Comminuted fractures of the radial head. Comparison of resection and internal fixation

BACKGROUND: Satisfactory internal fixation of comminuted radial head fractures is often difficult to achieve, and radial head resection has been the accepted treatment. In this study, we compared the results of radial head resection with those of open reduction and internal fixation in patients with a comminuted radial head fracture. METHODS: Twenty-eight patients with a Mason type-III radial head fracture (some with associated injuries) were enrolled in the study. Fifteen patients underwent radial head resection as the initial treatment (Group I), and thirteen patients underwent open reduction and internal fixation (Group II). The age at the operation averaged 41.1 and 38.2 years, respectively, and the duration of follow-up averaged ten and three years, respectively. The outcomes were assessed on the basis of pain, motion, radiographic findings, and strength measured with Cybex testing. The overall outcome was rated with the functional rating score described by Broberg and Morrey and with the American Shoulder and Elbow Surgeons Elbow Assessment Form. RESULTS: Elbow motion averaged 15.5 degrees (extension loss) to 131.4 degrees (flexion) in Group I and 7.1 degrees to 133.8 degrees in Group II. The carrying angle and ulnar variance averaged 8.2 degrees and 1.9 mm in Group I and 1.5 degrees and 0.5 mm in Group II. Compared with Group II, Group I had a loss of strength in extension, pronation, and supination (p < 0.01). The Broberg and Morrey functional rating score averaged 81.4 points in Group I and 90.7 points in Group II (p = 0.0034). The score on the American Shoulder and Elbow Surgeons Elbow Assessment Form averaged 87.3 points in Group I and 94.6 points in Group II (p = 0.0031). CONCLUSIONS: The patients in whom the comminuted radial head fracture was treated with open reduction and internal fixation had satisfactory joint motion, with greater strength and better function than the patients who had undergone radial head resection. These results support a recommendation for open reduction and internal fixation in the treatment of this fracture.     

Current status and problems in the chemotherapy of our outpatient clinic in the department of clinical oncology

The department of clinical oncology performed an analysis of the current situation and problems inherent to 4500 chemotherapies of the outpatient clinic for the last 20 months using a new department of the outpatient clinical treatment. Divided into primary organs and the application of chemotherapy are as follow: breast cancer 49%, and gastrointestinal cancer 47% (esophageal cancer 4%, stomach cancer 28%, colorectal cancer 15%) and others 4%. In terms of time consumed by chemotherapy, there were differences in the tumors, regimens and ages. Within one hour, 40% of all chemotherapies mainly included those of breast cancers. From one to two hours, 40% included half breast cancers and half gastro-intestinal cancers, two to three hours, 15% the same as one to two hours. Over 3 hours, 5% mainly include those of gastro-intestinal cancers. In outpatient clinical chemotherapy, there were no human errors such as the use of wrong drugs and wrong intravenous injections. There were a few patients with adverse effects of chemotherapy including high fever with bone marrow suppression and severe diarrhea, who had an emergency admission to the hospital. As we perform an outpatient clinical chemotherapy with safe, it is important to coordinate with family doctors. To decrease the patients' effort of outpatient clinic, we request the treatment of high fever and the dose of G-CSF for bone marrow suppression to family doctors. The outpatient clinical chemotherapy enables to offer the suitable tailor-made treatment for each individual and to control the adverse effects of any regimen. But, patients' waiting period is still longer due to lack of numbers of doctors. To improve these statuses, careful consideration will be required for the trusting relationship with paramedical staffs' in the Department of Clinical Oncology.     

Volumetric analysis of sulci/gyri-defined in vivo frontal lobe regions in schizophrenia: Precentral gyrus, cingulate gyrus, and prefrontal region

Methodological limitations in most previous magnetic resonance imaging (MRI)-based volumetric studies might have contributed to the inconsistent results regarding the frontal lobe regions of schizophrenia. Thus, applying the largest sample to date among those that have fully taken account of the intrinsic anatomical landmarks, this study aimed at clarifying the volumetric alterations of the frontal lobe and its subregions in schizophrenia. Participants comprised 59 patients with schizophrenia and 58 healthy controls. Measurements were performed on consecutive 1-mm-thick coronal slices reformatted from three-dimensional 1.5-T MR images. The whole frontal lobe was demarcated and then subdivided into the precentral gyrus (PCG), anterior cingulate, and posterior cingulate, and the remainder temporarily as the prefrontal region. Patients with schizophrenia had significant cortical volume reductions in the bilateral whole frontal lobe, prefrontal region, PCG, posterior cingulate, and right anterior cingulate. This study has confirmed that patients with schizophrenia do have cortical volume reductions in the whole frontal lobe and its subregions. Volume reduction in the PCG suggests that the primary motor cortex might contribute to the mechanisms of schizophrenia, considering its important role in the processing of multiple motor-related cognitive functioning suggested by the recent literature.     

