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The aim of the current study was to evaluate long-term outcomes of pediatric live kidney transplantation in patients with genitourinary anomalies relative to those with primary kidney diseases. The study included 35 pediatric patients who received a live kidney transplantation during the last 25 yr (28 males, six females). Median age at the time of transplantation was nine yr (range 1–15 yr), and the median follow-up period was 151 months (range 6–239 month). The patients were divided into two groups. The urological group (n = 14) included patients with primary obstructive/reflux nephropathy. The renal group (n = 20) included patients with primary renal disorders. Differences between groups in graft survival, clinical course, and final graft function were evaluated. Original diseases represented in the urological group included five cases with primary VUR and eight cases with secondary VUR. Diseases in the renal group included eight cases with bilateral hypo-dysplastic kidney, three cases with focal/segmental glomerular sclerosis, two cases with membranous proliferative glomerulonephritis, two cases with congenital nephrotic syndrome and five cases with other forms of chronic nephritis. Ten of 14 cases in the urological group, relative to six of 20 in the renal group, were preemptive. Median age at transplantation was 7.5 or 10 yr old, respectively, in the urological or renal group. Twelve kidney recipients in the urological group had also undergone other urinary surgeries, including upper urinary tract drainage, ureteroneocystostomy, augmentation cystoplasty, endoscopic incision of posterior-urethral valve, urethroplasty, etc. Cumulative post-operative complications occurred in nine or 16, respectively, in the urological or renal group. The acute rejection free and overall graft survival were similar in both groups. One patient in the urological group lost his graft while six patients in the renal group lost their grafts. Thus, the post-transplant clinical outcome

Triangular fibrocartilage complex (TFCC) insertion into the fovea of the distal ulna plays a crucial role in stabilizing the distal radioulnar joint. Consequently, surgical reattachment against avulsion of the foveal TFCC insertion is required to stabilize the distal radioulnar joint. However, because of technical difficulties, no arthroscopic procedure for such a lesion has currently been established. We present a new technique for arthroscopic reattachment of the avulsed TFCC into the fovea. An osseous tunnel 2.9 mm in diameter is created from the ulnar neck to the foveal surface. Under arthroscopic guidance, a nonabsorbable suture passed into a 21 gauge needle is placed into the TFCC through the osseous tunnel. The avulsed portion of the TFCC is anchored to the fovea by means of a repair suture passed through the TFCC. To achieve normal tension of the TFCC, the suture is tied onto the periosteum around the proximal entrance of the osseous tunnel. Our arthroscopic technique is relatively simple and has significant advantages for progressive healing at the attachment site between the TFCC and the fovea.

The authors report the cases of 3 patients with tuberculous spondylodiscitis. All patients suffered from severe back or low back pain. Posterolateral endoscopic debridement and irrigation were performed followed by retention of a drainage tube at the affected sites. Additional puncture and drainage were conducted at the same time when extensive cold abscesses were identified around the paravertebral muscle. All patients experienced immediate pain relief postoperatively. This technique is effective for rapid pain relief and in obtaining neurological resolution for patients in the early stages of tuberculous spondylodiscitis and may also be a good method for preventing further vertebral collapse and kyphotic spinal deformity such as Gibbus vertebrae.

In a prospective study, 194 knees undergoing total knee arthroplasty (110 knees with alumina ceramic prostheses; 84 knees with Co-Cr alloy prostheses) were clinically and radiologically evaluated. Average follow-up period was 66 months (36-124 months). Average age at the time of surgery was 66 years. In the ceramic prostheses, two revision surgeries were performed because of breakage of the tibial tray and late infection, whereas two revisions of the Co-Cr alloy prostheses were carried out due to loosening and late infection. In the other patients, there were no significant differences in clinical parameters (HSS knee score and range of motion) between the two prostheses. In radiological evaluation, we could not find any radiolucent lines around the femoral ceramic component while radiolucency was present in three knees (3.6%) around the Co-Cr femoral component. Beneath the tibial tray, three knees (2.7%) showed a radiolucent line around the former prosthesis while eight knees (9.5%) demonstrated a radiolucent line around the latter prosthesis. Chi-square tests showed a significant difference in the occurrence of radiolucent line around both of the femoral and tibial prosthesis. This study demonstrated that clinical results of the alumina ceramic PCL retaining total knee prosthesis are comparable to the standard Co-Cr alloy PCL retaining total knee prosthesis. Although we could not draw any conclusions regarding the superiority of the ceramic prosthesis with respect to UHMWPE wear and long-term survivorship, this report encouraged a long-term follow-up study on ceramic prostheses.

