Prognosis of asymptomatic hematuria and/or proteinuria in men. High prevalence of IgA nephropathy among proteinuric patients found in mass screening

AIM: To elucidate prognosis and prevalence of chronic renal diseases among proteinuric and/or hematuric subjects found in mass screening, a long-term follow-up study (6.35 years, range 1.03-14.6 years) was conducted on Japanese working men. METHODS: A total of 772 subjects selected from 50,501 Japanese men aged 15-62 years were found to have asymptomatic hematuria (n = 404), concomitant hematuria and proteinuria (n = 155), and proteinuria (n = 213) during their annual urine examination and five consecutive urinalyses. RESULTS: Hematuria patients showed significant improvements in urinary abnormalities as compared with both hematuria/proteinuria and proteinuria patients. Both hematuria/proteinuria patients with normotension and hematuria/proteinuria patients aged under 40 years showed significant improvements. During the follow-up period, 9.5% of the hematuria patients became hematuric/proteinuric. Hematuria/proteinuria patients had the highest risk of developing renal insufficiency. The presence of hypertension at detection of urinary abnormalities did not affect the renal function; however, if proteinuria appeared after the age of 40 years, these patients had a higher risk of developing renal insufficiency. The incidence of IgA nephropathy in the present subjects was as high as 143 cases per 1 million per year. CONCLUSION: Detailed follow-up and definitive diagnosis of asymptomatic urinary abnormalities may raise the prevalence of IgA nephropathy worldwide.     

Occlusive thrombosis with neovascularization of the internal carotid artery--two case report--

Two patients presented with sudden onset of occlusive thrombosis of the atherosclerotic carotid artery. The patients underwent carotid endarterectomy. Histological examination of the specimens clearly showed the presence of pre-existing atherosclerotic plaque with moderate stenosis and occlusive organized thrombus. Blood flow was maintained through a honeycomb pattern of multiple neovascularization within the organized thrombus. These cases suggest that both the degree of stenosis and the plaque characteristics should be considered when evaluating the risk of stroke in patients with carotid artery stenosis.     

A minimum 2-year comparative study of autologous cancellous bone grafting versus beta-tricalcium phosphate in anterior cervical discectomy and fusion using a rectangular titanium stand-alone cage

Although titanium stand-alone cages are commonly used in anterior cervical discectomy and fusion (ACDF), there are several concerns such as cage subsidence after surgery. The efficacy of β-tricalcium phosphate (β-TCP) granules as a packing material in 1- or 2-level ACDF using a rectangular titanium stand-alone cage is not fully understood. The purpose of this study is to investigate the validity of rectangular titanium stand-alone cages in 1- and 2-level ACDF with β-TCP. This retrospective study included 55 consecutive patients who underwent ACDF with autologous iliac cancellous bone grafting and 45 consecutive patients with β-TCP grafting. All patients completed at least 2-year postoperative follow-up. Univariate and multivariate analyses were performed to examine the associations between study variables and nonunion after surgery. Significant neurological recovery after surgery was obtained in both groups. Cage subsidence was noted in 14 of 72 cages (19.4 %) in the autograft group and 12 of 64 cages (18.8 %) in the β-TCP group. A total of 66 cages (91.7 %) in the autograft group showed osseous or partial union, and 58 cages (90.6 %) in the β-TCP group showed osseous or partial union by 2 years after surgery. There were no significant differences in cage subsidence and the bony fusion rate between the two groups. Multivariate analysis using a logistic regression model showed that fusion level at C6/7, 2-level fusion, and cage subsidence of grades 2–3 were significantly associated with nonunion at 2 years after surgery. Although an acceptable surgical outcome with negligible complication appears to justify the use of rectangular titanium stand-alone cages in 1- and 2-level ACDF with β-TCP, cage subsidence after surgery needs to be avoided to achieve acceptable bony fusion at the fused segments. Fusion level at C6/7 or 2-level fusion may be another risk factor of nonunion.     

Erythropoietin-resistant anaemia in a predialysis patient with Klinefelter syndrome

A diabetic predialysis patient who had significantly reduced sensitivity to erythropoietin therapy was admitted to Tsukuba University Hospital. Many factors that might have been the cause of the erythropoietin resistance were examined, and a diagnosis of refractory anaemia was made based on a bone marrow aspiration biopsy. A cytogenetic abnormality (47, XXY) was also detected in the bone marrow biopsy specimen, and hence the patient was also diagnosed with Klinefelter syndrome. It was suspected that the sex chromosome abnormality influenced glucose intolerance, renal insufficiency, and erythropoietin resistance due to myelodysplastic changes in the bone marrow.     

Surgical clipping of a recurrent small saccular aneurysm after repeated coil embolization

A 59-year-old healthy woman presented with sudden onset of severe headache. Computed tomography and digital subtraction angiography (DSA) demonstrated subarachnoid hemorrhage (grade I according to the Hunt and Hess classification) due to a ruptured small right posterior cerebral artery (PCA) aneurysm. The ruptured PCA aneurysm was completely embolized with three Guglielmi detachable coils (GDCs). However, follow-up DSA 3 months after the initial coiling confirmed refilling of the aneurysm. The aneurysm was successfully re-embolized with two GDCs. Follow-up DSA 10 months later revealed regrowth of the aneurysm. Surgical clipping was performed without compromising the parent vessels. Long-term angiographic follow up is necessary even in patients with small saccular aneurysms which are apparently completely embolized by endovascular coil treatment.     

