Increasing postural sway in balance test is related to locomotive syndrome risk: A cross-sectional study

BackgroundLocomotive syndrome risk level has been recently proposed to evaluate physical ability. Impaired balance control is one of the most important risk factors for falls. However, the relationship between locomotive syndrome risk and postural sway according to the balance test is unclear. This study aimed to investigate the relationship between locomotive syndrome risk and balance test results, including muscle mass and physical function, in a large-scale prospective general health checkup.MethodsWe enrolled 292 participants who underwent a basic health checkup and conducted a two-step test, stand-up test, evaluation using a 25-question geriatric locomotive function scale for the locomotive syndrome risk test, balance test, appendicular skeletal muscle mass measurement by bioelectrical impedance analysis, evaluation of physical function by the timed-up-and-go test, and back muscle and grip strength evaluation. A statistical comparative study was then conducted between normal and locomotive syndrome risk groups. Subsequently, significant factors for locomotive syndrome risk were investigated by multivariate analysis.ResultsThe comparative study was conducted by adjusting age and sex using a generalized linear model. No significant difference in muscle mass existed, but postural sway in the balance test significantly increased in the people at locomotive syndrome risk. Among the four posturographic variables by balance test, increase in back-and-forth sway was the most remarkable variable associated with locomotive syndrome risk together with back muscle strength, body mass index, and the timed-up-and-go test by logistic regression analysis. This posturographic variable was significantly related to the timed-up-and-go test and leg skeletal muscle mass by multiple regression analysis.ConclusionsA relationship was recognized between locomotive syndrome risk and postural sway. In particular, increase in back-and-forth sway was an important factor for locomotive syndrome risk. If the balance test shows an increase in back-and-forth sway, attention should be paid to locomotive syndrome risk for possible intervention and early treatment.     

Job's syndrome: a rare cause of recurrent lung abscess in childhood

A clinical syndrome characterized by recurrent staphylococcal infection of the skin and respiratory tract from birth was described in 1966 and referred to as Job's syndrome. Marked hyperimmunoglobulinemia E was later found to be associated with this syndrome. This article describes a case of Job's syndrome as a cause of recurrent lung abscess during childhood necessitating lung resection.     

Eagle syndrome: entrapment of the glossopharyngeal nerve? Case report and review of the literature

Eagle syndrome is characterized by unilateral pain in the oropharynx, the side of the face, and the earlobe. It is caused by an elongated styloid process; resection of the elongated process eliminates the pain. Although quite rare, this syndrome is well represented in the oral, ear, nose, and throat surgery literature. In the neurosurgical literature, on the other hand, there is little if any mention of Eagle syndrome. The author presents a case of a woman who suffered from severe pain in the throat, the side of the face, and the ear. After the diagnosis of Eagle syndrome was made based on radiographic findings and was confirmed using a local anesthetic block, resection of the elongated styloid process was performed, resulting in complete and lasting pain relief. Eagle syndrome, which is caused by compression of the glossopharyngeal nerve as it passes the elongated styloid process, may be classified as an entrapment syndrome deserving of neurosurgical attention. The goal of this report is to familiarize neurosurgeons with Eagle syndrome and its diagnostic work up and treatment.     

Superior Mesenteric Artery Syndrome in Association with an Abdominal Aortic Aneurysm

Superior mesenteric artery (SMA) syndrome, also known as Wilkie syndrome, is a rare condition characterised by compression of the third part of the duodenum against the aorta by the SMA. This can cause symptomatic duodenal obstruction. It is rarely associated with an abdominal aortic aneurysm (AAA). We report the case of a male patient presenting with an AAA and recurrent upper gastrointestinal symptoms. SMA syndrome was diagnosed with imaging and was then successfully treated by aneurysm repair. This is the smallest AAA associated with SMA syndrome in the literature. We propose an anatomical mechanism for SMA syndrome in this case.     

