Nagoya Journal of Medical Science: Celebrating 100 years
From the Editor-in-Chief
Toward the next century of the Nagoya Journal of Medical
Science: message from the Editor-in-chief
Shinya Toyokuni
pg(s) 1–4
<Abstract> - < PDF >
From the Dean of Nagoya University Graduate School of Medicine
The 100th anniversary of the Nagoya Journal of Medical
Science: a message from the Dean
Hiroshi Kimura
pg(s) 5–6
<Abstract> - < PDF >
Comments to the Highly Cited Articles
The dawn of a new era in surgery for lymphedema
Kazunobu Hashikawa and Yuzuru Kamei
pg(s) 7–9
<Abstract> - < PDF >
Comment to our article; Effects of varicocelectomy on
testis volume and semen parameters in adolescents:
a randomized prospective study
Hatsuki Hibi
pg(s) 10–12
<Abstract> - < PDF >
Commentary on “Mechanisms of asbestos-induced
carcinogenesis” published in 2009
Shinya Toyokuni
pg(s) 13–15
<Abstract> - < PDF >
Improving the maternal mortality rate in Lao PDR:
10 years after the publication of the Yang Ye paper
in the Nagoya Journal of Medical Science
Junichi Sakamoto
pg(s) 16–20
<Abstract> - < PDF >
The fruits of CD40 research in basic and clinical medicine
will soon be harvested
Tsutomu Kawabe
pg(s) 21–22
<Abstract> - < PDF >
Recent progress in adipocytokine research
Noriyuki Ouchi, Koji Ohashi and Toyoaki Murohara
pg(s) 23–26
<Abstract> - < PDF >
Neuroinflammation in neurodegenerative disease
Koji Yamanaka
pg(s) 30–32
<Abstract> - < PDF >
Immune checkpoint inhibitors for patients with pre-existing
autoimmune diseases
Osamu Maeda
pg(s) 33–34
<Abstract> - < PDF >
REVIEW ARTICLE
A systematic review regarding clinical characteristics,
complications, and outcomes of surgical and non-surgical
patients with fragility fracture of the pelvis
Takaomi Kobayashi, Takayuki Akiyama, Tadatsugu Morimoto,
Kensuke Hotta
and Masaaki Mawatari
pg(s) 35–49
<Abstract> - < PDF >
We conducted this systematic review to clarify the clinical characteristics, complications, and outcomes
of surgical and non-surgical patients with fragility fracture of the pelvis (FFP). We searched PubMed,
Google Scholar, Cochrane Library, Web of Science, and MEDLINE for English language articles on FFP.
We calculated pooled odds ratios (ORs) or mean differences (MDs) of surgical patients in comparison
to non-surgical patients for clinical characteristics (Rommens FFP classification, age, sex, dementia,
osteoporosis, diabetes mellitus, pulmonary disease, cardiovascular disease, and malignancy), complications
(pneumonia, urinary tract infection, cardiac event, thrombosis, pulmonary embolism, pressure ulcer, multiple
organ failure, anemia caused by surgical bleeding, and surgical site infection), and outcomes (hospital
mortality and one-year mortality). Five studies involving 1,090 patients with FFP (surgical patients, n=432;
non-surgical patients, n=658) were included. FFP type III and IV (OR=8.44; 95% confidence interval [CI]
5.99 to 11.88; p<0.00001), a younger age (MD=–3.29; 95% CI –3.83 to –2.75; p<0.00001), the absence
of dementia (OR=0.36; 95% CI 0.23 to 0.57; p<0.0001), and the presence of osteoporosis (OR=1.74; 95%
CI 1.29 to 2.35; p=0.0003) were significantly associated with the surgical patients. Urinary tract infection
(OR=2.06; 95% CI 1.37 to 3.10; p=0.0005), anemia caused by surgical bleeding (OR=4.55; 95% CI
1.95 to 10.62; p=0.0005), and surgical site infection (OR=16.74; 95% CI 3.05 to 91.87; p=0.001) were
significantly associated with the surgical patients. There were no significant differences in the outcomes
between the surgical and non-surgical patients. Our findings may help to further understand the treatment
strategy for FFP and improve clinical outcomes.
