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1.
Clin Exp Dermatol ; 43(7): 806-809, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-29952011

RESUMO

Acquired dermal melanocytosis of the face and extremities (ADMFE) is an unusual form of acquired dermal melanocytosis (ADM). In this paper, we report a case of ADMFE and review the published literature. Our review highlights several clinical differences between ADMFE and ADM: (i) more frequent involvement of the nasal alae in ADMFE than in ADM, (ii) less frequent involvement of the cheeks in ADMFE than in ADM, (iii) limbs affected in all cases of ADMFE but in few cases of ADM, and (iv) frequent involvement of conjunctiva and/or gingiva in ADMFE but very rare involvement in ADM. These findings strongly support the hypothesis that ADMFE is clinically distinct from the classic form of ADM, and gaining an understanding of its phenotype will enable accurate diagnosis and early intervention by Q-switched laser therapy, which should benefit those patients with disease-related cosmetic issues.


Assuntos
Melanose/diagnóstico , Povo Asiático , Diagnóstico Diferencial , Face/patologia , Feminino , Humanos , Japão , Melanose/classificação , Fenótipo , Doenças Raras , Adulto Jovem
2.
Am J Transplant ; 17(1): 69-80, 2017 01.
Artigo em Inglês | MEDLINE | ID: mdl-27467205

RESUMO

Liver ischemia reperfusion injury (IRI) is an important problem in liver transplantation. Thrombomodulin (TM), an effective drug for disseminated intravascular coagulation, is also known to exhibit an anti-inflammatory effect through binding to the high-mobility group box 1 protein (HMGB-1) known as a proinflammatory mediator. We examined the effect of recombinant human TM (rTM) on a partial warm hepatic IRI model in wild-type (WT) and toll-like receptor 4 (TLR-4) KO mice focusing on the HMGB-1/TLR-4 axis. As in vitro experiments, peritoneal macrophages were stimulated with recombinant HMGB-1 protein. The rTM showed a protective effect on liver IRI. The rTM diminished the downstream signals of TLR-4 and also HMGB-1 expression in liver cells, as well as release of HMGB-1 from the liver. Interestingly, neither rTM treatment in vivo nor HMGB-1 treatment in vitro showed any effect on TLR-4 KO mice. Parallel in vitro studies have confirmed that rTM interfered with the interaction between HMGB-1 and TLR-4. Furthermore, the recombinant N-terminal lectin-like domain 1 (D1) subunit of TM (rTMD1) also ameliorated liver IRI to the same extent as whole rTM. Not only rTM but also rTMD1 might be a novel and useful medicine for liver transplantation. This is the first report clarifying that rTM ameliorates inflammation such as IRI in a TLR-4 pathway-dependent manner.


Assuntos
Inflamação/prevenção & controle , Fígado/irrigação sanguínea , Traumatismo por Reperfusão/complicações , Trombomodulina/uso terapêutico , Receptor 4 Toll-Like/metabolismo , Animais , Inflamação/etiologia , Inflamação/metabolismo , Masculino , Camundongos , Camundongos Endogâmicos C57BL , Transdução de Sinais
5.
Tech Coloproctol ; 18(7): 647-52, 2014 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-24500723

RESUMO

BACKGROUND: We evaluated the efficacy and safety of superselective embolization with assistance of colonoscopy for acute colonic hemorrhage. METHODS: Of 92 cases of acute colonic hemorrhage requiring colonoscopic intervention, 11 (12 %) could not be successfully treated. Of these, 10 patients (9 men, mean age 65.5 years, range 39-75 years) underwent superselective embolization. Hemorrhage was caused by diverticular disease (n = 8), polypectomy (n = 1), and vascular malformation (n = 1). In all 10 cases, the radiopaque clips were placed at the bleeding point via colonoscopy. Microcatheters were used in all procedures, and embolization was performed at the level of the vasa recta leading to or near the clips with Gelfoam particles, microcoils, or both. RESULTS: Immediate hemostasis was achieved in all patients. In 6 of 10 patients (60 %), selective angiograms showed no active extravasation at the time of the procedure and the embolization was performed using clips as a landmark. In the remaining four patients, selective angiograms showed active extravasation from the vasa recta leading to the clips. The mean number of embolized vessels with no active extravasation and with active extravasation was 1.83 (range 1-3) and 1.25 (range 1-2), respectively. The mean duration of clinical follow-up was 11.6 months (range 1-29 months). One patient (10 %) bled from a different site than the treated site a month after embolization, but the bleeding ceased after endoscopic intervention. All the patients (100 %) were evaluated for objective evidence of ischemia by colonoscopy. Four of the 10 patients (40 %) were found endoscopically to have small areas of ischemia involving only the mucosa, but they remained asymptomatic. There was no bowel infarction or stricture. CONCLUSIONS: Colonoscopy-assisted superselective embolization may be a safe and useful procedure for acute colonic hemorrhage without active extravasation on angiogram.


