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Ōsaka, Japan

Shima H.,Osaka City University | Ishimura E.,Osaka City University | Naganuma T.,Osaka City University | Yamazaki T.,Osaka City University | And 9 more authors.
Nephrology Dialysis Transplantation | Year: 2010

Background. Gradient-echo T2*-weighted magnetic resonance imaging (T2*-weighted MRI) is highly sensitive for detecting cerebral microbleeds (CMBs). CMBs have been reported to be a risk factor for future cerebrovascular events and a marker of cerebral small vessel disease in the general population. Chronic kidney disease (CKD) is an independent risk factor for cardiovascular disease. The relationship between CKD and CMBs, which has not been clarified to date, is examined.Methods. In this cross-sectional study, T2*-weighted MRI of brain was performed with a 1.5-T MRI system in 162 CKD patients (CKD stages 1-5, excluding CKD stage 5(D)) and 24 normal subjects.Results. CMBs were found in 35 CKD patients (25.6%), but not in control subjects. CMBs were more prevalent in male patients, in those with higher blood pressure, advanced age and poor kidney function. There was a significant association between the prevalence of CMBs and the CKD stage, with higher prevalence of CMBs as the CKD stages advanced (P < 0.01). Estimated glomerular filtration rate was a significant factor associated with the prevalence of CMBs, independent of age, gender and hypertension. There was no significant relationship between CMBs and the presence of diabetes mellitus and dyslipidemia.Conclusions. Decreased renal function is a significant risk factor for CMBs, independent of the presence of hypertension. Poor kidney function could be associated with future cerebrovascular events. © The Author 2009. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved. Source


Mizuyama Y.,Ohno Memorial Hospital
Gan to kagaku ryoho. Cancer & chemotherapy | Year: 2013

A 47-year-old woman had undergone breast-conserving treatment for right breast cancer (T3, N1, M0, Stage IIIA, human epidermal growth factor receptor[ HER]-2 enriched subtype) after primary systemic chemotherapy with trastuzumab. Pathological examination revealed a quasi-pathological complete response( CR) in the breast tumor and no axillary nodal involvement. The patient then received conventional breast irradiation and adjuvant trastuzumab therapy. However, adjuvant anti- HER2 therapy was discontinued in the 19th week because of a decreased left ventricular ejection fraction( approximately 50%). A left adrenal tumor was detected by abdominal computed tomography (CT) 2 years after surgery. Positron emission tomography( PET) scans showed strong accumulation in the left adrenal gland and in the lymph node near the adrenal tumor. No other obvious lesion was detected on meticulous examination. Laparoscopic adrenalectomy was performed for diagnosis and treatment. Pathological examination of the resected specimen revealed that the tumor was a metastatic adenocarcinoma with overexpression of the HER2 protein but without expression of hormonal receptors. The patient received 12 cycles of chemotherapy with paclitaxel and trastuzumab, which was followed by trastuzumab monotherapy. However, trastuzumab monotherapy could not be continued because the left ventricular ejection fraction decreased to 50% at 24 weeks after initiation of chemotherapy. The patient has been observed since the cessation of trastuzumab, without the administration of anticancer therapy, and she continues to have a good performance status without relapse. Herein, we report a case of solitary adrenal metastasis from breast cancer, an extremely rare condition, and review the relevant literature. Source


Naganuma T.,Osaka City University | Takemoto Y.,Osaka City University | Shoji T.,Osaka City University | Shima H.,Osaka City University | And 3 more authors.
Nephrology | Year: 2012

