[Primary Leiomyosarcoma of the Epididymis : A Case Report].

A 63-year-old man presented with right scrotal swelling. A physical examination revealed a painless, palpable mass in the right scrotum. The mass was well defined and lobulated. Subsequently, a diagnosis of right epididymal tumor was made, and right high orchiectomy was performed. Hematoxylin-eosin and immunostaining revealed leiomyosarcoma of the epididymis. When a diagnosis of epididymal malignant tumor is made, the standard treatment is radical orchiectomy.

A case of adenocarcinoma of the rete testis with durable response to cisplatin-based chemotherapy.

INTRODUCTION: Adenocarcinoma of the rete testis is a rare malignancy with a poor prognosis. We report a case of adenocarcinoma of the rete testis with a durable response to cisplatin-based chemotherapy. CASE PRESENTATION: A 48-year-old man with Down syndrome (trisomy 21) presented with a 1-month history of painless swelling of the left scrotum. The physical examination revealed a left testis with a hydrocele associated with a tumor and enlarged pelvic and para-aortic lymph nodes. He underwent a radical orchiectomy. The specimen was diagnosed as adenocarcinoma of the rete testis. The patient received 7 cycles of chemotherapy (1 cycle of BEP and 6 cycles of EP) postoperatively. The metastatic lymph nodes were reduced in size for at least 12 months. Our patient with adenocarcinoma of the rete testis obtained an acceptable response to cisplatin-based chemotherapy. CONCLUSION: We treated a patient with an adenocarcinoma of the rete testis who had an acceptable response to platinum-based chemotherapy.

Rapid Destructive Arthropathy of the Knee in Parkinson's Disease with Pisa Syndrome: A Case of Knee-Spine Syndrome.

The changes occurring in knee osteoarthritis often cause alterations in the spinal loading condition, which further lead to degenerative changes. This close relationship of the knee and spine has been reported as knee-spine syndrome. A 60-year-old woman with Parkinson's disease (PD; Hoehn-Yahr stage IV) had severe knee pain with moderate lateral osteoarthritis of the knee (Kellgren-Lawrence classification grade II). Conservative therapy had no effect at all, and the knee developed destructive osteoarthritis rapidly without any traumatic episodes. The radiographic findings progressed to Kellgren-Lawrence grade IV within a month. Magnetic resonance imaging revealed partial depression of the joint surface, including shredded ossicles and substantial amounts of synovial fluid. The imaging findings were considered to be caused by a subchondral insufficiency fracture (SIF). Total knee arthroplasty was performed using a semiconstrained prosthesis. The alignment of her lower extremity improved, and the patient could walk without knee pain. The patient had Pisa syndrome, a lateral flexion of the trunk, which is a postural deformity of the trunk secondary to long-standing PD. The postural deformity in PD is not based on spinal deformity itself but on the loss of postural reflexes and the imbalance of muscle tonus. Her left knee pain appeared 1 month after L1-L4 posterior lumbar interbody fusion (PLIF) as the Pisa syndrome to her left side worsened. The more the trunk tilts to the lateral side, the center of the gravity axis will shift and pass through more lateral points of the knee and result in higher knee load. The stress concentration from the spine to the lateral joint of the knee caused lateral knee osteoarthritis, namely, knee-spine syndrome. When patients undergo correction surgery for adult spinal disorder with impairment of postural reflexes, they need to be followed up carefully regarding not only the spinal alignment but also the lower extremities.

Immediate changes in trunk muscle activation patterns during a lifting task following an abdominal drawing-in exercise in subjects with recurrent low back pain.

BACKGROUND: The abdominal drawing-in exercise could help improve delayed transversus abdominis (TrA) activation during limb movement in subjects with recurrent low back pain (rLBP). However, little is known about whether the same effect is observed during lifting tasks in subjects with rLBP. OBJECTIVE: This study aimed to clarify whether a single session of abdominal drawing-in exercise could correct the altered trunk muscle activation patterns during a lifting task in subjects with rLBP. METHODS: Fifteen subjects with rLBP performed lifting tasks before and immediately after three sets of 10 repetitions of isolated TrA voluntary contractions. The time of onset and activation amplitude during the lifting tasks were measured by surface electromyography (EMG) and compared between the trials before and immediately after exercise. RESULTS: During lifting, the onset of internal abdominal oblique/TrA (IO/TrA) and multifidus activation occurred earlier, the EMG amplitude of IO/TrA increased, and the EMG amplitude of erector spinae and multifidus decreased, compared with the pre-exercise data. CONCLUSIONS: These results suggest a possibility that the abdominal drawing-in exercise might be effective in improving the muscle recruitment pattern in people with rLBP.

