1.Persistent Severe Paraparesis after an Epidural Anesthesia Using Ropivacaine
Utako MIYAMOTO ; Etsuko MIZUTAMARI ; Makoto TOKUNAGA ; Kaoru MATSUNAGA ; Ryoji NAKANISHI
The Japanese Journal of Rehabilitation Medicine 2020;57(8):757-765
Paraparesis is a rare and serious complication following epidural anesthesia. Abnormal findings on magnetic resonance imaging (MRI) help with the diagnosis;however, diagnosis is challenging in the absence of MRI abnormalities.We present the case of a 26-year-old pregnant woman who received combined spinal-epidural anesthesia for cesarean delivery. The following day, she developed muscle weakness and sensory disturbances in the right lower extremity, which were attributable to the continuous epidural analgesia with ropivacaine that was used during the cesarean delivery. MRI revealed no spinal canal abnormalities;however, skeletal muscle MRI performed in the subacute phase revealed abnormally high signals on T2 and fat suppression T2-weighted imaging in the right paraspinal muscle below the L3 level. Nerve conduction studies revealed reduced amplitude of compound muscle action potentials and sensory nerve action potentials recorded in the lower extremities. After a 4-month period of rehabilitation, the patient could walk independently with a right ankle-foot orthosis and crutch;however, her right leg palsy and sensory disturbances persisted. Here, we report the clinical course of a patient who developed lumbosacral radiculopathy attributable to ropivacaine-induced neurotoxicity. Additionally, we present a review of the literature.
2.Persistent Severe Paraparesis after an Epidural Anesthesia Using Ropivacaine
Utako MIYAMOTO ; Etsuko MIZUTAMARI ; Makoto TOKUNAGA ; Kaoru MATSUNAGA ; Ryoji NAKANISHI
The Japanese Journal of Rehabilitation Medicine 2020;():19038-
Paraparesis is a rare and serious complication following epidural anesthesia. Abnormal findings on magnetic resonance imaging (MRI) help with the diagnosis;however, diagnosis is challenging in the absence of MRI abnormalities.We present the case of a 26-year-old pregnant woman who received combined spinal-epidural anesthesia for cesarean delivery. The following day, she developed muscle weakness and sensory disturbances in the right lower extremity, which were attributable to the continuous epidural analgesia with ropivacaine that was used during the cesarean delivery. MRI revealed no spinal canal abnormalities;however, skeletal muscle MRI performed in the subacute phase revealed abnormally high signals on T2 and fat suppression T2-weighted imaging in the right paraspinal muscle below the L3 level. Nerve conduction studies revealed reduced amplitude of compound muscle action potentials and sensory nerve action potentials recorded in the lower extremities. After a 4-month period of rehabilitation, the patient could walk independently with a right ankle-foot orthosis and crutch;however, her right leg palsy and sensory disturbances persisted. Here, we report the clinical course of a patient who developed lumbosacral radiculopathy attributable to ropivacaine-induced neurotoxicity. Additionally, we present a review of the literature.
3.Rimmed Vacuoles in Myositis Associated with Antimitochondrial Antibody
Rui SHIMAZAKI ; Akinori URUHA ; Hideki KIMURA ; Utako NAGAOKA ; Tomoya KAWAZOE ; Satoshi YAMASHITA ; Takashi KOMORI ; Kazuhito MIYAMOTO ; Shiro MATSUBARA ; Keizo SUGAYA ; Masahiro NAGAO ; Eiji SOZAKI
Journal of Clinical Neurology 2020;16(3):510-512
4.A Case of Cubital Tunnel Syndrome Due to Ulnar Nerve Dislocation Further Affected by Sitting Exercises Using an Over-table
Utako MIYAMOTO ; Kenichirou TERAMOTO ; Makoto TOKUNAGA ; Kei SAKAMOTO ; Seiya SHIIBA ; Hiroaki YAMANAGA
The Japanese Journal of Rehabilitation Medicine 2020;():20013-
Herein, we report a case of a 49-year-old man with a history of bilateral hemiplegia caused by severe traumatic brain injury. During his stay in the convalescent rehabilitation hospital, he developed a flexion deformity of the 4th and 5th fingers of his right hand. Elbow palpation and ultrasonography showed that the ulnar nerve was dislocated from the elbow canal, and a nerve conduction study revealed that the conduction velocity was low in the right elbow. Thus, a diagnosis of cubital tunnel syndrome was made and an ulnar nerve transfer was performed to prevent progression. Prior to onset, an over-table had been used by the patient for daily activities such as sitting, training, and eating. Therefore, it was considered that the repeated use of the over-table plausibly exerted pressure on the dislocated ulnar nerve, leading to the onset of the cubital tunnel syndrome.As over-tables and wheelchair armrests are often used during rehabilitation, it is imperative to pay attention to elbow compression when using them in patients with ulnar nerve dislocation.
5.A Case of Cubital Tunnel Syndrome Due to Ulnar Nerve Dislocation Further Affected by Sitting Exercises Using an Over-table
Utako MIYAMOTO ; Kenichirou TERAMOTO ; Makoto TOKUNAGA ; Kei SAKAMOTO ; Seiya SHIIBA ; Hiroaki YAMANAGA
The Japanese Journal of Rehabilitation Medicine 2021;58(5):572-577
Herein, we report a case of a 49-year-old man with a history of bilateral hemiplegia caused by severe traumatic brain injury. During his stay in the convalescent rehabilitation hospital, he developed a flexion deformity of the 4th and 5th fingers of his right hand. Elbow palpation and ultrasonography showed that the ulnar nerve was dislocated from the elbow canal, and a nerve conduction study revealed that the conduction velocity was low in the right elbow. Thus, a diagnosis of cubital tunnel syndrome was made and an ulnar nerve transfer was performed to prevent progression. Prior to onset, an over-table had been used by the patient for daily activities such as sitting, training, and eating. Therefore, it was considered that the repeated use of the over-table plausibly exerted pressure on the dislocated ulnar nerve, leading to the onset of the cubital tunnel syndrome.As over-tables and wheelchair armrests are often used during rehabilitation, it is imperative to pay attention to elbow compression when using them in patients with ulnar nerve dislocation.
6.5-1. Education on Diversity, Inclusion, and Co-Production in the Faculty of Medicine, the University of Tokyo
Yoshihiro SATOMURA ; Akiko KANEHARA ; Suzuka OKUBO ; Tatsuya SUGIMOTO ; Tomoe KATAOKA ; Yuka KONISHI ; Sakurako KIKKAWA ; Ryo KINOSHITA ; Mahiro SUEMATSU ; Yusuke TAKAHASHI ; Yousuke KUMAKURA ; Chie HASEGAWA ; Rie SASAKI ; Sosei YAMAGUCHI ; Utako SAWADA ; Yuki MIYAMOTO ; Norihito OSHIMA ; Shin-Ichiro KUMAGAYA ; Kiyoto KASAI
Medical Education 2024;55(2):121-127
The University of Tokyo Disability Services Office and the University of Tokyo Hospital have striven to advance the inclusion of individuals with disabilities and to encourage the co-production of research as well as mental health services with peer support workers. In convergence with these endeavors, the Center for Diversity in Medical Education and Research (CDMER) was founded in 2021. The Center aims to establish an environment and culture that facilitates the participation and success of medical professionals with disabilities. For this purpose, it is essential to integrate the perspective of the social model of disability into medical education and promote co-production in the medical field, which is among the most challenging areas that can realize co-production. The Center is involved in various educational and research activities, including managing educational programs for medical students and supporting student-led research.