A woman in her 50s underwent abdominal total hysterectomy for uterine myoma. She was discharged from the hospital on postoperative day (POD) 6 following an uneventful postoperative course but returned to the outpatient clinic on POD 11 with chief complaints of fever and abdominal pain. Blood tests at presentation showed a C-reactive protein level of 22.95 mg/dL and a white blood cell count of 21300/μL, indicating an increased inflammatory response. Transvaginal ultrasonography and contrast-enhanced computed tomography (CT) revealed a small amount of ascites and a thickened pelvic peritoneum. Based on these findings, pelvic peritonitis was diagnosed and the patient was readmitted to the hospital. After admission, antimicrobial treatment with cefmetazole 3 g/day was started, but transvaginal ultrasonography on POD 13 (3 days after readmission) revealed an intra-pelvic abscess. The abscess was punctured under transvaginal ultrasonographic guidance and the puncture fluid was submitted for microbiological examination, followed by CT-guided drainage. At the same time, the antimicrobial regimen was changed to sulbactam/ampicillin 9 g/day and doxycycline (DOXY) 200 mg/day (100 mg/day from the following day). On POD 18 (8 days after readmission), Mycoplasma hominis was detected in the abscess culture, leading to the decision to increase the dose of DOXY to 200 mg. Subsequently, with improvement of subjective and objective symptoms and reduction of the abscess cavity, the patient was discharged from the hospital on POD 21 (11 days after readmission). Although M. hominis is a common urogenital commensal, it can be a potential pathogen in a patient with a pelvic abscess that occurs as a late postoperative complication and does not respond to beta-lactam antibiotics, so treatment decisions should be made with this organism kept in mind.

The patient was a 36-year-old primipara with no comorbidities such as diabetes or hypertension. At 35 weeks and 3 days of pregnancy, she was admitted for rupture of membranes. She vomited often during the expulsive stage of labor, so a vacuum extraction was performed. Her vital signs were normal throughout the delivery. She vomited repeatedly after the delivery but did not complain of headache or arm weakness and her level of consciousness was Japan Coma Scale I-1. Head CT revealed right caudate hemorrhage and cerebral ventricular rupture. Head MRI showed no obvious cerebrovascular abnormality, so she was followed up with symptomatic treatment. Recovery was uneventful, without neurological sequelae, and she was discharged on postpartum day 27. Cerebral hemorrhage during pregnancy is caused in many cases by comorbidities such as cerebral aneurysm, cerebral artery malformation, and pregnancyinduced hypertension syndrome. Cerebral hemorrhage may occur in pregnant women with no risk factors, even when their vital signs are stable. It is necessary to pay attention to the appearance of new symptoms, such as vomiting, around the time of delivery.

There are few reports on opioid pharmacokinetics and opioid switching in patients with small intestinal stomas. We experienced a case in which a 40-year-old man with an ileostomy experienced shortened analgesia and increased pain after switching from a fast-release to an extended-release formulation of tramadol. It is possible that the time required for passage through the small intestine and the absorption capacity of the extended-release formulation were insufficient for the extended-release formulation to function effectively, and that more detailed medication adjustment is necessary for patients with small intestinal stomas.

Congenital fetal abnormalities, typically structural abnormalities, are found about 3-5% of all pregnancies. The prenatal detection of these abnormalities are especially important in providing optimal perinatal management for neonates. In many obstetric hospitals and clinics in Japan, fetal ultrasound screening is provided by obstetricians at regular pregnancy checkups. There were few reports on fetal ultrasound performed by medical technologists. Therefore, we conducted a retrospective investigation to determine the efficacy and accuracy of fetal ultrasound performed by medical technologists in our hospital. In total, 2,289 pregnancy women underwent fetal ultrasound screening. We excluded cases that were a second or subsequent scan, had gestational age of <22 weeks at the time of ultrasound screening, or had missing perinatal and neonatal outcomes. The remaining of 2,186 cases, including 65 cases of twins, were investigated. Abnormal findings were noted in 79 cases (3.6%): 31 for the heart, 14 for head, and 11 for urogenital organs. In those cases, congenital abnormalities were found in 39 neonates (1.8%). There were 95 cases (4.3%) in which abnormal finding were absent in fetal ultrasound screening but congenital abnormalities were diagnosed in neonates, including ventricular aneurysm, interruption of the vena cava, cerebellar medulloblastoma, atrial septal defect, and cleft palate. In conclusion, for detecting structural abnormalities, fetal ultrasound screening performed by medical technologists is an important alternative to ultrasound screenings performed by obstetricians. To increase the accuracy of fetal ultrasound screening, continuous improvement of fetal ultrasound skills is important.

