The Kurume Medical Journal
Online ISSN : 1881-2090
Print ISSN : 0023-5679
ISSN-L : 0023-5679
Volume 64, Issue 1.2
Displaying 1-8 of 8 articles from this issue
Original Contribution
  • HIDEKI KOMATANI, YUJI OKAMOTO, TAKACHIKA AOKI, KEI NOGUCHI, MOTOHIRO M ...
    2017 Volume 64 Issue 1.2 Pages 1-4
    Published: September 30, 2017
    Released on J-STAGE: February 26, 2018
    Advance online publication: June 12, 2017
    JOURNAL FREE ACCESS

    Summary: Prognosis after extracranial-intracranial (EC-IC) bypass surgery has only been studied for a few years and the benefits of this procedure are still controversial. In this single-center retrospective study, we examined the long-term prognosis of patients who underwent EC-IC bypass surgery. Subjects were patients with symptomatic internal carotid artery or intracranial lesion occlusive disease who underwent EC-IC bypass surgery between 1991 and 2003. Of these, long-term prognosis was examined in 57 patients (39 male, 18 female; mean age, 61.8 years) who showed good surgical outcomes 30 days after bypass surgery, measured as a 0-2 on the modified Rankin Scale (mRS). They were divided into 2 groups (survivors and non-survivors) and were analyzed to identify factors effecting long-term survival after bypass surgery. Sixteen patients (28%), whose mean follow-up period (survival time) was 8.3±3.8 years, died after the bypass surgery. The average follow-up period for the survivors was 12.0±1.1 years, which was significantly longer than that for the non-survivors (P<0.0001). At surgery, the non-survivors (mean age 71.5 years) were significantly older than the survivors (P=0.0012). Pneumonia and other respiratory diseases were a frequent cause of death (31.2%), but death by cerebrovascular disease also occurred (12.5%). The rate of recurrent ischemic stroke was 28%, with no significant difference between groups (survivors vs. non-survivors: 31.2% vs. 26.1%, P= 0.82). In the absence of perioperative complications, the long-term prognosis of patients who underwent EC-IC bypass surgery was very good.

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  • GEN SUZUKI, HIDEYA YAMAZAKI, NORIHIRO AIBE, KOJI MASUI, NAOMI SASAKI, ...
    2017 Volume 64 Issue 1.2 Pages 5-11
    Published: September 30, 2017
    Released on J-STAGE: February 26, 2018
    Advance online publication: December 15, 2017
    JOURNAL FREE ACCESS

    Summary: Reirradiation to previously irradiated peripheral bone metastases for pain has been shown to be safe and effective, but no specific trial has been completed to define the indications for reirradiation of patients with recurrent symptoms of metastatic bone disease. Thus, we aimed to assess the effectiveness and prognostic factors of reirradiation for painful bone metastases. To do so, we reviewed the cases of 14 patients with painful bone metastases who had undergone reirradiation at our hospital. A favorable pain response after reirradiation was achieved in 50% (7/14) of the patients. An interval from initial radiotherapy >6 months was a significant prog nostic factor for pain response (p = 0.03). Performance status was correlated with pain response, with borderline significance (p = 0.06). No severe adverse events were reported. We conclude that reirradiation of painful bone metastases is effective in providing pain relief, especially for patients with a long interval from initial radiation and good performance status.

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  • DAIGO MURAKAMI, SHINZO TAKAMORI, AKIHIKO KAWAHARA, MASAHIRO MITSUOKA, ...
    2017 Volume 64 Issue 1.2 Pages 13-20
    Published: September 30, 2017
    Released on J-STAGE: February 26, 2018
    Advance online publication: November 27, 2017
    JOURNAL FREE ACCESS

    Summary: Periostin is an extracellular matrix N-glycoprotein that is a major constituent of the desmoplastic stroma around solid tumors. Periostin promotes tumor invasion and metastasis via epithelial-mesenchymal transition. The aims of this study were to evaluate periostin expression immunohistochemically and quantitatively in patients with non-small cell lung cancer (NSCLC) and to assess any associations with clinical features and prognosis. A total of 184 specimens of NSCLC tissue were investigated, including 134 adenocarcinomas, 39 squamous cell carcinomas, and 11 other histologic subtypes. The intra-tumoral periostin expression area in each captured field was calculated using the image processing integration software WinROOF. The mean periostin expression score was classified as high or low by the median value of its expression area. Univariate analysis demonstrated that gender, tumor size, T status, N status, stage, histologic type, smoking habits, percent vital capacity, 1% forced expiratory volume, and pleural invasion were each significantly associated with periostin scores. Multivariate analysis revealed that high periostin expression score was an independent prognostic factor significantly associated with decreased cancer-specific survival (HR, 3.65; 95% CI, 1.04–12.84; P=0.0439). We concluded that intratumoral periostin expression was an independent prognostic factor for NSCLC.

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Case Report
  • JOE IWANAGA, KOICHI WATANABE, TSUYOSHI SAGA, NOBUHIRO TAHARA, YOKO TAB ...
    2017 Volume 64 Issue 1.2 Pages 21-24
    Published: September 30, 2017
    Released on J-STAGE: February 26, 2018
    Advance online publication: June 12, 2017
    JOURNAL FREE ACCESS

    Summary: L-shaped kidney is a congenital anomaly. The disorder results in the kidney appearing very similar in shape to horseshoe kidney (also a congenital anomaly), but either the right or left kidney is located at a position lower than the other kidney. In this report, we describe a woman with L-shaped kidney, identified during anatomical dissection, and compare the findings with clinical data obtained before her death. We discuss the embryology of L-shaped kidney based on detailed anatomical data on the kidney and its vascular system obtained by means of gross anatomical, radiological, and histological examinations. Our findings indicate the importance of detailed anatomical information when planning surgical procedures in patients with fused kidneys, as well as kidney transplantation, resection of renal carcinoma, or surgical treatment of abdominal aortic aneurysm.

