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Stenting of Inferior Right Hepatic Vein in a Patient with Budd-Chiari Syndrome: A Case Report. 为布德-卡氏综合征患者的右肝下静脉植入支架:病例报告
IF 1 4区 医学 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-03-09 Epub Date: 2023-06-02 DOI: 10.1272/jnms.JNMS.2023_90-603
Tetsuya Shimizu, Masato Yoshioka, Junji Ueda, Mampei Kawashima, Toshiyuki Irie, Yoichi Kawano, Akira Matsushita, Nobuhiko Taniai, Yasuhiro Mamada, Hiroshi Yoshida

A Japanese man in his 20s was referred to our hospital with a two-month history of abdominal fullness and leg edema. Abdominal computed tomography revealing massive ascites and ostial blockage of the main hepatic veins, and angiographic evaluation demonstrating obstruction of the main hepatic veins yielded a diagnosis of Budd-Chiari syndrome (BCS). Diuretic agents were prescribed for the ascites but failed to provide relief. The patient was referred to our department for further evaluation and treatment. Angiography showed ostial obstruction of the main hepatic veins, with most of the portal hepatic flow draining from an inferior right hepatic vein (IRHV) into the inferior vena cava (IVC) thorough an intrahepatic portal venous and venovenous shunt. Access between the main hepatic veins and IVC was impossible, but cannulation between the IRHV and IVC was achieved. Because of the venovenous connection between the main hepatic vein and the IRHV, metallic stents were placed into two IRHVs to decrease congestion in the hepatic venous outflow. After stent placement followed by balloon expansion, the gradient pressure between the hepatic vein and IVC improved remarkably. The ascites and lower leg edema improved postoperatively, and long-term stent patency (6 years) was achieved.

一名 20 多岁的日本男子因腹部饱胀和腿部水肿两个月的病史被转诊到我院。腹部计算机断层扫描显示大量腹水和肝主静脉血管阻塞,血管造影评估显示肝主静脉阻塞,诊断为巴德-恰里综合征(BCS)。医生开了利尿剂治疗腹水,但效果不佳。患者被转到我科接受进一步评估和治疗。血管造影术显示,肝主静脉闭塞,大部分肝门静脉血流通过肝内门静脉和静脉分流,从右肝下静脉(IRHV)排入下腔静脉(IVC)。肝主静脉和 IVC 之间无法进入,但可以在 IRHV 和 IVC 之间插管。由于肝主静脉和 IRHV 之间存在静脉连接,因此在两个 IRHV 中放置了金属支架,以减少肝静脉流出道的充血。放置支架并进行球囊扩张后,肝静脉和 IVC 之间的压力梯度明显改善。术后腹水和小腿水肿有所改善,支架也实现了长期通畅(6 年)。
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引用次数: 0
Predictive Postoperative Inflammatory Response Indicators of Infectious Complications Following Gastrectomy for Gastric Cancer. 胃癌胃切除术后感染性并发症的术后炎症反应预测指标
IF 1 4区 医学 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-03-09 Epub Date: 2023-08-08 DOI: 10.1272/jnms.JNMS.2024_91-103
Ryohei Nishiguchi, Takao Katsube, Takeshi Shimakawa, Shinichi Asaka, Kentaro Yamaguchi, Minoru Murayama, Masano Sagawa, Kotaro Kuhara, Takebumi Usui, Hajime Yokomizo, Seiji Ohigashi, Shunichi Shiozawa

Background: Perioperative factors are useful for predicting postoperative infectious complications (PIC) in gastric cancer. Specifically, postoperative inflammatory response indicators (PIRI), [C-reactive protein (CRP) level, body temperature (BT), and white blood cell (WBC) count], are widely used in clinical practice. We investigated predictive factors for PIC, including PIRI, to establish a simple and practical indicator of postoperative complications after gastrectomy.

Methods: We retrospectively collected clinical data from 200 patients with fStage I-III gastric cancer. Univariate/multivariate analysis was performed to evaluate the relationship of predictive factors [host factors, clinicopathological factors, and PIRI (BT, WBC count, and CRP level on postoperative day (POD) 1 and 3) ]. Cut-off values of the predictive factors were analyzed using receiver operating characteristic (ROC) curve modulated by the presence/absence of PIC Grade II, III (Clavien-Dindo classification).

