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Article: A Fatal Case of Takotsubo Cardiomyopathy Secondary to Refractory Hypoglycemia in Severe Starvation: An Autopsy Case Report.

Kirigaya, Jin / Iwahashi, Noriaki / Tanaka, Reiko / Inayama, Yoshiaki / Takeuchi, Ichiro

2022 Volume 14, Issue 3, Page(s) e23287

Abstract: A 56-year-old, severely malnourished man presented with loss of consciousness due to hypoglycemia. Echocardiography revealed left ventricular apical ballooning, indicating takotsubo cardiomyopathy. Although his caloric intake was gradually increased to ... ...

Abstract	A 56-year-old, severely malnourished man presented with loss of consciousness due to hypoglycemia. Echocardiography revealed left ventricular apical ballooning, indicating takotsubo cardiomyopathy. Although his caloric intake was gradually increased to avoid refeeding syndrome, hypoglycemia was refractory, and repetitive glucose administration was required. On day 4 of admission, he developed severe refractory hypoglycemia with a progressive decrease in blood pressure. Consequently, pulseless ventricular tachycardia followed by pulseless electrical activity developed. Although venoarterial extracorporeal membrane oxygenation was introduced, the patient did not respond to the treatment and died. Autopsy revealed myocardial degeneration and contraction-band necrosis, indicative of takotsubo cardiomyopathy. No coronary stenosis was observed. The liver showed moderate hepatocyte atrophy and autophagosomes, consistent with starvation and not with refeeding syndrome. We speculated that refractory hypoglycemia induced extreme catecholamine secretion, which led to severe complications of takotsubo cardiomyopathy, such as fatal arrhythmia and extremely low cardiac output. Early recognition of these critically ill patients and timely therapeutic interventions, including strict glycemic control and adequate caloric intake, may improve patient outcomes.
Language	English
Publishing date	2022-03-18
Publishing country	United States
Document type	Case Reports
ZDB-ID	2747273-5
ISSN	2168-8184
ISSN	2168-8184
DOI	10.7759/cureus.23287
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article: Conversion surgery after lenvatinib treatment for anaplastic thyroid carcinoma: a case report.

Yamazaki, Haruhiko / Masudo, Katsuhiko / Kanada, Sachie / Inayama, Yoshiaki / Hayashi, Hiroyuki / Fujii, Yu / Rino, Yasushi

Surgical case reports

2023 Volume 9, Issue 1, Page(s) 38

Abstract: Background: Anaplastic thyroid carcinoma (ATC) is the most aggressive form of thyroid carcinoma. Lenvatinib, a multikinase inhibitor, is rarely used in preoperative settings due to adverse effects including delayed wound healing and fistula formation. ... ...

Abstract	Background: Anaplastic thyroid carcinoma (ATC) is the most aggressive form of thyroid carcinoma. Lenvatinib, a multikinase inhibitor, is rarely used in preoperative settings due to adverse effects including delayed wound healing and fistula formation. Herein, we report the use of lenvatinib treatment prior to conversion surgery for the treatment of ATC. Case presentation: A 71-year-old woman was referred to our hospital with suspected thyroid cancer with recurrent laryngeal nerve invasion and cervical lymph node metastasis based on the results of ultrasonography. Computed tomography demonstrated the presence of a thyroid tumor invading the trachea and esophagus with no evidence of distant metastasis. Fine needle aspiration of the left cervical lymph node indicated the lymph node metastasis of ATC. As the tumor had widely invaded the trachea and esophagus, unresectable ATC was diagnosed and treatment with lenvatinib was initiated at a dose of 24 mg/day. On day 13 of lenvatinib treatment, the primary tumor and lymph node metastases demonstrated a partial response to therapy. As the tumor was now considered resectable, the decision was made to perform conversion surgery. Total thyroidectomy and left lateral neck node dissection were performed 7 days after the withdrawal of lenvatinib. The patient was discharged on postoperative day 5 with no complications. Histopathological examination demonstrated that the tumor contained the component of papillary thyroid carcinoma, squamoid ATC cells, and granulation tissue. In areas of granulation tissue, atypical cells with spindle-shaped or polygonal morphology, pyknotic nuclei, and scant cytoplasm were observed. Immunohistochemically, these cells were positive for cytokeratin AE1/AE3, TTF-1, and p53 and negative for thyroglobulin and PAX8. Therefore, the areas of granulation tissue observed within tumor samples were also considered ATC that were affected by lenvatinib treatment. In total, approximately 50% of resected tumor comprised ATC, and 70% of them had been changed to granulation tissue. Conclusions: The findings in the present case indicate that lenvatinib may have significant antitumor effects in preoperative settings. Lenvatinib may represent a promising candidate therapy for unresectable ATC by increasing tumor resectability.
Language	English
Publishing date	2023-03-15
Publishing country	Germany
Document type	Journal Article
ZDB-ID	2809613-7
ISSN	2198-7793
ISSN	2198-7793
DOI	10.1186/s40792-023-01619-6
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Article ; Online: Simultaneous Development of Ulcerative Colitis in the Sigmoidocolon Autotransplant Neovagina and the Residual Colorectum.