The patient was a 68-year-old woman who was diagnosed with stage IIIA cervical cancer and pyometra. Concurrent chemoradiotherapy was planned. She was admitted to our hospital 3 weeks after the initial examination due to vaginal bleeding and worsening of lower abdominal pain. On hospital day 5, she developed a fever, and free gas in the peritoneal cavity and ascites were confirmed by contrast-enhanced computed tomography. Emergency surgery was performed for suspected generalized peritonitis attributed to perforation in the digestive tract or uterus. A large amount of purulent ascites and 2 perforations in the anterior wall of the uterus, but none in the digestive tract, were observed. Peritoneal lavage and drainage were performed, and a colostomy was created. The patient was managed in the intensive care unit until postoperative day 13 due to septic shock and acute renal failure. After the peritonitis resolved, radiation therapy alone was provided, and then chemotherapy was started to treat residual lesions. Pyometra recurred, and transvaginal drainage was performed to prevent perforation of the uterus. However, a few days later, a colouterine fistula and an enterocutaneous fistula developed simultaneously, and her general condition worsened. In advanced cervical cancer complicated by pyometra, various complications can develop that are difficult to manage (e.g., uterine perforation and fistula formation due to radiation enteritis and dermatitis). 　This case demonstrates the importance of uterine drainage at appropriate timing, which can contribute to improved prognosis.

It is important to understand the impact of the COVID-19 pandemic on inpatient care and the needs of inpatients and their families. We conducted an anonymous self-administered questionnaire survey of inpatients who had been referred to our palliative care team, their families (hereafter referred to as patients' families), and their primary nurses (hereafter referred to as PNs). The EZR statistical software was used for statistical analysis, and p<0.05 was considered to indicate a significant difference. 31 patients [9 males, 22 females; median age 65 years (range 30-85 years)], 25 family members, and 26 PNs responded. The question “Do you ever feel depressed due to restricted visitation?” had a significantly stronger impact on patient families than on patients (p<0.05). Compared to patients, patient families tended to prefer face-to-face visits (p<0.05). The impact of visitation restrictions was greater on patients’ families than on the inpatients, suggesting that it is important to provide care and support to patients’ families especially during periods when there are visitation restrictions.

BACKGROUND: The absence of thyroid cysts may indicate latent thyroid damage, as demonstrated in our previous study. However, the association between the absence of thyroid cysts and latent functional damage of the thyroid is unknown. At low thyroid hormone productivity, which may be associated with latent functional damage of the thyroid, the association between thyroid-stimulating hormone (TSH) and hypertension might be enhanced. Therefore, we evaluated the association between TSH level and hypertension stratified by thyroid cyst status. METHODS: We conducted a cross-sectional study of 1724 euthyroid Japanese individuals aged 40-74 years who participated in an annual health checkup in 2014. RESULTS: In the study population, 564 and 686 participants had thyroid cysts and hypertension, respectively. A significant positive association was observed between TSH and hypertension in subjects without a thyroid cyst but not in subjects with thyroid cysts. There was a significant positive association between hypertension and TSH in subjects without a thyroid cyst (odds ratio [OR] 1.27; 95% confidence intervals [CI] 1.01, 1.61) but not in subjects with thyroid cysts (OR 0.79; CI 0.57, 1.09) in the model fully adjusted for known confounding factors. The correlation between the TSH and free triiodothyronine (fee T3) levels (simple correlation coefficient [r] = - 0.13, p < 0.01) was stronger in the subjects without thyroid cysts than in those with thyroid cysts (r = - 0.03, p = 0.525). CONCLUSIONS TSH is positively associated with hypertension only in individuals without thyroid cysts. The correlation between the TSH and free T3 levels was stronger in the subjects without thyroid cysts than in those with thyroid cysts. Therefore, the absence of thyroid cysts could be related to the association between TSH level and hypertension, possibly by indicating that the subjects without thyroid cysts had limited thyroid hormone reserves. Therefore, the absence of thyroid cysts could indicate the latent functional damage of the thyroid.
Aged ; Cross-Sectional Studies ; Cysts/etiology* ; Female ; Humans ; Hypertension/metabolism* ; Japan ; Male ; Middle Aged ; Thyroid Diseases/etiology* ; Thyroid Gland/pathology* ; Thyrotropin/metabolism*

