J Nippon Med Sch
· 2025 Nov · PMID 41242726
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Unlike Langerhans cell histiocytosis (LCH) involving the skull, LCH of the vertebrae and lungs requires careful long-term follow-up because of the risks of motor and respiratory dysfunction; however, few reports have add...Unlike Langerhans cell histiocytosis (LCH) involving the skull, LCH of the vertebrae and lungs requires careful long-term follow-up because of the risks of motor and respiratory dysfunction; however, few reports have addressed this issue. A boy aged 7 years 7 months presented with bilateral shoulder pain and neck pain. Initial imaging revealed C6 vertebral bone lysis, a mass spanning C5-C7, C6 vertebral body flattening, and epidural extension. Chest radiographs and CT scans showed diffuse reticular and funicular shadows, ground-glass opacities, interlobular septal thickening, and swollen hilar lymph nodes. Bone scintigraphy showed cervical accumulation, while gallium scintigraphy revealed diffuse lung uptake. Lung biopsy confirmed LCH (CD1a, S-100, langerin positivity), confirming a diagnosis of multisystem LCH involving lung, bone, skin, and soft tissue. Treatment with cytarabine, vincristine, and prednisolone, in accordance with the Japan LCH Study Group-02 protocol, resulted in rapid respiratory improvement, withdrawal of oxygen, and resolution of neck pain. Seven years after completing chemotherapy, the patient had no neck discomfort and satisfactory cervical motion, normal respiratory function, and no respiratory symptoms. A cervical MRI scan at 1.5 years after the end of chemotherapy showed persistent C6 vertebral flattening from the compression fracture, which remained clinically stable throughout follow-up, with no herniation, mass formation, or epidural recurrence. Chest imaging at a 7-year follow-up examination showed no abnormalities. These findings suggest that timely diagnosis and appropriate chemotherapy yield favorable long-term outcomes in multisystem LCH with vertebral and pulmonary involvement, and avoid major sequelae.
Yamagata S, Yasuda T, Kuge K
… +6 more, Arai H, Kakinuma D, Minamimura K, Watanabe M, Nakamura Y, Yoshida H
J Nippon Med Sch
· 2025 Nov · PMID 41242725
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INTRODUCTION: Because of its lower risk of mediastinal complications, the retrosternal route is commonly used for reconstruction after subtotal esophagectomy. However, cases of postoperative gastric conduit obstruction a...INTRODUCTION: Because of its lower risk of mediastinal complications, the retrosternal route is commonly used for reconstruction after subtotal esophagectomy. However, cases of postoperative gastric conduit obstruction at the thoracic inlet have been reported, as has passage disturbance at the feeding jejunostomy site. These obstructions are often managed by surgical treatment, but few reports have described endoscopic treatment. CASE PRESENTATION: A 75-year-old man with advanced mid-thoracic esophageal cancer underwent three courses of DCF chemotherapy, followed by robotic esophagectomy with gastric conduit reconstruction via the retrosternal route and feeding jejunostomy. Preoperative CT showed no thoracic inlet stenosis. On postoperative day (POD) 7, a barium swallow test revealed cervical esophageal dilation and narrowing of the gastric conduit due to external compression at the thoracic inlet. In addition, a passage disturbance at the feeding jejunostomy site developed later. Endoscopic balloon dilation was performed at both sites on POD 26 and 31, resulting in resolution of both obstructions. The patient resumed adequate oral intake and was discharged without the need for reoperation. CONCLUSIONS: This case suggests that endoscopic balloon dilation is an effective, minimally invasive alternative to surgery for managing postoperative gastric conduit and jejunostomy obstructions after esophagectomy.
