Language：Japanese   Publisher：(株)医学書院  

＜文献概要＞Point ・生理的な下垂体腫大が存在し,正確な診断は無用な医療を防ぐ.・Incidentalomaはasymptomaticとは限らず,治療介入の要否を判断しなければならない.・Endocrinological emergencyが存在し,遅滞なく診断し治療介入すべき病態を理解すべきである.

researchmap

Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2021&ichushi_jid=J01228&link_issn=&doc_id=20210406190014&doc_link_id=10.11477%2Fmf.1436204392&url=https%3A%2F%2Fdoi.org%2F10.11477%2Fmf.1436204392&type=%88%E3%8F%91.jp_%83I%81%5B%83%8B%83A%83N%83Z%83X&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00024_2.gif

Language：Japanese   Publisher：日本脳腫瘍病理学会  

researchmap

Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND Isolated adrenocorticotropic hormone deficiency (IAD) is a rare disorder characterized by central adrenal insufficiency (AI) but normal secretion of pituitary hormones other than adrenocorticotropic hormone. IAD usually presents with unspecific symptoms of AI, such as anorexia and fatigue, but some patients present with a variety of atypical manifestations. Rhabdomyolysis is a potentially life-threatening clinical syndrome caused by skeletal muscle injury with the release of muscle cell contents into the circulation. A wide variety of disorders can cause rhabdomyolysis. Herein, we report an unusual case of IAD presenting with hyponatremia and rhabdomyolysis. CASE REPORT A 67-year-old Japanese woman with a 2-month history of anorexia and fatigue was diagnosed with severe hyponatremia (serum sodium, 118 mEq/L) and rhabdomyolysis (serum creatine phosphokinase, 6968 IU/L), after 2 days of vomiting and muscle weakness. Physical and laboratory findings did not show dehydration or peripheral edema. Her rhabdomyolysis resolved with normalization of serum sodium levels during administration of sodium chloride. However, her anorexia and fatigue remained unresolved. After reducing the amount of sodium chloride administered, the patient still had hyponatremia. Detailed endocrinological examinations indicated IAD; her hyponatremia was associated with inappropriately high plasma arginine vasopressin levels. The patient received corticosteroid replacement therapy, which resolved her anorexia, fatigue, excessive arginine vasopressin, and hyponatremia. CONCLUSIONS This case highlights the importance of considering the possibility of central AI in patients with hyponatremia and excessive arginine vasopressin levels. In addition, rhabdomyolysis associated with hyponatremia can be an important manifestation of IAD.

DOI： 10.12659/AJCR.918427

PubMed

researchmap

Language：Japanese   Publisher：(一社)日本内分泌学会  

researchmap

DOI： 10.1186/s13256-019-2002-2

PubMed

researchmap

DOI： 10.1093/omcr/omy101

PubMed

researchmap

Language：Japanese   Publisher：新潟医学会  

researchmap

Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2018&ichushi_jid=J00990&link_issn=&doc_id=20200130080009&doc_link_id=%2Fdg3nigta%2F2018%2Fs13211%2F006%2F0399-0400%26dl%3D0&url=http%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fdg3nigta%2F2018%2Fs13211%2F006%2F0399-0400%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

DOI： 10.2169/internalmedicine.1101-18

PubMed

researchmap

Language：English   Publishing type：Research paper (scientific journal)   Publisher：Elsevier Inc.  

Background: Frontoethmoidal schwannomas are rare. No case manifesting exertional cerebrospinal fluid (CSF) rhinorrhea has ever been reported to the best of our knowledge. Case Description: In this report, we describe an extremely rare case of frontoethmoidal schwannoma extending through the olfactory groove with exertional CSF rhinorrhea as the initial symptom. A 50-year-old woman was presented to our clinic for frequent nasal discharge on exertion. A postcontrast computed tomographic scan demonstrated heterogeneously enhanced tumor from the anterior cranial fossa to the anterior ethmoid sinus. A gadolinium-enhanced T1-weighted magnetic resonance image revealed a well-defined heterogeneously enhanced tumor situated in the midline anterior cranial fossa and anterior ethmoid sinus. After the resection, the defect of the right anterior skull base was reconstructed with a fascia graft and adipose tissue taken from the abdomen, as well as a pedicle periosteum flap. A histologic examination revealed the tumor as schwannoma. Her rhinorrhea completely resolved. She regained her sense of smell and taste 1 month after the operation. Conclusion: According to previous reports, olfactory groove, and paraolfactory groove/periolfactory groove schwannomas can be divided into 4 types: subfrontal, nasoethmoidal, frontoethmoidal, and ethmofrontal. Among them, a frontoethmoidal schwannoma can manifest exertional CSF rhinorrhea as an initial symptom.

DOI： 10.1016/j.wneu.2018.01.015

Scopus

PubMed

researchmap

DOI： 10.1016/j.jocn.2017.10.086

PubMed

researchmap

Language：English   Publishing type：Research paper (scientific journal)   Publisher：Japanese Society of Internal Medicine  

A 63-year-old Japanese woman with advanced lung adenocarcinoma developed isolated adrenocorticotropin deficiency caused by immune checkpoint inhibitor (ICI)-related hypophysitis following 8 months of nivolumab therapy. Prompt corticosteroid replacement therapy effectively relieved her secondary adrenal insufficiency symptoms and allowed her to pursue nivolumab therapy, which had been effective for the control of lung adenocarcinoma. Human leukocyte antigen (HLA) typing revealed the presence of the DRB1*04:05-DQA1*03:03-DQB1*04:01 haplotype, which is associated with susceptibility to autoimmune polyglandular syndrome with pituitary disorder in the Japanese population. This case suggests that genetic factors, such as HLA, contribute to the development of endocrinopathies induced by ICIs.

DOI： 10.2169/internalmedicine.9074-17

Scopus

PubMed

researchmap

Language：English   Publishing type：Research paper (scientific journal)   Publisher：Elsevier B.V.  

Background Since the origin and growth pattern of third ventricle ectopic pituitary adenoma (ectPA) remain unclear, its optimal surgical approach is debatable. Clinical presentation We present a rare case of null cell pituitary adenoma arising from the pituitary infundibulum with long-term preoperative follow-up images. The tumor was resected gross-totally via an extended transsphenoidal approach. Conclusion To our best knowledge, this is the first case with long-term preoperative follow-up images, which can bridge the knowledge gap in operations of third ventricle ectPA as following: (1) Truly third ventricle ectPA can exist, (2) the third ventricle ectPA extended into the sella turcica along the pituitary stalk, (3) this ectPA can arise from the suprasellar peri-infundibular ectopic pituitary cells or the pars tuberalis of the adenohypophysis, and therefore adhere to the optic chiasm, (4) thus neurosurgeons should take great care in resection of ectPA arising from the infundibulum, and (5) it can be resected through an endoscopic extended transsphenoidal approach.

