Objective Oxidative modification of carbohydrates and lipids enhances the formation of advanced glycation end products (AGEs), which are formed not only in hyperglycemia, but also in normoglycemia. In this study, we determined skin AGEs in patients with cerebral infarction. Patients and Methods We non-invasively measured skin autofluorescence (AF) levels in patients with chronic cerebral infarction (CCI; n=95), patients with silent brain infarction (SBI; n=40), and age-matched controls (n=34), using an AGE Reader. Results Skin AF levels in patients with CCI and SBI were significantly increased compared with those in the control group (2.06±0.38, 2.16±0.47 and 1.84±0.35, respectively). Angiotension receptor blocker (ARB) or statins had no significant effect on the level of advanced glycation in any of the groups. Conclusion Our data suggest that increased formation of AGEs may be an indicator of oxidative stress, not only in diabetes and renal failure, but also in chronic cerebral ischemia.
Objective Free radicals are important in causing neural cell injury during cerebral infarction. Although there was a randomized, placebo-controlled, double-blind study at multiple centers in Japan showing the efficacy of the free radical scavenger, edaravone, in acute cerebral infarction, to date the clinical studies are few. This study investigated the effect of edaravone on the outcome of patients with acute lacunar infarction. Methods We retrospectively evaluated 124 consecutive patients with first-ever acute lacunar infarctions who were admitted to our hospital within 24 hours after the onset between January 2004 and June 2007. Of these, 59 patients received both edaravone and conventional therapy (edaravone group), and the other 65 underwent conventional therapy only (non-edaravone group). There was no significant difference in patients' baseline characteristics in the two groups. The clinical outcome was assessed by the National Institutes of Health Stroke Scale (NIHSS). Results The reduction of NIHSS scale during hospitalization (1.5±1.0 vs. 1.0±1.1; p = 0.007), especially that of the motor palsy scale (1.0±1.0 vs. 0.5±1.0; p = 0.006) was significantly larger, and the percentage of patients with a favorable outcome (NIHSS at discharge ≤1) (91.5% vs. 78.5%; p = 0.044) was significantly better in the edaravone group. Conclusion Edaravone improves the outcomes of patients with acute lacunar infarction, especially motor palsy, without regard to the conventional therapy performed concomitantly.
Portopulmonary hypertension (PPHTN) is pulmonary arterial hypertension (PAH) associated with portal hypertension. It is a common condition among liver transplantation candidates; however, its association with congenital absence of the portal vein (CAPV) has not yet been established. CAPV is a very rare developmental anomaly, which is usually accompanied by abnormal mesenteric drainage that bypasses the liver. Here, we report a rare case of severe PPHTN secondary to CAPV.
A 46-year-old man was admitted in our hospital with hypoglycemia; his FPG was 43 mg/mL. Five years earlier, he underwent simultaneous surgeries for an adrenal adenoma, a benign Leydig cell tumor (LCT), and a malignant lymphoma. Based on the laboratory results, he was diagnosed as congenital adrenal hyperplasia (CAH) due to nonclassical 21-hydroxylase deficiency (21-OHD). On immunohistochemistry analysis using the antibody against adrenal-specific 11β-hydroxylase antibody, the LCT showed both properties as a testicular cell and as an adrenal cell. The genetic background of 21-OHD might contribute to the development of malignant lymphoma. Such as a case of LCT and malignant lymphoma in a patient with 21-OHD seems to be rare.
Growth hormone (GH) deficiency is transient in most cases of adrenocorticotropin (ACTH) deficiency, while deficiency of both selective ACTH and GH in adults, as in the present case, is rare among hypopituitarism cases. In this patient, one year after hydrocortisone replacement for ACTH deficiency, data on GH secretion by insulin tolerance test and GH-releasing peptide-2 injection showed a partial improvement, but still there was lack of an adequate response. We consider that the patient had the deficiency of both selective GH and ACTH. Therefore, careful monitoring of GH function after the glucocorticoid replacement is required in cases of ACTH deficiency.
Hyperprolactinemia is the most common pituitary hormone hypersecretion syndrome in both men and women. Polycystic ovary syndrome (PCOS) is one of the most common endocrinopathies affecting 5%-10% of reproductive age women. Here, we present a patient with irregular menses, obesity, hirsutism and infertility, and hyperprolactinemia who was diagnosed as PCOS and prolactinoma and admitted to our clinic. Prolactinoma and PCOS association is a rare condition. This 33-year-old woman was admitted to the internal medicine outpatient clinic for irregular menses, obesity, hirsutism and infertility, and hyperprolactinemia. Her laboratory results were as follows: prolactin was 74 ng/mL (normal range:1.8-20.3 ng/mL). Pelvic ultrasonography was correlated with polycystic ovary syndrome. Pituitary MRI showed 6×8 mm microadenoma at left half. Bromocriptine was started with 1.25 mg/day and increased to 5 mg/day. After six months of bromocriptine treatment her prolactin level was normal and no adenoma was detected in pituitary MRI. PCOS and prolactinoma association should be taken into account in PCOS cases with mild hyperprolactinoma.
Autonomic dysfunction in patients with Parkinson's disease has been recognized since the original description by James Parkinson in 1817. In the present case, an 80-year-old woman who had been diagnosed with Parkinson's disease 3 years earlier (Hoehn and Yahr stage III) was admitted with a few days history of lethargy and bradykinesia. She lived in a heated house and used an electric blanket at night. On examination, her core temperature was 29.7°C. Her initial ECG showed sinus bradycardia, QT prolongation, and Osborn waves, which disappeared after rewarming. Successful rewarming was achieved with an external rewarming blanket over 12 hours. Follow-up ECG showed resolution of the Osborn waves. In Parkinson's disease, rapidly progressive hypothermia can occur in a well-heated house. Determining a rewarming strategy is a complex but not insurmountable task. In the elderly, the use of careful active external rewarming and a low stress strategy may be recommended.