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1.
Gan To Kagaku Ryoho ; 48(7): 955-957, 2021 Jul.
Artigo em Japonês | MEDLINE | ID: mdl-34267035

RESUMO

The case involved a 51-year-old woman who was diagnosed with Stage Ⅰ right breast cancer(cT1, N0, M0). Partial resection of the right breast and sentinel lymph node biopsy were performed. The histological type was found to be Stage Ⅰ triple-negative medullary carcinoma with pT1c, pN0(sn), and M0. A pituitary tumor was diagnosed after discharge. After removal of the pituitary tumor, whole-breast irradiation was performed. Subsequently, chemotherapy was started. Approximately 5 months after surgery, redness and swelling of the right breast were observed. Inflammatory breast cancer recurrence could not be ruled out by imaging, and skin biopsy was performed. No malignant findings were observed, and the symptoms were considered to indicate radiation recall dermatitis caused by chemotherapy. When chemotherapy was discontinued, the redness of the right breast improved.


Assuntos
Neoplasias da Mama , Neoplasias Inflamatórias Mamárias , Radiodermatite , Axila , Neoplasias da Mama/cirurgia , Feminino , Humanos , Neoplasias Inflamatórias Mamárias/diagnóstico , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/cirurgia , Radiodermatite/diagnóstico , Radiodermatite/etiologia , Biópsia de Linfonodo Sentinela
2.
Am J Case Rep ; 21: e922405, 2020 Mar 24.
Artigo em Inglês | MEDLINE | ID: mdl-32205837

RESUMO

BACKGROUND Strangulation ileus is caused by external obstruction to the small bowel, which results in ischemia and loss of bowel peristalsis. Low-grade appendiceal mucinous neoplasm (LAMN) is a low-grade adenocarcinoma that arises in the appendix. LAMN is usually asymptomatic but can present with appendiceal rupture and pseudomyxoma peritonei (PMP). This report is of a rare presentation of LAMN with strangulation ileus in a 92-year-old man. CASE REPORT A 92-year-old man was admitted to the emergency room with sudden onset of lower abdominal pain and abdominal distension. Laboratory investigations showed a leukocytosis with a white blood cell (WBC) count of 14.6×10³/µL with 85.5% neutrophils, blood urea nitrogen (BUN) of 26.6 mg/dL, and serum creatinine of 2.6 mg/dL, consistent with acute renal failure. Arterial blood gas analysis showed lactic acidosis (pH of 7.11) with a base excess of -20.8 mmol/L and lactate of 13.7 mmol/L. Abdominal computed tomography (CT) showed ascites and a dilated obstructed closed loop of the distal ileum associated with an external mass (3.9×2.8 cm). An initial diagnosis was of strangulation ileus due to Meckel's diverticulum. Emergency ileocecal resection was performed. Histopathology showed a low-grade mucinous tumor arising from the mucosa of the appendix, consistent with LAMN. At a 13-month follow-up, the patient was well with no tumor recurrence. CONCLUSIONS This report is of a rare case of LAMN that presented as a surgical emergency with strangulation ileus.


Assuntos
Adenocarcinoma Mucinoso/complicações , Neoplasias do Apêndice/complicações , Íleus/etiologia , Divertículo Ileal/etiologia , Adenocarcinoma Mucinoso/cirurgia , Idoso de 80 Anos ou mais , Neoplasias do Apêndice/cirurgia , Serviço Hospitalar de Emergência , Humanos , Íleus/cirurgia , Masculino , Divertículo Ileal/cirurgia , Resultado do Tratamento
3.
Hinyokika Kiyo ; 65(4): 117-121, 2019 Apr.
Artigo em Japonês | MEDLINE | ID: mdl-31247689

RESUMO

The patient was a 56-year-old female. She was referred to our department for further examination of right hydronephrosis in 2010. Computed tomography (CT) showed right hydronephrosis, and retrograde pyelography (RP) revealed stenosis of the right lower ureter. Urine cytology was negative. Transurethral biopsy of the right ureter was performed using ureteroscopic cup forceps and the histopathlogical diagnosis was ureteral amyloidosis. A whole-body search was performed, including rectal biopsy, but no evidence of amyloidosis was obtained. She was diagnosed with localized amyloidosis of the right ureter. A ureteral stent was indwelled and the patient was given occulusive dressing technique (ODT) therapy using dimethyl sulfoxide (DMSO) for 1 year. After ODT therapy, right hydronephrosis improved. After a 2-year followup, it worsened. ODT therapy was restarted and continued for 2 years. She consulted our department because of fever and right lumbago in April 2017 after a 4-month interruption of ODT therapy. CT revealed progression of the right hydronephrosis. A ureteral stent was indwelled and ODT therapy was restarted. The right hydronephrosis improved after 1 year. ODT therapy using DMSO was effective for localized ureteral amyloidosis, but periodic follow-up was necessary and ODT therapy was also effective when it recurred after the interruption of treatment.


