Journal of Nihon University Medical Association
Online ISSN : 1884-0779
Print ISSN : 0029-0424
ISSN-L : 0029-0424
Volume 81, Issue 1
Journal of Nihon University Medical Association
Displaying 1-11 of 11 articles from this issue
Preface:
Topics in Medical English Education:
Special Articles:
  • Masamichi Moriguchi
    Article type: review-article
    2022 Volume 81 Issue 1 Pages 11-17
    Published: February 01, 2022
    Released on J-STAGE: April 13, 2022
    JOURNAL FREE ACCESS

    The treatment of hepatocellular carcinoma (HCC) is based on the tumors’ condition and the liver reserve capacity. This article describes transcatheter arterial embolization (TAE) and systemic therapy, which is mainly used aspalliative therapy. TAE is widely used for conditions that cannot be curatively treated. We mainly used Lipiodol,an anticancer drug (mainly cisplatin and epirubicin) and a gelatin sponge. The procedure was performed on 832patients over the course of 16 years, from 2001 to 2016. The median survival time (MST) was I: 49 months, II:35 months, III: 24 months, and IV: 11 months for each stage. Recently, a permanent embolic material was used totreat a large HCC that measured at least 5 cm, and the survival period was extended. The MST was 24.3 monthsafter using a permanent embolic material 9.3 months before the procedure (P = 0.013). However, the incidenceof HCC is decreasing due to the decrease in HCV infection, so the number of TAE procedures is also decreasing. Molecularly-targeted therapy for HCC have been available since 2009, and several types of drugs have beendiscovered since then. Recent progress is especially remarkable. Systemic therapy was originally used to treatcases in which the efficacy of TAE was diminished or ineffective. Today, new attempts are being made to improvethe effectiveness of combination treatments, such as TAE, radiofrequency ablation and resection. At present, thefirst-line treatment of HCC is atezolizumab + bevacizumab combination therapy. The second-line treatment issorafenib and lenvatinib. Other drugs, such as ramucirumab (AFP ≥ 400 ng/mL), cabozantinib, and regorafenib,can also be used. Systemic therapy has made remarkable progress recently and is expected to improve the survivalof HCC.

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  • Kazuhiro Nakamura
    Article type: review-article
    2022 Volume 81 Issue 1 Pages 19-21
    Published: February 01, 2022
    Released on J-STAGE: April 13, 2022
    JOURNAL FREE ACCESS

    The treatment of pharyngeal and laryngeal cancers have special characteristics because the pharynx and larynxare closely related to QOL. The major roles of the pharynx and larynx are breathing, speaking, and swallowing.These three roles are important for performing daily living activities and are also important for humans. It isrequired to find a balance between cancer treatment and QOL. If a total laryngectomy is performed, you will beunable to speak after the operation. If a total or partial pharyngectomy is performed, dysphagia will occur; youwill be unable to eat well or speak clearly after the operation. After a total laryngectomy, you will be unable tosmell. If the tracheostomy is unable to be closed after a pharyngectomy, the cannula will remain, and QOL willdecrease. If chemoradiation therapy is performed, you will be unable to eat well, you will need PEG, and you willbe unable to smell or taste. The treatment of head and neck cancers are required to improve QOL and a cure isneeded. Therefore, reduction surgery should be considered without degrading the treatment results.

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  • Mikiko Asai-Sato
    Article type: review-article
    2022 Volume 81 Issue 1 Pages 23-28
    Published: February 01, 2022
    Released on J-STAGE: April 13, 2022
    JOURNAL FREE ACCESS

