Kurume Medical Journal最新文献

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.

We encountered a case of situs inversus totalis in conjunction with an anomalous artery connecting the common hepatic artery and a jejunal branch of the superior mesenteric artery during anatomical dissection of a cadaver. The heart was located in the center of the thorax, with the apex located anterioinferiorly to the right of the midline and the base located posterosuperiorly to the left of the midline. The aortic arch coursed from right anterior to right posterior. The right lung was divided into two lobes, and the left lung was divided into three. The entire intraperitoneal gastrointestinal tract, from the stomach to the rectum, formed a mirror image with the expected normal anatomy. The liver was located on the left side of the upper abdominal cavity, and the spleen was located on the right. The cardia of the stomach was located on the right side, and the pylorus was on the left. The cecum and appendix were located on the left, and the sigmoid colon ran toward the pelvic cavity from the right. In addition to situs inversus totalis, an anomalous artery called the arc of Bühler that branched off the common hepatic artery and entered the mesenteric arcade between the first and second jejunal arteries was observed. These anomalies were not embryologically related and occurred separately from each other. However, their presence may cause confusion during abdominal surgery. Knowledge of this specific combination of anatomical variations may help surgeons who encounter it in clinical practice.

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.

Background: Cerebral sinus venous thrombosis (CSVT) is a thrombosis of the cerebral veins and dural sinuses. It is a challenging condition for a physician due to varied symptoms. We aimed to study the clinical, radiological, etiology, and outcome of CSVT in a rural population.

Methods: Patients with suspected symptoms of CSVT and positive neuroimaging by MRI with MRV were enrolled in the study. Patients with normal neuroimaging, arterial stroke, space-occupying lesions, and unwillingness to participate were excluded from the study. The patient's demographic data and clinical presentation were noted. Protein C and S, anti-thrombin III, ANA, anti-phospholipid antibodies (APLA), and homocysteine were analyzed.

Results: The incidence of CSVT was most common in the age group of 21-40 years (44.3%) and in males. The presentation was mostly subacute (61.4%). Headache was the most common presentation (80%), followed by seizures. The most common site of the thrombus is the superior sagittal sinus (51.4%), the next being the transverse sinus (25.7%). CSVT was attributed to hyperhomocysteinemia in 40% of patients, and protein C and S deficiency was seen in 14.3%. Almost all of them recovered completely (93%).

Conclusion: Cerebral sinus venous thrombosis primarily afflicts adults in their middle age, marked by notable manifestations such as headaches and seizures. The prognosis is good with early diagnosis and management.

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.

Background: Although recent studies have revealed the importance of inflammation in the pathogenesis of aortic dissection (AD), little is known about the relationships among inflammatory cells in human AD tissue.

Methods and results: We assessed the relationships among various immune cell types, including neutrophils, macrophages (M1 and M2), B cells, and helper T cells (Th1, Th2, Th17, Treg and Tfh ) in human AD tissue. AD tissues displayed abundant infiltration of immune cells. Correlation analysis revealed two groups of highly correlated cell types: a group of neutrophils and M1 and M2 macrophages, and another group consisting of B cells and helper T cells. In one particular case of AD, we were able to analyze the correlations between neutrophils and M1 and M2 macrophages in the entry, border, and intact zones of the AD lesions. Neutrophils showed significant correlations with M1 and M2 macrophages in the border zones. The entry and border zones showed M1-dominant polarization, whereas the intact zone showed M2-dominant polarization.

Conclusions: These findings indicate the existence of cell type-specific and site-specific interactions among immune cell types in human AD tissues.

Introduction: Postpancreaticoduodenectomy hemorrhage (PPH) is a serious complication. Fatty or nonfibrous pancreas, or both, is a risk factor for pancreatic fistula. This study assessed various prognostic factors for interventional procedures for PPH, also focusing on the degree of pancreatic fatty infiltration/fibrosis evaluated histopathologically.

Material and methods: The participants were 29 patients with PPH who underwent endovascular treatment from September 2001 to March 2020. Univariate analysis was performed to determine whether the histopathological degree of pancreatic fatty infiltration/fibrosis and other factors were associated with complications and mortality after endovascular treatment for PPH.

Results: Of 39 treatment sessions overall, 38 (97%) achieved technical success and 34 (87%) had clinical success. In-hospital mortality occurred in five patients (17%). No association was found between the pancreatic fistula and the histopathological degree of pancreatic fatty infiltration/fibrosis. Fourteen patients with hemorrhagic shock before endovascular treatment included all five patients with in-hospital mortality, while the 15 patients without hemorrhagic shock survived (P = 0.017). A bleeding tendency was associated with complications after endovascular treatment for PPH (P = 0.033).

Conclusions: Although our results revealed no significant relation between the histopathological degree of pancreatic fatty infiltration/fibrosis and clinical success, including prognosis, endovascular treatment may be effective for PPH.

This study explored postoperative outcomes for patients with lower rectal cancer who underwent low anterior resection (LAR) or intersphincteric resection (ISR). A total of 49 patients (33 LAR, 16 ISR) were followed using anorectal manometry and quality of life (QOL) questionnaires over a year, pre- and post surgery. The primary aim of this study is to clarify differences in anal manometry, sphincter function, fecal incontinence, and QOL between the two surgical arms. The secondary aim was to identify indicators suitable for assessing relationships between anorectal manometry measurements, fecal incontinence, and QOL. Anorectal manometry elements (AMEs), such as atmospheric maximum mean squeeze pressure (aMSP), maximum tolerable volume (MTV), and incremental maximum mean squeeze pressure (iMSP), showed no significant differences during the observation period. However, maximum resting pressure (MRP), high-pressure zone length (HPZ), and threshold volume (TV) were significantly worse in the ISR group. Fecal incontinence, measured by Wexner and Kirwan scores, was significantly better in the LAR group. We observed no differences in SF36 between the two groups. Multi-correlation analysis revealed positive and negative correlations among these factors, with inverse correlations between anorectal manometry measurements and incontinence assessments decreasing post-surgery. We found no correlation between SF36 and anorectal manometry at any time. The findings indicate that surgical technique affects postoperative anal function, fecal incontinence, and SF36. However, combined assessment methods should be used with caution when deriving relationships between anal function and SF36.

This study surveys the factors regarding reading and writing difficulties in children with attentiondeficit hyperactivity disorder (ADHD) and uses these results to provide support. We conducted surveys on 16 elementary school children from 3rd to 6th grades who were diagnosed with ADHD by a physician based on the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). We conducted a Hiragana reading test, a Kanji reading and writing test, and a visual perception test on the subject children. We requested that the parents of the children complete a reading and writing symptom checklist, the Developmental Coordination Disorder Questionnaire (DCDQ), the Strength and Difficulties Questionnaire (SDQ), the ADHD-Rating Scale (ADHD-RS), and the Autism-Spectrum Quotient (AQ). We conducted a multiple regression analysis using the Kanji reading and writing test as the dependent variable. Results revealed that the positional task score in the visual perception test was a factor that influences Kanji writing. Meanwhile, gender, reading-related items on the reading and writing symptom checklist, and performance such as misreading of hiragana were factors that influenced Kanji reading. Based on the results, we suggested that when teaching Kanji writing, children's visual cognition ability should be assessed, and ways to incorporate learning methods that supplement visual perception, such as color masses and electronic learning materials, should be devised. When teaching reading, we suggest using teaching materials that present not only text but also audio as needed, and support the awareness of parents.