Mechanically aligned total knee arthroplasty (TKA) for valgus knee is considered a “challenging surgery.” Recently, the kinematic alignment (KA) method has gained attention. This study aimed to present objective cli...Mechanically aligned total knee arthroplasty (TKA) for valgus knee is considered a “challenging surgery.” Recently, the kinematic alignment (KA) method has gained attention. This study aimed to present objective clinical data, such as intraoperative balance assessment and radiographic evaluation of postoperative lower extremity alignment after TKA using the KA method for valgus deformity. Twenty-one TKA knees (mean age, 74 years;2 males, 19 females) with KA for severe valgus deformity (hip-knee-ankle-angle ≥ 10°) performed at our department in the past 3 years were included in this study. Intraoperative gap and balance measurements and postoperative radiographic evaluation were performed. A total arc of range of motion was achieved up to 98% of preoperative values at 3 weeks postoperatively. Intraoperative gap and balance were stable throughout the entire range of motion. In addition, there were no statistically significant differences in either balance or gap values at each flexion angle. KA TKA is a “simple surgery” rather than a “challenging surgery” because additional soft tissue procedures are not required, operative time is short, intraoperative and postoperative balance is very stable, and a good alignment is achieved. This procedure may relieve surgeons of the stress of TKA for valgus deformities.展开更多
<b><span style="font-family:Verdana;">Background: </span></b><span style="font-family:Verdana;">The number of total knee arthroplasty (TKA) surgeries performed each ye...<b><span style="font-family:Verdana;">Background: </span></b><span style="font-family:Verdana;">The number of total knee arthroplasty (TKA) surgeries performed each year is increasing worldwide and mechanical alignment (MA) is currently seen as the gold standard procedure. However, taking neutral alignment as the universal goal may be mistaken. In our hospital, we currently conduct kinematically aligned TKA (KA-TKA). Three different types of implants are used</span><span style="font-family:Verdana;">:</span><span style="font-family:;" "=""><span style="font-family:Verdana;"> the cruciate-retaining (CR) type, cruciate-sacrificing (CS) type, or bi-cruciate-retained (BCR) type. We aimed to compare the coronal alignment observed following KA-TKA and MA-TKA and in normal knees, as well as that achieved with different types of implants. </span><b><span style="font-family:Verdana;">Methods:</span></b><span style="font-family:Verdana;"> The study comprised 206 knees of Japanese patients who underwent KA-TKA using varying implants in our Hospital between May 2019 and April 2020. Measurements of pre- and postoperative coronal alignment were determined from weight-bearing full-leg standing radiographs. The postoperative results were </span><span style="font-family:Verdana;">compared to measurements taken from patients who underwent MA-TKA (</span><span style="font-family:Verdana;">N = 96) and normal knees (N = 60). </span><b><span style="font-family:Verdana;">Results: </span></b><span style="font-family:Verdana;">No significant differences between the KA-TKA group and normal knees were found for the medial proximal tibial angle (MPTA) (–4.2<span style="white-space:nowrap;">°</span> </span></span><span style="font-family:;" "=""><span style="font-family:Verdana;">±</span><span style="font-family:Verdana;"> 2.6<span style="white-space:nowrap;">°</span> vs –3.8<span style="white-space:nowrap;">°</span> </span><span style="font-family:Verdana;">±</span><span style="font-family:Verdana;"> 2.5<span style="white-space:nowrap;">°</span>) or joint line orientation angle (JLOA) (0.2<span style="white-space:nowrap;">°</span> </span><span style="font-family:Verdana;">±</span><span style="font-family:Verdana;"> 1.9<span style="white-space:nowrap;">°</span> vs 0.3<span style="white-space:nowrap;">°</span> </span><span style="font-family:Verdana;">±</span><span><span style="font-family:Verdana;"> 1.4<span style="white-space:nowrap;">°</span>). However, when MA-TKA was compared to KA-TKA and normal knees, there were significant differences in both the MPTA and JLOA (</span><i><span style="font-family:Verdana;">p </span></i><span style="font-family:Verdana;">< 0.01). Furthermore, for the different implant types, MPTA exhibited significantly greater varus alignment when a CS-type was used than with the other two. </span><b><span style="font-family:Verdana;">Conclusions:</span></b><span style="font-family:Verdana;"> Here, we demonstrated that following KA-TKA, the articular surface of the tibia exhibited a similar varus alignment as that of normal knees, meaning that the technique reproduces the native knee. Furthermore, KA is patient-specific, and does not have the same failures as MA-TKA. Therefore, we anticipate a paradigm shift from mechanical to kinematic alignment, which may help reduce the dissatisfaction rate of TKA patients.</span></span></span>展开更多
