A 64-year-old female was found lying by a river. She was unconscious and her lower body was under water. The patient was transported to the emergency room of our hospital. On arrival, her rectal temperature was 24.6°C. We immediately started rewarming and artificial respiration. Five days after admission, rewarming was completed and she became conscious and could communicate. Initially, she had been injured and examination showed paraplegia. Magnetic resonance imaging of her cervical spine showed no findings indicating bony or ligament injury, but there was a T2 high intensity area at C5/6 and C6/7 levels. The patient was diagnosed with spinal cord injury without radiological abnormality.At 5 months post-injury, the patient was able to walk without crutches.Spinal cord injury might be missed if there are no radiographic abnormalities. Spinal cord injury without radiological abnormality should be considered as a differential diagnosis of accidental hypothermia.
In the recent article by Pfau et al.,1Pfau A. Wytopil M. Chauhan K. et al.Assessment of plasma oxalate concentration in patients with CKD.Kidney Int Rep. 2020; 5: 2013-2020Abstract Full Text Full Text PDF PubMed Scopus (4) Google Scholar "Assessment of Plasma Oxalate Concentration in Patients With CKD," they reported a new simple procedure for evaluating plasma oxalate (POx) concentration that enabled the investigation of a large cohort of patients with chronic kidney disease (CKD).1Pfau A. Wytopil M. Chauhan K. et al.Assessment of plasma oxalate concentration in patients with CKD.Kidney Int Rep. 2020; 5: 2013-2020Abstract Full Text Full Text PDF PubMed Scopus (4) Google Scholar They measured POx in 1826 patients with CKD and found stable results; furthermore, they reaffirmed a negative correlation between the estimated glomerular filtration rate and POx. Recent studies using dual-energy computed tomography angiography have reported that calcium oxalate is one of the main components of coronary artery calcification,2Matsui K. Machida H. Mitsuhashi T. et al.Analysis of coronary arterial calcification components with coronary CT angiography using single-source dual-energy CT with fast tube voltage switching.Int J Cardiovasc Imaging. 2015; 31: 639-647Crossref PubMed Scopus (16) Google Scholar,3Nishizawa Y. Higuchi C. Nakaoka T. et al.Compositional analysis of coronary artery calcification in dialysis patients in vivo by dual-energy computed tomography angiography.Ther Apher Dial. 2018; 22: 365-370Crossref PubMed Scopus (14) Google Scholar which affects the survival rate of patients with CKD. We are interested in the effects of high POx levels, especially in patients who are undergoing dialysis, and the methods to suppress these effects.4Oka Y. Miyazaki M. Matsuda H. Do calcium-based phosphate binders accelerate or prevent coronary artery calcification in dialysis patients?.Ther Apher Dial. 2018; 23: 195-196Crossref PubMed Scopus (2) Google Scholar We think this new method may contribute to future research in this area; however, some limitations remain. For instance, they described the correlation between the estimated glomerular filtration rate and POx, but they did not show a regression line in the scatterplot or present a correlation coefficient for the data or its P value. We hoped the authors would present this information, because this figure may be cited widely. We recognize that this study is a part of an ongoing prospective, large-cohort study. Therefore, we hope that the authors clarify the role of POx not only in CKD progression but also in the progression of coronary artery calcification in the future. Author Reply to Comment on "Assessment of Plasma Oxalate Concentration in Patients With CKD" by Oka et al.Kidney International ReportsVol. 6Issue 4PreviewThe Author Replies: We thank Oka et al. for the precise summary of our study "Assessment of plasma oxalate concentration in patients with CKD"1 and their excellent suggestions for future investigations. As proposed, we added a regression line to the scatter plot that illustrates the correlation between estimated glomerular filtration rate and plasma oxalate concentration (Figure 1) with the correlation coefficient r being −0.22 (Spearman correlation; P < 0.001). Full-Text PDF Open AccessAssessment of Plasma Oxalate Concentration in Patients With CKDKidney International ReportsVol. 5Issue 11PreviewAlterations in oxalate homeostasis are associated with kidney stone disease and progression of chronic kidney disease (CKD). However, accurate measurement of plasma oxalate (POx) concentrations in large patient cohorts is challenging as prompt acidification of samples has been deemed necessary. In the present study, we investigated the effects of variations in sample handling on POx results and examined an alternative strategy to the established preanalytical procedures. Full-Text PDF Open Access
Study Design: Retrospective study. Objectives: The purpose of the present study was to elucidate the clinical features of cervical pyogenic spondylitis and intraspinal abscess and to use this knowledge for early diagnosis and treatment. Summary of Background Data: Cervical pyogenic spondylitis and intraspinal abscess are relatively rare diseases in which accurate diagnosis is difficult at early stage. However, because both diseases can cause severe paralysis and vital crisis at advanced stages, early diagnosis and treatment are very important. Methods: Fourteen patients (men: 9, women: 5; average age at treatment: 65.4 y; age range: 49−89 y) with cervical pyogenic spondylitis and/or intraspinal abscess were treated in our hospital. We analyzed their initial symptoms, initial diagnosis, duration between the appearance of initial symptoms and final diagnosis, symptoms at final diagnosis, level of the affected cervical spine, predisposing factors, organisms, and treatments. Results: Initial symptoms included neck pain with fever (n=7), neck pain without fever (n=3), pharyngeal pain with fever (n=1), muscle weakness in both the upper and lower extremities (n=1), gait disturbance (n=1), and numbness of the lower extremities (n=1). Patients were initially diagnosed with meningitis (n=4), fever of unknown origin (n=2), cervical spondylosis (n=2), polymyalgia rheumatica (n=1), upper respiratory tract inflammation (n=1), metastatic spinal tumor (n=1), cervical spondylotic myelopathy (n=1), and cervical disc herniation (n=1). Of the 14 patients, 1 was correctly diagnosed with cervical pyogenic spondylitis. Conclusions: The initial symptoms of cervical pyogenic spondylitis and intraspinal abscess varied and neck pain with fever was not essential. Therefore, doctors should consider the possibility of cervical pyogenic spondylitis and repeat the assessments of the clinical examination for early diagnosis of this disease.
