Removal of a left ventricular thrombus complicated by cardiac sarcoidosis using a 3D microscope system.

A woman in her 60s was brought to the previous hospital with respiratory distress. She was referred for the treatment of severe cardiac dysfunction and a mobile mass in the left ventricle. Echocardiography revealed the mass to be of 20×11 mm in size, mobile and slightly attached to the left ventricle by a stalk. As MRI had already revealed a small cerebral infarction, we have decided to perform emergency thrombectomy of the left ventricle. As the left ventricular contractility was diffusely impaired, we were able to remove the mass without any residuals using a transseptal approach without a left ventricular incision using a three-dimensional microscope system. The pathological diagnosis of the mass was thrombus, and subsequent close examination led to the diagnosis of cardiac sarcoidosis. We report the surgical technique and removal of a left ventricular thrombus complicated by cardiac sarcoidosis.

Radiological Findings of the Lumbar Spine in High School and Collegiate Sumo Wrestlers.

Background: Sumo wrestling is a traditional sport in Japan and becoming popular worldwide. Risk factors for lower back injuries in sumo wrestlers are heavier weight and larger body mass index (BMI). The mawashi (loincloth belt) worn by sumo wrestlers has been shown to restrict motion of the lumbar spine. Purpose: To study the effects of sumo wrestling on the lumbar spine of high school and freshmen collegiate wrestlers, investigating the relationship between radiological findings, wearing of the mawashi during training, and lower back symptoms. Study Design: Case series; Level of evidence, 4. Methods: From 2001 to 2017, a total of 197 members of the Japanese Sumo Federation (55 high school and 142 college freshman students) underwent routine radiographic examination of their lumbar spines and answered a questionnaire regarding lumbar symptoms. Wrestlers were classified as symptomatic and asymptomatic based on responses to a custom questionnaire. We used the unpaired t test to evaluate patient demographics and the chi square test to analyze radiographic lumbar spine abnormalities between symptomatic and asymptomatic wrestlers. Results: The wrestlers' mean height, weight, BMI, and duration in the sport were 174.0 ± 6.7 cm, 107.1 ± 22.4 kg, 35.2 ± 6.4, and 8.0 ± 3.2 years, respectively. There were 91 participants in the symptomatic group (46.2%) and 106 (53.8%) in the asymptomatic group. Ten wrestlers (5.1%) had osteophyte formations in the lumbar body; 8 of the 11 osteophytes (72.7%) appeared in the upper lumbar spine. Of the total, 48 wrestlers (24.4%) had deformities (Schmorl nodules) in the lumbar body, and 23 of 50 (46.0%) and 10 of 16 (62.5%) deformities were found in the upper lumbar spine of collegiate and high school wrestlers, respectively. Five wrestlers of the total 197 athletes (2.5%) had disc space narrowing in the lumbar body, with 3 of the 5 cases of disc space narrowing (60.0%) found in the upper lumbar spine. Spondylolysis in the lumbar body was found in 25 wrestlers (12.7%); 19 of the 91 symptomatic wrestlers (20.9%) had spondylolysis, compared with 6 of the 106 (5.7%) asymptomatic wrestlers (P = .0028). Conclusion: Almost one-third of sumo wrestlers had ≥1 abnormal radiological finding in the lumbar spine. There was a significant relationship between symptomatic wrestlers and spondylolysis.

Validating Knee Varus Alignment Measurements Using Markerless Motion Capture.

This study aimed to determine the validity of specific knee varus alignment measurement methods. We measured the femorotibial angle (FTA) using radiography and optical motion capture and validated the FTA measurement using markerless motion capture. The subjects included 34 legs of 19 patients with knee osteoarthritis (OA). One-way analysis of variance and multiple comparison tests were used to compare the FTA values between the Kellgren-Lawrence classification (KL) and Pearson's correlation coefficient for validity. The analysis showed that the FTA measured by markerless motion capture had a significant correlation to the FTA measured by radiography (r = 0.869, p < 0.01) and significantly increased with increasing KL (p < 0.05). These results indicate that markerless motion capture is a valid outcome measure for varus alignment in patients with knee OA.

Autologous Osteochondral Grafts for Knee Osteochondral Diseases Result in Good Patient-Reported Outcomes in Patients Older Than 60 Years.

