Certain populations with high incidences of Helicobacter pylori infection, such as those in East Asian countries, have high incidences of gastric cancer, while other highly infected populations, such as those in Africa and South Asia, do not. The various rates of gastric cancer associated with different geographic areas can be explained, at least in part, by the differences in the genotypes of H. pylori cagA and vacA. Populations expressing a high incidence of gastric cancer are mostly identical with regions where East Asian type CagA is predominant. In contrast, incidence of gastric cancer is low in Africa, South Asia, and Europe, where strains typically possess Western type CagA. Within East Asia, strains from northern parts, where the incidence of gastric cancer is high, predominantly possess the vacA m1 genotype, whereas the m2 genotype is predominant in southern parts where the gastric cancer incidence is low.
Objective The aim of this study was to elucidate the efficacy of short-term interferon (IFN) therapy for type C cirrhotic patients with genotype 2a and low virus load. Methods The present study was retrospective cohort study. Inclusion criteria were liver cirrhosis, hepatitis C virus (HCV) genotype 2a, the serum HCV RNA level of less than 100 KIU/mL, and IFN period of 6 or 8 weeks. Twenty-five consecutive patients who satisfied the above criteria were treated with IFN-beta daily at the dosage of 6 MU for 6 or 8 weeks. Independent factors that might have influenced sustained virologic response (SVR) were studied using multiple logistic regression analysis. Results Background of clinical profiles were as follows: median (range) age=64 (53-76) years, male/female=13/12, and median (range) HCV-RNA=31 (8-90) KIU/mL. Out of 25, 14 patients (56.0%) had SVR by the intention-to-treat analysis. The SVR was significantly associated with serum HCV RNA level. Logistic analysis showed that SVR occurred when HCV RNA level was <50 KIU/mL (p=0.047). Based on the difference of the serum HCV RNA level, the SVR rate was 68.4% (13/19) in patients with a serum HCV RNA level of <50 KIU/mL and 16.7% (1/6) in patients with a serum HCV RNA level of ≥50 KIU/mL. Conclusions The 6 or 8-week IFN-beta therapy is a possible selection of therapy for cirrhotic patients with HCV genotype 2a and a serum HCV RNA level of <50 KIU/mL.
Objective The significance of high triglyceride levels as a risk factor for coronary heart disease is uncertain. We hypothesized that oral glucose tolerance test (OGTT) and certain novel markers may help to identify high-risk patients. Patients and Methods We recruited 80 subjects with severe hypertriglyceridemia (age 27-73 years) without clinical proteinuria and diabetes mellitus (DM) which were diagnosed by fasting glucose <126 mg/dL from Hyperlipidemia Clinic of National Taiwan University Hospital for this study. We applied OGTT to evaluate occult DM and homeostasis model assessment (HOMA)-insulin resistance (IR) score to evaluate insulin resistance, and the measurements of microalbuminuria as a marker of vascular damage. In addition, serum or plasma markers of inflammation and fibrinolysis, fasting glucose and insulin as well as traditional cardiovascular risk factors were also evaluated. Results The serum level of triglyceride was higher in patients with microalbuminuria than in those without (14.1±5.7 vs. 9.6±3.9 mmol/L, p=0.025). Patients with microalbuminuria had higher fasting blood glucose and insulin, higher post-OGTT glucose and insulin, higher prevalence of newly developed diabetes mellitus (DM) (39% vs. 11%, p=0.007) and higher HOMA-IR (6.2±4.4 vs. 3.3±2.0, p<0.001). Among all the inflammatory and fibrinolytic markers, only soluble intercellular adhesion molecule showed significant different between these two groups. Multiple logistic regression analysis showed that among the serum markers, only HOMA-IR level was significantly related to microalbuminuria. Conclusions HOMA-IR is the major determinant for microalbuminuria in patients with severe hypertriglyceridemia. Impaired glucose metabolism is evident in patients with both severe hypertriglyceridemia and microalbuminuria.
