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A de novo aneurysm of a cerebral artery, defined as a newly growing aneurysm after aneurysmal clipping, but not close to a previously clipped one, is relatively rare. Five studies have reported that the annual incidence of de novo aneurysm formation ranged from 0.3% to 1.8%. A 56-year-old man presented with headache. Magnetic resonance angiography (MRA) and computed tomography (CT) showed an aneurysm with arachnoid hemorrhage located at the left middle cerebral artery (MCA) associated with an azygos anterior cerebral artery (ACA). Eight years later, the patient complained of dizziness, and MRA demonstrated no visualization of the MCA on the left due to metal artifact, but a new lesion, an azygos ACA aneurysm, 9 mm in diameter, was seen. Clipping was performed using multiple clips through the interhemispheric space. Late follow-up examination with MRA or three-dimensional CT to detect de novo aneurysms should be considered in a patient with this vascular anomaly after subarachnoid hemorrhage.

Multiple mating by females increases both the risk and intensity of sperm competition for males. The ability to temporarily or permanently inhibit female receptivity to further mating represents a highly adaptive strategy to reduce the risk of sperm competition. Males of the West Indian sweet potato weevil Euscepes postfasciatus (Fairmaire) (Coleoptera: Curculionidae) and the seed bug Togo hemipterus (Scott) (Heteroptera: Lygaeidae) use accessory gland substances to inhibit remating in females. It is known that there is variance in the length of the female refractory period (i.e., the effectiveness of male ejaculate substances that inhibit female remating) within a species. However, it is unclear what types of male traits affect the length of the female refractory period. The mechanism of the female refractory period is not sufficiently revealed. We focused on male body size, which is often a target of sexual selection, and investigated the relationship between male body size and both the refractory period of females and mating duration. Contrary to our thought, male body size did not significantly influence the refractory period of females or mating duration in either species. Smaller male body size was not particularly favored by post-copulatory sexual selection in either species.

Background Olanexidine gluconate (OLG) is a newly developed skin antiseptic, which is effective against a broad range of bacteria, including methicillin-resistant Staphylococcus aureus and vancomycin-resistant Enterococcus. The purpose of this study was to evaluate the bactericidal efficacy and safety of OLG in orthopaedic surgery. Methods This retrospective study included a total of 1103 patients who underwent clean orthopaedic surgery. They were divided into two groups: 556 patients who were treated with OLG (OLG group), and 547 patients who were treated with povidone-iodine (PVP-I) (PVP-I group). The efficacy and the safety outcomes were measured as the rate of surgical-site infection (SSI) within 30 days after surgery and the rate of adverse skin reaction, respectively. Results There was no significant difference between the OLG group and PVP-I group (1.80% vs. 2.38%; p = 0.50) based on the overall rate of SSI. Also, there was no significant difference in both superficial incisional infections (1.08% vs. 2.01%; p = 0.21) and deep incisional infections (0.72% vs. 0.37%; p = 0.35). The overall rate of adverse skin reaction was significantly higher in the OLG group than in the PVP-I group (2.16% vs. 0.73%; p = 0.047). Conclusions This retrospective study demonstrated that OLG has an efficacy similar to PVP-I in preventing SSI in clean orthopaedic surgery. However, adverse skin reactions at the application site of OLG requires more attention.

Peroneal spastic flatfoot caused by tarsal coalition is well known; however, tibial spastic varus foot is a rare clinical entity also caused by tarsal coalition in most cases. The os calcaneus secundarius is a rare accessory bone between the anterior process of the calcaneus and the navicular bone. The case of a 29-year-old woman with tibial spastic varus foot caused by os calcaneus secundarius is presented. Operative excision of the os calcaneus secundarius completely resolved the varus deformity. This is the first case report involving tibial spastic varus foot caused by os calcaneus secundarius.

Artificial diets have been employed for the mass-rearing of numerous insects because of their ease of use and standardized quality. An ability to store artificial diets under nonrefrigerated conditions over the long term could improve the efficacy of mass-rearing systems considerably. However, it remains largely unknown how long artificial diets can be stored at such temperatures without any adverse effects on the insects reared. In this study, we investigated yield, body size, and reproductive potential of West Indian sweet potato weevil, Euscepes postfasciatus (Fairmaire), which is a major sweet potato pest, under management using the sterile-insect technique in Japan and reared using artificial diets with different storage periods (14, 28, and 42 d) at nonrefrigerated temperatures (25 ± 1°C), and compared them with those of the control (0 d). Notably, E. postfasciatus yield and reproductive potential increased significantly with an increase in storage period (28 and 42 d). Conversely, male body size decreased significantly following feeding with artificial diet stored for 42 d, when compared with the control, while there were no significant differences in female body size between the control and all the treatments. We discuss the potential causes of such varying effects between yield and body size and conclude that E. postfasciatus artificial diet can be stored for at least 28 d without any adverse effects on weevil yield and weevil quality. To the best of our knowledge, this is the first report revealing the positive effects of long-term storage of the artificial diet on mass-reared insects.

STUDY DESIGN A retrospective study. OBJECTIVE To elucidate sex-related differences in the age at synchondroses closure, the normative size of the atlas, and the ossification patterns of the atlas in Japanese children. SUMMARY OF BACKGROUND DATA The atlas develops from three ossification centers during childhood. The anterior and posterior synchondroses, which are separate ossification centers, mimic fracture lines on computed tomography (CT). Sex-related differences of age dependent morphological changes of the atlas in a large sample size have not been reported. METHODS This study analyzed data of 688 subjects (449 boys) between 0 and 18 years old who underwent CT examination of the head and/or neck between January 2010 and July 2016. The age at synchondroses closure, anteroposterior outer, inner, and spinal canal widths of the atlas, and variations of the ossification centers were examined. RESULTS Anterior synchondroses closed by 10 years in boys and by 7 years in girls. Significant earlier closure of anterior synchondroses was observed in girls than in boys (P

