Comparison of Gait Motion Including Postoperative Trunk Deflection Between Direct Lateral and Anterolateral Approaches in Supine Total Hip Arthroplasty.

BACKGROUND: A prospective study was conducted to compare the effect of an anterolateral approach in the supine position (ALS) with that of a direct lateral (DL) approach on gait motion, including trunk deflection, in walking after total hip arthroplasty. We hypothesized that trunk deflection in walking after ALS would be significantly improved in comparison with use of the DL approach. METHODS: The subjects were 15 patients, with 7 in the ALS group and 8 in the DL group. Walking before and 9 and 28 weeks after surgery was analyzed using 3-dimensional motion analysis. RESULTS: Walking velocity, stride length, hip joint range of motion in the sagittal plane in walking, and locomotion range of trunk inclination were significantly improved 28 weeks after surgery in both groups. In gait analysis, there were no significant differences between the 2 groups. CONCLUSION: This study was conducted to compare the effect of ALS with that of a DL approach on locomotion in walking after total hip arthroplasty. Hip pain at 9 weeks after surgery was significantly improved using ALS compared to the DL approach, but there were no significant differences in gait function at 28 weeks after surgery using ALS or DL approach. Further long-term studies are required to examine differences between these procedures.

[Importance of a symptomatic visit in tuberculosis contacts--classification of secondary cases].

OBJECTIVES: In order to improve the appropriateness of contact examinations, we investigated the characteristics of secondary tuberculosis cases. SUBJECTS AND METHODS: We included tuberculosis patients that were located in Kawasaki City between 2008 and 2011. The patients were considered as 2 separate groups: those with tuberculosis following contact with index cases registered in Kawasaki City and those with tuberculosis who were located in Kawasaki City. Secondary cases were defined as subjects who underwent a contact examination and developed active tuberculosis within 2 years from the last contact with the index case. The secondary cases were classified by diagnostic method, time, and sputum smear test results, followed by consideration of improvement measures. RESULTS: There were 1196 tuberculosis patients and 6157 subjects who underwent a contact examination. Of these, 35 patients developed tuberculosis secondary to index cases registered in Kawasaki City. These 35 cases were classified by diagnostic methods. Diagnosis occurred during a contact examination in 31 cases and during a symptomatic visit in 4 cases. There were 2 sputum smear-positive patients detected in a contact examination that was conducted > or = 6 months after contact. These 2 cases had a symptomatic cough, but did not visit a medical institution. There were 39 patients with secondary tuberculosis who were located in Kawasaki City. These 39 cases were also classified by diagnostic methods. Diagnosis occurred during a contact examination in 33 cases and during a symptomatic visit in 6 cases. There were 4 sputum smear-positive patients detected in a contact examination that was conducted > or = 6 months after contact. These 4 cases had a symptomatic cough, but did not visit a medical institution. DISCUSSION: Of the secondary cases, a sputum smear-positive state was detected in some of the patients at the time of a contact examination that was conducted > or = 6 months after contact. However, secondary cases should be discovered at a sputum smear-negative stage. Appropriate education regarding the importance of a medical visit at the onset of symptoms could decrease the number of patients that are identified in the sputum smear-positive state during a contact examination that occurs at least 6 months after contact.

CT-guided transthoracic needle biopsy using a puncture site-down positioning technique.

OBJECTIVE: We have developed a new CT-guided technique using puncture site-down positioning during the biopsy. The goal of our study was to determine the efficacy and safety of this technique for biopsy of lung lesions compared with the standard technique. MATERIALS AND METHODS: Medical records of 236 patients who underwent CT-guided transthoracic needle biopsy were retrospectively evaluated. This study included 89 cases that were biopsied using the standard technique (group A) and 147 cases that were biopsied using the puncture site-down positioning technique (group B). A 20-gauge automated cutting needle without coaxial technique was used in all patients. Medical records were reviewed for lesion size and location, biopsy results, and complications. RESULTS: When using the standard technique, the sensitivity for malignant lesions was 96.1%; the sensitivity for benign lesions, 92.1%; and diagnostic accuracy, 94.4%. Thirty-seven patients (41.6%) had pneumothorax, with 16 (18.0%) requiring chest tube placement. When using the puncture site-down positioning technique, the sensitivity for malignant lesions was 95.4%; the sensitivity for benign lesions, 93.3%; and diagnostic accuracy, 94.6%. Nineteen patients (12.9%) had pneumothorax, with four (2.7%) requiring chest tube placement. Other complications were minimal. CONCLUSION: CT-guided transthoracic needle biopsy using the puncture site-down positioning technique is an effective and safe procedure with a high diagnostic accuracy and low complication rate. This new technique is especially useful in reducing the rate of pneumothorax.