Recently, arthroscopic operation for shoulder disease has shown excellent outcomes. In traditional shoulder surgery, with a wide incision, postoperative contracture is a serious concern for both patients and surgeons. Arthroscopic operation makes it possible for patients to return to their pre-injury daily activity level with minimal adverse functional effects to the surrounding shoulder joint. This is of particular importance especially for athletes. In general, traumatic shoulder dislocation and torn rotator cuff are treated with arthroscopic operation. The avulsion of the antero-inferior portion of the glenoid rim causes recurrent anterior instability of the shoulder, and surgeons should restore it to the anatomical position to prevent shoulder dislocation. Torn rotator cuff is the most common source of shoulder pain. Once, the rotator cuff is torn, in addåtion to shoulder pain, the decrease of range of motion causes distress to the patients. Therefore, suturing of the rotator cuff is performed. Using arthroscopy, surgeons can treat these traumas with minimal side effects. To perform arthroscopy for shoulder disease, well-established anatomical knowledge and technical training are necessary for surgeons. Although the long-term results of arthroscopic operation have not been investigated, the short-term results of arthroscopic repair in shoulder dislocation and torn rotator cuff have been satisfactory. This is because the reported benefits included less postoperative pain, decreased risk of deltoid dehiscence, and possible accelerated recovery and rehabilitation. Arthroscopic repair may arguably not be the most appropriate procedure for a younger person with a massive tear in whom long-term strength is more important, and a strong argument can be made for minimal-incision or open repair in this particular population. Future studies on arthroscopic repair methods and basic-science studies to improve the biological healing of the shoulder joint are needed before further recommendations can be made.
Placental abruption is one of the representative diseases in obstetrics that can cause perinatal death and maternal death. We examined the clinical findings and Fetal Heart Rate (FHR) monitoring of patients with abruptio placental. Methods: We analyzed the patients in our hospital with abruptio placental over the course of 10 years, including the DIC score, placental ablation area and FHR pattern. Results: There were 47 cases of abruptio placental, including 28 cases (60%) with a good neonatal prognosis, 7 cases (15%) with poor prognosis, 12 cases (25%) of intrauterine fetal demise (IUFD) out of 6,430 deliveries. In the case of IUFD, the gestational age was significantly earlier, the placental abruption area was wider and the DIC score was higher than those with a good neonatal prognosis. The FHR baseline variability was normal for all cases with Apgar scores of 7 out of 10 points. The umbilical cord arterial blood pH value was significantly better and the placental abruption area was smaller, when the FHR baseline variability was maintained. Conclusions: To further understand why the placental abruption area is larger and the DIC increases in cases of IUFD, careful management is necessary. The placental ablation area was not increased and the umbilical cord arterial blood pH and neonatal prognosis was better, when the FHR baseline variability was maintained. We concluded that FHR monitoring is important for the early diagnosis of abruptio placental and improvement of the neonatal prognosis and that the grade of placental ablation area can be estimated by the FHR pattern.
The Cell Search System was used to measure and analyze the circulating tumor cells (CTC) in blood from patients with lung cancer. The study was performed on 15 patients with untreated lung cancer between July 2007 and January 2008. Of the 15 patients, 3 patients were stage IA (T1N0M0), 1 patient was stage IIB (T2N1M0), 3 patients were stage IIIA (T1-2N2M0), 4 patients were stage IIIB (T4N1M0), and 4 patients were stage IV (Tx-2N1-3M1). Positive cell counts (one or more CTCs) were identified in 4 patients, all of whom had stage IIIB or stage IV lung cancer. The number of CTCs ranged from 1 to 4,186. No correlation was found between the number of CTC and the CEA tumor marker level. CTCs are found in lung cancer when the cancer is at an advanced stage or has metastasized to distant sites. This study suggested that the number of CTCs could be used to determine the prognosis if data is obtained from a larger number of patients.
A 17-year-old male was admitted to our hospital with sore throat, cough, dyspnea, high fever and general fatigue. Wheezing was heard on the chest and subcutaneous air was palpable in the neck. Chest X-ray and CT showed mediastinal emphysema. The patient had no underlying diseases and was diagnosed with primary bronchial asthma and mediastinal emphysema. We treated the patient with bed rest, antibiotics, oxygen inhalation, bronchodilator and a corticosteroid. After 10 days in the hospital, the mediastinal emphysema disappeared. Mediastinal emphysema with primary bronchial asthma rarely occurs. It is important that we should be suspicious of mediastinal emphysema when patients present with sore throat, chest pain, neck pain and pain swallowing and take activity chest X-rays and CT to confirm mediastinal emphysema in such cases.
We report a rare case of solitary cerebellar metastasis from colon cancer, in which it was difficult to make a correct diagnosis. A 57-year-old female came to us complaining of a continuous morning headache. Twenty-two months prior she had undergone curative resection of ascending colon cancer. The carcinoembryonic antigen (CEA) level before resection of the colon cancer was 10.6 ng/ml. Magnetic resonance imaging (MRI) revealed a mass lesion about 2 cm in diameter with perifocal brain edema in the right cerebellar hemispheric region. Whole-body 18-fluorodeoxyglucose positron emission tomography (FDG-PET) showed no other abnormal lesions, except for uptake. Furthermore, the CEA level was 2.0 ng/ml. Based on the preoperative diagnosis of malignant tentorial meningioma we performed total tumor resection. The pathological diagnosis was metastatic colorectal cancer. Preoperative diagnosis is difficult in cases of metastatic brain tumor from colon cancer without liver or lung metastasis.
Nesidioblastosis is rare, however it commonly causes severe hypoglycemia that is resistant to medical treatment in infants. Herein, we report local autopsy of a case of nesidioblastosis. The patient was born by emergency cesarean section, and was in a persistent state of hyperinsulinemic hypoglycemia. Ultimately, he died as a result of heart failure and infection. Histopathological examination of the pancreas showed a so-called ductulo-insular complex. In the future, this case will be important for investigating the pathological state and treatment of nesidioblastosis.