Ichiro Tonogai, Yuhei Yamasaki, Toshihiko Nishisho and Koichi Sairyo : Republication of "Mucous Cyst at the Interphalangeal Joint of the First Toe Caused by Contact Pressure With the Second Toe due to Hallux Valgus: A Case Report"., Foot & Ankle Orthopaedics, Vol.8, No.3, 2023.
(Summary)
A 77-year-old woman presented with a mucous cyst on the lateral aspect of the interphalangeal joint of the first toe caused by contact pressure with the second toe from hallux valgus. She complained of discomfort and discharge from the left first toe for approximately 4 months. Physical examination showed the second toe pressing strongly against the first toe due to hallux valgus and discharge from the skin on the lateral aspect of the interphalangeal joint of the first toe. Magnetic resonance imaging showed a cystic lesion at the same level. The patient underwent a modified scarf osteotomy of the first metatarsal for hallux valgus to resolve the contact pressure between the toes-considered the cause of the mucous cyst-and resection of mucous cyst. Forefoot weight bearing was allowed 6 weeks after surgery. As of 1 year after surgery, she has had no recurrence of the cyst. The score on the Japanese Society for Surgery of the Foot hallux metatarsophalangeal-interphalangeal scale improved from 59/100 points to 92/100. This outcome suggests that hallux valgus correction should be considered when a mucous cyst is associated with contact pressure due to a hallux valgus deformity. To the best of our knowledge, there are no previous reports of a mucous cyst caused by contact pressure between the first toe and second toe due to hallux valgus.
Yasuyuki Ohmichi, Shun-ichi Toki, Toshihiko Nishisho, Takeshi Harada, Nori Sato and Koichi Sairyo : Atypical femoral fracture in a multiple myeloma patient undergoing treatment with denosumab: A case report and literature review., International Journal of Surgery Case Reports, Vol.108, 2023.
(Summary)
Atypical femoral fracture may occur in patients with multiple myeloma who receive denosumab, even for a short period. Attending physicians should be cognizant of the early symptoms and signs of this fracture.
Makoto Takeuchi, Toshihiko Nishisho, Shun-ichi Toki, Shinji Kawaguchi, Shunsuke Tamaki, Takeshi Oya, Yoshihiro Uto, Toyomasa Katagiri and Koichi Sairyo : Blue light induces apoptosis and autophagy by promoting ROS-mediated mitochondrial dysfunction in synovial sarcoma., Cancer Medicine, Vol.12, No.8, 9668-9683, 2023.
(Summary)
Taken together, our results revealed that BL induced apoptosis via the ROS-mitochondrial signaling pathway, and autophagy was activated in response to the production of ROS, which protected SS cells from apoptosis. Therefore, BL is a promising candidate for the development of an antitumor therapeutic strategy targeting SS.
Shun-ichi Toki, Toshihiko Nishisho, Ryo Miyagi, Yoshimi Bando, Mika Sakaki, Yusuke Demizu, Tomoaki Okimoto and Koichi Sairyo : Combination chemotherapy of doxorubicin and ifosfamide with proton beam therapy for myoepithelial carcinoma originating in the paraspinal region: A case report and literature review., Molecular and Clinical Oncology, Vol.17, No.6, 2022.
(Summary)
Soft tissue myoepithelial carcinoma (MEC) is an extremely rare mesenchymal tumor that has a poor prognosis unless complete surgical resection is achieved. The present study reported a case of a 38-year-old woman with a tumor in the left paraspinal region at L2 to L3 with vertebral destruction. MEC was diagnosed based on molecular pathological examination of a biopsy specimen. Because curative surgery was expected to be difficult, a combination of chemotherapy with doxorubicin and ifosfamide and proton beam therapy as local therapy was performed, resulting in long-term survival for at least 7.8 years. To the best of our knowledge, this is the first case of soft tissue MEC for which classical cytotoxic chemotherapy and proton beam therapy were effective. Although surgical resection with negative margins is the mainstay of treatment for MEC, adequate doxorubicin-based systemic therapy and high-dose radiation therapy may be a feasible alternative in patients with unresectable or advanced MEC. Future studies on the relationship between molecular pathological features, including biomarkers, and the selection of therapeutic agents are warranted.
Satoshi Sumida, Shun-ichi Toki, Taisuke Mori, Kaishi Satomi, Shoichiro Takao, Sumihito Nobusawa, Takumi Kakimoto, Shinya Nakagawa, Eijitsu Ryo, Yuko Matsushita, Koichi Ichimura, Toshihiko Nishisho, Yoshimi Bando and Akihiko Yoshida : ZFTA::RELA fusion in a distinct liposarcoma morphologically overlapping with chondroid lipoma., Genes, Chromosomes & Cancer, Vol.62, No.2, 101-106, 2022.
(Summary)
Chondroid lipoma is a rare benign adipose tumor characterized by a recurrent ZFTA::MRTFB fusion. Herein, we report an unusual liposarcoma that partly exhibited overlapping features with those of chondroid lipoma and harbored a ZFTA::RELA fusion. A 59-year-old man presented with a shoulder mass that had existed for approximately 8 years and with increasing pain due to a pelvic mass. The 5.8-cm resected shoulder tumor partly consisted of nests and strands of variably lipogenic epithelioid cells within a hyalinized or focally chondromyxoid stroma, indistinguishable from chondroid lipoma. The histological pattern gradually transitioned to highly cellular, stroma-poor, diffuse sheets of cells with greater nuclear atypia and mitotic activity. Vascular invasion and necrosis were present. The metastatic pelvic tumor revealed a similar histology. Despite multimodal treatment, the patient developed multiple bone metastases and succumbed to the disease 14 months after presentation. Targeted RNA sequencing identified an in-frame ZFTA (exon 3)::RELA (exon 2) fusion, which was confirmed by reverse transcription-polymerase chain reaction, Sanger sequencing, and break-apart fluorescent in situ hybridization assays. The tumor showed a different histology from that of ependymoma, no brain involvement, and no match with any sarcoma types or ZFTA::RELA-positive ependymomas according to DNA methylation analysis. p65 and L1CAM were diffusely expressed, and a CDKN2A/B deletion was present. This is the first report of an extra-central nervous system tumor with a ZFTA::RELA fusion. The tumor partly displayed an overlapping histology with that of chondroid lipoma, suggesting that it may represent a hitherto undescribed malignant chondroid lipoma with an alternative ZFTA fusion.
Takeshi Morii, Ukei Anazawa, Chiaki Sato, Shintaro Iwata, Makoto Nakagawa, Makoto Endo, Tomoki Nakamura, Kunihiro Ikuta, Yoshihiro Nishida, Robert Nakayama, Toru Udaka, Teruya Kawamoto, Munehisa Kito, Kenji Sato, Jungo Imanishi, Toru Akiyama, Hiroshi Kobayashi, Akihito Nagano, Hidetatsu Outani, Shunichi Toki, Toshihiko Nishisho, Keita Sasa, Yoshiyuki Suehara, Hirotaka Kawano, Takafumi Ueda and Hideo Morioka : Dedifferentiated liposarcoma in the extremity and trunk wall: A multi-institutional study of 132 cases by the Japanese Musculoskeletal Oncology Group (JMOG)., EJSO - European Journal of Surgical Oncology, Vol.49, No.2, 353-361, 2022.
(Summary)
The typical clinical characteristics of dedifferentiated liposarcoma in the extremity and trunk wall were reconfirmed in the largest cohort ever. The evaluation of the dedifferentiated area in terms of grade, extension, and pathological margin, together with securing adequate surgical margins, was critical in the management of this entity.
(Keyword)
Humans / Retrospective Studies / East Asian People / Liposarcoma / Extremities / Treatment Outcome
Ryo Okada, Toshinori Sakai, Toshihiko Nishisho, Akihiro Nitta, Shigeyuki Takahara, Koichi Oba and Koichi Sairyo : Preoperative Planning Using Three-dimensional Printing for Full-endoscopic Spine Surgery: A Technical Note., NMC Case Report Journal, Vol.9, 249-253, 2022.
