While several different methods have been used to measure carpal kinematics, biplanar radiography is generally considered to be the most accurate and popular one. However, biplanar radiography is tedious and so only pseudo-dynamic kinematics can be measured. Recently, magnetic tracking system has been developed for the measurement of joint kinematics which is versatile and easy to use and so the possibility of measuring motions dynamically. In this study, the capability of a magnetic tracking device to accurately measure carpal kinematics was investigated by comparing it with biplanar radiography. The kinematics of the third metacarpal, scaphoid, and lunate in five fresh cadaveric specimens were measured using both methods as the wrists were placed in eight positions. The finite screw rotation of each bone with respect to the distal radius during selecting the seven wrist motions was calculated for both measuring techniques and compared. In general, the kinematics for all three bones measured by using either magnetic tracking device or biplanar radiography was identical and showed no statistical difference. The averaged differences ranged from 0.0 to 2.0 degrees. These differences were due to the potential effect of the weight of the sensors and the interference of the attaching rod to the surrounding tissue. It is concluded that the application of the magnetic tracking device to carpal kinematics is warranted, if proper technical procedures as suggested are followed.

Aged↗

PubMedDate not supplied

Oblique stress fracture of the olecranon in baseball pitchers.

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Adolescent↗

PubMedDate not supplied

Electromyographic study during isometric exercise of the shoulder in head-out water immersion.

Water exercises are used for early rehabilitation programs after shoulder injury such as rotator cuff tear, yet no literature discusses the muscle activity of such rehabilitation programs in water. The purpose of this study was to analyze the electromyographic activity from 8 volunteers during isometric exercises in water and on land. Nine isometric exercises were studied: with 30 degrees, 60 degrees, and 90 degrees shoulder flexion and abduction, and 3 positions of shoulder rotation at 0 degrees abduction (both maximal internal and external rotation and mid-position). Nine parts of 6 muscles were studied: the supraspinatus, infraspinatus, subscapularis, 2 parts of the pectoralis major (clavicular and costal), 3 parts of the deltoid (anterior, middle, and posterior), and the latissimus dorsi. The electromyographic signals were low-pass filtered, full-wave rectified, and integrated for 5 seconds. The electromyographic activity was quantified as a percentage of the maximal manual muscle test. The results showed that supraspinatus activity at 90 degrees abduction significantly decreased from 22.3+/-15.8 on land to 3.9+/-3.3% manual muscle test in water (P < .01). Other muscle activities in water also decreased remarkably compared with those on land. These results provide valuable information for the safety of water exercise for early rehabilitation programs after shoulder injury such as rotator cuff tear.

Adult↗

PubMedDate not supplied

Postoperative subcoracoid impingement syndrome in patients with rotator cuff tear.

Impingement of the tendinous rotator cuff on the coracoid process (subcoracoid impingement syndrome) has rarely been reported as a cause of pain after surgery for rotator cuff tear. We evaluated clinical features, surgical results, and histopathology findings of resected coracoid processes in patients with subcoracoid impingement syndrome after anterior acromioplasty and management of rotator cuff tear. Pain at the anterior aspect of the shoulder, localized tenderness of the coracoid process, anterior shoulder pain on horizontal adduction testing, and positive subcoracoid block suggest subcoracoid impingement syndrome. Postoperative subcoracoid impingement syndrome was investigated in 11 of 216 cases with rotator cuff surgery. The average patient age at the time of surgery was 61.2 y (range, 28-78 y). Coracoplasty (partial resection of the posterolateral side of the coracoid process) was performed in 9 shoulders that had not responded to a 6-month regimen of conservative treatment. Complete pain relief was achieved in all cases. Histopathologic findings revealed hypertrophic changes of the fibrocartilage layer at the posterior aspect of the resected coracoid process. We concluded that subcoracoid impingement syndrome was an important factor in unsuccessful rotator cuff surgery and recommend that coracoplasty be performed on patients with symptoms of subcoracoid impingement syndrome after management of the rotator cuff tear.

Adult↗

PubMedDate not supplied

Identification of a high-risk subgroup in cytology-positive stage IIIA endometrial cancer.

OBJECTIVE: To identify a high-risk subgroup among patients with cytology-positive stage IIIA endometrial cancer. STUDY DESIGN: Fifty-four stage IIIA endometrial cancer patients who were positive only on peritoneal cytology were divided into two groups based on the cytologic pattern of their peritoneal smears. In group A, malignant cell clusters had well-defined edges, while the tumor cell clusters had scalloped edges in group B. The prognostic significance of these findings was investigated. RESULTS: The five-year disease-free survival rate was 97.5% in group A (n=40) versus 50% in group B (n = 14). Multivariate analysis confirmed that the cytologic pattern had an independent influence on survival. CONCLUSION: Positive peritoneal cytology composed of malignant cell clusters with well-defined edges has no impact on survival. Only endometrial cancer patients who show tumor cell clusters with scalloped edges in peritoneal smears are worth considering for upstaging.

Adenocarcinoma↗

PubMedDate not supplied

Morphologic analyses of positive peritoneal cytology in endometrial carcinoma.

