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1.
J Gastroenterol ; 53(8): 924-931, 2018 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-29353347

RESUMO

BACKGROUND: ABC classification has been used to assess the risk for gastric cancer. The current problem of ABC classification is that Group A contains individuals with current and past H. pylori infection. The aims of this study were to assesse the proportion of current and past infection in Group A and to establish a criteria for the identification of subjects with past infection from Group A subjects with negative results of urea breath test (UBT) and/or stool antigen test. METHODS: 201 subjects classified into Group A received UBT and/or stool antigen test, and also subsequent upper gastrointestinal endoscopy. The subjects were classified by the status of H. pylori infection defined by endoscopic findings. Levels of pepsinogen (PG) I, PG II and PG I/II ratio were compared between the groups, and receiver operating characteristic curves were constructed to extract the corresponding cutoff values. RESULTS: 22 subjects were tested positive by UBT and/or stool antigen test. Endoscopic images of 157 out of 179 subjects were studied. 15 of the subjects were regarded to have past H. pylori infection. The optimal cut-off value of PG I and PG I/II ratio for the determination of past H. pylori infection were ≤ 31.2 ng/mL and ≤ 4.6, respectively. CONCLUSIONS: Approximately 20% of Group A subjects have current or past H. pylori infection. Addition of UBT and/or stool antigen test can identify current but not past infection. Serum PG levels would be useful to identify subjects with past H. pylori infection.


Assuntos
Endoscopia Gastrointestinal , Infecções por Helicobacter/sangue , Helicobacter pylori , Pepsinogênio A/sangue , Neoplasias Gástricas/sangue , Neoplasias Gástricas/diagnóstico por imagem , Adulto , Idoso , Idoso de 80 Anos ou mais , Antígenos de Bactérias/análise , Testes Respiratórios , Fezes/química , Feminino , Infecções por Helicobacter/diagnóstico , Helicobacter pylori/imunologia , Humanos , Masculino , Pessoa de Meia-Idade , Curva ROC , Medição de Risco/métodos , Adulto Jovem
2.
Intern Med ; 56(13): 1621-1627, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28674348

RESUMO

Objective CYP2C19 metabolic activity influences the efficacy of Helicobacter pylori eradication therapies comprising PPIs. Rabeprazole (RPZ) and esomeprazole (EPZ) are PPIs not extensively metabolized by CYP2C19. The aim of this study was to elucidate whether or not first-line triple therapies using RPZ or EPZ are equally effective in Japanese patients with different CYP2C19 genotypes. Methods Two-hundred patients infected with H. pylori were randomized to receive one of the following regimens: amoxicillin (750 mg), clarithromycin (200 mg), and either esomeprazole (20 mg) (EAC group) or rabeprazole (10 mg) (RAC group), twice a day for one week. The CYP2C19 polymorphisms were determined by polymerase chain reaction and the serum level of pepsinogens was measured. Results The eradication rates of the EAC and RAC regimens were 79.8% (95% confidential interval: 71.7-89.0%) and 74.7% (66.0-83.4%), respectively, in a per protocol (PP) analysis (p=0.488). The eradication rates of the EAC and RAC regimens were not significantly different between patients with the homo EM genotype (p=0.999) or hetero IM or PM genotypes (p=0.286). A lower PG I/II ratio was associated with lower eradication rates (p=0.025). Conclusion Although the eradication rate was less than 80%, the EAC and RAC regimens were equally effective in each CYP2C19 genotype group. The PG I/II ratio was associated with the results of EAC and RAC therapy in this series of patients.


Assuntos
Antibacterianos/uso terapêutico , Citocromo P-450 CYP2C19/genética , Esomeprazol/uso terapêutico , Infecções por Helicobacter/tratamento farmacológico , Inibidores da Bomba de Prótons/uso terapêutico , Rabeprazol/uso terapêutico , Adulto , Amoxicilina/uso terapêutico , Povo Asiático , Claritromicina/uso terapêutico , Quimioterapia Combinada , Feminino , Genótipo , Helicobacter pylori , Humanos , Japão , Masculino , Pessoa de Meia-Idade , Polimorfismo Genético
4.
Intern Med ; 54(3): 267-72, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-25748734

