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1.
Phys Rev Lett ; 124(18): 183001, 2020 May 08.
Artículo en Inglés | MEDLINE | ID: mdl-32441980

RESUMEN

Differences in postcollision interaction (PCI) effects on Kr L_{3}M_{4,5}M_{4,5} Auger electron spectra were observed, depending on whether the initial photoionization occurred slightly above the K threshold or slightly above the L_{3} threshold. For the former, KL fluorescence emission most likely happens and then Auger processes due to the L_{3} hole follow. The time delay due to fluorescence causes a reduced shift of the Auger peak and tailing toward lower energy, since the Auger overtaking of the photoelectron happens later in time and at a location farther away from the ionic core, compared to the case for the simple one-step L_{3}M_{4,5}M_{4,5} Auger decay after L-shell photoionization. Time-dependent theory for PCI in multistep processes agrees well with experiment, illustrating the effect as an internal clock for the time-sequence of the dynamical process.

2.
Allergy ; 71(7): 1031-6, 2016 07.
Artículo en Inglés | MEDLINE | ID: mdl-26991116

RESUMEN

BACKGROUND: Allergic rhinitis, a known risk factor for asthma onset, often accompanies mouth breathing. Mouth breathing may bypass the protective function of the nose and is anecdotally considered to increase asthma morbidity. However, there is no epidemiological evidence that mouth breathing is independently associated with asthma morbidity and sensitization to allergens. In this study, we aimed to clarify the association between mouth breathing and asthma morbidity and allergic/eosinophilic inflammation, while considering the effect of allergic rhinitis. METHODS: This community-based cohort study, the Nagahama Study, contained a self-reporting questionnaire on mouth breathing and medical history, blood tests, and pulmonary function testing. We enrolled 9804 general citizens of Nagahama City in the Shiga Prefecture, Japan. RESULTS: Mouth breathing was reported by 17% of the population and was independently associated with asthma morbidity. The odds ratio for asthma morbidity was 1.85 (95% CI, 1.27-2.62) and 2.20 (95% CI, 1.72-2.80) in subjects with mouth breathing alone and allergic rhinitis alone, which additively increased to 4.09 (95% CI, 3.01-5.52) when mouth breathing and allergic rhinitis coexisted. Mouth breathing in nonasthmatics was a risk for house dust mite sensitization, higher blood eosinophil counts, and lower pulmonary function after adjusting for allergic rhinitis. CONCLUSION: Mouth breathing may increase asthma morbidity, potentially through increased sensitization to inhaled allergens, which highlights the risk of mouth-bypass breathing in the 'one airway, one disease' concept. The risk of mouth breathing should be well recognized in subjects with allergic rhinitis and in the general population.


Asunto(s)
Asma/epidemiología , Asma/etiología , Respiración por la Boca , Adulto , Anciano , Asma/diagnóstico , Biomarcadores , Estudios de Cohortes , Femenino , Humanos , Japón/epidemiología , Masculino , Persona de Mediana Edad , Morbilidad , Oportunidad Relativa , Vigilancia de la Población , Pruebas de Función Respiratoria , Factores de Riesgo , Autoinforme
4.
Acta Anaesthesiol Scand ; 59(10): 1260-8, 2015 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-26079533

RESUMEN

BACKGROUND: In this randomized controlled trial, we examined whether intra- and postoperative infusion of low-dose ketamine decreased postoperative morphine requirement and morphine-related adverse effects as nausea and vomiting after scoliosis surgery. METHODS: After IRB approval and informed consent, 36 patients, aged 10-19 years, undergoing posterior correction surgery for adolescent idiopathic scoliosis, were randomly allocated into two groups: intra- and postoperative ketamine infusion at a rate of 2 µg/kg/min until 48 h after surgery (ketamine group, n = 17) or infusion of an equal volume of saline (placebo group, n = 19). All patients were administered total intravenous anesthesia with propofol and remifentanil during surgery and intravenous morphine using a patient-controlled analgesia device after surgery. The primary outcome was cumulative morphine consumption in the initial 48 h after surgery. Pain scores (Numerical Rating Scale, NRS, 0-10), sedation scales, incidence of postoperative nausea and vomiting (PONV), and antiemetic consumption were recorded by nurses blinded to the study protocol for 48 h after surgery. RESULTS: Patient characteristics did not differ between the two groups. Cumulative morphine consumption for 48 h after surgery was significantly lower in the ketamine group compared to the placebo group (0.89 ± 0.08 mg/kg vs. 1.16 ± 0.07 mg/kg, 95% confidence interval for difference between the means, 0.03-0.48 mg/kg, P = 0.019). NRS pain, sedation scales, and incidence of PONV did not differ between the two groups. Antiemetic consumption was significantly smaller in ketamine group. CONCLUSIONS: Intra- and postoperative infusion of low-dose ketamine reduced cumulative morphine consumption and antiemetic requirement for 48 h after surgery.


