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1.
Cardiovasc Interv Ther ; 31(2): 161-3, 2016 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-25917780

RESUMO

Saphenous vein graft (SVG) pseudoaneurysms are rare complications following coronary bypass graft surgery. A 46-year-old man presented with streptococcal infectious endocarditis and needed sequential operations for aortic root reconstruction. Shortly after the surgeries, a composite SVG on the right coronary artery developed a ruptured pseudoaneurysm, which was successfully treated using covered stents.


Assuntos
Falso Aneurisma/etiologia , Ponte de Artéria Coronária/efeitos adversos , Oclusão de Enxerto Vascular/cirurgia , Veia Safena/transplante , Falso Aneurisma/cirurgia , Angiografia Coronária , Oclusão de Enxerto Vascular/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Stents/efeitos adversos
2.
Heart Vessels ; 31(6): 855-62, 2016 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-25921916

RESUMO

Diabetes mellitus and impaired glucose tolerance are well-known risk factors for coronary artery disease (CAD) and adverse clinical events after percutaneous coronary intervention (PCI). Postprandial hyperglycemia is an important risk factor for CAD and serum 1,5-anhydroglucitol (1,5-AG) reflects postprandial hyperglycemia more robustly than hemoglobin (Hb)A1c. We aimed to clarify the relationship between serum 1,5-AG level and adverse clinical events after PCI. We enrolled 141 patients after PCI with follow-up coronary angiography. We evaluated associations between glycemic biomarkers including HbA1c and 1,5-AG and cardiovascular events during follow-up. Median serum 1,5-AG level was significantly lower in patients with any coronary revascularization and target lesion revascularization (TLR) [13.4 µg/ml (first quartile, third quartile 9.80, 18.3) vs. 18.7 (12.8, 24.2), p = 0.005; 13.4 µg/ml (10.2, 16.4) vs. 18.7 (12.9, 24.2), p = 0.001, respectively]. Multivariate logistic analysis showed lower 1,5-AG was independently associated with any coronary revascularization and TLR (odds ratio 0.93, 95 % confidence interval 0.86-0.99, p = 0.04; 0.90, 0.81-0.99, p = 0.044, respectively), whereas higher HbA1c was not. Postprandial hyperglycemia and lower 1,5-AG are important risk factors for adverse clinical events after PCI.


Assuntos
Desoxiglucose/sangue , Diabetes Mellitus/sangue , Infarto do Miocárdio/terapia , Intervenção Coronária Percutânea/efeitos adversos , Idoso , Biomarcadores/sangue , Glicemia/metabolismo , Distribuição de Qui-Quadrado , Angiografia Coronária , Diabetes Mellitus/diagnóstico , Regulação para Baixo , Feminino , Hemoglobinas Glicadas/metabolismo , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Infarto do Miocárdio/sangue , Infarto do Miocárdio/diagnóstico por imagem , Razão de Chances , Estudos Prospectivos , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento
3.
Cardiovasc Interv Ther ; 31(1): 75-8, 2016 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-25711731

RESUMO

Thrombus aspiration is currently the standard strategy for primary PCI. Thrombus can be aspirated via aspiration catheters, restoring coronary blood flow. However, there are a limited number of reports regarding thrombus aspiration toward tumor embolized occlusion. We present a case of 90-year-old male with AMI caused by the metastatic tumor embolism. Emergent coronary angiography revealed total occlusion in three epicardial vessels. Histopathological examination of the aspirated specimen revealed the mixture of thrombus and metastatic tumor cells. Thrombus aspiration was partially effective for restoring coronary blood flow; however, it was very helpful for the final diagnosis of tumor embolism.


Assuntos
Trombose Coronária/terapia , Fibrossarcoma/patologia , Átrios do Coração/patologia , Trombectomia , Idoso de 80 Anos ou mais , Embolia/etiologia , Humanos , Masculino
4.
Heart Vessels ; 30(4): 469-76, 2015 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-24691699

