1.Benign biliary stricture caused by transduodenal lumen-apposing metal stent placement for pancreatic acute necrotic collection
Shuhei SHINTANI ; Takuya OKAMOTO ; Kosuke HIROE ; Hidenori KIMURA ; Hiroto INOUE ; Atsushi NISHIDA ; Osamu INATOMI
International Journal of Gastrointestinal Intervention 2025;14(1):24-27
A 58-year-old male patient presented with acute alcohol-induced severe necrotizing pancreatitis. He reported a symptomatic acute necrotic collection in the pancreatic head. No improvements were observed despite one week of antimicrobial therapy. Endoscopic ultrasound-guided drainage via the superior duodenal angle was conducted and a lumen-apposing metal stent (LAMS) was placed. He had an obstructive jaundice progression 3 days postintervention. Endoscopic retrograde cholangiography showed that the cystic side flange of the LAMS caused the distal bile duct smooth stricture. The jaundice improved immediately after the placement of plastic stent in the bile duct, and the LAMS could be removed on the 15th day after placement. The plastic stent was removed after 4 months, and the biliary stricture improved, with no recurrence of jaundice. Here, we report a case of successful conservative treatment of a benign biliary stricture caused by the distal flange of the LAMS.
2.Benign biliary stricture caused by transduodenal lumen-apposing metal stent placement for pancreatic acute necrotic collection
Shuhei SHINTANI ; Takuya OKAMOTO ; Kosuke HIROE ; Hidenori KIMURA ; Hiroto INOUE ; Atsushi NISHIDA ; Osamu INATOMI
International Journal of Gastrointestinal Intervention 2025;14(1):24-27
A 58-year-old male patient presented with acute alcohol-induced severe necrotizing pancreatitis. He reported a symptomatic acute necrotic collection in the pancreatic head. No improvements were observed despite one week of antimicrobial therapy. Endoscopic ultrasound-guided drainage via the superior duodenal angle was conducted and a lumen-apposing metal stent (LAMS) was placed. He had an obstructive jaundice progression 3 days postintervention. Endoscopic retrograde cholangiography showed that the cystic side flange of the LAMS caused the distal bile duct smooth stricture. The jaundice improved immediately after the placement of plastic stent in the bile duct, and the LAMS could be removed on the 15th day after placement. The plastic stent was removed after 4 months, and the biliary stricture improved, with no recurrence of jaundice. Here, we report a case of successful conservative treatment of a benign biliary stricture caused by the distal flange of the LAMS.
3.Benign biliary stricture caused by transduodenal lumen-apposing metal stent placement for pancreatic acute necrotic collection
Shuhei SHINTANI ; Takuya OKAMOTO ; Kosuke HIROE ; Hidenori KIMURA ; Hiroto INOUE ; Atsushi NISHIDA ; Osamu INATOMI
International Journal of Gastrointestinal Intervention 2025;14(1):24-27
A 58-year-old male patient presented with acute alcohol-induced severe necrotizing pancreatitis. He reported a symptomatic acute necrotic collection in the pancreatic head. No improvements were observed despite one week of antimicrobial therapy. Endoscopic ultrasound-guided drainage via the superior duodenal angle was conducted and a lumen-apposing metal stent (LAMS) was placed. He had an obstructive jaundice progression 3 days postintervention. Endoscopic retrograde cholangiography showed that the cystic side flange of the LAMS caused the distal bile duct smooth stricture. The jaundice improved immediately after the placement of plastic stent in the bile duct, and the LAMS could be removed on the 15th day after placement. The plastic stent was removed after 4 months, and the biliary stricture improved, with no recurrence of jaundice. Here, we report a case of successful conservative treatment of a benign biliary stricture caused by the distal flange of the LAMS.
4.Mini-Open Anterior Retroperitoneal Lumbar Interbody Fusion: Oblique Lateral Interbody Fusion for Degenerated Lumbar Spinal Kyphoscoliosis.
