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[Purpose] This study aimed to compare the muscle activity around the foot and ankle joints, notably of the abductor digiti minimi, between affected and unaffected sides of individuals with chronic ankle instability. [Participants and Methods] Twelve adult males with chronic ankle instability in one ankle (age, 27.7 ± 5.4 years; height, 172.5 ± 8.1 cm; weight, 67.5 ± 8.1 kg) were included and underwent surface electromyography assessments in multiple positions on both affected and unaffected sides. Measurements were obtained for eight muscles including the abductor digiti minimi. Each measurement included a 5-s segment of the stable waveform, with the root mean square-processed and normalized to the resting position set to 1. [Results] Abductor digiti minimi activity on the affected side was significantly reduced during maximal toe extension/abduction with both ankle dorsiflexion and plantarflexion. Peroneus longus activity on the affected side was significantly greater during maximal toe extension/abduction with ankle plantarflexion; peroneus longus and tibialis anterior muscle activities were significantly greater on the affected side during maximal toe extension/abduction with ankle dorsiflexion. [Conclusion] In the absence of load, muscle imbalance in the intrinsic and extrinsic muscles of the foot was suggested. However, no significant differences were observed under loading conditions.

[Purpose] The external and internal abdominal muscles may be related to gait speed; however, this has not yet been elucidated. In this study, we aimed to clarify the relationship between gait speed and trunk muscle thickness in elderly individuals. [Participants and Methods] The participants were 12 elderly individuals (4 males and 8 females, mean age 83.4 years old, SD ± 0.5) that attend a day service center. We measured the 5 m free gait speed, the 5 m fastest gait speed, and the thickness of five trunk muscles (the rectus abdominis [divided into three parts: upper, central, and lower], external oblique, internal oblique, transverse abdominis, and iliopsoas muscles). [Results] There were positive correlations between the free gait speed and the thickness of the lower rectus abdominis, internal oblique, and transverse abdominis muscles. There were also positive correlations between the fastest gait speed and the thickness of the lower rectus abdominis, internal oblique, and transverse abdominis muscles. [Conclusion] Incorporating muscle strength training of the lower rectus abdominis, internal oblique, and transverse abdominis muscles into existing lower limb muscle training protocols is important to effectively maintain the gait speed of elderly individuals.

[Purpose] We aimed to determine the relationship between gait speed and diaphragm thickness in community-residing patients with hemiplegia caused by cerebrovascular accidents. [Participants and Methods] We recruited 11 elderly participants (six male and five female, mean age 71.1 ± 13.6 years) from an outpatient rehabilitation unit. The inclusion criteria were as follows: patients with hemiplegia caused by cerebrovascular accidents, those able to walk without assistance, and those able to understand our instructions. We measured the diaphragm thickness on both the paretic and non-paretic sides in each participant during maximum exhalation and inhalation during three laboured breaths by ultrasonography with a 7.5-MHz linear scanner. The liner scanner was placed on the eighth or ninth rib between the anterior and middle axillary lines. And their gait speed was measured during a 10 m walk. [Results] There was a strong positive correlation between gait speed and the ratio of diaphragm thickness between the paretic and the non-paretic sides during maximal inspiration. The other measured parameters did not show significant correlation with gait speed. [Conclusion] The symmetrical thickness of the diaphragm is a key factor in increasing gait speed in patients with hemiplegia. These findings may contribute to the development of trunk muscle strength-training programs that improve trunk function and gait speed in patients with hemiplegia.

[Purpose] This study aimed to compare the results of two questionnaires administered in 2013 and 2020, on the level of awareness and understanding of trunk muscle training. [Participants and Methods] In total, 238 soccer club members in high schools responded to our questionnaire regarding trunk muscle training. Two teams were recruited from the top (top 4), middle (top 16), and bottom levels (first-round losers), according to the prefectural tournament's results in 2019. This questionnaire comprised questions divided into four parts: 1. Prevalence of trunk muscle training; 2. Knowledge of the classification of trunk muscles (local and global); 3. Consciousness of local and global muscles during trunk muscle training; and 4. Knowledge of the role of each muscle. These results were compared to those obtained from the survey in 2013. [Results] A significant difference was observed only in the responses to question 2. Regarding question 2 in 2020, several student-athletes in the top-level teams were aware of muscle classification compared to those in the middle- and lower-level teams. [Conclusion] The number of athletes who understood the classification of trunk muscles increased significantly in 2020. Therefore, in the future, we would need to better educate young athletes concerning the purpose of trunk muscle training and the role of each muscle.

