Mini-microform cleft lip with complete cleft alveolus and palate: A case report.

Cleft lip and cleft alveolus are caused by incomplete fusion of the frontonasal and maxillary prominences. However, milder forms of cleft lip are rarely accompanied by cleft alveolus. Here, we report a rare case of mini-microform cleft lip with complete cleft alveolus and cleft palate. No findings suggestive of cleft lip were evident on initial examination. However, three-dimensional facial measurements confirmed the presence of cleft lip despite no evidence of orbicularis oris muscle (OOM) rupture on ultrasonography. Collapsed nostril, as observed in this case, is usually associated with OOM rupture. However, it can also be caused by skeletal abnormalities, such as cleft alveolus. Three-dimensional facial measurements and ultrasonography can assist in accurate diagnosis when visual examination is ambiguous.

Autologous osteochondral mosaicplasty for capitellar osteochondritis dissecans in teenaged patients.

BACKGROUND: Autologous osteochondral mosaicplasty is a new technique to provide hyaline repair for articular defects. Although recent studies have reported the successful treatment of articular defects in the knee and ankle joints with this surgical procedure, little attention has been given to the surgical efficacy of mosaicplasty in the treatment of osteochondritis dissecans of the humeral capitellum. PURPOSE: To clarify the clinical outcomes of mosaicplasty for teenaged patients with advanced lesions of capitellar osteochondritis dissecans. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: Eight teenaged patients with advanced lesions of capitellar osteochondritis dissecans underwent mosaicplasties. All patients were baseball players who were affected on the right side, which was also their throwing side. The surgical technique involves obtaining small-sized cylindrical osteochondral grafts from the lateral periphery of the femoral condyles and transplanting them to prepared osteochondral defects. At a mean follow-up of 24 months, all patients were evaluated clinically and radiographically. RESULTS: Seven of the 8 patients were free from elbow pain, and the remaining patient had mild pain occasionally. The mean clinical score described by Timmerman and Andrews (a maximum of 200 points) significantly improved from 140 points to 183 points postoperatively. All patients except one had excellent or good clinical results. Radiographically, the graft incorporation and a normal contour of the subchondral cortex were found in all patients. Magnetic resonance imaging showed that the preoperative heterogeneity of the lesion had disappeared and the signal intensity returned to normal. Six of the 8 patients, including all 3 pitchers, returned to competitive-level baseball. CONCLUSION: Mosaicplasty for advanced lesions of capitellar osteochondritis dissecans in teenaged baseball players can provide satisfactory clinical and radiographic results.

Reliability and validity of the Japanese version of the Addiction Severity Index (ASI-J).

The Addiction Severity Index (ASI) is a frequently used clinical and research instrument that collects data from substance abusers in seven problem areas: medical, employment, alcohol, drug use, legal, family-social functioning, and psychiatric status. In each area, the ASI provides a composite score and severity rating that estimate the seriousness of the problem and the client's need for treatment. In the present study, we investigated the reliability and validity of the Japanese version of the ASI (ASI-J). One hundred and eleven subjects with a history of drug abuse were interviewed with a test battery including the ASI with informed consent. This revealed that: (a) the problem areas were independent of each other, underscoring the need for multidimensional assessment, (b) the inter-rater correlation of severity ratings in each area ranged from 0.68 to 0.99, and Cronbach's alpha coefficient for the items used for the composite score in each area ranged from 0.57 to 0.86, indicating their reliability with the exception of the drug and employment areas, and (c) several composite scores were significantly correlated with the drug craving levels assessed by a visual analogue scale, the abstinence period, mental health, and/or relapse, supporting their concurrent and predictive validity. These results suggest that the ASI-J has acceptable reliability and validity.

Senile systemic amyloidosis presenting as bilateral carpal tunnel syndrome.

A 74-year-old woman who had developed numbness in both hands was diagnosed as having bilateral carpal and right cubital tunnel syndrome and underwent bilateral carpal and right cubital tunnel release. Transthyretin immunoreactive amyloid deposits were seen on specimens and were also detected in gastric, duodenal and ileal mucosal biopsies. The transthyretin gene analysis showed no mutation. This is a rare case of senile systemic amyloidosis presenting as carpal tunnel syndrome.

Atrophy of the deltoid muscle following rotator cuff surgery.

BACKGROUND: Less invasive procedures have recently been introduced to facilitate an earlier return to sports or work activities after rotator cuff repair. Few reports, however, have verified whether such procedures are really less invasive than conventional open repair. The purpose of this study was to compare the postoperative thickness of the deltoid muscle in patients treated with either conventional or mini-open rotator cuff repair. METHODS: Conventional open repair was performed from 1994 through 1997 in forty-three patients with rotator cuff tears. The mini-open deltoid-splitting approach was introduced in 1997, and the cases of thirty-five patients who underwent that procedure were reviewed. The two groups were compared with respect to the thickness of the anterior fibers of the deltoid muscle measured on the transverse magnetic resonance images, the degree of active forward flexion, and the times required for return to work and sports activities. RESULTS: The thickness of the anterior deltoid fibers did not change significantly after surgery in the mini-open repair group, whereas it was significantly decreased in the open repair group at six months as well as at twelve months postoperatively (p < 0.05). At three months postoperatively, the mean University of California at Los Angeles score for active forward flexion in the patients treated with the mini-open repair (4.9 points) was significantly greater than that in the patients in the conventional open repair group (4.6 points) (p < 0.05). In addition, the mean time-period required for return to work in the mini-open repair group (2.4 months) was significantly shorter than that required in the control group (3.4 months) (p < 0.05). CONCLUSIONS: The mini-open repair appeared to cause less postoperative atrophy of the deltoid muscle than did the conventional open rotator cuff repair, and patients treated with the mini-open repair recovered more quickly.

