Journal Of Nippon Medical School = Nippon Ika Daigaku Zasshi[JOURNAL]
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200 papers
Real-World Screening Data for Liver Fibrosis in Psoriasis Patients Treated with Biologics.
Ichiyama S, Ito M, Ozaki S … +7 more , Arai T, Atsukawa M, Iwakiri K, Hagino T, Hoashi T, Kanda N, Saeki H
J Nippon Med Sch · 2024 · PMID 39756942 · Publisher ↗
BACKGROUND: Metabolic dysfunction-associated steatotic liver disease (MASLD) is positively associated with the prevalence and severity of psoriasis. The fibrosis-4 (FIB-4) index was developed to predict significant liver...
BACKGROUND: Metabolic dysfunction-associated steatotic liver disease (MASLD) is positively associated with the prevalence and severity of psoriasis. The fibrosis-4 (FIB-4) index was developed to predict significant liver fibrosis. Using the FIB-4 index, the present study evaluated screening data for liver fibrosis, including MASLD, in patients with refractory psoriasis treated with biologics. METHODS: All adult patients with psoriasis who were prescribed biologics at Nippon Medical School from August 2023 to May 2024 were included in this study. The FIB-4 index was classified as high (≥2.67), intermediate (1.30-2.66), and low (<1.30). Patients younger than 65 years were referred to a hepatologist if the FIB-4 index was high. If the score was intermediate, type IV collagen 7S (4COL7S) was checked, and they were referred to a hepatologist if it was ≥4.8 ng/mL. Patients aged ≥65 years were referred to a hepatologist if the FIB-4 index was high. If it was 2.00-2.66, they were referred to a hepatologist if the 4COL7S level was ≥4.8 ng/mL. RESULTS: Data from 96 patients were analyzed. The FIB-4 index was high in 10 patients, intermediate in 35 patients, and low in 51 patients. Eleven of 96 registered patients were newly referred to a hepatologist. Of these 11 patients, 5 received lifestyle guidance. CONCLUSIONS: For patients with refractory psoriasis, close cooperation between dermatologists and hepatologists is essential to prevent progression of liver fibrosis.
Improvement in Atrial Fibrillation Detection by Pulse Checking of Patients with Non-Cardioembolic Stroke in Rehabilitation Hospitals: The ESCORT Study.
Katano T, Suda S, Ohta T … +5 more , Miyagami M, Kodaira Y, Konaka C, Nagashima M, Kimura K
J Nippon Med Sch · 2024 · PMID 39756941 · Publisher ↗
BACKGROUND: Rehabilitation therapists are sometimes unaware of the possibility of undiagnosed atrial fibrillation (AF) and the importance of AF detection. Thus, we aimed to increase awareness among rehabilitation therapi...
BACKGROUND: Rehabilitation therapists are sometimes unaware of the possibility of undiagnosed atrial fibrillation (AF) and the importance of AF detection. Thus, we aimed to increase awareness among rehabilitation therapists of the importance of AF detection at rehabilitation hospitals during regular pulse checks of patients with ischemic stroke. METHODS: In this multicenter prospective observational study, we enrolled patients with noncardiac stroke. The therapists performed pulse checks before, during, and after rehabilitation during the inpatient period. Electrocardiography (ECG) was performed to check for AF when arrhythmia or tachycardia was detected. The characteristics, ECG data, laboratory data, complications such as stroke recurrence, and functional outcomes of the patients were investigated. RESULTS: Among 158 included patients (97 [61.4%] men, median age 77 [interquartile range {IQR}, 71-84] years), the median stay in stroke centers was 21 (IQR,15-31) days. Regarding medication administered upon admission, 94 (59.5%) patients received single antiplatelet therapy and 14 (8.9%) patients received no antithrombotic medication. Electrocardiography and blood testing were performed on admission in 112 (70.9%) and 136 (87.3%) patients, respectively. The median hospitalization period in the rehabilitation center was 179 (IQR, 90-272) days. Four patients (2.5%) experienced recurrent events. No patients developed AF or palpitations. CONCLUSIONS: Although our results suggest increased awareness of AF detection in rehabilitation centers, AF was not detected. AF detection using pulse checks alone may be challenging; thus, further investigation is warranted.
Prognostic Factors for Mortality in Maintenance Hemodialysis Patients Infected with SARS-CoV-2.
