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Abstract

T. Takahashi, A. Kato, N. Ikegaya, T. Takita, Y. Maruyama, A. Hishida and M. Takahashi

¹Maruyama Hospital, ²First Department of Medicine and ³Orthopedics Surgery, Hamamatsu University School of Medicine and ⁴Shizuoka University, Hamamatsu, Shizuoka, Japan
Background: Carpal tunnel syndrome
(CTS) is one of the major problems of long-term hemodialysis (HD), but sometimes difficult
to distinguish from uremic or diabetic neuropathy by clinical symptoms. Patients and
methods: To evaluate the diagnosis of CTS more precisely, we examined the
ultrasonographic alterations of the carpal tunnel and tendons of 90 wrists from 45
patients undergoing HD for more than 5 years. We measured the thickness of the palmar
radiocarpal ligament (PRL), corresponding to the posterior wall of the carpal tunnel (CT),
and the width of the CT, and compared those values with sensory (SCV), motor conduction
velocity (MCV) of the median nerve and clinical symptoms. In addition, we longitudinally
measured CT and PRL in the same patients for 5 years, and compared ultrasonographic
changes and clinical parameters. Results: A linear positive relationship was found
between HD duration and PRL thickness (r = 0.43, p < 0.01) or CT width (r = 0.53, p
< 0.01). CT diameter was negatively correlated with MCV (r = –0.30, p < 0.01)
and SCV (r = –0.33, p < 0.04). PRL thickness was also inversely correlated with
MCV (r = –0.44, p < 0.01) and SCV (r = –0.46, p < 0.01) of the median
nerve, respectively. The wrists with clinical CTS and/or previous CTS surgery had
significantly greater CT and PRL values compared to patients without CTS (CT: 6.1 ± 0.2
vs. 8.0 ± 0.3 mm, p < 0.01; PRL: 1.9 ± 0.1 vs. 3.6 ± 0.2 mm, p < 0.01). There was
a significant increase in CT width from 6.2 ± 0.2 to 7.1 ± 0.2 mm (p < 0.01) and PRL
thickness from 2.4 ± 0.2 to 2.8 ± 0.2 mm (p < 0.01) during the 5-year observation,
respectively. PRL thickness was constantly increased at the rate of 0.4 mm during the
study. However, no significant association was found between the 5-year increases in CT
and PRL distance and age, gender, the prevalence of diabetes, or laboratory parameters
such as blood b₂-microglobulin,
pentosidine and Kt/Vurea. Conclusion: Our data suggest that echographic evaluation
of the wrist tissue thickness was useful to assess the progression of CTS. Serial
measurements of the wrist by echography may be helpful to clarify the advance of
subclinical CTS in patients receiving long-term HD.

Abstract

S. Qiao¹, T. Iwashita², M. Ichihara¹, Y. Murakumo³, A. Yamaguchi⁴, M. Isogai⁴, K. Sakata⁵ and M. Takahashi³

¹Department of Biomedical Sciences, College of Life and Health Sciences, Chubu University, ²Department of Pathology, Aichi Medical University School of Medicine, ³Department of Pathology, Nagoya University School of Medicine, ⁴Department of Surgery, Ogaki City Hospital, Gifu and ⁵Department of Pathology, National Hospital for Geriatric Medicine, Aichi, Japan
Intestinal ganglioneuromatosis (GN) is an uncommon disease of the enteric nervous system (ENS) and its pathogenesis remains unclear. Here we describe a unique case of diffuse GN of the intestinal wall associated with colon adenocarcinoma occurring in a 38-year-old female. Because it is well-known that glial cell line-derived neurotrophic factor (GDNF) and its receptor components, GDNF family receptor-alpha₁ (GFR-alpha₁) and RET receptor tyrosine kinase, play a crucial role in the development of ENS, their expression was analyzed by immunohistochemistry. Interestingly, GDNF as well as a related neurotrophic factor, neurturin (NTN), were expressed at high levels in adenocarcinoma cells whereas expression of GFRalpha₁ and RET was undetectable in them. In contrast, GFR-alpha₁ showed positive staining in both proliferating ganglion cells and glial cells, and RET immunoreactivity was found mainly in ganglion cell bodies. These findings suggested that GDNF and NTN expression in adenocarcinoma cells may play an important role in the pathogenesis of GN.Correspondence to:
S. Qiao, MD, PhD; Division of Pathology and Histology, Department of Biomedical Sciences, College of Life and Health Sciences, Chubu University, 1200 Matsumoto-cho, Kasugai City, Aichi 487-8501, Japan
Email: [email protected]

Abstract

Highly activated oral bioavailability of tacrolimus on coadministration of oral voriconazole

Y. Inoue, T. Saito, M. Takimoto, K. Ogawa, Y. Shibuya, Y. Suzuki, M. Kato, M. Takahashi, I. Miura, Y. Hatta and J. Takeuchi

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