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1.
Intern Emerg Med ; 2021 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-34596824

RESUMO

Cancer-associated ischemic stroke (CAS) refers to a hypercoagulation disorder related to malignant tumors, especially adenocarcinoma. Carbohydrate antigen (CA) 125 is a mucinous serum marker that might reflect hypercoagulation status, but the association between CA 125 and CAS is unclear across various types of cancer. The aim of this study was to investigate the associations among tumor markers, coagulation markers, and clinical factors in acute ischemic stroke (AIS) patients with active cancer. Consecutive AIS patients with active cancer (a diagnosis or ongoing active therapy for cancer within 6 months) were prospectively enrolled at four hospitals. D-dimer, C-reactive protein (CRP), carcinoembryonic antigen (CEA), CA19-9, and CA 125 levels were measured. Of 120 AIS patients with active cancer, 47 were diagnosed with CAS. CA 125 had the strongest correlations with D-dimer and CRP (ρ = 0.543, p < 0.001 and ρ = 0.452, p < 0.001, respectively). The areas under the receiver-operating characteristic curves for the diagnosis of CAS were 0.812 (95% CI 0.718-0.878) for CA 125, 0.714 (95% CI 0.602-0.801) for CEA, and 0.663 (95% CI 0.552-0.759) for CA 19-9. Multivariable analysis revealed that CA 125 levels in the highest quartile (OR 2.91, 95% CI 1.68-5.53), multiple lesions in multiple vascular territories observed on diffusion-weighted imaging, the absence of dyslipidemia, and the absence of atrial fibrillation were independently associated with CAS. Increased CA 125 levels, which indicate hypercoagulability, were useful for diagnosing CAS in AIS patients with active cancer.

2.
Neuropathology ; 41(4): 266-272, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-33942396

RESUMO

Immune-related adverse events (irAEs) commonly involve the gastrointestinal tract, endocrine glands, skin, and liver, and rarely the nervous system. The pathomechanism of irAEs in the nervous system is unclear, and so characterizing these severe toxic effects is a priority, even if irAEs are uncommon in the nervous system. Our patient presented subacute muscle weakness and dysesthesia with colitis as irAEs caused by pembrolizumab, one of the anti-programmed death-1 (PD-1) antibodies. Electromyography revealed abundant fibrillations and fasciculations of upper and lower extremities and severe reduction in motor unit potentials; however, antineutrophil cytoplasmic antibodies, rheumatoid factor, autoantibodies against Hu and Yo, and anti-ganglioside antibodies, such as GQ1b, were undetectable in the serum. Although he was treated with high-dose glucocorticoids, antibiotics, and a monoclonal anti-tumor necrosis factor alpha (TNFα) antibody, he developed colonic perforation. The total colorectal resection was performed, and the resected colon showed mucosal defect and perforation. He died of lung aspergillosis. Postmortem examination revealed CD8-positive lymphocyte infiltration around neurons of dorsal root ganglia. The sciatic nerve displayed the widening of myelin laminae and thinning of myelinated fibers but not a decrease in the density of myelinated nerve fibers. In the sural nerve, the density of myelinated fibers slightly decreased, and some fibers showed less densely myelinated laminae. Drug safety information, including previous randomized trials of anti-PD-1 and anti-cytotoxic T-lymphocyte-associated antigen-4 (CTLA-4) antibodies, showed that patients treated with anti-PD-1 antibodies appeared to have more frequent and severe peripheral neuropathies compared to those in patients who received anti-CTLA-4 antibodies (1.59% vs. 0.69%; Fisher exact test, P < 0.001; three severe events vs. zero severe events). The present results and drug safety information suggest that the pathomechanism of irAEs caused by anti-PD-1 antibodies is different from that by anti-CTLA-4 antibodies. The neurological irAEs might be clues to solving the pathomechanism of irAEs.

