INVITED REVIEW ARTICLE
Possible disease-protective roles of fibroblasts in cancer and
fibrosis and their therapeutic application
Yukihiro Shiraki, Shinji Mii, Nobutoshi Esaki and Atsushi Enomoto
pg(s) 484 - 496
<Abstract> - < PDF >
Cancer and fibrotic diseases are characterized by continuous inflammation, tissue wounds, and injuries.
Cancer is a “wound that does not heal,” and the uncontrolled proliferation of cancer cells disrupts normal
tissue integrity and induces stromal fibroinflammatory reactions. Fibroblasts proliferate extensively in the
stroma, playing a major role in the development of these diseases. There has been considerable evidence
that fibroblasts contribute to fibrosis and tissue stiffening and promote disease progression via multiple
mechanisms. However, recent emerging findings, mainly derived from single-cell transcriptomic analysis,
indicated that fibroblasts are functionally heterogeneous, leading to the hypothesis that both disease-promoting and -restraining fibroblasts exist. We recently showed that a fibroblast population, defined by
the expression of the glycosylphosphatidylinositol-anchored membrane protein Meflin may suppress but
not promote fibrotic response and disease progression in cancer and fibrotic diseases. Although currently
hypothetical, the primary function of Meflin-positive fibroblasts may be tissue repair after injury and
cancer initiation occurred. This observation has led to the proposal of a potential therapy that converts
the phenotype of fibroblasts from pro-tumor to anti-tumor. In this short review, we summarize our recent
findings on the function of Meflin in the context of cancer and fibrotic diseases and discuss how we
can utilize this knowledge on fibroblasts in translational medicine. We also discuss several aspects of the
interpretation of survival analysis data, such as Kaplan-Meier analysis, to address the function of specific
genes expressed in fibroblasts.
REVIEW ARTICLE
Pathological significance and classification of endolymphatic
hydrops in otological disorders
Michihiko Sone, Tadao Yoshida, Satofumi Sugimoto, Masumi Kobayashi, Masaaki Teranishi and Shinji Naganawa
pg(s) 497 - 505
<Abstract> - < PDF >
We summarize the presence of endolymphatic hydrops (EH) in otological disorders evaluated with
magnetic resonance imaging (MRI) of temporal bones, and propose a classification of EH based on its
pathological significance. A search of the literature published in English-language journals was performed
using electronic databases, especially focusing on EH-related otological disorders. Clinical articles that
contained the terms EH and contrast-MRI published from 2007 to the present, with relevant human temporal
bone studies, were included. The following three main points are discussed based on the results in the
relevant articles: i) otological disorders that present EH, ii) current grading for evaluation of EH on MRI,
and iii) a proposed classification of EH based on its pathological significance. MRI evaluation revealed that
EH exists extensively not only in ears with typical Meniere’s disease (MD), but also in those with various
other otological disorders. The etiological classification of EH helps to summarize ideas for determining the
pathophysiology of otological disorders, while a therapeutic classification provides clues to their management. MRI evaluations of EH have led to breakthroughs in investigations of EH in otological disorders.
Precise grading for evaluation and clarification of EH on MRI based on its pathological significance could
provide keys to elucidating the pathophysiology of EH-related otological disorders.
ORIGINAL PAPERS
Effects of serratus anterior plane block and thoracic
paravertebral nerve block on analgesia, immune function
and serum tumor markers in patients
after thoracoscopic radical resection of lung cancer
Xiaole Liu and Jing An
pg(s) 506 - 515
<Abstract> - < PDF >
We aimed to assess the effects of serratus anterior plane block (SAPB) and thoracic paravertebral nerve
block (TPVB) on analgesia, immune function and serum tumor markers in patients after thoracoscopic
radical resection of lung cancer. A total of 132 patients enrolled from February 2019 to November 2020
were prospectively selected and randomly divided into 3 groups (n=44). Control group received general
anesthesia. After induction of general anesthesia, TPVB or SAPB group was given TPVB or SAPB. Their
clinical data, operation conditions, Visual Analogue Scale (VAS) score, immune function, serum tumor
markers and adverse reactions were compared. TPVB and SAPB groups had lower dosage of sufentanil
during operation, later time of first pressing patient-controlled intravenous analgesia (PCA) pump after
operation and smaller number of pressing PCA pump within 48 h after operation than those of control
group (P<0.05). VAS scores at rest and coughing decreased 6 and 12 h after operation in TPVB and SAPB
groups compared with that in control group (P<0.05). Cluster of differentiation 3 (CD3)+, CD4+ and CD4+/CD8+ ratio were higher, while CD8+ was lower 24 and 48 h after operation in TPVB and SAPB groups
than those of control group (P<0.05). TPVB and SAPB groups had lower serum tumor marker levels 24
h after operation than those of control group (P<0.05). The three groups had similar incidence rates of
adverse reactions (P>0.05). SAPB and TPVB can markedly improve postoperative analgesic effect, enhance
immune function and decrease serum tumor marker levels in patients receiving thoracoscopic radical
resection of lung cancer, without increasing adverse reactions. However, TPVB may puncture the pleura.
