Japanese version of the Patient-rated elbow evaluation score correlates with physician-rated Japanese orthopaedic association-Japan elbow society elbow function score.

BACKGROUND: The association between Patient-Rated Elbow Evaluation: Japanese version (PREE-J) and Japanese Orthopaedic Association-Japan Elbow Society Elbow Function score (JOA-JES score) is unclear. This study evaluated the association between PREE-J and JOA-JES scores. METHODS: The patients with elbow disorders were divided into two groups: Group A (conservative treatment, n = 97) and Group B (surgical treatment, n = 156). The patients were also divided into four disease subgroups according to the JOA-JES classification (rheumatoid arthritis, trauma, sports, and epicondylitis groups), and the association between PREE-J and JOA-JES scores in each disease category was examined. In group B, associations between PREE-J and JOA-JES scores were examined pre-and postoperatively. RESULTS: In group A, there were significant associations between PREE-J and JOA-JES scores. In group B, a strong association between preoperative PREE-J and JOA-JES scores was observed in all disease categories. There was also a significant association between postoperative PREE-J and JOA-JES scores. Additionally, group B showed significant postoperative improvements in PREE-J and JOA-JES scores. CONCLUSIONS: The PREE-J score correlates well with the JOA-JES score and reflects treatment response before and after treatment.

Assessment of the severity of curly toe.

BACKGROUND: Curly/underlapping toe involves flexion, adduction, and varus deformity of the interphalangeal joints. There are no previous reports showing the relationship between physical examination and X-ray findings among patients with curly toe deformity. METHODS: We investigated the clinical findings of 116 consecutive patients associated with 239 underlapping toes. We compared the age and affected toes between patients whose deformities were pointed out at a pediatric medical examination (group 1) and those referred for medical treatment (group 2). The degree of curly toe deformity was graded by a physical examination and X-ray. RESULTS: The average age at presentation was 2.7 years. The affected toes were significantly different between groups 1 and 2 (p < .001). The morbidity of each toe differed significantly in group 2 (p < .005) but not in group 1. The correlation between the appearance grading and classification by X-ray was very strong using Spearman's rank correlation coefficient. The severity of curly toe was divided into mild in 104 toes, moderate in 105 toes, and severe in 17 toes. The methods of conservative treatment were observation only in 15 cases, manipulations in 30 cases, taping in 67 cases, and a brace in 9 cases. Surgery was performed in 8% of cases. CONCLUSION: Curly toe deformity of the third or fourth toes tend to be referred for medical treatment because of the abnormality. Our grading system using a physical examination and classification by X-ray was useful for assessing the severity of curly toe.

Visualization of persistent superior vena cava isolation by cryoballoon ablation.

A 54-year-old man with paroxysmal atrial fibrillation underwent pulmonary vein (PV) isolation using a 28-mm second-generation cryoballoon catheter. Unexpected electrical superior vena cava (SVC) isolation during cryoballoon application to the right superior PV was observed in the first procedure. Thirteen-months after cryoballoon-based PV isolation, sustained SVC fibrillation was confirmed irrespective of sinus rhythm. Voltage mapping visualized a low voltage area around the SVC was close to that around the right superior PV. SVC isolation was obtained by cryoballoon application to the right superior PV and persisted for over a year. .

Visualization of epicardial lead infection using 18F-FDG-PET/CT imaging.

18 F-FDG-PET/CT is promising tool to visualize not only transvenous lead infection but also epicardial lead infection.

Long-term results after simple rotational osteotomy of the radius shaft for congenital radioulnar synostosis.

