Toyokawa City Hospital

We report a case of resectable port site recurrence after laparoscopic surgery for transverse colon cancer. A 70-year-old woman was diagnosed as transverse colon cancer and performed laparoscopic right hemicolectomy with D3 lymphadenectomy. Histopathological findings revealed that the tumor was resected curatively and the staging was T4a, N1a, M0. As adjuvant chemotherapy, 2 courses of capecitabine and 3 courses of UFT/LV were administered. Fifteen months after surgery, elevated CA19-9 level was noted, and CT scan showed a mass corresponding to the left lower abdominal port site. Based on these findings, surgical resection of the abdominal wall tumor was performed, and complete resection was achieved. Based on histopathological findings, the lesion was diagnosed as a port site recurrence originating from the primary transverse colon cancer.

99mTechnetium-pyrophosphate ([99mTc]Tc-PYP) scintigraphy is the gold standard for diagnosing transthyretin amyloid cardiomyopathy (ATTR-CM). Conventional metrics, such as heart-to-contralateral-chest (H/CL) ratio and visual Perugini score, can be influenced by physiological blood pool uptake, leading to false positives and additional patient burdens. This study aimed to develop and validate a simple quantitative metric widely applicable for ATTR-CM diagnosis. This multicenter retrospective study enrolled 253 patients who underwent [99mTc]Tc-PYP SPECT/CT between April 2021 and September 2024. SPECT/CTs were acquired 3h post-injection of 740 MBq [99mTc]Tc-PYP. A lateral wall-to-aorta (LW/Ao) ratio was obtained by dividing the average radiotracer count in the lateral wall of the left ventricle by the average count in the ascending aorta. The diagnosis of ATTR-CM diagnosis was determined by endomyocardial biopsy. As statistical analyses, area under receiver operating characteristic (AUC) was used to compare diagnostic accuracy, and intraclass correlation coefficient (ICC) was used to assess inter-rater agreement. Among 52 patients (31 men; mean age 77) whose biopsy results were available, 11 were diagnosed with ATTR-CM. LW/Ao ratio showed a sensitivity of 100% (11/11), specificity of 97.6% (40/41), and positive likelihood ratio of 41.0. LW/Ao ratio showed higher AUC (0.99; 95% CI: 0.99-1.00) compared to H/CL ratio (AUC = 0.90, p = 0.04) and visual score (AUC = 0.87, p < 0.01). The ICC of LW/Ao ratio was excellent (0.91 ≥ 0.9). The quantitative SPECT/CT metric demonstrated superior diagnostic accuracy for ATTR-CM compared to conventional methods.

Duloxetine is a serotonin-norepinephrine reuptake inhibitor commonly used to treat depression and neuropathic pain. Duloxetine-associated parkinsonism has been previously reported in only two cases with psychiatric disorders. We present the first case where duloxetine unmasked motor manifestations of subclinical Parkinson's disease. A 41-year-old male underwent a discectomy for a lumbar herniation. As numbness in the left sole persisted postoperatively, duloxetine (20 mg/day) was initiated seven days after surgery. Two dayslater, the patient developed a slow gait, difficulty turning, and short steps. Neurological examination revealed resting tremor in the left foot, dystonic posturing of the left little toe, bradykinesia of both hands, reduced gait speed with short steps, and rigidity in the left lower limb and neck. Based on the temporal association, duloxetine-associated parkinsonism was suspected. Four days after discontinuing duloxetine, the patient's gait speed, step length, and right-hand bradykinesia improved, and the foot tremor and toe dystonia resolved. Dopamine transporter single-photon emission computed tomography revealed reduced tracer uptake in the bilateral striatum, leading to a diagnosis of duloxetine-associated parkinsonism and subclinical Parkinson's disease. One year and four months later, gait impairment reappeared, characterized by short steps and slow speed, though without foot tremor or toe dystonia. In this case, duloxetine appeared to unmask parkinsonism associated with subclinical Parkinson's disease. Potential mechanisms include inhibition of dopamine release due to 5-HT2 receptor activation, postoperative effects, drug hypersensitivity, or genetic phenotypes in serotonin receptors. This case highlights the importance of considering subclinical Parkinson's disease in patients with duloxetine-associated parkinsonism.

