RESUMEN
Polygenic inheritance plays a central role in Parkinson disease (PD). A priority in elucidating PD etiology lies in defining the biological basis of genetic risk. Unraveling how risk leads to disruption will yield disease-modifying therapeutic targets that may be effective. Here, we utilized a high-throughput and hypothesis-free approach to determine biological processes underlying PD using the largest currently available cohorts of genetic and gene expression data from International Parkinson's Disease Genetics Consortium (IPDGC) and the Accelerating Medicines Partnership-Parkinson's disease initiative (AMP-PD), among other sources. We applied large-scale gene-set specific polygenic risk score (PRS) analyses to assess the role of common variation on PD risk focusing on publicly annotated gene sets representative of curated pathways. We nominated specific molecular sub-processes underlying protein misfolding and aggregation, post-translational protein modification, immune response, membrane and intracellular trafficking, lipid and vitamin metabolism, synaptic transmission, endosomal-lysosomal dysfunction, chromatin remodeling and apoptosis mediated by caspases among the main contributors to PD etiology. We assessed the impact of rare variation on PD risk in an independent cohort of whole-genome sequencing data and found evidence for a burden of rare damaging alleles in a range of processes, including neuronal transmission-related pathways and immune response. We explored enrichment linked to expression cell specificity patterns using single-cell gene expression data and demonstrated a significant risk pattern for dopaminergic neurons, serotonergic neurons, hypothalamic GABAergic neurons, and neural progenitors. Subsequently, we created a novel way of building de novo pathways by constructing a network expression community map using transcriptomic data derived from the blood of PD patients, which revealed functional enrichment in inflammatory signaling pathways, cell death machinery related processes, and dysregulation of mitochondrial homeostasis. Our analyses highlight several specific promising pathways and genes for functional prioritization and provide a cellular context in which such work should be done.
Asunto(s)
Predisposición Genética a la Enfermedad/genética , Lisosomas/metabolismo , Mitocondrias/metabolismo , Enfermedad de Parkinson/metabolismo , Redes Comunitarias , Neuronas Dopaminérgicas/metabolismo , Perfilación de la Expresión Génica/métodos , Humanos , Herencia Multifactorial/fisiologíaRESUMEN
UNLABELLED: The effects of milk intake on bone health are not clear in elderly Asian men with low dietary calcium intake. This study showed that greater milk intake is associated with lower bone turnover, higher bone density, and higher bone microarchitecture index in community-dwelling elderly Japanese men. INTRODUCTION: The consumption of milk or dairy products is widely recommended for maintaining bone health regardless of gender or age. However, little evidence exists on the beneficial effects of milk intake on bone health in elderly Japanese men characterized with relatively low dietary calcium intake. Here we examined whether or not greater milk intake was associated with lower bone turnover, higher bone density, and stronger bone microarchitecture in community-dwelling elderly Japanese men. METHODS: Interviews were conducted to obtain information on medical history and lifestyle, including the amount of habitual milk intake, nutrient intake calculations based on a 1-week food diary, and measurements of areal bone mineral density (aBMD) at the lumbar spine (LS), total hip (TH), and femoral neck (FN) by dual-energy x-ray absorptiometry (DXA), trabecular bone score (TBS) using DXA images at LS, and biochemical markers of bone turnover in sera. Participants with a history of diseases or medications that affect bone metabolism, or with missing data, were excluded from the analysis. RESULTS: The median intake of milk in the 1479 participants (mean age, 73.0 ± 5.1 years) was one glass of milk per day. Bone turnover markers showed a decreasing trend (p < 0.05) and aBMD at TH (p = 0.0019) and FN (p = 0.0057) and TBS (p = 0.0017) showed increasing trends with greater milk intake after adjusting for demographic and behavioral confounding factors. This association was attenuated after further adjusting for nutrient intake, in particular, calcium intake. CONCLUSIONS: Greater milk intake was associated with lower bone turnover, higher aBMD, and higher TBS in community-dwelling elderly Japanese men.
