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Fukushima-shi, Japan

Miyake J.,Osaka University | Shimada K.,Osaka Kosei Nenkin Hospital | Masatomi T.,Yukioka Hospital
Journal of Shoulder and Elbow Surgery

Hypothesis: Osteosynthesis for longstanding nonunion of the lateral humeral condyle in adults has a high rate of complications, including failure of bony union and restriction of elbow motion. We hypothesized that rigid fixation may contribute to higher union rate and the placement of the condyle fragment with proper tilting may minimize the reduction of elbow motion. Materials and methods: Ten patients were treated with osteosynthesis. Average age at operation was 38.6 years. Three patients had dysfunction of the ulnar nerve, 2 experienced pain, and 5 had both presentations. According to Toh et al's radiographic criteria, nonunion was categorized as Group 1 in 2 patients and Group 2 in 8 (J Bone Joint Surg Am 2002;84:593-598). We performed osteosynthesis with iliac bone graft and ulnar nerve anterior transposition, with efforts to fix the fragment rigidly and to manage the fragment position properly. Results: Osseous union was achieved in all 8 Group 2 patients, while 1 Group 1 case showed delayed union and the other did not achieve union. Pain resolved and ulnar nerve symptoms improved in all cases. In 9 patients with union, total arc of motion was reduced by an average of 20°. The preoperative mobility of the condyle fragment determined by maximum flexion and extension lateral radiographs had a correlation to the postoperative loss of motion (P = .047); however, loss of motion was less than that expected by radiographs. Conclusion: Osteosynthesis appears to be indicated for Group 2 nonunion with pain. Rigid fixation with care of the position of the fragment is important for the good outcomes. © 2010 Journal of Shoulder and Elbow Surgery Board of Trustees. Source

Ohata C.,Ikeda Municipal Hospital | Nakai C.,Osaka Kosei Nenkin Hospital | Kasugai T.,Osaka Kosei Nenkin Hospital | Katayama I.,Osaka University
Journal of Cutaneous Pathology

Background: Consumption of the epidermis (hereafter, consumption), namely thinning of the epidermis with attenuation of basal and suprabasal layers and loss of rete ridges adjacent to collections of melanocytes, has been used to differentiate invasive melanoma from Spitz nevi. Evaluation of 213 invasive melanomas, including only two cases of acral lentiginous melanoma (ALM), showed that the frequency of consumption increases with increasing tumor thickness. Methods: We evaluated consumption in 52 acral melanomas relative to age, gender, Breslow depth, tumor thickness (based on the 2010 American Joint Commission on Cancer guidelines), Clark level, mitoses, ulceration, vertical-growth phase, regression, tumor-infiltrating lymphocytes and anatomical site. Results: Consumption was more frequent in ALM with increasing Breslow depth (p = 0.01), and in the presence of ulceration (p = 0.0078); in all cases with ulcer, consumption was found adjacent to the ulceration. There was no statistically significant difference in consumption in nail melanomas in comparison to melanomas of acral skin other than the nail. Conclusions: These results support the hypothesis that epidermal thinning in consumption represents an early phase of ulceration. No statistically significant difference in consumption was found between nail melanomas and melanomas of acral skin other than the nail, probably because of similar tumor thickness in both groups. Copyright © 2012 John Wiley & Sons A/S. Source

Akiyama K.,Osaka Kosei Nenkin Hospital | Sakai T.,Osaka University | Koyanagi J.,Osaka General Medical Center | Yoshikawa H.,Osaka University | Sugamoto K.,Osaka University
Journal of Orthopaedic Research

Our objectives were to clarify the 3D articular contact areas of the in vivo normal hip joint and acetabular dysplasia during specific positions using magnetic resonance imaging (MRI), voxel-based registration, and proximity mapping. Forty-two normal and 24 dysplastic hips were examined. MRI was performed at four positions: neutral; 45°flexion; 15°extension; and the Patrick position. Femur and pelvis bone models were reconstructed at the neutral position and superimposed over the images of each different position using voxel-based registration. The inferred cartilage contact and bony impingement were investigated using proximity mapping. The femoral head translated in the anterior or posteroinferior, anterosuperior, and posteroinferior direction from neutral to 45°flexion, 15°extension, and the Patrick position, respectively. Multiple regression analyses showed age, femoral head sphericity, and acetabular sphericity to be associated with higher hip instability. The present technique using subject-specific models revealed the in vivo hip joint contact area in a population of healthy individuals and dysplastic patients without radioactive exposure. These results can be used for analyzing disease progression in the dysplastic hip and pathogenesis of acetabular labral tear. Copyright © 2013 Orthopaedic Research Society. Source

Sakaura H.,Osaka University | Hosono N.,Osaka Kosei Nenkin Hospital | Mukai Y.,Osaka Kosei Nenkin Hospital | Fujimori T.,Osaka University | And 2 more authors.