Assuntos
Doenças do Colo/terapia , Colonoscopia/métodos , Embolização Terapêutica/métodos , Hemorragia Gastrointestinal/terapia , Doença Aguda , Adulto , Angiografia/métodos , Estudos de Coortes , Colectomia/métodos , Doenças do Colo/diagnóstico por imagem , Doenças do Colo/mortalidade , Feminino , Seguimentos , Hemorragia Gastrointestinal/diagnóstico por imagem , Hemorragia Gastrointestinal/mortalidade , Humanos , Japão , Masculino , Pessoa de Meia-Idade , Segurança do Paciente , Recidiva , Estudos Retrospectivos , Medição de Risco , Índice de Gravidade de Doença , Taxa de Sobrevida , Resultado do Tratamento
10.
Kyobu Geka ; 63(5): 355-7, 2010 May.
Artigo em Japonês | MEDLINE | ID: mdl-20446601

RESUMO

We describe a case of Stanford type A acute aortic dissection. Replacement of the ascending aorta and aortic arch was performed using an "arch 1st technique". Following the completion of replacement, hypotension of the left superficial temporal artery pressure was detected. Ultrasonography revealed dissection of the left common carotid artery (LCCA) and compressive occlusion of the true lumen. Reconstruction of the LCCA was performed in the neck. The patient did well after the operation without any neurological abnormalities.


Assuntos
Doenças das Artérias Carótidas/diagnóstico por imagem , Doenças das Artérias Carótidas/cirurgia , Artéria Carótida Primitiva/cirurgia , Idoso , Dissecção Aórtica/cirurgia , Aorta/cirurgia , Aorta Torácica/cirurgia , Aneurisma Aórtico/cirurgia , Humanos , Masculino , Ultrassonografia
12.
Int J Oral Maxillofac Surg ; 48(5): 644-650, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30609954

RESUMO

Patients with orofacial pain and discomfort often suffer from psychiatric disorders. However, few studies involving a large sample have examined the diagnostic results of patients with orofacial pain or discomfort in relation to psychiatric disorders. The purpose of this study was to summarize and clarify the characteristics and demographic data of 1202 patients attending the psychiatric liaison clinic at Aichi Gakuin University Hospital. Psychiatric diagnosis was performed by psychiatrists for all patients, based on the Diagnostic and Statistical Manual of Mental Disorders, fifth edition. Among the 1202 patients, 992 (82.5%) were female. The average age of the patients was 57.2±15.0years. The predominant broad categories of orofacial pain and discomfort seen were burning mouth syndrome (n=484, 40.3%), persistent idiopathic facial pain (n=258, 21.5%), and oral dysesthesia (n=215, 17.9%). The predominant broad categories of psychiatric diagnoses seen were somatic symptoms and related disorders (n=934, 77.7%) and depressive disorders (n=76, 6.3%). Among the 934 patients with somatic symptoms and related disorders, 678 had a somatic symptom disorder with predominant pain. The results confirmed that most patients with orofacial pain and discomfort were middle-aged and elderly women suffering from a somatic symptom disorder with predominant pain.


