Irreducible pulled elbow in an adult: a case report.
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Adult↗
Biomedical subjects
Osamu Ishida
Publications and source records attributed to Osamu Ishida.
Development of a novel articulator that reproduced jaw movement with six-degree-of-freedom.
A novel robotic articulator that reproduced a six-degree-of-freedom jaw movement was developed and tested. A precise six-axis micro-positioning stage was employed for this articulator. A high-resolution jaw-tracking device measured the functional jaw movement of the patient and a six-axis micro-positioning stage reproduced recorded jaw movement data. A full veneer crown restoration was fabricated with this articulator system. A working cast was mounted on the positioning stage of the articulator. An occlusal table with soft wax was attached on the cast tooth die, and the jaw movements were reproduced to create a functionally generated path on the occlusal table. The finished occlusal record was used to obtain the wax pattern for the crown. In this subject, no intra-oral occlusal adjustment was necessary for setting the finished full veneer crown. Since this articulator could perform a precise reproduction of the dynamic jaw motion during the functional jaw movement, this system has potential to improve accuracy of the prosthetic teeth occlusion.
Biomimetics↗
The autotomy relief effect of a silicone tube covering the proximal nerve stump.
A technique of covering the proximal nerve stump (PNS) has been reported as a preventative method or treatment for neuroma. However, its detailed pain relief mechanism remains unknown. We created a silicone tube model in which the PNS of the rat sciatic nerve was introduced into the tube, whereas the controls had no tube. The score of autotomy observed in the tube group was lower than that in the control group at 3 days to 2 weeks after surgery, which suggested that the silicone tube had pain-like behavior inhibitory action. To elucidate the mechanism of autotomy inhibition, immunohistochemistry and Toluidine blue staining were performed in the PNS. The increase in S-100-immunoreactivity (IR) including Schwann cells was inhibited at 1 week after surgery in the tube group, and the increase in the number of macrophages shown by ED-1-IR at 1, 2, and 4 weeks after surgery was similarly inhibited. Toluidine blue staining showed that the increase in the number of mast cells was inhibited at 1, 2, and 4 weeks after surgery and in the number of lymphocytes at 1 and 2 weeks after surgery in the tube group. Therefore, blocking of the infiltration of inflammatory cells into the PNS by the silicone tube was thought to be the mechanism of autotomy inhibition. To further explore details of this mechanism, the expression of nerve growth factor (NGF), production of which is induced by inflammatory cells and of the NGF receptor TrkA was examined in the PNS and the dorsal root ganglion using immunohistochemistry and a ribonuclease protection assay. In the PNS, the increase in NGF-IR was inhibited at 1, 2, and 4 weeks after surgery in the tube group, suggesting that this could be one of the pain-like behavior inhibitory effects.
Animals↗
Pollicization of the index finger for traumatic thumb amputation.
BACKGROUND: Indications for pollicization of the index finger have decreased since the toe-to-thumb transfer and wraparound flap have been developed for thumb reconstruction. Pollicization, however, remains a useful method of thumb reconstruction depending on the amputation level, age, and patients' requests. The purpose of this study was to evaluate the authors' results and to clarify indications for pollicization. METHODS: Eight patients treated by pollicization of the index finger after thumb amputation were reviewed retrospectively. Five men and three women were included. The age at surgery ranged from 24 to 66 years, with a mean age of 43 years. Amputation levels included the metacarpophalangeal joint in four patients, the first metacarpal in three, and the carpometacarpal joint in one. The period between injury and pollicization ranged from 0 days to 4 years. Postoperative evaluations included thumb range of motion, opposition and pinch function, grasp and pinch strength, sensation, conversion of position sense, a "picking-up" test, and appearance. RESULTS: The follow-up period ranged from 5 to 28 years, with an average of 15 years, excluding one patient who died during the follow-up period. The thenar muscles were retained in four patients, who had excellent postoperative function and satisfactory results. CONCLUSIONS: Pollicization gives excellent results if the thenar muscles can be retained; opposition can be expected after this procedure. However, if the thenar muscles cannot be preserved, the reconstructed thumb may function as a post against the fingers to regain grasping and pinching functions.
Adult↗
Spinal nephroblastoma in a miniature Dachshund.
A 2-year-old castrated miniature Dachshund dog was presented to the Rakuno Gakuen Veterinary Teaching Hospital for diagnosis of progressive hindlimb paresis and ataxia. There was no thoracolumbar intervertebral disk hernia and magnetic resonance imaging revealed an intramedullary spinal cord lesion at the ninth and tenth thoracic vertebrae. Following surgical excision of the neoplasm, there was minor amelioration of neurological signs, but forelimb function was not recovered. The extracted tumor was histopathlogically diagnosed as spinal nephroblastoma.
