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2022 ◽  
Vol 22 (1) ◽  
Author(s):  
Kuniaki Ota ◽  
Yukiko Katagiri ◽  
Masafumi Katakura ◽  
Takafumi Mukai ◽  
Kentaro Nakaoka ◽  
...  

Abstract Background In gynecology, the number of laparoscopic surgeries performed has increased annually because laparoscopic surgery presents a greater number of advantages from a cosmetic perspective and allows for a less invasive approach than laparotomy. Trocar site hernia (TSH) is a unique complication that causes severe small bowel obstruction and requires emergency surgery. Its use has mainly been reported with respect to gastrointestinal laparoscopy, such as for cholecystectomy. Contrastingly, there have been few reports on gynecologic laparoscopy because common laparoscopic surgeries, such as laparoscopic salpingo-oophorectomy, are considered low risk due to shorter operative times. In this study, we report on a case of a woman who developed a TSH 5 days postoperatively following a minimally invasive laparoscopic surgery that was completed in 34 min. Case presentation A 41-year-old woman who had undergone laparoscopic salpingo-oophorectomy 5 days previously presented with the following features of intestinal obstruction: persistent abdominal pain, vomiting, and inability to pass stool or flatus. A computed tomography scan of her abdomen demonstrated a collapsed small bowel loop that was protruding through the lateral 12-mm port. Emergency surgery confirmed the diagnosis of TSH. The herniated bowel loop was gently replaced onto the pelvic floor and the patient did not require bowel resection. After the surgical procedure, the fascial defect at the lateral port site was closed using 2-0 Vicryl sutures. On the tenth postoperative day, the patient was discharged with no symptom recurrence. Conclusions The TSH initially presented following laparoscopic salpingo-oophorectomy; however, the patient did not have common risk factors such as obesity, older age, wound infection, diabetes, and prolonged operative time. There was a possibility that the TSH was caused by excessive manipulation during the tissue removal through the lateral 12-mm port. Thereafter, the peritoneum around the lateral 12-mm port was closed to prevent the hernia, although a consensus around the approach to closure of the port site fascia had not yet been reached. This case demonstrated that significant attention should be paid to the possibility of patients developing TSH. This will ensure the prevention of severe problems through early detection and treatment.


Author(s):  
Fumitaka Obayashi ◽  
Atsuko Hamada ◽  
Sachiko Yamasaki ◽  
Taku Kanda ◽  
Shigeaki Toratani ◽  
...  

AbstractCowden syndrome (CS) is an autosomal dominant inherited disorder characterized by multiple hamartomas in various organs such as the mucosa, skin, and gastrointestinal tract. Patients with CS are at high risk for breast and thyroid cancers. Phosphatase and tensin homolog deleted on chromosome 10 (PTEN) is a tumor suppressor gene that negatively regulates the AKT pathway, and PTEN mutations are known to be the major causes of this syndrome. However, the pathogenesis of this syndrome has not been clarified. Here, we present a case of a Japanese woman with multiple oral polyps, breast cancer, and thyroid cancer who was clinically diagnosed with CS. We obtained DNA and RNA samples from the patient’s peripheral blood mononuclear cells (PBMCs) and buccal mucosa tumor. Next-generation sequencing revealed novel germline mutations (c.1020delT and c.1026G > A) in exon 8 of PTEN. Sanger sequencing identified no PTEN transcript from the mutant allele. Furthermore, CS-specific induced pluripotent stem cells (CS-iPSCs) were established from PBMCs of the patient under feeder- and serum-free culture. Compared with healthy PBMCs and iPSCs, both of the CS-derived PBMCs and CS-iPSCs exhibited significantly reduced expression of the PTEN transcript. The transcriptional variant, PTENδ, was increased in CS-iPSCs, suggesting that it may be the cause of the disease.


2022 ◽  
Vol 6 (1) ◽  
Author(s):  
Tadayuki Hirai ◽  
Kenji Miwa ◽  
Hiroshi Furusho ◽  
Toshihiko Yasuda

Abstract Background Although rare, angiosarcoma is the most common type of cardiac primary malignancy. This disease can cause life-threatening complications and the prognosis remains poor. There is no standard approach to care, and clinical judgement is exercised on a case-by-case basis. Tumour progression causes serious complications, such as heart failure and vascular disruption. Case summary A 64-year-old Japanese woman presenting with a right atrial tumour was referred to our department. Tumour biopsy revealed that the patient suffered from angiosarcoma. We performed a lumpectomy to excise the tumour, but due to tissue adhesions in and around the right atrium, the malignancy could not be completely removed. After 3 years of chemotherapy, the patient was admitted to our hospital with increased chest pain. Emergency coronary angiogram revealed severe stenosis of the ostial right coronary artery. Intravascular ultrasound (IVUS) and computed tomography suggested coronary compression due to cardiac angiosarcoma. In this study, we report a unique case of advanced cardiac angiosarcoma, presenting as unstable angina, which was successfully treated with percutaneous coronary intervention using stent implantation. Discussion Due to the rarity of cardiac primary angiosarcoma, many symptoms are misdiagnosed until mechanical complications arise, such as coronary compression. The clinical course and various imaging modalities are useful for differentiating angiosarcomas from coronary stenosis.


