Journal of UOEH
Online ISSN : 2187-2864
Print ISSN : 0387-821X
ISSN-L : 0387-821X
Volume 41 , Issue 2
Showing 1-17 articles out of 17 articles from the selected issue
  • Daisuke SHIMIZU, Shunsuke ARAKI, Masaru KAWAMURA, Mami KUWAMURA, Shuta ...
    Type: [Original]
    2019 Volume 41 Issue 2 Pages 131-138
    Published: June 01, 2019
    Released: July 09, 2019
    JOURNALS FREE ACCESS
    Previous studies on high-flow nasal cannula (HFNC) in very-low-birth-weight infants (VLBWIs) focused on comparing HFNC with nasal continuous positive airway pressure (nCPAP) to determine the usefulness of HFNC as a backup in the case of extubation failure and nasal trauma; however, the studies did not consider oral feeding. This retrospective case-control study aimed at elucidating whether HFNC could prevent the delay in feeding and achievement of full oral feeding in VLBWIs with chronic lung disease (CLD). Forty five VLBWIs were enrolled in this study: an HFNC group (n = 11) that was supported by HFNC at oral feeding initiation, and a non-HFNC group (n = 34) that could start oral feeding without HFNC. The gestational age and birth weight of the HFNC group were lower than those in the non-HFNC group. The median duration of exposure to oxygen and neonatal intensive care unit stay were comparable in both groups. The timings of oral feeding initiation and full oral feeding achievement in both groups were not significantly different: 35.3 (33.0 – 38.1) vs. 35.5 (33.7 – 42.4) weeks (P = 0.91) for the HFNC and 38.6 (34.4 – 42.3) vs. 36.7 (34.6 – 44.4) weeks postmenstrual age (P = 0.29) for the non-HFNC. Clinically significant aspiration pneumonia during the period of oral feeding was not observed in the HFNC group. Respiratory support by HFNC in VLBWIs with CLD might prevent oral feeding delay. Initiation of oral feeding of VLBWIs on HFNC might be safe and might accelerate the achievement of oral feeding milestones.
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  • Yukichi ZENKE, Kayoko FURUKAWA, Hideki FURUKAWA, Kazumichi MAEKAWA, Ta ...
    Type: [Original]
    2019 Volume 41 Issue 2 Pages 139-144
    Published: June 01, 2019
    Released: July 09, 2019
    JOURNALS FREE ACCESS
    Dorsal displaced distal radius fracture (Colles’ fracture) is very common and could occur from fragility in middle-aged and elderly people. Many Colles’ fractures are still treated conservatively in clinics without hospitalization. Internal fixation using a palmar locking plate has been the standard treatment, but some complications have been reported. The aim of this study was to analyze changes in radiographic parameters over time in patients with conservatively treated Colles’ fractures, and to establish whether the type of fracture influenced these changes. Prospective data collected included patient characteristics and radiological findings. The study was conducted at two private clinics and included 60 patients (13 men and 47 women; mean age, 72.5 years old; range, 55 to 96 years old) with a Colles’ fracture (types of injury: intramedullary [n = 15], anatomical [n = 39], extramedullary [n = 2], and unknown [n = 4]) who were treated conservatively with manipulation and cast immobilization. Conservative, non-surgical treatment with manipulation was performed first, then, cast immobilization continued for 4 weeks. Loss of correction between the time of reduction and the final observation was defined by the following radiographic measurements: palmar tilt, radial inclination, and ulnar variance. The average final follow up period was 4.6 months (1.5−12 months). Immediately after reduction, 11 intramedullary fractures, 42 anatomical fractures and 7 extramedullary fractures were confirmed. Correction loss according to ulnar variance was significantly greater (P = 0.012) during the final observation for patients with an intramedullary injury at reduction than that for patients with extramedullary and anatomical injuries at reduction. We found that the correction loss for ulnar variance from immediately after reduction until the final observation was significantly greater in the intramedullary group, suggesting that an alternative to conservative treatment may be beneficial for patients with intramedullary fractures.
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  • Tetsuya UEKI, Mikiro NAKASHIMA
    Type: [Review]
    2019 Volume 41 Issue 2 Pages 145-151
    Published: June 01, 2019
    Released: July 09, 2019
    JOURNALS FREE ACCESS
    Constipation is very common and can be caused by adverse drug reactions as a result of many drugs. While the adverse effects of several medications such as opioids and anticholinergic agents are well established and well known, other commonly prescribed drugs, such as hypnotics, are less well understood. This review presents the results of an analysis of the relationship between constipation and drugs.
