Dokkyo Medical University Koshigaya Hospital Research Articles

Post-colonoscopy colorectal cancer rate in the era of high-definition colonoscopy.

AIMTo investigate the post-colonoscopy colorectal cancer (PCCRC) rate for high-definition (HD) colonoscopy compared with that for standard-definition colonoscopy reported previously.METHODSUsing medical records at Sano Hospital (SH) and Dokkyo Medical University Koshigaya Hospital (DMUKH), we retrospectively obtained data on consecutive patients diagnosed as having CRC between January 2010 and December 2015. The definition of PCCRC was diagnosis of CRC between 7 and 36 mo after initial high-definition colonoscopy that had detected no cancer, and patients were divided into a PCCRC group and a non-PCCRC group. The primary outcome was the rate of PCCRC for HD colonoscopy. The secondary outcomes were factors associated with PCCRC and possible reason for occurrence of early and advanced PCCRC.RESULTSAmong 892 CRC patients, 11 were diagnosed as having PCCRC and 881 had non-PCCRC. The PCCRC rate was 1.7% (8/471) at SH and 0.7% (3/421) at DMUKH. In comparison with the non-PCCRC group, the PCCRC group had a significantly higher preponderance of smaller tumors (39 mm vs 19 mm, P = 0.002), a shallower invasion depth (T1 rate, 25.4% vs 63.6%, P = 0.01), a non-polypoid macroscopic appearance (39.0% vs 85.7%, P = 0.02) and an earlier stage (59.7% vs 90.9%, P = 0.03). Possible reasons for PCCRC were “missed or new” in 9 patients (82%), “incomplete resection” in 1 (9%), and “inadequate examination’” in 1 (9%). Among 9 “missed or new” PCCRC, the leading cause was non-polypoid shape for early PCCRC and blinded location for advanced PCCRC.CONCLUSIONThe PCCRC rate for HD colonoscopy was 0.7%-1.7%, being lower than that for standard-definition colonoscopy (1.8%-9.0%) reported previously employing the same methodology.

Successful amyotrophic lateral sclerosis treated with edaravone circle support network building from Dokkyo Medical University Koshigaya hospital (Successful allstar net from DMUK)

Background: A number of Neurologists for patients are not enough in Saitama. ALS requires complex multidisciplinary teams. After Treat with Edaravone Circle (TEC), we experienced some problems and a hope; crowded hospitals with many ALS patients: looking for spaces and specialized staff to drip: dealing with patients who cannot go hospital frequently because of walking difficulty or lack of care giver or come from far; General Physicians (GP) knew its clinical pathways, assistant plans and predictable course.

Vitrectomy in patients over 90 years of age.

PurposeThe aim of this study was to evaluate vitrectomy procedures performed in patients over 90 years of age at the Dokkyo Medical University Koshigaya Hospital (Koshigaya, Japan).Patients and methodsVitrectomies were performed in nine eyes of nine patients who were over 90 years of age between May 2010 and March 2015. Factors such as the underlying vitreoretinal disease, preoperative and postoperative best-corrected visual acuity (BCVA), surgical time, postoperative body position, need for a second surgery, systemic disease, and intraoperative changes in systemic conditions have been evaluated.ResultsThe most common cause of the underlying vitreoretinal disease was vitreous hemorrhage derived from age-related macular degeneration and posterior dislocation of the lens secondary to a posterior capsular rupture (two cases each). The mean values for the logarithm of the minimum angle of resolution BCVA were 2.15 preoperatively and 1.46 postoperatively (P=0.020, Wilcoxon signed-rank test). The mean surgical time was 109 minutes. Prone position was needed in two cases, and no second surgeries were needed. The most common cause of systemic disease was hypertension, which was found in six cases. Transient hypertension was found in two cases during surgery, and these patients were treated using intravenous calcium blocker injections.ConclusionPatients over 90 years of age who underwent vitrectomy procedures did not have serious problems, except transient hypertension during surgery. The BCVA significantly improved. These results indicated that vitrectomies could be performed successfully in patients over 90 years of age.

Massive Air Trapped in the Left Atrial Appendage During Catheter Ablation of Atrial Fibrillation Without a Symptomatic Air Embolism.