2022 ◽  
Vol 10 ◽  
pp. 2050313X2110693
Author(s):  
Eri Obata ◽  
Kentaro Kai ◽  
Saki Aso ◽  
Nao Tsukamoto ◽  
Takuya Hanaoka ◽  
...  

Demons syndrome is defined by hydrothorax and ascites associated with a benign genital tumor that resolves after resection of the tumor. However, Demons syndrome with pericardial effusion has never been reported. Intensive care unit–acquired weakness is a neurological sequela to sepsis/systemic inflammatory response syndrome, or multi-organ failure. A 47-year-old, nulligravid, Japanese woman, was transferred to our hospital for refractory heart failure and a ruptured ovarian tumor. She had an 11-cm left ovarian tumor with ascites, hydrothorax, and pericardial effusion; she was intubated for pulmonary hypertension and admitted to the intensive care unit for septic shock. Four days later, a left salpingo-oophorectomy was performed for Demons syndrome with pericardial effusion. The histological diagnosis indicated a serous cystadenoma with fibrotic changes. Following surgery, ventilator weaning was delayed due to intensive care unit–acquired weakness. The association between Demons syndrome and pericardial effusion should be recognized to ensure early treatment and for preventing sequalae from the disease.


2021 ◽  
Vol 35 (4) ◽  
pp. 9-12
Author(s):  
Łukasz Burkiewicz

The cover title of the new issue, An Oriental Journey, has attracted a great deal of interest from authors of various disciplines. Scholars of both remote and recent history have passionately explored this theme. The issue section contains three articles related to the medieval Levant. Wojciech Mruk, a medievalist from the Jagiellonian University, analyses the account given by Lionardo Frescobaldi, Simone Sigoli and Giorgio Gucci, who made a peregrination to the Holy Land together between 1384 and 1385. Another article, by Christopher Schabel (Cyprus University in Nicosia), discusses the best-known medieval Cypriot village of Psimolofu and its links with the patriarchs of Jerusalem. Nicholas Coureas of the Cyprus Research Center provides a broad perspective on the presence of the Greek Church on Cyprus during the Lusignan and Venetian rule (1191–1571). The next contribution takes us back to the 20th century and even further to the East. Magdalena Filipczuk (Jesuit University Ignatianum in Cracow) reconstructs selected themes in the reflections by Lin Yutang, a Chinese thinker, translator and editor, based on his work towards explaining and popularizing Chinese culture and philosophy in the West. One more article that takes us to the Far East, but back in time, is by Małgorzata Sobczyk (Nicolaus Copernicus University in Toruń) undertakes to characterize the image of a Japanese woman in the light of sixteenth-century European accounts. The next three studies invite us to learn more about Poles and their presence in the East. Ewa Siemieniec-Gołaś (Jagiellonian University) makes an attempt to discuss the figure of Władysław Jabłonowski, not only a physician in the Ottoman service, but also an expert and researcher of the East. Beata Gontarz (University of Silesia in Katowice) discusses the cultural experience of Jan Józef Szczepański based on his book Do raju i z powrotem [To Paradise and Back]. The last article in the issue section is a work of turkologist Sylwia Filipowska (Jagiellonian University), who discusses the circumstances of Tadeusz Kowalski’s journey to Turkey in 1927.


2021 ◽  
pp. 229-246
Author(s):  
Yuan-tsung Chen

Zhou Enlai tried but failed to protect Jack, and so in 1969, Jack and Yuan-tsung were evicted from their apartment and forced to live in a corner room at a slum house on Sheep Market Street. Most of their neighbors came from the urban underclass; among them were a retired prostitute, a semireformed thief, a laundress who doubled as a bed playmate to her employer, and an old witch who practiced black magic. They were purveyors of gossip and became new sources of information for Yuan-tsung. A Japanese woman named Noriko, punching bag to her Chinese husband, became Yuan-tsung’s best friend and played a key role in her fight against the Red Guards.


2021 ◽  
Vol 26 (1) ◽  
Author(s):  
Ryota Matsuoka ◽  
Noriaki Sakamoto ◽  
Takayasu Kato ◽  
Shigeru Chiba ◽  
Masayuki Noguchi

Abstract Background Solitary plasmacytoma of bone (SPB) is a rare plasma cell neoplasm. It arises in bone as a single locus in the absence of any plasma cell myeloma lesions. Plasma cell neoplasms intrinsically express only one immunoglobulin light chain (IgL)—kappa or lambda—and using this fact, kappa/lambda deviation is the decisive factor for diagnosis. Co-expression of both IgLs in a single tumor cell is extremely rare. Case presentation We report a case of SPB that arose in the vertebra of a 52-year-old Japanese woman. Histologically, the resected mass showed diffuse plasma cell proliferation. Dual IgL expression was detected by flow cytometry, immunohistochemistry, and in situ hybridization (ISH) targeting IgL mRNA. Conclusion We have presented an extremely rare case of SPB showing dual expression of kappa and lambda IgLs. This unusual case of plasma cell neoplasia might represent a possible exceptional example of failure of “IgL isotypic exclusion.”


