REVIEW ARTICLES
A systematic review assessing the effectiveness of hand
therapy programmes in adults with burns
using the International Classification of Functioning,
Disability and Health framework
Akihito Yoshida, Michiro Yamamoto, Cecilia W. P. Li-Tsang, Katsuyuki Iwatsuki and Hitoshi Hirata
pg(s) 689–704
<Abstract> - < PDF >
This systematic review aimed to confirm the effectiveness of hand therapy programmes using the
International Classification of Functioning, Disability and Health framework for each of the three phases
of the wound healing process in adults with burns. A systematic review was conducted to determine
the efficacy of different hand therapy programmes in the management of burnt hands. Two independent
reviewers conducted a literature search using the PubMed and Cumulative Index to Nursing and Allied
Health Literature databases for original articles reporting effectiveness of hand therapy programmes for
adults with burns. Only randomized and non-randomized controlled trials were selected using the Mixed
Methods Appraisal Tool. Demographic and clinical data including medical history, burn depth, and hand
therapy programme were extracted. Outcome measures were reviewed based on the International Classification of Functioning, Disability and Health framework for acute, convalescence, and chronic phases
of rehabilitation. Sixteen articles and 15 hand therapy programmes were identified, which included studies
showing improvements in different parameters in the framework. In the acute and convalescence phases,
improvements were found in health condition, body functions and structures, activities, and participation.
In the chronic phase, improvements were shown only in body functions and structures. Environmental
factors in the framework were not reported for all the phases. This review demonstrated the efficacy of
hand therapy programmes in adults with burns in terms of the health condition, body function, activities,
and participation during acute and convalescence phases but only the body function in the chronic phase.
Can on-top plasty for atypical radial polydactyly realize
a functional reconstruction corresponding to appearance?
Hidemasa Yoneda, Tatsuya Hara, Katsuyuki Iwatsuki, Michiro Yamamoto, Masahiro Tatebe and Hitoshi Hirata
pg(s) 705–715
<Abstract> - < PDF >
On-top plasty may be the best option for reconstructing atypical radial polydactyly, consisting of a
developed distal portion in one thumb and a developed proximal portion in the other thumb. However, it
is unclear if patients can gain thumb function corresponding to the reconstructed appearance. We performed
a retrospective bibliographic review to summarize the current literature and present our department’s on-top
plasty experiences. Over the last ten years, our department performed three on-top plasty radial polydactyly
reconstructions. We surveyed the appearance and use of the reconstructed thumb and the patient’s satisfaction level during postoperative follow-up. We also retrieved published case reports describing on-top plasty
for polydactyly reconstruction to compare with our cases. Our patients had an acceptable thumb appearance
and were satisfied with the gained function of the thumb. However, two patients required revision surgery.
We found 11 studies in the literature describing on-top plasty for polydactyly treatment, four of which
reported a limited range of thumb motion, but no patient or their family complained about the result.
Most patients who undergo on-top plasty for radial polydactyly can expect a fair to good appearance after
surgery. Although instability or limitation of the joint arc is possible, the reconstruction satisfies patients
regarding function and appearance.
ORIGINAL PAPERS
Circumumbilical incision for neonatal abdominal surgery:
additional skin incision when there is difficulty
in manipulating the intestine
Yoichi Nakagawa, Akinari Hinoki, Hizuru Amano, Hiroo Uchida,
Chiyoe Shirota, Takahisa Tainaka, Wataru Sumida, Kazuki Yokota,
Satoshi Makita, Masamune Okamoto, Aitaro Takimoto,
Akihiro Yasui, Shunya Takada and Daiki Kato
pg(s) 716–722
<Abstract> - < PDF >
This study aimed to evaluate the safety and effectiveness of circumumbilical incision (CUI) for neonates
requiring intestinal anastomosis. Seventy neonates requiring intestinal anastomosis at our institution between
2003 and 2020 were included in this retrospective case-control study. Patients were classified into the CUI
(25 patients: 36%) and transverse incision (TI) groups (45 patients: 64%). Postoperative complications and
surgical outcomes were compared between the two groups. Intestinal perforation at the non-anastomotic
site occurred significantly more often in the CUI group than in the TI group (3 patients: 12%, and 0
patients: 0%, respectively (p = 0.042)). There were no between-group differences regarding anastomotic
leakages, anastomotic strictures, time to enteral feeding, operative time, and blood loss. Neonatal intestinal
surgery employing CUI might be associated with increased intestinal perforation at the non-anastomotic
site. Hesitating to enlarge the skin incision to maintain favorable cosmetic outcomes might cause severe
injury to the delicate neonatal intestine during the surgical procedure owing to the restricted surgical field.
