Infiltrative nature of tumor-induced osteomalacia lesions in bone: Correlation between radiological and histopathological features

ObjectiveTumor-induced osteomalacia is a rare paraneoplastic syndrome usually caused by phosphaturic mesenchymal tumors, which commonly occur in bone. This study aimed to investigate the radiological features of tumor-induced osteomalacia lesions in bone, and their correlation with its histopathology.Materials and methodsThis study included 13 patients with tumor-induced osteomalacia treated between January 2000 and April 2018 at our hospital. All patients were surveyed to detect the tumor causing the condition. Diagnostic imaging studies of the suspected tumors were obtained before tumor removal. We evaluated the radiological features of all tumors, investigated histopathological findings in 10 cases that underwent surgery, and obtained evaluable tumor specimens.ResultsThe tumors were classified into the following three types by CT: sclerotic (n = 4), lytic (n = 7), and mixed (n = 2). In two cases, lytic lesions focally invaded the surrounding cancellous bone, detected by the soft tissue-window of CT, not the bone-window. Histopathology revealed inter-trabecular invasion in all cases, regardless of radiological features. Osteoclasts were seen in lytic types, and creeping substitution-like thickened trabecular bone and calcification were observed in sclerotic types. In all cases, focal invasion of the tumor into cortical bone was seen.ConclusionsTumor-induced osteomalacia lesions in bone showed a wide variety of radiological features, and tended to invade into cancellous and cortical bone. These findings suggest that extended curettage or resection of thinned cortical bone may be necessary. This might improve the cure rate of surgeries for tumor-induced osteomalacia lesions in bones.     

Adaptation and limitation of anterior column reconstruction for pyogenic spondylitis in lower thoracic and lumbar spine

Background

Surgical strategy for pyogenic spondylitis is controversial when vertebral body erosion is severe. Radical debridement and anterior column reconstruction is indicated for the purpose of early ambulatory to prevent secondary complication for long bed rest. However, such aggressive debridement and risk of perioperative complications are trade-off. The purpose of this study was to evaluate the risk factor of poor prognosis after anterior column debridement and reconstruction for pyogenic spondylitis in lower thoracic and lumbar spine.

Prognostic factors associated with the surgical indication for lumbar spinal stenosis patients less responsive to conservative treatments: An investigator-initiated observational cohort study

Background

A few cohort studies have determined which patients with lumbar spinal stenosis are likely to need surgery because of the deterioration of symptoms. However, there are still insufficient data regarding the management of lumbar spinal stenosis due to lack of prognostic factors associated with the need for surgery. The purpose of this study was to identify the prognostic factors associated with the need for surgical treatment in patients with lumbar spinal stenosis.

Prediction of quadriceps strength recovery after anterior cruciate ligament reconstruction with a hamstring autograft: Decision tree analysis

Background

The wide variations in patient demographics and concomitant injuries make the prediction of which patients will regain strength quickly following anterior cruciate ligament (ACL) reconstruction challenging. This study aimed to identify the dominant factor affecting quadriceps strength recovery after ACL reconstruction with a hamstring tendon autograft and to construct a predictive model for quadriceps strength recovery using decision tree analysis.

Co-existence of ossification of the nuchal ligament is associated with severity of ossification in the whole spine in patients with cervical ossification of the posterior longitudinal ligament -A multi-center CT study-

Background

Previous studies have shown that patients with cervical ossification of the posterior longitudinal ligament (OPLL) often have co-existing ossification of the nuchal ligament (ONL). However, no studies have focused on ONL and its relevance to the severity of OPLL or ossification of other spinal ligaments, such as anterior longitudinal ligament (OALL), ligamentum flavum (OLF), and supraspinous/interspinous ligament (OSIL).

Associated lateral/medial knee instability and its relevant factors in anterior cruciate ligament-injured knees

Background

Associations of lateral/medial knee instability with anterior cruciate ligament (ACL) injury have not been thoroughly investigated. The purposes of this study were to investigate whether lateral/medial knee instability is associated with ACL injury, and to clarify relevant factors for lateral/medial knee instability in ACL-injured knees.

Direct anterior versus anterolateral approach in one-stage supine total hip arthroplasty. Focused on nerve injury: A prospective,randomized, controlled trial

Background

The difference in clinical results between the direct anterior approach (DAA) and the anterolateral approach (ALA) for total hip arthroplasty (THA) is still unclear. The purpose of this study was to compare clinical results, including nerve injuries, between DAA and ALA in one-stage bilateral THA in a prospective, randomized controlled trial.

