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1.
Asian J Endosc Surg ; 10(1): 17-22, 2017 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-27456989

RESUMO

INTRODUCTION: Anastomotic leakage (AL) is a major complication of laparoscopic low anterior resection (LLAR) for rectal cancer. Although several recent reports have suggested that transanal tube placement can prevent AL, this practice is still controversial. Additionally, the mechanism by which a transanal tube prevents AL is unknown. The aim of this study was to evaluate the efficacy of transanal tube placement for prevention of AL following LLAR. METHODS: This was a retrospective study that included 69 patients who underwent LLAR between February 2012 and January 2016. After an anastomosis using a double stapling technique, a transanal tube was placed in 28 patients. A diverting stoma was created in 26 patients. Univariate and multivariate analyses of clinicopathological characteristics were performed. RESULTS: The overall incidence of AL was 15.9% (11/69). Univariate analysis showed that transanal tube placement (P = 0.022) and early postoperative diarrhea (P < 0.001) were associated with AL. The duration of the postoperative hospital stay for patients with transanal tube placement (13.1 ± 4.1 days) was significantly shorter than for patients without a transanal tube (22.7 ± 12.3 days; P < 0.001). However, transanal tube placement did not reduce postoperative diarrhea. Creation of a diverting stoma did not affect the incidence of AL. Multivariate analysis revealed that the absence of a transanal tube (odds ratio = 33.5, P = 0.018) and the occurrence of postoperative diarrhea (odds ratio = 86.3, P = 0.001) were independent risk factors for AL. CONCLUSION: Transanal tube placement prevents AL after LLAR. Furthermore, this protective effect may be due to a reduction in the unfavorable incidence of early postoperative diarrhea.


Assuntos
Fístula Anastomótica/prevenção & controle , Intubação , Laparoscopia , Neoplasias Retais/cirurgia , Reto/cirurgia , Adulto , Idoso , Canal Anal , Anastomose Cirúrgica , Fístula Anastomótica/epidemiologia , Feminino , Seguimentos , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento
2.
Hum Pathol ; 51: 57-63, 2016 May.
Artigo em Inglês | MEDLINE | ID: mdl-27067783

RESUMO

Differentiating low-grade lymphoma from preexisting sarcoidosis is difficult because of their pathological similarity. This article describes a case of pulmonary mucosa-associated lymphoid tissue lymphoma associated with pulmonary sarcoidosis. The patient, a 45-year-old Japanese man, presented with a 10-year history of pulmonary sarcoidosis and 5-year history of ocular sarcoidosis with histologic findings. Because only the right S3 lung nodule had gradually enlarged, partial resection was performed. Pathological study revealed noncaseous epithelioid granulomas with lymphoplasmacytic proliferation but also marked lymphoid cell proliferation with lymphoepithelial lesion findings that differed from findings of typical sarcoid lesions. Our lymphoepithelial lesion evaluation via immunohistochemistry and analysis of Ig heavy-chain gene rearrangements with assessment of Propionibacterium acnes-specific antibody reactions allow us to report, for the first time, this case of pulmonary mucosa-associated lymphoid tissue lymphoma associated with pulmonary sarcoidosis in exactly the same location, which may be significant for differentiating these diseases and understanding their pathogenic association.


Assuntos
Neoplasias Pulmonares/complicações , Linfoma de Zona Marginal Tipo Células B/complicações , Sarcoidose Pulmonar/complicações , Humanos , Masculino , Pessoa de Meia-Idade
3.
Int J Surg Case Rep ; 9: 34-8, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-25723745

