Tachikawa Hospital

To investigate the effect of anti-VEGF therapy on wide-field retinal and choroidal thickness in patients with macular edema secondary to RVO, and to identify how these effects vary based on clinical characteristics such as occlusion location and patient sex. Retrospective observational study. Thirty-eight patients (38 eyes) with RVO treated at Keio University Hospital (26 males, 12 females; mean age, 67.7 ± 8.5 years). Seventeen fellow eyes without injection served as internal controls. We analyzed 38 eyes with RVO who received intravitreal injections of aflibercept ( n = 31) or ranibizumab ( n = 7). Wide-field optical coherence tomography (OCT) was performed at baseline (within 7 days before the injection) and at the follow-up visit (30 ± 14 days after the injection). Changes in retinal and choroidal thickness were analyzed across nine predefined regions: a central 5-mm subfield (C0) and eight surrounding peripheral sectors: temporal (L1), superior-temporal (L2), superior (L3), superior-nasal (L4), nasal (L5), inferior-nasal (L6), inferior (L7), and inferior-temporal (L8). Statistical analysis was performed using the Wilcoxon signed-rank test and Bonferroni correction for nine regions. Changes in regional retinal and choroidal thickness Post-injection, retinal thickness significantly decreased in all regions except L4 and L6 ( p < 0.0056). Choroidal thickness showed a significant reduction in L2, L5, and L8 ( p < 0.0056). Subgroup analyses revealed no significant changes in choroidal thickness in either the superior RVO group (n = 9) or the inferior RVO group (n = 17). A clear sex-based difference was also observed: male patients ( n = 26) exhibited choroidal thinning in L4, L5, L6, and L8 ( p < 0.0056), whereas female patients ( n = 12) showed no significant changes in any region. Anti-VEGF therapy reduced retinal and choroidal thickness in specific regions in eyes with RVO. No significant differences were observed between eyes with superior and inferior occlusions. In male patients, significant thinning was observed in multiple peripheral regions, whereas no significant changes were noted in female patients. These findings suggest that the choroidal response to anti-VEGF therapy is complex and warrants further investigation.

ObjectivesInstrumentation failure remains a significant complication in spinal surgery. Preoperative bone health assessment is critical prior to spinal fusion surgery. Currently, bone mineral density (BMD) and Hounsfield Unit (HU) are common preoperative assessments, although it remains unclear which is more predictive of screw fixation strength. We aimed to identify the most reliable preoperative evaluation method for predicting screw insertional torque in patients undergoing lumbar fusion surgery.MethodsPatients who underwent lumbar fusion surgery utilizing pedicle screws between 2021 and 2023, were prospectively registered in our database. All participants underwent preoperative lumbar CT and Dual-Energy X-ray Absorptiometry (DEXA) scans. We analyzed data from 109 patients who underwent lumbar fusion surgery with 6.5mm pedicle screws. Preoperative BMD was measured via DEXA (lumbar spine and femur), and HU values were obtained from preoperative lumbar CT scans. Insertional torque of the screws was measured intraoperatively using a calibrated torque wrench. Correlations between insertional torque and BMD/HU as well as patients' demographic/lab data were analyzed.ResultsA total of 335 pedicle screws were analyzed. Femoral BMD exhibited the strongest correlation with insertional torque (r = 0.557, P < 0.001), compared with lumbar BMD and HU. Age, ASA grade, BMI, serum calcium, and albumin showed weak correlations.ConclusionsFemoral BMD demonstrated the strongest, although still moderate, association with intraoperative insertional torque among all preoperative bone quality measures evaluated, suggesting that it may offer a more informative estimate of underlying bone strength in patients undergoing lumbar fusion.

