[症例報告]Renal papillary necrosis : An autopsy case report and a brief review of the literature

An 83-year-old Japanese woman was admitted to our surgical department for persistent rectal bleeding on July 11, 1997. The patient had received radiotherapy for uterine cervical cancer 3 years previously. Her performance status was grade 3, due to bilateral femoral fracture. Sixteen months after radiotherapy, the patient demonstrated slight rectal bleeding. Since her rectal bleeding was persistent and intractable, she underwent proctectomy with colostomy. The resected rectum histologically showed severe endoarteritis and she was diagnosed to have a radiation proctitis. She developed paralytic bowel obstruction on the 6th post operative day (POD) and renal dysfunction with signs of systemic inflammatory response syndrome on the 10th POD. On the 25th POD, she developed a sudden onset of hematemesis and hypovolemic shock. An emergency endoscopic examination showed bleeding from multiple shallow ulcers in the stomach (acute gastric mucosal lesion). Simultaneously the patient presented with clinical manifestations of sepsis. The patient finally expired due to multiple organ failure. The autopsy revealed clinically insidiously progressing bilateral renal papillary necrosis, which was considered to be the primary cause of her death. Microscopically multiple extensive necrosis areas were observed in the renal papilla.論文http://purl.org/coar/resource_type/c_650

[症例報告]Colonic cancer associated with radiation colitis : A case report and a brief review of the literature

A 62-year-old Japanese woman was admitted to our hospital because of a slight rectal bleeding and stenosis in the left colon on a barium study. The patient had undergone a total hysterectomy and received radiotherapy for uterine cervical cancer at 35 years of age. Twenty-seven years after the treatment of uterine cervical cancer, the patient presented with slight rectal bleeding. The physical examination revealed a mid-line surgical scar, brown pigmentation of the skin and wall thickness in the lower abdomen consistent with radiation effect. A barium enema study showed stenosis of the descending colon. Colonoscopy was failed because of difficulty in inserting the endoscope. The patient underwent a left colectomy with lymph node dissection. The lower abdominal cavity showed extensive fibrosis (so-called frozen pelvis) which is often associated with the radiation effect. The resected colon showed a macroscopic Type 2 tumor which invaded the retroperitoneal space and the tumor was histologically diagnosed to be well-differentiated adenocarcinoma (stage IV). Severe endoarteritis was also observed in the vicinity of the tumor. The patient is doing well at the time of writing.論文http://purl.org/coar/resource_type/c_650

Improvements in the degree of understanding the treatment guidelines for schizophrenia and major depressive disorder in a nationwide dissemination and implementation study

Background: To implement clinical practice guidelines (CPGs), it is necessary for psychiatrists to deepen their understanding of the CPGs. The Effectiveness of Guidelines for Dissemination and Education in Psychiatric Treatment (EGUIDE) project is a nationwide dissemination and implementation study of two sets of CPGs for schizophrenia and major depressive disorder (MDD). Methods: A total of 413 psychiatrists (n = 212 in 2016; n = 201 in 2017) learned the two CPGs in the education program of the EGUIDE project, and clinical knowledge of these CPGs was evaluated at baseline and after the programs. To improve the correct answer rate for clinical knowledge after the programs, we revised the lecture materials associated with items that had a low correct answer rate in 2016 and used the revised lecture materials with the CPGs in 2017. The rates of correct answers after the programs between the 2016 and 2017 groups were compared. Results: The correct answer rate of one item on the schizophrenia CPG and one item on the MDD CPG tended to be improved (S-D5 and D-C6) and that of one on the MDD CPG was significantly improved (D-D3, P = 0.0008) in the 2017 group compared to those in the 2016 group. Conclusions: We reported improvements in clinical knowledge of CPGs after the EGUIDE program in the 2017 group following revision of the lecture materials based on results from the 2016 group. These attempts to improve the degree of understanding of CPGs may facilitate the successful dissemination and implementation of psychiatric guidelines in everyday practice

A case of intestinal perforation by an ingested fish bone

A case of ileal perforation by an ingested fish bone with treatment of laparoscopeassisted surgery in a 56-year-old man is reported. The patient was admitted to our hospital with a chief complaint of right lower quadrant pain. Abdominal CT scan demonstrated sharp-pointed foreign bodies in the ileum and sigmoid colon. He was diagnosed to have peritonitis secondary to ileal perforation. Initially we attempted to remove the foreign bodies through laparoscopic surgery, but failed to detect the perforated site and foreign bodies. Subsequently, the ileum was pulled outside of the abdomen through the median port inserted site where the incision was extended to comfortably expose it. A fish bone penetrated into the mesentery was easily detected and removed. The removed bone was 22 mm in length. As for a foreign body in the sigmoid colon, we expected it to pass spontaneously without treatment. The object passed spontaneously and it was confirmed on postoperative abdominal CT.論文http://purl.org/coar/resource_type/c_650

Prescription of Anticholinergic Drugs in Patients With Schizophrenia: Analysis of Antipsychotic Prescription Patterns and Hospital Characteristics

