Objective Transcatheter arterial chemoembolization (TACE) is an essential therapy for patients with hepatocellular carcinoma (HCC) in whom administering other treatments such as liver transplantation, resection or local therapy is not feasible. The purpose of our study was to determine the independent risk factors for one-year recurrence and two-year mortality in patients treated solely with TACE. Methods We conducted a retrospective cohort study of 34 consecutive patients (Group 1) with incident HCC who were treated solely with epirubicin-based TACE between April 2004 and March 2009. A subgroup analysis was performed among 24 patients (Group 2) who underwent complete TACE confirmed with abdominal computed tomography (CT) one month later. Tumor recurrence was evaluated using contrast CT every three months after the initial TACE. We calculated Kaplan-Meier estimates and performed a multiple regression analysis using a Cox-proportional hazard model. Results The patients in Group 1 (men, 59%), all of whom had liver cirrhosis, underwent TACE as the sole therapy for HCC. Kaplan-Meier estimates revealed a two-year survival rate [95% CI] of 70% [48-84%]. For the non-Child A patients, the adjusted hazard ratio (HR) [95% CI] for two-year survival was 7.1 [1.06-51.7]. In Group 2, the Kaplan-Meier estimate of the one-year recurrence rate [95% CI] was 61% [42-81%]. The adjusted HRs [95% CIs] for one-year recurrence for age and indocyanine green (ICG) 15-min >30% were 1.1 [1.0-1.26] and 7.87 [1.94-45.1], respectively. Conclusion Non-Child A cirrhosis is an independent risk factor for two-year mortality in patients treated solely with TACE. For ICG 15-min >30%, careful monitoring for HCC recurrence at one year, even after complete TACE, is warranted.
Objective Nonalcoholic fatty liver disease (NAFLD) is a condition associated with type 2 diabetes (T2D). Insulin resistance, a common pathogenesis of NAFLD and T2D, is partially caused by alterations in angiotensin II (Ang II) and is accompanied by hypoadiponectinemia. We aimed to investigate whether the circulating Ang II and adiponectin concentrations are related to hyperglycemia in male NAFLD patients. Methods Thirty-five controls and 85 NAFLD patients without prior known T2D were enrolled. All participants were non-smoking men who performed 75-g oral glucose tolerance tests. According to the American Diabetes Association (ADA) criteria, the NAFLD patients were divided into the euglycemia and hyperglycemia groups. The NAFLD patients with hyperglycemia were further divided into the isolated impaired fasting glucose (I-IFG) and postprandial hyperglycemia subgroups. The fasting serum Ang II and adiponectin concentrations were measured. Results Among the 85 NAFLD patients, 40 (47%) had hyperglycemia, including I-IFG (18%) and postprandial hyperglycemia (29%). The serum Ang II concentrations in the euglycemia and hyperglycemia groups were significantly higher than those observed in the control and euglycemia groups, respectively; whereas the serum adiponectin concentrations were significantly lower. The serum Ang II concentrations were significantly higher in the postprandial hyperglycemia subgroup than in the I-IFG subgroup. The serum Ang II and adiponectin concentrations were found to be independent predictors of hyperglycemia in the NAFLD patients. The serum Ang II concentration was significantly associated with the serum adiponectin and 2-hour postprandial glucose concentrations in the NAFLD patients. Conclusion An increased circulating Ang II concentration is associated with hypoadiponectinemia and postprandial hyperglycemia in male NAFLD patients and may be involved in the pathogenesis of T2D in NAFLD patients.