Asunto(s)
Ketamina/administración & dosificación , Escoliosis/cirugía , Adolescente , Niño , Femenino , Humanos , Masculino , Morfina/administración & dosificación , Dolor Postoperatorio/prevención & control , Náusea y Vómito Posoperatorios/prevención & control , Adulto Joven
5.
Ann Oncol ; 25(6): 1179-84, 2014 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-24669009

RESUMEN

BACKGROUND: Few nomograms can predict overall survival (OS) after curative resection of advanced gastric cancer (AGC), and these nomograms were developed using data from only a few large centers over a long time period. The aim of this study was to develop and externally validate an elaborative nomogram that predicts 5-year OS after curative resection for serosa-negative, locally AGC using a large amount of data from multiple centers in Japan over a short time period (2001-2003). PATIENTS AND METHODS: Of 39 859 patients who underwent surgery for gastric cancer between 2001 and 2003 at multiple centers in Japan, we retrospectively analyzed 5196 patients with serosa-negative AGC who underwent Resection A according to the 13th Japanese Classification of Gastric Carcinoma. The data of 3085 patients who underwent surgery from 2001 to 2002 were used as a training set for the construction of a nomogram and Web software. The data of 2111 patients who underwent surgery in 2003 were used as an external validation set. RESULTS: Age at operation, gender, tumor size and location, macroscopic type, histological type, depth of invasion, number of positive and examined lymph nodes, and lymphovascular invasion, but not the extent of lymphadenectomy, were associated with OS. Discrimination of the developed nomogram was superior to that of the TNM classification (concordance indices of 0.68 versus 0.61; P < 0.001). Moreover, calibration was accurate. CONCLUSIONS: We have developed and externally validated an elaborative nomogram that predicts the 5-year OS of postoperative serosa-negative AGC. This nomogram would be helpful in the assessment of individual risks and in the consideration of additional therapy in clinical practice, and we have created freely available Web software to more easily and quickly predict OS and to draw a survival curve for these purposes.


Asunto(s)
Adenocarcinoma/mortalidad , Nomogramas , Neoplasias Gástricas/mortalidad , Adenocarcinoma/patología , Adenocarcinoma/cirugía , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Gastrectomía , Humanos , Estimación de Kaplan-Meier , Masculino , Persona de Mediana Edad , Modelos de Riesgos Proporcionales , Neoplasias Gástricas/patología , Neoplasias Gástricas/cirugía , Adulto Joven
6.
Eur Rev Med Pharmacol Sci ; 16(2): 235-41, 2012 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-22428476

RESUMEN

BACKGROUND AND OBJECTIVES: We used a Japanese antihypertensive drug database to investigate the blood pressure-lowering effect of statins in hypertensive patients receiving antihypertensive medication. We also examined the class effect of antihypertensive drugs on blood pressure lowering by statins. MATERIAL AND METHODS: The Risk/Benefit Assessment of Drugs-Analysis and Response (RAD-AR) Council has developed an antihypertensive drug database which contains the results of post-marketing surveillance for various antihypertensive agents from 143,509 antihypertensive users in clinical settings. Antihypertensive patients in the database with concurrent hyperlipidemia were grouped into statin users and non-users, and changes in systolic and diastolic blood pressure over a three-month period were compared. Further, the class effects of antihypertensive drugs on the lipid lowering effects of statins were also investigated. RESULTS: A total of 1070 statin users and 1974 non-users were analyzed. Changes in systolic blood pressure were significantly greater in the statin user than in the non-user group (mean difference: 1.63 mmHg, p = 0.03). In contrast, no significant effect of statin use was observed on the change in diastolic blood pressure (DBP) (0.87 mmHg, p = 0.08). When stratified by antihypertensive class, reductions in blood pressure were greater in statin user groups for all antihypertensive classes without statistical significance, except for a significant change in DBP in those receiving beta-blockers (mean difference: 2.98 mmHg, p = 0.03). DISCUSSION: The present study documented that statin's effect on blood pressure in hypertensive patients with hyperlipidemia in clinical setting is statistically significant but has a minimal significance. With regard to class differences among antihypertensive agents, the decrease was greatest in the DBP of patients treated with beta-blockers. In contrast, no significant changes were seen in the ACE inhibitor or Ca antagonist subgroups. One possible explanation for the differential effects of antihypertensive class in our study might be the lack of a vasodilatation effect.


