Effective and selective stretching of the medial head of the gastrocnemius

Muscle injury frequently occurs in the medial head of the gastrocnemius (MG), and stretching is used for treatment. However, there are no studies based on anatomical considerations and biomechanics. This study therefore examined the macroscopic anatomical structure of the triceps surae muscle to design an effective and selective MG stretching method, before quantitatively verifying that method by ultrasonography. The macroscopic anatomy was analyzed in 16 Japanese cadavers (25 legs). Based on the anatomical findings and the arrangement of fascicles in the MG, we concluded that ankle inversion might be advantageous for selective stretching of the tendon fiber bundles into which the MG inserts. We devised a method in which the limb was initially positioned with the knee joint in extension and the ankle joint in plantar flexion. Then, the ankle was dorsiflexed and inverted. The proposed method was compared with standard stretching and verified by ultrasonography in eight healthy adult males. This method effectively and selectively stretched the MG, producing a significantly decreased pennation angle and increased muscle fiber length. This method may be beneficial for preventing future injuries and may enhance the effect of therapy on the MG.     

Case of massive pleural effusion during and after oophorectomy

A 26-year-old woman with ovarian tumor underwent bilateral oophorectomy. Pre-operative examination showed massive ascites, obvious edema of the lower extremities and absence of pleural effusion. Immedi- ately after removal of massive ascites during the operation, sudden deterioration of SpO2 appeared. We treated it with addition of PEEP and furosemido i.v., and SpO2 improved. After the operation we recognized left sided massive pleural effusion on the chest X-ray picture, and we drained it. However, the next day we recognized right side massive pleural effusion. We suspect that the fluid pooled in the lower extremities shifted to produce pleural effusion for some reason or other.     

Taste disturbance after general anesthesia with classic laryngeal mask airway (CLM)

A 27-year-old man underwent the right knee joint operation under general anesthesia with CLM. After the operation, he complained of taste disturbance of the left side of the tongue. We measured electrical taste threshold and the serum level of zinc, copper and iron. The taste threshold was elevated in the two nerve areas of the left side of the tongue (chorda tympani, N. glossopharyngeus) and the serum levels of zinc and iron were low. We concluded that he had been short of zinc and iron and the insertion of CLM had triggered taste disturbance.     

Anatomical study of the inferior patellar pole and patellar tendon

In this study, detailed investigations into the shape of the inferior patellar pole, the site of the patellar tendon attachment, and the length and course of the patellar tendon were performed with the aim of examining the anatomical factors involved in the developmental mechanism of patellar tendinitis. The investigation examined 100 legs from 50 cadavers. The inferior patellar pole was classified into three types: pointed, intermediate, and blunt. The attachment of the patellar tendon to the inferior patellar pole was classified into two types: an anterior and a posterior. The length of the patellar tendon was measured from the tibial tuberosity to the inferior patellar pole. The pointed type was seen in 57% of legs, the intermediate type in 21%, and the blunt type in 22%. Twenty‐one legs were the pointed type, as well as the anterior type. The patellar tendon was significantly shorter with the posterior type than with the anterior type. The blunt type also had a significantly shorter patellar tendon than the pointed type. In legs that were both the pointed type and the anterior type, the inferior patellar pole and the proximal posterior surface of the patellar tendon impinged during knee flexion due to the posterior tilt of the patella, suggesting the possibility that this may induce damage. With the posterior type and blunt type, on the other hand, the possibility of strong tensile stress on the tendon fibers of the posterior facet of the inferior patellar pole was suggested.     

Gender differences of muscle and crural fascia origins in relation to the occurrence of medial tibial stress syndrome

Although women reportedly have a higher prevalence of medial tibial stress syndrome (MTSS) than men, the possible role of gender-based anatomical differences has not been investigated. The aim of the present study was to investigate the presence of gender-based differences in the range of muscle attachments along the entire medial tibia, the proportion of muscle attachment at the middle and distal thirds of the medial margin of the tibia, the structure of the crural fascia, and chiasm position. The specimens were 100 legs of 55 Japanese cadavers. Statistical analysis was carried out using a chi-square test to compare anatomical features between the sexes. The flexor digitorum longus (FDL) had a higher proportion of attachment to the middle and distal thirds of the medial margin of the tibia than the soleus (SOL; P < 0.001). The proportion of the SOL attachment to the middle and distal thirds of the medial margin of the tibia was 33.3% in men and 72.5% in women (P < 0.001). The soleal aponeurosis was not observed in any specimen. In all specimens the FDL formed the top layer of both chiasms. These results suggest that the higher prevalence of MTSS reported among women may be the result of gender-based anatomical differences.     

