Calcar Femorale in Patients with Osteoarthritis of the Hip Secondary to Developmental Dysplasia

BACKGROUND: We investigated whether the calcar femorale, a cortical septum in the region of the lesser trochanter of the femur, correlates with results of femoral stem implantation in patients with osteoarthritis of the hip secondary to developmental dysplasia using computed tomography. METHODS: This retrospective study included 277 hips (41 males and 236 females; age, 37 to 92 years) of patients who had presented to Okayama Medical Center with hip pain. Of these, a total of 219 hips (31 males and 188 females) had previously undergone total hip arthroplasty. According to the Crowe classification, 147 hips were classified as Crowe grade I, 72 hips as Crowe grade II–IV, and 58 hips as normal. RESULTS: The calcar femorale was identified in 267 hips (96.4%). The calcar femorale was significantly shorter and more anteverted in Crowe grade II–IV hips than in Crowe grade I or normal hips. Significant differences in the shape of the calcar femorale were found according to the severity of hip deformity. Three stem designs were analyzed: single-wedge (59 hips), double-wedge metaphyseal filling (147 hips), and modular (13 hips). Single-wedge stems were inserted more parallel to the calcar femorale rather than femoral neck anteversion, while other types of stems scraped the calcar femorale. CONCLUSIONS: The angle of the calcar femorale differs according to the severity of hip deformity, and the calcar femorale might thus serve as a more useful reference for stem insertion than femoral neck anteversion in total hip arthroplasty using a single-wedge stem.

Comparison of Continuous Epidural Analgesia, Patient-Controlled Analgesia with Morphine, and Continuous Three-in-One Femoral Nerve Block on Postoperative Outcomes after Total Hip Arthroplasty

BACKGROUND: Postoperative pain relief can be achieved with various modalities. However, there are only few reports that have analyzed postoperative analgesic techniques in total hip arthroplasty patients. The aim of this retrospective study was to compare the postoperative outcomes of three different analgesic techniques after total hip arthroplasty. METHODS: We retrospectively reviewed the influence of three analgesic techniques on postoperative rehabilitation after total hip arthroplasty in 90 patients divided into three groups (n = 30 patients per group). Postoperative analgesia consisted of continuous epidural analgesia (Epi group), patient-controlled analgesia with morphine (PCA group), or a continuous femoral nerve block (CFNB group). We measured the following parameters relating to postoperative outcome: visual analog scale scores, the use of supplemental analgesia, side effects, length of the hospital stay, plasma D-dimer levels, and the Harris hip score. RESULTS: Each group had low pain scores with no significant differences between the groups. The PCA group had a lower frequency of supplemental analgesia use compared to the Epi and CFNB groups. Side effects (nausea/vomiting, inappetence) and day 7 D-dimer levels were significantly lower in the CFNB group (p < 0.05). There were no significant differences between the groups in terms of the length of the hospital stay or the Harris hip score. CONCLUSIONS: Although there were no clinically significant differences in outcomes between the three groups, the CFNB provided good pain relief which was equal to that of the other analgesics with fewer side effects and lower D-dimer levels in hospitalized patients following total hip arthroplasty.

The Sinus Tarsi Approach for the Treatment of Intra-Articular Calcaneal Fractures / 대한족부족관절학회지

Open reduction and internal fixation is currently considered as a gold standard of treatment in most of the intra-articular calcaneal fractures. Among various different approaches, extensile lateral approach is the most popular since it provides good exposure to the subtalar joint. However, wide skin incision followed by extensive soft tissue dissection leading to increased risk of wound breakdown is the most serious drawback. Sinus tarsi approach, a minimal invasive technique to approach the subtalar joint and reduce the intra-articular calcaneal fractures, provides good clinical outcome and less wound complications compared to the extensile lateral approach. This article introduces the surgical technique and review of the literature regarding the sinus tarsi approach.

