A Case Report of Isolated Traumatic Tear of the Triangular Fibro-Cartilage

We have recently experienced a case of solitary traumatic tear of the TFC which was diagnosed with the evident history of trauma, positive physical and arthrographic findings. Although the treatment is controversial for this problem, this case was treated with the excision of the torn TFC flap. Up to 13 months postoperative follow up, the patient is free of complains

上肢における遊離筋肉移植の長期観察と評価

A summary of the experimental and clinical evaluation of the long follow up cases which we have been doing from the past 8 years is reported. In experimental study, it was demonstrated that in the muscle graft which includes vessel and nerve anastomoses, the recovery of muscular power can be achieved up to 60 to 80% to that of normal, and thus its application in treatment of Volkmann's contracture and paralysis of brachial plexus has been increased. In clinical study, our conclusion is based on evaluation of the 5 successful cases in whom it was possible to make follow up examination for more than 2 years after operation. On clinical examinations, the contraction power of the grafted muscle were regained 30 to 75 % to that of normal; the total active motion of the fingers was increased on the average by 60 to 90 %, the grasping power for large objects increased much and it was used well in daily activities. However, as the fine delicate motion was not possible to achieve, this procedure is only one segment in the overall treatment of dysfunction of the limb. But it is felt that the procedure should be highly evaluated as a means for restoration of motion in those cases where all the measures had totally failed in the past

Evaluation of Sustained Grip Strength for a Stroke Patient with a Mild Paresis

The purpose of this study was to investigate whether a sustained grip strength test is workable as an accurate assessment of activity limitation related to muscle weakness of the paretic hands of stroke patients with mild pareses. Sixty-one stroke patients with mild pareses participated in this study. The maximal grip strength and an ability to sustain grip strength were examined with the Sustained Grip Strength Test. The latter ability was measured by the sustained period of the maximal grip strength (a period that exhibited more than 80% of the peak force during a six-seconds trial). The activity limitation of squeezing an object was evaluated in four ADL tasks, and the difficulties were rated according to three scores. We found that there was a significant positive relationship between the degree of the task difficulty and the maximal grip strength for paretic hands whose sustained period was over three sec, in all four assessments (p < 0.05). However, for paretic hands whose sustained period was under three sec, no such relationship was found. Consequently, measuring both the maximal grip strength and the sustained period was needed to assess accurately an activity limitation related to muscle weakness of the paretic hands of stroke patients with mild pareses

神経切断後の筋肉と神経筋接合部の変化

A histochemical study was conducted on the anterior tibial muscle of rats after transection of the right sciatic nerve at the proximal third of the thigh. Fibrillation was most prominent at the 4th week after denervation and even at the 7th month tiny fibrillations were infrequently recognized. The denervated muscle reduced its wet weight rapidly for the first one nonth and thereafter the decrease was gradual. From the 3rd month onwards muscle weight loss reached the plateau where the denervated muscle weighed about 15 to 20% against the control. The decrease of S. D. H. activity in the red muscle fibers resulted in histochemical undifferentiation of muscle fiber types, particularly from the 2nd month onwards after denervation. Motor end-plates stained by Wachstein, Meisel and Falcon's method became less visible in the course of time up to the 2nd month after denervation, but thereafter their staining intensity increased gradually with the abnormal internal structure of the synaptic folds

MRI analysis of carpal tunnel syndrome in hemodialysis patients versus non-hemodialysis patients: a multicenter case-control study