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  • Kazue YONEDA, Naoko IMANISHI, Yoshinobu ICHIKI, Fumihiro TANAKA
    Type: [Review]
    2019 Volume 41 Issue 2 Pages 153-163
    Published: June 01, 2019
    Released: July 09, 2019
    JOURNALS FREE ACCESS
    The discovery of activating mutations in the epidermal growth factor receptor (EGFR) gene and development of tyrosine kinase inhibitors (TKIs) of EGFR have achieved a paradigm shift in treatment strategy of non-small cell lung cancer (NSCLC). For advanced NSCLC harboring activating EGFR mutations, an EGFR-TKI is preferably prescribed as it provides a superior survival benefit over platinum-based chemotherapy. To further improve the therapeutic outcomes, more potent EGFR-TKIs through irreversible inhibition of tyrosine kinase have been developed. In a recent clinical trial, an irreversible EGFR-TKI (osimertinib) showed a superior survival benefit with lower toxicity profile. In addition, combination treatments such as an EGFR-TKI plus platinum-based chemotherapy may achieve a long-term survival. For earlier-stage resectable NSCLC with EGFR-mutations, several clinical trials to assess the efficacy of EGFR-TKIs in pre-operative induction setting and in postoperative adjuvant setting are now ongoing. Here we review and discuss the current status and future perspectives of treatment for EGFR-mutated NSCLC.
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  • Megumi MIYAZAKI, Yosuke OKADA, Keiichi TORIMOTO, Yoshiya TANAKA
    Type: [Case Report]
    2019 Volume 41 Issue 2 Pages 165-170
    Published: June 01, 2019
    Released: July 09, 2019
    JOURNALS FREE ACCESS
    A 74-year-old woman with a left neck mass and thyrotoxicosis was referred to our hospital, and was later diagnosed with Marine-Lenhart syndrome based on positivity for thyroid autoantibodies, ultrasonographically evident left lobe thyroid nodule with increased blood flow, and scintigraphically identified not only increased tumor-like accumulation but also diffused uptake. Disease control was difficult despite administration of antithyroid drugs, so subtotal thyroidectomy was performed. No hyperplastic changes or histopathological findings characteristic of Graves disease were evident on histopathology, so Plummer disease was considered to be dominant. In case of hot in low type which showed higher uptake in the nodule and lower uptake in the extranodular part on scintigraphy, there is a possibility of relapse in drug treatment.
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  • Shunsuke ARAKI, Kanako NAKAMURA, Yasumi KASHIWABARA, Hisashi EGUCHI, M ...
    Type: [Original]
    2019 Volume 41 Issue 2 Pages 171-178
    Published: June 01, 2019
    Released: July 09, 2019
    JOURNALS FREE ACCESS
    The number of children in Japan with disabilities who require medical care is increasing and is estimated to have reached about 17,000 in 2015. Their home care is a great burden on mothers, therefore it is presumed to be hard for the mothers to find outside employment. The aims of this survey are to clarify the working conditions of mothers of children with disabilities that require medical care, and to investigate effective social support for improving their working and economic status. We carried out an original questionnaire survey on parents of children with disabilities who were visiting the University Hospital of Occupational and Environmental Health, Japan or daycare facilities in Kitakyushu City. Seventy-five parents, including 73 mothers, responded. The median age of the enrolled children with disabilities was 9 years old. Thirty-two of the mothers who responded (42.7%, median age 40) were employed, but two-thirds of them were non-regular employees. Twenty-two of the mothers had experienced a loss of work because of their children’s disabilities. There were no significant relationships among the working conditions, children’s age, size of family and household income. Almost 89% of the mothers desired to get employment for their sense of worth and economic status, but almost 11% did not. This survey clarified that the employment rate of mothers of disabled children with special care needs was low, and that most of those who were employed had non-regular employment. It is important to support the mothers in finding employment for their mental and economic status, and special attention must be paid to the diversity of their needs.
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  • Midori NAKAMURA, Keigo UCHIMURA, Sachika HARA, Hidenori OHIRA, Yosuke ...
