Kamiichi General Hospital

Canine cutaneous epitheliotropic lymphoma (CEL) is a rare neoplastic disease with poor prognosis. Oclacitinib, a Janus kinase inhibitor primarily used to treat allergic and atopic dermatitis in dogs, may also cause other skin diseases. This study aimed to evaluate the efficacy of oclacitinib in the treatment of canine cutaneous lymphoma. Eight client-owned dogs with CEL were included in the study. The dogs were administered oclacitinib. This study examined the immunological characteristics, time to treatment initiation, dosage, cutaneous lesions and pruritus, adverse events, survival time and prior oclacitinib use. Only one of the eight dogs (12.5%) showed symptomatic improvement after oclacitinib treatment, with no clinical improvement observed in the other cases. Improvement in pruritus was noted in only one dog. Adverse events included mild leucopenia in one dog, which did not significantly affect prognosis. The median survival time after diagnosis was 228.5 days. These results suggest that oral oclacitinib has limited efficacy in the treatment of canine CEL. Larger prospective studies are recommended to further investigate the optimal dose, treatment duration and potential combination therapies involving oclacitinib.

PurposeA cyst-like structure near superior sagittal sinus (Arachnoid Cuff Exit Site cysts: ACES cysts) has been reported in MRI. The purpose of this study was to investigate the association between presence of ACES cysts and cognitive function, as assessed using mini-mental state examination (MMSE) scores.MethodsWe retrospectively analyzed patients who underwent head MRI for dementia screening. Differences in patient ages and MMSE scores between patients with and without ACES cysts were examined using the Mann-Whitney U test. Correlations between patient ages and MMSE scores were examined for patients with and without ACES cysts using Spearman’s rank correlation coefficient. Multivariate logistic regression analysis was performed to examine the influence of presence or absence of ACES cysts on MMSE score.ResultsA total of 112 patients (male: 28, female: 84) were included for the analysis. The patient ages ranged from 66 to 94 years (median: 83 years). MMSE scores ranged from 6 to 30 (median: 24). ACES cysts were detected in 57 patients (50.9%). There was no significant difference in patient ages between the patients with and without ACES cysts (P = 0.058). The patients with ACES cysts showed significantly lower MMSE scores compared to the patients without ACES cysts (P < 0.001). In the patients with ACES cysts, there was no significant correlation between patient ages and MMSE scores (ρ = −0.178, P = 0.185), whereas a significant negative correlation was observed in the patients without ACES cysts (ρ = −0.347, P = 0.001). The presence of ACES cysts was determined as an independent predictor for the lower MMSE score (odds ratio = 15.2, 95% confidence interval = 5.59–41.4, P < 0.001).ConclusionThe presence of the ACES cysts showed significant association with lower MMSE score. ACES cysts might be involved in the pathological processes affecting cognitive function.

伏在型下肢静脈瘤治療時，下腿部大伏在静脈（BK-GSV）併用処置の効用は議論中である．伏在型下肢静脈瘤1,791下肢に対し，初回治療時に高位結紮術（2カ所）と伏在静脈本幹および下腿静脈瘤の硬化療法を併用し，術後3カ月時点でBK-GSV閉塞群（1,632下肢），開存し逆流なし群（62下肢），開存し逆流あり群（97下肢）の3群で，BK-GSV累積逆流出現率，BK-GSV逆流による累積再発率を比較検討した．BK-GSV 10年累積逆流出現率は閉塞群37.1%，開存し逆流なし群72.6%であった．BK-GSVに起因する10年累積再発率は閉塞群7.2%に対し，開存し逆流なし群42.3%，開存し逆流あり群45.3%であった．いずれも閉塞群で有意に低かった．本法はBK-GSV逆流出現率およびBK-GSV逆流による再発率を減少させ，伏在型下肢静脈瘤治療の長期成績改善に有用と考えられた．

The long-term use of surgical masks to combat coronavirus disease 2019 may irritate the skin. A 67-year-old man developed a laceration on the auricle due to prolonged wearing of a mask. The patient had poor self-management skills and was required to wear masks. The torn auricular cartilage was surgically repaired. At four months post-operation, the auricular morphology had improved, and the scar was no longer visible. Continuous wearing of surgical masks can increase the risk of lacerations on the auricle, which can be sutured and healed within a short period. The proper use of regular breaks from masks is recommended. A medical device-related pressure ulcer of the auricle associated with surgical mask use is likely to occur in the left auricle of men with psychiatric disorders.

Background: Transient epileptic amnesia (TEA) is a special type of mesial temporal lobe epilepsy manifesting recurrent amnesia attacks as the main symptom. Patients with TEA often demonstrate two other types of memory symptoms: accelerated long-term forgetting (ALF) and autobiographical amnesia (AbA). In our previous reports, we presented two clinical cases in which the patients showed symptoms of ALF and/or AbA without any type of epileptic seizure, including TEA attacks. Based on these cases and a literature search, we proposed a new clinical entity, which we named ‘transient epileptic amnesia complex syndrome (TEACS)’. We also proposed a new type of neurocognitive disorder, which we named ‘epileptic cognitive impairment resembling Alzheimer's disease (ECI-A)’.

