Iwaki Kyoritsu General Hospital

IntroductionSince general improvements in the prognosis of cancer patients have been achieved through advances in surgery, radiotherapy, and chemotherapy, subsequent infertility in adolescents and young adults (AYAs) has become a serious problem. Sperm quality is often abnormal at the time of testicular cancer diagnosis. Anti-cancer therapy further impairs spermatogenesis and, following orchidectomy, leaves patients with a single testis, raising long-term concerns about fertility. We therefore evaluated fertility outcomes among testicular cancer survivors attending our male infertility clinic.Materials and methodsFrom 2004 to 2023, 3,361 male infertility patients consulted our division, 117 (3.5%) of whom had a history of cancer treatment. Thirty-nine patients diagnosed with testicular cancer were evaluated for cancer treatment, semen findings, and infertility treatment. Seminoma was observed in 29 participants and non-seminomatous germ cell tumor (NSGCT) in 10 participants.ResultsNineteen patients were followed up with a high orchidectomy alone. After orchidectomy, one patient received prophylactic radiotherapy to the retroperitoneal lymph node, and three were followed by chemotherapy (BEP (bleomycin, etoposide, and platinum); BLM, VP-19/CDDP). Fifteen patients underwent retroperitoneal lymph node dissection (RPLND) after BEP. One patient received high-dose chemotherapy with peripheral blood stem cell transplantation (PBSCT), followed by RPLND, and then received additional BEP.Twenty-six patients had azoospermia, and 13 patients were oligoasthenozoospermic. Sperm retrieval surgery was attempted in 18 patients with azoospermia. Thirteen patients underwent microscopic testicular sperm extraction (micro-TESE), two received onco-TESE, two received microscopic epididymal sperm aspiration (MESA), and one received retrograde vasal sperm aspiration (ReVSA) due to reduced efficacy of medications for ejaculatory dysfunction (EJD) caused by RPLND. Motile sperm recovery was obtained through micro-TESE (5/13), onco-TESE (2/2), MESA (2/2), and ReVSA (1/1). Eleven healthy deliveries were observed following intracytoplasmic sperm injection (ICSI) using surgically retrieved sperm.ConclusionsTesticular cancer survivors, even those with azoospermia, can achieve fatherhood through ICSI after precise evaluation and appropriate sperm retrieval surgery.

The aim of this study was to investigate the reporting and methodological qualities in systematic reviews (SRs) of rehabilitation journals following updating to the use of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 statement. SRs with pairwise meta-analyses on the effects of health interventions were selected, which were published in rehabilitation journals in 2020, 2021, and 2022 using MEDLINE (PubMed). Exposure was defined as reporting use of the PRISMA 2020 statement. A comparison group consisted of SRs that did not use the PRISMA 2020 statement. The adherence of the PRISMA 2020 items, PRISMA 2020 for abstracts, and A MeaSurement Tool to Assess systematic Reviews (AMSTAR) 2 items were evaluated. Thirteen thousand, three hundred eighty-one articles were identified after conducting a search on April 2, 2023. The study included 100 articles each that used and those that did not use the PRISMA 2020 statement. Of 41 items in the PRISMA 2020 statement, 48.8% (20/41) adhered to ≥80% of each item for those that used the PRISMA 2020 statement and 41.5% (17/41) in those that did not use the PRISMA 2020 statement. The PRISMA 2020 statement did not lead to any major improvement, and only a slight improvement of 9.8% (4/41) was observed when compared with those that did not use the PRISMA 2020 statement. Similarly, no item improved in the PRISMA 2020 for abstracts, and only 5.6% (1/18) improved in the AMSTAR 2 items. This study showed that reporting use of the PRISMA 2020 statement did not result in any major improvements; however, only a slight improvement was observed in the reporting and methodological qualities of SRs in rehabilitation journals. Researchers should adhere to each item in the PRISMA 2020 statement in SRs published in rehabilitation journals. The reporting and methodological quality of systematic reviews in rehabilitation journals is insufficient. It is important to improve the reporting and methodological quality of systematic reviews in rehabilitation journals. It is recommended that researchers not only declare their reporting use of the PRISMA 2020 statement, but also adhere to each item correctly.

Plasmablastic lymphoma (PBL) is a rare B-cell lymphoma. Reports on primary gastric PBL are limited, and its endoscopic features remain poorly understood. We report a case of gastric PBL with multiple polypoid lesions in an immunocompetent individual. A 72-year-old man presented with upper abdominal discomfort. Esophagogastroduodenoscopy (EGD) revealed multiple raised lesions of variable sizes in the stomach, prompting a tumor biopsy. Based on histopathological findings, diffuse large B-cell lymphoma was suspected. Rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) chemotherapy was administered. After six cycles of R-CHOP therapy, EGD showed a partial reduction of the gastric tumor, and a biopsy was performed on the remaining tumor. Histopathology was re-examined, and immunohistochemical analysis revealed that the tumor cells were plasmablastic and strongly positive for both CD38 and CD138. The cells showed cytoplasmic immunoglobulin lambda light-chain restriction, indicating PBL. Furthermore, gastric differentiated adenocarcinoma was incidentally detected in some biopsy samples. Finally, a total gastrectomy was performed, and the postoperative course was uneventful. The patient is currently alive, 15 months after the initial diagnosis. This case reveals an endoscopic feature of gastric PBL and suggests the rare possibility that gastric PBL may coexist with adenocarcinoma.