We experienced a very rare case of ulcerative colitis (UC) accompanied with analogous lesions in the stomach, duodenum, and ileal J -pouch. Ileal J-pouch anal anastomosis was performed on a 29-year old woman in 1996. ...We experienced a very rare case of ulcerative colitis (UC) accompanied with analogous lesions in the stomach, duodenum, and ileal J -pouch. Ileal J-pouch anal anastomosis was performed on a 29-year old woman in 1996. Six years later, she was admitted again to our hospital because of epigastralgia, nausea, watery diarrhea and low fever. Based on the results of endoscopic examination, we diagnosed it as pouchitis. Moreover, on hypotonic duodenography, expansion of the duodenal bulb and the descending portion were poor. Kerckring folds disappeared with typical lead-pipe appearance. The pathogenesis of the gastric and duodenal lesion in this patient was similar to that of the colonic lesions of UC. For the gastroduodenal lesions in this patient, symptomatic remission was obtained following administration of crushed mesalazine tablets (1500 mg/d) for 14 d with continuous administration of omeprazole. Firstly we used ciprofloxacin to treat pouchitis. On the fifth day, she got a fever because of catheter infection. In the catheter culture, methicillin-resistant Staphylococcus aureus (MRSA) was detected. Therefore we changed ciprofloxacin to vancomycin hydrochloride (Vancomycin?). Vancomycin was very effective, and the stool frequency dramatically improved in three days. Now she continues to take mesalazine, but her condition is stable and there has been no recurrence of pouchitis.展开更多
Introduction: To compare the measured dose distributions to calculated ones in dose-to-water (Dw) and dose-to-medium (Dm) reporting modes for simple plans and patient-specific intensity modulated radiation therapy (IM...Introduction: To compare the measured dose distributions to calculated ones in dose-to-water (Dw) and dose-to-medium (Dm) reporting modes for simple plans and patient-specific intensity modulated radiation therapy (IMRT) and volumetric modulated arc therapy (VMAT) plans using ArcCHECK with a fixed phantom density. Methods: The recommended density value of 1.18 g/cm3 for Acuros XB and X-ray voxel Monte Carlo was assigned to ArcCHECK on CT images. A total of 45 simple plans, including a 1-field plan, a 3-field plan, a 4-field plan, a half-arc plan from 270° to 90°, and a full-arc plan, were assessed. Subsequently, the patient-specific 96 IMRT and VMAT plans were evaluated. Gamma analysis with a 3% normalized global dose error and a 3 mm distance-to-agreement criteria (γ3%G/3mm) was performed in the Dw and Dm. The change in γ3%G/3mm between Dw and Dm were statistically analyzed using JMPPro11 software. Results: The median values of γ3%G/3mm for all simple plans for Dw and Dm were 98.1% (range, 75.2% - 100%) and 95.5% (range, 23.7% - 100%), respectively (p 0.01). In the patient-specific IMRT and VMAT plans, the median values of γ3%G/3mm for Dw and Dm were 98.6% (range, 90.1% - 100%) and 90.5% (range, 38.5% - 97.2%), respectively (p 0.01). Conclusion: Our results showed that the calculated and measured dose distributions were in good agreement for Dw, but were not for Dm. From the viewpoint of the rationale of dosimetry, Dw shows better agreement with measured dose distribution when using the fixedphantom density recommended by the vendor.展开更多
Introduction: We have previously developed an effective atomic number (Zeff) measurement method using linear attenuation coefficients (LACs) obtained by energy-resolved computed tomography (CT) with one-dimensional (1...Introduction: We have previously developed an effective atomic number (Zeff) measurement method using linear attenuation coefficients (LACs) obtained by energy-resolved computed tomography (CT) with one-dimensional (1D) detector. The energy-resolved CT was performed with a “transXend” detector, which measured X-rays as electric current and then gave X-ray energy distribution with unfolding analysis using pre-estimated response function (RF). The purpose of this study is to measure Zeff by the energy-resolved CT using a flat panel detector (FPD). Methods: To demonstrate a 2D transXend detector, we developed the stripe absorbers for the FPD. Eleven human tissue-equivalent material rods which were grouped into four material categories were measured by X-rays with 120 kVp tube voltage, 2.3 mA tube current, and 1.0 s exposure time. Zeff is measured by the ratio of LACs with two different pseudo-monochromatic X-ray energies. RFs of each rod material were estimated by numerical calculation. First, we employed the RF estimated for the same rod material (self-RF scenario). Second, we employed the RF estimated for the different rod materials in the same material category (cross-RF scenario). The purpose of the cross-RF scenario was to find representative rod materials in each material category. Results: Upon the self-RF scenario, measured Zeffs were systematically underestimated. Median relative error to theoretical Zeff was -6.92% (range: -7.89% - -4.60%). After normalizing measured Zeffs to the theoretical one for Breast, median relative error improved to -0.75% (range: -1.79% - +1.73%). Upon the cross-RF scenario, the representative rod materials were found in two material categories. Conclusion: Zeff measurements were performed by energy-resolved CT using 2D transXend detector with numerically-estimated RF data. Normalized Zeffs for all rod materials in the self-RF scenario were in good agreement with the theoretical ones.展开更多
