In infectious enteritis, the affected site differs depending on the organism causing the disease, and based on this feature, it is possible to estimate the causative organisms of infectious enteritis. However, there have been few reports of infectious enteritis mainly affecting the duodenum. This report describes a case of duodenal enteritis that was suspected to be associated with Legionella infection. The patient was a 66-year-old man. He was febrile for 5 days and had watery diarrhea for 3 days before admission, and he presented to our hospital when the symptoms did not improve. He was hypoxemic at presentation, and a CT scan on admission revealed nonsegmental ground-glass opacities in both lung fields and thickening of the intestinal wall, mainly in the duodenum. Blood tests and chest imaging findings led to suspicion of Legionella pneumonia. Urine specimens were submitted for Legionella antigen testing and were found to be positive, confirming the diagnosis. Subsequent antimicrobial therapy resulted in improvement of the diarrhea symptoms and duodenal wall thickening, and the patient was discharged on hospital day 19. This case shows that Legionella pneumonia can manifest as abdominal symptoms. The possibility of Legionella pneumonia should thus be considered in patients with duodenitis.

Methods: Nineteen volunteers (16 men, three women) lifted a 60-kg doll from a seated position to a standing position. The first transfer was performed without the HAL for Care Support, and the second was performed with the HAL for Care Support assistive robot. We evaluated transfer performance, the visual analog scale (VAS) score for lumbar fatigue, and electromyogram analyses of the trunk and hip. Results: Four participants (two men, two women) succeeded with the HAL for Care Support even though they were unable to perform the task without it. The mean lumbar fatigue VAS score for all participants without the HAL for Care Support was 62 mm, while that with it was 43 mm. With lumbar assistance from the HAL for Care Support, subjective lumbar fatigue during the transfer decreased significantly. A power analysis indicated adequate statistical power to detect a difference in the VAS score for lumbar fatigue (0.99). The activity of the left gluteus maximus alone increased significantly during transfers with the HAL for Care Support. No adverse events occurred during use of the HAL for Care Support for transfers. Conclusions The HAL for Care Support was able to reduce lumbar load in a simulated patient transfer.

Objective: Whether or not emergent decompression/fusion surgery for paralysis caused by metastatic spinal tumors of unknown origin improves patient neurological outcome and survival remains unclear. This study aimed to evaluate the clinical outcomes of emergent decompression/fusion surgery for paralysis caused by spinal tumors of unknown or not previously diagnosed origin.Patients and Methods: Data from the medical records of 11 patients with spinal tumors of unknown origin (study group) were compared with those of 15 patients with metastatic spinal tumors of known origin (control group). The outcome measures were postoperative performance status, motor function evaluated with the Frankel grade, and actual survival after surgery as compared with the estimated survival calculated using the Tokuhashi score. χ2 analyses were performed to evaluate differences between the groups.Results: The mean performance status was 3.6 preoperatively, which improved to 2.9 postoperatively (P<0.05), in the unknown origin group and 3.6 preoperatively, which improved to 2.7 postoperatively (P<0.05), in the control group. Seven patients (64%) in the unknown origin group showed improvement in paralysis by ≥1 Frankel grade. By contrast, only 4 patients (27%) in the control group showed improvement in paralysis. The unknown origin group tended to show better improvement (P=0.05). All the patients in the unknown origin group underwent adjuvant therapy after definitive diagnosis following surgery. The unknown origin group showed a slight tendency toward better survival than toward the estimated survival.Conclusion: Emergent decompression/fusion surgery for patients with paralysis caused by metastatic tumors of unknown origin is potentially useful for diagnosing tumor origin and improving neurological outcomes and performance status, and thus for extending survival.

