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

Natural history of Upshaw-Schulman syndrome based on ADAMTS13 gene analysis in Japan

Upshaw–Schulman syndrome (USS) is an extremely rare hereditary deficiency of ADAMTS13 activity, termed congenital TTP. The clinical signs are usually mild during childhood, often with isolated thrombocytopenia. But their symptoms become more evident when patients have infections or get pregnant. We identified 43 USS-patients in Japan, who ranged in age from early childhood to 79 years of age. Analysing the natural history of these USS patients based on ADAMTS13 gene mutations may help characterise their clinical phenotypes. Severe neonatal jaundice that requires exchange blood transfusion, a hallmark of USS, was found in 18 of 43 patients (42%). During childhood, 25 of 43 patients were correctly diagnosed with USS without gender disparity. These 25 patients were categorised as having ‘the early-onset phenotype’. Between 15 and 45 years of age, 15 were correctly diagnosed, and, interestingly, they were all female. The remaining three patients were male and were diagnosed when they were older than 45 years of age, suggesting that they were ‘the late-onset phenotype’. Two of these three males developed sudden overt TTP when they were 55 and 63 years old, respectively. These two men had two different homozygous ADAMTS13 gene mutations, p.R193W/p.R193W and p.C1024R/p.C1024R, respectively. Both of which were not discovered in the US or Western countries. In vitro expression studies showed that these two proteins were consistently secreted into the culture medium but to a lesser extent and with reduced activity compared to the wild-type protein. Our results indicate that ‘the late-onset phenotype’ of USS is formed with ethnic specificity.・The definitive version is available at " http://dx.doi.org/10.1111/j.1538-7836.2011.04341.x "・State of the Art 2011 : XXIII Congress of the International Society on Thrombosis and Haemostasis Invited Reviewhttp://dx.doi.org/10.1111/j.1538-7836.2011.04341.

Changing conception of indication for peripheral arterial reconstruction surgery.

末梢動脈の慢性閉塞性疾患に対する直達血行再建術の長期の予後は必ずしも満足できるものではない。合成代用血管は，長期の植え込みにより内被の肥厚，退行性変性，および材質の変性の様な合併症により，特に小口径の合成代用血管の適応は極めて限られたものになっている。一方，医用質量分析装置を用いた虚血肢の実験的研究によると，自由に運動させた犬の虚血肢では，急性期に比較すると3カ月以後その組織循環は有意に増加することが明らかとなった。また，家兎を用いた実験的研究によると，炭酸泉浴に高濃度のラドン吸入を合併すると皮下組織の組織循環が約30％増加して，同時に皮下の酸素分圧が上昇することを確かめた。従って，切迫壊死の症例をのぞいて，末梢動脈の慢性閉塞性疾患々肢，特に間欠性跛行に対しては，自 然予後を考慮して歩行負荷，および炭酸泉，ラドン泉の温泉療法を用いた保存的療法が長期の予後上効果的である。Peripheral arterial reconstruction surgery for chronic occlusive diseases has not always produced satisfactory results according to long-term (5-10 years) follow-up studies. Furthermore, application of synthetic vascular prostheses of small caliber for peripheral reconstruction is quite restricted to certain circumstances, because of the complications derived from long-term implantation such as thickening and degeneration of the inner capsule and deterioration of the grafts used. On the other hand, experimental studies on ischemic limbs revealed a significant increase of tissue perfusion in 3, 6 and 12 months following ischemia was induced (p<0.001) compared with the acute ischemic stage in freely moving dogs by means of medical mass spectrometry. In addition, subcutaneous tissue perfusion was found increased by about 30 % with CO(2) bathings in combination with Radon inhalation of high concentration (over 5000 Bq/l), which was accompanied by an elevation of subcutaneous pO(2). Therefore, medical treatments such as walking exercise and bathings with CO(2) and Radon based on the natural history of chronic peripheral arterial occlusive diseases, particularly intermittent claudication, appear feasible

Screening test for chromosome aberrations of long-time residents in misasa spa.