DOI： 10.1016/j.inat.2017.08.004

Scopus

researchmap

Language：English   Publishing type：Research paper (scientific journal)   Publisher：S. Karger AG  

We present a pediatric case of a rapidly expanding third ventricle germ cell tumor (GCT). A 14-year-old boy suffered from gradual-onset central diabetes insipidus (DI) and received desmopressin treatment. Magnetic resonance imaging (MRI) showed nonspecific findings of the pituitary-hypothalamic axis. Nine months after the initial DI diagnosis, he developed progressively worsening headache. MRI demonstrated a third ventricle tumor causing noncommunicating hydrocephalus, although an MRI 16 weeks before admission did not show the lesion. We performed gross total resection (GTR) of the tumor in 2 stages: a translamina terminalis approach and an extended transsphenoidal approach. The lesion was histologically diagnosed as immature teratoma with some germinoma. His noncommunicating hydrocephalus resolved after surgery. Through postoperative radiochemotherapy (whole ventricle: 23.4 Gy/13 fractions, tumor bed: 27.0 Gy/15 fractions, and 3 courses of carboplatin-etoposide), he has was in complete remission at the 3-year follow-up and has continued his high school program. This case suggests the following: (1) a mixed GCT originating from the neurohypophysis/infundibulum can show rapidly expansive growth in a child with central DI
(2) GTR and adjuvant radiochemotherapy can result in a good therapeutic outcome in rapidly expanding GCT
and (3) the extended transsphenoidal approach is a complementary approach to transcranial resection of anterior third ventricle GCTs.

DOI： 10.1159/000480021

Scopus

PubMed

researchmap

Language：English   Publishing type：Research paper (scientific journal)   Publisher：Elsevier B.V.  

Background Injury of the internal carotid artery (ICA) in the cavernous portion is one of the most critical complications of transsphenoidal surgery (TSS), especially in cases of coexistence with a pituitary adenoma (PA) and ICA aneurysm. Case description We present a rare case of unruptured medial paraclinoid ICA aneurysm (ICA-An) associated with symptomatic nonfunctioning giant PA. After endovascular coil embolization of the unruptured 4-mm saccular medial paraclinoid ICA-An, the patient underwent adenomectomy through an endoscopic endonasal TSS. During the bone resection over the right sellar floor near the right cavernous sinus, a tangle of packed coils in the treated medial paraclinoid ICA-An was observed immediately after a bite of a Kerrison rongeur. The dural layer over the coiled aneurysm had become thin to the point of transparency or complete absence. Careful inspection revealed that the bone hillock was formed by the medial paraclinoid ICA-An. Gross total resection of the adenoma was achieved without vascular injuries related to the coiled aneurysm despite postoperative transient right oculomotor paresis. Conclusions This case conveys three important lessons about TSS: 1) coil embolization will manage a medial paraclinoid ICA-An as a sufficient preoperative procedure for TSS
2) a medial paraclinoid ICA-An can appear directly under the sellar floor as an apparent extradural aneurysm
and
3) surgeons should take great care in procedures near a coil-embolized medial paraclinoid ICA-An because the aneurysmal wall can be thin to the point of transparency.

DOI： 10.1016/j.inat.2017.09.005

Scopus

researchmap

Language：English   Publishing type：Research paper (scientific journal)   Publisher：BioMed Central Ltd.  

Background: Pituitary tumor apoplexy is a rare clinical syndrome caused by acute hemorrhage or infarction in a preexisting pituitary adenoma. It typically manifests as an acute episode of headache, visual disturbance, mental status changes, cranial nerve palsy, and endocrine pituitary dysfunction. However, not all patients present with classical symptoms, so it is pertinent to appreciate the clinical spectrum of pituitary tumor apoplexy presentation. We report an unusual case of a patient with pituitary tumor apoplexy who presented with periorbital edema associated with hypopituitarism. Case presentation: An 83-year-old Japanese man developed acute anterior hypopituitarism
he showed anorexia, fatigue, lethargy, severe bilateral periorbital edema, and mild cardiac dysfunction in the absence of headache, visual disturbance, altered mental status, and cranial nerve palsy. Magnetic resonance imaging showed a 2.5-cm pituitary tumor containing a mixed pattern of solid and liquid components indicating pituitary tumor apoplexy due to hemorrhage in a preexisting pituitary adenoma. Replacement therapy with oral hydrocortisone and levothyroxine relieved his symptoms of central adrenal insufficiency, central hypothyroidism, periorbital edema, and cardiac dysfunction. Conclusions: Common causes of periorbital edema include infections, inflammation, trauma, allergy, kidney or cardiac dysfunction, and endocrine disorders such as primary hypothyroidism. In the present case, the patient's acute central hypothyroidism was probably involved in the development of both periorbital edema and cardiac dysfunction. The present case highlights the need for physicians to consider periorbital edema as an unusual predominant manifestation of pituitary tumor apoplexy.

DOI： 10.1186/s13256-017-1371-7

Scopus

PubMed

researchmap

Language：English   Publishing type：Research paper (scientific journal)   Publisher：KARGER  

We present a pediatric case of neurohypophyseal germinoma with a perifocal inflammatory reaction (PIR) with volume fluctuation caused by diagnostic radiation-induced regression (DRIR). On-target biopsy failed to confirm the histology because PIR hardly contained any germinoma cells. DRIR-related fluctuation of the tumor volume disguised germinoma as inflammation. We analyzed the cerebrospinal fluid (CSF) and detected a high level of placental alkaline phosphatase (PLAP), which demonstrated the neurohypophyseal lesion to be germinoma and brought the patient from successful radiochemotherapy up to complete remission. PIR adjacent to the germinoma (PIRAG) disappeared completely following radiochemotherapy, although it contained almost no germinoma cells. Examination of the CSF-PLAP level can complement the diagnosis of germinoma and will decrease the risk of misdiagnosis. Neurosurgeons should keep in mind PIRAG, DRIR, and the diagnostic value of CSF-PLAP when germinoma is suspected. (C) 2016 S. Karger AG, Basel

DOI： 10.1159/000450583

Web of Science

PubMed

researchmap

Language：English   Publishing type：Research paper (scientific journal)   Publisher：JAPAN SOC INTERNAL MEDICINE  

A 39-year-old woman with a 3-year history of a rounded face developed widespread myalgia. Detailed examinations revealed no disorders that could explain the pain other than concomitant Cushing's disease and central hypothyroidism. Both the hypercortisolemia and hypothyroidism completely resolved after the patient underwent surgery to treat Cushing's disease, but she continued to experience unresolved myalgia and met the diagnostic criteria for fibromyalgia. Few studies have so far investigated patients with fibromyalgia associated with Cushing's syndrome. In our case, the hypothyroidism caused by Cushing's disease probably played an important role in triggering and exacerbating fibromyalgia. This highlights the need to examine the endocrine function in patients with muscle pain.

