The Rehabilitation for Visual Cognitive Impairment due to Hippocampal Infarction: A Case Report.

Introduction: Disturbances in the visual pathway cause visual cognitive impairment. There is a lack of information regarding the effect of rehabilitation on individuals affected by this condition. Therefore, it is crucial to understand the effectiveness of rehabilitation interventions in this condition. Case Presentation: We present the case of an 87-year-old woman with hippocampal infarction. While the patient's ability to perform daily activities and engage in conversations was normal, she faced challenges at the execution stage, such as naming, constructing sentences, and copying. We diagnosed cerebral embolism because of atrial fibrillation and initiated direct oral anticoagulant therapy. Subsequently, we initiated a rehabilitation treatment comprising visual agnosia training (attribute learning training), verbalization learning training (writing training), and semantic memory training (copying training) to address visual agnosia. Conclusion: Associative visual perception challenges arising from hippocampal infarcts are rare and can be improved with early intervention through a rehabilitation program for visual agnosia.

Prediction of intraoperative surgical difficulty during laparoscopic cholecystectomy using drip infusion cholangiography with computed tomography.

BACKGROUND: Although findings from drip infusion cholangiography with computed tomography (DIC-CT) are useful in preoperative anatomic evaluation for laparoscopic cholecystectomy (LC), their relationship with intraoperative surgical difficulty based on the difficulty score (DS) proposed by Tokyo Guidelines 2018 is unclear. We examined this relationship. METHODS: Data were collected from 202 patients who underwent LC for benign gallbladder (GB) disease with preoperative DIC-CT in our department. DIC-CT findings were classified into GB-positive and GB-negative groups based on GB opacification, and clinical characteristics were compared. DS assessed only on findings from around Calot's triangle was considered "cDS", and patients were divided into cDS ≤2 and ≥3 groups. Preoperative data including DIC-CT findings were evaluated using multivariate analysis. RESULTS: DIC-CT findings showed 151 (74.8%) GB-positive and 51 (25.2%) GB-negative patients. Surgical outcomes were significantly better in the GB-positive versus GB-negative group for operation time (107 vs. 154 min, p < .001), blood loss (8 vs. 25 mL, p < .001), cDS (0.8 vs. 2.2, p < .001), and critical view of safety score (4.0 vs. 3.1, p < .001). cDS was ≤2 in 174 (86.1%) and ≥3 in 28 (13.9%) patients. By multivariate analysis, DIC-CT findings and alkaline phosphatase values were independent factors predicting intraoperative difficulty. CONCLUSION: DIC-CT findings are useful for predicting cDS in LC.

Combined rehabilitation therapy with botulinum toxin to the upper limbs for acute spinal cord injury: A case report.

INTRODUCTION: Patients with spinal cord injury (SCI) and incomplete paralysis may experience muscle immobilization due to functional impairment of agonist and antagonist muscles. This can induce spasticity and pain, with the risk of contracture increasing as the period of immobilization increases. This could be aggravated by pain, which interferes with rehabilitation. There is no established treatment for pain and joint contractures caused by acute SCI. Botulinum therapy plays a role in relieving muscle tension. Here, we report a case of acute SCI in which botulinum therapy was administered. CASE PRESENTATION: The patient experienced a C5-cervical SCI due to a road traffic accident, with marked paralysis in the upper and lower limbs below the C5 level. The patient had persistent elbow flexion since the SCI and complained of excruciating pain, making adequate rehabilitation difficult. Botulinum toxin was administered to the biceps and brachialis muscles 15 days after the SCI. After administration, the patient experienced a reduction in pain with relaxation of the elbow flexor muscles, and rehabilitation treatment was resumed. This patient's contracture did not worsen, his pain decreased, and he was able to initiate self-feeding training. DISCUSSION: In this case, occupational and physical therapy was administered with botulinum therapy. Together, they successfully reduced pain. Botulinum therapy provides analgesia and muscle relaxation and may lead to functional recovery, and we believe that treatment can be considered even in the acute phase.

Efficacy of pancreaticojejunostomy of the pancreatic stump during distal or central pancreatectomy.