Assuntos
Amiloidose , Dimetil Sulfóxido , Sequestradores de Radicais Livres , Ureter , Doenças Ureterais , Amiloidose/tratamento farmacológico , Bandagens , Dimetil Sulfóxido/uso terapêutico , Feminino , Seguimentos , Sequestradores de Radicais Livres/uso terapêutico , Humanos , Pessoa de Meia-Idade , Doenças Ureterais/tratamento farmacológico
4.
Nihon Shokakibyo Gakkai Zasshi ; 116(3): 256-264, 2019.
Artigo em Japonês | MEDLINE | ID: mdl-30853679

RESUMO

We herein report a rare case of autoimmune pancreatitis with small intestinal obstruction. A 72-year-old male was admitted to our hospital with abdominal fullness and vomiting and diagnosed with autoimmune pancreatitis by imaging and laboratory tests. Imaging studies also revealed narrowing of the proximal jejunum with dilated bowels and intramural cystic lesion adjacent to the pancreatic body. Small bowel resection was performed to alleviate stenosis. Pathological evaluation demonstrated invasion of IgG4-positive cells and fibrosis.


Assuntos
Doenças Autoimunes/diagnóstico , Constrição Patológica/diagnóstico , Obstrução Intestinal/diagnóstico , Pancreatite/diagnóstico , Idoso , Humanos , Masculino , Pâncreas , Pancreatite/imunologia
5.
Nihon Hinyokika Gakkai Zasshi ; 110(1): 22-27, 2019.
Artigo em Japonês | MEDLINE | ID: mdl-31956214

RESUMO

Three cases are reported of TURBT on the anterior wall, with bladder rupture occurring after discharge. Patient 1 was a 68-year-old man. He had macroscopic hematuria and he strained to void a bloody clot on the 10th day after TURBT. Subsequently, right lower abdominal pain occurred. Computed tomography (CT) revealed the extravasation of contrast medium into the prevesical space. He was diagnosed with extraperitoneal bladder rupture, and a urethral catheter was indwelled. Cancer invasion of muscle was diagnosed by pathological examination and total cystectomy was scheduled one and a half months later, but the prostate could not be resected due to hard tissue around the bladder neck. Patient 2 was an 82-year-old man and had a history of radiation therapy for a muscle invasive bladder tumor. He complained of pollakisuria two weeks after TURBT, and renal failure was detected on a blood test. CT revealed ascites, and a urethral catheter was indwelled. Ascites disappeared, but the urethral catheter deviated into the abdominal cavity based on repeated CT the next day, and he was diagnosed with intraperitoneal bladder rupture. Emergent surgery was performed, and the ruptured part was sutured with omentum covering and a cystostomy was created. Patient 3 was an 83-year-old man undergoing treatment for benign prostatic hypertrophy (BPH). He had received bladder instillation therapy of Bacillus Calmette-Guerin (BCG) ten months previously. When urinating 6 days after TURBT, lower abdominal pain developed. CT demonstrated retroperitoneal bladder rupture, and a urethral catheter was indwelled. The urethral catheter was removed 6 days later, but lower abdominal pain occurred again the next day. Thus, the urethral catheter was re-indwelled for a further two weeks.In TURBT on the anterior wall or dome, for the patients who had previously received radiation therapy to the pelvis, or intravesical instillation therapy of the BCG or accompanied by urinary disturbance, such as BPH, it is necessary to consider bladder rupture after discharge.


Assuntos
Complicações Pós-Operatórias , Neoplasias da Bexiga Urinária/cirurgia , Bexiga Urinária/cirurgia , Idoso , Idoso de 80 Anos ou mais , Humanos , Masculino , Ruptura Espontânea
6.
Taiwan J Obstet Gynecol ; 57(3): 449-451, 2018 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-29880183

RESUMO

OBJECTIVE: Spontaneous pneumothorax combined with thoracic endometriosis is a rare condition during pregnancy. We present a case of chemical pleurodesis with autologous blood and freeze-dried concentrated human thrombin during pregnancy. CASE REPORT: This report presents a case of spontaneous pneumothorax combined with thoracic endometriosis that arose at 22 weeks' gestation in a 35-year-old female. The initial chest drainage was unsuccessful. At 25 weeks' gestation, video-assisted thoracoscopic surgery was performed and revealed endometriosis in the thoracic cavity. Since the leak persisted, chemical pleurodesis was performed with autologous blood and freeze-dried concentrated human thrombin at 28 weeks' gestation. The leak improved markedly and did not recur. CONCLUSION: This is the first case report about chemical pleurodesis with autologous blood and freeze-dried concentrated human thrombin during pregnancy. This procedure might contribute to the management of pneumothorax in pregnant women.


