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Saito U, Minamikawa S, Otake S, Ishida Y, Mizuta M, Ishida T, Karakawa S, Kasai M, Nakagishi Y. A PEDIATRIC CASE OF PANNICULITIS INDUCED BY Pseudomonas aeruginosa WITH CLINICAL FEATURES SIMILAR TO ECTHYMA GANGRENOSUM. Pediatr Infect Dis J 2024:00006454-990000000-00832. [PMID: 38621161 DOI: 10.1097/inf.0000000000004363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/17/2024]
Abstract
The clinical features of panniculitis caused by Pseudomonas aeruginosa, in contrast to those caused by ecthyma gangrenosum, remain unknown. Here, we report a pediatric case of P. aeruginosa panniculitis. The patient had systemic involvement without bacteremia and also had a background of autoimmune neutropenia. These features are common in ecthyma gangrenosum but have not been reported in P. aeruginosa-induced panniculitis.
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Affiliation(s)
- Urara Saito
- From the Department of General Pediatrics, Hyogo Prefectural Kobe Children's Hospital
| | - Shogo Minamikawa
- From the Department of General Pediatrics, Hyogo Prefectural Kobe Children's Hospital
- Department of Pediatrics, Kobe University Graduate School of Medicine, Kobe
| | - Shogo Otake
- Division of Infectious Diseases, Department of Pediatrics
| | - Yusuke Ishida
- From the Department of General Pediatrics, Hyogo Prefectural Kobe Children's Hospital
| | - Mao Mizuta
- From the Department of General Pediatrics, Hyogo Prefectural Kobe Children's Hospital
| | - Toshiaki Ishida
- Department of Hematology and Oncology, Kobe Children's Hospital, Hyogo
| | - Shuhei Karakawa
- Department of Pediatrics, Hiroshima University Graduate School of Biomedical & Health Sciences, Hiroshima, Japan
| | - Masashi Kasai
- Division of Infectious Diseases, Department of Pediatrics
| | - Yasuo Nakagishi
- From the Department of General Pediatrics, Hyogo Prefectural Kobe Children's Hospital
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2
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Koga T, Ishida Y, Hirai F. Pigtail trap: Stent migration crisis following endoscopic ultrasound-guided gallbladder drainage. Dig Endosc 2024; 36:502-503. [PMID: 38323358 DOI: 10.1111/den.14762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 01/10/2024] [Indexed: 02/08/2024]
Abstract
Watch a video of this article.
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Affiliation(s)
- Takehiko Koga
- Department of Gastroenterology and Medicine, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Yusuke Ishida
- Department of Gastroenterology and Medicine, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Fumihito Hirai
- Department of Gastroenterology and Medicine, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
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3
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Ishida Y, Murata T, Kakiuchi N, Ogawa S, Kabashima K. Emergence of multiple revertant keratinocyte clones in a patient with KID syndrome. J Eur Acad Dermatol Venereol 2024; 38:e285-e287. [PMID: 37907277 DOI: 10.1111/jdv.19595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 10/23/2023] [Indexed: 11/02/2023]
Affiliation(s)
- Y Ishida
- Department of Dermatology, Kyoto University, Kyoto, Japan
| | - T Murata
- Department of Dermatology, Hyogo Medical University, Hyogo, Japan
| | - N Kakiuchi
- The Hakubi Center for Advanced Research, Kyoto University, Kyoto, Japan
| | - S Ogawa
- Department of Pathology and Tumor Biology, Kyoto University, Kyoto, Japan
- Institute for the Advanced Study of Human Biology (WPI-ASHBi), Kyoto University, Kyoto, Japan
| | - K Kabashima
- Department of Dermatology, Kyoto University, Kyoto, Japan
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4
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Harai S, Hijioka S, Yamada R, Ogura T, Fukasawa M, Okuda A, Horike H, Inoue D, Sekine M, Ishida Y, Koga T, Kitamura H, Tanaka Y, Yoshinari M, Kobayashi K, Chatto M, Yamashige D, Kawasaki Y, Nagashio Y, Okusaka T. Safety of biliary drainage with 6-mm metallic stent for preoperative obstructive jaundice in pancreatic cancer: PURPLE SIX STUDY. J Gastroenterol Hepatol 2024. [PMID: 38421093 DOI: 10.1111/jgh.16524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Revised: 01/31/2024] [Accepted: 02/05/2024] [Indexed: 03/02/2024]
Abstract
BACKGROUND AND AIM The 10-mm self-expandable metal stent (SEMS) is the standard for endoscopic transpapillary biliary drainage before pancreatic cancer surgery. However, the efficacy of stents thinner than 10 mm has not been adequately validated. Therefore, we aimed to evaluate the safety of a 6-mm fully covered SEMS (FCSEMS) for distal malignant biliary obstruction (DMBO) during preoperative chemotherapy for pancreatic cancer. METHODS This was a single-arm, multicenter, prospective phase II study of endoscopic transpapillary initial biliary drainage for DMBO before pancreatic cancer surgery. The primary endpoint was stent-related adverse events, and the key secondary endpoint was the non-recurrent biliary obstruction (non-RBO) rate during the observation period for both resectable (R) and borderline resectable (BR) pancreatic cancers. RESULTS The study enrolled 33 patients, among whom 32 received the study treatment. There were 23 and 9 cases of R and BR pancreatic cancers, respectively. The technical and clinical success rates were 97.0% and 90.1%, respectively. The stent-related adverse event rate was 3.1% (n = 1, acute pancreatitis) (95% confidential interval, 0.00-16.2), which met the criteria to be considered safe. The overall non-RBO rate during the observation period (median 96 days) was 78.1% (82.6% and 66.7% for R and BR pancreatic cancer cases, respectively). CONCLUSIONS The 6-mm FCSEMS is an extremely safe metallic stent with a low stent-related adverse event rate of 3.1% for preoperative biliary drainage in pancreatic cancer. It is considered the optimal stent for preoperative biliary drainage in terms of the non-RBO rate. UMIN Clinical Trial Registry (UMIN-CTR 000041704).
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Affiliation(s)
- Shota Harai
- Department of Hepatobiliary and Pancreatic Oncology, National Cancer Center Hospital, Tokyo, Japan
- Department of Gastroenterology, University of Yamanashi Faculty of Medicine Graduate School of Medicine, Yamanashi, Japan
| | - Susumu Hijioka
- Department of Hepatobiliary and Pancreatic Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Reiko Yamada
- Department of Gastroenterology and Hepatology, Mie University Graduate School of Medicine, Mie, Japan
| | - Takeshi Ogura
- Second Department of Internal Medicine, Osaka Medical and Pharmaceutical University, Osaka, Japan
| | - Mitsuharu Fukasawa
- Department of Gastroenterology, University of Yamanashi Faculty of Medicine Graduate School of Medicine, Yamanashi, Japan
| | - Atsushi Okuda
- Second Department of Internal Medicine, Osaka Medical and Pharmaceutical University, Osaka, Japan
| | - Hideyuki Horike
- Department of Gastroenterology and Hepatology, Tokyo Metropolitan Tama Medical Center, Tokyo, Japan
| | - Dai Inoue
- Department of Gastroenterology and Hepatology, Tokyo Metropolitan Tama Medical Center, Tokyo, Japan
| | - Masanari Sekine
- Department of Gastroenterology, Jichi Medical University Saitama Medical Center, Saitama, Japan
| | - Yusuke Ishida
- Department of Gastroenterology and Medicine, Fukuoka University Faculty of Medicine, Fukuoka, Japan
| | - Takehiko Koga
- Department of Gastroenterology and Medicine, Fukuoka University Faculty of Medicine, Fukuoka, Japan
| | - Hidetoshi Kitamura
- Department of Gastroenterology, International University of Health and Welfare Mita Hospital, Tokyo, Japan
| | - Yasuhito Tanaka
- Department of Gastroenterology and Hepatology, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Motohiro Yoshinari
- Department of Gastroenterology and Hepatology, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Katsumasa Kobayashi
- Department of Gastroenterology, Tokyo Metropolitan Bokutoh Hospital, Tokyo, Japan
| | | | - Daiki Yamashige
- Department of Hepatobiliary and Pancreatic Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Yuki Kawasaki
- Department of Hepatobiliary and Pancreatic Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Yoshikuni Nagashio
- Department of Hepatobiliary and Pancreatic Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Takuji Okusaka
- Department of Hepatobiliary and Pancreatic Oncology, National Cancer Center Hospital, Tokyo, Japan
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Okazaki H, Ishida Y, Wada M, Kobayashi R, Oe K. Anesthesia Management Using Remimazolam for Lower Limb Amputation in a Patient With Septic Shock Due to Necrotizing Fasciitis. Cureus 2024; 16:e54281. [PMID: 38500917 PMCID: PMC10945281 DOI: 10.7759/cureus.54281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/16/2024] [Indexed: 03/20/2024] Open
Abstract
We report a case of a patient with necrotizing fasciitis and septic shock caused by streptococcal toxic shock syndrome, who was anesthetized and managed with remimazolam. The patient, a woman in her 40s, was admitted to the ICU with a diagnosis of necrotizing fasciitis of the right lower extremity and septic shock and was scheduled for above-the-knee amputation under general anesthesia. She was anesthetized with remimazolam for sedation and fentanyl and remifentanil for analgesia. Intraoperatively, we were able to maintain hemodynamic stability with similar or only slightly higher doses of circulatory agonists during admission. In the present case, remimazolam, an ultrashort-acting benzodiazepine, was safely used to provide anesthesia to a patient in septic shock due to necrotizing fasciitis, who was receiving high doses of vasopressor agents for cardiovascular support, as it was necessary to select an anesthetic drug that would cause minimal circulatory depression.
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Affiliation(s)
- Haruko Okazaki
- Anesthesiology, Showa University School of Medicine, Tokyo, JPN
| | - Yusuke Ishida
- Anesthesiology, Showa University School of Medicine, Tokyo, JPN
| | - Miki Wada
- Anesthesiology, Yokohama Asahi Chuo General Hospital, Kanagawa, JPN
| | - Reon Kobayashi
- Anesthesiology, Showa University School of Medicine, Tokyo, JPN
| | - Katsunori Oe
- Anesthesiology, Showa University School of Medicine, Tokyo, JPN
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Ise K, Tanei ZI, Oda Y, Tanikawa S, Sugino H, Ishida Y, Tsuda M, Gotoda Y, Nishiwaki K, Yanai H, Hasegawa T, Nagashima K, Tanaka S. A Case of Uterine Tumor Resembling Ovarian Sex Cord Tumor With Prominent Myxoid Features. Int J Gynecol Pathol 2024; 43:41-46. [PMID: 37406360 DOI: 10.1097/pgp.0000000000000949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/07/2023]
Abstract
Uterine tumor resembling ovarian sex cord tumor (UTROSCT) is a rare tumor with low malignant potential that commonly occurs in middle age. Although more than 100 cases have been reported to date, myxoid morphology is not well documented. Here, we present a 75-yr-old woman with abnormal vaginal bleeding, with an 8-cm mass in the uterine corpus detected by irregular, high-intensity signaling on T2-weighted imaging. The uterine mass had a glistening mucinous appearance on gross examination. Microscopically, most of the tumor cells were floating in the myxoid stroma. The tumor cells formed clusters or nests with abundant cytoplasm, while some exhibited trabecular or rhabdoid appearances. Immunohistochemically, tumor cells were positive for pancytokeratin (AE1/AE3), α-smooth muscle actin, CD10, progesterone receptor, and some sex cord markers such as calretinin, inhibin, CD56, steroidogenic factor-1. Electron microscopy demonstrated epithelial and sex cord differentiation. This tumor was negative for JAZF1-JJAZ1 fusion gene that is frequently found in low-grade endometrial stromal sarcoma. Fusion genes related to UTROSCT, including NCOA2/3 , were not detected by reverse transcription polymerase chain reaction. The present case suggests that UTROSCT should be included in the differential diagnosis of myxoid uterine tumors.
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Koga T, Ishida Y, Tsuchiya N, Kitaguchi T, Kurogi T, Shimoji Y, Hirai F. Novel hemostatic option using self-assembling peptide gel for endoscopic necrosectomy-related bleeding. Endoscopy 2023; 55:E598-E599. [PMID: 36996885 PMCID: PMC10063351 DOI: 10.1055/a-2051-8099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/01/2023]
Affiliation(s)
- Takehiko Koga
- Department of Gastroenterology and Medicine, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Yusuke Ishida
- Department of Gastroenterology and Medicine, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Naoaki Tsuchiya
- Department of Gastroenterology and Medicine, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Takanori Kitaguchi
- Department of Gastroenterology and Medicine, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Takashi Kurogi
- Department of Gastroenterology and Medicine, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Yasuharu Shimoji
- Department of Gastroenterology and Medicine, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Fumihito Hirai
- Department of Gastroenterology and Medicine, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
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Affiliation(s)
- Yusuke Ishida
- Department of Gastroenterology and Medicine, Fukuoka University, Faculty of Medicine, Fukuoka, Japan
| | - Takehiko Koga
- Department of Gastroenterology and Medicine, Fukuoka University, Faculty of Medicine, Fukuoka, Japan
| | - Naoaki Tsuchiya
- Department of Gastroenterology and Medicine, Fukuoka University, Faculty of Medicine, Fukuoka, Japan
| | - Kaori Hata
- Department of Gastroenterology, Fukuokaken Saiseikai Futsukaichi Hospital, Fukuoka, Japan
| | - Kei Nishioka
- Department of Gastroenterology, Fukuokaken Saiseikai Futsukaichi Hospital, Fukuoka, Japan
| | - Noriko Shiga
- Department of Gastroenterology, Fukuokaken Saiseikai Futsukaichi Hospital, Fukuoka, Japan
| | - Fumihito Hirai
- Department of Gastroenterology and Medicine, Fukuoka University, Faculty of Medicine, Fukuoka, Japan
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Ishida Y, Sekiguchi S, Tsuzuki Y, Kawachi A, Tomino M. Severe acute cholecystitis successfully treated with endoscopic nasobiliary drainage tube insertion: A case report. SAGE Open Med Case Rep 2023; 11:2050313X231212303. [PMID: 38022856 PMCID: PMC10656800 DOI: 10.1177/2050313x231212303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 10/19/2023] [Indexed: 12/01/2023] Open
Abstract
In this report, we present a case of a patient with bile peritonitis caused by gallbladder perforation associated with acute cholecystitis, which required intensive postoperative care. The patient was a woman in her 40s who presented with abdominal pain. Upon examination, she was diagnosed as having acute cholecystitis and bile peritonitis caused by gallbladder perforation. Subsequently, a partial cholecystectomy, omental pack, and drainage were performed. Initially, her bile duct enzyme levels improved; however, they subsequently increased again. An endoscopic nasobiliary drainage tube was inserted, and thereafter, a decrease in inflammatory response and bile duct enzyme levels was observed. During the course of treatment, respiratory failure and renal impairment occurred, necessitating mechanical ventilation management and continuous hemodiafiltration. In patients with severe acute cholecystitis, in addition to treating the underlying condition, it is crucial to perform procedures perioperatively, in anticipation of the development of additional organ dysfunctions postoperatively.