(Summary)
Transforaminal full-endoscopic spine surgery (TF-FESS) is a novel minimally invasive spine surgery that requires only an 8-mm skin incision and causes minimal damage to the paravertebral muscles. To perform TF-FESS safely and efficiently, preoperative planning is quite important as the intervention requires anatomical understanding and high technical skills. Recently, three-dimensional (3D) printing has become a useful tool in various surgeries, and several studies have addressed its efficacy; however, there are no reports on the application of 3D printing to FESS. In this study, we present two cases of severe lumbar deformities for which preoperative 3D printing was useful. The 3D printing enabled the surgeons to visualize and plan the drilling of the superior articular process for a successful foraminoplasty at a low cost. The manufacturing equipment cost about USD 900 and is able to produce an actual-size model at a cost of less than USD 10 per patient. In conclusion, preoperative planning using 3D printing should be adopted to safely perform FESS.
Yugen Fujii, Toshihiko Nishisho, Fumitake Tezuka, Akio Iwanami, Kazuta Yamashita, Shun-ichi Toki, Masatoshi Morimoto, Kosuke Sugiura, Toshinori Sakai, Toru Maeda and Koichi Sairyo : Hemangioblastoma of the Cauda Equina : A Case Report and Review of the Literature., The Journal of Medical Investigation : JMI, Vol.69, No.3.4, 312-315, 2022.
(Summary)
Introduction : Hemangioblastoma in the spine mainly occurs at the cervical and thoracic levels and is often associated with von Hippel-Lindau (VHL) syndrome. Here, we reported a quite rare case of spinal sporadic hemangioblastoma arising from the cauda equina. Case presentation : A 66-year-old woman presented with a 5-year history of low back and leg pain. Imaging revealed a hypervascular intradural extramedullary tumor in the lumbar region. Preoperative angiography helped to identify the feeding arteries and draining vein, and so facilitated subsequent tumor resection. The pain was dramatically improved but weakness of the left tibialis anterior and left extensor hallucis longus muscles persisted. Discussion : We reported a rare case of spinal hemangioblastoma arising from the cauda equina. Preoperative angiography may be useful for diagnosis and understanding of the anatomy of feeding veins. J. Med. Invest. 69 : 312-315, August, 2022.
Takayoshi Shinya, Otomi Yoichi, Toshihiko Nishisho, B Beuthien-Baumann, Saho Irahara, Michiko Kubo, Hideki Otsuka, Yoshimi Bando, Koichi Sairyo and Masafumi Harada : Clinical application of dynamic 18F-fluorodeoxyglucose positron-emission tomography / computed tomography in the differential diagnoses of musculoskeletal lesions, The Journal of Medical Investigation : JMI, Vol.68, No.1. 2, 96-104, 2021.
(Summary)
<p>We aimed to assess the differential diagnostic efficacy of dynamic F-18 fluorodeoxyglucose (FDG) positron emission tomography / computed tomography (PET / CT) and to evaluate the appropriate scan timings for diagnosis of musculoskeletal lesions (MSLs). Dynamic scans (5-15 [phase 1], 15-25 [phase 2], and 25-35 [phase 3] min after F-18 FDG injection) and dual-time-point scans (1 and 2 h after injection) were acquired for 23 MSLs [4 benign MSLs (BMSLs). 10 primary malignant musculoskeletal tumors (PMMSTs), and 9 metastatic musculoskeletal tumors (MMSTs)]. We compared the maximum standardized uptake values (SUVmax) and corresponding retention indices for dynamic (RI-SUVdyn) and dual-time-point (RI-SUVdual) scans and evaluated diagnostic efficacy using receiver operating characteristic (ROC) curve analyses. The SUVmax gradually decreased or was almost identical with minimal fluctuation in 3 BMSLs and 1 PMMST. SUVmax increased over time after phase 2 in 18 malignant MSLs (MMSLs). There were significant differences in SUVmax (for all time phases) and RI-SUV dual between BMSLs and MMSLs and between PMMSTs and MMSTs. In the ROC analyses, the areas under the curve for SUV in phases 2 and 3 were highest for differentiating BMSLs from MMSLs and PMMSTs from MMSTs, respectively. Dynamic F-18 FDG PET / CT is valuable for diagnosis of musculoskeletal lesions. J. Med. Invest. 68 : 96-104, February, 2021</p>
(Keyword)
bone and soft tissue tumors / dynamic scan / musculoskeletal lesion / positron emission tomography computed tomography / sarcoma
Takayoshi Shinya, Youichi Otomi, Toshihiko Nishisho, Bettina Beuthien-Baumann, Michiko Kubo, Hideki Otsuka, Yoshimi Bando, Hiroaki Yanagawa, Koichi Sairyo and Masafumi Harada : Preliminary clinical assessment of dynamic carbon-11 methionine positron-emission tomography/computed tomography for the diagnosis of the pathologies in patients with musculoskeletal lesions: a prospective study., European Journal of Hybrid Imaging, Vol.26, No.4, 15, 2020.
(Summary)
Dynamic C-11 MET PET scans have the potential to be good predictors of discriminating MSLs in patients with primary unknown MSLs in clinical practice.
Fumitake Tezuka, Toshinori Sakai, Toshihiko Nishisho, Kosuke Sugiura, Yoshihiro Ishihama, Hiroaki Manabe, Kazuta Yamashita, Yoichiro Takata, Toru Maeda and Koichi Sairyo : Distribution of the Spinal Arteries in Adult Patients with Lumbar Spondylolysis., The Journal of Medical Investigation : JMI, Vol.67, No.1.2, 62-66, 2020.
(Summary)
INTRODUCTION : The pathology of lumbar spondylolysis is generally thought to begin with a stress fracture in adolescence. Stress fractures of the lower extremities occur in watershed areas with a poor vascular supply because of an inability to respond to stress and heal. This pathology has not been well researched in the lumbar spine. The aim of this study was to evaluate the distribution of the spinal arteries in patients with lumbar spondylolysis. METHODS : The extraosseous distribution of the arteries around the pars interarticularis was retrospectively investigated in 14 patients with colon cancer who underwent abdominal contrast-enhanced computed tomography (CE-CT) as part of a preoperative assessment at our hospital and were found to have spondylolysis at L5. RESULTS : All patients were found to have terminal-stage spondylolysis at L5 (1 unilateral, 13 bilateral). L5 segmental artery was absent in all cases. However, separate spinal arteries supplying the pars interarticularis at L5 were found above and below the transverse process at this level. CONCLUSION : All the patients had two separate arteries originating from the cranial and caudal sides that distributed to the superior and inferior articular processes, suggesting that the pars interarticularis is a posterior element containing a vascular watershed area. J. Med. Invest. 67 : 62-66, February, 2020.
Shota Shigekiyo, Toshihiko Nishisho, Yoichiro Takata, Shun-ichi Toki, Kosuke Sugiura, Yoshihiro Ishihama, Hiroaki Manabe, Fumitake Tezuka, Kazuta Yamashita, Toshinori Sakai, Toru Maeda and Koichi Sairyo : Intracanalicular Osteochondroma in the Lumbar Spine., NMC Case Report Journal, Vol.7, No.1, 11-15, 2020.
(Summary)
resection of the osteochondroma with the ligamentum flavum relieved the symptoms. Spinal osteochondroma occurs relatively frequently in elderly individuals compared with peripheral lesions and mimics a degenerative spinal disorder. Careful physical examination and imaging evaluation can reveal this tumor and surgery is effective for relieving the symptoms.
Kaori Momota, Toshihiko Nishisho, Ryo Miyagi, Shun-ichi Toki, Kazuta Yamashita, Fumitake Tezuka, Yoichiro Takata, Toshinori Sakai, Akihiro Nagamachi, Toru Maeda and Koichi Sairyo : A Rare Case of Acute-Onset Spastic Quadriparesis Caused by a Chondroma of the Cervical Spine., Case Reports in Orthopedics, Vol.2019, 2019.
(Summary)
Chondromas are benign cartilaginous tumors that occur very rarely in the spine. Moreover, chondromas of the extraskeletal origin are also very rare. In this case report, we describe an extremely rare case of chondroma arising from the ligamentum flavum in the cervical spine. A 67-year-old man presented to our clinic with acute-onset spastic quadriparesis. We performed emergent magnetic resonance imaging and found an epidural mass in the right ligamentum flavum at C4-C5. The acute-onset presentation was suspicious for intraligamentous hematoma in the ligamentum flavum at this level. We performed emergency decompression surgery and en bloc removal of the epidural mass with the right C4 and C5 lamina. The lesion had the appearance of cartilaginous tissue rather than hematoma. Based on the histological investigation, the final diagnosis was intraligamentous chondroma of the cervical spine. The quadriparesis improved postoperatively, as did the results of manual muscle testing in the affected area, and he was able to resume walking independently with a cane. At the one-year follow-up, the manual muscle testing results were almost normal. Surgeons should keep in mind the possibility of benign tumors including chondroma of the cervical spine when a patient presents with acute-onset quadriparesis.
