Understanding the Injury Mechanism in Hamate Hook Fractures by Investigating Fracture Morphologies: A Case Series Study.

BACKGROUND: Many studies have described hamate hook fractures resulting from direct force from sporting tools. However, several authors have reported fractures that did not occur during swing-related activities. This study aimed to understand the injury mechanism of fractures by investigating their morphologies. METHODS: We selected patients with hamate hook fractures and collected data on computed tomography scans, injury causes, and how athletes handled sporting tools. RESULTS: We investigated 50 patients, and the study cohort included 32 patients who sustained injuries during sports: 24 during baseball (group A) and 8 during other sports (group B). Sixteen patients sustained injuries from falls (group C), and 2 had their hands crushed while using an industrial press machine (group D). In group A, most patients had a fracture line starting from the middle section of the radial side, accompanied by osteosclerotic changes in their lower hand. In group B, most patients had fracture morphologies similar to those of most patients in group A. The main morphology of fractures in group C was a transverse fracture at the base. Two patients in group D had minimal fragments at the tip of the hooks. CONCLUSIONS: Our results question the theory that most hamate hook fractures in athletes are caused by direct force exerted on the palm because the fracture morphology was different from that of patients injured by acute trauma from direct force. Instead, these fractures likely stem from an indirect mechanism involving repetitive force generated by the tendons and muscles acting on the hook.

Metacarpophalangeal Joint Reconstruction by Vascularized Partial Metatarsophalangeal Joint Transplantation: A Case Report.

CASE: A 27-year-old man underwent metacarpophalangeal joint reconstruction of his right middle finger using vascularized tissue from the distal component of the metatarsophalangeal joint of the right second toe. The donor site was reconstructed using a portion of the iliac bone and overlying tendinous fiber. The reconstructed metacarpophalangeal joint was stable 2 years postoperatively, and the arc of active motion was 80°. The reconstructed metatarsophalangeal joint did not interfere with walking. Radiography revealed the satisfactory condition of these joints. CONCLUSION: Depending on the type of defective joint and soft tissue injuries, vascularized partial joint transplantation could be considered for reconstruction.

A case of severe acute hyponatremia after colonoscopy with polyethylene glycol plus ascorbic acid bowel preparation.

Previous reports have shown that bowel preparation can, in extremely rare circumstances, induce severe acute hyponatremia. Polyethylene glycol plus ascorbic acid as a bowel preparation is considered relatively safe with a smaller amount of free water load and a more pleasant taste with additives.We present the case of an 86-year-old man who developed severe acute hyponatremia presenting with tremor and impaired consciousness after colonoscopy, which is life-threatening. The severe hyponatremia in our case was not caused by free water loads from drinking large amounts of water during bowel preparation or hypovolemia due to bowel preparation-induced nausea, vomiting, and diarrhea, but might have been due to non-osmotic stimuli of antidiuretic hormone (ADH) release (i.e., pre-existing nausea, stress, anxiety, pain, stress, or the colonoscopy itself). Our study indicates that it is important to choose safer bowel preparation solutions, to be aware of ingested water volumes, to assess volume status, and also remain aware of other coexisting risk factors for acute hyponatremia, such as medical history, medication, and ADH release, especially in elderly patients.

Investigation of Schwannomas in the Forearms, Hands, and Digits: A Retrospective Study.

Background: Previous reports on schwannomas of the upper extremities have mainly focused on proximal involvement. This study aimed to evaluate pre- and peri-operative findings in schwannomas of the distal upper extremities and assess the accuracy of diagnosis and surgical outcome. Methods: We identified 24 patients with isolated tumors. Seven patients had schwannomas located in the forearm, eleven in the hand, and six in the digits. We collected the following data: preoperative clinical and magnetic resonance imaging findings, provisional diagnosis, surgical findings and procedures, tumor volume, and postoperative clinical findings. Data were compared between tumors of different locations. Results: The mean age of our cohort at the time of surgery was 48.0 years and the mean follow-up period was 10.6 months. All patients with forearm schwannomas were diagnosed preoperatively by the presence of the Tinel-like sign and suggestive magnetic resonance imaging findings. In contrast, schwannomas in the hands and digits often lacked these diagnostic features; only five patients with hand schwannomas and one with digit schwannoma were correctly diagnosed. Microsurgical enucleation was the most common treatment. Ten patients reported newly acquired paresthesia after operation, which resolved within the follow-up period in nine patients. Three of the four patients with preoperative paresthesia and one patient who underwent enucleation with surgical loupes still had paresthesia at the final follow-up. Conclusions: In schwannomas of the distal upper extremities, a more distal location is associated with a lower occurrence of the Tinel-like sign and fewer suggestive magnetic resonance imaging findings, resulting in lower diagnostic accuracy. However, intra-operative diagnosis is usually straightforward and microsurgical enucleation does not cause iatrogenic nerve deficit. When treating soft tissue tumors in the hand and digits that present without specific or suggestive findings, the possibility of schwannoma should be considered.

