Tokyo Metropolitan Tama Medical Center Research Articles

Incidence of Complications of Peripherally Inserted Central Catheter Placement by a Nurse Pertaining to Specified Medical Acts at a Japanese Tertiary Care Center.

Department of Infection Control, Tokyo Metropolitan Tama Medical Center, Fuchu, Tokyo, Japan Department of Infectious Diseases, Fujita Health University School of Medicine Toyoake, Japan. [email protected][email protected] The authors disclose no conflict of interest.

Utility of periodic medical questionnaires and examinations for immune-related adverse event screening: A prospective observational study.

Immune checkpoint inhibitors (ICIs) are associated with immune-related adverse events (irAEs) specific to the immunity-boosting activity of the drugs and may necessitate discontinuation of treatment depending on their severity. IrAEs may be difficult to diagnose in their early stages as they can occur in any organ. The present, prospective, observational study is the first to attempt to assess the utility of periodic medical questionnaires and laboratory, radiological, and physiological examinations in diagnosing irAEs. We analyzed 51 patients who received immunotherapy for metastatic renal or urothelial carcinoma at Tokyo Metropolitan Tama Medical Center between 2016 and 2020. A medical questionnaire consisting of 41 questions and laboratory tests were administered to the patients on the day of each ICI administration and 1 week afterwards. A significant complaint was defined as a complaint not addressed in the questionnaire immediately prior to the first ICI administration. Fifty-one patients with metastatic renal or urothelial carcinoma were enrolled. The mean age was 72.1 years (range: 54-88 years). The male: female ratio was 32: 19. Of the total cohort, 26 (51%) patients had renal carcinoma, and 25 (49%) had urothelial carcinoma. The median follow-up time was 2.6 (range: 0.4-40.7) months. Thirty-three patients (65%) experienced irAEs. In our cohort, periodic medical questionnaires and examinations were effective for early diagnosis and prompt treatment of irAEs. Although periodic examinations led to a high irAE diagnosis rate, the attendant medical cost was high. Further study is needed to find ways of addressing this issue.

Infantile primary sternal osteomyelitis due to group B Streptococcus.

Pediatrics InternationalVolume 64, Issue 1 e15030 Clinical Notes Infantile primary sternal osteomyelitis due to group B Streptococcus Koichiro Okumura, Corresponding Author Koichiro Okumura kookumuira-tki@umin.ac.jp orcid.org/0000-0002-3022-3796 Department of General Internal Medicine, Tokyo Metropolitan Tama Medical Center, Fuchu, Japan Correspondence: Koichiro Okumura, MD, Department of General Internal Medicine, Tokyo Metropolitan Tama Medical Center, 2-8-29 Musashidai, Fuchu, Tokyo 183-8524, Japan. Email: kookumuira-tki@umin.ac.jpSearch for more papers by this authorShun Sakatani, Shun Sakatani orcid.org/0000-0002-7510-6913 Department of General Pediatrics, Tokyo Metropolitan Children’s Medical Center, Fuchu, JapanSearch for more papers by this authorHanako Funakoshi, Hanako Funakoshi orcid.org/0000-0002-7680-4510 Division of Infectious Diseases, Department of Pediatrics, Tokyo Metropolitan Children’s Medical Center, Fuchu, JapanSearch for more papers by this authorKazuhiro Uda, Kazuhiro Uda orcid.org/0000-0002-2262-6130 Division of Infectious Diseases, Department of Pediatrics, Tokyo Metropolitan Children’s Medical Center, Fuchu, Japan Department of Pediatrics, Okayama University Hospital, Okayama, JapanSearch for more papers by this authorHiroshi Hataya, Hiroshi Hataya orcid.org/0000-0003-0241-6467 Department of General Pediatrics, Tokyo Metropolitan Children’s Medical Center, Fuchu, JapanSearch for more papers by this author Koichiro Okumura, Corresponding Author Koichiro Okumura kookumuira-tki@umin.ac.jp orcid.org/0000-0002-3022-3796 Department of General Internal Medicine, Tokyo Metropolitan Tama Medical Center, Fuchu, Japan Correspondence: Koichiro Okumura, MD, Department of General Internal Medicine, Tokyo Metropolitan Tama Medical Center, 2-8-29 Musashidai, Fuchu, Tokyo 183-8524, Japan. Email: kookumuira-tki@umin.ac.jpSearch for more papers by this authorShun Sakatani, Shun Sakatani orcid.org/0000-0002-7510-6913 Department of General Pediatrics, Tokyo Metropolitan Children’s Medical Center, Fuchu, JapanSearch for more papers by this authorHanako Funakoshi, Hanako Funakoshi orcid.org/0000-0002-7680-4510 Division of Infectious Diseases, Department of Pediatrics, Tokyo Metropolitan Children’s Medical Center, Fuchu, JapanSearch for more papers by this authorKazuhiro Uda, Kazuhiro Uda orcid.org/0000-0002-2262-6130 Division of Infectious Diseases, Department of Pediatrics, Tokyo Metropolitan Children’s Medical Center, Fuchu, Japan Department of Pediatrics, Okayama University Hospital, Okayama, JapanSearch for more papers by this authorHiroshi Hataya, Hiroshi Hataya orcid.org/0000-0003-0241-6467 Department of General Pediatrics, Tokyo Metropolitan Children’s Medical Center, Fuchu, JapanSearch for more papers by this author First published: 08 April 2022 https://doi.org/10.1111/ped.15030Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article. Volume64, Issue1January/December 2022e15030 RelatedInformation

