PubMed Health⌕ Search

Biomedical subjects

I Okutsu

Publications and source records attributed to I Okutsu.

At least 19 recordsLinked to original sources
PubMed1997

An anatomical study of the palmar ligamentous structures of the carpal canal.

To determine which structures should be divided for complete release of the carpal canal, we studied the palmar structures in 12 embalmed and eight fresh cadaveric hands. In all hands, fibres run transversely between the thenar and hypothenar fascia, distal to the flexor retinaculum in a layer separate from it. In fresh cadaveric hands, we first released only the flexor retinaculum as in endoscopic management of carpal tunnel syndrome and then these distal fibres. When the flexor retinaculum was released, the mean distance between the sectioned ends of the flexor retinaculum was 1.3 mm. When the distal fibres were also divided, the mean distance was 6.6 mm. We conclude that release of both the flexor retinaculum and the distal transversely running fibres is essential for complete release of the carpal canal in endoscopic surgery.

Aged↗
PubMed1996

Complete endoscopic carpal tunnel release in long-term haemodialysis patients.

The roof of the carpal tunnel (or canal) consists of the distal portion of the flexor retinaculum, the flexor retinaculum (or the transverse carpal ligament) and the proximal portion of the flexor retinaculum. We tried to determine which anatomical structures were relevant to complete endoscopic carpal tunnel decompression in long-term haemodialysis patients with carpal tunnel syndrome. Carpal tunnel pressure was measured using the continuous infusion technique before and after endoscopic release of the flexor retinaculum, distal portion of the flexor retinaculum and the proximal portion of the flexor retinaculum respectively in 257 hands. We concluded that release of the distal portion of the flexor retinaculum, in addition to the flexor retinaculum, is essential for complete carpal tunnel decompression in long-term haemodialysis patients.

Adult↗
PubMed1996

Complete endoscopic carpal canal decompression.

We made a model of the endoscopic decompression of the carpal canal in clinical cases. The model entailed the release of the transverse carpal ligament, ie, the flexor retinaculum, first; then the transverse fibers: deep layer of the midpalmar fascia or distal portion of the flexor retinaculum; and, finally, release of the forearm fascia. Carpal canal pressure was measured using the continuous infusion technique, and the carpal canal was observed endoscopically at each step. Carpal canal pressure data were analyzed by using the Wilcoxon matched pairs signed-rank test. When the transverse carpal ligament and the transverse fibers were divided, carpal canal pressure was significantly statistically lower than that with release of the transverse carpal ligament alone. We conclude that release of both the transverse carpal ligament and the transverse fibers are essential for complete decompression of the carpal canal in endoscopic surgery.

Adult↗
PubMed1995

Evaluation of carpal canal pressure in carpal tunnel syndrome.

Preoperative electrophysiologic testing and intraoperative carpal canal pressure measurements were performed on 957 hands in 647 patients with clinical signs of carpal tunnel syndrome. Fifty-five symptomatic hands in 48 patients were normal in both distal sensory latency and distal motor latency preoperatively. Carpal canal pressure was, however, significantly elevated compared to control data in all 55 hands. After complete subcutaneous release of the carpal canal using the Universal Subcutaneous Endoscope system, carpal canal pressure was reduced to within the normal control range. Clinical symptoms of carpal tunnel syndrome improved in all 55 hands. Postoperative electrophysiologic data remained within normal range in patients who agreed to receive electrophysiologic examinations.

Adult↗
PubMed1994

Effects of endoscopic release of the transverse carpal ligament on carpal canal volume.

Ten hands in 10 patients with carpal tunnel syndrome were treated by subcutaneous transverse carpal ligament release using the Universal Subcutaneous Endoscope system. We analyzed the morphologic changes of the carpal canal with magnetic resonance imaging (0.064 T) before and after the operation. The axial plane, which includes the beak of the trapezium and the hook of the hamate, was selected for analysis. The soft tissue boundaries of the carpal canal were outlined at the plane. The cross-sectional area of the carpal canal was 232 +/- 49 mm2 before surgery and 320 +/- 108 mm2 after surgery. There was a 33% +/- 15% increase of the carpal canal cross-section after transverse carpal ligament release. The transverse carpal ligament became more outwardly convex after the operation. The endoscopic procedure is effective for increasing the cross-sectional area and volume of the carpal canal.

