Purpose: The aims of this study were to evaluate 1) in transrectal biopsy, whether additional 4-core biopsies of the mid-peripheral region after lateral-peripheral sextant biopsy in the peripheral zone can improve the prostate cancer detection rate, and 2) the preventive role of flomoxef sodium and levofloxacin against infectious complications. Material and Methods: We retrospectively analyzed the records of 1541 patients who underwent initial transrectal ultrasound guided prostate biopsies at our hospital between January 2003 and November 2016. Two hundred and fifty-one patients underwent sextant prostate biopsy and 1290 underwent 10-core biopsy. The cancer detection rates of these two methods were analyzed. Since April 2009, a single-dose of flomoxef sodium (500 mg) has been injected immediately before the 10-core biopsy in addition to levofloxacin for antimicrobial prophylaxis. The infectious complication rate among biopsied patients with or without flomoxef sodium was also evaluated. Results: The additional 4-cores biopsies significantly increased the cancer detection rate compared with sextant biopsy, especially in a subgroup of patients with a serum prostate specific antigen level of 4.0–10.0 ng/ml (38.5% vs 28.7%, p=0.032) without increasing the rate of clinically insignificant cancer (5.2% vs 7.5%, p=0.367). Moreover, the incidence rate of acute prostatitis in 10-core-biopsied patients who were administered flomoxef sodium in addition to levofloxacin was significantly lower than in those administered levofloxacin alone (0.4% vs 4.6%, p<0.0001). Conclusions: The additional 4-core biopsies significantly increased the cancer detection rate compared with sextant biopsy without increasing the rate of clinically insignificant cancer. Moreover, flomoxef sodium together with levofloxacin may have preventive effects against infectious complications.
Objective: We investigated the outcomes of patients who underwent tracheotomy and how possible it was for closure of the tracheal stoma to occur. On the basis of these results, we highlighted points to note during surgery. Methods: The subjects were 204 patients who underwent tracheotomy in our department between April 2010 and March 2015. Patients were classified into 6 categories according to the primary disease: head and neck disease, cranial nerve disease, cardiovascular disease, digestive disease, respiratory disease, and other disease. Results: Outcome after tracheotomy in the 204 patients was as follows: 81 (39.7%) were discharged, 89 (43.6%) were referred to other hospitals, and 34 (16.7%) died. Patients with head and neck disease had the highest rates of stomal closure at discharge. Furthermore, the median interval until closure of the stoma in these patients was also significantly shorter than that in patients with non-head and neck disease. However, patients with cranial nerve disease had the highest rate of the tracheal stoma remaining open when referred to a rehabilitation hospital. Mortality rates for patients undergoing tracheotomy for cardiovascular, gastrointestinal, and respiratory diseases were high at 50.0% (11/22), 36.8% (7/19), and 26.7% (4/15), respectively. Conclusion: When long-term airway management is required, such as in cranial nerve disease, tracheal fenestration should be performed with the aim of preventing granulation and tracheal stoma stenosis. Perioperative management must be strict, especially when performing tracheotomy in patients with cardiovascular, gastrointestinal, and respiratory diseases.
Purpose: The novel 2019 coronavirus disease (COVID-19) is causing the current epidemic of pneumonia in Japan. This report evaluates contrast-enhanced computed tomography (CECT) features affecting clinical worsening in patients with non-severe pneumonia. Methods: Clinical data of 11 patients hospitalized at our institution due to non-severe COVID-19 pneumonia between April 1 and April 30, 2020, were analyzed retrospectively. Results: One patient (9.1%) deteriorated, and 10 patients (90.9%) improved and/or stabilized. CECT was performed on three patients with D-dimer elevated to >6-fold above the upper limit of normal. No patients suffered pulmonary embolism (PE). Heparin treatment was administered for 3 patients with elevated D-dimer levels, and the one patient with the sign of a RV/LV ratio of > 1.0 on CECT underwent intubation and respiratory management. Conclusion: A sign of RV dilatation without PE on CECT may be useful for predicting rapid clinical worsening and appropriate management in patients with non-severe COVID-19 pneumonia.
Purpose: The prevalence of valvular heart disease has been increasing recently, so we investigated the trends in surgical treatment in Japan. Methods: With reference to 20 years of data (1998 to 2017) in “Thoracic and cardiovascular surgery in Japan: Annual report by the Japanese Association for Thoracic Surgery,” medical treatment data were investigated in a survey conducted by the Japanese registry of all cardiac and vascular diseases (JROAD). Results: The number of surgeries for valvular heart disease has continually increased, reaching 23,312 in 2017, which represents a 2.6-fold increase over 20 years. Single aortic valve surgery was the most common procedure, with 10,690 such surgeries performed in 2017. The ratio of using a bioprosthesis has increased dramatically. Aortic valve replacement with a bioprosthesis, mitral valve repair and tricuspid valve repair have also increased over the years. Notably, the 30-day mortality rate has gradually decreased, reaching 1.9% in 2017. Conclusions: The number of operations for valvular heart disease is increasing. The rate per performing aortic valve replacement with a bioprosthesis has markedly increased. Although the hospital mortality rate has not changed much in the last 10 years, the surgical results in Japan are excellent in comparison to those in other countries.