Fibroma of the Tendon Sheath Arising from the Synovial Membrane of the Temporomandibular Joint / Oral Science International

Fibroma of the tendon sheath (FTS) involving the temporomandibular joint (TMJ) is very rare. A case of FTS arising from the synovial membrane of the TMJ is presented. The patient was a 17-year-old male with jaw opening pain and clicking in the left TMJ. MRI, arthrotomography, and arthroscopy showed a well-circumscribed mass that was localized in the superior articular cavity of the left TMJ. The tumor was removed with the attached synovial membrane. Macroscopic, histological and immunohistological features of the intra-articular tumor were identical to FTS. There have been no signs of recurrence in the 6 years since surgery.

Delayed Sternal Closure after Cardiac Operations for Congenital Heart Disease in Infancy / 日本心臓血管外科学会雑誌

Among 95 infants aged less than one year who underwent intracardiac repair for congenital heart disease at Kurume University Hospital between August 1990 and June 1995, a patients (3.9%) received primary elective open sternal (PEOS) and delayed sternal closure (DSC) after operation. 1) The mean interval for DSC was 4.3±0.9 (2-8) days, and DSC interval significantly correlated with the extracorporeal circulation (ECC) time. 2) Before DSC, patients became hemodynamically stable and requirements for inotropes and FiO₂ for mechanical ventilation decreased. 3) It was important to carefully manage fluid balance before DSC, and the balance after operation should be 0. 4) There was only one patient with mediastinal infection. Of the three patients who died in hospital the cause of death was pulmonary infection due to prolonged mechanical ventilation. 5) Both PEOS and DSC required careful postoperative management, but, the treatment seemed to improve postoperative results in cases in which postoperative hemodynamic status was unstable due to prolonged ECC.

Surgical Repair for Aortic Coarctation in Children Aged Less than One Year / 日本心臓血管外科学会雑誌

The operative results in case of aortic coarctation (CoA) were studied. Between June 1980 and June 1995, 37 children with CoA underwent surgical intervention during their first year of life in our institute. The aortic lesion was repaired by the subclavian flap (SCF) method in 27, direct anastomosis (DA) method in 7, grafting or other methods in 3 children, respectively. The mean follow up period was 7.4±5.3 years (6 months-13 years). Rate of re-stenosis of the aorta was 10% (2 in 20 children) after SCF method, 0% (0 in 7 children) after DA method. The stenotic lesion was successfully dilated by the percutaneous balloon reconstruction in one child. Perioperative mortality was 25% (1/4) in one-stage repair, while one-stage repair was successfully performed in the last three cases and 16.6% (3/18) in two-stage repair for CoA associated with ventricular septal defect (VSD). The mortality was 60% (6/10) of CoA associated with other complex anomalies. In conclusion, one-stage repair seems to be recommendable for the operation of CoA with VSD, and two-stage repair seems to be safe for CoA with complex anomalies.

Is It Safe to Use Intermittent Warm Blood Cardioplegia for Coronary Artery Bypass Grafting? / 日本心臓血管外科学会雑誌

Postoperative cardiac function, changes of LV wall motion and exercise tolerance test were studied in 49 patients who received coronary artery bypass grafting (CABG) using antegrade intermittent warm blood cardioplegia (IWBC) and had postoperative left ventriculography (LVG). The mean aortic cross clamp (ACC) time was 68.2±22.8 minutes, and the coronary perfusion time during ACC was 12.6±6.9 minutes (18.2±7.1% of total ACC time). Spontaneous return of normal sinus rhythm was seen in 45 patients (92%). Perioperative myocardial infarction occurred in only one patient and one patient required inotropic support>5μg/kg/min after operation. The mean cardiac index measured by Swan-Ganz catheter improved postoperatively, and the postoperative LVG revealed improvement of the LV wall motion in comparison with that of preoperative LVG, and no local asynergy due to inadequate distribution of IWBC was seen in the early postoperative period. The mean postoperative exercise tolerance performed in 24 patients was 6.6 METS (metabolic equivalents), and no patient revealed myocardial ischemia at exercise. In conclusion, the IWBC is considered to be an easy and safe technique for distal anastomoses of CABG with no influence upon the postoperative cardiac function and LV wall motion.