BACKGROUND: The present study was conducted to clarify the long-term (≥10 years) results of simple rotational osteotomy for congenital radioulnar synostosis (CRUS). METHODS: Twelve forearms in 9 Asian patients with CRUS who underwent simple rotational osteotomy of the radius shaft were monitored for an average of 13.6 years (range, 10-19 years) postoperatively. Before surgery, the forearm fixation averaged 51.3° of pronation (range, 30°-90°). The true position of the forearm in ankylosis was measured by a line through the styloid processes of the radius and the ulna. Palm pronation and supination angles were also measured. The osteotomy was performed at the insertion of the pronator teres to the shaft of the radius. The pronation position was then corrected manually to allow 90° of palm supination with compensatory rotation around the wrist, and a cast was applied. We evaluated activities of daily living items at a mean of 5.2 years after surgery. At the final follow-up, the 11-item version of the Disability of the Arm, Shoulder and Hand score was recorded. RESULTS: After surgery, the forearm was fixed at an average of 4.2° of supination. At the final follow-up, the palm was able to achieve an average motion arc ranging from 26° of pronation to 62° of supination. There were no neurologic or circulatory complications after surgery. Ability to perform daily activities was markedly improved, and all patients were satisfied with the results of surgery. The average score on the 11-item version of the Disability of the Arm, Shoulder, and Hand was 3.79 points at the final follow-up. CONCLUSION: Our procedure for forearm rotation in patients with CRUS is simple, reliable, satisfactory, and safe.

Renal dysfunction indicative of outcomes in hospitalized patients with takotsubo syndrome.

BACKGROUND:: Left ventricular dysfunction as part of takotsubo syndrome is reversible, and the long-term prognosis appears favorable. However, life-threatening complications are not uncommon during the acute phase, and it remains unclear whether renal dysfunction is a factor in complications suffered by hospitalized patients with takotsubo syndrome. The present study was conducted to investigate the implications of renal dysfunction in this setting. METHODS:: Data from 61 consecutive patients (male, 21; female, 40) diagnosed with takotsubo syndrome at our hospital between years 2010 and 2016 were evaluated retrospectively. In-hospital complications by definition were all-cause deaths and severe pump failure (Killip class ≥III). RESULTS:: Overall, 30 patients (49%) developed renal dysfunction. In the 32 patients (52%) who suffered in-hospital complications (mortality, 10; severe pump failure, 22), estimated glomerular filtration rate (eGFR) was significantly lower by comparison (51.3±29.8 vs. 69.5±29.0; p=0.019). Low eGFR (<30 ml/min per 1.73m2) proved independently predictive of in-hospital complications (hazard ratio =2.84, 95% confidence interval: 1.20-6.69) in multivariate Cox hazard analysis, also showing a significant association with peak event rate of Kaplan-Meier curve (log-rank test, p=0.0073). Similarly, patients with chronic kidney disease were at significantly greater risk of in-hospital complications (hazard ratio=2.49, 95% confidence interval: 1.01-5.98), relative to non-compromised counterparts (eGFR >60 ml/min per 1.73m2). CONCLUSION:: Renal dysfunction is a simple but useful means of predicting complications in hospitalized patients with takotsubo syndrome, especially those with chronic kidney disease.

The Neutrophil-to-Lymphocyte Ratio Predicts All-Cause Mortality in Patients with Implantable Cardioverter Defibrillators.

BACKGROUND: The relationship between the neutrophil-to-lymphocyte ratio (NLR) and outcome in patients with implantable cardioverter-defibrillators (ICDs) is unclear. METHODS AND RESULTS: Consecutive patients with cardiomyopathy who had received an ICD (n = 120, mean age 64 ± 11 years) were prospectively enrolled. Blood samples were obtained on the morning of the day of implantation. Patients were followed for a median period of 61.2 months, to an endpoint of all-cause mortality or appropriate ICD shock, which occurred in 35 (29%) and 28 (23%) patients, respectively. Multivariate Cox analysis revealed that secondary prevention was only associated with appropriate ICD shocks. The NLR, brain natriuretic peptide level, and estimated glomerular filtration rate were independent predictors of all-cause mortality but not of appropriate ICD shocks. Subgroup analysis revealed that a high NLR (≥2.1) was valuable for anticipating all-cause mortality among patients who had received ICDs for primary or secondary prevention. A high NLR was also associated with death prior to appropriate ICD shock. CONCLUSION: Evaluating the NLR may be useful for predicting outcomes in patients with cardiomyopathy who have received ICDs.

The association between defibrillation shock energy and acute cardiac damage in patients with implantable cardioverter defibrillators.