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Affiliation(s)
- Yusuke Ishida
- Department of Anesthesiology, Tokyo Medical University, Shinjuku-ku, Tokyo, Japan
- Department of Anesthesiology, Showa University Hospital, Shinagawa-ku, Tokyo, Japan
| | - Shunya Sekiguchi
- Department of Anesthesiology, Tokyo Medical University, Shinjuku-ku, Tokyo, Japan
| | - Yumi Tsuzuki
- Department of Anesthesiology, Tokyo Medical University, Shinjuku-ku, Tokyo, Japan
| | - Aya Kawachi
- Department of Anesthesiology, Tokyo Medical University, Shinjuku-ku, Tokyo, Japan
| | - Mikiko Tomino
- Department of Anesthesiology, Tokyo Medical University, Shinjuku-ku, Tokyo, Japan
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10
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Okada T, Yoshida M, Matsushita T, Ishida Y, Furukawa K, Murozono M. Anesthetic management of airway stent placement by rigid bronchoscopy with superior laryngeal nerve block while preserving spontaneous breathing: A case report. Clin Case Rep 2023; 11:e8232. [PMID: 38028085 PMCID: PMC10658590 DOI: 10.1002/ccr3.8232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 10/22/2023] [Accepted: 11/06/2023] [Indexed: 12/01/2023] Open
Abstract
Key Clinical Message The combination of superior laryngeal nerve block can reduce the respiratory depression that occurs during management under total intravenous anesthesia. Abstract Anesthetic management of endobronchial stent placement by rigid bronchoscopy requires the maintenance of spontaneous breathing while suppressing upper airway reflexes. The combination of superior laryngeal nerve block (SLNB) can reduce the respiratory depression that occurs during management under total intravenous anesthesia. The patient was diagnosed as having lung cancer with invasion into the right middle bronchus and stenosis of the right main bronchus on chest computed tomography, and emergency airway stent placement was performed. Sedation was initiated with propofol and dexmedetomidine, and ultrasound-guided SLNB was performed after local anesthetic spraying into the oral cavity and trachea. Bucking was minimally controlled during insertion of the rigid bronchoscope. The patient's intraoperative hemodynamics remained stable, and there were no hypoxic events. SLNB can provide the suppression of the upper airway reflex while minimizing effects on spontaneous breathing, and may be useful for achieving balanced anesthesia during rigid bronchoscopy.
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Affiliation(s)
- Toshio Okada
- Department of AnesthesiologyTokyo Medical UniversityTokyoJapan
| | - Mio Yoshida
- Department of AnesthesiologyTokyo Medical UniversityTokyoJapan
| | | | - Yusuke Ishida
- Department of AnesthesiologyTokyo Medical UniversityTokyoJapan
- Department of AnesthesiologyShowa University HospitalTokyoJapan
| | - Kinya Furukawa
- Department of Thoracic SurgeryTokyo Medical University Ibaraki Medical CenterIbarakiJapan
| | - Michihiro Murozono
- Department of AnesthesiologyTokyo Medical University Ibaraki Medical CenterIbarakiJapan
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Tsuzuki Y, Nishiyama T, Ishida Y, Maeda R, Tomino M, Ohseto K. A Case of Nerve Root Radiofrequency Thermocoagulation for Pain Due to Pleural Metastasis of Lung Cancer Leading to Improvement in the Patient's Quality of Life. Palliat Med Rep 2023; 4:288-291. [PMID: 37908493 PMCID: PMC10615080 DOI: 10.1089/pmr.2023.0036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/28/2023] [Indexed: 11/02/2023] Open
Abstract
Advances in medicine have made long-term survival of cancer patients possible. Hence, it is now necessary to consider how to approach common symptoms, such as cancer-related pain, in these patients. In this study, we describe a lung cancer patient in whom relief of intractable thoracic pain caused by pleural metastasis was achieved through thoracic radiofrequency thermocoagulation (RF), improving his quality of life (QOL). The patient was a man in his 70s with right upper lobe lung cancer, left 9th -11th rib metastasis, and left thoracic pain associated with parietal pleural metastasis. The patient experienced insomnia and weight loss due to poor appetite caused by opioid analgesics and inadequate pain control. Therefore, RF was performed as interventional treatment, resulting in a decrease in the numerical rating scale score from 10/10 to 2/10, and an improvement in QOL. In cases wherein long-term survival is expected, a long-term treatment plan for chronic cancer-related pain, which has a tendency to become persistent, becomes necessary. RF for the nerve roots might be a viable option for pain caused by pleural metastasis in cancer survivors.
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Affiliation(s)
- Yumi Tsuzuki
- Department of Anesthesiology, Tokyo Medical University, Shinjuku-ku, Japan
| | - Takahisa Nishiyama
- Department of Anesthesiology, Tokyo Medical University Hachioji Medical Center, Hachioji, Japan
| | - Yusuke Ishida
- Department of Anesthesiology, Tokyo Medical University, Shinjuku-ku, Japan
- Department of Anesthesiology, Showa University Hospital, Shinagawa-ku, Japan
| | - Ryoji Maeda
- Department of Anesthesiology, Tokyo Medical University Hachioji Medical Center, Hachioji, Japan
| | - Mikiko Tomino
- Department of Anesthesiology, Tokyo Medical University, Shinjuku-ku, Japan
| | - Kiyoshige Ohseto
- Department of Anesthesiology, Tokyo Medical University, Shinjuku-ku, Japan
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Hongo H, Nishiyama M, Ueda T, Ishida Y, Kasai M, Tanaka R, Nagase H, Maruyama A. Comparison of neurological manifestation in children with and without coronavirus 2019 experiencing seizures with fever. Epilepsy Behav Rep 2023; 24:100625. [PMID: 37860712 PMCID: PMC10583046 DOI: 10.1016/j.ebr.2023.100625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 10/03/2023] [Accepted: 10/04/2023] [Indexed: 10/21/2023] Open
Abstract
Whether neurologic symptoms due to SARS-CoV-2 differ from those of non-SARS-CoV-2 viral infection is unclear. We aimed to describe these neurological manifestations and compare the clinical characteristics and treatments in children with seizures and fever with or without COVID-19. We retrospectively analyzed data from 105 hospitalized children (<18 years) with clinical seizures and fever between September 2021 and August 2022. We compared the clinical characteristics and treatments between the COVID-19 (n = 20) and non-COVID-19 (n = 85) groups. Patients with COVID-19 were older than those without (32.5 [20-86] months vs. 20 [16-32] months, p = 0.029). Seizure type and duration and impaired consciousness duration did not differ between groups. Six and 32 patients experienced status epilepticus lasting 30 min in the COVID-19 and non-COVID-19 groups, respectively. Most treatments did not differ between groups; however, electroencephalography was used less frequently for COVID-19. Neurological sequelae occurred in one and four patients in the COVID-19 and non-COVID-19 groups, respectively. In conclusion, seizures with fever due to SARS-CoV-2 were more common in older children. Seizure characteristics and neurologic sequelae did not differ in children with and those without COVID-19. In general, electroencephalography was used less during COVID-19 for infection control measures.
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Affiliation(s)
- Hiroto Hongo
- Department of Neurology, Hyogo Prefectural Kobe Children’s Hospital, Kobe, Japan
| | - Masahiro Nishiyama
- Department of Neurology, Hyogo Prefectural Kobe Children’s Hospital, Kobe, Japan
- Department of Pediatrics, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Takuya Ueda
- Department of Neurology, Hyogo Prefectural Kobe Children’s Hospital, Kobe, Japan
| | - Yusuke Ishida
- Department of Neurology, Hyogo Prefectural Kobe Children’s Hospital, Kobe, Japan
| | - Masashi Kasai
- Division of Infectious Disease, Department of Pediatrics, Hyogo Prefectural Kobe Children's Hospital, Kobe, Japan
| | - Ryojiro Tanaka
- Department of Emergency and General Pediatrics, Hyogo Prefectural Kobe Children’s Hospital, Kobe, Japan
| | - Hiroaki Nagase
- Department of Pediatrics, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Azusa Maruyama
- Department of Neurology, Hyogo Prefectural Kobe Children’s Hospital, Kobe, Japan
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Nomaru R, Ishida Y, Kitaguchi T, Koga T, Tsuchiya N, Nakashima R, Sato K, Hamada Y, Hasegawa S, Hirai F. Preoperatively diagnosed intraductal oncocytic papillary neoplasm of the pancreas with prominent invasion: a case report. Clin J Gastroenterol 2023; 16:772-778. [PMID: 37434042 DOI: 10.1007/s12328-023-01828-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Accepted: 06/30/2023] [Indexed: 07/13/2023]
Abstract
Previously considered as one of the less-invasive subtypes of intraductal papillary mucinous neoplasm, intraductal oncocytic papillary neoplasm (IOPN) has recently been acknowledged as a new entity of pancreatic tumor. We herein present a case of preoperatively diagnosable IOPN invasion in the stomach and colon. A 78-year-old woman was referred to our hospital for evaluation of anorexia and gastroesophageal reflux. Upper gastrointestinal endoscopy revealed a gastric subepithelial lesion with ulcerated mucosa that required hemostasis. Computed tomography revealed a 96-mm-diameter solid tumor with a well-defined border and centrally positioned necrotic area, extending from the stomach to the transverse colon and pancreatic tail. Because it was suspected to be a pancreatic solid tumor with direct stomach invasion, endoscopic ultrasound-guided fine-needle biopsy (EUS-FNB) was performed, which led to a preoperative diagnosis of IOPN. Moreover, laparoscopic pancreatosplenectomy, proximal gastrectomy, and transverse colectomy were performed. Analysis of the surgical specimen revealed that the tumor was IOPN and had invaded the stomach and transverse colon. Lymph node metastasis was also confirmed. These findings indicate that IOPN can manifest as an invasive tumor, and EUS-FNB may be equally helpful for assessing the invaded area of a cystic lesion as it is for a solid lesion.
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Affiliation(s)
- Ryohei Nomaru
- Department of Gastroenterology and Medicine, Fukuoka University Faculty of Medicine, 7-45-1 Nanakuma, Jonan-ku, Fukuoka, 814-0180, Japan
| | - Yusuke Ishida
- Department of Gastroenterology and Medicine, Fukuoka University Faculty of Medicine, 7-45-1 Nanakuma, Jonan-ku, Fukuoka, 814-0180, Japan.
| | - Takanori Kitaguchi
- Department of Gastroenterology and Medicine, Fukuoka University Faculty of Medicine, 7-45-1 Nanakuma, Jonan-ku, Fukuoka, 814-0180, Japan
| | - Takehiko Koga
- Department of Gastroenterology and Medicine, Fukuoka University Faculty of Medicine, 7-45-1 Nanakuma, Jonan-ku, Fukuoka, 814-0180, Japan
| | - Naoaki Tsuchiya
- Department of Gastroenterology and Medicine, Fukuoka University Faculty of Medicine, 7-45-1 Nanakuma, Jonan-ku, Fukuoka, 814-0180, Japan
| | - Ryo Nakashima
- Department of Gastroenterological Surgery, Fukuoka University Faculty of Medicine, 7-45-1 Nanakuma, Jonan-ku, Fukuoka, 814-0180, Japan
| | - Keisuke Sato
- Department of Radiology, Fukuoka University Faculty of Medicine, 7-45-1 Nanakuma, Jonan-ku, Fukuoka, 814-0180, Japan
| | - Yoshihiro Hamada
- Department of Pathology, Fukuoka University Faculty of Medicine, 7-45-1 Nanakuma, Jonan-ku, Fukuoka, 814-0180, Japan
| | - Suguru Hasegawa
- Department of Gastroenterological Surgery, Fukuoka University Faculty of Medicine, 7-45-1 Nanakuma, Jonan-ku, Fukuoka, 814-0180, Japan
| | - Fumihito Hirai
- Department of Gastroenterology and Medicine, Fukuoka University Faculty of Medicine, 7-45-1 Nanakuma, Jonan-ku, Fukuoka, 814-0180, Japan
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Tsuzuki Y, Ishida Y, Tomino M. Presumed first episode of nonconvulsive status epilepticus as the cause of postoperative disorder of consciousness following the completion of general anesthesia: A case report. Clin Case Rep 2023; 11:e7988. [PMID: 37780924 PMCID: PMC10533385 DOI: 10.1002/ccr3.7988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 09/11/2023] [Accepted: 09/19/2023] [Indexed: 10/03/2023] Open
Abstract
Key Clinical Message Disorder of consciousness can lead to irreversible sequelae without proper intervention. Consequently, early diagnosis and treatment are of paramount importance in patients with disorder of consciousness. Abstract Disorder of consciousness (DOC) has various etiologies. Here, we report a case in which DOC following general anesthesia was suspected as being due to the first episode of nonconvulsive status epilepticus (NCSE). An elderly man in his 80s underwent uneventful tumor resection surgery under general anesthesia for extramammary Paget's disease. After the procedure, he regained consciousness following anesthesia discontinuation and was extubated. Soon after extubation, however, although his respiratory status remained stable, his level of consciousness deteriorated to a Glasgow Coma Scale (GCS) score of E1V1M1. Head computed tomography and magnetic resonance imaging scans indicated no abnormal findings. Subsequently, involuntary movements were noted in his left upper limb. Suspecting an epilepsy episode, diazepam was administered, leading to an improvement in the level of consciousness (GCS: E4V5M6). Based on the improvement in consciousness after diazepam administration, we strongly suspected NCSE.