Coronary Bypass Grafting by Using Arterial Graft in Simultaneous Valvular Surgery / 日本心臓血管外科学会雑誌

Between May in 1988 and October in 1990, simultaneous coronary artery bypass grafting (CABG) and valve surgery was performed in 14 patients. Nine patients received arterial graft conduit for CABG (AG group) and only saphenous vein graft (SVG) was used in 5 patients (SVG group). In AG group, mean age was 63.3 years and the number of distal anastomosis was 2.2/patient. In valve operation, valve replacement was performed in 5 and valve plasty was in 4, and the mean aortic cross clamping time was 116min. As AG, internal thoracic artery (ITA) was used in 8 and right gastroepiploic artery (RGEA) was in 4. Among them concomitant use of ITA and RGEA was in 3, and the use of SVG was in 5. In two patients, the AG pedicle did not reach to either left anterior descending or obtuse marginal artery and the SVG was used as a graft conduit. Between AG group and SVG group, there were no significances in the age and aortic cross clamping time. However, postoperative use of cathecholamin was in three (33%) in AG group and three (60%) in SVG group and there were significant differences between them. In AG group, there were no operative deaths and the late NYHA improved to class I in 4 and class II in 5. In simultaneous CABG with AG and valve surgery, the improvement of symptom was good and stable operative result was obtained, however, the length of the pedicled graft should be carefully considered for coronary anastomosis.

A case of bronchial asthma improved by acupuncture therapy / 全日本鍼灸学会雑誌

A 73 year old female, who had suffered from serious bronchial asthma and had been taking prednisolone and theophylline, was treated with acupuncture and herbal medicine. Twenty points, which are so called effective points for bronchial asthma, were used for acupuncture, e. g. LU 1: Zhongij, LU 2: Yunmen, and CV 22: Tiantu, etc. As Ryoudouraku mesurments showed suppression of F3 (Kidny Meridian) and F5 (Gallbladder Meridian), the exciting points on those meridians (KI 7: Fuliu and GB 43: Xiaxi) were also mildly stimulated by acupuncture. The severity of asthmatic attack, the strength of cough and the amount of sputum were expressed by a scoring system, where the most sever one which had been experienced before was scored as 10.<br>At the initiation of acupuncture, the frequency of asthmatic attack was 5 times a day, the severity of asthmatic attack was 6/10, the strength of cough was 6/10 and the amount of sputum was 8/10. Recently prednisolone was successfully reduced from 20mg to 7.5mg per day with acupuncture and the severity of asthmatic attack, the strength of cough and the amount of sputum were improved to 2/10, 1/10 and 3/10, respectively.<br>On the other hand, % FVC, FEV 1.0% and blood gas analysis data were not improved.<br>In summary, we believe that acupuncture acts beneficially to reduce the subjective symptoms of asthma even when the dose of prednisolone were decreased.