BACKGROUND: The aim of this study was to establish a minimally invasive defibrillation testing (DT) protocol for patients with implantable cardioverter defibrillators (ICDs). METHODS: Two different energy DTs were performed, immediately after (15 J-DT) and 7 days after (≤10 J-DT) device implantation, in 20 consecutive ICD implantation patients. Cardiac-troponin T (c-TNT) and heart-type fatty acid binding protein (H-FABP) levels were measured before implantation, 2 h after implantation, and 1 day after each DT. For an additional 122 patients with ICD, we retrospectively analyzed 203 DTs immediately and 7 days after device implantation. RESULTS: Serum c-TNT levels were significantly elevated 2 h after 15 J-DT [0.008 (0.004-0.019) vs. 0.053 (0.037-0.068) ng/mL, p<0.001], but not ≤10 J-DT [0.007 (0.004-0.018) ng/mL]. Similarly, serum H-FABP levels were significantly elevated 2 h after 15 J-DT (2.9±1.5 vs. 6.4±3.4 ng/mL, p<0.001), but not ≤10 J-DT (2.7±1.5 ng/mL). The changes in c-TNT and H-FABP levels between baseline and 2 h after DT were significantly greater for 15 J-DT compared with ≤10 J-DT [c-TnT: 0.039 (0.029-0.060) vs. 0 (0-0.003) ng/mL, p<0.001; H-FABP: 3.6±2.8 vs. -0.16±1.1 ng/mL, p<0.001]. The success rates of the initial shocks delivered for ventricular fibrillation were no different between ≤10 J-DT (85% [78/92]) and ≥15 J-DT (92% [103/111]). CONCLUSIONS: Elevated levels of myocardial damage markers such as c-TNT and H-FABP were not found after ≤10 J-DT. In addition, an acceptable success rate was confirmed in ≤10 J-DT.

Complications of Distal Radius Fractures Treated by Volar Locking Plate Fixation.

The current study investigated the incidence of complications after surgery for distal radial fractures. This multicenter retrospective study was conducted at 11 institutions. A total of 824 patients who had distal radius fractures that were treated surgically between January 2010 and August 2012 were identified. The study patients were older than 18 years and were observed for at least 12 weeks after surgery for distal radius fractures with a volar locking plate. Sex, age, fracture type according to AO classification, implants, wrist range of motion, grip strength, fracture consolidation rate, and complications were studied. Analysis included 694 patients, including 529 women and 165 men, with a mean age of 64 years. The mean follow-up period was 27 weeks. The fracture consolidation rate was 100%. There were 52 complications (7.5%), including 18 cases of carpal tunnel syndrome, 12 cases of peripheral nerve palsy, 8 cases of trigger digit, 4 cases of tendon rupture (none of the flexor pollicis longus), and 10 others. There was no rupture of the flexor pollicis longus tendon because careful attention was paid to the relationship between the implant and the tendon. Peripheral nerve palsy may have been caused by intraoperative traction in 7 cases, temporary fixation by percutaneous Kirschner wires in 3 cases, and axillary nerve block in 1 case; 1 case appeared to be idiopathic. Tendon ruptures were mainly caused by mechanical stress. [Orthopedics.2016; 39(5):e893-e896.].

Circulating heart-type fatty acid-binding protein levels predict ventricular fibrillation in Brugada syndrome.

BACKGROUND: The association between ongoing myocardial damage and outcomes in patients with Brugada syndrome who had received an implantable cardioverter-defibrillator (ICD) is unclear. METHODS: Consecutive patients with Brugada syndrome (n=31, 50±13 years) who had received an ICD were prospectively enrolled. Minor myocardial membrane injury [heart-type fatty acid-binding protein (H-FABP) >2.4ng/mL] and myofibrillar injury (troponin T >0.005ng/mL) were defined using receiver operating characteristic curves. Patients were followed for a median period of 5 years to an endpoint of appropriate ICD shock. RESULTS: Myocardial membrane injury (29%) and myofibrillar injury (26%) were similarly prevalent among patients with Brugada syndrome who had received ICDs. Appropriate ICD shocks occurred in 19% of patients during the follow-up period. Multivariate Cox regression analysis showed that serum H-FABP level >2.4ng/mL, but not troponin T level, was an independent prognostic factor for appropriate ICD shock due to ventricular fibrillation [hazard ratio (HR) 25.2, 95% confidence interval (CI) 1.33-1686, p=0.03]. CONCLUSIONS: Evaluating myocardial damage using H-FABP may be a promising tool for predicting ventricular arrhythmia in patients with Brugada syndrome who have received ICDs.

