コドモ ノ コッセツ ノ チリョウ

Trauma is the major cause of morbidity and mortality among children. Since the mid 1930’s, trauma has been the leading cause of death in persons from 1 to 44 years of age, far exceeding death from infections. In those younger than 35 years, morbidity and mortality resulting from injury far exceeds that from cancer and heart disease. Fractures in children differ from those in adults in several ways : ( 1 ) Bone healing is very rapid in childhood because of the thickened periosteum and abundant blood supply. ( 2 ) Accurate anatomic reduction is less important than in the adult because malunited fragments are realigned spontaneously by active bone remodeling. ( 3 ) Injuries involving the physis may produce growth disturbance with/without angular deformity. ( 4 ) Fractures through the diaphysis or metaphysis stimulate longitudinal overgrowth of the bone

Disuse Osteoporosis

Reduction of mechanical stress on bone inhibits osteoblast-mediated bone formation and accelerates osteoclast-mediated bone resorption, and leads to what has been called disuse osteoporosis. Prolonged therapeutic bed rest, immobilization due to motor paralysis from injury of the central nervous system or peripheral nerves, application of cast to treat fractures, a common causes of disuse osteoporosis. Imaging diagnosis shows coarse trabecular pattern and thinning of cortical bones. Bone metabolism markers have been used to evaluate bone metabolism. From the viewpoint of bone metabolism, antiresorptive agents should be administered to inhibit bone resorption. Rehabilitation, including bed positioning, therapeutic exercise and electrical stimulation, should be prescribed to subject the atrophied bone to an appropriate level of mechanical stress. In spite of these aggressive and continuous treatments, most cases of disuse osteoporosis require a long time for bone to recover its bone mineral density and strength. Hence, we have to keep in mind that there are no treatments better than prophylaxis of disuse osteoporosis

トクシマケン ニオケル ハイヨウ ショウコウグン ノ ジッタイ ト セイカツ シュウカン カラ ミタ ヨボウサク : コウセイ ロウドウ カガク ケンキュウヒ ホジョキン チョウジュ カガク ソウゴウ ケンキュウ ジギョウ カラ ロウジン ホケン ケンコウ ゾウシントウ ジギョウ エノ テンカイ

Long-term recumbency causes decreases not only in motor function, but also in other organs, which is called disuse syndrome. We had been engaged in a study entitled“Investigation of the actual condition of elderly Japanese with disuse syndrome and the development of therapeutic physical exercises to improve activities of daily living”, which was supported by Grant of Japanese Ministry of Health and Welfare from fiscal 2006 to 200７. This study showed the number of bedridden elderly residents of Tokushima and Naruto Cities. In addition, we developed a therapeutic physical exercise named“Awa Odori Dance for Rehabilitation”, which allowed elderly aged 65 years or over to improve their physical fitness and anxiety about falling down. We have been engaged in our current study entitled“Study of the therapeutic effects of Awa Odori Dance for Rehabilitation of Physical Fitness and Enjoyment of Living for Elderly Japanese.” A grant from the Japanese Ministry of Health and Welfare has also supported this study. Elderly residents of Tokushima Prefecture have been participating in this study. They performed Awa Odori Dance for Rehabilitation twice a week for one month at the medical facilities

Effects of constitution, atraumatic vertebral fracture and aging on bone mineral density and soft tissue composition in women

Constitution, atraumatic vertebral fracture and aging affect bone mineral density(BMD) and soft tissue composition. The high body weight of obese women involves a high mechanical load being exerted on weight bearing bones compared with thin women, which probably contributes to their higher BMD and the lower incidence of fractures in obese women compared with thin women. Atraumatic vertebral fracture (AVF) is a typical osteoporotic fracture and its favorite site of AVF is the vertebral bodies of the thoracolumbar region. The BMD of weight bearing bones is lower in patients with AVF than in patients without AVF, whereas there is no significant difference in soft tissue composition between the two. The regional and total BMD decrease with advancing age. The magnitude of the decrease in lumbar and thoracic BMD is high compared with other regional BMD, and total fat mass and total lean mass decline with age to their respective minimal level. The high rate of decrease in lumbar and thoracic BMD appears to be due to the high content of trabecular bone compared with other regional bones

Intergenerational comparison of total and regional bone mineral density and soft tissue composition in Japanese women without vertebral fractures

We measured total and regional bone mineral density (BMD) and soft tissue mass in 115 healthy Japanese women without vertebral fractures. The subjects, aged 20 to 75 years, were divided into four age groups : 20’s to 40’s group (n=33), 50’s group (n=26), 60’s group (n=26), and 70’s group (n=30). BMD was measured by dual energy X-ray absorptiometry (DXA).The evaluated regions were the head, arms, legs, ribs, thoracic vertebrae, lumbar vertebrae and pelvis. The total and regional BMDs were the highest in the 20’s to 40’s group, and they decreased with age, and reached their respective lowest values in the 70’s group. The decrease in BMDs of the spine and pelvis was the most prominent of all regional BMDs. Total and regional lean mass and fat mass were the highest in the20’s to 40’s group, and they decreased to their respective lowest values in the 70’s group. The results showed that the decrease in BMD of the spine and pelvis was the most prominent of all regional BMDs associated with a decrease in the total and regional lean mass and total and regional fat mass