Purpose: This study aims to examine the clinical autologous osteochondral grafts (AOG) outcomes for knee osteochondral diseases at operative ages >60 years, and to determine whether patients are able to sit straight in Japanese style after AOG. Methods: All patients who underwent AOG for knee osteochondral diseases between November 2001 and April 2018 were retrospectively identified. The inclusion criteria were AOG only without osteotomy, operative ages between 60 and 79 years, >2 years of follow-up, and involved femorotibial angle between 169° and 179° (normal alignment). Patients who underwent osteotomy to improve knee alignment and patients with inflammatory diseases such as rheumatoid arthritis were excluded. The patients' knee symptoms and their clinical outcome were evaluated according to the criteria of the knee scoring system of the Japanese Orthopedic Association (JOA), International Knee Documentation Committee (IKDC) subjective score, and the ability of straight sitting in Japanese style. Results: This study enrolled 57 cases and 60 knee joints during the study period. The follow-up ratio was 85.1%. Moreover, 14 men and 43 women and 29 right and 31 left knee joints were included in this study. The mean operative age and mean follow-up period were 67.8 years (range 60-76 years) and 81.1 months (range 24-167 months), respectively. In addition, the study involved 30 cases and 32 knee joints (60s group), and 27 cases and 28 knee joints (70s group). Moreover, 34 cases and 36 knee joints had osteonecrosis (ON group), and 23 cases and 24 knee joints had cartilage injury (CI group). The IKDC subjective and JOA scores in both the 60s and 70s groups showed significant differences: 2 years after AOG ＞at the follow-up period, ＞at the preoperative period. The scores in both the CI and ON groups showed similar significant differences. Furthermore, 8.3% and 53.5% of the patients could sit straight in Japanese style at the preoperative period and 2 years after AOG, respectively. Conclusion: Even if the patient's operative age was >60 years, the AOG only for their knee osteochondral diseases had good clinical outcomes, including the ability to sit straight in Japanese style. Level of Evidence: IV, Therapeutic case series Key words: autologous osteochondral grafts, aged patients, clinical outcome, knee joint, straight sitting in Japanese style.

[Ruptured Thoracic Aortic Aneurysm Treated with Total Arch Replacement and Direct Transaortic Thoracic Endovascular Aortic Repair].

Open stent grafting is an effective technique in surgery for treating-ruptured aortic aneurysms in the distal aortic arch, but it is not always applied as it depends on the shape of the aneurysm. In this case, the aneurysm was long in the distal aortic arch and sharply angulated into the descending aorta;thus, it was anticipated that an off-the-shelf open stent graft would not cover the ruptured area. Therefore, we used a stent graft device for thoracic endovascular aortic repair as an open stent and succeeded in saving the patient's life.

[Distal Anastomosis with Pleural Flap Wrap for Ruptured Acute Aortic Dissection].

A 69-year-old woman developed back pain was brought to our hospital. She was diagnosed with acute Stanford type B aortic dissection, and had a history of ascending aortic replacement for acute Stanford type A aortic dissection at another hospital 10 years before. In three days after admission, enhanced computer tomography (CT) revealed ruptured aortic dissection at the distal arch. Total aortic arch replacement was performed using the frozen elephant trunk technique. The Dacron polyester fabric prosthesis and aorta were anastomosed using the modified turn-up method at the distal anastomosis. Due to the fragility of the oesophageal side, the pleural flap was detached with the surrounding fatty tissue and transection was performed from the elephant trunk to the intima, adventitia, pleural flap, and felt strip. The use of an autologous pleural flap is a simple and effective method for controlling bleeding in a ruptured aortic dissection and for the distal anastomosis of fragile adventitia.

Preoperative diagnosis of knee cartilage, meniscal, and ligament injuries by magnetic resonance imaging.

