Xiphodynia with limited decrease in the xiphoid process-sternal angle but recognised compression of the rectus abdominis.

A woman in her 70s presented with epigastric pain accompanied by radiating pain. Despite various examinations showing no abnormalities, tenderness was identified on palpation of the xiphoid process. The symptoms were alleviated with a local injection of lidocaine, leading to a diagnosis of xiphodynia. While previous cases have often reported a decrease in the xiphoid process-sternal angle, this case exhibited minimal reduction in the xiphoid process-sternal angle. Conversely, compression findings were observed in the soft tissues, including the rectus abdominis, anterior to the xiphoid process. This case report suggests that in the imaging diagnosis of xiphodynia, consideration of compression findings in the soft tissues anterior to the xiphoid process may also be valuable.

Cross-sectional study investigating the relationship between pit recovery time and serum albumin levels in bilateral lower extremity pitting oedema.

OBJECTIVES: In this study, we re-evaluated the relationship between pit recovery time (PRT) and serum albumin levels and elucidated the factors influencing PRT. DESIGN: Cross-sectional study. SETTING: Patients who visited the outpatient department or were admitted to a small urban hospital in Japan. PARTICIPANTS: 135 adult Japanese patients with bilateral lower extremity pitting oedema. INTERVENTIONS: Primary and secondary outcome measures: this study assessed the correlation between PRT and serum albumin levels, calculated the predictive accuracy for identifying a group with low albumin levels when the PRT of the lower leg was <40 s, and identified variables that influence PRT. RESULTS: We found no significant correlation between lower leg PRT and serum albumin levels. Furthermore, a PRT of <40 s was largely ineffective in predicting low albumin levels. Factors influencing PRT included the diagnosis of malnutrition oedema, examinations conducted during hospitalisation, diagnosis of cardiac oedema, use of diuretics, thickness of the lower limb soft tissue, serum creatinine level, estimated right ventricular systolic pressure (RVSP), age, serum albumin level, potassium level and blood urea nitrogen to serum creatinine ratio. Notable correlations with PRT were observed in relation to lower limb soft tissue thickness, age and estimated RVSP. CONCLUSIONS: Given that the PRT is influenced by multiple factors, its correlation with serum albumin levels is weak. Thus, predicting hypoalbuminaemia based solely on PRT is inaccurate.

Predictive Factors for the Necessity of Hospitalization of Patients With Acute Alcohol Intoxication.

Background: The aim of the study was to identify factors related to the need for hospitalization due to acute alcohol intoxication. Methods: The data of 42 patients with acute alcohol intoxication who visited our hospital from April 1, 2014 to September 30, 2015 were available for analysis. Factors related to outcome included hospitalization or release to home, Glasgow coma scale (GCS), temperature, pulse rate, blood pressure, oxygen saturation of the peripheral artery (SpO2), and respiratory rate. A retrospective survey was done that included estimated blood alcohol concentration, osmotic pressure, and serum lactate level. The following formula was used to estimate blood alcohol concentration: (measured osmotic pressure - estimated osmotic pressure × 4.6 mg/dL). Univariate analysis of each variable was done for the two outcome groups, hospital admission or release to home, then statistically significant items were subjected to multivariate analysis. Results: Of the 42 patients (average age 22.8 ± 8.6 years, 33 men, six women), 29 were admitted and 13 were released to home. There was a weak correlation between estimated blood alcohol concentration and GCS. There was no significant difference in alcohol concentration or GCS between the hospitalized and released to home groups. In multivariate analysis using the outcome as the objective variable, a serum lactate level of 26 mg/dL or higher was associated with the need for hospitalization (odds ratio: 6.7). Conclusion: A serum lactate level of 26 mg/dL would be useful for deciding if hospitalization is necessary for patients with acute alcohol intoxication.

Useful clinical findings and simple laboratory data for the diagnosis of seasonal influenza.