患者は69歳，女性．10年以上前から全大腸に多発過形成性ポリープがあり，経過中に横行結腸癌の手術も受けていた．通院中断の3年間で血便を自覚し，下部消化管内視鏡検査で横行結腸髄様癌と診断，腹腔鏡下に結腸部分切除術（横行結腸）を施行．術後11日目に退院となった．

ABSTRACTBasal cell nevus syndrome (BCNS) is an autosomal dominant skin disorder characterized by multiple basal cell nevi. Patients with BCNS tend to develop basal cell carcinoma (BCC) and frequently show skeletal abnormalities. Most cases of BCNS are caused by mutations in patched 1 (PTCH1). PTCH1 encodes a transmembrane receptor protein for the secreted molecule sonic hedgehog, which plays a key role in the development of animals ranging from insects to mammals. We analyzed two Japanese BCNS patients from two independent families. Both of our patients had multiple jaw keratocysts. In one patient, these were the key to noticing his BCNS, as he had no skin tumors. The early detection of PTCH1 mutations would enable BCNS patients to be carefully followed up for the occurrence of BCC. The diagnosis of BCC at the early stage leads to prompt surgical treatments, resulting in a good prognosis. The present cases suggest that keratocysts of the jaw might be an important clue for diagnosing BCNS.

ABSTRACTWe investigated the impact of prior anticancer treatments such as chemotherapy and radiotherapy on subsequent infertility treatment in cancer survivors who consulted our male infertility division. Of 1,525 male infertility patients who consulted our division between 2008 and 2018, 56 (3.7%) were cancer survivors. Of these, 32 received anticancer treatment (group A) and 24 were treated with surgery alone or were seen before anticancer treatment (group B). Semen analysis revealed that azoospermia in 26 subjects (81.3%) and 14 (58.3%) in groups A and B respectively. Ejaculatory dysfunction was observed 1 in group A and in 2 group B subjects. Sperm cryopreservation before anticancer treatment was performed 4 subjects. Sperm retrieval surgery for intracytoplasmic sperm injection (ICSI) was performed in 13 cases in group A and 10 in group B. Motile sperm were recovered in 7 subjects and in 8 subjects in group A and B respectively. Overall pregnancies and deliveries with ICSI were achieved for 7 subjects (21.9%) in group A, and 9 (37.5%) in group B. Successful sperm retrieval may not be affected by prior anticancer treatment as shown in this study. However, some patients abandoned infertility treatment due to the cost of testing and sperm retrieval surgery. Support for the cost of infertility treatment in cancer survivors is necessary.

一般市中病院において開腹手術の手術記録として手術イラストを毎回作成している．通常のボールペンや色鉛筆を用いて，開腹所見や手術のポイントや流れなどをできるだけ分かりやすく記載している．手術イラストは，①術後できるだけ早く描き始め，②手術書や術中写真などを見ながら正確に記載し，③他医やスタッフに手術の内容が伝わるようになることを工夫し努力している．手術写真は詳細できれいであるが，情報量が多いために術者以外が記録を見たときに重要なことが伝わらない欠点がある．手術イラストは，術中情報を1枚の絵に記載することができるため術者以外の者が後で見ても，その手術の経験を追体験することができると考える．イラストは手術内容を伝えるツールとして不可欠なものだと考える．電子カルテ化された昨今の手術記録は効率的に作成できるようになっているが，手術の上達には，毎回コツコツと手術イラストを描くことが大切である．

IntroductionHip fracture is a common and serious orthopedic injury among the geriatric population, necessitating surgical treatment. We tested whether age is a significant risk factor for in-hospital mortality after surgery in this retrospective cohort study and, further, analyzed causes and pattern of death in those patients.MethodsWe queried the electronic hospital records of in-patients aged over 75 years who had undergone hip fracture surgery from the start of 2010 to the end of August 2016 in our hospital, a tertiary hospital on the main island of Japan. The extracted data included patient ID, age, gender, location of fracture, ASA-PS scores, types of anesthesia, durations of anesthesia and surgery, days of hospital stay after surgery, and outcomes at hospital discharge including in-hospital death. The extracted data were divided into two groups based on the patient’s age at the time of surgery: the aged group (age of < 85) and the advanced age group (age of ≥ 85 years), and we compared patient characteristics and management variables and discharge disposition between the two groups.ResultsEight hundred four patient records were extracted (360 in the aged and 444 in the advanced age groups). Although a smaller proportion of patients in the advanced age group could be discharged home, all-cause in-hospital mortality was also similar between the two groups (1.9 and 1.6%, aged and advanced age groups, respectively). Six patients died from advanced cancer, and five patients died of pneumonia resulting from aspiration.ConclusionsThe results of this study suggest that age is not a clinically significant risk factor for in-hospital mortality. The possibility decreasing in-hospital mortality exists in identifying patients at risk of aspiration and preventing it.