Results: Age [Odds ratio (OR): 5.67], smoking history (OR: 3.51), and CRP level (OR: 5.65), WBC count (OR: 8.96), and BT (OR: 3.37) on POD3 were selected as independent factors from multivariate analysis. Cut-off values were 77 years, 14.8 mg/dL, 116.0×102/μL, and 37.4°C, respectively.

Conclusions: Predictive factors relative to PIC in gastric cancer were CRP level ≥ 14.8 mg/dL, WBC count ≥ 116.0×102/μL, and BT ≥ 37.4°C all on POD3. Age ≥ 77 years, and history of smoking were relative to PIC, suggesting a simple and practical indicator applicable in clinical practice.

背景:围手术期因素有助于预测胃癌术后感染并发症(PIC)。具体而言,术后炎症反应指标(PIRI)[C反应蛋白(CRP)水平、体温(BT)和白细胞(WBC)计数]已广泛应用于临床实践。我们研究了包括 PIRI 在内的 PIC 预测因素,以建立一个简单实用的胃切除术后并发症指标:我们回顾性地收集了 200 例 I-III 期胃癌患者的临床数据。方法:我们回顾性收集了 200 例 IIII 期胃癌患者的临床资料,并进行了单变量/多变量分析,以评估预测因素(宿主因素、临床病理因素和 PIRI(术后第 1 天和第 3 天的 BT、白细胞计数和 CRP 水平))之间的关系。使用接收器操作特征曲线(ROC)分析了预测因素的临界值,并根据是否存在 PIC II 级、III 级(Clavien-Dindo 分级)进行了调节:结果:年龄[比值比(OR):5.67]、吸烟史(OR:3.51)、POD3 的 CRP 水平(OR:5.65)、白细胞计数(OR:8.96)和 BT(OR:3.37)被选为多变量分析的独立因素。截断值分别为 77 岁、14.8 mg/dL、116.0×102/μL 和 37.4°C:结论:POD3时CRP水平≥14.8 mg/dL、白细胞计数≥116.0×102/μL和BT≥37.4°C是胃癌PIC的预测因素。年龄≥ 77 岁和吸烟史与 PIC 相对,表明这是一个适用于临床实践的简单而实用的指标。
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引用次数: 0
Takotsubo Cardiomyopathy Presenting with QT Prolongation and Torsade de Pointes in a Patient with Coronavirus Disease 2019. 在冠状病毒疾病中出现 QT 间期延长和 Torsade de pointes 的 Takotsubo 心肌病 2019.
IF 1 4区 医学 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-03-09 Epub Date: 2023-02-21 DOI: 10.1272/jnms.JNMS.2023_90-607
Hidekazu Kawanaka, Michio Ogano, Keita Hibako, Jun Tanabe

Coronavirus disease 2019 (COVID-19) is associated with cardiovascular complications; however, Takotsubo cardiomyopathy (TCM) with QT prolongation and Torsade de pointes has been reported only rarely. We present a case of TCM after QT prolongation and Torsade de pointes. A 58-year-old woman was admitted because of COVID-19-related pneumonia. Seven days after admission, she developed sudden loss of consciousness without any indication of cardiovascular disease. A monitoring electrocardiogram indicated Torsade de pointes and a prolonged QT interval. Emergency cardiac catheterization revealed TCM. She was treated with favipiravir and steroids, followed by rehabilitation, and her condition improved. To detect asymptomatic TCM, routine electrocardiography screening should be considered for patients with COVID-19.