Assuntos
Transfusão de Sangue Autóloga , Hemostáticos/administração & dosagem , Pleurodese , Pneumotórax/terapia , Complicações na Gravidez/terapia , Trombina/administração & dosagem , Adulto , Endometriose/complicações , Endometriose/diagnóstico , Feminino , Humanos , Pneumotórax/complicações , Pneumotórax/diagnóstico por imagem , Pneumotórax/cirurgia , Gravidez , Doenças Torácicas/complicações , Doenças Torácicas/diagnóstico , Cirurgia Torácica Vídeoassistida
7.
Hinyokika Kiyo ; 64(4): 165-168, 2018 Apr.
Artigo em Japonês | MEDLINE | ID: mdl-29772618

RESUMO

The patient was an 88-year-old male. He was referred to the Department of Internal Medicine because of total body itching and jaundice in July 2011. The serum bilirubin level was elevated, and the serum CA19-9 level was also elevated to 266. 6 U/ml. Computed tomography (CT) and endoscopic retrograde cholangiopancreatography (ERCP) revealed a solid tumor between the hepatic hilus and common bile duct, and choler cytodiagnosis was class V ; adenocarcinoma. The patient was diagnosed with hilar cholangiocarcinoma and received conservative treatment with endoscopic nasobiliary drainage (ENBD) due to his advanced age. The patient was then referred to our department because CT revealed right hydronephrosis and thickening of the right side of the bladder wall, which had not been detected on admission in October 2011. Cystoscopy revealed a broad-based edematous tumor on the right side of the bladder. Transurethral resection of the bladder tumor (TURBT) was performed. The histological diagnosis was moderately differentiated tubular adenocarcinoma. Immunohistostaining using CA19-9 was performed, and cancer cells were positive. The final histology led to a diagnosis of metastasis of cholangiocarcinoma to the bladder. The patient died of liver failure in March 2012.


Assuntos
Neoplasias dos Ductos Biliares , Ductos Biliares Intra-Hepáticos , Colangiocarcinoma , Neoplasias da Bexiga Urinária , Adulto , Idoso de 80 Anos ou mais , Neoplasias dos Ductos Biliares/patologia , Colangiocarcinoma/secundário , Colangiocarcinoma/cirurgia , Colangiopancreatografia Retrógrada Endoscópica , Humanos , Masculino , Bexiga Urinária , Neoplasias da Bexiga Urinária/secundário , Neoplasias da Bexiga Urinária/cirurgia
8.
Nihon Hinyokika Gakkai Zasshi ; 107(1): 48-53, 2016.
Artigo em Japonês | MEDLINE | ID: mdl-28132992

RESUMO

We report a 33-year-old male with a left advanced non-seminomatous testicular germ cell tumor (NSGCT) accompanied panic disorder. He had experienced palpitation and hyperpnea in crowds in his twenties. He was admitted to the Department of Otorhinolaryngology with the chief complaint of left neck swelling. 18F-fluorodeoxy glucose positron emission tomography/computed tomography (FDG-PET/CT) demonstrated left neck, left supraclavicular, left axillary, and paraaortic lymph node (LN) swelling and left testicular swelling. He was referred to our department. The left testis had enlarged to the size of a fist. He rejected admission at that time, but next day, he was taken to our hospital by an ambulance because he lost consciousness at home. No abnormalities were found in the brain CT and electrocardiogram. He was admitted and left high orchiectomy was performed. The human chorionic gonadotropin (HCG) level had elevated to 9,717 IU/L and alpha fetoprotein level (AFP) had elevated to 427 ng/ml. The histopathological diagnosis was tumors of more than one histological type, mixed forms: seminoma and embryonal carcinoma.He had palpitation and hyperpnea after admission and was diagnosed with panic disorder by a psychiatrist. Psychotropic drugs (fluvoxamine maleate 50 mg/day, alprazolam 0.8 mg/day) were prescribed and the panic attacks disappeared afterwards. The psychiatric social worker supported his mind side. Bleomycin, etoposide, and cisplatin (BEP) therapy was performed for 4 courses. He put on a blanket to his face and came to avoid a conversation with other people during the chemotherapy. He was diagnosed with depression and psychotropic drugs were increased (fluvoxamine maleate 50→75 mg/day, alprazolam 0.8→1.2 mg/day) in quantity.Lymphadenectomies for LN metastases were performed and their histopathological examination revealed the existence of viable embryonal carcinoma in the supraclavicular LN. Etoposide, ifosfamide, and cisplatin (VIP) therapy was performed for 2 courses.The pateint has remained alive without tumor recurrence. Psychotropic drugs were reduced and the recent drug is fluvoxamine maleate 25 mg/day.


