Résumé
A 28-year-old woman was admitted due to fever, dyspnea, hematuria and acute renal insufficiency. 1 months ago, she had been diagnosed as having ventricular septal defect with mild dyspnea and chronic cough. Infective endocarditis (IE) was diagnosed by clinical findings including vegetation in echocardiography. A blood culture drawn during the hospitalization grew streptococcus sanguis. A renal biopsy showed IE-induced crescentic glomerulonephritis (GN). Antibiotic treatment alone was effective for fever, but not for gross hematuria and renal insufficiency. After the initiation of plasmapheresis, gross hematuria and acute renal insufficiency was dramatically improved. After clinical stability was achieved, closure of the ventricular septal defect was performed. This result suggests that plasmapheresis may be beneficial in the treatment infective endocarditis-induced crescent GN.
Sujets)
Adulte , Femelle , Humains , Atteinte rénale aigüe , Biopsie , Toux , Dyspnée , Échocardiographie , Endocardite , Fièvre , Glomérulonéphrite , Communications interventriculaires , Hématurie , Hospitalisation , Plasmaphérèse , Insuffisance rénale , Streptococcus sanguisRésumé
BACKGROUND: An increased frequency of the epsilon4 allele in Alzheimer's disease has been reported, which suggested a functional role of apolipoprotein E isoforms in pathophysiology of Alzheimer's disease. The aims of this study were to determine the frequency of ApoE genotypes in various types of dementia such as Alzheimer's disease, vascular dementia, and Parkinson's disease, to relate epsilon4 and assess risk factors for different types of dementia. METHODS: We assessed the frequency of Apolipoprotein E alleles in 29 patients with Alzheimer's disease, 10 patients with vascular dementia and 9 demented patients with Parkinson's disease. The Apolipoprotein E genotype was determined the polymerase chain reaction (PCR) with sequence-specific oligonuculeotide primers (SSOP) and reverse hybridiza- tion using the INNO-LiPA (Line Probe Assay) Apo E typing kit. RESULTS: Allele frequencies of epsilon2, epsilon3, and epsilon4 were : 0.5, 0.72, and 0.23 in Alzheimer's disease; 0, 0.65, and 0.35 in vascular dementia; 0.6, 0.83 and 0.11 in demented patients with Parkinson's disease. Conculsion : These results indicate that the apolipoprotein E4 allele is associated with not only Alzheimer's disease but also vascular dementia, however not associated with Parkinson's disease. No such an association was observed between the apolipoprotein E alleles and age.