Dissociation of neurological deficits in spinal decompression illness.

Functional differentiation is found in the spinal cord. A unique set of neurological deficits follows a multi-focal injury. Clinically, sensory and motor disturbance present independently, often resulting in sensory and motor deficit dissociation. This study examined 103 spinal decompression illness (DCI) cases. The neurological deficit dissociation was classified as follows: 1) Cases with sensory impairment only, or motor dysfunction alone, were tagged as having "dissociation" (44 cases); when a case was with both sensory and motor dysfunction, the spinal level of the sensory impairment was determined and was matched with the spinal segments responsible for the motor dysfunction; 2) If the two spinal areas did not match (i.e. with no regional overlap), they were tagged as having "dissociation" for each motor dysfunction (32 cases). In total, dissociation was present in 76 out of 103 cases. We concluded that clinical neurological deficit dissociation is frequently observed in spinal DCI.

The validity of the mangled extremity severity score in the assessment of upper limb injuries.

The Mangled Extremity Severity Score (MESS) may be used to decide whether to perform amputation in patients with injuries involving a limb. A score of 7 points or higher indicates the need for amputation. We have treated three patients with a MESS of 7 points or higher, in two of which the injured limb was salvaged. This scoring system was originally devised to assess injuries to the lower limb. However, a MESS of 7 points as a justification for amputation does not appear appropriate when assessing injuries to the major vessels in the upper limb.

Efficacy of famotidine and omeprazole in healing symptoms of non-erosive gastro-oesophageal reflux disease: randomized-controlled study of gastro-oesophageal reflux disease.

BACKGROUND: The epidemiology and pathophysiology of non-erosive gastro-oesophageal reflux disease differs from erosive gastro-oesophageal reflux disease. There is a possibility that non-erosive gastro-oesophageal reflux disease treatment requires a different regimen/approach but it is not yet acknowledged. AIM: To investigate the efficacy of famotidine and omeprazole in the treatment of gastro-oesophageal reflux disease, especially non-erosive gastro-oesophageal reflux disease. PATIENTS AND METHODS: A randomized, open-label trial was conducted. Fifty-four gastro-oesophageal reflux disease patients were assigned to treatment with famotidine at a dosage of 20 mg twice daily; or omeprazole, 20 mg once daily, for a period of 8 weeks. The Short Form-36 Health Survey and Gastrointestinal Symptom Rating Scale administered at baseline and after 8 weeks of treatment as well as a symptom questionnaire were conducted daily. RESULTS: Short Form-36 revealed that gastro-oesophageal reflux disease has severe impact on health-related quality of life. Thirty-nine subjects (77%) were endoscopically diagnosed as non-erosive gastro-oesophageal reflux disease. The mean Gastrointestinal Symptom Rating Scale abdominal pain, and indigestion score of non-erosive gastro-oesophageal reflux disease significantly improved in famotidine-treated patients (P < 0.05), but not in the omeprazole. There was no significant change regarding improved heartburn symptoms of non-erosive gastro-oesophageal reflux disease between treatments in the daytime or night-time. CONCLUSION: Famotidine and omeprazole were both effective in improving symptoms of gastro-oesophageal reflux disease, particularly non-erosive gastro-oesophageal reflux disease.

Evaluation of HBO2 therapy in pneumatosis cystoides intestinalis.

Pneumatosis cystoides intestinalis (PCI) is a disease characterized by retention of gas in the intestinal wall. Retention of gas can be caused by three mechanisms; gas entry through the intestinal mucosa, gas dissection from the pulmonary alveoli and bronchi, and gas generation in the mucous membrane. Since gas in cysts is composed almost entirely of nitrogen, hyperbaric oxygen therapy (HBO2) is effective for treating PCI due to the oxygen windows effect. However, PCI, caused by a mechanism involving pulmonary alveoli or branches, can become aggravated by HBO2. Therefore, we propose modifying HBO2 protocols for cases that do not require an invasive treatment. This study describes favorable results obtained in 2 PCI cases after HBO2 therapy according to our protocol.

Decompression sickness and recreational scuba divers.

OBJECTIVES: The aim of this study is to clear the status of recreational scuba divers in Japan for promoting safety in recreational diving. METHODS: A five year (from 1996 to 2001) questionnaire survey was performed of Japanese divers at the Osezaki area in Japan. The subjects of this survey included diving instructors as well as recreational divers. Based on the obtained data, the study investigated the theory predicted incidence of decompression sickness (DCS) among Japanese recreational divers. RESULTS: The average (SD) of the maximum depth for diving was 37.4 (13.1) metres, which was deeper than the recommended depth of recreational diving. The incident rate of nitrogen narcosis (12%) was the most frequent, followed by barotraumas of the ear (11%) and barotraumas of the paranasal sinus (5.6%). The rate of DCS was 1.9 % (60 divers) during investigated period, and that DCS occurred once per 19 011 dives in calculation. CONCLUSIONS: This investigation showed that the status of leisure diving in Japan is still serious, because DCS would be expected to occur once a weekend in Japan. It is speculated that many divers may develop DCS while moving through high altitudes after diving, particularly at the Osezaki diving spot in Japan. Based on the results of this study, it is emphasised that every Japanese leisure diver should take an increasing interest in the safety of diving activity.

[A case of recurrent mediastinal goiter (oxyphilic cell carcinoma)].

A case of recurrent mediastinal goiter (oxyphilic cell carcinoma) in a 66-year-old female was reported. 19 years ago, the patient submitted to a right-hemithyroidectomy for the oxyphilic cell adenoma. Since two months, her dyspnea gradually aggravated. On admission, abnormal mass of right upper mediastinum was shown by chest X-ray. CT scan and MRI showed a 8 cm sized right upper mediastinal tumor with tracheal compression.

[Survey of MRSA infection in Ibaraki-ken--Ibaraki Association for infectious diseases].

This study which was undertaken at several major hospitals in Ibaraki-ken revealed that, 1) the proportion of Staphylococcus aureus in all the isolates ranged from 5% to 17% and the prevalence of MRSA in isolates of Staphylococcus aureus varied from 51% to 82% depending upon each individual hospital. 2) the clinical response to FOM and CMZ combination therapy was 88.9% and, to FOM and CZON was 57.1% showing no statistical differences between the two regimens. 3) in vitro analyses assessed by the FIC index of 251 isolates revealed that FOM had an additive or synergistic effect with CMZ in 53.8%, with CZON in 66.9%, with minocycline (MINO) in 43.8%, with cefamandole (CMD) in 61.8%, with cefazolin (CEZ) in 62.9% and with imipenem/cliastatin sodium (IPM/CS) in 68.9% at all isolates. 4) the cumulative curve of susceptibility to single CMZ and the combination of CMZ and FOM revealed that the blood levels of CMZ at 3 hours after intravenous administration covered 57% of isolates when used alone and 82% of isolates when in combination with FOM. The blood levels of CZON at 3 hours covered 5% of isolates when used alone and 41% when in combination with FOM. The extent of the therapeutic effect increased from 6% to 42% by CMD, from 12% to 54% by CEZ, from 20% to 58% by IPM/CS and from 78% to 84% by MINO. The combination of CMZ and FOM was found to be the most effective for enhanced effects on MRSA in vitro.