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1.
Cureus ; 14(1): e20931, 2022 Jan.
Article in English | MEDLINE | ID: mdl-35004084

ABSTRACT

Introduction Patients requiring mechanical ventilation (MV) are commonly managed in an intensive care unit (ICU); however, Japan is unique in that many patients are treated in non-ICU settings. The characteristics of these patients, nevertheless, are unknown. We sought to identify disease severity and MV settings of patients in non-ICU. Methods We retrospectively analyzed the clinical data of Kinan Hospital and Owase General Hospital, where there are no ICUs. Data for adult patients who required MV from January through December 2018 were collected. To find the characteristics of patients who have been decided to treat in non-ICU hospitals without early transferring, we analyzed patients who have been treated for more than three days in those hospitals. Results A total of 171 patients received MV; 29 patients were treated for more than three days. Of those, the mortality rate was 44.8% (13 patients). The median age was 80 years (range: 72-84 years). The mean Acute Physiologic Assessment and Chronic Health Evaluation II (APACHE II) score was 20.9 ± 8.1, and predicted mortality was 0.42 ± 0.25. Tidal volume per predicted body weight was 8.8 ± 2.1 mL/kg, and set inspiratory time was 1.6 ± 0.3 seconds. Conclusions We have first described the severity and the initial ventilator setting of MV patients treated for more than three days in non-ICU setting in Japan. The overall predicted mortality was 42%, and the average age of the patients was 80 years. Further research on wider areas and the comparison to the patients treated in ICUs are needed to identify the appropriateness of treating patients in non-ICU settings.

2.
Int J Cardiol Heart Vasc ; 26: 100431, 2020 Feb.
Article in English | MEDLINE | ID: mdl-31890864

ABSTRACT

BACKGROUND: Fractional flow reserve (FFR) is useful for assessing the functional significance of coronary artery stenosis, even in lesions with prior myocardial infarction (pMI). Instantaneous wave-free ratio (iFR) is a vasodilator-free alternative for the physiological assessment of coronary artery stenosis. In addition, iFR shows good diagnostic agreement with FFR and an iFR-guided revascularization strategy was non-inferior to an FFR-guided revascularization strategy. However, the clinical usefulness of iFR for the evaluation of a coronary artery lesions with pMI has not been evaluated. METHODS AND RESULTS: A total of 200 lesions from 200 patients (44 pMI territories lesions and 156 non-pMI coronary artery lesions) were analyzed retrospectively. Major adverse cardiac events (MACE) were defined as cardiovascular death, non-fatal MI, unstable angina pectoris, fatal arrhythmia and heart failure during 12 months follow-up after the physiological assessment of coronary artery stenosis. iFR was closely correlated with FFR in pMI and non-pMI lesions (r = 0.81 and 0.72; P < 0.001, respectively). In pMI lesions, an iFR cut-off of 0.89 was optimal against a clinical FFR cut-off of 0.80 according to receiver operating characteristics (ROC) curve analysis, whereas in non-pMI lesions, the iFR cut-off value was 0.92 without statistical significance. In addition, the event rate of MACE was similar between pMI and non-pMI patients during follow-up even in the presence or absence of an PCI procedure. CONCLUSIONS: iFR may be a useful alternative method compared with FFR for clinical decision-making even in pMI patients.

3.
Clin Exp Hypertens ; 41(1): 92-99, 2019.
Article in English | MEDLINE | ID: mdl-29584458

ABSTRACT

BACKGROUND: Intradialytic hypertension (HTN), which is one of the poor prognostic markers in patients undergoing hemodialysis, may be associated with sympathetic overactivity. The L/N-type calcium channel blocker, cilnidipine, has been reported to suppress sympathetic nerves activity in vivo. Therefore, we hypothesized that cilnidipine could attenuate intradialytic systolic blood pressure (SBP) elevation. METHODS: Fifty-one patients on chronic hemodialysis who had intradialytic-HTN (SBP elevation ≥10 mmHg during hemodialysis) and no fluid overload were prospectively randomized into two groups: control and cilnidipine groups. Cilnidipine group patients took cilnidipine (10 mg/day) for 12 weeks. The primary endpoint was the change in the intradialytic SBP elevation before and after the 12-week intervention. RESULTS: Before the intervention, no differences were observed in age, sex or pre-dialytic SBP (148.5 ± 12.9 vs. 148.3 ± 19.3 mmHg) between the two groups. Intradialytic SBP elevation was unchanged in the control group. Cilnidipine significantly lowered the post-dialytic SBP with an attenuation of the intradialytic SBP elevation from 12.0 ± 15.4 mmHg to 4.8 ± 10.1 mmHg. However, the observed difference in the intradialytic SBP elevation by cilnidipine did not reach statistical significance (group×time interaction effect p = 0.25). Cathecolamine levels were unaffected by the intervention in both groups. CONCLUSION: Cilnidipine lowers both the pre- and post-dialytic SBP and might attenuate intradialytic SBP elevation. Therefore, cilnidipine may be effective in lowering SBP during HD in patients with intradialytic-HTN.