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Affiliation(s)
- Yumi Tsuzuki
- Department of AnesthesiologyTokyo Medical UniversityTokyoJapan
| | - Yusuke Ishida
- Department of AnesthesiologyTokyo Medical UniversityTokyoJapan
| | - Mikiko Tomino
- Department of AnesthesiologyTokyo Medical UniversityTokyoJapan
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15
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Sekiguchi S, Ishida Y, Tomino M, Ohseto K. Two Cases of Splanchnic Nerve Block With Epidural Anesthesia in Patients Unable to Maintain Prone Position Due to Pancreatic Pain. Palliat Med Rep 2023; 4:274-277. [PMID: 37786485 PMCID: PMC10541929 DOI: 10.1089/pmr.2023.0031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/08/2023] [Indexed: 10/04/2023] Open
Abstract
Splanchnic nerve block is considered to be effective for abdominal visceral pain, and is performed for the purpose of controlling abdominal pain and back pain caused by upper abdominal cancer. The patients in this case report were candidates for splanchnic nerve block owing to cancer-associated pain. However, because they could not assume the prone position that is required for the block owing to their pain, combined epidural anesthesia was used, resulting in successful implementation of the splanchnic nerve block. Patients who are candidates for splanchnic nerve block often have advanced cancer, and it is hence often difficult to secure and maintain the position required for the procedure owing to their severe pain. The two patients presented here suggest the possibility that epidural anesthesia might be useful as an adjunct in such cases.
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Affiliation(s)
- Shunya Sekiguchi
- Department of Anesthesiology, Tokyo Medical University Hospital, Shinjuku-ku, Tokyo, Japan
| | - Yusuke Ishida
- Department of Anesthesiology, Tokyo Medical University Hospital, Shinjuku-ku, Tokyo, Japan
| | - Mikiko Tomino
- Department of Anesthesiology, Tokyo Medical University Hospital, Shinjuku-ku, Tokyo, Japan
| | - Kiyoshige Ohseto
- Department of Anesthesiology, Tokyo Medical University Hospital, Shinjuku-ku, Tokyo, Japan
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16
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Narumi S, Ishida Y, Igarashi S, Sekiguchi S, Kawachi A, Tomino M. Anesthesia using remimazolam during coronary artery bypass surgery in a patient with decreased left ventricular function. Clin Case Rep 2023; 11:e7970. [PMID: 37767150 PMCID: PMC10520288 DOI: 10.1002/ccr3.7970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 07/06/2023] [Accepted: 09/15/2023] [Indexed: 09/29/2023] Open
Abstract
Key Clinical Message Remimazolam is a new benzodiazepine sedative and has the characteristic of causing minimal effects on circulation. This case indicates that it can be considered as an option for anesthesia management of patients with decreased cardiac function. Abstract Some patients who undergo cardiac surgery have reduced cardiac function, which can often make anesthesia management difficult owing to severe hypotension at the time of anesthesia induction. Therefore, it is important to select drugs that cause minimal circulatory depression. On the other hand, in 2020, the use of remimazolam, a short-acting benzodiazepine sedative, was approved in Japan, and reports of its use in various patients have been increasing. This drug has the characteristic of causing minimal effects on circulation. We here report the safe use of remimazolam in the anesthesia management of a patient with decreased cardiac function who was diagnosed as having angina pectoris. The patient was a 73-year-old man scheduled for coronary artery bypass graft (CABG) surgery. Remimazolam was used for sedation purposes during anesthesia induction. During surgery, there were no significant hemodynamic changes and the patient remained in stable cardiovascular condition. Our present case indicates that remimazolam can be considered as an option for anesthesia management in CABG for patients with decreased cardiac function.
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Affiliation(s)
- Shingo Narumi
- Department of AnesthesiologyTokyo Medical UniversityTokyoJapan
| | - Yusuke Ishida
- Department of AnesthesiologyTokyo Medical UniversityTokyoJapan
| | - Sae Igarashi
- Department of AnesthesiologyTokyo Medical UniversityTokyoJapan
| | | | - Aya Kawachi
- Department of AnesthesiologyTokyo Medical UniversityTokyoJapan
| | - Mikiko Tomino
- Department of AnesthesiologyTokyo Medical UniversityTokyoJapan
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17
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Koga T, Hijioka S, Nagashio Y, Maruki Y, Maehara K, Murashima Y, Kawasaki Y, Takeshita K, Yamada N, Yoshinari M, Hisada Y, Harai S, Kitamura H, Kawahara S, Ohba A, Morizane C, Ishida Y, Hirai F, Okusaka T. Prospective clinical trial of EUS-guided choledochoduodenostomy without fistula dilation for malignant distal biliary obstruction. Endosc Ultrasound 2023; 12:409-416. [PMID: 37969165 PMCID: PMC10631599 DOI: 10.1097/eus.0000000000000009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 04/12/2023] [Indexed: 11/17/2023] Open
Abstract
Background and Objectives During EUS-guided choledochoduodenostomy (EUS-CDS), fistula dilation before stent insertion is associated with adverse events (AEs), such as bile leakage and peritonitis. We hypothesized that EUS-CDS without fistula dilation using a novel self-expandable metal stent (SEMS) with a thin delivery system could overcome this problem, and we conducted this study to evaluate its feasibility and safety. Methods This was an open-label, single-arm, phase II study at a single institution. We planned EUS-CDS without fistula dilation using a fully covered SEMS with a 5.9-Fr delivery system for unresectable malignant distal biliary obstruction. The primary outcome was overall technical success. Secondary outcomes were technical success without fistula dilation, procedure time, functional success, time to recurrent biliary obstruction, and AEs. The planned sample size was 25 patients. Results In total, 24 patients were included in this study. In 21 patients, EUS-CDS was performed as primary drainage. The overall technical success rate was 100% (24 of 24 patients). The technical success rate without fistula dilation was 96% (23 of 24). The median procedure time was 16 min (range, 10-66 min). The functional success rate was 96% (23 of 24). The median time to recurrent biliary obstruction was 148 days (95% confidence interval, 29-266 days). There were no procedure-related AEs. Furthermore, computed tomography immediately after the procedure showed no leakage of contrast medium into the abdominal cavity in any patient. Conclusions EUS-guided choledochoduodenostomy without fistula dilation using a fully covered SEMS with a 5.9-Fr delivery system is feasible with a high probability and can be achieved quickly while effectively preventing bile leakage and peritonitis.
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Affiliation(s)
- Takehiko Koga
- Department of Hepatobiliary and Pancreatic Oncology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045, Japan
- Department of Gastroenterology and Medicine, Faculty of Medicine, Fukuoka University, 7-45-1 Nanakuma, Johnan-ku, Fukuoka, 814-0180, Japan
| | - Susumu Hijioka
- Department of Hepatobiliary and Pancreatic Oncology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045, Japan
| | - Yoshikuni Nagashio
- Department of Hepatobiliary and Pancreatic Oncology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045, Japan
| | - Yuta Maruki
- Department of Hepatobiliary and Pancreatic Oncology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045, Japan
| | - Kosuke Maehara
- Department of Hepatobiliary and Pancreatic Oncology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045, Japan
| | - Yumi Murashima
- Department of Hepatobiliary and Pancreatic Oncology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045, Japan
| | - Yuki Kawasaki
- Department of Hepatobiliary and Pancreatic Oncology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045, Japan
| | - Kotaro Takeshita
- Department of Hepatobiliary and Pancreatic Oncology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045, Japan
| | - Natsumi Yamada
- Department of Hepatobiliary and Pancreatic Oncology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045, Japan
| | - Motohiro Yoshinari
- Department of Hepatobiliary and Pancreatic Oncology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045, Japan
| | - Yuya Hisada
- Department of Hepatobiliary and Pancreatic Oncology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045, Japan
| | - Shota Harai
- Department of Hepatobiliary and Pancreatic Oncology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045, Japan
| | - Hidetoshi Kitamura
- Department of Hepatobiliary and Pancreatic Oncology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045, Japan
| | - Shun Kawahara
- Department of Hepatobiliary and Pancreatic Oncology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045, Japan
| | - Akihiro Ohba
- Department of Hepatobiliary and Pancreatic Oncology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045, Japan
| | - Chigusa Morizane
- Department of Hepatobiliary and Pancreatic Oncology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045, Japan
| | - Yusuke Ishida
- Department of Gastroenterology and Medicine, Faculty of Medicine, Fukuoka University, 7-45-1 Nanakuma, Johnan-ku, Fukuoka, 814-0180, Japan
| | - Fumihito Hirai
- Department of Gastroenterology and Medicine, Faculty of Medicine, Fukuoka University, 7-45-1 Nanakuma, Johnan-ku, Fukuoka, 814-0180, Japan
| | - Takuji Okusaka
- Department of Hepatobiliary and Pancreatic Oncology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045, Japan
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18
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Nagase H, Yamaguchi H, Tokumoto S, Ishida Y, Tomioka K, Nishiyama M, Nozu K, Maruyama A. Timing of therapeutic interventions against infection-triggered encephalopathy syndrome: a scoping review of the pediatric literature. Front Neurosci 2023; 17:1150868. [PMID: 37674514 PMCID: PMC10477367 DOI: 10.3389/fnins.2023.1150868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 08/07/2023] [Indexed: 09/08/2023] Open
Abstract
Our goal was to conduct a scoping review of the literature on the treatment of infection-triggered encephalopathy syndrome/acute encephalopathy in children, focusing on treatment targets and treatment initiation timing. We performed literature searches using PubMed for articles reporting treatments of infection-triggered encephalopathy syndrome/acute encephalopathy. We included articles describing specific treatments for acute encephalopathy with control groups. For the purpose of searching new therapies only experimentally tried in the case series, we also included case series studies without control groups in this review, if the studies contained at least two cases with clear treatment goals. Therapies were classified based on their mechanisms of action into brain protection therapy, immunotherapy, and other therapies. We operationally categorized the timing of treatment initiation as T1 (6-12 h), T2 (12-24 h), T3 (24-48 h), and T4 (>48 h) after the onset of seizures and/or impaired consciousness. Thirty articles were included in this review; no randomized control study was found. Eleven retrospective/historical cohort studies and five case-control studies included control groups with or without specific therapies or outcomes. The targeted conditions and treatment timing varied widely across studies. However, the following three points were suggested to be effective in multiple studies: (1) Careful seizure management and targeted temperature management within 12 h (T1) of onset of febrile seizure/prolonged impaired consciousness without multiple organ failure may reduce the development of acute encephalopathy with biphasic seizures and late reduced diffusion; (2) immunotherapy using corticosteroids, tocilizumab, or plasma exchange within 24 h (T1-T2) of onset of acute necrotizing encephalopathy may reduce sequelae; and (3) anakinra therapy and ketogenic diet demonstrate little evidence of neurologic sequelae reduction, but may reduce seizure frequency and allow for weaning from barbiturates, even when administered weeks (T4) after onset in children with febrile infection-related epilepsy syndrome. Although available studies have no solid evidence in the treatment of infection-triggered encephalopathy syndrome/acute encephalopathy, this scoping review lays the groundwork for future prospective clinical trials.
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Affiliation(s)
- Hiroaki Nagase
- Department of Pediatrics, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Hiroshi Yamaguchi
- Department of Pediatrics, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Shoichi Tokumoto
- Department of Pediatrics, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Yusuke Ishida
- Department of Neurology, Hyogo Prefectural Kobe Children’s Hospital, Kobe, Japan
- Department of Emergency and General Pediatrics, Hyogo Prefectural Kobe Children’s Hospital, Kobe, Japan
| | - Kazumi Tomioka
- Department of Pediatrics, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Masahiro Nishiyama
- Department of Pediatrics, Kobe University Graduate School of Medicine, Kobe, Japan
- Department of Neurology, Hyogo Prefectural Kobe Children’s Hospital, Kobe, Japan
| | - Kandai Nozu
- Department of Pediatrics, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Azusa Maruyama
- Department of Neurology, Hyogo Prefectural Kobe Children’s Hospital, Kobe, Japan
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Akao K, Ishida Y, Kamada S, Sekine S, Ohseto K. Two cases of low back pain of unknown etiology diagnosed as multiple myeloma. SAGE Open Med Case Rep 2023; 11:2050313X231187682. [PMID: 37456925 PMCID: PMC10338723 DOI: 10.1177/2050313x231187682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 06/26/2023] [Indexed: 07/18/2023] Open
Abstract
We report two cases of patients complaining of lumbar back pain of unknown etiology which were finally diagnosed as multiple myeloma. The first case was a woman in her 80s with a chief complaint of lumbar back pain. The second case was a male in his 70s. He also consulted our institution because his pain did not subside despite receiving increased doses of oral medication and nerve blocks from his previous doctor. Both patients presented with compression fractures on plain radiography, and additionally with cytopenia, hyperproteinemia, and hypoalbuminemia in blood tests. Further tests were conducted due to suspected multiple myeloma, revealing a punched-out legion in the skull and elevated levels of β2 microglobulin and Immunoglobulin G. Subsequently, both patients were transferred to the hematology department. In these two cases, we had predicted the presence of multiple myeloma from the results of initial testing and subsequently successfully provided definitive diagnoses following additional examinations.
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Affiliation(s)
| | - Yusuke Ishida
- Yusuke Ishida, Department of Anesthesiology, Tokyo Medical University Hospital, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo 160-0023, Japan.
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20
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Sekiguchi S, Nakazawa K, Ishida Y, Uchino H. Intraoperative difficulty in cardiorespiratory management during anesthesia for retroperitoneal paraganglioma resection. SAGE Open Med Case Rep 2023; 11:2050313X231183881. [PMID: 37434894 PMCID: PMC10331333 DOI: 10.1177/2050313x231183881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 06/06/2023] [Indexed: 07/13/2023] Open
Abstract
We report the anesthetic management of a case of paraganglioma, which was challenging because of intraoperative circulatory changes and difficult ventilatory management. A 52-year-old man with a history of chronic obstructive pulmonary disease was scheduled for paraganglioma resection under general anesthesia combined with epidural anesthesia. Since a marked increase in blood pressure was observed immediately after administration of rocuronium, antihypertensive agents were administered as necessary. The ventilatory settings were initially adjusted to deliver a tidal volume of 7 mL/kg, and the drive pressure was maintained at 13 cm H2O or less. However, despite increasing the minute volume, PETCO2 increased to 60 mmHg and PaCO2 to 76 mmHg before tumor removal. Blood pressure decreased immediately after tumor removal, and PETCO2 and PaCO2 gradually returned to normal. We speculated that the increases in PETCO2 and PaCO2 might have been due to both an increase in endogenous catecholamine secretion as well as chronic obstructive pulmonary disease. It is important to preoperatively evaluate the functionality of the tumor and to anticipate perioperative cardiorespiratory instability in the management of paragangliomas.
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Affiliation(s)
| | | | - Yusuke Ishida
- Yusuke Ishida, Department of Anesthesiology, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo 160-0023, Japan.