Assuntos
Carcinoma Embrionário/complicações , Carcinoma Embrionário/terapia , Neoplasias Embrionárias de Células Germinativas/complicações , Neoplasias Embrionárias de Células Germinativas/terapia , Neoplasias Primárias Múltiplas , Transtorno de Pânico/complicações , Neoplasias Testiculares/complicações , Neoplasias Testiculares/terapia , Adulto , Alprazolam/administração & dosagem , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Biomarcadores Tumorais/sangue , Carcinoma Embrionário/diagnóstico , Gonadotropina Coriônica/sangue , Terapia Combinada , Fluvoxamina/administração & dosagem , Humanos , Excisão de Linfonodo , Masculino , Neoplasias Embrionárias de Células Germinativas/diagnóstico , Orquiectomia , Transtorno de Pânico/tratamento farmacológico , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada , Psicotrópicos/administração & dosagem , Neoplasias Testiculares/diagnóstico , Resultado do Tratamento , alfa-Fetoproteínas
9.
Case Rep Obstet Gynecol ; 2014: 602139, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-24551466

RESUMO

Several etiologies have been proposed for erythrocytosis associated with uterine leiomyoma. We report a case of erythrocytosis associated with a large uterine leiomyoma, in which specific immunostaining for erythropoietin was positive. A 55-year-old woman, gravida 0, para 0, was referred to our hospital for treatment for a large uterine myoma and erythrocytosis. She had no vaginal bleeding after she reached menopause at 50 years old. She had severe polycythemia: hemoglobin (Hb), 19.9 g/dL; red blood cell count (RBC), 6.65 × 10(6)/mm(3); hematocrit, (Hct) 59.1%. An abdominal simple hysterectomy was performed, and a pathological examination confirmed the diagnosis of leiomyoma of the uterus. In addition, immunostaining demonstrated that the cytoplasm of the leiomyoma cells was strongly positive for erythropoietin. After the operation, the patient's hemoglobin and hematocrit levels normalized, and we diagnosed her condition as myomatous erythrocytosis syndrome.

10.
Hinyokika Kiyo ; 59(3): 179-81, 2013 Mar.
Artigo em Japonês | MEDLINE | ID: mdl-23633634

RESUMO

A 64-year-old woman presented to our hospital with the chief complaints of abdominal pain and appetite loss, and she was admitted to the internal medicine department. Kidney, ureter and bladder X-ray revealed intrapelvic calcification near the bladder, and so, the patient consulted our department. Computed tomography and magnetic resonance imaging revealed an urachal abscess accompanied by a stone. Open surgery was performed under general anesthesia. The mass adhered tightly to the intestine and bladder. The urachal abscess ruptured during the operation, and pus leaked into the intraabdominal cavity. Partial cystectomy was performed to remove the mass completely. The stone existed in the urachal abscess, and its constituents were CaOxa (51%) and CaP (49%). The pathological diagnosis was urachal abscess without malignancy.


Assuntos
Abscesso/diagnóstico , Úraco , Cálculos Urinários/complicações , Abscesso/cirurgia , Feminino , Humanos , Pessoa de Meia-Idade , Cálculos Urinários/diagnóstico , Cálculos Urinários/cirurgia
11.
Nihon Hinyokika Gakkai Zasshi ; 104(6): 702-5, 2013 Nov.
Artigo em Japonês | MEDLINE | ID: mdl-24564077

RESUMO

We report a case of a 73-year-old male with heterochronous triple urogenital cancer. The patient was referred to our hospital because serum PSA was elevated (7.0 ng/ml) in 1998. Prostatic needle biopsy revealed prostatic cancer in the right lobe, and total prostatectomy was performed. The histopathological diagnosis was moderately differentiated adenocarcinoma (TlcNOMO). Non-muscle invasive bladder cancer (NMIBC) was detected during an examination for microhematuria in 2002. Transurethral resection of the bladder tumor (TURBT) procedure was performed, and the histopathological diagnosis was grade 2 urothelial carcinoma (pTa). A right renal mass was detected incidentally on follow-up CT for bladder cancer in 2008. Renal enucleation was performed in 2009. The histopathological diagnosis was grade 2 clear cell renal cell carcinoma (pTlaNXMO). NMIBC was detected on follow-up urethrocystoscopy in 2011. The TURBT procedure was performed, and the histopathological diagnosis was grade 2 urothelial carcinoma (pTa). On follow-up for urogenital cancer patients, it is important to investigate recurrence of the primary cancer and also heterochronous canceration of other urogenital organs.