Milrinone for the treatment of cerebral vasospasm after subarachnoid hemorrhage: report of seven cases

OBJECTIVE: The intra-arterial infusion of papaverine has been used for dilation of spastic cerebral vessels after aneurysmal subarachnoid hemorrhage, although its efficacy is controversial. Milrinone is an inotropic drug that dilates vessels by phosphodiesterase inhibition in a mechanism similar to that of papaverine. We examined the effects of intra-arterial and subsequent intravenous administration of milrinone on patients with symptomatic cerebral vasospasm. METHODS: Seven patients with cerebral vasospasm were enrolled in this study. Milrinone was delivered intra-arterially via catheter at a rate of 0.25 mg/min. The total delivered dose was between 2.5 and 15 mg. Radiological measurement of the middle cerebral artery diameter and cerebral blood flow was carried out before and after arterial infusion. Intravenous treatment followed at 0.50 or 0.75 microg/kg/min for up to 2 weeks from the onset of subarachnoid hemorrhage. RESULTS: Dilation of the vasospastic vessels occurred in all patients. The rate of cerebral blood flow was calculated in six patients and was increased in all. Subsequent intravenous infusion was effective in preventing a recurrence of symptomatic vasospasm in four of the seven patients. CONCLUSION: It is suggested that milrinone was effective and safe for the treatment of cerebral vasospasm after subarachnoid hemorrhage in the patients in this series. Intra-arterial infusion with adjunctive intravenous infusion holds promise as a clinically advantageous treatment regimen.     

Basal cell adenoma arising in a minor salivary gland of the palate

Background

Basal cell adenoma is a benign neoplasm of the salivary glands. This tumor usually arises in the major glands, with the parotid being the most frequent site of occurrence, while it is rare in the minor salivary glands. We report a case of basal cell adenoma of a minor salivary gland on the palate.

Case

The patient was a 68-year-old man. Intraoral examination revealed a mass measuring 20?×?20?mm that was elastic-hard, dark violet, non-ulcerated, and covered the normal mucosa. Computed tomography scan and magnetic resonance imaging (MRI) both showed a mass situated in front of the soft palate. The T1-weighted MRI revealed tumor isointensity, and the T2-weighted image showed tumor hyperintensity. The clinical diagnosis was palate tumor, and excision was performed under general anesthesia. Histopathological examination revealed that an encapsulated mass had grown under the epithelium and indicated a diagnosis of basal cell adenoma.

Discussion

Although no recurrence has been detected in the 3?years and 6?months of follow up, there was a case of malignant transformation of a basal cell adenoma reported. Therefore, careful follow-up observation will continue to be important.     

Prevalence of and risk factors for suicide-related outcomes in the World Health Organization World Mental Health Surveys Japan

Aim:  Suicide is a major public health concern in Japan but little is known about the prevalence of and risk factors for suicidal ideation, plans, and attempts. The aim of the present study was to clarify the prevalence of and risk factors for important suicide-related outcomes.
Methods:  Important suicide-related outcomes and risk factors were assessed in face-to-face interviews with 2436 adult respondents in seven areas as part of the World Health Organization (WHO) World Mental Health Survey Initiative. Mental disorders were assessed with the WHO Composite International Diagnostic Interview (CIDI).
Results:   The lifetime prevalence estimates of suicidal ideation, plans, and attempts were 10.9%, 2.1%, and 1.9%, respectively. Risk of suicide plans and attempts was highest when suicidal ideation occurred at an early age and within the first year of ideation. In middle-aged individuals, the period after first employment and the presence of mental disorders were risk factors.
Conclusions:  Risk of suicide plans and attempts is highest when suicidal ideation occurred at an earlier age and within the first year of ideation. Mental disorders are as predictive of the suicide-related outcomes examined here, and comorbidity is an important predictor.     

Mycoleptodonoides aitchisonii affects Brain Nerve Growth Factor Concentration in Newborn Rats

Abstract

Fourteen days pregnant Wistar strain rats were fed powder or aqueous extract of the edible fungus MycoleptFodonoides aitchisonii . Nerve growth factor (NGF) concentrations were measured in the brain of newborn rats during the lactation period at 0, 7 and 14 days after the birth. Two M. aitchisonii -fed groups showed a significant increase in NGF concentrations in brain halves compared to those who were fed control feed at days 7 and 14. At day 21, NGF concentrations in the cerebral cortex and hippocampus were not significantly different among the three groups. After weaning, the young rats were fed the same test diet as their mothers. Ten days later, Morris water maze test was started. After the test, the rats were sacrificed and NGF concentrations in the cerebral cortex and hippocampus were measured. Significant NGF concentration increases were detected in the cerebral cortex for two M. aitchisonii -fed groups and in the hippocampus in the aqueous extract group. These results suggest that NGF in the brain reached the same levels by day 21, but that M. aitchisonii affected the growth rate in the lactation period. The learning test stimulated the brain and some compounds of M. aitchisonii enhanced NGF synthesis in rat cerebral cortex and hippocampus.