The Combined Suture Bridge With Mason-Allen Technique Is Superior to the Conventional Suture Bridge Technique for Arthroscopic Rotator Cuff Repair.

PURPOSE: To compare clinical results and retear rates between the combined suture bridge with Mason-Allen (SBMA) technique and the conventional suture bridge (SB) technique in patients with full-thickness rotator cuff tears who underwent arthroscopic rotator cuff repair. METHODS: One hundred two patients who underwent arthroscopic rotator cuff repair using the SB technique (n = 50) or SBMA technique (n = 52) for a full-thickness rotator cuff tear and had at least 2 years of follow-up were retrospectively analyzed. Magnetic resonance imaging was performed before surgery and 2 years after to determine preoperative tear size, Goutallier stage, and presence of retear after surgery. Patients were clinically evaluated using the Japanese Orthopaedic Association (JOA) score. RESULTS: The groups did not significantly differ in terms of follow-up period, age, sex, tear size, Goutallier stage, or number of suture anchors. The retear rate was significantly lower in the SBMA group (7.7% vs 28.0%; P < .01). The JOA score was significantly higher at last follow-up than before surgery in both groups (P <.01). The JOA score at last follow-up was significantly higher in the SBMA group (P = .02). CONCLUSIONS: Arthroscopic rotator cuff repair using the SBMA technique may provide better clinical and anatomical outcomes than the conventional SB technique. LEVEL OF EVIDENCE: Level III, retrospective cohort design; treatment study).

Shear wave elastography correlates to degeneration and stiffness of the long head of the biceps tendon in patients undergoing tenodesis with arthroscopic shoulder surgery.

BACKGROUND: Tendinopathy of the long head of the biceps (LHB) tendon causes degeneration and changes its stiffness. However, a reliable means of diagnosis has not been established. Shear wave elastography (SWE) provides quantitative tissue elasticity measurements. In this study, the relationship of preoperative SWE values with biomechanically measured stiffness and degeneration of the LHB tendon tissue was investigated. METHODS: LHB tendons were obtained from 18 patients who underwent arthroscopic tenodesis. SWE values were measured preoperatively at 2 sites, proximal to and within the bicipital groove of the LHB tendon. The LHB tendons were detached immediately proximal to the fixed sites and at their superior labrum insertion. Tissue degeneration was histologically quantified using the modified Bonar score. Tendon stiffness was determined using a tensile testing machine. RESULTS: The SWE values of the LHB tendon were 502.1 ± 113.6 kPa proximal to the groove and 439.4 ± 123.3 kPa within the groove. The stiffness was 39.3 ± 19.2 N/mm. The SWE values displayed a moderate positive correlation with the stiffness proximal to the groove (r = 0.80) and within it (r = 0.72). The SWE value of the LHB tendon within the groove showed a moderate negative correlation with the modified Bonar score (r = -0.74). CONCLUSIONS: These findings suggest that preoperative SWE values of the LHB tendon correlate moderately positively with stiffness and moderately negatively with tissue degeneration. Therefore, SWE may predict LHB tendon tissue degeneration and changes in stiffness caused by tendinopathy.

Comparison of anemia, renal function, and nutritional status in older women with femoral neck fracture and older women with osteoarthritis of the hip joint.

BACKGROUND: Several studies in older patients with femoral neck fracture found that preoperative anemia and malnutrition were associated with higher mortality and poorer physical function. Therefore, we compared nutritional status, Hb level, and renal function in women with femoral neck fracture and women of the same age with osteoarthritis of the hip joint. METHODS: We enrolled 257 women aged 70 years and older who suffered femoral neck fracture (F group) or who were scheduled to undergo total hip arthroplasty for osteoarthritis of the hip joint (OA group). The F and OA groups were further divided into 2 groups on the basis of age, ie, 74 years old and younger (F70 and OA70) and 75 years old and older (F75 and OA75). To assess whether patients had undernutrition, mortality risk, anemia, and renal dysfunction, we assessed Geriatric Nutritional Risk Index (GNRI), Hb, and eGFR. RESULTS: We found a significant difference in the mean Hb levels and GNRI scores between the F75 and OA75 and F70 and OA70. Moreover, we found a moderate correlation between Hb level and GNRI score in the F75 and OA75. With respect to the GNRI category, the percentage of patients at moderate or major risk was 42.1% in the F70 group and 57.6% in the F75 group but only 1.9% in the OA70 group and 4.3% in the OA75 group. CONCLUSION: We found that women with femoral neck fracture had significantly lower Hb levels and lower GNRI scores than women with hip OA in the same age and that anemia and undernutrition were closely linked in women aged 75 and above. Moreover, we found that more than 40% of patients with a femoral neck fracture had a moderate to major risk on the basis of their GNRI scores.

