Dokkyo Medical University Repository / 獨協医科大学リポジトリ
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Rib Osteomyelitis in an 11-year-old Girl without Fever
Full text linkRib osteomyelitis in children is rare. Here, we report a case of rib osteomyelitis in an 11-year-old girl who presented with chest pain as the only complaint. Based on physical examination and blood tests, pleurisy was suspected as the initial diagnosis, but contrast-enhanced computed tomography and magnetic resonance imaging confirmed the diagnosis of right rib osteomyelitis. The patient was treated with antibiotics and made a full recovery. Clinical manifestations of acute osteomyelitis include fever and localized pain; however, only 36% of patients with rib osteomyelitis have fever. Pediatricians need to consider rib osteomyelitis in the differential diagnosis of chest pain in children, even in the absence of fever.journal articl
Bilateral Thoracoscopic Extended Thymectomy for Myasthenia Gravis in Children and Report of Case
Full text linkA 13-year-old female was presented with vision impairment and ptosis, along with general fatigue. Elevated acetylcholine receptor antibodies, and positive findings in Tensilon and repetitive nerve stimulation tests were noted, leading to a diagnosis of generalized myasthenia gravis (gMG). Despite treatments with anticholinesterase drugs, methylprednisolone pulse therapy, immunosuppressants, and plasma exchange, the disease was refractory and a thymectomy was scheduled. The operation was performed under CO2 insufflation with three ports from the right side as much as possible, followed by two ports from the left side to complete the extended procedure. Following a good postoperative course, the patient was discharged on postoperative day 10 without onset of an MG crisis, with treatment continued thereafter. The present case of childhood MG was treated in a safe and effective manner with a bilateral thoracoscopic thymectomy.journal articl
Locally Advanced Rectal Cancer Achieving Clinical Complete Response after Total Neoadjuvant Therapy and Undergoing Follow-up: A Case Report
Full text linkWe report the case of a 79-year-old man with locally advanced rectal cancer (LARC) who underwent total neoadjuvant therapy (TNT). Treatment consisted of chemoradiotherapy (CRT) delivered to the pelvic region (including the lateral lymph nodes) with a total dose of 30 Gy in 10 fractions of 3 Gy each. Concurrently with radiation therapy, S-1 (80 mg) was administered orally twice daily on all days of radiotherapy. Following CRT, systemic chemotherapy with the SOX regimen (S-1 and oxaliplatin) was administered for two cycles. Eight weeks after completion of radiation therapy, evaluation revealed no evidence of distant metastasis. Colonoscopy showed complete macroscopic disappearance of the tumor, and biopsy specimens revealed no evidence of residual cancer, confirming a complete clinical response (cCR). Although surgery was initially planned after TNT, the patient strongly preferred non-operative management (NOM). The patient has maintained cCR for two years following NOM, making this a valuable case to report.journal articl
Genetic Counselling for a Pregnant Woman from Female Fabry Disease Families: Case Report and Newborn Screening Update
Full text linkFabry disease is caused by a deficiency in metabolic enzymes that leads to kidney failure, heart disease, and stroke with age. It is generally considered to be an X-linked recessive inheritance; however, a high incidence of female cases has been found in some families, and genetic counseling (GC) remains challenging.
A 39-year-old pregnant woman at 32 weeks of gestation was referred for GC. Her mother died of Fabry disease at the age of 66, her elder brother died at the age of 36, and she herself was confirmed to have a heterozygous mutation in the GLA gene. In GC, the probability of inheritance in her fetus, about the disease that is commonly likely to occur in boys, but in girls, there are large individual differences in onset or disease status, and enzyme replacement therapy, which can delay the progression of the disease, were explained. Her understanding of the disease was quite good. It has also been explained that expanded blood spot screening after birth is recommended for newborns (also for girls). Although the GC gave her a positive view of the disease, there was fear that the outcome would persist if the disease was severe.
