Journal of Nippon Medical School = Nippon Ika Daigaku zasshi
-
Case Reports
Permanent bilateral cortical blindness due to reversible posterior leukoencephalopathy syndrome.
Reversible posterior leukoencephalopathy syndrome (RPLS) is induced by acute cerebral edema. Its symptoms include seizures, headache, altered mental status, and visual disturbances. The clinical and radiological findings are usually transient. ⋯ Antihypertensive therapy improved the patient's general condition, including blood pressure. Radiological findings 5 months later showed resolution of most of the abnormal signal areas. However, total blindness had developed in both eyes by day 15, and two courses of pulsed corticosteroid therapy failed to restore the visual loss.
-
A 27-year-old nulligravida woman without a history of dermatosis was hospitalized for threatened preterm labor at 29 weeks' gestation; therefore, continuous infusion of ritodrine hydrochloride was started. At 31 weeks' gestation, erythematous plaques appeared and spread over the body surface; therefore, a topical steroid preparation was applied. At 32 weeks' gestation, the eruptions developed into irregular annular areas of erythema with multiple pustules accompanied by severe itching, and oral prednisolone treatment was started. ⋯ Within several days of delivery, the eruptions began to resolve, and no recurrence was observed after treatment with oral prednisolone was stopped 31 days after delivery. On the basis of a positive patch test for ritodrine, we diagnosed pustular drug eruptions caused by ritodrine hydrochloride. Although ritodrine-induced pathognomonic cutaneous eruptions are rare, we would like to emphasize that ritodrine can cause drug-induced pustular eruptions distinctly resembling life-threatening impetigo herpetiformis.
-
Traumatic injury of the superior mesenteric vein (SMV) by blunt trauma is a rare but frequently fatal injury. Although simple ligation should be considered for a patient in unstable condition, its complications have not been reported in detail. A 47-year-old man was struck on the abdomen during a fight. ⋯ However, collateral vessels were revealed on a 3-dimensional CT scan, and, on POD 23, a CT scan showed that the collateral vessels had developed. The patient was discharged on POD 37. This case demonstrates that simple ligation of the proximal SMV leads to the development of collateral vessels and is useful for preventing side effects and improving outcomes.
-
Coronary artery bypass grafting (CABG) is a highly successful treatment for prolonging the lives of selected patients; however, preoperative and postoperative renal dysfunction has been an important predictor of adverse cardiovascular events. Concerns have recently grown regarding chronic kidney disease (CKD), which is an independent risk factor for cardiovascular diseases. In the present study we examined the significance of renal function on the basis of the estimated glomerular filtration rate (eGFR) and analyzed other factors as predictors of long-term clinical outcomes after CABG. ⋯ The mean age of patients was 64.6 ± 9.3 years, and the mean duration of follow-up was 69.5 ± 44.5 months. There were no significant differences in either deaths from all causes or cardiovascular deaths between the CKD group and the non-CKD group. Multivariate analysis using the Cox proportional hazards model revealed that age (hazard ratio, 1.044; p=0.001) was a predictor of all-cause death and that age (hazard ratio, 1.154; p<0.001), diabetes mellitus (hazard ratio, 3.122; p=0.046), unstable angina (hazard ratio, 5.012; p=0.003), and proteinuria (hazard ratio, 7.982; p<0.001) were predictors of cardiovascular death. conclusions: Our study demonstrates that age, diabetes mellitus, unstable angina, and proteinuria are factors that affect long-term prognosis after CABG, whereas eGFR <60 mL/min/1.73 m(2) is not a predictive risk factor for either all-cause death or cardiovascular death. Although the predictive value of eGFR <60 mL/min/1.73 m(2) is generally accepted, analysis of our own data with receiver operating characteristic curves shows that eGFR <50 mL/min/1.73 m(2) is a more sensitive predictor of long-term outcome.
-
Case Reports
Novel hybrid mesh surgery combines sacrocolpopexy with transvaginal mesh placement for pelvic organ prolapse.
Mesh surgeries, such as sacrocolpopexy and transvaginal mesh surgery, are commonly used to treat pelvic organ prolapse. Although mesh surgeries have a high success rate, they are unsuitable for some patients. ⋯ This approach is simple, secure, and versatile for patients who are not good candidates for conventional mesh surgeries. This novel hybrid mesh surgery is an option for treating various types of pelvic organ prolapse.