JMA journal最新文献

Ichthyosis uteri is a rare benign condition characterized by extensive squamous metaplasia of the endometrium. We present an unusual case of ichthyosis uteri with radiological features mimicking myometrial invasion of endometrial cancer, occurring in a 50-year-old postmenopausal woman who presented with persistent abnormal vaginal bleeding. Laboratory findings revealed elevated serum squamous cell carcinoma (SCC) antigen level of 11.5 ng/mL. Magnetic resonance imaging (MRI) demonstrated an intrauterine lesion with apparent myometrial invasion, initially suggesting the International Federation of Gynecology and Obstetrics stage IA endometrial cancer. The lesion showed low signal intensity on the T2-weighted image compared to normal endometrium and weak enhancement on the contrast-enhanced T1-weighted image. While the lesion showed high signal intensity on diffusion-weighted imaging, the apparent diffusion coefficient value (0.96 × 10^-3 mm²/sec) indicated no substantial diffusion restriction. Despite the biopsy showing only squamous metaplasia without malignancy, a total hysterectomy was performed due to persistent bleeding, elevated serum SCC antigen level, and suspected myometrial invasion. Pathological examination revealed extensive papillary proliferation of bland squamous epithelium extending along adenomyosis, with concurrent endometrial hyperplasia. Postoperative serum SCC antigen level normalized to 0.7 ng/mL. This case highlights a unique radiological presentation of ichthyosis uteri, where extension along adenomyotic foci mimicked myometrial invasion of endometrial cancer. The relative lack of diffusion restriction on MRI, despite the lesion's size, may serve as a valuable diagnostic clue in differentiating ichthyosis uteri from endometrial cancer.

Introduction: Poor subjective health perception is a well-known risk factor for morbidity and mortality. This study aimed to investigate the relationship between social capital (SC) and health confidence among older individuals in a community setting.

Methods: The study included 884 individuals aged 60-79 years residing in a city in the Hokuriku region (460 men and 424 women; mean age: 70.32 ± 4.03 years). The analysis considered the following variables: residential area, sex, age, presence or absence of cohabitants, SC (general trust in the community, reciprocity among community members, attachment to the region, and engagement in hobbies and other community activities), health counseling-related resources, and lack of health confidence. The multivariate logistic regression analysis used lack of health confidence as the dependent variable. Multiple models were constructed.

Results: Of the 884 participants who provided data for the analyses, 176 (19.9%) reported a lack of confidence in their health. Women and individuals aged 70-79 years had significantly higher odds ratios (ORs) for reporting lack of health confidence (OR: 1.78 and 1.60, respectively). In men, the odds for reporting lack of health confidence were significantly higher among those who reported having no access to health or care counseling resources (OR 3.58, 95% confidence interval 1.47-8.72) and those who did not participate in sports-related group or club activities (OR 2.11, 95% confidence interval 1.15-3.86). In contrast, no significant associations were observed between SC factors and lack of health confidence among women.

Conclusions: The findings suggest that, particularly among men, access to health counseling resources and participation in community activities contribute to greater confidence in own health.

Introduction: This study aimed to determine the association between long-term care (LTC) risk and nonresponse to a subsequent survey.

Methods: Community-dwelling older adults aged ≥75 years without certified care needs residing in Hachioji City, Tokyo, who participated in the annual frailty screening program, were evaluated. Among the fiscal year (FY) 2020 survey respondents, those invited to the FY 2021 survey were included. The exposures of interest were LTC risk assessed using the seven domains of the Kihon Checklist (KCL) and frailty status in the FY 2020 survey. Frailty status was categorized based on total KCL scores. The outcome of interest was nonresponse to the FY 2021 survey. We conducted multivariable logistic regression analysis to evaluate these associations.

Results: Among 35,425 participants, 9,456 (26.7%) did not respond to the subsequent survey. Among seven KCL domains, activities of daily living limitation (adjusted odds ratio, 95% confidence interval 1.38, 1.27-1.50), low physical strength (1.17, 1.10-1.26), isolation (1.32, 1.22-1.44), memory decline (1.23, 1.17-1.30), and depressive mood (1.10, 1.04-1.16) were associated with nonresponse to the subsequent survey. In addition, frailty status was associated with nonresponse in a dose-responsive manner (prefrailty: 1.19, 1.12-1.26; frailty: 1.63, 1.53-1.73).

Conclusions: Although the annual frailty screening program aimed to identify those with high LTC risk, older adults with LTC risk were less likely to respond to the survey. Thus, conventional survey methods may need to be modified or different approaches may need to be adopted to identify older adults with high LTC risk.

Introduction: Numerous reports have suggested a relationship between asthma and migraine. We have encountered patients who presented with migraine attacks in association with asthma attacks.

Methods: In this study, we retrospectively evaluated the relationship between the condition of asthma (controlled or not) and the intensity of migraine attacks in 35 patients with asthma and migraine. We investigated the degree of changes in symptoms (change in fractional exhaled nitric oxide [FeNO], change in peak expiratory flow [PEF], and change in Asthma Control Test [ACT]) during exacerbation of asthma and observed the intensity of the headache (change in visual analog scale [∆VAS]). Next, we investigated the correlation between ∆VAS and biomarkers of bronchial asthma.