Aim: Cerebral white matter hyperintensities (WMHs), comprising periventricular hyperintensity (PVH) and deep and subcortical white matter hyperintensity (DSWMH) on magnetic resonance imaging (MRI), have been reported to be markers of ischaemic cerebral small-vessel disease and risk factors for future stroke, cognitive impairment and dementia in the general population. However, there have been only a few reports describing WMHs in haemodialysis (HD) patients and these previous studies have been relatively small population studies with little investigation on prevalence and risk factors according to the regional subtypes of WMHs. Methods: Cranial MRI was performed on 179 HD patients and 58 healthy control subjects and we investigated the prevalence of WMHs (PVH and/or DSWMH) and the clinical factors associated with the presence of WMHs. Results: The prevalence of WMHs was significantly higher in the HD patients than in the healthy subjects. In the HD patients, multiple logistic regression analysis showed that independent and significant factors associated with the presence of PVH were age, female gender and systolic blood pressure and those associated with the presence of DSWMH were age, female gender, systolic blood pressure and body mass index. Conclusions: These findings indicated a high prevalence of WMHs in HD patients. Older age, female gender and high blood pressure were strong factors associated with the presence of both PVH and DSWMH. Moreover, excess body weight was a significant factor associated with the presence of DSWMH only, indicating that there may be differences in risk factors according to the subtype of WMHs. This study demonstrates factors associated with cerebral white matter hyperintensities (WMH) on MRI in a relatively large cohort of HD patients. Among the risk factors that the authors described, female gender is a new finding as a risk factor of WMH. © 2012 The Authors. Nephrology © 2012 Asian Pacific Society of Nephrology. Source


Sonoda M.,Osaka City University | Shoji T.,Osaka City University | Kimoto E.,Meijibashi Hospital | Okute Y.,Osaka City University | And 10 more authors.
Journal of Atherosclerosis and Thrombosis | Year: 2014

Aim: Remnant lipoproteins are atherogenic and increased in patients with type 2 diabetes mellitus (T2DM), chronic kidney disease (CKD) and other conditions. Thus far, information is limited regarding the synthesis and absorption of cholesterol in CKD patients and a possible link to the remnant levels. We examined possible alterations in serum markers of cholesterol synthesis and absorption and their potential associations with remnant lipoproteins in patients with CKD. Methods: The subjects included 146 consecutive patients with T2DM in various stages of CKD. We measured the levels of remnant lipoprotein cholesterol (RemL-C), lathosterol (a cholesterol synthesis marker) and campesterol (a cholesterol absorption marker). The urinary albumin to creatinine ratio (U-ACR) and estimated glomerular filtration rate (eGFR) were used to describe the degree of CKD. Results: The median (interquartile range) levels of RemL-C, lathosterol and campesterol were 14.5 (11.5-23.4) mg/dL, 2.1 (1.7-2.9) μg/mL and 2.3 (1.7-3.0) μg/mL, respectively. The RemL-C level was positively correlated with the U-ACR and inversely correlated with the eGFR. The RemL-C level was positively correlated with both the lathosterol and campesterol levels. The lathosterol level was not significantly correlated with the U-ACR, although it was positively correlated with the eGFR. In contrast, the campesterol level was positively correlated with the ACR and inversely with the eGFR. In the multiple regression analysis, both lathosterol and campesterol were positively associated with the RemL-C level, independent of the U-ACR, eGFR and other variables. Conclusions: The serum campesterol concentrations are higher in patients with a greater degree of albuminuria and a lower renal funtion. In this study, the markers of cholesterol absorption and synthesis were independent determinants of the RemL-C level. Increased intestinal cholesterol absorption may be an additional mechanism for remnant accumulation in T2DM patients with CKD. Source


Maeda S.,Osaka City University | Naganuma T.,Osaka City University | Takemoto Y.,Osaka City University | Shoji T.,Osaka City University | And 2 more authors.
Molecular Medicine Reports | Year: 2012

Recently, it has been reported that kidney stones are a significant and independent risk factor for chronic kidney disease (CKD) in the general population. However, the prevalence of CKD in patients following successful extracorporeal shockwave lithotripsy (ESWL) has yet to be elucidated. In the present study, the prevalence of CKD and the clinical factors associated with the presence of CKD in patients following successful ESWL were investigated. A cross-sectional study was performed in 114 patients who had undergone ESWL for upper urinary tract stones and 96 age- and gender-matched healthy control subjects. We initially determined the stage of CKD and compared the prevalence of CKD between healthy subjects and patients who underwent successful ESWL. We then investigated the clinical factors associated with the presence of CKD by logistic regression analysis. The prevalence of CKD was significantly higher in patients following successful ESWL than in the healthy subjects [40 patients (35.1%) vs. 9 healthy controls (9.4%), P<0.0001]. Logistic regression analysis showed that the significant factors associated with the presence of CKD were increased body mass index (BMI) and the presence of a ureteric stone (pre-ESWL stone position). The findings indicated that there was a high prevalence of CKD among patients following successful ESWL, and that an increased BMI and a ureteric stone were factors associated with the presence of CKD. Source

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