JA Clinical Reports最新文献

{"title":"Unintentional injection of contrast agent into the subdural space during an epidural blood patch procedure identified the site of cerebrospinal fluid leak: a case report.","authors":"Momoko Hattori, Hiroai Okutani, Mayuu Kobata, Daisuke Ishimoto, Yumiko Takao, Nobutaka Kariya, Munetaka Hirose","doi":"10.1186/s40981-025-00830-8","DOIUrl":"10.1186/s40981-025-00830-8","url":null,"abstract":"<p><strong>Background: </strong>CT myelography is a definitive diagnostic tool for cerebrospinal fluid leakage. We report a case in which the site of a cerebrospinal fluid leak that had been difficult to identify on CT myelography was fortuitously localized owing to incidental injection of a contrast agent into the subdural space.</p><p><strong>Case presentation: </strong>A 37-year-old man developed headache and neck pain following a massage. He was diagnosed with intracranial hypotension, but the exact site of cerebrospinal fluid leakage could not be identified by CT myelography. An epidural blood patch was performed at the Th11/12 level, during which a contrast agent was inadvertently injected into the subdural space, revealing cerebrospinal fluid leakage from the Th2/3 level into the epidural space.</p><p><strong>Conclusions: </strong>An unintentional subdural injection of contrast agent resulted in extensive distribution, facilitating the precise identification of the cerebrospinal fluid leakage site.</p>","PeriodicalId":14635,"journal":{"name":"JA Clinical Reports","volume":"11 1","pages":"66"},"PeriodicalIF":1.0,"publicationDate":"2025-11-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12662907/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145633624","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Epidural labor analgesia in a pregnant woman with symptomatic recurrence of myelin oligodendrocyte glycoprotein antibody-associated disease: a case report.","authors":"Satoshi Toyama, Sooyeon Han","doi":"10.1186/s40981-025-00829-1","DOIUrl":"10.1186/s40981-025-00829-1","url":null,"abstract":"<p><strong>Background: </strong>Myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) is a demyelinating disorder that may relapse during pregnancy. The safety of neuraxial anesthesia in such patients remains unclear.</p><p><strong>Case presentation: </strong>We describe a 32-year-old multiparous woman with MOGAD who developed intractable hiccups due to new medullary lesions at 35 weeks of gestation. Despite steroid pulse therapy, symptoms persisted. At 36 weeks and 2 days, premature rupture of membranes occurred, and hiccups worsened with labor pain. After informed consent, labor epidural analgesia was initiated using low-concentration levobupivacaine with minimal fentanyl. Pain relief coincided with the reduction of hiccups. Vaginal delivery of a male infant was uneventful. Her hiccups resolved by postpartum day 4, and magnetic resonance imaging showed improvement in the lesion. She was discharged on postpartum day 7 without neurological worsening.</p><p><strong>Conclusions: </strong>Labor epidural analgesia provided effective pain control and was associated with symptom relief in a parturient with active MOGAD.</p>","PeriodicalId":14635,"journal":{"name":"JA Clinical Reports","volume":"11 1","pages":"65"},"PeriodicalIF":1.0,"publicationDate":"2025-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12589681/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145444868","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intraoperative transesophageal echocardiography under aortic arch branch blood flow monitoring in a patient with an aberrant left subclavian artery: a case report.","authors":"Yasutaka Suzuki, Takahiro Kawaji, Hidefumi Komura, Satoshi Komatsu, Naohide Kuriyama, Tomoyuki Nakamura","doi":"10.1186/s40981-025-00828-2","DOIUrl":"10.1186/s40981-025-00828-2","url":null,"abstract":"<p><strong>Background: </strong>Transesophageal echocardiography (TEE) is widely used in cardiac and non-cardiac surgeries with major hemodynamic fluctuations. In patients with vascular anomalies near the esophagus, such as an aberrant left subclavian artery (ALSA), TEE may pose a risk of vascular compression. However, no guidelines exist.</p><p><strong>Case presentation: </strong>A 19-year-old woman with biliary atresia underwent living donor liver transplantation. Preoperative imaging showed a right-sided aortic arch with ALSA coursing posterior to the esophagus, and ALSA compression was considered a risk during TEE. Therefore, bilateral radial arterial pressures and regional cerebral oxygen saturation (rSO₂) were monitored. The TEE probe was inserted under videolaryngoscopic guidance without resistance or hemodynamic disturbance, and no arterial waveform attenuation or rSO₂ changes occurred. Transplantation was uneventful, and the patient showed no postoperative neurological or upper-limb deficits.