Kurume Medical Journal最新文献

{"title":"Autoimmune Hepatitis in Transition: Advances in Diagnosis, Management, and Future Perspectives.","authors":"Teruko Arinaga-Hino, Takumi Kawaguchi","doi":"10.2739/kurumemedj.MS721234016","DOIUrl":"10.2739/kurumemedj.MS721234016","url":null,"abstract":"<p><p>Autoimmune hepatitis (AIH) is a liver disease of unknown etiology, characterized by the presence of autoantibodies, increased immunoglobulin G levels in blood, chronic/persistent liver disorder, and favorable response to immunosuppressive therapy. Although the diagnosis of typical AIH cases has become easier, the absence of disease-specific markers poses challenges when diagnosing atypical cases, such as acute-onset AIH or AIH overlapping with drug-induced liver injury, metabolic liver disease, or other autoimmune disorders. Corticosteroids remain the first-line treatment for AIH; however, azathioprine is now covered by health insurance in Japan and can be used to treat AIH. Expanding treatment options is desirable, particularly for elderly patients and refractory cases. This review aims to provide an overview of the diagnosis, treatment, and prognosis of AIH while introducing historical perspectives and current emerging topics. The prevalence of AIH is increasing in Japan and other countries. Although the prognosis is generally favorable, given the possibility of long-term survival, periodic cancer screenings are advisable owing to the risk of carcinogenesis.</p>","PeriodicalId":39559,"journal":{"name":"Kurume Medical Journal","volume":" ","pages":"1-11"},"PeriodicalIF":0.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148200389","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Longitudinal Observation of Twin-to-Twin Transfusion Syndrome, Twin Anemia-Polycythemia Sequence, and Selective Fetal Growth Restriction with Spontaneous Attenuation and Progressive Donor Twin Brain Injury: A Case Report.","authors":"Rumiko Aoki, Megumi Muto, Asami Inoue, Yozo Teramachi, Mamoru Saikusa, Yusuke Kurokawa, Takashi Horinouchi, Toshiyuki Yoshizato, Naotake Tsuda","doi":"10.2739/kurumemedj.MS721234012","DOIUrl":"10.2739/kurumemedj.MS721234012","url":null,"abstract":"<p><p>A 34-year-old woman with a monochorionic diamniotic twin pregnancy developed twin-to-twin transfusion syndrome and selective fetal growth restriction at 21 weeks, followed by the onset of twin anemia-polycythemia sequence at 23 weeks. Fetoscopic laser photocoagulation could not be performed. Therefore, the pregnancy was managed expectantly. By 24-26 weeks, amniotic fluid levels and cerebral Doppler parameters normalized, but the donor twin's cardiac function deteriorated progressively. At 26 weeks, neurosonography showed diffuse periventricular hyperechogenicity, followed by ventriculomegaly at 28 weeks. Cesarean delivery was performed at 34 weeks because of preeclampsia. The donor twin was severely anemic, showed cerebral atrophy, and died on day 6. The recipient remained stable. This case illustrates the natural progression and dynamic interplay of three clinical conditions, resulting in hypoxic-ischemic brain injury in the donor twin. Our findings indicate the importance of cardiovascular monitoring to understand the complex pathophysiology in such pregnancies.</p>","PeriodicalId":39559,"journal":{"name":"Kurume Medical Journal","volume":" ","pages":"143-148"},"PeriodicalIF":0.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147724350","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Risk Factors Related to Postoperative Acute Exacerbation in Patients with Interstitial Lung Disease.","authors":"Masayo Kawakami, Kiminori Fujimoto, Tomonori Chikasue, Masaki Tominaga, Natsumi Kumano, Kenta Murotani, Teruyuki Hiraki","doi":"10.2739/kurumemedj.MS721234013","DOIUrl":"10.2739/kurumemedj.MS721234013","url":null,"abstract":"<p><strong>Purpose: </strong>Patients with interstitial lung disease (ILD) often experience postoperative acute exacerbation (AE). There is a lack of consensus regarding the risk factors for postoperative AE. This study aimed to identify factors associated with postoperative AE in patients with ILD.</p><p><strong>Methods: </strong>Of 84,833 patients who underwent surgery under general anesthesia, we included 198 ILD patients. The patients were retrospectively divided into AE and non-AE groups. Exclusion criteria were those who were continuously on a ventilator preoperatively or postoperatively, and those with obvious infection. We investigated risk factors, adjusting for sex and pulmonary surgery.