[Reducing the Time Before the Console in Robotic-Assisted Laparoscopic Hysterectomy].

Robotic-assisted surgery enables precise manipulations with magnified vision, stereoscopic vision, and forceps with multi-joint functions. It requires unique procedures such as position setting, port placement, roll-in, and docking, which lead to prolonged operation and anesthesia time. Five conditions described below were established at our institution to reduce the time to the initiation of console: (1) changing the patients' position from the flat lithotomy position to the spread legs position; (2) attaching a Hasson cone to hold the umbilical cannula stable; (3) changing the cannula's obturator (inner tube) from blunt to bladeless; (4) fixing the team, and (5) conducting regular docking training. These outcomes were examined in this study. The study included 77 patients who underwent robotic-assisted total hysterectomy for benign uterine disease and stage IA uterine cancer at our individual institution between April 2019 and July 2022. We compared the median time from anesthesia to console initiation between the first half group (cases 1-40) and the second half group (cases 41-77). The former required 91.5 (53-131) minutes, whereas the latter required 59 (37-126) minutes. Appropriate equipment selection and team education can reduce the time to console initiation.

[A Case of Adenocarcinoma, HPV-independent, Mesonephric Type with Significant Response to Neoadjuvant Chemotherapy].

Adenocarcinoma, HPV-independent, mesonephric type (hereafter referred to as "mesonephric carcinoma") arising from the cervix is rare, its treatment has not been established, and its sensitivity to chemotherapy has not been fully investigated. Here we report on a 30-year-old female patient who presented at our hospital with a chief complaint of abnormal genital bleeding. We suspected cervical cancer. Based on examination, biopsy, and imaging, she was diagnosed with stage IIA2 adenocarcinoma of the cervix and was scheduled for surgery. Because she had a SARS-COV-2 infection, she was given two courses of paclitaxel-carboplatin (TC) therapy, based on the then-current surgical risk assessment after SARS-COV-2 infection, with a waiting period of at least 8 weeks. The patient was deemed to have a partial response and was treated with paclitaxel and carboplatin, after which she was deemed to have a partial response and underwent total hysterectomy. A diagnosis of stage IIA2 mesonephric carcinoma, ypT1b2N0M0, was made after histopathologic examination of an excised specimen. The patient was treated with 4 additional courses of TC therapy after surgery, and has had no recurrence in 13 months. We report a first case of response to neoadjuvant chemotherapy with TC regimen in a patient with mesonephric carcinoma of the cervix.

Long-term changes in bone mineral density following adolescent idiopathic scoliosis surgery: a minimum 34-year follow-up.

PURPOSE: To investigate longitudinal changes in bone mineral density (BMD) in middle-aged female patients who underwent spinal fusion for adolescent idiopathic scoliosis (AIS). METHODS: The study subjects were 229 female patients who were diagnosed with AIS and underwent spinal fusion between 1968 and 1988. A two-step survey study was conducted on 19 female AIS patients. BMD, Z-scores, T-scores, and the prevalence of osteoporosis and osteopenia were compared between the initial (2014-2016) and second (2022) surveys. Correlations between the annual changes in Z-scores and T-scores with radiographic parameters, body mass index (BMI), and the number of remaining mobile discs were analyzed. RESULTS: BMD decreased significantly from the initial (0.802 ± 0.120 g/cm2) to the second survey (0.631 ± 0.101 g/cm2; p < 0.001). Z-scores decreased from 0.12 ± 1.09 to - 0.14 ± 1.04, while T-scores decreased significantly from - 0.70 ± 1.07 to - 1.77 ± 1.11 (p < 0.001). The prevalence of osteopenia and osteoporosis increased significantly from 36.8% to 89.5% (p = 0.002), but the increase in osteoporosis alone was not statistically significant (5.3% to 26.3%; p = 0.180). Moderate negative correlations were found between annual changes in Z-scores and both main thoracic (MT) curve (r = - 0.539; p = 0.017) and lumbar curve (r = - 0.410; p = 0.081). The annual change in T-scores showed a moderate negative correlation with the MT curve (r = - 0.411; p = 0.081). CONCLUSION: Significant reductions in BMD and an increased prevalence of osteopenia and osteoporosis were observed in middle-aged female AIS patients who had undergone spinal fusion. The decline in Z-scores in patients with AIS suggested that there was an accelerated loss of BMD compared with the general population. Larger residual curves could pose an added osteoporosis risk. Further research is needed to understand if the onset of osteoporosis in AIS patients is attributable to the condition itself or the surgical intervention.

