Journal of Nippon Medical School
Online ISSN : 1347-3409
Print ISSN : 1345-4676
ISSN-L : 1345-4676
最新号
選択された号の論文の14件中1~14を表示しています
Originals
  • Takehisa Yamada, Yukinao Sakai, Tetsuya Kashiwagi, Masato Iwabu
    2024 年 91 巻 6 号 p. 520-526
    発行日: 2024/12/25
    公開日: 2024/12/27
    ジャーナル フリー

    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.

  • Takehiro Katano, Satoshi Suda, Tomohiro Ohta, Mitsusuke Miyagami, Yuzo ...
    2024 年 91 巻 6 号 p. 527-533
    発行日: 2024/12/25
    公開日: 2024/12/27
    ジャーナル フリー

    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.

  • Susumu Ichiyama, Michiko Ito, Saeko Ozaki, Taeang Arai, Masanori Atsuk ...
    2024 年 91 巻 6 号 p. 534-540
    発行日: 2024/12/25
    公開日: 2024/12/27
    ジャーナル フリー

    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.

Case Reports
  • Tetsuya Shimizu, Masato Yoshioka, Akira Matsushita, Junji Ueda, Mampei ...
    2024 年 91 巻 6 号 p. 541-547
    発行日: 2024/12/25
    公開日: 2024/12/27
    [早期公開] 公開日: 2023/08/08
    ジャーナル フリー

    Extrahepatic portal vein obstruction (EHPVO) is a rare disease-causing form of portal hypertension. Myeloproliferative neoplasm (MPN) including essential thrombocythemia (ET) is a reported risk factor for EHPVO due to underlying persistent thrombophilia. A Japanese woman in her 40s was referred to our hospital with a 1-month history of gastric variceal bleeding due to EHPVO. Laboratory investigation showed thrombocytosis despite portal hypertension. She had a mutation in clonal marker JAK2V617F with EHPVO, which prompted us to consult a hematologist. A bone marrow biopsy revealed megakaryocyte lineage proliferation, which confirmed a diagnosis of ET. Esophagogastroduodenoscopy revealed esophagogastric varices (LsF2CbRC2, Lg-cF1RC1), and abdominal computed tomography and angiography revealed splenomegaly and portal vein thrombosis with cavernous transformation, which suggested EHPVO. The patient had a history of ruptured esophagogastric varices and required prophylaxis against further variceal bleeding before antithrombotic therapy for EHPVO with ET. We performed laparoscopic Hassab's operation followed by endoscopic variceal ligation (EVL) and hematological cytoreduction therapy. Laparoscopic Hassab's operation and three bi-monthly EVL procedures improved the esophagogastric varix (LmF0RC0, Lg-f F0RC0) at 6 months after surgery. Cytoreduction therapy reduced platelet count to 60.1 × 104/uL, and the patient was very healthy at 7 months after surgery. Patients with EHPVO are traditionally referred to a gastroenterologist for abdominal pain, intestinal bleeding, or refractory ascites; however, hypercoagulative disease may be occult in such patients and require the attention of a hematologist. When treating patients with EHPVO, gastroenterologists should screen for hematological disease, including MPN.

  • Yi-Ling Lin, Jiung-Hsiun Liu
    2024 年 91 巻 6 号 p. 548-553
    発行日: 2024/12/25
    公開日: 2024/12/27
    ジャーナル フリー

    A variety of autoimmune disorders are associated with an increased risk of thrombosis. Previous studies have suggested combined therapy of heparin and therapeutic plasma exchange (TPE) with fresh frozen plasma (FFP) as the replacement fluid is beneficial in some cases of acute flare-up of autoimmune diseases complicated by thrombotic events. Nevertheless, it remains unknown whether clinicians do more harm than good by exposing patients to a "thrombotic storm" through simultaneous administration of heparin and the clotting factors in the FFP during TPE. A variety of data are currently available on therapeutic interventions for autoimmune diseases complicated with acute thrombosis; however, there is limited evidence on the exact efficacy of each individual approach and combinations of these measures. Herein, we report a case of catastrophic antiphospholipid syndrome (CAPS) to highlight the difficulty of therapeutic decision-making when complicated interactions occur between heparin and TPE. To our knowledge, this is the first case report of a patient diagnosed with CAPS successfully treated with a novel therapeutic strategy of escalating the heparin dosage when performing TPE by monitoring the partial prothrombin time to reduce the risk of the progression of thrombosis.

  • Masaki Miyao, Tsubasa Takahashi, Jun Hayakawa, Makoto Migita, Toshikaz ...
    2024 年 91 巻 6 号 p. 554-559
    発行日: 2024/12/25
    公開日: 2024/12/27
    ジャーナル フリー

    Paraganglioma, a catecholamine-producing tumor originating in extra-adrenal paraganglion cells, is rare in children. Although diagnosis of paraganglioma is based on the presence of catecholamine symptoms, some patients lack such symptoms. Delayed diagnosis is associated with tumor growth and invasion of surrounding vessels. Herein, we report a case of pediatric retroperitoneal paraganglioma invading the inferior vena cava. The tumor was completely resected and the patient has been free of recurrence for 2 years. Our findings suggest that complete resection can help prevent recurrence in cases of invasion of the inferior vena cava.

