INVITED REVIEW ARTICLE
Inner ear disturbances related to middle ear inflammation
Michihiko Sone
pg(s) 1 - 7
<Abstract> - < PDF >
The inner and middle ear are connected mainly through round and oval windows, and inflammation
in the middle ear cavity can spread into the inner ear, which might induce a disturbance. In cases with
intractable otitis media, attention should also be paid to symptoms related to the inner ear. In this paper,
middle ear inflammation and related inner ear disturbances are reviewed with a focus on representative
middle ear diseases (such as acute otitis media, chronic otitis media, otitis media with anti-neutrophil
cytoplasmic antibody-associated vasculitis, eosinophilic otitis media, cholesteatoma with labyrinthine fistula,
and reflux-related otitis media). Their clinical concerns are then discussed with reference to experimental
studies. In these diseases, early diagnosis and adequate treatment are required to manage not only middle
ear but also inner ear conditions.
ORIGINAL PAPERS
Fixed-dose combination of alogliptin/pioglitazone improves
glycemic control in Japanese patients with type 2
diabetes mellitus independent of body mass index
Chie Aoki, Kunihiro Suzuki, Hisamoto Kuroda, Masaaki Sagara,
Masanori Shimizu, Kikuo Kasai and Yoshimasa Aso
pg(s) 9 - 16
<Abstract> - < PDF >
This study investigated the effects of switching from combination therapy with either alogliptin (Alo)
or pioglitazone (Pio) to fixed-dose combination therapy (FDCT) with alogliptin and pioglitazone (Alo-Pio
FDCT). The usefulness and efficacy of Alo-Pio FDCT were investigated. A total of 50 outpatients with
type 2 diabetes mellitus (T2DM) treated with Alo and 47 outpatients with T2DM treated with Pio were
switched to Alo-Pio FDCT, and its efficacy and usefulness were evaluated. Significant improvements were
observed in hemoglobinA1c (HbA1c), alanine transaminase (ALT), and γ-glutamyl transpeptidase (GGT)
levels after switching to Alo-Pio FDCT for 16 weeks in both groups. Only the group switching from Alo
to Alo-Pio FDCT showed significant improvements in high-density lipoprotein cholesterol (HDL) levels and
triglyceride levels. In a multivariate logistic regression model of the variation in the change of HbA1c at
16 weeks, ALT and GGT were independent predictors of the change of HbA1c at 16 weeks. In addition,
the switch to Alo-Pio FDCT improved glycemic control to a certain degree regardless of BMI. Switching
from either Alo or Pio to Alo-PIO FDCT may, unlike monotherapy with a DPP-4 inhibitor, be effective
for patients with T2DM regardless of whether they are obese or lean.
Retrospective survey and evaluation of first-line antibiotics
for chemotherapy-induced febrile neutropenia
in patients with acute myeloid leukemia
Naoki Mukoyama, Marie Nakashima, Koichi Miyamura,
Akira Yoshimi, Yukihiro Noda and Kazuhiro Mori
pg(s) 17 - 26
<Abstract> - < PDF >
Patients with acute leukemia are susceptible to chemotherapy-induced severe myelosuppression, and
therefore are at a high risk for febrile neutropenia (FN). In such cases, the use of broad-spectrum antibiotics
such as fourth-generation cephalosporins and carbapenems is recommended as first-line antimicrobial
treatment; however, the effectiveness of these agents in patients with acute myeloid leukemia (AML) has
not been investigated in detail. We retrospectively examined and evaluated the effectiveness of first-line
antibiotic treatment regimens for chemotherapy-induced FN in patients with AML in Japanese Red Cross
Nagoya Daiichi Hospital. The evaluated first-line treatment regimens were as follows: cefozopran (CZOP)
+ amikacin (AMK) in 38 cases, cefepime (CFPM) alone in 2 cases, CFPM + AMK in 2 cases, piperacillin
(PIPC) + AMK in 2 cases, and CZOP alone in 1 case. Additionally, prophylactic antifungal agents were
administered in all cases. Markedly effective, effective, moderately effective, and ineffective responses
occurred in 31.1%, 8.9%, 8.9%, and 51.1%, respectively, of the treated cases. The response rate, defined
as the combination of markedly effective and effective outcomes, was 40.0%. In 11 cases, impairment
of renal functions were observed, and they were associated with combination treatments including AMK;
nine of these were associated with a glycopeptide. The combination of CZOP with AMK (84.4%) was the
most commonly used first-line treatment for FN in patients with AML; carbapenem or tazobactam/PIPC
has never been used for treatment of such cases. Our findings demonstrate that fourth-generation cephems
will be an effective first-line treatment for FN in patients with AML in our hospital.