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21
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Komatsu H, Ono T, Onouchi Y, Onoguchi G, Maita Y, Ishida Y, Maki T, Oba A, Tomita H, Kakuto Y. Polydipsia and autistic traits in patients with schizophrenia spectrum disorders. Front Psychiatry 2023; 14:1205138. [PMID: 37484674 PMCID: PMC10359144 DOI: 10.3389/fpsyt.2023.1205138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 06/19/2023] [Indexed: 07/25/2023] Open
Abstract
Introduction Polydipsia, prevalent in 6%-20% of patients with schizophrenia, results in seclusion and prolonged hospitalization. It is also observed in autistic individuals, with previous studies reporting that autism accounted for 20% of all hospitalized patients with polydipsia. The current study investigated the association between polydipsia and autistic traits in patients with schizophrenia spectrum disorders (SSDs) based on the hypothesis that higher autistic traits would be observed in schizophrenic patients with polydipsia. Methods In the first study (study A), the autism-spectrum quotient [(AQ); Japanese version] scores of long-stay inpatients with and without polydipsia were compared. Furthermore, the association between polydipsia and autistic traits was also examined in short-stay inpatients and outpatients with SSDs (study B). Results Study A showed that patients with polydipsia scored significantly higher on the three AQ subscales (attention switching; communication; and imagination) compared to those without. Study B also showed that patients with polydipsia had significantly higher AQ scores overall and for several subscales compared to those without polydipsia. Binary logistic regression analysis of the combined sample showed that male gender and higher autistic traits were significant predictors of polydipsia. Discussion The study highlights the importance of focusing on such traits to understand the pathogenesis of polydipsia in SSD patients.
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Affiliation(s)
- Hiroshi Komatsu
- Department of Psychiatry, Tohoku University Hospital, Sendai, Japan
- Department of Psychiatry, Graduate School of Medicine, Tohoku University, Sendai, Japan
- Miyagi Psychiatric Center, Natori, Japan
| | | | | | - Goh Onoguchi
- Department of Psychiatry, Graduate School of Medicine, Tohoku University, Sendai, Japan
| | | | | | | | - Akiko Oba
- Miyagi Psychiatric Center, Natori, Japan
| | - Hiroaki Tomita
- Department of Psychiatry, Tohoku University Hospital, Sendai, Japan
- Department of Psychiatry, Graduate School of Medicine, Tohoku University, Sendai, Japan
| | - Yoshihisa Kakuto
- Miyagi Psychiatric Center, Natori, Japan
- Department of Community Psychiatry, Graduate School of Medicine, Tohoku University, Sendai, Japan
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22
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Sekiguchi S, Ishida Y, Fujita Y, Tomino M, Ohseto K. A case of phantom pain and stump pain that was effectively controlled by ultrasound-guided ulnar and median peripheral nerve blocks. Clin Case Rep 2023; 11:e7672. [PMID: 37434961 PMCID: PMC10332250 DOI: 10.1002/ccr3.7672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 06/22/2023] [Accepted: 06/26/2023] [Indexed: 07/13/2023] Open
Abstract
Phantom limb pain and stump pain are often intractable, and their incidences are relatively high. We report a case of a patient with phantom limb and stump pain of the finger, who was successfully treated by peripheral nerve blocks. The patient was a male truck driver in his fifties, who had his left annular finger amputated in an accident 2 years previously. Owing to poor pain control at the stump of his finger, he was referred to our department. The initial examination revealed pain about numerical rating scale (NRS) 6/10 in the left annular finger transection as well as allodynia. Although some pain relief had been observed with postoperative medication, he still had persistent resting pain of about NRS 4/10. Therefore, blocks of the ulnar nerve and median nerve were performed. After the blocks were performed, the pain improved to NRS 1 to 2/10, and pain upon movement also almost disappeared. Peripheral nerve blocks can be a useful treatment modality for phantom limb pain and stump pain in the fingers, as in this case.
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Affiliation(s)
| | - Yusuke Ishida
- Department of AnesthesiologyTokyo Medical UniversityTokyoJapan
| | - Yosuke Fujita
- Department of AnesthesiologyTokyo Medical UniversityTokyoJapan
| | - Mikiko Tomino
- Department of AnesthesiologyTokyo Medical UniversityTokyoJapan
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Kawachi A, Sudo S, Ishida Y, Nakazawa K. Experience of general anesthesia in a patient with menstrual-associated coronary spasm. Clin Case Rep 2023; 11:e7641. [PMID: 37415577 PMCID: PMC10320362 DOI: 10.1002/ccr3.7641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 06/16/2023] [Accepted: 06/21/2023] [Indexed: 07/08/2023] Open
Abstract
Coronary angina due to low estrogen is relatively common around menopause, with almost no reports associated with the menstrual cycle or anesthetic management at younger ages. The patient was a 22-year-old woman who had developed ventricular fibrillation due to coronary spasm, resulting in cardiopulmonary arrest. She was resuscitated, and underwent ICD implantation. As her symptoms appeared at specific times during her menstrual cycle, she was diagnosed as having menstrual-associated coronary spasm, and started taking estrogen/progesterone medication. An endometrial ablation was scheduled for endometrial hyperplasia that was caused by the medicine. The surgery was scheduled in consideration of the patient's menstrual cycle, and general anesthesia was selected as the method of anesthesia. The surgery and perioperative management were uneventful, and her postoperative course was favorable. Our case is the first to our knowledge of general anesthesia performed on a patient with menstrual-associated coronary spasm.
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Affiliation(s)
- Aya Kawachi
- Department of AnesthesiologyTokyo Medical UniversityTokyoJapan
| | - Saho Sudo
- Department of AnesthesiologyTokyo Medical UniversityTokyoJapan
| | - Yusuke Ishida
- Department of AnesthesiologyTokyo Medical UniversityTokyoJapan
| | - Koichi Nakazawa
- Department of AnesthesiologyTokyo Medical UniversityTokyoJapan
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24
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Kurachi A, Ishida Y. Case of intraoperative acute pulmonary embolism diagnosed by transesophageal echocardiography under general anesthesia and successfully managed with extracorporeal membrane oxygenation. SAGE Open Med Case Rep 2023; 11:2050313X231185209. [PMID: 37440974 PMCID: PMC10333629 DOI: 10.1177/2050313x231185209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 06/05/2023] [Indexed: 07/15/2023] Open
Abstract
Acute pulmonary thromboembolism (PTE), which carries a high mortality rate, is difficult to diagnose when it occurs intraoperatively. Therefore, patient prognosis depends on a prompt diagnosis by anesthesiologists. A 49-year-old woman underwent right lower extremity dissection due to a contusion of the right lower extremity caused by trauma. Eleven days after surgery, she underwent debridement for necrosis of the amputation wound. Intraoperatively, a drop in blood pressure and tachycardia were observed, and PTE was suspected based on a rapid deterioration in oxygen saturation and a drop in end-tidal carbon dioxide partial pressure. Transesophageal echocardiography (TEE) showed a thrombus filling the right pulmonary artery, and a diagnosis of PTE was made. The patient was treated using venoarterial extracorporeal membrane oxygenation, and thrombectomy was performed the next day to save her life. In this case, we were able to diagnose and treat the intraoperative acute PTE at an early stage. In addition, the appropriate choice of treatment saved the patient's life without complications.
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Affiliation(s)
| | - Yusuke Ishida
- Yusuke Ishida, Department of Anesthesiology, Tokyo
Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo 160-0023, Japan.
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25
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Igarashi S, Ishida Y, Sekiguchi S, Fujita Y, Kawachi A, Tomino M. Evaluation of total intravenous anesthesia with remimazolam in general anesthesia for pulmonary endarterectomy of chronic thromboembolic pulmonary hypertension: a case report. JA Clin Rep 2023; 9:34. [PMID: 37306811 DOI: 10.1186/s40981-023-00626-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 05/09/2023] [Accepted: 05/31/2023] [Indexed: 06/13/2023] Open
Abstract
BACKGROUND Pulmonary endarterectomy (PEA) is a treatment modality for chronic thromboembolic pulmonary hypertension (CTEPH). PEA requires anesthesia management to prevent an increase in pulmonary vascular resistance (PVR) and circulatory failure. Therefore, it is necessary to select an anesthetic agent that can achieve these goals as much as possible. On the other hand, remimazolam, a short-acting sedative, was launched in Japan in 2020, and its use in various cases has been increasingly reported. This report demonstrates that remimazolam can be used safely in the anesthetic management of PEA. CASE PRESENTATION A 57-year-old man was scheduled to undergo PEA for CTEPH. Remimazolam was used for sedation from induction of anesthesia. Hemodynamics were stable during surgery without circulatory failure. Anesthesia was managed intraoperatively without any particular increase in PVR. DISCUSSION Anesthesia was successfully managed without any complications. This case suggests that remimazolam is one of the options for anesthetic management in PEA.
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Affiliation(s)
- Sae Igarashi
- Department of Anesthesiology, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan
| | - Yusuke Ishida
- Department of Anesthesiology, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan.
| | - Shunya Sekiguchi
- Department of Anesthesiology, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan
| | - Yosuke Fujita
- Department of Anesthesiology, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan
| | - Aya Kawachi
- Department of Anesthesiology, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan
| | - Mikiko Tomino
- Department of Anesthesiology, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan
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Ishida Y, Nakazawa K, Itabashi T, Tomino M. Transfusion-related acute lung injury under general anesthesia successfully treated with extracorporeal membrane oxygenation: A case report. Clin Case Rep 2023; 11:e7386. [PMID: 37220518 PMCID: PMC10199813 DOI: 10.1002/ccr3.7386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 04/08/2023] [Accepted: 05/05/2023] [Indexed: 05/25/2023] Open
Abstract
Transfusion-related acute lung injury (TRALI) is a serious complication of blood transfusion and can also develop severe hypoxemia. In TRALI cases with difficult blood oxygenation on mechanical ventilation support, temporary veno-venous extracorporeal membrane oxygenation support appears to maintain oxygen levels.
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Affiliation(s)
- Yusuke Ishida
- Department of AnesthesiologyTokyo Medical UniversityTokyoJapan
| | - Koichi Nakazawa
- Department of AnesthesiologyTokyo Medical UniversityTokyoJapan
| | - Toshio Itabashi
- Department of AnesthesiologyTokyo Medical UniversityTokyoJapan
| | - Mikiko Tomino
- Department of AnesthesiologyTokyo Medical UniversityTokyoJapan
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Murakami M, Fujimori N, Nakata K, Nakamura M, Hashimoto S, Kurahara H, Nishihara K, Abe T, Hashigo S, Kugiyama N, Ozawa E, Okamoto K, Ishida Y, Okano K, Takaki R, Shimamatsu Y, Ito T, Miki M, Oza N, Yamaguchi D, Yamamoto H, Takedomi H, Kawabe K, Akashi T, Miyahara K, Ohuchida J, Ogura Y, Nakashima Y, Ueki T, Ishigami K, Umakoshi H, Ueda K, Oono T, Ogawa Y. Machine learning-based model for prediction and feature analysis of recurrence in pancreatic neuroendocrine tumors G1/G2. J Gastroenterol 2023; 58:586-597. [PMID: 37099152 DOI: 10.1007/s00535-023-01987-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 03/28/2023] [Indexed: 04/27/2023]
Abstract
BACKGROUND Pancreatic neuroendocrine neoplasms (PanNENs) are a heterogeneous group of tumors. Although the prognosis of resected PanNENs is generally considered to be good, a relatively high recurrence rate has been reported. Given the scarcity of large-scale reports about PanNEN recurrence due to their rarity, we aimed to identify the predictors for recurrence in patients with resected PanNENs to improve prognosis. METHODS We established a multicenter database of 573 patients with PanNENs, who underwent resection between January 1987 and July 2020 at 22 Japanese centers, mainly in the Kyushu region. We evaluated the clinical characteristics of 371 patients with localized non-functioning pancreatic neuroendocrine tumors (G1/G2). We also constructed a machine learning-based prediction model to analyze the important features to determine recurrence. RESULTS Fifty-two patients experienced recurrence (14.0%) during the follow-up period, with the median time of recurrence being 33.7 months. The random survival forest (RSF) model showed better predictive performance than the Cox proportional hazards regression model in terms of the Harrell's C-index (0.841 vs. 0.820). The Ki-67 index, residual tumor, WHO grade, tumor size, and lymph node metastasis were the top five predictors in the RSF model; tumor size above 20 mm was the watershed with increased recurrence probability, whereas the 5-year disease-free survival rate decreased linearly as the Ki-67 index increased. CONCLUSIONS Our study revealed the characteristics of resected PanNENs in real-world clinical practice. Machine learning techniques can be powerful analytical tools that provide new insights into the relationship between the Ki-67 index or tumor size and recurrence.
