Nagoya journal of medical science (Nagoya J Med Sci)

Publications in this journal

• Article: Atherothrombotic lesion of the middle cerebral artery: report of 21 cases with stenotic and obstructive lesions.

  Hirofumi Oyama, Akira Kito, Hideki Maki, Kenichi Hattori, Tomoyuki Noda, Kentaro Wada
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  ABSTRACT: This was a retrospective analysis of 12 consecutive cases of middle cerebral artery stenosis and 9 consecutive cases of middle cerebral artery occlusion that presented to our hospital with acute cerebral ischemia. The degree and area of the cerebral infarctions were assessed with the Alberta Stroke Program Early CT Score (ASPECTS) and ASPECTS-DWI (APSECTS with assessment of white matter lesion using diffusion-weighted image). As for cerebral infarctions in the region of the perforating artery, lesions that were more than 20 mm long in the caudal-cranial direction were diagnosed as branch atheromatous disease (BAD). Activities of daily living (ADL) were poorer in the cases with lower ASPECTS and ASPECTS-DWI. ADL tended to be worse in cases with BAD than in those without. The prognosis was significantly poorer in the group with ASPECTS< or =7 points. ASPECTS tended to be lower in cases with BAD than in those without. ADL, ASPECTS and the presence of BAD were not significantly different between the stenosis and obstruction groups. In summary, the neurological prognosis was dependent on the extent of the cerebral infarction and was related to BAD to some extent. These findings will be important when considering medical treatment at the outpatient clinic setting.
  Nagoya journal of medical science 02/2013; 75(1-2):41-6.
• Article: Surface markers and gene expression to characterize the differentiation of monolayer expanded human articular chondrocytes.

  Takashi Hamada, Tadahiro Sakai, Hideki Hiraiwa, Motoshige Nakashima, Yohei Ono, Hirohito Mitsuyama, Naoki Ishiguro
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  ABSTRACT: Autologous chondrocyte implantation (ACI) is a method of cartilage repair. To improve the quality of regenerated tissue by ACI, it is essential to identify surface marker expression correlated with the differentiation status of monolayer expanded human articular chondrocytes and to define the index for discriminating dedifferentiated cells from monolayer expanded human articular chondrocytes. Normal human articular chondrocytes were cultured in monolayer until passage 4. At each passage, mRNA expression of collagen type I, II, and X and aggrecan was analyzed by real-time quantitative PCR, and the surface marker expression of CD14, CD26, CD44, CD49a, CD49c, CD54, and CD151 was analyzed by fluorescence-activated cell sorting (FACS). The ratios of mRNA levels of collagen type II to I (Col II/Col I) represented the differentiation status of chondrocytes more appropriately during monolayer culture. The surface marker expression of CD44, CD49c, and CD151 was upregulated according to the dedifferentiation status, whereas that of CD14, CD49a, and CD54 was downregulated. The most appropriate combination of the ratio of Col II/Col I was CD54 and CD44. Cell sorting was performed using a magnetic cell sorting system (MACS) according to CD54 and CD44, and real-time quantitative PCR was performed for the cell subpopulations before and after cell sorting. The expression of collagen type II and aggrecan of the chondrocytes after MACS was higher than that before sorting, but not significantly. The mean fluorescence intensity (MFI) ratio of CD54 to CD44 could be an adequate candidate as the index of the differentiation status.
  Nagoya journal of medical science 02/2013; 75(1-2):101-11.
• Article: New hypothesis on the origin of metastases.

  Nicola Schischmanov
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  ABSTRACT: A new hypothesis for the origin of metastases is presented. It assumes that a cancer-transformed gene in a primary tumour is incorporated in its identical form via a virus-vector function into biologically potent recipient cells in other organs, such as stem cells, multipotent cells or cells in an early phase of division. The origin of metastases may thus possibly occur via a genetic pathway.
  Nagoya journal of medical science 02/2013; 75(1-2):153-9.
• Article: A surface-based hemangioma of the radius which posed radiological diagnostic difficulties.

