Tuberculous spondylitis, or so-called Pott's disease, seems to be overlooked because of a lack of severe inflammation in the insidious generating process and tends to cause non-specific symptoms, such as back pain, fever, weakness, and weight loss. Diagnostic delay is common and the results can be disastrous. Discriminating between Pott's disease and other diseases, such as malignancy and pyogenic infection, is difficult. However, the inflammatory process in Pott's disease tends to spare the disk space, while that of pyogenic infection typically affects the area. Herein, we present a patient with Pott's disease who showed the characteristic clinical and radiological findings.

The purpose of this study is to evaluate MRI findings for the shoulder pain in hemiplegic stroke patients in relation to clinical characteristics. We studied 18 hemiplegic patients with first-ever stroke presenting with shoulder pain in the affected side (mean age±SD=67.6±10.1years ; 8 men and 10 women ; 12 right and 6 left hemiplegia). All patients had shoulder pain during passive movements and 4 also had pain at rest. The mean duration from stroke onset to MRI was 67±42 days. MRI revealed abnormal findings in all patients. Tendinosis of the long head of the biceps and supraspinatus tendon injuries were most frequently found. The tendinosis of the long head of the biceps was related to hemihypesthesia and a reduced range of motion for external rotation of the shoulder. The supraspinatus tendon injuries were related to older age and lower Fugl-Meyer (FM) and Functional Independence Measure (FIM) scores. The mean number of abnormal findings per patient was 3.2±1.4. The patients with more than 3 abnormal findings were significantly older, had shorter duration from stroke onset and lower FM and FIM scores than those with less findings. It was suggested that those patients with more severe paresis might have more abnormal findings on their MRIs for shoulder pain.

The authors experienced a case of fatal cerebellar, and brainstem infarction accompanying clamping of the left subclavian artery during operation for thoracic aortic aneurysm. Autopsy of this case revealed that right vertebral artery became markedly hypoplastic distal to the posteroinferior cere bellar artery, and left vertebral and basilar arteries were occluded by thrombus formation. These findings indicate that clamping of the dominant left subclavian artery is responsible for severe vertebrobasilar ischemia producing the fatal brain infarction. Since the occurrence of this devastating complication, we have performed pancerebral angiography and balloon occlusion test of the left subclavian artery in patients who might undergo proximal clamping of the aortic arch between the left carotid artery and the left subclavian artery during operations for thoracic aortic aneurysm. Selective perfusion of the left subclavian artery is then planned for those with abnormal vertebrobasilar communications producing neurological signs.

Left ventricular hypertrophy in patients with aortic valve disease has long been recognized as a significant risk factor for aortic valve replacement. Higher operative mortality in such patients has been attributed to poor myocardial preservation. In these patients improvement of left ventricular subendocardial blood flow during reperfusion seems to be mandatory to avoid subendocardial injury. Therefore, we attempted to increase subendocardial blood flow during reperfusion by terminal warm blood cardioplegia (TWBCP) followed by controlled aortic root reperfusion (CARR) in patients requiring isolated aortic valve replacement. The patients with TWBCP and CARR had a tendency towards severe left ventricular hypertrophy and more advanced NYHA function class compared to those with hypothermic cardioplegia alone. Nevertheless, the patients with TWBCP and CARR showed significantly better recovery of left ventricular function, i.e., spontaneous recovery of beating and higher cardiac index as well as left ventricular stroke work index, despite significantly less catecholamine support. These resuls suggest that TWBCP followed by CARR may offer significant benefits over unmodified reperfusion during aortic valve replacement for patients with severe left ventricular hypertrophy.