3.
J Hum Genet ; 66(10): 957-964, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-33742109

RESUMO

Parkinson's disease (PD) is caused by a combination of genetic and environmental factors. Notably, genetic risk factors vary according to ethnicity and geographical regions, and few studies have analyzed the frequency of PD causative genes in Japanese patients. Therefore, we performed genetic analyses of Japanese patients with PD. We recruited 221 participants, including 26 patients with familial PD. Genetic risk factors were evaluated by target sequencing and gene dosage analysis. We detected the genetic risk factors in 58 cases (26.2%) and classified patients into three groups to clarify the differences in genetic risk factors by age at onset (AAO). The early-onset group (AAO < 50 years) included 18 cases (44.7%), who tended to have a larger number of genetic risk factors than the later-onset groups. Regarding the AAO for each causative gene, patients with PRKN variants were significantly younger at onset than those bearing LRRK2 variants. LRRK2 variants showed similar frequency in each AAO group. Of note, we identified two novel variants. Patients with early-onset PD have more genetic risk factors than patients with late-onset PD. In Japanese patients with PD, PRKN, and LRRK2 were the major PD-related genes. Particularly, LRRK2 was a common genetic factor in all age groups because of the presence of the Asian-specific variant such as LRRK2 p.G2385R. Accumulation of genetic and clinical data can contribute to the development of treatments for PD.

4.
J Neuropathol Exp Neurol ; 79(4): 448-457, 2020 04 01.
Artigo em Inglês | MEDLINE | ID: mdl-32100014

RESUMO

Anti-3-hydroxy-3-methylglutaryl-coenzyme A reductase (HMGCR) and antisignal recognition particle (SRP) antibodies are frequently associated with immune-mediated necrotizing myopathy (IMNM). However, the difference in clinical manifestations between anti-HMGCR and anti-SRP antibodies is unclear. HMGCR is an essential enzyme for cholesterol biosynthesis and is inhibited by statins that regulate apoptosis of Bcl-2-positive and beta chemokine receptor 4 (CCR4)-positive lymphoma cells. In this study, we aimed to clarify Bcl-2 and CCR4 expressions of lymphocytes in anti-HMGCR antibody-positive IMNM and explore the difference between anti-HMGCR antibody-positive myopathy and other inflammatory myopathies. We retrospectively examined Bcl-2- and CCR4-positive lymphocyte infiltrations in muscle and skin biopsy specimens from 19 anti-HMGCR antibody-positive patients and 75 other idiopathic inflammatory myopathies (IIMs) patients. A higher incidence of Bcl-2- and CCR4-positive lymphocytes was detected in the muscle and skin of anti-HMGCR antibody-positive IMNM patients (p < 0.001). In 5 patients with anti-HMGCR antibodies, Bcl-2-positive lymphocytes formed lymphocytic accumulations, which were not observed in other IIMs. Low-density lipoprotein cholesterol levels were not increased except for patients with Bcl-2-positive lymphocytic accumulations (p = 0.010). Bcl-2 and CCR4 lymphocyte infiltrations could be a pathological characteristic of anti-HMGCR antibody-positive IMNM.


Assuntos
Hidroximetilglutaril-CoA Redutases/imunologia , Linfócitos/imunologia , Doenças Musculares/imunologia , Doenças Musculares/patologia , Miosite/imunologia , Miosite/patologia , Proteínas Proto-Oncogênicas c-bcl-2/imunologia , Receptores CCR4/imunologia , Adulto , Anticorpos/imunologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Músculo Esquelético/imunologia , Músculo Esquelético/patologia , Doenças Musculares/complicações , Miosite/complicações , Dermatopatias/imunologia , Dermatopatias/patologia
6.
Neurosci Lett ; 711: 134402, 2019 10 15.
Artigo em Inglês | MEDLINE | ID: mdl-31356844

