Dokkyo Medical University Repository / 獨協医科大学リポジトリ
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A Case of Delayed Diagnosis of Acute Pyelonephritis in a Horseshoe Kidney in an Elderly Patient
Get PDFIt is difficult for clinicians to predict the existence of undiagnosed asymptomatic congenital malformation, particularly in the emergency department (ED) setting. While it is sometimes directly associated with disease prevalence and clinical manifestation, we could overlook this significant background information without awareness. When an elderly patient with undiscovered malformation came to ED, the situation might become more challenging because their presentations are often ambiguous or atypical compared to younger patients. This leads to diagnostic delay due to some cognitive biases. In such situations, analytical thinking, especially consideration from the anatomical or physiological perspectives, should be warranted as well as intuitive thinking based on reconsidering the patient’s sensitivity of specific diseases. Herein, we report a good example: delayed diagnosis of acute pyelonephritis in a horseshoe kidney in an 83-year-old woman.journal articl
Gait Disturbance after Excision of Hamstrings and Effect of an Ankle-Foot Orthosis; A Case Report
Get PDFLimb-sparing surgery is important treatment for soft tissue sarcoma, but resection of major muscles in the lower extremities causes motor and gait dysfunction. However, we have experienced limb-sparing patients who have had significant improvement in their ability to walk.
We present the case of a 52-year-old woman who had limb-sparing surgery for soft tissue sarcoma that removed hamstring muscles (biceps femoris, semimembranosus, and semitendinosus). After surgery, the patient suffered from gait disturbance but was able to stabilize her gait by wearing ankle-foot orthosis. The patient underwent knee flexor strength testing and gait analysis with and without the ankle-foot orthosis. The maximum torque of the knee flexor muscles was higher when the patient used the ankle-foot orthosis than without it. Gait analysis demonstrated improvement of knee flexion with the ankle-foot orthosis. The surface electromyogram showed that gastrocnemius activity was increased markedly by using the ankle-foot orthosis.
The ankle-foot orthosis not only fixed the ankle in place to avoid foot drop, but also allowed gastrocnemius to act effectively as a knee flexor muscle after hamstring resection. We recommend using an ankle-foot orthosis to improve the gait of patients who have undergone hamstring resection because of a soft tissue tumor, infection, or trauma.journal articl
Evaluations of left anterior descendant coronary artery stenosis by transthoracic doppler echocardiography as compared with physiological parameters measured by pressure wire
Get PDF獨協医科大学博士（医学）令和3年度doctoral thesi
