Journal Of Nippon Medical School = Nippon Ika Daigaku Zasshi[JOURNAL]
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200 papers
Investigation of the Optimal Interval of Perioperative Serum Flomoxef Administration in Hepatobiliary-Pancreatic Surgery.
Takayama Y, Komatsu T, Tsumuraya S … +8 more , Kubo H, Nishizawa N, Tajima H, Kaizu T, Otori K, Okamoto H, Kumamoto Y, Hanaki H
J Nippon Med Sch · 2025 · PMID 40399116 · Publisher ↗
BACKGROUND: Perioperative prophylactic antimicrobials are re-administered at intervals of twice their half-life. However, the actual concentrations of antimicrobial agents and the degree of elevation remain unelucidated....
BACKGROUND: Perioperative prophylactic antimicrobials are re-administered at intervals of twice their half-life. However, the actual concentrations of antimicrobial agents and the degree of elevation remain unelucidated. METHODS: This prospective cohort study was conducted at a single tertiary care center. Serum concentrations were evaluated in patients who underwent hepatobiliary-pancreatic surgery between April 2019 and December 2020 and received an additional dose of flomoxef (FMOX) every 3 h or 5 h during the surgical procedure based on their renal function. RESULTS: Among the 31 participants, 25 and six received FMOX every 3 h and 5 h, respectively. Analysis based on renal function revealed median FMOX concentrations of 9.88 mg/L and 9.85 mg/L (p = 0.09) for patients with creatinine clearance (Ccr) >60 mL/min and 14.26 mg/L and 20.03 mg/L (p = 0.02) for the patients with Ccr ≤60 mL/min at 3 h and 6 h, respectively, with notable elevation at Ccr ≤60 mL/min. Moreover, the serum FMOX concentration at 6 h for the 3-h dosing patients with Ccr ≤60 mL/min was significantly higher than the concentration at 5 h for the 5-h dosing patients with Ccr ≤60 mL/min (20.03 mg/L vs. 12.85 mg/L, p = 0.04). Although serum concentrations at 3-h and 6-h intervals did not differ significantly in patients with Ccr ≥60 mL/min, these significantly increased in patients with Ccr <60 mL/min. CONCLUSIONS: Administering FMOX every 3 h when Ccr is ≥60 mL/min and every 5 h when Ccr is <60 mL/min are appropriate.
Phase II Study of Short Hydration without Diuretics for Cisplatin-Based Chemotherapy.
Wako T, Arakawa R, Nakamichi S … +11 more , Matsumoto M, Yamaguchi R, Shimbu K, Inoue T, Tozuka T, Aoyama J, Kato Y, Onda N, Miyanaga A, Seike M, Kubota K
J Nippon Med Sch · 2025 · PMID 40399115 · Publisher ↗
BACKGROUND: Diuretics are commonly used to reduce renal dysfunction during cisplatin-based chemotherapy; however, reports suggest that renal function is unaffected when diuretics are not administered. This phase II trial...
BACKGROUND: Diuretics are commonly used to reduce renal dysfunction during cisplatin-based chemotherapy; however, reports suggest that renal function is unaffected when diuretics are not administered. This phase II trial evaluated the effectiveness and safety of a short hydration method without diuretics. METHODS: Patients were included if they were aged 20-74 years, had a thoracic malignancy for which a cisplatin-based regimen (dose: ≥60 mg/m) was indicated, and had adequate renal function. All patients received cisplatin-based chemotherapy using a short hydration method without diuretics. The primary endpoint was the proportion of patients without grade 2 or higher elevations in creatinine levels during the first cycle of cisplatin. RESULTS: Forty-six patients were enrolled between June 2019 and April 2022. The patients included 38 men and 8 women with a median age of 64 years (range: 45-74 years). Of these, 13 patients received adjuvant chemotherapy, 19 received chemoradiotherapy, 1 received chemotherapy for post-surgical recurrence, and 13 received chemotherapy for advanced disease. The median number of chemotherapy cycles was 3 (range: 1-4). A total of 93.5% (43/46) of the patients completed cisplatin-based chemotherapy without grade 2 or higher creatinine elevation during the first cycle, and 84.8% (39/46) of participants, including those who discontinued treatment, did not show grade 2 or higher creatinine elevation after all cycles of cisplatin-based chemotherapy. CONCLUSIONS: Short hydration without diuretics is safe for patients receiving cisplatin-containing chemotherapy. Randomized trials with or without diuretics in this setting are warranted.