[18F]Fluorodeoxyglucose uptake by positron emission
tomography predicts outcomes for oropharyngeal and
hypopharyngeal cancer treated with definitive radiotherapy
Takeaki Ishihara, Kazuhiro Kitajima, Yuko Suenaga, Yasuo Ejima, Hirokazu Komatsu,
Naoki Otsuki, Ken-ichi Nibu, Naomi kiyota, Satoru Takahashi and Ryohei Sasaki
pg(s) 27 - 36
<Abstract> - < PDF >
This study evaluated the prognostic significance of the maximum standardized uptake value of the
primary site (pSUVmax) in 18F-fluorodeoxyglucose positron emission tomography (FDG-PET) scans of
patients with oropharyngeal or hypopharyngeal cancer who were treated using definitive radiotherapy.
The study included 86 patients who were primarily treated with radiotherapy for oropharyngeal or hypopharyngeal
cancer. Sixty-nine patients underwent concurrent chemotherapy. The associations between
pre-treatment pSUVmax and treatment outcomes were evaluated. The most appropriate pSUVmax cut-off
value for predicting disease-free survival (DFS) and local control (LC) was selected using receiver operating
characteristic (ROC) curves. The median follow-up time for surviving patients was 60 months, while the
median survival time in the entire patient cohort was 55 months. A pSUVmax cut-off value of 9.0 showed
the best discriminative performance. Five-year OS and DFS rates were 65.9% and 60.0%, respectively. In
univariate analyses, pSUVmax (p = 0.009), T-stage (p = 0.001), N-stage (p = 0.039), and clinical stage
(p = 0.017) were identified as significant prognostic predictors for DFS. The multivariate analysis did not
identify any statistically significant factors, but the association between pSUVmax and DFS was borderline
significant (p = 0.055). Interestingly, pSUVmax was predictive of local controllability in T1–T2 disease (p
= 0.024), but there was no significant association for T3–T4 disease (p = 0.735). In this study, pSUVmax
was predictive of DFS and LC in patients with oropharyngeal or hypopharyngeal cancer that was treated
with definitive radiotherapy. pSUVmax was strongly associated with LC in T1–T2 disease.
Marginal pulmonary function is associated with
poor short- and long-term outcomes in lung cancer surgery
Naoki Ozeki, Koji Kawaguchi, Toshiki Okasaka, Takayuki Fukui, Koichi Fukumoto,
Shota Nakamura, Shuhei Hakiri and Kohei Yokoi
pg(s) 37 - 42
<Abstract> - < PDF >
We sought to determine the short- and long-term prognoses among ‘marginal-risk’ non-small cell lung
cancer patients who have a predicted postoperative- (ppo) forced expiratory volume in the first second
(FEV1) of 30–60% and/or a ppo-diffusing capacity of the lung for carbon monoxide (DLCO) of 30–60%.
The present study included 73 ‘marginal-risk’ and 318 ‘normal-risk’ patients who underwent anatomical
resection for clinical stage I lung cancer between 2008 and 2012. The rates of postoperative morbidity,
prolonged hospital stay, and overall survival were assessed. Postoperative morbidity occurred in 35 (48%)
‘marginal-risk’ patients and 66 (21%) ‘normal-risk’ patients, and 17 (23%) ‘marginal-risk’ patients and
20 (6%) ‘normal-risk’ patients required a prolonged hospital stay. The three- and five-year survival rates
were 79% and 64% in the ‘marginal-risk’ patients and 93% and 87% in the ‘normal-risk’ patients,
respectively. A ‘marginal-risk’ status was a significant factor in the prediction of postoperative morbidity
(odds ratio [OR] 2.97, p < 0.001), the rate of prolonged hospital stay (OR 3.83, p < 0.001), and overall
survival (hazard ratio 2.07, p = 0.028). In conclusion, ‘Marginal-risk’ patients, who are assessed based
on ppo-values, comprise a subgroup of patients with poorer short- and long-term postoperative outcomes.
