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A Case of Angioedema of the Pharynx Requiring Tracheotomy
Get PDF浜松医科大学医学部耳鼻咽喉科・頭頸部外科学教室 峯田周幸教授退任記念論文集〜症例から学ぶ〜Festschrift for Professor Hiroyuki Mineta In Hornor of His Retirement as Chairman of Hamamatsu University School of MedicineAngioedema refers to edema of the deep dermis and subcutaneous tissues. Angioedema episodes may be mediated by mast cells or bradykinin. The episodes could be idiopathic, in which the symptoms appear without any evident triggers, or stimulus-induced, in which they are induced by a specific stimulus or load.
The condition is accompanied by superficial urticaria in some cases. On the other hand, stimulus-induced angioedema is usually not accompanied by urticaria. Angioedema caused by bradykinin includes hereditary angioedema, angioedema due to acquired C1-INH wasting or loss of function in the context of blood disorders or autoantibodies, and drug-induced angioedema.
We report a case with recurrent angioedema that resulted in airway stenosis. Three unexplained episodes of laryngeal edema occurred over a period of two years and two tracheotomies were performed. During the third episode of laryngeal edema, nasal intubation was performed immediately after the onset. Initially, we suspected hereditary angioedema, but there were no apparent abnormalities in blood or genetic testing. The patient had stopped taking an angiotensin II receptor blocker three years ago, but has not had any more attacks over the eight-year period since the last episode. Cases of angioedema of undiagnosed cause should be followed up with caution. In cases of angioedema that progresses gradually on an hourly basis, the airway should be secured, even if there are only mildly abnormal findings.journal articl
Effects of pirenzepine on vonoprazan-induced gastric acid inhibition and hypergastrinemia
Get PDFBackgrounds: Compared to proton pump inhibitors, vonoprazan exerts a greater inhibitory effect on gastric acid secretion and is useful for treating acid-related diseases, such as gastro-esophageal reflux disease. However, there is a problem that vonoprazan causes hypergastrinemia, which confers a risk of carcinoid tumor. A previous report demonstrated that pirenzepine, an M1 muscarinic receptor antagonist, enhances the acid inhibitory effects while suppressing hypergastrinemia induced by omeprazole. Here, we examined whether pirenzepine enhances the gastric acid inhibitory effects of vonoprazan without further increasing serum gastrin levels.
Methods: Eleven healthy volunteers were subjected to 24-hour intragastric pH monitoring and serum gastrin measurements on day 7 of three different regimens: pirenzepine 75mg alone, vonoprazan 10mg alone, and vonoprazan 10mg plus pirenzepine 75mg administered in a randomized crossover fashion.
Results: Median pH 4 holding time ratios (range) achieved with pirenzepine 75mg, vonoprazan 10mg and vonoprazan 10mg plus pirenzepine 75mg were 6.9% (2.4?32.8%), 88.4% (54.6?100%), and 84.2% (40.3?100%), respectively. Respective serum gastrin levels were 79 (75?210) pg/ml, 310 (110?870) pg/ml, and 170 (140?930) pg/ml. In cases with hypergastrinemia (gastrin?200pg/ml) induced by vonoprazan 10mg alone, concomitant treatment with pirenzepine significantly reduced serum gastrin levels from 370pg/ml to 180pg/ml (P=0.028).
Conclusion: Although pirenzepine does not enhance acid inhibition, it does improve hypergastrinemia induced by vonoprazan to some extent.journal articl
Late-onset oligosymptomatic myotonic dystrophy type 1 mimicking prodromal dementia with Lewy bodies
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Green nut oil or DHA supplementation restored decreased distribution levels of DHA containing phosphatidylcholines in the brain of a mouse model of dementia
Get PDF浜松医科大学博士（医学）doctoral医学系研究科Dementia is a major public health concern nowadays. Reduced levels of brain docosahexaenoic acid (DHA) and DHA-phosphatidylcholines (DHA-PCs) in dementia patients were reported previously. Recently, we have reported that supplementation of green nut oil (GNO) or DHA improves memory function and distribution levels of brain DHA in senescence accelerated mice P8 (SAMP8). GNO is extracted from Plukenetia volubilis seeds, and SAMP8 is a well-known model mouse of dementia. In this current study, we examined the results of GNO or DHA supplementation in the distribution levels of brain DHA-PCs in same model mouse of dementia using desorption electrospray ionization (DESI) mass spectrometry imaging (MSI).We observed significantly decreased distribution of brain DHA-PCs, PC (16:0_22:6), and PC (18:0_22:6) in SAMP8 mice compared to wild type mice, and GNO or DHA treatment restored the decreased distribution levels of PC (16:0_22:6) and PC (18:0_22:6) in the brain of SAMP8 mice. These results indicate that GNO or DHA supplementation can ameliorate the decreased distribution of brain DHA-PCs in dementia, and could be potentially used for the prevention and treatment of dementia.doctoral thesi
Liganded T3 receptor β2 inhibits the positive feedback autoregulation of the gene for GATA2, a transcription factor critical for thyrotropin production
Get PDF浜松医科大学博士（医学）doctoral医学系研究科The serum concentration of thyrotropin (thyroid stimulating hormone, TSH) is drastically reduced by small increase in the levels of thyroid hormones (T3 and its prohormone, T4); however, the mechanism underlying this relationship is unknown. TSH consists of the chorionic gonadotropin α (CGA) and the β chain (TSHβ). The expression of both peptides is induced by the transcription factor GATA2, a determinant of the thyrotroph and gonadotroph differentiation in the pituitary. We previously reported that the liganded T3 receptor (TR) inhibits transactivation activity of GATA2 via a tethering mechanism and proposed that this mechanism, but not binding of TR with a negative T3-responsive element, is the basis for the T3-dependent inhibition of the TSHβ and CGA genes. Multiple GATA-responsive elements (GATA-REs) also exist within the GATA2 gene itself and mediate the positive feedback autoregulation of this gene. To elucidate the effect of T3 on this non-linear regulation, we fused the GATA-REs at -3.9kb or +9.5kb of the GATA2 gene with the chloramphenicol acetyltransferase reporter gene harbored in its 1S-promoter. These constructs were co-transfected with the expression plasmids for GATA2 and the pituitary specific TR, TRβ2, into kidney-derived CV1 cells. We found that liganded TRβ2 represses the GATA2-induced transactivation of these reporter genes. Multi-dimensional input function theory revealed that liganded TRβ2 functions as a classical transcriptional repressor. Then, we investigated the effect of T3 on the endogenous expression of GATA2 protein and mRNA in the gonadotroph-derived LβT2 cells. In this cell line, T3 reduced GATA2 protein independently of the ubiquitin proteasome system. GATA2 mRNA was drastically suppressed by T3, the concentration of which corresponds to moderate hypothyroidism and euthyroidism. These results suggest that liganded TRβ2 inhibits the positive feedback autoregulation of the GATA2 gene; moreover this mechanism plays an important role in the potent reduction of TSH production by T3.doctoral thesi
Comparison of percutaneous extraperitoneal closure (LPEC) and open repair for pediatric inguinal hernia: experience of a single institution with over 1000 cases
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Development of a novel T cell-oriented vaccine using CTL/Th-hybrid epitope long peptide and biodegradable microparticles, against an intracellular bacterium
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Microsatellite frameshift variants in SGO1 of gastric cancer are not always associated with MSI status
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