Reducing the use of psychotropics in a convalescent rehabilitation ward.

AIMS: Many patients who are transferred to the convalescent rehabilitation ward of Kawasaki Kokoro Hospital (hereinafter, our hospital) are on psychotropics prescribed for delirium by their physicians at acute care hospitals. In this study, psychiatrists and pharmacists collaborated with rehabilitation physicians to reduce the use of psychotropics. METHODS: The basic information and psychotropics prescription statuses of 88 patients discharged from the convalescent rehabilitation ward of our hospital between April 1, 2021 and March 31, 2022 were derived from their medical records. RESULTS: At admission, psychotropics were prescribed to 55 patients and the number of prescribed drugs was 2 (median). At discharge, psychotropics were prescribed to 41 patients and the number of prescribed drugs was 1 (median), showing a significant decrease (p < 0.05). Compared with those at admission, prescribed psychotropic doses at discharge were significantly higher for lemborexant but significantly lower for antipsychotics, benzodiazepine/nonbenzodiazepine hypnotics, antidepressants, suvorexant, ramelteon, and sodium valproate (p < 0.05). CONCLUSIONS: These results suggest that it may be possible to reduce the types and doses of psychotropics prescribed at acute care hospitals in convalescent rehabilitation wards. However, further investigation is needed because the number of patients in this study was limited, and selection bias due to different patient characteristics cannot be ruled out.

Theoretical and evidence-based infection control during general anesthesia in the COVID-19 pandemic.

With the outbreak of COVID-19, attention has focused on measures to prevent droplet infection. Operating rooms, where we anesthesiologists mainly work, are equipped with various theories and techniques for performing surgical procedures and general anesthesia on patients with various infectious diseases, whether airborne, droplet, or contact infection, and are an environment where surgical procedures and general anesthesia can be safely performed on patients with compromised immune functions. Here, we describe the anesthesia management standards assuming COVID-19 from the viewpoint of medical safety, as well as the structure for supplying clean air in the operating room and the structure of a negative-pressure operating room.

Effect of estrogen on tissue elasticity of the ligament proper in rabbit anterior cruciate ligament: measurements using scanning acoustic microscopy.

BACKGROUND: Previous epidemiological studies revealed that anterior cruciate ligament (ACL) injuries were more frequently seen in female athletes than in male athletes. To elucidate the pathogenetic roles of estrogen in ACL ruptures, the elasticity of ACL tissue was measured using a scanning acoustic microscope (SAM) in an estrogen-controlled animal model. METHODS: A total of 40 ovariectomized Japanese white rabbits were randomly divided into four groups according to the administered dose of 17beta-estradiol (groups L, M, H, and C). Injection of 17beta-estradiol was performed 1, 2, 3, and 4 weeks after surgery, and doses in groups L, M, and H were 50, 100, and 500 microg/kg, respectively. Group C received no estradiol. Only groups L, M, and C were used for current analyses because their mean serum estrogen levels were within the physiological range (groups C, L, M, and H: 37, 50, 60, and 231 pg/ml, respectively). Five weeks after ovariectomy, the lateral portion of the ligament was harvested. Specimens were fixed with 10% neutralized formalin and embedded in paraffin. Then, 10 mum thick sections were cut perpendicular to the ligament fibers for routine histological staining and measurement with SAM. RESULTS: The mean tissue sound speeds of groups C, L, and M were 1727 +/- 32, 1683 +/- 53, and 1665 +/- 63 m/s, respectively. Group M presented significantly lower tissue sound speed than group C (P = 0.021). Furthermore, a negative correlation was found between the mean serum estrogen level and mean tissue sound speed of the ACL among all animals in groups C, L, and M (r = 0.47, P = 0.016). CONCLUSION: The results of the present study indicated that estrogen altered the tissue elasticity of rabbit ACL. Estrogen may constitute one of the pathogenetic factors in ACL rupture in female athletes.

Measurement of soft tissue elasticity in the congenital clubfoot using scanning acoustic microscope.

