Yonago Acta Medica
Online ISSN : 1346-8049
ISSN-L : 0513-5710
Current issue
Showing 1-21 articles out of 21 articles from the selected issue
Review Article: Special Contribution
  • Naoto Burioka
    Type: Review Article: Special Contribution
    2020 Volume 63 Issue 4 Pages 239-245
    Published: 2020
    Released: November 24, 2020
    [Advance publication] Released: September 19, 2020
    JOURNALS FREE ACCESS

    Home oxygen therapy allows patients requiring long-term oxygen therapy to receive care at home and helps improve the prognosis of patients with chronic respiratory failure. The usage conditions of oxygen concentrators, which are used to supply gaseous oxygen, and the effects of oxygen inhaled at a prescribed flow rate have not been confirmed in adequate detail. As a result of advances in information and communications technology, internet communication functions can now be incorporated into medical devices installed in patients’ homes. This allows time-series data on oxygen concentrator usage and biological variables to be stored on a server and accessed remotely by health care providers, enabling them to check the validity of home oxygen therapy and intervene appropriately. In Japan, telemonitoring of home oxygen therapy is covered by social insurance systems and is recognized as a new medical technology. This article reviews the usefulness of telemonitoring of home oxygen therapy and describes the cloud-based analytical system we have developed.

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Original Article
  • Makoto Kawasaki, Takayuki Tamura, Yusei Harada, Nobuyuki Fujii, Rieko ...
    Type: Original Article
    2020 Volume 63 Issue 4 Pages 246-254
    Published: 2020
    Released: November 24, 2020
    [Advance publication] Released: September 14, 2020
    JOURNALS FREE ACCESS

    Background Owing to the increase in the older population and the increased life span, the number of patients with oral multiple primary carcinomas will increase. Predicting the second and third carcinoma clinically is difficult, and the presence of second or third carcinomas is a factor that determines the prognosis of oral carcinoma. In this study, we examined the clinical features of oral multiple primary carcinomas treated in our department.

    Methods We retrospectively reviewed the medical records of patients with oral squamous cell carcinoma who underwent radical treatment at and were followed by the Department of Oral and Maxillofacial Surgery, Tottori University Hospital from January 2003 to October 2017.

    Results This study included 261 patients: 241 patients had oral single primary carcinoma and 20 patients had oral multiple primary carcinomas. Oral multiple primary carcinomas showed female predilection and occurred more frequently in the lower gingiva and significantly less frequently in the tongue (P < 0.01). Oral multiple primary carcinomas showed a significantly higher recurrence rate (P < 0.01). The 5-year overall survival of oral single primary carcinoma patients was 88.0% compared with 95% for oral multiple primary carcinomas, with no significant difference (log rank test, P = 0.54). However, the 15-year survival rate dropped to 28.1% in oral multiple primary carcinomas. The cumulative disease incidence rates of metachronous second primary carcinoma from first carcinoma at 5 years and 10 years were 3.45% and 5.36%, respectively.

    Conclusion Oral multiple primary carcinomas rarely occur in the tongue. The 5-year survival rate showed no difference between single and multiple carcinoma patients, but over longer observation, the prognosis of multiple carcinoma was poor owing to a high recurrence rate. Because of the high recurrence rate and risk of further metachronous carcinoma in oral multiple primary carcinomas, longer-term follow-up is required.

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  • Rieko Doi, Shuko Akagami, Katsuya Kondo, Yu Yoshida, Naoki Chiuriki, M ...
    Type: Original Article
    2020 Volume 63 Issue 4 Pages 255-265
    Published: 2020
    Released: November 24, 2020
    [Advance publication] Released: September 28, 2020
    JOURNALS FREE ACCESS

    Background Use of the Glatzel mirror for measuring expiratory nasal flow in preschool children has the disadvantage of vagueness, and the mirror may induce fear and inhibition of interest in those children. In response to these limitations, we developed a new device with dual cameras for measuring expiratory nasal flow in 2 to 6 year old children. The aim of this study is to compare the Glatzel mirror and the new device, in terms of accurate assessment of expiratory nasal flow, children’s feelings, and correlation to each child’s profile.

