Retroperitoneal fibrosis with periaortic and pericardial involvement.

A 66-year old man, who had been diagnosed with dilated cardiomyopathy and felt a progressive shortness of breath and fatigability, was admitted to hospital. Computed tomography showed a thickening of the aortic wall from the aortic arch to the aortic bifurcation, as well as mild pleural and pericardial effusion. Intravenous pyelography showed severe ureteral stenosis, along with hydronephrosis, of the left side. There was a marked increase in C-reactive protein and the erythrocyte sedimentation rate, but the serology for connective tissue disease and perinuclear antineutrophil cytoplasmic antibodies was negative. Retroperitoneal fibrosis (RPF) with intrathoracic extension was diagnosed. After confirming the absence of malignant disease, an oral predonisolone treatment of 30 mg/day was started, and this ameliorated the ureteral obstruction, aortic wall thickening and pericardial effusion. The patient had been taking 300 mg of loxoprofen sodium for headaches every day for 16 years. The relationship between loxoprofen, cardiomyopathy and RPF remains unclear. There is a possibility of RPF in the patients with a thickening of thoracic aortic wall, as in this case.     

Inflammation and disease duration have a cumulative effect on the risk of dysplasia and carcinoma in IBD: A case–control observational study based on registry data

Patients with long‐standing inflammatory bowel disease (IBD) have an increased risk for colorectal carcinoma (CRC). Earlier studies suggest that the severity of inflammation is an independent risk factor for CRC in ulcerative colitis (UC). We investigated the role of histological inflammation as a risk factor for colorectal dysplasia or CRC to better target dysplasia surveillance in IBD. By combining our hospital patient registry and pathology database between 1996 and 2008, we identified 183 IBD patients with dysplasia or CRC. The control group was collected from our registry of IBD patients. Histological severe inflammation was present in 41.4% of patients with dysplasia and in 24.1% of patients with CRC, but in only 4.3% of controls. Severe inflammation had an odds ratio (OR) of 31.8 [95% confidence interval (CI): 15.6–64.9] for dysplasia or carcinoma compared to patients with no inflammation. Among patients with mild to moderate inflammation, the OR was 2.6 (95% CI: 1.6–4.1). Disease duration increased the annual risk for dysplasia or CRC by 4.5%. Coexisting primary sclerosing cholangitis (PSC) did not elevate the risk, whereas use of thiopurines (OR = 0.09, 95% CI: 0.02–0.33) and also 5‐aminosalicylic acid (OR 0.17, 95% CI: 0.017–1.01) protected against CRC. As conclusion, degree of inflammation and duration of disease cumulatively increase the risk for dysplasia and CRC. PSC was not identified as a risk factor. We demonstrated that use of thiopurines strongly protects against CRC. These results can be applied to better target dysplasia surveillance in IBD patients.     

Genetic heterogeneity among bovine leukemia viruses in Japan and their relationship to leukemogenicity

Bovine leukemia virus (BLV) infection in cattle causes persistent lymphocytosis, and a few percent of infected animals develop lymphoid tumors, namely enzootic bovine leukosis (EBL). In this study, a 440-bp fragment of the env gene was amplified from 204 tumor samples collected from different regions of Japan and analyzed by restriction fragment length polymorphism (RFLP) to determine the association of BLV with EBL. Of the seven RFLP types defined, types I, II, and III were dominant and found in 12.7, 75.0, and 8.3% of tumor samples, respectively. Cattle harboring type III virus were significantly older than other animals at the time of diagnosis of EBL. Type III viruses were found in approximately 33% and 5.5% of Japanese Black and Holstein cattle, respectively, with EBL. These findings indicate that genetically distinct BLV was associated with EBL in Japan and that the genetic profile may influence the leukemogenicity of the virus.     

Gendered Communicative Construction of Patients in Consultation Settings

This study aimed to explore the communication in consultations between patients and health care staff from a gender perspective. We used 23 tape-recorded consultations between patients with Atrial Fibrillation and 5 nurses and 5 physicians at cardiac outpatient clinics at 6 different hospitals in southern Sweden during autumn 2009 to explore the verbal gendered constructions of patients. Through critical discourse analysis, we revealed that the male patients tended to describe their ailments with performance-oriented statements, whereas the female patients usually used emotional-oriented statements. The staff downplayed the male patients' questions and statements, while they acknowledged concern toward the female patients. Both the patients and the staff made conclusions according to a mutual construction. Male patients were constructed as competent, and female patients as fragile through gender-stereotypical communication. Open-ended statements and questions enabled consultations to be less limited by gender stereotypes.     

