Physical training has been shown to improve glucose tolerance and insulin action in peripheral tissues. In the present study, regular (R) and high (H) -dose euglycemic clamp procedures were performed to determine the effects of different types of physical training on insulin action (sensitivity/responsiveness) in 10 long-distance runners (LR), 10 weight-lifters (WL) and 12 healthy controls (HC), The amount of infused glucose (glucose metabolism, GM) during euglycemic clamping is a measure of the peripheral tissue sensitivity and/or responsiveness to insulin. For R clamping, when GM was calculated per unit body weight (BW), GM in LR (11.92±1.22 mg/kg BW·min) and WL (9.28±0.63 mg/kg BW·min) was significantly (P<0.05) higher than that in HC (7.44±0.39 mg/kg BW·min) . When calculated per unit lean body mass (LBM), LR (15.07±1.56 mg/kg LBM·min) differed from HC (9, 15±0.59 mg/kg LBM·min, P<0.05), whereas the value in WL (11.50±0.93mg/kg LBM·min) was identical to that in HC. For H clamping, there was no significant change in these three groups when GM was calculated per unit BW or LBM. These results suggest that enhancement of insulin action by physical training is due to an increase in insulin sensitivity, rather than to an increase in insulin responsiveness, and that aerobic exercise, for example long-distance running, is more effective for the improvement of decreased sensitivity to insulin, which is observed in patients with simple obesity and diabetes, than anaerobic exercise such as weight-lifting.

Ependymomas are uncommon tumors that arise in the brain, spinal cord or cauda equina. Myxopapillary ependymomas is located exclusively in the conus medullaris or cauda equina, or film terminale region. In most myxopapillary ependymomas, the histological examination reveals low mitotic activity that is associated with a low MIB-1 labeling index (LI). The prognosis is generally favorable, when the appropriate treatment, including a total resection, is performed. The authors encountered a 39-year-old man with multifocal type of myxopapillary ependymomas compressing the cauda equina from the L2 to L3 level and L5-S1 level. A subtotal resection of the tumor was carried out. The histological examination revealed extremely high mitotic activity with a MIB-1 LI of 9.1%. Therefore, cranio-spinal radiation was added after surgery. The postoperative course was uneventful over the 3.5 year follow-up period.
Adult ; Brain ; Cauda Equina ; Conus Snail ; Ependymoma ; Follow-Up Studies ; Humans ; Prognosis ; Sacrococcygeal Region ; Spinal Cord

Postoperative meningitis after spinal surgery is a rare complication that can result in a life-threatening condition. Linezolid (LZD) is an oxazolidinone which has been approved in Japan for infections caused by methicillin-resistant Staphylococcus aureus. The authors encountered a case of postoperative meningitis with cerebrospinal fluid leakage (liquorrhoea) that occurred after resection of a cervical cord tumor. The infection was caused by methicillin-resistant Staphylococcus epidermidis(MRSE). Debridement and suture of the dura matter was carried out. LZD was given intravenously. The infection was cured without any sequelae. Based on this result, we concluded that LZD might be considered as one of the first choices for the treatment of postsurgical meningitis caused by MRSE.
Acetamides ; Debridement ; Humans ; Japan ; Meningitis ; Methicillin Resistance ; Methicillin-Resistant Staphylococcus aureus ; Oxazolidinones ; Staphylococcus ; Sutures ; Linezolid

STUDY DESIGN: A case-series study. PURPOSE: To assess the long-term clinical and radiographic outcomes after vertebroplasty using calcium phosphate cement (CPC) for treatment of osteoporotic vertebral fractures (OVF). OVERVIEW OF LITERATURE: Vertebroplasty has become common for the treatment of OVF. However, few studies have reported the clinical application of CPC to vertebroplasty. METHODS: We reviewed 86 consecutive patients undergoing 99 vertebroplasties using CPC. Following repositioning and curettage of the pathological soft tissue of the vertebral body (VB), vertebroplasty using CPC was performed in patients with osteoporotic burst fracture and pseudoarthrosis (procedure A). Vertebroplasty was also performed in patients with osteoporotic compression fractures (procedure B). Back pain and lower back pain were evaluated using the visual analogue scale (VAS). The VB deformity index was measured in a lateral radiograph as the ratio of the VB's height to its longitudinal diameter. RESULTS: The mean age at time of surgery was 77 years old. The mean duration of follow-up was forty-four months. All patients reported decreased pain according to the VAS immediately after vertebroplasty, and pain relief was maintained at the last follow-up in all patients without new OVFs. Complete bone union was observed in all cases by six months after surgery. The mean recovery rate of deformity index was 5.9% in procedure A and 0.02% in procedure B at the final follow-up visit. CONCLUSIONS: Vertebroplasty using CPC gave a satisfactory outcome and no delayed complications in elderly patients with osteoporotic vertebral fractures at follow-up times of at least two years.
Aged ; Back Pain ; Calcium ; Calcium Phosphates ; Congenital Abnormalities ; Curettage ; Dinucleoside Phosphates ; Follow-Up Studies ; Fractures, Compression ; Humans ; Low Back Pain ; Osteoporosis ; Pseudarthrosis ; Vertebroplasty