Patient factors influencing a delay in diagnosis in pediatric
spinal cord tumors
Hiroyuki Koshimizu, Hiroaki Nakashima, Kei Ando,
Kazuyoshi Kobayashi, Yusuke Nishimura, Masaaki Machino,
Sadayuki Ito, Shunsuke Kanbara, Taro Inoue, Hidetoshi Yamaguchi,
Naoki Segi, Hiroyuki Tomita and Shiro Imagama
pg(s) 516 - 525
<Abstract> - < PDF >
The diagnosis of pediatric spinal cord tumor is frequently delayed due to the presence of non-specific
symptoms. We investigated the factors influencing the delay between the first symptom presentation and
the diagnosis for pediatric spinal cord tumor. We retrospectively analyzed 31 patients of age <20 years
(18 men, 13 women) who underwent surgery for spinal cord tumor at a single center during 1998–2018.
We extracted the relevant data on patients’ symptoms, affected spinal location (cervical: C1-7, thoracic:
T1-T12, and lumbosacral: L1-S), and tumor anatomical location (extradural, intradural extramedullary,
and intramedullary tumor) that could potentially affect the duration of symptom presentation prior to
the diagnosis. The most common symptom presented in the patients was pain (n = 22, 71.0 %). Motor
symptoms such as paralysis was associated with early diagnosis (P = 0.039). The duration of symptoms
prior to diagnosis was found to be significantly longer in patients with spinal tumor in the lumbar-sacral
region than in those with the involvement of the cervical and thoracic regions (2.1 ± 1.7 months vs 13.6
± 12.1 months; P = 0.006 and 2.9 ± 2.2 months vs 13.6 ± 12.1 months; P = 0.012, respectively). Our
study results demonstrated that pain was the most common symptom in the examined patients, although
it did not affect the delay in diagnosis, whereas the presentation of motor symptoms was helpful in the
diagnosis of pediatric spinal cord tumor and the diagnosis could be delayed in lumbar-sacral spinal tumors.
Effectiveness of a new interactive web teaching material for
improving lung auscultation skills: randomized controlled
trial for clinical nurses
Shintaro Higashiyama, Koji Tamakoshi and Toyoaki Yamauchi
pg(s) 526 - 538
<Abstract> - < PDF >
We developed a new interactive web-based teaching material to improve lung auscultation skills. Our
objective was to investigate the effectiveness of the web-based teaching material on nurses with less than
one-year work experience, using a prospective, open-label, stratified block randomized controlled trial. Of
the 69 participants, 23, 22, and 24 participants were assigned to the web-based, paper-based, and control
(with no intervention) groups, respectively. Using a simulator, a discrimination test on seven lung sounds,
such as “normal,” “wheeze,” “rhonchi,” “coarse crackles,” “fine crackles,” “left lung diminish,” and “right
lung absent,” was conducted. Next, a post-test was conducted after one-week of training. Answers with
formal names were considered “correct”; those with common names, misspellings, and without left and
right parts were considered “insufficient”; and wrong answers were considered “incorrect.” The control
group showed no significant difference between the pre-test and post-test for any lung sounds. The paper-based group showed significant improvement in performance for “wheeze” (p=0.004) and “coarse crackles”
(p=0.035). The web-based group showed a significant improvement in performance for “fine crackles”
(p=0.026). The number of correct answers in the post-test was higher in the paper- and web-based groups
than the control group (p=0.023). The web-based teaching materials that we had developed effectively
improved the ability of new graduate nurses to auscultate lung sounds. Additionally, the results suggest
that the combined use of web- and paper-based teaching materials may be more effective since the sounds
that each method enhanced their ability to auscultate different lung sounds.
