Kurume Medical Journal最新文献

{"title":"Histological Improvement of Hepatic Fibrosis of Decompensated Liver Cirrhosis after Prednisolone and Azathioprine Treatment in a Patient with Autoimmune Hepatitis.","authors":"Hiroyuki Suzuki, Keisuke Amano, Kanji Yamaguchi, Tomoya Sano, Teruko Arinaga-Hino, Jun Akiba, Atsushi Takahashi, Hiromasa Ohira, Atsushi Tanaka, Yoshito Itoh, Takumi Kawaguchi","doi":"10.2739/kurumemedj.MS7112007","DOIUrl":"https://doi.org/10.2739/kurumemedj.MS7112007","url":null,"abstract":"<p><p>The treatment of the underlying cause of liver disease may potentially reverse hepatic fibrosis. However, it remains uncertain whether improvement in fibrosis can be observed in decompensated liver cirrhosis (LC). Here, we present a case of autoimmune hepatitis (AIH)-related LC in which histological improvement of fibrosis was achieved despite the presence of decompensated LC. A Japanese female in her 20s was initially identified as having liver function impairments during her employment medical checkup. Following a laparoscopic liver biopsy, she was diagnosed with AIH-related decompensated LC (F4 and A3) with a Child-Pugh score of 10. The patient initially received treatment with prednisolone at a daily dose of 40 mg, followed by 20 mg/day of prednisolone plus 25 mg/day of azathioprine (subsequent increase of azathioprine to 100 mg/day). With this treatment, the abnormal serum marker levels returned to normal, thereby enabling the patient to avoid liver transplantation eight months after the initiation of treatment. Moreover, marked improvement was observed in non-invasive tests for hepatic fibrosis, including the FIB-4 index and FibroIndex, as well as liver stiffness evaluated by FibroScan®. Eleven months after diagnosis, the patient developed a cholestatic liver injury and was diagnosed with drug-induced cholestatic liver disease (azathioprine overcapacity as the causative agent). By percutaneous liver biopsy at this point, hepatic fibrosis (F2-3) was markedly improved compared with that at the diagnosis. Along with the improvement of hepatic fibrosis, notable improvements were also observed in patient-reported outcomes such as the SF-36® score and chronic liver disease questionnaire. In this report, we first described a case of AIH that showed a histological improvement of hepatic fibrosis even in decompensated LC by treatment with prednisolone and azathioprine.</p>","PeriodicalId":39559,"journal":{"name":"Kurume Medical Journal","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142740835","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":"Umbilical Cord Cysts from the Second Trimester of Pregnancy: Clinical Insights from 12 Cases of a 22-year Study in a Single Tertiary Center.","authors":"Aki Tetsuo, Megumi Muto, Masato Yokomine, Hironobu Kashiwada, Takashi Horinouchi, Toshiyuki Yoshizato, Naotake Tsuda","doi":"10.2739/kurumemedj.MS7112008","DOIUrl":"https://doi.org/10.2739/kurumemedj.MS7112008","url":null,"abstract":"<p><p>This study aimed to explore the clinical characteristics of umbilical cord cysts (UCCs) detected from the second trimester onwards in a single tertiary center over a 22-year period. The subjects consisted of a total of 12 cases of UCCs among 11 pregnant women (10 singleton pregnancies and 1 twin pregnancy), diagnosed at ≥ 14 weeks of gestation, and managed at Kurume University Hospital from 2000 to 2021. The maternal backgrounds, characteristics of the cysts, including their location, numbers, sizes, associated fetal/neonatal findings, and outcomes, were analyzed retrospectively. The median maternal age was 28 years, with diagnosis at 18.5 gestational weeks. Cysts were found near the umbilical ring (8 cases), in a free loop (3 cases), and in both of these locations (1 case). Single cysts appeared in 8 cases, and multiple cysts in 4 cases, with the median diameter being 25.0 mm. Sizes varied by gestation, being larger near the umbilical ring without correlation to cyst number. Among the 9 cases with cysts located near the umbilical ring, 5 cases had fetal abnormalities, including trisomy 18 (2 cases), Beckwith-Wiedeman syndrome (1), and intrauterine fetal death (1). Urachal remnants were found in 4 cases and omphalomesenteric duct remnants in 1 case after birth. When UCC is observed, particularly a cyst located near the umbilical ring, comprehensive fetal ultrasound screening is necessary, and attention should be paid to fetal anomalies that may coexist. In cases where these are not identified prenatally, the presence of conditions such as urachal remnants needs to be considered.