313 results match your criteria: "Nara City Hospital[Affiliation]"

Article Synopsis
  • - Moyamoya disease (MMD) is a cerebrovascular condition marked by narrowing of the internal carotid artery (ICA), with some patients also experiencing stenosis in the external carotid artery (ECA), though this is uncommon.
  • - A 48-year-old woman with no prior health issues presented with serious neurological symptoms and imaging revealed significant stenosis in both the ICA and ECA, leading to her diagnosis of MMD.
  • - The treatment involved a combination of percutaneous transluminal angioplasty (PTA) with a kissing balloon technique, followed by direct and indirect revascularization, showing potential effectiveness despite ongoing debates on the best treatment sequence.
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Background And Aims: We sought to validate the British Society of Gastroenterology (BSG) guidelines for acute lower gastrointestinal bleeding (ALGIB).

Methods: We analyzed 8,956 patients with ALGIB in CODE BLUE-J study and categorized them into four groups based on BSG guidelines. Outcomes included 30-day rebleeding, 30-day mortality, blood transfusion, therapeutic intervention, and severe bleeding.

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  • Fibro-Scope is an AI system designed for noninvasive diagnosis of liver fibrosis in patients suffering from metabolic dysfunction-associated steatotic liver disease, and the study assessed its effectiveness alongside the FIB-4 index in a cohort of Japanese patients.
  • A 6.4-year study involving 796 patients showed that the combined method classified patients into low, high, and middle-risk groups, achieving 84% sensitivity and specificity for detecting advanced fibrosis.
  • The two-step method proved valuable in identifying high-risk individuals, supporting its use as a cost-effective and practical screening tool in clinical settings in Japan.
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  • The study aimed to improve the prediction of liver-related events (LRE) in patients with metabolic dysfunction-associated steatotic liver disease (MASLD) by combining the Fibrosis-4 (FIB-4) index with genetic polymorphism data.
  • Researchers enrolled 1,304 Japanese patients, identifying key genotypes associated with LRE while tracking outcomes over an 8.1-year follow-up period, during which 96 LREs occurred.
  • The findings suggested that a two-step screening strategy using the FIB-4 index followed by genetic assessment effectively identifies high-risk patients, with notable differences in survival rates and LRE development across risk groups.
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  • A rare case of spontaneous direct vertebral artery-external vertebral venous plexus (VA-EVVP) fistula was diagnosed in an 82-year-old woman without trauma history or neurological deficits, presenting with right hemianopsia.
  • Initial MRI suggested an old infarction and a dural arteriovenous fistula, but further imaging revealed a specific AV fistula at the C2 level.
  • The patient underwent successful coil embolization, resulting in complete obliteration of the fistula after follow-up, providing new insights into treating VA-EVVP fistulas.
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  • Central giant cell granuloma (CGCG) is a rare, benign bone lesion primarily found in the jawbones, but this case highlights its occurrence in the temporal bone of a 31-year-old female.
  • The patient underwent advanced imaging which revealed a mass with significant involvement of nearby structures, leading to preoperative embolization to minimize blood supply before surgical intervention.
  • Post-surgery, a histopathological analysis confirmed the diagnosis of CGCG, and the patient had an uncomplicated recovery, highlighting a successful management approach that preserved critical ear structures.
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Background: Vertebral artery (VA) stump syndrome (VASS) is an embolic source for cerebral infarction (CI) in the posterior circulation after VA occlusion.

Case Description: A 63-year-old patient with a history of hypertension presented to our emergent department with dizziness, vomiting, and gait disturbance. Head magnetic resonance imaging (MRI) showed acute CIs in the bilateral cerebellar hemispheres and the vermis.

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Direct Clipping for Active Colonic Diverticular Bleeding Using an Endoclip with Re-grasping Function.

Turk J Gastroenterol

June 2024

Department of Gastroenterology and Hepatology, Center for Digestive and Liver Diseases, Nara City Hospital, Nara, Japan.

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Unresectable, metastatic, advanced urothelial carcinoma (aUC) is an aggressive disease and is treated with platinum-containing first-line chemotherapy, followed by immune checkpoint inhibitors and antibody-drug conjugates. Response to first-line chemotherapy is a vital priority in sequential treatment strategies because a better response to first-line chemotherapy is associated with a better response to subsequent therapies. Gemcitabine plus carboplatin chemotherapy is conventionally recommended for cisplatin-ineligible patients.

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Article Synopsis
  • A 74-year-old man with severe aplastic anaemia achieved a long-term remission due to the growth of HLA allele-deficient clones, despite initial treatment complications.
  • After starting eltrombopag and ciclosporin, his blood counts eventually normalized over a span of 3 years, showing a complete recovery of blood cell production.
  • Research techniques like flow cytometry and deep sequencing indicated that his recovery relied on clones with mutations that interfered with antigen presentation, demonstrating a potential new approach for managing immune-related aplastic anaemia in similar patients.
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Objective: To evaluate the effect of ventricular opening (VO) on recurrence patterns in patients with newly diagnosed glioblastoma (GBM) treated with bis-chloroethyl-nitrosourea (BCNU) wafer implantation.

Methods: This single-center retrospective study included 40 patients with newly diagnosed GBM who received BCNU wafer implantation after tumor resection between March 2013 and February 2022. The patients were categorized into two groups based on whether VO occurred during the GBM resection.