冠状病毒病 2019(COVID-19)导致心血管并发症的情况时有发生;然而,伴有 QT 间期延长和 Torsade de pointes 的 Takotsubo 心肌病(TCM)却鲜有报道。我们在此介绍一例在 QT 间期延长和 Torsade de pointes 之后发生的 Takotsubo 心肌病。一名 58 岁女性因 COVID-19 肺炎入院。入院七天后,她突然意识丧失,且没有任何心血管疾病的前兆。心电图监测显示出现了心搏过速和 QT 间期延长。急诊心导管检查显示她患有中风。她接受了法非拉韦和类固醇治疗,随后进行了康复治疗,病情有所好转。考虑对 COVID-19 患者进行常规心电图筛查,因为可以发现无症状的中风。
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引用次数: 0
Current Status of Robotic Hepatobiliary and Pancreatic Surgery. 机器人肝胆胰外科手术的现状。
IF 1.2 4区 医学 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-03-09 Epub Date: 2024-01-16 DOI: 10.1272/jnms.JNMS.2024_91-109
Keisuke Minamimura, Yuto Aoki, Youhei Kaneya, Satoshi Matsumoto, Hiroki Arai, Daisuke Kakinuma, Yukio Oshiro, Yoichi Kawano, Masanori Watanabe, Yoshiharu Nakamura, Hideyuki Suzuki, Hiroshi Yoshida

Laparoscopic surgery is performed worldwide and has clear economic and social benefits in terms of patient recovery time. It is used for most gastrointestinal surgical procedures, but laparoscopic surgery for more complex procedures in the esophageal, hepatobiliary, and pancreatic regions remains challenging. Minimally invasive surgery that results in accurate tumor dissection is vital in surgical oncology, and development of surgical systems and instruments plays a key role in assisting surgeons to achieve this. A notable advance in the latter half of the 1990s was the da Vinci Surgical System, which involves master-slave surgical support robots. Featuring high-resolution three-dimensional (3D) imaging with magnification capabilities and forceps with multi-joint function, anti-shake function, and motion scaling, the system compensates for the drawbacks of conventional laparoscopic surgery. It is expected to be particularly useful in the field of hepato-biliary-pancreatic surgery, which requires delicate reconstruction involving complex liver anatomy with diverse vascular and biliary systems and anastomosis of the biliary tract, pancreas, and intestines. The learning curve is said to be short, and it is hoped that robotic surgery will be standardized in the near future. There is also a need for a standardized robotic surgery training system for young surgeons that can later be adapted to a wider range of surgeries. This systematic review describes trends and future prospects for robotic surgery in the hepatobiliary-pancreatic region.

腹腔镜手术在全球范围内广泛开展,在缩短患者恢复时间方面具有明显的经济和社会效益。腹腔镜手术用于大多数胃肠道外科手术,但用于食道、肝胆和胰腺区域更复杂手术的腹腔镜手术仍具有挑战性。能准确切除肿瘤的微创手术在肿瘤外科手术中至关重要,而手术系统和器械的发展在帮助外科医生实现这一目标方面起着关键作用。20 世纪 90 年代后半期,达芬奇手术系统取得了显著进展,该系统包括主从式手术支持机器人。该系统具有带放大功能的高分辨率三维(3D)成像和带多关节功能、防抖功能和运动缩放功能的镊子,弥补了传统腹腔镜手术的缺点。肝胆胰手术需要精细的重建,涉及复杂的肝脏解剖结构、多种血管和胆道系统,以及胆道、胰腺和肠道的吻合,因此该系统有望在肝胆胰手术领域大显身手。据说学习曲线很短,希望在不久的将来机器人手术能标准化。此外,还需要为年轻外科医生建立标准化的机器人手术培训系统,以便日后适应更广泛的手术。本系统综述描述了肝胆胰区域机器人手术的发展趋势和未来前景。
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引用次数: 0
Changes in Metamorphopsia in Patients Undergoing Treatment for Vitreoretinal Disorders. 接受玻璃体视网膜疾病治疗的患者的变形视力变化。
IF 1 4区 医学 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-03-09 Epub Date: 2024-01-16 DOI: 10.1272/jnms.JNMS.2024_91-114
Fumiki Okamoto

Purpose: To quantify and compare the severity of metamorphopsia in patients undergoing vitrectomy for vitreoretinal disorders.