Posterior shoulder stiffness was associated with shoulder pain during throwing in college baseball players: assessment of shear wave elastography.

PURPOSE: To investigate shoulder stiffness on the throwing and non-throwing sides in college baseball players using ultrasound shear wave elastography (SWE), and investigate the relationship between stiffness and shoulder pain during throwing. METHODS: Forty-nine college baseball players (98 shoulders) were recruited. Shoulder range of motion was evaluated. SWE was used to measure stiffness of the bilateral supraspinatus tendons, infraspinatus tendons, subscapularis tendons, supraspinatus muscles, infraspinatus muscles (ISPM), and posterior capsules. Participants were divided into pain and no pain groups based on the presence or absence of shoulder pain during throwing within 1 month before measurements on the throwing side. Items were compared between the throwing and non-throwing sides, and between the pain and no pain groups. Factors affecting shoulder pain during throwing were also investigated via multiple logistic regression analysis. RESULTS: Compared with the non-throwing side, the throwing side had significantly greater external rotation at 90° abduction, significantly lesser internal rotation at 0° abduction and internal rotation at 90° abduction (AbdIR), significantly higher SWE values of the infraspinatus tendon, ISPM, and posterior capsule, and significantly lower SWE values of the subscapularis tendon. Compared with the no pain group, the pain group had a significantly higher SWE value of the ISPM, and significantly lesser AbdIR. Increased ISPM SWE values and decreased AbdIR were significantly correlated with shoulder pain during throwing. CONCLUSIONS: The posterior tissue was stiffer than the anterior tissue on the throwing side. Decreased AbdIR and increased ISPM stiffness may be correlated with shoulder pain during throwing.

Arthroscopic Bankart repair with additional footprint fixation using the double-row technique at the 4 o'clock position anatomically restored the capsulolabral complex and showed good clinical results.

PURPOSE: To investigate the clinical outcome and magnetic resonance imaging (MRI) findings after arthroscopic Bankart repair with additional double anchor footprint fixation (DAFF) at the 4 o'clock position, where the native footprint is widest anatomically, for recurrent anterior shoulder instability. METHODS: Forty-two patients (mean age 27.0 years) with recurrent anterior shoulder instability and without severe glenoid bone defects underwent arthroscopic Bankart repair with additional DAFF at the 4 o'clock position. Using three standard portals, single-row repair was performed at the 2, 3, and 5 o'clock positions, and DAFF with the suture bridging technique was conducted at the 4 o'clock position. MRI was performed preoperatively and at 6 months postoperatively. Patients with follow-up periods of ≥1 year were included in the present study and clinically evaluated at the final follow-up. The morphology at the 2 and 4 o'clock positions on radial MRI slices was compared between the preoperative and 6-month postoperative scans, and the footprint of the repaired capsulolabral complex at 6 months postoperatively was compared between the 2 and 4 o'clock positions. RESULTS: The average follow-up period was 19.5 ± 6.2 months. The rates of dislocation recurrence and positive apprehension test results were 2.4 and 4.8%, respectively. External rotation was restricted by 3.5°. The University of California at Los Angeles and Rowe scores at the final follow-up were 34.5 ± 1.0 points and 97.2 ± 5.7 points, respectively, representing significant improvements over the preoperative scores (p < 0.01). Although the capsulolabral complex at 6 months postoperatively was firmly repaired at both the 2 and 4 o'clock positions compared to its preoperative state, the footprint of the restored capsulolabral complex was wider at the 4 o'clock position than at the 2 o'clock position (p < 0.01). CONCLUSIONS: Additional DAFF at the 4 o'clock position improved the glenohumeral stability and function of the shoulder joint. This study suggests that this technique is a reliable and useful treatment for shoulder instability. LEVEL OF EVIDENCE: IV.

