RESUMO
A 40-year-old man presented with left-arm weakness, facial palsy, and dysarthria. Magnetic resonance imaging(MRI)revealed acute-stage cerebral infarction in the internal watershed area of the right hemicerebrum and MR angiography(MRA)demonstrated 56% stenosis of the right common and internal carotid arteries. Computed tomography(CT)scan showed no calcification and a stenotic lesion of the right common carotid artery, adjacent to the prolonged greater horn of the right hyoid bone. Because no other causes were found for the cerebral infarction, the compression of the stenosis of the right carotid artery was suspected as the cause of the cerebral infarction. Carotid arterectomy was performed five months after onset. Intraoperative finding showed tight adhesion between the carotid sheath and the adventitia of the carotid artery. Pathological findings showed a proliferation of fibroblast cells in the resected plaque. Common or internal carotid artery stenosis related to compression from the hyoid bone is rare. These cases hold a potential for tight adhesion around tissues. Therefore, in cases of prolonged hyoid bone, increased attention should be given to the operative procedure.
Assuntos
Estenose das Carótidas , Infarto Cerebral , Osso Hioide , Adulto , Artéria Carótida Primitiva , Artéria Carótida Interna , Estenose das Carótidas/diagnóstico , Estenose das Carótidas/etiologia , Humanos , Osso Hioide/patologia , MasculinoRESUMO
Oxidative stress accelerates the development of cardiovascular disease. Plasma cystine, a thiol oxidative stress marker, is related to several established factors for cardiovascular disease risk and prognosis. Although a comprehensive oxidative stress index is clinically required for hemodialysis patients with high oxidative stress, there are few reports concerning thiol oxidative stress markers predicting their prognosis. We investigated the relationship between plasma amino acids including cystine levels and cardiovascular disease-related and all-cause mortality in 132 maintenance hemodialysis patients. Higher cystine levels were associated with old age, longer hemodialysis duration, hemodialysis-associated hypotension, higher cardiothoracic ratio, higher blood urea nitrogen, and lower ankle-brachial index. Multivariate Cox regression analysis revealed that high plasma cystine was independently related with both cardiovascular disease mortality and all-cause mortality. Thus, high plasma cystine levels predict the prognosis of hemodialysis patients. High cystine levels necessitate a careful investigation for the cause of oxidative stress and comorbidities like vascular injury.
Assuntos
Doenças Cardiovasculares/mortalidade , Cistina/sangue , Estresse Oxidativo , Diálise Renal/métodos , Fatores Etários , Idoso , Índice Tornozelo-Braço , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Análise de Regressão , Estudos Retrospectivos , Fatores de Risco , Fatores de TempoRESUMO
BACKGROUND: COPD is characterized by a persistent airflow limitation that is not fully reversible; thus, the reversibility of airflow limitations in response to a bronchodilator is an important component of COPD. Several studies have established that two common nonsynonymous polymorphisms in the beta2-adrenergic receptor gene (ADRB2), Arg16Gly and Gln27Glu, have important effects in modulating responses to beta2-agonists; however, the effects of these polymorphisms on responses to beta2-agonists in patients with COPD is unknown. OBJECTIVE: To examine whether different genotypes at these two polymorphisms are related to differential responses to inhaled beta2-agonists in patients with COPD. DESIGN AND PARTICIPANTS: A total of 246 patients with COPD who were participants in a longitudinal study of COPD (ie, the Hokkaido COPD cohort study) were studied. We compared short-term bronchodilator responses (BDRs) to salbutamol according to ADRB2 genotypes at codons 16 and 27. RESULTS: The presence of the Arg16 allele was associated with lower BDRs to beta2-agonist inhalation. The mean (+/-SD) log (postbronchodilator FEV1-prebronchodilator FEV1) values of Gly16 homozygotes (n=65), Arg16Gly16 heterozygotes (n=106), and Arg16 homozygotes (n=75) were 2.19+/-0.43, 2.09+/-0.42, and 2.01+/-0.42, respectively (p<0.05). The genetic effects of the Arg16Gly polymorphism were independent of the severity of airflow limitation, age, and smoking status. The most common Arg16-Gln27 haplotype was also significantly associated with decreased BDRs to salbutamol (p<0.01). CONCLUSION: The genetic effects of ADRB2 gene polymorphisms may explain some of the variability in response to therapeutic doses of a short-acting beta2-agonists in patients with COPD.
