1.Irreversible electroporation of hepatocellular carcinoma: the role of ultrasonography
Katsutoshi SUGIMOTO ; Masakazu ABE ; Yu YOSHIMASU ; Hirohito TAKEUCHI ; Yoshitaka KASAI ; Takao ITOI
Ultrasonography 2020;39(3):229-237
Irreversible electroporation (IRE) is a novel form of soft tissue ablation therapy that uses highcurrent electrical pulses to induce the formation of pores in the cell membrane, leading to cell death. Although outcome data for the ablation of hepatocellular carcinoma (HCC) by IRE are limited, early results are encouraging and may suggest equivalency to the outcomes achieved by thermal ablation methods such as radiofrequency ablation (RFA) and microwave ablation (MWA). However, IRE can be a challenging and very time-consuming procedure compared to RFA and MWA. In this review article, we not only evaluate the efficacy and safety of IRE for the treatment of HCC, but also discuss imaging guidance, ablation monitoring, and endpoint assessment, with a particular focus on ultrasonography.
2.Elevated Levels of Serum Pentosidine Are Associated with Dropped Head Syndrome in Older Women
Yawara EGUCHI ; Toru TOYOGUCHI ; Kazuhide INAGE ; Sumihisa ORITA ; Kazuyo YAMAUCHI ; Miyako SUZUKI ; Hirohito KANAMOTO ; Koki ABE ; Masaki NORIMOTO ; Tomotaka UMIMURA ; Masao KODA ; Takeo FURUYA ; Yasuchika AOKI ; Kazuhisa TAKAHASHI ; Seiji OHTORI
Asian Spine Journal 2019;13(1):155-162
STUDY DESIGN: A retrospective observational study was performed. PURPOSE: We investigated the prevalence of sarcopenia in dropped head syndrome (DHS), and the relationship between biochemical markers, including major advanced glycation end products (AGEs), pentosidine, and DHS in older women. OVERVIEW OF LITERATURE: AGEs have been implicated in the pathogenesis of sarcopenia. METHODS: We studied 13 elderly women with idiopathic DHS (mean age, 77.2 years) and 20 healthy volunteers (mean age, 74.8 years). We used a bioelectrical impedance analyzer to analyze body composition, including appendicular skeletal muscle mass index (SMI; appendicular lean mass [kg]/[height (m)]2). Cervical sagittal plane alignment, including C2–C7 sagittal vertical axis (C2–C7SVA), C2–C7 angle, and C2 slope (C2S), was measured. Biochemical markers, such as serum and urinary pentosidine, serum homocysteine, 1, 25-dihydroxyvitamin D, and 25-hydroxyvitamin D, were measured. The level of each variable was compared between DHS and controls. The relationship between biochemical markers and DHS was examined. RESULTS: Sarcopenia (SMI < 5.75) was observed at a high prevalence in participants with DHS (77% compared to 22% of healthy controls). Height, weight, femoral bone mineral density, appendicular lean mass, total lean mass, and SMI all had significantly lower values in the DHS group. Serum and urinary pentosidine, and serum homocysteine were significantly higher in the DHS group compared to controls. Analysis of cervical alignment revealed a significant positive correlation of serum pentosidine with C2–C7SVA and C2S. CONCLUSIONS: Sarcopenia was involved in DHS, and high serum pentosidine levels are associated with severity of DHS in older women.
Aged
;
Biomarkers
;
Body Composition
;
Bone Density
;
Electric Impedance
;
Female
;
Glycosylation End Products, Advanced
;
Head
;
Healthy Volunteers
;
Homocysteine
;
Humans
;
Muscle, Skeletal
;
Neck Muscles
;
Observational Study
;
Prevalence
;
Retrospective Studies
;
Sarcopenia
3.Assessment of Clinical Symptoms in Lumbar Foraminal Stenosis Using the Japanese Orthopaedic Association Back Pain Evaluation Questionnaire.
