Crank-shaped arthrodesis for a flatfoot with a bipartite navicular: a case report.
Explore the source record for details and available documents.
Adult↗
Biomedical subjects
Tsukasa Kumai
Publications and source records attributed to Tsukasa Kumai.
Vascularized bone graft from the medial calcaneus for treatment of large osteochondral lesions of the medial talus.
BACKGROUND: Operative treatment of large osteochondral lesions of the talus is difficult because the blood supply is poor in the talar dome. The purpose of this study was to evaluate the results of a vascularized bone graft transfer from the medial calcaneus to the large osteochondral lesion. METHODS: Four ankles in four patients with medial osteochondral lesions were treated through a medial transmalleolar approach. Vascularized bone graft was harvested from the medial calcaneus using the calcaneal branch of the posterior tibial artery and was placed through a fenestration of the medial aspect of the talar dome. The mean duration of postoperative followup was 34 (range 24 to 48) months. Clinical and radiographic evaluations were made before surgery and at final followup. RESULTS: According to the AOFAS ankle-hindfoot scale, mean pain and function scores improved from 20 to 33 points and 30 to 43 points, respectively. The mean total score improved from 60 to 83 points. Plain radiography at followup showed slight osteosclerosis in all patients, but joint space narrowing was not seen in any patient. Cysts seen preoperatively on MRI or CT resolved after 12 months postoperatively, and MRI or CT did not reveal any findings indicative of osteonecrosis. CONCLUSIONS: Clinical and radiographic results were satisfactory. Vascularized bone grafts harvested from the calcaneus were successful for the treatment of large osteochondral lesions of the medial talus.
Adult↗
Earlier accumulation of calcium, phosphorus, and magnesium in the coronary artery in comparison with the ascending aorta, aortic valve, and mitral valve.
To explore reasons for a high accumulation of Ca and P occurring in the coronary artery of Thai with aging, the authors investigated age-related changes of elements in the coronary artery, ascending aorta near the heart, and cardiac valves in single individuals, and the relationships in the elements between the coronary artery and either the ascending aorta or cardiac valves. After an ordinary dissection by medical students at Chiang Mai University was finished, the anterior descending arteries of the left coronary artery, ascending aortas, mitral valves, and aortic valves were resected from the subjects. The subjects consisted of 17 men and 9 women, ranging in age from 46 to 76 yr. The element content was analyzed by inductively coupled plasma-atomic emission spectrometry. The average content of Ca and P was the highest in the coronary artery and decreased in the order aortic valve, ascending aorta, and mitral valve. The Ca, P, and Mg content increased in the coronary artery in the fifties and in the ascending aorta, aortic valve, and mitral valve in the sixties. It should be noted that the accumulation of Ca, P, and Mg occurred earlier in the coronary artery than in the ascending aorta, aortic valve, and mitral valve. It was found that with respect to the Ca, P, Mg, and Na contents, the coronary artery correlated well with both the aortic valve and ascending aorta, especially with the aortic valve, but it did not correlate with the mitral valves. This finding suggests that the accumulation of Ca, P, Mg, and Na occurs in the coronary artery together with the aortic valve and ascending aorta, but not together with the mitral valve. Because regarding the accumulation of Ca, P, and Mg, the ascending aorta and aortic valve are preceded by the coronary artery, it is unlikely that the accumulation of Ca, P, and Mg spreads from the ascending aorta or aortic valve to the coronary artery.
Aged↗
Silicon intake to vertebral columns of mice after dietary supply.
Vertebral columns were dissected and analyzed after birth with oral administration of silicon for 4 wk and for 8 wk. The silicon level was lower (20 microg/g) at the beginning. It remains unchanged after 4 wk and then increases twice as much as that for those mice bred for 8 wk than those bred for 4 wk. This increase depends remarkably on the mass ratio of Si/Ca (M/M). The ratio increases to three times higher than that of the control at the beginning of the experiments (5 wk after birth). Although the S and P contents appeared to be lower, these increased when Si was administered in combination with phosphopeptide. Other elements, such as Ca, Mg, Fe, and Zn, appeared to be unchanged as the weeks proceeded. These findings seem to support a proposal that silicon is necessary for the growth of backbones in mice.
Administration, Oral↗
Trace elements in human tendons and ligaments.
