A case of liver abscess caused by Fusobacterium nucleatum in a patient with periodontitis

We report a case of liver abscess due to Fusobacterium nucleatum in a 68-year-old man with periodontitis. He was admitted to our hospital complaining of high fever. Abdominal ultrasound sonography and computed tomography scan revealed a single liver abscess. Fusobacterium nucleatum was isolated from liver aspirates. He had no dental symptoms but periodontitis was diagnosed. After extraction of a tooth, he had high fever again suffered from sepsis. Fusobacterium nucleatum is anaerobic gram-negative bacilli found in normal flora of oral cavity and gastrointestinal tract, but it has rarely proven as a causative pathogen of liver abscess or systemic infection associated with periodontal disease. It should be noted that poor dental hygiene could lead to serious systemic infection

Shoulder elbow pain youth baseball players

Objectives: There are relatively few published epidemiological studies examining the differences in the risk of shoulder and elbow pain in young baseball players. Risk factors for shoulder pain are different from those for elbow pain in child and adolescent baseball players. Methods: A total of 1563 players aged 7 to 12 years participated in this investigation. Subjects were asked whether they had experienced episodes of shoulder or elbow pain. We investigated the following risk factors for shoulder and elbow pain: age, position, years of baseball experience, and training hours per week. Data from the groups with and without shoulder and elbow pain were analyzed using multivariate logistic regression models. Results: Among the 1563 participants, 15.9% and 29.2% reported episodes of shoulder and elbow pain, respectively. Multivariate analysis showed that shoulder pain was associated with age 10, 11, and 12 years, and that elbow pain was associated with age 10, 11, and 12 years, playing catcher, and >2 years of baseball experience. Training hours per week were not associated with either shoulder or elbow pain. Conclusion: In over 1000 baseball players aged 7 to 12 years, 15.9% reported episodes of shoulder pain, while 29.2% reported elbow pain in the throwing arm. The associated risk factors were different for each type of pain. Shoulder pain was associated with increased age while elbow pain was associated with increased age, increased years of baseball experience, and playing catcher

チアノーゼ性心疾患に対する肺動脈絞扼術

The early and late results of pulmonary artery banding (PAB) for cyanotic heart defects in early infancy were reviewed. Nine patients were divided into two groups : Group F (five patiens) in which Fontan type repairs were expected as definitive repair in the near future ; Group A (four patients) in which anatomical repairs were programmed in the near future. Six patients had a good early postoperative course, and then consisted of three patients of Group A and three patients of Group F. The band circumference, intraoperative pulmonary-to-systemic systolic pressure ratio and arterial oxygen tension after PAB in the good cases of Group A were 20.0±1.7 mm + 1 mm for each kilogram of the infant's weight, 0.52±0.07 and 46.4±11.3 mmHg respectively. These indices in the good cases of Group F were 21.1±1.7 mm + 1 mm for each kilogram of the infant's weight, 0.55±0.02 and 38.8±1.0 mmHg respectively. The standard deviations of every index for PAB in Group F were small. Three patients of Group A have undergone successful total correction. Intraoperative pulmonary-to-systemic systolic pressure ratio of 0.5 as the index of PAB is preferable to Group A. However, only two patient of Group F were waiting for Fontan type definitive repair. For the patient especially in Group F, careful observation and well-timed staged repair with regard to subaortic stenosis and restrictive atrial septal defect and ventricular septal defect are necessary after accurate PAB as mentioned above

Epidemiology of shoulder injuries in young baseball players and grading of radiologic findings of Little Leaguer’s shoulder

Relatively few epidemiological studies have examined shoulder injuries. This study aimed to investigate the epidemiology of such injuries in young baseball players. A total of 2,055 players aged 9-12 years who participated in a regional championship between 1983 and 1985 were the subjects of this investigation. They were assessed by questionnaire and radiographic examination. Prevalence of shoulder pain was determined according to position, years of baseball playing experience, and training hours per week. Radiographic examination was recommended to all players who complained of shoulder pain. Of the 2,055 subjects, 275 (13.4%) reported episodes of pain in the throwing shoulder. Years of baseball experience, but not player position or training hours per week, was significantly associated with shoulder pain. Forty-one of the 275 subjects reporting shoulder pain agreed to undergo radiography and 15 exhibited findings of Little Leaguer’s shoulder. Their lesions could be classified into three distinct grades based on radiographic findings : grade I, widening of the epiphyseal plate in the lateral area (n=9) ; grade II, widening at all areas of the epiphyseal plate and demineralization of the metaphysis (n=5) ; and grade III, a slipped epiphysis (n=1)

Successful Outcomes Using Interlocking Prostheses for Periprosthetic Fractures with Loose Femoral Components