Minodronate is a third-generation bisphosphonate that was developed and approved for clinical use in osteoporosis therapy in Japan. The mechanism of action for suppressing bone resorption is the inhibition of farnesyl pyrophosphate synthase, a key enzyme in the mevalonic acid metabolic pathway of osteoclasts, to induce apoptosis of the cells. Minodronate is the strongest inhibitor of bone resorption among the currently available oral bisphosphonates. Large randomized, placebo-controlled, double-blind clinical trials have revealed an increase in bone mineral density of both the lumbar spine and femoral neck over 3 years of daily minodronate therapy and risk reduction in vertebral fractures over 2 years of therapy. The increase in bone mass and the prevention of vertebral fractures are similar to those with alendronate or risedronate. The incidence of adverse events, especially gastrointestinal disturbance, is the same as or less than that with weekly or daily alendronate or risedronate. The unique mechanism of action of minodronate via the inhibition of the P2X(2/3) receptor compared with other bisphosphonates may be an advantage in reducing low back pain in patients with osteoporosis. The monthly regimen of minodronate, introduced in 2011, is expected to have better patient adherence and longer persistence. In experimental animal models, minodronate preserved, or even ameliorated, bone microarchitectures, including microcracks and perforation of the trabeculae in the short term. The lowest incidence of bisphosphonate-related osteonecrosis of the jaw among all bisphosphonates and the lack of atypical femoral fractures attributed to its use to date, however, are partly because only a smaller population used minodronate than those using other bisphosphonates. To date, minodronate is available only in Japan. Hip fracture risk reduction has not been verified yet. More clinical studies on minodronate and its use in osteoporosis treatment, with a large number of subjects, should be conducted to verify hip fracture risk reduction and long-term results.

Elderly patients with hip fracture are at risk for cardiac complications. N-terminal pro-brain type natriuretic peptide (NT-proBNP) has been shown to predict cardiac complications in surgical patients; however, to our knowledge, only two studies have evaluated the utility of this test in patients with hip fracture. We believe it is important to assess a more accurate cutoff value of NT-proBNP with exclusion of patients with renal failure. To assess the association between preoperative NT-proBNP and cardiac complications after hip fracture surgery. We performed 450 surgical procedures in patients with hip fractures between January 2011 and December 2014. Exclusion criteria were renal dysfunction and inadequate laboratory tests. The final study population consisted of 328 patients (mean age, 83 years; 80% women). Preoperatively, measurement of NT-proBNP level was performed. The primary endpoint was the occurrence of cardiac complications within 14 days after surgery based on a chart review. The predictive value of NT-proBNP was assessed using multivariate logistic regression analysis, controlling for relevant confounding variables such as age, gender, body weight, and renal function; we also performed receiver operating characteristic (ROC) curve analysis. Postoperative cardiac complications were encountered in 7% of patients (24 of 328). The median preoperative NT-proBNP level was higher in patients with complications than in those without (1090 [interquartile range, 614–3191 pg/mL] vs 283 pg/mL [interquartile range, 137–507 pg/mL], p

Retrospective study.To investigate the accuracy of freehand iliac screw insertion and to determine how this can be performed safely.Seventy-seven adult scoliosis patients with an average age of 70.1 years who underwent spinal deformity surgery with spinopelvic fixation using bilateral iliac screws were enrolled. Penetration of the iliac table was assessed using postoperative computed tomography. Screw penetration of the iliac table or screw insertion from the sacroiliac joint was considered misplacement. Screw positioning was classified as the screw being in the proper position (group C), the screw penetrating the outer table (group O), and the screw penetrating the inner table (group I). The iliac opening angle and the distance between the posterior superior iliac spines (PSISs) were measured using preoperative computed tomography. The angle between the sacral slope and the iliac screw, termed as the sagittal screw angle, was measured using postoperative lateral lumbar radiography.Of the 154 iliac screws in 77 patients, 14 screws in 12 patients penetrated the outer table and 12 screws in 11 patients penetrated the inner table. The total proportion of misplacement was 18.8%, although there were no major complications. With regard to iliac morphology, the iliac opening angle was 24.2±4.3 degrees and the distance between the PSISs was 90.6±7.7 mm. The distance between the PSISs correlated negatively with the iliac opening angle. The iliac opening angle was smaller in group O than in group C (P0.05). The sagittal screw angle in group I was smaller than that in group C (P0.01).Screw penetration of the outer iliac table possibly occurred in patients with a narrow iliac opening angle. Screw penetration of the inner table occurred when the screw was inserted more cranially than the sacral slope. Therefore, the iliac screw should be inserted approximately parallel to the sacral slope.

Purpose: The correlation between serum levels of homocysteine and bone mineral density remains controversial. The aim of this study was to identify the potential factors associated with the levels of serum total homocysteine (S-Hcy) and urinary N-terminal telopeptide of type I collagen (U-NTX) in female osteoporotic patients. Materials and Methods: This cross-sectional study included 163 female osteoporotic patients, aged between 48 and 91 years, who had never been treated with anti-osteoporosis therapy. Background data including spine and hip bone mineral density, ongoing therapy for the metabolic disease, aortic calcification score as evaluated by lateral lumbar X-ray film, and recent fragility fracture history were obtained. S-Hcy, U-NTX levels, and creatinine clearance were measured. Results: Multiple linear regression analysis revealed a significant correlation between S-Hcy levels and aortic calcification score (p = 0.022), creatinine clearance (p = 0.004), and recent fracture history (within 1 year after fracture) (p = 0.028); conversely, U-NTX levels correlated significantly with total hip bone mineral density (p < 0.0001) and recent fracture history (p = 0.0007). Conclusions: S-Hcy levels had no correlation with bone mineral density, but were associated with the degree of aortic calcification, renal function, and fracture events. These confounding factors should be taken into consideration when the relationship between S-Hcy and bone mineral density is discussed.

The aim of the present study was to investigate the efficacy of arthroscopic enlargement of unidirectional valvular slits for the treatment of popliteal cysts and to evaluate potential factors affecting the outcomes of our arthroscopic procedure.Twenty-nine patients aged 43-77 years with popliteal cysts were treated with arthroscopic cyst decompression. Surgery was performed via two posterior portals after creating a transseptal portal. Rauschning and Lindgren clinical score, magnetic resonance images, and osteoarthritic grade were evaluated pre- and postoperatively, and cartilage degeneration class was confirmed via arthroscopy. The mean follow-up period was 22.9 ± 14.6 months (range, 9-60 months).Twelve cysts disappeared completely (group D), while 16 reduced and one enlarged (group R) in size by the final follow-up. Twenty-two (75.9%) of 29 popliteal cysts diminished to a volume that was less than 10% of the preoperative volume. Clinical scores improved in 93.1% of the patients, and more patients (68.8%) in group R had positive joint effusion at the final follow-up compared with group D (17.7%; p0.01).Arthroscopic cyst decompression was effective in the treatment of symptomatic popliteal cysts. Intra-articular pathologies associated with joint effusion should be corrected simultaneously.