ORIGINAL PAPERS
Differences in gaze behaviors between trainees and experts
during endovascular therapy for cerebral aneurysms:
a preliminary study using a cerebral aneurysm model
Takafumi Otsuka, Takashi Izumi, Masaya Yamamoto, Yusuke Seshita, Takeshi Kohama, Masahiro Nishihori, Tetsuya Tsukada and Ryuta Saito
pg(s) 50–58
<Abstract> - < PDF >
In the neuroendovascular field, the training of operators has become an important issue. Recently,
eye-tracking technology has been introduced into various fields of medical education. This study aimed to
apply eye-tracking technology to the training of neuroendovascular therapy. Six neurosurgeons, including
three neuroendovascular specialists and three trainees, at our institution and related facilities participated
in the study. Eye movement was recorded by the eye-tracking device during the microcatheter navigation
and coil placement into the silastic aneurysm model under biplane X-ray fluoroscopy. Eye-tracking analysis
during neuroendovascular therapy was feasible in all six subjects. In microcatheter navigation, specialists
tended to more frequently switch their attention between frontal and lateral images than trainees. In coil
embolization, the overall gaze frequency tended to increase, and the average fixation duration tended to
decrease as the number of experienced cases increased. Inexperienced operators tend to fix their gaze
when they are operators than when they are assistants. More experienced operators tended to look at the
microcatheter longer in the coil insertion task. The eye-tracking analysis may be useful for operator training
in neuroendovascular therapy. Experts may have moved their eyes more frequently than trainees to gaze at
the right place. In the future, it will be necessary to collect gaze data for more operators in various tasks.
Factors associated with acceptance of a digital contact
tracing application for COVID-19
in the Japanese working-age population
Tomohiro Ishimaru, Koki Ibayashi, Masako Nagata, Seiichiro Tateishi,
Ayako Hino, Mayumi Tsuji, Hajime Ando, Keiji Muramatsu
and Yoshihisa Fujino, for the CORoNaWork Project
pg(s) 59–69
<Abstract> - < PDF >
The working-age population is at the epicenter of coronavirus disease 2019 (COVID-19) infections.
Therefore, it is important to increase the acceptance of digital contact tracing apps in this population.
Contact-Confirming Application (COCOA) is the only digital contact tracing app in Japan. This study aimed
to determine factors associated with acceptance of the COCOA for COVID-19 in the Japanese working-age
population. A cross-sectional study was performed for 27,036 full-time workers registered with an internet
survey company during December 2020 in Japan. Factors associated with COCOA adoption were evaluated by multivariate logistic regression analysis. The rate of downloading the COCOA was 25.1%. The
COCOA was more likely to be accepted by people with married status, university graduation or above,
higher income, and occupations involving desk work. Fear of COVID-19 transmission, wearing a mask,
using hand disinfection, willingness to be vaccinated against COVID-19, and presence of an acquaintance
infected with COVID-19 were also associated with a greater likelihood of adopting the app. The rate of
downloading the COCOA in Japan was not very high. The present findings have important implications
for widespread adoption of digital contact tracing apps in working-age populations in Japan and elsewhere.
Comparison study of the Le Fort I osteotomy
using 2- and 4-plate fixation
Masahito Fujio, Akira Sayo, Kota Ogisu, Qi Chang,
Makoto Tsuboi
and Hideharu Hibi
pg(s) 70–78
<Abstract> - < PDF >
This study was conducted to evaluate the postsurgical stability of Le Fort I osteotomy using zygomatic
buttress internal fixation alone with no piriform aperture internal fixation. Patients with maxillary retrognathia and mandibular prognathism underwent the Le Fort I osteotomy with a bilateral sagittal split ramus
osteotomy. In group I, fixation was accomplished using titanium plate and screws placed at the piriform
aperture and the zygomatic buttress (4 plates). In group II, fixation was accomplished using titanium
plate and screws placed at the zygomatic buttress (2 plates). Lateral cephalometric radiographs were taken
preoperatively (T1), immediately after surgery (T2), and at 6 months to 1 year (T3) to evaluate skeletal
movement. In total, 32 patients were included in this study. None of the patients had wound infection,
dehiscence, bone fragment instability, and long-term malocclusion. Regarding point A and the posterior
nasal spine (PNS), vertical and horizontal relapse in groups I and II did not differ significantly. In most
hospitals, the maxilla was fixed using four plates (piriform aperture and zygomatic buttress); however,
within the limitations of the study, the choice of the number of plates for osteosynthesis following Le Fort
I osteotomy and repositioning of the maxilla can be left to the discretion of the surgeon without putting
the patients at risk for increased relapse by careful intraoperative management.