    Methods This study evaluated 20 cleft lip and palate patients and 21 healthy children aged between 2 and 6 (under 7) years. After consent was granted, a 4-week screening period was undertaken followed by inspection at weeks 8, 16, 24, and 32. Each inspection was conducted while the children were asked to pronounce various sounds and comprised three stages: i) use of the Glatzel mirror, ii) subjective visual assessment using the new device, and iii) image recording by dual cameras of the new device. Questionnaires for the new device were administered at the initial and final inspections. To contrast the results between the Glatzel mirror and the new device, the numbers that indicated values of subjective visual assessment and camera assessment greater than the assessment values of the Glatzel mirror were compared. For measuring the children’s responses to the new device compared with those to the Glatzel mirror, the answers to the questionnaires were compared. For the comparison of the children’s profiles (age and sex) and feelings, the numbers of subjects who could use the new device were measured.

    Results The camera assessment of the new device indicated significantly greater values than that of the Glatzel mirror (P < 0.05). The feelings of the subjects to the new device mostly improved as the study progressed. Subjects aged 3 years and older were generally able to use the new device from the initial inspection. For both sexes, as the inspection progressed, the number occasions of successful use increased.

    Conclusion This study demonstrated the superiority of the new device with dual cameras to the Glatzel mirror in terms of functionality and attitude of children.

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  • Katsuro Kameyama, Tetsuya Ohbayashi, Kazutake Uehara, Atsuro Koga, Yos ...
    Type: Original Article
    2020 Volume 63 Issue 4 Pages 266-271
    Published: 2020
    Released: November 24, 2020
    [Advance publication] Released: September 25, 2020
    JOURNALS FREE ACCESS

    Background Visual examination by the naked eye is integral to medical diagnosis and surgery. The illumination in conditioned color is widely used for visual inspection in the industry but has not been introduced to the biomedical context. The color that can enhance the visual recognition of individual tissues is still unknown. Therefore, we carried out a visual recognition experiment on biological specimens to determine the subjective preference for illumination color based on questionnaires.

    Methods Twenty healthy subjects were asked to compare the visual recognizability of several rat tissues between the illuminations in test colors and white. The rats were anesthetized, and the femoral vein and abdominal cavity were exposed. Seven tissues were selected for a visual recognition test. Illumination was generated using a multi-color LED light. The subjects observed the tissues under the illuminations of white and one of the test colors alternately and reported which illumination is suitable for visual recognition using a questionnaire.

    Results The analysis of the questionnaires showed that the blue test color was more effective than white illumination in the visual recognition of fine structures such as the branching of blood vessels and nerves, and red illumination disturbed the visual recognizability of the same tissues. On the other hand, the red but not the blue illumination improved the visual recognizability of the vein beneath the intact skin. As to the recognition of individual tissues in the abdominal cavity, the white illumination gave a better visual recognizability compared to every other test color.

    Conclusion This study shows that the illumination color influences the visual recognition of biological specimens and the adequate color for the visual recognition of specific tissue parts is distinct among biological specimens. Using the lighting system to make fine adjustments to the illumination color may be useful in medical diagnosis and surgery.

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  • Yoshiaki Oshima, Naoto Okazaki, Kazumi Funaki, Akihiro Otsuki, Shunsak ...
    Type: Original Article
    2020 Volume 63 Issue 4 Pages 272-281
    Published: 2020
    Released: November 24, 2020
    [Advance publication] Released: October 05, 2020
    JOURNALS FREE ACCESS

    Background Breathing during a marathon is often empirically conducted in a so-called “2:2 breathing rhythm,” which is based on a four-phase cycle, consisting of the 1st and 2nd inspiratory and the 1st and 2nd expiratory phases. We developed a prototype ventilator that can perform intermittent positive pressure ventilation, mimicking the breathing cycle of the 2:2 breathing rhythm. This mode of ventilation was named the marathoners’ breathing rhythm ventilation (MBV). We hypothesized that MBV may have a lung protective effect.

