We demonstrate an aberrant ramification pattern of the renal and testicular vessels. On both sides, the anterior and posterior renal veins emerged from the renal. On the right side, the anterior renal vein collected the right testicular vein and drained into the inferior vena cava, while the posterior one directly drained into the inferior vena cava. Two retrocaval testicular arteries originated from the aorta. On the left side, the perinephric vein drained from the abdominal wall and adrenal gland and joined the anterior renal vein. The anterior renal vein also collected the testicular, suprarenal, and inferior phrenic veins. The posterior one received the other testicular vein and the first three lumbar veins. These renal veins converged, passed anteriorly to the aorta, and drained into the inferior vena cava. Knowledge of the varied anatomy of these vessels will contribute to safe surgical approach to the kidneys.

We demonstrate an aberrant ramification pattern of the renal and testicular vessels. On both sides, the anterior and posterior renal veins emerged from the renal. On the right side, the anterior renal vein collected the right testicular vein and drained into the inferior vena cava, while the posterior one directly drained into the inferior vena cava. Two retrocaval testicular arteries originated from the aorta. On the left side, the perinephric vein drained from the abdominal wall and adrenal gland and joined the anterior renal vein. The anterior renal vein also collected the testicular, suprarenal, and inferior phrenic veins. The posterior one received the other testicular vein and the first three lumbar veins. These renal veins converged, passed anteriorly to the aorta, and drained into the inferior vena cava. Knowledge of the varied anatomy of these vessels will contribute to safe surgical approach to the kidneys.

We demonstrate an aberrant ramification pattern of the renal and testicular vessels. On both sides, the anterior and posterior renal veins emerged from the renal. On the right side, the anterior renal vein collected the right testicular vein and drained into the inferior vena cava, while the posterior one directly drained into the inferior vena cava. Two retrocaval testicular arteries originated from the aorta. On the left side, the perinephric vein drained from the abdominal wall and adrenal gland and joined the anterior renal vein. The anterior renal vein also collected the testicular, suprarenal, and inferior phrenic veins. The posterior one received the other testicular vein and the first three lumbar veins. These renal veins converged, passed anteriorly to the aorta, and drained into the inferior vena cava. Knowledge of the varied anatomy of these vessels will contribute to safe surgical approach to the kidneys.

We demonstrate an aberrant ramification pattern of the renal and testicular vessels. On both sides, the anterior and posterior renal veins emerged from the renal. On the right side, the anterior renal vein collected the right testicular vein and drained into the inferior vena cava, while the posterior one directly drained into the inferior vena cava. Two retrocaval testicular arteries originated from the aorta. On the left side, the perinephric vein drained from the abdominal wall and adrenal gland and joined the anterior renal vein. The anterior renal vein also collected the testicular, suprarenal, and inferior phrenic veins. The posterior one received the other testicular vein and the first three lumbar veins. These renal veins converged, passed anteriorly to the aorta, and drained into the inferior vena cava. Knowledge of the varied anatomy of these vessels will contribute to safe surgical approach to the kidneys.

We demonstrate an aberrant ramification pattern of the renal and testicular vessels. On both sides, the anterior and posterior renal veins emerged from the renal. On the right side, the anterior renal vein collected the right testicular vein and drained into the inferior vena cava, while the posterior one directly drained into the inferior vena cava. Two retrocaval testicular arteries originated from the aorta. On the left side, the perinephric vein drained from the abdominal wall and adrenal gland and joined the anterior renal vein. The anterior renal vein also collected the testicular, suprarenal, and inferior phrenic veins. The posterior one received the other testicular vein and the first three lumbar veins. These renal veins converged, passed anteriorly to the aorta, and drained into the inferior vena cava. Knowledge of the varied anatomy of these vessels will contribute to safe surgical approach to the kidneys.

Objective: The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variant B.1.1.529 (Omicron) was first detected in Japan in November 2021. In Osaka, public health centres subsequently increased active case finding and encouraged self-isolation. This study investigated the effectiveness of these countermeasures. Methods: Cases targeted for analysis were persons who had neither recently travelled abroad nor had contact with foreign tourists but tested positive for SARS-CoV-2 between 24 November 2021 and 4 January 2022 and were suspected or confirmed to have the Omicron variant. We performed a descriptive analysis and calculated the reproduction number (R) for each generation using the branching process method. Genomic sequencing data were analysed to plot a haplotype network. Results: A total of 251 cases were analysed. The median age was 30 years, and 46% (115/251) were in their 20s or younger. The first Omicron case in Osaka was detected on 21 December 2021. Local public health centres conducted health monitoring and contact tracing. We analysed R, using information from six clusters, including 42 pairs with a clear relationship between the case and the infected contact (infector–infectee pairs); the clusters had 19, 21 and 2 cases in each subsequent generation. The basic R (t = 0) was estimated to be 3.2, and subsequent generations (t = 1, 2) of R decreased to 1.1 and 0.1, respectively. The haplotype network showed that these cases constituted a monophyletic group with others detected around Osaka, indicating that these case-related clusters had been contained and were not involved in the nationwide Omicron waves. Discussion: Active case finding and self-isolation were found to be effective in limiting the spread of an emerging novel variant.

