Tokai Journal of Experimental and Clinical Medicine最新文献

Objective: This study investigated the effects of Aromatherapy Massage on chronic pain and quality of life (QOL) in four patients with Parkinson's disease (PD) whose pain was unresponsive to medication.

Methods: A three-arm crossover trial was conducted, consisting of Inhalation (I), Massage (M), and Aromatherapy Massage (AM), each over three weeks. Pain was assessed using the Visual Analog Scale (VAS) and King's PD Pain Scale (KPPS). Plasma dopamine and β-endorphin levels and electroencephalography (EEG) were used as objective indicators. QOL was measured using the PDQ-39. Data were analyzed with linear mixed models (p < 0.05).

Results: Only AM significantly increased plasma dopamine. Both M and AM elevated β-endorphin levels and reduced VAS scores during and after intervention. KPPS scores improved following AM. EEG showed the highest peak alpha frequency during AM. PDQ-39 scores improved by 3.75 points after AM.

Conclusion: Aromatherapy massage may offer effective multisensory stimulation for alleviating chronic pain and enhancing QOL in PD patients. It may serve as a useful complementary strategy in pain management.

Objective: This study aimed to characterize the posturographic features of elderly patients newly diagnosed with early-stage Parkinson's disease (PD) who initially presented with dizziness.

Methods: Over a three-year period, 1,840 patients visited a dizziness-specialized otolaryngology clinic. Among them, four were newly diagnosed with early-stage PD. Posturographic data of these patients were analyzed.

Results: Common posturographic characteristics were observed, including elevated locus length per unit area (L/A), calculated by dividing the total locus length by the sway area, and increased sway frequencies in the 5-8 Hz range as seen in the power spectral analysis.

Conclusion: In line with previous findings, elevated L/A values and higher sway frequencies may be useful early indicators of PD.

Introduction: Sclerosing hepatic hemangiomas are a rare form of cavernous hemangioma, reported in 0.2% of autopsy cases. Preoperative diagnosis is difficult because of the variety of imaging findings. Herein, we report a case of hepatic sclerosing hemangioma that was difficult to differentiate from a liver metastasis of rectal cancer.

Case presentation: A 67-year-old man visited our hospital with a chief complaint of bleeding during defecation, and a colonoscopy revealed advanced rectal cancer. A dynamic contrast-enhanced magnetic resonance imaging (MRI) showed a 15 mm-sized tumor in S7 of the liver. In the arterial phase, the tumor interior showed low signal intensity, and the tumor margins were enhanced. The tumor interior was gradually stained from portal to equilibrium phases. Partial S7 resection was performed for liver metastasis from rectal cancer. Hematoxylin and Eosin staining revealed flattened endothelial cells with poor atypia that formed a lumen. Immunohistochemical staining was positive for CD31 and CD34, and the final diagnosis was sclerosing hemangioma.

Conclusion: Although a rare tumor, hepatic sclerosing hemangioma should always be considered as a differential diagnosis for liver tumors. If the diagnosis is difficult to make and malignancy cannot be ruled out, resection may be indicated as a diagnostic treatment.

Objective: We aimed to identify the inflammation-based prognostic score (IBPS) that can be used to predict the recurrence of early-stage pancreatic ductal carcinoma (PDAC).

Methods: In this retrospective study, the data of 109 patients with Union for International Cancer Control (UICC) stage I PDAC who underwent pancreatectomy between January 2005 and December 2020 at Tokai University Hospital were assessed. The clinicopathological and risk factors for early recurrence were compared between the early (within 12 postoperative months) recurrence (ER) group (n = 29) and non-ER group (n = 80).

Results: The median overall survival (OS) durations of the ER and non-ER groups were 15.0 (95% confidence interval [CI]: 8.0-22.0) and 109.0 (95% CI: 91.4-120.9) months, respectively (p < 0.001). The patients in the ER group had a significantly poorer prognosis. Multivariate analysis showed that the C-reactive protein-albumin-lymphocyte (CALLY) index ( < 4.4) (hazard ratio [HR]: 2.71, 95% CI: 1.21-6.02]), positive venous invasion (HR: 4.67, 95% CI: 1.10-19.90), tumor differentiation (moderately/poorly) (HR: 2.25, 95% CI: 2.05-13.43), and failure to complete adjuvant chemotherapy (HR: 12.50, 95% CI: 5.30-29.50) were independent risk factors for early recurrence.

Conclusions: Low pretreatment CALLY index was a useful predictor of early recurrence in patients with UICC stage I PDAC.

Colorectal perforation following an upper gastrointestinal series is rare. The majority of patients are women. Only 4 cases of perforation have been reported in men with the English literature. Here, we report two more cases of sigmoid colon perforation after an upper gastrointestinal series in men.

