CV and PS related Flashcards
(43 cards)
1-Horiuchi K, Kuno T, Takagi H, Egorova NN, Afezolli D. Predictive value of the G8 screening tool for postoperative complications in older adults undergoing cancer surgery: A systematic review and meta-analysis. J Geriatr Oncol. April 2024;15(3):101656.
It was my strong desire to work on a research project to fill in the gaps between geriatrics and oncology. This is my very first one, mentored by the Department of Geriatrics and Palliative Medicine. By conducting a systematic review and meta-analysis, I explored the predictive value of the G8 screening tool for post operative complications in older adults who are undergoing cancer surgery. Happily, this was published in the Journal of Geriatric Oncology.
It was a great collaboration with my mentors and statistician, and such a great pleasure to work on a project that is in align with my career vision, based on my own clinical question.
G8; 0-17. Fit 17-15. Not fit 14-0.
Domains (8)-age, nutrition, physical, psychological, medication, and self-reported health.
02-Horiuchi K, Fogel J. Challenges in diagnosing thoracic meningioma. BMJ Case Rep. April 2024;17(4):e257761.
This is one of my recent geriatric related case report, published in BMJ Case reports and also presented at AGS. This is an older patient presenting with progressive frailty disproportionate to his prior well-being, and imaging revealed a mass in the spinal canal. This was resected, and pathology confirmed meningioma. The take away from this case report is that even in older patients presenting with frailty, sometimes there is a reversible cause worth investigating.
03-Horiuchi K, Ikemura S, Sato T, Shimozaki K, Okamori S, Yamada Y, Yokoyama Y, Hashimoto M, Jinzaki M, Hirai I, Funakoshi T,Mizuno R, Oya M, Hirata K, Hamamoto Y, Terai H, Yasuda H, Kawada I, Soejima K, Fukunaga K. Pre-existing Interstitial Lung Abnormalities and Immune Checkpoint Inhibitor-Related Pneumonitis in Solid Tumors: A Retrospective Analysis. Oncologist. January 2024;29(1):e108.
This is a single institution retrospective research to collect a real-world data to evaluate whether underlying interstitial lung abnormalities be a risk factor for pneumonitis, associated with immune checkpoint inhibitors. This was one of the exciting projects that I engaged in, since this was generated from my own clinical question and I took a leadership role. This research involved many cancer related departments including dermatology, urology, GI, pulmonology, hematology, and radiology. This experience was meaningful because a high level leadership, team building, and coordination were required, which I was able to build through the journey.
04-Kim S, Horiuchi K, Arrazola E, Basnet A. Metastatic malignant melanoma presented as non-traumatic adrenal haemorrhage. BMJ Case Rep. June 2024;17(6):e260227.
This is one of the recent case report project that I mentored. A middle aged man came in with a flank pain, and imaging revealed adrenal hemorrhage. No clear etiology was found and patient was discharged. Several months later he presented with a seizure, and this time patient was found to have metastatic lesions in the brain and adrenal, which later was confirmed to be melanoma. The takeaway from this case is that adrenal hemorrhage could be an early sign of metastatic lesion, and should be investigated carefully.
05-Kim S, Horiuchi K, Ueda T, Boku S. Significant efficacy of electroconvulsive therapy on the behavioural symptoms of anti-N-methyl-d-aspartate receptor encephalitis. BMJ Case Rep. February 2024;17(2):e258460.
This is one of the case report project that I mentored. A rare case of NMDA encephalitis with significant late phase psychotic features, and electroconvulsive therapy was attempted along with steroids. This was not a common indication for electroconvulsive therapy but ended up being effective, so we decided to publish the case.
07-Horiuchi K, Fogel J, Sarmiento J. Endovenous radiofrequency ablation of great saphenous vein complicated by pulmonary embolism in an elderly patient. BMJ Case Rep. July 2023;16(7):e255543.
This was a case from two years ago. An older woman had varicose veins on the lower extremities, and and she underwent radiofrequency ablation, that was performed by vascular. Although she continued to take Eliquis for her afib and US doppler the day before procedure, per protocol, did not reveeal DVT, her course was complicated by PE/DVT. This case report was published to heighten awareness of this complication, with increased risk for older patients.
06-Shichijo Y, Horiuchi K, Fogel J. Immune thrombocytopaenic purpura following COVID-19 infection masquerading as senile purpura. BMJ Case Rep. April 2024;17(4):e259747
This is one of the case report project that I mentored, which was geriatric related. An older woman presented with purpura. At first we thought that this was non-specific, but because it recurred, blood work was performed and revealed an extremely low platelet count. She was admitted for further work-up, but did not reveal any specific etiology. Further history revealed a COVID-19 infection earlier, and then was thought to be immune related 2/2 COVID. The takeaway is that if an older patient comes in with purpura with recent COVID infection, it maybe safer to check CBC for possible thrombocytopenia.
09-Horiuchi K, Ikeda T, Kida A, Oyamada Y. Bilateral vocal cord paralysis due to direct invasion of right and left recurrent laryngeal nerves in a small cell lung cancer patient. BMJ Case Rep. August 2021;14(8):e245011.