Perioperative fluid management influences complication rates and length of hospital stay in the enhanced recovery after surgery (ERAS) protocol for patients with colorectal cancer.

PURPOSE: To evaluate the efficacy and safety of the enhanced recovery after surgery (ERAS) protocol and quantify the impact of each ERAS item on postoperative outcomes. METHODS: We used a generalized linear model to compare 289 colorectal cancer patients treated with the ERAS protocol between June, 2015 and April, 2021, with 99 colorectal cancer patients treated with the conventional colorectal surgery pathway between April, 2014 and June, 2015. RESULTS: The median length of hospital stay (LOHS) was significantly shorter in the ERAS group, at 9 days (range 3-104 days) vs. 14 days (range 4-44 days) (p < 0.001), but the complication rates (Clavien-Dindo grade 2 or more) were similar (16.6% vs. 22.2%; p = 0.227). However, in the ERAS group, the higher the compliance with ERAS items, the lower the complication rate and LOHS (both p < 0.001). Multiple regression analysis demonstrated that "Discontinuation of continuous intravenous infusion on POD1" and "Avoidance of fluid overload" were significantly associated with the LOHS (p < 0.001 and p = 0.008). CONCLUSION: The ERAS protocol is safe and effective for elective colorectal cancer surgery, and compliance with the ERAS protocol contributes to shorter LOHS and fewer complications. Items related to perioperative fluid management had a crucial impact on these outcomes.

Hip joint stress distribution changes depending on three-dimensional pelvic orientation: Finite-element analysis.

BACKGROUND: Pelvis experiences changes in its orientation due to the alignment of the hip joint and spine, and its orientation might affect both joints. Pelvic tilt on the sagittal plane has been widely discussed; however, the pelvis is oriented also on the coronal and horizontal planes. This study aimed to examine how stress distribution on intact hip joint changes under the three-dimensional pelvic orientation. METHODS: Computed tomography data of five patients with unilateral pelvic girdle were analyzed. Thirteen models were evaluated by the MECHANICAL FINDER: neutral position at 0°; 10° and 20° anterior and posterior pelvic tilt; 10° and 20° pelvic hike and drop; 10° and 20° pelvic forward and backward rotation. Stress assessment was performed in four parts of the acetabulum: anterosuperior, posterosuperior, posteroinferior, and central parts. RESULTS: Compared with the neutral position, the mean value of the equivalent stress and maximum principal stress in the anterosuperior part significantly increased by 1.51 times and 1.57 times at 20° posterior tilt, respectively. The maximum principal stress in the anterosuperior part significantly increased by 1.44 times at 20° hike. A significant increase of 1.45 times was found in the maximum principal stress in the anterosuperior part at 20° forward rotation. CONCLUSIONS: Local stress accumulated in the anterosuperior acetabulum at the posterior pelvic tilt, pelvic hike, and pelvic forward rotation, which might lead to hip overload. The effect of posterior pelvic tilt appears to be greater for the hip joint than at the pelvic hike or forward rotation.

Ovarian Clear Cell Carcinoma and Rectal Adenocarcinoma Detected by Tubo-Ovarian Abscess: A Case Report.