Posteroanterior Segmental Displacement of the Lumbar Spine: Assessment Using Ultrasound in Asymptomatic Men.

OBJECTIVE: This study aimed to assess posteroanterior (PA) segmental displacement of the lumbar spine using ultrasound (US). METHODS: Eight asymptomatic male participants (20.1 ± 0.4 years) were included in this study. The relative depth between the tip of the L4 and L3 spinous processes from the US probe (mm) was measured using US in the following 7 conditions, which were without PA force, applying PA force of 9.8 newton (N), 19.6 N, 29.4 N, 39.2 N, 49.0 N, and 58.8 N to both sides of the L4 costal processes. The measurements were repeated twice within a day. The intraclass correlation coefficient, standard error of measurement (SEM), and minimal detectable change (MDC) were calculated. A repeated-measures analysis of variance was also used to determine the influence of PA force on the relative depth. RESULTS: The intraclass correlation coefficients for the intrarater reliability of the 7 conditions were 0.95 (SEM: 0.43 mm, MDC: 1.19 mm), 0.93 (SEM: 0.45 mm, MDC: 1.25 mm), 0.93 (SEM: 0.47 mm, MDC: 1.30 mm), 0.95 (SEM: 0.37 mm, MDC: 1.02 mm), 0.95 (SEM: 0.40 mm, MDC: 1.10 mm), 0.96 (SEM: 0.38 mm, MDC: 1.04 mm), and 0.95 (SEM: 0.42 mm, MDC: 1.15 mm), respectively. The intrarater reliability of the relative depth using US was reliable. There was no significant change in the relative depth among the 7 conditions (F = 0.88, P = .41). Incrementally greater PA force was not related to greater intersegmental translation. CONCLUSION: Our US method could not detect PA segmental displacement of the lumbar spine.

Correlation between peak expiratory flow and abdominal muscle activity in elderly women while holding maximum expiration and performing the side bridge exercise.

INTRODUCTION: Expiratory flow is important to minimize the risk of infection by expelling foreign substances from the lungs. Abdominal muscle activities primarily produce expiratory flow. However, data on the association of abdominal muscle activity during expiratory effort and abdominal exercise posture with expiratory flow rate is limited. This study aimed to assess the correlation between expiratory flow and abdominal muscle activity while holding maximum expiration and performing the side bridge exercise in elderly women. METHODS: Rectus abdominis (RA), external oblique (EO), and internal oblique (IO) muscle activity was measured using electromyography in 14 elderly women (82.8 ±â€¯6.7 years), who could walk independently while performing 2 tasks: holding their breath after maximum expiration in the crook-lying position (maximum expiration), and performing the side bridge exercise on their knees without breathing instruction (side bridge). Peak expiratory flow (PEF) was obtained using a peak flow meter. Correlations between PEF and the abdominal muscle activity were determined using the Spearman rank correlation coefficient. RESULTS: The correlation coefficients between PEF and RA, EO, and IO activity while holding maximum expiration were 0.407 (p = 0.149), -0.345 (p = 0.227), and 0.732 (p = 0.003), respectively. The correlation coefficients between PEF and RA, EO, and IO activity while performing the side bridge exercise were -0.297 (p = 0.303), -0.552 (p = 0.041), and 0.147 (p = 0.615), respectively. CONCLUSIONS: Higher IO activity while holding maximum expiration or lower EO activity while performing the side bridge exercise was related to higher PEF. Thus, maximum expiration and abdominal exercise might be effective in the improvement or prevention of the decrease of expiratory flow.

[A Case of Extragonadal Germ Cell Tumor Treated by Induction Therapy with A Reduced Bep Regimen].

A 21-year-old man with chief complaints of left hypochondriac and chest pain was shown to have multiple masses in the lung, a pleural effusion in the right cavum thoracis, a mediastinal mass, and lymphadenopathy detected by computed tomographic scan. He was diagnosed with an extragonadal germ cell tumor based on pathologic findings from lung biopsies and elevation of the serum total human chorionic gonadotropin. He underwent a reduced chemotherapy regimen consisting of bleomycin, cisplatin, and etoposide (reduced BEP) to lower the risk of acute respiratory distress syndrome (ARDS), a manifestation of choriocarcinoma syndrome, which occurs at induction chemotherapy with the full-dose BEP regimen. Choriocarcinoma syndrome did not develop during chemotherapy, and he has been disease-free since salvage chemotherapy and subsequent retroperitoneal lymph node dissection.

Tape measure-based real-time feedback during the abdominal draw-in maneuver facilitates isolated transverse abdominal contraction.