Asunto(s)
Densidad Ósea/fisiología , Remodelación Ósea/fisiología , Calcio de la Dieta/administración & dosificación , Leche , Absorciometría de Fotón/métodos , Anciano , Animales , Biomarcadores/sangre , Dieta/estadística & datos numéricos , Conducta Alimentaria/fisiología , Humanos , Estilo de Vida , Masculino , Estudios ProspectivosRESUMEN
Zonisamide has been proven as an effective drug for the recovery of degenerating dopaminergic neurons in the animal models of Parkinson's disease. However, several lines of evidence have questioned the neuroprotective capacity of zonisamide in animal models of Parkinson's disease. Although it suppresses dopaminergic neurodegeneration in animal models, the cellular and molecular mechanisms underlying the effectiveness of zonisamide are not fully understood. The current study demonstrates the effects of zonisamide on astrocyte cultures and two 6-hydroxydopamine-induced models of Parkinson's disease. Using primary astrocyte cultures, we showed that zonisamide up-regulated the expression of mRNA encoding mesencephalic astrocyte-derived neurotrophic factor, vascular endothelial growth factor, proliferating cell nuclear antigen, metallothionein-2, copper/zinc superoxide dismutase, and manganese superoxide dismutase. Similar responses to zonisamide were found in substantia nigra where the rats were pre-treated with 6-hydroxydopamine. Notably, pharmacological inhibition of 6-hydroxydopamine-induced toxicity by zonisamide pre-treatment was also confirmed using rat mesencephalic organotypic slice cultures of substantia nigra. In addition to this, zonisamide post-treatment also attenuated the nigral tyrosine hydroxylase-positive neuronal loss induced by 6-hydroxydopamine. Taken together, these studies demonstrate that zonisamide protected dopamine neurons in two Parkinson's disease models through a novel mechanism, namely increasing the expression of some important astrocyte-mediated neurotrophic and anti-oxidative factors.
Asunto(s)
Antioxidantes/farmacología , Astrocitos/efectos de los fármacos , Isoxazoles/farmacología , Factores de Crecimiento Nervioso/biosíntesis , ARN Mensajero/biosíntesis , Regulación hacia Arriba/efectos de los fármacos , Animales , Animales Recién Nacidos , Astrocitos/metabolismo , Células Cultivadas , Masculino , Técnicas de Cultivo de Órganos , Ratas , Ratas Wistar , Regulación hacia Arriba/fisiología , ZonisamidaRESUMEN
We have previously reported that transplantation (Tx) of prevascularized donor islets as composite islet-kidneys (IK) reverses diabetic hyperglycemia in miniature swine. In order to test the potential clinical applicability of this strategy, we have extended it to a fully allogeneic nonhuman primate model. IKs were prepared in baboons by isolating islets from 50% to 70% partial pancreatectomies and injecting them under the autologous renal capsule, allowing vascularization before allogeneic Tx. Baboons with diabetes induced by stereptozotocin or total pancreatectomy, received composite IKs (n = 3) or free islets under the renal capsule or intraportally (n = 3), across fully allogeneic barriers with an immunosuppressive regimen consisting of ATG followed by MMF and tacrolimus. FBS of two of IK recipients decreased immediately after Tx and no insulin therapy was required throughout the experimental period (225 and 301 days). In contrast, all recipients of allogeneic free islets showed unstable FBS levels and required insulin within 2 months. We conclude that in addition to maintaining creatinine in the normal range, fully allogeneic IKs from single primate donors can achieve glucose regulation without insulin therapy, while free islets do not. These results support the feasibility of composite allogeneic IK Tx as a potential cure for end-stage diabetic nephropathy.