Assuntos
Síndrome da Ardência Bucal , Transtorno Depressivo , Transtornos Mentais , Adulto , Idoso , Dor Facial , Feminino , Humanos , Pessoa de Meia-Idade
13.
Physiol Res ; 67(Suppl 1): S155-S166, 2018 06 27.
Artigo em Inglês | MEDLINE | ID: mdl-29947536

RESUMO

Arterial compliance (AC) is an index of the elasticity of large arteries. Endothelial dysfunction has been reported to result in reduced arterial compliance, which represents increased arterial stiffness. A reduction in AC is elicited by high-intensity resistance training, however the mechanisms are obscure. Because a single bout of resistance exercise causes a transient increase in circulating plasma endothelin-1 in humans, some vasoconstrictors may play a role in the mechanisms. The present study aimed to investigate whether resistance training-induced decrease in AC is associated with changes in circulating vasoconstrictors levels in young men. Young sedentary men were assigned to control (n=5) or training (n=9) groups. The training group performed four-week high-intensity resistance training (weight training exercise; three sessions/week). We measured AC and plasma levels of endothelin-1, angiotensin II, and norepinephrine before and after intervention. Resistance training significantly decreased AC, whereas the changes in plasma levels of neither endothelin-1, nor angiotensin II, nor norepinephrine were significantly different between the control and the training groups. Moreover, we found no significant correlations between changes in circulating plasma levels (endothelin-1, angiotensin II, and norepinephrine) and in the AC. Despite of no alteration of the resting circulating plasma levels (endothelin-1, etc.), we cannot exclude a possibility that the tissue/local concentrations of vasoconstrictors (endothelin-1, etc.) around the vessels might be increased and also involved in a reduction of AC in the training group. Taken together, the present results suggest that circulating vasoconstrictors (endothelin-1, etc.) in plasma are not involved in a reduction in AC by the resistance training.


Assuntos
Endotelina-1/sangue , Treinamento Resistido/tendências , Rigidez Vascular/fisiologia , Vasoconstrição/fisiologia , Adulto , Biomarcadores/sangue , Pressão Sanguínea/fisiologia , Humanos , Estudos Longitudinais , Masculino , Treinamento Resistido/métodos , Adulto Jovem
14.
Physiol Res ; 67(Suppl 1): S175-S184, 2018 06 27.
Artigo em Inglês | MEDLINE | ID: mdl-29947538

RESUMO

The glucagon-like peptide-1 receptor (GLP-1R) agonist liraglutide is an incretin hormone mimetic used in the treatment of diabetes. However, the effects of liraglutide on pulmonary hypertension (PH) and pulmonary endothelin (ET) system are unknown. Eight-week-old C57BL6/J mice were injected liraglutide or vehicle for 5 weeks. One week after injection, the mice were exposed to either room air (normoxia) or chronic hypoxia (10 % O(2)) for 4 weeks. The right ventricular systolic pressure (RVSP) was significantly higher in hypoxia + vehicle group than in normoxia + vehicle group. ET-1 mRNA expression in the lungs was comparable among all the groups. ET(B) mRNA and protein expression in the lungs was significantly lower in hypoxia + vehicle group than in normoxia + vehicle group. The above changes were normalized by liraglutide treatment. The expression of phospho-eNOS and phospho-AMPK proteins in the lungs was significantly higher in hypoxia + liraglutide group than in normoxia + vehicle group. We demonstrated for the first time that liraglutide effectively improved RVSP and RV hypertrophy in hypoxia-induced PH mice by activating eNOS through normalization of impaired ET(B) pathway and augmentation of AMPK pathway. Therefore, GLP-1R agonists can be promising therapeutic agents for PH.


