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Jōetsu, Japan

Izawa A.,Shinshu University | Kashima Y.,Shinshu University | Miura T.,Shinshu University | Ebisawa S.,Shinshu University | And 8 more authors.
Circulation Journal

Background: Statins reduce the incidence of cardiovascular events, but no randomized trial has investigated the best statins for secondary prevention. We compared the efficacy of hydrophilic pravastatin with that of lipophilic atorvastatin in patients with acute myocardial infarction (AMI).Methods and Results: A prospective, multicenter study enrolled 508 patients (410 men; mean age, 66.0±11.6 years) with AMI who were randomly assigned to atorvastatin (n=255) or pravastatin (n=253). The target control level of low-density lipoprotein cholesterol (LDL-C) was <100 mg/dl, and patients were followed for 2 years. The primary endpoint was the composite of death due to any cause, non-fatal myocardial infarction, non-fatal stroke, unstable angina or congestive heart failure requiring hospital admission, or any type of coronary revascularization. The primary endpoint occurred in 77 patients (30.4%) and in 80 patients (31.4%) in the pravastatin and atorvastatin groups, respectively (hazard ratio, 1.181; 95% confidence interval: 0.862–1.619; P=0.299), whereas greater reductions in serum total cholesterol and LDL-C were achieved in the atorvastatin group (P<0.001 for each). Changes in hemoglobin A1c, brain natriuretic peptide, and creatinine were not significant between the 2 regimens, and safety and treatment adherence were similar.Conclusions: On 2-year comparison of hydrophilic and lipophilic statins there was no significant difference in prevention of secondary cardiovascular outcome. © 2014, The Japanese Circulation Society Source

Shintaku M.,Red Cross | Yoshida M.,Hyogo Prefectural Kobe Childrens Hospital | Ikarashi T.,Nagaoka Central General Hospital | Arakawa Y.,Joetsu General Hospital | Nagashima T.,Hyogo Prefectural Kobe Childrens Hospital

We report two cases of ependymoma which showed prominent "granular cell" changes of the cytoplasm. The patients were a 7-year-old boy with a tumor in the cerebellum (case 1) and a 70-year-old man with a tumor in the frontal lobe (case 2). The tumor of case 1 showed a histopathological appearance of ependymoma containing many focal aggregates of large polygonal cells in which the cytoplasm was stuffed with numerous eosinophilic granules. The tumor of case 2 predominantly showed the features of papillary ependymoma, and some tumor cells were swollen and contained similar eosinophilic granules. Intracytoplasmic granules in both tumors were immunoreactive for GFAP and ubiquitin, but not for epithelial membrane antigen, CD68 or mitochondria. Ultrastructurally, they were found as aggregates of membrane-bound, electron-dense, globular structures. Karyotypic analysis of the tumor in case 1 demonstrated 2, 11 and 12 trisomies. Intracytoplasmic eosinophilic granules occasionally occur in astrocytic and oligodendroglial neoplasms, but an appearance of similar granules is very rare in ependymoma. The two cases presented here may represent a new histopathological variant of ependymoma, and the term "granular cell ependymoma" is appropriate for them. © 2012 Japanese Society of Neuropathology. Source

Hayashi M.,Joetsu General Hospital
Nihon Kokyūki Gakkai zasshi = the journal of the Japanese Respiratory Society

A 52-year-old man noticed hardening and swelling of his salivary glands in the summer of 2009. We suspected Mikulicz disease and performed several work-ups. His serum IgG4 level was elevated, and a chest computed tomography scan demonstrated marked thickening of the bronchial wall. A histopathologic examination of a bronchial mucosa biopsy specimen revealed diffuse infiltration of IgG4-positive cells in the submucosal layers, and on this basis we diagnosed IgG4-related disease. After the administration of corticosteroids, the patient's symptoms, his serum IgG4 level and bronchial wall thickening all improved. When encountering a patient with thickening of the bronchial wall, IgG4-related disease should be considered. Source

Hasegawa K.,Nishinomiya Kyoritsu Neurosurgical Hospital | Kinoshita M.,Nishinomiya Kyoritsu Neurosurgical Hospital | Asahi T.,Joetsu General Hospital
Japanese Journal of Anesthesiology

A 71-year-old woman was scheduled for arthroscopic knee surgery. Anesthesia was administered with sevoflurane, fentanyl, and rocuronium bromide. Total dose of fentanyl was 200 μg and total dose of rocuronium bromide was 40 mg. After surgery sugammadex 150 mg was given before awakening of the patient and appearance of spontaneous breathing. Immediately after the administration of sugammadex airway pressure increased to 37 cmH 2O, and ventilation became difficult. After naloxone 0.1 mg injection, ventilation improved dramatically. The cause of difficult ventilation was surmised to be upper airway reflex or muscle rigidity caused by reaction to fentanyl. We thought the phenomenon was clearly manifested by rapid recovery from muscle relaxation by injection of sugammadex. Before injection of sugammadex, it is necessary to confirm the effects of anesthetics on the patient's condition. Source

Tada M.,University of Michigan | Tada M.,Niigata University | Coon E.A.,Mayo Medical School | Osmand A.P.,University of Tennessee at Knoxville | And 11 more authors.
Acta Neuropathologica

We report a retrospective case series of four patients with genetically confirmed Huntington's disease (HD) and sporadic amyotrophic lateral sclerosis (ALS), examining the brain and spinal cord in two cases. Neuropathological assessment included a polyglutamine recruitment method to detect sites of active polyglutamine aggregation, and biochemical and immunohistochemical assessment of TDP-43 pathology. The clinical sequence of HD and ALS varied, with the onset of ALS occurring after the mid-50's in all cases. Neuropathologic features of HD and ALS coexisted in both cases examined pathologically: neuronal loss and gliosis in the neostriatum and upper and lower motor neurons, with Bunina bodies and ubiquitinimmunoreactive skein-like inclusions in remaining lower motor neurons. One case showed relatively early HD pathology while the other was advanced. Expanded polyglutamine-immunoreactive inclusions and TDP-43- immunoreactive inclusions were widespread in many regions of the CNS, including the motor cortex and spinal anterior horn. Although these two different proteinaceous inclusions coexisted in a small number of neurons, the two proteins did not co-localize within inclusions. The regional distribution of TDP-43-immunoreactive inclusions in the cerebral cortex partly overlapped with that of expanded polyglutamine-immunoreactive inclusions. In the one case examined by TDP-43 immunoblotting, similar TDP-43 isoforms were observed as in ALS. Our findings suggest the possibility that a rare subset of older HD patients is prone to develop features of ALS with an atypical TDP-43 distribution that resembles that of aggregated mutant huntingtin. Age-dependent neuronal dysfunction induced by mutant polyglutamine protein expression may contribute to later-life development of TDP-43 associated motor neuron disease in a small subset of patients with HD. © 2012 Springer-Verlag. Source

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