The effect of multiple lesions in patients with ossification of the posterior longitudinal ligament of the cervical spine

PurposeOssification of the posterior longitudinal ligament of the cervical spine (cervical OPLL) is associated with the lesions at the thoracic and/or lumbar spine. Multiple spinal lesions cause additional neurological deficit, affecting the outcomes of cervical laminoplasty. This study aimed to clarify the effect of multiple lesions on the outcomes of cervical laminoplasty and to compare the results with data from patients without them.MethodsFrom April 1981 to October 2015, 201 patients underwent laminoplasty for cervical OPLL; however, 167 patients were followed for >2 years. Twenty-four patients underwent additional surgery for multiple lesions due to spinal stenosis. The pathologies of the lesions were assessed. The patients were divided into two groups: the thoracic and thoraco-lumbar group (T-group: 8 patients) and the lumbar group (L-group: 16 patients). One-hundred patients without an additional surgery served as the control group. The maximum Japanese Orthopaedic Association (JOA) score and the most recent score for recovery was compared between the multiple and control groups.ResultsThe maximum score and recovery rate and the score and recovery rate at the last follow-up in the multiple group were lower than those in the control group. There was no significant difference in the postoperative JOA score and recovery rate between the T-group and the L-group.ConclusionsNeurological recovery in patients with multiple lesions was poorer than in those without lesions. Therefore, special attention should be paid to cervical OPLL with multiple spinal lesions.     

Anatomical relationship between insertion sites,tunnel placement,and lateral meniscus anterior horn injury during single and double bundle anterior cruciate ligament reconstructions: A comparative macroscopic and histopathological evaluation in cadavers

PurposeThe influence of tunnel extension outside the anatomical anterior cruciate ligament (ACL) insertion in single-bundle (SB) or double-bundle (DB) ACL reconstruction is unclear. This study aimed to investigate the anatomical relationship between ACL insertion and tunnel extension in SB and DB ACL reconstruction, and the impact of tibial tunnel extension to the insertion of anterior horn of lateral meniscus in terms of injury.MethodsForty-six paired cadaver knees (mean age, 82.7 ± 10.7 years) were used. Right and left knees were used for SB (10 mm) and DB tunnel reaming (6 mm for the anteromedial and posterolateral bundles). Tibial and femoral tunnels were created to aim at the center of the ACL insertion by arthroscopic visualization. The relationship between tunnel extension and ACL insertion was evaluated macroscopically, and there ratio in two groups were compared by chi-square test. Further, the relative risk for meniscus injury based on tunnel placement was estimated. Coronal section of tibia and parallel section to Blumensaat line in femur were prepared to evaluate the relationship among tunnel position, ACL insertion, and anterior horn of the meniscus histologically.ResultsTibial tunnel extension out of the ACL insertion was observed macroscopically in 9 (39.1%) knees of the SB group, and 3 (13.0%) of the DB group (p = 0.045). In femoral tunnels, extension out of the ACL insertion was seen in 8 (34.8%) knees of the SB group and 1 (4.3%) of the DB group (p = 0.011). Partial injuries of the lateral meniscus anterior horn (LMAH) were observed in 5 (21.7%) knees of the SB group and 1 (4.3%) knee of the DB group (p = 0.091). The relative risk for LMAH injury was calculated as 5.0 (odds ratio, 6.1). Microscopically, SB tunnels appeared to expand out of ACL insertion, both in the femur and tibia.ConclusionsThe incidence of tunnel extension out of the ACL insertion in femur and tibia were higher with SB than with DB reconstruction. Furthermore, injury rate of the LMAH in the DB group was lower.     

Total cavopulmonary shunt with replacement of common atrioventricular valve for an infant with single atrium and single ventricle

A 22-month-old male infant with single atrium, single ventricle, regurgitant common atrioventricular valve, pulmonary atresia, patent ductus arteriosus, and inferior vena cava defect with azygos connection was treated successfully with total cavopulmonary shunt and replacement of the common atrioventricular valve. The indications for total cavopulmonary shunt in the management of univentricular heart with azygos continuity are discussed.     

