Cumulated ambulation score as predictor of postoperative mobility in patients with proximal femur fractures.

INTRODUCTION: The cumulated ambulation score (CAS) has been developed as an index for evaluating mobility in the early postoperative period. This study aimed to estimate the association between CAS and independent ambulation after surgery for proximal femur fractures. MATERIALS AND METHODS: This retrospective cohort study included 223 elderly patients who underwent surgery for proximal femur fractures and had independent ambulation before the injury. Multivariable logistic regression analyses with cognitive impairment, pre-injury Barthel index, and CAS as the test variables were used to predict independent ambulation at 2 weeks (model 1) and 3 months (model 2) postoperatively. We established scoring systems based on the modeling results. RESULTS: The number of patients with independent ambulation at 2 weeks and 3 months postoperatively was 115 and 169, respectively. Univariate analysis showed that the CAS was significantly associated with independent ambulation at 2 weeks and 3 months postoperatively. Multivariable analysis showed that models 1 and 2 had good predictive accuracies, with areas under the receiver-operating characteristic curve of 0.855 and 0.868, respectively. Among the explanatory variables, only the CAS in model 2 was not significantly associated with the postoperative ambulatory ability. Scoring systems for both models 1 and 2 also had good predictive accuracies, with cut-off scores of 3.5 for model 1 and 9.5 for model 2. CONCLUSIONS: The CAS predicted independent ambulation at 2 weeks postoperatively; however, this relationship was limited at 3 months postoperatively. Therefore, the CAS may help estimate independent ambulation at discharge from an acute-care hospital.

Mitral valve plasty in a patient with multiple cerebral cavernous malformations: A case report.

Cerebral cavernous malformations (CCMs) are blood vessel malformations, often untreated if asymptomatic. However, upon cardiac surgery with cardiopulmonary bypass, cerebral edema/hemorrhage may occur. We successful performed mitral valve plasty for a case of severe mitral regurgitation with multiple CCMs. Preoperative head magnetic resonance imaging and strict perioperative management are important.

Warfarin Reversal With Four-Factor Prothrombin Complex Concentrate for Left Ventricular Assist Device Conversion Surgery Monitored by TEG6s: A Case Report.

Left ventricular assist devices (LVADs) require careful therapeutic anticoagulation with warfarin to prevent pump thrombosis. However, the best method to reverse warfarin for elective LVAD conversion surgery with massive bleeding remains unclear. We report the case of a 39-year-old Japanese man who was administered a four-factor prothrombin complex concentrate (4F-PCC) as warfarin reversal when he underwent conversion surgery from paracorporeal LVAD to implantable LVAD. 4F-PCC with co-administration of vitamin K reduced the international normalized ratio and R time in TEG6s (Haemonetics Corporation, USA) immediately. The effect was prolonged, and good hemostasis was achieved. 4F-PCC with vitamin K provided good hemostasis in our patient; therefore, 4F-PCC could be a useful tool for elective LVAD conversion surgery with expected massive bleeding and requiring immediate warfarin reversal.

An autopsy case of sudden unexpected death with Barlow's disease.

A 45-year-old man was clinically diagnosed with mitral valve regurgitation 2 years before death. The autopsy showed left ventricular hypertrophy and mitral valve prolapse of the bileaflet with billowing valve and excessively thickened leaflet, the findings of which were consistent with Barlow's disease. Microscopically, destruction of the 3-layer structure of the mitral valve and advanced interstitial fibrosis of the left ventricular wall were evident. Additionally, a marked but limited reduction in conduction fibers was found in the branching point of the left and right branches, as seen in cases of idiopathic complete atrioventricular block. Genetic investigation using whole-exome sequencing showed some genetic variants with uncertain significance. In patients with Barlow's disease, a marked reduction of conduction fibers might be a subtype of sudden cardiac death. The overlap of some arrhythmogenic substrate in the heart may increase the risk of sudden cardiac death with asymptomatic Barlow's disease.