BackgroundAlthough posterior lumbar interbody fusion (PLIF) is effective in treating degenerative lumbar spine diseases, postoperative adjacent segment disease (ASD) significantly affects long-term prognosis and quality of life. The complex pathogenesis may involve systemic inflammation, lumbar muscle degeneration, biomechanical changes, and surgical factors, but comprehensive studies are lacking. The aim of this study was to analyze the risk factors for ASD following PLIF and to provide guidance for clinical prevention and management.MethodsA retrospective analysis was conducted on 500 patients who underwent PLIF from January 2017 to August 2022. Patients were divided into a non-ASD group (n=404) and an ASD group (n=96) based on postoperative imaging. Functional outcomes were assessed using the visual analog scale and the Oswestry Disability Index (ODI). Univariate and multivariate logistic regression analyses examined factors such as neutrophil-to-lymphocyte ratio (NLR), psoas major muscle index (PMI), multifidus muscle index (MMI), multifidus muscle fat infiltration rate (MFI), cage subsidence, pelvic incidence-lumbar lordosis mismatch, and nonunion to identify independent risk factors for ASD.ResultsThe incidence of ASD was 19.2%. Postoperative visual analog scale and ODI scores improved significantly in both groups, but the non-ASD group experienced a greater degree of pain relief and functional recovery. Elevated NLR, decreased PMI and MMI, increased MFI, cage subsidence, lower Hounsfield units (HU) values, and nonunion were identified as independent risk factors for ASD.ConclusionsASD after PLIF is closely associated with systemic inflammation, lumbar muscle degeneration, cage subsidence, and nonunion. Interventions targeting these risk factors—such as optimizing inflammatory status preoperatively, enhancing lumbar muscle rehabilitation, improving surgical techniques to prevent cage subsidence, and promoting bone fusion—may reduce the incidence of ASD and improve long-term outcomes.

BackgroundSince the approval of Lecanemab in Japan on September 25, 2023, for mild cognitive impairment (MCI) and mild dementia due to Alzheimer's disease (AD), the number of dementia‐related phone inquiries at our hospital has increased by 1.7 times over a period of 6 months (from 457 inquiries before to 759 inquiries after). Due to the public health insurance system and the high‐cost medical expense system in Japan, patients have equal access to Lecanemab treatment. We will present how we have prepared our outpatient services, our experience with using the drug, and the arrangements for continued administration after 6 months.MethodWe conducted a retrospective data analysis of 58 patients who were treated with Lecanemab between January and December 2024 at our Center for Dementia‐Related Diseases in Tokyo. All patients have been confirmed to be amyloid pathology positive by either cerebrospinal fluid (CSF) or amyloid PET.Result82% of the patients who started Lecanemab were referred by general practitioners, and 40% of those referrals specifically requested consideration of Lecanemab treatment. After scheduling an outpatient appointment, a head MRI and neuropsychological tests were performed at our facility before the first medical examination. Clinical characteristics of patients treated with Lecanemab were as follows: age at 1st Lecanemab infusion 76.2±8.5 years (54‐92 years), 69% female, 96.6% Japanese (1.7% Chinese, 1.7% Korean), MMSE 24.6±2.0 (22‐30), CDR‐J 0.5: 92%, and 1: 8%, CSF Aβ42/Aβ40 ratio 0.049±0.009, Amyloid PET Centiloid scale 75.2±21.1. None of the patients had amyloid‐related imaging abnormalities (ARIA) ‐E, 6.9% had ARIA‐H (5.2% asymptomatic mild, 1.7% asymptomatic moderate), 1.7% had mild infusion reaction. Following the initial 6 months of Lecanemab administration, continuous infusions can be carried out at facilities that meet certain criteria. Consequently, we have referred 11 patients to other facilities.ConclusionConsistent with prior evidence, Asian patients tend to have less ARIA side effects. Due to the high demand of Lecanemab treatment, it is necessary to promptly refer patients to continuous administration facilities after the initial 6 months of administration.

BackgroundThe present study primarily aimed to investigate whether preoperative pain associated with rotator cuff tears correlates with the severity of synovitis in the rotator interval (RI) on arthroscopic findings retrospectively.MethodsBetween July 2017 and December 2022, 131 shoulders with arthroscopic rotator cuff repair were retrospectively investigated. The pain domain of the preoperative Constant Score and Shoulder36 were used to assess preoperative pain. Two examiners confirmed the degree of synovitis of RI in the arthroscopic findings.ResultsThe mean patient age was 68.9 years. Synovitis in the RI was found in 118 shoulders (94%) assessed by arthroscopy. The pain domain of the Constant Score significantly correlated with synovitis in the RI assessed by arthroscopic findings (P < .01), but the size and the number of rotator cuff tears did not.ConclusionThe preoperative pain associated with rotator cuff tears significantly correlated with synovitis severity in the RI assessed by AS findings, highlighting the role of synovitis as a potential contributor to pain in patients with rotator cuff tears.