Satisfactory mid- to long-term clinical and radiographic
outcomes after surgical treatment of radial neck fracture in
10 children
Shinsuke Takeda, Hidemasa Yoneda, Masahiro Tatebe,
Toshikazu Kurahashi, So Mitsuya and Hitoshi Hirata
pg(s) 539 - 546
<Abstract> - < PDF >
Complications after surgical treatment of pediatric radial neck fractures are common. The purpose
of this study was to evaluate the mid- to long-term clinical and radiographic outcomes after surgical
treatment of pediatric radial neck fractures. We assessed 10 children who had been surgically treated
for radial neck fractures. We mainly performed percutaneous intrafocal pinning to reduce the fracture;
where this was inappropriate, we performed open reduction. Mid- to long-term clinical and radiographic
outcomes were assessed, as well as whether these affected patient-related outcomes (Hand 20 questionnaire)
at the final follow-up. Of the 10 patients (seven boys; mean age, 9 years; age range, 5–14 years; four
fractures on the right-hand side, six on the left), four each were grades II and III, and two were grade
IV, according to the Judet classification. The mean follow-up time was 6.7 (range, 3.6–11.2) years. Eight
patients had restricted forearm pronation. The mean radial neck angulation on the fractured side was 36°
(range, 5°–96°), preoperatively, and 2° (range, 0°–11°) at the final follow-up. There were eight cases of
radial head overgrowth, three of premature physeal closure, two of notching of the radial neck, and one
of heterotopic ossification. According to the Leung/Peterson Classification, four patients had “excellent,”
three had “good,” and three had “fair” functionality. Eight patients had a perfect score upon completing
the Hand 20 questionnaire. In conclusion, postsurgical patient-related outcomes for the 10 cases were
satisfactory despite slightly restricted forearm range of motion and complications detected using radiography.
Editors' Choice
Clinical impact of standardized creatinine on dose
adjustment of capecitabine
Ayaka Ito, Kazuya Ichikawa, Masayuki Miyazaki, Atsunobu Sagara, Toshiki Motegi, Yuichi Ando, Koji Senzaki, Taku Nagai and Kiyofumi Yamada
pg(s) 547 - 553
<Abstract> - < PDF >
Although the Cockcroft-Gault equation is still used for the dose adjustment of many drugs that
have been approved prior to creatinine standardization, the clinical impact of standardized creatinine in
the dose adjustment of capecitabine is poorly understood. We focused on patients with borderline renal
function and evaluated the tolerability and safety of capecitabine in patients who received capecitabine
plus oxaliplatin (Cape-Ox). We retrospectively identified patients with resected colorectal cancer who
had received adjuvant therapy with Cape-Ox regimen. Creatinine clearance (CrCL) was calculated by the
Cockcroft–Gault equation with standardized creatinine measured using enzymatic methods, and adjusted
CrCL was estimated by adding 0.2 (mg/dL) to the serum creatinine in the equation. We defined patients
with “pseudo-normal” renal function as those who had an adjusted CrCL of ≤50 mL/min in patients with
normal renal function (CrCL >50 mL/min). We evaluated the tolerability and grade 2 or severer adverse
events of capecitabine treatment. One hundred four patients had normal and 10 had impaired renal function
(CrCL <50 mL/min). Among the 104 patients with normal renal function, 23 (22.1%) had pseudo-normal
renal function. Seventeen patients completed the eight cycles of Cape-Ox therapy without treatment delay
or dose reduction, and all of them had truly normal renal function. The patients with pseudo-normal renal
function were more likely to have grade 2 or severer thrombocytopenia than those with truly normal renal
function. We should recognize correctly the clinical impact of standardized creatinine in the treatment of
borderline renal function with Cape-Ox regimen in patients.
Relationships between sleep efficiency and lifestyle evaluated
by objective sleep assessment: SLeep Epidemiology Project
at University of Tsukuba
Yu Ikeda, Emi Morita, Kei Muroi, Yo Arai, Tomohiko Ikeda, Tsukasa Takahashi, Nagisa Shiraki, Shotaro Doki, Daisuke Hori, Yuichi Oi, Shin-ichiro Sasahara, Asuka Ishihara, Sumire Matsumoto, Masashi Yanagisawa, Makoto Satoh and Ichiyo Matsuzaki
pg(s) 554 - 569
<Abstract> - < PDF >
Objectively measured sleep efficiency has recently been shown to be associated with health problems.