</p>","PeriodicalId":39559,"journal":{"name":"Kurume Medical Journal","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142740878","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":"Effects of Hyperbaric Oxygen Therapy for Malignant Bowel Obstruction Caused by Peritoneal Dissemination.","authors":"Daisuke Muroya, Shoichiro Arai, Takamichi Nishida, Takahide Ishimaru, Yuta Yamazaki, Youjirou Goto, Shinya Nadayoshi, Yutaro Kai, Tetsu Masuda, Hisaaki Shimokobe, Yuichi Goto, Yuichi Nagao, Yoshito Wada, Takayuki Torigoe, Yoshinori Tomoda, Yuji Maruyama, Hajime Imada, Hironobu Sou, Yoshito Akagi, Toru Hisaka","doi":"10.2739/kurumemedj.MS7112001","DOIUrl":"https://doi.org/10.2739/kurumemedj.MS7112001","url":null,"abstract":"<p><strong>Introduction: </strong>This study aimed to investigate the efficacy of hyperbaric oxygen therapy (HBOT) in patients presenting with malignant bowel obstruction (MBO) and peritoneal dissemination.</p><p><strong>Materials and methods: </strong>We retrospectively examined whether HBOT affects prognosis following MBO with peritoneal dissemination. This study included 44 patients diagnosed with MBO secondary to peritoneal dissemination at our hospital between January 2013 and December 2022. Among these patients, 30 underwent HBOT. The treatment protocol involved daily HBOT administration, comprising 100% oxygen at 2.5 atmospheres absolute for 60 min.</p><p><strong>Results: </strong>In a univariate analysis of HBOT and non-HBOT groups, the proportion of patients able to resume eating was significantly higher in the HBOT group. Therefore, the percentage of patients in the non-HBOT group whose MBO did not improve was significantly higher than that in the HBOT group. The percentage of patients undergoing surgery or receiving anticancer treatment did not differ significantly between the groups, whereas overall survival was significantly longer in the HBOT group. Furthermore, when examining inoperable patients, significantly more individuals in the HBOT group could resume eating, and their overall survival was significantly prolonged.</p><p><strong>Conclusions: </strong>HBOT may increase the spontaneous resolution rate and improve long-term prognoses of patients with MBO secondary to peritoneal dissemination.</p>","PeriodicalId":39559,"journal":{"name":"Kurume Medical Journal","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142356010","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":"Survival and Endoscopic/Clinical Features of Patients with Colorectal Cancer Resected by Cold Snare Polypectomy: The Importance of Chronic Kidney Disease.","authors":"Tsutomu Nagata, Miwa Sakai, Michita Mukasa, Hiroshi Tanaka, Shinpei Minami, Tomonori Cho, Tomoyuki Nakane, Akihiro Ohuchi, Shuhei Fukunaga, Jun Akiba, Yoshinobu Okabe, Takumi Kawaguchi","doi":"10.2739/kurumemedj.MS7112002","DOIUrl":"https://doi.org/10.2739/kurumemedj.MS7112002","url":null,"abstract":"<p><strong>Background and aims: </strong>Colorectal polyps resected by cold snare polypectomy (CSP) are rarely diagnosed as colorectal cancer (CRC). We aimed to investigate the prevalence, clinical features, and prognosis of patients with CRC resected by CSP.</p><p><strong>Subjects: </strong>Patients with colorectal polyps treated with CSP between 2018 and 2022 were enrolled and regularly followed up (median observation period: 30.6 months). Logistic regression analysis and decision tree analysis were employed to investigate the clinical features of the patients.</p><p><strong>Results: </strong>A total of 5,064 colorectal polyps from 2,530 patients were resected by CSP. Of these, 0.24% were diagnosed as CRC; however, no patients died due to CRC. eGFR was an independent risk factor for the presence of CRC (unit 10, OR 0.716, 95%CI 0.525-0.973, P=0.0323) and its optimal cut-off value was 59.9 mL/min/1.73 m². The decision-tree analysis revealed that 2.03% of patients with creatinine ≥ 1.0 mg/dL had CRC.</p><p><strong>Conclusion: </strong>CRC was diagnosed in 0.24% of the polyps; however, no patients died due to CRC. eGFR <60 mL/min/1.73 m² and creatinine >1.0 mg/dL were associated with CRC. Thus, colorectal polyps should be carefully examined in patients with chronic kidney disease.</p>","PeriodicalId":39559,"journal":{"name":"Kurume Medical Journal","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142356011","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":"Oral Colchicine and Low-Dose Aspirin Combination Therapy for Non-elderly, Non-severe, Early Time From Onset, Adult Outpatients with Coronavirus Disease 2019 (COVID-19) during \"The Fifth Pandemic Wave\" in Japan.","authors":"Tetsuaki Inokuchi, Tomoki Homma, Yasuhiko Kitasato, Mayu Akiyama, Ayako Chikasue, Yuuya Nishii, Shigeki Ban, Takeki Adachi, Aya Sonezaki, Hiroshi Masuda, Hideki Kamei, Miki Takenaka, Maki Tanaka, Masaki Okamoto, Tomoaki Hoshino","doi":"10.2739/kurumemedj.MS7012003","DOIUrl":"10.2739/kurumemedj.MS7012003","url":null,"abstract":"<p><strong>Background: </strong>Treatment with antiviral drugs for non-severe, early time from onset, adult outpatients with Coronavirus Disease 2019 (COVID-19) had not been established in 2021. However, some new variants of SARS-CoV-2 had caused rapid exacerbation and hospitalization among non-elderly outpatients with COVID-19, contributing to widespread crises within healthcare systems.