Journal of Nippon Medical School
Online ISSN : 1347-3409
Print ISSN : 1345-4676
ISSN-L : 1345-4676
早期公開論文
早期公開論文の35件中1~35を表示しています
  • Masahiro Sakaguchi, Yasunobu Nagata, Yasuhiro Terasaki, Atsushi Takeyo ...
    論文ID: JNMS.2023_90-105
    発行日: 2022年
    [早期公開] 公開日: 2022/11/25
    ジャーナル フリー 早期公開
    電子付録

    Hemophagocytic lymphohistiocytosis (HLH) involves pathological histiocytes and phagocytosis of normal blood cells through activation of inflammatory cytokines. We report a case of Epstein–Barr virus-HLH in a 75-year-old woman who presented with fever, thrombocytopenia, and loss of consciousness. Epstein–Barr virus-HLH was diagnosed after we identified massive hemophagocytosis in bone marrow and Epstein–Barr virus DNA in cerebrospinal fluid. The HLH-2004 protocol was applied, and lactate dehydrogenase levels—which reflect HLH disease status—decreased. However, persistent loss of consciousness and multiple organ failure led to the patient' s death on day 18. Most cases of primary and secondary HLH involve pediatric patients; adult cases are rare. Few cases of central nervous system involvement in older adults have been reported. Therefore, accumulation of more data will help in developing better treatment strategies.

  • Kentaro Maejima, Nobuhiko Taniai, Hiroshi Yoshida
    論文ID: JNMS.2023_90-111
    発行日: 2022年
    [早期公開] 公開日: 2022/11/25
    ジャーナル フリー 早期公開

    Background: Leakage at the esophagojejunal anastomosis site is an important postoperative complication of total gastrectomy. We analyzed our surgical cases to determine the risk factors for esophagojejunal anastomotic leakage.

    Methods: This study included 309 patients who underwent total gastrectomy and esophagojejunal anastomosis. The onset of esophagojejunal anastomotic leakage according to age, gender, performance status, American Society of Anesthesiologists classification, body mass index, presence or absence of diabetes, invasion depth, lymph node metastasis, histological type, presence or absence of esophageal infiltration, operative duration, amount of blood loss, experience of blood transfusion, procedural approach, and the prognostic nutritional index was analyzed.

    Results: Univariate analyses revealed a significant difference in the rate of esophagojejunal anastomotic leakage due to advanced age, male gender, the presence of diabetes, the presence of esophageal infiltration, and blood loss ≥1100 g. In the multivariate analysis, which included factors identified in the univariate analyses, advanced age, male gender, the presence of diabetes, and blood loss ≥1100 g were identified as independent risk factors for esophagojejunal anastomotic leakage.

    Conclusions: Advanced age (≥68 years), male gender, diabetes, and massive blood loss are risk factors for esophagojejunal anastomotic leakage.

  • Ryuta Watanabe, Yasuo Okumura, Koichi Nagashima, Yuji Wakamatsu, Akima ...
    論文ID: JNMS.2023_90-112
    発行日: 2022年
    [早期公開] 公開日: 2022/11/25
    ジャーナル フリー 早期公開

    Background: Chronological changes in ablation lesions after cryoballoon ablation (CBA) and hot balloon ablation (HBA) of atrial fibrillation (AF) remain unclear.

    Methods: Of 90 patients who underwent initial balloon-based catheter ablation of AF and cardiac magnetic resonance imaging (cMRI) 3 months after ablation, data from 48 propensity score–matched patients (24 per group; 34 males; age 62±10 years) were analyzed. High-density pulmonary vein-left antrum (PV-LA) voltage mapping was performed after PV isolation, and low voltage areas around the PV ostia were defined as the total acute ablation lesion area (cm2). cMRI-derived dense fibrotic tissue localized around PVs was defined as the total chronic ablation lesion area (cm2). The percentage of total ablation lesion areas to total PV-LA surface area (%ablation lesion) was calculated during each phase, and %acute ablation lesion and %chronic ablation lesion areas were compared in patients who had undergone CBA and HBA.

    Results: The %acute ablation lesion area was larger for the CBA group than for the HBA group (30.8±5.8% vs. 23.0±5.5%, p < 0.001). There was no difference in %chronic cMRI-derived ablation lesion area (24.8±10.8% vs. 21.1±11.6%, p = 0.26) between groups. The rates of chronic AF recurrence were 12.5% and 8.3%, respectively (p = 0.45; log-rank test). LA volume and LA surface area were strongly associated with AF recurrence, but %chronic ablation lesion area was not (27±8% vs. 23±12%, p = 0.39).

    Conclusion: Large acute ablation lesions after CBA were smaller during the chronic phase. The size of chronic ablation lesions and the rate of AF recurrence were both similar for CBA and HBA.

  • Shintaro Fujita, Masanobu Takeyama, Shingo Kato, Yusuke Kawabata, Yuta ...
    論文ID: JNMS.2023_90-113
    発行日: 2022年
    [早期公開] 公開日: 2022/11/25
    ジャーナル フリー 早期公開
    電子付録

    Background

    The active surveillance (AS) has been suggested for the initial treatment of extra-abdominal desmoid fibromatosis (EADF), the percentage of patients who shifted to invasive secondary treatments was significant. Tranilast, an anti-keloid medication, is frequently used in Japan, but there is no detailed report on its efficacy.

    Methods

    We retrospectively analyzed the medical records of EADF patients treated with tranilast between January 2009 and March 2021. Since EADF has been reported to shrink spontaneously, the effects of all drugs should be compared to AS. Therefore, we compared its clinical course with that under AS (determined by a systematic review) to assess the effect of tranilast. A systematic literature review of AS outcomes was conducted on July 22, 2021, according to PRISMA guidelines. The primary endpoint was the rate of conversion to secondary treatment. Secondary endpoints were progression-free survival, objective response rate (ORR), disease control rate (DCR), and adverse events. The rates of conversion to secondary treatment, ORRs, and DCRs were compared between the two groups using the Fisher's exact test.

    Results

    Eighteen patients who received tranilast as the initial treatment for EADF were included. Two patients (11.1%) underwent surgical resection due to tumor growth and continuous pain. Compared to the secondary treatment conversion rate from the pure AS approach (40.1%), tranilast was shown to significantly reduce the rate (p = 0.01). The ORR and DCR did not different between the two groups.