When performing CUI, we suggest that the skin incision should be extended without hesitation whenever
there is difficulty in manipulating the intestine.
Prognostic efficacy of a post-discharge visiting program
for patients with heart failure
Kenichiro Yasuda, Mitsutoshi Oguri, Takeshi Katagiri, Shiou Ohguchi, Kunihiko Takahara, Hiroshi Takahashi, Hideki Ishii and Toyoaki Murohara
pg(s) 723–732
<Abstract> - < PDF >
We aimed to investigate the impact of post-discharge scheduled hospital visits on readmission due to
heart failure (HF). In this retrospective study, a total of 245 patients (N = 101 in the scheduled hospital
visit group, N = 144 in the non-scheduled hospital visit group) who were alive with free from readmission
due to HF for 90 days after discharge were enrolled. The patients had been hospitalized with acute
decompensated HF between August 2018 and July 2019. Scheduled hospital visits were recommended 90
days after the patients had been discharged. After checking their self-care adherence, nurse-led self-care
maintenance and monitoring were provided. To determine the effectiveness of the scheduled hospital visits,
we conducted landmark analyses divided into two periods: Scheduled visits within 180 days, and after
180 days. The readmission rate due to HF within 180 days was lower in the scheduled visit group. In
the landmark analysis, the 1-year incidence rate of readmission was significantly lower in patients with a
scheduled hospital visit than in those without, in the period within 180 days (2.0% vs 9.0%, P = 0.029)
but not after 180 days. After adjusting for age and estimated glomerular filtration rate as confounders,
scheduled hospital visits tended to reduce readmission due to HF (P = 0.060); however, readmission was
significantly reduced in the period within 180 days (P = 0.007). In conclusion, scheduled hospital visits
at 90 days after discharge may be beneficial in delaying readmission due to HF by reducing risk of
readmission during the early post-visit period.
Analysis of immunologic comorbidities in ulcerative colitis
patients: a tool to prevent exacerbations
in ulcerative colitis cases
Miguel Ricardo Rodríguez Meza, Masanao Nakamura, Takeshi Yamamura, Keiko Maeda, Tsunaki Sawada, Eri Ishikawa, Naomi Kakushima, Kazuhiro Furukawa, Tadashi Iida, Yasuyuki Mizutani, Takuya Ishikawa, Eizaburo Ohno, Takashi Honda, Hiroki Kawashima and Masatoshi Ishigami
pg(s) 733–745
<Abstract> - < PDF >
There have been previous studies, especially in Western countries and even in some areas in Asia, about
extra-intestinal manifestations (EIMs) and its link with the outcome of inflammatory bowel disease (IBD),
which includes Crohn’s disease (CD), and ulcerative colitis (UC). This link is crucial when discussing
a patient’s prognosis and important when dealing with UC management. The aim of this study was to
clarify the most common comorbidities associated with UC, emphasizing immunologic comorbidities in
Japan. This study was a retrospective analysis performed at Nagoya University Hospital. The data collection
started in March, 2019, and continued for two years. We retrieved the medical records of 105 patients
with UC diagnosis, from which the data of 176 EIMs were extracted and analyzed. Results showed
that EIMs with UC in the active phase accounted for 43.7% of total EIMs. Twenty-six patients with
immune-mediated inflammatory disease frequently had an active phase (odds ratio [OR] 3.84, 99% CI,
1.44–10.27). Comorbidities showing an active manifestation of symptoms and UC in the active phase were
significantly correlated in patients with immunological comorbidities, such as peripheral arthritis (r = 0.97,
p < 0.01) and rheumatoid arthritis (RA) (r = 0.99, p < 0.01), as well as in patients with primary sclerosis
cholangitis (PSC) (r = 0.98, p < 0.01). In conclusion, this analysis suggests the importance of having full
comprehension of how immunological comorbidities affect the natural development of UC, which is of
vital importance to prevent further UC complications and properly adjust the management of the disease.
A single-center, single-arm, prospective, open-label trial to
evaluate the efficacy and safety of percutaneous sclerotherapy
with polidocanol for painful venous malformations
(SCIRO-2001): study protocol
Mayu Uka, Jun Sakurai, Yusuke Matsui, Toshihiro Iguchi, Koji Tomita, Noriyuki Umakoshi, Kazuaki Munetomo, Toshiharu Mitsuhashi, Hideo Gobara and Takao Hiraki
pg(s) 746–751
<Abstract> - < PDF >
This single-center, single-arm, prospective open-label trial is being conducted to evaluate the short-term
efficacy and safety of percutaneous sclerotherapy with polidocanol foam for painful venous malformations.
