ABSTRACT
<p><b>Objective: </b>To identify the clinical and epidemiological characteristics of pernicious anemia (PA) in patients treated at Miyagami hospital on Tokunoshima Island.</p><p><b>Methods: </b>We evaluated 14 patients with PA who were enrolled and treated from March 2009 to May 2014.</p><p><b>Results: </b>The majority of patients were older than 50 years of age and primarily consisted of elderly women. Routine medical examinations revealed macrocytic anemia in 6 of the 14 patients (43%), although they were clinically asymptomatic and subsequently diagnosed with PA. The average number of patients per year was reported to be 3 (95% confidence interval [CI]: 1.25-3.42).</p><p><b>Conclusions: </b>The annual incidence of PA per 100,000 individuals on Tokunoshima Island is possibly much higher than that previously reported in Japan. An increase in the elderly population, a negligence of the disease, and an ethnic and regional diversity may explain this discrepancy. As the annual incidence of PA may be higher than that previously reported, anemia must be carefully evaluated in the differential diagnosis of PA.</p>
ABSTRACT
Because of an increased number of Acanthamoeba keratitis (AK) along with associated disease burdens, medical professionals have become more aware of this pathogen in recent years. In this study, by analyzing both the nuclear 18S small subunit ribosomal RNA (18S rRNA) and mitochondrial 16S rRNA gene loci, 27 clinical Acanthamoeba strains that caused AK in Japan were classified into 3 genotypes, T3 (3 strains), T4 (23 strains), and T5 (one strain). Most haplotypes were identical to the reference haplotypes reported from all over the world, and thus no specificity of the haplotype distribution in Japan was found. The T4 sub-genotype analysis using the 16S rRNA gene locus also revealed a clear sub-conformation within the T4 cluster, and lead to the recognition of a new sub-genotype T4i, in addition to the previously reported sub-genotypes T4a-T4h. Furthermore, 9 out of 23 strains in the T4 genotype were identified to a specific haplotype (AF479533), which seems to be a causal haplotype of AK. While heterozygous nuclear haplotypes were observed from 2 strains, the mitochondrial haplotypes were homozygous as T4 genotype in the both strains, and suggested a possibility of nuclear hybridization (mating reproduction) between different strains in Acanthamoeba. The nuclear 18S rRNA gene and mitochondrial 16S rRNA gene loci of Acanthamoeba spp. possess different unique characteristics usable for the genotyping analyses, and those specific features could contribute to the establishment of molecular taxonomy for the species complex of Acanthamoeba.
Subject(s)
Humans , Acanthamoeba/classification , Acanthamoeba Keratitis/parasitology , Cell Nucleus/genetics , DNA, Mitochondrial/genetics , DNA, Protozoan/genetics , Japan , Molecular Sequence Data , Phylogeny , RNA, Ribosomal, 16S/genetics , RNA, Ribosomal, 18S/geneticsABSTRACT
Local residents were screened for colorectal cancer, and the results during six year period are reported. The two-day immunological fecal occult blood test was used as the first screening method. The barium enema radiography was used as the secondary screening method even if only one of the occult blood reactions was positive. Images were acquired in varius directions from rectum to the sigmoid colon (the most common site of colorectal cancer) and at least anterior-posterior images in two directions were obtained another sites as well. Barium enema radiography is less distressing to patients than the endoscopy of entire large intestine and can be carried out quickly. In addition, its accuracy is considered comparable to that of endoscopy, and the results of our study were no poorer than that obtained in institutions where only endoscopy was carried out.