Most cases of tubo-ovarian abscess (TOA) are due to transvaginal infection, while other internal diseases may also be associated with TOAs. We experienced a case of ovarian clear cell carcinoma and rectal carcinoma that was discovered to be a result of TOA. A 46-year-old woman was diagnosed with TOA and referred to our hospital. Laparoscopic abscess drainage was performed, and pathological findings confirmed the presence of ovarian clear cell carcinoma inside the abscess. The tumor marker carcinoembryonic antigen (CEA) was elevated, and rectal cancer was diagnosed by a gastrointestinal endoscopy. Abdominal computed tomography (CT) showed a left adnexal abscess with an air image inside, and penetration of the abscess wall and rectal cancer were observed. Histopathologically, there was an accumulation of neutrophils around the rectal tumor cells. We concluded that the rectal cancer had penetrated the existing ovarian tumor and formed TOA. Non-gynecological diseases may be associated with TOA. It is necessary to consider the possibility that other clinical diseases may be associated with the trigger of TOA.

[A Case of Conversion Surgery for Gallbladder Cancer with Para-Aortic Lymph Node Metastasis].

The study presents the case of a 71-year-old woman who visited a nearby hospital for epigastric pain and weight loss. A CT scan showed a mass in the gallbladder, and the CEA level was high, so she was referred to our hospital for further investigation. Abdominal US, CT, and MRI suggested gallbladder cancer with para-aortic metastasis, and the histological findings on the EUS-FNA confirmed the diagnosis. Since surgical resection was not indicated, chemotherapy was performed(gemcitabine plus cisplatin). After 10 courses of chemotherapy, CT and MRI showed downsizing of para-aortic lymph nodes, and no accumulation of FDG was found on FDG-PET. Confirming the downstaging of cancer, conversion surgery, comprising an extended cholecystectomy and a lymph node resection, was performed. The pathological diagnosis showed no lymph node metastasis. No recurrence was observed after 12 months of surgery. Initially, unresectable gallbladder cancer with para-aortic lymph node metastasis was indicated to be compatible with preoperative chemotherapy and conversion surgery.

[A Case of HER2-Positive Unresectable Advanced Gastric Cancer Showing Long-Term Complete Response Treated by Only Chemotherapy].

A 78-year-old man was diagnosed as HER2-positive unresectable advanced gastric cancer(cT4aN3M1[LYM], Stage Ⅳ). After 2 courses of first-line chemotherapy(S-1 plus oxaliplatin plus trastuzumab), PR was achieved. The treatment could not be continued due to adverse events after 5 courses, thus second-line chemotherapy was conducted. Corresponding to the physical condition. The third-line chemotherapy was also introduced. However, we clinically judged PD because of amount of ascites and chemotherapy was terminated. After that, he has survived for more than 2 years without chemotherapy, and endoscopy and CT showed the disappearance of the tumor, metastatic lymph nodes, and ascites at 41 months after diagnosis. Looking back on the changes in tumor markers, it was possible that he had already achieved CR at the first-line chemotherapy.

[A Case of Lymph Nodes Metastases of Gastric Neuroendocrine Carcinoma Treated with Nivolumab and Showing Complete Response].

A 78-year-old man was diagnosed with lymph node metastasis 2 months after surgery for gastric neuroendocrine carcinoma. He received chemotherapy(CDDP plus CPT-11)and showed partial response(PR)after 3 courses of the regimen. Serum CEA increased 5 months after surgery, thus nab-paclitaxel plus ramucirumab was administered. Although the lymph node kept shrinked after 2 courses of the regimen, the lymph node was detected 12 cm of the size in CT after 5 courses of the regimen. He started to receive nivolumab. The lymph nodes showed PR after 4 courses, and complete response after 6 courses of the regimen for 1 year and 4 months until now.

Frozen vein wrapping for chronic nerve constriction injury reduces sciatic nerve allodynia in a rat model.