Asunto(s)
Antihipertensivos/uso terapéutico , Presión Sanguínea/efectos de los fármacos , Inhibidores de Hidroximetilglutaril-CoA Reductasas/uso terapéutico , Hipertensión/tratamiento farmacológico , Hipertensión/fisiopatología , Antagonistas Adrenérgicos beta/uso terapéutico , Anciano , Inhibidores de la Enzima Convertidora de Angiotensina/uso terapéutico , Bloqueadores de los Canales de Calcio/uso terapéutico , Bases de Datos Factuales , Interacciones Farmacológicas , Femenino , Humanos , Hiperlipidemias/sangre , Hiperlipidemias/tratamiento farmacológico , Japón , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Resultado del Tratamiento
7.
J Clin Pharm Ther ; 36(4): 518-24, 2011 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-21105879

RESUMEN

WHAT IS KNOWN AND OBJECTIVE: The most appropriate immunosuppressive strategy with calcineurin inhibitors for the prevention of acute graft-versus-host disease (aGVHD) after allogeneic hematopoietic stem cell transplantation (alloHSCT) has not yet been established. To estimate the safety and efficacy of a new strategy, we investigated the pharmacokinetics of cyclosporine A (CyA) delivered by twice-daily infusion and oral administration maintained with a peak level above 1000 ng/mL to keep 24 h area under the concentration-time curve (AUC0-24) higher than 10 000 ng·h/mL in 12 patients. METHODS: Cyclosporine A was started as a twice-daily infusion at 1·5 mg/kg and then orally administered at twice the infusion dose to maintain the trough blood concentration between 200 and 500 ng/mL, and with a peak level above 1000 ng/mL. Serial blood samples were collected at 0, 1, 2, 3, 5, 8 and 12 h after CyA dosing (C0, C1, C2, C3, C5, C8 and C12) on days 14-21 after transplantation and on days 7-14 after switching to oral administration, and the AUC was calculated. RESULTS: In all patients, the AUC0-24 for both twice-daily infusion and oral administration was higher than 10 000 ng·h/mL. Two close relationships were observed between AUC0-12 and the C3 for infusion and between AUC0-12 and the C8 for oral administration. None of the patients had grades 3-4 aGVHD or other serious complications. WHAT IS NEW AND CONCLUSION: This strategy was well tolerated, and the C3 for twice-daily infusion and the C8 for oral administration were the optimal points for monitoring of CyA concentration in the early phase of transplantation.


Asunto(s)
Ciclosporina/farmacocinética , Monitoreo de Drogas/métodos , Trasplante de Células Madre Hematopoyéticas/métodos , Inmunosupresores/farmacocinética , Administración Oral , Adulto , Área Bajo la Curva , Ciclosporina/administración & dosificación , Ciclosporina/efectos adversos , Femenino , Enfermedad Injerto contra Huésped/prevención & control , Humanos , Inmunosupresores/administración & dosificación , Inmunosupresores/efectos adversos , Infusiones Intravenosas , Masculino , Persona de Mediana Edad , Factores de Tiempo , Trasplante Homólogo
8.
J Med Genet ; 45(7): 465-72, 2008 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-18310263

RESUMEN

BACKGROUND AND PURPOSE: More than half of the retinitis pigmentosa (RP) cases are genetically simplex or multiplex. To date, 37 causative genes of RP have been identified; however, the elucidation of gene defects in simplex or multiplex RP patients/families remains problematic. The aim of our study was to identify the genetic causes of RP in patients with unknown or non-Mendelian inheritance. METHODS AND RESULTS: Since 2003, 52 simplex RP patients, 151 patients from 141 multiplex RP families, and six sporadic patients with retinal degeneration were studied. A total of 108 exons of 30 RP-causing genes that harboured the reported mutations were screened by an efficient denaturing high performance liquid chromatography (dHPLC) based assay. Aberrant fragments were subsequently analysed by automatic sequencing. Twenty-six mutations, including two frameshift mutations, one single amino acid deletion, and 23 missense mutations, were identified in 28 probands (14.07%). Eighteen mutations have not been reported to date. Three pairs of combined mutations in different genes were identified in two sporadic cases and one multiplex family, indicating the possibility of novel digenic patterns. Of the 23 missense mutations, 21 were predicted as deleterious mutations by computational methods using PolyPhen, SIFT, PANTHER, and PMut programs. CONCLUSION: We elucidated the mutation spectrum in Japanese RP patients and demonstrated the validity of the mutation detection system using dHPLC sequencing for genetic diagnosis in RP patients independent of familial incidence, which may provide a model strategy for identifying genetic causes in other diseases linked to a wide range of genes.


Asunto(s)
Mutación Missense , Retinitis Pigmentosa/genética , Algoritmos , ADN/química , ADN/genética , Humanos , Proteínas de Filamentos Intermediarios/genética , Glicoproteínas de Membrana/genética , Proteínas del Tejido Nervioso/genética , Periferinas , Reacción en Cadena de la Polimerasa , Análisis de Secuencia de ADN
9.
Dis Esophagus ; 22(4): E6-E10, 2009.
Artículo en Inglés | MEDLINE | ID: mdl-19473209

RESUMEN

Esophageal schwannoma is rare and it is difficult preoperatively to confirm a definitive diagnosis, even using current imaging techniques. We present a case of a benign esophageal schwannoma that was surgically excised and confirmed by immunohistochemical staining. Conventional radiological studies, including barium meal, computed tomography and endoscopic examination had shown a solid submucosal tumor of the upper thoracic esophagus but had been unable to confirm the diagnosis. Positron emission tomography was carried out to evaluate the malignant potential and showed a high uptake of 18F-fluorodeoxyglucose (FDG) into the tumor in both the early and delayed phase, suggesting that the tumor was a potentially malignant tumor such as a gastrointestinal stromal tumor. This is the first reported case of esophageal schwannoma that indicated a high FDG uptake. Although consensus has not been reached regarding the precise mechanism of FDG accumulation in schwannomas, we discuss our clinicopathological findings and review other studies of the subject.


