Biomedical subjects
Publications and source records attributed to K Terayama.
We report two cases in which fracture of the tibial metal tray was thought to be due to improper design of the tray and heavy polyethylene wear. The bone beneath the fractured portion of the tray was deficient and had been replaced by granulomatous fibrous tissue including numerous polyethylene wear particles and foreign-body giant cells. Osteolysis occurred as a tissue reaction to these particles.
A simple method of arthroscopic reduction and fixation of a fracture of the intercondylar eminence of the tibia is described. A 23-year-old man with a completely displaced (Type IIIB) fracture was treated with arthroscopy. A satisfactory reduction was achieved by releasing the medial meniscus, which was entrapped in the fracture site. Link dynamic staples (W. Link, Hamburg, Germany) were used to firmly fix the fracture when the guide tube came downward from the medial mid-patellar portal. The secure fixation of the fragment and the prevention of the need for an arthrotomy facilitated early functional rehabilitation. One year after surgery the patient had a stable, painless joint with a full range of motion. The described method is technically straight-forward and can provide secure fixation of a bone fragment. The Link staples are useful in the fixation of a displaced fracture of the intercondylar eminence of the tibia.
To identify factors affecting radiologically detected loosening of the Charnley femoral prosthesis, 326 femoral prostheses with 10- to 20-year followup were studied. After observation of postoperative radiological changes, the criteria for fixation failure detected radiologically, of femoral prostheses were defined as progression or accompanying occurrences of subsidence, demarcation, separation of the prosthesis from cement, cement fracture, or endosteal cavitation. Sixteen femoral prostheses (4.9%) developed radiologically detected fixation failure. Male gender, low canal flare index, low femoral score, large medullary canal width, low implant (cement and stem)/canal ratio, low stem/canal ratio, and varus orientation of the stem affected fixation failure. Inadequate cementing techniques such as low implant/canal and stem/canal ratios and varus stem orientation might be within the surgeon's control and should be avoided. An unfavorable canal geometry (stovepipe canal) and osteopenia of the femur, indicated by a low femoral score, are risk factors that might be out of the surgeon's control, and require future research.
To identify the factors affecting Hodgkinson Type 3 or 4 radiological demarcation (presence of complete demarcation or migration, respectively) of the Charnley socket, 328 sockets with 10- to 20-year followup were studied. Fifty-five sockets (16.8%) developed Type 3 or 4 demarcation. In the osteoarthrosis group (237 sockets), removal of eburnated bone at the acetabular roof, the presence of large acetabular angles before and after surgery, and high placement of the socket were related to development of Type 3 or 4 demarcation. In the rheumatoid group (32 sockets), young patient age predisposed the socket to Type 3 or 4 demarcation. Rapid polyethylene wear, correlated with young age, male gender, and thin cement mantle in Zones I and II, was another important factor related to Type 3 or 4 demarcation in both groups and in the entire series. These risk factors should be taken into account when assessing the indications for arthroplasty, when performing arthroplasty, and when educating the patient.
Two hundred and sixty-seven consecutive primary low-friction arthroplasties, followed for 5 to 18 years after surgery, were studied to assess the factors influencing survival of the socket, using the Kaplan-Meier method. The end point of survival was defined radiologically in two ways: incipient failure (migration of 3 mm or more or rotation of 4 degrees or more) and definite failure (progressive change of position). Twenty-four sockets (9.0%) developed incipient failure, and 14 of them progressed to definite failure. Preservation of the subchondral bone plate or eburnated bone in the acetabular roof, multiple 6-mm anchor holes, and two steps of evolution in socket design (the advent of a pressure-injection socket and than an ogee-flanged socket) benefited socket survival. Polyethylene wear was considered to be the most important factor limiting longevity of the socket.
A portable stress-applying device for stress radiography was developed for daily clinical use. Using this device, stress radiography for the diagnosis of the anterior cruciate ligament (ACL) deficiency was performed with the knee flexed at 20 degrees and at 90 degrees. A 100-N force was chosen as a standardized stress. The subjects were classified into four groups: the manually tested ACL-deficient group (32 knees), the manually tested control group (80 knees), the instrumentally tested ACL-deficient group (14 knees), and the instrumentally tested control group (34 knees). There was no statistical difference in the reliability (sensitivity, specificity, and accuracy) of stress radiography between the manual technique and the instrumental technique. When stress radiography with the knee flexed at 20 degrees and that at 90 degrees were compared, the former was more reliable than the latter. As the manual technique is compromised by a lack of standardization in applied force, a mechanical device is required in quantitative stress radiography. The reliability of stress radiography with the knee flexed at 20 degrees is considered high enough to warrant dispensing with further stress radiography with the knee flexed at 90 degrees for diagnosing ACL deficiency.
