Background: Risk factors have been reported for osteoarthritis (OA) after anterior cruciate ligament (ACL) reconstruction, but previous studies did not include a control group, and may have included OA that would have naturally developed even in the absence of ACL injury. This study investigated risk factors compared with the patient's own contralateral knee. Methods: Three hundred forty-nine patients who had undergone ACL reconstruction at least 15 years previously were invited to visit the hospital. After exclusion criteria were applied, 40 patients were included in the study, including 16 with progressive OA and 24 without OA. Progressive OA was defined as OA that was more advanced on the affected side than on the contralateral side. The variables evaluated included age at the time of surgery, time from injury to surgery, sex, graft material, cartilage damage, and meniscectomy. Results: No significant differences between groups were seen in terms of age, time from injury to surgery, sex, graft material, or cartilage damage. Meniscectomy was ultimately performed significantly more frequently in the OA group (88%) than in the non-OA group (38%; p< 0.01). Conclusions: Meniscectomy was found to constitute a risk factor for the progression of OA after ACL reconstruction.
The efficacy of electroconvulsive therapy (ECT) is superior to that of repetitive transcranial magnetic stimulation (rTMS), particularly for the treatment of major depression with psychotic features. However, ECT is sometimes terminated for several reasons, including patient refusal. Here, the authors present the case of a 57-year-old woman who recovered from major depression with psychotic features with one course of rTMS after ECT was discontinued due to patient refusal. She had been suffering from depression with psychotic features (e. g., tactile hallucinations) for three years prior to admission. During the most recent episode, she was admitted to the authors' hospital and was eventually treated with one course of ECT; however, there was no change in her reported symptoms. Four weeks later, she refused a second course of ECT but agreed to a course of rTMS therapy. She demonstrated gradual recovery from depression three weeks after the initial rTMS therapy session. She demonstrated significant improvement and was discharged from the hospital after 55 days following the first rTMS session. Although the relationship between ECT and rTMS remains unclear, rTMS may be an option for major depression with psychotic features when the patient does not consent to continuing with ECT.
Alopecia areata (AA) is usually characterized by areas of patchy hair loss on the scalp, although in severe cases, the total loss of scalp or body hair may occur. While the association between AA and Graves' disease is described in textbooks, few reports have been published. We herein report a case of AA associated with Graves' disease, in which a skin biopsy revealed marked perifollicular infiltration of mononuclear cells and pigment incontinence in the dermis. Slight staining of IgG and IgM was observed in the follicle on a direct immunofluorescence test. Pulse corticosteroid therapy followed by contact immunotherapy with squaric acid dibutylester (SADBE) was effective.