    Methods We examined the effects of the MBV on the pulmonary pre-edema model in isolated perfused rabbit lungs. The pulmonary pre-edema state was induced using bloodless perfusate with low colloid osmotic pressure. The 14 isolated rabbit lung preparations were randomly divided into the conventional mechanical ventilation (CMV) group and MBV group, (both had an inspiratory/expiratory ratio of 1/1). In the CMV group, seven rabbit lungs were ventilated using the Harvard Ventilator 683 with a tidal volume (TV) of 8 mL/kg, a respiratory rate (RR) of 30 cycles/min, and a positive end-expiratory pressure (PEEP) of 2 cmH2O for 60 min. In the MBV group, seven rabbit lungs were ventilated using the prototype ventilator with a TV of 6 mL/kg, an RR of 30 cycles/min, and a PEEP of 4 cmH2O (first step) and 2 cmH2O (second step) for 60 min. The time allocation of the MBV for one cycle was 0.3 s for each of the 1st and 2nd inspiratory and expiratory phases with 0.2 s of intermittent resting between each phase.

    Results Peak airway pressure and lung wet-to-dry ratio after 60 min of ventilation were lower in the MBV group than in the CMV group.

    Conclusion MBV was considered to have a lung-protective effect compared to CMV.

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  • Chika Tanimura, Haruka Aoto, Nobuyuki Kobayashi, Abir Majbauddin, Tets ...
    Type: Original Article
    2020 Volume 63 Issue 4 Pages 282-293
    Published: 2020
    Released: November 24, 2020
    [Advance publication] Released: September 19, 2020
    JOURNALS FREE ACCESS

    Background Training peer leaders to deliver patient education is expected to be a low-cost approach to providing healthcare in urban-poor areas affected by a shortage of healthcare professionals. The purpose of this study was to examine the effects of a training program on the self-efficacy and knowledge of peer leaders with type 2 diabetes.

    Methods A single-group longitudinal survey with baseline, intervention, and follow-up periods was conducted at a diabetes clinic in a small municipality in Metro Manila, Philippines. The intervention, a self-efficacy theory–based training program for peer-leaders of diabetic patients conducted in August 2017, comprised hands-on learning, demonstrations, quizzes, role-playing, group sharing, physical exercise, and a buffet lunch. The primary outcome was participants’ self-efficacy for management of their diabetes. Secondary outcomes were participants’ knowledge of diabetes and levels of emotional distress, motivation, and confidence for guiding their peers, satisfaction with the training program, hemoglobin A1c, and quality of life.

    Results At 12 and 18 months after the intervention, participants’ knowledge of diabetes was significantly increased compared with baseline (both P < 0.05). At earlier time points, an increasing, but not significant, trend was observed. The change in knowledge of diabetes from baseline to 18 months after intervention tended to be positively correlated with the change in self-efficacy (r = 0.594, P = 0.054). No significant differences were observed for any of the other outcomes, although the descriptive statistics showed an increasing trend for all of the outcomes except motivation.

    Conclusion The training program significantly improved participants’ knowledge of diabetes at 12 and 18 months after the training programs compared with baseline. A positive correlation between the changes in the levels of knowledge and self-efficacy suggested that the observed improvement of self-efficacy was facilitated by the improvement of knowledge of diabetes.

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  • Masahiro Nishimura, Toshiaki Kato, Sho Onodera
    Type: Original Article
    2020 Volume 63 Issue 4 Pages 294-300
    Published: 2020
    Released: November 24, 2020
    JOURNALS FREE ACCESS

    Background In recent years, objective quantitative evaluations have become particularly important. Both qualitative and quantitative evaluations are also available for edema. It is thought that the technical problem of quantitative evaluation can be solved by using a simple and reproducible method. Several studies have evaluated various methods for measuring edema. Limitations, such as weaknesses, measurement complexity, and errors, have been identified. Therefore, this study aimed to consider a simple and effective measurement method for the quantitative evaluation of edema.

    Methods This study was a prospective, observational study. The subjects were 15 healthy adults (2 male and 13 female). Measurements were performed on the subjects’ right lower leg once in the morning and once in the afternoon, with a minimum interval of 4 hours.

    Results The actual volume of the lower leg was correlated with all indices except the ultrasonic echo findings for subcutaneous tissue. The intra-subject and inter-subject reliabilities for the indices using digital images were very high. The lower leg volume was greater significantly in the afternoon from the morning.

