Eosinophilic Granulomatosis with Polyangiitis Presenting with Myocarditis as an Initial Symptom: A Case Report and Review of the Literature

A 66-year-old woman with a history of bronchial asthma had shortness of breath and fatigue upon mild exercise. She was diagnosed as congestive heart failure. A blood test showed eosinophilia without the presence of anti-neutrophil cytoplasmic antibody (ANCA), and a myocardial biopsy specimen revealed eosinophilic infiltration in the myocardium. Eosinophilia was improved when she was administered short-term methylprednisolone. After that, she had numbness and pain in her lower limbs with re-elevation of eosinophils. She had dysesthesia and hypalgesia in the distal part of the limbs. Sural nerve biopsy revealed axonal degeneration and thickness of the arterial wall, indicating a diagnosis of eosinophilic granulomatosis with polyangiitis (EGPA). Two courses of steroid pulse therapy were performed, resulting in marked improvement of her sensory symptoms. ANCA-negative EGPA might be associated with myocarditis and peripheral neuropathy. A sufficient immunotherapy should have been considered to prevent rapid progression

ザイタク デ ニンチショウ オ ユウスル リョウヨウシャ オ カイゴ スル ダンセイ カイゴシャ ノ タイショ シャクド コウモク ノ ケントウ

在宅で認知症を介護する男性は年々増えている。最近の報告では、介護にかかわる事件の約2/3は、男性介護者である。介護を抱え困ったことがあっても悩みを人にうちあけない、相談しないなど、ソーシャルサポートに繋がることができない男性介護者の問題点が報告されている。しかし、現在、男性介護者の特徴や抱えている問題を客観的に測定するための対処尺度はない。今回の研究の目的は、男性介護者の対処尺度の項目を検討することである。まず、先行研究から男性介護者の対処における記述を抽出し既存の尺度と照合した。次に認知症療養者を在宅で介護している男性9名へ対処について調査を行った。さらに専門家と男性の対処について検討し、既存の対処尺度19項目に納まりきれない2項目を、新たに対処尺度の項目として追加した。The purpose of this paper was to report the development process of the scale for measuring for home care of male caregiver of dementia. First, male caregiver\u27s coping in precedence literatures reporting male caregivers of dementia applies with the pre-existing coping scale. Add questionnaire survey was given to 9 caregivers. And Experts in the field, consisting of university associate professors and specialists of dementia, established the content validity of the scale. Second, the category based on the main subject of the sentences. Each coping of sentences in a category was classified into 21 concepts, which form patients\u27 roles, and the sentences were then organized into 19 items for the primary questionnaire. Finally, the items were refined to represent the concepts, and carefully selected. Finally, the scale for measuring for home care of male caregiver of elderly of dementia, which consist of 21 items, was developed原著論文 = Original articl

Association between Brain White Matter Lesions and Disease Activity in HAM/TSP Patients

Human T-cell leukemia virus type 1-associated myelopathy/tropical spastic paraparesis (HAM/TSP) patients may have brain white matter (WM) lesions, but the association of these lesions with disease activity is poorly understood. We retrospectively evaluated the brain WM lesions of 22 HAM/TSP patients (male 4: female 18) including 5 rapid progressors, 16 slow progressors, and 1 very slow progressor. The severity of WM brain lesions on axial Fluid Attenuated Inversion Recovery images was evaluated utilizing the Fazekas scale, cerebrospinal fluid biomarkers, and proviral load in peripheral blood mononuclear cells. Imaging and biological data were compared at the first visit and a subsequent visit more than 4 years later. Patients with comorbidities including adult T-cell leukemia–lymphoma and cerebrovascular disease were excluded. The results revealed that brain WM lesions in the rapid progressors group were more pronounced than those in slow progressors. In patients with HAM/TSP, severe and persistent inflammation of the spinal cord may cause brain WM lesions

Circulatory 25(OH)D and 1,25(OH)2D as differential biomarkers between multiple system atrophy and Parkinson's disease patients

Background and purpose: There is sufficient evidence to support vitamin D's noncalcemic effects and the role of vitamin D deficiency in the development of a wide range of neurological disorders. This study aimed to evaluate whether serum 25(OH)D and 1,25(OH) 2 D could be used as biomarkers to differentiate between healthy subjects (HS), multiple system atrophy (MSA) and Parkinson's disease (PD) patients of both genders. Methods: A total of 107 subjects were included in this study, divided into three groups: 1- HS (n = 61), 2- MSA patients (n = 19), and 3- PD patients (n = 27). The patients were assessed using UMSARS II, UPDRS III, H;Y, MMSE and MoCA rating scales. The levels of 25(OH)D and 1,25(OH) 2 D in serum were determined using the radioimmunoassay technique. Results: The levels of 25(OH)D and 1,25(OH) 2 D in HS were 26.85 +/? 7.62 ng/mL and 53.63 +/? 13.66 pg/mL respectively. 25(OH)D levels were lower in both MSA and PD by 61% and 50%, respectively (P = 0.0001 vs. HS). 1,25(OH) 2 D levels were lower in MSA by 29%(P = 0.001 vs HS). There was a correlation between 25(OH)D and 1,25(OH) 2 D in MSA and PD, but not in HS. 1,25(OH) 2 D regressed with MMSE (? = 0.476, P = 0.04, R 2 = 0.226) in MSA, and with UPDRS III (? = ?0.432, P = 0.024, R 2 = 0.187) and MoCA (? = 0.582, P = 0.005,R 2 = 0.279) in PD. 25(OH)D displayed considerable differentiative strength between HS and MSA (Wald = 17.123, OR = 0.586, P = 0.0001; AUC = 0.982, sensitivity and Youden index = 0.882, P = 0.0001) and PD (Wald = 18.552, OR = 0.700, P = 0.0001; AUC = 0.943, sensitivity = 0.889, YI = 0.791, P = 0.0001). 1,25(OH) 2 D distinguished MSA from PD (Wald 16.178, OR = 1.117, P = 0.0001; AUC = 0.868, sensitivity = 0.926, Youden index =0.632, P = 0.0001). H;Y exhibited the highest sensitivity, AUC, and significant distinguishing power between MSA and PD. Conclusions: Serum 25(OH)D and 1,25(OH) 2 D could be useful biomarkers for MSA and PD. 25(OH)D and H;Y provided the highest sensitivity and group classification characteristics. © 2018Ministry of Health, Labour and Welfare, MHLWWe appreciate Assist. Prof. Hande Şenol's assistance with the statistical analysis. A grant-in-aid (No. 18 K 11009) from the Scientific Research and a grant-in-aid (No. 20FC 1049) from the Japanese Ministry of Health, Labor, and Welfare supported this research