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M Nakajo

Publications and source records attributed to M Nakajo.

At least 19 recordsLinked to original sources
PubMed2006

Early clinical signs and imaging findings in Gerstmann-Sträussler-Scheinker syndrome (Pro102Leu).

OBJECTIVE: To determine the clinical and radiologic features of Gerstmann-Sträussler-Scheinker syndrome caused by Pro102Leu mutation in PRNP (GSS102). METHODS: The authors report 11 patients (nine families) with clinically and radiologically diagnosed GSS102. RESULTS: All patients showed mild gait disturbance, dysesthesia and hyporeflexia of the lower legs, and truncal ataxia, and 9 of 11 patients showed proximal leg muscle weakness during the early stage of the disease. Dementia was not a main symptom during the early stage. Brain MRI and EEG abnormalities were not prominent initially. SPECT (N-isopropyl-p-[(123)I]iodoamphetamine) analyzed by the three-dimensional stereotactic surface projection (SSP) method detected abnormalities in five patients early during the course of the illness. SPECT findings showed diffusely decreased cerebral blood flow, demonstrated by a mosaic pattern, with the lowest perfusion noted in the occipital lobes. In contrast, blood flow to the cerebellum was preserved. These studies suggested sites of pathology in GSS102, with the main lesions probably located in the cerebrum and the spinal cord (posterior horn and spinocerebellar tract) instead of the cerebellum. CONCLUSIONS: Key features for early diagnosis of Gerstmann-Sträussler-Scheinker syndrome caused by Pro102Leu mutation in PRNP (GSS102) are truncal ataxia, dysesthesia and hyporeflexia of the lower legs, and mild dysarthria. Normal cerebellar MRI and abnormal cerebral SPECT findings are characters of early GSS102.

Amyloid↗
PubMed2005

Comparison of adrenal vein sampling value between aldosterone producing adrenal adenoma and non-functioning adrenal adenoma: evaluation using receiver operating characteristic analysis.

PURPOSE: To evaluate adequate criteria for adrenal vein sampling values in patients with aldosterone producing adrenal adenoma (APA), retrospectively. MATERIAL AND METHODS: Between 1988 and 2002, 59 hypertensive patients (15 M and 44 F, aged 47.58 +/- 9.45 years) were referred to our hospital and diagnosed with APA based on established criteria. During the same period, 23 patients with non-functioning adrenal adenoma (11 M and 12 F aged 53.56 +/- 11.76 years) were diagnosed based on computed tomography and laboratory data. RESULTS: All 82 patients were enrolled in the present study. Bilateral adrenal vein sampling (AVS) for measurement of plasma aldosterone (A) and cortisol (C) was performed, and a receiver operating characteristics (ROC) analysis was conducted to establish the best criteria from the AVS-derived index in patients with APA. A (APA side)/A (contralateral side) was confirmed to provide the best diagnostic accuracy {(>2.5: right APA, sensitivity 83.3%, specificity 79.5%), (> 3: left APA, sensitivity 84.2%, specificity 76.9)}. The Az values for A (APA side)/A (contralateral side) were 0.8948 and 0.9260 for right and left APA, respectively. CONCLUSION: The A (APA side)/A (contralateral side) value was the best compromise for sensitivity and false-positive rate for lateralization of APA.

Adenoma↗
PubMed2005

Embolization of spontaneous rupture of an aneurysm of the ovarian artery supplying the uterus with fibroids.

We report a case of spontaneous retroperitoneal hemorrhage caused by rupture of an aneurysm of the right ovarian artery in a 55-year-old woman. Diagnosis was achieved by computed tomography and arteriography. The ruptured aneurysm was treated by transcatheter arterial embolization using microcoils and gelatin sponge particles. This is the first case of rupture of an aneurysm of the ovarian artery not related to pregnancy, and the third case of embolization of a ruptured ovarian artery aneurysm in the literature. We illustrate the usefulness of embolization in treatment of an ovarian artery aneurysm without surgery.

