VOLUME 82 NUMBER 1 February 2020

Current Issue

ISSN 2186-3326
(Online ISSN)
ISSN 0027-7622
(Print ISSN--v.72no.3/4)

Impact Factor(2020)
 1.131

INVITED ARTICLE

Iatrogenic risk of osteonecrosis of the jaw? Bone substitutes for dental implants: a warning from Japan

Hideharu Hibi
pg(s) 1 - 3

<Abstract> - < PDF >

Commercial bone substitutes that are widely used for bone augmentation for dental implants are predisposing factors in the development of osteonecrosis of the jaw (ONJ), overlooking this situation may lead to serious problems. Most of these materials are supplied as inorganic porous granules of calcium phosphate, which have characteristics that exceed the bone resorption ability of normal osteoclasts; therefore, they can be equally regarded as existing antiresorptive necrotic bony granules in the body, i.e., micro-ONJs. In addition, because dental implants directly contact the surrounding bone without the periodontium with immunoprotective functions, the mucosal penetration of the dental implant itself predisposes the underlying bone to the risk of infection, latent osteomyelitis, and ONJ. Therefore, the remaining porous granules surrounding the dental implant pose an additional iatrogenic risk, even though the tissue may appear superficially healthy. In an aging society, an individual who was systemically healthy at the time of implantation with bone augmentation could develop osteoporosis or cancer bone metastasis later in life. ONJ can occur more easily if an antiresorptive agent such as bisphosphonates or denosumab is administered without sufficiently recognizing an intraoral situation. If the latent risk is known in advance, the selection or use of medicines could be restricted. Such restrictions can result in other crucial issues that are beyond the discretion of the dentists; however, dentists have not been warned about such possibilities. The use of antiresorptive agents and bone substitutes for dental implants should be reconsidered to avoid numerous adverse events such as ONJ.

ORIGINAL PAPERS

Association between locomotive syndrome and the Japanese version of the EQ-5D-5L in middle-aged and elderly people in Japan

Satoshi Tanaka, Kei Ando, Kazuyoshi Kobayashi, Taisuke Seki, Takashi Hamada, Masaaki Machino, Kyotaro Ota, Masayoshi Morozumi, Shunsuke Kanbara, Sadayuki Ito, Naoki Ishiguro, Yukiharu Hasegawa and Shiro Imagama
pg(s) 5 - 14

<Abstract> - < PDF >

The Japanese version of the EuroQol 5 dimension, 5 level version (EQ-5D-5L) can now be used to quantitatively evaluate the health-related quality of life (QoL) in Japan. Locomotive syndrome (LS) is a concept advocated in Japan to describe a condition requiring care for musculoskeletal disorders. However, no detailed study on the relationship between this index and LS in Japanese health checkup has been reported. We aimed to evaluate the relationship between the Japanese version of the EQ-5D-5L and LS. We enrolled 477 participants who were undergoing health checkups in Japan. All participants were administered the 25-question Geriatric Locomotive Functional Scale for the diagnosis of LS and the Japanese version of the EQ-5D-5L. We performed statistical analysis to compare the non-LS and LS patients; moreover, the risk factors and cut-off values were calculated and verified. The Japanese version of the EQ-5D-5L index was significantly lower in patients with LS than in non-LS patients and was significantly related to LS in logistic regression analysis. In subgroup analysis targeting the five dimensions of the EQ-5D-5L, it was seen that mobility, pain/discomfort, and self-care were significantly involved in LS. The cut-off value of the EQ-5D-5L index for LS was 0.875. The Japanese version of the EQ-5D-5L index was significantly related to LS in Japan. This index will be a useful tool that can easily measure health-related quality of life in middle-aged and elderly Japanese people. Future studies should investigate the relationship of not only LS but also various diseases with the Japanese version of the EuroQol 5 dimension, 5 level version.
Outcome of cesarean scar pregnancy treated with local methotrexate injection

Le Minh Tam, Tomomi Kotani, Tran Manh Linh, Phan Thi Minh Thu, Tran Viet Khanh, Nguyen Thi Kim Anh, Nguyen Tran Thao Nguyen, Yoshinori Moriyama, Eiko Yamamoto, Nguyen Vu Quoc Huy, Truong Quang Vinh, Cao Ngoc Thanh and Fumitaka Kikkawa
pg(s) 15 - 23

