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We evaluated the long-term outcome of the Pippi Salle procedure in patients with severe intrinsic urethral sphincter deficiency.We performed the Pippi Salle procedure in 6 males and 6 females with severe intrinsic sphincter deficiency between March 2003 and August 2013. Median patient age was 15 years (range 6 to 45). Mean followup was 75 months (range 17 to 142). Six males and 3 females had neurogenic intrinsic sphincter deficiency (spina bifida in 8 and spinal cord injury in 1). Three females had anatomical intrinsic sphincter deficiency (idiopathic bladder hypoplasia in 2 and pseudo-ureterocele in 1). Four patients had previously undergone bladder neck surgery, 3 had been treated with endoscopic injection of collagen, 2 had undergone fascial sling and 1 had been treated with tension-free vaginal tape surgery. The Pippi Salle procedure was performed alone (2 patients), or in combination with bladder augmentation (4) or catheterizable abdominal stoma (1), or both (5).Complete dryness was achieved in 7 patients (58%). Of 9 patients with neurogenic intrinsic sphincter deficiency 7 (78%) achieved complete dryness. Eight patients experienced complications, including continued urinary incontinence (5), difficulty catheterizing per urethra (3) and urinary calculi (1). These 8 patients were successfully treated with additional endoscopic interventions, including injection of collagen in 4, injection of dextranomer-hyaluronic acid in 1, transurethral incision of urethral kink in 3 and vesicolithotripsy in 1. After these simple interventions complete dryness was achieved in all 12 patients.Although we experienced some minor complications in the short term, most patients were simply and successfully treated with endoscopic surgery. The long-term results of the Pippi Salle procedure are promising.

Background— Atherosclerotic plaques progress in a highly individual manner. The purposes of the Prediction of Progression of Coronary Artery Disease and Clinical Outcome Using Vascular Profiling of Shear Stress and Wall Morphology (PREDICTION) Study were to determine the role of local hemodynamic and vascular characteristics in coronary plaque progression and to relate plaque changes to clinical events. Methods and Results— Vascular profiling, using coronary angiography and intravascular ultrasound, was used to reconstruct each artery and calculate endothelial shear stress and plaque/remodeling characteristics in vivo. Three-vessel vascular profiling (2.7 arteries per patient) was performed at baseline in 506 patients with an acute coronary syndrome treated with a percutaneous coronary intervention and in a subset of 374 (74%) consecutive patients 6 to 10 months later to assess plaque natural history. Each reconstructed artery was divided into sequential 3-mm segments for serial analysis. One-year clinical follow-up was completed in 99.2%. Symptomatic clinical events were infrequent: only 1 (0.2%) cardiac death; 4 (0.8%) patients with new acute coronary syndrome in nonstented segments; and 15 (3.0%) patients hospitalized for stable angina. Increase in plaque area (primary end point) was predicted by baseline large plaque burden; decrease in lumen area (secondary end point) was independently predicted by baseline large plaque burden and low endothelial shear stress. Large plaque size and low endothelial shear stress independently predicted the exploratory end points of increased plaque burden and worsening of clinically relevant luminal obstructions treated with a percutaneous coronary intervention at follow-up. The combination of independent baseline predictors had a 41% positive and 92% negative predictive value to predict progression of an obstruction treated with a percutaneous coronary intervention. Conclusions— Large plaque burden and low local endothelial shear stress provide independent and additive prediction to identify plaques that develop progressive enlargement and lumen narrowing. Clinical Trial Registration— URL: http:www.//clinicaltrials.gov . Unique Identifier: NCT01316159.

The aim of this work was to elucidate the relation between the clinical course and morphologic changes of lumbar disc herniation on magnetic resonance imaging (MRI).Twenty-one patients with lumbar disc herniation treated nonsurgically were followed for a minimum of 7 years and investigated with regard to their clinical outcome and the initial, 2-year, and final stage MRI findings. The space-occupying ratio of herniation to the spinal canal and the degree of disc degeneration were evaluated on serial MRI.The mean space-occupying ratio of herniation showed significant reduction both on the 2-year and on the final scans. Progression of degeneration of the intervertebral disc was seen in all patients at the final investigation. Comparing patients with and without symptoms, no factors were detected on the initial and 2-year MR images capable of distinguishing patients who were and were not destined to develop lumbago and/or sciatica in the future. Morphologic changes of lumbar disc herniation continued to occur even after 2 years.Clinical outcome did not depend on the size of herniation or the grade of degeneration of the intervertebral disc in the minimum 7-year follow-up.