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Affiliation(s)
- Masatoshi Murakami
- Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-Ku, Fukuoka, 812-8582, Japan
| | - Nao Fujimori
- Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-Ku, Fukuoka, 812-8582, Japan.
| | - Kohei Nakata
- Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Masafumi Nakamura
- Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Shinichi Hashimoto
- Digestive and Lifestyle Diseases, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Hiroshi Kurahara
- Department of Digestive Surgery, Breast and Thyroid Surgery, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Kazuyoshi Nishihara
- Department of Surgery, Kitakyushu Municipal Medical Center, Kitakyushu, Japan
| | - Toshiya Abe
- Department of Surgery, Kitakyushu Municipal Medical Center, Kitakyushu, Japan
| | - Shunpei Hashigo
- Department of Gastroenterology and Hepatology, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Naotaka Kugiyama
- Department of Gastroenterology and Hepatology, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Eisuke Ozawa
- Department of Gastroenterology and Hepatology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Kazuhisa Okamoto
- Department of Gastroenterology, Faculty of Medicine, Oita University, Oita, Japan
| | - Yusuke Ishida
- Department of Gastroenterology and Medicine, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Keiichi Okano
- Department of Gastroenterological Surgery, Faculty of Medicine, Kagawa University, Kita-gun, Japan
| | - Ryo Takaki
- Department of Gastroenterology, Urasoe General Hospital, Urasoe, Japan
| | - Yutaka Shimamatsu
- Division of Gastroenterology, Department of Medicine, Kurume University School of Medicine, Kurume, Japan
| | - Tetsuhide Ito
- Neuroendocrine Tumor Centre, Fukuoka Sanno Hospital, Fukuoka, Japan
- Department of Gastroenterology, Graduate School of Medical Sciences, International University of Health and Welfare, Fukuoka, Japan
| | - Masami Miki
- Department of Gastroenterology, National Hospital Organization Kyushu Cancer Center, Fukuoka, Japan
| | - Noriko Oza
- Department of Hepato-Biliary-Pancreatology, Saga-Ken Medical Centre Koseikan, Saga, Japan
| | - Daisuke Yamaguchi
- Department of Gastroenterology, National Hospital Organization Ureshino Medical Center, Ureshino, Japan
| | | | - Hironobu Takedomi
- Division of Gastroenterology, Department of Internal Medicine, Faculty of Medicine, Saga University, Saga, Japan
| | - Ken Kawabe
- Department of Gastroenterology, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan
| | - Tetsuro Akashi
- Department of Internal Medicine, Saiseikai Fukuoka General Hospital, Fukuoka, Japan
| | - Koichi Miyahara
- Department of Internal Medicine, Karatsu Red Cross Hospital, Karatsu, Japan
| | - Jiro Ohuchida
- Department of Surgery, Miyazaki Prefectural Miyazaki Hospital, Miyazaki, Japan
| | - Yasuhiro Ogura
- Department of Surgery, Fukuoka Red Cross Hospital, Fukuoka, Japan
| | - Yohei Nakashima
- Department of Surgery, Japan Community Health Care Organization, Kyushu Hospital, Kitakyushu, Japan
| | - Toshiharu Ueki
- Department of Gastroenterology, Fukuoka University Chikushi Hospital, Chikushino, Japan
| | - Kousei Ishigami
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Hironobu Umakoshi
- Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-Ku, Fukuoka, 812-8582, Japan
| | - Keijiro Ueda
- Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-Ku, Fukuoka, 812-8582, Japan
| | - Takamasa Oono
- Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-Ku, Fukuoka, 812-8582, Japan
| | - Yoshihiro Ogawa
- Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-Ku, Fukuoka, 812-8582, Japan
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Ohta N, Suzuki T, Noguchi N, Shirane S, Ansai N, Sato T, Ishida Y, Murakami K, Murakami K, Nakamura Y. A facelift procedure for resection of a branchial cleft cysts. Auris Nasus Larynx 2023; 50:272-275. [PMID: 35842275 DOI: 10.1016/j.anl.2022.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Revised: 06/24/2022] [Accepted: 06/30/2022] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Branchial cleft cysts (BCCs) are common in daily practice, however, BCC patients suffer aesthetic problems due to postoperative scars on visible parts after surgery. To analyze the feasibility, surgical outcomes and possible risks and complications encountered during a facelift procedure for patients with BCC. METHODS This retrospective analysis examined patients who had undergone surgery for branchial cleft cyst using a facelift procedure (n = 16) or conventional transcervical resection (n = 20) at our institutes between April 2015 and August 2021. RESULTS There was no significant difference between the groups that underwent the facelift procedure or conventional transcervical resection as to the average size of the cysts, operating time, bleeding, drain out, or recurrence. None of the patients needed to switch from the facelift procedure to conventional transcervical resection. In all the patients in the facelift procedure group, postoperative scars were fully concealed by the auricle and hair. However, four patients in the facelift procedure group experienced a transient auricular complication after surgery. CONCLUSION The facelift procedure provides adequate visualization, workspace and excellent cosmetic results in suitably selected cases with BCC.
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Affiliation(s)
- Nobuo Ohta
- Division of Otolaryngology, Tohoku Medical and Pharmaceutical University Hospital, 1-12-1, Fukumuro, Miyaginoku, Sendai 983-8512, Japan; Department of Otolaryngology, Yamagata City Hospital Saiseikan, Yamagata, Japan.
| | - Takahiro Suzuki
- Division of Otolaryngology, Tohoku Medical and Pharmaceutical University Hospital, 1-12-1, Fukumuro, Miyaginoku, Sendai 983-8512, Japan
| | - Naoya Noguchi
- Division of Otolaryngology, Tohoku Medical and Pharmaceutical University Hospital, 1-12-1, Fukumuro, Miyaginoku, Sendai 983-8512, Japan
| | - Shion Shirane
- Division of Otolaryngology, Tohoku Medical and Pharmaceutical University Hospital, 1-12-1, Fukumuro, Miyaginoku, Sendai 983-8512, Japan
| | - Nanako Ansai
- Division of Otolaryngology, Tohoku Medical and Pharmaceutical University Hospital, 1-12-1, Fukumuro, Miyaginoku, Sendai 983-8512, Japan
| | - Teruyuki Sato
- Division of Otolaryngology, Tohoku Medical and Pharmaceutical University Hospital, 1-12-1, Fukumuro, Miyaginoku, Sendai 983-8512, Japan
| | - Yusuke Ishida
- Division of Anatomy and Cell Biology, Tohoku Medical and Pharmaceutical University, 1-12-1, Fukumuro, Miyaginoku, Sendai 983-8512, Japan
| | - Keigo Murakami
- Division of Pathology, Tohoku Medical and Pharmaceutical University, 1-12-1, Fukumuro, Miyaginoku, Sendai 983-8512, Japan
| | - Kazuhiro Murakami
- Division of Pathology, Tohoku Medical and Pharmaceutical University, 1-12-1, Fukumuro, Miyaginoku, Sendai 983-8512, Japan
| | - Yasuhiro Nakamura
- Division of Pathology, Tohoku Medical and Pharmaceutical University, 1-12-1, Fukumuro, Miyaginoku, Sendai 983-8512, Japan
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Yajima R, Ishida Y, Kobayashi T, Uchino H. Anesthetic Management Using the Oxygen Reserve Index for Tracheal Resection and Tracheal End-to-End Anastomosis for a Malignant Thyroid Tumor With Tracheal Invasion. Cureus 2023; 15:e35728. [PMID: 37016655 PMCID: PMC10066925 DOI: 10.7759/cureus.35728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/03/2023] [Indexed: 03/06/2023] Open
Abstract
When tracheal invasion of cancerous diseases such as thyroid cancer occurs, tracheal resection followed by end-to-end anastomosis is a treatment of choice. Anesthetic management of the patient during this procedure may pose challenges, such as maintaining ventilation during tracheal dissection, resection of the tracheal invasion, and tracheal end-to-end anastomosis. Here, we have presented a case of a woman in her 50s. Computed tomography of the head and neck displayed a 31-mm mass in the medial lobe of the thyroid gland, and irregularities in the trachea and right tracheoesophageal groove. We decided to perform total thyroidectomy followed by tracheal resection and end-to-end tracheal anastomosis, as a radical treatment. Anesthetic management was successfully performed without a decrease in the peripheral blood oxygen saturation level, due to managing oxygenation by using the oxygen reserve index (ORITM) monitoring during the tracheostomy, tracheal infiltration division resection, and tracheal end-to-end suturing. This case was a unique situation requiring two intraoperative tube exchanges, but the ORI monitoring of oxygenation enabled safe anesthetic management.
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Koga T, Ishida Y, Hamada Y, Takayama Y, Tsuchiya N, Kitaguchi T, Matsumoto K, Kajiwara M, Naito S, Ishii F, Nakashima R, Sasaki T, Hirai F. High predictive ability of apparent diffusion coefficient value for wall-invasion pattern of advanced gallbladder carcinoma. Abdom Radiol (NY) 2023; 48:902-912. [PMID: 36694054 DOI: 10.1007/s00261-023-03805-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 01/09/2023] [Accepted: 01/10/2023] [Indexed: 01/26/2023]
Abstract
PURPOSE The wall-invasion pattern classification of advanced gallbladder carcinoma (GBC) has been reported. However, its association with clinical findings remains unclear. We aimed to clarify relationships between clinicopathological characteristics, prognosis, and apparent diffusion coefficient (ADC) values of advanced GBC based on the wall-invasion pattern. METHODS We reviewed the data of 37 patients who had undergone advanced GBC cholecystectomy at our institution between 2009 and 2021. Clinicopathological findings, prognosis, and ADC values were retrospectively analyzed. RESULTS Based on the wall-invasion pattern, patients were classified into infiltrative growth (IG) type (n = 22) and destructive growth (DG) type (n = 15). In the DG-type, the incidence of venous invasion (P = 0.027), neural invasion (P = 0.008), and lymph node metastasis (P = 0.047) was significantly higher than in the IG-type, and recurrent-free survival (RFS) was significantly shorter (P = 0.015); the median RFS was 11.4 months (95% confidence interval, 6.3-16.5 months) in the DG-type and not reached in the IG-type. The ADC value in the DG-type was significantly lower than in the IG-type (median, 1.19 × 10-3 mm2/s vs. 1.86 × 10-3 mm2/s, P < 0.001). The area under the receiver operating characteristic curve for the ADC values to differentiate wall-invasion patterns was 0.95 (95% confidence interval, 0.87-1.00). The optimal cutoff ADC value was 1.45 × 10-3 mm2/s (sensitivity, 92.9%; specificity, 90.9%). CONCLUSIONS The wall-invasion pattern of advanced GBC is associated with its aggressiveness and prognosis, and can be predicted by ADC values with high accuracy.
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Affiliation(s)
- Takehiko Koga
- Department of Gastroenterology and Medicine, Faculty of Medicine, Fukuoka University, 7-45-1 Nanakuma, Jonan-Ku, Fukuoka, 814-0180, Japan
| | - Yusuke Ishida
- Department of Gastroenterology and Medicine, Faculty of Medicine, Fukuoka University, 7-45-1 Nanakuma, Jonan-Ku, Fukuoka, 814-0180, Japan.
| | - Yoshihiro Hamada
- Department of Pathology, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Yukihisa Takayama
- Department of Radiology, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Naoaki Tsuchiya
- Department of Gastroenterology and Medicine, Faculty of Medicine, Fukuoka University, 7-45-1 Nanakuma, Jonan-Ku, Fukuoka, 814-0180, Japan
| | - Takanori Kitaguchi
- Department of Gastroenterology and Medicine, Faculty of Medicine, Fukuoka University, 7-45-1 Nanakuma, Jonan-Ku, Fukuoka, 814-0180, Japan
| | - Keisuke Matsumoto
- Department of Gastroenterology and Medicine, Faculty of Medicine, Fukuoka University, 7-45-1 Nanakuma, Jonan-Ku, Fukuoka, 814-0180, Japan
| | - Masatoshi Kajiwara
- Department of Gastroenterological Surgery, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Shigetoshi Naito
- Department of Gastroenterological Surgery, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Fuminori Ishii
- Department of Gastroenterological Surgery, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Ryo Nakashima
- Department of Gastroenterological Surgery, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Takahide Sasaki
- Department of Gastroenterological Surgery, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Fumihito Hirai
- Department of Gastroenterology and Medicine, Faculty of Medicine, Fukuoka University, 7-45-1 Nanakuma, Jonan-Ku, Fukuoka, 814-0180, Japan
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Koga T, Ishida Y, Ishikawa H, Kishimoto Y, Kojima S, Okabe M, Hirai F. Endoscopic transpapillary repositioning of a migrated cystic duct tube using a gooseneck snare technique. Endoscopy 2023; 55:E397-E399. [PMID: 36736361 PMCID: PMC9897947 DOI: 10.1055/a-2008-0087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- Takehiko Koga
- Department of Gastroenterology and Medicine, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Yusuke Ishida
- Department of Gastroenterology and Medicine, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Hiroto Ishikawa
- Department of Surgery, Munakata Suikokai General Hospital, Fukuoka, Japan
| | - Yukiya Kishimoto
- Department of Surgery, Munakata Suikokai General Hospital, Fukuoka, Japan
| | - Satoki Kojima
- Department of Surgery, Munakata Suikokai General Hospital, Fukuoka, Japan
| | - Masayuki Okabe
- Department of Surgery, Munakata Suikokai General Hospital, Fukuoka, Japan
| | - Fumihito Hirai
- Department of Gastroenterology and Medicine, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
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Noguchi S, Iwasaki H, Shiko Y, Kawasaki Y, Ishida Y, Shinomiya S, Ono Uokawa R, Mazda Y. Fetal outcomes with and without the use of sugammadex in pregnant patients undergoing non-obstetric surgery: a multicenter retrospective study. Int J Obstet Anesth 2023; 53:103620. [PMID: 36634449 DOI: 10.1016/j.ijoa.2022.103620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 12/10/2022] [Accepted: 12/16/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND The influence of sugammadex exposure during pregnancy on progesterone withdrawal and miscarriage is unknown. We aimed to compare the fetal outcomes in pregnant patients who had undergone non-obstetric surgery with and without sugammadex. METHODS We retrospectively reviewed the medical charts of pregnant women who underwent non-obstetric surgery at three tertiary perinatal care centers in Japan from January 2013 to December 2020. The women were divided into those who received general anesthesia with sugammadex (GA with SGX) and those who received general anesthesia without sugammadex (GA without SGX). We compared miscarriages and preterm births within four weeks after surgery. RESULTS Among the 124 women, 73 and 51 were included in the GA with SGX and GA without SGX groups, respectively. The two groups showed no differences in the rate of miscarriages or preterm births (3.0 % vs 4.3 %; odds ratio 1.42, 95 % confidence interval 0.19 to 10.47; P = 1.00). The SGX and no SGX groups were missing outcomes for 8.2 % and 7.8 % of cases, respectively. CONCLUSIONS Having GA with SGX or GA without SGX did not result in different rates of miscarriage or preterm birth within four weeks after the procedure. These findings do not exclude a potential association between sugammadex exposure during pregnancy and adverse pregnancy outcomes. Missing data may have obscured possible adverse outcomes from sugammadex exposure.
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Affiliation(s)
- S Noguchi
- Department of Obstetric Anesthesiology, Center for Maternal-Fetal and Neonatal Medicine, Saitama Medical Center, Saitama Medical University, Kawagoe, Japan
| | - H Iwasaki
- Department of Anesthesiology, Nihon University School of Medicine, Tokyo, Japan
| | - Y Shiko
- Department of Anesthesiology, Saitama Medical Center, Saitama Medical University, Kawagoe, Japan; Biostatistics Section, Clinical Research Center, Chiba University Hospital, Chiba, Japan
| | - Y Kawasaki
- Department of Anesthesiology, Saitama Medical Center, Saitama Medical University, Kawagoe, Japan; Faculty of Nursing, Japanese Red Cross College of Nursing, Tokyo, Japan
| | - Y Ishida
- Department of Anesthesiology, Seirei Hamamatsu General Hospital, Shizuoka, Japan
| | - S Shinomiya
- Department of Anesthesiology, Chibune General Hospital, Osaka, Japan
| | - R Ono Uokawa
- Department of Anesthesiology, Chibune General Hospital, Osaka, Japan
| | - Y Mazda
- Department of Obstetric Anesthesiology, Center for Maternal-Fetal and Neonatal Medicine, Saitama Medical Center, Saitama Medical University, Kawagoe, Japan.
