Kurume Medical Journal最新文献

A 67-year-old woman was referred for cardiac tumor. Computed tomography scans revealed a large mass occupying the left atrium causing the left pulmonary vein obstruction and pulmonary congestion. Positron emission tomography / computed tomography (PET/CT) showed abnormal accumulation at the border between the left atrium and the left pulmonary vein orifices, and the invasion of the malignant cell to the left upper and lower pulmonary veins was highly suspected. Operative finding was that the tumor was attached to the left atrial posterior wall adjacent to the left pulmonary vein orifices and extended to the left upper pulmonary vein about 1 cm beyond the left upper pulmonary vein orifice. The tumor was not extended to the left lower pulmonary vein. Considering the possibility that the tumor was a sarcoma, for which chemotherapy was less effective, radical resection including left upper lobectomy and reconstruction of the left atrium was considered, but a rapid intra-operative histological exam revealed a malignant lymphoma. Therefore, surgery was performed to reduce the tumor as much as possible. The postoperative course was good and the patient was treated with chemotherapy, surviving for 18 months without any signs of recurrence.

In this study, we investigated the histological examination of the pineal gland, the degree of brain sand accumulation, and the state of pineal cells by immunohistochemistry using melatonin antibodies in 20 corpses aged between 59 and 98 years. We also investigated changes in the bone mineral density of the calcaneus and the degree of arteriosclerotic lesions of the ascending aorta and evaluated the relationship between them. In the cadavers examined in the present study, the size of the pineal gland did not differ from that described in previous studies. However, there was no statistically significant association between the degree of brain sand formation and age or sex, and a negative correlation was found between the degree of brain sand accumulation and the number of melatonin antibody-positive cells. The higher the degree of accumulation of brain sand in the pineal gland, the lower the bone density of the calcaneus. Furthermore, the higher the accumulations of cerebral sand in the pineal gland, the higher the aortic arteriosclerotic lesions. These results suggest that the pineal cell depletion that occurs with brain sand accumulation probably reduces bone density, which in turn affects calcium metabolism, possibly leading to arteriosclerotic lesions.

Anatomical variations of the iliopsoas muscle are relatively uncommon but are clinically significant because of the muscle's relation to the femoral nerve (FN). Variants of the iliopsoas include accessory iliacus, iliacus minimus, psoas tertius, and psoas quartus muscles. This study describes anatomical findings of these variants. Dissections of the posterior abdominal wall in 95 Japanese cadavers at Kurume University School of Medicine (2015-2017) identified three cases of iliopsoas muscle variants. In the first case, a small variant muscle on the right side of a 91-year-old female cadaver originated from the iliolumbar ligament, pierced the FN, and joined the psoas major muscle (PMa). In the second case, a variant muscular slip was identified on the left side of a 78-year-old female cadaver. The slip originated from the anterior aspect of the middle part of the iliac crest and pierced the FN. The muscle joined the tendon of the PMa. Both cases were categorized as variations of the iliacus muscle (IM) and were called iliacus minimus muscles. In the third case, a bilateral variant muscle was noted in a 74-year-old male cadaver. The muscles mainly originated from the surface of the quadratus lumborum muscle. The variant muscle called the psoas quartus muscle, traveled posterior to the FN and united with the normal PMa and IM. This variation is seemingly very rare. A thorough understanding of these morphologic variations is essential for the accurate diagnosis and treatment of femoral nerve disorders and for safe lumbar and abdominal surgery.

A 65-year-old male with multiple hepatocellular carcinomas underwent hepatic artery chemoembolization in March X and was administered lenvatinib. In July X, 2 weeks after the initiation of this treatment, he developed latent hypothyroidism. However, he showed no response to these treatments. Consequently, a combination therapy consisting of an anti-programmed cell death protein-ligand 1 (PD-L1) antibody (atezolizumab) plus bevacizumab, administered every 3 weeks, was initiated in March X+1. During three cycles of this combination therapy, the patient developed thyrotoxicosis. Graves' disease (GD) was suspected by TSH receptor antibody (TRAb) positivity and diffuse uptake in thyroid scintigraphy, although ^99mTcO₄^- uptake was normal. He was treated with methimazole. Notably, the hyperthyroidism was transient, rapidly transitioning to hypothyroidism. The emergence of GD during treatment with immune checkpoint inhibitors (ICPi) is a rare occurrence. To date, 26 cases of new-onset GD and/or thyroid eye disease (TED) have been reported. Approximately 71% of patients develop GD and/or TED within 3 months following the initiation of ICPi treatment. They quickly transition to a hypothyroid state, necessitating levothyroxine therapy. Furthermore, the presence of thyroid autoantibodies at baseline has been identified as a significant risk factor for thyroid immune-related adverse events (irAEs), highlighting the need for baseline measurements of these autoantibodies before treatment. Future prospective studies and further case report accumulations are essential to elucidate the role of thyroid irAEs during the combined therapy of ICPi and molecularly targeted drugs in advanced carcinoma cases.

