1.A Case of Low Vision with Tonic Accommodation Exacerbated by Fatigue and Successfully Treated by Shokenchuto
Hiroko TAKAHASHI ; Koichiro TANAKA ; Koki CHIBA ; Kazuhiko NARA
Kampo Medicine 2017;68(1):23-28
An 8-year-old girl was admitted with vision loss. She had no history of amblyopia or other eye diseases. On examination, both eyes showed vision loss and uncorrected myopia, regardless of visual acuity correction by glasses. Her symptoms were considered exacerbated by fatigue. We diagnosed tonic accommodation because a regulatory paralysis agent provided relief. The patient had been treated with tropicamide methyl sulfate and neostigmine, but her visual acuity did not change. Based on a Kampo diagnosis, she was prescribed Shokenchuto. After 4 months' administration, her uncorrected vision improved by 1.2 in both eyes, and her visual acuity was maintained even when fatigued. Kampo medicine can be a treatment option for tonic accommodation in cases where standard treatments are ineffective.
2.Patient Taking Daikenchuto for More than 10 years Suffers from Excess Heat
Tomoko ITOGA ; Koki CHIBA ; Hiroko TAKAHASHI ; Kazuhiko NARA ; Koichiro TANAKA
Kampo Medicine 2017;68(2):123-126
A 54-year-old female had cesarean sections at ages 26 and 29, a left salpingophrectomy for left ovarian cyst at age 31, and a total abdominal hysterectomy for fibroids at age 41. After total abdominal hysterectomy, she had repeated bouts of ileus and started taking daikenchuto (DKT), which is commonly used to prevent ileus. At age 54, she visited our hospital when DKT failed to relieve her constipation and lower abdominal pain and had occasional heat flash above her neck. Tongue examination revealed pale red tongue and fissured tongue signs with yellow fur and dilation of the sublingual collateral vessels. Kampo diagnosis was blood stasis and excess heat, for which keishibukuryogan was prescribed to be taken daily and with which her symptoms dissipated after 7 days. Despite the popular use of DKT, its potential to cause excess heat after long-term use is not as well known. It is extremely important to warn clinicians who prescribe Kampo not to focus solely on a disease-to-prescription model but also to be learned of the discipline and to take measures to prevent adverse long-term effects and complications.
3.Correlation Between Walking Ability and Monthly Care Costs in Elderly Patients After Surgical Treatments for Hip Fractures.
Koki ABE ; Kazuhide INAGE ; Keishi YAMASHITA ; Masaomi YAMASHITA ; Akiyoshi YAMAMAOKA ; Masaki NORIMOTO ; Yoshinori NAKATA ; Takeshi MITSUKA ; Kaoru SUSEKI ; Sumihisa ORITA ; Kazuki FUJIMOTO ; Yasuhiro SHIGA ; Hirohito KANAMOTO ; Masahiro INOUE ; Hideyuki KINOSHITA ; Tomotaka UMIMURA ; Yawara EGUCHI ; Takeo FURUYA ; Kazuhisa TAKAHASHI ; Seiji OHTORI
Annals of Rehabilitation Medicine 2018;42(4):569-574
OBJECTIVE: To validate the relationship between residual walking ability and monthly care cost as well as long-term care insurance (LTCI) certification level in elderly patients after surgical treatment for hip fractures in Japan. METHODS: Elderly patients aged >75 years who underwent surgical treatment for hip fractures in our hospital were included. The preand post-surgical (6-month) walking ability and LTCI certification and the presence or absence of dementia was determined from medical records and questionnaires. Walking ability was classified into 6 levels used in our daily medical practice. Based on these data, we correlated the relationship between walking ability and the LTCI certification level. Further, based on the official statistics pertaining to the average monthly costs per person at each LTCI certification level, we evaluated the relationship between walking ability and monthly care cost. RESULTS: A total of 105 cases (mean age, 80.2 years; 16 men; 39 patients with dementia) were included. The correlation between walking ability and average monthly cost per person as well as LTCI certification level at 6 months postoperatively (r=0.58) was demonstrated. The correlation was found in both groups with and without dementia. CONCLUSION: The ability to walk reduced the cost of care in elderly patients who experienced hip fracture, regardless of the presence of dementia.