<Abstract> - < PDF >

Local injection of methotrexate (MTX) has been widely used for caesarean scar pregnancy (CSP),but the optimal candidate remains undetermined. The aim of this study is to determine the risk factors associated with treatment failure among patients who received a single dose of local MTX. This is a retrospective cohort study. Clinical information was compared between treatment success vs. failure groups. Risk factors related to treatment failure were also investigated with multivariate analysis. Of 47 patients diagnosed with CSP, 30 received local MTX injection. The initial serum ß- human chorionic gonadotropin (hCG) level in the failure group was significantly higher than in the success group (p = 0.048), and the cut-off value was 47,000 mIU/ml. The rate of type 2 position of the gestational sac in the failure group was significantly higher than in the treatment success group (p = 0.031). A high initial serum ß-hCG level (≥ 47,000 mIU/ml) was identified as the independent risk factor for treatment failure (adjusted odds ratio = 21.9; 95% confidence interval = 1.3–383.1). Type 2 gestational sac position and a higher level of ß-hCG at diagnosis appear to be associated with poor outcomes after local injection of a single dose of MTX.
Micro-computed tomography images of lung adenocarcinoma: detection of lepidic growth patterns

Shota Nakamura, Kensaku Mori, Shingo Iwano, Koji Kawaguchi, Takayuki Fukui, Shuhei Hakiri, Naoki Ozeki, Masahiro Oda and Kohei Yokoi
pg(s) 25 - 31

<Abstract> - < PDF >

Micro-computed tomography (μCT) provides extremely high-resolution images of samples and can be employed as a non-destructive inspection tool. Using μCT, we can obtain images comparable with microscopic images. In this work, we have attempted to take high-resolution images of the human lung using μCT. Compared to clinical high-resolution computed tomography (HRCT) images of living body (in-vivo imaging), we can obtain extremely high-resolution images by μCT of ex-vivo tissues (resected lungs) as three-dimensional data. The purpose of this study was to distinguish between areas of normal lung and lung cancer by μCT images in order to study the feasibility of cancer diagnosis using this novel radiological image modality. Ten resected human lungs containing primary cancer were fixed by Heitzman’s methods to obtain high-resolution μCT images. After fixation of the lung, images of the specimens were taken by μCT between January 2016 and November 2017. The imaging conditions were tube voltage: 90 kV and tube current: 110 μA. To compare details of images gained by conventional HRCT and μCT, we measured the thickness of the alveolar walls of the normal lung area and the cancer area of which alveoli might be replaced by tumor cells, and compared their appearance by means of histopathological images. All the nodules were diagnosed as adenocarcinoma. The median whole tumor size was 18 mm (9 mm–24 mm). Each specimen was clearly divided into areas of normal alveolar wall and of thickened alveolar wall on μCT ‘visually’. Median thickness of alveolar walls of the normal lung was 0.037 mm (0.034 mm–0.048 mm), and that of the cancer area was 0.084 mm (0.074 mm–0.094 mm); there was a statistically significant difference between both thicknesses by Student’s t-test (P < 0.01). The area of thickened alveolar walls on μCT corresponded well with the area of microscopically lepidic growth patterns of adenocarcinoma. We found that μCT images could be correctly divided by alveolar walls into normal lung area and lung cancer area. Further detailed investigations with regard to μCT are needed to make comparable histological diagnoses using μCT images with conventional microscopic methods of pathological diagnoses.
A prospective trial to evaluate treatment effects of a β-hydroxy-β-methylbutyrate containing nutrient for leakage at the anastomotic site after esophagectomy

Mitsuro Kanda, Masahiko Koike, Masahide Fukaya, Kazushi Miyata, Chie Tanaka, Daisuke Kobayashi, Masamichi Hayashi, Suguru Yamada, Goro Nakayama, Kenta Murotani, Michitaka Fujiwara, Masato Nagino and Yasuhiro Kodera
pg(s) 33 - 37

