A comparative analysis of sagittal spinopelvic alignment between young and old men without localized disc degeneration

Introduction

The purpose of this study was to compare the sagittal spinopelvic parameters between young normal asymptomatic adults and older normal asymptomatic adults without localized segmental disc degeneration.

Materials and methods

Standing sagittal radiographs of the whole spine including the pelvis in 342 adult male volunteers (Group 1: n = 184, average age 21.2 years, range 19–28 vs. Group 2: n = 158, average age 63.8 years, range 53–79) were analyzed prospectively. Volunteers with history of spine operation, spinal disease, chronic pain in their back or legs, scoliosis, spondylolisthesis, 1–3 segmental disc space narrowing, and/or compression fractures in radiographs were excluded. The following parameters were included: thoracic kyphosis between T5 upper endplate (UEP) and T12 lower endplate (LEP), thoracolumbar kyphosis (T10 UEP ? L2 LEP), T12 LEP-horizontal (H) angle (minus denotes EP above the H line), lumbar lordosis (T12 LEP ? S1 UEP), lower lumbar lordosis (L4 UEP ? S1 UEP), sacral slope, pelvic incidence and distances from C7 plumb/T12 plumb to the postero-superior endplate of S1. Group 2 (old men group) demonstrated larger thoracic kyphosis (30.1° ± 8.6° vs. 21.1° ± 7.8° in Group 1, P < 0.001), thoracolumbar kyphosis (10.0° ± 7.5° vs. 2.8° ± 7.1° in Group 1, P < 0.001), total lumbar lordosis at T12–S1 (57.3° ± 8.8° vs. 52.2° ± 9.2° in Group 1, P < 0.001), lower lumbar lordosis at L4–S1 (39.4° ± 6.7° vs. 32.4° ± 6.4° in Group 1, P < 0.001), a higher ratio of lower to total lumbar lordosis (69.5 ± 11.6 vs. 62.7 ± 10.6 % in Group 1, P < 0.001) and T12 LEP-H angle (?20.4° ± 5.7° vs. ?15.7° ± 5.1° in Group 1, P < 0.001). There were no significant differences in sacral slope (36.5° ± 7.3° in Group 1 vs. 36.8° ± 6.7° in Group 2, P = 0.67) and pelvic incidence (46.5° ± 7.7° in Group 1 vs. 48.2° ± 8.5° in Group 2, P = 0.06). There was no significant difference in the measurement of distance from C7 plumb to the postero-superior endplate of S1 (?0.7 ± 2.4 cm in Group 1 vs. ?0.3 ± 2.7 cm in Group 2, P = 0.197). However, the distance from T12 plumb to the postero-superior endplate of S1 (?0.7 ± 1.7 cm in Group 1 vs. ?2.2 ± 1.7 cm in Group 2, P < 0.001) demonstrated a significant difference.

Conclusion

The old men group demonstrated a significant increase in thoracic kyphosis, thoracolumbar kyphosis, total and lower lumbar lordosis, a higher ratio of lower to total lumbar lordosis, and a longer distance from T12 plumb to the postero-superior endplate of S1 without changes in sacral slope and global sagittal balance.     

Pancreatic Atrophy Relative to External Versus Internal Drainage of the Pancreatic Duct After Pylorus-Preserving Pancreaticoduodenectomy

Background

Atrophy of the pancreatic parenchyma, which occurs frequently after pylorus-preserving pancreaticoduodenectomy (PPPD), is often associated with pancreatic exocrine insufficiency. Many surgeons prefer to insert a drainage tube into the remnant pancreatic duct primarily to prevent pancreatic leakage at the pancreaticojejunostomy (PJ) after PPPD. Drainage methods vary widely but can be roughly classified as internal or external drainage. This study intended to evaluate their effects on pancreatic parenchymal atrophy following PPPD.

Methods

Fifty-seven patients who underwent PPPD were retrospectively divided into two groups, 28 who underwent external and 29 who underwent internal pancreatic drainage. External drainage tubes were removed 4 weeks after PPPD. The volume of the pancreatic parenchyma was serially measured on abdominal computed tomography (CT) scans before PPPD, as well as 7 days and 3, 6, and 12 months after surgery. Degree of pancreatic parenchymal atrophy was determined by calculating pancreatic volume relative to that on day 7.