三朝温泉のラドン含有は，源泉で約1347～2694Bq／l，常用温泉水で137～224Bq／l，また，屋内では7.3～73.7Bq／lである。三朝温泉地に出生して，28～75年にわたる入浴者9名，および三朝温泉地外に出生して16～78 年にわたる入浴者4名について末梢静脈血の染色体検査を，ギムザ染色，および特に長年入浴している3名についてはG一分染法による分析を行なった。浴水，および生活環境のラドン濃度の多寡によらず，長年の入浴によっても染色体の構造変化は正常範囲内であった。Screening test for chromosome aberrations of 13 long time residents, 9 native and 4 movingin in Misasa Spa was performed. Each Radon content in baths ranges 166-224 Bq/l, in homes 8.6-73.7 Bq/l, and in offices 8.4-22 Bq/l. Normal Karyotypes on both sexes and normal range of aberrations, gaps and breaks, were found in chromosome analyses. There are no significant radioactive effects from longtime bathings and from environment in both groups of Misasa spa districts, corresponding to the facts of no significant incidence of infertility, malformations, a brief span of life, and neoplasms compared to other places

Clinical effects of serial artificial CO(2) baths on degenerative disorders in consideration of the improved tissue perfusion.

組織循環の良不良は，結合織の退行性病変の予後に大いに影響をおよぼすものである。人工炭酸泉を用いた実験的検討で，すでに組織循環の30　％　増加を認めており，臨床的治験により好傾向を示す結果を得つつある。結合織病変を主とする慢性疾患4症例の治験前後に局所組織流量を測定して評価することができた。局所組織流量は医用質量分析装置を介したオンラインシステムで測定計算した。人工炭酸浴は，炭酸ガスキャビン，および人工炭酸浴剤浴を用いた。人工炭酸泉浴は，1カ月より1年におよび，それぞれ自覚症状の著名な改善と，組織流量の増加を定量しえた。人工炭酸泉の連浴による組織流量の改善は、結合織の退行性病変に有効に作用するものである。Tissue perfusion plays an important role in prognosis of the deteriorating connective tissue disorders. Tissue perfusion was evaluated before and after CO(2) treatment on the patients with connective tissue disorders by means of medical mass spectrometer. CO(2) treatment was performed in 2 ways ; one was with CO(2)-cabine, 20 litres per minute at 40℃ for 20 minutes, and the other was with an artificial CO(2) bathing prepared with 2 tablets of BUB-KAO, a 50 g sodium hydrogencarbonate and succinic acid tablet, in 280-litre-tub at 40℃ for 20 minutes. Case 1, 33-year-old female, suffering from chronic rheumatic arthritis with rheumatic thromboangiitis obliterans in the left 5th toe. Main arterial trees were found intact arteriographically. Her joint pain and muscle stiffness have been improved markedly after CO(2) treatment with cabin every day for one month though every medicine for rheumatism made little effect. Case 2, 46-year-old female, suffered from progressive systemic scleroderma. Major blood supply was found not blocked in upper extremities arteriographically. Tissue perfusion was found poor in muscle tissue of each forearm before CO(2) treatment with cabin, whereas an improved tissue perfusion was confirmed after one month of serial CO(2) treatment, leading to ameliorate persistent muscle stiffness, though every medicine for her made slow effect. Case 3, 48-year-old female, suffering from the weakness in strength with no positive laboratory findings of connective tissue disorders. Tissue perfusion has been found quite improved following serial artificial CO(2) bathings for 12 months, being able to work hard every day as a nurse. Serial CO(2) bathing is thought to be very useful in ameliorating the symptoms of deteriorating connective disorders by virtue of an improved tissue perfusion

Profile of Blood Glucose in Diabetic Patient Suffered from Diabetic Foot Osteomyelitis with Effective Low Carbohydrate Diet

The case was 52-year-old female with type 2 diabetes mellitus (T2DM) for 10-years. She complained of the decreased sensation of right lower foot, and revealed diabetic foot infection (DFI) and/or diabetic foot osteomyelitis (DFO) at right 1st proximal phalanx. Various data included body mass index (BMI) 33.3 kg/m2, HbA1c 11.4%, blood glucose 430 mg/dL, WBC 12100 /μL, C-reactive Protein (CRP) 13.5 mg/dL. On admission (day 1), she was started by 4 times of injection (Aspart and Glargin) with glucose profile 200-500 mg/dL. Surgical amputation of the right toe was performed between 1st metatarsal and proximal phalanx (day 17). Then, blood glucose profile decreased moderately. After discharge of the hospital, super-Low Carbohydrate Diet (LCD) was started without Aspart (day 37). Consequently, glucose profile was normalized with HbA1c 6.3% on (day 77). Consequently, LCD was evaluated to be effective for glucose variability in this case and some related discussion was described