  • Tatsunori Shiraishi, Masafumi Toyoshima, Mio Sugawara, Takashi Matsush ...
    2024 年 91 巻 6 号 p. 560-566
    発行日: 2024/12/25
    公開日: 2024/12/27
    ジャーナル フリー

    The abdominal wall is an uncommon site for endometriosis that occurs in the soft tissues of the wound site after laparotomy. The present study reviewed cases of post−cesarean section abdominal wall endometriosis that were surgically treated at our institution from April 2007 to August 2020. We analyzed data from nine patients who were diagnosed with abdominal wall endometriosis and selected surgery after receiving sufficient explanation of hormone therapy and from patients who reported no improvement in symptoms with hormone therapy. Written consent for case reporting was obtained from all patients. The location of abdominal wall endometriosis was at the wound site in seven cases and outside the wound in two cases. In addition, 7/9 (78%) of post-cesarean cases of abdominal wall endometriosis were related to the cesarean procedure, and 6/9 (67%) of the cases had symptoms related to menstruation. Post-cesarean abdominal endometriosis was associated with pain (7/9; 78%) and a palpable mass (3/9; 33%). Surgical resection did not cause large tissue defects, and artificial repairs such as synthetic mesh were not required for any patient. In conclusion, women with a history of a cesarean section who present with recurrent pain or masses in the wound or abdominal wall that coincide with the menstrual cycle should be closely evaluated for abdominal wall endometriosis. Because surgical treatment often requires postoperative wound reconstruction, collaboration with plastic surgeons and dermatologists is essential.

  • Mio Yagi, Toshihiko Yoneto, Keiko Yanagihara, Koji Nagata, Satoru Mats ...
    2024 年 91 巻 6 号 p. 567-573
    発行日: 2024/12/25
    公開日: 2024/12/27
    ジャーナル フリー

    In patients not infected by HIV, Pneumocystis jirovecii pneumonia (PCP) is characterized by rapid disease progression, difficulty in confirming the diagnosis, and poor prognosis. PCP has also been reported in immunocompromised patients receiving chemotherapy, most often for hematologic tumors, although some patients receiving treatment for breast cancer have been affected. Dose-dense chemotherapy (DDC) which is performed with shorter dosing intervals than standard chemotherapy and is now widely used in clinical practice. However, adverse events have been reported, including infections associated with decreased immune status. PCP infection is considerably more challenging to diagnose and treat than bacterial or viral infections. Furthermore, organizing pneumonia (OP), a pulmonary lesion of PCP, is infrequent and requires caution on the part of clinicians, as protozoan infections require different forms of treatment. Although we initially suspected bacterial, viral, and drug-induced pneumonia in our patient and started treatment with antibiotics, antifungals, and prednisolone, the final diagnosis was OP. The pulmonary lesion of PCP was treated with systemic corticosteroids, leading to recovery. There have been no similar reports of PCP during chemotherapy for malignant disease; however, the possibility of OP should be considered during chemotherapy. Herein, we report a case of PCP during preoperative DDC for advanced breast cancer.

  • Junya Sugihara, Mami Kurihara, Hikaru Takeshita, Hanako Tajima, Jun Ha ...
    2024 年 91 巻 6 号 p. 574-578
    発行日: 2024/12/25
    公開日: 2024/12/27
    ジャーナル フリー

    An infant was diagnosed as having X-linked agammaglobulinemia (XLA) at age 3 months and was receiving immunoglobulin replacement therapy. He developed SARS-CoV-2 infection at age 7 months and was treated with intravenous immunoglobulin, remdesivir, and dexamethasone. His respiratory symptoms improved quickly, and the infection resolved. Viral disappearance was confirmed via PCR, and the result of a SARS-CoV-2 test was negative on day 67 of illness, as a result of antiviral therapy. Immunoglobulin administered to the patient did not contain anti-SARS-CoV-2 antibodies, and no seroconversion of anti-SARS-CoV-2 antibodies was observed after healing. These findings suggest that humoral immunity did not contribute to infection in our patient. Thus, the importance of cellular immunity against COVID-19 was confirmed. In the future, it is hoped that testing companies will be able to use the ELISPOT assay to check cellular immunity in order to confirm the effectiveness of vaccines and the history of infection.