Although several factors have previously been reported to be associated with sleep efficiency, most of
these studies were conducted on older or younger adults, and the factors associated with sleep efficiency
in healthy workers remain unknown. The aim of this study was to investigate the relationship between
sleep efficiency and lifestyle factors using sleep measurement data recorded by an activity meter worn by
workers. In total, 693 workers (male, 43.6%; mean age, 42.7 ± 11.3 years) were recruited from five offices
in 2017. Sleep was measured over the period of 1 week by actigraphy. Workers’ attributes, lifestyle habits,
and occupational stress were identified using a questionnaire, and the association of sleep efficiency with
lifestyle, occupational stress, and attributes was explored by logistic regression analysis. A logistic regression
analysis using attributes and occupational stress as adjustment variables revealed that “longer sleeping hours
on weekends than on weekdays” [odds ratios (OR), 0.66; 95% confidence interval (CI), 0.47–0.94], “water
ingestion at bedtime” [OR, 2.09; 95% CI, 1.28–3.41], and “smartphone use at bedtime” [OR, 1.90; 95%
CI, 1.28–2.83] were associated with decreased sleep efficiency. This study found that lifestyle habits were
associated with sleep efficiency among workers. It is necessary to verify whether intervention in these
lifestyle habits would contribute to the improvement of sleep efficiency in future studies.
Relationship between changes in physical function parameters
and Roland-Morris disability questionnaire score after
decompression surgery for lumbar spinal canal stenosis
Hiroto Takenaka, Hideshi Sugiura, Mitsuhiro Kamiya,
Kasuri Nishihama, Atsuki Ito, Junya Suzuki, Morio Kawamura and Shuntaro Hanamura
pg(s) 570 - 579
<Abstract> - < PDF >
Although decompression surgery for lumbar spinal canal stenosis (LSS) improves leg symptoms, low
back pain (LBP), and disability, the factors related to the improvement of subjective disability have not
been studied sufficiently. The purpose of the study was to clarify the relationship between subjective
disability and objective physical function parameters. A total of 51 patients who underwent decompression
were included and evaluated preoperatively and 6 and 12 months postoperatively. Patient-reported outcomes
related to activity limitation due to LBP were evaluated using Roland–Morris disability questionnaire (RDQ)
and VAS (Visual Analog Scale). Physical function was assessed using 6-min walk distance (6MWD) and
trunk muscle strength. Univariate analysis and multivariable linear regression analysis were performed
to identify significant factors for RDQ score change. The 6- and 12-month postoperative RDQ scores,
VAS scores, and trunk extensor strength significantly improved relative to the preoperative values. In the
univariate analysis, age, changes in VAS (LBP, leg pain, and numbness) scores, and change in 6MWD
were associated with the RDQ score change (p < 0.05). Multivariable linear regression showed that 6MWD
changes were significantly associated with RDQ score changes, explaining 41% of the variance in the
RDQ score change. This study showed the change in 6MWD was significantly associated with the RDQ
score change. Our results suggest that improving 6MWD may reduce disability in activities of daily living.
The effect of a 6-month walking program
on biochemical parameters in sedentary adults
with type 2 diabetes mellitus
Aleksandar Antonijević, Emilija Stojanović, Aleksandar Jevtić,
Vladimir Živković, Sergey Bolevich and
Vladimir Jakovljević
pg(s) 580 - 592
<Abstract> - < PDF >
This study assessed the effect of a 6-month walking program on biochemical parameters in patients with
type-2 diabetes mellitus. A group of 40 sedentary patients with type-2 diabetes volunteered to participate
in this study. Plasma glucose, triglyceride, total cholesterol, low-density lipoprotein cholesterol (LDL),
high-density lipoprotein cholesterol (HDL), aspartate aminotransferase (AST), alanine aminotransferase
(ALT), gamma-glutamyl transferase, urea, creatinine, uric acid, C-reactive protein (CRP), and erythrocyte
sedimentation rate were measured. Differences in outcome measures between pre- and post-intervention
were assessed using paired t-test or Wilcoxon signed-rank test, with effect sizes interpreted separately for
normally (μ2 : small 0.01–0.06, moderate 0.061–0.14, and large >0.14) and non-normally distributed data
(r: small = 0.1–0.3, moderate = 0.3–0.5, and large >0.5). Significant (p < 0.001) large decrease between
the initial and final measurements was observed for glucose (r = 0.62), total cholesterol (μ2 = 0.88),
triglycerides (r = 0.62), LDL (r = 0.61), AST (μ2 = 0.82), ALT (μ2 = 0.79), gamma-glutamyl transferase
(μ2 = 0.79), urea (μ2 = 0.92), creatinine (r = 0.62), uric acid (r = 0.62), CRP (μ2 = 0.80), and erythrocyte
sedimentation rate (μ2 = 0.58). On the other hand, significant (p < 0.001) large increase between the
initial and final measurements was observed for HDL (r = 0.62). Supervised 6-month aerobic walking
program is an effective strategy in (1) reducing hyperglycemia; (2) increasing HDL and reducing LDL, and
triglycerides; (3) reducing plasma biomarkers of liver dysfunction, kidney dysfunction, and inflammation
in type-2 diabetic patients.
