We encountered a case of Japanese spotted fever in Unnan City, Shimane Prefecture. A 77-year-old woman visited our hospital complaining of fatigue. Initially, we diagnosed tsutsugamushi disease based on the constellation of presenting symptoms and clinical signs including fever, systemic erythema, and an eschar. However, the eschar was submitted for polymerase chain reaction analysis and was found to be positive for Rickettsia japonica. The final diagnosis was Japanese spotted fever. To the best of our knowledge, this is the first report of Japanese spotted fever in Unnan City, and there is a possibility that the condition has spread not only in the north of the prefecture but also in the south. This may be due to the widening habitat of ticks harboring R. japonica. Interestingly, the wild boar, a suspected vector, has expanded its habitat to the south of the prefecture. Research on the ecology of the wild boar is warranted.

We report our experience with percutaneous endoscopic gastrostomy (PEG) to assess the safety and usefulness of the PEG. We reviewed 21 cases (mean age, 72 years), including 20 patients with neurological impairment and one patient with cancer of the stomach.
Though two minor complications (wound infection and bleeding from the stomach) occurred, wound infection healed with antibiotics and bleeding stopped spontaneously. Six of these patients died (3 died from pneumonia, 2 from respiratory failure, and 1 from stomach cancer), but there were no PEG-related deaths. After PEG procedure, serum protein, albumin and cholesterol improved significantly. PEG was not only safe but also effective for the nutritional support and the 4-year survival rate was 56%. By this method, moreover, half of the patients could leave hospital and return home.
In conclusion, PEG, is thought to be the procedure of choice for the long-term enteral nutrition.

PURPOSE: This study aimed to investigate anterior knee symptoms in patients who underwent anterior cruciate ligament (ACL) reconstruction using bone-patellar tendon-bone (BPTB) graft followed by implantation of a beta-tricalcium phosphate (β-TCP) block as a bone void filler. MATERIALS AND METHODS: We retrospectively reviewed 84 cases of synthetic bone grafting using a β-TCP block for the patellar bone defect in ACL reconstruction with a BPTB autograft. Computed tomography of the operated knee was performed immediately after the surgery to evaluate whether the grafted β-TCP block protruded forward from the anterior surface of the patella. On the basis of the results, the cases were divided into a protrusion group (n=31) and a non-protrusion group (n=53). Anterior knee symptoms at 12 months postoperatively and absorption of the grafted β-TCP block were compared between the two groups. RESULTS: Except for patellofemoral crepitus, there was no significant difference in anterior knee symptoms between the two groups (p>0.05). The incidence of patellofemoral crepitus was significantly lower in the protrusion group than in the non-protrusion group (p=0.027). The groups showed no significant difference in β-TCP absorption. CONCLUSIONS: The present study demonstrated that the protrusion of β-TCP that was used as a bone void filler had no adverse effects.
Absorption ; Anterior Cruciate Ligament Reconstruction ; Anterior Cruciate Ligament ; Autografts ; Bone Transplantation ; Bone-Patellar Tendon-Bone Grafts ; Humans ; Incidence ; Knee ; Patella ; Retrospective Studies ; Tissue Donors ; Transplants

Introduction: Brachiocephalic artery stenosis rarely causes right hemispheric infarction with associated left hemiparesis. To date, there have been no reported cases of stroke associated with brachiocephalic artery stenosis that were successfully treated with recombinant tissue-type plasminogen activator (rt-PA), alteplase.Case Report: An 80-year-old woman presented with left hemiparesis. Brain computed tomography showed no hemorrhage, and computed tomography angiography demonstrated brachiocephalic artery stenosis. Alteplase was administered based on a diagnosis of ischemic stroke. Brain magnetic resonance imaging showed multiple acute infarctions. Thereafter, the blood pressure of the right arm was found to be lower than that of the left arm. The patient’s neurological deficits gradually improved; she was eventually able to walk again and was thus discharged home.Conclusion: While the combination of left hemiparesis and a decrease in blood pressure in the right arm are well known in patients with stroke associated with Stanford type A aortic dissections, it may also occur in patients with stroke due to brachiocephalic artery stenosis. Unlike stroke associated with Stanford type A aortic dissections, stroke due to brachiocephalic artery stenosis may be treated with alteplase.