</p><p><strong>Methods: </strong>From July to October 2021, we urgently assessed a therapeutic program using oral colchicine (1.0 mg loading dose, followed approximately half a day later by 0.5 mg twice daily for 5 days, and then 0.5 mg once daily for 4 days) and low-dose aspirin (100 mg once daily for 10 days), for non-elderly, non-severe, early time from onset, adult outpatients with COVID-19. To verify its effectiveness, we set loxoprofen as a control arm, and com parison of these two arms was performed. The primary outcomes were hospitalization, criticality, and death rates.</p><p><strong>Results: </strong>Thirty-eight patients (23 receiving colchicine and low-dose aspirin [CA]; 15 receiving loxoprofen [LO]) were evaluated. Hospitalization rate was lower in the CA group (1/23; 4.3%) than in the LO group (2/15; 13.3%); however, no significant difference was found between the two groups (p=0.34). No critical cases, deaths, or severe adverse events were found in either group.</p><p><strong>Conclusions: </strong>Our CA regimen did not show superiority over LO treatment. However, our clinical experience should be recorded as part of community health care activities carried out in Kurume City against the unprece dented COVID-19 pandemic.</p>","PeriodicalId":39559,"journal":{"name":"Kurume Medical Journal","volume":" ","pages":"39-45"},"PeriodicalIF":0.0,"publicationDate":"2024-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140177016","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":"Optimized Axenic Culture Medium for Comprehensive Biological and Physiological Analysis of Naegleria Fowleri.","authors":"Tatsuru Hara, Toshihide Fukuma","doi":"10.2739/kurumemedj.MS7012007","DOIUrl":"10.2739/kurumemedj.MS7012007","url":null,"abstract":"","PeriodicalId":39559,"journal":{"name":"Kurume Medical Journal","volume":" ","pages":"67-68"},"PeriodicalIF":0.0,"publicationDate":"2024-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140177015","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 Phase II Clinical Trial to Study the Safety of Triamcinolone after Endoscopic Radial Incision and Cutting Dilatation for Benign Stenosis of the Lower Gastrointestinal Tract: A Study Protocol.","authors":"Rintaro Moroi, Hisashi Shiga, Kotaro Nochioka, Hirofumi Chiba, Yusuke Shimoyama, Motoyuki Onodera, Takeo Naito, Masaki Tosa, Yoichi Kakuta, Yuichiro Sato, Shoichi Kayaba, Seichi Takahashi, Satoshi Miyata, Yoshitaka Kinouchi, Atsushi Masamune","doi":"10.2739/kurumemedj.MS7012005","DOIUrl":"10.2739/kurumemedj.MS7012005","url":null,"abstract":"<p><strong>Background: </strong>Lower gastrointestinal tract stenosis is commonly diagnosed and is typically treated with surgery or endoscopic balloon dilation (EBD). Radial incision and cutting (RIC) is a novel treatment approach that has several benefits compared with EBD and surgery. Although RIC has demonstrated a high technical success rate and has been shown to improve subjective symptoms, previous studies revealed that restenosis after RIC remain unsolved. Herein, we report the design of a prospective, multicenter, single-arm, interventional, phase II trial to evaluate the safety of local triamcinolone acetonide (TA) administration and its feasibility in preventing restenosis after RIC for lower gastrointestinal tract stenosis.</p><p><strong>Methods: </strong>The major inclusion criteria are age 20-80 years and the presence of benign stenosis in the lower gastrointestinal tract accessible by colonoscope. We will perform RIC followed by local administration of TA to 20 participants. The primary outcome is the safety of local TA administration, which will be assessed by determining the frequency of adverse events of special interest. The secondary outcomes are the technical success rate of RIC, duration of procedure, improvement in subjective symptoms, and duration of hospitalization. The outcomes, improvement in subjective symptoms, and long-term results will be evaluated using descriptive statistics, Student's t-test, and Kaplan-Meier curve, respectively.</p><p><strong>Discussion: </strong>This explorative study will provide useful information regarding the safety of TA administration after RIC, which may contribute to further investigations.</p>","PeriodicalId":39559,"journal":{"name":"Kurume Medical Journal","volume":" ","pages":"53-60"},"PeriodicalIF":0.0,"publicationDate":"2024-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140177013","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 Exploratory Study of the Associations Between Sensory Processing Patterns and Emotional/Behavioral Problems in Children with Autism Spectrum Disorder.","authors":"Nao Sakamoto, Misari Oe, Motohiro Ozone","doi":"10.2739/kurumemedj.MS7012002","DOIUrl":"10.2739/kurumemedj.MS7012002","url":null,"abstract":"<p><strong>Aim: </strong>In autism spectrum disorder (ASD), abnormal sensory processing patterns are observed in various sensory modalities, including visual, auditory, touch, olfactory, taste, vestibular, and proprioceptive senses. Few studies have examined the relationship between sensory processing patterns and emotions, or their effects on daily life. We investigated the relationship between sensory processing patterns and emotional/behavioral problems in children with ASD.