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Epidermal CD8+CD103+ skin resident memory T cells in psoriasis plaques are reduced in number but remain in the basement membrane zone after topical application of corticosteroid and vitamin D3
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Computed tomography and magnetic resonance imaging findings of gynecologic emergencies: a pictorial essay
Get PDF雑誌掲載タイトル：Computed tomography and magnetic resonance imaging findings of gynaecologic emergencies: A pictorial essayGynecologic emergencies include diseases resulting from adnexal and uterine disorders. Some emergencies are life-threatening; however, they often have nonspecific symptoms and physical findings. Thus, imaging diagnosis is important for evaluating these conditions. The first-choice modality for obstetrics and gynecology is ultrasonography; however, some cases require computed tomography (CT) and magnetic resonance imaging (MRI) for correct diagnosis. Treatment options for gynecologic emergencies vary from conservative therapy to emergency surgery, thus a correct diagnosis is critical. The purpose of this article is to describe notable CT and MRI findings of gynecologic emergencies, which will help emergency department physicians arrive at the correct diagnosis and thus facilitate optimal treatment for patients.journal articl
Efficacy of Intravenous Propranolol for Life-threatening Diffuse Neonatal Hemangiomatosis
Get PDFOral propranolol is recommended as the first-line agent for infantile hemangioma requiring systemic treatment. Life-threatening complications such as obstructive infantile hemangioma of the airway or infantile hepatic hemangioma associated with high-output congestive heart failure are major indications for the consideration of early treatment. We present the case of an infant with life threatening diffuse neonatal hemangiomatosis including airway obstruction due to subglottic hemangioma, heart failure due to multiple hepatic hemangiomas with portohepatic venous shunts and severe anemia due to continuous gastrointestinal bleeding, in which treatment with intravenous propranolol proved successful.journal articl
A subpopulation of agouti-related peptide neurons exciting corticotropin-releasing hormone axon terminals in median eminence led to hypothalamic-pituitary-adrenal axis activation in response to food restriction
Get PDF浜松医科大学博士（医学）doctoral医学系研究科The excitatory action of gamma-aminobutyric-acid (GABA) in the median-eminence (ME) led to the steady-state release of corticotropin-releasing hormone (CRH) from CRH axon terminals, which modulates the hypothalamic-pituitary-adrenal (HPA) axis. However, in ME, the source of excitatory GABAergic input is unknown. We examined agouti-related peptide (AgRP) expressing neurons in the arcuate nucleus as a possible source for excitatory GABAergic input. Here, we show that a subpopulation of activated AgRP neurons directly project to the CRH axon terminals in ME elevates serum corticosterone levels in 60% food-restricted mice. This increase in serum corticosterone is not dependent on activation of CRH neuronal soma in the paraventricular nucleus. Furthermore, conditional deletion of NaC-KC-2Cl⁻ cotransporter-1 (NKCC1), which promotes depolarizing GABA action, from the CRH axon terminals results in significantly lower corticosterone levels in response to food restriction. These findings highlight the important role of a subset of AgRP neurons in HPA axis modulation via NKCC1-dependent GABAergic excitation in ME.doctoral thesi
A case of large ovarian serous cystadenoma with sigmoid colon volvulus
Get PDF巨大卵巣嚢腫のフォロー中にS状結腸捻転をきたした一例を経験したため報告する。
症例は86歳、19×18×12cm大の巨大卵巣嚢腫にて当科フォロー中、腹痛をきたし受診。当初は卵巣嚢腫の破裂が疑われ、腹腔鏡下付属器切除術を予定したが、CT精査にてS状結腸捻転と診断された。内視鏡的整復を行ったが、腸穿孔が見つかったため外科と合同で開腹により付属器切除、S状結腸切除、人工肛門増設術を行った。術中所見では黒く変色し拡張したS状結腸と、巨大な漿液性卵巣嚢腫を認めた。双方を切除し手術は終了した。
