Rat-Bite Fever in Human with Streptobacillus notomytis Infection, Japan.

We report a case of rat-bite fever in a 94-year-old woman with Streptobacillus notomytis infection. We established an epidemiologic link between exposure to rats and human infection by performing nested PCRs that detected S. notomytis in the intraoral swab specimens obtained from rats captured in the patient's house.

Magnetic resonance imaging analysis of the extensor carpi ulnaris tendon and distal radioulnar joint in triangular fibrocartilage complex tears.

BACKGROUND: We compared the incidence of extensor carpi ulnaris (ECU) tendon and distal radioulnar joint (DRUJ) abnormalities using magnetic resonance imaging (MRI) between patients with triangular fibrocartilage complex (TFCC) tears and subjects without ulnar wrist pain. Additionally, we aimed to identify potential predictors of these MRI lesions. METHODS: The TFCC group comprised 70 consecutive patients with TFCC tears. The control group comprised 70 age- and sex-matched subjects without ulnar wrist pain. We evaluated the presence or absence of fluid collection in the DRUJ and ECU peritendinous area and longitudinal ECU tendon splitting. Dimensions of the fluid collection area around the ECU tendon were measured to evaluate the severity. The incidences of these abnormal MRI findings were compared between the two groups. We analyzed the correlation between the presence of ECU tendon and DRUJ lesions and variables including age, magnitude of ulnar variance, and type of TFCC tear. RESULTS: Significant differences were found between the two groups in the incidence of fluid collection of the DRUJ and ECU peritendinous area, and longitudinal ECU tendon splitting. Among the 70 patients with TFCC tears, age and the magnitude of ulnar variance were significantly correlated with the severity of fluid collection around the ECU tendon. The magnitude of ulnar variance in patients with DRUJ fluid collection was significantly larger than that in patients without fluid collection. There was a significant correlation between the presence of disc tears and DRUJ fluid collection. CONCLUSION: We found a higher incidence of accompanying abnormal MRI findings of the ECU tendon and DRUJ in patients with TFCC tears than in the control group. The presence of disc tears, the magnitude of ulnar variance, and age may be risk factors for these MRI lesions associated with TFCC tears.

Cholesterol Crystal Embolization Exacerbates Critical Limb Ischemia.

Chronic life-threatening ischemia (CLTI), characterized by chronic severe ischemic ulcers or gangrene in the legs with arterial occlusive disease, has a high rate of amputation and mortality. However, how lower extremity artery disease (LEAD) leads to CLTI is not fully understood yet. Here, we report a 79-year-old man with resting pain and gangrene in the left first and fifth toes for a year who had undergone repetitive endovascular treatment (EVT) that temporarily improved the ischemia. Non-obstructive general angioscopy (NOGA) revealed yellow and red floating emboli at the occluded left superficial femoral artery (SFA). Although a second EVT for the reoccluded SFA was successful, amputation of the left lower knee remained necessary because of osteomyelitis of the left heel. Cholesterol crystals (CCs) associated with innate inflammation were detected in spontaneously ruptured aortic plaques (SRAPs) via aortic screening using the NOGA, in occluded SFAs, and on the surface of the muscle cross-section of the amputated legs via a polarizing microscope. Histopathological analysis demonstrated CCs in small vessels in various stages of patchy necrosis and muscle regeneration. In this case, the process of CC embolization, such as the embolic source of CCs, occlusion in arteries, small arteries, and deposition in muscles, was confirmed in CLTI. CCs are the principal trigger of IL-6 production through the innate inflammatory response in spontaneously ruptured aortic plaques. Mechanical ischemia and chronic inflammation due to embolized CCs may cause chronic limb damage. In this case, the CC embolization might exacerbate CLTI.

Reliability and clinical importance of teardrop angle measurement in intra-articular distal radius fracture.

PURPOSE: The teardrop angle (TDA) is a newly characterized radiographic parameter that some authors propose as an indicator of articular incongruity of the lunate facet. The purposes of this study were to investigate intra-observer and interobserver reliability of the measurements of the TDA and to determine whether the TDA is a reliable indicator of articular step and gap formation after distal radius fracture. METHODS: We studied radiographs of 24 uninjured wrists and 24 wrists with intra-articular distal radius fractures. On standard and 10° tilt views of lateral wrist radiographs, the teardrop represents the volar rim of the lunate facet, and the TDA is defined as the angle between the central axis of the teardrop and the radial shaft. We examined interobserver and intra-observer reliability for 3 observers using the intraclass correlation coefficient (ICC) for measurements of the uninjured and fractured wrists. For subjects with fractures, we determined correlation of the TDA-volar tilt with the articular step and gap measured by computed tomography using simple linear regression. RESULTS: There was almost perfect intra-observer (ICC = 0.95) and interobserver (ICC = 0.93) reliability in the fractured wrists. We observed substantial intra-observer (ICC = 0.64) and fair interobserver (ICC = 0.28) reliability in the uninjured wrists on the standard lateral radiographs. On the 10° tilt views, intra-observer and interobserver reliability in the uninjured wrists increased to substantial levels (ICC = 0.76 and 0.61, respectively). The TDA-volar tilt was significantly associated with articular step and gap on computed tomography. CONCLUSIONS: The TDA, measured on the lateral radiograph of the wrist, exhibits higher intra-observer and interobserver reliability in fractured wrists compared with uninjured wrists. On the 10° tilt views, the reliability increased in the uninjured wrists. Measurement of the TDA in plain radiographs may allow direct estimation of articular incongruity as seen on sagittal computed tomography reconstruction images.

Importance of anterior humeral line for successful anatomical reduction in the surgical treatment of pediatric supracondylar humeral fractures.

Anterior humeral line (AHL) and tilting angle (TA) are used for the assessment of pediatric elbow sagittal plane alignment in surgical treatment of pediatric supracondylar humeral fracture. However, few studies exist that compare the reliabilities between these parameters. The purpose of this study is to determine whether measurements of radiographic parameters are reliable and useful for achieving anatomical reduction. In the current study, we demonstrated that the identifying the AHL location involves a simple and reliable measurement compared with TA. The intraoperative AHL identification is a good indicator for achieving anatomical reduction.