in the urinary tract. CTRX is frequently chosen for
intravenous administration to older people because it
has a wide antibacterial spectrum and as good tissue
transferability as third-generation cephem. In addition,
it can be administered once a day. CTRX has many
adverse effects, such as liver dysfunction, rashes, diar-
rhea and especially false cholelithiasis (biliary pseudo-
lithiasis), which is not seen with other antibiotics.
CTRX is combined with serum albumin in the blood
and shifts to the organ. It is excreted in the urine and
bile, and is thought to be connected in bile and form
the sediment, because it has a high afﬁnity with calcium
This material appears similar to a gallstone in
images and it disappears soon after stopping the admin-
istration of CTRX. In both these cases, their fasting
(neither ate anything due to pyrexia) and almost contin-
ual state of bedrest, in addition to their frail state, might
have facilitated the production of gallstones.
study is required to establish the causal relationship
between the state of fasting and bedrest and the inci-
dences of CTRX-induced pseudolithiasis in this
advanced age group.
This work was supported by a Grant-in-Aid for Scien-
tiﬁc Research (C) KAKENHI grant number 26469899.
The authors declare no conﬂict of interest.
Takahide Miyamoto, Takae Ebihara
Department of Geriatric Medicine, Kyorin University School of
Medicine, Tokyo, Japan
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Pulse pressure correlates poorly with basilar artery diameter
in community-dwelling older adults: The Atahualpa Project
The pathogenesis of intracranial arterial dolichoectasia
is controversial. The fact that dolichoectasia and ath-
erosclerosis share risk factors has led us to consider a
common underlying pathophysiology for both condi-
tions. Furthermore, atheromatous changes have been
found in a sizable proportion of intracranial ectatic
Nevertheless, increasing evidence suggests
that dolichoectasia differs from atherosclerosis because
it predominantly affects the internal elastic lamina, as
opposed to the endothelial injury and plaque formation
characteristics of atherosclerosis.
This is supported
by studies showing a lack of association between extra-
cranial atherosclerosis and intracranial dolichoectasia.
However, the relevance of intracranial atherosclerosis
in patients with dolichoectasia has not been investi-
gated at the population level.
We documented a relationship between pulse
pressure (PP) levels and intracranial atherosclerosis in
older Amerindians living in rural Ecuador.
be related to the exposure of major intracranial vessels
to the stretch caused by increases in pulsatile compo-
nents of blood pressure that, in turn, enhance arterial
stiffness and lead to atherosclerotic abnormalities. As
posterior circulation is most often involved in individ-
uals with intracranial dolichoectasia, we evaluated the
correlation between the PP and the basilar artery
(BA) diameter to assess the role of this reliable bio-
marker of intracranial atherosclerosis in the pathogene-
sis of BA dolichoectasia.
Atahualpa residents aged ≥60 years who accepted the
practice of magnetic resonance imaging and had no
contraindications for this procedure were enrolled. The
institutional review board of Hospital-Clínica Kennedy,
Guayaquil, Ecuador (FWA 00006867) approved the
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Letters to the Editor