Patients' need for information on permanent contraception during a cesarean section: A cross-sectional questionnaire survey.

The present study aimed to explore the need for information about permanent contraception in Japanese women with repeated cesarean sections (CS). The present, cross-sectional survey used a self-administered questionnaire mailed to women with a second or later CS at Tokyo Metropolitan Tama Medical Center between March 2010 and December 2017. Those who were pregnant, had given birth less than 1 year before the survey or had an hysterectomy were excluded. The present study analyzed 284 patients (60 with permanent contraception, 224 without permanent contraception). Forty-eight (80%) of women with permanent contraception, and 135 (60%) of women without permanent contraception believed that information on permanent contraception was needed before CS. Among women without permanent contraception, significantly fewer women obtained adequate information of permanent contraception from their healthcare workers before a CS compared with women with permanent contraception (8% vs. 71%, p < 0.001). A higher rate of unreliable contraceptive use (41%) and unintended pregnancies (4%) after the latest CS were found among the women without permanent contraception. A large portion of the study cohort wished they had received information on permanent contraception before CS; however, the patients without permanent contraception had limited access to this information. Adequate information about permanent contraception should be provided to women planning a CS to enable them to make an informed decision with respect to the treatment.

Serum solubleB7-H3is a prognostic marker for patients with non-muscle-invasivebladder cancer.

B7-H3 is a member of the B7 family of immune-regulatory ligands and is a costimulatory molecule promoting the T cell response in vitro. We herein investigated the clinical utility of serum soluble B7-H3 (sB7-H3) in patients with non-muscle invasive bladder cancer (NMIBC). We analyzed 555 patients in whom NMIBC was diagnosed at Tokyo Metropolitan Tama Medical Center between 2008 and 2013. We measured the serum sB7-H3 (sB7-H3) level using the enzyme-linked immunosorbent assay (ELISA) and evaluated the utility of sB7-H3 as a prognostic biomarker for NMIBC. We used the Cox proportional hazards regression model to assess recurrence-free survival (RFS) and progression-free survival (PFS) with the sB7-H3 level. We detected high levels of sB7-H3 in the sera of 47% of patients with NMIBC versus only 8% in healthy donors. The increase of sB7-H3 was significantly associated with poor RFS and PFS. Multivariate analysis showed that elevated sB7-H3 was an independent prognostic factor of RFS and PFS. According to the European Organization for Research and Treatment of Cancer (EORTC), in intermediate-low and intermediate-high risk groups, the presence of sB7-H3 significantly determined the rate of recurrence and progression. Our data suggested that evaluating serum sB7-H3 expression is a useful tool for predicting the prognosis of patients with NMIBC.