PURPOSE: The purpose of the study was to report on the current accuracy measures specific to 1.5-Tesla MRI of the knee in the patient population prone to injuries of the anterior cruciate ligament (ACL), the menisci, and the articular cartilage. METHODS: We accrued patients between January 2018 through August 2021 who underwent a preoperative MRI and were diagnosed with an articular cartilage injury either due to unevenness of articular cartilage in T2-weighted sequences or due to the irregularity of subchondral bone in T1-weighted sequences. All patients were treated arthroscopically. Sensitivity, specificity, and accuracy were calculated for the detection of ACL, meniscus, and cartilage injuries. A P-value of < 0.05 represented statistical significance. RESULTS: One-hundred and forty-seven cases which included 150 knee joints were enrolled in this study. The mean age at the time of surgery was 42.9 years-old. The sensitivity in the diagnosis of ACL injuries was significantly greater than that in the diagnosis of cartilage injuries (P = 0.0083). The ratios of the equality of operative indication in 6 recipient sites were found to be between 90.0% and 96.0%. The diagnostic critical point was within a 1 cm in diameter. CONCLUSION: The diagnostic sensitivity in cartilage injuries was significantly lower than ones of ACL and meniscal injuries. The ratios of the equality of operative indication was determined to be between 90.0% and 96.0%, if we consider the unevenness of articular cartilage or the irregularity of subchondral bone. LEVEL OF EVIDENCE: Level III, Prospective diagnostic cohort study.

Intraoperative Acoustic Evaluation of Living Human Knee Cartilage-Comparison with Respect to Cartilage Degeneration and Aging.

OBJECTIVE: The objective of the study was to evaluate the mechanical properties of living human knee cartilage using our ultrasonic device, and to compare the measurements with respect to cartilage degeneration and aging. DESIGN: A total of 95 knees which had undergone arthroscopic knee surgery, from 88 patients, were included in the study, with informed consent. All procedures were reviewed and approved by the ethical committee of our hospital. In the study group, there were 41 men, 47 women, 39 right knees, and 56 left knees. The conditions primarily included knee osteoarthritis and anterior cruciate ligament rupture. The mean operative age was 44.1 years old (range = 10-83). We compared mechanical properties of the knee cartilage with respect to aging and gender, in comparison with normal cartilage. A P value of <0.05 represented statistical significance. RESULTS: In the context of the International Cartilage Repair Society (ICRS) classification of cartilage degeneration (grade 0-3), the signal intensity in grade 0 was significantly larger than that in grade 1, 2, or 3. The thickness in grade 0 was significantly higher than that in grade 1, 2, or 3. Normal cartilage in older women had the lowest signal intensity and the least cartilage thickness among all the groups. CONCLUSION: The ultrasonic system we developed was able to detect early degenerative changes in living cartilage in knees. The lowest signal intensity and least cartilage thickness in normal cartilage among older women were correlated to a large prevalence of knee osteoarthritis in women. LEVEL OF EVIDENCE: Level IV, case series.

Mosaicplasty With High Tibial Osteotomy for Knee Subchondral Insufficiency Fracture Had Better Magnetic Resonance Observation of Cartilage Repair Tissue Scores With Less Bone Marrow Edema and Better Plug Union and Less Plug Necrosis Compared With Mosaicplasty Alone.

PURPOSE: To determine the magnetic resonance imaging (MRI) findings after mosaicplasty (MOS) for knee subchondral insufficiency fracture (SIFK), and to analyze the relationship between MRI findings and clinical outcomes. METHODS: We retrospectively reviewed the cases of consecutive patients who underwent MOS for SIFK with/without high tibial osteotomy (HTO) between January 1998 and December 2015. The MRI findings at 12 months after the surgery were assessed by the modified magnetic resonance observation of cartilage repair tissue (MOCART) score to determine the degree of bone marrow edema (BME), plug union, and plug necrosis. The clinical outcomes were assessed by Lysholm score to clarify the minimal clinically important difference (MCID) and patient acceptable symptom state analysis. RESULTS: In total, 58 patients (17 men and 41 women) were enrolled in this study. Among them, 30 knees were treated by MOS alone and 28 knees were treated by MOS with HTO. The MOCART scores of patients who received MOS alone were significantly lower in BME score (P = .0060), plug union score (P = .0216), and in plug necrosis score (P = .0326) than patients who received MOS with HTO. BME lesion was less likely to persist among elderly (odds ratio 1.20, P = .0248) and female (OR 41.8, P = .0118) patients. The MCID of Lysholm score was 6.6 in MOS alone and 8.4 in MOS with HTO cases, but there were no significant association between MRI findings and the postoperative Lysholm score. CONCLUSIONS: The MOS with HTO cases had better MOCART scores with less BME, better plug union, and less plug necrosis compared with MOS alone cases. Female and older patients had better resolution of BME, but there was no significant correlation between MRI findings and the postoperative Lysholm score. All cases in both groups showed improvement of Lysholm score exceeding MCID; thus, MOS may be effective as a joint preserving surgery for SIFK. LEVEL OF EVIDENCE: Level IV, clinical case series.