OBJECTIVE: To investigate the relationship between the morphologic features of endometrial adenocarcinoma cells in peritoneal fluids (effusions and washings) and macroscopic intraabdominal adenocarcinoma at laparotomy as well as prognosis. STUDY DESIGN: Seventy-one patients with endometrial adenocarcinoma who showed positive peritoneal cytology at laparotomy were clinically divided into three groups: 25 patients with macroscopic neoplastic seeding in the peritoneal cavity (type 1), 38 patients without macroscopic peritoneal metastasis who survived with no evidence of disease (type 2) and 8 patients without macroscopic peritoneal metastasis who later developed recurrence of adenocarcinoma (type 3). Morphologic features of the adenocarcinoma cells in smears of peritoneal fluids were examined. RESULTS: Most of the smears from type 1 patients showed moderate to high cellularity, scalloped edges of cell clusters and isolated adenocarcinoma cells, whereas these features were seldom observed in type 2 patients. Although not all type 3 patients demonstrated these three features, patients in the series whose specimens exhibited none of the three features did not show any peritoneal lesions or have a recurrence of their disease. CONCLUSION: The finding of endometrial adenocarcinoma cells exhibiting high cellularity, scalloped edge of cell clusters and isolated cells in smears of peritoneal fluid is associated with the presence of intraabdominal macroscopic metastatic lesions and could be regarded as a risk factor for intraabdominal recurrence of carcinoma.

Adenocarcinoma↗

PubMedDate not supplied

Digital ischemia in baseball players.

Eight baseball players developed digital ischemia as a result of repetitive ball impact. Symptoms and signs were coolness, numbness, cyanosis, paleness, and a positive reaction to the digital Allen's test. Seven of the eight players developed digital ischemia between the ages of 16 and 17. Angiograms of four patients with an occluded index digital artery are presented. Thermograms of four patients with a cool area of the left index finger are also presented. We investigated the incidence of digital ischemia by administration of a questionnaire. The respondents were 578 players belonging to clubs in junior high schools, high schools, and colleges. No digital ischemia was found in 207 junior high school baseball players. The incidence increased in high school (66 of 299) and college (29 of 72). The probability of developing digital ischemia corresponded to the accumulated playing time. Digital ischemia occurred characteristically in the left index finger.

Adolescent↗

PubMedDate not supplied

Long-term results of multiple muscle transfer to reconstruct shoulder function in patients with birth palsy: eleven-year follow-up.

We evaluated the long-term clinical results of multiple muscle transfer for reconstruction of shoulder function in 10 patients with birth palsy. Multiple muscle transfer consists mainly of Harmon's deltoid shift, Ober's biceps muscle transfer, and Hoffer's latissimus dorsi muscle transfer. The follow-up ranged from 5 to 14 years with an average of 10.5 years. Two of the 10 patients showed no improvement, one due to severely atrophied latissimus dorsi muscle, and the other who had not received Hoffer's latissimus dorsi muscle transfer. Except for these two patients, an averaged flexion and external angles were 114 degrees and 25 degrees, respectively. Harmon's deltoid shift and Hoffer's latissimus dorsi muscle transfer for reconstruction of shoulder function in patients with birth palsy have proven to be a useful method in reconstructing and maintaining the function of active elevation and external rotation of the shoulder.

Child↗

PubMedDate not supplied

Three-dimensionally corrective external fixator system for proximal femoral osteotomy.

The authors introduce a technique of proximal femoral osteotomy using three-dimensionally corrective external fixator systems for treatment of Legg-Calvé-Perthes disease and slipped capital femoral epiphysis, and describe the results of 47 hips in 44 children. Postoperative casting immobilization was not performed. All osteotomies gained the correction angle as planned. All osteotomies healed with no nonunions, malunions, device failures, or avascular necrosis. Complications occurred in 7 (15%) of 47 hips. Pin tract infection occurred in six (13%) hips; one of these (2%) needed debridement. The bulky external fixator caused slight inconvenience, but the current results indicate that the proximal femoral osteotomy using the external fixator system provided an easily repeatable intraoperative varus/valgus and flexion/extension correction compared with other internal fixation devices, and sufficient fixation for children without significant complications.

Child↗

PubMedDate not supplied

An in vitro method for testing the sensitivities to drugs of human osteosarcomas grafted onto nude mice.

Sensitivities to anticancer drugs were tested with cultured cells from six osteosarcomas transplanted onto nude mice and those of six human osteosarcomas cultured in vitro directly from the original tumor. The suppression by the anticancer drugs of 3H-TdR incorporation into the cultured cells was examined. The cells that had been grafted onto nude mice were highly sensitive to ADM and MMC and less sensitive to BLM and MTX in all of the tumors tested. Similar results were obtained with cells cultured directly in vitro from the original tumor. These results were somewhat comparable with those achieved by measuring cell survival and the success of back transplants onto nude mice after treatment with drugs. If further information on appropriate labeled precursors can be developed, testing the sensitivity of tumors to drugs by measuring the suppression of nucleic acid synthesis should prove useful in clinical applications.

Animals↗