2021 ◽  
Vol 15 (1) ◽  
Author(s):  
Yuka Kasuya ◽  
Yuji Inoue ◽  
Satoru Inoda ◽  
Yusuke Arai ◽  
Hidenori Takahashi ◽  
...  

Abstract Background The chorioretinal inflammatory lesions occurring in punctate inner choroiditis evolve into punched-out atrophic scars. Typically, the progression is gradual. We report a case of highly myopic punctate inner choroiditis with rapid progression of chorioretinal atrophy. Case presentation A 48-year-old Japanese woman with high myopia presented with decreased visual acuity. Best-corrected visual acuity was 20/28 in the right eye and 20/16 in the left eye; axial length was 29.0 mm and 28.7 mm, respectively. Fundoscopy revealed an epiretinal membrane in the left eye. Three years later, the best-corrected visual acuity in the left eye had decreased to 20/33; at this time, the patient underwent vitrectomy with epiretinal membrane and internal limiting membrane peeling in this eye. Six months later, the best-corrected visual acuity in the left eye decreased suddenly to 20/100. Optical coherence tomography showed a nodule-like lesion in the outer retina with disruption of the retinal pigment epithelium and a focally thickened choroid, compatible with PIC. One month later, the choroidal thickness had decreased. The central chorioretinal atrophy expanded rapidly at a rate of 0.45 mm2/year over the next 3 years, and new areas of patchy focal chorioretinal atrophy developed in the perifovea. Conclusions Rapid progression of chorioretinal atrophy was observed in a patient with punctate inner choroiditis. Because punctate inner choroiditis is often associated with degenerative myopia, the retina is fragile and may be susceptible to mechanical damage. This case report alerts clinicians to the need for careful management of patients with punctate inner choroiditis, especially after vitrectomy.


2021 ◽  
Vol 15 (1) ◽  
Author(s):  
Shunsuke Todani ◽  
Mao Takahashi

Abstract Background Takotsubo syndrome is a sudden and an acute form of transient cardiac dysfunction, triggered by mental and physical stress. The treatment for Takotsubo syndrome is not well understood and is incompletely established. Takotsubo syndrome is partly thought to be caused by coronary ischemia under sympathetic nerve activation. Case presentation We report the case of an 80-year-old Japanese woman with recurrent Takotsubo syndrome complicated with ischemic enteritis. In this case, abdominal pain and dehydration due to ischemic enteritis is thought to have triggered Takotsubo syndrome. Her life was saved with rapid, adequate intravenous hydration. She was diagnosed with coronary vasospastic angina using coronary angiography on her second admission. This case highlights the potential of adequate intravenous hydration in increasing coronary blood flow. In our case, it should be noted that pulmonary congestion was mild and may have improved Takotsubo syndrome without the use of diuretics. Conclusion Adequate hydration must be considered for prompt improvement of cardiac function in Takotsubo syndrome. Replenishment of fluid to increase coronary blood flow, improvement of heart load without exacerbating heart failure, and stabilization of circulation dynamics can help treat patients with Takotsubo syndrome without using diuretics.


2021 ◽  
Vol 15 (1) ◽  
Author(s):  
Ai Kato ◽  
Mami Ishihara ◽  
Nobuhisa Mizuki

Abstract Background In recent years, numerous studies have reported the development or exacerbation of sarcoidosis due to interferon therapy. However, ocular lesions rarely present as initial symptoms. Herein, we describe a rare case of interferon-α-induced sarcoidosis with uveitis as the initial symptom, and present a review of the relevant literature. Case presentation This case involved a 62-year-old-Japanese woman with a history of a combination treatment of pegylated interferon-α-2a, ribavirin, and simeprevir, after which she developed granulomatous panuveitis. She was subsequently diagnosed with sarcoidosis following histological examination of skin biopsy specimens. In addition to reporting this case, we performed a literature review of 27 cases (24 case reports) of histopathologically diagnosed interferon-α-induced sarcoidosis published between January 2009 and November 2018. Conclusions Among the reviewed cases, 23 (85.1%) cases developed skin lesions and 19 (70.1%) had lung lesions. Only three cases (11.1%) had accompanying eye lesions. Interferon-α therapy was discontinued in 16 cases (52.9%), and the majority exhibited improvement after systemic corticosteroid treatment. There are few reported cases of interferon-α-induced sarcoidosis with uveitis as the initial symptom. However, if uveitis develops during or after interferon-α treatment, it might represent an initial symptom of interferon-α-induced sarcoidosis, as observed in the present case.


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