Qp/Qs and RVEDV/LVEDV of medium-sized ASD increase together in childhood. Re-evaluation before adulthood should be considered in patients with no indications of ASD closure in childhood.
Our results suggested that a high dose of ATIII may influence the sequelae of arterial injury by reducing mural thrombus formation and limiting the inflammatory reaction of the vessel wall without altering the process of vascular remodeling.
Kawasaki disease is an acute illness of early childhood that is characterized by prolonged fever and vasculitis of unknown pathogenesis. Lactobacillus casei cell wall extract (LCWE)-induced vasculitis in mice is a well-validated model of Kawasaki disease. In the nervous system, glial cells play an important role in fever development. This study investigated whether LCWE directly stimulates glial cells, resulting in the induction of cyclooxygenase-2 (COX2), which is required for prostaglandin synthesis and fever development. We found that LCWE induced COX2 expression and activated the nuclear factor-κB signaling pathway in rat B92 glial cells, but Toll-like receptor-2, which is one of the receptors for LCWE, could not be detected in the cells. These results suggest that LCWE activates the nuclear factor-κB signaling pathway and induces COX2 in rat B92 glial cells through another LCWE receptor other than Toll-like receptor-2.
A 50‐year‐old man presented to the emergency department with repeated episodes of faintness and exertional dyspnea, and was found to have an atrioventricular (AV) block. Chest radiography and transthoracic echocardiography results were normal, without any evidence of heart failure, wall motion abnormalities, interventricular septum thinning, or bilateral hilar lymphadenopathy. A temporary pacemaker was implanted, followed by a permanent pacemaker. Chest computed tomography with contrast enhancement did not show abnormalities, including patent coronary arteries, lymph node adenopathy, and pulmonary abnormalities. Thus, an MRI conditional dual chamber pacemaker and leads were implanted. Six weeks following the implant, a cardiac MRI was performed to test for cardiac sarcoidosis. Although cine imaging showed normal left and right ventricular function, late gadolinium enhancement demonstrated multiple enhanced uptakes. Based on the results of the cardiac MRI, PET, and gallium scintigraphy, the most likely diagnosis was cardiac sarcoidosis. Although no abnormal findings were found on physical examination, blood work, chest radiography, and transthoracic echocardiogram, multiple regions of delayed enhancement were observed in the cardiac MRI. Thus, MRI conditional pacemakers are a useful tool for diagnosing cardiac sarcoidosis and early therapeutic intervention.
Histiocytic sarcoma (HS) is a rare hematopoietic neoplasm. We report a patient with HS treated with induction chemotherapy followed by curative surgery. A 50-year-old man was referred to our hospital because of a retroperitoneal tumor. A computed tomography scan revealed a bulky retroperitoneal mass, infiltrating the surrounding organ. An excisional biopsy confirmed the diagnosis of HS. The tumor shrunk after multidrug chemotherapy. However, positron emission tomography showed uptake of fludeoxyglucose in the residual tumor. He underwent right nephrectomy to remove the tumor. Pathological examination showed complete response. Surgery combined with induction chemotherapy may be an effective way to manage HS.
Purpose: To describe a novel case of bilateral rapidly progressive retinopathy after immunotherapy with pembrolizumab for metastatic urothelial carcinoma.Methods: Case report.Results: A 64-year-old man undergoing pembrolizumab immunotherapy was referred to our hospital because of bilateral acute vision loss. His best-corrected visual acuity was 20/30 in the right eye and 20/320 in the left eye, and a visual field test revealed central and paracentral scotomas in the right eye and central scotoma in the left eye. We suspected immune-related retinopathy based on the progressive photoreceptor damage with abnormal electroretinogram findings, absence of overt intraocular inflammation, and presence of malignancy. Cessation of pembrolizumab and steroid pulse therapy followed by decreasing oral prednisolone improved visual function and photoreceptor damage, although there was recurrence after pembrolizumab was restarted.Conclusion: We reported a case of rapidly progressive retinopathy that may have been triggered by pembrolizumab immunotherapy for metastatic urothelial carcinoma. Highdose corticosteroid pulse therapy was effective in reversing photoreceptor damage.
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