Asunto(s)
Diabetes Mellitus Experimental/prevención & control , Rechazo de Injerto/prevención & control , Hiperglucemia/prevención & control , Trasplante de Islotes Pancreáticos , Islotes Pancreáticos/irrigación sanguínea , Trasplante de Riñón , Donantes de Tejidos , Animales , Glucemia/metabolismo , Diabetes Mellitus Experimental/inducido químicamente , Femenino , Prueba de Tolerancia a la Glucosa , Rechazo de Injerto/inmunología , Hiperglucemia/inducido químicamente , Masculino , Pancreatectomía , Papio , Porcinos , Porcinos Enanos , Trasplante HomólogoRESUMEN
Clioquinol (CQ) was associated with cases of transient global amnesia and with the neurodegenerative syndrome subacute myelo-optico-neuropathy (SMON) in humans. However, CQ forms lipophilic chelates with cations and has the potential as a scientific and clinical tool used for selective modulation of histochemically reactive zinc pools. The relationship among transient lack of synaptic zinc release, hippocampal long-term potentiation (LTP) induction and cognitive memory is poorly understood. To evaluate the role of synaptic zinc release, in the present study, hippocampal LTP induction and cognitive behavior were examined in young rats after i.p. injection of CQ (30 mg/kg). Intracellular zinc detected by Timm's stain and extracellular (synaptic cleft) zinc detected by ZnAF-2 were significantly decreased in the hippocampus 6 h after CQ injection. The molecular layer of the dentate gyrus, in which perforant path-granule cell synapses exist, was most responsive to CQ injection. Dentate gyrus LTP was induced similarly to the control 2 h after CQ injection, while significantly attenuated 6-24 h after CQ injection. In the training trial of the object recognition memory 2 h after CQ injection, there was no significant difference in learning behavior between the control and CQ-treated rats. In the test trial, CQ-treated rats showed normal recognition memory 1 h after the training, whereas recognition memory deficit 24 h after the training unlike the control rats. These results indicate that acute exposure to CQ impairs long-term (24 h) memory in the hippocampus of young rats. The CQ-mediated attenuation of dentate gyrus LTP, which may be associated with the transient lack of zinc release from zincergic neurons, seems to be involved in the impairment of the long-term memory.
Asunto(s)
Clioquinol/toxicidad , Hipocampo/efectos de los fármacos , Potenciación a Largo Plazo/efectos de los fármacos , Memoria/efectos de los fármacos , Reconocimiento en Psicología/efectos de los fármacos , Animales , Cognición/efectos de los fármacos , Giro Dentado/efectos de los fármacos , Giro Dentado/fisiología , Hipocampo/fisiología , Técnicas In Vitro , Masculino , Ratas , Zinc/fisiologíaRESUMEN
Bone mineral density (BMD) around the femoral component has been reported to decrease after total knee replacement (TKR) because of stress shielding. Our aim was to determine whether a cemented mobile-bearing component reduced the post-operative loss of BMD. In our study 28 knees receiving a cemented fixed-bearing TKR were matched with 28 receiving a cemented mobile-bearing TKR. They underwent dual-energy x-ray absorptiometry, pre-operatively and at three weeks and at three, six, 12, 18 and 24 months post-operatively. The patients were not taking medication to improve the BMD. The pre-operative differences in the BMD of the femoral neck, wrist, lumbar spine and knee in the two groups were not significant. The BMD of the femur decreased postoperatively in the fixed-bearing group, but not the mobile-bearing group. The difference in the post-operative change in the BMD in the two groups was statistically significant (p < 0.05) at 18 and 24 months. Our findings show that a cemented mobile-bearing TKR has a favourable effect on the BMD of the distal femur after TKR in the short term. Further study is required to determine the long-term effects.
