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Clinical and radiological diagnosis of infantile fibrosarcoma (IFS) is challenging because of its similarity to vascular origin tumors. Treatment involves complete resection. Although chemotherapy may allow more conservative resection, treatment guidelines are not strictly defined. One IFS patient with an unresectable tumor had disease progression during chemotherapy. A primary tumor sample showed high VEGFR-1/2/3 and PDGFR-α/β expression. After pazopanib therapy, most tumor showed necrosis within 29 days and could be removed completely, with no relapse in 8 months post-resection. When IFS features hypervascularity, VEGFR and PDGFR expression may be high, thus allowing consideration of VEGFR inhibitors such as pazopanib.

Background There is a paucity of data that demonstrates a clinical impact of anatomical measurements of the aortic annulus by three-dimensional (3D) transesophageal echocardiography (TEE) on surgical aortic valve replacement (AVR). The aim of this study is to validate the accuracy of 3D TEE measurements compared with the direct intraoperative annular diameter and to investigate an impact of 3D TEE on a prediction of AVR with aortic annular enlargement (AAE). Methods and results We retrospectively enrolled 61 patients who underwent both two-dimension (2D) and 3D TEE and transthoracic echocardiography (TTE) before AVR. The annular diameters were measured noninvasively with 2D TEE (D2D) and TTE (DTTE) in a classical manner and the area- and perimeter-derived annular diameters (Darea, Dperim) were measured from using 3D TEE analysis. Intraoperative annular diameter was measured with the manufacture's sizer (Dintraope). Darea showed the best agreement with Dintraope in the Bland–Altman analysis. Darea, Dperim, D2D, and DTTE correlated well with Dintraope (r = 0.821, 0.820, 0.532, and 0.610, respectively; all p Conclusions 3D TEE measurement of aortic annular diameter showed better agreement with the direct intraoperative measurement than 2D TEE and TTE measurements. 3D TEE measurement could predict AVR with AAE more accurately than 2D TEE and TTE measurements.

Recently, exercise-induced spastic coronary artery occlusion at the site of moderate stenosis, which Prinzmetal's angina or cardiac syndrome X does not cover, was reported. Multi-modality imaging is important for the diagnosis of coronary artery disease with a complex ischemic mechanism. However, the previous report did not include findings from intracoronary imaging at the site of moderate coronary stenosis. We report a case of exercise-induced vasospastic angina at the site of moderate stenosis, where multi-modality imaging, including exercise stress echocardiography and intravascular ultrasound, was utilized to make a definitive diagnosis and investigate underlying causes.

Intensive treatment including surgery for patients with trisomy 13 (T13) remains controversial. This study aimed to evaluate the safety and efficacy of noncardiac surgical intervention for T13 patients. Medical records of patients with karyotypically confirmed T13 treated in the neonatal intensive care unit in Nagano Children's Hospital from January 2000 to October 2016 were retrospectively reviewed, and data from patients who underwent noncardiac surgery were analyzed. Of the 20 patients with T13, 15 (75%) underwent a total of 31 surgical procedures comprising 15 types, including tracheostomy in 10 patients and gastrostomy in 4. Operative time, anesthesia time, and amount of bleeding are described for the first time in a group of children with T13. All the procedures were completed safely with no anesthetic complications or surgery-related death. The overall rate of postoperative complications was 19.3%. Patients receiving tracheostomy had stable or improved respiratory condition. Six of them were discharged home and were alive at the time of this study. These results suggest at least short-term safety and efficacy of major noncardiac surgical procedures, and long-term efficacy of tracheostomy on survival or respiratory stabilization for home medical care of children with T13. Noncardiac surgical intervention is a reasonable choice for patients with T13.