Incidence Rate and Risk Factors for In-Hospital Ischemic Stroke among 83,990 Hospitalized Patients.
Sakurai S, Suzuki K, Nishino T … +6 more , Hayashi D, Saito T, Sakamoto Y, Aoki J, Nishiyama Y, Kimura K
J Nippon Med Sch · 2025 · PMID 40399114 · Publisher ↗
BACKGROUND: Details of in-hospital stroke are unknown. This study aimed to clarify the incidence rate and risk factors for in-hospital stroke among all inpatients. METHODS: This retrospective single-center study included...
BACKGROUND: Details of in-hospital stroke are unknown. This study aimed to clarify the incidence rate and risk factors for in-hospital stroke among all inpatients. METHODS: This retrospective single-center study included consecutive patients admitted to our hospital. Patients aged <18 years, discharged within 24 h, and admitted to the neurology and neurosurgery departments were excluded. The incidence rate for in-hospital stroke was calculated, and patients were divided into stroke and control groups based on ischemic stroke occurrence, and the risk factors were assessed using multivariate analysis. RESULTS: Of the 83,990 enrolled patients, 101 (0.12%) developed stroke. The stroke group had a higher proportion of patients with older age (76 vs 69 years; P <.01), hypertension (49% vs 26%; P <.01), diabetes mellitus (34% vs 22%; P =.01), atrial fibrillation (25% vs 8%; P <.01), cardiovascular disease (20% vs 11%; P =.01), and emergency admission (68% vs 32%; P <.01) compared to the control group. The risk factors for in-hospital stroke were old age (odds ratio [OR], 1.03; P <.01), hypertension (OR, 1.57; P =.04), diabetes mellitus (OR, 1.61; P =.03), atrial fibrillation (OR, 2.43; P <.01), emergency admission (OR, 3.38; P <.01), and low serum albumin (OR, 0.66; P =.03). CONCLUSION: The incidence rate of in-hospital stroke was 0.12% and the independent risk factors were old age, history of hypertension, diabetes mellitus, atrial fibrillation, emergency admission, and low serum albumin.
Sentinel Lymph Node Detection, Location, and Number on SPECT/CT Can Help Predict Pathological Axillary Lymph Node Metastasis in Women with Breast Cancer.
Hankyo M, Murakami R, Takei H … +5 more , Yanagihara K, Kurita T, Sakatani T, Ohashi R, Kumita S
J Nippon Med Sch · 2025 · PMID 40399113 · Publisher ↗
BACKGROUND: Use of radiocolloids for sentinel lymph node (SLN) detection in breast cancer (BC) offers the advantage of utilizing single-photon emission computed tomography/computed tomography (SPECT/CT). This study explo...
BACKGROUND: Use of radiocolloids for sentinel lymph node (SLN) detection in breast cancer (BC) offers the advantage of utilizing single-photon emission computed tomography/computed tomography (SPECT/CT). This study explored whether SPECT/CT findings can predict pathological axillary lymph node (ALN) metastasis. METHODS: A consecutive series of patients with invasive BC (clinical stage, T1-3, N0, and M0) who underwent SLN biopsy (SLNB) using SPECT/CT between January 2011 and December 2016 were included. SLN detection, location, and number on SPECT/CT, number of excised SLNs, and clinical and pathological characteristics were analyzed in relation to pathological ALN metastasis. RESULTS: Data from 408 patients (412 cases) with BC were analyzed. Patient age ranged from 28 to 93 years (mean: 59). SPECT/CT identified one to four SLNs (mean: 1.3) in 407 cases (98.8%) and no SLNs in 5 cases (1.2%). Of the 407 cases with at least one identified SLN, SLNs were solely in level I of the axilla in 394 cases (96.8%), both in and outside level I in 12 (2.9%), and solely outside of level I in 1 (0.2%). The number of ALNs removed via SLNB ranged from one to eight (mean: 2.0). SPECT/CT findings, including absence of SLN detection (P<0.001), SLN locations outside of axillary level I (P<0.001), and an increased number of SLNs (P=0.034), as well as removal of ≥3 SLNs (P=0.028), were significantly correlated with pathological ALN metastasis. CONCLUSIONS: SLNB with SPECT/CT yields useful information on pathological ALN metastasis in BC patients.
On-Scene Time and Outcomes in Patients with Out-of-Hospital Cardiac Arrest and Return of Spontaneous Circulation at the Scene: A Post-Hoc Analysis of a Multicenter Cohort Study.
