Objective. To determine the accuracy of postmortem computed tomography (PMCT) for the assessment of causes in nontraumatic deaths in children. Study Design. We enrolled cases of nontraumatic deaths ...of infants and children who underwent PMCT at a single center. The presumed cause of death determined by PMCT was prospectively compared with the clinical and pathological diagnoses of deaths. Results. Thirty-eight cases were enrolled for analysis. Among them, seven cases also underwent conventional medical autopsy. PMCT revealed an identifiable cause of death in accordance with the clinical diagnosis of death in 16 cases of the 38 cases (the concordance rate was 42%) and in accordance with the autopsy cause of death in four of the seven autopsy cases (the concordance rate was 57%). Among eight cases with unknown cause of death by clinical diagnosis, four cases (50%) were identified with cardiac tamponade as a cause of death (one case) and intracranial hemorrhage suggesting abuse (3 cases). Conclusions. PMCT seems to be a promising technique that might serve as a substitute for conventional medical autopsy and give us the complementary information to clinical diagnoses particularly in cases of child abuse. Larger multicenter trials are worthwhile to validate the general feasibility of PMCT.
Category:
Ankle Arthritis
Introduction/Purpose:
Total ankle arthroplasty (TAA) is a popular surgical treatment for the patients with end-stage ankle arthritis. Along with development of the implant, ...indication for TAA has been extended to the severe deformity due to osteoarthritis or rheumatoid arthritis. However, a certain rate of complication after TAA is still remaining. The main reasons for failed TAA are the complications of talar component such as aseptic loosening or subsidence. We developed artificial talar prosthesis and indicated for the patient with idiopathic necrosis of the talus. This time we applied this new implant combined with tibial component of the TAA for the patient with end-stage ankle arthritis having severe collapse of the talus. The purpose of this study is to evaluate the outcomes of TAA with artificial talus.
Methods:
【Materials】Thirteen patients (13 ankles) treated by TAA with artificial talus since 2007 to 2014 were investigated. The mean duration of follow-up was 35 months (range; 12 to 66 months). Twelve patients (12 ankles) were suffering from osteoarthritis of the ankle, and 1 was from rheumatoid arthritis. The mean age at the surgery was 71 year-old(range; 61 to 81 year-old).
【Methods】Clinical outcomes were evaluated by Visual Analog Scale (VAS) scores. Functional outcomes were assessed by scoring system produced by the Japanese Society for Surgery of the Foot (JSSF ankle-hindfoot scale) before surgery and at the final follow- up.
Results:
Postoperative VAS was improved from 8.9 to 2.3. Postoperative JSSF scale were improved from 41 to 87. There were no case that required the revision surgery due to implant failure or deep infection.
Conclusion:
The ankle has small joint surface compared with other weight-bearing joints, that causes the complications of talar component. For the patients with severe deformity or osteonecrosis of the talus, indications of TAA should be applied carefully. Patients of end-stage ankle arthritis with poor bone stock in the talus may have been unsatisfied with use of previous implant models of TAA. The artificial talus could be a possible option to solve this problem. In the current study, TAA with artificial talus remained favorable clinical and functional results for the patient with severe deformity or poor bone stock in the talus.
Category:
Ankle
Introduction/Purpose:
With the recent remarkable progresses in image diagnosis using magnetic resonance imaging (MRI), it could be possible to evaluate articular cartilage in detail. ...T1ρ mapping by MRI has recently drawn attention as a noninvasive cartilage evaluation method. While its validity has been proven, there are no reports describing T1ρ mapping for the ankle; therefore, in this present study, T1ρ values of the articular cartilage surfaces of the talar dome were measured in healthy individuals.
Methods:
The study sample comprised 10 ankles from 10 healthy volunteers (4 male and 6 female), with a mean age of 32.2 years. Images taken using a 3.0 T MRI device, manufactured by Philips, were processed using the PRIDE software (Philips, Inc.) and analyzed using Image J, a specialized analysis software. Evaluations were performed using slices in the coronal plane from the trochlear ridge of the talus and slices 10 mm anterior and posterior of the ridge. Each slice was divided into three equal parts including the medial, central, and lateral areas of cartilage on the articular surface of the trochlea tali, to totally yield 9 regions of interests where T1ρ values (ms) were measured. Furthermore, values were measured thrice for each region in each volunteer, and the mean was calculated.
Results:
T1ρ values for the medial, central, and lateral regions were 31.0 ± 6.4 ms, 31.2 ±7 .2 ms, and 32.2 ± 6.9 ms, respectively for the anterior talus; 24.2 ± 4.2 ms, 21.7 ± 5.6 ms, and 25.1 ± 5.5 ms, respectively for the trochlear ridge of the talus; and 33.8 ± 4.8 ms, 31.9 ± 4.5 ms, and 35.1 ± 4.8 ms, respectively for the posterior talus. T1ρ values were significantly lower in the anterior and posterior areas of the talar dome than in the trochlear ridge of the talus (p < 0.05).