In several clinical guidelines for schizophrenia, long-term use of anticholinergic drugs is not recommended. We investigated the characteristics of the use of anticholinergics in patients with schizophrenia by considering psychotropic prescription patterns and differences among hospitals. A cross-sectional, retrospective prescription survey at the time of discharge was conducted on 2027 patients with schizophrenia from 69 Japanese hospitals. We examined the relations among psychotropic drug prescriptions regarding anticholinergic prescription. We divided the hospitals into three groups— low rate group (LG), medium rate group (MG), and high rate group (HG)—according to their anticholinergic prescription rates, and analyzed the relationship between anticholinergic prescription rates and antipsychotic prescription. Anticholinergic drugs were prescribed to 618 patients (30.5%), and the prescription rates were significantly higher for high antipsychotic doses, antipsychotic polypharmacy, and first-generation antipsychotics (FGAs) use. The anticholinergic prescription rate varied considerably among hospitals, ranging from 0 to 66.7%, and it was significantly higher in patients with antipsychotic monotherapy, antipsychotic polypharmacy, and normal and high doses of antipsychotics in HG than in those LG and MG. The anticholinergics prescription rate in patients with second-generation antipsychotic monotherapy in HG was also significantly higher than in those LG and MG; however, the difference was no longer significant in patients with FGA monotherapy. Conclusively, in addition to high antipsychotic doses, antipsychotic polypharmacy, and FGA use, hospital characteristics influence the prescribing of anticholinergic drugs.http://purl.org/coar/resource_type/c_650

A case of complete remission of advanced esophageal cancer after preoperative combination chemotherapy

The patient was a 59-year-old male who complained of dysphagia and thus was admitted to our hospital. He was diagnosed to have a type 3 advanced thoracic esophageal carcinoma lesion (Im-Ei) measuring 7cm in length based on both the X-ray and endoscopic findings. Intramural metastases were also observed. We thus diagnosed the patient to have advanced carcinoma with rapid vessel invasion and therefore chemotherapy was done first. He was treated by six cycles of combination chemotherapy, consisting of an intermittent infusion of cisplatin (1Omg/body/dayl-5/week) and a continuous infusion of 5-FU ( lOOOmg/body/24hour /day1-5/week). The chemotherapy regimen proved to be very effective. The tumor reduction rate was observed to be 68% on esophageal X-ray. After chemotherapy, no further carcinoma was found in a biopsy of the remaining mild rough mucosal membrane. The patient thus achieved a complete remission. Several areas of lymph node swelling of the left supraclavian region were observed, but we did not recognize any residual carcinoma. Nevertheless an operation was performed. A histopathological examination of the section revealed no carcinoma cells but only fibrotic changes in the proper muscular layer with no lymph node metastasis Two year and 2 months after operation, no signs of recurrence of carcinoma have been observed.論文http://purl.org/coar/resource_type/c_650

Breast cancer in an infertile woman from the use of ovulation-inducing agents : A case report with a brief literature review

We describe a case of breast cancer in an infertile woman treated with ovulation-inducing agents and in vitro fertilization-embryo transfer (IVF-ET) for six years. The patient became infertile after her first childbirth. Later, she was referred to our surgical clinic where a diagnosis of left breast tumor was made. Mastectomy and axillary nodal dissection were performed (Auchincloss procedure). Histology showed invasive ductal carcinoma (solid tubular type) and she was diagnosed pathologically stage II. She recieved radiochemotherapy and is doing well without any recurrence 1.5 years after surgery. Our patient may be the first case report of breast cancer occurrence during the treatment of infertility. The association of breast cancer with treatment of infertility is not clear.論文http://purl.org/coar/resource_type/c_650

A case of synchronous double cancer of the lung and stomach undergoing right pneumonectomy and total gastrectomy

A 60-year-old man complaining of weight loss and general fatigue was referred to our hospital because of an abnormal chest radiograph. CT scan and transbronchoscopic lung biopsy revealed lung cancer (squamous cell carcinoma,c-T3N2M0, StageIIIA). At the same time, upper gastrointestinal X-ray examination and fiber gastroscopy showed an irregularity of the mucosa near the cardia and two polyps at the pylorus. A histological diagnosis of adenocarcmoma was made from transgastroscopic biopsy. At first, a right pneumonectomy was performed because of the lung cancer. Two months later, total gastrectomy was done because of the gastric cancer. The postoperative course of both operations was uneventful. Although the patient died 18 months after his second operation due to cerebral infarction, there had been no sign of recurrence, after all, he had maintained a good quality of life more than 13 months. We conclude that such extensive procedures as combined pneumonectomy and total gastrectomy should be considered as the treatment of choice, if complete resection could be performed safely.論文http://purl.org/coar/resource_type/c_650

Preterm toddlers have low nighttime sleep quality and high daytime activity.

A number of studies have been made on the sleep characteristics of children born preterm in an attempt to develop methods to address the sleep problems commonly observed among such children. However, the reported sleep characteristics from these studies vary depending on the observation methods used, i.e., actigraphy, polysomnography and questionnaire. In the current study, to obtain reliable data on the sleep characteristics of preterm-born children, we investigated the difference in sleep properties between 97 preterm and 97 term toddlers of approximately 1.5 years of age using actigraphy. Actigraphy units were attached to the toddlers’ waists with an adjustable elastic belt for 7 consecutive days, and a child sleep diary was completed by their parents. In the study, we found that preterm toddlers had more nocturnal awakenings and more daytime activity, suggesting that preterm-born children may have a different process of sleep development in their early development