Children with neuro-developmental disorders at Center for
Child and Adolescent Mental Health in Cambodia
Sreyleap Moeun, Jegannathan Bhoomikumar, Puthy Pat,
Tetsuyoshi Kariya, Yunosuke Suzuki, Nobuyuki Hamajima, Dearozet Sok
and Eiko Yamamoto
pg(s) 593 - 606
<Abstract> - < PDF >
The Center for Child and Adolescent Mental Health (CCAMH) is one of the centers that have psychiatric specialists for children in Cambodia. This study aims to understand the characteristics of children
with neuro-developmental disorders, especially autism spectrum disorder (ASD), at CCAMH. This study
included 440 cases that were randomly chosen from 2,147 new patients at CCAMH in 2018–2019 and
were aged 0–12 years. Socio-demographic factors, parent’s information, obstetrical factors, and clinical data
were collected from patients’ records. A logistic regression analysis and Pearson’s chi-square test were
used to compare the characteristics between children who were finally diagnosed with ASD and the others
(non-ASD). Of the 440 patients, most were male (75.2%), 0–4 years old (57.7%), and diagnosed with ASD
(50.0%). Common symptoms were delay of speech, playing alone, and hyperactivity. ASD was significantly
more prevalent in male patients compared to females and in the 0–4 years age group compared to the
5–12 years age group. Parents who lived in Phnom Penh and had high education were more likely to
visit the CCAMH with their children who were diagnosed with ASD. Regarding treatment, approximately
half of all 440 patients had family counselling and psychosocial education. ASD patients had more speech
therapy, special education and structured teaching, and networking and coordination therapy compared to
non-ASD patients. To provide education and therapy to children with ASD and their parents from the
early stage, information about the center and ASD should be widely distributed to all parents in Cambodia.
Association between serum carotenoids and premature
mortality in a population-based case-control study
Ryosuke Fujii, Koji Suzuki, Hiroya Yamada, Miyuki Kawado, Shuji Hashimoto, Yoshiki Tsuboi, Kenji Wakai, Hiroyasu Iso, Yoshiyuki Watanabe, Yoshihisa Fujino, Akiko Tamakoshi and JACC Study Group
pg(s) 607 - 620
<Abstract> - < PDF >
Carotenoids are abundant pigments mainly contained in vegetables and fruits, and show antioxidant
properties by quenching free radicals in human body. Few studies have investigated associations between
serum carotenoid levels and premature mortality. The objective of this study was to investigate the association
between serum carotenoid level and premature mortality in a Japanese population. This study
included 446 Japanese adults (174 men, aged of 40–64) recruited as participants in the Japan Collaborative
Cohort (JACC) Study. Serum carotenoid level was measured by high-performance liquid chromatography.
Premature mortality was defined as death before 65 years old during the follow-up period. Premature
mortality was ascertained in 60 men (34.5%) and 65 women (23.9%). In men, compared to the 1st tertile
of serum β-cryptoxanthin and provitamin A, those who were in the 3rd tertile had lower risks of premature
all-cause mortality (OR, 95% CI: 0.19, 0.07–0.47 for β-cryptoxanthin, and 0.24, 0.09–0.61 for provitamin
A). In women, compared to the 1st tertile of serum β-cryptoxanthin, those who were in the 3rd tertile had
higher risks of premature all-cause mortality (OR, 95% CI: 1.94, 1.00–4.03). These significant associations
were observed in analyses for premature cancer mortality. We found significant associations between higher
levels of serum β-cryptoxanthin and provitamin A and lower risks of premature mortality among Japanese
men, while a different directional association was found in women. Although these findings suggest roles
of serum carotenoids on premature mortality, further studies are needed to validate this association in
other populations.