The relationship between scapular position and glenohumeral rotational range of motion in high school baseball players.

BACKGROUND: Past research indicated that scapular malposition is related to the glenohumeral internal rotation deficit (GIRD). However, there is no research examining the effect of throwing-related pain on this relationship. This study investigated the relationship between scapular position and range of motion (ROM) and compared the difference in this relationship between with and without throwing-related pain. METHODS: Forty male baseball players in high school were recruited for this study. The existence and degree of throwing-related pain were obtained from a questionnaire. Participants were divided into 2 groups according to the presence or absence of the pain. Glenohumeral internal and external rotation ROM (abduction internal rotation angle and abduction external rotation angle [ABER], respectively) were measured using a digital inclinometer. The pectoralis minor muscle length was measured using a vernier caliper and scapula index, which indicated the scapular position, measured using a measuring tape. All these measurements were taken on both dominant and nondominant sides. The GIRD and total motion arc (TMA) deficit were calculated from the ROM measurements. Groups were compared using a mixed-model analysis of variance. RESULTS: There was a significant interaction between group and ABER dominance. Other variables were not seen as the interaction effect. There was a significant positive correlation between the scapula index and TMA (r = 0.47, P = .02) and a negative correlation between the scapula index and GIRD (r = -0.65, P < .01) in the dominant side of the pain group. In addition, in the nondominant side of the pain group, the scapula index and ABER were significantly correlated (r = 0.43, P = .04). CONCLUSIONS: The results of this study indicate that the scapular position is associated with the glenohumeral ROM in high school baseball players. In addition, this study demonstrated that the scapular internally rotated position was correlated with the GIRD and TMA deficit in high school baseball players who had throwing-related pain. On the other hand, the scapular externally rotated position was correlated with increased ABER, mainly in the pain-free baseball players or on the nondominant side. These results indicated that the scapular position might affect the glenohumeral rotational ROM in high school baseball players.

A case of chronic myocarditis remitted by immunosuppressive and central extracorporeal membrane oxygenation therapy.

The concept and therapeutic strategy for chronic lymphocytic myocarditis remain unestablished. We had a 57-year-old man with advanced biventricular (predominantly right ventricular) failure due to chronic lymphocytic myocarditis. He received central extracorporeal membrane oxygenation therapy that was explanted on day 129 following the aggressive steroid pulse and plasma exchange therapy. Infiltration of inflammatory cells persisted even after the device removal, which required long-term oral steroid administration after the index discharge on day 200. High-sensitivity cardiac troponin T level was normalized and inflammatory cell infiltration was remitted following post-discharge 4-month 10 mg/day prednisolone therapy. Aggressive immunosuppressive therapy under mechanical circulatory support might be a promising strategy for those with chronic lymphocytic myocarditis. .

A Rescue Use of ECPELLA for Sepsis-Induced Cardiogenic Shock Followed by Mitral Valve Replacement.

The use of veno-arterial extracorporeal membrane oxygenation (ECMO) in patients with sepsis-induced cardiogenic shock has been reported, but the clinical implication of the Impella percutaneous axial-flow left ventricular assist device for such patients remains unknown. We had a 37-year-old man with septic shock and severely reduced cardiac function. Veno-arterial ECMO and concomitant Impella CP support ameliorated his end-organ dysfunction and achieved cardiac recovery, whereas severe mitral valve regurgitation due to chordal rupture developed later. Mitral valve replacement concomitant with ECMO removal as well as an Impella upgrade successfully treated the patient. ECMO and Impella support might be an effective therapeutic strategy for the bridge to recovery in patients with sepsis-induced cardiogenic shock; however, paying attention to mitral chordal rupture is highly encouraged.

Takayasu Arteritis Complicated by Ischemic Colitis: A Case Report.

