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Akio Akagi Yasushi Iwasaki Akihiro Yamamoto Hiroshi Matsuura Toshimasa Ikeda Maya Mimuro Yuichi Riku Hiroaki Miyahara Tetsuyuki Kitamoto Mari Yoshida 《Neuropathology》2020,40(4):399-406
We report a case of early-phase sporadic Creutzfeldt–Jakob disease (sCJD) complicated by intracerebral hemorrhage (ICH), classified as MM1 + 2C-type based on autopsy. A 61-year-old Japanese man presented to our hospital with speaking difficulties including repeated usage of the same words. He was hospitalized on the seventh day after symptom onset, and diffusion-weighted images on magnetic resonance imaging showed hyperintense regions in the frontal cortex and caudate nucleus. On the 11th day after symptom onset, head computed tomography revealed ICH in the right occipital and parietal lobes. Routine laboratory evaluations and angiography revealed no cause of ICH. Myoclonus of the extremities and drowsiness were observed on the 15th day after symptom onset. He reached the state of akinetic mutism approximately two months after symptom onset. The cerebrospinal fluid test revealed positive real-time quaking-induced conversion and 14-3-3 protein. Electroencephalography revealed periodic sharp wave complexes. A clinical diagnosis of probable Creutzfeldt–Jakob disease was made according to the diagnostic criteria. After a relapse of pneumonia, he passed away on the 103rd day after symptom onset. Postmortem examination revealed ICH in the right posterior cingulate gyrus. No pathological change that might have caused ICH was obtained. Although the effect of sCJD on the onset of ICH is undeniable, the cause of ICH was unknown. Prion protein immunohistochemistry revealed the following results: (1) weak synaptic-type deposits in the tissue rarefacted by ICH; (2) synaptic-type deposits in the cerebral cortex, which showed fine vacuoles; and (3) perivacuolar-type deposits in the inferior temporal gyrus and lingual gyrus, which showed frequent large confluent vacuoles. Although it could be considered MM1-type sCJD clinically, this case was neuropathologically diagnosed as having MM1 + 2C-type sCJD. It was shown that ICH may occur in early-phase sCJD. To improve sCJD prognosis, treatment of complications and careful follow up are important. Furthermore, pathological diagnosis is indispensable for sCJD type diagnosis. 相似文献
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Kevin Robertson Alan Landay Sachiko Miyahara Alyssa Vecchio Mary Clare Masters Todd T. Brown Babafemi O. Taiwo 《Journal of neurovirology》2020,26(1):107-113
The AIDS Clinical Trials Group (ACTG) study A5303 investigated the associations between neuropsychological performance (NP) and inflammatory biomarkers in HIV-infected participants. Fifteen NP tests were administered at baseline and week 48 to 233 ART naïve participants randomized to maraviroc- or tenofovir-containing ART. Neurocognition correlated modestly with markers of lymphocyte activation and inflammation pre-ART (percent CD38+/HLA-DR+(CD4+) (r = − 0.22, p = 0.02) and percent CD38+/HLA-DR+(CD8+) (r = − 0.25, p = 0.02)), and with some monocyte subsets during ART (r = 0.25, p = 0.02). Higher interleukin-6 and percent CD38+/HLA-DR+(CD8+) were independently associated with worse severity of HIV-associated neurocognitive disorders (HAND) (p = 0.04 and 0.01, respectively). More studies to identify HAND biomarkers are needed. 相似文献
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Chikako Kusunoki Takuya Hamakawa Kazuhiro Nishikawa Hiromichi Sato Sayumi Imamura Satoru Miyahara Yu Sakano Hazuki Miyazaki Hiroto Seto Ryuta Ueda Reishi Toshiyama Masaaki Miyo Yusuke Takahashi Kenji Sakai Masakazu Miyake Atsushi Miyamoto Takeshi Kato Kiyoshi Mori Motohiro Hirao 《Asian journal of endoscopic surgery》2021,14(4):794-797
