Case Report Common Peroneal Nerve Palsy with Multiple-Ligament Knee Injury and Distal Avulsion of the Biceps Femoris Tendon

A multiple-ligament knee injury that includes posterolateral corner (PLC) disruption often causes palsy of the common peroneal nerve (CPN), which occurs in 44% of cases with PLC injury and biceps femoris tendon rupture or avulsion of the fibular head. Approximately half of these cases do not show functional recovery. This case report aims to present a criteria-based approach to the operation and postoperative management of CPN palsy that resulted from a multiple-ligament knee injury in a 22-year-old man that occurred during judo. We performed a two-staged surgery. The first stage was to repair the injuries to the PLC and biceps femoris. The second stage involved anterior cruciate ligament reconstruction. The outcomes were excellent, with a stable knee, excellent range of motion, and improvement in the palsy. The patient was able to return to judo competition 27 weeks after the injury. To the best of our knowledge, this is the first case report describing a return to sports following CPN palsy with multiple-ligament knee injury

Ultrasonography imaging of the anterolateral ligament using real-time virtual sonography

Background: The anterolateral ligament (ALL) functions as a stabilizer in the internal rotation of the knee. Previous studies have reported the ALL can be identified using magnetic resonance imaging (MRI); however, there are no reports on using ultrasonography (US) for this purpose. Real-time virtual sonography (RVS) uses magnetic navigation and computer software for the synchronized display of real-time US and multiplanar reconstruction MRI images. This study investigated the ability of using US with RVS to evaluate the ALL. Methods: Nine healthy subjects were enrolled. The Digital Imaging Communications in Medicine MRI dataset was loaded into the Hitachi Aloka Preirus, and US images were displayed on the same monitor. When the ALL was identified using MRI, the monitor was frozen to evaluate the ALL. The ALL was divided into the femoral, meniscal, and tibial portions. The portions and thickness of the ALLs and the lateral inferior genicular artery (LIGA), a landmark for the ALL, were evaluated. Results: All portions of the ALL could be identified using MRI. Using US, the tibial portion of the ALL was detected in all subjects and the femoral portion was detected in seven subjects; however, the meniscal portions could not be identified. The average ALL thickness as measured by US was 1.3 ± 0.1 mm and the LIGA was identified in all cases. Conclusions: Most portions of the ALL can be identified using US. As most ALL injuries occur at the femoral or tibial portion, US may be useful as a diagnostic tool for ALL injury.Level of Evidence: 4. © 2015 Elsevier B.V.Embargo Period 12 month

Using NU-KNIT® for hemostasis around recurrent laryngeal nerve during transthoracic esophagectomy with lymphadenectomy for esophageal cancer

BACKGROUND: We thought that using electrocautery for hemostasis caused recurrent laryngeal nerve palsy. We reflected the prolonged use of electrocautery and employed NU-KNIT® to achieve hemostasis nearby the recurrent laryngeal nerve. We assessed that using NU-KNIT® hemostasis prevented or not postoperative recurrent laryngeal nerve palsy, retrospectively. The present study was evaluated to compare using electrocautery hemostasis with using NU-KNIT® hemostasis during lymphadenectomy along recurrent laryngeal nerve. The variables compared were morbidity rate of recurrent laryngeal nerve palsy, operation time, and blood loss. RESULTS: We use NU-KNIT® to achieve hemostasis without strong compression. This group is named group N. On the other hand, we use electrocautery to achieve hemostasis. This group is named group E. Complication rate of recurrent laryngeal nerve palsy was higher in group E (55.6%) than group N (5.3%) (p = 0.007). CONCLUSIONS: Even hemostasis using NU-KNIT® was slightly more time-consuming than using electrocautery, we concluded that it would be useful to prevent recurrent laryngeal nerve palsy

