The therapeutic use of ultrasound has been investigated in a series of 427 patients with pain, such as rheumatoid arthritis, osteoarthritis, neuralgia (primary or secondary), myalgia, traumatic and skin diseases.
1) Methods:
US-intensity; 2w/cm, 1Mc/s
Moving method, 10 treatments in each patient.
Exposure; 10min.
2) Therapeutic effect in different disease:
In 88 patients with skin disease, sprain, contusion and back myalgia, over 30% of them were cured or improved 100%, In patients with rheumatoid arthritis, cervical spondylosis, neuralgia and tenovaginitis the two third of them were improved excellently. In four patients with acute gouty arthritis, the net result of US-therapy was spectacularly good.
3) Synergistic therapy:
In a series of 128 patients with rheumatoid arthritis, synergistic therapy of intra-articular injection of steroid hormone and US-treatment were given. The effect of intra-articular injection of steroid hormone have shown to be lasted longer than single intra-articular injection, In a series of 50 patients with skin disease, the phonophoretic trial of cream or ointment containing steroid hormone with US-treatment were performed. The therapeutic effect was good to excellent in patients with eczema or dermatitis.
In a series of 28 patients with sprain and contusion, the synergistic therapy of ointment containing heparinoid preparation with US-treatment have been studied in 17 patients. The swelling, pain and subcutaneous hemorrhage in those patients were improved earlier.
4) No appreciable side effect of US-therapy was observed in our study. The US-therapy appears to be important addition to the existing therapeutic armamentarium for diseases we have studied.

The authors performed a survey of the treatment of fracture and the prognosis and described about the importance of rehabilitation for improving the result of treatment of fracture.
Eight hundred and forty-six cases of fractures (included 324 cases of open fracture and 181 cases of pseudoarthrosis) were observed in this report. The main point of treatment of fracture is to avoid the sequels and to reduce a period of therapy.
The systematic treatment fo fracture should include a detailed plan of treatment a proper therapy and an appropriate after-treatment with the concept of rehabilitation. Namely, it has to keep a principle of treatment of fracture and needs to carry out autokinesis, the subject of after-treatment, constructively.
In 233 cases of fractures 17% of them showed dysfunction after treatment and the average period of admission was 4 months. At this point the authors realized an impostance of rehabilitation in cure of fracture.
On the after-treatment of fracture patients enforced to do isotonic muscular contraction and cross-education even in the time of fixation.
After removal of fixation, they received physical therapy, such as supported active movement, autokinesis and duplicated motion (or movement against resistance.) The hydrotherapy was more effective in the early muscular training.

PURPOSE : The purpose of the present study was to clarify the effect of static stretching on muscular performance with concentric isotonic muscle actions under various loads.METHODS : Concentric isotonic leg extension power outputs were assessed in 12 healthy male subjects after two types of pre-treatment. The pre-treatments included 1) static stretching (SS) treatment performing static stretching of leg extensors, and 2) non-stretching (NS) treatment by resting in a sitting position. Loads during the assessment of the power output were set to 5%, 30% and 60% of the maximum voluntary contractile (MVC) torque with isometric leg extension in each subject.RESULTS : The peak power output following the SS treatment was significantly (P<0.05) lower than that following the NS treatment under each load.CONCLUSION : The present study demonstrated that static stretching significantly reduces power output with concentric isotonic muscle actions under various loads. This result suggests that static stretching decreases power performance.

No abstract available.
Carcinosarcoma*

Background/Aims: Post-endoscopic retrograde cholangiopancreatography pancreatitis (PEP) is the most common and serious complication of endoscopic retrograde cholangiopancreatography. To prevent this event, a unique precutting method, termed opening window fistulotomy, was performed in patients with a large infundibulum as the primary procedure for biliary cannulation, whereby a suprapapillary laid-down H-shaped incision was made without touching the orifice. This study aimed to assess the safety and feasibility of this novel technique. Methods: One hundred and ten patients were prospectively enrolled in this study. Patients with a papillary roof size ≥10 mm underwent opening window fistulotomy for primary biliary access. In addition, the incidence of complications and success rate of biliary cannulation were evaluated. Results: The median size of the papillary roof was 6 mm (range, 3–20 mm). Opening window fistulotomy was performed in 30 patients (27.3%), none of whom displayed PEP. Duodenal perforation was recorded in one patient (3.3%), which was resolved by conservative treatment. The cannulation rate was high (96.7%, 29/30 patients). The median duration of biliary access was 8 minutes (range, 3–15 minutes). Conclusions Opening window fistulotomy demonstrated its feasibility for primary biliary access by achieving great safety with no PEP complications and a high success rate for biliary cannulation.