Journal of Cardiovascular ElectrophysiologyVolume 26, Issue 11 p. 1278-1278 EP Image Massive Air Trapped in the Left Atrial Appendage During Catheter Ablation of Atrial Fibrillation Without a Symptomatic Air Embolism AYAKO NAKAGAWA M.D., AYAKO NAKAGAWA M.D. Department of Cardiology, Dokkyo Medical University Koshigaya Hospital, Saitama, JapanSearch for more papers by this authorYUICHI HORI M.D., Corresponding Author YUICHI HORI M.D. Department of Cardiology, Dokkyo Medical University Koshigaya Hospital, Saitama, JapanAddress for correspondence: Yuichi Hori, M.D., 2-1-50 Minami Koshigaya, Koshigaya, Saitama 343-8555, Japan. Fax: +81-489-60-1708; E-mail: [email protected]Search for more papers by this authorSHIRO NAKAHARA M.D., Ph.D., SHIRO NAKAHARA M.D., Ph.D. Department of Cardiology, Dokkyo Medical University Koshigaya Hospital, Saitama, JapanSearch for more papers by this authorISAO TAGUCHI M.D., Ph.D., ISAO TAGUCHI M.D., Ph.D. Department of Cardiology, Dokkyo Medical University Koshigaya Hospital, Saitama, JapanSearch for more papers by this author AYAKO NAKAGAWA M.D., AYAKO NAKAGAWA M.D. Department of Cardiology, Dokkyo Medical University Koshigaya Hospital, Saitama, JapanSearch for more papers by this authorYUICHI HORI M.D., Corresponding Author YUICHI HORI M.D. Department of Cardiology, Dokkyo Medical University Koshigaya Hospital, Saitama, JapanAddress for correspondence: Yuichi Hori, M.D., 2-1-50 Minami Koshigaya, Koshigaya, Saitama 343-8555, Japan. Fax: +81-489-60-1708; E-mail: [email protected]Search for more papers by this authorSHIRO NAKAHARA M.D., Ph.D., SHIRO NAKAHARA M.D., Ph.D. Department of Cardiology, Dokkyo Medical University Koshigaya Hospital, Saitama, JapanSearch for more papers by this authorISAO TAGUCHI M.D., Ph.D., ISAO TAGUCHI M.D., Ph.D. Department of Cardiology, Dokkyo Medical University Koshigaya Hospital, Saitama, JapanSearch for more papers by this author First published: 23 May 2015 https://doi.org/10.1111/jce.12717Citations: 1 Disclosures: None. Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL No abstract is available for this article.Citing Literature Volume26, Issue11November 2015Pages 1278-1278 RelatedInformation

A semi-quantified evaluation of substantia nigra hyperechogenicity in Parkinson's disease and Parkinsonian syndrome

WCN 2013 No: 936 Topic: 2—Movement Disorders Clinical correlates of serum insulin-like growth factor 1 in patients with Parkinson's disease, multiple system atrophy and progressive supranuclear palsy A. Numao, K. Suzuki, M. Miyamoto, T. Miyamoto, K. Hirata. Department of Neurology, Dokkyo Medical University, Mibu, Japan; Department of Neurology, DokkyoMedical University Koshigaya Hospital,

Assessing injury severity in bicyclists involved in traffic accidents to more effectively prevent fatal bicycle injuries in Japan

The objective of this study was to clarify the relationship between injury severity in bicyclists involved in traffic accidents and patient outcome or type of vehicle involved in order to propose effective measures to prevent fatal bicycle injuries. Hospital records were reviewed for all patients from 2007 to 2010 who had been involved in a traffic accident while riding a bicycle and were subsequently transferred to the Shock Trauma Center of Dokkyo Medical University Koshigaya Hospital. Patient outcomes and type of vehicle that caused the injury were examined. The mechanism of injury, Abbreviated Injury Scale (AIS) score, and Injury Severity Score (ISS) of the patient were determined. A total of 115 patients' records were reviewed. The mean patient age was 47.1 ± 27.4 years. The average ISS was 23.9, with an average maximum AIS (MAIS) score of 3.7. The ISS, MAIS score, head AIS score, and chest AIS score were well correlated with patient outcome. The head AIS score was significantly higher in patients who had died (mean of 4.4); however, the ISS, MAIS score, and head AIS score did not differ significantly according to the type of vehicle involved in the accident. The mean head AIS scores were as high as 2.4 or more for accidents involving any type of vehicle. This study provides useful information for forensic pathologists who suspect head injuries in bicyclists involved in traffic accidents. To effectively reduce bicyclist fatalities from traffic accidents, helmet use should be required for all bicyclists.