Aged*
;
Certification
;
Cost-Benefit Analysis
;
Dementia
;
Hip Fractures*
;
Hip*
;
Humans
;
Insurance, Long-Term Care
;
Japan
;
Long-Term Care
;
Male
;
Medical Records
;
Mobility Limitation
;
Walking*
4.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
5.Inhibiting Vascular Endothelial Growth Factor in Injured Intervertebral Discs Attenuates Pain-Related Neuropeptide Expression in Dorsal Root Ganglia in Rats.
Jun SATO ; Kazuhide INAGE ; Masayuki MIYAGI ; Yoshihiro SAKUMA ; Kazuyo YAMAUCHI ; Masao KODA ; Takeo FURUYA ; Junichi NAKAMURA ; Miyako SUZUKI ; Go KUBOTA ; Yasuhiro OIKAWA ; Takeshi SAINOH ; Kazuki FUJIMOTO ; Yasuhiro SHIGA ; Koki ABE ; Hirohito KANAMOTO ; Masahiro INOUE ; Hideyuki KINOSHITA ; Masaki NORIMOTO ; Tomotaka UMIMURA ; Kazuhisa TAKAHASHI ; Seiji OHTORI ; Sumihisa ORITA
Asian Spine Journal 2017;11(4):556-561
STUDY DESIGN: An experimental animal study. PURPOSE: To evaluate effects of anti-vascular endothelial growth factor (VEGF) on the content and distribution of the calcitonin gene-related peptide (CGRP) in the dorsal ganglia in a rat model. OVERVIEW OF LITERATURE: Increased expression of VEGF in degenerative disc disease increases the levels of inflammatory cytokines and nerve ingrowth into the damaged discs. In animal models, increased levels of VEGF can persist for up to 2 weeks after an injury. METHODS: Through abdominal surgery, the dorsal root ganglia (DRG) innervating L5/L6 intervertebral disc were labeled (FluoroGold neurotracer) in 24, 8-week old Sprague Dawley rats. The rats were randomly allocated to three groups of eight rats each. The anti-VEGF group underwent L5/6 intervertebral disc puncture using a 26-gauge needle, intradiscal injection of 33.3 µg of the pegaptanib sodium, a VEGF165 aptamer. The control-puncture group underwent disc puncture and intradiscal injection of 10 µL saline solution, and the sham-surgery group underwent labeling but no disc puncture. Two rats in each group were sacrificed on postoperative days 1, 7, 14, and 28 after surgery. L1–L6 DRGs were harvested, sectioned, and immunostained to detect the content and distribution of CGRP. RESULTS: Compared with the control, the percentage of CGRP-positive cells was lower in the anti-VEGF group (p<0.05; 40.6% and 58.1% on postoperative day 1, 44.3% and 55.4% on day 7, and 42.4% and 59.3% on day 14). The percentage was higher in the control group compared with that of the sham group (p<0.05; sham group, 34.1%, 40.7%, and 33.7% on postoperative days 1, 7, and 14, respectively). CONCLUSIONS: Decreasing CGRP-positive cells using anti-VEGF therapy provides fundamental evidence for a possible therapeutic role of anti-VEGF in patients with discogenic lower back pain.
Animals
;
Back Pain
;
Calcitonin Gene-Related Peptide
;
Cytokines
;
Diagnosis-Related Groups
;
Endothelial Growth Factors
;
Ganglia
;
Ganglia, Spinal*
;
Humans
;
Intervertebral Disc*
;
Low Back Pain
;
Models, Animal
;
Needles
;
Neuropeptides*
;
Punctures
;
Rats*
;
Rats, Sprague-Dawley
;
Sodium
;
Sodium Chloride
;
Spinal Nerve Roots*
;
Vascular Endothelial Growth Factor A*
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*
;
Follow-Up Studies
;
Humans
;
Ligamentum Flavum*
;
Magnetic Resonance Imaging
;
Retrospective Studies
;
Spinal Canal
;
Spinal Fusion
;
Spine
;
Spondylolisthesis
7.Evaluation of Histological Changes in Back Muscle Injuries in Rats over Time.