Masashi Kano, Toshihiko Nishisho, Ryo Miyagi, Fumio Chikugo, Eiji Kudo, Shoichiro Takao, Seiji Iwamoto, Shun-ichi Toki and Koichi Sairyo : Intimal sarcoma arising from the common iliac artery presenting with artery occlusion : a case report and literature review., The Journal of Medical Investigation : JMI, Vol.66, No.1.2, 205-208, 2019.
(Summary)
We present a rare case of intimal sarcoma arising from the common iliac artery in an 82-year-old man who presented with intermittent claudication. He had undergone endovascular therapy with self-expanding stents to both iliac arteries that had occluded soon after placement. After salvage bypass grafting, a diagnosis of intimal sarcoma with angiosarcoma phenotype from the iliac artery was made. Further bypass graft surgery relieved symptoms temporarily. However, the tumor progressed and the left limb became ischemic. The chemotherapy of eribulin did not prevent tumor progression. The patient died of the disease 20 months after the first surgery. J. Med. Invest. 66 : 205-208, February, 2019.
Ichiro Tonogai, Toshihiko Nishisho, Shoichiro Takao, Ryo Miyagi, Kenji Yokoyama, Shunichi Toki and Koichi Sairyo : Symptomatic Os Intercuneiform: A Case Report., The Journal of Foot and Ankle Surgery, Vol.57, No.5, 997-999, 2018.
(Summary)
We encountered a case of an accessory bone in the foot in the distal portion of the tarsal navicular and the proximal portion of the intermediate cuneiform, namely an os intercuneiform. The patient presented with a history of pain on the dorsal aspect of the left foot, with tenderness and swelling. Perioperative findings revealed a synfibrotic connection between the accessory bone and the navicular and intermediate cuneiform. After unsuccessful conservative treatment, the accessory bone was excised, leading to postoperative symptomatic relief.
Ryosuke Sato, Yoshitaka Hamada, Naohito Hibino, Toshihiko Nishisho, Ichiro Tonogai, Kenji Endo and Koichi Sairyo : Restoration of the Active Forearm Rotation Using Vascularized Free Fibular Graft and Radial Head Arthroplasty for a Wide Defect of the Proximal Radius., The Journal of Hand Surgery, Asian-Pacific Volume, Vol.22, No.4, 531-534, 2017.
(Summary)
In this report we present a case of re-stabilization of the proximal radius using vascularized free fibular graft combined with anconeus arthroplasty to stabilize the transplanted fibula in a patient with large loss of the proximal radius due to Ewing's sarcoma. A 20-year-old woman had Ewing's sarcoma in the proximal three-fourths of the radius. The resection of large part of the radius containing radial head were necessary for removal of the sarcoma. Reconstruction of the proximal radius was performed using vascularized free fibular graft and the transplanted fibula was stabilized by attaching the anconeus to the proximal edge of the fibula. 2 years after surgery, she had neither recurrence nor metastasis, and achieved functional recovery. The combination anconeus arthroplasty with vascularized free fibular graft can be a good technique for re-stabilization of the elbow and recovery of the forearm function.
Toshihiko Nishisho, Mika Sakaki, Ryo Miyagi, Shoichiro Takao and Koichi Sairyo : Burned-out seminoma revealed by solitary rib bone metastasis., Skeletal Radiology, Vol.46, No.10, 1415-1420, 2017.
(Summary)
Burned-out tumor is a rare phenomenon in which a testicular tumor regresses in the primary lesion and progresses in a metastatic lesion. We report the case of a 30-year-old male with burned-out seminoma revealed by open biopsy of solitary 10th rib bone metastasis. He underwent inguinal orchiectomy, which revealed hyalinization, indicating a spontaneously regressed testicular tumor. Chemotherapy for seminoma was administered in three cycles of bleomycin + etoposide + cisplatin therapy. The chemotherapy was effective, and wide resection of the rib was subsequently performed. No postoperative chemotherapy was performed, and there has been no evidence of recurrence for 3 years postoperatively.
Ichiro Tonogai, Toshihiko Nishisho, Ryo Miyagi and Koichi Sairyo : Total calcanectomy for metastasis of renal cell carcinoma in the calcaneus: A case report., Foot and Ankle Surgery, Vol.24, No.1, e7-e12, 2017.
(Summary)
We present a rare case of metastasis of renal cell carcinoma to the calcaneus in a 59-year-old man who presented with pain and inability to bear weight on the left foot 3 years after right nephrectomy for renal cell carcinoma. He successfully underwent en bloc resection of his right calcaneus with a limb salvage procedure, total calcanectomy without bony reconstruction. Histological findings identified the lesion as a metastasis originating from a renal cell carcinoma. Recent follow-up examination showed no recurrence. To the best of our knowledge, this is the first reported case to be treated with total calcanectomy for renal cell carcinoma metastasis.
Akihiro Nagamachi, Mitsuhiko Takahashi, Noriaki Mima, Keisuke Adachi, Kazumasa Inoue, C Subash Jha, Akihiro Nitta, Masatoshi Morimoto, Tomoya Takasago, Toshiyuki Iwame, Keizo Wada, Fumitake Tezuka, Kazuta Yamashita, Fumio Hayashi, Ryo Miyagi, Toshihiko Nishisho, Ichiro Tonogai, Tomohiro Goto, Yoichiro Takata, Toshinori Sakai, Kousaku Higashino, Takashi Chikawa and Koichi Sairyo : Radiographic changes of cervical destructive spondyloarthropathy in long-term hemodialysis patients: A 9-year longitudinal observational study., The Journal of Medical Investigation : JMI, Vol.64, No.1.2, 68-73, 2017.
(Summary)
Analyses of radiographic changes and clinical symptom of destructive spondyloarthropathy (DSA) on consecutive 42 patients managed with long-term hemodialysis were performed to elucidate radiographic changes of DSA and the factors that influence to the destructive changes. Patients underwent plain radiographs of the cervical spine with 9 years interval. Grading of radiological feature from lateral view was classified into grade 0 to grade 3. Clinical symptom was evaluated using modified Japanese Orthopaedic Association scoring system for cervical myelopathy (mJOA score). Destructive changes were observed in 3 patients at the first examination, and those were observed in 15 patients 9 years after the first examination. There is no statistically significant difference between the duration of hemodialysis and the grade. The mean age at the onset of hemodialysis, however, was significantly higher in patients of grade 2 and 3 than those of grade 1. Older patients with long-term hemodialysis had destructive changes. Destructive changes commonly observed in lower cervical spine. The average numbers of the involved disc level were 1.6 in grade 2 and 1.0 in grade 3. Clinical symptoms were varied in each grade and there was no statistically significant difference in total mJOA score among these grades. J. Med. Invest. 64: 68-73, February, 2017.
Shunichi Toki, Toshihiko Nishisho, Shoichiro Takao, Ryo Miyagi, Fumitake Tezuka, Akihiro Nagamachi and Koichi Sairyo : Fibroma of tendon sheath on the medial side of the knee: a case report., The Journal of Medical Investigation : JMI, Vol.64, No.1.2, 173-176, 2017.
(Summary)
Fibroma of tendon sheath, which is a benign soft tissue tumor, primarily affects the finger, hand, or wrist. It rarely involves the knee and only a few cases appear in the literature. Here, we report a case of fibroma of tendon sheath on the medial side of the knee, in a previously hardly reported location, and provide detailed imaging and histological findings. A 54-year-old man presented with his right knee pain and a palpable mass that had developed 3 months earlier. Magnetic resonance imaging showed isointensity in the soft tissue tumor on T1-weighted images, variable intensity on T2-weighted images, and contrast enhancement. The specimen obtained by needle biopsy showed no histological findings of malignancy. Marginal resection was performed and the microscopic diagnosis was fibroma of tendon sheath. Since fibroma of tendon sheath is relatively rare, the radiological feature is not specific, and a rate of local recurrence following excision is high, careful diagnosis, surgical treatment and long-term follow-up are necessary. J. Med. Invest. 64: 173-176, February, 2017.