Yamada T, Sakai Y, Kashiwagi T … +1 more , Iwabu M
J Nippon Med Sch · 2024 · PMID 39756940 · Publisher ↗
BACKGROUND: Maintenance hemodialysis patients are immunosuppressed, which increases their mortality risk if they contract coronavirus disease 2019 (COVID-19). METHODS: We studied data from 36 consecutive patients undergo...
BACKGROUND: Maintenance hemodialysis patients are immunosuppressed, which increases their mortality risk if they contract coronavirus disease 2019 (COVID-19). METHODS: We studied data from 36 consecutive patients undergoing maintenance hemodialysis who were diagnosed as having COVID-19 from January 2020 to September 2023. Clinical data such as age and sex, laboratory data, radiological findings, modalities for blood purification therapy, and outcome at the time of discharge were collected from their hospital records. Binomial logistic regression analysis was used to predict risk factors for mortality and continuous hemodiafiltration (CHDF). RESULTS: After analyzing the correlation of outcomes with each prognostic factor, we identified 6 significant factors (P < 0.05). Age and initiation of CHDF were both associated with mortality. COVID-19 severity, steroid treatment, and serum lactate dehydrogenase level at admission were positively correlated with risk for CHDF initiation, while a greater number of vaccine doses was associated with lower risk. CONCLUSIONS: Elderly hemodialysis patients have a higher mortality risk if they develop COVID-19 and require CHDF. More attention is warranted for vulnerable older patients with COVID-19 if they require hemodialysis. Risk reduction strategies, such as appropriate vaccination, are necessary.
Artery of Percheron Infarction with Bilateral Thalamic Lesions in a 14-Year-Old Girl: A Case Report.
Takagi A, Asano T
J Nippon Med Sch · 2024 · PMID 39505510 · Publisher ↗
The artery of Percheron (AOP), a common anatomic vascular variation of the P1 segment of the posterior cerebral artery, provides arterial blood supply to the paramedian thalami and rostral midbrain. Occlusion of the AOP...
The artery of Percheron (AOP), a common anatomic vascular variation of the P1 segment of the posterior cerebral artery, provides arterial blood supply to the paramedian thalami and rostral midbrain. Occlusion of the AOP can lead to infarction of the bilateral paramedian thalamus, with or without midbrain involvement, but is rare in children. Here, we describe a case involving a 14-year-old girl with sudden onset of disturbance of consciousness, hypersomnia, and global aphasia. Brain magnetic resonance imaging showed symmetric bilateral paramedian thalamic infarcts. Left-sided AOP infarction was diagnosed by brain angiography.
A Rare Case of Extra-Nodal Rosai-Dorfman Disease of the Cheek.
Shoji M, Akaishi S, Ito K … +1 more , Kuwahara H
J Nippon Med Sch · 2024 · PMID 39505509 · Publisher ↗
Rosai-Dorfman disease (RDD), which was first reported by Rosai and Dorfman in 1969, is a rare, benign, non-neoplastic proliferation of histiocytes, characterized by painless lymphadenopathy and fever. Lymphadenopathy occ...
Rosai-Dorfman disease (RDD), which was first reported by Rosai and Dorfman in 1969, is a rare, benign, non-neoplastic proliferation of histiocytes, characterized by painless lymphadenopathy and fever. Lymphadenopathy occurs most commonly in the neck, but also appears in non-cervical lymph nodes or as extranodal lesions. In this case, biopsy of an atypical subcutaneous buccal mass, which was difficult to diagnose preoperatively, led to a diagnosis of RDD. In addition, although lesions were also confirmed in the maxilla, none of the lesions were in lymph nodes; therefore, we ultimately diagnosed the patient with extranodal RDD (ENRDD). Compared with classical RDD, characterized by painless lymphadenopathy and fever, ENRDD is observed only in soft tissue and bone, and occurs mostly frequently among older adults. Cases presenting with lymph node or vital organ lesions also present with systemic symptoms, usually with a progressive and sometimes fatal course. However, RDD localized in soft tissue and bone has a favorable prognosis, and follow-up alone is considered sufficient. Although this case featured epidemiological characteristics of ENRDD, and as there are no fixed therapeutic guidelines, the recommendation is that treatment be considered on a case-by-case basis according to the site and symptoms. There are few reports of ENRDD; therefore, we aim to contribute the details of an additional case to the literature.
Early Detection of Pyogenic Sacroiliitis by MRI: A Case Report.
