Kurume Medical Journal最新文献

{"title":"Prognostic Factors for Distal Bile Duct Carcinoma After Surgery.","authors":"Ryuichi Kawahara,&nbsp;Ryuuta Midorikawa,&nbsp;Shinichi Taniwaki,&nbsp;Satoki Kojima,&nbsp;Hiroki Kanno,&nbsp;Munehiro Yoshitomi,&nbsp;Yoriko Nomura,&nbsp;Yuichi Goto,&nbsp;Toshihiro Satou,&nbsp;Hisamune Sakai,&nbsp;Hiroto Ishikawa,&nbsp;Toru Hisaka,&nbsp;Masafumi Yasunaga,&nbsp;Takahiko Sakaue,&nbsp;Tomoyuki Ushijima,&nbsp;Makiko Yasumoto,&nbsp;Yoshinobu Okabe,&nbsp;Masahiko Tanigawa,&nbsp;Yoshiki Naitou,&nbsp;Hirohisa Yano,&nbsp;Koji Okuda","doi":"10.2739/kurumemedj.MS682002","DOIUrl":"https://doi.org/10.2739/kurumemedj.MS682002","url":null,"abstract":"<p><strong>Background: </strong>Distal bile duct carcinoma continues to be one of the most difficult cancers to manage in terms of staging and radical resection. Pancreaticoduodenectomy (PD) with regional lymph node dissection has become the standard treatment of distal bile duct carcinoma. We evaluated treatment outcomes and histological factors in patients with distal bile duct carcinoma.</p><p><strong>Methods: </strong>Seventy-four cases of resection of carcinoma of the distal bile ducts treated at our department during the period from January 2002 and December 2016 using PD and regional lymph node dissection as the standard surgical procedure were investigated. Survival rates of factors were analyzed using uni- and multivariate analyses.</p><p><strong>Results: </strong>The median survival time was 47.8 months. On univariate analysis, age of 70 years or older, histologically pap, pPanc2,3, pN1, pEM0, v2,3, ly2,3, ne2,3 and postoperative adjuvant chemotherapy were statistically significant factors. On multivariate analysis, histologically pap was identified as a significant independent prognostic factor. The multivariate analysis identified age of 70 years or older, pEM0, ne2,3 and postoperative adjuvant chemotherapy as showing a significant trend towards independent prognostic relevance.</p><p><strong>Conclusion: </strong>The good news about resected distal bile duct carcinoma is that the percentage of those who achieved R0 resection has risen to 89.1%. Our multivariate analysis identified age of 70 years or older, pEM0, ne2,3 and postoperative adjuvant chemotherapy as prognostic factors. In order to improve the outcome of treatment, it is necessary to improve preoperative diagnostic imaging of pancreatic invasion and lymph node metastasis, establish the optimal operation range and clarify whether aortic lymph node dissection is needed to control lymph node metastasis, and establish effective regimens of chemotherapy.</p>","PeriodicalId":39559,"journal":{"name":"Kurume Medical Journal","volume":"68 2","pages":"81-89"},"PeriodicalIF":0.0,"publicationDate":"2023-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10101585","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":"Proteinuria and Renal Dysfunction Due to Extremely Low Birth Weight in a Patient with Silver-Russell Syndrome.","authors":"Mayu Iwata,&nbsp;Tadashi Uramatsu,&nbsp;Kenta Torigoe,&nbsp;Ayuko Yamashita,&nbsp;Yuki Ota,&nbsp;Kumiko Muta,&nbsp;Mineaki Kitamura,&nbsp;Toshihiko Shirakawa,&nbsp;Dedong Kang,&nbsp;Kazuho Honda,&nbsp;Yasushi Mochizuki,&nbsp;Hideki Sakai,&nbsp;Tomoya Nishino","doi":"10.2739/kurumemedj.MS682017","DOIUrl":"https://doi.org/10.2739/kurumemedj.MS682017","url":null,"abstract":"<p><p>A 36-year-old woman diagnosed with Silver-Russell syndrome during childhood presented to our department after a primary care physician suspected renal dysfunction. At birth, she had an extremely low weight (1210 g), and in childhood, she was diagnosed with Silver-Russell syndrome. At the age of 14 she was found to have proteinuria; however, the condition was never further examined. One month prior to her presentation to our department, the following were noted: 3+ urinary protein, 3.9 urinary protein/creatinine ratio, and 48 mL/min/1.73 m² estimated glomerular filtration rate. Abdominal computed tomography revealed small kidneys