</p><p><strong>Results: </strong>AE occurred within 30 days after surgery in 11 patients (5.6%) and six of these patients (55%) died. Preoperative C-reactive protein (CRP) levels were significantly higher in the AE group than in the non-AE group (OR, 1.06; 95% confidence interval [CI], 1.00-1.13; p = 0.048). Chest high-resolution computed tomography (CT) evaluation was performed according to the updated 2022 idiopathic pulmonary fibrosis guidelines. CT revealed that patients in the CT-defined usual interstitial pneumonia (UIP) group, comprising UIP and probable UIP patterns, were significantly more likely to experience AE than those in the non-CT-UIP group, which included indeterminate UIP and alternative diagnosis patterns (OR, 4.00; 95% CI, 1.19-15.04; p = 0.025).</p><p><strong>Conclusion: </strong>In patients with ILD, the risk of postoperative AE across all surgeries, including non-pulmonary surgery, was associated with high preoperative CRP levels and the CT-UIP pattern.</p>","PeriodicalId":39559,"journal":{"name":"Kurume Medical Journal","volume":" ","pages":"103-112"},"PeriodicalIF":0.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147964854","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Factors Contributing to Depressive Symptoms and Post-traumatic Growth among Bereaved Families During the COVID-19 Pandemic.","authors":"Yumiko Inoue, Mie Kaetsu, Kenta Murotani","doi":"10.2739/kurumemedj.MS721234018","DOIUrl":"10.2739/kurumemedj.MS721234018","url":null,"abstract":"<p><strong>Objectives: </strong>We aim to establish support for bereaved families during the anticipated recurrence of an infectious pandemic by clarifying the relationship between the experiences of bereaved families during the COVID-19 pandemic with their depression symptoms and post-traumatic growth (PTG).</p><p><strong>Methods: </strong>We surveyed bereaved family members who lost their loved ones during the COVID-19 pandemic. Participants were asked to answer questions regarding \"experiences of bereaved families during the COVID-19 pandemic,\" \"depressive symptoms,\" and \"PTG.\" Multivariate analysis was then performed to examine their correlations.</p><p><strong>Results: </strong>Individuals were anxious about contracting an infection and those who had lost a spouse or partner were more likely to experience depression. In addition, a lack of satisfactory interactions with the deceased prior to death can lead to depression. Those who had satisfying interactions with medical professionals and who received support from medical professionals and neighbors tended to have higher PTG scores.</p><p><strong>Conclusion: </strong>During pandemics, meaningful interactions with the deceased prior to death and adequate social support for bereaved individuals, especially those who have lost their spouses or partners, is important.</p>","PeriodicalId":39559,"journal":{"name":"Kurume Medical Journal","volume":" ","pages":"71-82"},"PeriodicalIF":0.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148200408","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Case of Emanuel Syndrome Diagnosed with Congenital Diaphragmatic Hernia at 15 Weeks and 1 Day of Gestation Followed by Increased Nuchal Translucency: A Case Report and Literature Review.","authors":"Y U Okamura, Takashi Horinouchi, Toshiyuki Yoshizato, Yusuke Kurokawa, Megumi Muto, Masato Yokomine, Naotake Tsuda","doi":"10.2739/kurumemedj.MS721234003","DOIUrl":"10.2739/kurumemedj.MS721234003","url":null,"abstract":"<p><p>Congenital diaphragmatic hernia (CDH) diagnosed in the first or early second trimester is exceedingly rare. We herein present a unique case of Emanuel syndrome identified through early sequential findings of increased nuchal translucency (NT) and CDH. A 34-year-old Japanese woman was referred at 14 weeks of gestation because of an elevated NT of 3.9 mm detected at 12 weeks, with no other markers of aneuploidy. At 15+1/7 weeks, an ultrasound revealed right-sided heart displacement, a tubular structure near the heart, and a cystic structure on the left, presumed to be the stomach and intestines, respectively-findings indicative of CDH. Fetal karyotyping via amniocentesis confirmed Emanuel syndrome with a karyotype of 47,XY,+der(22) t(11;22)(q23.3;q11.2). This case suggests that early detection of increased NT could lead to the early diagnosis of CHD, which, in our case, was part of Emanuel syndrome.</p>","PeriodicalId":39559,"journal":{"name":"Kurume Medical Journal","volume":" ","pages":"119-123"},"PeriodicalIF":0.