Validation of the abbreviated version of the World Health
Organization Quality of Life in Mongolia: a population-based
cross-sectional study among adults in Ulaanbaatar
Enkhjin Bat-Erdene, Enkhnaran Tumurbaatar, Gantsetseg Tumur-Ochir,
Otgonbold Jamiyandorj, Tsolmon Jadamba, Eiko Yamamoto,
Nobuyuki Hamajima, Takakazu Oka
and Battuvshin Lkhagvasuren
pg(s) 79–92
<Abstract> - < PDF >
There is currently no validated tool to measure the quality of life (QOL) in the Mongolian language.
This study aimed to validate the Mongolian version of the World Health Organization Quality of Life – Brief
(WHOQOL-BREF) questionnaire for the general population of Mongolia. The subjects were 301 adults aged
18–65 years selected randomly by a computer from 30 centers in 8 districts of Ulaanbaatar, Mongolia,
in 2020. Reliability was measured using Cronbach’s α and intraclass correlation coefficients. Convergent,
discriminant, and construct validities were examined using exploratory and confirmatory factor analyses
for a four-domain factor structure. Among the participants, 56.1% were women, 32.9% held a bachelor’s
degree or higher, 48.8% were employed, and 61.8% were married. The overall Cronbach’s α coefficient
of the WHOQOL-BREF questionnaire was 0.804. Correlations between the component scores of the
WHOQOL-BREF ranged from 0.581–0.822. All items showed higher item-total correlations with their
corresponding domains than with other domains, except the mobility item from the physical domain.
Discriminative validity was evident in physical and psychological domains. Exploratory and confirmatory
factor analyses revealed a four-factorial structure consisting of 24 items that provided an acceptable fit
to the data (RMSEA=0.084; CFI=0.860). In conclusion, the Mongolian version of the WHOQOL-BREF
demonstrated evidence of good reliability and validity for assessing QOL in the general population of
Mongolia. These findings indicate that it allows the comparison of QOL of adults in Mongolia with those
in other countries.
Negative impact of behavior restriction amidst a clustered
COVID-19 infection on immobility syndrome
in older patients negative for COVID-19:
report from a chronic care hospital in Japan
Yoshinori Maki, Akio Goda, Masatoshi Koumo, Tetsuya Yamamoto,
Kouta Yokoyama, Masashi Ueno, Asuka Kishimoto, Masami Kusumoto,
Mayumi Takagawa, Tamako Takahashi, Chiharu Takahashi,
Keisuke Nakajima, Mika Hashimoto, Tsumugi Hosokawa,
Misuzu Kobayashi, Junichi Katsura
and Ken Yanagibashi
pg(s) 93–102
<Abstract> - < PDF >
Previous studies have reported on associations between immobility syndrome and the COVID-19
pandemic. However, little is known about the aggravation of this syndrome in older patients negative for
COVID-19 infection amidst behavior restriction due to a clustered COVID-19 infection. Patients hospitalized
one month before a clustered COVID-19 infection occurred in our hospital were recruited. Rehabilitation
therapy was suspended for 25 days during behavior restriction. The ability of daily living of the patients
was evaluated with the functional independence measure and Barthel index. Chronological changes in the
functional independence measure and Barthel index scores were evaluated monthly, beginning one month
before the clustered COVID-19 infection to one month after re-initiation of rehabilitation therapy. Patients
with minimum scores in the functional independence measure (18) and Barthel index (0) prior to the
clustered COVID-19 infection were excluded. Functional independence measure scores of 73 older patients
and the Barthel index scores of 48 patients were analyzed. The mean total functional independence measure
score amidst the behavior restriction significantly changed from 36.3 to 35.1 (p = 0.019), while statistical
significance was not detected in the mean motor subtotal (from 21.6 to 20.9 with p = 0.247) or cognitive
subtotal functional independence measure scores (from 14.6 to 14.2 with p = 0.478). During the behavior
restriction, the mean Barthel index scores declined from 25.8 to 23.2 without statistical significance (p =
0.059). Behavior restriction due to a clustered COVID-19 infection may aggravate immobility syndrome
in older patients who are negative for COVID-19.
