Sudden death has been reported in patients with low serum copper level, however its mechanism has not been fully clarified. Imbalance of trace elements including copper may affect the electrophysiological aspects of the conduction systems of the ventricle. QT dispersion (QTd equals maximal minus minimal QT interval) and JT dispersion (JTd equals maximal minus minimal JT interval) on a standard ECG has been shown to reflect severe cardiac arrhythmia and with abnormal ventricular repolarization. We investigated the QTd, JTd and QTc (heart rate-corrected QT interval) in the ECGs of 24 bed-ridden state patients aged 78.1±13.5 years and 11 controls aged 49.6±9.8 years. QTd and JTd and QTc intervals were determined by using cardiofaxV ECAPS 12 (Nihon Kohden). Serum levels of copper, zinc, total protein and albumin were also measured in bed-ridden patients. QTd, JTd and QTc prolongation were significantly correlated with the level of serum copper, but not with the level of serum zinc, total protein or albumin. The incidence of QTd, JTd and QTc prolongation was higher in the patients with low level of serum copper than in those with normal level of it. These findings suggest that the cardiac autonomic dysfunction is related to the level of serum copper, and that it may predispose such patients to cardiac disorders including sudden cardiac death.

View full abstract

We studied the results of various surgical treatments for femoral neck fractures. The results were measured mainly by comparing postrehabilitation walking ability with pretrauma walking ability. There were 56 patients in the study, covering the time period Nov. 1988 to Nov. 1996. All patients were 60 or more years of age and had a history of cerebrovascular disorders. 30 patients (54%) regained their pretrauma walking ability. Very old patients (85 and over) and patients with dementia had a poor rate of regaining their pretrauma walking ability. Hemiparesis did not influence the results for patients with affected side fractures but result were reduced for patients with non-affected side fractures. Bipolar arthroplasty produced excellent results for patients with medial type fractures of the Garden classification type III/IV. The prompt firm fixation at the fracture site allows the patient to rise from bed and start weight bearing in the shortest postoperative span. Ender pin fixation produced poor results for patients with unstable lateral type fractures. The lack of firm fixation after surgery causes patients to spend lengthy time in bed and delay the start of weight bearing. The lengthy time in bed contributes to worsening or development of dementia. Our conclusion is that bipolar arthroplasty is more suitable than the Ender pin method for unstable type of fractures with difficulty of reposition.

View full abstract

We evaluated the changes in the phantom limb sensation (PLS) of 4 patients with traumatic transhumeral amputation and 1 brachial plexus avulsion injury patient, using stimulation applied to the body surface (light touch, pin prick, hot and cold water). One subject who lost his PLS, experienced ambiguous PLS when stimuli applied to the lower face ipsilateral to the amputated arm. Two subjects, amputation and plexus injury, who had PLS, experienced vivid and one-to-one correspondent PLS, when stimuli applied to the face ipsilateral to the disturbed arm and both subjects also experienced PLS when stimuli applied to stump and upper chest wall ipsilateral to the disturbed arm. This amputee reported that stimuli moving down the face felt as stimuli moving down the phantom hand. These referred sensations, sensory input from the face and around the stump project the phantom arm, may appear because the hand area in primary somatosensory cortex is flanked on one side by the face and on the other side by area around the line of amputation side, sensory input from both regions invade the cortical hand area, and this may be reflect cortical reorganization.

View full abstract