ABSTRACT
BACKGROUND: Tiotropium is a long acting anticholinergic bronchodilator and it reduces exacerbations and improves the quality of life of patients with stable chronic obstructive pulmonary disease (COPD). The purpose of this study was to evaluate the effect of tiotropium on dyspnea, the quality of life and the pulmonary function in patients with COPD. METHODS: Between April 2005 and April 2006, the patients with moderate to severe COPD, as based on the Global Initiative for Chronic Obstructive Lung Disease (GOLD) criteria, and who needed to use long-acting bronchodilator were enrolled in this study. They inhaled tiotropium as a dry powder capsule, 18 microgram once daily for six months, with using the Handihaler(R) device. The lung function tests, including lung volume, the St. George's respiratory questionnaire and the MRC dyspnea scale, was measured at baseline and after 6 months treatment with tiotropium. RESULTS: 21 patients with COPD were enrolled. The mean age of the patients was 69 years and the mean baseline FEV1 was 1.0 L (40% predicted). Compared with the baseline, tiotropium produced significant improvement of the FEV1 (1.0+/-0.2 L vs. 1.1+/-0.3 L, respectively, p=0.013), IC (1.65+/-0.3 L vs. 1.7+/-0.3 L, respectively, p=0.037), the RV (4.0+/-0.7 L vs. 3.8+/-0.4, respectively, p=0.003), the SGRQ score (48.7+/-10 vs. 41.3+/-10.4, respectively, p<0.001), and the MRC dyspnea scale (3.4+/-0.6 vs. 3.0+/-0.8, respectively, p=0.009) after 6 months treatment. The dyspnea scale was associated with physical activity, the impact on life, the inspiratory capacity and the residual volume rather than the symptom score or FEV1. The treatment was well tolerated. CONCLUSIONS: Treatment with tiotropium once daily for 6 months improved lung functions, the health related quality of life and dyspnea.
Subject(s)
Humans , Dyspnea , Inspiratory Capacity , Lung , Motor Activity , Pulmonary Disease, Chronic Obstructive , Quality of Life , Residual Volume , Respiratory Function Tests , Tiotropium Bromide , Surveys and QuestionnairesABSTRACT
BACKGOUND: Recently it has been reported that several cytokine gene polymorphisms regulate cytokine production and play an important role in immune and inflammatory response. We evaluated IL-1beta IL-1Ra, and TNF-alpha gene polymorphism in patients with primary glomerulonephritis to determine the association between cytokine polymorphism and disease susceptibility. METHODS: In this study, we enrolled 118 patients with primary glomerulonephritis and healthy 300 persons who had visited the health screening center. We analyzed -511C/T polymorphism of IL-1beta tandem repeats polymorphism in intron 2 of IL-1Ra and -308G/A polymorphism of TNF-alpha We classified primary glomerulonephritis according to pathologic finding and clinical diagnosis. RESULTS: There were no differences with IL-1betaand TNF-alpha gene polymorphism between patient and control group. The carriage of IL1RN*2 was significantly associated with an increased risk of primary glomerulonephritis (patients:control=12.75:5.4%, p<0.01). IL1RN*2 was significantly frequent in patients with membranous GN or minimal change disease (p<0.05). When we classified glomerulonephritis according to clinical diagnosis, IL1RN*2 carriage rate was higher in patients with nephrotic syndrome and RPGN or acute nephritic syndrome than patients with asymptomatic urinary abnormalities (p<0.05). IL-1beta(TT) genotype was more prevalent in acute glomerulonephritis (68.4%) than asymptomatic urinary abnormalities or other glomerulonephritis. TNF2 carriage rate showed a lower tendency in patients with asymptomatic urinary abnormalities. CONCLUSION: IL1RN*2 is significantly associated with an increased risk of development of primary glomerulonephritis. We suggest cytokine gene polymorphism is also related to clinical manifestations of glumerulonephritis.
Subject(s)
Humans , Diagnosis , Disease Susceptibility , Genotype , Glomerulonephritis , Interleukin 1 Receptor Antagonist Protein , Introns , Mass Screening , Nephrosis, Lipoid , Nephrotic Syndrome , Tandem Repeat Sequences , Tumor Necrosis Factor-alphaABSTRACT
Malignant insulinomas are very rare endocrine tumours with a variable clinical course. Here, a case of a malignant insulinoma, resected from the tail of the pancreas 10 years previously, which was found to have hepatic metastasis, is reported. A pancreatic mass, without evidence of metastasis, has been found using an abdominal CT scan and intra-operative ultrasonography 10 years previously. Recently, the patient has suffered from dizziness, sweating and an altered mentality. Hyperinsulinemia was diagnosed from the biochemical laboratory finding. An abdominal CT scan and intra-operative abdominal sonography showed multiple hepatic metastasis, without local recurrence in pancreas. Therefore, a partial hepatic segmentectomy was performed. Immunohistochemical staining of the postoperative specimen was strongly positive for insulin. The postoperative biochemical response was normalized, and the patient experienced no further hypoglycemic symptom.