Numata H, Tagami T, Suzuki K … +8 more , Tabata R, Kohri M, Amano T, Hagiwara S, Kitano S, Kitamura N, Homma Y, Ogawa S
J Nippon Med Sch · 2025 · PMID 40399112 · Publisher ↗
BACKGROUND: The optimal on-scene time after the return of spontaneous circulation (ROSC) following out-of-hospital cardiac arrest (OHCA) has not been established. This study aimed to investigate the relationship between...
BACKGROUND: The optimal on-scene time after the return of spontaneous circulation (ROSC) following out-of-hospital cardiac arrest (OHCA) has not been established. This study aimed to investigate the relationship between the on-scene time after ROSC and neurological outcomes. METHODS: We analyzed data recorded in the SOS-KANTO 2017 registry between September 2019 and March 2021. Patients with OHCA who achieved ROSC on the scene were included and categorized into three groups based on on-scene time after ROSC (0-<6 min, 6-<10 min, and ≥10 min). Comparisons were performed using multiple propensity score analysis. The primary outcome was favorable neurological status at one month, defined as cerebral performance categories 1 and 2. RESULTS: In total, 331 patients were included. Favorable neurological outcomes at one month were observed in 29.1% (32/123) of patients in the 0-<6 min group, 37.2% (35/104) in the 6-<10 min group, and 36.3% (29/104) in the ≥10 min group. There was no significant association between shorter on-scene times (0-<6 min) and favorable neurological outcomes at one month compared to the other groups (adjusted odds ratio [AOR], 0.97; 95% confidence interval [CI], 0.39-2.41 for 6-<10 min; AOR, 0.90; 95% CI, 0.30-2.70 for ≥10 min). CONCLUSION: Differences in on-scene time after ROSC were not significantly associated with favorable neurological outcomes at one month. Future research should focus on identifying factors that may influence outcomes, and on exploring strategies to enhance care in the Japanese EMS context.
Constipation in Patients with Acute Ischemic Stroke: A Single-Center Retrospective Analysis.
Kutsuna A, Nishiyama Y, Sakamoto Y … +6 more , Suzuki F, Hayashi T, Fujisawa Y, Suzuki K, Aoki J, Kimura K
J Nippon Med Sch · 2025 · PMID 40399111 · Publisher ↗
BACKGROUND: Constipation, a symptom of autonomic nervous system dysfunction affecting gastrointestinal motility, is common after acute ischemic stroke. The insular cortex is associated with autonomic symptoms, and damage...
BACKGROUND: Constipation, a symptom of autonomic nervous system dysfunction affecting gastrointestinal motility, is common after acute ischemic stroke. The insular cortex is associated with autonomic symptoms, and damage to the left insula may result in constipation. We investigated the association between constipation and left-sided insular infarction in patients with acute stroke. METHODS: We retrospectively analyzed data from consecutive patients who received a diagnosis of acute infarction in the middle cerebral artery territory between January 2015 and December 2018. Constipation was defined as bowel movements less often than three times a week or a prescription for laxatives within 2 weeks of stroke onset. Clinical characteristics and factors associated with constipation were evaluated. RESULTS: Among 892 patients (mean age, 75 [66-82] years; male, 566 [63.5%]), 301 (32.8%) had constipation. Infarction involving the insula (57.7% vs. 25.1%) and left-sided infarction (62.5% vs. 46.4%) were more frequent in patients with constipation than in those without constipation. In multivariable analysis, infarction involving the insula (adjusted odds ratio [aOR], 2.30; 95% confidence interval [CI], 1.57-3.36; P<0.001), left-sided infarction (aOR, 1.93; 95% CI, 1.40-2.64; P<0.001), and baseline National Institutes of Health Stroke Score (aOR, 1.04; 95% CI, 1.01-1.06; P<0.001) were associated with constipation. The incidence of constipation was highest in cases of left-sided infarction with insular involvement (69.2%). CONCLUSIONS: Left-sided infarction, infarction involving the insular cortex, and baseline National Institutes of Health Stroke Score were identified as independent factors associated with constipation in patients with acute stroke.
Mitral Regurgitation Associated with Mitral Annulus Remodeling and Left Atrial Dilatation.
Izumi Y, Tokita Y, Honma H … +3 more , Ito-Hagiwara K, Iwasaki YK, Asai K
J Nippon Med Sch · 2025 · PMID 40399110 · Publisher ↗
BACKGROUND: Atrial functional mitral regurgitation (MR) involves functional MR with left atrial (LA) dilatation and mitral annulus (MA) remodeling. The relationship between LA dilatation and MA remodeling, and the mechan...