RESUMO

Motion perceptual deficits are common in Alzheimer's disease (AD). Although the posterior parietal cortex is thought to play a critical role in these deficits, it is currently unclear whether the primary visual cortex (V1) contributes to these deficits in AD. To elucidate this issue, we investigated the net activity or connectivity within V1 in 17 amnestic mild cognitive impairment (aMCI) patients, 17 AD patients and 17 normal controls (NC) using functional magnetic resonance imaging (fMRI). fMRI was recorded under two conditions: visual motion stimulation and resting-state. The net activity or connectivity within V1 extracted by independent component analysis (ICA) was significantly increased during visual motion stimuli compared with that of the resting-state condition in NC, but not in aMCI or AD patients. These findings suggest the alteration of the net activity or connectivity within V1, which may contribute to the previously reported motion perceptual deficits in aMCI and AD. Therefore, the decreased net V1 activity measured as the strength of the ICA component may provide a new disease biomarker for early detection of AD.


Assuntos
Doença de Alzheimer/fisiopatologia , Disfunção Cognitiva/diagnóstico por imagem , Disfunção Cognitiva/fisiopatologia , Córtex Visual/fisiopatologia , Idoso , Doença de Alzheimer/diagnóstico por imagem , Progressão da Doença , Diagnóstico Precoce , Feminino , Humanos , Imageamento por Ressonância Magnética , Masculino , Percepção de Movimento/fisiologia , Estimulação Luminosa , Córtex Visual/diagnóstico por imagem , Vias Visuais/diagnóstico por imagem , Vias Visuais/fisiopatologia
7.
J Stroke Cerebrovasc Dis ; 28(7): 1873-1878, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31103553

RESUMO

BACKGROUND AND PURPOSE: The influence of a weather front passage is rarely evaluated on stroke events. We hypothesized that a weather front passage on the stroke onset day or during the previous days may play an important role in the incidence of stroke. METHODS: A multicenter retrospective study was conducted to evaluate the frequency of stroke events and their interaction with weather front passages. Consecutive acute stroke patients (n = 3935, 73.5 ± 12.4 years, 1610 females) who were admitted to 7 stroke hospitals in 3 cities from January 2012 to December 2013 were enrolled in this study. Multivariate Poisson regression models involving time lag variables were used to compare the daily rates of stroke events with the day of a weather front passage and the previous 6 days, adjusting for considerable influences of ambient temperature and atmospheric pressure. RESULTS: There were a total of 33 cold fronts and 13 warm fronts that passed over the 3 cities during the study period. The frequency of ischemic stroke significantly increased when a warm front passed on the previous day (risk ratio 1.34, 95% confidence interval 1.07-1.69, P= .016). CONCLUSIONS: This study indicated that a weather front passage on the previous days may be associated with the occurrence of stroke.


Assuntos
Isquemia Encefálica/epidemiologia , Temperatura Alta , Acidente Vascular Cerebral/epidemiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Pressão Atmosférica , Isquemia Encefálica/diagnóstico , Criança , Feminino , Humanos , Incidência , Japão/epidemiologia , Masculino , Pessoa de Meia-Idade , Admissão do Paciente , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Acidente Vascular Cerebral/diagnóstico , Fatores de Tempo , Adulto Jovem
8.
J Stroke Cerebrovasc Dis ; 27(12): 3563-3569, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30201457

RESUMO

BACKGROUND: Fabry disease is an X-linked lysosomal storage disorder caused by mutations in GLA, which encodes the enzyme α-galactosidase A (α-Gal A). Although the prevalence of Fabry disease in patients with stroke has been reported to range from 0% to 4%, few cohort studies have examined Japanese stroke patients. We aimed to clarify the prevalence of Fabry disease and the frequency of GLA mutations among patients with young-onset stroke in Japan. METHODS: From April 2015 to December 2016, we enrolled patients with young-onset (≤60 years old) ischemic stroke or intracerebral hemorrhage. We measured α-Gal A activity and the concentration of globotriaosylsphingosine in plasma. Genetic evaluations were performed in patients with low α-Gal A activity or high concentrations of globotriaosylsphingosine. RESULTS: Overall, 516 patients (median age of onset, 52 years old; 120 women) were consecutively enrolled in this study. Five patients (4 men and 1 woman) had low α-Gal A activity, and no patients were detected with the screen for plasma globotriaosylsphingosine levels. The genetic analysis did not identify a causative mutation responsible for classic Fabry disease in any of the patients, but 2 patients (.4%) carried the p.E66Q in GLA. CONCLUSIONS: No patient with Fabry disease was detected in our young-onset stroke cohort.