  Takaaki Shinohara, Masahiro Tatebe, Michiro Yamamoto, Shigeru Kurimoto, Hitoshi Hirata
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  ABSTRACT: Surface-based bone hemangiomas are uncommon, mostly occurring in long bones of the lower extremities. Radiographic surface-based bone hemangioma images may present various features that provide a diagnostic challenge. We report a case of surface-based hemangioma of the radius that posed radiological diagnostic difficulties. The tumor size was small and the cortical reaction was subtle. MRI findings were nonspecific and angiography was useful in the assessment of painful but less obvious surface-based bone hemangioma. The patient's pain improved following surgery and no tumor recurrence was observed at 3 years after surgery.
  Nagoya journal of medical science 02/2013; 75(1-2):125-9.
• Article: Impact of back muscle strength and aging on locomotive syndrome in community living Japanese women.

  Kenichi Hirano, Shiro Imagama, Yukiharu Hasegawa, Norimitsu Wakao, Akio Muramoto, Naoki Ishiguro
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  ABSTRACT: The Japanese Orthopaedic Association has proposed the term locomotive syndrome (LS) to designate a condition of individuals in high-risk groups with musculoskeletal disease who are highly likely to require nursing care. This study investigates the influence of spinal factors on LS in Japanese females. A total of 187 women > or =50 years old were enrolled in the study. Those answering yes to least one of the 7 categories in the self-assessment checklist for LS were defined as having LS. We evaluated lateral lumbar radiographs, sagittal parameters, sagittal balance using the spinal inclination angle (SIA) as an index, spinal range of motion (ROM) as determined with SpinalMouse, back muscle strength (BMS), and body mass index (BMI). Age, BMI, BMS, SIA, sacral slope angle (SSA), and lumbar spinal ROM showed significant correlations with LS. Multiple logistic regression analysis indicated that an increase in age (OR 1.054, p<0.05) and a decrease in BMS (OR 0.968, p<0.01) were significantly associated with LS. Age had significant negative correlations with BMS, SSA, thoracic and lumbar spinal ROM, and it had positive correlations with BMI, SIA, and lumbar kyphosis. BMS had significant negative correlations with age, SIA, thoracic and lumbar kyphosis, and it had positive correlations with SSA, lumbar and total spinal ROM. An increase in age and a decrease in BMS may be the most important risk factors for LS in Japanese women. Back muscle strengthening and spinal ROM exercises could be useful for improving the status of an individual suffering from LS.
  Nagoya journal of medical science 02/2013; 75(1-2):47-55.
• Article: Impalement injury to the left buttock with massive bleeding: a case report.

  Shingo Oya, Kanji Miyata, Norihiro Yuasa, Eiji Takeuchi, Yasutomo Goto, Hideo Miyake, Keiichi Nagasawa, Yoichiro Kobayashi
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  ABSTRACT: A 67-year-old man fell from the second floor of his home and was impaled on an iron pipe used for a garden stake. The pipe was 2 cm in diameter and had entered his left buttock to his anus. A plain abdominal X-ray film showed that the tip of the pipe was located in front of the 4th lumbar vertebra, so the penetration distance was 30 cm. An emergency operation was performed for hemorrhagic shock. Laparotomy revealed massive intra-abdominal bleeding, injuries of the sigmoid and transverse mesocolon, superior rectal artery, and the first part of the duodenum. Because of suspected lower rectal injury, division of the upper rectum, closure of the rectal stump, and sigmoidostomy were performed. Gauze packing into the pelvic cavity was performed for uncontrollable bleeding. All the gauze was postoperatively removed from the drain wound without laparotomy. Six months after the operation, he underwent a second operation including anastomosis of the descending colon and lower rectum, which allowed him to live a normal daily life.
  Nagoya journal of medical science 02/2013; 75(1-2):147-52.
• Article: Glucocorticoid-induced hypertension and cardiac injury: effects of mineralocorticoid and glucocorticoid receptor antagonism.