Yawara EGUCHI ; Munetaka SUZUKI ; Hajime YAMANAKA ; Hiroshi TAMAI ; Tatsuya KOBAYASHI ; Sumihisa ORITA ; Kazuyo YAMAUCHI ; Miyako SUZUKI ; Kazuhide INAGE ; Hirohito KANAMOTO ; Koki ABE ; Yasuchika AOKI ; Masao KODA ; Takeo FURUYA ; Kazuhisa TAKAHASHI ; Seiji OHTORI
Korean Journal of Spine 2017;14(1):1-6
OBJECTIVE: It is important to develop an easy means of diagnosing lumbar foraminal stenosis (LFS) in a general practice setting. We investigated the use of the Japanese Orthopaedic Association Back Pain Evaluation Questionnaire (JOABPEQ) to diagnose LFS in symptomatic patients. METHODS: Subjects included 13 cases (mean age, 72 years) with LFS, and 30 cases (mean age, 73 years) with lumbar spinal canal stenosis (LSCS) involving one intervertebral disc. The visual analogue scale score for low back pain and leg pain, the JOABPEQ were evaluated. RESULTS: Those with LFS had a significantly lower JOA score (p<0.001), while JOABPEQ scores (p<0.05) for lumbar dysfunction and social functioning impairment (p<0.01) were both significantly lower than the scores in LSCS. The following JOABPEQ questionnaire items (LFS vs. LSCS, p-value) for difficulties in: sleeping (53.8% vs. 16.6%, p<0.05), getting up from a chair (53.8% vs. 6.6%, p<0.001), turning over (76.9% vs. 40%, p<0.05), and putting on socks (76.9% vs. 26.6%, p<0.01) such as pain during rest, and signs of intermittent claudication more than 15 minutes (61.5% vs. 26.6%, p<0.05) were all significantly more common with LFS than LSCS. CONCLUSION: Results suggest that of the items in the JOABPEQ, if pain during rest or intermittent claudication is noted, LFS should be kept in mind as a cause during subsequent diagnosis and treatment. LFS may be easily diagnosed from LSCS using this established patient-based assessment method.
Asian Continental Ancestry Group*
;
Back Pain*
;
Constriction, Pathologic*
;
Diagnosis
;
General Practice
;
Humans
;
Intermittent Claudication
;
Intervertebral Disc
;
Leg
;
Low Back Pain
;
Methods
;
Spinal Canal
4.Efficacy of TachoSil, a Fibrin-Based Hemostat, for Anterior Lumbar Spine Surgery.
Jo WATANABE ; Seiji OHTORI ; Sumihisa ORITA ; Kazuyo YAMAUCHI ; Yawara EGUCHI ; Yasuchika AOKI ; Junichi NAKAMURA ; Miyako SUZUKI ; Kazuhide INAGE ; Jun SATO ; Yasuhiro SHIGA ; Koki ABE ; Kazuki FUJIMOTO ; Hirohito KANAMOTO ; Eiji HANAOKA ; Kazuhisa TAKAHASHI
Asian Spine Journal 2016;10(5):930-934
STUDY DESIGN: Retrospective case series. PURPOSE: To examine the efficacy of TachoSil for vessel injury in 6 patients who underwent anterior lumbar fusion surgery (ALF). OVERVIEW OF LITERATURE: ALF for the lumbar spine has a high rate of success, although intraoperative concerns and iatrogenic complications are known, and injury of a major vessel is sometimes a complication. The efficacy of TachoSil, a fibrin-based hemostat, has been reported for several types of surgery; however, use of TachoSil for ALF surgery has not been described. Here, we report on the efficacy of TachoSil in 6 patients, who underwent ALF after vascular surgeons having difficulty in repairing vessels. METHODS: Two man and 4 women with average age of 50.8±10.9 (mean±standard deviation) were diagnosed with a vertebral tumor (2 patients), L4 degenerative spondylolisthesis (2 patients), and L5 spondylolytic spondylolisthesis (2 patients) and underwent ALF. The blood vessels injured included the common iliac vein in 2 patients and a branch of a segmental artery from the aorta in 4 patients. We consulted a vascular surgeon to suture or repair the vessels during surgery, and although the vascular surgeon attempted to address the injuries, suturing or repair was not possible in these cases. For this reason, we used TachoSil to repair the injury in the vessels walls or to stop the bleeding. RESULTS: Time to pressure hemostasis using TachoSil was 34±12 minutes, and total blood loss was 1,488±1,711 mL. Nevertheless, all vessel injuries were controlled by the use of TachoSil. CONCLUSIONS: We recommend the use of TachoSil for vessel injuries that vascular surgeons cannot suture or repair during ALF surgery.
