Background/Aims: Intestinal Behçet disease is typically associated with ileocecal punched-out ulcers and significant morbidity and mortality. Intestinal ultrasound is a noninvasive imaging technique for disease monitoring. However, no previous reports have compared intestinal ultrasound with endoscopic ulcer activity or histopathological findings for intestinal Behçet disease. We evaluated the usefulness of intestinal ultrasound for assessing the activity of ileocecal ulcers in intestinal Behçet disease. Methods: We retrospectively compared intestinal ultrasound findings with 73 corresponding endoscopic images and 6 resected specimens. The intestinal ultrasound findings were assessed for 7 parameters (bowel wall thickness, vascularity [evaluated using the modified Limberg score with color Doppler], bowel wall stratification, white-plaque sign [strong hyperechogenic lines or spots], mesenteric lymphadenopathy, extramural phlegmons, and fistulas), and endoscopic ulcer activity was classified into active, healing, and scar stages. Histopathological findings were evaluated by consensus among experienced pathologists. Results: Bowel wall thickness (P< 0.001), vascularity (P< 0.001), loss of bowel wall stratification (P= 0.015), and white-plague sign (P= 0.013) were significantly exacerbated in the endoscopic active ulcer stage. Receiver operating characteristic curve analysis revealed that a bowel wall thickness of > 5.5 mm (sensitivity 89.7%, specificity 85.3%) was potentially useful for detecting active lesions. When compared with histopathological findings, an increase in bowel wall thickness reflected the ulcer marginal ridge, and the white-plaque sign reflected the ulcer bottom. Conclusions Intestinal ultrasound is useful for monitoring intestinal ulcer activity in intestinal Behçet disease.

Dynamic knee valgus is considered a risk factor for anterior cruciate ligament (ACL) injuries. This study identified how knee in distance (KID) and hip out distance (HOD) affect one’s lateral trunk lean (LTL). The results were also tested for reliability. Fifteen female basketball players (30 legs) from a university participated in this study. The participants performed single-leg squats by bending the knee of the supporting leg to 60°. The trials were recorded using a video camera. The KID, HOD, and LTL were measured with two-dimensional images using the Dartfish software, which measured the maximal knee valgus. The Pearson’s correlation coefficient was used to measure the correlation between dynamic knee valgus (KID and HOD) and LTL. Additionally, the Interclass Correlation Coefficient (ICC) was used to measure the reliability of the KID, HOD, and LTL data sets. The statistical significance was established at a level of p<0.05. Results showed that the KID and LTL had a significantly negative correlation, measured at r=-0.227, p<0.05. The ICC (2.1) values were: 0.83 for HOD, 0.99 for KID, and 0.96 for LTL; while the ICC (1.2) values were: 0.86 for HOD, 0.83 for KID, and 0.85 for LTL. The two-dimensional analysis technique revealed that the values were highly reliable. In sum, dynamic knee valgus had a negative correlation with LTL during single-leg squats. Therefore, it was suggested that the factors of dynamic knee valgus might be evaluated using LTL on two-dimensional screening test.

Purpose: Our aim was the longitudinal assessment of cyst size in fetuses with biliary cystic malformation (BCM) to explore its etiology and the possibility of antenatal differentiation between biliary atresia (BA) and congenital biliary dilatation (CBD). Methods: We conducted a retrospective review of all patients diagnosed antenatally with BCM from 1994 to 2014 at our institutions. Results: The study cohort comprised of three patients with BA and six with CBD. There were no significant differences in the gestational age and cyst size at the first detection of BCM between the two groups. In fetuses with CBD, the cyst size steadily increased as the gestational age advanced, while it fluctuated around 1.5 cm and remained below 2.1 cm in those with BA. However, the ratio of cystic area to fetal trunk area was approximately constant due to linear fetal growth in fetuses with CBD. Conclusion Fetuses with BCM <2.1 cm in the late gestation period were more likely to have BA than CBD. Our observation of cyst enlargement with advancing gestational age in the CBD group was attributed solely to fetal growth. Biliary dilatation in fetuses with CBD and BA might be completed at the onset of BCM.

