Objective The aim of this study was to elucidate the side effects after combination therapy of peginterferon and ribavirin for Japanese patients with chronic hepatitis C. Methods Inclusion criteria were HCV-genotype 1b and serum HCV RNA level of >100 KIU/ml. Six hundred and twelve patients were received combination therapy and enrolled in this non-randomized prospective cohort study. Patients were monitored until the discontinuation of combination therapy based on treatment-related side effects. The percentage of each medication actually taken during treatment was calculated. Results Sixty-eight patients were stopped the combination therapy due to side effects. The cumulative discontinuation rate due to side effects of therapy was 8.4% at 0.5 year and 14.9% at one year. Discontinuation rate due to side effects was high with statistically significant in the following cases: 1) patients ≥65 years, 2) patients who had diabetes. Sustained viral response (SVR) was 17.6% (12/68) in the discontinuation group. In the discontinuation group, when the percentage of both peginterferon and ribavirin actually taken during treatment was ≥60%, SVR was 31% (9/29). On the other hand, when the percentage of each medication actually taken during treatment was <60%, SVR was 7.7% (3/39). In the discontinuation group, patients with adherence of >60% to the total of scheduled dose tended to have a high SVR compared to those with ≤60% adherence to the total of scheduled dose. Conclusion In combination therapy, patient age and complications of patient are important factors contributing to the safety. In the discontinuation group, patients with adherence of >60% to the total of scheduled dose tend to have a high SVR.
Background The coronary artery calcification (CAC) score determined by multi-detector row computed tomography (MDCT) predicts the onset of coronary artery disease (CAD). In addition, pulse wave velocity (PWV) also predicts the mortality of CAD. Therefore, the aim of this study was to assess whether or not the CAC score is associated with PWV. Methods and Results The subjects consisted of 535 consecutive patients with suspected CAD who underwent MDCT. Brachial-ankle (ba) PWV, ankle-brachial index, % mean artery pressure (MAP) and upstroke time (UT) were measured. When the subjects were divided into three groups according to the CAC score [low (0-12 IU), intermediate (13-445) and high (≥445)], the classification score was significantly associated with age, sex, prevalence of hypertension and diabetes mellitus, systolic blood pressure, plasma levels of high-density lipoprotein cholesterol and uric acid, medication by angiotensin II receptor blocker and calcium channel blocker, PWV, %MAP and UT. In a multivariate logistic regression analysis, UT (p<0.0001), sex (p=0.0001), age (p=0.0003) and PWV (p=0.0276) remained significant independent variables for the classification. Conclusions UT was most significantly associated with the classification according to the CAC score. Measurement of UT should be performed before MDCT angiography, because the assessment of coronary artery lumen narrowing by MDCT can not be diagnosed in patients with severe calcification.
Objective To evaluate the effect on coagulation and fibrinolysis parameters and on non-conventional cardiovascular risk factors of metformin plus nateglinide or glibenclamide in naïve type 2 diabetes patients. Patients and Methods A total of 248 type 2 diabetic patients were enrolled and randomly assigned to receive nateglinide or glibenclamide, and metformin for 12 months. We assessed body mass index (BMI), glycated hemoglobin (HbA1c), fasting plasma glucose (FPG), postprandial plasma glucose (PPG), fasting plasma insulin (FPI), postprandial plasma insulin (PPI), homeostasis model assessment index (HOMA index), lipid profile with lipoprotein (a) [Lp(a)], fibrinogen (Fg), plasminogen activator inhibitor-1 (PAI-1), tissue plasminogen activator (t-PA), homocysteine (Hcy), systolic blood pressure (SBP), diastolic blood pressure (DBP). Results After 9 months of treatment, both tested drug combinations were similarly associated with a significant reduction in FPG (nateglinide, -17.2%; glibenclamide, -16.9%, both p<0.05) compared to the baseline, while HbA1c (-17.3%, p<0.05) and PPG (-15.2%, p<0.05) significantly decreased only in the nateglinide group. After one year of treatment, compared to the baseline the nateglinide group showed a significant reduction in HbA1c (-21%, p<0.01), FPG (-20.7%), p<0.01, PPG (-21.5%, p<0.05), HOMA index (-25.4%, p<0.05); the glibenclamide group, showed a significant reduction in HbA1c (-11%, p<0.05), FPG (-23.2%, p<0.05), PPG (-11.2%, p<0.05), and HOMA index (-23.9%, p<0.05) but to a minor extent. Moreover, the HbA1c difference value from baseline observed in the nateglinide-treated group was significantly higher than that observed in the glibenclamide group. Therefore the nateglinide-treated patients showed a significant reduction in some prothrombotic parameters (PAI-1=-19%, Lp(a)=-31%, and Hcy=-32.3%, all p<0.05), whereas the glibenclamide-treated patients did not. Conclusion Nateglinide appears to improve glycemic control as well as the levels of some prothrombotic parameters compared to glibenclamide when administered in combination with metformin.