Aneurysm, Ruptured↗
PubMed2004

Multidetector-row CT findings of colonic perforation: direct visualization of ruptured colonic wall.

BACKGROUND: We examined the findings of contrast-enhanced multidetector-row computed tomography (MD-CT) in patients with colonic perforation. METHODS: Abdominal contrast-enhanced MD-CT findings in six patients with colonic perforation were reviewed retrospectively. Patients (three men and three women) were 74 to 88 years old (mean age = 78 years). Colonic perforation was confirmed by surgery. CT findings were correlated with surgical and pathologic findings. RESULT: The site of colonic perforation was suggested by the following combination of CT findings: free air, dirty mass, dirty fat sign, extraluminal fluid collection, bowel wall thickening, and interruption of colonic wall. The ruptured colonic wall was directly visualized in four cases (67%). CONCLUSION: Abdominal contrast-enhanced MD-CT may improve the accuracy of diagnosis and localization of colonic perforation.

Aged↗
PubMed2004

Visualization of the internal mammary artery via the hepatic falciform artery in a patient with hepatocellular carcinoma.

The hepatic falciform artery is a small vessel that arises as a terminal branch of the middle or left hepatic artery. Its anatomy and clinical importance have been described in several recent reports. During dissection of a cadaver, this artery is generally found connected with the ensiform branch of the internal mammary artery. However, to our knowledge, anastomosis has not previously been described radiologically.

Aged↗
PubMed2003

Long-term survivors of advanced esophageal cancer without surgical treatment: a multicenter questionnaire survey in Kyushu, Japan.

Since the introduction of recent improvements in adjuvant therapy for esophageal cancer, some patients have demonstrated good prognosis. In the present study, we analyzed 3- and 5-year survivors of advanced esophageal cancer who did not undergo any surgical treatment. Between 1990 and 1998, 831 patients were admitted to 14 university hospitals and one cancer center associated with the membership of the Kyushu study group for adjuvant therapy of esophageal cancer. Twelve (1.4%) of the patients were 3-year survivors and 13 (1.6%) were 5-year survivors. The reasons for non-operation were refusal (eight patients), tumor-related factors (11 patients), and host-related factors (six patients). With a single exception, all patients had locally advanced tumors. Almost all long-term survivors had fewer than five lymph node metastases, in regions limited to the neck and/or mediastinum. Radiation therapy was combined with chemotherapy for 16 of the 25 patients, and chemotherapy-based cisplatin was used for 15 of these 16 patients. Fifteen of the patients remain alive; 10 died seven of them from esophageal cancer. Chemoradiation therapy was effective for some patients with locally advanced esophageal cancer, particularly in the absence of or with few lymph node metastases. To improve the prognosis of patients with advanced esophageal cancer who, for various causes, cannot undergo surgical treatment, a new protocol for adjuvant therapy is required.

Aged↗
PubMed2003

Intraductal papillary mucinous tumors of the pancreas. Comparison of helical CT and MR imaging.

PURPOSE: To compare the effectiveness of thin-section helical CT and MR imaging with gadolinium-enhanced dynamic technique and MR cholangiopancreatography (MRCP) in the examination of patients with intraductal papillary mucinous tumors. MATERIAL AND METHODS: Helical CT, dynamic MR imaging, and MRCP of 25 intraductal papillary mucinous tumors were compared with ERCP and surgical findings. RESULTS: The duodenal papilla was identified by helical CT and dynamic MR imaging in 11 (44%) and 20 (80%) of the 25 patients, respectively (p<0.05). The main pancreatic duct was visualized on helical CT, dynamic MR imaging, and MRCP in all patients (100%): 25 (96.2%), 24 (92.3%), and 26 (100%) cystic lesions were depicted, respectively. A communicating duct between the main pancreatic duct and the cystic lesion was visualized on helical CT, dynamic MR imaging, and MRCP in 14 (53.8%), 11 (42.3%), and 15 (55.7%) lesions, respectively. The papillary projections corresponding to 3 mm or larger papillary neoplasms were depicted on helical CT and MR imaging in 7 patients (25%). CONCLUSION: MR imaging was equal or slightly superior to thin-section helical CT in the evaluation of intraductal papillary mucinous tumors.