Yamagata D, Kashimura T, Asano T
J Nippon Med Sch · 2024 · PMID 39505508 · Publisher ↗
Pyogenic sacroiliitis is rare and difficult to diagnose because of its deep location and the absence of definitive clinical signs. Delayed diagnosis can result in complications such as abscess or sequestration formation,...
Pyogenic sacroiliitis is rare and difficult to diagnose because of its deep location and the absence of definitive clinical signs. Delayed diagnosis can result in complications such as abscess or sequestration formation, prolonged sepsis, and chronic joint deformity. MRI is a well-known, noninvasive imaging technique with a high sensitivity and specificity for osteomyelitis diagnosis. Here, we present the MRI findings for pyogenic sacroiliitis, 3 days after symptom onset, in an 11-year-old girl and confirm its value in early diagnosis of pediatric pyogenic sacroiliitis.
Changing Characteristics of Young Severe Suicide Attempters Admitted to an Emergency Room in Tokyo, Japan.
Narishige R, Otaka Y, Tateno A
J Nippon Med Sch · 2024 · PMID 39505507 · Publisher ↗
BACKGROUND: The decreasing trend in the number of young suicides in Japan changed to a flat/increasing trend in 2017. To identify how this change was reflected in young suicide attempters, we investigated changes in the...
BACKGROUND: The decreasing trend in the number of young suicides in Japan changed to a flat/increasing trend in 2017. To identify how this change was reflected in young suicide attempters, we investigated changes in the characteristics of young suicide attempters admitted to our emergency room. METHODS: The subjects were suicide attempters younger than 30 years admitted to the Critical Care Medical Center of Nippon Medical School Hospital between January 1, 2010, and December 31, 2021. The means of suicide attempt, sociodemographic data, psychiatric diagnoses, and causes and motives of suicide attempts were retrospectively examined from medical records. We compared post-2017 to pre-2017 suicide attempts and performed a statistical analysis. RESULTS: The proportion of suicide attempters younger than 30 years was 27.9% (143 of 513) before 2017 and 38.0% (132 of 347) after 2017, a significant increase. From 2017 to 2021, there was a significant increase in the number of female suicide attempters younger than 30 years and in the percentage of drug overdoses. CONCLUSIONS: The proportion of suicide attempters younger than 30 years was significantly higher after the start of 2017 than before 2017, possibly because of an increase in drug overdoses.
Difference in Rotational Alignment of the Tibial Component, as Determined by the Range-of-Motion Technique and Akagi's Line, is Influenced by Tibial Varus Deformity: A Cross-Sectional Study.
Kataoka T, Iizawa N, Oshima Y … +1 more , Majima T
J Nippon Med Sch · 2024 · PMID 39505506 · Publisher ↗
BACKGROUND: Anatomical landmarks and range-of-motion (ROM) techniques are commonly used to rotationally align the tibial component in total knee arthroplasty (TKA). This study investigated; 1) the difference in tibial ro...
BACKGROUND: Anatomical landmarks and range-of-motion (ROM) techniques are commonly used to rotationally align the tibial component in total knee arthroplasty (TKA). This study investigated; 1) the difference in tibial rotational alignment between the ROM technique and Akagi's line, 2) the influence of preoperative deformity and intraoperative gaps on this difference, and 3) intraoperative tibial rotational kinematics associated with these 2 techniques. METHODS: Patients who underwent cruciate-substituting (CS) TKA (Evolution, Microport Orthopedics) for knee osteoarthritis were enrolled. Intraoperatively, the rotational alignment of the tibial component was determined with the ROM technique and recorded. The difference from the value determined using Akagi's line was evaluated. Correlations among preoperative coronal deformity, postoperative coronal alignment, and intraoperative gaps between the femur and tibia were evaluated. Differences in knee kinematics (rotational movement of the tibia against the femur) between the 2 techniques were compared. RESULTS: This study included 34 knees from 34 patients. The rotational alignment of the tibial component using the ROM technique was 2.5±6.4° externally rotated in relation to that determined using Akagi's line (p=0.029), which was increased in knees with a smaller preoperative medial proximal tibial angle (r=0.45). Tibial rotational kinematics did not significantly differ between the 2 techniques. CONCLUSIONS: The ROM technique and Akagi's line yielded significantly different values for the rotational alignment of the tibial component. Orthopedic surgeons using Evolution (CS) should be reminded that in knees with proximal tibial varus deformity, the ROM technique will result in external rotation of the tibial component in relation to Akagi's line.
