Journal of Nippon Medical School = Nippon Ika Daigaku zasshi
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Review Historical Article
Cervical anterior fusion with the Williams-Isu method: clinical review.
Anterior decompression and fusion of the cervical spine is a widely accepted treatment for cervical canal disease. The Williams-Isu method involves cervical anterior fusion with autologous bone grafts from cervical vertebral bodies. Its advantages are a wide operative field, excellent graft fusion, the absence of problems related to the iliac donor site, and direct visualization of the nerve root. ⋯ To reduce the levels to be fused in patients with multilevel lesions due to cervical disease, the Williams-Isu method can be combined with the transvertebral approach. The transvertebral approach facilitated by the wide Williams-Isu window allows the root bifurcation area to be confirmed during the early stage of surgery and possible decompression along the root. Radiological examination has shown that the combination of the Williams-Isu method and transvertebral approach does not affect the fusion level compared with the Williams-Isu method alone and produces better results than does the transvertebral approach alone.
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The fundamental principles of survival analysis are reviewed. In particular, the Kaplan-Meier method and a proportional hazard model are discussed. This work is the last part of a series in which medical statistics are surveyed.
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Sepsis is a devastating and complex syndrome and continues to be a major cause of morbidity and mortality among critically ill patients at the surgical intensive care unit setting in the United States. The occurrence of sepsis and septic shock has increased significantly over the past two decades. Despite of highly dedicated basic research and numerous clinical trials, remarkable progress has not been made in the development of novel and effective therapeutics. ⋯ In this regard, the role of inflammation in the pathophysiology of sepsis, although still incompletely understood, is clearly critical. Recent findings resulting from vigorous investigations have contributed to delineate various novel directions of sepsis therapeutics. Among these, this review article is focused on new promising mechanisms and concepts that could have a key role in anti-inflammatory strategies against sepsis, including 1) "inflammasome": a multiprotein complex that activates caspase-1; 2) "the cholinergic anti-inflammatory pathway": the efferent arm of the vagus nerve-mediated, brain-to-immune reflex; 3) "stem cells": unspecialized and undifferentiated precursor cells with the capacity for self-renewal and potential to change into cells of multiple lineages; 4) "milk fat globule-EGF factor VIII (MFG-E8)": a bridging molecule between apoptotic cells and phagocytes, which promotes phagocytosis of apoptotic cells.
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Congenital cytomegalovirus (CMV) infection can cause severe permanent disabilities. A mother who is seronegative before conception but acquires infection during pregnancy is a risk factor for congenital infection. We describe a neonate in whom congenital CMV infection was diagnosed at birth and confirmed with DNA quantitation by means of the polymerase chain reaction, was accompanied by cerebral ventriculomegaly and severe hearing loss, and was treated with ganciclovir/valganciclovir for 6 weeks. ⋯ Single-photon emission computed tomography showed marked improvement 6 months after treatment. This case provides compelling evidence that a reliable diagnosis of congenital CMV infections coupled with a prompt and appropriate treatment program can prevent permanent disability. It is, therefore, important to establish a more effective strategy for the management of congenital CMV infection.
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Case Reports
Two cases of flexor digitorum profundus avulsion due to enchondroma of the distal phalanx.
Avulsion of the flexor digitorum profundus tendon with fracture of the distal phalanx is rare. Moreover, enchondroma is less frequent in the distal phalanx. We report two unusual cases of avulsion of the flexor digitorum profundus tendon at its insertion in combination with pathological fracture of the distal phalanx due to enchondroma. ⋯ At the final follow-up examinations, there were no symptoms and no recurrence of the bone tumor. In the present cases, three-dimensional computed tomography imaging was useful for diagnosing the flexor tendon avulsion, determining the preoperative identification the location of a ruptured tendon stump, and planning the operation to minimize the surgical wound. The recommended treatment for avulsion of the FDP tendon due to enchondroma is curettage, bone grafting of the resultant cavity, and reattachment of the tendon to ensure sufficient structural strength to permit secure fixation and early mobilization and, especially, to prevent flexion contracture of the finger because the stump of the flexor digitorum profundus is buried in the cavity of the distal phalanx.