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Sugimoto T.,Higashiosaka City General Hospital | Uranishi R.,Bell Land General Hospital | Yamada T.,National Hospital Organization Osaka Minami Medical Center
World Neurosurgery

Background: Arachnoid cysts in the fourth ventricle are extremely rare, with only 13 cases having been described in the literature. Especially, only 1 case of a patient older than 70 years has been reported. Arachnoid cysts in the fourth ventricle may cause obstructive hydrocephalus. Here, we report the case of a 72-year-old man who presented with an arachnoid cyst in the fourth ventricle that caused gradually progressive symptoms of normal pressure hydrocephalus. Methods: A 72-year-old man complaining of persistent dizziness and gait difficulty was admitted to our hospital due to a gradual worsening of his symptoms and apparent cognitive impairment. Computed tomography scan of the head showed symmetrically dilated third, fourth, and lateral ventricles. Result: Though we performed a ventriculoperitoneal shunt operation, his trunk ataxia persisted. We finally diagnosed an arachnoid cyst in the fourth ventricle by direct ventricular infusion of enhanced material. We performed direct surgical fenestration of the cyst and achieved a good outcome. Conclusion: Arachnoid cysts of the fourth ventricle are exceedingly rare, but it is important to recognize them because they cause normal pressure hydrocephalus symptoms and cerebellar or brainstem deficit. We propose detailed neurologic and radiologic examinations of patients with normal pressure hydrocephalus symptoms to avoid unnecessary shunt. © 2016, Elsevier Inc. All rights reserved. Source

Kaito T.,National Hospital Organization Osaka Minami Medical Center
Archives of orthopaedic and trauma surgery

We reported that excessive disc space distraction caused by insertion of large cages during posterior lumbar interbody fusion (PLIF) combined with pedicle screws (PS) induces adjacent segment disease (ASD). Spinous process plate (SPP) is known to allow cage subsidence when used in PLIF, since they cannot share vertical loads. We therefore hypothesize that the incidence of ASD after PLIF with SPP should be lower than that after PLIF with PS due to this loss of disc space distraction. Radiographic ASD is defined as development of spondylolisthesis > 3 mm, decrease in disc height > 3 mm, or intervertebral angle at flexion lesser than -5°. Symptomatic ASD is defined by a decrease of ≥ 4 points in Japanese Orthopedic Association score. One hundred and thirty patients with L4 spondylolisthesis were treated with either PLIF with SPP (n = 45) or PLIF with PS (n = 85) and followed up for a minimum of 2 years (mean, 39.0 months). L4-5 disc space distraction in the SPP group was significantly smaller (0.4 mm) as compared to the PS group (1.8 mm). The incidence of clinical ASD in the SPP group (2%, 1/45) was also significantly less than that in the PS group (15%, 13/85). Multivariate analysis showed that disc space distraction was the most significant risk factor. Among various risk factors for ASD after PLIF, the excessive distraction of disc space proved to be a potent risk factor for ASD. Source

Saeki Y.,National Hospital Organization Osaka Minami Medical Center | Ishihara K.,Kawasaki Medical School
Autoimmunity Reviews

Autoimmunity causes pathological conditions resulting in autoimmune diseases (ADs). Although autoimmunity is a mystery, immunological dogma suggests that autoreactive cell reactivation (ACR) breaks self-tolerance and induces autoimmunity. Thus, ACR is a royal pathway for ADs. Cumulative evidence implicates environmental factors as secondary triggers of ADs in the genetically susceptible hosts. Infection is the most likely trigger. Although several mechanisms have been proposed to explain how infectious agents trigger ADs, ACR is assumed to be an essential pathway. Here, by showing some exemplary ADs, we propose two novel pathways, "molecular modification pathway" and "hyper-immune-inflammatory response pathway", which induce AD-like conditions directly by infectious agents without ACR. These AD-like conditions are actually not true "ADs" according to the current definition. Therefore, we define them as "pathogen-driven autoimmune-mimicry (PDAIM)". Confirming PDAIM will open perspectives in developing novel fundamental and non-immunosuppressive therapies for ADs. The idea should also provide novel insights into both the mechanisms of autoimmunity and the pathogenesis of ADs. © 2014 Elsevier B.V. All rights reserved. Source

Tanaka T.,National Hospital Organization Osaka Minami Medical Center | Kato T.,Kobe Hospital of Japan Seafarers Relief Association | Ohmichi M.,Osaka Medical College
Journal of Obstetrics and Gynaecology Research

The relation between the use of tamoxifen and gynecologic tumors has been documented. In this case, a 58-year-old postmenopausal woman had been treated with tamoxifen for 5 years followed by toremifene for 1.5 years due to the presence of stage II estrogen receptor-positive breast cancer. The patient was found to have a stage Ic granulosa cell tumor of the ovary despite undergoing annual gynecologic examinations. This report presents a case of granulosa cell tumor of the ovary after the long-term use of tamoxifen and toremifene. © 2012 Japan Society of Obstetrics and Gynecology. Source

Kaito T.,Osaka University | Ohshima S.,National Hospital Organization Osaka Minami Medical Center | Fujiwara H.,National Hospital Organization Osaka Minami Medical Center | Makino T.,Osaka University | Yonenobu K.,Jikei Institute

STUDY DESIGN.: Retrospective cohort analysis. OBJECTIVE.: To clarify the effect of biological agents (BAs) on the development and progression of cervical lesions in patients with rheumatoid arthritis (RA) and to identify biomarkers that accurately predict disease progression. SUMMARY OF BACKGROUND DATA.: The introduction of BAs changed the paradigm of RA treatment. However, their effects on cervical lesions in patients with RA have not been studied. METHODS.: Ninety-one subjects who had received BAs for 2 years or more were enrolled. Mean radiographical interval was 3.9 years. Disease activity was evaluated by disease activity score-C-reactive protein levels, and matrix metalloproteinase-3 levels. Cervical lesions were defined as an atlantodental interval more than 3 mm for atlantoaxial subluxation (AAS), Ranawat value less than 13 mm for vertical subluxation (VS), and anterior or posterior listhesis more than 2 mm for subaxial subluxation. Disease progression was defined radiographically as an increase in the atlantodental interval more than 2 mm for AAS, a decrease in both Ranawat and Redlund-Johnell values more than 2 mm for VS, and an increase in listhesis more than 2 mm for subaxial subluxation. We used multivariate regression techniques to assess predictors of disease progression. RESULTS.: Baseline radiographical evaluation showed no pre-existing cervical lesion in 44 patients, AAS in 29, and VS in 18. Radiological progression occurred in 7% patients without baseline lesions, 79% in the AAS group, and 72% in the VS group. The incidence of progression was significantly lower in patients without lesions at baseline. Multivariate regression analysis demonstrated pre-existing cervical lesions, disease activity score-C-reactive protein levels at baseline and metalloproteinase-3 levels at final visit as good predictors of RA progression. CONCLUSION.: BAs prevented de novo cervical lesions in patients with RA but failed to control progression in patients with pre-existing cervical lesions. Disease activity score-C-reactive protein levels at baseline were related to pre-existing joint destruction, and metalloproteinase-3 levels accurately predicted ongoing bone destruction during BA treatment. Copyright © 2013 Lippincott Williams &Wilkins. Source

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