Primary cardiac tumors are rare. Myxoma is the most common type of benign cardiac tumor and papillary fibroelastoma (PFE) is the second most common. We report a case of coexisting left atrial myxoma and aortic valve PFE. A 77-year-old Japanese woman with a left atrial mass was referred to our hospital for further diagnostic evaluation and surgical treatment. The mass was detected by coronary computed tomography, which was performed by her general practitioner. Investigation with an echocardiogram revealed a mass on the fossa ovalis, extending into the left atrium. Intraoperative transesophageal echocardiography (TEE) showed another mass attached between the left coronary cusp (LCC) and the right coronary cusp of the aortic valve. After cardiopulmonary bypass and cardioplegic arrest, we performed an aortotomy, and observed the aortic valve. We found a mobile mass on the LCC and resected it. After left atriotomy, a left atrial myxoma was identified and resected, together with its margin. Postoperatively, sinus bradycardia, sinus pauses, and atrial fibrillation tachycardia were identified. Therefore, we implanted a permanent pacemaker on the 29th postoperative day. The patient was discharged on the 38th postoperative day. Simultaneous existence of two different primary cardiac tumors is rare. We believe that preoperative and intraoperative TEE in patients with cardiac tumors is important.

Anterior Cruciate Ligament Injury often occurs as a result of knee valgus collapse during landing or pivoting in sports activity. Previous studies reported that the risk of ACL injuries was reduced by jump and balance training, and those training can be effective as the prevention program for the ACL injuries. But those studies often focused on only adult athletes, and there are few studies focused on junior athletes. The purpose of this study is to investigate the pattern of landing movement in junior athletes, and to verify the effect of the prevention program. One-hundred and ten junior basketball players (boys; 61, girls;49, age ranging 12 to 15) were subjected in this study. We measured the knee flexion, valgus angles and jump height during continuous vertical jump. After measuring, they executed a prevention program for 12 weeks. The motion pattern of the knee during jump test were compaired between before and after prevention program. Female athletes showed greater knee valgus angle at initial landing phase and grater maximum knee valgus angle than those of males. As a result of the prevention program, maximum knee valgus angle was significantly decreased in female athletes. The greater angle of knee valgus in female may increase the risk of ACL injuries. Present study suggests that the prevention program is useful for reducing the risk of ACL injury. Increment of jump height in male players after this program might be considered that this training program has also an effect of performance improvement.

The aim of this study is to investigate the characteristics of pre-existing physical factors associated with the onset of Osgood-Schlatter disease (OSD) in junior soccer players. Fifty-nine junior soccer players of the elementary school were included in this study. The boys who had been diagnosed as OSD were excluded. At the time of the first investigation, the subjects were examined through physical evaluation and an ultrasonography. The subjects were followed up one and a half years, and the tibial tuberosity was classified according to the growth stages using the ultrasonography. After the end of follow-up period, the subjects were divided into two groups, those with signs and symptoms of OSD that appeared during the follow up period and those without that. The Mann-Whitney U test was used for the comparison between OSD group’s and control group’s initial assessments. The players who were followed up for one and half years were 38 people. 5 knees of the 4 players were clinically diagnosed as OSD (OSD group), and the remaining 34 players with no symptoms of the OSD constituted the control group. The range of the bilateral hip external rotation, straight leg raise of the non-dominant side, and knee flexion in the OSD group were significantly lower than those in the control group (p < 0.05). We concluded that a decrease in specific joint flexibility might be related with the onset of OSD.

Chronic expanding haematoma (CEH) is a rare type of haematoma that enlarges slowly and continuously without coagulation. It can occur following surgery because of shear stress-induced bleeding in the scar tissue between the subcutaneous fat and fascia. We present three cases of large chronic CEH that were successfully treated with triamcinolone injections. Three female patients developed large chronic CEH at 9 months, 5 years, and 6 years, respectively, after latissimus dorsi flap harvesting for breast reconstruction. Although the condition did not improve after multiple sessions of haematoma aspiration in the first two patients, it resolved following a single 40-mg triamcinolone injection along with appropriate compression dressing for several weeks. In the third patient, triamcinolone was injected immediately after the initial aspiration of the haematoma, and the condition improved considerably. There were no side effects in any of the patients. To the best of our knowledge, this is the first report of successful treatment of large CEH using triamcinolone. Therefore, we suggest that triamcinolone injections be considered for the treatment of CEH.
Bandages ; Cicatrix ; Fascia ; Female ; Free Tissue Flaps ; Hemorrhage ; Humans ; Mammaplasty ; Seroma ; Subcutaneous Fat ; Superficial Back Muscles* ; Triamcinolone*

To explore the efficacy and safety of switching from once-daily basal insulin therapy to once-daily pre-meal injection insulin degludec/insulin aspart (IDegAsp) with respect to the glycemic control of participants with type 2 diabetes mellitus (T2DM).