Abstract Background Carpal tunnel syndrome (CTS) is common among patients receiving hemodialysis and deeply influences their daily life. Amyloid deposits are considered the main reason for median nerve compression, but its prevalence is unclear. Therefore, to determine the main region of amyloid deposition inside the carpal tunnel, we measured the cross-sectional area (CSA) of each component of the carpal tunnel in preoperative magnetic resonance imaging (MRI). Methods Thirty-five hemodialysis patients (HD group) and age- and sex-matched 35 non-hemodialysis patients (non-HD group), who underwent the first surgery for CTS in registered hospitals from 2005 to 2015, were retrospectively enrolled. CTS was diagnosed from clinical and electromyographic (EMG) findings. The CSA of carpal tunnel, each of the flexor tendons, and the median nerve at the level of the hook of hamate were measured in T1-weighted axial images in preoperative MRI, by using Synapse OP-A software. Statistical analysis was performed using the Student’s t test and Pearson’s chi-squared test. Results The mean age of the HD group was 65.9 years and the dialysis duration was 21.9 (11–35) years. The mean age of the non-HD group was 65.3 years. The CSA of carpal tunnel (p = 0.006), flexor tendon (p = 0.03), and flexor digitorum profundus (FDP) tendon (p = 0.04) were bigger in the HD group. However, the median nerve, the flexor digitorum superficialis (FDS) tendon, and the flexor pollicis longus tendon (FPL) were not significantly different between the two groups. The dialysis duration or age at surgery did not show any strong correlation to each CSA. Conclusions We confirmed that hemodialysis caused expansion of the carpal tunnel due to amyloid deposition as previously described. Hemodialysis also caused expansion of the CSA of the flexor tendon, especially the FDP, possibly because of amyloid deposition inside the tendon. Furthermore, the duration of dialysis or age did not correlate with any CSA, which could be due to the good progress of the beta 2-microglobulin removal technique. Based on our results, FDS excision could be considered in case severe deposition of amyloid in FDP is observed during surgery

Evaluation of Tissue Blood Flow of the Gastric Tube after Vessel Anastomosis for Esophageal Reconstruction

[Objectives and Methods] Impaired blood flow of the upper end of the gastric tube is one of the major causes of anastomotic leak following esophageal reconstruction after esophagectomy for cancer. We applied an additional microvascular anastomosis procedure-the supercharging technique-to improve blood flow. We investigated blood flow improvement in 15 patients who underwent the supercharging technique after total excision of the thoracic esophagus and gastric tube reconstruction through the posterior mediastinal route from August 2003 to March 2005. [ResultsTissue] blood flow was measured with laser Doppler flowmetry during surgery and was improved after microvascular anastomosis. Patency and blood flow of anastomosed arteries were evaluated with computed tomography and ultrasonography, respectively. Patency and stable blood flow of anastomosed arteries were confirmed more than 1 month after surgery. Therefore, microvascular anastomosis improved the tissue blood flow of the upper end of the gastric tube. Long-term blood flow improvement was confirmed, which suggests that microvascular anastomosis contributes to reducing the risk of anastomotic leak

Light and Electron Microscopic Study of Peripheral Nerve Damage in Patients with Lepromatous Leprosy (LL) and Borderline Lepromatous Leprosy (BL)

Cutaneous branches of radial nerves in patients with lepromatous leprosy (LL) and borderline lepromatous (BL) were studied by light and electron microscopy. Foamy macrophages were found more or less in the nerve fibers of all leprosy patients and distributed in the epineurial, perineurial and endoneurial areas. In the endoneurium, the foamy macrophages were mainly located in the subperineurial and perivascular spaces. Vacuolated Schwann cells were also found in the nerve fasciculus. In electron microscopy, these foamy macrophages and vacuolated Schwann cells contained numerous small dense materials, irregular in size and shape, considered to be degenerated and fragmented mycobacterium leprae. These dense materials were found also in the cytoplasm of vascular endothelial cells. These findings suggest that mycobacteria enter into the endoneurium via the blood vessels. In our present study, on the other hand, it was very difficult to find the intact mycobacteria in the cytoplasm of the foamy macrophages, Schwann cells or endothelial cells, as well as in the Ziehl-Neelsen staining of paraffin sections. The disappearance of intact bacilli in our present study might have been caused by multi drug therapy.　　 The myelinated nerve fibers were degenerated and disappeared in variable degrees. Degenerative changes of the myelin sheath developed from the outer layer to the inner layer with disarrangement of the lamellar structure. These findings were different from myelin destruction of peripheral nerves in Wallerian degeneration. The degenerative changes of the myelin sheath are caused by degeneration and destruction of Schwann cells in leprosy patients.　　 Fibrosis surrounding myelinated and unmyelinated nerve fibers, i.e, periaxonal fibrosis, was found to a greater or lesser extent in the endoneurium.　　 In the present study, it is still unclear whether the periaxonal fibrosis was due to necrosis of the Schwann cells by infection of mycobacteria or to an autoimmune mechanism such as antiperipheral nerve antibody. However, lamellated concentric fibrosis surrounding regenerative myelinated and unmyelinated nerve fibers with the disappearance of mycobacteria suggests that degenerations and regenerations of nerve axons were repeated during clinical cause. These findings indicated that autoimmune mechanisms play an important role in the pathogenesis of periaxonal fibrosis