Migration of the lag screw within the femoral head: a comparison of the intramedullary hip screw and the Gamma Asia-Pacific nail

OBJECTIVES: To study the functional difference in the performances of sliding femoral head screws by comparing the displacement of the screw in relation to the femoral head in hips treated with the Gamma Asia-Pacific nail (GN) and hips treated with the intramedullary hip screw (IMHS). STUDY DESIGN: Retrospective review of prospectively collected data. METHODS: Displacement of the femoral head screw in relation to the femoral head was measured in fifty-six elderly patients with intertrochanteric fractures who were treated with an IMHS or GN. Displacement of the femoral head screw was determined by comparing screw position in the immediate postoperative radiograph with a film taken 3 months after surgery. RESULTS: In the GN group, significant displacement of the screw was observed with 3.8 +/- 3.8 percent translation in the horizontal axis (P < 0.005) and 4.3 +/- 5.1 percent displacement in the vertical axis (P < 0.05) in comparison with the diameter of the femoral head. In comparison, displacement of the femoral head screw was not observed with the IMHS (P = 0.48 for horizontal, P = 0.18 for vertical). Total displacement of the femoral head screw in relation to the femoral head in the GN was twice that observed in the IMHS (P < 0.001). CONCLUSION: These results indicate that the displacement of the femoral head screw of the IMHS was less than the lag screw of the GN. However, it is still unknown whether this smaller displacement of the IMHS is clinically significant for reducing the rate of screw cut-out after surgery.     

Risk factors of the progression of abdominal aortic calcification in patients on chronic haemodialysis

Background. Vascular calcification is an independent determinantof cardiovascular events in maintenance haemodialysis (HD) patients.It is not known whether acute changes of the serum calcium concentrationbefore and after HD (Ca) are associated with the developmentof aortic calcification. Methods. We enrolled 71 patients dialysed with a dialysate with3.0 mEq/l calcium and determined their aortic calcificationindex (ACI) by abdominal computed tomography twice at an intervalof 3 years. To identify the factors contributing to the rateof progression of aortic calcification, we analysed the averagevalues for clinical and laboratory data obtained between thefirst and second evaluations of ACI. Results. The second ACI (mean ± SD: 80.2 ± 63.9)was significantly greater than the first ACI (61.0 ±61.0) after an interval of 35.8 ± 4.2 months. The annualizedchange of ACI (ACI/year) was significantly and directly associatedwith the Ca and C-reactive protein (CRP) (both P < 0.001,P for trend). Stepwise multivariate regression analysis revealedthat ACI/year was positively and independently associated withCRP, presence of diabetes mellitus and Ca, but negatively associatedwith a premenopausal status in women. Similarly, Ca was positivelyand independently associated with ACI/year and the ultrafiltrationrate, but was negatively associated with pre-HD Ca. Conclusion. The increase of serum calcium after HD was relatedto the rate of progression of aortic calcification. Excess calciumis transferred into patients on HD when using a dialysate of3.0 mEq/l calcium. This may be a risk factor for the developmentof vascular calcification.     

Endoscopic pancreatic duct drainage and stenting for acute pancreatitis and pancreatic cyst and abscess

Background/Purpose Endoscopic drainage of pancreatic pseudocysts using transpapillary and transmural approaches has been reported. In this study, endoscopic nasopancreatic drainage (ENPD) and pancreatic stenting were performed in patients with pseudocyst and abscess associated with acute pancreatitis, and the usefulness and problems of the procedures were investigated. Methods After endoscopic retrograde pancreatography was done, ENPD and/or pancreatic stenting were performed in 13 patients with pancreatitis and pseudocyst or abscess that communicated with the main pancreatic duct. Results ENPD was performed in seven patients, and was effective in all five patients with cysts: the cysts disappeared or shrank. However, the condition in the two patients with abscess was unchanged, and percutaneous drainage was performed. Stenting was carried out in six patients, and the cyst disappeared or pancreatitis was improved in all six. The stent was removed from two patients, but no recurrence has been noted so far. Conclusions ENPD and stenting are effective therapeutic choices for acute and chronic pancreatitis and pseudocysts, and they are superior to percutaneous drainage to avoid pancreatic fistula, but they may not be effective for pancreatic abscess. Selection of therapeutic methods corresponding to individual cases is important.     

Stonehenge technique is associated with faster aortic clamp time in group of minimally invasive aortic valve replacement via right infra-axillary thoracotomy

Background

Trans-right axillary aortic valve replacement (TAX-AVR) remains uncommon. We developed a special method to pull the heart closer to the right chest wall to make the surgery as easy and safe as aortic valve replacement via median sternotomy. Because the retraction sutures lifting the ascending aorta and aortic root are arranged circularly around the wound, we named this technique “Stonehenge technique”.

