We describe a patient with localized painful giant-cell thyroiditis. A 45-year-old woman noticed a tender lump in the left side of the neck. Sonography of the thyroid revealed diffuse swelling of the left lobe with irregular hypoechoic areas. Three months later, the tender swelling subsided, and the hypoechoic areas disappeared without any treatment. There were never any systemic signs of inflammation or thyroid dysfunction. Atypical localized subacute thyroiditis was considered to be the most probable diagnosis based on fine-needle aspiration cytology and serial sonography. Serial sonographic evaluations are useful to avoid unnecessary surgery.

Biopsy, Needle↗

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Rapidly growing esophageal leiomyosarcoma: case report and review of the literature.

We evaluated a 72-year-old woman who was experiencing dysphagia. Esophageal leiomyosarcoma was diagnosed by barium meal study, upper gastrointestinal endoscopy, endoscopic ultrasonography (EUS), by computed tomography (CT). A barium meal study and esophagoscopy performed 3 months before the diagnosis of esophageal leiomyosarcoma showed no abnormalities. Therefore, the tumor appeared to have grown rapidly during the 3-month period.

Aged↗

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Diagnostic value of push-type jejunal endoscopy in primary jejunal carcinoma.

Push-type jejunal endoscopy using a long forward-viewing duodenofiberscope was performed in two patients with primary jejunal carcinoma. Patient 1, a 48-year-old female, complained of nausea, vomiting, and weight loss, whereas patient 2, a 65-year-old female, presented epigastric pain. The lesion was located in the upper portion of the jejunum, and diagnosis was made by a double-contrast X-ray study of the small intestine in both patients. Endoscopic examinations revealed a reddish, nodular polypoid lesion with an annular constriction and an irregular central ulceration. Endoscopic biopsy confirmed a diagnosis of adenocarcinoma in both patients. Push-type jejunal endoscopy is valuable for an accurate preoperative diagnosis of primary jejunal carcinoma.

Adenocarcinoma↗

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Perfusion delay causes unintentional ischemic preconditioning in isolated heart preparation.

This study sought to show that unintentional preconditioning can be induced in the isolated perfused heart during the preparation procedure. The following four groups were compared: hearts were placed in ice cold saline and cooled for 15 s and then mounted to the Langendorff apparatus (n = 5; cool immediate group); hearts were cooled for 60 s and mounted (n = 5; cool delay group); hearts were mounted directly to the apparatus within 15 s after the isolation without cooling (n = 5; noncool immediate group); hearts were mounted without cooling, but the mounting was delayed for 60 s after the isolation (n = 5; noncool delay group). All hearts were paced at a fixed rate of 300 bpm, and an occlusion of left coronary (LCA) for 60 min was performed, which was followed by reperfusion for another 60 min. Coronary flow (CBF), left ventricular developed pressure (LVDP), and creatine phosphokinase (CPK) release did not change among the four groups during ischemia. At the end of reperfusion the LVDP values were 70 +/- 1%, 66 +/- 2%, 62 +/- 3%, and 73 +/- 2% of preischemic values in cool immediate, cool delay, noncool immediate, and noncool delay groups, respectively. CPK values were 116 +/- 4, 121 +/- 7, 138 +/- 6, and 29 +/- 1 x 10(3) U/g myocardium, and percentage necrosis/risk areas were 24 +/- 1.0%, 21 +/- 1.7%, 38 +/- 2.6%, and 13 +/- 0.5% in cool immediate, cool delay, noncool immediate, and noncool delay groups, respectively. The noncool delay group demonstrated high LVDP, least amount of CPK release, and smallest size of necrosis. These results indicate that an unintentional preconditioning effect can be induced when the cooling procedure is not applied and perfusion is delayed.

Analysis of Variance↗

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Probucol reduces lysophosphatidylcholines in low-density lipoprotein.

OBJECTIVES: Lysophosphatidylcholine (LPC) in low-density lipoprotein (LDL) comes into notice as an important atherogenic substance. METHODS: Since the effect of probucol, an antioxidative lipid-lowering drug, on LPC molecular species has not been elucidated, two LPC molecular species, stearoyl LPC (SLPC) and palmitoyl LPC (PLPC), were measured in LDL using high-pressure liquid chromatography. LDL was obtained from 11 hyperlipidemic patients, including 9 diabetic patients, in comparison with 11 age- and gender-matched controls. RESULTS AND CONCLUSION: Hyperlipidemic patients showed nearly twofold higher levels of SLPC and PLPC per gram of LDL protein than those of controls. All hyperlipidemic patients were treated with oral administration of 500 mg/day of probucol for 3 months. Both LPCs in LDL were significantly reduced to control levels and were increased again up to the pretreatment levels 4 weeks after cessation of the treatment. Therefore, probucol has a potent effect in reducing LPC and may contribute to decreasing the atherogenicity of LDL.

