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Tonami, Japan

Sasagawa Y.,Kanazawa Medical University | Akai T.,Kanazawa Medical University | Itou S.,Tonami General Hospital | Iizuka H.,Kanazawa Medical University
Neurosurgery | Year: 2011

Background and Importance: The authors report a rare case of multiple intraosseous inflammatory myofibroblastic tumors presenting with an aggressive clinical course. Clinical Presentation: A 60-year-old man presented with a 3-month history of headache and 2 weeks of jaw pain. Magnetic resonance imaging showed a homogeneously enhancing mass in the right parietal bone with subcutaneous and intracranial invasion. Bone scintigraphy revealed 4 intraosseous lesions involving the cranium, mandible, ischium, and calcaneum. After admission, the patient showed left hemiparesis and seizures caused by rapid intracranial tumor extension. The cranial and mandible tumors were resected. Histopathological examinations of both specimens revealed myofibroblastic spindle cell proliferation with inflammatory cell infiltration, and a diagnosis of inflammatory myofibroblastic tumor was made. Two days postoperatively, the patient presented with a high fever and disturbance of consciousness with swelling of the subcutaneous tissues of the head and mandibular lesions. Magnetic resonance imaging revealed a massive intracranial extension of the tumor. Corticosteroid therapy induced remarkable shrinkage of all lesions, and relief from symptoms was obtained. Radiotherapy was then performed for residual tumors. Conclusion: Multiple intraosseous inflammatory myofibroblastic tumors of the bone are very uncommon and may mimic malignant tumors. It is important to recognize that this entity can occur in the cranium and as multiple bony lesions. The recommended treatment is complete surgical resection with adjuvant steroid treatment. Considering the aggressive nature of this entity, additional chemo- and/or radiotherapy may be warranted. Copyright © 2011 by the Congress of Neurological Surgeons.

Shimizu M.,Kanazawa University | Yokoyama T.,Kanazawa University | Yamada K.,Tonami General Hospital | Kaneda H.,Toyama City Hospital | And 6 more authors.
Rheumatology | Year: 2010

Objectives: To compare the pro-inflammatory cytokine profiles and the cytokine kinetics in patients with secondary macrophage activation syndrome (MAS) due to systemic-onset juvenile idiopathic arthritis (s-JIA) and in both active and inactive disease states of s-JIA (but no MAS), with those demonstrated in EBV-induced haemophagocytic lymphohistiocytosis (HLH) and Kawasaki disease (KD), and to investigate the significance of IL-18 in the pathogenesis of s-JIA. Methods: Five patients with MAS complicating s-JIA (MAS/s-JIA), 10 with HLH due to EBV infection (EBV-HLH), 22 with KD and 28 healthy controls were analysed. Cytokine concentrations (IL-18, IL-6, neopterin and TNF-α receptor Types I and II) were quantified in serum by ELISA. Results: were compared with clinical features of MAS/s-JIA, including ferritin concentrations. Results. Serum IL-18 concentrations in MAS/s-JIA patients were significantly higher than those in EBV-HLH or KD patients (P<0.05). Serum IL-6 concentrations in KD patients were significantly higher than those in EBV-HLH or MAS/s-JIA patients. Serum neopterin concentrations in EBV-HLH patients were significantly higher than those in MAS/s-JIA or KD patients. Serum IL-18 correlated positively with the following measurements of disease activity: CRP, ferritin, lactate dehydrogenase and other cytokines (P<0.05). Serum concentrations of IL-18 in s-JIA patients remained elevated in the inactive phase of disease, whereas clinical parameters and other cytokines normalized. Conclusions: IL-18 may be an important mediator in s-JIA. Although serum Il-18 concentrations correlated with markers of the disease activity, IL-18 concentrations remained elevated even when other markers of disease activity normalized. Serum IL-18 concentration may be a promising indicator of the disease activity. The cytokine release pattern in MAS/HLH is different among patients with different aetiologies. Monitoring the cytokine profile, including IL-18, may be useful for differentiation of MAS/HLH and evaluation of disease activity in s-JIA. © The Author 2010. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved.

Yura S.,Tonami General Hospital
British Journal of Oral and Maxillofacial Surgery | Year: 2012

To clarify the features of acute closed lock of the temporomandibular joint we compared the clinical condition of patients with acute and chronic closed lock, and investigated the natural history of acute closed lock. Forty patients with unilateral acute closed lock who were given no treatment and 40 patients with unilateral chronic closed lock were enrolled in the study. The duration of locking in those with acute closed lock ranged from 1 to 7 days, and that of those with chronic closed lock from 3 to 4 months. Differences between the groups in sex, age, maximum mouth opening, and joint pain were analysed. In those with acute closed lock who had had no treatment, maximum mouth opening and joint pain were measured at the initial visit and after 2, 4, 8, and 12 weeks. The number of dysfunctional joints was counted during each period and the natural course of the acute closed lock investigated. There were more women and older patients among those with chronic, than among those with acute, closed lock. We found no significant differences in the symptoms in the two groups. After 2 weeks of allowing the acute closed lock to take its natural course only 15 of the 40 had not resolved successfully, and after 12 weeks of taking its natural course only 2 had been unsuccessful. The number of joints that did not resolve successfully decreased progressively over time. Any treatment for acute closed lock should be easier and more effective than that of following its natural course. © 2011 The British Association of Oral and Maxillofacial Surgeons.

Akahori H.,Tonami General Hospital | Sugimoto T.,Tonami General Hospital
Internal Medicine | Year: 2010

A 61-year-old man presented with central lymphocytic hypophysitis. Initial pituitary MRI imaging was normal, except for loss of the "bright spot" of the posterior lobe. A diagnosis of idiopathic diabetes insipidus was made. Two years later, pituitary gland enlargement with panhypopituitarism was detected. Eight months after commencing a replacement dose of corticosteroid, the pituitary enlargement was reduced in size. These findings resulted in a diagnosis of lymphocytic hypophysitis. In patients with idiopathic diabetes insipidus, it is important to suspect lymphocytic hypophysitis and to perform a long follow-up to repeat endocrinological examinations and pituitary imaging. © 2010 The Japanese Society of Internal Medicine.

Yura S.,Tonami General Hospital | Ooi K.,Tonami General Hospital | Kadowaki S.,Section of Oral Surgery | Totsuka Y.,Hokkaido University | Inoue N.,Hokkaido University
British Journal of Oral and Maxillofacial Surgery | Year: 2010

We aimed to record the prevalence of disc displacement and bony changes in the temporomandibular joints (TMJs) of patients with skeletal open bite. We studied 25 patients (50 joints) with skeletal open bite, 25 volunteers with no dentofacial abnormalities (50 joints), and 44 patients with closed lock and no dentofacial abnormalities (60 joints) using magnetic resonance imaging (MRI) of the TMJ. We found anterior disc displacement without reduction in 6 of the volunteers and in 24 of the patients with skeletal open bite (p = 0.01). Among the 24 affected joints, 16 showed signs of bony change (67%) as did 24 of those with closed lock (40%). The fact that we found a significant difference in the incidence of anterior disc displacement without reduction and bony change between patients with skeletal open bite and control groups without deformities of the jaw indicates that these changes may be caused by skeletal open bite. © 2009 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

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