BACKGROUND: Autologous vein wrapping (VW) is used in the treatment of recurrent chronic constriction neuropathy and traumatic peripheral nerve injury. However, use of autologous veins is limited by the inability to obtain longer veins of sufficient length for larger sites. Frozen allograft tissue has several advantages, including its availability for large grafts, avoidance of donor-site morbidity, and shorter operation time. Here, we investigated the effect of frozen vein wrapping (FVW) in Wistar rats as a model of sciatic nerve injury. RESULTS: The rats were grouped by treatment as (i) untreated after chronic constriction injury surgery (CCI; control group), (ii) treated with vein wrapping using freshly isolated vein (VW), and (iii) treated with vein wrapping using frozen vein (FVW). Mechanical allodynia was assessed with von Frey filaments on postoperative days (PODs) 1, 3, 5, 7, and 14. Gene expression of HO-1 was evaluated by quantitative polymerase chain reaction (qPCR). The response of heme oxygenase-1 gene, Hmox-1, expression to VW and FVW was assessed by RT-PCR. Both VW and FVW significantly increased withdrawal threshold levels compared to the untreated control group on POD 1, 3, and 5. Both VW and FVW also showed increased HO-1 expression compared to the CCI group. CONCLUSIONS: FVW increased the withdrawal threshold similar to VW in a rat CCI model for short periods. Frozen vein wrapping using vein allograft without donor site morbidity may be an alternative therapeutic option.

Analgesic effects and arthritic changes following intra-articular injection of diclofenac etalhyaluronate in a rat knee osteoarthritis model.

BACKGROUND: Diclofenac etalhyaluronate (DF-HA) is a recently developed analgesic conjugate of diclofenac and hyaluronic acid that has analgesic and anti-inflammatory effects on acute arthritis. In this study, we investigated its analgesic effect on osteoarthritis, using a rat model of monoiodoacetate (MIA). METHODS: We injected MIA into the right knees of eight 6-weeks-old male Sprague-Dawley rats. Four weeks later, rats were randomly injected with DF-HA or vehicle into the right knee. Seven weeks after the MIA injection, fluorogold (FG) and sterile saline were injected into the right knees of all the rats. We assessed hyperalgesia with weekly von Frey tests for 8 weeks after MIA administration. We took the right knee computed tomography (CT) as radiographical evaluation every 2 weeks. All rats were sacrificed 8 weeks after administration of MIA for histological evaluation of the right knee and immunohistochemical evaluation of the DRG and spinal cord. We also evaluated the number of FG-labeled calcitonin gene-related peptide (CGRP)-immunoreactive(ir) neurons in the dorsal root ganglion (DRG) and ionized calcium-binding adapter molecule 1 (Iba1)-ir microglia in the spinal cord. RESULTS: Administration of DF-HA significantly improved pain sensitivity and reduced CGRP and Iba1 expression in the DRG and spinal cord, respectively. However, computed tomography and histological evaluation of the right knee showed similar levels of joint deformity, despite DF-HA administration. CONCLUSION: DF-HA exerted analgesic effects on osteoarthritic pain, but did not affect joint deformity.

The Effect of an Additional Core Suture During Pulvertaft Tendon Repair: A Fresh-Frozen Cadaver Study.

