Kobe Journal of Medical Sciences最新文献

Purpose: Liver fibrosis is not thought to occur in patients with no adverse events after surgery for congenital biliary dilatation (CBD). However, this speculation is not supported by any reports. Real-time shear wave elastography (SWE) is a noninvasive, ultrasound-based technique to evaluate liver stiffness. We aimed to clarify the presence of liver fibrosis using SWE in patients who had undergone surgery for CBD.

Methods: We included patients who underwent radical surgery for CBD, who were followed up until March 2022, and have been performed with SWE at our institution from April 2021 to March 2022. Liver stiffness was evaluated using SWE, and liver fibrosis stages (F0-F4; METAVIR scoring) were determined based on the previously reported associations between liver stiffness and liver fibrosis. We assessed the general condition of each patient and performed routine blood investigations on the same day as SWE.

Results: Two out of 20 patients had long-term complications (intrahepatic stones without symptoms [n = 1], recurrent cholangitis [n = 1]). The median hepatic shear wave propagation velocity was 1.26 (range, 1.12-1.60) m/s in all cases. The estimated liver fibrosis stage was ≤F1 in patients without long-term complications. In patient with recurrent cholangitis, the hepatic shear wave propagation velocity was 1.60 m/s, and the estimated liver fibrosis stage was F3.

Conclusion: Liver fibrosis tended not to occur in patients with no complications after surgery for CBD. However, patients with long-term postoperative complications, such as cholangitis, should be examined using SWE so as not to overlook liver cirrhosis.

Aim: This study aimed to discuss the role of home-visit nurses in managing continuous catecholamine infusion in patients with heart failure by investigating the outcome of patients and the home-visit nursing intervention.

Methods: We conducted a retrospective, case series study of eight patients with heart failure who underwent home-based continuous catecholamine infusion between April 2016 and March 2024. Data including the patients' demographics, the duration of continuous catecholamine infusion, the frequency of nursing and emergency nursing visits, and patients' endpoints were collected.

Results: The median age of the patients was 68.5 (interquartile range: 51.8-80.0) years and 75% were men. The most common diagnosis requiring home-based catecholamine infusion was dilated cardiomyopathy. The median duration of continuous catecholamine infusion in the patients was 58.0 days. The median frequency of nursing visits was 8.4 times each week. Forty-five emergency nursing visits occurred, and the most common reason for these visits was managing infusion device malfunctions. Among the patients, six died at home, one was hospitalized owing to fatal arrhythmia, and one withdrew from continuous catecholamine infusion.

Conclusion: This study shows the complexities of providing home-based care for patients with heart failure requiring continuous catecholamine infusion. Most patients with heart failure were able to spend the rest of their lives at home, despite the challenges of managing such a treatment outside the hospital. Our findings indicate the need for early intervention, multidisciplinary collaboration, and the development of home care protocols to optimize treatment efficacy and the quality of life of these patients.

Food protein-induced enterocolitis syndrome (FPIES) caused by fish and others is prevalent in the Mediterranean regions but is less frequently reported in Japan. This case report describes a 3-year-old Japanese girl who developed FPIES triggered by multiple seafoods, including swordfish, cod, and squid. The diagnosis was confirmed through oral food challenge tests (OFC), which led to repeated vomiting and an increase in thymus and activation-regulated chemokine (TARC) levels. This case highlights the importance of considering fish-induced FPIES in the differential diagnosis of recurrent vomiting in children and suggests the potential utility of TARC levels in diagnosing and monitoring FPIES.

Backgrounds: The prescription of sodium-glucose cotransporter-2 (SGLT2) inhibitors have been increasing due to their additional benefits, including weight loss, cardioprotection and renoprotection. Accordingly, there are concerns about the potential rise in severe adverse drug reactions (ADRs), such as urinary tract infections, diabetic ketoacidosis, volume depletion, and hypoglycemia. The Society has announced recommendations on the proper use of SGLT2 inhibitors. We aimed to elucidate the recent occurrence of severe ADRs which need discontinuation of SGLT2 inhibitors or hospitalization.