院内発生の妊婦心肺停止症例に対応するための体制整備(System development and simulation training for management of in–hospital maternal cardiac arrest)

要旨【目的】妊婦が心肺停止に至ったときに，母体救命のため 死戦期帝王切開PMCD（perimortem cesarean delivery）を行うことが考慮される。当院は院外症例の受け入れ体制は整っていたが，院内症例の体制整備はされておらず，心停止から5分以内にPMCDを実施することが可能な体制をつくることとした。【対象】産科病棟で発生したと想定し，問題点の抽出をした。実施場所に関して，手術室で行うには手術申込みや入室認証が必要であったため，少しでも時間を短縮させるため分娩室とした。実施までのフローシート，連絡経路も事前に作成した。PMCDの適応や効果に関して教育を行い，PMCD器材と，新生児蘇生器材とに分けて準備し，シミュレーションを行った。【結果】第1回目のシミュレーションは救急科医の到着を待って，分娩室に移動しPMCDを実施したが，実施までに14分かかった。2回目は，心肺停止を覚知後すぐに患者を分娩室に移動させPMCDを実施し，4分で行うことができた。除細動の適応波形の場合にはどうするべきか，などの新たな問題点が抽出された。【結語】院内発生の妊婦心肺停止症例では，心停止から医療従事者接触までの時間が短く救命できる可能性が高い反面，短時間でPMCD実施の決断や実行が求められるため，シミュレーショントレーニングは重要と考えられる。

Serum soluble B7-H4 is a prognostic marker for patients with non-metastatic clear cell renal cell carcinoma.

BackgroundB7-H4 is a member of the B7 family of immune-regulatory ligands and is considered to be a negative regulator of the immune response. We investigated the clinical significance of serum soluble B7-H4 in patients with non-metastatic clear cell renal cell carcinoma.MethodsWe analyzed 108 patients in whom non-metastatic clear cell renal cancer was diagnosed at Tokyo Metropolitan Tama Medical Center between 2008 and 2013. We measured the serum soluble B7-H4 level using the Enzyme-Linked ImmunoSorbent Assay (ELISA) and evaluated the association between the peripheral blood neutrophil count and sB7-H4 as well as the utility of soluble B7-H4 as a prognostic biomarker for clear cell renal cancer. The Cox proportional hazards regression model was used to assess the PFS and OS with the soluble B7-H4 level.ResultsWe detected high levels of soluble B7-H4 in the sera of 56% of patients with non-metastatic clear cell renal cell carcinoma versus only 10% of healthy donors. Elevated soluble B7-H4 levels were associated with changes in an elevated peripheral blood neutrophil count. The increase of soluble B7-H4 also was significantly associated with poor PFS and OS. Multivariate analysis showed that the elevation of the soluble B7-H4 level was an independent prognostic factor for PFS and OS.ConclusionsOur data suggest that the association between serum soluble B7-H4 and peripheral blood neutrophil count, as well as the evaluation of serum soluble B7-H4 expression is a useful tool for predicting the prognosis of patients with non-metastatic clear cell renal cell carcinoma.

Absence of high-risk stigmata predicts good prognosis even in severely anemic patients with suspected acute upper gastrointestinal bleeding.

The need for a blood transfusion, defined as hemoglobin < 70 g/L, is the measure for assessing the risk levels in patients with upper gastrointestinal bleeding (UGIB). However, not all patients with a low hemoglobin level have a poor prognosis. We assessed the clinical predictive factors associated with poor short-term prognosis in patients with a low hemoglobin level. In this prospective cohort study, all consecutive patients with suspected acute UGIB at Tokyo Metropolitan Tama Medical Center were enrolled between 2008 and 2015. Then, we extracted those who needed a blood transfusion (hemoglobin < 70 g/L) and explored the variables associated with all-cause mortality within 28 days after presentation. Among 1307 patients, 311 needed a blood transfusion and 13 (4.2%) died from all causes. The presence of high-risk stigmata requiring endoscopic treatment (peptic ulcers; Forrest scores Ia, Ib and IIa; varices with current bleeding or signs of recent bleeding; and spurting or gushing bleeding or visible vessel in other diseases), diagnosed by emergency endoscopy, was a unique factor affecting mortality (odds ratio: 8.47, 95% confidence interval: 1.45-160, P = 0.01). Patients without high-risk stigmata neither died from UGIB nor had rebleeding, irrespective of the hemoglobin levels. Patients without high-risk stigmata showed a good prognosis even if they needed a blood transfusion. This result could facilitate triage of patients with suspected acute UGIB who only need a blood transfusion.

Effect of dutasteride on castration-resistant prostate cancer.