Animals↗
Modified Steindler procedure for the treatment of brachial plexus injuries.
A retrospective follow-up study was completed on ten patients who suffered from a brachial plexus injury that was treated with a modified Steindler procedure. The mean postoperative period was 6.8 years. The postoperative elbow joint range of motion was -42 degrees of extension (range -5 degrees to -65 degrees ) and 107 degrees of flexion (range 90 degrees -130 degrees ). Manual muscle testing showed grade 4 or 5 in eight patients and grade 3 in two patients. In the subjective assessment, the patients scored 20 out of 30 points and were able to perform almost all activities with the exception of shoulder elevation. Innervation of the musculocutaneous nerve was evaluated by electromyography and no correlation was seen between preoperative and postoperative amplitude of the biceps brachii by electromyogram. Based on these results, we concluded that a modified Steindler procedure is useful for reconstruction of upper brachial plexus injuries, and recovery of the biceps brachii was difficult to predict by an electromyogram.
Adult↗
Prefabrication of vascularized bone graft using a combination of fibroblast growth factor-2 and vascular bundle implantation into a novel interconnected porous calcium hydroxyapatite ceramic.
The aim of this study was to create a prefabricated vascularized bone graft using a novel interconnected porous calcium hydroxyapatite ceramic (IP-CHA) by combining vascular bundle implantation and basic fibroblast growth factor (FGF)-2 administration in a rabbit model. Twenty-four Japanese white rabbits were used. The saphenous artery and vein were passed through the hole of the IP-CHA. In an experimental group, 100 microg of FGF-2 was administered into the IP-CHA before implanting the vascular bundle. In the control group, the saline was administered into the IP-CHA before implanting the vascular bundle. Finally, the IP-CHA was placed subcutaneously in the medial thigh. Neovascularization from the vascular bundle was evaluated at 2 weeks after surgery, and osteogenesis was evaluated at 4 weeks. At 2 weeks, the length and density of newly formed vessels were significantly greater in the experimental group than in the control group. Histological evaluation showed osteoid deposition in the pores of the IP-CHA at 4 weeks in the experimental group, whereas no evidence of osteoid deposition was noted in the control group. This study showed the potential of creating a vascularized bone graft of a predetermined size and shape using a combination of FGF-2 and vascular bundle implantation in the IP-CHA.
Animals↗
Characterization of labeled neural progenitor cells for magnetic targeting.
For many diseases and injuries of the central nervous system, transplantation of neural progenitor cells is being evaluated as a possible treatment option. Although local, intravenous and subarachnoid injections have been reported as administration methods of neural progenitor cells, each of these methods has limitations. More effective and minimally invasive cell delivery systems are necessary for transplanting neural progenitor cells. In this study, we have developed a technique to form magnetically labeled neural progenitor cells for a magnetic targeting system. We demonstrated that neural progenitor cells can couple with magnetic beads, and that the labeled neural progenitor cells preserve the characteristics of non-labeled neural progenitor cells, and that they can be localized by magnetic force in vitro. Labeled neural progenitor cells have the potential to be used in magnetic targeting systems in-vivo models.
Amides↗
Congenital pseudoarthrosis of the ulna treated with a free vascularized fibular graft.
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Bone Neoplasms↗
Visualization of temporal increase in compound nerve action magnetic fields in the human median nerve during ischemia.
We studied the variation in the human median nerve activity during ischemia by measuring compound nerve action magnetic fields (CAFs). Temporal increases in the CAF during ischemia were successfully visualized on isofield contour maps. Intense paresthesias were induced after 29 +/- 5 s (mean +/- SD) of ischemia, which consistently reached a maximum after 4 min 55 +/- 12 s. The variations in CAFs were consistent with changes in sensory perception. The hyperexcitability in large myelinated axons can be visualized as temporary increases in CAF. These results are the first to demonstrate the efficacy of magnetic-recording techniques, which allow monitoring of changes in neural activity.
Adult↗
Natural course of the minimally symptomatic nonoperated hip in patients with bilateral hip dysplasia treated with contralateral rotational acetabular osteotomy.