Cataract surgery in patients older than 90 years of age

ObjectiveThe aim of this study was to examine whether differences exist after cataract surgery is performed in patients over and under 90 years of age. Study DesignRetrospective, nonrandomized study. ParticipantsCataract surgery was performed in 21 patients (31 eyes) who were older than 90 years of age and in 45 patients (70 eyes) who were younger than 90 years of age. MethodsThe medical records of all patients who underwent cataract surgery between January 2005 and September 2010 at Dokkyo Medical University Koshigaya Hospital were reviewed. Factors evaluated included systemic disease, changes in systemic condition, surgical time, preoperative and postoperative visual acuity, corneal endothelial cell density, and intraoperative complications. ResultsThe group of patients older than 90 years of age experienced greater occurrences of systemic disease (p < 0.05; χ2 test) and intraoperative changes in systemic conditions (p < 0.001; χ2 test). These patients also had significantly lower preoperative visual acuity (p < 0.001; Student t test). No differences were noted between the 2 age groups in surgical time, postoperative visual acuity, preoperative corneal endothelial cell density, or intraoperative complications. ConclusionsPoorer cataract surgery outcome results were noted in patients older than 90 years due to systemic disease and intraoperative changes in systemic condition. Factors that need to be taken into consideration prior to performing cataract surgery in older patients include age, systemic disease, and the likelihood of intraoperative changes in systemic condition.

A case of radial keratoneuritis in non-Acanthamoeba keratitis

A case of non-Acanthamoeba keratitis with radial keratoneuritis, which is thought to be pathognomonic for Acanthamoeba keratitis, is reported. A healthy 32-year-old woman with a history of frequent replacement of her contact lenses due to wear was examined at Dokkyo Medical University Koshigaya Hospital (Saitama, Japan) and found to have a slight corneal opacity that was accompanied by radial keratoneuritis. Based on both the patient’s clinical findings and past history, the presence of Acanthamoeba keratitis was highly suspected. However, direct light microscopy of corneal scrapings stained by the Parker ink–potassium hydroxide method only found Acanthamoeba-type material in the specimen collected at her initial visit. In all other specimens collected from the patient, no Acanthamoeba was found either when using the same method or when performing cultures of the surgical debridement of the corneal lesion. In addition, topical antifungal eye drops, systemic antifungal drugs, and surgical debridement were also not effective in this case. Since a precise diagnosis could not be made, the patient was treated with topical 0.1% betamethasone sodium, which ultimately resulted in a dramatic improvement of her corneal inflammation. At 23 days after initiation of topical administration of 0.1% betamethasone sodium, visual acuity was 20/250, with a slight corneal opacity noted at the original site of infection. The outcome of the current case suggests that radial keratoneuritis is not always pathognomonic for Acanthamoeba keratitis.

Lens dislocation has a possible relationship with laser iridotomy

We report our recent experience of four eyes with spontaneous lens dislocation in four patients with no history of trauma or any systemic disease associated with zonular dialysis. Lens dislocation developed with 0.5 to 6 months following laser iridotomy. All patients were male and two eyes were complicated with acute primary angle closure glaucoma preoperatively. Case 1 showed bilateral lens dislocation, while cases 2 and 3 involved unilateral lens dislocation. Cases 2 and 3 showed lenses completely dislocated into the vitreous cavity. All cases needed lens removal and scleral fixation of intraocular lenses. Final visual acuity was 1.2 in all cases. We suspect that laser iridotomy may induce localized zonular dialysis that results in progressive zonular weakness, leading to lens dislocation.