this study aimed to determine the effects of plyometric training (pt) on heading jump performance and motion in collegiate soccer players.Seventeen male soccer players belonging to the university soccer club were included in the study.the subjects were divided into pt (n = 8) and control (n = 9) groups.the pt group performed pt twice a week for 7 weeks.Before and after the intervention period (pre-and postintervention), vertical jump, heading jump in place, heading jump with a run-up, and rebound jump (rJ) were measured.Jump motions were analyzed using 3D motion analysis.Significant interactions were detected between height of the vertical jump, heading jump in place, heading jump with a run-up, and rJ index (p < 0.05), and these values after the intervention period (post) were significantly higher in the pt group compared with the values before the intervention (pre).the rate of change in the pt group was 10.0% for the height of the heading jump in place and 11.9% for the heading jump with a run-up.although no significant differences were observed in most jump motion variables, the hip joint flexion angles in the starting phase for vertical jump and heading jump in place were lower after the intervention compared with before the intervention (p < 0.05).our results indicate that sinking before jumps increased and recoil motion was used.pt improved height of the heading jump in soccer players and may be useful for improving performance during games in soccer games.

Microvascular decompression (MVD) of the trigeminal nerve is an effective procedure for treating patients with trigeminal neuralgia (TGN). However, vertebrobasilar decompression involves technical difficulties and demonstrates a higher risk of minor trigeminal hypesthesia/hypalgesia, transient diplopia, and hearing loss. Stereotactic radiosurgery (SRS) has been an effective alternative treatment for TGN. Few studies reported the treatment results of SRS for TGN caused by vertebrobasilar compression. This report presents the treatment results of SRS using gamma knife (GK) in four TGN cases. GK-SRS was performed for TGN due to vertebrobasilar compression in four patients, including two males and two females, aged 67-90 years. The maximum dose of 80 Gy was delivered at the retrogasserian portion (RGP) of the ipsilateral trigeminal nerve root. All four cases with TGN achieved relief in four to 10 months after GK-SRS. However, TGN recurred 41 months after GK-SRS in one of the four cases. A second GK-SRS at the root entry zone (REZ) at a maximum dose of 70 Gy relieved pain again 10 days later. TGN in another case among the four partially recurred in three years but did not deteriorate until the patient died from old age 62 months after GK-SRS. The other three cases, including the one with repeat GK-SRS, were alive with complete TGN remission at the end of follow-up of 20-52 months. GK-SRS-related adverse effects were not observed in any case. GK-SRS was a safe and effective treatment in all four TGN cases due to vertebral artery (VA)-basilar artery (BA)compression, although a second treatment session was added again for pain recurrence in one of the four cases.

Background:3M microfoam™ surgical tape (3ST: 3M Japan Limited) is used for pressure wound control of medical equipment. It is cushioned and can be fitted to any body part. Here we investigated whether 3ST prevents nasal pressure injury associated with nasotracheal intubation (NTI).Methods:We conducted a prospective, randomized double-blind study, enrolling 63 patients aged 20 to 70 years, who underwent general anesthesia with NTI. They were divided into 2 groups; those treated with 3ST (group S; n = 31) and control (group C; n = 31). After NTI and before securing the nasotracheal tube, a 35 × 25 mm 3ST was used to protect the nasal wing in group S, and the nasotracheal tube was fixed in place after NTI without protection in group C. The primary outcome was the presence or absence of nasal pressure injury after extubation. The Chi-Square test was used to assess the association between the 2 categorical variables.Results:Nasal pressure injury was observed in 7 and 19 patients from groups S and C, respectively, representing a significant difference between the 2 groups (24.1% vs 67.8%, P = .001). Remarkably, none of the patients developed ulcers.Conclusion:3ST prevents nasal pressure injury associated with NTI.

Self-expanding metallic stent (SEMS) and trans-anal colorectal tube (TCT) are alternative treatments to conventional emergency surgery for non-right-sided obstructive colon cancer (NROCC). However, the one with better short- and long-term outcomes remains controversial. Thus, this multicenter case-control study aimed to analyze and compare SEMS and TCT for NROCC. Patients with stage II/III NROCC who underwent surgery between January 2010 and December 2019 at either of the eight selected Japanese affiliate hospitals were, retrospectively, reviewed. Baseline characteristics between the SEMS and TCT groups were adjusted by propensity score (PS) matching. Among 239 reviewed patients (SEMS: 76, TCT: 163), 180 were finally included in two well-balanced cohorts through PS: SEMS group (65 patients) and TCT group (115 patients). Technical success, clinical success, morbidity, and short-term mortality were not significantly different between the two groups. SEMS placement achieved significantly higher rates for primary resection/anastomosis without stoma (SEMS: 90.8% vs. TCT: 77.4%, p < 0.001) and laparoscopic surgery (SEMS: 64.6% vs. TCT: 43.5%, p < 0.001) than TCT placement. However, 5-year overall survival (SEMS: 83.7% vs. TCT: 86.4%; p = 0.822) and 5-year relapse-free survival (SEMS: 64.7% vs. TCT: 66.4%; p = 0.854) showed no significant differences between these groups. Both SEMS and TCT revealed similar long-term outcomes, but SEMS placement was better in achieving primary resection/anastomosis and laparoscopic surgery in patients with stage II/III NROCC.

