Rotational acetabular osteotomy for advanced osteoarthritis of the hip joint with acetabular dysplasia

Between August 1986 and July 1997, we performed rotational acetabular osteotomy (RAO) according to the methods of Ninomiya and Tagawa in 161 patients (179 hips). Among them, 63 patients (68 hips) had advanced osteoarthritis. We assessed the outcome at a mean of 12 years after rotational acetabular osteotomy was performed for the treatment of advanced osteoarthritis in a series of patients with acetabular dysplasia. Eleven patients did not return for final follow-up and were excluded from the study, leaving 52 patients (57 hips) for analysis. The mean Merle d’Aubigné clinical score improved from 12.6 points (range 9–16) preoperatively to 14.3 points (range 7–18) postoperatively (p < 0.002), mainly because of increased scores for pain. At final follow-up, 50 of the 57 hips were still functioning. The results of rotational acetabular osteotomy for correction of advanced osteoarthritis in adults with acetabular dysplasia were satisfactory after a mean of 12.2 years.     

Intrapulmonary Solitary Fibrous Tumor Diagnosed by Immunohistochemical and Genetic Approaches: Report of a Case

Although solitary fibrous tumors (SFTs) of the pleura are not uncommon, intrapulmonary SFTs are extremely rare. A 72-year-old woman was admitted to our hospital for an investigation of an enlarging intrapulmonary tumor. Because a definitive diagnosis could not be readily established, a pulmonary wedge resection under video-assisted thoracic surgery was performed. Grossly, the tumor was white, well circumscribed, and separate from the pleural surface. Histologically, it consisted of spindle cells proliferating in a vague fascicular pattern, with many dilated capillaries, and intermingled glandular components. These findings suggested a differential diagnosis that included SFT and nonchondromatous pulmonary hamartoma. On immunohistochemical analysis, the spindle cells showed a strong positive reaction to the CD34 antigen. Interphase fluorescent in situ hybridization revealed an absence of HMGA-1 and -2 translocations. These results supported a diagnosis of SFT. A genetic approach may therefore be useful in the differentiation of SFT from nonchondromatous hamartoma.     

Labor epidural analgesia--how to set up the service: preface

The following featured articles are the proceedings of the panel discussion at the 19th Japanese Society of Regional Anesthesia, which was held on September 2nd, 2006 in Osaka. The president of the meeting, Professor Akira ASADA at Osaka City University Graduate School of Medicine, chose this topic among various aspects of regional anesthesia practice. Obstetric anesthesia practice relies heavily on regional anesthesia for both cesarean section and labor analgesia. Thus, obstetric anesthesiologists have played an important role in the basic as well as clinical research in the pharmacology of local anesthetic agents. Professor Morishima is one of those pioneers in obstetric anesthesia, and she kindly joined the panel discussion as the commentator. The distinguished panelists practice obstetric anesthesia at various settings from academic institution, regional perinatal center, to private practice. Some of them have started the labor epidural analgesia service by tackling obstacles. The others have strong interests in obstetric anesthesia, but yet are unable to provide labor analgesia. By sharing their success and difficulties, the readers of this discussion would be able to obtain some insights when they set up labor epidural analgesia service at their own practice settings.     

Rotational acetabular osteotomy for osteonecrosis of the femoral head after intracapsular fracture of the neck of the femur

The treatment of osteonecrosis of the femoral head in younger patients varies among orthopaedic surgeons. In particular, the optimal treatment of extensive osteonecrosis associated with femoral head collapse remains controversial. Since 1995, we have performed rotational acetabular osteotomy on 70 hips, including those of 3 patients with extensive osteonecrosis of the femoral head after intracapsular fracture of the neck of the femur. In all 3 patients, adequate coverage of the femoral head by the osteotomized acetabulum was obtained, and their symptoms (especially pain) showed marked improvement at latest follow-up.     

Two cases of colonic necrosis following aortoiliac surgery due to coronary-induced cardiogenic shock

We report two cases of abdominal aortic aneurysm in which the patent inferior mesenteric arteries were ligated. The patient in Case 1, with occlusion of the right coronary artery, developed sudden bradycardia during surgery, resulting in cardiac arrest. The patient was successfully resuscitated and the operation was completed. In Case 2, acute thrombotic obstruction occurred postoperatively in the stent previously implanted in the left anterior descending coronary artery. Although the thrombus was removed by aspiration, hypotension was sustained. In both cases, colonic necrosis extending from the descending colon to the rectum developed following cardiogenic shock. The affected portion of the colon was resected and a colonostomy was constructed. The incidence of coronary arterial disease is high in patients with abdominal aortic aneurysm. The occurrence of cardiac complications is not rare, and may result in catastrophic consequences. Therefore the inferior mesenteric artery should be reimplanted, especially in patients with concomitant heart disease.     

