Dokkyo Medical University Repository / 獨協医科大学リポジトリ
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A Case of HTLV-1-Associated Bronchiolo-Alveolar Disorder Diagnosed by Transbronchial Lung Cryobiopsy
Get PDFThe patient was a 78-year-old man who had been attending another medical institution for management of diabetes and hypertension. He began to notice dyspnea on exertion about a month early. Chest computed tomography performed at that institution revealed diffuse ground-glass opacities in the lungs bilaterally, leading to his referral to our department. The patient was from Oita Prefecture and had no fever, rash, superficial lymphadenopathy, or hepatosplenomegaly, but was positive for human T-cell leukemia virus type-1 (HTLV-1) antibodies. A transbronchial lung cryobiopsy (TBLC) of the pulmonary lesions was performed, revealing cellular infiltrates primarily composed of small lymphocytes in the interalveolar septum and vascular walls. Histologically, the findings were consistent with HTLV-1-associated bronchiolo-alveolar disorder (HABA). Here, we report this case of HABA, which demonstrated the diagnostic utility of HTLV-1 antibody testing and TBLC.journal articl
Massive Subchorionic Hematoma with Recurrent Massive Uterine Bleeding
Get PDF巨大絨毛膜下血腫（Massive subchorionic hematoma, MSH, Breus’ mole）の予後因子は明らかでなく，管理に一定したものはない．超音波断層法では血腫輝度変化により診断が困難なことがある．今回，MRI で診断できたものの，多量子宮出血のため妊娠終結を選択したMSH を経験した．症例は29 歳，3 妊1 産，妊娠15 週2 日の女性で，子宮出血で搬送された．超音波断層法ではMSH と胎盤後血腫等との鑑別が困難でMRI 検査によりMSH と診断した．多量子宮出血のため妊娠16 週6 日に妊娠終結となった．多量子宮出血を伴うMSH では妊娠終結を選択せざるをえないこともある．また，MSH の診断にMRI が有用であった．Massive subchorionic hematoma （MSH，Breus’ mole） is a very rare disease following a poor perinatal prognosis. The prognostic factor is unclear, so its clinical management has not been established. For diagnosis, the ultrasonic tomography is useful. But in case of the changed brightness of the hematoma, the diagnosis with the ultrasonic tomography may be difficult. We experienced a patient in MSH with difficult-to-treat massive bleeding, who can’t avoid deciding termination. The patient was 29 years old, had 3 gravity and 1 parity, and had undergone a medical checkup at another hospital after getting pregnant naturally, but was referred to our hospital for management purposes due to repeated genital bleeding at 15 weeks and 2 days of pregnancy, and was hospitalized. Deciding whether MSH or retroplacental hematoma using the ultrasonic tomography was impossible The pelvic MRI revealed MSH, but in hospitalization, she repeatedly suffered heavy bleeding and repeated blood transfusions, so it was judged that it was difficult to continue the pregnancy, and the pregnancy was terminated at 16 weeks and 5 days of pregnancy. MSH can cause life-threatening heavy bleeding as in this case. The pelvic MRI was useful for diagnosis of MSH.journal articl
Coronary Computed Tomography Angiography for Observation of Stabilized Coronary Arterial Plaque after “Drug Intervention”: A Case Report
Get PDFA 54-year-old woman with unstable angina underwent coronary stent deployment. She was started on rosuvastatin therapy before undergoing percutaneous coronary intervention (PCI). However, arriving at lowdensity lipoprotein cholesterol (LDL-C) levels lower than 70 mg/dL required more than a month of treatment. This was accomplished by increasing the rosuvastatin dose by 10 mg and adding ezetimibe. Chronic-phase coronary computed tomography angiography (CCTA) did not show stent restenosis but revealed plaque progression in the left main trunk (LMT). A combination of rosuvastatin, ezetimibe, and the proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitor was administered to promote regression of the plaque. Followup CCTA performed 12 months after the initial scan showed regression of the LMT plaque and the appearance of new calcification in the proximal plaque of the left anterior descending (LAD) artery. The aggressive lipid-lowering strategy that combined rosuvastatin, ezetimibe, and a PCSK9 inhibitor successfully achieved plaque regression without the occurrence of cardiovascular events.journal articl
Postoperative Gastric Cancer Cases with a High Helicobacter pylori Load Have a Good Prognosis
Get PDFObjective
H. pylori is considered a carcinogenic factor for gastric cancer. However, gastric cancer patients infected with H. pylori have a better postoperative course than uninfected patients. These studies classified gastric cancer patients into two groups, H. pylori-negative and positive. In the present study, gastric cancer patients were classified according to H. pylori load, and then the relationship of H. pylori load with the postoperative course was examined.
Patients and Methods
A total of 403 gastric cancer patients were examined endoscopically in the Department of Upper Gastrointestinal Surgery prior to gastric surgery. H. pylori infection was determined using the culture method, and the results were classified into five levels: negative, scant, little, moderate, and abundant growth. Overall survival (OS) was then analyzed by the pathological findings and culture results.
Results
H. pylori infection was detected in 57.3% (231/403) of patients. H. pylori-positive cases showed significantly better survival than negative cases. The patients with high H. pylori load (strongly positive group) showed significantly better OS than the H. pylori-negative group (p = 0.02). In relation to other histopathological findings and OS, the H. pylori-infected patients who showed a better prognosis were those with diffuse type gastric cancer and those with stage II, lymph node metastasis-positive disease.