BACKGROUND: Anti-thyroid peroxidase antibody (TPO-Ab) has been shown to cause autoimmune thyroiditis by inducing a deleterious influence on thyroid hormone synthesis. Further, thyroglobulin, which has an important role in thyroid hormone synthesis, is reported to be high in the fluid from thyroid cysts. Therefore, TPO-Ab could be associated with the presence of thyroid cyst, partly by affecting the activity of thyroid hormone synthesis. METHODS: To investigate the association between TPO-Ab and thyroid cysts, we conducted a cross-sectional study of 1432 Japanese with normal thyroid function [i.e., normal range of free triiodothyronine (free T3) and free thyroxine (free T4)] between the ages of 40 and 74 years, who participated in an annual health check-up. RESULTS: In men, the statistical power did not reach a statistical significance value. Additionally, subjects with TPO-Ab showed lower odds ratios (ORs) of thyroid cysts than those without TPO-Ab. In women, subjects with TPO-Ab showed significantly lower ORs of thyroid cysts than those without TPO-Ab. The fully adjusted ORs were 0.68 (0.40, 1.18) for men and 0.40 (0.27, 0.60) for women. When evaluating the association between logarithmic values of TPO-Ab titer and thyroid cysts in both men and women, a notable inverse correlation was observed. The fully adjusted ORs were 0.68 (0.50, 0.92) for men and 0.68 (0.57, 0.81) for women. CONCLUSION TPO-Ab titer revealed to be inversely associated with thyroid cysts among Japanese with normal thyroid function. The presence of a thyroid cyst could indicate a lower risk of having TPO-Ab among the general population with normal thyroid function.

Purpose: The present study aimed to clarify the status of exercise and related factors among survivors of breast cancer. Methods: Questionnaires were distributed to survivors of breast cancer. The question items addressed the status of exercise participation, knowledge about the effects of exercise and need for support. Factors associated with exercise participation were analyzed using logistic regression analysis. Results: Among 293 valid responses (rate, 84.2%). Fifty-eight point four percent participated in exercise and 41.3% decreased exercise participation after being diagnosed with breast cancer. Furthermore, 91.9% needed support from health care providers regarding exercise. About 70% of respondents were aware that exercise improves sleep, but <50% knew that exercise ameliorates symptoms associated with breast cancer. Among seven factors, age, employment status and chemotherapy were associated with exercise status. Conclusion: Breast cancer survivors who are younger, employed and undergoing chemotherapy might not participate in exercise. The preventive effects of exercise on breast cancer and the importance of continuing daily exercise should be promoted. Health care providers should provide support for patients to participate in exercise considering the influence of treatment and physical capabilities.

To administer oral anticancer drugs safely, the simple suspension method has been introduced in many hospitals. Therefore, concerning drugs for which it is unclear whether or not this method is applicable, testing must be able to be conducted at any time. In this study, we investigated 20 oral anticancer drugs to expand information on the application of the simple suspension method. Disintegration/suspension and permeability tests were conducted, as described in the 3rd version of the Tube Administration Handbook for Oral Drugs. All products were disintegrated/suspended after 10 minutes. On permeability tests, there was no residue in any tube for tubal feeding. On the final evaluation, the products were regarded as suitable (grade 1). Bicalutamide tablets (80 mg, TCK and KN), which were analyzed in this study, were regarded as suitable (grade 1) on the final evaluation. On the other hand, the simple suspension method is not applicable for a brand-name drug, Casodex^® tablets (80 mg). This may be related to the different additives. Furthermore, the results suggest that, even when the simple suspension method is not applicable for a brand-name drug, it may become applicable for generic drugs. This may provide a new merit for promoting the use of generic drugs.