BACKGROUND: A stapler is usually used for transection and closure of the pancreas in distal pancreatectomy (DP) or central pancreatectomy (CP). When the pancreas is transected to the right of the portal vein, it is difficult to use a stapler and clinically relevant postoperative pancreatic fistula (CR-POPF) frequently occurs. We report on the efficacy of pancreaticojejunostomy (PJ) of the pancreatic stump for patients in whom stapler use is difficult. METHODS: Patients who underwent DP or CP were enrolled in this study. The pancreas was usually transected by a stapler, and ultrasonic coagulating shears (UCS) were used depending on the tumor situation. When using UCS, hand-sewn closure or PJ was performed for the pancreatic stump. The relationship between clinicopathological factors and the methods of pancreatic transection and closure were investigated. RESULTS: In total, 164 patients underwent DP or CP, and the pancreas was transected with a stapler in 150 patients and UCS in 14 patients. The rate of CR-POPF was higher and the postoperative hospital stay was longer in the UCS group than in the stapler group. PJ of the pancreatic stump, which was performed for 7 patients, did not worsen intraoperative factors. CR-POPF was not seen in these 7 patients, which was significantly less than that with hand-sewn closure. CONCLUSIONS: PJ of the pancreatic stump during DP or CP reduces CR-POPF compared with hand-sewn closure and may be useful especially when the pancreas is transected to the right of the portal vein.

Low serum concentrations of bevacizumab and nivolumab owing to excessive urinary loss in patients with proteinuria: a case series.

PURPOSE: Proteinuria can cause interindividual variability in the pharmacokinetics of therapeutic antibodies and may affect therapeutic efficacy. Here, we measured the serum and urinary concentrations of bevacizumab (BV) and nivolumab (NIVO) in patients with proteinuria and reported a case series of these patients. METHODS: Thirty-two cancer patients who received BV every 3 weeks or NIVO every 2 weeks between November 2020 and September 2021 at Kyoto University Hospital were enrolled in this study. The serum and urinary concentrations of BV and NIVO were measured using liquid chromatography-tandem mass spectrometry. RESULTS: We divided the BV-treated patients and the NIVO-treated patients into two groups based on the urine protein-creatinine ratio (UPCR): UPCR 1 g/g or higher (BV, n = 9; NIVO, n = 3) and UPCR less than 1 g/g (BV, n = 14; NIVO, n = 6). Serum concentrations of the therapeutic antibodies adjusted by their doses were significantly lower in both BV- and NIVO-treated patients with UPCR 1 g/g or higher compared to those with less than 1 g/g. In patients with UPCR 1 g/g or higher, urinary concentrations of the therapeutic antibodies adjusted by their serum concentrations and urinary creatinine concentrations tended to increase. CONCLUSION: This case-series study suggests a possibility of reduction in serum concentrations of BV and NIVO in patients with proteinuria by urinary excretion of these drugs.

Image Findings as Predictors of Fall Risk in Patients with Cerebrovascular Disease.

This study examined computed tomography findings in patients with cerebrovascular disease and determined predictors for falls. Images of the head were divided into 13 regions, and the relationships between computed tomography findings and the presence or absence of falls were investigated. A total of 138 patients with cerebrovascular disease (66% men, aged 73.8 ± 9.6 years) were included. A comparison between the fall and non-fall groups revealed a significant difference in the total functional independence measure scores and imaging findings at admission. Logistic regression analysis showed that the thalamus (p < 0.001), periventricular lucency (p < 0.001), lateral hemisphere room enlargement (p < 0.05), and age (p < 0.05) were related to the presence or absence of falls. For the 42 patients with cerebral hemorrhage, the thalamus (p < 0.01), periventricular lucency (p < 0.05), lateral ventricle vicinity (p < 0.05), and posterior limb of the internal capsule (p < 0.05) were extracted as factors related to the presence or absence of falls. For the 96 patients with cerebral infarction, the thalamus (p < 0.001), periventricular lucency (p < 0.01), and anterior limb of the internal capsule (p < 0.05) were extracted as factors related to the presence or absence of falls. This study found a relationship between the thalamus, lateral ventricle enlargement, periventricular lucency, and falls. Fall prognosis can potentially be predicted from computed tomography findings at admission.