A 22-year-old woman was referred to our hospital with syncope following chest pain. Initial work-up with blood test, electrocardiography, and echocardiography were unremarkable. Diffusion-weighted magnetic resonance imaging showed acute-stage cerebral infarction in the right temporal to occipital

Severe calcium (Ca) often but not always limits stent expansion. We sought to develop an intravascular ultrasound (IVUS) Ca score that predicts stent underexpansion (ST-UEx) in lesions with severe Ca. A total of 77 lesions in 77 patients with max pre-percutaneous coronary intervention (PCI) Ca arc

Neoatherosclerosis (NeoA) is a major cause of late stent failure, but outcomes after repeat revascularization remain unknown. A total of 345 second-generation DES in-stent restenotic (ISR) lesions were assessed using pre-percutaneous coronary intervention optical coherence tomography, then treated

Peripheral vascular disease (PVD) is associated with an increased risk of adverse events in patients with coronary artery disease, but its impact on treatment (percutaneous coronary intervention [PCI] or coronary artery bypass graft [CABG]) of unprotected left main coronary artery disease (LMCAD) is

We observed greater postoperative shrinkage of grafted fascia lata without peritendinous areolar tissue (PAT) than with PAT in blepharoptosis surgery. In this article, we sought to evaluate the influence of PAT on tendon grafts.Pairs of anterior tibial tendons with or without PAT were grafted onto the backs of 12 adult Wistar rats. The cephalic and caudal ends of the tendons with or without PAT were fixed tightly on the fascia of the erector spinae muscles with 6/0 polypropylene sutures. A 7-mm distance was maintained between the sutures. Changes in the length between the sutures as well as changes in the histology of the tendons with or without PAT were evaluated at 1 and 5 months after grafting.The mean lengths of the grafted tendons with PAT at 1 and 5 months after grafting were significantly longer than those without PAT at 1 and 5 months after grafting, respectively (5.4 mm and 4.5 mm vs. 3.8 mm and 2.9 mm, respectively; Wilcoxon signed-rank test; P0.05). The grafted tendons without PAT displayed central necrosis and scar formation, whereas those with PAT displayed no alteration in the tissue properties.At both 1 and 5 months after grafting, the grafted tendons with PAT were significantly longer and survived better than those without PAT. Tendon grafts with PAT had increased survival of the endotendinous tissue and diminished postoperative shrinkage, since the vascular network of the PAT potentially contributes to early revascularisation of the graft.

There is a paucity of an investigation of 6-minite walk stress echocardiography (6WSE) for patients with aortic stenosis (AS). The aim of this study is to investigate the significance and safety of 6WSE for AS patients. We prospectively evaluate consecutive 102 ambulant patients with moderate or

Clinical and radiological diagnosis of infantile fibrosarcoma (IFS) is challenging because of its similarity to vascular origin tumors. Treatment involves complete resection. Although chemotherapy may allow more conservative resection, treatment guidelines are not strictly defined. One IFS patient with an unresectable tumor had disease progression during chemotherapy. A primary tumor sample showed high VEGFR-1/2/3 and PDGFR-α/β expression. After pazopanib therapy, most tumor showed necrosis within 29 days and could be removed completely, with no relapse in 8 months post-resection. When IFS features hypervascularity, VEGFR and PDGFR expression may be high, thus allowing consideration of VEGFR inhibitors such as pazopanib.

We present a case involving a giant hemangioma of the fetal neck, prenatal diagnosis of which was a teratoma. A 32-year-old pregnant woman was referred to our hospital at 31 weeks' gestation owing to a giant solid mass of the fetal neck and excessive amniotic fluid. The mass seemed to be occupying the neck almost entirely, extending to the nasopharyngeal cavity, the mandible, the surface of the left orbit and the left shoulder. Based on sonographic and magnetic resonance imaging (MRI) findings, diagnosis of a giant teratoma was made. Cesarean section was performed at 35.5 weeks' gestation, and a female infant weighing 2826 g was delivered. Purpurae were observed on the neck of the infant, and the tumor turned out to be a hemangioma. Postnatal MRI findings, in which the tumor's signal intensity differed from that of the prenatal findings, were quite compatible with the diagnosis of a typical hemangioma. Laser and corticosteroid treatment successfully decreased the volume of the mass. Although it may not always be possible to make a prenatal differential diagnosis between a hemangioma and a teratoma in the neck of the fetus, serial ultrasound and MRI examination are mandatory to evaluate the prognosis and to plan suitable treatment. Moreover, possible postnatal changes to the tumor characteristics have to be taken into consideration when evaluating the findings of prenatal diagnostic imaging.