The metabolic syndrome and chronic kidney disease in a Southeast Asian cohort

US adults with metabolic syndrome, as defined by National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III) criteria, have been shown to be at increased risk of chronic kidney disease (CKD), but there is limited information in other populations. The relationship between metabolic syndrome and CKD (defined as estimated glomerular filtration rate <60 ml/min/1.73 m(2)) was examined in a Southeast Asian cohort. This relationship was examined when the subjects (n=3195) were initially recruited in a cross-sectional analysis. The risks of developing new CKD associated with metabolic syndrome were also examined prospectively in a subgroup (n=2067) without CKD at entry after 12 years follow-up. Metabolic syndrome was defined according to both NCEP ATP III and the new International Diabetes Federation (IDF) criteria. The prevalence of CKD was 1.6%, and the incidence of new CKD was 6.3%. Metabolic syndrome by NCEP ATP III definition was associated with the increased risk of CKD at baseline (adjusted odds ratio (OR) 2.48 and 95% confidence interval 1.33-4.62), and of developing new CKD at follow-up (adjusted OR 1.62 and 95% confidence interval 1.00-2.61). There was a significant graded relationship between the number of metabolic syndrome components present and risk of CKD. By contrast, metabolic syndrome by IDF definition was not associated with increased risk of CKD. These results suggest the relationship between CKD and metabolic syndrome in a Southeast Asian population is highly dependent on the criteria used to define metabolic syndrome.     

Compartment syndrome with foot ischemia after inversion injury of the ankle

This article reports the case of a 17-year-old girl who presented with compartment syndrome and acute ischemia of the foot after a minor ankle sprain. The suspected cause of compartment syndrome was secondary emergence of swelling and palsy of the foot. The posterior tibial and dorsalis pedis pulses were nonpalpable. The syndrome was confirmed by measurement of the pressures in the compartments of the foot, which were >30 mm Hg. Foot fasciotomy was successfully performed by using a three-incision technique. In contrast with previous case reports, no bone or vessel lesion was detected to explain the onset of a compartment syndrome. To our knowledge, this is the first case report compartment syndrome of the foot after an isolated minor ankle injury. Physicians should be aware of the possibility of compartment syndrome of the foot emerging irrespective of the severity of the initial trauma.     

Erectile dysfunction as a predictor of the metabolic syndrome in aging men: results from the Massachusetts Male Aging Study

PURPOSE: The metabolic syndrome, characterized by central obesity, insulin dysregulation, abnormal lipids and borderline hypertension, is a precursor state for cardiovascular disease. We determined whether erectile dysfunction is predictive of the metabolic syndrome. MATERIALS AND METHODS: Data were obtained from the Massachusetts Male Aging Study, a population based prospective cohort observed at 3 points during approximately 15 years (T(1)-1987 to 1989, T(2)-1995 to 1997, T(3)-2002 to 2004). The metabolic syndrome was defined by using a modification of the Adult Treatment Panel III guidelines. The association between erectile dysfunction and the metabolic syndrome was assessed using relative risks and 95% confidence intervals estimated using Poisson regression models. RESULTS: Analysis was conducted of 928 men without the metabolic syndrome at T(1). There were 293 men with incident metabolic syndrome, of which 56 had erectile dysfunction at baseline. Body mass index and the presence of 1 or 2 conditions constituting the metabolic syndrome definition were the strongest predictors of the metabolic syndrome. The association of erectile dysfunction with the metabolic syndrome (unadjusted RR 1.35, 95% CI 1.01-1.81) was modified by body mass index, with a stronger effect of erectile dysfunction in men with body mass index less than 25 (adjusted RR 2.09, 95% CI 1.09-4.02), and no erectile dysfunction and metabolic syndrome association in men with body mass index 25 or greater (adjusted RR 1.06, 95% CI 0.76-1.50). CONCLUSIONS: Erectile dysfunction was predictive of the metabolic syndrome only in men with body mass index less than 25. This finding suggests that erectile dysfunction may provide a warning sign and an opportunity for early intervention in men otherwise considered at lower risk for the metabolic syndrome and subsequent cardiovascular disease.     