RESUMO

INTRODUCTION: We report a case of primary adenocarcinoma in the third portion of the duodenum (D3) curatively resected by laparoscopic and endoscopic cooperating surgery (LECS). PRESENTATION OF CASE: A 65-year-old woman had a routine visit to our hospital for a follow-up of rectal cancer resected curatively 2 years ago. A routine screening gastroduodenal endoscopy revealed an elevated lesion of 20mm in diameter in the D3. The preoperative diagnosis was adenoma with high-grade dysplasia; however, suspicion about potential adenocarcinoma was undeniable. Curative resection was performed by LECS. Pathological examination revealed intramucosal adenocarcinoma arising from normal duodenal mucosa. The tumor was stage I (T1/N0/M0) in terms of the tumor, nodes, metastasis (TNM) classification. LECS for duodenal tumor has seldom been reported previously, and this is the first report of LECS for primary adenocarcinoma in the D3. The transverse mesocolon was removed from the head of pancreas to expose the duodenum, and the accessory right colic vein was cut; this was followed by the Kocher maneuver for mobilization of the lesion site. DISCUSSION: LECS enabled en bloc resection with adequate surgical margins and secure intra-abdominal suturing. Thorough mobilization of the mesocolon and pancreas head is essential for this procedure because it facilitates correct resection and suturing. CONCLUSION: LECS is a feasible treatment option for duodenal neoplasms, including intramucosal adenocarcinoma, even though it exists in the D3.

4.
Eur Radiol ; 24(5): 1105-11, 2014 May.
Artigo em Inglês | MEDLINE | ID: mdl-24526284

RESUMO

PURPOSE: The purpose of this retrospective study was to investigate the incidence of contrast-induced nephropathy (CIN) caused by transarterial chemoembolisation (TACE) in patients with hepatocellular carcinoma (HCC). MATERIALS AND METHODS: One hundred forty-one patients treated between 2005 and 2008 undergoing 305 consecutive sessions of TACE were enrolled. CIN was defined as an increase in the serum creatinine level of more than 0.5 mg/dl or more than 25 % from baseline within 3 days after TACE without any other identifiable cause of acute kidney injury. RESULTS: CIN by the present definition was observed after 2.6 % of the TACE sessions. No patient showed clinical signs or symptoms of acute renal failure, or required haemodialysis. None of the patients with an estimated glomerular filtration rate of <60 ml/min/1.73 m(2) developed CIN. CONCLUSION: The present study suggests that TACE is a relatively safe procedure in terms of the risk of CIN under vigorous periprocedural hydration and that the incidence of CIN is comparable to that of AKI associated with intravenous CM administration. KEY POINTS: • CIN would be lower for non-coronary arterial intervention than for coronary intervention. • The present study suggests that the CIN rates following TACE are low. • The incidence of CIN is comparable to that after intravenous CM administration.


Assuntos
Injúria Renal Aguda/induzido quimicamente , Carcinoma Hepatocelular/terapia , Meios de Contraste/efeitos adversos , Embolização Terapêutica , Neoplasias Hepáticas/terapia , Injúria Renal Aguda/epidemiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Carcinoma Hepatocelular/epidemiologia , Embolização Terapêutica/efeitos adversos , Feminino , Taxa de Filtração Glomerular , Humanos , Incidência , Japão/epidemiologia , Neoplasias Hepáticas/epidemiologia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
5.
Clin J Gastroenterol ; 7(4): 376-80, 2014 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-26185890

RESUMO

Acute portal vein thrombosis is a rare but severe complication of intra-abdominal infection. It can be life-threatening, given the risk of developing liver abscess and subsequent liver failure. Various types of hereditary thrombophilia are known risk factors for acute portal vein thrombosis. In addition to surgical treatment and potent antibiotic therapy, systemic administration of anticoagulants and locoregional trans-catheter delivery of thrombolytic agents are known to be effective. We present a case report of acute portal vein thrombosis with pylephlebitis caused by acute appendicitis, successfully treated with catheter-directed thrombolysis through the operatively recanalized umbilical vein. The umbilical vein is a promising access route to the portal vein. Therefore, this procedure is an effective and preferred treatment option for portal septic thrombosis, particularly because it does not require puncture of the liver parenchyma or catheterization through an infected peritoneal cavity.