Takayasu arteritis is an inflammatory disease of the aorta and its major branches, which results in stenosis and aneurysm formation. Lesions of the abdominal aorta and renal arteries are common. Nevertheless, lesions of the celiac and superior mesenteric arteries are less common. Since the inferior mesenteric artery is usually preserved and functions as a collateral pathway, developing intestinal ischemia is very rare in patients with Takayasu arteritis. In this study, we report the case of a patient with Takayasu arteritis complicated by ischemic colitis. The patient was treated with surgical repair, which resolved the patient's symptoms.

Trans-Apical Transcatheter Aortic Valve Replacement in a Dialysis Patient with Systolic Heart Failure.

Mortality and morbidity remain high following transcatheter aortic valve replacement (TAVR) in dialysis patients or those with low left ventricular ejection fraction. Therapeutic strategy for those with these comorbidities remains unestablished. We had a dialysis patient with peripheral artery disease and low left ventricular ejection fraction, who received successfully scheduled trans-apical TAVR following sufficient reverse remodeling by 3-month optimal medical therapy. Our strategy should be validated in a larger robust cohort.

Gait cycle time variability in patients with knee osteoarthritis and its possible associating factors.

[Purpose] Knee osteoarthritis can alter gait variability; however, few studies have investigated the associating factors with gait cycle time variability. The first objective was to compare gait cycle variability between female patients with knee osteoarthritis and healthy elderly females and to determine gait characteristics in patients with knee osteoarthritis. The second objective was to identify the associating factors with gait cycle time variability. [Participants and Methods] The participants included 24 female patients diagnosed with knee osteoarthritis and 12 healthy elderly females. Gait cycle variability (coefficient of variation of gait cycle time), knee extension range of motion, knee extension strength, 5-m walk test, Timed Up & Go Test, and Western Ontario and McMaster Universities Osteoarthritis Index were measured. All assessment results were compared between the knee osteoarthritis and healthy groups. [Results] Gait cycle time variability was significantly higher in the knee osteoarthritis group than in the healthy group. Further, it showed a significant positive correlation with the 5-m walk test and the Western Ontario and McMaster Universities Osteoarthritis Index. [Conclusion] Patients with knee osteoarthritis presented greater gait cycle variability than that of healthy individuals. Therefore, rehabilitation to improve gait variability might enhance the quality of life of patients with knee osteoarthritis.

Transcatheter closure of patent foramen ovale accompanying right-to-left shunt during Impella support.

We experienced a 65-year-old woman who was diagnosed as fulminant myocarditis and transferred on mechanical ventilator and veno-arterial extracorporeal membrane oxygenation (ECMO) supports. Impella 5.0 support was additionally initiated to improve pulmonary edema and unload left ventricle. We found a patent foramen ovale (PFO) at the time of Impella insertion by transesophageal echocardiography. Follow-up transesophageal echocardiography found a development of right-to-left shunt flow through PFO accompanying central hypoxia during Impella P8 support. Veno-arterial ECMO was converted to veno-arterio-venous ECMO and PFO was occluded percutaneously on the next day, which stabilized hemodynamics and systemic oxygen supply. In case of Impella 5.0 support, the existence of PFO and the development of right-to-left shunt flow should be carefully surveyed and closed immediately to maintain hemodynamics and systemic oxygen supply.

Diagnosis of Carney complex following multiple recurrent cardiac myxomas.

Carney complex is a rare syndrome caused by a genetic mutation leading to multiple endocrine abnormalities and a variety of tumors. Here, we report a case of Carney complex diagnosed due to recurrent multiple myxomas in the right atrium of a patient 16 years after the resection of the primary left atrial myxoma. Surgical excision was performed for the multiple recurrent right atrial tumors under cardiopulmonary bypass. The patient remained complication-free after surgery and was discharged on the 14th day. He was scheduled to continue echocardiographic follow-up and periodic systemic review by an endocrinologist. This case emphasizes the fact that if cardiac myxomas tend to be multiple and recurrent at a relatively young age, the possibility of Carney complex should be considered, even in the absence of any other related feature other than cardiac tumors.

Acute effects of doorway stretch on the glenohumeral rotational range of motion and scapular position in high-school baseball players.