Results

Univariate analysis showed that patient sex, age, body mass index, concurrent pancreatitis, pathology, and types of PJ did not significantly affect changes in pancreatic volume following PPPD. The degree of pancreatic volume atrophy did not differ significantly in the external and internal drainage groups. No patient in the external drainage group experienced drainage-related surgical complications. The incidence of PJ leak was comparable in the two groups. Postoperative pancreatic atrophy did not induce new-onset diabetes mellitus at 1 year.

Conclusions

Both external and internal pancreatic drainage methods showed similar atrophy rate of the pancreatic parenchyma following PPPD.     

Muscle involvement in Dent disease 2

Background

Dent disease, an X-linked recessive renal tubulopathy, is caused by mutations in either CLCN5 (Dent disease 1) or OCRL (Dent disease 2). OCRL mutations can also cause Lowe syndrome. In some cases it is difficult to differentiate Dent disease 1 and 2 on the basis of clinical features only without genetic tests. Several studies have shown differences in serum levels of muscle enzymes between these diseases. The aim of our study was to test the validity of these findings.

Methods

In total, 23 patients with Dent disease 1 (Group A), five patients with Dent disease 2 (Group B) and 19 patients with Lowe syndrome (Group C) were enrolled in our study. The serum levels of three muscle enzymes [creatine phosphokinase (CPK), lactate dehydrogenase (LDH), aspartate aminotransferase (AST)], were measured. The levels of a hepatic enzyme, alanine aminotransferase (ALT), were also measured as a control.

Results

One patient in Group B had muscle hypoplasia of both upper extremities. The serum levels of all three muscle enzymes assayed were higher in Group B or C patients than in Group A patients. Serum ALT levels were normal in all three groups of patients.

Conclusions

The serum levels of muscle enzymes in patients with Dent disease can be used as a biomarker to predict genotypes, even though the patients do not have clinical symptoms of muscle involvement.     

Fucosyl neoglycoprotein binds to mouse epididymal spermatozoa and inhibits sperm binding to the egg zona pellucida

Glycan epitopes of cellular glycoconjugates act as versatile biochemical signals, and this sugar coding plays an important role in cell‐to‐cell recognition processes. In this study, our aims were to determine the distribution of sperm receptors with activity for fucosyl‐ and galactosyl glycans and to address whether monosugar neoglycoproteins functionally mimic the binding between zona pellucida (ZP) glycoproteins and spermatozoa. In mouse epididymal spermatozoa with intact acrosomes, fucopyranosyl bovine serum albumin (BSA‐Fuc) bound to the segment of the acrosome, the equatorial segment, and the postacrosome region of the sperm head. Galactosyl BSA (BSA‐Gal) binding activity was similar to that of BSA‐Fuc, but was weaker. In acrosome‐reacted spermatozoa treated with the Ca²⁺ ionophore A23187, BSA‐zuc binding was lost in the apical segment of the acrosome but remained in the equatorial segment and postacrosome regions. BSA‐Gal binding to the equatorial region was increased. In the presence of 2.5 μg ml^?1 BSA‐Fuc, in vitro sperm–ZP binding was significantly decreased, indicating that fucosyl BSA functionally mimics ZP glycoproteins during sperm–egg ZP interactions. At the same concentration, BSA‐Gal was not effective. Fucosyl BSA that efficiently inhibited the sperm–ZP binding can mimic the ZP glycoconjugate and has potential for use as a sperm fertility control agent in mouse.     

Umbilical portion of recipient's left portal vein: a useful vascular conduit in dual living donor liver transplantation for the thrombosed portal vein.

We considered performing living donor liver transplantation (LDLT) in a larger-size recipient. When the recipient was large-sized, or when the donor liver was severely steatotic or had a right-to-left volume discrepancy. We devised dual living donor liver transplantation (DLDLT) to make up for graft size insufficiency and to secure the donor's safety. However, portal vein thrombosis (PVT) presented a challenge for DLDLT because of the need for intact right and left portal veins for the implantation of both liver grafts. Our 52-year-old male patient with hepatitis B cirrhosis had suffered from repeated esophageal and gastric variceal bleeding and underwent 2 trials of a transjugular intrahepatic portosystemic shunt (TIPS). He developed TIPS occlusion and PVT involving the area just above the spleno-mesenteric confluence to the right and left PV. Also, the right PV orifice was destructed and difficult to isolate because of severe periportal inflammation and neointima growth in the TIPS mesh. The patient's two sons were inadequate for donation because of right-to-left volume discrepancy. Therefore, DLDLT using 2 left lobes was necessary to compensate for graft-size insufficiency and to secure donor safety, and we substituted an intact umbilical portion of recipient's left PV for the destroyed right PV. The patient recovered well, and liver function has been normal for more than a year. In conclusion, the umbilical portion of recipient's left PV can be a useful vascular substitute for the reconstruction of a thrombosed main portal branch in DLDLT.     

