Saitama Medical University

This review addresses the surgical management of pediatric nasal septal deviation. We discuss the challenges and considerations unique to children, including growth-related timing decisions, surgical techniques, and potential impacts on craniofacial development and quality of life. A narrative synthesis of recent literature was conducted. Key topics reviewed include the epidemiology of septal deviation in children, associations with complications (e.g. obstructive sleep apnea, sinusitis, cognitive or behavioral effects), timing of intervention in relation to septal growth, operative methods and preservation strategies, and complication rates and outcomes data. The prevalence of septal deviation in children is approximately 30%. Alone it rarely causes severe nasal obstruction, but in combination with conditions such as allergic rhinitis or adenoid hypertrophy it contributes significantly to symptomatology. Untreated nasal obstruction has been linked to craniofacial growth disturbances, sleep-disordered breathing, behavioral issues, and academic decline. Multiple authors now support that septal surgery can be safely performed in children aged six years and older without major detrimental effects on midface development. Critical technical principles include maximal conservation of cartilage and bone (especially in dorsal and caudal zones), avoidance of nasal floor mucosa dissection, and preservation of growth-center zones. Reported complications are low, but revision rates in pediatric septorhinoplasty remain higher than in adults (∼13.5%). Data accumulation suggests pediatric septal surgery is increasingly safe when performed with conservative technique. Surgical indication should be considered in children aged ≥6 who present with septal deviation resistant to medical therapy and who suffer complications such as snoring, OSA, recurrent sinusitis, or severely impaired quality of life. Meticulous operative planning with maximal structural preservation is paramount to optimize outcomes and minimize growth disruption.

In this nationwide retrospective study, we sought to evaluate the oncologic and functional outcomes and safety of transoral surgery (TOS) for hypopharyngeal and laryngeal squamous cell carcinomas in Japan and to clarify the appropriate indications for various TOS modalities. Data were obtained from the Head and Neck Cancer Registry of Japan. Patients who underwent transoral or endoscopic resection between 2011 and 2016 were selected. Detailed clinical information was collected from 55 institutions using web-based case report forms. Surgical modalities analyzed included endoscopic mucosal resection (EMR), endoscopic submucosal dissection (ESD), endoscopic laryngopharyngeal surgery (ELPS), transoral laser microsurgery (TLM), and transoral videolaryngoscopic surgery (TOVS). In total, 1825 patients were included (hypopharyngeal cancer, 62.5 %; laryngeal cancer, 37.5 %). Most cases (77.5 %) were T1 or lower, and 90.8 % were Stage II or earlier. TLM is predominantly used for glottic cancers, ELPS/ESD for superficial hypopharyngeal lesions, and TOVS for more advanced tumors, reflecting distinct indications for each modality. The 5-year disease-specific survival (DSS), recurrence-free survival (RFS), and overall survival (OS) were 97.1 %, 84.3 %, and 85.4 %, respectively. The laryngeal preservation rate was 98.2 %. Tracheostomy was performed in 5.0 % of cases, mainly for airway protection; major complications, including pneumonia (2.4 %), hemorrhage (1.1 %), fistula formation (0.4 %), and vocal cord fixation (2.6 %), occurred in <3 % of patients. Postoperative functional outcomes were favorable, with persistent dysphagia (Functional Outcome Swallowing Scale stage ≥ 3) in 1.6 % and tube feeding dependence in 1.8 %. Non-robot-assisted TOS demonstrated excellent oncologic control and functional preservation of the larynx with low complication rates in early-stage hypopharyngeal and laryngeal cancers. Each surgical modality has distinct indications depending on the tumor site, depth of invasion, and institutional expertise. These findings support the use of TOS as a safe and effective treatment option for selected patients. Further procedural standardization and data accumulation are required to refine the indications and facilitate their broader adoption in clinical practice.

