Objectives: Hormone replacement therapy (HRT) is considered for ovarian cancer patients who develop menopausal symptoms, dyslipidemia, and osteoporosis due to iatrogenic menopause caused by surgery or anticancer drug treatment. However, there have been few reports on HRT administration methods and those that evaluate cancer recurrence and complications of HRT.

Methods: We examined the administration method, adverse reactions and cancer recurrence in 28 patients who received HRT after ovarian cancer surgery at our hospital.

Results: All patients received estradiol monotherapy, and cancer recurrence was observed in four patients (14.3%); adverse reactions included skin eruption in two patients (7.1%), there were no other serious adverse reactions noted.

Conclusion: The method and duration of HRT administration and the timing of HRT discontinuation remain debated. Thus, a large-scale survey and standardization of HRT administration methods after ovarian cancer surgery in Japan are needed.

Objective: Uterine carcinosarcoma (UCS) is a rare and aggressive gynecological cancer with high recurrence rates and is associated with a poor prognosis. It is also characterized by a high frequency of copy number alterations (CNAs). This study aimed to determine which gene CNA contributes to progression-free survival (PFS) in patients with UCS to identify potential prognostic biomarkers and therapeutic targets.

Methods: DNA was extracted from formalin-fixed paraffin-embedded tissues of surgical specimens from 24 patients with UCS who were treated at Fujita Health University. Using the PleSSision-Rapid test, the mutation information of 145 cancer genes was analyzed. Oncoplot analysis was used to visualize gene mutation profiles. χ² test, Kaplan–Meier analysis, and log-rank test were used for statistical analyses.

Results: The most frequently observed gene mutation was TP53 in the 24 UCS cases studied, while genes associated with the PI3K/AKT/mTOR signaling pathway, including PIK3CA, PTEN, PIK3R1, and PIK3R2 were commonly detected. In the χ² test analysis, TP53 loss (p=0.029), PIK3CA amplification (p=0.034), and TSC2 loss (p=0.034) were significantly associated with recurrence. Kaplan–Meier survival analysis demonstrated a significant association between PIK3CA amplification and TSC2 loss with PFS, as determined by the log-rank test (p<0.05).

Conclusion: In patients with UCS, TSC2 loss is linked to poorer PFS, highlighting its utility as a prognostic marker. The association between TSC2 loss and increased recurrence risk highlights the potential therapeutic advantage of targeting the mTOR pathway in TSC2-deficient tumors.

Objectives: Subcutaneous emphysema (SE) in pneumoperitoneum surgery is a complication not observed in open abdominal surgery, but data are scarce and epidemiology is inadequate. Although SE is considered less problematic because it is caused by carbon dioxide gas, past reports have shown that severe complications can occur, such as airway obstruction and cardiopulmonary collapse. We conducted an exploratory single-center retrospective study of patients admitted to the ICU after robotic or conventional laparoscopic abdominal surgery, focusing on epidemiological factors promoting severe SE.

Methods: This retrospective study examined cases of severe SE following robotic or conventional laparoscopic abdominal surgery that necessitated ICU admission. Patients older than 18 years with unscheduled ICU admission for grade 5 head SE between 1 January 2010 and 31 December 2021 were included. All robotic surgeries used the da Vinci Surgical System.

Results: We reviewed data from all 8 of 3,532 robotic surgeries and 5 of 10,305 conventional laparoscopic surgeries resulting in severe SE. By approach, the incidence of severe SE was 0.23% for robotic surgery and 0.05% for laparoscopic surgery (p=0.006). By organ, gastric surgery was the leading cause, with 6 cases from 2,224 gastric surgeries and 7 from a total of 11,613 other abdominal surgeries, giving incidences of 0.27% and 0.06%, respectively (p=0.011). The incidence in women was 0.15% (10/6,496), compared with only 0.04% (3/7,341) in men (p=0.048).

Conclusions: Our findings confirmed that higher risk of severe SE—although still small—is associated with robotic and gastric surgeries and female sex.

Objectives: A new classification of heart failure based on the effects of medication has recently come into use. According to this classification, heart failure is divided into heart failure with normal ejection fraction (HFnEF; defined as an EF ≥55% for men and ≥60% for women) and non-HFnEF. However, the characteristics of patients with HFnEF are still unclear. Accordingly, in this study, we sought to identify the background characteristics, including non-cardiac factors, of patients with HFnEF.

Methods: We retrospectively divided 304 eligible patients who were hospitalized for worsening heart failure at our institution between December 2020 and December 2022 into an HFnEF group (n=37) and a non-HFnEF group (n=267) and compared their demographic and clinical characteristics.