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147964937","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"An Anatomical Study on the Characteristics of the Shape of the Foot and Talofibular and Calcaneofibular Ligaments in Relation to the Different Number of Bundles of the Anterior Talofibular Ligament and its Relevance.","authors":"Shinichi Tanaka, Tsuyoshi Saga, Joe Iwanaga, Yoko Tabira, Koichi Watanabe","doi":"10.2739/kurumemedj.MS721234011","DOIUrl":"10.2739/kurumemedj.MS721234011","url":null,"abstract":"<p><p>This study aimed to investigate anatomical features by comparing and verifying the shape of the talus and calcaneofibular ligament (CFL) depending on the number of anterior talofibular ligament (ATFL) bundles. We also aimed to reveal the relationship between the ATFL and talofibular and CFL. We examined 118 feet from 59 cadaveric specimens and measured the ATFL and CFL, as well as the length, width and thickness of the talus and foot, by using digital calipers. We counted the number of ATFL bundles, calcaneofibular ligament, talus and foot. The ATFL was divided into two groups: one group with one bundle and one group with two bundles. We further examined the relationship between the shapes of the ATFL, CFL, talus and foot. The results were tested for differences in sex and showed that women had significantly wider (p<0.05) and longer (p<0.05) talus in the two-bundle group than in the one bundle group. The CFL was also significantly longer in the two-bundle group (p<0.05). A moderately significant correlation was found between the shapes of the ATFL and the talofibular and CFL. This study provided new anatomical findings that the ATFL attached to the high talus has two bundles. In addition, the ankle joint evaluation and rehabilitation was basic research that considered sex differences.</p>","PeriodicalId":39559,"journal":{"name":"Kurume Medical Journal","volume":" ","pages":"59-70"},"PeriodicalIF":0.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148200355","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pathophysiology of Odontogenic Maxillary Sinusitis Arising from Marginal Periodontitis with Ascending Pulpitis.","authors":"Kiminori Sato, Shun-Ichi Chitose, Kiminobu Sato, Fumihiko Sato, Takeharu Ono, Hirohito Umeno","doi":"10.2739/kurumemedj.MS721234014","DOIUrl":"10.2739/kurumemedj.MS721234014","url":null,"abstract":"<p><strong>Objective: </strong>Ascending pulpitis refers to inflammation of the dental pulp that progresses from the apical region toward the coronal portion of the tooth. The purpose of this study is to investigate novel insights into the pathophysiology of OMS arising from marginal periodontitis with ascending pulpitis.</p><p><strong>Methods: </strong>Five adult patients diagnosed with OMS arising from marginal periodontitis were examined. Histological analysis of the causative teeth of OMS was conducted.</p><p><strong>Results: </strong>No coronal lesions (e.g., dental carious lesions) were observed in the causative teeth of OMS. Histologically, the periodontal ligament of the involved teeth exhibited necrosis, confirming the presence of marginal periodontitis. Within the pulp cavity of the causative tooth, both odontoblasts and pulp cells had disappeared, and necrosis was observed in the root canal and portions of the pulp chamber, indicating ascending pulpitis and pulpal necrosis. Additionally, inflammatory granulation tissues were present at the apex, consistent with apical periodontitis.These findings of the causative teeth of OMS suggest the following pathological sequence: marginal periodontitis initiated ascending pulpitis and pulpal necrosis of the tooth; these, in turn, led to the development of apical periodontitis, which subsequently caused OMS.</p><p><strong>Conclusion: </strong>In cases with absence of coronal lesions (e.g., dental carious lesions), diagnosing ascending pulpitis and pulpal necrosis is challenging and is not always straightforward. A thorough understanding of the pathophysiological progression - from marginal periodontitis to ascending pulpitis, pulpal necrosis and apical periodontitis that ultimately leads to OMS - is essential. Clinicians must maintain a high level of suspicion for this condition in daily practice.</p>","PeriodicalId":39559,"journal":{"name":"Kurume Medical Journal","volume":" ","pages":"135-141"},"PeriodicalIF":0.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147724305","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Electrocardiographic Changes in Cholecystitis and Cholangitis.","authors":"Daisuke Muroya, Yuu Sasaki, Daiki Miyazaki, Takamichi Nishida, Shin Sasaki, Syoichiro Arai, Yuichi Goto, Takatomo Yamayoshi, Masao Inoue, Kohji Okamoto","doi":"10.2739/kurumemedj.MS721-4006","DOIUrl":"10.2739/kurumemedj.MS721-4006","url":null,"abstract":"<p><strong>Introduction: </strong>Electrocardiographic (ECG) changes associated with biliary diseases, including cholecystitis and cholangitis, have been sporadically reported; however, detailed observational data remain scarce. This study aimed to investigate the prevalence and characteristics of ECG abnormalities in patients with cholecystitis and cholangitis, and to identify associated clinical factors.