部分てんかんの発作間欠期棘波局在診断における双極子追跡法の臨床的有用性に関する研究

京都大学0048新制・課程博士博士(医学)甲第7576号医博第2063号新制||医||703(附属図書館)UT51-99-D193京都大学大学院医学研究科脳統御医科学系専攻(主査)教授 三好 功峰, 教授 橋本 信夫, 教授 柴崎 浩学位規則第4条第1項該当Doctor of Medical ScienceKyoto UniversityDA

Serial assessment of multimodality imaging in anti-leucine-rich glioma-inactivated 1 antibody encephalitis: A case report

In autoimmune encephalitis, abnormalities of diffusion-weighted imaging (DWI), fluid-attenuated inversion recovery (FLAIR), arterial spin labeling (ASL) in magnetic resonance imaging (MRI), single-photon emission computed tomography (SPECT) and 18F-fluorodeoxyglucose-positron emission tomography (18F-FDG-PET) have been reported. However, there are few studies of long-term follow-up of imaging. We report a case of anti-leucine-rich glioma-inactivated 1 antibody encephalitis whose MRI (DWI, FLAIR and ASL), 99mTcHM-PAO SPECT (PAO-SPECT) and 18F-FDG-PET were evaluated through the clinical course. ASL, PAO-SPECT and 18F-FDG-PET consistently showed abnormalities in almost the same area. Serial assessment of these imaging modalities is useful in evaluating disease activity and efficacy of treatment

First evidence of tick-borne encephalitis (TBE) outside of Hokkaido Island in Japan

ABSTRACTTick-borne encephalitis (TBE) is an infection of the central nervous system caused by the tick-borne encephalitis virus (TBEV). TBE is endemic in parts of Europe and Asia. TBEV is transmitted to humans primarily by Ixodes ticks. There have been 5 TBE cases identified in Japan, all on the northern island of Hokkaido. Rodents with TBEV antibodies and Ixodes ticks have been identified throughout Japan, indicating that TBEV infection might be undiagnosed in Japan. Residual serum and cerebrospinal fluid (CSF) collected in 2010–2021 from 520 patients ≥1 year-of-age previously hospitalized with encephalitis or meningitis of unknown etiology at 15 hospitals (including 13 hospitals outside of Hokkaido) were screened by ELISA for TBEV IgG and IgM antibodies; TBEV infection was confirmed by the gold standard neutralization test. Residual serum was available from 331 (63.6%) patients and CSF from 430 (82.6%) patients; both serum and CSF were available from 189 (36.3%). Two patients were TBE cases: a female aged 61 years hospitalized for 104 days in Oita (2000 km south of Hokkaido) and a male aged 24 years hospitalized for 11 days in Tokyo (1200 km south of Hokkaido). Retrospective testing also identified a previous TBEV infection in a female aged 45 years hospitalized for 12 days in Okayama (1700 km south of Hokkaido). TBEV infection should be considered as a potential cause of encephalitis or meningitis in Japan. TBE cases are likely undiagnosed in Japan, including outside of Hokkaido, due to limited clinical awareness and lack of availability of TBE diagnostic tests

Long-term outcome of Ludloff’s medial approach for open reduction of developmental dislocation of the hip in relation to the age at operation

We reviewed long-term outcomes after open reduction by the medial approach for developmental dislocation of the hip (DDH). Forty-five hips in 43 patients with more than ten years of follow-up were assessed clinically and radiologically. The mean age at surgery was 14.0 (range 6–31) months, and the follow-up period ranged from ten to 28 years (mean 16.4 years). We compared the good (18 hips) and poor groups (27 hips) as classified by the Severin classification. The mean age at surgery was significantly older in the poor group than the good group (17.1 and 9.4 months, respectively, P < 0.001). Thirteen (29%) of 45 hips had avascular necrosis (AVN) of the femoral head. The mean age at surgery was significantly older in the patients with AVN than without AVN (20.0 and 11.6 months, respectively, P < 0.001). Another approach, such as the wide exposure method, should be selected for DDH with increased age at operation

Joint congruency in abduction before surgery as an indication for rotational acetabular osteotomy in early hip osteoarthritis

We conducted a retrospective review of the results of rotational acetabular osteotomy (RAO) procedures in 92 hips of 89 patients (81 females and eight males) with early-stage osteoarthritis. In this study, we discuss the indications for this surgery based on the preoperative congruency in abduction. The mean postoperative follow-up was 12.2 (7–19) years. The mean age at operation was 32.5 (13–54) years. Two hips with apparent technical failure were excluded. During follow-up, the osteoarthritic stage remained unchanged in 76 hips (good group) and progressed in 14 hips (poor group). Preoperative joint congruency in abduction was excellent in 20 hips, good in 62, and fair in eight. All eight hips with fair joint congruency showed progression to osteoarthritis at follow-up. Patients without good congruency in abduction may experience progression of osteoarthritis after RAO procedures even in early-stage osteoarthritis