Radiological osteoarthritic knee joint changes in high school and collegiate sumo wrestlers: The observational study.

We examined the effects of sumo on their knee joints, and investigated the relationship between radiological changes and knee joints symptoms, and the relationship between knee radiological changes and the physical characteristics of the wrestlers. Fifty-six high-school and 128 college freshman sumo wrestlers who belonged to the Japanese Sumo Federation. To evaluate radiological changes in the knee joints of high-school and college freshmen sumo wrestlers. They underwent routine radiographic examination of their knee joints and were instructed to answer a questionnaire regarding their knee symptoms as a medical check. The mean height, weight, body mass index (BMI), and sumo career/experience of the participants were 174.1 cm, 106.9 kg, 35.1 kg/m2, and 7.9 years, respectively. Twenty-five high-school (44.6%) and 54 collegiate (42.2%) sumo wrestlers had some knee symptoms, which was significantly associated with sumo career as a risk factor. Five high-school (8.9 %) and 18 collegiate (14.1 %) sumo wrestlers had joint space narrowing. Considering the relationship between knee symptoms and radiological changes, significant correlations between osteophyte formation and bony sclerosis and knee symptoms were observed. According to the Kellgren-Laurence (KL) classification, 7 high-school (12.5%) and 26 collegiate (20.3%) sumo wrestlers were grade 2, 3, or 4. The risk factors of degenerative radiographic changes in the knee joints of the participants were heavyweight, large BMI, and older age. The knee osteoarthritic changes had already appeared in 12.5% high-school sumo wrestlers at the admission.

Arteriovenous malformation with pseudoaneurysm on the left upper limb.

A 61-year-old woman developed a pulsatile mass on the left upper limb and was diagnosed with arteriovenous malformation with pseudoaneurysm. A two-stage operation including ligation and resection of the aberrant branches and subsequent resection of the mass with revascularization was performed. Histological analysis suggested arteriovenous malformation and pseudoaneurysm.

Autologous Osteochondral Grafts Result in Improved Clinical Outcomes in Patients With Early Knee Osteoarthritis.

Purpose: To determine whether autologous osteochondral grafts improve clinical outcomes in early knee osteoarthritis (EKOA) and whether the grafts prevent progression of radiographic joint degeneration. Methods: In this study, we identified patients older than 40 years with EKOA having no traumatic events, with grade 0, 1, or 2 on the Kellgren-Lawrence (KL) classification and more than grade 3 of cartilage degeneration according to the International Cartilage Repair Society scale. Recipient sites were as follows: 14 patellofemoral (PF3) joint, 18 medial femoral condyle (M1), and 6 lateral femoral condyle (L2). Japanese Orthopedic Association (JOA) score and International Knee Documentation (IKDC) subjective score (SUB) were examined as clinical outcomes. Results: The study included 31 knees in 31 patients who underwent autologous osteochondral grafts for EKOA and more than two years follow-up. The sample included 15 men and 16 women. The mean operative age was 56.0 years, and the mean follow-up period was 76 months (range, 24-170 months). In the preoperative period, JOA and SUB were 73.9 and 49.5, respectively. At follow-up, the JOA and SUB scores were 93.7 and 84.5, respectively. The differences were statistically significant. Progression of KL classification occurred in 0% of the PF3 group, 17% of the L2 group, and 33% of the M1 group. The outcomes of the M1 group significantly became worse (P = .0381) than those of the L2 and the PF3 groups, and the PF3 group significantly maintained good clinical outcomes (P = .0334). Conclusion: Autologous osteochondral grafts for degenerated cartilage improved clinical outcomes of EKOA even if the recipient had cartilage degeneration, and not trauma. The PF3 group maintained significantly good clinical outcomes, and the M1 group became significantly worse.

