Fukushima Journal of Medical Science最新文献

Many countries have adopted the use of helicopter emergency medical services (HEMS). One such system in Japan is called "Doctor Heli" (Doctor Helicopter), which is sometimes used as a means of maternal transport. Since 2008, there have been 18 cases of Doctor Heli maternal transport to Fukushima Medical University Hospital, the ultimate referral center of Fukushima Prefecture. Reasons for transport included umbilical cord prolapse (UCP), placental abruption, traffic accident, and fetal bradycardia. There were two cases of intrauterine fetal death upon arrival at the hospital. Although there is no specific requirement for an obstetrician to be on board, we encountered a case of UCP in which an obstetrician examined a patient and then traveled with her via helicopter ; the baby was successfully delivered at a tertiary care facility. In cases such as UCP, where immediate assessment of fetal condition is critical, involvement of an obstetrician prior to or during transport can be vital. Because aeromedical dispatch can connect doctors and patients more quickly, it may improve perinatal outcomes.

Background: Lymphangiomas are rare benign tumors typically occurring in children's head andneck regions. Pelvic lymphangiomas in adults are extremely uncommon and often mimic ovariantumors, making preoperative diagnosis challenging in peri- and postmenopausal women.

Case presentation: A 53-year-old Japanese woman with a duodenal ulcer history developed amulticystic right adnexal mass during follow-up for uterine fibroid (initially diagnosed at age43). The uterine fibroid measured 11 cm on imaging at the start of follow-up, with no abnormalitiesdetected in the adnexa. Magnetic resonance imaging (MRI) performed at age 52 revealed a58×37 mm multicystic mass in the right adnexa, which enlarged to 80 mm over the followingyear. MRI revealed a multicystic mass near the right ovarian vessels ; the left adnexa appearednormal. Surgery included right adnexectomy, total hysterectomy, and left salpingo-oophorectomy.Intraoperatively, a well-defined multicystic lesion was identified along the infundibulopelvicligament with normal right ovary appearance. Histopathological examination confirmed lymphangioma,with positive immunostaining for D2-40 and CD31. The postoperative course was uneventful,with no recurrence at the 3-year follow-up.

Conclusion: Pelvic lymphangioma should be considered in the differential diagnosis of multilocularpelvic masses. Comprehensive imaging and histopathological analysis are crucial for accurate diagnosisand management.

Leukocytoclastic vasculitis (LCV) is a disease secondary to infections, malignancies, or drug exposure, although its pathogenesis remains unclear. Secondary LCV from different causes in the same patient has been rarely reported. We present a case of LCV secondary to pancreatic cancer that remained in remission for one year post-surgery, after which the patient suffered from a subdiaphragmatic abscess caused by Escherichia coli, followed by recurrence of LCV. This case suggests that patients with acquired hyposplenism may be susceptible to developing LCV as a manifestation of underlying disease. Careful evaluation of the underlying disease is important to avoid inappropriate immunosuppressive treatment.

Non-invasive prenatal genetic testing (NIPT) began in Japan in 2013 as clinical research. Fukushima Medical University Hospital (FMU) was the only accredited facility for NIPT in Fukushima Prefecture from 2016 until 2022, when two additional collaborative facilities were accredited. This study aimed to describe the current status of NIPT at FMU through a retrospective analysis of the medical records of 1,123 individuals who sought NIPT and received genetic counseling at FMU between January 2016 and December 2023. Of these individuals, 1,078 underwent NIPT, while 45 did not. The total NIPT uptake corresponded to 1.2% of all births in Fukushima during this period. Although the number of patients undergoing NIPT at FMU has been continuously decreasing since 2022, overall uptake in the prefecture increased in 2023. All three accredited facilities are located in highly populated, easily accessible parts of Fukushima Prefecture, leading to higher uptake among those living in these and surrounding areas. After genetic counseling, some opted against NIPT, while others chose to undergo other tests, which indicates the importance of informed decision- making. In large regions like Fukushima, increasing the number of accredited facilities and improving access to appropriate genetic counseling are crucial for ensuring informed decision-making about NIPT.

Objective: To investigate the relationship between physical activity levels and atypical femoral fractures (AFF) in bisphosphonate (BP) users.

Methods: In the Assessing Daily-Activity-Level for Decisions on Bisphosphonate Prescription (ADD-BP) study, we retrospectively analyzed 27 women with AFF from five hospitals (2019-2023), categorized into BP (n = 18) and no-BP (n = 9) groups. Pre-injury physical activity was assessed via mobility aid usage, Long-Term Care Insurance System status, and independence in daily living.

Results: Median ages were 77 years (BP) and 86 years (no-BP). In the BP vs. no-BP groups, 83.3% vs. 33.3% used no mobility aids, 11.1% vs. 22.2% used canes, and 5.6% vs. 33.3% used walkers. No BP users (0%) vs. 33.0% of no-BP users were housebound ; others were independent.