This study will include patients who were clinically diagnosed with venous malformation by using ultrasound
and/or magnetic resonance imaging, and whose pain persisted even after treatment with medications.
Written informed consent for sclerotherapy will be obtained from all patients. The institutional review
board approved this prospective study protocol. The primary endpoint is pain relief at three months after
sclerotherapy. Local pain related to venous malformation will be evaluated using a numeric rating scale.
Patient recruitment commenced in December of 2020. Enrolment of 13 patients is planned over a 3-year
recruitment period. Herein, we describe the details of the clinical trial protocol.
Incidence rate of chronic pain after 1.5–2 years of
thoracotomy between paravertebral block versus
epidural block: a cohort study
Reona Mori, Takahiro Tamura, Shuichi Yokota, Saya Usami, Masahiko Ando, Yoko Kubo and Kimitoshi Nishiwaki
pg(s) 752–761
<Abstract> - < PDF >
Paravertebral block and epidural block are frequently employed for post-thoracotomy pain relief. It is
not clear which postoperative analgesia method is effective for the chronic pain after the postoperative
long term progress. Our hypothesis was that paravertebral block would be more effective than epidural
block for chronic pain 1.5–2 years after thoracotomy. A cohort study investigating postoperative pain was
performed in lung cancer patients undergoing thoracotomy between the ages of 20–80 year-old, employed
for another randomized controlled trial. In previously study, the patients were randomly allocated into
either the epidural block or paravertebral block group (n = 36/group). Patients in each group received the
respective block placement with continuous 0.2% ropivacaine infusion at 5 ml/h. The patients completed
a telephone observational survey using the EQ-5D-5L at 1.5–2 years. Forty-eight patients, 23 in the
epidural block group and 25 in the paravertebral block group, were included in the final analysis. Quality
of life scores at 1.5–2 postoperative years was similar in both groups. Mean scores ± standard deviation
and 95% confidence interval were 0.899 ± 0.081 (0.705–0.938) in the epidural block group and 0.905 ±
0.079 (0.713–0.938) in the paravertebral block group, respectively, p = 0.81. The incidence rate of chronic
postsurgical pain was eight patients; four in the epidural block group (17.4%) and four in the paravertebral
block group (16.0%). There was no difference in incidence rate of long-term chronic postsurgical pain at
1.5–2 years after thoracotomy between the both groups. Our result will be used for further study protocols.
Efficacy of comparing coil behavior and distribution
using the silicone aneurysm model:
difference of coil distribution in the early filling stage
Shunsaku Goto, Takashi Izumi, Masahiro Nishihori, Yoshio Araki,
Kinya Yokoyama, Kenji Uda and Ryuta Saito
pg(s) 762–771
<Abstract> - < PDF >
This study sought to establish an experimental aneurysm model of visualizing coil insertion using
radiolucent nylon coils. Moreover, this study aimed to clarify the characteristics and differences of each
coil and use them clinically as indices of coil selection. The coil insertion test was performed on the
10 mm spherical silicone aneurysm model filled to a nylon coil volume embolization ratio of 11.8%.
Five types of coil were randomly tested six times, and the distribution of the coils was analyzed by
fluoroscopy imaging. Indices of “Area (mm2),” “Feret’s diameter (mm),” and “Circularity” were calculated
from the fluoroscopic images. Among the indices, only “Area” showed a significant difference between
coils (p = 0.002). On multivariate analysis, “Area” of the ED Infini was larger than those of Target XL soft
and Galaxy G3 (p = 0.018 and 0.026, respectively). Furthermore, the area of the 360 soft was larger than
that of G3 (p = 0.049). Analysis of the correlation between these values and the coil configuration showed
that “Area” was negatively correlated with the stock-wire diameter (r = −0.50; p = 0.004) and primary coil
configuration (r = −0.65; p < 0.001). When inserting the coils in the early stage, although the difference
between each coil is relatively difficult to obtain, knowledge on the proper use of the coils with differences
in characteristics can help in selecting the coil most appropriate for the conditions.