  Takuya Hattori, Tamayo Murase, Erika Iwase, Keiji Takahashi, Masafumi Ohtake, Koji Tsuboi, Mayuko Ohtake, Masaaki Miyachi, Toyoaki Murohara, Kohzo Nagata
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  ABSTRACT: Glucocorticoids are widely administered for the treatment of various disorders, although their long-term use results in adverse effects associated with glucocorticoid excess. We investigated the pathophysiological roles of glucocorticoid receptors (GRs) and mineralocorticoid receptors (MRs) in the cardiac changes induced by exogenous corticosterone in rats. Corticosterone or vehicle was injected twice daily in rats from 8 to 12 weeks of age. The effects of the GR antagonist RU486, the MR antagonist spironolactone, or both agents on corticosterone action were also determined. Corticosterone induced hypertension, left ventricular (LV) fibrosis, and LV diastolic dysfunction. Neither RU486 nor spironolactone affected corticosterone-induced hypertension, whereas spironolactone, but not RU486, attenuated the effects of corticosterone on LV fibrosis and diastolic function. Corticosterone also increased cardiac oxidative stress and inflammation in a manner sensitive to spironolactone but not to RU486. The corticosterone-induced LV atrophy was not affected by either RU486 or spironolactone. Our results implicate MRs in the cardiac fibrosis and diastolic dysfunction, but not MRs or GRs in the cardiac atrophy, induced by corticosterone. Neither MRs nor GRs appear to contribute to corticosterone-induced hypertension.
  Nagoya journal of medical science 02/2013; 75(1-2):81-92.
• Article: Gastric cancer with minimal peritoneal metastasis: is this a sign to give up or to treat more aggressively?

  Yasuhiro Kodera
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  ABSTRACT: Peritoneal metastasis from gastric cancer is often undetectable by routine imaging studies. Even a microscopic metastasis detected only by cytologic examination of the peritoneal washes denotes a dismal prognosis, and surgery is ruled out as futile for patients who turn out to be cytology-positive by staging laparoscopy. On the other hand, recent developments in cancer chemotherapy have improved the outcome of the cytology-positive population to the point where a certain proportion of these patients survive for 5 years through a straightforward strategy of radical surgery followed by chemotherapy. Thus, there is certainly a role for surgeons in patients with minimal peritoneal metastasis, both in clinical practice and in clinical trials where multimodal treatment strategies including surgery are to be explored. Even in this category of patients, surgery in combination with various types of chemotherapy remains the only hope for a cure.
  Nagoya journal of medical science 02/2013; 75(1-2):3-10.
• Article: No association between MTHFR C677T and serum uric acid levels among Japanese with ABCG2 126QQ and SLC22A12 258WW.

  Yukako Hinohara, Mariko Naito, Rieko Okada, Guan Yin, Takahiro Higashibata, Takashi Tamura, Sayo Kawai, Emi Morita, Kenji Wakai, Hirotaka Matsuo, Atsuyoshi Mori, Nobuyuki Hamajima
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  ABSTRACT: Several genome-wide association studies (GWAS) have revealed that single nucleotide polymorphisms (SNPs) of ABCG2 and SLC22A12 were strongly associated with serum uric acid (SUA), but those of methylene tetrahydrofolate reductase (MTHFR) were not. However, there were several studies indicating the association with MTHFR C677T polymorphism. This study examined the association with the polymorphism, taking into account the genotypes of ABCG2 Q126X and SLC22A12 W258X. Subjects were 5,028 health checkup examinees of Seirei Preventive Health Care Center (3,416 males and 1,612 females) aged 35 to 69 years, who participated in the Japan Multi-Institutional Collaborative Cohort Study (J-MICC Study). Hyperuricemia was defined as SUA equal to 7 mg/dL or over. The genotype frequency was 35.9% for CC, 48.1% for CT, and 16.0% for TT, being in Hardy-Weinberg equilibrium (p=0.90). Among 4,425 participants with ABCG2 126QQ and SLC22A12 258WW who were not under medication for hyperuricemia, the mean SUA was 5.6 mg/dL, 5.6 mg/dL, and 5.7 mg/dL, respectively. When 114 participants with ABCG2 126QQ and SLC22A12 258WW under medication for hyperuricemia were included in hyperuricemia cases, the sex-age adjusted odds ratio (OR) of hyperuricemia was not significant; OR=1.00 (95% confidence interval, 0.89-1.24) for CT genotype and OR=0.98 (0.84-1.32) for TT genotype, relative to CC genotype. The present study indicated no association between SUA and MTHFR C677T genotype, after the influences of ABCG2 Q126X and SLC22A12 W258X were removed.
  Nagoya journal of medical science 02/2013; 75(1-2):93-100.
• Article: Stabilizing incomplete reduction of the radial head using a hinged splint: conservative treatment for a monteggia equivalent lesion.