Neck pain after cervical laminoplasty is associated with
postoperative atrophy of the trapezius muscle
Sadayuki Ito, Yoshihito Sakai, Kei Ando, Hiroaki Nakashima,
Masaaki Machino, Naoki Segi, Hiroyuki Tomita, Hiroyuki Koshimizu,
Tetsuro Hida, Kenyu Ito, Atsushi Harada
and Shiro Imagama
pg(s) 103–112
<Abstract> - < PDF >
Cervical laminoplasty is a safe and effective treatment for cervical myelopathy. However, it has a higher
frequency of postoperative axial pain than other methods. A variety of causes of postoperative axial pain
have been reported, but these have not been fully elucidated. This study aimed to investigate the association
between postoperative axial pain and changes in the posterior neck muscles before and after surgery. The
study included 93 patients with cervical myelopathy who underwent surgery at our institute between June
2010 and March 2013. The patients with greater preoperative and 1-year postoperative neck pain visual
analog scale scores comprised the neck pain group. The cross-sectional area of the cervical posterior
extensor muscles and the trapezius muscle were measured by magnetic resonance imaging before and 1
year after surgery at the C3/4, C4/5, and C5/6 levels to compare with neck pain. The total cross-sectional
area atrophy rate (C3/C4, C4/C5, and C5/C6) of the trapezius muscle was significantly larger in patients
with neck pain (12.8 ± 13.2) than in those without (6.2 ± 14.4; p<0.05). The cross-sectional area atrophy
rate of the trapezius muscle at only the C5/6 level was significantly higher in patients with neck pain
(16.7 ± 11.7) compared to those without (3.3 ± 14.4; p<0.001). No significant differences were found in
the cross-sectional areas of the cervical posterior extensor muscles. Trapezius atrophy, especially at the
lower cervical vertebrae, was associated with neck pain after cervical laminoplasty.
NOTE
Reporting system on mortality statistics in Lao People’s
Democratic Republic
Souphalak Inthaphatha, Viengsakhone Louangpradith,
Bounfeng Phoummalaysith, Bounbouly Thanavanh, Tetsuyoshi Kariya,
Eiko Yamamoto and Nobuyuki Hamajima
pg(s) 113–122
<Abstract> - < PDF >
The system to collect information on mortality statistics in Lao PDR is not well established, accurate
and timely death information is therefore not available. This article reports the system and process to
make the mortality statistical data of Lao PDR. The country has a paper-based resident registration system,
using a death notification document, a death certificate, and a family census book. The death notification
document is important as it provides the cause of death, which is issued from a health facility and the
village office. In the event of a death occurring at home, the family representative needs to report to the
village office verbally to obtain a death notification document. On the other hand, if the death occurred in
a medical facility, a death notification document from a health facility is provided. The family representative
should bring the death notification document to the district Home Affairs office to register the death and
obtain a death certificate. After that, the family representative needs to bring the death certificate to the
district Public Security office for an amendment in the family census book. ICD-10 is under development
regarding death notification from health facilities under the Ministry of Health. However, it is unclear how
death notification from village offices can adopt ICD-10 as the majority of deaths occur outside health
facilities. A comprehensive and integrated mortality reporting system is necessary in order to create a
holistic health policy and welfare for the country.
CASE REPORTS
Prominent dermal accumulation of Russell bodies underlying
pseudocarcinomatous hyperplasia with fungal infection
Tatsuhiro Noda, Norika Akashi, Maiko Shimomura, Haruka Koizumi,
Miyuki Mizuta, Kosei Nakajima, Takuya Takeichi,
Teruyuki Mitsuma and Masashi Akiyama
pg(s) 123–126
<Abstract> - < PDF >
Blockade of the secretion of immunoglobulins leads to their accumulation in plasma cells, resulting in
condensed immunoglobulins in the rough endoplasmic reticulum of plasma cells, termed Russell bodies.
They are sometimes found in lymphoplasmacellular inflammation of the intestinal mucosa and in lymphoid
cell malignancies, but only very rarely in skin diseases. Here, we report an 86-year-old female who
presented with a lesion with the prominent accumulation of Russell bodies underlying pseudocarcinomatous
hyperplasia with fungal infection in the face. Immunohistochemical staining showed the cells containing
Russell bodies to be positive for CD138 and the Russell bodies to be positive for immunoglobulin κ and
λ light chains. The present case suggests that when inflammatory cell infiltration with abundant round
intracellular eosinophilic materials is observed in the dermis, the dermal accumulation of Russell bodies
should be considered in cases with reactive pseudocarcinomatous hyperplasia with fungal infection.