As populations age worldwide, breast cancer mortality among older patients continues to rise despite therapeutic advances. This study investigates differences in treatment patterns and outcomes between older and younger patients with metastatic breast cancer. We analyzed clinical data from the Advanced Breast Cancer Database (ABCD) maintained by the Japanese Breast Cancer Research Group. The dataset included patients registered between June 1, 2020, and October 31, 2023, encompassing clinicopathologic information, treatment details, breast cancer specific survival (BCSS), and overall survival (OS). A total of 1629 patients were included. The frequency of chemotherapy and genomic testing decreased with age, yet patients in their 70s demonstrated treatment durations and survival outcomes comparable to those of younger patients. In contrast, patients aged ≥ 80years exhibited shorter duration of second-line therapy (adjusted HR:0.65, 95% CI: 0.43-1.04) and poorer OS (adjusted HR:0.62, 95% CI: 0.37-1.04) and BCSS (adjusted HR:0.66, 95% CI: 0.38-1.14), despite most deaths being attributable to breast cancer rather than non-cancer-related causes. This multicenter retrospective study demonstrates that patients in their 70s can achieve comparable benefits from systemic therapy to younger individuals, emphasizing the importance of not withholding treatment based solely on chronological age. Conversely, the limited effectiveness of later-line therapies in patients aged ≥ 80 highlights the need for individualized treatment strategies that balance efficacy, quality of life, and comorbidities through comprehensive geriatric assessment and shared decision-making.

Abstract Introduction Maintaining dose intensity is essential for the efficacy of adjuvant S-1 chemotherapy in gastric cancer. Although pharmacist interventions can reduce toxicity and improve adherence, multicenter evidence regarding their impact on dose maintenance is limited. Aim This study aimed to evaluate the impact of continuous pharmacist intervention on treatment completion and relative performance (RP) value in patients receiving adjuvant S-1 chemotherapy for gastric cancer. Methods This multicenter retrospective study analysed 225 patients across 12 institutions, categorised into continuous intervention (n=97) and non-continuous intervention (n=128) groups. Continuous intervention was defined as systematic monitoring and management for at least 50% of the treatment duration. Inverse probability of treatment weighting adjusted for baseline covariates. The primary and secondary endpoints were the eight-cycle completion rate and the RP value, respectively. Results Eight-cycle completion rate did not differ significantly between the continuous and non-continuous intervention groups (53.0% vs. 55.2%, p = 0.775), nor did the frequency of treatment modification events, including discontinuation or dose reduction. However, the RP value was significantly higher in the continuous intervention group than in the non-continuous intervention group (73.7% vs. 64.9%, p = 0.038), a finding robustly supported by sensitivity analysis between these two groups (75.1% vs. 61.1%, p = 0.0008). The continuous group maintained a high intervention rate (89.1%) throughout the final cycle, providing significantly more supportive care interventions than the non-continuous intervention group (53.2% vs. 4.9%, p &lt; 0.001). Conclusion Although continuous pharmacist intervention did not improve the binary completion rate, it was essential for maintaining RP values above the clinically essential 70% threshold through proactive toxicity management and dynamic dose optimization. These findings suggest that systematic pharmaceutical care contributes significantly to ensuring the quality and intensity of adjuvant chemotherapy.

Intravesical Bacillus Calmette-Guérin (BCG) therapy is an established treatment for non-muscle-invasive bladder cancer, involving direct instillation of a solution containing attenuated Mycobacterium bovis into the bladder. Although generally well-tolerated, rare vascular complications, including mycotic aneurysms and aortoenteric fistulas, have been reported. We report the case of a 76-year-old Japanese man who developed an aortoesophageal fistula three years after completing intravesical BCG therapy for superficial bladder carcinoma. The patient initially presented with bilateral lower limb pain following thoracic endovascular aortic repair. During hospitalization for lumbar pyogenic spondylitis, M. bovis was isolated from both sputum and spine biopsy cultures and confirmed using single-nucleotide polymorphism analysis. Despite the initiation of antimycobacterial therapy with rifampicin, isoniazid, ethambutol, and levofloxacin, he developed hematemesis and upper abdominal pain. Computed tomography findings were highly suggestive of an aortoesophageal fistula. The patient underwent successful surgical repair followed by a prolonged course of antimycobacterial therapy for at least ten months. To our knowledge, this is the first documented case of an aortoesophageal fistula caused by M. bovis following intravesical BCG therapy. Clinicians should maintain a high index of suspicion for this life-threatening complication in patients presenting with vascular abnormalities, hematemesis, or abdominal pain following BCG therapy, regardless of the time interval since treatment. Early recognition and aggressive management are essential for improving the outcomes of this rare but life-threatening condition.