Underwater weighing is based on the assumption that fat-free body density is roughly constant among humans. This assumption should be examined, because fat-free body density may in fact depend on the bone mineral and water contents of the body, with fat excluded. The purpose of this study was to investigate the effects of bone mineral content (BMC) and density (BMD) on the accuracy of body fat measured underwater. The subjects were 12 young men (25.1±3.7 years, mean ± SD), some of whom were trained athletes. BMC and BMD were measured by dual-energy x-ray absorptiometry (DXA), as was body fat, as a percentage of body weight; this method is not based on the assumption that fat-free body density is the same in different individual. Body fat as a percen tage of body weight was measured underwater, also. Body fat measured by DXA was significantly correlated with that found by underwater weighing (r = 0.83, p<0.01), as expected, but the mean body fat found by DXA was 4.3% higher. The differences between results by the two methods for individuals were from -11.5% to 2.7%, and the differences were negatively correlated with BMC/fat-free weight (FFW ; r=-0.82, p < 0.01) and BMD (r=-0.85, p<0.01) . Fat-free body density ranged from 1.097 to 1.111 g/cm³because BMC/FFWs varied with the individual. We concluded that individual differences in BMC/FFW and BMD affected the fat-free body density. The variations in fat-free body density would give rise to systematic errors in body composition measured underwater.

Background: Rotavirus vaccines were introduced in Japan in November 2011. We evaluated the subsequent reduction of the health-care burden of rotavirus gastroenteritis. Methods: We conducted active surveillance for rotavirus gastroenteritis among children under 5 years old before and after the vaccine introduction. We surveyed hospitalization rates for rotavirus gastroenteritis in children in Tsu City, Mie Prefecture, Japan, from 2007 to 2015 and surveyed the number of outpatient visits at a Tsu City clinic from 2010 to 2015. Stool samples were obtained for rotavirus testing and genotype investigation. We assessed rotavirus vaccine coverage for infants living in Tsu City. Results: In the pre-vaccine years (2007-2011), hospitalization rates for rotavirus gastroenteritis in children under 5 years old were 5.5, 4.3, 3.1 and 3.9 cases per 1000 person-years, respectively. In the post-vaccine years (2011-2015), the rates were 3.0, 3.5, 0.8 and 0.6 cases per 1000 person-years, respectively. The hospitalization rate decreased significantly in the 2013-2014 and 2014-2015 seasons compared to the average of the seasons before vaccine introduction (p < 0.0001). In one pre-vaccine year (2010-2011), the number of outpatient visits due to the rotavirus infection was 66. In the post-vaccine years (2011-2015), the numbers for each season was 23, 23, 7 and 5, respectively. The most dominant rotavirus genotype shifted from G3P[8] to G1P[8] and to G2P[4]. The coverage of one dose of rotavirus vaccine in Tsu City was 56.5% in 2014. Conclusion: After the vaccine introduction, the hospitalization rates and outpatient visits for rotavirus gastroenteritis greatly decreased.

A 47-year-old woman with body temperature 35.6 ℃ took the 3rd COVID-19 vaccine shot at our clinic on Day 1. Since she felt chills and suffered from genital bleeding on Day 3, she visited our clinic to take a gynecological examination. Her temperature was 37.1 ℃ at that time. On Day 15, she suffered sustained symptoms of chills and general fatigue, and she went to another internal medicine clinic to take a medical care. However, her condition was unexplained and she was referred to a general hospital. On Day 16, she came to our clinic to confirm results of the gynecological examination. Her symptoms persisted even though the data showed no problems, so we prescribed her saikokeishikankyoto (SAKK) for only 3 days. On Day 19, SAKK dramatically improved her symptoms. On Day 37, her temperature was 36.2 ℃ without any symptoms.

　　It is said that diabetes is one of the factors contributing to the onset of dementia and accelerating its progression. The number of dementia cases is expected to increase steadily year by year. Such being the circumstances, we encountered an elderly woman with diabetes and dementia, who managed to lower her blood glucose values to a proper level somehow or other, thus lightening the burden of caregivers. We shall hereby report the case because we thought it would make a good example for care in the region where the population is rapidly graying. The woman, then at age 80, visited our hospital complaining of languidness. Her blood sugar level was so high (random blood glucose level: 1,096 mg/dl) that she was hospitalized at once. By a stepwise insulin reinforcement therapy, the blood glucose levels were under control. During the stay in hospital, she was also diagnosed as having senile dementia. She was provided with effective health care and education for the control of blood sugar levels. Having snacks between meals was strictly prohibited. Considering that she was an elderly person living alone, only internal medicines were given. As a result, her blood glucose levels were elevated to about 300 mg/dl, but the combined use of GLP-1 injection and internal medicine once a week had good control over blood glucose levels. So, the patient was discharged from the hospital.