Chandra Subash Jha, Toshihiko Nishisho, Tetsuya Matsuura, Makoto Takeuchi, Ryo Miyagi, Shoichiro Takao, Naoto Suzue, Shunichi Toki, Akihiro Nagamachi and Koichi Sairyo : Pigmented villonodular synovitis of the knee joint in a 5-year-old girl treated with combined open and arthroscopic surgery: a case report., Journal of Pediatric Orthopaedics. Part B, Vol.25, No.6, 564-569, 2016.
(Summary)
Pigmented villonodular synovitis is an extremely rare disease in skeletally immature patients. Erosive destruction of the involved joint leads to early arthritis, and its high recurrence rate makes treatment challenging. Multiple surgical approaches exist, but it is unclear as to which among them achieves the lowest possible recurrence rate and morbidity. We report the case of a 5-year-old girl with left knee pain and swelling who was diagnosed with diffuse pigmented villonodular synovitis of the left knee based on MRI findings. Combined open and arthroscopic surgery was performed to completely remove the tumor. Postoperative histopathological examination confirmed the diagnosis of diffuse pigmented villonodular synovitis. The postoperative course was uneventful, with a gradual improvement in symptoms. There were no signs of recurrence on postoperative MRI performed at the 8-month follow-up, with neither knee pain nor limitation of range of motion. The favorable outcome in this case suggests that combined open and arthroscopic surgery may be an effective method for treating pigmented villonodular synovitis in skeletally immature patients.
Toshihiko Nishisho, Toshinori Sakai, Fumitake Tezuka, Kosaku Higashino, Shoichiro Takao, Yoichiro Takata, Ryo Miyagi, Shunichi Toki, Mitsunobu Abe, Kazuta Yamashita, Akihiro Nagamachi and Koichi Sairyo : Delayed Diagnosis of Primary Bone and Soft Tissue Tumors Initially Treated as Degenerative Spinal Disorders., The Journal of Medical Investigation : JMI, Vol.63, No.3-4, 274-277, 2016.
(Summary)
Background Symptoms of primary bone and soft tissue tumors located in the trunk mimic those of degenerative spinal disorders such as low back pain or pain or numbness of the legs. Due to their rarity, especially in sarcoma located in the trunk, diagnosis is sometimes delayed. Methods A retrospective review was performed of the records of 383 patients with primary bone and soft tissue tumors who visit our out patient clinic from 2011 to 2013 at a single institution. Patients with delayed diagnosis of primary bone and soft tissue tumors initially treated as degenerative spinal disorders for more than 2 months were identified. Results Of the 383 patients, 5 (1.3%) were initially diagnosed as having degenerative spinal disorders. All 5 patients had bone or soft tissue tumors in the lumbar spine or pelvis. Three patients had a malignant tumor (osteosarcoma, chondrosarcoma, or small round cell sarcoma) at the progressive stage, and 1 died of lung metastasis. Two patients had a benign tumor (aneurysmal bone cyst or simple bone cyst). Conclusions Our findings suggest that when low back pain and leg pain are refractory to conservative treatment, further radiological examination should be conducted. J. Med. Invest. 63: 274-277, August, 2016.
Toshihiko Nishisho, Shoichiro Takao, Ryo Miyagi, Shunichi Toki, Akihiro Nagamachi and Koichi Sairyo : Complete spontaneous regression of a subpubic cartilaginous cyst: a case report., The Journal of Medical Investigation : JMI, Vol.63, No.3-4, 319-322, 2016.
(Summary)
Subpubic cartilaginous cyst was recently reported as a rare degenerative mass on the pubic symphysis. We report here a 59-year-old woman who presented with a vulvar mass that showed complete spontaneous regression 48 months after the initial visit. Treatment was only wearing brace. This is the first report of complete spontaneous regression of a subpubic cartilaginous cyst. In the case of small subpubic cyst, observation and follow-up alone may be sufficient. J. Med. Invest. 63: 319-322, August, 2016.
Subash Jha C, Shoji Fukuta, Keizo Wada, Kousaku Higashino, Rui Amari-Kita, Takahiko Tsutsui, Tomohiro Goto, Daisuke Hamada, Naoto Suzue, Tetsuya Matsuura, Toshihiko Nishisho, Mitsunobu Abe, Yoichiro Takata, Toshinori Sakai, Akihiro Nagamachi and Koichi Sairyo : Optimizing baseplate position in reverse total shoulder arthroplasty in small-sized Japanese females: technical notes and literature review., The Journal of Medical Investigation : JMI, Vol.63, No.1-2, 8-14, 2016.
(Summary)
The management of cuff tear arthropathy (CTA) has always been a challenge for shoulder surgeons. Introduction of reverse total shoulder arthroplasty (RTSA) helped in providing pain relief and improved shoulder function in patients with CTA. In this study, we aimed to evaluate the short-term clinical results and some clinical details regarding the types of available prosthesis, positioning, and size of the components for RTSA in a population of short-stature female Japanese. In our seven cases, the average glenoid size was 23.9 mm in width and 34.2 mm in height. The average width was smaller than the size of all available baseplates. We implanted reverse shoulder prostheses with baseplate that measured 28 mm in diameter and two locking screws. The center of the baseplate was shifted to allow slight anterior overhang relative to the anatomical center to avoid breakage of the posterior cortex and to achieve firm fixation. One case of humeral shaft fracture occurred while inserting the humeral stem and required encircling wiring. In our experience, the short term clinical results of RTSA were excellent, but a new prosthesis that is designed to fit the short stature of Asians with smaller glenoid and humerus should be considered. J. Med. Invest. 63: 8-14, February, 2016.
Koichi Sairyo, Akihiro Nagamachi, Tetsuya Matsuura, Kousaku Higashino, Toshinori Sakai, Naoto Suzue, Daisuke Hamada, Yoichiro Takata, Tomohiro Goto, Toshihiko Nishisho, Yuichiro Goda, Takahiko Tsutsui, Ichiro Tonogai, Ryo Miyagi, Mitsunobu Abe, Masatoshi Morimoto, Kazuaki Mineta, Tetsuya Kimura, Akihiro Nitta, Tadahiro Higuchi, Shingo Hama, Jha C. Subash, Rui Takahashi and Shoji Fukuta : A review of the pathomechanism of forward slippage in pediatric spondylolysis : The Tokushima theory of growth plate slippage, The Journal of Medical Investigation : JMI, Vol.62, No.1,2, 11-18, 2015.
(Summary)
Spondylolysis is a stress fracture of the pars interarticularis, which in some cases progresses to spondylolisthesis (forward slippage of the vertebral body). This slip progression is prevalent in children and occurs very rarely after spinal maturation. The pathomechanism and predilection for children remains controversial despite considerable clinical and basic research into the disorder over the last three decades. Here we review the pathomechanism of spondylolytic spondylolisthesis in children and adolescents, and specifically the Tokushima theory of growth plate slippage developed from our extensive research findings. Clinically, we have observed the slippage site near the growth plate on MRI; then, using fresh cadaveric spines, we found the weakest link against forward shear loading was the growth plate. We subsequently developed an immature rat model showing forward slippage after growth plate injury. Moreover, finite element analysis of the pediatric spine clearly showed increased mechanical stress at the growth plate in the spondylolytic pediatric spine model compared with the intact pediatric spine. Thus, spondylolysis progresses to spondylolisthesis (forward slippage) in children and adolescents with the growth plate as the site of the slippage. Repetitive mechanical loading on to the growth plate may serve to separate the growth plate and subsequently progress to spondylolisthesis.
Jha C. Subash, Ichiro Tonogai, Yoichiro Takata, Toshinori Sakai, Kousaku Higashino, Tetsuya Matsuura, Naoto Suzue, Daisuke Hamada, Tomohiro Goto, Toshihiko Nishisho, Takahiko Tsutsui, Yuichiro Goda, Mitsunobu Abe, Kazuaki Mineta, Tetsuya Kimura, Akihiro Nitta, Shingo Hama, Tadahiro Higuchi, Shoji Fukuta and Koichi Sairyo : Percutaneous Endoscopic Lumbar Discectomy for a Huge Herniated Disc Causing Acute Cauda Equina Syndrome : A Case Report, The Journal of Medical Investigation : JMI, Vol.62, No.1,2, 100-102, 2015.