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Kurachi A, Ishida Y, Nakazawa K, Okada T, Kishida T, Uchino H. Necrotizing fasciitis and septic shock due to streptococcal toxic shock syndrome in an elderly patient: A case report. Clin Case Rep 2023; 11:e6846. [PMID: 36698511 PMCID: PMC9850853 DOI: 10.1002/ccr3.6846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Revised: 12/28/2022] [Accepted: 12/30/2022] [Indexed: 01/20/2023] Open
Abstract
Streptococcal toxic shock syndrome (STSS) has a high mortality rate, and most patients die within a few days of onset. We report an elderly patient with STSS, necrotizing fasciitis and septic shock caused by group G streptococcus who was successfully treated with multidisciplinary therapy.
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Affiliation(s)
- Akiko Kurachi
- Department of AnesthesiologyTokyo Medical UniversityTokyoJapan
| | - Yusuke Ishida
- Department of AnesthesiologyTokyo Medical UniversityTokyoJapan
| | - Koichi Nakazawa
- Department of AnesthesiologyTokyo Medical UniversityTokyoJapan
| | - Toshio Okada
- Department of AnesthesiologyTokyo Medical UniversityTokyoJapan
| | - Takumi Kishida
- Department of AnesthesiologyTokyo Medical UniversityTokyoJapan
| | - Hiroyuki Uchino
- Department of AnesthesiologyTokyo Medical UniversityTokyoJapan
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Tanaka T, Yamaguchi H, Ishida Y, Tomioka K, Nishiyama M, Toyoshima D, Maruyama A, Takeda H, Kurosawa H, Tanaka R, Nozu K, Nagase H. Clinical and laboratory characteristics of complex febrile seizures in the acute phase: a case-series study in Japan. BMC Neurol 2023; 23:28. [PMID: 36653748 PMCID: PMC9847116 DOI: 10.1186/s12883-023-03051-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 01/03/2023] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Patients with complex febrile seizures (CFS) often display abnormal laboratory results, unexpectedly prolonged seizures, and/or altered consciousness after admission. However, no standardized values have been established for the clinical and laboratory characteristics of CFS in the acute phase, making the management of CFS challenging. This study aimed to determine the clinical and laboratory characteristics of children with CFS during the acute phase. In particular, the duration of impaired consciousness and the detailed distribution of blood test values were focused. METHODS We retrospectively reviewed medical records of a consecutive pediatric cohort aged 6-60 months who were diagnosed with CFS and admitted to Kobe Children's Hospital between October 2002 and March 2017. During the study period, 486 seizure episodes with confirmed CFS were initially reviewed, with 317 seizure episodes included in the analysis. Detailed clinical and laboratory characteristics were summarized. RESULTS Among 317 seizure episodes (296 children with CFS), 302 required two or fewer anticonvulsants to be terminated. In 296 episodes showing convulsive seizures, median seizure duration was 30.5 min. The median time from onset to consciousness recovery was 175 min. Impaired consciousness lasting > 6, 8, and 12 h was observed in 13.9%, 7.6%, and 1.9% patients with CFS, respectively. Additionally, the distribution of aspartate aminotransferase, lactate dehydrogenase, creatinine, and glucose were clarified with 3, 10, 50, 90, and 97 percentile values. CONCLUSION This study detailed the clinical and laboratory findings of acute-phase CFS using the data of the largest 15-year consecutive cohort of children with CFS. These results provide important information for appropriate acute management of CFS.
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Affiliation(s)
- Tsukasa Tanaka
- grid.31432.370000 0001 1092 3077Department of Pediatrics, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-Cho, Chuo-Ku, Hyogo 650-0017 Kobe, Japan
| | - Hiroshi Yamaguchi
- grid.31432.370000 0001 1092 3077Department of Pediatrics, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-Cho, Chuo-Ku, Hyogo 650-0017 Kobe, Japan
| | - Yusuke Ishida
- grid.415413.60000 0000 9074 6789Department of Neurology, Hyogo Prefectural Kobe Children’s Hospital, Kobe, Japan
| | - Kazumi Tomioka
- grid.31432.370000 0001 1092 3077Department of Pediatrics, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-Cho, Chuo-Ku, Hyogo 650-0017 Kobe, Japan
| | - Masahiro Nishiyama
- grid.31432.370000 0001 1092 3077Department of Pediatrics, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-Cho, Chuo-Ku, Hyogo 650-0017 Kobe, Japan ,grid.415413.60000 0000 9074 6789Department of Neurology, Hyogo Prefectural Kobe Children’s Hospital, Kobe, Japan
| | - Daisaku Toyoshima
- grid.415413.60000 0000 9074 6789Department of Neurology, Hyogo Prefectural Kobe Children’s Hospital, Kobe, Japan
| | - Azusa Maruyama
- grid.415413.60000 0000 9074 6789Department of Neurology, Hyogo Prefectural Kobe Children’s Hospital, Kobe, Japan
| | - Hiroki Takeda
- grid.31432.370000 0001 1092 3077Department of Pediatrics, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-Cho, Chuo-Ku, Hyogo 650-0017 Kobe, Japan
| | - Hiroshi Kurosawa
- grid.415413.60000 0000 9074 6789Department of Pediatric Critical Care Medicine, Hyogo Prefectural Kobe Children’s Hospital, Kobe, Japan
| | - Ryojiro Tanaka
- grid.415413.60000 0000 9074 6789Department of Emergency and General Medicine, Hyogo Prefectural Kobe Children’s Hospital, Kobe, Japan
| | - Kandai Nozu
- grid.31432.370000 0001 1092 3077Department of Pediatrics, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-Cho, Chuo-Ku, Hyogo 650-0017 Kobe, Japan
| | - Hiroaki Nagase
- grid.31432.370000 0001 1092 3077Department of Pediatrics, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-Cho, Chuo-Ku, Hyogo 650-0017 Kobe, Japan
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Yamane T, Ueda T, Nishiyama M, Hongo H, Ishida Y, Maruyama A. Anti-MOG antibody-positive meningoencephalitis without demyelinating lesions. Pediatr Int 2023; 65:e15612. [PMID: 37589376 DOI: 10.1111/ped.15612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 06/21/2023] [Accepted: 06/26/2023] [Indexed: 08/18/2023]
Affiliation(s)
- Tetsuya Yamane
- Department of Neurology, Hyogo Prefectural Kobe Children's Hospital, Kobe, Japan
| | - Takuya Ueda
- Department of Neurology, Hyogo Prefectural Kobe Children's Hospital, Kobe, Japan
| | - Masahiro Nishiyama
- Department of Neurology, Hyogo Prefectural Kobe Children's Hospital, Kobe, Japan
- Department of Pediatrics, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Hiroto Hongo
- Department of Neurology, Hyogo Prefectural Kobe Children's Hospital, Kobe, Japan
| | - Yusuke Ishida
- Department of Neurology, Hyogo Prefectural Kobe Children's Hospital, Kobe, Japan
| | - Azusa Maruyama
- Department of Neurology, Hyogo Prefectural Kobe Children's Hospital, Kobe, Japan
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36
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Irie H, Otsuka A, Ishida Y, Kawakami A, Kabashima K. 552 Identification of cutaneous Schwann cell subsets based on single cell gene expression analysis. J Invest Dermatol 2022. [DOI: 10.1016/j.jid.2022.09.568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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37
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Ko YL, Matsuoka H, Nomaru R, Imakiire S, Sakisaka H, Matsuoka S, Kuno N, Abe K, Funakoshi S, Ishida Y, Ishibashi H, Miyagi S, Sakata T, Hirai F. Resolution of Laryngeal Ulceration with Prednisolone Therapy in a Patient with Crohn's Disease. Intern Med 2022. [PMID: 36450464 PMCID: PMC10400401 DOI: 10.2169/internalmedicine.0422-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
A 23-year-old man diagnosed with Crohn's disease (CD) was treated with infliximab. He developed new-onset sore throat and dysphagia during admission, and nasopharyngoscopy revealed epiglottic ulceration. Laryngeal ulceration was considered as an extraintestinal manifestation of CD owing to treatment failure with antibiotics and hydrocortisone. This strongly suggested that laryngeal ulceration was a complication of CD because of the rapid improvement in the symptoms and lesions after prednisolone administration. Furthermore, this treatment process demonstrated the superior anti-inflammatory effect of prednisolone over that of hydrocortisone and supported the assumption of inflammation related to CD.
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Affiliation(s)
- Yi-Ling Ko
- Department of Gastroenterology and Medicine, Fukuoka University Hospital, Japan
| | - Hiroki Matsuoka
- Department of Gastroenterology and Medicine, Fukuoka University Hospital, Japan
| | - Ryohei Nomaru
- Department of Gastroenterology and Medicine, Fukuoka University Hospital, Japan
| | - So Imakiire
- Department of Gastroenterology and Medicine, Fukuoka University Hospital, Japan
| | - Hideto Sakisaka
- Department of Gastroenterology and Medicine, Fukuoka University Hospital, Japan
| | - Satoshi Matsuoka
- Department of Gastroenterology and Medicine, Fukuoka University Hospital, Japan
| | - Nobuaki Kuno
- Department of Gastroenterology and Medicine, Fukuoka University Hospital, Japan
| | - Koichi Abe
- Department of Gastroenterology and Medicine, Fukuoka University Hospital, Japan
| | - Sadahiro Funakoshi
- Department of Gastroenterology and Medicine, Fukuoka University Hospital, Japan
| | - Yusuke Ishida
- Department of Gastroenterology and Medicine, Fukuoka University Hospital, Japan
| | - Hideki Ishibashi
- Department of Gastroenterology and Medicine, Fukuoka University Hospital, Japan
| | - Shinpei Miyagi
- Department of Otorhinolaryngology, Head and Neck Surgery, Fukuoka University Hospital, Japan
| | - Toshifumi Sakata
- Department of Otorhinolaryngology, Head and Neck Surgery, Fukuoka University Hospital, Japan
| | - Fumihito Hirai
- Department of Gastroenterology and Medicine, Fukuoka University Hospital, Japan
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Fujiwara M, Hashimoto H, Doi K, Kujiraoka M, Tanizawa Y, Ishida Y, Sasaki M, Nagasaki M. Secure secondary utilization system of genomic data using quantum secure cloud. Sci Rep 2022; 12:18530. [PMID: 36323706 PMCID: PMC9630297 DOI: 10.1038/s41598-022-22804-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 10/19/2022] [Indexed: 12/05/2022] Open
Abstract
Secure storage and secondary use of individual human genome data is increasingly important for genome research and personalized medicine. Currently, it is necessary to store the whole genome sequencing information (FASTQ data), which enables detections of de novo mutations and structural variations in the analysis of hereditary diseases and cancer. Furthermore, bioinformatics tools to analyze FASTQ data are frequently updated to improve the precision and recall of detected variants. However, existing secure secondary use of data, such as multi-party computation or homomorphic encryption, can handle only a limited algorithms and usually requires huge computational resources. Here, we developed a high-performance one-stop system for large-scale genome data analysis with secure secondary use of the data by the data owner and multiple users with different levels of data access control. Our quantum secure cloud system is a distributed secure genomic data analysis system (DSGD) with a "trusted server" built on a quantum secure cloud, the information-theoretically secure Tokyo QKD Network. The trusted server will be capable of deploying and running a variety of sequencing analysis hardware, such as GPUs and FPGAs, as well as CPU-based software. We demonstrated that DSGD achieved comparable throughput with and without encryption on the trusted server Therefore, our system is ready to be installed at research institutes and hospitals that make diagnoses based on whole genome sequencing on a daily basis.
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Affiliation(s)
- Mikio Fujiwara
- grid.28312.3a0000 0001 0590 0962National Institute of Information and Communications Technology (NICT), 4-2-1 Nukui-Kita, Koganei, Tokyo 184-8795 Japan
| | - Hiroki Hashimoto
- grid.258799.80000 0004 0372 2033Human Biosciences Unit for the Top Global Course Center for the Promotion of Interdisciplinary Education and Research, Center for Genomic Medicine, Graduate School of Medicine, Kyoto University, Kyoto, 606-8507 Japan
| | - Kazuaki Doi
- grid.410825.a0000 0004 1770 8232Corporate Research and Development Center, Toshiba Corporation, 1, Komukai Toshiba-Cho, Saiwai-Ku, Kawasaki-Shi, 212-8582 Japan
| | - Mamiko Kujiraoka
- grid.410825.a0000 0004 1770 8232Corporate Research and Development Center, Toshiba Corporation, 1, Komukai Toshiba-Cho, Saiwai-Ku, Kawasaki-Shi, 212-8582 Japan
| | - Yoshimichi Tanizawa
- grid.410825.a0000 0004 1770 8232Corporate Research and Development Center, Toshiba Corporation, 1, Komukai Toshiba-Cho, Saiwai-Ku, Kawasaki-Shi, 212-8582 Japan
| | - Yusuke Ishida
- ZenmuTech, Inc., THE HUB Ginza, OCT 804, 8-17-5 Ginza Chuo-Ku, Tokyo, 104-0061 Japan
| | - Masahide Sasaki
- grid.28312.3a0000 0001 0590 0962National Institute of Information and Communications Technology (NICT), 4-2-1 Nukui-Kita, Koganei, Tokyo 184-8795 Japan
| | - Masao Nagasaki
- grid.258799.80000 0004 0372 2033Human Biosciences Unit for the Top Global Course Center for the Promotion of Interdisciplinary Education and Research, Center for Genomic Medicine, Graduate School of Medicine, Kyoto University, Kyoto, 606-8507 Japan
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Tomioka K, Nishiyama M, Nagase H, Ishida Y, Tanaka T, Tokumoto S, Yamaguchi H, Toyoshima D, Maruyama A, Fujita K, Aoki K, Seino Y, Nozu K, Nishimura N, Kurosawa H, Iijima K. Corrigendum to: "Detailed clinical course of fatal acute encephalopathy in children" [Brain Dev. 41(8) (2019) 691-698]. Brain Dev 2022; 44:771-772. [PMID: 36055910 DOI: 10.1016/j.braindev.2022.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Kazumi Tomioka
- Department of Pediatrics, Kobe University Graduate School of Medicine, Kobe, Japan.