Pathogen outbreaks often represent a major issue when mass rearing target insects for biological control, even when applying sterile insect techniques (SIT). Here, we aimed to improve existing screening techniques used to detect a neogregarine Farinocystis sp. that infects the West Indian sweet potato weevil Euscepes postfasciatus Fairmaire (Coleoptera: Curculionidae) mass reared under the SIT program. Our results revealed that infected late-instar larvae exhibited swelling symptoms, and that their body weight and head width significantly increased compared to uninfected larvae. The head width to body weight ratio differed between infected and uninfected larvae; yet, head width was highly correlated with body weight in both cases. Visual diagnosis based on the appearance of the late-instar larvae showed concordance of almost 90 % with the current diagnostic methods of optical microscopy and PCR. Thus, the swelling symptoms observed in late-instar larvae were directly noticeable. Therefore, visual diagnosis, based on larval appearance, represents a feasible, low-cost technique for the early detection of Farinocystis sp. infection of the West Indian sweet potato weevil.

Monthly regimen of minodronate for osteoporosis more than two years has not been reported yet. The aim of this study is to elucidate the effect of monthly minodronate (M-MIN) on bone mineral density (BMD) and serum pentosidine (Pen) during 27 months.The study consisted of 52 newly treated patients (73.3 ± 8.8 years) (new group) and 47 patients (75.9 ± 9.5 years) who were switched from either alendronate or risedronate (switch group). Monthly minodronate (50 mg/every 4 weeks) was administered for 27 months. Lumbar, femoral neck, and total hip BMDs and serum pentosidine were monitored at baseline and after 9, 18, and 27 months of treatment.In the new condition, lumbar, neck, and total hip BMDs increased significantly by 9.07%, 3.15%, and 3.06%, respectively. Only the lumbar BMD significantly increased in the switch condition. Serum Pen increased in both groups in a time-dependent manner. In the group switch, multivariate logistic regression analysis revealed that the initial change in serum intact procollagen type I N-terminal propeptide (P1NP) at 9 months was an independent predictor of changes in neck and total hip BMDs at 27 months (OR = 1.039, 95% CI 1.003-1.077, p = 0.032 for neck and OR = 1.055, 95% CI 1.009-1.104, p = 0.020 for total hip).Monthly minodronate treatment increased BMDs in newly treated patients over 27 months. Serum Pen increased with M-MIN therapy, possibly indicating prolonged bone turnover. The initial 9-month changes in serum P1NP predicted the 27-month changes in hip BMDs when M-MIN replaced alendronate or risedronate.

A 24-year-old woman presented with a calcium deposit within the articular cartilage of her knee after an antecedent minor trauma. Arthroscopic examination revealed the articular surface of the lateral tibial plateau yielded easily to pressure by probing. Calcium-containing crystals within the articular cartilage was identified and debrided. Magnetic resonance images taken 4 years after operation showed the articular cartilage was completely repaired. This is the first report that demonstrated a painful well-defined calcium deposit detected by conventional radiography within the articular cartilage of the knee.

In black fungal infections, Exophiala species are frequently encountered as causative agents of human mycosis, particularly in immunocompromised patients. Among them, Exophiala jenselmei was previously reported as the most common etiological agent. Advances in molecular taxonomy proved this taxon to be heterogeneous, and led to newly introduced or redefined species. Exophiala xenobiotica is one of the novel species differentiated from E. jenselmei on the basis of molecular phylogeny.Here, we report a case of pheomycotic cyst caused by E. xenobiotica, which was well controlled via drainage and local thermotherapy. A 70-year-old man developed a cystic nodular lesion on the dorsum of his right thumb over the previous 3 months. He had been treated with prednisolone and methotrexate for 4 years for rheumatoid arthritis. The patient also had lung cancer with vertebral bone metastasis. Direct microscopic examination of the greenish pus aspirated from the cyst revealed mycelial elements. Culture of the pus on blood and Sabouraud dextrose agar yielded numerous black colonies multiple times. Histopathological examination of a biopsy specimen showed subcutaneous abscess formation surrounded by granulomatous tissues. Faintly pigmented pseudohyphae were seen within the abscess. The presence of melanin in the fungal cells was determined by Fontana-Masson staining. Initial microscopic examination of the isolate revealed annellidic conidiogenous cells, suggestive of E. jenselmei. This strain was further identified as E. xenobiotica by sequence analysis of the internal transcribed spacer (ITS) region of ribosomal RNA, showing a 100% sequence homology with the strain type.Pheomycotic cysts should be considered on identifying a slowly developing chronic subcutaneous abscess in immunocompromised patients. Sequencing is recommended for accurate species identification of causative pathogens.

Background To evaluate medial extrusion of the posterior segment of the medial meniscus in posterior horn tears. Methods This study enrolled 72 patients without medial meniscal tears (group N), 72 patients with medial meniscal tears without posterior horn tears (group PH −), 44 patients with posterior horn tears of the medial meniscus (group PH +). All meniscal tears were confirmed by arthroscopy. Medial extrusion of the middle segment and the posterior segment was measured on coronal MRIs. Results Extrusions of both middle and posterior segments in groups PH − and PH + (middle segment; 2.94 ± 1.51 mm for group PH − and 3.75 ± 1.69 mm for group PH +, posterior segment; 1.85 ± 1.82 mm for group PH − and 4.59 ± 2.74 mm for group PH +) were significantly larger than those in group N (middle segment; 2.04 ± 1.20, posterior segment; 1.21 ± 1.86). Both indicators of extrusion in group PH + were larger than those in group PH −. In the early OA category, neither middle nor posterior segment in group PH − extruded more than in group N. However, only the posterior segment in group PH + extruded significantly more than in group N. Multiple lineal regression analyses revealed that posterior segment extrusion was strongly correlated with the posterior horn tears (p Conclusion The newly presented indicator for extrusion of the posterior segment of the medial meniscus is associated with posterior horn tears in comparison with the extrusion of the middle segment, especially in the early stages of osteoarthritis. Level of Evidence Level II - Diagnostic Study

Pseudomeningocele arises after spinal fracture and nerve root avulsion or after complications of spine surgery. However, traumatic pseudomeningocele with spina bifida occulta is rare. In this report, a traumatic pseudomeningocele in a patient with spina bifida occulta that required surgical treatment is documented. This 37-year-old man presented to the authors' hospital with headache and a fluctuant mass in the center of his buttocks. A CT scan with myelography and MR imaging of the sacral region revealed a large subcutaneous area of fluid retention communicating with the intradural space through a defect of the S-2 lamina. Because 3 months of conservative treatment was unsuccessful, a free fat graft was placed with fibrin glue to seal the closure of the defect, followed by 1 week of CSF drainage. This is the first report on traumatic pseudomeningocele with spina bifida occulta successfully treated in this manner.

