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Migita K.,Clinical Research Center | Miyashita T.,Clinical Research Center | Mizuno A.,Clinical Research Center | Jiuchi Y.,Clinical Research Center | And 6 more authors.
Modern Rheumatology | Year: 2014

We describe herein a patient who presented with immunoglobulin G4-related disease (IgG4-RD) involving the testis and prostate as well as the submandibular glands. Massive infiltration of IgG4-expressing plasma cells was observed in testis and prostate tissues. Serum concentrations of B cell activating factor belonging to the tumor necrosis factor family (BAFF) were elevated in parallel with serum IgG4 concentrations, and infiltration of BAFF-receptor (BAFF-R)-expressing B cells and BAFF-expressing lymphoid cells was observed around the ectopic lymphoid foci in the affected urogenital tissues. To date, testicular involvement in a patient diagnosed with IgG4-RD had not been reported, making this the first reported case of IgG4-related epididymo-orchitis. These findings suggest that the immune mechanism underlying ectopic lymphoneogenesis in IgG4-RD may involve enhanced BAFF/BAFF-R interactions among lymphoid cells. © 2013 Japan College of Rheumatology.

Kawahara I.,Nagasaki Prefecture Shimabara Hospital | Nakamoto M.,Nagasaki Prefecture Shimabara Hospital | Matsuo Y.,Nagasaki Prefecture Shimabara Hospital | Tokunaga Y.,Nagasaki Prefecture Shimabara Hospital
Neurological Surgery | Year: 2010

Cerebral amyloid angiopathy (CAA) is predominantly recognized in elderly people and repeatedly causes a huge subcortical hemorrhage. Some cases of CAA can cause secondary subarachnoid hemorrhage (SAH), but cases in which it causes primary SAH is very rare. We describe a valuable reference case of a 75-year-old man in whom a restricted SAH recurred in the cortical sulcus following a huge subcortical hemorrhage. He presented with an unknown restricted SAH in the left frontal sulcus twice before neck clipping for a right IC-PC unruptured aneurysm. Postoperative computed tomography (CT) revealed a recurrent SAH in the left frontal lobe, and it spread gradually. T2* weighted imaging (T2*WI) revealed subarachnoid hemosiderosis and superficial cortical hemosiderosis in the frontal and parietal lobe. On the 21st postoperative day, he suddenly presented right hemiplegia and a huge subcortical hemorrhage was observed in the left frontal lobe on CT. Emergent removal of the hematoma was performed, but the patient had become bedridden. Pathological diagnosis of CAA was made. A recurrent restricted SAH in the frontal sulcus might have been a warning sign of a huge subcortical hemorrhage. In the aging society, a radiological prediction of CAA is very important. Although it is generally thought to be very difficult, T2*WI may be useful for predicting CAA. When we plan surgery for elderly people, we must always take CAA into consideration.

Kawahara I.,Nagasaki Prefecture Shimabara Hospital | Nakamoto M.,Nagasaki Prefecture Shimabara Hospital | Matsuo Y.,Nagasaki Prefecture Shimabara Hospital | Tokunaga Y.,Nagasaki Prefecture Shimabara Hospital
Neurologia Medico-Chirurgica | Year: 2010

We describe two rare cases of de novo basilar head aneurysms. The first patient presented with a ruptured basilar tip aneurysm, which developed de novo 5 years after the clipping of a left middle cerebral artery aneurysm. The second patient presented with a right basilar artery-superior cerebellar artery aneurysm, which developed de novo 3 years after the clipping of a right A 1 aneurysm. The formation of de novo aneurysm in the posterior circulation has significant implications for screening. Patients must be carefully examined not only at the sites of the initial aneurysm, but also at separate sites, including the posterior circulation, to evaluate the possibility of de novo appearance of another aneurysm.

Hakariya T.,Nagasaki University | Obata S.,Nagasaki prefecture Shimabara Hospital | Igawa T.,Nagasaki University | Sakai H.,Nagasaki University
Anticancer Research | Year: 2014

Aim: We examined the feasibility of local intensity-modulated radiation therapy (IMRT) with pelvic irradiation using the simultaneous integrated boost (SIB) technique to treat patients with castration-resistant prostate cancer (CRPC) after several lines of hormonal therapy. Patients and Methods: Data from 10 consecutive patients with CRPC treated with SIB-IMRT between November 2001 and September 2009 were analyzed retrospectively. Results: A decline in prostate-specific antigen (PSA) level was observed in all cases after SIB-IMRT. Biochemical progression-free survival at 5 years was 70% with a median follow-up of 33.5 months after SIB-IMRT. All patients completed SIB-IMRT without delay due to acute toxicity. The PSA nadir after first-line hormonal therapy, the PSA before SIB-IMRT, the PSA doubling time before SIB-IMRT and the PSA nadir after SIB-IMRT were significant factors for biochemical progression after SIB-IMRT. Conclusion: SIB-IMRT for patients with CRPC is feasible and has a satisfactory effect in terms of disease control. © 2014, International Institute of Anticancer Research. All rights reserved.

Matsuo M.,Nagasaki Prefecture Shimabara Hospital | Azuma T.,Nagasaki Prefecture Shimabara Hospital
Acta Urologica Japonica | Year: 2013

A 71-year-old male was admitted for bladder cancer, and we performed a radical cystectomy and urinary diversion by means of an ileal conduit. Twenty days postoperatively, we identified the presence of stool in the stoma and noted the existence of a fistula of the small intestine and ileal conduit urinary diversion. Treatment with fasting, intravenous hyperalimentation and intravenous drip administration of octreotide acetate were performed. The fistula was closed completely 47 days after the surgery. The early complications of urinary diversion by means of an ileal conduit were reported to be urinary tract infections, bowel obstruction, and delayed wound healing, but a fistula between the small intestine and ileal conduit is very rare. We herein report a case of a fistula between the small intestine and ileal conduit used for urinary diversion which thereafter healed by conservative treatment.