[Purpose] Although the abdominal draw-in maneuver improves delayed onset of transverse abdomen in patients with low back pain, it is difficult to perform. We investigated whether the maneuver with tape measure-based feedback was more effective in facilitating isolated transverse abdominal muscle contractions than that without feedback in healthy participants. [Participants and Methods] Twenty healthy males performed the maneuver without feedback (control condition) and then with feedback using a tape measure (tape measure condition) in the crook lying, sitting, and standing positions. A B-mode ultrasonography imaging system was used to determine lateral abdominal muscle thicknesses, the percent changes from before the maneuver were calculated for each condition, and the main effects and interactions for each tested muscle were determined. [Results] The percent change in the thickness of the transverse abdominal muscle was significantly greater under the tape measure condition than under the control condition. The percent change in internal oblique thickness during the maneuver was significantly greater in the standing position than in the crook lying or sitting positions. Significant condition-by-position interactions were not observed for any of the examined muscles. [Conclusion] The abdominal draw-in maneuver with tape measure-based feedback may be more effective at facilitating isolated transverse abdominal contractions in all the positions than that without feedback.

Muscle thickness and echo intensity measurements of the rectus femoris muscle of healthy subjects: Intra and interrater reliability of transducer tilt during ultrasound.

This study aimed to assess the intra and interrater reliability of transducer tilt during the ultrasound (US) measurements of the muscle thickness and the echo intensity of the rectus femoris muscle (RF). Fourteen healthy male subjects (20.8 ± 0.8 years) participated in this study. The transducer tilt was measured using a digital angle gauge (°) during US. Two experimenters took two images to measure the muscle thickness (mm) and the echo intensity (a.u.: arbitrary unit). The intra and interclass correlation coefficient (ICC), standard error of measurement (SEM), and minimal detectable change (MDC) were also calculated. These measurements were immediately repeated. The ICC for the intrarater reliability for the transducer tilt, muscle thickness, and echo intensity were 0.96 (SEM: 0.9°, MDC: 2.6°), 0.99 (SEM: 0.4 mm, MDC: 0.1 mm), and 0.97 (SEM: 0.6 a.u. , MDC: 1.7 a.u.), respectively. The ICC for the interrater reliability for the transducer tilt, muscle thickness, and echo intensity were 0.40 (SEM: 4.0°, MDC: 11.1°), 0.96 (SEM: 0.7 mm, MDC: 2.0 mm), and 0.95 (SEM: 0.9 a.u. , MDC: 2.4 a.u.), respectively. The intrarater reliability of the transducer tilt was reliable, but the interrater reliability was questionable. Meanwhile, both the intra- and interrater reliability of the muscle thickness and the echo intensity were reliable.

Altered trunk muscle recruitment patterns during lifting in individuals in remission from recurrent low back pain.

Changes in the recruitment pattern of trunk muscles may contribute to the development of recurrent or chronic symptoms in people with low back pain (LBP). However, the recruitment pattern of trunk muscles during lifting tasks associated with a high risk of LBP has not been clearly determined in recurrent LBP. The present study aimed to investigate potential differences in trunk muscles recruitment patterns between individuals with recurrent LBP and asymptomatic individuals during lifting. The subjects were 25 individuals with recurrent LBP and 20 asymptomatic individuals. Electromyography (EMG) was used to measure onset time, EMG amplitude, overall activity of abdominal muscles, and overall activity of back muscles during a lifting task. The onsets of the transversus abdominis/internal abdominal oblique and multifidus were delayed in the recurrent LBP group despite remission from symptoms. Additionally, the EMG amplitudes of the erector spinae, as well as the overall activity of abdominal muscles or back muscles, were greater in the recurrent LBP group. No differences in EMG amplitude of the external oblique, transversus abdominis/internal abdominal oblique, and multifidus were found between the groups. Our findings indicate the presence of an altered trunk muscle recruitment pattern in individuals with recurrent LBP during lifting.

Correlation between cervical flexor muscle thickness and craniocervical flexion torque in healthy subjects.

The purpose of this study was to clarify the relationship between the size of the cervical flexor muscles and craniocervical (CC) flexion torque. Thirty-eight healthy men participated in this study. Thickness of the deep cervical flexor (DCF) and sternocleidomastoid (SM) muscles were measured using ultrasonography. Maximal isometric CC flexion torque was measured using dynamometry. The DCF and SM muscle thickness and CC flexion torque were normalized relative to body weight. Correlations between normalized muscle thickness and normalized CC flexion torque were determined. A significant positive correlation was observed between normalized DCF muscle thickness and normalized CC flexion torque (r = 0.361, P = 0.028), whereas there was no significant correlation between normalized SM muscle thickness and normalized CC flexion torque (r = 0.233, P = 0.166). DCF muscle thickness appears to have potential clinical application in the performance of CC flexion.

