BACKGROUND: In the field of orthopedics, few studies have examined pain associated with soft tissue tumors. To accurately and promptly diagnose soft tissue tumors and provide appropriate treatment, it is necessary to hav...BACKGROUND: In the field of orthopedics, few studies have examined pain associated with soft tissue tumors. To accurately and promptly diagnose soft tissue tumors and provide appropriate treatment, it is necessary to have a comprehensive understanding of the relationship between soft tissue tumors and pain. METHODS: We analyzed data from patients with mass lesions in the extremities or trunk diagnosed by biopsy or surgery in our department and patients with ganglion cysts diagnosed by puncture between October 1, 2005, and September 30, 2011. Using medical records, we retrospectively investigated the clinical data. RESULTS: Data from 473 patients with 482 lesions were analyzed. Pain was observed in 204 of the 482 lesions (42.3%). So-called painful tumors accounted for approximately half of the painful lesions (45.0%). Logistic regression indicated that pain was significantly associated with so-called painful tumors (odds ratio [OR]: 5.64; P < 0.001), inflammatory nodules (OR: 3.42; P = 0.007), and sites with strong physical stimulation (OR: 2.45; 95% confidence interval [CI]: 1.58-3.81; P < 0.001) but not with long diameter (OR: 0.90; P = 0.001) or malignancy (OR: 1.78; P = 0.144). CONCLUSION: Our findings suggest that so-called painful tumors account for approximately half of soft tissue mass lesions requiring surgery, biopsy, or puncture in orthopedics. It is thus important to have a clear understanding of such tumors. Inflammatory nodules are also important in the differential diagnosis of painful soft tissue lesions. Lesions at sites exposed to strong physical stimulation can cause pain.
BACKGROUND: We retrospectively examined image quality (IQ) of thin-slice virtual monochromatic imaging (VMI) of half-iodine-load, abdominopelvic, contrast-enhanced CT (CECT) by dual-energy CT (DECT) with deep learning im...BACKGROUND: We retrospectively examined image quality (IQ) of thin-slice virtual monochromatic imaging (VMI) of half-iodine-load, abdominopelvic, contrast-enhanced CT (CECT) by dual-energy CT (DECT) with deep learning image reconstruction (DLIR). METHODS: In 28 oncology patients with moderate-to-severe renal impairment undergoing half-iodine-load (300 mgI/kg) CECT by DECT during the nephrographic phase, we reconstructed VMI at 40-70 keV with a slice thickness of 0.625 mm using filtered back-projection (FBP), hybrid iterative reconstruction (HIR), and DLIR; measured contrast-noise ratio (CNR) of the liver, spleen, aorta, portal vein, and prostate/uterus; and determined the optimal keV to achieve the maximal CNR. At the optimal keV, two independent radiologists compared each organ's CNR and subjective IQ scores among FBP, HIR, and DLIR to subjectively grade image noise, contrast, sharpness, delineation of small structures, and overall IQ. RESULTS: CNR of each organ increased continuously from 70 to 40 keV using FBP, HIR, and DLIR. At 40 keV, CNR of the prostate/uterus was significantly higher with DLIR than with FBP; however, CNR was similar between FBP and HIR and between HIR and DLIR. The CNR of all other organs increased significantly from FBP to HIR to DLIR (P < 0.05). All IQ scores significantly improved from FBP to HIR to DLIR (P < 0.05) and were acceptable in all patients with DLIR only. CONCLUSIONS: The combination of 40 keV and DLIR offers the maximal CNR and a subjectively acceptable IQ for thin-slice VMI of half-iodine-load CECT.