Effects of social isolation associated with the COVID-19 pandemic on hip muscle strength, hip joint pain, and walking ability in patients with osteoarthritis of the hip joint.

To reduce the spread of the Sars-CoV-2 virus, governments in many countries adopted a social isolation strategy. However, social isolation may adversely affect people's health, e.g., by decreasing the muscle function of lower limbs. We recruited 118 patients who had undergone total hip arthroplasty (THA) and 87 patients with moderate to severe hip joint osteoarthritis (OA) and measured hip muscle strength, hip joint pain, and walking ability from before to one year after the start of the COVID-19 pandemic. During the pandemic, hip flexion (straight leg raise, SLR) strength decreased in 13.1% of patients in the post-THA group and 25.6% in the severe-OA group; in the severe-OA group, the decrease in SLR strength was mainly in patients aged 65 years and older. In addition, pain increased to mild or moderate and walkable distance decreased in more patients in the severe-OA group.

Anatomical position of the corona mortis relative to the anteroposterior and inlet views.

PURPOSE: Although pubic ramus fractures are common in the elderly, resultant hemodynamic instability is a rare complication. The corona mortis, a vascular anastomosis between the obturator vessels and the external iliac vessels in the retropubic space, is occasionally damaged by fractures of the pubic ramus, causing significant hemorrhage. The purpose of this study was to evaluate the incidence and anatomical position of the corona mortis on the anteroposterior and inlet views. METHODS: Sixty-one cadavers (122 hemipelvizes) were dissected and the incidence of the corona mortis was evaluated. Photographs were then taken simulating anteroposterior and inlet radiographs, and labeled as the anteroposterior and inlet views. The distance from the pubic symphysis to the corona mortis was measured on each of the two views. RESULTS: The corona mortis was present in 76.1% of hemipelvizes. The corona mortis traverses along the periosteum of the dorsal surface of the pubis. The incidence of arterial corona mortis was 28.3% and that of venous corona mortis was 76.1%. The distance from the superior margin of the symphysis pubis to the corona mortis measured 47.7 ± 9.9 (45.9-49.6) mm on the anteroposterior view, and 59.4 ± 9.2 (57.3-61.5) mm on the inlet view. CONCLUSIONS: In order to predict possible hemodynamic instability of the corona mortis following pubic ramus fractures, it is of clinical significance to precisely establish the anatomical position of the corona mortis on the anteroposterior and inlet views.

Association of ABO blood group with postoperative total bleeding volume in patients undergoing total hip arthroplasty.

BACKGROUND AND OBJECTIVES: As individuals with blood types A, B and AB have approximately 25% higher levels of vWF than those with type O, the risk of developing venous thrombotic events has been investigated in a number of clinical studies, but whether individuals with type O blood experience increased bleeding remains to be clarified. The purpose of this study was to evaluate an association of ABO blood group with intraoperative bleeding and postoperative total bleeding in patients undergoing total hip arthroplasty. MATERIALS AND METHODS: We prospectively recruited 84 women who were undergoing total hip arthroplasty. The differences between blood groups in mean age, body weight, preoperative and postoperative Hct levels, and postoperative/preoperative Hct ratio, intraoperative bleeding volume (IBV), and total bleeding volume (TBV) were evaluated. RESULTS: Twenty-six patients had type A blood, 17 had type B, 9 had type AB, and 30 had type O. There were no significant differences in mean age, body weight or operating time between the different ABO blood groups. While there was no significant difference in these Hct levels or IBV among the different blood groups, there was a significant difference in TBV between type O and type AB, and between type O and non-type O. CONCLUSION: Our study in patients undergoing total hip arthroplasty suggests that patients in blood group O tend to have large amounts of bleeding.

Increased Stiffness of Rotator Cuff Tendons in Frozen Shoulder on Shear Wave Elastography.