<Abstract> - < PDF >

Anastomotic leakage after esophagectomy is associated with prolonged hospitalization and increased medical cost. Additionally, it sometimes leads to a fatal condition and impaired postoperative quality of life. During the process of wound healing, β-hydroxy-β-methylbutyrate (HMB) is important for collagen biosynthesis. An open-label prospective intervention trial has been designed to evaluate the treatment effect of an enteral nutrient containing HMB with arginine and glutamine (Abound, Abbott Japan Co., Ltd.) for leakage at the anastomotic site after esophagectomy. Patients in whom leakage at the anastomotic site developed within 14 days after esophagectomy are eligible and Abound (24 g) is administered for 14 days through an enteral feeding tube. The target sample size is 10. The primary endpoint is duration between diagnosis and cure of leakage. Surgical procedure, safety, length of fasting, drainage placement and hospital stay, and nutritional status are determined as secondary endpoints. A historical control consisting of 20 patients who had leakage at the anastomotic site after esophagectomy between 2005 and 2018 at Nagoya University Hospital is compared with enrolled patients.
The new bioabsorbable sheet for the sling method in immediate breast reconstruction with expander-implant: a study protocol for interventional prospective study

Satoko Watanabe, Yuko Mukai and Yoshihiro Kimata
pg(s) 39 - 45

<Abstract> - < PDF >

The popularity of a sling method using biomaterial sheets for immediate breast reconstruction based on prosthesis has been increasing in western countries. However, acellular dermal matrix, which is representative of the biomaterial sheet, is not available and the sling method also has not been accepted in Japan. We focused on a new bioabsorbable sheet (NEOVEIL sheet) as a substitute for the sling method and report a prospective study protocol to assess the safety and effectiveness of this material. This was an ongoing, single center, open-label, single-arm study. Inclusion criteria and exclusion criteria are defined restrictively. If the surgeon determined that the perfusion of skin envelope after mastectomy is poor, the surgical procedure can be modified and that patient was excluded from the study. The primary outcome was the incidence of tissue expansion or implant explantation occurring within 1 month after surgery. The secondary outcomes are as follows: (1) aesthetic outcome using a rating scale; (2) symmetry of the nipple areolar complex position; (3) patient reported outcomes using BREAST-Q; (4) pain intensity using the Visual Analog Scale; (5) histology of the capsule around the tissue expander; (6) inflation volume at the first stage and overall inflation time of expansion; and (7) other adverse events regarding the surgery. This study will determine the safety and effectiveness of the sling method using a NEOVEIL sheet in Japanese women.
Estimating cost of hospitalization for childbirth at a tertiary hospital in Mongolia

Bolorchimeg Taazan, Eiko Yamamoto, Bayart Baatar, Avirmed Amgalanbaatar, Tetsuyoshi Kariya, Yu Mon Saw and Nobuyuki Hamajima
pg(s) 47 - 57

<Abstract> - < PDF >

Health services for pregnancy and delivery at public health facilities are fully subsidized by the government in Mongolia. However, it has been reported that health financing, budget planning, and implementation processes are weak. Therefore, this study aims to estimate the costs per inpatient of vaginal delivery and cesarean section (C-section) by using data gathered from a tertiary hospital in Ulaanbaatar. Inpatient and financial data were collected from the Statistics and Finance, Economics Department of National Center for Maternal and Child Health. A top-down method was used for the calculation of unit costs. The total number of deliveries in 2016 were 11,033, including 7,777 vaginal deliveries and 3,256 C-sections. The cost per inpatient stay for vaginal delivery and C-section were USD 255 and USD 592, respectively. The average cost per bed-day of the six departments of the obstetrics and gynecology hospital was USD 80. The percentage that represents employees’ salary in the cost per inpatient was as low as 12.4% for vaginal delivery and 18.5% for C-section, although the cost for salaries accounted for 51.2% of the total expenditure of the hospital. Results show that the cost per inpatient of C-section was two times higher than that of vaginal delivery. The cost of childbirths may account for approximately 9% of total health expenditure of the country. These results may be advantageous to the government in instituting a policy and controlling the health care budget to improve cost-effectiveness and equal access to all in health care services in Mongolia.
How emergency physicians choose chest tube size for traumatic pneumothorax or hemothorax: a comparison between 28Fr and smaller tube

Takafumi Terada, Tetsuro Nishimura, Kenichiro Uchida, Naohiro Hagawa, Maiko Esaki and Yasumitsu Mizobata
pg(s) 59 - 68