Effects of electrical acupuncture on pain threshold / 全日本鍼灸学会雑誌

On twenty patients and ten healthy adult volunteers, pain threshold was measured by a dolorimeter (Pain meter NYT-5) to clarify whether analgesic effects of electrical acupuncture on various body surface may be changed by acupuncture points or not.<br>Electrical acupuncture was performed to the traditional acupuncture points on the two meridians. A group is the combination of LI 10 (Shousanli) and LI 14 (Hoku) on the right side, the other is the combination of ST 36 (Tsusanli) and ST 40 (Liangchiu) on the right side.<br>Measured points of pain threshold are (1) face, (the point 2cm above from the center of both eyelids), (2) (3) left and right upper extremities (LI 11; Chuchih) and (4) (5) left and right lower extremities (ST 41; Chiehhsi).<br>In the Shousanli-Hoku group, pain thresholds of face, both upper extrimities increased significantly. However, those of both lower extremities were not significantly changed.<br>In the Tsusanli-Liangchiu group, pain thresholds of the upper and lower extremities on both sides increased significantly. However there were no significant changes in the forehead.<br>In comparison of two groups, increases of pain thresholds of both lower extremities were observed in significantly more cases with acupuncture to Tsusanli and Liangchiu points than those with Shousanli and Hoku points by the Chi-square test (p<0.01). From this fact, acupuncture of Tsusanli-Liangchiu points seems to be more effective on the lower extremities than that of the Shousanli-Hoku points.<br>Therefore, we conclude that effects on pain threshold by electrical acupuncture depend on various points on meridians and are not evenly shown on the whole body surface.

Effects of electrical acupuncture on the autonomic nervous system function after local anesthesia to the acupuncture points / 全日本鍼灸学会雑誌

This study was performed to clarify whether local anesthesia or sympathetic ganglion block abolishes the effects of electrical acupuncture (EA) on the autonomic nervous system or not.<br>Twelve healthy adult volunteers and 24 patients are divided into the following three experimental groups of each 12. EA was performed to the traditional acupuncture points on the meridians (H7; SHENMEN and CX4; HSIMEN). (1) In control group, only EA was performed. (2) In stellate ganglion block (SGB) group, EA was performed after unilateral SGB. (3) In local anesthesia (LA) group, EA was performed after local anesthesia on the same acupuncture points. The measured parameters on the autonomic nervous system functions were heart rates, R-R intervals in ECG, blood pressure and deep tissue temperature.<br>Results are as follows; Means of heart rate decreased significantly by EA in both control and SGB groups. Systolic blood pressure, diastolic blood pressure and RR-CV showed no significant changes by EA in all groups. Deep tissue temperature of the anterior forearm ipsilateral to the stimulation side decreased significantly by EA in SGB group. Deep tissure temperature of the anterior forearm contralateral to the stimuli decreased significantly by EA in both control and SGB groups. In LA group, however, all parameters were not changed by EA.<br>In summary, the effects of electrical acupuncture on the autonomic nervous system were not much different between control and SGB groups. It seems that one side of stellate ganglion block dose not interfere with the effects of acupuncture. On the other hand, any changes on the autonomic nervous system by electrical acupuncture were not observed in LA group. The fact showed that local anesthesia abolishes the effects of acupuncture on site. Local anesthesia blocks peripheral nerves and nerve endings. Therefore, we conclude that the effects of acupuncture on the autonomic nervous system are transmitted through the peripheral nerves, especially through the sensory nerves.

Effects of electrical and laser acupuncture to the stellate ganglion on autonomic nervous system / 全日本鍼灸学会雑誌

Previously we reported that acupuncture to the stellate ganglion stimulates the parasympathetic nervous system as well as the sympathetic nervous system. We measured effects of laser acupuncture to the stellate ganglion (SGL) or electrical acupuncture to the same (SGA) on R-R intervals, deep tissue temperature and blood presure by using 45 patients; 12 in SGL-group and 33 in SGA-group.<br>Results are as follows; (1) Means of heart rate (HR) decreased with 2bpm in the SGL-group, 3bpm in the SGA-group. (2) Coefficient of variation (CV) of R-R intervals increased with 1% in the SGA-group only. (3) Deep tissue temperature of the ipsilateral anterior forearm of the stimulation did not increase significantly after SGA, while deep tissue temperature increased with 0.3-0.5°C after SGL. Deep tissue temperature of the contralateral anterior forearm showed no significant change in the both groups. (4) Systolic blood pressure increased with 2-4mmHg after SGA and 4-5mmHg after SGL, respectively.<br>It is suggested that SGL increases deep tissue temperature by affecting autonomic nervous system, but not directly.