Koki ABE ; Kazuhide INAGE ; Yoshihiro SAKUMA ; Sumihisa ORITA ; Kazuyo YAMAUCHI ; Miyako SUZUKI ; Go KUBOTA ; Yasuhiro OIKAWA ; Takeshi SAINOH ; Jun SATO ; Kazuki FUJIMOTO ; Yasuhiro SHIGA ; Hirohito KANAMOTO ; Kazuhisa TAKAHASHI ; Seiji OHTORI
Asian Spine Journal 2017;11(1):88-92
STUDY DESIGN: Animal model study. PURPOSE: The purpose of this study was to evaluate the histological variation in the injured muscle and production of calcitonin gene-related peptide in rats over time. OVERVIEW OF LITERATURE: Vertebral surgery has been reported to cause atrophy of the back muscles, which may result in pain. However, few reports have described the time series histological variation in the injured muscle and changes in the dominant nerve. METHODS: We used 30 male, 8-week-old Sprague-Dawley rats. The right and left sides of the paravertebral muscle were considered as the injured and uninjured sides, respectively. A 115 g weight was dropped from a height of 1 m on the right paravertebral muscle. Hematoxylin and eosin (H&E) staining of the muscle was performed 1–3 weeks after injury for histological evaluation. Fluoro-Gold (FG) was injected into the paravertebral muscle. The L2 dorsal root ganglia on both sides were resected 1, 2, and 3 weeks after injury, and immunohistochemical staining for calcitonin gene-related peptide was performed. RESULTS: H&E staining of the paravertebral muscle showed infiltration of inflammatory cells and the presence of granulation tissue in the injured part on the ipsilateral side 1 week after injury. Muscle atrophy occurred 3 weeks after injury, but was repaired via spontaneous replacement of muscle cells/fibers. In contrast, compared with the uninjured side, the percentage of cells double-labeled with FG and calcitonin gene-related peptide in FG-positive cells in the dorsal root ganglia of the injured side was significantly increased at each time point throughout the study period. CONCLUSIONS: These results suggest that sensitization of the dominant nerve in the dorsal root ganglia, which may be caused by cicatrix formation, can protract injured muscle pain. This information may be helpful in elucidating the underlying mechanism of persistent pain after back muscle injury.
Animals
;
Atrophy
;
Back Muscles*
;
Calcitonin Gene-Related Peptide
;
Cicatrix
;
Eosine Yellowish-(YS)
;
Ganglia, Sensory
;
Ganglia, Spinal
;
Granulation Tissue
;
Hematoxylin
;
Humans
;
Male
;
Models, Animal
;
Muscular Atrophy
;
Myalgia
;
Rats*
;
Rats, Sprague-Dawley
;
Spine
8.Mini-Open Anterior Retroperitoneal Lumbar Interbody Fusion: Oblique Lateral Interbody Fusion for Lumbar Spinal Degeneration Disease.
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 ; Kazuki FUJIMOTO ; Yasuhiro SHIGA ; Koki ABE ; Tomoaki TOYONE ; Gen INOUE ; Kazuhisa TAKAHASHI
Yonsei Medical Journal 2015;56(4):1051-1059
PURPOSE: Surgery for lumbar spinal degeneration disease is widely performed. While posterior decompression and fusion are popular, anterior lumbar interbody fusion (ALIF) is also used for treatment. Extreme lateral interbody fusion (XLIF) is commonly used for noninvasive ALIF; however, several complications, such as spinal nerve and psoas muscle injury, have been reported. In the current study, we examined the clinical efficacy and complications of oblique lateral interbody fusion (OLIF) for lumbar spinal degeneration disease. MATERIALS AND METHODS: Thirty-five patients with degenerated spondylolisthesis, discogenic pain, and kyphoscoliosis were examined. All patients underwent OLIF surgery (using a cage and bone graft from the iliac crest) with or without posterior decompression, without real-time electromyography monitoring. Posterior screws were used in all patients. Visual analog scale (VAS) score and Oswestry Disability Index (ODI) were evaluated before and 6 months after surgery. Surgical complications were also evaluated. RESULTS: Pain scores significantly improved after surgery, compared to those before surgery (p<0.05). There was no patient who underwent revision surgery. There was no spinal nerve, major vessel, peritoneal, or urinary injury. Few patients showed symptoms from psoas invasion. CONCLUSION: OLIF surgery produced good surgical results without any major complication.