    Conclusion The leg circumference was measured by utilizing a tape, while the width and volume were measured by utilizing digital imaging suitable for quantitatively evaluating edema. Furthermore, swelling of the lower leg with time can occur in the absence of daily exercise.

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  • Toshio Masumoto, Kazunari Onishi, Tasuku Harada, Hiroki Amano, Shinji ...
    Type: Original Article
    2020 Volume 63 Issue 4 Pages 301-307
    Published: 2020
    Released: November 24, 2020
    [Advance publication] Released: November 05, 2020
    JOURNALS FREE ACCESS

    Background Oxytocin has a key role in mother-infant bonding, maternal care, social interaction, and stress-related psychiatric disorders. However, the factors determining oxytocin concentrations during and after pregnancy such as medical history related to nursing or parental behavior are unknown. To elucidate these, we analyzed the relationships between oxytocin concentrations during and after pregnancy, and medical history assessed in the Japan Environment and Children’s Study (JECS).

    Methods We then selected the pregnant women with a medical history of anxiety disorder and endometriosis as cases and pregnant women without medical history as controls adjusting the cohort for age and parity for a nested case-control study, after which 162 women remained for analysis. We evaluated 162 pregnant women from JECS using answers provided in a questionnaire and by measuring plasma oxytocin concentration by ELISA during the first (T1) and second (T2) trimesters of pregnancy, and after childbirth (T3).

    Results Oxytocin concentration increased in a time dependent manner, consistent with previous reports. There were weak negative correlations between oxytocin concentration at T1 and the mother’s age and height, but no correlation with other factors. The mean oxytocin concentrations of pregnant women with a history of an anxiety disorder (n = 7) and endometriosis (n = 13) were significantly lower than those of pregnant women with no such history at T2 and T3.

    Conclusion These results suggest that oxytocin concentrations during and after pregnancy were affected by a past history of anxiety disorder and endometriosis. This is the first study of the relationship between oxytocin concentration and endometriosis. To elucidate the molecular mechanisms, further study is needed.

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  • Shunjiro Yagi, Takafumi Sasaki, Takahiro Fukuhara, Kaori Fujii, Maki M ...
    Type: Original Article
    2020 Volume 63 Issue 4 Pages 308-312
    Published: 2020
    Released: November 24, 2020
    [Advance publication] Released: October 29, 2020
    JOURNALS FREE ACCESS

    Background Technical issues in free flap transfer, such as the selection of recipient vessels and the positioning and method of anastomosis of the vascular pedicle, have been the subject of vigorous debate. Recent developments in computational fluid dynamics (CFD) have enabled the analysis of blood flow within microvessels. In this study, CFD was used to analyze hemodynamics in a microanastomosis.

    Methods In the fluid calculation process, the fluid domain modelizes microvessels with anastomosis. The inlet flow conditions were measured as venous waveform, and the fluid is simulated as blood. Streamlines (SL), wall shear stress (WSS), and oscillatory shear index (OSI) at the anastomosis were visualized and analyzed for observing effects from the flow field.

    Results Some flow disruption was evident as the SL passed over the sutures. The maximum recorded WSS was 13.37 Pa where the peak of a suture was exposed in the lumen. The local maximum value of the OSI was 0.182, recorded at the base of the anastomosis on the outflow side.

    Conclusion In the ideal anastomosis, the SL is disrupted as little as possible by the sutures. The WSS indicated that thrombus formation is unlikely to occur at suture peaks, but more likely to occur at the base of sutures, where the OSI is high. Tight suture knots are important in microanastomosis.

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  • Hiroaki Yazama, Tasuku Watanabe, Kazunori Fujiwara, Hiromi Takeuchi
    Type: Original Article
    2020 Volume 63 Issue 4 Pages 313-318
    Published: 2020
    Released: November 24, 2020
    JOURNALS FREE ACCESS

    Background Postoperative hearing results of type IV tympanoplasty have been shown to have poorer results than other reconstruction techniques. There are numerous reports evaluating the factors for hearing improvement. This preliminary study aimed to analyze and determine the factors that affect hearing results.

