A 67-year-old man underwent laparoscopic surgery for rectal cancer in the lithotomy position. After surgery he complained of bilateral lower limb pain, swollen legs, and sensory disturbance. The serum creatine kinase value was 46 662 U/l. Venography demonstrated compression from outside without any obstruction. The T2 image of magnetic resonance imaging (MRI) showed a massive swollen muscle and a partial high-intensity area in the bilateral lower limbs. The posterior compartment pressures of lower legs were high (gastrocnemius muscle: 30 mmHg [right] and 44 mmHg [left]). Compartment syndrome (superficial posterior compartment) was thus diagnosed. He underwent a fasciotomy using the single dorsal approach and the administration of a large amount of fluid. He recovered well without any motor or sensory deficits. Compartment syndrome is rare, occurring only once in every 3500 cases, but it is a severe complication of surgery in the lithotomy position. Several risk factors have been pointed out: including prolonged operation, hardness of the operating table, obesity, dehydration, and hypothermia. To prevent compartment syndrome, appropriate positioning during surgery is therefore essential. To make a timely diagnosis and identify the precise location of muscle edema, the T2 image of MRI is useful.
Background: Pleuroparenchymal fibroelastosis (PPFE) is a rare bilateral idiopathic interstitial pneumonia defined by pleural-parenchymal involvement. In clinical practice, we encountered patients with upper lung field pulmonary fibrosis (Upper-PF), which was radiologically consistent with PPFE, but apparently limited to the unilateral lung. Objectives: The purpose of the study was to clarify the clinical characteristics in those patients. Methods: We examined the medical records of all the consecutive patients from 2012 to 2016 to see whether there were patients having unilateral Upper-PF. Results: We found 6 patients with unilateral Upper-PF. The most common symptom was dyspnea, and all patients had a low body mass index and severe restrictive pulmonary impairment. Notably, all patients had a history of thoracotomy for resecting lung or esophageal cancer, and the lesions were limited to the operated side. Dynamic breathing chest MRI showed an impaired thoracic movement in the operated side. Serial chest CT from prethoracotomy to the first visit was obtained in 5 patients: before thoracotomy, only a slight apical cap, defined as a wedge- and triangle-shaped opacity with broad pleural contact, was observed only in the operated side, but progressed into the lesion after a median of 8.4 years following thoracotomy. After the first visit, the unilateral lesion rapidly deteriorated in all patients. Conclusions: Unilateral Upper-PF had some characteristics in common with PPFE. Because the lesion was limited to the operated side, unilateral Upper-PF would be a new disease entity related to thoracotomy. Our results indicate that thoracotomy impairs thoracic movement in the operated side and subsequently triggers unilateral Upper-PF development, especially in patients with an apical cap.
A 49-year-old man presented with palpitation and shortness of breath. He was seen to have a massive pleural and pericardial effusion on radiography and echocardiography. Computed tomography (CT) scanning showed that cardiac tumors arose from the right atrium with epicardial and endocardial extension. Pathology examination of samples at pericardiotomy revealed them to be angiosarcoma. Two days after the surgery, he developed left hemiparesis. CT scans showed a large cerebral hemorrhage on the right temporal lobe with midline shift by brain metastases. He died 37 days after the surgery. At autopsy, he had metastases in the brain, multiple bones, and soft tissues but no lung or left-side heart involvement. Primary cardiac angiosarcoma is rare, and mostly arises from the right side of the heart. Common metastatic sites are the lungs and liver. There are only a few reports of brain metastases. In conclusion, this is a rare report of cardiac angiosarcoma presenting with pericardial tamponade. There were rapid brain and multiple bone metastases but no lung or left-side heart lesions.
The purpose of this paper is to investigate women's participation in the labour force in urbanized and non-urbanized areas of Japan through the last three decades and to determine the factors affecting regional variation of the women's participation rate in 1985 .In 1955, the ratio of working persons (R. W. P.) in urbanized areas was much lower than that in non-urbanized areas, but in 1985 the R. W. P. in the two areas converged and their profiles by age group showed rather similar patterns. This is caused by the dramatic increase of female workers of middle age in urbanized areas and the heightened enrollment rate for middle school and university. Many of the increased number of female workers are employed on a temporary or part-time basis.A multiple regression analysis applied to the regional labour force participation rate (L . F. P. R.) by age group in 1985 indicates that the ratio of farming households out of the total number of households is the most important variable for 25-64 age groups to explain the regional variation of L. F. P. R, but no conspicuous factors are found for the 15-24 age group .
early stage lung cancer patients were performed until March 2016. The date range for the non-SABR patients extended back to January 1995, but the first 3D-CRT SABR papers assessed were found in 2003. Results of these searches were filtered in accordance to a set of eligibility criteria and analysed in accordance with the PRISMA Guidelines. Results: The systematic search yielded a total of 184 SABR and 360 non-SABR articles, which were filtered down to 75 SABR and 23 non-SABR articles. SABR patients were older than non-SABR patients with 35/75 SABR papers and 0/23 non-SABR papers recording a median age >75 years. Meta-analysis did not demonstrate a significant difference in pneumonitis rates between patients receiving SABR [11.4% (95% CI of 9.7 to 13.3)] and non-SABR treatment [14.4% (95% CI of 10.6 to 18.8)]. Conclusion:Although meta-analysis did not confirm that SABR had lower rates of pneumonitis, it appears that SABR patients are older, and thus potentially frailer than the non-SABR radically treated patients. SABR is safe and has justifiably become the treatment of choice for inoperable patients.
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