The systemic immune response due to cholesterol crystal embolization syndrome: a case report.

Background: Cholesterol crystal embolization syndrome (CES) occurs when an atherosclerotic plaque causes small-vessel embolization, resulting in multi-organ damage. Although CES is pathologically characterized by an infiltration of eosinophils, the implication of the systemic inflammatory response represented by hypereosinophilia is unclear in clinical practice. Herein we present the case of a patient diagnosed with CES who developed multiple allergic organ injuries, including daptomycin-related dermatitis and later vancomycin-induced acute tubulointerstitial nephritis, which was successfully treated by the withdrawal of each medicine with or without corticosteroid therapy, one by one.

Oral Management by a Full-Time Resident Dentist in the Hospital Ward Reduces the Incidence of Pneumonia in Patients with Acute Stroke.

Background: A full-time dentist was assigned to a ward at our hospital to improve the quality of oral healthcare for hospitalized patients. A dental care system (DCS) was created to facilitate the collaboration between the full-time dentist and the nursing department.

Objective: To investigate the effects of DCS implementation on the incidence of pneumonia in patients with acute stroke.

Utility of four-dimensional computed tomography angiography for evaluating the mobility of a thrombus in the ascending aorta.

Four-dimensional computed tomography has been used to evaluate moving structures and is a useful method to diagnose cardiovascular diseases. We report a case of cerebral infarction due to the thrombus in the ascending aorta, and utilized 4-dimensional computed tomography angiography for visualizing the movement of the thrombus, which prompted early surgical intervention to prevent further thromboembolism. Although transesophageal echocardiography is an established method to evaluate the ascending aorta, it has some contraindications and complications.

Syndrome of inappropriate secretion of antidiuretic hormone associated with angiotensin-converting enzyme inhibitor therapy in the perioperative period.

Introduction:: Angiotensin-converting enzyme (ACE) inhibitors are one of the most commonly used medications for hypertension. Rarely, ACE inhibitors have the potential to cause a syndrome of inappropriate secretion of antidiuretic hormone (SIADH).

Case Presentation:: A 70-year-old woman with > 10 years ACE inhibitor therapy with normonatremia suddenly developed severe SIADH when she took a liquid diet in the uneventful perioperative period, with hemodynamic stability and no surgical complications.

Successful Treatment of IgA Vasculitis Complicated with Bowel Perforation and Crescentic Glomerulonephritis by Combination Therapy of Glucocorticoid, Cyclosporine and Factor XIII Replacement.

We report the findings of an 18-year-old boy with immunoglobulin A vasculitis (IgAV) complicated with bowel perforation and nephritis. He presented with abdominal pain, arthralgia and palpable purpura. Massive proteinuria developed during his clinical course.

Tonsillectomy reduces recurrence of IgA nephropathy in mesangial hypercellularity type categorized by the Oxford classification.

Background: In patients with IgA nephropathy (IgAN), recurrence after steroid pulse therapy is associated with reduced renal survival. However, the predictors of recurrence have not yet been clarified.

Methods: All patients who received 6-month steroid pulse therapy from 2004 to 2010 in our four affiliated hospitals and achieved a reduction of proteinuria to <0.

Successful Combination Therapy with Rituximab and Glucocorticoids for Autoimmune Optic Neuropathy.

Background: Autoimmune optic neuropathy is optic neuropathy caused by an autoimmune mechanism. As treatment, steroid is usually used. If steroid is ineffective to improve visual function, other immunosuppressive agents are used as needed.

[Case of consciousness disturbance following a fever with spreading lesion over the bilateral splenia of the corpus callosum on MRI].

We report a 66-year-old man with spreading lesion over the bilateral splenia of the corpus callosum shown on MRI. On admission, unknown fever and myoclonus-like involuntary movement in the left forefinger and middle finger were observed. There were no remarkably abnormal data in the serum, the cerebrospinal fluid and electroencephalogram.

[Plasmacytoma with multiple hypervascular lesions revealed by angiography in a patient with multiple myeloma].

A 68-year-old woman suffering from a left iliac tumor and severe back pain was admitted to another hospital in May 1999. The bone X-ray, CT scan and MRI demonstrated a 7 cm x 5 cm left iliac tumor with osteolysis and she was transferred to our hospital. Angiography demonstrated multiple hypervascular lesions in the left ilium, lumbar vertebrae, left ischium, left pubis and left rib.

[A case of cerebral putaminal hemorrhage complicating a brain abscess proved by craniotomy].

A 40-year-old man was admitted to our hospital because of consciousness disturbance, dysarthria and numbness in his right hand. Computed tomography of the head showed a cerebral hemorrhage of the left putamen. The patient was judged to have an indication of operation, and frontal craniotomy to evacuate hematoma was performed.

[A young patient of acute encephalitis complicated with acyclovir encephalopathy without renal dysfunction].

A previously healthy 30-year-old woman was admitted to our hospital because of impaired consciousness after convulsion. A temporary diagnosis of herpes simplex encephalitis was made, and intravenous acyclovir (ACV) therapy (250 mg four times daily in normal saline over 2 hours) was started. Three days later, she became confused, and was having hallucinations, dysarthria and generalized painful seizures occurred without focal neurologic deficit.