BACKGROUND: We evaluated the effects of drug therapy on T lymphocyte subsets and their associations with recurrent chronic bronchitis (CB) attacks. METHODS: A total of 162 CB patients treated from April 2020 to April 202...BACKGROUND: We evaluated the effects of drug therapy on T lymphocyte subsets and their associations with recurrent chronic bronchitis (CB) attacks. METHODS: A total of 162 CB patients treated from April 2020 to April 2021 were selected. All patients underwent anti-infective, cough-relieving, and phlegm-eliminating treatment, as detailed in Clinical Pathway for Chronic Bronchitis. They were divided into a recurrent attack group (n=95) and a non-recurrent attack group (n=67). Changes in T lymphocyte subsets at different time points of treatment and their associations with the number of attacks were analyzed. Associated factors were analyzed in a multivariate logistic regression model, and their predictive value was validated using a nomogram prediction model and receiver operating characteristic (ROC) curves. RESULTS: The number of attacks at 1 year after treatment was positively correlated with CD8 and negatively correlated with CD3, CD4, and CD4/CD8. A history of smoking, CD3, CD4, CD8, and CD4/CD8 were independent risk factors for recurrent attacks. The nomogram prediction model showed that the total risk value corresponding to smoking history, low CD3, CD4, and CD4/CD8, and elevated CD8 was 0.86, and the concordance index and area under the ROC curve of the model was 0.896 (95% CI: 0.782-0.997, P<0.05) and 0.816 (95% CI: 0.803-0.847, P<0.001), respectively. There was an association between T lymphocyte subsets and recurrent attacks before and after treatment of CB. CONCLUSIONS: Low CD3, CD4/CD8 and CD4, elevated CD8, and smoking history were risk factors for recurrent attack.
BACKGROUND: Both ultraviolet B (UVB) phototherapy with 308-nm excimer light and excimer laser devices are widely used to treat vitiligo. While the devices share the 308-nm wavelength, they have distinct characteristics....BACKGROUND: Both ultraviolet B (UVB) phototherapy with 308-nm excimer light and excimer laser devices are widely used to treat vitiligo. While the devices share the 308-nm wavelength, they have distinct characteristics. Notably, the excimer laser exhibits laser properties (monochromatic coherent light) and unique device specifications (a high frequency of 400 Hz and a remarkably high irradiance of 83 million mW/cm). This study compared excimer light and laser irradiation, focusing on the depth of penetration into hair follicles and the effects on activation of melanocyte lineage cells, including melanocyte stem cells (McSCs) and melanoblasts. METHODS: We irradiated the dorsal skin of mice with both devices at 1,000 mJ/cm. Samples taken at 15 min and 3, 24, and 72 h after irradiation were used for immunostaining analysis. We evaluated penetration depth by using the staining pattern of cyclobutane pyrimidine dimers (CPDs), induction of apoptosis by using a terminal deoxynucleotidyl transferase-mediated deoxy-uridine triphosphate nick end-labeling (TUNEL) assay, and activation of melanocyte lineage cells by using fluorescent double immunostaining for TRP2 and β-catenin. RESULTS: The excimer laser induced significantly more CPDs in the deeper regions of hair follicles while causing significantly faster removal of CPDs and less apoptosis in the epidermis. Moreover, the percentage of TRP2-positive cells with nuclear β-catenin in the follicles was significantly higher with the excimer laser. CONCLUSIONS: As compared with excimer light, the excimer laser penetrated more deeply into hair follicles, resulted in fewer epidermal side effects, and activated significantly more melanocyte-lineage cells.
BACKGROUND: Although advances in neoadjuvant chemotherapy (NAC) are improving the rate of pathological complete response (pCR) and outcomes for triple-negative breast cancer (TNBC) patients, the prognosis remains poor. I...BACKGROUND: Although advances in neoadjuvant chemotherapy (NAC) are improving the rate of pathological complete response (pCR) and outcomes for triple-negative breast cancer (TNBC) patients, the prognosis remains poor. Insulin-like growth factor II mRNA-binding protein 3 (IMP3) expression was recently reported to be associated with chemotherapy resistance and poor prognosis in TNBC. METHODS: We evaluated IMP3 expression in 40 female TNBC patients to assess its association with NAC sensitivity and outcome. RESULTS: Among the cohort, 11 patients (27.5%) had IMP3-positive TNBC, which was associated with a higher Ki-67 labeling index (p = 0.119), indicating greater malignancy. However, IMP3 positivity showed no significant correlation with NAC resistance or differences in disease-free survival (DFS) as compared with IMP3-negative patients. CONCLUSIONS: Patients receiving effective immunotherapy or high-dose chemotherapy achieved pCR regardless of IMP3 status, which suggests that the NAC regimen is more important than IMP3 status for pCR. Even in IMP3-positive TNBC, NAC may improve prognosis by achieving pCR. Thus, while IMP3 might predict poor prognosis, it may not serve as a definitive marker in the context of NAC. Because IMP3 is involved in cancer stem cell (CSC) function, further research is necessary to understand its complex role in CSCs and TNBC.