    Conclusions

    As initial treatment for EADF, tranilast is preferred over AS.

  • Naoto Matsuda, Hiroaki Wakakuri, Kazuyuki Uehara, Hideya Hyodo, Toshih ...
    論文ID: JNMS.2023_90-505
    発行日: 2022年
    [早期公開] 公開日: 2022/11/25
    ジャーナル フリー 早期公開

    Nitrous oxide (N2O) is readily available, and its abuse for recreational purposes has become a social problem. In Japan, where N2O is strictly prohibited for non-medical use, abuse is often overlooked due to a lack of experience in the field. N2O abuse causes various long-term symptoms, including vitamin B12 deficiency, myelopathy, myeloneuropathy, subacute combined degeneration, mood changes, and psychosis. The diagnosis of N2O abuse is difficult due to the compound's short half-life and rapid elimination through the lungs. This report describes a case of fever and impaired consciousness in a patient with a history of N2O abuse.

  • Akira Saito, Motomichi Masuyama, Daisuke Ishiyama, Kenta Shigeta, Tsun ...
    論文ID: JNMS.2023_90-602
    発行日: 2022年
    [早期公開] 公開日: 2022/11/25
    ジャーナル フリー 早期公開

    Background Rehabilitation therapy for patients with severe coronavirus disease 2019 (COVID-19) is crucial; however, studies regarding rehabilitation strategies for intensive care unit (ICU) patients with COVID-19 are limited. We report a case of severe COVID-19 in an ICU patient whose physical function and basic movement ability rapidly improved after the initiation of active aerobic exercise in the supine position.

    Case A 70-year-old man with hypertension and obesity was admitted to the ICU and managed with a ventilator because of severe COVID-19. Physical therapy started on postadmission day 34. Problems encountered during physical therapy included low saturation of percutaneous oxygen (SpO2; <90%), dyspnea with a light exercise load, advancing muscle weakness, and endurance decline. The rehabilitation program included getting out of bed and resistance training of the upper and lower limbs twice daily while maintaining SpO2 at ≥90%. After ventilator weaning, we initiated aerobic training using a supine ergometer with varying load volume. On discharge from the ICU on postadmission day 45, the patient' s physical function (handgrip strength, Medical Research Council score, and Borg scale) and basic movement ability (Functional Status Score for ICU) rapidly improved.

    Conclusion Rehabilitation therapy involving aerobic cycling training based on a quantitative load setting may be effective in treating COVID-19.

  • Takanobu Otaguro, Tomokazu Motomura, Yutaka Funaki, Yuta Fukuyama, Tet ...
    論文ID: JNMS.2023_90-606
    発行日: 2022年
    [早期公開] 公開日: 2022/11/25
    ジャーナル フリー 早期公開

    A 79-year-old woman collided with a cliff in a passenger automobile. The fire department acknowledged an automated collision notification from the D-Call Net (DCN) at 1 min after the accident and called for doctors by helicopter ("Doctor-Heli" [DH] in Japan) 9 min after the injury. The DH reached the victim 28 min after the injury, and examinations revealed pain in the right side of her chest, tachypnea, and a weak radial artery pulse (indicating shock). The DH arrived at the hospital 49 min after the injury. A thoracic drainage was performed for right-sided tension pneumothorax. She recovered from the shock, but was diagnosed with flail chest and placed on a respirator. She was extubated on postoperative day 6 and transferred to a rehabilitation hospital on postoperative day 57. Due to the DCN, the patient received treatment 15 min earlier than the time taken by the conventional system. Emergency response task forces must develop strategies for connecting DCN warnings to a rapid medical response.

  • Youhei Tsunoda, Yoshio Shima, Hiroki Shinmura, Ryuhei Kurashina, Takas ...
    論文ID: JNMS.2022_89-612
    発行日: 2022年
    [早期公開] 公開日: 2022/10/21
    ジャーナル フリー 早期公開

    Background: It is suggested that antenatal corticosteroid administration (ACS) to women at risk for late preterm birth reduces neonatal respiratory complications. However, ACS to pregnant women at risk in late preterm is still not recommended in Japan due to concerns about the long-term prognosis of their children. We aimed to assess the late preterm neonatal respiratory morbidity risk from singleton cesarean delivery before labor without ACS in pregnancy.

    Methods: We retrospectively reviewed and analyzed data from the records of singleton cesarean deliveries of late preterm infants. The prevalence of neonatal respiratory morbidities necessitating ventilatory support such as continuous positive airway pressure or mechanical ventilation was compared with gestational age in late preterm. Respiratory distress syndrome (RDS) in the neonates was also compared.

    Results: One hundred singleton cesarean deliveries in the late preterm period were eligible for inclusion: 22 neonates were delivered at 34 weeks, 34 at 35 weeks, and 44 at 36 weeks. There was a significant difference in respiratory morbidity that decreased significantly with gestational age (p < 0.001). Similarly, there was a significant difference in RDS, and the most frequent was at 34 weeks (18.2 %, p = 0.017). There were no cases of RDS at 36 weeks.

    Conclusion: Late preterm birth via cesarean delivery before labor without ACS, especially at 34 and 35 weeks, was associated with the need for ventilation. Treatment with ACS in elective cesarean section with the risk of preterm delivery before 35 weeks and 6 days might be allowed.

  • Shigeru Matsuda, Masao Ichikawa, Hanako Kaseki, Kenichiro Watanabe, Sh ...
    論文ID: JNMS.2023_90-106
    発行日: 2022年
    [早期公開] 公開日: 2022/10/21
    ジャーナル フリー 早期公開

    Background: Accurate diagnosis of retroflexed uterus in daily practice is essential because this condition is related to pelvic pain and deep endometriosis. Uterine flexion can be measured by transvaginal ultrasonography (TVUS), a cost-effective primary test, but the accuracy required for diagnosing retroflexed uterus is unclear. This study assessed the accuracy of TVUS for diagnosis of retroflexed uterus in patients with endometriosis and compared it with that of magnetic resonance imaging (MRI) —the gold standard for measuring the uterine axis.