Seiji OHTORI ; Chikato MANNOJI ; Sumihisa ORITA ; Kazuyo YAMAUCHI ; Yawara EGUCHI ; Nobuyasu OCHIAI ; Shunji KISHIDA ; Kazuki KUNIYOSHI ; Yasuchika AOKI ; Junichi NAKAMURA ; Tetsuhiro ISHIKAWA ; Masayuki MIYAGI ; Hiroto KAMODA ; Miyako SUZUKI ; Gou KUBOTA ; Yoshihiro SAKUMA ; Yasuhiro OIKAWA ; Kazuhide INAGE ; Takeshi SAINOH ; Jun SATO ; Yasuhiro SHIGA ; Koki ABE ; Kazuki FUJIMOTO ; Hiroto KANAMOTO ; Tomoaki TOYONE ; Gen INOUE ; Kazuhisa TAKAHASHI
Asian Spine Journal 2015;9(4):565-572
STUDY DESIGN: Prospective case series. PURPOSE: To examine the clinical efficacy of mini-open anterior retroperitoneal lumbar interbody fusion: oblique lateral interbody fusion (OLIF) for degenerated lumbar spinal kyphoscoliosis. OVERVIEW OF LITERATURE: The existing surgical procedures for the treatment of spinal kyphotic deformity, including Smith-Petersen osteotomy, pedicle subtraction osteotomy, and vertebral column resection procedures, are invasive in nature. Extreme lateral interbody fusion to provide less invasive treatment of the deformity has been reported, but complications including spinal nerve and psoas muscle injury have been noted. In the current study, we examined the clinical efficacy and complications of OLIF for degenerated lumbar spinal kyphoscoliosis. METHODS: Twelve patients with degenerated lumbar spinal kyphoscoliosis were examined. All patients underwent OLIF surgery (using a cage and bone graft from the iliac crest) with open pedicle screws or percutaneous pedicle screws, without real-time monitoring by electromyography. Visual analog scale score and Oswestry disability index were evaluated before and 12 months after surgery, and fusion rate at OLIF cage, correction of the deformity, total blood loss, and surgical complications were also evaluated. RESULTS: Pain scores significantly improved after surgery (p<0.05). Fusion rate was found to be 90%, balance parameters also improved after surgery (p<0.05), and average total blood loss was less than 350 mL. There was no spinal nerve, major vessel, peritoneal, or urinary injury, or breakage of instrumentation. CONCLUSIONS: OLIF surgery for degenerated lumbar spinal kyphoscoliosis is less invasive than other procedures and good surgical results were produced without major complications.
Congenital Abnormalities
;
Electromyography
;
Humans
;
Osteotomy
;
Prospective Studies
;
Psoas Muscles
;
Spinal Nerves
;
Spine
;
Transplants
;
Visual Analog Scale
5.Efficacy of Direct Injection of Etanercept into Knee Joints for Pain in Moderate and Severe Knee Osteoarthritis.
Seiji OHTORI ; Sumihisa ORITA ; Kazuyo YAMAUCHI ; Yawara EGUCHI ; Nobuyasu OCHIAI ; Shunji KISHIDA ; Kazuki KUNIYOSHI ; Yasuchika AOKI ; Junichi NAKAMURA ; Tetsuhiro ISHIKAWA ; Masayuki MIYAGI ; Hiroto KAMODA ; Miyako SUZUKI ; Gou KUBOTA ; Yoshihiro SAKUMA ; Yasuhiro OIKAWA ; Kazuhide INAGE ; Takeshi SAINOH ; Jun SATO ; Yasuhiro SHIGA ; Koki ABE ; Kazuki FUJIMOTO ; Hiroto KANAMOTO ; Tomoaki TOYONE ; Gen INOUE ; Kazuhisa TAKAHASHI
Yonsei Medical Journal 2015;56(5):1379-1383
PURPOSE: Osteoarthritic (OA) pain is largely considered to be inflammatory pain. However, during the last stage of knee OA, sensory nerve fibers in the knee are shown to be significantly damaged when the subchondral bone junction is destroyed, and this can induce neuropathic pain. Several authors have reported that tumor necrosis factor-alpha (TNFalpha) in a knee joint plays a crucial role in pain modulation. The purpose of the current study was to evaluate the efficacy of etanercept, a TNFalpha inhibitor, for pain in knee OA. MATERIALS AND METHODS: Thirty-nine patients with knee OA and a 2-4 Kellgren-Lawrence grading were evaluated in this prospective study. Patients were divided into two groups; hyaluronic acid (HA) and etanercept injection. All patients received a single injection into the knee. Pain scores were evaluated before and 4 weeks after injection using a visual analogue scale (VAS) and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and they were compared between the groups. RESULTS: Before injection, VAS and WOMAC scores were not significantly different between the groups (p>0.05). Significant pain relief was found in the etanercept group at 1 and 2 weeks by VAS, and at 4 weeks by WOMAC score, compared with the HA group (p<0.05). No adverse events were observed in either group. CONCLUSION: Direct injection of etanercept into OA knee joints was an effective treatment for pain in moderate and severe OA patients. Furthermore, this finding suggests that TNFalpha is one factor that induces OA pain.