Adult↗

PubMedDate not supplied

Primary ileal plasmacytoma arising in mixed low- and high-grade B-cell lymphoma of mucosa-associated lymphoid tissue type.

We report an extremely rare case of primary ileal plasmacytoma accompanied by mixed low- and high-grade B-cell lymphoma of mucosa-associated lymphoid tissue (MALT) type. The radiographic and macroscopic features of the tumor were characterized by two constricting lesions in the ileum. Histologic examination of the resected specimen showed that one constrictive lesion was plasmacytoma and the other MALT lymphoma was low and high grade. The plasmacytoma seemed to have differentiated from the MALT lymphoma.

Adult↗

PubMedDate not supplied

Reduced regional cerebral blood flow in aged noninsulin-dependent diabetic patients with no history of cerebrovascular disease: evaluation by N-isopropyl-123I-p-iodoamphetamine with single-photon emission computed tomography.

Regional cerebral blood flow was measured using N-isopropyl-123I-iodoamphetamine with single-photon emission computed tomography (CT) in 16 aged patients with noninsulin-dependent diabetes mellitus (NIDDM, average age 72.8 years, average fasting plasma glucose 7.7 mmol/L), and 12 nondiabetic subjects (71.6 years, 5.3 mmol/L). None had any history of a cerebrovascular accident. Systolic blood pressure (SBP), total cholesterol, and triglyceride levels did not differ between groups. Areas of hypoperfusion were observed in 14 diabetic patients (12 patients had multiple lesions) and in 6 nondiabetic subjects (3 had multiple lesions). Areas where radioactivity was greater than or equal to 65% of the maximum count of the slice was defined as a region with normal cerebral blood flow (region of interest A, ROI-A), and areas where the count was greater than or equal to 45% were defined as brain tissue regions other than ventricles (ROI-B). The average ROI-A/B ratio of 16 slices was used as a semiquantitative indicator of normal cerebral blood flow throughout the entire brain. Mean ROI-A/B ratio was 49.6 +/- 1.7% in the diabetic group, significantly lower than the 57.9 +/- 1.6% at the nondiabetic group (p less than 0.005). The ratio was inversely correlated with SBP (r = -0.61, p less than 0.05), total cholesterol (r = -0.51, p less than 0.05), and atherogenic index (r = -0.64, p less than 0.01), and was positively correlated with high-density lipoprotein (HDL) cholesterol (r = 0.51, p less than 0.05) in the diabetic, but not the nondiabetic group. These observations suggest that the age-related reduction in cerebral blood flow may be accelerated by a combination of hyperglycemia plus other risk factors for atherosclerosis.

Aged↗

PubMedDate not supplied

Blood pressure changes associated with hyperinsulinemia or long-standing diabetes mellitus in spontaneously hypertensive rats.

We studied the long-term change in blood pressures of spontaneously hypertensive rats (SHR) treated neonatally with streptozotocin (STZ). Two-day-old male SHR were injected intraperitoneally with 37.5-75.0 mg/kg STZ or with vehicle as control. STZ-treated SHR were divided into mildly or severely diabetic groups according to the nonfasting plasma glucose level at age 12 weeks (the former less than 300 mg/dl, the latter greater than or equal to 300 mg/dl). In the mildly diabetic group (MD) (n = 5), body weight increased and nonfasting plasma glucose was normalized. At 52 weeks of age, fasting plasma glucose levels were lower than controls owing to hyperinsulinemia, and insulinomas were found in 60% of rats. The systolic blood pressure (SBP) as measured by a tail-cuff method, decreased after 40 weeks, and the mean BP from 44 to 52 weeks (188 +/- 4 mmHg) was significantly lower than that in the control group (209 +/- 3 mmHg, p less than 0.01). In the severely diabetic group (SD) (n = 6), hyperglycemia persisted until 52 weeks, although its severity became less marked. BP in the SD group increased after 36 weeks, and the mean BP from 44 weeks to 52 weeks (224 +/- 5 mmHg) was significantly higher than control (p less than 0.05). The present study demonstrated that hypertension was ameliorated in SHR associated with hyperinsulinemia, and deteriorated with long-standing diabetes mellitus.

Animals↗

PubMedDate not supplied

One-day survey of albuminuria in diabetic outpatients in Fukuoka Prefecture, Japan. Fukuoka Diabetic Clinic Group.

