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To investigate the frequency of symptoms and signs and their relationships with blood PCB (polychlorinated biphenyls) levels, twenty-five years after outbreak, we analyzed the data of 276 Yusho patients (male/female: 137/139) who had received health examination in 1993. For this purpose, 31 examination items which correspond or relate to the diagnostic criteria for Yusho (1976) were selected from the examination form. Mean blood PCB concentration in the subjects was 4.69 ppb with the highest value of 31.0 ppb (median : 4.0 ppb). The symptoms for which the proportion exceeded 60% were general fatigue, headache and numbness in extremities. Chronic bronchitis-like symptoms, such as cough and sputum, were observed in 50% of the subjects. Next, the subjects were classified into approximate quartiles of blood PCB: < 3.00, 3.00-4.06, 4.07-5.99, and 6.00+ppb. The distributions of subjects at four levels of blood PCBs were compared between the groups with or without each symptom or sign, using the Cochran-Mantel-Haenszel test. Significant differences were observed for comedones in the trunk (P = 0.02) and other regions (P = 0.02); acneiform eruptions in the genital regions (P = 0.01) and gluteal regions (P = 0.01); and hypersecretion in the Meibomian gland (P = 0.04). Thus, the typical skin and eye symptoms in Yusho patients still persist showing a close relation with blood PCB concentration.
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PMID:[Symptoms and blood PCB level among chronic Yusho patients, twenty-five years after outbreak]. 919 46

The present study was made not only to clarify endogenous factors (physical and psychological factor of the subjects) and exogenous factors (caregiver residential environment, social assistance) in the urinary incontinence of elderly persons at home undergoing public visiting nursing, both by sexes and by age-groups [65-74 years (young old), 75-84 years (middle old), more than 85 years (old old)], but also to examine nursing care problems at home. The subjects were 252 elderly persons > 65 years (46.8% of all subjects), who were detected for urinary incontinence by incontinence screening examination from among 538 subjects (224 males, 314 females), who underwent visiting nursing by Public Health Centers, and the health and welfare department of intra-metropolitan S Ward from April 1992 to August 1994. The screening examination was made via visiting interview and hearing by Public Health Nurses in charge, about items for examination such as disease, treatment, degree of independency for ADL, residence, utilization of social resources. nursing burden sensation, etc. The analysis was made comparatively by age-groups and by sexes, as mentioned above. The following information was obtained; 1) In terms of the incidence of urinary incontinence, female subjects showed higher incidence for higher age-grade (36.5%, for YO group, 45.1% for MO group and 61.4% for OO group), and male subjects showed higher incidence than female subjects (56.8% for YO group, 54.4% for MO group and 74.5% for OO group). 2) A few subjects were found within 3 months of the onset of urinary incontinence. Incontinence-favorite time zone was predominantly the midnight zone of 0-6 o'clock a.m. (23.5-52.2%). Care approach by caregiver was predominantly "use of diaper" (52.2-90.2%) and "use of diaper even with micturition" represented 30-50%. 3) Endogenous factors involved onset of cerebrovascular disease or dementia, narrow range of ADL, symptoms such as numbness and pain, bedsores, constipation, low social activity, etc. 4) Exogenous factors involved elderly caregiver persons, residual care fatigue sensation, inconvenient toilet and other housing condition, etc. 5) Endogenous-exogenous compound factors in possible urinary incontinence involved paralysis, contrature, social activity, start of visiting for morbid state observational nursing, guidance and utilization of social services for YO group, suggesting strong factor involving the care rather than physical problems of the subject concerned for elder group. From the above, suggestions for the subject concerned were made as follows; 1) start of visiting aiming at the prevention and improvement of urinary incontinence in early stage of onset of cerebrovascular disease (especially for males) or dementia (especially for females) and 2) promotion of rehabilitation for tension provocation of pelvic muscular group and enlargement of ADL and walking distance, and suggestions for caregiver were made as follows; 1) giving appropriate advice for excretory nursing at home and 2) assessment of the relationship with the subject concerned. From the viewpoint of housing environment, reconstruction of such a toilet as is easily usable by both an elderly person and its nursing person and from the viewpoint of regional system, necessary preparation of 24-hour approach to diminution of nocturnal excretory nursing burden was suggested.
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PMID:[A study of endogenous-exogenous factors in urinary incontinence and home care nursing of the elderly at home]. 928 14

