A Case of Olecranon Stress Fracture Caused by Throwing Motion

A 28-year-old man had right elbow pain just as he was throwing his usual fastball from the pitcher’s mound while playing a recreational baseball game. He had tenderness and swelling at the site of the olecranon without a history of trauma, previous elbow pain, instability or degenerative change in his elbow. An olecranon stress fracture was diagnosed caused by an impaction force during the throwing motion. Open reduction and internal fixation using tension band wiring was performed. Bone union was achieved and he returned to playing baseball as a pitcher. We report our case along with some discussion of the literature

Breathlessness-related Brain Activation: Electroencephalogram Dipole Modeling Analysis

Dyspnea is the feeling of shortness of breath and is a primary symptom of cardiopulmonary disease. Dyspneic symptoms include sensations such as labored respiration, chest tightness, air hunger, and uncomfortable or unpleasant urges to breathe. In this study, we investigated the brain areas associated with dyspnea using electroencephalogram dipole (EEG/DT) modeling. We hypothesize that good temporal resolution of EEG/DT recordings will enable determination of the neuroanatomical substrates of dyspnea in time course measures of inspiration. We measured EEG and respiration simultaneously during CO2 rebreathing, which induced dyspnea in the subjects and allowed us to find inspiration-related potentials during dyspnea. The waveform of the potentials was composed of a negative peak at 100ms and a positive peak at 250ms. Our EEG/DT modeling estimated their source generators in the left superior frontal and left orbitofrontal cortex (OFC) at 100ms after inspiration onset. In the next 100ms, the anterior cingulate cortex was activated, followed by the superior frontal and OFC. At 200ms to 300ms, dipoles finally converged in the left insula and amygdala. The first component of inspiration-related potentials thus involved frontal areas that play a role in the intention to inspire and emotional guidance, while the late component incorporated areas related to emotional reaction. We suggest that dyspnea with increasing ventilation could involve intentions or efforts to continue inspiration activities, and consequently, the perception of dyspnea could be associated with unpleasant emotions

Subpial Lipoma at the Conus Medullaris Level

We report a rare case of adult subpial spinal lipoma at the conus medullaris level. A 61-year-old man presented with lower back pain, numbness in his legs, difficulty walking and a sensation of residual urine. T1- and T2-weighted magnetic resonance imaging showed a well-demarcated hyperintense intradural tumor level with the lower part of the T12 vertebra. Laminectomy at the T12 level and partial removal of the tumor using ultrasonic aspiration were performed. Pathologically, the excised mass was composed of mature adipose tissue with no evidence of inflammatory cell invasion or malignancy. Symptoms other than numbness and hypoesthesia in the left leg were relieved postoperatively. This case report indicated that partial tumor removal and ultrasonic aspiration are useful methods for removing tumors with significant adhesion to the spinal cord

Prevention of Suppurative Knee Arthritis after Knee Ligament Reconstructive Surgery―“Povidone-iodine Pickled” Reconstructed Ligament―

Despite many reports describing the surgical procedure for knee ligament reconstruction, especially the anterior cruciate ligament, there have been few reports on infection prevention and none on sterilizing reconstruction materials using povidone-iodine during surgery. Here we report our surgical techniques for infection prevention. The participants included 522 patients who underwent arthroscopic knee ligament reconstruction at our hospital from April 2001 to October 2005. Despite taking various measures after cases of infection in 2001, such as the selection of sutures and artificial ligaments, and the use of indwelling intra-articular drains, the infection rate was not reduced to zero. Recently, we felt that soaking reconstruction ligaments in povidone-iodine and then washing with saline （“povidone-iodine pickling”） immediately prior to burr-hole insertion may prevent bacterial infections caused by surgical instruments and the surgery. Therefore, in this study, we examined the effects of our techniques for intraoperative and postoperative infection prevention, including “povidone-iodine pickling”. Although there were 6 cases of infection out of 100 in 2001, 3 out of 112 in 2002, 2 out of 121 in 2003, and 1 out of 121 in 2004, there were no cases of infection from September 2004 to October 2005 when “povidone-iodine pickling” was positively carried out. According to a 2015 study on the use of povidone-iodine, immersing a graft dropped on the floor during surgery in a chlorhexidine gluconate or povidone-iodine solution significantly reduced contamination of the graft. While the use of povidone-iodine for infection prevention may produce cytotoxicity, it is essential to mitigate the risk of septic arthritis. Going forward, we need to understand the specific pathologic basis of any cytotoxicity caused by the use of povidone-iodine on reconstructed ligaments