It has previously been demonstrated that the intratumoral generation of the potent androgen dihydrotestosterone (DHT), contributes critically to the progression of prostate cancer and its castration-resistant form, castration-resistant prostate cancer (CRPC). Circulating testosterone is converted into DHT by 5α-reductase (SRD5A). Dutasteride is a dual inhibitor of type I and II SRD5A. The present study assessed the effectiveness of dutasteride in the treatment of CRPC. Between 2010 and 2013, CRPC was diagnosed in 41 patients at the Tokyo Metropolitan Tama Medical Center. Following diagnosis, the patients received 0.5 mg dutasteride daily. The patients' median age was 77.3 years (range, 63-90). Bone metastases were recognized in 12 patients. All the patients received dexamethasone. Twenty-four (59%) patients had previously undergone chemotherapy, while 11 (27%) received docetaxel, and 24 (59%) estramustine. The prostatic-specific antigen (PSA) level declined in 17 (41%) patients from the baseline value, following dutasteride treatment. The median value for the PSA decrease was 23% (range, 4.3-89.8%), and the median duration of the response was 4 months (range, 1-10). The PSA response rate (defined as >50% decline in PSA from the baseline value) was recognized in 7 (17%) patients. The median duration of the response was 3 months (range, 2-10). Dutasteride was efficacious against CRPC in certain patients and may be a promising option in CRPC treatment. A prospective randomized trial is necessary to verify the efficacy of dutasteride.

Surgical treatment of substernal goiter: An analysis of 44 cases.

Substernal goiters are classified as primary or secondary intrathoracic goiters. Here, we report the diagnosis, symptoms, treatment, and postoperative complications of 44 substernal goiters (2 primary mediastinal goiter and 42 secondary mediastinal goiters). A retrospective chart review of 351 patients undergoing thyroidectomy at the Department of Otolaryngology-Head and Neck Surgery of the Tokyo Metropolitan Tama Medical Center. Between 2009 and 2015, 44 patients underwent surgery for substernal goiter. The frequency of primary and secondary mediastinal goiters was 0.5% and 11.9%, respectively. The preoperative symptoms were neck mass, dyspnea, and dysphagia. Eight patients were asymptomatic. Thirty-nine patients had benign masses and 5 patients had malignant masses. Most patients were operated on for adenomatous goiters (52.2%). In ten cases beyond the aortic arch, the tumors were benign and there were eight cases of adenomatous goiter. All patients underwent a successful transcervical incision without sternotomy. Even the primary intrathoracic goiters were extracted after total thyroidectomy via the cervical approach without complications. Although one case showed unilateral recurrent nerve paralysis as a postoperative complication, phonetic function improved in 6 postoperative months. No instances of postoperative bleeding or definitive hypoparathyroidism occurred, and tracheostomy was not performed in any of the cases. The cervical approach was safely performed in almost all substernal goiters without an extracervical procedure. Selected cases of primary mediastinal goiter may be excised via the cervical approach.

A clinical review of 38 cases of cervical tuberculous lymphadenitis in Japan - The role of neck dissection.

After tuberculous pleurisy, lymphadenitis arising from cervical lesion is the second most common form of extrapulmonary tuberculosis. It is generally treated with antituberculosis agents, but some patients resist chemotherapy. In such cases, surgical resection is often considered as an alternative treatment. This study aims to evaluate the therapeutic outcome of cervical tuberculous lymphadenitis and the future course of treatment of this disease. We retrospectively reviewed the clinical charts of patients diagnosed at the Tokyo Metropolitan Tama Medical Center between 2009 and 2015 and identified 38 cases of cervical tuberculous lymphadenitis. Precisely 798 patients were registered for primary tuberculosis at our institution during the same period. Patient ages ranged from 21 to 85 years (average: 58.9 years), and the male-to-female ratio was 1:1.2. The range of tuberculosis progression was as follows: 30 (78.9%) in only the cervical lymph node, 3 in the other (axillary, mediastinal, and abdominal) lymph nodes, 1 in the lung and vertebrae lumbales, 2 in the lung, and 1 in the pleural membrane. All 38 patients were initially treated with antituberculous drugs at the Department of Pulmonary Medicine based on guidelines for tuberculosis cases in Japan. In seven cases, the antituberculous drugs were replaced due to side effects. Four cases involved a single drug-resistant strain, and one case involved a double drug-resistant strain. Thirty-three (86.8%) cases were cured by chemotherapy alone. The three patients resistant to chemotherapy were successfully treated through neck dissection. Thirty-six cases (94.7%) were cured by chemotherapy or chemotherapy and surgery. Local therapy could prove effective in cervical tuberculous lymphadenitis patients who exhibit an inadequate response to drugs. The role of neck dissection in cervical tuberculous lymphadenitis remains an important consideration.