    Methods A total of 80 patients who underwent type IV tympanoplasty were evaluated to participate in this study. The medical records of the candidate patients were collected retrospectively. Fifty out of the 80 recruited patients were excluded due to the following reasons: they could not be followed-up for more than a year after the final operation, their initial surgery was not performed in our department, or they needed a revision surgery. The pre-, intra-, and postoperative factors were evaluated and analyzed using EZR software. Cases were divided into two groups according to postoperative hearing results, and each factor was analyzed univariately. The explanatory variables included in the multivariate analysis were the variables that satisfied P < 0.1 in the univariate analysis. Furthermore, all cases were divided into two groups according to the qualitative variables that showed significant difference in the multivariate analysis, and the background factors were evaluated.

    Results The results of univariate analysis showed P < 0.1 for ‘Age’ and ‘Material of external auditory canal (EAC) packing’. Multivariate analysis showed P < 0.05 for both. The comparison between the two packing material groups showed that the gauze group was more likely to have improved hearing than Spongel® group, and the ossicular chain condition of the gauze group was maintained better.

    Conclusion ‘Age’ and ‘Material of EAC packing’ were considered to be significant factors affecting the postoperative hearing results. The selection and use of packing materials that provide stability should be considered to obtain better postoperative hearing results in type IV tympanoplasty.

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  • Shinji Tanishima, Hiroshi Hagino, Hiromi Matsumoto, Chika Tanimura, Hi ...
    Type: Original Article
    2020 Volume 63 Issue 4 Pages 319-325
    Published: 2020
    Released: November 24, 2020
    JOURNALS FREE ACCESS

    Background Several factors, particularly osteoporosis, obesity, and a lack of exercise, contribute to low back pain (LBP). This observational longitudinal cohort study to identify the risk factors for worsening low back pain.

    Methods We sent a self-administered questionnaire and a consent form for this study to 1,450 subjects aged > 40 years in Hino, Japan. Baseline assessments of 273 individuals undergoing medical check-ups were conducted from 2014 to 2016. The subjects were divided into Group A (no change or improvement in LBP) and Group B (worsening LBP). LBP was assessed using a visual analog scale; body mass index (BMI), bone mineral density, skeletal muscle index (SMI), standing posture, and habitual exercise frequency were also evaluated. We defined, habitual exercise as nontherapeutic exercise (e.g. swimming, walking, physical exercise and work out).

    Results Overall, 81.2% subjects performed habitual exercise in Group A, a greater number of subjects than the 40.8% in Group B. BMI, SMI, and bone mineral density (BMD) were not significantly different between the two groups. Lack of exercise was a significant risk factor for worsening of LBP. On the other hand, the lack of osteoporosis treatment was significantly different between subjects with worsening LBP despite habitual exercise and those who did not perform habitual exercise.

    Conclusion Although habitual exercise is useful to prevent LBP, it may not necessarily be useful for those with a lack of osteoporosis treatment. Although exercise is typically posited to prevent LBP, it may not be effective in preventing LBP associated with osteoporosis.

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  • Masahiko Inoue, Shuhei Kaneko
    Type: Original Article
    2020 Volume 63 Issue 4 Pages 326-334
    Published: 2020
    Released: November 24, 2020
    JOURNALS FREE ACCESS

    Background Effective training programs for managing people with challenging behaviors should be established in both welfare and education settings, as it is important that the support system for challenging behaviors covers the entire life span. For consistent support, it is necessary to understand the difficulties and needs of support staff in caring for people with challenging behaviors from infancy through adulthood. The purpose of this study was to gather data from welfare facility staff and special school teachers regarding their difficulties and needs for managing challenging behaviors, and to determine the differences between teachers and staff members.

    Methods We investigated Japanese special school teachers (n = 317) and the staff of welfare facilities for intellectual disabilities (n = 202) regarding their difficulties and needs. The questionnaire comprised 23 items related to the needs and difficulties in responding to challenging behaviors.

    Results Three factors were extracted from the analysis of the survey items: “Difficulty in coordination and information sharing with other organizations,” “Difficulty in the workplace,” and “Difficulty in support and response.” The overall trend was that welfare staff have more difficulties and needs than special school teachers.