[Purpose] In this study, we investigated the therapeutic effects of capacitive and resistive electric transfer therapy in patients with chronic low back pain. [Participants and Methods] The study included 24 patients with chronic low back pain (12 patients each in the intervention and sham groups). Pain intensity, superficial and deep lumbar multifidus stiffness and maximum forward trunk flexion and associated activation level of the iliocostalis (thoracic and lumbar component) and lumbar multifidus muscles were measured. [Results] Post-intervention pain intensity and muscle stiffness were significantly lower than pre-intervention measurements in the intervention group. However, no between-group difference was observed in the muscle activation level at the end-point of standing trunk flexion. [Conclusion] Our findings highlight a significant therapeutic benefit of capacitive and resistive electric transfer therapy in patients with chronic low back pain and muscle stiffness.

[Purpose] The purpose of the current study was to reveal the association between posture control and muscle activity by measuring the trunk and hip joint muscle activities in the upright and slump sitting positions in both the healthy participants and patients with recurrent lower back pain. [Participants and Methods] We recruited eleven patients of recurrent lower back pain and ten healthy participants. During the maintenance of the two types of posture, upright and slump, we collected the surface electromyography data. We assessed the following muscles: rectus abdominis, external oblique, thoracic erector spinae, lumbar erector spinae, internal oblique, lumbar multifidus, iliacus, serratus anterior, rectus femoris, tensor fascia latae, and gluteus maximus. We studied the differences in spinal-pelvic curvature and muscle activity between the upright and slump positions in each group. [Results] In the healthy group, comparison of the muscle activity in upright and slump positions for both the trunk (external oblique, internal oblique, lumbar erector spinae, and lumbar multifidus), and the hip muscles (iliacus and gluteus maximus) showed a significant decrease in activity in the slump position. In the group with recurrent lower back pain, although the external oblique, lumbar erector spinae and lumbar multifidus showed reduced activity in slump position, these values were smaller when compared to those in the healthy group. [Conclusion] This study aimed to clarify the relationship between posture (upright and slump) and the activity of the trunk and hip joint muscles in the healthy participants and the patients with recurrent lower back pain. The results indicated that postural changes caused by recurrent lower back pain significantly affected the activity of the muscles involved in controlling the posture.

公開講演会(Lecture)

公開講演会(Lecture)

Most cases of abdominal lymphangioma are asymptomatic. However, patients may occasionally present with acute abdomen because of an intestinal obstruction or peritonitis caused by infected cysts, hemorrhaging, and/or torsion. These conditions may differ based on the location of the lymphangioma and do not always require emergency surgery. This report presents two cases of abdominal lymphangioma derived from the omentum, which required emergency surgery because of severe abdominal distension and peritonitis caused by torsion, respectively. In contrast, another case of retroperitoneal lymphangioma presented with acute abdomen and underwent elective surgery after conservative therapy for peritonitis. Elective surgery is acceptable if the symptoms are controllable under conservative therapy. However, it is important not to overlook the possible lethal complications such as intestinal and/or urological obstruction, aggressive peritonitis, and torsion of the cyst, which require emergency surgery.

But: II n'y a aucune etude nationale pour les patients avec un rhabdomyosarcome au Japon. Le but de cette etude est d'analyser l'etat actuel du traitement et du devenir de ces rhabdomyosarcomes. Patients et Methodes: De 1982 a 1996, 79 rhabdomyosarcomes etaient enregistres par ce groupe d'etude pour les tumeurs solides malignes dans la zone de Kyushu. Les facteurs pronostiques et les traitements etaient analyses, bases sur la survie a 5 ans. Le staging etait fait en accord avec la classification du groupe rhabdomyosarcome (IRS). Resultats: La survie a 5 ans pour tous les patients etait de 39,1 %. Le taux de survie pour chaque facteur etait le suivant: 1) rapport avec le groupe: 77,8% pour le groupe I, 51,9% pour le groupe II, 33,7% pour le groupe III et 20,2% pour le groupe IV; 2) en fonction de la localisation initiale: 56,3% pour tete et cou, 43,8% pour le tronc, 12,5% pour les extremites, 58,3% pour le pelvis et la localisation genito-urinaire et 30,5% pour les autres; 3) histologie: 35,8% etaient de type embryonnaire, 36,8% etaient de type alveolaire. Conclusion: Quoique le devenir de cette etude soit mediocre, pour ameliorer le devenir, une nouvelle etude nationale pour le rhabdomyosarcome doit etre realisee au Japon.