Calcification of the ligamentum flavum (CLF), which is a rare disorder that can potentially cause myelopathy, occurs uncommonly in the thoracic spine. Here, we report a rare case of thoracic myelopathy caused by CLF in a 78-year-old man. Magnetic resonance imaging (MRI) showed posterior spinal cord compression by a hypo-signal intense mass, and computed tomography (CT) revealed CLF and vacuum disc phenomenon at T10/11. After undergoing posterior decompression and instrumented fusion (T9–T12), the patient’s gait difficulties improved. The pathogenesis of CLF is largely unknown; however, it involves accumulation of calcium pyrophosphate dehydrate crystals (CPPD), and CLF from CPPD deposition tends to occur within a thickened and hypertrophic ligament. CLF occurs predominantly in the cervical spine and less frequently in the lumbar spine, with few cases involving the thoraco-lumbar spine. The thoracic spine is characterized by hypomobility; however, the thoraco-lumbar spine has a mobile segment which may potentiate CLF formation. Decompression with fusion surgery can be useful for treating patients with thoraco-lumbar CLF.

Objective: To treat vertebral fractures with posterior wall injury in the elderly, vertebral bone grafting is generally performed through a posterior transpedicular approach, combined with pedicle screw fixation. An autologous bone is ideal to treat this disorder. However, harvesting autologous bones from the elderly with osteoporosis is limited by the amount and quality of available autologous bone. Thus, we developed a bone-grafting substitute. The newly developed unidirectional porous β-tricalcium phosphate, with a porosity of 57% (UDPTCP; Affinos®, Kuraray Co., Ltd., Tokyo, Japan), is used in the bone-grafting procedure. This is the first report of UDPTCP used as an artificial bone graft in patients with an acute vertebral burst fracture.Materials and Methods: UDPTCP (mean: 4.2 g) was implanted through the pedicle, and posterior instrumentation was achieved with pedicle screws in five elderly patients. Resorption of UDPTCP and substitution with the autologous bone were evaluated on computed tomography (CT) and plain X-ray performed immediately and at 3, 6, and 12 months after the operation.Results: In case 1, the pedicle screws did not loosen, and UDPTCP was completely resorbed and replaced with the autologous bone at 3 postoperative months. In the other four cases, although the pedicle screws or the caudal part loosened because of osteoporosis, resorption of UDPTCP was observed at 3 postoperative months. At 6 postoperative months, progressive substitution with the autologous bone was confirmed, and at 12 postoperative months, formation of the good autologous bone was confirmed.Conclusion: This preliminary case series demonstrated that the newly developed UDPTCP shows good clinical potential as a bone-graft substitute for acute vertebral burst fractures in the elderly, including patients with osteoporosis.

A 55-year-old man visited our hospital for a detailed examination of a gastric submucosal tumor that was first detected 10 years prior. The tumor continued to grow and had developed a depressed area in its center. A histopathological examination of biopsy specimens revealed gastric adenocarcinoma of the fundic gland type (GA-FG). It was diagnosed as T2 based on the invasion depth as determined by white-light endoscopy and endoscopic ultrasonography. A total gastrectomy with lymphadenectomy was performed and a GA-FG in the mucosa and submucosa was confirmed histopathologically. However, there was a gradual transition to an infiltrative tubular adenocarcinoma with poorly differentiated components in the muscular and subserosal layers. Metastasis was identified in a dissected lymph node (LN). This is the first report of a GA-FG progressing to an aggressive cancer with LN metastasis. These findings modify our understanding of the pathophysiology of GA-FG.
Adenocarcinoma* ; Biopsy ; Endoscopy ; Endosonography ; Gastrectomy ; Gastric Mucosa ; Humans ; Lymph Node Excision ; Lymph Nodes* ; Middle Aged ; Mucous Membrane ; Neoplasm Metastasis*

The symptoms of anemia, decreases in the levels of circulating red blood cells (RBC), hemoglobin (Hb) and hematocrit (Ht) lead to decrease endurance performance, and the risk of anemia increases in female endurance athletes. Although Hb is composed of a large amount of amino acids, the relationships between circulating levels of amino acids and RBC, Hb and Ht in female endurance athletes have not been clarified yet. Thus, the purpose of the present study was to investigate the relationship between circulating levels of amino acids and RBC, Hb and Ht in female endurance athletes. Twenty-four female endurance athletes (19.8 ± 0.2 years) participated in this study. We measured circulating levels of RBC, Hb and Ht from blood. Also, we measured circulating levels of amino acids from plasma by use of comprehensive analysis. The levels of circulating RBC, Hb and Ht in all subjects were within the normal range. We found that circulating taurine levels were significantly correlated with RBC (r = 0.48, p < 0.05), Hb (r = 0.44, p < 0.05) and Ht (r = 0.42, p < 0.05) in female endurance athletes. In the present study, we demonstrated that circulating taurine levels were significantly associated with RBC, Hb and Ht in female endurance athletes. These results suggest that circulating taurine levels may be a predictor of anemia and treatment strategy for anemia.

