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Hiratsuka, Japan

Johkura K.,Hiratsuka Kyosai Hospital
Neuro-Ophthalmology Japan | Year: 2012

Vertical eye deviation in hypoxic coma is considered rare. Nevertheless, in a consecutive series of 50 post-resuscitation comatose patients, we found that 28 (56.0%) developed tonic upward or downward eye deviation. We suggest that both the upward and ownward deviations resulted from diffuse cerebro-cerebellar damage sparing the brainstem. Upward deviation is an early sign, whereas downward deviation appears later, and generally implies a transition to the vegetative state.

Inoue Y.,Hiratsuka Kyosai Hospital
Nihon Kokyūki Gakkai zasshi = the journal of the Japanese Respiratory Society | Year: 2011

Reversed halo sign (RHS) is often seen in computed tomography (CT) scans of cryptogenic organizing pneumonia (COP). To investigate its clinical features, we retrospectively reviewed 30 cases of COP in 13 men and 17 women, whose age range 28 to 73, with a mean of 58.4 years. All diagnoses were made with transbronchial lung biopsy (TBLB), but it took an average of 24.8 days from the first visit until the diagnosis of COP. RHS was seen in 7 cases (23%) and multiple RHSs were seen in 3 cases. We treated 5 cases (71%) with steroids. Their CT images showed parenchymal abnormalities which started as nodular lesions, then enlarged, and then the central lesion changed into ground-glass opacities, until finally, RHS was formed. The presence of RHS does not necessarily indicate a marked difference in the clinical course of COP. In conclusion, in the present series RHS was a phase of the clinical course of COP, and was useful to diagnose COP.

Ogawa A.,National Hospital Organization Okayama Medical Center | Yamadori I.,National Hospital Organization Okayama Medical Center | Matsubara O.,Hiratsuka Kyosai Hospital | Matsubara H.,National Hospital Organization Okayama Medical Center
Internal Medicine | Year: 2013

Pulmonary tumor thrombotic microangiopathy is a lethal, yet difficult to diagnose, complication of gastrointestinal carcinoma. Even if properly diagnosed, there is no treatment, especially after a circulatory collapse. We herein report a case of pulmonary tumor thrombotic microangiopathy with circulatory failure due to pulmonary hypertension. The patient was temporarily successfully treated with imatinib, an inhibitor of the platelet-derived growth factor receptor. Pulmonary hypertension was dramatically ameliorated and the patient was able to be weaned from percutaneous cardiopulmonary support within 20 days of treatment. Imatinib may be effective for ameliorating pulmonary hypertension that is caused by pulmonary tumor thrombotic microangiopathy. © 2013 The Japanese Society of Internal Medicine.

Johkura K.,Hiratsuka Kyosai Hospital
Brain and Nerve | Year: 2013

Vertigo or dizziness is primarily caused by peripheral vestibular disorders, such as benign paroxysmal positional vertigo (BPPV) and vestibular neuritis. BPPV can be diagnosed from associated positional torsional or direction-changing horizontal nystagmus and can be treated with canalith repositioning procedures. In contrast, vestibular neuritis and other acute peripheral vestibulopathies can be diagnosed from associated unidirectional horizontal nystagmus. Evaluation of nystagmus is essential for the diagnosis of peripheral vestibular disorders. Vertigo/dizziness caused by disorders in the brainstem or upper cerebellum is usually associated with other neurological signs or symptoms, such as motor palsy, sensory deficit, dysarthria, ocular motor palsy, and limb ataxia. In contrast, vertigo/dizziness caused by disorders in the lower cerebellum is not associated with these signs or symptoms; however, truncal ataxia becomes apparent in a standing position. Small lesions in the lower cerebellum can rarely cause unidirectional horizontal nystagmus directed toward the side of the lesions or direction-changing apogeotropic positional nystagmus; both types of nystagmus are enhanced when a patient lies on the non-affected side. This positional enhancement suggests that the same pathogenetic mechanism is involved in both types of nystagmus. The cerebellar lesions may disinhibit both semicircular-ocular and otolith-ocular reflexes. Semicircular-ocular reflex-dominant disinhibitions may result in the ipsilateral horizontal nystagmus, whereas otolith-ocular reflex-dominant disinhibitions may result in the direction-changing apogeotropic positional nystagmus.

Kurata K.,Hiratsuka Kyosai Hospital
Nihon Kokyūki Gakkai zasshi = the journal of the Japanese Respiratory Society | Year: 2011

A 69-year-old man complained of fever in September 2009, after returning from Vietnam where he has been working for 20 years. He had diabetes mellitus and was on diabetic oral medication. He was examined at a nearby hospital, and found out to have pneumonia with cavity formation in the right upper lobe which was found out to be not due to tuberculosis. Although the patient once recovered with antibacterial medicine, after a few months, in January 2010, he was admitted to our hospital because of recurrent fever. Computed tomography revealed multiple pulmonary nodules which were thought to be pulmonary emboli, as well as subcutaneous abscess, spleen abscess, and kidney abscess. Blood test showed that he also had DIC. As Burkholderia pseudomallei was cultured from the subcutaneous abscess and blood, was diagnosed as melioidosis. The patient was treated with meropenem for 8 weeks, and then a maintenance oral antibacterial medicine was continued for the next 6 months. The patient fully recovered after those treatments and has not relapsed since then. This is the ninth case report of melioidosis in Japan which is an imported infectious disease.

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