Asunto(s)
Neoplasias Esofágicas/diagnóstico por imagen , Fluorodesoxiglucosa F18 , Neurilemoma/diagnóstico por imagen , Neurilemoma/cirugía , Tomografía de Emisión de Positrones/métodos , Anciano , Anastomosis Quirúrgica , Biopsia con Aguja , Neoplasias Esofágicas/patología , Neoplasias Esofágicas/cirugía , Esofagectomía , Femenino , Estudios de Seguimiento , Humanos , Inmunohistoquímica , Estadificación de Neoplasias , Neurilemoma/patología , Medición de Riesgo , Sensibilidad y Especificidad , Toracotomía , Tomografía Computarizada por Rayos X/métodos , Resultado del Tratamiento
10.
J Clin Invest ; 95(3): 1040-6, 1995 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-7533783

RESUMEN

CD36 deficiency is divided into two subgroups: neither platelets nor monocytes express CD36 (type I deficiency), and monocytes express CD36 in spite of the lack of platelet CD36 (type II deficiency). We have already demonstrated that a 478C-->T substitution (proline90-->serine) in platelet CD36 cDNA predominates in type II deficiency (Kashiwagi, H., S. Honda, Y. Tomiyama, H. Mizutani, H. Take, Y. Honda, S. Kosugi, Y. Kanayama, Y. Kurata, and Y. Matsuzawa. 1993. Thromb. Haemostasis. 69:481-484). In this study, we revealed that monocyte CD36 cDNA from two type II deficient subjects was heterozygous for C478 and T478 form, while platelet CD36 cDNA of these subjects consisted of only T478 form. In a type I deficient subject, both platelet and monocyte CD36 cDNA showed only T478 form. Expression assay using C478 or T478 form of CD36 cDNA transfected cells revealed that there was an 81-kD precursor form of CD36, and that the maturation of the 81-kD precursor form to the 88-kD mature form of CD36 was markedly impaired by the substitution. The mutated precursor form of CD36 was subsequently degraded in the cytoplasm. These results indicate that the 478C-->T substitution directly leads to CD36 deficiency via defects in posttranslational modification, and that this substitution is the major defects underlying CD36 deficiency.


Asunto(s)
Antígenos CD/genética , Plaquetas/inmunología , Glicoproteínas de Membrana/deficiencia , Glicoproteínas de Membrana/genética , Monocitos/inmunología , Secuencia de Aminoácidos , Antígenos CD/biosíntesis , Secuencia de Bases , Antígenos CD36 , ADN Complementario , Vectores Genéticos , Humanos , Datos de Secuencia Molecular , Familia de Multigenes/genética , Mutación Puntual , ARN Mensajero/análisis , Proteínas Recombinantes/biosíntesis , Homología de Secuencia de Aminoácido , Transfección
11.
Eur J Pain ; 21(7): 1144-1153, 2017 08.
Artículo en Inglés | MEDLINE | ID: mdl-28169489

RESUMEN

BACKGROUND: This prospective study was designed to examine the associations of demographic, clinical, psychological and neuroendocrine factors with acute and chronic post-operative pain following partial mastectomy. METHODS: Sixty-four female patients scheduled for partial mastectomy were enrolled. Pre-operative anxiety/depression was assessed, using the Hospital Anxiety and Depression Scale (HADS). Pre-operative 24-h urinary cortisol levels were measured 2 days before surgery. Post-operative pain was examined using a visual analog scale (VAS) for acute pain on 0-2 post-operative day (POD), and a short-form McGill Pain Questionnaire for chronic pain at 6 months after surgery. In the last 29 subjects, post-operative 24-h urinary cortisol levels were also measured on 0 POD and were subjected to correlation analysis. RESULTS: Multivariate logistic regression analysis revealed that lower pre-operative cortisol secretion and greater pre-operative anxiety were significantly associated with an increased risk of moderate to severe acute post-operative pain [Odds Ratio (95% Confidence Interval); 0.96 (0.92-0.98), and 1.24 (1.04-1.54)], and that patients with greater pre-operative anxiety and moderate to severe acute pain were more likely to develop chronic post-operative pain [OR (95% CI); 1.63 (1.23-2.40), and 5.07 (1.30-24.6)]. Correlational analysis demonstrated that the post-operative cortisol level was inversely correlated with pre-operative anxiety and the intensity of acute post-operative pain (r = -0.40, p < 0.05, and r = -0.50, p < 0.01), but not with the intensity of chronic pain. CONCLUSIONS: This study confirms that pre-operative anxiety is associated with both acute and chronic post-operative pain after partial mastectomy. It also suggests that lower perioperative cortisol secretion might be associated with greater acute post-operative pain. SIGNIFICANCE: Although the associations between psychological stress/stress hormone levels and chronic post-operative pain remain to be determined, pre-operative psychological stress and perioperative cortisol levels are correlated with acute post-operative pain.


