Transforaminal full-endoscopic lumbar surgery is widely accepted as a method of treating lumbar conditions, such as disc herniation, spinal stenosis, and lumbar foraminal stenosis (LFS). This minimally invasive approach, often performed under local anesthesia, is ideal for older patients and those with significant comorbidities. Full-endoscopic lumbar foraminotomy (FELF) has shown high success rates and notable symptom relief for LFS. However, complications including postoperative dysesthesia, dural tears, restenosis, and scoliosis progression, especially at L5–S1 due to extensive facet joint resection, remain challenges. In such cases, lumbar fusion may be more appropriate. A unique anatomical feature, the "lateral kissing spine," is characterized by contact between the L5 transverse process and the sacral ala. This feature appears to mitigate scoliosis progression, regardless of the preoperative Cobb angle or bone resection extent during FELF. We report two L5–S1 foraminal stenosis cases treated with FELF under local anesthesia: one with a lateral kissing spine, showing no scoliosis progression, and another without it, demonstrating significant progression. A review of 11 additional cases supports the protective role of the lateral kissing spine against scoliosis, even in cases with severe preoperative Cobb angles. This study reviews the complications of FELF, focusing on scoliosis progression, and proposes indications for FELF, highlighting the importance of the lateral kissing spine in surgical decision-making.

In the 2 decades or so since full-endoscopic spine surgery (FESS) was introduced, the procedure has advanced considerably. There are 2 major approaches of FESS, transforaminal (TF) and interlaminar. In this review article, we discuss the key strengths and merits of TF-FESS based on a literature search. First, the minimal invasiveness of the procedure allows for early return to work. Second, minimal invasiveness of the back muscles enables athletes to make a faster return to their previous competitive level. Third, the ability to perform TF-FESS under local anesthesia means it is suitable even in the elderly with poor general health.

We report a case of Waldenström's macroglobulinemia (WM) treated using clarithromycin (CAM) and prednisolone (PSL). An 84-year-old woman was admitted to our hospital for bleeding after a tooth extraction and hematuria. Computed tomography showed multiple ill-defined nodules in the omentum (omental cake). Although the cause of the omental cake remained unclear, the patient was diagnosed with WM, based on the detection of M-protein of immunoglobulin (Ig) M in serum and lymphoplasmacytes in bone marrow. The bleeding tendency in the patient may have been due to acquired hemophilia and/or hyper IgM-induced platelet dysfunction. The patient was treated using CAM (800 mg/day) and PSL (10 mg/day). As a result, IgM levels gradually decreased. Because the omental cake contracted along with improvement in IgM, it was thought to be lymphoplasmacytic lymphoma-like lymphoma. This case shows that treatment using CAM and PSL may be effective in some cases of WM.
Aged, 80 and over ; Blood Platelets ; Bone Marrow ; Clarithromycin* ; Female ; Hematuria ; Hemophilia A ; Hemorrhage ; Humans ; Immunoglobulin M ; Immunoglobulins ; Lymphoma ; Omentum ; Prednisolone* ; Tooth Extraction ; Waldenstrom Macroglobulinemia*

BACKGROUND: Oral food challenge (OFC) tests are conducted in both specialized institutions and general hospitals. We aimed to compare the severity of the conditions of the patients between these 2 types of institutions in order to consider the role of such institutions in society. OBJECTIVE: We evaluated the results of OFC tests for hen's egg, cow's milk, and wheat that were conducted in a specialized institution (Aichi Children's Health and Medical Center [ACHMC], n = 835) and in 4 general hospitals (n = 327) in Aichi prefecture, Japan. METHODS: The symptoms provoked were scored using the total score (TS) of the Anaphylaxis Scoring Aichi scoring system in combination with the total ingested protein dose (Pro) before the appearance of allergic symptoms. RESULTS: The total ingested dose of the challenge-positive patients in ACHMC was significantly less than that in the general hospitals (p < 0.01). The median TS of the provoked symptoms in ACHMC and the general hospitals did not differ to a statistically significant extent in the hen's egg or cow's milk challenges; however, the median TS in ACHMC was significantly lower than that in the general hospitals for the wheat challenge (p = 0.02). The median TS/Pro values in ACHMC were almost identical to the upper 25% of the TS/Pro values in the general hospitals, suggesting that the specialized institution usually managed more severe patients. CONCLUSION: The specialized institution performed OFC tests at a lower threshold dose, but provoked similar TSs to the general hospitals. This evaluation may help in optimizing the distribution of patients to general hospitals and specialized institutions.
Anaphylaxis ; Child Health ; Hospitals, General ; Hospitals, Special ; Humans ; Japan ; Milk ; Ovum ; Severity of Illness Index ; Triticum

