Hilar cholangiocarcinoma has been reputed as a slow growth tumor in the past. Skeletal muscle is one of the most unusual sites of metastasis from any malignancy. We report herein a case of hilar cholangiocarcinoma wit...Hilar cholangiocarcinoma has been reputed as a slow growth tumor in the past. Skeletal muscle is one of the most unusual sites of metastasis from any malignancy. We report herein a case of hilar cholangiocarcinoma with synchronous metastases to skeletal muscle and breast, and review the literature. The patient was a 48-year-old woman who presented with jaundice and weight loss. An inoperable hilar cholangiocarcinoma was diagnosed. She was treated with a combination of endoscopic plastic stent biloiary drainage and three-dimensional conformal radiotherapy （3DCRT）. Good response was achieved. Ten months later, she exhibited with a painful metastatic mass in the muscle rectus femoris of left thigh and a painless mass in the left breast. She underwent operation to relieve the pain, but died from liver failure after 8 months. The literature only offers isolated cases of cholangiocarcinoma with distant metastases, of which the common sites were cervical lymph node, bone, and portal venous system. Most patients were presented with multiple metastases with extensive local disease.展开更多
AIM:To examine the frequency and prevention of musculoskeletal pain in Japanese gastrointestinal endoscopists and non-endoscopist physicians.METHODS:Questionnaires were sent to 275 endoscopists and 173 non-endoscopist...AIM:To examine the frequency and prevention of musculoskeletal pain in Japanese gastrointestinal endoscopists and non-endoscopist physicians.METHODS:Questionnaires were sent to 275 endoscopists and 173 non-endoscopists working in Hiroshima University Hospital and its affiliated hospitals.RESULTS:The completed questionnaires were returned by 190(69%)endoscopists and 120(69%)non-endoscopists.The frequency of pain in the hand and wrist,and especially the left thumb,was significantly higher in endoscopists than in non-endoscopists(17%vs 6%,P=0.004).Using multivariate analysis,the only significant factor associated with this pain was the age of the endoscopist(odds ratio 2.77,95%confidence interval,1.23-6.71,P=0.018).Interestingly,endoscopists had made significantly fewer modifications to their endoscopic practices than non-endoscopists(12%vs 33%,P <0.0001)to prevent pain.CONCLUSION:Pain in the hand and wrist may be endoscopy-related.However,endoscopists made little modifications in practice to prevent such pain.More attention to prevention appears necessary.展开更多
Malaysia is the biggest crude palm oil exporter to the world market for the last 16 years. However this achievement is still be overshadowed by the harvesting method which is conventional and labor intensive. An attem...Malaysia is the biggest crude palm oil exporter to the world market for the last 16 years. However this achievement is still be overshadowed by the harvesting method which is conventional and labor intensive. An attempt to use mechanization into the harvesting system, in particular the cutting process of tall palm trees, has been unsuccessful. At the beginning of the oil palm＇s fruit bearing fife, i.e. 3 to 4 years of age, fi＇uit bunches are still accessible. For these palms, a chisel is used to cut the fiuit bunches. Growth is such 8-10 years, and the trees have already reached substantial height. In these cases a sickle mountedon flexible telescopic aluminum tube （pole） is used. This, however, exposes plantation worker to the risk of musculoskeletal discomfort and injury. This paper examines the problems by assessing the task posture and tool, and their implications for operators, using questionnaire survey and videotape analysis techniques. The result prevails that there is evidence to associate the problems of musculoskeletal disorders among the operators.展开更多
文摘Hilar cholangiocarcinoma has been reputed as a slow growth tumor in the past. Skeletal muscle is one of the most unusual sites of metastasis from any malignancy. We report herein a case of hilar cholangiocarcinoma with synchronous metastases to skeletal muscle and breast, and review the literature. The patient was a 48-year-old woman who presented with jaundice and weight loss. An inoperable hilar cholangiocarcinoma was diagnosed. She was treated with a combination of endoscopic plastic stent biloiary drainage and three-dimensional conformal radiotherapy （3DCRT）. Good response was achieved. Ten months later, she exhibited with a painful metastatic mass in the muscle rectus femoris of left thigh and a painless mass in the left breast. She underwent operation to relieve the pain, but died from liver failure after 8 months. The literature only offers isolated cases of cholangiocarcinoma with distant metastases, of which the common sites were cervical lymph node, bone, and portal venous system. Most patients were presented with multiple metastases with extensive local disease.
文摘AIM:To examine the frequency and prevention of musculoskeletal pain in Japanese gastrointestinal endoscopists and non-endoscopist physicians.METHODS:Questionnaires were sent to 275 endoscopists and 173 non-endoscopists working in Hiroshima University Hospital and its affiliated hospitals.RESULTS:The completed questionnaires were returned by 190(69%)endoscopists and 120(69%)non-endoscopists.The frequency of pain in the hand and wrist,and especially the left thumb,was significantly higher in endoscopists than in non-endoscopists(17%vs 6%,P=0.004).Using multivariate analysis,the only significant factor associated with this pain was the age of the endoscopist(odds ratio 2.77,95%confidence interval,1.23-6.71,P=0.018).Interestingly,endoscopists had made significantly fewer modifications to their endoscopic practices than non-endoscopists(12%vs 33%,P <0.0001)to prevent pain.CONCLUSION:Pain in the hand and wrist may be endoscopy-related.However,endoscopists made little modifications in practice to prevent such pain.More attention to prevention appears necessary.
文摘Malaysia is the biggest crude palm oil exporter to the world market for the last 16 years. However this achievement is still be overshadowed by the harvesting method which is conventional and labor intensive. An attempt to use mechanization into the harvesting system, in particular the cutting process of tall palm trees, has been unsuccessful. At the beginning of the oil palm＇s fruit bearing fife, i.e. 3 to 4 years of age, fi＇uit bunches are still accessible. For these palms, a chisel is used to cut the fiuit bunches. Growth is such 8-10 years, and the trees have already reached substantial height. In these cases a sickle mountedon flexible telescopic aluminum tube （pole） is used. This, however, exposes plantation worker to the risk of musculoskeletal discomfort and injury. This paper examines the problems by assessing the task posture and tool, and their implications for operators, using questionnaire survey and videotape analysis techniques. The result prevails that there is evidence to associate the problems of musculoskeletal disorders among the operators.