Asunto(s)
Dolor Agudo/fisiopatología , Trastornos de Ansiedad/complicaciones , Ansiedad/psicología , Dolor Crónico/complicaciones , Depresión/psicología , Dolor Postoperatorio/etiología , Humanos , Mastectomía , Dimensión del Dolor , Estudios Prospectivos , Estrés Psicológico
12.
Nucleic Acids Res ; 28(4): 960-7, 2000 Feb 15.
Artículo en Inglés | MEDLINE | ID: mdl-10648789

RESUMEN

Ethylene-Insensitive3 (EIN3) is a transcription factor that works in the ethylene signaling pathway in Arabidopsis. We isolated a tobacco cDNA encoding an EIN3 homolog as a sequence-specific DNA-binding protein. The encoded protein TEIL (tobaccoEIN3-like) shares 60% identity in amino acid sequence with EIN3. The DNA-binding domain was localized in the N-terminal half, which shows 92% identity in amino acid sequence with the corresponding region of EIN3, suggesting a conserved function in DNA-binding specificity. TEIL was indeed functionally similar to EIN3 because, like EIN3-overexpressing plants, transgenic Arabidopsis seedlings overexpressing TEIL cDNA exhibited constitutive triple response phenotypes. Random binding site selection analysis revealed that the consensus binding sequence for TEIL is AYGWAYCT, where Y and W represent A or C and A or T, respectively. A reporter plasmid containing the TEIL binding sites showed a 7- to 10-fold higher activation relative to that containing a mutated TEIL-binding sequence in tobacco protoplasts. A further 2- to 3-fold increase in activation was observed when a plasmid for TEIL overproduction was co-transfected, indicating that TEIL is a transcriptional activator. Moreover, nuclear extracts from ethylene-treated leaves showed an increase in DNA-binding activity specific to the TEIL-binding sequence, despite the level of the transcripts being unchanged. These observations suggest that TEIL functions as a transcription activator with a relatively redundant DNA-binding specificity, and its function may be regulated at least in part by modulation of the DNA-binding activity through ethylene signaling.


Asunto(s)
Proteínas de Arabidopsis , ADN de Plantas/metabolismo , Nicotiana/genética , Proteínas Nucleares/genética , Plantas Tóxicas , Factores de Transcripción , Secuencia de Aminoácidos , Arabidopsis/genética , Secuencia de Bases , Sitios de Unión , Clonación Molecular , Proteínas de Unión al ADN , Genes Reporteros , Datos de Secuencia Molecular , Proteínas Nucleares/metabolismo , Fenotipo , Plantas Modificadas Genéticamente , Homología de Secuencia de Aminoácido
13.
Acta Anaesthesiol Belg ; 57(3): 253-7, 2006.
Artículo en Inglés | MEDLINE | ID: mdl-17067136

RESUMEN

Although it has side effects, succinylcholine is still widely used in rapid sequence induction. The aim of the present study is to evaluate the effects of pretreat ment with magnesium and precurarization of vecuroni um on succinylcholine-induced fasciculation and subse quent tracheal intubation-induced hemodynamic changes during rapid sequence induction. Fifty-five patients were allocated to three groups by a blinded randomization: Group M received saline 100 ml with magnesium 40 mg x kg(-1) for 5 min at 6.5 min before induction and sub sequently administered saline 1-2 ml at 1.5 min before induction; Group V received saline 100 ml for 5 min at 6.5 min before induction and subsequently administered vecuronium 0.02 mg x kg(-1) at 1.5 min before induction; Group C received saline 100 ml for 5 min at 6.5 min before induction and then saline 1-2 ml at 1.5 min before induction. Fasciculation scores and mean percent changes of heart rate, systolic blood pressure and rate pressure product between baseline and after induction were significantly lower in group M than those in group C and group V. Pretreatment with magnesium is more effective to limit succinylcholine-induced fasciculation and subsequent tracheal intubation-induced hemody namic changes in rapid sequence induction compared with vecuronium pretreatment, although magnesium does not prevent the elevation of serum potassium con centration after induction.


