Desmoid fibromatosis (DF) is defined as a borderline tumor of the soft tissues with a low malignant potential. The most common tumor sites are the extremity, trunk, abdominal cavity, and head and neck. Surgical resection has been the standard treatment for DF. However, there are concerns regarding long-term cosmetic outcomes or functional morbidity associated with surgery particularly in the head and neck. Recently, the use of the front-line wait-and-see strategy and pharmacologic treatment such as chemotherapy for progression has been proposed as tumors can spontaneously stabilize and regress. Herein, we report the efficacy of vinblastine (VBL) and methotrexate (MTX) in a childhood patients with DF. A 21-month-old female patient with a 4-cm tumor at the left lower jaw was diagnosed with DF. She did not initially receive any therapies (wait-and-see) according to the recent treatment guidelines. However, the tumor gradually progressed, and the patient was managed with COX2 inhibitor. Since the tumor was not controlled with such a treatment and tracheal exclusion caused by the mass was a cause of concern, the patient was managed with chemotherapy with VBL and MTX. VBL and MTX were administered weekly for 26 weeks, every other week, and further for 26 weeks. The tumor size gradually decreased with VBL and MTX. Magnetic resonance imaging revealed no evidence of the disease at the end of chemotherapy. Good cosmetic outcomes were achieved, and recurrence was not observed after 24 months of follow-up.
Childhood asthma can lead to chronic obstructive pulmonary disease in adults, thus necessitating an early diagnosis and timely intervention from early childhood. A retrospective study was conducted on parameters related to lung sound power in three-year-old healthy children. All cases were surveyed using the ATS-DLD questionnaire, which mainly covered items related to the history of wheezing, diagnosis of asthma/asthmatic bronchitis, and history of allergies, and then lung sounds were measured. From these data, the characteristics of inspiratory and expiratory sound power at this age were examined. There were correlations between the parameters related to lung sound power at the low- and middle-range frequencies. In addition, children with a history of wheezing or diagnosed with asthma/asthmatic bronchitis showed an increase in the power of inspiratory and expiratory sounds and the power ratio of inspiratory and expiratory sounds compared with children without such histories. Furthermore, the parameters of lung sound power correlated with those of the inspiratory sound spectrum. Measurements of the power of inspiratory and expiratory sounds confirmed that three-year-old children with a history of wheezing or diagnosed asthma/asthmatic bronchitis had characteristic lung sounds even when healthy.
To clarify the characteristics of medical care for amyotrophic lateral sclerosis (ALS) by examining the most memorable experiences of multidisciplinary medical professionals involved in patient care. In a questionnaire, "the most impressive thing about the experience" was efficiently categorized using inductive thematic coding. Responses were categorized using keywords, and similar content was categorized using codes. The instances of each quantified item were calculated by expressing them as numbers and frequencies. Furthermore, representative quotations and context-specific nuances were analyzed to investigate the emotional and ethical dimensions of each category. Questionnaires were distributed to 269 medical professionals treating patients with ALS at three hospitals in the western region of Kanagawa Prefecture. Of these, 164 (60%) responded to the questionnaire, and 143 were included (valid response rate: 53%). Based on the questionnaire responses, the experiences of the medical professionals were classified into 27 categories. Medical professionals are continuously involved in fulfilling the wishes of patients as much as possible, realizing individuality and patient commitment, and intervening without giving up. For multidisciplinary medical professionals involved in the care of patients with ALS in clinical practice, the most memorable experiences coincided with those associated with the challenges of ALS care.
Thyroid hemangiomas are rare. However, preoperative investigations should be considered because of the potential risk of significant intraoperative hemorrhage. Here, we report a case of thyroid hemangioma in a 58-year-old woman. Physical examination revealed a large, hard, non-tender mass measuring approximately 60 mm in the anterior neck. Laboratory tests indicated hypothyroidism (triiodothyronine: 2.32 pg/mL, thyroxine: 0.62 ng/dL, thyroid-stimulating hormone: 22.4 nIU/mL) and markedly elevated anti-thyroglobulin (1,357 IU/mL) and anti-TPO (405 IU/mL) antibodies. Ultrasonography revealed a well-defined, heterogeneous internal mass measuring 60 mm within the right lobe of the thyroid gland, with a hyperechoic image bordering the mass. Contrast-enhanced CT revealed a 44 mm mass in the right lobe with calcification at the rim and gradual contrast enhancement towards the interior. Fine-needle aspiration cytology (FNAC) yielded mostly blood cells, with no evident epithelial components. A right thyroid lobectomy was performed, and post-operative histopathology confirmed a diagnosis of hemangioma. This case highlights the importance of considering thyroid hemangiomas in the differential diagnosis of thyroid masses due to the risk of intraoperative hemorrhage. It also emphasizes the role of various imaging modalities such as ultrasonography and CT in the preoperative evaluation of such cases.