    Methods: The study included 123 patients who underwent endometriosis surgery in our department between 2012 and 2017. Uterine flexion angles were measured by retrospectively examining TVUS and MRI images, and the correlation was analyzed. Analysis of anteverted and retroverted uterine subgroups identified aspects of diagnosing uterine flexion with TVUS.

    Results: Uterine flexion angles on TVUS were strongly positively correlated (r = 0.86) with MRI results. Additionally, TVUS yielded no false-positive diagnoses and 28 false-negative diagnoses of retroflexion. All false-negative diagnoses occurred in patients with anteverted retroflexed uteruses.

    Conclusions: TVUS was generally accurate for measuring uterine flexion angle, as indicated by its strong correlation with MRI. Misdiagnosis of anteverted retroflexed uterus was a limitation of using TVUS for retroflexion diagnosis.

  • Ryohei Nishiguchi, Shinichi Asaka, Takeshi Shimakawa, Teppei Kono, Sac ...
    論文ID: JNMS.2023_90-107
    発行日: 2022年
    [早期公開] 公開日: 2022/10/21
    ジャーナル フリー 早期公開

    Background Totally extraperitoneal (TEP) repair is a recommended procedure for inguinal hernia repair in European hernia guidelines. However, technical challenges have limited its uptake in Japan, where transabdominal preperitoneal (TAPP) repair is more common. We evaluated the association of preoperative subcutaneous fat area (preSFA) with surgical outcomes and identified factors associated with the difficulty of TEP repair.

    Methods Clinical data from 62 patients undergoing TEP repair were collected retrospectively. Using the median for the preoperative subcutaneous fat index (preSFI; 45.9 cm2/m2), we classified patients as having a high SFI (HSFI) (n=31) and low SFI (LSFI) (n=31). Surgical outcomes and perioperative complications were then compared between these groups. Additionally, TEP repair was divided into five phases (e.g., Phase 1: dissection of the caudal side of the preperitoneal space), and operative time was measured during each phase. Phase 1 was divided into two sub-phases (1A: insertion of the first port, 1B: reaching Cooper's ligament).

    Results Operative time was longer (133 min vs 111 min, P = 0.028) and the peritoneal injury rate was higher (35.5% vs 9.7%, P = 0.015) for the HSFI patients. Furthermore, operative time for HSFI patients was significantly longer during Phase 1 (P = 0.014) and Phase 1A (P = 0.022).

    Conclusions preSFA was associated with a higher peritoneal injury rate and longer operative time in HSFI patients, suggesting that the presence of abundant subcutaneous fat increases the difficulty of TEP repair.

  • Masashi Nakaishi, Koji Sakamoto, Atsuko Sakanushi, Takeshi Matsunobu, ...
    論文ID: JNMS.2023_90-504
    発行日: 2022年
    [早期公開] 公開日: 2022/10/21
    ジャーナル フリー 早期公開

    Salivary gland carcinoma is a rare type of cancer with more than 20 different histopathological types. While chemotherapy has been the mainstay of treatment for unresectable carcinomas, such as multiple recurrence or distant metastasis, no standard regimen had yet been approved. In this article, we report a case of poorly differentiated salivary duct carcinoma of the submandibular gland with distant metastases who was successfully treated with pembrolizumab monotherapy. A 66-year-old male patient had become aware of a left submandibular mass 2 months before his first visit to our department. Needle biopsy at the previous hospital revealed carcinoma, not otherwise specified. The combined positive score of programmed death ligand-1 immunohistochemistry test was 1%–10%. The patient was then referred to our department for further treatment. Computed tomography revealed left level II and IV neck lymphadenopathy, bilateral lung shadowing, and osteolytic changes in the 12th thoracic vertebra. Needle biopsy showed poorly differentiated carcinoma, positive human epidermal growth factor receptor 2, and positive androgen receptor, which suggests salivary duct carcinoma. Based on the aforementioned data, a diagnosis of submandibular carcinoma T4aN2bM1 stage IVC was established. We then started with pembrolizumab monotherapy. After three courses of treatment, tumor shrinkage was observed. After 1 year, complete response was achieved without adverse events, with the treatment still ongoing. Despite the lack of evidence for the efficacy of immune checkpoint inhibitors in salivary gland carcinoma, some cases might successfully respond to this treatment, as in the current case. Hence, future clinical trials are needed to accumulate evidence.

  • Ryuta Nagaoka, Marie Saitou, Kiyotaka Nagahama, Ritsuko Okamura, Haruk ...
    論文ID: JNMS.2023_90-601
    発行日: 2022年
    [早期公開] 公開日: 2022/10/21
    ジャーナル フリー 早期公開

    Downhill varices are usually caused by superior vena cava (SVC) obstruction due to bronchogenic carcinoma or mediastinal tumors. These structures show retrograde blood flow and are located in the proximal esophagus. Varices in the hypopharynx resulting from mediastinal thyroid tumor are extremely rare. A 70-year-old man visited a local hospital with a 35-year history of enlarging thyroid tumor in the right neck. Fine needle aspiration cytology of the tumor revealed benign goiter. Contrast-enhanced computed tomography showed a huge tumor (13×10×5 cm) in the right to left lobe of the thyroid extending into the mediastinum. Further, a well-enhanced mass mimicking hypopharyngeal cancer was identified in the hypopharynx. Endoscopic examination demonstrated varices in the postcricoid region, so we avoided biopsy. The preoperative diagnosis was huge adenomatous goiter and hypopharyngeal varices caused by obstruction of the internal jugular and brachiocephalic vein by the goiter. Total thyroidectomy was performed and hypopharyngeal varices had disappeared by the next day. The histopathological diagnosis of the thyroid tumor was poorly differentiated carcinoma. Mediastinal thyroid tumor rarely causes downhill varices due to SVC obstruction. However, in this case, signs of SVC obstruction were absent and varices were found not in the upper esophagus, but in the hypopharynx. Obstructed venous flow from the thyroid plexus might circulate via superior laryngeal vein and cause varices in the postcricoid region. When a patient with large mediastinal tumor shows a tumor-like lesion in the hypopharynx, considering the possibility of downhill varices is important before conducting immediate biopsies.