Adult↗
PubMed2001

Decreases in blood perfusion of the anterior cingulate gyri in Anorexia Nervosa Restricters assessed by SPECT image analysis.

BACKGROUND: It is possible that psychopathological differences exist between the restricting and bulimic forms of anorexia nervosa. We investigated localized differences of brain blood flow of anorexia nervosa patients using SPECT image analysis with statistic parametric mapping (SPM) in an attempt to link brain blood flow patterns to neurophysiologic characteristics. METHODS: The subjects enrolled in this study included the following three groups: pure restrictor anorexics (AN-R), anorexic bulimics (AN-BP), and healthy volunteers (HV). All images were transformed into the standard anatomical space of the stereotactic brain atlas, then smoothed. After statistical analysis of each brain image, the relationships among images were evaluated. RESULTS: SPM analysis of the SPECT images revealed that the blood flow of frontal area mainly containing bilateral anterior cingulate gyri (ACC) was significantly decreased in the AN-R group compared to the AN-BP and HV groups. CONCLUSIONS: These findings suggest that some localized functions of the ACCare possibly relevant to the psychopathological aspects of AN-R.

Anorexia Nervosa↗
PubMed2001

Decreased perfusion of the bilateral thalami in patients with chronic pain detected by Tc-99m-ECD SPECT with statistical parametric mapping.

The purpose of this study was to examine whether the Tc-99m-ECD SPECT can detect any difference between the brain perfusion in patients with chronic pain and normal controls by means of the Statistical Parametric Mapping (SPM96). The subjects were twelve patients with chronic pain (CP group) and twelve normal controls (NC group). After informed consent was obtained, 720 MBq of Tc-99m-ECD was intravenously injected as a bolus. The SPECT data were acquired once for 20 mins from 5 mins after i.v. injection of Tc-99m-ECD, with a triple-head rotating gamma camera. The SPECT data were transformed into a standard stereotactic space, and group comparisons between CP and NC groups were performed on a voxel-by-voxel basis. The subset of voxels exceeding a threshold of p < 0.001 in omnibus comparisons and remaining significant after correction for multiple comparison (p < 0.05) was displayed as a volume image rendered in three orthogonal projections. There was a significant decrease in perfusion in the bilateral thalami in the CP group, suggesting that perfusion in the thalamus generally decreases in patients with chronic pain. Tc-99m-ECD SPECT with SPM96 may be useful for studies of the mechanisms of chronic pain.

Adult↗
PubMed2001

Aberrant brain activation following motor skill learning in schizophrenic patients as shown by functional magnetic resonance imaging.

BACKGROUND: Motor skill learning may be impaired in schizophrenia. While functional brain imaging studies have shown reduced activation during motor task performance in schizophrenic patients, brain activity changes with motor skill learning in these patients have not been studied by functional imaging. METHODS: A sequential complex motor task involving the right hand was performed by nine medicated schizophrenic patients and 10 age-matched healthy controls. Functional magnetic resonance images were obtained using a gradient echo, echoplanar imaging (EPI) pulse sequence before and after 1 week of training in performing the task. RESULTS: Bilaterally, patients showed significantly less blood oxygenation level-dependent (BOLD) signal response in the premotor area (PMA) before beginning motor training than controls. BOLD signal response increased in the left PMA of schizophrenic patients after 1 week of motor training; in contrast, the signal decreased in the left PMA of control subjects. Training effects concerning the number of finger movement sequences achieved did not differ between groups. Daily neuroleptic dose did not significantly affect changes with training in BOLD signal response in the PMA. CONCLUSIONS: These preliminary results suggest that schizophrenic patients have dysfunction of neural networks in areas including the PMA that are involved in executing a complex motor task. In terms of brain activity, motor learning may be less efficient or slower in the patients than in healthy subjects.