Video assisted surgery for esophageal cancer is an advanced surgical technique. It is being adopted with a concept of minimally invasive surgery. Since there are several options of the operative procedure for thoracic esophageal cancer, there are several laparoscopic approaches. The first VATS esophagectomy through a right thoracoscopic approach and the first transhiatal esophagectomy were reported in early 1990's. Mediastinoscope-assisted esophagectomy is also reported as a substitute of the blunt dissection of the esophagus. Moreover, video assisted Ivor-Lewis esophagectomy by right thoracotomy with intrathoracic anastomosis has also been tried. Furthermore, laparoscopic gastric mobilization and gastroplasty is also widely accepted as a substitution for open laparotomy. This article serves to review the literature on laparoscopic approaches for esophageal cancer.

Video assisted surgery for esophageal cancer is an advanced surgical technique. It is being adopted with a concept of minimally invasive surgery. Since there are several options of the operative procedure for thoracic esophageal cancer, there are several laparoscopic approaches. The first VATS esophagectomy through a right thoracoscopic approach and the first transhiatal esophagectomy were reported in early 1990's. Mediastinoscope-assisted esophagectomy is also reported as a substitute of the blunt dissection of the esophagus. Moreover, video assisted Ivor-Lewis esophagectomy by right thoracotomy with intrathoracic anastomosis has also been tried. Furthermore, laparoscopic gastric mobilization and gastroplasty is also widely accepted as a substitution for open laparotomy. This article serves to review the literature on laparoscopic approaches for esophageal cancer.

Background: No studies have been conducted to clarify an in vivo remodeling of the radiofrequency-treated lesion of the anterior cruciate ligament. The purpose was to determine in vivo effects of radiofrequency shrinkage on mechanical properties of the anterior cruciate ligament. Methods: Thirty skeletally mature rabbits were used. In each group, radiofrequency energy set at non-ablative levels was applied to the posterolateral bundle of the anterior cruciate ligament with a bipolar radiofrequency generator. All animals were sacrificed at 0, 6, and 12 weeks after surgery, respectively. In each group, 7 and 3 out of the 10 specimens were used for biomechanical and histological evaluations. Findings: After shrinkage treatment, the anterior–posterior translation of the knee and the length of the posterolateral bundle were significantly reduced immediately after surgery, but that this effect disappeared at 6 weeks. The tensile strength and the tangent modulus of the treated bundle were significantly lower than that of the normal control bundle at each period. In addition, the tensile strength and the tangent modulus measured at 12 weeks were significantly lower than that at 0 week. Histological examination showed granulation-like tissues with numerous plump fibroblasts and inflammatory cells were dominantly found in the midsubstance of the posterolateral bundle at 12 weeks. Interpretations: This result suggested that the anterior cruciate ligament tissue shortened with the radiofrequency treatment is elongated gradually over time. The mechanical properties of the posterolateral bundle of the anterior cruciate ligament reduced by the radiofrequency shrinkage are not restored in vivo, but significantly deteriorated with time.

Spindle cell-type undifferentiated carcinoma arising from the extrahepatic bile duct is extremely rare. We report herein a case of this type of carcinoma in the common bile duct of the hepatic hilus. A 59-year-old man was admitted to our hospital complaining of jaundice. Laboratory data revealed elevation of serum CA 19-9. Cholangiography revealed complete obliteration of the left hepatic bile duct and stenosis of the bile duct from the superior to the right hepatic bile duct. Computed tomography showed the tumor, measuring 15×12 mm, in the hepatic hilus, obliteration of the right to main trunk of the portal vein and a lymph node in the hepato-duodenum ligament swelling. Arteriography revealed a kink of the right hepatic artery, so encasement of the right hepatic artery was suspected. We preoperatively diagnosed hilus bile duct carcinoma and scheduled right trisection hepatectomy. Intraoperative frozen sections taken from the tumor and tissues around hepatic arteries showed spindle cells and inflammatory cells, so inflammatory pseudotumor was diagnosed intraoperatively. Because the right hepatic bile duct was occluded, right lobe hepatectomy was performed. However, permanent section revealed both spindle cells and poorly differentiated tubular adenocarcinoma cells positive for CAM5.2, AE1/AE3 and vimentin. Based on these findings, the tumor was finally diagnosed as spindle cell-type undifferentiated carcinoma. The patient died of pulmonary infarction 11 days after the operation.