RESUMO

Postprandial hyperglycemia is a risk factor for cardiovascular disease and mortality. Serum 1,5-anhydroglucitol (1,5-AG) level is an useful clinical marker of glucose metabolism which reflects postprandial hyperglycemia more robustly compared to hemoglobin A1c (HbA1c). Relationship between serum 1,5-AG level and cardiovascular disease has been reported; however, comparison between HbA1c and 1,5-AG as markers of cardiovascular disease was not performed. We included 227 consecutive patients who underwent coronary angiography meeting the following inclusion criteria: (1) patients who had no history of coronary artery disease (CAD); (2) patients without acute coronary syndrome; (3) patients without poorly controlled diabetes mellitus; (4) patients without anemia, liver dysfunction, acute, and chronic renal failure and malnutrition; and (5) patients without adhibition of acarbose or Chinese herbal medicine. We measured HbA1c, glycoalbumin, and 1,5-AG. Serum 1,5-AG was significantly lower in patients with CAD (16.6 ± 8.50 vs. 21.1 ± 7.97 µg/ml, P < 0.001). Multivariable logistic regression analysis showed decrease in serum 1,5-AG was independently associated with the presence of denovo CAD (0.93, 95% CI 0.88-0.98, P = 0.006). Serum 1,5-AG was also independently associated with the presence of denovo CAD in patients without diabetes mellitus (0.94, 95% CI 0.88-0.99, P = 0.046). In conclusion, lower serum 1,5-AG was associated with the presence of denovo CAD. Serum 1,5-AG may identify high cardiovascular risk patients for denovo CAD in both diabetic and non-diabetic patients.


Assuntos
Glicemia/metabolismo , Doença da Artéria Coronariana/sangue , Desoxiglucose/sangue , Diabetes Mellitus/sangue , Hemoglobinas Glicadas/análise , Hiperglicemia/sangue , Idoso , Biomarcadores/sangue , Angiografia Coronária , Feminino , Produtos Finais de Glicação Avançada , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Estudos Prospectivos , Curva ROC , Fatores de Risco , Albumina Sérica , Albumina Sérica Glicada
5.
Heart Vessels ; 30(5): 696-701, 2015 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-24736945

RESUMO

Dipeptidyl peptidase-4 (DPP4) is an integral membrane glycoprotein that modulates the pathological state of diabetes mellitus (DM), and DPP4 inhibitors are a new class of anti-type-2 DM drugs. Recent preclinical studies have associated DPP4 inhibition with improved myocardial systolic and diastolic function. Based on preclinical findings, we investigated associations between the administration of DPP4 inhibitors and cardiac function after acute myocardial infarction (AMI) in a clinical setting. We enrolled 34 patients with diabetes who were treated for acute myocardial infarction at our hospital between January 2010 and December 2012. We retrospectively compared changes in cardiac parameters determined by trans-thoracic echocardiography between patients treated with (DPP4-I group; n = 13) or without (non-DPP4-I group; n = 21) a DPP4 inhibitor during follow-up. The values of E/e' and of e'/a' significantly decreased and increased, respectively, in the DPP4-I, compared with the non-DPP4-I group (-2.53 ± 5.53 vs. 2.58 ± 5.68, p = 0.038 and 0.08 ± 0.23 vs. -0.12 ± 0.21, p = 0.036, respectively). We concluded that DPP4 inhibitors could improve E/e' and e'/a' in patients with DM and AMI and thus might be effective for treating left ventricular diastolic failure.


Assuntos
Diabetes Mellitus Tipo 2/complicações , Inibidores da Dipeptidil Peptidase IV/uso terapêutico , Ventrículos do Coração/fisiopatologia , Infarto do Miocárdio/tratamento farmacológico , Função Ventricular Esquerda/efeitos dos fármacos , Idoso , Diástole , Ecocardiografia , Eletrocardiografia , Feminino , Seguimentos , Ventrículos do Coração/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/complicações , Infarto do Miocárdio/fisiopatologia , Estudos Retrospectivos , Resultado do Tratamento
6.
J Cardiol ; 64(5): 334-8, 2014 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-24802171

RESUMO

BACKGROUND: The perioperative risk of non-cardiac surgery (NCS) in the patients on antiplatelet therapy after percutaneous coronary intervention (PCI) remains unclear. METHODS: This study was a retrospective and single center study. Between January 2008 and December 2011, 198 patients who had already received PCI underwent NCS in our hospital. Among them, 63 patients underwent surgery on dual antiplatelet therapy (DAPT group) and 88 patients on single antiplatelet therapy (SAPT group). We compared bleeding events and cardiovascular events during perioperative period between the two groups. RESULTS: There was no stent thrombosis in either group. The bleeding events in the DAPT group were significantly higher than that in the SAPT group (9.5% vs 2.3%, p=0.049). There was no difference in events between with or without heparin-bridge in the SAPT group. CONCLUSIONS: The frequency of bleeding events was higher in the DAPT group. Both bleeding and cardiovascular events with aspirin alone were low in our study. It may be safe to undergo NCS with SAPT after PCI.