The Oral Administration of Highly-Bioavailable Curcumin for One Year Has Clinical and Chondro-Protective Effects: A Randomized, Double-Blinded, Placebo-Controlled Prospective Study.

Purpose: The purpose of this study was to determine the clinical and chondroprotective efficacy and safety of orally administered Theracurmin in patients who underwent mosaicplasty for knee chondral or osteochondral diseases over 12 months of treatment. Methods: We enrolled 50 patients, older than 20 years of age, who underwent mosaicplasty for their knee joint diseases. Theracurmin at 180 mg of curcumin per day or placebo was administered orally every day for 12 months. Because 7 patients dropped out of the study, 43 patients were examined; they included 14 men and 29 women and 24 right and 19 left knees. The mean operative age was 59.5 years (range, 24-84 years). We evaluated the Japanese Orthopaedic Association knee osteoarthritis score (JOA), visual analog scale (VAS), and Japanese Knee Osteoarthritis Measure (JKOM) as clinical symptoms; T2 mapping values using magnetic resonance imaging as an indication of the chondroprotective effect; and blood concentration of curcumin at 0, 3, 6, and 12 months after the operations. We performed intraoperative acoustic evaluation of articular cartilage as a measure of chondroprotective effect during the operations and second-look arthroscopy. Results: The JOA, VAS and JKOM at 3, 6, and 12 months were significantly better than those during the preoperative period. However, the values of JOA, VAS and JKOM and T2 mapping were not significantly different between the Theracurmin and placebo groups. The blood concentration of curcumin in the Theracurmin group was significantly higher than that in the placebo group at 3, 6, and 12 months after the operations. Cartilage stiffness and surface roughness were significantly better in the Theracurmin group than in the placebo group at second-look arthroscopy. Conclusions: The oral administration of Theracurmin for 1 year demonstrated significantly better chondroprotective effects and no worse clinical effects and adverse events than the placebo. Level of Evidence: Level I, double-blinded, placebo-controlled, prospective study.

Successful one-stage operation for type B acute intramural hematoma with descending aortic rupture.

A 76-year-old man who complained of back pain was referred to our hospital. Computed tomography revealed an intramural hematoma with a descending aortic rupture. Total arch replacement with the frozen elephant trunk technique and thoracic endovascular aortic repair was performed emergently in one stage. The patient was discharged without symptoms.

The effects of alendronate on the suppression of bone resorption and the promotion of cartilage formation in the human mosaicplasty donor site: A randomized, double-blind, placebo-controlled prospective study.

BACKGROUND: We previously reported that early alendronate administration accelerated bone formation and improved the quality of repaired cartilage in the donor site in rabbits. To investigate whether alendronate administration has effects in humans similar to those observed in rabbits. METHODS: The study cohort included 35 patients over the age of 12-years old who underwent mosaicplasty without osteoporotic therapy from March 2011 to October 2012. The donor sites were medial or lateral in the patellofemoral joint. Placebo (P) or Bonalon containing 35 mg of alendronate (A) was administered orally every week for 8 weeks. The cohort comprised 15 male and 20 female, including 14 right and 21 left knees. The mean age at the time of surgery was 57.1 years. Bone formation was examined using computer tomography and lateral knee radiography, and cartilage formation was examined using magnetic resonance imaging (MRI), second-look assessment, and intraoperative acoustic evaluation. The clinical outcomes were assessed using the Japanese Orthopaedic Association knee score and visual analog scale (VAS). Bone and cartilage formation in the donor site and clinical outcomes were assessed at 3, 6, and 12 months after mosaicplasty. RESULTS: The ratio of TRAP-5b in group A was significantly smaller than that in group P at 2 and 8 weeks after mosaicplasty. The extent of bone formation in the donor sites in group A was significantly greater than that in group P at 3 and 6 months after mosaicplasty. Cartilage formation did not differ significantly between the two groups as determined by MRI, macroscopic assessment, and intraoperative acoustic evaluation. Clinical outcomes did not differ significantly between the two groups, and no negative clinical outcomes were observed. CONCLUSION: Early alendronate administration accelerated bone formation but not cartilage formation in the mosaicplasty donor site in humans.

