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Saeki T.,Red Cross | Kawano M.,Kanazawa University | Mizushima I.,Kanazawa University | Yamamoto M.,Sapporo Medical University | And 9 more authors.
Kidney International

Long-term follow-up for IgG4-related kidney disease, including relapse information, is sparse. To gather data on this we retrospectively examined the clinical course of 43 patients with IgG4-related kidney disease, in which most patients were treated with, and maintained on, corticosteroids. One month after the start of treatment, most of the abnormal serology and radiology parameters had improved. In 34 of the steroid-treated patients whose follow-up period was more than 12 months (median 34 months), excluding one hemodialysis patient, the estimated glomerular filtration rate (eGFR) before treatment was over 60 ml/min in 14 patients (group A) and under 60 ml/min in 20 patients (group B). In group A, there was no difference between the eGFR before therapy and at the last review. In group B, the mean eGFR before treatment (34.1 ml/min) was significantly improved after 1 month (45.0 ml/min), and renal function was maintained at a similar level through last follow-up. Among 24 evaluated patients at the last review, however, renal atrophy had developed in 2 of 9 in group A and in 9 of 15 in group B. Relapse of IgG4-related lesions occurred in 8 of 40 treated patients. Thus, the response of IgG4-related kidney disease to corticosteroids is rapid, not total, and the recovery of renal function persists for a relatively long time under low-dose maintenance. A large-scale prospective study to formulate more useful treatment strategies is necessary. © 2013 International Society of Nephrology. Source

Sugimoto A.,Niigata Prefectural Shibata Hospital
General thoracic and cardiovascular surgery

A 70-year-old woman without any previous history of heart disease was referred to our hospital for repeated chest discomfort. She had experienced temporary hemiparesis because of a cerebral infarction of unknown etiology. Clinical evaluations were all within normal limits except for echocardiography. There was a mobile tumor in her ascending aorta, about 15 mm in diameter, adhering to a part of the right coronary cusp on its aortic side. Urgent surgery was performed. The tumor was attached to the edge of the right coronary cusp and excised with a part of the right coronary cusp, which was then repaired. Histological examination revealed the tumor to be a papillary fibroelastoma. The chest discomfort responsible for admission disappeared after the operation. In patients with events that may be embolic in nature and are not explained by other cardiovascular or neurological diseases, a cardiac source of emboli should be considered. Source

Seki Y.,Niigata University | Wakaki K.,Niigata Prefectural Shibata Hospital
International Journal of Hematology

An 80-year-old man was diagnosed with disseminated intravascular coagulation (DIC) and thrombotic microangiopathy (TMA) associated with mucin-producing gastric cancer with bone marrow metastasis. He died suddenly on the third day of hospitalization before chemotherapy. Microscopic autopsy findings revealed fibrin thrombi by phosphotungstic acid hematoxylin (PTAH) staining of the renal glomeruli, and platelet thrombi by von Willebrand Factor (Factor VIII Antigen) staining of the microvessels of the bleeding intestine. Tumor cells were negative for both stains. Staining of endothelial cells (EC) of the small vessels with thrombomodulin (TM) stain revealed destruction of EC structure. This patient was thought to have had systemic dissemination of solid tumor cells associated with DIC and TMA, the clinical course of which is extremely aggressive. Different types of thrombi were observed in different organs, such as the kidneys and small intestine, which supported the co-occurrence of DIC and TMA by microscopic pathological findings. These findings provide pathological evidence for the pathology of the concurrent development of DIC and TMA and show differences in the types of thrombi according to the blood vessel localization. Furthermore, the findings were highly suggestive of the mechanisms causing organ dysfunction, such as renal dysfunction, and gastrointestinal bleeding. © 2016 The Japanese Society of Hematology Source

Sato T.,Niigata Prefectural Shibata Hospital
Clinical calcium

Previously, there was few data as for low back pain (LBP) in childhood and adolescent in Japan, we conducted a cross-sectional study a total of 43,630 pupils, including all elementary school students from the 4(th) to 6(th) grade and all junior high students from the 1(st) to 3(rd) year in Niigata City to examine the detail of LBP. The point prevalence was 10.2% (52.3% male and 47.7% female) and the lifetime prevalence was 28.8% (48.5% male and 51.5% female) and there was a tendency to have more severe LBP in both cases who experienced pain for more than 1 month and those with recurrent low back pain. In comparison to the pupils who did not participate in sports activities, the odds ratio with LBP was significantly higher in the pupils who participated in sports activities (1.57) . This suggests that sports activity may be one of the risk factors for the occurrence of LBP in childhood and adolescence. Source

Aiba T.,Niigata Prefectural Shibata Hospital
Neurological Surgery

We retrospectively investigated 459 computed tomography (CT) scans of head injuries in children who were 7 years of age or younger that we experienced at our institute from 2008 to 2014, and investigated whether or not the algorithm created by the Pediatric Emergency Care Applied Research Network and the guidelines by the National Institute for Health and Care Excellence, which are the standards for CT scans of head injuries in infants, are adequate. As a result, all 12 cases that required surgery or resulted in serious brain damage fell into the category for CT recommendation according to both standards. Although several cases that fell into the category for consideration of CT involved intracranial lesions, all such cases were mild. There were some cases with negligible CT findings that were excluded by both standards. We believe that adapting these standards is significant for reducing the degree to which children are exposed to irradiation. Source

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