DOI： 10.2169/internalmedicine.55.5926

Web of Science

PubMed

researchmap

Language：English   Publishing type：Research paper (scientific journal)   Publisher：SPRINGER WIEN  

For pineal nongerminomatous malignant germ cell tumors (NGMGCTs), we mainly performed radical tumor resection during initial treatment combined with adjuvant therapy.
We retrospectively analyzed 17 patients treated for pineal NGMGCTs between 1986 and 2007 at the University of Niigata.
Twelve patients underwent total or subtotal resection of their tumor via the occipital transtentorial approach. Five patients underwent partial resection, and four of them later underwent total resection by salvage surgery. After surgery, eight patients were treated with combined radiochemotherapy including whole-brain irradiation, two received radiation monotherapy, one had chemotherapy with local irradiation, and six were treated with chemotherapy alone. The median follow-up period for surviving patients was 179 months. The 10-year overall survival and progression-free survival rates for the radiochemotherapy group were both 75.0 % (two patients had a recurrence and died); the rates for other adjuvant therapies were 77.8 % (two died) and 22.2 % (seven had a recurrence), respectively. Radiochemotherapy was significantly associated with an increased rate of progression-free survival compared with the other adjuvant therapies (p = 0.0396).
For pineal NGMGCTs, initial treatment strategies including gross total resection of the tumor before or after whole-brain irradiation and chemotherapy provided good therapeutic outcomes. Obtaining complete remission of the primary tumor, irrespective of the timing of surgical resection (i.e., before or after adjuvant therapies), or complete response by neoadjuvant radiochemotherapy during an initial treatment appears to be essential for improving therapeutic outcomes of intracranial NGMGCTs.

DOI： 10.1007/s00701-015-2614-2

Web of Science

PubMed

researchmap

Language：Japanese   Publisher：(一社)日本小児神経外科学会  

researchmap

Language：English   Publishing type：Research paper (scientific journal)   Publisher：MANEY PUBLISHING  

Objectives: The study objectives are (1) to identify factors predicting the excellent visual recovery after transsphenoidal removal of pituitary tumors and (2) to describe the association of excellent visual recovery and early restoration of symmetry of the decompressed optic chiasm.
Methods: Thirty-five patients with visual symptoms due to pituitary tumors underwent endoscopic endonasal surgery. All patients received perioperative diagnostic magnetic resonance (MR) imaging and ophthalmological assessments within 2 weeks before surgery, within 2 weeks after surgery, and 3 months or later after surgery. Preoperative best-corrected visual acuity (BCVA >= 20/20), degree of visual field deficit (VFD, less than half of VF), thickness of retinal nerve fiber layer (RNFL) measured by optical coherence tomography (OCT), and thickness of ganglion cell complex (GCC) measured by OCT were considered for statistical analysis as predictive factors of VF outcome. Multivariate logistic regression models were used in statistical evaluation of data.
Results: In the multivariate analysis, RNFL (odds ratio = 62.137, P < 0.001) and preoperative VFD (odds ratio = 8.244, P < 0.02) proved to be effective as factors predicting sufficient VF recovery. Postoperative restoration of symmetry of the optic chiasm was related to sufficient VF recovery (P < 0.0001, Fisher's exact test) and RNFL (P < 0.0001, Fisher's exact test).
Discussion: Early decompression is crucial for sufficient VF recovery, in particular, while RNFL preserves normal or borderline thickness and while VFD keeps within hemianopia. Morphological reversibility is associated with functional reversibility in the optic chiasm compressed by a pituitary tumor. In particular, early morphological recovery suggests functional recovery, which indicates neurocyte reserve in the compressed optic pathway with functional recovery.

DOI： 10.1179/1743132814Y.0000000407

Web of Science

PubMed

researchmap

Language：English   Publisher：Japanese Society for Medical and Biological Engineering  

Pituitary tumors frequently compress the optic chiasm, causing visual field deficits. Surgical removal of these tumors could improve visual functions. Thus, predicting the prognosis of visual field function is required, but currently there is no method for predicting postoperative visual field status from preoperative data of tumor and optic chiasm characteristics. In this study, we performed preoperative evaluation of visual field prognosis using numerical parameters in 40 patients with pituitary tumors. Data from 30 patients were used to calculate the regression equation and those from the remaining 10 patients were used to confirm the validity of these equations. We defined quantitative values (area of tumor, <i>A_tumor</i>; curvature of chiasm, <i>C_chiasm</i>; and area of chiasm, <i>A_chiasm</i>) based on tumor size, tumor shape, and optic chiasm shape as determined using magnetic resonance imaging. We determined pre- and postoperative visual field sizes by ophthalmologic methods, and quantified them as numerical values (<i>TNR</i>). Postoperative recovery of the visual fields (obtained by comparing the post- and preoperative visual fields) was confirmed by increased postoperative <i>TNR</i>s (<i>P</i> < 0.01 for 4 isopters and <i>P</i> = 0.01 for 1 isopter, <i>t</i>-test). We attempted to predict postoperative visual field size using preoperative <i>A_tumor</i>, <i>C_chiasm</i>, and <i>A_chiasm</i>. Multiple regression analysis was performed, and three significant regression equations for predicting visual field size were obtained (N = 30, <i>P</i> < 0.01, <i>F</i>-test). The measured and predicted visual field sizes showed strong correlation (N = 10, <i>r</i> > 0.70). Thus, the quantitative parameters defined in this study clearly predicted postoperative visual functions in patients with pituitary tumor, and could find clinical applications in preoperative evaluation of visual field prognosis in neurosurgery.