Matsune, Yusuke / Yaguchi, Katsuki / Saito, Shin / Sakakibara, Hideya / Inayama, Yoshiaki / Kimura, Hideaki / Kunisaki, Reiko

Inflammatory bowel diseases

2021 Volume 28, Issue 2, Page(s) e18–e20

MeSH term(s)	Autografts ; Colitis, Ulcerative/surgery ; Humans ; Transplantation, Autologous
Language	English
Publishing date	2021-08-26
Publishing country	England
Document type	Journal Article
ZDB-ID	1340971-2
ISSN	1536-4844 ; 1078-0998
ISSN (online)	1536-4844
ISSN	1078-0998
DOI	10.1093/ibd/izab222
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Article ; Online: Progression of ulcerative colitis following diversion colitis.

Yaguchi, Katsuki / Matsune, Yusuke / Kunisaki, Reiko / Araki, Kentaro / Kimura, Hideaki / Inayama, Yoshiaki / Kumagai, Jiro / Maeda, Shin

Clinical journal of gastroenterology

2022 Volume 15, Issue 6, Page(s) 1088–1093

Abstract: Diversion colitis and ulcerative colitis (UC) can be caused by different mechanisms; however, several case reports have described the development of typical UC following diversion colitis. A 63-year-old man underwent Hartmann's operation following a ... ...

Abstract	Diversion colitis and ulcerative colitis (UC) can be caused by different mechanisms; however, several case reports have described the development of typical UC following diversion colitis. A 63-year-old man underwent Hartmann's operation following a diagnosis of perforation of a sigmoid colon diverticulum and peritonitis. Stoma closure was performed 4 months later, and the portion of the sigmoid colon with the diverticulum was unintentionally left as a blind end. Following stoma closure, hematochezia worsened, and he was diagnosed as having developed diversion colitis only in the blind sigmoid colon. Intermittent use of topical mesalazine enemas controlled the bowel symptoms; however, 4 years after the stoma closure, bloody stools were observed again. Colonoscopy revealed coarse and friable granular mucosa with adherent mucopurulent exudate in the rectum, and mucosal erythematous edema with adherent mucopurulent exudate in the blind sigmoid colon. The histological findings indicated basal plasmacytosis, and goblet cell depletion and cryptitis in the lamina propria, which is characteristic of UC. To the best of our knowledge, this is the fourth description of a patient who developed UC following diversion colitis. Local inflammation may have triggered the development of UC through hematogenous or lymphogenous circulation of lymphocytes or autoantibodies.
MeSH term(s)	Male ; Humans ; Middle Aged ; Colitis, Ulcerative/pathology ; Colitis/pathology ; Diverticulum, Colon/complications ; Colonoscopy/adverse effects ; Mesalamine/therapeutic use
Chemical Substances	Mesalamine (4Q81I59GXC)
Language	English
Publishing date	2022-09-06
Publishing country	Japan
Document type	Case Reports ; Journal Article
ZDB-ID	2429411-1
ISSN	1865-7265 ; 1865-7257
ISSN (online)	1865-7265
ISSN	1865-7257
DOI	10.1007/s12328-022-01696-4
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Article ; Online: Inflammatory bowel disease-specific findings are common morphological changes in the ileal pouch with ulcerative colitis.

