著者

Hiroaki SHIMIZU Takahiro ONO Takatsugu ABE Masaaki HOKARI Yusuke EGASHIRA Koji SHIMONAGA Masahiko KAWANISHI Kyoko NOMURA Yusuke TAKAHASHI

出版者

The Japan Neurosurgical Society

雑誌

Neurologia medico-chirurgica (ISSN:04708105)

巻号頁・発行日

pp.2022-0249, (Released:2023-01-05)

参考文献数

21

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Intracranial carotid artery dissection causing cerebral ischemia is a rare but important cause of cerebral infarction in children and adolescents. Although endovascular therapy has been reported to be effective, questions regarding the indications for intervention are yet to be addressed. Therefore, this study aimed to evaluate factors related to clinical outcomes through a nationwide survey. Overall, 35 neurosurgical centers reported patients within 2 weeks after ischemic onset due to intracranial carotid artery dissection causing cerebral ischemia treated between January 2015 and December 2020. Data on clinical and radiological findings were statistically analyzed. Twenty-eight patients met the inclusion criteria. The median age was 36 years (range, 7-59 years), without sex differences. Headache at onset was documented in 60.7% of the patients. Dissection findings were categorized into stenosis (71.4%) or occlusion (28.6%). Initial treatments, including various antithrombotic agent combinations in 23 (82.1%) patients, effectively improved or prevented aggravation in half of the patients. The patients with stenotic dissection were significantly more likely to experience aggravation during the initial treatment than did those with occlusive dissection (P = 0.03). In addition, the patients with moderate to severe neurological deficits on admission had poorer outcomes at discharge more frequently than did those with mild neurological deficits on admission. Eight patients undergoing endovascular therapy had no procedural complications or further aggravation after intervention. In conclusion, patients with intracranial carotid dissection causing cerebral ischemia who had a stenotic dissection were at risk of further aggravation, and endovascular therapy effectively improved or prevented aggravation.

著者

Aiko HATA Masaya ODA Takahiro ONO Akira SUZUKI Noriaki HANYU Masataka TAKAHASHI Toshio SASAJIMA Manabu HASHIMOTO Taizen NAKASE Hiroaki SHIMIZU

出版者

The Japan Neurosurgical Society

雑誌

Neurologia medico-chirurgica (ISSN:04708105)

巻号頁・発行日

vol.61, no.7, pp.404-413, 2021 (Released:2021-07-15)

参考文献数

21

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The efficacy of stereotactic radiotherapy (SRT) has been well established for postoperative residual and recurrent nonfunctioning pituitary adenomas (NFPAs). However, the risk of visual impairment due to SRT for lesions adjacent to the optic pathways remains a topic of debate. Herein, we evaluated the long-term clinical outcomes of hypofractionated stereotactic radiotherapy (HFSRT) for perioptic NFPAs. From December 2002 to November 2015, 32 patients (18 males and 14 females; median age 63 years; range, 36–83 years) with residual or recurrent NFPAs abutting or displacing the optic nerve and/or chiasm (ONC) were treated with HFSRT. The median marginal dose was 31.3 Gy (range, 17.2–39.6) in 8 fractions (range, 6–15). Magnetic resonance imaging (MRI) and visual and hormonal examinations were performed before and after HFSRT. The median follow-up period was 99.5 months (range, 9–191). According to MRI findings at the last follow-up, the tumor size had decreased in 28 (88%) of 32 patients, was unchanged in 3 (9%), and had increased in 1 (3%). The successful tumor size control rate was 97%. Visual functions remained unchanged in 19 (60%) out of 32 patients, improved in 11 (34%), and deteriorated in 2 (6%). Two patients had deteriorated visual functions; no complications occurred because of the HFSRT. One patient developed hypopituitarism that required hormone replacement therapy. The result of this long-term follow-up study suggests that HFSRT is safe and effective for the treatment of NFPAs occurring adjacent to the ONC.

著者

Hiroaki Shimizu Naoko Mori Shunji Mugikura Yui Maekawa Minoru Miyashita Tatsuo Nagasaka Satoko Sato Kei Takase

出版者

Japanese Society for Magnetic Resonance in Medicine

雑誌

Magnetic Resonance in Medical Sciences (ISSN:13473182)

巻号頁・発行日

pp.mp.2022-0091, (Released:2023-03-01)