    Type: [Original]
    2019 Volume 41 Issue 2 Pages 179-184
    Published: June 01, 2019
    Released: July 09, 2019
    JOURNALS FREE ACCESS
    Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) has been widely used in Japan. The guidelines of the American College of Chest Physicians has recommended that EBUS-TBNA should be performed by well-trained operators who can perform highly accurate procedures, but the indicators of the degree of experience and training are unclear. In our department, physicians who do not have enough experience perform EBUS-TBNA under the supervision of bronchoscopic instructors who have EBUS-TBNA techniques (Board Certified Member of the Japan Society for Respiratory Endoscopy) after guidance and training in EBUS-TBNA using a simulator as an operator and helper. In order to evaluate the influence of the experience and training of EBUS-TBNA on diagnostic accuracy and safety, we retrospectively compared the diagnostic accuracy and safety of EBUS-TBNA performed by physicians within one year of experience of EBUS-TBNA and those performed by physicians with more than one year of experience. A total of 111 cases (148 lesions) who were eventually diagnosed as having primary lung cancer and underwent EBUS-TBNA in our department between April 2014 and January 2016 were divided into two groups. Group A (43 cases, 57 lesions) was examined by third-year doctors within one year of experience of EBUS-TBNA, and group B (68 cases, 91 lesions) was examined by doctors with four or more years of experience and with more than one year of experience of EBUS-TBNA. Diagnostic rate, examination time, and complications were evaluated. There were no significant differences between the two groups in the diagnostic rate (A, 89.5% vs. B, 90.1%, P = 1.0) or examination time (A, 27 min vs. B, 23 min, P = 0.149), and no complications were observed in either group. This study suggests that even less-experienced physicians may safely perform EBUS-TBNA as well as moderately-experienced physicians with more than 1 year experience of EBUS-TBNA with similar diagnostic rates when proper training and supervision are supplied.
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  • Kentaro AKATA, Shingo NOGUCHI, Toshinori KAWANAMI, Ryosuke HATA, Keisu ...
    Type: [Review]
    2019 Volume 41 Issue 2 Pages 185-192
    Published: June 01, 2019
    Released: July 09, 2019
    JOURNALS FREE ACCESS
    The number of patients with pneumonia has been increasing as the population ages, and most fatal pneumonia cases are the elderly with aspiration pneumonia. Although aspiration pneumonia leads to poor short- and long-term prognosis, there have been no practical ways to diagnose it precisely. Persistent subclinical aspiration without any subjective symptoms is problematic in clinical practice in patients with aspiration pneumonia, and physicians can only use aspiration risks such as brain infarction to diagnose aspiration pneumonia. Anaerobes have been believed to be major causative pathogens in aspiration pneumonia, based on data from the 1970’s. In relation to these data, Marik insisted that there is a possible overestimation of anaerobes because 1) the sampling of microbiologic specimens was in the late phase in the course of the illness, especially frequently after developing complications such as abscesses, necrotizing pneumonia, or empyema thoracis; 2) the organisms recovered by percutaneous transtracheal aspiration (PTA) sampling could have been contaminated by the aspiration of oropharyngeal flora during the PTA procedure or colonized in the trachea; and 3) many of the patients had chronic alcoholism or were under general anesthesia. In addition, 4) oral care was not common in the 1970s, and 5) the patients in these reports were relatively young. Molecular biological approaches using the 16S ribosomal RNA (rRNA) gene have recently been used, and have enabled us to detect more exact pathogens compared to conventional bacterial culture. Using the method with the detection of the 16S rRNA gene, we evaluated the bacterial phylotypes in bronchoalveolar lavage fluid in patients with aspiration pneumonia and found that oral streptococci were the most detected phylotypes (31.0%), while anaerobes were only 6.0%. Our results suggest that oral streptococci are important, and anaerobes may have been overestimated as causative pathogens in patients with aspiration pneumonia.
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  • Hiroshi HARADA
    Type: [Review]
    2019 Volume 41 Issue 2 Pages 193-201
    Published: June 01, 2019
    Released: July 09, 2019
    JOURNALS FREE ACCESS
    Current research on stem cells and regenerative medicine indicates new perspectives on the relationship between differentiation and gene information. Induced pluripotent stem (iPS) cells need the artificial gene expression of the somatic cell, which is related to initialization. Paradoxically, that means that cell differentiation depends on almost all the gene information stored precisely in the nucleus of a somatic cell, plus the transformation of gene expression. Our research team tried to identify the culture conditions in the transdifferentiation of human leiomyoma cells, closely similar to the early embryonal stage, composed of various factors (hypoxia, non-serum, and regulation of cell adhesion molecules such as Wnt/β-catenin signaling). As a result, inhibition of Wnt/β-catenin signaling under serum starvation and hypoxia induces adipocytic transdifferentiation in human leiomyoma cells. Here we explain this unique culture system, referring to the components of intracellular mechanisms and the extracellular microenvironment in embryo development.