  • Mami Matsui, Tomoo Jikuzono, Shoko Kure, Osamu Ishibashi, Haruki Akasu ...
    論文ID: JNMS.2023_90-604
    発行日: 2022年
    [早期公開] 公開日: 2022/10/21
    ジャーナル フリー 早期公開

    Parathyroid tumors (PTs) are sometimes difficult to diagnose because they are small and have a low-velocity blood flow, which can be missed by current imaging modalities. PTs consist of parathyroid adenoma (PA), parathyroid cyst, and parathyroid carcinoma (PC). Detective flow imaging (DFI) is a new imaging technology that displays a low-velocity blood flow. Herein, we report two cases in which DFI was useful for the diagnosis of PTs. One case consisted of a PA and a parathyroid cyst in close proximity, and the other was a PC. To the best of our knowledge, this is the first report to demonstrate the usefulness of DFI in the diagnosis of PTs.

  • Yujiro Tanabe, Haruka Ota, Shuya Kaneko, Kanae Tsuno, Makoto Watanabe, ...
    論文ID: JNMS.2023_90-605
    発行日: 2022年
    [早期公開] 公開日: 2022/10/21
    ジャーナル フリー 早期公開

    Trisomy 21 is sometimes complicated by congenital heart disease; however, comorbid type I diabetes mellitus and diseases involving autoantibodies such as Hashimoto's disease and Graves' disease are not uncommon. In contrast, autoinflammatory diseases such as Kawasaki disease and systemic juvenile idiopathic arthritis are rarely observed. We report a rare case of trisomy 21 with systemic juvenile idiopathic arthritis that responded well to the first course of methylprednisolone pulse therapy, but flared up and was complicated by macrophage activation syndrome (MAS). Subsequent methylprednisolone pulse therapy and cyclosporine resolved this condition. Cytokine analyses at several time points during the clinical course revealed that interleukin-18, interleukin-6, and chemokine ligand 9 levels were elevated even MAS onset in the patient with trisomy 21 once the clinical symptoms seemed to have settled down. Thus, in the future, early analysis of cytokine profiles should be performed for risk assessments of MAS and for determining the treatment intensity, even T21 patients.

  • Akihisa Matsuda, Takeshi Yamada, Ryo Ohta, Hiromichi Sonoda, Seiichi S ...
    論文ID: JNMS.2023_90-102
    発行日: 2022年
    [早期公開] 公開日: 2022/05/30
    ジャーナル フリー 早期公開

    Surgical site infections (SSIs) remain one of the most common serious surgical complications and are the second most frequent healthcare-associated infection. Patients with SSIs have a significantly increased postoperative length of hospital stay, hospital expenses, and mortality risk compared with patients without SSIs. The prevention of SSI requires the integration of a range of perioperative measures, and approximately 50% of SSIs are preventable through the implementation of evidence-based preventative strategies. Several international guidelines for SSI prevention are currently available worldwide. However, there is an urgent need for SSI prevention guidelines specific to Japan because of the differences in the healthcare systems of Japan versus western countries. In 2018, the Japan Society for Surgical Infection published SSI prevention guidelines for gastroenterological surgery. Although evidence-based SSI prevention guidelines are now available, it is important to consider the appropriateness of these guidelines depending on the actual conditions in each facility. A systemic inflammatory host response is a hallmark of bacterial infection, including SSI. Therefore, blood inflammatory markers are potentially useful in SSI diagnosis, outcome prediction, and termination of therapeutic intervention. In this review, we describe the current guideline-based perioperative management strategies for SSI prevention, focusing on gastroenterological surgery and the supplemental utility of blood inflammatory markers.

  • Ryuzo Bessho
    論文ID: JNMS.2023_90-103
    発行日: 2022年
    [早期公開] 公開日: 2022/05/30
    ジャーナル フリー 早期公開

    Neuroprotection is important in open aortic arch surgery because of the dependence of brain tissues on cerebral perfusion. Therefore, several techniques have been developed to reduce cerebral ischemia and improve outcomes in open aortic arch surgery. In this review, I describe various neuroprotective strategies, such as profound and deep hypothermic circulatory arrest, selective antegrade cerebral perfusion, retrograde cerebral perfusion, and lower body circulatory arrest; compare their advantages and disadvantages, and discuss their evolution and current status by reviewing relevant literature.

  • Naoto Chihara, Nobuhiko Taniai, Ryosuke Nakata, Yasuyuki Yokoyama, Kei ...
    論文ID: JNMS.2023_90-403
    発行日: 2022年
    [早期公開] 公開日: 2022/05/30
    ジャーナル フリー 早期公開

    Sciatic hernia is a rare type of pelvic floor hernia. The hernia contents can include the ureter, small and large bowel, or ovary, among others. Only a few cases of laparoscopic treatment for a sciatic hernia with small bowel incarceration have been reported.

    We report our experience using a laparoscopic approach for the treatment of a sciatic hernia in an 83-year-old woman and present a review of previous reports to characterize sciatic hernias more clearly. The patient was referred to our hospital complaining of constipation and abdominal bloating. A computed tomography (CT) examination showed a right sciatic hernia containing the small bowel. Laparoscopic repair of the sciatic hernia was performed using a self-fixating mesh. The patient was discharged after an uneventful postoperative course. The patient has not experienced abdominal bloating or constipation since the surgery. This case report describes the successful repair of a sciatic hernia using a laparoscopic trans-preperitoneal approach and the ProGrip™ Self-Fixating Mesh.

  • Masae Hoshi, Tomoo Jikuzono, Shigekazu Suzuki, Osamu Ishibashi, Yoko K ...
    論文ID: JNMS.2023_90-501
    発行日: 2022年
    [早期公開] 公開日: 2022/05/30
    ジャーナル フリー 早期公開

    A metastatic thyroid tumor (MTT) arising from breast carcinoma (BC) is rare and sometimes difficult to diagnose. We present a case of MTT from BC; we suspected anaplastic thyroid carcinoma at initial presentation. The patient was a 58-year-old female with a hard nodule in the right anterior neck and a history of breast cancer. Computed tomography indicated tumors on both thyroid lobes, and ultrasonography (US) with shear wave measurement (SWM) showed malignant features. We performed fine needle aspiration cytology (FNAC), the results of which led us to strongly suspect MTT from BC. The surgically resected specimen was evaluated histopathologically, including by immunohistochemistry (IHC), and the diagnosis was confirmed. In addition to FNAC and IHC, SWM is useful to diagnose MTT from BC.