Evaluation of the association between locomotive syndrome
and depressive states: a cross-sectional study
Tomohiro Saito, Hideaki Watanabe, Ichiro Kikkawa and Katsushi Takeshita
pg(s) 43 - 46
<Abstract> - < PDF >
The Japanese Orthopaedic Association has proposed the term “locomotive syndrome” to designate a
condition that places a person at high risk for long-term care. However, in daily clinical practice, even when
a diagnosis of locomotive syndrome is made, exercise therapy often cannot be successfully performed in
some patients owing to their lack of motivation. We speculated that locomotive syndrome and depressive
states co-exist in elderly people. The purpose of this study was to determine the presence or absence of
depressive states in older patients aged ≥ 65 years who were diagnosed with locomotive syndrome. A
questionnaire survey, the 25-Question Geriatric Locomotive Function Scale and Self-Rating Questionnaire
for Depression was conducted. The items of the interview survey were sex, age, and history of treatment
for hypertension or diabetes mellitus. For somatometry, height and body weight were measured. Patients
diagnosed with locomotive syndrome (LS group) were compared with those without locomotive syndrome
(non-LS group). The LS group included 99 patients, mean age was 79.4 years old, while the non-LS group
included 101 patients, mean age was 76.3 years old. The number of patients with depressive states and
number of females were significantly higher in the LS group. In addition, the LS group was significantly
older and shorter. Multivariate analysis revealed depressive states and age to be independent factors. Therapy
for patients with LS should include evaluation and, if necessary, treatment for concomitant depression.
Polymorphisms of insulin receptor substrate 2 are putative
biomarkers for pediatric medulloblastoma: considering
the genetic susceptibility and pathological diagnoses
Baocheng Wang, Yang Zhao, Wei Meng, Yipeng Han, Jiajia Wang, Feili Liu,
Shengying Qin and Jie Ma
pg(s) 47 - 54
<Abstract> - < PDF >
Molecular profiling subgrouped medulloblastoma (MB) into four subtypes featured by distinct footprints.
However, germline studies on genetic susceptibility in Chinese population have not been reported. To
investigate the correlation of polymorphisms involved in the AKT signaling pathway with clinicopathological
parameters in pediatric MB, and their contribution to the clinical outcome, we performed a case-controlled
cohort consisting of 48 patients with pediatric MB and 190 healthy controls from Han population. Significant
association in rs7987237 of insulin receptor substrate 2 (IRS2) was identified as risk allele/genotype
between MB patients and control group (P<0.05). The allele “C” of rs7987237 in IRS2 gene was associated
with an increased risk of MB (P=0.025; OR=2.95, 95%CI 1.43–6.11) after Bonferroni correction. Among
48 patients, various genotypes of rs7987237 show significant association with pathological diagnosis and
metastases risk (P<0.05). Furthermore, the survival curve of patients with genotype “CC” of rs7987237
was confirmed with better outcome (P<0.001). Combined with previous results, our study suggests that
polymorphisms of IRS2 putatively participated in the development of pediatric MB development. Therefore,
it may benefit the early diagnosis and indicate the prognosis of patients with MB in Han population.