J Nippon Med Sch
· 2025 Nov · PMID 41242724
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A transgender (trans) man is a trans person who was assigned female sex at birth. Some trans men undergo gender-affirming surgical procedures, particularly mastectomy. We present a case of keloid formation after gender-a...A transgender (trans) man is a trans person who was assigned female sex at birth. Some trans men undergo gender-affirming surgical procedures, particularly mastectomy. We present a case of keloid formation after gender-affirming mastectomy that highlights the importance of choosing the most appropriate mastectomy technique in patients at risk of keloid and the most effective therapeutic strategies for anterior-chest keloids. A 40-year-old Japanese trans man developed keloids along inverted-T mastectomy-induced anterior-chest scars. The keloids were completely excised, and the defects were closed by primarily using a layered technique. Starting the next day, the wounds were treated with radiotherapy over 3 consecutive days. The wounds/scars were carefully monitored and treated with continuous taping fixation for 1 year. There was no recurrence, and aesthetic outcomes at 18 months were good. To prevent keloids after gender-affirming mastectomy, surgeons must estimate individual risk of keloid formation. If the patient is young, of Asian or African descent, or has a personal or family history of keloids, surgical methods that leave long lateral scars on the anterior chest (e.g., the inverted T procedure) should be avoided. Tensionless or tension-reducing surgical techniques should also be used, along with postoperative radiotherapy, long-term taping or compression, close follow-up to detect early signs of keloid formation, and referral to a plastic surgery department if any scar induration or elevation is observed. Surgeons performing gender-affirming mastectomy can potentially reduce the risk of keloid formation by carefully considering these factors.
Kurata M, Tajiri T, Ueda M
… +8 more, Inomoto C, Sugiyama T, Suzuki T, Izumi H, Kaneko J, Nomura E, Nakamura N, Masugi Y
J Nippon Med Sch
· 2025 Nov · PMID 41242723
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A 78-year-old man was diagnosed as having a submucosal gastric mass (diameter 4 cm). Preoperative findings from endoscopic ultrasound-guided fine needle aspiration suggested a diagnosis of gastric neuroendocrine neoplasm...A 78-year-old man was diagnosed as having a submucosal gastric mass (diameter 4 cm). Preoperative findings from endoscopic ultrasound-guided fine needle aspiration suggested a diagnosis of gastric neuroendocrine neoplasm. Total gastrectomy with excision of a metastatic liver lesion and dissection of gastric lymph nodes was performed. Analysis of frozen sections indicated adenocarcinoma of the peritoneum, which suggested the possibility of a mixed neuroendocrine-non-neuroendocrine neoplasm (MiNEN), based on the presence of solid tubules, metastatic spread, and lymphovascular invasion. However, the smooth gastric mucosal surface, organoid architecture with rare atypia or necrosis, immunopositivity for neuroendocrine markers, a Ki-67 index of 21%, and the presence of somatostatin receptor 2 expression confirmed a final pathological diagnosis of grade 3 gastric neuroendocrine tumor (NETG3) with glandular formation. NETG3 with glandular formation can be difficult to distinguish from MiNEN because their histological features overlap. However, gastric NETG3 with glandular formation is distinguishable from MiNEN by the presence of a submucosal tumor with a histological organoid pattern without frequent mitoses and/or necrosis, immunopositivity for neuroendocrine markers, and the absence of an adenocarcinoma or neuroendocrine carcinoma component within the tumor, as determined by immunohistochemistry for somatostatin receptor 2 expression, Ki-67, and Rb1.
Hayakawa T, Nakamura Y, Masuda H
… +3 more, Takahashi G, Matsutani T, Yoshida H
J Nippon Med Sch
· 2025 Nov · PMID 41242722
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Leptomeningeal metastasis (LM) from colorectal cancer is rare. LM is characterized by rapid progression, making diagnosis and treatment challenging, and are associated with a poor prognosis. A 63-year-old man undergoing...Leptomeningeal metastasis (LM) from colorectal cancer is rare. LM is characterized by rapid progression, making diagnosis and treatment challenging, and are associated with a poor prognosis. A 63-year-old man undergoing chemotherapy with bevacizumab for colorectal cancer was admitted to our hospital with loss of appetite. On admission, he experienced frequent episodes of loss of consciousness. Imaging to identify the underlying cause revealed no abnormalities. Cytological examination of cerebrospinal fluid confirmed LM. Because of worsening symptoms, the patient had difficulty communicating, thus preventing continuation of chemotherapy. He died at 3 weeks post-admission. In patients with cancer who exhibit central nervous system symptoms without abnormal imaging findings, LM should be considered even if the primary tumor is in the transverse colon. In such cases, cytological examination of cerebrospinal fluid and imaging studies should be conducted. This rare case of LM from colorectal cancer after resection and chemotherapy with molecularly targeted agents yielded insights that might guide future treatment strategies.