(Summary)
Microsurgery for lumbar disc herniation that requires surgical intervention has been well described. The methods vary from traditional open discectomy to minimally invasive techniques. All need adequate preanesthetic preparation of patients as general anesthesia is required for the procedure, and nerve monitoring is necessary to prevent iatrogenic nerve injury. Conventional surgical techniques sometimes require the removal of the corresponding lamina to assess the nerve root and herniated disc, and this may increase the risk for posterior instability of the vertebral body. Should this occur, fusion surgery may be needed, further increasing morbidity and cost. We present here a case of lumbar herniated disc fragments causing acute cauda equina syndrome that were endoscopically resected through a transforaminal approach in an awake patient under local anesthesia. Percutaneous endoscopic discectomy under local anesthesia proved to be a better alternative to open back surgery as it made immediate intervention possible, was associated with fewer perioperative complications and morbidity, minimized soft tissue damage, and allowed early rehabilitation with a better outcome and greater patient satisfaction. In addition to these advantages, percutaneous endoscopic discectomy protects other approaches that may be needed in subsequent surgeries, whether open or minimally invasive.
Toshihiko Nishisho, Naoyoshi Hanaoka, Ryo Miyagi, Toshinori Sakai, Shunichi Toki, Mitsuhiko Takahashi, Kenji Endo, Natsuo Yasui and Koichi Sairyo : Local administration of zoledronic Acid for giant cell tumor of bone., Orthopedics, Vol.38, No.1, e25-30, 2015.
(Summary)
Giant cell tumor of bone is a locally aggressive tumor with a high local recurrence rate. Several adjuvant therapies have been employed to reduce the recurrence rate, but their effectiveness remains controversial. The authors attempted local administration of zoledronic acid, a nitrogen-containing bisphosphonate that strongly inhibits bone resorption, as an adjuvant treatment for histologically proven giant cell tumor of bone in 5 patients at their institution. After biopsy, 4 patients were treated with local administration of zoledronic acid with artificial bone and 1 was treated with zoledronic acid without artificial bone. Histologic response to the treatment was evaluated with surgically resected specimens. The 4 patients treated with artificial bone showed local control, with histologic tumor necrosis rates of 90%, 90%, 50%, and 10%. Magnetic resonance imaging showed poor gadolinium enhancement, and histologic examination after local zoledronic acid treatment showed tumor necrosis. One patient without artificial bone showed no histologic tumor necrosis and had local recurrence in soft tissue 18 months after tumor resection. A 3-week waiting period between biopsy and zoledronic acid treatment appears reasonable from the histological study. Complication of this therapy was delayed wound healing and it occurred in 2 cases. Taken together, this case series suggests that local administration of zoledronic acid with artificial bone is a potential adjuvant therapy for giant cell tumor of bone. On the other hand, effective local administration of zoledronic acid requires some bone matrix, including artificial bone. Campanacci's grading is important for predicting the effect of local administration of zoledronic acid. [Orthopedics. 2015; 38(1):e25-e30.].
Athletes sometimes experience overuse injuries. To diagnose these injuries, ultrasonography is often more useful than plain radiography, computed tomography (CT), or magnetic resonance imaging (MRI). Ultrasonography can show both bone and soft tissue from various angles as needed, providing great detail in many cases. In conditions such as osteochondrosis or enthesopathies such as Osgood-Schlatter disease, Sinding-Larsen-Johansson disease, bipartite patella, osteochondritis dissecans of the knee, painful accessory navicular,and jumper's knee, ultrasonography can reveal certain types of bony irregularities or neovascularization of the surrounding tissue. In patients of enthesopathy, ultrasonography can show the degenerative changes at the insertion of the tendon. Given its usefulness in treatment, ultrasonography is expected to become essential in the management of overuse injuries affecting the lower limb in athletes. J. Med. Invest. 62: 109-113, August, 2015.
Mitsunobu Abe, Yoichiro Takata, Kousaku Higashino, Toshinori Sakai, Tetsuya Matsuura, Naoto Suzue, Daisuke Hamada, Tomohiro Goto, Toshihiko Nishisho, Yuichiro Goda, Takahiko Tsutsui, Ichiro Tonogai, Ryo Miyagi, Masatoshi Morimoto, Kazuaki Mineta, Tetsuya Kimura, Akihiro Nitta, Shingo Hama, Tadahiro Higuchi, Subash Jha C, Rui Takahashi, Shoji Fukuta and Koichi Sairyo : Foraminoplastic transforaminal percutaneous endoscopic discectomy at the lumbosacral junction under local anesthesia in an elite rugby player., The Journal of Medical Investigation : JMI, Vol.62, No.3-4, 238-241, 2015.
(Summary)
Percutaneous endoscopic discectomy (PED) is the least invasive disc surgery available at present. The procedure can be performed under local anesthesia and requires only an 8 mm skin incision. Furthermore, damage to the back muscle is considered minimal, which is particularly important for disc surgery in athletes. However, employing the transforaminal (TF) PED approach at the lumbosacral junction can be challenging due to anatomical constraints imposed by the iliac crest. In such cases, foraminoplasty is required in addition to the standard TF procedure. A 28-year-old man who was a very active rugby player visited us complaining of lower back and left leg pain. His visual analog scale (VAS) score for pain was 8/10 and 3/10, respectively. MRI revealed a herniated nucleus pulposus at L5-S level. TF-PED was planned; however, the anatomy of the iliac crest was later found to prevent access to the herniated mass. Foraminoplasty was therefore performed to enlarge the foramen, thereby allowing a cannula to be passed through the foramen into the canal without causing exiting nerve injury. The herniated mass was then successfully removed via the TF-PED procedure. Pain resolved after surgery, and his VAS score decreased to 0/10 for both back and leg pain. The patient returned to full rugby activity 8 weeks after surgery. In conclusion, even with an intracanalicular herniated mass at the lumbosacral junction, a TF-PED procedure is possible if additional foraminoplasty is adequately performed to enlarge the foramen. J. Med. Invest. 62: 238-241, August, 2015.
Yoichiro Takata, Toshinori Sakai, Kousaku Higashino, Tetsuya Matsuura, Naoto Suzue, Daisuke Hamada, Tomohiro Goto, Toshihiko Nishisho, Takahiko Tsutsui, Yuichiro Goda, Masatoshi Morimoto, Mitsunobu Abe, Kazuaki Mineta, Tetsuya Kimura, Akihiro Nitta, Shingo Hama, Tadahiro Higuchi, Subash Jha C, Rui Takahashi, Shoji Fukuta and Koichi Sairyo : State of the art: Intraoperative neuromonitoring in spinal deformity surgery., The Journal of Medical Investigation : JMI, Vol.62, No.3-4, 103-108, 2015.
(Summary)
Application of deformity correction spinal surgery has increased substantially over the past three decades in parallel with improvements in surgical techniques. Intraoperative neuromonitoring (IOM) techniques,including somatosensory evoked potentials (SEPs), muscle evoked potentials (MEPs), and spontaneous electromyography (free-run EMG), have also improved surgical outcome by reducing the risk of iatrogenic neural injury. In this article, we review IOM techniques and their applications in spinal deformity surgery. We also summarize results of selected studies including hundreds of spinal correction surgeries. These studies indicate that multimodal IOM of both motor and sensory responses is superior to either modality alone for reducing the incidence of neural injury during surgery. J. Med. Invest. 62: 103-108, August, 2015.
Takeuchi Makoto, Tomohiro Goto, Kiminori Yukata, Naoto Suzue, Daisuke Hamada, Toshihiko Nishisho, Ichiro Tonogai, Tetsuya Matsuura and Koichi Sairyo : Nonunion of the First Sternocostal Synchondrosis Accompanied by Sternoclavicular Joint Synovitis, Case Reports in Orthopedics, Vol.2014, 798329, 2014.
(Summary)
Injury to the sternocostal synchondrosis of the first rib is quite rare. We report one such case in a 50-year-old man with nonunion of the first sternocostal synchondrosis accompanied by synovitis of the sternoclavicular joint. He first underwent arthroscopic surgery of the left sternoclavicular joint. Postoperatively, the patient's symptoms decreased by half, but another pain and crepitus at the inferior lateral portion of the sternoclavicular joint developed. Since MRI and functional CT reexaminations revealed nonunion of the first sternocostal synchondrosis, resection arthroplasty of the first sternocostal joint was performed. This resulted in immediate resolution of the symptoms. At 2-year follow-up, his symptoms disappeared entirely with no limited range of motion of the shoulder.
