Primary aldosteronism (PA) is associated with a high risk of cardiovascular complications. Large-scale clinical studies have demonstrated that mineralocorticoid receptor antagonists (MRA) exhibit organ-protective effects and improve the prognosis of patients with heart failure and myocardial infarction, and daily clinical practice suggests that MRA seem to improve vascular endothelial dysfunction. In this pilot study, we treated 10 PA patients with eplerenone for 3 months. We used Endo-PAT to evaluate the effects of MRA on vascular endothelial function and analyzed the data for correlative factors. The primary outcome measure, the reactive hyperemia index (RHI), was 1.71 before therapy and increased significantly to 2.21. Univariate analysis showed a significant correlation between the rate of change in RHI and that in plasma renin activity (PRA). Since plasma aldosterone concentration increases during MRA therapy, PRA may be the best marker for selecting the most appropriate dose of MRA. PRA can potentially be used for adjusting the dose of MRA, in addition to adjusting blood pressure and serum potassium level.

This study examines how psychological distress (measured by the K10 screening test) and presenteeism (measured by the quality and quantity method) change in the six months after returning to work from having taken a sick leave because of a mental illness. In a manufacturing company with approximately 2,600 employees, 23 employees returned to work after experiencing mental illness between April 2015 and March 2016, and all 23 agreed to participate in the study. We analyzed 18 cases for which we had sufficient data. Two of the employees were absent from work in the sixth month. We performed multilevel analysis for K10 and presenteeism over time on the 16 without recurrence. A significant decreasing trend was observed for both K10 and presenteeism. Eleven of the 16 employees were consistently below the K10 cutoff value of 10 for six months, and 5 had zero presenteeism in the sixth month, whereas 6 employees showed improvement in presenteeism that stopped midway through the study. An occupational physician judged that the employees could work normally with presenteeism of zero. After returning to work, it is important to monitor not only psychiatric symptoms but also presenteeism.

Considering the relationship between occupational burnout and oxidative stress, identifying the factors that affect occupational burnout, such as recognizing individual characteristics, would be beneficial for implementing strategies to reduce oxidative stress levels. This study was conducted on 92 nurses from a hospital in Shahroud, a city in northeastern Iran, who were chosen at random. The data was collected through the Demographic Questionnaire, Maslach Burnout Inventory and Personality Factors Inventory. Each participant’s serum markers of oxidative stress were also measured. Total antioxidant capacity (TAC) and neuroticism were found to have a negative relationship in this study. Furthermore, marital status, the ward where nurses work, the type of contract, emotional exhaustion, and depersonalization were all found to be significant predictors of malondialdehyde (MDA). Neuroticism, emotional exhaustion, and depersonalization were the most important predictors of oxidative stress levels.

The results of this study suggest that some approaches to reducing oxidative stress can be implemented by identifying the factors influencing occupational burnout and also by recognizing individuals’ personality traits.

The most common sites for recurrence of breast cancer are the lungs, liver, and bones. The frequency of peritoneal, gastrointestinal metastasis is significantly lower than those, and bilateral ureteral obstruction caused by peritoneal metastasis is relatively rare. A 66-year-old woman was referred to our hospital because of appetite loss and frequent urination. She was on adjuvant hormonal therapy for local recurrence of right breast cancer. She was diagnosed with bilateral ureteral obstruction due to extramural compression. Exploratory laparoscopy revealed omental cake and peritoneal nodules of which pathological examination showed peritoneal metastasis of invasive lobular carcinoma. Peritoneal metastases from breast cancer are unusual and consequently difficult to identify without non-invasive tools. Exploratory laparoscopy revealed that the cause of hydronephrosis in this case was peritoneal metastasis of invasive lobular carcinoma. Clinical history and histological study play a pivotal role in determining the correct diagnosis.

Magnetic resonance imaging (MRI) features of meningiomas typically reveal a well-circumscribed and contrast-enhancing dural mass. Here we discuss the differences in MRI findings between typically benign and atypical meningioma, and their clinical implications. An MRI of a 67-year-old man revealed a substantial homogeneous enhancing tumor nodule. The MRI also showed two components in the tumor, and the regional cerebral blood volume (rCBV) was higher in the lateral than in the medial mass. A pathological examination also revealed features of both benign and atypical meningiomas. The Ki-67 labeling index was 1% on the medial side and 5% on the lateral side. There were clearly two components within the tumor mass, and the MRI revealed differential rCBV in the tumor. The results indicated a nontypical MRI of meningiomas, allowing for predictability of atypical meningiomas using MRI before surgical resection.