</p><p><strong>Participants and methods: </strong>A retrospective chart review was conducted. Forty-three children with ASD (33 boys, 10 girls, median age 9 years) in the outpatient clinic of a psychiatric hospital participated; their parent (s) were invited to complete the Sensory Profile 2 (SP2) and the Child Behavior Checklist (CBCL) questionnaires. The participants' teachers were invited to complete the Teacher's Report Form (TRF).</p><p><strong>Results: </strong>In the correlation analyses, each of the four quadrants of the SP2 (low registration, sensory seeking, hypersensitivity, and sensory avoiding) had significant positive correlations with different types of emotional and behavioral problems measured by the CBCL. Focusing on emotion, 'anxious/depressed' was correlated with low registration (r = 0.41) and sensory avoiding (r = 0.60), while 'withdrawal/depressed' was correlated with sensory avoiding (r = 0.46). Only one significant correlation was revealed between the SP2 and the TRF.</p><p><strong>Conclusion: </strong>Our results suggest a link between sensory processing patterns and emotional/behavioral problems. In school settings, the relationship between sensory processing patterns and emotional/behavioral problems may be easily overlooked.</p>","PeriodicalId":39559,"journal":{"name":"Kurume Medical Journal","volume":" ","pages":"47-52"},"PeriodicalIF":0.0,"publicationDate":"2024-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140332109","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":"Is Mean Platelet Volume a Predictive Marker for the Development of Thrombosis in Patients with COVID-19 Infection?","authors":"Ilknur Erdem, Enes Ardic, Ilker Yildirim, Caglar Kavak, Levent Cem Mutlu, Berna Erdal, Gulsum Ozkan","doi":"10.2739/kurumemedj.MS7012006","DOIUrl":"10.2739/kurumemedj.MS7012006","url":null,"abstract":"<p><p>Mean platelet volume (MPV) can provide important information about the course and prognosis of many diseases. MPV is an early indicator of platelet activation, which has an important role in the pathogenesis of thrombosis. In this study, we aimed to investigate whether MPV was a predictive marker for the development of thrombosis in hospitalized patients with COVID-19 infection. Fifty-seven patients whose courses were followed after the diagnosis of COVID-19 infection using a polymerase chain reaction test during the pandemic were included in the study. Our results demonstrated that there was a negative correlation between platelet count and MPV (r=0.470, p≤ 0.01), and there was a positive correlation between Platelet Distribution Width (PDW) and MPV (r=0,933, p≤ 0.01), but no significant correlation was found between the other variables and MPV.</p>","PeriodicalId":39559,"journal":{"name":"Kurume Medical Journal","volume":" ","pages":"61-66"},"PeriodicalIF":0.0,"publicationDate":"2024-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140332111","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":"The Assessment of Airway Compression Due to Cervical Fusion in Klippel-Feil Syndrome Patients: A Report of Two Cases.","authors":"Shosaburo Jotaki, Hiroko Taniguchi, Haruka Miyakawa, Teruyuki Hiraki","doi":"10.2739/kurumemedj.MS7012009","DOIUrl":"10.2739/kurumemedj.MS7012009","url":null,"abstract":"<p><p>In general anesthesia for Klippel-Feil syndrome (KFS) patients, there is a potential risk of difficult intubation. However, airway assessment to predict difficult intubation for KFS patients is not known. In Patient 1, cervical spine computed tomography (CT) revealed airway compression due to cervical fusion. For airway assessment, bronchofiberscopy, three-dimensional (3-D) CT, and virtual bronchoscopic image (VBI) construction were performed. Based on these images, fiberoptic nasotracheal awake intubation was performed. In Patient 2, magnetic resonance imaging and bronchofiberscopy showed no airway compression due to cervical fusion; therefore, tracheal intubation was performed using a video laryngoscope after anesthetic administration. Airway compression due to cervical fusion is considered one of the risk factors for difficult intubation in KFS patients.</p>","PeriodicalId":39559,"journal":{"name":"Kurume Medical Journal","volume":" ","pages":"73-75"},"PeriodicalIF":0.0,"publicationDate":"2024-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141066195","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}