BACKGROUND: The purpose of this study was to investigate the natural course of the minimally symptomatic nonoperated hip in patients with pre-osteoarthritis or early osteoarthritis in bilaterally dysplastic hips. METHODS: The material consisted of 61 patients with bilaterally dysplastic hips who underwent rotational acetabular osteotomy in their symptomatic hip and nonoperative treatment in their asymptomatic or minimally symptomatic hip. The average follow-up was 10.1 years (range 7.0-15.6 years), and the average age at the time of surgery was 38.2 years (range 20-58 years). All patients were divided into two groups by joint congruity of the nonoperated hip at surgery with rotational acetabular osteotomy. RESULTS: On radiographic assessment, 1 of the 35 pre-osteoarthritis hips had developed early osteoarthritis, and 6 of the 26 early osteoarthritis hips had progressed to advanced osteoarthritis. The Kaplan-Meier survivorship analysis for the whole group of nonoperated hips, with radiographic progression of osteoarthritis as the endpoint, predicted a 10-year survival rate of 83.7% (95% confidence interval 70%-98%). Significant differences were observed in the radiographic stage (pre- and early osteoarthritis group, P=0.015) and joint congruity (good and fair group, P=0.005). CONCLUSIONS: If the contralateral nonoperated hip has good joint congruity, minimal symptoms, and no or little radiographic change in patients with pre- or early osteoarthritis and bilateral acetabular dysplasia, the probability of radiographic progression is low.
Adult↗
Reoperation of the Kay-Shiley disc valve 35 years after replacement.
The Kay-Shiley disc valve (Shiley Inc, Irvine, CA) was manufactured in 1965 and is no longer in clinical use due to its high incidence of thromboembolism. We report a case of tricuspid valve replacement with the Kay-Shiley valve 35 years previously. The valve was replaced successfully with a St. Jude Medical valve (St. Jude Medical, Inc, St. Paul, MN). This is the longest interval from implantation to re-replacement with the Kay-Shiley valve that has been reported in the literature.
Heart Valve Prosthesis↗
Effective repair of a fresh osteochondral defect in the rabbit knee joint by articulated joint distraction following subchondral drilling.
PURPOSE: Joint distraction has been used to treat osteoarthritis and was found to delay the need for arthrodesis or joint replacement. However, there has been little basic research on articulated joint distraction for the repair of osteochondral defects. We investigated the effects of joint distraction with motion after drilling on a fresh osteochondral defect in the weight bearing area of the rabbit knee joint. METHODS: A full thickness osteochondral defect was created in the weight bearing area of both medial femoral condyles of an adult Japanese white rabbit. After drilling of the defect, the experimental knee joint was distracted for 1.5 mm using a pair of external fixators to decrease compression force. The contralateral knee joint was used as a control with no apparatus. Gross findings and histological evaluation were assessed to study morphology of the repaired cartilage. RESULTS: A partial repair with cartilage-like tissue was observed in the joints of the experimental group at 4 weeks. While cartilage-like tissue stained with Safranin O was found in the experimental group at 8 and 12 weeks, destructive changes were observed in the control joints. Morphological changes were evaluated using the histological grading scale [Wakitani S, Goto T, Pineda SJ, et al. Mesenchymal cell-based repair of large, full-thickness defect of articular cartilage. J Bone Joint Surg Am 1994;76(4):579-92]. There was no significant difference between experimental and control groups at 4 weeks (mean 11.2 and 13.8 points, respectively). However, the mean scores of the experimental groups at 8 and 12 weeks (mean 6.8 and 7.5, respectively) were significantly better than those of the control groups at the same time points (mean 14 points each). Between the experimental groups, the scores at 8 and 12 weeks were both significantly better than those at 4 weeks. CONCLUSION: A combination of subchondral drilling, joint motion and distraction by an articulated external fixator promoted repair of a fresh osteochondral defect in the weight bearing area. Although distraction for 4 weeks was not a long enough period to repair the defect, distraction for 8 and 12 weeks resulted in a good outcome.
Animals↗
Role of simple cold storage in preventing epiphyseal growth plate impairment after replantation surgery in immature rats.
The purpose of this study was to investigate the effect of ischemia time on longitudinal bone growth after replantation, and to evaluate the usefulness of simple cold storage of an amputated limb in preventing epiphyseal growth-plate impairment. A hind-limb replantation model was produced with 5-week-old rats after various ischemia times. With more than 6 hr of warm ischemia, growth disturbance was observed, and extensive necrosis was histologically apparent in the central region of the growth plate of the proximal tibia, even at 1 week postoperatively. Destruction of the growth plate was complete at 4 weeks after surgery. By simple cold storage of the amputated limb, growth disturbance was not observed, even following ischemia for 9 hr, and no abnormal findings were observed histologically. Segmental necrosis and destruction of the growth plate observed histologically suggested the possibility of indirect impairment of the epipyseal chondrocytes due to disturbance of the epiphyseal arterial system, attributable to ischemia. The study confirmed experimentally that cold storage of the amputated part may prevent longitudinal bone-growth disturbance after extension of ischemia time.
Amputation, Traumatic↗
Neural progenitor cells promote corticospinal axon growth in organotypic co-cultures.
