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1.
Brain Behav ; : e01708, 2020 Jun 24.
Artigo em Inglês | MEDLINE | ID: mdl-32578955

RESUMO

OBJECTIVES: The aim of this study was to investigate alterations in structural and functional brain connectivity between patients with end-stage renal disease (ESRD) who were undergoing peritoneal dialysis (PD) and hemodialysis (HD). METHODS: We enrolled 40 patients with ESRD who were undergoing PD (20 patients) and HD (20 patients). We also enrolled healthy participants as a control group. All of the subjects underwent diffusion tensor imaging (DTI) and resting-state functional magnetic resonance imaging (rs-fMRI). Using data from the structural and functional connectivity matrix based on DTI and rs-fMRI, we calculated several network measures using graph theoretical analysis. RESULTS: The measures of global structural connectivity were significantly different between the patients with ESRD who were undergoing PD and healthy subjects. The global efficiency and local efficiency in the patients with PD were significantly decreased compared with those in healthy participants. However, all of the measures of global structural connectivity in the patients with HD were not different from those in healthy participants. Conversely, in the global functional connectivity, the characteristic path length was significantly increased and the small-worldness index was decreased in patients with HD. However, the measures of the global functional connectivity in the patients with PD were not different from those in healthy subjects. CONCLUSION: This study revealed that alterations in structural and functional connectivity in patients who were undergoing PD and HD were different than those in healthy controls. These findings suggest that brain networks may be affected by different types of renal replacement therapy.

2.
Clin Neurol Neurosurg ; 195: 105902, 2020 May 12.
Artigo em Inglês | MEDLINE | ID: mdl-32442806

RESUMO

OBJECTIVES: Cognitive impairment (CI) has been recognized as a complication of end-stage renal disease (ESRD) and its treatment. Neuron-specific enolase (NSE) and S100B protein are known neuro-biochemical markers of brain damage. The aim of this study was to investigate the potential role of serum NSE and S100B levels in predicting CI in patients with ESRD. PATIENTS AND METHODS: Thirty patients with ESRD were prospectively enrolled. All of them were receiving maintenance hemodialysis three times weekly for 180 days. We analyzed the potential value of serum NSE and S100B levels for distinguishing patients with CI from those without CI. The Mini-Mental State Examination was used for neuropsychological assessment. The differences between the groups were analyzed using demographic and laboratory profiles as independent variables. RESULTS: Of the 30 patients with ESRD, 13 had CI, whereas the other 17 did not. The demographic profiles, including age, and laboratory profiles, including S100B level, were significantly different between the patients with and without CI. The patients with CI were older than those without CI. Additionally, serum S100B levels in patients with CI were significantly higher than those in patients without CI. However, serum NSE levels did not differ between the groups. The best cut-off values for predicting CI were 17.7 mg/mL for NSE and 36.1 pg/mL for S100B, respectively, based on receiver operating characteristic analysis. Multiple logistic regression analyses showed that serum S100B level was a statistically significant independent predictor of CI. CONCLUSIONS: We found that approximately 40% of patients with ESRD had CI. Serum S100B levels but not serum NSE levels are significantly increased in patients with ESRD. These findings suggest that CI in patients with ESRD is associated with glial cell dysfunction in the brain.

3.
Am J Case Rep ; 21: e922567, 2020 May 03.
Artigo em Inglês | MEDLINE | ID: mdl-32361709

RESUMO

BACKGROUND Hemolytic uremic syndrome (HUS) can be categorized as primary (typical or atypical) or secondary (with a coexisting diseases). Typical HUS usually means shiga-toxin-medicated and thrombotic thrombocytopenic purpura. Secondary HUS is often initiated by coexisting diseases or conditions such as infections, transplantation, cancer, and autoimmune disease. Atypical HUS (aHUS) is usually induced by genetic mutations of one or several complement-regulating genes and associated with dysregulated complement activation. In the era of compliment-inhibiting therapy, early recognition of aHUS is important for patient prognosis. However, compliment-inhibiting therapy is not always beneficial in patients with secondary HUS. CASE REPORT We present a case of a 49-year-old woman with aHUS, which was caused by a novel genetic point mutation of complement factor H gene (p.Gly1110Ala) mimicking secondary HUS with scleroderma. Instead of administering eculizumab treatment for C5 polymorphism, the patient was successfully treated with mycophenolate mofetil. CONCLUSIONS HUS has complex and mixed etiologies and requires genetic testing. Attention should be paid to new point mutations in aHUS.