We conducted maxillary distraction utilizing internal distraction devices in three patients with Apert syndrome. For these cases, we examined maxillary bone displacement, the relapse of bone distraction length and inclination changes. For this study, we chose three female patients between nine years two months and fifteen years eight months of age at the time of operation. After receiving a Le Fort III osteotomy, each patient received maxillary advancement utilizing internal distraction devices. The device was activated 1.0mm per day. After the lengthening devices were removed, the maxilla was reconstructed using poly L-lactic acid (PLLA) plates. Corresponding to pre-operation, post-operation, 1-year and 2-year post-operative periods, lateral cephalogram tracings were made. By standardizing the superimposition lateral cephalogram for the cranial base, each measurement point reflected it on the FH plane. Based on these observations, we studied the displacement in the horizontal and vertical directions of the maxilla which were indicated by point A, and we examined the inclination changes of the palatal plane based on the FH plane. As a result, the distraction lengths at point A were from 10.0mm to 14.8mm. In the two younger age groups, large differences between setting and real quantities of bone distraction lengths have not been found. Yet for the other case, actual distraction length was less than the setting length. As for the bone distraction length relapse, an average rate of 4.0% was recognized in the horizontal direction, but was not found in the vertical direction. To explain such a small relapse rate, the following reasons were discussed: longer than three months of retention period had been taken for the studies; mini-plate fixation had been applied as well as retention with the maxillary protractor; and anterior and downward growth of maxilla had taken place. The changes of the palatal plane angle had rotated counter-clockwise from 1.5° to 3.0° in the pre- and post-operative stages, and had rotated clockwise from 0.5° to 3.0° in the immediately-post and 1-year post-operative period. For the 1-year and 2-year post-operative period, a clockwise rotation rate from 1.0° to 1.5° was recognized. The palatal plane had rotated counter-clockwise after the operation, but we succeeded in achieving a relapse rate almost the same as the preoperative length.

眼瞼外層の再建に対しては，局所皮弁，特に眼輪筋を茎とした前進皮弁が有用である。上眼瞼の1/4以上の欠損には，下眼瞼の交差皮弁が機能的，整容的に優れている。広範な欠損には，耳介島状皮弁や遊離前腕皮弁のような薄い皮弁が動きのある再建に適している。挙筋機能を失った上眼瞼全層欠損に対し，遊離前腕皮弁と硬口蓋粘膜移植を用いた再建例では，上直筋の動きで上眼瞼の挙上が可能となり，色調質感も優れていた。広背筋皮弁や腹直筋皮弁は，前外側大腿皮弁よりも色調質感で勝ってはいるが，白さがやや目立つ。組織拡張器を用いた前額皮弁は，色調質感の点で優れているが，手術が二期的になる欠点がある。下眼瞼の欠損には，鼻唇溝皮弁や上眼瞼からの筋皮弁，頬部回転皮弁が用いられる。下眼瞼後壁の再建には耳介軟骨移植が有用だが，結膜円蓋が温存されていない場合には，粘膜付き鼻中隔軟骨移植が望ましい。