The silicone breast implant controversy rages on. Recent work has demonstrated that normal or baseline breast tissue silicon levels in women who had had no prior exposure to any type of breast implant may be as high as 446 microg/gm of tissue. These data ranged from 4 to 446 microg/gm of tissue, with a median of 27.0 microg/gm of tissue. In addition, numerous other epidemiologic and rheumatologic studies have demonstrated no association between silicone breast implants and any connective-tissue diseases. Despite these reports, the use of silicone implants remains restricted. The present study measured breast and capsular tissue silicon levels from 23 breasts in 14 patients with saline implants, and from 42 breasts in 29 patients with silicone implants. No patient in the saline implant group presented with signs or symptoms of connective-tissue disease. Patients with silicone implants, however, were divided into three groups based on the presence or absence of signs or symptoms of connective-tissue disease: group I, no symptoms or signs; group II, + symptoms, no signs; and group III, + symptoms, + signs. Six patients in group III were diagnosed with a specific connective-tissue disease, including systemic lupus erythematosus, rheumatoid arthritis, or scleroderma. The most common indications for implant removal or exchange were capsular contracture and implant rupture, although 41 percent of patients with silicone implants expressed media-related concern over the implant issue. The most common symptoms described by patients in groups II and III were joint pain and stiffness, arm pain and numbness, and fatigue. In all groups, capsular tissue silicon levels were significantly greater than breast tissue levels. This finding may indicate that the capsule serves as a barrier to the distribution of silicone from the implant into adjacent breast tissue. Although breast tissue silicon levels in patients with silicone implants were not significantly greater than those in patients with saline implants (p = 0.48), capsular tissue levels in patients with silicone implants were, indeed, significantly greater than those in patients with saline implants (p < 0.001). However, no statistically significant differences in tissue silicon levels were observed with relation to the presence or absence of connective-tissue disease signs or symptoms in patients with silicone implants (groups I to III). Therefore, these data strengthen the conclusion that there is no association between tissue silicon levels and connective-tissue disease.
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PMID:Silicon analysis of breast and capsular tissue from patients with saline or silicone gel breast implants: II. Correlation with connective-tissue disease. 962 24

This is the first report of a schwannoma originating from the C7 nerve root causing thoracic outlet compression syndrome. The patient was a 30-year-old woman with a 3-year history of numbness on the radial side of the left hand, left arm tiredness, nocturnal pain in the left forearm and pain in the left elbow, shoulder and neck. Conservative treatment and previous operations, including carpal tunnel release and first rib resection, provided no relief. A left scalenectomy was performed. During the removal of the anterior scalene muscle, a mass approximately 3 cm long and 1.5 cm in diameter was noted under the anterior scalene muscle involving the C7 nerve root. The tumour was encapsulated and covered with attenuated and stretched nerve fascicles. It was completely excised without disturbing the nerve fascicles. The clinical impression was schwannoma, which was confirmed on pathological examination.
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PMID:Thoracic outlet compression syndrome caused by a schwannoma of the C7 nerve root. 975 28

Two cases of cerebral arterial gas embolism (CAGE) occurred after a decompression incident involving five maintenance crew during a cabin leakage system test of a Hercules C-130 aircraft. During the incident, the cabin pressure increased to 8 in Hg (203.2 mm Hg, 27 kPa) above atmospheric pressure causing intense pain in the ears of all the crew inside. The system was rapidly depressurized to ground level. After the incident, one of the crew reported chest discomfort and fatigue. The next morning, he developed a sensation of numbness in the left hand, with persistence of the earlier symptoms. A second crewmember, who only experienced earache and heaviness in the head after the incident, developed retrosternal chest discomfort, restlessness, fatigue and numbness in his left hand the next morning. Both were subsequently referred to a recompression facility 4 d after the incident. Examination by the Diving Medical Officer on duty recorded left-sided hemianesthesia and Grade II middle ear barotrauma as the only abnormalities in both cases. Chest X-rays did not reveal any extra-alveolar gas. Diagnoses of Static Neurological Decompression Illness were made and both patients recompressed on a RN 62 table. The first case recovered fully after two treatments, and the second case after one treatment. Magnetic resonance imaging (MRI) of the brain and bubble contrast echocardiography performed on the first case 6 mo after the incident were reported to be normal. The second case was lost to follow-up. Decompression illness (DCI) generally occurs in occupational groups such as compressed air workers, divers, aviators, and astronauts. This is believed to be the first report of DCI occurring among aircraft's ground maintenance crew.
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PMID:Cerebral arterial gas embolism in air force ground maintenance crew--a report of two cases. 1041 7

We describe the case of a 56-year-old man who presented with numbness and tingling of the extremities, weakness, and fatigue. Laboratory findings included anemia and thrombocytopenia. A diagnosis of intravascular lymphomatosis was established when liver, omentum, and bone marrow samples were examined. A review of the literature reveals that most cases of intravascular lymphomatosis have cytopenias, mainly anemia and thrombocytopenia, but bone marrow involvement is rare. In our case, a subtle neoplastic infiltrate in the marrow sinusoids was highlighted with a B-cell marker. While immunohistochemical analysis was not performed in most reported cases in the literature, our studies suggest that a systematic search in bone marrow of cases of intravascular lymphomatosis may reveal unsuspected neoplastic cells. We conclude that bone marrow involvement in intravascular lymphomatosis appears to be rare, has subtle features, and is difficult to diagnose if unsuspected and not searched for.
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PMID:Intravascular lymphomatosis with bone marrow involvement. 1050 53