Cardiac tumors are rare, and multiple myxomas are even rarer. The latter phenomenon is mostly associated with the Carney complex, a dominantly inherited disease characterized by multiple primary cardiac myxomas, endocrinopathy, and spotty pigmentation of the skin. We report the rare case of a patient who did not have the Carney complex but had multiple primary cardiac tumors. A 78-year-old woman with a past history of breast cancer was referred to our hospital for further examination of multiple cardiac tumors. Echocardiography showed 4 tumors in the left atrium and left ventricle. We could not diagnose them preoperatively and decided to resect them surgically because they were mobile and could have caused embolism and obstruction. The postoperative pathological findings of all 4 tumors were myxomas, although the patient did not meet the diagnostic criteria of the Carney complex. Therefore, a rare case of multiple primary cardiac myxomas was diagnosed.
Aged ; Breast Neoplasms ; Carney Complex* ; Echocardiography ; Embolism ; Female ; Heart Atria ; Heart Neoplasms ; Heart Ventricles ; Humans ; Myxoma* ; Pigmentation ; Skin

Obesity and increasing of arterial stiffness are known as independent risk factors for cardiovascular disease. Previously, we demonstrated that dietary modification or aerobic exercise training can decrease arterial stiffness in obese individuals. However, it has not been compared the effect of dietary modification and/or aerobic exercise training on arterial stiffness in obese men. We compared the effect of three patterns of lifestyle modification (i.e., dietary modification, aerobic exercise training or combined them) on arterial stiffness in obese men. Fifty-three obese men completed the 12-week lifestyle modification program, dietary modification (D), aerobic exercise training (E) or combined D and E (DE). Before and after the program, all participants were measured central, peripheral, and systemic arterial stiffness (measured by carotid-femoral pulse wave velocity [cfPWV], femoral-ankle PWV [faPWV] and brachial-ankle PWV [baPWV]). We demonstrated that the degree of decrease in BMI was the greatest after DE, and that was greater after D than E. The level of decrease in baPWV after DE was the greatest among three interventions. On the other hand, the level of decrease in baPWV in D group was similar to E group. These results suggested that systemic arterial stiffness may be decreased by different mechanisms between D and E groups. We demonstrated that dietary modification decreased central and systemic arterial stiffness, and aerobic exercise training decreased central, systemic, and peripheral arterial stiffness in obese individuals. We also showed an additional effect of decreasing systemic arterial stiffness by combining dietary modification and aerobic exercise training in obese individuals.

Objective: The purpose of this study was to confirm the effect of feeding Okara fermented by Bacillus coagulans on cecum microflora in rat. Method: Three groups of SD rat of 8 weeks old were used in the experiment. The experimental animals were fed control diet, 2% okara diet, 2% fermented okara diet in each group for two weeks. The experimental diet and water were provided ad libitum. Food intake was measured every day. After 24 hours fast, we performed drawing blood with heparin after the experimental period. After drawing blood, several organs were removed for measuring their weight. In addition, we removed cecum after drawing blood about each three groups and studied their microflora. We also measured about plasma albumin, ALT, AST, ALP, LDH, total cholesterol, triacylglycerol, glucose, and cytokine level. Result: Bifidobacteria of cecum and blood IFN-g levels significantly increased in the fermented okara group. The total cholesterol level in blood significantly decreased. Conclusion: Okara fermented by Bacillus coagulans had an influence on not only intestinal microflora but also the immune system in rat, suggesting that the fermented okara can expect development as functional materials.