Examination of the effectiveness of bedside nasojejunal tube
placement using a portable imaging device
with a flat panel detector
Naohiro Takamoto, Shinya Takazawa, Yuki Yoshida, Tamotsu Sasaki and Akira Nishi
pg(s) 772–781
<Abstract> - < PDF >
Transporting pediatric patients with severe cardiovascular complications to the fluoroscopy room can
be difficult. Therefore, we started using a portable imaging device with a flat panel detector (FPD) for
nasojejunal tube (NJT) placement. The purpose of this study was to investigate the differences in length
of time of NJT placement and dosage of radiation exposure using a portable imaging device with FPD
versus fluoroscopy. Pediatric patients who underwent NJT placement between April 2016 and December
2018 were identified retrospectively from the clinical records. The age, sex, body weight, and height of
each child at the time of the procedure as well as the procedure time, outcomes of the procedure, and
dosage of radiation exposure was compared between the two groups. In 76 cases of NJT placement (41
patients), there was no significant difference in the success rate of NJT placement between the FPD (90%)
and fluoroscopy groups (95%). However, the NJT placement time was significantly longer in the FPD
group than in the fluoroscopy group (488 s vs 291 s). According to our calculations, the radiation dosage
was lower in the FPD group than in the fluoroscopy group (136 μGy per procedure vs 2819 μGy per
procedure). These results suggest that NJT placement using a portable imaging device with an FPD can
be an effective method for children who are difficult to transport with an equal success rate and lower
dosage of radiation exposure compared with conventional fluoroscopy.
Sex differences in blood pressure and inactive limb blood
flow responses during dynamic leg exercise
with increased inspiratory muscle work
Kana Shiozawa, Kaori Shimizu, Mitsuru Saito, Koji Ishida, Sahiro Mizuno and Keisho Katayama
pg(s) 782–798
<Abstract> - < PDF >
We hypothesized that, compared with young males, young females have a smaller decrease in blood
flow to the inactive limb, accompanied by a smaller increase in arterial blood pressure, during dynamic
exercise with increased inspiratory muscle work. Young males and females performed dynamic knee-extension
and -flexion exercises for 10 min (spontaneous breathing for 5 min and voluntary hyperpnoea
with or without inspiratory resistance for 5 min). Mean arterial blood pressure (MAP) and mean blood
flow (MBF) in the brachial artery were continuously measured by means of finger photoplethysmography
and Doppler ultrasound, respectively. No sex differences were found in the ΔMAP and ΔMBF (Δ: from
baseline) during exercise without inspiratory resistance. In contrast, the ΔMAP during exercise with
inspiratory resistive breathing was greater (P < 0.05) in males (+31.3 ± 2.1 mmHg, mean ± SE) than
females (+18.9 ± 3.2 mmHg). The MBF during exercise with inspiratory resistance did not change in males
(–4.4 ± 10.6 mL/min), whereas it significantly increased in females (+25.2 ± 15.4 mL/min). These results
suggest that an attenuated inspiratory muscle-induced metaboreflex in young females affects blood flow
distribution during submaximal dynamic leg exercise.
Locomotive syndrome in rheumatoid arthritis patients
during the COVID-19 pandemic
Yasumori Sobue, Mochihito Suzuki, Yoshifumi Ohashi, Hiroshi Koshima, Nobuyuki Okui, Koji Funahashi, Hisato Ishikawa, Hidenori Inoue, Masayo Kojima, Shuji Asai, Kenya Terabe, Kyosuke Hattori, Kenji Kishimoto, Nobunori Takahashi, Shiro Imagama and Toshihisa Kojima
pg(s) 799–812
<Abstract> - < PDF >
This study aimed to longitudinally evaluate the development of locomotive syndrome (LS) in rheumatoid
arthritis (RA) patients during the COVID-19 pandemic using the 25-question Geriatric Locomotive Function
Scale (GLFS-25). Subjects were 286 RA patients (female, 70.6%; mean age, 64.2 years) who had GLFS-25
and Clinical Disease Activity Index (CDAI) data available for a 1-year period during the COVID-19 pandemic
and who did not have LS at baseline. Associations between subject characteristics and development
of LS were determined using logistic regression analysis. Among the 286 patients, 38 (13.3%, LS group)
developed LS at 1 year after baseline. In the LS group, scores of the GLFS-25 categories “GLFS-5” and
“Social activities” were significantly increased at 1 year relative to baseline. GLFS-5 is a quick 5-item
version of the GLFS-25, including questions regarding the difficulty of going up and down stairs, walking
briskly, distance able to walk without rest, difficulty carrying objects weighing 2 kg, and ability to carry out
load-bearing tasks and housework. A significant correlation was also observed between changes in “Social
activities” and that of “GLFS-5.” Multivariable logistic regression analysis revealed that the development of
LS was significantly associated with BMI (OR: 1.11 [95% confidence interval (CI): 1.00–1.22]) and CDAI
(OR: 1.08 [95%CI: 1.00–1.16]) at baseline. Adequate exercise and tight control of RA disease activity are
important for preventing the development of LS in view of restrictions on going out imposed during the
COVID-19 pandemic. GLFS-5 is useful for evaluating the physical function of RA patients.
