Treatment of osteochondral fracture of the trochlea of the PIP joint

Introduction: Osteochondral (OC) fractures of the trochlea of the PIP joint are rare but the treatment of these fractures can be challenging [2, 5, 6, 10]. And the therapeutic guideline is not determined. Materials and Methods: All of the three cases were male. Two were delayed union with minimal displacement and the other was a fresh displaced fracture. All cases were treated with ORIF using small K-wires. In delayed union cases, bone grafting was added. Results: Although bone union was obtained in all cases, rotation of the fragment due to the absorption of the grafted bone resulted in deformity of the trochlea in one of the delayed union cases. The functional recovery at the 2-year follow-up was satisfactory in all cases. Conclusion: Although OC fracture of the trochlea of PIP joint carry significant fixation implications, successful treatment could be done with ORIF using small K-wire fixation technique.     

A long-term follow-up study of acute myocarditis an electrocardiographic and echocardiographic study

In an attempt to prove that myocarditis may be a cause of idiopathic cardiomyopathy, 10 cases with acute myocarditis were involved in a long-term follow-up study. There were 9 males and 1 female patient, ranging in age from 22 to 63 years. The etiology of myocarditis was idiopathic in 9 cases and rubella virus in 1 case. Clinical findings in the acute stage consisted of congestive heart failure in 6 cases, Adams-Stokes syndrome in 2 cases and cardiomegaly in 2 cases. The mean follow-up period was 55 months. Follow-up studies included physical examinations, 12-lead ECG, chest X-rays and two-dimensional echocardiograms. Various patterns of residual ECG abnormalities in the chronic stage were found, such as conduction disturbance in 1 case, pseudoinfarction pattern in 4 cases, ST-T changes in 2 cases and premature ventricular contractions in 2 cases. The cardiothoracic ratio of all cases was 60 +/- 4% in the acute stage. Two cases (Case 1 and 2) died 16 and 36 months after the acute onset, respectively. Four cases had residual cardiomegaly even in the last study period. An echocardiographic follow-up study of 7 cases disclosed progressive left ventricular (LV) dilatation and dysfunction in 3 cases, regression of LV dilatation in 2 cases and stable LV function in 2 cases. Two cases out of 3 with progressive LV dilatation and dysfunction expired after the acute illness. It was therefore suggested that acute myocarditis may cause LV dilatation and/or wall hypertrophy and that idiopathic cardiomyopathy may represent the end-stages of previous myocarditis.     

Possible antenatal and perinatal related factors in development of cystic periventricular leukomalacia

Cystic periventricular leukomalacia (cPVL), the principal ischemic brain injury in premature infants, is characterized by necrosis of the white matter in the periventricular region and the major neuropathology for spastic motor deficits in cerebral palsy or epilepsy. Recent reports strongly suggest that the brain injury associated with cPVL may have already occurred in utero. In this study we searched retrospectively for possible clinical situations related to cPVL to facilitate assessment of optimal management. A total of 201 babies born at gestational ages from 24 to 33 weeks were entered into the study (1992-1997) and examined for involvement of 18 factors in cPVL retrospectively. And psychomotor development was examined at least until 18 months of corrected age. Among 201 premature babies 35 cases were diagnosed as cPVL later developed spastic diplegia. There are 23 cases of preeclampsia, no infant suffering from cPVL. In the univariate analysis, exposure to antenatal indomethacin, cord length > or =40 cm, and a low Apgar score were significantly associated with a 2-3 risk increased of cPVL occurrence, while antenatal magnesium sulfate reduced the risk. Chorioamnionitis was positively correlated with the risk, but did not reach statistical significance. In the multivariate analysis we found the statistical significance in exposure to antenatal indomethacin, a low Apgar score, and antenatal magnesium sulfate. Our results suggested that preeclampsia and antenatal exposure of magnesium sulfate reduced the risk while antenatal exposure of indomethacin and low Apgar score associated with the occurrence of cPVL. These findings support a growing consensus that cPVL is often the result of maternal and fetal factors as well as antenatal treatment.     

Surgical treatment for cervical myelopathy in patients aged > 80 years

The surgical outcomes of 13 patients who were diagnosed with cervical spondylotic myelopathy were reviewed retrospectively. Mean patient age at surgery was 83 years. The severity of cervical spondylotic myelopathy was evaluated using the Japanese Orthopaedic Association score. Daily activities were evaluated using the Barthel index. The preoperative JOA score and Barthel index were 7.8 and 63.5, respectively. The mean JOA score and Barthel index maximum recovery rate were 35% and 24%, respectively. The results of this study imply that surgery for patients with cervical spondylotic myelopathy aged > 80 years is warranted.     

Postural reaction during maximum grasping maneuvers using a hand dynamometer in healthy subjects

The purpose of this study was to quantitatively evaluate spontaneous body sway during maximum grasping maneuver with a hand dynamometer, which we sometimes encounter in clinical practice. The postural reaction of the whole body during maximum grasping maneuver was analyzed in 26 right-handed healthy male volunteers using a three-dimensional motion analysis system (VICON system, Oxford Metrics, UK) and force plates. We found that the gravity center of the body moved toward the grasping side. Also, voluntary rotation of the trunk and flexion of the neck was observed during grasping on each side.     

Effects of lithium and valproate on agonist-induced platelet intracellular calcium mobilization: relevance to myosin light chain kinase

Serotonin (5-HT)- or thrombin-stimulated platelet intracellular calcium (Ca) mobilization has been reported to be enhanced in patients with bipolar disorders. However, the mechanism of this enhancement is unknown. As a preliminary study, the authors examined the effects of a myosin light chain kinase (MLCK) inhibitor, 1-(5-chloronaphthalene-1-sulfonyl)-1H-hexahydro-1,4-diazepine hydrochloride (ML-9), and two drugs that are mainstays of treatment for bipolar disorder, lithium and valproate, on 5-HT- or thrombin-induced Ca increase in the platelets of normal subjects. When preincubated with 30 microM ML-9, Ca responses to both agonists were enhanced. Valproate showed a dose-dependent attenuation of agonist-induced intracellular Ca rise, both in the absence and presence of ML-9. Although lithium alone had no significant effect on the Ca increase, a high concentration of lithium significantly decreased Ca mobilization only in the presence of ML-9. These results suggest that the enhanced Ca response observed in bipolar disorder might be relevant to decreased function of MLCK and that the mechanism of action of lithium may include a compensatory effect on MLCK modulation.     

Salivary cystatins induce interleukin-6 expression via cell surface molecules in human gingival fibroblasts

Recently, family 2 cystatins have been demonstrated to upregulate interleukin-6 (IL-6) production by human gingival fibroblasts [Biol. Chem. 381 (2000) 1143]. To elucidate the mechanism of the IL-6 inducing activity of cystatins, we tested NF-kappa B activation with salivary cystatins SA1 and SA2-stimulated human gingival fibroblast whole cell lysates. The IL-6 production by human fibroblasts in response to these cystatins was inhibited by tyrosine kinase inhibitors and an inhibitor of NF-kappa B activation. The IL-6 inducing activity of the cystatins was depressed by the anti-CD58 monoclonal antibody. These findings supply evidence that cystatins SA1 and SA2 adhere to human fibroblasts and that the event results in tyrosine phosphorylation and upregulation of the release of IL-6 mediated enhancement of NF-kappa B activity.