Assuntos
Adenocarcinoma/cirurgia , Carcinoma de Células Renais/cirurgia , Carcinoma/cirurgia , Neoplasias Renais/cirurgia , Neoplasias Primárias Múltiplas , Neoplasias da Próstata/cirurgia , Neoplasias da Bexiga Urinária/cirurgia , Adenocarcinoma/diagnóstico , Adenocarcinoma/patologia , Idoso , Carcinoma/diagnóstico , Carcinoma/patologia , Carcinoma de Células Renais/diagnóstico , Carcinoma de Células Renais/patologia , Seguimentos , Humanos , Neoplasias Renais/diagnóstico , Neoplasias Renais/patologia , Masculino , Neoplasias da Próstata/diagnóstico , Neoplasias da Próstata/patologia , Resultado do Tratamento , Neoplasias da Bexiga Urinária/diagnóstico , Neoplasias da Bexiga Urinária/patologia
12.
Mod Pathol ; 25(7): 956-67, 2012 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-22481280

RESUMO

Progressively transformed germinal centers is a benign condition of unknown pathogenesis characterized by a distinctive variant form of reactive follicular hyperplasia in lymph nodes. We recently reported Ig G4-related disease in progressively transformed germinal centers. However, no large case series has been reported and clinicopathologic findings remain unclear. Here, we report 40 Japanese patients (28 men, 12 women; median age, 56 years) with progressively transformed germinal centers of the lymph nodes who fulfilled the histological diagnostic criteria for IgG4-related disease (IgG4(+) progressively transformed germinal centers), with asymptomatic localized lymphadenopathy involving the submandibular nodes in 24, submandibular and cervical nodes in 14, cervical nodes only in 1, and cervical and supraclavicular nodes in 1. In all, 16 (52%) of 31 examined patients had allergic disease. Histologically, the lymph nodes demonstrated uniform histological findings, namely marked follicular hyperplasia with progressively transformed germinal centers, and localization of the majority of IgG4(+) plasma cells in the germinal centers. Serum IgG4, serum IgE and peripheral blood eosinophils were elevated in 87%, 92% and 53% of examined patients, respectively. Eighteen patients subsequently developed extranodal lesions (including five who developed systemic disease), which on histological examination were consistent with IgG4-related disease. IgG4(+) progressively transformed germinal centers presents with uniform clinicopathological features of asymptomatic localized submandibular lymphadenopathy, which persists and/or relapses, and sometimes progresses to extranodal lesions or systemic disease. Nine patients were administered steroid therapy when the lesions progressed, to which all responded well. We suggest that IgG4(+) progressively transformed germinal centers should be included in the IgG4-related disease spectrum.


Assuntos
Centro Germinativo/patologia , Imunoglobulina G , Doenças Linfáticas/patologia , Adulto , Idoso , Feminino , Humanos , Imuno-Histoquímica , Masculino , Pessoa de Meia-Idade
13.
Pathol Int ; 60(8): 566-74, 2010 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-20618734

RESUMO

Lymphohistiocytoid mesothelioma (LHM), reported to be a rare variant of sarcomatoid mesothelioma, is challenging to differentiate from non-Hodgkin's lymphoma due to marked lymphocytic infiltration. To aid accurate recognition of LHM, we examined immunohistochemical, in situ hybridization (ISH) of Epstein-Barr virus RNA (EBER-1) mRNA, fluorescence ISH (FISH) for homozygous deletion of 9p21, and asbestos analysis in four cases (three men and 1 woman). Three patients died, while Case 4 was still alive 19 months after extrapleural pneumonectomy. Histologically, these cases were characterized by heavy lymphocytic infiltration. All neoplastic cells were positive for calretinin, AE1/AE3, and epithelial membrane antigen, but negative for CEA. EBER1 factor was negative. FISH analysis demonstrated homozygous deletion of the 9p21 locus in three of the four cases. In Case 1: (i) autopsy findings showed mesothelioma primarily located in the right parietal pleura, but metastasized into the left lung and abdominal organs; (ii) the histological findings at autopsy indicated sarcomatoid mesothelioma; and (iii) we found asbestos bodies and fibers in extracts from lung tissue (Cases 1 & 4) using digestion with bleaching fluid. LHM, an infrequent variant of sarcomatoid mesothelioma, displayed homozygous deletion of the 9p21 locus (three of four cases), and has a relatively favorable prognosis for the sarcomatoid type.


Assuntos
Mesotelioma/patologia , Neoplasias Pleurais/patologia , Biomarcadores Tumorais/genética , Biomarcadores Tumorais/metabolismo , Feminino , Herpesvirus Humano 4/genética , Herpesvirus Humano 4/metabolismo , Humanos , Imuno-Histoquímica , Hibridização In Situ , Masculino , Mesotelioma/genética , Mesotelioma/metabolismo , Microscopia Eletrônica , Pessoa de Meia-Idade , Neoplasias Pleurais/genética , Neoplasias Pleurais/metabolismo , RNA Viral/genética , RNA Viral/metabolismo
14.
Nihon Kokyuki Gakkai Zasshi ; 48(12): 918-22, 2010 Dec.
Artigo em Japonês | MEDLINE | ID: mdl-21226298

