Objective: Postoperative knee range of motion (ROM) is among the most important factors influencing patient satisfaction after total knee arthroplasty (TKA). The purpose of this study was to clarify the time course of improvement in knee ROM up to 12 months after TKA, including intraoperative knee ROM after implantation, and to clarify a target ROM for rehabilitation after TKA.

Patients and Methods: In total, 39 knee joints in 26 patients with osteoarthritis who underwent TKA (retaining the posterior cruciate ligament) were evaluated. Goniometry was used to measure the knee range of extension and flexion preoperatively; intraoperatively; at 1 and 2 weeks after TKA; and then at 1, 3, 6, and 12 months after TKA.

Results: The postoperative extension range gradually improved up to a maximum at 6 months after TKA; there were no significant differences in the extension range between intraoperative and 6 months after TKA, intraoperative and 12 months after TKA, or 6 and 12 months after TKA. The postoperative flexion range gradually improved, with the maximum improvement observed at 3 months after TKA; there were no significant differences in the flexion range before TKA and 3, 6, and 12 months after TKA. There were no significant differences between flexion ROM measured at 3, 6, and 12 months after TKA.

Conclusions: The changes in the knee range of extension plateaued 6 months after TKA, and those in the knee range of flexion plateaued 3 months after TKA. The target range of extension for rehabilitation from 6 months to 12 months after TKA was the intraoperative range, and the target range of flexion for rehabilitation from 3 months to 12 months after TKA was the preoperative range.

Objective: This study aimed to evaluate the effectiveness of soft-tissue release on hip subluxation and dislocation in cerebral palsy as well as activities of daily living after surgery.

Patients and Methods: Soft-tissue release was performed in 13 patients (19 hips) with cerebral palsy. Of them, 10 had spastic quadriplegia and three had spastic diplegia. Mean ages were 8.6 years at surgery and 13.8 years at the last investigation. The mean follow-up period was 5.2 years. Hip subluxation and dislocation severities were analyzed before and after surgery and at the final investigation as migration percentage on radiographs. Postoperative activities of daily living were also evaluated in 12 patients.

Results: Seven hips classified as mild and moderate preoperatively were classified as good, mild, and moderate at the last investigation. Nine of 12 hips classified as severe preoperatively continued to be severe at the last investigation. However, three of 12 hips classified as severe preoperatively improved at the last investigation. There was a positive correlation between preoperative migration percentage and that at the last investigation. Daily activities improved postoperatively in 12 patients.

Conclusions: Early treatment is necessary to prevent hip dislocation and improve hip subluxation. However, several patients with severe subluxation might experience improvement with soft-tissue release alone. Soft-tissue release is effective for treating hip dislocation and subluxation in cerebral palsy and improving daily activities.

Objectives: To investigate the details of patients’ status on admission and at discharge at our hospital, to compare the ambulatory group and non-ambulatory group at discharge, and to assess the factors associated with ambulatory ability at discharge in patients aged ≥ 90 years with proximal femoral fractures (PFFs).

Patients/Materials and Methods: Twenty patients admitted to our hospital for rehabilitation after surgery for a PFF were evaluated retrospectively. The rate of regaining ambulatory ability, presence of dementia, body mass index, serum albumin level, hemoglobin level, lymphocyte count, and functional independence measure (FIM) were assessed on admission and at discharge. Relationships between patients’ ambulatory ability and ambulatory parameters were compared between the ambulatory and non-ambulatory groups.

Results: The rate of regaining ambulatory ability was 55% at discharge. The serum albumin level at discharge was significantly higher in the ambulatory group than that in the non-ambulatory group. More patients had dementia on admission in the non-ambulatory group than in the ambulatory group. On admission, scores for the cognitive items of the FIM (“expression” and “memory”) were significantly higher in the ambulatory group than those in the non-ambulatory group.

Conclusions: The rate of ambulatory ability at discharge was 55% in those with a PFF, who were aged ≥ 90 years. The presence of dementia on admission and serum albumin level at discharge were factors related to ambulatory ability. It is very important to use a general rehabilitation protocol that takes cognitive function and nourishment into account, in addition to the physical aspect.

Objectives: This study was performed to elucidate the characteristics of amputees in our hospital. We also evaluated whether the causes and characteristics of the amputations influenced the patients’ prosthetic walking ability.

