We aimed to clarify the effect of aging on trabecular bone volume and trabecular bone microstructure in a rat model of Duchenne muscular dystrophy (DMD). Six rats each of wild type (WT) and DMD model at 15 weeks of age, and 4 rats each at 30 weeks of age, were analyzed by dual energy X-ray absorptiometry and by micro-CT for analysis of trabecular and cortical bone of the femur. Bone mineral density was significantly lower in the DMD group than in the WT group at both 15 and 30 weeks of age. Micro-CT showed that trabecular bone volume and number were not significantly different between the two groups at 15 weeks, but at 30 weeks both were significantly lower in the DMD group than in the WT group. Connectivity density and structure model index were not significantly different between the two groups at 15 weeks, but at 30 weeks they differed significantly. No significant differences between the WT and DMD groups in cortical thickness and cortical area were evident at both 15 and 30 weeks. In conclusion, trabecular bone volume is significantly reduced, with deteriorated microstructure, with aging in a rat model of DMD.
The selection of appropriate recipient vessels is important for the success of head and neck reconstruction. Vessels located outside of previously-dissected neck regions tend to be more frequently selected due to relative ease of preparation. However, some advantages are offered regarding dead space filling and formation by using vascular anastomoses within regions previously dissected, or reusing former free flap pedicle due to their proximity to the defect. We analyzed microsurgical anastomoses in patients requiring oral reconstruction who had previously undergone neck dissection. Contralateral vascular anastomoses were preoperatively planned in 10 cases of which 9 could be successfully performed (achievement rate, 90%). Ipsilateral side anastomoses were planned in 28 cases, with 26 anastomosed as planned (achievement rate, 92.9%). There was no statistically significant difference between the two groups. Vascular anastomosis within the scar region can be performed safely, based on preoperative planning and intraoperative judgment.
Little is known about the factors related to return to work (RTW) in patients with peri-operative lung cancer (LC). This study aimed to investigate whether pre-operative physical performance is associated with early RTW in patients with peri-operative LC. A total of 59 patients who wished to resume work after lung resection surgery were included and were divided into three groups: early RTW (within 14 days after discharge), delayed RTW (within 15–90 days), and non-RTW (failure of RTW within 90 days). The early RTW group had significantly lower scores on the modified Medical Research Council dyspnea scale (mMRC) and significantly higher scores on the Euro Quality of Life 5-Dimension 3-Level (EQ-5D-3L) than the non-RTW group. Multivariate logistic regression analysis showed that EQ-5D-3L scores were significantly associated with early RTW, and mMRC scores and knee extensor strength tended to be associated with early RTW. Better pre-operative quality of life, mild dyspnea, and greater lower limb muscle strength tended to be associated with early RTW in patients with peri-operative LC.
An 89-year-old man with polycystic liver disease (PCLD) received uncovered self-expandable metallic stent (SEMS) placement above the papilla for malignant biliary obstruction caused by cholangiocarcinoma. He developed cholangitis ten months later due to SEMS occlusion caused by tumor ingrowth, and 2 plastic biliary stents were placed inside the SEMS across the papilla. Fever and right costal pain appeared two weeks after reintervention. Suspecting hepatic cyst infection based on imaging studies, percutaneous transhepatic cyst drainage was performed. Increased inflammatory cells and the presence of pathogens in the cyst fluid led to a definitive diagnosis of hepatic cyst infection. Following drainage, the hepatic cyst shrank with resolution of the symptoms. SEMS occlusive-related cholangitis or retrograde infection due to duodenal-biliary reflux after reintervention was considered as the cause of the hepatic cyst infection. Careful clinical and imaging evaluation should be performed in patients with PCLD undergone biliary stenting, because cyst infection may occur following stent occlusion or subsequent biliary reintervention.
The Japan “Ordinance on Safety and Health of Work under High Pressure”, which is the law regulating health conditions for workers under high pressure environments, was amended in 2014. The revised regulations have highlighted other difficulties and new problems, but they have not yet written an appropriate amendment based on the aspect of occupational and environmental health. Health management for occupational divers and caisson workers in accordance with the new regulations has not determined the best approach to reducing related disorders and will cause other legal problems. This paper presents some issues in the new regulations for hyperbaric workers, which directly or indirectly involve occupational health physicians. Health checkups and work limitations should be done in consideration of the occupational characteristics of the undersea and hyperbaric environment. Regular examinations using specific studies are useful to diagnose the early stages of chronic conditions for workers, and are also useful for determining the hiring suitability for hyperbaric workers. Work limitations should be decided by the conditions that induce serious accidents or disorders that result from exposure to hyperbaric environments, and depend on the obstacles for work due to sequelae of decompression sickness. The new regulations need to be properly revised, based on scientific evidence, to include health management for workers in undersea and hyperbaric environments.
