Sleep-disordered breathing (SDB) is frequently observed in patients with heart failure (HF), and complex pathologic conditions exist between both conditions. In this review article, we describe the characteristics of SDB complicated with HF, the prognostic impact of SDB in HF patients, and the favorable effects of positive airway pressure in HF patients with SDB.
Endoscopic ultrasonography (EUS) plays a major role in diagnosing gallbladder (GB) cancer and pancreatic cancer (PC). In cases of GB cancer, EUS allows for precise observations of morphology and wall layers. However, proficiency is required for the morphologic diagnosis of GB tumors. Therefore, contrast-enhanced harmonic EUS (CH-EUS) began to be performed to diagnose GB lesions. CH-EUS enables real-time observation of the hemodynamics of GB tumors. The enhanced patterns generated by CH-EUS improve precision in the diagnosis of such tumors.PC appears as a hypoechoic mass on EUS. However, distinguishing between PC and mass-forming pancreatitis or focal autoimmune pancreatitis (AIP) is difficult via conventional EUS. CH-EUS allows for differentiating among these diseases (PC is hypoenhanced and heterogeneously enhanced, pancreatitis is isoenhanced, and a pancreatic neuroendocrine tumor is hyperenhanced). EUS-guided fine needle aspiration (EUS-FNA) also contributes to pathological diagnoses of pancreatic lesions. However, certain PC patients cannot be diagnosed via EUS-FNA. PC is heterogeneously enhanced on CH-EUS, and unenhanced regions have been reported to be areas of fibrosis or necrosis. CH-EUS-guided fine needle aspiration (CH-EUS-FNA) permits puncturing of the enhanced area while avoiding necrotic and fibrotic regions. Moreover, as CH-EUS findings have been quantitatively analyzed, a time-intensity curve (TIC) has become usable for diagnosing solid pancreatic lesions. CH-EUS-related techniques have been developed and increasingly utilized in the pancreaticobiliary area.
Robot-assisted radical prostatectomy (RARP) has enabled steady and stable surgical procedures due to both meticulous maneuvers and magnified, clear, 3-dimensional vision. Therefore, better surgical outcomes have been expected with RARP than with other surgical modalities. However, even in the RARP era, post-prostatectomy incontinence has a relatively high incidence as a bothersome complication. To overcome post-prostatectomy incontinence, it goes without saying that meticulous surgical procedures and creative surgical procedures, i.e., “Preservation”, “Reconstruction”, and “Reinforcement” of the anatomical structures of the pelvis, are most important. In addition, medication and appropriate pad usage might sometimes be helpful for patients with post-prostatectomy incontinence. However, patients who have 1) BMI > 26 kg/m2, 2) prostate volume > 70 mL, 3) eGFR < 60 mL/min, or a 4) Charlson comorbidity index > 2 have a tendency to develop post-prostatectomy incontinence despite undergoing the same surgical procedures. It is important for patients who have a high risk for post-prostatectomy incontinence to be given information about delayed recovery of post-prostatectomy incontinence. Thus, not only the surgical procedures, but also a comprehensive approach, as mentioned above, are important for post-prostatectomy incontinence.
The Japan Environment and Children’s Study is an ongoing nationwide birth cohort study that is being conducted at 15 regional centers throughout Japan. The recruitment of subjects in the study area within Fukushima Prefecture, which includes Fukushima City, Minami Soma City and Futaba County, was begun on January 31, 2011 with the cooperation of the obstetrics and gynecology departments of local medical institutions. On March 11, soon after the start of recruitment, the Tohoku region was hit by an unprecedented disaster in the shape of the Great East Japan Earthquake, which was closely followed by the Tokyo Electric Power Company’s Fukushima Daiichi Nuclear Power Plant accident. As a result of the disaster, the study area in Fukushima Prefecture was expanded on October 1, 2012 to include 59 municipalities across Fukushima Prefecture. Three points are seen as particularly important: 1) Radiation risk communication, 2) The motto is “Be attentive. Be supportive.”, and 3) Establishing cooperating partnerships. With the cooperation of all concerned, the recruitment period ended on March 31, 2014. The tentative total number of the participants enrolled at the Fukushima Regional Center was 34,666 (13,134 pregnant mothers, 8,695 fathers and 12,837 children born before November 30, 2014 as of June 2016).