Perception and attitude of medical doctors in Dhaka,
Bangladesh, with regard to Ayurvedic medicine
Yoshitoku Yoshida, Md. Abdul Alim, Zakia Alam, Mohammad Asaduzzaman,
Yasuko Yoshida and Manikdrs Shahabuddin
pg(s) 55 - 64
<Abstract> - < PDF >
The World Health Organization (WHO) Traditional Medicine Strategy (2014–2023) aimed to help
member states promote the safe and effective use of traditional medicine. While economic conditions have
markedly improved in Bangladesh, the country is experiencing significant public health problems. Because
of limited medical resources, there is a strong incentive to enhance complementary and alternative medicine
usage in Bangladesh. Therefore, this study aimed to confirm the perceptions and attitudes of medical
doctors (MDs) in Dhaka, Bangladesh, with regard to Ayurvedic medicine (AM). A total number of 159
MDs in Dhaka were interviewed by face-to-face between February and June 2015. The study revealed that
62.0% of MDs had treated patients with AM and 55.3% believed that AM should be regarded as its own
specialty, whereas 39.7% of MDs believed that AM should be part of the conventional medical curriculum
and 32.7% thought that AM did not seem scientific. In terms of gender, 45.3% of male MDs agreed or
strongly agreed that AM only had a placebo effect. On the other hand, 65.8% of female MDs disagreed
or strongly disagreed it. In terms of age, 77.0% of MDs aged 36 or elder (elder MDs) believed they
were more likely to recommend AM use and 80.3% of elder MDs believed that the government should
encourage more initiatives to promote AM. To enhance AM use, scientifically robust information on the
efficacy, safety and scientific basis of AM should be more effectively conveyed to male MDs.
CASE REPORTS
A case report of idiopathic iliopsoas hematoma
which occurred soon after transfer to the wheelchair
after total hip arthroplasty
Tomoo Okumura, Hiroshi Fujita, Hideto Harada, Ryuuichi Nishimura and Tomohiro Tominaga
pg(s) 65 - 73
<Abstract> - < PDF >
A 79-year-old woman was diagnosed with osteoarthritis of the left hip and scheduled for total hip
arthroplasty. As two lesions were detected in branches of the coronary arteries, she was treated with catheter
treatment. The patient was receiving anticoagulant treatment, which was suspended eight days before the
operation; however, heparin was started at 6 days before the operation and was stopped 9 hours before
the operation. On the 2nd postoperative day soon after transfer to the wheel chair, she was feeling unwell
and was suffering from severe pain in her left buttock and left thigh. Her blood pressure had decreased to
70 mmHg. During abdominal contrast-enhanced CT, a hematoma was detected in the left iliopsoas muscle.
Catheter therapy was started by the cardiovascular department and bleeding had stopped spontaneously. The
patient was able to walk with a cane and was discharged on the 40th postoperative day.
Accessory left gastric artery aneurysms in granulomatosis
with polyangiitis: a case report and literature review
Toshihide Tomosugi, Takuji Takahashi, Yoshihisa Kawase, Koichi Yoshida, Shogo Hayashi,
Takefumi Sugiyama, Mitsuya Shimizu, Michita Shoka, Kohichi Sawaki, Eiji Onishi,
Naomi Hayashi, Hidenobu Matsushita and Osamu Okochi
pg(s) 75 - 83
<Abstract> - < PDF >
Aneurysm formation is a potential complication of granulomatosis with polyangiitis (GPA), previously
known as Wegener’s granulomatosis. It is a very rare complication, but immediate diagnosis and therapy
should be performed because an aneurysm can be life-threatening if it ruptures. An accessory left gastric
artery (ALGA) is also a rare variant gastric artery that may obtain its blood supply from the left hepatic
artery and left gastric artery. We herein describe a 57-year-old Japanese man who was diagnosed with
GPA complicated by aneurysm rupture in an ALGA. Emergency surgery was performed after failure of
arterial coil embolization to interrupt blood flow in the ALGA. The patient underwent partial resection of
the lesser omentum, which contained all aneurysms. During partial resection of the lesser omentum, both
the left gastric artery and ALGA were ligated because they were thought to be feeders of the aneurysms.
Postoperative recovery was uneventful; no bleeding or recurrence of the aneurysms occurred. Immediate
diagnosis and therapy should be performed for patients with GPA with symptoms of vascular ischemia
or aortitis. Endovascular intervention is the first-choice therapy especially for hemodynamically stable
patients with ruptured aneurysms or aneurysms located on variant arteries, which may have multiple blood
supplies. In the present case, although endovascular treatment failed, the approach described herein was
helpful during open surgery.
