Nagoya Journal of Medical Science最新文献

Risk-adapted stereotactic body radiation therapy is preferred over conventional radiotherapy at the authors' institution based on the hypothesis that even with a lower than recommended dose, stereotactic body radiation therapy would yield better local control than conventional radiotherapy. This retrospective study was performed to verify the hypothesis. Data from 34 patients with non-small cell lung cancer, who underwent risk-adapted stereotactic body radiation therapy delivered in 4 fractions between 2012 and 2018, were analyzed. The 3-year local control rate for patients receiving 42-44 Gy, 40 Gy, and 32-38 Gy was 80.8%, 75.0%, and 66.7%, respectively. The 3-year overall survival rate was 63.5%, 63.5%, and 40.0%, respectively. Three patients experienced grade 3 toxicities, with no toxicities > grade 3 observed. The results support the use of risk-adapted stereotactic body radiation therapy, both with a relatively high dose and a low dose.

Studies have suggested that the administration of epidural analgesia (Epi) and oxytocin (OT) during labor affects offspring outcomes. However, the effects of their combined use remain unclear. This article aimed to review the outcomes of offspring exposed to Epi and OT, identify research gaps, and discuss future research directions. We searched the MEDLINE/PubMed, Web of Science, and Cochrane Library databases to identify studies describing offspring outcomes in the Epi, OT, Epi-OT, and control groups. We included one systematic review, six cohort studies, and one case-control study. The offspring outcomes at birth did not differ between the Epi-OT and Epi groups. In the first hour of life, the pre-feeding and sucking behaviors of the Epi-OT group showed an inverse correlation. At 2 days of age, the breastfeeding behavior and skin temperature patterns differed significantly between the Epi-OT and other groups. At 4 days of age, hyperbilirubinemia was more prevalent in the Epi-OT versus control group. Behavioral scores at 1 month differed little among the Epi-OT, Epi, and control groups. No eligible studies examined 1 month to 1 year of life. From 1 to >13 years of age, the risk of autism spectrum disorder was higher in the Epi and Epi-OT groups versus the control group. Most eligible studies were small and observational without randomization, and the results were inconsistent. Additional large cohort studies of various aspects of offspring development are required to assess the long-term effects of Epi-OT administration.

Intracardiac migration of inferior vena cava (IVC) filter or stent is a rare but potentially fatal complication of endovascular venous device placement. There is no consensus whether migrated stents should be surgically removed by open cardiac surgery or retrieved by the percutaneous endovascular route and whether an intervention should be performed immediately or expectantly. Herein, we report a 39-year-old female who received emergent left lobe living donor liver transplantation (LDLT) owing to posthepatectomy liver failure. She underwent angioplasty for IVC stenosis 13 days after her LDLT during which time two IVC stents migrated into right antrum (RA). Because of acute kidney failure, she received perioperative continuous venous-venous hemofiltration. Owing to unstable hemodynamics and impaired liver graft function, an emergent open-heart operation or angiography to remove the migrated metallic stents in the RA was considered very high-risk. After recovery of liver graft and kidney function, she underwent an open-heart surgery to remove the intracardiac migrated IVC stents 40 days after the stent migration and recovered well. Our report is the first to show that a delayed open-heart operation for removal of migrated intracardial IVC stents can be an acceptable choice in selected LDLT recipients.