The role of soluble immune response suppressor lymphokine in the prediction of steroid responsiveness in idiopathic nephrotic syndrome

The role of serum soluble immune response suppressor (SIRS) lymphokine in the prediction of steroid responsiveness in idiopathic nephrotic syndrome was investigated. Serum SIRS was detected by its capacity to suppress the induction of plaque forming cells in pokeweed mitogen-stimulated in vitro lymphocyte culture in a dose dependent manner, and specificity was determined by the ability of monoclonal anti-SIRS coated beads to specifically absorb the suppressor activity. Serum SIRS was present in 7 of 18 patients with steroid responsive nephrotic syndrome and in 1 of 6 patients with nephrotic syndrome who were resistant to steroid treatment. It was also found in 2 of 4 patients with nephrotic syndrome which would be expected to be resistant to steroid treatment, in 2 of 10 patients with steroid responsive nephrotic syndrome in remission and in 2 of 8 normal healthy controls but was absent in 8 patients with non-nephrotic proteinuria secondary to a variety of renal disease. It was concluded that, although serum SIRS was present more often in patients with steroid responsive nephrotic syndrome, it is not a sensitive enough assay for predicting the response to treatment.     

Handgrip Strength Among Korean Adolescents With Metabolic Syndrome in 2014–2015

The prevalence of metabolic syndrome is increasing worldwide in adolescents. Metabolic syndrome is a systemic disease that is likely to be associated with other diseases. Studies have shown a relationship between muscle strength, muscle quality, and metabolic syndrome. Handgrip strength is known as a simple tool to measure muscle strength. Therefore, we aimed to investigate the relationship between handgrip strength and metabolic syndrome and each metabolic syndrome features in adolescents. Data were obtained from 1050 adolescents (574 boys, 476 girls; age 10–18 years) who participated in the Korea National Health and Nutrition Examination Survey. We used the International Diabetes Federation metabolic syndrome guideline and National Cholesterol Education Program Adult Treatment Panel III guideline for children to define metabolic syndrome. The highest handgrip strength for both hands was recorded. Handgrip strength was also divided by the participants’ own weight (handgrip-to-weight ratio). Adolescents with metabolic syndrome defined by each guideline have higher handgrip strength (p < 0.05). When handgrip strength was divided with participants’ own body weight (handgrip-to-weight ratio), values were decreased in participants with metabolic syndrome (p < 0.05). The male participants tend to have higher handgrip-to-weight ratio than female. However, the handgrip-to-weight ratio was found to be decreased regardless of gender when the metabolic syndrome feature was present. This study shows that handgrip strength is associated with metabolic syndrome in adolescents. This is the first study to compare handgrip strength and metabolic syndrome in Korean adolescents. Given that handgrip strength is associated with metabolic syndrome in adolescents, it can be a diagnostic modality to easily identify the patients’ current state in the clinic.     

Unspecific Increase of Tumor Markers in a Girl with Nephrotic Syndrome and Ovarian Teratoma

Coexistence of nephrotic syndrome and neoplasm is rarely observed in children. We report the diagnostic and therapeutic problems of a 16-year-old female with nephrotic syndrome, ovarian tumor, and increased levels of tumor markers. She was suspected to have paraneoplastic nephrotic syndrome. After ovarian tumor resection, the nephrotic syndrome remission was not observed, while increased tumor marker levels were noted. The patient’s final diagnosis was nephrotic syndrome in the course of primary mesangial proliferative glomerulonephritis. In conclusion, nephrotic syndrome in a patient with neoplasia might occur in the course of the primary and nonparaneoplastic glomerulopathy. Elevated serum tumor markers in patients with nephrotic syndrome might be nonspecific because of the stimulation of their production by peritoneal mesothelium, due to transudation to body cavities, that is, ascites.     

The beneficial role of simultaneous splenectomy in living donor liver transplantation in patients with small-for-size graft

Small-for-size (SFS) graft syndrome is one of the major causes of graft loss in living donor liver transplantation (LDLT). We examined whether splenectomy is beneficial for overcoming SFS graft syndrome in LDLT. The patients were classified into two groups: the Sp (−) group ( n  = 69), in which splenectomy was not performed, and the Sp (+) group ( n  = 44), in which it was. The incidence of SFS graft syndrome was investigated. Risk factors of SFS graft syndrome were identified by univariate- and multivariate analysis. To clarify whether splenectomy is beneficial for patients with a SFS graft, subgroup analysis was performed for patients who had a graft weight-to-standard liver weight (GW-SLW) ratio of 40% or less ( n  = 50). Thirty-one of 113 patients developed SFS graft syndrome. A multivariate analysis identified that having a male donor was an independent risk factor of SFS graft syndrome. SFS graft syndrome occurred in 11 of 50 patients with a GW-SLW ratio <40%, and Sp (−) was an independent risk factor for the occurrence of SFS graft syndrome in patients ( P  = 0.014). Simultaneous splenectomy is favorable for overcoming SFS graft syndrome in LDLT patients with a GW-SLW of 40% or less.     