Conclusion:
Proteoglycan content of articular cartilage in the talar dome was determined to be low in the anterior and posterior areas, that reveals load application might be concentrate on these areas.
Category:
Sports
Introduction/Purpose:
The pathogenesis of fifth metatarsal stress fractures remains uncertain. We hypothesized that physical characteristics and environmental factors, which have ...received limited attention in the literature thus far, might be involved in the development of such fractures. To test our hypothesis, we performed a medical checkup and a survey of the living environment of athletes in college soccer teams, and subsequently, we investigated the existence of fifth metatarsal stress fractures, and examined the differences between the injury group and the non-injury group.
Methods:
The survey and measurements were conducted in 273 male athletes from the same college soccer team between 2005 and 2013. A medical checkup, comprising assessment of stature, body weight, body mass index, arch height ratio, toe-grip strength, quadriceps angle, leg-heel angle, functional reach test, one-leg standing time with eyes closed, straight leg raise test, finger-floor distance, heel-to-buttock distance, ankle joint range of motion, and general joint laxity test, and a questionnaire survey were performed once a year. A survey was conducted at the time of injury that resulted in fifth metatarsal stress fractures. The study participants were separated into an injury group and a non-injury group, depending on whether they had a fifth metatarsal stress fracture. The measurement items and survey items were compared, and the association between the presence or absence of injury and the measurement items was analyzed.
Results:
Toe-grip strength was significantly weaker in the injury group, compared with the non-injury group, suggesting that a weak toe-grip is associated with fifth metatarsal stress fracture (p < 0.05). In addition, injury on the non-dominant leg was more frequent in the fifth metatarsal stress fracture injury group (p < 0.05). Between-group comparisons of the other items showed no statistically significant differences.
Conclusion:
The association between weak toe-grip strength and fifth metatarsal fracture suggests that a weak toe-grip may lead to an increase in the load applied onto the lateral side of the foot; this may cause mechanical stress on the bone. In addition, the effect of the non-dominant leg on the fifth metatarsal bone may need to be studied further.
The purpose of this study is to examine the appropriateness of MRI navigation surgery following chemoradiotherapy (CRT), including lateral pelvic lymph node dissection (LLND) for middle to low rectal ...cancer.
Forty-three consecutive patients with cT2-4b rectal cancer within 10 cm from the anal verge who underwent laparoscopic radical surgery following CRT (45–50.4Gy + S1 80mg/m2) from January 2014 and February 2020 were analyzed. We decided on the operative procedure, including LLND, based on the restaging MRI. We examined the rates of 3-year postoperative local pelvic recurrence, permanent stoma, and recurrent risk factors (Group S). We also compared the results to that of the fourteen patients who enrolled in the previous phase II trial and underwent laparoscopic radical surgery following CRT (40Gy + S-1 (80mg/m2) or UFT (300 mg/m2)) for consecutive cT2-4b rectal cancer below the peritoneal reflection. The operative procedure was decided at the initial MRI diagnosis, and the LLND was not performed (Group P).
We had no local pelvic recurrence in Group S, and the three-year local pelvic recurrence-free survival was significantly better in Group S than P (100 % in S 85.1 % in P, p < 0.05). The permanent stoma rate was not different between the Groups, irrespective of the significantly high rate of cCRM(+) in Group S. The Cox proportional hazards model for significant factors of recurrence on the univariate analysis revealed that ycM and ycEMVI scores were independently significant (p < 0.001).
MRI navigation surgery, including LLND for rectal cancer following chemoradiotherapy, improves local control and functional preservation.
•CRT does not compensate for the lateral lymph node dissection.•Selective TME and selective LLND following CRT improve local control and functional preservation.•ESGAR ‘s metastatic lymph node diagnostic criteria helped differentiate patients requiring LLND.•MRI navigation surgery can be based on ycCRM and metastatic LLN diagnosis.
Previous reports on the learning curve of total ankle arthroplasty (TAA) revealed that inexperienced surgeons should be more careful about operative indications and procedures during the learning ...curve period. Patients who underwent surgery with inexperienced surgeons may be associated with inferior clinical outcomes, such as frequent complications. This study aimed to evaluate the effect of the participation of experienced surgeons as assistants on the results of TAA performed by inexperienced surgeons.
Surgeons whose experience in performing TAA included less than 15 ankles were defined as inexperienced surgeons; on the other hand, those whose experience included more than 20 ankles were defined experienced surgeons in this study. Thirteen ankles operated by inexperienced surgeons, with an experienced surgeon who participated as an assistant, were assigned to the inexperienced group. Fifteen ankles operated on by an experienced surgeon were assigned to the experienced group. TNK Ankle (Kyocera, Kyoto, Japan) was used for all experiments. The coronal and sagittal alignments and the size of the tibial component relative to the tibial shaft were measured. Preoperative and postoperative Japanese Society for Surgery of the Foot (JSSF) and the Self-Administered Foot Evaluation Questionnaire (SAFE-Q) were used for clinical assessment.