The prevalences and risk factors of micro- and macroalbuminuria were surveyed in all 927 patients with diabetes mellitus who visited outpatient clinics in 27 hospitals in the Fukuoka prefecture on a designated day. The urinary albumin-creatinine ratio (UAI; mg/g Cr) of spot urine was determined in all patients except those with persistent macroproteinuria. The results were as follows: (1) The prevalences of microalbuminuria (UAI 30-299) and macroalbuminuria (UAI greater than or equal to 300) were 26% and 15%, respectively. (2) Hyperglycemia and high blood pressure synergistically increased the prevalences. (3) The independent risk factors of microalbuminuria were severities of retinopathy and neuropathy, duration of diabetes, blood pressure, and HbA1c, as determined by logistic regression analysis, although the explanation rate was low.

Albuminuria↗

PubMedDate not supplied

Phosphate depletion with phosphate binder arrests the development of nephropathy in spontaneously hypertensive rats with non-insulin-dependent diabetes mellitus fed a high-protein diet.

The protective effect of phosphate binder (PB) on nephropathy was examined in spontaneously hypertensive rats with non-insulin-dependent diabetes mellitus (NIDDM) fed a high-protein diet. The rats were treated with vehicle or streptozocin neonatally. After 14 weeks, all rats were fed a high-protein diet (50% protein content), and in half of the diabetic rats the diets were supplemented with PB. At 24 weeks, the urinary excretion rate of albumin and kidney weight increased in diabetic rats, but decreased or tended to decrease in diabetic rats treated with PB. The elevation of urinary excretion rate of N-acetyl-beta-D-glucosaminidase, probably due to protein load, was also abolished with PB.

Aluminum Hydroxide↗

PubMedDate not supplied

Development of ischemic stroke in normotensive and hypertensive diabetic patients with or without antihypertensive treatment: an 8-year followup study.

Although the impact of hypertension as a risk factor for brain infarction in diabetes mellitus is evident, the beneficial effect of antihypertensive therapy has not been demonstrated. Therefore, we designed a prospective cohort study to elucidate the effects of antihypertensive therapy on the development of ischemic stroke in diabetic outpatients. Two hundred forty patients, 219 non-insulin-dependent diabetes mellitus (NIDDM) and 21 insulin-dependent diabetes mellitus (IDDM), without history of cerebrovascular accident were followed for 8 years, from January 1981 until December 1988, in our diabetic clinic. Forty-eight of 88 hypertensive patients had received antihypertensive drugs. Among 40 untreated hypertensive and 152 initially normotensive diabetics, 14 hypertensives and 11 normotensives required antihypertensive therapy during followup period. Twenty-three patients were dropped out because of the unidentified reasons. Cerebrovascular accident occurred in 24 patients (10%): 18 brain infarctions, 4 transient ischemic attack (TIA), 1 subarachnoidal hemorrhage, and 1 brain hemorrhage. The percent incidence of ischemic strokes in the hypertension-treated patients was 8.9% which was similar to the 8.1% of the normotensives. In contrast, ischemic strokes developed in 29% of the untreated hypertensives, being significantly more frequent than in the former two groups. Multivariate analysis showed that serum total cholesterol and male gender were independent significant precursors of brain infarction in diabetic patients. In conclusion, antihypertensive treatment decreased the incidence of ischemic stroke in diabetics. Serum total cholesterol turned to independent risk factors for ischemic stroke in diabetic patients.

Adult↗

PubMedDate not supplied

Obstructive colitis: endoscopic diagnosis using a pediatric colonofiberscope.

Explore the source record for details and available documents.

Adenocarcinoma↗

PubMedDate not supplied

Endoscopic and biopsy findings of the upper digestive tract in patients with amyloidosis.

Endoscopic and biopsy findings of the esophagus, stomach, duodenum, and colorectum were studied in 37 patients with amyloidosis involving the gastrointestinal tract. Endoscopic examinations revealed fine granular appearance, polypoid protrusions, erosions, ulcerations, and mucosal friability in many cases. These findings were most marked and noticed most often in the second portion of the duodenum. The frequency of amyloid deposition in the biopsy specimens was as follows; 100% in the duodenum, 95% in the stomach, 91% in the colorectum, and 72% in the esophagus. The degree of amyloid deposition in the duodenum, which was the highest of the entire gastrointestinal tract, significantly correlated with the frequency of endoscopic findings such as fine granular appearance and polypoid protrusions. Therefore, the two endoscopic findings described above are characteristic of this disease and may reflect amyloid deposition in the mucosa or submucosa of the alimentary tract. Our results indicate that for a diagnosis of amyloidosis, it is important to examine the upper gastrointestinal tract, especially the duodenum, using endoscopy and biopsy techniques.

Adult↗