Study Design: Prospective study. Objective: To examine whether preservation of subaxial deep extensor muscles plays any significant role in reducing axial neck pain and unfavorable radiologic changes after cervical laminoplasty in patients with cervical spondylotic myelopathy and to confirm the benefits of preserving muscles attached to the C2 and C7 spinous processes. Summary of Background Data: Axial neck pain and unfavorable radiologic changes after cervical laminoplasty have been reported to mostly result from detachment of cervical extensor muscles, particularly muscles attached to the C2 and C7 spinous processes. Other surgeons have reported that preservation of subaxial deep extensor muscles reduces these adverse effects after cervical laminoplasty. Methods: Subjects comprised 36 patients with cervical spondylotic myelopathy who underwent C3-C6 open-door laminoplasty and were followed up for >24 months. Of these, 18 consecutive patients underwent our modified laminoplasty (muscles-preserved group) and the remaining 18 consecutive patients underwent the conventional procedure (muscles-disrupted group). Both procedures preserved all muscles attached to the C2 and C7 spinous processes. Subaxial deep extensor muscles on the hinged side were also preserved in the muscles-preserved group. Radiologic and clinical data were prospectively collected. Results: Both groups achieved equal neurologic improvement. Frequencies of axial neck pain showed no significant differences between groups. This value did not vary according to the side of preservation of subaxial deep extensor muscles or the side of muscle disruption. Postoperative loss of lordosis and range of motion of the cervical spine also demonstrated no significant difference between groups. Conclusion: These results indicate that preservation of subaxial deep extensor muscles plays no significant role in reducing axial neck pain and unfavorable radiologic changes after cervical laminoplasty, supporting the hypothesis that these adverse effects after laminoplasty largely result from detachment of muscles attached to the C2 and C7 spinous processes. © 2010, Lippincott Williams & Wilkins. Source

Sakaura H.,Kansai Rosai Hospital | Hosono N.,Osaka Kosei Nenkin Hospital | Mukai Y.,Osaka Kosei Nenkin Hospital | Iwasaki M.,Osaka University | Yoshikawa H.,Osaka University
European Spine Journal

C3-6 laminoplasty preserving muscle insertions into the C7 spinous process is reportedly associated with a significantly decreased frequency of postoperative axial neck pain. However, no prospective study has reported medium-term outcomes of C3-6 laminoplasty. The purpose of this study was to elucidate medium-term outcomes after C3-6 laminoplasty. Subjects comprised 31 patients with cervical myelopathy who underwent C3-6 laminoplasty preserving all bilateral muscles attached to the C2 and C7 spinous processes and were followed for C5 years. Clinical and radiological data were prospectively collected. Neurological status was assessed using Japanese Orthopaedic Association (JOA) score. Axial neck pain was graded as severe, moderate or mild. Sagittal alignment of the cervical spine and progression of ossification of the posterior longitudinal ligament (OPLL) were assessed by comparing serial lateral radiographs. Mean JOA score improved significantly from 10.6 before surgery to 14.7 at the time of maximum recovery, and slightly declined to 14.3 at final follow-up. In six patients who developed late deterioration, these conditions were unrelated to the cervical spine. As of final follow-up, only one patient (3.2%) had complained of axial neck pain persisting for 5 years. Although progression of OPLL was found in 63.6% of patients, none had experienced neurological deterioration due to this progression. At final follow-up, sagittal alignment of the cervical spine was more lordotic than before surgery. Medium-term outcomes of C3-6 laminoplasty were satisfactory. Frequencies of persistent axial neck pain and loss of cervical lordosis after surgery remained significantly decreased for C5 years postoperatively. © Springer-Verlag 2011. Source

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