Laparoscopic wedge resection (LWR) for intraluminal gastrointestinal stromal tumor (GIST) leads to excessive resection of normal gastric wall. We report a case of GIST around the cardia successfully treated with full-thickness partial resection using a hybrid approach of laparoscopic surgery and single-incision intragastric surgery (SIIGS). A 69-year-old woman had a 5 cm intraluminal GIST at the posterior wall around the cardia. Submucosal injection of glycerin and indigo carmine was performed with transoral endoscopy. Circumferential seromuscular incision followed by placement of seromuscular sutures to invert the lesion into the stomach was performed under laparoscopy. By SIIGS, resection of the inverted mucosa and retrieval of the tumor were completed. A hybrid approach consisting of laparoscopic wall-inversion surgery and SIIGS was useful for intraluminal GIST and may expand the indications for laparoscopic wall-inversion surgery by removing size limitations. 相似文献
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Hiroyuki Nakano Yoshihide Mori Takamitsu Mano Katsuhiro Minami Ken Matsumoto Yoshiya Ueyama Yoshiaki Yura 《Oral and maxillofacial surgery》2010,14(2):119-121
Introduction
We reported an infant with temporomandibular joint (TMJ) osteoarthritis who required long-term tracheostomy.Case findings
At 1 year of age, he received urgent tracheostomy because of apnea due to pneumonia. The tracheal cannula could not be removed thereafter due to trismus. Computed tomography (CT) images demonstrate irregular bone formation. However, we could not diagnose osteoarthritis of temporomandibular joint because TMJ adhesion was not clear on CT images.Interventions
Arthroplasty was performed under general anesthesia, but there was no significant improvement. A 3-D plastic model based on intraoperative findings showed that atrophic change of the muscles also disturbed movement of the mandible. Therefore, an additional procedure called “pan-muscle-release surgery” was performed, resulting in further improvement of mandible movement. After confirming that mouth opening was stable, the tracheal cannula was removed. 相似文献8.
Hiroto Kayashima Ken Shirabe Rumi Matono Shohei Yoshiya Kazutoyo Morita Kenji Umeda Toru Ikegami Tomoharu Yoshizumi Yuji Soejima Yoshihiko Maehara 《Surgery today》2014,44(11):2077-2085
Purpose
To evaluate the anatomical variations in the middle hepatic vein tributaries (V5/V8) for determining the reconstruction strategy in right lobe living donor liver transplantation (LDLT).Methods
The V5/V8 variations were examined in 268 patients and were classified into three and two types, respectively. The reconstruction rate (RR), patency rate (PR) and clinical outcomes were retrospectively evaluated in 46 right lobe LDLT cases.Results
In terms of V5 variations, the RR and PR were significantly higher for type 2 than type 3 (82.6 vs. 44.4 % and 73.7 vs. 25.0 %, respectively). The alanine aminotransferase level on postoperative day (POD) 5 in the V5 patent group was significantly lower than in the occluded group (123 vs. 191 IU/dL). Regarding V8 variations, the RR and PR were significantly higher for type 1 than type 2 (44.4 vs. 17.6 % and 75.0 vs. 33.3 %, respectively). The aspartate aminotransferase level on POD 3 was significantly lower in the V8 patent group than in the occluded group (50 vs. 121 IU/dL).Conclusion
For right lobe grafts with single large V5 (type 2) or V8 (type 1) variations, reconstruction is necessary. Our new classification of the MHV tributaries is useful for determining the reconstruction strategy to use in right lobe LDLT. 相似文献9.
A Iwai T Miyahara H Koyama H Niwa 《Nihon rinsho. Japanese journal of clinical medicine》1992,50(11):2734-2739
Irritable bowel syndrome (I.B.S.) is treated with medication, change of life style, various psychotherapies, oriental medicine, and etc., But no specific therapy is recognized useful for all the symptoms derived from I.B.S.. In fact the combination of these therapies are useful. When the therapeutic schedule is planned for individuals, we must keep it in mind that the relief from the symptoms is most important for patients. 相似文献