Shaggy aorta refers to an aorta with intimal roughening due to atheromatous aortic plaques. Catheterization and anticoagulation therapy can result in cholesterol emboli, potentially leading to systemic organ infarction....Shaggy aorta refers to an aorta with intimal roughening due to atheromatous aortic plaques. Catheterization and anticoagulation therapy can result in cholesterol emboli, potentially leading to systemic organ infarction. Contrast-enhanced computed tomography (CT) and transesophageal echocardiography are commonly used to diagnose shaggy aorta. A patient in his ninth decade of life had a history of right occipital lobe ischemic stroke, bilateral internal carotid artery stenosis, and shaggy aorta syndrome related to transfemoral cerebral angiography. Dysarthria occurred immediately after the procedure. Brain magnetic resonance imaging (MRI) confirmed cerebral infarction, and anticoagulant therapy was administered. Four days later, after observing numbness of the left 5th finger and purplish discoloration of the tips of the 2nd and 5th fingers, we performed contrast-enhanced CT and diagnosed shaggy aorta. There was no renal impairment or eosinophilia and the patient was discharged 16 days after the examination. Aortic MRI performed 1 month later revealed an unstable plaque in the vessel wall. Although we report our experience with a single patient, we recommend that patients scheduled for cerebral angiography, especially those with severe arteriosclerosis, undergo preprocedural aortic fast spoiled gradient echo MRI screening to avoid shaggy aorta syndrome.
Mashiko K, Okada K, Hara Y
… +15 more, Takayama H, Nakagawa Y, Kobayashi M, Tsuchiya A, Hayakawa T, Noda T, Ito K, Endo H, Suda T, Yanagawa Y, Kato S, Yamamori Y, Kanemaru K, Yonemori T, Yokobori S
BACKGROUND: The effects of helicopter emergency medical services on the treatment of cerebral infarction remains unclear. We investigated the effects of helicopter transport on outcomes in patients with cerebral infarcti...BACKGROUND: The effects of helicopter emergency medical services on the treatment of cerebral infarction remains unclear. We investigated the effects of helicopter transport on outcomes in patients with cerebral infarction. METHODS: This study included 1,246 patients with cerebral infarction who were assigned to two groups: patients transported by "Doctor-Heli" (DH group) and patients transported by ground ambulances (GA group). Cerebral performance category (CPC), overall performance category (OPC), and in-hospital mortality were evaluated. Multivariate logistic regression analysis was used to adjust for background factors and evaluate a subgroup of patients with severe cerebral infarction (i.e., a National Institutes of Health Stroke Scale (NIHSS) score >10). RESULTS: The DH group included more patients with severe cerebral infarction. No difference was observed in the interval from illness onset to recombinant tissue plasminogen activator treatment between the groups; however, the interval from illness onset to interventional radiology (IR) was significantly shorter in the DH group. The DH group had a lower CPC than the GA group, but there was no significant difference in OPC. Multivariate logistic regression analysis showed that the odds ratio of DH transport for OPC1-2 was 2.33. Subgroup analysis of severe cases yielded odds ratios of 2.19 and 2.62 for CPC1-2 and OPC1-2 respectively. CONCLUSION: The DH group included patients with severe cerebral infarction living in remote areas and provided with emergency IR treatment. This analysis suggested that DH transport improves OPC and CPC, particularly in patients with an NIHSS scores of >10.