To compare the soft-tissue elasticity between the medial, lateral, and posterior aspects, the deltoid and calcaneofibular ligaments, and the medial, lateral, and posterior capsular tissues were collected from 27 feet of 16 congenital-clubfoot patients. The tissue sound speed, which closely correlates to the Young's modulus, was measured using a scanning acoustic microscope. Contrary to our expectations, lateral ligament showed a significantly higher sound speed than medial ligament (P=0.0023). Lateral capsule also showed a higher sound speed than the medial one (P=0.0338). The results of the study indicated that the lateral soft tissues including the ligaments and capsule underwent severe contracture in congenital clubfoot.

Does decalcification alter the tissue sound speed of rabbit supraspinatus tendon insertion? In vitro measurement using scanning acoustic microscopy.

Failure of the tendon or ligament insertions is one of the most common injuries in the Orthopaedic field. To elucidate the pathogenesis of those injuries, the authors had attempted to measure the tissue sound speed that could be correlated to its elasticity using scanning acoustic microscopy (SAM). For the application of SAM to tendon or ligament insertions, it was necessary to determine the role of decalcification in SAM measurements since mineralized tissues including bone or mineralized fibrocartilage were present at the insertion site. To assess whether decalcification alters the tissue sound speed or not, supraspinatus tendon insertion of six Japanese white rabbits were measured with SAM operating in the frequency range of 50-150 MHz. Right supraspinatus tendons attached to the humeral head were cut into two pieces at the center of the tendon. Then, they were fixed with 10% neutralized formalin for 12 h. In each specimen, medial half was not decalcified, while lateral half was decalcified with ethylene-diamine-tetra-acetic acid (EDTA). After embedding in paraffin, 5 microm thick specimens were prepared for the measurement using SAM. The mean sound speed in each histologic zone was evaluated, and subsequently compared to that measured in the undecalcified and the decalcified specimens. Mean sound speed of non-mineralized fibrocartilage was 1544 m/s in the undecalcified specimens, while the value of 1541 m/s was determined in the decalcified ones. On the other hand, it decreased 2-3% after decalcification in the mineralized tissue including mineralized fibrocartilage and bone (mineralized fibrocartilage: undecalcified = 1648 m/s, decalcified = 1604 m/s; bone: undecalcified = 1716 m/s, decalcified = 1677 m/s). However, no significant differences were found between the undecalcified and the decalcified specimens (non-mineralized fibrocartilage: p = 0.84, mineralized fibrocartilage: p = 0.35, bone: p = 0.28). These results indicate that SAM could be applied to determine the properties of the tendon or the ligament insertions after decalcification with EDTA. Although SAM is applicable only for in vitro experimental study, it is expected that these data will contribute to better understanding concerning the biomechanics of tendon or ligament insertions as well as the pathogenesis of their failure at a microscopic level.

Spindle cell lipoma showing biphasic pattern--a case report.

This is a case report of a rare spindle cell lipoma (SCL) showing an unusual biphasic pattern with radiological findings and histological features. SCL is most common in men between the ages of 45 and 65 and it is reported that the tumor has a tendency to occur in the posterior neck area. This case was a 75-year old man with a 7 x 5 cm subcutaneous tumor in the posterior neck. Magnetic resonance imaging (MRI) examination demonstrated an unusual biphasic pattern. The signal intensities on T1 and T2 weighted images of the outer layer of the mass were high, and were suppressed on fat suppression views and showed no enhancement after gadolinium (Gd) injection. There was a low signal intensity area of 15 mm in diameter on both T1 and T2 weighted images, in the central part of the mass. This area was well enhanced with the Gd compound. Also macroscopically it could be seen that the excised tumor consisted of two different tissue components. Microscopically, the outer yellowish portion was mainly composed of mature adipose tissue. The inner whitish fibrous portion contained a mixture of small and uniform spindle-shaped cells, collagen fibers, and scattered mature adipose cells. No malignancy was observed. The diagnosis of spindle cell lipoma was made. No recurrence was seen seven months after marginal excision.

Scrotum-like protrusion of lipoma arising from the proximal thigh--report of two cases.

We report two cases of large lipomas arising from the proximal thigh with an extremely uncommon shape. The tumors were elastic soft and movable. MRI examination revealed both tumors with high signal intensity as fatty tissue on both T1 and T2-weighted images. Needle biopsy of the specimens revealed lipoma. Marginal excision was carried out for both cases because of the patients' discomfort. No recurrence was found three and five years after surgery, respectively.