How Cervical Reconstruction Surgery Affects Global Spinal Alignment.

BACKGROUND:There have been no reports describing how cervical reconstruction surgery affects global spinal alignment (GSA). OBJECTIVE:To elucidate the effects of cervical reconstruction for GSA through a retrospective multicenter study. METHODS:Seventy-eight patients who underwent cervical reconstruction surgery for cervical kyphosis were divided into a Head-balanced group (n = 42) and a Trunk-balanced group (n = 36) according to the values of the C7 plumb line (PL). We also divided the patients into a cervical sagittal balanced group (CSB group, n = 18) and a cervical sagittal imbalanced group (CSI group, n = 60) based on the C2 PL-C7 PL distance. Various sagittal Cobb angles and the sagittal vertical axes were measured before and after surgery. RESULTS:Cervical alignment was improved to achieve occiput-trunk concordance (the distance between the center of gravity [COG] PL, which is considered the virtual gravity line of the entire body, and C7 PL < 30 mm) despite the location of COG PL and C7PL. A subsequent significant change in thoracolumbar alignment was observed in Head-balanced and CSI groups. However, no such significant change was observed in Trunk-balanced and CSB groups. We observed 1 case of transient and 1 case of residual neurological worsening. CONCLUSION:The primary goal of cervical reconstruction surgery is to achieve occiput-trunk concordance. Once it is achieved, subsequent thoracolumbar alignment changes occur as needed to harmonize GSA. Cervical reconstruction can restore both cervical deformity and GSA. However, surgeons must consider the risks and benefits in such challenging cases

A Case of Inflammatory Lung Disease and Retroperitoneal Fibrosis Attributed to Systemic IgG4-related Disease

Recently, immunoglobulin (Ig) G4-related diseases such as autoimmune pancreatitis (AIP), sclerosingsialadenitis, retroperitoneal fibrosis, and sclerosing cholangitis have been reported. IgG4-related diseases arecharacterized by high serum IgG4 concentrations, sclerosing inflammation with numerous IgG4-positiveplasma cells, and steroid sensitivity, irrespective of their organ of origin. We describe a case of inflammatorylung disease and retroperitoneal fibrosis, suggested to involve IgG4. The patient was a 76-year-old man. Acomputed tomographic scan of the chest showed nodular air-space consolidation in the left upper lobe. Theserum IgG4 concentration was abnormally elevated, but there was no evidence of AIP. Bilateral hydronephrosisassociated with thickened soft tissue around the abdominal aorta had been diagnosed previously. Hehad undergone surgery, and retroperitoneal fibrosis was diagnosed histologically (hematoxylin and eosinstain). Histological examination of bronchoscopic specimens taken from the left S3 region showed mononuclear-cell infiltration of the fibrotic bronchial wall, including many IgG4-positive plasma cells. Specimens ofthe region affected by retroperitoneal fibrosis were retrospectively reanalyzed, and the cells were positivefor IgG4 on immunostaining, similar to the lung tissue. The patient responded to treatment with corticosteroids.In conclusion, the present case shared many clinical and clinicopathological similarities with systemicIgG4-related autoimmune disease. To our knowledge, however, this is the first reported case of inflammatorylung disease with retroperitoneal fibrosis in a patient with systemic IgG4-related autoimmune disease

ヒフ キンエン ノ ハッショウ オ ケイキ ニ シンダン サレタ ショウサイボウ ハイガン ノ 1レイ

74 歳男性.顔面,四肢,体幹の紅斑に続き,構音障害および嚥下障害,四肢筋肉痛並び脱力が出現し,起立困難となり入院となった.CK, ALD, AST, LDH 等筋原性酵素の著明上昇及び臨床所見により皮膚筋炎と診断された.高用量ステロイド療法その後シクロスポリンの追加にて治療開始し,検査所見に続き,臨床所見も改善傾向にあった.同時にproGRP 高値並びに全身CT 画像上縦隔リンパ節腫大認め,気管支鏡下気管支粘膜生検にて小細胞肺癌の病理診断が得られ,CBDCA+CPT-11 にて化学療法を施行,腫瘍の縮小効果を見た.皮膚筋炎が腫瘍随伴症候として,小細胞癌とほぼ同時期に発病したことを示唆した症例であったA 74-year-old man was admitted because of erythemaon face, extremities and trunk, followed by dysarthria, dysphagia,extremity myalgia accompanied with weakness, andthen difficulty in upstanding. Dermatomyositis (DM) wasdiagnosed on the basis of a marked increase in serum levelof myogenic enzymes, such as creatinin kinase, aldolase, aspartateaminotransferase and lactate dehydrogenase, andthe clinical manifestations. Introduction of high-dose glucocorticoidtherapy, subsequently concurrent administrationof cyclosporin, made laboratory data gradually return tonormal and produced slight symptom improvement. Inscreening for malignancies, high level of proGRP detectedin peripheral blood, computed tomography scan showed mediastinallymphadenopathy, and histopathologial testing ofthe transbronchial biopsy specimens revealed small celllung cancer (SCLC). Chemotherapy (CBDCA+CPT-11)started, resulting in tumor reduction. The current case maysuggest that DM coincided with SCLC around at the sametime, as a mean of paraneoplastic syndrome