BACKGROUND: Role-playing is a key learning method in genetic counseling education, with facilitators playing a crucial role. Although facilitator training exists in other fields, it lacks a structured framework in the co...BACKGROUND: Role-playing is a key learning method in genetic counseling education, with facilitators playing a crucial role. Although facilitator training exists in other fields, it lacks a structured framework in the context of genetic counseling. Identifying the factors contributing to facilitator success can improve the quality of education. This study aims to examine the key factors associated with successful experiences as genetic counseling facilitators. METHODS: An anonymous cross-sectional survey was conducted in September 2023 among 356 members of the Japanese Association of Certified Genetic Counselors. RESULTS: A total of 106 responses (29.7%) were collected, with 45 participants (42.4%) possessing facilitator experience. Logistic regression analysis identified prior learning experiences (OR = 10.02, 95% CI: 1.07-93.7) and confidence as a facilitator (OR = 25.94, 95% CI: 2.27-295.96) as significant factors for successful facilitation. Prior learning experiences correlated with observing inappropriate facilitation (OR = 6.39, 95% CI: 1.25-32.76). Confidence was linked to both skill improvement opportunities (OR = 14.30, 95% CI: 1.41-145.14) and inappropriate facilitation (OR = 9.65, 95% CI: 1.67-55.67). CONCLUSION: Successful facilitator experiences were associated with prior learning and confidence. Inappropriate facilitation played an indirect role in facilitator success. Enhancing confidence through learning opportunities and exposure to facilitation challenges is crucial for facilitator development.
BACKGROUND: Ischemic stroke (IS) is one of the most serious complications after cardiac catheterization. This study aimed to investigate the incidence of IS in patients undergoing cardiac catheterization as well as the r...BACKGROUND: Ischemic stroke (IS) is one of the most serious complications after cardiac catheterization. This study aimed to investigate the incidence of IS in patients undergoing cardiac catheterization as well as the risk factors and neurological prognosis of IS. METHODS: We retrospectively analyzed the data of consecutive 2,848 patients (age 69.1 ± 11.1 years, 2,118 men) who underwent cardiac catheterization from January 2011 to December 2013 to determine the incidence and clinical outcomes of IS. RESULTS: Thirteen patients (0.46%) developed IS after cardiac catheterization, necessitating treatment in the stroke care unit. Multivariate analysis identified five unmodifiable risk factors (age, atrial fibrillation, current smoking, prior stroke, and prior coronary artery bypass graft surgery) and two modifiable risk factors (additional internal thoracic artery angiography and the transbrachial approach) associated with IS. The initial National Institutes of Health Stroke Scale score was 6.9 ± 9.3 at the onset of IS, which improved to 3.1 ± 8.2 at the time of discharge. Five patients demonstrated complete recovery at discharge (modified Rankin Scale [mRS] score = 0), seven demonstrated residual neurological deficit (mRS = 2.7 ± 1.7, including two cases of severe deficit), and one patient died in hospital (mRS = 6). CONCLUSIONS: Although rare, IS following cardiac catheterization is associated with significant morbidity and mortality. Avoiding unnecessary internal thoracic artery angiography and the brachial approach may reduce the incidence, and appropriate use of anticoagulants or thrombolytics may improve the prognosis and decrease residual neurological deficits.
