Intervertebral disc degeneration associated with lumbosacral transitional vertebrae: a clinical and anatomical study.

We studied 52 patients, each with a lumbosacral transitional vertebra. Using MRI we found that the lumbar discs immediately above the transitional vertebra were significantly more degenerative and those between the transitional vertebrae and the sacrum were significantly less degenerative compared with discs at other levels. We also performed an anatomical study using 70 cadavers. We found that the iliolumbar ligament at the level immediately above the transitional vertebra was thinner and weaker than it was in cadavers without a lumbosacral transitional vertebra. Instability of the vertebral segment above the transitional vertebra because of a weak iliolumbar ligament could lead to subsequent disc degeneration which may occur earlier than at other disc levels. Some stability between the transitional vertebra and the sacrum could be preserved by the formation of either an articulation or by bony union between the vertebra and the sacrum through its transverse process. This may protect the disc from further degeneration in the long term.

Comparative studies of MRI and operative findings in rotator cuff tear.

A prospective study was performed to determine the accuracy of magnetic resonance imaging (MRI) compared with operative findings in the evaluation of patients associated with rotator cuff tears. Fifty-four of 60 shoulders (58 patients) examined by MRI were confirmed as full-thickness tears and 6 as partial-thickness tears at the time of surgery. The oblique coronal, oblique sagittal, and axial planes of T2-weighted images with the 0.5 tesla MRI system were obtained preoperatively and compared with operative findings. MRI correctly identified 46 of 54 full-thickness rotator cuff tears and 5 of 6 partial-thickness tears. A comparison of MRI and operative findings in full-thickness cuff tears showed a sensitivity of 85%, a specificity of 83%, and a positive prospective value (PPV) of 99%. A comparison of partial-thickness tears showed a sensitivity of 83%, a specificity of 85%, and PPV of 39%. Linear regression analysis showed an excellent correlation between the MRI assessment and measurement at the time of surgery (r = 0.90, P < 0.01). MRI was useful in evaluating large and medium-sized rotator cuff tears, but less useful in distinguishing small full-thickness tears from partial-thickness tears.

Stress fracture of the ulnar styloid process in kendo player--a case report.

We present a case report of a 15-year-old kendo (Japanese fencing) player who suffered a stress fracture of the ulnar styloid process. Exercise of the kendo requires the athlete to flex his non-dominant wrist repeatedly in an ulnar direction, and causes the disorder. Excision of the osteochondral fragment relieved the symptoms. This lesion is likely to occur with other sports or activities which demand similar motion of the wrists.

[A case of acute pancreatitis that occurred after an operation of the lumbar spine].

A 56-year-old female, who had been suffering from heart failure and diabetes mellitus, underwent posterior instrumentation in the prone position and anterior interbody fusion in the right lateral decubitus position for pyogenic spondylitis between the fourth and fifth lumbar spine under general and epidural anesthesia. We induced hypotensive anesthesia by using continuous infusion of dopamine, prostaglandin E1 and nitroglycerin in order to prevent heart failure and reduce the blood loss. After the operation, the patient complained of upper abdominal pain, nausea and vomiting. We found high levels of serum amylase and other pancreatic enzymes. The massive gas of small intestine was pooled in abdominal X-P, and the pancreatic head was slightly swollen in abdominal CT and US. Therefore we came to the diagnosis of postoperative acute pancreatitis. We administered a single bolus intravenous infusion of ulinastatine and continuous venous infusion of gabexate mesilate. As the serum amylase level gradually decreased, the patient improved. We suspect that postoperative pancreatitis was due to invasive anesthetic and surgical stress on the patient who had had pancreatitis in the preoperative period.

[Stump pain relieved by continuous intravenous ketamine infusion therapy].

We experienced a case of stump pain relieved by continuous intravenous ketamine infusion therapy. A 59-year-old male had his left first through fourth toes amputated because a giant iron plate at work fell on his left foot fifteen years ago. Thereafter he had refractory spontaneous burning pain and night pain on his stump. On examination, we found his left foot skin hard, lustrous, and with sweating disturbance, allodynia and hyperpathia. As intravenous administrations of ketamine 10 mg and thiamylal 50 mg were positive as a drug challenge test, we performed intravenous ketamine infusion at 1 mg.kg-1.hr-1 for 1 hour and a half. After this treatment, his visual analogue scale (VAS) improved dramatically to 0 mm, and night pain, allodynia and hyperpathia disappeared for three days. Thereafter stump pain was relieved to the level of VAS 20 mm. Therefore we diagnosed his stump pain as central pain of neuropathic origin. We suspect that continuous intravenous infusion of ketamine, a noncompetitive blocker of N-methyl-D-aspartic acid receptor, might be an effective and useful alternative treatment in a patient with refractory stump pain.

Pavlik harness applications for congenital dislocation of the hip. How short can they be made?

We studied the results of different durations of application of the Pavlik harness for congenital dislocation or subluxation of the hip. For this, 110 hips in 106 patients were successfully reduced and examined when 6 years old. Dislocation and subluxation cases were divided into two groups: a long-term (4 months for dislocation and 3 months for subluxation) and a short-term (3 months for the former and 2 months for the latter) group. We compared them by roentgenographic analysis. The association between the long- and short-term groups was tested using statistical analyses. There were no significant differences between them, except for one item in subluxation. Therefore, we can say that the duration of application of the Pavlik harness should be reduced to 3 months for dislocation and 2 months for subluxation.