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A case of endometrial cancer associated with dermatomyositis
Get PDF皮膚筋炎はしばしば悪性腫瘍を合併するが子宮悪性腫瘍との合併は稀である。皮膚筋炎を契機に子宮体癌を診断し、子宮体癌手術後皮膚筋炎に対しステロイド治療を施行した悪性腫瘍合併筋炎の一例を経験した。症例は56歳2妊2産。皮膚症状と筋症状より皮膚筋炎が疑われ当院紹介受診した。不正性器出血を認め当科受診となった。病理検査、画像検査より子宮体癌、類内膜癌G3、臨床進行期IA期と診断した。皮膚症状と筋症状は増悪傾向にて可及的な病巣除去と術後ステロイド長期投与を鑑み、低侵襲、縮小術式として全腹腔鏡下単純子宮全摘術、両側付属器摘出術を施行した。術後診断は子宮体癌、類内膜癌G3、IA期であり、抗NXP-2抗体陽性より皮膚筋炎と診断した。術後筋症状の改善が乏しくステロイド治療を開始し、子宮体癌再発中リスク群に対し全骨盤放射線治療を施行した。現在、子宮体癌は再発なく経過、皮膚筋炎は改善傾向にてステロイド減量中である。Dermatomyositis is often associated with malignancy but rarely with uterine cancer. We report a case of dermatomyositis diagnosed as endometrial cancer with the administration of steroid therapy for dermatomyositis after endometrial cancer surgery. A 56-year-old woman, who had two pregnancies and two children, with a history of irregular genital bleeding was referred to our hospital for suspected dermatomyositis based on skin and muscle symptoms. Based on pathological examination and imaging studies, she was diagnosed with endometrial cancer G3, clinical stage IA. Worsening skin and muscle symptoms necessitated removal of the lesion and long-term postoperative steroid therapy, and we performed minimally invasive laparoscopic hysterectomy and bilateral adnexalectomy. She was postoperatively diagnosed with endometrial cancer G3, stage IA and dermatomyositis based on detection of the positive anti-nuclear matrix protein 2 antibody. Steroid therapy was initiated for persistent muscle symptoms postoperatively, and total pelvic radiotherapy was performed for the intermediate risk of recurrent uterine cancer. Currently, the uterine cancer has not recurred, dermatomyositis is improving, and the steroid dose is being reduced.journal articl
Frequency and clinical relevance of anti-cyclic citrullinated peptide antibody in idiopathic interstitial pneumonias
Get PDF浜松医科大学博士（医学）doctoral医学系研究科thesi
Prospective nursing care certification using the 25-question Geriatric Locomotive Function Scale
Get PDF浜松医科大学博士（医学）doctoral医学系研究科thesi
Comprehensive genetic analysis confers high diagnostic yield in 16 Japanese patients with corpus callosum anomalies
Get PDF浜松医科大学博士（医学）doctoral医学系研究科thesi
Extrastriatal dopamine D2/3 receptor binding, functional connectivity, and autism socio-communicational deficits: a PET and fMRI study
Get PDF浜松医科大学博士（医学）doctoral医学系研究科thesi
Inhibitory Effects of Amniotic Fluid on the Activated Protein C Anticoagulation System in Maternal Plasma
Get PDFPulmonary thromboembolism (PTE) is one of the leading causes of maternal mortality. We previously reported that possible contamination of amniotic fluid (AF) into maternal circulation accelerated thrombin production and activated platelet function in maternal blood through the extrinsic pathway, which may be associated with the high incidence of PTE in early puerperium. However, it remains unclear whether the maternal anticoagulation system, e.g., the activated protein C (APC) pathway, contributes to the hypercoagulable condition induced by AF. Our previous study using an endogenous thrombin potential (ETP)-based assay revealed that sensitivity to APC was reduced during the postpartum first day, i.e., immediately after delivery, when parturients were supposed to be exposed to AF. Our aim is to investigate the susceptibility of maternal plasma to APC when mixed with AF. We collected plasma from 51 pregnant females and mixed with AF as well as APC. APC-sensitivity ratio (APC-sr) was calculated using the ETP-based assay. Addition of AF to maternal plasma showed a significant increase of ETP in the presence of APC. APC-sr was significantly increased, indicating decreased sensitivity to APC, after AF mixture to maternal plasma. The present APC-sr difference with AF contamination was smaller than that we reported previously in venous thromboembolism cases. The inhibitory effects of AF on the APC anticoagulation pathway may contribute, at least partly, to further promotion of thrombin production induced by AF. Combined with other classical thrombophilic risk factors, the present findings support possible involvements of AF exposure in the high incidence of PTE in early puerperium.journal articl
Extrastriatal dopamine D2/3 receptor binding, functional connectivity, and autism socio-communicational deficits: a PET and fMRI study
Get PDFThe social motivation hypothesis of autism proposes that social communication symptoms in autism spectrum disorder (ASD) stem from atypical social attention and reward networks, where dopamine acts as a crucial mediator. However, despite evidence indicating that individuals with ASD show atypical activation in extrastriatal regions while processing reward and social stimuli, no previous studies have measured extrastriatal dopamine D2/3 receptor (D2/3R) availability in ASD. Here, we investigated extrastriatal D2/3R availability in individuals with ASD and its association with ASD social communication symptoms using positron emission tomography (PET). Moreover, we employed a whole-brain multivariate pattern analysis of resting-state functional magnetic resonance imaging (fMRI) to identify regions where functional connectivity atypically correlates with D2/3R availability depending on ASD diagnosis. Twenty-two psychotropic-free males with ASD and 24 age- and intelligence quotient-matched typically developing males underwent [11C]FLB457 PET, fMRI, and clinical symptom assessment. Participants with ASD showed lower D2/3R availability throughout the D2/3R-rich extrastriatal regions of the dopaminergic pathways. Among these, the posterior region of the thalamus, which primarily comprises the pulvinar, displayed the largest effect size for the lower D2/3R availability, which correlated with a higher score on the Social Affect domain of the Autism Diagnostic Observation Schedule-2 in participants with ASD. Moreover, lower D2/3R availability was correlated with lower functional connectivity of the thalamus-superior temporal sulcus and cerebellum-medial occipital cortex, specifically in individuals with ASD. The current findings provide novel molecular evidence for the social motivation theory of autism and offer a novel therapeutic target.journal articl