Assuntos
Doenças Cardiovasculares/induzido quimicamente , Hemorragia/induzido quimicamente , Intervenção Coronária Percutânea , Assistência Perioperatória/efeitos adversos , Inibidores da Agregação Plaquetária/efeitos adversos , Stents/efeitos adversos , Idoso , Aspirina/administração & dosagem , Aspirina/efeitos adversos , Doenças Cardiovasculares/epidemiologia , Feminino , Hemorragia/epidemiologia , Heparina/administração & dosagem , Heparina/efeitos adversos , Humanos , Masculino , Proteínas de Membrana , Pessoa de Meia-Idade , Período Perioperatório , Inibidores da Agregação Plaquetária/administração & dosagem , Estudos Retrospectivos , Fatores de Tempo , Proteínas Supressoras de Tumor
7.
Acta Haematol ; 130(4): 230-7, 2013.
Artigo em Inglês | MEDLINE | ID: mdl-23816831

RESUMO

INTRODUCTION: Aberrant expression of T-cell markers is occasionally observed in B-cell lymphomas. We conducted a retrospective study to establish its incidence and to determine its relationship with clinical features of patients with diffuse large B-cell lymphoma (DLBCL). PATIENTS AND METHODS: We reviewed DLBCL patients diagnosed between January 2002 and April 2009. Patients fulfilled the following criteria: (1) age >18 years, (2) HIV negative, (3) B-cell lymphoma confirmed by restricted expression of surface immunoglobulin light chains by flow cytometry (FCM). Aberrant T-cell marker expression (ATCME) was defined as positivity for CD2, CD3, CD4, CD7, and/or CD8 on DLBCL cells by FCM. Phenotyping was also performed by immunohistochemistry (IHC). Patients were grouped according to positive or negative ATCME and their clinical features including survival were compared. RESULTS: Of 150 patients, 11 (7.3%) showed ATCME; CD2 and CD7 were most often expressed. ATCME was less often detected and the signal was weaker using IHC. There were no statistically significant differences in clinical features between the two groups. CONCLUSIONS: FCM may be useful to detect ATCME in a small amount of lymphoma cells. The mechanism responsible for ATCME, and whether it contributes in any way to the pathogenesis of B-cell neoplastic transformation, requires clarification.


Assuntos
Antígenos CD/imunologia , Linfoma Difuso de Grandes Células B/imunologia , Linfócitos T/imunologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Antígenos CD7/imunologia , Antígenos CD2/imunologia , Feminino , Citometria de Fluxo , Humanos , Cadeias Leves de Imunoglobulina/imunologia , Imuno-Histoquímica , Japão/epidemiologia , Linfoma Difuso de Grandes Células B/mortalidade , Linfoma Difuso de Grandes Células B/patologia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
8.
Int J Clin Pharmacol Ther ; 51(6): 513-6, 2013 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-23557868

RESUMO

OBJECTIVE: Lenalidomide is now widely used for the treatment of multiple myeloma in virtue of its potent anti-tumor activity and low toxicity. Very few reports stressed the association of this drug with serious pulmonary toxicity. Here we present the case of multiple myeloma who underwent acute respiratory failure caused by non-specific interstitial pneumonia after few days of treatment with lenalidomide. CASE SUMMARY: A 50-year-old man diagnosed as multiple myeloma of IgA κ type, International Staging System III received a combination therapy of lenalidomide (15 mg, Day 1 - 21) with dexamethasone (40 mg, Day 1, 8, 15, 22). After 4 days on chemotherapy, he experienced worsened dyspnea and was urgently hospitalized because of acute respiratory failure. Because serial imaging procedures and thorough laboratory workup strongly suggested that his lung injury was caused by drug-induced interstitial pneumonia, lenalidomide, which was the most suspicious drug, was discontinued immediately, and the glucocorticoid pulse was performed. He showed an excellent response to the therapy. Interstitial pneumonia on the CT scan was resolved dramatically at 12 days after the start of the glucocorticoid pulse. CONCLUSION: We are convinced that our case is so instructive as to arouse attention to clinicians that lenalidomide has an extremely rare but potential adverse effect.