RESUMO

OBJECTIVE: The number of endoscopic submucosal dissection (ESD) procedures for early gastric cancers among patients 75 years of age or older has been increasing. We herein examined both the outcomes and complications of ESD in elderly patients. METHODS: We investigated the effects of underlying diseases, lesion characteristics, treatment outcomes and complications during and in the postoperative periods of ESD among elderly patients 75 years of age or older versus non-elderly patients less than 75 years of age. Patients A total of 318 early gastric cancers in consecutive 307 patients, all of whom underwent ESD for gastric cancer, were included in this study. RESULTS: The number of patients with hypertension and ischemic heart disease was significantly higher in the elderly group than in the non-elderly group. The proportion of lesions with an absolute indication, extended indication or no indication was not significantly different between the groups. During the ESD procedure, the use of atropine sulfate for bradycardia was significantly more frequent in the elderly group. No significant differences were observed between the groups in terms of the treatment for hypertension, oxygen administration or incidence of perforation. In addition, there were no significant differences with respect to oxygen administration, postoperative bleeding or the occurrence of fever and/or pneumonia after the ESD procedure. CONCLUSION: Although bradycardia was more frequently observed in the elderly patients during ESD in this study, ESD was performed safely and managed appropriately, with infrequent postoperative complications. ESD appears to be effective, even in elderly patients.


Assuntos
Adenocarcinoma/cirurgia , Povo Asiático/estatística & dados numéricos , Procedimentos Cirúrgicos do Sistema Digestório/efeitos adversos , Dissecação , Mucosa Gástrica/patologia , Gastroscopia/efeitos adversos , Neoplasias Gástricas/cirurgia , Adenocarcinoma/patologia , Idoso , Idoso de 80 Anos ou mais , Comorbidade , Procedimentos Cirúrgicos do Sistema Digestório/métodos , Intervalo Livre de Doença , Dissecação/efeitos adversos , Detecção Precoce de Câncer , Estudos de Viabilidade , Feminino , Humanos , Japão/epidemiologia , Masculino , Medição de Risco , Neoplasias Gástricas/patologia , Resultado do Tratamento
10.
Intern Med ; 50(20): 2329-32, 2011.
Artigo em Inglês | MEDLINE | ID: mdl-22001459

RESUMO

A 43-year-old man was admitted to our hospital with right hypochondriac and epigastric pain. An abdominal radiograph showed a large niveau in the right subphrenic space. An abdominal CT scan demonstrated a large liver abscess (diameter, 13 cm) with gas formation. Klebsiella pneumoniae cells were isolated from the abscess, and the patient was treated with antibiotics and percutaneous drainage. It is very important to treat gas-forming liver abscess immediately, because subsequent bacteremia and septic shock are frequently noted, and the associated mortality rate is high.


Assuntos
Complicações do Diabetes/microbiologia , Infecções por Klebsiella/complicações , Klebsiella pneumoniae , Abscesso Hepático/complicações , Adulto , Complicações do Diabetes/diagnóstico , Gases , Humanos , Infecções por Klebsiella/diagnóstico , Abscesso Hepático/diagnóstico , Masculino
12.
Heart Vessels ; 26(4): 385-91, 2011 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-21110198

RESUMO

Elderly populations are increasingly represented among patients with acute coronary syndrome (ACS), and advanced age has been identified as an important risk factor for death and adverse outcome in patients with ACS treated invasively. Although considerable data have demonstrated a prognostic benefit of early revascularization in ACS particularly in high-risk patients, elderly patients with ACS are treated invasively less often than younger patients because older age is thought to be an independent predictor of mortality after percutaneous coronary intervention (PCI) in ACS. Over the past 5 years, a total of 54 ACS patients over 85 years old were treated. The 6-month survival rate was around 50% in the non-PCI group (n = 12) and around 80% in the PCI group (n = 42) (P < 0.05). Cardiac death occurred in 6 patients in the PCI group and in 6 patients in the non-PCI group. The rates of both cardiac death and all-cause death were significantly lower in the PCI group. The change in ADL score before and 6 months after the procedure was from 1.57 to 1.59 in the PCI group and from 2.25 to 2.20 in the non-PCI group. PCI for elderly patients with ACS is safe and life saving, and does not reduce the ability to perform activities of daily living. PCI should be recommended even for octo-nonagenerians with ACS.