Instrumentation surgery in combination with radiotherapy (RT) is one of the key management strategies for patients with spinal metastases. However, the use of materials can affect the RT dose delivered to the tumor site and surrounding tissues, as well as hinder optimal postoperative tumor evaluation. The association of the preoperative Spine Instability Neoplastic Score (SINS) with the need for spinal stabilization and life expectancy are unclear. This multicenter prospective study aimed to investigate the current situation and make recommendations regarding the choice of surgical procedure based on the preoperative SINS and prospectively collected postoperative patient-reported outcomes (PROs). The study prospectively included 317 patients with spinal metastases who underwent palliative surgery and had a minimum follow-up period of 6 months. The survey items included SINS, patient background, and clinical data including surgical procedure, history of RT, prognosis, and PROs (i.e., the visual analog scale score, Faces Scale, Barthel Index, Vitality Index, and 5-level EQ-5D health survey) at baseline, and at 1 and 6 months after surgery. The association of preoperative SINS with life expectancy, PROs, and surgical procedures was examined using statistical analysis. Preoperative SINS (three categories) had no association with life expectancy. All PROs evaluated in the study improved up to 6 months after surgery. Pain categories (visual analog scale score and/or Faces Scale) at baseline were correlated with preoperative SINS. As many as 90.9% of enrolled patients underwent fusion surgery, and even in SINS 0-6 cases, implants were used in 64.3% of patients. Postoperative RT was performed in 42.9% of the patients. However, prospective assessments of PROs showed no significant difference between surgical procedures (with and without fusion) in patients with SINS 0-9. In addition, no cases required conversion from noninstrumentation surgery to fusion surgery. Although the choice of surgical procedure should be made on a case-by-case basis on the NOMS (neurological, oncological, mechanical, and systemic) framework, careful consideration is required to determine whether spinal stabilization is needed in patients with SINS ≤ 9, considering the patient's background and the plan for postoperative adjuvant therapy.
Abstract Objectives This study investigated the enamel and dentin bond durability of a two-step adhesive system, using a universal adhesive-derived primer (G2-Bond Universal [GU]), and compared it with the two conventional, two-step, self-etch adhesive systems (Clearfil SE Bond 2 [CS] and OptiBond XTR [OX]) under thermal cycling (TC) and long-term water storage (WS). Materials and Methods The shear bond strengths to bovine enamel and dentin were determined using the etch-and-rinse and self-etch modes. Twelve specimens per test group were prepared and further divided into the following subgroups: 1) subjected to TC, 2) long-term WS, and 3) WS for 24 h (baseline). The cured adhesive layers’ water contact angle and surface free energy were measured. Results Among the specimens in the baseline subgroups, the GU’s enamel and dentin bond performances were equivalent to those of CS, regardless of the etching mode. Although GU’s enamel bond durability was similar to that of CS, its dentin bond durability was superior to those of the other adhesive systems in both etching modes. GU’s cured adhesive layer was more hydrophobic than those of the other adhesive systems. Conclusion The enamel and dentin bond durability of GU was superior to those of CS and OX in different etching modes and under different degradation conditions. Clinical Relevance The latest two-step adhesive system, which utilizes universal adhesives' benefits in its primer, might offer durable clinical bonding performances and can be widely used in a clinical setting.
In our experience, continuous epidural administration of fentanyl in doses of 12.5 micrograms.h-1, has not been sufficient to relieve postoperative pain in patients after hysterectomy with para-aortic lymph node resection. Thus, a prospective, randomized, single-blind study was performed to compare the analgesic efficacy of fentanyl 25 micrograms.h-1 with 12.5 micrograms.h-1 in these patients for 48 hours after surgery. Twenty-one women undergoing hysterectomy with para-aortic lymph node resection were allocated into three groups; Group C (control, n = 7): fentanyl 12.5 micrograms.h-1, infusion rate 2 ml.h-1, Group S2 (double speed, n = 7): fentanyl 25 micrograms.h-1, infusion rate 4 ml.h-1, and Group C2 (double concentration, n = 7): fentanyl 25 micrograms.h-1, infusion rate 2 ml.h-1. At postoperative 0, 2, 6, 12, 24, and 48 hours, the degree of analgesia was evaluated by visual analogue scale (VAS) and verbal pain scores at both rest and movement. Groups S2 and C2 showed significantly lower VAS scores than group C at the postoperative 6- and 24-hour points. At movement, the analgesic efficacy was not sufficient in any groups, but, at rest, groups S2 and C2 experienced significantly less pain than the group C. The degree of pain relief was not different between groups S2 and C2. In conclusion, epidural fentanyl 25 micrograms.h-1 provided significantly superior analgesia compared with epidural fentanyl 12.5 micrograms.h-1.
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