Atypical femoral fracture associated with delayed union for which the cessation of alendronate and daily administration of teriparatide contributed to fracture healing: histopathological evidence of the enhancement in bone formation parameters.

A female patient with systemic lupus erythematosus developed an atypical femoral fracture of the left femur after 5 years of glucocorticoid and alendronate therapy. We performed intramedullary nailing. However, 1 week later, we performed a revision surgery using a locking plate and an iliac bone graft because of displacement at the fracture site. At this stage, alendronate was discontinued and daily teriparatide was introduced and continued for 24 months. Twenty months after the revision surgery, a re-revision surgery was performed with an iliac bone graft because of breakage of the locking plate and fracture non-union. Fracture healing was eventually obtained 15 months after the re-revision surgery. Biopsies of the ilium before the treatment and 20 months after daily teriparatide treatment were evaluated. The histology revealed that proliferating osteoid and cuboidal osteoblasts were detected around the osteoid tissue after teriparatide treatment. Bone histomorphometry findings showed that bone volume parameters and osteoid parameters prominently increased with the teriparatide treatment, but not bone resorption parameters. Laboratory findings revealed the elevation of bone-specific alkaline phosphatase (24 U/L at 7 months) compared to its pre-teriparatide level (8.1 U/L) and increased bone mineral density of the hip (from -0.2 to 0.0 in T-score). These data indicated that the discontinuation of alendronate and initiation of teriparatide treatment activated bone-forming ability in our patient and may have contributed to fracture healing.

Low Bone Mineral Density of the Forearm and Femur among Postmenopausal Women with Metaphyseal Comminuted Fracture of the Distal Radius.

Osteoporosis is characterized by bone loss and skeletal fragility and is likely to occur in postmenopausal women. Distal radius fracture is a type of fragility fractures associated with osteoporosis. Bone mineral density (BMD) refers to the amount of mineral in bone tissue and is an indicator of osteoporosis. This study aimed to investigate the relationship between the severity of distal radius comminution and the BMD of the healthy contralateral forearm and femur in postmenopausal women. Of 165 women who sustained low-energy trauma from falls on flat ground, forearm and femoral neck BMDs were measured in 155 and 163 participants, respectively. Evaluation of distal radius comminution was performed by computed tomography, and the severity is classified based on the degree of articular surface comminution and on the presence of metaphyseal comminution. We thus evaluated 165 cases of articular surface comminution (extra-articular, 43 cases; intra-articular simple, 91 cases; and intra-articular multifragment, 31 cases) and metaphysis comminution (metaphyseal simple, 58 cases; metaphyseal monocortical comminution on either the palmar or dorsal side, 82 cases; and metaphyseal bicortical comminution on the palmar and dorsal sides, 25 cases). There was no significant association between intra-articular comminution and BMD of the forearm and femur. By contrast, the participants with metaphyseal bicortical comminution showed lower BMD of the forearm and femur compared with other types of metaphysis comminution (p < 0.05). In conclusion, postmenopausal women who developed bicortical comminuted fractures of the distal radius tend to have lower femoral BMD, which may predispose them to future hip fractures.

Enterococcus durans TN-3 Induces Regulatory T Cells and Suppresses the Development of Dextran Sulfate Sodium (DSS)-Induced Experimental Colitis.

BACKGROUND AND AIMS: Probiotic properties of Enterococcus strains have been reported previously. In this study, we investigated the effects of Enterococcus (E.) durans TN-3 on the development of dextran sulfate sodium (DSS) colitis. METHODS: BALB/c mice were fed with 4.0% DSS in normal chow. Administration of TN-3 (10mg/day) was initiated 7days before the start of DSS feeding. Mucosal cytokine expression was analyzed by real time-PCR and immunohistochemistry. The lymphocyte subpopulation were analyzed by flow cytometry. The gut microbiota profile was analyzed by a terminal-restriction fragment length polymorphism method (T-RFLP). RESULTS: The disease activity index and histological colitis score were significantly lower in the DSS plus TN-3 group than in the DSS group. The mucosal mRNA expression of proinflammatory cytokines (IL-1ß, IL-6, IL-17A and IFN-γ) decreased significantly in the DSS plus TN-3 group as compared to the DSS group. The proportion of regulatory T cells (Treg cells) in the mucosa increased significantly in the DSS plus TN-3 group as compared to the DSS group. Both fecal butyrate levels and the diversity of fecal microbial community were significantly higher in the TN-3 plus DSS group than in the DSS group. CONCLUSIONS: E. durans TN-3 exerted an inhibitory effect on the development of DSS colitis. This action might be mediated by the induction of Treg cells and the restoration of the diversity of the gut microbiota.

