Background The relationships between uric acid and metabolic syndrome (MetS) and diabetes, as well as the gender differences in these relationships are controversial. Methods Medical check-up data from 2,449 Japanese men and 1,448 Japanese women were examined. The prevalence of MetS and diabetes was calculated by the quartiles of serum levels of uric acid. Correlation coefficients between uric acid and MetS-related risk factors were calculated and compared between men and women. Results The prevalence of MetS in the 3rd quartile (Q3) of uric acid was significantly higher than that in the 1st (lowest) quartile (Q1) and the prevalence of MetS in the 4th quartile (Q4) was significantly higher than that in Q1, the 2nd quartile (Q2), and Q3 in men. The prevalence of MetS in Q4 was significantly higher than that in Q1, Q2, and Q3 in women. The prevalence of diabetes in Q3 was significantly lower than that in Q1 and the prevalence of diabetes in Q4 was significantly lower than that in Q1 and Q2 in men. The prevalence of diabetes was not significantly different among the quartiles of uric acid in women. The age-adjusted correlation coefficient between uric acid and fasting glucose was not significant in men. Conclusion Uric acid is positively associated with metabolic syndrome but negatively associated with diabetes in Japanese men.
Background The dynamic nature of QT dispersion (QTd) and the absence of an acceptable normal value suggest that the relative change not the absolute value of QTd would be a better predicator of coronary restenosis. We sought to examine the usefulness of the relative change in QTd, compared to the absolute value, as a predictor for coronary restenosis after previously successful percutaneous transluminal coronary angioplasty (PTCA). Methods Ninety-two patients with a history of successful PTCA who were referred for coronary angiography (CA) for exclusion of coronary restenosis were included in this analysis. QTd was calculated as the difference in milliseconds between the maximum and minimum QT interval in the 12-lead ECG. Relative change in QTd was measured as [QTd at the time of angiography (current) - QTd after the successful PTCA (baseline)]/QTd (baseline) %. Receiver operating characteristics (ROC) analysis was used to detect the best cut-off point and also to compare the diagnostic accuracy of the relative change in QTd vs. the absolute QTd for prediction of coronary restenosis. Results The relative change in QTd showed a significantly larger ROC area under curve (AUC) compared to the absolute QTd [AUC (95% CI): 0.79 (0.698, 0.872) and 0.61 (0.498, 0.703) respectively; p=0.011 for AUCs comparison]. The best cut-off point for the relative QTd was 40%, and for the absolute QTd this was 50 ms. The sensitivity and specificity of ≥40% increase in QTd to detect coronary restenosis was 71% and 83%, with positive and negative predictive values of 90% and 57%, respectively. The diagnostic accuracy of the absolute value of QTd was much less than this; the sensitivity and specificity of QTd ≥50 ms were 48% and 58%, with positive and negative predictive values of 71% and 34%, respectively. Conclusions Compared to the absolute value, the relative change in QTd is a better predictor of coronary restenosis after a previously successful PTCA. These findings may open the door for rethinking the use of QTd as a simple ECG predictor for cardiovascular outcomes.
Objective High molecular weight (HMW)-adiponectin has been found to be a better negative regulator of insulin resistance than total adiponectin. The aim of this study was to investigate the influence of HMW-adiponectin on antiretroviral therapy (ART)-induced dyslipidemia in Japanese human immunodeficiency virus (HIV)-infected individuals. We also examined the effect of some antiretroviral drugs (ARVs) on adipocytes in vitro. Patients and Methods Fifty-seven HIV-infected patients were enrolled in four clinical groups; (I) patients who started ART containing efavirenz (EFV); (II) patients who started ART containing a protease inhibitor without atazanavir (ATV); (III) patients who started ART containing ATV; (IV) patients who switched from ART without ATV into ART containing ATV. We measured the serum HMW-adiponectin before and one year after starting or changing ART, using an enzyme-linked immunoSorbent assay (ELISA). Furthermore, we treated the mouse adipocytes (3T3-L1) with some ARVs. The lipid content was assessed using Oil Red O staining. The expression of adiponectin was measured by quantitative real-time PCR. Results The serum HMW-adiponectin decreased significantly in groups (I) and (II) after starting ART, and increased significantly in group (IV) after changing from ART without ATV to ART with ART. EFV, ritonavir (RTV) and nelfinavir (NFV) inhibited the expression of adiponectin mRNA in mature 3T3-L1 and to a greater extent in pre-mature 3T3-L1. This phenomenon was reversible when ARV was changed to ATV. Conclusion Effects of the ARVs on adiponectin may vary depending on the administration of different drugs. These data suggest that the distinct metabolic effects of ARV could therefore be a consequence of their differential effects on the production of adiponectin.