The Clinical Value of Nongated Dual-Source Computed Tomography in Atrial Fibrillation Catheter Ablation.

INTRODUCTION: Using a high-pitch dual-source CT (DSCT), we aimed to quantify the amounts of contrast media, radiation doses, and image qualities in patients undergoing pulmonary vein (PV) isolation. METHODS AND RESULTS: The study enrolled 60 patients who were randomly assigned in a 1: 1: 1 ratio to undergo ECG-gated 64-slice multidetector computed tomography (MDCT; group I, n = 20), ECG-gated 128-DSCT (group II, n = 20), and nongated 128-DSCT (group III, n = 20). The total amount of contrast media was lower in groups II and III compared with group I (I: 54.7 ± 5.6, II: 26.6 ± 2.7, and III: 28.7 ± 6.9 mL, P < 0.001). The CT dose index was lower in groups II and III compared with group I (I: 73.1 ± 5.2, II: 3.5 ± 0.1, and III: 3.7 ± 0.1 mGy, P < 0.001). The dose length product was lower in groups II and III compared with group I (I: 1154.8 ± 82.8, II: 75.4 ± 2.3, and III: 77.2 ± 1.9 mGy × cm, P < 0.001). The total CT effective radiation dose was lower in groups II and III compared with group I (I: 16.2 ± 1.2, II: 1.1 ± 0.1, and III: 1.1 ± 0.1 mSv, P < 0.001). The total CT scan duration was shorter in group III compared with groups I and II (I: 30.8 ± 2.2, II: 23.4 ± 3.6, and III: 16.0 ± 2.4 minutes, P < 0.001). There were no significant differences in quality for integrated electroanatomical mapping (EAM) and parameters associated with PV isolation among the 3 groups. CONCLUSION: Nongated 128-DSCT provides sufficient image quality to allow integrated EAM while exposing the patient to less contrast media, lower radiation doses, and shorter CT scan durations.

Prevention of immediate recurrence of atrial fibrillation with low-dose landiolol after radiofrequency catheter ablation.

BACKGROUND: Immediate recurrence of atrial fibrillation (AF) after radiofrequency (RF) catheter ablation is commonly observed within 3 d after the procedure. The mechanism and pharmacological management of immediate AF recurrence remain unclear. METHODS: A total of 50 consecutive patients with paroxysmal AF were randomized to receive either low-dose landiolol (landiolol group) or a placebo (placebo group). In the landiolol group, intravenous landiolol (0.5 µg kg(-1) min(-1)) was administered for 3 d after AF ablation. RESULTS: No serious adverse event associated with RF catheter ablation or landiolol administration was observed. The prevalence of immediate AF recurrence (≤3 d after RF catheter ablation) was significantly lower in the landiolol group than in the placebo group (16% vs. 48%, p=0.015). Although the postprocedural change in heart rate was significantly lower in the landiolol group compared to that in the placebo group, the changes in blood pressure and body temperature were not different between the two groups. Multiple logistic regression analysis revealed that landiolol treatment was the only independent predictor of immediate AF recurrence after ablation (odds ratio: 0.180; 95% confidence interval: 0.044-0.729; p=0.016). CONCLUSIONS: Prophylactic administration of low-dose landiolol after AF ablation may be effective and safe for preventing immediate AF recurrence within 3 d after AF ablation.

Predictors of left atrial coagulation activity among paroxysmal atrial fibrillation patients.

BACKGROUND: The difference between left atrial (LA) and systemic coagulation activity in paroxysmal atrial fibrillation (PAF) is unclear. METHODS AND RESULTS: We enrolled 100 patients with PAF who underwent AF ablation. Warfarin was stopped 1 day before the procedure. LA volume index and LA emptying fraction were measured by 64-slice multidetector computed tomography. Immediately after transseptal puncture, blood samples were simultaneously collected from the LA and systemic circulation (SC). In addition, to evaluate the effect of warfarin on D-dimer levels we recruited an additional 27 PAF patients on continuous warfarin. Even in patients with low CHADS2 scores (mean 0.59 ± 0.68) and during sinus rhythm, the prevalence of positive LA-D-dimer (≥ 0.5 µg/ml) was greater than that of SC-D-dimer (23% vs. 10%, P<0.01). The LA-D-dimer-positive patients had a larger mean LA volume index and reduced LA emptying fraction than the LA-D-dimer-negative patients. Multiple logistic regression analysis revealed that LA volume index was independently correlated with positive LA-D-dimer (odds ratio 2.245, 95% confidence interval 1.194-4.626, P=0.0112). The prevalence of positive LA-D-dimer was significantly lower in patients taking continuous warfarin, than in those on discontinuous warfarin (3.7% vs. 23%, P=0.025). CONCLUSIONS: An enlarged LA volume index was associated with high LA coagulation status in patients with paroxysmal AF. Adequate warfarin control during AF catheter ablation may reduce the prevalence of positive LA-D-dimer.

