Bone Gla protein (BGP) is a vitamin K-dependent protein which is a marker of bone turnover. To determine whether serum BGP is a useful indicator for parathyroidectomy in patients with secondary hyperparathyroidism, we measured serum BGP levels. Thirty-seven patients with secondary hyperparathyroidism who were followed up for more than 1 year after parathyroidectomy were studied. All patients underwent total parathyroidectomy and autotransplantation. Controls were 46 patients who were treated by chronic hemodialysis for more than 3 years. Serum BGP levels (normal: less than 6.5 ng/ml) were markedly increased in 37 patients with parathyroidectomy, ranging from 4.2 ng/ml to 645 ng/ml, with a mean value of 278.8 +/- 159.8 ng/ml (mean +/- standard deviation) versus 65.0 +/- 85.2 ng/ml in the 46 controls (p less than 0.001). Patients with a high BGP level had severe bone and joint pain. Serum BGP in patients with parathyroidectomy was significantly correlated with serum alkaline phosphatase and mPTH (p less than 0.001 for both). The total weight of resected parathyroid tumors was 2,152 +/- 1,368 mg, and tumor weights ranged from 200 mg to 5,600 mg. There was a highly significant correlation between BGP level and tumor weight (r = 0.656, p less than 0.001). The 2 patients who showed BGP levels below 10 ng/ml had tumor weights of only 470 mg and 240 mg, respectively, and revealed no improvement of pain postoperatively, although their mPTH levels were increased. These results suggested that BGP measurement is a sensitive method for detecting increased bone turnover and is possibly useful as an indicator for parathyroidectomy in patients with secondary hyperparathyroidism.

Adult↗

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Spinal deformity and instability after multilevel cervical laminectomy.

Sixty-four patients who had undergone multilevel cervical laminectomy were studied for postoperative spinal deformity and instability. Special attention was given to patients with cervical spondylosis (CS), ossification of the posterior longitudinal ligament (OPLL), and spinal cord tumors. Twenty-three (36%) of 64 patients showed postoperative changes in curvature type and 9 (14%) had developed spinal deformity (kyphotic or meandering-type curvature). In two juvenile patients, the deformity developed soon after operation and spinal fusion was required to prevent neurologic complications. In the adult cases, contrary to the hitherto accepted concept, long-term follow-up revealed the tendency of the deformity to develop more frequently in OPLL cases than in CS cases. Mobility of the cervical spine was reduced considerably after laminectomy, both in CS and OPLL cases. There was no adult patient who required further operation for severe deformity or instability after laminectomy. Extensive laminectomy, even including the C2 lamina, seemed to have no adverse effect on the stability of the cervical spine.

Cervical Vertebrae↗

PubMedDate not supplied

Multiple neurilemmoma of the cauda equina. A case report.

A 49-year-old male, with a relatively uncommon multiple neurilemmoma, exhibited symptoms of cauda equina compression. Following a diagnosis of multiple tumor of the cauda equina and extradural cyst, based on myelography and CTM, the tumors at L1-L2, the left S1 nerve root, and left hip were resected. Three years after the operation, the patient is asymptomatic apart from slight numbness in the right hip and there is no evidence of tumor recurrence. The rarity of such a case prompted this report.

Cauda Equina↗

PubMedDate not supplied

The relationship between a subcutaneously placed afferent jejunal loop in a hepaticojejunostomy and postoperative cholangitis.

A subcutaneously placed afferent jejunl loop pexis, which is often performed during a hepaticojejunostomy, opens a route to the biliary tract, through which appropriate instruments can be passed should postoperative complications arise, requiring a choledochoscopy, the removal of calculi, and for the dilatation of the anastomotic site. From our clinical experience with such a pexis, however, postoperative cholangitis showing a transient fever with abdominal pain and liver dysfunction frequently develops. Further, in cases in which a subsequent dissection of this jejunal pexis was performed, there was a reduction in the incidence of cholangitis, which suggests a possible correlationship between such a pexis and cholangitis. In this investigation, bile stasis in jejunal loop has been studied, using hepatobiliary scintiscanning in examining 31 patients given a hepaticojejunostomy. Fourteen of these patients were also given a jejunal loop pexis, and 17 patients were without such a pexis. Bile stasis was found to be more frequent in the group given a jejunal loop pexis (p less than 0.001). Further, bile stasis was found in 90% of patients showing postoperative cholangitis whereas postoperative cholangitis was observed in 60% of patients with bile stasis (p less than 0.01). Thus, based on the data obtained, as well as our clinical experience, it would seem that a subcutaneously placed jejunal loop pexis should be avoided while performing a hepaticojejunostomy, unless the possibility of anastomotic stenosis and/or the retention of stones are strongly expected.

Anastomosis, Roux-en-Y↗

PubMedDate not supplied

CT score and the severity of acute pancreatitis.

The CT findings in 28 patients with acute pancreatitis were compared with the severity of the disease. The pancreatic image, which demonstrates the pancreatic lesion, was studied with respect to 9 items, and fluid accumulation showing the peripancreatic status with respect to 13 items. According to Forell's classification, the lesion was mild in 8 patients, moderate in 11, and severe in 9. The detection rates of abnormal pancreatic images and fluid accumulation increase with the advance in the severity of the disease. The mean CT score according to severity was 0.9 +/- 0.6 for mild pancreatitis, 7.2 +/- 4.5 for moderate pancreatitis, and 13.4 +/- 4.2 for severe pancreatitis. Significant differences were observed among the groups, suggesting that the CT score is useful for evaluating the severity of acute pancreatitis.

Acute Disease↗

PubMedDate not supplied

Ultrasonographic diagnosis of acute appendicitis in surgical indication.

The visualization rate and cross section width of the appendix were compared with the severity of appendicitis by using ultrasonography in 77 patients with acute appendicitis. An appendicitis echo was obtained in 100% of phlegmonous and gangrenous appendicitis cases in which emergency surgery was indicated, but in only 32% of catarrhal appendicitis cases in which conservative therapy was generally indicated. The cross section width of the appendix was 19.00 +/- 2.76 mm in gangrenous appendicitis, 15.22 +/- 3.73 mm in phlegmonous appendicitis and 9.50 +/- 1.76 mm in catarrhal appendicitis; i.e. the severer the inflammation the longer the diameter (p less than 0.01). A fluid echo, which suggests the existence of a complication, was observed in patients with gangrenous and phlegmonous appendicitis. The above facts suggest that ultrasonographic examination can be useful in assessing the severity of acute appendicitis.

Acute Disease↗

PubMedDate not supplied

Statistical analysis in the differentiation between cases of serious acute pancreatitis and generalized peritonitis due to a perforated peptic ulcer.

Serious acute pancreatitis was considered by the authors as one of the diseases which must be distinguished from generalized peritonitis due to perforated peptic ulcer. An attempt was made to differentiate between these two conditions without reference to two factors, namely amylase value and intraperitoneal free air. Differential diagnosis by linear discriminant analysis, making full use of information such as the history of the present illness, general and abdominal findings and laboratory data, was undertaken. This resulted in a satisfactory predictive value, at least for sample cases. Lastly, items which seem to be important for differentiation between the diseases are discussed.

Acute Disease↗