Dokkyo Medical University Repository / 獨協医科大学リポジトリ
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Spinal Reconstruction Surgery for Patients with Osteoporotic Vertebral Fractures
Full text linkAmidst the rising elderly demographic, osteoporotic vertebral fractures (OVF) have become a common condition that orthopedic surgeons in Japan encounter on a daily basis. Most cases are treated conservatively to achieve bony union and improve symptoms, but vertebral collapse and kyphotic deformities can cause neurological deficit and persistent pain, requiring spinal reconstruction surgery, such as anterior spinal column reconstruction and long-extent fixation including the fracture site.
In Japan, the spine reconstruction techniques for OVF include anterior spinal fusion, vertebroplasty combined with posterior spinal fusion (PSF), three-column osteotomy combined with PSF and combined anterior/posterior spinal fusion, each of which has its own advantages and disadvantages.
This paper described the overview of spinal reconstruction surgery for OVF and mentioned the selection of surgical techniques and the extent of fixation required.journal articl
Abdominal Ultrasonography Avoids Unnecessary Autopsies in NASH Model Mice
Full text linkPurpose: The aim of this study was to examine whether abdominal ultrasonography (US) could be used to diagnose fatty liver, hepatic fibrosis, and hepatic tumors in nonalcoholic steatohepatitis (NASH) and nonalcoholic fatty liver disease (NAFLD) model mice, obviating unnecessary autopsies and increasing the efficiency of research.
Methods: Thirty-eight, 19-week-old, male C57BL/6J mice were used to produce NASH and NAFLD group mice and a control group. US was performed on Day 120, and the mice were then autopsied for histopathological examination and to identify hepatic tumors. Relationships of hepatorenal echo contrast (HEC) and the heterogeneity of liver parenchyma (HOLP) on US with histopathological findings were evaluated.
Results: Histopathological examination confirmed fatty degeneration and hepatic fibrosis in the NAFLD and NASH groups, as did US. The correlation coefficient of the HEC ratio and the fat deposition area showed a significant correlation (0.7295, p < 0.01); the HOLP index showed no correlation with the fat deposition area. Sixteen hepatic tumors were confirmed on autopsy, all in the NASH group, in 9 of 15 mice; of the 16 tumors, 13 (81.2%) were seen on abdominal US. The mean diameter of the tumors imaged was 2.2 ± 0.7 mm, and the mean diameter of the tumors not imaged was 2.9 ± 0.9 mm, with no significant difference (p = 0.2017). The tumors that were not imaged were on the liver periphery or protruding outside the liver from the posterior surface.
Conclusion: This study shows that US can confirm the extent of hepatic fatty degeneration and tumor formation in NASH model mice without autopsy.journal articl
A Case of Lewy Body Dementia in Which Caffeine Loading Provided Effective Electroconvulsive Therapy
Full text linkThe patient initially presented at age 86 with memory loss, hallucinations, and violent behavior, including physical aggression toward her husband. Two years prior to hospitalization, she had physical symptoms such as resting tremor and gait disturbance. Despite a diagnosis of unspecified cognitive decline and treatment with quetiapine (increased to 150 mg), her condition worsened, leading to admission to the psychiatric ward. Standard diagnostic procedures, including brain dopamine transporter scintigraphy, confirmed probable dementia with Lewy bodies (DLB). Her aggressive behavior, including physical assault on staff, continued. Traditional treatments, including increased doses of antipsychotics and electroconvulsive therapy (ECT), were initially ineffective. In particular, ECT failed to effectively induce seizures, a common challenge in elderly patients with DLB due to altered electrical activity in the brain. A breakthrough in treatment came with the preoperative administration of 500 mg of caffeine, which effectively eased seizures during ECT. Taken together, these findings indicate that while ECT may be effective at treating DLB symptoms, its efficacy is still uncertain. Thus, individualized approaches, such as preoperative caffeine administration, may be necessary.journal articl
Science experiments for elementary and junior high school students in medical university ~ Let's observe the properties of red blood cell ~
Full text linkUniversity is required to contribute to the local community and society. Tochigi Prefecture offers a wide variety of courses for elementary and junior high school students. These courses are prepared by higher education institutions, private companies, and prefecture-related organizations within the prefecture. In order to contribute to the local community, we provided a science experimental course for the students. We report the experiment that is designed from the chemistry and biology viewpoints and utilizes medical school advantage.departmental bulletin pape
Nodal Tumor Occupancy Is an Unrecognized but Crucial Prognostic Factor for Postoperative Recurrence in Prostate Cancer Patients with Lymph Node Oligometastases
Full text linkObjectives: No well-defined guidelines are in place to manage pathologically node-positive (pN1) cases after definitive surgery for localized prostate cancer. We explored the prognostic value of the nodal tumor burden in positive nodes by offsetting the strong impact of the number of positive nodes.