Assuntos
Agonistas Adrenérgicos beta/uso terapêutico , Albuterol/uso terapêutico , Broncodilatadores/uso terapêutico , Polimorfismo Genético , Doença Pulmonar Obstrutiva Crônica/tratamento farmacológico , Doença Pulmonar Obstrutiva Crônica/genética , Receptores Adrenérgicos beta 2/genética , Idoso , Alelos , Códon , Feminino , Genótipo , Haplótipos , Humanos , Japão , Estudos Longitudinais , Masculino , Doença Pulmonar Obstrutiva Crônica/fisiopatologia , Testes de Função RespiratóriaRESUMO
We report a case of theophylline-induced hypercalcemia. The patient, a 51 year old women, had been administered theophylline for about five years because of bronchial asthma. She was referred to us in March 2003 for the treatment of renal failure and hypercalcemia(15.2 mg/dL), which had been increasing since 2001. Clinical and laboratory findings were not consistent with any endocrinopathy. We suspected drug induced hypercalcemia. Three months after discontinuation of theophylline therapy, the hypercalcemia was completely cured. When admitted to our hospital, the patient was diagnosed as also having Hashimoto's disease. Hyperthyroidism might enhance the effect of theophylline on parathyroid hormone action. Therefore, theophylline induced hypercalcemia even though she was taking the therapeutic level. Moreover, her calcium excretion did not increase despite hypercalcemia. We concluded that her hypercalcemia was induced by theophylline and hyperthyroidism, and that hypocalciuria might have enhanced these conditions.
Assuntos
Broncodilatadores/efeitos adversos , Hipercalcemia/induzido quimicamente , Teofilina/efeitos adversos , Asma/tratamento farmacológico , Feminino , Doença de Hashimoto/complicações , Humanos , Hipertireoidismo/complicações , Pessoa de Meia-IdadeRESUMO
The dnaJ and gyrB nucleotide sequences were determined for members of the genus Streptococcus. The average similarity between the species tested was 76.4% (69.7-100%) for dnaJ and 75.9 (70.1-98.7%) for gyrB. These data indicated that the dnaJ and gyrB genes are more divergent and more discriminatory than the 16S rDNA gene. Furthermore, the variation in the dnaJ nucleotide sequences among the mitis group was greater than that of the gyrB nucleotide sequences, especially between Streptococcus pneumoniae and Streptococcus mitis. Subsequently, the high discrimination power of dnaJ within the mitis group was confirmed. Thus, we conclude that the dnaJ and gyrB genes are efficient alternative targets for the classification of the genus Streptococcus, and that dnaJ is suitable for phylogenetic analysis of closely related Streptococcus strains.
Assuntos
DNA Girase/genética , Proteínas de Choque Térmico HSP40/genética , Proteínas de Choque Térmico HSP70/genética , Streptococcus/classificação , Streptococcus/genética , Proteínas de Bactérias/genética , Sequência de Bases , Filogenia , Superóxido Dismutase/genéticaRESUMO
Leukocytapheresis (LCAP) has recently been investigated for the treatment of drug-resistant rheumatoid arthritis (RA). In the present clinical study, we used LCAP in three patients with rheumatoid arthritis (RA), with drug-resistant leg ulcers. LCAP was carried out once a week for five weeks. Erythrocyte sedimentation rate, C-reactive protein, rheumatoid factor titers and tender joint counts did not change when LCAP was used but the ulcers began to recede after the first treatment and, by the end of the fifth treatment, the ulcers had healed. The activated leukocytes that are the major part of the inflammation of skin ulcers are removed from the peripheral blood by LCAP. Thus, it is supposed that the activated leukocytes shift from the inflammatory skin ulcer to peripheral blood, causing the skin ulcer to recover. We hypothesize that LCAP is a useful treatment for refractory leg ulcers complicated with RA.
Assuntos
Artrite Reumatoide/complicações , Úlcera da Perna/complicações , Leucaférese , Idoso , Sedimentação Sanguínea , Proteína C-Reativa/análise , Feminino , Humanos , Úlcera da Perna/terapia , Contagem de Leucócitos , Pessoa de Meia-Idade , Fator Reumatoide/sangue , TermografiaRESUMO
We report the treatment of a patient suffering from intractable epilepsy caused by a large cavernous angioma in the hippocampus of his dominant hemisphere. Surgical removal of a lesion and epileptic focus located in the surrounding brain tissue significantly improves seizure conditions. However, total removal of a large cavernous angioma in the medial temporal structure of dominant hemisphere is occasionally difficult because of the depth of the lesion and its contiguity with eloquent brain structures. Furthermore, when an intracranial electrocorticogram with grid electrodes is adopted, swelling of soft tissue caused by the initial operation for the installation of the grid electrodes narrows the operative view obtained by conventional frontotemporal craniotomy. We added a zygomatic osteotomy to the operative procedure for the present patient, and this enabled us to push soft tissue down and away from the operative field to provide a wider operative corridor through which total removal of the lesion and epileptic focus was accomplished. The patient has had a favorable postoperative course without suffering any seizure for 4 years.