The usefulness of three-dimensional fusion imaging of
spinal arteriovenous malformation by a workstation
connected to angiography systems
Yoshitaka Nagashima, Takashi Izumi, Yusuke Nishimura,
Masahiro Nishihori, Takahiro Oyama, Mamoru Matsuo, Hiroshi Ito,
Tomoya Nishii and Ryuta Saito
pg(s) 127–133
<Abstract> - < PDF >
Digital subtraction angiography (DSA) is the most useful technique for diagnosing spinal arteriovenous
malformations (AVM). In recent years, with the improvement of imaging capabilities, the usefulness of
three-dimensional (3D) imaging by fusing various modalities has been recognized. The use of 3D fusion
imaging with a workstation connected to an angiography system has been reported in many cases of
intracranial disease, but less frequently for spinal AVM. In this article, we describe two illustrative cases
of spinal AVM in which 3D fusion imaging was useful for treatment. Although 3D fusion images using
the system have the disadvantage that only a maximum of two images can be fused, it provides spinal
surgeons with useful information for preoperative evaluation in a small amount of time.
Successful prevention of stenosis after circumferential
endoscopic resection of esophageal cancer
Hitoshi Tanaka, Naomi Kakushima, Koichi Muroi, Takashi Hirose,
Tomohiko Suzuki, Takahiro Suzuki, Emiko Hida, Keiko Hirai,
Hiroyuki Shibata, Nobuhito Ito, Satoshi Furune, Kazuhiro Furukawa
and Mitsuhiro Fujishiro
pg(s) 127–133
<Abstract> - < PDF >
Circumferential resection of a >5-cm longitudinal mucosal defect following esophageal endoscopic
submucosal dissection (ESD) is a risk factor for refractory stenosis. Circumferential ESD was performed
in 3 patients with 64, 69, and 70 mm longitudinal mucosal defects. A local steroid injection was used
to treat the postoperative ulcer, followed by an oral steroid. In all three cases, the ulcer healed without
the need for endoscopic dilation. A combination of local injection and oral steroids effectively prevented
esophageal stenosis in patients with high-risk stenosis after ESD.
Surgical revascularization for quasi-moyamoya
disease associated with polyneuropathy, organomegaly,
endocrinopathy, monoclonal gammopathy, and
skin changes (POEMS) syndrome: a case report
and literature review
Yuki Kubota, Yoshiki Hanaoka, Jun-ichi Koyama, Yusuke Takahashi,
Nagaaki Katoh, Mai Iwaya, Yu Fujii, Toshihiro Ogiwara
and Tetsuyoshi Horiuchi
pg(s) 141–149
<Abstract> - < PDF >
POEMS (polyneuropathy, organomegaly, endocrinopathy, monoclonal gammopathy, and skin changes)
syndrome is a rare multisystem disease characterized by plasma cell dyscrasia and overproduction of
vascular endothelial growth factor, which is related to disease activity. Recent treatment strategies have
improved survival of patients suffering from this disorder; however, ischemic stroke remains a poor
prognostic factor. POEMS patients with ischemic stroke frequently develop cerebral large artery stenosis/
occlusion, followed by progressive stroke. Post literature review, we present an ischemic stroke case of
quasi-moyamoya disease linked with this syndrome that was successfully treated with surgical revascularization. A 41-year-old woman diagnosed with POEMS syndrome developed progressive ischemic stroke due
to quasi-moyamoya disease, despite decreased vascular endothelial growth factor level with lenalidomide
and dexamethasone treatment. She underwent superficial temporal artery to middle cerebral artery bypass
with encephalo-duro-myo-synangiosis bilaterally. The postoperative course was uneventful. Two years
and five months after the stroke, neuroimaging demonstrated bypass patency, neovascularization after
encephalo-duro-myo-synangiosis, and no recurrence of stroke. Our case is the first to report successful
surgical revascularization for a POEMS patient. Surgical revascularization may be a useful treatment option
for patients with quasi-moyamoya disease associated with POEMS syndrome, especially for those who
develop refractory ischemic stroke despite reduced vascular endothelial growth factor level.