DOI： 10.14326/abe.4.80

Web of Science

CiNii Article

researchmap

Language：English   Publishing type：Research paper (scientific journal)   Publisher：Elsevier  

Introduction Supratentorial dermoid cysts arise due to the misplacement of embryonic inclusions in the vicinity of the developing neural tube up to the third week of life, when the neural groove begins to close. This report describes a case of a suprasellar dermoid cyst anchored to the anterior optic chiasm, which was accurately located by endoscopic observation, removed gross-totally without visual disturbance, and confirmed pathologically. Although the cyst wall was gross-totally resected, the patient's impaired visual field returned to a normal level. The resection procedure under endoscopic vision is demonstrated. Materials and Methods A 22-year-old man gradually developed bitemporal hemianopsia with retrobulbar pain over two months. Magnetic resonance imaging demonstrated a suprasellar cyst with intracystic fat contents forming a fluid level within the lesion. The suprasellar cyst was gross-totally removed with endoscopic endonasal transsphenoidal procedures. Intraoperative inspection confirmed that this cyst arose from the optic chiasm. Pathological examination showed the lesion as a dermoid cyst. Results After gross-totally resection of the cyst, the patient presented a further, transient impairment of bitemporal hemianopsia
at four month follow-up, his visual disturbance was not evident any longer. Conclusion To the best of our knowledge, ours is the only case of a dermoid cyst anchored to the anterior optic chiasma, which was visually confirmed under endoscopic observation. After surgery, the patient presented a transient impairment of the visual field, which was not evident at four month follow-up. It will contribute to a similar case, in which surgeons hesitate to make an incision in the optic chiasm. A subtotal excision should be considered in cases of dermoid cysts anchored to the anterior optic chiasm, because all the previously reported cases of suprasellar dermoid cysts are young people or those who have a relatively long life expectancy. © 2014 The Authors.

DOI： 10.1016/j.inat.2014.03.001

Scopus

researchmap

Language：Japanese   Publisher：(一社)日本内分泌学会  

頭蓋内胚腫(胚腫)の治療成績および患者の機能予後に影響を与える因子について検討した。初期治療を行った胚腫46例を後方視的に分析した。全例に手術を行い、全摘出3例、亜全摘出8例、部分摘出10例、生検術25例であった。永続的な手術合併症が4例で生じた。組織診断確定後、46例中38例に対し放射線単独治療を行い、7例に対し化学療法併用放射線治療を行い、1例に化学療法単独治療を行った。放射線単独治療を行った38例には再発を認めなかった。化学療法単独例と化学療法を併用した局所照射例で1例ずつ再発を認めたが、全脳以上に照射を行った症例では再発を認めなかった。4例が死亡し、いずれも腫瘍関連死ではあったが、死亡までに腫瘍の再発は認めなかった。5年、10年、15年生存率は、それぞれ100%、93.3%、88.2%で、5年、10年、15年無再発生存率は、それぞれ95.7%、89.3%、84.3%であった。

researchmap

DOI： 10.1007/s00701-013-1687-z

Web of Science

PubMed

J-GLOBAL

researchmap

Language：English   Publishing type：Research paper (scientific journal)  

OBJECT: Radiation monotherapy-prophylactic craniospinal or whole-brain irradiation paired with a radiation boost to the primary tumor-is the standard treatment for intracranial germinomas at the authors' institution. The authors assessed long-term outcomes of patients with germinoma who underwent therapy and identified factors affecting them. METHODS: The authors retrospectively analyzed data obtained in 46 patients (35 males and 11 females, age 5-43 years at diagnosis) who had been treated for intracranial germinomas between 1990 and 2009 at the authors' institution. Thirty patients had germinomas in localized regions and 16 in multiple regions. Thirty-eight patients (83%) underwent radiotherapy alone (craniospinal irradiation in 32 and whole-brain irradiation in 6). Seven patients underwent radiochemotherapy and 1 underwent chemotherapy alone. The mean radiation doses for the whole brain, spine, and primary tumor site were 26.9, 26.6, and 49.8 Gy, respectively. The median follow-up period was 125 months. RESULTS: The 10-year overall and recurrence-free survival rates were 93.3% and 89.3%, respectively. None of the 38 patients who received radiation monotherapy developed a recurrent lesion, whereas 1 of 7 who underwent radiochemotherapy and the 1 patient who underwent chemotherapy had a recurrent lesion. Of the entire population, 26 patients required hormone replacement therapy, 2 had short stature, and 1 developed a radiation-induced meningioma. Seventeen of the 25 childhood- or adolescent-onset patients were 19 years or older at the latest follow-up visit, 15 of whom graduated from senior high school, and only 2 of whom graduated from college. Of 34 patients who were 19 years or older at the latest visit, 4 were students, 18 worked independently, 4 worked in sheltered workplaces, and 8 were unemployed. Of the 34 patients, 4 got married after the initial treatment, 3 of whom had children. There were 8 patients (17%) with low postoperative Karnofsky Performance Scale (KPS) scores that were significantly associated with impaired neurocognitive functions, severe surgical complications, and neurological impairments. In 10 of the 46 patients, KPS scores at the latest visit were lower than their postoperative KPS scores. These decreases in KPS scores were significantly correlated with a delayed decline in neurocognitive functions in childhood-onset patients and a postoperative impairment of neurocognitive functions in patients with adolescent- or adult-onset germinoma. CONCLUSIONS: No tumor recurrence occurred in germinoma patients treated with the authors' radiation monotherapy, which appears to be effective enough to cure the tumor. Brain damage caused by tumors themselves and surgical complications were found to adversely affect functional outcomes in patients regardless of their age. Although radiotherapy rarely caused late adverse effects in patients with adolescent- or adult-onset, in some childhood-onset lesions, the radiation seems to carry the risk of neurocognitive dysfunctions, which are attributable to late adverse effects. Accordingly, treatments for germinoma patients should be selected according to a patient's age and the extent of the tumor and with particular care to avoid surgical complications.