A 3-month alcoholism rehabilitation program at psychiatric hospitals is common in Japan for patients with alcohol use disorder (AUD). However, many AUD patients are often hospitalized for the treatment of digestive disorders due to alcohol-related liver diseases and pancreatitis. In this sense, AUD patients need to be better supported by professionals and departments in general hospitals. Here we analyzed the problems in alcohol-related medical care in Japan and examined the measures to be taken at general hospitals.

Calcified amorphous tumor (CAT) is a non-neoplastic mass characterized by calcified nodules that was first reported in 1997. It is often associated with dialysis or mitral annular calcification (MAC). CAT is considered a risk factor for systemic embolism, but there has been no report of CAT damaging the native valve tissue and leading to valvular disease. An 81-year-old woman had shortness of breath on exertion starting 1 year previously, and was referred to our hospital with cardiac murmur detected on physical examination. Echocardiography showed evidence of severe mitral valve regurgitation with ruptured chordae tendineae of the posterior leaflet and a poorly mobile club-shaped structure protruding into the left ventricle and appearing to be continuous with MAC. She underwent elective mitral valve repair. A club-shaped calcification originating from MAC was found under the P2 segment, with ruptured P2 chordae tendineae immediately above it and mitral perforation in the contralateral A2 segment, which were likely to have resulted from direct damage by the hard structure. Mitral valve repair was successful with mass resection, triangular resection of the posterior leaflet P2 segment, and closure of the perforation. Histopathological findings of the mass were consistent with CAT, with no evidence of infection or malignancy. CAT may not only cause embolism but also grow while damaging the native valve tissue. It is important to closely follow-up and perform surgery in proper timing.

Following the revision of nursing care remuneration in FY 2015, our health service facility for the elderly made improved support available based on the outcomes of rehabilitation case conferences (RCCs) we convened for users of visiting rehabilitation services. In this study, we conducted a survey to investigate the implementation status of the RCC outcomes by respondents,including service users, their family members, and healthcare professionals,at our facility and the changes observed in service users who participated in the RCCs.Survey items inquired about the basic attributes of service users, RCC topics discussed, status of participation in the RCCs by occupation,and independence in activities of daily living (ADL) of elderly disabled people.The topics covered in the RCCs were classified using the International Classification of Functioning,Disability,and Health.In total,85 of 108 people who needed nursing care (34 men, 51 women; mean age 81.4±9.4 years;mean duration of service use 16.3 months) participated in the RCCs.The majority of topics covered in the RCCs concerned ADL and environmental factors,and more than half of the respondents participated in RCCs several times.Because ADL and environmental factors were discussed most,it can be said that the RCC concerning visiting rehabilitation services for users living at home is an effective means of expanding ADL and instrumental ADL. An advantage of holding RCCs is that the users themselves can clarify the current status and future goals. Also, from the service provider perspective, multidisciplinary cooperation becomes easier and helps to further improve support for users.

STUDY DESIGN: Retrospective and comparative study. PURPOSE: We assessed surgical treatment outcomes in patients with thoracic myelopathy due to ossification of the ligamentum flavum (OLF), and OLF combined with ossification of the posterior longitudinal ligament (OPLL) or vertebral fracture (VF) at the same level. OVERVIEW OF LITERATURE: OLF and OPLL cause severe thoracic myelopathy. Osteoporotic VF commonly occurs at the thoracolumbar junction. There have been no investigations of thoracic myelopathy due to OLF and VF. METHODS: Forty patients were divided among three groups: the OLF group (n=23): myelopathy due to OLF, the OLF+OPLL group (n=12): myelopathy due to OLF and OPLL, and the OLF+VF group (n=5): myelopathy due to OLF and VF. We recorded OLF, OPLL, and VF sites and operative procedures. Each patient’s neurological status, according to the Japanese Orthopaedic Association (JOA) score, and walking ability were evaluated pre- and postoperatively. RESULTS: Patients in the OLF+OPLL group were significantly younger than those in the other two groups. The preoperative JOA score was significantly lower in the OLF+VF than OLF group. The final JOA score was significantly lower in the OLF+VF than OLF and OLF+OPLL groups. The JOA score recovery rate was significantly lower in the OLF+VF than OLF group. Final walking ability was significantly worse in the OLF+OPLL and OLF+VF groups than in the OLF group and significantly worse in the OLF+VF than OLF+OPLL group. CONCLUSIONS: Thoracic myelopathy due to OLF+VF occurs primarily in older females, who also exhibit worse preoperative and postoperative neurological status, and worse walking ability, than patients with thoracic myelopathy due to OLF or OLF+OPLL.