White spongiform nevus is an autosomal dominant inherited disorder first reported by Cannon in 1935. It is a rare disease in which the oral mucosa thickens into an edematous and spongy state and is often accompanied by difficult to recognize subjective symptoms. We report a case of multiple non-hereditary white cavernous nevi in the oral mucosa. The subject was a 22-year-old man with a chief complaint of white lesions in his oral cavity. Examination revealed thick edematous and sponge-like white lesions on the bilateral buccal mucosa, upper and lower lip mucosa, and bilateral lingual margins. There was no history of similar lesions in his family or among his relatives. We diagnosed the case as non-hereditary white sponge nevus, based on clinical and histopathological findings. Although difficult to treat, the lesions disappeared with tetracycline ointment application and oral intake of multiple vitamin supplements. No recurrence of the lesion was observed thereafter.

The purpose of this study is to examine the factors related to oncologists’ use of the disease treatment and employment support guidance fee in Japan. A cross-sectional online survey was conducted in January 2021 among all the diplomates of the subspecialty board of medical oncology in the Japanese Society of Medical Oncology (n = 1,452), using the official mailing list. Logistic regression analysis was used to investigate the association between demographic and other factors and use of the disease treatment and employment support guidance fee. In total, 146 individuals participated in the study (response rate 10.0%). Experience of using the fee was associated with medical specialty and knowledge of the Guideline for Workplace Patient Coordination and Disease Treatment. It may be possible to increase the use of the disease treatment and employment support guidance fee among oncologists by raising awareness of the Guideline for Workplace Patient Coordination and Disease Treatment.

症例は55歳の女性で，2020年7月に左側頭部の腫瘤を自覚し，急速に増大してきたために9月に当院に紹介となった．頭部CTで頭蓋骨の腫瘍性病変が疑われた．頚部-骨盤部CT検査を施行したところ，上行結腸に腫瘤陰影と肝臓に転移を疑う多発病変を認めた．大腸内視鏡検査でも上行結腸に2型様病変を認め，生検検査では腺癌の結果であった．4年前に他院で上行結腸に有茎性ポリープを指摘されており，病理結果は腺腫であったが，内視鏡的な切除は行われなかった．腺腫が多段階発癌の機序で転移を伴った進行大腸癌となったものと考えられた．頭蓋骨病変に関しては，上行結腸癌の転移性病変が疑われたが，急速に増大していることに加え，美容の面からも摘出術を希望され，同年11月に手術を施行した．術後の病理診断においても上行結腸癌由来の転移性頭蓋骨腫瘍であった．大腸癌取扱い規約第9版ではStage IVbの診断で，全身化学療法を開始したが，転移性肝癌は急速に増大し，2021年4月に永眠となった．

日本では，がんをはじめとした疾患を持つ労働者の治療と仕事の両立支援（以下，両立支援）の取り組みが本格化している．産業医科大学病院では2018年に治療と仕事の両立支援部門として，多職種からなる就学・就労支援センターと，日本初の両立支援専門の医学的な診断・治療を行う両立支援科を開設した．診療科および主要診断群（MDC: Major Diagnostic Category）ごとの両立支援の対象数および診療報酬の算定数を明確にすることは，今後療養・就労両立支援指導料の算定基準を作成する際の基礎データとなる．今回我々は，両立支援外来が中心となった活動によって，3年間で704件の支援実績を達成することができた．コロナ禍にあっても，両立支援実施数は年々増加傾向にあり，支援実施の診療科数も増加傾向を認めた．就労に関する意見書発行数は2018年度28件，2019年度105件，2020年度54件と推移し，これに伴う診療報酬算定数も2018年度6件，2019年度18件，2020年度25件と年々増加している．活動実態の把握と今後の課題を明らかにすることを目的に実態調査を行ったところ，当院での両立支援への取り組みが拡大した要因としては，当院には産業医資格を有し疾患を抱えた労働者への基本的な支援スキルを習得済みである臨床医が多いという属人的強みと，両立支援ビジョンを明確に掲げることで，コロナ禍であってもその優先度が下がることなく取り組みを推進していく当チームの組織的な強みが挙げられる．社会的に両立支援の取り組みが加速する一方で，医療機関での両立支援の具体的な実績やモデルは未だ示されておらず，当院の本報告が本邦の両立支援活動を牽引し，国際的にも患者の治療と就労の両立支援モデルの一助となることが期待される．

重複脳底動脈（Duplication of Basilar artery）は，posterior longitudinal neural arteries （PLNA）が癒合せずに残存した稀な破格である．今回，重複脳底動脈の1例を経験し，その発生過程について考察した．症例は71歳男性．黒内障発作精査にて，magnetic resonance imaging（MRI）上脳幹の前で脳底動脈と縦走する血管を認め，右側は右椎骨動脈よりつながっていたため，重複脳底動脈と診断した．症状とは関連がないため，外来で経過を追っている．重複脳底動脈の1例を経験したが，過去の脳底動脈窓形成の報告の中には重複脳底動脈も含まれて，実際にはもっと多くの症例があるものと思われ，その診断や鑑別にあたっては注意が必要である．また，重複脳底動脈は，その灌流領域の循環動態を安定させた結果，発生したものと考えた．