l-DOPA neurotoxicity is mediated by glutamate release in cultured rat striatal neurons

The exposure of cultured rat striatal neurons to

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-DOPA caused marked cell death. The

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-DOPA cytotoxicity was inhibited by the addition of Mg²⁺ to and by the removal of Ca²⁺ from the culture medium, and also by the application of tetrodotoxin. Moreover, prolonged application of

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-DOPA increased the glutamate content in the culture medium. These results indicate that

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-DOPA produces neurotoxicity by facilitating glutamate release.     

Modified procedure of a direct in vitro exposure system for mammalian cells to whole cigarette smoke.

In vitro biological studies on cigarette smoke have usually been made using either cigarette smoke condensate--obtained by trapping the particulate phase of smoke on a filter, or soluble smoke components--obtained by trapping cigarette smoke in buffer solution. However, these approaches may not truly reflect the physical and chemical condition of freshly generated smoke. Clearly it is important to be able to evaluate the biological effects of fresh smoke on mammalian cells for a better understanding of the potential effects of smoking. The CULTEX technology is a new experimental system for cultivation and exposure techniques enhanced the efficiency of in vitro studies, and allows direct exposure of cells intermittently at the air/liquid interface with ultrafine particles, gases, or mixtures of both which fixedly flows. The CULTEX technology has therefore been modified to evaluate the biological effects of whole cigarette smoke in an in vitro system. The exposure system design was based on a combination of the sedimentation procedure and the CULTEX cultivation technique. After freshly generated smoke was delivered onto cells, the flow was shut off and the medium was slowly removed. In this manner, cells were exposed to both the vapor and particulate phase of smoke efficiently. Cells were maintained in the liquid medium except during the exposure period to maintain the culture conditions and to protect the cells from both the influence of puff pressure and the airflow, which served to remove residual cigarette smoke. The medium was changed at every puff of smoke and so effectively eliminating the possibility of any effects caused by accumulation of soluble cigarette smoke components into the medium. This cycle was repeated and cells were exposed to freshly generated cigarette smoke intermittently.     

Sex-related differences in coordination and variability among foot joints during running

Background

Women, as compared with men, have a higher proportion of injuries in the ankle/foot region. However, the reason for this sex-related difference in foot injuries remains unclear. Recently, joint coordination and variability of coordination have been suggested to be a critical index for defining both the state of injury and the potential risk of injury. The purpose of this study was to investigate sex-related differences in coordination and variability among the foot joints during running.

Methods

Twelve healthy men and 12 healthy women ran on a treadmill. A modified vector coding technique was used to identify coordination and variability among foot joints involving the shank, rearfoot, midfoot, and forefoot segments, and categorized into the following four coordination patterns: in-phase with proximal dominancy, in-phase with distal dominancy, anti-phase with proximal dominancy, and anti-phase with distal dominancy.

Results

There were no differences in all spatiotemporal parameters and in the foot strike angle between men and women. Coordination of variability of the foot joints during running was similar between men and women, but the anti-phase with proximal dominancy in proportion of frontal rearfoot-shank vs. midfoot-rearfoot couple (men; 7.2%, women; 13.9%) and midfoot-rearfoot vs. forefoot-midfoot couple (men; 18.6%, women; 39.8%) in women was significantly increased compared to that in men. Other all coordination of the foot joints during running differed between men and women, and effect sizes of these parameters were all large.

Conclusion

The results may be useful for understanding the underlying mechanism contributing to differences in injury risk in men and women, and may provide novel data on foot joint coordination and variability that could be used as reference data for both biomechanical and clinical running studies.

     

Minitracheotomy in treating upper airway obstruction after anterior cervical fusion

Respiratory disturbance occurs sometimes after anterior cervical fusion. This is often a result of upper airway obstruction due to prevertebral soft tissue swelling. Therefore we used cricothyrotomy tubes (Mini-Trach) in two patients with postoperative upper airway obstruction and performed assist-ventilation via the tubes. After starting to ventilate through Mini-Trach II, respiratory disturbance disappeared soon and respiration improved markedly. Mini-Trach II is an effective device to use in patients with post-operative respiratory disturbance due to prevertebral soft tissue swelling.