Adult↗
PubMed1993

Dynamic external finger fixator for fracture dislocation of the proximal interphalangeal joint.

The treatment of fracture dislocations of the proximal interphalangeal joint often results in pain and stiffness. A small dynamic external finger fixator was designed to maintain the reduced position of the dislocated middle phalanx and allow early active range-of-motion exercise. Four patients with acute unstable fracture dislocations and three with old malunited fracture dislocations of the proximal interphalangeal joint were treated with this apparatus. The average range of the proximal interphalangeal joint motion with this device was 88 degrees. The average follow-up period was 21 months.

Adolescent↗
PubMed1993

Results of endoscopic management of carpal-tunnel syndrome in long-term haemodialysis versus idiopathic patients.

The purpose of this paper is to compare the results of our endoscopic management of carpal-tunnel syndrome caused by long-term haemodialysis to that with no apparent cause (idiopathic). We have operated on 551 hands in 370 patients using the Universal Subcutaneous Endoscope system under local anaesthesia without a pneumatic tourniquet on an out-patient basis since 1986. Ninety-six hands in 64 patients who suffered from carpal-tunnel syndrome from long-term haemodialysis and 85 hands in 52 patients who suffered from carpal-tunnel syndrome for no apparent cause were statistically analysed using complete pre- and postoperative electrophysiological and clinical studies for periods of time ranging from over 6 months to 4.8 years (mean 16.9 months). Electrophysiological and clinical results showed that our endoscopic management in long-term haemodialysis patients is effective, safe and yields the same results as in patients who suffered from carpal-tunnel syndrome for no apparent cause.

Adult↗
PubMed1993

Results of endoscopic management of carpal tunnel syndrome.

This paper is a retrospective study of 27 women with carpal tunnel syndrome (39 hands) who underwent a new endoscopic operative procedure utilizing the Universal Subcutaneous Endoscope system developed by the lead author. Operations on 199 hands were performed under local anesthesia on an outpatient basis. The etiology was considered idiopathic in all cases. Complete preoperative and postoperative clinical and electrophysiologic data were analyzed in 39 hands. The follow-up period ranged from 12 to 45.8 months (mean, 18.3 months). Symptoms of sensory disturbances disappeared in an average of 20 weeks in all patients. Electrophysiologic studies showed definite improvement when compared with preoperative studies. No complications were recorded. Clinical and electrophysiologic results showed that the less-invasive management of carpal tunnel syndrome by endoscopy is safe and effective.

Ambulatory Surgical Procedures↗
PubMed1992

Coracoacromial ligament release for shoulder impingement syndrome using the Universal Subcutaneous Endoscope system.

We developed a new operative procedure of coracoacromial ligament release for shoulder impingement syndrome. The operative procedure was confirmed by cadaveric studies and applied to clinical cases in 40 shoulders of 37 patients who suffered from shoulder impingement without bony abnormalities. The subacromial space was observed under local anesthesia using the Universal Subcutaneous Endoscope (USE) system on an outpatient basis. A popping phenomenon was observed between the coracoacromial ligament and the greater tuberosity of the humerus, which was covered by the rotator cuff, and the coracoacromial ligament was resected with a rongeur under endoscopic visualization in all shoulders. Resection of the coracoacromial ligament relieved the impingement and clinical signs, as in open or arthroscopic resection of the coracoacromial ligament. Resection of the coracoacromial ligament using the USE system is a safe and less-stressful surgical invasion than open or standard arthroscopic resection of the coracoacromial ligament.

Anesthesia, Local↗
PubMed1991

Endoscopic management of shoulder pain in long-term haemodialysis patients.

In 48 shoulders of 29 patients receiving long-term haemodialysis and complaining of intolerable shoulder pain, endoscopic resection of the coracoacromial ligament was performed under local anaesthesia on an outpatient basis, using the Universal Subcutaneous Endoscope system. Predominant endoscopic findings were proliferation of the subacromial bursae and popping between the coracoacromial ligament and the rotator cuff. Amyloid originating from beta 2 microglobulin (beta 2-M) was demonstrated in 87% of the resected coracoacromial ligaments and 86% of the subacromial bursae. Resection of the coracoacromial ligament relieved the shoulder pain in all patients.

Adult↗
PubMed1991

Transient osteoporosis of the hip. Magnetic resonance imaging.