Pyuria predicts poor prognosis in patients with non-muscle-invasive bladder cancer treated with bacillus Calmette-Guérin.

This study was conducted to evaluate the utility of pyuria as a predictive marker of bacillus Calmette-Guérin (BCG) treatment for non-muscle-invasive bladder cancer (NMIBC). A cohort of 243 NMIBC patients treated with BCG through intravesical instillation between 1994 and 2007 at the Tokyo Metropolitan Tama Medical Center were enrolled in this retrospective study. Pyuria was defined as urine containing ≥10 white blood cells per high-power field. A total of 30 of the patients with pyuria (30/37, 81%) and 87 patients of those without pyuria (87/206, 42%) exhibited recurrence following BCG treatment. The 3-year recurrence-free survival rate of patients with and without pyuria following BCG treatment was 20 and 62%, respectively. The multivariate Cox proportional hazards regression model indicated that pyuria was an independent predictor of disease recurrence following BCG treatment. Patients with inflammatory NMIBC exhibited resistance to therapy with intravesical instillation of BCG.

THU0295 Prophylactic Use of Trimethoprim-Sulfamethoxazole against Pneumocysitis Pneumonia May Reduce the Risk of Bloodstream Infection in Patients with Connective Tissue Diseases Undergoing High-Dose Corticosteroid Therapy

BackgroundProphylaxis with trimethoprim-sulfamethoxazole (TMP/SMP) is highly effective for the prevention of Pneumocysitis pneumonia (PCP) and recommended in patients with connective tissue diseases (CTD) undergoing high-dose corticosteroid therapy.[1] Prophylaxis with TMP-SMZ...

施設奨励賞 東京都立多摩総合医療センター・小児総合医療センターの電気設備

施設奨励賞 東京都立多摩総合医療センター・小児総合医療センターの電気設備

Preoperative Neutrophil-Lymphocyte Ratio as an Independent Prognostic Marker for Patients With Upper Urinary Tract Urothelial Carcinoma

BackgroundTo predict the prognosis, we evaluated the significance of the preoperative neutrophil-lymphocyte ratio (NLR) in patients with upper urinary tract urothelial carcinoma (UUTUC). Patients and MethodsA cohort of 137 patients diagnosed with UUTUC from 1994 to 2008 at Tokyo Metropolitan Tama Medical Center was enrolled in this retrospective study. Log-rank test and Cox proportional hazards regression models were used for univariate and multivariate analyses. ResultsOn univariate analysis, pathologic T stage, grade, lymphovascular invasion, C-reactive protein (CRP) level, and NLR were significantly associated with recurrence-free survival (RFS) and cancer-specific survival (CSS). The RFS rates for an NLR < 2.5 and for one ≥ 2.5 at 5 years were 74.3% and 30.4%, respectively. The CSS rates for an NLR < 2.5 and for one ≥ 2.5 at 5 years were 81.3% and 29.4%, respectively. The multivariate Cox proportional hazards regression models showed that the NLR could be an independent predictor for RFS and CSS. Based on the results of multivariate analysis, the scoring model was developed. RFS and CSS rates at 5 years were as follows: 0 risk factor, 97.1% and 97.0%, respectively; 1 risk factor, 91.1% and 90.9%, respectively; 2 risk factors, 39.5% and 58.6%, respectively; 3 risk factors, 26.6% and 28.6%, respectively; and 4 risk factors, 6.0% and 5.6%, respectively. ConclusionsThe preoperative NLR is an independent prognostic predictor. The model based on the NLR and pathologic factors can be useful in clinical practice.

Pyuria Predicts Poor Prognosis in Patients With Non–Muscle-Invasive Bladder Cancer

BackgroundTo evaluate the significance of inflammation in non–muscle-invasive bladder cancer (NMIBC), we assessed the presence of pyuria at time of diagnosis. Patients and MethodsA cohort of 805 patients with newly diagnosed NMIBC between 1994 and 2007 at the Tokyo Metropolitan Tama Medical Center were enrolled in this retrospective study. Pyuria was defined as urine containing ≥ 10 white blood cells (WBCs) per high power field (HPF). ResultsOne hundred ninety-nine (24%) of the patients with NMIBC had pyuria. The 3-year recurrence-free survival rates of patients with and without pyuria were 10.9 vs. 45.0%, respectively. The 5-year progression-free survival rates of patients with and without pyuria were 72.3% and 95.7%, respectively. Multivariate Cox proportional hazards regression models indicated that pyuria was an independent predictor of disease recurrence and progression. After dividing the sample according to the European Organization for Research and Treatment of Cancer (EORTC) risk tables, we further classified patients into subgroups according to the presence of pyuria. The recurrence-free survival rates were higher in the pyuria-negative subgroups of the low, intermediate-low, intermediate-high, and high risk for recurrence groups. Similarly, the progression-free survival rates at 5 years were higher in the pyuria-negative subgroups of the low, intermediate-low, and intermediate-high risk for progression groups. ConclusionPatients with inflammatory NMIBC exhibited poor clinical outcomes.