BACKGROUND: Information is limited on the incidence and risk factors for further serious conditions after an in-hospital fall. Using data from the incident-accident reports, we assessed the incidence and risk factors for...BACKGROUND: Information is limited on the incidence and risk factors for further serious conditions after an in-hospital fall. Using data from the incident-accident reports, we assessed the incidence and risk factors for subsequent adverse events (SAEs) among outpatients after in-hospital falls. METHODS: Incident-accident reports from April 2017 to March 2024 at Nippon Medical School Tama Nagayama Hospital were reviewed to identify outpatient falls. Data on patient characteristics and fall-related details were collected. Multivariable logistic regression analysis was performed to identify risk factors for SAEs. RESULTS: We analyzed data from 118 outpatients with in-hospital falls (mean age: 76.4±11.7 years; male: 56.8%): 39 (33.1%) experienced SAEs, including 5 fractures (4.2%), 13 functional disorders (11.0%), 17 surgical procedures (14.4%), and 17 admissions (14.4%). Multivariable analysis showed that males had a significantly higher odds ratio (OR) for SAEs than females, even after adjusting for age (OR, 2.80; 95% CI, 1.21-6.48; P=0.016). For each SAE, the floor of the fall, number of previous falls, and site of the fall were significantly associated with a subsequent fracture, functional disorder, and surgical procedure after an in-hospital fall, respectively. CONCLUSIONS: The incidence rate of SAEs among outpatients with in-hospital falls was 33.1%. Male sex was the only significant risk factor for SAEs, and factors contributing to individual SAE types were distinct. To prevent further adverse outcomes after in-hospital falls, medical staff should pay more attention to patients with these risk factors.
BACKGROUND: Cancer pain distresses pediatric patients, affects quality of life, and is a psychological burden for families. The purpose of this study was to clarify the role of pharmacists in assisting children with canc...BACKGROUND: Cancer pain distresses pediatric patients, affects quality of life, and is a psychological burden for families. The purpose of this study was to clarify the role of pharmacists in assisting children with cancer pain and their families. METHODS: Between February and May 2024, a nationwide questionnaire survey was conducted among hospital pharmacists from the Japanese Society for Pharmaceutical Palliative Care and Sciences. The survey examined pharmacist involvement with children <15 years of age with cancer pain and their families, particularly in pain assessment, explaining analgesic use, and managing psychological, social, and spiritual pain. RESULTS: Of 2,720 pharmacists, 219 (8.1%) responded, 57 of whom (26.0%) had pediatric palliative care experience. Most pharmacists performed pain assessments, provided analgesic explanations (86.0%), and intervened in psychological, social, and spiritual pain (54.4%). Among those who intervened, more than 90% either communicated with patients and their families or listened to their concerns. Pharmacists with ≥5 years of experience were significantly more involved in psychological, social, and spiritual pain than were those with <5 years of experience (odds ratio, 3.46; 95% confidence interval, 1.04-11.54). However, most pharmacists reported difficulties in pain assessment and providing analgesic explanations; the main reasons were "due to patient age and comprehension" (87.0%) and "reluctance to initiate opioid analgesics by patients or their families" (68.3%), respectively. CONCLUSIONS: Pharmacists were actively engaged in pain management for children with cancer and their families. However, most reported difficulties, particularly in pain assessment and analgesic explanations. Therefore, educational programs should be developed to facilitate effective pain management.
BACKGROUND: Triple-negative breast cancer (TNBC) comprises subgroups with distinct characteristics and histological types. Tumor-infiltrating lymphocyte (TIL) concentration and programmed death-ligand 1 (PD-L1) expressio...BACKGROUND: Triple-negative breast cancer (TNBC) comprises subgroups with distinct characteristics and histological types. Tumor-infiltrating lymphocyte (TIL) concentration and programmed death-ligand 1 (PD-L1) expression are prognostic factors for TNBC. We analyzed the association of immune cell PD-L1 expression, in relation to histological type and TIL concentration, with TNBC outcomes. METHODS: Data from 86 patients with TNBC treated between 2008 and 2014 were analyzed. Those treated with immune-checkpoint inhibitors (ICIs) were excluded. PD-L1 expression in immune cells was assessed by immunohistochemistry using an SP142 clone. TIL concentration was measured with hematoxylin and eosin staining. Tumor histology was classified as basal type (G1), apocrine type (G2), metaplastic change (G3), special type (G4), and adenoid cystic carcinoma (G5). RESULTS: The rate of PD-L1 positivity was 2.5%, 17.3%, and 58.6% for patients with TIL concentrations classified as low (TIL-L), moderate (TIL-M), and high (TIL-H) (p < 0.0001). Five-year overall survival (OS) was 78.8% among patients with PD-L1-positive tumors and 81.8% among those with PD-L1-negative tumors. Among TIL-L patients, 5-year OS in PD-L1-positive and -negative tumors was 100% and 77.4%, respectively (p = 0.9993). Among TIL-H patients, 5-year OS for PD-L1-positive and -negative tumors was 73.0% and 83.3%, respectively (p = 0.8241). In multivariate analysis, tumor size and lymphatic vessel invasion were independent prognostic factors for OS. CONCLUSIONS: The rate of PD-L1 positivity was higher in TIL-H patients. Patients classified as TIL-H and PD-L1-positive had worse TNBC outcomes.
