Asymmetry of mediolateral laxity of the normal knee

Background Understanding the normal kinematics of the joints is important for reconstructive surgery. However, only a few extensive studies have been done on medial and lateral laxity of the normal knee. Methods Radiographs of 50 normal knees were obtained under varus and valgus stress in both extension and flexion and the relative angle of the articular surface was measured. Results In extension, the mean angle was 4.9° in varus stress and 2.4° in valgus stress. In flexion, the mean angle was 4.8° in varus stress and 1.7° in valgus stress. Lateral laxity was significantly greater than medial laxity in both extension and flexion. Conclusions Lateral laxity may be necessary for the medial pivot movement of the normal knee. There is some disagreement regarding the importance of pursuing the perfect rectangular gaps during total knee arthroplasty (TKA). The methods for measuring the tension of soft tissues during the operation are not accurate and do not always reflect the postoperative tensions of dynamic phases, such as walking and standing. Slight lateral laxity can be accepted with TKA, and further studies are necessary to determine whether prosthesis lift-off occurs in the replaced knee with slight lateral laxity similar to that in the normal knee.     

CLINICAL RESULTS OF ENDOSCOPIC HEMOSTASIS USING A SHORT TRANSPARENT HOOD AND SHORT HEMOCLIPS FOR NON‐VARICEAL UPPER GASTROINTESTINAL BLEEDING

Aim: Endoscopic hemostasis using hemoclips is useful, but there are technical difficulties because the angle of the approach is tangential. A transparent hood facilitates the observation and treatment of these lesions, and a shorter hood provides a wider visible field. Endoscopic hemoclipping of hard lesions with hemoclips of the conventional size does not reliably result in sustained hemostasis because the clips slip. Short clips, however, can be easily clamped on protruded visible vessels without slip. The aim of the present study was to evaluate the efficacy of endoscopic hemostasis with a short transparent hood and short clips. Methods: Subjects were 198 patients with 214 lesions of non‐variceal upper gastrointestinal bleeding at Keio University Hospital. We used a video endoscope with a short transparent hood attached to its distal tip and carried out hemostasis using short hemoclips. Results: The short transparent hood provided a good visual field. If the lesions were in the tangential, the short hood made it possible to observe them in the frontal view and made clip hemostasis much easier. The short clip could be securely clamped against protruded visible vessels. Of 214 lesion, 211 (98.6%) had temporal hemostasis. Rebleeding occurred in 13 of 211 lesions (6.2%), and 205 of 214 lesions (95.8%) had permanent hemostasis. Nine cases were endoscopically difficult. Conclusion: Endoscopic hemostasis with a short transparent hood and short clips is useful for non‐variceal upper gastrointestinal bleeding.     

The questionnaire survey to clarify correspondence of medical doctors and dentists in Fukuoka City, Japan, for warfarin therapy at the dental extraction]

PURPOSE: The questionnaire survey was performed in order to clarify correspondence of medical doctors and dentists working at hospital service for warfarin therapy at the dental extraction. METHODS: For 17 senior dentists in 17 hospitals and 142 senior physicians in 82 hospitals in Fukuoka City, we investigated using the questionnaire whether they supported dental extraction under warfarin therapy or not in patients having warfarin treatment with past history of cardioembolic stroke due to non-valvular atrial fibrillation (NVAF). Specialty and experience of stroke after withdrawal of warfarin were also asked in medical doctors. RESULT: The reply was obtained from 14 dentists (82.4%) and 66 doctors (46.5%). The number of dentists and doctors who pull out a tooth under warfarin treatment continuation were 12 persons (85.7%) and 32 persons (48.5%), respectively. The rates in doctors whose specialty was stroke, cardiovascular disease, and others were 78.6% (11/14), 36.0% (9/25), and 44.4% (12/27), respectively. The rate in stroke specialists was significantly higher than that in cardiovascular disease specialists (p = 0.019). The stroke specialists had experience of stroke after withdrawal of warfarin more frequently than the cardiovascular disease specialists (57.1% vs. 20.0%, p = 0.033). CONCLUSION: The rates of acceptance in tooth extraction under warfarin treatment continuation of the dentist were high in Fukuoka city, while that of the medical doctors were not. Rate of doctor's acceptance differed according to the specialties, and may be affected by experience of stroke after cessation of warfarin therapy.     

Two cases of intractable hepatic hydrothorax successfully treated with nasal CPAP]

Hepatic hydrothorax is often resistant to various treatments. A failure in the treatment for hepatic hydrothorax may be associated with poor prognosis. We report two cases of intractable hepatic hydrothorax successfully treated by combining chemical pleurodesis using OK-432 with nasal continuous positive airway pressure. Combination therapy may provide a minimally invasive and effective treatment for intractable hepatic hydrothorax.