Assuntos
Hemangioma Cavernoso/diagnóstico , Hemangioma Cavernoso/cirurgia , Espaço Subdural/patologia , Espaço Subdural/cirurgia , Zigoma/patologia , Zigoma/cirurgia , Adulto , Eletroencefalografia , Humanos , Imageamento por Ressonância Magnética , Masculino , OsteotomiaRESUMO
A 3-month-old boy and a 29-year-old woman presented with myelodysplastic syndrome (MDS) following therapy for primary malignant brain tumor. Both received intensive alkylating agent doses for induction and maintenance chemotherapy combined with craniospinal or cranial radiation for medulloblastoma and anaplastic astrocytoma, respectively. They developed refractory anemia and pancytopenia. Approximately 9 years after the completion of induction chemoradiotherapy, chromosomal analysis of bone marrow cells resulted in the diagnosis of MDS. The boy died of leukemic evolution 15 months later, the woman died of hematopoietic failure 3 months later. The most common symptom of MDS is refractory anemia, either alone or as part of bi- or pancytopenia. Clonal proliferation with chromosomal analysis of bone marrow cells establishes the diagnosis of MDS. Patients with malignant brain tumors are at risk of the development of MDS as a late complication of chemotherapy based on high cumulative doses of alkylating agents.
Assuntos
Antineoplásicos Alquilantes/efeitos adversos , Astrocitoma/tratamento farmacológico , Neoplasias Encefálicas/tratamento farmacológico , Meduloblastoma/tratamento farmacológico , Síndromes Mielodisplásicas/induzido quimicamente , Adulto , Astrocitoma/radioterapia , Neoplasias Encefálicas/radioterapia , Terapia Combinada , Evolução Fatal , Feminino , Humanos , Lactente , Masculino , Meduloblastoma/radioterapiaRESUMO
During hemodialysis, amino acid loss through the dialysate remained a significant problem and was not clear in some dialyzers; therefore, we investigated amino acid loss with hydrophilic and nonhydrophilic polyester-polymer alloy membranes and polyacrylonitrile membranes. Nine maintenance hemodialysis patients were studied to assess amino acid loss during hemodialysis with the three membranes. Total amino acid losses were 85.7 ± 27.2 mg/L, 83.3 ± 16.1 mg/L, and 72.1 ± 22.5 mg/L with the hydrophilic, nonhydrophilic polyester-polymer alloy, and polyacrylonitrile membranes, respectively. Amino acid losses were greater with the hydrophilic membrane compared with the polyacrylonitrile membrane for ornithine (2.0 ± 0.6 vs. 1.4 ± 0.4 mg/L, P = 0.025), phenylalanine (2.4 ± 0.9 vs. 1.8 ± 0.8 mg/L, P = 0.012), and tryptophan (0.6 ± 0.2 vs. 0.4 ± 0.2 mg/L, P = 0.023). Amino acid losses were greater with the nonhydrophilic membrane than with the polyacrylonitrile membrane for ornithine (2.0 ± 0.4 vs. 1.4 ± 0.4 mg/L, P = 0.017), phenylalanine (2.3 ± 0.5 vs. 1.8 ± 0.8 mg/L, P = 0.018), tryptophan (0.7 ± 0.2 vs. 0.4 ± 0.2 mg/L, P = 0.003), and cystine (3.2 ± 0.7 vs. 2.0 ± 0.7 mg/L, P = 0.005). In conclusion, greater losses of ornithine, phenylalanine, tryptophan, and cystine were observed with polyester-polymer alloy than with polyacrylonitrile membranes during hemodialysis. Constant attention should be paid to the amino acid loss profile to improve nutritional control in hemodialysis patients.
