We evaluated the factors influencing outcomes of flexor tendon repair in 112 fingers using a six-strand suture with the Yoshizu #1 technique and early postoperative active mobilization in 101 consecutive patients. A total of 32 fingers had injuries in Zone I, 78 in Zone II, and two in Zone III. The mean follow-up period was 6 months; 16 patients (19 fingers) participated in long-term follow-up of 2 to 16 years. The total active motion was 230° SD 29°; it correlated negatively with age. The total active motion was 231° SD 28° after repair of the lacerated flexor digitorum superficialis tendon, and was 205° SD 37° after excision of the flexor digitorum superficialis tendon ends (p = 0.0093). A total of 19 fingers showed no significant increases in total active motion more than 2 years after surgery. The rupture rate was 5.4% in our patients and related to surgeons' level of expertise. Five out of six ruptured tendons were repaired by inexperienced surgeons. Level of Evidence IV.

This study investigated the ability of recognizing emotion in dementia. Twenty-five patients with dementia of the Alzheimer type (DAT), 25 patients with vascular dementia (VD), and 12 normal control subjects were evaluated as to general cognition, visuoperception and emotion recognition. The score on the emotion recognition task significantly correlated with that of the Mini-Mental State Examination for VD patients while this was not the case for DAT patients. Moreover, VD patients performed significantly worse than DAT patients on the emotion recognition task in spite of the fact that there was no difference in the general cognitive and visuoperceptual abilities between them. The result of this study coupled with the past studies led to the hypothesis that the relationship between intellectual deficits and the deterioration in recognizing emotions differs according to type of dementia. Caregivers in nursing homes and hospitals need to take into account their patients’ intellectual deficits but also their deteriorating ability of identifying emotions.

7 pediatric patients with injuries of basal ganglia following head trauma were reported. They ranged in age from 10 months to 10 years. 5 boys and 2 girls comprised the patients. Cases 1–4 are mild cases in which the children fell down backward while playing, followed by a minimum loss of consciousness. In every case there was hemiparesis, but all of them showed remarkable recovery. CT findings are that of unilateral basal ganglia infarction. In cases 5–7, patients suffered from symptoms of brain contusion after running out in front of an oncoming car, and they developed hemiparesis. CT findings in cases 5 and 6 showed unilateral infarction. CT of case 7 showed a massive unilateral hemorrhage of the basal ganglia. All 7 cases sustained only slight scalp wounds and no skull fracture in spite of the severity of injuries signs and CT findings. This discrepancy seems to be explained only by the so-called shearing strain theory. But we have hypothesized that anterior stretch of the lateral branch of the perforator of the middle cerebral artery plays a major role in its pathogenesis.

In fingertip amputations, conventional stump plasty provides an almost acceptable functional result. However, replanting fingertips can preserve the nail and minimize loss of function. We investigated the functional and cosmetic results of fingertip replantation at the terminal branch of the digital artery. Outcomes were nailbed width and distal-segment length; sensory recovery; and range of motion (ROM) of thumb-interphalangeal (IP) or finger-distal interphalangeal (DIP) joints, and total active motion (TAM) of the replanted finger. Of 15 fingertips replanted after only arterial anastomosis, 13 were successful, and 12 were studied. After a median of 1.3 years, mean nailbed widths and distal-segment lengths were 95.4% and 93.0%, respectively, of the contralateral finger. Average TAM and ROM of the thumb-IP or finger-DIP joints were 92.0% and 83.0% of normal, respectively. Semmes-Weinstein results were blue (3.22 to 3.61) in 4 fingers and purple (3.84 to 4.31) in 8; the mean result from the 2-point discrimination test was 5.9 mm (range, 3 to 11 mm). Thus, amputated fingertips should be aggressively replanted.

The authors reviewed the Japanese literature on moyamoya disease. In the article we discuss the history of such investigations in Japan, the signs and symptoms, the diagnosis (especially concerning diagnostic criteria and magnetic resonance imaging), the pathology in relation to its etiology, and the current methods of treatment. On the whole, the main aim of the paper was to introduce our concept of moyamoya disease that is now current in Japan.