Two-dimensional speckle tracking imaging as a novel strategy for accurately identifying the accessory pathway.

A 14-year-old patient was diagnosed with hypertrophic cardiomyopathy associated with Wolff-Parkinson-White syndrome. The two-dimensional speckle tracking strain method showed normal left ventricular local contraction, but the peak systolic longitudinal strain of the right ventricular (RV) anterior wall was earlier than that of the septal wall. As expected, the location of the accessory pathway was at the RV anterior wall. The patient's RV local contraction was normalized by successful radiofrequency application.

Prognostic value of myocardial damage markers in patients with chronic heart failure with atrial fibrillation.

OBJECTIVE: The aim of the present study was to examine the relationship between myocardial damage caused by atrial fibrillation (AF) and subsequent cardiovascular events in AF patients with chronic heart failure (CHF). METHODS AND RESULTS: We measured the serum levels of heart-type fatty acid binding protein (H-FABP) and high-sensitivity troponin T in 402 consecutive CHF patients with chronic AF (CHF-AF, n=201) or sinus rhythm (CHF-SR, n=201). The patients with CHF-AF had higher H-FABP and troponin T levels than those with CHF-SR. In order to examine the prognostic value of myocardial damage markers in CHF-AF and CHF-SR patients, we followed the above patients and analyzed their clinical outcomes. A multivariate Cox proportional hazard analysis revealed that both the serum H-FABP and troponin T levels independently predicted subsequent cardiovascular events. A Kaplan-Meier analysis demonstrated that the rate of cardiovascular events was higher in the patients with elevated H-FABP and troponin T levels. The optimal cut-off values for the myocardial damage markers of cardiovascular events were higher in the CHF-AF patients than in the CHF-SR patients (H-FABP, 5.4 vs. 4.6 ng/mL and troponin T, 0.030 vs. 0.013 ng/mL). CONCLUSION: Myocardial damage advances in association with the presence of AF and is associated with subsequent cardiovascular events in both CHF-AF and CHF-SR patients. In this study, the cut-off values for the myocardial damage markers were higher in the CHF-AF patients than in the CHF-SR patients.

Circulating heart-type fatty acid binding protein levels predict the occurrence of appropriate shocks and cardiac death in patients with implantable cardioverter-defibrillators.

BACKGROUND: The association between ongoing myocardial damage and outcomes in patients who have received an implantable cardioverter-defibrillator (ICD) is unclear. METHODS AND RESULTS: Consecutive patients with cardiomyopathy, who had received an ICD (n = 107, mean age 65 ± 11 years), were prospectively enrolled. Myocardial membrane injury (heart-type fatty acid binding protein [H-FABP] >4.3 ng/mL) and myofibrillar injury (troponin T >0.01 ng/mL) were defined using receiver operating characteristic curves. Patients were followed for a median of 33.6 months, to an end point of appropriate ICD shock or cardiac death. Myocardial membrane injury (45%) and myofibrillar injury (41%) were equally prevalent among patients with cardiomyopathy who had received ICDs. Appropriate ICD shocks or cardiac death occurred in 31% and 15% of patients, respectively. Multivariate Cox regression analysis showed that serum H-FABP levels >4.3 ng/mL, but not troponin T levels, were a significant independent prognostic factor for cardiac events (hazard ratio 5.502, 95% confidence interval 1.705-17.75, P = .004). Subgroup analysis revealed that measuring H-FABP levels was valuable for anticipating event-free survival among patients with ICDs who were receiving amiodarone. High H-FABP levels also predicted subsequent outcomes in patients who had received ICDs for primary or secondary prevention. CONCLUSION: Evaluating myocardial damage using H-FABP may be a promising tool for predicting outcomes in patients with cardiomyopathy who have received ICDs.