Toritani, Kenichiro / Kimura, Hideaki / Otani, Masako / Fukuoka, Hironori / Kunisaki, Reiko / Watanabe, Jun / Ishibe, Atsushi / Misumi, Toshihiro / Inayama, Yoshiaki / Endo, Itaru

Scientific reports

2022 Volume 12, Issue 1, Page(s) 20361

Abstract: Why inflammation is common in ileal pouches with ulcerative colitis (UC) is unclear. We therefore clarified the morphological changes in pouches and afferent limbs (AL) of patients with UC and explored the relationship between these findings. We ... ...

Abstract	Why inflammation is common in ileal pouches with ulcerative colitis (UC) is unclear. We therefore clarified the morphological changes in pouches and afferent limbs (AL) of patients with UC and explored the relationship between these findings. We evaluated the morphological findings (histological and endoscopic inflammation as the Pouchitis Disease Activity Index [PDAI] histology subscore [hPDAI] and endoscopy subscore [ePDAI], inflammatory bowel disease [IBD]-specific findings using the IBD score [S
MeSH term(s)	Humans ; Colonic Pouches ; Colitis, Ulcerative ; Inflammatory Bowel Diseases ; Inflammation ; Chronic Disease ; Metaplasia
Language	English
Publishing date	2022-11-27
Publishing country	England
Document type	Journal Article
ZDB-ID	2615211-3
ISSN	2045-2322 ; 2045-2322
ISSN (online)	2045-2322
ISSN	2045-2322
DOI	10.1038/s41598-022-24708-2
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Article: Granulocyte Colony-Stimulating Factor-Producing Bladder Cancer.

Morinaga, Ryota / Kawahara, Takashi / Kuroda, Shinnosuke / Inayama, Yoshiaki / Uemura, Hiroji

Case reports in oncology

2019 Volume 12, Issue 2, Page(s) 603–607

Abstract: Granulocyte colony-stimulating factor (G-CSF)-producing bladder cancer is rare, with only 75 cases reported in Japan. A 67-year-old woman was referred to our institution for the further examination of gross hematuria. Cystoscopy revealed a 7-cm bladder ... ...

Abstract	Granulocyte colony-stimulating factor (G-CSF)-producing bladder cancer is rare, with only 75 cases reported in Japan. A 67-year-old woman was referred to our institution for the further examination of gross hematuria. Cystoscopy revealed a 7-cm bladder tumor. The initial white blood cell count was 17,100/μL, and a transurethral resected specimen showed G-CSF expression. CT revealed that the tumor had invaded the colon. As the patient had uncontrollable schizophrenia, radical cystectomy was abandoned. We herein report a case of G-CSF-producing bladder tumor.
Language	English
Publishing date	2019-08-06
Publishing country	Switzerland
Document type	Case Reports
ZDB-ID	2458961-5
ISSN	1662-6575
ISSN	1662-6575
DOI	10.1159/000502174
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Article ; Online: Intraductal Carcinoma of the Parotid Gland Presenting as Parapharyngeal Mass.

Oki, Yamato / Hatakeyama, Hiromitsu / Otani, Masako / Ikemiyagi, Hidetaka / Komatsu, Masanori / Inayama, Yoshiaki / Oridate, Nobuhiko

Biomedicine hub

2020 Volume 5, Issue 3, Page(s) 958–964

Abstract: Intraductal carcinomas are rare, malignant tumors that arise from the salivary glands. They commonly grow from the parotid gland and no cases growing from the parapharyngeal space have been reported to date. We report a 76-year-old man who was ... ...