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Craniosynostosis (CS) can develop in the fetal period, but it is difficult to diagnose prenatally. In this case, a 3-month-old female baby developed extensive subgaleal hematoma and severe anemia after vacuum-assisted delivery. Her computed tomography showed bilateral lambdoid and sagittal synostosis (BLSS) with a depressed fracture of the right parietal bone.

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Background: The persistence of diagnostic errors, despite advances in medical knowledge and diagnostics, highlights the importance of understanding atypical disease presentations and their contribution to mortality and morbidity. Artificial intelligence (AI), particularly generative pre-trained transformers like GPT-4, holds promise for improving diagnostic accuracy, but requires further exploration in handling atypical presentations.

Objective: This study aimed to assess the diagnostic accuracy of ChatGPT in generating differential diagnoses for atypical presentations of common diseases, with a focus on the model's reliance on patient history during the diagnostic process.

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Article Synopsis
  • Maintenance avelumab is recommended for patients with metastatic urothelial carcinoma (mUC) who have stable disease after first-line chemotherapy, while pembrolizumab offers an alternative option.
  • In a study of 626 patients, those transitioning from first-line chemotherapy to pembrolizumab had better outcomes in terms of response and progression-free survival compared to those moving to avelumab, especially if they had a partial response.
  • Overall survival rates were similar for both treatment options, highlighting that while pembrolizumab may provide better short-term efficacy, long-term survival outcomes remained unchanged.
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Article Synopsis
  • The study examined the link between blood group O and the likelihood of rebleeding in patients with acute lower gastrointestinal bleeding (ALGIB).
  • Out of 2336 patients analyzed, those with blood group O had higher rebleeding rates within 30 days (17.9%) and 1 year (21.9%) compared to non-O patients.
  • Blood group O was found to be an independent risk factor for rebleeding, while rates of thrombosis and mortality were similar between groups.
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Article Synopsis
  • ! This study investigated the safety and effectiveness of combined atezolizumab and bevacizumab therapy in liver cancer (hepatocellular carcinoma) patients who are on anti-platelet or anticoagulant medications. * ! It analyzed 185 patients, comparing those on these medications (IM out) with those not on them (IM in), finding no significant differences in progression-free survival or overall survival between the two groups. * ! The conclusion indicates that the combination therapy is safe and effective for patients taking anti-platelet agents or anticoagulants, making it a viable option for this population. *
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Article Synopsis
  • The study focused on the genetic changes in extramammary Paget disease (EMPD), specifically looking at CDKN2A and MTAP alterations and their impact on disease progression.
  • Researchers analyzed 24 invasive/metastatic EMPD cases using immunohistochemistry and DNA sequencing, finding that p16 expression was mostly preserved in early-stage tumors but significantly lost in invasive and metastatic stages.
  • The study confirmed CDKN2A deletions in all five metastatic cases tested, suggesting that loss of p16 expression and CDKN2A alterations are common in aggressive forms of EMPD.
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Purpose: We investigated the inhibitory effect of edaravone (EDR) lotion on chemotherapy-induced alopecia (CIA) to improve the quality of life for patients with cancer.

Methods: Wistar rats were intraperitoneally injected with cyclophosphamide (CPA, 75 mg/kg) to induce CIA and divided into six groups: (1) Control; (2) EDR 0%; (3) EDR 0.3%; (4) EDR 3%.

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Introduction: Respiratory syncytial virus (RSV) is a causative virus for the common cold worldwide and can result in hospitalisations and even death in patients with high-risk conditions and older adults. However, the relationship between RSV or other incidental respiratory infections and acute exacerbations of underlying conditions has not been well investigated. The primary objective of this study is to estimate RSV prevalence, risk factors for adverse outcomes or hospitalisation and their effect on the hospital course of patients with acute respiratory symptoms admitted from emergency departments.

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Burton line and basophilic stippling in lead poisoning.

CMAJ

April 2024

Department of General Medicine (Morita, Morikawa), Nara City Hospital, Higashikideracho, Nara, Japan; Department of General Internal Medicine (Nishizawa), St. Luke's International University, Tokyo, Japan.

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Background & Aims: PNPLA3 rs738409, TM6SF2 rs58542926, and HSD17B13 rs72613567 have been associated with an increased risk of liver-related events (LREs) in patients with metabolic dysfunction-associated steatotic liver disease (MASLD). In this study, we investigated the combined effects of these variants on LREs.

Methods: The longitudinal multicenter cohort study enrolled 1178 patients with biopsy-proven MASLD.

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Background: Macular neovascularization (MNV) has been evaluated by optical coherence tomography (OCT) imaging using various approaches. However, few studies have examined their differences. This study analyzed type 1 MNV with a combination of two approaches: scale bar and binarization.

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This opinion paper addresses the challenges and future directions for preventing aspiration pneumonia in Japan's rapidly aging population. It highlights the increasing proportion of elderly individuals and the associated rise in health issues like decreased swallowing function, a risk factor for aspiration pneumonia. The paper emphasizes the effectiveness of dentist-provided oral care in preventing this condition but notes the lack of collaboration between dentists and physicians in Japan's clinical practice.

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