This study aimed to investigate the association between prolonged preoperative sedentary time (ST) and postoperative ileus (POI) after adjusting for confounders in patients with colorectal cancer (CRC). This single-center retrospective study enrolled 155 consecutive patients who underwent surgery for primary CRC. A diagnosis of POI was made by the surgeons if the Clavien-Dindo classification (CD) grade is ≥ 2 within 30days after surgery. Preoperative ST was assessed using the International Physical Activity Questionnaire usual week short version (Japanese version). Patients were classified into two groups (ST < 6h/day and ST ≥ 6h/day) based on results from the questionnaire, and data were analyzed using a propensity score-matching strategy to adjust for confounders. In addition, receiver operating characteristic (ROC) curve analysis was performed to identify the optimal cutoff value of preoperative ST for predicting POI. Of the 155 patients, 134 were included in the analysis. POI occurred in 16 (11.9%) patients of overall patients and 11 (12.5%) of the 88 matched patients. The logistic regression analysis after propensity score-matching showed that prolonged preoperative ST (ST ≥ 6h/day) was associated with POI (odds ratio 5.40 (95% confidence interval: 1.09 - 26.60), p = 0.038). The ROC curve analysis indicated that the optimal cutoff value of preoperative ST for predicting POI was 6h/day. Prolonged preoperative ST is a risk factor for POI in patients with CRC. Therefore, reducing preoperative ST may play an important role in preventing POI.

BackgroundInterprofessional collaboration in the community is becoming essential in primary care, particularly collaboration between public health nurses and general practitioners. However, the precise value of such collaboration has not been sufficiently studied. The purpose of this study was to conduct a qualitative analysis of collaboration between general practitioners and public health nurses in the community to explore the details of the phenomenon and its possible impact on the community.MethodsSince 2015, The University of Toyama has been implementing the Collaborative Health Activities Project, in which general practitioners and public health nurses work together to promote community health. Focus group and individual interviews were conducted with participating staff, and the data were analyzed qualitatively.ResultsFifteen themes were generated, in six categories. The categories were as follows: enhanced roles of public health nurses and physicians in the community, new perspectives on the community, public health nurses' sense of trust and empathy toward physicians, bonds of solidarity between public health nurses and physicians, proactive change in residents, and supporting “hangout places”.ConclusionThe collaboration between general practitioners and public health nurses familiar with the same community fostered a sense of trust and empathy and created the bonds of solidarity between staff and residents. The results also suggest the collaboration may have a positive impact on the local community by inspiring residents to change proactively and supporting “hangouts” where residents and professionals can informally connect.

IntroductionGeneral internists in Japanese hospitals sometimes consult on adolescents. Our university hospital encounters more adolescents with mental health complaints than other city hospitals. Consequently, based on our experience, we hypothesized that psychiatric disorders are significantly more common among teenagers who visit general internists. Therefore, we retrospectively analyzed the clinical profiles of teenage outpatients who visited general internists at three hospitals to test this hypothesis.MethodsThis study included 342 patients aged 13-19 years who visited the Departments of General Internal Medicine at Toyama University Hospital, Nanto Municipal Hospital, and Kamicichi General Hospital between January 2019 and December 2021. Data on age, sex, chief complaint, the period from onset to visit, referral status, and final diagnosis were collected from medical records. We also identified the final diagnoses of 1,375 outpatients from the university hospital during the same period, stratifying them by age. Multiple comparison analyses, Chi-squared tests, and residual analyses were performed to analyze the data.ResultsThe number of psychiatric teen patients was significantly higher in the university hospital group than in the other city hospital groups (p<0.01). The incidence of psychiatric disorders, such as stress-related mental disorders, including adjustment and eating disorders (p<0.001), was also significantly higher in the teenage group (13-19 years) than in other age groups. Most psychiatric disorders lead to complaints of physical symptoms.ConclusionsThe potential onset of clinical episodes during consultations with teenage patients can make treating this age group more challenging; thus, they may require care at university hospitals. Furthermore, Japanese general internists in university hospitals encounter patients in their late teens with physical signs more often than in other hospitals. This trend may be unique to general medicine departments (“Sogo-Shinryo”) in Japanese university hospitals. However, if general internists act under primary care principles, they can adequately assist adolescent patients.

β-ray strontium-89 (Sr-89) intra-irradiation therapy has been approved and clinically used to reduce bone metastasis pain not alleviated by bone-modifying agents, external radiation, and analgesic agents. We examined the efficacy of zoledronic acid (ZOL) and Sr-89 combination therapy compared with ZOL alone in breast cancer patients with bone metastases. A randomized controlled trial was conducted on breast cancer patients with bone metastasis to compare the efficacy between ZOL monotherapy and ZOL plus Sr-89 combination therapy. The primary endpoints were changes in urinary NTX levels at 13weeks and brief pain inventory scores. The secondary endpoints were analgesic drug usages, response rates, changes in bone metabolism markers, quality of life, and adverse event rates. Thirty of the planned 60 cases were randomly assigned to ZOL alone or ZOL + Sr-89. There were no significant differences in the changes in urinary NTX levels between the 2 groups (P = 0.365). There was no consistent difference in the pain score changes between the 2 groups. Sr-89 addition to ZOL slightly reduced the white blood cell and platelet counts. However, all adverse events were Grade 1. Safety and analgesic drug dose reduction were more evident in ZOL + Sr-89. This trial showed the lack of benefits from Sr-89 addition to ZOL for breast cancer patients with painful bone metastases. However, safety and analgesic drug dose reduction were more evident in ZOL + Sr-89, indicating its potential for pain control. Sr-89 therapy is safe, thus more effective radiopharmaceuticals are anticipated.