Background/Aims: Endoscopic ultrasound-guided tissue acquisition (EUS-TA) is a standard diagnostic method for biliary tract cancer (BTC), and samples obtained in this manner may be used for comprehensive genomic profiling (CGP). This study evaluated the utility of EUS-TA for CGP in a clinical setting and determined the factors associated with the adequacy of CGP in patients with BTC. Methods: CGP was attempted for 105 samples from 94 patients with BTC at the Aichi Cancer Center, Japan, from October 2019 to April 2022. Results: Overall, 77.1% (81/105) of the samples were adequate for CGP. For 22-G or 19-G fine-needle biopsy (FNB), the sample adequacy was 85.7% (36/42), which was similar to that of surgical specimens (94%, p=0.45). Univariate analysis revealed that 22-G or larger FNB needle usage (86%, p=0.003), the target primary lesions (88%, p=0.015), a target size ≥30 mm (100%, p=0.0013), and number of punctures (90%, p=0.016) were significantly positively associated with CGP sample adequacy. Conclusions EUS-TA is useful for CGP tissue sampling in patients with BTC. In particular, the use of 22-G or larger FNB needles may allow for specimen adequacy comparable to that of surgical specimens.

Background/Aims: Endoscopic ultrasound (EUS)-guided hepaticogastrostomy (EUS-HGS) performed at the intrahepatic bile duct segment 3 (B3) is widely used for biliary drainage. Although performing post-puncture procedures is easier in the intrahepatic bile duct segment 2 (B2) when using a conventional oblique-viewing (OV) EUS scope, this method may cause transesophageal puncture and severe adverse events. We evaluated the safety and efficacy of B2 puncture using a novel OV-EUS scope. Methods: In this single-center retrospective study, we prospectively enrolled and collected data from 45 patients who consecutively underwent EUS-HGS procedures with a novel OV-EUS scope between September 2021 and December 2022 at our cancer center. Results: The technical success rates of B2-EUS-HGS and EUS-HGS were 93.3% (42/45) and 97.8% (44/45), respectively. The early adverse event rate was 8.9% (4/45) with no cases of scope changes or transesophageal punctures. The median procedure time was 13 minutes (range, 5–30). Conclusions B2-EUS-HGS can be performed safely with the novel EG-740UT (Fujifilm) OV-scope without transesophageal puncture and with a high success rate. B2-EUS-HGS using this novel OV scope may be the preferred strategy for EUS-HGS.

Background/Aims: Endoscopic ultrasound (EUS)-guided hepaticogastrostomy (EUS-HGS) is useful for patients with biliary cannulation failure or inaccessible papillae. However, it can lead to serious complications such as bile peritonitis in patients with ascites; therefore, development of a safe method to perform EUS-HGS is important. Herein, we evaluated the safety of EUS-HGS with continuous ascitic fluid drainage in patients with ascites. Methods: Patients with moderate or severe ascites who underwent continuous ascites drainage, which was initiated before EUS-HGS and terminated after the procedure at our institution between April 2015 and December 2022, were included in the study. We evaluated the technical and clinical success rates, EUS-HGS-related complications, and feasibility of re-intervention. Results: Ten patients underwent continuous ascites drainage, which was initiated before EUS-HGS and terminated after completion of the procedure. Median duration of ascites drainage before and after EUS-HGS was 2 and 4 days, respectively. Technical success with EUS-HGS was achieved in all 10 patients (100%). Clinical success with EUS-HGS was achieved in 9 of the 10 patients (90 %). No endoscopic complications such as bile peritonitis were observed. Conclusions In patients with ascites, continuous ascites drainage, which is initiated before EUS-HGS and terminated after completion of the procedure, may prevent complications and allow safe performance of EUS-HGS.

Background/Aims: Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) is a highly accurate method for diagnosing pancreatic neuroendocrine tumors (PNETs); however, some PNETs are difficult to diagnose. Recently, the efficacy of needle-based confocal laser endomicroscopy (nCLE) in diagnosing solid pancreatic masses has been reported. However, the efficacy of nCLE in the diagnosis of PNETs remains unknown and only a small number of cases have been reported. Hence, this study aimed to evaluate the efficacy of nCLE in the diagnosis of PNETs. Methods: This single-center retrospective study evaluated 30 consecutive patients with suspected PNETs on contrast-enhanced computed tomography, who consented to nCLE combined with EUS-FNA and were diagnosed using EUS-FNA or surgical resection. The diagnostic criteria for PNETs using nCLE were based on the nesting and trabecular and glandular arrangement of tumor cell clusters surrounded by capillary vessels and fibrosis, as reported in previous studies. Results: The diagnosis using nCLE was classified into three categories: misdiagnosis in three cases (10%), non-diagnostic in six cases (20%), and diagnostic in 21 cases (70%). nCLE was able to diagnose PNET in one of the two cases with inconclusive EUS-FNA. Conclusions Although further development of the resolution and optimization of the diagnostic criteria are required, nCLE may constitute a useful diagnostic option in cases of inconclusive EUS-FNA for PNETs.