Increased Expression of Interleukin-36, a Member of the Interleukin-1 Cytokine Family, in Inflammatory Bowel Disease.

BACKGROUND: Interleukin (IL)-36 (IL-36α, IL-36ß, and IL-36γ) is a recently reported member of the IL-1 cytokine family. In this study, we investigated IL-36 expression in the inflamed mucosa of patients with inflammatory bowel disease and characterized the proinflammatory actions of IL-36 cytokines in human colonic epithelial cells. METHODS: IL-36 mRNA expression was evaluated using real-time PCR. IL-36 protein expression was analyzed using immunoblotting and immunohistochemical technique. Intracellular signaling pathways were evaluated by immunoblotting and by specific siRNA-transfected cells. RESULTS: The mRNA expression of IL-36α and IL-36γ, but not of IL-36ß, was enhanced in the inflamed mucosa of patients with inflammatory bowel disease, in particular, in ulcerative colitis. Immunohistochemical analysis showed that T cells, monocytes, and plasma cells are the source of IL-36α and IL-36γ in colonic mucosa. DNA microarray analysis indicated that IL-36α induces the mRNA expression of CXC chemokines and acute phase proteins in intestinal epithelial cell line, HT-29 cells. IL-36α and IL-36γ dose-dependently and time-dependently induced the mRNA and protein expression of CXC chemokines (CXCL1, CXCL2, CXCL3 etc.) in HT-29 and Widr cells. Stimulation with IL-36α and IL-36γ assembled MyD88 adaptor proteins (MyD88, TRAF6, IRAK1, and TAK1) into a complex and induced the activation of NF-κB and AP-1 and also the phosphorylation of MAPKs. MAPK inhibitors and siRNAs specific for NF-κB and c-Jun AP-1 significantly reduced IL-36-induced CXC chemokine expression. CONCLUSIONS: IL-36α and IL-36γ may play a proinflammatory role in the pathophysiology of inflammatory bowel disease through induction of CXC chemokines and acute phase proteins.

Favorable outcome of intraoperative radiotherapy to the primary site in patients with metastatic prostate cancer.

BACKGROUND: The aim of this study was to determine whether local radiotherapy to the prostate by intraoperative radiotherapy (IORT) increases the overall and cancer-specific survival rates of patients with metastatic prostate cancer. METHODS: Between 1993 and 2000, 102 patients with prostate cancer were treated with a combination of (a) IORT of the prostate (25 or 30 Gy per fraction); (b) external beam radiotherapy of the prostate (30 Gy in 10 fractions), starting approximately 1 week post-operatively; and (c) endocrine treatment. Of these, 16 patients had stage D1 disease (D1 IORT group), 32 had stage D2 disease without visceral metastasis (D2 IORT group), and 38 had stage D2 disease without visceral metastasis and did not receive local therapy (D2 control group). Overall and cancer-specific survival rates were compared. RESULTS: The 5- and 10-year cancer-specific survival rates were 75.9 and 52.7 %, respectively, in the (D1 + D2) IORT group and 45.8 and 33.5 %, respectively, in the D2 control group, with cancer-specific survival being significantly longer in the D2 IORT than in the D2 control group (P = 0.030). Univariate and multivariate reduced-rank regression analyses showed that extent of skeletal disease Grade 4 and non-regional lymph node metastasis were significantly prognostic of poorer cancer-specific survival (P < 0.001 each). CONCLUSIONS: Local radiotherapy to the prostate by IORT in patients with metastatic prostate cancer may contribute to better survival, especially in patients without extent of skeletal disease Grade 4 or non-regional lymph node metastasis.

The processus vaginalis transection method is superior to the simple prophylactic procedure for prevention of inguinal hernia after radical prostatectomy.