Application of the Y-method for Two Cases of Intradural Tumor in the Lumbar Region

We excised intradural tumors in the lumbar region by en bloc laminectomy using the Y-method. Incisions were made in the dura mater and arachnoid membrane using a T-saw to expose the surgical field. The laminectomy involved repositioning of the resected vertebral arches into their original positions and performing suture fixation with absorbable sutures. Bone fusion was achieved in the vertebral arch and spinous process, with posterior elements of the lumbar vertebra successfully preserved. The first case was a schwannoma and the second was a relatively rare epidermoid cys

Changes in Blood Pressure after the First Dose of Calcitonin (Elcatonin)

We had found previously that calcitonin treatment (elcatonin once a week for 10 weeks) results in significant decreases in blood pressure. The aim of the present study was to determine whether these effects were due to a cumulative effect of elcatonin or could be elicited by treatment with a single dose. To this end, we recruited 62 patients (eight men, 54 women; mean age 83 years; range 67-101 years) with a chief complaint of lower back pain to the present study and examined changes in blood pressure following administration of the first dose of elcatonin. All subjects in the study had been hospitalized either at our institution or an affiliated hospital. After acute phase symptoms had settled, subjects received 1 U (1mL), i.m., elcatonin S20. Blood pressure was measured the day before the first scheduled treatment and on the day of treatment. Both systolic and diastolic blood pressure decreased from 2 h after administration, and dropped significantly 4 and 6 h after administration. Therefore, elcatonin decreased blood pressure without first having to be accumulated in the body. There are several possible explanations for the results, including effects mediated by changes in concentrations of calcitonin gene-related peptide and calcium ions, as well as involvement of the parasympathetic nervous system. In conclusion, calcitonin inhibits bone resorption and pain, lowers blood pressure, and is easy to use in elderly patients who exhibit age-related increases in blood pressure

Ultrasound Elastographic Assessment of the Medial Collateral Ligament in the Elbow Joints of Baseball Players

We investigated the elasticity of the medial collateral ligament (MCL) in baseball players using ultrasound elastography (EG). We examined 72 elbows in 36 male baseball players (including 12 junior high students, 12 high school students, and 12 university students) with no history of pitching injuries. We used the Hitachi Medical Corporation HI VISION Avius, an acoustic coupler for quantification, as well as real-time tissue EG, which was applied to subjects in the supine position. Pressure was applied manually with the subject\u27s forearm in supination, elbow joint at 30° of flexion, and shoulder joint at 90° abduction. The strain ratio (SR) of the coupler and MCL was used for evaluation. SR increased with age (P < 0.05) in both arms, and the SR in the university student group was higher than that in the other groups (P < 0.05). In addition, the throwing side exhibited significantly lower SR values compared to the non-throwing side (P < 0.05), but there was no correlation between SR and other factors. Findings and Conclusions: Elasticity in MCLs of baseball players decreases with age, and increases on the throwing side. Quantifying the elasticity of the elbow MCL in this study will facilitate future investigation of how ligament characteristics could affect MCL injuries

