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Endoscopic Endonasal Surgery for Suprasellar Rathke's Cleft Cyst Mimicking a Dermoid Cyst
Get PDFThe differential diagnoses of cystic epithelial masses in the sellar and parasellar regions, when based on clinical findings, imaging, and even histopathological examination, can be challenging. Considerable evidence in the literature supports the existence of a common ectodermal origin of selected sellar and suprasellar cysts, which may account for the overlap of radiological features and pathological transitional states observed among these lesions. Here, we describe a case of suprasellar Rathke's cleft cyst (RCC) mimicking a dermoid cyst, which after successful removal by endoscopic endonasal surgery (EES) by an experienced team of neurosurgeons and otolaryngologists achieved a good clinical outcome. A 30-year-old male was referred with chief complaints of left-sided loss of vision and headache. Magnetic resonance imaging findings indicated possible diagnoses as RCC, craniopharyngioma, or dermoid cyst because the cyst partly contained fluid with a lipid signal. The cyst was resected en-bloc with EES, and the histopathological diagnosis was RCC. RCCs may contain lipid components within the cyst, presumed to be cholesterin crystals due to chronic inflammation. In preoperative imaging of suprasellar cystic lesions, the presence of lipid components in the cyst may not indicate dermoid cyst, and care should be taken to differentiate it from RCC or craniopharyngioma.journal articl
Carboplatin plus nab-paclitaxel for recurrent small cell lung cancer: A phase Ⅱ study
Get PDF獨協医科大学博士（医学）令和4年度doctoral thesi
Effects of the COVID-19 Pandemic on Patients with Alcoholic Liver Disease
Get PDFBackground: The coronavirus disease 2019 (COVID-19) pandemic has caused many people mental distress. Negative changes have been reported in physical activity, sleep, alcohol consumption, and smoking. Many patients with alcoholic liver disease (ALD) have a tendency for alcohol dependence, but there are no reports on how the COVID-19 pandemic has affected ALD patients.
Aims: The purpose of this study was to clarify the effects of the COVID-19 pandemic on ALD patients.
Methods: The study consisted of two parts. In the first part, changes in the alcohol consumption and blood biochemistry of ALD patients who continued to visit our hospital as outpatients before and during the COVID-19 pandemic were compared. In the second part, the clinical backgrounds at the time of the initial examination of ALD patients who were first examined in the year before the COVID-19 pandemic (before outbreak group) and ALD patients who were first examined in the six months after the start of the COVID-19 pandemic (after outbreak group) were compared. Patients in the after outbreak group were asked whether their motivation to drink was related to the COVID-19 pandemic.
Results: In part 1, of the 95 ALD patients surveyed, alcohol consumption increased after the start of the pandemic in 20 (21.1%) patients, and 13 (65%) of these 20 patients blamed the increase on the COVID-19 pandemic. Gamma-glutamyltransferase levels increased and prothrombin activity (PT%) decreased markedly after the start of the pandemic in the 20 patients in this increased alcohol consumption group. Although 32 patients reported that their alcohol consumption remained unchanged, liver function appeared to deteriorate after the start of the pandemic, which suggests that ALD patients’ self-reports of alcohol consumption were inaccurate. In part 2, the clinical backgrounds of 28 ALD patients first examined in our hospital in the year before the COVID-19 pandemic and 12 ALD patients first examined in the six months after the start of the pandemic were compared. Liver damage was more severe in the after outbreak group, and 8 of these 12 patients (66.7%) blamed their drinking on the COVID-19 pandemic. Although the difference was not significant, there tended to be more employed people among the ALD patients who were first examined after the start of the COVID-19 pandemic.
Conclusion: Liver function in ALD worsened due to the COVID-19 pandemic. In some ALD patients who were first examined for ALD after the start of the pandemic, the motive for drinking was associated with the COVID-19 pandemic.journal articl
Microcirculatory and metabolic responses during voluntary cycle ergometer exercise with a whole-body neuromuscular electrical stimulation device
Get PDF獨協医科大学博士（医学）令和3年度doctoral thesi
MRI-based kinematics of the menisci through full knee range of motion
Get PDF獨協医科大学博士（医学）令和3年度doctoral thesi
Overview of Idiopathic REM Sleep Behavior Disorder
Get PDFREM sleep behavior disorder (RBD) is a REM sleep-related parasomnia characterized by action of dream content, which is often an aggressive or terrible nightmare. Because of the self-defense movements and behaviors in dreams, sleep-talking (e.g., yelling and screaming) and violent movements of the arms and legs may injure the patient or bed partner. Idiopathic or isolated RBD that develops after middle age may progress to neurodegenerative diseases, such as Parkinson's disease, dementia with Lewy bodies, or multiple system atrophy, in half of the patients after 10 years. The development of a method that can accurately diagnose RBD by polysomnography may help to identify patients at high short-term risk of developing α-synucleinopathies. Such patients may be enrolled in trials of disease-modifying therapy. Several techniques for the early diagnosis of α-synucleinopathies are under development for clinical use and await application in clinical trials of candidate therapies.journal articl
Background Factors in the Interpretation of the Results of REM Sleep Behavior Disorder Screening Questionnaire-Japanese Version
Get PDFPolysomnography (PSG) is necessary for the diagnosis of REM sleep behavior disorder (RBD) according to the diagnostic criteria of the International Classification of Sleep Disorders, 2nd edition. We administered the REM sleep behavior disorder screening questionnaire-Japanese version (RBDSQ-J) to patients admitted to the hospital for PSG due to suspected sleep disorders and evaluated the background factors in patients with suspected RBD. We analyzed data from 261 out of 269 consecutive patients who were administered the RBDSQ-J and underwent PSG. Probable RBD was defined as a total RBDSQ-J score of ≥ 5. Sixty-six of the 261 patients (25.3%) had a total RBDSQ-J score of ≥ 5. Among the 66 patients, 10 (15.2%) had idiopathic or isolated RBD, 1 (1.5%) had secondary RBD with multiple system atrophy, and 55 (83.3%) did not have RBD. Among patients aged 50 years or older, all patients (n = 11) had RBD, whereas among those aged less than 50 years, none had RBD. The background factor in patients with false positive results was mainly obstructive sleep apnea syndrome (OSAS), whereas among young patients, the factors other than OSAS included narcolepsy, migraine, psychological disorders (such as PTSD, depression, or schizophrenia), and complications of central neurological disorders (such as sequelae of brainstem infarction or limbic encephalitis). RBDSQ-J is useful to screen for idiopathic/isolated RBD-associated synucleinopathies among middle-aged and elderly people aged ≥ 50 years, but among young patients and those with positive result of RBDSQ-J, various background factors may be present and the results should be interpreted with caution.journal articl