Journal of Nippon Medical School = Nippon Ika Daigaku zasshi
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In recent years, our understanding of motor learning, neuroplasticity, and functional recovery after the occurrence of brain lesion has grown significantly. New findings in basic neuroscience have stimulated research in motor rehabilitation. Repeated motor practice and motor activity in a real-world environment have been identified in several prospective studies as favorable for motor recovery in stroke patients. ⋯ Although many physiotherapeutic modalities have been established, conclusive proof of their benefit and physiological models of their effects on neuronal structures and processes are still missing. A multichannel near-infrared spectroscopy study to noninvasively and dynamically measure hemoglobin levels in the brain during functional activity has shown that cerebral blood flow in the sensory-motor cortex on the injured side is higher during a power-assisted FES session than during simple active movement or simple electrical stimulation. Nevertheless, evidence-based strategies for motor rehabilitation are more easily available, particularly for patients with hemiparesis.
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Interdigital pilonidal sinus is a rare occupational disease related to work with short hair. Hair dresser's disease is the interdigital pilonidal sinus encountered in male barbers. A case of pilonidal sinus in the interdigital web is reported. ⋯ There were neither complications nor recurrence in the third month after excision. We propose that surgical excision is inevitable and that any primary treatment can improve the patients' postoperative comfort. Thus, primary closure or closure with a flap, instead of secondary healing, should always be the first choice of treatment for a defect due to excision of an interdigital pilonidal sinus.
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Vertebral artery injury associated with non-penetrating cervical trauma is rare. We report 11 cases of vertebral artery injury diagnosed with magnetic resonance imaging (MRI) after blunt trauma to the cervical spine and discuss about the importance of MRI in the diagnosis of this injury. Seven cases were caused by motor vehicle accidents, three by diving accidents, and one by static compression of the neck. ⋯ None were treated with anticoagulants. All of them survived and were discharged to other hospitals for physical and occupational therapy. Although DSA remains the gold standard for diagnosing vertebral artery injuries, MRI is a newer modality for assessing cervical cord injury, and it may be useful for evaluating the presence of vertebral injury after blunt cervical spine trauma.
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The hypothalamic-pituitary-adrenal axis is an essential component for the maintenance of homeostasis following trauma. Major surgical trauma often induces overwhelming inflammatory responses leading to sepsis and organ dysfunction. This study was designed to evaluate the adrenal responses both before and after various degrees of surgical trauma and to determine the incidence of postoperative relative adrenal insufficiency resulting in the marked inflammatory response often associated with postoperative complications. ⋯ Furthermore, there were significant differences in the length of the postoperative stay among the three groups (p<0.01). One nonresponder had serious postoperative inflammatory complications. These results suggest that a short ACTH stimulation test performed preoperatively is a helpful method for determining the maximal cortisol response to surgical trauma and to identify high-risk individuals and that a relative postoperative adrenal insufficiency may be closely related to the decreased cortisol secretion following major surgical trauma.
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Markers of inflammation, such as C-reactive protein (CRP) and white blood cell count, have, because of their low specificity, proven far from ideal in identifying patients with sepsis. Procalcitonin (PCT) has been shown to be a useful marker for differentiating patients with bacterial infection from other acute inflammatory conditions. Corticosteroid therapy has been demonstrated to be effective for treating patients with septic shock, late-phase acute respiratory distress syndrome (ARDS), or functional adrenal insufficiency, and the use of corticosteroid in critical illness has recently increased. It is also well established that corticosteroid modulate inflammatory variables in acute inflammatory conditions. The purpose of this study was to evaluate the clinical usefulness of PCT measurement for assessing the severity of bacterial infection in patients requiring corticosteroid therapy. ⋯ PCT can be a more sensitive and useful marker than CRP for evaluating the severity and progression of sepsis in patients requiring corticosteroid therapy. Further studies are needed to confirm these results in larger groups of patients.