Tokyo Metropolitan Police Hospital

ABSTRACTIntroductionWe report two cases of ectopic prostate tissue exhibiting fluorescence during photodynamic diagnosis using 5‐aminolevulinic acid.Case PresentationThe first case involved a 57‐year‐old man with a 9‐mm papillary tumor on the right side of the bladder neck. The second case involved a 75‐year‐old man with a history of left renal pelvic cancer who presented with a 2‐mm papillary tumor in the bladder trigone. In both cases, the tumors fluoresced red under blue light during photodynamic diagnosis‐assisted transurethral resection. Histopathological examination revealed ectopic prostate tissue in both cases. No recurrence was observed, and a slight decrease in serum prostate‐specific antigen levels was noted at 12 and 5 months of follow‐up in cases 1 and 2, respectively.ConclusionEctopic prostate tissue in the bladder is a rare benign tumor that may exhibit false‐positive fluorescence during photodynamic diagnosis, making it difficult to distinguish from bladder cancer even with this technique.

Psoriasis is a chronic, immune-mediated inflammatory skin disease associated with systemic comorbidities such as cardiovascular disease and autoimmune disorders. Deucravacitinib, a selective oral tyrosine kinase 2 (TYK2) inhibitor, has demonstrated strong efficacy and safety in the treatment of psoriasis. However, its use in patients with hematologic malignancies, such as myelodysplastic syndrome (MDS), has not been thoroughly investigated. We report the case of a 73-year-old man with psoriasis vulgaris complicated by MDS and chronic kidney disease (CKD). The patient had a long-standing history of psoriasis managed with topical therapies but experienced an acute flare, presenting with erythema, scaling, and pustules involving over 40% of the body surface area (Psoriasis Area and Severity Index (PASI) score: 28.8). Given his underlying MDS and the need for a safe therapeutic option, deucravacitinib (6 mg once daily) was initiated. Over eight months of treatment, the patient's skin lesions markedly improved, achieving a PASI 75 response with a final PASI score of 4.6. No adverse effects or signs of MDS progression were observed. Moreover, his anemia remained well controlled without the need for monthly darbepoetin alfa injections.This case highlights the potential of deucravacitinib as a safe and effective treatment option for psoriasis patients with concurrent MDS. Given the emerging understanding of TYK2 as an oncogenic driver in myeloproliferative diseases, further studies are warranted to clarify the therapeutic implications of TYK2 inhibition in this patient population.

Atopic dermatitis (AD) is a chronic inflammatory skin condition with a multifactorial etiology. Herein, we report a case of a patient with AD undergoing long-term topical treatments who developed a dermatophyte infection following the administration of dupilumab. Dupilumab is known to enhance skin barrier function and induce changes in the skin microbiome. Notably, head and neck dermatitis caused by the overgrowth of Malassezia species due to dupilumab has been widely discussed. This phenomenon is thought to result from the suppression of T helper (Th)2 cytokines by dupilumab, leading to a decrease in the proportion of Staphylococcus aureus and a relative increase in fungal populations. Additionally, feedback activation of Th17 cytokines may trigger excessive inflammation against fungi, contributing to fungal infections. IL-13 plays critical roles in fungal colony formation, and tralokinumab, an IL-13 inhibitor, has shown potential efficacy in treating this head and neck dermatitis. While the relationship between microbiome changes and biologics like lebrikizumab and nemolizumab remains unexplored, investigating the differential effects of these therapies on the cutaneous microbiome could provide deeper insights into not only the unique characteristics of each biologic agent but also the roles of Th2 cytokines such as IL-4, IL-13, and IL-31 in the pathophysiology of AD. The present case underscores the importance of the comprehensive therapeutic approach for AD that accounts for microbiome dynamics and adapts to evolving skin changes throughout the course of treatment.

