Acta Med Okayama
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Review Case Reports
Spinal metaplastic meningioma with osseous differentiation in the ventral thoracic spinal canal.
Ossified meningioma is classified histologically as a phenotype of metaplastic meningioma, and it is extremely rare. There are only 12 cases involving ossified spinal meningiomas in the literature. We present the case of a 61-year-old female with a primary tumor within the ventral spinal canal at T12. ⋯ The neurologic findings worsened immediately after surgery. Histologically, the tumor was diagnosed as a metaplastic meningioma with osseous differentiation. In order to avoid spinal cord injury, great care must be taken when removing an ossified meningioma located on the ventral spinal cord.
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Case Reports
Discordance between train-of-four response and clinical symptoms in a patient with amyotrophic lateral sclerosis.
A 47-year-old woman with amyotrophic lateral sclerosis was scheduled for total thyroidectomy with cervical node dissection. During anesthetic management by total intravenous anesthesia using remifentanil, propofol, and rocuronium, train-of-four (TOF) monitoring findings were not consistent with clinical signs. Sugammadex successfully reversed shallow respiration.
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A 64-year-old man suffering polyarthralgia and bone pain was referred to our hospital. Renal dysfunction, hypophosphatemia and increased levels of bone alkaline phosphatase were found. The patient's serum creatinine level had gradually increased after the initiation of adefovir dipivoxil administration for hepatitis B. ⋯ Reducing the dose of adefovir and initiating the administration of eldecalcitol were effective for reducing proteinuria and glucosuria, and for ameliorating bone pain with an increase in serum phosphate level. This case first showed a clinical course of hypophosphatemic osteomalacia caused by secondary Fanconi's syndrome for 8 years after adefovir administration. Early diagnosis is important for the reversibility of bone damage and for a better renal prognosis.
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In neurosurgery in particular, the recommended placement of electrodes for monitoring depth of anesthesia during surgery sometimes conflicts with the surgical site or patient positioning. Therefore, we proposed this study to evaluate the agreement and correlation of bispectral index values recorded from the usual frontal area and the alternate, post-auricular areas in neurosurgery patients. Thirty-four patients scheduled for neurosurgery under general anesthesia were included. ⋯ The correlation coefficient between frontal- and post-auricular-area electrodes was 0.74 with a p-value<0.001. The post-auricular placement of a BIS electrode is a practical alternative to frontal lobe placement. Nevertheless, proper electrode location is important to minimize error.
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On April 25, 2005, a Japanese express train derailed into a building, resulting in 107 deaths and 549 injuries. We used "First Impression Triage (FIT)", our new triage strategy based on general inspection and palpation without counting pulse/respiratory rates, and determined the feasibility of FIT in the chaotic situation of treating a large number of injured people in a brief time period. The subjects included 39 patients who required hospitalization among 113 victims transferred to our hospital. ⋯ There were no statistical differences between FIT and START in the accuracy rate calculated by means of probability of survival and ICU stay. Overall validity and reliability of FIT determined by outcome assessment were similar to those of START. FIT would be a simple and accurate technique to quickly triage a large number of patients.