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ABSTRACT: Glucocorticoids-induced osteoporosis is a serious problem for patients with systemic autoimmune disease requiring relatively long-term glucocorticoid treatment. Effectiveness of alendronate for the prevention of glucocorticoids-induced osteoporosis was evaluated in comparison with that of alfacalcidol in Japanese women with autoimmune disease excluding rheumatoid arthritis. Loss of bone mass was evaluated with bone mineral density (BMD) of lumber vertebrae, bone resorption was with urinary N-telopeptide for type I collagen (NTX), and bone formation was with serum bone-specific alkaline phosphatase (B-ALP). A total of 33 patients who were treated with oral glucocorticoids (>or=5 mg/day of prednisolone equivalence) for more than 6 months were randomized into two groups; alendronate group (n = 17) received 5 mg/day of alendronate, and alfacalcidol group (n = 16) received 1.0 mug/day of alfacalcidol for 24 months with glucocorticoids. The dose of alendronate was the maximal dose approved in Japan. BMD had tendency to decrease with alfacalcidol, while increase with alendronate. The difference in BMD change between the two groups was significant by 4.3% at 18 months and by 4.2% at 24 months (both P < 0.05). Bone resorption was significantly reduced only with alendronate; NTX was decreased by 28 to 35% at 6 to 24 months (P < 0.05), but not changed with alfacalcidol at 24 months. The bone formation was found to be unchanged according to the B-ALP measured between the two groups. In conclusion, the treatment of 5 mg alendronate daily is more effective than alfacalcidol for preventing the glucocorticoid-induced osteoporosis by the mechanism of reducing bone resorption in Japanese women with systemic autoimmune disease.
Modern Rheumatology 01/2008; 18(3):271-6. · 1.58 Impact Factor
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Yoshie Sasatomi,
Hiroshi Sato,
Yoshiro Chiba,
Yasuhiro Abe, Seiji Takeda,
Satoru Ogahara,
Toshiaki Murata,
Hidetoshi Kaneoka,
Shigeo Takebayashi,
Hiroshi Iwasaki,
Takao Saito
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ABSTRACT: There is no standardized therapy for renal amyloidosis, which shows rapid progression and poor prognosis. Here, we used cluster analysis to examine the correlation between amyloid-related renal damage and prognosis, and determined the clinicopathological prognostic factors for renal amyloidosis.
We analyzed 125 patients with renal amyloidosis (men/women: 43/82; mean age at renal biopsy: 58.8+/-11.1 years, +/-SD; range: 21-78 years). Cluster analysis was performed using clinical parameters, renal histological findings, type of renal amyloidosis, and follow-up data. We also analyzed survival data.
We divided 125 cases (prognosis was checked in 97 [77.6%] cases) into three groups by cluster analysis. In the cluster groups, accelerated progression correlated with serum creatinine (s-Cr) levels at renal biopsy and histological grade of renal damage by amyloid deposition (p<0.0001). The most important prognostic factors were glomerular, tubulointerstitial, and vascular lesions induced by amyloid deposition at biopsy (p<0.0001). We also found that amyloid-A (AA) type amyloidosis correlated is more significantly with amyloid-mediated vascular (P=0.0010) and tubulointerstitial lesions (p=0.0705) than with amyloid-L (AL) type amyloidosis. Proteinuria and nephrotic syndrome were more severe in AL than AA amyloidosis (p=0.0836). The 10-year individual survival rate was about 20%, and most deaths were due to cardiovascular disease and infection.
Our results indicate that the quantity of amyloid deposition in the kidney, and the extent of glomerular, tubulointerstitial, and vascular damage are significant renal prognostic factors in amyloidosis.
Internal Medicine 01/2007; 46(5):213-9. · 0.94 Impact Factor
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Seiji Takeda
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ABSTRACT: The association of malignancy with collagen diseases has been a focus of interest. Especially, relation between dermatomyositis and malignancy is well-recognized. I reviewed here about the coexistence of SSc and malignancy in literature. I would like to raise four points as characteristics of the relationship. (1) Special attention should be paid to the patients who is late-onset, with advanced skin sclerosis (ex. Barnett III type) and male. (2) There are three generalized mechanisms of the association. The first is the predisposition of the malignancy on the basis of organ fibrosis, such as pulmonary fibrosis and lung cancer. The second is the nature of paraneoplastic syndrome. Lastly, immunological derangement inherent to SSc might cause carcinogenesis. (3) It has been documented that the interval of the onsets of SSc and breast cancer is extremely short. (4) Longstanding reflux esophagitis and Barrett's esophagus with SSc is suspected to predispose to esophageal carcinoma.
Japanese Journal of Clinical Immunology 01/2005; 27(6):389-96.
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ABSTRACT: We report a patient with sepsis caused by Pasteurella haemolytica, an extremely rare etiologic agent of human infection, who had mitral valve disease and developed a splenic abscess.
Scandinavian Journal of Infectious Diseases 02/2003; 35(10):764-5. · 1.72 Impact Factor
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ABSTRACT: We present an unusual case of polymyositis that was complicated by the development of severe cardiac conduction disturbance.
This 55-year-old Japanese woman had a history of polymyositis for which she had received corticosteroids for the past 6 years.
She then developed palpitations and vertigo for which she was hospitalized. Electrocardiographic abnormalities (right bundle
branch block, right axis deviation and atrioventricular block) with a prolongation of H-V time on the His bundle electrogram
revealed the presence of a severe cardiac conduction disturbance. The myocardium was biopsied and showed perivascular fibrosis
with fatty infiltration. Patients with polymyositis can thus develop cardiac disorders such as severe conduction disturbances.
Therefore, attention should be paid to the cardiac condition of these patients.
Modern Rheumatology 04/1997; 7(1):69-74. · 1.58 Impact Factor
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ABSTRACT: An outbreak of penicillin-resistantStreptococcus pneumoniae (PRSP) infections occurred in our hospital between January and May of 1993. Nine patients with infections/colonizations were
located in 3 multiplebed rooms on an internal medicine ward. Two of the 9 patients developed pneumonia, 3 developed acute
bronchitis, and 4 patients demonstrated colonization in the respiratory tract. Only 1 case of acute bronchitis was confirmed
as a community-acquired infection, while the others were considered nosocomial infections, subsequently shown to be caused
by at least 2 different bacterial strains. The cases of pneumonia were thought to be cross-infections transmitted by droplets.
All patients with either pneumonia or bronchitis were cured by the administration of various antibiotics, including imipenem
and ofloxacin. Of the 4 colonization cases, 3 patients were treated with antibiotics and the organisms successfully eradicated.
Although all 5 patients with infections were cured, it is important to be attentive to the emergence of PRSP infections, as
there are potential difficulties in the treatment of this organism.
Journal of Infection and Chemotherapy 05/1996; 2(2):94-97. · 1.80 Impact Factor