Aorta
;
Arteries
;
Blood Vessels
;
Female
;
Hemorrhage
;
Hemostasis
;
Humans
;
Iliac Vein
;
Retrospective Studies
;
Spine*
;
Spondylolisthesis
;
Surgeons
;
Sutures
5.Classification of Chronic Back Muscle Degeneration after Spinal Surgery and Its Relationship with Low Back Pain.
Seiji OHTORI ; Sumihisa ORITA ; Kazuyo YAMAUCHI ; Yawara EGUCHI ; Yasuchika AOKI ; Junichi NAKAMURA ; Tetsuhiro ISHIKAWA ; Masayuki MIYAGI ; Hiroto KAMODA ; Miyako SUZUKI ; Gou KUBOTA ; Kazuhide INAGE ; Takeshi SAINOH ; Jun SATO ; Yasuhiro SHIGA ; Koki ABE ; Kazuki FUJIMOTO ; Hirohito KANAMOTO ; Gen INOUE ; Kazuhisa TAKAHASHI
Asian Spine Journal 2016;10(3):516-521
STUDY DESIGN: Retrospective case series. PURPOSE: To classify back muscle degeneration using magnetic resonance imaging (MRI) and investigate its relationship with back pain after surgery. OVERVIEW OF LITERATURE: Back muscle injury and degeneration often occurs after posterior lumbar surgery, and the degeneration may be a cause of back pain. However, the relationship between back muscle degeneration and back pain remains controversial. METHODS: A total of 84 patients (average age, 65.1 years; 38 men, 46 women) with lumbar spinal stenosis underwent posterior decompression surgery alone. MRI (1.5 tesla) was evaluated before and more than a year after surgery in all patients. Muscle on MRI was classified into three categories: low intensity in T1-weighted imaging, high intensity in T2-weighted imaging (type 1), high intensity in both T1- and T2-weighted images (type 2), and low intensity in both T1- and T2-weighted imaging (type 3). The prevalence of the types and their relationship with back pain (determined on a visual analog scale) were evaluated. RESULTS: MRI revealed muscle degeneration in all patients after surgery (type 1, 6%; type 2, 82%; and type 3, 12%). Type 2 was significantly more frequent compared with types 1 and 3 (p<0.01). Low back pain was significantly improved after surgery (p<0.01). Low back pain was not associated with any MRI type of muscle degeneration after surgery (p>0.05). CONCLUSIONS: Various pathologies of back muscle degeneration after posterior lumbar surgery were revealed. Type 2 (fatty) change was most frequent, and other patients had type 3 (scar) or type 1 (inflammation or water-like) changes. According to the Modic classification of bone marrow changes, Modic type 1 change is associated with inflammation and back pain. However, no particular type of back muscle degeneration was correlated with back pain after surgery.
Back Muscles*
;
Back Pain
;
Bone Marrow
;
Classification*
;
Decompression
;
Humans
;
Inflammation
;
Low Back Pain*
;
Magnetic Resonance Imaging
;
Male
;
Pathology
;
Prevalence
;
Retrospective Studies
;
Spinal Stenosis
6.Classification of Chronic Back Muscle Degeneration after Spinal Surgery and Its Relationship with Low Back Pain.
