Effects of monthly feedback of VFA measured by dual BIA method in Japanese patients with obesity: a randomized controlled study.

Objective: To investigate the effects of monthly feedback of changes in visceral fat area (VFA) as measured by dual bioelectrical impedance analysis method and the importance of VFA in individuals with obesity. Methods: Thirty-eight Japanese patients with obesity underwent VFA measurements. The feedback group was given feedback on VFA measurements each month for 4 months. The control group underwent VFA measurements at the beginning and end of the study but was not informed of the results. All the study participants completed eating behaviour and weight efficacy lifestyle questionnaires. Results: Mean age was 53.9 (14.3) years; mean body mass index was 30.6 (4.3) kg m-2. At the 4-month follow-up, there was no significant difference in VFA reduction between the control and feedback groups (-4.4% vs. -3.0%; 95% CI, -3.8 to 5.5). In post-hoc analysis using the overall group irrespective of allocation, changes of eating style were significantly associated with a reduction in VFA at 4 months (p = 0.034). Conclusions: Monthly feedback on changes in VFA does not reduce VFA. More frequent feedback may be required. In post-hoc analysis, changes of eating style were associated with a reduction in VFA.

Prototyping sensor network system for automatic vital signs collection. Evaluation of a location based automated assignment of measured vital signs to patients.

OBJECTIVE: Development of a clinical sensor network system that automatically collects vital sign and its supplemental data, and evaluation the effect of automatic vital sensor value assignment to patients based on locations of sensors. METHODS: The sensor network estimates the data-source, a target patient, from the position of a vital sign sensor obtained from a newly developed proximity sensing system. The proximity sensing system estimates the positions of the devices using a Bluetooth inquiry process. Using Bluetooth access points and the positioning system newly developed in this project, the sensor network collects vital sign and its 4W (who, where, what, and when) supplemental data from any Bluetooth ready vital sign sensors such as Continua-ready devices. The prototype was evaluated in a pseudo clinical setting at Kyoto University Hospital using a cyclic paired comparison and statistical analysis. RESULTS: The result of the cyclic paired analysis shows the subjects evaluated the proposed system is more effective and safer than POCS as well as paper-based operation. It halves the times for vital signs input and eliminates input errors. On the other hand, the prototype failed in its position estimation for 12.6% of all attempts, and the nurses overlooked half of the errors. A detailed investigation clears that an advanced interface to show the system's "confidence", i.e. the probability of estimation error, must be effective to reduce the oversights. CONCLUSIONS: This paper proposed a clinical sensor network system that relieves nurses from vital signs input tasks. The result clearly shows that the proposed system increases the efficiency and safety of the nursing process both subjectively and objectively. It is a step toward new generation of point of nursing care systems where sensors take over the tasks of data input from the nurses.

Effect of short-term low-intensity exercise on insulin sensitivity, insulin secretion, and glucose and lipid metabolism in non-obese Japanese type 2 diabetic patients.

The aim of the present study was to investigate the effects of short-term physical exercise that did not change body mass on insulin sensitivity, insulin secretion, and glucose and lipid metabolism in 39 non-obese Japanese type 2 diabetic patients. Insulin sensitivity and insulin secretion were estimated with homeostasis model assessment insulin resistance (HOMA-IR) and HOMA-B-cell function proposed by Matthews et al., respectively. All patients were hospitalized and were engaged in low-intensity exercise that consisted of walking and dumbbell exercise for successive 7 days. There were no changes in hospital diet and the dose of any medications used throughout the study. Fasting glucose, insulin, and lipids were measured before and after exercise. After exercise, serum triglyceride levels significantly decreased, but no significant changes were observed in total and HDL cholesterol concentrations. Fasting glucose, insulin, and HOMA-IR levels significantly decreased after exercise, but HOMA-B-cell function did not change during the study. There was no significant difference between BMI levels before and after exercise. From these results, it can be concluded that short-term (7 days) low-intensity physical exercise combined with hospital diet reduces serum triglycerides, insulin resistance, and fasting glucose levels without affecting BMI in non-obese Japanese type 2 diabetic patients.

Trigeminal neuralgia caused by compression from arteries transfixing the nerve. Report of three cases.

