VOLUME 83 NUMBER 2 May 2021

Current Issue

ISSN 2186-3326
(Online ISSN)
ISSN 0027-7622
(Print ISSN--v.72no.3/4)

Impact Factor(2019)
 0.762

ORIGINAL PAPERS

Comparison of vitamin D sufficiency between indoor and outdoor elite male collegiate athletes

Itaru Kawashima, Hideki Hiraiwa, Shinya Ishizuka, Ryosuke Kawai, Yushi Hoshino, Yoshiaki Kusaka and Takashi Tsukahara
pg(s) 219 - 226

<Abstract> - < PDF >

This study compared vitamin D sufficiency between indoor and outdoor elite athletes. We also evaluated the association between vitamin D level, body composition, and stress fractures incidence. 27 outdoor elite male collegiate athletes (field hockey players) and 21 indoor elite male collegiate athletes (fencing players) were enrolled. Participants’ demographic information including past fractures were recorded. Furthermore, all the athletes’ body compositions including percentage of body fat were measured. Blood samples were collected to test serum calcium, phosphorus, and 25(OH)D. levels. Participants were classified into three groups: vitamin D sufficiency (serum 25(OH)D levels of ≥30 ng/ml), vitamin D insufficiency (serum 25(OH)D levels of <30 ng/ml), and vitamin D deficiency (serum 25(OH)D levels of <20 ng/ml). The indoor athletes showed significantly higher mean percentage of body fat than outdoor athletes, 12.2 ± 3.2% and 9.7 ± 3.7%, respectively. The serum 25(OH)D levels of indoor athletes were significantly lower than those of outdoor athletes, 15.3 ± 3.3 ng/mL and 24.9 ± 4.5 ng/ml, respectively (P < 0.001). Furthermore, the indoor athletes showed a significantly higher rate of vitamin D deficiency than the outdoor athletes, 19 of 21 (90.5%) and 5 of 27 (18.5%), respectively (P < 0.001). The cohort of outdoor athletes with stress fractures’ history had significantly lower serum 25(OH)D levels than those without history of any fractures, 21.1 ± 4.3 ng/ml and 26.4 ± 3.0 ng/ml, respectively (P < 0.05). In conclusion, a majority of the indoor elite athletes were vitamin D-deficient. The serum 25(OH)D levels were significantly higher in outdoor elite athletes. However, lower serum 25(OH)D levels might be associated with stress fractures among outdoor athletes.
Editors' Choice
Learning curve of robotic lobectomy for lung malignancies by certified thoracic surgeons

Takayuki Fukui, Koji Kawaguchi, Hideki Tsubouchi, Harushi Ueno, Tomoshi Sugiyama, Shunsuke Mori, Masaki Goto, Naoki Ozeki, Shuhei Hakiri, Shota Nakamura and Toyofumi Fengshi Chen-Yoshikawa
pg(s) 227 - 237

<Abstract> - < PDF >

Video-assisted thoracic surgery (VATS) has become widespread in the last 20 years, followed by robot-assisted thoracic surgery (RATS). Few studies compared the learning curve between RATS lobectomy and conventional VATS. This study included 79 RATS lobectomy cases performed in our hospital from November 2015 to October 2019. To estimate the required number for learning, the cumulative sum method, which is to plot a value obtained by sequentially accumulating a difference from a mean value was applied. As a result, the median total operative time and the median console time for all cases were 167 minutes and 138 minutes, respectively. Firstly, for our team, 28 cases were estimated to be required for learning curve for RATS lobectomy. For individual, each surgeon might be learned in only 5 to 6 cases. By contrast, the number of cases for learning VATS lobectomy which was underwent by a ‘single’ surgeon from 2009 was estimated to be 35 cases. The time to dock from start operation (median 14 minutes) reached plateau in 18 cases, but the time after rollout was median of 18 minutes and there was no significant change from the beginning. In conclusion, RATS lobectomy might be a technique that could be learned in a small number of cases compared to VATS. The results of this study might be helpful for certified surgeons who tried to get started with RATS and for establishing a learning program.
Survival benefit of surgery for very elderly patients with pancreatic cancer: what extent of pancreatectomy is acceptable?

