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1.
J Int Med Res ; 39(2): 549-57, 2011.
Article in English | MEDLINE | ID: mdl-21672360

ABSTRACT

Percutaneous coronary intervention (PCI) using a drug-eluting stent (DES) leads to less re-stenosis than PCI using a bare metal stent (BMS), however there is still controversy whether use of a DES for severe coronary disease leads to an acceptable outcome in patients with diabetes mellitus (DM). In this study 8159 lesions were treated in 6739 patients (mean age 68.9 years) with coronary artery disease. Use of a DES significantly decreased the re-stenosis rate compared with BMS in both DM (9.6% versus 21.3%) and non-DM (9.5% versus 17.1%) patients. The re-stenosis rate was significantly higher in DM than in non-DM patients in the BMS group but not in the DES group. There was no statistically significant difference in event-free survival after stenting of patients with left main coronary artery (LMCA) disease between the BMS and DES groups. It was concluded that, compared with BMS, DES reduced re-stenosis in patients with DM, however, we advise careful treatment after using DES for severe coronary disease, including LMCA lesions, in patients with DM.


Subject(s)
Angioplasty, Balloon, Coronary , Coronary Disease/complications , Coronary Disease/therapy , Diabetes Complications/pathology , Stents , Aged , Coronary Angiography , Coronary Disease/diagnostic imaging , Coronary Restenosis/complications , Coronary Restenosis/therapy , Drug-Eluting Stents/adverse effects , Female , Hospitalization , Humans , Kaplan-Meier Estimate , Male , Stents/adverse effects , Treatment Outcome
2.
J Antimicrob Chemother ; 46(5): 839-42, 2000 Nov.
Article in English | MEDLINE | ID: mdl-11062211

ABSTRACT

The effects of haemodialysis on the pharmacokinetics of a carbapenem, biapenem, were evaluated in five patients with end-stage renal disease, who received 1 h iv infusions of 300 mg biapenem on both the days on and off 4 h haemodialysis. With haemodialysis, plasma biapenem exhibited two elimination phases, one during and the other after haemodialysis with half-lives of 1.16 +/- 0.12 and 3.33 +/- 0. 91 h, respectively. Ninety percent of biapenem was removed from blood to dialysate. Without haemodialysis, plasma biapenem was mono-exponentially eliminated with a half-life of 4.35 +/- 1.30 h.


Subject(s)
Anti-Infective Agents/blood , Kidney Failure, Chronic/blood , Renal Dialysis , Thienamycins/blood , Adult , Anti-Infective Agents/pharmacokinetics , Area Under Curve , Half-Life , Humans , Middle Aged , Renal Dialysis/methods , Thienamycins/pharmacokinetics
3.
Antimicrob Agents Chemother ; 42(6): 1433-6, 1998 Jun.
Article in English | MEDLINE | ID: mdl-9624490

ABSTRACT

The pharmacokinetics and tolerability of a new parenteral carbapenem antibiotic, biapenem (L-627), were studied in healthy elderly volunteers aged 65 to 74 years (71.6 +/- 2.7 years [mean +/- standard deviation], n = 5; group B) and > or = 75 years (77.8 +/- 1.9 years, n = 5; group C), following single intravenous doses (300 and 600 mg), and compared with those of healthy young male volunteers aged 20 to 29 years (23.0 +/- 3.5 years, n = 5; group A). The agent was well tolerated in all three age groups. Serial blood and urine samples were analyzed for biapenem to obtain key pharmacokinetic parameters by both two-compartment model-dependent and -independent methods. The maximum plasma concentration and area under plasma concentration-versus-time curve (AUC) increased in proportion to the dose in all three groups. Statistically significant age-related effects for AUC, total body clearance, and renal clearance (CLR) were found, while elimination half-life (t1/2 beta) and percent cumulative recovery from urine of unchanged drug (% UR) remained unaltered (t1/2 beta, 1.51 +/- 0.42 [300 mg] and 2.19 +/- 0.64 [600 mg] h [group A], 1.82 +/- 1.14 and 1.45 +/- 0.36 h [group B], and 1.75 +/- 0.23 and 1.59 +/- 0.18 h [group C]; % UR, 52.6% +/- 3.0% [300 mg] and 53.1% +/- 5.1% [600 mg] [group A], 46.7% +/- 7.4% and 53.0% +/- 4.8% [group B], and 50.1% +/- 5.2% and 47.1% +/- 7.6% [group C]). A significant linear correlation was observed between the CLR of biapenem and creatinine clearance at the dose of 300 mg but not at 600 mg. The steady-state volume of distribution tended to be decreased with age, although not significantly. Therefore, the age-related changes in parameters of biapenem described above were attributable to the combination of decreased lean body mass and lowered renal function of the elderly subjects. However, the magnitude of those changes does not necessitate dosage adjustment in elderly patients with normal renal function for their age.