Avellis syndrome after minor head trauma: report of two cases.

Avellis syndrome is a rare condition that usually occurs in association with infarction of the medulla oblongata or mass lesions around the jugular foramen; this syndrome has rarely been reported after trauma. Two cases of Avellis syndrome that occurred following minor head trauma are presented. The mechanism by which Avellis syndrome is produced is briefly discussed. The relative resistance to damage of the spinal accessory nerve was thought to play an important role in producing the peripheral type of Avellis syndrome. The outcome was favorable in both cases.     

Venous thoracic outlet syndrome caused by a congenital rib malformation

Venous thoracic outlet syndrome (VTOS) represents a rare disorder. Hypertrophy of the anterior scalene musculature is the cause of the compression syndrome in most cases. To our knowledge, we describe the first reported case worldwide of a venous compression syndrome caused by a congenital malformation of the 1st and 2nd ribs. Treatment by transaxillary partial rib resection was necessary and a very good postoperative result was achieved.     

Laparoscopy-assisted left ovarian vein transposition to treat one case of posterior nutcracker syndrome

We report one case of posterior nutcracker syndrome treated by left ovarian vein (LOV) transposition. A 36-year-old woman was suffering from nutcracker syndrome associated with pelvic congestion syndrome. Color duplex scan, computed tomographic scan, and angiography demonstrated a stenosis of a retroaortic left renal vein with proximal dilatation and incompetence of the LOV. The renocaval pullback gradient was 10 mm Hg. The LOV was harvested laparoscopically and transposed into the inferior vena cava. Completion angiography showed a patent reconstruction with no significant gradient. At day 4, an asymptomatic thrombosis was treated by thromboaspiration. Forty months later, the patient remained asymptomatic with a patent transposition. Posterior nutcracker syndrome is a rare condition. When associated with pelvic congestion syndrome due to LOV reflux, it can be treated by LOV transposition.     

严重腹腔感染所致多脏器功能障碍综合征中医辨证规律研究

目的：研究严重腹腔感染所致多脏器功能障碍综合征中医证型分布规律及变化特点,方法：采用八纲辨证方法连续观察外科重症监护病房46例严重腹腔感染所致MODS患者,在采取病因及对症治疗同时按不同证型进行中医辨证论治观察记录中医证型变化。结果：第1d以里实热证和虚实夹杂证为主,第3d和第7d以虚实夹杂证为主,其次为里实热证和里虚热证,里虚寒证及亡阴／亡阳证少见,未见里实寒证。结论：随病情加重里实热证逐渐减少,里虚热症有增加趋势。     

Outcome of pregnancies with HELLP syndrome complicated by acute renal failure (1989-1999)

HELLP syndrome, a syndrome of hemolysis, elevated liver enzymes and low platelets may occur in pregnancy with pre-eclampsia/eclampsia, and its a significant complication is acute renal failure (ARF). The aim of study was to determine frequency and outcome of HELLP syndrome complicated by ARF. Thirty-nine patients with pregnancy-related ARF were treated between Jan 1, 1989 and Jan 1, 1999. In these patients, the most frequent causes were HELLP syndrome (n = 14; 36%), postpartum hemorrhage (n = 10; 26%), pre-eclampsia/eclampsia (n = 6; 15%) and abruptio placenta (n = 4; 10%). Seven of the patients with HELLP syndrome had impairment of consciousness during hospitalization. Of these patients, coma in 5, stupor in 1, confusion in 1 were diagnosed. Twelve of the patients with HELLP syndrome and 14 of the other patients were treated by dialysis. Mann-Whitney U test and chi2 test(corrected by Yates and Fisher exact) were used for statistical analysis. Although serious clinical findings, with supportive treatment, 12 patients with HELLP syndrome and 21 other patients were fully recovered. One patient both with and without HELLP syndrome could not recovered due to diffuse cortical necrosis. Moreover, one patient with HELLP syndrome and 3 other patients were died. Mortality rate of the patients with HELLP syndrome was not found different from those of the other patients (p = 0.544). The causes of death were cerebral hemorrhage in patient with HELLP syndrome and disseminated intravascular coagulation (n = 1), cerebral emboli (n = 1), adult respiratory distress syndrome (n = 1). Fetal death occurred in 4 patients with HELLP syndrome (28.5%) and 7 other patients (28%), and rates were similar (p > 0.5). Finally, HELLP syndrome was the most frequent cause leading to ARF in pregnancy and their prognosis was not different from those of the other patients.     