OBJECTIVES: To evaluate the stiffness and morphologic characteristics of the capsule, rotator cuff tendons and muscles, coracohumeral ligament (CHL), and long head of the biceps in patients with frozen shoulder using shear wave elastography (SWE) with B-mode ultrasound. METHODS: Thirty-two patients with frozen shoulder were divided into freezing and frozen phases. All patients had limitations of their range of motion without rotator cuff tears. Stiffness was measured by SWE in the supraspinatus (SSp) tendon, infraspinatus (ISp) tendon, SSp muscle, ISp muscle, teres minor muscle, upper and lower trapezius muscles, posterior capsule, CHL, and long head of the biceps. The posterior capsule and CHL thicknesses were also investigated with B-mode ultrasound. All values were compared in the affected and unaffected shoulders in each phase. RESULTS: The SWE values for the SSp and ISp tendons in the freezing phase and the CHL in the frozen phase were significantly greater on the affected side than the unaffected side (mean ± SD, 280.4 ± 125.3 versus 178.1 ± 73.3, 318.4 ± 110.7 versus 240.8 ± 91.5, and 287.2 ± 135.3 versus 214.1 ± 91.1 kPa, respectively; P < .05). The posterior capsule in both the freezing and frozen phases and the CHL in the frozen phase were significantly thicker on the affected side than the unaffected side (1.3 ± 0.2 versus 0.9 ± 0.3, 1.2 ± 0.4 versus 0.9 ± 0.3, and 4.4 ± 1.4 versus 3.3 ± 1.1 mm; P < .01). CONCLUSIONS: The SWE values of the both SSp and ISp tendons increased in the freezing phase, and that of the CHL also increased in the frozen phase. Not only the change in thickness of the capsule but also the change in stiffness of the rotator cuff may correlate with frozen shoulder.

Anatomic Analysis of the Attachment of the Posteroinferior Labrum and Capsule to the Glenoid: A Cadaveric Study.

PURPOSE: To measure the height of the posteroinferior glenohumeral ligament (PIGHL) attachment to the labrum and the depth of the posteroinferior labrum to the glenoid, macroscopically, and to investigate the morphology of the attachment of the posteroinferior labrum to the glenoid, histologically. METHODS: Fifty cadaveric shoulders without exposed subchondral bone on the glenoid and detached posterior labrum were used. We examined the frequency of the heights of the PIGHL attachments to the labrum and the length of the labral attachment on the glenoid rim at the 7, 8, 9, and 10 o'clock positions, macroscopically. According to morphology of the histological labral attachments, it was divided into 3 groups. Labra attached on the articular surface and the glenoid neck were defined as the SN type, while labra attached only to the glenoid neck constituted labra attached to the bone and side of the articular cartilage (Nc type) and labra attached only to bone (Nb type). RESULTS: The PIGHL attached from 7 o'clock to 9 o'clock in 48 shoulders (96%). The mean labral attachment at the 7 o'clock position was 6.3 ± 1.0 mm (range, 4.6-9.4 mm), which was significantly longer than at the other positions (P < .05). Histologically, the frequency of SN type attachment was 49 (98%) shoulders at the 7 o'clock position. CONCLUSIONS: The PIGHL attached between 7 and 9 o'clock in 96% of the shoulders. In 98% of the shoulders, the labrum did not attach to the articular surface, but attached to both the articular cartilage and the bone of the glenoid neck at 7 o'clock. CLINICAL RELEVANCE: The posteroinferior labrum should be repaired widely at the 7 o'clock position and not on the articular surface because the labrum attached anatomically to the glenoid neck.

Healing Process of Gastrocnemius Muscle Injury on Ultrasonography Using B-Mode Imaging, Power Doppler Imaging, and Shear Wave Elastography.

OBJECTIVES: Muscle injury often occurs in sports activity. To avoid reinjury, it is important to determine the appropriate period until return to play after injury. The purpose of this study was to evaluate characteristics of the healing process for gastrocnemius muscle injury by B-mode imaging, power Doppler (PD) imaging, and shear wave elastography (SWE). METHODS: Twenty patients with acute calf musculotendinous injury were enrolled. Scar thickness on B-mode imaging, new vessels according to PD grades, and SWE values in the muscle, musculotendinous junction, and tendon of the medial head of gastrocnemius were measured at 4, 8, and 12 weeks after injury. RESULTS: Scar thickness was significantly larger at 8 and 12 weeks compared with 4 weeks (P < .01 for both). Power Doppler grades at 4 and 8 weeks were significantly higher compared with 12 weeks (P < .01 for both). Shear wave elastographic values in the muscle on the injury side were significantly higher at 8 and 12 weeks compared with 4 weeks (P < .01 for both), whereas those in the musculotendinous junction on the injury side were significantly higher at 12 weeks compared with 4 and 8 weeks (P < .01; P = .01, respectively). CONCLUSIONS: B-mode imaging, PD imaging, and SWE can measure the healing process after musculotendinous injury of the gastrocnemius medial head.