  Takaaki Shinohara, Emiko Horii, Masahiro Tatebe, Michiro Yamamoto, Shigeru Kurimoto, Hitoshi Hirata
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  ABSTRACT: Radial head dislocation associated with plastic bowing of the ulna is classified as a Monteggia equivalent lesion. This injury in children can be treated by closed reduction, but manipulative reduction may not completely correct plastic bowing of the ulna. We encountered two cases of incomplete reduction in which the radial head was reduced in a supination position, but redislocated during rotation from neutral to a pronation position. The patients were treated conservatively using an adjustable hinged elbow splint. Plain radiography at 6 weeks after incomplete closed reduction showed that the radial head was reduced in all positions from supination to pronation; thus, both patients had good outcomes. Our method is non-invasive and may be an option for treatment of incomplete reduction of radial head dislocation with acute plastic bowing of the ulna.
  Nagoya journal of medical science 02/2013; 75(1-2):131-7.
• Article: Simple and rapid quantitation of 21 bile acids in rat serum and liver by UPLC-MS-MS: effect of high fat diet on glycine conjugates of rat bile acids.

  Yudai Suzuki, Rina Kaneko, Mina Nomura, Hisao Naito, Kazuya Kitamori, Tamie Nakajima, Tadashi Ogawa, Hideki Hattori, Hiroshi Seno, Akira Ishii
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  ABSTRACT: In this report, we present a simple and rapid method for analysis of 21 kinds of bile acids and the conjugates in rat serum and liver samples by ultra-performance liquid chromatography-tandem mass spectrometry (UPLC-MS-MS) in the negative ionization mode, using cholic-2, 2, 4, 4-d4 acid as internal standard. After liquid-liguid extraction from serum and liver samples, specimens were analyzed by UPLC equipped with an Acquity TQD tandem quadrupole mass spectrometer. All of the 21 bile acids were sufficiently separated within 5 min. For most bile acids, calibration curves showed good linearities in the range of 0.25 to 5000 ng/mL for serum samples, 2.5 ng/g to 50 microg/g for liver samples. The limits of detection (LOD) were estimated to be less than 0.25 to 7.5 ng/mL in serum, less than 2.5 to 10 ng/g in liver samples. The present method was validated with respect to repeatability; the coefficient of variation (CV) values were less than 26.7% in the serum and 25.9% in the liver. In the animal study, we compared 21 bile acids in the serum and liver samples of the stroke-prone spontaneously hypertensive (SHRSP) rats fed with control (SP) diet or high-fat and high-cholesterol-containing (HFC) diet. By feeding with HFC diet, the glycine conjugates of some bile acids significantly increased and the taurine conjugate of ulsodeoxicolate (TUDC) decreased in serum and liver samples. Our results suggest that the change of bile acid profiles could be applied for the diagnosis of non-alcoholic fatty liver disease (NAFLD).
  Nagoya journal of medical science 02/2013; 75(1-2):57-71.
• Article: Selective IgA deficiency mimicking Churg-Strauss syndrome and hypereosinophilic syndrome: a case report.

