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Fujiwara Y.,Shiga Medical Center for Adults
Kyobu geka. The Japanese journal of thoracic surgery | Year: 2013

A 33-year-old male with hereditary deficiency of antithrombin III (AT III) was diagnosed with annuloaortic ectasia and scheduled for the aortic root replacement. As perioperative anticoagulation, AT III was administered to have its activity≥70% in addition to heparin. During the operation with cardiopulmonary bypass, 3,000 IU of AT III concentrate was infused, and there was no hemorrhagic complication. After the operation low-molecular-weight heparin was used instead of unfractionated heparin to avoid bleeding. However, renal infarction occurred on postoperative day 11. Heparin was continuously given in combination with 1,500 IU/day of AT III concentrate until oral warfarin reached within therapeutic range. The patient recovered without further sequelae. Cardiac surgery might be safely performed in patients with AT III deficiency by replenishing AT III concentrate to keep its activity higher than 80%.

Nishio H.,Shiga Medical Center for Adults
Kansenshōgaku zasshi. The Journal of the Japanese Association for Infectious Diseases | Year: 2012

We report a case of fungemia caused by Scedosporium prolificans, an emerging pathogen. An 83-year-old man with myelodysplastic syndrome (MDS) and agranulocytosis was admitted for pneumonia in January 2009. He was treated with meropenem, minocycline, and gamma-globulin for pneumonia and G-CSF and platelet transfusion for MDS. Although he recovered from pneumonia as neutrophil count increased, intermittent fever continued. On hospital day 17, blood culture yielded fungal colonies indicating S. prolificans. Voriconazole was started immediately, but the man's general condition deteriorated with cerebral infarction and he died of cerebral hemorrhage on hospital day 65. Attention must therefore be paid to the increasing scedosporiosis incidence in Japan.

Nakamura Y.,Shiga Medical Center for Adults
Kansenshōgaku zasshi. The Journal of the Japanese Association for Infectious Diseases | Year: 2011

Mycotic aortic aneurysm due to Streptococcus pneumoniae is rare. The case of we report occurred in 62-year-old man with no antecedent infection admitted for appetite loss and lower leg edema. Chest and abdominal computed tomography, blood culture, and gene analysis to detec arterial wall pneumococci led to a diagnosis of mycotic aortic aneurysm caused by S. pneumoniae. The man had a graft replaced and was administered antibiotics. He remains well and infection-free 12 months after surgery. We also review the literature on these aortic aneurysms.

Shioi T.,Kyoto University | Inuzuka Y.,Shiga Medical Center for Adults
Journal of Cardiology | Year: 2012

Heart failure is a typical age-associated disease. However, the mechanism by which heart function declines and heart failure increases in association with age is not clear. Recent advances in basic science clarify several important mechanisms of aging. The mechanisms identified are likely to serve as substrates by which heart function declines and predisposes elderly people to heart failure. One such mechanism is insulin/insulin-like growth factor (IGF)-1 signaling. Suppression of insulin/IGF-1 signaling prevents cardiac aging associated with improved protein homeostasis in the heart. However, the role of insulin/IGF-1 signaling in heart diseases is likely to be pleiotropic, and both protective and sensitizing effects have been described in different contexts. Reduction in function of extra-cardiac organs is likely to be another important mechanism by which heart failure increases with aging, since heart failure is a multiple organ system disease. © 2012 Japanese College of Cardiology.

Kono F.,Kyoto University | Honda T.,Kyoto University | Aini W.,Kyoto University | Manabe T.,Shiga Medical Center for Adults | And 2 more authors.
British Journal of Dermatology | Year: 2014

Background There have been extensive studies regarding which types of T lymphocytes are involved in psoriasis vulgaris (PV). However, it has remained unclear which types of T lymphocytes might directly contribute to psoriasiform epidermal and vascular hyperplasia. Objectives To understand the role of T-cell receptor (TCR)Vα24+ invariant natural killer (iNK)T cells in the development of PV. Methods Seventeen patients were enrolled in this study. Using biopsy samples of PV plaques, TCRVα24+ iNKT cells were investigated regarding their cytokine production to understand their roles in development of disease. Results The number of interferon (IFN)-γ+ iNKT cells correlated with the length of the psoriasiform hyperplasia rete ridge and the Psoriasis Area and Severity Index. IFN-γ+ iNKT cells in psoriatic skin exhibited higher C-C chemokine receptor (CCR)5 expression, and the amount of C-C chemokine ligand (CCL)5, a ligand for CCR5, was increased in capillary veins of psoriasis plaques. CCR5+ iNKT-cell numbers significantly correlated with the number of capillary vein endothelial cells expressing CCL5 in PV. Furthermore, the number of CCL5+ capillary veins correlated with the maximum rete ridge length. Conclusions IFN-γ/CCR5 expression in iNKT cells and CCL5 expression in vessels of dermal papillae correlate with the development of psoriasiform hyperplasia and microabscess. We propose that these iNKT cells may become useful targets for development of novel therapeutic approaches to PV. What's already known about this topic? Natural killer (NK)T cells are present in psoriasis plaques, and injection of NKT cells into transplanted psoriatic skin drives lesion formation. Imbalance of interferon (IFN)-γ and interleukin (IL)-4 contributes to lesion development. Injection of IL-4 into the plaque ameliorates psoriasis. What does this study add? Invariant NK (iNK)T-cell number correlates with the length of the rete ridge, and with the Psoriasis Area and Severity Index, epidermal hyperplasia and degree of microabscess formation. iNKT cells in psoriatic skin have higher CCR5 expression, and the CCR5+ iNKT-cell count correlates with that of CCL5+ capillaries in dermal papillae. The CCL5+ capillary endothelial cell count correlates with epidermal hyperplasia. © 2013 British Association of Dermatologists.

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