OBJECT: The objectives of this study were to compare the biomechanical effects of five lumbar reconstruction models on the adjacent segment and to analyze the effects of three factors: construct stiffness, sagittal alignment, and the number of fused segments. METHODS: Nondestructive flexion-extension tests were performed by applying pure moments to 10 calf spinal (L3-S1) specimens. One-segment (L5-6) or two-segment (L5-S1) posterior fusion methods were simulated: 1) one-segment posterolateral fusion (PLF); 2) one-segment PLF with interbody fusion cages (one-segment PLIF/PLF); 3) two-segment PLF; 4) two-segment PLIF/PLF; and 5) two-segment PLF in kyphosis (two-segment kyphotic PLF). The range of motion (ROM) of the reconstructed segments, intradiscal pressure (IDP), and lamina strain in the upper (L4-5) adjacent segment were analyzed. The ROM was significantly decreased in the PLIF/PLF models compared with that in the PLF alone models after both the one- and two-segment fusions. If the number of fused segments was increased, the pressure and strains were also increased in specimens subjected to the PLIF/PLF procedure, more so than the PLF-alone procedure. In the one-segment PLIF/PLF model the authors observed a reduced IDP and lamina strain compared with those in the kyphotic two-segment PLF model despite the latter's higher levels of initial stiffness. CONCLUSIONS: If the number of fused levels can be reduced by using PLIF to correct local kyphosis, then this procedure may be valuable for reducing adjacent-segment degenerative changes.

Study design: A case report. Objectives: To report a rare case of extension of edema and hemorrhage from initial C4–5 spinal injury to the medulla oblongata. Setting: Center for Spinal Disorders and Injuries, Bibai Rosai Hospital, Japan. Methods: A 68-year-old man with ossification of the posterior longitudinal ligament (OPLL) had sustained tetraplegia after tumbling over a stone. Initially, the patient was diagnosed with an acute C4–5 spinal cord injury without radiological abnormalities and was treated conservatively. At 7 h after the injury, the patient had an ascending neurological deficit, which required respiratory assistance. Magnetic resonance imaging revealed a marked swelling of the spinal cord above C4–5 extending to the medulla oblongata. Results: Retrospective radiological assessment revealed that the spine was unstable at the injury level because of discontinuities in both anterior and posterior longitudinal ligaments. There was also signal intensity change within the retropharyngeal space at the C4–5 intervertebral disc. This injured segment was highly vulnerable to post-injury dynamic stenosis and easily sustained secondary neural damage. Conclusions: This case report emphasizes a careful radiological assessment of latent structural instability in patients with OPLL in order to detect and prevent deteriorative change in the spinal cord.

OBJECT. As increasing numbers of patients receive long-term hemodialysis, the number of reports regarding hemodialysis-related cervical spine disorders has also increased. However, there have been few reports summarizing the surgical results in patients with these disorders. The objective of this study was to evaluate the long-term follow up and clinical results after surgical treatment of cervical disorders in patients undergoing hemodialysis. METHODS. Seventeen patients in whom surgery was performed for cervical spine disorders while they received long-term hemodialysis therapy were enrolled in this study. Of these, 15 underwent follow-up review for more than 3 years after surgery, and these represent the study population. The remaining two patients died of postoperative sepsis. The average follow-up period was 120 months. Five patients without spinal instability underwent spinal cord decompression in which bilateral open-door laminoplasty was performed. Ten patients with destructive spondyloarthropathy (DSA) underwent reconstructive surgery involving pedicle screw (PS) fixation. In eight patients in whom posterior instrumentation was placed, anterior strut bone grafting was performed with autologous iliac bone to treat anterior-column destruction. Marked neurological recovery was obtained in all patients after the initial surgery. In the mobile segments adjacent to the site of previous spinal fusion, the authors observed progressive destructive changes with significant instability in four patients (40%) who underwent circumferential spinal fusion. No patients required a second surgery after laminoplasty for spinal canal stenosis without DSA changes. CONCLUSIONS. Cervical PS-assisted reconstruction provided an excellent fusion rate and good spinal alignment. During the long-term follow-up period, however, some cases required extension of the spinal fusion due to the destructive changes in the adjacent vertebral levels. Guidelines or recommendations to overcome the