Seiji OHTORI ; Sumihisa ORITA ; Kazuyo YAMAUCHI ; Yawara EGUCHI ; Yasuchika AOKI ; Junichi NAKAMURA ; Tetsuhiro ISHIKAWA ; Masayuki MIYAGI ; Hiroto KAMODA ; Miyako SUZUKI ; Gou KUBOTA ; Kazuhide INAGE ; Takeshi SAINOH ; Jun SATO ; Yasuhiro SHIGA ; Koki ABE ; Kazuki FUJIMOTO ; Hirohito KANAMOTO ; Gen INOUE ; Kazuhisa TAKAHASHI
Asian Spine Journal 2016;10(3):516-521
STUDY DESIGN: Retrospective case series. PURPOSE: To classify back muscle degeneration using magnetic resonance imaging (MRI) and investigate its relationship with back pain after surgery. OVERVIEW OF LITERATURE: Back muscle injury and degeneration often occurs after posterior lumbar surgery, and the degeneration may be a cause of back pain. However, the relationship between back muscle degeneration and back pain remains controversial. METHODS: A total of 84 patients (average age, 65.1 years; 38 men, 46 women) with lumbar spinal stenosis underwent posterior decompression surgery alone. MRI (1.5 tesla) was evaluated before and more than a year after surgery in all patients. Muscle on MRI was classified into three categories: low intensity in T1-weighted imaging, high intensity in T2-weighted imaging (type 1), high intensity in both T1- and T2-weighted images (type 2), and low intensity in both T1- and T2-weighted imaging (type 3). The prevalence of the types and their relationship with back pain (determined on a visual analog scale) were evaluated. RESULTS: MRI revealed muscle degeneration in all patients after surgery (type 1, 6%; type 2, 82%; and type 3, 12%). Type 2 was significantly more frequent compared with types 1 and 3 (p<0.01). Low back pain was significantly improved after surgery (p<0.01). Low back pain was not associated with any MRI type of muscle degeneration after surgery (p>0.05). CONCLUSIONS: Various pathologies of back muscle degeneration after posterior lumbar surgery were revealed. Type 2 (fatty) change was most frequent, and other patients had type 3 (scar) or type 1 (inflammation or water-like) changes. According to the Modic classification of bone marrow changes, Modic type 1 change is associated with inflammation and back pain. However, no particular type of back muscle degeneration was correlated with back pain after surgery.
Back Muscles*
;
Back Pain
;
Bone Marrow
;
Classification*
;
Decompression
;
Humans
;
Inflammation
;
Low Back Pain*
;
Magnetic Resonance Imaging
;
Male
;
Pathology
;
Prevalence
;
Retrospective Studies
;
Spinal Stenosis
7.Efficacy of Anti-NaV1.7 Antibody on the Sensory Nervous System in a Rat Model of Lumbar Intervertebral Disc Injury.
Daisuke NOJIMA ; Kazuhide INAGE ; Yoshihiro SAKUMA ; Jun SATO ; Sumihisa ORITA ; Kazuyo YAMAUCHI ; Yawara EGUCHI ; Nobuyasu OCHIAI ; Kazuki KUNIYOSHI ; Yasuchika AOKI ; Junichi NAKAMURA ; Masayuki MIYAGI ; Miyako SUZUKI ; Gou KUBOTA ; Takeshi SAINOH ; Kazuki FUJIMOTO ; Yasuhiro SHIGA ; Koki ABE ; Hirohito KANAMOTO ; Gen INOUE ; Kazuhisa TAKAHASHI ; Seiji OHTORI
Yonsei Medical Journal 2016;57(3):748-753
PURPOSE: The pathophysiology of discogenic low back pain is not fully understood. Tetrodotoxin-sensitive voltage-gated sodium (NaV) channels are associated with primary sensory nerve transmission, and the NaV1.7 channel has emerged as an analgesic target. Previously, we found increased NaV1.7 expression in dorsal root ganglion (DRG) neurons innervating injured discs. This study aimed to examine the effect of blocking NaV1.7 on sensory nerves after disc injury. MATERIALS AND METHODS: Rat DRG neurons innervating the L5/6 disc were labeled with Fluoro-Gold (FG) neurotracer. Twenty-four rats underwent intervertebral disc puncture (puncture group) and 12 rats underwent sham surgery (non-puncture group). The injury group was divided into a saline infusion group (puncture+saline group) and a NaV1.7 inhibition group, injected with anti-NaV1.7 antibody (puncture+anti-NaV1.7 group); n=12 per group. Seven and 14 days post-surgery, L1 to L6 DRGs were harvested and immunostained for calcitonin gene-related peptide (CGRP) (an inflammatory pain marker), and the proportion of CGRP-immunoreactive (IR) DRG neurons of all FG-positive neurons was evaluated. RESULTS: The ratio of CGRP-IR DRG neurons to total FG-labeled neurons in the puncture+saline group significantly increased at 7 and 14 days, compared with the non-puncture group, respectively (p<0.05). Application of anti-NaV1.7 into the disc significantly decreased the ratio of CGRP-IR DRG neurons to total FG-labeled neurons after disc puncture at 7 and 14 days (40% and 37%, respectively; p<0.05). CONCLUSION: NaV1.7 antibody suppressed CGRP expression in disc DRG neurons. Anti-NaV1.7 antibody is a potential therapeutic target for pain control in patients with lumbar disc degeneration.