Assuntos
Fibrinolíticos/uso terapêutico , Veia Porta , Terapia Trombolítica/métodos , Veias Umbilicais/cirurgia , Trombose Venosa/tratamento farmacológico , Doença Aguda , Cateterismo , Feminino , Humanos , Masculino
6.
Emerg Radiol ; 20(1): 3-9, 2013 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-22910982

RESUMO

The purpose of this study is to illustrate computed tomography (CT) findings suggestive of small bowel strangulation. We have performed the precontrast and postcontrast CT with single and multidetector CT scanners and evaluated the bowel wall changes and mesentery changes and correlated them with the operative findings. The direct CT findings suggestive of small bowel strangulation included high-density bowel wall on precontrast scans; lack of, or diminished contrast enhancement of the involved bowel wall; localized mesenteric fluid accumulation (mesenteric congestion); and localized pneumatosis. The indirect CT signs included C- or U-shaped loops with mesenteric vessels converging toward the obstruction site, ascites, target sign, two adjacent collapsed round loops, and whirl sign. We particularly emphasize the importance of contrast enhancement of bowel mucosa for early diagnosis to differentiate strangulation from a mechanical obstruction without bowel ischemia, and also the importance to differentiate proximal secondary gas-filled dilated small bowel loops from distal primary involved fluid-filled small bowel loops because these two types of small bowel loops are present in the single peritoneal cavity. As early recognition of small bowel strangulation may help improve the patient outcome because the involved bowel loops can be preserved without resection, it is essential to become familiar with the CT signs suggested small bowel obstruction strangulation.


Assuntos
Meios de Contraste , Obstrução Intestinal/diagnóstico por imagem , Intestino Delgado/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos , Diagnóstico Diferencial , Humanos
7.
Emerg Radiol ; 20(1): 69-76, 2013 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-23109230

RESUMO

Large-bowel obstruction (LBO) is a relatively common abdominal emergency. The CT exam has become the most important imaging modality for the diagnosis of LBO, following abdominal ultrasound and plain radiography. The recent multi-detector CT (MD-CT) is able to clarify the etiology of LBO and to help in deciding how to treat LBO. Therefore, it is important for the radiologists to become familiar with the imaging findings of LBO, including plain radiograph and CT, due to various causes. In this article, we have shown the characteristics of the radiological findings including plain radiograph, barium study, and CT as well as their correlations with pathologic findings of LBO. The etiology of LBO is usually divided into neoplastic diseases and nonneoplastic diseases. However, the most common cause is the neoplastic etiology. Now, we can afford the critical information concerning the level of obstruction, its cause, the viability of the involved bowel loops, and a decision-making regarding the therapy for patients with LBO, using MD-CT high technology.


Assuntos
Obstrução Intestinal/diagnóstico por imagem , Obstrução Intestinal/etiologia , Intestino Grosso , Tomografia Computadorizada por Raios X/métodos , Sulfato de Bário , Colite/complicações , Colite/diagnóstico por imagem , Neoplasias Colorretais/complicações , Neoplasias Colorretais/diagnóstico por imagem , Meios de Contraste , Diagnóstico Diferencial , Humanos , Intussuscepção/complicações , Intussuscepção/diagnóstico por imagem , Invasividade Neoplásica , Inoculação de Neoplasia
8.
Intern Med ; 51(21): 3085-8, 2012.
Artigo em Inglês | MEDLINE | ID: mdl-23124156

RESUMO

We herein report a case of toxic shock syndrome (TSS) associated with the 2009 pandemic H1N1 (pH1N1) influenza virus and a community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) infection in a 16-year-old Vietnamese girl. Staphylococcal enterotoxin B (SEB) was detected in the patient's serum, and the level of anti-SEB antibodies was found to be elevated. A flow cytometric analysis showed evidence of activated SEB-reactive Vß3+ and Vß12+ T cells. These data suggest that the CA-MRSA-induced activation of SEB-reactive T cells may cause TSS in patients with pH1N1 virus infection. Moreover, this is the first report describing immunological confirmation of SEB contributing directly to TSS in a patient fulfilling the diagnostic criteria of TSS.


Assuntos
Infecções Comunitárias Adquiridas/etiologia , Enterotoxinas/toxicidade , Staphylococcus aureus Resistente à Meticilina , Choque Séptico/etiologia , Infecções Estafilocócicas/etiologia , Adolescente , Antibacterianos/administração & dosagem , Infecções Comunitárias Adquiridas/tratamento farmacológico , Infecções Comunitárias Adquiridas/microbiologia , Feminino , Humanos , Vírus da Influenza A Subtipo H1N1 , Influenza Humana/complicações , Pneumonia Estafilocócica/tratamento farmacológico , Pneumonia Estafilocócica/etiologia , Pneumonia Estafilocócica/microbiologia , Choque Séptico/tratamento farmacológico , Choque Séptico/microbiologia , Infecções Estafilocócicas/tratamento farmacológico , Infecções Estafilocócicas/microbiologia
9.
Jpn J Radiol ; 30(7): 541-52, 2012 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-22744438

