Objective: Percutaneous tibial nerve stimulation (PTNS) is used to treat refractory urinary frequency, urgency, and urgency urinary incontinence. To date, it is not approved by the US Food and Drug Administration in the treatment of chronic pain syndromes, and its use in the treatment of chronic clitoral pain has not been reported. Methods: We describe 2 cases of women who presented with symptoms of urgency urinary incontinence, urinary frequency, and clitoral pain. After inadequate response to conservative treatment of their urinary symptoms, they received PTNS. Results: By the 12th session, significant improvement in urinary symptoms and resolution of clitoral pain were noted. Conclusions: The findings of this report suggest that PTNS may be a therapeutic option in patients with idiopathic clitoral pain.

Indiana University-Purdue University Indianapolis (IUPUI) / Skeletal fractures due to bone disease impact an estimated 1.5 million Americans per year, creating a large economic burden on our society. Treatment of bone diseases prior to fracture often involves bisphosphonates (current gold-standard in osteoporosis care and prevention). Although bisphosphonates decrease fracture incidence, they often improve bone mass without regard for bone quality. Thus, although bisphosphonates increase the amount of bone present, the inherent bone material strength often decreases, creating a trade-off that increases the risk of atypical fractures after long-term use. This trade-off demonstrates the need for a treatment that targets both bone quality AND quantity. Although bone quality is important, the components of bone that contribute to bone quality are incompletely understood, making it difficult to create new pharmacological agents. With this in mind, my particular area of interest is in understanding how mechanical stimuli protects the formation of bone, leading to improved bone quality. Initially, this area was explored through use of tibial loading in a disease mouse model (osteolathyrism, induced by injection of beta-aminoproprionitrile) as a means of assessing how the body is able to compensate for decreased bone quality. The results of the BAPN and tibial loading studies indicated that injecting mice with BAPN may not be the ideal method to induce osteolathyrism. However, other intriguing results from the BAPN studies then led us into an exploration of how tibial loading itself contributes to bone quality.

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No / Little has been written about the functional outcome of patients treated with bone transport to reconstruct a distal tibial defect. The aim of this study was to investigate the functional capabilities of patients who had undergone reconstruction with distraction osteogenesis for the treatment of a distal tibial defect in one lower limb. At least eighteen months after completion of treatment, eight patients who had no pain and were able to walk and climb stairs without difficulty performed isometric ankle plantar flexion maximum voluntary contractions while the electromyographic activity of the tibialis anterior and triceps surae muscles was simultaneously recorded. Seven of the patients also underwent gait analysis. Data for the involved limb were compared with those collected for the contralateral limb. During gait, stance time (p = 0.01), the plantar flexion angular displacement and peak moment developed during the second half of stance (p < 0.046), and the amount of ankle power generated (p = 0.02) were significantly decreased in the involved limb compared with the contralateral limb. Similar decreases were observed in the plantar flexion (p = 0.01) and dorsiflexion (p = 0.01) maximum voluntary contractions and the corresponding electromyographic activity (p = 0.01). These results suggest that adaptive changes had occurred at the level of the transported muscles, which affected both routine and maximal effort capabilities. These findings contribute to our understanding of the functional limitations of patients who have undergone bone transport with its obligatory shortening of muscle length.

yes / Background Unilateral trans-tibial amputees have bilaterally reduced toe clearance, and an increased risk of foot contact, while crossing obstacles compared to the able-bodied. While the able-bodied tend to lead with a ‘preferred’ limb it is equivocal whether amputees prefer to lead with the intact or prosthetic limb. This study determined the effects of laterality, compared to side of amputation, on amputees' obstacle crossing performance. To help understand why laterality could affect performance we also assessed knee proprioception for both limbs. Methods Foot placement and toe clearance parameters were recorded while nine amputees crossed obstacles of varying heights leading with both their intact and prosthetic limbs. Joint-position sense was also assessed. Participants self-reported which limb was their preferred (dominant) limb. Findings There were no significant differences in foot placements or toe clearance variability across lead-limb conditions. There were no significant differences in toe clearance between intact and prosthetic lead-limbs (p = 0.28) but toe clearance was significantly higher when amputees led with their preferred compared to non-preferred limb (p = 0.025). There was no difference in joint-position sense between the intact and residual knees (p = 0.34) but joint-position sense tended to be more accurate for the preferred, compared to non-preferred limb (p = 0.08). Interpretation Findings suggest that, despite the mechanical constraints imposed by use of a prosthesis, laterality may be as important in lower-limb amputees as it is in the able bodied. This suggests that amputees should be encouraged to cross obstacles leading with their preferred limb. / Engineering and Physical Sciences Research Council