Assuntos
Atividades Cotidianas , Síndrome Coronariana Aguda/terapia , Angioplastia Coronária com Balão , Síndrome Coronariana Aguda/diagnóstico por imagem , Síndrome Coronariana Aguda/mortalidade , Síndrome Coronariana Aguda/fisiopatologia , Fatores Etários , Idoso de 80 Anos ou mais , Envelhecimento , Angioplastia Coronária com Balão/efeitos adversos , Angioplastia Coronária com Balão/mortalidade , Angiografia Coronária , Feminino , Nível de Saúde , Humanos , Japão/epidemiologia , Estimativa de Kaplan-Meier , Masculino , Seleção de Pacientes , Modelos de Riscos Proporcionais , Recuperação de Função Fisiológica , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Taxa de Sobrevida , Fatores de Tempo , Resultado do Tratamento
13.
Int J Cardiol ; 139(2): 193-5, 2010 Mar 04.
Artigo em Inglês | MEDLINE | ID: mdl-18723233

RESUMO

Total occlusion of the left main trunk (LMT) frequently results in sudden cardiac death. As a result, it is rarely observed on coronary arteriogram. There are only a few reports on chronic total occlusion of the LMT. Most patients present with recent, severe angina, but it is not easy to distinguish chronic total occlusion of the LMT from other types of severe coronary heart diseases. Here, we report a very rare case of chronic total occlusion of the LMT. The patient is a 38-year-old female with a history of three normal deliveries. Chronic total occlusion of the LMT was suspected on coronary arteriogram 2 years previously in the other hospital; however, she continued working as a part-time employee at a supermarket. She was referred to our hospital because of slightly increased effort angina and shortness of breath. The final diagnosis and the site of occlusion were determined by three-dimensional computed tomography (3-D CT). The patient underwent coronary artery bypass graft (CABG) surgery, and ischemic symptoms completely disappeared.


Assuntos
Angina Pectoris/diagnóstico por imagem , Doença da Artéria Coronariana/diagnóstico por imagem , Índice de Gravidade de Doença , Tomografia Computadorizada por Raios X , Adulto , Feminino , Humanos , Imageamento Tridimensional
14.
Heart Vessels ; 23(4): 264-70, 2008 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-18649057

RESUMO

Recent advances in interventional devices and technology have greatly improved the results of percutaneous transluminal angioplasty (PTA), and it is now being widely used. However, it is important to obtain information regarding its results and its long-term patency. We examined the primary success rates and long-term patency in 29 limbs out of 27 patients with superficial femoral artery (SFA) occlusion who underwent PTA with self-expandable stents. Among the 29 lesions, 19 were long occlusions (>10 cm) and 10 were short (<10 cm). Overall primary success was achieved in 26 of the 29 limbs (90%). There were three unsuccessful cases in which the patients were on dialysis and had hard calcification in the arterial walls. After 3 years, primary patency, primary-assisted patency, and secondary-assisted patency were 81%, 86%, and 96%, respectively. In the case of short occlusions (<10 cm), the 3-year patency was 100%. Both the primary success rate and the long-term patency were considerably better than expected. Our results with self-expanding stents were superior to previously reported results and were not inferior to those of surgical bypass. Therefore, PTA may be considered as a good first option for the treatment of SFA occlusions.


Assuntos
Angioplastia com Balão/instrumentação , Arteriopatias Oclusivas/terapia , Artéria Femoral , Stents , Idoso , Idoso de 80 Anos ou mais , Angioplastia com Balão/efeitos adversos , Arteriopatias Oclusivas/diagnóstico por imagem , Arteriopatias Oclusivas/fisiopatologia , Constrição Patológica , Feminino , Artéria Femoral/diagnóstico por imagem , Artéria Femoral/fisiopatologia , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Radiografia Intervencionista , Fatores de Tempo , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Grau de Desobstrução Vascular
15.
Heart Vessels ; 22(3): 202-7, 2007 May.
Artigo em Inglês | MEDLINE | ID: mdl-17533526

RESUMO

Congestive heart failure developed in a 42-year-old man who had very mild acromegalic features. Echocardiography showed a marked dilatation of the left ventricle and decreased systolic function. Laboratory examinations revealed the elevated levels of growth hormone and insulin-like growth factor-1 and pituitary microadenoma was demonstrated by magnetic resonance imaging. Although the extensive conventional medical treatment was ineffective, short-term addition of somatostatin analog, octreotide, rapidly improved his cardiac function. After discontinuation of octreotide, further improvement was observed with minimal residual diastolic dysfunction. All medical treatment could be stopped after successful trans-sphenoidal surgery. Early diagnosis and effective treatment is important to reverse the acromegalic cardiomyopathy.


Assuntos
Acromegalia/tratamento farmacológico , Insuficiência Cardíaca/tratamento farmacológico , Octreotida/uso terapêutico , Acromegalia/diagnóstico por imagem , Ecocardiografia , Eletrocardiografia , Insuficiência Cardíaca/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Radiografia
16.
Int J Cardiol ; 116(1): e25-6, 2007 Mar 02.
Artigo em Inglês | MEDLINE | ID: mdl-17107727

RESUMO

Late stent thrombosis occurred in the lesion of a sirolimus-eluting stent implanted 6 months previously for an in-stent restenosis lesion in the distal right coronary artery. Seventeen days before admission due to acute myocardial infarction this time, aspirin was discontinued for colon polypectomy. Ticlopidine had been discontinued 3 months before the discontinuation of aspirin. In drug-eluting stent era, the interventional strategy and antiplatelet therapy require long term attention.


