We report a 30-year-old man with an extensive cerebral contusion. He presented with severe left upper and lower limb paralysis and mild right lower limb palsy. He was diagnosed with severe sleep apnea syndrome and was treated with nighttime nCPAP (nasal Continuous Positive Airway Pressure). Four years after the injury, he was able to walk with Lofstrand crutches. However, he gradually began to have difficulty standing, walking and driving his wheelchair because his spasticity developed markedly. He received ITB (intrathecal baclofen) therapy and noted a reduction in spasticity. He was once again able to drive his wheelchair and to walk with support. In addition, his respiratory function didn't show any deterioration. Spasticity is a common complication after cerebral or spinal cord injury, for which treatment has been difficult. ITB therapy can dramatically reduce spasticity, but has been demonstrated that it may also depress respiratory function in patients with respiratory insufficiency. This case suggests that ITB therapy may reduce spasticity without affecting respiratory function even in patients with a respiratory disorder.

BACKGROUNDThere are few longitudinal studies on the associations of obesity with hypertension in young adults.

OBJECTIVESTo analyze longitudinally to what extent weight gain associates with hypertension in young adults.

METHODSThe subjects of this study consisted of 6,178 university students (male 4,098; female 2,080). The associations of hypertension with body type change were longitudinally examined by using the records of health examinations while at university. The prevalence ratios (PRs) for hypertension in their senior year were calculated on groups that changed toward obese against those that changed toward underweight. The logistic regression analyses were used to estimate odds ratios (ORs) for hypertension in their senior year of each factor. The analyses were conducted on (i) all subjects, (ii) non-hypertensive subjects in their freshman year, and (iii) by schools, in order to take into account physical activities.

RESULTSThe PRs of hypertension in subjects changed toward obese from their freshmen to seniors against ones toward underweight were 1.47 (95% CI; 1.00-2.15) for males and 3.50 (0.93-13.22) for females. In analyses limited to non-hypertensive subjects in their freshman year, results were similar to those of all subjects. The analyses by school also showed similar results to those including all subjects. In logistic regression analyses, although the factor most strongly associated with hypertension was body type in their senior year, the body type in their freshman still showed significant association with hypertension after the adjustment of senior year body type and hypertension in freshman year. The ORs for hypertension in obese subjects to normal weight ones in their senior year were 9.13 (95% CI; 5.77-14.45) for males and 22.59 (5.69-89.67) for females after adjusted by hypertension in freshman, body type in freshman and school.

CONCLUSIONSThese data suggest that the increase of BMI is linked to hypertension in university students.

A 51-year-old woman presented with a high fever and weakness and was diagnosed with mitral valve infective endocarditis. Medical treatment was unsuccessful, and the patient developed disseminated intravascular coagulation syndrome, multiple cerebral infarctions, and massive cerebral hemorrhage. She was transferred to our hospital for surgical treatment. On admission, she had motor aphasia and right-sided hemiplegia. Echocardiography showed mild mitral regurgitation with a huge mobile vegetation measuring greater than 20 mm on the anterior leaflets. Head CT showed a huge cerebral hemorrhage in the left frontal lobe. Chest radiography revealed severe pulmonary congestion, and laboratory data showed disseminated intravascular coagulation syndrome. Despite medical treatment, the pulmonary congestion worsened. There were concerns that a fatal cerebral infarction would develop, and so urgent open-heart surgery was performed. On the day after the cerebral hemorrhage had occurred, hematoma removal and decompressive craniotomy were performed to reduce the risks associated with cardiopulmonary bypass. Four days after the craniotomy, mitral valve plasty was performed following the complete excision of the infected tissue. Heparin was administered at our normal dosage as an anticoagulant during cardiopulmonary bypass. Postoperative head CT showed no aggravation of the preoperative cerebral lesion. The patient still had symptomatic epilepsy and difficulty performing exact movements with her right hand, but she was able to walk unaided after 1 year of rehabilitation. Generally, early surgery for infective endocarditis is not recommended if the patient has concomitant cerebral hemorrhage ; our strategy may be the safest option for patients in such a serious condition.

Objective: Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), was first reported in China and subsequently spread worldwide. In Japan, many clusters occurred during the first wave in 2020. We describe the investigation of an early outbreak in a Tokyo hospital. Methods: A COVID-19 outbreak occurred in two wards of the hospital from April to early May 2020. Confirmed cases were individuals with laboratory-confirmed SARS-CoV-2 infection linked to Wards A and B, and contacts were patients or workers in Wards A or B 2 weeks before the index cases developed symptoms. All contacts were tested, and cases were interviewed to determine the likely route of infection and inform the development of countermeasures to curb transmission. Results: There were 518 contacts, comprising 472 health-care workers (HCWs) and 46 patients, of whom 517 were tested. SARS-CoV-2 infection was confirmed in 42 individuals (30 HCWs and 12 patients). The proportions of SARS-CoV-2 infections in HCWs were highest among surgeons, nurses, nursing assistants and medical assistants. Several HCWs in these groups reported being in close proximity to one another while not wearing medical masks. Among HCWs, infection was thought to be associated with the use of a small break room and conference room. Discussion Nosocomial SARS-CoV-2 infections occurred in two wards of a Tokyo hospital, affecting HCWs and patients. Not wearing masks was considered a key risk factor for infection during this outbreak; masks are now a mandated countermeasure to prevent the spread of SARS-CoV-2 infection in hospital settings.