RESUMEN
Skeletal Class III patients exhibit malocclusion characterised by Angle Class III and anterior crossbite, and their occlusion shows total or partially lateral crossbite of the posterior teeth. Most patients exhibit lower bite force and muscle activity than non-affected subjects. While orthognathic surgery may help improve masticatory function in these patients, its effects have not been fully elucidated. The aims of the study were to evaluate jaw movement and the electromyographic (EMG) activity of masticatory muscles before and after orthognathic treatment in skeletal Class III patients in comparison with control subjects with normal occlusion. Jaw movement variables and EMG data were recorded in 14 female patients with skeletal Class III malocclusion and 15 female controls with good occlusion. Significant changes in jaw movement, from a chopping to a grinding pattern, were observed after orthognathic treatment (closing angle P < 0.01; cycle width P < 0.01), rendering jaw movement in the patient group similar to that of the control group. However, the grinding pattern in the patient group was not as broad as that of controls. The activity indexes, indicating the relative contributions of the masseter and temporalis muscles (where a negative value corresponds to relatively more temporalis activity and vice versa) changed from negative to positive after treatment (P < 0.05), becoming similar to those of control subjects. Our findings suggest that orthognathic treatment in skeletal Class III patients improves the masticatory chewing pattern and muscle activity. However, the chewing pattern remains incomplete compared with controls.
Asunto(s)
Maxilares/fisiopatología , Maloclusión de Angle Clase III/fisiopatología , Masticación/fisiología , Músculos Masticadores/fisiopatología , Movimiento/fisiología , Adolescente , Adulto , Fuerza de la Mordida , Estudios de Casos y Controles , Electromiografía/métodos , Femenino , Humanos , Maloclusión de Angle Clase III/cirugía , Procedimientos Quirúrgicos Ortognáticos , Resultado del Tratamiento , Adulto JovenRESUMEN
A posterior cross-bite is defined as an abnormal bucco-lingual relationship between opposing molars, pre-molars or both in centric occlusion. Although it has been reported that patients with unilateral posterior cross-bite often show unique chewing patterns, the relationship between the form of cross-bite and masticatory jaw movement remains unclear in adult patients. The objective of this study was to investigate masticatory jaw movement among different forms of cross-bite. One hundred and one adults were recruited in this study: 27 had unilateral first molar cross-bite (MC group); 28, unilateral pre-molar cross-bite (PC group); 23, anterior cross-bite (AC group); and 23, normal occlusion (control group). Masticatory jaw movement of the lower incisor point was recorded with six degrees of freedom jaw-tracking system during unilateral mastication. Our results showed that the reverse chewing ratio during deliberate unilateral mastication was significantly larger in the MC group than in the PA (P < 0.001), AC (P < 0.001) and control (P < 0.001) groups. These findings suggest that compared to the anterior or pre-molar cross-bite, the first molar cross-bite is more closely associated with a higher prevalence of a reverse chewing cycle.
Asunto(s)
Diente Premolar/fisiopatología , Maloclusión/fisiopatología , Masticación/fisiología , Diente Molar/fisiopatología , Femenino , Humanos , Masculino , Adulto JovenRESUMEN
Scissors-bite is a malocclusion characterised by buccal inclination or buccoversion of the maxillary posterior tooth and/or linguoclination or linguoversion of the mandibular posterior tooth. This type of malocclusion causes reduced contact of the occlusal surfaces and can cause excessive vertical overlapping of the posterior teeth. This case-control study is the first to evaluate both masticatory jaw movement and masseter and temporalis muscle activity in patients with unilateral posterior scissors-bite. Jaw movement variables and surface electromyography data were recorded in 30 adult patients with unilateral posterior scissors-bite malocclusion and 18 subjects with normal occlusion in a case-control study. The chewing pattern on the scissors-bite side significantly differed from that of the non-scissors-bite side in the patients and of the right side in the normal subjects. These differences included a narrower chewing pattern (closing angle, P < 0.01; cycle width, P < 0.01), a longer closing duration (P < 0.05), a slower closing velocity (P < 0.01) and lower activities of both the temporalis (P < 0.05) and the masseter (P < 0.05) muscles on the working side. In 96% of the patients with unilateral posterior scissors-bite, the preferred chewing side was the non-scissors-bite side (P = 0.005). These findings suggest that scissors-bite malocclusion is associated with the masticatory chewing pattern and muscle activity, involving the choice of the preferred chewing side in patients with unilateral posterior scissors-bite.