Quantitative evaluation of regular and irregular corneal astigmatism in patients having overnight orthokeratology

PURPOSE: To quantitatively assess changes in regular and irregular corneal astigmatism in patients having overnight orthokeratology. SETTING: Matsumoto Eye Clinic, Ibaraki, Japan. METHODS: A prospective study was conducted of 64 eyes of 39 patients having overnight orthokeratology for myopia. Inclusion criteria were an uncorrected visual acuity (UCVA) of 20/20 or better after treatment and a minimum follow-up of 3 months. Using Fourier series harmonic analysis, videokeratography data were decomposed into spherical component, regular astigmatism, asymmetry (tilt or decentration), and higher-order irregularity. RESULTS: Orthokeratology significantly reduced the manifest refraction from -2.60 diopters (D) +/- 1.13 (SD) to -0.17 +/- 0.31 D (P<.0001, paired t test) and improved the UCVA from 0.82 +/- 0.30 to -0.11 +/- 0.06 logMAR (P<.0001). Regular astigmatism increased significantly from 0.53 +/- 0.23 D preoperatively to 0.63 +/- 0.40 D postoperatively (P =.0206). The asymmetry component increased significantly from 0.35 +/- 0.22 D to 0.64 +/- 0.40 D (P<.0001). Higher-order irregularity did not change significantly: 0.14 +/- 0.11 D before treatment and 0.17 +/- 0.20 D after treatment (P =.2166). The amount of myopic correction correlated significantly with the increase in the asymmetry component (Pearson correlation coefficient, R = 0.40, P =.0009) but not with the increase in regular astigmatism (R = 0.24, P =.055). CONCLUSIONS: Irregular corneal astigmatism significantly increased, even in clinically successful orthokeratology cases. The effect of the changes on visual function should be studied further.     

Abdominal Sonographic Findings at Primary Diagnosis of Acute Lymphoblastic Leukemia in Children: A Comparison with Different Clinical Risk Factors

We evaluated the presence of abdominal organomegaly and lymphadenopathy with ultrasound in 92 children with acute lymphoblastic leukemia (ALL) prior to chemotherapy, and compared these findings with the different immunophenotypes, age groups, and white blood cell (WBC) counts as well as the survival of the patients and the clinical findings of organomegaly. All the patients (n = 13) with a WBC higher than 50/μL showed intra-abdominal pathology compared with the patients with a low WBC, of whom 37% (n = 18) had normal scans. The children with a high WBC count also had hepatomegaly (P = 0.003) and splenomegaly (P = 0.06) significantly more often, and showed high echogenicity of the kidneys (P = 0.001). Lymphadenopathy was found significantly more often in children with T-cell leukemia (P = 0.005). The younger age groups (0 to 2 and 2 to 5 years of age) had hepatomegaly significantly more often (P = 0.02), and the youngest age group (0 to 2 years) showed increased echogenicity of the kidneys more often (P = 0.04). Ultrasound showed hepatomegaly in 14 patients and splenomegaly in 23 patients who were assessed clinically as normal. According to our results, abdominal ultrasound is a useful tool for evaluating abdominal organomegaly and the extra-medullary leukemic burden and can give information that is not available in clinical examination. There was no statistical association between the primary ultrasonographic findings and the patients' later survival.     

Functional characterization of adenosine transport across the BBB in mice

We investigated transport characteristics of adenosine across the blood–brain barrier (BBB) in mice. Uptake clearance across the BBB was measured by using an in situ mouse brain perfusion technique and cultured mouse brain capillary endothelial cell line (MBEC4 cells). Nucleoside transporter was cloned by RT-PCR and expressed on Xenopus laevis oocyte. Both in situ and in vitro studies revealed that the adenosine uptake is concentration-dependent, Na⁺-independent and S-(p-nitrobenzyl)-6-thioinosine (NBMPR)-sensitive. The K_t values of in situ and in vitro studies were 31.7 ± 13.8 μM and 11.9 ± 2.84 μM, respectively. A good correlation was found for the inhibitory effects of nucleoside analogs to adenosine uptake between in situ and in vitro studies. RT-PCR revealed the expression of RNA of mouse equilibrative nucleoside transporter (mENT1) in mouse brain capillary and MBEC4 cells. In mENT1 expressed on X. laevis oocyte, K_t value of adenosine transport was 6.9 ± 2.7 μM (and comparable to those in situ and in vitro studies). In conclusion, we characterized the adenosine transport across the BBB in mice by using in situ brain perfusion technique and MBEC4 cells and found that these transports share common characteristics with mENT1-mediated transport. Transport of adenosine across the BBB in mice may be attributable to mENT1.