  Noriyuki Takahashi, Takeshi Kondo, Mamiko Fukuta, Ayumu Takemoto, Yuichiro Takami, Motoki Sato, Takafumi Ando, Naozumi Hashimoto, Tomio Suzuki, Juichi Sato, Masahiro Yamamura, Nobutaro Ban
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  ABSTRACT: Selective IgA deficiency (SIgAD) is the most common type of primary immunoglobulin deficiency. Most individuals with SIgAD are asymptomatic. However, some patients are associated with allergic and autoimmune disease. SIgAD is included in the list of differential diagnoses of eosinophilia. We experienced a patient who initially presented with abdominal pain and eosinophilia. A >1-year follow-up revealed SIgAD, and we had difficulty differentiating it from Churg-Strauss syndrome (CSS) or hypereosinophilic syndrome (HES). A 66-year-old Japanese male presented with a history of recurrent abdominal pain. A diagnostic work-up revealed eosinophilia, eosinophilic gastritis, eosinophilic pneumonia, and SIgAD over 1 year of clinical observation. He also suffered from asthma and sinusitis. Anti-neutrophil cytoplasmic antibody was negative and vasculitis was not detected in the obtained tissue specimens of stomach, lung, nose and skin. The patient showed no evidence of drug ingestion, parasitic infections, or malignant neoplasms. Although we cannot rule out prevasculitic CSS and idiopathic HES, the whole clinical picture in this patient can be explained most consistently by SIgAD.
  Nagoya journal of medical science 02/2013; 75(1-2):139-46.
• Article: The regulation of sleep and wakefulness by the hypothalamic neuropeptide orexin/hypocretin.

  Ayumu Inutsuka, Akihiro Yamanaka
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  ABSTRACT: Orexins, also known as hypocretins, are neuropeptides that are exclusively expressed by neurons in the lateral hypothalamic area. Although originally recognized as regulators of feeding behavior, orexins are now mainly regarded as key modulators of the sleep/wakefulness cycle. In addition, anatomical studies of neural networks and analyses of transgenic mice have revealed integrated roles for orexin neurons in the coordination of emotion, energy homeostasis, and the reward system. A functional link between the limbic system and orexin neurons may be important for increasing vigilance in response to emotional stimuli. These findings suggest that orexin neurons relay information about an organism's environment to maintain the proper amount of sleep and wakefulness in animals.
  Nagoya journal of medical science 02/2013; 75(1-2):29-36.
• Article: Advantage of a more central incision onto left atrium by using ultrasonic scalpel.

  Min-Ho Song
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  ABSTRACT: Exposure of the mitral valve is of critical importance in mitral valve surgery. The mitral valve is located near the interatrial groove. As we accumulated experience and learned from embryology, we found that a more central left atriotomy was advantageous, and was made possible by interatrial groove dissection using an ultrasonic scalpel. This crucial finding prompted us to report the technique.
  Nagoya journal of medical science 02/2013; 75(1-2):121-3.
• Article: Reappraisal of importance of the left internal mammary artery to the left anterior descending artery in improving mid-term outcome in patients with severe left ventricular dysfunction.

  Min-Ho Song
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  ABSTRACT: We sought to investigate the effects of the left internal mammary artery anastomosed to the left anterior descending artery for improving mid-term outcome in patients with severe left ventricular dysfunction. Twenty consecutive coronary artery bypass grafts performed by a single surgeon for less than 35% ejection fraction patients were reviewed retrospectively from April 2000 to November 2008. There was one perioperative death (5.0% mortality). The mean survival was 55 months with an actual 5-year survival rate of 75%. Echocardiography showed the ejection fraction improved to 10.7 +/- 0.32% (p < 0.01). The strongest correlation was observed between both the flow and the pulsatile index of the left internal mammary artery measured intraoperatively by transit time flow meter and the postoperative ejection fraction improvement (R2=0.737 and 0.639, respectively). We reappraised the mid-term beneficial effects of the internal mammary artery anastomosed to the left anterior descending artery in patients with severe left ventricular function.
  Nagoya journal of medical science 02/2013; 75(1-2):113-9.
• Article: What happens in the brain of schizophrenia patients?: an investigation from the viewpoint of neuropathology.