Aged
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Etanercept/*administration & dosage/therapeutic use
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Female
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Humans
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Hyaluronic Acid/administration & dosage/*therapeutic use
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Injections, Intra-Articular
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Knee Joint/physiopathology
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Male
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Middle Aged
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Neuralgia/drug therapy
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Osteoarthritis, Knee/*drug therapy
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Pain Measurement
;
Prospective Studies
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Severity of Illness Index
;
Treatment Outcome
;
Tumor Necrosis Factor-alpha
;
Viscosupplements/administration & dosage/*therapeutic use
;
Visual Analog Scale
6.Change of Lumbar Ligamentum Flavum after Indirect Decompression Using Anterior Lumbar Interbody Fusion.
Seiji OHTORI ; Sumihisa ORITA ; Kazuyo YAMAUCHI ; Yawara EGUCHI ; Yasuchika AOKI ; Junichi NAKAMURA ; Masayuki MIYAGI ; Miyako SUZUKI ; Gou KUBOTA ; Kazuhide INAGE ; Takeshi SAINOH ; Jun SATO ; Kazuki FUJIMOTO ; Yasuhiro SHIGA ; Koki ABE ; Hiroto KANAMOTO ; Gen INOUE ; Kazuhisa TAKAHASHI ; Takeo FURUYA ; Masao KODA
Asian Spine Journal 2017;11(1):105-112
STUDY DESIGN: Retrospective case series. PURPOSE: The purpose of this study was to examine changes in the ligamentum flavum thickness and remodeling of the spinal canal after anterior fusion during a 10-year follow-up. OVERVIEW OF LITERATURE: Extreme lateral interbody fusion provides minimally invasive treatment of the lumbar spine; this anterior fusion without direct posterior decompression, so-called indirect decompression, can achieve pain relief. Anterior fusion may restore disc height, stretch the flexure of the ligamentum flavum, and increase the spinal canal diameter. However, changes in the ligamentum flavum thickness and remodeling of the spinal canal after anterior fusion during a long follow-up have not yet been reported. METHODS: We evaluated 10 patients with L4 spondylolisthesis who underwent stand-alone anterior interbody fusion using the iliac crest bone. Magnetic resonance imaging was performed 10 years after surgery. The cross-sectional area (CSA) of the dural sac and the ligamentum flavum at L1–2 to L5–S1 was calculated using a Picture Archiving and Communication System. RESULTS: Spinal fusion with correction loss (average, 4.75 mm anterior slip) was achieved in all patients 10 years postsurgery. The average CSAs of the dural sac and the ligamentum flavum at L1–2 to L5–S1 were 150 mm² and 78 mm², respectively. The average CSA of the ligamentum flavum at L4–5 (30 mm²) (fusion level) was significantly less than that at L1–2 to L3–4 or L5–S1. Although patients had an average anterior slip of 4.75 mm, the average CSA of the dural sac at L4–5 was significantly larger than at the other levels. CONCLUSIONS: Spinal stability induced a lumbar ligamentum flavum change and a sustained remodeling of the spinal canal, which may explain the long-term pain relief after indirect decompression fusion surgery.
Decompression*
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Follow-Up Studies
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Humans
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Ligamentum Flavum*
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Magnetic Resonance Imaging
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Retrospective Studies
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Spinal Canal
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Spinal Fusion
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Spine
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Spondylolisthesis
7.Transient Receptor Potential Vanilloid 1-Immunoreactive Innervation Increases in Fractured Rat Femur.
Yuya KAWARAI ; Miyako SUZUKI ; Kensuke YOSHINO ; Gen INOUE ; Sumihisa ORITA ; Kazuyo YAMAUCHI ; Yasuchika AOKI ; Tetsuhiro ISHIKAWA ; Masayuki MIYAGI ; Hiroto KAMODA ; Go KUBOTA ; Yoshihiro SAKUMA ; Yasuhiro OIKAWA ; Kazuhide INAGE ; Takeshi SAINOH ; Jun SATO ; Junichi NAKAMURA ; Masashi TAKASO ; Tomoaki TOYONE ; Kazuhisa TAKAHASHI ; Seiji OHTORI
Yonsei Medical Journal 2014;55(1):185-190
PURPOSE: Pain from vertebral or femoral neck fractures is a particularly important problem in clinical orthopaedics. Transient receptor potential vanilloid 1 (TRPV1) is a ligand-gated nonselective cation channel, and there are recent reports on an association between bone pain and TRPV1. However, an increase in TRPV1 activity has not been reported following femoral fracture. MATERIALS AND METHODS: We applied a neurotracer [Fluoro-gold (FG)] onto femur to detect dorsal root ganglia (DRGs) innervating the cortex of the femur in 30 Sprague Dawley rats. Seven days after application, a closed mid-diaphyseal fracture of the femur was performed. FG labeled TRPV1-immunoreactive (ir) DRGs innervating the femur were examined in nonfractured controls, and 3 days, 1 week, 2 weeks, and 4 weeks after fracture. We evaluated bone healing of the femur and compared the ratio of TRPV1-ir DRG neurons innervating the femur at the time points. RESULTS: Four weeks after fracture, complete bone union was observed. There was no significant difference in the ratio of FG labeled DRG neurons to total DRG neurons at each time point. The percentages of TRPV1-ir neurons in DRGs innervating the femur at 3 days and 1 week after fracture were significantly higher than those in control, 2 weeks, and 4 weeks after fracture (p<0.05). CONCLUSION: Fracture induced an increase of TRPV1-ir neurons in DRGs innervating the fractured femur within 3 days, and decreased during bone healing over 4 weeks. These findings show that TRPV1 may play a role in sensory sensation of bone fracture pain.