文摘Mechanically aligned total knee arthroplasty (TKA) for valgus knee is considered a “challenging surgery.” Recently, the kinematic alignment (KA) method has gained attention. This study aimed to present objective clinical data, such as intraoperative balance assessment and radiographic evaluation of postoperative lower extremity alignment after TKA using the KA method for valgus deformity. Twenty-one TKA knees (mean age, 74 years;2 males, 19 females) with KA for severe valgus deformity (hip-knee-ankle-angle ≥ 10°) performed at our department in the past 3 years were included in this study. Intraoperative gap and balance measurements and postoperative radiographic evaluation were performed. A total arc of range of motion was achieved up to 98% of preoperative values at 3 weeks postoperatively. Intraoperative gap and balance were stable throughout the entire range of motion. In addition, there were no statistically significant differences in either balance or gap values at each flexion angle. KA TKA is a “simple surgery” rather than a “challenging surgery” because additional soft tissue procedures are not required, operative time is short, intraoperative and postoperative balance is very stable, and a good alignment is achieved. This procedure may relieve surgeons of the stress of TKA for valgus deformities.
文摘<b><span style="font-family:Verdana;">Background: </span></b><span style="font-family:Verdana;">The number of total knee arthroplasty (TKA) surgeries performed each year is increasing worldwide and mechanical alignment (MA) is currently seen as the gold standard procedure. However, taking neutral alignment as the universal goal may be mistaken. In our hospital, we currently conduct kinematically aligned TKA (KA-TKA). Three different types of implants are used</span><span style="font-family:Verdana;">:</span><span style="font-family:;" "=""><span style="font-family:Verdana;"> the cruciate-retaining (CR) type, cruciate-sacrificing (CS) type, or bi-cruciate-retained (BCR) type. We aimed to compare the coronal alignment observed following KA-TKA and MA-TKA and in normal knees, as well as that achieved with different types of implants. </span><b><span style="font-family:Verdana;">Methods:</span></b><span style="font-family:Verdana;"> The study comprised 206 knees of Japanese patients who underwent KA-TKA using varying implants in our Hospital between May 2019 and April 2020. Measurements of pre- and postoperative coronal alignment were determined from weight-bearing full-leg standing radiographs. The postoperative results were </span><span style="font-family:Verdana;">compared to measurements taken from patients who underwent MA-TKA (</span><span style="font-family:Verdana;">N = 96) and normal knees (N = 60). </span><b><span style="font-family:Verdana;">Results: </span></b><span style="font-family:Verdana;">No significant differences between the KA-TKA group and normal knees were found for the medial proximal tibial angle (MPTA) (–4.2<span style="white-space:nowrap;">°</span> </span></span><span style="font-family:;" "=""><span style="font-family:Verdana;">±</span><span style="font-family:Verdana;"> 2.6<span style="white-space:nowrap;">°</span> vs –3.8<span style="white-space:nowrap;">°</span> </span><span style="font-family:Verdana;">±</span><span style="font-family:Verdana;"> 2.5<span style="white-space:nowrap;">°</span>) or joint line orientation angle (JLOA) (0.2<span style="white-space:nowrap;">°</span> </span><span style="font-family:Verdana;">±</span><span style="font-family:Verdana;"> 1.9<span style="white-space:nowrap;">°</span> vs 0.3<span style="white-space:nowrap;">°</span> </span><span style="font-family:Verdana;">±</span><span><span style="font-family:Verdana;"> 1.4<span style="white-space:nowrap;">°</span>). However, when MA-TKA was compared to KA-TKA and normal knees, there were significant differences in both the MPTA and JLOA (</span><i><span style="font-family:Verdana;">p </span></i><span style="font-family:Verdana;">< 0.01). Furthermore, for the different implant types, MPTA exhibited significantly greater varus alignment when a CS-type was used than with the other two. </span><b><span style="font-family:Verdana;">Conclusions:</span></b><span style="font-family:Verdana;"> Here, we demonstrated that following KA-TKA, the articular surface of the tibia exhibited a similar varus alignment as that of normal knees, meaning that the technique reproduces the native knee. Furthermore, KA is patient-specific, and does not have the same failures as MA-TKA. Therefore, we anticipate a paradigm shift from mechanical to kinematic alignment, which may help reduce the dissatisfaction rate of TKA patients.</span></span></span>
文摘We experienced a very rare case of ulcerative colitis (UC) accompanied with analogous lesions in the stomach, duodenum, and ileal J -pouch. Ileal J-pouch anal anastomosis was performed on a 29-year old woman in 1996. Six years later, she was admitted again to our hospital because of epigastralgia, nausea, watery diarrhea and low fever. Based on the results of endoscopic examination, we diagnosed it as pouchitis. Moreover, on hypotonic duodenography, expansion of the duodenal bulb and the descending portion were poor. Kerckring folds disappeared with typical lead-pipe appearance. The pathogenesis of the gastric and duodenal lesion in this patient was similar to that of the colonic lesions of UC. For the gastroduodenal lesions in this patient, symptomatic remission was obtained following administration of crushed mesalazine tablets (1500 mg/d) for 14 d with continuous administration of omeprazole. Firstly we used ciprofloxacin to treat pouchitis. On the fifth day, she got a fever because of catheter infection. In the catheter culture, methicillin-resistant Staphylococcus aureus (MRSA) was detected. Therefore we changed ciprofloxacin to vancomycin hydrochloride (Vancomycin?). Vancomycin was very effective, and the stool frequency dramatically improved in three days. Now she continues to take mesalazine, but her condition is stable and there has been no recurrence of pouchitis.