This patient with stage 4 small cell lung cancer had a large mediastinal mass invading recurrent laryngeal nerves both right and left. He had a hoarse voice but still maintaining airway. There were extremely high risk of airway compromise so goals of care was discussed carefully. The takeaway for this case is that if there is concern for b/l vocal cord paralysis, GOC needs to be carefully discussed in advance.
08-Horiuchi K, Sato T, Kuno T, Takagi H, Hirsch FR, Powell CA, Fukunaga K. Platinum-doublet chemotherapy as second-line treatment for relapsed patients with small-cell lung cancer: A systematic review and meta-analysis. Lung Cancer. June 2021;156(1):59.
This is a meta-analysis evaluating the effectiveness of platinum-doublet re-challenge in the second line for the treatment for small cell lung cancer. I came up with this clinical question as a thoracic medical oncologist, and along with my team we decided to conduct a meta-analysis. It was such an exciting process, gathering publications, extracting data, and we came up with some beautiful figures. This meta-analysis supported the use of rechallenge regimen in the second line, which I believe has a remarkable impact.
10-Akiyama Y, Horiuchi K, Kondo Y, Kabata H, Ishii M, Fukunaga K. A case of non-severe COVID-19 complicated by pulmonary embolism. Respirol Case Rep. July 2020;8(7):e00622.
This is one of the case report projects that I mentored. This patient had non-severe COVID-19, and it was complicated by pulmonary embolism. At the time, thromboembolism was mainly reported in severe cases, so we published this complication. This is one of the first projects that I served as a mentor, where I explored my roles.
11-Horiuchi K, Asakura T, Sakaguchi S, Saito F. Bilateral chylothorax associated with osteophytes in an elderly patient. BMJ Case Rep. April 2019;12(4):e229473.
It was when I was PGY5 that I experienced this case. This patient was brought in for shortness of breath, and further work up revealed bilateral chylothorax. Lymphangiography was performed, and we found a leakage near an osteophyte of the vertebra, suggestive as a cause for damage after a blunt trauma. This mechanism for chylothorax was not reported in previous literature, so we published the case.
12-Horiuchi K, Asakura T, Ochi J, Saito F. Pneumothorax associated with giant bullous emphysema and mediastinum deviation. BMJ Case Rep. December 2019;12(12):e230353.
It was when I was PGY 5 that I experienced this case. This patient was brought in for shortness of breath, and further work-up revealed pneumothorax and a deviated mediastinum, a condition suspicious for tension pneumothorax. However, the deviation persisted even after chest tube insertion. We discussed here that the chronic deviation may have been due to a unilateral giant bullous emphysema.
13-Horiuchi K, Asakura T, Ikeda N. Rhabdomyolysis diagnosed in an older woman with dementia on examination after a wandering episode. Geriatr Gerontol Int. September 2019;19(9):956.
It was when I was PGY 5 that I experienced the case. This patient in her 80s with dementia, was brought in by ambulance, unable to walk on a street. Further work-up revealed an elevated CPK of 15,000. We were not totally sure why she had rhabdo. Thereafter, detailed history obtained from her revealed her wandering episode. This case report published to notify the importance of careful history taking in an elderly patient with rhabdomyolysis.
14-Horiuchi K, Asakura T, Sakaguchi S, Saito F. Successful osimertinib treatment in a patient who exhibited intramedullary spinal cord metastases of lung adenocarcinoma with an acquired EGFR T790M mutation. BMJ Case Rep. June 2019;12(6):e229310.
It was when I was PGY 5 that I experienced this case. This patient with lung cancer had an extremely rare site of metastasis – intramedullary spinal cord. The use of Osimertinib, an EGFR tyrosine kinase inhibitor, demonstrated remarkable response and the tumor almost vanished. We published this case to share its unusual treatment course.
15-Horiuchi K, Asakura T, Sakaguchi S, Saito F, Yamamoto J. Placental transmogrification of the lung masquerading as difficult-to-treat pneumonia. QJM. March 2020;113(3):213.
It was when I was PGY 5 that I experienced this case. This patient presented with difficult-to-treat pneumonia, showing no response to antibiotics nor systemic steroids. Surgical resection of the consolidation revealed an extremely rare pathology - placental transmogrification of the lung. This is abnormal tissue resembling placenta without any function. We published this case to share its unusual presentation.
16-Horiuchi K, Asakura T, Bessho Y, Saito F. Infectious tenosynovitis of the long head of the biceps caused by methicillin-resistant Staphylococcus aureus in a patient with diabetes and small cell lung cancer. BMJ Case Rep. March 2019;12(3):e229040.
It was when I was PGY 5 that I experienced this case. This patient with diabetes and small cell lung cancer presented with fever, and further work-up revealed an infectious tenosynovitis of the long head of the biceps caused by MRSA. This was such a rare site of infection, so I published the case. It may be related with the use of insulin injection.
17-Horiuchi K, Asakura T, Saito F, Asakura T. Superior vena cava syndrome. QJM. September 2019;112(9):703.