OBJECTIVE: We evaluated the effect of various patient characteristics and time-density curve (TDC)-factors on the test bolus-affected vessel enhancement on coronary computed tomography angiography (CCTA). We also assessed the value of generalized linear regression models (GLMs) for predicting enhancement on CCTA. MATERIALS AND METHODS: We performed univariate and multivariate regression analysis to evaluate the effect of patient characteristics and to compare contrast enhancement per gram of iodine on test bolus (ΔHUTEST) and CCTA (ΔHUCCTA). We developed GLMs to predict ΔHUCCTA. GLMs including independent variables were validated with 6-fold cross-validation using the correlation coefficient and Bland–Altman analysis. RESULTS: In multivariate analysis, only total body weight (TBW) and ΔHUTEST maintained their independent predictive value (p < 0.001). In validation analysis, the highest correlation coefficient between ΔHUCCTA and the prediction values was seen in the GLM (r = 0.75), followed by TDC (r = 0.69) and TBW (r = 0.62). The lowest Bland–Altman limit of agreement was observed with GLM-3 (mean difference, −0.0 ± 5.1 Hounsfield units/grams of iodine [HU/gI]; 95% confidence interval [CI], −10.1, 10.1), followed by ΔHUCCTA (−0.0 ± 5.9 HU/gI; 95% CI, −11.9, 11.9) and TBW (1.1 ± 6.2 HU/gI; 95% CI, −11.2, 13.4). CONCLUSION: We demonstrated that the patient's TBW and ΔHUTEST significantly affected contrast enhancement on CCTA images and that the combined use of clinical information and test bolus results is useful for predicting aortic enhancement.
Angiography* ; Body Weight ; Cardiac Output ; Heart ; Humans ; Iodine ; Linear Models* ; Multivariate Analysis

OBJECTIVE: To evaluate the effect of patient characteristics on popliteal aortic contrast enhancement at lower extremity CT angiography (LE-CTA) scanning. MATERIALS AND METHODS: Prior informed consent to participate was obtained from all 158 patients. All were examined using a routine protocol; the scanning parameters were tube voltage 100 kVp, tube current 100 mA to 770 mA (noise index 12), 0.5-second rotation, 1.25-mm detector row width, 0.516 beam pitch, and 41.2-mm table movement, and the contrast material was 85.0 mL. Cardiac output (CO) was measured with a portable electrical velocimeter within 5 minutes of starting the CT scan. To evaluate the effects of age, sex, body size, CO, and scan delay on the CT number of popliteal artery, the researchers used multivariate regression analysis. RESULTS: A significant positive correlation was seen between the CT number of the popliteal artery and the patient age (r = 0.39, p < 0.01). A significant inverse correlation was observed between the CT number of the popliteal artery and the height (r = −0.48), total body weight (r = −0.52), body mass index (r = −0.33), body surface area (BSA) (r = −0.56), lean body weight (r = −0.56), and CO (r = −0.35) (p < 0.001 for all). There was no significant correlation between the enhancement and the scan delay (r = 0.06, p = 0.47). The BSA, CO, and age had significant effects on the CT number (standardized regression: BSA −0.42, CO −0.22, age 0.15; p < 0.05, respectively). CONCLUSION: The BSA, CO, and age are significantly correlated with the CT number of the popliteal artery on LE-CTA.
Angiography* ; Body Mass Index ; Body Size ; Body Surface Area ; Body Weight ; Cardiac Output ; Humans ; Informed Consent ; Lower Extremity* ; Popliteal Artery ; Tomography, X-Ray Computed