  • Ami Shibata, Fumio Yamaguchi, Kazuma Sasaki, Shoji Yokobori, Akio Mori ...
    論文ID: JNMS.2023_90-502
    発行日: 2022年
    [早期公開] 公開日: 2022/05/30
    ジャーナル フリー 早期公開

    Intracranial tumors rarely accompany Down syndrome. Although germ cell tumor and glioma have been reported in Down syndrome, primary central nervous system lymphoma (PCNSL) has not been reported in Down syndrome. We report our experience with a patient with Down syndrome in whom PCNSL was diagnosed. The patient, a 48-year-old man with a diagnosis of Down syndrome, had no history of malignant tumors. The patient visited the hospital with complaints of left hemiparesis and gait disturbance. A thorough examination revealed the brain tumors, and tumor biopsy confirmed the diagnosis of PCNSL. The final pathological diagnosis was diffuse large B-cell lymphoma of the central nervous system. Chemotherapy with rituximab, methotrexate, procarbazine, and vincristine was administered, and whole-brain irradiation was planned in conjunction with chemotherapy. It is unclear whether the chromosomal abnormalities of Down syndrome were involved in the development of PCNSL or not. Further molecular biological analysis may clarify the mechanism of the combination of Down syndrome and PCNSL.

  • Mitsutoshi Shindo, Miho Tsukada, Sachiko Hirotani, Masamitsu Morishita
    論文ID: JNMS.2023_90-503
    発行日: 2022年
    [早期公開] 公開日: 2022/05/30
    ジャーナル フリー 早期公開

    An arteriovenous graft (AVG), which is necessary for hemodialysis (HD), has frequent complications; stenosis that causes venous hypertension is concerning for physicians. Herein, we present a case of improved venous hypertension using a Viabahn stent graft in an elderly HD patient. An 86-year-old woman underwent maintenance HD with left arm AVG. Two years later, she was referred to our hospital for treatment of juxta-graft-venous junction (GVJ) stenosis. Subsequently, she underwent four percutaneous transluminal angioplasty (PTA) procedures in the span of 9 months owing to recurrence of stenosis at the juxta-GVJ. One month after the last PTA, the patient had redness, swelling, and pain in her left forearm. We diagnosed venous hypertension based on angiography showing regurgitation to the periphery of the basilic vein and juxta-GVJ stenosis. The stenosed juxta-GVJ was adequately expanded using a 7-mm balloon, and a 7-mm stent graft was inserted into the stenosis site. Following the successful treatment of the condition, there was no regurgitation to the periphery of the basilic vein, and no symptoms were observed. This complication should be considered when an AVG is created because cutting off peripheral veins might prevent venous hypertension. Clinicians should perform regular postoperative monitoring.

  • Rinko Kokubo, Kyongsong Kim, Daijiro Morimoto, Toyohiko Isu, Akio Mori ...
    論文ID: JNMS.2023_90-201
    発行日: 2022年
    [早期公開] 公開日: 2022/01/25
    ジャーナル フリー 早期公開

    OBJECTIVE: Common peroneal nerve (C-PN) entrapment neuropathy is the most common peripheral nerve neuropathy of the legs. C-PN decompression surgery can be performed less invasively, but it may result in neurological complications. We report a rare case of nerve paralysis immediately after C-PN decompression surgery.

    CASE REPORT: This 85-year-old male suffered from leg numbness and pain. Electrophysical study revealed C-PN entrapment in the affected area and he underwent surgical decompression. Immediately thereafter he complained of slight paralysis without pain (manual muscle test: 3/5). It gradually worsened and 60 min after surgery his paralysis was complete. We re-opened the skin incision 3 hours after the first operation and found that a subcutaneous suture had been applied to the connective tissue near the C-PN, resulting in strong squeezing of the nerve. Upon release of the suture his paralysis improved immediately. We confirmed that there was no other nerve compression and finished the operation. His paralysis disappeared completely.

    CONCLUSION: Peripheral nerve surgery, including C-PN decompression surgery, is less invasive and the risk for complications is low. As the C-PN is located in the shallow layer under the skin, a stitch too deep in the subcutaneous layer may squeeze the nerve and elicit nerve palsy. Therefore, careful postoperative follow-up is necessary because early decompression leads to good surgical results.

  • Shigeru Matsuda, Yoshimitsu Kuwabara, Ryoko Kato, Kimihiko Nakao, Mire ...
    論文ID: JNMS.2023_90-202
    発行日: 2022年
    [早期公開] 公開日: 2022/01/25
    ジャーナル フリー 早期公開

    A 29-year-old nulliparous woman was diagnosed with ovotesticular disorder of sex development (DSD) based on postoperative histopathological findings after undergoing unilateral gonadectomy at the age of 6 years; later (age of 8 years), she had also undergone vulvoplasty and vaginoplasty. Her karyotype was 46, XX. She had dyspareunia because of a narrow vagina, but had a normal uterus and left gonad.Spontaneous ovulation was confirmed, but sexual intercourse was impossible because of dyspareunia despite performing vaginal self-dilatation using a vaginal dilator. Artificial insemination was initiated; however, five cycles failed to yield a viable pregnancy. We decided to perform in vitro fertilization (IVF), which resulted in conception. To reduce her distress during IVF because of insufficient lumen expansion following vaginoplasty, we administered adequate intravenous anesthesia before oocyte collection. The patient delivered a healthy male infant weighing 2,558 g at 37 weeks of gestation via cesarean section, which was performed because of gestational hypertension. This is the eighth report of a viable neonate born from a patient with ovotesticular DSD following gonadectomy and the first such pregnancy achieved by IVF. Therefore, IVF seems to be an effective option for infertile patients with ovotesticular DSD. Additionally, self-management of the plastic vagina is important during the peri- and postoperative periods of early vaginoplasty to prevent dyspareunia.