Aims: To investigate the efficacy and safety of leflunomide, including the side-effects, we assessed 84 rheumatoid arthritis (RA) patients who received leflunomide treatment. Methods: We analyzed the C-reactive protein (CRP), white blood cell count (WBC), KL-6, and visual analogue scale (VAS) scores, modified Stanford Health Assessment Questionnaire (MHAQ) score, American Rheumatism Association score (ACR20 and ACR50) within a time course after treatment with leflunomide. We treated 84 RA patients, 12 male and 72 female from 28 to 81-years-old, with an average age of 63.5 years. The patients were divided into three groups: a group consisting of 38 patients who received 100 mg/day of leflunomide for 3 days followed by 20 mg/day thereafter; a second group of 11 patients who received a no-loading dose of 10 mg/day; and a third group of 35 patients who received a no loading dose of 20 mg/day. Results: The 50% decrease of CRP seen in 2 weeks was 52% of the total of 84 patients. The WBC score did not change significantly after the medication was given. The KL-6 score did not change significantly, either. The VAS pain score improved 4 weeks later, and then further improved 8 weeks later. Therefore, RA patients using leflunomide obtained pain relief 4 weeks after commencing medication. The MHAQ score did not change significantly until 8 weeks after the patients started the medication. ACR20 was 62% and ACR50 was 38% at 8 weeks after treatment. The side-effects of leflunomide observed in our patients were rash, respiratory infection, diarrhea, nausea, alopecia, muscle pain, headache, dizziness and general fatigue. Twenty-three out of 84 patients experienced side-effects (27%), and 48/84 (57%) experienced withdrawal. In our hospital, there were no patients who developed severe interstitial pneumonia (IP) or who died after taking leflunomide; however, the incidence of side-effects of the 100 mg/day loading dose (42.1%) was 2.5 times higher than in the patients who received 20 mg/day (17.1%) of a no-loading dose. Conclusion: Because of this, it is possible that a 100 mg/day loading dose is a relatively high risk dose in terms of causing side-effects, especially for severely ill RA patients with a high CRP level.

Background/Purpose: The Nuss procedure involves elevation of the sternum using a pectus bar, which is subsequently removed after approximately 3 years. When removing the bar, the tip of 1 end of the bar is exposed, and then the body is changed to the lateral recumbent position to remove the bar along the body surface. However, changing body positions in a sterile manner is often difficult. In this report, the authors present a new technique using their original bender design with which pectus bars can be smoothly removed. Methods: After exposing the pectus bar by placing a skin incision in the same location as had been used for bar insertion, benders were inserted subcutaneously into the thoracic wall at both ends of the bar. The bar was then immobilized, straightened, and removed. No change of body position was required. Conclusions: Between 2002 and 2003, this technique was used on 10 patients, and the bars were removed easily from all patients. The new procedure uses benders at both ends of the pectus bar as supporting points. This reduces the force required to straighten the bar and stabilizes the bar during removal. Most importantly, our procedure eliminates the need for change of body position.

A 73-year-old man underwent ascending and total arch replacement for thoracic aortic aneurysm. Seven days after the surgery, he developed acute coronary syndrome with ST-segment elevation in the aVR and aVL leads, and diffuse ST-segment depression in all other leads ([Figure 1][1]). Emergent

Background: Although proton pump inhibitors (PPI) and H2-receptor antagonists (H2-RA) are routinely used in the treatment of reflux esophagitis (RE), no consensus has been reached yet as to whether the first-choice drug should be PPI or H2-RA. In this study, the effects of omeprazole (OMP) and famotidine (FAM) on RE have been examined in a randomized comparative study. Methods: Protocols of OMP 20 mg once daily or FAM 20 mg twice daily for 8 weeks were allocated to 56 cases with RE at random, using an envelope randomization method. Their efficacy in achieving healing was examined endoscopically and a relief from subjective symptoms was compared. Results: Patient's background such as sex, age, recurrence, hiatal hernia, smoking and drinking habits, and complications, and the severity of esophagitis at the time of enrolment were not significantly different between the two groups. Healing in the OMP group and the FAM group was observed in 72 and 32% (P = 0.025) of patients at week 4 and 95 and 53% (P = 0.003) of patients at week 8, respectively. Subjective symptoms were relieved more frequently in the OMP group (at week 2, 67% compared with 29%, P = 0.005; at week 4, 95% compared with 55%, P = 0.009), but this superiority was not significant at week 8 (94% compared with 65%, P = 0.085). No serious adverse events occurred. Conclusions: Omeprazole provided quicker healing and a greater relief from subjective symptoms than did FAM in the treatment of RE, and was considered more suitable as a first-choice drug. © 2002 Blackwell Publishing Asia Pty Ltd

