approximately 6 weeks after onset of disease without corticosteroid treatment in parallel with a decrease in the anti-thyroglobulin antibody in the cerebrospinal fluid. HE should be considered as a possible diagnosis even in elderly patients with neuropsychiatric symptoms, particularly when a previous history of thyroid disease is present.
Human herpesvirus-6 (HHV-6) is the main etiologic agent of exanthema subitum in young children. Central nervous system (CNS) infections in children due to HHV-6 have been described on many occasions. HHV-6 is also a common cause of infections in immunocompromised individuals. However, little is known concerning the impact of HHV-6 on the CNS in immunocompetent adults. We report the first case of relapsing HHV-6 encephalitis in a healthy 73-year-old female.
Article type: Successful Treatment of Refractory Thrombotic Thrombocytopenic Purpura with Cyclosporine and Corticosteroids in a Patient with Systemic Lupus Erythematosus and Antibodies to ADAMTS13
2007 Volume 46 Issue 18 Pages
Published: 2007 Released on J-STAGE: September 25, 2007
Wrong:Therefore, intensive immunosuppressive therapy may be needed in addition to PE, and it is possible that cyclosporine may be an effective treatment option in cases of TTP with ADAMTS13 inhibitors.
Right:Therefore, intensive immunosuppressive therapy may be needed in addition to PE, and it is possible that cyclosporine may be an effective treatment option in cases of TTP with ADAMTS13 inhibitors. Acknowledgement We thank for Drs. Masanori Matsumoto and Yoshihiro Fujimura (Department of Blood Transfusion Medicine, Nara Medical University) for analyzing ADAMTS13 activity and its inhibitor. Plasma ADAMTS13 activity and its inhibitor were measured by conventional VWF multimer method. The titer of inhibitor against ADAMTS13 was calculated to be 1.0 Bethesda Unit/ml. One Bethesda Unit is defined as the amount necessary to reduce ADAMTS13 activity to 50% of control levels.