Preexisting essential hypertension accelerates the development of diabetic renal lesions in early stage nephropathy.
Explore the source record for details and available documents.
Disease Progression↗
Biomedical subjects
Toshio Hashimoto
Publications and source records attributed to Toshio Hashimoto.
A new quantitative classification of diabetic nephropathy by morphometric analysis.
Explore the source record for details and available documents.
Data Interpretation, Statistical↗
Vascular remodeling of the carotid artery in patients with untreated essential hypertension increases with age.
We examined whether hypertrophy of the carotid artery in patients with untreated essential hypertension is associated with compensatory carotid artery enlargement as these patients age. Carotid ultrasonography was evaluated in 163 patients with untreated essential hypertension (74 males and 89 females) and in 76 normotensive subjects. Intima-media end-diastolic thickness (IMT) and outer vessel diameter (VD) were measured, and relative wall thickness (IMT/R, R=VD/2) and vascular mass (VM) were calculated. Determinants of vascular hypertrophy in patients with untreated essential hypertension were also investigated. VD, VM, and IMT were significantly correlated with age in both the normotensive and hypertensive groups. Additionally, IMT was significantly correlated with VD in both groups. There was no correlation between increasing age and IMT/R in either group. IMT, VD and VM were significantly higher in the hypertensive group >50 years than in age-matched normotensive controls. However, IMT/R was significantly higher in the 50-59 years hypertensive group than in normotensive controls of the same age group. In addition to age, VM was related to systolic blood pressure, pulse pressure, fasting blood sugar, IMT, VD, and IMT/R in the hypertensive group. Multivariate regression analysis in the hypertensive group indicated that IMT/R was the strongest predictor of carotid vascular mass. Age and pulse pressure were also independently related to vascular mass. These results indicate that, as patients with untreated hypertension age, carotid arteries undergo remodeling. This should add further impetus to the implementation of appropriate hypertension treatment for such patients.
Adult↗
[An elderly case of advanced gastric cancer with gynecomastia and high serum levels of hCG].
A 74-year-old man was admitted because of appetite loss in November 1999. A gastric ulcer was diagnosed, and a H2 blocker was given. He had had appetite loss since July 1997 and had experienced epigastric discomfort since October of 1997. On admission, hepatic and pancreatic lymph node swelling was detected by ultrasonography of the abdomen. Physical examination revealed a palpable mass in the middle region of the upper abdomen as well as gynecomastia. Laboratory findings showed high serum levels of hCG (11,700 mIU/ml) and high urinary levels of hCG (1,600 mIU/ml). Upper gastrointestinal endoscopy showed a gastric cancer of Borrmann type 3 in the posterior wall of the middle body. A biopsy revealed a moderately differentiated adenocarcinoma. hCG immunoreactivity was not seen in the cancer tissue. A contrast-enhanced CT scan of the abdomen revealed multiple lymph node swelling in the hepatic and pancreatic lymph nodes. There was a low-density area suggesting liver metastases. No other primary carcinomas were not detected. We believe that the gynecomastia was due to the hCG-producing tumor. The patient died 2 months after diagnosis.
Adenocarcinoma↗
[So-called "ampulla" cardiomyopathy associated with coronary vasospasm compared with acute myocardial infarction showing similar abnormal left ventricular wall motion: two case reports].
So-called "ampulla" cardiomyopathy is characterized by transient abnormal left ventricular wall motion showing hypokinesia around the apical area and hyperkinesia at the basal area, without any detectable coronary lesion. We recently treated a patient with "ampulla" cardiomyopathy (Case 1) and a patient with acute myocardial infarction showing similar abnormal left ventricular wall motion (Case 2). A 75-year-old female (Case 1) presented with "ampulla" cardiomyopathy without coronary lesion. Vasospasm was induced at segment 8 on the left anterior descending (LAD) coronary artery by intracoronary administration of acetylcholine. A 58-year-old male (Case 2) presented with acute myocardial infarction due to occlusion at segment 8 and underwent successful coronary reperfusion therapy by direct percutaneous transluminal coronary angioplasty. Both Case 1 and Case 2 revelaed similar abnormal left ventricular wall motion, with hypokinesia around the apical area and hyperkinesia at the basal area by echocardiography, in the acute phase. Furthermore, these two patients showed elevated ST segment at both anterior and inferior leads by electrocardiography, and markedly reduced uptake of beta-methyl-p-iodophenyl-pentadecanoic acid around the apical area in the acute phase by scintigraphy. Interestingly, the LAD perfused a relatively wide area including the anterior, apical and part of the inferior area of the left ventricle in both patients by coronary angiography. The abnormal wall motion of Case 1 disappeared 4 weeks after onset, but that of Case 2 did not disappear. Although the diagnoses of Case 1 and Case 2 were different, abnormal wall motion of these cases might be due to myocardial ischemia due to distal LAD lesion. "Ampulla" cardiomyopathy might develop from transient myocardial ischemia induced by coronary vasospasm at the distal LAD which perfuses a relatively wide area.