4.
J Clin Neurosci ; 72: 360-364, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31892496

RESUMO

Tuberous sclerosis complex (TSC) is an inherited genetic disorder caused by mutations in the TSC1 or TSC2 genes, encoding hamartin and tuberin. We aimed to evaluate structural volumes and connectivity of patients with TSC compared to those of healthy subjects. We consecutively enrolled 13 patients with a diagnosis of TSC and 15 age- and sex-matched healthy control subjects. Subjects underwent three-dimensional volumetric T1-weighted imaging, suitable for a quantitative analysis. Structural volumes were investigated using FreeSurfer image analysis software, and structural connectivity was calculated from a connectivity matrix, which was estimated from the correlation analysis of structural volumes using the Brain Analysis using Graph Theory software package. Differences in structural volumes and connectivity were analyzed between patients with TSC and healthy subjects. There were no differences of cortical volumes between the patients with TSC and healthy controls. However, we found decreased gray matter volumes in several subcortical regions in the patients with TSC compared to those in healthy controls, specifically in the putamen (0.3212 vs. 0.3841%, p = 0.001), even after multiple corrections. Regarding global structural connectivity, the small-worldness index was significantly decreased in patients with TSC compared to that in healthy controls (0.907 vs. 0.977, p = 0.049). This study revealed structural volumes and connectivity in patients with TSC that are significantly different from those in healthy controls. These alterations have implications for the pathogenesis of TSC.

5.
J Thorac Dis ; 11(4): 1485-1494, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31179091

RESUMO

Background: Impulse oscillometry (IOS) is a noninvasive and convenient technique to measure both airway resistance and reactance. This study aimed to evaluate whether IOS can be used to measure bronchodilator response (BDR) in elderly patients with asthma and chronic obstructive pulmonary disease (COPD) and also describe the difference between asthma and COPD. Methods: Seventy patients (30 and 40 with asthma and COPD, respectively) over 65 years of age were enrolled. IOS and spirometry measurements were obtained before and after bronchodilator administration. Correlation analysis was used to compare the percentage changes in spirometry and IOS parameters after bronchodilator administration between the asthma and COPD groups. Results: The changes in IOS parameters after bronchodilator administration were strongly correlated with changes in forced expiratory volume at 1 second (FEV1) and forced expiratory flow at 25-75% (FEF25-75). However, the percentage changes in IOS parameters failed to discriminate between the asthma and COPD groups. Receiver operating characteristic curve (ROC) analysis of resistance at 5 and 20 Hz (R5-20) at the best cutoff (-15.4% change) showed both high sensitivity and specificity for BDR. Conclusions: IOS serves as a reliable and useful technique for identifying BDR in elderly patients with chronic obstructive airway disease. There was a difference in IOS parameters between the asthma and COPD groups; however, it was difficult to distinguish between both diseases. Further larger studies are required to investigate the real implications of using IOS in the clinical practice.

6.
Chin J Integr Med ; 2019 May 08.
Artigo em Inglês | MEDLINE | ID: mdl-31069694

RESUMO

OBJECTIVE: To study the effect of Liuwei Dihuang Decoction () or Yukmijihwangtang (YJT) on endurance exercise by in vivo experiment. METHODS: ICR mice were randomly divided into the control group (distilled water) and the YJT groups (1, 10, 100 mg/kg), 5 animals per group. YJT and distilled water were orally administered. The anti-fatigue effect of YJT was evaluated by open fifiled test (OFT), forced swimming test (FST), and tail suspension test (TST). RESULTS: In the OFT, YJT signifificantly increased the total movement distance in a dose-dependent manner. Additionally, treatment with YJT signifificantly decreased immobility time in the FST and the TST. Various neurotransmitters such as norepinephrine (NE), serotonin (5-HT), dopamine (DA) levels were increased by FST. Administration of YJT down-regulated the expression levels of NE, 5-HT, 5-hydroxyindole-acetic acid (5-HIAA), and DA in the brain stem and hypothalamus of mice. Moreover, protein expression of HSP70 in mice liver and heart muscles was signifificantly increased in the YJT groups. CONCLUSIONS: YJT could ameliorate fatigue and enhance exercise tolerance through suppressing of brain monoamines including NE, 5-HT, 5-HIAA, and DA in FST mice model.