We report a bilateral medial medullary infarction in which diffusion-weighted images revealed a unique configuration: a heart appearance sign. If it is early diagnosed, it might predict a poor outcome. An 85-year-old man developed dysarthria and numbness in his four limbs and was transferred to our hospital. Brain MR diffusion-weighted images revealed a high-intensity lesion in the bilateral medial medulla oblongata -- a heart appearance sign -- and we diagnosed a bilateral medial medullary infarction. Although his symptom changed aggressively for the worse, it finally changed for the better without bulbar paralysis, and he was transferred to another hospital for rehabilitation. When the medial medulla oblongata is supplied by the unilateral control of the anterior spinal artery, its occlusion can cause a bilateral medial medullary infarction.
A 60-year-old female had a subcutaneous mass in the B region of the left breast. A needle aspiration cytologic examination revealed class IV, and she was referred to our surgical department for examination and treatment. She underwent an ultrasound echography on bilateral the mammary glands and axillary lymph nodes. Erythematous papules and plaques were revealed on her left breast, left axilla, and in the center of the chest area. The patient was referred to our dermatology department for evaluation of her skin eruption. Histopathological examination revealed the infiltration of lymphocytes and eosinophils in the perivascular of the upper dermis with spongiosis and liquid degeneration in the epidermis. A patch testing showed a positive reaction to ultrasonography gel. Based on the clinical course and examinations, we diagnosed her skin eruption as contact dermatitis due to ultrasonography gel. Her skin eruption improved rapidly by topical application of betamethasone butyrate propionate ointment. Recurrence of her skin eruption could be avoided by the removal of the gel after the ultrasonography examination. Our case report demonstrated to us that contact dermatitis could be prevented by promptly wiping off the ultrasonography gel from the skin after the examination.
A 30-year-old woman had recognized general fatigue and joint pain 5 years before her first visit to our hospital. Keratinized skin lesions were also observed on her hand, elbows, and other interstitial sites at the same time. She was referred to our department for evaluation of her skin eruption because psoriatic arthritis was suspected. A physical examination revealed hyperkeratotic, brownish plaques on her hand, elbows, and knees. Although a skin biopsy taken from her right hand could not confirm a diagnosis, another biopsy taken from her right elbow revealed hyperkeratosis and parakeratosis with agranulosis epithelial hyperplasia, indicating a diagnosis of psoriasis. Taking an additional skin biopsy from a site other than the main one can be helpful for a diagnosis of psoriatic arthritis.
Anterior inferior cerebellar artery (AICA) syndrome is a well-known symptomatic disorder. AICA syndrome is one of the causes of sudden hearing loss seen in recent years, but most of these cases were diagnosed as hearing loss preceded by other symptoms. Due to variations in AICA, we consider that many cases are actually not recognized as AICA syndrome. In this report, we describe a case of AICA syndrome preceded by hearing loss and describe its course of progression.
Pesticides are essentially toxic to living things and are used openly, so it is necessary to monitor them to prevent their adverse effects. We have studied farmers’exposure to pesticides during soil fumigation operations with chloropicrin, and have noted a danger to the farmers in the form of dyspnea. We examined accidents/symptoms of residents from chloropicrin reported by the Ministry of Agriculture, Forestry, and Fishery from 2010 to 2019. Eighty percent of the cause of these manifestations was the failure to cover fumigated soil with plastic film. Symptoms shown by residents included eye pain (91%), sore throat (35%), and headache (14%). The most common film used for covering fumigated soil in Japan is polyethylene. The agricultural technology centers in Japan have studied the use of gas barrier films, and found it possible to decrease the amount of chloropicrin used to 1/3, and leakage into the atmosphere to less than 1/10. This technology has become popular in the production of sweet potatoes in Tokushima Prefecture. Soil disinfection by solar heat has also been studied in Japan. These studies have shown positive advancements in the fertilization of soil and in the control of microbes. Chloropicrin has caused occupational exposure to farmers and environmental exposure to local residents. It is advisable that the technologies mentioned above become common practice.