Methods: We examined 242 patients (age >60 years) who underwent surgery for thoracic to lumbar spine fractures from 2010 to 2020. Subsequently, the maxVB was classified into three groups: maxVB (0), maxVB (2–8), and maxVB (9–18), and parameters, including fracture morphology (new Association of Osteosynthesis classification), fracture level, and neurological deficits were compared. In a sub-analysis, 146 patients with thoracolumbar spine fractures were classified into the three aforementioned groups based on the maxVB and compared to determine the optimal operative technique and evaluate surgical outcomes. Results: Regarding the fracture morphology, the maxVB (0) group had more A3 and A4 fractures, whereas the maxVB (2–8) group had less A4 and more B1 and B2 fractures. The maxVB (9–18) group exhibited an increased frequency of B3 and C fractures. Regarding the fracture level, the maxVB (0) group tended to have more fractures in the thoracolumbar transition region. Furthermore, the maxVB (2–8) group had a higher fracture frequency in the lumbar spine area, whereas the maxVB (9–18) group had a higher fracture frequency in the thoracic spine area than the maxVB (0) group. The maxVB (9–18) group had fewer preoperative neurological deficits but a higher reoperation rate and postoperative mortality than the other groups. Conclusions The maxVB was identified as a factor influencing fracture level, fracture type, and preoperative neurological deficits. Thus, understanding the maxVB could help elucidate fracture mechanics and assist in perioperative patient management.

A 20-year-old man was admitted to our hospital with persistent cough and dyspnea. He had bilateral distention of the jugular veins, and swollen lymph nodes were palpable in the right subclavicular region. Plain X-ray and computed tomography (CT) of the chest showed a solid soft tissue mass in the upper mediastinum, with leftward displacement of the trachea and complete obstruction of the superior vena cava. Mediastinal radiotherapy (1.8 Gy/day) and methylprednisolone (100 mg/day) were started immediately. Biopsy of the right subclavicular lymph nodes revealed metastatic seminoma. The patient was referred for chemotherapy, which was performed with a combination of cisplatin, bleomycin and etoposide (BEP). A partial response was observed after completion of 3 cycles of chemotherapy, but there was no further tumor shrinkage after additional salvage chemotherapy. The patient is being followed up on an outpatient basis and has been free of recurrence for 32 months after intensive treatment.

A 76-year-old woman presented because of bilateral lower-extremity edema and dyspnea. Transthoracic echocardiography revealed a mobile mass in the right atrium. A right atrial mass associated with heart failure was diagnosed. Surgery was performed. Intraoperative transesophageal echocardiography showed that the mass was contiguous with the inferior vena cava. However, the primary lesion was unclear. Therefore, only the intracardiac mass was resected. The margins of the residual tumor were marked with clips. Computed tomography performed immediately after surgery revealed a clip in structures contiguous with the region from a uterine myoma to the inferior vena cava. Intravenous leiomyomatosis was diagnosed on histopathological examination of the resected specimens. Computed tomography 6 months after surgery showed that the clip had moved from the inferior vena cava to a vein contiguous with the uterus. The tumor regressed slightly. Close follow-up is required.

A 83-year-old woman suffered pulseless-electrical-activity (PEA) because of cardiac tamponade after acute myocardial infarction with blow-out type cardiac rupture. Immediately median sternotomy was performed and active bleeding from the postero-lateral wall was found. It was impossible to stop bleeding only by putting pressure on the aperture of the myocardium with a piece of TachoComb coated with gelatin-resorcinol-formaldehyde (GRF) glue, however, the chemical action of GRF glue made the delicate myocardium after acute infarction stronger and we managed to stop that bleeding with mattress sutures that had initially seemed to be impossible. She was discharged on POD 103 uneventfully. We think this is a useful and safe operation procedure for blow-out type cardiac rupture.

Recurrence of seminoma in the scrotum after inguinal orchidectomy is extremely rare. Herein, we report the second case in the literature of recurrence of seminoma in the scrotum following inguinal orchidectomy for stage I seminoma.
Seminoma ; Recurrence ; Disease of scrotum ; Benign neoplasm of scrotum ; Orchiectomy

Hemolytic uremic syndrome (HUS) is a heterogeneous disorder characterized by hemolytic anemia, thrombocytopenia and renal failure that occurs predominantly in infants and young children. However, HUS in adults has also been described as a complication of various chemotherapy regimens with a relatively poor prognosis. Since cisplatin is now widely used for treatment of solid cancers, it is necessary to take into account the possibility of cisplatin-induced hemolytic uremic syndrome as a rare but potentially fatal side- effect. Herein, we describe our experience with a 67-year old woman being treated for a urothelial carcinoma of the bladder who suffered chemotherapy-induced HUS after a cisplatin-based regimen. Plasmapheresis was carried out five times; however, her serum platelets remained depressed, and she subsequently died. We conclude that there is a high risk potential for HUS in patients undergoing intensive chemotherapy for advanced-stage bladder cancer.
Hemolytic-Uremic Syndrome ; Chemotherapy-Oncologic Procedure ; Cisplatin ; Cancer of Bladder ; regimen