<Abstract> - < PDF >

Most traumatic pneumothoraxes and hemothoraxes can be managed non-operatively by means of chest tube thoracostomy. This study aimed to investigate how emergency physicians choose chest tube size and whether chest tube size affects patient outcome. We reviewed medical charts of patients who underwent chest tube insertion for chest trauma within 24 hours of admission in this retrospective, single-institution study. Patient characteristics, inserted tube size, risk of additional tube, and complications were evaluated. Eighty-six chest tubes were placed in 64 patients. Sixty-seven tubes were placed initially, and 19 additionally, which was significantly smaller than the initial tube. Initial tube size was 28 Fr in 38 and <28 Fr in 28 patients. Indications were pneumothorax (n=24), hemothorax (n=7), and hemopneumothorax (n=36). Initial tube size was not related to sex, BMI, BSA, indication, ISS, RTS, chest AIS, or respiratory status. An additional tube was placed in the same thoracic cavity for residual pneumothorax (n=13), hemothorax (n=1), hemopneumothorax (n=1), and inappropriate extrapleural placement (n=3). Risk of additional tube placement was not significantly different depending on tube size. No additional tube was placed for tube occlusion or surgical intervention for residual clotted hemothorax. Emergency physicians did not choose tube size depending on patient sex, body size, or situation. Even with a <28 Fr tube placed in chest trauma patients, the risk of residual hemo/pneumothorax and tube occlusion did not increase, and drainage was effective.
Risk factors for pulmonary infection after diagnostic bronchoscopy in patients with lung cancer

Takahiro Shimizu, Shotaro Okachi, Naoyuki Imai, Tetsunari Hase, Masahiro Morise, Naozumi Hashimoto, Mitsuo Sato and Yoshinori Hasegawa
pg(s) 69 - 77

<Abstract> - < PDF >

Pulmonary infection is a relatively rare but serious complication of flexible bronchoscopy. The aim of this study was to identify the risk factors for pulmonary infectious complications after diagnostic bronchoscopy in patients with lung cancer. We retrospectively analyzed the medical records of 636 patients who underwent bronchoscopic biopsy for lung cancer diagnosis between April 2011 and March 2016. We compared patients’ characteristics, chest computed tomography and bronchoscopic findings, undertaken procedures, and final diagnoses between patients who developed the complication and those who did not. Pulmonary infection after the diagnostic bronchoscopy occurred in 19 patients (3.0%) and included pneumonia in 16 patients and lung abscess in 3. Patients with larger lesions, presence of endobronchial lesions, histology of small cell lung cancer, and advanced disease stage tended to develop pulmonary infectious complications more often. Our multivariate analysis revealed that a larger lesion size and the presence of endobronchial lesions were independently associated with post-bronchoscopy pulmonary infection. Although we found no mortality associated with the infections, two patients were left with significant performance status deterioration after the pulmonary infection and received no anticancer treatment. In conclusion, endobronchial lesions and a larger lesion size are independent risk factors for the incidence of infections following bronchoscopic biopsy in patients with lung cancer.
Compatibility of magnetic resonance imaging in patients with orthopedic implants: manufacturer questionnaires

Katsuyuki Iwatsuki, Hidemasa Yoneda, Tetsuro Onishi, Hisao Ishii, Shigeru Kurimoto, Michiro Yamamoto, Masahiro Tatebe and Hitoshi Hirata
pg(s) 79 - 84

<Abstract> - < PDF >

In clinical practice, surgeons have stated that magnetic resonance imaging (MRI) can be performed in patients with titanium alloy implants. However, manufacturers and distributors of many implants may not comply with this common practice. As such, this study aimed to investigate manufacturers’ views on MRI use in patients fitted with their implants.
The questionnaire survey was conducted between May and August 2018.
Is your product compatible with MRI? ( ) Select from (1) to (3).
In case of (1) or (2), up to ( ) Tesla.
(1) MRI can be performed even at the sites of implanted fixators.
(2) MRI can be performed at sites without implanted fixators.
(3) MRI cannot be performed, or the manufacturer does not approve MRI use (cannot issue a certificate).
The questionnaire forms were sent to 12 manufacturers, and the response rate was 100%. Manufacturers responded that they could not publicly allow MRI use in patients with their products.
These findings do not conclude that MRI cannot be performed in such patients. This survey revealed that currently decisions regarding MRI use is left to the treating physicians. This situation poses a great problem for medical safety and imposes a substantial burden on physicians. As many problems remain in the field of orthopedic surgery, manufacturers of implants should proactively manage issues surrounding the usage of MRI.
Editors' Choice
Stanniocalcin-1 mRNA expression in soft-tissue tumors