According to the Japanese Association for Thoracic Surgery annual surgery survey, the number of aortic surgery has been increasing constantly in the last two decades, with the rates approximately doubling in each decade (5,167, 11,956, and 22,708 cases in 1999, 2009, and 2019, respectively). In 2019, aortic surgery was performed for 11,036 (49%) nondissecting unruptured aneurysm, 730 (3%) ruptured aneurysm, 6,351 (28%) acute type A aortic dissection, 1,412 (6%) chronic type A aortic dissection, 2,385 (11%) acute type B aortic dissection, and 703 (3%) chronic type B aortic dissection cases. The outcomes have been improving annually. From 1999 to 2019, the hospital mortality rates decreased significantly in each case: nondissecting unruptured aneurysm, 9.8% to 4.2%; ruptured aneurysm, 38.5% to 19.7%; acute type A aortic dissection, 18.7% to 10.4%; chronic type A aortic dissection, 7.2% to 4.5%; acute type B aortic dissection, 25.2% to 9.8%; and chronic type B aortic dissection, 7.5% to 3.4%. Furthermore, stent graft, a new technology developed in 1990, was performed in 35%, 53%, 1%, 21%, 62%, and 75% of cases mentioned above, respectively, in 2019. The widespread use of stent graft greatly contributed to the increased number of aortic surgeries and improvement of surgical outcomes.

The anatomical characteristics of middle cerebral artery aneurysms make endovascular treatment difficult. This study evaluated the efficacy and safety of endovascular treatment of unruptured middle cerebral artery aneurysm in preventing rupture. A retrospective review of patients who underwent coil embolization for unruptured middle cerebral artery aneurysm between 2006 and 2022 at Nagoya University Hospital with at least 12 months followed up was conducted. Imaging and clinical outcomes were described using the Raymond classification and the modified Rankin Scale, respectively. Good imaging outcome was defined as complete occlusion or neck remnant and clinical outcome as modified Rankin Scale score of 0-2. Patients were divided into initial and recurrent group based on the number of treatments, pre- and post-stent groups based on when stents became available in Japan. A total of 77 patients (80 with aneurysms) were included in the final analysis. Their average age was 60.3 years, and their average follow-up period was 38 months. Favorable clinical outcomes were achieved for 96.2% among 66 (97.0%) initial and 11 (91.7%) recurrent aneurysms. Furthermore, good imaging outcomes were obtained in 90.0 %, and 5% had permanent symptomatic ischemic complications. The pre-stent group had a significantly higher proportion of patients with narrow-neck aneurysms than the post-stent group. There were no significant differences in terms of imaging and clinical outcomes or complication rates. The present study demonstrated that endovascular treatment of unruptured middle cerebral artery aneurysm was safe and effective in preventing rupture. The wide-neck aneurysm was also well embolized by using adjunctive technique.

We report a case of a woman presenting with an erythematous finger nodule, with a history of exposure to tropical fish. The erythematous nodules subsequently spread proximally from the finger. Initial treatment with oral amoxicillin-clavulanate was unsuccessful, and she developed a drug eruption. Treatment with oral minocycline and thermotherapy was initiated, as we suspected infection with Mycobacterium marinum (M. marinum) from her history and clinical features. A culture from a skin biopsy from the finger grew M. marinum, confirming the diagnosis. There is no established treatment regimen for skin infections caused by M. marinum. In this case, it took time for cultures to confirm the diagnosis of non-tuberculous mycobacterial infection. While it would be ideal to await culture results, we felt it was better for the patient to initiate treatment, and in M. marinum infections, minocycline is considered particularly effective. However, it was envisaged that this would result in a prolonged treatment course, leading to potential resistance. Thermotherapy was added in an attempt to shorten the treatment period. This regime was successful, and the patient has remained free of recurrence since. The early initiation of treatment for cutaneous non-tuberculous mycobacterial infection requires aggressive suspicion. Also, testing, including adequate sampling and culturing, is essential for an accurate diagnosis. Slow-growing mycobacteria may take several months to be definitively diagnosed, as they grow only under certain conditions. Therefore, thorough clinical history-taking and information sharing with the microbiology team are essential. Our case illustrates this, and we believe this has important educational value.

