Malignant transformation of diffuse infiltrating glial neoplasm after prolonged stable period initially discovered with hypothalamic hamartoma

We present a case of malignant transformation of diffuse infiltrating glial neoplasm after a prolonged stable period on magnetic resonance imaging (MRI) and spectroscopy (MRS) initially discovered with a hypothalamic hamartoma. Although MRI and MRS suggest the possibility of malignant transformation in future, they cannot precisely predict the timing of rapid growth

家兎開頭術後の硬膜変化に関するMR画像: 硬膜増強効果と病理組織像との対比

取得学位 : 博士（医学）, 学位授与番号 : 医博甲第1073号, 学位授与年月日：平成5年3月25日,学位授与年：199

Extracorporeal membrane oxygenation in Stenotrophomonas maltophilia pneumonia during acute myeloid leukemia: A case report

Stenotrophomonas maltophilia (S. maltophilia) is a Gram-negative, multidrug-resistant organism that both opportunistically infects the bloodstream and leads to pneumonia in immunosuppressed patients, including those with hematologic malignancies. In patients with severe respiratory failure, venovenous extracorporeal membrane oxygenation (VV ECMO) can stabilize the respiratory status. However, whether ECMO in patients with hematologic malignancies improves the clinical outcomes is still controversial because ECMO increases the risk of the exacerbation of sepsis and bleeding. We report a case of a 46-year-old man with Stenotrophomonas maltophilia hemorrhagic pneumonia acquired during consolidation chemotherapy for acute myeloid leukemia in whom VV ECMO lead to a good clinical outcome. The stabilization of his respiratory status achieved with VV ECMO allowed time for trimethoprim-sulfamethoxazole antibiotic therapy to improve the pneumonia. We suggest the background of patients, including comorbidities and general conditions, should be taken into account when considering the clinical indications of ECMO

〈Originals〉Usefulness of romiplostim for elderly patients with idiopathic thrombocytopenic purpura

[Abstract] Five elderly patients with idiopathic thrombocytopenic purpura (ITP) considered to require thrombopoietin receptor agonist (TRA) administration were treated with romiplostim at our department. The patients\u27 conditions were as follows, respectively : 1) Splenectomy was difficultto perform and the response to steroid treatment was poor, 2) the disease was intractable, for which combination with steroid was effective and the steroid dose could be reduced later, 3) the performance status (PS) was markedly reduced due to concomitant diseases, 4) the disease was intractable, and another TRA caused an adverse reaction, and 5) PS was markedly reduced by active infection. These are characteristics frequently observed in elderly ITP patients, and only first- and/or second-line treatments were considered difficult to obtain the effect for these patients. Romiplostim waseffective in all patients, and the safety was marked. It was suggested that TRA treatment is useful for elderly ITP patients difficult to treat following the current guidelines

Prediction of carotid artery in-stentrestenosis by quantitative assessment ofvulnerable plaque using computed tomography

Background and purpose To assess the relationship between plaque volume evaluated by multidetector computed tomographic angiography (MDCT) and in-stent restenosis (ISR) after carotid artery stenting (CAS). Materials and methods From a retrospectively maintained database, data were collected for 52 patients with carotid artery stenosis treated with CAS between 2007 and 2012. We defined ISR of ≥ 50% as a peak systolic velocity ≥ 200 cm/s on echo-duplex scan. Carotid plaques were subdivided into four components according to radiodensity in Hounsfield units (HU) as follows: 600 HU. Risk factors that influenced ISR were compared using univariate and multivariate Cox regression analyses. Results During a median follow-up period of 36 months, ISR of ≥ 50% was detected in five patients (9.6%). In the univariate Cox proportional hazard regression analysis, renal insufficiency, coronary artery disease, total plaque volume, and plaque volumes with radiodensities < 0 and ≥ 600 HU increased the risk for ISR (P < 0.10). When the significant risk factors determined from the univariate analysis were subjected to a multivariate analysis, only the volumes of the plaque components with radiodensities < 0 HU independently predicted the development of ISR (hazard ratio: 1.041; 95% confidence interval: 1.006–1.078; P = 0.021). Conclusion Our data suggest that the high volume of the plaque components with radiodensities < 0 HU was independently associated with the increased risk of ISR after CAS. Quantitative and qualitative tissue characterizations of carotid plaques using MDCT might be a useful predictive tool of the development of ISR.Embargo Period 12 month

Long-term predictive factors of the morphology based outcome in bare platinum coiled intracranial aneurysms: Evaluation by pre- and post-contrast 3D time-of-flight MR angiography