DOI： 10.3171/2012.12.PEDS12336

PubMed

researchmap

Language：Japanese   Publisher：(一社)日本小児神経外科学会  

researchmap

Language：English   Publishing type：Research paper (scientific journal)  

The authors report a rare case involving the occurrence of metachronous pure germinomas long after treatment of a mixed germ cell tumor (GCT) categorized as having a poor prognosis. A neurohypophysial germinoma occurred 4 years and 6 months after the initial treatment of a mixed pineal GCT containing a yolk sac tumor and a germinoma. Furthermore, intramedullary germinomas occurred 21 years after the initial treatment of the mixed GCT and 15 years after the second treatment of the neurohypophysial germinoma. The neurohypophysial germinoma was not confirmed histopathologically, but the intramedullary germinoma was histopathologically diagnosed as a pure germinoma. Serum α-fetoprotein levels at the second neurohypophysial and third intramedullary occurrences of the germinomas were less than 10 ng/ml. Therefore, no yolk sac components seemed to be contained in the tumors. The second neurohypophysial and third intramedullary germinomas might be recurrences of the germinoma component of the pineal mixed GCT, which consisted of a yolk sac tumor and a germinoma. However, it seems very unlikely that only the germinoma, categorized in the good prognosis group, would be the only one to recur. Hence, it seems plausible that both the second and the third occurrences of pure germinoma were de novo metachronous GCTs arising after the pineal mixed GCT was cured. The authors' case indicates the possibility of multicentric GCTs in the CNS.

DOI： 10.3171/2012.9.PEDS12151

PubMed

researchmap

Language：English   Publishing type：Research paper (scientific journal)  

Background: Lesions associated with a thickened pituitary stalk (TPS lesions) revealed by magnetic resonance imaging have a diverse pathology. Accordingly, for clinical decision-making, it is necessary to make a diagnosis based on histopathological examination of the TPS lesions. The objectives of this study were to review endoscopic biopsies of TPS lesions and to assess the surgical strategy for treating these lesions. Methods: Eleven patients (four males and seven females) aged from 6 to 75 years underwent endoscopic biopsy of a TPS lesion between 2006 and 2011 at University of Niigata. The relationships of the extent of lesions with surgical approaches were retrospectively examined. Results: Among the 11 patients, a biopsy was performed via an endoscopic transsphenoidal approach for five with intrasellar lesions
via an endoscopic extended transsphenoidal approach for two with localized TPS lesions
and via an endoscopic intraventricular approach for four with the lesion protruding from the infundibulum. Histopathological examinations of all the lesions confirmed diagnoses of germinoma in four patients, hypophysitis in three, Langerhans cell histiocytosis in two, craniopharyngioma in one, and cancer metastasis in one. None of the 11 patients had further deterioration of pituitary function postoperatively. Conclusions: Endoscopic biopsy of TPS lesions is a less invasive alternative to open biopsy requiring transcranial surgery. The endoscopic transsphenoidal approach is most suitable for biopsies of TPS lesions associated with intrasellar lesions. Otherwise, the endoscopic intraventricular approach seems reasonable for intraventricular lesions protruding from the infundibulum, and the endoscopic extended transsphenoidal approach appears appropriate for localized TPS lesions. © 2012 Springer-Verlag Wien.

DOI： 10.1007/s00701-012-1543-6

Scopus

PubMed

researchmap

Language：English   Publishing type：Research paper (scientific journal)   Publisher：SPRINGER  

In this report, an extremely rare case of pediatric thyrotropin-secreting pituitary macroadenoma (TSHoma) is described. An 8-year-old boy, complaining of unsteady gait, was suspected of endocrinopathy because of emaciation and muscle weakness of the legs. Endocrinological work-up established a diagnosis of hyperthyroidism due to syndrome of inappropriate secretion of TSH. Magnetic resonance imaging showed a pituitary macroadenoma with suprasellar and sphenoidal extension without cavernous sinus invasion. He underwent an endoscopic endonasal transsphenoidal adenomectory due to the diagnosis of TSHoma. The adenoma was soft and it was totally removed. Histopathological staining confirmed diagnosis of TSHoma. Postoperative evaluation revealed a subnormal level of TSH (from 13-21 to 0.03 micro U/ml), normalization of alpha-subunit (from 10.0 to 0.09 ng/ml), and as a result, hypothyroidism. The boy left the hospital with oral levothyroxine that continued until 12 months of discharge. The present 8-year-old case is the youngest case to the best of our knowledge based on a bibliographical search. Reasons for endocrinological remission following adenomectomy are (1) correct diagnosis without delay: lack of cavernous sinus invasion, (2) soft and non-fibrous adenoma tissue, and (3) endoscopic technique with wide vision and illumination: safe even for a 8-year-old child. Early recognition/detection and pituitary-conserving adenomectomy can cure TSHoma and avoid long-term medical therapy and/or irradiation, which contribute to the best interests of patients with TSHoma.

DOI： 10.1007/s11102-010-0275-y

Web of Science

PubMed

researchmap

Language：English   Publishing type：Research paper (scientific journal)   Publisher：SPRINGER WIEN  

DOI： 10.1007/s00701-011-1250-8

Web of Science

researchmap

Language：Japanese   Publisher：新潟医学会  

researchmap

Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2012&ichushi_jid=J00990&link_issn=&doc_id=20120618090027&doc_link_id=%2Fdg3nigta%2F2012%2Fs12601%2F018%2F0060-0060%26dl%3D0&url=http%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fdg3nigta%2F2012%2Fs12601%2F018%2F0060-0060%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

Language：Japanese   Publishing type：Research paper (scientific journal)  

A 34-year-old man had a 3-month history of left upper eyelid swelling and pain. Computed tomography showed osteolytic lesion of the left frontal bone. Magnetic resonance imaging (MRI) revealed a mass lesion with heterogeneously gadolinium enhancement and extension to both the lateral orbit and the frontal base. We performed mass resection via left frontotemporal craniotomy to diagnose the lesion. Pathological findings of the specimen were Langerhans cell histiocytosis (LCH). Systemic investigations revealed no sign of the disease elsewhere. The patient was diagnosed with unifocal orbital LCH and received neither chemotherapy nor radiotherapy. Follow-up MRI has shown no recurrences 2 years after surgery. Although orbital LCH rarely occurrs in adults, it should be considered in differential diagnosis of orbital tumor. The patients with unifocal orbital LCH required no treatment in addition to mass resection.