Asunto(s)
Artroplastia de Reemplazo de Rodilla/métodos , Prótesis de la Rodilla , Osteoporosis/prevención & control , Absorciometría de Fotón , Anciano , Anciano de 80 o más Años , Artroplastia de Reemplazo de Rodilla/efectos adversos , Artroplastia de Reemplazo de Rodilla/instrumentación , Densidad Ósea , Cementación , Estudios de Cohortes , Femenino , Humanos , Articulación de la Rodilla/fisiopatología , Masculino , Persona de Mediana Edad , Osteoporosis/etiología , Periodo Posoperatorio , Diseño de Prótesis , Rango del Movimiento Articular , Resultado del TratamientoRESUMEN
Clinical transplantation for the treatment of end-stage organ disease is limited by a shortage of donor organs. Successful xenotransplantation could immediately overcome this limitation. The development of homozygous alpha1,3-galactosyltransferase knockout (GalT-KO) pigs removed hyperacute rejection as the major immunologic hurdle to xenotransplantation. Nevertheless, GalT-KO organs stimulate robust immunologic responses that are not prevented by immunosuppressive drugs. Murine studies show that recipient thymopoiesis in thymic xenografts induces xenotolerance. We transplanted life-supporting composite thymokidneys (composite thymus and kidneys) prepared in GalT-KO miniature swine to baboons in an attempt to induce tolerance in a preclinical xenotransplant model. Here, we report the results of seven xenogenic thymokidney transplants using a steroid-free immunosuppressive regimen that eliminated whole-body irradiation in all but one recipient. The regimen resulted in average recipient survival of over 50 days. This was associated with donor-specific unresponsiveness in vitro and early baboon thymopoiesis in the porcine thymus tissue of these grafts, suggesting the development of T-cell tolerance. The kidney grafts had no signs of cellular infiltration or deposition of IgG, and no grafts were lost due to rejection. These results show that xenogeneic thymus transplantation can support early primate thymopoiesis, which in turn may induce T-cell tolerance to solid organ xenografts.
Asunto(s)
Galactosiltransferasas/genética , Trasplante de Riñón/inmunología , Timo/trasplante , Trasplante Heterólogo/inmunología , Animales , Creatinina/sangre , Técnicas de Inactivación de Genes , Trasplante de Riñón/métodos , Papio/inmunología , Proteinuria/etiología , Porcinos , Porcinos Enanos/inmunologíaRESUMEN
The patellar clunk syndrome describes painful catching, grinding or jumping of the patella when the knee moves from a flexed to an extended position after total knee replacement (TKR). The posterior stabilised TKR had been noted to have a higher incidence of this problem. Mobile-bearing posteriorly stabilised TKRs have been introduced to improve patellar tracking and related problems by a mechanism of self-alignment. We evaluated the patellar clunk syndrome in 113 knees in 93 patients with such a TKR at a mean follow-up of 2.3 years (2.0 to 3.2). The syndrome was identified in 15 knees (13.3%). Logistic regression analysis showed that the absolute value of the post-operative angle of patellar tilt was significantly associated with the occurrence of patellar clunk (p = 0.025). Patellar tracking should be carefully checked during surgery.