A 46-year-old man with a 4-month history of bronchial asthma was admitted to our hospital complaining of progressive dyspnea, weakness of the lower extremities, multiple truncal erythematous purpura and hemoptysis. Neurological examination identified the presence of mononeuritis multiplex. Laboratory data indicated marked anemia, eosinophilia, severe renal failure with nephrotic condition and elevated serum myeloperoxidase anti-neutrophil cytoplasmic antibody (MPO-ANCA) levels (1,050 EU). Chest computed tomography showed diffuse ground glass opacity in both lungs. Bronchoalveolar lavage fluid revealed bloody fluid with eosinophilia (81%). Microscopic findings of a transbronchial lung biopsy were consistent with alveolar hemorrhage. A skin biopsy revealed eosinophilic vasculitis consistent with Churg-Strauss syndrome (CSS). A renal biopsy specimen revealed pauci-immune crescentic necrotizing glomerulonephritis. Consequently, he was diagnosed as having CSS presenting with diffuse alveolar hemorrhage (DAH) and rapidly progressive glomerulonephritis (RPGN) with MPO-ANCA-associated systemic vasculitis. His clinical condition markedly improved with the administration of intravenous corticosteroid (CS) and cyclophosphamide (CY). Thus, we report a case of CSS presenting with the rare complication of DAH and RPGN.
Here, we describe a case of colonic sarcoidosis that developed over a 7-year period of observation of intrathoracic sarcoidosis. The patient was asymptomatic, but colonoscopy showed multiple elevated lesions mimicking submucosal tumors in several areas of the colon. The specimens obtained by biopsy showed noncaseating granuloma, suggesting sarcoidosis. The observations in the present case indicate that colonic involvement should be considered in patients with sarcoidosis. Furthermore, the macroscopic appearance of multiple submucosal tumor-like lesions in colonic sarcoidosis is extremely rare.
Paraneoplastic nephrotic syndrome has been reported in various malignancies: malignant lymphoma, colon cancer, lung cancer, and prostate cancer. Of these, lung cancer is the most commonly associated with the syndrome. Here, we report 4 cases of nephrotic syndrome associated with lung cancer, in one of which urinary protein and edema were improved by steroid therapy. These results suggest that in patients with paraneoplastic nephrotic syndrome histologically diagnosed as having minimal change disease (MCD), it is important not only to treat the cancer itself but also to use steroids as early as possible. On the other hand, our results also showed that treatment is still difficult for locally advanced or metastatic tumors. Therefore, when we encounter patients with nephrotic syndrome, it is important to be aware of the association of nephrotic syndrome and lung cancer.
A 26-year-old woman with lymphoangioleiomyomatosis (LAM) was hospitalized for the surgical excision of a giant abdominal tumor of right kidney origin. The pathological diagnosis of the tumor was conventional angiomyolipoma (AML). After 8 months, 2 liver tumors appeared and grew rapidly. The tumors were resected, and the pathological finding of these tumors was epithelioid AML. Thereafter, metastatic multiple lung tumors appeared, and there was local recurrence of the liver tumors. Sirolimus, an mTOR protein inhibitor, was used to treat epithelioid AML. However, the drug did not inhibit the rapid growth of the tumor at all. This finding suggests that sirolimus might not be effective against epithelioid AML, and in such cases, complete surgical resection should be the treatment of choice.
A 74-year-old man with multiple myeloma was refractory to melphalan/prednisolone (MP), high-dose dexamethasone and VAD chemotherapy. He had the following poor prognostic factors: 1) multiple extramedullary plasmacytomas, 2) massive myelomatous effusion, 3) increasing immature myeloma cells with plasmablastic morphology, and 4) predominance of MPC1-CD49e-CD45+ phenotype immature myeloma cells. Combination therapy with thalidomide and dexamethasone resulted in a rapid response and a partial remission despite his multiple poor prognostic factors. The present case suggests that combination therapy with thalidomide and dexamethasone is still an alternative treatment regimen for resistant extramedullary plasmacytoma with a plasmablastic morphology.
Plasma cell leukemia (PCL) is a rare variant of multiple myeloma, which is very aggressive and resistant to chemotherapy. We report a case of PCL successfully treated with syngeneic peripheral blood stem cell transplantation followed by low-dose thalidomide. As of March 2009, the patient has maintained CR for 39 months posttransplant. The clinical course of the present case suggests that autologous stem cell transplantation using a graft with reduced contamination of malignant cells followed by low-dose thalidomide maintenance therapy may improve the PCL treatment outcome.
There are many reports that obstructive sleep apnea syndrome (OSAS) is a risk factor for ischemic stroke of arterial origin, however, the relationship between OSAS and cerebral venous thrombosis (CVT) remains unknown. We report the case of a 44-year-old man who had episodic headaches, unconsciousness attacks and seizures. Cerebral angiography showed CVT. He was obese and had severe OSAS. Noninvasive continuous positive airway pressure (CPAP) therapy prevented the recurrence of CVT as well as of headache. OSAS may be one of the multiple risk factors of CVT as well as arterial ischemic stroke.
Relapsing polychondritis (RP) is a rare multisystem autoimmune disease. Though meningitis in RP is not common, some cases with cerebrospinal fluid (CSF) pleocytosis of the lymphocyte cells have been reported. Of the 18 previously reported cases, two cases demonstrated pleocytosis of polymorphonuclear leukocytes (PMN) in the CSF. In addition, cases with a decreased glucose level in the CSF were also seen. Our case also demonstrated pleocytosis of PMN in CSF mimicking bacterial meningitis. In the clinical field, as it is not possible to obtain a culture of CSF on admission day, the glucose level and cellular fraction are considered important. Therefore, meningitis in RP should be considered as a differential diagnosis of bacterial meningitis.