Kurume Medical Journal最新文献

Background: The purpose of this study was to investigate the effect of the main fragment fracture type (oblique or transverse) on the union rate of femoral shaft fractures.

Methods: Patients who underwent surgical treatment with an antegrade intramedullary nail for femoral shaft fracture (Arbeitsgemeinschaft für Osteosynthesefragen / Orthopaedic Trauma Association; AO/OTA type 32 type B or C) between January 2009 and March 2021 were included in this study. Patients with oblique fractures of the two main fragments on radiographs immediately after surgery were classified into the oblique fracture group. Patients with at least one of the two main fractures being transverse fractures were classified into the transverse fracture group. We investigated age, sex, height, weight, body mass index (BMI), AO/OTA classification, time from fracture to surgery, intramedullary nail length and diameter, number of interlocking screws, and bone union rate.

Results: A total of 55 fractures were included. The mean age was 34.4 ± 16.7 (range, 16-77) years. There were 41 fractures classified into the oblique fracture group and 14 fractures classified into the transverse fracture group. There was a significantly higher proportion of men in the transverse fracture group. Patients in the transverse fracture group were significantly younger and taller. Only 1 of 41 (2.4%) patients in the oblique group experienced nonunion, while 3 of 14 (21.4%) patients in the transverse group experienced nonunion (p = 0.030).

Conclusion: Comminuted femoral shaft fractures with transverse fracture components are more prone to nonunion.

Profunda femoris artery aneurysms (PFAAs) are rare because of the histo-anatomical characteristics of the profunda femoris arteries. We present a case of simultaneous PFAA and common femoral artery aneurysm (CFAA) incidentally detected on computed tomography in a 58-year-old man with diverticular bleeding. Images revealed a 37-mm right PFAA and a 24-mm right CFAA. According to the report, PFAAs >20 mm are a surgical indication, and surgery should be decided based on the patient's general condition. We resected the aneurysms and reconstructed the arteries using vascular prostheses. The postoperative course was uneventful, and the patient was discharged 8 days postoperatively.

N-myc downstream regulated gene-1 (NDRG1) has attracted much attention as a protein associated with angiogenesis. This study investigated the associations of NDRG1 expression, determined by immunohistochemical analysis, with other clinicopathological factors and prognosis in patients with endometrial endometrioid carcinoma (EEC). Surgical specimens were obtained from 113 patients with EEC. High NDRG1 expression was correlated with advanced stage, poor differentiation, lymph node metastasis, and significantly poorer survival compared with patients with low expression. High expression of NDRG1 was also correlated with high levels of angiogenesis and low expression of the estrogen receptor. These results suggest that high expression of NDRG1 is associated with angiogenesis and is an indicator of a poor prognosis in women with EEC.

Background: The present study investigated the acute mucosal reaction (AMR) after high-dose-rate interstitial brachytherapy at 54 Gy/9 fractions (HDR54) as monotherapy administered twice a day for tongue cancer in 13 patients, and attempted to validate HDR54 by comparing the AMR with that of our previously reported HDR at 60 Gy/10 fractions (HDR60), and low-dose-rate interstitial brachytherapy at approximately 70 Gy (LDR70).

Methods: The European Organization for Research on Treatment of Cancer/ Radiation Therapy Oncology Group scoring system with modifications (score: 1-4.5) was used to evaluate AMR. The time courses of the AMR scores of HDR54 were recorded. The time courses of the AMR of HDR54, HDR 60, and LDR70 were each divided into 6 phases and compared.

Results: The number of cases in the HDR54 group with a lower score (1-2) at the time of the initial response was significantly higher (12 cases) than those in the HDR60 group (1 case) (p=0.0077) and LDR70 group (1 case) (p=0.0077). In the HDR54 group, the time between the end of treatment and appearance of the first response was significantly longer (median: 3 days) than those in the HDR60 group (median: 1 day) (p<0.001) and LDR70 group (median: 1 day) (p<0.001). No significant differences were observed in the maximum score, its duration, or other parameters.

