We describe a case of meningeal carcinomatosis of the internal auditory meatus presenting as sudden deafness accompanied by dizziness. A 54-year-old woman complained of acute right-side hearing loss in October 2014. The pure tone audiometry test revealed right-side hearing loss of 47.5 dB. She was treated with oral steroids. Her hearing as well as her symptoms of dizziness worsened and she was admitted for further examination. Her right and left-side hearing had worsened to 105.0 dB and 47.5 dB, respectively. A magnetic resonance imaging scan of the head revealed bilateral enhancement of the internal auditory canal and multiple brain metastases. The chest radiograph revealed a mass in the left lung. Adenocarcinoma of the lung was diagnosed. Lumbar puncture yielded no evidence of carcinoma cells in the cerebrospinal fluid, but an increased number of lymphocytes was confirmed. A diagnosis of multiple brain metastases and leptomeningeal metastasis from the adenocarcinoma of the lung was considered. Whole-brain radiation therapy (30 Gr/10 fractions) was administered. Progressive bilateral hearing loss is a rare first manifestation of meningeal carcinomatosis. It is quite important to consider the possibility of this condition when patients present with sudden deafness.
Adenocarcinoma ; Audiometry ; Brain ; Cerebrospinal Fluid ; Diagnosis ; Dizziness ; Ear, Inner ; Female ; Head ; Hearing ; Hearing Loss ; Hearing Loss, Bilateral ; Hearing Loss, Sudden ; Humans ; Lung ; Lymphocytes ; Magnetic Resonance Imaging ; Meningeal Carcinomatosis ; Middle Aged ; Neoplasm Metastasis ; Radiography, Thoracic ; Spinal Puncture ; Steroids ; Temporal Bone

Methods: We retrospectively evaluated 54 hands of 40 girls with AIS who visited Nara Medical University Hospital from 2000 to 2015 using previously collected radiographs. The examiners included a spine surgeon and a pediatric orthopedic surgeon, each with over 10 years of experience. The reliability of the DRU and sTW3 was evaluated using the kappa coefficient. Results: The left-hand radiographs of 40 female patients with AIS (mean age, 13.9±1.7 years; N=54 hands) were evaluated by two blinded examiners using the sTW3 and DRU methods. The highest inter-observer and intra-observer reliabilities (kappa, 0.64 and 0.62, respectively) for radius evaluation were determined. Radius evaluation by the DRU showed the highest agreement rate and smallest error between the inter- and intra-observer examinations. Conclusions The DRU was the most reliable assessment tool, and it has the potential to be useful for precisely determining the stage of skeletal maturity in outpatient clinics.

PURPOSE: Recently, the clinical application of the forced oscillation technique (FOT) has progressed with the spread of commercially available FOT devices, including the impulse oscillation system and MostGraph. We investigated the usefulness of color 3D imaging of respiratory impedance in asthma using MostGraph. METHODS: Whole-breath and within-breath respiratory system resistance (Rrs) and reactance (Xrs) were measured in 78 patients with asthma. Color 3D images were classified into three patterns: the chronic obstructive pulmonary disease (COPD)-like pattern (high values of Rrs and Xrs with a marked respiratory cycle and frequency dependence), the asthma pattern (moderately high Rrs over the entire frequency and a respiratory cycle with slight Xrs changes), and a normal-like pattern (low Rrs and Xrs with few within-breath changes). The classification was performed by three researchers, who were unaware of the clinical information, and the clinical characteristics were compared among the three groups. RESULTS: Color 3D imaging provided a COPD-like pattern in 25 patients, an asthma pattern in 39 patients, and a normal-like pattern in 14 patients. Patients with the COPD-like pattern were predominantly female with a higher body mass index, lower forced expiratory volume in 1 second (FEV1) and forced vital capacity (FVC), and higher Rrs and Xrs values (whole-breath and within-breath variation). Those with the normal pattern had higher FEV1 and FVC, and a lower single-breath nitrogen washout slope. There were no differences in asthma control or exhaled nitric oxide levels among the three groups. CONCLUSIONS: These results suggest that color 3D imaging of respiratory impedance may show asthma phenotypes.
Asthma ; Body Mass Index ; Electric Impedance ; Female ; Forced Expiratory Volume ; Humans ; Nitric Oxide ; Nitrogen ; Phenotype ; Pulmonary Disease, Chronic Obstructive ; Respiratory System ; Vital Capacity

Background/Aims: Metabolic dysfunction-associated steatotic liver disease (MASLD) was recently proposed as an alternative disease concept to nonalcoholic fatty liver disease (NAFLD). We aimed to investigate the prognosis of patients with biopsy-confirmed MASLD using data from a multicenter study. Methods: This was a sub-analysis of the Clinical Outcome Nonalcoholic Fatty Liver Disease (CLIONE) study that included 1,398 patients with NAFLD. Liver biopsy specimens were pathologically diagnosed and histologically scored using the NASH Clinical Research Network system, the FLIP algorithm, and the SAF score. Patients who met at least one cardiometabolic criterion were diagnosed with MASLD. Results: Approximately 99% of cases (n=1,381) were classified as MASLD. Patients with no cardiometabolic risk (n=17) had a significantly lower BMI than patients with MASLD (20.9 kg/m2 vs. 28.0 kg/m2, P<0.001), in addition to significantly lower levels of inflammation, ballooning, NAFLD activity score, and fibrosis stage based on liver histology. These 17 patients had a median follow-up of 5.9 years, equivalent to 115 person-years, with no deaths, liver-related events, cardiovascular events, or extrahepatic cancers. The results showed that the prognosis for pure MASLD was similar to that for the original CLIONE cohort, with 47 deaths and one patient who underwent orthotopic liver transplantation. The leading cause of death was extrahepatic cancer (n=10), while the leading causes of liver-related death were liver failure (n=9), hepatocellular carcinoma (n=8), and cholangiocarcinoma (n=4). Conclusions Approximately 99% of NAFLD cases were considered MASLD based on the 2023 liver disease nomenclature. The NAFLD-only group, which is not encompassed by MASLD, had a relatively mild histopathologic severity and a favorable prognosis. Consequently, the prognosis of MASLD is similar to that previously reported for NAFLD.