Objective: The purpose of the present study was to clarify the efficacy of alendronate and raloxifene for preventing bone loss in patients with hip fracture by monitoring bone mineral densities (BMDs) and biochemical markers during the 9-month period after fracture. Patients and Methods: Eighty-two female hip fracture patients from 50 to 99 years old (mean ± SD: 81.6 ± 9.5) were randomly divided into two groups; there were 46 patients in the alendronate-treated group (group ALN) and 36 patients in the raloxifene-treated group (group RLX). Drugs were administered to patients six weeks after their operations. Lumbar spine BMD and neck, trochanter, Ward’s and total BMDs of the contralateral proximal femur, serum intact osteocalcin (intact OC), bone-specific alkaline phosphatase (BAP) and urinary N-terminal telopeptide of type I collagen (NTX) were measured just before the start of drug administration and at 9 months thereafter. Results: Twenty-two out of 46 patients in group ALN and 23 out of 36 patients in group RLX completed the study. The most common reason for dropping out was the patient’s failure to visit the outpatient clinic. Trochanter BMD in group ALN tended to increase by 8.4% compared with the baseline, and total hip BMD in group RLX showed a significant increase (5.7%), although neck BMD in both groups decreased during the 9 months of treatment (−8.7% for group ALN and −4.2% for group RLX compared with the baseline). Spine BMD did not change significantly in eithr group. Serum BAP and urinary NTX decreased significantly in both groups. Serum intact OC did not change significantly. Conclusions: Both alendronate and raloxifene have a favorable effect on trochanter and total BMDs of the contralateral proximal femur in the short period after hip fracture. However, both drugs could not prevent bone loss in the femoral neck during the 9 months of treatment.

The Kansai Electric Power Co., Inc. (KEPCO) has developed energy efficient chemical absorbents and economical processes which aim to reduce the cost of CO 2 capture, in collaboration with Mitsubishi Heavy Industries, Ltd. (MHI). Together the companies have been developing and critically testing high efficiency, economical absorbents according to the latest absorbent development procedures and process simulation for CO 2 capture processes. This work has been ongoing since 1991, using several Japan based R&D facilities and a pilot plant, used to verify improvements, located at Nanko Power Station in Osaka, Japan. Following significant testing of a range of absorbents in the mid 1990s, KS-1 TM , KS-2 and KS-3 were developed. Based on subsequent rigorous evaluation of the three solvents, KS-1 TM was selected for commercialization because of its overall technical and economical merits. During long-term pilot plant testing, the improved absorbents demonstrated superior performance in relation to the regeneration energy requirements leading to the following results: 2.94 MJlkg- CO 2 in combination with KS-1 TM ” and the Kansai Mitsubishi Carbon Dioxide Recovery (KM-CDR Process TM ) commercial process. In addition, practical, commercially applicable improved absorbent properties such as low corrosiveness and low solvent consumption were also confirmed. KEPCO and MHI continue development work in this area and the current status is summarized as follows: The highly successful R&D phase has led to the commercial deployment of CO 2 capture technology and seven (7) commercial CO 2 capture plants are currently under operation, with a maximum CO 2 capture capacity of 450 metric tons per day (tpd). These commercial plants are deployed in the chemical and fertilizer industry, where the operational performance is assisting in the improved development of R&D concepts. Two (2) further commercial plants are under construction, with commissioning expected in Q3 2010. For further cost reductions in relation to CO 2 capture, recent work has focused on developing new energy efficient chemical absorbents and processes. Following modifications to the Nanko CO 2 capture pilot plant a new “Energy Saving Process”, was developed, which leads to a greater than 10% steam consumption reduction over the MHI conventional process using KS-1 TM absorbent. Additionally the same reduced steam consumption was recorded for tests using the KS-1 TM absorbent. A thermal energy requirement of less than 2.5 MJ/kg- CO 2 in combination with KS-1 TM and the “New Energy Efficient Process” has been confirmed under the optimum operation condition of the CO 2 capture process. In addition to select new absorbents which feature the best profile and fit to the actual operating condition, KEPCO and MHI have intensively evaluated vapor-liquid equilibrium (VLE) and reaction kinetics for a range of newly developed absorbents and their performance is presented in this paper. The above data was obtained using the Nanko CO 2 capture pilot plant which operates under a natural gas fired boiler condition and we expect that the thermal energy requirement of coal fired boiler flue gas (with greater CO 2 concentration condition) will be further reduced. KEPCO and MHI are continuing pilot tests for the “Energy Saving Process”, leading to the application of this new process in commercial CO 2 capture plant design. This paper introduces and presents the current status of the KEPCO & MHI CO 2 capture technology and concepts for future energy reduction improvements. The paper will also include test results in relation to newly developed absorbents, and the “New Energy Efficient Process”, which have enhanced the performance and reduced the associated energy penalty of the CO 2 capture process. KEPCO and MHI are continuing the development of efficient absorbents and optimized processes, thus helping to facilitate the future wide scale deployment of CO 2 capture technology as an effective counter measure against global warming.

It is the opinion of the authors that CO2 Capture and Storage (CCS) technology can significantly contribute as an effective countermeasure against climate change, allowing us to continue the utilization of fossil fuels for primary energy production. However for this technology to be widely deployed on a commercial basis there are three key issues that need to be addressed; (1) Reduction in energy consumption, (2) Efficient integration with other environmental control equipment of a PC power plant and (3) Reduction in the decrease of net electrical output. MHI has delivered multiple commercial CO2 recovery plants in the chemical and fertilizer industries, which recover CO2 from natural gas fired flue gas, with four commercial plants in operation and another four under construction, all utilizing the proprietary KM-CDR process. In order to gain experience with CO2 recovery from a coal fired flue gas stream, Mitsubishi Heavy Industries (MHI), together with a subsidy from RITE and cooperation from J-POWER, constructed a 10 metric ton per day (T/D) CO2 recovery demonstration plant at the 2×500 MW Matsushima power station in southern Japan. This demonstration plant has subsequently achieved more than 4,000 hours of successful test operation during 2006–2007 with a further 1,000 hours during 2008, and testing continues today. The demonstration testing confirmed that the KM-CDR process is applicable to coal fired flue gas streams. Future research priorities include the improved integration of the CO2 recovery process with the flue gas pre-treatment components and the additional optimization of removal and separation methods for coal based impurities accumulating in the absorbent. An issue of concern for power plant operators is the reduction of the net electrical output due to the demands of CO2 recovery process. MHI has made significant improvements in this area and in the efficiency of absorbents. However, it is necessary to further reduce the adverse impact on the net electrical output of the power plant via astute integration of the energy transferred between the power plant and the Post Combustion CO2 Capture (PCC) plant. MHI is investigating the following concepts; (1) Utilizing the waste heat of the PCC plant for the power plant, (2) Utilizing heat recovery from the flue gas for the CO2 recovery process and (3) Utilizing the compression heat of the CO2 compressor for the CO2 recovery process.

