Falls represent a major public health problem for older adults, and loss of balance (LOS) abilities is one of the primary causes of falls. Previous studies have shown that balance training is effective in improving physical function and decreasing risk of falls. However, little attention has been given specifically to balance training in older adults with very poor balance. The purpose of this study was to determine the effect of a 12-week customized balance exercise program on LOS for community-dwelling older women with poor balance ability. Twenty-four older women with poor balance (composite maximum excursion [MXEcomp] score of less than 70% based on Limits of Stability) were divided into an exercise group and control group. After 12 weeks of balance exercises, mean MXEcomp improved (p < .05) from 58.6% to 79.0% in the exercise group. EPEcomp (composite endpoint excursion), RTcomp (composite reaction time), SVcomp3 (composite sway velocity on thick foam with the eyes open), UG (up and go) also improved, but the functional reach and other static balance indexes did not change. These results indicated that balance training allows older adults with poor balance to improve dynamic balance ability and potentially reduce risk for falls.
In the expanded indications for endoscopic resection, J apanese guidelines for gastric cancer include differentiated cancers confined to the mucosa with an ulcer <30 mm. We describe a patient with lymph node metastasis after curative endoscopic submucosal dissection ( ESD ) for a tumor of this indication. The patient was a 70‐year‐old man with chronic hepatitis C . He underwent ESD for early gastric cancer in M ay 2010. Pathology revealed a moderately differentiated adenocarcinoma, 22 × 17 mm in size, that was confined to the mucosa with an ulcer. The horizontal and vertical margins were negative for the tumor. We diagnosed thiscase as curative resection of expanded indication and followed this patient with endoscopy, abdominal ultrasonography ( AUS ) or enhanced computed tomography ( CT ) approximately every 6 months. After 17 months, lymph node metastasis was detected with AUS and CT and diagnosed by endoscopic ultrasound‐guided fine‐needle aspiration biopsy in A ugust 2011. Distal gastrectomy with D 2 dissection was carried out in D ecember 2011. Although it is low, the possibility of recurrence should be borne in mind after endoscopic treatment of early gastric cancer, despite its inclusion in the expanded indications for endoscopic resection.
The leiomyomatous hamartoma is uncommon in the oral cavity. We recently experienceda case of multiple hamartomas of the tongue with palatal recess in a 15-day-oldboy.The two hamartomas were located on the dorsal surface of tongue along the medianline as polypoid masses measuring 10× 10× 4 mm and 4× 3mm.The two masses were removed under general anesthesia. Microscopically, the posteriormass was composed of heterotopic smooth muscle fibers interspersed with salivary glandtissue, blood vessels, lymphatic vessels and adipose tissue. Myxomatous fibrous tissue wasobserved in the subepithelial area of the mass.The anterior mass was an ill-defined focus composed of smooth muscle and blood vesselwith mucosal cover.Histopathological diagnosis was multiple leiomyomatous hamartomas of the tongue.The postoperative course was uneventful.Neither recurrence nor metastasis occured in these one year after the surgical operation.This report is the third case of multiple leiomyornatous hamartomas of the tongue found inthe literature.
Acute mesenteric ischemia is often fatal, and many survivors develop short bowel syndrome. To avoid massive bowel resection, revascularization is recommended for acute mesenteric ischemia patients. However, whether acute mesenteric ischemia patients with clinical peritonitis can be revascularized remains uncertain. Therefore, this study aimed to evaluate the histopathological potential reversibility of resected bowel in acute mesenteric ischemia patients with peritonitis.We retrospectively reviewed the medical records of acute mesenteric ischemia patients treated at the Kameda Medical Center between January 2001 and March 2015. Pathological evaluation regarding bowel resection was performed. Patients with and without peritonitis were compared. The primary outcome was the proportion of patients with reversible or irreversible ischemia. Patients with reversible and irreversible ischemia were characterized.Of 41 patients, 17 underwent laparotomy, 6 endovascular surgery, and 18 palliative care. Among 23 patients receiving curative treatment, 7 had peritonitis and 13 did not. Seven patients of each group received bowel resection, but 85.7% of those with peritonitis had reversible ischemia. We categorized patients with ischemia into reversible and irreversible groups. The median time between symptom onset and diagnosis in the reversible group was >27 h. Systemic inflammatory response syndrome was found in 72.2% and 66.7% of the reversible and irreversible groups, respectively.Acute mesenteric ischemia patients with clinical peritoneal signs may have potentially reversible ischemia. As a result, revascularization should be considered, even in the case of peritonitis.