Background Alpha-actinin-4 is an actin filament crosslinking protein that interacts with intercellular adhesion molecules. Recent animal studies suggested that alpha-actinin-4 is an essential component of the glomerular filtration barrier. However, little is known about its expression in human diabetic nephropathy (DN). Methods Renal biopsy tissues were obtained from 17 patients with DN. We determined the mRNA and protein expression levels of alpha-actinin-4 by in situ hybridization and immunohistochemistry. The histopathological severity of DN was classified into two groups: mild and moderate mesangial expansion groups. We also measured urinary protein excretion and creatinine clearance. Results Podocytes were positively stained for alpha-actinin-4 mRNA and protein. In the glomeruli, the percentage of cells positive for alpha-actinin-4 mRNA was significantly lower in moderate mesangial expansion group than in mild mesangial expansion group and control. The percentage of immunohistochemically positive area for alpha-actinin-4 protein in moderate mesangial expansion group was significantly lower than in mild mesangial expansion group and control. The percentage of cells positive for alpha-actinin-4 mRNA and area positive for the protein correlated inversely with severity of proteinuria. Conclusion Our results suggest that low expression levels of alpha-actinin-4 mRNA and protein are linked to the progression of glomerulopathy and proteinuria in human DN.
Background The lowest peak expiratory flow (PEF) over a week, expressed as a percentage of the highest PEF (Min%Max PEF) has been reported to be the index that most closely correlates with airway hyperresponsiveness (AHR) in asthmatics. However, both fluctuation of the airway caliber and airflow limitation are regarded as physiological properties of asthma closely related to AHR. An accurate index that shows the degree of AHR may be obtained by combining the index of airway lability with the parameters that represent airway caliber. Methods Ninety-two steroid-naive and twenty-eight steroid-treated asthmatic patients were enrolled. Using the physiological parameters obtained from spirometry and PEF monitoring, we investigated the indices which correlate accurately with airway responsiveness measured by the inhalation challenge test. Results Although the methacholine threshold was related to all parameters that represent airway caliber and lability, Min%Max PEF had the strongest correlation with AHR. When Min%Max PEF was adjusted by the airway geometric factors, the normalization of Min%Max PEF with forced expiratory volume in one second as a percentage of the predicted value (%FEV1) improved the relationship between Min%Max PEF and AHR. Conclusions Min%Max PEF adjusted by %FEV1 showed a good correlation with airway responsiveness measured by the inhalation challenge test, and may be useful as a convenient alternative index of AHR in asthmatic patients
Lactobacillus (LB) is a gram-positive rod-shaped bacterium that inhabits the oral cavity, gastrointestinal tract, vagina and nasal cavity. Although LB plays a role in the prevention of infections caused by pathogenic bacteria, it causes some critical infectious diseases such as infective endocarditis (IE). IE due to LB is rare; however, early diagnosis and early treatment are important because of its high mortality rate. We report the onset of IE after otologic treatment in a heavy drinker of alcohol, the second case of IE due to LB in Japan.
A case of bronchial pleomorphic adenoma is herein presented. The patient came to the hospital for a detailed examination of a bronchial polyp that was detected by computed tomography. Chest computed tomography revealed a bronchial tumor which was located at the distal end of the left main bronchus. The patient refused surgical resection. An electrosurgical snare was performed two times and the patient received several rounds of argon plasma coagulation with a flexible bronchoscope. The diagnosis of a pleomorphic adenoma was made following examination of the resected specimens. No recurrence has been observed by biopsy at the resected site.
A 72-year-old woman without a history of spinal injury was admitted to our hospital with prolonged severe back pain and high fever. Clinical laboratory findings and magnetic resonance imaging (MRI) revealed severe inflammation of the L2 and L3 lumbar vertebrae. Meropenem trihydrate administration improved her symptoms. Klebsiella pneumoniae isolated from the patient's blood indicated that the organism caused the spontaneous pyogenic spondylitis.
