- 著者
- Reiko Muto Koji Inagaki Naokazu Sato Tetsuro Sameshima Yuka Nagakura Satoshi Baba Noritoshi Kato Shoichi Maruyama Toshiyuki Akahori
- 出版者
- The Japanese Society of Internal Medicine
- 雑誌
- Internal Medicine (ISSN:09182918)
- 巻号頁・発行日
- pp.4731-20, (Released:2020-08-12)
- 参考文献数
- 32
- 被引用文献数
- 2
The relationship between anti-neutrophil cytoplasmic antibody (ANCA) titer levels and relapse risk in patients with ANCA-associated vasculitis (AAV) following clinical remission remains controversial. We herein report a case showing ectopic relapse of AAV in the pituitary with no ANCA elevation after renal remission. Magnetic resonance imaging revealed an enlarged pituitary gland. A pituitary biopsy showed geographic necrosis with multinucleated giant cells. We diagnosed this case as relapse of AAV in the pituitary. One month after rituximab therapy, the pituitary gland volume had decreased. The intensification of therapy due to the possibility of vasculitis relapse may facilitate better control of AAV.
- 著者
- Kenji SUGIYAMA Takao NOZAKI Tetsuya ASAKAWA Tetsuro SAMESHIMA Schinichiro KOIZUMI Hisaya HIRAMATSU Hiroki NAMBA
- 出版者
- The Japan Neurosurgical Society
- 雑誌
- Neurologia medico-chirurgica (ISSN:04708105)
- 巻号頁・発行日
- pp.st.2018-0115, (Released:2018-08-09)
- 参考文献数
- 19
Deep brain stimulation (DBS) is used to treat symptoms by modulating the cortico-striato-thalamo-cortical (CSTC) loop in the central nervous system (CNS), and attempts to research loop circuit disorders have been globally initiated among the intractable neurological and psychiatric disorders. DBS treatment has been evaluated for all these newly found CNS loop circuit disorders. In 2011, neurosurgical treatments for psychiatric disorders were renamed from “psychosurgery” to “neurosurgery for psychiatric disorders (NPD)” by the World Society for Stereotactic and Functional Neurosurgery (WSSFN). Moreover, in 2014, “Consensus on guidelines for stereotactic neurosurgery for psychiatric disorders” was published by the WSSFN to address the differences in correspondence of stereotactic NPD. Globally, two multicenter prospective randomized control trials regarding DBS of the subcallosal cingulated gyrus and ventral anterior internal capsule/ventral striatum for intractable depression have been terminated after futility analysis. However, DBS for intractable obsessive-compulsive disorder (OCD), unlike for intractable depression, is showing steady development. In Japan, NPDs have not been performed since 1975 following the adoption of “Resolution of total denial for psychosurgery” by the Japanese Society of Psychiatry and Neurology. Nevertheless, a trend to adopt new neuro-modulation techniques for psychiatric disorders, including DBS, are emerging. We have created a clinical research protocol for the use of DBS in intractable OCD, which has been approved by the ethical committee of Hamamatsu University School of Medicine, with the hope of commencing DBS treatment for intractable OCD patients in the near future.