Response to hydroxychloroquine in Japanese patients with systemic lupus erythematosus using the cutaneous lupus erythematosus disease area and severity index (CLASI)

We evaluated the cutaneous lupus erythematosus disease area and severity index (CLASI) in Japanese patients with systemic lupus erythematosus (SLE) in order to design a clinical trial of hydroxychloroquine (HCQ) in Japan. Our prospective cohort study consisted of seven SLE patients with active skin disease who started HCQ at Tokyo Metropolitan Tama Medical Center. The therapeutic responses were assessed at 4 months. Patients were categorized as responders (improved) or non-responders (unchanged or worsened) using the criteria of a 4-point or 20% decrease in the CLASI activity score. We also assessed joint pain determined by patient visual analog scale (VAS), malaise (VAS), patient global assessment of SLE (VAS), and constitutional and musculoskeletal symptoms according to the British Isles Lupus Assessment Group (BILAG) disease activity index. Six patients (86%) were categorized as responders. The median (range) CLASI activity score of all patients at assessment had changed from 8.0 (2–22) to 4 (2–10). All five patients with joint pain and all five patients with malaise showed improvement in patient VAS but the BILAG findings failed to capture these improvements. In conclusion, the cutaneous aspects of SLE can be measured by the CLASI. The CLASI activity score may be a reasonable primary endpoint when performing a clinical trial of HCQ.

Response to hydroxychloroquine in Japanese patients with systemic lupus erythematosus using the cutaneous lupus erythematosus disease area and severity index (CLASI)

We evaluated the cutaneous lupus erythematosus disease area and severity index (CLASI) in Japanese patients with systemic lupus erythematosus (SLE) in order to design a clinical trial of hydroxychloroquine (HCQ) in Japan. Our prospective cohort study consisted of seven SLE patients with active skin disease who started HCQ at Tokyo Metropolitan Tama Medical Center. The therapeutic responses were assessed at 4 months. Patients were categorized as responders (improved) or non-responders (unchanged or worsened) using the criteria of a 4-point or 20% decrease in the CLASI activity score. We also assessed joint pain determined by patient visual analog scale (VAS), malaise (VAS), patient global assessment of SLE (VAS), and constitutional and musculoskeletal symptoms according to the British Isles Lupus Assessment Group (BILAG) disease activity index. Six patients (86%) were categorized as responders. The median (range) CLASI activity score of all patients at assessment had changed from 8.0 (2-22) to 4 (2-10). All five patients with joint pain and all five patients with malaise showed improvement in patient VAS but the BILAG findings failed to capture these improvements. In conclusion, the cutaneous aspects of SLE can be measured by the CLASI. The CLASI activity score may be a reasonable primary endpoint when performing a clinical trial of HCQ.

A Large Solitary Fibrous Tumor of the Tongue

A 75-year-old man had consulted with an orthopedic clinic for numbness of the hands and feet. The orthopedist initially suspected cervical spondylosis but referred the patient to the Department of Dental and Oral Maxillofacial Surgery, Tokyo Metropolitan Tama Medical Center. Magnetic resonance imaging showed a large tumor on the tongue. The patient had a medical history of cerebral infarction and spinal stenosis at 10 years and 1 month, respectively, before the tumor was diagnosed. The patient had not perceived any abnormality involving his tongue before magnetic resonance imaging. The tumor appeared on the left dorsal side of the tongue (Fig 1). The surface of the tumor was covered with healthy mucosa. On palpation, the lesion was elastic, firm, well-circumscribed, and painless. Other than the tumor on the tongue, the oral cavity and neck appeared normal. T1-weighted magnetic resonance image visualized the tumor as hypointense, and T2-weighted and short T1 inversion recovery image showed the lesion as isointense compared