Considerations on the Factors Influencing Living Kidney Donors' Autonomous Decision-Making: A Systematic Literature Review

As outcomes of organ transplantation have improved with advances in medicine, managing medical ethics issues has become increasingly more important. Although a basic consensus has been formed on the respect of autonomy in decision-making by prospective donors regarding living kidney transplantation, concrete and practical measures at the clinical site are required to ensure donor autonomy.The aim of the study was to identify elements related to autonomy in the kidney donor decision-making process.

Mortality and morbidity after hepatic resection in patients undergoing hemodialysis: analysis of a national inpatient database in Japan

Background

Whether patients undergoing hemodialysis have greater risks of mortality and morbidity after hepatic resection remains unclear.

Tunnel malpositions in anterior cruciate ligament risk cartilaginous changes and bucket-handle meniscal tear: Arthroscopic survey in both primary and revision surgery

Objectives

There are not many chances to arthroscopically reassess how graft tunnel malpositions in primary anterior cruciate ligament reconstruction (ACLR) associate with intra-articular degeneration in revision ACLR. This study was aimed to evaluate whether radiographic tunnel position in primary ACLR affect cartilaginous changes and bucket-handle meniscus tears in revision ACLR.

Long-term results of a prospective study of anterior decompression with fusion and posterior decompression with laminoplasty for treatment of cervical spondylotic myelopathy

Background

There have been no prospective studies comparing anterior surgery and posterior method in terms of long-term outcomes. The purposes of this study is to clarify whether there is any difference in long-term clinical and radiologic outcomes of anterior decompression with fusion (ADF) and laminoplasty (LAMP) for the treatment of cervical spondylotic myelopathy (CSM).

Centralization of extruded medial meniscus delays cartilage degeneration in rats

Background

Meniscus extrusion often observed in knee osteoarthritis has a strong correlation with the progression of cartilage degeneration and symptom in the patients. We recently reported a novel procedure “arthroscopic centralization” in which the capsule was sutured to the edge of the tibial plateau to reduce meniscus extrusion in the human knee. However, there is no animal model to study the efficacy of this procedure. The purposes of this study were [1] to establish a model of centralization for the extruded medial meniscus in a rat model; and [2] to investigate the chondroprotective effect of this procedure.

Comparison of three approaches for femoral tunnel during double-bundle anterior cruciate ligament reconstruction: A case controlled study

Background

It is still controversial whether which femoral tunnel creation technique is best during anterior cruciate ligament reconstruction (ACLR). We aimed to clarify the features of three different techniques based on the femoral tunnel position created with the same tunnel-creating concept and the measurement data.

Effect of hip fracture surgery within 24 hours on short-term mobility

BackgroundHip fracture constitutes a high-mortality injury in elderly patients. In addition, caregiver burden is also a relevant issue, as patients after hip fracture surgery lose ambulation and require support in the perioperative period and after discharge. Early surgery is recommended to improve mortality. However the positive effect of early surgery on the short-term postoperative ambulatory function is unknown. The objective of this study was to determine whether a shorter waiting time for hip fracture surgery improves short-term postoperative mobility in elderly patients. We used the cumulated ambulation score (CAS), a feasible function scoring system using low-demand activities, to measure short-term postoperative mobility.MethodsIn this retrospective, observational study of 175 hip fracture patients at a single hospital, the patients were divided based on the waiting period for surgery (within 24 hours of arrival, early group; after 24 hours of arrival, delayed group). The primary outcome was postoperative mobility, assessed using the CAS. Multivariable linear regression analysis with adjustment for covariates, age, sex, mobility before injury, comorbidity, presence of dementia and type of fracture. As a subgroup analysis, cognitive function and the interaction between the surgical waiting time and the presence of dementia were considered.ResultsThe early group had a significantly better CAS (adjusted beta = 1.36; 95% confidence interval [95% CI]: 0.24–2.48, p = 0.02) than the delayed group. Significant CAS improvement was observed among cognitively intact patients (adjusted beta = 2.66; 95% CI: 0.62–4.69, p = 0.01), but not among those with dementia (adjusted beta = 0.43; 95% CI: ?0.93 to 1.79, p = 0.53). However, the interaction between the surgical waiting time and the presence of dementia in the entire population did not reach statistical significance (p for interaction = 0.15).ConclusionsHip fracture surgery within 24 hours could improve the recovery of postoperative ambulatory function faster. The postoperative caregiver burden would be reduced by early surgery.