The Relationship Between Serum Homocysteine Levels and Vertebral Fractures

Serum homocysteine and pentosidine levels have attracted attention as associated markers of bone quality, which affects bone strength. We examined the relationship of serum homocysteine levels with existing vertebral fractures and renal function. We evaluated 279 of 960 osteoporosis outpatients (12 men, 267 women; mean age, 72 years) whose serum homocysteine levels had been measured in our department. Using a glomerular filtration rate (GFR)-based chronic renal failure severity classification system, we divided patients into three groups: G1/G2, G3a/G3b/G4, and G5. We further divided the patients in the G1/G2 and G3a/G3b/G4 groups into two subgroups on the basis of the presence of fractures. Vertebral fractures were significantly more frequent when serum homocysteine levels were high in the G1/G2 group (P = 0.002). Serum homocysteine levels were lower in patients in the G1/G2 group than the G3a/G3b/G4 group despite the presence or absence of vertebral fractures (P < 0.001). Significant differences in serum homocysteine levels were also seen between patients with and without vertebral fractures in both the G1/G2 and G3a/G3b/G4 groups (P = 0.02). There were also significant correlations between GFR and serum homocysteine levels in both the G1/G2 and G3a/G3b/G4 groups (correlation coefficients, −0.43 and −0.65, respectively; P < 0.001). A negative correlation was observed between serum homocysteine levels and GFR in the G1/G2 and G3a/G3b/G4 groups, and we were able to reaffirm that serum homocysteine levels are affected by renal function. In the G1/G2 group, the prevalence of vertebral fractures was significantly higher in patients with high serum homocysteine levels. Even if renal function was poor, serum homocysteine levels were significantly higher in patients with vertebral fractures. Thus, serum homocysteine is a valid marker of bone quality

Effects of 3 Years of Treatment with a Selective Estrogen Receptor Modulator for Postmenopausal Osteoporosis on Markers of Bone Turnover and Bone Mineral Density

Aim: The aim of the present study was to assess the changes in bone mineral density and bone turnover markers in long-term SERM. Methods: The study was performed on 25 female outpatients with primary osteoporosis treated at the Osteoporosis Department of Showa University School of Medicine. All patients had been on raloxifene (60mg/day) for ≥ 3 years. The mean patient age was 67.1 years and the women were, on average, 18.4 years postmenopausal. Levels of bone turnover markers (urinary naltrexone [NTX] and bone-specific alkaline phosphatase [BAP]) and bone mineral density (BMD; front lumbar vertebrae, three proximal femur sites, and two distal radius sites) were determined before and then annually after starting raloxifene for a period of 3 years. Results: Over the 3-year treatment period, significant decreases were seen in both urinary NTX and BAP levels. Although BMD of the lumbar vertebrae and distal radius was increased over the 3 years after initiation of raloxifene treatment, the difference failed to reach statistical significance. The BMD of the femoral neck decreased, whereas that of the femoral trochanter and femoral intertrochanter area increased. Conclusions: The selective estrogen receptor modulator raloxifene is suitable for the treatment of osteoporosis in postmenopausal patients because it reduces bone turnover while maintaining adequate bone density

Periprosthetic Bone Mineral Density Changes after Cementless Total Knee Arthroplasty

Bony atrophy around the components following total knee arthroplasty (TKA) is often observed by radiography. To investigate the underlying cause of this incidence, we sought to quantitatively evaluate postoperative bone changes around the total knee components using dual-energy X-ray absorptiometry (DXA) over time. A retrospective study was conducted to compare bone mineral density (BMD) around the components in 22 patients pre-operatively and at 1, 3, 6, 12, and 24 months after cementless TKA for the treatment of osteoarthritis. In the coronal view, the medial tibia showed that a significant decrease in BMD at 12 months compared with 1 month after surgery (P<0.05), while the sagittal view showed that a significant decrease in BMD only at the anterior femoral condyle at 24 months compared with 1 month postoperatively (P<0.05). TKA improved the leg alignment and load-bearing axis in all patients, but we found that BMD tended to decrease on the medial side of the tibia and the anterior femoral condyle area over time following surgery. Our results suggest that recreating proper valgus alignment of the knee joint provides physiological balancing and condition. A larger prospective study is warranted