Intraoperative evaluation of blood flow for soft tissues in orthopaedic surgery using indocyanine green fluorescence angiography: A pilot study.

OBJECTIVES: Indocyanine green (ICG) fluorescence angiography is an emerging technique that can provide detailed anatomical information during surgery. The purpose of this study is to determine whether ICG fluorescence angiography can be used to evaluate the blood flow of the rotator cuff tendon in the clinical setting. METHODS: Twenty-six patients were evaluated from October 2016 to December 2017. The participants were categorized into three groups based on their diagnoses: the rotator cuff tear group; normal rotator cuff group; and adhesive capsulitis group. After establishing a posterior standard viewing portal, intravenous administration of ICG at 0.2 mg/kg body weight was performed, and fluorescence images were recorded. The time from injection of the drug to the beginning of enhancement of the observed area was measured. The hypovascular area in the rotator cuff was evaluated, and the ratio of the hypovascular area to the anterolateral area of the rotator cuff tendon was calculated (hypovascular area ratio). RESULTS: ICG fluorescence angiography allowed for visualization of blood flow in the rotator cuff in all groups. The adhesive capsulitis group showed significantly earlier enhancement than the other groups. Furthermore, the adhesive capsulitis group had a significantly smaller hypovascular area ratio than the other groups. CONCLUSION: ICG fluorescence angiography allowed for evaluation of real-time blood flow of the rotator cuff in arthroscopic shoulder surgery. The techniques of ICG fluorescence angiography are simple and easy to observe, observer reliability is high, and it has utility for evaluating blood flow during surgery.Cite this article: N. Doi, T. Izaki, S. Miyake, T. Shibata, T. Ishimatsu, Y. Shibata, T. Yamamoto. Intraoperative evaluation of blood flow for soft tissues in orthopaedic surgery using indocyanine green fluorescence angiography: A pilot study. Bone Joint Res 2019;8:118-125. DOI: 10.1302/2046-3758.83.BJR-2018-0151.R1.

Association between the HER2 expression and histological differentiation in Wilms tumor.

Human epidermal growth factor receptors (HER) play a critical role in the branching morphogenesis of renal tubules. In the current study, we analyzed the expression of HER2 in Wilms tumor and assessed the role of this gene in the tumorgenesis of Wilms tumor. During the period from 1960 to 2005, 40 patients with Wilms tumor were treated in our department. Twenty-four of those patients (except those with clear cell sarcoma of the kidney and malignant rhabdoid tumor of the kidney) were collected and assessed. The histological component of each Wilms tumor was divided into three categories (epithelial, blastemal, and mesenchymal) and the extent of HER2 protein expression was analyzed immunohistochemically. The normal kidney tissue accompanied with 12 cases of Wilms tumor was also examined. In the normal kidney, HER2 showed a strong immunoreactivity in the cell membranes of the collecting tubules and in the endothelial cells. Of 24 cases, 15 cases showed an epithelial component, while 24 cases had a blastemal component and 21 cases had a mesenchymal component, respectively. Among the 15 specimens with epithelial cell differentiation, eight (53.3%) showed HER2 immunoreactive epithelial cells. HER2 immunoreactive blastemal cells were present in 11 (45.8%) of 24 specimens with blastemal cells. On the other hand, only 3 (14.3%) of 21 specimens containing mesenchymal cells showed HER2 immunoreactivity. These results suggest that the extent of HER2 expression is associated with epithelial differentiation in Wilms tumor. These histological findings may therefore help to explain the development of Wilms tumor from the standpoint of histological differentiation.

Cornelia de Lange syndrome associated with cecal volvulus: report of a case.

UNLABELLED: Cornelia de Lange syndrome is known to be occasionally associated with gastrointestinal malformation. However, the occurrence of cecal volvulus in such anomalies is very rare. We report a 15-y-old Japanese boy with Cornelia de Lange syndrome associated with a cecal volvulus secondary to non-fixation of the cecum and ascending colon. The patient was admitted to our hospital because of abdominal pain and bilious vomiting. At emergent laparotomy, cecal volvulus with non-fixation of the ascending colon and cecum was diagnosed. Release of the cecal volvulus and the fixation of the cecum and ascending colon to the right retroperitonium were performed. The postoperative course was uneventful, except for sepsis caused by aspiration pneumonia soon after the operation. CONCLUSION: Clinicians treating patients with this syndrome should be aware that such patients may be at risk for developing severe gastrointestinal anomalies, including cecal volvulus.

