Long-term Trial of Corticosteroid Therapy for the Recurrence of Cerebral Amyloid Angiopathy-related Hemorrhages : A Case Study Using [11C] BF-227 Amyloid-PET

Article信州医学雑誌 62(3):155-165(2014)journal articl

The importance of stabilizing PaCO<inf>2</inf> during long-term non-invasive ventilation in subjects with COPD

Objective In subjects with chronic obstructive pulmonary disease (COPD), the effect of partial pressure of CO2 (PaCO2) alterations during long-term non-invasive ventilation (NIV) on continuance remains uncertain. We herein investigated the utility of PaCO2 stability during long-term NIV as a prognostic outcome. Methods We retrospectively assessed data from 54 subjects with COPD who received long-term NIV. Theannual alteration in PaCO2 during NIV was determined using a simple linear regression method for each subject who had at least two 6-month intervals of PaCO2 data. Annual alterations in PaCO2 during long-term NIV and probable confounders were examined, and long-term NIV discontinuation was the major outcome. Results Data from 37 subjects who met the criteria were analyzed. PaCO2 during long-term NIV increasedslightly in 19 subjects (group 1, 2 mmHg/y).In the multivariate modality model, smaller annual alterations in PaCO2 (p=0.009) and lower PaCO2 6 monthsafter the start of long-term NIV (6 m-PaCO2) (p=0.03) were associated with a significantly higher probability of continuing NIV. The 2- and 5-year probabilities of continuing NIV were 89% and 66% for group 1 and 78% and 32% for group 2, respectively. Conclusion A lower 6 m-PaCO2 and a lower annual alteration of PaCO2 during long-term NIV are significant predictive variables for patients with COPD

Aldosterone-, Corticosterone- and Cortisol- Secreting Adrenocortical Carcinoma in a Dog : Case Report

A 12-year-old, intact female beagle exhibited symptoms of polyuria-polydipsia and hyperorexia for two months. Blood tests showed elevated asparate aminotransferase, alanine aminotransferase, alkaline phosphatase and creatine kinase levels, as well as marked hypokalemia. The results of adrenocorticotropic hormone stimulation test showed elevated cortisol, aldosterone and corticosterone concentrations. Abdominal ultrasonography confirmed a mass in the left adrenal gland. Masses were also seen in the liver and caudal vena cava. Diagnosis was a tumor of the adrenal cortex with metastases. Trilostane administration was initiated. The dog initially showed improved demeanor as a result of regulating hormone secretion. However, after 88 days, the dog weakened rapidly, before dying on the 117th day. Pathological findings confirmed a diagnosis of adrenocortical carcinoma

Perioperative corticosteroids for intermittent and mild persistent asthma

Objectives: Asthmatics are considered to be at high risk for pulmonary complications during general anesthesia with tracheal intubation. The purpose of the present study was to determine the usefulness of perioperative corticosteroids for mild asthmatics in preventing perioperative exacerbation of asthma. Methods: Airway hyperresponsiveness to inhaled methacholine was determined in patients with intermittent (n = 27) and mild persistent (n = 48) asthma before general anesthesia who underwent surgery between January 1990 and January 1999. All patients were treated with corticosteroids during the perioperative period, consisting of a course of oral prednisolone 10–20 mg/day for 1–2 days pre-operatively, methylprednisolone 80–125 mg 2 h before the operation, followed by 80 mg methylprednisolone just after the operation. The incidence of perioperative bronchospasm was evaluated based on medical records. Airway hyperresponsiveness to inhaled methacholine was determined in six other asthmatics before and after a similar regimen of perioperative corticosteroids treatment. Results: Only three cases (4.0%) developed mild asthma during the perioperative period. No evidence of adverse effects of corticosteroids was noted in any case. The use of the same therapeutic regimen in another six asthmatics significantly suppressed airway hyperresponsiveness to inhaled methacholine. Conclusions: Our results suggest that perioperative corticosteroids are effective in preventing perioperative bronchospasm in stable asthmatics during surgery under general anesthesia by suppressing airway hyperresponsiveness

Importance of the PaCO(2) from 3 to 6 months after initiation of long-term non-invasive ventilation.

The level at which arterial carbon dioxide tension (PaCO(2)) a few months after introduction of long-term non-invasive positive pressure ventilation (NPPV) is associated with a favorable prognosis remains uncertain