The role of nursing members in research ethics committees
in Japan
Yuki Sakaida, Katsumasa Ota and Chikako Sone
pg(s) 813–824
<Abstract> - < PDF >
The International Council of Nurses (2012) and the Council for International Organizations of Medical
Sciences (2016) determined and published ethical standards relevant to nursing researchers and practitioners;
based on these standards, nurses are expected to participate in committees where decisions on ethical issues
are made. While clinical practitioners and nursing educators actively serve on research ethics committees,
their precise role in these platforms has yet to be elucidated. In this study, medical, humanities/social
science, lay, and nursing members in research ethics committees across Japan were invited to participate
in a semi-structured interview; data were analyzed through a qualitative analysis method. Specifically, we
interviewed 23 research ethics committee members in Japan to clarify the role of nursing members in
the committee. Our qualitative analysis yielded six themes: share perspectives and experiences in nursing,
protect research participants, evaluate the research design, represent the voice of research participants,
confirm the informed consent documents and ascertain research participants’ free will. The analyses revealed
a slight difference between what other committee members expected of the role of nursing members and
nursing members’ recognition of their own role. Nursing members make an important and independent
contribution to ethics committees on deliberations and decision-making regarding research ethics. Within
the context of research ethics committees, member selection and training are essential issues, and this
study contributes to the literature by showing how these topics relate to the role of the research ethics
committees and of their members.
The effects of ustekinumab on small intestinal lesions
and stenotic lesions
Hirotaka Wada, Kentaro Murate, Masanao Nakamura, Kazuhiro Furukawa, Naomi Kakushima, Takeshi Yamamura, Keiko Maeda, Tsunaki Sawada, Eri Ishikawa, Takuya Ishikawa, Eizaburo Ohno, Takashi Honda, Hiroki Kawashima, Goro Nakayama, Norifumi Hattori, Shinichi Umeda and Masatoshi Ishigami
pg(s) 825–838
<Abstract> - < PDF >
Crohn’s disease patients suffer from symptoms originating from small bowel lesions, including
strictures. As many of these patients also have a potential risk of surgery, it is important to consider
various therapeutic strategies for small bowel lesions. We retrospectively analyzed the therapeutic effects
of ustekinumab, interleukin-12 and -23 blocker, for small intestinal lesions and intestinal stenosis in order
to contribute to the optimal management of Crohn’s disease. Patients who underwent total colonoscopy
or small bowel endoscopy before and after the introduction of ustekinumab were enrolled in this study.
The colonoscopy findings were evaluated by the simple endoscopic score for Crohn’s disease, and small
bowel endoscopy findings were evaluated using the modified simple endoscopic score for Crohn’s disease.
Endoscopic scores were compared before and after the introduction of ustekinumab and between the
responders and non-responders to ustekinumab. Responders were defined as those whose Crohn’s disease
activity index score at 24 weeks fell below 150 points, or those whose score decreased by more than 100
points from the pre-induction level. A total of 50 patients were enrolled in the study, and the number of
responders was 35. Pre-induction simple endoscopic scores were lower for responders, but no significant
difference was observed in the modified simple endoscopic scores. The total decrease in the endoscopic
score was significantly higher in the responders for both the small and large intestine. Use of ustekinumab
as a first-line treatment for patients with small bowel lesions or stricture-prone lesions may be a new
treatment consideration in the future.
Evaluation of the serum zinc concentration in male
infertility patients: an analysis of 2010 cases
Hatsuki Hibi, Mikiko Tokoro, Miho Sugie, Tadashi Ohori, Megumi Sonohara, Noritaka Fukunaga and Yoshimasa Asada
pg(s) 839–847
<Abstract> - < PDF >
Zinc is an important trace element, and its importance for male infertility has been reported. The aim
of the study was to assess whether the serum zinc concentrations were related to semen quality in male
infertility patients. In 2010 subjects who consulted at our male infertility clinic between November 2018
and May 2021, serum zinc concentrations were assessed along with age, sperm concentration, sperm
motility, endocrine panel, and body mass index (BMI). A normal zinc concentration was observed in 1069
(53.2%), subclinical deficiency in 845 (42.0%), and deficiency in 79 subjects (3.9%). On the other hand,
high a zinc level was observed in only 17 subjects (0.9%). The serum zinc concentration did not relate
with age, sperm concentration, sperm motility, luteinizing hormone (LH), follicle stimulating hormone
(FSH), testosterone, and body mass index (BMI). However, normozoospermic subjects showed significantly
higher zinc concentrations than among azoospermic (included non-obstructive; NOA and obstructive; OA)
and cryptozoospermic patients. Furthermore, the zinc concentration was lower in NOA subjects when
comparing to oligozoospermia and/or asthenozoospermia. An association between zinc concentration and
semen analysis remained unclear. This study was cross-sectional and retrospective, however, this is a largest
investigation of the zinc concentration during reproductive life span in Japan. Further accumulation of cases
are required to further examine the potential relationship between zinc concentration and semen quality.