BACKGROUND: Atrial functional mitral regurgitation (MR) involves functional MR with left atrial (LA) dilatation and mitral annulus (MA) remodeling. The relationship between LA dilatation and MA remodeling, and the mechanism of MR associated with MA remodeling, are unclear and were investigated in this study. METHODS: This single-center, cross-sectional retrospective study prospectively enrolled 97 consecutive patients with atrial fibrillation (AF) referred for three-dimensional transesophageal echocardiography. Mitral valve echocardiographic data of 18 AF patients with moderate or severe MR (MR group) and 79 with mild or less severe MR (non-MR group) were analyzed. RESULTS: The LA volume index was larger and tenting height was lower in the MR group than in the non-MR group (63.9±17.9 mL/m vs. 43.6±13.9 mL/m; p<0.001; 3.9 mm vs. 4.9 mm; p = 0.041). Anteroposterior (AP) diameter, annulus area, and sphericity index (AP diameter/anterolateral-posteromedial diameter) of MA were larger in the MR group than in the non-MR group (30.1 mm vs. 26.4 mm; p<0.001; 8.8 cm vs. 7.4 cm; p = 0.002; 80.1% vs. 74.5%; p<0.001, respectively). Linear regression analysis indicated that AP diameter was moderately correlated with LA volume index (R = 0.535, p<0.001). The area under the receiver operating characteristics curve of the AP diameter for the association with significant MR was significantly larger than that for the annulus area (0.8003 vs. 0.7180; p = 0.003). Multivariable analysis revealed that AP diameter (p = 0.006) and sphericity index (p = 0.041) were independently associated with significant MR, but annulus area was not (p = 0.083). CONCLUSIONS: LA dilatation correlated with MA remodeling, primarily via enlargement of AP diameter. Circular change with AP diameter enlargement in MA may be a key mechanism of MR associated with MA remodeling.
Saisei-Gakusha and Hideyo Noguchi's Temporary Return to Japan.
Shimura T, Gemma A, Tokura T
J Nippon Med Sch · 2025 · PMID 40399109 · Publisher ↗
During the period from September 5 to November 4, 1915 (Taisho 4), the bacteriologist Dr. Hideyo Noguchi temporarily returned to Japan after living and working in the United States for 15 years. This article discusses th...
During the period from September 5 to November 4, 1915 (Taisho 4), the bacteriologist Dr. Hideyo Noguchi temporarily returned to Japan after living and working in the United States for 15 years. This article discusses the many lectures he delivered during his visit, particularly those at the alumni meeting of Saisei-Gakusha, the institution from which he graduated, and the Mita Speech Meeting at Keio University. Additionally, this paper provides an overview of Saisei-Gakusha, a private medical school from the Meiji era that later became the predecessor of Nippon Medical School, highlighting its founding philosophy of "Saisei" (to save lives). It also introduces materials such as Noguchi's handwritten Curriculum Vitae and Autograph, which he prepared while studying abroad at the Rockefeller Institute for Medical Research. Furthermore, we examine an article from The New York Times reporting on Noguchi's serious illness several years after his return to the United States, as well as related articles from Japanese newspapers. We also present a thank-you postcard and a business card sent by Noguchi to his close friend Dr. Shinichi Wani, a fellow alumnus of Saisei-Gakusha, illustrating their enduring friendship. These materials reflect Noguchi's meticulous nature, thoughtful personality, and warm character, as seen through his relationship with his dear friend Wani.
Tarsal Tunnel Syndrome: A Clinical Review.
Yoshida H, Kim K, Tajiri T … +4 more , Fujihara F, Matsumoto J, Abe H, Isu T
J Nippon Med Sch · 2025 · PMID 40399108 · Publisher ↗
Tarsal tunnel syndrome (TTS) is elicited by compression of the tibial nerve in the tarsal tunnel. TTS in the absence of a lesion tends to be idiopathic, and most TTS is idiopathic. Patients complain of several plantar sy...
Tarsal tunnel syndrome (TTS) is elicited by compression of the tibial nerve in the tarsal tunnel. TTS in the absence of a lesion tends to be idiopathic, and most TTS is idiopathic. Patients complain of several plantar symptoms, and TTS affects their quality of life. The symptoms tend to worsen with walking, and ankle joint movement and arterial distortion may also be involved. Because TTS symptoms are similar to those of diabetic neuropathy and lumbar disease, clinical symptoms are diagnostically important. While magnetic resonance imaging reveals nerve compression, it is difficult to identify causative factors, and false-positive results are a concern. Wound-related complications after TTS surgery may be reduced by a zigzag skin incision. Surgery for carpal tunnel syndrome yields better outcomes and greater patient satisfaction than TTS surgery.
