Successfully treated case of cervical abscess and mediastinitis due to esophageal perforation after gastrointestinal endoscopy.

Perforations of the esophagus are uncommon complications of flexible gastrointestinal endoscopy. Perforations after endoscopy are likely to occur in the cervical esophagus, where fiber insertion is difficult anatomically. The diagnosis should be made as soon as possible, because mediastinitis and sepsis frequently develop following esophageal perforations. The surgical strategies are dependent on the location of the perforations and the condition of the patients. For a successful outcome, surgery is a preferred treatment for most perforation cases, and non-operative treatment, such as antibiotics, parental nutrition, and no food intake by mouth, should be applied carefully.

Ligamentous ossification of the cervical spine in the late middle-aged Japanese men. Its relation to body mass index and glucose metabolism.

STUDY DESIGN: The present study investigated the relationship of obesity and glucose metabolism in persons with ossification of the anterior longitudinal ligament, ossification of the nucal ligament, and ossification of the posterior longitudinal ligament of the cervical spine. OBJECTIVE: To provide a insight into the etiology of ligamentous ossification of the cervical spine. SUMMARY OF BACKGROUND DATA: The high incidence of ligamentous ossification of the cervical spine with obese patients has been reported, but no definite association was reported between the incidence of ossification of the anterior longitudinal ligament, ossification of the nucal ligament, and ossification of the posterior longitudinal ligament and their bone mass index values. METHODS: Lateral cervical radiographs and 75 g oral glucose tolerance tests of more than 4802 Japanese men aged 48-57 years at the Self Defense Force Hansin Hospital were evaluated. RESULTS: The incidences of ossification of the anterior longitudinal ligament, ossification of the nucal ligament, and ossification of the posterior longitudinal ligament were 23.1% (1110 of 4802), 23.3% (1117 of 4802) and 4.1% (198 of 4802), respectively. In the groups whose body mass index was 25 or more, the incidences of ossification of the anterior longitudinal ligament, ossification of the nucal ligament, and ossification of the posterior longitudinal ligament were significantly high (P < 0.01). The higher incidence of diabetes or impaired glucose tolerance was statistically significant in ossification of the anterior longitudinal ligament and ossification of the posterior longitudinal ligament but not in ossification of the nucal ligament. The rates, which showed significantly high glucose response by 1-hour or 2-hour plasma glucose level after oral glucose tolerance tests with body mass index-matched control subjects, were ossification of the anterior longitudinal ligament, 93.5%; ossification of the posterior longitudinal ligament, 52.0%; and ossification of the nucal ligament, 14.0%, respectively. CONCLUSIONS: From this study, obesity was shown to be the major risk factor of ossification of the nucal ligament, and obesity and glucose intolerance were risk factors in ossification of the anterior longitudinal ligament and ossification of the posterior longitudinal ligament. The authors concluded the morbidity rates of ossification of the anterior longitudinal ligament. ossification of the nucal ligament, and ossification of the posterior longitudinal ligament were high in obesity, however, concerning the glucose intolerance, ossification of the nucal ligament is etiologically different from ossification of the anterior longitudinal ligament and ossification of the posteior longitudinal ligament.