Methods: Of 389 patients who underwent extended pelvic lymph node dissection (PLND) during robot-assisted radical prostatectomy, 50 (12.9%) patients with ≤ 3 positive nodes were enrolled, excluding those who were clinically node-positive or received neoadjuvant androgen deprivation therapy. Detailed investigations concerning the positive nodes with maximum cancer occupancy (MCO) and largest cancer nest (LCN) size were performed, and their associations with biochemical recurrence (BCR)-free survival were analyzed.
Results: After a median follow-up period of 27.5 months, 28 patients were diagnosed with BCR. International Society of Urological Pathology (ISUP) grade group > 3 at prostatectomy, MCO > 80%, and LCN > 2150μm were significant prognostic factors of BCR. Independent prognostic values were maintained in multivariate models with known factors analyzed separately for the above parameters. The BCR-free survival rate decreased with the increasing number of adverse factors, including surgical margins (model using MCO: not reached to the median with zero risk, 39.0 months with one risk, 15.0 months with two risks, and 1.5 months with three risks).
Conclusions: The tumor burden on the positive node provides independent prognostic value for biochemical recurrence and adds a rationale for selecting management options when PLND has been performed for therapeutic intent and diagnosed with ≤ 3 positive nodes.journal articl
CT Findings of Complex Small Bowel Obstruction Due to Internal Hernia Caused by Meckel's Diverticulum with Mesodiverticular Band
Full text linkMeckel's diverticulum is the most common gastrointestinal anomaly, often remaining asymptomatic but occasionally resulting in bowel obstruction. Herein, we present a case of a 6-year-old girl with an internal hernia caused by Meckel's diverticulum and mesenteric diverticular band as a rare cause of small bowel obstruction. Preoperative imaging diagnosis of this disease has been reported to be difficult. However, a detailed retrospective CT evaluation of the presented case confirmed key diagnostic findings, including identifying Meckel's diverticulum, strangulated small intestine, and findings suggesting ischemia. A meticulous CT evaluation, keeping in mind that internal hernia due to Meckel's diverticulum and mesodiverticular band is a rare cause of small bowel obstruction, is crucial. Such a detailed CT evaluation may contribute to an accurate and rapid preoperative diagnosis.journal articl
Advances in Perinatal Medicine and Future Prospects
Full text link本邦の新生児外科疾患の死亡率はすべての疾患で近年，経年的に低下している．一方で，超低出生体重児の新生児外科死亡率はまだ改善の余地がある．また，周産期および新生児管理，胎児診断の進歩もあり，特に重症先天性横隔膜ヘルニアの治療成績は飛躍的に向上した．胎児治療も芽吹いており，脊髄髄膜瘤では神経損傷が軽減され，神経予後が改善される可能性がある．外科の技術面では，低侵襲手術である内視鏡手術が食道閉鎖症や先天性横隔膜ヘルニアで適用され，良好な手術成績を示している．今後は，これまで以上に患児のQOL を見据えた治療戦略が新生児外科領域でも重要となる．Mortality rates for neonatal surgical diseases in Japan have been declining over the years for all neonatal surgical diseases. However, there is still room for improvement in neonatal surgical mortality rates for extremely low birth weight infants. In addition, advances in perinatal and neonatal management and fetal diagnosis have led to dramatic improvements in treatment outcomes, particularly for severe congenital diaphragmatic hernia. Fetal treatments are also emerging, and in myelomeningoceles, neurological damage may be reduced and neurological prognosis may be improved. In terms of surgical techniques, endoscopic surgery, a minimally invasive procedure, has been applied to esophageal atresia and congenital diaphragmatic hernia, and has shown good surgical outcomes. In the future, treatment strategies that focus on the quality of life of patients will become even more important in the field of neonatal surgery.journal articl
