Muneaki Ohshita

Short-term clinical results of arthroscopic osteochondral fixation for elbow osteochondritis dissecans in teenaged baseball players.

BACKGROUND Reports regarding arthroscopic fixation of the osteochondral fragments for elbow osteochondritis dissecans (OCD) are few. This study assessed the clinical outcomes of arthroscopic fixation of unstable osteochondral fragments by using absorbable pins over a postoperative period of at least 1 year. METHODS The patients were 13 adolescent baseball players with a mean age of 14 years (range, 12-16 years) who underwent OCD of primary lesions at International Cartilage Repair Society grades III and IV. The patients were evaluated by using validated outcome measures at a mean follow-up period of 24 months (range, 12-50 months). RESULTS The mean (standard deviation) score in the disability/symptom section of the Disabilities of the Arm, Shoulder, and Hand improved from 12.4 (6.0) before the surgery to 0.5 (1.2) after the surgery, and the sports section improved from 74.5 (25.4) to 1.4 (5.2). The mean (standard deviation) extension improved from -11° (10.8) to -2° (3.9; P < .001). The mean (SD) flexion improved from 129° (11.6) to 137° (5.6; P = .040). All patients were able to resume playing baseball, and 9 (69%) resumed playing at the same position as before their injuries. CONCLUSIONS The clinical results of arthroscopic osteochondral fragment fixation in the teenaged baseball players with elbow OCD, albeit obtained over only a short period, were favorable. This arthroscopic treatment enables repair of lesions and is considered appropriate for unstable OCD during the adolescent growth spurt.

25% Albumin Infusion Maintains Antithrombin III (AT) Activity after AT AgentAdministration in Critically Ill Patients with Disseminated IntravascularCoagulation (DIC)

Objective: To report for the first time critically ill patients with disseminated intravascular coagulation (DIC) in whom the infusion of 25% albumin solution produces remarkable elevations in plasma antithrombin III (AT) activities after administration of AT agents. Design: A prospective observational study. Interventions: 1) Plasma AT activities were serially measured in DIC patients after AT administration, enable us to analyze their pharmacokinetics; 2) Comparisons of AT activities between two groups of receiving AT agent with or without the infusion of 25% albumin solution; 3) in vitro examinations were conducted to define whether albumin application itself would influence directly an AT measurement system using samples already determined the levels of AT activities. Methods and main results: Twenty consecutive critical patients with DIC were divided into two groups: groups receiving AT agents of 1500 units with (N=11) and without (N=9) the application of 25% albumin solutions. Patients treated with albumin solutions after AT agents showed remarkable elevations in AT peak and trough activities, whereas patients receiving the same dose of the AT agents without albumin co-administration did not maintain its trough activity. Pharmacokinetic analyses revealed that patients had shortened the distribution half-life time of AT, suggesting enhanced vascular permeability. The levels of AT activities in patients treated with both albumin and AT agents (N=11) were significantly higher than those without albumin administration (N=9, p=0.01). Furthermore, in vitro albumin applications to the AT measurement system did not effect on its values in the samples. Conclusion: This is the first report indicating that 25% albumin administration could elevate and sustain AT activities, even when a limited AT dose was administered to DIC patients with increased vascular permeability. This may be due to a certain binding effect of albumin, which needs to be defined in the future.

Effects of Dexamethasone on Pulmonary Oxygenation Impairments inTherapeutic Hypothermia for Patients with Traumatic Brain Injury

Objectives: We studied retrospectively to examine differences in the occurrence rate of pneumonia and the time-course changes in pulmonary oxygenation between hypothermic and normothermic therapies with or without dexamethasone (D) administration in patients with traumatic brain injury (TBI). Design: A retrospective observational study. Setting: Two university hospitals. Subjects and Methods: In consecutive TBI patients (GCS ≤ 8) treated with hypothermic (N=23, 32-33°C) or normothermic (N=16, 36-37.5°C) therapy, the occurrence rate of pneumonia, PaO2/FIO2 (P/F) ratios and C-reactive protein (CRP) levels were examined. The comparisons were made among hypothermic and normothermic groups with or without D administration. In several patients in both groups, neutrophil functions were examined. Data were analyzed with ANOVA followed by Sheffe’s F-test, Mann-Whitney U-test, Kruskal-Wallis tests or chi-squared test (p<0.05) as appropriate. Results: The occurrence rate of pneumonia in a hypothermic group with D administration was significantly lower than in a hypothermic group without D. In the hypothermic group without D treatment, CRP elevation during the rewarming phase occurred, which was followed by more severe P/F ratio deteriorations as compared to the hypothermic group given D. Neutrophil phagocytic functions in hypothermic patients without D were activated around 35°C, which were followed by marked decreases in pulmonary oxygen. In contrast, phagocytic function in a hypothermic patient receiving D was depressed, but without P/F ratios below 280. Conclusion: This study poses hypotheses that neutrophils play a role in the pulmonary oxygenation impairment in hypothermic therapy for TBI patients, and that dexamethasone improves the pulmonary complications in therapeutic hypothermia.

Sudden cerebral depression detected by bispectral index monitoring in cryptococcal meningitis with elevated near-fatal cerebrospinal fluid pressure

An increase in cerebrospinal fluid pressure (CSFP) is usually prominent in cryptococcal meningitis, which has a high mortality rate, so aggressive management to control CSFP is crucial. In this case, a 40‐year‐old‐man survived cryptococcal meningitis treated with continuous spinal drainage under bispectral index (BIS) monitoring. He unexpectedly showed hypertension, went into a coma, and even loss his light reflexes due to CSFP elevation. His BIS values had abruptly dropped before developing these symptoms, but dramatically recovered after lumbar puncture drainage, suggesting that BIS monitoring could reflect cerebral function changes due to CSFP alternations.