We present here a case of gouty synovitis of the knee in a patient with partial hypoxanthine-guanine phosphoribosyl transferase deficiency (Kelley-Seegmiller syndrome), which is an inherited purine metabolic disorder. Magnetic resonance images and computed tomography showed a diffuse mass with stippled calcification around the posterior cruciate ligament (PCL) in the posterior intercondylar notch. Arthroscopic examination revealed that the articular surfaces and menisci in the affected knee were almost completely covered with white chalky monosodium urate (MSU) crystals. The diffuse mass around the PCL was composed of proliferative synovial villi covered with MSU crystals that looked like "snow covered trees". Arthroscopic total synovectomy was performed. The posterior trans-septal portal was especially useful for removal of the proliferative villi around the PCL. To our knowledge, this is the first report of arthroscopic examination in a patient with Kelley-Seegmiller syndrome.

Objective: The purpose of the present study is to clarify the efficacy of etidronate and vitamin K2 in sustaining bone mineral density (BMD) in patient with hip fracture by monitoring metabolic bone markers and BMD during the 36-week period after fracture.Materials and Methods: Forty-seven hip fracture patients from 51 to 93 years old (77.2±9.6) were randomly divided into three groups: 14 patients in the intermittent cyclical etidronate-treated group (group E), 16 patients in the vitamin K2-treated group (group K), and 17 patients in the control (group C). Drugs were administered to patients in groups E and K six weeks after their operations. Blood and urine samples were obtained just before the start of drug administration and at 12, 24, and 36 weeks thereafter. Urinary type I collagen C-terminal telopeptide (uCTx), pyridinoline (PYR), deoxypyridinoline (DPD), serum CTx (sCTx), osteocalcin (OCN-mid), and undercarboxylated osteocalcin (ucOC) were measured. The contra-lateral proximal femur and lumbar spine BMDs were measured at baseline and at 36 weeks.Results: Deoxypyridinoline at 12 weeks and OCN-mid at 36 weeks after treatment were lower in group E than those in group C. N-mid osteocalcin and ucOC at 24 and 36 weeks were lower in group K than those in group C. Although femoral neck BMD in groups C and E decreased compared to the baseline values at 36 weeks, femoral neck BMD in group K tended to increase. Specifically, in group K the BMD of Ward's triangle increased significantly after treatment. Bone mineral density of the lumbar spine in each group did not change significantly during the 42 weeks following hip fracture.Conclusion: Vitamin K2 prevented further bone loss in the contralateral proximal femur. The administration of vitamin K2 to patients with hip fractures in the early period after fracture is potentially useful in preventing a second hip fracture on the contralateral side.

Objective: The aim of the present study was to clarify whether patients with Graves' disease who have lost bone mass can restore bone mass to age-matched control levels by antithyroid drug therapy.Patient/Materials and Methods: One male and 16 female patients (aged 21-71 years, mean±SE 39.9±16.5) with untreated Graves' disease were included in the study. Methimazole or propylthiouracil was given to all of the patients. Biochemical markers (serum N-mid osteocalcin (OCN-mid), alkaline phosphatase (ALP), type I collagen C-terminal telopeptide (sCTx), urinary pyridinoline (Pyr), deoxypyridinoline (Dpyr) and type I collagen C-terminal telopeptide (uCTx) and bone mineral density at the distal one third of the radius were assessed prior to treatment, and in the first, third, sixth and twelfth months of treatment.Results: All biochemical markers had increased significantly 12 months after treatment compared with the baseline values (OCN-mid, p

The incidence of second hip fractures occurring within a year of initial fractures is 20%-45%. The high incidence of second hip fractures in this period can be attributed to the rapid bone loss that occurs during this time. Restoring bone mass at an early stage after hip fractures is critical for preventing subsequent fractures. The aim of this study was to investigate the efficacy of monthly minodronate therapy (50 mg/4 wk) for preventing bone loss over a 9-mo period following hip fractures. Minodronate was administered monthly to 51 patients (44 females), beginning within 3 mo after hip fracture surgery. The mean (±standard deviation) age of the patients was 82.0 ± 0.9 yr. Demographics, mobility status, bone turnover makers, and bone mineral density (BMD) in the lumbar spine and proximal femur (including femoral neck and total hip BMD) were examined prior to and after 9 mo of treatment. Lumbar BMD was increased by 2.7% ± 4.4% (p

The authors report the case of a giant medial meniscal cyst in an osteoarthritic knee of an 82-year-old woman that was successfully treated with only arthroscopic cyst decompression. The patient noticed a painful mass on the medial side of the right knee that had been gradually growing for 5 years. Magnetic resonance imaging showed an encapsulated large medial cystic mass measuring 80×65×40 mm that was adjacent to the medial meniscus. An accompanying horizontal tear was also detected in the middle and posterior segments of the meniscus. The medial meniscus was resected up to the capsular attachment to create bidirectional flow between the joint and the cyst with arthroscopic surgery. Magnetic resonance imaging performed 14 months postoperatively showed that the cyst had completely disappeared, and no recurrence was observed during a 2-year follow-up period. An excellent result could be obtained by performing limited meniscectomy to create a channel leading to the meniscal cyst, even though the cyst was large. Among previously reported cases of meniscal cysts, this case is the largest to be treated arthroscopically without open excision. [ Orthopedics. 2016; 39(1):e166–e168.]

Barrett’s adenocarcinoma is an esophageal cancer arising from Barrett’s esophagus. In this report, a metastatic epidural tumor from Barrett’s adenocarcinoma with paraplegia that required surgical treatment is documented. A 50-year-old man who had had a resection of the distal esophagus due to Barrett’s adenocarcinoma six month before presented with progressive weakness and numbness in lower limbs with urinary disturbance. Magnetic resonance imaging of the thoracic region revealed compression of the spinal cord at the T3-4 level by a dorsally located epidural mass. No signal changes were detected in vertebrae. Since the paraplegia and urinary disturbance were rapidly progressing, laminectomy and tumor resection was performed. Postoperatively, neurological function improved immediately and there was no recurrence of spinal region. This is the first report on an isolated metastatic Barrett’s adenocarcinoma of the thoracic epidural space.

