Fukushima Journal of Medical Science最新文献

AbstractA 27-year-old man with no medical history developed a fever and sore throat 5 days before visiting a primary care doctor. He was admitted to our hospital due to worsening symptoms, with a fever of 38.3ºC, redness of the pharynx, left tonsillar hypertrophy, uvular deviation to the right, and left submandibular lymph node enlargement with tenderness. Plain computed tomography (CT) revealed an enlarged left tonsil and lymph node. As it was difficult to differentiate between peritonsillar abscess (PTA) and peritonsillar cellulitis by plain CT, bedside cervical ultrasonography as point-of-care ultrasound (POCUS) was performed. A low echogenic area was observed in the center of the image. The mass with a low signal area on contrast-enhanced CT (CECT) was diagnosed as PTA. The patient was transferred to the otolaryngology department for pus drainage and was discharged 5 days later.Complications of PTA are rare but potentially fatal, warranting early diagnosis and prompt, appropriate management. CECT is useful for the diagnosis of PTA, but given the risk of complications by contrast agents and radiation, appropriate patient selection is important when performing CECT. POCUS was useful in diagnosing PTA that could not be diagnosed by plain CT.

Background: Advances in treatment strategies and interventional radiology have led to the widespread adoption of nonoperative management for liver trauma;however, severe cases still require surgery, and are associated with high mortality. While the widely used American Association for the Surgery of Trauma (AAST) Liver Injury Scale is regularly updated and includes computed tomography (CT) findings, the Japanese Association for the Surgery of Trauma (JAST) Liver Injury Classification is also utilized in Japan but may have limitations in predicting prognosis based solely on imaging. Few studies have compared the prognostic utility of the two systems.

Methods: This retrospective study analyzed patients who underwent laparotomy for liver injury at Fukushima Medical University Hospital (2013-2023). Liver injury-related mortality cases were compared with survivors to assess the predictive accuracy of the AAST and JAST classifications.

Results: Among 23 patients, the overall mortality rate was 34.8%, with 5 liver injury-related deaths. AAST grades IV-V yielded 100% sensitivity and 80% specificity for predicting mortality (p=0.001), whereas JAST had lower sensitivity (60.0%) and specificity (86.7%, p=0.073).

Conclusion: AAST grading may be more effective than the JAST classification for predicting liver injury-related mortality. Future JAST revisions should integrate imaging findings and treatment strategies to enhance its prognostic accuracy.

To clarify the characteristics of children with attention deficit hyperactivity disorder (ADHD) requiring early drug therapy and changes in ADHD treatment over time, we undertook a clinical survey of ADHD children. We retrospectively classified 168 children with ADHD into groups based on the presence [Group 1, (the early treatment Group A, non-early treatment Group B)] or absence (Group 2) of ADHD drug therapy. The older age at first examination and the frequency of patients born with low birth weight in Group 1 were higher than those in Group 2. The ADHD-Rating Scale (ADHD-RS) scores for total (ADHD-RS-T) and trouble scores (TS) in Group 1 were higher than those in Group 2. All patients requiring early drug medication were diagnosed with ADHD at age 6 or older and showed significantly higher ADHD-RS hyperactivity disorder (ADHD-RS-H) and TS. Guanfacine was the main drug prescribed, being the first-line drug in 45.0% of cases. These results suggest that characteristics of patients requiring early ADHD drug medication include age 6 years or older at first examination and high ADHD-RS-H, ADHD-RS-T and TS. Furthermore, an increase in the frequency of prescriptions for guanfacine was observed as a prescription trend for ADHD medications.

Combinatorial immunotherapy using anti-programmed cell death 1 (PD-1) monoclonal antibody (mAb) is being developed to overcome the limited efficacy of monotherapy with anti-PD-1 mAb for patients with advanced gastric cancer (GC). Anti-PD-1 mAb exhibits clinical efficacy by enhancing the function of cytotoxic T lymphocyte (CTL) through the inhibition of the PD-1 pathway;however, there are various immunosuppressive mechanisms that inhibit CTL function, as well as the PD-1 pathway in the tumor microenvironment (TME). Immune suppressive cells and expression of the inhibitory immune checkpoint molecules are included as main inhibitory mechanisms against CTL in the TME. On the other hand, increasing the number of CTLs enhances the efficacy of anti-PD-1 mAb, and immunogenic tumor cell death (ICD) is crucial to induce CTL through the activation of the cancer immunity cycle. In the present review, we discuss the therapeutic potential of developing combinatorial immunotherapy focusing on the inhibitory immune checkpoint molecules and immune suppressive cells in the TME, as well as on the ICD induced by radiotherapy for patients with advanced GC.

Background: Bladder inguinal hernias are relatively rare, accounting for 0.5-5% of all inguinal hernias. They often present with nonspecific symptoms, making diagnosis challenging. Without timely treatment, complications such as urinary tract infection, bladder obstruction, or renal dysfunction may occur. Early recognition is crucial, and computed tomography (CT) is particularly effective in identifying bladder involvement, providing detailed anatomical information needed for surgical planning.

Methods: We evaluated three cases of bladder inguinal hernia successfully diagnosed preoperatively using CT and treated with transabdominal preperitoneal repair (TAPP). These cases highlight the diagnostic value of CT and the safety and efficacy of TAPP.

Results: Three patients, aged 65, 80, and 81, presented with groin pain or urinary symptoms. CT confirmed bladder prolapse in all cases. TAPP was performed without major complications. Operative times ranged from 97 to 106 minutes, with minimal blood loss. All patients were discharged within 3 days, and no recurrences were observed during 1-4 years of follow-up.