The Current Status of Comprehensive Genomic Profiling in the Management of Metastatic Castration-Resistant Prostate Cancer: A Study from a Cooperative Hospital for Cancer Genomic Medicine in Japan.
Akatsuka J, Kimura G, Takadate M … +12 more , Hiraoka S, Sahara T, Iwai T, Hasegawa H, Mikami H, Obayashi K, Takeda H, Endo Y, Toyama Y, Yamamoto Y, Yamada T, Kondo Y
J Nippon Med Sch · 2024 · PMID 39505505 · Publisher ↗
BACKGROUND: Several effective treatment modalities against metastatic castration-resistant prostate cancer (mCRPC) are available; however, an unmet clinical need persists for mCRPC treatment because resistance to these t...
BACKGROUND: Several effective treatment modalities against metastatic castration-resistant prostate cancer (mCRPC) are available; however, an unmet clinical need persists for mCRPC treatment because resistance to these therapies is inevitable. This study aimed to evaluate the status of comprehensive genomic profiling (CGP) and its impact on subsequent treatments for patients with mCRPC at our hospital. METHODS: Between December 2020 and August 2023, we assessed 41 patients with mCRPC who underwent CGP testing at the Nippon Medical School Hospital. The testing comprised FoundationOne CDx for 30 patients and FoundationOne Liquid CDx for 11 patients, following the procedures outlined by the Japanese Urological Association. RESULTS: CGP testing was successfully conducted in 40 out of 41 patients (97.6%), which resulted in the identification of 140 actionable genomic alterations. The most common alteration was TP53 in 12 patients (30.0%). Twenty-three patients (57.5%) with druggable gene alterations were identified; 21 were recommended for clinical trials, four for patient-proposed healthcare services, and six for insurance-covered drugs. Consequently, genotype-matched therapy with insurance-covered drugs was administered to five patients (12.5%) with a BRCA2 mutation. Notably, none of the patients underwent clinical or prospective trials based on patient-suggested medical services. CONCLUSIONS: Our results offer insights into the real-world application of CGP testing for patients with mCRPC at a cooperative hospital for cancer genomic medicine in Japan. Thus, urologists require a comprehensive understanding of the current status of CGP testing to enhance mCRPC management.
Management of Asymptomatic Spontaneous Isolated Superior Mesenteric Artery Dissection and Morphology Features and Variations on Abdominal Contrast-Enhanced Computed Tomography: A Single-Center Experience.
Kobayashi Y, Yamaguchi H, Ando T … +4 more , Tamai J, Yamamoto A, Hayashi H, Kumita SI
J Nippon Med Sch · 2024 · PMID 39505504 · Publisher ↗
BACKGROUND: Spontaneous isolated visceral artery dissection (SIVAD) is rare. Recently, appropriate treatment strategies for symptomatic SIVAD have been proposed. We aimed to determine the management of asymptomatic spont...
BACKGROUND: Spontaneous isolated visceral artery dissection (SIVAD) is rare. Recently, appropriate treatment strategies for symptomatic SIVAD have been proposed. We aimed to determine the management of asymptomatic spontaneous isolated superior mesenteric artery dissection (ASISMAD), which is relatively frequently encountered in SIVAD. METHODS: We retrospectively reviewed abdominal contrast-enhanced computed-tomography (CE-CT) scans from January 2015 to December 2020 in our institution and identified 24 patients with ASISMAD. Patient characteristics, vascular risk factors, complications, morphology features on CE-CT images, changes in abdominal CE-CT, and treatments outcomes were analyzed. RESULTS: All patients were male. The mean age of the patients was 66.0 ± 8.9 (standard deviation) years, and the follow-up period was 24.8 ± 28.7 months. The CE-CT images revealed that 1 patient had periarterial fat stranding, 15 patients had aneurysmal dilatation, and 7 patients had branch vessel involvement. The mean length of the dissection was 19.9 ± 13.5 mm. The mean distance from the orifice of the superior mesenteric artery to the dissection origin point was 14.9 ± 8.8 mm. The mean branching angle was 54.8°± 19.7°. None of the patients had dissection-related abdominal symptoms or complications. Follow-up CE-CT scans showed progression of the dissection in 2 (8.3%), improvement in 2 (8.3%), stable dissection in 17 (70.9%), and complete remodeling in 3 (12.5%). CONCLUSIONS: Patients with ASISMAD do not require hospitalization because the pathology does not usually progress to visceral ischemia. Nevertheless, follow-up CE-CT is required because of progression of the dissection in rare cases.