The CNS is limited in regeneration following injury in adult mammals. Recent studies show that the transplantation of the neuronal progenitor cells is useful in promoting regeneration. However, the mechanisms of action of the transplanted neural progenitor cells have not been clarified. In this study, we used organotypic co-cultures with neonatal brain cortex and spinal cord as an in vitro assay system for assessing the factors that regulate corticospinal axonal growth. Our results show that the transplantation of neural progenitor cells enhanced corticospinal axon growth in these co-cultures. In addition, neural progenitor cell conditioned medium also significantly promoted axonal growth. These findings strongly suggest that factors derived from neural progenitor cells participate in the effect on axonal growth.
Age Factors↗
Morphological changes of the ligamentum flavum as a cause of nerve root compression.
The ligamentum flavum is considered to be one of the important causes of radiculopathy in lumbar degenerative disease. Although there have been several reports anatomically examining the positional relationship between the ligamentum flavum and nerve root, there are few reports on ventral observation. The purpose of this study is to clarify the shape of the ligamentum flavum seen ventrally, and to obtain anatomic findings related to nerve root compression. The subjects were 18 adult embalmed cadavers, with an average age of 78 years at the time of death. The ventral shapes of the ligamentum flavum were observed. The relationships between the morphological change of the ligamentum flavum and nerve root compression or radiographic findings were statistically evaluated. Among the shapes of the ligamentum flavum, bulging of the ligament was most frequently observed. Proximal bulging indicates the type with the cranial portion bulging from the subarticular zone to the foraminal zone of the ligamentum flavum. In this type associated with a decrease in disc height, nerve root compression was frequently observed. Thus, we could more realistically grasp the relationship between bulging morphology of the ligamentum flavum and nerve root compression.
Aged↗
Intravenously injected neural progenitor cells of transgenic rats can migrate to the injured spinal cord and differentiate into neurons, astrocytes and oligodendrocytes.
Transplantation of neural progenitor cells (NPCs) has been reported recently to promote regeneration of the injured spinal cord. In the majority of these reports, cell transplantation was performed by local injection with a needle. However, direct injection might be too invasive for clinical use; therefore, the authors investigated a new method of delivering NPCs for the treatment of spinal cord injury. In this study, NPCs were obtained from E15 fetal hippocampus of transgenic rats expressing green fluorescent protein and 100,000 cells were transplanted intravenously into each animal 24h after contusion injury. It was found that the injected NPCs migrated to the lesion site widely and demonstrated nestin at an early phase after transplantation. These NPCs differentiated into neurons, astrocytes and oligodendrocytes, and survived at least for 56 days. These results indicated that intravenously injected neural stem cells migrated into the spinal cord lesion while preserving their potential as NPCs, and that this procedure is a potential method of delivering cells into the lesion for the treatment of spinal cord injury.
Animals↗
Intracellular targeting of sodium mercaptoundecahydrododecaborate (BSH) to solid tumors by transferrin-PEG liposomes, for boron neutron-capture therapy (BNCT).
The successful treatment of cancer by boron neutron-capture therapy (BNCT) requires the selective delivery of relatively high concentration of 10B compounds to malignant tumor tissue. This study focuses on a new tumor-targeting drug delivery system for BNCT that uses small (less than 200 nm in diameter), unilamellar mercaptoundecahydrododecaborate (BSH)-encapsulating, transferrin (TF)-conjugated polyethyleneglycol liposomes (TF-PEG liposomes). When TF-PEG liposomes were injected at a dose of 35 mg 10B/kg, we observed a prolonged residence time in the circulation and low uptake by the reticuloendothelial system (RES) in Colon 26 tumor-bearing mice, resulting in enhanced accumulation of 10B into the solid tumor tissue (e.g., 35.5 microg/g). TF-PEG liposomes maintained a high 10B level in the tumor, with concentrations over 30 microg/g for at least 72 h after injection. This high retention of 10B in tumor tissue indicates that binding and concomitant cellular uptake of the extravasated TF-PEG liposomes occurs by TF receptor and receptor-mediated endocytosis, respectively. On the other hand, the plasma level of 10B decreased, resulting in a tumor/plasma ratio of 6.0 at 72 h after injection. Therefore, 72 h after injection of TF-PEG liposomes was selected as the time point of BNCT treatment. Administration of BSH encapsulated in TF-PEG liposomes at a dose of 5 or 20 mg 10B/kg and irradiation with 2 x 10(12) neutrons/cm2 for 37 min produced tumor growth suppression and improved long-term survival compared with PEG liposomes, bare liposomes and free BSH. Thus, intravenous injection of TF-PEG liposomes can increase the tumor retention of 10B atoms, which were introduced by receptor-mediated endocytosis of liposomes after binding, causing tumor growth suppression in vivo upon thermal neutron irradiation. These results suggest that BSH-encapsulating TF-PEG liposomes may be useful as a new intracellular targeting carrier in BNCT therapy for cancer.
Animals↗