Conclusions: The results indicated that the AMR of HDR54 started later and was gentler and more easily tolerated than the other two methods, suggesting the validity of HDR54 in terms of AMR.

Lymph node recurrence is common in patients with breast cancer, and breast surgeons often diagnose it based solely on computed tomography (CT) or fluorine-18 fluorodeoxyglucose positron emission tomography-computed tomography (FDG-PET/CT). In this case report, we present a patient with breast cancer having a false positive lymph node detected by FDG-PET/CT, which was later identified as a sarcoid reaction through thoracoscopic surgery. This pathological diagnosis allowed the patient to avoid unnecessary long-term cancer therapies, such as chemotherapy and hormone therapy. In conclusion, lymph nodes in patients with breast cancer should undergo pathological diagnosis, and thoracoscopic surgery is a valuable approach for accurate diagnosis, even when FDG-PET/CT shows positive results.

The treatment of the underlying cause of liver disease may potentially reverse hepatic fibrosis. However, it remains uncertain whether improvement in fibrosis can be observed in decompensated liver cirrhosis (LC). Here, we present a case of autoimmune hepatitis (AIH)-related LC in which histological improvement of fibrosis was achieved despite the presence of decompensated LC. A Japanese female in her 20s was initially identified as having liver function impairments during her employment medical checkup. Following a laparoscopic liver biopsy, she was diagnosed with AIH-related decompensated LC (F4 and A3) with a Child-Pugh score of 10. The patient initially received treatment with prednisolone at a daily dose of 40 mg, followed by 20 mg/day of prednisolone plus 25 mg/day of azathioprine (subsequent increase of azathioprine to 100 mg/day). With this treatment, the abnormal serum marker levels returned to normal, thereby enabling the patient to avoid liver transplantation eight months after the initiation of treatment. Moreover, marked improvement was observed in non-invasive tests for hepatic fibrosis, including the FIB-4 index and FibroIndex, as well as liver stiffness evaluated by FibroScan®. Eleven months after diagnosis, the patient developed a cholestatic liver injury and was diagnosed with drug-induced cholestatic liver disease (azathioprine overcapacity as the causative agent). By percutaneous liver biopsy at this point, hepatic fibrosis (F2-3) was markedly improved compared with that at the diagnosis. Along with the improvement of hepatic fibrosis, notable improvements were also observed in patient-reported outcomes such as the SF-36® score and chronic liver disease questionnaire. In this report, we first described a case of AIH that showed a histological improvement of hepatic fibrosis even in decompensated LC by treatment with prednisolone and azathioprine.

This study aimed to explore the clinical characteristics of umbilical cord cysts (UCCs) detected from the second trimester onwards in a single tertiary center over a 22-year period. The subjects consisted of a total of 12 cases of UCCs among 11 pregnant women (10 singleton pregnancies and 1 twin pregnancy), diagnosed at ≥ 14 weeks of gestation, and managed at Kurume University Hospital from 2000 to 2021. The maternal backgrounds, characteristics of the cysts, including their location, numbers, sizes, associated fetal/neonatal findings, and outcomes, were analyzed retrospectively. The median maternal age was 28 years, with diagnosis at 18.5 gestational weeks. Cysts were found near the umbilical ring (8 cases), in a free loop (3 cases), and in both of these locations (1 case). Single cysts appeared in 8 cases, and multiple cysts in 4 cases, with the median diameter being 25.0 mm. Sizes varied by gestation, being larger near the umbilical ring without correlation to cyst number. Among the 9 cases with cysts located near the umbilical ring, 5 cases had fetal abnormalities, including trisomy 18 (2 cases), Beckwith-Wiedeman syndrome (1), and intrauterine fetal death (1). Urachal remnants were found in 4 cases and omphalomesenteric duct remnants in 1 case after birth. When UCC is observed, particularly a cyst located near the umbilical ring, comprehensive fetal ultrasound screening is necessary, and attention should be paid to fetal anomalies that may coexist. In cases where these are not identified prenatally, the presence of conditions such as urachal remnants needs to be considered.