Tendons and ligaments are key structures in promoting joint movement and maintaining joint stability. Although numerous reviews have detailed their structure, molecular composition, and biomechanical properties, far less attention has been paid to their content of trace elements. Tendons and ligaments are generally rich in calcium, sulfur, and phosphorus, although there are intriguing differences between one tendon/ligament and another. Furthermore, there can be significant regional variations that correlate with the presence or absence of fibrocartilage in the "wrap-around" regions of tendons or ligaments, where they change direction and press against bone. Here, their sulfate and calcium contents are particularly high. This is undoubtedly associated with the high levels of proteoglycans that are found in these cartilaginous tissues and the occasional presence of sesamoid bones within them.
Humans↗
Quantitative ultrasound can assess living human cartilage.
Explore the source record for details and available documents.
Adult↗
Cartilage thickness of the talar dome.
PURPOSE: To perform a successful operation, accurate information on the articular cartilage thickness of the talus is essential. The purpose of this study was to determine the articular cartilage thickness of the talar dome in the area where osteochondritis dissecans is common. TYPE OF STUDY: Convenient samples. METHODS: Articular cartilage thickness of the mid talar dome was measured in 29 ankles of 17 cadavers. The average age of the specimens was 70 years (range, 53 to 91 years). Twenty-two were from men and 7 were from women. Coronal sections of the mid talar domes were obtained from the specimens measuring 2 mm in width and 5 mm in depth. Radiographs of the sectioned specimens were taken and were enlarged with a personal computer. The thickness of the articular cartilage was measured at 9 areas: medial gutter (area 1), medial corner (area 2), medial edge of the dome plateau (area 3), lateral edge of the dome plateau (area 7), lateral corner (area 8), lateral gutter (area 9), and quarter points between areas 3 and 7 (areas 4, 5, and 6). RESULTS: The average thickness of the total areas was 1.35 +/- 0.22 mm in the male specimens and 1.11 +/- 0.28 mm in the female specimens. The thickest was area 2, which represented the medial corner, and the thinnest was area 9, which represented the lateral gutter in both men and women. There was a relationship between the thickness of the cartilage and the width of the talar dome. CONCLUSIONS: The thickness was usually less than 2 mm. However, the cartilage thickness varies widely by gender, area, and individual. CLINICAL RELEVANCE: Our report will help surgeons predict the volume of cartilage that needs to be repaired and produce treatment at a reasonable cost without an excessive invasion of patients.
Aged↗
Age-dependent increases of calcium and phosphorus in human epiglottal cartilage.
To elucidate compositional changes of the elastic cartilage with aging, the authors investigated age-related changes of elements in the epiglottal cartilages by inductively coupled plasma-atomic emission spectrometry. After the ordinary dissection by medical students at Chiang Mai University was finished, the epiglottises were resected from the subjects. The epiglottal cartilages were isolated and the element contents were determined. The subjects consisted of 11 men and 14 women, ranging in age from 39 to 92 yr old. It was found that although the extent of accumulation of calcium and phosphorus was slight, calcium and phosphorus increased progressively in the epiglottal cartilages with aging. In contrast, sulfur, magnesium, zinc, iron, and sodium did not change significantly in them. Regarding the relationships among elements, it was found that there were significant correlations among calcium, phosphorus, magnesium, and sodium in the epiglottal cartilages, with one exception between calcium and sodium contents. In comparison between men and women, no significant differences were found in the predominant elements such as calcium, sulfur, and phosphorus in the epiglottal cartilages.
Adult↗
Extraabdominal fibromatosis in retroperitoneal space.
BACKGROUND: Fibromatosis or desmoid tumor covers a broad spectrum of benign fibrous tissue proliferations. It is characterized by infiltrative growth and a tendency towards recurrence; however, unlike sarcoma, it never metastasizes. CASE PRESENTATION: We report on a case of extraabdominal fibromatosis originating from the retroperitoneal space in a 43-year-old woman. Seven years earlier she had undergone ureterolysis and ureteroureterostomy for ureteral obstruction. Computed tomography revealed a tumor between the iliocostalis and the psoas muscle. Histopathological evaluation revealed uniform proliferation of spindle cells, with a moderate amount of collagen fibers, suggesting extraabdominal fibromatosis (desmoid tumor). The tumor was surgically resected, and since then, the patient has remained asymptomatic without any restrictions of daily living activities and without any signs of tumor recurrence during the two-year follow-up. CONCLUSIONS: Complete resection is the treatment of choice. Adjuvant therapy using non steroidal anti-inflammatory agents, tamoxifen, interferon, anti-neoplastic agents, and radiotherapy, either alone or in combination finds application for unresectable or recurrent cases.
