Effects of using cane and vestibular rehabilitation on the walking function in elderly patients with dizziness

ObjectiveAdults over the age of 65 years with balance disorders are at about twice the risk of falls, compared with those without balance disorders. Falls contribute to about 74% of the proximal femoral fractures commonly seen in the elderly. Since balance disorders are more prevalent in older adults than in younger adults, it is important to deal with balance disorders in older adults to prevent falls and the resulting deterioration in their ADL (activity of daily living). In this study, we investigated the effects of vestibular rehabilitation (VR) and cane use on improving gait and balance in patients aged over 65 years with balance disorder.Methods: Patients aged over 65 years presenting to the Department of Otolaryngology at St. Marianna University School of Medicine between July 1 and November 1, 2018, with symptoms of dizziness for ≥ 3 months and a Japanese translation of the Dizziness Handicap Inventory score of ≥ 26 were included in the study. We quantitatively analyzed their gait before and after VR, and with and without the use of a cane.ResultsA total of 21 patients participated in the study (14 women; mean age 73.9 ± 6.9 years). Before VR, using a cane made no difference to step length or walking speed. After VR, using a cane increased step length from 50.5 cm (95% confidence interval [CI], 47.4–53.7 cm) to 52.0 cm (95% CI, 48.9–55.1 cm) (p = 0.039). There was no change in walking speed. A comparison of walking assessment results while using a cane before and after VR showed that step length increased from 49.9 cm (95% CI, 46.6–53.2 cm) to 52.0 cm (95% CI, 48.9–55.1 cm) (p = 0.005), and walking speed increased from 90.5 cm/s (95% CI, 82.7–98.4 cm/s) to 96.1 cm/s (95% CI, 88.3–103.9 cm/s) (p = 0.005).ConclusionsWalking speed and step length with the use of a cane significantly improved following VR. VR and cane use may act synergistically to improve walking.     

Assessment of CAD-generated tumor volumes measured using MRI in breast cancers before and after neoadjuvant chemotherapy

Objective

To evaluate inter-observer agreement and the predictive value of tumor size measurements using MRI for breast cancer under neoadjuvant chemotherapy (NAC) by comparing the measurements of the longest diameters (LD), total enhanced volumes (TEV) and washout volumes (WOV).

Methods

Thirty-seven female breast cancer patients were prospectively enrolled from August 2008 to October 2010. Two of these patients had locally advanced disease. MRI examinations were acquired within 2 weeks before and after NAC. Interim scans were also conducted in 30 patients. Tumor resection was undertaken within 2 weeks after the cessation of NAC. MRI images were independently measured for LD, TEV and WOV by two experienced radiologists. Inter-observer agreement was evaluated using concordance correlation coefficients (CCCs). Tumor sizes after NAC were evaluated relative to their initial sizes for early prediction of a pathological complete response (pCR).

Results

The CCCs were 0.93 (CI: 0.90–0.95) for LD, 0.98 (CI: 0.97–0.98) for TEV and 0.99 (CI: 0.991–0.996) for WOV. All measurements had high inter-observer agreement, but the CCCs were significantly increased in the aforementioned order (P < 0.0001). WOV measured after the completion of chemotherapy had significant discriminating ability (P = 0.0056) when evaluated using receiver operating characteristic analysis, and was found to be superior to LD (P = 0.045). The average WOV size was significantly smaller in pCR cases than in non-pCR cases (P = 0.016).

Conclusion

Computer-aided detection-generated tumor volumes had significantly higher inter-observer concordance than conventional LD measurements. WOV measurements had the highest concordance, and WOV could better predict pCR after NAC at smaller tumor sizes.     

Perforation in pediatric non-complicated appendicitis treated by antibiotics: the real incidence

Pediatric Surgery International - The incidence of perforation during antibiotic therapy (AT) of children triaged as non-complicated acute appendicitis (NC-Ap) was investigated. Abdominal...     

Development of ossification of the posterior longitudinal ligament of the cervical spine after atlanto-axial fusion

We report three cases of the development of ossification of the posterior longitudinal ligament (OPLL) after atlanto-axial fusion. This fusion should be recognized as a causative factor in the development of OPLL. The pathological mechanism is suggested to be increased mechanical stress. Received: December 8, 2000 / Accepted: July 10, 2001