Since 1984, we have treated 10 hands with Kienböck's disease at Lichtman's stage IV by replacing the lunate with a palmaris longus tendon ball. There were 9 cases (7 males, 2 females), whose ages ranged from 24 to 61 years (average 41.0 years). 5 right lunates and 5 left lunates were involved. All patients were right-handed. The period of follow-up ranged from 3 months to 6.75 years (average 3 years and 5 months). We evaluated the postoperative results clinically and radiologically.All of the 9 patients were able to return to their previous jobs. There was no significant change in the postoperative range of motion of the wrist joint. Clinical results were evaluated as excellent in 6 hands, good in 3 hands and fair in one hand according to Dornan's criteria, and satisfactory in 7 hands and unsatisfactory in 3 hands according to Lichtman's criteria. The mean preoperative ulnar variance was -0.70mm and there was no cases with plus variance. Carpal height ratio significantly changed from 0.493 preoperatively to 0.466 postoperatively (p=0.092). Most cases had a significant decrease in carpal height ratio one month after the operation. Radio-scaphoid angle did not change postoperatively.In conclusion, the replacement operation using the tendon ball was clinically effective for stage IV Kienböck's disease, but radiologically carpal height ratio decreased early after surgery.
The aim of this study was to determine the efficacy of once-weekly teriparatide as a function of baseline fracture risk. Treatment with once-weekly teriparatide was associated with a statistically significant 79 % decrease in vertebral fractures, and in the cohort as a whole, efficacy was not related to baseline fracture risk.
Abstract To clarify the role of nitric oxide (NO) in regulation of bone metabolism in response to skeletal loading, we examined inducible NO synthase (iNOS) gene knockout mice in the tail-suspension model. Histomorphometric analyses of proximal tibias revealed that 7 days of tail suspension decreased the bone volume (BV/TV) and bone formation rate (BFR/BS) and increased the osteoclast surface (Oc.S/BS) in mice with all iNOS genotypes. Both iNOS+/+ and iNOS+/− mice responded to subsequent 14-day reloading, with increases in BV/TV and BFR/BS and a decrease in Oc.S/BS, whereas these responses were abolished in iNOS−/− mice. The osteoblasts flattened after tail suspension appeared cuboidal during subsequent reloading. Immunoreactivity for iNOS was detected in these osteoblasts and osteocytes by immunohistochemistry. These defective responses after reloading were rescued in iNOS−/− mice by treatment with an NO donor nitroglycerine (NG). Conversely, the responses in iNOS+/+ mice were inhibited by treatment with an NOS inhibitor aminoguanidine (AG). In bone marrow cell cultures, mineralized nodules derived from iNOS−/− mice after reloading were significantly reduced. Taken together, our results suggest that NO generated by iNOS in osteoblasts plays a critical role in adjusting bone turnover and increasing osteogenic activity in response to the acute increase in mechanical loading after tail suspension.
Nociceptive stimulation elicits neuroendocrine responses such as arginine vasopressin (AVP) release as well as activation of the hypothalamo-pituitary-adrenal axis. We have generated novel transgenic rats expressing an AVP–enhanced green fluorescent protein (eGFP) fusion gene, and we examined the effects of nociceptive stimulation on transgene expression in the hypothalamus after subcutaneous injection of saline or formalin into the bilateral hindpaws in these rats. We have assessed (1) AVP levels in plasma and the changes of eGFP mRNA and AVP heteronuclear RNA (hnRNA) in the supraoptic nucleus (SON) and the paraventricular nucleus (PVN) using in situ hybridization histochemistry, (2) gene expression changes in distinct magnocellular and parvocellular divisions of the PVN, (3) eGFP fluorescence in the SON, the PVN, the median eminence (ME), and the posterior pituitary gland (PP). Plasma AVP levels were significantly increased 15 min after formalin injection. In the same time period, the AVP hnRNA levels in the PVN were increased, especially in the parvocellular division of the PVN in formalin-injected rats. In the same region, eGFP mRNA levels after formalin injection were also significantly increased to a much greater extent than those of AVP hnRNA. The eGFP fluorescence in the SON, the PVN, the ME, and the PP was markedly increased in formalin-injected rats and especially increased in the parvocellular divisions of the PVN. Together, our results demonstrate robust and rapid changes in the expression of the AVP-eGFP transgene in the rat hypothalamus after acute nociceptive stimulation.
Bone mineral density (BMD) is a strong predictor of osteoporotic fractures. However, the increase in fracture risk is not steep, rather gentle, for the decline in BMD values. Postmenopausal women with osteopenia (T scores between - 2.5 and - 1.0) may also be at risk. Case finding strategies such as the combination of BMD and appropriate clinical risk factors for fracture are shown to identify subjects at high fracture risk. World Health Organization developed a fracture risk assessment tool, recommending its exploitation in the case findings. Under these circumstances, Japan guideline 2006 provided new criteria for the pharmacological intervention to prevent fragility fracture, besides the conventional criteria for diagnosing osteoporosis.