Precise risk factors for Osgood–Schlatter disease

Introduction: A number of studies have examined the risk factors for Osgood–Schlatter disease (OSD). Studies on risk factors have not necessarily accurately demonstrated the risk factors of this disease because they were not prospective cohort studies or the populations in the studies were not categorized by the skeletal maturation of the tibial tuberosity. We can identify the precise risk factors for OSD by performing a prospective cohort study of a group of asymptomatic patients in particular times of adolescent using ultrasonography. In the present study, we aimed to investigate the precise risk factors for OSD. Methods: For all examinations, we used a 3-stage classification for tibial tuberosity development observed on ultrasonography: sonolucent (stage S), individual (stage I), and connective stages (stage C). Among 150 players with 300 knees, we included 37 male players with 70 knees at asymptomatic stage I on the first examination. We re-examined the included knees 1 year after the first examination and compared 10 knees with OSD (OSD group) and 60 knees without OSD (control group). Height, body weight, body mass index, tightness of the quadriceps femoris and hamstring muscles, muscle strength during knee extension, and flexion were assessed during the first medical examination. Results: The incidence of OSD was 14.3 % in this 1-year cohort study. A significant difference was found in body weight, quadriceps muscle tightness, and muscle tightness and strength during knee extension between the 2 groups. The precise risk factors for OSD were increased, namely the quadriceps femoris muscle tightness and strength during knee extension and flexibility of the hamstring muscles, using logistic regression analysis. Conclusions: This information may be useful for teaching quadriceps stretching in preadolescent male football players with stage I. © 2015 Springer-Verlag Berlin Heidelber

Technique of anatomical single bundle ACL reconstruction with rounded rectangle femoral dilator

Background: This study aimed to present a new technique for anatomical single bundle anterior cruciate ligament (ACL) reconstruction. We developed an original rounded rectangular dilator set to create rounded rectangular femoral tunnels. This technique can increase the femoral tunnel size without roof impingement, and has the potential to reduce the graft failure rate. We investigated the tunnel position and the incidence of intraoperative complications. Method: The presented technique is anatomical single bundle ACL reconstruction using a semitendinosus graft (with or without the gracilis tendon). The tunnel was drilled via an additional medial portal. Rounded rectangular tunnels were created using a special dilator. Tibial tunnels were created using conventional rounded tunnels. Fixation was achieved using a suspensory device on the femoral side and a plate and screw on the tibial side. Patients: Fifty patients underwent this surgery, and intraoperative complications were investigated. The femoral tunnel positions were documented postoperatively from computed tomography scans using the quadrant method. The tibial tunnel positions (anterior-to-posterior, medial-to-lateral) were documented using intraoperative X-ray scans. Results: Only one patient had a partial posterior tunnel wall blowout. The femoral tunnel length varied between 30 and 40 mm (mean, 34.9 ± 3.3 mm). All femoral and tibial tunnels were located within the area of the anatomical ACL insertions. Conclusion: We did not experience any serious intraoperative complications during anatomical single bundle ACL reconstruction using a rounded rectangle dilator, and the resulting locations of the femoral and tibial tunnels were within the anatomical ACL footprint. Level of evidence: Level IV. © 2015 Elsevier B.V..Embargo Period 12 month

Changes in muscle activity after performing the FIFA 11+ programme part 2 for 4 weeks

Changes in muscle activity were evaluated by positron emission tomography–computed tomography (PET–CT) after performing part 2 of the Fédération Internationale de Football Association’s 11+ programme (11+) for 4 weeks. Eleven males performed part 2 of the 11+ for 20 min before and after 37 MBq of 18F-fluorodeoxyglucose (FDG) was injected intravenously. PET–CT images were obtained 50 min after FDG injection. The participants were then instructed to perform part 2 of the 11+ 3 times per week for 4 consecutive weeks, after which another set of PET–CT images was obtained following the same procedure. Regions of interest were defined within 30 muscles. The standardised uptake value (SUV) of FDG by muscle tissue per unit volume was calculated, and FDG accumulation was compared between pre- and post-training PET–CT results. Performing part 2 of the 11+ for 4 weeks increased mean SUV in the sartorius, semimembranosus, biceps femoris, abductor hallucis, and flexor hallucis brevis muscles (P < 0.05). In conclusion, routinely performing part 2 of the 11+ for 4 weeks increased glucose uptake related to muscle activity in the hamstrings and hallux muscles. We speculate that there is some possibility of this change of muscle activity contributing to a decrease in sports-related injuries. © 2016 Taylor & FrancisEmbargo Period 18 month