7.
SAGE Open Med Case Rep ; 7: 2050313X19832164, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30886718

RESUMO

Relapsing polychondritis is a rare and multi-system autoimmune disease of unknown etiology characterized by inflammation and destruction of cartilaginous structures. Its clinical manifestations include recurrent chondritis of the ears, nose, pinna, peripheral joints, and laryngotracheobronchial tree and can be life-threatening in advanced cases of laryngotracheal stenosis. Because of the rarity of relapsing polychondritis and lack of understanding of its pathogenesis, there is no standard medical therapy, and treatment is tailored according to disease activity and site of organ involvement. In respiratory failure due to laryngotracheal involvement, which has been reported in up to 50% of relapsing polychondritis patients and is a major cause of death, immediate procedures such as stenting and tracheostomy are very important. This report describes a 70-year-old male patient suffering from tracheobronchomalacia due to relapsing polychondritis who was treated with Montgomery T-tube insertion.

8.
Am J Case Rep ; 19: 1430-1433, 2018 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-30504755

RESUMO

BACKGROUND Idiopathic basal ganglia calcification, also known as Fahr's disease or Fahr's syndrome, is a rare neurological disorder characterized by abnormal calcified deposits in the basal ganglia. Here, we report a case of Fahr's syndrome with calcification of the basal ganglia due to hypoparathyroidism in a patient with seizures. CASE REPORT A 52-year-old male patient visited our clinic with seizures. Brain computed tomography (CT) showed bilateral symmetrical calcifications in cerebellar white matter, the corpus striatum, the posterior thalami, and the centrum semiovale of both cerebral hemispheres. He had symptoms of hypocalcemia and low parathyroid hormone levels. The patient was diagnosed with Fahr's syndrome due to primary hypoparathyroidism. He underwent calcium supplementation and calcifediol treatment. His symptoms improved, and he was discharged from the hospital. CONCLUSIONS In patients with hypocalcemia accompanied by parathyroid dysfunction, neurological examination and CT should be performed to confirm abnormal intracranial calcification.


Assuntos
Doenças dos Gânglios da Base/diagnóstico , Calcinose/diagnóstico , Hipoparatireoidismo/complicações , Convulsões/etiologia , Encéfalo/diagnóstico por imagem , Humanos , Hipoparatireoidismo/diagnóstico , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios X
9.
Am J Case Rep ; 19: 1272-1278, 2018 Oct 26.
Artigo em Inglês | MEDLINE | ID: mdl-30361471

RESUMO

BACKGROUND Rhabdomyolysis is a syndrome characterized by muscle necrosis and secretion of intracellular muscle components into the blood circulation. Acute compartment syndrome is a potential complication of severe rhabdomyolysis. CASE REPORT We report 3 cases of compartment syndrome-related peripheral neuropathy in alcoholic individuals with rhabdomyolysis. All patients were confirmed to have peripheral neuropathy by electrophysiologic studies. CONCLUSIONS Patients with underlying metabolic abnormalities, such as those related to long-term alcoholism, should be aware that rhabdomyolysis is likely to cause neurological abnormalities.


Assuntos
Síndromes Compartimentais/etiologia , Doenças do Sistema Nervoso Periférico/etiologia , Rabdomiólise/complicações , Adulto , Síndromes Compartimentais/diagnóstico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Doenças do Sistema Nervoso Periférico/diagnóstico
10.
Medicine (Baltimore) ; 97(41): e12786, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30313102

RESUMO

RATIONALE: Standard treatment of lipoid pneumonitis remains unclear. This study reports a case of kerosene pneumonitis successfully treated with systemic steroid and segmental bronchoalveolar lavage (BAL). PATIENT CONCERNS: A 30-year-old woman referred to our hospital because of worsening of respiratory symptoms and fever despite antibiotic therapy following accidental ingestion of kerosene. She had no underlying disease. DIAGNOSES: Chest CT scan showed necrotic consolidation, ground glass opacity (GGO), bronchial wall thickening in the right middle/lower lobe (RML/RLL) and right pleural effusion. The lipoid pneumonitis was confirmed by identification of a lipid laden macrophage in bronchoalveolar lavage fluid. INTERVENTIONS: The patient was treated with systemic corticosteroid and segmental BAL. OUTCOMES: The patient's symptoms rapidly improved after treatment and she was discharged one week after admission. A follow-up CT scan a week after discharge revealed marked resolution of consolidation. No recurrence was reported for 8 months. LESSONS: This is the first case of kerosene pneumonitis successfully treated with systemic steroid and bronchoscopic segmental lavage therapy in Korea. Very few cases have been reported worldwide.