Conclusion: BP users with AFF exhibited higher physical activity levels than non-users, suggesting low activity may not elevate AFF risk in long-term BP use. These findings support the safety of extended BP therapy for fragility fracture prevention in less active patients. Future case-control studies are needed to confirm these results. This study was approved by the Fukushima Medical University Ethics Committee (REC2023-176).

Infectious mononucleosis (IM), caused by Epstein-Barr virus, often mimics group A streptococcal (GAS) pharyngitis and may result in an ampicillin rash when aminopenicillins are administered. We report a 22-year-old woman with fever, sore throat, lymphadenopathy, and a generalized erythematous rash after a 7-day course of amoxicillin-clavulanate. Although a rapid streptococcal antigen test was positive, non-tender lymphadenopathy and absence of left shift in the white blood cell count suggested viral infection, and the result was considered consistent with a carrier state rather than true GAS infection. No additional antibiotics were given ; corticosteroid and antihistamine treatment led to improvement. Serology confirmed acute Epstein-Barr virus infection, and throat culture revealed only alpha-hemolytic streptococci. This case underscores the diagnostic overlap between IM and streptococcal pharyngitis, the need for caution in interpreting rapid antigen tests, and the importance of avoiding unnecessary antibiotics in suspected viral illness.

The objective of this study was to investigate the trends in the number of positive cases of influenza and dengue fever before and during the COVID-19 pandemic in a private hospital in Cambodia. This study was a preliminary observational prospective descriptive study. A total of 2,991 patients were included. The positivity rate for dengue fever was higher before COVID-19 (14.7%, 179/1217) than during the COVID-19 period (4.1%, 10/242). For influenza, the positivity rates before COVID-19 were 13.3% (185/1394) for influenza A and 10.7% (149/1394) for influenza B. During the COVID-19 period, these rates changed to 18.2% (174/958) for influenza A and 0.4% (4/958) for influenza B. A whole country assessment of dengue and influenza disease patients should be done during the COVID-19 pandemic term.

Background: The aim of this questionnaire-based study is to characterize serum uric acid (UA) levels in a cohort of young adults and to assess associations of serum uric acid levels with epidemiological factors.

Methods: Cohort data from 15,574 new university enrollees aged 18 to 20 years, including their serum UA levels, were collected. The prevalence of hyperuricemia and the relationship between serum UA and epidemiological factors, including blood pressure, sex, and obesity, were examined.

Results: The mean serum UA (mg/dL) was 5.2 (4.2 in women and 5.8 in men) and the prevalence of hyperuricemia (UA>7.0 mg/dL) was 6.6%. Serum UA levels were positively correlated with systolic blood pressure (SBP) levels. No statistically significant interactions were detected between serum UA and sex or obesity in relation to SBP.

Conclusion: Hyperuricemia is common among young adults. A higher UA level is related to increased blood pressure, irrespective of sex and obesity.

Background: Transient abnormal myelopoiesis (TAM) is a transient abnormal leukemoid reaction that occurs in approximately 5-10% of Down syndrome cases. TAM is typically self-limiting, however, it can be life-threatening because of severe pulmonary or hepatic complications. Approximately 20% of these patients develop acute megakaryoblastic leukemia after remission by the age of 4 years. Here, we report a case of TAM with trisomy 21, tetrasomy 21, and trisomy 19.

Case report: The patient was a 1-day-old male neonate with nuchal translucency measured by fetal ultrasonography at 16 weeks of gestation. He was suspected to have Down syndrome due to his characteristic facial appearance at birth. G-band staining of the peripheral blood when TAM was diagnosed showed trisomy 21, tetrasomy 21, and trisomy 19. The blasts disappeared from the peripheral blood at 4 months of age. G-band staining of the peripheral blood at the time of blast disappearance demonstrated that tetrasomy 21 and trisomy 19 had resolved.

Conclusion: It was inferred from the course of the disease that the cells with tetrasomy 21 and trisomy 19 might be blast cells of TAM.

The Fukushima Field Trip Course (Harvard T.H. Chan School of Public Health, GHP549, Winter Session 2025) offered a unique educational experience for 15 graduate students from various disciplines at Harvard University, to examine ongoing recovery challenges in Fukushima following Japan's 2011 triple disaster, which included a massive earthquake with powerful aftershocks, a tsunami, and explosive meltdowns at a coastal nuclear power plant. The course included interactions with diverse stakeholders in Fukushima and Tokyo and site visits to foster a comprehensive understanding. Organized into three groups (Health Monitoring, Risk Communication, and Environmental Decontamination), students presented their reports and results at Fukushima Medical University on January 21, 2025. The Health Monitoring group recommended enhancing the Fukushima Health Management Survey through community engagement, mixed-method approaches, and integrated data systems. The Risk Communication group proposed a national 15th anniversary campaign to revise and renew public perceptions of Fukushima in Japan and abroad. The Environmental Decontamination group suggested leveraging international solidarity to create a global network around reconstruction after disasters and promoting "Hope Tourism." The course is designed to connect Fukushima with the world and prepare future leaders in community rebuilding after major crises.