Assuntos
Aminoácidos/metabolismo , Membranas Artificiais , Polímeros/química , Diálise Renal , Resinas Acrílicas/química , Adulto , Idoso , Idoso de 80 Anos ou mais , Ligas , Soluções para Diálise/metabolismo , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Poliésteres/químicaAssuntos
Fezes/microbiologia , Lactobacillus/metabolismo , Síndrome do Intestino Curto/complicações , Deficiência de Vitamina B 12/epidemiologia , Vitamina B 12/metabolismo , Adolescente , Humanos , Lactobacillus/crescimento & desenvolvimento , Lactobacillus/isolamento & purificação , Síndromes de Malabsorção/complicações , Masculino , Necessidades Nutricionais , Estado Nutricional , Deficiência de Vitamina B 12/etiologiaRESUMO
Residual renal function preservation in patients with renal failure has been shown to be related to better outcomes not only in the pre-dialysis phase but also after hemodialysis initiation. However, the effect of factors such as antihypertensive agents on residual renal function preservation has not been investigated adequately in prevalent hemodialysis patients. This study examined factors related to the rate of residual renal function preservation in 1-year hemodialysis patients who had residual renal function. We enrolled 191 consecutive maintenance hemodialysis patients who underwent hemodialysis for 1 year and maintained a urine output of more than 200 mL/day, to assess residual renal function loss. The rate of residual renal function loss was 19.9%. Multivariate analysis using residual renal function as the dependent variable revealed significant independent relationships with renin-angiotensin system inhibitor use (hazard ratio, 0.438; P = 0.027), history of cardiovascular disease (hazard ratio, 2.475; P = 0.024), and rate of weight gain between dialysis sessions (hazard ratio, 1.348; P = 0.013). No relationship was observed with calcium channel blocker use. Renin-angiotensin system inhibitor use, rate of body weight gain between dialysis sessions, and cardiovascular diseases are independently associated with residual renal function preservation in patients with residual renal function after 1 year of hemodialysis. A further intervention study is required to investigate whether treatment with renin-angiotensin system inhibitors and suppression of body weight gain preserves residual renal function for a longer time in hemodialysis patients.
Assuntos
Anti-Hipertensivos/farmacologia , Falência Renal Crônica/terapia , Diálise Renal , Sistema Renina-Angiotensina/efeitos dos fármacos , Adulto , Idoso , Idoso de 80 Anos ou mais , Antagonistas de Receptores de Angiotensina/farmacologia , Inibidores da Enzima Conversora de Angiotensina/farmacologia , Bloqueadores dos Canais de Cálcio/farmacologia , Doenças Cardiovasculares/fisiopatologia , Feminino , Seguimentos , Humanos , Falência Renal Crônica/fisiopatologia , Testes de Função Renal , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Modelos de Riscos Proporcionais , Fatores de Tempo , Aumento de Peso , Adulto JovemRESUMO
BACKGROUND: Chronic kidney disease (CKD) is often associated with atrial fibrillation (AF). However, its impact on the results of radiofrequency catheter ablation for AF has not been fully examined. OBJECTIVE: The purpose of this study was to clarify the relationship between CKD and postcatheter ablation AF recurrence. METHODS: The study included 221 patients with AF who underwent successful catheter ablation. The prevalence and characteristics of AF recurrences were determined. CKD was defined as an estimated glomerular filtration rate <60 mL/min/1.73 m(2). RESULTS: After mean follow-up of 31.9 ± 7.6 months, 87 (39%) patients had AF recurrences. Multivariate Cox regression analysis revealed that CKD (hazard ratio [HR] 2.089, 95% confidence interval [CI] 1.292-3.378, P <.01) and left atrial volume (HR 1.009, 95% CI 1.002-1.017, P <.05) were independent predictors of AF recurrences. Among the 221 patients, 54 (24.4%) had CKD. Patients with CKD had a higher incidence of AF recurrences (57.4%) compared to the non-CKD patients (33.5%, P <.01). Compared with patients without CKD, patients with CKD were older (64 ± 11 years vs 58 ± 10 years, P <.001) and had a higher prevalence of hypertension (72% vs 53%, P <.05), larger left atrial volume (74.7 ± 29.4 mL vs 62.0 ± 26.0 mL, P <.01), and higher plasma B-type natriuretic peptide levels (129.6 ± 209.3 pg/mL vs 68.8 ± 91.0 pg/mL, P <.01). CONCLUSION: The presence of CKD increased the risk of AF recurrences after catheter ablation. Multifactorial physiologic factors due to CKD may account for the higher prevalence of recurrent AF in patients with CKD than in those without.