Esophagogastric neoplasms: palliation with a modified gianturco stent.

Self-expanding metallic stents of a modified Gianturco design were used for palliative treatment of malignant esophagogastric strictures. Over a 10-month period, 10 stents were placed in nine patients. All patients with severe dysphagia due to malignant strictures in whom all other treatment options had failed were candidates for these stents. Neither extensive length of esophageal involvement nor complete esophageal obstruction was a contraindication. All stents were placed with fluoroscopic guidance without any technical failures or procedural morbidity or mortality. Mild reflux occurred in three patients in whom the stent tubes straddled the distal esophageal sphincter. Five patients were still alive after 1-8 months. The remaining four patients died 6-28 weeks after stent placement; all stents were patent at the time of death. These stents are easy to insert, safe, and reasonably effective for short-term palliative treatment of esophagogastric neoplasms.     

Arthroscopy of the first metatarsophalangeal joint in 59 consecutive cases

The authors analyzed the results of 59 consecutive cases of the first metatarsophalangeal (MTP-I) joint arthroscopy to verify the efficacy and safety of the procedure. Fifty-nine patients were followed for >18 months after MTP-I joint arthroscopic procedures. The mean duration of follow-up was 25 months. Clinically, the American Orthopaedic Foot and Ankle Society (AOFAS) hallux metatarsophalangeal-interphalangeal scale and the satisfaction of the patients were evaluated. Hallux valgus angle, the first intermetatarsal angle, and medial sesamoid position were analyzed in cases of hallux valgus. The American Orthopaedic Foot and Ankle Society hallux metatarsophalangeal-interphalangeal scale score was increased from 69 points preoperatively to 92 points postoperatively (p < .05). Radiologically, the mean hallux valgus angle was decreased from 29.2° preoperatively to 9.7° postoperatively (p < .05). The mean first intermetatarsal angle was decreased from 14.8° preoperatively to 7.7° postoperatively (p < .05). The medial sesamoid position was improved from 4.8 preoperatively to 2.0 postoperatively (p < .05). Ninety-five percent of the patients were satisfied with the procedures. There was 1 case of a wound problem and 1 case of temporary digital nerve injury as complications. Based on our experience, arthroscopy of MTP-I joint appears to be a safe and reproducible procedure for selected cases of MTP-I joint disorders.     

Factors associated with non-orthotopic urinary diversion after radical cystectomy

Introduction

Preoperative factors favoring the performance of non-orthotopic bladder substitution (OBS) after radical cystectomy for muscle-invasive bladder cancer were identified.

Patients and methods

We retrospectively reviewed the medical records of 730 patients who underwent radical cystectomy for urothelial carcinoma of the bladder. After excluding 75 patients who were unable to undergo OBS due to the tumor location or elevated serum creatinine level, we assessed the preoperative factors in the remaining 655 patients. Multivariate logistic regression analysis was performed to identify the independent preoperative predictors of type of urinary diversion.

Results

Of the 655 patients, 171 (26.1%) underwent non-OBS. Patients who underwent non-OBS were more likely to be older and females, to have a lower educational status, non-organ confined disease, more comorbid medical conditions, more impaired performance status, lower body mass index, anemia, azotemia, and hypoalbuminemia, and to be treated by less-experienced surgeons (P?<?0.05 each). After adjusting for provider-based factors, multivariate analysis showed that factors independently associated with non-OBS included advanced age (odds ratio [OR] 4.10, P?<?0.001), female gender (OR 2.08, P?=?0.027), ECOG performance status (??1 vs 0, OR 5.20, P?<?0.001), low educational status (OR 1.59, P?=?0.042), clinically node-positive disease (OR 2.36, P?=?0.003), anemia (OR 1.67, P?=?0.041), azotemia (OR 3.97, P?<?0.001), and hypoalbuminemia (OR 1.84, P?=?0.046).

Conclusion

Several patient-based as well as provider-based factors were associated with the type of urinary diversion after radical cystectomy. Advanced age, female gender, low performance status, low education level, clinically node-positive disease, anemia, hypoalbuminemia, and azotemia were associated with non-OBS, as surgery was performed by relatively inexperienced surgeons.