  Shuji Iritani
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  ABSTRACT: Studies that seek to determine the etiology of schizophrenia through pathological images and morphological abnormalities of the brain have been conducted since the era of E. Kraepelin, and pioneers in neuropathology such as A. Alzheimer have also eagerly pursued such studies. However, there have been no disease-specific findings, and there was a brief era in which it was said that "schizophrenia is the graveyard of neuropathologists." However, since the 1980s, neuroimaging studies with CT and MRI etc., have been used in many reports of cases of schizophrenia with abnormal brain morphology, thus generating renewed interest in developments within brain tissue and leading to new neuropathological studies. There are now many reports in which, in addition to morphological observations, cell distribution and the like are image-processed and statistically processed through computers. Due to methodological problems in making progress in the field of cerebral pathology, we have not yet been able to observe disease-specific findings, although there are several findings with high certainty. However, the neurodevelopmental hypothesis has been supported as being able to reasonably explain the accumulated findings of previous studies. At the same time, results of recent molecular-biological studies have revealed the risk genes for this disease, and because many of those genes are associated with functions related to nerve differentiation, development, and plasticity, there is growing interest in their correlations with cerebral pathology. We are now on the verge of uncovering the etiology of this disease by integrating cerebral neuroimaging, molecular genetics, and cerebral neuropathology. In that sense, neuropathological studies of this disease from new viewpoints have become essential.
  Nagoya journal of medical science 02/2013; 75(1-2):11-28.
• Article: Cerebral hemorrhage and cerebral infarction in 30 cases of adult moyamoya disease: comparison between conservative therapy and superficial temporal artery-middle cerebral artery anastomosis.

  Hirofumi Oyama, Akira Kito, Hideki Maki, Kenichi Hattori, Tomoyuki Noda, Kentaro Wada
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  ABSTRACT: To clarify the effect of surgery on the prevention cerebral hemorrhage in adult moyamoya disease, we compared postoperative courses between superficial temporal artery-middle cerebral artery (STA-MCA) anastomosis and conservative therapy. The study subjects were 30 adults with moyamoya disease. Unilateral STA-MCA anastomosis was conducted in 7 of these 30 cases, and bilateral STA-MCA anastomosis was conducted in 8 of these 30 cases. Therefore, anastomosis was performed in a total of 23 sides. The postoperative clinical course was observed for more than 5 years after the STA-MCA anastomosis. Cerebral hemorrhage occurred after operation in 2 sides (8.7%) among the 23 sides that received STA-MCA anastomosis. On the contrary, hemorrhage occurred during conservative therapy in 5 sides (13.5%) among 37 non-operation sides (no significance in chi2 test). Cerebral infarction occurred in 3 sides (13%) among 23 sides treated with STA-MCA anastomosis. However, the infarction occurred in 2 sides (5.4%) among the 37 non-operation sides (no significance in chi2 test). Cerebral hemorrhage tended to occur less frequently after STA-MCA anastomosis, and bypass surgery was suggested to have some beneficial effect in preventing cerebral hemorrhage in adult moyamoya disease. However, it was revealed that STA-MCA anastomosis exacerbated the brain ischemia. Therefore, strict management is mandatory in the perioperative period.
  Nagoya journal of medical science 02/2013; 75(1-2):37-40.
• Article: DPP4 genetic variants influence baseline prostate-specific antigen levels: the J-MICC study.