Assuntos
Fibrilação Atrial/epidemiologia , Fibrilação Atrial/cirurgia , Ablação por Cateter , Insuficiência Renal Crônica/epidemiologia , Idoso , Fibrilação Atrial/diagnóstico por imagem , Comorbidade , Feminino , Seguimentos , Taxa de Filtração Glomerular , Humanos , Masculino , Pessoa de Meia-Idade , Recidiva , Insuficiência Renal Crônica/fisiopatologia , Estudos Retrospectivos , UltrassonografiaRESUMO
The production of riboflavin from vegetable oil was increased using a mutant strain of Ashbya gossypii. This mutant was generated by treating the wild-type strain with N-methyl-N'-nitro-N-nitrosoguanidine (MNNG). Riboflavin production was 10-fold higher in the mutant compared to the wild-type strain. The specific intracellular catalase activity after 3 d of culture was 6-fold higher in the mutant than in the wild-type strain. For the mutant, riboflavin production in the presence of 40 mM hydrogen peroxide was 16% less than that in the absence of hydrogen peroxide, whereas it was 56% less for the wild-type strain. The isocitrate lyase (ICL) activity of the mutant was 0.26 mU/mg of protein during the active riboflavin production phase, which was 2.6-fold higher than the wild-type strain. These data indicate that the mutant utilizes the carbon flux from the TCA cycle to the glyoxylate cycle more efficiently than the wild-type strain, resulting in enhanced riboflavin production. This novel mutant has the potential to be of use for industrial-scale riboflavin production from waste-activated bleaching earth (ABE), thereby transforming a useless material into a valuable bioproduct.
Assuntos
Ascomicetos/metabolismo , Riboflavina/biossíntese , Ascomicetos/genética , Bacillus subtilis/metabolismo , Candida/metabolismo , Ciclo do Ácido Cítrico , Mononucleotídeo de Flavina/metabolismo , Flavina-Adenina Dinucleotídeo/metabolismo , Glioxilatos/metabolismo , Mutagênese , Mutação , Óleos de Plantas/metabolismo , Microbiologia do Solo , Esporos Fúngicos/genética , Esporos Fúngicos/metabolismoRESUMO
The genetic relationship between Streptococcus agalactiae and Streptococcus difficilis was studied. S. difficilis was originally described as serologically non-typable but was later reported to be a group B, type Ib streptococcus. Upon comparative analysis of five gene sequences, it was found that S. agalactiae and S. difficilis are closely related. Sequence similarity values between these two species were 100.0 % for 16S rRNA, 99.6 % for gyrB, 98.6 % for sodA, 99.5 % for gyrA and 99.8 % for parC genes. These data strongly suggest that S. agalactiae and S. difficilis are synonyms. The biochemical characteristics of S. difficilis, which differ slightly from those of typical S. agalactiae, are similar to those of other group B, type Ib streptococci isolated from fish and frogs. Whole genome DNA-DNA hybridization values between the type strains of both species were greater than 78.6 %. On the basis of these data, it is proposed that S. difficilis is a later synonym of S. agalactiae.
Assuntos
Streptococcus agalactiae/classificação , Streptococcus/classificação , Animais , Proteínas de Bactérias/genética , DNA Girase/genética , DNA Topoisomerase IV/genética , DNA Bacteriano/análise , Humanos , Dados de Sequência Molecular , Hibridização de Ácido Nucleico , Filogenia , RNA Ribossômico 16S/genética , Análise de Sequência de DNA , Streptococcus/genética , Streptococcus agalactiae/genética , Superóxido Dismutase/genéticaRESUMO
BACKGROUND: To develop an effective therapeutic strategy for patients with diencephalic pilocytic astrocytomas (PA), we must understand the long-term effects and problems of conventional treatments. METHODS: We performed a retrospective follow-up of four infants with PA in the diencephalon. CONCLUSION: The initial treatment consisted of partial tumor removal and/or external radiation. The mean progression-free duration after the initial treatment was 108.5 months. All patients received a second course of radiation to treat recurrent tumors. These conventional treatments produced relatively long survival. Three patients died 105, 202, and 379 months after the initial treatment. One patient is still alive at 249 months after the initial treatment. However, mental retardation was obvious in all four patients 6 to 12 years after the first irradiation and within 2 years of the second course of irradiation. Therefore, new therapeutic strategies must focus on delaying the timing of radiation until the patients are at least 5 years old and avoiding a second course of radiation to treat recurrence.