RESUMO

Large-bowel obstruction (LBO) is a relatively common abdominal emergency. Computed tomography (CT) diagnosis of LBO is often easy, but it is essential to clarify LBO etiology and to decide how to treat it. Therefore, it is important for the radiologist to become familiar with the imaging findings of LBO, including plain radiography and CT, to determine its various causes, as well as the many diseases mimicking LBO. In this article, we show the characteristics of radiological findings of plain radiograph, barium study, and CT and their correlations with pathologic findings. LBO etiology comprises two main categories: neoplastic and nonneoplastic disease. However, the primary causes of LBO are neoplastic etiologies, and nonneoplastic causes are relatively uncommon and unfamiliar to many radiologists in clinical practice. Therefore, in this review, we present nonneoplastic etiology of LBO and diseases simulating LBO and provide critical information concerning the causes of LBO and viability of the involved bowel loops.


Assuntos
Abdome Agudo/diagnóstico por imagem , Abdome Agudo/etiologia , Obstrução Intestinal/diagnóstico por imagem , Obstrução Intestinal/etiologia , Tomografia Computadorizada por Raios X/métodos , Abdome Agudo/patologia , Diagnóstico Diferencial , Humanos , Obstrução Intestinal/patologia
10.
Intern Med ; 51(12): 1531-6, 2012.
Artigo em Inglês | MEDLINE | ID: mdl-22728486

RESUMO

Neurofibromatosis type 1 (NF1) is associated with benign and malignant neoplasms, but the coincidence of abdominal neoplasms is rare. A 65-year-old woman with NF1 had episodes of nausea, tachycardia, hypertension, and loss of consciousness. Bilateral adrenal tumors were detected by abdominal computed tomography, and plasma and urinary catecholamine levels were elevated. Open bilateral adrenalectomy and histological findings revealed bilateral pheochromocytomas (PCCs). Furthermore, malignant peripheral nerve sheath tumor (MPNST) and multiple gastrointestinal stromal tumors (GISTs) were incidentally found in the abdominal cavity. Early diagnosis of abdominal neoplasms in NF1 patients is important because of the risk of malignancy, organic complications and hemorrhagic-obstructive complications.


Assuntos
Neoplasias das Glândulas Suprarrenais/patologia , Neoplasias Gastrointestinais/patologia , Tumores do Estroma Gastrointestinal/patologia , Neoplasias de Bainha Neural/patologia , Neurofibromatose 1/patologia , Feocromocitoma/patologia , Idoso , Feminino , Humanos
11.
Jpn J Clin Oncol ; 42(7): 632-6, 2012 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-22525211

RESUMO

This report presents the cases of three patients with fatal pneumonia that was highly suspected to be Pneumocystis pneumonia (PCP) based on serological diagnosis. Their chest radiographs showed bilateral pneumonia and each had presented with severe respiratory failure requiring mechanical ventilation when they arrived at the hospital. Although bronchoscopical sampling could not be performed, their chest computed tomography imaging and a marked elevation of serum KL-6 and ß-D-glucan levels were characteristic of Pneumocystis pneumonia. All three were found to have been treated with temozolomide after surgery for malignant glioma. Temozolomide can cause Pneumocystis pneumonia. The three patients did not receive prophylactic medication against Pneumocystis pneumonia during treatment with temozolomide, and their histories suggested that all had delayed seeking treatment. It may be difficult to diagnose Pneumocystis pneumonia because the symptoms are not specific for Pneumocystis pneumonia and they tend to be similar to those of common respiratory infectious diseases. Therefore, patients who receive temozolomide therapy have the potential to develop fatal pneumonia and should be carefully observed. The patients should also be adequately informed about Pneumocystis pneumonia, and prophylaxis against Pneumocystis pneumonia should be considered proactively before treatment with temozolomide is initiated.