Intestinal spirochetosis is a zoonotic infection caused by gram-negative bacteria of the genus Brachyspira. In Japan, several cases have been reported since Nakamura et al. first reported the disease in 1998, and although it has been recognized by pathologists, there have only been a handful of reports on the disease. In this study, we investigated an incidence of intestinal spirochetosis in samples obtained through colonoscopic biopsy, polypectomy, and EMR. Ten patients (6 men and 4 women) were diagnosed with intestinal spirochetosis and had been infected with Brachyspira aalborgi among 537 patients (318 men and 219 women). Ages ranged from 49 to 73 years. The overall incidence was 1.9%, and the incidence in men (1.88%) and women (1.82%) was almost equal. In past reports, intestinal spirochetes was more common among men, although only one report examined the sex-specific incidence of this disease. Our results suggested that a similar number of infections occur in women, but the infection route is not clear.
We report a 75-year-old woman with advanced hepatocellular carcinoma (HCC) with portal vein main trunk tumor thrombosis treated successfully by repeated hepatic arterial infusion chemotherapy (HAIC). She had been diagnosed with hepatitis B virus cirrhosis since 1998 and followed up by a local practitioner. As hepatocellular carcinoma occurrence was suspected on abdominal computed tomography in March 2007, she was referred to our hospital. Although transcatheter arterial chemoembolization (TACE) with emulsion of epirubicin and lipiodol was performed twice, the therapeutic response was poor and temporary. Serum alpha-fetoprotein (AFP) level was elevated, and portal vein tumor thrombosis (PVTT) involving main trunk of portal vein (Vp4) appeared. In January 2008, the treatment was changed to hepatic arterial infusion chemotherapy (HAIC) with a fine-powder formulation of cisplatin (IA-call®). Immediately after HAIC, there was a significant decrease in AFP levels, and we estimated that IA-call® was effective. An arterial infusion reservoir was placed in the right hepatic artery in March 2008, and repeated HAIC of IA-call® was performed 7 times until December 2008. During this period, HCC with PVTT disappeared, and AFP level decreased to normal range. We judged complete remission was obtained, and it persisted for 7 years and 8 months after terminating HAIC. In July 2016, although recurrence was observed, it was controlled by repeated TACE, and she is alive as of December 2020. We encountered a case of advanced HCC with Vp4 who survived for over 13 years owing to the remarkable effect of repeated HAIC of IA-call®.
Objective We aimed to summarise recent epidemiological findings regarding parasitic diseases and other animal-derived diseases based on our studies in Kawasaki City with a reference to other areas in Japan. Methods We conducted a retrospective survey of animal-derived diseases reported between 2001–2019 in the Department of Immunology and Medical Zoology of St. Marianna University School of Medicine. Results Thirty-two patients were referred to our department from neighboring hospitals for evaluation and consultation regarding suspicious parasitic diseases and other animal-derived diseases. Twenty patients were diagnosed as having parasitic disease or some other animal-derived disease. Twelve patients remained undiagnosed despite detailed examination of their clinical samples. Among the 20 patients with parasitic disease, six and four patients were diagnosed with diphyllobothriasis and anisakiasis, respectively. Tick bites without obvious microbial infection were found in two cases. Conclusion We found that parasitic diseases reported over the past two decades were mostly of helminthic origins and food-borne. Although the number of cases was small, we identified two cases of tick bites in Kawasaki City. Therefore, careful attention should be paid to the emergence of severe tick-borne diseases even in urban areas.
Background: Because mitochondrial encephalomyopathy carries a risk of malignant hyperthermia, volatile inhalation anesthetics are contraindicated, but propofol can also carry the risk of propofol infusion syndrome. In recent years, increasing reports have shown that the use of volatile inhalation anesthetics can be safely managed for anesthesia. We report that sevoflurane made it possible to safely manage anesthesia in a patient with mitochondrial encephalomyopathy undergoing MitraClip® implantation. Case presentation: The patient was a 82-year-old woman with mitral regurgitation (MR) and mitochondrial encephalomyopathy discovered by genetic testing. She also had rheumatoid arthritis and was taking steroids. Preoperative transthoracic echocardiography revealed severe MR due to left atrium dilatation. Due to her high risk for surgery, she was scheduled to undergo MitraClip® implantation. She was placed under general anesthesia, which was induced with midazolam, and neuromuscular monitoring was used for administration of a muscle relaxant. Anesthetic management was maintained with remifentanil and sevoflurane. After MitraClip® implantation, mitral regurgitation was reduced. Conclusion: MitraClip® implantation in a patient with mitochondrial encephalomyopathy could be safely managed under monitoring using an inhalation anesthetic.