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1.
Asia Pac Fam Med ; 15: 4, 2016.
Artículo en Inglés | MEDLINE | ID: mdl-27499687

RESUMEN

BACKGROUND: Obesity is a major risk factor for obstructive sleep apnea (OSA), and weight loss is necessary in the overall management of obese patients with OSA. However, primary care physicians can provide only limited weight loss with lifestyle interventions, usually reducing a patient's body weight by only 2.5 kg or less after 6-18 months. CASE PRESENTATION: A 45-year-old Japanese man was referred to our clinic owing to obesity, daytime sleepiness, and snoring during sleep. His weight was 130.7 kg and his body mass index (BMI) was 41.0 kg/m(2). He underwent polysomnography, which revealed OSA with an apnea-hypopnea index of 71.2 events/h (normal, <5 events/h). His laboratory results were as follows: thyroid stimulating hormone, >500 µIU/mL; free triiodothyronine, 1.4 pg/mL; free thyroxine, <0.15 ng/dL; thyroid peroxidase antibody, 10 IU/mL; thyroglobulin antibody, >4000 IU/mL; total cholesterol (TC), 335 mg/dL; high-density lipoprotein cholesterol, 45 mg/dL; triglycerides (TGs), 211 mg/dL; low-density lipoprotein cholesterol, 248 mg/dL; fasting blood sugar, 86 mg/dL; and glycated hemoglobin (HbA1c), 6.1 %. These results showed that he also had primary hypothyroidism (Hashimoto's disease). Continuous positive airway pressure (CPAP), levothyroxine replacement, and a low-carbohydrate diet (LCD) were initiated. CPAP use and a euthyroid condition induced by 175 µg/day levothyroxine allowed the patient to proactively reduce his body weight. After 18 months, the patient achieved a weight reduction of 32.4 kg (25 % of his initial weight) and a BMI reduction of 10.2 kg/m(2), as well as improved laboratory results, including an HbA1c level of 5.3 %, TC level of 194 mg/dL, and TG level of 89 mg/dL. CONCLUSION: An LCD may be an effective intervention for weight loss in obese Japanese patients with OSA. Further studies are needed to investigate the weight loss effect of an LCD compared with a conventional calorie-restricted diet. Hopefully, this case report will help to improve the management of obese Asian patients with OSA who typically consume a higher amount of carbohydrates.

2.
Cancer Sci ; 95(4): 334-41, 2004 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-15072592

RESUMEN

The degree of malignancy of neuroendocrine lung tumors (NEs) increases in this order: from typical carcinoids (TCs) through atypical carcinoids (ACs) to large cell neuroendocrine carcinomas (LCNECs) and small cell lung carcinomas (SCLCs). However, histological classification has sometimes proved difficult. We here investigated loss of heterozygosity (LOH) using eight microsatellite markers and expression of p53, Bcl-2 and Bax proteins using immunohistochemical methods in 57 NEs (19 TCs, 5 ACs, 14 LCNECs and 19 SCLCs), looking for objective genetic markers to distinguish between subtypes. The frequencies of LOHs on D3S1300, RBi2 and TP53, the combinations of LOH status for RBi2 and TP53, and the immunohistochemically demonstrated Bcl-2/Bax ratios and p53-positive rates significantly differed among histopathologically diagnosed NEs. Differentiation between TC and AC was possible with reference to LOH on D3S1300, RBi2 and TP53, and the combined LOH status on RBi2 and TP53 (i.e., both LOH(-) versus one LOH(+)). For comparison between AC and LCNEC + SCLC, LOH on TP53 or the combination of two markers--one LOH(+) versus both LOH(+)--was applied. Furthermore, in three discordant cases of diagnoses based on histology and LOH markers, diagnoses using the latter were considered to be more probable by survival analysis. The present study indicated that assessment of LOHs using microsatellite markers could provide objective markers that can distinguish subtypes of NEs, for which histological assessment may commonly result in disagreement.


Asunto(s)
Biomarcadores de Tumor/análisis , Neoplasias Pulmonares/clasificación , Tumores Neuroendocrinos/clasificación , Adulto , Anciano , Anciano de 80 o más Años , Tumor Carcinoide/química , Tumor Carcinoide/clasificación , Tumor Carcinoide/genética , Tumor Carcinoide/patología , Carcinoma Neuroendocrino/química , Carcinoma Neuroendocrino/clasificación , Carcinoma Neuroendocrino/genética , Carcinoma Neuroendocrino/patología , Carcinoma de Células Pequeñas/química , Carcinoma de Células Pequeñas/clasificación , Carcinoma de Células Pequeñas/genética , Carcinoma de Células Pequeñas/patología , ADN de Neoplasias/genética , Femenino , Genes bcl-2 , Genes p53 , Humanos , Pérdida de Heterocigocidad , Neoplasias Pulmonares/química , Neoplasias Pulmonares/genética , Neoplasias Pulmonares/patología , Masculino , Repeticiones de Microsatélite , Persona de Mediana Edad , Proteínas de Neoplasias/análisis , Tumores Neuroendocrinos/química , Tumores Neuroendocrinos/genética , Tumores Neuroendocrinos/patología , Pronóstico , Proteínas Proto-Oncogénicas/análisis , Proteínas Proto-Oncogénicas c-bcl-2/análisis , Proteína p53 Supresora de Tumor/análisis , Proteína X Asociada a bcl-2
4.
Intern Med ; 42(10): 1031-4, 2003 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-14606721