Fracture-dislocation of the tarsal navicular is rare injury because of strong ligamentous support on both its plantar and dorsal sides. The authors report a case of a twenty-five-year-old man who sustained bilateral isolated tarsal navicular fracture-dislocations, treated by open reduction and internal fixation combined with external fixation. The patient reported no difficulty in activities of daily living, but T1-weighted magnetic resonance imaging showed a low-intensity area in right tarsal navicular, raising suspicion of osteonecrosis when he was last seen two year three months after operation.

Apert's disease is distinguished from other acrocephalosyndactylys by bilateral and symmetrical deformities, including symphalangism of the hands, which is commonly present in the index, long, and ring fingers. In the correction of the Apert hand, simple separation and skin grafting may be used to create a five-digit hand. However, this technique may result in narrow, atrophic fingertips, and pulp pads. In this paper, a simple technique to create nail folds and pulps for each finger with four transposition flaps from the common pulp is described. During the past 3 years, four Apert hand deformities in 2 patients were treated with this procedure. At a mean follow-up of 32 months, good results were obtained.

We examined the effects of lansoprazole and famotidine on gastric basic fibroblast growth factor (bFGF) levels and ulcer healing in patients with gastric ulcer. Sixteen patients with active gastric ulcer were divided into two groups and received treatment with lansoprazole 30 mg/day or famotidine 40 mg/day. They were examined endoscopically at 2, 4, and 8 weeks to measure gastric bFGF levels at the ulcer margin and to assess ulcer healing. Helicobacter pylori infection was determined by a rapid urease test. The two groups were comparable with regard to age, male :female ratio, H. pylori infection rates, and bFGF levels. During treatment, bFGF levels did not change significantly in the famotidine group, whereas they increased by a factor of 2.2 to 2.6 in the lansoprazole group. Cumulative healing rates were also significantly lower in the famotidine group than in the lansoprazole group. These results indicate that lansoprazole increases tissue bFGF levels and promotes gastric ulcer healing in humans.

A case of stenosis of the external auditory canal secondary to a burn injury was reconstructed with a chondrocutaneous postauricular flap. Advantages of this technique include the use of a single flap to reconstruct the whole circumference of the canal, the fact that a chondrocutaneous flap is more likely to prevent restenosis than a skin flap alone, and the fact that reconstruction with an axial-pattern flap is more reliable than reconstruction with a random-pattern flap.

Objective This study aimed to elucidate dynamic effects of the Nuss procedure on the spine in the treatment of patients with pectus excavatum with asymmetric thoraces. Methods Twenty-five patients with pectus excavatum who underwent the Nuss procedure were categorized into 4 groups by preoperative morphology of the spine and thoracic asymmetry. In group 1 (n = 8), the right side of the thorax was concave and the spine bowed to the right. In group 2 (n = 4), the right side of the thorax was concave and the spine bowed to the left. In group 3 (n = 5), the left side of the thorax was concave and the spine bowed to the right. In group 4 (n = 8), the left side of the thorax was concave and the spine bowed to the left. With computed tomographic data, finite-element models were produced to simulate each patient's thorax. Thereafter, dynamic response patterns of the spine to the Nuss procedure were examined. Validity of these biomechanical findings was verified by referring to clinical outcomes. Results In group 1 and group 4 models, deformed spines were straightened; in group 2 and group 3 models, spinal bowing increased. These biomechanical findings were compatible with clinical evaluations. Conclusions Performance of the Nuss procedure for asymmetric pectus excavatum exerts dynamic influence on the spine. Response patterns of the spine are predictable from morphologic relationships between the asymmetric patterns of the anterior thoracic wall and the spine.