Assuntos
Antineoplásicos Alquilantes/efeitos adversos , Dacarbazina/análogos & derivados , Glioma/tratamento farmacológico , Hospedeiro Imunocomprometido , Pneumonia/diagnóstico , Pneumonia/etiologia , Idoso , Antineoplásicos Alquilantes/administração & dosagem , Dacarbazina/administração & dosagem , Dacarbazina/efeitos adversos , Rotulagem de Medicamentos , Evolução Fatal , Feminino , Haemophilus influenzae/isolamento & purificação , Humanos , Japão , Masculino , Pessoa de Meia-Idade , Pneumocystis carinii/isolamento & purificação , Pneumonia/diagnóstico por imagem , Pneumonia/imunologia , Pneumonia/microbiologia , Pneumotórax/etiologia , Pseudomonas aeruginosa/isolamento & purificação , Radiografia , Staphylococcus aureus/isolamento & purificação , Temozolomida
12.
J Nippon Med Sch ; 79(6): 403-8, 2012.
Artigo em Inglês | MEDLINE | ID: mdl-23291837

RESUMO

The Department of Respiratory Medicine of Nippon Medical School Hospital and the Working Committee of Clinical Simulation Laboratory have held training sessions for chest tube drainage since 2007. The training program consists of the preparation of a training manual, a small-group session, and a review of the process of chest tube drainage using a checklist of steps after the session. A total of 21 medical interns of Nippon Medical School Hospital participated in training sessions from April 2010 through February 2011. A questionnaire survey at the end of the session revealed that most participants rated highly both the explanations given by the instructors and the descriptions in the manual for comprehensibility. Only 3 interns felt that they had successfully acquired the clinical skill, and the other 18 interns felt that they had somewhat acquired the skill. Research after the interns had completed the program of the department showed that 80% of interns had performed chest tube drainage for patients during the rotation. The interns assessed the training program as useful, and some interns felt they could perform the skill with confidence or without anxiety. Other systematic programs of skill training for medical interns are recommended to ensure definite acquisition of basic skills.


Assuntos
Tubos Torácicos , Drenagem/métodos , Internato e Residência/métodos , Adulto , Competência Clínica/normas , Técnicas de Laboratório Clínico/instrumentação , Técnicas de Laboratório Clínico/métodos , Drenagem/instrumentação , Humanos , Internato e Residência/normas , Avaliação de Programas e Projetos de Saúde/normas , Inquéritos e Questionários
13.
Intern Med ; 50(16): 1703-8, 2011.
Artigo em Inglês | MEDLINE | ID: mdl-21841329

RESUMO

A 62-year-old woman presented with a markedly increased serum ALP level of skeletal origin during a regular follow-up of chronic hepatitis C. Serum calcium, phosphorus, and intact-PTH levels were normal and bone turnover markers were increased. Her generalized bone density was diffusely increased. These findings were consistent with hepatitis C-associated osteosclerosis (HCAO). She underwent cholecystectomy, as gallbladder cancer was suspected; however, histopathological findings demonstrated xanthogranulomatous cholecystitis. After cholecystectomy, serum ALP level and bone turnover markers were gradually decreased. This may indicate the existence of a novel osteogenic factor in the gallbladder in HCAO.


Assuntos
Colecistite/diagnóstico , Granuloma/diagnóstico , Hepatite C Crônica/diagnóstico , Osteosclerose/complicações , Xantomatose/diagnóstico , Fosfatase Alcalina/sangue , Colecistite/complicações , Colecistite/enzimologia , Feminino , Granuloma/complicações , Granuloma/enzimologia , Hepatite C Crônica/complicações , Hepatite C Crônica/enzimologia , Humanos , Pessoa de Meia-Idade , Osteosclerose/diagnóstico , Osteosclerose/enzimologia , Xantomatose/complicações , Xantomatose/enzimologia
14.
Arch Oral Biol ; 54(12): 1128-35, 2009 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-19913217