Assuntos
Corticosteroides/uso terapêutico , Lavagem Broncoalveolar/métodos , Querosene/efeitos adversos , Pneumonia Aspirativa/induzido quimicamente , Pneumonia Aspirativa/terapia , Adulto , Feminino , Humanos , República da Coreia
11.
Infect Chemother ; 50(3): 268-273, 2018 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-30270587

RESUMO

Emphysematous osteomyelitis, characterized by intraosseous gas, is a rare but potentially fatal condition that requires prompt diagnosis and aggressive therapy. Causative organisms are members of the bacterial family Enterobacteriaceae or anaerobes in most cases and significant comorbidities such as diabetes mellitus and malignancy, may predispose an individual to the development of emphysematous osteomyelitis. We report a case of extensive emphysematous osteomyelitis via hematogenous spread from Klebsiella pneumoniae liver abscess, complicated by gas-containing abscesses in adjacent soft tissues and epidural space, and multiple systemic septic emboli in a diabetic patient.

12.
Brain Behav ; 8(6): e01006, 2018 06.
Artigo em Inglês | MEDLINE | ID: mdl-29791077

RESUMO

OBJECTIVE: We evaluated global topology and organization of regional hubs in the brain networks and microstructural abnormalities in the white matter of patients with reflex syncope. METHODS: Twenty patients with reflex syncope and thirty healthy subjects were recruited, and they underwent diffusion tensor imaging (DTI) scans. Graph theory was applied to obtain network measures based on extracted DTI data, using DSI Studio. We then investigated differences in the network measures between the patients with reflex syncope and the healthy subjects. We also analyzed microstructural abnormalities of white matter using tract-based spatial statistics analysis (TBSS). RESULTS: Measures of global topology were not different between patients with reflex syncope and healthy subjects. However, in reflex syncope patients, the strength measures of the right angular, left inferior frontal, left middle orbitofrontal, left superior medial frontal, and left middle temporal gyrus were lower than in healthy subjects. The betweenness centrality measures of the left middle orbitofrontal, left fusiform, and left lingual gyrus in patients were lower than those in healthy subjects. The PageRank centrality measures of the right angular, left middle orbitofrontal, and left superior medial frontal gyrus in patients were lower than those in healthy subjects. Regarding the analysis of the white matter microstructure, there were no differences in the fractional anisotropy and mean diffusivity values between the two groups. CONCLUSIONS: We have identified a reorganization of network hubs in the brain network of patients with reflex syncope. These alterations in brain network may play a role in the pathophysiologic mechanism underlying reflex syncope.


Assuntos
Encefalopatias/patologia , Síncope/patologia , Substância Branca/patologia , Adulto , Anisotropia , Estudos de Casos e Controles , Imagem de Difusão por Ressonância Magnética , Imagem de Tensor de Difusão/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Reflexo/fisiologia , Lobo Temporal/patologia
13.
Am J Case Rep ; 18: 498-501, 2017 May 05.
Artigo em Inglês | MEDLINE | ID: mdl-28473689

RESUMO

BACKGROUND Polyomavirus nephropathy has emerged as an important cause of graft loss in kidney transplant recipients. Polyomavirus rarely affects the native kidneys of an immunocompetent individual. Until now, polyomavirus nephropathy in native kidneys of an immunocompetent individual has not been reported, as far as we know. CASE REPORT A 34-year-old man was transferred from a local clinic to be evaluated for the cause of azotemia. Serum creatinine was 2.85 mg/dL. We performed renal biopsy to identify the cause of azotemia. The result of kidney biopsy was consisted to polyomavirus nephropathy. CONCLUSIONS We report the first case of polyomavirus nephropathy in native kidneys of an immunocompetent individual.