[A Vesected Case of Pancreatic Metastasis from Breast Cancer Which Recurred Six Years after Breast Surgery].

A 43-year-old woman who underwent surgical resection of invasive ductal carcinoma in the left breast at the age of 37 years old presented at our hospital for evaluation of pancreatic tumor. The original tumor was estrogen receptor(ER)progesterone receptor(PgR)and HER2 positive. At that time, she underwent radical mastectomy with no evident nodal disease. Postoperatively, the patient was placed on adjuvant tamoxifen therapy for several years. Six years following the original diagnosis of breast cancer, she was referred to the hospital for routine check-up while asymptomatic. Follow-up examination showed a solitary hypodense mass approximately 0.9 cm in size in the pancreas body on dynamic CT scan. The patient underwent a standard distal pancreatectomy with standard regional lymphadenectomy. Histopathological examination and immunohistochemical features revealed that the tumor was compatible with metastatic pancreatic adenocarcinoma from breast cancer.

Shear Wave Elastography Can Predict Passive Stiffness of Supraspinatus Musculotendinous Unit During Arthroscopic Rotator Cuff Repair for Presurgical Planning.

PURPOSE: To determine the feasibility of shear wave elastography (SWE) with B-mode ultrasound in predicting the stiffness of the rotator cuff muscle before arthroscopic rotator cuff repair to evaluate the difficulty of the surgical procedure, as well as to compare SWE with the Goutallier stage on magnetic resonance imaging (MRI). METHODS: Thirty-eight patients with a full-thickness supraspinatus tear requiring arthroscopic rotator cuff repair participated. The Goutallier stage of fatty infiltration on MRI was measured before surgery, as was the SWE modulus of the anterior superficial, anterior deep, posterior superficial, and posterior deep (PD) regions of the supraspinatus muscle. To measure the stiffness of the supraspinatus musculotendinous unit during surgery, the supraspinatus tendon was axially stretched until the anatomic insertion site was reached, and force per deformation was recorded. The correlation between stiffness of the supraspinatus and SWE value in each region of the supraspinatus muscle or Goutallier stage was determined. In addition, patients were divided into 2 groups: (1) In the complete footprint coverage group, greater than 50% of the footprint was covered during the stiffness measurement, and (2) in the incomplete footprint coverage group, less than 50% of the footprint was covered during the stiffness measurement. Differences in SWE value and Goutallier stage were measured between the 2 groups. RESULTS: The best correlation of stiffness with the SWE modulus of the PD muscle of the supraspinatus was R = 0.69, and the correlation of stiffness with the Goutallier stage on MRI was R = 0.48. The SWE value of the PD region was greater in the incomplete footprint coverage group than in the complete footprint coverage group, although the Goutallier stage was not significantly different. CONCLUSIONS: The highest correlation with stiffness of the supraspinatus musculotendinous unit was with the SWE modulus of the PD muscle, as compared with SWE evaluation of the other regions or the Goutallier stage on MRI. Ultrasound SWE can predict the stiffness of the supraspinatus musculotendinous unit best. CLINICAL RELEVANCE: Rotator cuff retraction adds difficulty to arthroscopic rotator cuff repair. Ultrasound SWE may be used for presurgical planning.

A new technique of surgical planning for anterior cruciate ligament reconstruction: Feasibility Assessment of Shear Wave Elastography to Tendon of Semitendinosus Muscle.