    Ovarian cancer is a group of malignant tumors of various histological types. In this article, we discuss the mostfrequently occurring epithelial ovarian malignant tumor (ovarian cancer). Ovarian cancer tends to metastasize tothe peritoneum at an early stage, while symptoms do not appear until a progressed stage. Furthermore, an effectivecancer screening method has not been established. Therefore, most cases of ovarian cancer at the time of diagnosisare unresectable and advanced. Even in advanced cases with intra-abdominal metastases, an active mass reductionsurgery is recommended to improve the prognosis. Such aggressive surgical procedures often require a multidisciplinary approach, including gastroenterology and urology. Pharmacotherapy, mainly with cytotoxic agents, isthe mainstay of treatment for advanced ovarian cancer. In addition, angiogenesis inhibitors and molecular targetedagents that utilize double-stranded DNA repair deficiency (homologous recombination repair deficiency) havebeen developed for ovarian cancer and are expected to improve treatment outcomes. Despite remarkable progressin ovarian cancer treatment in recent years, many patients still suffer from unfortunate outcomes. As stated in theJapanese 3rd Basic Plan for the Promotion of Cancer Control, providing holistic support to these patients’ dailylives is also an essential element of ovarian cancer treatment.

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Original Article:
  • Yuko Omori, Yasuo Amano, Fumi Yanagisawa, Yasuyuki Suzuki, Chisato And ...
    Article type: dissertation
    2022 Volume 81 Issue 1 Pages 29-34
    Published: February 01, 2022
    Released on J-STAGE: April 13, 2022
    JOURNAL FREE ACCESS

    Background: Chronic kidney disease (CKD) leads to myocardial tissue alterations that are associated with cardiac events and mortality. Cardiac magnetic resonance imaging (MRI) may be useful for noninvasively detectingmyocardial abnormalities associated with CKD and its relationship with patients’ prognoses.Objectives: The aim of this study was to evaluate the relationship between myocardial T1 and T2 values, cardiacfunction and 1-year outcomes in male patients with CKD.Methods: Thirty-eight patients with CKD were examined using a 1.5T imager. The relationship between thepatients’ native T1 or T2 values and their age, renal function, cardiac functional parameters measured by cardiacMRI, and 1-year outcomes was assessed. The 1-year outcomes was defined as cardiac events including hospitalization or death associated with coronary artery diseases or heart failure that occurred within 1 year after having acardiac MRI.Results: Native T1 and T2 values of the myocardium were significantly higher than those of our institutional reference standard (P < 0.05 for both). The patients’ T1 values were correlated with several cardiac functionalparameters (P < 0.05). There were significant differences in the left ventricular end-diastolic volume (LVEDV) aswell as the LVEDV index (LVEDVI) between patients with and without cardiac events within 1 year after havinga cardiac MRI (P = 0.048 for both). A receiver operating characteristic analysis revealed that a LVEDV of 124 mLand a LVEDVI of 75.05 mL/m2 were appropriate thresholds for identifying patients with CKD with poor 1-yearoutcomes.Conclusions: T1T2 mapping might be a useful tool to quantify myocardial tissue alterations specific for CKD andits cardiac function. LVEDV and LVEDVI are significantly related to 1-year outcomes in male patients with CKD.

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  • Sakurako Hattori, Masahiro Yan, Kazuhiko Wakabayashi, Yutaka Ito
    Article type: research-article
    2022 Volume 81 Issue 1 Pages 35-38
    Published: February 01, 2022
    Released on J-STAGE: April 13, 2022
    JOURNAL FREE ACCESS

    We examined the treatment outcome of 17 patients who received gemcitabine (GEM) + nab-paclitaxel (nabPTX) therapy (GnP therapy) as the first-line treatment for unresectable pancreatic cancer at our hospital. Thedisease staging at the time of treatment planning was such that 3 patients had Stage IIA disease, 4 patients hadStage III disease and 10 patients had Stage IV disease, and the resectability classification was such that 7 patientshad UR-LA and 10 patients had UR-M. The response to treatment was PR in 6 patients, SD in 8 patients and PDin 3 patients, and the response rate and disease control rate were 35.3% and 82.4%, respectively. Four patientsunderwent conversion surgery after GnP therapy. Three patients had UR-LA and one patient had UR-M. All resected patients had better overall survival than unresected patients. Conversion surgery should be attempted forpatients who have responded to multidisciplinary treatment and would tolerate surgery.