    Conclusion It is necessary to emphasize not only how to respond to challenging behavior but also the importance of establishing a collaborative system within the workplace and with other organizations for staff training in light of their perceptions of working conditions.

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  • Wataru Miyauchi, Tomoyuki Matsunaga, Yuji Shishido, Kozo Miyatani, Tak ...
    Type: Original Article
    2020 Volume 63 Issue 4 Pages 335-342
    Published: 2020
    Released: November 24, 2020
    JOURNALS FREE ACCESS

    Background The purpose of this study was to compare postoperative complications and nutritional status between esophagogastrostomy and double-tract reconstruction in patients who underwent laparoscopic proximal gastrectomy, and assess the advantages of both surgical procedures.

    Methods Between 2010 and 2018, 47 cases underwent proximal gastrectomy with esophagogastrostomy (n = 23) or double-tract reconstruction (n = 24) at our institution for the treatment of clinical T1N0 adenocarcinoma located in the upper third of the stomach. Patient clinical characteristics, short-term outcomes, nutrition status, and skeletal muscle index were compared among the two groups.

    Results There was no significant difference between esophagogastrostomy and double-tract reconstruction in terms of operation time, blood loss, and length of postoperative hospital stay. Reflux symptoms and anastomotic stenosis were significantly higher in the esophagogastrostomy group compared with the double-tract reconstruction group (P < 0.001 and P = 0.004, respectively). There was no significant difference in anastomotic leakage, surgical site infection, and pancreatic fistula. For the nutritional status, the decrease rate of cholinesterase was significantly higher in the esophagogastrostomy group compared with the double-tract reconstruction group at 6 months (P = 0.008) There was no significant difference in the decrease rate of skeletal muscle mass index at 1 year after surgery.

    Conclusion Compared with esophagogastrostomy, double-tract reconstruction tends to have better short-term nutritional status and postoperative outcomes in terms of preventing the occurrence of gastroesophageal reflux and anastomosis stenosis. These findings suggest that double-tract reconstruction may be a useful method in laparoscopic proximal gastrectomy.

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  • Yuka Hirai, Shin-ichi Yoshioka
    Type: Original Article
    2020 Volume 63 Issue 4 Pages 343-352
    Published: 2020
    Released: November 24, 2020
    JOURNALS FREE ACCESS

    Background Emotional intelligence (EI) refers to a person’s ability to acknowledge the feelings of oneself and others, and to control those feelings so as to behave in a socially acceptable manner. We investigated the relationships between the characteristics of EI among nurse managers, and their perceptions of how much their position’s roles and responsibilities can be delegated to other staff members.

    Methods We surveyed 150 nurse managers working at 30 hospitals by using an anonymous questionnaire. The questionnaire consists of basic attributes, EI and work perception. The emotional intelligence scale (EQS) domain scores were analyzed by means of one-way repeated-measures analysis of variance. EQS scores were compared with corresponding averages for working adults in the instructions. The perceived importance of duties of nurse managers was compared between the resulting EQS scores ‘High’ and ‘Low’ groups.

    Results The analysis population consisted of 105 nurse managers. Their EQS scored higher in all three domains, and with the exception of Altruism for all factor scores than the average for working adults. The perceived importance of the typical duties of nurse managers were compared between the High and Low groups for each EQS domain. Significant differences were observed between nurse managers with High and Low Intrapersonal emotional quotient (EQ) on four tasks. No significant differences were found for any of the responsibilities when nurse managers with High and Low Interpersonal EQ or Situational EQ were compared.

    Conclusion The nurse managers’ average EQS scores were higher in all areas. The high scores that were exhibited by could be considered desirable qualities for nurse managers. It seemed nurse managers with high scores in intrapersonal EQ struck a good balance between placing importance on EI considerations like managing relationships and creating a comfortable workplace, and management and leadership behaviors like department management and operations and data management.