Assuntos
Receptor do Peptídeo Semelhante ao Glucagon 1/agonistas , Hipertensão Pulmonar/tratamento farmacológico , Hipoglicemiantes/uso terapêutico , Hipóxia/tratamento farmacológico , Liraglutida/uso terapêutico , Receptor de Endotelina B/biossíntese , Animais , Expressão Gênica , Receptor do Peptídeo Semelhante ao Glucagon 1/metabolismo , Hipertensão Pulmonar/metabolismo , Hipoglicemiantes/farmacologia , Hipóxia/metabolismo , Liraglutida/farmacologia , Masculino , Camundongos , Camundongos Endogâmicos C57BL , Receptor de Endotelina B/genética
15.
Hepatogastroenterology ; 54(79): 1970-5, 2007.
Artigo em Inglês | MEDLINE | ID: mdl-18251141

RESUMO

BACKGROUND/AIMS: The aim of this study was to evaluate the outcome of patients undergoing colorectal resection for colon cancer using a minilaparotomy approach or conventional surgical procedure. METHODOLOGY: In a prospective randomized trial, twenty consecutive patients undergoing colon resection by minilaparotomy and 26 patients undergoing conventional open colorectal resection were evaluated. Immunologic, metabolic and hemodynamic studies were performed in all patients. Cell surface markers were used to characterize Th1/2 balance, using flow cytometry. Indirect calorimetry to measure energy expenditure, and pulse dye densitometry for a hemodynamic study were performed in patients until 14 POD. RESULTS: The lengths of laparotomy incisions were 7.5+/-1.5 cm and 20.5+/-2.5 cm in the minilaparotomy and conventional group, respectively. Mean operative time, morbidity and postoperative hospital stay of the two groups was not significantly different. However, mean operative blood loss, days to p.o. liquids and walking, and amount of analgesic usage were significantly less in the minilaparotomy group. The postoperative ratio of Th1/2 in CD4+T cells was decreased in both groups, but no significant difference was seen between the groups. Significant increase of resting energy expenditure and cardiac index was seen until day 3 in the conventional group, whereas those values increased until day 1 in the minilaparotomy group. CONCLUSIONS: Compared with conventional colorectal resection for colon cancer, colorectal resection by minilaparotomy results in a more rapid return of bowel function, less pain and host response. However, the alternations of the host response for surgical stress between the two groups are similar in the early postoperative stage (days 1-2).


Assuntos
Neoplasias do Colo/cirurgia , Idoso , Idoso de 80 Anos ou mais , Contagem de Linfócito CD4 , Calorimetria Indireta , Colectomia , Neoplasias do Colo/fisiopatologia , Metabolismo Energético , Feminino , Citometria de Fluxo , Hemodinâmica , Humanos , Interferon gama/análise , Interleucina-4/análise , Laparotomia/métodos , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Minimamente Invasivos , Estudos Prospectivos
16.
Kyobu Geka ; 60(1): 69-71, 2007 Jan.
Artigo em Japonês | MEDLINE | ID: mdl-17249542

RESUMO

Anaphylactic shock related to aprotinin has been reported to be induced exclusively in the presence of IgE antibody. And the possibility of anaphylactic shock induced by anti-aprotinin IgG antibody alone was controversial. In this paper, we describe the first case of anaphylactic shock induced by aprotinin-specific IgG antibody alone. A 55-year-old man underwent surgical repair of the descending aorta with the use of aprotinin at 2 months after first aprotinin usage. Immediately after initiation of cardiopulmonary bypass with the continuous infusion of aprotinin, clinical symptoms of anaphylactic reaction were found. Postoperative drug lymphocyte stimulation test for aprotinin and aprotinin-specific IgE antibody were negative, but aprotinin-specific IgG antibody was 163 mg/l and positive.


Assuntos
Anafilaxia/imunologia , Anticorpos/sangue , Aprotinina/imunologia , Imunoglobulina G/sangue , Humanos , Masculino , Pessoa de Meia-Idade
17.
Hernia ; 21(5): 705-713, 2017 10.
Artigo em Inglês | MEDLINE | ID: mdl-28812202