  • Kenji Suzuki, Takashi Sasaki, Keisuke Ohta, Junya Aoyama, Shun-Ichiro ...
    論文ID: JNMS.2023_90-301
    発行日: 2022年
    [早期公開] 公開日: 2022/01/25
    ジャーナル フリー 早期公開

    Background: Residual shunt after the closure of an inferior sinus venosus defect (ISVD) is a rare complication with a high rate of reintervention.

    Case presentation: Here, we report a rare case of a patient with a recurrent defect identified 22 years after the closure of ISVD. The 25 × 10-mm defect was situated at the inferior vena cava–right atrial junction and was closed directly at 5 years of age. No residual shunt was detected, and when the patient reached 12 years of age, follow-up was discontinued. However, the residual atrial septal defect shunt was detected incidentally at 27 years of age. During the second surgery, the lower end of the original defect was opened and then closed using an expanded polytetrafluoroethylene patch.

    Conclusions: In light of the high rate of reintervention for residual shunt after ISVD closure, patch closure appeared to be a better option to reduce the tension in the inferior–posterior border. Moreover patients with this profile should be followed up closely at least in their childhood, including assessment by echocardiography.

  • Kotaro Nanno, Seiichi Shinji, Takeshi Yamada, Akihisa Matsuda, Ryo Oht ...
    論文ID: JNMS.2023_90-302
    発行日: 2022年
    [早期公開] 公開日: 2022/01/25
    ジャーナル フリー 早期公開

    A peritoneal loose body (PLB) is a tissue completely separated from other intraperitoneal organs. It is rare and usually found incidentally during laparotomy, examination, or autopsy. It is usually located free in the peritoneal cavity and does not exist in the extraperitoneal space. It is generally thought to originate from the epiploic appendices released into the abdominal cavity following ischemic necrosis. We report a case of a giant PLB outside the peritoneal cavity, adjacent to the rectovesical excavation, inan asymptomatic 83-year-old man who underwent evaluation for cholecystolithiasis, preoperatively. Computed tomography revealed a mass with well-defined margins in the rectovesical excavation, consisting of a calcified core and peripheral soft tissue measuring 60 mm in diameter; it did not seem to invade adjacent organs. Although there were no symptoms or tumor growth over time, for a definitive diagnosis, we scheduled a laparoscopic extraction. On laparoscopic exploration, a white oval mass was found in the rectovesical excavation; there was no invasion of adjacent organs. We diagnosed the patient with a giant PLB.Postoperative recovery was uneventful. Most PLBs are asymptomatic and do not require surgery except when symptomatic, large in size, or suspicious for malignancy. The PLB is rarely extraperitoneal and usually freely mobile; however, in our patient, it was fixed and outside the abdominal cavity, near the rectovesical fossa. Although it could not be diagnosed preoperatively as being extra-peritoneal, it showed the typical imaging findings of PLB; thus, it was possible to remove the mass laparoscopically without bowel resection.

  • Ryosuke Nakata, Nobuhiko Taniai, Naoto Chihara, Hideyuki Suzuki, Hiros ...
    論文ID: JNMS.2023_90-303
    発行日: 2022年
    [早期公開] 公開日: 2022/01/25
    ジャーナル フリー 早期公開

    Bariatric surgery is performed worldwide to address morbid obesity. The benefits of this surgery are continued weight loss and decreased obesity-related complications. The relationship between bariatric metabolic surgery and reemployment has already been evaluated in Western countries, but there are few papers reporting these relationships in Japan since the number of bariatric metabolic surgery is small. Few Japanese studies have evaluated the effects of bariatric surgery on obesity stigma, which affects obese people's chances of employment and advancement, and may result in dismissal. We describe a 39-year-old man who underwent bariatric surgery after being dismissed from his job because of morbid obesity. Traditional weight loss methods failed to maintain weight loss. Preoperatively, the patient was treated for type 2 diabetes, hypertension, and abnormal lipid metabolism. He underwent sleeve gastrectomy and lost 50.4 kg (percent excess weight loss: 68.1%) in the first postoperative year. All medications were stopped after improved blood laboratory test results, and he was re-employed 8 months after surgery. Increased social activity associated with employment is a factor in suppressing rebound weight gain after bariatric surgery, and the weight loss associated with bariatric surgery helps decrease anti-obesity social stigma.

  • Taro Mikami, Yuki Homma, Yoshihiko Tamanoi, Yuichiro Yabuki, Yusuke Ka ...
    論文ID: JNMS.2023_90-401
    発行日: 2022年
    [早期公開] 公開日: 2022/01/25
    ジャーナル フリー 早期公開
    電子付録

    Many previous reviews of the literature have described the grafts and techniques for management of defects in the upper arm. However, the alternatives are limited in cases where some conventional flaps are not available and the nearby donor vessels have been previously sacrificed for free flaps. A 77-year-old man presented with a tumor in the right upper arm just above the axilla. The patient had already undergone surgeries for three recurrences of low-grade myxofibrosarcoma, the primary site of which was around the right scapula. The pectoralis major musculocutaneous flap was used for the defect caused by tumor resection, since there was no other available option. An acceptable result was obtained without any major complications. Thus, the pectoralis major myocutaneous flap may be a candidate for reconstruction of defects in the proximal part of the upper arm.

  • Natsuki Hashiba, Ryuta Nakae, Daisuke Yasui, Masaaki Inoue, Riko Maeji ...
    論文ID: JNMS.2022_89-601
    発行日: 2021年
    [早期公開] 公開日: 2021/11/26
    ジャーナル フリー 早期公開

    Rupture of a racemose hemangioma causing dilatation and tortuosity of the bronchial artery can result in massive bleeding and respiratory failure. Bronchial artery embolization (BAE) can treat this life-threatening condition, as we show in two cases. The first case was of an 89-year-old female complaining of sudden-onset chest and back pain. Bronchial artery angiography demonstrated a racemose hemangioma with a 2 cm aneurysm. The second case was of a 50-year-old male with hemoptysis and dyspnea, eventually requiring intubation. Bronchial arteriography showed a racemose hemangioma and a bronchial artery-pulmonary arterial fistula. BAE was successfully performed in both cases, with no recurrent hemorrhage. Therapeutic interventions in bronchial artery racemose hemangiomas include lobectomy or segmentectomy, bronchial arterial ligation, and BAE. BAE should be considered as first-line therapy for bleeding racemose hemangiomas of the bronchial artery because of its low risk of adverse effects on respiratory status, minimal invasiveness, and faster patient recovery.