An experimental study on movement of broken acupuncture needles / 全日本鍼灸学会雑誌

An accidental break of an acupuncture needle is one of the most serious complication in acupuncture.<br>A German Shepherd weighed 25kg was anesthetized with pentobarbital.<br>Then, unused 7 needles of 1.0, 1.5, 2.0, 2.5, 3.0, 3.5 and 4.0cm long each were inserted at 7 acupuncture points.<br>The movement of broken acupuncture needles were observed by X-ray for 72 days and pathological examination of tissue surrounding broken needles was also done.<br>While broken needles inserted nearby the joints were found moving much around, others inserted in the region of straight bones stayed almost.<br>The dog was dissected 72 days after the preparation. Three broken needles were found just beneath the muscular fascia and two broken needles were in the subcutaneous tissue. Another broken needle in the lumbar region was penetrated into the lumbar spinal cord and the other needle in the region of neck was lost.<br>Pathological examination showed chronic inflammatory changes such as cellular infiltration and muscle fiber necrosis in the lumbar spinal cord and the thigh region, but little changes in the other four regions.

Effects of electrical acupuncture to the stellate ganglion on R-R intervals in electrocardiogram / 全日本鍼灸学会雑誌

Previously we reported that acupuncture to the stellate ganglion stimulates sympathetic nervous system while it decreases heart rate.<br>As it is said that R-R intervals in electrocardiogram (ECG) reflect functions of parasympathetic nervous system, we measured effects of electrical acupuncture to the stellate ganglion (SG) or traditional acupuncture points (AP) on the meridians (H7: SHENMEN and P4: HSIMEN) on R-R intervals in ECG by using 24 patients; 12 each in SG-group and AP-group.<br>Results are as follows; (1) Means of heart rate (HR) decreased with 1-3bpm in the both groups; (2) Coefficients of variation (CV) of HR increased with 1-2% in the both groups; (3) Means of R-R intervals prolonged with 39-47msec in the SG-group and 20-44msec in the AP-group, respectively; (4) CV of R-R intervals increased with 1% in the SG-group only.<br>It is suggested that acupuncture stimulates not only sympathetic nervous system, but also parasympathetic nervous system.

Effects of electrical acupuncture to the stellate ganglion on carotid blood flow, deep tissue temperature, blood pressure and pulse rate in the humans / 全日本鍼灸学会雑誌

Previously we reported effects of acupuncture to the stellate ganglion on measurements of skin electroconductivity by a Neurometer.<br>By using 8 healthy adults and 23 patients, we measured effects of electrical acupuncture to the stellate ganglion on carotid blood flow, deep tissue temperature, blood pressure and pulse rate in order to clarify the influence on functions of the autonomic nervous system.<br>After electrical acupuncture to the right stellate ganglion (SGA), the right and left carotid blood flow decreased with 4-9% and 7-12%, respectively. Deep tissue temperature of the right anterior forearm after SGA showed a little increase (with no significance), while the temperature increased with 0.4-0.7°C after the right stellate ganglion block (SGB). Deep tissue temperature of the left anterior forearm showed no significant change after SGA, while it increased with 0.1-0.3°C significantly after SGB. Systolic blood pressure increased with 2-4mmHg after SGA and this also increased with 9-11mmHg after SGB. Those increases were significant. While the pulse rate decreased (2bpm) significantly after SGA, it increased (4-6bpm) significantly after SGB.<br>Except the decreased pulse rate after SGA, the other data did not support a common hypothesis that electrical acupuncture to the stellate ganglion suppresses the sympathetic system as SGB.

