Journal of Rural Medicine
Online ISSN : 1880-4888
Print ISSN : 1880-487X
ISSN-L : 1880-487X
Volume 16, Issue 2
Displaying 1-16 of 16 articles from this issue
Original article
  • Tomoyuki Asada, Hirotaka Mutsuzaki
    2021 Volume 16 Issue 2 Pages 67-71
    Published: 2021
    Released on J-STAGE: April 01, 2021

    Objective: To analyze injury patterns in a male Japanese professional basketball team of this new league, with a particular focus on the difference between injuries of Asian and non-Asian players.

    Patients and Methods: During four basketball seasons, we analyzed all injuries in a B2 league team. We investigated the injury rate (IR), game injury rate (GIR), practice injury rate (PIR), pathology, and body area of each injury. Player demographics and injuries were collected from a database, which was updated by the team’s athletic trainer.

    Results: In total, 47 injuries in 51 players during the 4-year seasons were included. The IRs overall, in Asian, and in non-Asian players were 4.42, 4.37, and 3.11/1000 player hours (PH), respectively. The GIR (47.16/1000 PH overall, 4.37 in Asian, and 3.11 in non-Asians) was significantly higher than the PIR (1.50/1000 PH overall, 1.66 in Asian, and 0.84 in non-Asian; P<0.001 in all groups). Injuries of the upper body occurred only in Asian players (n=17; 51%, P=0.022). Most injuries occurred in the lower extremities than in other body parts (n=30; 64%, P<0.001), for which Asian and non-Asian players showed similar tendencies. Ankle sprains were the most common acute injury (n=7; 15%, P=0.007), while joint problems were the most common chronic injury (n=7; 15%, P=0.046).

    Conclusion: In this Japanese basketball team, the GIR of Asian, non-Asian, and overall players was higher than that of PIR. Injuries of the upper body were more frequent in Asian players than in non-Asian players in this league. Ankle sprains were the most common injury in both groups, while acute skin injuries occurred predominantly in Asian players. Prevention programs should be developed for injuries of the upper body in Asian players and those with lower extremity injuries.

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  • Ryohei Kamei, Michiru Sawahata, Naoko Yoshizumi, Masafumi Sata, Masayu ...
    2021 Volume 16 Issue 2 Pages 72-76
    Published: 2021
    Released on J-STAGE: April 01, 2021

    Objective: Pulmonary mycobacterium avium complex (MAC) disease is increasing significantly worldwide. Several studies have investigated the clinical features of pulmonary MAC disease in the setting of cancer. Here, we aimed to clarify the clinical characteristics of patients with cancer with recent onset of pulmonary MAC disease and the effect of cancer on the onset of this disease.

    Patients and Methods: Of the 323 consecutive Japanese patients newly diagnosed with pulmonary MAC disease at Jichi Medical University Hospital between and 2006–2017, we retrospectively reviewed 79 consecutive patients with cancer.

    Results: Seventeen patients had lung cancer (21.0%), while 62 had non-lung cancer. Of the 17 patients with lung cancer, 16 had adenocarcinoma of which 10 had stage I to III disease; 8 of the 10 patients had not received chemotherapy. Sixteen patients with lung cancer had a MAC infection in the ipsilateral lung. Notably, 9 of the 11 lung cancer patients who did not undergo surgery had a MAC infection in the affected lobe. Of the 39 patients with the most common types of non-lung cancer (14 had gastric cancer, 13 had colorectal cancer, and 12 had breast cancer), 22 had stage I to III disease, and 18 of these 22 had not received chemotherapy.

    Conclusion: Lung cancer may act as a local factor contributing to the onset of pulmonary MAC disease in the ipsilateral lung. However, the underlying mechanism by which a history of cancer might affect the onset of pulmonary MAC disease remains unclear. Further investigation into this mechanism is needed.