Assuntos
Isquemia Encefálica/sangue , Hemorragia Cerebral/sangue , Doença de Fabry/sangue , Glicolipídeos/sangue , Esfingolipídeos/sangue , Acidente Vascular Cerebral/sangue , alfa-Galactosidase/sangue , Adulto , Idade de Início , Isquemia Encefálica/enzimologia , Isquemia Encefálica/epidemiologia , Isquemia Encefálica/genética , Hemorragia Cerebral/enzimologia , Hemorragia Cerebral/epidemiologia , Hemorragia Cerebral/genética , Doença de Fabry/enzimologia , Doença de Fabry/genética , Feminino , Humanos , Japão , Masculino , Pessoa de Meia-Idade , Acidente Vascular Cerebral/enzimologia , Acidente Vascular Cerebral/epidemiologia , Acidente Vascular Cerebral/genética , Adulto Jovem , alfa-Galactosidase/genética
9.
Intern Med ; 57(20): 3063-3064, 2018 Oct 15.
Artigo em Inglês | MEDLINE | ID: mdl-29780115
10.
BMJ Case Rep ; 20172017 Dec 20.
Artigo em Inglês | MEDLINE | ID: mdl-29269367

RESUMO

A 55-year-old right-handed man with a history of hypertension suddenly fell and developed right hemiparesis. Neurological examination revealed that he was alert, but did not appropriately respond to verbal questions and commands. Detailed examination revealed that he could correctly respond to written commands. His speech was almost fluent, showing no paraphasia and normal articulation. His written sentences were legible. Pure tone audiometry showed that his auditory acuity was relatively preserved. His brainstem auditory evoked potential components from I to V were recorded bilaterally with normal latency. Cerebral CT demonstrated fresh bleeding in the left putamen and an old haemorrhage on the opposite side. He was treated by antihypertensive therapy and rehabilitation. Although there remained mild sensory deficit on his right extremities and he felt a slight noise during conversation, he had little difficulty with verbal communication when he was transferred to another hospital on day 38.


Assuntos
Acidentes por Quedas , Agnosia/fisiopatologia , Anti-Hipertensivos/uso terapêutico , Potenciais Evocados Auditivos do Tronco Encefálico/fisiologia , Hipertensão/fisiopatologia , Hemorragia Putaminal/fisiopatologia , Agnosia/diagnóstico por imagem , Agnosia/reabilitação , Audiometria de Tons Puros , Percepção Auditiva/fisiologia , Angiografia por Tomografia Computadorizada , Humanos , Hipertensão/complicações , Masculino , Pessoa de Meia-Idade , Hemorragia Putaminal/complicações , Hemorragia Putaminal/diagnóstico por imagem , Fonoterapia , Resultado do Tratamento , Comportamento Verbal/fisiologia
11.
PLoS One ; 12(6): e0178223, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28575005