<title>Abstract</title> Laparoscopic inguinal hernia repair is now standard, with totally extraperitoneal (TEP) and transabdominal preperitoneal (TAPP) techniques showing similar outcomes. TEP avoids intraperitoneal manipulation, reducing the risk of organ injury, but mesh erosion is an extremely rare complication. We report the first Japanese case―and the first worldwide presenting with hematochezia―of mesh erosion into the sigmoid colon six years after TEP repair in a 67-year-old man. Colonoscopy revealed mesh protrusion, and laparoscopic-assisted sigmoidectomy with mesh removal was performed. Recovery was uneventful. Despite no intraoperative peritoneal injury, chronic inflammation, compression necrosis, and unrecognized subclinical peritoneal injury are possible mechanisms. Literature suggests a lower incidence of mesh erosion after TEP than TAPP, but vigilance is warranted. Mesh erosion should be considered in patients with lower gastrointestinal bleeding long after TEP, and early imaging is advised for unexplained gastrointestinal or urinary symptoms.

血瘤腫は血腫と結合組織からなる非腫瘍性腫瘤性病変であり, 蝶形骨洞に生じることはまれである. 今回われわれは鼻性視器障害を来した蝶形骨洞血瘤腫を経験した. 症例は75歳女性, 脳梗塞に対してクロピドグレル内服開始後に左眼痛, 複視が出現した. 画像検査で骨破壊を伴う左蝶形骨洞病変があり, 当科紹介となった. 初診時に左動眼神経麻痺, 右視力低下を認めた. 緊急で内視鏡下鼻副鼻腔手術を施行し, 術中所見から蝶形骨洞血瘤腫と診断した. 術後１カ月で左動眼神経麻痺, 右視力の改善を認めた. 迅速な外科的治療が良好な視力予後に寄与したと考える. 抗血小板薬内服など, 出血素因のある蝶形骨洞病変では血瘤腫も念頭に置く必要がある.

BackgroundCardiovascular disease (CVD) is a major complication in patients on maintenance hemodialysis (MHD). While the effect of left ventricular dysfunction on patients on MHD is well known, the association between right ventricular (RV) dysfunction and their prognosis remains poorly understood.MethodsWe conducted a retrospective cohort study of 149 patients on MHD (median age, 72 years; male, 67%) between 1 April 2022 and 31 March 2024. All subjects underwent transthoracic two-dimensional and Doppler echocardiographic examination. RV dysfunction was determined when the tricuspid annular plane systolic excursion (TAPSE) was under 16 mm. Kaplan–Meier survival analysis was used to compare survival between patients with and without RV dysfunction. Multivariate Cox regression analyses were used to estimate the effects of RV dysfunction on all-cause mortality, including the effect of confounding factors such as age, sex, previous CVD events, and left ventricular (LV) dysfunction.ResultsIn total, 20 out of 149 patients on MHD (13%) had RV dysfunction. Indexes of their LV function (such as the LV ejection fraction and E/e' ratio) were similar to those of patients without RV dysfunction. During the follow-up period, 23 patients died (7 with RV dysfunction [without LV dysfunction], 3 with LV dysfunction [without RV dysfunction], 2 with biventricular dysfunction, and 11 without any ventricular dysfunction). Kaplan–Meier analyses showed significantly lower survival among patients with RV dysfunction (p < 0.01). The multivariate Cox regression analysis revealed that RV dysfunction (without LV dysfunction) was independently associated with all-cause mortality (hazard ratio: 3.44; 95% confidence interval: 1.28–9.23) after adjusting for confounders.ConclusionsRV dysfunction is a significant risk factor for all-cause mortality among patients on MHD.