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  • Noritaka Sakamoto, Michiru Sawahata, Yoshitaka Yamanouchi, Satoshi Kon ...
    2021 Volume 16 Issue 2 Pages 77-82
    Published: 2021
    Released on J-STAGE: April 01, 2021

    Objective: Histological verification of epithelioid cell granuloma is important in diagnosing sarcoidosis; tissue sampling is a worldwide requirement. In 2006, to reduce medical expenses and avoid invasive procedures, diagnostic criteria without histological verification were permitted by the Japanese government. In 2015, new diagnostic criteria, allowed clinical diagnoses based on only respiratory, ocular, and cardiac systems with at least a two-system involvement, increasing the need to sample tissue from clinically unevaluable organs in suspected sarcoidosis. This study aimed to compare the characteristics of patients who were diagnosed with sarcoidosis according to the 2006 and 2015 criteria.

    Materials and Methods: Using the 2015 version, we re-evaluated the characteristics of 264 patients with diagnosed or suspected sarcoidosis according to the 2006 criteria, at Jichi Medical University Hospital between 2004 and 2012 (clinical diagnosis, 84; histological diagnosis, 117; suspected sarcoidosis 63).

    Results: Thirty-nine patients were diagnosed with suspected sarcoidosis due to the absence of at least a two-system involvement; two patients had insufficient laboratory data suggestive of sarcoidosis. Six patients moved from suspected sarcoidosis to a histological diagnosis because of a greater leniency in the criteria for supportive findings. The 2015 diagnostic criteria excluded patients with organ involvement without a requirement for systemic steroids from the clinical diagnosis group. A case of schwannoma, erroneously placed in the clinical diagnosis group by the 2006 criteria, was reclassified according to the 2015 criteria.

    Conclusion: The 2015 version is preferable for clinically diagnosing sarcoidosis, even without histological specimens, and provides guidance for indications for systemic treatment.

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  • Hironori Takehashi, Tomofumi Nishino, Hajime Mishima, Hiroshi Wada, Ma ...
    2021 Volume 16 Issue 2 Pages 83-90
    Published: 2021
    Released on J-STAGE: April 01, 2021

    Objective: In this study, thermoelastic stress analysis was conducted to clarify the surface stress distribution of a femur in which a BiCONTACT E stem was inserted. The contact sites between the stem and femur were examined to investigate the association with the range of stress distribution.

    Materials and Methods: BiCONTACT E was set up using two synthetic femurs that mimic the morphology and mechanical properties of living bone. Preoperative planning was performed using three-dimensional imaging software. The synthetic bone was placed in a sample holder. After the stem was implanted into the synthetic bone, computed tomography imaging was performed. The contact sites between the stem and the cortical part of the synthetic bone were examined using the imaging software. Subsequently, thermoelastic stress measurements were performed on the sample.

    Results: The results of thermoelastic stress analysis indicated a minimum change in the sum of principal stresses [Δ (σ12)] on the medial side and a maximum change in the sum of principal stresses on the lateral side. Thus, no minimum change was observed in the sum of the principal stresses at the maximum proximal part. It is reasonable to assume that the use of a cementless stem can inevitably lead to bone atrophy in the proximal part of the femur. The contact sites between the stem and femur were also investigated, and the results of the study clearly and quantitatively demonstrated the correlation of the contact sites with a range of stress distributions.

    Conclusion: The surface stress distribution of a femur, in which a BiCONTACT E stem was inserted, was clarified. The contact sites between the stem and femur were also investigated. Furthermore, the correlation between these results and clinical bone response was investigated in this study.

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  • Akihiro Karube, Fumiko Saito, Masato Waga, Shota Yokoyama, Katsuhiro K ...
    2021 Volume 16 Issue 2 Pages 91-97
    Published: 2021
    Released on J-STAGE: April 01, 2021

    Background: This study aimed to examine whether genotype categories of high-risk human papillomaviruses (HR-HPVs), when divided into HPV16/18, HPV 31/33/45/52/58, and HPV35/39/51/56/59/68, had an effect on the time required for and the proportion of cases that progressed to cervical intraepithelial neoplasia (CIN) grade 3 among women with CIN2.

    Patients: A total of 160 women aged 20–49 years and having CIN2 were recruited between January 2008 and June 2018. The time required for progression to CIN3 was determined by Kaplan-Meier time-to-event analysis. HPV genotypes were determined using the Linear Array HPV genotyping test.

