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Yamaguchi S.,Shi Koga Hospital | Ito O.,Shi Koga Hospital | Suzuki S.,Nippon Steel Yawata Memorial Hospital
Neurologia Medico-Chirurgica

An 81-year-old woman was transferred to our hospital after suffering loss of consciousness. Computed tomography revealed subarachnoid hemorrhage. Angiography revealed middle cerebral artery fenestration and a ruptured aneurysm arising from the inferior limb of the fenestrated artery. Coil embolization of the aneurysm and the proximal portion of the inferior limb was performed, and she showed good recovery after the procedure. Ruptured aneurysms associated with middle cerebral artery fenestration are very rare, but may occasionally have complex structures that complicate lesion treatment, so coil embolization should be considered in some cases. Source

Furusyo N.,Kyushu University | Ogawa E.,Kyushu University | Sudoh M.,Chugai Pharmaceutical Co. | Murata M.,Kyushu University | And 11 more authors.
Journal of Hepatology

Background & Aims: Early menopause in women with chronic hepatitis C virus (HCV) infection is associated with a low likelihood of a sustained virological response (SVR) in conjunction with their antiviral treatment. This is potentially related to their reduced estrogen secretion. The study was done to determine whether selective estrogen receptor modulator administration might improve the efficacy of the current standard of care (SOC) treatment, pegylated interferon (PegIFN) α2a plus ribavirin (RBV), for postmenopausal women. Methods: One hundred and twenty-three postmenopausal women with genotype 1b chronic hepatitis C were randomly assigned to one of two treatment groups: raloxifene hydrochloride (RLX) (60 mg/day) plus SOC (PegIFNα2a 180 μg/week and RBV 600-1000 mg/day) (n = 62) or SOC only (n = 61). Genotyping was performed of the polymorphism in the interleukin-28B (IL28B) gene region (rs8099917) of DNA collected from each patient. Results: One RLX-treated patient discontinued RLX because of a systemic rash following 2 weeks of treatment. Twenty-four weeks after treatment, the SVR rate was significantly higher for RLX plus SOC patients (61.3%) than for SOC only patients (34.4%) (p = 0.0051). Further, the SVR rate was significantly higher for RLX plus SOC patients with IL28B TT (72.5%) than for SOC only patients with IL28B TT (39.2%) (p = 0.0014), but no such relationship was observed in patients carrying the minor IL28B allele. Conclusions: RLX improved the efficacy of SOC in the treatment of postmenopausal women with chronic hepatitis C. RLX shows promise as an adjuvant to the standard antiviral treatment of such patients. © 2012 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved. Source

Tsutsumi M.,Hitachi General Hospital | Miyagawa T.,Hitachi General Hospital | Matsumura T.,Hitachi Medical Corporation | Endo T.,Tsukuba Medical Center Hospital | And 3 more authors.
American Journal of Roentgenology

OBJECTIVE. The use of elastography is limited for prostate cancer detection because of the difficulty in obtaining stable and reproducible images. To overcome these limitations, we developed a new technique called real-time balloon inflation elastography (RBIE); with RBIE, balloon inflation and deflation are used in place of manual compression. We present the accuracy and feasibility of the RBIE technique for detecting prostate cancer. MATERIALS AND METHODS. The results of a pathologic analysis of 55 prostatectomy specimens were compared with elastographic moving images obtained at the time of biopsy of the prostate. RESULTS. The RBIE technique generated stable and repeatable elastographic moving images. The percentage of images affected by artifact due to slippage in the compression plane was reduced to 1% using the RBIE method compared with 32% using the manual compression method. With regard to tumor location, elastographic moving images obtained using the RBIE technique were in complete agreement with clinicopathologic evaluation of tumor location in eight cases (15%), showed partial agreement in 43 cases (78%), and disagreed in four cases (7%). In three different regions of the prostate, 84% of anterior tumors, 85% of middle tumors, and 60% of posterior tumors were detected. The tumor detection rates by Gleason score were 60% in tumors with a Gleason score of 5 or 6, 73% in tumors with a Gleason score of 7, 72% in tumors with a Gleason score of 8, and 74% in tumors with a Gleason score of 9 or 10. CONCLUSION. The RBIE method improved the quality of elastographic moving images compared with the manual compression method. High-grade tumors and tumors of impalpable regions of the prostate were more frequently detected using RBIE. We conclude that RBIE is a promising method with which to detect prostate cancer. © American Roentgen Ray Society. Source

Tsubouchi K.,Nippon Steel Yawata Memorial Hospital
Nihon Kokyūki Gakkai zasshi = the journal of the Japanese Respiratory Society

A 46-year-old man, who had been treated for Kimura disease, was found to have abnormal findings on a chest radiograph. Chest CT showed a mass shadow in the right lower lobe. Histological findings of a transbronchial biopsy specimen showed inflammatory cells infiltrating the alveolar septum. Inflammatory cells consisted of plasma cells, lymphocytes and eosinophils. He had had sustained eosinophilia and elevation of IgE for 8 years, and his serum IgG and IgG4 (3480 mg/dl) levels were elevated. Contrast-enhanced computed tomography showed multiple low density areas in both kidneys. Since immunohistochemical staining of the lung specimens revealed infiltration of IgG4-positive plasma cells (IgG4-positive/IgG-positive plasma cells=35%), we diagnosed IgG4-positive multiorgan lymphoproliferative syndrome. The mass shadow had disappeared after treatment with celestamine (0.25 mg betamethasone and 2 mg dexchlorpheniramine) for Kimura disease, but another solid consolidation appeared in the contralateral lower lobe 5 months later. After the steroid dosage was increased, the consolidation improved. To the best of our knowledge, this case is the first report of IgG4-positive multi-organ lymphoproliferative syndrome associated with Kimura disease. Source

Yanagihara T.,Nippon Steel Yawata Memorial Hospital
Nihon Kokyūki Gakkai zasshi = the journal of the Japanese Respiratory Society

A 76-year-old woman with a 20-year history of chronic hepatitis C was referred to our hospital for worsening exertional dyspnea. She had been given a diagnosis of interstitial pneumonia based on chest computed tomography findings 5 years previously. Contrast-enhanced echocardiography confirmed an intrapulmonary right-to-left shunt, and therefore we diagnosed hepatopulmonary syndrome comorbid with interstitial pneumonia. In July 2009 she was admitted to our hospital with a low grade fever, headache, and vomiting. We diagnosed a left cerebellar brain abscess caused by Streptococcus intermedius. She underwent stereotactic burr-hole drainage and received vancomycin, piperacillin and cefotaxime. Cases of brain abscess secondary to hepatopulmonary syndrome are rare. Nevertheless, we should be aware of this complication of hepatopulmonary syndrome. Source

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