The authors present three patients with trigeminal neuralgia due to compression by an artery that transfixed the sensory root of the fifth cranial nerve. These cases represented 0.8% of 384 patients with trigeminal neuralgia treated by microvascular decompression at the authors' clinic during the past 12 years. In the remaining 381 cases, the compressing vessels were successfully removed from the trigeminal nerve without much difficulty, for an initial cure rate of 94.3%. In the three cases reported, however, the compressing artery penetrating the nerve could not easily be maneuvered away from the nerve. In the first two cases, partial rhizotomy perpendicular to the axis of the nerve at the site of arterial transfixion made it possible to separate the artery from the nerve. However, these two patients developed postoperative facial sensory impairment. In the third case, rhizotomy was performed longitudinal to the axis of the nerve at the site of arterial transfixion, making it possible to reposition the artery peripherally beyond the root entry zone of the nerve without causing any postoperative sensory deficits of the face. No recurrent pain has developed in more than 2 1/2 years since surgery in any of these three cases. When performing microvascular decompression surgery on patients in whom the compressing artery penetrates the nerve, the technique used in our third patient is the procedure of choice.

[Anterior decompression surgery of aged patients with cervical myelopathy].

One hundred and thirty-nine patients with cervical myelopathy who underwent anterior decompression surgery were reviewed to determine the characteristics and surgical outcome in 26 elderly patients over the age of 65. The mean age of the aged group was 69.7 and that of the remaining 113 patients was 50.0. Extensive spur removal and interbody fusion with iliac bone graft were performed in all patients. Evaluation of clinical grades was based on the Japan Orthopedic Association Score (JOA score) on admission, at discharge and at the time of follow-up (mean 26.8 months). The improvement rate was calculated from Hirabayashi's formula at each point. Preoperatively, the mean duration of illness was longer and the mean JOA score was significantly lower in the aged group. Furthermore, low incidence of soft disc and multi-level lesions were characteristic for the aged. Final JOA score increased from 8.2 to 13.0 in the aged group, while that in the non-aged group increased from 10.5 to 14.8. These differences were statistically significant at each point. Excellent and good results which were designated as an improvement rate of 50% or more were obtained in 73.1% of the aged group, and in 79.6% of the non-aged group. Postoperative complications were slightly more frequent in the aged group, all of which, however, were dislocation of bone graft seen in 3 patients. As compared with the non-aged group, poorer surgical outcome in the aged group was attributed to preoperative poor clinical condition, long duration of preoperative symptoms, low incidence of soft disc herniation and multi-level lesions which were characteristic features for the aged patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Pneumocephalus associated with benign brain tumor: report of two cases.

Two cases of spontaneous pneumocephalus, which developed after ventriculoperitoneal shunt procedures for severe hydrocephalus caused by benign brain tumors, are reported. In both cases there was no previous history of cerebrospinal fluid leakage. Operation revealed that both patients had many small defects of the dura mater and the bone in the middle cranial fossa, which were plugged by necrotic brain tissue. These defects were remote from the sites of the original tumors but may have been produced by long-standing raised intracranial pressure, and they presumably allowed air to enter after intracranial pressure was reduced by shunting. Repair of the defects prevented further intracranial air retention.

Subarachnoid hemorrhage possibly caused by a saccular carotid artery aneurysm within the cavernous sinus. Case report.

Aneurysms arising from the intracavernous portion of the internal carotid artery very rarely rupture. A patient is presented in whom rupture of an aneurysm wholly within the cavernous sinus caused a subarachnoid hemorrhage. The aneurysm was successfully clipped via a direct surgical approach. The possible mechanism by which subarachnoid hemorrhage occurred is briefly discussed.

Calcified metastatic brain tumor.

The case of a 57-year-old woman with a calcified metastatic brain tumor, histologically confirmed to be a squamous cell carcinoma, is reported. This patient is unusual because this metastatic squamous cell carcinoma contained an extraordinary huge conglomerated calcification, that was well-defined radiographically. This case is documented with a discussion of the pathogenesis of the calcification.

[Solitary cerebral varix. Case report].

A 69-year-old male presented with a 4-month episode of tonic seizures of the right arm and leg. Neurological examination revealed no abnormal findings. In the electroencephalogram, sharp wave trains were seen dominantly in the left frontal region. Computed tomography scans showed a spotty hyperdense lesion in the left insular area with minimal enhancement. Left carotid angiogram demonstrated no abnormalities in the arterial and capillary phases. In the venous phase, however, a varicose dilatation of the posterior insular vein was found, which was also noticed in the delayed phase. Magnetic resonance T1-weighted images failed to detect the lesion, but T2-weighted images showed a slight signal focus in the same area. After administration of 300 mg of phenytoin daily, the frequency of attacks markedly decreased and the patient was kept under close outpatient observation.