Assuntos
Lesão Pulmonar Aguda/induzido quimicamente , Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Mieloma Múltiplo/tratamento farmacológico , Talidomida/análogos & derivados , Lesão Pulmonar Aguda/diagnóstico por imagem , Lesão Pulmonar Aguda/terapia , Protocolos de Quimioterapia Combinada Antineoplásica/administração & dosagem , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Humanos , Lenalidomida , Masculino , Pessoa de Meia-Idade , Radiografia , Talidomida/administração & dosagem , Talidomida/efeitos adversos , Talidomida/uso terapêutico , Resultado do Tratamento
9.
Intern Med ; 52(7): 807-10, 2013.
Artigo em Inglês | MEDLINE | ID: mdl-23545680

RESUMO

Acquired hemophilia (AHA) is a relatively rare and life-threatening disease caused by autoantibodies against factor VIII. Autoimmune bullous diseases (ABD) are also caused by autoantibodies against specific skin proteins. We herein report two cases of AHA associated with ABD. These coincidences are extremely rare, and only 14 documented cases have been reported previously. We further analyzed the properties of the autoantibodies in our patients. The epitopes were the A2 domain in patient 1, and both the A2 domain and the light chain in patient 2. Their isoforms were predominantly IgG4. Cross-reactivity could not be demonstrated. An accumulation of cases is required to unveil the pathogenesis of AHA.


Assuntos
Hemofilia A/complicações , Hemofilia A/diagnóstico , Penfigoide Bolhoso/complicações , Penfigoide Bolhoso/diagnóstico , Adulto , Idoso de 80 Anos ou mais , Autoanticorpos/sangue , Doenças Autoimunes/sangue , Doenças Autoimunes/complicações , Doenças Autoimunes/diagnóstico , Feminino , Hemofilia A/sangue , Humanos , Penfigoide Bolhoso/sangue
10.
Intern Med ; 51(7): 749-53, 2012.
Artigo em Inglês | MEDLINE | ID: mdl-22466832

RESUMO

A 62-year-old man with hypertrophic obstructive cardiomyopathy (HOCM) had complete atrioventricular (AV) block and subsequent cardiac standstill. A previous electrocardiogram revealed a bifascicular block pattern. Because he also suffered from infective endocarditis of the native aortic valve, surgical therapy (dual-chamber permanent pacing, myectomy of the left ventricular outflow tract, and valve replacement) was performed. Complete AV block unrelated to a procedure is a rare complication in patients with HOCM, but it may be life-threatening. Therefore, a pre-existing cardiac conduction disturbance should be specifically recognized as the aura of a higher degree of AV block.


Assuntos
Bloqueio Atrioventricular/complicações , Cardiomiopatia Hipertrófica/complicações , Endocardite/complicações , Insuficiência da Valva Aórtica/complicações , Insuficiência da Valva Aórtica/cirurgia , Bloqueio Atrioventricular/cirurgia , Bloqueio Atrioventricular/terapia , Dispositivos de Terapia de Ressincronização Cardíaca , Cardiomiopatia Hipertrófica/cirurgia , Endocardite/cirurgia , Implante de Prótese de Valva Cardíaca , Humanos , Masculino , Pessoa de Meia-Idade , Obstrução do Fluxo Ventricular Externo/complicações , Obstrução do Fluxo Ventricular Externo/cirurgia
11.
J Smooth Muscle Res ; 48(5-6): 137-47, 2012.
Artigo em Inglês | MEDLINE | ID: mdl-23538510

RESUMO

CD3 is a complex of polypeptides which form part of the T cell receptor. Normal human peripheral pan T cells, express not only CD3, but the mRNA for myosin regulatory light chains MYL9, MYL12A, and MYL12B are also significantly expressed. In the Jurkat wild strain, an acute T cell leukemia cell line, CD3 on the surface and MYL9 mRNA are not expressed, while both MYL12A mRNA and MYL12B mRNA are expressed. Jurkat-I, a new clone was established by the transfection of the MYL9 gene into the Jurkat wild strain. As a result, the level of CD3 expressed on the surface of Jurkat-I cells was significantly higher than those in the Jurkat wild strain. Phorbol 12-myristate 13-acetate increased the surface CD3 levels in Jurkat wild strain cells without resulting in MYL9 gene expression, indicating that protein kinase C is partially involved in the expression of CD3 on the surface. These results suggest that surface CD3 expression proceeds through both MYL9-dependent and MYL9-independent pathways (i.e. the protein kinase C- dependent pathway) in Jurkat cells.