Tetsuro Yamagishi, Hiroyuki Kawashima, Akira Ogose, Takashi Ariizumi, Naoki Oike, Taro Sasaki, Hiroshi Hatano and Naoto Endo
pg(s) 85 - 92

<Abstract> - < PDF >

Stanniocalcin-1 (STC1) is a glycoprotein that was originally identified as a calcium-regulating hormone in bony fish, and that has been shown to also critically mediate cell growth, proliferation and differentiation, etc. in humans. Increased STC1 expression levels have been previously detected in different human cancer samples, such as those isolated from lung, breast, ovary, colon, pancreas, and liver tumors; thus, the present study evaluated STC1 expression in various soft-tissue tumors. STC1 mRNA isolated from 16 cell lines and 186 clinical soft-tissue tumor specimens were analyzed via quantitative real-time PCR, and the calculated expression levels were normalized to those exhibited by STC1-expressing MDA-MB-231 cells. The results of these analyses did not reveal any specific histological tumor types that displayed significantly increased STC1 expression; however, they did not indicate that STC1 expression was significantly higher in malignant compared to benign soft-tissue tumors. Furthermore, in adipocytic tumors, STC1 expression in dedifferentiated liposarcomas was found to be highest and lowest in lipoma tissues, respectively, suggesting that adipocytic tumors may express increasely high levels of STC1 mRNA as they become histologically more advanced. STC1 expression correlates with the malignancy grade in soft-tissue tumors.
Editors' Choice
Efficacy of pectoral nerve block type-2 (Pecs II block) versus serratus plane block for postoperative analgesia in breast cancer surgery: a retrospective study

Kazumi Kubodera, Tasuku Fujii, Akiko Akane, Wakana Aoki, Akiko Sekiguchi, Keiko Iwata, Makiko Ban, Reiko Ando, Nozomi Nakamura, Yasuyuki Shibata and Kimitoshi Nishiwaki
pg(s) 93 - 99

<Abstract> - < PDF >

Thoracic wall nerve blocks reduce postoperative acute pain after breast cancer surgery (BCS); however, their short-term effects and the most effective technique remain unclear. To compare the effects of pectoral nerve block type-2 (Pecs II block) and serratus plane block for postoperative short-term analgesia, we retrospectively reviewed 43 BCS patients who underwent Pecs II block (n=22) or serratus plane block (n=21). The primary outcome was the proportion of patients with no complaints of pain 2 months post-BCS. The odds ratio (OR) was assessed, adjusting for axillary lymph node dissection. The secondary outcomes were pain severity 24 hours and 2 months post-operation using the numerical rating scale score, and morphine consumption within 24 hours. The proportion of patients without pain 2 months post-BCS was significantly less with Pecs II block than in patients with serratus plane block (55% vs. 19%, adjusted OR, 5.04; 95% confidence interval, 1.26–20.07; P=0.02); the median [interquartile range] score for pain 2 months post-operation was also significantly lower with Pecs II block (Pecs II block 0.5 [0–1] vs. serratus plane block 1 [1–2]); P=0.03). Regarding post-BCS acute analgesia, the median [interquartile range] postoperative 24-hour pain score was 2 [1–3] and 3 [1.5–3.5], and the median morphine consumption within 24 hours was 1.5 [0.75–5.5] and 3 [1.5–10] mg in Pecs II block and serratus plane block (P=0.47 and P=0.11), respectively. This study suggests that Pecs II block prevents short-term post-BCS pain better than serratus plane block. However, further studies are needed in order to support this finding.
A comparison of the features of fluorine-18 fluorodeoxyglucose-positron emission tomography (FDG-PET) between IgG4-related disease with bilateral hilar lymphadenopathy and sarcoidosis