卵巣嚢腫は圧排や癒着により腸閉塞をきたす他、茎捻転時にS状結腸を巻き込むことでS状結腸捻転を引き起こした報告はあるが、本症例のように巨大卵巣嚢腫の存在のみで外的要因なくS状結腸捻転が発生した症例は珍しい。
巨大卵巣嚢腫を有する患者の腹痛に関しては、手術の前に破裂以外の鑑別診断につき、慎重な検討が必要となると思われた。We report a case of sigmoid colon volvulus diagnosed in an 86-year-old patient while followed up for a large ovarian serous cystadenoma that was 19×18×12 cm in size when she visited our department with severe stomachache. Initially, we suspected a rupture of cyst and laparoscopic salpingo-oophorectomy was scheduled. However, CT examination revealed a sigmoid colon volvulus. Subsequently, we performed laparotomic salpingo-oophorectomy, sigmoid colon resection, and colostomy in cooperation with our Department of Surgery. We found a blackened and dilated sigmoid colon and a large ovarian cyst, which were subsequently resected. Ovarian cysts can cause intestinal obstruction by compression and adhesion and can also lead to sigmoid colon volvulus by carrying the sigmoid colon with torsion of the ovarian cyst. Our findings are rare in that a large ovarian cyst caused the sigmoid colon volvulus and no external factors were involved. Therefore, when elderly patients with large ovarian cysts report abdominal pain, differential diagnosis other than rupture must be considered before moving on to surgery.journal articl
A case of atypical endometrial hyperplasia in early pregnancy and achieved a remission after delivery, but progressed to juvenile endometrial cancer 2 years later.
Get PDF子宮内膜異型増殖症合併妊娠は稀である。妊娠初期の子宮頸管ポリープの診断、切除により子宮内膜異型増殖症と診断され、分娩2年後に子宮体癌を発症した症例を経験したので報告する。症例は31歳、2妊1産。自然妊娠し、前医で妊娠12週に子宮頸管ポリープを切除した。病理検査で子宮内膜異型増殖症と診断され、妊娠16週に精査・妊娠管理目的で紹介された。妊娠を中断し、精査・加療することも検討したが、本人と家族の強い希望により妊娠継続の方針となった。妊娠経過に異常はなく、妊娠39週3日に2,506gの男児を正常経腟分娩した。産褥1か月時に2cm弱の子宮内腫瘤を認め、腫瘤摘出と内膜全面掻爬を行ったが、悪性所見はなく3か月毎の外来受診の方針とした。分娩2年後の頸部細胞診でAGCを指摘され、子宮内膜全面掻爬で類内膜癌の診断であった。MRI検査で筋層浸潤なく、CT検査で転移所見はなかった。挙児希望はなく、腹腔鏡下子宮全摘術と両側附属器切除術を施行した。病理診断は類内膜癌Grade1、pT1aで、子宮体癌ⅠA期と診断した。現在、経過観察中で再発を認めていない。子宮内膜異型増殖症合併妊娠は、分娩後に寛解しても慎重な経過観察が重要と考えられた。Pregnancies complicated by endometrial atypical hyperplasia are rare. We report a case of atypical endometrial hyperplasia diagnosed by excision of cervical polyps in early pregnancy, and endometrial cancer developed 2 years after delivery. A 31-year-old, gravida 2, para 1 woman conceived spontaneously and had a cervical polyp removed at 12 weeks of gestation. The patient was diagnosed as atypical endometrial hyperplasia by pathological examination and was referred to our hospital at 16 weeks of gestation for further examination and maternal management during pregnancy. We considered termination of the pregnancy for further examination and treatment but decided to continue the pregnancy as it was according to the strong request of the patient and her family. The patient had a normal vaginal delivery of a 2,506g baby at 39 weeks. At one month after delivery, an intrauterine mass of less than 2cm was found. There were no malignant findings in the specimens obtained at the dilatation and curettage. We continued with follow-up observation. Two years after delivery, cervical cytology revealed AGC. The patient was diagnosed with endometrial carcinoma by endometrial biopsy. She did not wish to have a baby and underwent total laparoscopic hysterectomy and bilateral salpingo-oophorectomy. The pathological diagnosis was endometrioid carcinoma grade 1, pT1a. The patient is currently under follow-up and no recurrence has been observed. In conclusion, careful follow-up is important in pregnancies complicated with atypical endometrial hyperplasia, even if the disease goes into remission after delivery.journal articl
Effect of perioperative mental status on health-related quality of life in patients with adult spinal deformities
Get PDF浜松医科大学博士（医学）doctoral医学系研究科thesi
How is degenerative lumbar scoliosis associated with spinopelvic and lower-extremity alignments in elderly volunteers?
