Changes in the global spine alignment in the sitting position in an automobile.

BACKGROUND CONTEXT: Studies of the changes in spine alignment in the sitting position have been limited to specific spine segments. Because there have been few studies of global spinopelvic alignment in the sitting position, it is important to assess the changes associated with this position for such settings as developing future design of seats and achieving appropriate restoration of spine alignment. PURPOSE: This study aimed to measure changes in global spine alignment when people are sitting in car seats and to analyze the characteristics of those changes. STUDY DESIGN: This was a prospective, collaborative study of the radiological evaluation of changes in global spine alignment. PATIENT SAMPLE: The study included 113 asymptomatic adult participants (56 men and 57 women) without a history of spine disease or lower limb surgery, and with no current lower back or leg pain. OUTCOME MEASURES: Radiographic findings were assessed by measurement of various angles: cervical lordosis (CL), thoracic kyphosis (TK), thoracolumbar kyphosis (TLK), lumbar lordosis (LL), sacral slope (SS), pelvic tilt (PT), pelvic incidence (PI), C7 sagittal vertical axis (C7-SVA), T1 spinopelvic inclination (T1SPI), and T1 pelvic angle (TPA). METHODS: Radiographs were obtained in the standing and sitting positions. The objective variables analyzed statistically were spine alignments (CL, TK, TLK, LL, C7-SVA, T1SPI, TPA, SS, PT, and PI) measured in the standing position, body alignments (CL, TK, TLK, LL, C7-SVA, T1SPI, TPA, SS, and PT) measured in the sitting position, and stand-to-sit changes (∆CL, ∆TK, ∆TLK, ∆LL, ∆C7-SVA, ∆T1SPI, ∆TPA, ∆SS, and ∆PT). Explanatory variables were sex, age, body height, and body mass index. RESULTS: Changing posture from standing to sitting decreased CL by an average of 5.3°, slightly decreased TK by an average of 1.3°, increased TLK by an average of 6.8°, decreased LL by an average of 35°, decreased SS by an average of 49.2°, increased PT by an average of 49.2°, shifted C7-SVA backward by an average of 106.7 mm, decreased T1SPI by an average of 18.8°, and increased TPA by an average of 21.1°. Statistical analysis revealed that ΔLL was significantly decreased in elderly participants. After the stand-to-sit change, ΔTLK and ∆TPA were significantly increased in taller participants and ΔT1SPI was significantly decreased in taller participants. CONCLUSIONS: Among other changes, most notably LL is decreased and the pelvic tilt is increased when a person is sitting in a car seat. However, these changes in spine alignment differ with age and height. These findings may be useful for the development of future design of seats and for achieving appropriate surgical restoration of spine alignment.

[A long-term survival case in advanced mucinous cystadenocarcinoma of the appendix using cytoreductive surgery and S-1/CDDP chemotherapy].

Prognosis of patients with advanced mucinous cystadenocarcinoma of the appendix (AMCA) is extremely poor. However, there has been no established treatment strategy. We preliminary report here a successfully treated case with AMCA using intensive cytoreductive surgery and chemotherapy. A 61-year-old woman had a right lower abdominal pain and was diagnosed as acute appendicitis. At surgery, about 5 cm tumor with mucosal fluid was detected at the distal part of the appendix. The tumor was invading the ileum and bladder. We performed appendectomy with tumor, partial resection of the small intestine and debridement of mucosal fluid. Histopathology revealed AMCA invading the ileum and bladder. After non curative surgery, we started S-1 plus cisplatin chemotherapy, which S-1 was given orally, twice daily for 3 consecutive weeks, and cisplatin was given intravenously on day 1, 8 and 15 followed by a 3-week rest period. After 6 courses starting with chemotherapy, a complete response was obtained. We followed by S-1 until two years after the initial surgery. At 36 months after the initial surgery, CT scan demonstrated a peritoneal recurrence. Then, she underwent intensive peritonectomy with intraperitoneal hyperthermic chemotherapy. Currently, she had no apparent recurrence for 59 months after initial surgery.