Human cytomegalovirus (HCMV) is universally distributed among humans without any adverse effects; however, it induces severe diseases in immunocompromised patients such as organ transplant recipients and AIDS patients. To manage these immunocompromised patients, an easy clinical examination for the monitoring of disease risk is required. In this study, we modified the interferon-γ (IFN-γ) release test (QuantiFERON®-CMV) using HCMV immediate early-1 (IE-1) or pp65 whole proteins, or UV-inactivated HCMV particles as an antigen. The response of heparinized peripheral blood from healthy volunteers to the pp65 protein showed an obvious dose-dependent sigmoid curve, although no correlation was observed between results of this assay and an ELISPOT assay. The addition of pp65 to the blood samples at a final concentration of 1×103 to 1×105 pg/ml was found to be optimum. Using this assay, we observed a significant enhancement in cellular immunity in volunteers after the daily ingestion of yogurt for 8 weeks, which suggested a novel application of the assay in addition to monitoring HCMV infection risk. IFN-γ secretion from peripheral blood cells on HCMV-antigen stimulation differed significantly between individuals; therefore, the assay could not be normalized. Nevertheless, it was found to be particularly useful for observing fluctuations in cellular immune activity on an individual level.
Background: Schwannomas are difficult to diagnose using imaging alone. Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) is an effective and safe tissue sampling technique. Nevertheless, few reports have described EUS-FNA for schwannoma.
Objective: This study evaluates the efficacy of EUS-FNA for diagnosing schwannoma.
Methods: This retrospective study examined six consecutive schwannoma patients who were diagnosed as having schwannoma either from EUS-FNA results or from surgically resected specimens. The primary endpoint was diagnostic accuracy of EUS-FNA for schwannoma. The secondary endpoint was EUS-FNA safety.
Results: Based on cytomorphologic features and immunocytochemistry results after EUS-FNA, 4 out of 6 patients (66.7%) were diagnosed with schwannoma. The diagnoses before EUS-FNA were the following: 3 cases of gastric subepithelial lesion (SEL, suspicious for gastrointestinal stromal tumor), 1 case of intraperitoneal tumor, 1 case of retroperitoneal tumor, and 1 case of pancreatic tumor, with sizes of 15-44 mm (median 36 mm). No case was diagnosed as schwannoma solely based on image findings. Two cases of gastric SELs could not be diagnosed as schwannoma by EUS-FNA before surgery. Inadequate sampling and a lack of additional material for immunohistochemical studies could have engendered less-definite diagnoses in those cases. No procedural adverse events occurred.
Conclusion: The diagnostic accuracy rate of EUS-FNA for schwannoma is somewhat low. However, tissue samples were obtained safely using this method. Moreover, it is an important procedure for diagnosing schwannoma, which cannot be diagnosed solely from image findings.
The purpose of this study was to develop a comprehensive back school program that included elements of CBT (Cognitive Behavioral Therapy), implement this through multidisciplinary collaboration, and ascertain its effectiveness as a pilot study.
This school was implemented in the form of five 90-minute group sessions held every other week.
Participants comprised 7 chronic low back pain patients with poor improvement in the usual treatment. Practitioners were orthopaedic surgeon, physical therapist, and a clinical psychologist.
This school contents were patient education, self-monitoring, back exercise, relaxation, stress management, cognitive restructuring, activity pacing, and exposure.
From the Wilcoxon signed-rank test, each score of four scales or items (sense of control, PCS (pain catastrophizing), PASS-20 (escape/avoidance), FFD (finger-floor distance)) after this program significantly improved. Results of calculating the effect size, sense of control (d=0.55) is ‘moderate’, the PCS (d=1.12) and the PASS-20 (d=1.64) were ‘large’.
This back school may be useful for physical function and psychological variables which much related to pain management and daily disabilities in patients with poor respond to standard orthopaedic treatment.
AIMS: To evaluate the relationship between the apparent diffusion coefficient (ADC) value for bladder cancer and the recurrence/progression risk of post-transurethral resection (TUR).
METHODS: Forty-one patients with initial and non-muscle-invasive bladder cancer underwent MRI from 2009 to 2012. Two radiologists measured ADC values. A pathologist calculated the recurrence/progression scores, and risk was classified based on the scores. Pearson’s correlation was used to analyze the correlations of ADC value with each score and with each risk group, and the optimal cut-off value was established based on receiver operating characteristic (ROC) curve analysis. Furthermore, the relationship between actual recurrence / progression of cases and ADC values was examined by Unpaird U test.
RESULTS: There were significant correlations between ADC value and the recurrence score as well as the progression score (P<0.01, P<0.01, respectively). There were also significant correlations between ADC value and the recurrence risk group as well as progression risk group (P=0.042, P<0.01, respectively). The ADC cut-off value on ROC analysis was 1.365 (sensitivity 100%; specificity 97.4%) for the low and intermediate recurrence risk groups, 1.024 (sensitivity 47.4%; specificity 100%) for the intermediate and high recurrence risk groups, 1.252 (sensitivity 83.3%; specificity 81.3%) for the low and intermediate progression risk groups, and 0.955 (sensitivity 87.5%; specificity 63.2%) between the intermediate and high progression risk groups. The difference between the ADC values of the recurrence and nonrecurrence group in Unpaired t test was significant (P<0.05).
CONCLUSION: ADC on MRI in bladder cancer could potentially be useful, non-invasive measurement for estimating the risks of recurrence and progression.