BACKGROUND: Diagnosis of bone metastases would be hastened if they could be detected on plain radiographs obtained at the first visit to an orthopedic surgeon. However, lesions are often undetectable on plain radiography...BACKGROUND: Diagnosis of bone metastases would be hastened if they could be detected on plain radiographs obtained at the first visit to an orthopedic surgeon. However, lesions are often undetectable on plain radiography. Bone metastasis is diagnosed at the first visit in only a few patients, and diagnosis is delayed in many cases. We investigated the diagnostic performance of plain radiography that used a new image processing method, Dynamic Visualization II (DV), to diagnose bone metastases. METHODS: We enrolled 29 patients with symptomatic pelvic bone metastases who visited our hospital between April 2018 and March 2021. The evaluation images were created by processing the original plain radiography data with the default settings for DV (Presets 1-4). Processing with Preset 1 resulted in an image converted to conventional film parameters, whereas Presets 2-4 utilized different DV processing methods. The readers were six orthopedic trainees, and the reading time was 30 seconds per image. The rate of correct answers for images processed with Preset 1 was compared to the rates for those processed with the other presets. Additionally, the rate of correct answers was analyzed in relation to clinical variables. RESULTS: The correct answer rate was significantly higher for Preset 3 (43.7%) and Preset 4 (42.5%) than for Preset 1 (28.7%). Correct answer rates for Presets 3 and 4 were significantly higher for elderly patients, male patients, patients with innominate bone lesions, patients with osteolytic bone metastases, and patients with a normal body weight. CONCLUSIONS: Image processing by DV improved diagnosis of bone metastases by plain radiography. DV might hasten diagnosis of bone metastases and help prevent associated complications.
BACKGROUND: Osteoporosis-related fragility fractures such as proximal femoral and vertebral fractures are associated with decreased activities of daily living and a shorter life span. Many persons with osteoporosis do no...BACKGROUND: Osteoporosis-related fragility fractures such as proximal femoral and vertebral fractures are associated with decreased activities of daily living and a shorter life span. Many persons with osteoporosis do not receive testing or treatment. Introducing fracture liaison services (FLSs) to hospitals is an effective approach for reducing this treatment gap. Understanding interest in osteoporosis among nurses and physicians, their knowledge of osteoporosis, and their thoughts on team medicine for treatment of osteoporosis might be helpful when implementing FLSs. METHODS: An FLS had not been introduced at our hospital. We conducted a questionnaire survey of nurses and physicians at our hospital regarding their interest in osteoporosis, their knowledge of osteoporosis, and their thoughts on team medicine for osteoporosis. RESULTS: About half of the nurses and physicians were interested in osteoporosis. About 70% of nurses and physicians believed that team medicine was necessary for treating osteoporosis, and 50-60% believed that it should be introduced in the hospital. Only 5% of nurses and 18% of physicians had knowledge of FLSs. CONCLUSION: Staff perceptions of team care for osteoporosis were generally supportive in our hospital. However, the introduction of an FLS to the hospital required educational activities for staff. The results of this survey will be helpful to other hospitals introducing FLSs.
BACKGROUND: The purpose of this study was to determine whether cases of placenta previa and low-lying placenta previa in patients with retroverted uterus are significantly associated with endometriosis. METHODS: Particip...BACKGROUND: The purpose of this study was to determine whether cases of placenta previa and low-lying placenta previa in patients with retroverted uterus are significantly associated with endometriosis. METHODS: Participants were patients who underwent cesarean section at our hospital with a diagnosis of placenta previa or low-lying placenta previa within a 7-year period from January 2015 to December 2022. Of these, patients with multiple pregnancies and those without a complete uterine image in the medical record at less than 12 weeks' gestation were excluded. Included patients were divided into two groups according to the presence or absence of endometriosis. The presence of endometriosis was determined based on intraoperative findings. A retrospective case-control study was conducted by examining the presence or absence of retroverted uterus during early pregnancy and the presence or absence of posterior placenta. RESULTS: A total of 110 patients were included, 32 in the group with endometriosis and 78 in the group without endometriosis. There were 15 (46.9%) cases of retroverted uterus in the group with endometriosis and 17 (21.8%) in the group without endometriosis, indicating significantly more cases in the group with endometriosis (P=0.01). There were 15 (46.9%) cases of retroverted uterus with posterior placenta in the group with endometriosis and 16 cases (20.5%) in the group without endometriosis, indicating significantly more cases in the group with endometriosis (P=0.009). CONCLUSION: Placenta previa and low-lying placenta previa in cases of retroverted uterus are significantly associated with endometriosis.