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  • Ertugrul Erken, Cansu Ulgen, Feyza Nur Sarisik, Neziha Erken, Ozkan Gu ...
    Type: Original Article
    2020 Volume 63 Issue 4 Pages 353-359
    Published: 2020
    Released: November 24, 2020
    [Advance publication] Released: October 10, 2020
    JOURNALS FREE ACCESS

    Background Hematological parameters like red cell distribution width (RDW) and mean platelet volume (MPV) were reported to be associated with inflammation, atherosclerosis, and chronic kidney disease (CKD) progression. In this study, we evaluated RDW and MPV along with clinical features in patients with advanced CKD. We also aimed to detect clues for causative relations concerning these parameters, renal function and comorbidities.

    Methods Stage 3-5 CKD patients (627 total) were included (mean age 63.1 years, 48.3% male). Patients with malignancies, cirrhosis, infections, severe anemia, and systemic inflammation were excluded. Patients were evaluated for clinical features and grouped for comparison using median RDW and MPV. Linear regression models were generated to predict potential influences on RDW and MPV.

    Results Mean estimated glomerular filtration rate (eGFR) was 27.3 mL/min/1.73m2. Mean Charlson Comorbidity Index (CCI) score was 5.83 ± 2.06. Patients with high RDW (n = 303) were older with higher CRP and CCI, they also had lower eGFR, hemoglobin, and albumin (P < 0.001 for all). Patients with low MPV (n = 311) had lower eGFR, and platelet counts (P = 0.015 and 0.017). eGFR was negatively correlated with RDW after adjusting for age, gender and comorbidities. In a further adjusted model RDW was associated with CRP, CCI, hemoglobin and albumin (P < 0.05 for all), not with eGFR. MPV was positively correlated with eGFR in our adjusted, and fully adjusted regression models (P = 0.003).

    Conclusion In this study, we found that high RDW is associated with comorbidity burden, anemia, and inflammatory status in patients with advanced CKD. Meanwhile, low MPV seems to be associated with worse renal function.

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  • Sultan Alan, Burcu Avcıbay Vurgec, Ayseren Cevik, Ebru Gozuyesil, Sule ...
    Type: Original Article
    2020 Volume 63 Issue 4 Pages 360-367
    Published: 2020
    Released: November 24, 2020
    [Advance publication] Released: November 06, 2020
    JOURNALS FREE ACCESS

    Background This cross-sectional study aims to identify the relationship between perceived stress, social support and sleep quality and the effects of the COVID-19 pandemic on pregnant women’s perceived stress, social support and sleep quality.

    Methods The target population of the study was pregnant women who applied to the Family Health Center. After the sample calculation was performed, the study involved 166 participants. The data, which were quantitative in nature, were collected through a web-based, online questionnaire administered within a determined period. Data collection tools included the Multidimensional Scale of Perceived Social Support (MSPSS), the Perceived Stress Scale (PSS), and the Pittsburgh Sleep Quality Index (PSQI).

    Results Of all the participating pregnant women, 88% reported to have poor sleep quality during the COVID-19 pandemic. A moderate, negative relationship was found between the Pittsburgh Sleep Quality Index and the Multidimensional Scale of Perceived Social Support and a weak, positive relationship with the Perceived Stress Scale. While statistically significant differences were found between the pregnant women’s perceived stress according to their psychological perceptions and perceptions about daily life (P < 0.05), no significant differences were found between the perceived social support level and sleep quality index.

    Conclusion It was considered that pregnant women’s perceived social support levels, sleep quality, and perceived stress levels were affected during the COVID-19 pandemic.

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Patient Report
  • Fumi Shoji, Nobuo Ohta, Kazuhiro Murakami, Naoya Noguchi, Takahiro Suz ...
    Type: Patient Report
    2020 Volume 63 Issue 4 Pages 368-371
    Published: 2020
    Released: November 24, 2020
    [Advance publication] Released: October 15, 2020
    JOURNALS FREE ACCESS