Materials and Methods: We retrospectively examined 47 amputees in our hospital from December 1996 to April 2016 with respect to the causes and levels of amputation. Of 28 lower limb amputees from April 2008 to April 2016, 22 received prostheses and were divided into 2 groups according to the cause of the amputation, as follows: the internal cause group (e.g., vascular deficiency and infection) and the external cause group (e.g., trauma, burn injury, and crush syndrome). The characteristics and process of achieving prosthetic ambulation were compared between these groups.

Results: Trauma was the most common cause of both upper (70.0%) and lower limb amputations (40.5%). Unilateral amputation was performed in 93.2% of patients (upper limb amputation, 100.0%; lower limb amputation, 91.9%). Patients were older in the internal than in the external cause group (P = 0.026). The serum albumin (P = 0.003) and total cholesterol concentrations (P = 0.046) on admission were significantly lower in the internal than in the external cause group. All patients in the internal cause group had comorbidities. The proportions of patients with diabetes mellitus (P = 0.011) and cerebrovascular disease (P=0.036) were significantly higher in the internal than in the external cause group. No significant difference in walking ability was found between the internal and external cause groups at the time of discharge.

Conclusion: Most amputees in our hospital underwent unilateral lower limb amputation due to trauma. Although the patients with internal causes of amputation were older, more frequently had malnutrition, and had more comorbidities than those with external causes, they achieved prosthetic walking with statistically insignificant difference at the end of hospitalization, excluding six patients who had no prosthetic prescription.

Since the discovery of the first strain in 1961 in England, MRSA, the most notorious multidrug-resistant hospital pathogen, has spread all over the world. MRSA repeatedly turned down the challenges by number of chemotherapeutics, the fruits of modern organic chemistry. Now, we are in short of effective therapeutic agents against MRSA prevailing among immuno-compromised patients in the hospital. On top of this, we recently became aware of the rise of diverse clones of MRSA, some of which have increased pathogenic potential compared to the classical hospital-associated MRSA, and the others from veterinary sources. They increased rapidly in the community, and started menacing otherwise healthy individuals by causing unexpected acute infection. This review is intended to provide a whole picture of MRSA based on its genetic makeup as a versatile pathogen and our tenacious colonizer.
Adenosine ; Chemistry, Organic ; Chromatography, Micellar Electrokinetic Capillary ; Clone Cells ; Colon ; England ; Fruit ; Humans ; Methicillin ; Methicillin Resistance ; Methicillin-Resistant Staphylococcus aureus ; Sprains and Strains ; Staphylococcus ; Staphylococcus aureus

Objective: To improve poor medication adherence in schizophrenic patients, long-acting injectable (LAI) antipsychotics are used. However, it has not yet become common in Japan. Recently, aripiprazole LAI was approved for alternative injection into the deltoid muscle in addition to the gluteal muscle. The acceptance for the proposal to switch from gluteal to deltoid injections of aripiprazole LAI was investigated. Methods: The subjects were 32 outpatients with schizophrenia who had continuously received aripiprazole LAI administration into the gluteal muscle for ≥ 6 months. In the patients who had continued deltoid injection for 3 months after switching, the changes in the pain and shame in comparison with gluteal injections were evaluated. Results: Switching to the deltoid injection was chosen by 17 out of 32 patients. Three months later, 9 patients were still receiving deltoid injections with highly rated satisfaction. The main reasons for switching to deltoid injections included the pain and shame associated with gluteal injections. The main reason for returning to the gluteal injection was the pain experienced from the injection in the deltoid. Conclusion The option to select the injected area was based on the amount of pain in the deltoid and gluteal sites, leading to the widespread use of aripiprazole LAI.