Changes in aortic endothelial gene expressions and relaxation responses following chronic short-term insulin treatment in diabetic rats

The purpose of the present study was to examine the relationship between the changes in the expressions of several mRNAs and changes in endothelial function in streptozotocin-induced diabetic and chronic short-term insulin-treated rats. Aortas from later-stage (10 week) diabetics, but not those from their insulin-treated counterparts, showed an impaired endothelial function. We found that the mRNA expressions for 30 genes were significantly upregulated, while those for 13 other genes were downregulated in aortic endothelial cells from diabetes. In later-stage diabetes, chronic insulin treatment ameliorated the endothelial dysfunction and normalized the expressions for 20 out of the 43 genes altered in diabetes. Further, 12 of the remaining 23 genes were altered by high-dose insulin treatment in the controls. In early-stage (1 week) diabetic aortas, which did not show impaired endothelial function, expression changes were shown by only 12/30 and 5/13 of the genes up- or downregulated, respectively, in later-stage diabetes. Thus, in the diabetic aortas endothelial gene expressions and function exhibited time-related changes, and several gene expressions and endothelial function were normalized by insulin treatment. The hyperinsulinemia caused by this treatment may oppose the alterations in some gene expressions and the endothelial proliferation (cell growth-related gene expressions) that occur in established diabetes.     

Elevated plasma endothelin-1 level in streptozotocin-induced diabetic rats and responsiveness of the mesenteric arterial bed to endothelin-1

1. Both the plasma endothelin-1 (ET-1) levels and the plasma glucose levels were markedly elevated in streptozotocin (STZ)-induced diabetic rats.
2. The maximum contractile response of the mesenteric arterial bed to ET-1 was significantly reduced, and the vasodilatation induced by the ET_B-receptor agonist IRL-1620 in the mesenteric arterial bed was significantly reduced in STZ-induced diabetic rats.
3. ET-1 (10⁻⁸ M) caused a transient vasodilatation followed by a marked vasoconstriction in methoxamine-preconstricted mesenteric arterial beds. The ET-1-induced vasodilatation was significantly larger in beds from diabetic rats than in those from age-matched controls. By contrast, the ET-1-induced vasoconstriction was significantly smaller in STZ-induced diabetic rats than in the controls.
4. Both removal of the endothelium with Triton X-100 and preincubation with BQ-788 (10⁻⁶ M) (ET_B-receptor antagonist) abolished the ET-1-induced vasodilatation. Preincubation with BQ-485 (10⁻⁶ M) or BQ-123 (3×10⁻⁶) (ET_A-receptor antagonist) significantly augmented the ET-1-induced vasodilatation in control mesenteric arterial beds, but not that in beds from diabetic rats.
5. These results demonstrate that marked increases not only in plasma glucose, but also in plasma ET-1 occur in STZ-induced diabetic rats. We suggest that the decreased contractile response and the increased vasodilator response of the mesenteric arterial bed to ET-1 may both be due to desensitization of ET_A receptors, though ET_B receptors may also be desensitized. This desensitization may result from the elevation of the plasma ET-1 levels seen in STZ-induced diabetic rats.

     

Tooth-pulp-evoked rostral spinal trigeminal nucleus neuron activity is inhibited by conditioning sciatic nerve stimulation in the rat: possible role of 5-HT3 receptor mediated GABAergic inhibition

The purpose of the present study was to determine whether modulation of the trigeminal spinal nucleus oralis (TSNO) neurons related to tooth-pulp (TP)-evoked jaw-opening reflex (JOR) after electrical stimulation of the sciatic nerve (SN) is mediated by the descending serotonergic (5-HT(3)) inhibitory system activated by inhibitory GABAergic interneurons. In 30 anesthetized rats, the activity of TSNO neurons (87.5%, 35/40) and all digastric muscle electromyograms (dEMG, n=30) in response to TP stimulation (at an intensity of 3.5 times the threshold for JOR) were inhibited by conditioning stimulation of the SN (5.0 mA x 0.5 ms, 1 Hz, conditioning-test intervals; 50 ms). The inhibitory effects were significantly attenuated after intravenous administration of the 5-HT(3) receptor antagonist ICS 205-930 (n=6). Using multibarrel electrodes, iontophoretic application of ICS 205-930 into the TSNO significantly reduced the SN stimulation-induced inhibition of TP-evoked TSNO neuronal excitation (n=6), and in the same neurons, iontophoretic application of the GABA(A) receptor antagonist bicuculline into the TSNO greatly inhibited their effect. On the other hand, we found the expression of 5-HT(3) receptor immunoreactive neurons in the TSNO. These results suggest that SN stimulation may activate the descending serotonergic (5-HT(3)) inhibitory system through activation of inhibitory GABAergic interneurons, which inhibit excitatory responses of the TSNO neurons to TP stimulation.