Assuntos
Complexo CD3/biossíntese , Regulação da Expressão Gênica/fisiologia , Cadeias Leves de Miosina/biossíntese , Proteína Quinase C/metabolismo , Transdução de Sinais/fisiologia , Complexo CD3/genética , Carcinógenos/farmacologia , Regulação da Expressão Gênica/efeitos dos fármacos , Humanos , Células Jurkat , Cadeias Leves de Miosina/genética , Proteína Quinase C/genética , RNA Mensageiro/biossíntese , RNA Mensageiro/genética , Transdução de Sinais/efeitos dos fármacos , Acetato de Tetradecanoilforbol/farmacologia
12.
Intern Med ; 49(16): 1775-7, 2010.
Artigo em Inglês | MEDLINE | ID: mdl-20720357

RESUMO

We present a 78-year-old woman with prosthetic valve endocarditis due to Stenotrophomonas maltophilia (S. maltophilia) 3 years after mitral valve replacement. Administration of sulfamethoxazole-trimethoprim was effective; however, it was discontinued because of side effects, which led to failure of antibiotic therapy. Complications of multiple cerebral infarction and paravalvular abscess developed. Although the prosthetic valve was removed 50 days after admission, she died 4 months after surgery. S. maltophilia has been increasingly being considered as a serious nosocomial pathogen. S. maltophilia endocarditis is rare; however, it should be recognized as a possible life-threatening disease in patients with prosthetic valve.


Assuntos
Endocardite/diagnóstico , Infecções por Bactérias Gram-Negativas/diagnóstico , Próteses Valvulares Cardíacas/microbiologia , Valva Mitral/microbiologia , Infecções Relacionadas à Prótese/diagnóstico , Stenotrophomonas maltophilia , Idoso , Endocardite/etiologia , Feminino , Infecções por Bactérias Gram-Negativas/etiologia , Próteses Valvulares Cardíacas/efeitos adversos , Humanos , Valva Mitral/patologia , Infecções Relacionadas à Prótese/complicações , Stenotrophomonas maltophilia/isolamento & purificação
13.
J Cardiol ; 55(2): 196-204, 2010 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-20206072

RESUMO

BACKGROUND: Causes of left atrial (LA) enlargement and its gender difference in patients with normal left ventricular (LV) systolic function have not been clarified. We investigated the factors contributing to LA enlargement in patients with normal LV systolic function, addressing its gender difference. METHODS: We enrolled 380 patients (175 males and 205 females; mean age: 63 + or - 15 years) with LV ejection fraction > or = 50% who underwent Doppler echocardiography and blood tests at the same time as echocardiography. Patients with arrhythmias, significant valvular heart disease, and LV asynergy were excluded. The LA volume was measured by Simpson's method from apical 2- and 4-chamber views, and LA volume index (LAVI) was calculated as LA volume/body surface area. All patients, male and female were assigned to a group with a low or a high LAVI based on the median LAVI value, respectively. RESULTS: Age, female gender, hypertension, diabetes, hemoglobin concentration, LV mass index, Doppler parameters of LA contraction, and the ratio of mitral early diastolic velocity to early diastolic velocity of the mitral annulus (E/E') were significantly associated with a high LAVI in all patients. Multivariate analysis showed that LV mass index [odds ratio (OR) 1.05, 95% confidence interval (CI) 1.03-1.06, P<0.0001], hemoglobin concentration (OR 0.76, 95% CI 0.64-0.90, P<0.01), and female gender (OR 1.92, 95% CI 1.12-3.30, P<0.05) independently contributed to a high LAVI in all patients. In addition, LV mass index and hemoglobin concentration independently contributed to a high LAVI in both genders despite the absence of overt LV hypertrophy or anemia. CONCLUSION: Increased LV wall thickness and decreased hemoglobin concentration might contribute to LA enlargement in patients with normal LV systolic function irrespective of gender.


Assuntos
Cardiomegalia/etiologia , Átrios do Coração/patologia , Função Ventricular Esquerda/fisiologia , Volume Cardíaco , Ecocardiografia , Feminino , Hemoglobinas/análise , Humanos , Masculino , Pessoa de Meia-Idade , Fatores Sexuais , Volume Sistólico/fisiologia
14.
Rinsho Ketsueki ; 51(12): 1762-8, 2010 Dec.
Artigo em Japonês | MEDLINE | ID: mdl-21258186

