Matsuyama Shimin Hospital

症例は45歳，女性．2024年に乳がん検診にて左側胸部に皮下腫瘤を指摘され精査目的で他院を受診した．MRI検査で左第5肋間を貫通し胸腔内外におよぶ4.5 cm大の腫瘤が指摘され，脂肪組織と同程度の信号域を呈し，脂肪腫または脂肪肉腫が疑われ，手術目的で当科を紹介された．手術に際しては，最初に経皮的針生検を行い術中迅速病理組織診断で良性脂肪組織と診断し，胸腔鏡下に腫瘍切除術を行った．永久病理組織検査で胸腔内砂時計型脂肪腫と確定診断した．胸腔内脂肪腫は比較的稀な疾患で，胸腔内限局型と砂時計型に分類され，砂時計型はさらに稀である．胸腔鏡下に切除した砂時計型胸腔内脂肪腫を報告する．

Aim: Early vancomycin-associated acute kidney injury (AKI) identification is important during the initial dosing period when non–steady-state pharmacokinetic exposure may influence nephrotoxicity risk. We aimed to conduct a multicentre retrospective cohort study of hospitalised adult patients who received vancomycin at three tertiary care hospitals in Japan between April 2019 and March 2024. Methods: Early area under the concentration–time curve (AUC) metrics, trough concentrations, concomitant medications, and comorbidities were used to develop and compare machine learning models to predict vancomycin-associated AKI. Eleven algorithms were evaluated using a nested cross-validation framework to minimise optimistic bias and prevent data leakage. Results: Among 442 patients (median age 72 years), AKI occurred in 5.7%. Across models, day 2 AUC and trough concentration consistently emerged as the most influential predictors, followed by concomitant use of piperacillin/tazobactam, diuretics, and vasopressors. The random forest model showed the best overall discriminative performance (area under the receiver operating characteristic curve 0.89; area under the precision–recall curve 0.47). Shapley additive explanations revealed nonlinear increases in AKI risk at approximately day 2 AUC ≥ 550 mg·h/L and trough concentration ≥ 20 μg/mL. These findings indicate that early vancomycin exposure, particularly cumulative exposure within the first 48 h, is strongly associated with AKI risk. Conclusion: Machine learning models incorporating early AUC metrics with trough concentrations may provide a clinically informative framework for early risk stratification during vancomycin therapy and support further evaluation of early AUC-guided dosing strategies with trough concentrations as complementary exposure markers.

While decreased renal function is a known risk factor for hypermagnesemia caused by magnesium oxide (MgO), few studies have comprehensively investigated other contributing factors. In this study, the researchers analyzed the risk factors for hypermagnesemia development in 256 inpatients receiving MgO treatment at the Matsuyama Shimin Hospital. Multivariate analysis identified blood urea nitrogen ≧22 mg/dL, estimated glomerular filtration rate ≦43.1 mL/min, and MgO ≧1000 mg/d as risk factors. Additionally, the researchers' findings suggest a correlation between the number of risk factors and the incidence of hypermagnesemia, including the prevalence of Grade 3 cases. Interestingly, low body mass index emerged as a potential risk factor even in patients without the three identified factors. These findings highlight the importance for pharmacists to advocate for routine serum Mg level monitoring in patients with the risk factors identified in this study.

The purpose of this study was to investigate factors that influence clinical outcomes after anterior cruciate ligament (ACL) reconstruction in patients aged ≥40 years. We studied 264 patients aged ≥40 and 154 patients aged ≤20 years who underwent ACL reconstruction at several surgical centers. A logistic regression analysis was conducted to identify factors that influenced the Knee Injury and Osteoarthritis Outcome Score (KOOS) at 1 year post-ACL reconstruction. In the older patient group, cartilage damage in the patellofemoral compartment at surgery was a significant risk factor for poor postoperative KOOS subscores (pain, activities of daily living [ADL], sports, and quality of life [QOL]). Articular cartilage damage in the lateral compartment also significantly influenced one of the postoperative KOOS subscores (symptoms). In the younger patient group, articular cartilage damage in any compartments did not influence the postoperative KOOS subscores; only two preoperative KOOS subscores (symptoms and QOL) significantly influenced their postoperative KOOS subscores. We concluded that the articular cartilage damage in the patellofemoral compartment at ACL reconstruction predicts poor KOOS subscores at the 1-year follow-up in patients aged ≥40 years. STUDY DESIGN: Cohort study (Prevalence); Level of evidence, 2.