The aim of this study was to clarify vascular endothelial growth factor (VEGF) expression and angiogenesis in the patellar tendon (PT) autograft in the early phase after anterior cruciate ligament (ACL) reconstruction using a rabbit model. The right knees of 30 Japanese white rabbits underwent ACL reconstruction using the medial third of the PT complex. We evaluated the grafted tendon at 1, 2, 3, 4, and 8 weeks after ACL reconstruction by immunohistology for proliferating cell nuclear antigen, VEGF, and CD31, which is a marker for vascular endothelial cells. At week 1 , few cells were observed at the midsubstance of the grafted tendon. A number of proliferating cells were observed at the surface area of the PT graft 2 weeks after graft transplantation, while no vessel formation was observed in the graft at the same time. VEGF was highly expressed 2–3 weeks postoperatively. Vessel formation in the PT graft increased with time from 3 to 8 weeks after ACL reconstruction. The rates of proliferating cells and VEGF-expressing cells decreased with time from 3 to 8 weeks. This study has suggested that VEGF is involved in the graft remodeling process particularly at the early phase after ACL reconstruction.

N116Y, H-RAS mutant, has dominant negative activity in the RAS function and a suppressive effect on the growth of various types of cancer cells. However, a replication error of N116Y is of potential concern for carcinogenesis in clinical application. To decease the concern, we constructed modified N116Y by deleting the carboxyl terminus, which is necessary for the oncogenic function of Ras. One of the C-terminal deletion mutants of N116Y, N116Y-Cdel2 showed a growth-suppressing effect on various human cancer cell lines in vitro: the cervical cancer cell line HeLa, the pancreatic cancer cell line PCI43, the colon cancer cell lines SW480 and LoVo, and the tongue cancer cell line SAS. In addition, the suppressive effect of N116Y-Cdel2 on LoVo cells was also observed in vivo using a non-viral gene transfer vector, HVJ envelope. Our experiments suggest that the modified N116Y is a potential candidate gene for human cancer gene therapy.

Castleman's disease is an uncommon lymphoproliferative disorder, which occurs most commonly in the mediastinum. Sporadic reports of its occurrence in the hepatoduodenal ligament and other extrathoracic locations have also been documented. Ultimately, Castleman's disease can develop anywhere lymphoid tissue is found, and the preoperative diagnosis is often difficult. We report a case of hyaline vascular-type Castleman's disease in the hepatoduodenal ligament. An asymptomatic 26-year-old woman was admitted to our hospital for further examination of a mass found on ultrasonography. A contrast-enhanced computed tomography scan confirmed a hypervascular mass in the hepatoduodenal ligament, and angiography showed that the mass was receiving its blood supply from various arteries. These findings suggested a diagnosis of Castleman's disease and we removed the tumor without resecting any other organs. Computed tomography and angiography were helpful in establishing a correct preoperative diagnosis, which minimized the magnitude of surgery.

Methods: A 48-year-old woman presented with a complaint of severe back pain radiating from the right side of her chest. Plain radiographs of the spine showed osteolytic destruction of the right side of the T10 vertebral body at T10 level, with an involvement of the pedicle. Magnetic resonance image of the spine showed a low signal intensity from the T10 vertebral body on a Tl-weighted image and an increased signal intensity on T2-weighted sequence image. These lesions were enhanced when a contrast medium was used. The patient underwent open biopsy and specimens were collected through the right pedicle. Results: Diagnosis was established on the basis of direct identification of the microorganism. Histological findings were consistent with examination of B. pickettii spondylitis. Chemotherapy (intravenous cefepime and per os minocycline) resulted in complete cure. Conclusion: B. pickettii is widely distributed in aqueous sources in nature and has not previously been considered to be an aggressive pathogen towards humans. This case report will help to improve our understanding of the ecology and virulent pathogenicity of this organism. A biopsy is an essential and reliable method for the early etiologic diagnosis, which will lead to prevent the development of more severe complications such as spinal cord compression.

OBJECT. Posterior lumbar interbody fusion (PLIF) was developed to overcome the limitations of posterolateral fusion in correcting spinal deformity and maintaining lumbar lordosis. In this study the authors compare the biomechanical effects of three different posterior reconstructions on the adjacent motion segment. METHODS. Ten calf spinal (L2-S1) specimens underwent nondestructive flexion-extension testing (± 6 Nm). The specimens were destabilized at the L5-S1 levels after intact testing. This was followed by pedicle screw fixation with and without interbody cages as follows: 1) with straight rods ("aligned" posterolateral fusion); 2) with kyphotically prebent rods ("kyphotic" posterolateral fusion); and 3) with interbody cages combined with straight rods ("aligned" PLIF/posterolateral fusion). The range of motion (ROM) of the operative segments, the intradiscal pressure (IDP), and longitudinal lamina strain in the superior adjacent segment (L4-5) were analyzed. The ROM associated with aligned PLIF/posterolateral fusion-treated specimens was significantly less than both the aligned and kyphotic posterolateral fusion-treated procedures in both flexion and extension loading (p<0.05). The aligned PLIF/posterolateral fusion was associated with greater IDP and the lamina strain compared with the aligned and kyphotic posterolateral fusion groups in flexion loading. Under extension loading, greater IDP and lamina strain were present in the kyphotic posterolateral fusion group than in the aligned posterolateral fusion group. The highest IDP and lamina strain were shown in the aligned PLIF/posterolateral fusion group. CONCLUSIONS. Compared with kyphotic posterolateral fusion, PLIF may lead to even higher load at the superior adjacent level because of the increased stiffness of the fixed segments even if local kyphosis is corrected by PLIF.