1991年のInternational Mechanical pulping Conference においてカヤーニ社から発表されたメカニカルパルプの連続フリーネス測定装置 (カヤーニPDA) についてのAntti Kaunonen, Matti Luukkonenの論文及び関連文献としてNBKPのリファィニング最適化のための繊維長測定装置 (カヤーニFS-200) の活用法に関するKajaani Application Report (Hannu Suutari) を紹介する。

Background Since tendons show viscoelastic behavior, dynamic viscoelastic properties should be assessed in addition to static biomechanical properties. We evaluated differences between static and dynamic biomechanical properties of the regenerating rabbit Achilles tendon following tenotomy. Methods At 3, 6, or 12 weeks after right Achilles tenotomy, the right (regenerating) and left (control) tendons were collected with the calcaneus from 49 rabbits. A unidirectional failure test and a dynamic viscoelastic test were conducted. Findings Tensile strength and Young’s modulus (static biomechanical properties) in the regenerating group at Week 6 were significantly greater than at Week 3, while at Week 12, these were significantly greater than at Week 6. However, even at Week 12, both parameters were less than in the control group. The value of tan δ represents dynamic viscoelasticity, a smaller tan δ indicates greater elasticity. tan δ for the regenerating group was significantly greater than for the control group at Week 3, but regenerating and control groups did not significantly differ at Week 6. No marked change was seen from Weeks 6 to 12 in the regenerating group, and no significant difference in tan δ was evident between the regenerating and control groups at Week 12. Interpretation Dynamic biomechanical properties of regenerating rabbit Achilles tendons may improve more rapidly than static biomechanical properties. Ability to tolerate dynamic movement in the healing Achilles tendon may improve more rapidly than ability to withstand static stresses.

We report a case in which combination chemotherapy of TS-1 and paclitaxel was effective for gastric cancer with malignant ascites, metastatic ovarian cancer and hydronephrosis. Judging from the above issue, the stage was IV and the type was Borrmann 4. The chemotherapy schedule was adjusted at the patient' s request without hindering her activities of daily living. The patient was a 53-year-old woman who suffered from gastric cancer as having malignant ascites and metastatic ovarian tumor. As an outpatient, she was treated with combination chemotherapy of TS-1 and paclitaxel for 2 cycles. The ascites had remarkably disappeared after 2 cycles. The adverse event was alopecia (grade 2), but she could continue the chemotherapy as an outpatient treatment. After completing 5 cycles of chemotherapy, we recognized the primary tumor as an endoscopic complete response.

Summary We report the long-term results of nail fusion plasty in eight duplicated thumbs. These eight cases were hypoplastic, with nails less than 80% the size of that on the normal side. We operated on these duplicated thumbs using a technique that we developed. We evaluated postoperative nail shape in our series using both our and Tada's scoring systems. The average follow-up period was 12 years. Excellent results were obtained in six cases, with natural-looking nails and even curvature. One case showed acceptable results. Only one case had uneven curvature and a gap in the nail. To reconstruct a natural-looking nail, it is important to correctly design and suture together two nails under no tension. To obtain one nail with even curvature, bones are left floating so that the nail can grow with a natural transverse curve without interference. This technique yielded promising results on long-term follow-up.

We have performed numerical analysis of localized surface plasmons (LSP) at a nano silver particle on a glass substrate using the finite-difference time-domain method, taking into account the size dependence of the dielectric constants of silver. It was found that the characteristics of LSP at a nano metal particle depend on both shapes of the particles and a dielectric constant of the substrate. In calculations, we employed the geometry in which a nano-particle was located on a glass substrate, the area of calculations. The three types of particles were assumed: a sphere, a spheroid and a hemisphere. In spheroid, the aspect ratio of particles R, is changed from 1.0 to 2.0. For the normal incidence to the spheroid, i.e., the long-axis, the characteristics of LSP are insensitive to R compared. It was observed the red-shift of LSP resonance wavelength and the field enhancement due to the mirror image in the substrate. For spheres and spheroid, the strong enhancement of the z-component field was observed on the substrate. For the hemisphere, we have found the strong localization of the field along the edge of the hemisphere and the strong enhancement of the x-component field was observed on the surface of the substrate.

