Comparison of scapular upward rotation during arm elevation in the scapular plane in healthy volunteers and patients with rotator cuff tears pre- and post-surgery.

[Background] Function loss caused by rotator cuff tears alters the scapular orientation, however, few prior studies have reported on scapular movements after rotator cuff repair. The purpose was to determine the scapular orientations before and after rotator cuff repair. [Methods] We recruited 14 healthy controls, 10 small and six massive rotator cuff tear in patients. The scapular upward rotation during arm elevation was analyzed using fluoroscopic imaging. [Findings] Before surgery, both rotator cuff groups demonstrated greater scapular upward rotation compared to healthy controls. Two months postoperation, the analyses showed significant differences between the patients with small rotator cuff tears and healthy controls at arm elevations of 90°, and between patients with both rotator cuff tear groups and healthy controls at arm elevations of 120°. At five months post-operation, significant differences still existed between the healthy controls and both rotator cuff groups. In regard to the temporal effects in the patients with small rotator cuff tears, the scapular upward rotation decreased significantly over time (2–5 months postoperation) at arm elevations of 120°. We did not identify a main effect owing to time in the patients with massive rotator cuff tears. [Interpretation] In patients with small rotator cuff tears, scapular upward rotation was reduced over the period of 2–5 months postoperation, however, the patients with massive rotator cuff tears showed greater scapular upward rotation throughout the experimental period. The results suggested that the execution of the rehabilitation program should consider that the tear size could affect scapular motion

Gastric perforation caused by Candida infection：Report of a case

An 89-year-old female was admitted to our hospital because of fever and abdominal pain. The patient had used an antihypertensive agent, but had not used either antibiotics, steroids, or potent antacids. An abdominal CT scan revealed free air and ascites. An emergency operation was performed for acute peritonitis caused by a gastrointestinal perforation. A perforated ulcer was observed at the posterior wall of the gastric body. A distal gastrectomy with intraperitoneal drainage and a Billroth II reconstruction was performed. A histological examination demonstrated a perforated ulcer surrounded by Candida infection. The patient developed an abscess in the abdominal cavity, but was discharged on the 52nd postoperative day. Although gastrointestinal Candida infection is commonly seen in immunocompromised host with diabetics or malignant diseases, habitual use of strong antacids can also cause severe Candida infection of the stomach in healthy persons. In this case, it was thus concluded that there may have been a decrease in immunity in this patient because of her advanced age 89 years old and malnutrition

トクシマ シミン ビョウイン ダイキボ ビョウイン ニオケル ソシキテキ Safety Management

Numerous medical errors have been reported on mass media recently. It is a regret that people have become less confident in medicine and have a great deal of skepticism in medical service. Medical profession is now committing to do everything possible to remove their skepticism and restore the confidence in medicine. However, increasing complexity in medical technologies and diversified medical services have made it difficult to eradicate medical errors completely. Nevertheless, we must do everything possible to reduce medical mistakes to an acceptable level. This can be only achieved by the all-out effort of the entire hospital staffs, not by the vigilance of the individual doctor, nurse or technician. We have to face a challenge to improve patient safety and build safer system by the joint effort of all the members of the hospital staffs. We have just initiated the systematic safety programs for the patients, though there are still many problems remaining to be solved. We documented and discussed our concept of informed consent at Tokushima Municipal Hospital, how it is practiced in our daily medical service

Day Surgery ヒガエリ シュジュツ ノ ゲンジョウ

From May 1999, the Day Surgery for the operations of inguinal hernia, cholecystolithiasis and benign thyroid tumor were introduced in our department. Twenty nine patients (5 inguinal hernia repairs in children, 11 tension free inguinal hernia repairs in adults, 8 laparoscopic cholecystectomies, 3 extirpations of benign thyroid tumors, 1 extirpation of giant breast tumor, 1 extirpation of skin tumor in child) were attempted to put the Day Surgery into practice. 2 cases (one : inguinal hernia of child, another inguinal hernia of adult) were not successful because of postoperative complications like wound pain. The day surgery for 27 cases were successfully carried out. As the Day Surgery has benefits of cutting down on expenses, saving time and reducing mental fatigue, the feelings of satisfaction of all of these patients were remarkably high. The system of the Day Surgery was almost established in our department , so we actively would like to extend the kinds of operations suitable for the Day Surgery

A Metastatic Jejunal Tumor from Squamous Cell Carcinoma of the Lung Found in an Intestinal Perforation

An 85-year-old male with advanced squamous cell carcinoma of the lung, who was diagnosed about 10 years prior to his current presentation, suddenly complained of abdominal pain and underwent an abdominal computed tomography scan, which revealed free air and massive ascites. He was admitted to our hospital for acute peritonitis and emergency surgery was performed. During the surgical procedure, a perforation of the jejunum was diagnosed and repaired. He was diagnosed to have a metastatic tumor originating from a squamous cell carcinoma of the lung. He improved and was transferred to the former hospital on the 27th postoperative day. Jejunal metastasis from squamous cell carcinoma of the lung is rare, and the prognosis of peritonitis due to a perforated intestinal metastasis from lung cancer is poor. There have been 10 reports of jejunal metastasis of squamous cell carcinoma of the lung reported in Japan between 2000 and 2011. Therefore, when patients with advanced lung cancer present with acute abdomen, it is necessary to keep in mind the possibility of a gastrointestinal metastatic tumor