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  • SHUHEI FUKUNAGA, HIDETOSHI TAKEDATSU, KEIICHI MITSUYAMA, TAKUJI TORIMU ...
    2017 Volume 64 Issue 1.2 Pages 25-27
    Published: September 30, 2017
    Released on J-STAGE: February 26, 2018
    Advance online publication: July 03, 2017
    JOURNAL FREE ACCESS

    Summary: Concomitant association of histologically proven inflammatory bowel disease (IBD) and neurofibromatosis type 1 (NF1) is a rare finding documented in only 5 adult clinical cases. A 34-year-old woman with known neurofibromatosis was admitted to our department with a 6-month history of intractable bloody diarrhea and abdominal pain. After a thorough clinical examination and paraclinical assessments, including colonoscopy and biopsy, ulcerative colitis (UC) was confirmed as the cause of gastrointestinal bleeding. NF1 is considered an autosomal dominant condition caused by mutations in the NF1 gene, which is located on chromosome 17q11.2 [1]. A wide variety of NF1 mutations have been found in patients with NF1, but no frequently recurring mutation has been identified. Since the pathogenesis of IBD is also associated with genetic make-up, these two entities may be associated with a genetic factor.

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  • JUN-ICHI OHKUBO, AZUSA TAKAHASHI, SHOJI IKEZAKI, FUMIKO TAKENAGA, YUFU ...
    2017 Volume 64 Issue 1.2 Pages 29-33
    Published: September 30, 2017
    Released on J-STAGE: February 26, 2018
    Advance online publication: October 20, 2017
    JOURNAL FREE ACCESS

    Summary: Objective: We report a case of anaplastic thyroid carcinoma (ATC) with local recurrence and distant metastasis that responded very well to treatment with lenvatinib, a new molecular-targeted anticancer drug. Case Report: A 91-year-old Japanese woman presented with a 5-month history of a painless mass in her left anterior neck. She had a past history of total thyroidectomy and neck dissection for papillary carcinoma of the thyroid. Here she underwent neck dissection, and the histopathological diagnosis was lymph node metastasis of papillary carcinoma with anaplastic transformation. Five months later, a cervical lymph node swelled up again. Computed tomography demonstrated an enhanced mass in the neck and multiple nodules in both lungs. Recurrent ATC with multiple lung metastases was diagnosed, and molecular-targeted therapy with lenvatinib was initiated. The neck tumor reduced in 1 week, and the pulmonary nodules became completely hollow within 1 month. However, we had to discontinue lenvatinib because of severe side effects including high blood pressure, hypocalcemia, and hypoalbuminemia. Soon after discontinuation, the side effects subsided, but the tumor rapidly regrew. The patient died of lymphangiosis carcinomatosa 6 days after discontinuation. Conclusion: Although recent advances in molecular-targeted therapy have provided powerful cancer therapy tools, the negative side of this therapy must be addressed.

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  • ASAKO KUHARA, NORIMITSU TANAKA, TOMOKO KUGIYAMA, MASAMICHI KOGANEMARU, ...
    2017 Volume 64 Issue 1.2 Pages 35-38
    Published: September 30, 2017
    Released on J-STAGE: February 26, 2018
    Advance online publication: November 27, 2017
    JOURNAL FREE ACCESS

    Summary: Management of venous malformation (VM) in the pharynx is challenging because of difficulties in needle access and the presence of nerves as well as other critical anatomical structures around the lesion. We describe the successful treatment of a large pharyngeal VM using transoral sclerotherapy. The patient, a 21-yearold male, visited our hospital for sclerotherapy treatment consultation after complaining of difficulty in swallowing because of a pharyngeal VM. Transoral sclerotherapy was successful, and the symptoms showed complete alleviation. Using a flat detector-equipped angiographic C-arm CT (CACT) enabled the precise assessment of sclerosant placement, facilitating safer sclerotherapy in the pharynx.

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Technical Note
  • KOICHI WATANABE, YOKO TABIRA, TSUYOSHI SAGA, JOE IWANAGA, WAKAKO MATSU ...
    2017 Volume 64 Issue 1.2 Pages 39-43
    Published: September 30, 2017
    Released on J-STAGE: February 26, 2018
    Advance online publication: October 20, 2017
    JOURNAL FREE ACCESS

    Summary: Vascular injection into extracted tissue may be associated with leakage due to excessive local injection pressure. Historically, this complication has been impossible to resolve because the injection pressure has been the only available force with which to send the agent to the peripheral vasculature. We have developed a new vascular injection method that utilizes a material affected by magnetic force and is therefore not solely dependent upon the injection pressure. We mixed the same weights of latex and magnetic fluid and injected the solution into the arterial stump of an extracted tissue specimen. Next, we used a permanent magnet to attract the agent into the peripheral vasculature. We repeated the injection and magnetic application until no further fluid could be injected. We used this method in 20 formalin-fixed tissue specimens. The vessels were clearly observable through to the peripheral areas, and leakage from the injected artery was minimal. This new agent has several beneficial characteristics: it is X-ray impermeable, is durable in the face of chemical insult, and allows for easy visual observation. The injected tissue can be studied for X-ray film examination, tissue clarification, and gross anatomical dissection. Additionally, this method can be applied to both fresh and formalin-fixed tissue. We consider that this method has the potential to expand the applications of injection studies.

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