Later, she had a successful spontaneous birth of a female baby at term. Screening of the newborn showed no problems with enzyme expression, and disease was not considered to be present at this stage. Female Fabry disease is rare, but careful GC is strongly needed if there is female onset in the family tree, especially in relation to pregnancy.journal articl
Emergency Surgical Patients with Severe Motor and Intellectual Disabilities
Full text linkPatients with severe motor and intellectual disabilities (SMID) have communication challenges, and treatment tends to be late. This study aims to examine the clinical courses of SMID patients who required emergency surgeries and identify key considerations for their management in emergency situations. Clinical courses of emergency surgeries, examinations and treatments under general anesthesia for SMID from December 2011 to November 2022 were retrospectively examined based on medical records. To evaluate the relationship between elapsed time and clinical course severity, we compared the time from symptom recognition by caregivers to consultation and from consultation to the start of the operation between the groups with and without perioperative complications. During the study period, a total of 18 emergency surgeries were required for 15 SMID patients, addressing conditions such as bowel obstruction, acute appendicitis, and complications after tracheostomy or gastrostomy. 8 cases presented perioperative complications, 2 of them died perioperatively. The time from symptom recognition by caregivers to consultation was significantly longer in the group with perioperative complications compared to the group without perioperative complications. In emergency situation of SMID, most of the cases were already advanced at the time of consultation, with longer consultation times increasing the likelihood of perioperative complications. Ensuring prompt and accurate diagnosis of surgical indications is crucial for effective treatment.journal articl
Establishment of a Murine Desensitization Model to PLA2-induced Anaphylaxis
Full text linkBackground: The major allergen in honeybee venom is the enzyme phospholipase A2 (PLA2). To develop new treatments for honeybee venom allergy, it is necessary to elucidate the mechanism underlying allergen immunotherapy. In this study, we first created a PLA2 mouse model of honeybee venom anaphylaxis and then established its desensitized model.
Method: Balb/c mice were subcutaneously sensitized four times with PLA2. Blood was collected before sensitization and serum PLA2-specific IgE antibodies were analyzed by enzyme-linked immuno-sorbent assay (ELISA). Rectal temperature was measured before and 30 min after subcutaneous challenge with PLA2, and blood histamine concentration was measured 30 min after that by ELISA. In addition, the PLA2 mouse model of anaphylaxis was desensitized a total of 20 times over 4 weeks, and rectal temperature and blood histamine concentration were measured before and/or 30 min after subcutaneous challenge with PLA2.
Results: After the second sensitization in the PLA2 mouse model of anaphylaxis, a significant increase in serum PLA2-specific IgE antibody was observed compared with the control group. There was a significant decrease in rectal temperature and an increase in histamine levels in the model mice compared with the controls. In addition, there was no decrease in rectal temperature before and after the challenge with PLA2 in the desensitized mice model, and a decrease in histamine levels in the desensitized mice model compared with that in the non-desensitized one.
Conclusion: We have created a PLA2-desensitized mouse model of anaphylaxis in this study. This model is expected to be useful for an immunological analysis of the response mechanism underlying allergen immunotherapy as well as basic research aimed at developing new treatments.journal articl
Nursing Awareness and Current Practices of Psychological Support for Patients Undergoing Primary Percutaneous Coronary Intervention