Subject(s)
EndoscopyABSTRACT
To evaluate a comparison for endovascular repair (EVAR) versus open repair (OR) for the treatment of abdominal aortic aneurysm (AAA). Data of all patients with infrarenal AAA treated electively, both with OR (107 cases) and EVAR (24 cases), at our institute between January 1999 and March 2004 were retrospectively reviewed. No difference was found between the 2 groups for sex, age, and AAA size. Cases of chronic obstructive pulmonary disease (20.8% vs 6.5%, <i>p</i><0.04) and frequencies of laparotomy (25% vs 2.8%, <i>p</i><0.001) were significantly more in the EVAR group than the OR group. In the initial results, deployment of the stent grafts was successful in all cases and complete thrombosis of the aneurysm was achieved in 21 cases (87.5%). One graft occlusion and a wound infection occurred in the EVAR group. OR was successfully performed in all cases. These were 6 cases of paralytic ileus, 1 of re-operation for hemorrhage, 1 of respiratory failure, and 1 of ischemic colitis in the OR group. One hospital death occurred in each group. Mean blood transfusion (0ml vs 238±345ml) and operation time (131±53min vs 250±76min) were significantly less in the EVAR group than the OR group. In the long term results, the cumulative survival rate was 88.0±6.5% at 1 and 2 years, 80.6±9.2% at 3 years in the EVAR group; 99.0±0.9% at 1 year, 94.1±2.6% at 2 years, 87.7±3.9% at 3 years in the OR group, with no difference between the 2 groups regarding survival rate. Four new endoleak and 3 graft infections were encountered in the EVAR group. Freedom from stent graft-related complications was 81.3±8.5% at 1 year, 61.4±11.9% at 2 years, 47.8±12.6% at 3 years in the EVAR group, but 100% at 1, 2 and 3 years in the OR group. Freedom from procedure-related complications in the EVAR group was significantly lower than that in OR group. In the long term results, EVAR was associated with more procedure-related complications. This finding may justify reappraisal of currently accepted EVAR for AAA management strategies.
ABSTRACT
A infertilidade conjugal é um problema que aflige milhares de casais em todo o mundo. Para que se alcance um tratamento adequado é necessário que os fatores etiológicos sejam identificados pelo médico assistente. Neste contexto, este estudo visa analisar as principais causas de infertilidade em casais atendidos no Serviço de Reprodução Humana da Universidade Federal do Pará / Fundação Santa Casa de Misericórdia do Pará no período de junho de 1997 a junho de 2000. Foram estudadas, 67 pacientes inférteis submetidas ao protocolo de rotina deste serviço, constando de exames clínicos e complementares. Os fatores etiólogicos pesquisados foram: psicológico, masculino, ovulatório, tubo-peritoneal, uterino-cervical e uterino-corporal. No estudo observamos a incidência de mulheres inférteis entre 15 a 30 anos de idade, o tempo de união conjugal entre 2 a 5 anos, o predominio de infertilidade primária, e o fator mais frequente foi o tubo-peritoneal. Observou-se nesta análise que, em nossas pacientes, a maior frequência do fator tubo-peritoneal reflete o baixo nível sócio-econômico a que elas estão inseridas, predispondo-as principalmente a processos inflamatórios pélvicos e consequente infertilidade
Subject(s)
Humans , Male , Female , Adult , Adolescent , InfertilityABSTRACT
A 74-year-old man undergone mitral valve plasty. After cessation of cardiopulmonary bypass, bleeding persisted from the cardioplegia injection site and dilatation of the ascending aorta with discoloration was observed. The diagnosis of type A aortic dissection extending to the descending aorta was made by transesophageal echocardiogram. Replacement of the ascending aorta was performed under deep hypothermic circulatory arrest. The postoperative course was uneventful. The false lumen of the aortic arch and descending aorta was thrombosed completely on postoperative computed tomography. Intraoperative aortic dissection is a rare but fatal complication of cardiopulmonary bypass. Prompt recognition and appropriate surgical management are of prime importance.
ABSTRACT
Yabakei Town is an underpopulated rural area in Oita Prefecture. Eight workers of the Shimogo Clinic interviewed all the people who were more than 70 years old and lived alone in this town. All the 92 subjects who were interviwed responded to this survey. Among them, 81 subjects (88 percent of the interviewees) answered that they chose to live alone as they preferred a life free from restraint, and 28 subjects (30 percent) answered they did not want to leave the place where they were born and lived for a long time.<BR>A modified Face Scale revealed that among the 92 subjects surveyed, 43 subjects (47 percent) felt that they were “complacent” or “very complacent” about their lives as a whole, and 46 subjects (50 percent) answered “not so bad, ” while only three subjects (3 percent) answered “not complacent.” Neither physical dysfunction nor the degree of complacency toward their families was correlated with the satisfaction about their lives. Only the relationship with their neighborhood and/or friends correlated significantly with the satisfaction level in their lives.<BR>As for their futures, only nine people (10 percent of the respondents) replied they were “anxious” or “very anxious.” Howerver, in a question asking them what they would do if they definitely needed someone's help, for example, by accidental injruy of gradual deterioration of their health status, 32 subjects (35 percent of the respondents) answered they had no idea what to do, while another 32 subjects (35 percent) expected their families would help them in some way without much assurance.<BR>On the whole, the aged people were rather complacent about their present lives. But, thinking of their future, it seemed that fragility of their lives was undeniable.