[Acute cerebellitis presenting as acute hydrocephalus: case report].
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Biomedical subjects
Publications and source records attributed to H Nakajima.
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This paper describes definition and classification of Eating Disorders which centered on the atypical cases. Eating disorders in DSM-IV were further classified into 3 groups. Three groups were Anorexia Nervosa, Bulimia Nervosa and Eating Disorders Not Otherwise Specified. Binge Eating Disorders frequently transfer to obese patient. This disease entity become independent of Anorexia Nervosa and Bulimia Nervosa. Body weight changing trend evaluated not only cross section but also longitudinal observation. There are some experience cases which Anorexia Nervosa cause by diet therapy of obesity patient. A lot of Eating Disorder patients revealed atypical courses during clinical treatment. The symptom of disturbances in the way in which their body weight and sharp could not easy to confirm routine history taking. One type of eating disorders eat throughout the day with no planned mealtimes.
Language processing was investigated using event-related potentials obtained using a multichannel (58-channel) EEG system, with regard to semantic dependency (i.e., selectional restriction between a verb and the arguments it takes: the SR type) and syntactic dependency between sentence-final particles and interrogative phrases (the WH-Q type) in Japanese. It was found that semantic violations elicited the conventional N400, which was distributed in the bilateral occipital and the right temporal regions, and that the syntactic violations elicited the P600 in a broad area, predominantly in the centroparietal regions. Scalp current density mappings suggested that the right temporal cortex plays a significant role in integrating pieces of contextual information, especially when it is difficult to integrate a word in the context of a sentence, and that the P600 was connected to the syntactic processes conceivably indexed by the left temporal current sink with a relatively early onset.
A 63-year-old man with rapidly progressive glomerulonephritis of the immune-complex type showed typical findings of idiopathic retroperitoneal fibrosis involving the left ureter resulting in hydronephrosis. Treatment with steroid improved both conditions. Our case and previously reported cases showing the same association of conditions support the hypothesis that the association is not fortuitous but reflects a common immunological mechanism.
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A 63-year-old man was referred to our hospital for rapid deterioration of his renal function. He had worked as a metal founder for more than 40 years, and had been diagnosed as having silicosis. Laboratory data on admission showed severe anemia, thrombocytopenia, and end-stage renal failure (BUN 88.8 mg/dl, serum creatinine 9.0 mg/dl). Myeloperoxidase anti-neutrophil cytoplasmic antibody(MPO-ANCA) was also detected in his sera. On the next day after admission, he complained of sudden dyspnea and hemoptysis. Mechanical ventilation with pure oxygen was insufficient to improve hypoxia without concomitant use of percutaneous cardio-pulmonary support(PCPS) and continuous hemofiltration(CHF). We diagnosed his condition as MPO-ANCA-associated rapidly progressive glomerulonephritis with diffuse alveolar hemorrhage. Treatment with plasmapheresis, pulse methylprednisolone and pulse cyclophosphamide effectively improved his hemoptysis as well as chest X-ray findings and blood gas analysis. However on his later clinical course, he was complicated with superimposed complex infection and passed away. Autopsy findings showed crescentic glomerulonephritis in the kidneys and silica nodules in the lungs. Recently it has been postulated that some relationship exists between ANCA-associated(especially MPO-ANCA-associated) glomerulonephritis and silica exposure. The reported cases of glomerulonephritis in the patients with silica exposure showed a rapidly progressive clinical course and pauci-immune necrotizing crescentic glomerulonephritis in their histology. Gregorini et al. reported that 12 of 37 (32%) male patients with RPGN had either silicosis or significant silica exposure, and 7 of 8 patients examined were ANCA-positive(6 of 7 were MPO-ANCA-positive). Therefore silica seems to cause glomerulonephritis by disrupting the immune response. Including this case mentioned above, we have experienced 10 cases of MPO-ANCA-associated glomerulonephritis, at least 3 cases out of which had suffered from silicosis in the past(30%). These results indicate that silicosis should be considered a relevant pathogen of MPO-ANCA-associated glomerulonephritis beyond the race.