The purposes of this study were to establish a quantitative method for evaluating rabbit tear film status and investigate the efficacy of artificial tear preparations through ocular surface bathing or eye drop application.The rabbit tear film was evaluated using a noninvasive specular reflection video recording system. The appearance of a tear break area (TBA) on the tear film images (7.4 mm2/mm) after 30 seconds of eye opening was quantified by image analysis. To induce disruption of the rabbit tear film, the ocular surface was challenged for 60 minutes with 1 ppm hypochloric acid (HOCl). Immediately after irrigation, artificial tear preparations composed of viscosity agents sodium hyaluronate (SH), hydroxypropylmethycellulose (HPMC), hydroxyethylcellulose (HEC), or chondroitin sulfate (CS) were applied to the rabbit eye through ocular surface bathing or eye drop application, and the recovery of the disrupted tear film was compared for each preparation.A dramatic increase in TBA was observed immediately after the ocular surface was challenged with HOCl, and it returned to the initial level after 6 hours. Immediately after ocular surface bathing and eye drop application, a dramatic recovery of TBA was observed in all the test solution-treated eyes. One hour after treatments, prolonged amelioration of the tear film instability was observed after ocular surface bathing, but not by eye drop application, with the artificial tear preparations composed of HPMC or SH.Ocular surface bathing with artificial tear preparations composed of a suitable viscosity agents could be useful in managing tear film instability.

Results are reported for combined intertrochanteric valgus and rotational acetabular osteotomies in 18 dysplastic hips (17 patients), involving two types of femoral head and neck deformities, after an average followup of 13 years (range, 8.9-22.6 years). The mean age of the patients at the time of surgery was 25 years (range, 11-36 years). Pain was the indication for surgery in all patients. The preoperative deformities were classified into two groups. Hips in Group I had an angular head and a normal or valgus neck. Hips in Group II had an ovoid head, a short neck in varus angulation, and relative overgrowth of the greater trochanter. There were seven hips (seven patients) in Group I, and 11 hips (10 patients) in Group II. The sum of the most recent pain score and gait score of Merle d'Aubigné (a full score of 12 points) was 11 to 12 points for seven of 11 hips of Group II, and 11 to 12 points for only one of the seven hips of Group I. For patients with hip pain in Group II, this operation fairly consistently relieves pain for at least an average of 13 years, but whether the rate of development of osteoarthrosis is retarded is not known.

Background Previous studies have shown that stents can be inserted in coronary arteries of patients who are subsequently treated safely with antiplatelet therapy only (ticlopidine and/or aspirin) with a low incidence of stent thrombosis, provided that stent expansion is adequate and there are no other flow-limiting lesions present. However, it is unknown whether ticlopidine combined with aspirin is superior to aspirin alone in preventing stent thrombosis. Methods and Results From March 1993 through July 1995, 801 consecutive patients assigned to receive either aspirin therapy alone (ASA, 264 patients, 348 lesions) or a combination of ticlopidine and aspirin (TIC-ASA, 537 patients, 737 lesions) after a successful stent insertion, in most accomplished with intravascular ultrasound guidance, were evaluated retrospectively. At 1 month, there was no difference in the ASA group compared with the TIC-ASA group in the rate of any stent thrombosis (1.9% versus 1.9%; P =1), subacute stent thrombosis (1.9% versus 1.3%; P =.5), cumulative major adverse clinical events (1.9% versus 2.0%; P =1), and peripheral vascular complications (0.5% versus 0.2%; P =.3). Medication side effects that required termination of antiplatelet therapy occurred only in 1.9% of patients in the TIC-ASA group ( P =.04). Conclusions At 1-month clinical follow-up, stent thrombosis and other adverse clinical outcomes were not significantly different between the ASA and TIC-ASA groups. Medication side effects occurred only in patients treated with ticlopidine. These results provide further evidence of the safety of treatment with antiplatelet therapy only after optimal stent implantation and support the efficacy of aspirin alone in preventing stent thrombosis.