Osteochondromatosis is a benign proliferative disorder characterized by cartilage-capped bony protuberances. In humans and most mammals, variants in the EXT1 or EXT2 gene are strongly correlated with the etiology of osteochondromatosis. However, in cats, osteochondromatosis has only been associated with feline leukemia virus infection. In this study, to explore other factors involved in the etiology of feline osteochondromatosis, we examined the EXT1 and EXT2 genes in a feline leukemia virus-negative cat with osteochondromatosis. Genetic analysis revealed a heterozygous single base pair duplication in exon 6 of the EXT1 gene (XM_023248762.2:c.1468dupC), leading to a premature stop codon in the EXT1 protein. Notably, this frameshift variant is recognized as one of the most common pathogenic variants in human osteochondromatosis. Our data suggest for the first time that genetic variants can have etiologic roles in osteochondromatosis in cats, as in humans and other animals.

Two methods of transpapillary covered self-expandable metal stent (SEMS) placement are used for distal malignant biliary obstruction (MBO): after initial drainage by plastic stent (two-step method) and without previous drainage (one-step method). In total, 90 patients with unresectable pancreatic cancer and distal MBO were enrolled in this prospective multicenter randomized study and allocated to one-step (n=45) and two-step (n=45) groups. The main outcome was the time to recurrent biliary obstruction (TRBO). Secondary outcomes were the rates of early and late adverse events, survival time, the time required for bilirubin level reduction, and cost-effectiveness. The median TRBO did not differ significantly between the one-step and two-step groups (not available vs 314days, P=0.134). SEMS migration occurred significantly more frequently in the two-step group (14.3% vs 0%, P=0.026). No significant difference was observed between groups in early (7.3% vs 14.3%, P=0.483) or late (12.2% and 11.9%, P=1) adverse events other than RBO, survival time (P=0.104), or the median number of days required to reach a bilirubin level considered to be acceptable for chemotherapy administration (<3mg/dL; P=0.881). The total costs of stent placement and reintervention were significantly lower in the one-step SEMS group (3347 vs 5465 US dollars, P<0.001). The superiority of TRBO with two-step SEMS placement was not demonstrated. One-step SEMS placement might be a promising method from the viewpoints of cost-effectiveness and less invasiveness (UMIN-CTR clinical trial registration number: UMIN000016010).

To assess the relationship among iron accumulation, blood-brain barrier (BBB) damage, and cognitive function in patients with cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL). We enrolled 21 patients with NOTCH3 mutations and 21 age-matched healthy controls in this cross-sectional study. All participants underwent global physical and cognitive assessments and brain MRI using voxel-based quantitative susceptibility mapping (QSM; iron deposition measure) and dynamic contrast-enhanced MRI (BBB permeability measure). We compared behavioral and imaging data between the groups and analyzed the correlations in each group. Among 21 NOTCH3 mutation carriers, 10 were symptomatic and 11 asymptomatic. Montreal Cognitive Assessment scores were significantly different among the groups (symptomatic < asymptomatic < control participants). Voxel-based QSM analysis revealed that the symptomatic group had higher QSM values than did the asymptomatic group in the putamen, caudate nucleus, temporal pole, and centrum semiovale. These QSM values were positively correlated with regional BBB permeabilities (putamen: r = 0.57, p = 0.006; caudate nucleus: r = 0.51, p = 0.019; temporal pole: r = 0.48, p = 0.030; centrum semiovale: r = 0.45, p = 0.044) and negatively correlated with Montreal Cognitive Assessment scores (caudate nucleus: r = -0.53, p = 0.012; temporal pole: r = -0.56, p = 0.008). This study showed that cerebral iron burden was associated with regional BBB permeability and cognitive dysfunction in patients with CADASIL, highlighting the potential of these imaging techniques as auxiliary biomarkers to monitor the course of small vessel disease.