RESUMO

A 78-year-old man with complaints of appetite loss and weight loss visited our hospital in November 2006. Positron-emission tomography and computed tomography (PET/CT) showed swollen lymph nodes in the abdominal para-aorta, mediastinum and neck, with intense FDG accumulation. The pathological findings of the cervical lymph nodes revealed small-cell cancer. We diagnosed extensive small-cell lung cancer (SCLC), which occurred primarily in the left upper lobe. As subsequent CT revealed spontaneous shrinkage of the pulmonary nodule and swollen lymph nodes, the clinical course was monitored without anticancer therapy. In February 2007, progressive muscle weakness of the lower extremities developed. In July he was admitted with respiratory failure and required mechanical ventilation. Although we did not administer anticancer therapy due to his poor performance status, he survived for 30 months receiving mechanical ventilation, and the tumors continued to grow moderately. We diagnosed Lambert-Eaton myasthenic syndrome (LEMS) based on the clinical symptoms, the presence of anti-VGCC antibodies and waxing phenomenon on electromyography obtained in April 2009. Chemotherapy with amrubicin shrank the tumors, but his muscle weakness did not improve. Previous reports showed that a prognosis of SCLC with LEMS was better than that without LEMS. In this case, the tumors showed spontaneous regression without any anticancer therapy, and then increased moderately. The immune response was considered to have affected tumor growth.


Assuntos
Síndrome Miastênica de Lambert-Eaton/complicações , Neoplasias Pulmonares/complicações , Carcinoma de Pequenas Células do Pulmão/complicações , Idoso , Antraciclinas/uso terapêutico , Antineoplásicos/uso terapêutico , Canais de Cálcio/imunologia , Humanos , Síndrome Miastênica de Lambert-Eaton/diagnóstico , Síndrome Miastênica de Lambert-Eaton/imunologia , Neoplasias Pulmonares/diagnóstico , Neoplasias Pulmonares/imunologia , Neoplasias Pulmonares/terapia , Masculino , Respiração Artificial , Insuficiência Respiratória/etiologia , Insuficiência Respiratória/terapia , Carcinoma de Pequenas Células do Pulmão/diagnóstico , Carcinoma de Pequenas Células do Pulmão/imunologia , Carcinoma de Pequenas Células do Pulmão/terapia , Fatores de Tempo
15.
Intern Med ; 46(14): 1123-6, 2007.
Artigo em Inglês | MEDLINE | ID: mdl-17634712

RESUMO

A 74-year-old man was referred to our hospital because of hypertension, blue toe syndrome and an elevation of serum creatinine from 0.8 to 1.4 mg/dl for eleven months. He had no history of invasive vascular procedures. Atherosclerosis was initially suspected, but renal impairment was accelerated following anticoagulant therapy. A renal biopsy established the diagnosis of cholesterol crystal embolism. Withdrawal of anticoagulants and the combination therapy with LDL apheresis and corticosteroids led to stabilization of the renal function. In patients with risk factors for atherosclerosis, cholesterol crystal embolism should be included in the differential diagnosis of chronic kidney disease.


Assuntos
Embolia de Colesterol/diagnóstico , Idoso , Arteriosclerose Obliterante/diagnóstico , Doença Crônica , Creatinina/sangue , Diagnóstico Diferencial , Embolia de Colesterol/complicações , Embolia de Colesterol/terapia , Humanos , Hipertensão/diagnóstico , Hipertensão/etiologia , Hipertensão/terapia , Nefropatias/sangue , Nefropatias/etiologia , Nefropatias/patologia , Nefropatias/terapia , Masculino , Resultado do Tratamento
16.
Drug Metab Dispos ; 35(10): 1832-9, 2007 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-17639025

RESUMO

Isoline, a major retronecine-type pyrrolizidine alkaloid (PA) from the Chinese medicinal herb Ligularia duciformis, was suggested to be the most toxic known PA. Its in vitro metabolism was thus examined in rat and mouse liver microsomes, and its toxicity was compared with that of clivorine and monocrotaline after i.p. injection in mice. Isoline was more rapidly metabolized by both microsomes than clivorine and monocrotaline and converted to two polar metabolites M1 and M2, which were spectroscopically determined to be bisline (a deacetylated metabolite of isoline) and bisline lactone, respectively. Both metabolites were formed in the presence or absence of an NADPH-generating system with liver microsomes but not cytosol. Their formation was completely inhibited by the esterase inhibitors, triorthocresyl phosphate (TOCP) and phenylmethylsulfonyl fluoride, but not at all or partially by cytochrome P450 (P450) inhibitors, alpha-naphthoflavone and proadifen (SKF 525A), respectively. These results demonstrated that both metabolites were produced by microsomal esterase(s) but not P450 isozymes. The esterase(s) involved showed not only quite different activities but also responses to different inhibitors in rat and mouse liver microsomes, suggesting that different key isozyme(s) or combinations might be responsible for the deacetylation of isoline. Isoline injected i.p. into mice induced liver-specific toxicity that was much greater than that with either clivorine or monocrotaline, as judged by histopathology as well as serum alanine aminotransferase and aspartate aminotransferase levels. Isoline-induced hepatotoxicity was remarkably enhanced by the esterase inhibitor TOCP but was reduced by the P450 inhibitor SKF 525A, indicating that rodent hepatic esterase(s) played a principal role in the detoxification of isoline via rapid deacetylation in vivo.