RESUMO

We hypothesized that meteorological conditions on the onset day and conditions on the former days may play important roles in the modulation of physical conditions. Associations of meteorological factors and their changes in former days with stroke onset are of interest. We conducted a multicenter retrospective study to evaluate the frequency of stroke events and their interaction with meteorological conditions and their daily changes. Acute stroke patients (n = 3935, 73.5±12.4 years, 1610 females) who were admitted to 7 stroke hospitals in three restricted areas were enrolled in this study. Poisson regression models involving time-lag variables was used to compare daily rates of stroke events with mean thermo-hydrological index (THI), atmospheric pressure, and their daily changes. We divided onset days into quintiles based on the THI, atmospheric pressure, and their daily changes for the last 7 days. The frequencies of ischemic stroke significantly increased when THI varied either cooler or warmer from a previous day (extremely cooler, risk ratio (RR) 1.19, 95% confidence interval (CI) 1.05 to 1.34; extremely warmer, RR 1.16, 95% CI 1.03 to 1.31; r2 = 0.001 for the best regression, p = 0.001). Intracerebral hemorrhage frequencies significantly decreased on high-THI days (extremely high, RR 0.72, 95% CI 0.54 to 0.95; r2 = 0.013 for the best regression, p<0.001) and increased in high atmospheric pressure days (high, RR 1.31, 95% CI 1.04 to 1.65; r2 = 0.009 for the best regression, p<0.001). Additionally, even after adjusting for the THI on the onset day and its changes for the other days, intracerebral hemorrhage increased when THI got extremely cooler in 4 days prior (RR 1.33, 95% CI 1.03 to 1.71, r2 = 0.006 for the best regression, p<0.001). Various meteorological conditions may exhibit influences on stroke onset. And, when temperature cooled, there may be a possibility to show delayed influence on the frequency of intracerebral hemorrhage 4 days later.


Assuntos
Hemorragia Cerebral/epidemiologia , Acidente Vascular Cerebral/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Pressão Atmosférica , Feminino , Humanos , Japão/epidemiologia , Masculino , Conceitos Meteorológicos , Pessoa de Meia-Idade , Fatores de Risco , Temperatura
12.
J Immunoassay Immunochem ; 38(2): 127-139, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-27600877

RESUMO

Serum sialic acid (SA) levels are important for diagnosis, follow-up, and mechanistic analysis of malignant diseases. However, little is known about the levels of SA bound to serum IgM. Here, we isolated IgM from sera of healthy individuals and patients with cancer using DEAE chromatography and 8% polyethylene glycol precipitation. In this fraction, which contained partially purified IgM (recovery; 52%; purity: 25%), SA was quantified with fluorescence detection-HPLC (detection limit: 0.08 µM). SA levels in the IgM-enriched fraction was significantly higher in cancer patients (104 ± 27 µM) than in healthy individuals (81 ± 11 µM; P = 0.003).


Assuntos
Imunoglobulina M/sangue , Imunoglobulina M/isolamento & purificação , Ácido N-Acetilneuramínico/sangue , Neoplasias/sangue , Cromatografia Líquida de Alta Pressão , Cromatografia por Troca Iônica , Humanos , Neoplasias/diagnóstico , Polietilenoglicóis/química
13.
J Stroke Cerebrovasc Dis ; 24(12): 2747-53, 2015 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-26360972

RESUMO

OBJECTIVE: Approximately 10 years have passed since intravenous (IV) recombinant tissue plasminogen activator therapy was approved in Japan. The aim of this retrospective study was to identify the effectiveness and safety of IV alteplase therapy with the Japanese original dose around Hiroshima via consideration of the patients' backgrounds, examination findings, and outcomes. METHODS: All consecutive patients with ischemic stroke who received IV alteplase therapy between October 2005 and October 2010 were registered. RESULTS: Four hundred twenty-nine patients with ischemic stroke (172 female [40.1%], mean age 73.7 ± 11.8 years) were registered. The proportion of patients over 75 years old was 51.5% (221 patients). The median National Institutes of Health Stroke Scale (NIHSS) scores at admission were 13 (interquartile range, 9-19), and the NIHSS scores 24 hours after alteplase infusion were 8 (interquartile range, 3-15). The proportion of intracerebral hemorrhage within the initial 36 hours was 20.2% (86 patients). After the multivariate regression analysis, a history of hypertension (odds ratio = 4.14; 95% confidence interval, 1.32-14.79; P = .01) and no recanalization (odds ratio = 10.10; 95% confidence interval, 3.03-39.33; P < .0001) were independently associated with a modified Rankin Scale (mRS) score of 2 or higher at 3 months. Patients over 75 years old were not significantly associated with an intracerebral hemorrhage within the initial 36 hours and an mRS score of 2 or higher at 3 months. CONCLUSIONS: The results of our study demonstrated that IV alteplase therapy with the Japanese original dose was effective and exhibited a safety profile similar to other studies. Moreover, we should not hesitate to IV alteplase therapy simply because of advanced age.