| | - Masahiro Nishiyama
- Department of Pediatrics, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Hiroaki Nagase
- Department of Pediatrics, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Yusuke Ishida
- Department of Pediatrics, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Tsukasa Tanaka
- Department of Pediatrics, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Shoichi Tokumoto
- Department of Neurology, Hyogo Prefectural Kobe Children's Hospital, Kobe, Japan
| | - Hiroshi Yamaguchi
- Department of Neurology, Hyogo Prefectural Kobe Children's Hospital, Kobe, Japan
| | - Daisaku Toyoshima
- Department of Neurology, Hyogo Prefectural Kobe Children's Hospital, Kobe, Japan
| | - Azusa Maruyama
- Department of Neurology, Hyogo Prefectural Kobe Children's Hospital, Kobe, Japan
| | - Kyoko Fujita
- Department of Emergency and General Medicine, Hyogo Prefectural Kobe Children's Hospital, Kobe, Japan
| | - Kazunori Aoki
- Department of Pediatric Critical Care Medicine, Hyogo Prefectural Kobe Children's Hospital, Kobe, Japan
| | - Yusuke Seino
- Department of Pediatric Critical Care Medicine, Hyogo Prefectural Kobe Children's Hospital, Kobe, Japan
| | - Kandai Nozu
- Department of Pediatrics, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Noriyuki Nishimura
- Department of Pediatrics, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Hiroshi Kurosawa
- Department of Pediatric Critical Care Medicine, Hyogo Prefectural Kobe Children's Hospital, Kobe, Japan
| | - Kazumoto Iijima
- Department of Pediatrics, Kobe University Graduate School of Medicine, Kobe, Japan
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40
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Sasaki M, Ebata M, Tanei ZI, Oda Y, Hamauchi A, Tanikawa S, Sugino H, Ishida Y, Abe T, Arai N, Sako K, Tanaka S. An autopsy case report of adult-onset Krabbe disease: Comparison with an infantile-onset case. Pathol Int 2022; 72:558-565. [PMID: 36200664 DOI: 10.1111/pin.13275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 09/14/2022] [Indexed: 11/27/2022]
Abstract
Krabbe disease is a lysosomal storage disease caused by a deficiency of the galactocerebrosidase (GALC) enzyme, which leads to demyelination of the central and peripheral nervous systems. Almost all patients with Krabbe disease are infants, and this is the first report of adult-onset cases that describe pathological findings. Here, we present two autopsy cases: a 73-year-old female and a 2-year-old male. The adult-onset case developed symptoms in her late thirties and was diagnosed by the identification of GALC D528N and L634S mutations and by T2-weighted magnetic resonance imaging; she had increased signal in the white matter along the pyramidal tract to the bilateral precentral gyrus, as well as from the triangular part to the posterior horn of the lateral ventricle. Microscopically, Klüver-Barrera staining was pale in the white matter of the precentral gyrus and occipito-thalamic radiation, and a few globoid cells were observed. The GALC mutations that were identified in the present adult-onset case do not completely inactivate GALC enzyme activity, resulting in focal demyelination of the brain.
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Affiliation(s)
- Miu Sasaki
- Department of Cancer Pathology, Faculty of Medicine, Hokkaido University, Sapporo, Japan
| | - Miori Ebata
- Department of Cancer Pathology, Faculty of Medicine, Hokkaido University, Sapporo, Japan
| | - Zen-Ichi Tanei
- Department of Cancer Pathology, Faculty of Medicine, Hokkaido University, Sapporo, Japan
| | - Yoshitaka Oda
- Department of Cancer Pathology, Faculty of Medicine, Hokkaido University, Sapporo, Japan
| | - Akiko Hamauchi
- Department of Neurology, Nakamura Memorial Hospital, Sapporo, Japan.,Department of Internal Medicine & Neurology, Takeuchi Clinic, Doushoukai Medical Corporation, Setouchi, Japan
| | - Satoshi Tanikawa
- Department of Cancer Pathology, Faculty of Medicine, Hokkaido University, Sapporo, Japan.,Institute for Chemical Reaction Design and Discovery (WPI-ICReDD), Hokkaido University, Sapporo, Japan
| | - Hirokazu Sugino
- Department of Cancer Pathology, Faculty of Medicine, Hokkaido University, Sapporo, Japan
| | - Yusuke Ishida
- Department of Cancer Pathology, Faculty of Medicine, Hokkaido University, Sapporo, Japan
| | - Takenori Abe
- Department of Neurology, Nakamura Memorial Hospital, Sapporo, Japan
| | - Nobutaka Arai
- Laboratory of Neuropathology, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan
| | - Kazuya Sako
- Department of Neurology, Nakamura Memorial Hospital, Sapporo, Japan
| | - Shinya Tanaka
- Department of Cancer Pathology, Faculty of Medicine, Hokkaido University, Sapporo, Japan.,Institute for Chemical Reaction Design and Discovery (WPI-ICReDD), Hokkaido University, Sapporo, Japan
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Ishida Y, Tsuchiya N, Koga T, Kitaguchi T, Matsumoto K, Kuno N, Funakoshi S, Ishibashi H, Ashizuka S, Hirai F. A novel self-assembling peptide hemostatic gel as an option for initial hemostasis in endoscopic sphincterotomy-related hemorrhage: a case series. Clin J Gastroenterol 2022; 15:1210-1215. [DOI: 10.1007/s12328-022-01702-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 09/07/2022] [Indexed: 11/24/2022]
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Kishida T, Ishida Y, Okada T, Tsuzuki Y, Kurita K, Uchino H. Successful Perioperative Management of Cochlear Implantation in a Patient With Mitochondrial Encephalopathy, Lactic Acidosis, and Stroke-Like Episodes (MELAS). Cureus 2022; 14:e27761. [PMID: 36106294 PMCID: PMC9449252 DOI: 10.7759/cureus.27761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/07/2022] [Indexed: 11/29/2022] Open
Abstract
Mitochondrial encephalopathy, lactic acidosis, and stroke-like episodes (MELAS) is a type of mitochondrial disease that is characterized by stroke-like seizures. For these patients, serious, unexpected complications have occurred during and following anesthetic exposure. Provision of anesthesia is challenging, including the choice of anesthetic agents. We here report a case of general anesthesia management for a patient with MELAS. A 46-year-old woman was diagnosed with MELAS at the age of 40. She subsequently underwent cochlear implantation for hearing loss. Anesthesia was induced with midazolam and maintained with desflurane. In the present case, anesthesia was maintained with inhalation anesthetics to avoid the development of propofol infusion syndrome. Her intraoperative and postoperative courses were uneventful. The anesthesia management of patients with MELAS can be performed safely with carefully planned anesthesia and close monitoring at each step, including the postoperative period.
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Ishida Y, Tsunoda T, Hamada Y, Tsuchiya N, Koga T, Kitaguchi T, Matsumoto K, Matsumoto S, Sasaki T, Nakashima R, Ishii F, Kajiwara M, Shirasawa S, Hasegawa S, Hirai F. Standardized Methods Using EUS-guided Fine-needle Biopsy and a Minimal Medium Creates Three Pancreatic Cancer Organoids. Anticancer Res 2022; 42:4103-4109. [PMID: 35896269 DOI: 10.21873/anticanres.15908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 06/19/2022] [Accepted: 06/30/2022] [Indexed: 11/10/2022]
Abstract
BACKGROUND/AIM Recently, endoscopic ultrasound-guided fine-needle biopsy (EUS-FNB) has been conducted for diagnosing pancreatic ductal adenocarcinoma (PDAC), after which obtained samples were used in organoid cultures. However, no standardized method for PDAC organoid cultures exists. Therefore, to standardize or simplify sample collection and culture methods for PDAC organoids, we performed a floating culture using non-minced specimens obtained by EUS-FNB in a minimal medium, lacking growth factors or inhibitors for pancreatic organoids. PATIENTS AND METHODS A total of 38 patients with clinically diagnosed PDAC were enrolled in the study. First, EUS-FNB was conducted using a 22- or 25-gauge biopsy needle. Then, a surplus of samples was collected for organoid formation after rapid on-site cytological evaluations of sample adequacy. Subsequently, the established organoids were compared with clinical data and pathological diagnosis, following periodic observations and evaluations for morphology. RESULTS PDAC organoids were successfully created in 24 of the 38 cases (63.2%), including four cases with pathologically inconclusive EUS-FNB results. Afterward, PDAC organoid morphology was classified into ductal, dormant, and adhesive small cluster (ASC) types. Although the ductal and ASC types were seen separately, they were also seen together in other cases, which we named "mixed type". CONCLUSION We propose a feasible and straightforward method for establishing organoids, especially for diagnosing PDAC, particularly when the result of EUS-FNB is pathologically inconclusive. Furthermore, PDAC organoids are morphologically classified into three types reported for the first time.
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Affiliation(s)
- Yusuke Ishida
- Department of Gastroenterology and Medicine, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Toshiyuki Tsunoda
- Department of Cell Biology, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Yoshihiro Hamada
- Department of Pathology, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Naoaki Tsuchiya
- Department of Gastroenterology and Medicine, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Takehiko Koga
- Department of Gastroenterology and Medicine, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Takanori Kitaguchi
- Department of Gastroenterology and Medicine, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Keisuke Matsumoto
- Department of Gastroenterology and Medicine, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Shinji Matsumoto
- Department of Pathology, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Takahide Sasaki
- Department of Gastroenterological Surgery, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Ryo Nakashima
- Department of Gastroenterological Surgery, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Fuminori Ishii
- Department of Gastroenterological Surgery, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Masatoshi Kajiwara
- Department of Gastroenterological Surgery, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Senji Shirasawa
- Department of Cell Biology, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Suguru Hasegawa
- Department of Gastroenterological Surgery, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Fumihito Hirai
- Department of Gastroenterology and Medicine, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
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Akao K, Ishida Y, Nakazawa K, Okada T, Fujiyoshi T, Kawachi A, Uchino H. Esophageal Submucosal Giant Hematoma Detected After Mitral Repair Using Transesophageal Echocardiography. Cureus 2022; 14:e27292. [PMID: 36039225 PMCID: PMC9403247 DOI: 10.7759/cureus.27292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/26/2022] [Indexed: 12/04/2022] Open
Abstract
Transesophageal echocardiography (TEE) is a necessary diagnostic tool for cardiac surgery, including for intraoperative evaluation of the morphology and function of each structure. On the other hand, many complications caused by insertion and manipulation of the TEE probe have been reported, such as gastrointestinal injuries and hematoma, as well as esophageal perforation. Here, we report a case in which a large submucosal esophageal hematoma was found on the fourth postoperative day after surgery using TEE for mitral regurgitation. The patient was an 81-year-old man who underwent mitral valve replacement for mitral regurgitation. On the fourth postoperative day, anorexia and blood-tinged sputum were observed. A computed tomography (CT) scan of the chest displayed a giant esophageal submucosal hematoma. When performing TEE, to avoid complications, it is important to handle the TEE probe with care and to avoid leaving the device at the same site for long periods of time.
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Shibata Y, Kumamoto N, Sakuma E, Ishida Y, Ueda T, Shimada S, Ugawa S. A gain-of-function mutation in the acid-sensing ion channel 2a induces marked cerebellar maldevelopment in rats. Biochem Biophys Res Commun 2022; 610:77-84. [PMID: 35447498 DOI: 10.1016/j.bbrc.2022.04.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 04/07/2022] [Indexed: 11/02/2022]
Abstract
Specific amino acid substitutions in degenerin mechano-gated channels (DEGs) of C. elegans convert these channels into constitutively active mutants that induce the degeneration of neurons where DEGs are expressed. Acid-sensing ion channel-2a (ASIC2a), a proton-gated cation channel predominantly expressed in central neurons, is a mammalian ortholog of DEGs, and it can remain unclosed to be cytotoxic once the same mutations as the DEG mutants are introduced into its gene. Here we show that heterozygous transgenic (Tg) rats expressing ASIC2a-G430F (ASIC2aG430F), the most active form of the gain-of-function mutants, under the control of the intrinsic ASIC2a promoter exhibited marked cerebellar maldevelopment with mild whole-brain atrophy. The Tg rats were small and developed an early-onset ataxic gait, as evidenced by rotarod and footprint tests. The overall gross-anatomy of the Tg brain was normal just after birth, but a reduction in brain volume, especially cerebellar volume, gradually emerged with age. Histological examination of the adult Tg brain revealed that the cell-densities of cerebellar Purkinje and granule cells were markedly reduced, while the cytoarchitecture of other brain regions was not significantly altered. RT-PCR and immunoblot analyses demonstrated that ASIC2aG430F transcripts and proteins were already present in various regions of the neonatal Tg brain before the deforming cerebellum became apparent. These results suggest that, according to the spatiotemporal pattern of the wild-type (WT) ASIC2a gene expression, the ASIC2aG430F channel induced lethal degeneration in Tg brain neurons expressing both ASIC2aG430F and ASIC2a channels.
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Affiliation(s)
- Yasuhiro Shibata
- Department of Anatomy and Neuroscience, Graduate School of Medical Sciences, Nagoya City University, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, Aichi, 467-8601, Japan
| | - Natsuko Kumamoto
- Department of Anatomy and Neuroscience, Graduate School of Medical Sciences, Nagoya City University, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, Aichi, 467-8601, Japan
| | - Eisuke Sakuma
- Department of Integrative Anatomy, Graduate School of Medical Sciences, Nagoya City University, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, Aichi, 467-8601, Japan
| | - Yusuke Ishida
- Division of Histology and Anatomy, Department of Medicine, Faculty of Medicine, Tohoku Medical and Pharmaceutical University, 4-4-1 Komatsushima, Aoba-ku, Sendai, Miyagi, 981-8558, Japan
| | - Takashi Ueda
- Department of Anatomy and Neuroscience, Graduate School of Medical Sciences, Nagoya City University, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, Aichi, 467-8601, Japan
| | - Shoichi Shimada
- Department of Neuroscience and Cell Biology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan; Addiction Research Unit, Osaka Psychiatric Research Center, Osaka Psychiatric Medical Center, Osaka, 541-8567, Japan
| | - Shinya Ugawa
- Department of Anatomy and Neuroscience, Graduate School of Medical Sciences, Nagoya City University, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, Aichi, 467-8601, Japan.
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Ishida Y, Okada T, Kobayashi T, Funatsu K, Uchino H. Pain Management of Acute and Chronic Postoperative Pain. Cureus 2022; 14:e23999. [PMID: 35547410 PMCID: PMC9086530 DOI: 10.7759/cureus.23999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/09/2022] [Indexed: 12/04/2022] Open
Abstract
Inadequate management of acute postoperative pain is associated with effects related to both physiological and psychological function. Postoperative pain increases the risk of perioperative complications, so postoperative pain should be prevented. Postoperative pain management by sufficient analgesia is important while considering the use of various kinds of analgesics. Insufficient management of postoperative pain may lead to chronic postsurgical pain (CPSP). It is suggested that CPSP is dependent not only upon biological factors but also upon psychological factors, including the type of surgery, age, physical health, mental health, and preoperative pain. As CPSP is a severe complication that may prolong hospitalization and interferes with activities of daily living (ADL) and quality of life (QoL), its prevention of development is paramount. Therefore, in order to prevent the onset of CPSP, it is necessary to craft analgesic management to prevent CPSP during the perioperative period.