Daisuke Hayashi, Seiji Natsume, Yasuhiro Shimizu, Yoshiki Senda, Masataka Okuno, Keitaro Matsuo, Seiji Ito, Koji Komori, Tetsuya Abe and Kazuo Hara
pg(s) 239 - 250

<Abstract> - < PDF >

The purpose of this study is to clarify the survival benefit and acceptable extent of surgery for very elderly patients with pancreatic cancer. Patients (n=55) ≥80 years with resectable pancreatic cancer were studied. 29 underwent pancreatectomy, 16 underwent chemotherapy, and 10 received best supportive care. Uni and multivariate analysis were performed to explore predictive factors for overall survival (OS) with surgery and chemotherapy (n=45). Postoperative survival of PD (pancreatoduodenectomy) and DP (distal pancreatectomy) and of PD-PVR (PD with portal vein resection) and PD were compared. OS was equivalent with surgery and chemotherapy (median survival time [MST]; 685 vs. 626 days, respectively; p=0.057); 6 patients surivived ≥3 years after surgery. Pancreatectomy was not a prognostic factor. Survival was significantly worse with PD-PVR than with PD, but equivalent with PD and DP. Within 2 years after PD-PVR, 8 patients have died. Surgery was not a positive prognostic factor for very elderly patients with pancreatic cancer, but was the sole chance for survival ≥3 years. Indication for PD-PVR for very elderly patients should be determined more cautiously compared with that for non-elderly patients.
Early glottic cancer treatment with concurrent chemoradiotherapy with once-daily orally administered S-1

Yuuki Takase, Yoshiyuki Itoh, Kazuhiro Ohtakara, Mariko Kawamura, Junji Ito, Yumi Oie, Tamami Ono, Yutaro Sasaki, Ayumi Nishida and Shinji Naganawa
pg(s) 251 - 258

<Abstract> - < PDF >

Glottic carcinoma is the most common laryngeal cancer. The outcomes for T1 bulky Glottic carcinoma and T2N0 Glottic carcinoma after radiation therapy alone are unsatisfactory. This study was conducted to evaluate the efficacy and safety of unique concurrent chemoradiotherapy regimen using S-1 for early glottic cancer. Concurrent chemoradiotherapy consisted of 60 Gy in 30 fractions with once-daily, orally administered S-1 exclusively within three to six hours prior to each irradiation. Twenty-one consecutive patients treated with this regimen were retrospectively reviewed. Initial complete remission was achieved in all patients without any subsequent local and/or regional recurrences to the last follow-up. The 4-year local control, overall survival, and disease-free survival rates were all 100%. No significant toxicities were observed, except for three cases with Grade 3 acute dermatitis.This regimen is highly effective and well-tolerated, and these results encourage further research to long-term efficacy and functional preservation.
Assessment of myocardial performance index in late-onset fetal growth restriction

Tran Thao Nguyen Nguyen, Tomomi Kotani, Kenji Imai, Takafumi Ushida, Yoshinori Moriyama, Tomoko Kobayashi, Kaoru Niimi, Seiji Sumigama, Eiko Yamamoto, Van Duc Vo, Minh Tam Le, Lam Huong Le, Dac Nguyen Nguyen, Vu Quoc Huy Nguyen, Quang Vinh Truong, Ngoc Thanh Cao and Fumitaka Kikkawa
pg(s) 259 - 268