A case of Erdheim–Chester disease with the BRAF V600E
mutation diagnosed via endoscopic sinus surgery
Takaharu Matsuhisa, Masaaki Teranishi, Yuta Tsuyuki,
Michihiko Sone and Juichi Sato
pg(s) 150–156
<Abstract> - < PDF >
Erdheim–Chester disease is characterized by the infiltration of foamy histiocytes in tissues. Lesional
tissue biopsy is recommended to confirm diagnosis and establish the BRAF mutational status. A 52-year-old
man presented to our hospital with hydronephrosis. Computed tomography showed enhancement of
soft shadows around the left renal pelvis transition area and the aorta. He was treated with prednisolone
0.2 mg/kg for 1 year; however, no improvement was observed. 18Fluorodeoxyglucose–positron emission
tomography/computed tomography revealed increased fluorodeoxyglucose uptake in various body parts,
including the maxillary sinuses, indicative of Erdheim–Chester disease. He refused further examination,
and the maxillary sinus lesions were treated with antibiotics and intranasal steroids, but no improvement
was observed. Two years later, he underwent biopsy with endoscopic sinus surgery of the maxillary sinus,
which showed the highest increase in fluorodeoxyglucose uptake on repeat 18fluorodeoxyglucose–positron
emission tomography/computed tomography. Endoscopic findings showed only nonspecific inflammatory
findings, but pathological findings revealed the proliferation of cells with abundant foamy cytoplasms.
Sufficient tumor volume was available to perform PCR for BRAF V600E mutation analysis, which was
positive and resulted in a diagnosis of Erdheim–Chester disease with the BRAF V600E mutation. This is
the first case of a patient with Erdheim–Chester disease with the BRAF V600E mutation identified in a
sinus lesion. Endoscopic sinus surgery biopsy of the paranasal sinuses was considered to contribute to the
histological and genetic diagnosis of Erdheim–Chester disease, particularly following the notable increase
in fluorodeoxyglucose uptake.
Single-lane clipping technique for a ruptured aneurysm of
A1 fenestration of the anterior cerebral artery:
a case report and literature review
Yuki Kubota, Yoshiki Hanaoka, Tatsuro Aoyama, Yu Fujii,
Toshihiro Ogiwara, Tatsuya Seguchiand Tetsuyoshi Horiuchi
pg(s) 157–166
<Abstract> - < PDF >
Fenestration of the A1 segment of the anterior cerebral artery is a rare vascular anomaly with a high
risk of saccular aneurysm at the proximal end of the A1 fenestration. These aneurysms have a high risk
of rupture. However, conventional surgical clipping can be technically challenging due to the anatomical
characteristics. We report a case of A1 fenestration with a ruptured aneurysm wherein we successfully
achieved complete obliteration of the aneurysm with a new “single-lane” clipping technique. A 64-year-old
woman presented with a ruptured saccular A1 aneurysm at the proximal end of an A1 fenestration,
resulting in subarachnoid hemorrhage. Microsurgical clipping was attempted; however, adequate exposure
of the aneurysm could not be achieved. The recurrent artery of Heubner originated near the distal end of
the lateral limb of the A1 fenestration. The lateral limb of the A1 fenestration had no perforating arteries,
according to surgical examination. Thus, the aneurysm neck and lateral limb were concurrently obliterated
using a nonfenestrated clip, preserving the medial limb of the A1 fenestration. The antegrade flow of the
recurrent artery of Heubner was detected using the retrograde flow of the distal part of the lateral limb
of the A1 fenestration during intraoperative indocyanine green video angiography. The postoperative course
was uneventful without any evidence of ischemic stroke. For A1 aneurysms arising from the proximal
end of the A1 fenestration, this technique may be a useful treatment option. Before using this technique,
careful surgical exploration should be performed to assess the A1 perforating arteries.
Successful perioperative management of simultaneous
transcatheter aortic valve implantation and
hip fracture surgery: a case report
Kochi Yamane, Tadashi Aoyama, Yohei Aoki, Hironori Momohara
and Mikio Nonogaki
pg(s) 167–170
<Abstract> - < PDF >
A 90-year-old woman with severe aortic stenosis experienced hospital readmission for chronic heart
failure exacerbations many times and was admitted to our hospital for undergoing transcatheter aortic valve
implantation. Thereafter, she fell in the ward and fractured her femoral trochanter, requiring early hip
fracture surgery. We proposed that we should perform simultaneous transcatheter aortic valve implantation
and hip fracture surgery to cardiologist and orthopedist from anesthetic and perioperative management perspective. We considered that it was difficult to maintain cardiovascular function without cardiac intervention
during hip fracture surgery and starting rehabilitation as early as possible was important. General anesthesia
was induced without any complications, and the tracheal tube was removed after the successive surgeries.