Abstract	Intraductal carcinomas are rare, malignant tumors that arise from the salivary glands. They commonly grow from the parotid gland and no cases growing from the parapharyngeal space have been reported to date. We report a 76-year-old man who was inadvertently found to have a parapharyngeal lesion by CT scans and MR imaging. The tumor was resected through an upper neck approach and diagnosed histopathologically as intraductal carcinoma. As far as we are aware, this is the first case of intraductal carcinoma arising from the parapharyngeal space. Here, we describe the management of this disease together with a review of the relevant literature.
Language	English
Publishing date	2020-12-09
Publishing country	Switzerland
Document type	Case Reports
ISSN	2296-6870
ISSN (online)	2296-6870
DOI	10.1159/000511677
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Article ; Online: A novel risk-scoring system for predicting lymph node metastasis of rectal neuroendocrine tumors.

Chida, Keigo / Watanabe, Jun / Hirasawa, Kingo / Inayama, Yoshiaki / Misumi, Toshihiro / Kunisaki, Chikara / Endo, Itaru

Annals of gastroenterological surgery

2020 Volume 4, Issue 5, Page(s) 562–570

Abstract: Aim: Although rectal neuroendocrine tumors (NETs) are considered to be rare low-grade malignancies when lymph node metastasis (LNM) is present, their degree of malignancy is comparable to that of colorectal cancer (CRC). However, it remains unclear as ... ...

Abstract	Aim: Although rectal neuroendocrine tumors (NETs) are considered to be rare low-grade malignancies when lymph node metastasis (LNM) is present, their degree of malignancy is comparable to that of colorectal cancer (CRC). However, it remains unclear as to which patients require radical lymph node dissection. The aim of this study was to elucidate the risk factors for LNM and develop a risk-scoring system for LNM to help determine appropriate therapeutic approaches. Methods: In this study, we examined 103 patients with rectal NETs who underwent local resection (n = 55) or radical resection with LN dissection (n = 48). We evaluated each pathological feature, including the depth of submucosal invasion (SM depth) and tumor budding grade. Results: According to our univariate analyses and previous reports, the significant five risk factors for LNM were weighted with point values: 2 points for tumor size ≥ 15 mm and muscularis invasion, and 1 point each for SM depth ≥ 2000 µm, positive lymphovascular invasion, budding grade 3, and vertical margin. The area under the receiver operating curve for the scoring system was 0.899 (95% CI: 0.843-0.955). When a score of 2 was used as the cut-off value, the sensitivity and specificity for the prediction of LNM were 100% and 72.1%, respectively. Conclusions: The risk-scoring system for LNM of rectal NETs showed high diagnostic performance. Using this risk-scoring system, it is possible to predict the risk of LNM and thereby potentially avoid unnecessary surgery. Further prospective external validation studies should be performed. The study was registered in the Japanese Clinical Trials Registry as UMIN000036658.
Language	English
Publishing date	2020-06-10
Publishing country	Japan
Document type	Journal Article
ISSN	2475-0328
ISSN (online)	2475-0328
DOI	10.1002/ags3.12355
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Article ; Online: Predictors of severe submucosal fibrosis during endoscopic submucosal dissection in patients with ulcerative colitis: Retrospective cohort study.

Nishio, Masafumi / Hirasawa, Kingo / Saigusa, Yusuke / Atsusaka, Reo / Azuma, Daisuke / Ozeki, Yuichiro / Sawada, Atsushi / Ikeda, Ryosuke / Fukuchi, Takehide / Kobayashi, Ryosuke / Sato, Chiko / Ogashiwa, Tsuyoshi / Inayama, Yoshiaki / Kunisaki, Reiko / Maeda, Shin

Digestive endoscopy : official journal of the Japan Gastroenterological Endoscopy Society

2023 Volume 36, Issue 2, Page(s) 172–181

Abstract: Objectives: Severe submucosal fibrosis is a crucial technical difficulty encountered during endoscopic submucosal dissection (ESD) in patients with ulcerative colitis (UC). We aimed to identify predictors of severe submucosal fibrosis in patients with ... ...