参考文献数

43

被引用文献数

1

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Purpose: To evaluate the effectiveness of the texture analysis of axillary high-resolution 3D T2-weighted imaging (T2WI) in distinguishing positive and negative lymph node (LN) metastasis in patients with clinically node-negative breast cancer.Methods: Between December 2017 and May 2021, 242 consecutive patients underwent high-resolution 3D T2WI and were classified into the training (n = 160) and validation cohorts (n = 82). We performed manual 3D segmentation of all visible LNs in axillary level I to extract the texture features. As the additional parameters, the number of the LNs and the total volume of all LNs for each case were calculated. The least absolute shrinkage and selection operator algorithm and Random Forest were used to construct the models. We constructed the texture model using the features from the LN with the largest least axis length in the training cohort. Furthermore, we constructed the 3 models combining the selected texture features of the LN with the largest least axis length, the number of LNs, and the total volume of all LNs: texture-number model, texture-volume model, and texture-number-volume model. As a conventional method, we manually measured the largest cortical diameter. Moreover, we performed the receiver operating curve analysis in the validation cohort and compared area under the curves (AUCs) of the models.Results: The AUCs of the texture model, texture-number model, texture-volume model, texture-number-volume model, and conventional method in the validation cohort were 0.7677, 0.7403, 0.8129, 0.7448, and 0.6851, respectively. The AUC of the texture-volume model was higher than those of other models and conventional method. The sensitivity, specificity, positive predictive value, and negative predictive value of the texture-volume model were 90%, 69%, 49%, and 96%, respectively.Conclusion: The texture-volume model of high-resolution 3D T2WI effectively distinguished positive and negative LN metastasis for patients with clinically node-negative breast cancer.

著者

百目木 希実 門傳 剛 松村 美穂子 清水 裕晶 池田 志織 助川 敦子 柳 一徳 青木 千枝 川越 宣明 加瀬 浩之 笠井 貴久男 Nozomi Domeki Tsuyoshi Monden Mihoko Matsumura Hiroaki Shimizu Shiori Ikeda Atsuko Sukegawa Kazunori Yanagi Chie Aoki Yoshiaki Kawahoe Hiroyuki Kase Kikuo Kasai 獨協医科大学内科学(内分泌代謝) 獨協医科大学内科学(内分泌代謝) 獨協医科大学内科学(内分泌代謝) 獨協医科大学内科学(内分泌代謝) 獨協医科大学内科学(内分泌代謝) 獨協医科大学内科学(内分泌代謝) 獨協医科大学内科学(内分泌代謝) 獨協医科大学内科学(内分泌代謝) 獨協医科大学内科学(内分泌代謝) 獨協医科大学内科学(内分泌代謝) 獨協医科大学内科学(内分泌代謝) Department of Endocrinology and Metabolism Dokkyo Medical University School of Medicine Department of Endocrinology and Metabolism Dokkyo Medical University School of Medicine Department of Endocrinology and Metabolism Dokkyo Medical University School of Medicine Department of Endocrinology and Metabolism Dokkyo Medical University School of Medicine Department of Endocrinology and Metabolism Dokkyo Medical University School of Medicine Department of Endocrinology and Metabolism Dokkyo Medical University School of Medicine Department of Endocrinology and Metabolism Dokkyo Medical University School of Medicine Department of Endocrinology and Metabolism Dokkyo Medical University School of Medicine Department of Endocrinology and Metabolism Dokkyo Medical University School of Medicine Department of Endocrinology and Metabolism Dokkyo Medical University School of Medicine Department of Endocrinology and Metabolism Dokkyo Medical University School of Medicine

雑誌

Dokkyo journal of medical sciences (ISSN:03855023)

巻号頁・発行日

vol.37, no.3, pp.181-186, 2010-10-25

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日本甲状腺学会から甲状腺クリーゼの診断基準が2008 年に発表された.2004 年4 月から2009 年3月に当院で臨床的に甲状腺クリーゼと診断,治療した20 症例を,その診断基準にあてはめ,治療と予後等について解析した.基礎疾患は全例バセドウ病だった.誘因として服用不規則や中断が9 例,感染症6 例,糖尿病性ケトアシドーシス3 例,情動ストレス2 例,脳血管障害1 例,外傷1 例だった.診断基準で確定診断例が15例,疑い例が1 例,除外症例が4 例だった.症状では中枢神経症状が疑い・確定診断例では11 例,脈拍130/分以上は12 例認められたが,除外例では認められなかった.治療としてはチアマゾールが全症例に使用されていた.ヨードは13 例,b ブロッカーは17 例,ステロイドは12 例の症例で使用されており全例救命できた.服用不規則や中断,感染症が誘引となりやすく,症状では中枢神経症状・脈拍が特にクリーゼの診断には重要と考えられた.後遺症を残す重症例は6 例で全て新診断基準によって確定診断された症例であり,新診断基準は予後への有用性も期待できると考えられた.