  • Yoko Kawamoto, Shoko Kure, Hironori Katayama, Kiyoko Kawahara, Kiyoshi ...
    論文ID: JNMS.2022_89-605
    発行日: 2021年
    [早期公開] 公開日: 2021/11/26
    ジャーナル フリー 早期公開

    Introduction: Desmoplastic malignant pleural mesothelioma (DMPM) is a sarcoma type mesothelioma, comprising about 5% of malignant pleural mesotheliomas. Although effusion cytology is commonly used as the primary diagnostic approach for mesothelioma, this may not be useful for DMPM due to its desmoplastic nature and bland cellular atypia. We hereby report a case of DMPM diagnosed through autopsy along with its cytological features that have not been described previously.

    Case Presentation: A male in his 60s with a history of occupational asbestos exposure was referred to our hospital with right chest pain. Chest computed tomography scan showed right pleural effusion. Thirteen months later, the patient died of respiratory failure. In autopsy, the scrape-imprint smear and the pleural effusions cytology were performed. The scrape-imprint smear samples exhibited spindle cells with mild nuclear atypia and grooves with fibrous stroma. In the pleural effusion cytology, spindle cells having mild nuclear atypia and grooves with loose epithelial connections were observed. Histological examination of the right pleura showed spindle cells proliferating with dense collagen fibers, as seen in cytological samples, thus rendering the diagnosis of DMPM. Diagnosis was confirmed by fluorescence in situ hybridization.

    Conclusion: Cytological procedures, such as pleural effusion cytology and scrape-imprinting method, may be useful as an ancillary tool in the diagnosis of rare tumors such as DMPM.

  • Yuka Kasai, Ryoji Aoki, Nobuhiko Nagano, Hide Kaneda, Tsugumichi Koshi ...
    論文ID: JNMS.2022_89-606
    発行日: 2021年
    [早期公開] 公開日: 2021/11/26
    ジャーナル フリー 早期公開

    The site of perforation is difficult to identify preoperatively in many cases with spontaneous perforation of congenital biliary dilatation (CBD). We report a case of spontaneous perforation of CBD in which the perforation site was identified preoperatively using thin-slice contrast-enhanced computed tomography (CT). The patient was a girl aged 1 year and 4 months. She was admitted to our hospital because of vomiting and diarrhea that had continued for 3 days prior to admission. Abdominal contrast CT on admission showed dilated common bile duct, thickening of the gall bladder wall, and marked ascites. In addition, an area of low density with a diameter of 1 cm was detected near the neck of the gallbladder. We evaluated the area via thin-slice contrast-enhanced CT and detected a defect in the wall of the bile duct. Cholangiography revealed abnormal confluence of the pancreaticobiliary duct and a protein plug in the common duct. A diagnosis of CBD with perforation of the bile duct was made, and surgery was performed. The intraoperative findings matched that seen on the enhanced CT. There are some reports of pseudocysts and fluid retention around the perforation site; however, no reports are found in which the perforation site was confirmed by preoperative CT. If localized fluid retention is observed in cases with biliary perforation, confirmation with thin-slice contrast-enhanced CT might be useful for identifying the perforation site.

  • Yuusuke Fujiwara, Sohichi Aizawa, Hisao Ogawa, Atsushi Mamiya, Kenta S ...
    論文ID: JNMS.2022_89-607
    発行日: 2021年
    [早期公開] 公開日: 2021/11/26
    ジャーナル フリー 早期公開

    Schwannoma is an uncommon benign tumor in the oral and maxillofacial region, and development of schwannoma in the lower lip is rare. Herein, we present the case of a 68-year-old woman who visited Nihon University Itabashi Hospital complaining of a painless mass in the lower lip. The lesion was surgically resected under local anesthesia. On histopathological examination, the resected specimen was a mixture of Antoni types A and B schwannoma. No recurrence has been seen over a postoperative follow-up period of 58 months. In the schwannoma of the lower lip, the mean tumor volume was compared for type A and the mixed type, which tended to be larger in the mixed type. No previous reports have described the relationship between the size of schwannoma in the lower lip and Antoni classification. Therefore, this report discusses the possibility of a relationship between tumor size and Antoni classification for schwannomas in the lower lip.

  • Kohki Takeda, Akihisa Matsuda, Takeshi Yamada, Seiichi Shinji, Ryo Oht ...
    論文ID: JNMS.2022_89-608
    発行日: 2021年
    [早期公開] 公開日: 2021/11/26
    ジャーナル フリー 早期公開

    Kyphosis makes abdominal surgery difficult. Here, we report a case of rectal cancer in a patient with kyphosis on whom laparoscopic surgery was adequately performed owing to preoperative simulation. An 81-year-old woman with rectal cancer was admitted to our department, and laparoscopic surgery was planned. On physical examination, the patient showed severe kyphosis. To adequately perform laparoscopic surgery, a detailed and thorough preoperative simulation was conducted. 1) Simulations of port arrangement and anatomy with 3-D CT, 2) body position simulation, 3) selection of surgical instruments, 4) preoperative discussion with the anesthesiologist were conducted. We planned to insert the first port from the umbilical region for pneumoperitoneum and the camera port from the ventral region under pneumoperitoneum. We planned to insert the ports on the right side of the patient's body from caudal regions, considering the location of the inferior mesenteric artery and the limited degrees and space due to the costal arch and the promontorium. Beach chair position was planned. We used a fan-shaped retractor and a sponge-made retractor to remove the small intestine from the surgical view. We discussed with the anesthesiologist preoperatively, and decided to keep the pneumoperitoneum pressure under 8 mmHg during the operation considering the respiratory function. Lower anterior resection with D2 lymph node dissection was performed without any intraoperative complications, and at 2 years post-surgery, the patient was healthy with no signs of recurrence. Laparoscopic surgery may be a good choice in patients with kyphosis, and we believe that preoperative simulation will result in an uneventful surgery.