RESUMO

The response criteria proposed by European Leukemia Net are useful to predict the prognosis of de novo chronic myeloid leukemia (CML) patients in the chronic phase (CP) treated with imatinib. However, the clinical significance of late suboptimal response, which is defined as the achievement of CCgR without MMR after 18 months, is controversial. In this study, we retrospectively analyzed the clinical courses of 16 CML-CP patients, who satisfied the criteria for late suboptimal response. The median duration of imatinib treatment was 62 (25∼87) months. The median starting dose of imatinib was 400 mg/day. Imatinib dose was escalated to 600∼800 mg/day in 10 patients for various reasons. Among 4 patients who continued high-dose imatinib for late suboptimal response, 2 patients subsequently achieved MMR, and BCR-ABL mRNA transcript levels were decreasing in 2 patients. However, imatinib was kept at 300 or 400 mg/day in 6 patients. Among these six patients, 4 patients achieved MMR, while 2 failed to achieve MMR. None of 16 patients progressed to the acute phase or blast phase. Imatinib dose escalation was effective for late suboptimal response. Furthermore, a second tyrosine kinase inhibitor such as nilotinib may be more potent to reduce the risk of disease progression by achieving earlier MMR.


Assuntos
Antineoplásicos/administração & dosagem , Piperazinas/administração & dosagem , Pirimidinas/administração & dosagem , Adulto , Antineoplásicos/efeitos adversos , Benzamidas , Feminino , Humanos , Mesilato de Imatinib , Leucemia Mielogênica Crônica BCR-ABL Positiva , Masculino , Pessoa de Meia-Idade , Piperazinas/efeitos adversos , Prognóstico , Pirimidinas/efeitos adversos , Fatores de Tempo , Adulto Jovem
15.
Circ J ; 73(7): 1278-82, 2009 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-19398844

RESUMO

BACKGROUND: A unique transient retinopathy characterized by soft exudates around the optic disc after percutaneous coronary intervention (PCI) for acute myocardial infarction (AMI) has been reported, so in the present study the risk factors for retinopathy associated with AMI (RAMI) were investigated. METHODS AND RESULTS: The study group comprised 62 patients with their first AMI who underwent successful PCI within 24 h of onset (48 men, 14 women; age 63 +/-10 years). The fundus of each eye was assessed on days 3-5, and again at 4 weeks after AMI onset. New soft exudates developed in 29 patients (47%) at 4 weeks. The frequency of diabetes mellitus (DM), and the hemoglobin A(1c) and peak creatine kinase concentrations were higher in patients with than in those without RAMI (55% vs 21%, P=0.008; 7.0 +/-2.0% vs 5.9 +/-1.4%, P=0.013; and 3,428 +/-2,210 IU/L vs 2,352 +/-1,652 IU/L, P=0.036, respectively). Multivariate analysis identified DM as an independent predictive factor for the occurrence of RAMI (odds ratio, 6.60; 95% confidence interval, 1.68-25.90; P=0.007). CONCLUSIONS: DM might be a risk factor for RAMI.


Assuntos
Complicações do Diabetes/complicações , Retinopatia Diabética/diagnóstico , Retinopatia Diabética/epidemiologia , Infarto do Miocárdio/diagnóstico , Infarto do Miocárdio/epidemiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Angioplastia Coronária com Balão , Feminino , Seguimentos , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Infarto do Miocárdio/terapia , Reperfusão Miocárdica , Valor Preditivo dos Testes , Prognóstico , Estudos Prospectivos , Fatores de Risco
16.
Acta Haematol ; 121(1): 21-6, 2009.
Artigo em Inglês | MEDLINE | ID: mdl-19295190

RESUMO

A 61-year-old Japanese man was referred to our hospital in 2002 due to severe pancytopenia. Bone marrow and peripheral blood findings indicated he had severe aplastic anemia (AA). A whole-body CT scan and Ga scintigraphy revealed no abnormal findings. Antithymocyte globulin and cyclosporine A (CyA) were administered and he got transfusion independently. In September 2004, he complained of abdominal fullness and a skin eruption in the lower abdomen. An abdominal CT revealed a spleen mass and lymphoadenopathy of the pancreas head. Splenectomy was done, and he was diagnosed with a diffuse large B cell lymphoma (DLBCL) of the spleen and skin. His karyotype was associated with t(14; 18). CyA was stopped, all lesions disappeared, and then his AA relapsed. In January 2007, antithymocyte globulin/CyA was readministered. In May 2007, he complained of acute swelling in his right thigh. A biopsy from the tumor revealed DLBCL. CyA was stopped again, yet the lymphoma did not regress. He was given R-CHOP (rituximab, cyclophosphamide, doxorubicin hydrochloride, vincristine, prednisolone), followed by 5 cycles of R-VP (rituximab, vincristine, prednisolone) and radiation therapy, resulting in a partial remission. We report DLBCL after immunosuppressive therapy for AA. Although this is a rare complication, it should be considered before beginning immunosuppressive therapy.