Multiple Functions of Cell Adhesion Molecule 1 (CADM1) and Its Role in the Pathogenesis of Cancer and Other Diseases.
Murakami Y, Kasai Y, Masuda T … +2 more , Ichihara H, Ito T
J Nippon Med Sch · 2025 · PMID 40399107 · Publisher ↗
Cell adhesion molecule 1 (CADM1) is an immunoglobulin superfamily cell adhesion molecule that was first identified as a tumor suppressor in non-small cell lung cancer because of its role in suppressing tumor formation in...
Cell adhesion molecule 1 (CADM1) is an immunoglobulin superfamily cell adhesion molecule that was first identified as a tumor suppressor in non-small cell lung cancer because of its role in suppressing tumor formation in nude mice. CADM1 forms a homophilic dimer on the cell membrane and associates with actin-binding proteins (4.1s) and scaffold proteins (MAGuKs), which contain PDZ motifs. It forms a ternary protein complex involved in cell adhesion and the formation of epithelium-like structure. While CADM1 is expressed in epithelium, neuronal tissue, and testes, CADM1 expression is absent in many cancers of epithelial origin, including cancers of the lung, esophagus, stomach, liver, pancreas, breast, and prostate. In addition to its tumor-suppressive activity in epithelial cell adhesion, CADM1 acts as a tumor antigen, recognized by activated NK cells and CD8+ T cells through heterophilic interaction with CRTAM, thereby serving as a tumor suppressor in two ways. In contrast, CADM1 is overexpressed in adult T-cell leukemia/lymphoma (ATL) cells, making it a specific diagnostic marker of ATL on FACS analysis. CADM1 is also highly expressed in small cell lung cancer (SCLC) and other neuroendocrine tumors, and promotes metastasis, suggesting its potential as a target for diagnosis and treatment of SCLC. CADM1 also has a role in synapse formation and spermatogenesis, and deficient or abnormal CADM1 is linked to disorders such as male infertility in mice and autism spectrum disorder. Here, we summarize the multiple functions of CADM1 and its involvement in cancer and other diseases, focusing on disorders of aberrant cell adhesion.
Microtia with Coexistent Large External Auditory Canal Cholesteatoma: A Case Report.
Matsunobu T, Suzuki H, Sakuma N … +2 more , Ohashi R, Okubo K
J Nippon Med Sch · 2026 Jan · PMID 40128972 · Publisher ↗
Microtia is a congenital disorder characterized by an anomaly in the auricle. It is often associated with atresia, stenosis, or obstruction of the external auditory canal. In cases of microtia, the incidence of a normal...
Microtia is a congenital disorder characterized by an anomaly in the auricle. It is often associated with atresia, stenosis, or obstruction of the external auditory canal. In cases of microtia, the incidence of a normal external auditory canal, congenital external auditory canal stenosis, and congenital complete closure of the external auditory canal (aural atresia) is reported to be 8%, 8%, and 84%, respectively. Congenital stenosis of the external auditory canal can sometimes be accompanied by intractable otorrhea and otalgia, raising the possibility of complications of external auditory canal cholesteatoma. Here, we report a case of an adult with microtia and external auditory canal stenosis who presented to our clinic with complaints of otalgia. A large external auditory canal cholesteatoma was found in the patient's left ear. Although cholesteatoma is common in cases of canal stenosis, its extensive spread within the temporal bone is quite rare. A temporal bone-targeted computed tomography scan revealed a soft tissue shadow in the left external auditory canal with distensible expansion and bony destruction in the upper, anterior, and posterior walls of the external auditory canal. In patients with microtia who experience severe aural pain, the possibility of latent extended cholesteatoma should be considered.
Video-Assisted Thoracoscopic Surgery for Catamenial Pneumothorax: A Report of Five Cases Treated by Diaphragm Reefing with and without Chemical Pleurodesis.
Kubokura H, Tomioka Y, Okamoto J … +2 more , Yoshino N, Usuda J
J Nippon Med Sch · 2026 Jan · PMID 40128971 · Publisher ↗
BACKGROUND: Catamenial pneumothorax (CP), the most common manifestation of thoracic endometriosis syndrome, is a rare form of primary spontaneous pneumothorax that occurs in women of reproductive age. Although CP is usua...