RESUMO

OBJECTIVE: The purpose of the present study was to examine the role of various neutral proteases released during the development of periradicular lesion. DESIGN: This lesion produced by pulpal exposure of mandibular first molar in rat. The histological and histometrical changes in periapical tissue examined. The presence of neutrophil elastase, cathepsin G, collagenase 2, gelatinase B, and secretory leukocyte protease inhibitor (SLPI) was immunohistochemically evaluated in the periapical tissue. RESULTS: After pulpal exposure, some inflammatory cells were present in the periapical tissue at 7 days, and periapical inflammation gradually increased. Alveolar bone resorption observed after 14 days and apical abscess found after 21 days. After 14 days, the area of periradicular lesion significantly increased compared from normal one (p<0.05). Neutrophil elastase, cathepsin G, collagenase 2, and gelatinase B were detected around the root apex at 14 days, then these proteases increased gradually and demonstrated in and around the abscess at 21 and 28 days. Morphologically, these protease-expressing cells are almost polymorphic and polynuclear shaped after 14 days. These cells significantly increased after 14 days compared from normal one (p<0.05). However, SLPI detected after 21 days around apical root. It significantly increased after 21 days (p<0.05). CONCLUSIONS: These results suggested that neutrophil elastase, cathepsin G, collagenase 2, and gelatinase B induce the destruction of periapical tissue. We demonstrated that these neutral proteases released play an important role in development of periradicular lesion.


Assuntos
Endopeptidases/metabolismo , Abscesso Periapical/enzimologia , Animais , Catepsina G/metabolismo , Elastase de Leucócito/metabolismo , Masculino , Metaloproteinase 8 da Matriz/metabolismo , Metaloproteinase 9 da Matriz/metabolismo , Abscesso Periapical/patologia , Ratos , Ratos Wistar , Inibidor Secretado de Peptidases Leucocitárias/metabolismo
15.
Nihon Kokyuki Gakkai Zasshi ; 47(2): 116-21, 2009 Feb.
Artigo em Japonês | MEDLINE | ID: mdl-19260534

RESUMO

An 82-year old man was admitted to our hospital for evaluation of progressive general malaise. He had previously been in good health. His chest roentgenogram showed reticular shadows and we suspected interstitial lung disease. On admission, his roentgenographic images showed deterioration compared with previous images. Acute lung injury was diagnosed by transbronchial lung biopsy, and steroid administration was started. He initially responded to treatment, but bilateral spontaneous pneumothorax occurred. Despite treatment, he died of respiratory failure. Amitani disease (idiopathic pulmonary upper lobe fibrosis) was suspected based on postmortem pathology, but his lung parenchyma was poor due to the presence of changes producing diffuse alveolar damage. We report and discuss this case because there are apparently no previous similar cases.


Assuntos
Fibrose Pulmonar/fisiopatologia , Idoso de 80 Anos ou mais , Humanos , Masculino
16.
J Endod ; 34(9): 1072-6, 2008 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-18718368

RESUMO

Macrophage elastase and neutrophil elastase are involved in tissue destruction in periradicular lesions. The purpose of this study was to examine these elastases immunohistochemically during development of periradicular lesions induced in rat mandibular first molar by pulpal exposure for 7, 14, 21, 28, and 42 days. Histologically, periapical inflammation developed from 7 to 21 days and then subsided after 28 days. The area of these lesions gradually increased from 7 to 28 days and subsequently decreased at 42 days. Macrophage elastase was first detected at 7 days and predominantly shown from 14 to 28 days, whereas neutrophil elastase gradually increased from 14 to 28 days. Macrophage elastase was significantly greater than neutrophil elastase from 7 to 21 days. These results suggest that macrophage elastase was enhanced from an early stage during the development of these lesions and that neutrophil elastase was related to the expansion of periapical tissue destruction including bone resorption.


Assuntos
Elastase de Leucócito/biossíntese , Metaloproteinase 12 da Matriz/biossíntese , Periodontite Periapical/enzimologia , Perda do Osso Alveolar/enzimologia , Animais , Macrófagos/enzimologia , Masculino , Neutrófilos/enzimologia , Ratos , Ratos Wistar , Fatores de Tempo
17.
Intern Med ; 47(7): 585-91, 2008.
Artigo em Inglês | MEDLINE | ID: mdl-18379141

