Plexiform Neurofibromatosis in a Woman With a Pubic Ramus Stress Fracture.

A 22-year-old woman in Army Basic Combat Training was evaluated in a physical therapy clinic for insidious-onset groin pain. The referring primary care physician assistant ordered initial radiographs, which were noncontributory, followed by a bone scan that indicated a left inferior pubic ramus stress fracture. She was prescribed a 30-day convalescent leave. Due to the palpable mass and severe pain upon return, the physical therapist ordered magnetic resonance imaging, which showed plexiform neurofibromas, with a left buttock mass and left inferior pubic ramus stress fracture. J Orthop Sports Phys Ther 2019;49(1):37. doi:10.2519/jospt.2019.7495.

Patient education and educational activity in the general public.

In Japan, about 97% of diabetic patients suffer from non-insulin dependent diabetes. Because of its insidious onset, public education with regard to diabetes is very important. According to a survey in 1989, approximately 87% of diabetic patients were treated at hospitals. Considering the difficulty of organizing an educational team targetting small clinics, diabetes education should be provided with close cooperation between hospitals and local clinics. Since 1967, National Diabetes Week is annually held in the second week of November; in more than 150 cities and towns, lecture meetings, screening tests and consultation by physicians and health professionals are performed under the sponsorship of the Japan Diabetes Society and the Japan Association of Diabetes Care and Education. The Japan Diabetes Society has edited 'Diabetes Treatment Guide' and 'Meal Exchange List' since 1961 to provide the minimum requirement of knowledge and skill in the diabetes treatment regimen. More than 850 hospitals and clinics now have a particular educational program. Admission for the education of diabetic patients is provided by 366 hospitals. In 1991, summer camps for children were held at 37 sites, where about 1200 patients participated. For the training of the educators, the Japan Diabetes Society and several other organizations offer many lecture meetings and courses with experiential format; the curriculum for diabetes educators is expected to be much improved in the near future.

Extradural tethering effect as one mechanism of radiculopathy complicating posterior decompression of the cervical spinal cord.

STUDY DESIGN: This study used anatomical and clinical data to analyze the postoperative tension-status of cervical roots after posterior decompression of the cervical spinal cord. The efficacy of longitudinal durotomy with regard to prevention of postoperative palsy was investigated in a controlled study. OBJECTIVES: To elucidate the mechanism of postoperative radiculopathy and to prevent its occurrence. SUMMARY OF BACKGROUND DATA: Previous anatomical studies by the authors revealed that the posteromedial shift of the dura-root junction following posterior bulging of the cervical dural sac exerted a traction force on the portion of the roots outside the dural sac and reduced the tension on the rootlets inside the dural sac. These traction-related phenomena disappear after longitudinal durotomy. METHODS: Lengths of various parts of an anterior root were measured in 20 Japanese adult cadavers. The shortest pre- and postoperative distances between the anterolateral mid-edge of the spinal cord and dura-root junction were compared, using computed tomography-myelograms of postoperative C5 radiculopathies. The effects of longitudinal durotomy were also investigated in a controlled study involving 118 patients with laminoplasty. RESULTS: The length ratio between the longest and shortest anterior rootlet in each cervical root showed fairly constant values. Clinically, the length of the shortest rootlet could be calculated using a myelogram. Radiographical findings in cases of postoperative radiculopathies suggested increased tension on roots outside the dural sac but not on rootlets inside the dural sac. Application of longitudinal durotomy in a type of lateral opening laminoplasty resulted in the disappearance of postoperative radiculopathy. CONCLUSIONS: An extradural tethering effect was suggested as one mechanism leading to postoperative radiculopathy. Durotomy may be useful in the treatment of postoperative palsy.

Prevention of post-transfusion graft-versus-host disease.

Post-transfusion graft-versus-host disease (PT-GVHD) is a rare complication of blood transfusion. However, it occurs not only in immunosuppressed patients but also in immunocompetent patients, and is a phenomenon with a heavy mortality rate of more than 90 percent. At present, the use of blood irradiated is considered the most effective method of preventing of PT-GVHD. However, there are some unsettled problems such as the appropriate dose of irradiation, the influence of irradiation on the function of blood components, the elevation of potassium levels and the selection of patients suitable for irradiated blood transfusion.

Graft-versus-host disease: introduction and prospect.

In order to devise the way of prevention and the progress in the treatment of transfusion-associated graft-versus-host disease (TA-GVHD), this issue is published as the results of the symposium on GVHD at Fukushima Medical College, 1992. HLA analyses of TA-GVHD forced us to alter our concept of mechanism of this disease. As one-way matching in HLA from donor to recipient is important in developing the TA-GVHD, transfusions between relatives are most hazardous and there is a higher risk even unrelated donors in Japanese. Prophylactic irradiation of blood components is the method of inactivating immunocompetent lymphocytes and is nowadays the most effective in preventing the TA-GVHD. In the future we will have leukocyte depletion filters of next generation and ultraviolet irradiation on platelet concentrates as alternative to irradiation.

[Efficacy of intrahepatic arterial chemotherapy to prevent recurrence of residual liver in metastatic liver cancer patients after hepatectomy].

Five-year overall survival rates in 17 cases who underwent the hepatectomy for metastatic liver cancer from digestive tract averaged 43%. Postoperative intrahepatic arterial infusion in combination with Farmorubicin and 5-FU was performed in 9 cases (i.a group). Survival and recurrence rate on cases (i.a group) were compared with that of 8 cases without chemotherapy (control group). The 5-year survival rate was superior in the i.a group to that in the control group. There was no residual liver recurrence in the i.a group, but two cases had recurrence in the residual liver in the control group. These results suggest that the post-hepatectomized intrahepatic arterial infusion of anticancer drugs is useful to prevent recurrence in the residual liver and may prolong the survival time of patients with metastatic liver cancer from GI tract.

[Late phase II clinical study of RP56976 (docetaxel) in patients with advanced/recurrent breast cancer].

A late phase II clinical study of RP56976 (Docetaxel), a new semisynthetic anticancer agent, was conducted in patients with advanced/recurrent breast cancer. RP56976 (Docetaxel) was in general administered at an intravenous dose of 60 mg/m2 with dose-free intervals of 3-4 weeks. Of the 74 patients enrolled, 64 patients completed the scheduled course of treatment. Three patients showed complete response (CR), 32 patients partial response (PR), 3 patients minor response (MR), 18 patients no change (NC), and 8 patients had progressive disease (PD). The overall response rate was 54.7%. The response rate in patients who previously had received chemotherapy was 55.7%, and the response rate in patients who had resistance to anthracycline agents or who did not respond to previous treatment was 58.7%. Adverse reactions included nausea/vomiting in 38 patients (57.6%), fatigue in 46 patients (69.7%), anorexia in 46 patients (69.7%), fever in 26 patients (39.4%), and alopecia in 60 patients (90.9%), all of which were tolerable. Abnormal laboratory findings included leukopenia (Grade III or more) in 57 patients (86.4%) and neutropenia (Grade III or more) in 56 patients (86.2%). The results show that RP56976 (Docetaxel) is an excellent agent with high antitumor effect for the treatment of advanced/recurrent breast cancer.