A case of far-out syndrome: case report and review of the literature

Far-out syndrome (FOS) is a rare disease in which the L5 nerve root is compressed by a transverse process, the sacral ala, and a bony spur at the extraforaminal zone. We report the case of patient with FOS due to a bulging disc and review the literature. This 34-year-old male experienced severe left leg pain and slight motor weakness of the left extensor digitorum. Radiographic studies revealed no abnormality in the spinal canal. The intervertebral disk bulged to the left. Because of fat it was difficult to discern the left L5 nerve root from the sacral ala in the extraforaminal zone. His symptoms failed to respond to conservative treatment and he underwent decompression of the L5 nerve root without fusion. During the operation, the left L5 nerve root was exposed by drilling the sacral ala via the left paraspinal approach. The sacral ala was removed along with the left L5 nerve root to obtain sufficient pulsation and movement of the left L5 nerve root. Neither the intervertebral joint nor the intervertebral disk was removed. The patient's symptoms disappeared immediately after surgery. Due to anatomical factors, the L5 nerve root is easily compressed and the presence of this syndrome should be considered in a differential diagnosis. Careful and appropriate decompression without fusion yielded an excellent outcome.     

Double-blind comparison of L-keflex and cephalexin (Keflex) in dental infections (author's transl)

In order to evaluate efficacy and safety of L-Keflex (granule form of sustained release cephalexin), a double blind study comparing it with Keflex (capsule of regular cephalexin) was conducted in dental infections. Evaluable cases in adults for efficacy of the drugs were 196 consisting of 97 for L-Keflex and 99 for Keflex. Those in children were 19 (8 for L-Keflex and 11 for Keflex). There were no significant differences in background of the patients and severity of the diseases between both groups (L-Keflex and Keflex groups). The daily doses used in both groups were 1,000 mg in adults and 500 mg in children, respectively. The dose was given in two divided doses for L-Keflex group and in four divided doses for Keflex group. Following are evaluation by the committee members for the study: Adults 1. Clinical response rate at final therapy day was 93.8% in L-Keflex group and 92.9% in Keflex group, showing no significant difference between both groups. 2. No significant difference in severity of subjective and objective symptoms between both groups was observed at each therapy day. 3. Side effects were found in 6.7% of 105 patients receiving L-Keflex and in 5.6% of 107 patients with Keflex, and there was no significant difference between both groups. As the side effects, gastrointestinal symptoms, rash and itching were observed, but no any other side effects were found in both groups. Children 1. As shown in the above, number of the cases enough to evaluate statistically was not obtained, but all of both groups clinically responded to the drugs. 2. As for side effects diarrhea was observed in only one patient of Keflex group consisting of 12 patients. In the patient, however, discontinuation of the drug was not required and the side effect disappeared during the therapy. From the above results, L-Keflex (granule) is judged to have more convenience than Keflex (capsule) in that (1) it can be administered with b.i.d. regimen and (2) it can be easily taken in dental patients such as patients having difficulty in opening mouth of swallowing pain.     

PEG-appended beta-(1-->3)-D-glucan schizophyllan to deliver antisense-oligonucleotides with avoiding lysosomal degradation

Schizophyllan is a natural beta-(1-->3)-d-glucan existing as a triple helix in water and as a single chain in dimethylsulfoxide (DMSO). As we already reported, when a homo-polynucleotide [e.g., poly(dA) or poly(C)] is added to the schizophyllan/DMSO solution and subsequently DMSO is exchanged for water, the single chain of schizophyllan forms a complex with the polynucleotide. One of the potential applications for this novel complex is an antisense-oligonucleotide (AS ODN) carrier. The present paper describes a modification technique that enabled us to introduce PEG only to the side chain of schizophyllan. This technique consisted of periodate oxidation of the glucose side chain and subsequent reaction between methoxypolyethylene glycol amine and the formyl terminate, followed by reduction with NaBH4. Subsequently, we made a complex from PEG-appended schizophyllan and an AS ODN sequence, and carried out an in vitro antisense assay, administrating the AS ODN complex to depress A375 c-myb mRNA of A375 melanoma cell lines. The PEG-SPG/AS ODN complex showed more enhanced antisnese effect than naked AS ODN dose, i.e., the same level as that of RGD-appended SPG. Here, the RGD system has been shown one on the most effective AS ODN carrier (Science 261 (1993) 1004-1012). When we added nigericin to the assay system, the antisense effect was not affected in the PEG-SPG system, on the other hand, it was almost eliminated in the RGD system. Nigericin is well known to interrupt transport from endosome to lysosome. Therefore, the difference between the PEG and RGD complexes indicates that, in the PEG system, AS ODN was able to escape from lysosomal degradation. The present work has thus proposed a new strategy to delivery AS ODN using schizophyllan as a new carrier.     