Asunto(s)
Maloclusión/fisiopatología , Músculo Masetero/fisiopatología , Masticación/fisiología , Músculo Temporal/fisiopatología , Adulto , Estudios de Casos y Controles , Electromiografía , Femenino , Humanos , Masculino , Movimiento/fisiología , Adulto JovenRESUMEN
It is known that maximum bite force has various influences on chewing function; however, there have not been studies in which the relationships between maximum bite force and masticatory jaw movement have been clarified. The aim of this study was to investigate the effect of maximum bite force on masticatory jaw movement in subjects with normal occlusion. Thirty young adults (22 men and 8 women; mean age, 22.6 years) with good occlusion were divided into two groups based on whether they had a relatively high or low maximum bite force according to the median. The maximum bite force was determined according to the Dental Prescale System using pressure-sensitive sheets. Jaw movement during mastication of hard gummy jelly (each 5.5 g) on the preferred chewing side was recorded using a six degrees of freedom jaw movement recording system. The motion of the lower incisal point of the mandible was computed, and the mean values of 10 cycles (cycles 2-11) were calculated. A masticatory performance test was conducted using gummy jelly. Subjects with a lower maximum bite force showed increased maximum lateral amplitude, closing distance, width and closing angle; wider masticatory jaw movement; and significantly lower masticatory performance. However, no differences in the maximum vertical or maximum anteroposterior amplitudes were observed between the groups. Although other factors, such as individual morphology, may influence masticatory jaw movement, our results suggest that subjects with a lower maximum bite force show increased lateral jaw motion during mastication.
Asunto(s)
Fuerza de la Mordida , Mandíbula/fisiología , Masticación/fisiología , Adulto , Oclusión Dental , Femenino , Alimentos , Dureza , Humanos , MasculinoAsunto(s)
Inhibidores de la Enzima Convertidora de Angiotensina/administración & dosificación , Antihipertensivos/administración & dosificación , Bloqueadores de los Canales de Calcio/administración & dosificación , Glomerulonefritis por IGA/tratamiento farmacológico , Hipertensión Renal/tratamiento farmacológico , Adulto , Preparaciones de Acción Retardada , Quimioterapia Combinada , Femenino , Glomerulonefritis por IGA/complicaciones , Humanos , Hipertensión Renal/complicacionesRESUMEN
The association of the angiotensinogen (AGT) gene variation at codon 235, the T235 variant, with hypertension induced by erythropoietin (Epo) was investigated in patients with progressive renal disease requiring treatment for renal anemia with Epo. The subjects for the study were patients with renal diseases with serum creatinine concentration exceeding 2 mg/dl and a hematocrit (Ht) of less than 30%. During the run-in period, blood pressure was well controlled with an appropriate salt restricted diet and/or antihypertensive treatment. The patients were then given 6,000 IU of Epo once a week until the Ht rose by 5%. For the overall patient group, AGT gene polymorphism analysis revealed T235T (T/T) in 31 cases (61%), M235T (M/T) in 19 cases (37%), and M235M (M/M) in 1 case (2%). In response to treatment with Epo, hypertension (defined as an increase in mean blood pressure greater than 10 mmHg) was found in 11 cases (22%), all of who carried the homozygous T allele (T/T). On the other hand, the frequency of T/T in patients who did not develop hypertension was 50% (T/T:T/M=20:19 cases), indicating a significant difference (p=0.003 by Chi-square). Variables estimated to be associated with Epo-induced hypertension were the T allele, gender (male), and the degree of increase in Ht, in descending order. Our preliminary research indicates that individuals who carry two copies of the T allele, i.e., who are homozygous for T, are highly susceptible to development of hypertension when subjected to Epo. These results suggest that the AGT T235 variant may be the primary gene responsible for the development of Epo-induced hypertension.