Adolescent↗
PubMed2001

Bone and Tl-201 scintigraphy in a case of hereditary multiple exostoses.

A 17-year-old girl with hereditary multiple exostoses, who was thought to have malignant transformation of an exostotic lesion, was examined by bone and Tl-201 chloride scintigraphy. Scintigraphy showed markedly intense uptake by the lesion, whereas Tl-201 imaging did not. Bone scintigraphy revealed intense to moderate uptake in other exostotic lesions, but none was apparent on the Tl-201 study. The lesion was resected and the histopathologic diagnosis was osteochondroma. Negative findings of Tl-201 scintigraphy may not exclude the possibility of chondrosarcoma, and the utility of this method may be limited. However, Tl-201 scintigraphy appears to have a useful role in differentiating malignant transformation from benign osteochondroma in hereditary multiple exostoses.

Adolescent↗
PubMed2001

[A study on the isolation period of patients with metastatic thyroid cancer treated by 131I according to a new guideline].

In Japan, a new guideline for the release of patients administered 131I was issued by the Ministry of Welfare on June, 1998: The dose rate is under 30 microSv/h at 1 m or the activity in the body is under 500 MBq. This study was designed to set the appropriate isolation period enough to satisfy these limits. A total of 28 patients with the history of total thyroidectomy and metastasis were selected for this study. In these patients, 28 patients were treated with oral administration of 3.7 GBq of Na131I (72 times), and one of 28 patients was once treated with 5.55 GBq of Na131I. Two of them were also received a total of 4 courses of a split dose therapy of 3.7 GBq of Na131I (740 MBq once a week for 5 consecutive weeks = one course). Measurements of the external exposure dose (microSv/h) at 1 m and the urinary excretory radioactivity (MBq) were performed at various times. There was a good correlation of the external exposure dose between standing (x microSv/h) and sitting (y microSv/h) postures (y = 0.99x + 0.406, r = 0.99, p < 0.0001, n = 169). The difference in the external exposure dose before and after urination (x microSv/h) had a significant correlation with the urinary excretory radioactivity (y MBq); y = 16.6x + 24.8, r = 0.96, p < 0.001, n = 41. Also, there was a significant correlation between the predicted value of residual radioactivity in the body (y' MBq) and the external exposure dose (x' microSv/h); y' = 20.8x' + 31.5, r = 0.98, p < 0.001, n = 77. In the patients treated with 3.7 GBq of Na131I, the mean and S.D. values of the external exposure dose (microSv/h) changed as follow: After 6 hr, 168 +/- 40; 24 hr, 52 +/- 23; 48 hr, 20 +/- 15; 72 hr, 10 +/- 9; and 96 hr, 8 +/- 9. The percentages of the patients satisfied the new guideline were as follow; 21.7% at 24 hr, 81.2% at 48 hr and 100% after 72 hr. Therefore the 3-day isolation is sufficient for the patients administered 3.7 GBq of Na131I.

Adult↗
PubMed2000

Transcatheter arterial chemoembolization therapy using iodized oil for patients with unresectable hepatocellular carcinoma: evaluation of three kinds of regimens and analysis of prognostic factors.

