Tokai Journal of Experimental and Clinical Medicine最新文献

The patient was a 62-year-old woman. She had been treated for systemic lupus erythematosus (SLE) for 15 years and had a stable clinical course with cyclosporine, prednisolone, and ticlopidine. She experienced anal pain, diarrhea, and bloody stools for four months. Colonoscopy showed scattered large and small punchedout ulcers in the colon and deep longitudinal ulcers in the sigmoid colon. Blood test results indicated low SLE activity. Culture of mucosal biopsy did not reveal any findings. Computed tomography showed intestinal membrane arteriovenous dilatation (comb sign), therefore lupus enteritis was suspected. After initiating endoxan pulse therapy, symptoms improved rapidly. Disappearance of ulcers was confirmed by endoscopic images.

Objective: To develop versatile and interactive model classes by generating the contents of Kampo classroom sessions that can be taught by instructors who are not familiar with Kampo medicine.

Methods: In 2018, we conducted Kampo classroom sessions among fourth-year medical students at Kyushu University in which we incorporated new content. A videotaped digest edition of the classes was sent to Kampo medicine instructors in medical schools throughout Japan. An online questionnaire was given to the instructors regarding effectiveness of the class content (Q1) and whether they would introduce the content in their classes (Q2). We modified the curriculum according to survey responses and conducted revised classroom sessions again in 2019. A second online survey was given and we finalized the model classes. We compared survey responses between staff and instructors (group A) and non-specialists in Kampo medicine (group B).

Results: In 2018, there were significant differences between groups A (44) and B (52) regarding a patient's story and case report (Q1). In 2019, there were significant differences between groups A (42) and B (54) regarding the case report using e-learning(Q1) and an instructor's experience (Q2).

Conclusions: We propose that Kampo medicine classes should incorporate an instructor's experience and interactive case report presentation using e-learning.

Zinc deficiency has long been known as acrodermatitis enteric dermatitis (congenital zinc deficiency). On the other hand, acquired zinc deficiency has attracted attention as a familiar disease in recent years. Epidemiological studies in Japan have shown that acquired zinc deficiency is more common than expected. It is also known that serum zinc levels fall markedly with age. In this report, several cases of acquired zinc deficiency that caused cheilitis are described. In all cases, the only symptom was cheilitis, the serum zinc level was low, and all cases were relieved by zinc supplementation. Zinc deficiency is associated with a range of pathological conditions, including mucocutaneous symptoms, delayed wound healing, dysgeusia, anemia, impaired immunity, and retarded growth development disorders. However, zinc deficiency may be overlooked even in cases of cheilitis alone. Especially in intractable cases, it is important to suspect zinc deficiency as one at the differential diagnoses.

While palliative care for patients with cancer is actively performed, it is provided only occasionally for patients with chronic non-cancerous respiratory diseases. This is due to various factors, including the fact that palliative care is not covered by health insurance and the difficulty in determining end-of-life in these patients. This paper presents two case studies to highlight the significance of palliative care team intervention for patients in the terminal stage of chronic non-cancerous respiratory diseases. Palliative care is essential to support physical problems, such as dyspnea, as well as mental disorders, such as depression, and to provide nutrition therapy and rehabilitation. To achieve care at the appropriate time in accordance with the patient's wishes, it is essential for patients to understand and accept the progress and deterioration of their disease and prepare for the end of life at an earlier stage under multidisciplinary involvement (advance care planning).

Objective: After bypass surgery in patients with moyamoya disease, several changes on magnetic resonance imaging (MRI)/fluid attenuated inversion recovery (FLAIR) have been recognized, while findings on MRI/gadolinium-enhanced (Gd) vessel wall imaging (VWI) have never been reported. The purposes of this study were to investigate postoperative changes on MRI/Gd VWI and to clarify the relationship between the MRI/Gd VWI and MRI/FLAIR findings.

Methods: Consecutive patients who underwent bypass surgery at our hospital from September 2020 to March 2022 were candidates.

Results: In 20 patients with moyamoya disease, 25 operated hemispheres were investigated. In all hemispheres, hyperintensities in the cortical sulci on MRI/FLAIR and enhancement in the cortical sulci on MRI/Gd VWI appeared after bypass surgery. The maximum appearance of sulci enhancement on MRI/Gd VWI occurred earlier than the maximum appearance of the sulci hyperintensity on MRI/FLAIR, and this difference was significant (p = 0.001).

