JOURNAL OF MEDICAL INVESTIGATION最新文献

Background: Transforaminal full-endoscopic surgery can be performed under local anesthesia, which is safer than general anesthesia, especially in the elderly. However, emergencies can still occur under local anesthesia. We describe a case of cardiac arrest at the start of full-endoscopic spine surgery under local anesthesia.

Case presentation: The patient was an 80-year-old woman with right lower leg pain caused by two-level lumbar spinal canal stenosis. Two-stage full-endoscopic spine surgery under local anesthesia was planned. The first surgery was completed uneventfully. However, during the second surgery, cardiac arrest occurred because of Mobitz type II atrioventricular block. Percutaneous pacing was started immediately, followed by insertion of a temporary pacemaker via the femoral artery as a life-saving measure. Four days later, a permanent pacemaker was implanted. One month later, the second-stage decompression was completed without complications.

Conclusion: Elderly patients require careful intraoperative monitoring for emergencies during surgery under local anesthesia as under general anesthesia. J. Med. Invest. 71 : 314-319, August, 2024.

A 70-year-old man presented with cardiopulmonary arrest. Previous medical history included orally medicated diabetes mellitus, hypertension, stroke, and depression. The family observed that the patient had been sleeping for approximately 10 h. He was brought to the hospital and pronounced dead. Postmortem blood examinations revealed a blood insulin level of 0.54 μU/mL, C-peptide level of 0.14 ng/mL, and blood glucose of 9 mg/dL. Autopsy revealed an injection scar with intradermal hemorrhage and a subcutaneous hemorrhage in the left abdomen measuring 0.2 cm in diameter. Histopathological analysis revealed hemorrhage and inflammatory cell infiltration in the scar. Furthermore, subcutaneous adipose tissue, perivascular area, and neurons stained positive for anti-insulin antibody. HE staining of the brain revealed mild edema, and anti-GFAP antibody revealed clasmatodendrosis with bead-like staining of astrocyte subdivisions in the cerebral gray matter. Postmortem blood glucose evaluation is difficult because blood glucose levels are not stable and blood insulin is degraded relatively quickly. However, the cause of death was determined to be hypoglycemic encephalopathy due to insulin overdose because insulin was detected in the skin at the injection site. Furthermore, immunohistochemical examination of the brain revealed findings that were consistent with hypoglycemic encephalopathy. Therefore, histological examination was useful for postmortem diagnosis. J. Med. Invest. 71 : 340-342, August, 2024.

A 17-year-old male with thrombocytosis and exacerbation of arthralgia during intensified immunosuppressive therapy with tocilizumab, prednisolone, and methotrexate for juvenile idiopathic arthritis (JIA) was referred to our department. Bone marrow examination revealed myelodysplastic syndrome/myeloproliferative neoplasm, unclassifiable (MDS/MPN-U). Peripheral myeloblasts disappeared temporarily after discontinuation of tocilizumab but progressed to acute myeloid leukemia six months after the development of MDS/MPN-U. The patient sustained complete remission after unrelated bone marrow stem cell transplantation, followed by chemotherapy. The arthralgia also improved after chemotherapy. The possibility of developing malignancies during immunosuppressive therapy in patients with JIA should be considered. J. Med. Invest. 71 : 335-339, August, 2024.

Background: Hirayama disease (HD) is characterized by slow progression of muscle atrophy without sensory disturbance in a single upper extremity in adolescent boys. HD can be treated using both conservative measures and surgery. However, the optimal treatment remains controversial.

Case presentation: We have encountered an 18-year-old man with HD who presented to us with a 2-year history of progressive muscle atrophy and weakness of the left upper extremity. He underwent posterior cervical fusion surgery in the extended position without decompression. As of 5 years postoperatively, there has been no deterioration of his muscular atrophy and weakness and his condition has mildly improved. He was able to return to daily life and work with no difficulty.

Conclusions: Although cervical fusion surgery has several risks, including adjacent segment disease, posterior spinal fusion surgery without decompression in the short segment can be considered as a surgical option for HD. J. Med. Invest. 71 : 298-302, August, 2024.

Background: Carotid artery stenting (CAS) is commonly performed to treat internal carotid artery (ICA) stenosis;however, it is associated with high recurrence rates. The treatment of in-stent restenosis (ISR) following CAS poses several challenges, and percutaneous transluminal angioplasty (PTA) is a possible treatment option. Scoring balloons used in the cardiovascular field can prevent slipping and plaque incisions during balloon expansion;however, their efficacy in treating cervical ICA ISR remains uncertain.

Case description: An 81-year-old man underwent CAS for carotid artery stenosis and subsequently developed ISR. Initial PTA with a noncompliant balloon failed to achieve sufficient dilation. However, the employment of a non-slip-element (NSE) PTA scoring balloon for additional expansion resulted in successful dilation, indicating its effectiveness in treating cervical ICA ISR. The patient was discharged postoperatively without any new neurological deficits, although magnetic resonance imaging revealed new ischemic lesions.