BACKGROUND: Pectoralis minor tightness has been thought to affect the scapular position. Despite the wide implementation of doorway stretch in clinical practice owing to its apparent effectiveness in stretching the pectoralis minor, limited studies have investigated its influence on the glenohumeral rotational range of motion (ROM). This study aimed to examine the acute effects of doorway stretch on the glenohumeral rotational ROM and the correlation between the scapular position and ROM. MATERIALS AND METHODS: In total, 34 male high-school baseball players participated in this study. Outcomes included the pectoralis minor muscle length, glenohumeral rotational ROM, and scapular position. The distance between the sternocostal joint of rib 4 and the coracoid process was measured as the pectoralis minor length. Internal and external rotation ROM with the shoulder abducted at 90° were measured. The scapular position was defined by the following two measurements: the distance between the surface and the posterolateral corner of the acromion as well as the scapular index. The participants performed doorway stretch by abducting and externally rotating the shoulder at 90° and flexing the elbow at 90°. The outcomes were compared before and after stretching. Furthermore, the correlation between these changes was investigated. RESULTS: Pectoralis minor muscle length and glenohumeral internal rotation ROM was significantly higher after stretching than before, and the scapular position also significantly changed (P < .01 for both). A moderate correlation was found between the degree of change in the glenohumeral internal rotational ROM and scapular position (r = 0.44, P < .01). DISCUSSION: Our results indicated that doorway stretch significantly increased the pectoralis minor muscle length and glenohumeral internal rotation ROM and significantly altered the scapular position. Furthermore, a significant correlation between the degree of change in the scapular position and glenohumeral internal rotation ROM was observed. These results suggest that doorway stretch could be beneficial for improving the scapular position and glenohumeral internal rotation ROM, which are considered the cause of throwing injuries. Furthermore, the glenohumeral ROM may be affected by the scapular position.

A cross-sectional study to assess variability in knee frontal plane movement during single leg squat in patients with anterior cruciate ligament injury.

BACKGROUND: Single leg squat (SLS) tests help predict anterior cruciate ligament injuries. However, the variability in joint movement during this test has not been fully investigated. The aim of this study was to examine the knee frontal plane movement variability during SLS in patients with anterior cruciate ligament (ACL) injury. METHODS: In this cross-sectional study, we enrolled 56 patients with ACL injury (28 males; 28 females) and 46 healthy subjects (23 males; 23 females). All participants underwent SLS tests. All kinematic variables were joint angle of trunk, pelvis and lower limb, center of gravity (COG), center of pressure (COP). These data were obtained at the frontal plane and the coefficient of variation (CV) were calculated. Multiple comparisons were performed between healthy subjects and the injured leg and uninjured leg of patients with ACL injury. The correlation of the CV in knee varus/valgus range of motion (ROM) with the CV in other kinematic variables were investigated in patients with ACL injury. RESULTS: Compared with healthy subjects, patients with ACL injury exhibited significantly larger the CV in knee varus/valgus ROM. A positive correlation was observed between the CV in knee varus/valgus ROM and the CV in pelvic lateral inclination ROM in patients with ACL injury. CONCLUSIONS: Knee frontal plane movement variability during SLS may help evaluate the risk of ACL injury/re-injury. In addition, pelvic lateral inclination variability during SLS may need to be evaluated in conjunction with knee frontal plane movement variability.

Anastomotic stenosis of a reconstructed dissecting superior mesenteric artery aneurysm undetectable by intraoperative indocyanine green angiography: A case report.

Intraoperative evaluation of blood flow using ICG angiography revealed no significant abnormality. However, the anastomotic stenosis was revealed by postoperative CT angiography; more precise intraoperative evaluation methods need to be developed.

Application of the Konno procedure for infective endocarditis in native bicuspid aortic valve with annular abscess extending into the interventricular septum.