The finger-to-nose test improved diagnosis of cerebrovascular
events in patients presenting with isolated dizziness
in the emergency department
Kazuki Nishida, Takuya Usami, Nana Matsumoto, Mitsuaki Nishikimi,
Kunihiko Takahashi and Shigeyuki Matsui
pg(s) 621 - 629
<Abstract> - < PDF >
It is difficult to identify patients with isolated dizziness caused by cerebrovascular events. The estimated
risk of cerebrovascular events in isolated dizziness patients is not completely understood. We aimed to
evaluate the association of the finger-to-nose test (FNT) in diagnosing cerebrovascular events in isolated
dizziness patients in emergency departments (EDs). We combined 2 datasets from a single center for
consecutive isolated dizziness patients, with the same inclusion and exclusion criteria. Those who met
any of the following criteria were excluded: no FNT data, age < 16 years, and psychological trauma.
The primary outcome was cerebrovascular event, which was defined as cerebral stroke due to cerebral
infarction, cerebral hemorrhage, vertebral artery dissection, or transient ischemic attack. In the combined
dataset, there were 357 patients complaining of isolated dizziness and 31 cerebrovascular events. After
adjusted by 5 previously reported risk factors for cerebrovascular event, (age, hypertension, hyperlipidemia,
diabetes mellitus, nystagmus), a multivariable logistic model analysis showed that the existence of FNT
abnormalities was significantly associated with cerebrovascular events (odds ratio, 25.3; 95% confidence
interval, 7.3–88.2; p < 0.001). There was a significant increase in predictive accuracy, with an AUC increase
of 0.116 in the in a ROC analysis (p = 0.023). The existence of FNT abnormalities is considered as a
strong risk factor that could be useful for predicting cerebrovascular events in isolated dizziness patients.
We recommend the FNT for screening isolated dizziness patients in EDs to judge whether they need to
undergo further diagnostic evaluation.
Editors' Choice
Multicenter survey for carbapenemase-producing
Enterobacterales in central Japan
Yuki Hara, Mitsutaka Iguchi, Nobuyuki Tetsuka, Hiroshi Morioka,
Aki Hirabayashi, Masato Suzuki, Yuka Tomita, Keisuke Oka
and Tetsuya Yagi
pg(s) 630 - 639
<Abstract> - < PDF >
Carbapenemase-producing Enterobacterales (CPE) raise concerns about the treatment options for infectious
diseases and infection control. We conducted a multicenter study to clarify the molecular epidemiology
of CPE in the Aichi Prefecture during the first 3-month period from 2015 to 2019. Carbapenemase
production was screened using a modified carbapenem inactivation method, and the genotypes of the
carbapenemase genes were determined by polymerase chain reaction sequencing. Genetic relatedness was
analyzed using multilocus sequence typing (MLST). Twenty-four hospitals participated in this study. Of
the 56,494 Enterobacterales strains detected during the study period, 341 (0.6%) that met the susceptibility
criteria were analyzed. Sixty-five of the 341 strains were determined to be CPE, with an incidence rate
of 0.12% (65/56,494). The bacterial species responsible for CPE were Klebsiella pneumoniae (n = 24),
Enterobacter cloacae complex (n = 23), Klebsiella oxytoca (n = 10), and Escherichia coli (n = 8). Most of
the carbapenemase genotypes were IMP-1 (58/65), and only three were IMP-6 types. Three E. coli strains
that produced NDM-5 were detected. MLST analysis showed that Sequence type (ST) 78 was predominant
in E. cloacae complex CPE (14/23, 60.9%). Meanwhile, various STs were detected in carbapenemase-producing
(CP) K. pneumoniae, of which ST37 and ST517 were the most common. The incidence rate
of CPE in this region was comparable to national data. This 3-month surveillance revealed the spread of
ST78 of CP E. cloacae complex and ST517 and ST592 of CP K. pneumoniae across hospitals, indicating
the need to strengthen regional infection control programs.
CASE REPORTS
Achieving good neurological outcome by combining
decompressive craniectomy for acute subdural hematoma and
transarterial embolization of intraperitoneal injured arteries
for multiple severe trauma: a case report
Ko Okada, Takafumi Tanei, Takenori Kato, Takehiro Naito, Yuta Koketsu,
Risa Ito, Kento Hirayama and Toshinori Hasegawa
pg(s) 640 - 647
<Abstract> - < PDF >
A 22-year-old woman jumped from the 4th floor of her apartment in an attempt to commit suicide.
