Oolong tea is useful for lens cleansing in transnasal small-caliber esophagogastroduodenoscopy.

BACKGROUND AND STUDY AIMS: Unsedated transnasal small-caliber esophagogastroduodenoscopy (EGD) has been used to examine the upper gastrointestinal tract with proven feasibility and tolerability. However, a limitation of transnasal EGD is the poor lens-cleansing function of the scope due to the small-caliber water-jet nozzle. Therefore, this trial was designed to evaluate the cleansing effect of oolong tea for transnasal small-caliber EGD. PATIENTS AND METHODS: Oolong tea (O), barley tea (B), and distilled water (W) were prepared as washing solutions for endoscopic lenses. Study I: after the lenses were soiled by lard oil, they were washed with one of the three washing solutions, and the image quality of photographs was judged. Study II: 982 patients who were due to undergo transnasal EGD were enrolled and randomly assigned to the O-, B-, or W-groups. The level of lens cleansing, the overall time required for endoscopy, and the volume of washing solution used were measured. RESULTS: Study I: the image quality of photographs taken with lenses washed with oolong tea was significantly superior to that associated with other solutions. Study II: the level of lens cleansing in the O-group was significantly superior to that of the B- and W-groups ( P < 0.001). The volume of solution used for lens cleansing in the O-group was significantly smaller than that in the W-group ( P < 0.05). Endoscopic examination times in the O-group were shorter than those in the B- and W-groups ( P < 0.05). CONCLUSIONS: In transnasal small-caliber EGD, oolong tea instead of water as a washing solution for endoscopic lens cleansing is useful to maintain good visibility.

Adult onset tethered cord syndrome associated with intradural dermoid cyst. A case report.

STUDY DESIGN: A case report and a review of literature. OBJECTIVES: To describe a rare case of adult onset tethered cord syndrome associated with intradural dermoid cyst. SETTING: General Orthopedics, Japan. METHODS: A 50-year-old woman was referred to us because of right leg pain and pollakiuria. Neurological examinations and radiological assessments including myelography, computerized tomography scan and Magnetic resonance image were carried out. We diagnosed it as the adult onset tethered cord syndrome associated with an intradural cystic lesion. RESULTS: The cystic lesion was totally removed following laminectomy from L5 through S4. Histologically, the tumor was diagnosed as a dermoid cyst. CONCLUSIONS: Intradural dermoid could produce adult onset tethered cord syndrome, but it was not reported in the English literatures to our knowledge.

Biomechanical rationale of endoscopic decompression for lumbar spondylolysis as an effective minimally invasive procedure - a study based on the finite element analysis.

We evaluated the biomechanical behavior of the endoscopic decompression for lumbar spondylolysis using the finite element technique. An experimentally validated, 3-dimensional, non-linear finite element model of the intact L3 - 5 segment was modified to create the L4 bilateral spondylolysis and left-sided endoscopic decompression. The model of Gill's laminectomy (conventional decompression surgery of the spondylolysis) was also created. The stress distributions in the disc and endplate regions were analyzed in response to 400 N compression and 10.6 Nm moment in clinically relevant modes. The results were compared among three models. During the flexion motion, the pressure in the L4/5 nucleus pulposus was 0.09, 0.09 and 0.16 (MPa) for spondylolysis, endoscopic decompression and Gill's procedure, respectively. The corresponding stresses in the annulus fibrosus were 0.65, 0.65 and 1.25 (MPa), respectively. The stress at the adjoining endplates showed an about 2-fold increase in the Gill's procedure compared to the other two models. The stress values for the endoscopic and spondylolysis models were of similar magnitudes. In the other motions, i. e., extension, lateral bending, or axial rotation, the results were similar among all of the models. These results indicate that the Gill's procedure may lead to an increase in intradiscal pressure (IDP) and other biomechanical parameters after the surgery during flexion, whereas the endoscopic decompression did not change the segment mechanics after the surgery, as compared to the spondylolysis alone case. In conclusion, endoscopic decompression of the spondylolysis, as a minimally invasive surgery, does not alert mechanical stability by itself.

Surgical treatment of lumbar disc herniation in elderly patients.