difficult to visualize using ultrasound. Therefore, an open renal biopsy was performed. The renal biopsy revealed no significant findings in the glomerulus except glomerular hypertrophy, and the glomerular density in the cortical area was low (0.6/mm²). The patient was diagnosed with oligomeganephronia. Proteinuria and renal dysfunction were likely due to glomerular hyperfiltration resulting from a low nephron count caused by low birth weight. Silver-Russell syndrome is characterized by intrauterine growth retardation and additional developmental disorders after birth. Here, we detected oligomeganephronia following kidney biopsy in a patient with Silver-Russell syndrome. We suspect that a reduced number of nephrons due to low birth weight caused proteinuria and renal dysfunction.</p>","PeriodicalId":39559,"journal":{"name":"Kurume Medical Journal","volume":"68 2","pages":"165-170"},"PeriodicalIF":0.0,"publicationDate":"2023-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9745480","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":"Sleep Medications and Fall Injury.","authors":"Shinji Yokoyama,&nbsp;Yoshihiro Fukumoto,&nbsp;Hisashi Adachi,&nbsp;Yoshiaki Tanaka,&nbsp;Naohisa Uchimura","doi":"10.2739/kurumemedj.MS682003","DOIUrl":"https://doi.org/10.2739/kurumemedj.MS682003","url":null,"abstract":"","PeriodicalId":39559,"journal":{"name":"Kurume Medical Journal","volume":"68 2","pages":"129-131"},"PeriodicalIF":0.0,"publicationDate":"2023-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9751521","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":"Changes in Acidity Levels in the Gastric Tube After Esophagectomy for Esophageal Cancer.","authors":"Kazutaka Kadoya,&nbsp;Toshiaki Tanaka,&nbsp;Naoki Mori,&nbsp;Satoru Matono,&nbsp;Haruhiro Hino,&nbsp;Ryosuke Nishida,&nbsp;Kohei Saisho,&nbsp;Masahiro Fujisaki,&nbsp;Syou Komukai,&nbsp;Takashi Yanagawa,&nbsp;Hiromasa Fujita,&nbsp;Yoshito Akagi","doi":"10.2739/kurumemedj.MS682005","DOIUrl":"https://doi.org/10.2739/kurumemedj.MS682005","url":null,"abstract":"<p><p>Reflux esophagitis and gastric tube ulcer sometimes cause severe clinical problems in patients undergoing esophagectomy with gastric tube reconstruction. We previously reported that acidity in the gastric tube was decreased for 1 year after esophagectomy, and that lower acidity levels were associated with Helicobacter pylori (H. pylori) infection. However, the long-term changes in gastric acidity remain unknown. We aimed to investigate the long-term changes in gastric acidity after surgery. Eighty-nine patients who underwent esophagectomy with gastric tube reconstruction for esophageal cancer were analyzed. They underwent 24-hour pH monitoring, serum gastrin measurement, and H. pylori infection examination before surgery, at 1 month, 1 year, and 2 years after surgery. The gastric acidity at 1 month and 1 year after surgery was significantly lower than that before surgery (p=0.003, p=0.003). However, there was no difference in gastric acidity before and 2 years after surgery. The gas tric acidity in H. pylori-infected patients was significantly lower in comparison to non-infected patients at each time point (p=0.0003, p<0.0001, p<0.0001, p<0.0001, respectively). In H. pylori-infected patients, gastric acid ity was decreased for 1 year after surgery, and recovered within 2 years after surgery. However, no significant differences were observed in the acidity levels of non-infected patients during the 2-year follow-up period. The serum gastrin level increased after esophagectomy. The acidity levels in the gastric tube recovered within 2 years after surgery. Periodic endoscopy examination is recommended for early detection of acid-related disease, such as reflux esophagitis or gastric tube ulcer, after esophagectomy with gastric tube reconstruction.