Bilateral lacrimal caruncle lesions
Yuta Okumura, Yoshiko Takai, Shunsuke Yasuda and Hiroko Terasaki
pg(s) 85 - 90
<Abstract> - < PDF >
A 65-year-old man was referred to our hospital for the treatment of a lesion on the medial lacrimal
canthus of both eyes. He had a history of perinuclear anti-neutrophil cytoplasmic antibodies, i.e., pANCApositive
interstitial pneumonia. Orbital magnetic resonance imaging excluded space occupying lesions,
and laboratory testing excluded thyroid-related diseases. The masses were excised, and histopathological
examinations showed sebaceous gland hyperplasia and inflammatory changes around the gland. In addition,
the specimen from the left eye showed a retention cyst possibly caused by an infection. It was also possible
that the use of steroid was involved in the development of the lesions. A relationship between the ANCA
and the lesions was not completely eliminated.
Cervical chyloma after neck dissection: a case report
Masashi Kimura, Hiroyuki Ohto, Akio Shibata, Hiroki Yamada, Shusuke Nishiwaki
and Masahiro Umemura
pg(s) 91 - 95
<Abstract> - < PDF >
Cervical chylomas are rare pseudocystic collections that lack an epithelial lining and arise from the
thoracic duct or its tributaries; although they typically develop after neck surgery or trauma, they can arise
from unknown causes. Treatment options include not only conservative therapy, such as dietary modification,
repeated aspirations, and sclerotherapy, but also include surgical excision. We describe a case of a
chyloma in a 64-year-old Japanese woman with squamous cell carcinoma of the gingiva. The chyloma
developed following left segmental mandibulectomy with radical neck dissection and reconstruction, using
a titanium plate and a pectoralis major myocutaneous flap. One month after surgery, a left supraclavicular
swelling was noted, so ultrasound-guided fine-needle aspiration and cytology were performed to exclude a
recurrence of neck metastasis. The aspiration yielded a milky fluid without atypical or malignant cells on
cytology, confirming the diagnosis of chyloma. Although we performed continuous compressive dressing
and started the patient on a low-fat diet, the mass persisted. When the patient died of bone, lung, and
liver metastases five months after the second surgery, the mass had not changed in size. Awareness of this
complication is important to ensure timely diagnosis and appropriate treatment.
Intraspinal meningioma with malignant transformation and
distant metastasis
Kenyu Ito, Shiro Imagama, Kei Ando, Kazuyoshi Kobayashi, Yoji Shido, Go Yoshida,
Hideyuki Arima, Shunsuke Kanbara, Takanori Hirose, Yukihiro Matsuyama,
Yoshihiro Nishida and Naoki Ishiguro
pg(s) 97 - 102
<Abstract> - < PDF >
Meningioma is typically considered to be a benign tumor. Malignant transformation and metastasis of
meningiomas are rare. Moreover, most meningiomas are intracranial, and there are few reports on intraspinal
meningiomas. This report aimed to describe the clinical features and pathological findings of a case of
malignant transformation and distant metastasis of intraspinal meningioma, with a review of the literature.
A 44-year-old man with a bilateral lower limb paresis was diagnosed with an intradural extramedullary
tumor of the thoracic spine. Primary tumor resection was performed, and the histological findings revealed
atypical meningioma. The meningioma recurred 2 years after the primary surgery, and a second resection
was performed, but only partial resection was possible because of decreased motor evoked potential. At age
48, the patient’s lower limb weakness returned, and a third resection was performed, and the histological
finding remained atypical meningioma. At age 54, the tumor increased and stereotactic irradiation was
performed. At age 60, the patient was diagnosed with metastatic tumors of the rib, lumbar vertebra, cervical
spine, and sacrum. Biopsy of the rib metastatic tumor was performed, and the histological findings revealed
anaplastic meningioma. This case is the first report of an intraspinal meningioma that transformed from
atypical to anaplastic meningioma with distant hematogenous metastasis.