Postoperative atrial fibrillation complicates 15-40% of cardiac surgery cases and is associated with various adverse health outcomes including high mortality. Although vasopressin administration decreases postoperative atrial fibrillation in on-pump coronary artery bypass grafting, its use in off-pump coronary artery bypass grafting has not been investigated. Therefore, we evaluated the effect of vasopressin use in off-pump coronary artery bypass grafting. For this retrospective, observational study at a single-center community hospital in Yokkaichi, Japan, 298 patients who had undergone elective or emergency off-pump coronary artery bypass grafting between April 2015 and March 2021 were enrolled. Participants were divided into two groups: vasopressin and non-vasopressin groups. The outcomes in both groups were analyzed after propensity score matching, which revealed 40 patients in each matched group. Patients with chronic atrial fibrillation and those who were converted from off-pump to on-pump surgery were excluded. The primary outcome was postoperative atrial fibrillation occurrence within 4 days post-surgery. Secondary outcomes were 30-day mortality, intensive care unit and hospital stays, and postoperative complications (acute kidney injury, stroke, acute myocardial infarction, and respiratory complications). Although 11 patients (27.5%) in the vasopressin group were affected by postoperative atrial fibrillation when compared to 18 (45%) patients in the non-vasopressin groups, the difference was not significant (P=0.163). Similarly, no significant differences were observed in the secondary outcomes between groups. In off-pump coronary artery bypass grafting, vasopressin use may contribute to reduced postoperative atrial fibrillation; however, a large prospective study needs to be conducted for confirmation.

The presence of anti-thyroid antibodies (ATAs) is a biomarker for the development of thyroid dysfunction induced by anti-programmed cell death-1 antibodies (PD-1-Abs). While patients with thyroid dysfunction reportedly showed better overall survival (OS), it remains unknown if ATAs at baseline can predict OS. Therefore, in this study, we examined the association of ATAs at baseline with OS in non-small cell lung cancer (NSCLC) patients with different levels of programmed cell death-1 ligand 1 (PD-L1) positivity associated with PD-1-Ab treatment efficacy. A total of 81 NSCLC patients treated with PD-1-Abs were evaluated for ATAs at baseline and prospectively for OS. Among the 81 patients, 49 and 32 patients had ≥50% (group A) and <50% (group B) PD-L1 positivity, respectively. Median OS did not differ significantly between patients with (n = 13) and without (n = 36) ATAs at baseline in group A. In contrast, median OS was significantly longer in patients with (n = 10) versus without (n = 22) ATAs at baseline in group B (not reached vs 378 days, respectively; 95% CI, 182 to 574 days, p = 0.049). These findings suggest that the presence of ATAs at baseline is a biomarker to predict better treatment efficacy of PD-1-Abs in NSCLC patients with low PD-L1 positivity, while the difference in OS in those with high PD-L1 positivity may be masked by increased tumor expression of PD-L1.

Clinical diagnosis of intraoperative transfusion anaphylaxis using clinical symptoms is challenging and should be made carefully, as an incorrect clinical diagnosis can exacerbate surgical bleeding secondary to stopping a clinically indicated blood transfusion. The timing of onset of anaphylaxis to start of transfusion may be the key to correctly diagnosing intraoperative transfusion anaphylaxis clinically. However, the reliability of this measure remains unknown. A literature search was conducted using MEDLINE, Embase, the Cochrane Database of Systematic Reviews, and the Cochrane Central Register of Controlled Trials up to June 29, 2021. No language restriction was applied. Two pairs of review authors independently reviewed intraoperative transfusion anaphylaxis cases and extracted data on the timing of onset of anaphylaxis to start of transfusion. A total of 8,918 articles were reviewed, the full texts of 186 articles were assessed, and 20 intraoperative transfusion anaphylaxis cases were included in this study. The 20 intraoperative transfusion anaphylaxis cases included a precise timing of onset. With nine cases, cardiovascular surgery was the most prevalent, and one case was fatal. Fifteen cases had a timing of onset in minutes, and of those, 14 reported timeframes within 30 minutes of initiation of transfusion (median: 15.5, 5-30 minutes). Almost all cases of intraoperative transfusion anaphylaxis occurred within 30 minutes of the transfusion initiation. This timeframe may be helpful in the clinical diagnosis of intraoperative transfusion anaphylaxis.