<Abstract> - < PDF >

The aim of this study is to determine whether the myocardial performance index (MPI) is increased in fetal growth restriction (FGR) fetuses and if increased MPI is related to adverse outcomes of FGR. This is a prospective cross-sectional study. Seventy-three late-onset FGR fetuses and 97 gestational-age matched control fetuses were enrolled in this study. Fetal blood flow parameters including MPI values were measured and compared between the two groups. For the effect of severity of growth restriction on MPI value, they were also compared with < 3rd and 3rd – 10th centile groups. FGR fetuses were divided into two groups by favorable and adverse outcome and ultrasound parameters were compared between these two groups. Moreover, significant factors related to adverse outcomes by univariate analysis were analyzed by multivariate logistic regression analysis. Pulsatility index of umbilical arterial flow (UA-PI), MPI and amniotic fluid index in the FGR were significantly different from the control fetuses. However, no significant difference between < 3rd and 3rd – 10th centile groups was detected in MPI and UA-PI. The increased levels of MPI and UA-PI were independently related with adverse outcome of late-onset FGR pregnancy. In conclusion, MPI values were increased in late-onset FGR pregnancy, and the higher level of MPI could predict adverse outcome as well as the measurement of UA-PI. Clinicians should consider cardiac dysfunction in FGR through increased MPI.
Clinical characteristics of Corynebacterium simulans

Masahiko Ogasawara, Takaharu Matsuhisa, Takeshi Kondo and Juichi Sato
pg(s) 269 - 276

<Abstract> - < PDF >

Corynebacterium simulans was first reported in 2000. Its characteristics such as isolation frequency, specimen types, and antimicrobial susceptibilities are poorly understood, because identification is difficult using conventional methods. We performed a retrospective observational study of 13 and 317 strains of C. simulans and C. striatum, respectively, isolated from consecutive patients at Nagoya University Hospital from January 2017 to December 2018. We analyzed patients’ backgrounds, types of specimens, and antimicrobial susceptibilities. Antimicrobial susceptibilities were compared with those of C. striatum. The frequencies of isolation of C. simulans and C. striatum were 3.9% and 96%, respectively. C. simulanswas not detected in specimens associated with mucous membranes, such as sputum and secretions from the craniocervical region, which were frequent for C. striatum. C. simulans was mainly detected in the skin (61.5%). All C. simulans isolates were susceptible to anti-MRSA drugs, as well as to numerous other antibiotics, including those that are orally administered. For example, C. simulans was significantly more susceptible to penicillin G, ceftriaxone, and ciprofloxacin than C. striatum (respective susceptibilities: 66.7% vs 5.4%, 50.0% vs 4.0%, 66.7% vs 5.9%). There was no significant difference between meropenem and erythromycin, although susceptibility to each was relatively high (100.0% vs 31.7%, 50.0% vs 11.9%). C. simulans was susceptible to numerous orally administered antibiotics and more susceptible to antimicrobial drugs than C. striatum. C. simulans was detected less frequently than C. striatum and was infrequently detected in specimens associated with mucous membranes. These characteristics will aid the selection of optimal antimicrobial therapies.
Distribution of scatter radiation by C-arm cone-beam computed tomography in angiographic suite: measurement of doses and effectiveness of protection devices

Mayako Yamaji, Tsuneo Ishiguchi, Shuji Koyama, Shuji Ikeda, Akira Kitagawa, Makiyo Hagihara, Yuji Itoh, Masaru Nakamura, Toyohiro Ota and Kojiro Suzuki
pg(s) 277 - 286

<Abstract> - < PDF >

Distribution of radiation by C-arm cone-beam computed tomography (CBCT) in the angiographic suite and effectiveness of protection devices were assessed. CBCT image of a human phantom was obtained by a rotation of 220 degrees during 8 seconds of exposure. One hundred and twelve dosimeters were placed at different positions around the beam entry site, and color maps of dose distributions were drawn for horizontal and vertical planes. The measurements showed the highest radiation dose over 600 μGy by a single CBCT image acquisition at a distance of 60 cm from the beam entry site and a height of 90 cm from the floor. The color maps demonstrated the dose distribution to be more intense at the bilateral directions of the phantom. With the use of a ceiling-mounted transparent lead-acryl screen and a table-suspended lead curtain, the doses were reduced by 45–92 % at a direction of 210 degrees and a distance of 120 cm.
Perceptions and behaviors related to noncommunicable diseases in Palau: a qualitative study