When I was doing outpatient clinic service, one older man came complaining distended vessels on his chest, and he was an active smoker. I soon realized that that could be SVC syndrome, and x ray performed on the same day revealed a mediastinum mass, concerning for lung cancer. Pictures of dermatologic features for SVC syndrome were not well reported in the literature, so I decided to publish for educational purpose.
18-Horiuchi K, Asakura T, Sakaguchi S, Saito F. Lung cancer masquerading as fungus-associated mucoid impaction. BMJ Case Rep. December 2018;11(1):e227470.
It was when I was PGY 5 that I experienced this case. This patient presented with slight cough and chest images revealed a localized mucoid impaction of the lung. Follow-up over several months revealed an emerging mass at the site, and bronchoscopy revealed lung cancer. This was a rare presentation for lung cancer, so we published the case.
19-Horiuchi K, Asakura T, Hasegawa N, Saito F. Recurrence of allergic bronchopulmonary aspergillosis after adjunctive surgery for aspergilloma: a case report with long-term follow-up. BMC Pulm Med. December 2018;18(1):185.
It was when I was PGY 5 that I experienced this case. This patient had both aspergilloma and ABPA under a condition called aspergillus march. Surgical resection of aspergilloma led to control of ABPA. The treatment course was unique, so I published the case for a guidance to clinicians.
01- Horiuchi K, Hortelano C, Nikfar R, Fogel J. Hereditary transthyretin-mediated amyloidosis masquerading as diabetic neuropathy and lumbar radiculopathy. BMJ Case Rep. June 2024.
This is my most recent geriatric related case report is under review by BMJ Case reports and also present at AGS. Older man with diabetes and lumbar radiculopathy presented with progressive frailty becoming wheel chair bound. At first, we had an impression that this could be a combination of diabetes and radiculopathy, but the way his function declined was disproportionately progressive. But he also had hx of carpal tunnel syndrome and HFpEF. We made our effort to “connect the dots”, and raised our suspicion for amyloidosis. Later sural nerve biopsy confirmed the diagnosis. I realized that there may be a strong anchor bias towards initial diagnosis, but sometimes that has to be re-visited.
02- Goto T, Horiuchi K, Hui J. Spontaneous paraspinal muscle hematoma in an older woman with ANCA-associated glomerulonephritis. QJM. June 2024.
This is one of the case report project that I have been mentoring, which is under review by a journal and presented at the Society of General Internal Medicine. A middle aged man who was initially admitted for renal failure requiring HD, had a sudden onset flank pain during the hospital course. Clinically the reason was not clear but notably had a drop in Hgb, so CT with contrast was obtained. Image revealed a paraspinal muscle hematoma. Non-traumatic etiology is extremely rare, so we decided to publish the case.
03- Horiuchi K, Mulholland C. Urinary obstruction at end of life after withdrawal from hemodialysis in an older man. Geriatr Gerontol Int. January 2024.
This is about an older patent who decided to withdraw from HD. His wishes were appreciated by the team and patient was referred to hospice. While awaiting for hospice placement, the patient experienced sever lower abdominal pain. At first we focused mainly on pain regimen, but due to the nature of the pain, bladder scan was obtained which showed urinary retention. Foley placement resolved his pain. This was very interesting to share because his residual kidney function was underrecognized and reversible source of pain should still be explored. We decided to work on this project to heighten the awareness of urinary obstruction as a rare etiology of reversible pain, even for patient withdrawing from HD.
04- 04. Ito F, Sato T, Horiuchi K, Arai D, Ohgino K, Ishioka K, Terai H, Ikemura S, Yasuda H, Nakachi I, Kawada I, Inoue T, Oyamada Y, Terashima T, Sayama K, Fujisawa D, Takeuchi D, Fukunaga K, Naoki K, Soejima K. Health insurance and its psychosocial correlates in patients with advanced lung cancer in Japan. Support Care Cancer. June 2024.
This is one of the projects that I took part when I was in Japan. Based on a questionnaire obtained from patients with lung cancer and their caregivers, we were investigating correlates with their insurance status and social/psychological well-being. A large proportion of patients were old. Patients with insurance tend to maintain their psychological well-being and tend to be socially well supported. This is more about correlation rather than cause and effect, but was an interesting perspective. I had a role in gathering data.
05-Okada M, Ohgino K, Horiuchi K, Ikemura S, Kawada I, Sayama K, Arai D, Watase M, Kobayashi K, Terashima T, Ishioka K, Miyawaki M, Sakamaki F, Masuzawa K, Kinoshita K, Terai H, Yasuda H, Soejima K, Fukunaga K. Real-world efficacy and safety of atezolizumab for advanced non-small cell lung cancer; a retrospective multicenter analysis. Clin Lung Cancer. January 2024.
This is a project that I took part when I was in Japan. This is a multicenter retrospective analysis to describe the real-world efficacy of atezolizumab for patients with lung cancer. Atezolizumab is one of the immune checkpoint inhibitors. Since there were a large proportion of older patients, we were trying to focus on how geriatric features correlates to treatment outcomes and toxicities. I mainly took a role in gathering data. There were no surprising correlates, maybe because this is not cytotoxic agent.
