Ito Hospital

We aimed to examine the psychometric properties of the second version of the Brief Evaluation of Psychosis Symptom Domains (BE-PSD-V2.0) and its correspondence with the Positive and Negative Syndrome Scale (PANSS) and Clinical Global Impression-Severity scale (CGI-S) scores. This cross-sectional study was conducted at 18 institutes in Japan. We performed correlational analyses to test the convergent and divergent validity of the BE-PSD-V2.0. Inter-rater reliability was assessed using intraclass correlation coefficients (ICCs). The equipercentile equating method was employed to examine the linking of the BE-PSD-V2.0 with the PANSS and the CGI-S. A total of 353 patients with schizophrenia spectrum disorders were included. Spearman's rank correlation coefficients between the BE-PSD-V2.0 item scores and their corresponding PANSS factor scores ranged from 0.64 to 0.86, indicating sufficient convergent validity. These specific correlation coefficients were consistently the highest among all item-to-factor comparisons, indicating sufficient divergent validity. In 34 patients, ICCs for the BE-PSD-V2.0 itemand total scores ranged from 0.60 to 0.94, showing sufficient inter-rater reliability. Conversion tables were established between the BE-PSD-V2.0 total score and the PANSS total score, between the BE-PSD-V2.0 total score and the CGI-S score, and between the BE-PSD-V2.0 item scores and their corresponding PANSS factor scores. A correspondence between symptomatic remission criteria using the PANSS and BE-PSD-V2.0 was confirmed. The BE-PSD-V2.0 possesses sufficient psychometric properties and corresponds to the PANSS and CGI-S. It is a sound and reliable brief rating scale for assessing symptoms in schizophrenia spectrum disorders, and its established conversion correspondences facilitate score interpretation within existing clinical paradigms for both clinical practice and research.

Endocrine surgery encompasses various organ systems, but thyroid surgery represents the major component. The Japanese Association of Thyroid Surgeons published nationwide data on thyroid cancer surgery until 2005, since when no further reports have been published. Thus, we analyzed thyroid surgery trends using data from the National Clinical Database (NCD) from 2014 to 2023. We analyzed cases of thyroid surgery, for malignant and benign conditions, recorded in the NCD. A detailed analysis of papillary thyroid carcinoma (PTC) cases was conducted in 2014, 2019, and 2023 to assess TNM classification, surgical procedures, complications, and outcomes. The number of thyroid surgery facilities and the number of thyroid surgeries being performed have both declined since 2020. A trend toward more hemithyroidectomies and fewer total thyroidectomies for PTC is evident. The number of surgeries for cancers < 1cm and lateral node dissection for PTC have also decreased. Endoscopically assisted surgery has increased continuously, accounting for > 4% of thyroid operations in 2020. The incidence of permanent hypoparathyroidism has decreased and perioperative mortality is rare. The changes in surgical trends are aligned with guideline updates and shifts in surgical practice. Future efforts will refine data collection and utilize the NCD to improve thyroid surgical quality and research.

Background: There is limited information about the clinical behavior and no standardized treatment guidelines for primary thyroid lymphoma (PTL). Prognostic factors and treatment outcomes remain poorly defined despite diagnostic and therapeutic advancements. We evaluated PTL survival outcomes and treatment strategies, using a large population-based cohort from the Tokyo Cancer Registry (TCR), a government-operated database that systematically collects cancer incidence and outcome data in Tokyo, Japan. Patients and Methods: This retrospective, population-based study analyzed PTL cases registered in 2012-2020 in the TCR. The patients (n = 401) were identified through an International Classification of Diseases for Oncology, third edition topography code C73.9 (thyroid gland) and nonthyroidal lymphoma ICD-10 codes. Results: The median follow-up was 3.3 years (interquartile range, 1.2-5.5 years). Disease-specific mortality was concentrated in the first two years postdiagnosis, particularly in the initial six months. Advanced age (≥80 years) and diffuse large B-cell lymphoma (DLBCL) were associated with poorer overall survival (OS) and disease-specific survival (DSS). The current lymphoma staging systems do not significantly differentiate survival outcomes. Favorable outcomes were observed with localized treatments, including curative surgery alone, for stage IE PTL. Conclusions: Disease-specific mortality was highest in the first two years, particularly the first six months, highlighting this as a critical management period and the importance of timely treatment. Despite recent treatment advances that have improved the overall prognosis and reduced prognostic differences among disease stages, age at diagnosis and histological subtype remain key OS and DSS determinants, with older patients and DLBCL patients experiencing poorer outcomes. Notably, favorable outcomes were observed in selected Stage IE cases treated with surgery alone, suggesting that less-intensive treatment may be appropriate for certain PTL patients.