Four cases of endophthalmitis after 25-gauge pars plana vitrectomy

We report our recent experience with four cases of endophthalmitis (one male, three females) after 25-gauge pars plana vitrectomy (PPV). One was a case of persistent cystoid macular edema caused by branch retinal vein occlusion, whereas the remaining three were cases of epiretinal membrane. Preoperative antibiotics before the first PPV procedure were not administered in three of the four cases. Endophthalmitis occurred 2–4 days after the first procedure in all cases, for which ceftazidime 2.0 mg/0.1 mL and vancomycin 1.0 mg/0.1 mL were injected into the vitreous cavity. This was followed by emergent 20-gauge PPV and intraocular lens removal using an infusion fluid containing ceftazidime and vancomycin. After the second PPV procedure, progress was good in three cases while retinal detachment occurred in the remaining case one month after surgery; this case required a third PPV procedure. Final best-corrected visual acuity ranged from 20/100 to 20/25 for the four cases. Bacterial cultures were negative after the second PPV procedure in all cases. In conclusion, postoperative endophthalmitis occurred in four of 502 cases (0.80%) that underwent 25-gauge PPV at our hospital. It is important to minimize the incidence of endophthalmitis after 25-gauge PPV.

Hypomyelination with atrophy of the basal ganglia and cerebellum in an infant with Down syndrome

Division of Medical Genetics, Division of Neurology, Gunma Children’s Medical Center, Shibukawa, Department of Medical Genetics, Shinshu University School of Medicine, Matsumoto, Department of Pediatrics, Dokkyo Medical University Koshigaya Hospital, Koshigaya, Department of Human Genetics, Yokohama City University Graduate School of Medicine, Yokohama, Japan and Department of Child Neurology, VU University Medical Center, Amsterdam, The Netherlands Correspondence to Yoko Narumi, MD, PhD, Department of Medical Genetics, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto 390-8621, Japan Tel: + 81 263 37 2618; fax: + 81 263 37 2619; e-mail: ynarumi@shinshu-u.ac.jp

64 Behind every healthy man, there's a woman: A qualitative inquiry

during the short-term follow-up, with 6 cystic fat nodules. The satisfaction rate for sexual function, morphology and global state were 79.8%, 78.9%, and 91.7%. Conclusions: Our technique shows very effective shortterm outcomes and patient’s satisfaction without serious complications. 62 A case of 47,XXY/46,XY Klinefelter syndrome H. Masuda1, Y. Katsuoka2. 1Aino Hospital, 2 Osaka Medical College, Japan Klinefelter syndrome represents the most commonly found human sex chromosomal abnormality. It is characterized by small, firm testes with hyalinization of the seminiferous tubules, elevated gonadotropins and azoospermia. Males with Klinefelter syndrome may have a 47,XXY or a mosaic 47,XXY/46,XY constitutional karyotype and varying degrees of spermatogenic failure. Mosaicism 47,XXY/46,XX with clinical features suggestive of Klinefelter syndrome is very rare. We report here a case of a mosaic 47,XXY/46,XX infertile male. The patient was a 31-year-old male. Physical examination revealed perfect male-type of genitalia, almost normal penis and bilateral small testicles, being 1.0 × 2.0 × 1.0 cm sized for the right and 1.0 × 2.0 × 1.0 cm for the left. Chromosome analysis by means of culture of peripheral blood lymphocytes revealed twokinds of 46 chromosomes and of 47 chromosomes. The genotype of the former was XX and of the later was XXY, making XX/XXY mosaicism. Testicular sperm extraction was performed, but we could find the sperm in microdissection testicular sperm extraction procedure. Histologically the testicle showed atrophy of seminiferous tubules with hyalinizaition of the canaliculi. No spermatogenesis was observed at all. 63 Coenzyme Q10 treatment for oligoasthenoteratozoospemia in infertile men with varicocele Y. Kobori, H. Okada, G. Arai, S. Soh, H. Yagi. Dokkyo Medical University Koshigaya Hospital, Department of Urology, Japan Objective: To evaluate the effectiveness of coenzyme Q10 treatment in improving semen quality in men who have varicocele with infertility. Patients: Sixty-nine infertile patients (21–51 years of age) with the following baseline sperm selection criteria: concentration 30%. Patients underwent therapy with coenzyme Q10, 30mg/day. We investigated seminograms, background, hormonal analyses. We also investigated the modern ART used to overcome sterility. Results: Coenzyme Q10 and ubiquinol increased significantly sperm concentration, aswell as spermatozoa motility. Intracytoplasmic sperm injection (ICSI) was performed 2 patients, varicocelectomy was performed 1 patient, and total 10 patients are resulted pregnancy. Conclusions:The exogenous administration of coenzyme Q10 increases the level of the same and ubiquinol in semen and is effective in improving sperm kinetic features in patients affected by idiopathic asthenozoospermia with valicocele.

