Sakai, Japan
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PubMed | Hirakata Municipal Hospital, Seikeikai Hospital, Appalachian State University, Japan National Institute of Advanced Industrial Science and Technology and 3 more.
Type: Case Reports | Journal: Brain & development | Year: 2016

The mechanism of post-vaccination acute disseminated encephalomyelitis (ADEM) has been hypothesized as resulting from vaccination-injected antigens cross-reacting with myelin components, however, a precise etiology has been uncertain. In this report, we describe the case of a 6-year-old Japanese boy who had multiphasic disseminated encephalomyelitis (MDEM), and was positive for both anti-myelin oligodendrocyte glycoprotein (MOG) antibodies and Chlamydophila pneumoniae antibodies. After vaccinations that were the second one for measles and rubella, and the booster immunization for Japanese encephalitis, the patient presented with fever, headache, vomiting, and a change in personality. He was treated with a high-dose of intravenous methylprednisolone in the diagnosis of ADEM. However, these symptoms recurred with different magnetic resonance imaging lesion, and he was diagnosed as MDEM. Retrospective testing for pathogens revealed C. pneumoniae IgM and IgG antibodies, and it was considered that he was infected with C. pneumoniae subclinically. The patients serum indicated a positive response for the anti-MOG antibody from the onset of the ADEM diagnosis and in all recurrent episodes. Chlamydia species infection has been known to play a role in demyelinating diseases. It is also known that the anti-MOG antibody may be present but not exhibit its pathogenesis in the absence of a cell-mediated inflammatory response; however, the precise mechanism of action of the anti-MOG antibodies is not yet determined. We propose the possibility that post-vaccination demyelinating disease may result from the synergistic effects of a preceding anti-MOG antibody, possibly produced in response to a subclinical Chlamydia species infection.


Nakajima H.,Seikeikai Hospital | Nakajima H.,Osaka Medical College | Fujiki Y.,Seikeikai Hospital | Ito T.,Seikeikai Hospital | And 2 more authors.
Case Reports in Neurology | Year: 2011

The distribution of neuromyelitis optica (NMO)-characteristic brain lesions corresponds to sites of high aquaporin-4 (AQP4) expression, and the brainstem and hypothalamus lesions that express high levels of AQP4 protein are relatively characteristic of NMO. The syndrome of inappropriate antidiuretic hormone secretion (SIADH) is one of the important causes of hyponatremia and results from an abnormal production or sustained secretion of antidiuretic hormone (ADH). SIADH has been associated with many clinical states or syndromes, and the hypothalamic-neurohypophyseal system regulates the feedback control system for ADH secretion. We report the case of a 63-year-old man with NMO, whose initial manifestation was hyponatremia caused by SIADH. Retrospective analysis revealed that the serum anti-AQP4 antibody was positive, and an MRI scan showed a unilateral lesion in the hypothalamus. SIADH recovered completely with regression of the hypothalamic lesion. As such, NMO should even be considered in patients who develop SIADH and have no optic nerve or spinal cord lesions but have MRI-documented hypothalamic lesions. © 2011 S. Karger AG, Basel.


Nakajima H.,Osaka Medical College | Nakajima H.,Seikeikai Hospital | Hosokawa T.,Osaka Medical College | Sugino M.,Osaka Medical College | And 4 more authors.
BMC Neurology | Year: 2010

Background: Neuromyelitis optica (NMO) is an inflammatory demyelinating disease that predominantly affects the optic nerves and the spinal cord, and is possibly mediated by an immune mechanism distinct from that of multiple sclerosis (MS). Central scotoma is recognized as a characteristic visual field defect pattern of optic neuritis (ON), however, the differing pathogenic mechanisms of NMO and MS may result in different patterns of visual field defects for ON.Methods: Medical records of 15 patients with NMO and 20 patients with MS having ON were retrospectively analyzed. A thorough systemic and neurological examination was performed for evaluating ON. The total number of relapses of ON and visual fields was investigated. Visual fields were obtained by Goldmann perimeter with each ON relapse.Results: All MS patients experienced central scotoma, with 90% of them showing central scotoma with every ON relapse. However, 53% of NMO patients showed central scotoma with every ON relapse (p = 0.022), and the remaining 47% of patients experienced non-central scotoma (altitudinal, quadrant, three quadrant, hemianopia, and bitemporal hemianopia). Thirteen percent of NMO patients did not experience central scotoma during their disease course. Altitudinal hemianopia was the most frequent non-central scotoma pattern in NMO.Conclusions: NMO patients showed higher incidence of non-central scotoma than MS, and altitudinal hemianopia may be characteristic of ON occurring in NMO. As altitudinal hemianopia is highly characteristic of ischemic optic neuropathy, we suggest that an ischemic mechanism mediated by anti-aquaporin-4 antibody may play a role in ON in NMO patients. © 2010 Nakajima et al; licensee BioMed Central Ltd.