Assuntos
Anemia Aplástica/complicações , Terapia de Imunossupressão/efeitos adversos , Linfoma Difuso de Grandes Células B/etiologia , Neoplasias Cutâneas/etiologia , Neoplasias Esplênicas/etiologia , Anemia Aplástica/patologia , Anemia Aplástica/terapia , Anticorpos Monoclonais/administração & dosagem , Anticorpos Monoclonais Murinos , Soro Antilinfocitário/administração & dosagem , Soro Antilinfocitário/efeitos adversos , Protocolos de Quimioterapia Combinada Antineoplásica/administração & dosagem , Povo Asiático , Ciclofosfamida/administração & dosagem , Ciclosporina/administração & dosagem , Ciclosporina/efeitos adversos , Doxorrubicina/administração & dosagem , Humanos , Imunossupressores/administração & dosagem , Imunossupressores/efeitos adversos , Japão , Linfoma Difuso de Grandes Células B/patologia , Linfoma Difuso de Grandes Células B/terapia , Masculino , Pessoa de Meia-Idade , Prednisolona/administração & dosagem , Cintilografia , Radioterapia/métodos , Rituximab , Neoplasias Cutâneas/patologia , Neoplasias Cutâneas/terapia , Esplenectomia , Neoplasias Esplênicas/patologia , Neoplasias Esplênicas/terapia , Tomografia Computadorizada por Raios X , Vincristina/administração & dosagem
17.
Ann Nucl Med ; 22(4): 317-21, 2008 May.
Artigo em Inglês | MEDLINE | ID: mdl-18535883

RESUMO

OBJECTIVE: Prone thallium-201 ((201)Tl) myocardial perfusion single-photon emission computed tomography (SPECT) reduces false-positive rates when evaluating inferior wall abnormalities by minimizing diaphragmatic attenuation. The present study investigates the diagnostic validity of prone (201)Tl stress myocardial perfusion SPECT for detecting coronary artery disease in the inferior wall of the left ventricle in Japanese patients. METHODS: Of the 104 consecutive patients who underwent (201)Tl stress myocardial perfusion SPECT to diagnose coronary artery disease, we evaluated 46 who underwent image acquisition in both the supine and prone positions, and coronary angiography within 3 months thereafter. Images were acquired in the routine supine position immediately following (201)Tl (111 MBq) injection and 4 h following early acquisition. Images were acquired in the prone position only during the early phase following supine acquisition. We evaluated the SPECT images of the inferior half segments of the left ventricle using a five-point defect scoring system. According to the coronary angiographic findings, we investigated the diagnostic accuracy of stress-rest supine, stress supine, stress prone, and combined supine-prone images. Reduced uptake in the stress supine image of the combined images was considered as attenuation when uptake was normal in the prone image. RESULTS: The sensitivity of the stress-rest supine, stress supine, stress prone, and stress-combined supine-prone images was 77%, 86%, 55%, and 55%, and the specificity was 71%, 54%, 79%, and 83%, respectively. Diagnostic accuracy was the highest in stress-rest supine images. CONCLUSIONS: Prone images tended to improve the specificity of detecting coronary artery disease in the inferior wall, but not diagnostic accuracy compared with stress-rest supine images because of decreased sensitivity.


Assuntos
Doença da Artéria Coronariana/diagnóstico por imagem , Ventrículos do Coração/diagnóstico por imagem , Ventrículos do Coração/fisiopatologia , Decúbito Ventral , Decúbito Dorsal , Idoso , Idoso de 80 Anos ou mais , Protocolos Clínicos , Circulação Coronária , Teste de Esforço , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Compostos Radiofarmacêuticos/farmacocinética , Descanso , Sensibilidade e Especificidade , Radioisótopos de Tálio/farmacocinética , Tomografia Computadorizada de Emissão de Fóton Único , Disfunção Ventricular Esquerda/diagnóstico por imagem , Disfunção Ventricular Esquerda/fisiopatologia
18.
J Cardiol ; 49(6): 345-52, 2007 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-17633572

RESUMO

A 68-year-old man with familial hypercholesterolemia developed effort angina and received a sirolimus-eluting stent (SES) to treat 99% stenosis in segment 6 of the left anterior descending coronary artery in January 2005. A further stent was implanted 14 months later to treat 99% restenosis at the proximal stent edge. A 66-year-old man with diabetes developed acute anterior myocardial infarction and underwent SES implantation to treat 90% stenosis in segment 4 atrioventricular node artery branch of the right coronary artery in April 2006. Heart failure developed 14 months later. Another stent was implanted to treat 100% obstructive stenosis of the proximal stent site. Late stent restenosis may occur over 1 year after SES implantation, so longer follow-up is required compared to bare metal stent.