OBJECTIVE: It is important to develop an easy means of diagnosing lumbar foraminal stenosis (LFS) in a general practice setting. We investigated the use of the Japanese Orthopaedic Association Back Pain Evaluation Questionnaire (JOABPEQ) to diagnose LFS in symptomatic patients. METHODS: Subjects included 13 cases (mean age, 72 years) with LFS, and 30 cases (mean age, 73 years) with lumbar spinal canal stenosis (LSCS) involving one intervertebral disc. The visual analogue scale score for low back pain and leg pain, the JOABPEQ were evaluated. RESULTS: Those with LFS had a significantly lower JOA score (p<0.001), while JOABPEQ scores (p<0.05) for lumbar dysfunction and social functioning impairment (p<0.01) were both significantly lower than the scores in LSCS. The following JOABPEQ questionnaire items (LFS vs. LSCS, p-value) for difficulties in: sleeping (53.8% vs. 16.6%, p<0.05), getting up from a chair (53.8% vs. 6.6%, p<0.001), turning over (76.9% vs. 40%, p<0.05), and putting on socks (76.9% vs. 26.6%, p<0.01) such as pain during rest, and signs of intermittent claudication more than 15 minutes (61.5% vs. 26.6%, p<0.05) were all significantly more common with LFS than LSCS. CONCLUSION: Results suggest that of the items in the JOABPEQ, if pain during rest or intermittent claudication is noted, LFS should be kept in mind as a cause during subsequent diagnosis and treatment. LFS may be easily diagnosed from LSCS using this established patient-based assessment method.
Asian Continental Ancestry Group* ; Back Pain* ; Constriction, Pathologic* ; Diagnosis ; General Practice ; Humans ; Intermittent Claudication ; Intervertebral Disc ; Leg ; Low Back Pain ; Methods ; Spinal Canal

PURPOSE: Opioids improve pain from knee and hip osteoarthritis (OA) and decrease the functional impairment of patients. However, there is a possibility that opioids induce analgesia and suppress the physiological pain of OA in patients, thereby inducing the progression of OA changes in these patients. The purpose of the current study was to investigate the possibility of progressive changes in OA among patients using opioids. MATERIALS AND METHODS: Two hundred knee or hip OA patients were evaluated in the current prospective, randomized, active-controlled study. Patients were randomized 1:1:1 into three parallel treatment groups: loxoprofen, tramadol/acetaminophen, and transdermal fentanyl groups. Medication was administered for 12 weeks. Pain scores and progressive OA changes on X-ray films were evaluated. RESULTS: Overall, pain relief was obtained by all three groups. Most patients did not show progressive OA changes; however, 3 patients in the transdermal fentanyl group showed progressive OA changes during the 12 weeks of treatment. These 3 patients used significantly higher doses than others in the transdermal fentanyl group. Additionally, the average pain score for these 3 patients was significantly lower than the average pain score for the other patients in the transdermal fentanyl group. CONCLUSION: Fentanyl may induce progressive changes in knee or hip OA during a relatively short period, compared with oral Non-Steroidal Anti-Inflammatory Drugs or tramadol.
Aged ; Aged, 80 and over ; Analgesics, Opioid/*adverse effects/therapeutic use ; Disease Progression ; Female ; Fentanyl/*adverse effects/therapeutic use ; Humans ; Male ; Middle Aged ; Osteoarthritis, Hip/*drug therapy/radiography ; Osteoarthritis, Knee/*drug therapy/radiography ; Pain/drug therapy

STUDY DESIGN: Retrospective observational study. PURPOSE: To examine fractional anisotropy (FA) values and apparent diffusion coefficient (ADC) values of damaged nerves to discriminate between lumbar intraspinal stenosis (IS) and foraminal stenosis (FS) using diffusion tensor imaging (DTI) OVERVIEW OF LITERATURE: It is important in the selection of surgical procedure to discriminate between lumbar IS and FS, but such discrimination is difficult. METHODS: There were 9 cases of IS, 7 cases of FS, and 5 healthy controls. The regions of interest were established in the lumbar intraspinal zone (Iz), nerve root (N), and extraforaminal zone (Ez). The FA and ADC values were measured on the affected and unaffected sides of the nerves. The FA ratio and the ADC ratio were calculated as the affected side/unaffected side ×100 (%). RESULTS: In the Ez, the FA value was significantly lower in FS than in IS (p<0.01). FA ratio was significantly lower in FS than in IS for the Ez (p<0.01). In the Iz, the ADC value was significantly higher in IS than FS (p<0.01). ADC ratio was significantly higher in FS than in IS for the N and Ez (p<0.05). For the Ez, receiver operating characteristic analysis of parameters revealed that the FA values showed a higher accuracy for the diagnosis of FS than the ADC values, and the FA value cut-off value was 0.42 (sensitivity: 85.7%, false positive: 11.1%) and the FA ratio cut-off value was 83.9% (sensitivity: 85.7%, false positive: 22.2%). CONCLUSIONS: The low FA value in the extraforaminal zone suggests the presence of foraminal stenosis. When the FA value and FA ratio cut-off value were established as 0.42 and 83.9%, respectively, the accuracy was high for the diagnosis of foraminal stenosis. It may be possible to use DTI parameters to help in the discrimination between IS and FS.
Anisotropy ; Constriction, Pathologic* ; Diagnosis ; Diffusion Tensor Imaging* ; Diffusion* ; Discrimination (Psychology)* ; Observational Study ; Retrospective Studies ; ROC Curve

Diagnosis of lumbar foraminal stenosis remains difficult. Here, we report on a case in which bilateral lumbar foraminal stenosis was difficult to diagnose, and in which diffusion tensor imaging (DTI) was useful. The patient was a 52-year-old woman with low back pain and pain in both legs that was dominant on the right. Right lumbosacral nerve compression due to a massive uterine myoma was apparent, but the leg pain continued after a myomectomy was performed. No abnormalities were observed during nerve conduction studies. Computed tomography and magnetic resonance imaging indicated bilateral L5 lumbar foraminal stenosis. DTI imaging was done. The extraforaminal values were decreased and tractography was interrupted in the foraminal region. Bilateral L5 vertebral foraminal stenosis was treated by transforaminal lumbar interbody fusion and the pain in both legs disappeared. The case indicates the value of DTI for diagnosing vertebral foraminal stenosis.
Constriction, Pathologic* ; Diagnosis* ; Diffusion Tensor Imaging* ; Diffusion* ; Female ; Humans ; Leg ; Leiomyoma ; Low Back Pain ; Magnetic Resonance Imaging ; Middle Aged ; Neural Conduction