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Biomedical subjects

A Minami

Publications and source records attributed to A Minami.

At least 55 records · Page 3Linked to original sources
PubMed1998

Force transmission through the wrist joint in Kienböck's disease: a two-dimensional theoretical study.

This study quantifies the changes in force and pressure distributions across the wrist joint in different stages of Kienböck's disease using a 2-dimensional computer simulation model. Twenty-four cases classified as Lichtman's stage II, IIIA, or IIIB (8 cases in each category) were analyzed using the rigid body spring model technique. A 2-dimensional model in the posteroanterior plane of the wrist was loaded through the metacarpals under a total force of 142 N. The joint forces, peak pressures, and ligament tensions calculated on the involved side were normalized against the contralateral normal side values of the same patient. The results demonstrated that significant changes of the force transmission across the wrist joint occurred only from stage IIIA to IIIB, in which scaphoid rotation was prominent. On the basis of this study, scaphoid rotation plays an important role in affecting the wrist joint contact pressure distribution. This may be responsible for the progression of Kienböck's disease.

Biomechanical Phenomena↗
PubMed1998

Functional results of low median and ulnar nerve repair with intraneural fascicular dissection and electrical fascicular orientation.

Twenty-eight low median nerve injuries and 23 low ulnar nerve injuries were repaired using intraneural fascicular dissection and electrical fascicular orientation. Eleven freshly lacerated nerves were seen within 48 hours after injury; 40 nerve lacerations were chronic. Fascicular orientation between sensory and motor fascicles at the proximal nerve end could be accurately differentiated in 47 nerves (92%) independent of whether it was acute or chronic. At the distal nerve end in fresh lacerations, the motor fascicles could be determined conclusively by muscle contraction with sequential electrical stimulation of the fascicles. In chronic nerve lacerations, the distal fascicles could be estimated anatomically after internal neurolysis. After fascicular orientation, nerves were repaired with end-to-end group fascicular suture or interfascicular sural nerve grafting. Twenty-four nerves repaired with end-to-end suture and 13 nerves repaired with nerve grafting were monitored more than 25 months. Satisfactory sensory results (i.e., S3+ or S4 functions) were obtained in 29 nerves (78%) and M4 or M5 motor functions were achieved in 29 nerves (78%). There were no patients who needed additional tendon transfers to reconstruct thumb opposition or to correct claw finger deformity. These results suggest that low median or ulnar nerve lacerations, whether acute or chronic, partial or complete, may be successfully repaired with the aid of electrical fascicular orientation with or without intraneural fascicular dissection.

Adolescent↗
PubMed1998

Ulnar shortening for triangular fibrocartilage complex tears associated with ulnar positive variance.

Twenty-five patients with triangular fibrocartilage complex (TFCC) tears associated with ulnar positive variance who did not respond to conservative management were treated by ulnar shortening. The follow-up period averaged 35 months. All patients complained of pain, restricted forearm rotation, and weakness of grip. Arthroscopy was performed in 23 of 25 wrists to assess the status of the TFCC and the degree of the degenerative change of the proximal aspect of the lunate and triquetrum. Arthroscopic findings consisted of 15 class 1 and 8 class 2 tears according to Palmer's classification. When the TFCC showed a traumatic flap tear, only the torn flap was removed arthroscopically. Ulnar shortening averaged 3 mm. Transverse osteotomies healed in all patients at a mean postoperative time of 7 weeks. Twenty-three patients had either complete relief or occasional mild pain of the wrist. Two patients with persistent pain had additional procedures performed. Postoperative x-ray films revealed slight degenerative changes at the distal radioulnar joint in 7 patients. Complications included 1 reflex sympathetic dystrophy and 2 fractures through the osteotomy site after early plate removal. Ulnar shortening is a useful procedure for TFCC tears associated with ulnar positive variance.

Adolescent↗
PubMed1998

Complete removal plus dorsalis pedis flap for arteriovenous malformation in the hypothenar region.

Complete removal of arteriovenous malformations of the hand, without functional impairment of the hand and fingers, is extremely difficult. A dorsalis pedis flap was used to reconstruct a soft-tissue defect, following complete removal of a malformation in the hypothenar region. This method allowed sufficient excision to militate against postoperative recurrence of the abnormality, while maintaining finger function. Two years after the operation, there has been no recurrence of the malformation and nearly normal finger function.