    Results: During an average follow-up time of 22 months, 62 (39%) women with CIN2 progressed to CIN3, whereas 34 (21%) eliminated HR-HPVs and became cytologically normal. The majority (63%) of the women harboring HPV16/18 progressed to CIN3 with a 50% progression time of 11 months, whereas 26% of those harboring HPV31/33/45/52/58 progressed to CIN3 with a 50% progression time of 70 months.

    Conclusion: For every patient diagnosed with CIN2, genotyping to distinguish HPV16/18 from other HR-HPVs should be performed. Therefore, electing a surgical treatment, such as conization, should be considered as the primary option for women who are positive for HPV16/18, particularly when they are likely to be lost for follow-up or are 40 years old or older. In contrast, follow-up cytology should be repeated every 12 months for women harboring non-16/18 HR-HPVs. Those who tested negative for HR-HPV may be followed at the maximum interval of 24 months.

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  • Takuya Watanabe, Yuichi Temma, Junichi Okada, Eijiro Yamada, Tsugumich ...
    2021 Volume 16 Issue 2 Pages 98-101
    Published: 2021
    Released on J-STAGE: April 01, 2021

    Objective: Because patients with diabetes mellitus (DM) were forced to stay indoors during the state of emergency, resulting in stress and a lack of physical activity, concerns about their glycemic control were raised.

    Patients and Methods: The 165 patients’ glycated hemoglobin (HbA1c) levels were compared during the following periods: the 4 months that were selected as a representative condition 1 year before the COVID-19 pandemic (May 2018, March 2019, June 2019, and July 2019) and the latter 3 months as a 1-year follow-up during the COVID-19 pandemic (May 2019, March 2020, June 2020, and July 2020).

    Results: The patients’ HbA1c levels were 7.32 ± 1.23, 7.44 ± 1.20, 7.16 ± 1.06, 7.01 ± 1.05, 7.23 ± 1.06, 7.45 ± 1.18, 7.15 ± 10.7, and 7.11 ± 1.17 in May 2018, March 2019, June 2019, July 2019, May 2019, March 2020, June 2020, and July 2020, respectively (expressed as mean ± standard deviation).

    Conclusion: The analysis showed that HbA1c levels did not worsen during the self-restraint period.

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Case report
  • Takao Miwa, Takahiro Kochi, Keitaro Watanabe, Tatsunori Hanai, Kenji I ...
    2021 Volume 16 Issue 2 Pages 102-110
    Published: 2021
    Released on J-STAGE: April 01, 2021

    Objective: Lenvatinib is an oral multitarget tyrosine kinase inhibitor (mTKI) and is recommended for patients with advanced hepatocellular carcinoma (HCC) with Child-Pugh A liver function, who are not amenable to surgical resection, locoregional treatment, or transcatheter arterial chemoembolization. Hepatogastric fistula is a rare complication with a poor prognosis in patients with HCC. Previous reports on fistula formation during mTKI therapy for HCC were all associated with sorafenib. Here, we report the first case of recurrent hepatogastric fistula during lenvatinib therapy for advanced HCC managed using an over-the-scope clip (OTSC).

    Patient: We present the case of a 73-year-old man with alcoholic liver cirrhosis who was treated for multiple HCC for 7 years. HCC was treated using repetitive transcatheter arterial chemoembolization, radiofrequency ablation, and sorafenib. Owing to disease progression, lenvatinib treatment was started. During lenvatinib treatment, recurrent hepatogastric fistulas developed. An OTSC was useful for fistula closure and prevention of recurrence.

    Results: The major cause of fistula formation is considered to be the direct invasion of HCC; however, HCC treatment might also be a contributing factor in our case. In addition, OTSC was useful for fistula closure.

    Conclusion: Clinicians should be aware of the fatal complications during HCC treatment.

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  • Yosuke Shibao, Masao Koda, Tetsuya Abe, Kentaro Mataki, Kousei Miura, ...
    2021 Volume 16 Issue 2 Pages 111-114
    Published: 2021
    Released on J-STAGE: April 01, 2021

    Objective: To report a case of anterior longitudinal ligament (ALL) injury that was not noticeable during lateral lumbar interbody fusion and was disclosed after posterior corrective fusion surgery.