Conclusion
OS was high when H. pylori was present at the time of operation, and it was even better when H. pylori load was high. In addition, conditions associated with a good prognosis in H. pylori-positive patients were diffuse type adenocarcinoma and localized metastasis-positive cases.journal articl
Clinical Characteristics of Obstructive Hypertrophic Cardiomyopathy and Other Conditions with Increased Left Ventricular Outflow Tract Pressure Gradient
Get PDFPurpose:
To estimate the clinical characteristics of obstructive hypertrophic cardiomyopathy (HOCM) and other diseases or conditions with left ventricular outflow tract obstruction (LVOTO).
Methods:
Forty cases (mean age 71 years, 31 women) with LVOTO (LVOT pressure gradient ≥ 30 mmHg) on resting transthoracic echocardiography were investigated and divided into two groups: HOCM group and other conditions (non HOCM group), and their clinical characteristics were compared. The mean follow-up period was 41 ± 8 months.
Results:
There were 17 patients (42.5%) in the HOCM group and 23 (57.5%) in the non HOCM group, with sigmoid septum being the most common (12 patients, 30%), followed by hypertensive heart (10%), takotsubo syndrome (7.5%). and small left ventricle with hyperkinetic wall motion (7.5%). Compared to the HOCM group, the non HOCM group was older (76 ± 10 vs. 67 ± 10 years, p = 0.006), had more frequent hypertension (HT) (78% vs. 47%, p = 0.041), and the mitral regurgitation severity at the first transthoracic echocardiography was significantly lower. Compared to the first LVOT velocity, the last LVOT velocity was significantly reduced in the HOCM group (4.6 ± 0.1 m/sec vs. 2.8 ± 1.8 m/sec, p = 0.001). However, there was no significant change in the non HOCM group (4.1 ± 1.0 m/sec vs. 3.3 ± 1.1 m/sec, p = 0.100). The frequency of cardiovascular events showed no significant difference between the 2 groups.
Conclusions:
This study showed different clinical background and change of LVOT velocity during follow-up periods in both groups. As the population ages, the patients with various LVOTO will increase further. It is important to investigate factors causing LVOTO and comprehensive management are required individually.journal articl
A Case of Rheumatoid Meningitis without Symptoms of Arthritis and IgG4-positive Cellular Infiltration on Brain Biopsy
Get PDFA 68-year-old man presented with a chronic headache, without signs of meningeal irritation, at the age of 67. Diffusion-weighted and FLAIR MRI of the head revealed hyperintense signal areas in the white matter of the right parietal lobe and the subarachnoid space within the falx cerebri, with enhancement of the pia mater. Serum and cerebrospinal fluid (CSF) anti-cyclic citrullinated peptide antibody (ACPA) levels, as well as the intrathecal ACPA antibody titer index (ACPA index), were elevated. Although serum IgG4 levels were normal, brain biopsy demonstrated an IgG4-positive cellular infiltrate exceeding 40% in the cerebral pia mater. Steroid treatment led to an improvement in meningitis, along with a reduction in CSF ACPA levels and the ACPA index. These findings suggest a shared pathogenic mechanism between rheumatic meningitis andIgG4-associated leptomeningitis.journal articl
A 1-year-old Girl with No Underlying Diseases Who Developed Clostridioides difficile Infection after Taking Antibiotics
Get PDFA 1-year-old girl with no underlying medical conditions developed bloody stools after antibiotic treatment and was diagnosed with Clostridioides difficile infection (CDI). The possibility of developing CDI should be considered even in healthy children. The incidence of CDI among healthy children has increased in recent years. A history of antimicrobial therapy for children with gastrointestinal symptoms is important. Longer durations of antimicrobial therapy, more types of antimicrobials, and third-generation cephems have been cited as risk factors for CDI development. Above all, antimicrobial stewardship is essential.journal articl
Surgery for Partial Anomalous Pulmonary Venous Connection without Atrial Septal Defect Diagnosed in Young Adulthood
Get PDFBackground: Partial anomalous pulmonary venous connection (PAPVC) accounts for 0.4-0.7% of congenital heart disease. Herein, we report a case of successful surgical treatment of PAPVC that preserves the specialized conduction system without any artificial materials.
Case presentation: A 21-year-old male patient had no significant medical history. The patient was referred to our department because the enlargement of right hilar shadow was shown on chest X-ray during a school physical examination. Partial anomalous pulmonary venous connection was diagnosed by contrast enhanced computed tomography. The right upper pulmonary vein was returning to the higher superior vena cava. The pulmonary systemic blood flow ratio was 2.88 on right heart catheterization. Surgery was performed under general anesthesia, with the patient in a supine position. An atrial septum defect was created under cardiac arrest using cardiopulmonary bypass as usual, and the rerouted right upper pulmonary vein blood flow using fresh autologous pericardial patch. An incision was made in the right atrial appendage and sutured to the superior vena cava for creating a pathway for blood flow from the superior vena cava to enter the right atrium (modified Warden procedure). Postoperative CT scan revealed successful rerouting blood flow of right upper pulmonary vein and superior vena cava. Superior vena cava-right atrium anastomosis, such as Warden procedure has the advantage of reducing the risk of postoperative sick sinus syndrome because not touching the sinus node. Reconstruction using only autologous tissue has advantages of antithrombogenicity. There are some case reports of an adult patient with using a fresh autologous pericardial patch who developed pulmonary vein obstruction in the remote term. Therefore, careful follow up is necessary in this case.
Conclusions: We performed a successful operation for repair of PAPVC connected to SVC with modified
Warden procedure. The procedure was safe and simple and yielded excellent postoperative outcomes.journal articl