Asunto(s)
Anestesia General , Presión Sanguínea/efectos de los fármacos , Fasciculación/inducido químicamente , Fasciculación/prevención & control , Frecuencia Cardíaca/efectos de los fármacos , Intubación Intratraqueal/efectos adversos , Sulfato de Magnesio/uso terapéutico , Fármacos Neuromusculares Despolarizantes/efectos adversos , Fármacos Neuromusculares no Despolarizantes/efectos adversos , Succinilcolina/efectos adversos , Bromuro de Vecuronio/efectos adversos , Adulto , Anciano , Femenino , Humanos , Magnesio/sangre , Masculino , Persona de Mediana Edad , Potasio/sangre
14.
Transplant Proc ; 48(4): 1212-4, 2016 May.
Artículo en Inglés | MEDLINE | ID: mdl-27320589

RESUMEN

Endoscopic management of acute necrotic pancreatitis and walled off necrosis is less invasive than surgical treatment and has become the 1st choice for treating pancreatic necrosis and abscess. We treated a case of acute necrotic pancreatitis and walled off necrosis after auxiliary partial orthotopic living-donor liver transplantation (APOLT). A 24-year-old woman was admitted to our university hospital for removal of the internal biliary stent, which had already been placed endoscopically for the treatment of biliary stricture after APOLT. She had been treated for acute liver failure by APOLT 10 years before. After we removed the internal stent with the use of an endoscopic retrograde approach, she presented with severe abdominal pain and a high fever. Her diagnosis was severe acute pancreatitis after endoscopic retrograde cholangiography (ERC). Her symptoms worsened, and she had multiple organ failure. She was transferred to the intensive care unit (ICU). Immunosuppression was discontinued because infection treatment was necessary and the native liver had already recovered sufficiently. After she had been treated for 19 days in the ICU, she recovered from her multiple organ failure. However, abdominal computerized tomography demonstrated the formation of pancreatic walled off necrosis and an abscess on the 20th day after ERC. We performed endoscopic ultrasonography-guided abscess drainage and repeated endoscopic necrosectomy. The walled off necrosis diminished gradually in size, and the symptoms disappeared. The patient was discharged on the 87th day after ERC. This is the 1st report of a case of acute necrotic pancreatitis and walled off necrosis that was successfully treated by endoscopic management after APOLT.


Asunto(s)
Colangiografía , Remoción de Dispositivos , Endoscopía del Sistema Digestivo/métodos , Trasplante de Hígado , Pancreatitis Aguda Necrotizante/cirugía , Complicaciones Posoperatorias/cirugía , Stents , Procedimientos Quirúrgicos del Sistema Biliar , Manejo de la Enfermedad , Drenaje/métodos , Femenino , Humanos , Insuficiencia Multiorgánica , Pancreatitis Aguda Necrotizante/diagnóstico por imagen , Complicaciones Posoperatorias/diagnóstico por imagen , Tomografía Computarizada por Rayos X , Adulto Joven
15.
Transplant Proc ; 48(4): 1215-7, 2016 May.
Artículo en Inglés | MEDLINE | ID: mdl-27320590

RESUMEN

Surgical resection should be considered for isolated locally recurrent retroperitoneal liposarcomas. We experienced a case of successful re-resection for locally recurrent retroperitoneal liposarcomas 4 years after ex vivo tumor resection and autotransplantation of the liver. A 75-year-old man was admitted to our hospital. His diagnosis was local recurrence of liposarcomas. He had previously undergone ex vivo tumor resection and autologous orthotopic liver transplantation for a retroperitoneal tumor 4 years earlier. The resected tumor size was 23.5 × 15.5 × 12.5 cm. The tumor was revealed by means of histopathologic study to be a myxoid liposarcoma. Follow-up computerized tomography showed 2 recurrent tumors in the retropancreatic and para-aortic lesions. Although adhesion was severe within the operative field, we successfully performed complete en bloc re-resection of each recurrent tumor. The operative time was 250 minutes, and blood loss was 300 mL. The resected tumor sizes were 3.9 × 3.2 × 1.5 cm and 4.5 × 3.3 × 3.0 cm. The tumors were revealed by means of histopathologic study to be dedifferentiated liposarcomas. Postoperative complications included intestinal obstruction and colocutaneous fistula formation, both of which were treated surgically. The patient was discharged in an ambulatory state at 80 days after re-resection of the recurrent tumors. At the time of writing, he was alive with no evidence of recurrence, 14 months after re-resection and 62 months after primary ex vivo tumor resection. This is the first case of successful surgical re-resection for locally recurrent liposarcoma after ex vivo tumor resection and autotransplantation of the liver.