CD7+ and CD56+ myeloid/natural killer cell precursor acute leukemia treated with idarubicin and cytosine arabinoside.

We describe a 69-year-old Japanese male with acute leukemia with a CD7+ and CD56+ immunophenotype presenting with multiple lymphadenopathy. He was treated with idarubicin and cytosine arabinoside. Although the leukemia showed partial response, the patient did not achieve complete remission.

[A case of codon 232 mutation-induced Creutzfeldt-Jakob disease visualized by the MRI-FLAIR images with atypical clinical symptoms].

A 50-year-old man was admitted to our hospital because of disorientation and nocturnal restlessness. The patient presented chronically progressive dementia. No myoclonus or periodic synchronous discharge (PSD) was found over time, with abnormal evidence in MRI-FLAIR (fluid-attenuated inversion recovery) images alone.

Encephalopathy in scleromyxedema.

The authors monitored CSF findings for over 5 months in a patient with a fatal case of scleromyxedema and two episodes of encephalopathy. During both encephalopathy episodes, CSF protein and immunoglobulin G (IgG) levels were elevated without an increased IgG index or IgG synthesis rate. A CSF-dominant increase in the concentration of interleukin-6 (IL-6) also was noted during encephalopathy.

Imprint cytology of large B-cell lymphoma with high content of epithelioid cells. A report of two cases.

An association of epithelioid cell reaction in follicular center cell lymphomas seems to be a rare phenomenon. The cytological features of this type of B-cell lymphoma from two patients are presented. In both cases, immunohistochemistry applied to paraffin sections revealed reactivity of tumor cells for CD10, 20 and 79a.

Systemic lupus erythematosus (SLE) lymphadenopathy presenting with histopathologic features of Castleman' disease: a clinicopathologic study of five cases.

Lymph node enlargement is common in active systemic lupus erythematosus (SLE), a disease characterized by well defined clinical criteria. Although numerous reports have described the characteristic histology of SLE lymphadenopathy to include necrotizing lesions and hematoxylin bodies, no detailed description has examined the histopathologic features that are similar to Castleman's disease (CD) in SLE patients. In this report, we describe the clinicopathologic findings of CD-like peripheral lymphadenopathy, which was identified in five (26%) of 19 SLE patients.

Correlation of in vivo nitric oxide and cGMP with glutamate/glutamine metabolism in the rat striatum.

We have examined how the suppression of endogenous production of nitric oxide (NO) in the striatal tissue affects release of glutamate (GLU) and glutamine (GLN) in pentobarbital-anesthetized male Sprague-Dawley rats. For the quantitative measurement of tissue NO production and amino acid release, an in vivo assay system for extracellular nitrite (NO2-) and amino acids was employed using an in vivo microdialysis technique. An NO synthase inhibitor (NG-nitro-L-arginine methyl ester, L-NAME) in concentrations ranging between 4-40 mM was perfused into the rat striatum using the assay system.

[Changes in the level of thrombomodulin with aging].

Thrombomodulin (TM) is a thrombin receptor on endothelial cells. When endothelial cells are damaged TM is degraded and released into the blood. We examined whether levels of TM in plasma reflect endothelial damage related to aging.

[Multiple cerebral infarction after treatment with cisplatin].

A 46-year-old woman with a tumor the uterine cervix who experienced cerebrovascular accident as a complication of cisplatin-based chemotherapy is presented. Five days after the eleventh cycle of cisplatin 75 mg, intravenously, she had an acute onset of mild memory disturbance and right-sided weakness. On neurological examination, pyramidal sign was discovered on the right side.

Effect of thyrotropin-releasing hormone (TRH) on cerebral blood flow in spinocerebellar degeneration and cerebrovascular disease.

The effect of TRH on cerebral blood flow in patients with spinocerebellar degeneration and cerebrovascular disease was investigated. Cerebral blood flow was measured by the 133Xenon arterial injection method before, and 30 min after, the intravenous administration of 1000 micrograms of TRH. TRH had no effect on mean arterial blood pressure in either group.

[Lower level of endothelin-1 in migraine with aura].

Endothelin-1 (ET-1) exerts powerful vasoconstrictive and blood pressure elevating properties through endothelial cells. However, no systematic examination of ET-1 in migraine has ever been attempted. The present investigation was focused on evaluating the level of ET-1 in patients with migraine with aura.

[Changes in the level of endothelin-1 with aging].

Endothelin-1 (ET-1) is a potent and long-lasting vasoconstrictor peptide. In order to clarify the changes in the level of ET-1 with aging, we measured the ET-1 level in plasma by radioimmunoassay and used 74 healthy subjects including 61 males and 13 females, aged from 30 to 69, who were admitted in the health check center of Ashikaga Red Cross Hospital. None of them had risk factors related to hypertension, obesity, diabetes mellitus or cardiovascular disease.

Clinicopathological observations in middle cerebral artery occlusion in the cat.

This study was designed to investigate the relationships among neurological deficits, changes in the electroencephalogram (EEG) and morphological damage over a one week period following temporary occlusion (2 h) of the middle cerebral artery (MCA) in the cat. The animals were grouped into mild, moderate, and severe stroke based on the EEG alterations produced 30 min after the MCA occlusion. All three grades of stroke showed a precipitous fall in mean EEG amplitude followed by a recovery during a 4 h recirculation period.