Animals
;
Antibodies
;
Calcitonin Gene-Related Peptide/metabolism
;
Disease Models, Animal
;
Ganglia, Spinal/*metabolism
;
Intervertebral Disc/*drug effects/*injuries
;
Intervertebral Disc Degeneration/metabolism
;
Low Back Pain/*physiopathology
;
Lumbar Vertebrae/injuries
;
Male
;
NAV1.7 Voltage-Gated Sodium Channel/*metabolism
;
Neurons/*metabolism
;
Pain/metabolism
;
Rats
;
Rats, Sprague-Dawley
;
Stilbamidines
8.Does Discontinuing Teriparatide Treatment and Replacing It with Bisphosphonate Maintain the Volume of the Bone Fusion Mass after Lumbar Posterolateral Fusion in Women with Postmenopausal Osteoporosis?.
Seiji OHTORI ; Sumihisa ORITA ; Kazuyo YAMAUCHI ; Yawara EGUCHI ; Yasuchika AOKI ; Junichi NAKAMURA ; Miyako SUZUKI ; Gou KUBOTA ; Kazuhide INAGE ; Yasuhiro SHIGA ; Koki ABE ; Kazuki FUJIMOTO ; Hirohito KANAMOTO ; Masahiro INOUE ; Hideyuki KINOSHITA ; Takeo FURUYA ; Masao KODA
Asian Spine Journal 2017;11(2):272-277
STUDY DESIGN: Retrospective case series. PURPOSE: The purpose of this study was to determine whether discontinuing teriparatide treatment and replacing it with bisphosphonate treatment maintains the volume of the fusion mass after posterolateral fusion (PLF) in women with postmenopausal osteoporosis. OVERVIEW OF LITERATURE: Clinical data support the efficacy of parathyroid hormone (PTH) for lumbar PLF. However, the use of PTH is limited to 2 years. METHODS: We treated 19 women diagnosed with osteoporosis and degenerative spondylolisthesis with teriparatide (20 µg daily subcutaneously). All patients underwent one-level instrumented PLF. Teriparatide was used during 2 months prior to surgery and more than 8 months after surgery. After discontinuing teriparatide treatment, all patients used bisphosphonate (17.5 mg risedronate weekly, oral administration). Area of the fusion mass across the transverse processes at one segment was determined on an anteroposterior radiograph at 1, 2, and 3 years after surgery. RESULTS: We followed 19 patients for 3 years. The average duration of teriparatide treatment was 11.5 months. The bone union rate was 95%. The average area of the bone fusion mass was not significantly different between the right and left sides at 1, 2, or 3 years after surgery (p>0.05). CONCLUSIONS: This study showed that replacing teriparatide treatment with bisphosphonate maintained the bone fusion mass volume after PLF in women with postmenopausal osteoporosis.
Female
;
Humans
;
Osteoporosis
;
Osteoporosis, Postmenopausal*
;
Parathyroid Hormone
;
Retrospective Studies
;
Risedronate Sodium
;
Spine
;
Spondylolisthesis
;
Teriparatide*
9.Long-Term Outcomes of In Situ Fusion for Treating Dysplastic Spondylolisthesis.