</p><p><strong>Materials and methods: </strong>We conducted a retrospective analysis of 402 patients hospitalized for biliary diseases between January 2018 and January 2025. After excluding patients without comparable ECGs or with confounding cardiovascular conditions, 79 cholecystitis and 111 cholangitis cases were included. ECG changes such as T-wave abnormalities, ST-segment deviations, and conduction blocks were evaluated. Clinical variables, including demographics, laboratory results, disease severity (Tokyo Guidelines), and comorbidities, were compared between patients with and without ECG changes.</p><p><strong>Results: </strong>ECG abnormalities were observed in 43% of cholecystitis cases and 34% of cholangitis cases. In both groups, T-wave abnormalities-particularly negative T-waves-were the most common findings, followed by ST-segment changes and conduction blocks. In cholecystitis, ECG changes were significantly associated with lower serum potassium levels and higher disease severity. In cholangitis, a history of stroke and elevated alkaline phosphatase (ALP) levels were significantly associated with ECG changes. All ECG abnormalities normalized following appropriate treatment of the underlying biliary disease.</p><p><strong>Conclusion: </strong>Electrocardiographic changes were observed in a significant proportion of patients with either cholecystitis or cholangitis. Awareness of the potential association between biliary disease and electrocardiographic abnormalities is essential to avoid misdiagnosis and to ensure appropriate management in acute care settings.</p>","PeriodicalId":39559,"journal":{"name":"Kurume Medical Journal","volume":" ","pages":"49-58"},"PeriodicalIF":0.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147575611","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cone-Beam Computed Tomography Scan and Three-Dimensional Roadmap for Balloon Pulmonary Angioplasty.","authors":"Yoichi Sugiyama, Kazunori Yamaji, Yuki Koga, Ken-Ichiro Sasaki, Nobuhiro Tahara, Yoshihiro Fukumoto","doi":"10.2739/kurumemedj.MS721-4010","DOIUrl":"10.2739/kurumemedj.MS721-4010","url":null,"abstract":"","PeriodicalId":39559,"journal":{"name":"Kurume Medical Journal","volume":" ","pages":"149-151"},"PeriodicalIF":0.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147481960","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Circulating Thrombospondin-2 Levels Reflect Hepatic Fibrosis Severity and Renal Dysfunction in a General Population: Uku Study.","authors":"Sachiko Kyogoku, Hisashi Adachi, Mika Enomoto, Ako Fukami, Yume Nohara, Nagisa Morikawa, Hiromi Sato, Harumi Takubo, Mayo Shimoyama, Yoshihiro Fukumoto","doi":"10.2739/kurumemedj.MS721234004","DOIUrl":"https://doi.org/10.2739/kurumemedj.MS721234004","url":null,"abstract":"<p><strong>Background: </strong>Serum thrombospondin-2 (TSP-2) plays a role in various biological processes, including collagen and fibrin formation. Preclinical studies have implicated TSP-2 in liver fibrosis and renal impairment. However, the clinical significance of serum TSP-2 levels in relation to liver and renal function in the general population remains unclear. This study aimed to investigate the association between serum TSP-2 levels and the severity of hepatic fibrosis or renal dysfunction.</p><p><strong>Methods: </strong>A cross-sectional study was conducted in Uku Town, Nagasaki Prefecture, Japan, in 2019. A total of 225 participants were enrolled, and serum TSP-2 levels were directly measured. Univariate and multivariate analyses were performed to assess the relationship between TSP-2 levels and hepatic fibrosis severity or renal dysfunction.</p><p><strong>Results: </strong>The mean ± standard deviation (SD) age of the participants was 69.0±7.9 years. Serum TSP-2 levels were significantly elevated with increasing FIB-4 index scores (p = 0.003) and progressively increased with decreasing estimated glomerular filtration rate (eGFR) levels (p = 0.027). Furthermore, the association between TSP-2 levels and the FIB-4 index remained statistically significant (p < 0.001) after adjustment for age, sex, and potential confounders.</p><p><strong>Conclusions: </strong>These findings suggest a significant association between serum TSP-2 levels and both liver fibrosis and renal dysfunction, even in a healthy Japanese general population.</p>","PeriodicalId":39559,"journal":{"name":"Kurume Medical Journal","volume":"72 1.2.3.4","pages":"29-37"},"PeriodicalIF":0.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148370283","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}