ABSTRACT
Dopamine supersensitivity psychosis (DSP) is an unstable clinical condition observed in individuals with schizophrenia who have been treated with an antipsychotic medication at a high dosage and/or for a long period. An up-regulation of dopamine D2 receptors (DRD2) is thought to be involved in the essential pathology of DSP. An antipsychotic agent with both tight binding to DRD2 and a long half-life is generally effective for treating DSP, but a patient who meets the criteria of treatment-resistant schizophrenia sometimes needs treatment with clozapine. We report the case details of two patients whose DSP was not controlled with several antipsychotics but was successfully controlled with asenapine.Asenapine binds to a broad range of dopamine receptors and serotonin receptors, and it is thus distinct from other atypical antipsychotics. The unique profile of asenapine may contribute to the control of severe DSP symptoms in individuals with schizophrenia.
ABSTRACT
We investigated the possible association between genetic polymorphisms in the dopamine receptor and serotonin transporter genes and the responses of schizophrenic patients treated with either risperidone or perospirone. The subjects comprised 27 patients with schizophrenia who were clinically evaluated both before and after treatment. The genotyping of the polymorphisms of the dopamine D2 receptor gene (DRD2) (rs1801028 and rs6277), the dopamine D4 receptor gene (DRD4) (120-bp tandem repeats and rs1800955), and serotonin transporter gene (5HTT)(variable number of tandem repeats; VNTR) were performed using the real-time polymerase chain reaction and sequencing. In DRD2 and 5HTT-VNTR, there were no significant correlations between clinical response and polymorphism in the case of risperidone, and for perospirone treatment it was impossible to analyze the clinical evaluation due to the absence of genotype information. On the other hand, in DRD4 there were significant correlations in the two-factor interaction effect on the Positive and Negative Syndrome Scale (PANSS) between the two drugs [120-bp tandem repeat, p=0.003; rs1800955, p=0.043]. Although the small sample represents a serious limitation, these results suggest that variants in DRD4 are a predictor of whether treatment will be more effective with risperidone or with perospirone in individual patients.
Subject(s)
Humans , Genotype , Hand , Isoindoles , Polymorphism, Genetic , Real-Time Polymerase Chain Reaction , Receptors, Dopamine , Receptors, Dopamine D2 , Receptors, Dopamine D4 , Risperidone , Schizophrenia , Serotonin Plasma Membrane Transport Proteins , Tandem Repeat Sequences , ThiazolesABSTRACT
Fatal intestinal necrosis developed following off-pump CABG and implantation of a bifurcated vascular prosthesis in a 70-year-old man with unstable angina pectoris and abdominal aortic aneurysm. A CT scan with three-dimensional reconstruction (3D-CT), showed no narrowing or obstruction of the SMA. The patient was scheduled to undergo an extensive resection of the intestine on the 23rd postoperative day. The pathological diagnosis was nonocclusive mesenteric ischemia (NOMI). He died of multiple organ failure on the 38th postoperative day. Early diagnosis of NOMI is essential to lower mortality and postoperative morbidity. Invasive angiography is the gold standard in diagnosis. 3D-CT, a non-invasive method, is an increasingly useful technique, which may allow identification of vascular anatomy and pathology with sufficient detail for diagnosis. Several other causes of acute abdomen, other than mesenteric ischemia, can be ruled out. Therefore, 3D-CT might be useful in screening for NOMI.
ABSTRACT
A 16-year-old boy with multiple injuries suffered in a motorcycle accident was admitted to our hospital. On admission, X-ray films showed left hemothorax and bone fractures of the left humerus, thigh bone, and pelvis. Computed tomography of the chest revealed a pseudoaortic aneurysm approximately 6.0cm in diameter at the proximal portion of the descending aorta. Because of multiple severe associated injuries, we considered that conventional aortic repair in the acute phase would be difficult. We therefore performed an endovascular stent-graft treatment 140 days after injury. The postoperative course was uneventful and the pseudoaneurismal sac has confirmed to decrease. Transluminal placement of endovascular stent-graft is a technically feasible method for treatment of traumatic aortic aneurysm. However, because the long-term results are still unknown, we should follow-up carefully, particularly in young patients.
ABSTRACT
An 86-year-old woman was transferred to our hospital because of chest pain and left incomplete paralysis. CT-scan revealed a dissecting aortic aneurysm (DeBakey type 2) 6cm in diameter. Coronary angiography and aortography were perfomed to assess the coronary artery disease and ASO, they showed occluded LAD, 90% stenosis of CX and occluded left external iliac artery. We planned a 1-stage operation. Coronary artery bypass grafting with the beating heart was carried out prior to replacement of the ascending aorta. Then we performed femoro-femoro bypass. The postoperative course was uneventful and the patient was discharged 23 days after the operation.
ABSTRACT
A 50-year-old man was admitted with a fusiform descending thoracic aortic aneurysm measuring 60mm. Chest CT scan revealed porcelain aorta from the aortic arch to the abdominal aorta. Severe calcification found on the descending aortic wall was considered to entail greater risk for conventional aortic repair and reconstruction of intercostal arteries. Therefore endovascular stent grafting was planned. The stent graft was deployed from near the origin of the left subclavian artery to the 10th thoracic vertebral level. Neither paraplegia nor other complication occurred. Endovascular stent grafting may be a safe and effective method for descending thoracic aneurysms with severely calcified aorta.
ABSTRACT
A 65-year-old man suffered abdominal pain and anterior chest pain due to a ruptured abdominal aortic aneurysm (AAA) and acute myocardial infarction. Abdominal CT scanning demonstrated infrarenal AAA measuring 6.0cm in diameter with retroperitoneal hematoma. Coronary angiography was performed revealing total occlusion of the left anterior descending and 90% stenosis in the circumflex coronary artery. The operation was performed immediately after CAG. After median sternotomy, cardioplumonary bypass was initiated using moderate hypothermia (32.0°C). After completion of CABG, AAA replacement using a Y-shaped prosthesis was performed during extracorporeal circulation. Extracorporeal circulation protects the heart from the hemodynamic changes after aortic clamping or declamping during abdominal aortic surgery. Our experience shows that one-stage operation is a feasible option for patients with AAA and coronary artery disease accompanied by impaired left ventricular function.
ABSTRACT
Coronary artery bypass surgery was performed in 7 chronic hemodialysis patients. Hemodialysis and extracorporeal ultrafiltration methods were used during cardiopulmonary bypass, and continuous hemofiltration was performed in the early postoperative days in the intensive care unit. Water and electrolyte balances were successfully controlled in all patients, and hemodialysis was restarted after the second postoperative day. There were no perioperative complications and all patients are surviving. These methods of perioperative management for chronic hemodialysis patients undergoing coronary artery bypass surgery, especially consinuous hemofiltration in the early postoperative days, are considered safe and useful.