Conclusions: MRI/Gd VWI demonstrated that the peak of the enhancement changes preceded the peak of hyperintensity changes on MRI/FLAIR. These MRI changes may reflect alterations in blood-brain barrier permeability after bypass surgery in patients with moyamoya disease.

Objectives: We conducted a survey to determine whether the general public who participated in a café-style event to raise awareness of advance care planning (ACP) actually implemented ACP after attending the event.

Methods: On February 20, 2020, a café-style event (Tokai Blue Café: TBC) was held at the Tokai University Hospital. The TBC consisted of a lecture about ACP, "The Go-Wish Game," and a tea party. A questionnaire-based survey was conducted on ACP implementation after one month of TBC.

Results: Of the 14 participants (three males and 11 females), 11 agreed to answer the questionnaire and eight responded. Two respondents were male and six were female. Six of the respondents were aged ≥ 60 years. Seven of the eight respondents implemented ACP with their family members, while none did so with their family doctor, even though all of them indicated that they had a family doctor. Several respondents reported that they were uncomfortable discussing the issue with their doctors.

Conclusion: The results indicate that a café-style event as an awareness-raising activity may have a significant effect on ACP implementation, although it suggests that there are some challenges in involving family doctors.

Physicians occasionally come across with patients with locally advanced breast cancer (LABC) bringing about distress, due to tumor growth, invasion to the skin, bleeding or an ill smell. Physicians often experience much difficulty in selecting and administering therapeutic option. The clinical courses of patient who had been treated with total resection of LABC and an attachment of artificial dermis (TERUDERMIS) were mentioned. Elimination of the symptoms derived from the tumors could be successfully accomplished for all of the patients. Except for one patients who initially had bone metastasis and died 13 months after operation, the other patients have been alive under preferable condition without any signs for tumor recurrence. The surgical resection and an attachment of artificial dermis is quite reliable and helpful for both patients and physicians in palliating symptoms and reducing care for infections and hemorrhage due to LABC.

Objective: Placenta previa complicates 0.3-0.5% of pregnancies and can cause sudden antepartum massive hemorrhage (APH). Previous studies have indicated that cervical length (CL) measured by transvaginal ultrasonography may be a predicting parameter for APH in patients with placenta previa; however, conflicting data exist. Thus, we investigated the association between CL and APH in patients with placenta previa.

Methods: In total, 129 singleton pregnant women with placenta previa, who delivered at our institution from January 2010 to December 2016, were included in this study. The shortest CL measured throughout gestation was used for analysis, and we defined CL less or more than 30 mm as short or normal CL, respectively. We performed univariate and multivariate analyses, and a receiver-operating characteristics (ROC) curve was plotted to determine the cut-off CL value to predict APH.

Results: APH occurred in 26 patients. The adjusted odds ratio for APH was 3.80 (95% CI, 1.36-10.65) in patients with short CL. ROC analysis was performed to determine a cut-off CL value of 35 mm to predict APH, with a sensitivity of 80.7% and a specificity of 60.2%.

Conclusions: Our data indicated that CL measurements may be useful in determining patients at high risk of APH.

We present the autopsy procedure and findings of severe coronavirus disease 2019 (COVID-19) pneumonia in an 85-year-old man. The patient required intubation immediately after admission for severe COVID-19 pneumonia. He had severe hypoxia that did not improve despite treatment with remdesivir, corticosteroids, and appropriate mechanical ventilation. On day 13, the patient developed sudden hypercapnia. His renal dysfunction subsequently worsened and became associated with hyperkalemia, and he passed away on day 15. An autopsy was performed to clarify the cause of the hypercapnic hypoxia. None of the medical personnel involved in the autopsy developed symptoms of COVID-19. Histologic examination showed various stages of diffuse alveolar damage throughout the lungs, with intra-alveolar hemorrhage in the upper zones. Microscopic examination of the kidneys revealed acute tubular necrosis. There was no significant systemic thrombosis. The autopsy findings were consistent with those typical of COVID-19.