Association between trunk acceleration during walking and clinically assessed balance in patients with stroke.

BACKGROUND: Accelerometers provide information regarding balance and gait, but they are rarely used in clinical settings for stroke patients. Clinically, balance is assessed with simple tests, but their relationships with accelerometry results after stroke are unknown. OBJECTIVE: We examined the relationship between accelerometry-assessed gait indices calculated from trunk acceleration and results of the Timed Up and Go (TUG) and Berg Balance Scale (BBS) tests in stroke patients. METHODS: Twenty-nine stroke patients completed assessments with the TUG, BBS, and trunk acceleration during walking using a tri-axial accelerometer. The root mean square (RMS), stride regularity (SR), and step symmetry (SS), which indicate gait fluctuations, regularity, and symmetry, respectively, were calculated based on trunk acceleration. These were calculated in the vertical (VT), anteroposterior, and mediolateral directions. A multiple linear regression analysis was performed to determine whether these gait indices contributed independently to TUG and BBS results. RESULTS: VT-RMS and VT-SS were significant determinants of TUG, and VT-SS, VT-RMS, and VT-SR were significant determinants of BBS. CONCLUSIONS: This study suggested that the gait indices calculated from trunk acceleration that were relevant to balance were those in the VT direction. These may be useful for evaluating dynamic gait balance in patients with stroke.

Electromyographic activities of the abdominal muscles during 30% and 75% of maximum expiratory pressure.

The aim of this study was to quantify the activities of the rectus abdominis (RA), external oblique (EO), and internal oblique (IO) muscles during 30% and 75% of maximum expiratory pressure (PE max). Fifteen healthy male university students participated in this study. Electromyographic (EMG) activities of the RA, EO, and IO muscles were measured during 30% and 75% of PE max and then normalized relative to maximum voluntary contractions (%MVC). All muscles during 75% of PE max showed significantly higher %MVC compared to that during 30% of PE max (P < 0.01). The EO and IO muscles showed significantly higher %MVC compared to the RA muscle during 30% and 75% of PE max (P < 0.05). Muscle endurance and strength induced by expiratory muscle strength training might be different in each abdominal muscle.

A Method of Calculating Functional Independence Measure at Discharge from Functional Independence Measure Effectiveness Predicted by Multiple Regression Analysis Has a High Degree of Predictive Accuracy.

BACKGROUND: Multiple linear regression analysis is often used to predict the outcome of stroke rehabilitation. However, the predictive accuracy may not be satisfactory. The objective of this study was to elucidate the predictive accuracy of a method of calculating motor Functional Independence Measure (mFIM) at discharge from mFIM effectiveness predicted by multiple regression analysis. METHODS: The subjects were 505 patients with stroke who were hospitalized in a convalescent rehabilitation hospital. The formula "mFIM at discharge = mFIM effectiveness × (91 points - mFIM at admission) + mFIM at admission" was used. By including the predicted mFIM effectiveness obtained through multiple regression analysis in this formula, we obtained the predicted mFIM at discharge (A). We also used multiple regression analysis to directly predict mFIM at discharge (B). The correlation between the predicted and the measured values of mFIM at discharge was compared between A and B. RESULT: The correlation coefficients were .916 for A and .878 for B. CONCLUSION: Calculating mFIM at discharge from mFIM effectiveness predicted by multiple regression analysis had a higher degree of predictive accuracy of mFIM at discharge than that directly predicted.

Availability of the Two-step Test to evaluate balance in frail people in a day care service.

[Purpose] This study evaluated balance tests in users of a day care service who needed nursing care or support, and investigated the usefulness of the Two-step Test for evaluating balance. [Subjects and Methods] The subjects were users of a day care service, and had certified need for long-term care or support. All subjects were able to undergo the balance evaluations. Balance tests included the 3-m Timed Up and Go test (TUG), the one-leg standing time, and the Two-step Test. [Results] The Two-step Test and other balance tests were strongly correlated. [Conclusion] In this study of subjects who needed nursing care or support, the results were the same as in a previous study of subjects who did not need nursing care or support. The Two-step Test should be considered as an indicator of balance ability in elderly individuals requiring nursing care or support.

Comparison of abdominal muscle activity and peak expiratory flow between forced vital capacity and fast expiration exercise.