Methods: In this retrospective cohort study, we identified 391 diabetic patients who were prescribed SGLT2 inhibitors upon admission to our hospital between April 2017 and March 2023. Of these, 68 patients who discontinued SGLT2 inhibitors for reasons other than ADRs were excluded. Patients were classified into the 2017 group and the 2020 group based on the treatment period of SGLT2 inhibitors, and the occurrence of ADRs and patient backgrounds were compared between the two groups.

Results: A total of 323 eligible patients were identified. Discontinuations of SGLT2 inhibitors decreased in the 2020 group (p < 0.05). However, discontinuations due to frailty increased (p < 0.05). Hospitalization due to ADRs, specifically those due to urinary tract infections, diabetic ketoacidosis, or volume depletion, did not specifically decrease (p = 0.273).

Conclusions: This study indicated that there has been some improvement in the awareness of the proper use of SGLT2 inhibitors and there is still a need to continue enlightenment activities.

Background: We present a case involving a pregnant woman who needed transurethral lithotripsy for ureteral stent removal because of the stent encrustation.

Clinical case: A 34-year-old woman was diagnosed with calculous pyelonephritis, and a double-loop ureteral stent was placed in her right ureter, after which the pyelonephritis resolved. One week after her delivery, we attempted to remove the ureteral stent; however, the encrustation of the proximal and distal coils made it impossible. We then crushed the encrustation by transurethral lithotripsy and removed the ureteral stent successfully. The encrustation component was calcium phosphate, and the urinary pH during pregnancy and after delivery was 7.5.

Conclusion: Even in pregnant patients, patients placed ureteral stents for obstructive pyelonephritis with high urine pH might need to be replaced in the short term due to concerns regarding phosphate encrustation.

Few studies have examined the relationship between pelvic size and the success or failure of trial of labor after cesarean delivery (TOLAC). Here we aimed to determine whether pelvic size and morphological data obtained from radiography contribute to the first successful TOLAC. This retrospective single-center observational study enrolled pregnant women who underwent TOLAC between 2010 and 2021. The results of X-ray pelvimetry data, including obstetric conjugate (OC), transverse diameter of the pelvic inlet (TD), anteroposterior diameter of the pelvic inlet (APD), shape of the pelvic inlet, and other obstetrical clinical data, were compared between the success and failure groups. Seventy-five patients in successful group after excluding 35 patients with previous successful TOLAC, and 21 patients in failure group were eligible. The failure group had a higher rate of previous cesarean sections due to failed labor trials (p = 0.042) and heavier newborns (p = 0.014). OC, TD, and APD on X-ray pelvimetry did not differ significantly between the two groups nor did the shape of the pelvic inlet affect the success rate for TOLAC. The generalized linear model identified a history of failed trials of labor as a significant predictor of failed TOLAC (odds ratio, 0.26; 95% confidence interval 0.071-0.923; p = 0.037), whereas no pelvimetric parameters were found. Pelvic size and morphological findings have no discernible impact on the outcomes of TOLAC. The universal application of X-ray pelvimetry in all women attempting TOLAC may not have significant clinical relevance.

Intussusception is a common cause of intestinal obstruction in infants aged 6-18 months. However, intussusception in preterm neonates (IPN) is an exceedingly rare disorder. The etiology of IPN remains unclear, but common prenatal injuries, such as those causing intestinal hypoxia/hypoperfusion, dysmotility, and strictures, have been proposed as possible contributing factors. Diagnosis is often delayed because the symptoms closely resemble those of necrotizing enterocolitis (NEC). Given the divergent treatments for IPN and NEC, establishing an early and accurate diagnosis is crucial. IPN is predominantly located in the small intestine (91.6%), and ultrasonography proves useful in its diagnosis. We present a case of a very preterm infant who developed intussusception triggered by acquired cytomegalovirus (aCMV) infection, necessitating surgical treatment. The cause of intussusception in this case was diagnosed as aCMV enteritis because no organic lesions were observed in the advanced part of the intussusception. The presence of CMV was confirmed by CMV-DNA-PCR examination of the resected intestinal tract. Intestinal edema and decreased intestinal peristalsis due to aCMV enteritis are likely the primary causes of the intussusception.