Between 1995 and 1999, 12 patients aged 65 years or more (mean 70.2) with lumbar disc herniation, underwent partial laminectomy and nucleotomy. The results were compared with those of 25 younger patients aged between 20 and 40 years (mean 30.1), who underwent the same surgical procedure. The Japanese Orthopedic Association (JOA) score was used to assess the clinical outcome. The minimum follow-up was 12 months. The pre- and post-operative total JOA scores and the rate of improvement of the JOA score were not significantly different between the elderly (11.1, 24.3 points, and 74.1%), and the younger group (11.6, 26.4 points and 84.5%). The results of this study indicate that the outcome of lumbar discectomy in elderly patients is as good as in younger patients.

Effects of active recovery under a decreasing work load following intense muscular exercise on intramuscular energy metabolism.

The effect of active recovery at a decreasing % of MVC following intense muscular exercise on intramuscular pH was investigated in vivo using 31P-MRS. Seven healthy men participated, and their right wrist flexor muscle group was examined. The subjects were asked to flex their right wrist at 60 % of the maximum voluntary contraction (MVC) every 2 s until the intracellular pH in the wrist flexor muscle decreased to 6.4. After the exercise period, the subjects underwent active or passive recovery for 10 min. For the active recovery (AR), the subject was asked to continue exercising at a decreasing % of MVC, decreasing from 25 to 5 % MVC every two min during AR. 31P-MR-spectra were obtained throughout the experiments, and from the spectra the intracellular pH (pHi) was calculated as an indicator of intracellular events. AR data were compared to data collected during passive recovery (PR). During AR, the pHi increased immediately after the exercise period; whereas in that of PR, it did not recover within 5 minutes after exercise. The results suggested that mild exercise was an effective manoeuver to promote recovery from intramuscular metabolic acidosis.

Characteristics of velocity-controlled knee movement in patients with cervical compression myelopathy: what is the optimal rehabilitation exercise for spastic gait?

STUDY DESIGN: The isokinetic strength of knee extensors and flexors was measured at various controlled velocities in patients with spastic paraparesis caused by cervical compression myelopathy. OBJECTIVE: To evaluate leg function objectively in patients with myelopathy. SUMMARY OF BACKGROUND DATA: Cervical compression myelopathy causes varying degrees of spastic paresis in the legs and affects the activities of patients. However, the leg function characteristics of the patients have not been fully elucidated. METHODS: Velocity-controlled voluntary knee movements were studied in 39 patients (25 men and 14 women) with compression myelopathy. Their mean age was 60.2 years (range, 44-77 years). The patients were divided into Group A (ambulation without aid, n = 22) and Group AA (ambulation with aid, n = 17). Isometric peak torque values were measured in knee flexor and extensor muscles at 60 degrees of knee flexion, and isokinetic peak torque values were determined in maximal voluntary concentric movements of these muscles at constant angle velocities of 40 degrees, 80 degrees, 120 degrees, 160 degrees, and 180 degrees per second. The relative strength (percentage of isometric peak torque value) of the isokinetic motion was calculated at each velocity. RESULTS: In both groups, the relative strength decreased as the velocity increased, and the degree of reduced strength in the flexors at the high velocities of 160 degrees and 180 degrees per second was significantly greater in Group AA than in Group A (P < 0.05), whereas no significant difference was found in the extensors between the groups. CONCLUSIONS: The results indicate that isokinetic strength at a high velocity may reflect the severity of spastic paresis in the legs resulting from compression myelopathy.

Cathepsins B and L in synovial fluids from patients with rheumatoid arthritis and the effect of cathepsin B on the activation of pro-urokinase.

To clarify the pathophysiological role of cathepsins in rheumatoid arthritis (RA), we investigated whether cathepsin B or cathepsin L was increased in synovial fluid (SF) of RA joints, and whether the cathepsin isolated from SF of RA patients activated pro-urokinase or not. Thus, we estimated the content of cathepsins in SF of RA patients by measuring their activities by fluorospectrometry, using Z-Phe-Arg-MCA as the substrate. Cathepsin activity was approximately 4-fold higher in the SF of RA patients than in those of patients with osteoarthritis. Cathepsin B and cathepsin L were separated by cation-exchange column chromatography. As a result, a large peak corresponding to cathepsin B and a very small peak corresponding to cathepsin L were detected. Biochemical sequential fractionation of the cathepsin purified from the SF showed that the large peak was mainly composed of cathepsin B. This purified enzyme induced conversion of pro-urokinase to urokinase, and the Km for pro-urokinase was approximately 8.27 microM. These findings indicated that an imbalance between cathepsin B and its inhibitors occurred due to increased concentrations of active cathepsin B in RA articular lesions, and that cathepsin B might be related to the degradation of cartilage in RA by activating the fibrinolytic cascade.