Whole-body computed tomography showed multiple injuries, including right acute subdural hematoma,
left hemopneumothorax, several fractures, intraperitoneal hemorrhage, and spleen injury. Her consciousness
deteriorated rapidly, and her right pupil was dilated. Furthermore, she had unstable vital signs including
blood pressure of approximately 70/40 mmHg, pulse about 150/minute, respiratory rate 25/minute, and
percutaneous oxygen saturation of 90% on 10 L oxygen. Intratracheal intubation and insertion of a
thoracostomy tube were performed in the emergency room. Due to concomitant brain herniation and
hemorrhagic shock, simultaneous decompressive craniectomy for acute subdural hematoma and transarterial
embolization of intraperitoneal injured arteries were performed in our hybrid operating room. Despite
rapid blood transfusions, the blood pressure did not increase. After starting embolization of the injured
arteries of the spleen, the blood pressure increased, thereby making it possible to remove the acute
subdural hematoma, and hemostasis was then achieved. Four hours later, the acute subdural hematoma
and intracranial pressure increased again, and re-operation was performed in the normal operating room.
Cranioplasty and clavicular fracture reduction were performed 14 days later. She recovered enough to talk
and walk, and her consciousness stabilized. Interviews with her and her family by a psychiatrist determined
that abnormal behaviors had first appeared 2 months earlier. She was diagnosed with acute and transient
psychotic disorders, and treatment was started. The patient was discharged home 1 month later with mild
disability of her higher-order brain function.
Upper thoracic empyema and concomitant superior vena
cava syndrome treated with reconstructive surgery using
a pedicled omental flap
Masashi Ono, Hirohisa Suzuki, Shinsuke Matsumoto, Keisuke Takanari
and Yuzuru Kamei
pg(s) 648 - 655
<Abstract> - < PDF >
Superior vena cava (SVC) syndrome refers to a constellation of symptoms secondary to obstruction
of blood flow through the SVC. In this condition, venous blood that usually drains into the SVC is
diverted into the inferior vena cava (IVC) via collateral veins. Reconstructive surgery is challenging in
such cases owing to the anomalous venous system. In this case report, we describe reconstructive surgery
using a pedicled omental flap in a patient with upper thoracic empyema and concomitant SVC syndrome.
A 68-year-old man underwent resection of malignant thymoma, the bilateral brachiocephalic veins, and
a part of the right upper lobe, followed by polytetrafluoroethylene (PTFE) graft placement for venous
system reconstruction, 2 years prior to presentation. He developed postoperative upper thoracic cavity
empyema, which necessitated PTFE graft removal. Although the infection was controlled after 2 months,
multiple right upper lobe pulmonary fistulas persisted, and the patient was referred to our department for
further evaluation. Contrast-enhanced computed tomography revealed SVC syndrome characterized by SVC
obstruction and consequent drainage of venous blood from the upper trunk into the IVC via collateral
vessels. We debrided necrotic and infected tissues, and a pedicled omental flap was placed for upper lobe
fistula coverage. The patient showed an uncomplicated postoperative course, and no recurrent empyema
or pulmonary fistulas were observed 3 years postoperatively. Flaps associated with the SVC system show
high venous pressures. The use of a pedicled omental flap was deemed feasible because this graft reaches
the upper thorax even though it is associated with the IVC system.
Paraplegia due to spinal epidural lipoma without spinal
dysraphism in an adolescent patient: a case report
Naoki Segi, Hiroaki Nakashima, Kei Ando, Masaaki Machino,
Sadayuki Ito, Akiyuki Matsumoto, Hiroyuki Koshimizu,
Hiroyuki Tomita, Takayuki Nojima and Shiro Imagama
pg(s) 656 - 663
<Abstract> - < PDF >
We report the case of a rare lipoma arising in the epidural space of a 14-year-old boy without spinal
dysraphism. Lipomas are rare in pediatric soft tissue tumors, accounting for only about 4% of cases.
