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Kawabata H.,Kyoto University | Kotani S.-I.,Kyoto University | Matsumura Y.,Kyoto University | Kondo T.,Kyoto University | And 4 more authors.
Internal Medicine | Year: 2013

We herein describe an unusual case of multicentric Castleman's disease accompanied by thrombocytopenia, ascites, renal failure and myelofibrosis in a Japanese woman. The patient was initially diagnosed as having myelodysplastic syndrome with myelofibrosis. The general condition of the patient deteriorated rapidly; however, treatment with tocilizumab, an anti-interleukin-6 receptor antibody, together with corticosteroids dramatically improved her symptoms. The clinical features of this case were similar to those of three cases previously reported by Takai et al. (Rinsho Ketsueki, 2010, 51:320-5), which were determined to be thrombocytopenia, anasarca, fever, reticulin myelofibrosis and organomegaly (TAFRO) syndrome, a possibly distinct clinical entity. © 2013 The Japanese Society of Internal Medicine. Source


Nomura T.,Ijinkai Takeda General Hospital | Nomura T.,Kyoto University | Kabashima K.,Kyoto University | Miyachi Y.,Kyoto University
Journal of Dermatological Science | Year: 2014

Skin protects body from continual attack by microbial pathogens and environmental factors. Such barrier function of skin is achieved by multiple components including immune system, which is mainly regulated by lymphocytes. T lymphocytes (T cells) that express T cell receptor (TCR) α and β chains (αβT cells) control the strength and the type of immune response. CD4T cell population consists of helper T (Th) cell-subsets and immunosuppressive regulatory T (Treg) cells. Th1 cells produce IFN-γ and protect against intracellular pathogens. Th2 cells produce IL-4 family cytokines and participate in allergic skin diseases, including atopic dermatitis (AD). Th17 cells secrete IL-17, recruit granulocytes to fight against extracellular microorganisms, and play a role in psoriasis and AD. Th22 cells produce IL-22 that activates epithelial cells and mediates acanthosis in psoriasis and AD. On the other hand, Foxp3+ Treg cells attenuate immune responses partly via TGF-β or IL-10. Tissue resident memory T (Trm) cells in the skin-most of which are epidermal CD8T cells-constitute the first line of the defense against repeated infections. CD8 T cells are also engaged in psoriasis, lichen planus, and drug eruptions. Skin harbors innate-like αβT cells such as natural killer T (NKT) cells as well, whose function is not fully revealed. Understanding these αβT cells helps to comprehend skin diseases. © 2014 Japanese Society for Investigative Dermatology. Source


Kanno T.,Ijinkai Takeda General Hospital | Kubota M.,Ijinkai Takeda General Hospital | Sakamoto H.,Kyoto University | Nishiyama R.,Ijinkai Takeda General Hospital | And 3 more authors.
Urology | Year: 2014

Objective To assess the efficacy of ultrasonography (US) for the detection of ureteral stone using non-contrast-enhanced computed tomography (NCCT) as a standard reference. Materials and Methods From January 2009 to September 2011, 428 patients underwent both NCCT and US on the same day. The sensitivity and specificity of US to detect ureteral stone was evaluated. The detection rates using US imaging were examined according to location and stone size. The sizes of stones determined in the longest axis of NCCT and US were compared. We also performed group classification based on size to examine whether stone sizes measured by NCCT and US were similar. Moreover, the factors that may affect the detection of ureteral stone by US were analyzed. Results Out of 856 ureters, NCCT could detect 171 stones in 169 patients, whereas US could detect 98 stones, yielding a sensitivity of 57.3% and a specificity of 97.5%. Expectedly, detection rate of US increased with stone size but was lower for distal ureter. With hydronephrosis, the sensitivity of US improved from 57.3% to 81.3%. Stone sizes measured by US correlated positively with those by computed tomography, and were concordant with those of NCCT in 68 of 98 patients (69.4%). Interestingly, stone size and the presence of hydronephrosis were factors that independently affected ureteral stone detection by US. Conclusion These results indicate that US may be useful as an initial imaging modality for detecting ureteral stone. © 2014 Elsevier Inc. All Rights Reserved. Source


Kanno T.,Ijinkai Takeda General Hospital | Kubota M.,Ijinkai Takeda General Hospital | Sakamoto H.,Kyoto University | Nishiyama R.,Ijinkai Takeda General Hospital | And 3 more authors.
Urology | Year: 2014

Objective To assess the efficacy of ultrasonography (US) for detecting renal stone using noncontrast enhanced computed tomography (NCCT) as a standard reference. Methods We performed a retrospective study of 428 patients who underwent NCCT and US imaging on the same day from January 2009 to September 2011. The sensitivity of US to detect each individual stone and at least 1 stone per kidney was evaluated. The detection rates according to the location and stone size were also examined. We compared the sizes of stones determined in the longest axis of NCCT and US, and performed group classification based on size to examine whether stone sizes measured by NCCT and US were similar. Results Of 856 kidneys, NCCT detected 474 stones in 361 kidneys, whereas US detected 332 stones of 474 stones detected by NCCT, yielding a sensitivity of 70.0% and a specificity of 94.4%. Similarly, US alone detected at least 1 stone in 285 kidneys, yielding a sensitivity of 78.9% and a specificity of 83.7%. Expectedly, the detection rate for the left upper calyx was lower than that for other sites (P =.002), and the detection rate increased with stone size. Furthermore, stone sizes obtained by US were positively correlated with those obtained by CT, and stone size measurement by NCCT and US was concordant in 240 of 332 cases (72%). Importantly, stone size was only a factor that affected renal stone diagnosis using US. Conclusion US is an effective imaging modality for detecting renal stones. © 2014 Elsevier Inc. Source


Sakamoto H.,Ijinkai Takeda General Hospital | Matsuda A.,Ijinkai Takeda General Hospital | Arakaki R.,Kyoto University | Yamada H.,Ijinkai Takeda General Hospital
Acta Urologica Japonica | Year: 2012

A number of patients with benign prostatic hyperplasia can not undergo surgical therapy because of advanced age, concomitant diseases, and other reasons. Since 1980, various types of urethral stents have been used for high-risk patients with benign prostatic hyperplasia. We report our experience with the use of urethral stents (Memotherm® Between July 2002 and December 2010, we implanted urethral stents in 36 patients. The average follow-up period was 24.0 months. After stent implantation, 34 of the 36 patients were able to micturate. The average residual urine volume was 24.7 ml (0-250 ml), and the maximal urinary flow rate was 10.7 ml/s (3-24 ml/s). One stent had to be removed due to bladder tamponade, and one had to be exchanged due to dislocation. In 2 patients, a stone formed at the bladder end of the stent, and one of these patients underwent transurethral lithotripsy. Our results suggest that therapy with the Memotherm® urethral stent is a good option for patients suffering from urinary retention due to benign prostatic hyperplasia. Source

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