Objective There are conflicting results regarding the frequency and clinical significance of sleep related breathing disorders in patients with Parkinson's disease (PD). The aim of this study was to investigate the relationship between snoring and its clinical correlates in patients with PD. Methods A total of 93 PD patients and 93 controls were analyzed from a previously conducted cross-sectional study. Snoring was defined as a snoring frequency of ≥2 days/week (a score of 2 or higher on the PD Sleep Scale-2 subitem 15). Excessive daytime sleepiness (EDS) was defined as an Epworth Sleepiness Scale score of ≥10. Results Snoring was more prevalent in the patients with PD than in the controls (14.0% vs. 1.1%). The PD patients who snored exhibited greater disease severity, worse scores on the motor section of the Unified Parkinson's Disease Rating Scale (UPDRS) and the Parkinson fatigue scale and more impaired scores in several domains of the Parkinson's Disease Questionnaire, including the domains of mobility, activities of daily living, emotional well-being, communication and bodily discomfort, when compared to those who did not snore. No between-group differences were found in EDS. A higher proportion of the UPDRS motor scores for bradykinesia was seen in the PD patients who snored compared to that observed in the PD patients who did not snore. Conclusion We found that snoring was more frequent in PD patients than in controls. Furthermore, snoring in PD patients was associated with disease severity, an impaired motor function and a decreased quality of life, although it was not associated with EDS.
Objective For patients with Parkinson's disease (PD), driving is challenging due to an impaired motor function and decreased attention capabilities. This study assessed the driving capacity in PD patients by comparing neurological signs. Methods The driving ability of PD patients was evaluated using a driving simulator (Safety Master NT-932) that tested the reaction time in response to traffic signals and steering wheel errors. We studied the correlations between the total Unified Parkinson's Disease Rating Scale (UPDRS) score, the UPDRS part III score, the subscores of the UPDRS part III score, age, PD disease duration, braking reaction time, steering wheel errors and total scores for driving safety test results. 'On' state regular PD licensed drivers (n=42; mean age: 63 years) in Hoehn and Yahr stages II-III participated after their cognitive status was confirmed using mini-mental state examinations. Results The UPDRS scores, the UPDRS part III scores and the postural instability subscores exhibited significant (p<0.05) correlations with the number of steering wheel errors but not with the braking reaction time or the total safety scores of the test results. Conclusion The UPDRS is an established evaluation method used to estimate PD signs, although it is not sufficient alone for deciding whether PD patients should be allowed to drive. Our findings suggest that determining the driving ability using a driving simulator might be a useful adjunct to UPDRS scores in the assessment of PD patients who are active drivers. Estimating the driving ability requires complex measurements, including motor performance with perception of stimuli and attention.
Objective Hippocampal sclerosis (HS) is observed in many intractable, mesial temporal lobe epilepsy (MTLE) patients. We aimed to delineate the internal structural changes (ISC) shown as loss of internal architecture in the hippocampus on 3-Tesla magnetic resonance imaging (3T-MRI) due to its higher spatial resolution. Methods We studied 12 MTLE patients who exhibited unilateral HS on conventional 1.5 Tesla-MRI. Using 3T-MRI, high resolution T2-weighted coronal images of the hippocampus were investigated by visual inspection without the use of detailed clinical information. In addition, tissue samples obtained from four patients who underwent epilepsy surgery were analyzed histopathologically. Results In addition to hippocampal atrophy (HA) in the abnormal side, blurring of the low-intensity streak, i.e., ISC, in the hippocampus was seen in 12 patients and atrophy or high signal intensity was observed in Ammon's horn or the dentate gyrus in nine patients. After four patients underwent epilepsy surgery, tissue samples showed astrogliosis and a loss of pyramidal neurons in the hippocampal body, concordant with ISC or HA on MRI examination. Conclusion High-resolution MRI suggests that minute internal structural changes in the hippocampus reflect neuronal cell loss or gliosis, possibly in the early stage, and also show laterality of changes more sensitively. Different internal structural changes could further subclassify HS and may predict the surgical outcomes of seizure control based on the clinicopathological correlation.