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Expression of FLRT2 in Postnatal Central Nervous System Development and After Spinal Cord Injury
Get PDF浜松医科大学博士（医学）doctoral医学系研究科Fibronectin and leucine-rich transmembrane (FLRT) proteins are necessary for various developmental processes and in pathological conditions. FLRT2 acts as a homophilic cell adhesion molecule, a heterophilic repulsive ligand of Unc5/Netrin receptors, and a synaptogenic molecule; the last feature is mediated by binding to latrophilins. Although the function of FLRT2 in regulating cortical migration at the late gestation stage has been analyzed, little is known about the expression pattern of FLRT2 during postnatal central nervous system (CNS) development. In this study, we used Flrt2-LacZ knock-in (KI) mice to analyze FLRT2 expression during CNS development. At the early postnatal stage, FLRT2 expression was largely restricted to several regions of the striatum and deep layers of the cerebral cortex. In adulthood, FLRT2 expression was more prominent in the cerebral cortex, hippocampus, piriform cortex (PIR), nucleus of the lateral olfactory tract (NLOT), and ventral medial nucleus (VM) of the thalamus, but lower in the striatum. Notably, in the hippocampus, FLRT2 expression was confined to the CA1 region and partly localized on pre- and postsynapses whereas only few expression was observed in CA3 and dentate gyrus (DG). Finally, we observed temporally limited FLRT2 upregulation in reactive astrocytes around lesion sites 7 days after thoracic spinal cord injury. These dynamic changes in FLRT2 expression may enable multiple FLRT2 functions, including cell adhesion, repulsion, and synapse formation in different regions during CNS development and after spinal cord injury.doctoral thesi
Radial-artery vs saphenous-vein grafts for sequential coronary bypass grafting as a second conduit for the left coronary territory
Get PDF雑誌掲載タイトル：Radial artery vs saphenous vein grafts for sequential coronary bypass grafting as a second conduit for the left coronary territoryObjective
Although the radial artery graft has an adaptive property to flow demand, its flow characteristics in aorto-coronary sequential bypass grafting are not well elucidated. We evaluated the differences between the vein and radial artery grafts in the patency and the transit time flow meter-derived parameters (flow and pulsatile index), according to the stenosis rate of terminal target vessels and the number of anastomoses, in sequential bypass grafting to the left coronary territories as a second conduit.
Methods
We analyzed 222 patients who underwent isolated on pump beating coronary artery bypass grafting with an aorto-coronary bypass to the left coronary territory. The patients were divided into radial artery group (n=154) and vein graft group (n=68). Sequential bypass was performed 1n 171 patients (127 radial arteries, 44 veins).
Results
Flow of the radial artery grafts was lower than that of the vein grafts (40.9±22.3 vs 47.5±23.8mL/min, p=0.044), while it became higher as the number of anastomoses per graft increased (1: 28.9±16.3 vs 2: 40.9±19.9 vs 3: 55.8±27.5, p<0.001). The patency of radial artery grafts was better than that of vein grafts (98.0% vs 92.6%, p=0.010; p<0.001 after propensity score weighting).
Conclusions
Although intraoperative flow rate of the radial artery graft is lower, it has sufficient flow reserve for sequential bypass grafting, and its early patency is high enough. Radial artery is suitable for sequential bypass grafting to the left coronary territories as a second arterial conduit.journal articl