Aged↗
[Improvement of extrapulmonary lesions of eosinophilic granuloma after cessation of smoking].
We encountered a case of pulmonary eosinophilic granuloma complicated with pneumothorax. A 24-year-old man was admitted to our department because of respiratory difficulty. Chest radiography on admission showed a right pneumothorax. A thoracic catheter was therefore inserted, and the pneumothorax was improved. A chest radiograph obtained after treatment showed diffuse linear reticular shadows; and a chest CT scan showed starlike nodular lesions and multiple cysts in the lungs, and a large nodule in the left rib. Because an ulcer had been diagnosed in the oral cavity 1 year previously, a mandible biopsy was performed, and a granulomatous lesion consisting of eosinophils was recognized. Taken together with the pulmonary findings, an eosinophilic granuloma was diagnosed. The patient was instructed not to smoke and the clinical course was observed. The pulmonary, mandibular, and costal lesions improved.
Adult↗
[Comparative study of bone resorption markers for the diagnosis of bone metastasis in lung cancer].
NTx and I CTP, a metabolite of type I collagen, were compared as to their usefulness as indicators of bone metastasis in lung cancer. The NTx level was significantly higher in lung cancer patients with bone metastasis (107.9 +/- 56.1 nM BCE/mM) than in those without it (p < 0.0001), as was the I CTP level (10.0 +/- 6.5 ng/ml; p < 0.0001). The Z scores of NTx and I CTP were 2.37 and 2.04, respectively, indicating that NTx is superior to I CTP in sensitivity to bone metastasis because of its higher Z score and its higher area under the ROC curve. The cutoff values of these markers were set to produce the highest accuracy/sensitivity rates and to make possible the highest diagnostic efficiency, and then the odds ratios at these cutoff values were calculated. The odds ratios of NTx and I CTP at cutoff values for the highest accuracy were 66.3 and 12.6, respectively; those offering the highest diagnostic efficiency were 46.5 and 10.0, respectively. These results indicated that NTx offers better prediction of bone metastasis in lung cancer than does I CTP.
Biomarkers, Tumor↗
Contribution of Velocity Profiles at the Left Ventricular Outflow Tract to Calculations of Stroke Volume: A Magnetic Resonance Imaging Study.
OBJECTIVE: The goal of the study was to determine whether the central velocity of the left ventricular outflow tract represents the mean velocity of the total outflow area. METHODS: Thirteen healthy men (mean age, 30 +/- 6 years) and nine patients with aortic valve disease (seven with aortic regurgitation and two with aortic valve stenosis) were examined. Cine gradient echo images were obtained in the left ventricular outflow long axis. Cine images with velocity mapping were obtained in the short axis of the outflow tract. Values for peak velocity were obtained on the right-left axis and on the anteroposterior axis. Distances were measured along the axes from the right and anterior edges of the outflow tract at the point of peak velocity. Percentages of the distances for outflow diameter were calculated. Peak velocity at the left ventricular outflow tract using pulsed-Doppler method were also measured. RESULTS: In normal subjects and in patients, on the right-left axis, the peak velocity was 87 +/- 16 and 72 +/- 11 cm/sec, respectively, and the distance from the right edge of outflow tract corresponded to 19% +/- 8% and 21% +/- 7%, respectively. On the anteroposterior axis, the peak velocity was 86 +/- 16 and 60 +/- 9 cm/sec, and the corresponding distance from the anterior edge was 30% +/- 13% and 41% +/- 12% for normal subjects and patients, respectively. The central velocity of the outflow tract was 74 +/- 15 cm/sec, whereas the mean of the total outflow tract was 74 +/- 13 cm/sec. Central and mean velocities of the outflow tracts as revealed by magnetic resonance imaging showed a close and highly significant correlation in both groups. Velocity obtained by pulsed-Doppler method and mean velocity of the outflow tract by magnetic resonance imaging also showed significant correlation in both groups. CONCLUSIONS: Central velocity at the left ventricular outflow tract represented the mean of the total outflow tract both in normal subjects and in patients with aortic valve disease. The stroke volume measured by pulsed Doppler is therefore considered reliable if the sampling point is placed exactly at the center of the outflow.
Journal Article↗