This study examined the experiences of multidisciplinary medical professionals in providing daily clinical care for patients with amyotrophic lateral sclerosis (ALS), with a focus placed on their persistence in sustaining clinical care for this patient group. A questionnaire survey was administered to multidisciplinary medical professionals involved in ALS care at three hospitals in western Kanagawa Prefecture, Japan. The questionnaire results were used to examine the relationships between years of medical experience, years of ALS care experience, self-evaluation, and motivation to continue providing clinical care to patients with ALS. Of the 269 questionnaires distributed and 164 collected by the multidisciplinary medical professionals, 143 (53%) were deemed valid. Analysis revealed an association between "years of medical experience" with both "self-assessment of clinical care for ALS patients practice experience" and "commitment to continue clinical care for ALS patients," as well as between "years of ALS medical experience" and "self-assessment of clinical care for ALS patients." Medical professionals with more than ten years of medical experience expressed their commitment to continue providing medical care in a comprehensive self-assessment of both the positive and negative aspects of their practice. Negative evaluations can be used to identify and improve ALS medical practices.
A lumbar hernia, an exceptionally rare abdominal wall defect, accounts for only 1.5-2% of all reported hernia cases. An inguinal hernia is most common type in adults. The simultaneous occurrence of these two distinct hernias is extremely uncommon; only a few cases have been documented to date. Herein, we report a rare case of concomitant iatrogenic lumbar hernia and indirect inguinal hernia that was successfully repaired in a single session using a combined laparoscopic approach. A 74-year-old Japanese woman presented with a bulge and pain in the left flank and swelling in the left inguinal region 1 year following lumbar spinal surgery with bone graft harvesting from the left iliac crest. Computed tomography revealed an intestinal herniation above the left iliac crest and an omental herniation in the left inguinal region. Laparoscopic exploration confirmed a 6 cm × 7 cm lumbar defect containing the sigmoid colon and an indirect inguinal hernia. The lumbar hernia was repaired using a Symbotex™ Composite Mesh (20 cm × 15 cm; Medtronic, Minneapolis, MN, USA) fixed with absorbable tacks, and the inguinal hernia was repaired with a Bard® 3D Max® mesh (M size; Davol, Warwick, RI, USA) using the transabdominal preperitoneal (TAPP) approach. The total operative time was 120 min, and the postoperative course was uneventful. The patient was discharged on postoperative day 4. This case demonstrates the technical feasibility and safety of simultaneous laparoscopic repair of iatrogenic lumbar and inguinal hernias using a combination of intraperitoneal onlay mesh (IPOM) and TAPP techniques. This strategy facilitates minimally invasive, effective, and simultaneous repair under a single anesthesia and hospitalization, highlighting the versatility of laparoscopic surgery in managing complex abdominal wall hernias.
Japanese Traditional (Kampo) Medicine (JTM) relies on traditional diagnostic patterns (sho). However, half of Japanese physicians do not consider Kampo patterns when prescribing, increasing the risk of improper use and adverse events. This study evaluated the accuracy and challenges of KAMPO365, a diagnostic support system for JTM, by comparing its outputs with diagnoses and prescriptions by certified physicians of the Japan Society for Oriental Medicine. Twenty outpatients at two hospitals participated by inputting clinical data into KAMPO365, which generated Kampo pattern diagnoses and formula recommendations. Specialists, blinded to KAMPO365 outputs, conducted independent diagnoses and prescribed five candidate Kampo formulas. The results showed a 35% concordance rate between KAMPO365-recommended formulas and specialists' selections, with higher agreement in pharmacological classification (45%). Concordance rates for diagnostic patterns were 55% for deficiency/excess and 65% for cold/heat. For qi, blood, and fluid disturbance patterns, fluid retention had the highest concordance (75%), while qi counter flow and blood deficiency had the lowest (30%). KAMPO365 demonstrated potential in aiding non-specialists, though improvements in diagnostic algorithms and the coverage of Kampo formulas are needed. Despite its limitations, this study suggests the potential utility of KAMPO365 for diagnosing Kampo patterns and providing precise prescriptions.
