An in vivo model for intraoperative assessment of impingement and dislocation in total hip arthroplasty

We have developed an intraoperative model to quantify total hip arthroplasty impingement and dislocation mechanics using fluoroscopy and shape-matching techniques. Two patient groups were investigated: group 1 consisted of 12 hips using 28- or 32-mm femoral heads and an anterolateral surgical approach, and group 2 consisted of 17 hips using 22- or 26-mm femoral heads and a posterolateral surgical approach. During intraoperative hip stability testing consisting of extension and external rotation motions, group 1 was more unstable, and prosthetic impingement was the major reason for dislocation. With flexion and internal rotation motions, group 2 was more unstable, and superior-lateral impingement or soft tissue traction was the major reason for dislocation. Intraoperative quantitative assessment of hip mechanics provides a safe and clinically relevant method to characterize potential complications and evolve techniques to prevent them.     

Laparoscopic gastrectomy for early gastric cancer targeting as a less invasive procedure

Background Since only a few extensive reports are available on the less invasive nature of laparoscopic gastrectomy, we compared postoperative changes over time in vital signs and hematological parameters between this surgery and laparotomic gastrectomy. Methods Of 188 patients who underwent distal gastrectomy for preoperatively diagnosed early gastric cancer between January 2004 and September 2006, 87 underwent laparoscopy-assisted distal gastrectomy (LADG) and 101 underwent laparotomic distal gastrectomy (DG). The invasiveness of the two procedures was evaluated in 164 patients with no postoperative complications (82 cases of LADG and 82 cases of DG by measuing vital signs daily and performing hematological examination on postoperative days (POD) 1, 4, 7, and 10. Results For body temperature, heart rate, and blood pressure, significantly lower values were obtained with LADG on 3 and 4 POD, 4 POD, and 3 and 4 POD, respectively. For white blood cell counts (WBC) and C-reactive protein (CRP), significantly lower values were obtained with LADG on 7 and 10 POD, and 10 POD, respectively. For serum protein levels and lymphocyte counts, significantly higher values were obtained with LADG on 1, 4, 7, and 10 POD, and 4 and 10 POD, respectively. Body temperature, WBC, and CRP showed no significant difference immediately after surgery but earlier recovery occurred with LADG. For protein levels and lymphocyte counts, higher values were obtained immediately after surgery. There seemed to be two patterns of less invasiveness in the parameters: the early recovery found for body temperature, WBC and CRP, and the smaller shift immediately after surgery in protein level and lymphocyte count, and probably, heart rate and blood pressure. The complication rate was 18.8% for DG and 5.7% for LADG. Conclusions LADG is a less-invasive surgical procedure as it produces early normalization or smaller shifts in various parameters and exhibits a low prevalence of complications.     

Successful resection of dermatomyositis associated with thymic carcinoma: Report of a case

We report a case of thymic carcinoma associated with dermatomyositis (DM) in a 53-year-old man. The patient presented with the characteristic features of a skin rash with Gottron’s papules, proximal muscle weakness, and increased serum levels of the muscle-associated enzymes. Comprehensive clinical examinations revealed an anterior mediastinal tumor. We resected the tumor and histological examination confirmed squamous cell carcinoma of the thymus. Thereafter, his clinical symptoms improved dramatically and his serum levels of muscleassociated enzymes dropped, indicating that the DM was a paraneoplastic phenomenon. Our search of the literature found only one other case report of DM accompanied by thymic carcinoma, and to our knowledge, this is the fi rst documented case of dramatic improvement of DM after resection of thymic carcinoma. We propose that thymic carcinoma should be added to the list of malignancies that can complicate DM as a paraneoplastic disease. The first two authors contributed equally to this study.     

Involvement of histamine released from mast cells in acute radiation dermatitis in mice

A possible involvement of histamine in acute radiation dermatitis in mice was investigated. The dose of 40 Gy of gamma irradiation induced erythema and edema in C57BL/6 mice treated with vehicle. However, in C57BL/6 mice treated with chlorpheniramine and WBB6F1-W/Wv mice, erythema and edema were not observed. In all of these mice, epilation and dry desquamation were induced, but bepotastine significantly reduced the extent of these areas. These results suggest that gamma irradiation-induced erythema and edema were caused by histamine released from mast cells via histamine H1 receptor, and epilation was induced by other inflammatory mediators.     

A case of orbital metastasis from prostatic carcinoma as an initial symptom

Orbital metastasis caused by prostate cancer is rare. We report a case of prostate cancer diagnosed from the initial ocular signs with complaints of decreased vision and exophthalmos. The orbital tumor was surgically removed and endocrine therapy was performed subsequently. Metastatic carcinoma of the prostate should be considered in the elderly male with exophthalmos.     

Antimicrobial therapy for acute cholangitis: Tokyo Guidelines

Antimicrobial agents should be administered to all patients with suspected acute cholangitis as a priority as soon as possible. Bile cultures should be performed at the earliest opportunity. The important factors which should be considered in selecting antimicrobial therapy include the agent's activity against potentially infecting bacteria, the severity of the cholangitis, the presence or absence of renal and hepatic diseases, the patient's recent history of antimicrobial therapy, and any recent culture results, if available. Biliary penetration of the microbial agents should also be considered in the selection of antimicrobials, but activity against the infecting isolates is of greatest importance. If the causative organisms are identified, empirically chosen antimicrobial drugs should be replaced by narrower-spectrum antimicrobial agents, the most appropriate for the species and the site of the infection.     

Contrast-enhanced MR imaging of subchondral insufficiency fracture of the femoral head: a preliminary comparison with that of osteonecrosis of the femoral head

Introduction  Subchondral insufficiency fracture of the femoral head (SIF) may be confused with osteonecrosis of the femoral head (ON) due to clinical and imaging similarities. Materials and methods  Contrast-enhanced MR images in patients with SIF (ten hips in ten patients) were retrospectively reviewed and compared with those from patients with ON (ten hips in six patients). Results  Low-signal intensity bands on T1-weighted images were present within the femoral head in all hips examined. The segment proximal to the band was contrast-enhanced following IV gadolinium administration in nine of ten hips (90%) with SIF and in none of the 10 hips with ON. Conclusion  These results suggest that the presence of contrast enhancement in the segment proximal to the low-signal intensity band in the femoral head may serve as a supplemental diagnostic measure for the differentiation of SIF from ON.