Lower extremity lymphedema index: a simple method for severity evaluation of lower extremity lymphedema

Measurement of the circumference is the most commonly used method for evaluating extremity lymphedema. However, comparison between different patients is difficult with this measurement. To resolve this problem, we have formulated a new index, lower extremity lymphedema (LEL) index, which can be easily obtained from measurements of the body. We evaluated correlation between lower LEL index and clinical stage in patients with LEL. The LEL indices were significantly correlated with clinical stages and could be used as a severity scale. The LEL index makes objective assessment of the severity of lymphedema through a numerical rating, regardless of the body type. This numerical rating makes the index useful for evaluation of lymphedema severities between different cases.     

Cervical range of motion and alignment after laminoplasty preserving or reattaching the semispinalis cervicis inserted into axis

STUDY DESIGN: A radiographic study in 111 patients using radiographs was conducted. OBJECTIVE: To clarify whether the modified laminoplasty with C3 laminectomy preserving the semispinalis cervicis (SSC) inserted into C2 could maintain the postopertive range of motion (ROM) and sagittal alignment compared with conventional C3-C7 laminoplasty reattaching the muscle to C2. SUMMARY OF BACKGROUND DATA: Intraoperative injury of the SSC is relevant to the significant loss of ROM and the malalignment after laminoplasty. To expose the C3 lamina, however, the SSC inserted into C2 could not be preserved in conventional C3-C7 laminoplasty. METHODS: The ROM and sagittal alignment of 70 patients (group A) (52 men, 18 women, mean age 59 y, mean follow-up period 1 y and 7 mo) with C4-C7 laminoplasty with C3 laminectomy were compared with those of 41 patients (group B) (28 men, 13 women, mean age 59 y, mean follow-up period 2 y and 6 mo) with C3-C7 laminoplasty using radiographs of the cervical spine. RESULTS: Regarding C2-C7 ROM, the postoperative ROM was larger (P=0.003) and the decrease rate of ROM was smaller (P=0.0006), and decreased ROM in extension was smaller (P<0.0001) in group A. Regarding O-C2 ROM, the increased ROM was smaller (P=0.043) and increased ROM in extension was smaller (P=0.001) in group A. Regarding O-C7 ROM, the postoperative ROM was larger (P=0.029) in group A. Regarding the cervical alignment, the increased lordotic angle at O-C2 was smaller (P=0.046) in group A. CONCLUSIONS: This modified laminoplasty preserving the SSC inserted into C2 is an effective procedure for maintaining postoperative ROM, especially in extension, and sagittal alignment of the upper cervical spine well.     

Limitations of activities of daily living accompanying reduced neck mobility after cervical laminoplasty

Introduction After laminoplasty, difficulties with neck mobility often interfere with patients’ activities of daily living (ADL). Although it has been reported that the flexion–extension range of motion significantly decreased after laminoplasty, in many studies using radiographs there were few patient-based outcomes. The purpose of this study was to reveal the frequency, severity and factors related to limitations of ADL accompanying neck mobility after laminoplasty. Materials and methods A total of 58 patients were evaluated after laminoplasty to determine the frequency, severity and pre- and postoperative related factors of postoperative limitations of ADL accompanying each of three neck movements: (1) extension, (2) flexion and (3) rotation. The severity of limitations of each ADL was assessed using a questionnaire that was completed by the patient. Results Difficulties in neck movement, such as rotation (41%), extension (34%) and flexion (17%), in that order (P = 0.001), caused limitations of ADL. The most relevant factor of limitations of ADL accompanying extension, flexion, and rotation were small postoperative O–C7 range of motion (P = 0.0001), small preoperative O–C7 range of motion (P = 0.001), and small postoperative rotation range of motion (P = 0.0005), respectively. Conclusion There were more than a few patients with limitations of ADL accompanying reduced neck mobility after laminoplasty. This knowledge may be useful in the clinical outcomes of cervical laminoplasty.     

Functional development in the infant brain for auditory pitch processing

Understanding how the developing brain processes auditory information is a critical step toward the clarification of infants' perception of speech and music. We have reported that the infant brain perceives pitch information in speech sounds. Here, we used multichannel near-infrared spectroscopy to examine whether the infant brain is sensitive to information of pitch changes in auditory sequences. Three types of auditory sequences with distinct temporal structures of pitch changes were presented to 3- and 6-month-old infants: a long condition of 12 successive tones constructing a chromatic scale (600 ms), a short condition of four successive tones constructing a chromatic scale (200 ms), and a random condition of random tone sequences (50 ms per tone). The difference among the conditions was only in the sequential order of the tones, which causes pitch changes between the successive tones. We found that the bilateral temporal regions of both ages of infants showed significant activation under the three conditions. The stimulus-dependent activation was observed in the right temporoparietal region of the both infant groups; the 3- and 6-month-old infants showed the most prominent activation under the random and short conditions, respectively. Our findings indicate that the infant brain, which shows functional differentiation and lateralization in auditory-related areas, is capable of responding to more than single tones of pitch information. These results suggest that the right temporoparietal region of the infants increases sensitivity to auditory sequences, which have temporal structures similar to those of syllables in speech sounds, in the course of development.     