  Takahiro Higashibata, Mariko Naito, Atsuyoshi Mori, Noriyo Ozawa, Masatoshi Furuta, Rumi Tsuchiya, Erina Koyama, Emi Morita, Sayo Kawai, Rieko Okada, Guang Yin, Kenji Wakai, Nobuyuki Hamajima
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  ABSTRACT: Prostate specific antigen (PSA) testing plays a major role in prostate cancer screening; however, the low positive predictive value of PSA testing leads to many unnecessary biopsies. Genetic background is one of factors that could cause it. That's why an association between genetic background and PSA levels should be elucidated. This study aimed to investigate whether DPP4 genetic variants are associated with baseline PSA levels. A cross-sectional study was performed on 2,074 Japanese men aged between 35 and 69 in the Shizuoka area from the Japan Multi-institutional Collaborative Cohort (J-MICC) Study. Three DPP4 tagging single nucleotide polymorphisms (SNPs) were selected for genotyping: rs3788979 (A/G), rs7608798 (T/C), and rs2268889 (A/G). Higher mean serum PSA levels were significantly associated with an increase in the number of the rs7608798 C allele (p for trend = 0.02). A stratified analysis by age groups demonstrated that PSA levels had positive significant trends with the numbers of the minor alleles of rs3788979 or rs7608798 in the oldest group (men aged between 60 and 69) (p for trend=0.004 for rs3788979 and p for trend=0.001 for rs7608798). Haplotype analysis showed that the C-A (rs7608798-rs2268889) haplotype was significantly associated with increased PSA levels (p=0.006), compared with the most common haplotype, T-A. In summary, our study suggests that DPP4 genetic variants influence baseline PSA levels, especially in men aged between 60 and 69.
  Nagoya journal of medical science 02/2013; 75(1-2):73-80.
• Article: Intravascular lymphoma of the central nervous system presenting as multiple cerebral infarctions.

  Hiroyuki Momota, Yoshitaka Narita, Yasuji Miyakita, Soichiro Shibui
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  ABSTRACT: A 67-year-old woman presented with an acute onset of left-sided weakness. Magnetic resonance (MR) imaging revealed multiple cerebral infarctions and gadolinium-enhanced lesions in both cerebral hemispheres. Her symptoms once improved after starting steroid treatment; however, soon developed consciousness disturbance and hemiparesis on the left side. She was referred to our hospital where she underwent stereotactic needle biopsy, that revealed an intravascular large B-cell lymphoma in the cerebrum. She received high-dose methotrexate chemotherapy followed by whole-brain radiation therapy, and the MR findings improved. However, her medical condition gradually worsened, and she died 6 months after disease onset. Intravascular lymphoma (IVL) limited to the central nervous system (CNS) is very rare, and the optimal treatment for this medical condition has not been established yet. IVLs showing only neurologic manifestations might be overlooked or misdiagnosed as cerebral infarctions. Here, we present a case of CNS IVL, with its radiographic and pathologic features and treatment with high-dose methotrexate chemotherapy.
  Nagoya journal of medical science 08/2012; 74(3-4):353-8.
• Article: Postoperative function following radical surgery in gastric and colorectal cancer patients over 80 years of age--an objection to "ageism".

  Shinji Fukata, Masahiko Ando, Takeshi Amemiya, Kojiro Kuroiwa, Koji Oda
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  ABSTRACT: With rapid growth in the elderly population, the number of elderly cancer patients who should be offered life-prolonging radical surgery has been increasing. The aim of this report is to demonstrate the outcome of elective radical surgery for gastric or colorectal cancer patients 80 years of age or older, including the natural course of recovery of functional independence, in order to avoid the negative attitude held toward surgery that is due only to patients' high chronological age. Physical condition, ADL, and QOL of 108 patients 80 years of age or older with gastric or colorectal cancer were evaluated preoperatively and at the 1st, 3rd, and 6th postoperative months. There were no operative deaths, and the morbidity rate was 27.9%. Only 6% of the patients showed a decrease in ADL at the 6th postoperative month. This decrease typically occurred following discharge from the hospital. Patient QOL showed recovery to an extent equal to or better than average preoperative scores. Of the patients who underwent elective surgery for gastric or colorectal cancer, only a few showed a protracted decline in ADL, and most exhibited better QOL after surgery. Surgical treatment should therefore be considered, whenever needed, for elderly patients 80 years of age or older with gastric or colorectal cancer.
  Nagoya journal of medical science 08/2012; 74(3-4):241-51.