Full text link本研究は，プライマリー経皮的冠動脈インターベンションを受ける患者への救急外来および集中治療室の看護師の心理的支援の認識と現状について明らかにすることを目的とした．5 医療施設45 名の看護師（救急外来看護師21 名，集中治療室看護師24 名）を対象に，独自に作成した調査用紙を用いて調査を実施した．調査結果は，救急外来・集中治療室の看護師は入室時・治療中の患者への心理的支援を必要と認識していた．救急外来の看護師は，入室時・治療中ともに「患者の心理的支援よりも患者の身体的支援を優先すべき」（入室時p＜0.001，治療中P＝0.011）としていた．集中治療室の看護師は，入室時・治療中ともに「安心感を与える声掛けが必要」（入室時p＝0.004，治療中P＝0.007）「患者の心理的支援する時に声掛けのタイミングや声のトーンに配慮することは必要」（入室時p＝0.013，治療中p＝0.016），「患者の心理的支援に心理状況の把握は必要」（入室時p＝0.005，治療中P＜0.001）「患者の心理的支援に環境整備は必要」（入室時P＝0.013・治療中p＝0.002），としていた．治療中は，「患者の心理的支援する時に現在の状況や治療に対する情報提供への配慮が必要」（p＝0.005）としていた．以上のことにより，ER およびICU 看護師のいずれも，入室時および治療中における心理的支援の重要性を認識していたが，病棟間で認識に差がみられた．このため，病棟機能で行われる治療内容と患者の心理状況を理解し，病棟間で連携を行うことが必要であることが示唆された．The purpose of this study was to clarify the perception and current status of psychological support of emergency room and intensive care unit nurses for patients undergoing primary percutaneous coronary intervention. 45 nurses（ 21 emergency room nurses and 24 intensive care unit nurses） from 5 medical facilities were surveyed using an originally developed survey form. We conducted a survey of 45 nurses（ 21 emergency room nurses and 24 intensive care unit nurses）at five medical facilities, using a survey form that we developed ourselves. The results of the survey showed that nurses in the emergency room and intensive care unit recognized the need for psychologicalsupport for patients upon admission and during treatment.Emergency room nurses stated that “physical support of the patient should be prioritized over psychological support”（ p＜0.001 on admission, P＝0.011 during treatment）both on admission and during treatment.Nurses in the intensive care unit stated that “it is necessary to give reassurance” （p＝0.004 when entering the room, p＝0.007 during treatment）and “it is necessary to consider the timing and tone of voice when giving psychological support to patients”（ p＝0.013 when entering the room, p＝0.016 during treatment）, and “it is necessary to give psychological support to patients”（p＝0.016 when entering the room, p＝0.017 during treatment）. The following were also found：“It is necessary to understand the patient’s psychological situation for psychological support”（ p＝0.005 when entering the room, P＜ 0.001 during treatment） and “It is necessary to improve the environment for psychological support”（ p＝0.013 when entering the room, p＝0.002 during treatment）. During treatment, “consideration for providing information on the current situation and treatment is necessary when providing psychological support to patients”（ p＝0.005）. As described above, both ER and ICU nurses recognized the importance of psychological support at admission and during treatment, but there were differences in recognition among the wards. This suggests that it is necessary to understand the contents of treatment and the psychological status of patients in the ward functions, and to collaborate among the wards.departmental bulletin pape
Preoperative MRI-Estimated Uterine Volume and the Possibility of Vaginal Extraction in Robot-Assisted Total Hysterectomy
Full text linkIntracorporeal morcellation within the vaginal canal is feasible for benign uterine tumors but not malignant ones. Moreover, predicting whether the uterus can be extracted transvaginally via robot-assisted hysterectomy without morcellation is challenging, especially in patients with an enlarged uterus. We retrospectively analyzed 38 women who underwent robot-assisted hysterectomies for benign uterine tumors between August 2021 and September 2024. We assessed the correlation between preoperative magnetic resonance imaging(MRI)-estimated uterine volume and extracted uterine weight. Logistic regression analysis was used to identify the factors influencing the decision for morcellation. Receiver operating characteristic (ROC) curve analysis was used to determine the optimal cutoff value of the MRI-estimated uterine volume for predicting the need for morcellation. Morcellation was necessary in 24 patients, while 14 patients underwent vaginal extraction without morcellation. The median uterine weights were 275 and 135 g in the morcellation and nonmorcellation groups, respectively. Uterine weight > 200 g and the presence of subserosal fibroids were significantly associated with morcellation necessity. A strong correlation (r = 0.775, p < 0.001) was observed between the MRI-estimated volume and uterine weight. ROC analysis identified 391 cm3 as the optimal cutoff for predicting morcellation (area under the curve = 0.799; sensitivity, 58%; specificity, 100%). The MRIestimated uterine volume is a reliable predictor of whether the uterus can be removed vaginally without morcellation, aiding in preoperative planning for robot-assisted hysterectomy.journal articl
The roles of learning to understand people based on developmental knowledge
Full text linkIn medical education, in addition to understanding a patient's illness medically, it is necessary to understand the patient as a human being. However, there are various biases in understanding people.
In order to understand people objectively, medical students need to learn to assess people comprehensively. I reported on a class that teaches understanding people based on developmental knowledge and discussed its implications.departmental bulletin pape