Editors' Choice
Advantages of gasless single-port transumbilical
extracorporeal laparoscopic-assisted appendectomy
in the treatment of uncomplicated acute appendicitis
in children in China:
a multi-institutional retrospective study
Jian-Hua He, Yi-Peng Han, Tian Hang, Zhi-Cai Lin, Shi-Jiao Lu, Jian-Feng Wang and Zhi-Hua Hong
pg(s) 848–856
<Abstract> - < PDF >
Gasless transumbilical extracorporeal laparoscopic-assisted appendectomy is an approach used increasingly
to treat uncomplicated acute appendicitis (UAA). However, there is limited information on its clinical
effects and value in the Chinese pediatric population. This study retrospectively reviewed patients with
UAA treated in two pediatric institutions from January 2018 through October 2021. Enrolled patients were
divided into two groups by operative technique: gasless transumbilical laparoscopic-assisted appendectomy
(gasless-TULAA, n=142) and conventional laparoscopic appendectomy (CLA, three-port, n=126). The
perioperative clinical data, including age, sex, body mass index (BMI), operation time, time to postoperative
ambulation, time to first postoperative exhaust, hospitalization expenses, and postoperative complications
(incision infection, intestinal obstruction, and residual abdominal abscess), were compared between the
two groups. Operations in both groups were successfully conducted without converting to open surgery.
There were no significant differences (p > 0.05) in age and BMI in the two groups. Compared with CLA,
gasless-TULAA showed significantly shorter operation time, earlier postoperative ambulation, shorter
postoperative exhaust time, and lower hospital cost (p < 0.001). All patients were followed for 3 months,
and postoperative complications were observed in three patients: two patients in the gasless-TULAA group
(one with surgical wound effusion, one with intra-abdominal abscess), and one patient in the CLA group
(surgical wound infection); there was no significant difference between the groups. Notably, 38 patients
initially treated by gasless-TULAA were converted because of intraoperative factors. The gasless-TULAA
technique had potential benefits: shortened operation time, better outcome, and greater cost-efficiency. These
superiorities are worthy of future large-scale prospective study.
SHORT COMMUNICATION
Effect of illness uncertainty on alanine transaminase levels
and aspartate aminotransferase levels in patients
with nonalcoholic fatty liver disease
Naoki Ozawa, Kazuki Sato, Ayumi Sugimura, Shigeyoshi Maki,
Taku Tanaka, Kenta Yamamoto, Takanori Ito, Yoji Ishizu, Teiji Kuzuya, Takashi Honda, Masatoshi Ishigami, Mitsuhiro Fujishiro, Tetsuya Ishikawa and Shoko Ando
pg(s) 857–864
<Abstract> - < PDF >
Patients with nonalcoholic fatty liver disease (NAFLD) have illness uncertainty. The purpose of this
longitudinal study was to investigate the effect of the degree of illness uncertainty in patients with NAFLD
on liver function values. We conducted a questionnaire survey and collected blood samples from outpatients
with NAFLD. The items in the questionnaire were measured for illness uncertainty using the Japanese
version of the Mishel Uncertainty in Illness Scale-Community (MUIS-C). Blood samples were collected
at baseline and after 1 year. We divided the patients into two groups: one with high illness uncertainty
and the other with low illness uncertainty. We then compared changes in alanine transaminase (ALT)
and aspartate aminotransferase (AST) levels over time from baseline using multiple regression analysis.
This study analyzed 148 patients with NAFLD; 75 were male and 73 were female, with a mean age of
58.4 ± 12.3 years. The group with higher illness uncertainty had significantly higher ALT and AST levels
at 1 year (β = .185 and .183, respectively) than the group with lower illness uncertainty. High illness
uncertainty in patients with NAFLD can lead to higher ALT and AST levels. Healthcare providers must
focus on reducing illness uncertainty in patients with NAFLD.