Effect of the COVID-19 Pandemic on the Mental Status of Pregnant Women: A Single-Center Study.
Watanabe A, Sagawa K, Harigane E … +4 more , Shinmura H, Kurashina R, Matsushima T, Suzuki S
J Nippon Med Sch · 2024 · PMID 39505503 · Publisher ↗
BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic has forced people to make major life changes, and there is concern that depressive tendencies have increased in pregnant women during the pandemic. This study...
BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic has forced people to make major life changes, and there is concern that depressive tendencies have increased in pregnant women during the pandemic. This study used the Edinburgh Postnatal Depression Scale (EPDS), administered in the second trimester, to investigate the effect of COVID-19 on the mental health of Japanese women during pregnancy and to provide early intervention. METHODS: The study included 1,320 pregnant women (663 pre-COVID-19 and 657 during COVID-19) with similar background characteristics and compared the results for the COVID-19 period (September 2020-August 2021) and control period (September 2018-August 2019). Women treated for psychiatric disorders were excluded. The EPDS cutoff score was 13. RESULTS: The median EPDS scores were 3 (1-6) points during the control period and 3 (1-5) points during the pandemic (p = 0.166) for the control and pandemic periods. Fourteen patients (2.1%) during the control period and 20 (3.0%) during the pandemic scored ≥13 points; however, the difference was not significant (odds ratio, 1.455; 95% confidence interval: 0.692-3.143). CONCLUSIONS: COVID-19 did not change mid-pregnancy EPDS scores at a single Japanese center.
Physiological Studies of the Palatopharyngeal Muscle as a Speech Muscle in the Adjustment of Velar Position during Speech Production.
Komachi T, Saigusa H, Yamaguchi S … +3 more , Kadosono O, Ito H, Okubo K
J Nippon Med Sch · 2024 · PMID 39505502 · Publisher ↗
BACKGROUND: We aimed to investigate the contribution of the palatopharyngeal muscle (PP) as a speech muscle in adjusting the velar position. METHODS: X-ray kinematic analysis of the position of the palatopharyngeal arch...
BACKGROUND: We aimed to investigate the contribution of the palatopharyngeal muscle (PP) as a speech muscle in adjusting the velar position. METHODS: X-ray kinematic analysis of the position of the palatopharyngeal arch and an electromyographic study of the PP during speech were performed in two healthy volunteers. RESULTS: X-ray kinematic analysis revealed that the palatopharyngeal arch was positioned lower during the production of the low-back vowel /a/. However, no significant differences were observed between the vowels included in the nasal sounds during nasal sound productions. The electromyographic study showed higher PP activity during nasal sound productions. However, no significant differences were observed in muscle activity during the productions of five vowels or the same vowels included in the nasal sounds. During the production of two consecutive phonemes involving voiceless bilabial plosive consonants and nasal sounds, the PP activity demonstrated synchronous coordination with the levator veli palatini muscle activity. This activity was higher during the production of the low-back vowel /a/ included in the voiceless bilabial plosive consonant. It was also higher during the production of voiceless bilabial plosive sounds than during the production of voiced bilabial plosive sounds. CONCLUSIONS: When the distance between the origin and arrest of the PP is achieved through the velar elevation, the tonic condition and muscle strength of the PP are enhanced. When the scaffold below the PP is stabilized by the contractions of the glossopharyngeal part of the superior pharyngeal constrictor muscle during the production of the low-back vowel, the PP likely contributes to regulation of the velar position.
Impact of Home-Based Rehabilitation on Renal Prognosis in Patients with Chronic Kidney Disease.
Ikenouchi A, Sakai Y, Wada S … +3 more , Yanagida Y, Kashiwagi T, Iwabu M
J Nippon Med Sch · 2024 · PMID 39505501 · Publisher ↗
BACKGROUND: The increasing prevalence of chronic kidney disease (CKD) requires effective preventive measures, particularly due to an aging population. This study aimed to assess the effectiveness of home visit rehabilita...