Introduction: This study aimed to investigate the efficacy of hyperbaric oxygen therapy (HBOT) in patients presenting with malignant bowel obstruction (MBO) and peritoneal dissemination.

Materials and methods: We retrospectively examined whether HBOT affects prognosis following MBO with peritoneal dissemination. This study included 44 patients diagnosed with MBO secondary to peritoneal dissemination at our hospital between January 2013 and December 2022. Among these patients, 30 underwent HBOT. The treatment protocol involved daily HBOT administration, comprising 100% oxygen at 2.5 atmospheres absolute for 60 min.

Results: In a univariate analysis of HBOT and non-HBOT groups, the proportion of patients able to resume eating was significantly higher in the HBOT group. Therefore, the percentage of patients in the non-HBOT group whose MBO did not improve was significantly higher than that in the HBOT group. The percentage of patients undergoing surgery or receiving anticancer treatment did not differ significantly between the groups, whereas overall survival was significantly longer in the HBOT group. Furthermore, when examining inoperable patients, significantly more individuals in the HBOT group could resume eating, and their overall survival was significantly prolonged.

Conclusions: HBOT may increase the spontaneous resolution rate and improve long-term prognoses of patients with MBO secondary to peritoneal dissemination.

Background and aims: Colorectal polyps resected by cold snare polypectomy (CSP) are rarely diagnosed as colorectal cancer (CRC). We aimed to investigate the prevalence, clinical features, and prognosis of patients with CRC resected by CSP.

Subjects: Patients with colorectal polyps treated with CSP between 2018 and 2022 were enrolled and regularly followed up (median observation period: 30.6 months). Logistic regression analysis and decision tree analysis were employed to investigate the clinical features of the patients.

Results: A total of 5,064 colorectal polyps from 2,530 patients were resected by CSP. Of these, 0.24% were diagnosed as CRC; however, no patients died due to CRC. eGFR was an independent risk factor for the presence of CRC (unit 10, OR 0.716, 95%CI 0.525-0.973, P=0.0323) and its optimal cut-off value was 59.9 mL/min/1.73 m². The decision-tree analysis revealed that 2.03% of patients with creatinine ≥ 1.0 mg/dL had CRC.

Conclusion: CRC was diagnosed in 0.24% of the polyps; however, no patients died due to CRC. eGFR <60 mL/min/1.73 m² and creatinine >1.0 mg/dL were associated with CRC. Thus, colorectal polyps should be carefully examined in patients with chronic kidney disease.

Aim: We developed and evaluated the statistical reliability and validity of a family needs scale directly answerable by families in critical care settings.

Methods: In this qualitative study, 39 questions were drafted to capture family needs. These questions were then administered to the families of patients in emergency care settings. Exploratory factor analyses identified several needs factors and factor structures of the questions with oblique rotation. A confirmatory factor analysis examined internal consistency and criterion-related and construct validity.

Results: Three factors comprising 32 items were extracted from the exploratory factor analysis: "Needs for fulfilling family roles," "Needs for appropriate treatment and care," and "Needs for respecting family ties." Cronbach's α was 0.949 for the total score and 0.927, 0.914, and 0.896 for factors A-C, respectively, with cumulative variance of 50.0%. The three factors' confirmatory factor analysis revealed a relatively good model fit. A significant correlation was found between this scale and the assessment scale for the needs of families of patients in the intensive care unit.

Conclusions: A new scale assessing family needs was developed, and its reliability and validity were confirmed. The scale has acceptable psychometric properties and can be used to measure family needs in critical care settings, particularly in Japanese cultural contexts.