Ulnar-styloid nonunion and partial rupture of extensor carpi ulnaris tendon: two case reports and review of the literature.

Two unusual cases of symptomatic partial rupture of the extensor carpi ulnaris tendon associated with ulnar-styloid nonunion are described. Intraoperative findings suggested that the jagged surface of the distal ulna was the cause of flaying. In one case, debridement of the frayed extensor carpi ulnaris tendon and fixation of the ulnar styloid were effective for the relief of symptoms. But after the same procedure in another case, osteosynthesis of the ulnar-styloid could not be attained and tenodesis of the extensor carpi ulnaris tendon to the ulnar head was needed. Partial rupture of the ECU tendon should be taken into account in the differential diagnosis of a patient with ulnar wrist pain after ulnar-styloid fracture.

Design and its application of the f(n)-zeta chart capable of direct readout of the highest frequency indicating the limit of obtaining distortion-free waveforms.

We have already reported that the highest frequency (f(h)) could serve as an index for evaluating the fidelity of pressure waveform derived via a catheter manometer system and be read off by the f(n)-zeta chart. Fh is determined by the natural frequency (f(n)) and damping coefficient ( zeta ) in the frequency characteristics of the system. Inversely, f(h) determines two pairs of f(n) and zeta in the f(n)-zeta chart, one in the case of zeta < 0.7 and the another zeta > 0.7. Then, each pair of f(n) and zeta determines respectively the resonant frequency (f(r)) and its amplitude (Ar) ( zeta < 0.7), or the corner frequency (f(c)) and its amplitude (Ac) ( zeta > 0.7) in the frequency characteristics. Thus, the point (f(r), Ar) or (f(c), Ac) represents the position of f(h) projected in the frequency characteristics. Repeating the same operation for other f(n) and zeta corresponding to the same f(h), yields the curve of f(h) in the frequency characteristics. Calculations for other f(h)'s provide a group of curves. Frequency characteristics of pulmonary artery catheters were measured and overwritten thereupon, resulting in f(h)'s to be from 1.2 to 3.2 Hz. These results were in agreement with that calculated by the conventional method.

Inhibition of peroxisome proliferator-activated receptor gamma activity in esophageal carcinoma cells results in a drastic decrease of invasive properties.

Esophageal cancer is difficult to treat because of its rapid progression, and more effective therapeutic approaches are needed. The PPARgamma is a nuclear receptor superfamily member that is expressed in many cancers. PPARgamma expression is a feature of esophageal cancer cell lines, and in the present investigation, the PPARgamma antagonists T0070907 and GW9662 could induce loss of invasion but could not induce growth reduction or apoptosis at low concentrations (< 10 mM). A high concentration of antagonists (50 microM) inhibited cell growth and induced apoptosis, but these effects did not explain our result at the low concentration. Morphological change, decreased expression of the cell signaling pathway and inhibition of cancer cell invasion were observed in the low concentration. This suggested that PPARgamma antagonists inhibited esophageal cancer cell invasion as well as cell adherence, most likely due to alteration in the FAK-MAPK pathway, and this was independent of apoptosis. These results suggested that PPARgamma plays an important role in cancer cell invasion and that it might be a novel target for therapy of esophageal cancer.

Volume changes of supraspinatus and infraspinatus muscles after supraspinatus tendon repair: a magnetic resonance imaging study.

Muscle volume was measured, by use of magnetic resonance imaging (MRI), as a direct indicator of functional recovery of the supraspinatus and infraspinatus muscles after supraspinatus tendon repair, because atrophy of the supraspinatus and infraspinatus muscles was observed in all patients with a torn supraspinatus tendon. Seventy-three patients who had a cuff tear limited only to the supraspinatus tendon were included in this study. The University of California, Los Angeles score improved significantly after surgery. MRI was carried out before surgery and 6, 12, and 24 months postoperatively in all patients. Muscle volume of the supraspinatus was assessed on images of the oblique coronal plane, and that of the infraspinatus was assessed on images of the axial plane. The width of the supraspinatus muscle did not recover until 6 months postoperatively. Direct measurement of the infraspinatus muscle volume by use of MRI can be a good indicator when evaluating whether the repaired rotator cuffs are actually functioning.

Vein grafting with telescoping anastomoses for repair of a double-cut artery.

The rat femoral artery was cut in two places, and the telescoping anastomosis technique was used for all vascular repairs in combination with vein grafting, to determine whether the telescoping technique could safely be used more than three times for repair of an artery that has been injured at two places. One cut was repaired with vein grafting, and the other with either a telescoping anastomosis (the triple group) or with a second vein grafting (the quadruple group). The patency rate 3 weeks postoperatively was 86.4% for the triple group, and 90.5% for the quadruple group. Although tension of the repaired vessel was kept low by vein grafting, and deformities of the inserted vessel were carefully minimized, the patency rate was not 100%. It appears that a telescoping anastomosis should not be used more than three times on the same artery in combination with vein grafting.

Property analysis of ectopic calcification in the carpal tunnel identification of apatite crystals: a case report.

INTRODUCTION: A 64-year-old woman presented with symptoms of subacute exacerbation of a year-long carpal tunnel syndrome that was caused by a large calcified mass in the tunnel. CONCLUSION: The resected mass consisted of very tiny rods, and x-ray diffraction analysis, as well as the component analysis using energy dispersive x-ray microanalysis, revealed the mass to be most compatible with apatite. The back-scattered electron images suggested that precipitation might be a mechanism for development of the calcified mass.