BACKGROUND: Catamenial pneumothorax (CP), the most common manifestation of thoracic endometriosis syndrome, is a rare form of primary spontaneous pneumothorax that occurs in women of reproductive age. Although CP is usually treated surgically or with hormonal therapy, there is no standard treatment and recurrence is common. We performed video-assisted thoracoscopic surgery (VATS) for five patients with CP from 2014 to 2023. METHODS: Our surgical basic procedure (BP) was as follows. VATS was performed by using one port site for the camera and a 5-cm mini-thoracotomy. Perforated holes or blueberry spots were detected on the diaphragm, and lesions were ligated with an endoscopic loop. After reefing by ligation, the diaphragm was covered with a polyglycolic acid sheet. Three methods were used: (A) BP only (one case); (B) BP with tetracycline plus OK432 (two cases); (C) BP with tetracycline (two cases); because the use of OK432 (an anti-cancer agent) was disallowed in 2019 in our Institutional Review Board rules for patients with benign disease. RESULTS: Age ranged from 33 to 45 years (mean, 38.6±5.1 years), and CP occurred on the right side in all cases. Recurrence occurred in only two of the five cases (one case each for procedures B and C). CONCLUSION: Our procedure (diaphragm reefing by ligation and covering with a polyglycolic acid sheet) was a more convenient and more effective treatment for CP.
Familial Congenital Ossicular Anomaly: A Case Report.
Matsunobu T, Suzuki H, Okubo K
J Nippon Med Sch · 2026 Jan · PMID 40128970 · Publisher ↗
Middle ear anomalies are uncommon in persons with intact auricles and external auditory canals. Most reported cases have been sporadic, and only a few were inherited. Every anomaly can be explained by embryonic ear devel...
Middle ear anomalies are uncommon in persons with intact auricles and external auditory canals. Most reported cases have been sporadic, and only a few were inherited. Every anomaly can be explained by embryonic ear development. Here, we report a case of bilateral congenital ossicular anomalies in a 7-year-old girl without anomalies of the external ear canal or tympanum. Her mother and two maternal aunts had the same congenital incudostapedial disconnection. A school examination revealed bilateral hearing loss (53.3 dB in the right ear and 51.7 dB in the left ear) indicative of bilateral conductive hearing loss. Her mother and two maternal aunts also had bilateral conductive hearing loss. Surgery on her left ear revealed the absence of the long limbs of the incus and incudostapedial disconnection. An interposition was performed between the crura of the stapes, the handle of the malleus, and the body of the incus. Postoperatively, hearing levels improved in both ears. Although the heredity pattern is unclear, we identified four individuals in the same family with the same bilateral anomalies, suggesting a hereditary origin.
Vagal Reflex-Induced Asystole during Suspension Laryngoscopy: A Rare Complication.
Matsunobu T, Okubo K, Saito K
J Nippon Med Sch · 2026 Jan · PMID 40128969 · Publisher ↗
Suspension laryngoscopy is commonly used in diagnostic and operative procedures involving the larynx. This study presents a rare case of asystole during suspension laryngoscopy. A 58-year-old woman with an unremarkable m...
Suspension laryngoscopy is commonly used in diagnostic and operative procedures involving the larynx. This study presents a rare case of asystole during suspension laryngoscopy. A 58-year-old woman with an unremarkable medical history underwent suspension laryngoscopy for a left polypoid vocal cord under general anesthesia. Anesthesia induction and tracheal intubation were performed without complications. However, upon inserting a direct laryngoscope and exposing the larynx, her heart rate gradually decreased and asystole occurred. The direct laryngoscope was immediately removed, and atropine sulfate was injected. Spontaneous circulation was restored after 20 s of asystole. The direct laryngoscope was then re-inserted, and the operation was successfully completed without complications. Asystole was attributed to stimulation of the pharyngolaryngeal mucosa through direct laryngoscope-induced vagal reflex. This case highlights the need for surgeons and anesthesiologists to be aware of this rare but potentially life-threatening complication and emphasizes the importance of vigilant electrocardiography monitoring during direct laryngoscope adjustment.
Use of Sialendoscopy to Diagnose Sialodochitis Fibrinosa: A Case Report.
Matsunobu T, Suzuki H, Shimizu A … +2 more , Sakamoto K, Okubo K
J Nippon Med Sch · 2026 Jan · PMID 40128968 · Publisher ↗
First reported by Kussmaul in 1879, sialodochitis fibrinosa is a disease of the parotid and/or submandibular glands that is characterized by pain and diffuse swelling. It is believed to be caused by obstruction of the sa...