[Florida Sleeve Technique Concomitant with Total Aortic Arch Replacement].

A 73-year-old man with chest pain was brought to our hospital. He was diagnosed with acute myocardial infraction (AMI) by coronary arteriogram and underwent emergent intervention. Enhanced computer tomography( CT) revealed thoracic aortic aneurysm extending from sinus of Valsalva to proximal aortic arch. Fifty days after the onset of AMI, we performed valve-sparing aortic root replacement with the Florida sleeve technique, total aortic arch replacement and coronary artery bypass grafting. Post operatively, the patient's recovery went well without any complications. In subsequent CT, sinus of Valsalva was shrunk from 47 mm to 38 mm. The Florida sleeve technique is simple, effective and could reduce surgical risks.

Concomitant decalcification of the anterior mitral leaflet via the aortic annulus during aortic valve replacement for significant aortic and mitral stenoses.

An 82-year-old man undergoing regular hemodialysis with substantial aortic and mitral valve stenoses underwent aortic valve replacement with concomitant mitral decalcification via the aortic annulus. Postoperative transthoracic echocardiography showed reduced mitral stenosis. The patient was discharged on the 14th postoperative day uneventfully.

Intra-Articular Injections of Curcumin Monoglucuronide TBP1901 Suppresses Articular Cartilage Damage and Regulates Subchondral Bone Alteration in an Osteoarthritis Rat Model.

OBJECTIVE: Curcumin monoglucuronide (TBP1901) is highly water soluble and can convert to free form curcumin, which has pharmacological effects, on intravenous administration. This study aimed to investigate the effectiveness of TBP1901 intra-articular injections in an osteoarthritis (OA) rat model. METHODS: Sixty-four male Wistar rats (12 weeks old) who underwent destabilized medial meniscus (DMM) surgery were randomly separated into the TBP1901 injection or saline solution (control) injection group. They were sacrificed at 1, 2, 6, or 10 weeks postoperatively (weeks 1, 2, 6, and 10; n = 8 for each group). TBP1901 (30 mg/mL) or saline solution of 50 µL was injected into the knee joints twice a week during weeks 1 and 2 to investigate the effects in the acute phase of posttraumatic (PT) OA or once a week during weeks 6 and 10 to investigate it in the chronic phase of PTOA. Histology, immunohistochemistry, and micro-computed tomography were performed to evaluate the changes in OA. RESULTS: TBP1901 injections significantly reduced synovial inflammation at weeks 1 and 2, and tumor necrosis factor-α expression in the articular cartilage at week 6. The TBP1901 injections also significantly suppressed articular cartilage damage, subchondral bone (SB) plate thickening, SB plate perforation, and osteophyte formation at week 10. CONCLUSIONS: TBP1901 intra-articular injections suppressed synovial inflammation in the acute phase of PTOA in DMM rats. In the chronic phase, TBP1901 suppresses articular cartilage damage and regulates SB plate changes.

[The Mid-term Results of Transapical Transcatheter Aortic Valve Implantation for Aortic Stenosis].

We aimed to evaluate the results of transapical transcatheter aortic valve implantation (TAVI) for aortic stenosis. Thirty patients who had aortic stenosis and underwent transapical TAVI between 2016 and 2020 were enrolled. Medical records were reviewed, and the following data were retrieved and analyzed:basic demographic data, and intraoperative data and postoperative outcomes. Mean age was 85.8 years. There were 3 intraoperative complications (1 apex bleeding, 1 coronary stenosis and 1 mitral regurgitation). Extracorporeal membrane oxygenation was initiated due to unstable hemodynamics in two patients. One patient was converted to mitral valve replacement due to severe mitral regurgitation. There were 2 in-hospital complications (1 with sick sinus syndrome and 1 with cerebral infarction). One patient died of cerebral infarction and eventually, the 30-day mortality was 3%. Median observational period was 1.3 years. Three-year survival was 87.3%. Left ventricular ejection fraction increased by six months after the procedure and then, reached plateau. Left ventricular mass index decreased constantly throughout the observational period. Both parameters at one year after the procedure were significantly higher than preoperative ones. In conclusion, survival after transapical TAVI was favorable because of the low critical complication rate. Both left ventricular functional improvement and reverse remodeling were obtained.