Results: There were more elderly patients in the non-HFnEF group, along with fewer patients with coronary artery disease and low serum hemoglobin and NT-proBNP levels and a higher proportion of patients with a low skeletal muscle index (<7.0 kg/m² for men and <5.7 kg/m² for women). Multivariate analysis with addition of patient sex identified a low skeletal muscle index (odds ratio 2.96, p<0.01) to be an independent determinant of HFnEF along with older age and low NT-proBNP.

Conclusions: A low skeletal muscle index was significantly more common in patients with HFnEF than in those with non-HFnEF. Intensive nutrition and exercise therapy to increase skeletal muscle mass may improve the prognosis in patients with HFnEF who respond poorly to standard pharmacological treatment.

Objective: In palliative medicine, accurate prognosis of patients with terminal cancer is crucial. Serum albumin (Alb), transthyretin (TTR), and C-reactive protein (CRP) have been reported to be associated with prognosis. Pancreatic cancer is generally a rapidly progressing disease with an extremely poor prognosis. In the present study, we focused on identifying prognostic factors in patients with terminal pancreatic cancer.

Methods: Overall, 756 patients with terminal cancer were admitted for palliative care and died during the 3-year period from April 2018; of these, 72 patients with pancreatic cancer (9.5%; excluding those who died within 7 days of admission) were included in the study. In addition to assessing clinical symptoms at admission, blood tests were performed to measure serum Alb (g/dL), TTR (mg/dL), CRP (mg/dL), and tumor markers. Body composition was analyzed using bioelectrical impedance analysis (BIA; InBody S10) to determine skeletal muscle mass index (SMI, kg/m²), extracellular water to total body water ratio (ECW/TBW), and phase angle (°). Prognostic factors were then evaluated.

Results: The median age was 75 years (range: 33–91 years), with a male-to-female ratio of 37:35. The median survival time was 24 days (range: 7–99 days). After adjusting for age, sex, and performance status as potential confounders, multivariate analysis revealed that CRP (hazard ratio [HR]: 1.0998; 95% confidence interval [CI]: 1.0248–1.1781; p=0.0072), ECW/TBW (HR: 1.4391; 95% CI: 1.1429–1.8080; p=0.0018), and depressed mood (HR: 1.155; 95% CI: 1.036–1.281; p=0.0074) were significantly associated with prognosis. The cutoff values for 4-week survival (approximately 1-month survival) were CRP ≥2.0 mg/dL and ECW/TBW ≥0.430.

Conclusion: Patients with terminal pancreatic cancer presented with advanced chronic inflammation at admission in addition to cachexia. Multivariate analysis revealed that serum CRP level and ECW/TBW ratio are independent prognostic factors, suggesting that prognosis in terminal pancreatic cancer is associated with the severity of chronic inflammation and edema. Among clinical symptoms, the degree of depression may also be related to prognosis, indicating that psychological distress should be considered in palliative care assessments.

Objectives: External nasal deformity in patients with cleft lip and palate causes both functional and aesthetic problems. Corrective rhinoplasty using a reverse U-shaped incision and suturing of the alar cartilage is not always successful. Therefore, we compared the use of a newer septal extension graft technique with the conventional suture technique to determine an effective surgical method for improving nasal tip morphology.

Methods: We compared the outcomes of the conventional reverse U-shaped incision technique with the septal extension graft in 12 patients undergoing secondary cleft rhinoplasty (6 in each group). Ten plastic surgeons evaluated 6-month postoperative photographs using six criteria: nasal tip shape (frontal, lateral, and basal views), left–right asymmetry (frontal and basal views), and overall improvement. Each item was rated on a 4-point scale (1=poor, 4=excellent). Mann–Whitney U tests were used to assess statistical significance.

Results: The septal extension graft group showed significantly better nasal tip morphology in the frontal and basal views (P<0.001) and in the lateral view (P=0.007). However, there were no significant differences in symmetry improvement between the two techniques for the front (P=0.685) and bottom (P=0.602) views.

Conclusions: Corrective rhinoplasty using a septal extension graft can significantly improve nasal tip morphology in cleft lip cases compared with the reverse U-shaped incision and alar cartilage suturing technique. However, decreased mobility of the nasal tip was noted. Further improvement is needed in terms of patient-reported satisfaction and postoperative stability.

Objectives: This study aimed to identify specific care scenarios and procedures perceived as noisy or quiet by medical professionals working in the neonatal intensive care unit (NICU) and elucidate factors influencing the sound environment that may affect preterm infants.

Methods: Semi-structured interviews were conducted with 12 nurses and eight doctors working in the NICU. Participants identified care and procedural situations perceived as noisy or quiet for preterm infants. Specific sound environment factors that could potentially affect preterm infants were extracted and visualized to demonstrate the interrelationships among these factors.

Results: Medical professionals recognized that noise levels fluctuated based on specific care scenarios, with sudden sounds and background noises amplifying disturbances in otherwise quiet settings. Participants also identified the overlap of multiple noise sources in various locations, including continuous beeping or other disruptive noises, as potentially affecting preterm infants.