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  • Keiko TSUJI, Naomi IWATA, Miwa SIMOJO, Tomoko HAGIWARA, Youko SASAKI, ...
    Type: [Report]
    2019 Volume 41 Issue 2 Pages 203-209
    Published: June 01, 2019
    Released: July 09, 2019
    JOURNALS FREE ACCESS
    It is not easy for nurses to estimate a patient’s degree of shame, as the sense of shame depends on each person’s personality, but nurses are requested to evaluate it as correctly as possible and to reduce the patient’s mental load. We presume that most of the sense of shame is generated by body defects or disadvantages recognized by the patient. In this study, we tried to measure the degree of shame and to improve the basic nursing curriculum, depending on students’ school year, under the assumption of what cases the nurses would frequently meet in a hospital. We prepared 13 figures that show common cases in hospitals. In these figures: 1) 6 figures show cases in which a nurse touched a patient’s body; 2) 3 figures show common daily life; and 3) 4 figures show cases in which there are other people around the patient. A questionnaire was given to the first and second year students in A Nursing University, and we allocated scores of 1 to 10: 1 is “no-shame”, and 10 is “very much shame”. The students answered that patients must feel shame when: 1) they take off their clothes, 2) they show their disability to another person even without taking their clothes off, and 3) having people other than medical staff around them. In the results, as 2) appeared more strongly in the second year students than in the first, we thought that the second year students could surmise a patient’s position in a hospital through the effect of the nursing education.
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  • Yuko TASHIMA, Kasumi KUSANAGI, Yusuke TAKEDA, Katsuma YOSHIMATSU, Teru ...
    Type: [Case Report]
    2019 Volume 41 Issue 2 Pages 211-216
    Published: June 01, 2019
    Released: July 09, 2019
    JOURNALS FREE ACCESS
    This report describes the case of a 67-year-old male with inflammatory breast cancer. He had noticed a left breast mass about seven years previously, but he had ignored it. He then visited our hospital 4 months previously when multiple small masses occurred in the left front chest wall. The tumor was diagnosed as skin metastasis of breast cancer by skin biopsy and he was referred to our department. The tumor cells were positive for estrogen receptor and progesterone receptor, and negative for HER2/neu, and the Ki67 expression was 10-15%. The subtype of his breast cancer was luminal A type. It had secondary inflammatory breast cancer and preceded chemotherapy. Also, as the veins in the lower extremity were filled with thrombus, we gave him an anticoagulant (Edoxaban), but due to the malignant hyper coagulable state (Trousseau syndrome) a CV port could not be implanted. 3 courses of docetaxel every 3 weeks failed to control the disease. Since an obstruction of the right iliac artery was newly observed, the anticoagulant was changed to cilostazol and rivaroxaban, but left second finger and fourth finger necrosis occurred due to peripheral circulatory failure. The condition of the disease was stabilized by FEC (5-FU, epirubicin, cyclophosphamide) therapy, but it became difficult to secure the blood vessel. Without constructing a CV port because of the thrombus, chemotherapy was changed to S-1 oral administration, and strength to the chest wall Modulated radiotherapy intensity modulated radiation therapy (IMRT) was performed. Although the tumor was reduced, the condition of the whole body gradually weakened and the patient died a year and a half after the start of the treatment. This case of inflammatory luminal in male breast cancer that caused thrombus was difficult to treat. Thrombosis in advanced cancer patients is often pointed out, but since male breast cancer patients tend to take a long time to visit the hospital after becoming aware of the mass and arrive at an advanced state, it is necessary to notify the public of the existence of male breast cancer.