Methods: Data were collected evaluated from 319 patients with vitreoretinal disorders, including epiretinal membrane (ERM), macular hole (MH), cystoid macular edema with branch retinal vein occlusion (BRVO-CME), CME with central retinal vein occlusion (CRVO), diabetic macular edema (DME), macula-off rhegmatogenous retinal detachment (M-off RD), and macula-on RD (M-on RD). Metamorphopsia was recorded with the M-CHARTS preoperatively and at 3 and 6 months postoperatively.

Results: Preoperative and 6-month postoperative metamorphopsia scores were 0.69 ± 0.50 and 0.50 ± 0.52, respectively. Before surgery, 94% of patients presented with metamorphopsia (score ≥0.2). Preoperative metamorphopsia scores were significantly correlated with postoperative metamorphopsia scores (r = 0.378, p < 0.0001). Preoperative metamorphopsia score was significantly higher for ERM (0.89) than for DME (0.51). Vitrectomy significantly improved metamorphopsia in ERM and MH but not in the other disorders. In contrast, treatment improved visual acuity for all disorders except CRVO-CME and M-on RD.

Conclusion: This quantitative study indicated that metamorphopsia is present in most patients undergoing surgery for vitreoretinal diseases and is most severe in ERM. In these patients, vitrectomy improved visual acuity but not metamorphopsia.

目的:量化和比较因玻璃体视网膜病变而接受玻璃体切除术的患者的变性视力严重程度:收集了319名玻璃体视网膜疾病患者的评估数据,包括视网膜上膜(ERM)、黄斑孔(MH)、囊样黄斑水肿伴视网膜分支静脉闭塞(BRVO-CME)、CME伴视网膜中央静脉闭塞(CRVO)、糖尿病性黄斑水肿(DME)、黄斑-关闭流变性视网膜脱离(M-off RD)和黄斑-开启性视网膜脱离(M-on RD)。术前、术后3个月和6个月用M-CHARTS记录变形:术前和术后 6 个月的变形评分分别为 0.69 ± 0.50 和 0.50 ± 0.52。手术前,94%的患者出现了变形(评分≥0.2)。术前变形评分与术后变形评分呈显著相关性(r = 0.378,p < 0.0001)。ERM 的术前变形评分(0.89)明显高于 DME(0.51)。玻璃体切除术能明显改善 ERM 和 MH 的变形,但对其他疾病则无效。相比之下,除了CRVO-CME和M-on RD外,其他所有疾病的治疗都能提高视力:这项定量研究表明,大多数接受玻璃体视网膜疾病手术的患者都会出现变形,其中 ERM 的情况最为严重。在这些患者中,玻璃体切除术能改善视力,但不能改善变形。
{"title":"Changes in Metamorphopsia in Patients Undergoing Treatment for Vitreoretinal Disorders.","authors":"Fumiki Okamoto","doi":"10.1272/jnms.JNMS.2024_91-114","DOIUrl":"10.1272/jnms.JNMS.2024_91-114","url":null,"abstract":"<p><strong>Purpose: </strong>To quantify and compare the severity of metamorphopsia in patients undergoing vitrectomy for vitreoretinal disorders.</p><p><strong>Methods: </strong>Data were collected evaluated from 319 patients with vitreoretinal disorders, including epiretinal membrane (ERM), macular hole (MH), cystoid macular edema with branch retinal vein occlusion (BRVO-CME), CME with central retinal vein occlusion (CRVO), diabetic macular edema (DME), macula-off rhegmatogenous retinal detachment (M-off RD), and macula-on RD (M-on RD). Metamorphopsia was recorded with the M-CHARTS preoperatively and at 3 and 6 months postoperatively.</p><p><strong>Results: </strong>Preoperative and 6-month postoperative metamorphopsia scores were 0.69 ± 0.50 and 0.50 ± 0.52, respectively. Before surgery, 94% of patients presented with metamorphopsia (score ≥0.2). Preoperative metamorphopsia scores were significantly correlated with postoperative metamorphopsia scores (r = 0.378, p < 0.0001). Preoperative metamorphopsia score was significantly higher for ERM (0.89) than for DME (0.51). Vitrectomy significantly improved metamorphopsia in ERM and MH but not in the other disorders. In contrast, treatment improved visual acuity for all disorders except CRVO-CME and M-on RD.</p><p><strong>Conclusion: </strong>This quantitative study indicated that metamorphopsia is present in most patients undergoing surgery for vitreoretinal diseases and is most severe in ERM. In these patients, vitrectomy improved visual acuity but not metamorphopsia.</p>","PeriodicalId":56076,"journal":{"name":"Journal of Nippon Medical School","volume":" ","pages":"28-36"},"PeriodicalIF":1.0,"publicationDate":"2024-03-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139485942","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Smoking-Related Interstitial Fibrosis and Smoker's Macrophages. 与吸烟有关的肺间质纤维化和吸烟者巨噬细胞。
IF 1 4区 医学 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-03-09 Epub Date: 2024-01-16 DOI: 10.1272/jnms.JNMS.2024_91-113
Namiko Taniuchi, Yoshinobu Saito, Norio Motoda, Masahiro Seike