Thalassemia is a chronic hemolytic anemia, endemic around the Mediterranean basin. Extramedullary hematopoiesis (EMH) is a normal compensatory reaction that can involve many organs or tissues, including the epidural space, leading to a spinal cord compression syndrome. In almost all cases, the clinical and MR patterns are those of a lower dorsal spinal cord progressive compression secondary to an epidural expanding process. The management still remains controversial, including mainly blood transfusions, decompressive surgery and radiotherapy. We present a case of EMH in a thalassemic adolescent boy presenting with a T12 level of compression, treated successfully with blood transfusion, surgical decompression and radiotherapy.
We report a rare case of urinary retention secondary to Listeria meningitis. A 90-year-old woman presented with high fever, nausea, diarrhea, and incontinence of urination and feces. Lumbar puncture was performed. The total cell number of the cerebrospinal fluid (CSF) was elevated indicating that the glucose level was decreased. A CSF culture and a blood culture revealed Listeria monocytogenes (L. monocytogenes). We treated this bacterial meningitis with antibiotic medicine. One month after onset, stiff neck and laboratory data greatly improved and only urinary retention continued. Lumbar magnetic resonance imaging (MRI) showed no responsible lesions for the urinary retention. She received urological examination for urinary retention and was diagnosed with a neurogenic bladder. Two months later, she was able to walk after rehabilitation. However, the urinary retention continued despite urological therapy. We are not aware of descriptions on urinary retention resulting from bacterial meningitis in the recent literature. This is a rare case of prolonged urinary retention caused by bacterial meningitis.
We report a patient with myeloma-associated systemic AL amyloidosis who showed chronic polyarthralgia as the main symptom. The clinical picture was similar to that of rheumatoid arthritis with regard to symmetrical swelling with tenderness in multiple joints, but inflammatory reactions were almost normal and autoantibodies were negative. He was diagnosed as having systemic AL amyloidosis based on deposition of κ-light chain-immunoreactive amyloid in biopsied tissue and Bence Jones protein in serum and urine. Magnetic resonance imaging and bone scintigraphy suggested this disease as the cause of the polyarthralgia. Systemic AL amyloidosis may be important in the differential diagnosis of chronic polyarthralgia.
A 62-year-old man developed a fever, fatigue, anorexia and arthralgia. Central hypocorticoidism and central hypothyroidism were observed, and a low serum antidiuretic hormon level without symptoms of diabetes insipidus, as well. Images showed swelling of pituitary stalk, mediastinal and hilar lymphnodes and pancreas, pulmonary infiltrates and retroperitoneal mass. Serum CRP level was 20.6 mg/dL, and IgG4 level was 292 mg/dL. Lung biopsy revealed pseudotumor containing IgG4-positive plasmacytes, and obliterative vasculitis both in arterioles and venules. These features were similar to those of reported IgG4-related autoimmune disease. However, replacement steroid therapy for hypocorticoidism brought about almost complete recovery except that diabetes insipidus got apparent. This is the first report on the efficacy of only a small dose of steroid, and on features of pituitary stalk involvement and central hypocorcicoidism.
Lactococcus garvieae is considered a rare, opportunistic pathogen with low virulence in human infection. There are only scattered case reports of L. garvieae-related infection in humans in the past 20 years. The majority of them were reported to be infective endocarditis. We present a case study of a 41-year-old man with infective endocarditis caused by L. garvieae which is the first reported case with initial presentation as acute cerebral infarction.
Pituitary abscess is a rare infection and it is difficult to make the correct diagnosis. It is usually treated by a combination of surgical drainage and intravenous administration of antibiotics. We describe a 74-year-old woman with recurrent meningo-encephalitis due to pituitary abscess. The abscess increased in size in spite of the intravenous administration of panipenem/betamipron (PAPM/BP), clindamycin (CLDM) and chloramphenicol (CP). Finally she was successfully treated with oral administration of sparfloxacin (SPFX) without operation.