PURPOSE: Pulvertaft tendon repair is a strong suture technique; however, proper tendon tension is impaired by repair site elongation. Therefore, methods to reduce postoperative elongation are warranted. This study aimed to determine the effects of additional core sutures during Pulvertaft tendon repair on repair site elongation and rupture strength. METHODS: A total of 48 finger extensor tendons were harvested from fresh-frozen cadavers, and tendons with similar diameters were paired. The 24 pairs of tendons were divided into the following 4 groups: group I, 3 interlaced weaves only; group II, 3 interlaced weaves and 2 core suture strands with 4-0 nylon; group III, 3 interlaced weaves and 2 core suture strands with 4-0 FiberWire; and group IV, 4 interlaced weaves only. Each sutured tendon was placed in a Universal Testing Machine, and repair site elongation after repeated traction loads and rupture strength were measured. RESULTS: The mean elongation values were 2.74 ± 0.84 mm, 1.80 ± 0.16 mm, 1.60 ± 0.18 mm, and 1.92 ± 0.18 mm for groups I, II, III, and IV, respectively. The elongation values were significantly lower in groups II, III, and IV than in group I. The mean rupture strengths were 64.9 ± 16.0 N, 94.8 ± 17.2 N, 110.9 ± 21.3 N, and 104.9 ± 17.5 N for groups I, II, III, and IV, respectively. Rupture strengths were significantly higher for groups III and IV than for group I. CONCLUSIONS: After adding core sutures during Pulvertaft tendon repair, the elongation amount decreased, and the rupture strength improved. CLINICAL RELEVANCE: The study showed the effect of additional core sutures during Pulvertaft tendon repair, suggesting that it could be useful in reducing postoperative tendon elongation when extensor tendon transfers are performed.

Recovery of Forearm Bone Strength After Plate Removal: A Finite Element Analysis Study.

PURPOSE: The purpose of this study was to estimate the bone strength after plate removal over time and to investigate the progression of bone strength recovery. METHODS: A consecutive series of 31 patients was investigated to evaluate bone strength before and after forearm plate removal. Patients who were included underwent plate fixation for forearm diaphyseal fractures and were scheduled for plate removal. Computed tomography (CT) scans of the entire length of the bilateral forearms were taken before plate removal and at 1, 3, and 6 months after surgery. Patient-specific CT-based finite element analysis was used to predict the forearm bone fracture strength against an axial load (N), defined as the bone strength. Bone strength was estimated by patient-specific CT-based finite element analysis at each time point. RESULTS: The mean age of the patients was 40.4 years. The mean time between plate fixation and removal was 27.5 months. Bone strength before the removal was estimated as reduced to 47% of that of the uninjured side. This was constant regardless of age group, involvement of the radius or ulna, Arbeitsgemeinschaft für Osteosynthesefragen (AO) classification, open fracture, or type of plate. Bone strength at 1, 3, and 6 months after removal was estimated to be 66%, 85%, and 97%, respectively. The bone strength of the distal ulna was weaker than that at the other sites in the forearm and showed delayed recovery. CONCLUSIONS: Bone strength after plate removal showed recovery within 3-6 months and was fully recovered by 6 months. The degree of recovery of bone atrophy varies from site to site, and patients should be careful about refracture after removal. CLINICAL RELEVANCE: Clinicians should be aware that bone strength may not be sufficiently restored even 6 months after plate removal of forearm fractures.

A novel treatment strategy using continuous local antibiotic perfusion: A case series study of a refractory infection caused by hypervirulent Klebsiella pneumoniae.

BACKGROUND: Conventional topical antimicrobial therapy cannot maintain a constant local concentration, resulting in uncontrolled infection and complications. We propose continuous local antibiotic perfusion (CLAP), which can maintain a constant appropriate local antibiotic concentration for a long time with less invasiveness and complications. CLAP is clearly different from traditional treatment because it uses negative pressure to direct the continuously infused antibiotic solution to the center of infection and excrete it outside the body. This study aimed to demonstrate the effectiveness of CLAP by presenting cases in which even refractory bone and soft-tissue infections caused by the hypervirulent Klebsiella pneumoniae (hvKp) could be cured without significant tissue loss and dysfunction. METHODS: This study is a case series in which four patients with limb infection due to hvKp were treated by CLAP. hvKp was defined by a positive string test. The therapy included intra-soft-tissue antibiotic perfusion and intramedullary antibiotic perfusion. Gentamicin (60 mg/50 cc) was infused continuously through dual-lumen tubes and bone marrow needles at low-flow rates (2 mL/h). Negative pressure was used to collect the antimicrobial solution and eliminate the dead space. RESULTS: The infection was controlled in all four patients after a mean period of 44.3 days. The mean maximum blood concentration of gentamicin was 1.6 µg/dL, and no cases of renal dysfunction or ototoxicity occurred. After CLAP, wound closure was required in two patients and iliac bone grafting was required in one patient. As sequelae, there were one case of osteoarthritis and one case of higher brain dysfunction due to hypoxia. CONCLUSIONS: Our results suggest that intractable hvKp infections can be controlled by CLAP. CLAP may give us the option to directly control local infections with less systemic complications. Therefore, it is considered a valuable treatment for further basic and clinical research, and this research report may be a first step.