BACKGROUND: The increasing prevalence of chronic kidney disease (CKD) requires effective preventive measures, particularly due to an aging population. This study aimed to assess the effectiveness of home visit rehabilitation in preventing renal function decline among patients with CKD. METHOD: In this retrospective study, patients with non-dialysis CKD undergoing home visit rehabilitation were compared with those receiving outpatient care at the Nippon Medical School Hospital between August 2017 and August 2023. Patients' backgrounds were matched using propensity scores derived from a logistic regression model. The primary endpoint was the annual change in the estimated glomerular filtration rate (eGFR), and the secondary endpoint was the annual change in blood parameters (Δblood urea nitrogen, Δcreatinine, Δtotal protein, Δalbumin, ΔC-reactive protein, Δhemoglobin, and Δhematocrit). Furthermore, the incidence of clinical outcomes, including mortality, hospitalization rate, and dialysis initiation rate, were analyzed within the additional 1-year observation period. RESULTS: Overall, 128 patients (64 matched pairs) were analyzed. After a mean follow-up period of 12.7 ± 4.6 months, there was no significant difference in the eGFR between both groups (40.1 ± 13.7 vs. 37.8 ± 13.8 mL/min/1.73 m, p = 0.36), but the annual decline in eGFR (%/year) was significantly lower in the rehabilitation group (-1.1 ± 29.8% vs. -11.8 ± 27.7%/year, p = 0.037). The annual change in the level of each blood test parameter and clinical outcomes were not significantly different between the two groups. CONCLUSION: Home-based rehabilitation interventions may mitigate the progression of renal impairment in patients with CKD.
Postoperative Bleeding Risk in Thyroid Surgery: Differences between Conventional and Endoscopic Video-Assisted Neck Surgery Methods.
Saitou M, Akasu H, Jikuzono T … +4 more , Sen M, Kazusaka H, Matsui M, Sugitani I
J Nippon Med Sch · 2024 · PMID 39505500 · Publisher ↗
BACKGROUND: Postoperative bleeding is a potentially life-threatening complication following thyroidectomy, but the risk factors and timing remain insufficiently understood. The bleeding rate for endoscopic surgery, speci...
BACKGROUND: Postoperative bleeding is a potentially life-threatening complication following thyroidectomy, but the risk factors and timing remain insufficiently understood. The bleeding rate for endoscopic surgery, specifically video-assisted neck surgery (VANS), also remains unclear in Japan. METHODS: We conducted a retrospective case-control study of postoperative bleeding requiring readmission to the operating room. RESULTS: The overall postoperative bleeding rate was 1.85%. Multivariate analysis revealed that postoperative bleeding was independently associated with antithrombotic therapy (odds ratio 2.95; 95% confidence interval 1.15-7.59) and dialysis (odds ratio 6.53; 95% confidence interval 1.75-24.2). Among patients with postoperative bleeding, the complication developed within 6 h in 56.1% and within 24 h in 93.0%. The postoperative bleeding rate in endoscopic surgery was 1.6%. The most common site of bleeding was around the thyroid in conventional surgery and around the flap in endoscopic surgery. CONCLUSIONS: Post-thyroidectomy bleeding is associated with antithrombotic therapy or dialysis. While the bleeding rate in endoscopic surgery is similar to that in conventional surgery, the bleeding site differs.
Effect of Dural Puncture Epidural Technique on Management of Breakthrough Pain for Parous Women Receiving Labor Analgesia during Induced Labor: A Retrospective Cohort Study.
Tsunoda Y, Osumi M, Matsushima T … +2 more , Ishikawa M, Suzuki S
J Nippon Med Sch · 2024 · PMID 39505499 · Publisher ↗
BACKGROUND: This study assessed the effectiveness of the dural puncture epidural (DPE) technique in managing breakthrough pain in parous women receiving labor analgesia during induced labor. METHODS: This single-center r...