Subject(s)
Blood Pressure/drug effects , Calcium Channel Blockers/therapeutic use , Dihydropyridines/therapeutic use , Hypertension/drug therapy , Aged , Calcium Channels, L-Type , Calcium Channels, N-Type , Catecholamines/blood , Female , Humans , Hypertension/complications , Hypertension/physiopathology , Male , Prospective Studies , Renal Dialysis , Renal Insufficiency, Chronic/complications , Renal Insufficiency, Chronic/therapy , Sympathetic Nervous System/physiopathology , Systole
4.
Circ J ; 82(2): 586-595, 2018 01 25.
Article in English | MEDLINE | ID: mdl-29093429

ABSTRACT

BACKGROUND: The aim of this study was to assess the echocardiographic characteristics of chronic hemodialysis (HD) patients with end-stage renal disease (ESRD) in a multicenter prospective cohort study.Methods and Results:Three hundred and fifteen patients with ESRD (67.9±10.6 years, 47.6% male) on chronic HD for ≥1 year were examined on transthoracic echocardiography, including Doppler-derived aortic valve area (AVA) measurement. Only 11.5% and 3.4% of all patients had normal left ventricular (LV) geometry and normal LV filling pattern, respectively. The majority of patients had aortic and mitral valvular calcification, and approximately 50% of all 315 patients had aortic valve narrowing with AVA <2.0 cm2. Patients were divided into 3 groups according to AVA index tertile: group 1, highest tertile; group 2, middle tertile; and group 3, lowest tertile. Group 3 was older, had a greater cardiothoracic ratio on chest X-ray, higher plasma brain natriuretic peptide and total LV afterload, and lower stroke volume index than the other 2 groups. Age and intact parathyroid hormone (PTH) level were independently associated with low AVA index. CONCLUSIONS: Patients with ESRD on chronic HD have a high prevalence of cardiac structural and functional abnormalities including calcified aortic sclerosis. High age and PTH were associated with aortic valve narrowing in these patients.


Subject(s)
Echocardiography/methods , Heart Defects, Congenital/diagnostic imaging , Kidney Failure, Chronic/complications , Renal Dialysis , Aged , Aortic Valve Stenosis , Calcinosis , Humans , Middle Aged , Mitral Valve/pathology , Parathyroid Hormone/blood , Prospective Studies , Risk Factors , Ventricular Function, Left
5.
J Clin Hypertens (Greenwich) ; 19(10): 990-998, 2017 Oct.
Article in English | MEDLINE | ID: mdl-28849629

ABSTRACT

This study investigated the effects and safety of eplerenone or thiazide diuretics in patients with hypertension and albuminuria (pretreatment urinary albumin/creatinine ratio ≥10 mg/gCr) treated with an angiotensin II receptor blocker. The primary end point was the mean percent change in the urinary albumin/creatinine ratio from baseline to 48 weeks. An efficacy analysis was performed in 195 patients (98 in the eplerenone group and 97 in the thiazide group). Systolic and diastolic blood pressures at 48 weeks were similar in the two groups. The mean percent change in the urinary albumin/creatinine ratio from baseline to 48 weeks was similar in the two groups (P=.804). In the safety analysis, the withdrawal rates for adverse events were similar in both groups. The antialbuminuric effects and safety of eplerenone therapy were similar to those of thiazide diuretics when combined with an angiotensin II receptor blocker in patients with hypertension and albuminuria.