We evaluated the availability of NMP22 for the diagnosis of urothelial cancer. Of 154 patients with gross hematuria or microscopic hematuria, 14 patients with bladder cancer and 4 patients with upper urothelial cancer were detected. Of 73 patients continued to be followed for urothelial cancers, 11 patients with bladder cancer were detected. NMP22 was not available when a large number of RBC was present in urine. Also, NMP22 was significantly higher in patients with urothelial cancers. Interpretation of the ROC curve indicated an optimal cutoff value of 9.2 u/ml. Using 9.2 u/ml as a cutoff, the sensitivity and specificity were, respectively 87.0% and 64.0% in patients with hematuria, and 81.8% and 78.7% in patients with a history of TCC. This indicated that when NMP22 was used for the diagnosis of urothelial cancers, 12.0 u/ml, the value recommended as a cutoff in Japan, might be too high to differentiate patients with urothelial cancers.
OBJECTIVE: The treatment for brain metastasis has undergone remarkable changes since the development of radiosurgery. We investigated the results of treatment for brain metastasis from lung cancer since the initiation of gamma knife radiosurgery (GKRS) and we discuss the usefulness of GKRS combined with other treatments in cases with recurrence. METHODS: We treated 142 patients with brain metastasis from lung cancer. Sixteen patients were treated surgically, 11 patients were treated with whole brain radiation therapy (WBRT), and 115 patients were treated with GKRS. Our treatment plan is to use GKRS in cases with less than 5 lesions and lesions less than 3 cm in mean diameter. We use WBRT in cases with 5 or more lesions, and surgery in cases with lesions 3 cm or larger. If new lesions or tumor regrowth appeared after the initial treatment, we retreated them with one of the methods mentioned above. RESULTS: Twice or three-time treatments were performed in 30 patients. Median survival including all cases was 10 months and the number of deaths due to local treatment failure was only 5 (6.5%) out of the total 77 deaths which occurred. CONCLUSION: We were able to carry out less invasive treatment for brain metastasis from lung cancer by utilizing GKRS. Though we have to consider the indications for other treatments, we can say that radiosurgery is usually the treatment of first choice for brain metastasis from lung cancer. When new lesions appear in cases where a particular initial treatment was used, it is possible to maintain or improve the quality of life by retreatment, using a combination of GKRS, surgery or WBRT, to prolong the patient's life.
Breast conservation surgery has become a standard operation as a minimally invasive surgery for breast cancer in Japan. Now sentinel lymph node biopsy (SLNB), day surgery, and endoscopy assisted surgery are being introduced as more minimally invasive surgeries for breast cancer. When blue dye and/or isotope are injected into the peri-tumoral breast gland, the sentinel lymph nodes (SLN) can be detected easily, and node negative patients can be selected with certainty. When no metastasis is found in SLN by frozen section, T1N0 breast cancer patients can be treated without lymph node dissection. Using this technique, day surgery for patients who have clinically node-negative small breast cancer (less than 1.5 cm in diameter) is performed under local anesthesia. We have developed an endoscopy assisted conservation surgery for breast cancer. Using endoscopy, partial or total glandectomy with radical axillary lymph node dissection is performed via a 5 cm skin incision on the middle axillary line. When the amount of glandectomy is over one third, we perform immediate reconstruction using the latissimus dorsi. These minimally invasive surgeries for breast cancer will result in a better quality of life for breast cancer patients.