Expression of enhancer of zeste homolog 2 correlates with survival outcome in patients with metastatic breast cancer: exploratory study using primary and paired metastatic lesions

Evaluation of immunostaining of EZH2 and Ki67. (DOC 52 kb

Retinol Supplements Antiviral Action of Interferon in Patients with Chronic Hepatitis C: A Prospective Pilot Study

Sustained virologic response with peg-interferon and ribavirin combination therapy for 48 weeks is still inadequate. Our study examined whether short-term administration of retinol clinically influences the anti-viral activity of interferon early during interferon and ribavirin combination therapy. The control group received 6 MIU of interferon α-2b every day for two weeks and then 3 times a week for 22 weeks intramuscularly plus 600 mg or 800 mg per day of ribavirin orally for 24 weeks. The retinol group, in addition to above treatment, received retinol 30,000 units per day orally for 3 weeks from one week before the start of interferon α-2b plus ribavirin combination therapy. The hepatitis C virus (HCV) RNA negativity rate at 1 week after the end of interferon α-2b and ribavirin combination therapy was 46.7% (28/60) for the retinol group and 31.7% (19/60) for the control group, which was significantly higher for the retinol group. The level of serum HCV RNA in the retinol group was significantly lower at 1 week after beginning treatment as compared to the control group (p<0.01). Furthermore, serum 2,5'AS protein at 1 week after beginning treatment was significantly higher in the retinol group (p = 0.0002). The results suggest that retinol supplement increases the antiviral effect of interferon α-2b plus ribavirin only during the administration of IFN α-2b, ribavirin and retinol in patients with chronic hepatitis C

Primary placement technique of jejunostomy using the entristar™ skin-level gastrostomy tube in patients with esophageal cancer

<p>Abstract</p> <p>Background</p> <p>We developed a skin-level jejunostomy tube (SLJT) procedure for patients undergoing esophagectomy using a skin-level gastrostomy tube (G-tube) (Entristar™; Tyco Healthcare, Mansfield, Mass), in order to improve their nutrition status and quality of life (QOL). We describe the procedure and the adverse effects of SLJT in patients with esophageal cancer (EC).</p> <p>Methods</p> <p>Over a 24-month period (March 2008 to March 2010), there were 16 patients (mean age: 61.8 years; age range: 49-75 years; 15 men, 1 woman) who had Stage II or III EC. Primary jejunostomy was performed under general anesthesia during esophagectomy. The technical success and the immediate and delayed complications of the procedure were recorded.</p> <p>Jejunostomy techniques</p> <p>SLJT placement using the G-tube (20Fr) was performed 20 cm from the Treitz ligament on the side opposing the jejunal mesenterium. The internal retention bolster was exteriorized through an incision in the abdominal wall. A single purse string suture using a 4-0 absorbable suture was performed. The internal retention bolster was then inserted into the jejunal lumen via the small incision. The intestine adjacent to the tube was anchored to the peritoneum using a single stitch.</p> <p>Results</p> <p>The SLJT was successfully inserted in all 16 patients. No early complications were documented. Follow-up for a median of 107 days (range, 26-320 days) revealed leakage to the skin in four patients, including superficial wound infections in two patients. There were no cases of obstruction of the tube or procedure-related death.</p> <p>Conclusions</p> <p>This SLJT placement technique using the G-tube is a safe procedure in patients with EC and allows the creation of a long-term feeding jejunostomy.</p