Periprosthetic femoral fractures with implant loosening are difficult to treat, especially when accompanied by severe bone loss.We report here the treatment outcomes of 4 patients (1 man, 3 women ; age range 69-86 years) with periprosthetic femoral fractures and implant loosening after bipolar hemiarthroplasty. Fractures were classified according to the Vancouver classification as type B2 and B3, with adequate or compromised bone stock, respectively. One patient was initially treated conservatively but symptoms due to implant loosening persisted and revision surgery was required. All patients underwent revision using a long-stem cementless implant with interlocking screws as well as a cancellous allograft to augment the bone stock. At final follow-up (mean, 25 months), all patients had stable implant fixation, bony union of the fracture, and marked recovery of the proximal femoral bone stock through allograft use. This revision procedure achieved implant fixation and fracture healing with reconstitution of the femur even in the short term and even in cases with severe bone deficiency

Surgical management of infants with mitral valve stenosis or atresia without diminutive ascending aorta

The surgical strategy in infants with mitral valve stenosis or atresia without diminutive ascending aorta remains to be established, including the potential for biventricular repair as a definitive operation. Our surgical experience of six infants with mitral valve stenosis (4patients) or atresia (2patients) without diminutive ascending aorta was evaluated based on three important factors:left ventricular volume;the nature of the systemic outflow obstruction; and the type of mitral valve anomaly. Two patients with systemic outflow tract diameter less than 65% of normal underwent systemic outflow tract reconstruction, and the other patients with outflow tract diameter more than 68%of normal were able to maintain systemic circulation without repair. Only one patient with mitral valve stenosis without left ventricular outflow tract obstruction underwent a successful open mitral valvotomy as a biventricular repair after first-stage palliation. The left ventricle of the other patients did not grow after first-stage palliation. Due to progressive subaortic narrowing, pulmonary artery banding should be avoided in patients with mitral atresia due to absent atrioventricular connection who are future Fontan candidates. Most patients with this lesion can be expected to become candidates for safe Fontan-type repair

Outcome of an elbow check-up system for child and adolescent baseball players

Purpose : Our aim was to examine the outcome of an elbow check-up system for youth baseball players. In particular, we investigated the nature of elbow injuries in youth baseball players with elbow pain and ultrasonographic findings of the capitellum. Materials and Methods : A total of 1605 players participating in the regional summer championship in July 2013 underwent a questionnaire survey, physical examination, ultrasound imaging, and radiographic examination. Results : A total of 499 (31.1%) players reported episodes of elbow pain, of whom 320 (64.1%) had abnormal findings on physical examination, and 115 (35.9%) agreed to undergo radiography. Among them, 98 (85.2%) exhibited radiographic abnormalities. On the initial ultrasonography screening, 60 (3.7%) players had an abnormal finding and 55 (91.7%) agreed to undergo radiography. Among them, 26 (47.3%) were found to have osteochondritis dissecans (OCD) of the capitellum on radiographs. Conclusions : About 30% of youth baseball players had episodes of elbow pain, and 64.1% of players with elbow pain had abnormal findings on physical examination. Furthermore, 85.2% of subjects who underwent radiographic examination exhibited radiographic abnormalities. About 4% of young baseball players had an abnormal finding on initial ultrasonography screening, and nearly 50% of them had OCD of the capitellum on radiographs

Percutaneous Endoscopic Lumbar Discectomy for a Huge Herniated Disc Causing Acute Cauda Equina Syndrome : A Case Report

Microsurgery for lumbar disc herniation that requires surgical intervention has been well described. The methods vary from traditional open discectomy to minimally invasive techniques. All need adequate preanesthetic preparation of patients as general anesthesia is required for the procedure, and nerve monitoring is necessary to prevent iatrogenic nerve injury. Conventional surgical techniques sometimes require the removal of the corresponding lamina to assess the nerve root and herniated disc, and this may increase the risk for posterior instability of the vertebral body. Should this occur, fusion surgery may be needed, further increasing morbidity and cost. We present here a case of lumbar herniated disc fragments causing acute cauda equina syndrome that were endoscopically resected through a transforaminal approach in an awake patient under local anesthesia. Percutaneous endoscopic discectomy under local anesthesia proved to be a better alternative to open back surgery as it made immediate intervention possible, was associated with fewer perioperative complications and morbidity, minimized soft tissue damage, and allowed early rehabilitation with a better outcome and greater patient satisfaction. In addition to these advantages, percutaneous endoscopic discectomy protects other approaches that may be needed in subsequent surgeries, whether open or minimally invasive

Arthroscopic excision of unstable os acromiale associated with impingement syndrome : a case report

Os acromiale is a rare anatomical variant that is caused by failure of fusion of the acromial apophysis and is usually asymptomatic. We report a case of impingement syndrome of the left shoulder secondary to unstable os acromiale, which was initially overlooked and confirmed only during arthroscopic examination. Arthroscopic excision of the unstable fragment was successful without residual dysfunction of the deltoid muscle