On postoperative day 1, bedside rehabilitation was started, and on postoperative day 3, she was transferred
from the intensive care unit to the general ward. On postoperative day 32, she was transferred to another
hospital. Anesthesiologist should play an important role for decision making in not only intraoperative but
perioperative management for critical case, we should communicate with other departments. The successful
perioperative management of simultaneous transcatheter aortic valve implantation and hip fracture surgery
enabled to start rehabilitation early and prevented further patient hospitalization.
A case of eosinophilic polyangiitis with granulomatosis that
evolved to cardiac arrest due to advanced
atrioventricular block
Yuichiro Sakurai, Chiyako Oshikata, Takaharu Katayama,
Shunsuke Takagi, Yasushi Kaneko, Kikuo Yo, Takeshi Kaneko,
Hiroyuki Kubota, Takashi Matsubara
and Naomi Tsurikisawa
pg(s) 171–178
<Abstract> - < PDF >
Cardiac manifestations are the major cause of mortality in patients with eosinophilic granulomatosis with
polyangiitis (EGPA). Among these manifestations in EGPA patients, in the literature, there are fewer reports
describing bradycardia in EGPA patients than those describing tachycardia. A 50-year-old woman with a
history of childhood-onset asthma. At age 28, she was diagnosed with eosinophilic gastroenteritis without
the diagnosis of EGPA and was started on a systemic steroid and had maintenance daily dose of 2.5 mg
after gradually tapered. She had experiencing dizziness and palpitations 2 weeks after discontinuation of
the steroid treatment. At emergency visit, electrocardiography revealed an advanced atrioventricular block
of 3:1 or less. Forty-eight minutes after the start of electrocardiography, only a P wave was observed
and cardiac arrest occurred for 9 s and temporary emergency pacing was performed immediately. She was
diagnosed as EGPA presenting leukocyte count, 16,500/µL, 42.8% of which were eosinophils and sinusitis
in computed-tomography. She could be survival by treatment of steroid, following the patient to withdraw
from an external pacemaker. She received prednisolone of 60 mg, intravenous cyclophosphamide and
intravenous immunoglobulin. She had relapsed presenting peripheral eosinophilia, abdominal and numbness
in the toes of the left leg pain, but not arrythmia after tapered of prednisolone. Following additional steroid
pulse, she had an increase of prednisolone and continued by intravenous cyclophosphamide, intravenous
immunoglobulin and started mepolizumab. We presented a severe case of EGPA presenting an advanced
atrioventricular block into cardiac arrest.
Transorbital penetrating head injury by a wooden chopstick
in the cavernous sinus: a case report and literature review
Daisuke Yamazaki, Naoki Ogihara, Takehiro Yako, Yu Fujii,
Yoshiki Hanaoka, Toru Kurokawa
and Tetsuyoshi Horiuchi
pg(s) 179–184
<Abstract> - < PDF >
Penetrating head injury is a relatively rare condition associated with high morbidity and mortality.
Although the immediate treatment of penetrating head injury is needed, surgical strategies are varied based
on the trajectory of the penetrating objects in the cranium. We present a case of 24-year-old man who
sustained a transorbital penetrating injury caused by a wooden chopstick. Neuroimages revealed a linear
lesion extending from the left intraorbital segment to the cavernous sinus passing through the superior
orbital fissure. The foreign body was successfully removed via the transcranial approach without complications. A careful management based on the perioperative images and correct diagnosis is necessary to avoid
unfavorable complications. Four cases of transorbital penetrating injuries have been previously reported, in
which the foreign body penetrated through the superior orbital fissure and lodged in the cavernous sinus.
The frontotemporal craniotomy with extradural approach can be a useful option to remove foreign bodies
around the cavernous sinus regions.