Intestinal malrotation is a congenital abnormality and is rarely seen in the adulthood. Most adult cases would be classified to the non-rotation type with Ladd's band and Ladd procedure is the treatment of choice. A 66 year-old woman admitted to our hospital due to duodenum obstruction. Several tests revealed that she had intestinal malrotation previously undiagnosed. Operative findings showed the fusion of duodenum with jejunum by the incomplete Treitz ligament. There was no Ladd's band and the right colon was unfixed. Dissection of the fusion completely released her symptom and she discharged without any complication. This is the first report of untypically intestinal malrotation in the adulthood without Ladd's band.

The occurrence of primary lung cancer is rare in childhood. The case of an 11-year-old boy with primary lung cancer is presented in this report. He had a substantial family history of cancer. His chief complaint was coughing with right chest pain. A chest radiograph showed a coin lesion in the right lower lung. A right lower lobectomy revealed a squamous cell carcinoma (stage IIIA at Japanese TNM classification). Systemic chemotherapy using cisplatin, vindesine, THP-adriamycin and cyclophosphamide was performed. Six months after surgery, a recurrent tumor occurred. An analysis of the familial cancer related genes (p53 gene and mismatch repair gene) showed no abnormality.

Background/Purpose : The N - myc amplification status in neuroblastoma has been evaluated previously for the whole tumor by the Southern blot method. The aim of this study is to evaluate the effectiveness of the fluorescence in situ hybridization (FISH) method to analyze N - myc amplification in neuroblastoma and compare the findings with those using the Southern blot method. Methods : In 26 neuroblastoma primary tumors and metastatic lesions, the N - myc amplification status was evaluated by both the Southern blot method and FISH method. Results : Of the 22 samples with no N - myc amplification using Southern blot, no cells with N - myc amplification using FISH were present in 21 of the samples. However, one metastatic liver lesion showed 16% of the nuclei to display more than 10 copies of N - myc based on FISH analysis. In the 4 remaining samples with N - myc amplification using the Southern blot method (17 copies, 15 copies, 6 copies, and 3 copies), the rates of cells with more than 10 copies of N - myc based on a FISH analysis were 79%, 68%, 94%, and 9%, respectively. Conclusions : The FISH method can detect more accurately N - myc amplification than the Southern blot method either when the rate of cells with N - myc amplification is low or intratumor heterogeneity is present.

Various types of fibromatosis have been reported in infancy and early childhood. We describe an infant with diffuse fibromatosis on the scalp. A one year and five months-old girl showed a diffuse and hard mass 3 x 5 cm in diameter and no tenderness on the scalp. Two months later, the size of the mass had increased and several other tumors appeared on the lateral head. The magnetic resonance imaging (MRI) disclosed that a large and diffuse tumor had spread from the frontal to occipital head; a 'helmet-like' configuration of the tumor was exhibited on sagittal MR images. The tumor showed high signal intensity on T2-weighted images and was enhanced with Gd-DTPA. Histological examination showed a fibroblastic proliferation with intervening thick collagen bundles. The patient was diagnosed as having diffuse fibromatosis. The tumor at the resection site immediately recurred, whereas the tumor in the frontal head showed marked regression. Three months after the resection, new tumors appeared in the occipital head. The size and number of these tumors have remained unchanged for more than 18 months. The sites and appearance of the tumors were identical to that of juvenile hyaline fibromatosis (JHF) in this patient. However, JHF usually includes fibroblasts associated with large amounts of hyalinized collagen-like material, which were not present in our patient. The different histology of JHF comparing our case and other reported cases may depend on the different phase of the disease progression at resection. Long-term observation is necessary for the appropriate diagnosis and evaluation of prognosis in this patient.