Conclusion: Because noise levels in the NICU fluctuate during specific care scenarios, comparative verification of noise levels inside and outside the incubator is necessary. The present results revealed that even in periods perceived as quiet, sudden sounds and background noises may amplify disturbances to preterm infants. Furthermore, because overlapping noise sources during care and procedures affect the sound environment, empirical evaluation of sound quality by measuring noise during quiet hours is recommended.

We here present what we believe to be the first documented successful pregnancy and live birth following in vitro fertilization (IVF) and embryo transfer in a patient with benign multicystic peritoneal mesothelioma (BMPM). BMPM, a rare peritoneal disease, predominantly affects women of reproductive age. This condition is thought to result from peritoneal irritation, which may be exacerbated by invasive procedures such as oocyte retrieval during IVF. In this report, we present data on a 28-year-old woman who was diagnosed with BMPM by laparoscopic biopsy performed to investigate abdominal pain. Follow-up imaging during and after the pregnancy showed no progression of the cysts. The patient gave birth to a 3130-g baby by vaginal delivery at 40 weeks gestation. An MRI was performed one month after delivery; the findings resembled those of previous MRIs, except for the presence of multiple cysts in the omentum. To the best of our knowledge, there have been no published reports of infertility treatments, pregnancy, or childbirth in women with BMPM. Thus, careful follow-up, including regular MRI scans, is required.

Renal cell carcinoma is a malignant tumor that is prone to distant metastasis, primarily developing in the lungs, bones, lymph nodes, liver, and brain. Conversely, ovarian metastasis is rare, and its clinical characteristics and optimal treatment strategies remain unestablished. We report two cases with renal cell carcinoma and concomitant ovarian metastasis. Case 1 was of a 52-year-old woman with a metastatic tumor in the left ovary detected 9 years after radical nephrectomy for left-sided clear cell renal cell carcinoma. Case 2 was of a 56-year-old woman with a metastatic tumor in the right ovary detected 15 years after radical nephrectomy for right-sided clear cell renal cell carcinoma. In both cases, preoperative imaging revealed a pelvic tumor with a strong contrast effect. Surgery was performed for diagnosis and treatment of suspected ovarian metastasis from the renal cell carcinoma. Rapid intraoperative diagnosis was performed to determine the surgical approach, and the diagnosis of ovarian metastasis from renal cell carcinoma was made. Subsequently, bilateral adnexectomy was performed, and following pathological examination led to the definite diagnosis of ovarian metastasis from clear cell renal cell carcinoma. Long after radical nephrectomy, ovarian metastasis from the renal cell carcinoma can occur. Therefore, continuous follow-up is important. Complete resection of ovarian metastases from renal cell carcinoma may contribute to improved prognosis; however, more case studies are needed to establish standard treatment.

Purpose: In recent years, the benefits of probiotics for perioperative management have been recognized, and butyrate-producing bacteria are attracting attention as new beneficial intestinal bacteria. The present study reports a case of cytomegalovirus (CMV) infection and frequent watery diarrhea caused by immunosuppressants after living donor liver transplantation, wherein administration of butyrate-producing bacteria was considered effective.

Case: The patient was a 75-year-old woman presenting with the chief complaints of weight loss and generalized muscle weakness. History of present illness: Seven years ago, the patient underwent living donor liver transplantation with her daughter as the donor at University Hospital A for liver cancer concurrent with cirrhosis. Following the postoperative outpatient visit, the patient was admitted to a local geriatric care facility because of her advanced age; however, she was urgently rehospitalized at the same university hospital for acute renal failure caused by decreased food intake and diarrhea. Although intensive care saved her life, she was admitted to our hospital for nutritional management and rehabilitation because of considerable weight loss and generalized muscle weakness caused by disuse syndrome resulting from prolonged bed rest. At admission, she was 142 cm tall, weighed 39.5 kg, and had a body mass index 19.6. She was unable to stand up unassisted or transfer to a wheelchair and remained in bed. After admission, central venous nutrition and rehabilitation therapy were initiated. However, on day 10 of admission, she abruptly developed watery diarrhea that occurred 12 times/day, with a blood test showing strong positive results for CMV antigen. Consequently, immunosuppressive drugs were reduced, valganciclovir was administered as an anti-CMV drug, and butyrate-producing bacteria were administered as a probiotic. Subsequently, the watery stools improved, and the frequency of defecation decreased to 4 times/day within 3 weeks after treatment initiation. One month later, she had normal stools twice daily, and CMV antigen results were negative. After her nutritional status improved, the patient was transferred to a different hospital.

Conclusion: We experienced a case in which butyrate-producing bacteria effectively treated a patient with watery diarrhea following liver transplantation.