Asunto(s)
Artroplastia de Reemplazo de Rodilla/efectos adversos , Prótesis de la Rodilla , Síndrome de Dolor Patelofemoral/etiología , Anciano , Anciano de 80 o más Años , Artritis Reumatoide/cirugía , Artroscopía , Femenino , Estudios de Seguimiento , Humanos , Modelos Logísticos , Masculino , Persona de Mediana Edad , Osteoartritis de la Rodilla/cirugía , Diseño de PrótesisRESUMEN
AIMS: Carboxy-terminal telopeptide of type I collagen (ICTP) is a parameter of bone absorption, and has recently been introduced to monitor bone metastases. The aim of this retrospective study was to investigate the potential of ICTP as a candidate serum marker of bone metastasis in prostate cancer. MATERIALS AND METHODS: Serum markers in 155 men pathologically diagnosed with prostate cancer were measured. The serum levels of ICTP, prostate-specific antigen (PSA), and alkali phosphatase (ALP) were compared to assess the extent of disease (EOD) scores from bone scans and then analysed statistically. RESULTS: The serum ICTP levels were not well correlated with the EOD scores in the total group of men, men newly diagnosed with prostate cancer, or men previously diagnosed with prostate cancer who were followed up. The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of ICTP (cut-off value, 5.0 ng/ ml) of the men newly diagnosed with prostate cancer were 78.6%, 88.0%, 78.6%, and 88.0%, respectively. In these men, the specificity and PPV of ALP (cut-off value, 335 IU/l) were 100%, whereas the sensitivity and NPV of PSA (cut-off value, 40 ng/ml) were 100% in this study. The serum levels of ICTP in the men with low ALP (< 335 IU/l) and high PSA (> or = 40 ng/ ml) clearly separated the men with or without bone metastasis, as judged by bone scans. CONCLUSION: We found that the ICTP is not a superior serum marker for bone metastases compared with ALP or PSA. Our study suggests, however, that the ICTP measurement is useful in a certain subset of men with the combination of PSA and ALP in distinguishing men with bone metastasis from those without.
Asunto(s)
Fosfatasa Alcalina/sangre , Neoplasias Óseas/diagnóstico , Neoplasias Óseas/secundario , Colágeno Tipo I/sangre , Péptidos/sangre , Antígeno Prostático Específico/sangre , Neoplasias de la Próstata/diagnóstico , Anciano , Anciano de 80 o más Años , Antagonistas de Andrógenos/uso terapéutico , Biomarcadores/sangre , Progresión de la Enfermedad , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Neoplasias de la Próstata/tratamiento farmacológico , Radioinmunoensayo , Estudios Retrospectivos , Sensibilidad y EspecificidadRESUMEN
Pigmented villonodular synovitis of the temporomandibular joint (TMJ) is rare. We present a patient in whom the lesion had invaded the infratemporal fossa and destroyed the mandibular condyle.
Asunto(s)
Sinovitis Pigmentada Vellonodular/diagnóstico , Trastornos de la Articulación Temporomandibular/diagnóstico , Adulto , Biopsia , Diagnóstico Diferencial , Estudios de Seguimiento , Humanos , Masculino , Cóndilo Mandibular/patología , Hueso Temporal/patologíaRESUMEN
A 64-year-old man was admitted to our hospital with chief complaint of chest discomfort. He received coronary artery bypass grafting utilizing the in situ left internal thoracic artery 10 years ago. Coronary and left subclavian artery angiogram revealed coronary subclavian steal syndrome and 90% stenosis in the proximal left subclavin artery. Ultrasonography of neck vessels demonstrated 75% stenosis in the bifurcation of left carotid artery. We performed axilloaxillary artery bypass grafting to avoid brain ischemia. Myocardial thallium scintigraphy on dipyridamole testing after axilloaxillary artery bypass grafting could not detect myocardial ischemia. Axilloaxillary artery bypass grafting was effective for coronary subclavian steal syndrome.
Asunto(s)
Síndrome del Robo de la Subclavia/cirugía , Arteria Axilar/cirugía , Implantación de Prótesis Vascular , Puente de Arteria Coronaria , Humanos , Masculino , Persona de Mediana Edad , Politetrafluoroetileno , Procedimientos Quirúrgicos Vasculares/métodosRESUMEN
A 50-year-old woman was admitted to our hospital because of heart failure (NYHA III) due to mitral valve regurgitation (MR) with pulmonary hypertension (PH) and tricuspid valve regurgitation (TR). She had a history of chronic renal failure undergoing dialysis (peritoneal dialysis, homodialysis) since 1996. Cardiac catheterization and ultrasonic cardiography showed severe MR (Sellers III), severe TR and PH (mean pressure 33 mmHg). So we performed mitral valve replacement and tricuspid annuloplasty (DeVega). Frequent blood transfusion was needed because severe hemolytic anemia appeared after operation. Ultrasonic cardiography demonstrated moderate aortic valve regurgitation (AR) with no paravalvular prosthetic leakage. We diagnosed hemolytic anemia due to AR. We performed aortic valve replacement. Hemolytic anemia improved soon after second operation. We investigated the mechanical process of the AR. She had a very short subaortic curtain (5.9 mm) compared with the average (8.7 +/- 2.1 mm: mean +/- SD) of cardiac patients. We think that we must be very careful with suture to short subaortic curtain. In addition measurement of subaortic curtain before operation is very useful.