BACKGROUND: This study assessed the effectiveness of the dural puncture epidural (DPE) technique in managing breakthrough pain in parous women receiving labor analgesia during induced labor. METHODS: This single-center retrospective cohort study included term pregnant women with singleton pregnancies who received treatment for breakthrough pain during labor. All participants underwent induced labor, and some parous women among them underwent DPE. The DPE technique consisted of placing an epidural catheter after dural puncture with a 27-gauge spinal needle. Eligible women were allocated into a DPE group and conventional epidural (CE) anesthesia group. Pain was assessed with a numerical rating scale (NRS), and a patient-controlled epidural analgesia (PCEA) bolus was administered when the NRS score was ≥3. Breakthrough pain was defined as an NRS score ≥3 during PCEA management. The primary outcome was the efficacy of rescue interventions in managing breakthrough pain, as determined by a reduction in pain intensity to an NRS score <3 before birth. RESULTS: Among the 55 parous women who received labor analgesia, 44 required additional rescue administration for breakthrough pain. Of the remaining women, 23 received DPE and 19 received CE anesthesia. The DPE group experienced significantly more effective relief of breakthrough pain before birth than did the CE group (DPE: 100%; CE: 68.4%; p=0.005). CONCLUSION: In parous women, DPE anesthesia was more effective than CE anesthesia in providing analgesia for breakthrough pain immediately before delivery during induced labor.
Unilateral Vocal Cord Paralysis in a Patient with Anti-Galactocerebroside Antibodies: A Case Report.
Yanagihashi M, Okamoto R, Matsuoka A … +4 more , Morioka H, Fukuo A, Wada K, Kano O
J Nippon Med Sch · 2024 · PMID 39231647 · Publisher ↗
Anti-galactocerebroside (Gal-C) antibodies are present in patients with conditions such as Guillain-Barré syndrome and mycoplasma pneumonia. We report a rare case of left vocal cord paralysis in a patient with anti-Gal-C...
Anti-galactocerebroside (Gal-C) antibodies are present in patients with conditions such as Guillain-Barré syndrome and mycoplasma pneumonia. We report a rare case of left vocal cord paralysis in a patient with anti-Gal-C IgG antibodies that improved after administeration of antivirals and steroids.
Choledochal Cyst Diagnosed during Pregnancy and Treated by Postpartum Laparoscopic Choledochal Cyst Excision: Case Report.
Shimizu T, Nakamura Y, Matsushita A … +4 more , Yoshioka M, Kanda T, Mizuguchi Y, Yoshida H
J Nippon Med Sch · 2024 · PMID 39231646 · Publisher ↗
We report a rare case of choledochal cyst with acute cholangitis that was diagnosed at 37 weeks' gestation and treated by laparoscopic choledochal resection and biliary reconstruction after delivery. A 31-year-old Japane...
We report a rare case of choledochal cyst with acute cholangitis that was diagnosed at 37 weeks' gestation and treated by laparoscopic choledochal resection and biliary reconstruction after delivery. A 31-year-old Japanese primigravida at 37 weeks' gestation presented with right upper quadrant pain. The patient was diagnosed as having acute cholangitis due to a type-Ia choledochal cyst, according to the Todani classification, with pancreaticobiliary maljunction. Acute cholangitis improved with conservative treatment, the fetus was delivered by Cesarean section at 38 weeks' gestation, and the patient was treated by laparoscopic choledochal cyst excision and biliary reconstruction at 47 days postpartum. Total operation time was 579 minutes and intraoperative body fluid loss was 100 mL. The patient is now healthy with normal liver function 7 years after the operation. To ensure good outcomes for the mother and fetus, treatment decisions for choledochal cyst diagnosed during pregnancy must be carefully considered.
Awareness-Raising Activities to Identify Children with Short Stature.
Takeuchi M, Asano T
J Nippon Med Sch · 2024 · PMID 39231645 · Publisher ↗
BACKGROUND: Although short stature is sometimes treatable in children, family members do not always realize that their children have short stature. To develop better educational materials for identifying short stature, w...
BACKGROUND: Although short stature is sometimes treatable in children, family members do not always realize that their children have short stature. To develop better educational materials for identifying short stature, we conducted a questionnaire survey on children with short stature. Using the results of the survey, we revised educational activities regarding short stature. METHODS: To assess the effectiveness of the revised activities, we examined changes in the numbers of consultations before and after the changes to the educational activities, the height of children examined after such changes, the test implementation rate, and the test results. RESULTS: After the start of direct promotion for school nursing staff in 2015, the number of outpatients with short stature who visited the hospital significantly increased (16.1/year before 2014 vs. 68.8/year after 2015; p = 0.02). The number of patients hospitalized for a growth hormone secretion stimulation test also significantly increased, from 9.3/year before 2014 to 47.0/year after 2015 (p = 0.02). However, 35% of families did not want to subject their child to a growth hormone stimulating test, even if their child was extremely short. CONCLUSIONS: Our revised educational activities for short stature among school nursing staff, school physicians, and nurses at health centers were more effective than conventional activities consisting of public relations magazines and lectures for the general public. It is important to provide proper explanations to enable a better understanding of hormone therapy.