Some patients with Graves’ disease (GD) develop hypothyroidism after antithyroid drug (ATD) treatment and are found to be positive for thyroid stimulation-blocking antibody (TSBAb). However, thyroid volume (TV) changes throughout this process remain unclear. Therefore, we aimed to quantify TV changes before and after hypothyroidism onset in patients with GD harboring TSBAb and compare them with those in patients with GD who developed hypothyroidism without TSBAb or achieved remission with ATD. This retrospective study evaluated TV changes using ultrasonography in three groups: 10 patients with GD who developed hypothyroidism with TSBAb (TSBAb(+)-hypo group), nine without TSBAb (TSBAb(–)-hypo group), and 91 who achieved remission after ATD treatment (Remission group). In the TSBAb(+)-hypo group, TV significantly decreased from the hyperthyroid to hypothyroid phase (median: 33.3 mL [range: 14.2–52.0] vs. 13.6 mL [4.3–23.3], respectively; p = 0.001). In the TSBAb(–)-hypo group, TV significantly decreased from the hyperthyroid to hypothyroid phase (26.6 mL [11.9–49.2] vs. 20.9 mL [7.4–34.2], respectively; p = 0.037). In the Remission group, TV also decreased significantly from the hyperthyroid to remission phase (29.8 mL [8.2–88.4] vs. 25.1 mL [9.5–72.0], respectively; p = 0.0002). The decrease in TV was significantly higher in the TSBAb(+)-hypo group than in the TSBAb(–)-hypo and Remission groups (53.9% [37.9–74.5] vs. 30.9% [–22.3 to 63.0] and 10.7% [–100.7 to 52.0], respectively; p = 0.027 and <0.0001). This study documents the first precise measurement of TV reduction using ultrasonography in patients with GD who developed hypothyroidism with TSBAb, showing a markedly greater decrease than in those without TSBAb or in remission after ATD treatment.

Screw-related complication rates after the Bristow-Latarjet procedure vary in studies. Hence, we utilized an arthroscopic-assisted conjoined tendon-coracoid tip complex transfer combined with Bankart repair without screws for anterior recurrent shoulder instability. This retrospective analysis of prospectively collected data included 51 shoulders in 48 patients (39 males, 9 females) who underwent the procedure with a mean age of 24.8 years (range, 15-69 years). Clinical assessments included the American Shoulder and Elbow Surgeons, Constant, Rowe, and Western Ontario Shoulder Instability Index scores. Postoperative complications, including recurrent instability (dislocation, subluxation, or positive apprehension sign), and revision surgeries, were documented. Computed tomography scans were utilized to evaluate postoperative graft healing status. Clinical scores demonstrated significant improvement from preoperative levels to the final follow-up without revision surgery. Two patients (3.9%) experienced traumatic recurrent shoulder instability (subluxation) at 7 and 9 months postoperatively. At a mean follow-up of 26.7 months (range, 24 to 42), one of these patients reported satisfaction due to the absence of apprehension signs, whereas the other expressed mild satisfaction despite persistent apprehension. Forty-three (84.3%) coracoid grafts achieved complete healing with the scapular neck, whereas 4 (7.8%) exhibited partial healing, 3 (5.9%) showed resorption, and 1 (2.0%) experienced graft migration. Implant migration was not observed. The index procedure effectively improved shoulder stability and function, achieving a relatively high rate of coracoid graft union with no requirement for revision surgeries at a mean follow-up of 26.7 months.

