Diagnosing clinical progressive supranuclear palsy (PSP) is challenging. We hypothesize that there are more cases of pathological PSP than have been clinically identified, but its diagnosis is challenging because the initial lesions and progression of PSP have not yet been clarified. The purpose of our study was to clarify the incidence of PSP in consecutive autopsy cases and identify pathological characteristics of early PSP. We investigated 324 consecutive autopsy patients from a general geriatric hospital (age, mean±SD=82.5±8.7 years). Paraffin sections of the midbrain were immunostained with anti 4-repeat tau antibodies (RD4). We selected cases showing RD4-positive neurofibrillary tangles and tufted astrocytes in the midbrain sections. Then, we used anti-phosphorylated tau antibody to immunostain sections from the basal ganglia, subthalamic nucleus, midbrain, pons, medulla, and cerebellum. Of the 324 patients, 35 had RD4-positive structures in the midbrain. From these 35 cases, we excluded those for which autopsies confirmed definite PSP (n=5) and cases of corticobasal degeneration (n=1), Alzheimer's disease (n=11), dementia of grain (n=10), and neurofibrillary tangles predominant forms of senile dementia (n=2), leaving 8 cases. We diagnosed these 8 cases as pure PSP-type tauopathy. Pure PSP-type tauopathy was detected in 2.5% of the consecutive autopsy cases, and this incidence was 1.6 times greater than that of neuropathologically definite PSP. This pure PSP-type tauopathy likely indicates preclinical stages of PSP. Furthermore, the novel neuropathological finding, which we term "preclinical PSP," is unique and has not previously been reported. In order to elucidate the causes and pathological mechanisms of PSP, preclinical PSP should be investigated further.

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Background: The blood concentration of high-sensitivity cardiac troponin T (hs-cTnT) is an established, useful biomarker for evaluating the pathogenesis of heart failure and predicting cardiovascular events. The aim of this study was to evaluate factors that are potentially associated with elevated blood hs-cTnT in patients with type 2 diabetes mellitus. Patients and Methods: Patients with type 2 diabetes mellitus (N=280, 111 men and 169 women; mean ± SD age: 71±9 years) with no history of cardiovascular events were enrolled. Relationships between hs-cTnT level and various clinical parameters were examined. Results: Hs-cTnT was detected in 244 (87.1%) patients. There were no significant relationships between hs-cTnT and fasting blood glucose levels or insulin resistance. hs-cTnT was significantly correlated with advanced glycation end-product levels at the skin (r=0.23, p<0.001), blood concentrations of brain natriuretic peptide (r=0.23, p<0.001), reactive oxygen metabolites as markers of oxidative stress (r=0.28, p<0.001), and the augmentation index at the radial artery as marker of arterial reflection (r=0.31, p<0.001). Furthermore, multiple regression analysis revealed that these factors were also selected as independent variables, with hs-cTnT as a subordinate factor. Conclusion: These results indicate that novel cardiovascular risk factors including advanced glycation end-products, in vivo oxidative stress, and high arterial reflection are closely associated with high concentrations of blood hs-cTnT in patients with type 2 diabetes mellitus.

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Background: Relationships between various climate factors and stroke have long been a subject of investigation. The present study investigated in a single medical center the effects of periodic temperature changes on the onset of intracerebral hemorrhage (ICH), subarachnoid hemorrhage (SAH), atherothrombotic infarction (AI), lacunar infarction (LI), cardiogenic embolism (CE), and transient ischemic attack (TIA). Methods: The subjects were 4,310 patients who had been hospitalized because of hemorrhagic or ischemic stroke from January 2000 through December 2005. Ambient temperature data were collected from the Japan Meteorological Agency Database. The following factors were analyzed: number of stroke onsets per day; mean, maximum, and minimum ambient temperatures; and differences between the mean temperatures on the onset day and the previous week. Relationships between temperature factors and totals based on stroke subtypes were assessed by means of regression analyses with a standard least squares model controlling for specific covariates. Results: The daily admissions for ICH, SAH, AI, LI, and CE increased when the mean temperature on the onset day was 1°C lower than that of the previous week. Decreases in minimum ambient temperature predicted increased numbers of admissions for ICH and for SAH. Conversely, a 1°C increase in maximum ambient temperature significantly affected ICH, AI, and CE admissions. There was no definitive relationship between temperature change and admissions for TIA. Conclusion: Both absolute and comparative changes in ambient temperature are related to increased onsets of hemorrhagic and ischemic stroke in Japan.