Assuntos
Reestenose Coronária/complicações , Reestenose Coronária/terapia , Trombose Coronária/etiologia , Sistemas de Liberação de Medicamentos/efeitos adversos , Imunossupressores/administração & dosagem , Sirolimo/administração & dosagem , Stents/efeitos adversos , Idoso , Angiografia Coronária , Reestenose Coronária/diagnóstico por imagem , Trombose Coronária/diagnóstico por imagem , Vias de Administração de Medicamentos , Humanos , Masculino , Inibidores da Agregação Plaquetária/uso terapêutico , Desenho de Prótese , Falha de Prótese
18.
Int J Cardiol ; 115(1): e20-1, 2007 Jan 31.
Artigo em Inglês | MEDLINE | ID: mdl-17045669

RESUMO

A 71-year-old man visited our hospital complaining of increasing fatigue and exertional dyspnea. He had had severe epigastric pain for the past 5 months. On admission, chest radiogram showed marked cardiac dilatation and echocardiogram massive pericardial effusion with a small subepicardial aneurysm at the posterior wall of the left ventricle. An urgent pericardiocentesis removed 1300 ml of bloody effusion. The red blood cell count of the pericardial effusion was similar to that of the peripheral blood, and there were no abnormal findings on cytologic and bacteriological examinations. Coronary angiography showed a blunt occlusion of the mid-portion of the circumflex artery. Left ventricular angiogram revealed aneurysmal deformity of the left ventricular posterior wall. These findings suggested that an oozing type of left ventricular rupture via a subepicardial aneurysm had occurred after the onset of myocardial infarction (MI), resulting in massive accumulation of pericardial effusion. The patient is presently doing well without any clinical symptoms 18 months after pericardiocentesis. This is the first case report in which a subepicardial aneurysm with massive pericardial effusion was detected in the chronic stage of MI and successfully managed without surgical repair.


Assuntos
Aneurisma Cardíaco/complicações , Ruptura Cardíaca Pós-Infarto/etiologia , Idoso , Ruptura Cardíaca Pós-Infarto/terapia , Ventrículos do Coração , Humanos , Masculino , Pericardiocentese , Fatores de Tempo
19.
Rinsho Byori ; 54(4): 335-9, 2006 Apr.
Artigo em Japonês | MEDLINE | ID: mdl-16722451

RESUMO

To assess the merit of serum HIV-1 RNA quantification in detecting acute HIV infection, we reviewed the results of HIV-1 RNA assay and antibody tests in all patients who received those tests at our hospital from August 1999 to December 2004. Of 3530 such patients, five were sero-negative and PCR-positive with more than 105 copies/ml at initial examination. Four of them had HAART and followed a favorable course; they were later confirmed to be sero-positive by Western blotting. The other one, positive only by CLEIA, was lost to follow-up. This reconfirms the importance of using PCR in the initial assessment of HIV infection in high-risk patients.


Assuntos
Infecções por HIV/diagnóstico , HIV-1/genética , RNA Viral/sangue , Doença Aguda , Adulto , Feminino , Humanos , Masculino
20.
Int J Cardiol ; 109(2): 271-2, 2006 May 10.
Artigo em Inglês | MEDLINE | ID: mdl-15939492

RESUMO

Systolic anterior motion (SAM) of the anterior mitral leaflet with mitral-septal contact was generally thought to be a major contributor to dynamic left ventricular outflow tract obstruction in patients with hypertrophic cardiomyopathy. We report an interesting case of SAM of the posterior mitral leaflet in a patient without left ventricular hypertrophy, which led to dynamic left ventricular obstruction.


Assuntos
Hipertrofia Ventricular Esquerda/fisiopatologia , Valva Mitral/fisiopatologia , Obstrução do Fluxo Ventricular Externo/fisiopatologia , Idoso , Cardiomiopatia Hipertrófica/fisiopatologia , Cardiomiopatia Hipertrófica/cirurgia , Ablação por Cateter , Ecocardiografia Doppler , Ecocardiografia Transesofagiana , Feminino , Humanos , Hipertrofia Ventricular Esquerda/cirurgia , Valva Mitral/cirurgia , Marca-Passo Artificial , Volume Sistólico , Sístole , Obstrução do Fluxo Ventricular Externo/cirurgia
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