Kazuhide INAGE ; Sumihisa ORITA ; Kazuyo YAMAUCHI ; Miyako SUZUKI ; Yoshihiro SAKUMA ; Go KUBOTA ; Yasuhiro OIKAWA ; Takeshi SAINOH ; Jun SATO ; Kazuki FUJIMOTO ; Yasuhiro SHIGA ; Koki ABE ; Hirohito KANAMOTO ; Masahiro INOUE ; Hideyuki KINOSHITA ; Masaki NORIMOTO ; Tomotaka UMIMURA ; Kazuhisa TAKAHASHI ; Seiji OHTORI
Asian Spine Journal 2017;11(2):213-218
STUDY DESIGN: Retrospective, observational, single-center study. PURPOSE: To investigate the long-term outcomes of in situ fusion procedures for treating dysplastic spondylolisthesis. OVERVIEW OF LITERATURE: In situ fusion performed in patients with dysplastic spondylolisthesis avoids the development of nerve complications. METHODS: In total, 12 of 28 patients who underwent in situ fusion for treating dysplastic spondylolisthesis at Chiba University Hospital from 1974 to 2004 were followed up in August 2013. Surgical complications were evaluated. Low back pain and leg pain were assessed using a visual analog scale (VAS). Vertebral alignment, including the lumbosacral angle and lumbar lordosis angle measurement on radiographic images (profile view in the neutral standing position), was evaluated during preoperative, postoperative, and final examinations. RESULTS: The mean follow-up duration, patient age at the final examination, and patient age at operation were 20.0±7.2, 42.3±13.3, and 22.3±11.4 years, respectively. No complications were reported. Mean VAS scores for low back pain and leg pain were significantly lower at the final examination than at the preoperative examination (p<0.05). At the preoperative, postoperative, and final examinations, the mean lumbosacral angle was 32.3°±14.2°, 33.7°±11.8°, and 36.5°±16.4°, while the mean lumbar lordosis angle was 51.0°±14.8°, 48.6°±18.8°, and 49.6°±15.5°, respectively. No significant differences were noted among these values across the different time periods (p<0.05). CONCLUSIONS: In situ fusion performed in patients with dysplastic spondylolisthesis avoids the development of nerve complications such as nerve paralysis that may occur after repositioning operation and maintains appropriate long-term sagittal alignment, even 20 years after operation.
Animals
;
Follow-Up Studies
;
Humans
;
Leg
;
Lordosis
;
Low Back Pain
;
Paralysis
;
Retrospective Studies
;
Spondylolisthesis*
;
Visual Analog Scale
10.Freeze-Dried Human Platelet-Rich Plasma Retains Activation and Growth Factor Expression after an Eight-Week Preservation Period.
Yasuhiro SHIGA ; Go KUBOTA ; Sumihisa ORITA ; Kazuhide INAGE ; Hiroto KAMODA ; Masaomi YAMASHITA ; Toru ISEKI ; Michihiro ITO ; Kazuyo YAMAUCHI ; Yawara EGUCHI ; Takeshi SAINOH ; Jun SATO ; Kazuki FUJIMOTO ; Koki ABE ; Hirohito KANAMOTO ; Masahiro INOUE ; Hideyuki KINOSHITA ; Takeo FURUYA ; Masao KODA ; Yasuchika AOKI ; Tomoaki TOYONE ; Kazuhisa TAKAHASHI ; Seiji OHTORI
Asian Spine Journal 2017;11(3):329-336
STUDY DESIGN: Controlled laboratory study. PURPOSE: This study aimed to evaluate the efficacy of platelet-rich plasma (PRP) stored at room temperature (RT), frozen, or after freeze-drying. OVERVIEW OF LITERATURE: PRP enriches tissue repair and regeneration, and is a novel treatment option for musculoskeletal pathologies. However, whether biological activity is preserved during PRP storage remains uncertain. METHODS: PRP was prepared from blood of 12 healthy human volunteers (200 mL/person) and stored using three methods: PRP was stored at RT with shaking, PRP was frozen and stored at −80℃, or PRP was freeze-dried and stored at RT. Platelet counts and growth factor content were examined immediately after preparation, as well as 2, 4, and 8 weeks after storage. Platelet activation rate was quantified by flow cytometry. RESULTS: Platelet counts were impossible to determine in many RT samples after 2 weeks, but they remained at constant levels in frozen and freeze-dried samples, even after 8 weeks of storage. Flow cytometry showed approximately 80% activation of the platelets regardless of storage conditions. Almost no growth factors were detected in the RT samples after 8 weeks, while low but significant expression was detected in the frozen and freeze-dried PRP. Over time, the mean relative concentrations of various growth factors decreased significantly or disappeared in the RT group. In the frozen group, levels were maintained for 4 weeks, but decreased significantly by 8 weeks (p <0.05). The freeze-dried group maintained baseline levels of growth factors for the entire 8-week duration. CONCLUSIONS: Freeze-drying enables PRP storage while maintaining bioactivity and efficacy for extended periods.
Blood Preservation
;
Flow Cytometry
;
Freeze Drying
;
Healthy Volunteers
;
Humans*
;
Intercellular Signaling Peptides and Proteins
;
Pathology
;
Platelet Activation
;
Platelet Count
;
Platelet-Rich Plasma*
;
Regeneration