Objective: In Japan, pharmaceutical manufacturers have been required to develop a Risk Management Plan (RMP) since April 2013. Publication of the RMP is expected to enable the wide content-sharing of post-marketing risk management and its utilization among medical professionals to further enhance and strengthen post-marketing safety measures. In this study, we examined what points should be focused on for continuous utilization of RMPs after drug approvals by investigating the numbers of safety concerns addition of antineoplastic and immunomodulating agents, and where safety concerns added after approval are listed in package inserts. Furthermore, we investigated the reasons why these safety concerns were considered as such. Methods: Antineoplastics and immunomodulating agents, which account for more than half of all drugs containing new active ingredients approved in recent years, among drugs containing new active ingredients approved from fiscal year (FY) 2013 to FY 2019 were included in the study. The safety concerns (excluding important missing information) in RMPs as of April 1, 2021 for the subject drugs were compared with those at the time of approval. Safety concerns added after approval were investigated where they were listed in package inserts as of April 1, 2021. Furthermore, risks that were added as important potential risks were investigated as to why they were considered as such. Results: There were 117 risks added after approval. Those added to the important identified risks were listed in one of the sections of the package insert, whereas 11 risks were added to the important potential risks that could not be confirmed in the package inserts. Some important potential risks added after approval are suspected to have a causal relationship with the drug, but were not listed in the package inserts. Conclusion: It is important to utilize RMPs continuously to further understand risks of taking the drug.

Purpose: Patients with head and neck cancer (HNC) who undergo dental procedures during radiotherapy (RT) face an increased risk of developing osteoradionecrosis (ORN). Accordingly, new tools must be developed to extract critical information regarding the dose delivered to the teeth and mandible. This article proposes a novel approach for visualizing 3-dimensional planned dose distributions on panoramic reconstruction computed tomography (pCT) images. Materials and Methods: Four patients with HNC who underwent volumetric modulated arc therapy were included. One patient experienced ORN and required the extraction of teeth after RT. In the study approach, the dental arch curve (DAC) was defined using an open-source platform. Subsequently, pCT images and dose distributions were generated based on the new coordinate system. All teeth and mandibles were delineated on both the original CT and pCT images. To evaluate the consistency of dose metrics, the Mann-Whitney U test and Student t-test were employed. Results: A total of 61 teeth and 4 mandibles were evaluated. The correlation coefficient between the 2 methods was 0.999, and no statistically significant difference was observed (P>0.05). This method facilitated a straightforward and intuitive understanding of the delivered dose. In 1 patient, ORN corresponded to the region of the root and the gum receiving a high dosage (approximately 70 Gy). Conclusion The proposed method particularly benefits dentists involved in the management of patients with HNC. It enables the visualization of a 3-dimensional dose distribution in the teeth and mandible on pCT, enhancing the understanding of the dose delivered during RT.

Background/Aims: Natural history of chronic intestinal pseudo-obstruction (CIPO), a rare disease characterized by episodes of non-mechanical obstruction, is unclear in adults. This study evaluates the clinical course of CIPO and palliative care needs of patients. Methods: From October 2010 to September 2021, 74 patients who underwent cine MRI and had a definitive diagnosis of CIPO were prospectively included. We investigated disease etiology and outcomes, age at onset, nutritional status at consultation (body mass index and serum albumin), hydrogen breath test results, and total parenteral nutrition (TPN) during the disease course. Results: Forty-seven patients (64%) were women, with a mean age of 44 years at onset and 49 years at diagnosis. Primary CIPO was observed in 48 patients (65%). Secondary CIPO was observed in 26 cases (35%), of whom 18 (69%) had scleroderma. The mean body mass index, serum albumin level, and hydrogen breath test positivity rate were 17 kg/m2 , 3.8 mg/dL, and 60%, respectively. TPN and invasive decompression therapy were required by 23 (31%) and 18 (24%) patients, respectively. Intestinal sterilization was performed in 51 (69%) patients and was effective in 33 (65%); of these, 28 (85%) were taking metronidazole. Seven (9%) patients used opioids. There were 9 deaths (12%), including 5 (56%) from infection and 2 (22%) from suicide. Of the deaths, 6 (67%) and 4 (44%) underwent TPN management and decompression therapy, respectively. Fifty-one patients (69%) wanted palliative care. Conclusion CIPO is a rare, severe, and under-recognized disease. Standardization of treatment strategies, including palliative care and psychiatric interventions, is desired.

Bilateral shoulder joint disorders caused by rheumatoid arthritis significantly impair daily functioning owing to a lack of contralateral compensation. In Japan, reverse shoulder joint prostheses were approved in 2014. This was expected to improve the surgical outcomes of rheumatoid shoulder arthroplasty. We report two patients with rheumatoid arthritis who underwent bilateral reverse shoulder arthroplasty. This study aims to evaluate their postoperative clinical outcomes and activities of daily living. The patients were women in their 70s with stage III class 2 rheumatoid arthritis. Their treatment and postoperative activities of daily living were retrospectively reviewed. The first patient underwent the inlay type and experienced a residual limitation of external rotation postoperatively; therefore, she was restricted to dress with front-open clothes. However, she was able to undress after the lining of the garment was changed to a slippery material. The second patient underwent the onlay type and showed almost no limitations in postoperative activities of daily living. She was able to undress with an external rotation of 40–50°. Bilateral reverse shoulder arthroplasty improved range of motion, the Japanese Orthopaedic Association shoulder score, and functional outcomes. Only a few difficulties were encountered in the activities of daily living.