There is currently no method to quantify the quality of the harvested graft before anterior cruciate ligament (ACL) reconstruction. The purpose of this study was to explore a method for measuring stiffness of the normal tendon of the semitendinosus muscle using shear wave elastography (SWE). Our investigation comprised two steps. First, we determined orientation of the semitendinosus tendon fibers in 20 lower legs of embalmed cadavers. Second, we investigated the feasibility of quantifying stiffness of the normal semitendinosus tendon by SWE in 24 subjects (48 legs: 24 male and 24 female subjects) in vivo. Measured values were compared between male and female subjects. The point at the intersection of the semitendinosus tendon with the axial section through the center of the patella mostly was the middle of the semitendinosus tendon in the cadavers. The SWE modulus in all of the subjects could be measured on this point in vivo. The SWE modulus of males and females were 474.0 ± 71.9 kPa and 396.9 ± 104.5 kPa, respectively. The SWE modulus of males was significantly larger than that of females (P < 0.01). This study demonstrates that stiffness of the tendon of the semitendinosus muscle can be measured by SWE. It also shows that tendon of the semitendinosus muscle in males is stiffer than in females. Clin. Anat. 31:404-408, 2018. © 2017 Wiley Periodicals, Inc.

Application of shear wave elastography for the gastrocnemius medial head to tennis leg.

Muscle strain of the gastrocnemius medial head mainly occurs at the musculotendinous junction (MTJ), and stiffness is a risk factor. Shear wave elastography (SWE) measures elasticity by determining the propagation velocity. The aim of this study was to measure the elasticity of the normal muscle and aponeurosis in the MTJ of the gastrocnemius medial head using SWE, thus obtaining information relevant to muscle strain at this point. Forty-one volunteers (82 legs) were recruited and the gastrocnemius medial heads were examined at four points: three on the aponeurosis, namely at the center of the MTJ (Central), 10 mm proximal to it (Proximal) and 10 mm distal to it (Distal); and at one on the muscle belly (Muscle). The measurements were compared among the points, between males and females, and between younger and middle-aged subjects. Correlations between the elastic modulus and age were also examined. The elastic moduli at Proximal, Central, Distal, and Muscle were 2.82 ± 0.53 m/s, 3.43 ± 0.83 m/s, 4.83 ± 1.56 m/s, and 2.25 ± 0.43 m/s, respectively. These values differed significantly among the points of the aponeurosis, Distal having the highest modulus followed by Central. The elastic moduli were significantly greater in males than females at Distal and Muscle and in younger subjects than middle-aged subjects at Muscle. No significant correlations between elastic modulus and age were observed for any point. SWE could be a feasible method for quantifying the elasticity of muscle and aponeurosis in the MTJ of the gastrocnemius medial head. Clin. Anat. 30:114-119, 2017. © 2016 Wiley Periodicals, Inc.

Survival and clinical results of a modified "crosse de hockey" procedure for chronic isolated patellofemoral joint osteoarthritis: mid-term follow-up.

BACKGROUND: The optimum treatment for isolated patellofemoral joint osteoarthritis (PFJ-OA) remains controversial. The aim of this study was to assess the mid-term clinical results of a modified crosse de hockey procedure for the treatment of isolated PFJ-OA. MATERIALS AND METHODS: We assessed 37 knees in 31 patients treated by a modified crosse de hockey procedure. The mean age was 57.6 years (range, 46-75 years) and mean follow-up was 90.1 months (range, 24-216 months). We evaluated clinical and radiographic outcomes, as well as complication rates at the mid-term follow-up. RESULTS: The Kujala score (mean improvement of 46.7, P < 0.001) and the Fulkerson score (mean improvement of 19, P = 0.001) were significantly higher compared to preoperative values. Overall clinical results rated excellent in 24.3 %, very good in 21.6 %, good in 35.1 %, fair in 13.5 %, and poor in 5.4 % of knees. Patellar tilting (P = 0.015) and congruence angle (P = 0.018) significantly improved postoperatively. On the other hand, the Insall-Salvati index decreased at the time of follow-up, although it remained in the physiologic range. Postoperatively, consecutive disease progression in the tibiofemoral joint and patellofemoral joint osteoarthritis were 18.9 and 5.4 %, respectively. The operative complication rate was 5.4 % in this case series. These percentages were lower than those of alternative tibial tuberosity osteotomy techniques. CONCLUSION: In most patients with chronic isolated PFJ-OA, tibial tuberosity osteotomy by modified crosse de hockey is a reliable procedure that provides good/excellent mid-term clinical results. LEVEL OF EVIDENCE: Level IV.

Lateral femoral cutaneous nerve injury with the direct anterior approach for total hip arthroplasty.

