Purpose: This study aimed to evaluate the kinematics of the flexor pollicis longus tendon (FPL) at the wrist by examining the movement of the FPL on the distal radius during various wrist and finger motions using transverse ultrasound in healthy volunteers. Methods: Forty-eight wrists of 24 asymptomatic volunteers were examined by transverse ultrasound to observe the location of the FPL on the distal radius at 5 wrist positions (neutral, 60° dorsal flexion, 60° palmar flexion, 40° ulnar deviation, and 10° radial deviation) with all 5 fingers in full extension and full flexion, and isolated thumb in full flexion, respectively. Results: We found that the FPL was situated statistically significantly more ulnodorsally at the wrist dorsal and ulnar deviation positions, more ulnopalmarly at the wrist palmar flexion position, and more radiopalmarly at the wrist radial deviation-position than at the wrist neutral position with all 5 fingers at full extension. Especially, it moved statistically significantly most ulnodorsally at the wrist dorsal flexion position during finger motion. The FPL moved most statistically significantly ulnopalmarly at the wrist palmar flexion position with all 5 fingers in full extension among all wrist positions during finger motion. During finger motion, the wrist dorsal flexion position induced significant displacement of the FPL to the distal radius and compressed it between the flexor tendons and the distal radius. The average distance between the FPL and the volar surface of the distal radius in the palmar-dorsal direction at wrist dorsal flexion position in all fingers at full flexion was 1.9 mm, the smallest among all wrist positions during finger motion. Conclusions: There is a significant relationship between the transverse movement of the FPL at the distal radius and wrist and finger motions. Our findings indicated that the irritation of the FPL caused by the movement of both the FPL itself and of the flexor digitorum superficialis and profundus is most induced with the wrist in dorsal flexion with all 5 fingers at full flexion compared to other wrist positions during finger motion. This wrist position might be the optimum one at which to evaluate the irritation of the FPL from volar locking plates in patients with distal radius fracture. We believe that our transverse ultrasound results can play a role in the gaining of a better understanding of the kinematics of the FPL. Moreover, they have potential to lead to improved diagnosis of and treatment for fractures of the distal radius and help to minimize the risk of FPL rupture related to volar locking plates.
Purpose: Because dry eye greatly reduces quality of life, this study aimed to examine rebamipide instillation in patients with dry eye and assess the improvement of signs and symptoms as evaluated with the Ocular Surface Disease Index, which is the most popular index and is highly reliable. Methods: From June 2013 through January 2014, we examined 50 eyes of 25 patients with dry eye (6 men and 19 woman) at our institution. Dry eye was diagnosed on the basis of the presence of symptoms, tear dynamics, and ocular surface abnormalities according to the Japanese criteria for dry eye. Before being enrolled, all patients underwent ocular surface health assessment, including history interviews, and completed the Ocular Surface Disease Index questionnaire. Patients received 2% rebamipide ophthalmic solution 4 times daily for 4 weeks. Signs and symptoms were analyzed before and 4 weeks after rebamipide administration. Tear dynamics, tear break-up time, and ocular surface abnormalities were measured and compared between before and 4 weeks after rebamipide administration. Results: Of the 25 patients, 9 had definite dry eye and 16 had probable dry eye. Tear break-up time and the fluorescein staining score significantly improved after 4 weeks. However, no significant change was observed for the Schirmer test I and the lissamine green staining score. Conclusions: The administration of 2% rebamipide 4 times daily for 4 weeks improves the signs and symptoms of dry eye and improves patients' quality of life.
