Lumbar foraminal stenosis was suggested to exist as early as the 1800s; however, its importance faded when lumbar canal stenosis attracted attention. Subsequently, it was warned that lumbar foraminal stenosis should be considered as a “hidden zone.” Additionally, the importance of distinguishing foraminal stenosis from canal stenosis was reaffirmed when investigating the cause of lumbar nerve root symptoms. However, this condition is now widely recognized after the development of imaging modalities, such as computed tomography (CT) and magnetic resonance imaging (MRI); nonetheless, the accurate diagnosis of lumbar foraminal stenosis remains challenging. Lumbar foraminal stenosis is most commonly defined as a stenotic lesion extending from the medial edge of the pedicle to the lateral part. Conventional imaging examinations mainly include radiography and myelography; however, these imaging methods are unable to clearly visualize lateral lesions. Therefore, there is limited literature on lumbar foraminal stenosis. Subsequently, selective nerve root injection and CT have become popular, with MRI being the main diagnostic modality. The development of sequences such as 3-dimensional MRI, oblique coronal MRI, and diffusion tensor tractography has improved the diagnostic performance of imaging examinations. Thus, a better understanding of lumbar stenotic lesions among spine surgeons, in combination with more accurate imaging examinations, is expected to improve the accuracy of diagnoses, which in turn will help enhance the quality of treatment.

Left-sided gallbladder is a rare finding that is mostly discovered incidentally during surgery and is often associated with anatomic anomalies. We herein report a case in which laparoscopic cholecystectomy and common bile duct exploration were achieved for an 89-year-old female patient with left-sided gallbladder. Surgery was carried out using our usual trocar position.Calot triangle was covered by the body of the gallbladder and could not be detected. We dissected the gallbladder from the fundus towards the neck. The cystic duct joined the common bile duct from the right side, and common bile duct exploration was performed routinely without perioperative comorbidities. Although the preoperative diagnosis rate is low and the risk of intraoperative bile duct injuries in patients with left-sided gallbladder is high, laparoscopic cholecystectomy and common bile duct exploration can be safely performed by understanding the location and bifurcation of the cystic duct.

Objectives: To examine the efficacy and clinical and radiological outcomes of the use of a streamlined clavicle plate® (MEIRA, Aichi, Japan) for midshaft clavicular fractures.Methods: This was a retrospective cohort study of 155 patients with displaced midshaft clavicular fractures treated using a streamlined clavicle plate between 2015 and 2019 in 18 hospitals across Japan. A questionnaire regarding bone union and postoperative complications was used, and 136 cases were followed up for one year or until bone union. Plate fitting was evaluated retrospectively using surgical records, radiographic findings, and surgeon’s opinion.Results: During surgery, plate bending was needed in 19 cases (12.3%), poor fitting was observed in 8 cases (5.2%), and bone union was achieved in 133 cases (97.8%). Total implantation failure, including plate breakage and screw loosening, occurred in 10 cases (6.5%) from the intraoperative to postoperative period. Subjective complications were observed in 26 cases (16.8%): incongruity around the surgical scar or in the anterior chest in 23, and contracture of the shoulder in three. Plate removal was performed in 66 cases (48.5%) per patient’s request.Conclusion: The use of a streamlined clavicle plate is effective for midshaft fractures of the clavicle, and the success rates of bone union and implantation using this approach are comparable to those of other existing plates.

As for the clinical condition to be called “cold stagnating in the liver vessel” (寒滞肝脈kantaikanmyaku),cold invades a liver-­meridian (肝経絡) and causes pain. We report a case of 7-­year-­old boy that reached the difficulty in walking for agreed pain of lower extremities in a liver-­meridian by cold house environment after the diarrhea. There was no abnormality in a blood test and the MR imaging in Western medicine. The treat­ment principle was to warm the meridian and reduce the pain. We chose the infusion of “dankanzen­-based prescription” (暖肝煎加味方) to warm the meridian and to remove the pain. The symptom improved. And the bathing therapy to warm a body relieved pain too. The case report of children of kantaikanmyaku was not found as far as we examined it. However, we believe that such cases are latent in Japan where air conditioners are widely used.

　　Recently, eosinophilic chronic rhinosinusitis (ECRS) has become a very common disease in Japan. ECRS differs from other types of sinusitis in terms of clinical features, such as high rate of recurrence, olfactory disorders, ineffective macrolide therapy, and severe paranasal sinus shadow on CT imaging. The diagnosis of ECRS requires a biopsy of nasal polyps. Therefore, we tried to predict ECRS by evaluating CT images using the Lund-Mackay CT Scoring system (LMS). This retrospective study involved 105 patients who had undergone surgical treatment (ESS) between July 2011 and November 2012. These patients were divided into three groups based on patterns of pathogenesis: ECRS, fungal sinusitis (FS), and chronic sinus infection (CSI). The pathological classification of nasal polyp was graded on a 3-point scale according to the degree of eosinophilic infiltration. Total LMS score for the ECRS was 9.4±0.6 (mean±SE), which was significantly higher than for the other LMS scores (FS: 4.6±1.0, CSI: 5.8±0.2). LMS scores for the maxillary sinus were high for all three patterns of pathogenesis (ECRS: 1.4± 0.1, FS: 1.7±0.2, CSI: 1.3±0.1). The scores for the frontal and sphenoid sinus forECRS were significantly higher than the scores for the FS and CSI (maxillary sinus, ECRS: 1.5±0.1, FS: 0.4±0.2, CSI: 0.6±0.1; sphenoid sinus, ECRS: 1.4±0.2, FS: 0.2±0.1, CSI: 0.6±0.3). We assessed for and found a positive correlation between the bilateral LMS score and eosinophilic infiltration (rs＝0.665). Therefore, ECRS can be predicted by LMS without biopsy and LMS helps determine the management of chronic rhinosinusitis.