Sixty consecutive patients who had undergone replacement of dental amalgam fillings and a protocol of nutritional support and heavy metal detoxification using dimercapto-propanyl-sulfate and neural therapy were surveyed. A questionnaire was mailed to the patients and 42 responded, resulting in a response rate of 70%. The reasons for undergoing treatment were many, ranging from a patient's desire to avoid potential health problems in the future to treatment of serious current disease. Although medical diagnoses were made when possible before treatment, this survey studied only the patients' estimations of their most distressing symptoms and their evaluations of response to treatment. The most common complaints were problems with memory and/or concentration; muscle and/or joint pain; anxiety and insomnia; stomach, bowel, and bladder complaints; depression; food or chemical sensitivities; numbness or tingling; and eye symptoms, in descending order of frequency. The most distressing symptoms were headache and backache, fatigue, and memory and concentration problems. Headache and backache responded best to treatment, but all symptoms showed considerable improvement on average. Of the respondents, 78% reported that they were either satisfied or very satisfied with the results of treatment, and 9.5% reported that they were disappointed.
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PMID:Results of dental amalgam removal and mercury detoxification using DMPS and neural therapy. 1089 13

The authors examined donor-site complications and morbidity in 37 patients after reconstruction with free or pedicled anterolateral thigh flaps. Intraoperative assessment included damage to the vastus lateralis muscle and whether the main pedicle of the rectus femoris muscle had been killed. Postoperative assessment of the donor site included wound healing, range of motion, muscle strength, gait, and sensation. Patients were surveyed with a questionnaire about fatigue in their activities of daily life and the appearance of the donor site. All 32 patients who underwent primary skin closure could perform activities of daily life normally, and most (87.5 percent) reported that donor-site appearance was satisfactory. However, the severity of donor-site dysfunction was related to the degree of damage to the vastus lateralis muscle, and most patients (87.5 percent) had some loss of sensation at the anterolateral aspect of the thigh. Because of adhesions between the meshed skin graft and the underlying fascia, range of motion at the hip and knee was limited in significantly more patients who had received split-thickness skin grafts (60 percent) than patients who had undergone primary skin closure (3.1 percent). Therefore, wider flaps or flaps harvested nearer the knee may increase donor-site morbidity. The authors concluded that the incidence of long-term morbidity with the anterolateral thigh flap is low, although it is increased when the flap includes the vastus lateralis muscle or is wider and requires additional skin grafting at the donor site.
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PMID:Anterolateral thigh flap donor-site complications and morbidity. 1098 64

Patients with a soft tissue malignancy involving the sciatic nerve who present with neurologic loss generally are advised to have an amputation. Twenty patients who underwent limb-sparing procedures with complete resection of the sciatic nerve as treatment for neurofibrosarcomas (12 patients), liposarcomas (four patients), malignant fibrous histiocytomas (two patients), recurrent desmoid tumor (one patient), and epithelioid hemangioendothelioma (one patient) were reviewed retrospectively. The mean age of these nine women and 11 men at the time of surgery was 51 years (range, 28-84 years). The right sciatic nerve was affected in 12 patients. These tumors were large and high grade. A mean of 22 cm of the nerve had to be resected (range, 8-42 cm). Ten patients received preoperative radiotherapy and 16 patients had intraoperative or postoperative radiotherapy. At a mean followup of 35 months (range, 7-97 months), 14 of the 20 patients were alive. Two patients had local recurrences develop (10%), whereas 12 patients had distant metastases. The function of the 10 patients as assessed by the Toronto Extremity Salvage Score averaged 74%. Most patients indicated that walking in the house is not difficult, but walking is compromised as soon as an effort is needed. Four patients walk without a cane, four needed one cane, and two needed two canes. The patients experienced stiffness, a sense of numbness, and premature fatigue. The use of analgesics was infrequent. Generally, patients rated themselves to be mildly to moderately disabled. From this small number of patients, it is shown that a tumor involving the sciatic nerve can be treated by limb-sparing surgery, including complete nerve resection, as an alternative to hip disarticulation or hindquarter amputation because the limb salvage option provides an acceptable functional outcome.
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PMID:Sciatic nerve resection in the thigh: a functional evaluation. 1115 2

The most common symptoms of chronic beriberi due to thiamine deficiency include dyspnoea, fatigue, leg oedema, lower extremity weakness and numbness. When collapsed peripheral circulation, metabolic acidosis, or shock are present, the disease has advanced from chronic beriberi to pernicious or fulminating beriberi heart failure (Shoshin beriberi). We report two patients with fulminating beriberi; both of whom had been incarcerated at a detention centre for 5 months before hospitalization. A prolonged monotonous diet, low in thiamine, was a major risk factor in both patients. Thiamine deficiency should be considered for any patient with symptoms and signs compatible with beriberi.
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PMID:Cardiac beriberi among illegal mainland Chinese immigrants. 1127 46


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