Assuntos
Imunocompetência , Infecções por Polyomavirus/complicações , Insuficiência Renal/virologia , Adulto , Azotemia/virologia , Humanos , Masculino , Polyomavirus
14.
J Thorac Dis ; 9(3): 555-567, 2017 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-28449463

RESUMO

BACKGROUND: Although there have been studies regarding the role of nebulized colistin as adjunctive therapy of ventilator-associated pneumonia (VAP) caused by carbapenem-resistant Acinetobacter baumannii (CRAB), a paucity of information on the efficacy of nebulized colistin as monotherapy is available. METHODS: We retrospectively reviewed 219 patients with VAP caused by CRAB treated with either intravenous (n=93) or nebulized colistin (n=126), from March 2010 to November 2015. Factors related to clinical failure was assessed using propensity-score-matched analysis. RESULTS: Of 219 patients, 39 patients from each group (n=78) were matched after covariate adjustment using propensity score. There were no significant differences in baseline characteristics as well as the rates of clinical failure between the propensity-score-matched groups [Odds ratio (OR), 0.48; 95% confidence interval (CI), 0.19-1.19; P=0.11], while a significantly lower rate of acute kidney injury (AKI) during colistin therapy (18% vs. 49%, P=0.004) was observed in nebulized colistin group. In addition, multivariable analysis revealed that nebulized colistin did not significantly alter the rate of clinical failure [adjusted odds ratio (aOR), 0.36; 95% CI, 0.12-1.09; P=0.070]. Instead, medical intensive care unit (ICU) admission (aOR, 7.14; 95% CI, 1.60-32.00; P=0.010), and septic shock (aOR, 3.93; 95% CI, 1.27-12.17; P=0.018) were independent risk factors for clinical failure. CONCLUSIONS: Our findings suggest that nebulized colistin-based therapy, even without concurrent administration of intravenous colistin, may be an effective and safe treatment option for VAP caused by CRAB.

15.
Yonsei Med J ; 58(1): 252-254, 2017 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-27873521

RESUMO

Although formaldehyde is well known to cause type 4 hypersensitivity, immunoglobulin E (IgE)-mediated hypersensitivity to formaldehyde is rare. Here, we report a case of recurrent generalized urticaria after endodontic treatment using a para-formaldehyde (PFA)-containing root canal sealant and present a review of previous studies describing cases of immediate hypersensitivity reactions to formaldehyde. A 50-year-old man visited our allergy clinic for recurrent generalized urticaria several hours after endodontic treatment. Prick tests to latex, lidocaine, and formaldehyde showed negative reactions. However, swelling and redness at the prick site continued for several days. The level of formaldehyde-specific IgE was high (class 4). Thus, the patient was deemed to have experienced an IgE-mediated hypersensitivity reaction caused by the PFA used in the root canal disinfectant. Accordingly, we suggest that physicians should pay attention to type I hypersensitivity reactions to root canal disinfectants, even if the symptoms occur several hours after exposure.


Assuntos
Desinfetantes/efeitos adversos , Formaldeído/efeitos adversos , Hipersensibilidade Imediata/induzido quimicamente , Imunoglobulina E/imunologia , Urticária/induzido quimicamente , Cimento de Óxido de Zinco e Eugenol/química , Humanos , Masculino , Pessoa de Meia-Idade , Recidiva , Testes Cutâneos , Fatores de Tempo , Urticária/diagnóstico
16.
Kidney Res Clin Pract ; 35(2): 123-6, 2016 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-27366669

RESUMO

Renal artery aneurysms and pseudoaneurysms are an uncommon clinical problem with a low incidence rate. They are abnormal dilatations of the vessel lumen with some different natures. However, the rupture of an aneurysm and pseudoaneurysm is the most dreaded complication because it causes death of the patient. There are many causes of renal artery aneurysm and pseudoaneurysm, including Behçet's disease; however, renal involvement in Behçet's disease is less frequent. We report a case of renal artery pseudoaneurysm induced by Behçet's disease and treated successfully with coil embolization. A 56-year-old woman with Behçet's disease presented with an incidental left renal artery pseudoaneurysm measuring 18 mm. We successfully performed endovascular treatment with coil embolization instead of surgical treatment.