62 A case of 47,XXY/46,XY Klinefelter syndrome

during the short-term follow-up, with 6 cystic fat nodules. The satisfaction rate for sexual function, morphology and global state were 79.8%, 78.9%, and 91.7%. Conclusions: Our technique shows very effective shortterm outcomes and patient’s satisfaction without serious complications. 62 A case of 47,XXY/46,XY Klinefelter syndrome H. Masuda1, Y. Katsuoka2. 1Aino Hospital, 2 Osaka Medical College, Japan Klinefelter syndrome represents the most commonly found human sex chromosomal abnormality. It is characterized by small, firm testes with hyalinization of the seminiferous tubules, elevated gonadotropins and azoospermia. Males with Klinefelter syndrome may have a 47,XXY or a mosaic 47,XXY/46,XY constitutional karyotype and varying degrees of spermatogenic failure. Mosaicism 47,XXY/46,XX with clinical features suggestive of Klinefelter syndrome is very rare. We report here a case of a mosaic 47,XXY/46,XX infertile male. The patient was a 31-year-old male. Physical examination revealed perfect male-type of genitalia, almost normal penis and bilateral small testicles, being 1.0 × 2.0 × 1.0 cm sized for the right and 1.0 × 2.0 × 1.0 cm for the left. Chromosome analysis by means of culture of peripheral blood lymphocytes revealed twokinds of 46 chromosomes and of 47 chromosomes. The genotype of the former was XX and of the later was XXY, making XX/XXY mosaicism. Testicular sperm extraction was performed, but we could find the sperm in microdissection testicular sperm extraction procedure. Histologically the testicle showed atrophy of seminiferous tubules with hyalinizaition of the canaliculi. No spermatogenesis was observed at all. 63 Coenzyme Q10 treatment for oligoasthenoteratozoospemia in infertile men with varicocele Y. Kobori, H. Okada, G. Arai, S. Soh, H. Yagi. Dokkyo Medical University Koshigaya Hospital, Department of Urology, Japan Objective: To evaluate the effectiveness of coenzyme Q10 treatment in improving semen quality in men who have varicocele with infertility. Patients: Sixty-nine infertile patients (21–51 years of age) with the following baseline sperm selection criteria: concentration 30%. Patients underwent therapy with coenzyme Q10, 30mg/day. We investigated seminograms, background, hormonal analyses. We also investigated the modern ART used to overcome sterility. Results: Coenzyme Q10 and ubiquinol increased significantly sperm concentration, aswell as spermatozoa motility. Intracytoplasmic sperm injection (ICSI) was performed 2 patients, varicocelectomy was performed 1 patient, and total 10 patients are resulted pregnancy. Conclusions:The exogenous administration of coenzyme Q10 increases the level of the same and ubiquinol in semen and is effective in improving sperm kinetic features in patients affected by idiopathic asthenozoospermia with valicocele.