BACKGROUND: We compared retrospectively the efficacy of two methods for prevention of post-radical prostatectomy inguinal hernia: blunt dissection of the peritoneum at the internal inguinal ring, and isolation of the spermatic cord from the peritoneum (simple prophylactic procedure) and transection of the processus vaginalis. METHODS: Of the 367 patients who underwent open radical retropubic prostatectomy for clinically localized prostate cancer between February 2005 and March 2012 at Saitama Cancer Center Hospital, 344 patients whose follow-up period was more than 2 years were enrolled in this study. Of these patients, 178 patients received the simple prophylactic procedure and 57 underwent processus vaginalis transection. We evaluated the risk factors for inguinal hernia (age; anastomotic stricture post radical prostatectomy; prophylactic procedures for inguinal hernia; previous history of abdominal surgery; previous inguinal hernia surgery; body mass index) using univariate and multivariate analysis. The effects of the two prophylactic procedures on incidence of inguinal hernia were analyzed using Kaplan-Meier plots. RESULTS: The incidence of inguinal hernia was 24.8 % in those not undergoing the prophylactic procedure; 18.5 % in those undergoing the simple prophylactic procedure; and 0.00 % in those undergoing the processus vaginalis transection procedure (p < 0.001). In univariate and multivariate analysis, undergoing the processus vaginalis transection procedure and high body mass index were significant predictors for hernia-free survival after radical prostatectomy. CONCLUSION: Our data suggest that the processus vaginalis transection procedure is superior to the simple prophylactic procedure for the prevention of inguinal hernia after radical prostatectomy.

[Cases of Three Patients with Gastric Cancer and Metastasis to the Skeletal Muscle].

Metastasis to the skeletal muscle from gastric cancer is relatively rare. We report cases of 3 patients undergoing chemotherapy for gastric cancer with metastasis to the skeletal muscle. Case 1: A man in his 70s was diagnosed with advanced gastric cancer (cT4N3M1P0, stage IV), with metastasis to the lung, brain, lymph node, and iliopsoas muscle. Case 2: A man in his 60s was diagnosed with advanced gastric cancer (cT3N3M1P0, stage IV), with metastasis to the brain, lung, lymph node, and iliopsoas muscle. Case 3: A man in his 50s was diagnosed with advanced gastric cancer (cT4N3M1P0, stage IV), with metastasis to the urinary duct, lymph node, back muscle, and iliopsoas muscle. All 3 patients died within 7-8 months after the diagnosis due to progressive disease despite chemotherapy. The prognosis of these 3 patients was significantly poorer than that of patients in our hospital with metastasis not involving the skeletal muscle (p<0.01). Accordingly, metastasis to the skeletal muscle may be an adverse prognostic factor in gastric cancer.

Interleukin(IL)-36α and IL-36γ Induce Proinflammatory Mediators from Human Colonic Subepithelial Myofibroblasts.

BACKGROUND: Interleukin (IL)-36 cytokines are recently reported member of the IL-1 cytokine family. However, there is little information regarding the association between IL-36 cytokines and gut inflammation. In the present study, we investigated the biological activity of IL-36α and IL-36γ using human colonic subepithelial myofibroblasts (SEMFs). METHODS: The mRNA expression and the protein expression of target molecules in SEMFs were evaluated using real-time polymerase chain reaction and enzyme-linked immunosorbent assay, respectively. The intracellular signaling of IL-36 cytokines was analyzed using Western blot analysis and small interfering RNAs (siRNAs) specific for MyD88 adaptor proteins (MyD88 and IRAK1) and NF-κB p65. RESULTS: IL-36α and IL-36γ significantly enhanced the secretion of IL-6 and CXC chemokines (CXCL1, CXCL2, and CXCL8) by SEMFs. The combination of IL-36α/γ and IL-17A or of IL-36α/γ and tumor necrosis factor-α showed a synergistic effect on the induction of IL-6 and CXC chemokines. The mRNA expression of proinflammatory mediators induced by IL-36α and/or IL-36γ was significantly suppressed by transfection of siRNA for MyD88 or IRAK1. Both inhibitors of mitogen activated protein kinases and siRNAs specific for NF-κBp65 significantly reduced the expression of IL-6 and CXC chemokines induced by IL-36α and/or IL-36γ. CONCLUSION: These results suggest that IL-36α and IL-36γ contribute to gut inflammation through the induction of proinflammatory mediators.

[Complete histological response in advanced gastric cancer with Virchow's node metastasis after chemotherapy including S-1/CDDP--report of a case].

