Spine Alignment in Standing and Maximal Upper Limb Elevation in Baseball Players with Lumbar Spondylolysis and Those without Low Back Pain

The changes in lumbar lordosis angle (LL) and sacral slope angle (SS) related to upper limb elevation and thoracic kyphosis angle (TK) in baseball players with spondylolysis remain unclear. Herein, we investigated baseball players with spondylolysis and those without low back pain, comparing LL and SS with upper limb elevation within and between groups and TK between groups. Baseball players with spondylolysis were enrolled as subjects, and baseball players without low back pain were enrolled as controls (n = 8 each). X-rays were obtained in the standing position and with maximal elevation position of the upper limb (elevation position). LL and SS were measured in the standing and elevated positions, and TK was measured in the standing position. LL was significantly larger in individuals with spondylolysis than controls. The SS of the control group was significantly larger in the elevated position than in the standing position, while the SS of the spondylolysis group was not significantly different between positions. SS was significantly larger in the spondylolysis group than in the control group, only in the standing position. Physical therapy for spondylolysis should focus on hyperlordosis alignment in the standing and maximal elevation positions of both upper limbs, sacral hyper-slope alignment in the standing position, and decreased sacral slope motion

SUCCESSFUL TREATMENT OF OBSTRUCTIVE JAUNDICE IN A CARCINOMA OF THE PAPILLA OF VATER BY ENDOSCOPIC ULTRASOUND-GUIDED CHOLEDOCHODUODENOSTOMY

A 78-year-old man who was admitted to Akita University Hospital complained of jaundice andabdominal discomfort. He was diagnosed with obstructive jaundice that was caused by the carcinomaof the papilla of Vater based on the esophagogastroduodenoscopy (EGD) with a biopsy andcomputed tomography (CT). His condition was inoperable due to hepatic and lung metastasis,and he rejected any chemotherapy. Therefore, a palliative therapy to decompress the biliaryobstruction for the improvement of jaundice and the prophylaxis of cholangitis wasrequired. Although endoscopic retrograde biliary drainage (ERBD) was first attempted todecompress the biliary obstruction, it failed because of the tumor invasion. Next, endoscopicultrasound-guided choledochoduodenostomy (EUS-CDS) was carried out successfully, and thejaundice improved with the decrease of the serum bilirubin values from 30.1 mg/dl to 6.1 mg/dl onthe day of his discharge. He left the hospital and maintained his quality of life