Objective: To investigate the accuracy of cone beam CT (CBCT) to diagnose non-invasive chronic fungal rhinosinusitis.
Methods: Preoperative CT evaluation of non-invasive chronic fungal rhinosinusitis was performed by CBCT (3D Accuitomo 170®) and traditional multidetector CT (MDCT) (Aquilion 32®) in 13 and 38 patients with non-invasive chronic fungal maxillary sinusitis, respectively, in different facilities. Detection of intrasinus calcification was compared between these two groups.
Results: Detection of intrasinus calcification in patients with non-invasive chronic fungal maxillary sinusitis was higher in the MDCT group (84.2%) than the CBCT group (46.2%).
Conclusion: CBCT is inferior to MDCT in detection of intrasinus calcification in patients with non-invasive chronic fungal maxillary sinusitis. CBCT is frequently used in the screening of the paranasal lesion, but it is not enough to evaluate non-invasive chronic fungal maxillary sinusitis alone.
Angiosarcomas are rare malignant tumors derived from endothelial cells and occur most commonly in the scalp and the face. The prognosis is poor. Therefore, spontaneous regression of angiosarcoma is a rare phenomenon.
We describe a case of a 73-year-old man with multiple metastatic angiosarcoma.
In the present case, weekly paclitaxel therapy had an effect, but could not be continued because of interstitial pneumonia (IP). Weekly docetaxel therapy did not have an effect, but further chemotherapy was not carried out because aggravation of the IP was a concern.
The primary lesion and other metastatic lesions were inconspicuous on the positron emission tomography/computed tomography scan performed in one year and two months after best supportive care.
We reported an extremely rare case of spontaneous regression of therapy-resistant metastases of angiosarcoma that has remained controlled for 40 months since the initial diagnosis.
The patient was an 86-year-old woman with back pain after a fall. She had no neurological findings at the initial visit. Plain radiographs and magnetic resonance imaging (MRI) showed diffuse idiopathic skeletal hyperostosis (DISH) and a Th10 fracture. Two weeks later, she started gait exercise with immobilization by a rigid orthosis. Twenty-five days later, she presented with paralysis and numbness of her legs. Computed tomography (CT) showed anterior expansion in the vertebral body of Th10. MRI showed an intramedullary high-intensity area on T2-weighted images at the same level. She was diagnosed as having delayed paraplegia after a Th10 fracture and transferred to our hospital for surgery. Laminectomy of Th10, posterior fusion from Th7 to L1 with pedicle screws and hooks to Th6 and L1 laminae, anterior fusion from Th9 to Th11 with a plate, and autologous bone grafting were performed simultaneously. The patient’s paralysis improved, and she started gait exercise with no limitation of bed rest and without an orthosis after surgery. At 8 days after surgery, she again presented with low back pain and paralysis in her legs. CT revealed an L1 fracture, which was the caudal end of the surgical fusion. The decreased kyphosis after surgery compared to that at pre-injury might have caused a subsequent horizontal shear force to L1 when the patient sat on the bed and when she walked. In conclusion, to avoid postoperative adjacent vertebral fracture after fusion, appropriate correction of spinal alignment to that at pre-injury is needed for vertebral fractures in patients with DISH.
The patient was a male infant with an antenatal diagnosis of huge intraabdominal mass. Prenatal ultrasound at 35 weeks gestation revealed a markedly enlarged cystic mass in the lower abdomen. After birth at 38 weeks, the infant was allowed to void spontaneously and passed meconium. Ultrasonography showed an enlarged bladder with wall thickness of 2.9 mm and no hydronephrosis. Voiding cystourethrograms showed no evidence of vesicoureteral reflex and posterior urethral valve. The post-void residuals were 15 mL at 11 days of life, 5 mL at 1 month and 0 mL at 5 months. Over 10 years’ follow-up, the patient remains completely well without any urinary or gastrointestinal symptoms. In sporadic isolated congenital megacystis, which is not so rare in fetuses but is quite rare in neonates, gastrointestinal symptoms may be masked in the neonatal period; however, the present patient has never presented any symptoms.
A 24-year-old man with severe atopic dermatitis underwent anterior cruciate ligament (ACL) reconstruction of the right knee seven years earlier but developed a surgical site infection. The infection did not heal after removal of the metal implants, and a fistula eventually developed. This condition was left untreated for six years before he was referred to our hospital. Magnetic resonance imaging showed fluid in the tibial bone tunnel and extensive bone marrow edema surrounding the bone tunnel. Based on these findings, abscess formation within the tibial bone tunnel and osteomyelitis spreading to the proximal tibia were suspected. During the surgery, a portion of artificial ligament and non-absorbable suture were observed in the bone tunnel, and the infection healed immediately after removal of this complex. When surgical site infection occurs after ACL reconstruction, it is important to completely remove all artificial materials as early as possible.
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