RESUMO

PURPOSE: The aim of this study was to investigate the efficacy of prone-position computed tomography (CT) for detecting and classifying inguinal hernia relative to supine-position CT before laparoscopic inguinal hernia repair. METHODS: Seventy-nine patients who underwent laparoscopic transabdominal preperitoneal repair of inguinal hernia were enrolled in this prospective study. Patients diagnosed with inguinal hernia by physical examination underwent abdominal CT in the supine and prone positions for preoperative assessment. The anatomy of the right and left inguinal regions was confirmed during the surgery and compared with the preoperative CT findings. RESULTS: The 79 cases included 87 operated lesions and 71 non-operated contralateral inguinal sites. Of the 84 clinical hernias, inguinal hernia was detected significantly more frequently on prone-position CT images (84, 100%) than on supine-position CT images (55, 65.5%). In addition, the inguinal hernia type was determined with significantly greater accuracy on prone-position CT images (96.4%) than on supine-position CT images (58.3%). Twenty-two occult hernias were detected by laparoscopy. The detection rate and accuracy for determining the type of occult hernia were significantly greater when using prone-position CT images [19 of 22 lesions (86.4%) and 77.3%, respectively] than when using supine-position CT images [8 of 22 lesions (36.4%) and 27.3%, respectively]. CONCLUSIONS: Prone-position CT is adequate for detecting and classifying inguinal hernia and for evaluating occult hernia.


Assuntos
Hérnia Inguinal/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Hérnia Inguinal/classificação , Hérnia Inguinal/cirurgia , Herniorrafia , Humanos , Laparoscopia , Masculino , Pessoa de Meia-Idade , Cuidados Pré-Operatórios , Decúbito Ventral , Estudos Prospectivos , Decúbito Dorsal , Adulto Jovem
18.
Hepatogastroenterology ; 53(68): 228-33, 2006.
Artigo em Inglês | MEDLINE | ID: mdl-16608030

RESUMO

BACKGROUND/AIMS: Systemic inflammatory response syndrome (SIRS) includes a number of pathologic states because of its loose definition. This study assessed differences in metabolic and circulatory host responses in various patients with SIRS perioperatively. METHODOLOGY: Fifty-four patients who underwent abdominal surgeries [gastric resection (n=20), colorectal resection (n=24), hepatic resection (n=8)] were divided into two groups: Group A; SIRS (+) on 1 postoperative day (POD), (n=29), B; SIRS (-) on 1 POD, (n=25). The other eight non-operated patients with SIRS caused by infection were enrolled in Group C, as common SIRS. Indirect calorimetry, body impedance measurement to assess water compartments and pulse dye-densitometry for hemodynamic examination were performed in subjects until 14 POD. RESULTS: The ratio of energy expenditure to basal energy expenditure (%REE) was significantly increased postoperatively, and there were significant differences on %REE from 3 POD to 14 POD between groups A and B. However, %REE in group C was 162+/-23%, which was significantly increased compared with that at 1 POD of groups A (130 +/- 17%) and B (125+/-18%). Cardiac output in group A showed a significant increase until 3 POD compared with that in group B but was significantly lower than that in group C. CONCLUSIONS: Subjects with common SIRS caused by infection were significantly more hypermetabolic than subjects with postoperative SIRS. Adequate energy intake and circulatory management should be cautiously determined according to the severity of SIRS.


Assuntos
Volume Sanguíneo/fisiologia , Débito Cardíaco/fisiologia , Procedimentos Cirúrgicos do Sistema Digestório/efeitos adversos , Metabolismo Energético/fisiologia , Síndrome de Resposta Inflamatória Sistêmica/metabolismo , Síndrome de Resposta Inflamatória Sistêmica/fisiopatologia , Idoso , Composição Corporal , Água Corporal , Estudos de Casos e Controles , Densitometria , Impedância Elétrica , Feminino , Humanos , Líquido Intracelular , Masculino , Pessoa de Meia-Idade , Síndrome de Resposta Inflamatória Sistêmica/etiologia
19.
Hepatogastroenterology ; 53(70): 497-500, 2006.
Artigo em Inglês | MEDLINE | ID: mdl-16995448