First reported by Kussmaul in 1879, sialodochitis fibrinosa is a disease of the parotid and/or submandibular glands that is characterized by pain and diffuse swelling. It is believed to be caused by obstruction of the salivary duct by mucofibrinous plugs and is often misdiagnosed as other types of sialadenitis, such as Sjögren's syndrome, or sialadenitis caused by bacterial or viral infection. Although specific diagnostic criteria have not been defined, the typical pathological finding of sialodochitis fibrinosa is infiltration of lymphocytes and eosinophils into the interstitium around the salivary ducts. Sialendoscopy, a minimally invasive endoscopic technique, has recently been used to diagnose and treat diseases of the salivary glands. This new technique can be used to irrigate and dilate the salivary gland ducts under direct vision. We successfully used sialendoscopy to diagnose and treat sialodochitis fibrinosa, making this the first reported use of this technique for salivary gland biopsies. Sialendoscopy is a modern approach to salivary gland disorders that was helpful for understanding, diagnosing, and managing sialodochitis fibrinosa.
Aggravation of Pre-Existing Cervical Spondylotic Myelopathy with Limb Paralysis Following Lumbar Puncture: A Case Report.
Yamazaki A, Mishina M, Sakamaki M … +2 more , Nagao T, Kimura K
J Nippon Med Sch · 2026 Jan · PMID 40128967 · Publisher ↗
This case report highlights a rare occurrence of paraplegia following lumbar puncture (LP) in the presence of cervical disc herniation during cerebrospinal fluid (CSF) drainage. The patient was an elderly woman undergoin...
This case report highlights a rare occurrence of paraplegia following lumbar puncture (LP) in the presence of cervical disc herniation during cerebrospinal fluid (CSF) drainage. The patient was an elderly woman undergoing investigation for suspected neoplastic meningitis who experienced sudden acute paraplegia on the day following the LP procedure. LP is often contraindicated in patients with intracranial lesions. If patients exhibit myelopathy symptoms, such as increased lower extremity reflexes and positive Hoffmann and Trömner's signs without intracranial lesions, a thorough evaluation for occupying lesions, including cervical spondylotic myelopathy, is recommended before LP is carried out.
Large First Branchial Cyst Extending into the Parapharyngeal Space: A Case Report.
Matsunobu T, Kurioka T, Okubo K
J Nippon Med Sch · 2026 Jan · PMID 40128966 · Publisher ↗
Cystic diseases of the salivary gland include mucous cysts and plunging ranula; cysts in the parotid region are rare. In this report, we describe a case of a first branchial cyst in the parotid region. The cyst extended...
Cystic diseases of the salivary gland include mucous cysts and plunging ranula; cysts in the parotid region are rare. In this report, we describe a case of a first branchial cyst in the parotid region. The cyst extended into the parapharyngeal space and was repeatedly infected. The patient was a 35-year-old woman who presented to our hospital with a mass on the left lower ear. Imaging findings revealed a cystic lesion in the parotid region that extended to the parapharyngeal space. A yellowish slurry was aspirated on a percutaneous fine-needle aspiration biopsy. Cytology revealed a class II tumor. The patient initially showed signs of infection and was treated with intravenous antimicrobial agents. After the infectious inflammation had resolved, surgery was performed to resect the cyst. The infection did not recur postoperatively. A large first branchial cyst extending into the parapharyngeal space, which communicates with Stensen's duct, is rare. Care must be taken during surgery because of the complicated positional relationship between the first branchial cyst, parotid gland, and facial nerve.
Immune Checkpoint Inhibitor-Related Immunoglobulin A Nephropathy in a Patient with Advanced Head and Neck Cancer.
Aratani S, Matsunobu T, Nakaishi M … +5 more , Shimizu A, Kashiwagi T, Sakai Y, Okubo K, Iwabu M
J Nippon Med Sch · 2025 Nov · PMID 40128965 · Publisher ↗
Immune checkpoint inhibitors (ICIs) have revolutionized the treatment of many cancers, including cancers of the head and neck. Despite the promising therapeutic efficacy of ICIs, immune-related adverse events (irAEs) are...