The Oikawa-Nagao (ON) mouse is a polygenic animal model of type 2 diabetes and obesity developed by selective breeding of mice with inferior glucose tolerance [diabetes-prone (ON mouse DP; ON-DP) strain] and superior glu...The Oikawa-Nagao (ON) mouse is a polygenic animal model of type 2 diabetes and obesity developed by selective breeding of mice with inferior glucose tolerance [diabetes-prone (ON mouse DP; ON-DP) strain] and superior glucose tolerance [diabetes-resistant (ON mouse DR; ON-DR) strain]. Hybrid mice of three different inbred strains (C57BL/6, AKR, and AKR) were fed a high-fat diet and then selectively bred for higher and lower post-challenge blood glucose levels in oral glucose tolerance tests over 20 generations. Compared to ON-DR mice, ON-DP mice were found to be predisposed to develop obesity and diabetes after being fed a high-fat diet. Our recent studies suggest that the emergence of these phenotypes is associated with novel pathophysiology of type 2 diabetes and obesity, such as low insulin secretion capacity associated with high CD36 expression in pancreatic β-cells and hypoleptinemia preceding obesity due to low leptin secretion capacity in adipocytes. In addition, it has been suggested that ON-DP mice fed an atherogenic diet are a suitable model to reproduce atherosclerotic lesion formation due to fluctuations in blood glucose levels. This may facilitate the elucidation of mechanisms underlying diabetic macrovascular complications. This review will present the development strategy of the ON mouse strain, representative metabolic phenotypes and their underlying mechanisms. Furthermore, their relevance to the pathophysiology of type 2 diabetes and obesity in humans will be discussed.
MicroRNA (miRNA) is a small RNA molecule that does not code for proteins, and organ- and disease-specific miRNAs are being investigated as diagnostic tools and therapeutic targets, particularly for cardiovascular disease...MicroRNA (miRNA) is a small RNA molecule that does not code for proteins, and organ- and disease-specific miRNAs are being investigated as diagnostic tools and therapeutic targets, particularly for cardiovascular disease and cancer. Much remains unknown about how anesthetics, other drugs, and perioperative management affect miRNAs, but miRNA-targeted drugs might eventually be used perioperatively. This review examines changes in miRNA expression related to anesthesia management. Sevoflurane results in gene expression patterns that differ by organ. The author investigated changes in miRNA expression induced by anesthetics in the brain, lungs, and liver and found that changes in miRNA expression differ by drug and organ. Since miRNA does not have a one-to-one correspondence with its target mRNA and exhibits complex effects within and between cells, as well as remotely, drug- and organ-specific changes in mRNA expression caused by anesthetics likely involve complex alterations. Cardiovascular disease and cancer are related to perioperative management via miRNAs. Inhalational anesthetics may exacerbate or suppress cellular activity, depending on the type of cancer, and the mechanisms of action differ depending on the inhalational anesthetic. These findings suggest that propofol is more likely to contribute to suppression of cancer cells through intercellular communication. The role of miRNA in perioperative management remains unclear. In the future, it is expected that changes in miRNA expression will be considered when selecting and administering anesthetic drugs perioperatively.
Informed consent (IC) is closely related to shared decision making (SDM), and SDM can lead to IC. IC is fundamental to medical ethics as described in the Geneva, Helsinki, and Lisbon declarations and is essential for cli...Informed consent (IC) is closely related to shared decision making (SDM), and SDM can lead to IC. IC is fundamental to medical ethics as described in the Geneva, Helsinki, and Lisbon declarations and is essential for clinical practice, as it provides legal protection for healthcare professionals. IC should be achieved through SDM based on both narrative-based medicine and evidence-based medicine. SDM should also involve healthcare professionals other than physicians (e.g., nurses, pharmacists, social workers). Communication skills for IC are important and are encapsulated in the SPIKES protocol. IC for breast cancer treatment requires explanation of the roles of local and systemic therapy. A documented "do not attempt resuscitation" order should be obtained for end-of-life IC.