Failure of internal fixation for ankle joint Charcot
neuroarthropathy with beta(2)-microglobulin amyloidosis:
a case report
Yang Zheng, Jiu-Dan Zhang, Jie-Feng Huang and Ya-Hong Zhu
pg(s) 185–194
<Abstract> - < PDF >
Charcot neuroarthropathy (CN) is a serious diabetic complication with a poor prognosis and a high
rate of misdiagnosis. Furthermore, beta(2)-microglobulin amyloidosis (Abeta2M) makes the diagnosis and
therapy more difficult and complex. This case report highlights the pathophysiology, clinical evaluation,
treatment, and prevention of the major diabetic complications associated with CN and Abeta2M that cause
poor quality of life, limit the patient’s ability to walk independently, and are directly or indirectly linked
with a high risk for lower limb amputation. Ankle CN was discovered in a 36-year-old single female
with a history of type 1 diabetes mellitus and diabetic nephropathy. We performed early internal fixation.
However, because she lived alone and needed hemodialysis three times a week, wearing a brace and
non-weight-bearing were extremely inconvenient. Furthermore, she did not experience any pain and only
some edema; thus, she proceeded to bear weight ahead of schedule without authorization. Due to the
premature weight-bearing and poor compliance, the patient suffered severe bone resorption and infection
and eventually had to undergo amputation. Abeta2M was suggested by bone pathological sections. We
present a case of failed internal fixation of ankle CN with Abeta2M, emphasizing the importance of social
factors and postoperative management.
Myelodysplastic syndrome with trisomy 8 presenting periodic
fever and multiple MEFV gene variants outside exon 10:
a case report
Noriyuki Takahashi, Ryo Hanajiri, Masashi Suzuki, Chise Anan,
Atsushi Inagaki, Dai Kishida, Shohei Ozawa, Sho Kohri,
Nobuhide Kamiya, Motoki Sato and Juichi Sato
pg(s) 195–203
<Abstract> - < PDF >
Myelodysplastic syndrome is associated with the development of autoinflammatory conditions, such as
recurrent fever, polymyalgia, arthralgia, and erythema. Trisomy 8 is a common chromosomal abnormality
in patients with myelodysplastic syndrome. Myelodysplastic syndrome with trisomy 8 involves autoinflammatory conditions, especially Behçet’s disease-like symptoms with intestinal mucosal damage. MEFV
variants, particularly those in exon 10, are pathogenic in familial Mediterranean fever, the most common
autoinflammatory disease, presenting typical symptoms such as periodic fever and pleuritis/pericarditis/
peritonitis. MEFV variants outside exon 10 are common in Japanese patients with familial Mediterranean
fever and are associated with atypical symptoms, including myalgia and erythema. MEFV variants in
myelodysplastic syndrome with trisomy 8 have rarely been investigated, although myelodysplastic syndrome
with trisomy 8 might develop autoinflammatory conditions similar to those in familial Mediterranean fever.
We encountered a 67-year-old man who had myelodysplastic syndrome with trisomy 8 and multiple MEFV
variants outside exon 10. He presented with periodic fever, as well as chest/abdominal pain, myalgia, and
erythema, although the symptoms did not fulfill the diagnostic criteria of familial Mediterranean fever.
We discussed the possibility that these symptoms are modified by MEFV variants outside exon 10 in
myelodysplastic syndrome with trisomy 8.
Multiple tendon transfer for a case of radial nerve palsy in
hereditary neuropathy with liability to pressure palsy
Federico Palumbo, Michiro Yamamoto and Hitoshi Hirata
pg(s) 204–210
<Abstract> - < PDF >
Hereditary neuropathy with liability to pressure palsy (HNPP) is a rare autosomal dominant disease
characterized by focal, recurrent, demyelinating peripheral neuropathies. It is caused by deletions of the gene
encoding for peripheral myelin protein 22 (PMP22) on chromosome 17. While it may range widely, the
most common clinical presentation is an acute, focal mononeuropathy with numbness or muscle weakness
after trauma or compression. Diagnostic tools include electrophysiological studies, genetic tests and nerve
biopsies. There is no standard surgical or pharmacological treatment. The course of the disease is usually
benign, with spontaneous improvement after most episodes of peripheral nerve palsy. HNPP is best managed
by early detection, preventative measures, and subsequent treatment of symptoms. According to the medical
literature, operative treatment was undertaken in few cases and limited to decompression of the nerve at
the classic entrapment sites of the carpal or cubital tunnels. We present a case of multiple tendon transfer
(pronator teres to extensor carpi radialis brevis and flexor carpi radialis to extensor digitorum communis)
with a two-year follow-up in a 24-year-old woman with HNPP who was affected by irreversible radial
nerve palsy, and conclude with a review of the medical literature related to the disease.