Yoko Ozawa, Hiroshi Yamamoto, Masanori Yasuo, Masamichi Komatsu, Atsuhito Ushiki, Hideaki Hamano, Takeshi Uehara, Satoshi Kawakami, Akira Fujita, Yasunari Fujinaga, Kazuhiro Oguchi, Shigeyuki Kawa and Masayuki Hanaoka
pg(s) 101 - 111

<Abstract> - < PDF >

We aimed to show the differentiation of the degree and distribution on Fluorine-18 fluorodeoxyglucosepositron emission tomography (FDG-PET) between patients with immunoglobulin G4-related disease (IgG4-RD) and sarcoidosis, though both diseases frequently show bilateral hilar lymphadenopathy (BHL). The clinical records were retrospectively reviewed in 25 patients with IgG4-RD with BHL and 15 patients with sarcoidosis (stage I–II) diagnosed at Shinshu University Hospital. All patients underwent FDG-PET at Aizawa Hospital from January 2004 to December 2015. The FDG accumulation pattern and maximum standardized uptake value (SUVmax) of the hilar lymph nodes were compared between the two groups. The IgG4-RD group (21 men; median age 69 years) showed a significant male predominance and older age compared with the sarcoidosis group (3 men, median age 55.4 years). The IgG4-RD group showed a significantly higher incidence of FDG accumulation in the lachrymal gland, submandibular gland, pancreas, prostate and periurethral and periarterial regions compared with the sarcoidosis group. In contrast, the sarcoidosis group showed a significantly higher incidence of FDG accumulation in the supraclavicular and abdominal lymph nodes, muscle and soft tissues compared with the IgG4-RD group. Furthermore, the SUVmax of the hilar lymph nodes was significantly higher in the sarcoidosis group (median 7.20) than in the IgG4-RD group (median 4.20, p=0.002). In conclusion, significant differences were observed in the FDG accumulation patterns and SUVmax values of the hilar lymph nodes between IgG4-RD with BHL and sarcoidosis, although both diseases develop through the lymphatic routes of the lungs and are frequently associated with BHL.

NOTE

Disease frequency among inpatients at a tertiary general hospital in Lao PDR

Viengsakhone Louangpradith, Bounfeng Phoummalaysith, Tetsuyoshi Kariya, Yu Mon Saw, Eiko Yamamoto and Nobuyuki Hamajima
pg(s) 113 - 121

<Abstract> - < PDF >

In Lao People’s Democratic Republic (Lao PDR), reports on disease frequency are very limited. This study aimed to report frequencies of the main cause of admission among inpatients of a tertiary general hospital (Mittaphab Hospital) in Vientiane. Subjects were inpatients who were admitted from January 3 to February 2 in 2017. The dataset were made as a pilot run to establish hospital statistics. The data on sex, age, address (province), dates of admission and discharge, and main diagnosis were collected from paper-based medical charts. International Classification of Diseases 10 was applied for classifying the main diagnosis. During the 1-month period, 1,201 inpatients (637 males and 564 females) were admitted, including 171 (14.2%) aged <20 years and 254 (21.1%) aged ≥60 years. About 20% patients were from outside of Vientiane. Among them, 67.5% (62.5% in males and 73.8% in females) were admitted within 7 days. The main causes with more than 10% in males were injury and poisoning S00-T98 (49.8%), while those in females were injury and poisoning S00-T98 (25.2%), pregnancy and childbirth O00-O99 (19.0%), and diseases of genitourinary system N00-N99 (13.7%). Injury and poisoning S00-T98 among inpatients aged <20 years was 81.8% in males and 59.0% in females. Among those aged 20–59 years, it was 49.9% and 22.4%, and among those aged ≥60 years it was 22.3% and 16.9%, respectively. This is the first report on the frequencies of main diseases among inpatients in Lao PDR. Injury was the first main cause of admission at the tertiary hospital.