BACKGROUND: When using rapid antigen test kits for the diagnosis of influenza, false-negative results may occur if done too soon after the onset of symptoms. The purpose of this study was done to determine clinical laboratory items other than rapid antigen testing are useful for diagnosing influenza. METHODS: The subjects were 915 patients who visited the outpatient clinic of hospital between April 2010 and March 2017 during the influenza epidemic seasons, from December to April, and had both fever of 37.0 degrees or more and cold symptoms. RESULTS: Of the 214 patients who met the inclusion criteria, 176 had influenza. Multivariate analysis extracted patient consultation within four days of onset, fever of 37 degrees or higher, posterior pharyngeal lymphoid follicles, CRP of 0.77 mg/dL or less, and a lymphocyte count of 900/µL less as independent variables. CONCLUSION: In previous study, lymphoid follicles on the posterior pharyngeal wall and decreased lymphocyte count were reported as influenza-specific findings. Both were confirmed with high specificity in our study, indicating that both would be useful when patients with influenza-like symptoms were false-negative for the rapid antigen test.

Relationship between renal function and serum magnesium concentration in elderly outpatients treated with magnesium oxide.

AIMS: We investigated the relationship between renal function and serum magnesium concentration in elderly patients treated with magnesium oxide (MgO) in an outpatient setting of an urban hospital in Japan. METHODS: In the present study, 44 elderly outpatients (23 patients with constipation treated with daily oral MgO and 21 untreated patients in the control group) who visited Kameyama municipal medical center were enrolled. Variables were age, sex, weight, height, serum magnesium concentration, serum blood urea nitrogen level, serum creatinine level, use of other magnesium-containing supplements and symptoms associated with hypermagnesemia. We calculated the estimated glomerular filtration rate (eGFR) and classified patients based on eGFR category. RESULTS: Compared with the control group, the MgO group showed a significantly higher concentration of serum magnesium (median 2.2 mg/dL [interquartile range 2.1-2.3] vs 2.4 mg/dL [2.2-2.6], P < 0.001). Hypermagnesemia (>2.6 mg/dL) was noted only in the MgO group. However, symptoms associated with hypermagnesemia occurred in patients from both groups, with no significant difference between groups. In the MgO group, significant difference was seen in the median serum magnesium concentration between eGFR categories (P < 0.05). The category G4 (eGFR 15-29 mL/min/1.73 m(2) ) group had the highest serum magnesium concentration in the MgO group (3.0 mg/L [2.9-3.1]). CONCLUSIONS: Elderly patients treated with MgO have higher serum magnesium levels compared with the control group. MgO should be prescribed with caution in patients with low renal function as shown by a GFR category G3b or less (eGFR < 30 mL/min/1.73 m(2) ). Geriatr Gerontol Int 2016; 16: 600-605.

Inappropriate use of ambulance services by elderly patients with less urgent medical needs.

Elderly patients with less urgent medical needs represent a high proportion of all emergency patients in Japan; this trend is gradually increasing, presenting a burden on the emergency medical system. To design effective interventions, it is important to understand the basic characteristics of emergency service use. For elderly Japanese patients, there is currently no detailed report on less urgent cases (LUC), or those cases that could be diagnosed by primary care physicians. Since there is a need for a timely reporting of detailed LUC data, we used data of 2004-2006 from an immediately available database at the Yao Tokushukai General Hospital. With a focus on LUC, we analyzed 7,800 cases of elderly patients, aged over 65 years, who were transported via ambulance to a secondary emergency hospital in Osaka. Of these, 3,354 patients (43.0%) were classified as having initial emergencies and were given outpatient care in the emergency department, and 1,544 patients (19.8%) were LUC, in which 541 subjects (6.9%) may have used ambulance services somewhat inappropriately owing to a lack of alternate transportation. In the remaining 1,003 patients, ambulance use could have been avoided if primary care clinics were available at night and during holidays. We therefore focus on three important points: awareness-raising activities to prevent inappropriate ambulance use, strengthening of transport services to healthcare facilities, and expanding primary care clinic office hours. This study is the first detailed report on the use of ambulance services in Japan by elderly patients with less urgent medical needs.