Methods

We examined 47 patients who underwent aortic valve replacement through a small right infra-axillary thoracotomy as the initial surgical therapy. These patients were divided into two groups: the conventional TAX-AVR group that underwent AVR via the conventional small right axillary incision approach (n?=?20) and the TAX-AVR with SH group that underwent AVR with the Stonehenge technique (n?=?27).

Results

The aortic cross-clamp and the extracorporeal circulation time were significantly shorter in the TAX-AVR with SH group than in the conventional TAX-AVR group (conventional TAX-AVR group: 125.5?±?47.9; TAX-AVR with SH group: 96.0?±?14.0, p?=?0.004, and conventional TAX-AVR group: 163.8?±?55.9; TAX-AVR with SH group: 140.0?±?16.8, p?=?0.04).

Conclusion

The outcomes of this technique depend on the site of the retraction sutures in the opened pericardium, direction of pull, amount of force applied, and precautions taken. If performed correctly, the ascending aorta and the root can be pulled from the wound to within the surgeon’s fingers’ reach, thereby reducing aortic cross-clamp and extracorporeal circulation times in group of minimally invasive aortic valve replacement via right infra-axillary thoracotomy.

     

Characteristics affecting cervical sagittal alignment in patients with chronic low back pain

BackgroundSagittal spino-pelvic malalignment in patients with chronic low back pain (CLBP) have been reported in the past, which may also affect cervical spine lesions. The purpose of this study is to investigate the cervical alignment in patients with CLBP.MethodOf the patients who visited an orthopedic specialist due to low back pain lasting more than three months, 121 cases (average 71.5-years-old, 46 male and 75 female) with whole standing spinal screening radiographs were reviewed (CLBP group). Cervical parameters included cervical lordosis (CL), C2–C7 sagittal vertical axis (C2-7 SVA), and the T1 slope minus CL (T1S-CL). Cervical spine deformity was defined as C2-7 SVA >4 cm, CL <0°, or T1S-CL ≧20°. We compared the cervical alignment of these patients with 121 age and gender matched volunteers (control group).ResultsThe prevalence of cervical spine deformity was significantly higher in the CLBP group than in the control group (20.7% vs. 10.7%, P = 0.034). The mean CL was smaller in the CLBP group than in the control group (16.1° vs. 21.4°, P = 0.002). The mean C2-7 SVA was 17.6 mm vs. 18.7 mm in the CLBP group and in the control group, respectively (P = 0.817). The mean T1S-CL was larger in the CLBP group than in the control group (9.1° vs. 3.5°, P < 0.001). Multivariate analysis showed that people with CLBP were more likely to have cervical deformities than people without CLBP (odds ratio 2.16, 95% confidence interval 1.006 to 4.637).ConclusionsThis study results suggest that people with CLBP present with worse cervical sagittal alignment and higher prevalence of cervical spine deformities than age and gender matched volunteers with no CLBP. This means CLBP impacts cervical spine lesions negatively.Level of evidenceⅣ     

Brain tumour imaging with carbon-11 choline: comparison with FDG PET and gadolinium-enhanced MR imaging

The purpose of this study was to assess the clinical potential of methyl-¹¹C-choline (¹¹C-choline) in the diagnosis of brain tumours. To this end, the results of ¹¹C-choline positron emission tomography (PET) in 22 patients suspected of having brain tumours were compared with the findings of contrast-enhanced magnetic resonance (MR) imaging and fluorine-18 fluorodeoxyglucose PET. A histopathological diagnosis was made for each patient during open surgery. The standardised uptake values of brain tumours and the tumour-to-white matter count (T/W) ratios were determined. The degree of ¹¹C-choline accumulation noted in PET images was compared with the gadolinium-enhanced areas of MR images. The mean T/W ratio of ¹¹C-choline in high-grade gliomas was found to be higher than that in low-grade gliomas. This difference was statistically significant (mean-SD: 8.7Lj.2, n=9 versus 1.5ǂ.7, n=5, P<0.03) when data pertaining to the prominent uptake of ¹¹C-choline in a patient with a pilocytic astrocytoma were excluded. ¹¹C-choline PET failed to detect non-neoplastic lesions in two patients. Areas of ¹¹C-choline accumulation in PET scans were larger than areas enhanced on MR images in five cases involving high-grade gliomas. ¹¹C-choline PET differentiated between low-grade gliomas and high-grade gliomas, but did not differentiate between low-grade gliomas and non-neoplastic lesions. The combination of ¹¹C-choline PET and MR imaging may provide investigators with an accurate means by which to identify high-grade gliomas.     