</p>","PeriodicalId":39559,"journal":{"name":"Kurume Medical Journal","volume":"68 2","pages":"91-96"},"PeriodicalIF":0.0,"publicationDate":"2023-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10101588","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":"Goshuyuto Reduced the Monthly Intake of Anti-headache Drugs and Improved Pain Status in Patients with 20-Year History of Medication Overuse Headache in an Outpatient Setting.","authors":"Y U Hasegawa,&nbsp;Jun-Ichi Kuratsu","doi":"10.2739/kurumemedj.MS682019","DOIUrl":"https://doi.org/10.2739/kurumemedj.MS682019","url":null,"abstract":"<p><p>The management of medication overuse headache (MOH) is sometimes challenging, particularly for patients with a long disease duration. We observed that patients who used goshuyuto, a traditional Japanese medicine, exhibited a favorable clinical course. Two women who had a history of MOH for over 20 years were treated using 5.0-7.5 g/day goshuyuto in an outpatient setting. The treatment reduced their use of habitual drugs, including triptan (33-55%) and non-steroidal anti-inflammatory drugs (75-82%), as well as the headache impact test score-6 (16-23%) over 24 weeks. As goshuyuto has a protective effect on chronic headache and is reported not to lead to MOH, it is a good candidate for the treatment of patients with MOH in an outpatient setting, even for those with an over 20-year history of MOH.</p>","PeriodicalId":39559,"journal":{"name":"Kurume Medical Journal","volume":"68 2","pages":"153-156"},"PeriodicalIF":0.0,"publicationDate":"2023-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9743064","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":"Characteristics of Immune Checkpoint Inhibitor-Induced Colitis: A Systematic Review.","authors":"Tomoyuki Nakane,&nbsp;Keiichi Mitsuyama,&nbsp;Ryosuke Yamauchi,&nbsp;Tatsuyuki Kakuma,&nbsp;Takuji Torimura","doi":"10.2739/kurumemedj.MS682006","DOIUrl":"https://doi.org/10.2739/kurumemedj.MS682006","url":null,"abstract":"<p><strong>Background: </strong>Immune checkpoint inhibitors (ICIs) including anti-CTLA-4, anti-PD-1, and anti-PD-L1 antibodies have been increasingly used for various malignancies. These ICIs activate immune functions to treat malignant tumors; however, this causes characteristic complications called immune-related adverse events (irAE). In the gastrointestinal tract, ICIs cause adverse events such as diarrhea and enterocolitis, thus warranting treatment discontinuation. These irAEs require treatment that suppresses immunity; however, no treatment strategies based on approved guidelines have been reported. This review aimed to investigate the current treatment status for refractory cases of ICI-induced colitis in accordance with their diagnosis, therapy, and prognosis.</p><p><strong>Summary: </strong>We systematically reviewed studies in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) checklist. Two investigators searched PubMed and Scopus in January 2019. We extracted data, including the number of ICI-treated patients developing colitis and diarrhea. The number of cases classified as severe per the National Cancer Institute's Common Terminology Criteria for Adverse Events (CTCAE) definitions and the progress of corticosteroid-treated and anti-TNF-α- antibody-treated cases (e.g., infliximab) were recorded. Details of further treatment were also recorded for cases that did not improve with antiTNF-α- antibody. Among patients receiving anti-CTLA-4 antibody, corticosteroids were administered to 14.6% of patients, and infliximab was administered to 5.7% of patients. Among patients receiving anti-PD-1/PD-L1 antibody, corticosteroids were administered to 2.37% of patients. For refractory cases unsuccessful with infliximab, the continuation of infliximab every 2 weeks, tacrolimus administration, prolonged corticosteroid treatment, colectomy, or vedolizumab administration were reported.</p><p><strong>Key messages: </strong>Treatment of ICI-induced colitis is important to avoid the need to discontinue cancer treatment. Many therapeutic agents for inflammatory bowel disease are reportedly effective in treating refractory ICI-induced colitis.