Radiographic Measurement of Joint Space Width Using the Fixed Flexion View in 1,102 Knees of Japanese Patients with Osteoarthritis in Comparison with the Standing Extended View

PURPOSE: The fixed flexion view (FFV) of the knee is considered useful for evaluating the joint space when assessing the severity of osteoarthritis (OA) of the knee. To clarify the usefulness of FFV for evaluation of the joint space and severity of knee OA, this study evaluated changes in the joint space on the FFV and standing extended view (SEV) in patients with knee OA. MATERIALS AND METHODS: The SEV and FFV images were acquired in 567 patients (1,102 knees) who visited the hospital with a chief complaint of knee joint pain. Medial joint space width (MJSW) and Kellgren-Lawrence (K-L) classification assessed using the SEV and FFV images were compared. RESULTS: Mean MJSW was significantly smaller when assessed on the FFV than on the SEV (3.02±1.55 mm vs. 4.31±1.30 mm; p<0.001). The K-L grade was the same or higher on the FFV than on the SEV. CONCLUSIONS: The FFV is more useful than the SEV for evaluating the joint space in OA knees. Treatment strategies in patients with knee OA should be determined based on routinely acquired FFV images.

Medial and Lateral Discoid Menisci of Both Knees

Discoid menisci on both the medial and lateral sides are rare, and there are very few reports on cases involving both sides. We report a case of a 52-year-old female with medial and lateral discoid menisci in both knees. Arthroscopy revealed the lateral menisci of both knees were complete discoid menisci, and partial meniscectomy was performed. The medial menisci were incomplete discoid menisci, but there were no findings of abnormal mobility or injury; therefore, the medial menisci were observed without treatment. At six months postoperatively, her pain and range of motion restrictions disappeared.

Comparative Effects of Periarticular Multimodal Drug Injection and Single-Shot Femoral Nerve Block on Pain Following Total Knee Arthroplasty and Factors Influencing Their Effectiveness

PURPOSE: This study compared the analgesic effects of local infiltration analgesia (LIA) and femoral nerve block (FNB) after total knee arthroplasty (TKA) and assessed factors associated with analgesia obtained by these two methods. MATERIALS AND METHODS: Study subjects included 66 patients (72 knees) who underwent TKA for osteoarthritis of the knee. Pain visual analogue scale (VAS), the amount of analgesics used, number of days to achieve 90° of flexion of the knee joint, date of initiating parallel-bar walking, range of motion of the knee joint at discharge, and adverse events were investigated. RESULTS: The VAS scores did not differ significantly between two groups, whereas the amount of analgesics used was significantly lower in the LIA group. Preoperative flexion contracture was significantly more severe in the LIA group with high VAS compared with low VAS. No serious adverse event occurred in the LIA or FNB group. CONCLUSIONS: The lower analgesic usage in the LIA group than the FNB group indicates that the analgesic effect of LIA was greater than that of singleshot FNB after TKA. There were no serious complications in either group. The postoperative analgesic effect of LIA was smaller in patients with severe than less severe preoperative flexion contracture.

Comparison with Magnetic Resonance Three-Dimensional Sequence for Lumbar Nerve Root with Intervertebral Foramen

STUDY DESIGN: Prospective study based on magnetic resonance (MR) imaging of the lumbar spinal root of the intervertebral foramen. PURPOSE: This study was to compare MR three-dimensional (3D) sequences for the evaluation of the lumbar spinal root of the intervertebral foramen. OVERVIEW OF LITERATURE: The diagnosis of spinal disorders by MR imaging is commonly performed using two-dimensional T1- and T2-weighted images, whereas 3D MR images can be used for acquiring further detailed data using thin slices with multi-planar reconstruction. METHODS: On twenty healthy volunteers, we investigated the contrast-to-noise ratio (CNR) of the lumbar spinal root of the intervertebral foramen with a 3D balanced sequence. The sequences used were the fast imaging employing steady state acquisition and the coherent oscillatory state acquisition for the manipulation of image contrast (COSMIC). COSMIC can be used with or without fat suppression (FS). We compared these sequence to determine the optimized visualization sequence for the lumbar spinal root of the intervertebral foramen. RESULTS: For the CNR between the nerve root and the peripheral tissue, these were no significant differences between the sequences at the entry of foramen. There was a significant difference and the highest CNR was seen with COSMIC-FS for the intra- and extra-foramen. CONCLUSIONS: In this study, the findings suggest that the COSMIC-FS sequences should be used for the internal or external foramen for spinal root disorders.

Large Ascending Aortic Aneurysms Eroding the Sternum / 日本心臓血管外科学会雑誌

In particular, pseudoaneurysms formed at suture lines often are injured during resternotomy. Between 1993 and 1997, 5 patients with large ascending aortic aneurysms eroding the sternum underwent graft replacement using profound hypothermic circulatory arrest. A VA bypass was established through the femoral artery and vein and the patients were cooled to achieve profound hypothermia. After total disappearance of EEG activity was confirmed, circulatory arrest was established and resternotomy was conducted. In 4 patients who had pseudoaneurysms at proximal suture lines, the aneurysms were injured during resternotomy, however the grafts above the aneurysms were clamped 5 to 10min after resternotomy and cardiopulmonary bypass resumed. Infected grafts were removed and replaced with new grafts in 4 cases and hemiarch repair was conducted in 1 case. There was 1 hospital death due to multiple organ failure. Four patients survived operations and were discharged without any deficit. The hypothermic circulatory arrest technique makes it easier to obtain a good operative field and to manage any rupture immediately than by the selective cerebral perfusion technique.