We present a case report of a Japanese patient who showed prolonged infection after acute hepatitis B with genotype H. The patient was a 60-year-old man who underwent an annual health care check every year for several years and was never pointed out to have any liver damage, and markers for hepatitis B and C were negative. He was found to be positive for hepatitis B surface antigen (HBsAg) at his health care check in December 2005. After one month, he had an elevated aminotransferase level with hepatitis B e antigen and a high level of serum HBV DNA. He was diagnosed as having acute hepatitis B. On HBV genotype, he had genotype H by the direct sequence method, and he was given a 100 mg of lamivudine daily. However, his acute hepatitis tended to go toward prolonged infection. After two months, he was treated with interferon daily for 28 days. He had negative HBsAg in August 2006. Genotype H, the newest type of hepatitis B, could be the type which shows a poor response to lamivudine. The present paper is the first report, describing the clinical course of acute hepatitis B with genotype H from onset to remission.
The papilla of Vater emptying into the duodenal bulb site is extremely rare and considered an aberrant condition. We report here a case with recurrent duodenal ulcer bleeding associated with this anomaly. A 42-year-old man was admitted to St. Mary Hospital because of tarry stool for three days. Despite no documented etiology to explain recurrent ulceration, the patient had about ten episodes of ulcer bleeding since 1995. On duodenoscopy, 1.0 × 0.6 cm sized active stage duodenal ulcer with oozing was observed at the posterior wall side below the pylorus. The papilla of Vater was bulging just below the pylorus. Bile juice was excreted from its opening. Pancreatic duct and common bile duct, which drained into the bulb site, were observed on ERCP. In this report, we show that recurrent duodenal ulcer can be associated with the papilla of Vater just below the pylorus.
A 64-year-old woman was admitted because of persistent chest pain and ST-elevation in the precordial and inferior leads on electrocardiogram. Emergent coronary angiography demonstrated that there was no obstruction, and left ventriculography showed apical akinesis and basal hyperkinesis. She was diagnosed with takotsubo cardiomyopathy. Chest pain subsided within the day of admission followed by T-wave inversion on electrocardiogram. Nevertheless, chest pain and ST-elevation reappeared late on the third hospital day, accompanied by fever and small amounts of pericardial and pleural effusions. Under the administration of nonsteroidal anti-inflammatory drug, the inflammation lessoned. This is the first report of acute pericarditis in the recovery phase of takotsubo cardiomyopathy.
Mesangiolytic glomerulopathy is an uncommon complication of irradiation and chemotherapy of THP-COP [pirarubicin, cyclophosphamide (CPA), vincristin (VCR), predonisolone (PSL)] and CHOP (CPA, Doxorubicin, VCR, PSL). We report a case of 63-year-old man 7 months status post radiation, and 10 months post chemotherapy for gastric lymphoma. The patient showed proteinuria and mild renal insufficiency. Renal biopsy revealed marked mesangiolysis in the glomeruli without any immune depositions. After the administration of angiotensin II receptor blocker, the patient's renal function remained stable for over two years. Mesangiolysis was thought to be a characteristic glomerular lesion in this patient treated with both chemoagents and radiation.
The predominantly young woman-orientated systemic lupus erythematosus (SLE) is a disease that involves an extremely complicated and multifactorial interaction of various genetic and environmental factors. Crystalline silica (Si) may act as an immunoadjuvant to increase secretions of inflammatory endogenous substances and antibody production. In addition, previous studies have suggested that exposure to Si may induce SLE. Although the biologic mechanism of Si in SLE is unclear, defective apoptosis leading to the prolonged survival of pathogenic lymphocytes was thought to be one of mechanisms of Si-associated SLE (sSLE). In the present study, a rare case of an elderly man suffering from sSLE responded well to glucocorticoid therapy. The present findings were reviewed with reference to previous literature.
We encountered the rare case of a 50-year-old woman who developed rheumatoid arthritis (RA) while suffering from Takayasu's arteritis of arch vessel type. prednisolone (PSL) therapy was continued at a maintenance dose of 7.5 mg due to recurring inflammation. She was affected with RA for 7 years after Takayasu's arteritis. Disease-modifying antirheumatic drugs (DMARDs) were unusable because of side effects. In the summer of 2005, RA activity increased, and treatment with tacrolimus hydrate at 1.5 mg was started; thereafter, the activity of RA and Takayasu's arteritis was relieved, especially MRA findings. We report that therapy with tacrolimus hydrate markedly relieved two disorders, and review the literature.