An 80-year-old woman who had been diagnosed with an endobronchial carcinoid tumor visited our hospital for treatment with an endoscopic technique. However, a bronchoscopic examination at our hospital showed spontaneous regression of the tumor at the orifice of the right middle lobar bronchus. Chest computed tomography five months later revealed no local recurrence. This is the second report of an endobronchial carcinoid tumor vanishing after an endoscopic biopsy.

Occupational exposure of anticancer agents during their preparation has been recognized as a serious hazard. Closed system drug transfer devices (CSTDs) enable “safe” preparation of agents for medical personnel and ensure a safe hospital environment. However, artificial particles of infusion materials have been reported during CSTD use. Here, the incidence of insoluble fine particles during preparation of anticancer agents using CSTDs was examined. Visible insoluble fine particles were found in 465 (9.4%) of 4948 treatment cases at Ehime University Hospital with CSTD use. Contaminants occurred more frequently during preparation of monoclonal antibodies than cytotoxic anticancer agents (19.4% vs. 4.1%, respectively, P < 0.01). A similar survey was conducted at nine hospitals to investigate the incidence of insoluble fine particles with or without CSTDs. Insoluble fine particles were detected in 113 (15.4%) of 732 treatment cases during preparation of monoclonal antibodies with CSTD use. In contrast, the occurrence of insoluble fine particles without CSTDs was found in only 3 (0.073%) of 4113 treatment cases. Contamination with CSTDs might cause harmful effects on patients during cancer therapy. We strongly recommend the use of in-line filters combined with infusion routes after CSTD use to avoid contamination-associated adverse events.

Most patients with pancreatic cancer are ineligible for curative resection at diagnosis, resulting in poor prognosis. This study aimed to evaluate the prognostic factors in patients with unresectable pancreatic cancer.We retrospectively collected clinical data from 196 patients with unresectable pancreatic cancer who received palliative chemotherapy (N = 153) or palliative care alone (N = 43) from January 2011 to December 2013. Patients’ background data and overall survival were analyzed using the Cox proportional hazard regression model.In patients receiving palliative chemotherapy (gemcitabine-based regimen, 88.2%) and palliative care alone, the median (range) ages were 68 (43–91) and 78 (53–90) years, and metastatic diseases were present in 80% (N = 123) and 86% (N = 37), respectively. Multivariate analysis in the palliative chemotherapy patients showed that liver metastasis (hazard ratio [HR] 2.25, 95% confidence interval [CI] 1.58–3.20, P < .001), neutrophil-to-lymphocyte ratio (>4.5 vs ≤4.5; HR 3.45, 95% CI 2.22–5.36, P < .001), and cancer antigen 19-9 (CA19-9) (≥900 vs <900 U/mL; HR 1.45, 95% CI 1.02–2.05, P = .036) were independent prognostic factors. In those receiving palliative care alone, lung (HR 3.27, 95% Cl 1.46-7.35, p = 0.004) and peritoneum (HR 2.50, 95% CI 1.20–5.18, P = .014) metastases and the C-reactive protein-to-albumin ratio (≥1.3 vs <1.3; HR 3.33, 95% Cl 1.51–7.35, P = .003) were independent prognostic factors. Furthermore, patients with multiple factors had worse prognosis in both groups. Median survival time of palliative chemotherapy patients with risk factors 0, 1, 2, and 3 were 13.1 (95% CI 8.0–16.9), 9.4 (95% CI 7.9–10.1), 6.6 (95% CI 4.9–7.8), and 2.5 (95% CI 1.7–4.0) months, respectively. Similarly, median survival time was 5.7 (95% CI 1.3 -8.0), 2.1 (95% CI 1.5–3.9), and 1.3 (95% CI 0.6–1.7) months, respectively, for palliative care alone patients with risk factor 0, 1, and 2 to 3.Prognostic markers for pancreatic cancer were neutrophil-to-lymphocyte ratio, liver metastasis, and CA19-9 in patients undergoing palliative chemotherapy and C-reactive protein-to-albumin ratio and lung/peritoneum metastases in patients undergoing palliative care alone. These simple markers should be considered when explaining the prognosis and therapeutic options to patients.