</p><p><strong>Conclusion: </strong>This case highlights that appropriate imaging and monitoring strategies can support safe TEE use in non-cardiac surgery, even with vascular anomalies.</p>","PeriodicalId":14635,"journal":{"name":"JA Clinical Reports","volume":"11 1","pages":"64"},"PeriodicalIF":1.0,"publicationDate":"2025-11-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12583351/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145438048","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association between intraoperative hypotension and adverse clinical outcomes after esophagectomy for esophageal cancer: retrospective observational study.","authors":"Takashi Juri, Koichi Suehiro, Hikaru Yasuhara, Masayo Takai, Shinta Yasuda, Aya Kimura, Kanae Takahashi, Yohei Fujimoto, Takashi Mori","doi":"10.1186/s40981-025-00826-4","DOIUrl":"10.1186/s40981-025-00826-4","url":null,"abstract":"<p><strong>Background: </strong>Esophagectomy for esophageal cancer is complex and frequently complicated by pulmonary issues, cardiac problems, and anastomotic leakage. While numerous factors contribute to these complications, the specific effects of intraoperative hypotension (IOH) on postoperative outcomes remain poorly understood. This study examined the relationship between IOH severity during esophagectomy and subsequent complications.</p><p><strong>Methods: </strong>This retrospective observational study analyzed patients undergoing elective open transthoracic or thoraco-laparoscopic esophagectomy for esophageal cancer between May 2007 and February 2020. Multiple logistic regression assessed IOH's association with primary outcomes (composite of major complications including 30-day mortality, reoperation, anastomotic leakage, pneumonia, reintubation, and prolonged ventilation > 48 h) and secondary outcomes of anastomotic leakage. Additionally, Cox regression analyzed IOH's impact on long-term prognosis.</p><p><strong>Results: </strong>The final cohort comprised 884 patients. The most prevalent postoperative complications were anastomotic leakage (25.2%) and pneumonia (23.4%). The 30-day mortality rate was 0.8%. No significant association existed between IOH and major composite outcomes across mean blood pressure (MBP) and systolic blood pressure thresholds. However, IOH was significantly associated with anastomotic leakage when MBP fell below 65 mmHg for extended periods (adjusted odds ratio: 1.02 per 10-min interval, 95% confidence interval: 1.01-1.04, P = 0.01). IOH did not significantly affect long-term survival.</p><p><strong>Conclusions: </strong>This study did not identify a significant association between intraoperative hypotension and composite major postoperative complications or long-term survival outcomes. However, intraoperative hypotension, specifically prolonged episodes with mean blood pressure below 65 mmHg, was significantly associated with the short-term complication of anastomotic leakage.</p><p><strong>Trial registration: </strong>UMIN Clinical Trials Registry, UMIN000040455. Registered 28 May 2020, https://center6.umin.ac.jp/cgi-open-bin/ctr/ctr_view.cgi?recptno=R000046165 .</p>","PeriodicalId":14635,"journal":{"name":"JA Clinical Reports","volume":"11 1","pages":"63"},"PeriodicalIF":1.0,"publicationDate":"2025-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12579064/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145421749","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A case of thoracic aortic aneurysm discovered following poor ventilation during induction of anesthesia.","authors":"Mahiro Isogai, Ko Ishikawa, Ryosuke Funabiki, Takashi Suto, Shigeru Saito","doi":"10.1186/s40981-025-00827-3","DOIUrl":"10.1186/s40981-025-00827-3","url":null,"abstract":"<p><p>Several cases of tracheal stenosis due to thoracic aortic aneurysm have been reported. However, cases of aortic aneurysm discovered following ventilation difficulties immediately after the induction of general anesthesia are rare. The patient, a 90-year-old woman with a history of ascending aortic replacement for a thoracic aortic aneurysm, was scheduled for sternum infection debridement. During induction, adequate ventilation could not be achieved despite the use of positive pressure, even after tracheal intubation. Bronchoscopy showed tracheal compression, which was not apparent in preoperative evaluations. CT imaging on the day demonstrated that the compression was caused by a thoracic aortic aneurysm. A thoracic endovascular aneurysm repair was performed successfully, and the tracheal compression improved afterwards. Compression from outside the trachea should be considered as a potential cause of sudden ventilation difficulties. Particularly in patients with a history of aortic surgery, additional preoperative assessments should be considered.