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Tokumoto S, Nishiyama M, Yamaguchi H, Tomioka K, Ishida Y, Toyoshima D, Kurosawa H, Nozu K, Maruyama A, Tanaka R, Iijima K, Nagase H. Prognostic effects of treatment protocols for febrile convulsive status epilepticus in children. BMC Neurol 2022; 22:77. [PMID: 35247987 PMCID: PMC8897930 DOI: 10.1186/s12883-022-02608-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 02/28/2022] [Indexed: 11/29/2022] Open
Abstract
Background Febrile status epilepticus is the most common form of status epilepticus in children. No previous reports compare the effectiveness of treatment strategies using fosphenytoin (fPHT) or phenobarbital (PB) and those using anesthetics as second-line anti-seizure medication for benzodiazepine-resistant convulsive status epilepticus (CSE). We aimed to examine the outcomes of various treatment strategies for febrile convulsive status epilepticus (FCSE) in a real-world setting while comparing the effects of different treatment protocols and their presence or absence. Methods This was a single-center historical cohort study that was divided into three periods. Patients who presented with febrile convulsive status epilepticus for ≥60 min even after the administration of at least one anticonvulsant were included. During period I (October 2002–December 2006), treatment was performed at the discretion of the attending physician, without a protocol. During period II (January 2007–February 2013), barbiturate coma therapy (BCT) was indicated for FCSE resistant to benzodiazepines. During period III (March 2013–April 2016), BCT was indicated for FCSE resistant to fPHT or PB. Results The rate of electroencephalogram monitoring was lower in period I than period II+III (11.5% vs. 85.7%, p<0.01). Midazolam was administered by continuous infusion more often in period I than period II+III (84.6% vs. 25.0%, p<0.01), whereas fPHT was administered less often in period I than period II+III (0% vs. 27.4%, p<0.01). The rate of poor outcome, which was determined using the Pediatric Cerebral Performance Category scale, was higher in period I than period II+III (23.1% vs. 7.1%, p=0.03). The rate of poor outcome did not differ between periods II and III (4.2% vs. 11.1%, p=0.40). Conclusions While the presence of a treatment protocol for FCSE in children may improve outcomes, a treatment protocol using fPHT or PB may not be associated with better outcomes.
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Yamaguchi H, Nishiyama M, Tomioka K, Hongo H, Tokumoto S, Ishida Y, Toyoshima D, Kurosawa H, Nozu K, Maruyama A, Tanaka R, Nagase H. Growth and differentiation factor-15 as a potential prognostic biomarker for status-epilepticus-associated-with-fever: A pilot study. Brain Dev 2022; 44:210-220. [PMID: 34716034 DOI: 10.1016/j.braindev.2021.10.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 09/17/2021] [Accepted: 10/11/2021] [Indexed: 01/07/2023]
Abstract
OBJECTIVE Biomarkers predicting poor outcomes of status-epilepticus-associated-with-fever (SEF) at an early stage may contribute to treatment guidance. However, none have been reported thus far. We investigated the dynamics of serum growth and differentiation factor (GDF)-15 after seizure onset in patients with SEF and determined whether GDF-15 can predict poor outcomes, particularly in the first 6 h after seizure onset. METHODS We enrolled 37 pediatric patients with SEF and eight patients with simple febrile seizures (SFS) and collected their blood samples within 24 h of seizure onset and eight febrile control patients between March 1, 2017 and September 30, 2020. All patients were aged ≤15 years. RESULTS In the SEF group, the median post-seizure serum GDF-15 values were 1,065 (<6h), 2,720 (6-12 h), and 2,411 (12-24 h) pg/mL. The median serum GDF-15 in the first 6 h was measured in patients with SEF without a significant past medical history (n = 21) and was found to be statistically significantly higher (1,587 pg/mL) than in the febrile control (551 pg/mL) and SFS (411 pg/mL) groups. The median serum GDF-15 was statistically significantly higher in patients with SEF with sequelae (n = 5) and patients with acute encephalopathy with biphasic seizures/reduced diffusion/hemorrhagic shock and encephalopathy syndrome (n = 6) than in patients with SEF without sequelae (n = 16) (15,898 vs 756 pg/mL) and patients with prolonged FS (n = 15) (9,448 vs 796 pg/mL). CONCLUSIONS This study demonstrates the dynamics of serum GDF-15 in patients with SEF and indicates the potential of GDF-15 as an early predictor of poor outcomes.
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Affiliation(s)
- Hiroshi Yamaguchi
- Department of Pediatrics, Kobe University Graduate School of Medicine, Hyogo, Japan.
| | - Masahiro Nishiyama
- Department of Pediatrics, Kobe University Graduate School of Medicine, Hyogo, Japan
| | - Kazumi Tomioka
- Department of Pediatrics, Kobe University Graduate School of Medicine, Hyogo, Japan
| | - Hiroto Hongo
- Department of Neurology, Hyogo Prefectural Kobe Children's Hospital, Hyogo, Japan
| | - Shoichi Tokumoto
- Department of Pediatrics, Kobe University Graduate School of Medicine, Hyogo, Japan; Department of Neurology, Hyogo Prefectural Kobe Children's Hospital, Hyogo, Japan
| | - Yusuke Ishida
- Department of Emergency and General Pediatrics, Hyogo Prefectural Kobe Children's Hospital, Hyogo, Japan
| | - Daisaku Toyoshima
- Department of Neurology, Hyogo Prefectural Kobe Children's Hospital, Hyogo, Japan
| | - Hiroshi Kurosawa
- Department of Pediatric Critical Care Medicine, Hyogo Prefectural Kobe Children's Hospital, Hyogo, Japan
| | - Kandai Nozu
- Department of Pediatrics, Kobe University Graduate School of Medicine, Hyogo, Japan
| | - Azusa Maruyama
- Department of Neurology, Hyogo Prefectural Kobe Children's Hospital, Hyogo, Japan
| | - Ryojiro Tanaka
- Department of Emergency and General Pediatrics, Hyogo Prefectural Kobe Children's Hospital, Hyogo, Japan
| | - Hiroaki Nagase
- Department of Pediatrics, Kobe University Graduate School of Medicine, Hyogo, Japan
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Nakazawa K, Kodaira A, Matsumoto R, Matsushita T, Yoshikawa R, Ishida Y, Uchino H. Positive end-expiratory pressure setting based on transpulmonary pressure during robot-assisted laparoscopic prostatectomy: an observational intervention study. JA Clin Rep 2022; 8:10. [PMID: 35150377 PMCID: PMC8840948 DOI: 10.1186/s40981-022-00501-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 01/22/2022] [Accepted: 02/04/2022] [Indexed: 11/10/2022] Open
Abstract
Background In robot-assisted laparoscopic prostatectomy (RALP), concerns include the formation of atelectasis and reduced functional residual capacity. The present study aimed to examine the feasibility of positive end-expiratory pressure (PEEP) setting based on transpulmonary pressure (Ptp) as well as the effects of incremental PEEP on respiratory mechanics, blood gases, cerebral oxygenation (rSO2), and hemodynamics. Methods Fourteen male patients who were scheduled to receive RALP were recruited. Patients received mechanical ventilation (tidal volume of 6 mL kg−1) and were placed in Trendelenburg position with positive-pressure capnoperitoneum. PEEP levels were increased from 0 to 15 cmH2O (5 cmH2O per increase) every 30 min. PEEP levels were assessed where end-expiratory Ptp levels of ≥0 cmH2O were achieved (PtpEEP0). Airway pressure, esophageal pressure, cardiac index, and blood gas and rSO2 values were measured after 30 min at each PEEP step and respiratory mechanics were calculated. Results With increasing PEEP levels from 0 to 15 cmH2O or PtpEEP0, the values of PaO2 and respiratory system compliance increased, and the values of driving pressure decreased. The median PEEP level associated with PtpEEP0 was 15 cmH2O. Respiratory system compliance values were higher at PtpEEP0 than those at PEEP5 (P = 0.02). Driving pressure was significantly lower at PtpEEP0 than at PEEP5 (P = 0.0036). The cardiac index remained unchanged, and the values of rSO2 were higher at PtpEEP0 than at PEEP0 (right; P = 0.0019, left; P = 0.036). Conclusions PEEP setting determined by transpulmonary pressure can help achieve higher respiratory system compliance values and lower driving pressure without disturbing hemodynamic parameters.
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Affiliation(s)
- Koichi Nakazawa
- Department of Anesthesia, Tokyo Medical University Hospital, 6-7-1 Nishishinjyuku, Shinjyuku-ku, Tokyo, 1600023, Japan.
| | - Ami Kodaira
- Department of Anesthesia, Mitsui Memorial Hospital, Kanda-Izumi-cho 1, Chiyoda-ku, Tokyo, 101-8643, Japan
| | - Rika Matsumoto
- Department of Anesthesia, Tokyo Medical University Hospital, 6-7-1 Nishishinjyuku, Shinjyuku-ku, Tokyo, 1600023, Japan
| | - Tomoko Matsushita
- Department of Anesthesia, Tokyo Medical University Hospital, 6-7-1 Nishishinjyuku, Shinjyuku-ku, Tokyo, 1600023, Japan
| | - Ryotaro Yoshikawa
- Department of Anesthesia, Tokyo Medical University Hospital, 6-7-1 Nishishinjyuku, Shinjyuku-ku, Tokyo, 1600023, Japan
| | - Yusuke Ishida
- Department of Anesthesia, Tokyo Medical University Hospital, 6-7-1 Nishishinjyuku, Shinjyuku-ku, Tokyo, 1600023, Japan
| | - Hiroyuki Uchino
- Department of Anesthesia, Tokyo Medical University Hospital, 6-7-1 Nishishinjyuku, Shinjyuku-ku, Tokyo, 1600023, Japan
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Ko YL, Matsuoka H, Nomaru R, Imakiire S, Sakisaka H, Matsuoka S, Kuno N, Abe K, Funakoshi S, Ishida Y, Ishibashi H, Koga K, Saito T, Takeshita M, Hirai F. Observation of the drainage process of the residual lipoma after endoscopic unroofing technique during colonoscopic evaluation of post-procedural hematochezia. Clin J Gastroenterol 2022; 15:407-412. [PMID: 35076862 DOI: 10.1007/s12328-022-01594-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 01/08/2022] [Indexed: 10/19/2022]
Abstract
A 57-year-old man was referred to our hospital for further management of a subepithelial lesion noted on colonoscopy. He underwent endoscopic treatment of unroofing technique, in which the protruding portion of the tumor was partially resected. Due to a small amount of hematochezia, colonoscopy was performed to re-evaluate the lesion post-treatment. This enabled the observation of the drainage process of the residual lipoma. Remission was achieved and confirmed 8 months after the treatment. Endoscopic unroofing technique has been reported as a safe and effective method of treating lipomas, particularly large ones. To the best of our knowledge, this is the first endoscopic unroofing case in which the drainage process of the residual lipoma was observed and the remission of the lesion was confirmed.
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Affiliation(s)
- Yi-Ling Ko
- Department of Gastroenterology and Medicine, Faculty of Medicine, Fukuoka University, 7 Chome-45-1 Nanakuma, Jonan Ward, Fukuoka, 814-0180, Japan
| | - Hiroki Matsuoka
- Department of Gastroenterology and Medicine, Faculty of Medicine, Fukuoka University, 7 Chome-45-1 Nanakuma, Jonan Ward, Fukuoka, 814-0180, Japan
| | - Ryohei Nomaru
- Department of Gastroenterology and Medicine, Faculty of Medicine, Fukuoka University, 7 Chome-45-1 Nanakuma, Jonan Ward, Fukuoka, 814-0180, Japan
| | - So Imakiire
- Department of Gastroenterology and Medicine, Faculty of Medicine, Fukuoka University, 7 Chome-45-1 Nanakuma, Jonan Ward, Fukuoka, 814-0180, Japan
| | - Hideto Sakisaka
- Department of Gastroenterology and Medicine, Faculty of Medicine, Fukuoka University, 7 Chome-45-1 Nanakuma, Jonan Ward, Fukuoka, 814-0180, Japan
| | - Satoshi Matsuoka
- Department of Gastroenterology and Medicine, Faculty of Medicine, Fukuoka University, 7 Chome-45-1 Nanakuma, Jonan Ward, Fukuoka, 814-0180, Japan
| | - Nobuaki Kuno
- Department of Gastroenterology and Medicine, Faculty of Medicine, Fukuoka University, 7 Chome-45-1 Nanakuma, Jonan Ward, Fukuoka, 814-0180, Japan
| | - Koichi Abe
- Department of Gastroenterology and Medicine, Faculty of Medicine, Fukuoka University, 7 Chome-45-1 Nanakuma, Jonan Ward, Fukuoka, 814-0180, Japan
| | - Sadahiro Funakoshi
- Department of Gastroenterology and Medicine, Faculty of Medicine, Fukuoka University, 7 Chome-45-1 Nanakuma, Jonan Ward, Fukuoka, 814-0180, Japan
| | - Yusuke Ishida
- Department of Gastroenterology and Medicine, Faculty of Medicine, Fukuoka University, 7 Chome-45-1 Nanakuma, Jonan Ward, Fukuoka, 814-0180, Japan
| | - Hideki Ishibashi
- Department of Gastroenterology and Medicine, Faculty of Medicine, Fukuoka University, 7 Chome-45-1 Nanakuma, Jonan Ward, Fukuoka, 814-0180, Japan
| | - Kaori Koga
- Department of Pathology, Faculty of Medicine, Fukuoka University, 7 Chome-45-1 Nanakuma, Jonan Ward, Fukuoka, 814-0180, Japan
| | - Tetsuhiro Saito
- Ai Clinic of Internal Medicine and Gastroenterology, 1 Chome-6-24 Komodanishi, Iizuka, Fukuoka, 820-0017, Japan
| | - Morishige Takeshita
- Department of Pathology, Faculty of Medicine, Fukuoka University, 7 Chome-45-1 Nanakuma, Jonan Ward, Fukuoka, 814-0180, Japan
| | - Fumihito Hirai
- Department of Gastroenterology and Medicine, Faculty of Medicine, Fukuoka University, 7 Chome-45-1 Nanakuma, Jonan Ward, Fukuoka, 814-0180, Japan.
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