Adolescent↗
PubMed1998

Endoscopic papillary dilation by balloon and isosorbide dinitrate drip infusion for removing bile duct stone.

BACKGROUND: Endoscopic papillary dilation (EPD) by balloon in the management of bile duct stones has recently been claimed to be effective for removing bile duct stones. METHODS: Without endoscopic sphincterotomy, we attempted to remove large or multiple bile duct stones through EPD combined with drip infusion of isosorbide dinitrate in 35 patients. Isosorbide dinitrate, at a rate of 5 mg/h, was administered intravenously, and a balloon dilator with a 10-mm diameter was inflated within 3 min across the papilla. Stones were then smashed using a mechanical lithotriptor, and the fragments were extracted with a basket or the balloon. RESULTS: Extraction of stones was successful in 33 (94%) of 35 patients by the combined therapy. Two of them (6%) developed mild pancreatitis. CONCLUSION: EPD combined with medical sphincter dilation was effective for large and multiple bile duct stones.

Adult↗
PubMed1998

Second fracture of the distal humerus after varus malunion of a supracondylar fracture in children.

Nine children sustained a second fracture of the distal humerus after union of an ipsilateral supracondylar fracture which had healed with cubitus varus. There were eight boys and one girl with a mean age of five years (1 to 8) at the time of the second fracture which occurred at a mean of 1.5 years after the first. In all patients, the second fracture was an epiphyseal injury of the distal humerus, either associated with a fracture of the lateral metaphysis below the site of the previous supracondylar fracture, or a fracture-separation of the entire distal humeral epiphysis. This suggests that the physis and epiphysis tend to be more subject to injury than the metaphysis of the distal humerus in children who have had a previous supracondylar fracture with varus malunion.

Child↗
PubMed1997

Treatment of flexor tendon sheath ganglions using ultrasound imaging.

Forty-one patients with a symptomatic digital mass or swelling of suspected ganglionic origin were examined by ultrasound. Findings were classified into 4 groups: group 1, solitary cyst appearing as a well-defined solitary oval anechoic mass (27 digits); group 2, multiple cysts having multiple oval anechoic masses (3 digits); group 3, solid tumor indicating a heterogeneous hypoechoic mass (6 digits); and group 4, tenosynovitis with no abnormal echoic mass (5 digits). Treatment was determined by lesion classification. In group 1, 26 of the 27 solitary cysts were punctured, and a jellylike material was aspirated from 24 cysts. Postaspiration ultrasound examination revealed that a cyst was still present in 2 cases, and these were excised surgically. In group 2, all the cysts were surgically removed. A ganglion with multiple cysts was confirmed on pathological examination. In group 3, the lesions were removed surgically; among the diagnoses were tendon sheath ganglion, giant-cell tumor of tendon sheath, neurilemmoma, and hemangioma. In group 4, no abnormal masses had appeared at follow-up examination. The 24 patients whose ganglions were treated by aspiration, as well as the 8 patients whose ganglions were excised, were monitored for more than 12 months. None of these 32 patients experienced residual pain or lesion recurrence. These results indicate that ultrasound is useful, in cases in which flexor tendon sheath ganglion are suspected, for assisting in diagnosis and determining whether patients should undergo aspiration or surgical excision.

Adolescent↗
PubMed1997

Left brachial approach for transcatheter arterial embolization therapy in patients with hepatocellular carcinoma.

We evaluated the efficacy of the lipiodol-transcatheter arterial embolization (L-TAE) technique for hepatocellular carcinoma (HCC) performed using a left brachial approach. A total of 64 procedures were performed using the brachial route in 53 patients with HCC between 1989 and 1996 using a 4-French catheter and these patients were retrospectively studied. The technical success rate was 95.3%. The overall complication rate was 31.3%: fever of over 38.0 degrees C lasting longer than three days (18.8%), transient neurologic complications (4.7%), and pancreatitis (1.6%). Complications such as lumbago, back pain, and dissection of the celiac artery or its branches, which frequently complicated femoral approaches, were avoided. These data indicate that L-TAE using the left brachial approach may be a safe and effective alternative to the transfemoral approach in patients with HCC.

Adult↗
PubMed1997

Free vascularised fibular strut graft for anterior spinal fusion.