A 63-year-old male complaining of jaundice was examined and diagnosed with advanced gastric cancer (type 3, tub 2, cT3, cN3, cH0, cM1, cStage IV), and obstructive jaundice due to lymph node metastasis. Since curative surgery was deemed not possible, we started chemotherapy with S-1+CDDP. S-1 (120 mg/day) was administered orally for 21 days, followed by CDDP (60 mg/m2) div on day 8. After the 9th course, a significant tumor reduction was obtained. Total gastrectomy and lymph node resection (D1) were performed. The histological diagnosis revealed complete disappearance of cancer cells in both the main tumor and lymph nodes. Herein we report this rare case with a view of the literature.

[Visualization of prostate cancer with 11C-choline positron emission tomography (PET): localization of primary and recurrent prostate cancer].

A total of 33 11C-choline positron emission tomography scans for 23 patients with prostate cancer were performed to elucidate the localization of primary site within the prostate gland (primary group) and of recurrent site after radical treatment (recurrent group) from 2000 to 2005. As a control group, one scan for benign prostate hyperplasia and 3 scans for bladder cancer were also studied. Mean PSA values of 14 scans in the primary group and 19 scans in the recurrent group were 39.8 ng/ml (range 1.6-150) and 5.0 ng/ml (range < 0.2-11), respectively. The primary cancer could be visualized as a hot spot within the prostate gland in 10 out of 14 scans and histopathological analysis of biopsy and prostatectomy specimens verified the correct laterality. Positive scans were demonstrated in 2 out of 4 local recurrent sites, 4 out of 4 lymph node recurrent sites and 4 out of 4 bone recurrent sites with a mean PSA value of 6.22 ng/ml (range 2.3-11). Four scans with a PSA value of 2.3 ng/ml or less, no positive spot was demonstrated. These 4 scans consisted of 2 false negative and 2 true negative studies. 11C-choline PET seems to be useful to detect primary prostate cancer and could play a complementary role for conventional imaging methods in recurrent site staging.

[Three-dimensional conformal radiation therapy for prostate cancer in Hamamatsu Medical Center].

We retrospectively evaluated acute and late radiation morbidity and short-term PSA relapse-free survival of 53 patients with localized prostate cancer who received three dimensional radiation therapy (3D-CRT) that targeted prostate and seminal vesicles in Hamamatsu Medical Center from 1999.10 to 2005.4. The total dose was increased from 70 to 74 Gy in increments of 2.0 Gy. We divided these patients into two groups who received 70-72 Gy or 74 Gy. Then we analyzed whether there were differences between those two groups in acute radiation morbidity. We also analyzed late radiation morbidity in the 70(-)-72 Gy group. Acute radiation morbidity and late morbidity were described according to the RTOG acute radiation morbidity scoring criteria 1995 and RTOG/EORTC late radiation morbidity scoring scheme 1995, respectively. No acute grade 3 or 4 toxicity and no late grade 4 toxicity was observed. Late grade 3 rectal bleeding was observed in only one patient who received 70 Gy. Acute toxicity was well tolerated and did not correlate with total dose.

Usefulness of positron emission tomography (PET) in a retroperitoneal primary non-seminomatous germ cell tumor: a case report.

A 32-year-old Japanese man was admitted complaining of palindromic fever and abdominal pain. Computed tomography (CT) revealed retroperitoneal mass and positron emission tomography (PET) demonstrated massive radiotracer uptake in this tumor. Serum levels of alpha-fetoprotein (AFP) and human chorionic gonadotropin (hCG) were 4,760 ng/ml, 6,000 mIU/ml, respectively. Biopsy specimen from the tumor showed non-seminomatous germ cell tumor. The International Germ Cell Cancer Collaborative Group (IGCCCG) staging system indicated this case as an intermediate prognosis group. After three cycles of bleomycin, etoposide and cisplatin (BEP) therapy, CT revealed a degenerated residual mass. Serum levels of tumor markers were normalized completely and PET showed no radiotracer uptake in the retroperitoneal lesion. Although he did not receive further chemotherapy and lymph nodes were not dissected, he was free of disease for two years.

Attritional rupture of the flexor digitorum profundus tendon to the index finger caused by accessory carpal bone in the carpal tunnel: a case report.

We describe a case of attritional rupture of a flexor digitorum profundus tendon to the right index finger in a 73-year-old man by an accessory carpal bone located on the palmar side of the capitate and triquetrum. The radial edge of the accessory carpal bone appeared to be the cause of the rupture. Excision of the accessory carpal bone, bridge tendon graft using the palmaris longus tendon, and early controlled mobilization after surgery led to a successful outcome.