17.
Am J Chin Med ; 44(3): 565-78, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-27109161

RESUMO

Rutin, also called rutoside or quercetin-3-O-rutinoside and sophorin, is a glycoside between the flavonol quercetin and the disaccharide rutinose. Although many effects of rutin have been reported in vitro and in vivo, the anti-adipogenic effects of rutin have not been fully reported. The aim of this study was to confirm how rutin regulates adipocyte related factors. In this study, rutin decreased the expressions of adipogenesis-related genes, including peroxisome proliferators, activated receptor [Formula: see text] (PPAR[Formula: see text], CCAAT/enhancer-binding protein [Formula: see text] (C/EBP[Formula: see text], fatty acid synthase, adipocyte fatty acid-binding protein, and lipoprotein lipase in 3T3-L1 cells. Rutin also repressed the expression of lipin1, which is an upstream regulator that controls PPAR[Formula: see text] and C/EBP[Formula: see text]. In addition, when 3T3-L1 was transfected with lipin1 siRNA to block lipin1 function, rutin did not affect the expressions of PPAR[Formula: see text] and C/EBP[Formula: see text]. These results suggest that rutin has an anti-adipogenic effect that acts through the suppression of lipin1, as well as PPAR[Formula: see text] and C/EBP[Formula: see text].


Assuntos
Adipogenia/efeitos dos fármacos , Adipogenia/genética , Proteínas Nucleares/fisiologia , Fosfatidato Fosfatase/fisiologia , Rutina/farmacologia , Células 3T3 , Proteínas Quinases Ativadas por AMP/fisiologia , Animais , Proteínas Estimuladoras de Ligação a CCAAT/genética , Proteínas Estimuladoras de Ligação a CCAAT/metabolismo , Diferenciação Celular/efeitos dos fármacos , Diferenciação Celular/genética , Sobrevivência Celular/efeitos dos fármacos , Sobrevivência Celular/genética , Metabolismo dos Lipídeos/efeitos dos fármacos , Metabolismo dos Lipídeos/genética , Camundongos , Proteínas Nucleares/antagonistas & inibidores , PPAR gama/genética , PPAR gama/metabolismo , Fosfatidato Fosfatase/antagonistas & inibidores , Transdução de Sinais/efeitos dos fármacos , Transdução de Sinais/genética
18.
Int J Artif Organs ; 38(12): 667-70, 2015 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-26847501

RESUMO

BACKGROUND: In patients who developed a combined situation of severe acute respiratory distress syndrome with refractory hypoxemia and acute cardiac failure with circulatory collapse, traditional veno-venous or veno-arterial extracorporeal membrane oxygenation approach alone may not be sufficient enough to maintain both an acceptable range of gas exchange and a hemodynamic stability. CASE REPORT: A 27-year-old male patient was suffering from severe acute respiratory distress syndrome caused by community-acquired pneumonia and acute myocarditis with circulatory shock. After mechanical ventilation for respiratory support, he was in a persistently refractory shock state. Veno-veno-arterial mode of extracorporeal membrane oxygenation was thus applied to provide both respiratory and circulatory support simultaneously, with good success. DISCUSSION: Modifying to a veno-veno-arterial mode can be another alternative strategy in a combined situation of refractory respiratory and cardiac failure, thus providing not only respiratory support but also circulatory support. In veno-veno-arterial mode, the returning circuit from the pump was divided with a Y connector into 2 reinfusion circuits; each reinfusion circuit was connected to the contralateral side femoral vein and artery, respectively. The distribution of reinfusion flow was adjusted depending on the patient's cardiopulmonary status. CONCLUSIONS: Although there is no consensus about the veno-veno-arterial mode of extracorporeal membrane oxygenation, this combined mode can be helpful in patients with acute refractory respiratory and cardiac failure, as shown in the present case. We need further experience and improvements in the circuit system used in the veno-veno-arterial mode of ECMO.


Assuntos
Oxigenação por Membrana Extracorpórea/métodos , Miocardite/terapia , Síndrome do Desconforto Respiratório do Adulto/terapia , Doença Aguda , Adulto , Oxigenação por Membrana Extracorpórea/instrumentação , Humanos , Masculino , Miocardite/complicações , Miocardite/diagnóstico , Miocardite/fisiopatologia , Pneumonia/complicações , Pneumonia/microbiologia , Recuperação de Função Fisiológica , Respiração Artificial , Síndrome do Desconforto Respiratório do Adulto/diagnóstico , Síndrome do Desconforto Respiratório do Adulto/microbiologia , Síndrome do Desconforto Respiratório do Adulto/fisiopatologia , Choque Cardiogênico/etiologia , Choque Cardiogênico/terapia , Tomografia Computadorizada por Raios X , Resultado do Tratamento
19.
Int J Artif Organs ; 38(11): 595-9, 2015 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-26728787