Clinical comparison of Healon5 and Healon in phacoemulsification and intraocular lens implantation; Randomized multicenter study

PURPOSE: To compare the overall clinical performance during phacoemulsification and intraocular lens (IOL) implantation, the effect on intraocular pressure (IOP), and the effect on corneal endothelium of Healon5 (sodium hyaluronate 2.3%) and Healon (sodium hyaluronate 1.0%) ophthalmic viscosurgical devices (OVDs). SETTING: Multicenter study. METHODS: In this randomized prospective clinical study, the performance of Healon5 (viscoadaptive; dispersive and cohesive) and Healon (cohesive) during cataract surgery was evaluated in 157 patients, 79 with Healon5 and 78 with Healon. Surgeons evaluated the following on a 5-point scale: retention during phacoemulsification (primary endpoint), ease of injection, anterior chamber maintenance during continuous curvilinear capsulorhexis (CCC), facilitation of IOL implantation, and ease of removal from the eye. Masked examiners other than the surgeon performed the following measurements: IOP preoperatively and 5 and 24 hours, 7 days, and 3 months postoperatively; corneal thickness before and 24 hours, 7 days, and 3 months postoperatively; and corneal endothelial cell count preoperatively and 3 months postoperatively. RESULTS: Intraocular retention during phacoemulsification was assessed as good or very good in 77% in the Healon5 group and 8% in the Healon group; the difference was statistically significant (P<.0001, Wilcoxon rank sum test). The Healon5 group had significantly better scores for anterior chamber maintenance during CCC (P<.0001) and facilitation of IOL implantation (P =.032), and the Healon group had significantly better scores for ease of injection (P<.0001) and ease of removal (P<.0001). There were no statistically significant between-group differences in IOP, corneal endothelial cell count, or corneal thickness. CONCLUSIONS: Surgeons rated Healon5 better than Healon in retention during phacoemulsification, anterior chamber maintenance during CCC, and facilitation of IOL implantation. They assessed Healon as easier to inject and remove. There was no difference in safety-related parameters between the 2 OVDs. These findings indicate that Healon5 is effective in cataract surgery.     

Visual cognitive function in infants with intractable epilepsy before and after surgery

Purpose

One purpose of pediatric epilepsy surgery is to improve psychomotor development. However, few methods are available for evaluating cognitive function in infants with severe developmental delays. We used the following battery of tests to evaluate visual cognitive function of infants following surgery for intractable epilepsy.

Methods

The following battery of tests were used to evaluate eight patients before and 1 month after surgery: (1) Erhardt Developmental Vision Assessment (EDVA); (2) evaluation of ocular pursuit for a flashing LED toy; (3) three visual acuity tests preferential looking procedure, optokinetic nystagmus, and Sheridan’s Test for Young Children and Retarded balls vision test; and (4) existing developmental test.

Results

EDVA scores and ocular pursuit score with a flashing LED toy showed the same trends with developmental age as the existing developmental tests. However, in some patients, the EDVA score and ocular pursuit score improved greatly, whereas the developmental age changed very little.

Conclusions

These tests are suitable for patients with intractable epilepsy and severe developmental delay. By performing these tests before and after surgery, small cognitive changes occurring soon after the surgery may be detected.     

Exponential fitting of postextrasystolic potentiation may underestimate the cardiac Ca2+ recirculation fraction: a theoretical analysis

The recirculation fraction of intramyocardial Ca(2+) (RF) has conventionally been obtained from the monotonic decay of postextrasystolic potentiation (PESP). The used assumption is that the decay is exponential. However, we have found that PESP usually decays in alternans even at spontaneous heart rates (>100 beats/min) in excised, cross-circulated canine heart preparations under normal coronary perfusion and normothermia. We have already devised a means of extracting the exponential decay component for RF calculation by subtracting the oscillatory component from the alternans PESP decay by a curve-fitting method. Using mathematics, we assessed the possible error in estimated RF when an exponential curve was naively fit to the alternans PESP decay. We obtained results showing that the exponential assumption may considerably underestimate RF even when the alternans is trivial with the oscillatory component of only 10% of the exponential component.