RESUMO

OBJECTIVE: Low-dose, long-term macrolide therapy has been shown to be effective for the treatment of diffuse panbronchiolitis (DPB) and similar disorders in terms of the presence of airway mucus hypersecretion such as bronchiectasis, chronic bronchitis and sinobronchial syndrome. However, there are some patients, especially advanced cases, whose volume of sputum does not decrease sufficiently with macrolide therapy. These patients suffer from copious expectoration. There is currently no effective treatment, and an effective therapy is therefore urgently required. The aim of this study was to clarify whether or not the inhalation of tiotropium improves the symptoms in these cases. METHODS: Tiotropium (18 microg/day) was administered to patients with DPB and similar disorders with airway mucus hypersecretion who did not respond to macrolide. The symptoms were evaluated by a visual analog scale (VAS) prior to and at 1 and 3 months after tiotropium administration. Radiological and pulmonary function tests were also performed to evaluate the effects of tiotropium. RESULTS: Thirteen patients (DPB 5, sinobronchial syndrome 5, bronchiectasis 3) were enrolled. The VAS scores were dramatically improved after the introduction of tiotropium. FEV(1) was significantly improved after 3 months of treatment with tiotropium. In contrast, the radiological findings remained unchanged. CONCLUSION: Tiotropium improved the symptoms of cough, sputum and breathlessness in the macrolide-resistant cases of DPB or similar disorders. These beneficial effects might be due to the suppression of airway secretion through the anticholinergic effect of tiotropium on the submucosal gland, however, the long-term efficiency of this treatment still needs to be further assessed.


Assuntos
Bronquite/tratamento farmacológico , Macrolídeos/uso terapêutico , Muco/metabolismo , Derivados da Escopolamina/uso terapêutico , Administração por Inalação , Adulto , Idoso , Bronquite/patologia , Doença Crônica , Resistência Microbiana a Medicamentos/fisiologia , Feminino , Humanos , Macrolídeos/farmacologia , Masculino , Pessoa de Meia-Idade , Muco/efeitos dos fármacos , Projetos Piloto , Estudos Prospectivos , Derivados da Escopolamina/farmacologia , Brometo de Tiotrópio
19.
Chem Commun (Camb) ; (41): 4291-3, 2007 Nov 07.
Artigo em Inglês | MEDLINE | ID: mdl-18217609

RESUMO

Micrometer-sized Ag(core)-AgCl(shell) composite crystals have been formed on TiO2 thin films by a two-st epelectrochemical method to provide information on the thermodynamic condition for efficient photoinduced interfacial electron transfer.


Assuntos
Compostos de Prata/química , Prata/química , Titânio/química , Cristalização , Eletroquímica , Transporte de Elétrons , Membranas Artificiais , Microeletrodos , Tamanho da Partícula , Propriedades de Superfície , Termodinâmica , Fatores de Tempo
20.
Radiat Med ; 24(1): 35-40, 2006 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-16715660

RESUMO

PURPOSE: The purpose of this study was to determine whether dynamic helical computed tomography (CT)-mammography could assist in selecting the most appropriate surgical method in women with breast cancer. MATERIALS AND METHODS: Preoperative contrast-enhanced helical CT scanning of the breast was performed on 133 female patients with suspicion of breast cancer at the same time as clinical, mammographic, and/or ultrasonographic examinations. The patients were scanned in the prone position with a specially designed CT-compatible device. A helical scan was made with rapid intravenous bolus injection (3 ml/s) of 100 ml of iodine contrast material. Three-dimensional maximum intensity projection (MIP) images were reconstructed, and CT findings were correlated with surgical and histopathological findings. RESULTS: Histopathological analysis revealed 84 malignant lesions and seven benign lesions. The sensitivity, specificity, and accuracy levels of the CT scanning were 94.6%, 58.6%, and 78.9%. Helical scanning alone revealed additional contralateral carcinomas in three of four patients and additional ipsilateral carcinomas in three of five patients. However, the technique gave false-positive readings in 24 patients. The preoperative CT-mammogram altered the surgical method in six patients. CONCLUSION: Dynamic helical CT-mammography in the prone position may be one of the choices of adjunct imaging in patients with suspected breast cancer scheduled for surgery.


Assuntos
Neoplasias da Mama/diagnóstico por imagem , Mamografia , Tomografia Computadorizada Espiral , Adulto , Idoso , Meios de Contraste , Desenho de Equipamento , Feminino , Humanos , Pessoa de Meia-Idade , Sensibilidade e Especificidade , Tomografia Computadorizada Espiral/instrumentação , Ultrassonografia Mamária
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