Subject(s)
Carbapenems/pharmacokinetics , Thienamycins/pharmacokinetics , Adult , Age Factors , Aged , Area Under Curve , Carbapenems/administration & dosage , Carbapenems/urine , Female , Humans , Male , Metabolic Clearance Rate , Thienamycins/administration & dosage , Thienamycins/urine
4.
Am J Kidney Dis ; 31(3): E4, 1998 Mar.
Article in English | MEDLINE | ID: mdl-10074578

ABSTRACT

We report two long-term hemodialysis patients who developed severe congestive heart failure attributable to cardiac heavy amyloid deposition. Both patients became hypotensive during dialysis sessions, gradually making it difficult to continue hemodialysis, and they died of congestive heart failure. At autopsy, left ventricle walls in each case contained diffuse extensive deposits of amyloid. The distribution of amyloid was not localized to vessel walls but was widely disseminated throughout the left ventricle walls and replaced myocardial muscle fibers. Immunohistochemical examination showed positive staining for anti-human beta2-microglobulin antibody. We conclude that cardiac dialysis-related amyloidosis should also be considered in long-term hemodialysis patients with congestive heart failure as a life-threatening complication.


Subject(s)
Amyloidosis/etiology , Heart Diseases/etiology , Renal Dialysis/adverse effects , beta 2-Microglobulin/analysis , Amyloidosis/pathology , Fatal Outcome , Heart Diseases/pathology , Heart Failure/etiology , Heart Ventricles/chemistry , Heart Ventricles/pathology , Humans , Male , Middle Aged , Organ Size
5.
Jpn Heart J ; 31(2): 259-64, 1990 Mar.
Article in English | MEDLINE | ID: mdl-2355461

ABSTRACT

A rare case of early stage eosinophilic heart disease was diagnosed by endomyocardial biopsy findings, despite the relatively low peripheral eosinophil blood count (640/mm3).


Subject(s)
Biopsy , Cardiomyopathies/diagnosis , Eosinophilia/diagnosis , Myocardium/pathology , Adult , Cardiomyopathies/diagnostic imaging , Cardiomyopathies/pathology , Endocardium/pathology , Eosinophilia/diagnostic imaging , Eosinophilia/pathology , Humans , Male , Radiography
6.
J Cardiol ; 20(2): 293-300, 1990.
Article in Japanese | MEDLINE | ID: mdl-2104405

ABSTRACT

The relation of left ventricular diastolic function and the histopathological findings of the myocardium in patients with diabetes mellitus were observed using echocardiography and endomyocardial biopsy. The subjects consisted of six diabetic patients (mean age 49.3 years) and eight normal control subjects (mean age 44.8 years). Coronary angiography had no significant stenotic lesions in their coronary arteries. Their diabetic complications were mild to moderate in severity. Echoes from the left ventricular margin of the septum and from the posterior left ventricular wall were traced on a digitizing board; then the isovolumic relaxation period, rapid filling period, slow filling period and atrial contraction period were determined to calculate fractional shortening (FS), isovolumic relaxation time (IRT), and three filling volumes (RFV, SFV and ACV). The quotients of the left ventricular filling volume and stroke volume were also determined. Right ventricular endomyocardial biopsies were performed to determine the diameters of myocytes, the percentage of fibrosis and the eccentricity e, as a parameter of the degree of myocardial dysarrangement. The results were as follows: IRT was significantly longer and RFV/SV was significantly greater in patients with diabetes mellitus than those among the controls. Also the diameters of myocytes and the percentage of fibrosis were significantly greater, while the eccentricity e was less compared to that of the controls. There were no significant correlations, among IRT, RFV/SV, the diameters of myocytes, and eccentricity e, but the percentage of fibrosis significantly correlated with IRT and RFV/SV (r = 0.62, r = -0.63). IRT and RFV/SV were mainly responsible for the percentage of fibrosis.(ABSTRACT TRUNCATED AT 250 WORDS)