Hiroko Shimizu, Yoshihisa Hirakawa, Chifa Chiang, Bernie Ngiralmau, Julita Tellei, Faustina K. Rehuher-Marugg, Takashi Mita, Hiroshi Yatsuya, and Atsuko Aoyama
pg(s) 287 - 298

<Abstract> - < PDF >

The increasing burden of noncommunicable diseases (NCDs) is a major public health concern in Palau. This study aims to identify social and psychological factors related to NCDs among Palauan people using a qualitative approach. We conducted eight key informant interviews and eight focus group discussions, which were audio-recorded, transcribed and translated into English. Ideas of the respondents were extracted and labeled, and the labels were analyzed using an inductive multistage approach referred to as qualitative content analysis. Three themes emerged: (1) home education, (2) traditional local community, and (3) modernization and westernization of lifestyle. Respondents believed that the influence of the family on lifestyle was significant, but that disciplining children at home had become difficult. They considered that the traditional lifestyle was mostly healthy, and were reluctant to abandon certain unhealthy customs, such as serving abundant food to guests as a sign of fraternity. They also thought that they overate because of their stressful modernized lifestyle. This is the first qualitative study to analyze perception and behavior of the Palauan people in relation to NCDs. We found that the increase in NCDs was related to two concurrent trends: preserving certain traditional customs unfavorable to good health, and abandoning time-consuming healthy traditional lifestyle to adopt a modernized one. We also found that Palauan people were not confident in their ability to prevent NCDs. Therefore, health promotion activities should be designed to empower people to make positive changes.
The status of central ethical reviewing and challenges regarding its introduction to non-interventional studies in Japan

Yoshihiko Iijima, Tadao Takano and Toshinori Murayama
pg(s) 299 - 309

<Abstract> - < PDF >

In 2018, we conducted a study on 121 ethics review committee offices in Japan to examine the state of “central review” in non-interventional studies and discern any challenges regarding its introduction. Of the 452 offices that were invited to participate, 121 responded (26.8% response rate), and 35 (28.9%) had records of furnishing contracting agreements with ethical reviews by other research institutions. The merits of central reviewing include easing the burden on ethics review committees, improving the quality level and consistency of ethical reviews, and enhancing the efficiency in conducting them. The demerits include increased administrative overheads and work for researchers, such as preparing application forms and checking institutional requirements, and a lack of clarity regarding who is responsible for conducting the research, which makes it is less desirable for institutions to have their own ethics review committees. This study revealed that the comprehensive introduction of central review in non-interventional studies continues to encounter many hurdles, and promoting central review requires overcoming these challenges one at a time. The Ethical Guidelines for Medical and Health Research Involving Human Subjects will be revised in 2021 to require central review as a part of ethical reviews for non-interventional studies. In the future, central reviews of non-interventional studies will need to be of high quality and conducted efficiently, and this will require research institutions to utilize relevant central review guidelines and checklists.
Outcomes in symptomatic preterm infants with postnatal cytomegalovirus infection

Koji Takemoto, Makoto Oshiro, Yoshiaki Sato, Hikaru Yamamoto, Masatoki Ito, Seiji Hayashi, Eiko Kato, Yuichi Kato and Masahiro Hayakawa
pg(s) 311 - 319

<Abstract> - < PDF >

Premature infants are at risk for developing symptomatic postnatal cytomegalovirus (CMV) disease, including sepsis-like syndrome. We performed a retrospective case–control study including infants born before 32 weeks of gestation and diagnosed with symptomatic postnatal CMV infection during the neonatal period. Neurodevelopmental outcome was evaluated using the Kyoto Scale of Psychological Development 2001 at 18 months of corrected age and at 3 years of age. Twenty-four infants were diagnosed with postnatal CMV infection; of them, 14 had sepsis-like symptoms and 10 had laboratory test abnormalities only. Home oxygen therapy was used significantly higher in the CMV-positive group compared with the control group at hospital discharge (52% vs 21%, P=0.032). The incidence of neurodevelopmental impairment was not significantly different between the two groups at 18 months of corrected age (29% vs 17%, P=0.48) and at 3 years of age (43% vs 29%, P=0.34). Postnatal CMV infection did not have a significant influence on neurodevelopmental outcomes of symptomatic preterm infants, although those in the CMV-positive group appeared worse. Larger studies with long-term follow-up are needed for a better understanding of continued neurodevelopmental outcomes in preterm infants with postnatal CMV infection.
Editors' Choice
Differential effects of combination therapy on the components of the risk stratification table in patients with idiopathic or heritable pulmonary arterial hypertension in a Japanese population