  • Shimpei Ikeda, Takahiko Mine, Shohei Mizushima, Soh Ueshima, Seigoh Ha ...
    2024 年 91 巻 6 号 p. 579-585
    発行日: 2024/12/25
    公開日: 2024/12/27
    ジャーナル フリー

    As a blood flow control technique for embolization using glue (n-butyl cyanoacrylate; NBCA) for peripheral artery aneurysm/pseudoaneurysm, we placed a vascular plug or coils at the proximal inflow vessel before glue injection. We describe this maneuver, which we call the glue in lockdown technique. Four peripheral aneurysms-two pulmonary artery pseudoaneurysms, one pancreaticoduodenal arcade pseudoaneurysm, and one internal iliac artery aneurysm-deemed unsuitable for conventional embolization because of abnormal blood flow, coagulopathy, or anatomical complexity were embolized with our technique. Technical and clinical outcomes were reviewed to evaluate the effectiveness of the procedure. Reliable and rapid embolization was achieved in coagulopathy cases and hemodynamically or anatomically complicated lesions. Glue in lockdown technique was successfully used to treat peripheral aneurysms and can be further developed for application to other lesions.

  • Katsuya Umeoka, Fumihiro Matano, Yasuo Murai
    2024 年 91 巻 6 号 p. 586-589
    発行日: 2024/12/25
    公開日: 2024/12/27
    ジャーナル フリー

    A patient with trigeminal neuralgia due to venous compression was successfully treated by transposition achieved by drilling the suprameatal tubercle. A 53-year-old woman presented with classical trigeminal neuralgia affecting the maxillary division of the right trigeminal nerve. MRI and CT revealed a bony prominence, called the suprameatal tubercle, above the opening of the internal acoustic meatus. MRI showed a thick venous flow void interposed between the suprameatal tubercle and trigeminal nerve. The patient underwent retrosigmoid craniotomy. The bony prominence restricted transposition of the compressed vein, so the compressed vein was successfully transposed after drilling the prominence. The patient's symptoms resolved completely. Drilling the suprameatal tubercle is useful for transposing sandwiched compression vessels.

  • Hiroya Hasegawa, Jun Akatsuka, Shogo Imai, Yuki Endo, Masato Yanagi, H ...
    2024 年 91 巻 6 号 p. 590-594
    発行日: 2024/12/25
    公開日: 2024/12/27
    [早期公開] 公開日: 2023/12/08
    ジャーナル フリー

    Renal abscesses require prompt diagnosis and appropriate intervention, as they can be life-threatening. However, diagnosis based solely on clinical findings is often challenging. We present the case of a 69-year-old woman with left renal masses on follow-up computed tomography (CT) after surgery for pT2aN0M0 lung carcinosarcoma. The masses were localized only in the left kidney without suspected metastatic lesions at other sites. The patient was referred to our department for further evaluation and treatment under a diagnosis of suspected metastatic lung carcinosarcoma of the left kidney. On enhanced CT, the left renal masses, the largest of which had a diameter of 40×36 mm had thick irregular walls gradually enhanced by the contrast media and an internal low-attenuation area. The masses showed heterogeneous signal intensity with a pseudocapsule on T2-weighted magnetic resonance imaging. Clinical symptoms such as fever or costovertebral angle tenderness were absent, and blood and urine tests were not sufficiently inflammatory to suggest a renal abscess. Histopathological findings on CT-guided renal biopsy revealed only inflammatory tissue and no tumor cells. However, because lung carcinosarcoma metastatic nodules could not be ruled out, laparoscopic left nephrectomy was performed for a definitive diagnosis and curative intent. The pathological diagnosis was renal abscess without malignant lesions. Here, we present a case of renal abscess mimicking metastatic lesions in a patient with lung carcinosarcoma. Accurately differentiating renal abscesses from metastatic renal tumors before treatment is often difficult. Renal abscess diagnosis should be considered through a comprehensive evaluation of the clinical findings of individual cases.

  • Yuki Ideguchi, Shimpei Ono, Shintaro Kaneyuku, Taishi Murakami, Rei Og ...
    2024 年 91 巻 6 号 p. 595-599
    発行日: 2024/12/25
    公開日: 2024/12/27
    ジャーナル フリー

    The reliable engraftment of skin grafts into areas with complex shapes can be challenging. Here, we report a case of successful fixation of a genital skin graft using negative pressure wound therapy (NPWT) with RENASYS® Cotton Filler. A 44-year-old male with no relevant medical history underwent split-thickness skin grafting for a genital skin defect caused by Fournier's gangrene. A 0.4-mm sheet graft was applied for the penile skin defect, while 0.4-mm 1.5 times mesh grafting was applied for the testis and spermatic cord. NPWT with a cotton filler was used for seven days of fixation. No postoperative pain or stool contamination was observed. Although a small area of partial necrosis developed, the lesion healed with conservative treatment. Six months after surgery, there was no scar contracture, urination disorder, or pain during erection. Cotton fillers are highly malleable and adaptable, allowing for simple and reliable fixation of skin grafts in complex areas. Moreover, NPWT for genital graft fixation avoids contamination from stools. Therefore, we recommend fixation using NPWT with a cotton filler for genital skin grafting.

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