ドッキョウ イカ ダイガク ビョウイン コキュウキ・アレルギー ナイカ ニオケル HIVカンセン カンジャ ノ カイセキ : トクニ ニューモシスチス ハイエン ノ ガッペイ レイ ニ ツイテ

獨協医科大学病院呼吸器・アレルギー内科を受診したHIV感染者を解析し,わが国および栃木県のHIV 感染者との比較検討を行った.対象は,2002年7月より2009年6月までの間,当科に受診歴のある34名(男27名,女7名,日本人29名,外国人5名),平均年齢は44.2歳(29歳〜67歳).男性の感染理由は,異性間(風俗,不特定)40.7%,同性間37.0%,女性はパートナーからの感染が57.1 %であった.64.7%がAIDS 発症によりHIV感染が判明し,HIV感染判明時の精査では79.4%がAIDSを発症しており,全症例の55.9%にニューモシスチス肺炎の合併を認めた.治療開始が推奨されているCD4陽性細胞低値(350/m l以下)は,97.1%の症例に認めた.以上の結果より,感染理由や年齢層については,全国の平均と同様な傾向を認めた.全国的には,HIV感染判明者の約7割がAIDS 発病前のキャリアの状態でHIV 感染が判明し,栃木県でも同様の傾向である.しかし,当科では大多数がAIDS 発症後およびAIDS 発症直前の低免疫状態でHIV 感染が判明しており,早期発見および早期介入が課題と考えられた.To be clear the clinical characteristics in Tochigi, we analyzedpatients with HIV infection in our department. Patientswith HIV infection between July 2002 and June 2009were 34 subjects (Man:Woman=27:7, Japanese:Foreigner=29:5), and mean age was 44.2 years old. In reasonof HIV infection for men, men who were infected by sexualintercourse with indefinite women were 40.7 % and menwho were infected by sexual intercourse with men were37.0 %. Women who were infected by their partners were57.1 %. 64.7 % of patients were recognized HIV infection byshowing AIDS. 79.4% of patients already had complicationsindicating AIDS, when they came to our hospital, and 55.9% of patients had pneumocystis jiroveci pneumonia. In 97.1% of patients, the number of CD4 positive cells were under350/m l. In conclusion, around 70 % of patients were recognizedHIV infection before they become AIDS in Japan. But,a large majority of patients in our department were withbecoming AIDS or just before AIDS. We need to developthe system of early intervention for HIV infection

Analysis of the Transition State of the Carbon and Iron Oxide Mixture Activated by Mechanical Milling

In previous study, the extremely high reaction rate obtained by the mechanical milling has been reported. It was found that the phenomena were quite complicated and the many factors were affected on the reactivity. Among these factors, the crystal state of hematite and atmosphere (air and argon) during the milling were quite important ones. Milling of hematite and graphite mixture was carried out both in the air and in the argon. Rate constants for the reactions were obtained by kinetic analysis. The enthalpy ΔH* and entropy ΔS* of activation were estimated on the basis of transition state theory. The interpretation of ΔS* and ΔH* was performed to explain the effect of milling on the reactivity related to the milling conditions. The temperature of peak of reaction curve decreased with increasing milling time. The reactivity of the sample milled in the argon atmosphere showed higher reactivity than that milled in the air. The enthalpy ΔH* and entropy ΔS* of activation were obtained from experimental rate constants. The variation of ΔH* and ΔS* with milling time showed opposite tendency between the sample milled in the air and in the argon. It was considered that the active complex having loose bonding would form during milling in the air atmosphere. On the other hand, the active complex having a structure closed to the product (metallic iron) might form