RESUMO

BACKGROUND/AIMS: Gasless laparoscopic surgery using the abdominal wall lifting (AWL) method was first developed in Japan and has been used in various surgical fields. The AWL method allows the use of conventional reusable surgical instruments. The purpose of this study was to compare the cost-effectiveness of laparoscopic cholecystectomy (LSC) using the AWL method in relation to that using pneumoperitoneum (P) method. METHODOLOGY: Retrospective analysis of 431 LSC procedures between 1991 and 2004 was performed. The two surgical groups consisted of consecutively operated patients with a diagnosis of cholecystolithiasis or gallbladder polyps. One group consisted of 224 LSC procedures performed using the P method from 1992 to 1998 and the other group comprised 207 LSC performed using the AWL method from 1998 to 2004. All instruments used in the P method were disposable, whereas trocars, scissors, dissectors, graspers and L-hook electrodes (excluding clips) used in the AWL method were reusable. Hospital expenses, length of hospital admission and complication rates were analyzed. RESULTS: Mean hospital cost per case for LSC using the AWL method (dollars 6743) was 7% less expensive than that using the P method (dolars 7215). Costs of operative equipment contributed to the difference (mean dollars 912 per case) in total cost. Conversion to open cholecystectomy occurred in 6 cases (2.9%) using the AWL method and 7 cases (3.1%) using the P method. There were no significant differences in length of hospital admission or complication rates between the two groups. CONCLUSIONS: LSC using AWL method was less expensive than that using P method. This is mainly due to the use of reusable instruments in the AWL method. If LSC is performed using the AWL method instead of using disposable equipment, considerable savings can be achieved without compromising patient safety.


Assuntos
Parede Abdominal/cirurgia , Colecistectomia Laparoscópica/economia , Colecistectomia Laparoscópica/métodos , Pneumoperitônio Artificial , Adulto , Idoso , Colecistectomia Laparoscópica/efeitos adversos , Colecistectomia Laparoscópica/instrumentação , Análise Custo-Benefício , Equipamentos Descartáveis , Reutilização de Equipamento , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pneumoperitônio Artificial/efeitos adversos , Pneumoperitônio Artificial/economia , Pneumoperitônio Artificial/instrumentação , Pneumoperitônio Artificial/métodos , Equipamentos Cirúrgicos
20.
Hepatogastroenterology ; 53(71): 730-5, 2006.
Artigo em Inglês | MEDLINE | ID: mdl-17086878

RESUMO

BACKGROUND/AIMS: The age-associated dysregulation of hemodynamic, metabolic and immune responses contributes to the high incidence of complications after major abdominal surgery. METHODOLOGY: Ninety-five patients who underwent gastric resection (n=51) and colorectal resection (n=44) were divided according to age into Groups A (n=45, less than 70 years old), B (n=30, 70-79 years) and C (n=20, over 80 years). Flow cytometric analysis of CD4+ lymphocytes for interferon (IFN)-gamma and interleukin (IL)-4 production determined the Th1/2 balance. Energy expenditure was measured by indirect calorimetry, and hemodynamics were studied using pulse dye densitometry. RESULTS: Surgical procedures, operating time, blood loss and morbidity did not significantly differ among the three groups. The cardiac index (CI) in group A and B increased significantly over preoperative levels until POD 3, but there were no significant perioperative changes in the CI levels of group C. Resting energy expenditure levels changed similarly to those of CI. The postoperative Th1/2 ratio decreased from young to elderly to very elderly patients, although no differences were significant before surgery. The postoperative percentage of CD4+IFN-gamma +T cells (Th1) in group C decreased significantly despite of no significant changes in that of group A and B. In contrast, the ratio of CD4+IL-4+T cells (Th2) in the all groups significantly increased after surgery. CONCLUSIONS: Host responses in elderly patients after major abdominal surgery were more hyperdynamic and hypermetabolic than those of young patients. Postoperative dysregulation of the Th1/2 balance was also associated with aging. However, host responses appear to significantly differ between elderly and very elderly patients.


Assuntos
Colectomia , Gastrectomia , Idoso , Idoso de 80 Anos ou mais , Perda Sanguínea Cirúrgica , Volume Sanguíneo , Calorimetria Indireta , Débito Cardíaco , Metabolismo Energético , Feminino , Citometria de Fluxo , Humanos , Interferon gama/metabolismo , Interleucina-4/metabolismo , Contagem de Linfócitos , Masculino , Pessoa de Meia-Idade , Período Pós-Operatório , Células Th1 , Células Th2
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