Tajiri H.,Nagasaki Prefecture Shimabara Hospital
Nihon Hoshasen Gijutsu Gakkai zasshi | Year: 2013

Almost all mammary lesions are detected by a mammography and an ultrasound. However, a small part of lesions cannot be shown by only a magnetic resonance imaging (MRI). MRI-guided vacuum-assisted breast biopsy is a very useful means for the pathological diagnosis of these lesions. We performed MRI-guided vacuum-assisted breast biopsy to 4 patients with the lesions seen only by MRI. Biopsies were safely and easily performed using biopsy software (syngo BreVis). These biopsied specimens resulted cancer in 1, adenoma in 1 and benign lesions in 2. With an increase of the opportunity of MRI for the mammary lesions, we expect these lesions become increasingly large. We believe that MRI-guided vacuum-assisted breast biopsy will be an important diagnostic modality.

PubMed | Nagasaki Prefecture Shimabara Hospital, Yonezawa National Hospital and Nagasaki University
Type: Journal Article | Journal: Modern rheumatology | Year: 2016

To investigate whether aquaporins (AQPs) are involved in salivary gland dysfunction in patients with neuromyelitis optica (NMO) complicated with Sjgrens syndrome (SS).Eight primary SS (pSS) patients, four NMO spectrum disorder (NMOsd) patients complicated with SS (NMOsd-SS), and three control subjects were enrolled. Immunohistochemistry of labial salivary glands (LSGs) was performed to determine the expressions of AQP4, AQP5, and tumor necrosis factor-alpha (TNF-). In vitro expression of AQP5 was examined by Western blotting in cultured primary salivary gland epithelial cells (SGECs).No expression of AQP4 was shown in all LSGs. AQP5 was clearly expressed in the all acini, but the predominant localization of AQP5 in the apical side was diminished in the patients with pSS or NMOsd-SS compared with the controls and tended to be even lower in NMOsd-SS than pSS. The abnormal localization of AQP5 was associated with poor saliva secretion. No difference was found in TNF- expression in the LSGs between patients with pSS and NMOsd-SS. AQP5 expression of SGECs in vitro was not changed by TNF- or interleukin-10.Our results suggest that AQP5 but not AQP4 contributes to salivary secretion in patients with SS including those with NMO complicated with SS.

PubMed | Nagasaki Prefecture Shimabara Hospital and Nagasaki University
Type: Journal Article | Journal: Case reports in gastroenterology | Year: 2016

Hepatic portal venous gas (HPVG) is induced by various abdominal diseases. Since HPVG is accompanied by bowel ischemia, intestinal infection and hypovolemia, various modes of critical management are needed to treat the underlying conditions. HPVG associated with abdominal complications after surgery has rarely been reported. We present 4 patients with HPVG after abdominal surgery: 2 of the 4 patients died of multiple organ failure, and the other 2 recovered with solely conservative therapy. Although postoperative HPVG is a severe and life-threatening condition, early detection and systemic treatment lead to a better patient outcome.

PubMed | Nagasaki Memorial Hospital, Nagasaki Prefecture Shimabara Hospital and Nagasaki University
Type: Journal Article | Journal: Japanese journal of radiology | Year: 2016

Our aim was to clarify the frequency of cardiovascular border obliteration on frontal chest radiography and to prove that the phrenic nerve with accompanying vessels can be considered as a cause of obliteration of cardiovascular border on an otherwise normal chest radiography.Two radiologists reviewed chest radiographs and computed tomography (CT) images of 100 individuals. CT confirmed the absence of intrapulmonary or extrapulmonary abnormalities in all of them. We examined the frequency of cardiovascular border obliteration on frontal chest radiography and summarized the causes of obliteration as pericardial fat pad, phrenic nerve, intrafissure fat, pulmonary vessels, and others, comparing them with CT in each case.Cardiovascular border was obliterated on frontal chest radiography in 46 cases on the right and in 61 on the left. The phrenic nerve with accompanying vessels was found to be a cause of obliteration in 34 of 46 cases (74%) on the right and 29 of 61 (48%) cases on the left. The phrenic nerve was the most frequent cause of cardiovascular border obliteration on both sides.The phrenic nerve with accompanying vessels, forming a prominent fold of parietal pleura, can be attributed as a cause of cardiovascular border obliteration on frontal chest radiography.

PubMed | Nagasaki Prefecture Shimabara Hospital and Nagasaki University
Type: Case Reports | Journal: Hinyokika kiyo. Acta urologica Japonica | Year: 2015

Extramammary Pagets disease occurring in the female vulva is occasionally associated with invasive disease to urethra and bladder mucosa. For such cases, ensuring adequate surgical margin is essential. Not only adequate removal of tumor, but also urinary diversion is important for patients quality of life. A 77- year-old woman was treated with excision of vulvar tumor, urethra, vagina, rectum and anus. The determination of excision area was decided according to the result of mapping biopsy including urethra and bladder. Then she received reconstruction of vulva using the gracilis muscle skin flap. We applied a technique of channel formation for intermittent catheterization using the retubularized sigmoid colon based on the Monti principle. The tube was implanted submucosally into the bladder to prevent the reflux of urine. Fifteen days after operation, self-intermittent catheterization was started successfully. Surgical margins were negative in urethra, skin, vagina and rectum. There are no obvious recurrence or metastasis 1 year after surgery.

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