We describe a rare case of lumbar spinal stenosis due to a large calcified mass in the ligamentum flavum. This patient presented with a 12-month history of severe right leg pain and intermittent claudication. A computed tomography scan was performed, revealing a large calcified mass on the ligamentum flavum at the right-hand side of the lumbar spinal canal. We performed a laminotomy at the L4/5 level with resection of the calcified mass from the ligamentum flavum. The findings of various analyses suggested that the calcified mass consisted mostly of Ca3(PO4)2 and calcium phosphate intermixed with protein and water. The calcified mass in the ligamentum flavum was causing lumbar spinal stenosis. Surgical decompression by resection of the mass was effective in this patient. The calcified material was composed mainly of elements derived from calcium phosphate. Degenerative changes in the ligamentum flavum of the lumbar spine may have been involved in the production of this calcified mass.
Calcium ; Calcium Phosphates ; Decompression, Surgical ; Humans ; Intermittent Claudication ; Laminectomy ; Leg ; Ligamentum Flavum ; Spinal Canal ; Spinal Stenosis ; Spine ; Water

Thoracic and thoracolumbar ossification of the posterior longitudinal ligament (OPLL) can be difficult to treat due to the anatomical position. The purpose of this study was to report the significance of a novel surgical technique that represented two cases of thoracic or thoracolumbar OPLL. The first patient was a 72-year-old woman who had a beak-type OPLL at the T11/12. The second was a 45-year-old woman who had a beak-type OPLL at the T12/L1. We performed circumferential spinal cord decompression through a single posterior approach with microendoscopy in both cases. The postoperative computed tomography revealed the complete removal of the OPLL, and the magnetic resonance imaging confirmed adequate decompression of the spinal cord. Preoperative symptoms were substantially improved in both patients. To date, we have used this novel technique to treat five patients with thoracic or thoracolumbar OPLL. This new surgical technique is likely to be useful in patients with a beak-type OPLL of the thoracic or thoracolumbar spine.
Aged ; Decompression* ; Dura Mater ; Female ; Humans ; Longitudinal Ligaments* ; Magnetic Resonance Imaging ; Middle Aged ; Spinal Cord* ; Spinal Fusion ; Spine

Some gel types have been reported to prevent left ventricular (LV) remodeling in myocardial infarction (MI) animal models. In this study, we tested biodegradable thermoresponsive gels. Poly(L-lactic acid)-poly(ethylene glycol) (PLLA-PEG) and poly(D-lactic acid)-poly(ethylene glycol) (PDLA-PEG) were synthesized by the polycondensation of Land D-lactic acids in the presence of PEG and succinic acid. Each of these block copolymers was used to prepare particles dispersed in an aqueous medium and mixed together to obtain a PLLA-PEG/PDLA-PEG suspension, which was found to show a sol-to-gel transition around the body temperature by the stereocomplex formation of enantiomeric PLLA and PDLA sequences. In the present study, the G' of the PLLA-PEG/PDLA-PEG suspension in the rheological measurement remained as low as 1 Pa at 20 ℃ and increased 2 kPa at 37 ℃. The sol-gel systems of PLLA-PEG/PDLA-PEG might be applicable to gel therapy. The effect of the PLLA-PEG/PDLA-PEG gel injection was compared with that of a calciumcrosslinked alginate gel and saline in a rat MI model. The percent fractional shortening improved in the PLLA-PEG/ PDLA-PEG (20.8 ± 4.1%) and alginate gel (21.1 ± 4.8%) compared with the saline (14.2 ± 2.8%) with regard to the echocardiograph 4 weeks after the injection (p<0.05). There were reduced infarct sizes in both PLLA-PEG/PDLA-PEG gel and alginate gel compared with the saline injection (p<0.05). Moreover, a greater reduction in LV cavity area was observed with the PLLA-PEG/PDLA-PEG gel than with the alginate gel (p = 0.06). These results suggest that the PLLA- PEG/PDLA-PEG gel should have high therapeutic potential in gel therapy for LV remodeling after MI.
Animals ; Body Temperature ; Gels ; Lactic Acid ; Models, Animal ; Myocardial Infarction* ; Rats* ; Succinic Acid ; Ventricular Remodeling*