PURPOSE: Although injury of the lateral femoral cutaneous nerve (LFCN) is a known complication after total hip arthroplasty (THA) via the direct anterior approach (DAA), the impact of this complication on postoperative quality of life (QOL) is unclear. This study aims to investigate the incidence of LFCN injury after DAA for THA, and to determine the impact of LFCN injury on QOL and hip function. METHODS: We prospectively investigated 122 hips operated upon using the DAA regarding the incidence of LFCN injury using self-reported questionnaires, hip functional scores such as the Harris Hip Score (HHS) and the Japanese Orthopaedic Association (JOA) score, and patient-reported outcomes such as the Western Ontario and McMaster Universities Osteoarthritis Index, the Japanese Orthopaedic Association Hip disease Evaluation Questionnaire (JHEQ), and the Forgotten Joint Score-12 (FJS). RESULTS: LFCN injury was seen in 39 hips (31.9 %). In affected hips, the leading symptom was hypo-aesthesia (46.2 %), followed by tingling or jolt-like sensation (28.2 %). There was no difference in the HHS and JOA score between those with LFCN injury and those without. There was a significant difference in the FJS-12 between the two groups (50.9 ± 25.3 for hips with LFCN injury vs 64.3 ± 25.7 without, p = 0.01). There was a non-significant tendency for patients with LFCN injury to have a lower JHEQ than those without (63.6 ± 19.6 for hips with LFCN injury vs 70.8 ± 22.9 without, p = 0.13). CONCLUSIONS: The incidence of LFCN injury decreased QOL but not hip function after DAA for THA.

Serodiagnosis of Mycobacterium avium complex pulmonary disease in rheumatoid arthritis.

BACKGROUND: Mycobacterium avium complex (MAC) pulmonary disease (PD) is often difficult and complicated to diagnose or to discriminate from follicular bronchitis, bronchiectasis, or other conditions associated with rheumatoid arthritis (RA) lung in the clinical setting. OBJECTIVE: We investigated whether a serologic test for anti-glycopeptidolipid (GPL) antibody was useful for distinguishing MAC-PD from RA lung in diagnosis. METHODS: Serum IgA antibody to MAC-specific GPL core antigen was measured by an enzyme immunoassay. Antibody levels were measured in sera from 14 RA patients with MAC-PD (RA + MAC), 20 RA patients with bronchial or bronchiolar lesions without MAC-PD (RA w/o MAC), 20 RA patients without pulmonary lesions (RA only), and 25 healthy volunteers (HV). RESULTS: The levels of serum anti-GPL antibodies were higher in the RA + MAC group than in the RA w/o MAC, RA-only, and HV groups (2.87 ± 2.83 vs. 0.50 ± 0.45, 0.31 ± 0.24, and 0.38 ± 0.10 U/ml, respectively; p < 0.001). With the cutoff point in receiver-operating characteristic analysis set at 0.7 U/ml, the serologic test differentiated RA + MAC from RA w/o MAC with a sensitivity of 100% and specificity of 90%. CONCLUSIONS: This serologic test for anti-GPL antibody is useful for diagnosing MAC-PD in RA.

[A case of postoperative recurrent hilar cholangiocarcinoma in the lower bile duct treated with pancreatoduodenectomy].

When surgery is selected to treat postoperative recurrent hilar cholangiocarcinoma in the intrapancreatic bile duct, attention should be paid to the following: 1 ) technical resectability of the lesion, 2) reconstruction, and 3) high risk of complications. Eight cases, including the present case, of pancreatoduodenectomy (PD) for postoperative recurrent hilar cholangiocarcinoma in the intrapancreatic bile duct have been reported thus far. In October 2009, a 73-year-old man noticed that his stools were gray and visited a physician. He was diagnosed with cholangiocarcinoma on close examination and underwent left hepatic and caudate lobectomy in January 2010. After the surgery, he was treated with TS-1 (80 mg) and followed up at the outpatient clinic of our hospital. In July 2013, he was diagnosed with cancer of the lower bile duct and was admitted for surgery. The first and second pathological findings were carcinoma of the bile duct and papillary adenocarcinoma, respectively. The findings from the immunostaining were also inconsistent. The histopathological examination result suggested multicentric recurrence. The surgery was highly invasive, increasing the patient's risk of complications, in addition to the presence of postoperative adhesion. Therefore, surgery may be an important option for cases of localized recurrence but not for multicentric recurrence.