Purpose Two-dimensional (2D) and three-dimensional (3D) measurements of prosthetic alignment and "outliers" after total knee arthroplasty (TKA) might not necessarily be comparable. The aim of this study was to compare the use of 2D and 3D measurements in the identiication of prosthetic alignment and outliers after TKA. Methods This cross-sectional study included 159 consecutive TKAs. All patients underwent plain radiography, luoroscopyguided radiography, and computed tomography after TKA. The same baseline was used for 2D and 3D measurements. The reliability of prosthetic alignment and outlier identiication (> 3° from neutral alignment) was compared between the 2D and 3D measurements. ResultsThe mean prosthetic alignment and rate of outliers were not signiicantly diferent the between 2D and 3D measurements. The inter-and intra-observer reliabilities were higher for the 3D measurements than for the 2D measurements. The agreement between 2D and 3D measurements in outlier identiication was poor, except for femoral coronal alignment. Cohen's κ coeicients were 0.19 in femoral sagittal (poor), 0.02 in tibial coronal (poor), and 0.10 in tibial sagittal (poor) on plain radiography. The values were 0.23 in tibial coronal (poor) and 0.002 in tibial sagittal (poor) on luoroscopy-guided radiography. Conclusions The agreement between 2D and 3D measurements in the identiication of outliers was poor, even on luoroscopy-guided radiography. Since 2D measurements have an inherent risk of misidentifying alignment outliers, this inding is clinically relevant. To properly analyze the correlation between outliers and clinical results, such as longevity, patient satisfaction, and patient-reported outcome, 3D measurements for prosthetic alignment are desirable. Level of evidence III.

Rectal carcinoid tumours are often small and rarely metastatic. Endoscopic resection may, therefore, be the best treatment for small tumours. We diagnosed rectal carcinoid tumours in four women and three men (mean age 53 years; range, 43 -63) between 1994 and 1999. Tumour depth was evaluated using a high-frequency ultrasonographic probe in five of the seven patients. All tumours were resected by endoscopic mucosal resection using an aspiration method with a transparent overcap. Histologically, all tumours were located within the submucosal layer. Tumour cells were found at the resected margin of the lateral side in one patient, and at the bottom of the margin in another. Both patients were followed up with frequent endoscopy, and no local recurrences have been detected at 1-year or 4-year follow-ups. Ultrasonographic examination before resection is useful to estimate tumour depth. Endoscopic resection by an aspiration method with a transparent overcap is safe and effective for the treatment of small rectal carcinoid tumours.

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Background Biomechanical changes in articular cartilage are associated with the onset of osteoarthritis. We developed an optical coherence tomography-based strain rate tomography method: stress relaxation optical coherence straingraphy (SR-OCSA). The purpose of this study was to establish an approach for measuring mechanical properties of articular cartilage using SR-OCSA, and to investigate the distribution of viscoelastic properties of articular cartilage in early osteoarthritis. Methods Anterior cruciate ligament transection surgery was performed on the left knees of 8–9-month-old New Zealand white rabbits. SR-OCSA was used to visualize and measure the viscoelastic properties of articular cartilage via attenuation coefficient of strain rate (ACSR). Using the same conditions as in the SR-OCSA test, an indentation test was conducted, and relaxation time was measured to evaluate the relationship between ACSR and relaxation time. Results SR-OCSA could nondestructively detect and visualize changes in the distribution of viscoelastic properties of articular cartilage in early osteoarthritis. SR-OCSA captured significant increases in ACSR in cartilage at 2 weeks after surgery, when a histologically slight osteoarthritis sign was present. As cartilage degeneration progressed, ACSR increased, whereas relaxation time decreased in a time-dependent manner. Moreover, ACSR negatively correlated with relaxation time. In particular, ACSR was elevated around the tidemark and the elevation tended to move as cartilage degeneration progressed. Conclusions SR-OCSA could tomographically and nondestructively detect and visualize changes in the distribution of viscoelastic properties of articular cartilage in early osteoarthritis. The mechanical properties around the tidemark were degraded as cartilage degeneration progressed. Thus, SR-OCSA provides important data needed to understand the biomechanics of early osteoarthritis.

III.