Free fat graft for congenital hand differences.

BACKGROUND: Free fat graft has been used for the treatment of congenital hand differences. However, there have been a few reports about the outcome of that treatment. In this study, the outcome of free fat grafts for congenital hand and foot differences was investigated. METHODS: Fourteen bones with longitudinal epiphyseal bracket, 3 wrists with Madelung deformity, and 5 cases of osseous syndactyly were treated with free fat graft with osteotomy, physiolysis, or separation of osseous syndactyly. Of the fourteen bones with longitudinal epiphyseal bracket, 9 were treated with open wedge osteotomy with free fat graft and 5 with physiolysis and free fat graft. The Madelung deformity was treated with physiolysis with free fat graft. For osseous syndactyly, syndactyly release with free fat graft was performed five times on four hands. RESULTS: In the fourteen cases with longitudinal epiphyseal bracket, lateral deviation improved in all except two cases after surgery. The average lateral deviation angle changed from 32.5 degrees before surgery to 15.2 degrees after surgery. The average improvement of the lateral deviation angle was 12.2 degrees in the osteotomy group and 20.6 degrees in the physiolysis group. The mean ratio of improvement of the lateral deviation angle to the lateral deviation angle before surgery was 39.4% in the osteotomy group and 51.2% in the physiolysis group. The Madelung deformity improved after surgery in two cases but there was no improvement in one case. For these conditions, the results were not good enough when surgery was done after age 13 or at age four for severely hypoplastic brachymesophalangy. Of the 5 cases of osseous syndactyly, reunion of the separated bones occurred in one case. The grafted free fat should be deep enough to cover the osteotomy site of the bones to prevent reunion of the separated bones. CONCLUSIONS: Physiolysis and free fat graft performed during the growth period can correct the deviation due to longitudinal epiphyseal bracket and Madelung deformity. Free fat graft is also useful to prevent reunion of the bones after separation of osseous syndcatyly, if the grafted fat is securely filled into the space between the separated bones.

Device troubleshooting: cross connection of ventricular leads in a patient with decreased right ventricular electrical activity.

A patient with cardiac sarcoidosis showed low R-wave amplitude in the entire right ventricle (RV). To troubleshoot this, a left ventricular (LV) lead was implanted in the coronary vein. The pace/sense terminal of the defibrillation lead was connected to LV:IS-1 of the defibrillator. Conversely, the LV lead was connected to RV:IS-1. Induced ventricular fibrillation was successfully terminated without any undersensing.

Serial evaluation of left ventricular contraction and relaxation in Takotsubo cardiomyopathy by 2D speckle tracking echocardiography.

A 78-year-old woman was referred to our hospital because of general fatigue. The electrocardiogram showed ST elevation in the I, II, aVL, and V2-V6 leads. Echocardiography showed left ventricular apical akinesis. On emergent cardiac catheterization, left ventricular basal hyperkinesis and apical akinesis without coronary artery stenosis were found. The patient was diagnosed with Takotsubo cardiomyopathy. Two-dimensional myocardial speckle tracking echocardiography was performed on admission, the 8th hospital day, and the 15th hospital day. Gradual improvement in wall motion abnormality and longitudinal peak systolic strain, peak systolic strain rate, and early diastolic strain rate from the basal to apical region of the left ventricle were observed objectively, and she achieved remission. We herein report a case of Takotsubo cardiomyopathy in which objective improvement in left ventricular contraction and relaxation was observed by 2D speckle tracking imaging and bull's eye mapping.

Percutaneous transvenous stent implantation to external iliac vein stenosis in a patient with retroperitoneal fibrosis.

A 59-year-old man visited our hospital due to right leg edema and right leg pain. Computed tomography revealed that the circumferential enhancement of bilateral external iliac arteries by soft tissue that had similar density as the adjacent psoas muscle and that the right external iliac vein that was constricted by those tissues. The patient was diagnosed as retroperitoneal fibrosis. He underwent stent implantation to the right external iliac vein stenosis and steroid therapy. His right leg edema and pain was immediately improved after the stent implantation and he achieved remission.