Women With Acute Aortic Dissection Have Higher Prehospital Mortality Than Men.

Background: Acute aortic dissection (AAD) often leads to out-of-hospital cardiac arrest (OHCA) and death before hospital arrival. Objectives: The purpose of this study was to investigate differences in AAD incidence by sex. Methods: A population-based study in a city with 121,180 residents was conducted using postmortem computed tomography data to identify patients with AAD who died before hospital arrival in 2008-2020. The incidence rate ratio and odds ratio were estimated using Poisson regression and univariable logistic regression, respectively. Results: A total of 266 patients with incident AAD were enrolled: 84 patients with OHCA, 137 women [n = 137], and 164 patients with type A AAD. The crude and age-adjusted incidence of AAD was 16.2 and 14.3/100,000 person-years, respectively. The incidence of AAD was comparable by sex (men, 16.7/100,000 person-years; women, 15.7/100,000 person-years; incidence rate ratio: 0.94; 95% CI: 0.74-1.20; P = 0.64). Compared with men with AAD, women with AAD were older (77 ± 11 years vs 70 ± 14 years; P < 0.001), and a higher proportion had type A AAD (76% vs 47%; P < 0.001). Women with AAD had higher prehospital mortality than men with AAD (37% vs 21%; P = 0.004; OR: 2.24; 95% CI: 1.30-3.87; P = 0.004). Among 1,373 patients with OHCA, the proportion of women with AAD was significantly higher than the proportion of men with AAD (11% vs 3.9%; P < 0.001; OR: 2.90; 95% CI: 1.86-4.53; P < 0.001). AAD was most common in women aged 60 to 69 years (16.4%). Conclusions: Women had a higher incidence of AAD presenting as prehospital death than men.

Prediction of intracerebral hemorrhage in patients with out-of-hospital cardiac arrest using post-resuscitation electrocardiogram: An observational cohort study.

Aim: We evaluated the characteristics of patients with intracerebral hemorrhage in nontraumatic out-of-hospital cardiac arrests (OHCA) after return of spontaneous circulation (ROSC) to identify patients who required brain computed tomography as the next diagnostic workup. Methods: We conducted a retrospective cohort study on 1303 consecutive patients with nontraumatic OHCA who were admitted to Miyazaki Prefectural Nobeoka Hospital between 2008 and 2020. Among these, 454 patients achieved sustained ROSC. We excluded 126 patients with obvious extracardiac causes. Clinical and demographic characteristics of patients and post-resuscitation 12-lead electrocardiogram were compared. Patients were categorized into the intracerebral hemorrhage (n = 32, 10%) and no intracerebral hemorrhage group (n = 296). All causes of intracerebral hemorrhage were diagnosed based on brain computed tomography images by board-certified radiologists. Results: We included 328 patients (mean age, 74 years; women, 36%) who achieved ROSC. Logistic regression analyses showed that female sex, younger age (<75 years), no shockable rhythm changes, tachycardia (≥100 bpm), lateral ST-segment elevation, and inferior ST-segment depression on post-resuscitation electrocardiogram were independently associated with intracerebral hemorrhage. We developed a new predictive model for intracerebral hemorrhage by considering 1 point for each of the six factors. The odds ratio for intracerebral hemorrhage increased 2.36 for each 1-point increase (P < 0.001). A score ≥ 4 had 43.7% sensitivity, 90.8% specificity, 34.1% positive predictive value, and 93.7% negative predictive value. Conclusion: Our new predictive model might be useful for risk stratification of intracerebral hemorrhage in patients with OHCA who achieved ROSC.

Corticosteroids May Have Negative Effects on the Management of Patients with Severe Fever with Thrombocytopenia Syndrome: A Case-Control Study.

Severe fever with thrombocytopenia syndrome (SFTS) is an emerging viral hemorrhagic fever in China, Korea, and Japan. To date, no standardized treatment protocol for SFTS has been established. Corticosteroids (CS) may be administered to patients with SFTS and hemophagocytic syndrome, but its effectiveness and safety are still debatable. We conducted a retrospective case series review at four medical facilities in Miyazaki, Japan. Based on the medical records, clinical data, including the patients background, symptoms, physical findings, laboratory data at initial presentation, treatment, and outcome, were compared between the CS-treated and the non-CS-treated group. A total of 47 patients with confirmed SFTS in each hospital were enrolled in this study; there were 14 fatal cases and 33 nonfatal cases. The case fatality ratio was 29.8%. After adjusting patients' background by propensity score matching, the case fatality ratio was higher (p = 0.04) and complications of secondary infections, including invasive pulmonary aspergillosis, tended to be more frequent (p = 0.07) in the CS-treated group than in the non-CS-treated group. These data suggested that administration of CS to patients with SFTS should be carefully considered.

Impact of C-Reactive Protein Levels on Differentiating of Severe Fever With Thrombocytopenia Syndrome From Japanese Spotted Fever.