Study on the electroconductivity of the human skin. Part 3. Regional changes of electric resistance by acupuncture / 全日本鍼灸学会雑誌

We invented to clarify the influences of acupuncture on the regional skin electroconductivity on humans. An acupuncture needle in situ for a certain time or electroacupuncture using DC 12 volt, 200μA for 7 sec. was applied on the forearm.<br>Measurements of skin electroconductivity were done on several representative points which were distal or proximal to the acupuncture periodically.<br>A needle in situ and electroacupuncture on LI4 did not change the electroconductvity of the proximal skin area around the elbow level on the same extremity.<br>A needle in situ on LI11 increased electroconductivity of the regional skin on the distal area around Manus dorsalis.<br>Electroacupuncture on LI11 increased electroconductivity of the skin on LI5.<br>A needle in situ on LI7 did not change electroconductivity of the skin on the proximal elbow level, but significantly decreased electroconductivity of the skin on LU9.

Effects of Electrical Acupuncture to the Stellate Ganglion on Measurements by Neurometer / 全日本鍼灸学会雑誌

It has been told that acupuncture to the stellate ganglion suppresses the sympathetic activity. By using 15 patients, we made measurements of electrical current of the skin at the 24 typical determinate points of Ryodoraku with a Neurometer before and after electrical acupuncture to the right stellate ganglion.<br>After 20min rest in the supine position, average values of 6 points of the right and left upper extremities decreased with 30% and 27%, and those of the right and the left lower extremities decreased with 34% and 31%, respectively.<br>Immediately after 30min of electrical acupuncture, average values of 6 points of the right and left upper and the right and left lower extremities increased with 9%, 12%, 17% and 9%, respectively.<br>Twenty minutes after the right stellate ganglion block, average values of 6 points of the right upper extremity decreased with 16%, and those of the left one, the right and left lower extremities decreased with 9%, 18% and 14%, respectively.<br>These data suggest that acupuncture to the stellate ganglion stimulates the sympathetic tone by showing increase of electrical conductivity of the skin, while the stellate ganglion block shows the decrease.

Nature of the Local Differences in Electroconductivity by D. C. Measurement / 全日本鍼灸学会雑誌

In order to clarify the physiological nature of the local differences in the skin electroconductivity we measured transcutaneous electric current on the representative (determinate) points of Ryodo-Raku (by Y. Nakatani) which correspond to so-called Genketu of traditional Chinese medicine with a wet electrode of 1cm in diameter in the condition of D. C. 12 volts and 200 uA when, both electrodes are directly connected. Eighty-two healthy adults were tested once and four other healthy adults were tested daily for eight days. We analysed mathematically the values of measurements by the principal component analysis.<br>As a result, we found that the electroconductivity of the skin in the upper and lower limbs both, and volar and dorsal sites of the upper limb changed independently each other and showed from rough to close interrelations according to the orders as above-mentioned.

The Effects of Stellate Ganglion Block on Measurement with A Neurometer and An Electrodermometer / 全日本鍼灸学会雑誌

It is said that Ryodoraku reflects the dysfunction of the autonomic nerve in spite of no objective evidence for the theory.<br>Using 60 patients received right stellate ganglion block, we measured 24 typical determinate points of ryodoraku with a neurometer and an electrodermometer.<br>With a neurometer, an average current value of 6 points of the right upper extremity decreased in 52% as well as that of 6 points of the left decreased in 62%. Both the right and the left lower extremities decreased in 91% and 85%.<br>With an electrodermometer, the average impedance of the right upper extremity increased in 108%.<br>Finally, the sympathetic blockade showed decrease in a current value with a neurometer and increase in impedance with an electrodermometer.

A Study of Electroconductivity to the Human Skin / 全日本鍼灸学会雑誌

We made the electrophotography which is able to visualize the distribution of electroconductivity to the skin.<br>According to an electric quantity, reducing KI into iodine, we got a compound of AgI with galvanochemical response and took a picture of a galvanic skindistribution on it. We may be able to apply both the A. C. and the D. C. in power supply. In order to take a good picture of electroconductive points, we used 12V of the D. C.. In this case, an electric quantity was<br>3.6×10^-4-4.8×10^-3W.Min./cm²