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A Case of Male Anorgasmia with Cerebral Infarction

Open Journal of Urology 2012年第3期2卷 151-152页

作者： masato shirai Yoshio Kawachi Shigeto Yanada Hajime Watanabe Youichiro Toyonaga Sousuke Sugimura Toru Sakurai Makoto Fujime Department of Urology Juntendo University Urayasu Hospital Chiba Japan

Objective: The deficit of male orgasm is an unusual clinical condition. This is a case report on secondary male anorgasmia with cerebral infarction. Material and Method: The patient was a 55-year-old man who had suffered from male anorgasmia, acquired type. The patient had a normal erectile response, but ejaculated without any sensation of orgasm. The patient underwent an evaluation by a psychiatrist and an urologist trained in sexual medicine. Result: The results of physical, psychological, and laboratory examination were normal. Brain MRI revealed cerebral infarction at bilateral parietal lobes and frontal lobes. Conclusion: There is a possibility that these brain regions are related to male orgasmic dysfunction.

关键词： Male Anorgasmia Orgasmic Dysfunction Cerebral Infarction Brain Imaging

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Multicentric occurrence of hepatocellular carcinoma with nonalcoholic steatohepatitis

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World Journal of Hepatology 2011年第1期3卷 15-23页

作者： Hirokazu Kawai Minoru Nomoto Takeshi Suda Kenya Kamimura Atsunori Tsuchiya Yasushi Tamura Masahiko Yano Masaaki Takamura masato Igarashi Toshifumi Wakai Satoshi Yamagiwa Yasunobu Matsuda Shogo Ohkoshi Isao Kurosaki Yoshio shirai Masahiko Okada Yutaka Aoyagi Department of Clinical Laboratory Niigata University Medical and Dental Hospital Division of Gastroenterology and Hepatology Niigata University Graduate School of Medical and Dental Sciences Division of Digestive and General Surgery Niigata University Graduate School of Medical and Dental Sciences Department of Medical Technology Niigata University Graduate School of Health Sciences Division of Preventive Medicine Niigata University Graduate School of Medical and Dental Sciences

AIM:To reveal the manner of hepatocellular carcinoma (HCC) development in patients with nonalcoholic steatohepatitis(NASH) focusing on multicentric occurrence (MO) of ***:We compared clinicopathological characteristics between patients with and without MO of HCC arising from NASH *** clinical features were implicated with reference to the literature ***:MO of HCC was identified with histological proof in 4 out of 12 patients with NASH-related HCC(2 males and 2 females).One patient had synchronous MO;an advanced HCC,two well-differentiated HCCs and a dysplastic nodule,followed by the development of metachronous MO of *** other three patients had multiple advanced HCCs accompanied by a well-differentiated HCC or a dysplastic *** these three patients,one had synchronous MO,one had metachronous MO and the other had both synchronous and metachronous *** were no obvious differences between the patients with or without MO in terms of liver function tests,tumor markers and anatomical extent of *** the other hand,all four patients with MO of HCC were older than 70 years old and had the comorbidities of obesity,type 2 diabetes mellitus(T2DM),hypertension and *** these conditions were not limited to MO of HCC,all the conditions were met in only one of eight patients without MO of ***,concurrence of these conditions may be a predisposing situation to synchronous MO of *** particular,old age,T2DM and cirrhosis were suggested to be prerequisite for MO because these factors were depicted in common among two other cases with MO of HCC under NASH in the ***:The putative predisposing factors and necessary preconditions for synchronous MO of HCC in NASH were suggested in this *** investigations are required to clarify the accurate prevalence and predictors of MO to establish better strategies for treatment and prevention leading to the prognostic improvement in NASH.

关键词： Nonalcoholic steatohepatitis Hepatocellular carcinoma Multicentric occurrence

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Polyarteritis nodosa clinically mimicking nonocclusive mesenteric ischemia

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World Journal of Gastroenterology 2013年第23期19卷 3693-3698页

作者： Tsuyoshi shirai Hiroshi Fujii Shinichiro Saito Tomonori Ishii Hideyuki Yamaya Shigehito Miyagi Satoshi Sekiguchi Naoki Kawagishi masato Nose Hideo Harigae Department of Hematology and Rheumatology Tohoku University Graduate School of MedicineSendai 980-8574 Japan Division of Advanced Surgical Science and Technology Tohoku University Graduate School of MedicineSendai 980-8574 Japan Department of Histopathology Tohoku University Graduate School of MedicineSendai 980-8574 Japan

Here, we present the case of a 74-year-old Japanese man with segmental intestinal necrosis, which developed after treatment with pulsed methylprednisolone for mononeuritis multiplex. The patient was weakly positive for myeloperoxidase (MPO)-anti-neutrophil cytoplasmic antibody (ANCA). Computed tomography and surgical findings were compatible with nonocclusive mesenteric ischemia (NOMI). He underwent small intestinal resection by emergency surgery and an intestinal fistula was made. Pathologically, necrotizing vasculitis with fibrinoid necrosis was present in medium to small-sized arteries, which was equivalent to Arkin's classification Ⅱ-Ⅳ. Most of the arteries had fibrous intimal thickening, which was considered to obstruct the arteries and thus cause segmental intestinal necrosis. A diagnosis of polyarteritis nodosa (PAN) was made, and intravenous cyclophosphamide pulse therapy was added to the therapeutic regimen. This patient was successfully treated with these multidisciplinary therapies and his stoma was finally closed. This is a very rare and indicative case of PAN weakly positive for MPO-ANCA and clinically mimicking NOMI, which occurred even after treatment with pulsed methylprednisolone.

关键词： Anti-neutrophil cytoplasmic antibody Intestinal necrosis Myeloperoxidase Nonocclusive mesenteric ischemia Polyarteritis nodosa

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