Fibrous Structure and Connection Surrounding the Metacarpophalangeal Joint

The fibrous components of the metacarpophalangeal (MP) joint including the palmar plate, the collateral ligament and the dorsal plate were studied with particular attention paid to the fibrous structure of the fibrous tendon sheath and the deep transverse metacarpal ligament. The tough fibrillar structure around the MP joint, especially the force nucleus, consisted of three types of mixed fibers: the fibrous tendon sheath of the A1 pulley, the deep transverse metacarpal ligament, and the palmar plate. The tendon sheath was located on the ulnar side in the index and middle fingers, on the central position in the ring finger, and on the radial side in the little finger. These fibrous connections among the fingers formed a transverse arch in the hand. The palmar plate of the MP joint was relatively rigid and appears to function as a cushion when flexed. A fold-like protrusion of the synovial layer of the palmar plate of the MP joint had a meniscoid function, which was larger than that of the proximal interphalangeal joint. The capsule of the MP joint was thicker at the dorsal area, forming a dorsal plate, which is a sliding floor of the extensor mechanism and has a meniscoid function for joint congruity. The main lateral stabilizer consisted of collateral ligaments and accessory collateral ligaments anchored to the palmar plate. These structures act together as a &#34;phalangeal cuff&#34;, connecting the proximal phalanx to the metacarpal head and sta</p

Ultrasonographic Analysis of Shoulder Rotator Cuff Tears

Seventy-nine shoulders suspected of rotator cuff tears were examined by ultrasonography (US) and forty-three received surgery. Long and short axis scans were performed and findings of each were separately classified according to a five-grade system, and the results were correlated with the actual extent of tear observed during surgery. Internal echogenicity and subacromial impingement were analyzed before and after surgery. A accuracy of US in detecting rotator cuff tears was analyzed. In addition, the correlation between cuff shape observed by US before surgery and actual shape observed during surgery was assessed. It was noted that cuff thinning and abnormalities in shape did not recover to normal after surgery. However, in the cases of discontinuities observed by US before surgery, US findings indicated that the torn cuff was anchored to the greater tuberosity and functional during active motion. Although post-operative US findings were not normal, clinical results were good in most cases. Sensitivity of US for detecting rotator cuff tear was 100% and specificity 94%. US is non-invasive, cost effective and allows the physician to examine the joint while it is in motion. Therefore, at this time, we use US as a screening method for detecting rotator cuff tears. Furthermore, US allows us to check for re-tears while the joint is in motion, which is essential for accurate diagnosis.</p

Chronic encapsulated intracerebral hematoma formation after radiosurgery for cerebral arteriovenous malformation

We report a rare case of chronic encapsulated intracerebral hematoma (CEIH) after radiosurgery for a cerebral arteriovenous malformation (AVM). A 49-year-old male underwent transarterial embolization and surgical excision of a cerebral AVM presenting with cerebral hemorrhage in the left temporal lobe. Stereotactic radiosurgery (SRS) was done after 12 months. Magnetic resonance imaging (MRI) 14 months after SRS showed a small-enhancing lesion close to the left lateral ventricle and marked white matter edema. At that time a diagnosis of radiation-induced necrosis was made and steroids administered. At 43 months after SRS, MRI showed a small-enhancing mass close to the lateral ventricle with a hematoma cavity. Surgical excision was performed and histological examination revealed that the capsule consisted of an outer collagenous layer and an inner granulated layer with deposits of hemosiderin, which was compatible with CEIH. CEIH should be considered after SRS for AVM

本態性高血圧症患者および正常血圧者の Nifedipine 1回経口投与に対する交感神経ならびに内分泌応答のレニン群間比較

Behaviors of sympathetic and renin-angiotensin-aldosterone systems to an acute sublingual administration of nifedipine (10 mg) were studied in essential hypertensive (EHT) and normotensive (NT) groups. Basal values of plasma norepinephrine (NE) and plasma renin activity (PRA) were not consistent with mean blood pressure (BP), indicating no important role of NE and PRA values for determining BP level. Nifedipine reduced BP, and increased NE and PRA in both groups. Simultaneously, nifedipine produced a significant decrease of plasma aldosterone concentration (PAC) and plasma cortisol. High-renin EHT subgroup showed greater responses of BP, NE and PRA than normal- or low-renin subgroup but not in NT group. In high-, normal- and low-renin subgroups of both groups, the correlations between mean BP and △mean BP (r= -0.85, p<0.001; r= -0.89, p<0.001 and r= -0.77, p<0.001, respectively), △mean BP and △NE (r= -0.76, p<0.01; r= -0.71, p<0.05 and r= -0.57, NS, respectively) and △mean BP and △PRA (r= -0.87, p<0.001; r=0.59, NS and r= -0.05, NS, respectively) were observed. A significant relationship between basal PRA and △PRA was demonstrated in EHT group (r=0.77, p<0.001) but not in NT group (r=0.37, NS). These data indicate the presence of high vascular tone in high-renin EHT subgroup which is probably produced by an increased vascular responsiveness to sympathetic and/or to angiotensin II or by some other factors. It is suspected that juxtaglomerular cell response to vasodilator may be altered in patients with low-renin essential hypertension. The present study also suggests that nifedipine blocked aldosterone and cortisol secretion through Ca++ influx inhibition into the adrenal cortex