ROC Analysis of Detection of Metastatic Pulmonary Nodules on Digital Chest Radiographs with Temporal Subtraction

RATIONALE AND OBJECTIVES: The authors' purpose was to evaluate the effect of temporal subtraction on digital chest radiographs in the detection of metastatic pulmonary nodules. MATERIALS AND METHODS: The study included 21 cases with metastatic pulmonary nodule and 21 cases without metastatic nodule. Eleven radiologists, including eight residents and three certified radiologists, provided their confidence levels for the presence or absence of pulmonary nodules without and with temporal subtraction. Their performances without and with temporal subtraction were evaluated by means of receiver operating characteristic analysis with both independent and sequential tests. RESULTS: For the independent test, the radiologists' Az (area under the receiver operating characteristic curve) values were 0.871 without and 0.954 with temporal subtraction, compared with 0.882 and 0.955, respectively, for the sequential test. Diagnosis accuracy was significantly improved with the use of temporal subtraction. There was no significant difference in Az values between the independent and sequential tests. CONCLUSION: Temporal subtraction is useful in the detection of metastatic pulmonary nodules, and this technique augments the value of digital chest radiography.     

Parathyroid hormone increases the expression level of matrix metalloproteinase-13 in vivo

Parathyroid hormone (PTH) increases serum calcium (Ca) by enhancing bone resorption and renal Ca reabsorption. However, detailed mechanisms of enhanced bone resorption by PTH remain to be elucidated. Although PTH has been shown to increase the expression level of osteoblastic matrix metalloproteinase (MMP)-13 in vitro, only limited results are available regarding the in vivo regulation of MMP expression. In the present study, we have examined expression levels of MMPs in PTH-infused rats. Infusion of 1.5 or 2.0 nmol/kg/day rat PTH(1–34) for 3 days resulted in a dose-dependent increase in serum Ca. PTH infusion also decreased serum phosphate levels and increased urinary excretion of Ca and phosphate. Infusion of PTH for 7 days resulted in less severe hypercalcemia and hypophosphatemia. Urinary Ca and phosphate excretion in rats infused for 7 days was less than that in rats infused for 3 days. Northern blot analysis showed that PTH infusion increased the expression level of MMP-13 in calvaria, although it did not affect MMP-2 expression. Furthermore, the time-course and severity of hypercalcemia and hypercalciuria correlated with the expression level of MMP-13. In situ hybridization also showed that PTH infusion increased the expression level of MMP-13 in femora. These results indicate that PTH enhances MMP-13 expression in vivo and suggest that PTH stimulates bone resorption at least partly by enhancing MMP-13 expression. Received: June 5, 2000 / Accepted: January 12, 2001     

Minute liver metastases from a rectal carcinoid: A case report and review

We here report a 43-year-old male patient with minute liver metastases from a rectal carcinoid. Hepatic nodules were diagnosed during surgery, although they were not diagnosed by preoperative computed tomography or ultrasound examination. The rectal carcinoid was resected together with liver metastases and the patient has had no disease recurrence for 5 years following postoperative treatment of hepatic arterial infusion chemotherapy (HAIC) using 5-fluorouracil (5-FU) and oral administration of 1-hexylcarbamoyl-5-fluorouracil (HCFU). In 2003, a health check examination indicated presence of occult blood in his stool. Barium enema study revealed a rectal tumor in the lower rectum and colonoscopy showed a yellowish lesion with a size of 30 mm in diameter. Pathological examination of the biopsy specimen indicated that the rectal tumor was carcinoid. Although preoperative imaging examinations failed to detect liver metastases, 2 min nodules were found on the surface of liver during surgery. A rapid pathological examination revealed that they were metastatic tumors from the rectal carcinoid. Low anterior resection was performed for the rectal tumor and the pathological report indicated that there were 4 metastatic lymph nodes in the rectal mesentery. The patient received treatment by HAIC using 5-FU plus oral administration of HCFU and survived for 5 years.We also review world-wide current treatments and their efficacy for hepatic metastases of carcinoid tumors.     

Rare case of a rudimentary medial metatarsal non-ossified structure

A 9-year-old boy presented with a rudimentary medial metatarsal non-ossified structure. We considered his condition to be classified as hypoplastic medial member type in the metatarsal type of medial ray polydactyly. When it was considered as polydactyly, it had the longest delay of ossification among reported cases.