Conclusion: The NSE PTA balloon could be considered as a valuable and effective treatment option for ISR when conventional balloon catheters face challenges in achieving dilation, although potential risks such as debris embolization should be considered. J. Med. Invest. 71 : 303-305, August, 2024.

Schizophrenia is a psychiatric disorder with cognitive dysfunction as a core symptom along with positive and negative symptoms. Cognitive dysfunction in schizophrenia can be broadly classified into neurocognitive and social cognitive deficits, with these deficits significantly influencing social functioning. Therapeutic interventions aiming to enhance neurocognition and social cognition have been developed. In this review, we describe the characteristics of cognitive dysfunction in patients with schizophrenia, its relationship to social function, and intervention strategies. J. Med. Invest. 71 : 205-209, August, 2024.

Purpose of the study: This study aims to clarify practices and challenges on pressure ulcer management as perceived by home-visit nurses who have completed the specified medical acts training.

Methods: We gathered 8 home-visit nurses who have completed the training in Japan. First-author conducted in-depth, semi-structured individual interviews, asking for their insights on home care pressure ulcer management.

Findings: We found that the home-visit nurses conducted the following practices;[having understandings and empathy as a health care professional who engage with client's lives with developing/worsening pressure ulcer], [pressure ulcer care at its best within limited resources], [systematic advice and guidance to caregivers and other professionals], and [demonstration of nursing as the post-training nurse of the specified medical acts]. We also learn that the home-visit nurses were faced with following challenges:[difficulties in smoothly collaborating with multiple professionals from different organizations], [not reaching a high level of expertise or skill], [limitations under the long-term care and medical insurance systems] and [impact of COVID-19].

Conclusion: Home-visit nurses who have completed the specified medical acts training provided the nurses worked toward raising community's awareness of the care by providing leaderships to those involved in health care teams and collaborating with other professionals. J. Med. Invest. 71 : 346-355, August, 2024.

The establishment of an adaptive immune system is critical for protecting our bodies from neoplastic cancers and invading pathogens such as viruses and bacteria. As a primary lymphoid organ, the thymus generates lymphoid T cells that play a major role in the adaptive immune system. T cell generation in the thymus is controlled by interactions between thymocytes and other thymic cells, primarily thymic epithelial cells. Thus, the normal development and function of thymic epithelial cells are important for the generation of immunocompetent and self-tolerant T cells. On the other hand, the degeneration of the thymic epithelium due to thymic aging causes thymic involution, which is associated with the decline of adaptive immune function. Herein we summarize basic and current knowledge of the development and function of thymic epithelial cells and the mechanism of thymic involution. J. Med. Invest. 71 : 29-39, February, 2024.

Purpose Non-invasive biomarkers including systemic inflammatory or nutrition-based index including neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR) lymphocyte to monocyte ratio (LMR), and prognostic nutritional index (PNI) can be useful in determining treatment strategies for elderly patients with early gastric cancer (EGC). The aim of this study was to investigate the significance of these index for predicting the long-term survival of EGC patients aged 80 years over. Methods This study included 80 elderly EGC patients with pStageIA after gastrectomy. Optimal cutoff value for PNI, NLR, PLR and LMR were set by using receiver operating curve analysis. The long-term outcomes after gastrectomy were analyzed by univariate and multivariate Cox regression analyses. Results Cut-off value for PNI, NLR, PLR and LMR was set at 46.5, 2.8, 210 and 4.6, respectively. By univariate analyses, low PNI, high NLR, high PLR and low LMR were significantly associated with worse prognosis. By multivariate analysis, low PNI was confirmed as an independent prognostic factor after gastrectomy (HR 0.17 ; 95% CI 0.03-0.91 ; P = 0.04). 5-year overall survival rate of patients with low PNI (≤ 46.5) were 52.4%. Conclusion Low PNI might be useful biomarker to predict worse prognosis of elderly EGC patients after gastrectomy. J. Med. Invest. 71 : 113-120, February, 2024.

Background: Recent technical advances have reduced the incidence of intraoperative complications associated with pancreatoduodenectomy (PD). We aimed to determine whether inexperienced surgeons (ISs) would be as successful as experienced surgeons (ESs) when performing the complete artery-first approach using the intestinal de-rotation method of PD.

Methods: Seventy patients who underwent PD using the intestinal de-rotation method in Tokushima University Hospital were enrolled in the present study. Intra- and post-operative parameters were compared between patients operated on by ESs (n=20) or ISs (n=50).

Results: The surgical procedure lasted longer in the IS group (ES : 402 }68 min vs. IS : 483 }51 min, p<0.0001), but the volume of blood loss was similar (p=0.7304). There was no mortality in either group, and the incidences of postoperative complications with a Clavien-Dindo grade of>III did not differ between the groups. Grade B postoperative pancreatic fistulae developed in 20.0% of patients in the ES group and 22.0% in the IS group (p=0.9569). Finally, the postoperative hospital stay of the IS group (32 }33 days) was equivarent to that of the ES group (33 }16 days) (p=0.9256).

Conclusion: ISs were able to perform similarly successful PDs using the intestinal de-rotation method to ESs. J. Med. Invest. 71 : 75-81, February, 2024.