CASE REPORTS
A case of undifferentiated carcinoma of the bladder
treated by combination therapy of surgery, local radiation,
and immune checkpoint inhibitors
Wataru Nakane, Yushi Naito, Koya Morishita, Kazuna Matsuo, Shohei Ishida and Yoshihisa Matsukawa
pg(s) 865–870
<Abstract> - < PDF >
Undifferentiated carcinoma of the bladder is a rare malignancy with a poor prognosis. We present the
case of an 81-year-old woman complaining of bladder irritation. Computed tomography (CT) and magnetic
resonance imaging (MRI) revealed a bulky bladder tumor, which was diagnosed as cT4aN0M0. A transurethral
resection of the bladder tumor revealed pT2 or higher urothelial carcinoma. The patient underwent
total cystectomy with an ileal conduit diversion. Histological examination revealed a primary undifferentiated
bladder carcinoma with a sarcoma component, pT3aN0M0. Postoperative adjuvant chemotherapy with
gemcitabine plus carboplatin was administered. However, this regimen was discontinued after one course
due to significant myelosuppression. Four months after total cystectomy, a pelvic tumor with suspected
local recurrence was detected on CT. The patient was diagnosed with recurrent undifferentiated carcinoma
with a sarcoma component by a transperineal ultrasound-guided biopsy. Local radiation therapy and immunotherapy
with immune checkpoint inhibitors were prescribed. After three courses of immunotherapy with
pembrolizumab, the primary tumor disappeared. Upon continuing immune checkpoint inhibitor treatment,
the patient has maintained a complete response without tumor recurrence in the following six months.
PTPN11 c.853T>C (p.Phe285Leu) mutation
in Noonan syndrome with chylothorax
Daisuke Watanabe, Yohei Hasebe, Shin Kasai, Tamao Shinohara, Yuki Maebayashi, Nobuyuki Katsumata, Atsushi Nemoto and Atsushi Naitoh
pg(s) 871–876
<Abstract> - < PDF >
Recent advances in molecular and genetic approaches have identified a number of genes responsible
for Noonan syndrome (NS). However, there has been limited analysis of the genotype-phenotype correlation
of NS patients. Here, we report the case of a Japanese patient with NS possessing a c.853T>C
(p.Phe285Leu) mutation in the gene encoding protein-tyrosine phosphatase, nonreceptor-type 11 (PTPN11).
To clarify genotype-phenotype correlations, the accumulation of data on the clinical course of patients with
genetically confirmed NS is important. We summarized the cases with mutations at PTPN11 position 285
and found that c854T>C (p.Phe285Ser) is the most common mutation at this position. In these reports,
although little is mentioned about the genotype-phenotype correlation, two patients with NS possessing
the PTPN11 c854T>C (p.Phe285Ser) mutation accompanied by chylothorax are described. There is still a
lack of detailed information about the phenotype associated with the c.853T>C (p.Phe285Leu) mutation
observed in this case. More research is needed to better understand these cases.
Posterior ischemic optic neuropathy following postoperative
bleeding and internal jugular vein compression
Keishi Kohyama, Hisakazu Kato, Masashi Kuroki, Hiroshi Okuda, Hirofumi Shibata, Toshimitsu Ohashi and Takenori Ogawa
pg(s) 877–883
<Abstract> - < PDF >
Perioperative blindness, especially posterior ischemic optic neuropathy (PION), is an uncommon but
potentially devastating complication. We report a case of a 65-year-old male patient who underwent laryngopharyngectomy,
bilateral neck dissection, and free jejunum flap reconstruction, but then experienced PION
in his right eye following postoperative bleeding and bilateral internal jugular veins (IJVs) compression.
Despite systemic corticosteroid therapy, his visual recovery prognosis was poor. The specific mechanism
responsible for PION remains unclear, and no therapy has been shown to improve this condition. As such,
prevention of perioperative PION remains the only available strategy. Surgeons should be aware of this
rare potential complication and its risk factors and strive to avoid it. As postoperative bleeding and IJV
compression are one of important risk factors for PION, avoiding these are critical.