Effects of home massage rehabilitation therapy for the bed-ridden elderly: a pilot trial with a three-month follow-up

OBJECTIVES: To assess the effects of home massage rehabilitation therapy on the bed-ridden elderly. DESIGN: Alternatively allocated trial. SETTING: Subjects' homes, three home nursing stations, 13 visit care stations and one day service centre in Aichi prefecture, Japan. SUBJECTS: Bed-ridden patients who were 65 years and above, no dementia, stable general condition, and receiving no rehabilitation therapy. INTERVENTION: Thirty-minute sessions of home massage rehabilitation therapy by a massage practitioner 2 or 3 days a week for three consecutive months or usual care. MAIN MEASUREMENTS: Barthel Index (BI), Subjective Satisfaction and Refreshment Scale, Apathy Scale and Self-rating Depression Score. RESULTS: Fifty-three subjects were recruited, 26 in the home massage rehabilitation group (HMG) and 27 in the routine care group without massage (RCG). The protocol was completed for 40 subjects, 22 in the HMG and 18 in the RCG. There were no significant differences between the baseline characteristics of both groups; age, presence of spouse, diseases associated with disabilities and use of day care rehabilitation (p = 0.76, 0.36, 0.94 and 0.71, respectively). The total BI score of the HMG (15.27+/-4.51) at baseline was nonsignificantly lower (p= 0.03) than those of the RCG (11.44+/-5.90). Subjective Satisfaction and Refreshment Scale, Apathy Scale and Self-rating Depression Score of both groups at baseline were matched (p = 0.12, 0.32 and 0.89, respectively). There were no statistical differences between the intergroup changes over time in BI, Subjective Satisfaction and Refreshment Scale, Apathy Scale and Self-rating Depression Score (p = 0.35, 0.08, 0.70 and 0.55, respectively). CONCLUSION: Home massage rehabilitation therapy did not show a positive effect on the bed-ridden elderly, either mentally or physically. We would require large-size trials to determine whether it is effective.     

Comparison between whole and intact parathyroid hormone assays

The standard measurement of parathyroid hormone (PTH) is the intact PTH (iPTH) assay, which is used for approximately 90% of Japanese dialysis patients. The iPTH assay reacts not only with 1-84?PTH, but also with large truncated fragments of non-1-84?PTH, including 7-84?PTH. On the other hand, the whole PTH assay is specific for 1-84?PTH. The aim of the current study was to define the validity of both whole and intact PTH assays. A total of 738 hemodialysis patients were enrolled from twelve dialysis services. The serum PTH level was evaluated by both intact and whole PTH assays simultaneously. Non-1-84?PTH was determined by subtracting the whole PTH value from that of the intact PTH assay. The median level of whole PTH was 121?pg/mL, and that of iPTH was 210?pg/mL. The whole PTH assay had a very high correlation with the iPTH assay (r?=?0.870, P?相似文献   

Schwannoma developing in the psoas major muscle: a case report

Schwannoma can occur wherever peripheral nerve Schwann cells are found. However, retroperitoneal schwannoma is extremely rare in that only 16 cases have been reported, including that of the present patient. A 51-year-old male complained of chronic lower back pain and paresthesia in the lower left region. Lower back pain increased with leftward bending. Magnetic resonance imaging (MRI) revealed a neoplastic lesion about 6 cm in diameter in the left psoas major muscle, and the lesion was in contact with the L4 and L5 vertebral bodies. The tumor did not continue to the lumbar foramen. The symptom had become disabling, therefore tumor removal was performed using Wiltse's approach. From intraoperative findings, the origin of the tumor was suspected to be the L4 nerve root. The ventral surface of the tumor could not be observed with this posterior approach. Lumbar plexus might adhere closely to the ventral surface of the tumor, therefore the capsule of the tumor was left to avoid neurological deterioration. Schwannoma was diagnosed by pathological analysis, and no malignancy was evident. After the operation, symptoms were completely relieved, and the residual capsule of the tumor diminished in size on MRI after 12 months. The posterior Wiltse's approach can be useful to treat mass lesions in the psoas major muscle. The 16 reported cases of retroperitoneal schwannoma, including that of the present patient, are reviewed.