Smoking-related interstitial lung diseases (SRILDs) are a group of heterogeneous diffuse pulmonary parenchymal diseases associated with tobacco exposure. Smoking-related interstitial fibrosis (SRIF) is relatively recent, a pathologically defined form of SRILDs. SRIF is characterized by the accumulation of macrophages in the alveolar spaces, which is associated with interstitial inflammation and fibrosis. The macrophages frequently contain light brown pigment and are called 'smoker's macrophages'. Patients with SRIF who have clinical evidence of interstitial lung disease are most commonly relatively young, heavy smokers with abnormalities on chest computed tomography showing ground-glass opacities, peripheral consolidation, and reticulation. Although SRIF is caused by cigarette smoking, the exact pathophysiological mechanisms by which smoking causes this type of interstitial fibrosis remain unknown. The degree of fibrosis and appearance of macrophage aggregates are important points of distinction when evaluating and diagnosing SRIF. Macrophage heterogeneity, particularly the activation and function of monocyte-derived alveolar macrophages (Mo-AMs) and interstitial macrophages (IMs), has important implications for the pathogenesis of SRIF and developing treatments. Further researches focused on smoker's macrophages are needed to understand of the pathogenesis of SRIF.

吸烟相关肺间质疾病(SRILDs)是一组与烟草暴露相关的异质性弥漫性肺实质疾病。吸烟相关肺间质纤维化(SRIF)是最近才出现的,是 SRILDs 的一种病理形式。SRIF 的特点是巨噬细胞在肺泡间隙聚集,并伴有间质炎症和纤维化。巨噬细胞经常含有浅棕色色素,被称为 "吸烟者巨噬细胞"。有间质性肺病临床表现的 SRIF 患者多为相对年轻的重度吸烟者,胸部计算机断层扫描显示磨玻璃不透明、外周合并症和网状结构异常。虽然 SRIF 是由吸烟引起的,但吸烟导致这种间质纤维化的确切病理生理机制仍不清楚。在评估和诊断 SRIF 时,纤维化程度和巨噬细胞聚集的外观是重要的鉴别点。巨噬细胞的异质性,尤其是单核细胞衍生的肺泡巨噬细胞(Mo-AMs)和间质巨噬细胞(IMs)的活化和功能,对 SRIF 的发病机制和治疗方法的开发具有重要意义。要了解 SRIF 的发病机理,还需要进一步研究吸烟者的巨噬细胞。
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引用次数: 0
Usefulness of Self-Selected Scenarios for Simple Triage and Rapid Treatment Method Using Virtual Reality. 利用虚拟现实技术进行简单分诊和快速治疗的自选场景的实用性。
IF 1 4区 医学 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-03-09 Epub Date: 2023-12-08 DOI: 10.1272/jnms.JNMS.2024_91-111
Satoshi Harada, Ryotaro Suga, Kensuke Suzuki, Shinnosuke Kitano, Kenji Fujimoto, Kenji Narikawa, Mayumi Nakazawa, Satoo Ogawa

Background: Repeated triage training is necessary to maintain and improve the accuracy of simple triage and rapid treatment (START), a popular triage method. Virtual reality (VR) may be more effective than conventional training methods. This study aimed to verify the educational usefulness of START using VR originally developed for students.