Early changes in muscle atrophy and muscle fiber type conversion after spinal cord transection and peripheral nerve transection in rats

BACKGROUND: Spinal cord transection and peripheral nerve transection cause muscle atrophy and muscle fiber type conversion. It is still unknown how spinal cord transection and peripheral nerve transection each affect the differentiation of muscle fiber type conversion mechanism and muscle atrophy. The aim of our study was to evaluate the difference of muscle weight change, muscle fiber type conversion, and Peroxisome proliferator-activated receptor-γ coactivatior-1α (PGC-1α) expression brought about by spinal cord transection and by peripheral nerve transection. METHODS: Twenty-four Wistar rats underwent surgery, the control rats underwent a laminectomy; the spinal cord injury group underwent a spinal cord transection; the denervation group underwent a sciatic nerve transection. The rats were harvested of the soleus muscle and the TA muscle at 0 week, 1 week and 2 weeks after surgery. Histological examination was assessed using hematoxylin and eosin (H&E) staining and immunofluorescent staing. Western blot was performed with 3 groups. RESULTS: Both sciatic nerve transection and spinal cord transection caused muscle atrophy with the effect being more severe after sciatic nerve transection. Spinal cord transection caused a reduction in the expression of both sMHC protein and PGC-1α protein in the soleus muscle. On the other hand, sciatic nerve transection produced an increase in expression of sMHC protein and PGC-1α protein in the soleus muscle. The results of the expression of PGC-1α were expected in other words muscle atrophy after sciatic nerve transection is less than after spinal cord transection, however muscle atrophy after sciatic nerve transection was more severe than after spinal cord transection. CONCLUSION: In the conclusion, spinal cord transection diminished the expression of sMHC protein and PGC-1α protein in the soleus muscle. On the other hand, sciatic nerve transection enhanced the expression of sMHC protein and PGC-1α protein in the soleus muscle

Differences of therapeutic effects on regional bone mineral density and markers of bone mineral metabolism between alendronate and alfacalcidol in Japanese osteoporotic women

We studied the differences of therapeutic effects on regional bone mineral density (BMD) and markers of bone mineral metabolism between alendronate and alfacalcidol in Japanese osteoporotic women. Ninety-two Japanese women suffering from primary osteoporosis without osteoporotic fractures, aged 55 to 81 years, were divided into two groups : women treated orally with alendronate for one-year (5mg/day)(alendronate group, n=35) and women treated orally with alfacalcidol for one year (0.5μg/ day) (alfacalcidol group, n=57). The mean BMD of the 2nd to 4th lumbar vertebrae (L2-4 BMD) and regional BMD were measured using dual energy X-ray absorptiometry. In the alendronate group, the percentage changes of L2-4BMD, lumbar spine BMD, thoracic spine BMD, pelvis BMD in the alendronate group were 106.3±4.6%, 104.2±6.6%, 107.1± 10.4%, 107.1±10.5%, respectively. The percentage changes of L2-4BMD and regional BMD except for head BMD in the alendronate group were significantly greater than those in the alfacalcidol group. In the alfacalcidol group, L2-4BMD, thoracic spine BMD and lumbar spine BMD were maintained at respective pretreatment levels, whereas other regional BMD were decreased. Both serum bone-specific alkaline phosphatase and urinary type I collagen cross-linked N-telopeptide of the alendronate group were decreased, whereas these markers of bone mineral metabolism of alfacalcidol group were increased compared with the respective pre-treatment levels. The results suggest that one-year treatment with alendronate increased L2-4BMD, lumbar spine BMD, thoracic spine BMD and pelvis BMD, and that markers of both bone formation and bone resorption were decreased following one-year treatment with alendronate

MRI Changes of the Spinal Subdural Space after Lumbar Spine Surgeries: Report of Two Cases

Although magnetic resonance imaging (MRI) is frequently used to assess the lumbar spine, there are few reports in the medical literature that have evaluated using MRI immediately following spinal surgery. Furthermore, descriptions of the subdural changes after lumbar spine surgery are also infrequent. In this paper, we present two cases with subdural change seen on MRI immediately after lumbar surgery. Both the patients had mild symptoms that resolved spontaneously, and the follow-up MRI scans showed resolution of the subdural changes. Subdural changes should be considered as one of the possible causes of unexpected symptoms in patients following lumbar spinal surgery