Background: The fitting of oxygen mask affects the performance of it such as oxygenation or CO₂ elimination. The intersurgical EcoLite™ adult high-concentration oxygen mask (EcoLite with a reservoir, Intersurgical, UK) was developed to give well-fitting. The purpose of this study is to evaluate the performance of EcoLite with a reservoir compared to the conventional mask.

Methods: Ten healthy volunteers were included in this study. EcoLite with a reservoir and conventional mask were given to patients at different oxygen flow rates (5, 8, 10, 12, and 15 L/min). Fraction of inspiratory O₂ (F_IO₂) and partial pressure of inspiratory CO₂ (P_ICO₂) were measured by a sampling tube at the middle pharynx inserted via nose.

Results: The EcoLite with a reservoir had a significantly higher F_IO₂ than the control reservoir mask. However, the P_ICO₂ was significantly higher in the EcoLite with a reservoir than in the control reservoir mask, especially when the oxygen flow rate was low.

Conclusion: The EcoLite with a reservoir provided improved oxygenation and a better fit than the conventional reservoir masks in healthy volunteers. However, the EcoLite with a reservoir might cause higher CO₂ rebreathing at low oxygen flow rates.

Olfactory neuroblastoma (ONB) is an uncommon malignant tumor and is usually treated by a multidisciplinary approach includes surgery, radiotherapy, and chemotherapy. A 62 years-old male had a tumor in the nasal cavity and diagnosed as ONB with Kadish A stage. Anterior skull base surgery was performed as radical treatment. Since the surgical margin was negative, no postoperative radiotherapy was administered. 14 years after the surgery, bilateral otitis media with effusion (OME) was occurred, we found the recurrence tumor at bilateral retropharyngeal lymph node (RPLN) which surrounded the internal carotid arteries. Since these were unresectable, we planned chemoradiotherapy which was 70Gy of intensity modulated radiotherapy combined with two courses of carboplatin and etoposide. The tumor volume was reduced and bilateral OME were improved. He has been alive for 3 years after salvage treatment. Although ONB has a relatively good prognosis, it is known to often cause cervical lymph node metastasis. Grades III and IV of Hyams classification are considered high risk. This case, initial tumor was limited in the nasal cavity and its clinical classification was early stage, but Hyams classification was grade III. In reference to this case, considering that RPLN metastasis are difficult to radically resect at the salvage surgery, including this area in postoperative radiotherapy was considered an option.

Patients with heart failure have difficulty recognizing and identifying changes in bodily sensations, despite the importance of symptom monitoring. The way patients with heart failure experience their bodies from exacerbation to recovery is poorly understood. We aimed to describe the lived bodily experience of heart failure from exacerbation to recovery. Participatory observations and interviews were conducted in seven patients admitted to the intensive care unit with worsening heart failure. Benner's interpretive phenomenology was used for analysis. Four major themes were identified: a non-functional body becomes the central concern and an object; being conscious of bodily changes before hospitalization when asked; the central concern shifted to daily life and the body becomes the background; and having a feeling of death in the body that no longer functions or a weakened body after recovery. This study found that patients with heart failure were conscious and concerned about their bodies changing as they underwent rapid changes during exacerbations and recovery. In addition, immediately after their bodies recovered and until they were discharged from the hospital, they looked toward their daily lives through their bodily experiences during heart failure exacerbation. The lived bodily experience of heart failure, which is less conscious in daily life, is made conscious through storytelling in the period immediately following recovery from an acute exacerbation and can be the basis for subsequent self-care exploration.