Changes in Cerebrospinal Fluid Interleukin-6 Levels after Surgical Treatment of Subarachnoid Hemorrhage.
Onda H, Kanaya T, Igarashi Y … +3 more , Nakae R, Fuse A, Yokobori S
J Nippon Med Sch · 2024 · PMID 39231644 · Publisher ↗
BACKGROUND: We measured postoperative changes in cerebrospinal fluid (CSF) interleukin (IL)-6 levels in subarachnoid hemorrhage (SAH) due to aneurysm rupture and examined factors associated with outcomes and cerebral vas...
BACKGROUND: We measured postoperative changes in cerebrospinal fluid (CSF) interleukin (IL)-6 levels in subarachnoid hemorrhage (SAH) due to aneurysm rupture and examined factors associated with outcomes and cerebral vasospasm. We used physiologic saline or artificial CSF as the intraoperative irrigation fluid and examined the differences. METHODS: The participants were 16 men and 41 women who were transported to our facility for SAH and underwent surgical treatment during the period from February 2012 through March 2015. In terms of severity, 31 cases were World Federation of Neurological Surgeons (WFNS) grade I-III and 26 cases were grade IV-V. All cases underwent clipping. Physiologic saline and artificial CSF were used as intraoperative irrigation fluid. We placed a ventricular drainage tube intraoperatively and collected CSF daily from postoperative day (POD) 1 through 10 or until drain removal. RESULTS: IL-6 level varied from 74 pg/mL to 407,936 pg/mL and peaked on PODs 1 and 5. Patients with favorable outcomes had significantly lower postoperative IL-6 levels. POD 1 IL-6 level significantly differed in relation to the presence of cerebral vasospasm but was not associated with its timing or severity. Use of artificial CSF was associated with a significantly lower incidence of cerebral vasospasm. Age and WFNS grade were significantly associated with outcome, and use of artificial CSF had a tendency toward favorable outcomes. CONCLUSIONS: Artificial CSF is a potentially useful intervention when managing subarachnoid hemorrhage.
A Retrospective Study of the Clinicopathological Characteristics of Approximately 1,600 Pilomatricomas Treated at a Single Institution.
Kinoshita Y, Ogita A, Ito K … +1 more , Saeki H
J Nippon Med Sch · 2024 · PMID 39231643 · Publisher ↗
BACKGROUND: First reported by Malherbe in 1880, pilomatricoma is a common benign skin tumor generally believed to occur mainly in children and adolescents. We conducted this study to better define the characteristics of...
BACKGROUND: First reported by Malherbe in 1880, pilomatricoma is a common benign skin tumor generally believed to occur mainly in children and adolescents. We conducted this study to better define the characteristics of pilomatricoma and compare our findings with current knowledge. METHODS: Patients diagnosed pathologically with pilomatricoma from 2016 through 2020 at Nippon Medical School Musashi Kosugi Hospital were included (1,559 patients, 1,590 tumors). Clinicopathological characteristics were analyzed. RESULTS: The male to female ratio was 1:1.6, and the most common tumor site was the upper limbs (33.7%). Preoperative diagnosis was correct in 48.5% of the patients, and their average age at resection was 33.5 years. Resection was carried out in 70% of the patients within 1 year, but time to resection was more than 1 year in the other 30%. Pathologically, squamous stratifying keratinocytes were observed in 41.7% of the patients, cells with a large pale pink cytoplasm in 38.9%, hair papilla-like structures in 33.9%, ossification in 15.7%, trichohyalin granules in 11.9%, and aggregations of follicular germinative cells in 7.8%. Of the chronological and morphological stages proposed by Kaddu (stage 1: early, stage 2: fully developed, stage 3: early regressive, stage 4: late regressive), stage 3 was the most common (70.6%). CONCLUSION: Pilomatricoma is more common in females, regardless of ethnicity or age, but the tumor location in the upper limbs commonly observed in Japanese patients may indicate ethnic differences. Pathologically, the fact that cells linked to follicular differentiation are observed suggests that pilomatricoma is a complex panfollicular neoplasm. Time to resection appears to correlate with Kaddu stages. Factors such as age, location, sex, depth, and stage may affect the pathological features of this tumor.
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