Monocyte chemoattractant protein (MCP)-1 has a pathogenic role in herpesvirus-induced encephalomyelitis (HSM). Anti-MCP-1 antibody greatly decreased HSM severity in mice infected with herpes simplex virus type 2 (HSM mice), compared with its effect in control HSM mice treated with rabbit immunoglobulin. HSM severity was markedly enhanced in mice previously treated with a mixture of interleukin (IL) 4 and -10. In response to stimulation with antigen, HSM mouse cells isolated from cerebrospinal fluids (CSF cells) produced IL-4 in culture fluids; however, IL-4 production decreased in CSF cells derived from HSM mice previously treated with anti-MCP-1 antibody. A macrophage population isolated in CSF cells from HSM mice (CSF-Mphi) produced MCP-1 in culture fluids. In response to stimulation with herpesvirus antigen, a population of T cells isolated from CSF cells from HSM mice (CSF-T cells) produced IL-4 into their culture fluids, although MCP-1 was not produced by CSF-T cells stimulated by this antigen. IL-4 production by CSF-T cells was markedly enhanced when they were stimulated with viral antigen in the presence of murine recombinant MCP-1 (rMCP-1). Furthermore, IL-4 was produced in naive splenic T cells cocultured with CSF-Mphi. These results indicate that the severity of HSM is influenced by MCP-1, which stimulates Th2 responses.
We report our experience with a 3.2F cerebral diagnostic catheter system. Thirty patients (aged 6 months to 76 years) had undergone cerebral angiography. All targeted brachiocephalic vessels were catheterized except for one artery (98.9% success rate). The image quality obtained with the 3.2F catheter was judged to be comparable with that using the 4F catheter in all cases. This catheter system could be used for cerebral angiography as the standard for patients of all ages.
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AIM: This study was conducted to verify whether bronchial asthma (BA) alone causes pulmonary emphysema (PE), and to examine the computed tomography (CT) findings in non-smokers with BA demonstrating the flow volume curve (FV curve) characteristic of PE. SUBJECTS AND METHODS: Non-smoking patients with a history of BA for more than 20 years were divided into 2 groups: the dogleg pattern group (n = 5), with an FV curve characteristic of PE, and the concave pattern group (n = 16) with an FV curve characteristic of BA. CT scans was performed using CT values (level, 900 H.U.; width, 400 H.U.) that facilitate detection of a low attenuation area (LAA), and using conventional CT values (level, 700 H.U.; width, 1,300 H.U.). LAA (including air trapping), thickness of the bronchial wall, and partial atelectasis were compared between the 2 groups. RESULTS: PE was not detected, although air trapping was found in all subjects. The thickness of the airway was greater in the dogleg pattern than in the concave pattern. The incidences of air trapping and partial atelectasis were higher in the former than in the latter. DISCUSSION: BA alone may not cause PE. Some BA patients without PE show the FV curve characteristic of PE, reflecting an increase in the thickness of the airway wall and a decrease in the pulmonary ventilation probably due to the air trapping and the partial atelectasis.
We report a case of small cell carcinoma of the urinary bladder. A 60-year-old man with microscopic hematuria was referred to our hospital. Cystoscopy revealed a sessile tumor on the left lateral wall of the urinary bladder. The patient underwent transurethral resection of the bladder tumor (TUR-Bt). Because of muscle invasion (pT2), total cystectomy was recommended, but was not performed because the patient would not give consent for the operation. Six months after TUR-Bt, invasive bladder tumor recurred and total cystectomy was performed. Pathological examination of the operative specimen revealed small cell carcinoma. Adjuvant combined therapy of irradiation and chemotherapy (nedaplatin and etoposide) was ineffective. Metastases to retroperitoneal lymph nodes, lung and liver were detected soon after the adjuvant therapy. The patient died 15 months after his first visit to our hospital.
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Pulmonary functions are classified two kinds of functions which are respiratory and non-respiratory. We explained new clinical significant results by looking at the usual respiratory pulmonary function tests and devices in this paper. We found two new indexes on uneveness of ventilation by analyzed compartments of forced expiratory curves(Tiffneu curves) and at improvement of CO single breathing method on diffusing capacity test. We found new index on bronchial anaphylaxis for bronchial asthma by time constant measured from forced expiratory curves, also. We found new index on ventilatory efficiency at developing the automatic respiratory resistance meter by the forced oscillation method of Du Bois, too.
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