文摘Introduction: To compare the measured dose distributions to calculated ones in dose-to-water (Dw) and dose-to-medium (Dm) reporting modes for simple plans and patient-specific intensity modulated radiation therapy (IMRT) and volumetric modulated arc therapy (VMAT) plans using ArcCHECK with a fixed phantom density. Methods: The recommended density value of 1.18 g/cm3 for Acuros XB and X-ray voxel Monte Carlo was assigned to ArcCHECK on CT images. A total of 45 simple plans, including a 1-field plan, a 3-field plan, a 4-field plan, a half-arc plan from 270° to 90°, and a full-arc plan, were assessed. Subsequently, the patient-specific 96 IMRT and VMAT plans were evaluated. Gamma analysis with a 3% normalized global dose error and a 3 mm distance-to-agreement criteria (γ3%G/3mm) was performed in the Dw and Dm. The change in γ3%G/3mm between Dw and Dm were statistically analyzed using JMPPro11 software. Results: The median values of γ3%G/3mm for all simple plans for Dw and Dm were 98.1% (range, 75.2% - 100%) and 95.5% (range, 23.7% - 100%), respectively (p 0.01). In the patient-specific IMRT and VMAT plans, the median values of γ3%G/3mm for Dw and Dm were 98.6% (range, 90.1% - 100%) and 90.5% (range, 38.5% - 97.2%), respectively (p 0.01). Conclusion: Our results showed that the calculated and measured dose distributions were in good agreement for Dw, but were not for Dm. From the viewpoint of the rationale of dosimetry, Dw shows better agreement with measured dose distribution when using the fixedphantom density recommended by the vendor.
文摘Introduction: We have previously developed an effective atomic number (Zeff) measurement method using linear attenuation coefficients (LACs) obtained by energy-resolved computed tomography (CT) with one-dimensional (1D) detector. The energy-resolved CT was performed with a “transXend” detector, which measured X-rays as electric current and then gave X-ray energy distribution with unfolding analysis using pre-estimated response function (RF). The purpose of this study is to measure Zeff by the energy-resolved CT using a flat panel detector (FPD). Methods: To demonstrate a 2D transXend detector, we developed the stripe absorbers for the FPD. Eleven human tissue-equivalent material rods which were grouped into four material categories were measured by X-rays with 120 kVp tube voltage, 2.3 mA tube current, and 1.0 s exposure time. Zeff is measured by the ratio of LACs with two different pseudo-monochromatic X-ray energies. RFs of each rod material were estimated by numerical calculation. First, we employed the RF estimated for the same rod material (self-RF scenario). Second, we employed the RF estimated for the different rod materials in the same material category (cross-RF scenario). The purpose of the cross-RF scenario was to find representative rod materials in each material category. Results: Upon the self-RF scenario, measured Zeffs were systematically underestimated. Median relative error to theoretical Zeff was -6.92% (range: -7.89% - -4.60%). After normalizing measured Zeffs to the theoretical one for Breast, median relative error improved to -0.75% (range: -1.79% - +1.73%). Upon the cross-RF scenario, the representative rod materials were found in two material categories. Conclusion: Zeff measurements were performed by energy-resolved CT using 2D transXend detector with numerically-estimated RF data. Normalized Zeffs for all rod materials in the self-RF scenario were in good agreement with the theoretical ones.