The incidence of an intraspinal epidural lipoma without spinal dysraphism is extremely rare in pediatric
patients. In this case, the patient had progressive motor deficits in the lower extremities and difficulty in
urination and defecation. Magnetic resonance imaging showed an extradural tumor compressing the spinal
cord at the T3–T7 level. Because of the progressive neurological deficits, we performed an emergency
surgery. The tumor was completely resected en bloc, and histopathology revealed mature adipose tissue
with fibrous septa, diagnosed as atypical lipomatous tumor / well-differentiated liposarcoma. The patient
fully recovered and there was no tumor recurrence for 6 years since the surgery. However, re-examination
using fluorescence in situ hybridization after 6 years of surgery changed the diagnosis to lipoma as no
amplification of murine double-minute type 2 oncogene was observed. In liposarcoma, histopathological
diagnosis using fluorescence in situ hybridization is mandatory. Our case illustrates that immunohistochemical
diagnosis alone can be misleading. Hence, prompt surgery is required for progressive neuropathy.
Cases of allergic coronary syndrome (Kounis syndrome) :
what we should know
Türkay Akbaş, Adnan Kaya, Gülşah Altun, Ümit Eşbah
and Attila Önmez
pg(s) 664 - 672
<Abstract> - < PDF >
Kounis syndrome (KS) is an acute coronary syndrome that occurs with allergic, hypersensitivity,
anaphylactic, or anaphylactoid reactions associated with mast cell activation, and entails significant morbidity
and mortality risks. We present four cases of acute coronary syndrome developing after insect bites,
chemotherapy, and coronary stent implantation. Two patients were lost due to anaphylactic shock-related
multiorgan failures and sudden cardiac death. Since a wide range of drugs, foods, environmental conditions,
and disease states may be associated with KS, all physicians must be aware of the syndrome.
Challenges in left sleeve pneumonectomy in the left lateral
decubitus position
Shota Nakamura, Takayuki Fukui, Hideki Ito, Masaki Goto,
Naoki Ozeki and Toyofumi Fengshi Chen-Yoshikawa
pg(s) 673 - 677
<Abstract> - < PDF >
We report the case of a 20-year-old woman with carinal adenoid cystic carcinoma who underwent
left sleeve pneumonectomy in the left lateral decubitus position, during which severe desaturation was
encountered. After transecting the left main bronchus, the left lung was selectively intubated and ventilated.
However, oxygenation was inadequate. Hence, venoarterial extracorporeal membrane oxygenation (ECMO)
was introduced. Initially, Barclay’s procedure was planned to preserve the left lung, but this plan was
altered due to the extent of the tumor and unstable ventilation. After the lesion was removed, the trachea
and right main bronchus were anastomosed end-to-end. During left pneumonectomy, the right lung was
selectively ventilated, but oxygen saturation (SpO2) dropped to <70% despite ECMO. SpO2 improved on
additionally ventilating the left lung using another breathing circuit. Temporary right chest closure was
performed with ventilation of the left lung across the thoracotomy wound. The patient was turned to the
semi-supine position, and tolerated selective right lung ventilation with ECMO. Subsequently, left thoracotomy and pneumonectomy were successfully performed. Careful management is required for desaturation
in left sleeve pneumonectomy in the left lateral decubitus position.
Spontaneous regression of asymptomatic tumefactive
perivascular spaces in the anterior temporal lobe
Miki Hashida, Yoshitaka Nagashima, Yusuke Nishimura, Kaoru Eguchi,
Toshiaki Taoka, Hisashi Kawai and Ryuta Saito
pg(s) 678 - 685
<Abstract> - < PDF >
Perivascular spaces are fluid-filled spaces that surround the perforating vessels of the brain and are
normal findings on brain imaging. These are usually asymptomatic and are considered a manifestation of
aging. Perivascular spaces occasionally undergo significant enlargement and are referred to as tumefactive
perivascular spaces, which are often indistinguishable from neoplastic lesions. Spontaneous regression of
tumefactive perivascular spaces during follow-up is rare. We report the imaging findings and clinical course
of a patient who showed spontaneous regression of tumefactive perivascular spaces in the anterior temporal
lobe, together with a literature review and discussion regarding the characteristics and pathogenesis of
spontaneous regression of tumefactive perivascular spaces. Most studies in the available literature report
tumefactive perivascular spaces in the anterior temporal lobe; in our view, the characteristics of anterior
temporal lobe tumefactive perivascular spaces may differ from those of tumefactive perivascular spaces
that occur at other locations.
MEDICAL IMAGE AT A GLANCE
Black ascites
Yasuyoshi Sato, Naomi Hayashi and Shunji Takahashi
pg(s) 686 - 688
<Abstract> - < PDF >