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  • Toshiko TANAKA, Hiroaki SATO, Kentaro KASAI
    Type: [Case Report]
    2019 Volume 41 Issue 2 Pages 217-223
    Published: June 01, 2019
    Released: July 09, 2019
    JOURNALS FREE ACCESS
    The victim was a morbidly obese and bull-necked woman in her twenties. She had the disorders, due to Downʼs syndrome, including severe mental retardation, advanced hearing loss, congenital cataract surgery, and amblyopia at postoperative glaucoma. She was deeply sedated for rest with an intravenous drip infusion of 350 mg of thiopental (TP) for 5 minutes during an intraocular pressure examination with secondary glaucoma at a hospital. The examination was finished within 10 minutes after the TP injection, but her respiratory condition deteriorated rapidly when the doctor left the patient. Although immediate artificial respiration was carried out, she was declared dead about 20 hours after the examination. Medical malpractice was suspected for her death. At autopsy, no fatal disease or injury was observed in the victim. The serum TP level was 0.80 µg /ml. TP is an ultra-short-acting intravenous anesthetic, and usually only the smallest amount should be administered by frequent additions after pre-anesthesia administration while maintaining contact with patients. Although contact with patients with a disability can be difficult, it was diagnosed that the death was caused by both respiratory arrest due to a single dose of TP and delay in resuscitation due to the absence of a doctor.
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  • Natsumasa NISHIZAWA, Takeshi HANAGIRI, Rintaro OYAMA, Shuhei ASHIKARI
    Type: [Case Report]
    2019 Volume 41 Issue 2 Pages 225-230
    Published: June 01, 2019
    Released: July 09, 2019
    JOURNALS FREE ACCESS
    Case 1: A 81-year-old man was admitted to our hospital because of a mass shadow on chest x-ray examination. Chest computed tomography (CT) showed a 1.5 cm nodule in the middle lobe of the right lung. We suspected a primary lung cancer and performed video-assisted right middle lobectomy. Histopathological examination showed a white, elastic, hard and solid 30 × 10 × 10 mm nodule with infiltration of small-to-medium-sized lymphocytes that were positive for CD20 and CD79a, and negative for CD10 and Cyclin D1 in immunohistochemical staining. We diagnosed mucosa-associated lymphoid tissue (MALT) lymphoma. Case 2: A 67-year-old woman was admitted to our hospital because of a mass shadow in the right upper lobe on chest x-ray and chest CT. As the lesion had not grow in 1 year, the patient strongly wanted it resected, therefore we performed wedge resetion of the right upper lobe via video-assisted thoracic surgery. Histopathological examination showed a white, elastic, hard and solid 25 × 25 × 16 mm nodule with infiltration of small-to-medium-sized lymphocytes that had positive staining of CD20 and CD79a, and negative staining of CD10 and Cyclin D1. We diagnosed MALT lymphoma. Primary lung MALT lymphoma shows a variety of shadows on chest CT, similar to lung cancer and other inflammatory diseases. Local therapies such as surgery and radiation therapy are effective against early stage MALT lymphoma, but there is no consensus of a standard surgery.
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  • Kentaro KASAI, Toshiko TANAKA, Hiroaki SATOU
    Type: [Case Report]
    2019 Volume 41 Issue 2 Pages 231-237
    Published: June 01, 2019
    Released: July 09, 2019
    JOURNALS FREE ACCESS
    We had a forensic autopsy case in which drugs were detected in a cadaver that had been stored in a cold and wet condition for 5 years. The skin of the cadaver was hard, and the color was partly whitish or dark brown. Though the cadaver had transformed into adipocere in the wet and cold condition, QuEChERS extraction and LC-MS/MS revealed the presence of sulpiride and estazolam in the femoral muscle and bone marrow. The concentrations of sulpiride and estazolam in the femoral muscle were 10.6 ng/g and 39.9 ng/g, respectively. The result of a drug screening test led not only to the cause of death but also to the personal identification of the cadaver. The individual had a history of drug taking, which had been stored in his medical records at the hospital for a long time. The fact of taking sulpiride and estazolam at the same time was characteristic, and it was useful in identifying the cadaver in this case. The progress in analytical technology has made possible the detection of particle drugs from old or adipoceratous cadavers, but there have been no reports of particle drugs being detected in a cadaver that had been dead for 5 years and had transformed to adipocere, as in our present case. The analytical results by LC-MS/MS were certainly important for the diagnosis of the cause of death, and, moreover, they were useful for the purpose of personal identification.