Statins are generally recommended to be discontinued once pregnancy is recognized; however, unintentional exposure during early pregnancy may occur in women receiving long-term lipid-lowering therapy, and clinical decision-making often requires careful consideration of potential risks and benefits. We aimed to evaluate the risk of congenital anomalies detected at 1 month and perinatal outcomes among infants born to women exposed to statins during early pregnancy (4–13 weeks of gestation) in Japan. Using data from the Japan Drug Information Institute in Pregnancy database (2005–2017), we compared pregnant women exposed to statins during early pregnancy (statin-exposed group) and unexposed controls. Neonatal congenital anomalies at 1 month among live births were the primary outcome; secondary outcomes included pregnancy outcomes such as live birth, miscarriage, abortion, and stillbirth. Propensity score matching (1:1) was conducted to estimate the associations between statin exposure and pregnancy outcomes, and inverse probability weighting was performed using stabilized weights as a sensitivity analysis. Among 968 eligible pregnant women, 65 were in the statin-exposed group and 903 in the control group. After propensity score matching, the prevalence of congenital anomalies did not significantly differ between the statin-exposed (1.6%) and control (1.6%) groups, however, estimates were imprecise (odds ratio: 1.00; 95% confidence interval: 0.06–15.99). Increased risks of preterm birth (risk ratio: 4.26 [2.02–8.99]) and low birth weight (risk ratio: 3.32 [1.73–6.36]) were observed in the IPW analysis but not in the primary PSM analysis. No increase was observed in congenital anomalies detected at 1 month among live births following early statin exposure, although the estimates were imprecise and the study was underpowered for rare outcomes. Higher risks of preterm birth and low birth weight were observed in weighted analyses but not in the primary propensity score–matched analysis. Further research is needed to clarify perinatal risks associated with statin use in pregnancy. These findings may help inform individualized shared decision-making for women who require statin therapy during pregnancy.

It is becoming increasingly important to investigate not only micro-/macrovascular complications, but also comorbidities associated with diabetes. In the Asahi Diabetes Complications Study (Asahi Study), in addition to micro-/macrovascular complications, the onset and progression of dementia and sarcopenia were also investigated in patients with diabetes. The Asahi Study is a prospective 8-year observational cohort study of subjects with diabetes receiving outpatient care at the Institute of Medical Science, Asahi Life Foundation. Participants were enrolled between November 2014 and December 2017. The baseline data include the age, HbA1c level, and median duration of diabetes. In addition, medication use, prevalence of micro-/macrovascular complications, and presence/absence of malignant neoplasms were also assessed. A total of 49 patients with type 1 DM (T1DM group) and 791 patients with type 2 DM (T2DM group) were enrolled in the study. The mean age was 58.4 years in the T1DM group and 64.9 years in the T2DM group. Other baseline characteristics (T1DM/T2DM) were: mean HbA1c 7.5%/7.0%; median duration of diabetes 23 years/18 years. In regard to medication history, in the T2DM group, 57.3% were receiving oral hypoglycemic agents, 5.6% were receiving injectable GLP-1 receptor agonists, and 28.4% were receiving insulin therapy. The prevalences of microvascular complications, macrovascular complications, and malignant neoplasms were approximately 30-50%, 10%, and 7%, respectively, in the study participants. This 8-year observation study may offer valuable insights into the relationship between risk factor management and development of diabetic complications/comorbidities in persons with diabetes.

Use of the etanercept biosimilar during pregnancy was associated with favourable outcomes, supporting its safety and utility in managing rheumatoid arthritis during pregnancy.