Assuntos
Isquemia Encefálica/tratamento farmacológico , Fibrinolíticos/uso terapêutico , Acidente Vascular Cerebral/tratamento farmacológico , Terapia Trombolítica/efeitos adversos , Ativador de Plasminogênio Tecidual/uso terapêutico , Idoso , Idoso de 80 Anos ou mais , Feminino , Fibrinolíticos/administração & dosagem , Fibrinolíticos/efeitos adversos , Humanos , Japão , Masculino , Pessoa de Meia-Idade , Sistema de Registros , Estudos Retrospectivos , Ativador de Plasminogênio Tecidual/administração & dosagem , Ativador de Plasminogênio Tecidual/efeitos adversos , Resultado do Tratamento
14.
J Stroke Cerebrovasc Dis ; 24(7): 1500-5, 2015 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-25881777

RESUMO

BACKGROUND: Predicting a day that presents a high risk for the occurrence of ischemic stroke events may enable health professionals to prepare for emergency stroke therapy more properly. We evaluated the association between meteorological conditions and the frequency of ischemic stroke events in Japanese patients. METHODS: Ischemic stroke patients (n = 299) who were treated with alteplase at 9 stroke hospitals in 3 restricted areas were examined. The daily rates of ischemic stroke events were compared with the daily mean thermo-hydrological index (THI), the atmospheric pressure, and the daily changes of these variables for the 6 days preceding an ischemic stroke event using Poisson regression analysis. RESULTS: We trisected onset days based on the THI (low-temperature, intermediate-temperature, and high-temperature), atmospheric pressure (low-pressure, intermediate-pressure, and high-pressure), changes in THI for preceding 6 days from the previous day (cooler, unchanged-temperature, and warmer), and changes in atmospheric pressure (decreased-pressure, unchanged-pressure, and increased-pressure). The frequency of ischemic stroke was significantly higher on low-temperature or high-pressure days (risk ratio, 1.398, P = .022; risk ratio, 1.374, P = .039), on warmer-temperature days, and when atmospheric pressure varied from the day before (P < .05). There were significantly lower risks for ischemic stroke events on cooler-temperature days, and higher risks were associated with a variation in atmospheric pressure 3 days before the onset from 4 days before (P < .05). CONCLUSIONS: There were higher risks for ischemic stroke events associated with low ambient temperature, high atmospheric pressure, increased temperature, and varied atmospheric pressure. Also, atmospheric pressure variation 3 days before may be associated.


Assuntos
Isquemia Encefálica/tratamento farmacológico , Fibrinolíticos/efeitos adversos , Acidente Vascular Cerebral/tratamento farmacológico , Terapia Trombolítica/efeitos adversos , Ativador de Plasminogênio Tecidual/efeitos adversos , Tempo (Meteorologia) , Adulto , Idoso , Idoso de 80 Anos ou mais , Pressão Atmosférica , Isquemia Encefálica/diagnóstico , Isquemia Encefálica/epidemiologia , Feminino , Fibrinolíticos/administração & dosagem , Humanos , Japão/epidemiologia , Masculino , Pessoa de Meia-Idade , Recidiva , Medição de Risco , Fatores de Risco , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/epidemiologia , Temperatura , Fatores de Tempo , Ativador de Plasminogênio Tecidual/administração & dosagem , Resultado do Tratamento
15.
Can J Anaesth ; 62(1): 50-3, 2015 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-25224877

