The prevalence of chronic kidney disease (CKD) as well as Alzheimer's disease (AD) increases with age. With the aging of the population in Japan, there is an increasing likelihood that patients with CKD will receive donepezil hydrochloride (DPZ), an antidementia drug, in the near future. Nevertheless, there have been few reports on how to use DPZ in patients with severe CKD. We report on 2 CKD stage 5 patients who received DPZ under different prescriptions. In case 1, 3 mg/day of DPZ was initially administered for 4 months, after which the dose was increased to 5 mg/day. In case 2, 5 mg was administered twice a week. The plasma concentration of DPZ was measured and the effectiveness was assessed using the Mini-Mental Health State Examination and the Hasegawa Dementia Rating Scale. We found that (1) only a slight increase in the plasma concentration of DPZ was observed with a dose of 3 mg daily, (2) there was a significant increase in the plasma concentration with a dose of 5 mg daily, and (3) when 5 mg of DPZ was administered twice a week, the plasma concentration did not differ significantly from healthy controls who had received 5 mg daily. Although cognitive function was improved best when the 5-mg dose was administered daily with no apparent side effects, the plasma concentration came close to reaching a toxic level at this dose. Careful follow-up may be essential when DPZ is used at 5 mg/day or greater in severe CKD patients.
Microwave endometrial ablation (MEA) is effective for the emergency control of uterine hemorrhage. However, to the best of our knowledge, there has been only a single report of life-threatening hemorrhage induced by endometrial carcinoma that was treated with MEA. The present report evaluates the efficacy of MEA as an emergency therapeutic option for the control of bleeding due to advanced endometrial carcinoma and minimally-invasive, early-stage endometrial carcinoma in 3 patients. MEA was able to effectively control massive uterine bleeding due to endometrial carcinoma in 2 patients with advanced disease and was curative in a patient with minimally-invasive endometrial carcinoma. Given its safety, simplicity and effectiveness, MEA may be utilized for the emergency treatment of uterine bleeding in advanced endometrial carcinoma, and may be used as a curative treatment in early-stage endometrial carcinoma.
Superior mesenteric artery (SMA) dissection without aortic dissection is a rare condition, and its diagnosis is considered to be difficult. Intestinal infarction is a severe complication of the disease, which may require resection of the intestine. We present a case of isolated SMA dissection. A 53-year-old man experienced sudden pain in the abdomen while playing Japanese pinball and was admitted to our hospital due to acute abdominal symptoms of uncertain cause. Enhanced CT revealed a defect of the root of the SMA, while angiography and intravascular ultrasound findings showed dissection of the SMA wall. Conservative treatment was chosen at the time, while a part of the small intestine was eventually resected because of progressive ischemia. Although SMA dissection is a rare occurrence in cases with acute abdominal symptoms, awareness of the condition is important for differential diagnosis.
Malignant peritoneal mesotheliomas (MPMs) are rare and progressive tumors, which may present similarly to primary peritoneal carcinoma or ovarian carcinoma (OC). The current study reports two cases of MPM that initially presented with the features of OC, for which paired box 8 (PAX8) immunostaining was found to be useful for diagnosis. The two patients were women, aged 58 and 56 years, respectively. The primary presenting symptoms and clinical findings included prolonged abdominal pain, abdominal swelling and cough. The two cases were initially diagnosed as OC and were treated with primary debulking surgery. The patient in case 1 had no history of asbestos exposure, while the patient in case 2 did. Final diagnoses were determined based on histological and immunohistochemical results, which included negative PAX8 immunostaining, and which were consistent with MPM. The present cases demonstrated that PAX8 negativity may be a useful diagnostic biomarker for differentiating MPM from OC.
PurposePostmortem computed tomography (PMCT) has recently become important to clarify the cause of death in forensic medicine. It has also been proven to be useful for in-hospital deaths to a certain extent when interpreted by radiologists. However, accuracy of the interpretations of PMCT by non-radiologists remains to be elucidated. Nevertheless, they are often required to write death certificates based on the findings of PMCT in the absence of radiologists in Japan. We compared the interpretations of postmortem head CT (PMCT-H) by non-radiologists with the autopsy findings.MethodsThis study included 13 patients who underwent both brain dissection at autopsy and PMCT between June 2011 and December 2014. All cases were non-traumatic in-hospital deaths. Interpretation of PMCT was performed by the clinicians in charge of the patients, not by radiology experts.ResultsThe patients were first examined with PMCT and then autopsies were performed. Ten out of 13 cases were confirmed to have no lesions in the cranial cavity by both PMCT-H and autopsy. Two cases were diagnosed with intracranial hemorrhage (intracerebral and/or subarachnoid hemorrhage) and one with recurrent malignant lymphoma by both the clinicians and the pathologists. Intracranial hemorrhages were thought to be the direct causes of mortality of the two patients, and recurrent malignant lymphoma was considered to be one of the cardinal findings of the cancer death. There were no discrepancies between PMCT-H and autopsy findings.ConclusionsThe interpretations of PMCT-H by non-radiologists were completely the same as the autopsy findings regarding the non-traumatic in-hospital deaths in this study. It is premature to draw a definitive conclusion at present, but PMCT-H might be as effective as autopsy not only for those lesions described above but also for no remarkable changes in the brain. There has been no report on such a comparison. We believe further verification of the validity of interpretation of PMCT by non-radiologists is worthwhile in terms of death certificates made out in the absence of radiology experts and pathologists.
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