Tonami, Japan
Tonami, Japan

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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 | 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.


Matano S.,Tonami General Hospital | Satoh S.,Tonami General Hospital | Harada Y.,Tonami General Hospital | Nagata H.,Tonami General Hospital | Sugimoto T.,Tonami General Hospital
Journal of Infection and Chemotherapy | Year: 2010

Multiple myeloma is a hematolymphoid malignancy, and patients with this disorder are frequently complicated by infection. An 80-year-old woman with multiple myeloma was complicated by bacterial meningitis, and was admitted to our hospital in August 2007. She initially received ceftriaxone, but culture of cerebrospinal fluid detected Listeria monocytogenes. Ampicillin was administered, but headache and pyrexia persisted for 2 weeks, and on cerebrospinal fluid examination, the proliferation of polymorphonuclear leukocytes had not resolved. After medication with meropenem was started, the clinical symptoms completely disappeared, and the abnormalities on cerebrospinal fluid examination resolved. The patient ultimately received meropenem for 27 days, resulting in a cure. In conclusion, meropenem is useful to treat bacterial meningitis caused by L. monocytogenes. This agent is indicated when ampicillin shows inadequate effect or if the patient has an allergy to ampicillin. © 2010 Japanese Society of Chemotherapy and The Japanese Association for Infectious Diseases.


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 | Izumiyama Y.,Tonami General Hospital
Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology and Endodontology | Year: 2011

Objective To clarify wound-healing situations with artificial dermis used for the repair of oral mucosal defects, we investigated the incidence of postoperative scar contracture and studied factors related to cicatrization. Study design Forty patients who underwent repair of oral mucosal defects using artificial dermis participated in this study. The degree of scar contracture was recorded 1 month after surgery. To study the factors related to cicatrization, patient characteristics of sex, age, excision region, fixation used, size of the graft, and number of days for silicon seat removal were examined. Logistic regression analysis was used for analysis of the relationship between cicatrization and patient characteristics. Results One month after surgery, 70% of patients had no contracture, 22.5% of patients had moderate contracture, and 7.5% of patients had severe contracture. A significant correlation was found between cicatrization and the minimum diameter of the artificial dermis (P <.001). Conclusions Reducing the minimum diameter of the artificial dermis may contribute to a decrease in scar contracture. © 2011 Mosby, Inc. All rights reserved.


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.


Yura S.,Tonami General Hospital | Nobata K.,Tonami General Hospital | Shima T.,Tonami General Hospital
British Journal of Oral and Maxillofacial Surgery | Year: 2010

Our aim was to investigate the incidence of a hyperintense signal in the joint space of the temporomandibular joint (TMJ) on fat-saturated T2-weighted magnetic resonance images (MRIs). We studied 112 patients (224 joints) with disorders of the TMJ who were examined by T2-weighted MRI, and recorded the association between displacement of the disc and the hyperintense signal using the κ coefficient. A hyperintense signal was found in 4 of 91 joints (4%) when the disc was in the normal position, in all 19 joints with anterior disc displacement with reduction, and in 108 of the 114 joints (95%) with anterior disc displacement without reduction. There was a significant correlation between displacement of the disc and the hyperintense signal (p < 0.001). The κ coefficient was 0.91. Such a signal in the joint space of the TMJ on fat-saturated T2-weighted MRI may indicate the presence of synovial fluid in the joint space with displacement of the disc. © 2009 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.


Yura S.,Tonami General Hospital | Nobata K.,Tonami General Hospital | Shima T.,Tonami General Hospital
Dentomaxillofacial Radiology | Year: 2012

Objective: The purpose of this study is to compare intra-articular adhesions of the temporomandibular joint (TMJ) between fat-saturated T 2 weighted MR images and arthroscopic findings. Methods: 50 patients (50 joints) with closed locking of the TMJ who were examined with MRI and then underwent arthroscopic surgery participated in this study. The concordance rate of intra-articular adhesions between fat-saturated T 2 weighted MR images and arthroscopic findings was studied using the kappa coefficient. Results: Intra-articular adhesions were seen on MRI in 21 joints (42%) and in arthroscopic findings in 26 joints (52%). Thus, five joints had false-negative results and mild adhesions were arthroscopically observed in these five joints. There was significant concordance between these two findings (p < 0.001). The kappa coefficient was 0.801, which was considered to be complete concordance. Conclusions: On fat-saturated MRI, a low signal intensity area and narrowing image in the joint space of the TMJ may indicate the presence of intra-articular adhesions or fibrosis. © 2012 The British Institute of Radiology.


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

The accuracy of diagnosing a perforation of the articular disc of the temporomandibular joint (TMJ) is poor with conventional magnetic resonance imaging (MRI). We recently reported that a high signal-intensity area is usually found on fat-saturated T2-weighted MRI in the joint space between the articular disc and cartilage surface in joints in which the disc is displaced. A discrete image with an area of high signal-intensity in the middle of the articular disc may indicate perforation or rupture. The purpose of this study was to compare the accuracy of diagnosis of a perforated articular disc by fat-saturated T2-weighted MRI with that of arthroscopy. We studied 50 joints in 50 patients with closed lock of the TMJ who were examined with MRI and then by arthroscopy using an ultra-thin arthroscope. The agreement between the two methods of diagnosis was assessed using the κ coefficient. Evidence of perforation of the disc on MRI and arthroscopically was found in the same 7 joints; there was complete concordance (κ = 1.00, p < 0.001). The accuracy of diagnosis of perforation of a disc by fat-saturated MRI was therefore the same as that by arthroscopy using an ultra-thin arthroscope. © 2011 The British Association of Oral and Maxillofacial Surgeons.


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.

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