Axonal growth of the spinal cord interneurons expressing a homophilic adhesion molecule SC1 ectopically.

SC1/DM-GRASP/BEN, a cell adhesion molecule of the immunoglobulin super family, promotes the extension of neurites from neurons that express SC1 in culture, presumably by direct homophilic interactions. SC1 is specifically and transiently expressed on motoneurons during the period of their axonal growth, suggesting that it plays an important role in this growth. To explore this possibility, we expressed SC1 ectopically on the spinal cord interneurons of quail and chick embryos by in ovo electroporation at E3, when the motoneuron axonal growth starts. The axonal growth of the interneurons expressing chick SC1 was analyzed by immunohistochemistry with chick-specific anti-SC1 monoclonal antibody in quail, and by retrograde labeling with a dye in chick and quail embryos at E5. The majority of the axons of SC1-positive interneurons passed through the motor column and extended normally along the spinal cord basement membrane, but a few appeared to grow out from the cord. However, a dye back-labeling of the spinal nerves revealed that none of the interneurons were both SC1 and dye positive. These results suggest that the expression of SC1/DM-GRASP/BEN alone is insufficient for regulating the first step of the selective axonal pathfinding of motoneurons.

Successful coil embolization in an infant with congenital intrahepatic portosystemic shunts.

The authors report the case of a 7-month-old Japanese infant with congenital intrahepatic portosystemic shunts. He had hypergalactosaemia and hyperammonemia at age 1 month. The diagnosis was made by ultrasonography and angiography. Coil embolization was performed successfully, and then hyperammonemia and hypergalactosaemia improved soon after surgery.

Extrahepatic biliary atresia associated with trisomy 18.

A case of extrahepatic biliary atresia (EBA) associated with trisomy 18 is presented. A 1-month-old boy was suspected to have Alagille syndrome with obstructive jaundice, a systolic heart murmur, growth retardation, and a small, pointed chin. However, surgery and chromosomal analysis revealed EBA associated with trisomy 18. Chromosomal examination must be performed in patients with jaundice and congenital anomalies. It is possible that EBA in trisomy 18 syndrome is due to a chromosomal disorder.

Transiliac catheterization of the inferior vena cava for long-term venous access in children.

In infants and children requiring prolonged, multiple central venous (CV) catheterizations, the superior (SVC) and inferior vena cava may become thrombosed or stenotic, making CV access a difficult problem. Use of the iliac vein may be an acceptable alternative. We report a patient with thrombosis of the SVC in whom the external iliac vein was accessed through a retroperitoneal approach for placement of an implantable port. This technique is easy to perform, and there are no special materials or patient positioning required.

[Post-operative intra-arterial chemotherapy in patients with malignant bone and soft tissue tumors].

Fourteen patients with bone and soft tissue sarcoma were treated with post-operative intra-arterial chemotherapy. Three drugs (Adriamycin, vincristine, carboquone or THP-adriamycin, cisplatin, vindesine) or two drugs (cisplatin, vindesine) were used post-operatively for patients with local recurrence, patients with poor response of pre-operative intra-arterial chemotherapy or patients with intra-lesional or marginal surgical margin. Of the 14 patients treated with post-operative intra-arterial chemotherapy, 8 (57.1%) were continuously disease-free (7.1%) were disease-free after treatment of lung metastasis, 2 (14.3%) had a local recurrence and/or multiple distant metastasis, and 3 (21.4%) died with multiple distant metastases. The rate of local recurrence was 14.3%. The Kaplar-Meier disease free survival curves showed 59.6%). Evaluation of limb function were excellent or good in 9 (69.2%) of 13 patients treated with limb-saving procedures.