  • Hisako Yamamoto, Yusaku Miyamoto, Naoki Shimizu
    論文ID: JNMS.2022_89-609
    発行日: 2021年
    [早期公開] 公開日: 2021/11/26
    ジャーナル フリー 早期公開

    Acute encephalopathy is a syndrome characterized by an acute onset of disturbance of consciousness. Many acute encephalopathies are caused by viral infections; however, they can also be a result of bacterial infections. Acute focal bacterial nephritis (AFBN) can cause neurological symptoms, such as irritation, unconsciousness, and seizures. In some cases, AFBN-associated acute encephalopathy has also been reported. This report describes the first case of acute encephalopathy without the characteristic findings of MRI-associated AFBN. The patient was a 3-year-old male, who had febrile seizure at the ages of 1 and 2 years. He developed disturbance of consciousness, irritability, excitability, and neck stiffness on the day after admission. There were no abnormal findings on brain MRI; however, a generalized high-voltage slow wave was noted on electroencephalography (EEG). His urinary sediment count was elevated, and Morganella morganii and Enterococcus faecalis were detected in the urinary culture. A diagnosis of acute encephalopathy with urinary tract infection (UTI) was made. Intravenous (IV) antibiotics were administered to treat the UTI, while methylprednisolone pulse therapy and IV immunoglobulin were administered to treat acute encephalopathy. Additionally, AFBN was detected in both kidneys on contrast-enhanced CT. The patient received a second course of methylprednisolone pulse therapy due to the persistent high voltage slow wave noted on the EEG on day 8. Furthermore, contrast-enhanced CT revealed AFBN in both kidneys. The final diagnosis was acute encephalopathy with AFBN; however, we had initially diagnosed febrile seizures associated with UTI. It should be noted that acute encephalopathy is associated with AFBN.

  • Teruyuki Dohi, Hoyu Cho, Mina Kamegai, Kumi Fukumitsu, Takuya Shimizug ...
    論文ID: JNMS.2022_89-610
    発行日: 2021年
    [早期公開] 公開日: 2021/11/26
    ジャーナル フリー 早期公開

    Keloids are laterally growing fibroproliferative skin disorders. In severe cases, keloids spread widely, sometimes over joints, thus significantly limiting motor function. Severe keloids also associate with repeated and very painful draining infections. Here, we report the case of a giant keloid that was successfully treated by combination therapy composed of surgery (partial resection followed with local flap transposition) followed by radiotherapy and steroid-plaster therapy. The keloid of the patient started growing at the age of 7 from the BCG injection that she received on her left shoulder in infancy. The keloid grew rapidly and widely after adulthood. Malignant tumor was suspected at another hospital but a biopsy at the age of 45 indicated it was a keloid. Thereafter, the keloid grew from the shoulder onto the chest and back and over the anterior axilla. At 62 years of age, the patient was referred to our hospital. After providing general anesthesia, the keloid was partially resected and the wound was covered with a local flap. Postoperative radiotherapy was performed 1 week later. The residual keloid was treated for 18 months with steroid tape. Eighteen months after surgery, keloid recurrence was not observed. The patient had no pain or movement restriction. She was extremely satisfied with the results and considered the treatment to have improved her quality of life. While a standard strategy for severe keloid remains to be established, combination therapy composed of surgery, postoperative radiotherapy, and steroid-plaster therapy that aims to reduce inflammation and skin tension may be an option.

  • Yuji Tomori, Norio Motoda, Ryu Tsunoda, Ryuji Ohashi, Yasuyuki Kitagaw ...
    論文ID: JNMS.2022_89-602
    発行日: 2021年
    [早期公開] 公開日: 2021/09/14
    ジャーナル フリー 早期公開

    We present a case of solitary chondrosarcoma arising from the proximal phalanx of the ring finger in an elderly man. The chondrosarcoma developed over a period of 14 years, during which the phalanx became progressively more deformed. Several radiographic investigations were carried out, but the patient declined further suggested diagnostic examinations (computed tomography, magnetic resonance imaging, biopsy). Eventually, the lesion became significantly enlarged, and radiographs showed osteolytic lesions in the phalangeal bone. Ray amputation of the finger was required to establish a wide resection of the chondrosarcoma. Most osteochondral tumors arising from the phalanges are benign tumors such as enchondromas, but primary chondrogenic malignant bone tumors (chondrosarcomas) occasionally occur. Chondrosarcoma of the phalanx is difficult to distinguish from enchondroma of the phalanx, because histological investigations of the two neoplasms often produce similar findings. Even with a combination of clinical, biopsy, and imaging findings, differentiating these neoplasms is still challenging, because the characteristic clinical and radiological features of chondrosarcoma do not appear until it becomes aggressive and starts to cause destructive changes. Once that happens, radical expanded resection of the tumor is essential. Therefore, longstanding enchondroma-like lesions should be actively treated in elderly patients, even if a definite diagnosis of chondrosarcoma cannot be made.

  • Koji Sakamoto, Hiroyuki Ozawa, Masayuki Shimoda, Masashi Nakaishi, Ats ...
    論文ID: JNMS.2022_89-603
    発行日: 2021年
    [早期公開] 公開日: 2021/09/14
    ジャーナル フリー 早期公開

    Objectives: Reconstruction of medium-sized skin defect after excision of parotid carcinoma is performed using local flaps, pedicled flaps, or free flaps. The bilobed flap is one of the local flaps adopted by plastic surgeons primarily for a small nasal skin defect. We report a case of a patient with parotid carcinoma with skin infiltration who successfully underwent skin reconstruction with the bilobed flap. Methods: An 84-year-old man had visited our hospital with a parotid mass 2 months earlier. He was diagnosed with parotid carcinoma with skin infiltration and underwent radical surgery. The skin defect was round-shaped with a 6 cm diameter. It was resected and reconstructed using a bilobed flap designed caudal to the defect. Results: Except for the postoperative facial nerve palsy, which improved within 6 months, the postoperative course was uneventful, and the patient was discharged on the seventh postoperative day. Pathological examination revealed a sarcomatoid salivary duct carcinoma. Conclusions: The bilobed flap is useful for reconstructing skin defects measuring up to 6 cm in diameter.

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