Assuntos
Asteraceae/química , Esterases/antagonistas & inibidores , Alcaloides de Pirrolizidina/metabolismo , Alcaloides de Pirrolizidina/toxicidade , Alanina Transaminase/sangue , Animais , Antitussígenos/metabolismo , Antitussígenos/toxicidade , Aspartato Aminotransferases/sangue , Benzoflavonas/farmacologia , Inibidores das Enzimas do Citocromo P-450 , Medicamentos de Ervas Chinesas/metabolismo , Medicamentos de Ervas Chinesas/toxicidade , Esterases/metabolismo , Expectorantes/metabolismo , Expectorantes/toxicidade , Fígado/efeitos dos fármacos , Fígado/patologia , Masculino , Camundongos , Camundongos Endogâmicos , Microssomos Hepáticos/metabolismo , Monocrotalina/metabolismo , Monocrotalina/toxicidade , Fluoreto de Fenilmetilsulfonil/farmacologia , Proadifeno/farmacologia , Ratos , Ratos Sprague-Dawley , Tritolil Fosfatos/farmacologia
17.
Intern Med ; 45(15): 897-901, 2006.
Artigo em Inglês | MEDLINE | ID: mdl-16946571

RESUMO

A 65-year-old man underwent transurethral resection of the prostate on a diagnosis of benign prostatic hypertrophy. Almost simultaneously, a diagnostic resection of minor salivary glands was performed. After the resections he suffered from obstructive jaundice. Laboratory examinations revealed an increase in eosinophils and an elevation of serum IgG4. Pancreaticoduodenectomy was performed because of the possibility of pancreatic cancer. The prostate, salivary glands and pancreas showed common histological characteristics, namely, infiltration of lymphocytes and plasma cells accompanying dense fibrosis. Most of the infiltrating plasma cells showed strong immunoreactivity to IgG4. This is the first case with IgG4-associated prostatitis complicating autoimmune pancreatitis.


Assuntos
Doenças Autoimunes/complicações , Imunoglobulina G/sangue , Pancreatite/complicações , Prostatite/complicações , Idoso , Doenças Autoimunes/sangue , Doenças Autoimunes/diagnóstico por imagem , Humanos , Masculino , Pancreatite/sangue , Pancreatite/diagnóstico por imagem , Prostatite/sangue , Prostatite/diagnóstico por imagem , Radiografia
18.
Am J Surg Pathol ; 29(6): 783-91, 2005 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-15897744

RESUMO

Chronic sclerosing sialadenitis (CSS) is a cryptogenic tumor-like condition of the salivary gland(s). While immune-mediated processes are suspected in its pathogenesis, and CSS is occasionally reported to be associated with sclerosing pancreatitis, an IgG4-related disease, the exact immunopathologic processes of CSS remain speculative. In this study, we examined the clinicopathologic findings of CSS (12 cases) in comparison with sialolithiasis (8 cases) and Sjogren's syndrome (13 cases), and tried to clarify whether CSS is an IgG4-related disease or not. Submandibular gland(s) were affected in all cases of CSS. CSS cases could be divided into two types: 5 cases were associated with sclerosing lesions in extrasalivary glandular tissue (systemic type), while only salivary gland(s) were affected in the remaining 7 cases (localized type). In the former type, which showed male predominance, bilateral salivary glands were frequently affected, and eosinophilia and elevations of gamma-globulin and IgG in serum were frequently found. Histologically, all cases of CSS showed marked lymphoplasmacytic infiltration admixed with fibrosis and the destruction of glandular lobules. Obliterative phlebitis was found in the affected salivary glands in all cases of CSS. Immunohistochemically, the proportion of IgG4/IgG-positive plasma cells was more than 45% in CSS, while it was less than 5% in controls. The resemblance of the clinicopathologic features of CSS with those of sclerosing pancreatitis suggests the participation of a similar immunopathologic process with IgG4 disturbance in CSS. The abundance of IgG4-positive plasma cells in the lesions would be useful for distinguishing CSS from other forms of sialadenitis.