Asunto(s)
Angiotensinógeno/genética , Eritropoyetina/efectos adversos , Hipertensión Renal/inducido químicamente , Hipertensión Renal/genética , Polimorfismo Genético , Adulto , Anciano , Presión Sanguínea/efectos de los fármacos , Femenino , Marcadores Genéticos , Predisposición Genética a la Enfermedad , Genotipo , Humanos , Masculino , Persona de Mediana Edad , Proyectos PilotoAsunto(s)
Corticoesteroides/uso terapéutico , Diálisis Peritoneal/efectos adversos , Peritonitis/tratamiento farmacológico , Prednisolona/uso terapéutico , Adulto , Candidiasis/complicaciones , Femenino , Humanos , Masculino , Resistencia a la Meticilina , Persona de Mediana Edad , Peritonitis/microbiología , Peritonitis/mortalidad , Infecciones por Pseudomonas/complicaciones , Pseudomonas aeruginosa , Estudios Retrospectivos , Esclerosis , Infecciones Estafilocócicas/complicaciones , Staphylococcus aureus , Resultado del TratamientoAsunto(s)
Angiotensina II/metabolismo , Antagonistas de Receptores de Angiotensina , Inhibidores de la Enzima Convertidora de Angiotensina/uso terapéutico , Bloqueadores de los Canales de Calcio/uso terapéutico , Diabetes Mellitus Tipo 1/complicaciones , Nefropatías Diabéticas/tratamiento farmacológico , Proteinuria/tratamiento farmacológico , Adulto , Nefropatías Diabéticas/orina , Quimioterapia Combinada , Enalapril/uso terapéutico , Femenino , Humanos , Losartán/uso terapéuticoRESUMEN
Levels of adrenomedullin (AM) have been shown to be elevated in hypertension and chronic renal failure, suggesting that AM plays a role in the pathogenesis of these diseases. The objective of the present study was to investigate whether circulating AM is involved in erythropoietin (Epo)-induced hypertension in patients with renal anemia due to progressive renal disease. Following treatment with 6,000 IU of Epo once a week, the hematocrit (Ht) rose significantly from 25.9+/-4.0 to 33.4+/-3.3% (n=54, p<0.001) with an overall rate of increase in Ht of 0.43+/-0.04%/week. In response to treatment with Epo, a rise in mean blood pressure of >10 mmHg (Epo-induced hypertension) was found in 22% (12/54 cases) of the patients enrolled. There was no difference in the rate of Ht increase between patients with and without Epo-induced hypertension. There was a significant positive correlation between mature AM and serum creatinine (Cr) concentration before treatment with Epo. However, no correlation was found between the plasma concentration of total AM and serum Cr concentration. Long-term treatment with Epo did not influence plasma concentration of either mature AM or total AM in patients developing hypertension during the study period. These results suggest that circulating AM may play a role in the progression of renal disease. However, the present study does not support the notion that circulating AM is associated with the pathogenesis of Epo-induced hypertension. It is too early yet to claim that there is no AM-mediated mechanism in Epo-induced hypertension.
Asunto(s)
Eritropoyetina/efectos adversos , Hipertensión/sangre , Hipertensión/inducido químicamente , Péptidos/sangre , Adrenomedulina , Adulto , Anciano , Anemia/sangre , Anemia/tratamiento farmacológico , Anemia/etiología , Creatinina/sangre , Hematócrito , Humanos , Fallo Renal Crónico/sangre , Fallo Renal Crónico/complicaciones , Persona de Mediana EdadRESUMEN
The periodic structure of 24-hour blood pressure variation(circadian rhythm of blood pressure by ambulatory blood pressure monitoring(ABPM) in hypertensive CAPD patients was investigated by a new method of analysis based upon the maximum entropy method(MEM). In addition, this method allows the adequacy of antihypertensive therapies to be evaluated in such patients. The results were as follows; 1) The frequency of non-dipper type hypertension was 88%(36/41 cases), and the remaining 12% (5/41) were dipper type hypertension patients. The rise in morning blood pressure(morning surge: MS) was noted in 64% of the former. 2) Night time systolic blood pressure(182 +/- 22 mmHg, n = 36) was higher in patients with non-dipper type hypertension than in those with the dipper type(151 +/- 17 mmHg, n = 5, p < 0.01). 3) The standardized level of systolic blood pressure(SLSBP) calculated by MEM analysis in patients with non-dipper type hypertension(177 +/- 7 mmHg) was comparable with that in those with dipper type hypertension(168 +/- 13 mmHg, ns). 4) Treatment with long-acting Ca antagonist alone significantly reduced both SLSBP and the area over the SLSBP from 188 +/- 18 mmHg to 160 +/- 7 mmHg(p < 0.01, n = 8), and area over the SLSBP from 2,735 +/- 340 mmHg.hr to 1,945 +/- 298 mmHg.hr(p < 0.01, n = 8). 5) In addition to long-acting Ca antagonist, administration of alpha 1-blocker given at bed time was significantly efficacious in reducing the rise in morning blood pressure, MS. The present study using MEM analysis of ABPM suggests that the blood pressure profile of hypertensive CAPD patients is characterized by a non-dipper type dominance and a frequent morning surge. Furthermore, the combined therapy with long-acting Ca antagonist and alpha 1-blocker was substantially effective both in reducing the overall blood pressure level, and in inhibiting the MS. This combined antihypertensive therapy may be potentially useful to prevent CAPD patients from the future development of cardiovascular complications.