Increased proportion of high-affinity dopamine D2 receptors in rats with excitotoxic damage of the entorhinal cortex, an animal model of schizophrenia

Excitotoxic lesions of the left entorhinal cortex (EC) cause dopamine supersensitivity. In order to determine if these lesions selectively alter the high-affinity state of dopamine D2 receptors (D2(High)), these high-affinity states were measured by competition between dopamine and [3H]domperidone in striata from lesioned rats and sham-operated animals. The proportion of D2(High) sites was significantly elevated by 200% in the EC-lesioned rats while that of the D1(High) sites, measured by dopamine/[3H]SCH23390 competition, was unaltered. These results provide a biochemical basis for behavioral supersensitivity in rats with EC lesions.     

Effects of exercise intensity, posture, pressure on the back and ambient temperature on palmar sweating responses due to handgrip exercises in humans

We have, by using newly developed ratemeters, attempted to examine the effects of exercise intensity, posture, pressure on the skin of the back, and ambient hyperthermic conditions (approximately 30 degrees C) on the 5-s handgrip exercise-mediated responses of active palmar sweating in humans. Thirty-five right-handed male (n=5) and female (n=30) volunteer students (20.2+/-1.3 years old) participated in the present study. Oral explanation of only the isometric handgrip exercise (IHG) caused a rapid and oscillatory response (pre-operational) of active palmar sweating in almost all subjects (10 of 14 subjects). Performing the IHG for 5-s caused a significant increase in active sweating rate (operation-mediated response) in both ipsi- and contra-lateral palmar surfaces of the thumbs of all subjects. The operation-mediated responses of active palmar sweating to the IHG were reproducible, resulting in no habituation. The increase of operation-mediated responses to the IHG was dependent upon exercise intensity (100-25% maximal voluntary contractions). The IHG-mediated ipsi- and contra-lateral responses of active palmar sweating were significantly decreased by changing the body posture from a seated to a supine position or by pressing the skin of the back. Ambient hyperthermic conditions (approximately 30 degrees C) for 60 min also resulted in a significant decrease in the back-pressure-dependent reduction of the operation-mediated responses of active palmar sweating to the IHG. In conclusion, in order to optimize the precision and reproducibility of clinical tests involving palmar sweating responses, it is important that subjects maintain a constant handgrip force and posture and that ambient temperature be kept under normothermic conditions.     

Epstein-Barr Virus-associated Gastric Carcinoma in Japanese Brazilians and Non-Japanese Brazilians in São Paulo

The proportion of Epstein-Barr virus-associated gastric carcinoma (EB V-GC) was examined in 149 Japanese-Brazilian and 151 non-Japanese-Brazilian gastric-carcinoma cases using in situ hybridization (ISH) assay to detect EBV-encoded small RNA (EBER), and the results were compared with our referent Japanese data. We found that 4.7% of cases in Japanese Brazilians were EBER-positive. This frequency was slightly lower than that of the referent Japanese, among whom 6.2% of 2038 gastric-carcinoma cases were EBER-positive. On the other hand, the non-Japanese-Brazilian series showed a significantly higher proportion of EBV-GC (11.2%) than the referent group did (P=0.01). Although EBV-GC was predominant in males among non-Japanese Brazilians (M/ F=3.6, P=0.047), as was the case in Japanese (M/F=2.7), Japanese Brazilians did not show such a male predominance. The sex-ratio difference between the Japanese Brazilians and Japanese was statistically significant (P=0.005). In conclusion, the present study in Japanese Brazilians and Japanese yielded no evidence suggesting any change in the frequency of EBV-GC caused by migration, except the absence of male predominance, which was observed both in Japanese and non-Japanese Brazilians.     

A crossover study of the acrylonitrile-co-methallyl sulfonate and polysulfone membranes for elderly hemodialysis patients: the effect on hemodynamic, nutritional, and inflammatory conditions

Many maintenance hemodialysis (MHD) patients have recently been treated with high flux (HF) dialysis membranes such as polysulfone (PSu) membranes. However, the appropriateness of HF for elderly MHD remains to be elucidated. In order to estimate hemodialysis (HD) efficiency, the hemodynamic condition during HD, and the nutritional status, 28 elderly MHD patients were treated with PSu for 3 months. After this, the patients were switched to acrylonitrile-co-methallyl sulfonate (AN69) membranes for the next 3 months and then returned to PSu for another 3 months. Reduction ratio of inflammatory cytokines (interleukin [IL]-6) by AN69 was significantly higher than the reduction ratio by PSu. After 3 months with AN69, the serum total protein, albumin, and cholesterol levels significantly increased, and after switching back to PSu, the levels returned to baseline. Furthermore, the frequency of saline used to treat episodes of hypotension during HD significantly decreased in the AN69 period. In elderly MHD patients, it was possible to achieve improvements in both malnutrition and chronic inflammatory conditions with AN69. This suggests that AN69 may be the preferred membrane for elderly MHD, because it stabilizes the hemodynamic condition and demonstrates a higher removal of inflammatory cytokines during HD.