Invasive Pneumococcal Infection Serotype 24B after Three Doses of 13-valent Pneumococcal Vaccine：Case Report
Full text link症例は6 か月の女児で，13 価肺炎球菌ワクチンを3 回接種していた．発熱2 日目に活気不良で入院した．外来診察時には大泉門膨隆，項部硬直，上気道症状はなく，嘔吐を1 回認めた．血液検査は白血球の増多，CRP高値を示した．髄液検査で細胞数増多があり，髄液FilmArray® により，起因菌は肺炎球菌と診断した．CTX150 mg/kg/日，MEPM 120 mg/kg/日による治療を開始したが解熱せず，CTX を300 mg/kg/日に増量し，cグロブリン静注とデキサメタゾン静注を追加した．後日，血液培養から肺炎球菌莢膜血清型24B が検出された．本邦で導入されている肺炎球菌ワクチンは改良を重ねているが，未だ24B は含まれていない．本症例は，既存の肺炎球菌ワクチンでカバーされていない莢膜血清型による侵襲性肺炎球菌感染症であった．We report a case of an infant who developed an invasive pneumococcal infection despite receiving three doses of the 1 3 -valent pneumococcal conjugate vaccine. The patient was admitted to the hospital on the second day of fever, presenting with a high fever and unstable vital signs. There were no signs of meningitis or upper respiratory tract symptoms, although a single episode of vomiting was noted. Blood tests revealed leukocytosis and an elevated C-reactive protein（ CRP） level. Initial treatment included cefotaxime （CTX） at 150 mg/kg/day and meropenem （MEPM） at 120 mg/kg/day. Due to persistent fever, the CTX dose was increased to 300 mg/kg/day, and intravenous gamma-globulin and dexamethasone were administered. Blood cultures performed at admission identified Streptococcus pneumoniae capsular serotype 24B. Although improvements have been made to the pneumococcal vaccine introduced in Japan, serotype 24B remains uncovered. This case highlights the need to consider invasive pneumococcal infections caused by non-vaccine serotypes in clinical practice.journal articl
Congenital Syphilis in Preterm Infants with Severe Respiratory Distress and Hepatic Dysfunction：Two Case Reports
Full text link近年，本邦における成人梅毒の感染者が増加しており，それに伴い先天梅毒の報告例も増加している．しかし，早産で出生した先天梅毒症例の予後については報告が少なく，出生後の問題点も明らかではない．今回，出生後に重度の呼吸障害と胆汁うっ滞性肝障害を呈した先天梅毒の早産児2 例を報告する．症例1 は在胎30週4 日，出生体重1,562 g，症例2 は在胎30 週0 日，出生体重1,444 g であった．いずれも出生直後から重度の呼吸障害を呈し，長期の人工呼吸器管理を要した．両例ともに日齢0 からペニシリンG による治療を実施した．肝機能障害は，症例1 は日齢55 に直接ビリルビン値3.7 mg/dL まで上昇したが，ウルソデオキシコール酸などの投与を行い，軽快した．症例2 は日齢18 に直接ビリルビン値19.2 mg/dL まで上昇した．内服加療が困難であったため脂溶性ビタミンの静脈内投与のみで経過をみたが，自然に軽快した．梅毒による胆汁うっ滞性肝障害の機序は，梅毒トレポネーマの肝胆道系への直接的な障害なのか免疫反応なのかは結論は得られていない．近年の梅毒感染の増加に伴い，今後も先天梅毒の発症例が増加する可能性があり，出生後の胆汁うっ滞性肝障害の出現に注意して経過をみることが必要である．In recent years, the number of adult syphilis cases in Japan has been increasing, and consequently, reports of congenital syphilis have also been on the rise. However, there are few reports on the prognosis of congenital syphilis cases born prematurely, and postnatal complications remain unclear. Here, we report two cases of premature infants with congenital syphilis who developed severe respiratory distress and cholestatic liver dysfunction after birth. Case 1 was born at 30 weeks and 4 days of gestation, weighing 1,562 g, while Case 2 was born at 30 weeks and 0 days of gestation, weighing 1,444 g. Both cases exhibited severe respiratory distress immediately after birth and required long-term mechanical ventilation. Both infants were treated with penicillin G from day 0. Regarding liver dysfunction, in Case 1, the direct bilirubin level increased to 3.7 mg/dL on day 55, but improved with the administration of ursodeoxycholic acid and other treatments. In Case 2, the direct bilirubin level increased to 19.2 mg/dL on day 18. Since oral treatment was difficult, only intravenous administration of fat-soluble vitamins was provided, and the condition improved spontaneously. The mechanism of syphilis-induced cholestatic liver dysfunction remains unclear. It is reported due to direct damage to the hepatobiliary system by Treponema pallidum or an immune response. Given the recent increase in syphilis infections, the number of congenital syphilis cases may continue to rise. Therefore, careful monitoring for the development of cholestatic liver dysfunction after birth is essential.journal articl