　　As part of the special study project of the Japanese Association of Rural Medicine (JARM), a questionnaire survey was conducted to probe into the attitude of rural people toward their eating habits and health. Most of the people surveyed had received health checkups carried out by medical facilities affiliated with the JARM.　　Questionnaires were distributed to a total of 5,397 people (2,588 men; 2,809 women) living in and around provincial cities. Mean age was 53.4 for men and 53.8 for women. More than half of those questioned were farmers or had experienced in farming. The people aged 80 and older accounted for 3.2% of the total.　　Eighty percent of the total said they felt happy, and those who felt short of exercise also represented 80%, but with advancing age, the ratio decreased. Those over the age of 70 who said they had a habit of taking exercise made up as high as 60%.　　Many said they were satisfied with food in terms of quantity, but not a few people expressed uneasiness about food safety, dietary life and supply of food. Regarding favorite foodstuffs, many gave rice, vegetables and dairy products. There was a tendency for older people to eat meat less. It was found that, with increasing age, people took to eat dairy products, soybeans, vegetables, fruits and fish were ranked among the most popular foodstuffs.　　A study of factors related to local production for local consumption and commitment to agriculture found that a significantly large number of people were interested in social participation, eating breakfast, securing food supply and purchasing foodstuffs at outlet stores run by local agricultural cooperatives.　　From these findings, it was suggested that many residents in and around provincial cities oriented themselves to healthy eating habits and lifestyle, and were very interested in social participation, local economy, agricultural production and consumption of local farm produce.

　　We conducted a questionnaire survey of ≥4,000 elderly individuals living in mountainous and hilly areas about everyday situations and analyzed their responses to reveal the role of field work.　　The analysis revealed that field work greatly influenced activities of daily living (ADL) and the Geriatric Depression Scale (GDS) score in these elderly individuals. We summarized the major results as follows:　　 ・A group of elderly individuals who were care in the fields had many opportunities to go out, play active social roles, and participate in local activities.　　・In the same group, improvement was observed in overall ADL scores, but particularly in instrumental ADL.　　・Depressive tendency was less likely to be observed in elderly individuals who were cared than in those who were not cared. Such intergroup difference intensified among older age groups.

　　The subjects of this study were people 65 and older, who live in a mountainous region in the Province of Mikawa, Aichi Prefecture. To determine the factors pertaining to their ability to perform the basic activities of daily living, we used the TMIG index of competence for rating functional capacity and the geriatric depression scale for assessing mental health status, and carried out a logistic regression analysis to examine how the 37 items in the questionnaire survey on senile dementia were related to the functional capacity in the old people.　　To the index of competence, (To the ability to perform daily activities,?) answers to these questions -“Is there anything you have to do every day,” “Do you have farm work to do,” “Do you have any hobbies,%rdquo; “Are you willing to work hand in hand with others as a volunteer,” and “Do you have someone to talk to” - were closely related, with the odds ratio calculated at 2.0 or above (p‹0.001). Also in mental health status, the odds ratio came to 2.0 or over (p‹0.001) in similar items. These findings suggested that a sense of purpose, a role to play and involvement in community affairs could be the essentials of life for the senior citizens.　　In the not- too-distant future, it will become necessary to build a system based on the idea that healthy old people are supposed to take care of, and support, their contemporaries who are frail mentally and physically.

　　We have embarked on a project to help old people finding something to live for. The project was worked out as we found that more than half of the elderly we queried said that they preferred to stay at home rather than go out because there was nothing to do.　　Years ago, an ad hoc committee, comprised of hospital employees, was organized to think up how to use facilities in our hospital effectively for the benefit of the health of the stay- at-home elderly. Based on the ideas proposed by the committee, a total of eight health classes came into existence. They included the exercise class with an aim to prevent locomotive syndrome, the brain training course for maintaining or improving cognitive abilities, the beauty salon dealing with cosmetic treatments and the karaoke club. Each club had a membership of 10 to 30 persons. More than 80% were women. The average age was around 75 years. The club dues range from \0 to \500. Later on, some clubs raised fees, but the number of participants remained almost the same. Many participants in the one-year brain training course had their cognitive abilities improved significantly.　　It has been found that there are many people living far from the hospital wish to join these clubs but their wish remains unfulfilled. This is one of the tasks we have to tackle with together with the problem that there are too few male participants. In any way, as part of our efforts to revitalize regional communities, we think that it is important to expand our project from now on to have activities built into the daily lives of the elderly.

　　Mountainous areas facing such demographic problems as depopulation and aging, have yet to get over difficulties in securing a means of transportation for people to visit medical facilities. Asuke Hospital, located in a mountainous district of Mikawa, Aichi Prefecture, has worked on the project to improve living conditions for years with a view to laying the foundations for the inhabitants to continue to lead a healthy life. As part of the project, we started shuttle services on a trial basis in 2010 and 2011. As a result, we reaffirmed that there was a pressing need of door-to-door services on the part of patients and members of their families. It was also made clear that, if transportation services are to be an economically feasible project, there must be more users and that users would have to pay a certain amount of money as a fare on the user-pays principle.

  We looked into the effects of the specified health examination and health guidance, which was enforced in 2008 in place of the fundamental health examination, and found that there were plenty of problems to be addressed. The changes in the standard range of the specified health examination and checkup items seemed to have been received much more unfavorably than anticipated. In the new health scheme as compared with the previous one, the occasion to perform blood tests for anemia and electrocardiography decreased drastically;there was veritably no funduscopy (ophthalmoscopy?); and the chances that the examinees were told to receive medical treatment or to watch yourself carefully were increased by a large margin. Since the objective of the health checkup was changed greatly, emphasis was placed on the detection of metabolic syndrome in the specified health examination. We thought that the hospitals, affiliated with the Aichi Prefectural Federation of Agricultural Coopeatives for Health and Welfare, had to renew their efforts for the maintenance of the health of local residents and the prevention of disease.