Conclusions: CT is effective for diagnosing bladder involvement in inguinal hernias and should be considered for all suspected cases. TAPP offers a safe and effective way to manage this condition.

Objective: This study aimed to compare the clinical outcomes of total laparoscopic hysterectomy (TLH) and robot-assisted laparoscopic hysterectomy (RALH) for treating symptomatic uterine fibroids at a single institution in Japan. Additionally, we identified factors associated with operative time in each surgical approach.

Methods: This retrospective cohort study included 163 premenopausal women with symptomatic uterine fibroids who underwent TLH (n = 119) or RALH (n = 44) between October 2021 and March 2025. Clinical characteristics, magnetic resonance imaging findings, and surgical outcomes were reviewed. Operative time was defined as the time from skin incision to closure. Multivariate linear regression analyses stratified by surgical method were performed to identify factors influencing operative time.

Results: Operative time was significantly longer in the RALH than in the TLH group (median:208 vs. 176 min, p < 0.001). Multivariate analysis revealed that uterine length (LU) was associated with longer operative time in both groups, whereas parity was associated with reduced operative time in the RALH group.

Conclusion: Both UL and parity were independent factors influencing operative time and highlighted the clinical implications of longer operative time in early-phase RALH compared with TLH.

AbstractRectal neuroendocrine tumor (NET) G1 is a docile-looking tumor. We herein report a 77-year-old male whose rectal NET G1 measuring 10 mm recurred eight years after endoscopic mucosal resection. Tumor recurrence was detected by his mild general fatigue. Abdominal computed tomography revealed widespread metastasis, including the liver, lymph nodes around the rectum, and cervical spines. Subsequent somatostatin receptor scintigraphy, as well as histological reassessment of previously resected specimen, proved that these metastatic diseases originated from the rectal NET G1 with vascular invasion and possible positive vertical margin. First, octreotide long-acting repeatable 30 mg i.m. was administered every four weeks. Second, transcatheter arterial chemoembolization (TACE) for multiple liver metastases and irradiation therapy for spinal metastasis were carried out. One year after these treatments started, everolimus (mTOR inhibitor) 10 mg p.o. was administered every day. For the last five years, he received two rounds of TACE treatments and one round of irradiation. Although recurrent diseases were temporally controlled by these multidisciplinary treatments for the last month, he died of multiple metastases six years later, after tumor recurrence was detected. This case underscores the potential for late recurrence even in rectal NET G1 with unfavorable histological features, highlighting the importance of long-term surveillance.

This paper reports a rare case of coexisting systemic sarcoidosis and eosinophilic gastroenteritis. Multiple inflammatory lesions were detected by computed tomography and (18)F-fluorodeoxyglucose positron emission tomography, and a diagnosis of systemic sarcoidosis was established by biopsies from the hilar lymph node and palpable purpura. The patient exhibited peripheral blood eosinophilia. Upper endoscopy revealed duodenitis, and histological examination confirmed marked eosinophilic infiltration of the duodenal mucosa, consistent with eosinophilic gastroenteritis (EGE). The patient also had hypopituitary adrenal insufficiency, thought to be caused by neurosarcoidosis, based on medical history and evidence of systemic sarcoidosis. Early administration of corticosteroids resulted in improvement without sequelae. Our case suggests that hypereosinophilia and EGE may manifest as a lethal disease phenotype, such as adrenal insufficiency or neurosarcoidosis.

AbstractChronic pain patients can achieve substantial improvement within six months, but some require prolonged care. This study aimed to explore differences in baseline characteristics and questionnaire responses between patients who showed significant improvement within six months (completion group) and those requiring treatment beyond six months (continuation group). A cross-sectional study was conducted among 131 patients. Patients were classified into completion group (n = 97) or continuation group (n = 34). Baseline data included demographic information (sex, age), ICD-11J classification, average pain intensity using the numeric rating scale (NRS) and scores from the Brief Pain Inventory (BPI), Pain Catastrophizing Scale (PCS), Pain Disability Assessment Scale (PDAS), Hospital Anxiety and Depression Scale (HADS), Pain Self-Efficacy Questionnaire (PSEQ), EuroQol Five Dimensions Questionnaire (EQ-5D), and Athens Insomnia Scale (AIS). There were no significant differences in age, sex, or ICD-11J classification between the groups. However, the continuation group exhibited significantly higher baseline scores for average pain intensity, PDAS, and HADS depression than the completion group. Patients with higher baseline pain intensity, greater functional impairment, and more severe depressive symptoms were more likely to require extended multidisciplinary treatment. Early identification of these risk factors is critical for optimizing treatment planning and improving outcomes in chronic pain management.

Patients with schizophrenia often experience deficits in timing and rhythm-processing abilities, yet the impact of group-based expressive rhythm training on these functions remains unclear. In this study, we examined the effects of short, daily rhythm training sessions on rhythm perception and production in patients with schizophrenia. Participants (N = 15) in an acute care ward received an average of 18.6 training sessions (15 minutes each). Rhythm abilities were assessed before and after the intervention using the Harvard Beat Assessment Test (H-BAT). Group-level analyses showed no significant changes in the mean values of H-BAT measures. However, correlation analysis revealed that the association between the two rhythm production subtests strengthened considerably post-training (from ρ = -0.539 to ρ = -0.896), indicating greater consistency in rhythm production performance. These findings suggest that expressive rhythm training may help stabilize rhythm output in patients with schizophrenia, even when average performance levels do not significantly change. This improvement in internal consistency provides new insights into the potential mechanisms linking schizophrenia pathology to impaired rhythmic processing and may contribute to the development of novel rehabilitation strategies for this population.