</p>","PeriodicalId":14635,"journal":{"name":"JA Clinical Reports","volume":"11 1","pages":"62"},"PeriodicalIF":1.0,"publicationDate":"2025-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12579087/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145421803","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Potential utility of the Tumguide® LED Light Source for safe and accurate gastric tube placement during laparoscopic gastrectomy.","authors":"Yuto Rai, Suguru Hayase, Chiaki Nemoto, Satoki Inoue","doi":"10.1186/s40981-025-00824-6","DOIUrl":"10.1186/s40981-025-00824-6","url":null,"abstract":"","PeriodicalId":14635,"journal":{"name":"JA Clinical Reports","volume":"11 1","pages":"61"},"PeriodicalIF":1.0,"publicationDate":"2025-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12552192/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145354782","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Perioperative management of thoracoscopic left cardiac sympathetic denervation for refractory long QT syndrome: a case report.","authors":"Asako Nitta, Atsushi Sawada, Kanami Abe, Naoyuki Kamiyama, Yuki Takahashi, Masahiro Miyajima, Mitsutaka Edanaga, Michiaki Yamakage","doi":"10.1186/s40981-025-00815-7","DOIUrl":"10.1186/s40981-025-00815-7","url":null,"abstract":"<p><strong>Background: </strong>Long QT syndrome (LQTS) refractory to standard treatments, including β-blockers and implantable cardioverter-defibrillators (ICDs), has been indicated for left cardiac sympathetic denervation (LCSD) in Europe and the United States. However, the clinical implementation of LCSD remains rarely performed in Japan as it is not covered by national health insurance.</p><p><strong>Case presentation: </strong>A 49-year-old woman with LQTS experienced frequent ICD activations, and β-blocker up-titration was limited due to severe heart failure. As a stellate ganglion block transiently shortened QT interval, LCSD was considered to prevent life-threatening arrhythmic events. Total intravenous anesthesia combined with a left thoracic paravertebral block was used to attenuate sympathetic nervous activation. Thoracoscopic LCSD was performed without arrhythmia or hemodynamic instability. The patient remained stable postoperatively, with no further ICD activations.</p><p><strong>Conclusion: </strong>This case demonstrates the safe perioperative management of LCSD for drug-refractory LQTS by incorporating strategies to minimize QT prolongation and suppress malignant arrhythmias.</p>","PeriodicalId":14635,"journal":{"name":"JA Clinical Reports","volume":"11 1","pages":"60"},"PeriodicalIF":1.0,"publicationDate":"2025-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12545946/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145345210","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Venous air embolism induced by burr hole drilling before dural incision in craniotomy: two case reports.","authors":"Yohei Motoi, Shuji Okahara, Makiko Tani, Nobushige Tsuboi, Hiroshi Morimatsu","doi":"10.1186/s40981-025-00823-7","DOIUrl":"10.1186/s40981-025-00823-7","url":null,"abstract":"<p><strong>Background: </strong>Venous air embolism (VAE) is a rare but potentially fatal complication in neurosurgery typically caused by injury to dura mater, especially venous sinuses, during craniotomy. We report two cases of VAE that occurred before dural incision.</p><p><strong>Case presentation: </strong>Both patients underwent craniotomy under general anesthesia in a head-up position. Hemodynamic and respiratory deterioration occurred during or immediately after burr hole drilling with abnormal vital signs and transesophageal echocardiography findings, raising suspicion for VAE. Immediate management, including surgical field protection and cardiopulmonary support, stabilized the patients' conditions. The procedure was subsequently discontinued in case 1 and modified to limited resection in case 2. Postoperative computed tomography revealed intracranial venous air within the internal jugular vein, cavernous sinus, and diploic veins.</p><p><strong>Conclusion: </strong>These cases highlight that VAE can occur even before dural incision. Vigilant intraoperative monitoring and prompt intervention are essential for preventing potentially fatal outcomes.