Animals
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Female
;
Femur/*innervation/*metabolism
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Immunohistochemistry
;
Rats
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Rats, Sprague-Dawley
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TRPV Cation Channels/*metabolism
8.Transdermal Fentanyl for Chronic Low Back Pain.
Seiji OHTORI ; Gen INOUE ; Sumihisa ORITA ; Yawara EGUCHI ; Nobuyasu OCHIAI ; Shunji KISHIDA ; Masashi TAKASO ; Yasuchika AOKI ; Kazuki KUNIYOSHI ; Junichi NAKAMURA ; Tetsuhiro ISHIKAWA ; Gen ARAI ; Masayuki MIYAGI ; Hiroto KAMODA ; Miyako SUZUKI ; Tomoaki TOYONE ; Kazuhisa TAKAHASHI
Yonsei Medical Journal 2012;53(4):788-793
PURPOSE: Chronic low back pain is a common clinical problem. As medication, non-steroidal anti-inflammatory drugs are generally used; however, they are sometimes non-effective. Recently, opioids have been used for the treatment of chronic low back pain, and since 2010, transdermal fentanyl has been used to treat chronic non-cancer pain in Japan. The purpose of the current study was to examine the efficacy of transdermal fentanyl in the treatment of chronic low back pain. MATERIALS AND METHODS: This study included patients (n=62) that suffered from chronic low back pain and were non-responsive to non-steroidal anti-inflammatory drugs. Their conditions consisted of non-specific low back pain, multiple back operations, and specific low back pain awaiting surgery. Patients were given transdermal fentanyl for chronic low back pain. Scores of the visual analogue scale and the Oswestry Disability Index, as well as adverse events were evaluated before and after therapy. RESULTS: Overall, visual analogue scale scores and Oswestry Disability Index scores improved significantly after treatment. Transdermal fentanyl (12.5 to 50 microg/h) was effective in reducing low back pain in 45 of 62 patients; however, it was not effective in 17 patients. Patients who experienced the most improvement were those with specific low back pain awaiting surgery. Adverse events were seen in 40% of patients (constipation, 29%; nausea, 24%; itching, 24%). CONCLUSION: Disability Index scores in 73% of patients, especially those with specific low back pain awaiting surgery; however, it did not decrease pain in 27% of patients, including patients with non-specific low back pain or multiple back operations.
Administration, Cutaneous
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Adult
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Aged
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Aged, 80 and over
;
Chronic Disease
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Female
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Fentanyl/*administration & dosage/*therapeutic use
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Humans
;
Low Back Pain/*drug therapy
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Male
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Middle Aged
;
Young Adult
9.Injection of Bupivacaine into Disc Space to Detect Painful Nonunion after Anterior Lumbar Interbody Fusion (ALIF) Surgery in Patients with Discogenic Low Back Pain.