BACKGROUND: The current study was conducted to evaluate retrospectively the effects of three kinds of regimens used in transcatheter arterial chemoembolization (TACE) in patients with unresectable hepatocellular carcinoma (HCC) and patients' prognosis, and to analyze their prognostic factors. METHODS: The study population was comprised of 152 patients who were treated by TACE alone. Three kinds of regimens were used successively: doxorubicin hydrochloride (ADM) and mitomycin C mixed with iodized oil in 26 patients (ADMOS group), a combination of cisplatin (CDDP) solution and ADMOS in 70 patients (CDDP-ADMOS group), and CDDP powder and pirarubicin hydrochloride mixed with iodized oil in 56 patients (CTLS group). The CTLS group was comprised of patients with significantly worse background factors than the other two groups. RESULTS: The initial tumor response rate with a > 50% reduction was 12%, 23%, and 30%, respectively, in the ADMOS, CDDP-ADMOS, and CTLS groups. CTLS was significantly more effective than ADMOS (P < 0.05), and slightly but not significantly better than CDDP-ADMOS (P <0.1). The cumulative survival rates for the ADMOS, CDDP-ADMOS, and CTLS groups were 59.0%, 70.1%, and 72.0%, respectively, at 1 year; 0%, 16. 3%, and 29.8%, respectively, at 3 years; and 0%, 4.1%, and 16.8%, respectively, at 5 years, with median survival times of 448 days, 574 days, and 758 days, respectively. The CTLS group showed a slightly but not significantly better survival than the ADMOS and CDDP-ADMOS groups (P <0.1). Multivariate analysis indicated that the significantly important prognostic factors (in order) were extrahepatic metastasis followed by the TACE regimen, serum alpha-fetoprotein levels, and portal vein involvement and that CTLS was the best of the three regimens. CONCLUSIONS: Although TACE, using an effective regimen, improves clinical results, tumor factors appear to be more important when determining prognosis.

Adult↗
PubMed2000

Adrenal incidentalomas showing unilateral concordant visualization by adrenocortical scintigraphy: comparison with adenomas in Cushing's syndrome.

An adrenocortical adenoma causing Cushing's syndrome (Cushing's adenoma) produces a unilateral concordant visualization (UCV) imaging pattern in which the adenoma is only visualized on radioiodocholesterol adrenocortical scintigraphy. But because this imaging pattern is also noted in some patients with adrenal incidentalomas, we examined whether the UCV-incidentaloma was essentially identical with Cushing's adenoma and would develop Cushing's syndrome. The subjects were 9 patients with UCV-incidentalomas (mean size, 30 mm; range, 20-45 mm) and 6 patients with Cushing's adenomas (mean size, 28 mm; range, 25-35 mm). Endocrinological evaluations showed several abnormalities including blunted diurnal rhythm of plasma cortisol within the normal range, low plasma ACTH and/or high 24-hr urinary 17-OHCS levels in 8 of 9 patients with UCV-incidentalomas, but these abnormalities did not meet the diagnostic criteria of Cushing's syndrome. Adrenal uptake of the tracer in the patients with UCV-incidentalomas was not statistically different from that in the patients with Cushing's adenomas and had no relationship with hormonal values in either patient group. Tumor size on CT correlated with the levels of 24-hr urinary 17-OHCS (r = 0.75, p = 0.02) and plasma cortisol at 7:00 (r = 0.82, p = 0.007) in the patients with UCV-incidentalomas, but not in the patients with Cushing's adenomas. Although 3 UCV-incidentalomas increased slightly in size, none of 9 patients with UCV-incidentalomas has developed Cushing's syndrome for 4 to 52 months. These results suggest that the UCV-incidentaloma may be essentially different from the Cushing's adenoma and unlikely to develop Cushing's syndrome.

17-Ketosteroids↗
PubMed2000

Localization of insulinomas. Comparison of conventional arterial stimulation with venous sampling (ASVS) and superselective ASVS.

