Lumbar spinal canal stenosis is a disease characterized by numbness and intermittent claudication of the lower limbs by caudaequina and strangulation of the nerve root. Generally, it occurs in subjects who are more than 50 years old, increases with aging and is one of the most common of the spinal diseases. However, the definition of this disorder has not yet been established. The clinical guidelines for lumbar spinal canal stenosis were published in 2011, and an evidence-based approach to lumbar spinal canal stenosis has gradually been established. We introduce the diagnosis and treatment of lumbar spinal canal stenosis in addition to reporting the latest topics related to the clinical guidelines.
Failure-to-thrive has been described in patients with organic acidemia who are treated using a low-protein diet. We report very different courses of growth due to dietary treatment in two cases of organic acidemia (methylmalonic acidemia [MMA] and propionic acidemia [PA]). Both patients showed early onset, but the durations from the first symptom to the diagnosis and initiation of sufficient diet therapy differed. One case (MMA) exhibited metabolic acidosis and severe hyperammonemia for 5 days and from day 7 to 11, respectively. He was diagnosed on day 13, and was then started on a protein-restricted diet without essential amino acids. He currently exhibits a serious mental development delay and is short in stature (-2.6 SD). The other case (PA) had hyperammonemia for only 12 hours on day 7 and was diagnosed on day 8 by neonatal tandem-mass screening. She was started on a sufficient protein-restricted diet with essential amino acids and adequate energy immediately after diagnosis. She has shown no mental delay or failure-to-thrive (final height, -0.3 SD). We conclude that improved growth with organic acidemia can be expected with early diagnosis and early initiation of suitable nutrition management.
The patient was a 73-year-old man with advanced gastric cancer. Because of invasion to pancreas, we initiated neoadjuvant chemotherapy (NAC) with S-1 and cisplatin (CDDP), and anticipated down-staging of the tumor. After 3 cycles of this regimen, we performed a total gastrectomy with lymph node dissection (D2). Microscopic findings revealed remarkable fibrous changes and no cancer cells in the gastric wall and lymph nodes, which were judged to be a Grade 3 effect (Complete response). This case suggested that S-1/CDDP combination chemotherapy may be useful in treating patients with advanced gastric cancer.
Papillary muscle rupture is considered to be one of the least frequently critical complications of acute myocardial infarction. It causes rapid hemodynamic collapse, and requires surgical treatment. Recently, cardiac surgeries have increased in the oldest-old patients, however postoperative complications are comparatively high among these patients. An octogenarian male patient was admitted with chest pain and dyspnea, and diagnosed with rupture of the papillary muscle after sub-acute myocardial infarction. Urgent mitral valve replacement was performed. The postoperative condition was favorable with no complication and the patient was discharged 12 days after the operation.
Omental bleeding is frequently caused by trauma; i.e., it occurs as a result of inflammation, such as peritonitis following abdominal trauma, and omental torsion due to thrombus or hematoma. Causes of non-traumatic bleeding include rupture of omental varices, infarction, anti-coagulant therapy, diathesis, such as hemophilia, and malignant omental tumors. Omental bleeding of unknown cause has, however, only been reported rarely. We experienced a case of resection with idiopathic omental bleeding but no history of trauma or aneurysm. This case is presented with a discussion of the relevant literature.