Abstract We investigated the number of cases for which the secondary fracture prevention fee 1 could not be calculated and the causes. The subjects were 100 patients who were hospitalized and operated on for proximal femur fractures from April to September 2022. The number of cases was 24 in April, 7 in May, 9 in June, 20 in July, 12 in August, and 28 in September. There were 8 non-calculated patients: 5 in April, and 1 each in May, June, and August. Of these, 2 were under 50 years of age and were not calculated, 3 were omitted even though they fulfilled the conditions for calculation, 2 had incomplete examinations, and 1 had incomplete prescriptions. In June 2022, as a countermeasure against omissions, a cost entry field was added to the surgical checklist to alert the nurse in charge of the patient, and a message board in the electronic medical record clearly indicated that the patient was eligible for the calculation. To prevent omissions of tests and prescriptions, the staff in charge of receipts checks for omissions of tests and prescriptions in a timely manner during hospitalization, and notifies the orthopaedic surgeon in charge if there are any omissions. These measures enabled us to calculate 100% of the charges by September 2022.

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[in Japanese]

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In April 2022, the medical service fee was revised and 〈″〉additional fee for exercise guidance during dialysis〈/″〉 was approved as a new evaluation of exercise guidance during dialysis. In this study, we examined the calculation status of the additional fee for exercise during dialysis and the effect of exercise therapy during dialysis on physical function. Of 24 outpatients who received the additional fee for exercise during dialysis from August to October 2022, 14 patients who had completed the final evaluation of changes in physical function as of December 6, 2022, were included in the analysis. The total number of patients who received the additional fee for exercise during dialysis treatment during the same period was 676, and the total amount of the fee was 50,700 points. The effect of exercise therapy on physical function was observed as a significant decrease in grip strength, but a trend toward improvement in walking speed and Short Physical Performance Battery was observed. Patient satisfaction was also high. Key words: additional fee for exercise guidance during dialysis, dialysis, exercise therapy, physical functions, patient satisfaction

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[in Japanese]

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[in Japanese]

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[in Japanese]

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[in Japanese]

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Diagnosing intraabdominal testis is important because it can cause small bowel obstruction (SBO). There are reports of SBO caused by malignant tumors in the intraabdominal testis, but only a few studies report SBO caused by factors other than malignant tumors. Herein, we report a case of intraabdominal testis complicated with a tunica albuginea cyst, which caused adhesive SBO due to abdominal trauma. Intraabdominal testis can cause recurrent SBO if not surgically removed. In our case, the SBO recurred a month after adhesiotomy was performed, and intraabdominal testis was removed. The characteristic imaging findings of intraabdominal testis should be known and a correct preoperative diagnosis should be made.

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A 72-year-old man was admitted to our hospital after a new type of coronavirus infection, worsening ischemia of the right lower extremity, and necrosis of the right toes. Contrast-enhanced CT showed occlusion of external iliac artery, superficial femoral artery and popliteal artery, and patency of common femoral artery and posterior tibial artery. Coronary angiography showed severe stenosis of left anterior descending artery (LAD) and circumflex artery (CX). Preoperative ankle brachial pressure index (ABI) was unmeasurable, and skin perfusion pressure (SPP) was highly depressed. Stent grafting of right common iliac artery to external iliac artery and right common femoral artery to posterior tibial artery bypass with a great saphenous vein were performed. After confirming improvement of ABI and SPP, the patient underwent right total toe amputation by plastic surgery. He underwent off-pump coronary artery bypass (left internal thoracic artery to LAD) and percutaneous coronary angioplasty for CX for a two-vessel coronary artery lesion. In the present case, a hybrid technique was selected for both lower extremity and coronary revascularization, and good results were obtained.

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A 73-year-old man, critically injured in a burn incident resulting from cooking gas explosion, was transferred by helicopter ambulance to Shimane Prefectural central hospital. Upon arrival, the patient was intubated. The Total Burn Surface Area (TBSA) was 84%, mainly with Deep Burns (DB), and the Prognostic Burn Index (PBI) was 150. We performed enzymatic debridement on the maximum insurance coverage of 30% Burn Surface Area (BSA) in total with topical agent Nexobrid (Kaken Pharmaceutical Co.,Ltd.), a concentrate of proteolytic enzymes extracted from pineapple stem, launched in Japan in August, 2023. Nexobrid only removes nonviable necrotic tissue or eschar in Deep Dermal Burns (DDB) and DB even in the early period after trauma, when accurate evaluation of burn depth is often challenging. Early accurate debridement raises the possibility of dermal preservation, which is important for spontaneous epithelization, and wound bed preparation if skin graft is needed. While the patient died of circulatory failure 4 days after trauma, our experience suggests that Nexobrid is an early, accurate, and less-invasive alternative in debridement, and may assist treatment for burns that affected larger area with surgical debridement combination. However, additional experiences and follow-ups are required to susbtantiate its benefit.

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Posterior cerebral circulation aneurysms are difficult to reach surgically because of their deep location in the brain. In recent years, endovascular coil embolization has been the first choice in many centers. However, it is assumed that surgical treatment options may be necessary for various reasons. We report a case in which a basilar artery-superior cerebellar artery aneurysm was successfully treated by clipping. The patient, a woman in her 70s, underwent clipping of an incidental aneurysm of the basilar artery-superior cerebellar artery. Intraoperative findings indicated that the anterior temporal approach was difficult, so a modified Dolenc approach was used, and neck clipping was possible. Various approaches have been developed to obtain a good surgical field for distal basilar artery aneurysms. Because of the risk of nerve damage associated with the dissection of the intrinsic dura mater during epidural manipulation, we report on our efforts to minimize the need for this manipulation and to ensure sufficient working space.

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[in Japanese]

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Background: Cervical spine infectious diseases such as pyogenic spondylitis and epidural abscess can be fatal if diagnosis is delayed; however, it is difficult to distinguish them from non-infectious inflammatory diseases, especially from pseudogout. This study aim to identify clinical indicator facilitate the swift diagnosis of pseudogout. Methods: Patients diagnosed with cervical spine infectious diseases and cervical spine non-infectious inflammatory diseases between January 1, 2000, and December 31, 2020, at Shimane Central Hospital were included. Data on patient’s characteristics, vital signs, physical examination findings, underlying diseases, laboratory tests, medication history, lifestyle history, and imaging tests were extracted from the integrated information system; multivariate analysis was performed using descriptive statistics, univariate analysis, and logistic analysis. Results: The study included 265 participants; of them, 147 (56%) were male, the mean age was 73±16 years, and 84 (32%) had infectious diseases. In the univariate analysis, infectious diseases were prevalent in male, younger patients, and those with a history of alcohol consumption, patients with smoking history, patients with paralysis, patients who experienced numbness, and patients who used psychotropic medication. Dyslipidemia was potentially associated with non-infectious diseases. In the multivariate analysis of infectious diseases, the odds ratios were higher for paralysis (odds ratio [95% confidence interval]: 5.5 [2.4–12.5]) and psychotropic medication use (3.2 [1.4–7.2]) and lower for older age (0.9 [0.9–0.95]) and dyslipidemia (0.2 [0.1–0.6]). Conclusion: Paralysis, psychotropic medication use, age, and dyslipidemia are important factors in differentiating cervical spine infectious diseases.

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