Object. Radiosurgical treatment of spinal arteriovenous malformations (AVMs) is becoming a practical therapeutic option as methodology improves, but no comparative study has yet been published on focal fractionated radiotherapy. The authors report their experience with conventional and hypofractionated radiotherapy for spinal AVM. Methods. Candidates for this study were patients who experienced symptoms due to an intramedullary AVM but were ineligible for embolization or surgery. Of 21 patients with spinal AVMs, 10 cases in a 10-year period met this criterion. Angiography and contrast-enhanced computerized tomography scanning were used for treatment planning in all cases. Fractionated radiotherapy was performed using a linear accelerator, extracranial immobilization system, and frequent orthogonal linacographic verification. The starting radiation dose was 32 Gy in two, 36 Gy in three, and 40 Gy in two patients, in a regimen involving 1.8 to 2–Gy daily fractions; this was recently changed to a hypofractionation schedule of 30 Gy (in eight sessions) in one and 20 Gy (in four sessions) in two patients. Results. The follow-up period ranged from 26 to 124 months (median of 49 months). There were no hemorrhages nor any adverse reactions attributable to irradiation. Of the seven patients who consented to undergo follow-up angiography, the nidus size decreased in five, but complete obliteration did not occur in any patient. Conclusions. Because no patient experienced adverse effects, the maximum tolerable radiation dose for the spinal cord associated with an AVM could not be identified, although it presumably is higher than those administered. The lack of rebleeding in patients in whom complete angiographic occlusion was absent suggests that the natural history of spinal AVMs may be less aggressive than previously reported.

The sublaminar wiring procedure has been commonly used for stabilizing the atlantoaxial complex. Multistrand braided cables were introduced in the early 1990s. In previous biomechanical studies these cables were demonstrated to be superior to monofilament wires in terms of their flexibility, mechanical strength, and fatigue-related characteristics. To the authors' knowledge, they are the first to describe clinically the occurrence of delayed spinal cord compression resulting from multistrand cables after the completion of rigid spinal arthrodesis in the upper cervical spine. Three patients underwent posterior atlantoaxial fusion in which two sublaminar multistrand cables were placed. Between 15 and 48 months postoperatively, they suffered from upper- and lower-extremity numbness as well as gait disturbance. Plain radiography and computerized tomography myelography revealed spinal cord compression caused by the sublaminar cables, although fusion was complete and physiological alignment was maintained at the fused segment. The radiographs obtained immediately after surgery demonstrated that the initial cable placement had been properly performed. The shape of the cable at the initial surgery was oval and then gradually became circular. The anterior arc of the circular shape of the cable in fact led to the spinal cord compression. Considering the mechanism of this late complication, a cable tends to spring open because of its high flexibility and becomes circular shaped even after the complete arthrodesis. When applying multistrand cables for intersegmental fixation at the atlantoaxial complex, delayed complications related to bowing of the cables is possible.

4 v. ; 24 cm, Nieuwediep : J.C. de Buisonjé , 1863-1866, door Samuel D. Gross ; naar de tweede, zeer vermeerderde en zorgvuldig herziene uitgave, voor Nederland bewerkt, door J.D. Sachse

4 v. ; 24 cm, Nieuwediep : J.C. de Buisonjé , 1863-1866, door Samuel D. Gross ; naar de tweede, zeer vermeerderde en zorgvuldig herziene uitgave, voor Nederland bewerkt, door J.D. Sachse

4 v. ; 24 cm, Nieuwediep : J.C. de Buisonjé , 1863-1866, door Samuel D. Gross ; naar de tweede, zeer vermeerderde en zorgvuldig herziene uitgave, voor Nederland bewerkt, door J.D. Sachse