OBJECTIVE To examine serum undercarboxylated osteocalcin (OC) with application of an ELISA in normal women and in osteoporotic patients with vertebral fractures or hip fractures, and to investigate the effects of vitamin K and/or D treatment on undercarboxylated OC and intact OC in vertebral fractures. PATIENTS They were 43 premenopausal (PRE) and 48 postmenopausal healthy females (POST), 89 osteoporotic patients with vertebral fractures (VX) and, 24 patients with hip fracture (HX). MEASUREMENTS Intact OC was measured by an IRMA and undercarboxylated OC was measured by an ELISA. RESULTS Intact osteocalcin was significantly higher in POST and VX than in PRE, and was significantly lower in HX than in POST and VX. Undercarboxylated OC tended to be higher in POST, VX and HX than in PRE, but not significantly. The ratio of undercarboxylated OC to intact OC was significantly higher in HX than in POST and in VX. After 4 weeks treatment with K, D, and K + D to 56 VX, undercarboxylated OC decreased significantly in the groups with K and K + D. Intact OC tended to increase slightly in the groups given K, D, K + D, but not significantly so. Vitamin K and vitamin K + D markedly decreased the ratio of undercarboxylated/intact OC to approximately 80%. On the other hand, vitamin D did not decrease that ratio. CONCLUSIONS There was a disproportion of undercarboxylated osteocalcin to intact osteocalcin between postmenopausal women and osteoporotic patients with vertebral fractures or hip fractures. Vitamin K did decrease undercarboxylated osteocalcin, vitamin D did not change undercarboxylated osteocalcin, and vitamin D did not enhance the effect of vitamin K on undercarboxylated osteocalcin.

The purpose of this study was to assess the ultrasound (US) parameters measured by the Contact Ultrasound Bone Analyser (CUBA) clinical system for discriminating the subjects with vertebral fractures from those without vertebral fractures. The subjects consisted of 114 postmenopausal women over age 50 (mean ± SD: 72.2 ± 8.7). Seventy-three had vertebral fractures (fracture group) and 41 had no vertebral fractures (control group). Values of all US parameters and bone mineral density (BMD) in the fracture group were significantly lower than those in the control group, even after adjusting for age. Area under the receiver operating characteristic (ROC) curve was 0.768 ± 0.056 (mean ± SE) for broadband ultrasound attenuation (BUA), 0.828 ± 0.045 for velocity of sound (VOS), 0.707 ± 0.058 for lumbar spine, 0.872 ± 0.050 for femoral neck, 0.790 ± 0.050 for trochanter, and 0.695 ± 0.060 for Ward's triangle. There were no significant differences among the areas under the ROC curves in BUA, VOS, lumbar spine, femoral neck, trochanter, and Ward's triangle. US parameters (BUA and VOS) had the same discriminatory power as spine and hip BMD for evaluating the vertebral fracture risk. As far as the disadvantages of the use of BMD measurement against US measurement, US measurement is potentially useful for screening of vertebral fractures. However, the bias concerning the proportion of the numbers of patients with or without vertebral fractures could not be neglected in this study.

The aim of this study was to investigate bone mineral density (BMD) and bone turnover in patients with primary knee osteoarthritis (KOA) and to compare them with generalized OA (GOA) and nonGOA patients. A total of 88 postmenopausal primary KOA patients were studied. OA was graded by using knee radiographs. BMD of the lumber spine, femur, and radius, and biochemical markers of bone turnover, pyridinoline (Pyr), deoxypyridinoline (Dpyr), CTx, and osteocalcin were compared among each grade. BMD was also compared with 88 normal controls who were age and weight-matched. In 88 KOA patients, 56 were divided into 28 GOA and 28 non-GOA groups by grading hand radiographs. BMD and biochemical markers were compared between GOA and non-GOA. KOA patients had higher BMD at several skeletal sites compared with age- and weight-matched normals. A significant difference of BMD between each grade was observed between grades 0–1 and 3 (0.774 ± 0.143 versus 0.940 ± 0.185 g/cm2, P < 0.001), grades 2 and 3 (0.781 ± 0.125 versus 0.940 ± 0.185 g/cm2, P < 0.01) in the spine, and between grades 0–1 and 3 (0.505 ± 0.100 versus 0.564 ± 0.127 g/cm2, P < 0.05) in the trochanter. A significant difference of biochemical bone markers was observed between grades 0–1 and 3 (P < 0.05) and between grades 2 and 3 (P < 0.05) in Pyr and grades 0–1 and 3 (P < 0.05) and between grades 1 and 4 (P < 0.05) in Dpyr, but not in osteocalcin and CTx. GOA patients had higher BMD of the spine (0.902 ± 0.175 versus 0.747 ± 0.138 g/cm2, P < 0.01), trochanter (0.535 ± 0.107 versus 0.480 ± 0.107 g/cm2, P < 0.05), and one-third of the radius (0.526 ± 0.068 versus 0.472 ± 0.089 g/cm2, P < 0.05) and had significantly higher biochemical markers in Pyr and Dpyr than non-GOA patients. It is concluded that KOA patients had higher BMD at several skeletal sites. Biochemical bone markers were influenced by some degree of cartilage damage in OA patients. This tendency was stronger in GOA patients than in non-GOA patients.

Objectives. To compare plasma levels of matrix metalloproteinase (MMP)-3, MMP-9 and tissue inhibitor of metalloproteinases-1 ( TIMP-1) between patients with knee osteoarthritis and normal subjects, to investigate whether the degree of knee joint involvement is related to those measurements, and to compare patients with and without generalized osteoarthritis. Methods. Eighty-three women with knee osteoarthritis (OA patients) were studied. Plasma levels of MMP-3, MMP-9 and TIMP-1 were measured by enzyme immunoassays. Knee and hand radiographs were taken of all patients. The joints of the knee and hand were graded from 0 to 4 according to Kellgren and Lawrence criteria. All OA patients were divided into a generalized OA (GOA) group (n= 37) and a knee OA ( KOA) group (n= 46) according to Doherty’s criteria. MMPs and TIMP were also measured in 19 normal subjects. Results. Plasma levels of MMP-3 and TIMP-1 were significantly higher in OA patients than in normal subjects. In contrast, MMP-9 was lower in OA patients than in normal subjects. Plasma levels of MMP-3 and MMP-9 were not influenced by the grade of knee OA. TIMP-1 was influenced by the grade of knee OA. Plasma levels of MMP-3 were significantly elevated in GOA compared to KOA. In contrast, there were no significant diVerences in plasma levels of MMP-9 and TIMP-1 between GOA and KOA. Conclusion. Since the plasma level of MMP-3 in GOA was higher than that in KOA patients, it may be a superior indicator for whole-joint degeneration.