The purpose of this study was to obtain basic data for stress management by clarifying the current state of stress among the general public and how they cope with stress. An online survey was conducted on 100,000 men and women registered with an online survey company. Respondents with stress test scores of 77 or more were classified as the high-stress group and those with scores below 77 were classified as the non-high-stress group. The proportion of men and women in the high-stress group was 14.8% and 17.7%, respectively. By age, the proportion of men and women in their 20s and 30s was significantly higher than other age groups. For both men and women, the most common ways to deal with stress were "sleeping" and "bathing." In the high-stress group, the most common ways to deal with stress were "receiving chiropractic massage" for men and "spending time in the bathroom" for women. A binomial logistic regression analysis revealed that factors influencing the high-stress group included "short sleep time," "long working hours," and "low household income." The stress factors and coping methods revealed in this study are considered to be important health issues for the entire nation, and we believe that this report will contribute to preventive medicine and public health, which aim to reduce stress among the general public.
Cesarean scar pregnancy (CSP) is a rare form of ectopic pregnancy in which a fertilized embryo implants into the cesarean section scar on the anterior uterine wall. CSP occurs more frequently after assisted reproductive technology (ART) than after spontaneous conception; therefore, understanding the relation between ART and CSP is crucial for appropriate pregnancy management. Because CSP may lead to severe complications, termination of pregnancy during the first trimester is often selected. However, when continuation of the pregnancy is desired, management becomes challenging. We report a case of CSP following in vitro fertilization and embryo transfer. The patient chose to continue the pregnancy. Magnetic resonance imaging at 19 weeks and 1 d revealed findings suggestive of placenta accreta (also referred to as placenta creta) at the cesarean scar site. Magnetic resonance imaging at 29 weeks and 1 d showed complete replacement of the anterior myometrium by the placenta. At 32 weeks and 3 d, an elective cesarean section and total hysterectomy with bilateral salpingectomy were performed under multidisciplinary management. The placenta was completely attached to the scar area but did not invade adjacent organs, confirming placenta accreta. Both maternal and neonatal outcomes were favorable. Despite high risks associated with continuing a CSP pregnancy, outcomes can be favorable when management is carefully planned and individualized. Given the increasing prevalence of ART, clinicians should remain aware of the risk of CSP in patients with prior cesarean delivery and focus on early recognition, comprehensive imaging evaluation, and personalized management strategies to ensure optimal maternal and neonatal outcomes.
We report that the effect of combination therapy with SGLT2 inhibitors (SGLT2i) and glucagon-like peptide-1 receptor agonists (GLP1Ra) on renal composite outcomes is not affected by the preceding drug in patients with type 2 diabetes (T2D). In this study, we performed a post-hoc analysis of dulaglutide and liraglutide users and investigated the differences between GLP1Ra. We analyzed 266 patients treated with an SGLT2i followed by dulaglutide or liraglutide and 194 treated with dulaglutide or liraglutide followed by an SGLT2i. In addition, we analyzed dulaglutide users (n = 246) and liraglutide users (n = 214). Renal composite outcome was defined as the progression of albuminuria and/or a ≥ 30% eGFR decline. The incidence of renal composite outcomes in the SGLT2i-preceding and GLP1Ra (dulaglutide or liraglutide)-preceding groups was not significantly different. It also did not differ between the dulaglutide and liraglutide users. The incidence of ≥ 30% eGFR decline was more frequent in liraglutide users, with an odds ratio of 2.63 (95% confidence interval: 1.07-6.45, p = 0.04), with a significantly larger decrease in albuminuria in liraglutide users, with an odds ratio of 0.44 (95% confidence interval: 0.04-0.85, p = 0.03). Dulaglutide and liraglutide may have different effects on albuminuria and the kidney function in combination with SGLT2i.
Intravascular large B-cell lymphoma is a rare type of extranodal lymphoma that has an aggressive and sometimes fatal course. Early diagnosis is necessary to improve the prognosis, but very few studies have reported random skin biopsies comparing positive and negative patients. A total of 161 patients with malignant lymphoma in the differential diagnosis underwent random skin biopsies. Their clinical presentations included fever, night sweats, and unintentional weight loss. Their laboratory and radiological findings were evaluated. Six patients were diagnosed with intravascular large B-cell lymphoma, 12 patients were diagnosed with other malignant lymphomas, and the remainder were diagnosed with other diseases. Patients who were diagnosed with intravascular large B-cell lymphoma had a tendency to have B symptoms (p = 0.046), include senile/cherry angioma(s) at the sites of random skin biopsies (p = 0.040), and have thrombocytopenia (p = 0.009). Patients with intravascular large B-cell lymphoma who have B symptoms and thrombocytopenia tend to be easily diagnosed. In cases with these manifestations, random skin biopsy is recommended, if the patients do not have hemophagocytic lymphohistiocytosis.