Regular physical activity has been regarded as a possible means to minimize the adverse physiological changes associated with aging, as well as to contribute to mental health and well-being in later life. To encourage increased participation in exercise among elderly people, and to emphasize the value of exercise in geriatric health care, this article provides an overview of the effects of primary care based physical activity on healthy aging. It is clear from the number of recently published papers on this topic that daily participation in 30 minutes or more of moderate physical activity should be recommended for elderly people. The results of physical activity interventions focusing on balance and resistance training in both home- and group-based exercises suggest that it is possible to improve physical functions and to prevent falls and disabilities in daily living. Multiple-element interventions (e. g., advice, as well as strategies to increase self-efficacy and motivation, and to eliminate barriers to participation), tailored to individual activity preferences, are likely to be more successful than more prescriptive single-focus interventions. A home-based physical therapy program can successfully enhance the independence of the frail elderly in community dwellings.

The purpose of this study was to investigate muscle volume (MV) and strength characteristics of the rotator cuff (supraspinatus, infraspinatus, teres minor, and subscapularis) and deltoid muscles in each shoulder of asymptomatic baseball pitchers. Twelve collegiate baseball pitchers (PG) and ten male students (CG) who never played an overhand sports volunteered to participate in this study. Magnetic resonance imaging (Straits II, Hitachi Medico, 1.5 T) was used to measure the MV of rotator cuff and deltoid muscles in both shoulders of each subject. Since the individual muscles were difficult to identify on MRI scans, the infraspinatus and teres minor were analyzed as one infraspinatus muscle. Shoulder abduction (ABD), external rotation (ER), and internal rotation (IR) strengths were measured each side using a hand-held dynamometer (Power Track II, Jtech Medical Industry) . The MV of deltoid muscle was significantly larger value on the dominant side (DOM) than on the non-dominant side (NDOM) in both the PG and CG groups (p<0.05) . However, no significant differences in the MV of the rotator cuff muscles and the measured shoulder strength (ABD, ER, and IR) were observed between both sides in either group. Similarly, no significant differences in the DOM/NDOM ratio of the muscle volume and the measured shoulder strength were observed between the two groups. These results suggest that the rotator cuff muscle volume and strength does not differ in both sides of the PG, and DOM/NDOM ratios of the rotator cuff muscle volume and strength of the PG does not differ in those of the CG.

The purpose of this study was to investigate the influence of a shoulder injury on rotator cuff muscle thickness and shoulder muscle strength in baseball players. Based on orthopedic medical checks performed by a doctor for 57 male collegiate baseball players, two groups, the pain-free normal group (NOR group, n=19) and the impingement test positive group (IMP group, n=17) volunteered to participate in the study. Muscle thickness of the supraspinatus, infraspinatus and posterior deltoid muscles was measured bilaterally using a B-mode ultrasound apparatus (SSD-500, Aloka) with a 5-MHz transducer. Isometric shoulder abduction strength was measured bilaterally with a hand-held dynamometer in the sitting position with the arm at 45 degrees abduction, and shoulder external and internal rotation strength were measured bilaterally with an isokinetic dynamometer in the sitting position with the upper arm at 90 degrees abduction.
When the two groups were compared, the NOR group showed significantly greater values on the dominant side than on the non-dominant side for muscle thickness of the posterior deltoid. However, the IMP group showed significantly greater values on the non-dominant side than on the dominant side of muscle thickness of the supraspinatus, the muscle strength with the abduction and external rotation (300 deg/sec) and external internal rotation strength ratio (180 deg/sec) .
Also, the IMP group had a significantly weaker dominant/non-dominant ratio of supraspinatus muscle thickness (p<0.05) and abduction strength than the NOR group (p<0.01) .
These results suggest that baseball players with positive impingement show both a morphological and functional decline in the supraspinatus muscle. The dominant side supraspinatus weakness observed in the IMP group of this study may reflect muscle atrophy and chronic fatigue.

The Raynaud phenomenon of fingers, a specific physical disturbance, frequently occurs in those who have used pneumatic vibrating tools such as chain saws for many years. Only a few pathological studies of this lesion have been reported although there are many clinical physiological studies. We conducted an autopsy of a 71-year-old man, who was a patient with cholecystocarcinoma and died of pneumonia. He had worked for 17 years using pneumatic vibrating tools and had been an out-patient of the surgical department, where he received physical treatment and spa therapy because he suffered from the Raynaud syndrome in his left fingers. The findings obtained from a microscopic observation of the finger tip skin of the corpse are summarized as follows:
1. Many dilated small arteries, accompanied by local thickening of the intima and torn medial elastic fibers, were noticed between the subpapillary and deep layer of the dermis.
2. Stenotic arterioles due to muscular hyperplasia of the media were relatively few.
3. Dilatation of capillaries was found in the subpapillary layer of the dermis, and dilatation of small veins, in the deep layer.
4. Atrophy was noticed in the peripheral neurofibers, Vater-Pacini corpuscles, and sweat glands.
5. The dermis showed sclerotic changes with marked diffuse fibrosis.