RESUMO

PURPOSE: We describe a case of urinary retention caused by viral sacral myeloradiculitis (Elsberg syndrome) that occurred one week after spinal anesthesia. The differential diagnosis of urinary retention after spinal anesthesia is discussed. CLINICAL FEATURES: A 76-yr-old male patient presented for operative removal of a right testicular hydrocele under spinal anesthesia. Anesthesia and surgery were uneventful, and he was discharged on the fifth postoperative day. Two days after discharge, he developed intermittent anal pain and voiding difficulty and was readmitted to hospital on the tenth postoperative day. He subsequently developed urinary retention, incontinence of feces, and difficulty in defecation. Magnetic resonance imaging showed no epidural hematoma, abscess, or other lesions in the spinal column, cauda equina, or spinal cord. Neurological examination showed dysesthesia in the perineal region and loss of the anal reflex and bulbocavernosus response, which indicated sacral (S4-5) radiculopathy or a lesion of the conus of the spinal cord. A cerebrospinal analysis showed slight elevation of protein without pleocytosis. After neurologic consultation, herpetic sacral myeloradiculitis was suspected and intravenous acyclovir was administered along with large doses of methylprednisolone and immunoglobulin. The symptoms gradually resolved, and the difficulty in voiding resolved 19 days after initiation of the treatment. The patient was discharged 23 days after the start of the treatment without any other complications. CONCLUSION: This case suggests that Elsberg syndrome is important in the differential diagnosis of urinary retention after spinal anesthesia and should be discriminated from other anesthesia-related complications.


Assuntos
Raquianestesia/efeitos adversos , Infecções por Herpesviridae/diagnóstico , Radiculopatia/diagnóstico , Retenção Urinária/etiologia , Aciclovir/uso terapêutico , Idoso , Raquianestesia/métodos , Diagnóstico Diferencial , Infecções por Herpesviridae/complicações , Humanos , Imunoglobulinas/uso terapêutico , Masculino , Metilprednisolona/uso terapêutico , Radiculopatia/complicações , Radiculopatia/virologia , Fatores de Tempo , Retenção Urinária/diagnóstico
16.
J Stroke Cerebrovasc Dis ; 23(6): 1485-90, 2014 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-24560246

RESUMO

BACKGROUND: Clopidogrel is sometimes substituted for ticlopidine when cerebrovascular or cardiovascular patients develop hematologic abnormalities after ticlopidine treatment. However, the adverse event rate after the substitution to clopidogrel remains undetermined. Therefore, in this study, we aimed to define the risk of adverse events after substituting clopidogrel for ticlopidine without a washout period. METHODS: We prospectively enrolled patients older than 20 years who had a history of noncardioembolic strokes, including transient ischemic attacks, were treated with ticlopidine for at least 6 months. This study was conducted from August 26, 2008, when the first patient was enrolled, to January 16, 2012, the date of the last patient examination, at 8 active stroke centers in Hiroshima, Japan. We excluded patients who had severe disabilities, evidence of cardioembolic stroke, or history of a bleeding event. Each patient received clopidogrel (either 50 mg or 75 mg) once a day in place of ticlopidine without a washout period. Follow-up exams were scheduled within 12 months after the medication substitution. The primary end point of this study was adverse events of interest, including clinically significant reduced blood cell counts, hepatic dysfunction, bleeding, and other serious side effects. RESULTS: In this study, 110 patients were enrolled and analyzed in an intent-to-treat manner (modified intent to treat). Within the scheduled follow-up periods, 9 primary end point events were observed in separate patients. The primary end point events were observed at a rate of 8.4% per year (Kaplan-Meier method). At the time of enrolment, 16 patients met the exclusion criteria, of which 8 recovered from their abnormal hematologic results to the institutional normal limit after the substitution of ticlopidine for clopidogrel (57.4% per year). CONCLUSIONS: The adverse event rates after the substitution of ticlopidine for clopidogrel is similar to the adverse event rates of patients who were initially treated with clopidogrel. The substitution of clopidogrel for ticlopidine should be considered for patients who develop hematologic abnormalities from ticlopidine treatment.