Subject(s)
Albuminuria/drug therapy , Hypertension/drug therapy , Serum Albumin, Human/drug effects , Sodium Chloride Symporter Inhibitors/pharmacology , Spironolactone/analogs & derivatives , Aged , Aged, 80 and over , Albuminuria/etiology , Angiotensin Receptor Antagonists/adverse effects , Angiotensin Receptor Antagonists/pharmacology , Antihypertensive Agents/pharmacology , Blood Pressure/drug effects , Creatinine/blood , Eplerenone , Female , Humans , Male , Middle Aged , Mineralocorticoid Receptor Antagonists/adverse effects , Mineralocorticoid Receptor Antagonists/pharmacology , Prospective Studies , Serum Albumin, Human/urine , Sodium Chloride Symporter Inhibitors/administration & dosage , Sodium Chloride Symporter Inhibitors/adverse effects , Spironolactone/administration & dosage , Spironolactone/adverse effects , Spironolactone/pharmacology
6.
Heart Vessels ; 19(4): 199-202, 2004 Jul.
Article in English | MEDLINE | ID: mdl-15278395

ABSTRACT

Primary cardiac lymphoma is a rare disorder with a poor prognosis. We present here a case of 77-year-old woman who was diagnosed as having cardiac lymphoma antemortem according to a cytologic examination of the pericardial effusion. Determination of the levels of serum-soluble interleukin-2 receptor and serum deoxythymidine kinase was useful for the diagnosis. Echocardiography, computed tomography, magnetic resonance imaging, and gallium scan revealed neither lymphadenopathy nor tumor in the heart, so she was diagnosed as having malignant lymphoma that probably originated from the pericardium. Systemic chemotherapy with CHOP (cyclophosphamide, farmorubicin, oncovin, and prednisolone) resulted in a complete resolution of the pericardial effusion. She has been in remission 48 months after discontinuation of the chemotherapy.


Subject(s)
Heart Neoplasms/diagnosis , Lymphoma/diagnosis , Pericardial Effusion/pathology , Aged , Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Cyclophosphamide/therapeutic use , Doxorubicin/therapeutic use , Female , Heart Neoplasms/drug therapy , Humans , Lymphoma/drug therapy , Pericardial Effusion/drug therapy , Prednisolone/therapeutic use , Vincristine/therapeutic use
7.
Intern Med ; 42(10): 983-6, 2003 Oct.
Article in English | MEDLINE | ID: mdl-14606712

ABSTRACT

We report a primigravida woman with acute myocardial infarction caused by coronary artery spasm induced by intravenous administration of methyl ergometrine maleate just after delivery. Despite the frequent usage of ergot derivatives to promote uterine contractions, cardiac complications related to this drug are rare. Myocardial infarction may be overlooked in young women in the early postpartum period. Careful monitoring and prompt evaluation should be performed when this drug is administered for obstetrical purposes.


Subject(s)
Coronary Vasospasm/chemically induced , Ergonovine/adverse effects , Myocardial Infarction/chemically induced , Oxytocics/adverse effects , Puerperal Disorders/chemically induced , Adult , Angina Pectoris, Variant/etiology , Female , Humans , Postpartum Period , Pregnancy
9.
Pathology ; 35(2): 141-4, 2003 Apr.
Article in English | MEDLINE | ID: mdl-12745462

ABSTRACT

Cerebrotendinous xanthomatosis (CTX) is a rare autosomal recessive lipid-storage disorder characterised by xanthomas, neurological dysfunctions and premature atherosclerosis. A case of a well differentiated adenocarcinoma of the gallbladder occurring in a 57-year-old Japanese man with CTX, confirmed clinically, biochemically and at autopsy is reported together with analyses of the sterol 27-hydroxylase (CYP27) and p53 genes. A missense mutation of the p53 (G for C) was detected in the gallbladder adenocarcinoma. Direct sequence analysis also showed a silent mutational substitution of unknown significance, C for A, in CYP27 at codon 89. In the past, CTX patients have only demonstrated this infrequently, indicating no direct relationship between CYP27 dysfunction and tumour development. Thus, the present case of gallbladder cancer appears to be a chance occurrence.


Subject(s)
Adenocarcinoma/genetics , Adenocarcinoma/pathology , Gallbladder Neoplasms/genetics , Gallbladder Neoplasms/pathology , Genes, p53 , Steroid Hydroxylases/genetics , Xanthomatosis, Cerebrotendinous/genetics , Xanthomatosis, Cerebrotendinous/pathology , Achilles Tendon/metabolism , Achilles Tendon/pathology , Adenocarcinoma/complications , Adenocarcinoma/metabolism , Biomarkers, Tumor/metabolism , Cholestanetriol 26-Monooxygenase , DNA Mutational Analysis , DNA, Neoplasm/analysis , Gallbladder Neoplasms/complications , Gallbladder Neoplasms/metabolism , Humans , Immunoenzyme Techniques , Male , Middle Aged , Mutation, Missense , Steroid Hydroxylases/metabolism , Tumor Suppressor Protein p53/genetics , Tumor Suppressor Protein p53/metabolism , Xanthomatosis, Cerebrotendinous/complications , Xanthomatosis, Cerebrotendinous/metabolism
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