We encountered a cadaver with bilateral persistent sciatic veins (PSVs) in the anatomical dissection course at our institution. Although PSV is associated with Klippel-Tranaunay syndrome, there were no other findings typical of the syndrome in this case. The PSVs on each side differed. On the left, the PSV ascended in the posterior thigh and passed through the intramuscular space caudal to the quadratus femoris. It then coursed anteriorly and joined the deep femoral vein. The femoral vein originated from the popliteal vein; it passed through the adductor canal, ascended in the femoral triangle, and passed under the inguinal ligament after receiving the deep femoral vein. On the right, the PSV ascended in the posterior thigh and passed through the intermuscular space between the adductor magnus and adductor minor (a lower position than on the left); it then coursed anteriorly and merged with the femoral vein. The right femoral vein originated from the popliteal vein; it then passed through the adductor canal, ascended in the femoral triangle, and merged with the PSV. It is important to correctly diagnose PSV at the time of surgical or radiological intervention to avoid complications of the procedure and to improve outcomes. PSV can cause unexpected bleeding during lower extremity surgery. Clinicians should be aware of this rare anomaly.

Although parental bereavement during childhood or adolescence increases the risk of depression, few studies focus on young adult Japanese who have lost a parent. This study investigates the risk of psychological distress among Japanese young adults who experienced parental bereavement during childhood or adolescence (bereavement group), comparing their mental health with non-bereaved students (control group). A questionnaire survey was performed on 6385 students at A University, following the Japanese version of Kessler 6 (K6) to assess psychological distress. In total, 1508 students (42 in the bereavement group, 1185 in the control group) provided responses to the questionnaires, 1227 were analyzed, excluding those who did not respond the bereavement question. As a result, no statistically significant differences in the levels of psychological distress were observed between the bereavement and control groups. However, it can be confirmed that some factors influencing the total score of K6. Higher psychological distress in the bereavement group was significantly associated with medical faculty affiliation (β = 4.416, p = 0.050) and low caregiver income (β = 4.491, p = 0.042). Elevated distress levels in the control group were linked to non-medical faculty affiliation (β = -1.579, p < 0.001) and a history of psychiatric disorders (β = 7.094, p < 0.001). These findings emphasize the need for tailored psychological support targeting specific groups. Further research is required to validate the relationship between parental bereavement and mental health, and it is noteworthy that economic and psychological support is crucial for university students who have experienced parental bereavement.

Surgical technique and the clinical outcomes of intersegmental fixation with an interspinous spacer (IFIS) for lumbar spinal instability are reported in this study. Four patients underwent surgery using this procedure. There were no surgical complications, and the clinical outcomes were satisfactory. Spinal alignment was maintained successfully as observed radiographically, and bone fusion was obtained in all cases. This technique may be an alternative for patients with degenerative lumbar disease such as spondylolisthesis and lumbar spinal stenosis (LSS) with mild spinal instability.

A 71-year-old woman who had received resection for gastrointestinal stromal tumor (GIST) in the rectum after imatinib mesylate administration, revealed a pulmonary nodule measuring 11 × 10 mm in the right lung on chest computed tomography (CT), which was 26 months after the operation. The pulmonary nodule had gradually increased to 13 × 13 mm in diameter on follow-up chest CT. The standardized uptake value (SUV) of the pulmonary nodule on positron emission tomogram (PET) with 2-fluoro-2-deoxy-D-glucose (FDG) was 1.8. For diagnostic and therapeutic purposes, thoracoscopic partial resection of the lung, including the nodule, was performed. The pathological findings showed pulmonary metastasis from rectal GIST. On immunohistochemical examination, the tumor was diagnosed as the high-risk group, whereas the primary site in the rectum was the lowrisk group according to the Modified Fletcher classification. Imatinib mesylate was administered again, but her disease progressed. Although pulmonary metastasis from rectal GIST is a rare disease with a possible poor prognosis, pathological diagnosis should be essential to deciding treatment modality.