The reliable engraftment of skin grafts into areas with complex shapes can be challenging. Here, we report a case of successful fixation of a genital skin graft using negative pressure wound therapy (NPWT) with RENASYS C...The reliable engraftment of skin grafts into areas with complex shapes can be challenging. Here, we report a case of successful fixation of a genital skin graft using negative pressure wound therapy (NPWT) with RENASYS Cotton Filler. A 44-year-old male with no relevant medical history underwent split-thickness skin grafting for a genital skin defect caused by Fournier's gangrene. A 0.4-mm sheet graft was applied for the penile skin defect, while 0.4-mm 1.5 times mesh grafting was applied for the testis and spermatic cord. NPWT with a cotton filler was used for seven days of fixation. No postoperative pain or stool contamination was observed. Although a small area of partial necrosis developed, the lesion healed with conservative treatment. Six months after surgery, there was no scar contracture, urination disorder, or pain during erection. Cotton fillers are highly malleable and adaptable, allowing for simple and reliable fixation of skin grafts in complex areas. Moreover, NPWT for genital graft fixation avoids contamination from stools. Therefore, we recommend fixation using NPWT with a cotton filler for genital skin grafting.
A patient with trigeminal neuralgia due to venous compression was successfully treated by transposition achieved by drilling the suprameatal tubercle. A 53-year-old woman presented with classical trigeminal neuralgia aff...A patient with trigeminal neuralgia due to venous compression was successfully treated by transposition achieved by drilling the suprameatal tubercle. A 53-year-old woman presented with classical trigeminal neuralgia affecting the maxillary division of the right trigeminal nerve. MRI and CT revealed a bony prominence, called the suprameatal tubercle, above the opening of the internal acoustic meatus. MRI showed a thick venous flow void interposed between the suprameatal tubercle and trigeminal nerve. The patient underwent retrosigmoid craniotomy. The bony prominence restricted transposition of the compressed vein, so the compressed vein was successfully transposed after drilling the prominence. The patient's symptoms resolved completely. Drilling the suprameatal tubercle is useful for transposing sandwiched compression vessels.
As a blood flow control technique for embolization using glue (n-butyl cyanoacrylate; NBCA) for peripheral artery aneurysm/pseudoaneurysm, we placed a vascular plug or coils at the proximal inflow vessel before glue inje...As a blood flow control technique for embolization using glue (n-butyl cyanoacrylate; NBCA) for peripheral artery aneurysm/pseudoaneurysm, we placed a vascular plug or coils at the proximal inflow vessel before glue injection. We describe this maneuver, which we call the glue in lockdown technique. Four peripheral aneurysms-two pulmonary artery pseudoaneurysms, one pancreaticoduodenal arcade pseudoaneurysm, and one internal iliac artery aneurysm-deemed unsuitable for conventional embolization because of abnormal blood flow, coagulopathy, or anatomical complexity were embolized with our technique. Technical and clinical outcomes were reviewed to evaluate the effectiveness of the procedure. Reliable and rapid embolization was achieved in coagulopathy cases and hemodynamically or anatomically complicated lesions. Glue in lockdown technique was successfully used to treat peripheral aneurysms and can be further developed for application to other lesions.
An infant was diagnosed as having X-linked agammaglobulinemia (XLA) at age 3 months and was receiving immunoglobulin replacement therapy. He developed SARS-CoV-2 infection at age 7 months and was treated with intravenous...An infant was diagnosed as having X-linked agammaglobulinemia (XLA) at age 3 months and was receiving immunoglobulin replacement therapy. He developed SARS-CoV-2 infection at age 7 months and was treated with intravenous immunoglobulin, remdesivir, and dexamethasone. His respiratory symptoms improved quickly, and the infection resolved. Viral disappearance was confirmed via PCR, and the result of a SARS-CoV-2 test was negative on day 67 of illness, as a result of antiviral therapy. Immunoglobulin administered to the patient did not contain anti-SARS-CoV-2 antibodies, and no seroconversion of anti-SARS-CoV-2 antibodies was observed after healing. These findings suggest that humoral immunity did not contribute to infection in our patient. Thus, the importance of cellular immunity against COVID-19 was confirmed. In the future, it is hoped that testing companies will be able to use the ELISPOT assay to check cellular immunity in order to confirm the effectiveness of vaccines and the history of infection.