PURPOSE: To examine the value of superselective arterial stimulation venous sampling (ASVS) to localize insulinomas. MATERIAL AND METHODS: Superselective ASVS (SS-ASVS) was performed in 9 patients with insulinoma. Injection of secretagogue (calcium gluconate: 0.01 mEq Ca++/kg) was performed into the gastroduodenal, splenic (proximal and distal), and superior mesenteric arteries in 9 patients and additionally into the dorsal pancreatic artery in 6 patients. Sampling from the hepatic vein was performed to measure serum insulin concentrations at 30, 60 and 120 s after each injection of secretagogue into these arteries. SS-ASVS results were correlated with surgical findings, compared to those of conventional ASVS. RESULTS: Insulinomas were correctly localized to the head, body or tail of the pancreas by SS-ASVS in 8 patients (89%). Conventional ASVS detected insulinomas in 7 patients (78%), although it could not distinguish whether the insulinoma was located in the pancreatic body or tail in 4 of the 7 patients. There were eight-fold or more increases in serum insulin levels in hepatic venous samples related to the artery supplying the tumor in 8 patients. Localization of the insulinomas was verified at surgery in all patients. CONCLUSION: SS-ASVS is a useful method for detailed evaluation of overproduction of insulin from pancreatic insulinomas and their localization. When the pancreatic insulinoma is situated in the pancreatic body or tail, the localization is more accurately made by SS-ASVS than by conventional ASVS.

Aged↗
PubMed2000

Hepatic falciform artery. Angiographic findings in 25 patients.

PURPOSE: To determine the frequency of hepatic falciform artery (HFA) occurrence on celiac or hepatic angiograms and elucidate the anatomy and clinical importance. MATERIAL AND METHODS: Among 1,250 patients who underwent celiac or hepatic arteriography, we encountered 25 patients (2%) with a HFA. Prospectively, CT hepatic falciform arteriography (CTHA) was performed in 4 patients. Indigocarmine dye was injected into the HFA in 6 patients to evaluate whether the abdominal skin was stained. Embolization of the HFA before chemoembolization for hepatocellular carcinoma was performed in 4 patients to prevent abdominal wall injury. RESULTS: Among 25 patients, the HFA arose as a terminal branch of the middle hepatic artery in 14 patients (56%) and of the left hepatic artery in 11 patients (44%). The vessel was single in 18 patients (72%) and double in 7 patients (28%). Two vessels ran side by side along the hepatic falciform ligament. On CTHA, the HFA ran within the hepatic falciform ligament and the branches were connected with the liver around the hepatic falciform ligament. After indigocarmine dye injection, the stain of abdominal skin was recognized in all 6 patients. No abdominal wall injury occurred in any of the 4 patients who were subjected to hepatic chemoembolization. CONCLUSION: HFA is an extrahepatic pathway which runs to the abdominal wall. Before chemoembolization of the middle or left hepatic artery for hepatic malignancy, the HFA should be recognized.

Abdominal Muscles↗
PubMed2000

Focal fatty infiltration in the posterior aspect of hepatic segment IV: relationship to pancreaticoduodenal venous drainage.

OBJECTIVE: We aimed to investigate the relationship between fatty infiltration in the posterior aspect of hepatic segment IV and pancreaticoduodenal venous drainage. METHODS: Pancreaticoduodenal arteriography was performed in 21 patients who had nontumorous portal perfusion defects in the posterior aspect of hepatic segment IV, as demonstrated on CT during arterial portography (CTAP). RESULTS: In 10 patients, pancreaticoduodenal arteriography showed an aberrant nonportal vessel with flow toward the hepatic hilum in the venous phase. Four of the 10 patients with nonportal vessels from the pancreaticoduodenal arterial system had fatty infiltration in segment IV. In three of these four patients, the fatty infiltration was focal and localized to that area. On the other hand, none of the 11 patients without nonportal vessels from the pancreaticoduodenal arterial system had fatty infiltration in the regions corresponding to the nontumorous portal perfusion defects on CTAP. Moreover, three patients with diffuse fatty liver had a focal nonfatty area in segment IV. CONCLUSIONS: Focal fatty infiltration in the posterior aspect of hepatic segment IV seems to be related to pancreaticoduodenal venous drainage.

Aged↗