Use of the facial dismasking flap approach for surgical treatment of a multifocal craniofacial abscess

The decision of which surgical approach to use for the treatment of a multifocal craniofacial abscess is still a controversial matter. A failure to control disease progress in the craniofacial region can potentially put the patient's life at risk. Therefore, understanding the various ways to approach the craniofacial region helps surgeons to obtain satisfactory results in such cases. In this report, we describe a patient who visited the emergency department with a large swelling in his right cheek. A blood test and computed tomography revealed odontogenic maxillary sinusitis. The patient developed sepsis due to a progressive multifocal abscess. An abscess was seen in the temporal muscle, infratemporal fossa, and interorbital region. To control this multifocal abscess, we used the facial dismasking flap (FDF) approach. After debridement using the FDF approach, we succeeded in obtaining sufficient drainage of the abscess, and the patient recovered from sepsis. The advantages of the FDF approach are that it provides a wide surgical field, extending from the parietal region to the mid-facial region, and that it leaves no aesthetically displeasing scars on the face. The FDF approach may be one of the best options to approach multifocal abscesses in the craniofacial region.

Rehabilitation of a Patient with Neutral Lipid Storage Disease with Myopathy and Triglyceride Deposit Cardiomyovasculopathy : a Case Report / The Japanese Journal of Rehabilitation Medicine

Adipose triglyceride lipase (ATGL) catalyzes the first step of triglyceride hydrolysis. The gene mutations cause neutral lipid storage disease with myopathy (NLSDM) and/or triglyceride deposit cardiomyovasculopathy (TGCV) . Here we give the first report on rehabilitation of a patient with NLSDM and TGCV. The 62-years-old patient was admitted to our hospital for rehabilitation for skeletal myopathy and rehabilitation for cardiac dysfunction (NYHA class Ⅲ , ejection fraction 20%) . He complaint of dyspnea during the activity of daily life and exercise torelance was low. Our rehabilitation program consisted of physical therapy, occupational therapy, nutrition and cardiac education. We had paid a special attention to the intensity of exercise (aerobic training and resistance training) due to the low cardiac function, energy dysfunction and myopathy. After rehabilitation for two months, muscle strength had increased and 6MWT, ATVO₂ had improved. Importantly, the reduction of dyspnea on exertion as well as the increase in exercise capacity are considered to have led to improvement of quality of life.

Reliability of the Estimation of Non-Metabolic CO2 Output During Incremental Exercise / 体力科学

It is known that lactic anions and hydrogen ions (H<SUP>+</SUP>) produced during intense exercise are partly transported or diffused from muscle to blood resulting in the production of non-metabolic CO<SUB>2</SUB> through the bicarbonate buffering system. The purpose of the present study was to examine the reliability of the estimation of non-metabolic CO<SUB>2</SUB> output using respiratory gas analysis during incremental exercise. Six healthy subjects underwent an incremental pedaling exercise test accompanied by respiratory gas and arterial blood sampling. The rate of non-metabolic CO<SUB>2</SUB> output (VCO<SUB>2</SUB>-NM) was calculated by subtracting projected metabolic VCO<SUB>2</SUB> from actual VCO<SUB>2</SUB> after CO<SUB>2</SUB> threshold (CT) . CT was determined using a modified V-Slope method. Bicarbonate (HCO<SUB>3</SUB><SUP>-</SUP>), pH, CO<SUB>2</SUB> partial pressure and lactate concentration were measured from arterial blood samples using automatic analyzers. The kinetics of VCO<SUB>2</SUB>-NM and HCO<SUB>2</SUB><SUP>-</SUP> were compared throughout the exercise test. VCO<SUB>2</SUB>-NM was significantly correlated with HCO<SUB>3</SUB><SUP>-</SUP>decrease after CT (r=0.976, p<0.001) and the kinetics of VCO<SUB>2</SUB>-NM and HCO<SUB>3</SUB><SUP>-</SUP> decrease were similar during exercise. Furthermore, the amount of non-metabolic CO<SUB>2</SUB> output (NM-CO<SUB>2</SUB>) calculated integrating VCO<SUB>2</SUB>-NM above CT was significantly correlated with the difference in HCO<SUB>3</SUB><SUP>-</SUP>between CT and exhaustion (r=0.929, p<0.01) and with the difference in arterial blood pH between rest and exhaustion (r=0.863, p<0.05) . However, NM-CO<SUB>2</SUB> was not significantly related to maximum ventilation (r=0.111, ns) . These results suggest that the estimation of non-metabolic CO<SUB>2</SUB> output during incremental exercise proposed in the present study is reliable. It was also suggested that the primary factor which influenced nonmetabolic CO<SUB>2</SUB> output during incremental exercise was the addition of H<SUP>+</SUP> into blood and not hyperventilation.