Calcification of a ventriculoperitoneal shunt tube. Case report.

A 16-year-old boy who had undergone a ventriculoperitoneal (VP) shunt because of hydrocephalus at 8 years of age complained of pain around the right neck and chest. He concomitantly had a slight fever of unknown etiology, which had been lasting for several years. Skull and chest roentgenograms revealed an unusual calcified shadow around the shunt tube. After removal of the shunt apparatus, his pain and fever disappeared. Silicone tubes used in a VP shunt apparatus may induce fibrous connective tissue proliferation around the tubes in both children and adults, but no reports of radiologically verified calcification of a VP shunt tube are found in the literature, to the best of our knowledge. The possible mechanism of calcification of the VP shunt tube is discussed.

[A case of spontaneous superficial temporal artery aneurysm].

A rare case of a 14-year-old boy with a spontaneous (true) aneurysm of the superficial temporal artery is presented. The mass in the right parietal region was pulsatile and gradually enlarged in size for the last several months without any notable history of head trauma. The mass was successfully removed by surgery and has proved histopathologically to be a true aneurysm. While almost all cases of the superficial temporal artery aneurysm reported are traumatic ones, the true aneurysm of this artery which is verified by angiography is extremely rare. The pathology, etiology and treatment of this true aneurysm of the superficial temporal artery were discussed.

[Intracranial benign chondroblastoma. A case report and review of the literature].

A case of benign chondroblastoma extending from the nasal cavity to the frontal region, was reported. A 1-year and 9-month old girl was admitted to our hospital in April 1981 because of generalized convulsion. On admission, she was intact neurologically and had It. nasal obstruction and It. eye discharge. Her laboratory examinations, including serum electrolytes and A1-P, were all in normal range. Plain skull X-P showed marked calcification from midfrontal region to the nasal cavity, and destruction of the frontal base especially in It. side. Plain CT showed isodensity mass with spotty calcification in the nasal cavity and marked high density mass in the frontal region. By contrast enhancement, nasal mass was markedly enhanced and new enhanced mass appeared around the intracranial calcification. Lt. ext. CAG showed the enlarged middle meningeal artery which is the feeder of the tumor, fine tumor vessels and slight tumor stain. Lt. int. CAG only showed the mass effect. After three-stage operation of bifrontal craniotomy, sublabial transnasal approach and rhinotomy, all the tumor was removed and she was discharged with no neurological deficits. The tumor was well demarcated and consisted from solid, cystic and calcified region. The solid region was grayish and easy-hemorrhagic. Histological examination revealed characteristic features of benign chondroblastoma, such as diffuse proliferation of polygonal or round cells, foci of chondroid matrices, scattered polynuclear giant cells and some mitosis.

Sequential CT observations of irradiated intracranial germinomas.

Computed tomography (CT) has improved the accuracy of preoperative diagnosis of intracranial tumors. CT findings of germinoma are a mass of isodensity or of slightly increased density with significant, homogeneous enhancement after intravenous contrast injection. These findings are characteristic but not pathognomonic, and differential diagnosis from other solid tumors is not easy. Cerebrospinal fluid cytology and response to irradiation aid in this differential diagnosis. The nine cases of germinoma reported showed rapid response to irradiation even at small doses (600 rad), and complete disappearance of the mass on CT at 1,600--3,300 rad. Other radiosensitive masses to be differentiated in the pineal region are pinealocytoma or pinealoblastoma.

The EEG in normal pressure hydrocephalus.

Fourteen patients with NPH were studied with special reference to associated EEG changes, one case being reported in detail. In 13 cases the EEG was abnormal, the abnormality most frequently observed being a of the rhythmic slow wave type, consisting of bursts of monorhythmic theta or delta waves seen in both hemispheres. This type of abnormality was present in 7 cases. In 4 of the 5 cases with serial EEG's the abnormality became more accentuated with the advance of the illness. In 4 of 5 cases in whom postoperative EEGs were obtained there was significant improvement of the EEG after the shunting procedure. There were stron correlations between the EEG abnormality described, demonstrable ventricular reflux on cisternography, and the effectiveness of the shunt operation. It was considered that serial EEGs are a useful diagnostic procedure in following up patients at risk of developing NPH.