RESUMEN

After chemotherapy and radiotherapy for non-Hodgkin's lymphoma during a one-year period, a 66-year-old man developed synchronous triple lung cancers in both lungs. Of the three resected tumors, one was advanced large cell carcinoma with neuroendocrine morphology, and the other two were early squamous cell carcinoma without lymph node metastasis. Although he received repeated chemotherapy for lung cancer, the patient died of hepatic failure due to multiple liver metastases. Autopsy revealed disseminated metastasis of the large cell carcinoma with neuroendocrine morphology throughout the entire body, but no recurrence of malignant lymphoma or squamous cell carcinoma was found. To our knowledge, this is the first report of triple lung cancers occurring after treatment for malignant lymphoma.


Asunto(s)
Protocolos de Quimioterapia Combinada Antineoplásica/efectos adversos , Carcinoma de Células Grandes/etiología , Carcinoma de Células Escamosas/etiología , Ciclofosfamida/efectos adversos , Doxorrubicina/efectos adversos , Neoplasias Pulmonares/etiología , Linfoma no Hodgkin/tratamiento farmacológico , Linfoma no Hodgkin/radioterapia , Neoplasias Primarias Múltiples/etiología , Neoplasias Primarias Secundarias/etiología , Prednisona/efectos adversos , Radioterapia/efectos adversos , Vincristina/efectos adversos , Anciano , Humanos , Masculino
5.
Nihon Kokyuki Gakkai Zasshi ; 41(3): 237-41, 2003 Mar.
Artículo en Japonés | MEDLINE | ID: mdl-12772608

RESUMEN

We report a case of dilated azygos vein simulating a tumor in the posterior mediastinum. The patient was a 47-year-old male who was found to have anomalies of unification of the superior vena cava and absence of the left brachiocephalic vein. He was admitted to our hospital because chest radiographs and computed tomography (CT) scans showed a well-circumscribed oval mass 2.5 cm in diameter, behind the bifurcation of the trachea. This lesion, which was markedly enhanced in chest CT, magnetic resonance imaging (MRI) and MR angiography (MRA) was diagnosed as a dilated azygos vein. An enlarged hemiazygos vein and collaterals were also recognized. Upon digital subtraction venography of both upper extremities, the right atrium and the left brachiocephalic vein could not been distinguished from the superior vena cava and the infraclavicular vein, respectively. Collaterals entering the azygos and hemiazygos veins were, however, recognized. It was considered that MRA and disital subtraction venography were very useful for confirmation of the diagnosis in this case.


Asunto(s)
Anomalías Múltiples/diagnóstico , Vena Ácigos/patología , Venas Braquiocefálicas/anomalías , Vena Cava Superior/anomalías , Angiografía de Substracción Digital , Vena Ácigos/diagnóstico por imagen , Venas Braquiocefálicas/diagnóstico por imagen , Dilatación Patológica/diagnóstico , Dilatación Patológica/patología , Humanos , Angiografía por Resonancia Magnética , Imagen por Resonancia Magnética , Masculino , Neoplasias del Mediastino , Persona de Mediana Edad , Flebografía , Tomografía Computarizada por Rayos X , Vena Cava Superior/diagnóstico por imagen
6.
Gan To Kagaku Ryoho ; 29(1): 29-35, 2002 Jan.
Artículo en Japonés | MEDLINE | ID: mdl-11816475

RESUMEN

Differences of critical pathway in cancer chemotherapy from its protocol are the unification of the treatment, setting of the treatment goal and its provision for the patient. By the uniform treatment at least in the same hospital and the variance analysis of side effects with chemotherapy, the scientific and objective evaluation of treatment outcome and toxicities is possible. It is also useful for the consideration in the aspect of the ethics with the exhibition of the treatment by the provision of critical pathway for the patient. Therefore, critical pathway in chemotherapy for lung cancer is the useful tool to establish the clinical practice guidelines based on both scientific and ethical evidences in addition to the improvement of the patient satisfaction and the promotion of the team medical treatment.


Asunto(s)
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Vías Clínicas , Neoplasias Pulmonares/tratamiento farmacológico , Registros Médicos , Esquema de Medicación , Control de Formularios y Registros , Humanos
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