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We report an extremely rare case of proximal entrapment neuropathy of the median nerve above the elbow in a 44-year-old man who presented with paresthesia with median nerve distribution. Tinel's sign was located in the upper arm medial to the biceps and 5 cm proximal to the elbow. The patient underwent microsurgery under local anesthesia. The fascia covering the brachial- and the biceps brachii muscle entrapped median nerve. After operation, he reported symptom improvement. Lesions above the elbow should be considered as possible causative factors of entrapment neuropathy of the median nerve.

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Introduction: Necrotizing fasciitis (NF) is an aggressive soft tissue infection that involves the deep fascia and is characterized by the extensive deterioration of the surrounding tissue. Immediate recognition and aggressive treatment, including debridement and systemic antibiotics, are mandatory for the successful management of NF. Following radical debridement, closure of the remaining wound can pose significant reconstructive challenges. Accumulating evidence indicates that application of negative-pressure wound therapy (NPWT) is useful in the treatment of patients with severe acute complex wounds, including NF. Case Presentation: A 58-year-old man who had undergone surgical resection for rectal carcinoma followed by chemo-radiation therapy developed NF of the pelvis and thigh three years after the surgical procedure. Following extensive debridement, a VAC system was applied to the large open wound and successfully contributed to wound bed cleansing, which was followed by surgery for skin grafting. Conclusion: This case demonstrates the successful management of a complex and potentially lethal wound of the perineum to lower leg with debridement and skin grafting as well as with the application of the VAC system.

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Objective: Current data indicate that the rate of trauma in children during gymnastic formation is increasing, especially while creating a structure with a certain height, such as the human pyramid. The goal of the present study was to clarify the clinical characteristics of these injuries. Methods: In this single-institution review, all children treated for a gymnastic formation-related injury at Nippon Medical School Hospital from 2013 through 2015 were identified through the institution's registry. The injury mechanism was classified, and injury severity, interventions, and outcome were examined. Results: Eight children were treated for a gymnastic formation-related injury. They were 7 boys and 1 girl aged 10 to 15 years (mean age, 13.1±1.8 years). Neurotrauma ranging from concussion to spinal cord injury without radiographic abnormality occurred in 6 patients (75%). No intracranial hemorrhagic lesions were detected. The Glasgow Coma Scale score on arrival was 15 in all 8 patients, and neurological deficits were present in 1 patient. No patient required surgical intervention. All patients made a full recovery after discharge from the hospital. No patients died. The average follow-up period was 2.1±0.9 weeks. Conclusions: Neurotrauma is a frequent result of gymnastic formation accidents in children. Healthcare workers and teachers should recognize this type of injury, and public education that targets parents should be introduced.

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Gallstone ileus is a rare complication of cholecystolithiasis, with the majority of cases requiring surgical treatment. In this paper, we describe a case of gallstone ileus that was successfully treated twice with conservative therapy. An 85-year-old woman was admitted to our hospital because of abdominal pain and vomiting. She had previously been treated with antibiotics for cholecystitis arising from 2 gallbladder stones. Computed tomography (CT) revealed that the small bowel was dilated and that 1 of the gallbladder stones had disappeared. In addition, a 28×22-mm calcified mass was found in the small-bowel lumen. We diagnosed gallstone ileus and performed nasogastric drainage for decompression. Follow-up CT revealed migration of the impacted stone, and symptoms had improved. However, 2 months after discharge, the patient's symptoms recurred. A CT scan revealed that the small bowel was again dilated and that the remaining gallstone had disappeared from the gallbladder. A 28×25-mm calcified mass was found in the small-bowel lumen. We diagnosed recurrent gallstone ileus. Because the gallstone was almost the same size as the previous one, we selected the same conservative decompression treatment. Fourteen days after the patient was admitted, the stone was evacuated with the feces. Although many cases of gallstone ileus require surgical treatment, spontaneous passage was achieved in this case. When treatment is chosen for gallstone ileus, the patient's presentation and clinical course must be considered.

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We report a case of previously unreported metastasis to the spermatic cord from esophageal squamous cell carcinoma. A 63-year-old Japanese man underwent laparoscopy-assisted esophageal bypass surgery for an advanced esophageal cancer. An elastic hard tumor was found in the right lateral inguinal fossa on intraoperative laparoscopy, and laparoscopic enucleation was performed. Histological examination of the resected tumor revealed a moderately differentiated squamous cell carcinoma, compatible with metastasis from the esophageal cancer. Two months after the operation, computed tomography revealed a heterogeneously enhanced groin mass (20 mm in diameter) involving the right spermatic cord. To our knowledge, this is the first reported case of a solitary metastasis to the spermatic cord from esophageal squamous cell carcinoma.

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