Hosokawa T.,Osaka Medical College | Nakajima H.,Osaka Medical College | Nakajima H.,Seikeikai Hospital | Doi Y.,Osaka Medical College | And 4 more authors.
Journal of Neuroimmunology | Year: 2011

Matrix metalloproteinase-9 (MMP-9) plays an important role in some neuroinflammatory diseases through the blood-brain barrier (BBB) disruption. To investigate the pathogenicity of MMP-9 in neuromyelitis optica (NMO), serum and CSF MMP-9 concentrations were measured in 13 NMO and 15 multiple sclerosis (MS) patients and 14 healthy controls, and correlated with clinical and laboratorial parameters. Serum MMP-9 concentrations were significantly higher in NMO than MS and controls, and correlated with EDSS score, CSF/serum albumin ratio, and CSF IL-8 concentrations. Our results indicate that MMP-9, promoted by elevated IL-8 activation, plays a crucial role in the pathogenesis of NMO through the BBB disruption. © 2011 Elsevier B.V.


Fukui M.,Osaka Medical College | Shimakawa S.,Osaka Medical College | Tanabe T.,Tanabe Kadobayashi Childrens Clinic | Nomura S.,Osaka Medical College | And 3 more authors.
Brain and Development | Year: 2014

Background: Partial seizures often develop during the clinical course of infantile spasms. Herein, we report a boy with cryptogenic West syndrome, who developed partial seizures that we suspected were induced by the ACTH therapy. Subject: The patient developed cryptogenic West syndrome at six months of age and ACTH therapy was started. On the tenth day of treatment, he developed frequent partial seizures, characterized by being motionless during the seizure with eye deviation to the right. The partial seizures stopped after the ACTH was discontinued, although oral carbamazepine was commenced at the same time. Thus, a definitive role for carbamazepine in the treatment of the partial seizures was unclear as the timing of the seizure cessation also corresponded to the discontinuation of the ACTH therapy. We suspected that the partial seizures were induced by the ACTH therapy for the following reasons: (1) seizures appeared only during ACTH therapy, (2) no new epileptic focus was revealed by EEG, MRI, or 99mTcECD SPECT, and (3) the seizures were different from the epileptic spasms. Conclusion: Our results suggest that ACTH might induce partial seizures in West syndrome. Further studies are required to confirm this phenomenon. © 2013 The Japanese Society of Child Neurology.


PubMed | Seikeikai Hospital, Yodogawa Christian Hospital, Osaka City University, Sato Hospital and 5 more.
Type: | Journal: Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA | Year: 2016

This study revealed the time course of osteoporotic vertebral fracture by magnetic resonance imaging using a simple classification. Signal changes were associated with the compression degree and mobility of the fractured vertebral body. This classification showed sufficient reliability in categorizing magnetic resonance imaging findings of osteoporotic vertebral fractures.Magnetic resonance imaging (MRI) is useful in diagnosing osteoporotic vertebral fractures (OVFs). This study investigated the time course of OVFs by MRI using a simple classification.This multicenter cohort study was performed from 2012 to 2015. Consecutive patients with 2-week-old OVFs were enrolled in 11 institutions. MRI was performed at enrollment and at 1-, 3-, 6-, and 12-month follow-up. Signal changes on T1-weighted imaging (T1WI), T2WI, and short inversion recovery (STIR) were classified according to signal intensity. Height and angular motion of vertebral bodies were also measured.The 6-month follow-up was completed by 153 patients. At enrollment, fractured vertebrae signal changes were 43% diffuse and 57% confined low on T1WI; on T2WI, 56, 24, and 5% were confined low, high, and diffuse low, respectively; on STIR, 100% were high. On T1WI, diffuse low remained most common (90% at 1month and 60% at 3months) until 6 and 12months, when most were confined low (54 and 52%, respectively). On T2WI, confined low remained most common (decreasing to 41% at 12months). On STIR, high signal change was shown in 98, 87, and 64% at 3, 6, and 12months, respectively. At 3, 6, and 12months, diffuse low signal change was associated with significantly lower vertebral height, and high signal change was associated with significantly greater angular motion.MRI signal changes were associated with the compression degree and angular motion of fractured vertebrae. This classification showed sufficient reliability in categorizing MRI findings of OVFs.