Infective endocarditis (IE) is a rare but severe condition caused by microbial infection of the endocardium. It affects both adults and children with underlying conditions or immunosuppression, including infants of mothers with diabetes (IDMs). We report a case of IE caused by methicillin-resistant Staphylococcus epidermidis (MRSE) in a newborn IDM. A male infant was born at 38 weeks gestation, weighing 5,102 g. His mother had poorly-controlled type 2 diabetes, and the infant had asymmetric septal hypertrophy of the heart. He was admitted to our unit with severe hypoglycemia and respiratory distress necessitating treatment using an indwelling peripherally-inserted central catheter (PICC). The tip of the PICC was moved to the appropriate position because it was initially located in the patient's right ventricle. He was determined to have IE via a positive MRSE blood culture and vegetation in the right atrium. He was treated with vancomycin followed by surgery at 74 days of age to remove the vegetation. He recovered well and was discharged at 92 days of age. IDMs whose mothers have poorly-controlled diabetes may be at higher risk of IE, particularly if they have hemodynamic abnormalities and indwelling PICCs. However, further studies are warranted to confirm this hypothesis.

A 19-year-old woman with three seborrheic keratosis on her right abdomen and five seborrheic keratosis on her both buttocks is presented. That developed at the age of five and two months prior to the visit. At our initial dermatological examination, we noticed three oval, well defined, brown tumors on her right abdomen, and several round, well defined, brown nodules on her both buttocks. Dermoscopy findings showed comedo-like openings, fissures, and ridges. Histopathological examination showed hyperkeratosis and pseudohorn cysts, and basaloid keratinocytes proliferation with no dysplastic cells. These findings were consistent with SK. She was treated by cryotherapy using a liquid nitrogen spray, and her tumors and nodules dropped off entirely. Juvenile-onset of seborrheic keratosis is quite rare in East Asian countries and needs to be differentiated from keratinocytic epidermal nevus.

Objective: We report that the effect of combination therapy with SGLT2 inhibitors (SGLT2i) and glucagon-like peptide-1 receptor agonists (GLP1Ra) on renal composite outcomes is not affected by the preceding drug in patients with type 2 diabetes (T2D). In this study, we performed a post-hoc analysis of dulaglutide and liraglutide users and investigated the differences between GLP1Ra.

Methods: We analyzed 266 patients treated with an SGLT2i followed by dulaglutide or liraglutide and 194 treated with dulaglutide or liraglutide followed by an SGLT2i. In addition, we analyzed dulaglutide users (n = 246) and liraglutide users (n = 214). Renal composite outcome was defined as the progression of albuminuria and/or a ≥ 30% eGFR decline.

Results: The incidence of renal composite outcomes in the SGLT2i-preceding and GLP1Ra (dulaglutide or liraglutide)-preceding groups was not significantly different. It also did not differ between the dulaglutide and liraglutide users. The incidence of ≥ 30% eGFR decline was more frequent in liraglutide users, with an odds ratio of 2.63 (95% confidence interval: 1.07-6.45, p = 0.04), with a significantly larger decrease in albuminuria in liraglutide users, with an odds ratio of 0.44 (95% confidence interval: 0.04-0.85, p = 0.03).

Conclusions: Dulaglutide and liraglutide may have different effects on albuminuria and the kidney function in combination with SGLT2i.

Background: Carcinoid tumors of the middle ear are rare and difficult to diagnose preoperatively. These low-grade malignant tumors require complete surgical removal; however, consensus on the amount of radicality required is lacking. Herein, we report two cases of carcinoid tumors of the middle ear.

Case presentation: The first patient was a 40-year-old woman who presented with right-sided hearing loss and a white mass behind the tympanic membrane. The tumor was surgically removed using a transcanal approach, while maintaining an intact ossicular chain. The histopathological diagnosis was carcinoid tumor, and no additional treatment was administered. The second patient was a 28-year-old woman who presented with left-sided hearing loss and a white mass in the ear canal. Preoperative biopsy revealed a carcinoid tumor. The tumor was excised using the same approach as in Case 1 with tentative removal of the incus during surgery, and reconstruction with tympanoplasty type IIIc (Ost) was performed. No recurrence was observed in either case during > 3 years of follow-up.

Conclusion: Treatment algorithms for carcinoid tumor of the middle ear are lacking; therefore, surgical plans vary according to the tumor extension. Furthermore, because carcinoid tumors are low-grade malignant tumors, long-term follow-up after complete macroscopic removal is necessary.

Objective: A novel external oblique intercostal block (EOIB) might have analgesic effects on T6-10 and be indicated for laparoscopic gastrectomy. However, EOIB effects on postoperative pain are unknown. We aim to generate evidence to support such EOIB application. We will compare the efficacy of EOIB and wound infiltration (WI) in a single-center, single-blind, randomized controlled trial.

Methods: We will assess plasma concentrations of levobupivacaine after EOIB, its pharmacokinetics, and the pinprick test in patients randomly assigned to receive EOIB or WI before laparoscopic or robot-assisted gastric distal or total gastrectomy. The EOIB and WI will start after general anesthesia induction with 20 and 40 mL of 0.25% levobupivacaine per side, respectively, before skin closure. The outcomes will be numeric rating scale (NRS) scores at 12 h postoperatively (primary) and postoperative NRS scores at 2, 24, and 48 h; fentanyl application; QoR-15 scores on postoperative days 1, 2, and 7; and World Health Organization Disability Assessment Schedule 2.0 scores at 3 months (secondary).

Conclusions: We hope that our study will provide evidence to support EOIB application in laparoscopic surgery. Plasma concentrations will help determine levobupivacaine pharmacokinetics, which if similar to conventional nerve blocks, will indicate EOIB's safety.