    Case presentation: After performing lateral lumbar interbody fusion followed by posterior corrective fusion surgery, we observed an anterior longitudinal ligament rupture that required additional surgery. Postoperative pain in the left lower limb and muscle weakness due to nerve traction appeared, but this was improved by stabilization between the vertebral bodies.

    Conclusion: Unidentified anterior longitudinal ligament rupture can result in unexpected local lordosis during posterior surgery, possibly related to lower extremity palsy. Therefore, checking for possible rupture during and after anterior surgery is important. If the ALL damage is disclosed before posterior surgery, the proper surgical strategy for the posterior surgery must be considered.

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  • Naoki Takeno, Yasuyuki Shimada, Yasushi Terada
    2021 Volume 16 Issue 2 Pages 115-118
    Published: 2021
    Released on J-STAGE: April 01, 2021

    Objective: Isolated abdominal aortic dissection (IAAD) co-occurring with an abdominal aortic aneurysm (AAA) is rather rare. The objective of this report was to discuss the adequate timing and method of surgery for this condition.

    Patients: We encountered two operative cases, for which we carefully considered the timing and method of surgery. One patient underwent open repair 1 month after the onset, and the other patient underwent endovascular aneurysm repair (EVAR) 3 years after the onset.

    Results: Both patients had a good postoperative recovery and are doing well 8 months after the surgery.

    Conclusion: The presence of symptoms or an increase in the diameter of an AAA is important in determining the timing of intervention.

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  • Hidenobu Ochiai, Katsuhiro Kanemaru, Shuntaro Matsuda, Hajime Ohta
    2021 Volume 16 Issue 2 Pages 119-122
    Published: 2021
    Released on J-STAGE: April 01, 2021

    Objective: Herein, we report a patient with acute cerebral infarction with a favorable prognosis after being managed by a general physician with support from the telestroke program.

    Patient and Methods: An 85-year-old man was transferred to a regional hospital due to sudden onset of dysarthria and left hemiparesis. As no neurosurgeons or neurologists were available in that hospital or area, the patient was examined by a general physician who diagnosed him with cardioembolic stroke on the left middle cerebral artery territory. The physician consulted a stroke specialist using the telestroke system; with the support from the telestroke program, the physician administered thrombolytic therapy 4 hours and 10 minutes after the onset of symptoms.

    Results: The patient’s National Institutes of Health Stroke Scale score improved from 9 to 3 and he was subsequently transferred to the stroke center. However, the occluded left middle cerebral artery had already re-canalized. His hemiparesis completely improved one week after the onset.

    Conclusion: A telemedicine system for general physicians is indispensable in areas without accessible stroke specialists as it provides access to a standard of care for hyper-acute stroke patient assessment and management, and helps improve neuroprognosis.

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  • Yuta Mitani, Zen Kobayashi, Eijiro Hattori, Yoshiyuki Numasawa, Shoich ...
    2021 Volume 16 Issue 2 Pages 123-125
    Published: 2021
    Released on J-STAGE: April 01, 2021

    Introduction: Brachiocephalic artery stenosis rarely causes right hemispheric infarction with associated left hemiparesis. To date, there have been no reported cases of stroke associated with brachiocephalic artery stenosis that were successfully treated with recombinant tissue-type plasminogen activator (rt-PA), alteplase.

    Case Report: An 80-year-old woman presented with left hemiparesis. Brain computed tomography showed no hemorrhage, and computed tomography angiography demonstrated brachiocephalic artery stenosis. Alteplase was administered based on a diagnosis of ischemic stroke. Brain magnetic resonance imaging showed multiple acute infarctions. Thereafter, the blood pressure of the right arm was found to be lower than that of the left arm. The patient’s neurological deficits gradually improved; she was eventually able to walk again and was thus discharged home.

    Conclusion: While the combination of left hemiparesis and a decrease in blood pressure in the right arm are well known in patients with stroke associated with Stanford type A aortic dissections, it may also occur in patients with stroke due to brachiocephalic artery stenosis. Unlike stroke associated with Stanford type A aortic dissections, stroke due to brachiocephalic artery stenosis may be treated with alteplase.

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Letter to the editor