RESUMO

PURPOSE: Anticoagulation is mandatory for extracorporeal membrane oxygenation (ECMO), but systemic heparinization, which has been most widely used as an anticoagulant, has been associated with bleeding complications. The present study reviewed the usefulness and safety of nafamostat mesilate as a regional anticoagulant in patients with bleeding complication during ECMO. METHODS: We retrospectively reviewed the record of 13 cases. The nafamostat mesilate dose was regulated to maintain the activated clotting time (ACT) or activated partial thromboplastin time (aPTT) values within an adequate range at the ECMO reinfusion route. ACT or aPTT values in blood samples from the ECMO circuit and from the patients were measured simultaneously and consecutively. RESULTS: We measured the ACT value in 6 cases and aPTT in 7 cases. The bleeding complications were treated in 11 cases. When we compared the difference in 2 anticoagulation values (ACT and aPTT) between the 2 blood samples, one taken from ECMO and the other from patients, mean anticoagulation values of blood from patients were lower than those from ECMO circuit in 11 cases. With respect to the type of ECMO reinfusion mode, the difference was significant only in veno-arterial mode ECMO group (p<0.001). CONCLUSIONS: Nafamostat mesilate, with which we can reduce anticoagulation values of patient to a safe level without losing the ECMO anticoagulation values is expected to be useful as a regional anticoagulant in patients with bleeding complications or a high risk of bleeding during ECMO.


Assuntos
Anticoagulantes/uso terapêutico , Oxigenação por Membrana Extracorpórea/efeitos adversos , Guanidinas/uso terapêutico , Hemorragia/tratamento farmacológico , Adulto , Idoso , Feminino , Hemorragia/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento
20.
Pancreas ; 43(1): 118-27, 2014 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-24326366

RESUMO

OBJECTIVE: The aim of this study was to evaluate the effects of Opuntia humifusa (OH) on cerulein-induced acute pancreatitis (AP). METHODS: Acute pancreatitis was induced via intraperitoneal injection of cholecystokinin analog cerulein (50 µg/kg). In the OH pretreatment group, OH was administered intraperitoneally (100, 250, or 500 mg/kg) 1 hour before first cerulein injection. In the posttreatment group, OH was administered intraperitoneally (500 mg/kg) 1 hour after the first cerulein injection. Furthermore, we isolated the pancreatic acinar cells using collagenase method, then investigated the acinar cell viability, cytokine productions, and the regulating mechanisms. RESULTS: The both pretreatment and posttreatment of OH treatment attenuated the severity of AP, as shown by the histology of the pancreas and lung, and inhibited neutrophil infiltration; serum amylase and lipase activities; proinflammatory cytokine expression such as interleukin 1, interleukin 6, and tumor necrosis factor α; and cell death including apoptosis and necrosis. Furthermore, OH inhibited the activation of c-Jun N-terminal kinases. CONCLUSIONS: These results suggest that OH reduces the severity of AP by inhibiting acinar cell death through c-Jun N-terminal kinases.


Assuntos
Opuntia/química , Pâncreas/efeitos dos fármacos , Pancreatite/prevenção & controle , Extratos Vegetais/farmacologia , Células Acinares/efeitos dos fármacos , Células Acinares/metabolismo , Doença Aguda , Amilases/sangue , Animais , Apoptose/efeitos dos fármacos , Western Blotting , Sobrevivência Celular/efeitos dos fármacos , Células Cultivadas , Ceruletídeo , Citocinas/genética , Citocinas/metabolismo , Relação Dose-Resposta a Droga , Feminino , Expressão Gênica/efeitos dos fármacos , Proteína HMGB1/metabolismo , Injeções Intraperitoneais , Lipase/sangue , Camundongos , Camundongos Endogâmicos C57BL , Proteínas Quinases Ativadas por Mitógeno/metabolismo , Pâncreas/metabolismo , Pâncreas/patologia , Pancreatite/sangue , Pancreatite/induzido quimicamente , Extratos Vegetais/administração & dosagem , Reação em Cadeia da Polimerase Via Transcriptase Reversa , Fatores de Tempo
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