BACKGROUND: Severe fever with thrombocytopenia syndrome (SFTS) is an emerging viral hemorrhagic fever in China, Korea, and Japan. Japanese spotted fever (JSF), which belongs to spotted fever group rickettsioses, is also endemic to Western Japan. Patients with SFTS and those with JSF display many of the same clinical manifestations. Sudden fever, rash, tick bite, and neurological and gastrointestinal symptoms may be seen in both infections, but the frequency and severity of each disease have not been compared and studied. Because laboratory confirmation of pathogens takes time, it is important to predict diagnosis of SFTS vs JSF based on the features of the clinical characteristics at the initial presentation, particularly in primary care settings. METHODS: We conducted a case series review at 4 medical facilities in Miyazaki, Japan. Based on the medical records, clinical and laboratory characteristics were compared between patients with SFTS and those with JSF. RESULTS: Eighty-one patients were enrolled in this study, including 41 with SFTS and 40 with JSF. The absence of rash (P < .001), leukopenia (P < .001), and normal C-reactive protein (CRP) levels (P < .001) were the variables distinguishing SFTS from JSF. Normal CRP levels (≤1.0 mg/dL) had a 95% sensitivity (84%-99%) and 97% specificity (87%-100%) for SFTS, with a positive likelihood ratio of 37.1 (5.35-257). CONCLUSIONS: Normal serum CRP levels were shown to differentiate SFTS from JSF with a very high probability.

Unusual cystic hamartomatous lung lesion with clinical manifestation of subpleural bullae in a woman of reproductive age: A case report.

Pulmonary hamartoma is a common benign lung disorder, and most cases show solid nodules. Here, we documented the clinicopathological features of a growing, bulla-like, multilocular hamartomatous lung lesion in a woman of reproductive age. To the best of our knowledge, this disorder has not been reported in the literature to date. An asymptomatic 29-year-old Japanese woman with no significant past medical history was referred to our institution for surgical treatment of a bullous lesion in the right upper lobe because the pulmonary lesion had enlarged to multilocular cysts, including a giant bulla, within 1 year, leading to compression of the right lung. The bullous lesion, which was projected from the apex of the lung via a narrow stalk, showed nonemphysematous, multiloculated tissue. The wall mimicked a bronchiolar structure with ciliated, nonatypical epithelium and layers of nonatypical spindle cells that were positive for smooth muscle markers and sex steroid hormone receptors. No cartilage was included in the lesion. We believe that this may be a novel form of hamartoma. This disorder may be included in a differential diagnosis of subpleural bullous diseases in women of reproductive age.

[Ten-year questionnaire survey on adult asthma patients in Miyazaki Prefecture, Japan].

OBJECTIVES: To decrease the number of asthma deaths occurring in Miyazaki Prefecture in Japan by promoting guideline-based treatment through the bronchial asthma forum. METHODS: A self-completed questionnaire survey of adult asthma patients was conducted in Miyazaki Prefecture during the same season for 10 consecutive years from 1999 to 2008. RESULTS: A total of 7899 responses were collected from medical institutions throughout the prefecture. In the course of 10 years, the doses of the drugs used for long-term management, including inhaled steroids, long-acting inhaled ß2-stimulants, and leukotriene receptor antagonists, increased year after year. Consequently, the frequency of asthma symptoms declined and there was a decrease in the use of short-acting inhaled ß2-stimulants, parenteral aminophylline, and slow-release theophylline preparations in response to this trend. Prescription rate of inhaled steroids and patients satisfaction was higher in the facilities of specialists than non-specialists. In patients with rhinitis symptoms, asthma was improved by concurrently treating both rhinitis and asthma in the survey of 2008. CONCLUSIONS: Asthma treatment based on the guideline was increasing in Miyazaki Prefecture, and this may have resulted in the improvement of asthma symptoms, increased patient satisfaction, and more importantly, a decrease in the number of asthma deaths.

Haunting appearance of bcr/abl fusion gene products in a patient with therapy related leukaemia.

A 81-year-old man was diagnosed as multiple myeloma and had received melphalan for 6 years. After that, he developed acute myeloid leukemia (AML) with monosomy 7 and minor bcr/abl transcripts. Fluorescence in situ hybridization identified no detectable level of bcr/abl rearrangement. During chemotherapy for AML, minor bcr/abl transcripts disappeared and instead major bcr/abl transcripts emerged. He died of pneumonia 3 months later. At that time, neither minor nor major bcr/abl transcripts were seen. These observations suggest that certain therapy related leukemia may be susceptible to generate very small clones with bcr/abl rearrangements.

Multicentric Castleman's disease manifesting in the lung: clinical, radiographic, and pathologic findings and successful treatment with corticosteroid and cyclophosphamide.

Multicentric Castleman's disease (MCD) is an uncommon and often incurable lymphoproliferative disorder. There has been some recent evidence that rare cases of MCD manifest diffuse lung involvement, but the features in these cases are not well characterized. We report just such a biopsy-proven case of MCD with typical laboratory abnormalities including serum interleukin-6 elevation and characteristic high-resolution CT findings. Immunopathologically, the features of the lung tissue resembled those of lymphocytic interstitial pneumonia with predominant infiltration of B cells and plasma cells. In addition, the abnormal appearance of B cells in bronchoalveolar lavage fluid was of diagnostic value. Although MCD is often refractory to treatment including corticosteroid, chemo- and immuno-therapy, we show successful treatment with corticosteroid and cyclophosphamide and 4 years of complete remission.

[Successful treatment of Crow-Fukase syndrome with radiation therapy].

A 73-year-old woman was referred to our hospital because of gait disturbance. She had peripheral polyneuropathy which was mainly of the demyelinating type, splenomegaly, a skin change and M protein (IgA-lambda). A bone scinti and a CT scan showed a mass lesion in the thoracic vertebra, and a biopsy revealed plasmacytoma. She was diagnosed as Crow-Fukase syndrome, and treated with local radiation therapy. After the treatment, M protein became undetectable, and gait disturbance was improved.