High-dose intravenous pulse steroid therapy for optic disc
swelling and subretinal fluid in non-arteritic anterior
ischemic optic neuropathy
Kei Takayama, Hiroki Kaneko, Shu Kachi, Eimei Ra, Yasuki Ito and Hiroko Terasaki
pg(s) 103 - 108
<Abstract> - < PDF >
Non-arteritic anterior ischemic optic neuropathy (NAION) is a disease with microvascular abnormality
that causes acute optic disc swelling (ODS) and, in severe cases, subretinal fluid (SRF) accumulation.
ODS causes compartment syndrome and subsequent axonal degeneration and loss of retinal ganglion cells
by apoptosis. No treatment modalities have been effective, although some cases improved after the intake
of oral systemic steroids. We reported a case of a 72-year-old man who was referred due to a visual
defect in the right eye. At first presentation, visual acuity and visual field were disturbed; critical flicker
frequency (CFF) was decreased; and optic coherence tomography (OCT) showed ODS and SRF. Microscopic
examination revealed parapapillary hemorrhage and fluorescence angiography showed non-filling,
temporal-superior choroidal lesion adjacent to the optic disc at an early phase. After high-dose intravenous
steroid treatment, SRF and ODS were decreased, and completely resolved after 30 days. Visual acuity and
CFF were improved, and visual field was enlarged. High-dose intravenous steroids could possibly resolve
SRF and ODS and improve visual function of patients with NAION. Some cases in NAION improved
visual acuity and visual function in natural course, more cases were needed to evaluate the efficiency.
Ileo-ileal knot: a rare case of acute strangulated intestinal
obstruction
Kohei Taniguchi, Ryo Iida, Tomohiko Watanabe, Masahiko Nitta, Masao Tomioka,
Kazuhisa Uchiyama and Akira Takasu
pg(s) 109 - 113
<Abstract> - < PDF >
Strangulated intestinal obstruction is one of the most common types of acute abdomen and requires
urgent surgical treatment. Herein, we report a very rare case of strangulated intestinal obstruction caused
by an ileo-ileal knot. An 80-year-old woman was admitted to our hospital with suspicion of strangulation
ileus and underwent emergency laparotomy after investigation by exploratory single-port laparoscopy.
During surgery, a small bowel gangrene caused by an ileo-ileal knot was found. The gangrenous segment
was resected, and primary anastomosis was performed. Post-operative recovery was uneventful except for
a minor wound infection. Our extensive search of the literature found only 7 case reports of ileo-ileal
knot including ours. An ileo-ileal knot should be considered in the differential diagnosis of acute intestinal
obstruction, because this rare phenomenon requires urgent surgical treatment; and some complications
should be considered during or after surgery.
Discrimination between spinal extradural meningioma and
both intra and extradural meningioma: Case Report
Kenyu Ito, Shiro Imagama, Kei Ando, Kazuyoshi Kobayashi, Tetsuro Hida,
Mikito Tsushima, Akiyuki Matsumoto, Masayoshi Morozumi,
Satoshi Tanaka, Yoshihiro Nishida and Naoki Ishiguro
pg(s) 115 - 121
<Abstract> - < PDF >
Meningiomas are common spinal tumor and mostly located at intradura. Recurrence rate after surgery
for extradural meningioma was higher than intradural meningioma. A patient with intra and extradural
spinal meningioma was treated and discussed its features and clinical management. A 41-year-old woman
noted numbness of bilateral legs, gait disturbance, and mild bladder disturbance for over the two-month
period. Magnetic resonance imaging revealed an epidural mass at T8-9 involving the dura mater from
the left side. Intraoperatively, ultrasonography showed extradural tumor suppress the dura from the left
side and no subarachnoid space. Therefore, it was difficult to diagnose the tumor was located at only
extradural or both intra and extradural. The extradural tumor was resected as much as possible, then
ultrasonography was performed for the second time. The spinal cord was decompressed and subarachnoid
space was appeared with intradural tumor. The dura mater was opened in the midline for intradural
exploration, and the intradural tumor appeared beside the spinal cord. The dura mater with attachment
to the tumor was rescected. To prevent a recurrence, ultrasonography after removing extradural tumor is
recommended to detect intra dural tumor and invasion of tumor into dura mater. In such case, removing
only extradural meningioma is not enough, and gross total resection including intradural meningioma and
dura mater is required.