65 Effects of Clinacanthus nutans and mebeverine hydrochloride on bladder activity

during the short-term follow-up, with 6 cystic fat nodules. The satisfaction rate for sexual function, morphology and global state were 79.8%, 78.9%, and 91.7%. Conclusions: Our technique shows very effective shortterm outcomes and patient’s satisfaction without serious complications. 62 A case of 47,XXY/46,XY Klinefelter syndrome H. Masuda1, Y. Katsuoka2. 1Aino Hospital, 2 Osaka Medical College, Japan Klinefelter syndrome represents the most commonly found human sex chromosomal abnormality. It is characterized by small, firm testes with hyalinization of the seminiferous tubules, elevated gonadotropins and azoospermia. Males with Klinefelter syndrome may have a 47,XXY or a mosaic 47,XXY/46,XY constitutional karyotype and varying degrees of spermatogenic failure. Mosaicism 47,XXY/46,XX with clinical features suggestive of Klinefelter syndrome is very rare. We report here a case of a mosaic 47,XXY/46,XX infertile male. The patient was a 31-year-old male. Physical examination revealed perfect male-type of genitalia, almost normal penis and bilateral small testicles, being 1.0 × 2.0 × 1.0 cm sized for the right and 1.0 × 2.0 × 1.0 cm for the left. Chromosome analysis by means of culture of peripheral blood lymphocytes revealed twokinds of 46 chromosomes and of 47 chromosomes. The genotype of the former was XX and of the later was XXY, making XX/XXY mosaicism. Testicular sperm extraction was performed, but we could find the sperm in microdissection testicular sperm extraction procedure. Histologically the testicle showed atrophy of seminiferous tubules with hyalinizaition of the canaliculi. No spermatogenesis was observed at all. 63 Coenzyme Q10 treatment for oligoasthenoteratozoospemia in infertile men with varicocele Y. Kobori, H. Okada, G. Arai, S. Soh, H. Yagi. Dokkyo Medical University Koshigaya Hospital, Department of Urology, Japan Objective: To evaluate the effectiveness of coenzyme Q10 treatment in improving semen quality in men who have varicocele with infertility. Patients: Sixty-nine infertile patients (21–51 years of age) with the following baseline sperm selection criteria: concentration 30%. Patients underwent therapy with coenzyme Q10, 30mg/day. We investigated seminograms, background, hormonal analyses. We also investigated the modern ART used to overcome sterility. Results: Coenzyme Q10 and ubiquinol increased significantly sperm concentration, aswell as spermatozoa motility. Intracytoplasmic sperm injection (ICSI) was performed 2 patients, varicocelectomy was performed 1 patient, and total 10 patients are resulted pregnancy. Conclusions:The exogenous administration of coenzyme Q10 increases the level of the same and ubiquinol in semen and is effective in improving sperm kinetic features in patients affected by idiopathic asthenozoospermia with valicocele.

63 Coenzyme Q10 treatment for oligoasthenoteratozoospemia in infertile men with varicocele

during the short-term follow-up, with 6 cystic fat nodules. The satisfaction rate for sexual function, morphology and global state were 79.8%, 78.9%, and 91.7%. Conclusions: Our technique shows very effective shortterm outcomes and patient’s satisfaction without serious complications. 62 A case of 47,XXY/46,XY Klinefelter syndrome H. Masuda1, Y. Katsuoka2. 1Aino Hospital, 2 Osaka Medical College, Japan Klinefelter syndrome represents the most commonly found human sex chromosomal abnormality. It is characterized by small, firm testes with hyalinization of the seminiferous tubules, elevated gonadotropins and azoospermia. Males with Klinefelter syndrome may have a 47,XXY or a mosaic 47,XXY/46,XY constitutional karyotype and varying degrees of spermatogenic failure. Mosaicism 47,XXY/46,XX with clinical features suggestive of Klinefelter syndrome is very rare. We report here a case of a mosaic 47,XXY/46,XX infertile male. The patient was a 31-year-old male. Physical examination revealed perfect male-type of genitalia, almost normal penis and bilateral small testicles, being 1.0 × 2.0 × 1.0 cm sized for the right and 1.0 × 2.0 × 1.0 cm for the left. Chromosome analysis by means of culture of peripheral blood lymphocytes revealed twokinds of 46 chromosomes and of 47 chromosomes. The genotype of the former was XX and of the later was XXY, making XX/XXY mosaicism. Testicular sperm extraction was performed, but we could find the sperm in microdissection testicular sperm extraction procedure. Histologically the testicle showed atrophy of seminiferous tubules with hyalinizaition of the canaliculi. No spermatogenesis was observed at all. 63 Coenzyme Q10 treatment for oligoasthenoteratozoospemia in infertile men with varicocele Y. Kobori, H. Okada, G. Arai, S. Soh, H. Yagi. Dokkyo Medical University Koshigaya Hospital, Department of Urology, Japan Objective: To evaluate the effectiveness of coenzyme Q10 treatment in improving semen quality in men who have varicocele with infertility. Patients: Sixty-nine infertile patients (21–51 years of age) with the following baseline sperm selection criteria: concentration 30%. Patients underwent therapy with coenzyme Q10, 30mg/day. We investigated seminograms, background, hormonal analyses. We also investigated the modern ART used to overcome sterility. Results: Coenzyme Q10 and ubiquinol increased significantly sperm concentration, aswell as spermatozoa motility. Intracytoplasmic sperm injection (ICSI) was performed 2 patients, varicocelectomy was performed 1 patient, and total 10 patients are resulted pregnancy. Conclusions:The exogenous administration of coenzyme Q10 increases the level of the same and ubiquinol in semen and is effective in improving sperm kinetic features in patients affected by idiopathic asthenozoospermia with valicocele.