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  • Takehiro KISHIGAMI, Eigo IKUSHIMA, Toru YASUTSUNE, Yosuke NISHIMURA
    Type: [Case Report]
    2019 Volume 41 Issue 2 Pages 239-242
    Published: June 01, 2019
    Released: July 09, 2019
    JOURNALS FREE ACCESS
    We report a case of a 55-year-old male who had been diagnosed with mitral regurgitation and atrial septal defect 5 years earlier. He was referred to our institution because of worsening of mitral regurgitation accompanied by exertional dyspnea. As an echocardiography showed atrioventricular valve regurgitation and ostium primum atrial septal defect, but without ventricular septal defect, he was diagnosed as having partial atrioventricular septal defect (pAVSD). An operation was performed through median sternotomy. The anterior atrioventricular leaflet had a cleft and thickening with calcification. Suturing the cleft could not control the regurgitation. Incomplete coaptation was seen at the edge of the anastomosis site of the cleft, where the severe calcification had been identified. A rough zone including a part of the chordae tendineae was sutured in order to compensate for the gap. The atrioventricular septal defect was closed with an autologous pericardial patch. He was discharged uneventfully on the 24th postoperative day and has been followed up without complications for 1.5 years.
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  • Kazuki NEMOTO, Keigo UCHIMURA, Sachika HARA, Yosuke CHIBA, Yu ISOSHIMA ...
    Type: [Case Report]
    2019 Volume 41 Issue 2 Pages 243-248
    Published: June 01, 2019
    Released: July 09, 2019
    JOURNALS FREE ACCESS
    A 58-year-old Japanese woman with fever and cough visited A hospital. Her chest X-ray and CT showed a tumor attached to the mediastinum in the left upper lobe with mediastinal lymphadenopathy (#4R). After an introduction from A hospital to our hospital, endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) for the mediastinal lymphadenopathy and a simultaneous approach to the mass lesion in the left upper lobe were performed. In spite of twice aspiration by EBUS-TBNA for mediastinal lymphadenopathy, we failed to obtain enough specimens, and, as the mass lesion in the left upper lobe was invisible in the endobronchial ultrasound, we could not approach it. Then using the same ultrasound bronchoscope, we subsequently performed a transesophageal endoscopic ultrasound with bronchoscope-guided fine needle aspiration (EUS-B-FNA) to the mass lesion in the left upper lobe twice, with the result that sufficient tissues were obtained. Then we changed from the ultrasound bronchoscope to a normal bronchoscope and we performed brushing and transbronchial lung biopsy for the left upper lobe mass lesion. Pathological results revealed that only the specimens obtained by EUS-B-FNA were diagnostic for adenocarcinoma; the other specimens obtained using EBUS-TBNA and normal bronchoscope failed to be diagnostic. EUS-B-FNA in combination with EBUS-TBNA has been recommended for the diagnosis of mediastinal and near-mediastinal lesions in the guidelines of the American College of Chest Physicians in 2013, but EUS-B-FNA has not been widely used in Japan. As shown in our present patient who was successfully diagnosed as having lung cancer by EUS-B-FNA alone, respiratory physicians should be aware of being skillful at performing EUS-B-FNA to accurately and effectively approach target lesions.
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  • Taro SHIMAMOTO, Yukiyo YAMAMOTO, Mami KUWAMURA, Hiroshi ASAI, Masahiro ...
    Type: [Case Report]
    2019 Volume 41 Issue 2 Pages 249-257
    Published: June 01, 2019
    Released: July 09, 2019
    JOURNALS FREE ACCESS
    Here we report a case of a 12-year-old girl who was referred to our department because of marked short stature of more than −5 SD below the median. Although her growth failure began suddenly at 6 years of age, she never had an examination because she had no other symptoms. Brain MRI examination suggested a tumor in the suprasellar region, and endocrine examination revealed combined pituitery hormone deficiency due to the tumor. Before surgery, the supplementation with hydrocortisone and levothyroxine was initiated. The pathological diagnosis of the surgically removed tumor was xanthogranuloma. The pattern of her growth curve showed a growth failure with sudden onset, which is a typical pattern of short stature secondary to pituitary disfunction including growth hormone deficiency associated with brain tumors. This case suggests that growth failure could be the only symptom in pediatric cases with brain tumors. Improved awareness regarding the association of growth failure with brain tumors is needed for earlier diagnosis and treatment. Furthermore, the growth curves should be carefully evaluated in regular health examinations at school.
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