</p>","PeriodicalId":39559,"journal":{"name":"Kurume Medical Journal","volume":"68 2","pages":"43-52"},"PeriodicalIF":0.0,"publicationDate":"2023-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9742548","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 Immediate Anastomotic Leakage After Low Anterior Resection for Rectal Cancer.","authors":"Fumihiko Fujita,&nbsp;Kenichi Yasushi,&nbsp;Takafumi Ohchi,&nbsp;Tomoaki Mizobe,&nbsp;Suguru Ogata,&nbsp;Hiroyuki Nakane,&nbsp;Kenichi Koushi,&nbsp;Takefumi Yoshida,&nbsp;Keizo Yamaguchi,&nbsp;Tomoya Sudo,&nbsp;Tetsushi Kinugasa,&nbsp;Yoshito Akagi","doi":"10.2739/kurumemedj.MS682010","DOIUrl":"https://doi.org/10.2739/kurumemedj.MS682010","url":null,"abstract":"<p><p>A man in his seventies was referred to our hospital for radical therapy for advanced rectal cancer with multiple liver metastases. A colonic stent had already been placed in his rectum at the previous hospital because of malignant colorectal obstruction, so our therapeutic strategy was to perform systematic chemotherapy after resection of the primary tumor. Laparoscopic low anterior resection with a covering stoma was performed under general anesthesia. At about one hour after the surgery, the patient had sudden abdominal pain with watery diarrhea, and a similar discharge from his drainage tube. We suspected peritonitis caused by bowel perforation and emergency surgery was performed. The operative findings showed that his peritonitis was caused by anastomotic leakage from the rectum. Radical lavage of the abdominal space and reconstruction of colostomy was performed. The patient gradually recovered and we were able to start systematic chemotherapy at one month after the surgery. Anastomotic leakage immediately after anterior resection caused by watery diarrhea is rare, and it may be concerned with several issues. The covering stoma is intended to stop anastomotic leakage but it cannot prevent all cases of leakage especially when obstruction is present. We recommend that preventive measures be taken against anastomotic leakage, including intraoperative leakage tests or anal decompression tube placement.</p>","PeriodicalId":39559,"journal":{"name":"Kurume Medical Journal","volume":"68 2","pages":"149-152"},"PeriodicalIF":0.0,"publicationDate":"2023-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10101597","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":"Correlation Between Work Motivation and Life Events in Female Physicians.","authors":"Fukuko Moriya,&nbsp;Tatsuyuki Kakuma,&nbsp;Hitoshi Obara,&nbsp;Mihoko Mori,&nbsp;Megumi Hara,&nbsp;Miho Masuoka,&nbsp;Takuji Torimura,&nbsp;Mizuho Kido,&nbsp;Hirohisa Yano","doi":"10.2739/kurumemedj.MS682001","DOIUrl":"https://doi.org/10.2739/kurumemedj.MS682001","url":null,"abstract":"<p><p>This study interviewed 39 mother-doctors from two university hospitals in Japan to investigate how certain stages in their lives influenced their working motivation. We conceptualized a Motivational Drive Chart to track changes of work motivation from enrollment in medical courses to the present day, recording changes in motivational values, age, and life events. It was found that the average value of motivation increased from the beginning of medical school enrollment until graduation; however, a sudden drop was noted in the age group 25 to 29 due to childcare and work-life conflicts. Motivational values were found to gradually increase in the 30 to 34 age group, owing to professional accomplishments, such as obtaining a specialist license. In Japanese society, social roles have traditionally been divided between men and women. The present study found that Japanese female doctors faced a decrease in work motivation during childrearing stages. The finding suggests that new avenues should be explored to support mother-doctors.