Methods: A VR was initially developed with a function that allowed students to select the triage procedure and its evaluation. Triage was performed using a simple modified START method, and eight scenarios were developed. The participants included 70 paramedic students classified into VR and live lecture groups. They took a 20-question written test that evaluated their academic ability before the course. After the course, a practical test and a 20-question written test were conducted. The total score of the practical test was 43 points. Triage procedure (1 point), observation and evaluation (1-5 points), and triage categories (1 point) were evaluated in this test.

Results: The VR and live lecture groups consisted of 33 and 29 participants, respectively. No significant differences were observed pre- and post-test. In the practical test, the median (interquartile range) score was 29 (26-32) and 25 (23-29) for the VR and live lecture groups, respectively, with the VR group scoring significantly higher (P=0.03).

Conclusion: Our results confirmed the educational usefulness of selective VR for active learning of START. Therefore, VR combined with live lectures and simulations would be an optimal educational technique.

背景:要保持和提高简单分诊和快速治疗(START)这一常用分诊方法的准确性,必须进行反复分诊培训。虚拟现实(VR)可能比传统的培训方法更有效。本研究旨在利用最初为学生开发的 VR 验证 START 的教育实用性:方法:最初开发的 VR 具有让学生选择分诊程序及其评估的功能。使用简单的改良 START 方法进行分诊,并开发了 8 个场景。参与者包括 70 名护理专业学生,分为 VR 组和现场授课组。在课程开始前,他们参加了一个 20 道题的笔试,以评估他们的学习能力。课程结束后,进行了实践测试和 20 道题的笔试。实践测试总分为 43 分。在这次测试中,对分诊程序(1 分)、观察和评估(1-5 分)以及分诊类别(1 分)进行了评估:虚拟现实组和现场授课组分别有 33 人和 29 人参加。测试前后无明显差异。在实际测试中,VR 组和现场讲座组的中位数(四分位间距)分别为 29 分(26-32)和 25 分(23-29),VR 组的得分明显更高(P=0.03):我们的研究结果证实了选择性 VR 在主动学习 START 方面的教育作用。结论:我们的研究结果证实了选择性 VR 在主动学习 START 方面的教育作用,因此,VR 与现场讲座和模拟相结合将是一种最佳的教育技术。
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引用次数: 0
Relapse of Acquired Hemophilia A after COVID-19 Infection. 感染 COVID-19 后获得性血友病 A 复发。
IF 1 4区 医学 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-01-20 Epub Date: 2023-02-21 DOI: 10.1272/jnms.JNMS.2023_90-609
Atsushi Marumo, Hisae Sugihara, Ikuko Omori, Eriko Morishita

Acquired hemophilia A (AHA) is a rare disease in which an autoantibody causes bleeding by interacting with and inhibiting the coagulation activity of endogenous factor VIII (FVIII). Most cases of AHA are idiopathic; known causes include autoimmune diseases, malignant tumors, pregnancy, drugs, and viral infections. An 86-year-old man was diagnosed with AHA based on the following results: an activated partial thromboplastin time (aPTT) extension of 130.7 seconds, presence of an inhibitor pattern in a mixing study, an endogenous factor VIII (FVIII) level of <1%, and an FVIII inhibitor titer of >5.1 Bethesda units (BU). The activity of von Willebrand factor (vWF) was diminished (<10%), which was considered a complication of acquired von Willebrand syndrome (AVWS). The patient was started on prednisolone, and the inhibitor level eventually became negative. vWF values also became normal. However, 1 year later, he was hospitalized for treatment of coronavirus disease 2019 (COVID-19). Blood testing showed an aPTT extension of 110.5 seconds, FVIII level of 4%, and FVIII inhibitor titer of 0.8 BU; thus, a relapse of AHA was diagnosed. After administration of corticosteroid and remdesivir, he recovered from COVID-19 and AHA. The inhibitor level became negative on the 9th day of admission. Several studies have implicated COVID-19 infection and vaccination in AHA. We recommend that aPTT be measured when patients with AHA are infected with SARS-CoV2, to confirm AHA relapse.

