scholarly journals Clinicopathologic Appearance of Advanced Ketoacidosis With Basal Vacuolation in Renal Tubules

2021 ◽  
Author(s):  
Shojiro Ichimata ◽  
Yukiko Hata ◽  
Naoki Nishida
Keyword(s):  
Coronary Artery ◽  
Alcohol Abuse ◽  
Hepatic Fibrosis ◽  
Coronary Artery Stenosis ◽  
Definitive Diagnosis ◽  
Renal Tubules ◽  
Histopathologic Examination ◽  
Alcohol Abuser ◽  
Pathologic Findings ◽  
Cardiac Steatosis

Context.— Basal vacuolization (BV) in renal tubules is a histopathologic hallmark of advanced ketoacidosis that enables us to retrospectively diagnose these cases. Objective.— To clarify the pathologic background and serologic findings of ketoacidosis with BV, and to reveal the pathologic findings by each pathologic background. Design.— We examined 664 serial autopsy cases. A systemic histopathologic examination and measurement of serum β-hydroxybutyrate concentration were performed for the cases with BV. The extent of steatosis and fibrosis in the organs and the degree of coronary artery stenosis were semiquantitatively investigated. Immunohistochemistry for adipophilin was also performed to analyze its usefulness for the pathologic diagnosis. Results.— Basal vacuolization was found in 16 cases, all of which showed a pathologic serum β-hydroxybutyrate concentration. The main background of ketoacidosis was considered as alcohol abuse in 6 cases, diabetes in 5, malnutrition in 3, and hypothermia and infection in 1 case each. Severe hepatic fibrosis was observed only in the alcohol-abuser group. Moreover, cardiac steatosis was more severe in patients with possible alcohol abuse than in those with other causes. Immunohistochemistry for adipophilin showed immunoreactivity consistent with BV in 13 of 16 cases. There was no correlation between β-hydroxybutyrate concentration and either the postmortem or storage interval. Conclusions.— Basal vacuolization may be a useful finding for detecting ketoacidosis cases in a postmortem investigation. Serum β-hydroxybutyrate was a stable and reliable compound for the definitive diagnosis of ketoacidosis in such cases. The present study showed that pathologic changes in some organs may vary by each pathologic background of ketoacidosis with BV.

Two cases of unstable angina with proximal coronary artery stenosis diagnosed by transthoracic Doppler echocardiography

Choonpa Igaku ◽  
2008 ◽  
Vol 35 (4) ◽  
pp. 443-449 ◽  
Author(s):  
Yuko SUGIYAMA ◽  
Masayo SUZUKI ◽  
Keiichi HIRANO ◽  
Keijirou NAKAMURA ◽  
Mao TAKAHASHI ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Unstable Angina ◽  
Doppler Echocardiography ◽  
Coronary Artery Stenosis ◽  
Artery Stenosis ◽  
Transthoracic Doppler Echocardiography ◽  
Proximal Coronary Artery

Relationship between Whole Blood Viscosity and Lesion Severity in Coronary Artery Disease

2021 ◽  
Author(s):  
Gökhan Ceyhun ◽  
Oğuzhan Birdal
Keyword(s):  
Coronary Artery ◽  
Shear Rate ◽  
Confidence Interval ◽  
Odds Ratio ◽  
Coronary Artery Stenosis ◽  
Artery Stenosis ◽  
Significant Stenosis ◽  
Whole Blood Viscosity ◽  
Significant Coronary Artery Stenosis ◽  
Coronary Syndrome

Abstract Objective This article investigates the relationship of fractional flow reserve (FFR) with whole blood viscosity (WBV) in patients who were diagnosed with chronic coronary syndrome and significant stenosis in the major coronary arteries and underwent the measurement of FFR. Material and Method In the FFR measurements performed to evaluate the severity of coronary artery stenosis, 160 patients were included in the study and divided into two groups as follows: 80 with significant stenosis and 80 with nonsignificant stenosis. WBVs at low shear rate (LSR) and high shear rate (HSR) were compared between the patients in the significant and nonsignificant coronary artery stenosis groups. Results In the group with FFR < 0.80 and significant coronary artery stenosis, WBV was significantly higher compared with the group with nonsignificant coronary artery stenosis in terms of both HSR (19.33 ± 0.84) and LSR (81.19 ± 14.20) (p < 0.001). In the multivariate logistic regression analysis, HSR and LSR were independent predictors of significant coronary artery stenosis (HSR: odds ratio: 1.67, 95% confidence interval: 1.17–2.64; LSR: odds ratio: 2.46, 95% confidence interval: 2.19–2.78). In the receiver operating characteristic (ROC) curve analysis, when the cutoff value of WBV at LSR was taken as 79.23, it had 58.42% sensitivity and 62.13% specificity for the prediction of significant coronary artery stenosis (area under the ROC curve: 0.628, p < 0.001). Conclusion WBV, an inexpensive biomarker that can be easily calculated prior to coronary angiography, was higher in patients with functionally severe coronary artery stenosis, and thus could be a useful marker in predicting the hemodynamic severity of coronary artery stenosis in patients with chronic coronary syndrome.

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