Mitsuhiko Takahashi, Tokio Kasai, Toshihiko Nishisho, Michihiro Takai, Hideko Endo, Takanori Hirose and Koichi Sairyo : Reverse adipofascial flap after resection of a malignant perineurioma of the forearm., Orthopedics, Vol.37, No.7, e661-4, 2014.
(Summary)
The authors describe a patient with recurrent perineurioma arising in the subcutaneous tissue of the dorsal forearm and extending along the forearm fascia. Soft tissue perineurioma is a rare, originally benign peripheral nerve sheath neoplasm arising from the perineurium, a protective cell barrier surrounding the individual fascicles in peripheral nerves. Perineurioma has only recently been recognized as an entity distinct from other nerve sheath tumors, such as schwannoma and neurofibroma, with unique morphologic, ultrastructural, and immunoreactive features. The recurrent tumor had converted into malignant perineurioma, defined as increased nuclear pleomorphism and cellularity. The ill-marginate feature extending along the fascia required wide resection, leaving a substantial defect on the distal forearm. Surgical repair of large forearm skin defects is challenging because of limited skin extensibility for flap creation, the prominence of the site in terms of aesthetic outcome, and the risk of damage to extrinsic muscles that control delicate hand movements. The reverse forearm adipofascial flap, which was based on distal perforators of the radial artery, was suitable for the current case to cover the exposed myotendinous junctions of the forearm extensor muscles. This flap did not sacrifice skin, a major vessel, or skeletal muscles, and preserved function at both the donor and the recipient sites. The texture of the graft was similar to that of the surrounding skin. The clinical and histopathologic features of this rare tumor are also described to aid in the differential diagnosis and as a reference for surgeons who treat soft tissue neoplasms and may encounter this type of soft tumor.
Yasuaki Tamaki, Tomohiro Goto, Daisuke Hamada, Toshihiko Nishisho, Kiminori Yukata, Naoto Suzue, Hiroshi Egawa and Koichi Sairyo : Massive femoral osteolysis secondary to loosening of a cemented roughened long stem: a case report., Case Reports in Orthopedics, Vol.2014, 840267, 2014.
(Summary)
The surface finish of a femoral stem plays an important role in the longevity of cemented total hip arthroplasty. In efforts to decrease the rate of aseptic loosening, some prostheses have been designed to have a roughened surface that enhances bonding between the prosthesis and cement, but clinical outcomes remain controversial. We present a rare case of massive osteolysis with extreme femoral expansion that developed after cemented revision total hip arthroplasty. The destructive changes in the femur were attributable to abnormal motion of the stem and were aggravated by the roughened precoated surface of the long femoral component. Revision surgery using a total femur prosthesis was performed because there was insufficient remaining bone to fix the new prosthesis. The surgical technique involved wrapping polypropylene meshes around the prosthesis to create an insertion for the soft tissue, which proved useful for preventing muscular weakness and subsequent dislocation of the hip.
Kosuke Sugiura, Ichiro Tonogai, Tetsuya Matsuura, Kousaku Higashino, Toshinori Sakai, Naoto Suzue, Daisuke Hamada, Tomohiro Goto, Yoichiro Takata, Toshihiko Nishisho, Yuichiro Goda, Ryosuke Sato, Kenji Kondo, Fumitake Tezuka, Kazuaki Mineta, Makoto Takeuchi, Mitsuhiko Takahashi, Hiroshi Egawa and Koichi Sairyo : Discoscopic findings of high signal intensity zones on magnetic resonance imaging of lumbar intervertebral discs., Case Reports in Orthopedics, Vol.2014, 245952, 2014.
(Summary)
A 32-year-old man underwent radiofrequency thermal annuloplasty (TA) with percutaneous endoscopic discectomy (PED) under local anesthesia for chronic low back pain. His diagnosis was discogenic pain with a high signal intensity zone (HIZ) in the posterior corner of the L4-5 disc. Flexion pain was sporadic, and steroid injection was given twice for severe pain. After the third episode of strong pain, PED and TA were conducted. The discoscope was inserted into the posterior annulus and revealed a migrated white nucleus pulposus which was stained blue. Then, after moving the discoscope to the site of the HIZ, a migrated slightly red nucleus pulposus was found, suggesting inflammation and/or new vessels penetrating the mass. After removing the fragment, the HIZ site was ablated by TA. To our knowledge, this is the first report of the discoscopic findings of HIZ of the lumbar intervertebral disc.
Koichi Sairyo, Hiroshi Egawa, Tetsuya Matsuura, Mitsuhiko Takahashi, Kousaku Higashino, Toshinori Sakai, Naoto Suzue, Daisuke Hamada, Tomohiro Goto, Yoichiro Takata, Toshihiko Nishisho, Yuichiro Goda, Ryosuke Sato, Takahiko Tsutsui, Ichiro Tonogai, Kenji Kondo, Fumitake Tezuka, Kazuaki Mineta, Kosuke Sugiura, Makoto Takeuchi and Akira Dezawa : State of the Art: Transforaminal Approach for Percutaneous Endoscopic Lumbar Discectomy under Local Anesthesia., The Journal of Medical Investigation : JMI, Vol.61, No.3-4, 217-225, 2014.
(Summary)
Minimally invasive percutaneous endoscopic discectomy (PED) with a transforaminal approach under local anesthesia was started in the late 20th century. As the procedure requires a skin incision of only 8 mm, it is the least invasive disc surgery procedure at present, and owing to advances in instruments and optics, the use of this technique has gradually spread. In Japan, Dr. Dezawa from Teikyo University Mizonokuchi Hospital introduced this technique in 2003. Thanks to his efforts, the number of surgeons who can perform PED has increased, although the number of active PED surgeons is still only around 20. The first author (K.S.) started PED in 2010. In this review article, we explain the state-of-the-art PED transforaminal technique for minimally invasive disc surgery and present three successful cases. J. Med. Invest. 61: 217-225, August, 2014.
Tomohiro Goto, Daisuke Hamada, Kazuaki Mineta, Ichiro Tonogai, Hiroshi Egawa, Tetsuya Matsuura, Mitsuhiko Takahashi, Kousaku Higashino, Toshinori Sakai, Naoto Suzue, Yoichiro Takata, Toshihiko Nishisho, Yuichiro Goda, Ryosuke Sato, Fumitake Tezuka, Kenji Kondo, Makoto Takeuchi, Kousuke Sugiura and Koichi Sairyo : The state of the art in arthroscopic hip surgery., The Journal of Medical Investigation : JMI, Vol.61, No.3-4, 226-232, 2014.
(Summary)
Hip arthroscopy is among the most rapidly evolving arthroscopic techniques in the last decade and offers the benefits of being both a minimally invasive procedure and an excellent diagnostic tool. Improvements in instrumentation and surgical skills have advanced our ability to accurately diagnose and treat various conditions of the hip joint, and hip arthroscopy has elucidated several pathologies that cause disabling symptoms. Many of these conditions were previously unrecognized and left untreated. The indications for hip arthroscopy include the management of early osteoarthritis, synovial disorders (e. g., synovial osteochondromatosis), labral tears, chondral lesions, and femoroacetabular impingement (FAI), which is increasingly recognized as a disorder that can lead to the development of early cartilage and labral injury. A better understanding of hip arthroscopy, including the anatomy, improved surgical techniques, indications, and complications of the procedure, is essential for its success. This review article discusses the state of the art of arthroscopic hip surgery. J. Med. Invest. 61: 226-232, August, 2014.
Tetsuya Matsuura, Hiroshi Egawa, Mitsuhiko Takahashi, Kousaku Higashino, Toshinori Sakai, Naoto Suzue, Daisuke Hamada, Tomohiro Goto, Yoichiro Takata, Toshihiko Nishisho, Yuichiro Goda, Ryosuke Sato, Ichiro Tonogai, Kenji Kondo, Fumitake Tezuka, Kazuaki Mineta, Kosuke Sugiura, Makoto Takeuchi and Koichi Sairyo : State of the art: elbow arthroscopy: review of the literature and application for osteochondritis dissecans of the capitellum., The Journal of Medical Investigation : JMI, Vol.61, No.3-4, 233-240, 2014.