Objective To investigate whether chronic obstructive pulmonary disease (COPD) screening that combines screening with questionnaires and pulmonary function testing is a useful method for the early detection of COPD. Methods A total of 3,367 subjects over 50 years of age underwent COPD screening. Two thousand five hundred and seventy-two of these subjects underwent "Ningen Dock" (a Japanese-English term for annual health checkup) examinations, regularly-scheduled checkups or screenings in outpatient clinics. Of these subjects, 795 lived in one city and one town in Nagasaki Prefecture and exhibited a score of at least 5 points on the Eleven-item pre-interview questionnaire (11-Q). The prevalence of airflow limitation in each type of examination was calculated for each gender, and the odds ratios of airflow limitation with each type of examination were obtained using the subjects who underwent "Ningen Dock" examinations as the reference group. Results The COPD prevalence was 6.5% in the "Ningen Dock" group (7.9% men, 1.8% women), 5.8% in the regularly-scheduled checkup group (7.4% men, 4.1% women), 9.8% in the screening in outpatient clinics group (12.1% men, 7.2% women) and 22.3% in the COPD screening group (31.1% men, 8.1% women), with the COPD screening group showing the highest prevalence. The odds ratios of the COPD prevalence confirmed that COPD screening is more effective for identifying airflow limitation than other types of examinations. Conclusion Conducting COPD screening with questionnaires and pulmonary function testing among the general population is a useful examination method for the early detection and treatment of COPD.
Type 1 autoimmune pancreatitis (AIP) is characterized by a high serum IgG4 concentration and is closely associated with the HLA-DRB1*04:05-DQB1*04:01 haplotype, for which family studies may disclose its immunogenetic significance. In the present study, we encountered two male siblings with type 1 AIP who exhibited diffuse pancreatic swelling with a capsule-like rim and diffuse pancreatic duct stricture. The younger brother also displayed characteristic IgG4-related sialadenitis and retroperitoneal fibrosis. Contrary to our expectations, the siblings showed only normal or slightly elevated values of serum IgG4 and no HLA DRB1*04:05-DQB1*04:01 haplotype, suggesting that type 1 autoimmune pancreatitis is associated with multiple immunogenetic factors.
We encountered a rare case of cytotoxic molecule-positive and Epstein-Barr virus (EBV)-associated peripheral T-cell lymphoma, not otherwise specified (PTCL-NOS), which was clinically preceded by polymyositis. A 50-year-old woman with a 4-year history of steroid-refractory polymyositis developed ulcerative skin swelling on her left arm. A diagnosis of cytotoxic molecule (TIA-1)-positive and EBV-associated PTCL-NOS was made on the basis of immunohistochemical and molecular examinations of the biopsied brachial muscle. Combination chemotherapies were ineffective, with a fatal outcome. Reassessment of the biopsy specimens of the muscle taken at the age of 46 years showed that the PTCL was already present, indicating that the polymyositis was likely a paraneoplastic manifestation.
A 73-year-old Japanese man with synchronous follicular lymphoma and adenocarcinoma of the stomach underwent curative surgical resection. The follicular lymphoma lesion was preoperatively diagnosed as extranodal marginal zone lymphoma of mucosa-associated lymphoid tissue (MALT lymphoma) according to biopsy samples. However, postoperative pathological evaluations revealed components of CD10-positive and CD10-negative lymphoma cells within the lymphoma lesion. This case highlights the potential difficulty of diagnosing gastric follicular lymphoma. In such cases, conducting repeat pathological examinations of biopsy samples or resected specimens is required to obtain a correct diagnosis of follicular lymphoma.
Two women, 66-year-old and 63-year-old, were admitted for drastically progressive neuropathy, and diagnosed with eosinophilic granulomatosis with polyangiitis (EGPA). Steroid pulse therapy failed to exert effect upon neuropathy, so we administered early intravenous immunoglobulin (IVIG) for fear of immobilization of neuropathy. This resulted in marked improvement in neuropathy without apparent side effects. Recent evidence suggests the efficacy of IVIG for steroid refractory neuropathy associated with EGPA, but has previously been administered during the chronic phase resulting in slow improvement. Our two successfully treated cases indicate the efficacy of early IVIG in preventing the immobilization of neuropathy, especially in progressive cases.
Klebsiella pneumonia usually causes urinary tract infections, pneumonia, and other infectious diseases in hospitalized and immunocompromised patients. Among the types of Klebsiella pneumonia, serotype K1 is known to be a highly virulent pathogen. We herein report the case of a healthy 63-year-old man with a pyogenic liver abscess and bilateral endogenous endophthalmitis caused by serotype K1 Klebsiella pneumonia. Although the patient received percutaneous abscess drainage and antibiotic therapy, he lost his eyesight. To improve the poor prognoses of ocular complications, providing both an earlier diagnosis and treatment is critical.