Asunto(s)
Liposarcoma Mixoide/cirugía , Liposarcoma/cirugía , Neoplasias Hepáticas/cirugía , Trasplante de Hígado/métodos , Recurrencia Local de Neoplasia/cirugía , Neoplasias Retroperitoneales/cirugía , Trasplante Autólogo/métodos , Anciano , Humanos , Liposarcoma/diagnóstico por imagen , Liposarcoma/patología , Liposarcoma Mixoide/diagnóstico por imagen , Liposarcoma Mixoide/patología , Masculino , Recurrencia Local de Neoplasia/diagnóstico por imagen , Recurrencia Local de Neoplasia/patología , Tempo Operativo , Neoplasias Retroperitoneales/diagnóstico por imagen , Neoplasias Retroperitoneales/patología , Tomografía Computarizada por Rayos X
16.
Transplant Proc ; 48(3): 988-90, 2016 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-27234786

RESUMEN

BACKGROUND: Long-term graft survival of partial pancreas auto-transplantation after total pancreatectomy has not been clarified. The clinical implications of repeat completion pancreatectomy for locally recurrent pancreatic carcinoma in the remnant pancreas after initial pancreatectomy also have not been clarified. METHODS: We have previously reported a 61-year-old woman presenting with re-sectable carcinoma of the remnant pancreas at 3 years after undergoing a pylorus-preserving pancreaticoduodenectomy for invasive ductal carcinoma of the pancreas head. We also performed distal pancreas auto-transplantation with the use of a part of the resected pancreas to preserve endocrine function. RESULTS: The patient was discharged at 20 days after surgery without any complications. She had been followed regularly in our outpatient clinic. She had been treated with S-1 as adjuvant chemotherapy; 72 months after the completion total pancreatectomy with distal partial pancreas auto-transplantation, the patient was alive without any evidence of the pancreatic carcinoma recurrence. The pancreas graft was still functioning with a blood glucose level of 112 mg/dL, HbA1C of 6.7%, and serum C-peptide of 1.2 ng/mL; and urinary C-peptide was 11.6 µg/d. CONCLUSIONS: Our patient demonstrated that repeated pancreatectomies can provide a chance for survival after a locally recurrent pancreatic carcinoma if the disease is limited to the remnant pancreas. An additional partial pancreas auto-transplantation was successfully performed to preserve endocrine function. However, the indications for pancreas auto-transplantation should be decided carefully in the context of pancreatic carcinoma recurrence.


Asunto(s)
Supervivencia de Injerto , Trasplante de Páncreas , Neoplasias Pancreáticas/cirugía , Femenino , Estudios de Seguimiento , Humanos , Persona de Mediana Edad , Trasplante Heterotópico , Neoplasias Pancreáticas
17.
Transplant Proc ; 48(4): 1119-22, 2016 May.
Artículo en Inglés | MEDLINE | ID: mdl-27320570

RESUMEN

BACKGROUND: Complete immune tolerance is the chief goal in organ transplantation. This study aimed to evaluate patients who successfully withdrew from immunosuppressive (IS) agents after living donor liver transplantation (LDLT). MATERIALS AND METHODS: A retrospective review of all adult LDLT from July 1999 to March 2012 was conducted. In patients who acquired immune tolerance after LDLT, their background and the course of surgical procedures were evaluated. RESULTS: Of a total of 101 adult LDLT patients, 8 patients were completely free of IS agents. Six of these patients (75%) were female, and the median age at the time of transplantation was 56 years (range, 31-66 years). The primary disease causing liver failure was type C liver cirrhosis (50%), fulminant hepatitis (25%), type B liver cirrhosis (12%), and alcoholic liver cirrhosis (12%). The median Child-Pugh score and MELD score were 13 points (range, 8-15 points) and 19 points (range, 10-18 points), respectively. The living related donor was the recipient's child (75%), sibling (12%), or parent (12%). ABO compatibility was identical in 62%, compatible in 25%, and incompatible in 12%. CONCLUSIONS: In this study, we evaluated the adult patients who successfully withdrew from IS agents after LDLT. In most cases, it took more than 5 years to reduce IS agents. Because monitoring of the serum transaminase level is not adequate to detect chronic liver fibrosis in immune tolerance cases, further study is required to find appropriate protocols for reducing IS agent use after LDLT.


Asunto(s)
Fallo Hepático/inmunología , Fallo Hepático/cirugía , Trasplante de Hígado , Tolerancia al Trasplante , Adulto , Anciano , Esquema de Medicación , Femenino , Humanos , Inmunosupresores/uso terapéutico , Donadores Vivos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Resultado del Tratamiento
18.
Oncogene ; 18(28): 4131-6, 1999 Jul 15.
Artículo en Inglés | MEDLINE | ID: mdl-10435594

RESUMEN

Our previous allelic loss analysis of gamma-ray induced thymic lymphomas in F1 hybrid and backcross mice between BALB/c and MSM strains mapped the Tlsr4 region exhibiting a high frequency of allelic loss (62%) to a 2.9 cM interval between the markers D12Mit53 and D12Mit279 on mouse chromosome 12. To narrow further the interval harboring a putative tumor suppressor gene, a high-density scan has been carried out for informative 361 thymic lymphomas. Construction of a physical map of Tlsr4 with 3 YAC and 15 BAC clones and isolation of YAC- and BAC-derived polymorphic probes lead to fine allelic loss mapping. Three successive polymorphic sites within one BAC exhibit the retention of both alleles in seven, one and four lymphomas, suggesting that a common region of allelic loss for Tlsr4 exists within the BAC region. Pulsed-field gel electrophoresis of NotI digests of this and other clones determines that the commonly lost region is a 35 kb interval with a NotI site. NotI sites are frequently associated with coding regions, and our preliminary sequencing has identified ESTs in the region. Thus, the present study facilitates the identification of genes in the Tlsr4 region that would lead to isolation of a novel tumor suppressor gene.