Asunto(s)
Monitoreo Ambulatorio de la Presión Arterial/métodos , Hipertensión/tratamiento farmacológico , Hipertensión/fisiopatología , Diálisis Peritoneal Ambulatoria Continua/efectos adversos , Antagonistas Adrenérgicos alfa/administración & dosificación , Anciano , Amlodipino/administración & dosificación , Presión Sanguínea , Bloqueadores de los Canales de Calcio/administración & dosificación , Ritmo Circadiano , Preparaciones de Acción Retardada , Doxazosina/administración & dosificación , Quimioterapia Combinada , Femenino , Humanos , Hipertensión/etiología , Masculino , Persona de Mediana EdadRESUMEN
We have investigated the clinical characteristics of renal damage and associated complications of 79 patients with accidental hypothermia whom we encountered over the last 5 years. All patients were male, with an average age of 58.9 +/- 9.2 years. Most of these patients were homeless. Body temperature on admission was 29.3 +/- 3.0 degrees C. The most common clinical manifestations on admission were consciousness disturbance and severe hypotension. Complications, including increase in serum transaminase, alcoholism, pneumonia, liver cirrhosis, sepsis, diabetes mellitus, hypoglycemia, acidosis, and an increased level of serum CPK and amylase were found frequently on admission. Death within 48 hours after admission occurred in 23 cases (the death rate; 23/79 = 29%). Renal damage was found in 36 cases (36/79 = 46%), consisting of acute renal failure (ARF) in 27, and acute on chronic in 6. Urinary diagnostic indices suggested that the etiological factor for ARF was pre-renal, which responded well to passive rewarming and an appropriate fluid replacement therapy, resulting in full recovery in most of the cases (the recovery rate; 25/27 = 93%). Among patients with renal damage, there were no cases requiring dialysis. The present data suggest that accidental hypothermia is a fatal condition with an extremely high death rate. It also is associated with multiple complications including ARF. The main cause for ARF is pre-renal, possibly caused by cold diuresis or dehydration superimposed on the underlying diseases such as alcoholism, diabetes mellitus, liver cirrhosis. Such complications, independent of renal damage, determine the patient's prognosis.
Asunto(s)
Lesión Renal Aguda/complicaciones , Hipotermia/complicaciones , Lesión Renal Aguda/epidemiología , Anciano , Humanos , Hipotensión/complicaciones , Pruebas de Función Renal , Masculino , Persona de Mediana Edad , Trastornos Urinarios/complicacionesRESUMEN
A 54-year-old male patient presented with a granulocyte colony-stimulating factor (G-CSF)-producing primary pericardial mesothelioma, while showing symptoms of congestive heart failure, a fever of 38 to 39 degrees C, and marked leucocytosis of 52.7 x 10(3) cells/mm3. The histopathologic diagnosis was established after autopsy. G-CSF production was confirmed by the expression of G-CSF mRNA in the tumor extract and the patient's high serum G-CSF concentration. The expression of G-CSF by benign and malignant mesothelial cells has already been reported. However, this is the first case report of G-CSF production in a pericardial mesothelioma.