糖尿病肢体动脉闭塞症不同中医证型炎症指标比较

目的：观察糖尿病肢体动脉闭塞症湿热下注证患者炎症指标与血瘀证炎症指标的变化特点。方法：对30例糖尿病肢体动脉闭塞症湿热下注证和30例血瘀证患者采用放射免疫法检测白介素I（IL-1）、肿瘤坏死因子（TNF）水平,采用免疫比浊散射法检测超敏C反应蛋白（Hs-cRP）水平,采用生物酶法测定检测脂蛋白（α）（LP（dα））水平。结果：湿热下注证Hs—CRP于血瘀证患者（P〈0．01）,IL-1、TNF、LP（α）与血瘀证患者比较,差异无统计学意义（P〉0．05）。结论：超敏c反应蛋白可作为糖尿病肢体动脉闭塞症湿热下注证的微观辨证参考。     

Evolving compartment syndrome not masked by a continuous peripheral nerve block: evidence-based case management

Compartment syndrome is a potentially devastating complication of many orthopedic surgeries. Whether regional anesthesia can delay the diagnosis of compartment syndrome remains a subject of debate. Previous case reports have described compartment syndrome primarily in the setting of an epidural infusion, but also following single-injection peripheral nerve blocks. A case of evolving compartment syndrome in an ambulatory setting that was not masked by a continuous peripheral nerve block is presented, followed by a discussion of the literature pertaining specifically to peripheral nerve blockade and the diagnosis of compartment syndrome. Diagnosis depends on close postoperative monitoring of analgesic use and pain trends, and patients with ambulatory catheters require thorough education about compartment syndrome so they can be evaluated in a timely manner. The current literature on compartment syndrome diagnosis and regional anesthesia is limited to case reports and expert opinion, making evidence-based recommendations difficult.     

下肢深静脉血栓形成的证候要素研究

目的:探讨下肢深静脉血栓形成证候要素的分布规律。方法:对近28年来下肢深静脉血栓形成证候文献进行筛选,构建相关数据系统,对其证候要素分布规律进行研究。结果:下肢深静脉血栓形成的常见证候要素为湿、热、血瘀、脾阳虚;常见证候要素靶位为脾,其中急性期的基本证候要素为湿、热,非急性期常见证候要素为血瘀、湿和脾阳虚。结论:下肢深静脉血栓形成的病机变化是以血瘀为基础,受多因素影响、虚实错杂的复杂过程。证候研究中,简化成证候要素的形式具有更强的可操作性。     

Steal Syndrome Complicating Hemodialysis Access Procedures: Can It Be Predicted?

The development of steal syndrome distal to an arteriovenous fistula (AVF) created for hemodialysis access remains a significant clinical problem. This study was undertaken to determine the role of intraoperative noninvasive testing in the prediction and management of steal syndrome following arteriovenous fistula creation. First, in order to determine a threshold digital/brachial index (DBI) for patients at risk for steal syndrome, we performed a retrospective review of patients who had had the DBI measured and who developed symptoms (steal syndrome) following AVF creation. This was followed by a prospective evaluation of the ability of the DBI to predict which patients undergoing AVF surgery would develop steal syndrome. A DBI of <0.6 identifies a patient at risk for steal syndrome. Intraoperative DBI cannot be used to predict which patient will develop steal syndrome; however, if revision is indicated, the DBI should be increased to >0.6. Failure to accomplish this puts the patient at risk for continued steal syndrome.