Scopus

PubMed

researchmap

Language：Japanese   Publishing type：Research paper (scientific journal)  

To evaluate the anatomy of cranial nerves running in and around the cavernous sinus, we employed three-dimensional reversed fast imaging with steady-state precession (FISP) with diffusion weighted imaging (3D PSIF-DWI) on 3-T magnetic resonance (MR) system. After determining the proper parameters to obtain sufficient resolution of 3D PSIF-DWI, we collected imaging data of 20-side cavernous regions in 10 normal subjects. 3D PSIF-DWI provided high contrast between the cranial nerves and other soft tissues, fluid, and blood in all subjects. We also created volume-rendered images of 3D PSIF-DWI and anatomically evaluated the reliability of visualizing optic, oculomotor, trochlear, trigeminal, and abducens nerves on 3D PSIF-DWI. All 20 sets of cranial nerves were visualized and 12 trochlear nerves and 6 abducens nerves were partially identified. We also presented preliminary clinical experiences in two cases with pituitary adenomas. The anatomical relationship between the tumor and cranial nerves running in and around the cavernous sinus could be three-dimensionally comprehended by 3D PSIF-DWI and the volume-rendered images. In conclusion, 3D PSIF-DWI has great potential to provide high resolution "cranial nerve imaging", which visualizes the whole length of the cranial nerves including the parts in the blood flow as in the cavernous sinus region.

PubMed

researchmap

DOI： 10.1186/1752-1947-5-39

PubMed

researchmap

Language：English   Publishing type：Research paper (scientific journal)   Publisher：WILEY-BLACKWELL  

BACKGROUND
In this article, we present two can&apos;t-miss findings on preoperative magnetic resonance imaging (MRI) using a 3.0-T MR system resulting in a better surgical option in prolactinoma treatment after emergent of dopamine agonists.
METHODS
We reviewed six cases of pituitary prolactinoma; each had vague or occult bulk of adenoma on 1.5-T MR imaging, which were finally confirmed by surgery. Four cases were preoperatively examined with a 3.0-T MR imaging system. With the 3.0-T MR system, 3-dimension-anisotropy-contrast (3DAC) MR imaging and 3-dimension fast spoiled gradient recalled acquisition in the steady state (3D-FSPGR) imaging were used for depiction of the adenoma.
RESULTS
3DAC imaging revealed cavernous sinus (CS) pathology in three cases, and multiplanar reconstruction of 3D-FSPGR imaging revealed normal pituitary gland and invasive adenoma into the CS in three cases and creeping extension up to the contralateral side of the CS invasion in four cases.
CONCLUSIONS
Two can&apos;t-miss findings: (1) intrasellar creeping extension up to the opposite side of the adenoma main body and (2) intracavernous-localized adenoma with indistinct intrasellar mass should be carefully considered when neurosurgeons perform adenomectomy for patients with prolactinoma, even in cases of microprolactinoma.

DOI： 10.1111/j.1552-6569.2009.00364.x

Web of Science

PubMed

researchmap

Language：English   Publishing type：Research paper (scientific journal)  

Growth without growth hormone (GH) has occasionally been described in patients who have had tumors removed in the hypothalamic-pituitary area. Most of these patients have metabolic abnormalities such as obesity, dyslipidemia and fatty liver. This report describes the metabolic beneficial effects of GH replacement in pediatric patients with growth without GH. Two children in whom the growth without GH phenomenon occurred after therapy for brain tumors participated in this study. Case 1 is a 15-yr-old Japanese girl, diagnosed as having Langerhans cell histiocytosis with multiple intracranial lesions at the age of two. She showed a slight body fat increase, dyslipidemia and fatty liver. Case 2 is a 10-yr-old Indonesian boy, diagnosed with craniopharyngioma at the age of three. He was obese and had low bone mineral density (BMD). In both cases, GH replacement therapy was started at 0.042 mg/kg/week for 12 months. Body composition, BMD, and visceral abdominal area were measured every 3 months. Serum fasting blood glucose, insulin, ALT, lipid profile, leptin, and adiponectin levels were also measured every 3 months. Case 1 showed improvement of transaminase (ALT from 64 to 16 IU/L) and triglyceride (from 239 to 129 mg/dL) over 12 months, but did not show a decrease in visceral fat area or of body fat percentage. Case 2 showed a decrease in body fat percentage and visceral fat area, accompanied by elevated serum adiponectin and decreased leptin levels. In conclusion, twelve months GH replacement therapy improves metabolic abnormalities in pediatric patients with growth without GH.

PubMed

researchmap

Language：English   Publishing type：Research paper (scientific journal)   Publisher：JAPAN SOC INTERNAL MEDICINE  

A 59-year-old man diagnosed as gastric cancer with peritonitis carcinomatosa was treated with paclitaxel and TS-1; 60 mg/m(2)/day of paclitaxel was given on days 1 and 8, and 60-80 mg/m(2)/day of TS-1 was given for 2 weeks. Six courses of combination therapy were administered, and the ascites disappeared completely. Because multiple bone metastases occurred, we attempted combination therapy with cisplatin and irinotecan hydrochloride; 50 or 30 mg/m(2)/day of cisplatin was given on day 1 or day 15, and 70 mg/m(2)/day of irinotecam hydrochloride was given on days 1 and 15. The patient achieved a remarkable response, however, intrameningeal dissemination occurred and he died from rapidly progressive meningitis carcinomatosa.

DOI： 10.2169/internalmedicine.48.1319

Web of Science

researchmap

Language：English   Publishing type：Research paper (scientific journal)  

In pediatric and adolescent patients, the most common causes for a thickened pituitary stalk with central diabetes insipidus are germ cell tumors, lymphocytic infundibuloneurohypophysitis (LIN), and Langerhans cell histiocytosis (LCH). We describe here a 13-year-old girl who had an abrupt onset of polyuria and polydipsia. Magnetic resonance imaging of the brain revealed thickening of the pituitary stalk, and loss of the physiological hyperintense signal of the posterior pituitary gland. Based on a histopathology, she was diagnosed as having LCH. Another LCH lesion was not detected. The prognoses for LCH patients with single-system and single-site are generally good so we decided on only simple observation. The lesion spontaneously regressed 3 months later, resembling a typical self-limiting course of LIN. In conclusion, the present case suggests that 1) radiological differential diagnosis between LIN and LCH is so difficult that histological confirmation is crucial for correct diagnosis, 2) some past cases of histologically-unconfirmed LIN can include LCH, 3) solitary neurohypophyseal LCH can shrink spontaneously up to near remission level.