[Purpose] The purpose of this investigation was to compare the activities of the abdominal muscles and peak expiratory flow between forced vital capacity and fast expiration exercise. [Subjects and Methods] Fifteen healthy male participated in this study. Peak expiratory flow and electromyographic activities of the rectus abdominis, external oblique, and internal oblique/transversus abdominis muscles were measured during forced vital capacity and fast expiration exercise and then peak amplitude and its appearance time were obtained. [Results] Peak expiratory flow values were significantly higher during fast expiration exercise than during forced vital capacity. The internal oblique/transversus abdominis muscles showed significantly higher peak amplitude during fast expiration exercise than during forced vital capacity. However, there were no significant differences between forced vital capacity and fast expiration exercise in the rectus abdominis and external oblique muscles. There was no difference in the appearance time of the peak amplitude between forced vital capacity and fast expiration exercise in any muscle. [Conclusion] Fast expiration exercise might be beneficial for increasing expiratory speed and neuromuscular activation of the internal oblique/transversus abdominis muscles compared to forced vital capacity. These findings could be considered when recommending a variation of expiratory muscle strength training as part of pulmonary rehabilitation programs.

Influence of the ultrasound transducer tilt on muscle thickness and echo intensity of the rectus femoris muscle of healthy subjects.

[Purpose] This study aimed to assess the influence of ultrasound (US) transducer tilt on muscle thickness and echo intensity of the rectus femoris muscle (RF) in healthy subjects. [Subjects and Methods] Fourteen healthy male subjects (20.8 ± 0.8 years) participated in this study. Transducer tilt was measured during US, with a digital angle gauge. Muscle thickness and echo intensity were measured in 4 transducer tilt conditions: reference angle; +3°; +6°; and +9° cranial from the reference angle. [Results] All differences in transducer tilt relative to the reference condition were larger than the minimal detectable change (MDC) of the reference condition. All differences in muscle thickness relative to the reference condition were not larger than the MDC of the reference condition. All differences in the echo intensity relative to the reference condition, except between the reference and the +3° condition, were larger than the MDC of the reference condition. [Conclusion] Our results indicated that an examiner should maintain a precise transducer tilt during repeated US measurements to quantify the minimal change in the echo intensity of the RF.

Effects of fast expiration exercises without pressure on the respiratory muscle strength of healthy subjects.

[Purpose] The aim of this investigation was to determine the effects of 4 weeks of fast expiration exercises performed without pressure on respiratory muscle strength. [Subjects and Methods] Respiratory muscle strength of the training group that performed fast expiration exercises (n=12) was compared with that of a control group that performed no exercises (n=12). The fast expiration exercises were performed using a peak expiratory flow meter device and consisted of 20 fast expiration exercises performed 3 times per week for 4 weeks. Maximal expiratory and inspiratory pressures were evaluated as respiratory muscle strength using a spirometer pre- and post- intervention. [Results] There were significant increases in maximal expiratory pressure from 76.9 ± 29.1 to 96.1 ± 37.5 cmH2O and maximal inspiratory pressure from 80.8 ± 36.6 to 95.3 ± 37.6 cmH2O in the training group, but there was no significant difference in respiratory muscle strength between pre- and post-intervention in the control group. [Conclusion] Fast expiration exercises may be beneficial for increasing respiratory muscle strength. The findings of this study should be considered when prescribing a variation of the expiratory muscle strength training, as part of a pulmonary rehabilitation program.

In-Line Reactions and Ionizations of Vaporized Diphenylchloroarsine and Diphenylcyanoarsine in Atmospheric Pressure Chemical Ionization Mass Spectrometry.

We propose detecting a fragment ion (Ph2As(+)) using counter-flow introduction atmospheric pressure chemical ionization ion trap mass spectrometry for sensitive air monitoring of chemical warfare vomiting agents diphenylchloroarsine (DA) and diphenylcyanoarsine (DC). The liquid sample containing of DA, DC, and bis(diphenylarsine)oxide (BDPAO) was heated in a dry air line, and the generated vapor was mixed into the humidified air flowing through the sampling line of a mass spectrometer. Humidity effect on the air monitoring was investigated by varying the humidity of the analyzed air sample. Evidence of the in-line conversion of DA and DC to diphenylarsine hydroxide (DPAH) and then BDPAO was obtained by comparing the chronograms of various ions from the beginning of heating. Multiple-stage mass spectrometry revealed that the protonated molecule (MH(+)) of DA, DC, DPAH, and BDPAO could produce Ph2As(+) through their in-source fragmentation. Among the signals of the ions that were investigated, the Ph2As(+) signal was the most intense and increased to reach a plateau with the increased air humidity, whereas the MH(+) signal of DA decreased. It was suggested that DA and DC were converted in-line into BDPAO, which was a major source of Ph2As(+). Graphical Abstract ᅟ.