Assuntos
Isquemia Encefálica/tratamento farmacológico , Substituição de Medicamentos/efeitos adversos , Fibrinolíticos/efeitos adversos , Hemorragia/induzido quimicamente , Acidente Vascular Cerebral/tratamento farmacológico , Ticlopidina/análogos & derivados , Ticlopidina/uso terapêutico , Idoso , Idoso de 80 Anos ou mais , Clopidogrel , Feminino , Fibrinolíticos/uso terapêutico , Humanos , Japão , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Ticlopidina/efeitos adversos , Resultado do Tratamento
17.
J Thorac Cardiovasc Surg ; 142(2): 366-71, 2011 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-21664626

RESUMO

OBJECTIVE: Recently, linear staplers have been used frequently in thoracic surgery; however, air leakage from the staple line is still unresolved. Various buttress materials have been developed to prevent air leakage, but performance is still not satisfactory. We are therefore developing a new material, consisting of calcium alginate nonwoven fabric covered with sodium alginate sponge. METHODS: Thirty-three beagle dogs were divided into 7 groups, and each underwent thoracotomy. Right middle lobe incision was performed with a linear stapler and 1 of the following buttress methods: group A, no buttress; group B, polyglycolic acid nonwoven fabric; group C, fibrin glue alone; group D, polyglycolic acid nonwoven fabric with fibrin glue; group E, polyglycomer sheet; group F, new alginate material; and group G, polyglycolic acid nonwoven fabric plus new alginate material. Burst pressures were measured under mechanical ventilation management. RESULTS: Burst pressures were 12.0 ± 6.8 cm H(2)O in group A, 31.3 ± 6.6 cm H(2)O in group B, 13.9 ± 3.8 cm H(2)O in group C, 26.9 ± 2.8 cm H(2)O in group D, 24.8 ± 1.8 cm H(2)O in group E, 48.5 ± 4.9 cm H(2)O in group F, and 54.2 ± 12.4 cm H(2)O in group G. F and G group pressures reached the target of 40 to 50 cm H(2)O and were significantly higher than those of the 5 conventional groups (P < .0005) CONCLUSIONS: This alginate buttress should be effective for preventing air leakage during operations because it has both sealant and bolster effects working in conjunction.


Assuntos
Alginatos , Pneumonectomia/instrumentação , Suturas , Ar , Animais , Cães , Feminino , Adesivo Tecidual de Fibrina , Ácido Glucurônico , Ácidos Hexurônicos , Pneumotórax/prevenção & controle , Ácido Poliglicólico , Complicações Pós-Operatórias/prevenção & controle , Grampeadores Cirúrgicos
19.
Am J Med Genet B Neuropsychiatr Genet ; 124B(1): 48-9, 2004 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-14681912

RESUMO

Various factors have been suggested to participate in Alzheimer's disease (AD) pathology, and some inflammatory cytokines may play an important role in the development of AD. Interferon-gamma (IFNG), an important pro-inflammatory cytokine, is encoded by a single gene mapped to chromosome 12, one of the candidate locus of AD. The first intron in the IFNG gene represents a CA repeat polymorphism that is possible to affect the IFNG secretion dose. We speculate that the polymorphism may have some roles on the inflammatory process and the pathologic change in AD, so we analyzed the IFNG gene polymorphism in 199 Japanese AD patients and 225 Japanese controls. There were no significant differences in allele frequency between the AD and control groups. We conclude that IFNG gene polymorphism is not associated with development of AD.


Assuntos
Doença de Alzheimer/genética , Repetições de Dinucleotídeos/genética , Interferon gama/genética , Polimorfismo Genético , Idoso , Idoso de 80 Anos ou mais , Alelos , Doença de Alzheimer/patologia , Feminino , Frequência do Gene , Humanos , Masculino , Pessoa de Meia-Idade
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