Mitochondria are target subcellular organelles of ethanol. In this study, the effects of ethanol on protein composition was examined with 2-dimensional electrophoresis of protein extracts from cultured neonatal rat cardiomyocytes exposed to 100 mM ethanol for 24 hours. A putative β subunit of mitochondrial ATP synthase was increased, which was confirmed by Western blot. The cellular protein abundances in the α and β subunits of ATP synthase increased in dose (0, 10, 50, and 100 mM) - and time (0.5 hour and 24 hours) -dependent manners. The DNA microarray analysis of total RNA extract demonstrated that gene expression of the corresponding messenger RNAs of these subunit proteins did not significantly alter due to 24-hour ethanol exposure. Therefore, protein expression of these nuclear-encoded mitochondrial proteins may be regulated at the translational, rather than the transcriptional, level. Alternatively, degradation of these subunit proteins might be decreased. Additionally, cellular ATP content of cardiomyocytes scarcely decreased following 24-hour exposure to any examined concentrations of ethanol. Previous studies, together with this study, have demonstrated that protein abundance of the α subunit or β subunit or both subunits of ATP synthase after ethanol exposure or dysfunctional conditions might differ according to tissue: significant increases in heart but decreases in liver and brain. Thus, it is suggested that the abundance of subunit proteins of mitochondrial ATP synthase in the ethanol-exposed heart, being different from that in the liver and brain, should increase dose-dependently through either translational upregulation or decreased degradation or both to maintain ATP production, as the heart requires much more energy than other tissues for continuing sustained contractions.
Tension-free hernia repair with a mesh plug causes relatively low postoperative pain and allows an earlier return to work, as well as a low recurrence rate. Occasionally, however, hernioplasty can result in complications including mesh migration and invasion of intra-abdominal organs. This report describes the case of a 57-year-old man who had undergone a right inguinal hernioplasty 13 years previously. Recovery was uneventful until he experienced inflammation of the groin, and required open drainage three times for a refractory abscess in his right groin. Additional colonoscopy and x-ray examinations with contrast medium clearly demonstrated a mesh plug that had migrated and penetrated the cecum, forming a colocutaneous fistula. The mesh was successfully removed under general anesthesia, and the inflammation in the groin resolved.
Background: Forced normalization has been reported in association with almost all anti-epileptic drugs. Patient: We report on a 9-year-old girl with idiopathic epilepsy who showed forced normalization after administration of levetiracetam (LEV). She initially presented with generalized tonic-clonic seizures when she was 4 years old. Diffuse sharp and slow wave complexes (SWCs) were observed on electroencephalography (EEG). We prescribed sodium valproate (VPA) and benzodiazepines, but the seizures and EEG findings worsened gradually. Although subsequent administration of LEV stopped the seizures, the patient became subject to episodes of rage and violent behavior. Forced normalization was confirmed by the disappearance of SWCs on EEG. We reduced the dose of LEV and tried in various ways to resolve the situation, but finally we had to abandon LEV. Conclusions: To the best of our knowledge, this is the first report of a patient with idiopathic epilepsy but without disabilities in everyday life showing forced normalization associated with LEV administration.
A 36-year-old man presented with facial nerve palsy, hearing loss, vertigo and headache. He was initially diagnosed with Ramsay Hunt syndrome and treated with a systemic steroid and valaciclovir; however, his symptoms deteriorated. Serum rapid plasma reagin (RPR) and treponema pallidum hemagglutination tests were positive. Cerebrospinal fluid analysis revealed an elevated white blood cell count and positive RPR, confirming the diagnosis of neurosyphilis. Penicillin G (PCG) was administered, and his facial nerve function and headache improved. However, left-side hearing loss worsened temporarily, which was assumed to be a Jarisch-Herxheimer reaction. Betamethasone was administered along with PCG, and he recovered completely.
Introduction: Aconitine is a highly toxic diterpenoid alkaloid, produced by plants of the Aconitum genus, that is still used in Chinese herbal medicines. Aconitine poisoning remains common in China and other parts of Asia. Case Report: A 48-year-old man received a diagnosis of aconitine poisoning after ingesting herbal medicinal wine made with caowu, which is made from Aconitum kusnezoffii roots, and was admitted to our hospital' s emergency department. Electrocardiography and thoracoabdominal computed tomography showed cardiovascular toxicity from aconitine poisoning along with polycystic renal hemorrhaging. Because the arrhythmia was not controlled with lidocaine, blood purification with a reduced dosage of heparin was performed to treat the arrhythmia and to avoid increasing the bleeding of the polycystic renal hemorrhage. The patient recovered from aconitine poisoning and polycystic kidney hemorrhage. Conclusions: This case significantly advances our understanding of hemoperfusion with reduced heparin for the treatment of ventricular arrhythmia caused by aconitine poisoning.