We have evaluated the effect of aging, menopause and osteoporosis on the measurements of both nonisomerized type I collagen C-telopeptide breakdown products (alpha-CTx) by radioimmunoassay (RIA) and beta-isomerized type I collagen C-telopeptide breakdown products (beta-CTx) by enzyme-linked immunosorbent assay (ELISA). In 86 premenopausal healthy women (PRE), 144 postmenopausal healthy women (POST), 74 patients with vertebral fractures (VX) and 61 patients with hip fractures (HX), urinary CTx excretion was measured by both ELISA and RIA assays. Samples were collected more than 6 months after fracture in the VX group and within 48 h after fracture in the HX group. In all subjects a highly significant correlation was found between alpha-CTx and beta-CTx (r = 0.85). The values of beta-CTx in the POST group greatly increased compared with those in the PRE group (% mean increase: 82%), while the values of alpha-CTx in the POST group moderately increased compared with those in the PRE group (% mean increase: 47%). The values of both alpha-CTx and beta-CTx in the HX group were significantly higher than those in the other groups, but particularly the increase in mean alpha-CTx (211% for HX versus POST) was very high compared with the increase in mean beta-CTx (68% for HX versus POST). Moreover, the alpha-CTx/beta-CTx ratio in the HX group was significantly higher than in the other groups. These results suggest that both assays well reflect the increase in bone resorption associated with high bone turnover, especially, in osteoporotic patients with hip fracture. However, there was a difference between the urinary excretion of alpha-CTx and beta-CTx in patients with hip fracture, so the alpha-CTx/beta-CTx radio might be a good indicator reflecting the characteristics of bone metabolism for osteoporosis with hip fracture.

patient had been running his own barber shop 5 days a week for 20 years. There were no episodes that resulted in immobilization osteoporosis. The patient had a previous history of hypertension, arterial sclerosis obliterance (ASO) of the legs, and cataracts bilaterally. The patient had been taking 1.0-Ig daily doses of 1AE(OH)D3 orally and 10-IU weekly doses of calcitonin intramuscularly between 1988 and 1990, followed by 1.0-Ig daily doses of 1AE(OH)D3 orally and 600-mg daily doses of ipriflabon orally until admission in 1995 because of hypogonadotropic hypogonadism. The patient had a history of low back pain in 1988, olecranon and distal radius fractures in 1990, and multiple rib fractures in 1992 and 1995 after simple falls. Physical examination revealed an eunuchoidism-like body 172 cm in height and 52 kg in weight. The patient had an arm span of 182 cm. Skull hair was normal. There was no axial or pubic hair (Tanner stage I). No gynecomastia was palpable. Sense of smell was intact. Bilateral undescended testis cryptorchidism were found and the testes were soft and small. Visual fields were full to confrontation.

OBJECTIVE Whether patients, who have lost bone mass, can be restored to age-matched control levels by some means is still controversial. We investigated how the thyroid status after antithyroid drug therapy for various periods of time affects bone metabolism in patients with hyperthyroidism by assessing currently used biochemical markers of bone turnover and distal radius bone mineral density (BMD). DESIGN AND PATIENTS The biochemical markers of bone turnover and BMD at the distal one third of the radius were measured in 79 women with hyperthy-roidism treated with antithyroid drugs for various periods of time. The patients were divided into two groups according to thyroid function at the time of study: a hyperthyroid group (serum thyroid stimulating hormone (TSH)

The aim of this study was to evaluate the changes of biochemical markers during fracture healing in patients with osteoporosis. The study included 26 patients; 9 underwent hip hemiarthroplasty (mean age +/- SD: 71.0 +/- 10.2 years, group EN) for femoral neck fractures. 7 underwent osteosynthesis (75.3 +/- 8.2 years, group OS) for trochanteric fractures, and 10 subjects had spinal compression fractures (68.2 +/- 12.0 years, group CO). No operative procedures were performed in group CO. Urinary pyridinoline (Pyr), deoxypyridinoline (Dpyr) by high performance liquid chromatography (HPLC), Crosslaps by both enzyme-linked immunosorbent assay (ELISA) and radioimmunoassay (RIA) (CTx-ELISA and CTx-RIA) and serum N-terminal mid-fragment osteocalcin (OCN-Mid) by ELISA were analyzed at the time of admission and at weeks 1, 2, 4, 8 and 24 after operation or, in the case of group CO, after admission. As a whole, bone resorption markers started to increase from week 1, with various peak values between weeks 4 and 8 depending upon the particular marker, but returned to the initial vales at week 24. OCN-Mid started to increase from week 8 and remained at elevated levels at week 24. In groups EN and OS, bone resorption markers changed in the same manner as they did as a whole group. OCN-Mid did not change in group EN, although it increased significantly from week 8 in group OS. No biochemical markers changed significantly in group CO. In conclusion, bone resorption was accelerated at an early stage due to acute osteonecrosis or bed rest, followed by bone formation due to callus or mechanical stress later on. As far as bone resorption markers are concerned, 24 weeks are enough to eliminate the effect of fracture.