In Response

Myopathy related to IM injection of local anesthetics depends on toxicity of the local anesthetic and the dose, frequency, and interval between injections. Although myotoxicity after IM bupivacaine and ropivacaine is described,1 ultrasound-guided injection of mepivacaine into the longus colli muscle for stellate ganglion block2 is reproducibly effective and currently often used by anesthesiologists in Japan. In our university hospital (Koshigaya), >100 patients have received at least 5 unilateral injections of 5 to 7 mL mepivacaine into the longus colli muscle in the past 10 years without clinical signs (limitation of neck flexion and rotation) of cervical myopathy (oral personal communication, Professor Y. Okuda, Dokkyo Medical University Koshigaya Hospital, Saitama, Japan, July 2010) (Fig. 1). Accordingly, we consider any myopathy caused by a small-dose IM injection of mepivacaine to be subclinical. Figure 1: A panel of magnetic resonance images of a 40-year-old man taken 3 months after the last injection of 7 mL mepivacaine into the right longus colli. This patient had numbness of the right third and fifth fingers because of radiculopathy of right C7 (red arrows) for 10 years. He received >20 injections of mepivacaine intermittently when numbness worsened. This patient showed no limitation of neck flexion and rotation and no muscle weakness or abnormal reflex at the C5 to C7 levels. Magnetic resonance images show no significant atrophy or fibrosis of the right longus colli (pink circles) at the C4 to T2 level.Concerning Figures 1 and 2 of our report,3 the cervical plexus is situated in a groove between the longus capitis and the scalenus medius. The roots of the cervical plexus are located below the prevertebral fascia and their rami perforate the fascia to enter this groove (Fig. 3, C and D3). Therefore, the posterior cervical space described by Choquet et al.4 is actually a space between the prevertebral fascia and a fascia surrounding the posterior surface of the sternocleidomastoid muscle in our study. The latter can be seen as a white line above the prevertebral fascia (yellow drawing) in Figure 1, E and F (upper right).3 It should also be noted that the existence of the superficial cervical fascia that Choquet et al. mentioned has recently been questioned.5 Any greater risk of deep cervical plexus block6 can be reduced to that of the superficial block if the injection point is carefully monitored and a minimal dose of anesthetic is injected. Our precise examination of the neck anatomy, using ultrasound-guided technique, and a small dose of anesthetic (5 mL mepivacaine) satisfy these requirements. Although we too may choose the intermediate cervical plexus block for neck surgery, we prefer our method for patients in the pain clinic because it can block not only the deep cervical plexus but also the cervical sympathetic trunk. It should be noted that the intermediate block might block the vagus nerve because the local anesthetic solution can easily spread toward the carotid sheath. In conclusion, ultrasound-guided mepivacaine injection into the longus capitis muscle can block not only the deep cervical plexus but also the cervical sympathetic trunk with a reduced risk of complications. This method is suitable for pain control in the pain clinic. Myopathy (if it occurs) may be at a subclinical level. Yosuke Usui, MD Departments of Anatomy (Macro) and Anesthesiology Hiroyuki Kakinuma, MD Department of Anesthesiology Kenjiro Matsuno, MD, PhD Department of Anatomy (Macro) Dokkyo Medical University Mibu, Tochigi, Japan [email protected]

Effects of late evening snack on diurnal plasma glucose profile in patients with chronic viral liver disease

Glycemic control is important to improve the prognosis in cirrhotic patients with complications from diabetes. A late evening snack (LES) has been recommended for cirrhotic patients. We investigated the effects of LES on diurnal plasma glucose levels. Subjects comprised 47 patients with chronic viral liver disease (chronic hepatitis, n = 11; cirrhosis, n = 36) treated in the Department of Gastroenterology & Hepatology, Dokkyo Medical University Koshigaya Hospital. Diurnal variations in plasma glucose were first investigated with three meals/day, in accordance with the European Society for Clinical Nutrition and Metabolism (ESPEN) guidelines. Starting the next day, patients were given four meals including a LES, without changing meal content. Diurnal variations in plasma glucose were examined on day 7, and urine C-peptide immunoreactivity (CPR), and homeostasis model assessment insulin resistance (HOMA-IR) were investigated. With a LES, plasma glucose levels in patients with chronic hepatitis were significantly lower 2 hours before and 2 hours after dinner. In cirrhotic patients, significant decreases in plasma glucose levels were seen 2 hours after breakfast, before lunch, and before dinner. Significant decreases were noted in average plasma glucose levels and highest plasma glucose levels with four meals including a LES in patients with liver cirrhosis. This decrease was greater when maximum plasma glucose levels were higher on the three-meal regimen. Improvements in plasma glucose levels were seen with four meals per day, including a LES, in viral chronic liver disease, particularly cirrhosis.