BACKGROUND: Current guidelines lack recommendations for serum tumor markers in patients with upper tract urothelial carcinoma (UTUC) undergoing radical nephroureterectomy (RNU). This study assessed the potential of the p...BACKGROUND: Current guidelines lack recommendations for serum tumor markers in patients with upper tract urothelial carcinoma (UTUC) undergoing radical nephroureterectomy (RNU). This study assessed the potential of the postoperative serum C-terminus of cytokeratin 19 (CYFRA21-1, CYFRA) level, hereafter referred to as poCY, as a predictor of early progression in patients treated with RNU. METHODS: Overall, 117 patients were categorized into the high group (HG) or low group (LG) based on a poCY cutoff level of 3.5 ng/mL after excluding those who did not meet the inclusion criteria. Kaplan-Meier curves and log-rank tests were used to measure cancer-specific survival (CSS) and progression-free survival (PFS) rates. Multivariate analysis was performed using the Cox proportional hazards model. RESULTS: During a median follow-up of 34 months, the 5-year CSS and PFS rates were 79% and 66%, respectively. The HG had a significantly worse CSS and 2-year PFS than the LG. Multivariate analyses identified poCY and lymph node involvement (LNI) as independent prognostic factors. Regarding the 2-year PFS, poCY, LNI, and resection margin status (RM) emerged as independent prognostic factors. CONCLUSIONS: poCY, LNI, and RM predicted early progression following RNU in patients with UTUC. Patients with elevated poCY may benefit from adjuvant chemotherapy, irrespective of their pathological findings.
BACKGROUND: Remimazolam is an ultrashort-acting benzodiazepine that maintains stable hemodynamics during anesthesia. However, few reports have focused on hemodynamic stability and opioid use during cardiac surgery with r...BACKGROUND: Remimazolam is an ultrashort-acting benzodiazepine that maintains stable hemodynamics during anesthesia. However, few reports have focused on hemodynamic stability and opioid use during cardiac surgery with remimazolam. We hypothesized that administration of remimazolam for induction and maintenance of anesthesia for transcatheter aortic valve implantation would maintain hemodynamics as effectively as conventional anesthetics and allow use of an appropriate dose of opioids. We compared intraoperative hemodynamics and opioid use in patients with severe aortic stenosis who received remimazolam or conventional anesthetics. METHODS: This retrospective cohort study analyzed data for patients who underwent transcatheter aortic valve implantation from October 2022 to September 2023. The 23 patients were divided into two groups: a remimazolam group and midazolam + sevoflurane group. The primary outcome was intraoperative blood pressure. The secondary outcomes were the doses of vasoconstrictors, vasodilators, and opioids used. RESULTS: There was no significant difference in any patient characteristic or intraoperative blood pressure between the two groups (before anesthesia: 92.0 [87.0-99.8] vs. 91.0 [86.0-107.0] mm Hg, P=0.935; 1 minute after induction of anesthesia: 91.0 [83.0-98.5] vs. 90.0 [86.3-95.3] mm Hg, P=0.843; at the start of surgery: 77.0 [70.0-79.0] vs. 82.5 [75.5-105.5] mm Hg, P=0.072; at the end of surgery: 74.0 [71.0-78.0] vs. 82.5 [75.5-90.8] mm Hg, P=0.082). The maximum rate of remifentanil administration was significantly higher in the remimazolam group (0.10 [0.10-0.20] vs. 0.10 [0.013-0.10] μg/kg/min, P=0.012). CONCLUSIONS: Remimazolam maintained hemodynamics as effectively as midazolam + sevoflurane, even when used in combination with opioids. Remimazolam thus appears to be noninferior to midazolam + sevoflurane.