PubMed | Japan National Institute of Advanced Industrial Science and Technology, Seikeikai Hospital and Osaka Medical College
Type: Journal Article | Journal: Pediatrics international : official journal of the Japan Pediatric Society | Year: 2016

The effects of valproic acid (VPA) on oxidative stress are controversial due to differences in experimental conditions. Recently, total hydroxyoctadecadienoic acid (tHODE), derived from linoleic acid, was proposed as a potent biomarker to evaluate oxidative stress.The subjects consisted of 10 new-onset epilepsy patients treated with VPA. We measured plasma tHODE consecutively for 1 year to evaluate the degree of oxidative stress and then compared plasma tHODE at the beginning and the end of experiments with the peak level. Ten age-matched healthy subjects were recruited as a control group and their plasma tHODE was compared to the initial plasma tHODE of the epilepsy group. Measurements were done using liquid chromatography-tandem mass spectrometry.Mean initial plasma tHODE in the epilepsy group was 165.2 76.8nmol/L, which was not significantly different from that of the control group (199.3 62.5nmol/L). In five epilepsy patients, plasma tHODE increased above the pathological level in 6months, but returned to normal within 1year. In the whole group, the difference plasma tHODE between peak, at the beginning and 1 year later, was significant.Oxidative stress generated by VPA increased temporarily, but decreased to normal after 1year. it is reasonable to be concerned about the effects of oxidative stress, especially at the start of VPA treatment.


Suzuki K.,Hoshigaoka Koseinenkin Hospital | Tsuji S.,Hoshigaoka Koseinenkin Hospital | Fukushima Y.,Seikeikai Hospital | Nakase T.,Hoshigaoka Koseinenkin Hospital | And 3 more authors.
Modern Rheumatology | Year: 2013

Objectives: We aimed to evaluate the clinical efficacy of monotherapy with alendronate and combined therapy with alendronate and menatetrenone (vitamin K2 [VitK2]) in postmenopausal rheumatoid arthritis (RA) patients with osteoporosis or osteopenia. Methods: Sixty-two postmenopausal RA patients with untreated osteoporosis or osteopenia (lumbar spine bone density ≤80 % of young adult mean [YAM]) were enrolled: 39 had abnormal serum undercarboxylated osteocalcin (ucOC) levels (>4.5 ng/mL) and received combined therapy with alendronate (35 mg/week) and VitK2 (45 mg/day) (ALN + K group); 23 had normal ucOC levels (≤4.5 ng/mL) and received alendronate monotherapy (35 mg/week) (ALN group). The clinical results for the 57 patients in both groups were evaluated after 1-year treatment. Results: The mean baseline/follow-up (FU) lumbar spine bone density (%YAM) values were 73.0/76.8 % (P < 0.01) in the ALN + K group and 77.0/80.3 % (P < 0.01) in the ALN group; a significant increase was shown in both groups. Mean proximal femoral bone density values at baseline/FU were 71.4/73.8 (P < 0.01) in the ALN + K group and 71.4/71.6 % (not significant; NS) in the ALN group; a significant increase was shown in the ALN + K group only. Serum ucOC levels were normalized in the ALN + K group at FU. At FU, bone metabolism markers [bone-specific alkaline phosphatase (BAP) and N-terminal cross-linked telopeptides of type I collagen] were decreased in both groups. One patient in the ALN + K group and three in the ALN group suffered new fractures. Conclusions: Combined therapy with alendronate and VitK2 decreases bone metabolism marker levels and serum ucOC levels, and increases lumbar spine and femoral neck bone density in postmenopausal RA patients with abnormal ucOC levels and osteoporosis or osteopenia. © 2012 Japan College of Rheumatology.


Fujikawa T.,Seikeikai Hospital | Imbe H.,Seikeikai Hospital | Date M.,Seikeikai Hospital | Go Y.,Seikeikai Hospital | Kitaoka H.,Seikeikai Hospital
Diabetes Research and Clinical Practice | Year: 2012

Insulin allergy is a rare complication of insulin therapy. Proper management, though difficult, is critical. Here, we report the case of a patient with type 2 diabetes and insulin allergy, successfully treated with continuous subcutaneous insulin infusion (CSII). © 2012 Elsevier Ireland Ltd.


PubMed | Seikeikai Hospital
Type: Journal Article | Journal: Gan to kagaku ryoho. Cancer & chemotherapy | Year: 2017

A72 -year-old woman who complained of abdominal pain and distention visited the emergency clinic of our hospital in April 2014. Computed tomography(CT)showed an omental mass and a pelvic mass with massive ascites. The fluid was removed by abdominal aspiration, and the patient showed perforative peritonitis next day. An emergency operation was performed. The surgical operation showed that the rectum was perforated due to stenosis covered by the ovarian cancer metastases. Aleft colectomy combined with a transverse colostomy was performed. After 4 weeks of rest, 6 courses of tri- weekly TC chemotherapy were administered, and the CA125 level decreased from 140 U/mL to 11.8 U/mL. She underwent a complete cytoreductive surgery in February 2015. She was histologically diagnosed with Grade 2b serous adenocarcinoma. After these 2 surgical operations, she underwent a splenectomy to remove a single metastasis in February 2016 and consecutive chemotherapy. For ovarian cancer, if dissemination occurs, rectal perforation can be a treatment target with a gastrointestinal surgeons help.

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