获得性血友病 A(AHA)是一种罕见疾病,自身抗体与内源性因子 VIII(FVIII)相互作用并抑制其凝血活性,从而导致出血。大多数 AHA 病例是特发性的;已知的病因包括自身免疫性疾病、恶性肿瘤、妊娠、药物和病毒感染。一名 86 岁的男性根据以下结果被诊断为 AHA:活化部分凝血活酶时间(aPTT)延长至 130.7 秒,混合研究中出现抑制剂模式,内源性因子 VIII(FVIII)水平为 5.1 贝塞斯达单位(BU)。冯-威廉因子(von Willebrand factor,vWF)的活性降低了((
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引用次数: 0
Impact of Home-Based Rehabilitation on Renal Prognosis in Patients with Chronic Kidney Disease. 居家康复对慢性肾病患者肾脏预后的影响
IF 1.2 4区 医学 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-01-01 DOI: 10.1272/jnms.JNMS.2024_91-508
Ayako Ikenouchi, Yukinao Sakai, Shouhei Wada, Yorito Yanagida, Tetsuya Kashiwagi, Masato Iwabu

Background: The increasing prevalence of chronic kidney disease (CKD) requires effective preventive measures, particularly due to an aging population. This study aimed to assess the effectiveness of home visit rehabilitation in preventing renal function decline among patients with CKD.

Method: In this retrospective study, patients with non-dialysis CKD undergoing home visit rehabilitation were compared with those receiving outpatient care at the Nippon Medical School Hospital between August 2017 and August 2023. Patients' backgrounds were matched using propensity scores derived from a logistic regression model. The primary endpoint was the annual change in the estimated glomerular filtration rate (eGFR), and the secondary endpoint was the annual change in blood parameters (Δblood urea nitrogen, Δcreatinine, Δtotal protein, Δalbumin, ΔC-reactive protein, Δhemoglobin, and Δhematocrit). Furthermore, the incidence of clinical outcomes, including mortality, hospitalization rate, and dialysis initiation rate, were analyzed within the additional 1-year observation period.

Results: Overall, 128 patients (64 matched pairs) were analyzed. After a mean follow-up period of 12.7 ± 4.6 months, there was no significant difference in the eGFR between both groups (40.1 ± 13.7 vs. 37.8 ± 13.8 mL/min/1.73 m2, p = 0.36), but the annual decline in eGFR (%/year) was significantly lower in the rehabilitation group (-1.1 ± 29.8% vs. -11.8 ± 27.7%/year, p = 0.037). The annual change in the level of each blood test parameter and clinical outcomes were not significantly different between the two groups.

Conclusion: Home-based rehabilitation interventions may mitigate the progression of renal impairment in patients with CKD.

背景:慢性肾脏病(CKD)的发病率越来越高,需要采取有效的预防措施,特别是由于人口老龄化。本研究旨在评估家访康复在预防 CKD 患者肾功能衰退方面的效果:在这项回顾性研究中,在2017年8月至2023年8月期间,接受家访康复治疗的非透析型慢性肾脏病患者与在日本医科大学附属医院接受门诊治疗的患者进行了比较。采用逻辑回归模型得出的倾向分数对患者的背景进行匹配。主要终点是估计肾小球滤过率(eGFR)的年度变化,次要终点是血液参数(Δ血尿素氮、Δ肌酐、Δ总蛋白、Δ白蛋白、ΔC反应蛋白、Δ血红蛋白和Δ血细胞比容)的年度变化。此外,在额外的 1 年观察期内,还分析了临床结果的发生率,包括死亡率、住院率和开始透析率:共分析了 128 名患者(64 对配对患者)。在平均 12.7 ± 4.6 个月的随访期后,两组患者的 eGFR 没有显著差异(40.1 ± 13.7 vs. 37.8 ± 13.8 mL/min/1.73 m2,p = 0.36),但康复组患者的 eGFR 年下降率(%/年)显著低于对照组(-1.1 ± 29.8% vs. -11.8 ± 27.7%/年,p = 0.037)。两组患者血液检测各项参数的年变化水平和临床结果无明显差异:结论:家庭康复干预可减轻慢性肾脏病患者肾功能损害的进展。
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引用次数: 0
Management of Asymptomatic Spontaneous Isolated Superior Mesenteric Artery Dissection and Morphology Features and Variations on Abdominal Contrast-Enhanced Computed Tomography: A Single-Center Experience. 无症状自发性孤立性肠系膜上动脉夹层的处理及腹部对比增强计算机断层扫描的形态特征和变化:单中心经验。
IF 1.2 4区 医学 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-01-01 DOI: 10.1272/jnms.JNMS.2024_91-511
Yuko Kobayashi, Hidenori Yamaguchi, Takahiro Ando, Jin Tamai, Akira Yamamoto, Hiromitsu Hayashi, Shin-Ichiro Kumita