Asunto(s)
Factor Estimulante de Colonias de Granulocitos/metabolismo , Neoplasias Cardíacas/metabolismo , Mesotelioma/metabolismo , Pericardio , Resultado Fatal , Factor Estimulante de Colonias de Granulocitos/sangre , Factor Estimulante de Colonias de Granulocitos/genética , Neoplasias Cardíacas/sangre , Neoplasias Cardíacas/genética , Neoplasias Cardíacas/patología , Humanos , Masculino , Mesotelioma/sangre , Mesotelioma/genética , Mesotelioma/patología , Persona de Mediana Edad , ARN Mensajero/metabolismo , Reacción en Cadena de la Polimerasa de Transcriptasa InversaRESUMEN
The observation that antiplatelet therapy may decrease the incidence of Epo-induced hypertension in dialysis patients remains a subject of particular interest. The aim of the present study was to test this hypothesis in patients at the predialysis stage. Predialysis patients with renal anemia were treated with EPO (6000 IU/week) for 6-12 months. Patients were divided into two groups, one of which received antiplatelet therapy and the other did not, and a comparison was made between them with respect to the incidence of EPO-induced hypertension. Logistic regression analysis was used to determine the risk factors for developing hypertension during the EPO therapy. Such predictors included age, gender, antecedent of hypertension, antiplatelet drugs and diabetes mellitus. Overall, 66 patients were enrolled in the study and 18 developed hypertension (27%). Out of the 35 patients not receiving antiplatelet therapy, 15 developed hypertension (43%). In contrast, out of the 31 patients receiving antiplatelet therapy, only 3 (10%) developed hypertension (p=0.003 by Chi square test). Multiple regression analysis showed that the best predictive variables for the development of hypertension were antecedent of hypertension (odds ratio: 0.064, p=0.0118), and use of antiplatelet drugs (odds ratio: 5.081, p=0.0295). The present data provide evidence that antiplatelet therapy may prevent EPO-induced hypertension in predialysis patients. However, the mechanism to explain such an effect still remains to be elucidated.
Asunto(s)
Eritropoyetina/efectos adversos , Hipertensión/prevención & control , Inhibidores de Agregación Plaquetaria/uso terapéutico , Adulto , Anciano , Anemia/sangre , Anemia/tratamiento farmacológico , Anemia/etiología , Dilazep/uso terapéutico , Dipiridamol/uso terapéutico , Femenino , Hematócrito , Humanos , Hipertensión/etiología , Enfermedades Renales/complicaciones , Enfermedades Renales/terapia , Masculino , Persona de Mediana Edad , Proteínas Recombinantes , Diálisis Renal , Factores de RiesgoRESUMEN
OBJECTIVE: The preservation of ultrafiltration (UF) capacity is crucial to maintaining long-term continuous ambulatory peritoneal dialysis (CAPD).The aim of the present study was to investigate whether the antiplasmin agent tranexamic acid (TNA) increases UF volume in CAPD patients. PATIENTS AND METHODS: Fifteen patients on CAPD, 5 with UF loss and 10 without UF loss, were recruited for the study. The effect of TNA was evaluated with respect to changes in UF volume, peritoneal permeability, peritoneal clearance, bradykinin (BK), and tissue plasminogen activator (tPA) concentration. SETTING: Dialysis unit of the Saiseikai Central Hospital. RESULTS: In patients with UF loss, 2 weeks of treatment with oral TNA produced a significant increase in UF volume in all subjects (5/5).TNA also produced a significant increase in peritoneal clearances of urea and creatinine (Cr). However, the peritoneal equilibration test (PET) revealed that TNA had no effect on dialysate/plasma (D/P) Cr, Kt/V, or the protein catabolic rate (PCR).TNA also had no effect on net glucose reabsorption. In contrast, significant decreases in BK and blood tPA concentrations in response to TNA treatment were noted. BK concentration in drainage fluid was also reduced. In the case of patients without UF loss,TNA produced an increase in UF volume in 70% (7/10). However, no differences were found in blood and drainage BK and tPA concentrations between theTNA treatment and nontreatment periods in these patients. A comparison of basal BK and tPA concentration showed that there were no differences in these parameters between patients with UF loss and those without loss of UF. Furthermore,TNA given intraperitoneally to a patient also produced a marked increase in UF volume. CONCLUSION: The present study suggests thatTNA enhances UF volume in patients both with and without UF loss. SinceTNA did not affect peritoneal permeability and glucose reabsorption, the mechanism by which TNA exerts an enhancing action on UF is largely unknown. We speculate that it may be associated with suppression of the BK and/or tPA system, at least in patients with UF loss.