Biomechanical assessment of the first dorsal compartment of the wrist: A fresh cadaver study with relevance to de Quervain's disease.

Resistance of de Quervain's disease to conservative treatment has been associated with an intertendinous septum in the first compartment. This study aimed to investigate the relationship between intertendinous septum's presence or absence, internal pressure and wrist positon in the first compartment. Fourteen arms were obtained from seven fresh frozen cadavers. A pressure sensor was inserted into the first compartment; if a septum was present, the pressure sensor was inserted into the abductor pollicis longus (APL) side and the extensor pollicis brevis (EPB) side, respectively. Three wrist positions were also tested: neutral, 45° flexion, and 45° extension. Intertendinous septa were present in seven wrists. The average pressure change in the first compartment measured on the EPB side of a present septum was significantly greater than that measured on the APL side of a present septum or where no septum existed: no septum = 54.6 ± 48.3 kPa; septum, EPB = 81.7 ± 76.5 kPa; and septum, APL = 32.8 ± 37.4 kPa. The average pressure change was also significantly greater in the flexion wrist position relative to the neutral and extension positions: neutral = 36.3 ± 58.0 kPa; 45° flexion = 79.5 ± 65.9 kPa; and 45° extension = 50.4 ± 42.6 kPa. Clear relationships existed between (1) the presence of a septum and increased internal pressure on the EPB side in the first compartment and (2) increased internal pressure with the wrist at 45° flexion compared with the neutral and extension position.

Detecting Distal Radial Fractures from Wrist Radiographs Using a Deep Convolutional Neural Network with an Accuracy Comparable to Hand Orthopedic Surgeons.

In recent years, fracture image diagnosis using a convolutional neural network (CNN) has been reported. The purpose of the present study was to evaluate the ability of CNN to diagnose distal radius fractures (DRFs) using frontal and lateral wrist radiographs. We included 503 cases of DRF diagnosed by plain radiographs and 289 cases without fracture. We implemented the CNN model using Keras and Tensorflow. Frontal and lateral views of wrist radiographs were manually cropped and trained separately. Fine-tuning was performed using EfficientNets. The diagnostic ability of CNN was evaluated using 150 images with and without fractures from anteroposterior and lateral radiographs. The CNN model diagnosed DRF based on three views: frontal view, lateral view, and both frontal and lateral view. We determined the sensitivity, specificity, and accuracy of the CNN model, plotted a receiver operating characteristic (ROC) curve, and calculated the area under the ROC curve (AUC). We further compared performances between the CNN and three hand orthopedic surgeons. EfficientNet-B2 in the frontal view and EfficientNet-B4 in the lateral view showed highest accuracy on the validation dataset, and these models were used for combined views. The accuracy, sensitivity, and specificity of the CNN based on both anteroposterior and lateral radiographs were 99.3, 98.7, and 100, respectively. The accuracy of the CNN was equal to or better than that of three orthopedic surgeons. The AUC of the CNN on the combined views was 0.993. The CNN model exhibited high accuracy in the diagnosis of distal radius fracture with a plain radiograph.

Poorly Differentiated Cervical Squamous Cell Carcinoma Resembling Giant Cell Carcinoma of the Lung: Extreme Morphology of This Tumor and Its Clinical Course.