We report our experience with two cases of adrenal cytomegaly, both of which were detected as cystic adrenal masses during prenatal ultrasonographic examinations. In Case 1, a left suprarenal cystic mass was detected in the fetus at 25 weeks of gestation. The mass, measuring 7 cm in diameter, did not show any change in size and was resected 26 days after birth. In Case 2, a right suprarenal lesion was found at 30 weeks of gestation. The cystic lesion, measuring 2 cm × 1.5 cm, did not change in size and was resected 3 months after birth. Adrenal cytomegaly is still not well known. It is characterized by the presence of large polyhedral cells with eosinophilic granular cytoplasm and enlarged nuclei in the adrenal cortex. This condition is thought to be a degenerative process but not a malignancy. Adrenal cytomegaly rarely forms cysts. It seemed to be impossible to diagnose preoperatively in our cases. Because of the difficulty of differentiating between cystic adrenal cytomegaly and other cystic diseases such as neuroblastoma, operative intervention is required in cases where the cysts do not decrease in size. Further study of a larger number of cases is needed to establish an optimal treatment protocol for these tumours.

Most neuroblastomas with N-myc amplification, a sign of extremely poor prognosis, are extensively invasive to surrounding tissues. Therefore, we investigated the relationship between N-myc amplification and invasiveness of neuroblastoma cells, using an in-vitro assay system. Five human neuroblastoma cell lines were used for this study. IMR-32, GOTO, and DZ, all of which had N-myc amplification, showed a highly invasive capacity. In contrast, SK-N-SH without N-myc amplification showed extremely low invasiveness. ST unexpectedly showed high invasiveness in spite of the lack of N-myc amplification. Treatment of GOTO with 10(-5) mol/L all-trans-retinoic acid (RA) for 72 hours markedly decreased both N-myc expression and invasiveness. Treatment of GOTO with 2 mmol/L dibutyryl cyclic AMP (dbcAMP) for 72 hours caused a slight decrease of N-myc expression and invasiveness. These results indicate that N-myc amplification and expression might be closely related to the invasiveness of human neuroblastoma cells.

The subcellular localization of Bcl-2 protein in surgically resected, fixed-frozen tissue specimens of seven tumors from six cases of synovial sarcoma and a synovial sarcoma cell line was examined using laser-scanning confocal microscopy and immunoelectron microscopy. Bcl-2 protein in synovial sarcoma cells was detected in the nuclear envelope, endoplasmic reticulum membrane, and mitochondrial circumference. Based on the finding of pre-embedding immunoelectron-microscopy observation, the distribution of Bcl-2 protein in such membranous organella was patchy. A computer-based image analysis failed to reveal any quantitative differences between the inner and the outer mitochondrial membranes. The tumorigenesis of synovial sarcoma is also discussed from the viewpoint of Bcl-2 overexpression.

Un cas de xanthogranulome (JXG) juvenile developpe dans la cavite pelvienne est rapporte. Le patient, une enfant de 4 mois, a ete adresse a notre service pour investigations et traitement d'une masse abdominale gauche. Les etudes radiologiques ont suggere fortement la possibilite d'une tumeur maligne d'origine musculaire. L'extirpation de la tumeur a ete realisee. La tumeur etait fusionnee au muscle psoas gauche. Un examen histologique a montre que la tumeur etait constituee par des cellules polygonales contenant de petites vacuoles avec des cellules geantes Touton eparpillees; le diagnotic de JXG a ete fait. A notre connaissance, c'est le premier cas de JXG pelvien.

We report two cases of prenatally diagnosed cystic neuroblastoma (PDCN). In the first case, prenatal ultrasonography (US) at 33 weeks' gestation showed a 30 × 20 mm cyst at the upper pole of the right kidney. The size and content of the mass demonstrated no change during pregnancy. Postnatal US showed no change in the cystic mass 4 weeks after birth compared to the prenatal findings. The infant underwent total resection of the tumour at 28 days of age. In the second case, a left cystic mass measuring 50 × 40 mm was detected in a fetus in the 37th week of pregnancy. Postnatal US showed a cystic mass in the left adrenal gland. The US findings showed no change 18 days after birth and the infant underwent total resection of the tumour at 19 days of age. In both cases, pathological examination revealed a neuroblastoma and all of the biological prognostic factors were favourable. Surgical intervention was necessary for a final histological and biological diagnosis to be made. We recommend that prenatally suspected neuroblastomas should normally undergo surgical intervention, unless tumour size decreases within about 1 month after birth.