Journal Article↗
Partial tarsal arthrodesis for rheumatoid feet.
Partial intertarsal joint arthrodesis was performed on 12 feet of 11 patients as a surgical treatment for planovalgus deformity of the foot and lesions of the intertarsal joints caused by rheumatoid arthritis. Single arthrodesis was performed on the talocalcaneal joint in eight feet, two of which underwent simultaneous total ankle arthroplasty, and on the talonavicular joint in two feet. Double arthrodesis was done on the talocalcaneal and talonavicular joints in one foot and on the talonavicular and calcaneocuboid joints in one foot. Screws or staples were used for fixation. Patients were followed for 2 years to 8 years 7 months (average 4 years 3 months). Osseous fusion was achieved in all feet, and satisfactory pain relief was obtained in all cases except one. We performed this surgery in patients who were relatively active, and the results indicated that arthrodesis of a small number of joints that caused pain and deformity was effective in reducing pain and correcting the deformity. We concluded that partial tarsal arthrodesis should be performed on a limited number of joints during the early stages of planovalgus deformity of the foot because more joints are found to be fixed during the advanced stages. However, progression of the osteoarthritis was found in the neighboring joints. Close follow-up observation is needed.
Journal Article↗
Ankle arthroplasty using three generations of metal and ceramic prostheses.
Ankle arthroplasties using metal and polyethylene prostheses were done on 28 patients (30 ankles) with painful osteoarthritis or rheumatoid arthritis between 1975 and 1980. Significant loosening and subsidence of the metal prostheses occurred in most patients, and ceramic prostheses were introduced in 1980. Ceramic prostheses with or without cement were used to replace 60 ankles in 56 patients with painful arthritis between 1980 and 1991. Revision surgery was required for five patients (five ankles) during the followup period (mean, 12 years 6 months). Loosening and subsidence of the prostheses were seen in 50% of patients within 5 years after the index procedure. As a result, a new design of bead-formed alumina coated with hydroxyapatite was used. A tibial prosthesis fixed to the posterior cortex of the tibia with a screw was used from 1991. These new ceramic prostheses were used to replace 70 ankles in 62 patients between 1991 and 2000. Thirty-six patients (36 ankles) with a mean age of 71 years (range, 50-87 years) had osteoarthritis, and 26 patients (31 ankles) with a mean age of 60 years (range, 41-76 years) had rheumatoid arthritis. During followup, with an average of 5 years 2 months, three patients (three ankles) required revision surgery (one for infection, two for talar necrosis). Overall results for patients with osteoarthritis were excellent in 21 ankles, good in 10 ankles, fair in two, ankles and poor in zero ankles. Results in patients with rheumatoid arthritis were excellent in five ankles, good in 16 ankles, fair in three ankles, and poor in two. In the intermediate study, 29 patients (31 ankles; 91.2%) with osteoarthritis and 19 patients (21 ankles; 76.9%) with rheumatoid arthritis were satisfied with the short-time results of arthroplasty.
Adult↗
Accumulation of calcium in human common iliac artery, aortic valve, xiphoid process, costal cartilage, posterior longitudinal ligament, trigeminal nerve, and rib accompanied by increase of magnesium.
To examine whether an accumulation of Ca in the tissues was accompanied by an increase of Mg, the authors investigated the relationships between Ca and Mg contents in the common iliac arteries, aortic valves, xiphoid processes, costal cartilages, posterior longitudinal ligaments, trigeminal nerves, and ribs by inductively coupled plasma-atomic emission spectrometry. After the ordinary dissections by medical students were finished, the common iliac arteries, aortic valves, xiphoid processes, bilateral the fourth costal cartilages, posterior longitudinal ligaments between the fourth and fifth cervical vertebrae, trigeminal nerves, and bilateral the sixth ribs were resected from the subjects and elements were determined. It was found that there were extremely significant direct correlations between Ca and Mg contents in all of the common iliac arteries, aortic valves, costal cartilages, posterior longitudinal ligaments, and trigeminal nerves, whereas there were significant direct correlations in both the xiphoid processes and ribs. As for the tissues containing Ca higher than 20 mg/g, the average mass ratios of Mg/Ca were similar among the seven tissues. As Ca increased in all of the common iliac arteries, aortic valves, xiphoid processes, costal cartilages, posterior longitudinal ligaments, trigeminal nerves, and ribs, Mg increased simultaneously in the seven tissues.
Aged↗
The structure and histopathology of the "enthesis organ" at the navicular insertion of the tendon of tibialis posterior.