Subject(s)
Diabetes Mellitus/physiopathology , Myocardial Contraction , Myocardium/pathology , Adult , Coronary Angiography , Diabetes Mellitus/pathology , Diastole , Echocardiography , Female , Humans , Male , Middle Aged , Regression Analysis
7.
Kokyu To Junkan ; 37(12): 1353-7, 1989 Dec.
Article in Japanese | MEDLINE | ID: mdl-2616912

ABSTRACT

A 55-year-old man, previously treated for primary hypothyroidism, was admitted for evaluation of atypical chest pain. On physical examination, the pulse rate was 60 and blood pressure was 132/84 mmHg. Heart sounds were normal and no murmur was heard. Abdominal palpation showed no abnormal finding, and bruit was not heard. The electrocardiogram was normal and stress-induced ischemia was not found. The chest X-ray showed no sign of pulmonary hyperaemia or mass lesion, and central shadow was normal (CTR = 44%). During right heart catheterization, the pressures were normal in the cardiac chambers, pulmonary artery, and wedge position. A significant increase in oxygen saturation was disclosed at pulmonary artery level (10%) and the upper site of the inferior vena cava (22%). Coronary arteriography found coronary artery fistulas from the left main trunk, the left anterior descending artery, the left circumflex, and the right coronary artery to the pulmonary trunk. The left and right ventriculograms were normal. The digital subtraction angiography of celiac artery showed hepatic arteriovenous fistula. Ultrasonography and computed tomography found no mass lesion of the liver. Since combination of the bilateral coronary artery with pulmonary artery fistula, and hepatic arteriovenous fistula is very rare, the present case is worth noting for the investigation of the pathogenesis of congenital arteriovenous fistulas.


Subject(s)
Arterio-Arterial Fistula/complications , Arteriovenous Malformations/complications , Coronary Vessel Anomalies/complications , Hepatic Artery/abnormalities , Hepatic Veins/abnormalities , Pulmonary Artery/abnormalities , Arterio-Arterial Fistula/congenital , Humans , Male , Middle Aged
8.
J Cardiol ; 18(2): 353-61, 1988 Jun.
Article in Japanese | MEDLINE | ID: mdl-2977793

ABSTRACT

This study elucidated diastolic left ventricular dysfunction and whether myocardial interstitial fibrosis correlates with diastolic dysfunction in mild to moderate systemic hypertension (HT). Six normotensive subjects, 18 hypertensive patients without left ventricular hypertrophy (LVH) and 10 hypertensive patients with significant LVH were evaluated. M-mode echocardiography was used to determine fractional shortening (FS), isovolumic relaxation time (IRT), and left ventricular filling volume during rapid and slow filling periods and the atrial contraction period (RFV, SFV, ACV). The quotients of the left ventricular filling volume and the end-diastolic volume and stroke volume were also calculated. Simultaneous biventriculography was used to determine the end-diastolic thickness of the interventricular septum and posterior wall. Right ventricular endomyocardial biopsies were performed to calculate the percentages of fibrosis. The FS was normal in all groups. The percentages of fibrosis in the two HT groups were significantly greater than those in the normals. The IRT of the HT groups was significantly greater, and the RFV, RFV/EDV and RFV/SV were significantly less than those of the normals. Multiple regression analysis showed that the wall thickness and the percentages of fibrosis correlated significantly with IRT, RFV, RFV/EDV and RFV/SV. The standard coefficients of correlation of wall thickness and the percentages of fibrosis were 0.333 and 0.239 in respect to IRT, and -0.304 and -0.473 in respect to RFV. There were significant correlations between the percentages of fibrosis and RFV (r = -0.675), RFV/EDV (r = -0.664) and RFV/SV (r = -0.602) in the normals and in cases of HT without LVH.(ABSTRACT TRUNCATED AT 250 WORDS)


Subject(s)
Diastole , Hypertension/pathology , Myocardial Contraction , Myocardium/pathology , Cardiac Catheterization , Cardiomegaly , Echocardiography , Fibrosis , Heart Ventricles/physiopathology , Humans , Hypertension/physiopathology
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