Shimizu T, Yoshida H, Mamada Y
… +10 more, Taniai N, Yoshioka M, Matsushita A, Kawano Y, Ueda J, Murokawa T, Ono T, Haruna T, Hamaguchi A, Ga R
J Nippon Med Sch
· 2025 Aug · PMID 40866218
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High blood flow and intravariceal pressure in pipeline esophageal varices (EVs) can cause refractory variceal bleeding that is difficult to control with endoscopic procedures and interventional radiology. We used combina...High blood flow and intravariceal pressure in pipeline esophageal varices (EVs) can cause refractory variceal bleeding that is difficult to control with endoscopic procedures and interventional radiology. We used combination therapy with Hassab's procedure (HP) and subsequent endoscopic variceal ligation (EVL) to successfully treat two patients with pipeline EVs.Case 1A woman in her 30s with recurrent hemorrhagic pipeline EVs caused by idiopathic portal hypertension was referred for surgery. Magnetic resonance imaging revealed a dilated left gastric vein (LGV) connected to EVs with no palisade zone. Esophagogastroduodenoscopy (EGD) identified high-risk EVs (Ls, F3, Cw, RC1) and gastric varices (GVs) (Lg-c, F2, Cw, RC0). Eradication of the esophagogastric varices was maintained 5 years after laparoscopic HP followed by EVL at 1, 6 and 16 months postoperatively.Case 2A woman in her 50s with cirrhosis (type B) and enlarged pipeline EVs was referred for prophylactic surgery. Computed tomography (CT) imaging revealed that the EVs were supplied by a dilated LGV without a palisade zone. EGD identified high-risk EVs (Lm, F3, Cb, RC2) and GVs (Lg-c, F3, Cw, RC1). Combination therapy with laparoscopic HP and EVL at 2, 4, and 6 months showed the eradication of esophagogastric varices 8 months after surgery. CT scanning performed 10 days postoperatively in case 2 revealed residual EVs supplied by gastric intramural blood flow, strongly supporting the need for additional EVL after HP. HP involves gastroesophageal devascularization and splenectomy, which reduce blood supply to EVs, facilitating subsequent EVL to eradicate pipeline EVs. This combination therapy appears to enhance outcomes and should be considered a viable option for treating refractory pipeline EVs.
Sugimoto T, Kinoshita Y, Igarashi T
… +5 more, Kurihara M, Ota Y, Ito K, Saeki H, Ogita A
J Nippon Med Sch
· 2025 Aug · PMID 40866217
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A 3-year-old boy presented with recurrent eczema that began at 2 months of age. The patient was treated by multiple dermatologists using topical steroids, topical immunosuppressants, and oral antihistamines. The patient...A 3-year-old boy presented with recurrent eczema that began at 2 months of age. The patient was treated by multiple dermatologists using topical steroids, topical immunosuppressants, and oral antihistamines. The patient was subsequently referred to our clinic for improved symptom control. During the initial visit, he exhibited serous erythema, scaling, and scratch marks on the scalp, face, and limbs. Laboratory findings revealed elevated levels of immunoglobulin E at 5400 IU/mL, thymus and activation-regulated chemokine at 3029 pg/mL, and an Eczema Area and Severity Index score of 16. Due to sleep disturbances caused by nocturnal itching and substantially reduced quality of life, we initiated treatment with dupilumab. A pediatrician conducted pre-treatment assessments, including blood tests and chest radiography. Following the initiation of dupilumab therapy, the pediatrician monitored the patient for potential reactions and side effects, and the dermatologist managed the skin symptoms. This case underscores the importance of interdisciplinary collaboration between pediatrics and dermatology in managing severe eczema in young children treated with dupilumab.