Results: When migraine was aggravated, indexes of asthmatic symptoms (ACT, PEF, and FeNO) were also exacerbated. We found a linkage between insufficiently controlled asthma and aggravation of migraine. Moreover, the three indexes of asthma (ACT, PEF, and FeNO) reviewed in this study showed a close correlation. There was a positive correlation between the degree of exacerbation of migraine symptoms and the degree of change in the three indexes. In 14 of 35 patients, administration of a short-acting β2 agonist for asthma attacks indirectly relieved headache.

Conclusions: here is a close correlation between the condition of asthma attacks and the intensity of migraine attacks.

Cow's milk-induced non-IgE-mediated gastrointestinal food allergies (non-IgE-GIFAs) are common and generally considered to have a favorable prognosis; however, severe cases can occur. We report a case of a neonate who presented with hypovolemic shock and subsequently developed cerebral infarction due to deep medullary venous thrombosis. A female infant, born at 35 weeks of gestation, was initially fed formula but transitioned to exclusive breastfeeding within a few days. After discharge on day 17, mixed feeding was resumed, leading to frequent pale-colored diarrhea. On day 19, she developed hypovolemic shock and was admitted to the intensive care unit. Her symptoms improved with nil per os management; however, on day 20, her hemoglobin levels declined despite no signs of bleeding on ultrasonography. She was treated with red blood cell transfusion and intravenous vitamin K. An amino acid-based formula was introduced on day 22 without adverse events, which suggested a possibility of non-IgE-GIFAs. However, the patient developed intermittent transient fevers thereafter; a cranial ultrasound performed on day 41 revealed a low-echoic area in the right frontal lobe. Subsequent magnetic resonance imaging revealed a cystic lesion in the right frontal lobe accompanied by surrounding parenchymal degeneration, leading to a diagnosis of venous infarction due to deep medullary vein thrombosis. Blood tests ruled out vitamin K deficiency and protein C or S defects. Despite this neurologic complication, she exhibited no neurologic symptoms throughout the clinical course. At 10 months of age, her neurodevelopment remains normal without any delays. This case highlights the potential for severe complications, including cerebral venous infarction, in neonatal non-IgE-GIFAs. Close monitoring for systemic complications is crucial in severe cases.

Chronic recurrent multifocal osteomyelitis (CRMO) is a rare, non-infectious autoinflammatory bone disorder that predominantly affects children. Some studies have reported cases of CRMO in patients with autoimmune diseases such as inflammatory bowel disease (IBD). We encountered a rare pediatric case of CRMO in a patient with both IBD and primary sclerosing cholangitis (PSC). The patient was a 14-year-old male with a history of ulcerative colitis and PSC, both controlled with vedolizumab, who developed recurrent right wrist pain. Imaging revealed bone marrow edema suggestive of osteomyelitis. Initially suspected to be bacterial osteomyelitis, the patient was treated with antibiotics; however, symptoms recurred, and new lesions appeared on the heel, ultimately leading to a diagnosis of CRMO. The patient was successfully managed with analgesics alone, without antibiotics, and no long-term complications were observed. This is a rare pediatric case of CRMO occurring in the context of both IBD and PSC. Clinicians should consider CRMO in patients with IBD and PSC who present with musculoskeletal symptoms to avoid unnecessary antibiotic use. Early-stage diagnosis of CRMO can be achieved by detecting multifocal lesions on magnetic resonance imaging.

Approximately 250,000 foreign nationals reside in Japan under the specified skilled worker (SSW) visa category. Due to Japan's aging population and declining birth rate, a labor shortage is anticipated, prompting an increase in the intake of SSWs. All SSWs are required to undergo pre-arrival health screenings, but renal function assessments, such as the estimated glomerular filtration rate (eGFR), are not currently included. We present a case of a woman in her early 20s from Myanmar who developed severe anemia and renal dysfunction after arriving in Japan as an SSW. Before arrival, an initial health checkup identified anemia with a hemoglobin level of 10.3 g/dL, but renal function tests were not conducted. Ten months later, her hemoglobin had dropped to 7.7 g/dL, and her serum creatinine level was elevated to 7.83 mg/dL. Subsequent testing revealed severe renal dysfunction, and imaging showed extensive cysts in the right kidney and atrophy of the left kidney, suggesting a congenital malformation. She required immediate hemodialysis. This case highlights the gap in SSW health screenings, where renal function tests are omitted. Given Japan's rising number of SSWs, we emphasize the importance of including kidney function assessments, such as eGFR, in pre-employment health checkups. Early detection could prevent delays in diagnosing conditions like chronic kidney disease. As hemodialysis initiation often complicates treatment continuity after returning home, appropriate screening is essential for patient safety and improved health outcomes. In conclusion, we suggest updating the pre-employment health checkup protocol for SSWs to include kidney function tests to address this critical gap.