Ectopic thyroid glands occur in the head and neck, typically at the base of the tongue but rarely in the abdominal cavity. Malignant tumors can also arise from ectopic thyroid glands. Here, we present an extremely rare case of intraperitoneal ectopic thyroid cancer. A 61-year-old woman was diagnosed with a mass in the left para-aortic region based on computed tomography (CT) at another hospital for a preoperative diagnosis of rectal cancer. Positron emission tomography-computed tomography revealed mild fluorodeoxyglucose accumulation in the mass, and rectal cancer metastasis was suspected. The mass was resected laparoscopically along with the primary tumor. Postoperative pathology revealed a follicular papillary carcinoma of the thyroid gland. The patient had a history of an ovarian cyst; therefore, we considered teratoma as a differential diagnosis, in addition to lymph node metastasis of thyroid cancer into the abdominal cavity. However, based on the histological findings, we considered primary intra-abdominal thyroid cancer to be the most likely diagnosis. The mechanism of intra-abdominal thyroid tissue development remains unknown because of the small number of cases, and future case reports are warranted.
In 1992, we devised an operation using the two-window method in which ports are created at only two sites in the thoracic wall for malignant lung tumors. However, in robot-assisted thoracic surgery (RATS), five ports are considered necessary for most thoracic approaches, which is in contrast to the concept of minimal invasiveness. This study aimed to determine the outcome of the two ports and one-window method using fusion surgery for RATS. Twenty-one RATSs were performed between November 2023 and September 2024. We performed the two ports and one-window method in all patients. Among 21 planned RATSs for anatomical pulmonary resections, there were no conversions to thoracotomy and no requirement for extra ports. The mean surgery time was 121.0 minutes and the mean console time was 73.1 minutes. The mean intraoperative blood loss volume was 20.7 mL. The mean duration of chest tube drainage and hospital stay were 3.1 and 4.4 days, respectively. There were no postoperative complications or mortalities. Our early results suggest that the two ports and one-window method is safe, feasible, and provides excellent perioperative outcomes.
Carcinoid tumors of the middle ear are rare and difficult to diagnose preoperatively. These low-grade malignant tumors require complete surgical removal; however, consensus on the amount of radicality required is lacking. Herein, we report two cases of carcinoid tumors of the middle ear. The first patient was a 40-year-old woman who presented with right-sided hearing loss and a white mass behind the tympanic membrane. The tumor was surgically removed using a transcanal approach, while maintaining an intact ossicular chain. The histopathological diagnosis was carcinoid tumor, and no additional treatment was administered. The second patient was a 28-year-old woman who presented with left-sided hearing loss and a white mass in the ear canal. Preoperative biopsy revealed a carcinoid tumor. The tumor was excised using the same approach as in Case 1 with tentative removal of the incus during surgery, and reconstruction with tympanoplasty type IIIc (Ost) was performed. No recurrence was observed in either case during > 3 years of follow-up. Treatment algorithms for carcinoid tumor of the middle ear are lacking; therefore, surgical plans vary according to the tumor extension. Furthermore, because carcinoid tumors are low-grade malignant tumors, long-term follow-up after complete macroscopic removal is necessary.
Infective endocarditis (IE) is a rare but severe condition caused by microbial infection of the endocardium. It affects both adults and children with underlying conditions or immunosuppression, including infants of mothers with diabetes (IDMs). We report a case of IE caused by methicillin-resistant Staphylococcus epidermidis (MRSE) in a newborn IDM. A male infant was born at 38 weeks gestation, weighing 5,102 g. His mother had poorly-controlled type 2 diabetes, and the infant had asymmetric septal hypertrophy of the heart. He was admitted to our unit with severe hypoglycemia and respiratory distress necessitating treatment using an indwelling peripherally-inserted central catheter (PICC). The tip of the PICC was moved to the appropriate position because it was initially located in the patient's right ventricle. He was determined to have IE via a positive MRSE blood culture and vegetation in the right atrium. He was treated with vancomycin followed by surgery at 74 days of age to remove the vegetation. He recovered well and was discharged at 92 days of age. IDMs whose mothers have poorly-controlled diabetes may be at higher risk of IE, particularly if they have hemodynamic abnormalities and indwelling PICCs. However, further studies are warranted to confirm this hypothesis.