Objective: This study aimed to investigate the age at which scoliosis progresses to a severe condition and identify the factors related to severe scoliosis in patients with cerebral palsy.Patients and Methods: This retrospective study included 51 patients aged ≥15 years. The Cobb angle was measured over time using radiographs. Patients were divided into the following groups according to their final Cobb angle: <60°, 60°–100°, and ≥100°. The age at which the Cobb angle was ≥20° in the patients was compared among the groups. Moreover, the age at which a significant difference in the Cobb angle occurred in the groups was considered the age at which the scoliosis worsened. Association of the final Cobb angle with factors such as the location of curve, Gross Motor Functional Classification System (GMFCS), capability of turning over, orthosis use, hip dislocation, tracheotomy, and gastric fistula was examined.Results: The mean age at which the Cobb angle was ≥20° was significantly lower in the ≥100° group. From 9 years of age, a significant difference was noted in the Cobb angle between the <60° group and ≥100° group. Between 13–19 years, a significant difference in the Cobb angle was observed among the three groups. Furthermore, GMFCS, capability of turning over, hip dislocation, and gastric fistula were the factors showing a significant difference among the three groups.Conclusion: Scoliosis progressed to the severe form (Cobb angle ≥100°) at 9 years of age. Moreover, scoliosis is aggravated during the growth period. Severe cerebral palsy with low motor function levels and problems with internal functions was considered the cause of scoliosis deterioration.

Objective: Postoperative management of children having cerebral palsy (CP) with mental retardation is difficult. This report presents a case of severe CP with mental retardation, which resulted in anorexia and condylar fracture of the femur following a surgery for bilateral lower limb joint contracture.Case report: A 14-year-old male was diagnosed with CP having severity of Gross Motor Functional Classification System Level V, and severe mental retardation. Due to bilateral spasticity in hip adduction, knee flexion, and valgus of the feet, tenotomies of the adductors of both hips, bilateral lengthening of the hamstrings and bilateral tenotomy of the peroneal tendons were performed. At 4 weeks postoperatively, knee casts were used; thereafter, knee extension braces were attached for 12 weeks. After surgery, he showed severe anorexia for 8 weeks and weight loss of 8.8 kg (from 35.2 kg to 26.4 kg) during the 4 months of hospitalization. Six months postoperatively, he was diagnosed with supracondylar fracture of the right femur.Discussion: Severe CP with mental retardation requires attention to the physical symptoms caused by stress related to the hospitalization, surgery, fixation by casts, and braces. Moreover, care must be taken not to increase the risk of fracture by fixation or immobility of the postoperative cast, because it can lead to the progression of low bone mineral density.

Deep neck abscess can cause upper airway stenosis and obstruction, and sometimes emergency airway management is required. Here we present a case of deep neck abscess in which awake intubation with a video laryngoscope (McGRATH™ MAC) was more useful than with flexible bronchoscope. A man in his 80s was transported to our hospital with throat and chest pain. Contrast-enhanced computed tomography revealed a deep neck abscess (right peritonsillar abscess). The otolaryngologist attempted drainage by puncture, but this was ineffective. There was a risk of upper airway obstruction, and emergency airway management was required. First, we attempted endotracheal intubation with a flexible bronchoscope but could not secure the field of view because of the upper airway edema and stenosis. Next, we attempted tracheal intubation using a video laryngoscope, which ultimately was successful. The blade of the video laryngoscope compressed and lifted the soft tissue and then it secured the space of the upper airway.

The patient was an 81-year-old woman who had undergone TAVI (Evolut PRO® 26 mm) for severe aortic stenosis at our hospital approximately 6 months previously. She was discharged from the hospital without any postoperative complications, but at 6 months after the surgery, fever, back pain, and high inflammatory findings were observed. Based on lumbar spine MRI findings, the patient was diagnosed with pyogenic spondylitis and epidural abscess, and drainage surgery was performed. Enterococcus faecalis was identified from a blood culture. MRI of the head showed scattered subacute infarcts in the right frontal lobe, and transthoracic echocardiography revealed hyperintense deposits at the aortic valve leaflet, suggesting vegetation. The diagnosis of PVE was made and medical therapy was initiated. However, the vegetation gradually increased in size and mobility, and a surgical approach was indicated. A surgical procedure was performed through a median sternotomy to remove the prosthetic valve and replace the aortic valve. The postoperative course was good, with no recurrence of infection, and the patient was transferred to another hospital for rehabilitation on the 26th postoperative day. In general, TAVI patients are older and have more comorbidities, and surgery is associated with a higher degree of risk. However, radical surgery should be considered if medical therapy is not effective in PVE after TAVI. We reported a case of surgical aortic valve replacement for PVE after TAVI.