Factors on the Measurement of Effective Thermal Diffusivity of Molten Slag Using Double Hot Thermocouple Technique

The molten slags that are used not only in the continuous caster but also in every metal industry play an important role and affect the quality of products. The authors initially developed the double hot thermocouple technique (DHTT) for in situ observation of mold slag crystallization. In this study, the DHTT was further developed to allow the measurement of the overall thermal diffusivity of molten slag applying the principle of the laser flash method. The affecting factors (finite pulse time, shape of pulse and heat loss from sample surface) on the measurement of thermal diffusivity using the DHTT were discussed theoretically using both the analytical and the numerical methods. New relationship between the thermal diffusivity a and the time at half-maximum temperature t0.5 was obtained as follows: a(×104m2/s) = 0.000707(t0.5/tp)-1.8946 The thermal diffusivity obtained from the experimental half-maximum time t0.5/tp (tp is the time of peak on the heat pulse) was in good agreement with the one from literature

Kinetic analysis of coke gasification based on non-crystal/crystal ratio of carbon

Gasification of metallurgical coke was studied at 1 000, 1 200 and 1 400°C with Ar-CO-CO2 mixtures. Reaction of coke in blast furnace is dominant from 1 000°C. And at the same time, growth of graphite crystal in coke begins around the temperature. In present paper, two types of carbon structure were classified by means of X-ray diffraction. One is crystallite that contributes to X-ray diffraction, the other is noncrystalline carbon that contributes to background intensity alone. In this study, reaction model that the two kinds of carbon have different reactivity and react simultaneously and independently, was developed and kinetic analysis was performed. The following results were obtained. (1) Lc is linear function of temperature and there is no influence of reaction. (2) La is linear function of temperature in Ar atmosphere. But in existence of reaction, the size of La becomes to be smaller. From this result, it was considered that the gasification reaction proceeds such as mode of decreasing La. Reaction mechanism combining to characteristic of crystallographic structure is proposed

Water Gas Shift Reaction and Effect of Gasification Reaction in Packed-bed under Heating-up Condition

For the decrease of CO2 emission from ironmaking field, it is important to clarify the behaviors of hydrogen in blast furnace (BF). However, when hydrogen content increased in BF, many reactions related to hydrogen occurred, and many complicated relationships among the reactions are generated. Especially, the behavior of water gas shift reaction (WGSR) is not understood correctly and the effects on the gasification reaction and the reduction reaction are not known at all. In the present study, the interest was focused on the relationship between WGSR and coke gasification reaction. The WGSR was examined experimentally and kinetic analysis was performed with and without gasification reaction. The quantification of reaction rates was carried out by gas analysis method. Several kind of crucibles were developed for determining the respective reaction rates occurring in different position. The rate equation of invers WGSR was decided aswhere the rate constant in the alumina crucible was obtained as The single WGSR in alumina crucible is in an equilibrium state over 1573 K. Calculation of gasification reaction (KB, Boudouard reaction) in Zone 1 and Zone 1+2+3 were in excellent agreement with the observation under CO–CO2 system (without Hydrogen). When H2 was added to the reaction gases, Water gas reaction I (KW1) and II (KW2) in addition to KB were calculated separately and the total gasification reaction RCScal (=KB+KW1+KW2) was in good agreement with the observation. The relationship between the separated gasification reactions (KB, KW1 and KW2) and WGSR was discussed

Gas Evolution during Mechanical Milling of Hematite-Graphite Mixture

In previous studies, the reactivity of hematite-graphite mixture obtained by the mechanical milling was investigated. The rate of reaction has remarkably increased and the starting temperature of reaction decreased with the milling time. Understanding the phenomena and its mechanism occurring in the milling would contribute to develop the new feeding material for ironmaking process. In this study, milling of hematite and graphite mixture was carried out with the same procedure. Gas analysis by QMS was performed to clarify the evolved gas during milling qualitatively and quantitatively. Gas evolution from graphite was mainly CO gas. CO2 gas also evolved in the early stage of milling. These gases would be related to the adsorbed gases before milling. When the sample exposed to air in the course of milling, much gas adsorbed on the surface of milled graphite, which increased with the increasing milling time. When the hematite and graphite mixture was milled under argon atmosphere, mainly CO gas evolved owing to the reduction reaction. From these results of gas analysis, the mechanisms for the gas evolution during the milling were proposed