Fukushima Journal of Medical Science最新文献

Acute pancreatitis in children in Japan is often caused by an anatomical abnormality of the pancreatic and bile duct, resulting in fever, abdominal pain, vomiting, diarrhea, and other symptoms.　Crohn's disease, however, is a chronic granulomatous inflammatory bowel disease with ulcerative lesions of the intestinal tract of unknown cause that occurs mainly in young people, with symptoms similar to those of acute pancreatitis.　We report a case of acute pancreatitis diagnosed in a patient not only with incomplete fusion of the pancreatic duct but also with Crohn's disease.　A 14-year-old girl, healthy by nature, presented to our hospital with complaints of abdominal pain and diarrhea.　She was initially diagnosed as having acute pancreatitis due to incomplete pancreas divisum.　However, a high level of fecal calprotectin led to endoscopic examination, which resulted in the diagnosis of Crohn's disease.　Fecal calprotectin can be useful in the diagnosis of inflammatory bowel disease associated with acute pancreatitis in children.　Although the relationship between inflammatory bowel disease and acute pancreatitis has not yet been clarified, we suggest that in the present case, acute pancreatitis may have manifested as a complication of Crohn's disease and an underlying case of incomplete pancreas divisum.

Fukushima Medical University (FMU) organizes annual International Symposiums on the Fukushima Health Management Survey (FHMS) to share up-to-date Survey findings.　In response to radiation released from the Tokyo Electric Power Company's Fukushima Daiichi Nuclear Power Plant after the Great East Japan Earthquake, the FHMS was established with the aim of providing long-term follow-up for the physical and mental health of Fukushima residents, and maintaining and improving their health into the future.　This year, the sixth annual symposium was convened in Tokyo on Saturday, March 2, 2024, with the theme, "3.11:Sharing Lessons of Fukushima with Japan and the World."

Myositis-specific autoantibodies play an important role on the disease phenotype of idiopathic inflammatory myopathies (IIMs). Anti-signal recognition particle (SRP) antibody-positive patients with IIMs may present with severe myopathy and highly elevated serum creatine kinase levels. These patients are often resistant to immunosuppressive therapy, but there is no established treatment strategy. A 51-year-old man referred to our department was diagnosed with IIM based on imaging and pathological findings. A high dose of corticosteroids followed by intravenous cyclophosphamide (IV-CY) treatment (750 mg three times) resulted in an improvement in clinical manifestations and functional outcomes, and recurrence did not occur. Our case suggests that IV-CY is an effective induction regimen for patients with anti-SRP antibody-positive IIMs.

Increased fear of falling (FOF) increases the risk of falling and is an important issue for living an independent life.　Patients undergoing hemodialysis (HD) frequently fall, and this may be attributed to increased FOF due to common fall risk factors as well as severe chronic kidney disease and HD-related factors.　The purpose of this narrative review was to summarize the current knowledge on the mechanisms of increased FOF leading to falls in patients undergoing HD.　Patients undergoing HD have enhanced FOF compared to community elderly people.　Furthermore, an increase in FOF is correlated with a decrease in physical activity and physical function.　It has been reported that FOF in patients undergoing HD may be associated with past and future falls, and the risk of falling increases sharply when FOF exceeds a certain threshold.　Increased FOF may serve as a fundamental mechanism leading to increased fall risk by interacting with physical inactivity and physical frailty, affecting lower limb muscle activity during walking.　Further research is needed to clarify the relationship between increased FOF and falls in patients undergoing HD.　Regular clinical assessment of FOF is critical for identifying fall risk in patients undergoing HD.

This study aimed to assess long-term changes in pregnancy and birth outcomes after the Great East Japan Earthquake and the accident at the Tokyo Electric Power Company's Fukushima Daiichi Nuclear Power Plant in Fukushima Prefecture.　This is the final report on perinatal outcomes of the Prefectural Health Survey, which ended after a 10-year observation period.　Questionnaires based on a pregnancy and birth survey conducted by the Radiation Medical Science Center for the Fukushima Health Management Survey were sent to women who had received maternal and child health handbooks from municipal officers in Fukushima Prefecture.　Annual data from six geographic areas in Fukushima Prefecture were separately analyzed.　The number of eligible respondents, which was approximately 16,000 in 2011 when the earthquake occurred, declined temporarily the following year, recovered temporarily one year later, and has gradually declined since then.　However, the response rate remained at approximately 50% throughout the decade.　The incidence of preterm deliveries, low-birthweight infants, and congenital anomalies did not vary over the decade and showed a similar trend in national surveys and general reports.　Our analysis shows that the disaster had no significant adverse perinatal outcomes in Fukushima Prefecture and we recommend measures to ensure the safe delivery of babies in the region.

Background: White fiber dissection is essential for studying brain connections.　However, preparation protocols have not been validated.

Methods: We microstructurally analyzed Klingler's brain preparation method and freezing process and assessed changes under two protocols:freeze-only and freeze-thaw.　The microstructure changes of these protocols were evaluated by measuring the ratio of the total gap area to the white matter area and determining the mean eccentricity value to assess the degree of anisotropy.

Results: Sixty hemispheres were allocated to ten different freezing protocols.　In the freeze-only protocols, the total gap area ratio was significantly higher compared to that of specimens fixed with only formaldehyde, particularly after continuous freezing for 3-4 weeks;however, the difference in eccentricity was not significant.　In the freeze-thaw protocols, both the area ratio and eccentricity were significantly higher compared to the freeze-only.　The optimum degree of fiber separation in the freeze-thaw protocols reached its peak with four cycles of 1-week freezing periods interrupted by six hours of thawing.