京都大学 / 新制・課程博士 / 博士(医学) / 甲第24829号 / 医博第4997号 / 新制||医||1067(附属図書館) / 京都大学大学院医学研究科医学専攻 / (主査)教授 森信, 暁雄, 教授 竹内, 理, 教授 濵﨑, 洋子 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DFAM

Objective To assess the role of the proximodistal and caudocranial relative position of the patellar ligament insertion on the tibia and patellar ligament length-to-patellar length ratio (PLL:PL) in small-breed dogs with and without grade II medial patellar luxation (MPL). Study Design Retrospective study. Sample Population Dogs weighing ≤15 kg, including 43 stifles with MPL and 34 control stifles. Methods The proximodistal and caudocranial relative position of the patellar ligament insertion was determined as a ratio using the vertical (VTT) and horizontal distance (HTT) between the tibial tuberosity insertion and the tibial plateau divided by the tibial plateau length (TPL). In addition, PLL:PL and tibial plateau angle (TPA) were determined. Results The VTT:TPL ratio was lower in affected stifles (95% CI: 0.86–0.94) than in the control group (0.93–1.01; p = .01). No other difference was identified between affected and normal stifles. Conclusion The only difference identified in this study consisted of a more proximal position of the patellar ligament insertion in the stifles of small-breed dogs with grade II MPL. Clinical Significance The more proximal position of the patellar ligament insertion will result in a more proximal position of the patella in the trochlear groove and may contribute to the development of MPL. Potentially, this will also affect the risk of recurrence of MPL after surgical treatment.

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Background: Tibial fractures are associated with prolonged recovery. The aim of this study was to identify predictors of long-term physical functioning after tibial shaft fracture. Methods: We used data from the Trial to Re-evaluate Ultrasound in the Treatment of Tibial Fractures (TRUST) to determine, in patients with unilateral, open or closed tibial shaft fracture, the association between baseline factors and physical functioning at 1-year. All fractures were fixed using intramedullary nails. Physical functioning was measured using the 100-point Short Form-36 (SF-36) Physical Component Summary (PCS) score; higher is better; minimally important difference is 2 to 5 points. Results: There were 299 tibial fracture patients with complete data available for analysis. In an adjusted analysis, the factors associated with lower physical functioning at 1-year were: (1) current smokers (mean difference [MD] -2.55, 95% confidence interval [95%CI] -4.63 to -0.46, p=0.017), (2) body mass index >30 kg/m² (MD -2.57, 95% CI -4.86, -0.27, p = 0.029), and (3) patients who were receiving disability benefits or involved in litigation, or planned to be (MD -2.65, 95% CI -4.58 to -0.72, p = 0.007). Patients who were employed at the time of their fracture reported significantly higher physical functioning at 1-year (MD 4.56, 95% CI 2.32 to 6.80, p= <0.001) and those who were allowed to partial or full weight-bear post-operatively (MD 1.98, 95% CI 0.13 to 3.82, p=0.036). Neither age, sex, fracture severity or receipt of physical therapy were associated with long-term physical functioning. Conclusions: Among patients undergoing surgical repair of tibial fractures, partial or full weight-bearing post-operatively and employment at the time of injury predict better long-term functioning, whereas smoking, obesity, and receipt of disability benefits or involvement in litigation (or plans to be) predict worse long-term functioning. / Thesis / Master of Science (MSc)