Yokufukai Hospital

Surgery is the most effective treatment for early-stage lung cancer but imposes a greater physical burden than other therapies. We previously identified socioclinical factors associated with reduced perioperative health-related quality of life (HR-QOL) in patients undergoing anatomical pulmonary resection. This study aimed to evaluate the relationship between predictors of HR-QOL and long-term survival. In this prospective study, 87 patients undergoing anatomical pulmonary resection for non-small cell lung cancer at Shonan Kamakura General Hospital, Japan, were evaluated using the Short Form Health Survey 36. Multivariable analyses identified socioclinical factors associated with physical and mental QOL preoperatively and at 6 months postoperatively. Survival analyses were performed for factors showing differences in multivariable analysis and related trends in univariable analysis of HR-QOL. Preoperatively, lower performance status (PS) and living alone were independently associated with poorer physical QOL (regression coefficient [95% CI]: -10.94 [-14.34--7.54] and -9.86 [-13.89--5.82], respectively; both p < 0.001) and mental QOL (-9.34 [-13.30--5.37] and -10.33 [-15.30--5.35]; both p < 0.001). At 6 months postoperatively, smoking cessation within 1 year, lower PS, and living alone predicted worse physical QOL, while smoking cessation and lower PS predicted worse mental QOL. Lower PS and higher comorbidity burden were also adverse prognostic factors for long-term survival (p < 0.001 and p = 0.015, respectively). Reduced physical activity and greater comorbidity are associated with poorer HR-QOL and survival after lung cancer surgery. These findings highlight the need for careful consideration of surgical indications in patients with these risk factors.

The postoperative recurrence rate of esophageal cancer ranges from 28 to 47%, with recurrences often affecting distant organs such as the lungs, liver, bones, and brain. However, colonic metastasis is rare. This report presents a case of transverse colon metastasis after radical resection of esophageal cancer in a 70-year-old man. The patient underwent neoadjuvant chemotherapy followed by esophagectomy for advanced esophageal cancer 15months ago. He reported loss of appetite during a routine outpatient visit, and computed tomography revealed bowel obstruction and intussusception with a tumorous lesion in the transverse colon. Positron emission tomography did not reveal any abnormal accumulation in other areas. Based on these findings, a transverse colectomy was performed. Pathological examination of the resected specimen revealed squamous cell carcinoma components in the normal colonic mucosa, which were diagnosed as colonic metastases from the esophageal cancer. Postoperatively, the patient recovered uneventfully and commenced adjuvant therapy with capecitabine monotherapy, which was later discontinued at the patient's request. Four months post-surgery, liver metastasis developed, and the patient underwent immunochemotherapy. Colorectal metastasis from esophageal cancer is relatively rare, making preoperative diagnosis challenging. Nonetheless, a multidisciplinary approach combining surgery and perioperative systemic therapy has the potential to improve patient outcomes.

Craniotubular dysplasia, Ikegawa type (CTDI) is a rare autosomal recessive skeletal dysplasia characterized by hyperostosis of the calvaria and skull base, metadiaphyseal undermodeling of the long tubular bones, and mild shortening and diaphyseal broadening of the short tubular bones. Its causal gene is TMEM53. Six CTDI families have been reported; however, its clinical course and prognosis still remain to be determined. Here, we report two Iranian siblings carrying a novel homozygous missense variant of TMEM53. The affected individuals were referred for progressive severe visual loss of unknown cause. The patient had severe optic atrophy and optic canal narrowing. Radiographic evaluation suggested the diagnosis of CTDI, which was confirmed by the identification of TMEM53 variant (c.704G > T, p.R235L) co-segregating in the consanguineous family. The proband underwent trans-nasal endoscopic optic canal decompression and showed remarkable improvement in visual acuity and daily visual tasks. We recommend early comprehensive clinical and genetic evaluation followed by proper treatment to improve the prognosis of CTDI.

A metastatic thyroid tumor (MTT) arising from breast carcinoma (BC) is rare and sometimes difficult to diagnose. We present a case of MTT from BC; we suspected anaplastic thyroid carcinoma at initial presentation. The patient was a 58-year-old female with a hard nodule in the right anterior neck and a history of breast cancer. Computed tomography indicated tumors on both thyroid lobes, and ultrasonography (US) with shear wave measurement (SWM) showed malignant features. We performed fine needle aspiration cytology (FNAC), the results of which led us to strongly suspect MTT from BC. The surgically resected specimen was evaluated histopathologically, including by immunohistochemistry (IHC), and the diagnosis was confirmed. In addition to FNAC and IHC, SWM is useful to diagnose MTT from BC.

A 76-year-old man was admitted to our hospital with a history of fever and difficulty in moving. Blood culture at admission grew β-hemolytic streptococci, identified by biochemical testing (BD CRYSTAL GP) as Streptococcus porcinus. S. porcinus is a swine-derived streptococcal species, and has been reported as a causative bacterium of female genitourinary infection. The clinical background of our patient did not match with the detected bacterium, so further testing by MALDI-TOF MS and 16S rRNA gene sequencing was performed, which identified the bacterium as Streptococcus iniae. There are many case reports of cellulitis caused by this bacterium in persons cooking infected fish, and some reports of arthritis, endocarditis, and empyema. Reports of S. iniae from Japan are rare, and since this bacterium may not be included in some biochemical identification databases, it might not have been identified correctly. In cases with inconsistency between the culture-identified organisms and the clinical course, performing additional identification tests may be useful to obtain an accurate diagnosis.

IntroductionWe report a case of emergency laparoscopic omental patch repair in a patient with super-super obesity (body mass index of 64.7) who presented with upper gastrointestinal perforation. Case presentationA 52-year-old male patient with difficulty moving his body due to abdominal pain was transported to the emergency department. Contrast-enhanced computed tomography revealed duodenal bulb wall thickening and increased fat stranding in the surrounding tissue. Free air was also observed under the liver and on its surface. Therefore, diagnostic laparoscopy was performed because of a suspected upper gastrointestinal perforation. Clinical discussionBecause the weight limit of the surgical bed was 150 kg and the width was insufficient, even when two beds were placed side-by-side, the patient's fixation on the bed was unstable, and the surgery was performed on a regular hospital bed. A 5-mm full-thickness perforation of the duodenal bulb wall was confirmed, and omental patch repair was performed. Because the bed was regular, securing the visual field without changing the patient's position was difficult. There were also limitations on the movement of the ports; therefore, seven ports were used. Postoperatively, bile-like drainage was observed from the surgical drain. However, upper gastrointestinal contrast imaging on the 14th day after the surgery revealed no contrast leakage. ConclusionThe patient recovered well and was discharged on the 31st day after the surgery.