Masahiro Yoshida, Shiro Adachi, Ryo Imai, Shigetake Shimokata, Yoshihisa Nakano, Toyoaki Murohara and Takahisa Kondo
pg(s) 321 - 330

<Abstract> - < PDF >

Risk stratification by ESC/ERS guideline is recommended to estimate the vital prognosis and select the treatment strategy in patients with idiopathic or heritable pulmonary arterial hypertension (IPAH/HPAH). However, we are not confident whether we can achieve low-risk status in the risk table at the follow-up shortly after combination therapy. Therefore, we aimed to verify the effects of combination therapy in IPAH/HPAH on each category of the risk table at diagnosis and at the first follow-up. We retrospectively analyzed 10 consecutive patients with IPAH/HPAH with no previous treatment history diagnosed at Nagoya University Hospital between October 2014 and January 2019. Four categories including symptoms, exercise tolerance, BNP levels and hemodynamics were validated both at baseline and at the first follow-up of right heart catheterization. Score of 1, 2 and 3 were assigned to the low risk, intermediate risk and high risk, respectively. In each category the highest score was adopted. The scores at diagnosis were compared with those at the first follow-up. The result shows that all patients were female, median age was 32 years old, and were treated with initial combination therapy. The median total risk score also was improved from 2.6 to 1.4 (p<0.01). However, the score in exercise tolerance was not improved (3 to 2.5 p=0.16). In conclusion, at the first follow up shortly after the initial combination therapy of IPAH/HPAH, the mean total risk score was significantly improved, however, even patients in the low-risk status may not achieve improvement in exercise tolerance.
Tooth brushing, tooth loss, and risk of upper aerodigestive tract cancer: a cohort study of Japanese dentisits

Mineko Tsukamoto, Mariko Naito, Kenji Wakai, Toru Naito, Masaaki Kojima, Osami Umemura, Makoto Yokota, Nobuhiro Hanada and Takashi Kawamura
pg(s) 331 - 341

<Abstract> - < PDF >

Previous studies have focused on the association between poor oral health and upper aerodigestive tract (UADT) cancer. However, whether toothbrushing and tooth loss are associated with UADT cancer risk is still unclear. Therefore, we investigated the association between toothbrushing or tooth loss and UADT cancer in the Longitudinal Evaluation of Multi-phasic, Odontological, and Nutritional Associations in Dentists (LEMONADE) cohort study. From 2001 to 2006, we recruited 20,445 dentists (mean age ± standard deviation, 51.8 ± 12.0 years; 1,607 women [7.9%]) and followed for incidence or mortality of UADT cancer through March 2014. Information on lifestyle and oral health was collected by the baseline questionnaire. The Cox proportional hazards model was used to estimate hazard ratios (HRs) for UADT cancer and corresponding 95% confidence intervals (CI) for brushing frequency and tooth loss with adjustment for covariates. During the mean follow-up of 9.5 years, we confirmed 62 incident or fatal cases of UADT cancer. Infrequent toothbrushing (< 2 times/day) was significantly associated with increased risk of UADT cancer (multivariate HR = 2.13, 95% CI: 1.04–4.37). On the contrary, tooth loss was not significantly correlated with UADT cancer risk; multivariate HR was 1.03 (95% CI: 0.41–2.61) for loss of 15–27 teeth and 1.37 (0.50–3.75) for that of 28 teeth compared to tooth loss of 0–14 teeth. In conclusion, Infrequent toothbrushing was significantly associated with the risk of UADT cancer.