OBJECTIVE: To investigate the structure, histopathology, and molecular composition of tissue specializations of the tibialis posterior enthesis. They collectively reduce stress concentration at the insertion site and are part of an "enthesis organ." This has implications for understanding the basis of enthesopathy. METHODS: Fifty-two specimens of tibialis posterior and the associated superomedial part of the calcaneonavicular ligament taken from cadavers were sectioned longitudinally and examined by routine histology (42 samples) or immunohistochemistry (10 samples). Serial sections of formalin fixed material were stained with Masson's trichrome, toluidine blue, or hematoxylin, eosin and alcian blue. A panel of antibodies against collagens, glycosaminoglycans, and proteoglycans was used to immunolabel methanol fixed material. RESULTS: The enthesis organ consists of the enthesis itself, the superomedial part of the calcaneonavicular ligament (which may fuse with the tendon), the tendon sheath, and associated accessory bones. The accessory bones lay in a region of fibrocartilage that was present even in specimens where the bones themselves were absent. Degenerative changes were seen at the enthesis, around the accessory bones, and in the walls of the tendon sheath. The navicular and accessory bone entheses, together with the calcaneonavicular ligament, were all rich in fibrocartilage. This immunolabeled for aggrecan, link protein, type II collagen, and versican. CONCLUSION: The complexity of the enthesis organ, and the diversity of sites showing histopathological changes, suggest that enthesopathy may not be located precisely at the osteotendinous junction. It could target a number of adjacent locations, in accord with what happens at other entheses; e.g., in patients with spondyloarthropathy. The prominence of fibrocartilage in the enthesis organ, and the degenerative changes to which it is subject, support the view that spondyloarthropathy has an underlying biomechanical basis.
Aged↗
Heel spur formation and the subcalcaneal enthesis of the plantar fascia.
OBJECTIVE: To describe the structure and significance of subcalcaneal heel spurs associated with the plantar fascia. METHODS: The enthesis of the plantar fascia was removed from 17 elderly cadavers by sagittal saw cuts either side of the medial tuberosity, radiographs were taken, and the tissue was processed for routine histology. Sagittal sections were stained with toluidine blue, Masson's trichrome, or alcian blue, and sections were matched with the corresponding radiographs. RESULTS: Spurs develop on the deep surface of the plantar fascia but their formation is heralded by degenerative changes that occur within it. According to differences between small and large spurs, we propose that there are 3 stages in their development: (1) an initial formation of cartilage cell clusters and fissures at the plantar fascia enthesis; (2) thickening of the subchondral bone plate at the enthesis as small spurs form; (3) development of vertically oriented trabeculae buttressing the proximal end of larger spurs. The spurs grow by a combination of intramembranous and chondroidal ossification. CONCLUSION: Contrary to popular belief, subcalcaneal heel spurs cannot be traction spurs as they do not develop within the plantar fascia itself. They are thus fundamentally different from heel spurs in the Achilles tendon. We suggest instead that they develop as a consequence of degenerative changes that occur in the plantar fascia enthesis.
Aged↗
Reconstruction of the lateral ankle ligaments with bone-patellar tendon graft in patients with chronic ankle instability: a preliminary report.
BACKGROUND: Unsatisfactory long-term results have been reported after use of a Broström repair for patients with chronic ankle ligament insufficiency. HYPOTHESIS: Repair or reconstruction of both the anterior talofibular and calcaneofibular ligaments is essential for normal kinematics of the ankle-hindfoot. STUDY DESIGN: Case series. METHODS: Thirteen patients with chronic instability of the ankle were found at operation to have injuries of both the anterior talofibular and calcaneofibular ligaments, with a lack of healthy ligament margins suitable for suturing. Reconstruction of the ligaments was performed with bone-patellar tendon graft. The score devised by Good et al. was used to assess the patients' clinical condition before the operation and at final follow-up. RESULTS: Before the operation, six patients had a grade 3 clinical condition and seven had a grade 4 condition. At a mean follow-up of 26.5 months, all patients had a grade 1 condition. The average talar tilt of the patients was improved from 18.4 degrees +/- 5.5 degrees to 4.9 degrees +/- 2.6 degrees, and the average anterior drawer sign was improved from 9.1 +/- 2.6 mm to 5.8 +/- 1.6 mm. CONCLUSION: In cases of combined injuries, short-term results of reconstruction of the anterior talofibular and calcaneofibular ligaments using bone-split patellar tendon graft were good, with a low frequency of complications.
Adult↗