This study aimed to introduce and evaluate a novel software-based system, BioTrace, designed for real-time monitoring of thermal ablation tissue damage during image-guided radiofrequency ablation for hepatocellular carcinoma (HCC). BioTrace utilizes a proprietary algorithm to analyze the temporo-spatial behavior of thermal gas bubble activity during ablation, as seen in conventional B-mode ultrasound imaging. Its predictive accuracy was assessed by comparing the ablation zones it predicted with those annotated by radiologists using contrast-enhanced computed tomography (CECT) 24 hours post-treatment, considered the gold standard. The study included 20 liver tumors. The median tumor measurement along the major axis was 1.2 cm. The median Dice coefficient, Sensitivity, and Precision between BioTrace and CECT were 0.90, 0.91, and 0.91, respectively. The intraclass correlation showed excellent agreement in volume size between BioTrace and CECT findings (0.98). BioTrace effectively generates an ablation damage prediction map based on real-time ultrasound imaging, accurately predicting the ablation zone as confirmed by 24-hour post-procedural CECT. This system has the potential to enhance the safety and efficacy of ablation procedures in clinical settings.

BackgroundDrug-induced phospholipidosis (DIPL) is an acquired lysosomal storage disorder characterized by the accumulation of lamellar bodies and phospholipids, typically associated with the use of cationic amphiphilic drugs (CADs). Over 200 marketed CADs, including widely prescribed β-blockers, have the potential to induce phospholipid deposition in various organs. In rare cases, DIPL may lead to secondary cardiomyopathy.Case summaryWe report the case of a 70-year-old man with a history of hypertension, permanent atrial fibrillation, and Stanford type B aortic dissection. The patient presented with a 2-week history of worsening dyspnoea. Examination revealed cardiomegaly, elevated B-type natriuretic peptide, and left ventricular dysfunction with an ejection fraction of 24%. Despite intensive medical treatment, the patient developed severe pulmonary congestion and died on Day 35. Post-mortem examination revealed vacuolar degeneration and lamellar body accumulation in the myocardium, consistent with DIPL. The most likely causal agent was bisoprolol, one of the patient’s prescribed CADs.DiscussionWhile β-blockers are commonly used for the treatment of hypertension and heart failure, their potential to induce phospholipid deposition in the heart is rare but significant. This case underscores the need for awareness of DIPL as a potential adverse effect, especially in patients receiving CADs.

Various classifications of hemifacial microsomia (HFM) have been described previously. Although some of these classifications are used widely, others use external outlines of reference organs, even in three-dimensional (3D) images. The purpose of this study was to investigate the 3D characteristics of the mandibular condyle in HFM and to update the Pruzansky and Kaban classification as a 3D classification. Fifty-three patients with HFM were classified according to the Pruzansky and Kaban classification (type I, IIA, IIB, and III) using computed tomographic scan images. 3D images of the mandible were isolated, and the 3D characteristics were observed; furthermore, the angle of inclination of the mandibular condyle was measured in 3D. Subtypes of retroflexed mandibular condyle in 3D were observed in the Pruzansky and Kaban classification type IIA and IIB, termed as type IIAβ (33.3% in type IIA) and type IIBβ (100% in type IIB). Although some differences were observed in the inclination of the mandibular condyle between the control and the affected sides in type I and IIAα, multiple differences were observed in type IIAβ and IIBβ. To the best of our knowledge, this is the first report that identified the retroflexed mandibular condyle as subtypes type IIAβ and IIBβ. Notably, this could not be identified in the two-dimensional images (lateral cephalogram) yet. We proposed to update the Pruzansky and Kaban classification as a 3D classification with a new 3D subtype. The angle of the retroflexed mandibular condyle may predict mandibular growth in HFM.

