Alkyl phosphorothionates are isomerized to phosphorothiolates by the catalytic action of dimethylformamide. Methyl parathion (0,0-dimethyl O-p-nitrophenyl phosphorothionate) and sumithion (0,0-dimethyl O-3-methyl-4-nitrophenyl phosphorothionate) are more reactive than ethyl parathion (0,0-diethyl O p-nitrophenyl phosphorothionate). Saligenin cyclic methyl phosphorothionate (salithion) decomposed to give a complicated pattern of products on thin layer chromatography. Besides S-methyl isomer, desmethyl sumithion (0-methyl 0-3-methyl-4-nitrophenyl hydrogen phosphorothioate), 3-methyl-4-nitrophenol, methyl formate and dimethylamine were detected as reaction products from sumithion. Some other carboxylic amides including dimethylacetamide, acetamide and urea are also active. A reaction mechanism is proposed.
Dear Editor, As the number of patients with coronavirus disease 2019 (COVID-19) is increasing in Japan, we are facing a shortage of inpatient beds. Thus, the patients with mild symptoms (e.g., fever, cough, or fatigue) are asked to stay at home. However, if their health deteriorates, it becomes difficult to monitor their condition and decide on when to transfer them to a hospital, especially at night. 1 To prevent unexpected deterioration, we have started home-visit medical care for COVID-19 patients from April 2020. The home-visit medical care team is composed of a doctor and several staff members of the regional public health-care center. A staff member calls each patient daily; based on the patient's condition, the home-visit medical care team prioritizes the most serious patients for early visit and arranges the visiting order for the day accordingly. The home-visit medical care team visits each patient's home to check the current medical condition. If the patient needs hospitalization due to deteriorating vital signs and requires oxygen, the regional public health-care center immediately arranges with a hospital that has an available bed and facilities to treat the patient. This home-visit medical care not only prevents health emergencies, but also makes it easy to find a suitable hospital for the patients, because the patients are transported during daytime. The home-visit medical care team also provides precise information about the disease and counsels the patients and families about their concerns regarding the patient's daily care, possibility of transmission within the household, and mental stress. 2 To address these concerns, we have also composed and distributed documents containing essential information about COVID-19. Because the occupancy of hospital beds for COVID-19 patients in Chiba prefecture is now over 200%, more than half of the patients remain at home. 3 We need to provide care to these patients, in addition to the ones who are hospitalized. Patients at home need social support, the same as inpatients, as they tend to be socially isolated. The patients staying at home are sometimes isolated within even the family. Appropriate separation needs to be clearly distinguished from unnecessary and unethical isolation. 4 Providing correct information and instructions is another important role of home-visit medical care to prevent consequent deprivation and negligence. Additionally, the home-visit care team wearing personal protective equipment may look strange to the neighbors, and the team must be considerate about this. Home-visit medical care is an effective strategy to avoid the collapse of the regional healthcare system and to maintain the health of the residents with limited resources, in COVID-19 hotspots.
Retained surgical sponges (RSS) are inflammatory masses due to surgical sponges remaining after surgery. We experienced an RSS case of a 58 year old woman who was scheduled for a laparoscopic cholecystectomy. She had a past medical history of a cesarean section 30 years earlier. A CT scan imaged a mass with well-defined margins in her right lower quadrant. Suspecting a gynecologic disease such as an ovarian tumor, we further examined her with a pelvic exam, ultrasound (US), and magnetic resonance imaging (MRI). Under a diagnosis of the right ovarian tumor, we performed laparoscopic removal of the pelvic mass following the cholecystectomy. Laparoscopic findings were a 5 cm diameter mass surrounded by the right adnexa, greater omentum, and colon. Pathologic examination revealed that the mass contained numerous threads (foreign bodies), histiocytes, multinucleated giant cells, and ossification. The final diagnosis was RSS incurred at a surgical procedure 30 years ago. This case illustrates the need to include RSS in a patient with a history of past surgery and evaluate imaging studies in this context.
Objective: We experienced a rare case of lymph node recurrence in stage IA1 squamous cell carcinoma after conization, which was diagnosed using laparoscopic surgery. Conclusion: Lymphatic recurrences are rare in stage IA1 squamous cell carcinoma of the cervix; therefore, patients with low-risk features could be safely followed-up after conization. When early-stage lymphadenopathy is identified in a patient, the laparoscopic approach might be a viable option for the diagnosis of pelvic lymph node recurrence.Furthermore, in a patient with stromal invasion likely of stage IA2 cervical cancer, like in this case, aggressive surgical management may be considered.
Objective: To describe an occult endometrial adenocarcinoma discovered unexpectedly after a vaginal hysterectomy performed for uterine prolapse. Design: Case report Patient: a 52-year-old perimenopausal gravida 3, para 3 who presented with symptomatic pelvic organ prolapse. Intervention: a vaginal hysterectomy performed for uterine prolapse followed by a laparoscopic salpingo-oophorectomy. Results: The patient was preoperatively diagnosed with uterine prolapse, small myomas, and an endometrial polyp. Preoperative multiple endometrial samplings appeared normal except for the presence of an endometrial polyp. An early stage endometrial adenocarcinoma was discovered unexpectedly after a vaginal hysterectomy for uterine prolapse. Therefore, she underwent a laparoscopic bilateral salpingo-oophorectomy six weeks after the initial procedure. The pathologic findings showed no evidence of residual cancer. Two years postoperatively, there was no evidence of recurrence. Conclusions: In cases such as this, the patient must be informed of the possibility of recurrent disease when a laparoscopic bilateral salpingo-oophorectomy without the lymphadenectomy is chosen. In addition, the treatment of early stage endometrial adenocarcinoma by a vaginal hysterectomy followed by laparoscopic surgery may be one of the options for carefully selected patients who wish to undergo minimally invasive surgery.
Background
We report a case of acute renal failure with loin pain and patchy renal ischemia after anaerobic exercise (ALPE) caused by sudden training resumption.
Case presentation
A 19‐year‐old Asian man who was a college American football player presented with severe back pain, headache, and malaise. He developed acute kidney injury without myoglobinuria. Based on the typical medical history and symptoms, we made a diagnosis of ALPE. Symptoms improved within a few days, and serum creatinine levels improved after discharge. He resumed training, adjusting his load step by step.
Conclusion
During the coronavirus disease 2019 pandemic, many athletes were unable to undergo adequate training. Long‐term de‐training leads to decreased various organ function and reduces the anaerobic threshold. Rapid resumption after prolonged de‐training may put individuals at risk of developing ALPE.
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