CASE REPORTS

Repair of temporal branch of the facial nerve with novel polyglycolic acid-collagen tube: a case report of two cases

Yutaka Nakamura, Keisuke Takanari, Katsumi Ebisawa, Miki Kanbe, Ryota Nakamura and Yuzuru Kamei
pg(s) 123 - 128

<Abstract> - < PDF >

Autologous nerve transplantation has been the gold standard in the treatment of facial nerve injury, however it has not been achieved satisfactory result and needs donor sacrifice. A polyglycolic acid collagen conduit (Nerbridge, Toyobo Co., Japan) has the potential to compare to or exceed autologous nerve grafts in promoting nerve regeneration. Here we report two cases of traumatic temporal facial nerve injury repairs with Nerbridge. The severed temporal branch of the facial nerve was repaired with Nerbridge conduits in two patients. Recovery of movement was assessed by clinical photography and needle electromyography. The frontal muscle started moving five months postoperatively in both cases. Electromyography at twelve months showed polymorphic electric discharge, suggesting connection of the injured nerve to the frontal muscle. In the final results, each patient had good eyebrow elevation distance and moderate forward gaze recovery in comparison to their healthy sides. Considering that facial nerves are reported to recover incompletely even in autologous nerve graft repair cases, our two cases showed reasonable recovery comparable to nerve autografting. The Nerbridge conduit is a promising alternative to standard treatments for facial nerve recovery.
Pathological changes of the myocardium in reworsening of anthracycline-induced cardiomyopathy after explant of a left ventricular assist device

Hiroaki Hiraiwa, Takahiro Okumura, Shinya Shimizu, Yoshihito Arao, Hideo Oishi, Hiroo Kato, Tasuku Kuwayama, Shogo Yamaguchi, Tomoaki Haga, Tsuyoshi Yokoi, Toru Kondo, Yuki Sugiura, Naoaki Kano, Naoki Watanabe, Kenji Fukaya, Kenji Furusawa, Akinori Sawamura, Ryota Morimoto, Kazuro Fujimoto, Masato Mutsuga, Akihiko Usui and Toyoaki Murohara
pg(s) 129 - 134

<Abstract> - < PDF >

We herein report the long-term changes in cardiac function and pathological findings after successful explantation of a left ventricular assist device in a 42-year-old patient with anthracycline-induced cardiomyopathy with reworsening heart failure. Endomyocardial biopsy samples revealed that the cardiomyocyte diameter decreased and collagen volume fraction increased just after left ventricular assist device explantation. The collagen volume fraction decreased after 6 months, despite preserved systolic function. At 5 years after left ventricular assist device explantation, the systolic function markedly decreased and cardiomyocyte diameter increased. Pathological changes of the myocardium may enable the identification of cardiac dysfunction prior to echocardiographic changes in patients with reworsening heart failure after left ventricular assist device explantation.
Pediatric nasopharyngeal cancer with repeated oligometastases involving the bone, liver and distant lymph nodes who achieved cure after radiotherapy

Takayuki Ohguri, Sho Kakinouchi, Hajime Imada, Atsuji Matsuyama, Katsuya Yahara, Sota Nakahara, Nobusuke Hohchi, Hideaki Suzuki and Yukunori Korogi
pg(s) 135 - 141

<Abstract> - < PDF >

Systemic chemotherapy is a standard treatment for Stage IVc nasopharyngeal carcinoma (NPC). Stage IVc NPC patients with oligometastases have a better prognosis, and local therapy has an important role in further development of the disease. However, the efficacy of local therapy to the metastases in patients with multiple-site and/or multiple-organ metastases is limited due to the aggressive behavior of the tumor. We report a NPC case in a pediatric patient with repeated oligometastases involving the bone, liver and distant lymph nodes who achieved 10-year disease free status after initial chemotherapy and radiotherapy to all the metastases. This very rare case demonstrated that radiotherapy to oligometastatic lesions have a potential to cure repeated oligometastases which involved multiple-organ metastases in a pediatric NPC with stage IVc.
Temporal arteritis with focal pachymeningitis: a deceptive association

Raja K Kutty, Michitaka Maekawa, Tsukasa Kawase, Naoko Fujii and Yoko Kato
pg(s) 143 - 150

<Abstract> - < PDF >

Temporal arteritis is an immunological disorder mostly affecting the elderly population. This frequently occurs in association with other rheumatological diseases of the elderly. The symptoms of Temporal arteritis overlap with other symptoms of commonly occurring diseases in that population. Focal pachymeningitis in association with temporal arteritis is a rare finding and a literature review revealed less than ten cases of similar associations being published. In such instances, this finding can be mistaken for aseptic meningitis and treated erroneously. We present our case, discuss the management and summarize a review of literature about focal pachymeningitis along with temporal arteritis which was managed successfully with steroids and Toclizumab.