Abstract	Objectives: Severe submucosal fibrosis is a crucial technical difficulty encountered during endoscopic submucosal dissection (ESD) in patients with ulcerative colitis (UC). We aimed to identify predictors of severe submucosal fibrosis in patients with UC. Methods: We retrospectively included 55 tumors resected using ESD from 48 consecutive patients with UC. We analyzed the clinicopathological characteristics and treatment outcomes between the F0/1 (none to mild submucosal fibrosis) group (n = 28) and F2 (severe submucosal fibrosis) group (n = 27). Results: No significant difference was found between the F0/1 and F2 groups in en bloc resection rate (100% vs. 96%, P = 0.49), the R0 resection rate (100% vs. 93%, P = 0.24), and the dissection speed (0.18 vs. 0.13 cm Conclusion: Long UC duration and scarring background mucosa were predictors of severe submucosal fibrosis associated with perforation during ESD.
MeSH term(s)	Humans ; Endoscopic Mucosal Resection/adverse effects ; Colitis, Ulcerative/surgery ; Colitis, Ulcerative/pathology ; Retrospective Studies ; Cicatrix/pathology ; Oral Submucous Fibrosis ; Risk Factors ; Fibrosis ; Colorectal Neoplasms/surgery ; Treatment Outcome
Language	English
Publishing date	2023-05-17
Publishing country	Australia
Document type	Journal Article
ZDB-ID	1171589-3
ISSN	1443-1661 ; 0915-5635
ISSN (online)	1443-1661
ISSN	0915-5635
DOI	10.1111/den.14570
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Article: Liver Injury and Use of Contrast-Enhanced Ultrasound for Evaluating Intrahepatic Recurrence in a Case of TACE-Refractory Hepatocellular Carcinoma Receiving Atezolizumab-Bevacizumab Combination Therapy: A Case Report.

Komiyama, Satoshi / Numata, Kazushi / Ogushi, Katsuaki / Chuma, Makoto / Tanaka, Reiko / Chiba, Sawako / Otani, Masako / Inayama, Yoshiaki / Nakano, Masayuki / Maeda, Shin

Diagnostics (Basel, Switzerland)

2021 Volume 11, Issue 8

Abstract: A 67-year-old male with type 2 diabetes (T2DM) was diagnosed with postoperative intrahepatic recurrence for hepatocellular carcinoma (HCC). Nine sessions of transarterial chemoembolization (TACE) proved ineffective, and the patient was diagnosed as ... ...

Abstract	A 67-year-old male with type 2 diabetes (T2DM) was diagnosed with postoperative intrahepatic recurrence for hepatocellular carcinoma (HCC). Nine sessions of transarterial chemoembolization (TACE) proved ineffective, and the patient was diagnosed as having TACE-refractory disease and received seven cycles of atezolizumab-bevacizumab combination therapy. After that, the patient developed hyperglycemia with the HbA1c elevation and the marked fasting serum C-peptide reduction and was diagnosed with developed immune-mediated diabetes (IMD) (T2DM exacerbation with insulin-dependent diabetes development). Subsequently, the hepatobiliary enzyme levels, which were high before the systemic therapy, worsened. Thus, we clinically diagnosed an exacerbation of liver injury due to TACE-induced liver injury complicated by drug-induced liver injury such as immune-mediated hepatotoxicity (IMH). Meanwhile, after contrast-enhanced computed tomography revealed complete response, contrast-enhanced ultrasound was performed to assess intrahepatic recurrence. We found that the latter modality allowed earlier and more definitive diagnosis of intrahepatic recurrence of HCC. Subsequently, despite systemic therapy discontinuation and steroids administration, the liver injury worsened, and the patient died. The autopsy revealed intrahepatic recurrence of HCC and extensive arterial obstruction by the beads used for TACE within the liver, which indicated that disturbed circulation was the primary cause of the liver injury and histopathologically confirmed IMD, but not IMH.
Language	English
Publishing date	2021-08-01
Publishing country	Switzerland
Document type	Case Reports
ZDB-ID	2662336-5
ISSN	2075-4418
ISSN	2075-4418
DOI	10.3390/diagnostics11081394
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