Correlation between the matrix metalloproteinase-9 activity and chondroitin sulfate concentrations in tear fluid after laser in situ keratomileusis

The aim of the present study was to evaluate the correlation between matrix metalloproteinase-9 (MMP-9) and chondroitin sulfate (CS) concentrations in human tear fluid following laser in situ keratomileusis (LASIK). Twelve eyes from six patients who had no ocular complaints except for refractive errors, and who had undergone LASIK, were enrolled in this study. We measured the concentrations of chondroitin 4 sulfate (C4S), chondroitin 6 sulfate (C6S), and MMP-9 activity with an enzyme-linked immunosorbent assay and an enzyme immunocapture activity assay preoperatively and postoperatively on days 1 and 4, week 1, and at 1 and 3 months. Although the preoperative MMP-9 activity and the C4S concentration were highly correlated (r = 0.900; P < 0.001), they were not postoperatively correlated at month 1. Although the preoperative MMP-9 activity and the C6S concentration were highly correlated (r = 0.885; P < 0.001), they were not postoperatively correlated at either week 1 or months 1 and 3. The correlation appeared to be collapsed by LASIK, and it did not recover to the preoperative score at 3 months post-surgery. Our study indicates that the corneal wound healing was not terminated at 3 months following LASIK.

Free radicals in the aqueous humor of patients with glaucoma

To clarify the presence of oxidative stress in glaucoma and discuss whether free radicals contribute to neovascular glaucoma (NVG) and non-NVG. Two patient groups were formed: the NVG group (n = 10) and the non-NVG group (n = 17). Free radicals in aqueous humor were detected by measuring the electron spin resonance (ESR). To identify free radical species, either superoxide dismutase (SOD) or catalase was added to the aqueous humor and compared with aqueous humor in which SOD or catalase was not added. In the NVG group, free radical waveforms were detected that differed from ascorbate-free radical (AFR) in all cases. Under SOD was added, the characteristic waveforms disappeared and the AFR of a specific waveform appeared. After catalase was added, the waveforms were unchanged. In the non-NVG group, the AFR of specific waveforms were detected in all cases. In 4 cases, the waveforms detected the presence of a trace of superoxide. In the NVG group, superoxides were detected, suggesting that superoxide scavenging activity was decreased markedly. L-ascorbic acid likely has an antioxidative function in the non-NVG group, suggesting that the aqueous humor in the NVG group was under higher oxidative stress compared with the non-NVG group.

A retrospective study of nine cases of Acanthamoeba keratitis

PurposeTo evaluate the clinical features of Acanthamoeba keratitis in nine patients diagnosed at Dokkyo Medical University Koshigaya Hospital, Saitama, Japan.MethodsIn nine eyes of nine patients, Acanthamoeba keratitis was diagnosed by direct light microscopy of corneal scrapings stained by the Parker ink-potassium hydroxide method between September 2006 and September 2009. Their clinical features and course were studied retrospectively. Antifungal eye drops, systemic antifungal therapy, and surgical debridement of the corneal lesions were performed in all patients.ResultsAt presentation, the clinical stage was initial in six cases, transient in one case, and complete in two cases. The patients were all contact lens wearers who had washed their lens storage cases with tap water. After treatment, final visual acuity was improved in six cases, unchanged in one case, and worse in two cases. The patient with the worst final vision (hand motion) had rheumatoid arthritis and was taking oral prednisolone, which led to corneal perforation and prevented adequate debridement from being done.ConclusionAcanthamoeba keratitis is closely related to wearing contact lenses and washing the lens storage case with tap water. Although final visual acuity improved after treatment in most patients, insufficient surgical debridement resulted in a poor visual prognosis.