A vascularised fibular strut graft was used for anterior spinal fusion in 16 patients with spinal kyphosis. The procedure was abandoned in three because of difficulty in establishing a vascular anastomosis and in one because the grafted fibula dislodged two days after operation. One patient died after five days. Of the 11 remaining patients, there were seven males and four females. Their ages at the time of operation averaged 30.9 years (12 to 71). The number of vertebrae fused averaged 6.7 (5 to 9) and the length of fibula grafted averaged 10.9 cm (6.5 to 18). Average follow-up was 54 months (27 to 84). Bone union occurred at both ends of the grafted fibula in all 11 patients, with an average time to union of 5.5 months (3 to 8). We did not see a fracture of the grafted fibula. Two patients had postoperative complications; the graft dislodged in one and laryngeal oedema occurred two days after operation in the other. A vascularised fibular strut graft provides a biomechanically stable and long-standing support in spinal fusion because the weak phase of creeping substitution does not take place in the graft.

Adolescent↗
PubMed1997

Endoscopic lithotomy of common bile duct stones with sublingual nitroglycerin and guidewire.

OBJECTIVE: In 21 patients, our objective was the endoscopic removal of common bile duct stones by sphincter dilation with the application of sublingual nitroglycerin. METHODS: Nitroglycerin 0.3-0.6 mg was needed for proper dilation of the orifice and for successful cannulation of the Dormia basket into the bile duct. Cannulation of the Dormia basket was simplified by placing the guidewire in the common bile duct beforehand. Because of possible stone impaction, a mechanical lithotriptor was applied smoothly in two patients. RESULTS: Complete stone removal was successful in 18 of the 21 (86%) patients. One patient who developed a mild form of acute pancreatitis recovered in a few days by conservative management with drip infusion of protease inhibitor. Blood pressure dropped transiently in a patient receiving nitroglycerin, but the general condition of the patient was stable. CONCLUSIONS: This procedure was found to be safe, easy, and effective in extracting common bile duct stones.

Acute Disease↗
PubMed1996

Increased expression of cytokines in liver and serum in patients with extrahepatic diseases.

To determine whether the liver plays an immunological role in certain extrahepatic disorders, we investigated the expression of interleukin (IL)-1 beta, IL-6, interferon (IFN)-gamma, and tumor necrosis factor (TNF)-alpha in 11 patients who had recovered from cholecystolithiasis, 12 patients with gastric cancer, 20 patients with chronic hepatitis, and 6 healthy controls. Cytokine mRNAs in the liver were detected by semiquantitative reverse transcribed-polymerase chain reaction. Serum cytokines and soluble IL-2 receptor (sIL-2R) were investigated by enzyme-linked immunosorbent assays. Increases in TNF-alpha, IL-6, IL-1 beta, and IFN-gamma mRNAs were found in the livers of patients with extrahepatic diseases. TNF-alpha and IL-6 peptides were increased in the sera of patients with gastric cancer. TNF-alpha in the sera and TNF-alpha mRNA in the liver were correlated in gastric cancer patients. Surprisingly, sIL-2R in the serum of gastric cancer patients was significantly higher than the level in healthy controls. Our findings suggest that the liver produces cytokines in reaction to extrahepatic lesions. Further, the increase in sIL-2R in gastric cancer patients indicates that malignancy may affect the immune network in vivo.

Biopsy, Needle↗
PubMed1996

Clinical results of treatment of triangular fibrocartilage complex tears by arthroscopic debridement.

In order to determine indications for arthroscopic debridement and the management of triangular fibrocartilage complex (TFCC) tears, we reviewed 16 wrists retrospectively. The mean patient age was 30 years, with a range of 20 to 53 years. The follow-up period averaged 35 months. Two groups were identified: post-traumatic tears (n = 11) and degenerative tears (n = 5). The results of arthroscopic debridement were compared and analyzed based on the preoperative and postoperative evaluation of pain, range of motion, grip strength, return to work, patient acceptance, and complications. Failures were further evaluated to determine identifiable lesions or anatomic defects associated with poor results. Patients with positive ulnar variance and lunotriquentral interosseous ligament tears had a poor clinical outcome. Good results correlated with grip strength; all patients with post-traumatic TFCC tears had excellent results, while those with degenerative TFCC tears did poorly.

Adult↗
PubMed1996

Scanning of polypoid gallbladder lesions by ultrasonic microprobes using transpapillary catheterization.