CASE REPORTS

The effect of liraglutide on insulin allergy in a patient with glucocorticoid-induced diabetes and multiple sclerosis

Jiudan Zhang, Ye Chen, Jian Wang, Hong Xia and Yang Zheng
pg(s) 343 - 351

<Abstract> - < PDF >

Glucocorticoid use may trigger secondary diabetes or exacerbate hyperglycemia in patients with diabetes mellitus (DM). Liraglutide is a glucagon-like peptide-1 (GLP-1) receptor agonist used for the treatment of patients with type 2 diabetes. Few reports mention liraglutide as a treatment for steroid-induced DM (SIDM). Here, we report a patient with SIDM and multiple sclerosis, for whom switching to liraglutide combined with metformin therapy improved glucose levels and ameliorated the symptoms of insulin allergy. Liraglutide may be useful for treating SIDM with insulin allergy.
Arterial embolism due to massive cement leakage during total hip arthroplasty revision

Yusuke Kazama, Yasuhiko Takegami, Yusuke Osawa, Kazuya Makida and Taisuke Seki
pg(s) 353 - 359

<Abstract> - < PDF >

Total hip arthroplasty with cementing techniques leads to good clinical outcomes, but critical vascular complications can sometimes occur due to cement leakage into the pelvis. In this report, we describe a case of massive cement leakage that caused an arterial embolism. When exfoliating cement from an artery, the surgeon should note not only direct injury to the vessels but also the potential for arterial embolism.
A case of paroxysmal kinesigenic dyskinesia suspected to be reflex epilepsy

Chie Nakayama-Kamada, Rei Enatsu, Shinobu Fukumura, Tomoyoshi Kuribara, Satoko Ochi and Nobuhiro Mikuni
pg(s) 361 - 365

<Abstract> - < PDF >

An 11-year-old male patient developed weakness or right arm elevation after sudden movement at the age of eight. Reflex epilepsy was initially suspected; however, magnetic resonance imaging and electroen-cephalography (EEG) revealed no abnormality. Video-EEG monitoring was performed, but no change was noted during attacks of weakness. He was diagnosed with paroxysmal kinesigenic dyskinesia (PKD) and carbamazepine has stopped his attacks. PKD is a rare neurological disorder characterized by brief attacks of involuntary movement triggered by sudden voluntary movements, which may be confused with reflex epilepsy. PKD should be considered as a differential diagnosis of reflex epilepsy.
Parathyroid carcinoma detected within the thyroid

Koki Otake, Yuichi Kondo, Kenji Tsukamoto, Tomomi Kurahashi, Katsunori Sato, Hiroaki Ozawa, Kazuki Yokoi and Minemori Watanabe
pg(s) 367 - 374

<Abstract> - < PDF >

Parathyroid carcinoma (PC) is a rare disease accounting for approximately 1% of primary hyperparathy-roidism cases. The preoperative differentiation of PC is critical because PC can occasionally metastasise and invade the local tissue. However, this is challenging in asymptomatic cases and when the tumour is adjacent to the thyroid. Herein, we report a rare case of PC without clinical symptoms. Fine needle aspiration was performed, despite being contraindicated in PC, and an intrathyroidal tumour was preoperatively suggested.
Strangulating bowel obstruction due to a small intestinal knot in a case of parastomal hernia

Tetsuro Kato, Hideo Miyake, Hidemasa Nagai and Norihiro Yuasa
pg(s) 375 - 378

<Abstract> - < PDF >

An intestinal knot is a rare cause of intestinal obstruction. We report a rare case of strangulating bowel obstruction due to a small intestinal knot. A 69-year-old man who had an end colostomy was admitted with severe abdominal pain and vomiting. Contrast enhancement computed tomography showed dilated intestinal loops with decreased contrast enhancement in the parastomal hernia sac. Emergent laparotomy revealed a dilated and congested intestinal loop strangulated by a small intestinal knot. The knot was carefully untied, and the color of the intestinal loop improved subsequently. Intestinal resection was not performed. Immediate diagnosis and prompt surgical treatment are crucial for strangulating small bowel obstruction due to an intestinal knot. A high degree of clinical suspicion of an intestinal knot is needed in patients with a large extra-abdominal cavity.
Rare sphenoid ridge intracranial mature teratoma in an adult female