Immune checkpoint inhibitors (ICIs) have revolutionized the treatment of many cancers, including cancers of the head and neck. Despite the promising therapeutic efficacy of ICIs, immune-related adverse events (irAEs) are a major concern. Acute tubular injury and interstitial nephritis are the most common irAEs involving the kidneys. The present patient was diagnosed as having advanced papillary squamous cell carcinoma of the head and neck. After failure of the initial treatments, including chemotherapy, nivolumab (programmed death-1 inhibitor) was introduced. Shortly after initial administration of nivolumab, the patient developed acute kidney injury with hematuria and proteinuria. A renal biopsy and his clinical course indicated a diagnosis of ICI-related IgA nephropathy. Although glomerular involvement in irAEs is rare and challenging to treatment, the present patient was successfully treated with steroids, which improved kidney function and led to complete remission, as confirmed by urinalysis.
Effect of Perfusion CT on Time Required to Evaluate Indications for Thrombectomy for Acute Cerebral Infarction.
Mihara R, Ideguchi M, Kim K … +2 more , Koketsu K, Murai Y
J Nippon Med Sch · 2025 · PMID 40058841 · Publisher ↗
BACKGROUND: Rapid treatment of patients with emergency large vessel occlusion (ELVO) improves outcomes. With Vitrea software, the cerebral infarct size and penumbra can be quantified, and 4D images can be constructed qui...
BACKGROUND: Rapid treatment of patients with emergency large vessel occlusion (ELVO) improves outcomes. With Vitrea software, the cerebral infarct size and penumbra can be quantified, and 4D images can be constructed quickly. We investigated the performance of Vitrea in ELVO patients. METHODS: To evaluate indications for mechanical thrombectomy, we performed plain brain CT, then MRI (group 1, n=30). In May 2022 we acquired perfusion CT scans with Vitrea after plain CT on the same equipment (group 2, n=27) and then compared time from onset to the end of mechanical thrombectomy. At 1 month post-treatment we recorded the neurological outcome by using the modified Rankin scale (mRS). We also compared the infarction areas identified with Vitrea and MRI the day after treatment using DWI-ASPECTS in 25 of 27 patients in group 2. We excluded 2 patients with basilar artery occlusion because this type of occlusion is not included in DWI-ASPECTS. RESULTS: There were no significant intergroup differences in patient characteristics, time from admission or puncture to re-canalization, and outcome 1 month after treatment. Vitrea overestimated the infarct area in 1 of 25 patients (4.0%). Times from admission to transit for examination, to the examination end, and time from admission to puncture, were significantly shorter in group 2. CONCLUSIONS: In ascertaining indications for thrombectomy in patients with acute cerebral stroke, perfusion CT with Vitrea shortened time to treatment. However, further investigation is needed to confirm the accuracy of Vitrea in determining the infarct area.
Effects of Biologics on Fibrosis-4 Index in Patients with Psoriasis.
Morita T, Ichiyama S, Ito M … +8 more , Ozaki S, Arai T, Atsukawa M, Iwakiri K, Hagino T, Hoashi T, Kanda N, Saeki H
J Nippon Med Sch · 2025 · PMID 40058840 · Publisher ↗
BACKGROUND: Psoriasis is accompanied by systemic inflammation that includes the liver. The fibrosis-4 (FIB-4) index was developed to predict significant liver fibrosis. The present study evaluated the effects of biologic...
BACKGROUND: Psoriasis is accompanied by systemic inflammation that includes the liver. The fibrosis-4 (FIB-4) index was developed to predict significant liver fibrosis. The present study evaluated the effects of biologics, including TNF inhibitors, on the FIB-4 index in psoriasis patients. METHODS: All adult patients with psoriasis who were prescribed biologics (TNF inhibitors, IL-17 inhibitors, or IL-23 inhibitors) at Nippon Medical School from June 2014 to January 2024 for the first time (biologic-naïve patients) were included in this study. The FIB-4 index was calculated before and after 6 months of treatment with biologics. RESULTS: A total of 105 patients were enrolled. The FIB-4 index was higher after 6 months of treatment with TNF inhibitors (P=0.0018) and IL-17 inhibitors (P=0.045) but did not change with IL-23 inhibitors. Aspartate aminotransferase and alanine aminotransferase levels did not change after treatment with TNF inhibitors, IL-17 inhibitors, or IL-23 inhibitors. Platelet count decreased after treatment with TNF inhibitors (P=0.0011) and IL-23 inhibitors (P=0.039) but did not change with IL-17 inhibitors. CONCLUSIONS: Downregulation of platelets seems to be a major contributing factor for the increase in FIB-4 index in patients treated with TNF inhibitors. Although the FIB-4 index is a simple marker to screen for liver fibrosis, changes in this index should be interpreted with caution, and imaging findings such as transient elastography should also be used to evaluate the status of liver fibrosis.
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