Purpose Our aim was to identify long-term predictive factors of the morphology-based outcome (MBO) of bare platinum coiled intracranial aneurysms. Materials and Methods A retrospective analysis of 96 bare platinum coiled intracranial aneurysms followed up from 1997 to 2016 using pre- and post-contrast 3D time-of-flight MR angiography (MRA) was performed. Logistic regression analysis was used to identify factors associated with a positive history of surrounding coil mass enhancement (SCME) and poor MBO. Spearman's rank correlation test was used to analyze the relationship between the initial angiographic result (IAR) class, sequential change of the SCME category, and MBO grade. Results Factors independently associated with poor MBO were incomplete IAR (OR=14.94, 95%CI: 2.46, 289.21, P=0.002) and a history of SCME (OR=4.13, 95% CI: 1.05, 18.65, P=0.043). The MBO grade strongly correlated with the IAR class (correlation coefficient [r]=0.84, P&lt;0.0001). MBO grade correlated with sequential change of the SCME category (r=0.56, P&lt;0.0001). The sequential change of the SCME category correlated with IAR class (r=0.53, P&lt;0.0001). Conclusion Although IAR and its class were strong long-term predictive factors of MBO, a history of SCME and upgrading of sequential change of SCME category were also long-term predictive factors of the MBO of bare platinum coiled intracranial aneurysms

Contribution of sellar dura integrity to symptom manifestation in pituitary adenomas with intratumoral hemorrhage

Purpose: Although hemorrhage within pituitary adenomas frequently exacerbates the symptoms, there are many grades of severity. Moreover, the contributing factors for symptom severity are still controversial. Methods: This retrospective study included 82 patients who underwent transsphenoidal surgery for pituitary adenomas with intratumoral hemorrhage. The grades of preoperative symptoms were classified into group A, asymptomatic or minor symptoms; group B, moderate symptoms sufficient for complain; and group C, severe symptoms disturbing daily life. Results: The hemorrhage volume within an adenoma was significantly higher in group C (92.6%) than in groups A (48.6%) and B (58.7%). Both headache and diplopia were dominant in group C, occurring in 72.2% and 27.8% of the patients, respectively. In group C, there was no significant difference in frequency between adenoma extensions into the sphenoid sinus (0%) and involvement of the cavernous sinus of Knosp grade 4 (0%), and extensions into the suprasellar region were not common (38.9%). The most distinctive feature was that “no extrasellar extension” was found only in group C (41.2%), and “multidirectional extension” was not detected in this group (0%). Multiple regression analysis revealed that the most powerful determining factors were the high frequencies of intratumoral hemorrhage and lack of extrasellar and multidirectional extensions. Conclusion: Rapid volume expansion of a hematoma and lack of extension or unidirectional extension might lead to significant compression of the sellar and surrounding structures. Of note, the integrity of the sellar dura might contribute to the acute onset of symptom manifestations caused by hemorrhage in pituitary adenomas. © 2017 Springer Science+Business Media, LLCEmbargo Period 12 month

Optimizing the Volume of the Initial Framing Coil to Facilitate Tight Packing of Intracranial Aneurysms

Background: During endovascular treatment of an aneurysm, the importance of the initial coil volume for facilitating tight packing is unclear. We retrospectively studied the relationships between initial packing density (PD; initial coil volume divided by aneurysm volume), final PD (volume of all coils divided by aneurysm volume). Methods: We reviewed 105 aneurysms in 98 patients who underwent endovascular coiling between April 2011 and March 2014. The initial coil was defined as the first coil in the single-catheter method and the first 2 coils in the double-catheter method. The patient data were divided into groups with or without a final PD ≥20%, and the significant predictors of a final PD ≥20% were determined using multivariable logistic regression. The optimal cutoff value for the initial PD was determined using a receiver operating characteristic curve. Results: Of 105 aneurysms, 56 and 49 were treated with single- and double-catheter methods, respectively. Statistically significant differences in rupture status, neck size, dome/neck ratio, and initial PD were observed between aneurysms with and without a final PD ≥20% (all P < 0.05). Multivariate analysis showed that initial PD (P = 0.025; odds ratio, 1.22) and rupture status (P = 0.002; odds ratio, 0.19) were significantly associated with a final PD ≥20%. Using receiver operating characteristic curve analysis, the cutoff points of initial PD to achieve a final PD ≥20% were 8.0% and 10.0% in single- and double-catheter groups, respectively. Conclusions: Initial PD appears to be a critical factor for achieving tight packing. © 2016 Elsevier Inc. All rights reserved.Embargo Period 12 month