Conclusion: The Klingler method assists in the separation of the white fibers through the gaps formed by ice crystals, but an appropriate degree of anisotropy is reached when the freezing protocol is interrupted by at least four thawing cycles.

Although uterine sarcoma is a rare disease, its prognosis is extremely poor;thus, it is important to differentiate it from uterine leiomyoma.　In this retrospective study, we examined the association between preoperative MRI findings and postoperative pathology results in 170 patients with uterine tumors who underwent preoperative MRI examination at Fukushima Red Cross Hospital.　In 4 cases of sarcoma / smooth muscle tumor of unknown malignant potential (STUMP), abnormal findings were found at a high frequency with T1-weighted imaging (T1WI) (75%), T2-weighted imaging (T2WI), diffusion-weighted imaging (DWI), and contrast enhancement (CE) (100%).　In cases of ordinary leiomyoma, on the other hand, abnormal findings were less frequent.　The rates of high DWI signal intensity for degenerated and cellular leiomyoma were 31% and 64%, respectively, and the CE-positive rates were 31% and 57%, respectively.　Apparent Diffusion Coefficient (ADC) values appeared to be useful in differentiating degenerated leiomyoma from sarcoma.　The relatively characteristic findings of uterine sarcoma on MRI images may overlap with those of degenerated leiomyoma and cellular leiomyoma, making it difficult to diagnose sarcoma on imaging alone.　However, findings that distinguish sarcoma from ordinary, degenerated, and cellular leiomyoma cases are worthy of attention, to avoid overlooking sarcoma.

Introduction: Computer-aided design and manufacturing (CAD/CAM) methods have gained prominence in early orthotic provision.　This study introduces an innovative approach using compact three-dimensional (3D) printers and computed tomography data to generate segmented body models for traditional Damen corset orthoses.　The goals included evaluating the comfort and fit of orthoses and assessing the effectiveness of our approach for prosthetic companies with limited financial resources.

Materials and methods: Lumbar and thoracolumbar orthoses were crafted via CAD/CAM.　Four healthy patients wore the orthoses, with whom immediate and 1-week comfort and fit assessments were conducted.　A prosthetist assessed fit, and the Japanese edition of OPUS-CSD, the Orthotics Prosthetics Users' Survey-Client Satisfaction with Device, was used for subjective assessment of comfort and fit.

Results: The fit evaluations were satisfactory for all patients with positive predefined criteria.　Questionnaire responses confirmed high satisfaction and comfort, confirming a successful orthosis fit.

Conclusion: We established an orthotic fabrication method using CAD/CAM methods with 3D printers.　Additionally, we confirmed the comfort and fit of the corsets so produced.　The initial cost of 3D printers is lower than that of traditional carving machines, enabling even small-scale orthotic fabrication facilities to utilize CAD/CAM methods.　Further research and refinements of this manufacturing approach are expected to expand its applicability.

There are increasing reports of patients with refractory otitis media caused by anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV), especially myeloperoxidase (MPO)-ANCA-positive middle ear disease.　However, making a definitive diagnosis can be difficult, which can adversely affect the outcome of treatment.　We reviewed the diagnostic features of MPO-ANCA-positive middle ear disease and here discuss the difficulties of timely diagnosis and treatment.　Seven cases were eligible (6 women, 1 man;aged 57-83 years), and all were MPO-ANCA positive and proteinase 3 (PR3)-ANCA negative.　The patients were referred to our institution for management of intractable otitis media (2/7), progressive hearing loss (7/7) with facial palsy (1/7), and/or a high MPO-ANCA titer (5/7).　All patients underwent tapering steroid therapy and their MPO-ANCA titer was monitored.　Refractory MPO-ANCA-positive otitis media was noted:5 of 7 cases showed improvement with tapering steroid therapy but cure was not achieved in the remaining 2 cases.　This study demonstrates the difficulties in the diagnosis and treatment of localized AAV.　Early diagnosis and treatment can improve the prognosis of patients with AAV but global diagnostic criteria for ear disease have not been established.　Additional cases should be prospectively examined to establish a treatment for MPO-ANCA-positive middle ear disease.

Changing perceptions of schizophrenia is crucial for both medical professionals and students.　This study examined negative attitudes toward schizophrenia among medical students, psychiatrists, psychiatric staff, physicians, and non-medical workers.　We created an 18-item survey using a web-based tool to assess attitudes toward schizophrenia, focusing on three factors:stigma, underestimation of patients' abilities, and skepticism about treatment.　To compare scores among the five participants' groups, we used analysis of covariance, adjusting for age and sex.　The study included 237 medical students, 10 psychiatrists, 16 psychiatric staff, 26 physicians, and 98 non-medical workers.　After adjusting for age and sex, the overall discrimination score for psychiatrists was significantly lower than those of medical students, physicians, and non-medical workers.　Among medical students, a comparison of each score by grade revealed that underestimation of patients' abilities scores was significantly higher in the fourth year than in the third year.　Furthermore, those aspiring to become psychiatrists had significantly lower adjusted mean and stigma scores than students with different career goals (p<0.05).　In conclusion, medical students, as well as physicians and non-medical workers, displayed higher levels of stigma towards schizophrenia than psychiatrists.　It is essential to explore modifying factors to improve medical students' attitudes towards schizophrenia.