Six cases of congenital dislocation of the knee (CDK) reduced spontaneously or with minimal treatment were investigated. Reduction was achieved from 4 days to 3 months after birth. Clinical results were good, although in four cases, hyperextension < or = 20 degrees persisted. In view of the perinatal complications and associated anomalies, CDK reduced with no or minimal treatment is supposed to be a category of congenital postural deformity. We believe that it is advisable to wait 1 month for spontaneous reduction of CDK in cases not associated with clubfoot, arthrogryposis multiplex congenita, and Larsen's syndrome.

We agree entirely with Dr Kaneda that both the local endothelial shear stress (ESS) stimulus and the local atherosclerotic plaque change may occur in a highly focal manner within each 3-mm segment, and one must look at both ESS and the arterial wall in portions of the wall circumference to assess plaque behavior accurately. In our original article,1 we were limited by space to describe the effect of focal ESS on focal plaque progression around the circumference of the 3-mm segment, but we presented those results from a database study at the American Heart Association Scientific Sessions in 2012.2 Focal eccentric plaque growth in a portion of the circumference of the arterial wall is indeed strongly related …

Background The placement of stents in coronary arteries has been shown to reduce restenosis in comparison to balloon angioplasty. However, clinical use of intracoronary stents is impeded by the risk of subacute stent thrombosis and complications associated with the anticoagulant regimen. To reduce these complications, the hypothesis that systemic anticoagulation is not necessary when adequate stent expansion is achieved was prospectively evaluated on a consecutive series of patients who received intracoronary stents. Methods and Results From March 1993 to January 1994, 359 patients underwent Palmaz-Schatz coronary stent insertion. After an initial successful angiographic result with Conclusions The Palmaz-Schatz stent can be safely inserted in coronary arteries without subsequent anticoagulation provided that stent expansion is adequate and there are no other flow-limiting lesions present. The use of high-pressure final balloon dilatations and confirmation of adequate stent expansion by intravascular ultrasound provide assurance that anticoagulation therapy can be safely omitted. This technique significantly reduces hospital time and vascular complications and has a low stent thrombosis rate.

Brachyolmia is a rare form of skeletal dysplasia characterized by generalized platyspondyly without significant epiphyseal, metaphyseal, or diaphyseal changes in the long bones. Two cases of brachyolmia are reported: one of the Hobaek type, and another of the dominant type. One patient developed linear densities in the femoral necks: The manifestation is thought to be specific to the Hobaek type. Another patient had atlantoaxial instability and failure of ossification of the dens. These complications of brachyolmia have not been previously reported.

Spondylo-epi-metaphyseal dysplasia is a rare skeletal dysplasia showing radiographic abnormalities in the epiphyses and metaphyses of the long and short tubular bones, and in the spine. There are very few reports of a case followed throughout the entire growth period. Here we report the case of a Japanese girl followed from 1 month old to skeletal maturity at 16 years old. She developed progressive kyphoscoliosis at 7 years old, and underwent a surgical correction of the spine at 14 years old. The diagnosis of spondylo-epi-metaphyseal dysplasia was made from examining all the follow-up radiographs showing abnormalities in the spine, long bones and hands involving epiphyses and metaphyses. She had normal stature--a rare finding in this condition.

Diagnostic criteria for primary osteoarthritis of the hip joint in the Japanese population were determined by the roentgenographic measurements of the center-edge (CE) angle, the Sharp angle, and the acetabular roof obliquity in 254 normal hips. Primary osteoarthritis must meet the following conditions: (1) absence of femoral head deformities; (2) a CE angle of Wiberg greater than 19 degrees; (3) a Sharp angle less than 45 degrees; and (4) acetabular roof obliquity less than 15 degrees. These measurements are taken from roentgenograms during the early stage of the disease. Under these criteria, primary osteoarthritis accounted for only 0.65% of 2000 consecutive cases of osteoarthritis. Observation of the natural course of primary osteoarthritis revealed two subtypes. The superolateral type developed from the subset of normal hips with a relatively greater degree of acetabular roof obliquity.