</p>","PeriodicalId":14635,"journal":{"name":"JA Clinical Reports","volume":"11 1","pages":"59"},"PeriodicalIF":1.0,"publicationDate":"2025-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12546170/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145345243","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of flumazenil on recovery of memory following recovery of consciousness from general anesthesia with remimazolam: a randomized, open-label, single-center controlled trial.","authors":"Keiko Nobukuni, Kazuhiro Shirozu, Masako Asada, Taichi Ando, Etsuko Kanna, Kotaro Kakehashi, Ryotaro Shiraki, Makoto Kubo, Ken Yamaura","doi":"10.1186/s40981-025-00825-5","DOIUrl":"10.1186/s40981-025-00825-5","url":null,"abstract":"<p><strong>Background: </strong>Recovery of consciousness from general anesthesia with remimazolam, an ultrashort-acting benzodiazepine, occurs rapidly. However, patients after recovery of consciousness from general anesthesia with remimazolam often experience periods of amnesia. Remimazolam can be antagonized by flumazenil. Therefore, we investigated the effect of flumazenil on the recovery of memory following the recovery of consciousness from general anesthesia with remimazolam.</p><p><strong>Methods: </strong>This single-center randomized controlled trial was conducted from November 2023 to July 2024. Forty-four patients undergoing breast surgery were enrolled. The patients received general anesthesia with remimazolam and remifentanil and were randomized to receive flumazenil after recovery of consciousness or not. The recovery of the memory was evaluated by showing an A4-size poster (illustration) to the patients and asking them to remember the poster every 1 h. Furthermore, the effect-site concentration of remimazolam was calculated using the Masui model.</p><p><strong>Results: </strong>All 44 patients (22 with and 22 without flumazenil) were assessed. The percentage of patients who remembered the poster 1 h after regaining consciousness was significantly higher in the flumazenil group than in the no flumazenil group (95.5 vs 40.9%; p < 0.001). All patients could recall the poster within 2 h postoperatively. The mean effect-site concentration of remimazolam at the time of consciousness recovery was similar between the two groups (0.31 ± 0.08 µg/mL).</p><p><strong>Conclusions: </strong>Flumazenil significantly accelerated the recovery of memory retention in patients who had recovered consciousness from general anesthesia with remimazolam. However, even without the administration of flumazenil, all patients successfully recovered their memory within 2 h after regaining consciousness.</p><p><strong>Trial registration: </strong>This clinical trial was registered at the University Hospital Medical Information Network (UMIN) Center on November 01, 2023 (UMIN-CTR: UMIN000052659).</p>","PeriodicalId":14635,"journal":{"name":"JA Clinical Reports","volume":"11 1","pages":"58"},"PeriodicalIF":1.0,"publicationDate":"2025-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12540950/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145337111","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prediction of financial deficits of postoperative patients in the intensive care unit using machine learning.","authors":"Saori Ikumi, Takuya Shiga, Eichi Takaya, Shinya Sonobe, Yu Kaiho, Yukiko Ito, Masanori Yamauchi","doi":"10.1186/s40981-025-00819-3","DOIUrl":"10.1186/s40981-025-00819-3","url":null,"abstract":"<p><strong>Background: </strong>Operational loss, defined as unanticipated financial deficits in intensive care unit (ICU) management, is challenging to predict yet critical for hospital sustainability. This study aimed to evaluate whether machine-learning models can predict financial loss events in postoperative ICU patients.</p><p><strong>Methods: </strong>We conducted a retrospective analysis of postoperative patients admitted to the ICU at Tohoku University Hospital between April 2017 and March 2021. A total of 22 clinical and administrative variables collected within 24 h of ICU admission were used to develop machine-learning models. The outcome was defined as financial loss events, determined by a negative contribution margin below the break-even threshold of - 909 USD. The dataset was randomly split into training (70%) and test (30%) sets. Predictive performance was assessed using the area under the receiver operating characteristic curve (AUC) and accuracy.</p><p><strong>Results: </strong>Among 6743 postoperative ICU patients, 425 (6.3%) experienced financial loss events. The random forest classifier demonstrated high predictive performance, with an AUC of 0.859 and accuracy of 0.785.</p><p><strong>Conclusions: </strong>Machine-learning models may accurately predict financial loss events in postoperative ICU patients, potentially supporting efficient resource allocation and hospital financial planning.</p>","PeriodicalId":14635,"journal":{"name":"JA Clinical Reports","volume":"11 1","pages":"57"},"PeriodicalIF":1.0,"publicationDate":"2025-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12540221/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145337076","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}