The anemia frequently observed in lead poisoning is thought to result from the shortening of erythrocyte life span in combination with inhibition of hemoglobin synthesis. However, the exact mechanism by which lead shortens the life span of red blood cells (RBCs) remains unclear. In the present study, the effects of injected lead on electrophoretic mobility, membrane sialic acid content, deformability and survival of rat RBCs were investigated in order to clarify the relationships between them. As indices of lead exposure, RBC counts, hemoglobin (Hb) levels, hematocrits (Ht), mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH), mean corpuscular hemoglobin concentration (MCHC) and blood lead (blood Pb) levels in the rats were also examined. Exposure to lead significantly decreased RBC counts, Hb levels, Ht, MCV and MCH. Similarly, exposure to lead significantly decreased the mobility, sialic acid content and deformability of rat RBCs. A shortening of erythrocyte survival time was also observed in the rats exposed to lead. It is speculated that decreases in membrane sialic acid content and deformability of RBCs induce a shortening of erythrocyte survival time in anemia caused by lead.
Among 52 patients with porous-coated anatomic total knee arthroplasties, three (6%) underwent revision surgery because of failure of the tibial polyethylene at two years and three months, four years and three months, and four years and nine months after surgery. Thinning of the tibial polyethylene may have contributed to the failure in one patient. Heat pressing fabrication and the articular geometry possibly played a role in the development of failure in all three patients. Surgical latitude of the prosthetic design was considered to be too narrow to be applied to knee joints with severe deformity, for which knee prostheses with more intrinsic stability might be appropriate.
Recently, embryonic chicken brain extract was shown to contain a glucuronyltransferase, which transfers glucuronic acid from UDP-glucuronic acid to glycolipid acceptors (neolactotetraosyl ceramide). The enzyme was also suggested to transfer glucuronic acid to glycoprotein acceptors (asialoorosomucoid) (Das, K. K., Basu, M., Basu, S., Chou, D. K. H., and Jungalwala, F. B. (1991) J. Biol. Chem. 266, 5238-5243). In this study, the glucuronyltransferase activity in rat brain extract was separated into two groups by UDP-glucuronic acid-Sepharose CL-6B column chromatography. The enzyme recovered predominantly in the effluent fraction (GlcAT-L) catalyzed the transfer of glucuronic acid to glycolipid acceptors but not to glycoprotein acceptors, whereas the enzyme recovered in the eluate fraction (GlcAT-P) transferred glucuronic acid most predominantly to glycoprotein acceptors and very little to glycolipid acceptors. GlcAT-P was able to transfer glucuronic acid to oligosaccharide chains on asialoorosomucoid. The enzyme recognized a terminal lactosamine structure, Gal beta 1-4GlcNAc, on glycoproteins. It was localized in the nervous system and was hardly detectable in other tissues, including the thymus, spleen, lung, kidney, and liver. Although GlcAT-L and GlcAT-P shared some properties in common such as tissue distributions and developmental changes, they exhibited marked differences in their phospholipid dependence and in their pH profiles, apart from their respective acceptor preference to glycolipids and glycoproteins. The acceptor specificity and tissue distribution suggest that a novel glucuronyltransferase, GlcAT-P, is involved in the biosynthesis of the sulfoglucuronylgalactose structure in the HNK-1 carbohydrate epitope that is expressed on glycoproteins.
Acetabular osteonecrosis is a rare condition. Only five cases with histological analysis have been reported in the literature, and these patients had previously received radiotherapy. The 67-year-old woman reported on here, who had had no major systemic disorder or local radiotherapy, and who had never consumed alcohol, developed aseptic osteonecrosis of the acetabulum after femoral head replacement with a cemented Austin-Moore prosthesis for aseptic osteonecrosis of the femoral head following femoral neck fracture. The necrosis was found during surgery to go so deeply into each bone composing the acetabulum that the hip joint could not be revised, and we had to perform a Girdlestone resection arthroplasty. The radiographic and histological findings resembled those reported in cases of aseptic osteonecrosis of the acetabulum after radiotherapy.
The properties of a rat brain glucuronyltransferase, which is presumed to be associated with the biosynthesis of the HNK-1 epitope on sulfoglucuronyl glycolipids, are described. The enzyme required divalent cations for reaction, with maximal activity at 10 mM Mn2+, and exhibited a dual optimum at pH 4-5 and pH 6 depending upon the buffer used, with the highest activity at pH 4.5 in MES buffer. This enzyme strictly recognized the Gal beta 1-4GlcNAc terminal structure, and was highly specific for neolacto (type 2) glycolipids as acceptor. The enzyme was localized specifically in the brain, and was barely detected in other issues, including the thymus, spleen, liver, kidney, lung, and sciatic nerve fibres. Phosphatidylinositol and phosphatidylserine increased the enzymatic reaction 4.4- and 2.3-fold, respectively, whereas phosphatidylcholine slightly decreased the rate.