In patients not infected by HIV, Pneumocystis jirovecii pneumonia (PCP) is characterized by rapid disease progression, difficulty in confirming the diagnosis, and poor prognosis. PCP has also been reported in immunocompr...In patients not infected by HIV, Pneumocystis jirovecii pneumonia (PCP) is characterized by rapid disease progression, difficulty in confirming the diagnosis, and poor prognosis. PCP has also been reported in immunocompromised patients receiving chemotherapy, most often for hematologic tumors, although some patients receiving treatment for breast cancer have been affected. Dose-dense chemotherapy (DDC) which is performed with shorter dosing intervals than standard chemotherapy and is now widely used in clinical practice. However, adverse events have been reported, including infections associated with decreased immune status. PCP infection is considerably more challenging to diagnose and treat than bacterial or viral infections. Furthermore, organizing pneumonia (OP), a pulmonary lesion of PCP, is infrequent and requires caution on the part of clinicians, as protozoan infections require different forms of treatment. Although we initially suspected bacterial, viral, and drug-induced pneumonia in our patient and started treatment with antibiotics, antifungals, and prednisolone, the final diagnosis was OP. The pulmonary lesion of PCP was treated with systemic corticosteroids, leading to recovery. There have been no similar reports of PCP during chemotherapy for malignant disease; however, the possibility of OP should be considered during chemotherapy. Herein, we report a case of PCP during preoperative DDC for advanced breast cancer.
The abdominal wall is an uncommon site for endometriosis that occurs in the soft tissues of the wound site after laparotomy. The present study reviewed cases of post-cesarean section abdominal wall endometriosis that wer...The abdominal wall is an uncommon site for endometriosis that occurs in the soft tissues of the wound site after laparotomy. The present study reviewed cases of post-cesarean section abdominal wall endometriosis that were surgically treated at our institution from April 2007 to August 2020. We analyzed data from nine patients who were diagnosed with abdominal wall endometriosis and selected surgery after receiving sufficient explanation of hormone therapy and from patients who reported no improvement in symptoms with hormone therapy. Written consent for case reporting was obtained from all patients. The location of abdominal wall endometriosis was at the wound site in seven cases and outside the wound in two cases. In addition, 7/9 (78%) of post-cesarean cases of abdominal wall endometriosis were related to the cesarean procedure, and 6/9 (67%) of the cases had symptoms related to menstruation. Post-cesarean abdominal endometriosis was associated with pain (7/9; 78%) and a palpable mass (3/9; 33%). Surgical resection did not cause large tissue defects, and artificial repairs such as synthetic mesh were not required for any patient. In conclusion, women with a history of a cesarean section who present with recurrent pain or masses in the wound or abdominal wall that coincide with the menstrual cycle should be closely evaluated for abdominal wall endometriosis. Because surgical treatment often requires postoperative wound reconstruction, collaboration with plastic surgeons and dermatologists is essential.
Paraganglioma, a catecholamine-producing tumor originating in extra-adrenal paraganglion cells, is rare in children. Although diagnosis of paraganglioma is based on the presence of catecholamine symptoms, some patients l...Paraganglioma, a catecholamine-producing tumor originating in extra-adrenal paraganglion cells, is rare in children. Although diagnosis of paraganglioma is based on the presence of catecholamine symptoms, some patients lack such symptoms. Delayed diagnosis is associated with tumor growth and invasion of surrounding vessels. Herein, we report a case of pediatric retroperitoneal paraganglioma invading the inferior vena cava. The tumor was completely resected and the patient has been free of recurrence for 2 years. Our findings suggest that complete resection can help prevent recurrence in cases of invasion of the inferior vena cava.
A variety of autoimmune disorders are associated with an increased risk of thrombosis. Previous studies have suggested combined therapy of heparin and therapeutic plasma exchange (TPE) with fresh frozen plasma (FFP) as t...A variety of autoimmune disorders are associated with an increased risk of thrombosis. Previous studies have suggested combined therapy of heparin and therapeutic plasma exchange (TPE) with fresh frozen plasma (FFP) as the replacement fluid is beneficial in some cases of acute flare-up of autoimmune diseases complicated by thrombotic events. Nevertheless, it remains unknown whether clinicians do more harm than good by exposing patients to a "thrombotic storm" through simultaneous administration of heparin and the clotting factors in the FFP during TPE. A variety of data are currently available on therapeutic interventions for autoimmune diseases complicated with acute thrombosis; however, there is limited evidence on the exact efficacy of each individual approach and combinations of these measures. Herein, we report a case of catastrophic antiphospholipid syndrome (CAPS) to highlight the difficulty of therapeutic decision-making when complicated interactions occur between heparin and TPE. To our knowledge, this is the first case report of a patient diagnosed with CAPS successfully treated with a novel therapeutic strategy of escalating the heparin dosage when performing TPE by monitoring the partial prothrombin time to reduce the risk of the progression of thrombosis.