</p>","PeriodicalId":39559,"journal":{"name":"Kurume Medical Journal","volume":"68 2","pages":"69-74"},"PeriodicalIF":0.0,"publicationDate":"2023-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9797403","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":"Revisiting the Muscular Innervation of the Obturator Nerve: Application to Neurotization Procedures.","authors":"Joe Iwanaga,&nbsp;Francisco Reina,&nbsp;Basem Ishak,&nbsp;Miguel Angel Reina,&nbsp;Aaron S Dumont,&nbsp;R Shane Tubbs","doi":"10.2739/kurumemedj.MS682009","DOIUrl":"https://doi.org/10.2739/kurumemedj.MS682009","url":null,"abstract":"<p><strong>Background: </strong>Our goal was to revisit the innervation of the adductor muscles of the thigh and add new evidence to currently existing knowledge.</p><p><strong>Methods: </strong>Ten thighs from five fresh frozen cadavers were dissected. Obturator nerve innervation to the pectineus, obturator externus, adductor brevis, adductor magnus, adductor longus, and gracilis was documented.</p><p><strong>Results: </strong>The adductor longus and gracilis were innervated by the anterior branch in 100%, and the adductor magnus was innervated by the posterior branch in 100%. The adductor brevis was supplied by both the anterior and posterior branches in 90%. The obturator externus was innervated by the posterior branch in 60% and a direct branch from the main trunk in 10%. No innervation of the obturator externus by the obturator nerve was found in 30%.</p><p><strong>Conclusions: </strong>The obturator externus and adductor brevis need to be explored further to clarify their innervation.</p>","PeriodicalId":39559,"journal":{"name":"Kurume Medical Journal","volume":"68 2","pages":"75-80"},"PeriodicalIF":0.0,"publicationDate":"2023-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9797841","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":"Direct Oral Anticoagulants Would Be Best Choice for Atrial Fibrillation Patients After Coronary Stenting: Retrospective Study in a Japanese Population.","authors":"Hiroshi Koiwaya,&nbsp;Nozomi Watanabe,&nbsp;Nehiro Kuriyama,&nbsp;Yoshisato Shibata","doi":"10.2739/kurumemedj.MS682015","DOIUrl":"https://doi.org/10.2739/kurumemedj.MS682015","url":null,"abstract":"<p><strong>Background: </strong>The combination of dual antiplatelet therapy (DAPT) plus warfarin in atrial fibrillation (AF) patients after coronary stenting has been reported to confer a significant risk of bleeding complications. Direct oral anticoagulants (DOAC) reduce the risk of stroke and bleeding complications in AF patients compared to warfarin. The optimal anticoagulation strategy for Japanese non-valvular AF patients after coronary stenting remains unclear.</p><p><strong>Methods: </strong>A total of 3230 patients who underwent coronary stenting were retrospectively reviewed. Of these, 284 cases (8.8%) were complicated by AF. Following coronary stenting, 222 patients received triple antithrombotic therapy (TAT) by DAPT plus oral anticoagulants; 121 patients received DAPT plus warfarin, and 101 patients received DAPT plus DOAC. We compared the clinical data between the two groups.</p><p><strong>Results: </strong>The median International normalized ratio (INR) in the DAPT plus warfarin group was 1.61. Bleeding complications occurred in both groups. No cerebral infarction occurred in the DAPT plus DOAC group, while 4.1% of the DAPT plus warfarin group experienced cerebral infarction during follow-up (P=0.04). Twelve-month freedom from cerebral infarction, myocardial infarction, and cardiovascular death was significantly higher in the DAPT plus DOAC group than in the DAPT plus warfarin group [100% vs. 93.4%, P=0.009].</p><p><strong>Conclusions: </strong>DOAC might be an optimal selection as an oral anticoagulant for Japanese AF patients who are receiving DAPT after PCI. A larger, longitudinal follow-up should be performed to clarify the clinical advantage of DOAC over warfarin, including among patients who receive single antiplatelet after coronary stent implantation.</p>","PeriodicalId":39559,"journal":{"name":"Kurume Medical Journal","volume":"68 2","pages":"97-106"},"PeriodicalIF":0.0,"publicationDate":"2023-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9797853","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}