Understanding the trajectory of complications following total pharyngolaryngectomy (TPL) with free jejunal transfer (FJT) is crucial for enhancing patient management and improving surgical outcomes. However, the traditional Clavien-Dindo classification captures only the highest grade of complication and is unable to capture the progression of complications, limiting its utility for longitudinal assessments. This study utilized the comprehensive complication index (CCI) to provide a continuous evaluation of complications over time. This retrospective observational study included patients who underwent TPL with FJT between 2018 and 2023. Daily postoperative complications were tracked using the CCI, calculated from postoperative day 1 to day 30. A group-based trajectory model was employed to classify patterns of change in daily CCI. The predictive power of early CCI for a subsequent serious complication course was evaluated using receiver operating characteristic curve analysis. The trajectory modeling for a total of 161 eligible patients identified three distinct complication trajectories: no complication (n = 80), moderate (n = 66), and severe (n = 15). Initial CCI values were predictive of the severe complication course: a cutoff value of 8.7 for the CCI on postoperative day 2 provided an area under the curve of 0.926 with 86.7% sensitivity and 93.8% specificity. Complication trajectories after TPL with FJT can be effectively categorized using the CCI, providing insights beyond the traditional grading systems. Early identification of the severe complication course allows for targeted interventions that may improve patient outcomes.

〔目的〕両大腿骨頸部骨折患者に対し，体幹前傾角に着目した理学療法を実施し，結果を考察した．〔対象と方法〕自宅で転倒し，左右大腿骨頸部骨折の診断で入院となり，骨接合術と人工骨頭挿入術を受けた80歳代の一女性を対象に，膝蓋下脂肪体（Infrapatellar Fat Pad：IFP）のストレッチ，大殿筋の筋力練習やタイミング練習を実施した．〔結果〕IFPの圧痛やHoffa testは右左とも陰性となり，体幹前傾角は右19°から11°，左13°から7°と左右とも軽減した．歩行時痛は，10段階のNumerical Rating Scaleで，右膝前面が6から0，左膝前面が4から0となった．〔結語〕IFPや大殿筋への理学療法実施により体幹前傾角は軽減し，両膝前部痛は消失した．

The impact of suture materials on surgical site infections (SSIs) has been well documented in various surgical fields; however, it has not been thoroughly examined in oral oncological surgery with free-flap reconstruction. This study aimed to evaluate the incidence of oral SSIs associated with the use of monofilament and braided sutures for flap fixation. A retrospective chart review of patients who underwent oral oncological resection with free-flap reconstruction was conducted between May 2020 and April 2024. Either monofilament (4-0 PDS® II or Monodiox®) or braided (3-0 Vicryl®) suture was used for flap suturing. The primary outcome was the incidence of oral SSIs, defined according to the guidelines of the United States Centers for Disease Control and Prevention. Multivariable logistic regression and inverse probability of treatment weighting based on propensity scores were used to estimate the risk differences. Of 209 eligible patients, 58 experienced oral SSIs, resulting in an incidence of 27.8%. Monofilament sutures were used in 174 patients and braided sutures in 35. The incidence of oral SSIs was higher in the braided suture group (42.9%) than in the monofilament suture group (24.7%). Analysis using propensity scores revealed a significantly higher risk of oral SSIs associated with braided sutures than with monofilament sutures, with a 18.5% risk difference (95% confidence interval, 2.1%-34.9%; P = 0.027). Braided sutures may pose an increased risk of SSIs in oral oncological surgeries with free-flap reconstructions. Monofilament sutures are recommended for reconstructions, especially of the floor of the mouth.