Asunto(s)
Antifibrinolíticos/uso terapéutico , Diálisis Peritoneal Ambulatoria Continua , Peritoneo/efectos de los fármacos , Ácido Tranexámico/uso terapéutico , Absorción , Administración Oral , Adulto , Anciano , Antifibrinolíticos/administración & dosificación , Proteínas Sanguíneas/metabolismo , Bradiquinina/análisis , Bradiquinina/sangre , Creatinina/análisis , Creatinina/sangre , Soluciones para Diálisis/análisis , Femenino , Glucosa/farmacocinética , Humanos , Inyecciones Intraperitoneales , Masculino , Persona de Mediana Edad , Peritoneo/metabolismo , Permeabilidad/efectos de los fármacos , Activador de Tejido Plasminógeno/análisis , Activador de Tejido Plasminógeno/sangre , Ácido Tranexámico/administración & dosificación , Ultrafiltración , Urea/análisis , Urea/sangreRESUMEN
A 32-year-old man who had had frequent gouty arthritis over the past 17 years, was admitted for acute renal failure. Acute renal failure was improved rapidly after medication was resumed and the patient was sufficiently hydrated. The hypoxanthine-guanine phosphoribosyltransferase (HPRT) activity in the patient had been reduced to about 30% of the normal control. Therefore we considered that this patient suffered from a partial deficiency of HPRT. A point mutation of HPRT gene 68G (guanine) to T (thymine) was detected. This is a mutation that has not been previously reported. Familial analysis indicated that his mother and sister were heterozygotes.
Asunto(s)
Lesión Renal Aguda/enzimología , Hipoxantina Fosforribosiltransferasa/deficiencia , Lesión Renal Aguda/diagnóstico , Adulto , Alopurinol/uso terapéutico , Artritis Gotosa/complicaciones , Artritis Gotosa/diagnóstico , Artritis Gotosa/tratamiento farmacológico , Artritis Gotosa/enzimología , ADN/análisis , Sondas de ADN/química , Diagnóstico Diferencial , Estudios de Seguimiento , Supresores de la Gota/uso terapéutico , Humanos , Hipoxantina Fosforribosiltransferasa/genética , Masculino , Persona de Mediana Edad , Núcleo Familiar , Mutación Puntual , Reacción en Cadena de la Polimerasa de Transcriptasa InversaRESUMEN
In order to investigate the influence of aldehyde dehydrogenase 2(ALDH2) genotype in the pathogenesis of nephropathy due to non-insulin dependent diabetes mellitus (NIDDM), genotyping of ALDH2 was measured using the PCR-RFLP method in patients with NIDDM on chronic hemodialysis (HD). The results were as follows; 1) The frequency of active ALDH2 was 63% and that of inactive ALDH2 was 37%. 2) The percentage of active ALDH2 was significantly higher in patients with alcohol tolerance than that in those without it (38%). 3) The estimated amount of alcohol consumption in the past was 506 +/- 720 g/week in the active ALDH2 group, and 156 +/- 288 g/week in the inactive ALDH2 group, showing a significant difference between the two groups. 4) Interdialytic body weight gain was larger in patients with active ALDH2 than in those with inactive ALDH2. Since the frequency of active ALDH2 was similar to that in patients without nephropathy, these results do not support the hypothesis that ALDH2 gene polymorphism is involved in the development and persistence of chronic renal failure due to NIDDM. However, salt and water craving in dialysis patients may be influenced partially by an active ALDH2 gene.
Asunto(s)
Aldehído Deshidrogenasa/genética , Fallo Renal Crónico/genética , Polimorfismo Genético , Anciano , Consumo de Bebidas Alcohólicas , Aldehído Deshidrogenasa Mitocondrial , Diabetes Mellitus Tipo 2/complicaciones , Genotipo , Humanos , Fallo Renal Crónico/enzimología , Fallo Renal Crónico/etiología , Persona de Mediana Edad , Diálisis RenalRESUMEN
A 56-year-old man was referred to our hospital for evaluation of episodic disturbance of consciousness. Hypoglycemic symptoms were noted and Whipple's triad was satisfied. The 75 g OGTT and the glucagon test revealed a high baseline insulin level and hyperreactivity to glucagon. A pancreatic tumor and liver metastases were found by abdominal computed tomography (CT). Based on the finding of liver biopsy, the final diagnosis was malignant insulinoma with liver metastasis. He selected conservative treatment and no hypoglycemic crisis has occurred for one year since discharge. Early diagnosis and long-term follow-up is necessary since this tumor is slow growing.