There were two malleolar fractures during the operation in both groups, and there were no cases of revision surgery. There were no significant differences in the coronal and sagittal tibial component alignment and size between the groups. The JSSF and SAFE-Q improved. There were no significant differences between groups, except for the preoperative JSSF score.
During the learning curve period, careful surgical indications and surgeries are desired. However, we found that when experienced surgeons participated as assistants, favorable results could be expected even when inexperienced surgeons performed the surgery.
Ⅲ.
This study proposes a novel derivative-free-optimization-based bifurcation point detection strategy that automatically adjusts parameter settings during the search. The proposed method is based on an ...adaptive differential evolution (JADE) and does not require parameter tuning by the user. Simulation results show that the proposed method obtains accurate bifurcation parameter sets with a higher success rate and a shorter time than the classic DE. Furthermore, we investigate the influence of the population size on the performance, and the proposed method requires fewer populations than DE. By using the proposed method, the user obtains a two-parameter bifurcation diagram without the derivative of the objective function or the careful setting of the simulation parameters.
Background
Combined small cell lung carcinoma (SCLC) is defined as SCLC combined with elements of non-small cell lung carcinoma (NSCLC), accounting for approximately 30% of cases of SCLC. However, ...combined SCLC and giant cell carcinoma (GC) is very rare.
Case presentation
A 50-year-old woman with a 45 pack-year smoking history was referred to our hospital for further investigation of an abnormal left hilar shadow. Chest computed tomography (CT) revealed a 28-mm solid pulmonary nodule in the left lower lobe and an enlarged left hilar lymph node adjacent to the left main pulmonary artery. CT-guided biopsy of the pulmonary nodule led to the diagnosis of high-grade neuroendocrine carcinoma. The preoperative clinical stage was defined as cT1bN1M0. Thus, the patient underwent left lower lobectomy with ND2a-2 lymph node dissection via thoracotomy. Pathological investigation revealed a 22-mm tumor and dense sheet-like growth of small tumor cells with scant cytoplasm and finely granular nuclear chromatin. Moreover, there was a sheet-like growth of bizarre, highly pleomorphic mono- or occasionally multinucleated giant cells, accounting for approximately 40% of the tumor. Both the small and giant cell components were thyroid transcription factor-1-positive and p40-negative and exhibited neuroendocrine differentiation, as indicated by positivity for synaptophysin and CD56 and negativity for chromogranin A. While the small cell component was E-cadherin-positive and vimentin-negative, the giant cell component was E-cadherin-negative and vimentin-positive, indicating an epithelial-to-mesenchymal transition. Only the small cell component was found within the mediastinal and hilar lymph nodes. The final pathological diagnosis was combined SCLC and GC, pT1bN2M0, and pStage IIIA. The patient received adjuvant chemotherapy with 4 cycles of cisplatin and irinotecan. No sign of recurrence has been noted for 1 year after the surgery.
Conclusions
This is the first detailed report of a unique case with combined SCLC and GC. The coexistence of SCLC and GC in the presented case might indicate several possibilities: (1) GC may arise from SCLC via epithelial-to-mesenchymal transition, (2) SCLC may arise from GC through phenotypic conversion, and (3) SCLC and GC may have derived from a common neuroendocrine origin. Further investigation is necessary to reveal the underlying pathological process.
Ureteral injury during pelvic surgery is a serious complication that requires special attention. The fluorescent ureteral catheter near-infrared ray catheter sets are 6.0F catheters containing ...fluorescent substances along their length that can be recognized by a laparoscopic indocyanine green camera. We present our experience using a near-infrared ray catheter in 6 consecutive patients who underwent surgery for recurrent pelvic tumors.
The near-infrared ray catheters were inserted into the bilateral ureters in all patients, with the exception of patient 5 (left unilateral), by urologists using a cystoscope with the same technique as that commonly used in placing ureteral stents under general anesthesia. A laparoscopic indocyanine green camera was adapted to identify the ureters. From February 2020 to July 2020, 6 consecutive patients with recurrent pelvic tumors underwent surgery using a near-infrared ray catheter. In 3 patients, recurrent tumors were detected in the pelvic cavity after surgery for colon cancer (1 patient each of peritoneal recurrence behind the seminal vesicles, lymph node metastasis on the residual superior rectal artery, and peritoneal recurrence at the peritoneal reflection). Two patients had postoperative local recurrences of rectal cancer. The last patient had a recurrence of cervical carcinoma invading the rectum.
All patients underwent surgery under ureteral image navigation using near-infrared ray catheter not only for ureter preservation during the operation (4 patients) but also for the combined resection of the ureter with recurrent tumors (2 patients). One patient experienced postoperative ureteral stenosis on postoperative day 21 that required a ureteral double J-stent placement in the left ureter.
Near-infrared ray catheter has the potential to reduce inadvertent periureteral dissection because the ureter can be identified before approaching it.
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