The treatment of complicated syndactyly has been a difficult problem because it involves not only cutaneous syndactyly but also abnormal arrangement of the finger rays. This means that this anomaly is characterized by abnormal patterns of the palmar creases. The authors prepared a template for tracing the proximal, middle, and distal palmar creases of the nonaffected hand on a clear film and used it as a mirror image to create the preoperative design, to measure the distance between the fingers, and to estimate the location and size of the skin graft intraoperatively. The authors think that the recreation of the normal palmar crease pattern in the affected hand can lead to normal arrangement of the fingers and it is very useful for the reconstruction of multiple finger webbing as part of the treatment of complicated syndactyly.

We describe a simple method of correction of the Stahl's ear deformity. The deformed portion of the auricular cartilage is cut into tiny pieces and put back into the abnormal area. The helix and the scapha are then moulded into a normal ear shape and maintained in position with a tie-over bolster. A gutta-percha splint is used for a further month. Over a 3-year period, 6 Stahl's ear deformities in 5 patients were treated with this procedure. All patients were followed up for at least 1 year. We believe that this procedure can be applied to other partial auricular deformities as well.

Accurate measurement of the cross-sectional area of tendons and ligaments is essential in determining the mechanical properties of biological specimens. We measured these cross-sectional areas in rabbit specimens in vitro, using ultrasonography, in order to evaluate the usefulness of this method as a noncontact measurement technique. The cross-sectional areas of a rabbit's Achilles tendon, medial collateral ligament (MCL), and anterior cruciate ligament (ACL) were measured by means of ultrasonography, digital calipers, and computerized image analysis. For each of these three soft tissues, there was a high correlation between the values yielded by digital calipers and ultrasonography, and there was no significant difference in the values obtained by these three methods. Ultrasonography can detect the concavities on the surface of a specimen such as the ACL, because the shape of the specimen's transverse sonogram resembles its cross-sectional shape on a photograph. We concluded that the values yielded by ultrasonography were acceptable, and that ultrasonography is a useful noncontact measurement technique.

The molecular behavior of water in normal and regenerating tendons was analyzed using the transverse relaxation time (T(2)) measured by spin-echo proton nuclear magnetic resonance ((1)H-NMR) spectroscopy at 2.34 T (25 degrees C). A section of the Achilles tendon was dissected from an anesthetized Japanese white rabbit, and its longitudinal axis was oriented at 0, 35, 54.7, 75, and 90 degrees to the static magnetic field. In the normal tendon, the T(2) relaxation of water presented biexponential relaxation and anisotropy in both the long T(2) (5.41 to 6.21 ms) and short T(2) (0.41 to 1.43 ms) components, in which the greatest values were obtained at 54.7 degrees. However, the range of the anisotropy was much narrower than we expected from the (1)H dipolar interaction of water bound to the collagen fibers in the tendon. The apparent fractions of water proton density also varied with orientation: the fraction of the longer T(2) components was at its maximum at 54.7 degrees. These results suggest that a simple two-compartment model could not be applicable to orientational dependency of the T(2) value of the tendon, and the well ordered water in the short T(2) relaxation component may show an elongated T(2) relaxation time that falls in the range of the long T(2) relaxation component at 54.7 degrees. This hypothesis can explain both the narrower range of the T(2) relaxation time and the orientational dependency on the apparent fraction of (1)H density. Regenerating processes of the Achilles tendon were followed for 18 weeks by analyzing the T(2) relaxation time. There is only a long T(2) relaxation time component (21.8 to 28.0 ms) up to 3 weeks after transection. Biexponential relaxation is revealed at 6 weeks and thereafter, whereby (i) the T(2) relaxation times become shorter, (ii) there is anisotropy in the short and long T(2) values, and (iii) the orientational dependency of the apparent fraction of water proton density becomes evident with maturation of the regenerating tendon. From these results, the (1)H T(2) relaxation time of water might be used to monitor the healing process of collagen structures of the tendon non-invasively.