    A 79-year-old Japanese woman presented with a rare case of metastatic renal cell carcinoma to the left sphenoid sinus with left nasal bleeding. She had previously had right radical nephrectomy for renal cell carcinoma at the age of 64 years and brain and spinal cord infarction at 74 years. Endoscopic examination revealed no mass in the nasal cavity. CT and MRI revealed a tumor in the left sphenoid sinus. The size of the tumor increased gradually from 12 to 15 years after the radical nephrectomy. Complete resection with endoscopic surgery was performed without preoperative embolization. The tumor cells had clear cytoplasm and were arranged in a trabecular pattern lined by a layer of endothelial cells. These findings were identical to the pathological findings of the surgical specimen of the renal cell carcinoma from 15 years previous. A pathological diagnosis of metastatic renal cell carcinoma of clear cell type (grade 1) was made. PET-CT demonstrated no metastasis. The patient’s condition was successfully managed with excision of the tumor, and she remains well with no evidence of recurrence and metastasis 36 months after treatment. Metastatic renal cell carcinoma to the sphenoid sinus is rare, but it might be considered in the differential diagnosis of masses in the paranasal sinus even long after initial treatment of renal cancer.

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  • Yohei Takeda, Takumi Onoyama, Yuri Sakamoto, Shiho Kawahara, Wataru Ha ...
    Type: Patient Report
    2020 Volume 63 Issue 4 Pages 372-375
    Published: 2020
    Released: November 24, 2020
    [Advance publication] Released: October 29, 2020
    JOURNALS FREE ACCESS

    We report the case of a 68-year-old woman who had abdominal pain and slightly elevated biliary enzymes. Magnetic resonance cholangiopancreatography detected biliary duct stenosis, while contrast-enhanced magnetic resonance imaging showed that the right hepatic artery transversed the extrahepatic bile duct at the level of bifurcation of the bile duct. We performed endoscopic retrograde cholangiopancreatography and peroral cholangioscopy with the SpyGlass DS™ system. Then, mild extrinsic pulsatile compression of the bile duct was observed at stricture level with an intact bile duct epithelium. Therefore, she was diagnosed with right hepatic artery syndrome and underwent cholecystectomy. Six months later, her biliary enzyme level decreased, and the recurrence of pain gradually decreased.

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  • Hiroaki Yazama, Kensaku Hasegawa, Masamichi Kurosaki, Yasuomi Kunimoto ...
    Type: Patient Report
    2020 Volume 63 Issue 4 Pages 376-378
    Published: 2020
    Released: November 24, 2020
    JOURNALS FREE ACCESS

    A 75-year-old female patient presented with a suspected recurrence of a clival chordoma. The tumor was resected using the infratemporal fossa type B and anterior petrosal approach with the help of a neurosurgeon. During cauterization of the trigeminal nerve, the patient developed cardiac arrest for approximately 10 seconds because of the trigemino-cardiac reflex (TCR). After several sternal compressions, there was return of spontaneous circulation. The operation was resumed after the circulatory dynamics stabilized. Subsequently, the surgery was completed with partial resection of the tumor without the recurrence of cardiac arrest. The pathological diagnosis was chondrosarcoma, and postoperative treatment with radiotherapy was started. Stimulation of the sensory branches of the trigeminal nerve induces TCR. There are reports of TCR developing in approximately 10% of skull base surgery cases in the absence of atropine administration. We report a rare case of TCR during the surgical procedure for the treatment of a skull base chondrosarcoma.

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  • Kenkichiro Taira, Kazunori Fujiwara, Takahiro Fukuhara, Tsuyoshi Moris ...
    Type: Patient Report
    2020 Volume 63 Issue 4 Pages 379-384
    Published: 2020
    Released: November 24, 2020
    JOURNALS FREE ACCESS

    Cetuximab is an effective drug used to treat patients with recurrent or metastatic head and neck squamous cell carcinoma. Skin toxicities such as paronychia and skin exsiccation are common adverse events caused by cetuximab. Skin toxicities may cause significant physical and psychosocial discomfort. The goal of managing skin toxicities is to minimize the detrimental effects on quality of life and continue the treatment. In one patient, skin toxicities became severe, up to grade 2, during treatment. The pain induced by paronychia and skin exsiccation made daily life difficult. Ten days after starting Unseiin, symptoms and finger findings resolved significantly. The patient could resume daily activities. No adverse effects induced by Unseiin were observed during treatment. Unseiin was effective on paronychia and skin exsiccation in this case and may contribute to successful treatment of skin toxicities induced by cetuximab.

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