Background: Spontaneous isolated visceral artery dissection (SIVAD) is rare. Recently, appropriate treatment strategies for symptomatic SIVAD have been proposed. We aimed to determine the management of asymptomatic spontaneous isolated superior mesenteric artery dissection (ASISMAD), which is relatively frequently encountered in SIVAD.

Methods: We retrospectively reviewed abdominal contrast-enhanced computed-tomography (CE-CT) scans from January 2015 to December 2020 in our institution and identified 24 patients with ASISMAD. Patient characteristics, vascular risk factors, complications, morphology features on CE-CT images, changes in abdominal CE-CT, and treatments outcomes were analyzed.

Results: All patients were male. The mean age of the patients was 66.0 ± 8.9 (standard deviation) years, and the follow-up period was 24.8 ± 28.7 months. The CE-CT images revealed that 1 patient had periarterial fat stranding, 15 patients had aneurysmal dilatation, and 7 patients had branch vessel involvement. The mean length of the dissection was 19.9 ± 13.5 mm. The mean distance from the orifice of the superior mesenteric artery to the dissection origin point was 14.9 ± 8.8 mm. The mean branching angle was 54.8°± 19.7°. None of the patients had dissection-related abdominal symptoms or complications. Follow-up CE-CT scans showed progression of the dissection in 2 (8.3%), improvement in 2 (8.3%), stable dissection in 17 (70.9%), and complete remodeling in 3 (12.5%).

Conclusions: Patients with ASISMAD do not require hospitalization because the pathology does not usually progress to visceral ischemia. Nevertheless, follow-up CE-CT is required because of progression of the dissection in rare cases.

背景:自发性孤立内脏动脉夹层(SIVAD)非常罕见。最近,有人提出了针对无症状 SIVAD 的适当治疗策略。我们旨在确定无症状自发性孤立肠系膜上动脉夹层(ASISMAD)的治疗方法,这种情况在 SIVAD 中比较常见:我们回顾性地查看了本院2015年1月至2020年12月期间的腹部造影剂增强计算机断层扫描(CE-CT),确定了24例ASISMAD患者。分析了患者特征、血管风险因素、并发症、CE-CT图像上的形态特征、腹部CE-CT的变化以及治疗结果:所有患者均为男性。结果:所有患者均为男性,平均年龄为(66.0±8.9)岁(标准差),随访时间为(24.8±28.7)个月。CE-CT 图像显示,1 名患者动脉周围脂肪滞留,15 名患者动脉瘤扩张,7 名患者分支血管受累。夹层的平均长度为 19.9 ± 13.5 毫米。从肠系膜上动脉开口到夹层起源点的平均距离为(14.9 ± 8.8)毫米。平均分支角度为 54.8°±19.7° 。所有患者均未出现与夹层相关的腹部症状或并发症。随访CE-CT扫描结果显示,2例(8.3%)夹层恶化,2例(8.3%)好转,17例(70.9%)夹层稳定,3例(12.5%)完全重塑:结论:ASISMAD 患者无需住院治疗,因为病理变化通常不会发展为内脏缺血。结论:ASISMAD 患者无需住院治疗,因为病变通常不会发展为内脏缺血,但在极少数情况下,由于夹层的发展,需要进行后续的 CE-CT 检查。
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Journal of Nippon Medical School
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