Seiji KIMURA ; Seiji OHTORI ; Sumihisa ORITA ; Gen INOUE ; Yawara EGUCHI ; Masashi TAKASO ; Nobuyasu OCHIAI ; Kazuki KUNIYOSHI ; Yasuchika AOKI ; Tetsuhiro ISHIKAWA ; Masayuki MIYAGI ; Hiroto KAMODA ; Miyako SUZUKI ; Yoshihiro SAKUMA ; Gou KUBOTA ; Yasuhiro OIKAWA ; Kazuhide INAGE ; Takeshi SAINOH ; Kazuyo YAMAUCHI ; Tomoaki TOYONE ; Junichi NAKAMURA ; Shunji KISHIDA ; Jun SATO ; Kazuhisa TAKAHASHI
Yonsei Medical Journal 2014;55(2):487-492
PURPOSE: Bupivacaine is commonly used for the treatment of back pain and the diagnosis of its origin. Nonunion is sometimes observed after spinal fusion surgery; however, whether the nonunion causes pain is controversial. In the current study, we aimed to detect painful nonunion by injecting bupivacaine into the disc space of patients with nonunion after anterior lumbar interbody fusion (ALIF) surgery for discogenic low back pain. MATERIALS AND METHODS: From 52 patients with low back pain, we selected 42 who showed disc degeneration at only one level (L4-L5 or L5-S1) on magnetic resonance imaging and were diagnosed by pain provocation on discography and pain relief by discoblock (the injection of bupivacaine). They underwent ALIF surgery. If the patients showed low back pain and nonunion 2 years after surgery, we injected bupivacaine into the nonunion disc space. Patients showing pain relief after injection of bupivacaine underwent additional posterior fixation using pedicle screws. These patients were followed up 2 years after the revision surgery. RESULTS: Of the 42 patient subjects, 7 showed nonunion. Four of them did not show low back pain; whereas 3 showed moderate or severe low back pain. These 3 patients showed pain reduction after injection of bupivacaine into their nonunion disc space and underwent additional posterior fixation. They showed bony union and pain relief 2 years after the revision surgery. CONCLUSION: Injection of bupivacaine into the nonunion disc space after ALIF surgery for discogenic low back pain is useful for diagnosis of the origin of pain.
Back Pain
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Bupivacaine*
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Diagnosis
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Humans
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Intervertebral Disc
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Intervertebral Disc Degeneration
;
Low Back Pain*
;
Magnetic Resonance Imaging
;
Methods
;
Spinal Fusion
;
Spine
10.Efficacy of Combination of Meloxicam and Pregabalin for Pain in Knee Osteoarthritis.
Seiji OHTORI ; Gen INOUE ; Sumihisa ORITA ; Masashi TAKASO ; Yawara EGUCHI ; Nobuyasu OCHIAI ; Shunji KISHIDA ; Kazuki KUNIYOSHI ; Yasuchika AOKI ; Tetsuhiro ISHIKAWA ; Masayuki MIYAGI ; Hiroto KAMODA ; Miyako SUZKUKI ; Junichi NAKAMURA ; Gou KUBOTA ; Yoshihiro SAKUMA ; Yasuhiro OIKAWA ; Tomoaki TOYONE ; Kazuhide INAGE ; Takeshi SAINOH ; Kazuyo YAMAUCHI ; Kazuhisa TAKAHASHI
Yonsei Medical Journal 2013;54(5):1253-1258
PURPOSE: Osteoarthritic pain is largely considered to be inflammatory pain. Sensory nerve fibers innervating the knee have been shown to be significantly damaged in rat models of knee osteoarthritis (OA) in which the subchondral bone junction is destroyed, and this induces neuropathic pain (NP). Pregabalin was developed as a pain killer for NP; however, there are no reports on pregabalin use in OA patients. The purpose of this study was to investigate the efficacy of pregabalin for pain in OA patients. MATERIALS AND METHODS: Eighty-nine knee OA patients were evaluated in this randomized prospective study. Patients were divided into meloxicam, pregabalin, and meloxicam+pregabalin groups. Pain scores were evaluated before and 4 weeks after drug application using a visual analogue scale (VAS), and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Pain scales among groups were compared using a Kruskal-Wallis test. RESULTS: Before drug application, there was no significant difference in VAS and WOMAC scores among the three groups (p>0.05). Significant pain relief was seen in the meloxicam+pregabalin group in VAS at 1, 2, and 4 weeks, and WOMAC score at 4 weeks, compared with the other groups (p<0.05). No significant pain relief was seen in the meloxicam only group in VAS during 4 weeks and WOMAC score at 4 weeks compared with the pregabalin only group (p>0.05). CONCLUSION: Meloxicam+pregabalin was effective for pain in OA patients. This finding suggests that OA pain is a combination of inflammatory and NP.
Aged
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Aged, 80 and over
;
Drug Therapy, Combination/adverse effects
;
Female
;
Humans
;
Male
;
Middle Aged
;
Osteoarthritis, Knee/*drug therapy
;
Pain Measurement
;
Thiazines/administration & dosage/adverse effects/*therapeutic use
;
Thiazoles/administration & dosage/adverse effects/*therapeutic use
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gamma-Aminobutyric Acid/administration & dosage/adverse effects/*analogs & derivatives/therapeutic use