Moses Osaodion Inojie, Yota Suzuki, Hisashi Tamada, Naoki Ogihara, Yuki Inomata, Takehiro Yako, Samuel Chukwunoyerem Ohaegbulam and Tetsuyoshi Horiuchi
pg(s) 379 - 386

<Abstract> - < PDF >

Intracranially located teratomas usually involve midline brain structures. However, they rarely occur in adults. A 26-year-old woman presented with a growing intracranial mass lesion in the left sphenoid ridge without neurological deficits. Magnetic resonance imaging revealed homogenous hyperintensities without contrast enhancement. The patient underwent gross total excision of the soft, yellowish sphenoid ridge tumor with no cystic component. The surgery was uneventful, with no intraoperative complications. Histological analysis revealed a mature teratoma. She attended regular outpatient neuroradiology follow-up appointments. The present case is an unusual example of a mature teratoma with regard to location, neuroimaging ap-pearance, macroscopic intraoperative findings, histological tumor subtype, and patient age and sex.
Ossification of the posterior longitudinal ligament located on the concave side of the apex vertebra in adult spinal deformity

Hiroyuki Koshimizu, Kei Ando, Kazuyoshi Kobayashi, Hiroaki Nakashima, Masaaki Machino, Sadayuki Ito, Shunsuke Kanbara, Taro Inoue, Hidetoshi Yamaguchi and Shiro Imagama
pg(s) 387 - 392

<Abstract> - < PDF >

A 48-year-old female patient presented with discomfort in the front of the chest. Whole spinal X-ray revealed a thoracic curve of 52°, and thoracic computed tomography (CT) myelography and magnetic resonance imaging (MRI) showed that ossification of the posterior longitudinal ligament (OPLL) on the concave side of the apex vertebra (T9) had highly compressed the spinal cord. Cervical MRI also showed that the C4–C5 intervertebral disc herniation mildly compressed the spinal nerve. In concomitant surgery, the patient underwent cervical laminoplasty, in which OPLL was removed by decompressive laminectomy and posterior correction surgery.In patients with adult spinal deformity (ASD), asymmetric mechanical stress at the apex vertebra can cause various abnormal conditions. Long-term local mechanical stress on the concave side of the apex vertebra might have affected OPLL formation in the present case. This is the first report of a surgical case for an ossification located on the concave side of the apex vertebra in a patient with ASD. Mechanical stress at the concave side of the apex vertebra was suspected to be a cause of formation of OPLL.
Odontogenic keratocysts are an important clue for diagnosing basal cell nevus syndrome

Kaori Kaibuchi-Ando, Takuya Takeichi, Yasutoshi Ito, So Takeuchi, Yuta Yamashita, Motohito Yamada, Yoshinao Muro, Tomoo Ogi and Masashi Akiyama
pg(s) 393 - 396

<Abstract> - < PDF >

Basal cell nevus syndrome (BCNS) is an autosomal dominant skin disorder characterized by multiple basal cell nevi. Patients with BCNS tend to develop basal cell carcinoma (BCC) and frequently show skeletal abnormalities. Most cases of BCNS are caused by mutations in patched 1 (PTCH1). PTCH1encodes a transmembrane receptor protein for the secreted molecule sonic hedgehog, which plays a key role in the development of animals ranging from insects to mammals. We analyzed two Japanese BCNS patients from two independent families. Both of our patients had multiple jaw keratocysts. In one patient, these were the key to noticing his BCNS, as he had no skin tumors. The early detection of PTCH1mutations would enable BCNS patients to be carefully followed up for the occurrence of BCC. The diagnosis of BCC at the early stage leads to prompt surgical treatments, resulting in a good prognosis. The present cases suggest that keratocysts of the jaw might be an important clue for diagnosing BCNS.