This study was performed to investigate the circadian variation of urinary CrossLaps (CTx), which was the type I collagen peptide released during bone matrix degradation, and peptide-bound and free forms of urinary pyridinium crosslinks. Urine was obtained during the 24 h of the study in seven separate collections as follows: from 23:00 h to the first void (FV) followed by FV at 11:00, 11:00-14:00, 14:00-17:00, 17:00-20:00, 20:00-23:00, and 23:00 h to FV the next morning. Total, free, and peptide-bound pyridinoline (Pyr) and deoxypyridinoline (Dpyr) excretion measured by high-performance liquid chromatography (HPLC) and CTx measured by enzyme-linked immunosorbent assay in nine premenopausal women aged 22-40 years and nine osteoporotic women aged 65-83 years was analyzed. Among three parameters of Pyr measured by HPLC, a significant day and night difference was found only in total Pyr (21.9% higher at night than during the day in premenopausal women and 24.0% in osteoporotic women, whereas no significant day and night variation was found in free and peptide-bound Pyr in either group. In contrast, total and peptide-bound Dpyr were significantly (37.9% and 66.9%) higher at night than those during the day in premenopausal women (38.0%) and osteoporotic women (48.8%). For free Dpyr, there were no day and night differences in the two groups. The day and night variances were significantly greater in peptide-bound Dpyr than with total Dpyr in both groups. In urinary CTx, a significant circadian variation with a peak at night and a nadir at 17:00 h was found (p0.0001) (premenopausal was 54.0% higher at night than during the day; osteoporotic was 38.4%. In conclusion, urinary CTx represented remarkable circadian variation compared with urinary pyridinium crosslinks measured by HPLC. Furthermore, free pyridinium crosslinks did not undergo a circadian variation. Peptide-bound crosslinks might contribute mostly to the circadian variation of total excretion of pyridinium crosslinks.

A large osteochondral fragment trapped in the posterolateral compartment of a knee was removed from a posteromedial portal through the trans-septal portal and fixed on an osteochondral defect of the lateral femoral condyle in a 16 year-old boy. When a free body in the posterolateral compartment is so large that enlargement of the portal site is required for removal, doing so from a posteromedial portal is safer and easier than from a posterolateral portal.

Urinary pyridinoline (Pyr) and deoxypyridinoline (Dpyr) are collagen crosslinks found in bone and cartilage and are sensitive bone resorption markers. In this study, values of urinary Pyr and Dpyr during 24-h periods in 6 normal men, 10 normal women, and 10 osteoporotic patients were measured. In these three groups, urinary Pyr and Dpyr showed significant circadian variations only in normal men. Neither urinary Pyr nor Dpyr showed significant circadian variations in normal women or osteoporotic subjects, although they had the same trend as the diurnal changes of urinary crosslinks in normal men. Comparing the values of urinary crosslinks in the daytime (11:00–20:00 h) and at night (20:00–11:00 h), the latter were significantly higher than the former in both normal and osteoporotic subjects. Furthermore, the nighttime and daytime difference of urinary Pyr in osteoporotic subjects was significantly larger than those in normal subjects. Urinary Pyr and Dpyr were 22.6% and 10.7% higher, respectively, at night compared to during the day in normal women, while in osteoporotic patients, the values were 51.2% and 25.5% higher at night than during the day, respectively. In conclusion, the acceleration of bone resorption at night may be one of the etiologies of involutional osteoporosis.

We present this case of a meniscal ossicle of the posterior horn of the medial meniscus that was treated by an arthroscopic ossicle resection followed by a pullout repair of the remaining meniscus. A 49-year-old businessman complained of catching and left knee pain. Radiographic and arthroscopic findings revealed a meniscal ossicle embedded in the posterior horn of the medial meniscus and posterior horn tear. After resection of the posterior horn with the ossicle, a pullout suture repair for the posterior segment of the meniscus was done to minimize the further extrusion of the meniscus. A histologic appearance supported the vestigial development of the meniscal ossicle as the etiology. This is the first report describing a repair of the meniscus after ossicle resection.

Objective. To determine the content of two crosslinks, pyridinoline (a mature crosslink) and pentosidine (a senescent crosslink), in human articular cartilage, and to examine the effect of bone and joint disorders on the content of those crosslinks in articular cartilage. Methods. After pretreatment with SP-Sephadex C-25, high-performance liquid chromatography was conducted on a hydrolysate of human articular cartilage from 53 patients with one of the following diseases: osteoarthritis (OA), rheumatoid arthritis (RA), osteoporosis, femoral head necrosis, and renal osteodystrophy (ROD). Results. Pyridinoline levels were either unchanged with age or were slightly decreased in elderly patients. Pentosidine levels increased with age in the entire patient population. There was no significant difference in the pyridinoline content among the study groups, but there was a significant difference in pentosidine content (P < 0.001). ROD patients had the highest mean level of pentosidine (407 μmoles/mole of hydroxyproline), and RA patients had a higher mean level than age-matched OA patients (214 versus 103 μmoles/mole of hydroxyproline). Conclusion. Bone and joint disorders do not affect the pyridinoline content in articular cartilage, but they do affect the pentosidine content.

Pseudomeningocele arises after spinal fracture and nerve root avulsion or after complications of spine surgery. However, traumatic pseudomeningocele with spina bifida occulta is rare. In this report, a traumatic pseudomeningocele in a patient with spina bifida occulta that required surgical treatment is documented. This 37-year-old man presented to the authors' hospital with headache and a fluctuant mass in the center of his buttocks. A CT scan with myelography and MR imaging of the sacral region revealed a large subcutaneous area of fluid retention communicating with the intradural space through a defect of the S-2 lamina. Because 3 months of conservative treatment was unsuccessful, a free fat graft was placed with fibrin glue to seal the closure of the defect, followed by 1 week of CSF drainage. This is the first report on traumatic pseudomeningocele with spina bifida occulta successfully treated in this manner.

We investigated the incidence of occult hip and pelvic fractures and associated muscle injuries around the hip. A total of 113 patients aged 60–102 years with suspected hip fracture but negative plain radiographs underwent further examination by magnetic resonance imaging (MRI) within 2 days after an X-ray examination. Coronal and axial T1 and T2 or short tau inversion recovery sequences of MRI of the hip including the sacrum were obtained. One hundred and two cases (90.2%) had bone or soft-tissue abnormalities and 83 cases (73.5%) had fractures of the hip and/or pelvis. The frequency of hip fracture and pelvic fracture was almost the same. More than half of the patients among those with pelvic fractures sustained occult sacral fractures; therefore, it was important to determine if a sacral fracture was involved when occult hip fracture was suspected. Muscles located at the lateral aspect of the hip, such as gluteus maximus, gluteus medius, gluteus minimus and quadratus femoris, were frequently injured in cases with intertrochanteric and greater trochanter fracture, suggesting that direct impact may be associated with fractures of the trochanteric region. However, hip rotator and adductor muscles such as obturator internus, obturator externus and adductor brevis were commonly injured in cases with pelvic fracture, indicating indirect force mediated by these muscles may be associated with pelvic fracture. Occult hip and pelvic fractures were almost equally seen among 113 cases with suspected hip fracture but were negative on plain radiography. Different patterns of associated muscle injuries in cases of occult hip fracture and pelvic fracture suggest that the mechanism of hip fracture and pelvic fracture is possibly different.