Brainstem Infarction and Panuveitis due to Sarcoidosis Successfully Treated with Steroid Pulse Therapy

A 36-year-old man visited our hospital because of blurred vision and redness of the conjunctiva. Slit-lamp examination showed panuveitis. Two days later, he suddenly experienced dizziness, speech disturbance, paralysis of his right extremities, and gait disturbances. Neurological examinations suggested that his symptoms were caused by a left lateral medullary lesion. He also had erythema mainly on his trunk. Magnetic resonance imaging (MRI) of his brain demonstrated a small infarct on the left side of the medulla oblongata. Clinical presentation and MRI findings were consistent with the diagnosis of a Wallenberg's syndrome. He also had bilateral hilar lymphadenopathy. A skin biopsy showed granulomatous nodular dermatitis compatible with sarcoidosis. He was treated with steroid pulse therapy and his neurological and ocular symptoms immediately improved. Only seven similar cases of intracranical sarcoidosis have been reported, but none had been treated with steroid pulse therapy. We recommend that steroid pulse therapy be considered to treat patients with sarcoidosis with signs of lesions in the central nervous system

A chin cap type protractor device was used for skeletal mandibular protrusion,A case of orthodontic treatment by extracting maxillary and maxillary premolars while paying attention to lateral changes

Summary This case was a 10–years and 10–month–old girl who visited the hospital with a complaint of opposite anterior bite. Facial findings showed no anterior asymmetry, but lateral features showed a concave type. The molar relationship was Angle Class III on both sides,and the left side showed a more prominent class III relationship. Anterior cross bite and labial inclination of both upper and lower side anterior teeth were observed. The diagnosis was a case of skeletal mandibular protrusion with functional factors. It was decided to use a chin–cap type anterior traction device of the upper jaw that can promote the growth of the upper jaw and suppress the growth of the lower jaw. In the phase of adult treatment, it was decided to extract the maxillary right first premolar, the maxillary left second premolar,and the mandibular bilateral first premolar to establish Angle Class I. At the end of the dynamic treatment, the molar relationship showed Angle Class I on both the left and right sides, and a tight and stable cusp fitting was maintained. Although ANB did not change on the lateral cephalogram, labial inclination was observed on both upper and lower anterior teeth. The dynamic treatment period was 2 years and 11 months, and the end age was 18 years and 1 month. No problem was observed in the occlusal state 4 years after the device was removed, but it will be carefully observed in the future

Incidence rates for hospitalized infections, herpes zoster, and malignancies in patients with ulcerative colitis in Japan: an administrative health claims database analysis

Background/Aims: Patients with ulcerative colitis (UC) are at an increased risk of certain infections and malignancies compared with the general population. Incidence rates (IRs) of hospitalized infections, herpes zoster (HZ), and malignancies in patients with UC, stratified by treatment, in Japan were estimated.Methods: This retrospective study identified patients with UC treated with corticosteroids, immunosuppressants, or tumor necrosis factor inhibitors (TNFi) from 2 administrative databases (Japan Medical Data Center [JMDC] and Medical Data Vision [MDV]). IRs (unique patients with events per 100 patient‐years) were estimated for hospitalized infections, HZ, and malignancies, between June 2010 and May 2018.Results: Among 6,033 MDV patients with UC receiving corticosteroids, immunosuppressants, or TNFi, IRs (95% confidence intervals) were: hospitalized infections, 1.73 (1.52–1.93); HZ, 1.00 (0.85–1.16), and malignancies, 1.48 (1.29–1.66). Among 958 JMDC patients with UC receiving corticosteroids, immunosuppressants, or TNFi, IRs (95% confidence intervals) were: HZ, 1.82 (1.27–2.37) and malignancies, 1.35 (0.87–1.82). In both cohorts, IRs of malignancies were generally similar among patients receiving immunosuppressants, TNFi, or combination therapy (immunosuppressants and TNFi); this was also true for IRs of hospitalized infections and HZ in the MDV cohort. IRs of hospitalized infections, HZ, and malignancies were higher in patients receiving calcineurin inhibitors compared with immunosuppressants or TNFi, in both cohorts.Conclusions: IRs of hospitalized infections, HZ, and malignancies among patients with UC were generally similar regardless of UC treatment, except for calcineurin inhibitors.</jats:p