Asunto(s)
Anemia Hemolítica/etiología , Insuficiencia de la Válvula Aórtica/etiología , Insuficiencia de la Válvula Mitral/cirugía , Complicaciones Posoperatorias/etiología , Válvula Aórtica/patología , Insuficiencia de la Válvula Aórtica/cirugía , Femenino , Implantación de Prótesis de Válvulas Cardíacas , Humanos , Persona de Mediana Edad , Reoperación , Técnicas de SuturaRESUMEN
We studied 185 total hip replacements and related the identification of radiolucent lines (RLLs) at two years to the later development of lytic lesions and loosening. Linear polyethylene wear was also measured. RLLs appeared in 34 hips at a mean of 2.0 years after operation, and lytic lesions in ten hips at 5.7 years. Of 151 THRs without RLLs there was neither rapid migration nor loosening and only one developed a possible lytic lesion. Of 23 hips with non-progressive RLLs there was neither rapid migration nor loosening, but six developed a lytic lesion. By contrast, 11 THRs with progressive RLLs migrated rapidly and seven developed a lytic lesion. Six THRs with progressive RLLs failed. The wear rates were the same in all groups, although limited numbers were available for study. If the surgeon achieves secure initial fixation as shown by slow or no migration and no RLLs during the first two years, it is likely that no lytic lesions will develop by five years or aseptic loosening by ten years. If an imperfect, but adequate, interface is achieved, as shown by slow migration and non-progressive RLLs lytic lesions adjacent to the RLLs may develop by five years, but aseptic loosening will be unlikely at ten. Insecure initial fixation, as shown by more rapid migration and progressive RLLs at two years, is likely to lead to the formation of lytic lesions at five years and loosening at ten. The outcome after THR is therefore determined at the initial operation and may be predicted at two years. The presence of lytic lesions reflects soft tissue at the interface as shown by the RLLs which accompany and promote loosening but, in our study, did not cause it.
Asunto(s)
Cementos para Huesos , Articulación de la Cadera/diagnóstico por imagen , Prótesis de Cadera , Anciano , Anciano de 80 o más Años , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Falla de Prótesis , RadiografíaRESUMEN
BACKGROUND: Lip carcinomas are rare oral tumors, and there have been few reports of lip carcinoma in Japan. METHODS: Of 914 patients with oral carcinomas treated between January 1980 and December 1998, 12 (1.3%) had lip carcinoma and 5 (0.5%) had lip mucosal carcinoma. We investigated the clinicopathological features of these 17 patients. RESULTS: Of the 12 patients with carcinoma of the lip, 10 had squamous cell carcinomas (9, external lower lip; 1 commissures) and 2 had mucoepidermoid carcinomas (external upper lip). Of the 5 patients with lip mucosal carcinoma, 3 had squamous cell carcinomas (2, mucosa of the lower lip; 1, mucosa of the upper lip), 1 had mucoepidermoid carcinoma (mucosa of the lower lip), and 1 had acinic cell carcinoma (mucosa of the lower lip). Of the 12 patients with lip carcinoma, 9 were classified as stage I, 2 as stage II, and 1 as stage III; all 5 of the patients with lip mucosal carcinoma were stage I. Five patients with lip carcinoma were treated by resection, 5 by a combination of resection and reconstruction, and 2 by radiotherapy alone. All patients with lip mucosal carcinoma were treated by resection. After the initial therapy, 3 patients without neck dissection had regional recurrences and received delayed neck dissection, and 2 died with neck regional recurrence after dissection. The 5-year cumulative survival rates of the patients with lip carcinoma and those with lip mucosal carcinoma were 82.5% and 80.0%, respectively. CONCLUSION: We suggest that early-stage carcinomas of the lip and of the mucosa of the upper and lower lips are frequent, and we found that the outcome of these patients was excellent. However, an aggressive therapeutic approach to the lip carcinoma patient with cervical metastasis appears warranted, in an attempt to improve locoregional control and ultimate survival.