BACKGROUND AND STUDY AIMS: Polypoid lesions of the gallbladder can be diagnosed by transabdominal ultrasonography and endoscopic ultrasonography. However, the image resolution is limited, and the histopathology of these lesions is difficult to determine. We report here on our preliminary results in four patients using a high-frequency (20 MHz) ultrasonic microprobe introduced into the gallbladder via the transpapillary approach. PATIENTS AND METHODS: Insertion of the microprobe into the gallbladder through the papilla of Vater was attempted in four patients with gallbladder diseases without preceding endoscopic sphincterotomy. RESULTS: The lesions in the gallbladder were clearly visualized in three of the four patients. We tried to correlate the characteristic ultrasound findings with the histopathology of the lesions, which were found to be early cancer, adenoma, and adenomyomatosis on histopathology of the specimens after cholecystectomy. No complications occurred. CONCLUSIONS: High-resolution endoscopic transpapillary ultrasonography of the gallbladder is feasible and safe, and may contribute to the diagnosis of gallbladder diseases, particularly of small polypoid lesions.

Adenoma↗
PubMed1995

Vascularized fibular graft for bone reconstruction of the extremities after tumor resection in limb-saving procedures.

We treated 18 patients (8 males and 10 females) with bone or soft tissue tumors in the extremities by vascularized fibular grafts (VFGs). The average age was 29 years. Two had malignant soft tissue tumors in the forearm (angiosarcoma and synovial sarcoma) and the other 16 had bone tumors [osteosarcoma (8), chondrosarcoma (3), angiosarcoma (1), adamantinoma (1), and giant cell tumor (3)]. Affected sites of the bone tumor cases were tibia (5), femur (5), humerus (3), radius (2), and ulna (1). According to the surgical staging system of Enneking et al. 1 patient was in stage III, 12 in IIB, 2 in IB, and 3 in IA. The surgical margin was curative in 5 patients, wide in 9, marginal in 2, and intralesional in 2. One patient died due to lung metastasis although bone union was obtained by the VFGs. Functional results of the bone reconstruction in the remaining 17 patients were evaluated according to the modified scale of Enneking et al. The VFGs resulted in substantial bone unions in all patients except 1. Bone unions in all 17 patients occurred in less than 10 months. Overall clinical results were satisfactory. Based on a 30-point scale overall clinical results ranged from 10 to 30 points with an average of 21 points. Functional evaluation in the upper extremity were, generally, superior to those in the lower extremity. Postoperative complications were 5 metastases (4 in the lung and 1 in the mediastinum) in 4 patients, 1 recurrence, and 2 fractures after obtaining bone union. One patient died from metastasis.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1995

Hemiresection-interposition arthroplasty for osteoarthritis of the distal radioulnar joint.

Hemiresection-interposition arthroplasty of the distal radioulnar joint has been carried out in 12 men. The indication was osteoarthritis with an intact triangular fibrocartilage, or when the fibrocartilage could be reconstructed. The average age was 41 years and average follow up for 53 months. In all the patients, there was relief of pain and a significant increase in movement and in grip strength.

Adult↗
PubMed1995

Papillary dilation vs sphincterotomy in endoscopic removal of bile duct stones. A randomized trial with manometric function.

To circumvent the long-term effects of papillary ablation for extracting common bile duct stones (< 12 mm in diameter) in endoscopic sphincterotomy (EST), endoscopic papillary dilation (EPD) was attempted in 20 patients. To evaluate papillary function before and after the procedures, manometry of the sphincter of Oddi was carried out in 13 with EPD and 10 of 20 patients with EST. Extraction of all stones was successful (100%) in both groups at an equal rate. Repeated numbers of procedures were common in both groups. However, the mean duration of the procedure was high in EPD compared to EST (63 min vs 42 min, P < NS). Adjunctive therapies like mechanical lithotripsy (ML), nasobiliary drainage, and choledochoscopy were included in EPD, while EST required a basket catheter and ML. There was no significant difference on manometry before and after the procedures (P = NS), although papillary function was found to have decreased after the EPD. In contrast, all patients in the EST group lost papillary function after the procedure. Thirty-day morbidity and mortality rate were absent in both groups. Immediate and 2.5-year follow up complications were uncommon in both groups. As a simple method, EPD may be an effective and safe alternative to EST in the management of patients with bile duct stones who require maintenance of papillary function.

Aged↗