Annular abscess is a serious complication of infective endocarditis, which often requires complex surgery and has a very high post-operative mortality rate. The Konno procedure involves valve annuloplasty for a narrow aortic annulus or left ventricular outflow tract stenosis in children; it is also performed for various cardiac conditions in adults. Here, we report a case of the Konno procedure performed in a patient with aortic valve infective endocarditis, with an annular abscess extending into the interventricular septum (IVS). A 58-year-old man who presented to our hospital with fever was diagnosed with aortic valve infective endocarditis caused by Streptococcus saccharolyticus. On echocardiography, an annular abscess in the direction of the IVS was detected, and surgery was planned. The Konno procedure was performed to secure an adequate surgical field and to debride and reconstruct the cavity created by the interventricular septal abscess. The patient was discharged uneventfully 29 days after surgery.

Peak Lag Between Plasma Vasopressin and Urine Aquaporin-2 Following Cardiac Surgery.

Tolvaptan, a vasopressin type-2 receptor antagonist, is utilized to ameliorate fluid retention following cardiac surgery. However, the optimal timing of tolvaptan administration considering novel biomarkers remains unknown. We prospectively included patients who underwent cardiac surgery between 2016 and 2020. We measured perioperative trends of free water reabsorption mediators including plasma arginine vasopressin and urine aquaporin-2. A total of 20 patients (68 [60, 75] years old, 18 men) were included. Urine volume decreased gradually after the initial 3 hours following cardiac surgery. The plasma arginine vasopressin level increased significantly with a peak at postoperative 6 hours, whereas the urine aquaporin-2 level increased later with a delayed peak at postoperative 12 hours. As a result, urine aquaporin-2 relative to the plasma arginine vasopressin level, which represents the activity of the collecting ducts and indicates predicted responses to tolvaptan, was a minimum at postoperative 6 hours. Tolvaptan administration immediately after cardiac surgery might not be recommended given the transient refractoriness to tolvaptan probably due to the stunning of kidney collecting ducts.

Iatrogenic diversion of the inferior vena cava into the left atrium diagnosed 43 years after surgical atrial septal defect closure.

The diversion of the inferior vena cava into the left atrium after surgical atrial septal defect closure is a fatal complication. Cases of atrial septal defect with no inferior rim should be treated with this complication in mind.

Surgical repair of a right coronary aneurysm with a coronary artery fistula to the right atrium.

A coronary artery fistula is a rare condition caused by abnormal coronary artery embryological development. Although most cases are asymptomatic, in some, the large shunt volume and the myocardial ischemia due to the steal phenomenon require surgical treatment. We present the case of a 40-year-old woman who presented with angina on exertion. Enhanced computed tomography showed a giant right coronary artery (RCA) aneurysm with an RCA-to-right atrium fistula. Because of the presence of symptoms and the presence of large fistulous tract, the patient was considered a surgical candidate. The procedure was performed under cardiopulmonary bypass. Ligation and closure of the fistula were performed in combination with dissection of the enlarged main trunk of the RCA and coronary artery bypass using the internal thoracic artery because of its potential for long-term patency. The postoperative course was uneventful.

Lower limb kinematics of single-leg squat performance in patients with anterior cruciate ligament deficiency.

[Purpose] This study investigated the parameters that characterize the knee, hip, and pelvic kinematics during a single-leg squat in preoperative anterior cruciate ligament rupture injury. [Participants and Methods] Overall, 15 patients with unilateral anterior cruciate ligament deficiency were enrolled in this study. For each single-leg squat, data from two-dimensional video cameras and three-dimensional motion analysis were collected. Measurement indices included the articular angles of the knee, hip, and trunk. The anterior cruciate ligament-injured leg was compared with the uninjured leg. [Results] The maximum knee valgus and flexion angles during a single-leg squat were smaller in the injured leg than in the uninjured leg. During the single-leg squat, the effect of "compensatory mechanisms" appeared as knee valgus and flexion movements. In particular, the knee valgus angle decreased in the anterior cruciate ligament-injured leg compared to that in the uninjured leg. [Conclusion] This phenomenon suggests that it is possible to utilize recurrence prevention training for anterior cruciate ligament injury.