Abnormal foreshortening of a Flow Re-Direction
Endoluminal Device caused by in-stent thrombosis
immediately after deployment
Takafumi Otsuka, Takashi Izumi, Masahiro Nishihori, Tetsuya Tsukada, Shunsaku Goto, Mizuka Ikezawa, Naoki Kato, Mizuki Nakano, Kenji Uda, Kinya Yokoyama, Yoshio Araki and Ryuta Saito
pg(s) 884–889
<Abstract> - < PDF >
Thromboembolic complications are a concern in the treatment of cerebral aneurysms using a flow
diverter. In this study, we report a case of abnormal foreshortening of a Flow Re-Direction Endoluminal
Device (FRED) caused by in-stent thrombosis immediately after its deployment. A 72-year-old woman had
a large cavernous carotid aneurysm, which caused ptosis and diplopia. FRED deployment was planned,
and dual antiplatelet therapy was initiated 2 weeks before the procedure. Under systemic heparinization,
FRED was deployed with local compaction over the aneurysm orifice. Cone-beam computed tomography
subsequently revealed slightly poor wall apposition at the proximal side. While the balloon catheter was
prepared for angioplasty, the stent became abnormally foreshortened, the proximal side slipped into the
aneurysm, and the internal carotid artery became occluded. FRED was removed using a snare wire, and
recanalization was obtained. The lumen of the removed FRED was filled with thrombus. The antiplatelet
therapy was changed to triple regimen, and a Pipeline Flex embolization device was placed 1 month
later. At that time, no thromboembolic complications were noted. It was considered that thrombotic
occlusion was followed by foreshortening of FRED on the distal side because of antegrade blood flow.
Multiple factors, such as increased mesh density by locally compacted stent deployment, slightly poor
wall apposition, clopidogrel resistance, and the dual-layer structure of FRED, may have been involved in
thrombus formation.
Editors' Choice
Surgical removal of an intracranially migrated acupuncture
needle: a case report and literature review
Daishiro Abe, Yoshiki Hanaoka, Kentaro Kobayashi, Takafumi Kiuchi, Tomofumi Watanabe, Sumio Kobayashi, Toshihiro Ogiwara and Tetsuyoshi Horiuchi
pg(s) 890–899
<Abstract> - < PDF >
Acupuncture is a popular alternative therapy worldwide and is generally safe. However, serious
acupuncture-related complications can occur. Intracranial complications caused by a migrated acupuncture
needle are extremely rare. Herein we report a surgical case of intracranial acupuncture needle migration
and discuss the key technical aspects of the procedure. We additionally performed a review of the relevant
literature. A 55-year-old woman presented with migration of a broken acupuncture needle via the posterior
cervical skin. Computed tomography (CT) showed that the needle migrated intra- and extradurally via the
atlanto-occipital junction. CT angiography revealed that the needle tail was located adjacent to the right
distal horizontal loop of the vertebral artery. Meanwhile, the needle tip was positioned in the premedullary
cistern adjacent to the medulla oblongata via the right lateral medullary cistern. Emergent surgical
removal was conducted. Intradural exploration was required as the needle was not found in the epidural
space. The needle penetrated the adventitia of the right intradural vertebral artery. We failed to pull out
the needle toward the epidural space. After the needle was completely pulled into the intradural space, it
was successfully removed without bleeding complication. Postoperative CT showed no evidence of residual
needle fragment. The patient was discharged home without any sequelae. To the best of our knowledge,
this is the first case of penetrating vertebral artery injury caused by radiologically confirmed acupuncture
needle migration. An intracranially migrated needle should be removed urgently to prevent further migration
causing brainstem, cranial nerve, and vessel injuries. The surgical strategy should be selected according
to needle location and direction.
Primary laryngeal cryptococcosis mimicking laryngeal malignancy: a case report
Kazuya Tonai, Naoki Nishio, Sayaka Yokoi, Masumi Kobayashi and Michihiko Sone
pg(s) 900–905
<Abstract> - < PDF >
Primary laryngeal cryptococcosis is an extremely rare infection and presents with non-specific symptoms
such as hoarseness or sore throat, resulting in delayed diagnosis. Here, we report the patient of a 56-year-old
female patient with primary laryngeal cryptococcosis, who was being treated with oral and inhaled
steroids for rheumatoid arthritis and bronchial asthma. The patient suffered from prolonged hoarseness
and sore throat, and endoscopic biopsy was performed several times under local anesthesia, demonstrating
only inflammatory cell infiltration. Considering the possibility of laryngeal malignancy, a third biopsy
was performed by endoscopic laryngomicrosurgery under general anesthesia. Intraoperative frozen section
revealed non-neoplastic laryngeal mucosa with erosion and severe inflammatory cell infiltration. However,
we could not confirm the definite diagnosis of the lesion in the intraoperative consultation. Postoperative
histopathological examination revealed a small number of yeast-type fungi and a definitive diagnosis was
established by special stains including Alcian blue stain. Finally, the patient was diagnosed as primary
laryngeal cryptococcosis. Daily oral administration of fluconazole (400 mg/day) was performed for 6 months
according to the treatment protocol for pulmonary cryptococcosis. The symptoms gradually improved, and
endoscopy revealed no recurrence 6 months post-treatment. Clinicians should consider the possibility of
laryngeal cryptococcosis when severe inflammation is found in the larynx and discuss the disease history
and pathological results with pathologists more closely.