Giant cell tumor is a highly aggressive tumor characterized by a marked proliferation of pleomorphic, bizarre giant cells usually observed in the lungs. The importance of histopathological imaging and the clinical course of this tumor are unknown. The objective of our report was to investigate whether these components affect treatment outcomes and prognosis compared to conventional cancers. A 40-year-old woman with cervical cancer showed leukocytosis and elevated granulocyte colony simulating factor (G-CSF). The patient underwent a radical abdominal hysterectomy. Pathology revealed a poorly differentiated squamous cell carcinoma of the cervix, similar to giant cell carcinoma. The patient recovered from the disease and is alive 37 months after concurrent chemoradiotherapy (CCRT). Leukocytosis and G-CSF were normalized after treatment. This was our second case of giant cell carcinoma of the cervix. Cumulative data on giant cell carcinoma are limited, thus we considered the prognostic significance of the presence of giant cell carcinoma in uterine carcinoma.

Uterine Tumor Resembling Ovarian Sex Cord Tumor: A Case Report.

Uterine tumors resembling ovarian sex cord tumors (UTROSCTs) are extremely rare, occurring in less than 1% of uterine stromal tumors, and they are considered to have a low malignant potential. Due to the small number of cases, no standard treatment has been defined. A 77-year-old woman with postmenopausal bleeding was admitted to our department. Imaging studies revealed a substantial mass around 30 mm in size on the anterior uterine wall. A total hysterectomy and bilateral salpingo-oophorectomy were performed for further diagnosis and treatment. The tumor revealed histopathological findings of a sex cord-like growth pattern in the form of fascicles, cords, or small nests. Immunohistochemical findings revealed that the tumor cells were positively reactive to alpha-SMA, calretinin, CD99, estrogen receptor, and progesterone receptor, collectively diagnosed as UTROSCT. No recurrence was observed over 12 months after treatment. We experienced the treatment of UTROSCT, an extremely rare tumor that occurs in elderly women. Although most cases of UTROSCT have a benign clinical course, several cases of recurrence and metastasis have been reported. It should be followed up for a long term after treatment.

[A Case of Cardiac Tamponade during Multimodal Treatment for Mediastinal Lymph Node Metastasis of Gastric Cancer].

A 52-year-old man underwent total gastrectomy for gastric cancer and chemoradiotherapy for thoracic paraaortic lymph node metastasis. He also underwent esophageal stent implantation for stenosis. He was admitted to our hospital with fever and breathing difficulty and was diagnosed with infectious pericarditis. He showed symptoms of shock due to cardiac tamponade. After pericardial drainage, his vital signs improved. When signs of infection are detected in patients with a history of chemoradiotherapy or stent implantation, we should consider infectious pericarditis due to esophageal pericardial fistula and apply immediate drainage of cardiac tamponade.

Decreased physical activity in patients with ankle osteoarthritis. A case-control study comparing daily step counts.

BACKGROUND: The purpose of this study was to compare physical activity levels and the proportion of patients who met physical activity recommendations in patients with ankle osteoarthritis and controls. METHODS: Ankle osteoarthritis patients (n = 50) and controls (n = 50) were recruited. physical activity was measured using an accelerometer-based monitor. Physical activity parameters, including the step count/day, the proportion of patients who met physical activity recommendations of ≥7000 steps/day, and moderate to vigorous physical activity minutes/day, were compared between the patient groups. RESULTS: The patients with ankle osteoarthritis walked 3998 steps/day, while the controls walked 6531 steps/day (P < .001). Only 7 (14%) ankle osteoarthritis patients and 17 (34%) controls met the physical activity recommendations of ≥7000 steps/day (P = .01). Time spent performing moderate to vigorous physical activity was 58 and 78 min/day in the ankle osteoarthritis and controls, respectively. CONCLUSIONS: The physical activity level of ankle osteoarthritis patients was lower than that of controls. Only a limited proportion of ankle osteoarthritis patients met the physical activity recommendation.