Background and Objective Various extrapulmonary effects and comorbidities have been noted to contribute to the burden of chronic obstructive pulmonary disease (COPD). However, the relationship between the prevalence of COPD and non-respiratory diseases has not been well investigated. The aim of the present study was to determine whether or not COPD is different among patients already suffering from other diseases. Methods Spirometry was performed by patients aged ≥40 years old with non-respiratory diseases who visited primary care clinics. Four hundred eighty-one patients performed spirometry and 7 patients were excluded because of poor spirometry maneuvers, resulting in 474 patients that were eligible for the current study. In subjects showing abnormalities in their spirograms, precise diagnoses were made using a questionnaire and chest X-ray examination. Results Among the 474 patients, airflow limitation (FEV1/FVC<70%) was observed in 53 patients (11.2%). Forty-nine patients (10.3%) were diagnosed as COPD and 4 patients (0.8%) as bronchial asthma. Among the various diseases, the prevalence of COPD was significantly higher only in the patients with liver diseases, which was 18.8% (12 of 64 patients). The odds ratio adjusted by both the amount of smoking and age was 2.66 (95%CI 1.06-6.63, p=0.037). Conclusions The prevalence of COPD was different according to the type of disease, and patients with liver diseases had a higher prevalence of COPD.
Objective This study was to clarify the roles of midkine (MK) in the brain. Methods We determined cerebrospinal fluid MK levels in patients with neurological disorders by enzyme-linked immunoassay and immunostained autopsied brain samples in patients with meningitis. Results MK levels were 0.37±0.21 ng/ml in controls (n=46, mean ± S.D.), 0.67±0.19 ng/ml in patients with cerebral infarction (n=8), 1.78±1.32 ng/ml in patients with meningitis (n=25; ANOVA and post-hoc Fisher's PLSD test, p<0.0001), 0.31±0.25 ng/ml in patients with human T-lymphotrophic virus type I-associated myelopathy/tropical spastic paraparesis (n=29), and 0.42±0.17 ng/ml in patients with amyotrophic lateral sclerosis (n=8). The regression equations were Y=0.005X+0.498 (Y, CSF MK level; X, cell number) and Y=0.007X+0.326 (Y, MK level; X, protein level) for all CSF samples. Autopsy brain samples from patients with meningitis expressed MK weakly in mononuclear cells on immunohistochemical examination. Western blot and polymerase chain reaction analyses showed that leukocytes were MK positive. CSF MK levels were not high in patients with cerebral infarction but were increased in patients with meningitis. CSF MK levels were high in normal controls, compared to those of other cytokines. MK was expressed in choroid plexus of normal brain and released there. Conclusion Our findings suggested that MK may maintain normal adult brain as a neurotrophic factor, and that MK may be released from leucocytes in brain of patients with meningitis as an immunological mediator.
A 34-year-old woman was admitted for treatment of esophageal varices. Seven years earlier, she had been diagnosed with Budd-Chiari syndrome, and percutaneous transluminal angioplasty (PTA) for right hepatic vein (RHV) stenosis was done. On admission, Doppler sonography showed a flat waveform in the RHV. RHV re-stenosis was confirmed on X-ray sonography. After PTA, the stenosis improved. Heterogeneous liver enhancement on enhanced computed tomography became homogeneous, her esophageal varices became inconspicuous, and the flat Doppler waveform pattern changed to a triphasic pattern. Doppler sonography was very useful for evaluating the effect of angioplasty and to diagnose re-stenosis.
Peripartum cardiomyopathy (PPCM) is a form of heart failure that affects women late in pregnancy or early in peripartum. The present report describes a case of a patient with PPCM demonstrated by magnetic resonance imaging (MRI) with late gadolinium enhancement of the left ventricle (LV). The late gadolinium enhancement of MRI improved associated with recovery of cardiac function. Endomyocardial biopsy showed mild cell infiltration and fibrosis. Thus, MRI may be useful for the evaluation of myocardial damage and to predict the outcome of PPCM.
Extraintestinal manifestations of Crohn's disease are common. Granulomas may occur in different tissues in Crohn's disease, although kidney granulomas are extremely rare. Although ocular complications of Crohn's disease are infrequent, most ocular manifestations include iritis, uveitis, episcleritis, scleritis, and conjunctivitis. Central retinal vein occlusion has been reported in a few patients with Crohn's disease. The choroidal neovascularization is related to inflammatory disorders such as panuveitis, sarcoidosis. We report a patient with Crohn's disease complicated by granulomatous interstitial nephritis, choroidal neovascularization, and central retinal vein occlusion.
We report a case of pulmonary adenocarcinoma metastasizing to the adrenal glands, which caused adrenal insufficiency leading to impaired consciousness. A 62 year-old man was admitted with impaired consciousness. The patient started chemotherapy from 2004 for pulmonary adenocarcinoma. In August 2004, a metastatic adrenal tumor was detected and chemotherapy was continued thereafter. From July 2005, the patient started to have mild hyperkalemia, anorexia and general malaise, which progressed to disturbance of consciousness. At admission, physical examination showed generalized pigmentation in the skin and mucosa. Blood test revealed hypoglycemia, hyponatremia and hyperkalemia. A dexamethasone suppression test and a rapid ACTH loading test led to a diagnosis of primary hypoadrenalism (Addison's disease). Treatment with hydrocortisone improved the physical status and blood test values. However, the patient subsequently died of disseminated intravascular coagulation due to the tumor.
We report herein 6 cases of sudden cardiac arrest in alcoholic ketoacidosis (AKA). All cases displayed evidence of prolonged excessive alcohol consumption and elevated β-hydroxybutyric acid levels and exhibited pulseless electrical activity (PEA) upon collapse. Severe metabolic acidosis was also seen in all cases. Some cases also displayed concomitant respiratory acidosis, hypothermia, hypoxia and/or hemorrhage. No evidence of myocardial infarction, tamponade or right heart strain, which would suggest pulmonary embolism, was found on cardiac ultrasonography. As PEA in AKA is induced by severe metabolic acidosis, aggressive correction of acidosis may represent a useful therapeutic strategy for such patients.