Asunto(s)
Carcinoma/patología , Carcinoma/cirugía , Neoplasias de los Labios/patología , Neoplasias de los Labios/cirugía , Anciano , Anciano de 80 o más Años , Carcinoma/radioterapia , Femenino , Humanos , Neoplasias de los Labios/radioterapia , Masculino , Persona de Mediana Edad , Disección del Cuello , Estadificación de Neoplasias , Pronóstico , Procedimientos de Cirugía Plástica , Estudios Retrospectivos , Análisis de SupervivenciaRESUMEN
We present the case of a patient with atrial septal defect and severe pulmonary hypertension with pulmonary artery peak pressure greater than 110 mm Hg. Open lung biopsy was done prior to the corrective operation, and pathological findings in the small pulmonary arteries included "musculoelastosis" and complete occlusion of 70% of these small arteries and arterioles. The atrial septal defect was closed, and long-term oral prostacyclin therapy was initiated. Pulmonary artery peak pressure decreased to 65 mm Hg 2 years after the operation. This case demonstrates that in a patient with 70% complete occlusion of small pulmonary arteries and arterioles resulting from "musculoelastosis," not only is surgical intervention possible but also pulmonary artery pressure decreases in the long term after operation.
Asunto(s)
Defectos del Tabique Interatrial/cirugía , Hipertensión Pulmonar/fisiopatología , Adulto , Antihipertensivos/uso terapéutico , Biopsia , Presión Sanguínea , Tejido Elástico/patología , Epoprostenol/uso terapéutico , Femenino , Defectos del Tabique Interatrial/complicaciones , Hemodinámica , Humanos , Hipertensión Pulmonar/complicaciones , Hipertensión Pulmonar/tratamiento farmacológico , Hipertensión Pulmonar/patología , Músculo Liso Vascular/patología , Arteria Pulmonar/patologíaRESUMEN
Results of total hip arthroplasties with a modified cementing technique using hydroxyapatite were evaluated. Femoral and acetabular components were inserted with cement after hydroxyapatite granules (phi = 100-300 microm). The study group comprised 268 hips in 232 patients. The diagnosis was osteoarthritis in 197 patients. After a mean follow-up of 10.3 years, 5 patients died and 30 patients were lost to follow-up, leaving 218 hips (197 patients; mean age, 58.2 years) for evaluation. Three hips were revised because aseptic (1) and septic (2) loosening of acetabular components. Six other sockets were defined as radiologically loose, and no femoral component was loose. Osteolysis was identified in 2 femora and 0 acetabula. The overall loosening rate was 3.2% for acetabular components and 0% for femoral components. These results show that the loosening rate of cemented total hip arthroplasty components, especially the acetabulum, is reduced markedly with this modified cementing technique.