(Summary)
Elbow arthroscopy has become a safe and effective treatment option for a number of elbow disorders. The most rewarding and successful indication is the removal of loose bodies. Loose bodies are often a result of osteochondritis dissecans (OCD) of the capitellum, and arthroscopy in this case is useful for performing debridement, thereby eliminating the need for a more extensive open procedure associated with complications. In this review, we describe our arthroscopic technique for OCD of the capitellum. We usually conduct arthroscopy in the supine position, and use 2.9-mm arthroscopes of 30° and 70°. The 70° arthroscope provides a greater operative field than the 30° arthroscope. Arthroscopic treatment for OCD may require 2 anterior and 2 posterior portals. Loose bodies are commonly found in the radial fossa, coronoid fossa, and in the olecranon fossa. Once the loose bodies are removed, all unstable cartilage of the capitellum lesion is removed to create a stable bed. If any sclerotic changes to the lesion bed are observed, we create microfractures in the lesion bed. The most significant complication in arthroplasty is neurovascular injury. However, we have never experienced this devastating complication, which can be avoided by paying careful attention to detail. J. Med. Invest. 61: 233-240, August, 2014.
Koichi Sairyo, Tetsuya Matsuura, Kousaku Higashino, Toshinori Sakai, Yoichiro Takata, Yuichiro Goda, Naoto Suzue, Daisuke Hamada, Tomohiro Goto, Toshihiko Nishisho, Ryosuke Sato, Takahiko Tsutsui, Ichiro Tonogai and Kazuaki Mineta : Surgery Related Complications in Percutaneous Endoscopic Lumbar Discectomy under Local Anesthesia., The Journal of Medical Investigation : JMI, Vol.61, No.3-4, 264-269, 2014.
(Summary)
The minimally invasive percutaneous endoscopic discectomy (PED) as the postero-lateral approach with the local anesthesia was started in the late 20th century. The procedure only requires 8 mm of skin incision; thus, it is the least invasive disc surgery presently. The surgery related complications were reviewed in the initial 100 cases from the single surgeon (K. S., first author). Two cases showed exiting nerve irritation, and complained of leg paresthetic pain for 6 to 12 weeks after the surgery (2.0%). The symptoms got better with medicines. One showed post-surgical epidural hematoma, and required surgical removal of the mass (1.0%). Two cases complained neck pain during surgery (2.0%). Surgeons would be aware of the specific complications for the postero-lateral approach of PED procedure. J. Med. Invest. 61: 264-269, August, 2014.
Yoichiro Takata, Tetsuya Matsuura, Kousaku Higashino, Toshinori Sakai, Takuya Mishiro, Naoto Suzue, Hirofumi Kosaka, Daisuke Hamada, Tomohiro Goto, Toshihiko Nishisho, Yuichiro Goda, Ryosuke Sato, Takahiko Tsutsui, Ichiro Tonogai, Fumitake Tezuka, Kazuaki Mineta, Tetsuya Kimura, Akihiro Nitta, Tadahiro Higuchi, Shingo Hama and Koichi Sairyo : Hybrid technique of cortical bone trajectory and pedicle screwing for minimally invasive spine reconstruction surgery: A technical note., The Journal of Medical Investigation : JMI, Vol.61, No.3-4, 388-392, 2014.
(Summary)
The pedicle screw (PS) system is widely used for spinal reconstruction. Recently, screw insertion using the cortical bone trajectory (CBT) technique has been reported to provide increased holding strength of the vertebra, even in an osteoporotic spine. CBT is also beneficial due to its low invasiveness. We have been performing hybrid reconstruction with CBT at the cranial level and PS at the caudal level based on the concept of minimal invasiveness. We applied this hybrid technique to 6 cases of degenerative spondylolisthesis. Surgery was completed with a small skin incision of around 5-6 cm, which is shorter than that of the conventional PS procedure. The mean percent slippage before surgery was 19.8%, and this was reduced to 3.9% after surgery and almost maintained 3 months after surgery. Furthermore, no major surgical complications were observed. Here, we introduce the minimally invasive hybrid technique of CBT-PS. Surgeons should be aware of the procedure as an option for minimally invasive lumbar spine reconstructive surgery. J. Med. Invest. 61: 388-392, August, 2014.
Makoto Takeuchi, Naoto Suzue, Tetsuya Matsuura, Kousaku Higashino, Toshinori Sakai, Daisuke Hamada, Tomohiro Goto, Yoichiro Takata, Toshihiko Nishisho, Yuichiro Goda, Ryosuke Sato, Ichiro Tonogai, Kazuaki Mineta and Koichi Sairyo : Reconstruction of chronic Achilles tendon rupture using the semitendinosus tendon: a case report., The Journal of Medical Investigation : JMI, Vol.61, No.3-4, 417-420, 2014.
(Summary)
Achilles tendon rupture is a common trauma requiring surgical management. For chronic Achilles tendon rupture in particular, reconstructive surgery is desirable and several methods have been described. Here we present a case of chronic Achilles tendon rupture reconstructed using the semitendinosus tendon because of the difficulty in pulling down the proximal stump to reach the distal stump and due to an insufficient margin for hooking a suture to the distal stump. Postoperatively, the patient had a fully functional tendon and resumed his normal activities of daily living. Using this surgical technique, we expect favorable outcomes in cases of Achilles tendon rupture. J. Med. Invest. 61: 417-420, August, 2014.
Kazuaki Mineta, Tomohiro Goto, Daisuke Hamada, Takahiko Tsutsui, Ichiro Tonogai, Naoto Suzue, Tetsuya Matsuura, Kousaku Higashino, Toshinori Sakai, Yoichiro Takata, Toshihiko Nishisho, Ryousuke Sato, Yuichiro Goda, Tadahiro Higuchi, Shingo Hama, Tetsuya Kimura, Akihiro Nitta and Koichi Sairyo : Efficacy of hip arthroscopy in the diagnosis and treatment of synovial osteochondromatosis: a case report and literature review., The Journal of Medical Investigation : JMI, Vol.61, No.3-4, 436-441, 2014.
(Summary)
Here we report a rare case of synovial osteochondromatosis of the hip and provide a brief review of the literature. A 37-year-old woman was referred to our department with a 3-year history of right hip pain. At initial consultation, she complained of pain upon standing and when sitting down, occasional pain at rest and nocturnal pain in the right hip, and worsening of the pain at premenstruum. The range of motion of the affected hip was totally limited by pain. Plain radiography revealed a slightly calcified (or ossified) lesion at the acetabular fossa of the right hip. Computed tomography showed clusters of loose bodies filling the acetabular fossa. Synovial osteochondromatosis was suspected and she underwent hip arthroscopic surgery. Complete resection was performed using the lateral and anterior portals. Postoperatively, her symptoms disappeared entirely and she was discharged 4 days after surgery. The patient regained full range of motion of the right hip and follow-up CT revealed no remaining loose bodies in the right hip. Hip arthroscopy is considered to be effective for the diagnosis and treatment of synovial osteochondromatosis of the hip and is minimally invasive. J. Med. Invest. 61: 436-441, August, 2014.
Kousaku Higashino, Tetsuya Matsuura, Katsuyoshi Suganuma, Kiminori Yukata, Toshihiko Nishisho and Natsuo Yasui : Early changes in muscle atrophy and muscle fiber type conversion after spinal cord transection and peripheral nerve transection in rats., Journal of Neuroengineering and Rehabilitation, Vol.10, No.1, 46, 2013.
(Summary)
BACKGROUND: Spinal cord transection and peripheral nerve transection cause muscle atrophy and muscle fiber type conversion. It is still unknown how spinal cord transection and peripheral nerve transection each affect the differentiation of muscle fiber type conversion mechanism and muscle atrophy. The aim of our study was to evaluate the difference of muscle weight change, muscle fiber type conversion, and Peroxisome proliferator-activated receptor-gamma coactivatior-1alpha (PGC-1alpha) expression brought about by spinal cord transection and by peripheral nerve transection. METHODS: Twenty-four Wistar rats underwent surgery, the control rats underwent a laminectomy; the spinal cord injury group underwent a spinal cord transection; the denervation group underwent a sciatic nerve transection. The rats were harvested of the soleus muscle and the TA muscle at 0 week, 1 week and 2 weeks after surgery. Histological examination was assessed using hematoxylin and eosin (H&E) staining and immunofluorescent staing. Western blot was performed with 3 groups. RESULTS: Both sciatic nerve transection and spinal cord transection caused muscle atrophy with the effect being more severe after sciatic nerve transection. Spinal cord transection caused a reduction in the expression of both sMHC protein and PGC-1alpha protein in the soleus muscle. On the other hand, sciatic nerve transection produced an increase in expression of sMHC protein and PGC-1alpha protein in the soleus muscle. The results of the expression of PGC-1alpha were expected in other words muscle atrophy after sciatic nerve transection is less than after spinal cord transection, however muscle atrophy after sciatic nerve transection was more severe than after spinal cord transection. CONCLUSION: In the conclusion, spinal cord transection diminished the expression of sMHC protein and PGC-1alpha protein in the soleus muscle. On the other hand, sciatic nerve transection enhanced the expression of sMHC protein and PGC-1alpha protein in the soleus muscle.
