We report the case of an eight-month-old girl who presented with a poliomyelitis-like paralysis in her left upper limb caused by enterovirus 71 infection. She recovered useful function after nerve transfers performed six months after the onset of paralysis. Early neurotisation can be used successfully in the treatment of poliomyelitis-like paralysis in children.

Aim: There have been increasingly publications about the complicated disease of patello-femoral joints after total knee arthroplasty (TKA). We have treated soft tissue impingement under the patella after TKA by arthroscopic surgery and investigated the findings and efficacy of the treatment.

Materials and Methods: 6 patients and 8 knees which showed soft tissue impingement of patello-femoral joints after TKA. Surgical arthroscopy was performed and impinging soft tissues were classified and the efficacy of arthroscopic treatment were evaluated.

Results: We classified the patients with soft tissue impingement under the patella into three groups: (I) patellar clunk syndrome; the isolated fibrous nodule located suprapatellar lesion, without the other fibrous tissues causing the impingement, (II) impinging hypertrophic synovitis; generalized hypertrophic synovitis, no fibrous nodule, and (III) the combined type of (I)+(II), the suprapatellar fibrous nodule with generalized hypertrophic synovitis. Therapeutic efficacy was that in the category of type I two were good-excellent, in type II three were fair and one was poor, and in type III two were fair.

Conclusions: Better results were obtained in type I (a patellar clunk syndrome) than type II (impingement synovitis).

Introduction: Carpal tunnel syndrome (CTS) occurs as one of clinical features of Dialysis Related Amyloidosis (DRA). Recently, it has been suggested that advanced glycation endproducts (AGEs) and bate 2 microglobulin (b2m) modified with AGEs are related to DRA. In our previous cross-sectional study, the fact that serum pentosidine, which is an AGE, was higher in DRA than in non-DRA indicates that it has potential as an indicator for the occurrence of DRA in HD patients.

Aim: In this prospective study we examined to elucidate whether serum levels of pentosidine relate to the occurrence of CTS in patients with HD in 4 years longitudinal follow up.

Material and Methods: The subjects are 106 end-stage renal failure patients undergoing HD, who had never operated for CTS. Serum pentosidine was measured by the HPLC method with column switching. b2m and intact PTH were also measured. During follow up period we operated 15 patients for CTS.

Results: Pentosidine levels were significantly elevated in the operated group than the non-operated group, whereas there were not significant differences in b2m and intact-PTH.

Conclusion: These results indicate that serum pentosidine has the potential as an indicator for the occurrence of CTS in long-term hemodialysis patients.

Aim: Urinary C-terminal telopeptide of type I collagen (u-CTx) has been reported to be a sensitive biochemical marker of bone turnover. There have been two assays for urinary CTx, which are u-aCTx and u-BCTx. A newly developed immunoassay for serum CTx (s-CTx) is now available for assessment of bone resorption. We have both evaluated the effects of menopause, and osteoporosis on the measurements of serum CTx and compared them to urinary CTx assays.

Subjects: 79 premenopausal healthy women, 80 post-menopausal healthy women, 61 osteoporotic patients with vertebral fractures and 34 osteoporotic patients with hip fractures

Results: Bone resorption markers were increased after menopause. There was no significant difference among s-CTx, u-aCTx and u-BCTx in the T-scores of post-menopausal group over premenopausal group (T -score; s-CTx:2.3, u-aCTx:1.8, u-BCTx:2.1). Patients with vertebral fractures and patients with hip fracture had elevated levels of bone resorption markers compared to age-matched healthy postmenopousal women. There was no significant difference among s-CTx, u-aCTx and u-BCTx in the T-scores against postmenopausal group in vertebral fracture group (T -score; s-CTx:0.8, u-aCTx:0.9, u-BCTx:0.7) and in hip fracture group women (T-score; s-CTx:1.1, u-aCTx: 1.3 u-BCTx: 1.3).

Conclusions: These findings indicate that s-CTx reflects the increase of bone resorption associated with menopause and osteoporosis with vertebral fractures and hip fractures.

We describe a method of exposing the whole length of the axillary and suprascapular nerves through a sabre-cut incision. The coracoid process is osteotomised and part of trapezius is detached from its insertions. The posterior deltoid is freed from its scapular origin to expose infraspinatus.

We have used this approach to explore combined injuries of the axillary and suprascapular nerves with good results, and no serious complications. Its success depends on a meticulous surgical technique.

We report the results in 33 patients who had nerve grafting of the axillary or the suprascapular nerve or of both. There were 32 men and one woman; their mean age was 21 years and the average interval between injury and operation was three months.

At a mean follow-up of 27 months, the deltoid had recovered to M3 or better in 23 of 30 patients (77%) and the infraspinatus in 18 of 25 patients (72%). Shoulder elevation had reached 120° or more in 27 patients (82%), with external rotation of 30° or more in 27 (82%). Twenty-six patients (79%) could reach to the top of their head with their hand.

Recovery of muscle strength, range of movement and shoulder function were satisfactory when surgery was performed within four months of the injury. Early exploration and nerve grafting can lead to a good functional recovery, but thorough exploration and careful repair of both nerves are essential.

We have assessed the efficacy of free nerve grafts in 90 cases of brachial plexus injury. Relatively good recovery of the elbow flexor and extensor muscles and of those of the shoulder girdle was found but recovery of the flexors and extensors of the forearm and of the intrinsic muscles of the hand was extremely poor.

Poor results were found when spinal nerve roots seemed normal to the touch and appeared intact but had abnormal somatosensory evoked potentials or myelography. Recovery of the deltoid and infraspinatus muscles was better when injury had occurred to the circumflex and suprascapular nerves rather than to the plexus itself, perhaps because these nerves were explored in their entirety to determine the presence of multiple lesions.

It is important to visualise the entire nerve thoroughly to assess the overall condition. Thorough exploration of the plexus and the use of intraoperative recording of somatosensory evoked potentials are essential.