Magnetic resonance (MR) images of seven hips were reviewed in six patients with transient osteoporosis of the hip. The MR images of the affected joint showed increased joint fluid and diffuse signal abnormalities in the marrow of the femoral head, corresponding to a decreased signal intensity on T1-weighted images and an increased signal intensity on T2-weighted images. The MR images at the time of clinical improvement showed regression of the abnormalities. These MR abnormalities reflect the pathophysiology of this condition.

Acute Disease↗
PubMed1989

Endoscopic management of carpal tunnel syndrome.

This article describes a subcutaneous endoscopic operative procedure for carpal tunnel syndrome and analyzes its effectiveness using electrophysiological data. Subcutaneous transverse carpal ligament release under universal subcutaneous endoscope (USE) was performed using local anesthesia without pneumotourniquet in 54 hands of 45 patients since June 1986. The mean follow-up period was 13.8 months. Sensory disturbances began to subside immediately after the operation and disappeared within 2 months in all cases. After the disappearance of sensory disturbances, we performed postoperative electrophysiological studies in 27 patients (33 hands). Postoperative electrophysiological data were significantly improved in all cases. Patients did not suffer from any serious complications such as motor branch injuries of the median nerve, hypesthesia of the palm, or injuries of the superficial palmar arch. From these results, we conclude that the transverse carpal ligament can be safely incised by this procedure.

Adult↗
PubMed1989

Measurement of pressure in the carpal canal before and after endoscopic management of carpal tunnel syndrome.

In forty-six patients who had carpal tunnel syndrome, a technique of continuous infusion, given under local anesthesia and without a pneumatic tourniquet, was used to measure pressures in the carpal canal before and after endoscopic release of the transverse carpal ligament (retinaculum flexorum manus). Pressures were similarly measured in sixteen subjects in a control group. The mean preoperative pressures were significantly higher in the patients who had carpal tunnel syndrome than in the patients in the control group when the pressures were measured under four conditions: with the wrist in the resting position, with active grip, and with maximum passive extension and flexion of the wrist. The mean pressures improved significantly postoperatively and were in the range of values that were found under each condition for the control group. Measurement of pressure in the carpal canal before and after operation may be useful in diagnosing carpal tunnel syndrome and in determining the effectiveness of endoscopic management.

Adult↗
PubMed1988

Free functional musculocutaneous transfer: electrophysiological studies.

Transplanted autogenous muscles were electrophysiologically studied in 2 patients with forearm crush injury. Only fibrillation action potentials and positive sharp waves were seen at 1 month after the operation. Low-amplitude and short-duration muscular unit potentials (MUPs) appeared at 3 months and high-amplitude, long-duration and polyphasic MUPs were frequently seen at 6-7 months after the transplantation. The distal latencies of the evoked motor responses were gradually shortened from time to time and eventually became normal at about 1 year after the grafting. The mean consecutive difference became normal at about 6 months after the normalization of the distal latencies. We conclude that the motor endplate is functionally completed at about half a year after the completion of the myelination of the grafted nerve.

Action Potentials↗
PubMed1987

Three-loop technique for A2 pulley reconstruction.

A three-loop technique of secondary A2 pulley reconstruction has been developed by the authors. This method was applied to six fingers of six patients. The average follow-up period was 21 months and ranged from a minimum of 9 months to a maximum of 3 years. Total active motion of metacarpophalangeal, proximal interphalangeal, and distal interphalangeal joints improved by 30 degrees on the average from the preoperative 175 degrees to the postoperative 205 degrees. Similarly, tip palm distance showed an improvement of 10 mm on the average from the preoperative 32 mm to the postoperative 22 mm. Satisfactory grip functions were restored for all patients after the secondary pulley reconstruction.

Adolescent↗
PubMed1987

[Subcutaneous operation and examination under the universal endoscope].

Endoscopes are mainly used to study the internal structures of organs and tissues with inherent space. These include the gastrointestinal tract, abdominal space and joint space. The standard endoscope, however, cannot be used to evaluate tissues without such space. We have invented a new type of operation tube to be used with the arthroscope. This combination enables us to study subcutaneous soft tissues without inherent space. Our new device is a powerful tool to be used for evaluation of subcutaneous soft tissues in any part of the body. Surgical procedures can also be carried out with this device. Areas of future applications of our device will be extremely wide including orthopaedic surgery, plastic surgery and general surgery. The presentation will discuss the procedure for utilizing this new instrument.

Adult↗