Introduction: High rates of vitamin D deficiency rickets have been reported among Uzbek infants. Our study attempts to clarify the implications of the traditional Uzbek custom of constraining infants to a type of cradle known as a Beshik, in the development of infantile rickets. For up to 2 years after birth, Uzbek infants may spend almost the entire day inside Beshik under a full cover and with their body swaddled, i.e. wrapped snugly in sheaths of cloth or similar material so that the movement of the limbs becomes severely restricted. This practice generally prevents all exposure to sunlight.

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Gamma-tocopherol is largely metabolized to 2,7,8-trimethyl-2-(2'-carboxyethyl)-6-hydroxychroman (γ-CEHC), which has natriuretic activity that is mediated via inhibition of 70 pS ATP-sensitive K+ channels in the thick ascending limb of the loop of Henle. However, the effects of γ-tocopherol administration on edema are unclear. To determine the effects of γ-tocopherol administration on pretibial edema, we measured urinary γ-CEHC concentration by high-performance liquid chromatography with electrochemical detection (HPLC-ECD) after administration of γ-tocopherol. Twenty young women who had a history of pretibial edema due to premenstrual syndrome were randomly divided into two groups. The γ-tocopherol group received 4 "γ-tocopherol capsules" (each containing 100mg of γ-tocopherol), and the control group received 4 "placebo capsules" (each containing 250mg of soybean oil) per day for 7 days. Urinary sodium and potassium secretion and urine volume did not increase after cessation of γ-tocopherol administration, yet the degree of pretibial edema improved in all participants in the γ-tocopherol group. The serum γ-tocopherol concentration significantly increased in the γ-tocopherol group. Urinary excretion of γ-CEHC significantly increased after γ-tocopherol administration. Our results suggest that orally administered γ-tocopherol on renal sodium handling is not apparent, but γ-tocopherol is a precursor of prolonged natriuresis of γ-CEHC and may be effective for edema.

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Difficulty in standing up from a chair is associated with weakness of the muscles of the lower extremity and is an important factor that indicates frailty in elderly people. Little is known about the factors that influence this difficulty among the elderly. To elucidate these factors, we studied 323 community-dwelling people from Nagasaki Prefecture, Japan, who were aged 65 years and over. The body weight and height of the subjects were measured, and their body mass index (BMI) was calculated. Obesity was defined as BMI ≥ 25 (kg/m²). The subjects were asked whether they experienced any difficulty in standing up from a chair (chair stand difficulty). Information on comorbidities, back pain, pain in any joint, and chewing ability was collected. The proportion of people who experienced chair stand difficulty increased with age (p = 0.061 for men and p = 0.005 for women). The results of multiple logistic regression analysis showed that older age (odds ratio (OR): 2.16; 95% confidence interval (CI): 1.22-3.71), obesity (OR: 3.00; 95% CI: 1.47-6.14), pain in any joint (OR: 2.73; 95% CI: 1.42-5.26), and poor chewing ability (OR: 2.65; 95% CI: 1.33-5.28) were significantly associated with chair stand difficulty. Intervention to reduce the risk of frailty among the elderly would be decided on the basis of physical factors such as obesity, musculoskeletal pain, and chewing ability.

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A 71-year-old man was noted to have a nodular opacity in S8 of the right lung. Thirteen months later, the chest CT showed a lesion “gloved finger shape” with focal calcification, and a small nodular opacity appeared in right S7. A right lower lobectomy was performed under video-assisted thoracic surgery. The tumor filled the S8 bronchus, with invasion into the pulmonary parenchyma and S7 metastasis. Mitotic figures were seen in 5 of 10 high power fields. Positive staining for chromogranin A and synaptophysin led to the diagnosis of atypical carcinoid. The patient has been disease-free without treatment for 9 months.

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A rare case of cecal volvulus that was preoperatively diagnosed and surgically treated is herein reported. An 85-year-old woman was admitted to our hospital because of abdominal pain and distension concomitant with nausea and vomiting. She had no past history of laparotomy. Her abdomen showed distention with muscle rigidity and positivity for Blumberg's sign. Plain abdominal X-ray showed a markedly air-distended bowel segment in the right lower abdomen associated with dilated small intestine. An abdominal computed tomography showed extremely dilated bowel in the right lower abdomen that resembled a “coffee bean” in appearance. However, there was no evidence of air-distention in the descending colon. A colonoscopy did not show any bowel obstruction of the left side colon. We diagnosed a cecal volvulus associated with intestinal strangulation. An emergency laparotomy was thus performed. During the laparotomy, the ileocecal region, which was unfixed at the retroperitoneum, was found to be twisted clockwise 360°around the mesentery with the terminal ileum, thus resulting in a diagnosis of cecal volvulus. Since the colonic wall demonstrated vascular compromise and patchy gangrene, we therefore conducted an ileocecal resection without detorsion and reperfusion, followed by primary anastomosis. The patient recovered with minor complication. This case demonstrates the need for clinicians to consider cecal volvulus as a possible cause of acute abdomen. Abdominal computed tomography studies in such patients may enable early diagnosis. Resection without detorsion and reperfusion is the favored option for gangrenous bowel.

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