Asunto(s)
Alelos , Eliminación de Gen , Genes Supresores de Tumor , Linfoma de Células T/patología , Neoplasias Inducidas por Radiación/patología , Neoplasias del Timo/patología , Animales , Mapeo Cromosómico , Cromosomas Artificiales de Levadura , Clonación Molecular , Cruzamientos Genéticos , Desoxirribonucleasas de Localización Especificada Tipo II/metabolismo , Electroforesis en Gel de Campo Pulsado , Etiquetas de Secuencia Expresada , Rayos gamma/efectos adversos , Genes p53 , Marcadores Genéticos , Vectores Genéticos/genética , Pérdida de Heterocigocidad , Linfoma de Células T/genética , Ratones , Ratones Endogámicos BALB C , Ratones Endogámicos , Neoplasias Inducidas por Radiación/genética , Polimorfismo de Longitud del Fragmento de Restricción , Neoplasias del Timo/genética , Proteína p53 Supresora de Tumor/deficiencia
19.
Oncogene ; 18(48): 6677-83, 1999 Nov 18.
Artículo en Inglés | MEDLINE | ID: mdl-10597273

RESUMEN

Our previous genome-wide analysis of allelic loss for thymic lymphomas that were induced by gamma-irradiation in F1 hybrid mice between BALB/c and MSM strains suggested the centromeric region on chromosome 11 as a site harboring a tumor suppressor gene. Interestingly, to this region the mouse Ikaros gene was mapped which was postulated to participate in oncogenic process from the study of Ikaros knockout mice. Here we show fine allelic loss mapping in the vicinity of Ikaros in 191 lymphomas, indicating that the critical region of allelic loss was centered at the Ikaros locus. PCR analysis revealed that nine lymphomas failed to give PCR-amplification for either of two exon primer pairs, indicative of homozygous deletion. Six and five mutations were detected in the N-terminal zinc finger domain and the activation domain of Ikaros, respectively, and six of the eleven were frameshift or nonsense mutations that resulted in truncation of Ikaros protein. The results strongly suggest a direct role for Ikaros in development of mouse thymic lymphomas. This provides the experimental basis for further analysis of Ikaros mutations in human cancer.


Asunto(s)
Proteínas de Unión al ADN , Homocigoto , Linfoma/genética , Mutación Puntual , Eliminación de Secuencia , Neoplasias del Timo/genética , Factores de Transcripción/genética , Animales , Secuencia de Bases , ADN de Neoplasias , Rayos gamma , Humanos , Factor de Transcripción Ikaros , Linfoma/etiología , Ratones , Ratones Endogámicos , Neoplasias Inducidas por Radiación/genética , Reacción en Cadena de la Polimerasa , Especificidad de la Especie , Neoplasias del Timo/etiología , Dedos de Zinc
20.
Oncogene ; 16(21): 2747-54, 1998 May 28.
Artículo en Inglés | MEDLINE | ID: mdl-9652741

RESUMEN

A total of 429 gamma-ray-induced thymic lymphomas were obtained from F1 and backcross mice between BALB/c and MSM strains, about a half of which carried a p53-deficient allele. A genome-wide allelic loss analysis has revealed two loci exhibiting frequent allelic losses but no allelic preference, one is localized within a 2.9 cM region between D12Mit53 and D12Mit279 loci on chromosome 12, and the other is near the D16Mit122/D16Mit162 loci on chromosome 16. The frequency of allelic loss in the D12Mit279 region is 62% and does not differ in tumors between the presence and absence of the p53-deficient allele. In contrast, the loss frequency of D16Mit122 is raised by the existence of p53-deficient allele: 62% for p63(-/+) and 13% for p53(+/+), suggesting co-operative function of the two losses. The D12Mit279 and D16Mit122 regions probably harbor different types of tumor suppressor gene that play key roles in lymphoma development.


Asunto(s)
Mapeo Cromosómico , Genes Supresores de Tumor , Pérdida de Heterocigocidad , Linfoma/genética , Neoplasias del Timo/genética , Animales , Femenino , Rayos gamma , Genotipo , Masculino , Ratones , Ratones Endogámicos BALB C , Proteína p53 Supresora de Tumor/genética
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