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Research Report:
  • Etsue Tsukada, Akiko Shibuya, Yukihiro Maeda, Rie Ichikawa, Teruyoshi ...
    Article type: rapid-communication
    2022 Volume 81 Issue 1 Pages 39-44
    Published: February 01, 2022
    Released on J-STAGE: April 13, 2022
    JOURNAL FREE ACCESS

    We administered the Chinese herbal medicine Hachimijiogan to 5 males, aged 60 years or older, who had grade2 or grade 3 idiopathic sudden sensorineural hearing loss without vertigo between 2019 and 2020. Three of thesefive cases healed or recovered. From 2015 to 2018, four males, aged 60 years or older, who had the same level ofidiopathic sensorineural hearing loss without dizziness visited. We did not administer Hachimijiogan to them. Oneof these four cases was cured.The thresholds observed while using the 5-frequency method at the first visit and the last visit of the Hachimijiogan-administered group were 58.2 ± 9.7 dB and 36.2 ± 14.2 dB, respectively, showing a significant improvement. On the other hand, the means of those thresholds observed in the nonadministered group were 49.2 ± 12.5dB and 50.2 ± 20.0 dB, respectively, and no significant improvement was observed.The degree of hearing improvement between the administered group and the nonadministered group was compared to the average threshold for hearing using the 5-frequency method at the first visit and the last visit. Thechange in the hearing threshold in the treated group was −22.0 (± 18.2) dB and the change in the nontreated groupwas 2.6 (± 13.3) dB. At P = 0.050044, there was no significant difference in the degree of improvement betweenthe two groups.

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Case Reports:
  • Komei Igei, Haruyasu Sakuranaka, Airi kato, Takashi Nakagawa, Shun Yok ...
    Article type: case-report
    2022 Volume 81 Issue 1 Pages 45-48
    Published: February 01, 2022
    Released on J-STAGE: April 13, 2022
    JOURNAL FREE ACCESS

    In the present study, when 13 patients who were classified as having moderate COVID-19 (coronavirus disease2019) with percutaneous oxygen saturation (SpO2) levels of ≤ 93% while receiving ≥ 3 L/min of oxygen therapywere placed in an awake prone position during therapy, SpO2 levels increased in 11 patients. There were no differences in age, sex, or blood test results between the group in which improvements were observed while receivingtreatment in the prone position alone and the group that required subsequent mechanical ventilation. However,chest computed tomography (CT) showed lesions in the center of the dorsal side in the former and from the dorsalto the ventral side in the latter. If lesions are located in the center of the dorsal side on chest CTs, mechanical ventilation management may be avoided by placing patients in the awake prone position during therapy

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  • Katsuhisa Enomoto, Satsuki Fukumoto, Eiji Osaka, Yoshiaki Kusumi, Keii ...
    Article type: case-report
    2022 Volume 81 Issue 1 Pages 49-52
    Published: February 01, 2022
    Released on J-STAGE: April 13, 2022
    JOURNAL FREE ACCESS

    Background: Giant parathyroid adenoma presenting with a brown tumor is considered to be rare. This conditionrequires special consideration.Case Presentation: A 21-year-old woman presented to the clinic with persistent pain in her right knee. A radiographic examination showed an osteolytic lesion in her right tibia. Blood laboratory tests revealed that serumcalcium and intact parathyroid hormone were increased significantly. Physical examination showed a 3-cm, firm,immovable lump in her neck. Ultrasonography of the patient’s neck revealed a 3.5-cm, well-circumscribed masswith a homogeneous internal texture. Computed tomography also showed a localized tumor with clear margins.The 99mTc-MIBI scintigraphy showed a hot spot in the right inferior gland. Based on these findings we judgedthat she had giant parathyroid adenoma presenting with a brown tumor. These pre-operative findings suggest thatthe possibility of carcinoma was low. We performed a parathyroidectomy via a small incision. The excised parathyroid gland weighed 10.3 g. The patient’s postoperative course was unremarkable.Conclusions: Giant parathyroid adenoma presenting with a brown tumor is rare. Accordingly, the differentiationbetween giant adenoma and parathyroid carcinoma is crucial. However, we determined that the possibility ofcarcinoma was low based on imaging studies, including ultrasonography and computed tomography. As a result,we performed successful parathyroidectomy with a small incision.

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