Two hundred sixty-seven consecutive primary low-friction arthroplasties, followed for 5-18 years after surgery, were studied to assess the factors influencing survivorship of the femoral component, using the Kaplan-Meier method. The end point of survivorship was defined radiographically in two ways: incipient failure (subsidence of the femoral component of > or = 2 mm) and definite failure (progressive change of position). Twenty-two femoral components developed incipient failure, and twelve of these advanced to definite failure. A canal filling ratio of the stem of > or = 75%, cement extent distal to the stem tip of > or = 1 cm, use of an intramedullary bone plug, and an exaggerated valgus alignment of the stem correlated positively with survivorship of the femoral component. Calcar resorption and atrophy of the femoral cortex after surgery were associated with aseptic loosening of the femoral component.
This paper describes new passive splints which have been developed using a shape memory alloy. The peculiar feature of the splints is that the way in which they change shape in use conforms to the stretching motion which it would be desirable to apply in certain conditions of deformity. The alloy consists of 55.66% by weight Nickel and 44.34% Titanium. The heat treatment of the alloy for memorising shape was implemented at 500 degrees C for one hour. This alloy was easily bent when cool, but the original shape was recovered on heating. It was used as the supporting structure of the reverse knuckle bender splint and the cock-up splint. The new splints could be easily attached to the deformed limb after cooling. The splints avoided the development of spasticity, because they gradually recovered their original shapes and corrected the deformities when the heat of the room or body heat warmed the splints. Since the shape memory alloy has the dual function of thermal sensor and kinetic power source it was a simple device. The splint was, as a result, small and smart. It was apparent from clinical use that the splint was easy to wear and could be worn with comfort for an extended period. The design of the splints and the fabrication process are described and their application is indicated.
This study provides additional radiographic information concerning the long-term effect of ulnar impingement. Films of 198 wrists of 102 patients with vibration disease observed over ten or more years were reviewed. All the wrists showed ulnar plus variance of more than 0 mm except seven. Degenerative changes were found in 58 wrists and were seen only on the ulnar side of the wrist, especially in the ulnoproximal area of the lunate. Most of the degenerative changes in the wrists with ulnar plus variance had progressed or changed during the ten or more years. Ulnar plus variance may play an important role in inducing or causing progression of degenerative change in the wrist.
The electrophoretic mobility of Staphylococcus aureus 209P treated with cefodizime or cefotiam was examined by microscopic electrophoresis, and the production of oxygen-derived radicals by human polymorphonuclear leucocytes (PMN) was measured by a luminol-chemiluminescence assay. S. aureus cells moved from the negative to the positive electrode. Treatment with more than 0.039 mg/L (1/256 MIC) cefodizime or 0.313 mg/L (1/4 MIC) cefotiam significantly reduced the mean mobility compared with the untreated bacterial cells. The decrease of the electrophoretic mobility of antibiotic treated bacteria indicated the decrease of the negative charge of the cell surface. Chemiluminescence of PMN when stimulated by S. aureus treated with more than 0.156 mg/L cefodizime (1/64 MIC) or 1.25 mg/L cefotiam (MIC) increased significantly compared with the untreated cells. These results suggested that the antibiotics caused a decrease of negative charge density on the cell surface of S. aureus, followed by an increase of phagocytic activity of PMN for S. aureus. Furthermore, cefodizime showed this effect even at the low drug-concentration which did not influence the growth of the bacteria cells.
The combination of endogenous hypercortisolism and avascular necrosis is rare. A 53-year-old woman suffering from Cushing's disease, whose presenting symptom was hip-joint pain due to osteoarthritis secondary to avascular necrosis of the femoral head is described. About 6 years passed between a remarkable increase in weight and the onset of hip-joint pain. The hip joint was progressively destroyed, and total hip replacement was necessary 7 years after the onset of pain. This case report, as well as several previous reports, shows that avascular necrosis of bone may appear as a rare presenting manifestation of Cushing's disease.
We studied the radiographs of 211 low-friction arthroplasties, followed for five to 15 years after operation. The first 92 simple hemispherical sockets were fixed with an old technique: eburnated bone in the acetabular roof was removed and only a few large anchor holes were bored for cement fixation. With the next 119 sockets, 111 of which were flanged, the eburnated and subchondral bone was preserved and multiple small anchor holes were used. The modified technique and the use of flanged sockets significantly improved the late radiological findings as regards socket demarcation and wear. On the femoral side, the intramedullary canal filling ratio, the distal packing of cement, calcar resorption and atrophy of the femoral cortex were correlated with prosthetic subsidence.
A case of neurofibromatosis with spinal paralysis due to arteriovenous fistula is reported. Preoperatively, the appropriate diagnosis was missed because angiography had not been performed. Postoperative angiography disclosed that an arteriovenous fistula formed a tumor-like mass, and that a part of the mass had invaded the spinal canal, compressing the spinal cord. It is concluded that the possibility of an arteriovenous fistula should be kept in mind in neurofibromatosis patients with spinal cord symptoms.