Ichiro Tonogai, Mitsuhiko Takahashi, Hiroaki Manabe, Toshihiko Nishisho and Natsuo Yasui : A massive chondroblastoma in the proximal humerus simulating malignant bone tumors, Case Reports in Orthopedics, Vol.2013, 673576, 2013.
(Summary)
Chondroblastoma is a mostly benign bone neoplasm that typically affects the second decade of life and exhibits a lytic lesion in the epiphysis of long bones. We report an extreme case of massive, destructive chondroblastoma of the proximal humerus in a 9-year-old girl. It was difficult to differentiate using imaging information the lesion from malignant bone tumors such as osteosarcoma. Histopathological examination from biopsy proved chondroblastoma. The tumor was resected after preoperative transcatheter embolization. Reconstructive procedure for the proximal humerus was not performed due to the local destruction. The present case demonstrates clinical and radiological differentiations of the massive chondroblastoma from the other lesions and histopathological understandings for this lesion.
Ryosuke Sato, Mitsuhiko Takahashi, Toshihiko Nishisho, Kenji Endo and Koichi Sairyo : An undifferentiated Pleomorphic Sarcoma with Massive Intratumoral Hematoma: A Case Report and Literature Review., Ann Orthop Rheumatol, Vol.1, No.1, 1006, 2013.
49.
Toshihiko Nishisho, Kiminori Yukata, Yoshito Matsui, Tetsuya Matsuura, Kousaku Higashino, K Suganuma, Takeshi Nikawa and Natsuo Yasui : Angiogenesis and myogenesis in mouse tibialis anterior muscles during distraction osteogenesis: VEGF, its receptors, and myogenin genes expression., Journal of Orthopaedic Research, Vol.30, No.11, 1767-1773, 2012.
Seiji Iwamoto, Shoichiro Takao, Hayato Nose, Yoichi Otomi, Mitsuhiko Takahashi, Toshihiko Nishisho, Junji Ueno, Natsuo Yasui and Masafumi Harada : Usefulness of transcatheter arterial embolization prior to excision of hypervascular musculoskeletal tumors., The Journal of Medical Investigation : JMI, Vol.59, No.3-4, 284-288, 2012.
(Summary)
The objective of this study was to evaluate the usefulness of transcatheter arterial embolization prior to surgical excision of musculoskeletal tumors. We reviewed the records of nine patients (3 females and 6 males) who received arterial embolization prior to excision of musculoskeletal tumors in our hospital from December 2009 to April 2010. We evaluated tumor region, size, histopathology, feeding artery, embolic material, and blood loss during surgery. We compared the actual amount of intraoperative bleeding with arterial embolization to estimated amounts of bleeding without embolization predicted by three orthopedic surgeons. Arterial embolization was performed on the same day or within 5 days before surgery. Operations were performed as planned in all patients without serious complications. The amount of intraoperative bleeding was 35-4200 mL and there was significantly less bleeding with arterial embolization compared with the estimated amounts (p<0.01). Our results show that arterial embolization prior to resection of hypervascular musculoskeletal tumors reduces the amount of bleeding during surgery and contributes to patient safety.
Masatoshi Morimoto, Mitsuhiko Takahashi, Nori Sato, Toshihiko Nishisho, Seiko Kagawa, Eiji Kudo, Shoichiro Takao and Natsuo Yasui : Expansively Hemorrhagic Foreign Body Granuloma at the Pelvis Caused by Microscopic Materials., Open Journal of Orthopedics, Vol.2, No.1, 1-5, 2012.
Mitsuhiko Takahashi, Yoshiteru Kawasaki, 高砂 智哉, Toshihiko Nishisho and Natsuo Yasui : Treatment Strategy for Congenital Pseudarthrosis of the Tibia, The Journal of the Japanese Orthopaedic Association, Vol.87, No.1, 32-37, 2013.
(Keyword)
congenital pseudarthrosis of the tibia / Ilizarov / neurofibromatosis type I (NF1)
Toshihiko Nishisho, Shun-ichi Toki, Ryo Miyagi and Koichi Sairyo : ASSESSMENT OF SURGICAL MARGIN CLASSIFICATION FOR SOFT TISSUE SARCOMA: DEFINITIONS OF ADEQUATE MARGINS SYSTEM FOR PLANNING AND EVALUATION, The Connective Tissue Oncology Society 2022 annual meeting, Vancouver, Nov. 2022.
2.
Shun-ichi Toki, Toshihiko Nishisho and Numoto Kunihiko : Core needle biopsy versus open biopsy of malignant bone tumor in diagnostic accuracy, complications, and cost-effectiveness: A systematic review and meta-analysis, 21st General Meeting of the International Society of Limb Salvage (ISOLS), Los Angeles, Jun. 2022.
3.
Toshihiko Nishisho, Shun-ichi Toki, Ryo Miyagi and Koichi Sairyo : ACIDIC MICROENVIRONMENTS IN SOFT TISSUE SARCOMA PROMOTES FOXM1 EXPRESSION AND TUMORIGENESIS., The Connective Tissue Oncology Society Annual Meeting, Nov. 2020.
4.
Toshihiko Nishisho, Shun-ichi Toki, Ryo Miyagi and Koichi Sairyo : SOFT-TISSUE SARCOMA IN ELDERLY PATIENTS: PATTERNS OF CARE AND SURVIVAL, The Connective Tissue Oncology Society Annual Meeting, November 18-21, 2020., Nov. 2020.
5.
Ryo Miyagi, Toshihiko Nishisho, Shunichi Toki and Koichi Sairyo : Multiple primary malignancys in the patients with bone and soft tissue sarcoma, The 19th International Society of Limb Salvage (ISOLS) General Meeting(May 10-12, 2017), May 2017.
6.
Ryo Miyagi, Toshihiko Nishisho, Shuichi Toki and Koichi Sairyo : The role of the vacuolar type H+-ATPase in the liposarcoma., 2016 Annual meeting of the Orthopaedic Research Society, Orland, USA, Mar. 2016.
7.
Toshihiko Nishisho, N Hanaoka, Kenji Endo, Mitsuhiko Takahashi and Natsuo Yasui : Locally administered zoledronic acid therapy for giant cell tumor of bone, ASBMR 33rd Annual Meeting, San Diego, Sep. 2011.
8.
Mitsuhiko Takahashi, Tetsuya Enishi, Shinjiro Takata, Toshihiko Nishisho, T Takao and Natsuo Yasui : Fate of the chondrocyte-like cells in chondroid bone during distraction osteogenesis in the rabbits., ASBMR 33rd Annual Meeting, San Diego, Sep. 2011.
Yasuyuki Ohmichi, Toshihiko Nishisho, Shun-ichi Toki and Koichi Sairyo : 大腿骨骨転移の病的骨折危険予測は複数の方法を組み合わせることで精度を高めることができるか, 第48回 日本骨折治療学会【開催期間:2022年6月24日-25日】, Jun. 2022.
20.
Yasuyuki Ohmichi, Toshihiko Nishisho, Shun-ichi Toki and Koichi Sairyo : 大腿骨骨転移の病的骨折危険予測は複数の方法を組み合わせることで精度を高めることができるか, 第95回日本整形外科学会学術総会【開催期間:2022年5月19日- 22日】, May 2022.
21.
Toshihiko Nishisho, Shun-ichi Toki, Ryo Miyagi and Koichi Sairyo : 軟部肉腫局所制御予測に最適な切除縁評価法の検討, 第95回日本整形外科学会学術総会【開催期間:2022年5月19日- 22日】, May 2022.