IntroductionSince the SARS-CoV-2 Omicron variant became dominant, assessing COVID-19 vaccine effectiveness (VE) against severe disease using hospitalization as an outcome became more challenging due to incidental infections via admission screening and variable admission criteria, resulting in a wide range of estimates. To address this, the World Health Organization (WHO) guidance recommends the use of outcomes that are more specific to severe pneumonia such as oxygen use and mechanical ventilation. MethodsA case-control study was conducted in 24 hospitals in Japan for the Delta-dominant period (August-November 2021; “Delta”) and early Omicron (BA.1/BA.2)-dominant period (January-June 2022; “Omicron”). Detailed chart review/interviews were conducted in January-May 2023. VE was measured using various outcomes including disease requiring oxygen therapy, disease requiring invasive mechanical ventilation (IMV), death, outcome restricting to “true” severe COVID-19 (where oxygen requirement is due to COVID-19 rather than another condition(s)), and progression from oxygen use to IMV or death among COVID-19 patients. ResultsThe analysis included 2125 individuals with respiratory failure (1608 cases [75.7%]; 99.2% of vaccinees received mRNA vaccines). During Delta, 2 doses provided high protection for up to 6 months (oxygen requirement: 95.2% [95% CI:88.7–98.0%] [restricted to “true” severe COVID-19: 95.5% {89.3–98.1%}]; IMV: 99.6% [97.3–99.9%]; fatal: 98.6% [92.3–99.7%]). During Omicron, 3 doses provided high protection for up to 6 months (oxygen requirement: 85.5% [68.8–93.3%] [“true” severe COVID-19: 88.1% {73.6–94.7%}]; IMV: 97.9% [85.9–99.7%]; fatal: 99.6% [95.2–99.97]). There was a trend towards higher VE for more severe and specific outcomes. ConclusionMultiple outcomes pointed towards high protection of 2 doses during Delta and 3 doses during Omicron. These results demonstrate the importance of using severe and specific outcomes to accurately measure VE against severe COVID-19, as recommended in WHO guidance in settings of intense transmission as seen during Omicron.

A uterine artery pseudoaneurysm (UAP) is a life-threatening complication during pregnancy and postpartum. Early diagnosis of exophytic UAP rupture is difficult due to the absence of vaginal bleeding. This study reports the case of a 31-year-old postpartum woman who presented with abdominal pain and fever seven days after vaginal delivery, without symptoms of maternal shock. Ultrasonography revealed a ruptured exophytic UAP with hemoperitoneum, which was confirmed using computed tomography. Interventional radiology confirmed that the site of the pseudoaneurysm was at the level of the uterine artery bifurcation, and embolization was performed immediately after diagnosis using a coil and n-butyl-2-cyanoacrylate. The patient's symptoms were relieved, and she was discharged 12 days after the embolization. At eight months postpartum, the UAP was not visible on transvaginal ultrasonography. Exophytic UAP can occur even in the absence of specific risk factors such as cesarean section or endometriosis, and the UAP may not necessarily rupture immediately after delivery. Obstetricians must remain aware of the possibility of exophytic UAP rupture manifesting as abdominal pain with postpartum fever, rather than as unstable vital signs. This is the first report of an exophytic UAP that occurred at the level of the uterine artery bifurcation. Identification of the sites where exophytic UAP can occur can aid in the early diagnosis of the condition.

Background:The retromandibular anterior trans-parotid (RAT) approach and a triangular-positioned double mini-plate osteosynthesis (TDO) technique have been reported from Innsbruck Medical University. This minimally invasive technique involves direct visualization of the condyle and is associated with lower incidence of facial palsy.Methods:A retrospective review was performed on the RAT approach and TDO technique conducted by a surgeon and team at two hospitals in Tokyo during a period of 3 years and 10 months.Results:This technique was performed on 35 patients with 39 condylar fractures. Sixty-nine percent of cases were due to accidental fall, 17% to traffic accidents, and 9% to sports. Furthermore, 92% cases were condylar base fractures. Nighty-seven percent of cases achieved good occlusion. The mean maximum mouth opening was 49 ± 1.3 mm. Postoperatively, facial palsy developed in three patients (7.7%), and two of them developed Frey syndrome at approximately 2.5 years postoperatively (5.1%). All patients completely recovered within 3 months postoperatively. One case each of salivary fistula, visible scar, and condylar resorption was found (2.6%). No case of massive bleeding during surgery, hematoma, or TMJ pain after surgery was found.Conclusion:This technique could achieve good occlusion with low incidence of complications and could contribute to early social reintegration among patients.