Assuntos
Reestenose Coronária/etiologia , Sirolimo/administração & dosagem , Stents/efeitos adversos , Idoso , Angina Pectoris/terapia , Doença da Artéria Coronariana/terapia , Humanos , Hiperlipoproteinemia Tipo II/complicações , Masculino , Infarto do Miocárdio/terapia
19.
Am Heart J ; 153(5): 762.e1-7, 2007 May.
Artigo em Inglês | MEDLINE | ID: mdl-17452150

RESUMO

BACKGROUND: This study investigates whether pioglitazone reduces neointimal hyperplasia after coronary stenting in nondiabetic patients with metabolic syndrome (MS) using intravascular ultrasound (IVUS). Pioglitazone, a novel insulin-sensitizing thiazolidinedione, has been shown to reduce neointimal hyperplasia after coronary stenting in patients with type 2 diabetes. However, the effect of pioglitazone on in-stent restenosis in nondiabetic patients with MS remains unknown. METHODS AND RESULTS: Twenty-eight nondiabetic patients with MS after bare-metal stent implantation were randomized to 6-month treatment with or without 30 mg/d of pioglitazone (pioglitazone group [PIO] of 14 patients with 16 lesions and control group [CONT] of 14 patients with 16 lesions). At baseline and at 6-month follow-up, assessment of insulin resistance and visceral fat accumulation, quantitative coronary angiographic analysis, and IVUS measurements were performed. Pioglitazone treatment improved insulin resistance and decreased visceral fat accumulation without significant changes in plasma glucose levels, glycosylated hemoglobin A1c levels, and lipid profiles. Intimal index (intimal area/stent area) and intimal area were reduced in PIO compared with CONT (13% +/- 7% vs 21% +/- 13%, P = .033; 1.28 +/- 0.76 mm2 vs 1.90 +/- 1.16 mm2, P = .084; respectively). Binary restenosis rate was 0% in PIO versus 31% in CONT (P = .043). CONCLUSIONS: This is the first randomized, prospective IVUS study demonstrating that pioglitazone reduces neointimal hyperplasia after coronary stenting in nondiabetic patients with MS. Our data suggest that pioglitazone treatment may represent a novel therapeutic tool to target in-stent restenosis in nondiabetic patients with MS.


Assuntos
Vasos Coronários/patologia , Hipoglicemiantes/uso terapêutico , Síndrome Metabólica/terapia , Stents , Tiazolidinedionas/uso terapêutico , Túnica Íntima/patologia , Reestenose Coronária/etiologia , Reestenose Coronária/prevenção & controle , Vasos Coronários/diagnóstico por imagem , Feminino , Seguimentos , Humanos , Hiperplasia/diagnóstico por imagem , Hiperplasia/tratamento farmacológico , Hiperplasia/etiologia , Masculino , Síndrome Metabólica/complicações , Pessoa de Meia-Idade , Pioglitazona , Resultado do Tratamento , Túnica Íntima/diagnóstico por imagem , Ultrassonografia de Intervenção
20.
Angiology ; 57(2): 155-60, 2006.
Artigo em Inglês | MEDLINE | ID: mdl-16518522

RESUMO

Noninvasive characterization of coronary plaques is challenging for cardiologists. The authors' goal was to explore the clinical feasibility of newly developed 16-slice computed tomography (CT) in tissue characterization of coronary arterial plaques in patients with acute coronary syndrome. Sixteen patients with acute coronary syndrome underwent 16-slice CT (Aquillion, Toshiba) and coronary arteriography with intravascular ultrasound (IVUS) within 7 days. Twenty-three plaques were classified by IVUS according to plaque echogenicity: 6 soft plaques, 11 intermediate plaques, and 6 calcified plaques. Mean (+/- SD) CT numbers (Hounsfield units [HU]) of these 3 types of plaques were 50.6 +/-14.8 HU, 131 +/-21.0 HU, and 721 +/-231 HU, respectively. Sixteen-slice CT facilitates noninvasive tissue characterization of coronary arterial plaques.


Assuntos
Angina Instável/diagnóstico por imagem , Infarto do Miocárdio/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Angiografia Coronária , Vasos Coronários/diagnóstico por imagem , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Índice de Gravidade de Doença , Ultrassonografia de Intervenção
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