Asunto(s)
Artroplastia de Reemplazo de Cadera , Cementos para Huesos , Durapatita , Osteoartritis de la Cadera/cirugía , Anciano , Anciano de 80 o más Años , Artroplastia de Reemplazo de Cadera/instrumentación , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Osteólisis/diagnóstico por imagen , Osteólisis/cirugía , Diseño de Prótesis , Falla de Prótesis , Radiografía , Reoperación , Instrumentos QuirúrgicosRESUMEN
We report a case of inflammatory pseudotumor of the kidney. A 73-year-old man presenting with general malaise and minimal grade fever visited a medical department in our hospital. Computerized tomography incidentally revealed a tumor, 3.5 cm in diameter, in the lower pole of the left kidney, and he was referred to our outpatient department. Selective left renal arteriography disclosed an avascular mass on the affected site. Left radical nephrectomy was performed under the diagnosis of avascular renal cell carcinoma. Histological examination demonstrated a tumor composed of spindle-shaped fibroblastic cells infiltrated by variable numbers of plasma cells, small lymphocytes and histiocytes. The pathologic diagnosis was renal inflammatory pseudotumor. Fourteen previously reported cases of this tumor have reviewed in the literature.
Asunto(s)
Granuloma de Células Plasmáticas/diagnóstico , Enfermedades Renales/diagnóstico , Anciano , Granuloma de Células Plasmáticas/patología , Granuloma de Células Plasmáticas/cirugía , Humanos , Enfermedades Renales/patología , Enfermedades Renales/cirugía , Imagen por Resonancia Magnética , MasculinoRESUMEN
We compared the usefulness of PSA and PSA density (PSAD) in diagnosing prostate cancer in 102 men who had a PSA value higher than 4.0 ng/ml and normal digital rectal examination and who had undergone transrectal ultrasonography-guided systematic sextant biopsies of the prostate between August 1996 and October 1999. In addition, for a group of 53 patients who underwent retropubic simple prostatectomy, PSA, PSAD and PSA transition zone (PSA-TZ) examination results for those with stage A prostate cancer were compared with the results for those with benign prostatic hyperplasia (BPH). Of the former 102 men, 20 (19.6%) had prostate cancer. There was no significant difference in mean PSA level between patients with negative and those with positive biopsy results (mean 9.3 and 11.8, respectively, p = 0.295), but the mean PSAD of patients with positive biopsy results was significantly higher than that of those with negative results (mean 0.55 and 0.29, respectively, p = 0.0007). Of the 53 men who underwent retropubic simple prostatectomy, 10 (18.9%) were diagnosed with stage A prostate cancer. There was no significant difference in mean PSA, PSAD and PSA-TZ examination results between patients with BPH and those with stage A prostate cancer. For all 102 patients and for 71 patients with PSA levels of 4.1-10.0 ng/ml, a PSAD cutoff value of 0.1 reduced the number of biopsies 15.7% (16 of 102 cases), and 22.5% (16 of 71 cases), respectively. These results suggest that by measurement of PSAD some patients with benign disease could be spared a biopsy which would have been performed based on PSA results alone.
Asunto(s)
Palpación , Antígeno Prostático Específico/sangre , Neoplasias de la Próstata/diagnóstico , Recto/fisiología , Anciano , Anciano de 80 o más Años , Biopsia , Diagnóstico Diferencial , Humanos , Masculino , Persona de Mediana Edad , Estadificación de Neoplasias , Valor Predictivo de las Pruebas , Próstata/patología , Hiperplasia Prostática/diagnóstico , Neoplasias de la Próstata/patologíaRESUMEN
A 26-year-old man was referred to our hospital for further evaluation of a cystic lesion in the pelvis. He was completely asymptomatic, although he experienced gross hematuria 10 months before his visit. Drip infusion pyelography (DIP) and abdominal computerized tomography (CT) showed a cystic structure behind the bladder and absence of the left kidney. Transrectal ultrasonography (TRUS) suggested left ejaculatory duct obstruction and seminal vesicle deformity. On cystoscopy a large bulging mass under the left side of the bladder was seen. The left half of the trigone and left ureteral orifice were absent. Vasovesiculography demonstrated dilated and tortuous left seminal vesicle. Three days after this procedure, the patient suffered left epididymitis. It did not respond rapidly to antibiotic therapy, so percutaneous drainage of the cyst was performed. He has been completely free of symptoms and no seminal vesicle cysts have been detected on TRUS at five months follow-up.