PubMed

researchmap

DOI： 10.3171/JNS/2008/108/01/0037

PubMed

researchmap

Language：English   Publishing type：Research paper (scientific journal)   Publisher：TAYLOR & FRANCIS INC  

Ocular motor nerve palsies are rare complications of pituitary adenoma. We treated a patient who presented with an isolated abducens palsy and was subsequently found to have a pituitary adenoma. A 62-year-old woman was referred to us for an evaluation of her diplopia. She had an esotropia, which was larger on right gaze, and a limited abduction OD. Visual fields were normal. CT and MRI revealed a sellar region tumor invading the right cavernous sinus without compressing the optic chiasm. A diagnosis of macroprolactinoma was made endocrinologically. Her diplopia and right abducens palsy were quickly resolved and MRI showed significant shrinkage of the tumor after she was treated with cabergoline. A sixth nerve palsy can be the sole presenting feature of pituitary adenoma and can be treated effectively with medication.

DOI： 10.1080/01658100802115155

Web of Science

researchmap

Language：Japanese   Publishing type：Research paper (scientific journal)  

Progress in imaging techniques has contributed to improvements in reliable diagnosis and surgical decision making in neurosurgery. From the viewpoint of neurosurgeons, there are two major needs in the development of imaging techniques. One is greater accuracy in demonstrating the anatomy of the brain at microscopic resolutions and the other is visualization of function or metabolism that is invisible on surgical views. Use of 3.0 T magnetic resonance imaging (MRI) in clinical patients has revealed anatomy appropriate for microsurgery at high resolution, and three-dimensional reconstruction of MRI on high-specification computers helps neurosurgeons to understand the anatomy of the brain in individual patients. Functional imaging methods such as functional MRI, positron emission tomography, and magnetoencephalography have provided new insights in brain surgery, visualizing various cerebral functions on anatomic images. Recently, diffusion tensor imaging is used to visualize neural tracts passing through subcortical white matter and MR spectroscopy is used to show the metabolic status of lesions. These tools are also forms of functional imaging. New noninvasive imaging techniques are still being developed to visualize function more easily. Here, we summarize the roles of recent imaging techniques in our previous studies and discuss the future of imaging in neurosurgery.

PubMed

researchmap

Language：English   Publishing type：Research paper (scientific journal)   Publisher：SPRINGER WIEN  

We present a rare case of complete human Kluver-Bucy syndrome (KBS) following recovery from transtentorial herniation caused by acute subdural haematoma (ASDH). A 17-year-old right-handed high school boy got into stupor within five minutes after 3-rounds of sparing at boxing. Emergency computed tomographic (CT) scan showed right cerebral hemispheric ASDH, which was evacuated following intentional decompressive craniectomy. After recovery of consciousness, he developed emotional changes (placidity with loss of normal fear and anger), psychic blindness, aberrant sexual behaviour, excessive oral tendencies, increased appetite, and hypermetamorphosis in order of mention, which were observed with waxing and waning from 17th to 28th hospital day. Peri-operative CT scaning and magnetic resonance imaging showed lesions of the right temporal lobe and right-dominant orbitofrontal regions including bilateral rectal and medial orbital gyri, and the intact left temporal lobe. Two pathogeneses can be thought of and the whole picture of KBS following ASDH can arise even though one (left in this case) temporal lobe is preserved, 1) in which associated orbitofrontal lesions of the frontal lobes may correlate with occurrence of KBS, or 2) cerebral blood hypoperfusion of both temporal lobes due to increased intracranial pressure and/or compression of both posterior cerebral arteries at the edge of the tentorium cerebelli occurs.

DOI： 10.1007/s00701-004-0373-6

Web of Science

researchmap

DOI： 10.1016/S0006-8993(00)02717-7

PubMed

researchmap

DOI： 10.1016/S0006-8993(00)02717-7

PubMed

researchmap

Language：Japanese   Publisher：(一社)日本小児神経外科学会  

J-GLOBAL

researchmap

Language：Japanese   Publisher：(一社)日本内分泌学会  

J-GLOBAL

researchmap

Language：Japanese  

J-GLOBAL

researchmap

Language：Japanese   Publisher：新潟医学会  

J-GLOBAL

researchmap

Language：Japanese  

J-GLOBAL

researchmap

Language：Japanese   Publisher：新潟医学会  

J-GLOBAL

researchmap

Language：Japanese   Publisher：新潟医学会  

人口構成と健康寿命の変化により、手術適応を有する高齢者脳疾患患者は漸増している。適応を有する高齢者脳疾患の安全な手術は、地域医療を担う脳神経外科が直面している問題のひとつである。同時に、高齢者人口の増加に伴う医療費の増加が懸念されている。高齢者人口比率の高い地域医療における低侵襲手術の意義は、低侵襲が故の、(1)人的医療資産の占有率の低減、(2)医療物資の低消費、(3)時間的資産の低消費、の実現にある。高齢患者と医療提供側の双方に、人的、物的、時間的に少ない負担で、有意・有効な医療効果をあげつつ、医療コストを低く抑え得ると期待される。この観点に立てば、高齢社会の医療に対応するひとつの鍵となり、人口減少地域での病院運営の鍵とも期待される。しかしながら、低侵襲外科の実践において、望まれた結果を得るためには、正確な診断、適切な手術適応、高練度の手術手技、更には標準化された周術期管理が求められ、期待に応えるために要求される医療水準は低くない。所属する外科系診療科の総力を垣間見る指標ともなり、地域の基幹病院の在り方が問われている。当センターでの実践を供覧し、現状(2017年現在)での問題点を考察する。(著者抄録)

J-GLOBAL

researchmap

Language：Japanese   Publisher：新潟医学会  

J-GLOBAL

researchmap

Language：Japanese  

J-GLOBAL

researchmap

Language：Japanese   Publisher：日本神経眼科学会  

researchmap

Language：Japanese   Publisher：新潟医学会  

researchmap

Language：Japanese   Publisher：新潟医学会  

researchmap

Language：Japanese   Publisher：新潟医学会  

researchmap

Language：Japanese   Publisher：新潟医学会  

CiNii Article

CiNii Books

researchmap

Language：Japanese   Publisher：新潟医学会  

researchmap

Language：Japanese   Publisher：新潟医学会  

researchmap

Language：Japanese   Publisher：(一社)日本内分泌学会  

2006〜2014年に初回手術を受けたGH産生下垂体腺腫連続73例を対象に、手術年代により分類し、2006〜2008年の26例をA群、2009〜2011年の19例をB群、2012〜2014年の28例をC群とし、初診時の症状、GH基礎値、合併症および予後を比較した。その結果、C群はA、B群に比べ初診時の軟部組織の肥大が軽度で、GH基礎値が低く、microadenomaが少なからずみられた。また、C群は術前に耐糖能異常を示す患者が少なく、術後さらに減少した。更にC群は術後に照射・投薬などの追加治療を要する症例が少なかった。近年の早期発見傾向は治療成績の向上に寄与し、患者に恩恵をもたらしていると考えられた。