Background A new radiographic view was proposed to evaluate the coronal plane alignment of the hindfoot under weightbearing conditions. Methods We studied 46 feet of individuals with normal appearing asymptomatic feet. On the antero-posterior roentgenogram using this new method, the line from the top of the sustentaculum tali to the lateral-inferior end of the posterior articular surface of the talus was obtained as the standard line showing varus or valgus of the calcaneus. We defined the angle between the longitudinal axis of the tibia and the standard line as described above as Varus-Valgus angle (V-V angle). Results The mean (±SD) V-V angle of the 46 feet studied was 76.4 (±3.6) degrees. Conclusion The findings from this study indicate that it is possible to estimate the alignment of the hindfoot quantitatively by comparing individuals to the mean V-V angle that we calculated in our sample, which was 76.4 degrees.

Bilateral nasolabial flaps pedicled on the infraorbital vessels, and costal cartilage grafts were used to reconstruct a severe nasal deformity caused by Wegener's granuloma. We believe this flap is another useful method for nasal reconstruction, when nasolabial flaps pedicled on the angular vessels cannot be used.

The effects of healing time and anterior cruciate ligament reconstruction on healing of the medial collateral ligament and stability of the knee joint were evaluated in a rabbit model of an O'Donoghue triad injury (rupture of the medial collateral ligament with removal of the anterior cruciate ligament and part of the medial meniscus). At time 0 and at 6 and 12 weeks postoperatively, the anterior-posterior translation and varus-valgus rotation of the knee, the structural properties of the femur-medial collateral ligament-tibia complex, and the mechanical properties of the substance of the medial collateral ligament were evaluated. Although anterior-posterior translation increased significantly with time, we could not demonstrate a significant temporal effect on varus-valgus rotation. The ultimate load, elongation at failure, and energy absorbed to failure improved with time. In addition, with time, failure of the complex occurred more often in the ligament substance than at the osseous insertion. Because healing time did not affect the cross-sectional area or modulus of the medial collateral ligament, the improved structural properties of the complex resulted not from improvements in the mechanical properties of the tissue but rather from healing of the tibial insertion site. By 12 weeks, the reconstructed knees had only minor signs of osteoarthrosis on the tibiofemoral surfaces; this is in contrast to the findings in anterior cruciate ligament-deficient knees in our earlier study. Additionally, at 12 weeks, the stiffness of the complexes from the reconstructed group was 1.3 times that of the anterior cruciate ligament-deficient group (p < 0.05), and te ultimate load had increased by a factor of 1.6 (p < 0.05). Our findings demonstrate that reconstruction of the anterior cruciate ligament in the rabbit helps to stabilize the joint, improves healing of the medial collateral ligament, and may decrease the incidence of early-onset osteoarthrosis after an O'Donoghue triad injury.

This study was designed to compare five different suture methods that are used clinically for tendon repair. The flexor digitorum profundus tendons from the digits of adult mongrel dogs and adult human cadavers were used as models. The tendons in zone II of the hand, defined as the region from the distal palmar crease to the insertion of the flexor digitorum superficialis tendon at the middle phalanx, were transected and then were repaired by one of the suture methods developed by Kessler, Tsuge, Tajima, Savage, or Lee. The gliding function and tensile properties of the repaired tendons were evaluated biomechanically at time zero. The Tajima and Savage methods produced better gliding function than the other techniques. In the canine specimens that had been repaired by one of these two methods, the rotation of the distal interphalangeal joint was more than 60% of the rotation of the canine control specimens; only the Savage technique produced a rotation 124% that of the human control specimens. After the Tajima repair, the rotation of the proximal interphalangeal joint was 113% that of the canine control specimens and 157% that of the human controls. In the canine specimens that had had the Tajima or Savage repair, excursion of the tendon was greater than 55% that of the controls. The tendons repaired by the Savage method tolerated a significantly higher ultimate load to failure (14 and 25% that of the canine and human control specimens, respectively) than the other methods.(ABSTRACT TRUNCATED AT 250 WORDS)