Assuntos
Imunoglobulina G/imunologia , Plasmócitos/imunologia , Sialadenite/imunologia , Idoso , Colangite Esclerosante , Doença Crônica , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pancreatite/complicações , Cálculos das Glândulas Salivares/complicações , Esclerose/patologia , Sialadenite/complicações , Sialadenite/patologia , Síndrome de Sjogren/complicações
19.
J Comp Neurol ; 482(1): 33-49, 2005 Jan 31.
Artigo em Inglês | MEDLINE | ID: mdl-15612017

RESUMO

The zinc finger-homeodomain (ZFH) transcription factors contain a zinc finger motif and a homeodomain that might regulate neural and mesenchymal cell differentiation. We have cloned the ZFH4 gene that encodes a protein with structures closely related to ATBF1. In order to study the expression pattern of ZFH4 in the developing rat brain, we raised an antibody against a glutathione-S-transferase (GST) fusion protein of ZFH4. Western blotting with this antibody identified a gene product of 390 kDa in the normal rat brain. Levels of the protein were high in the brainstem at embryonic and neonatal periods and in the midbrain and diencephalon in neonatal rat brain. In addition, the corresponding mRNA of 12.5 kb was detected by Northern blotting. An immunolocalization study showed that postmitotic neurons in the brainstem were the major site of ZFH4 expression, and the levels of expression varied depending on age and anatomical sites. Expression was transient and weak in precursor cells at early neurogenesis. Although ZFH4 levels decreased after birth, ZFH4 continued to be expressed in the mature neurons including DOPA decarboxylase-positive neurons. High levels of expression were also detected in non-neuronal cells of the subcommissural organ, but the expression was almost undetectable throughout precursor cells to mature neurons in the cerebral cortex and hippocampus. The spatial and temporal expression patterns closely resembled those of ATBF1, and we detected neurons that expressed ZFH4, ATBF1, or both. We postulate that ZFH4 participates in the regulation of neural cell maturation or of region-specific differentiation of the brain.


Assuntos
Encéfalo/metabolismo , Proteínas de Homeodomínio/metabolismo , Proteínas do Tecido Nervoso/metabolismo , Fatores de Transcrição/metabolismo , Dedos de Zinco/fisiologia , Animais , Northern Blotting , Western Blotting , Encéfalo/citologia , Encéfalo/embriologia , Diferenciação Celular/fisiologia , Regulação da Expressão Gênica no Desenvolvimento , Imuno-Histoquímica , Ratos , Ratos Wistar , Distribuição Tecidual
20.
J Comp Neurol ; 465(1): 57-71, 2003 Oct 06.
Artigo em Inglês | MEDLINE | ID: mdl-12926016

RESUMO

The ATBF1 gene encodes transcription factors containing four homeodomains and multiple zinc finger motifs. However, the gene products have yet to be identified and the role remains unknown in vivo. In this study, we raised an antiserum for ATBF1 and found high levels of expression of ATBF1 in developing rat brain. Western and Northern blot analyses detected a 400 kDa protein and 12.5 kb mRNA in developing rat brain, respectively; both corresponding to ATBF1-A but not the B isoform. The protein was highly expressed in the midbrain and diencephalon and mRNA was highly expressed in the brainstem, mostly in embryo and neonatal brain. Immunohistochemistry identified postmitotic neurons in the brainstem as the major site of ATBF1 expression, and the expression levels varied depending on age of and location in the brain. Expression was transient and weak in the precursor cells at early neurogenesis. ATBF1 decreased postnatally, but remained in mature neurons, including those expressing DOPA decarboxylase (DDC). High levels of ATBF1 were expressed in precursor cells in accordance with neurogenesis and were continued to the mature neurons in specific areas such as the inferior colliculus. Expression was not significant from precursor cells to mature neurons in the cerebral cortex and hippocampus. ATBF1 and its Drosophila homolog, Zfh-2, are known to regulate cell differentiation and proliferation via the interaction with either of the basic helix-loop-helix transcription factors, c-myb, or the DDC gene. Together with these reported functions the expression features detected here suggest that ATBF1 may participate in the regulation of neuronal cell maturation or region-specific central nervous system differentiation.


Assuntos
Encéfalo/embriologia , Encéfalo/crescimento & desenvolvimento , Diferenciação Celular/genética , Regulação da Expressão Gênica no Desenvolvimento/genética , Proteínas de Homeodomínio/metabolismo , Neurônios/metabolismo , Células-Tronco/metabolismo , Envelhecimento/genética , Envelhecimento/metabolismo , Animais , Animais Recém-Nascidos , Encéfalo/metabolismo , Divisão Celular/genética , Dopa Descarboxilase/metabolismo , Feto , Sequências Hélice-Alça-Hélice/genética , Proteínas de Homeodomínio/genética , Imuno-Histoquímica , Isoformas de Proteínas/genética , Isoformas de Proteínas/metabolismo , RNA Mensageiro/metabolismo , Ratos , Ratos Wistar , Células-Tronco/citologia
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