Nordic Walking Increases Distal Radius Bone Mineral Content in Young Women.

Unlike the lumbar spine and femur, the radius does not bear a gravitational mechanical compression load during daily activities. The distal radius is a common fracture site, but few studies have addressed the effects of exercise on fracture risk. The aim of this study was to determine the effects of the pole push-off movement of Nordic walking (NW) on the bone mineral content (BMC) and areal bone mineral density (aBMD) of the distal radius and the muscle cross-sectional area (CSA) at the mid-humeral and mid-femoral levels. The participants were allocated to two groups: an NW group and a control group. The NW group walked at least 30 min with NW poles three times a week for six months. There were no significant changes in muscle CSA at the mid-humeral or mid-femoral levels between or within groups. There were also no significant changes in BMC or aBMD at 1/3 and 1/6 of the distance from the distal end of the radius in either group. However, the BMC and aBMD at 1/10 of the distance from the distal end of the radius were significantly increased by NW. The NW pole push-off movement provided effective loading to increase the osteogenic response in the ultra-distal radius. The ground reaction forces transmitted through the poles to the radius stimulated bone formation, particularly in the ultra-distal radius.

The management of compensatory sweating after thoracic sympathectomy.

OBJECTIVE: The main therapeutic method of treatment for local hyperhidrosis is endoscopic thoracic sympathectomy. Generally, resections of the sympathetic trunk or ganglia are performed between the second rib and sixth rib. However, this procedure can result in compensatory sweating, in which excess sweating occurs on the back, chest, and abdomen. Compensatory sweating has been regarded as a thermoregulatory response and thought to be untreatable. This study suggests that compensatory sweating is not a physiologic reaction and is indeed treatable. METHODS: Eight patients with severe compensatory sweating were treated by observing blood perfusion of the skin with laser speckle flowgraphy, which determines the sympathetic nerves related to the area of skin with compensatory sweating. When intraoperative monitoring with laser speckle flowgraphy indicated the position of compensatory sweating by electrical stimulation of the sympathetic ganglion, ganglionectomy was performed. RESULTS: The skin domain that each sympathetic nerve controls was able to be detected by laser speckle flowgraphy. In all patients, compensatory sweating was resolved after interruption of the ganglia or sympathetic nerves related to compensatory sweating. CONCLUSIONS: Our results demonstrate that compensatory sweating is caused by denatured sympathetic nerves influenced by endoscopic thoracic sympathectomy and is not the result of a physiological response. With laser speckle flowgraphy, the sympathetic nerve related to the sweating of various parts of the body could be identified. The treatment of compensatory sweating on the back, chest, and stomach was previously considered to be difficult; however, compensatory sweating is demonstrated to be treatable with this technique.

Sympathetic ganglionectomy for facial blushing using application of laser speckle flow graph.

OBJECTIVE: Endoscopic thoracic sympathectomy at the second rib level is considered effective as a therapeutic treatment for facial blushing. However, 10% to 15% of patients do not benefit from this intervention. No additional procedure has been developed for this disorder. Recently, ganglionectomy using application of laser speckle flow graph has been evaluated for the treatment of compensatory sweating. We report our results of ganglionectomy for facial blushing as a redo surgery. METHODS: Between August 2012 and April 2017, 8 patients with facial blushing who underwent an initial sympathectomy reported symptom recurrence. Seven patients had undergone transection of the sympathetic trunk at the second rib and 1 patient had undergone transection of the sympathetic trunk at the second and third ribs. These patients were treated using ganglionectomy guided by application of laser speckle flow graph. After temporary decreases in facial skin blood perfusion were confirmed by stimulating the sympathetic ganglions, ganglionectomy was performed. RESULTS: All patients' symptoms improved. There were no side effects, including deterioration of compensatory sweating, worsening of gustatory sweating, or Horner syndrome. There were no cases of mortality or conversion to open surgery. CONCLUSIONS: This study shows the effectiveness of ganglionectomy for the treatment of facial blushing, representing a new treatment option for this condition. Considering the mechanism of facial blushing, it is important to recognize that ganglionectomy is effective after the interception of the sympathetic trunk on the cranial side.

A New Device of Needlescopic Thoracic Sympathectomy Through a Skin Incision.

We describe a new technique of performing sympathectomy with a new device. A single skin incision 3 mm long was made in the armpit. The device enables complete resection of the sympathetic segment through a single skin incision, whereas sympathectomy is limited by the use of the conventional needle technique. Even if sympathetic nerves and blood vessels were overlapping, separation of the two organs was performed safely. This device increases the possibility of planning surgical procedures for patients with difficult anatomies.

Horner's syndrome caused by a thoracic dumbbell-shaped schwannoma: sympathetic chain reconstruction after a one-stage removal of the tumor.

STUDY DESIGN: A case of Horner's syndrome caused by a thoracic dumbbell-shaped schwannoma is reported. OBJECTIVES: To report a rare case of a mediastinal dumbbell-shaped schwannoma as a cause of Horner's syndrome and to show the result of intercostal nerve grafting for sympathetic chain reconstruction after resection of the sympathetic nerve. SUMMARY OF BACKGROUND DATA: It has been reported that approximately 10% of neurogenic mediastinal tumors extend through the neural foramen into the spinal canal, creating a dumbbell shape. Although the most frequent causes of Horner's syndrome are tumors, a dumbbell-shaped schwannoma has rarely been described as a cause of the syndrome. Moreover, there have been no previous reports that primary sympathetic chain reconstruction has been performed with an intercostal nerve graft after resection of the sympathetic nerve with the tumor. METHODS: A 48-year-old woman was diagnosed with a mediastinal tumor by routine chest radiography. The patient had right-sided Horner's syndrome, the signs of which she had not noticed. Surgical resection of the dumbbell-shaped tumor was performed in a one-stage combined resection of both the intraspinal and the mediastinal component of the tumor. Primary sympathetic chain reconstruction was also performed with an intercostal nerve graft. RESULTS: The tumor was resected completely, and no recurrence of the tumor was observed 1 year after the operation. Blepharoptosis and anhidrosis on the right side of her face and upper limb gradually improved after surgery, and compensatory oversweating on the left side eventually improved. In bright illumination, the right pupil diameter was 3.5 mm and the left was 5 mm after surgery; the right pupil measured 4 mm and the left measured 5 mm 1 year after the operation. CONCLUSIONS: A mediastinal dumbbell-shaped schwannoma has rarely been described as a cause of Horner's syndrome. Primary sympathetic nerve reconstruction with an intercostal nerve was shown to be useful after resection of the sympathetic nerve involved in the tumor.