The aim of this study was to clarify the effects of reduced frame rates in videofluoroscopic swallowing studies (VFSS) on aspiration assessment. The consecutive key frames (CKFs), that is, the range of key frames that are essential for penetration-aspiration scale (PAS) scoring of abnormal laryngeal penetration (ALP) and aspiration, was defined using retrospective 30-frames/second (fps) VFSS records for 50 adult dysphagia patients at an acute care university hospital. The results showed that the CKFs was larger in 24 aspiration patients than in 26 ALP patients, and its distribution was wider. The minimum CKFs that included no trace of residual liquid (TRL) was 8 for aspiration. When reducing the frame rate in seven steps to 3.75 fps, the complete disappearance of CKFs with no TRL was seen in only four ALP patients. With partial disappearance of CKFs, the PAS scoring of ALP and aspiration even with a reduction to 3.75 fps agreed consistently and almost completely with that at 30 fps, and high reliability was obtained. This study was exploratory, but 3.75 fps was the lower limit that satisfied the criteria in analyses after defining the acceptable level for frame rate reductions in assessing aspiration.
Evaluating the driving ability of a vehicle is important in the development of in-vehicle systems and the training of driving skills. Driving ability has been investigated extensively in terms of recognition, judgment, and operation. However, the role of the brain in advanced driving operations within the limits of vehicle performance has not been thoroughly investigated. In this study, we perform functional magnetic resonance imaging to evaluate brain functions associated with advanced driving skills when drivers are shown a video of cornering involving a vehicle slipping sideways. Based on the results, the skilled driver group indicates broad activity in both the right and left parietal associations, right-side primary somatosensory, left-side premotor, and supplementary motor areas. Because the premotor cortex is a region involved in the execution of movement, whereas the supplementary motor cortex is a region involved in spontaneous movement, it is assumed that the skilled drivers visualized the driving operation, and that the brain functions necessary for the operation are activated. These findings indicate that drivers with high skill levels exhibit distinctive brain activities. We believe that a further understanding regarding the brains of skilled drivers will facilitate the development of in-vehicle control that incorporates high driving skills and training.
Usage of time in range (TIR), measured by continuous glucose monitoring (CGM), has become common as a new index of glycemic control. Therefore, we compared points in range (PIR), measured by the self-monitoring of blood glucose (SMBG), with TIR. In this prospective observational study, 43 patients with diabetes wore FreeStyle Libre Pro and conducted SMBG at the same time. Time above range (TAR), TIR, time below range (TBR) and points above range (PAR), PIR, points below range (PBR) were compared, respectively. The median PAR was 35.7%, while the median TAR was 20.8% for CGM. Conversely, the PIR was 64.3%, while the TIR was 74.9%; similarly, the PBR was 0%, while the TBR was 1.7%. A significant positive correlation was found between PIR and TIR (r = 0.784, P < 0.001). In the Bland-Altman analysis performed to assess the association between the two methods, PIR showed a -9.9% bias compared with TIR. PIR may be used in patients who find it difficult to use CGM as a substitute of TIR, however caution is needed when interpreting the data due to the difference between PIR and TIR.
We encountered a case involving a brain abscess in the right frontal lobe of a 12-year-old girl who was diagnosed with a chief complaint of headache and nausea. Left maxillary sinusitis, a dental infection related to dental caries and apical periodontitis, was observed in the left maxillary first molar in addition to left frontal sinusitis also being present. In addition to administering antibacterial agents, extraction of the left maxillary first molar and drainage of the paranasal sinuses and brain abscess were performed. Follow-up over the course of 1 year and 5 months indicated that the patient had progressed without any sequelae; therefore, the prognosis was good. In this case, although bone destruction was observed in the posterior wall of the frontal sinus, which could be a route for bacteria to enter the skull, we considered the possibility of direct invasion from the same site to be low because the brain abscess occurred on the opposite side. We believe that a route for hematogenous invasion from apical periodontitis, in addition to sinusitis, is also possible. Regardless of the route, the outset was an infection in the dental field; therefore, this case reaffirmed the importance of dental cavity treatment in childhood.
This study investigated the effects of Aromatherapy Massage on chronic pain and quality of life (QOL) in four patients with Parkinson's disease (PD) whose pain was unresponsive to medication. A three-arm crossover trial was conducted, consisting of Inhalation (I), Massage (M), and Aromatherapy Massage (AM), each over three weeks. Pain was assessed using the Visual Analog Scale (VAS) and King's PD Pain Scale (KPPS). Plasma dopamine and β-endorphin levels and electroencephalography (EEG) were used as objective indicators. QOL was measured using the PDQ-39. Data were analyzed with linear mixed models (p < 0.05). Only AM significantly increased plasma dopamine. Both M and AM elevated β-endorphin levels and reduced VAS scores during and after intervention. KPPS scores improved following AM. EEG showed the highest peak alpha frequency during AM. PDQ-39 scores improved by 3.75 points after AM. Aromatherapy massage may offer effective multisensory stimulation for alleviating chronic pain and enhancing QOL in PD patients. It may serve as a useful complementary strategy in pain management.