researchmap

Language：Japanese   Publisher：新潟医学会  

researchmap

Language：Japanese   Publisher：新潟医学会  

researchmap

Language：Japanese   Publisher：新潟医学会  

CiNii Article

CiNii Books

researchmap

Other Link： http://search.jamas.or.jp/link/ui/2016135687

Language：Japanese   Publisher：新潟医学会  

CiNii Article

CiNii Books

researchmap

Other Link： http://search.jamas.or.jp/link/ui/2015356125

Language：Japanese   Publisher：新潟医学会  

CiNii Article

CiNii Books

researchmap

Other Link： http://search.jamas.or.jp/link/ui/2015373787

Language：Japanese   Publisher：新潟医学会  

CiNii Article

CiNii Books

researchmap

Language：Japanese   Publisher：新潟医学会  

CiNii Article

CiNii Books

researchmap

Other Link： http://search.jamas.or.jp/link/ui/2014230044

Language：Japanese   Publisher：新潟医学会  

CiNii Article

CiNii Books

researchmap

Other Link： http://search.jamas.or.jp/link/ui/2014230022

Language：Japanese   Publisher：新潟医学会  

CiNii Article

CiNii Books

researchmap

Other Link： http://search.jamas.or.jp/link/ui/2014039925

Language：Japanese   Publisher：新潟医学会  

CiNii Article

CiNii Books

researchmap

Other Link： http://search.jamas.or.jp/link/ui/2013333135

Language：Japanese   Publisher：新潟医学会  

CiNii Article

CiNii Books

researchmap

Language：Japanese   Publisher：(一社)日本小児神経外科学会  

当施設における小児期発症の頭蓋内胚腫の治療成績と長期予後を検討した。対象は、1990年から2009年に初期治療を行った15歳以下の胚腫23名で、88%に照射単独治療(全脳脊髄照射15名、全脳照射5名)を、残り3名に化学療法単独もしくは併用治療を行った。照射単独治療群では、再発を認めなかった。10歳以下で同治療を行った3名で高次脳機能低下を認めた。胚腫における照射単独治療は、治癒が望める有効な治療法ではあるが、低年齢時の放射線治療は、高次脳機能低下を来す可能性があり、年齢や病変の広がりに応じた治療法の検討が必要である。(著者抄録)

CiNii Article

CiNii Books

researchmap

Language：Japanese   Publisher：新潟医学会  

researchmap

Language：Japanese   Publisher：新潟医学会  

CiNii Article

CiNii Books

researchmap

Language：Japanese   Publisher：新潟医学会  

CiNii Article

CiNii Books

researchmap

Language：Japanese   Publisher：(一社)日本内分泌学会  

J-GLOBAL

researchmap

Language：Japanese   Publisher：(一社)日本小児神経外科学会  

researchmap

Language：Japanese   Publisher：(一社)日本内分泌学会  

頭蓋咽頭腫60例を対象に、治療経過の分析、治療方法と内分泌機能・視機能・ADL・高次脳機能・有害事象との関連を検討した。観察期間は平均100.9ヵ月であった。その結果、59例に初回手術が行われ、到達法はpterional/subfrontal approachが27例、anterior/basal interhemispheric approachが23例と多用されていた。手術後放射線治療群は、手術単独群に比べ無増悪生存期間が有意に長かったが、全生存期間に有意差はなかった。全摘・亜全摘群と部分摘出・生検群の間でも、全生存期間に有意差は認めなかった。視機能は治療後44例中32例が改善した。下垂体前葉機能は52例中2例が改善したが、14例で悪化し、41例にホルモン補充療法を要した。尿崩症は11例中1例が改善したが、治療後に25例が新たに尿崩症を呈し、35例でDDAVP投与を要した。腫瘍摘出度・到達法・照射療法の有無と下垂体前葉機能ならびに後葉機能・視機能・KPS・高次脳機能の転帰の間に関連性は認めなかった。

researchmap

Language：Japanese   Publisher：新潟医学会  

CiNii Article

CiNii Books

researchmap

Language：Japanese  

CiNii Article

CiNii Books

researchmap

Language：Japanese  

CiNii Article

CiNii Books

researchmap

Language：Japanese  

CiNii Article

CiNii Books

researchmap

Language：Japanese  

CiNii Article

CiNii Books

researchmap

Language：Japanese   Publisher：新潟大学  

CiNii Article

CiNii Books

researchmap

Other Link： http://search.jamas.or.jp/link/ui/2008183277

Language：Japanese   Publisher：新潟大学  

CiNii Article

CiNii Books

researchmap

Other Link： http://search.jamas.or.jp/link/ui/2008162770

Language：Japanese   Publisher：新潟大学  

CiNii Article

CiNii Books

researchmap

Other Link： http://search.jamas.or.jp/link/ui/2008050075

Language：Japanese   Publisher：(株)医学書院  

researchmap

Other Link： https://search.jamas.or.jp/default/link?pub_year=2007&ichushi_jid=J01228&link_issn=&doc_id=20070226100008&doc_link_id=1573387450881688704&url=https%3A%2F%2Fcir.nii.ac.jp%2Fcrid%2F1573387450881688704&type=CiNii&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00003_1.gif

Language：Japanese   Publisher：新潟大学  

CiNii Article

CiNii Books

researchmap

Other Link： http://search.jamas.or.jp/link/ui/2005047720

Language：Japanese   Publisher：新潟大学  

CiNii Article

CiNii Books

researchmap

Other Link： http://search.jamas.or.jp/link/ui/2004205299

Language：Japanese   Publisher：新潟大学  

CiNii Article

CiNii Books

researchmap

Other Link： http://search.jamas.or.jp/link/ui/2004199909

Language：Japanese   Publisher：新潟大学  

CiNii Article

CiNii Books

researchmap

Other Link： http://search.jamas.or.jp/link/ui/2004125223

Language：Japanese   Publisher：新潟大学  

CiNii Article

CiNii Books

researchmap

Other Link： http://search.jamas.or.jp/link/ui/2003021461

Language：Japanese   Publisher：新潟医学会  

CiNii Article

CiNii Books

researchmap

Other Link： http://search.jamas.or.jp/link/ui/1999129187