Asunto(s)
Trastornos de la Conciencia/diagnóstico , Insulinoma/secundario , Neoplasias Hepáticas/secundario , Neoplasias Pancreáticas/patología , Glucemia/metabolismo , Diagnóstico Diferencial , Estudios de Seguimiento , Humanos , Hipoglucemia/sangre , Hipoglucemia/etiología , Insulinoma/diagnóstico , Insulinoma/psicología , Neoplasias Hepáticas/diagnóstico , Neoplasias Hepáticas/psicología , Masculino , Persona de Mediana Edad , Neoplasias Pancreáticas/diagnóstico por imagen , Neoplasias Pancreáticas/psicología , Tomografía Computarizada por Rayos XRESUMEN
A 68-year-old male patient with chronic active hepatitis C was treated with interferon-alpha (IFN-alpha) for a period of 5 months. The patient responded well to the IFN therapy showing substantial improvement in liver function and disappearance of HCV-RNA. However, one year after the treatment he was found to have developed proteinuria and showed a reduction in Ccr. Renal biopsy findings were as follows: Light microscopy showed diffuse expansion of mesangial cells with a focal/local increase in cellularity accompanied by capillary loop thickening. Splitting of the basement membrane was also present. An immunofluorescent study showed that IgA was localized predominantly in the peripheral capillary wall. Electron microscopy showed that there was mesangial cell interposition between the peripheral capillary wall and endothelial cells. Furthermore, endothelial cells were expanded and numerous platelets were seen in the capillary lumen. These findings were compatible with focal MPGN accompanied by activation of endothelial cells. These histological data suggest two clinical disease entities: late-onset renal damage induced by IFN-alpha alone, and HCV-induced renal damage possibly modified by the direct effect of IFN-alpha on the endothelium. The present case suggests that IFN therapy for HCV may produce a particular type of renal damage, under the influence of either IFN or HCV infection, and/or both.
Asunto(s)
Antivirales/efectos adversos , Glomerulonefritis Membranosa/etiología , Hepatitis C Crónica/terapia , Interferón-alfa/efectos adversos , Anciano , Anticoagulantes/uso terapéutico , Dipiridamol/uso terapéutico , Glomerulonefritis Membranosa/tratamiento farmacológico , Heparina/uso terapéutico , Hepatitis C Crónica/complicaciones , Humanos , Masculino , Inhibidores de Agregación Plaquetaria/uso terapéuticoRESUMEN
Successful treatment of tumoral calcinosis using continuous ambulatory peritoneal dialysis (CAPD) combined with hemodialysis is described. A 32-year-old male patient with a 2-year history of CAPD rapidly developed multiple metastatic calcification (tumoral calcinosis) adjacent to his fingers, elbows, and knee joints. Tests showed severe hyperphosphatemia, moderate hypercalcemia, and increased Ca-P product without elevation of intact parathyroid hormone. An enlarged parathyroid gland was not found by echography. In order to rapidly lower the excessive Ca and P levels, a combined therapy with CAPD and vigorous transient hemodialysis using a low-Ca dialysate was performed. In parallel, the patient was given calcitonin, bisphosphonate, and short-term Al to ameliorate the metastatic calcifications more effectively. The result was dramatic with disappearance of the tumoral calcinosis as well as improvement in subjective symptoms within a few months. The present case suggests that combined therapy with hemodialysis and CAPD using a low-Ca dialysate, together with Ca-modulating agents, can be effective in ameliorating tumoral calcinosis in patients on CAPD.
Asunto(s)
Calcinosis/terapia , Diálisis Peritoneal Ambulatoria Continua , Diálisis Renal , Adulto , Calcinosis/sangre , Calcio/sangre , Humanos , MasculinoRESUMEN
A case of reversible acute renal failure (ARF) following binge drinking together with the transient use of a nonsteroidal antiinflammatory drug (NSAID) is described. After binge drinking. the patient experienced hyperdipsia, and the volume of his urine decreased. Subsequently, he took an NSAID to relieve systemic joint pain associated with low grade fever, and then he had complete anuria. One day after taking the NSAID, he visited our hospital, and was found to have severe renal dysfunction accompanied by severe liver damage (blood urea nitrogen and creatinine concentrations were 57 and 5.4 mg/dl, respectively). The impaired renal function progressed over the first three hospital days, as reflected by an elevated creatinine concentration to 11.6 mg/dl. Nine treatment sessions of hemodialysis were, therefore, required to recover the loss of renal function. The present case suggests that binge drinking may be a potential risk factor for ARF in the presence of NSAIDs.