Adult
;
Aged
;
Decompression, Surgical/*methods
;
Electromyography
;
Female
;
Humans
;
Lumbar Vertebrae/surgery
;
Male
;
Middle Aged
;
Pain
;
Pain Measurement
;
Scoliosis/*surgery
;
Spinal Diseases/surgery
;
Spinal Fusion/*methods
;
Spondylolisthesis/*surgery
;
Treatment Outcome
;
Young Adult
9.Low-Dose Tramadol and Non-Steroidal Anti-Inflammatory Drug Combination Therapy Prevents the Transition to Chronic Low Back Pain.
Kazuhide INAGE ; Sumihisa ORITA ; Kazuyo YAMAUCHI ; Takane SUZUKI ; Miyako SUZUKI ; Yoshihiro SAKUMA ; Go KUBOTA ; Yasuhiro OIKAWA ; Takeshi SAINOH ; Jun SATO ; Kazuki FUJIMOTO ; Yasuhiro SHIGA ; Koki ABE ; Hirohito KANAMOTO ; Masahiro INOUE ; Hideyuki KINOSHITA ; Kazuhisa TAKAHASHI ; Seiji OHTORI
Asian Spine Journal 2016;10(4):685-689
STUDY DESIGN: Retrospective study. PURPOSE: To determine whether low-dose tramadol plus non-steroidal anti-inflammatory drug combination therapy could prevent the transition of acute low back pain to chronic low back pain. OVERVIEW OF LITERATURE: Inadequately treated early low back pain transitions to chronic low back pain occur in approximately 30% of affected individuals. The administration of non-steroidal anti-inflammatory drugs is effective for treatment of low back pain in the early stages. However, the treatment of low back pain that is resistant to non-steroidal anti-inflammatory drugs is challenging. METHODS: Patients who presented with acute low back pain at our hospital were considered for inclusion in this study. After the diagnosis of acute low back pain, non-steroidal anti-inflammatory drug administration was started. Forty patients with a visual analog scale score of >5 for low back pain 1 month after treatment were finally enrolled. The first 20 patients were included in a non-steroidal anti-inflammatory drug group, and they continued non-steroidal anti-inflammatory drug therapy for 1 month. The next 20 patients were included in a combination group, and they received low-dose tramadol plus non-steroidal anti-inflammatory drug combination therapy for 1 month. The incidence of adverse events and the improvement in the visual analog scale score at 2 months after the start of treatment were analyzed. RESULTS: No adverse events were observed in the non-steroidal anti-inflammatory drug group. In the combination group, administration was discontinued in 2 patients (10%) due to adverse events immediately following the start of tramadol administration. At 2 months, the improvement in the visual analog scale score was greater in the combination group than in the non-steroidal anti-inflammatory drug group (p<0.001). CONCLUSIONS: Low-dose tramadol plus non-steroidal anti-inflammatory drug combination therapy might decrease the incidence of adverse events and prevent the transition of acute low back pain to chronic low back pain.
Anti-Inflammatory Agents, Non-Steroidal
;
Diagnosis
;
Drug Therapy
;
Humans
;
Incidence
;
Low Back Pain*
;
Retrospective Studies
;
Spine
;
Tramadol*
;
Visual Analog Scale
10.Dose Optimization for Single Intradiscal Administration of the Tumor Necrosis Factor-α Inhibitor, Etanercept, in Rat Disc Injury Models.
Kazuhide INAGE ; Sumihisa ORITA ; Kazuyo YAMAUCHI ; Takane SUZUKI ; Miyako SUZUKI ; Yoshihiro SAKUMA ; Go KUBOTA ; Yasuhiro OIKAWA ; Takeshi SAINOH ; Jun SATO ; Kazuki FUJIMOTO ; Yasuhiro SHIGA ; Koki ABE ; Hirohito KANAMOTO ; Masahiro INOUE ; Hideyuki KINOSHITA ; Kazuhisa TAKAHASHI ; Seiji OHTORI
Asian Spine Journal 2016;10(4):619-623
STUDY DESIGN: Experimental animal study. PURPOSE: We aimed to determine the optimal dose of a single direct injection of the tumor necrosis factor (TNF)-α inhibitor, etanercept, by using the rat model of degenerative intervertebral disc from injury. OVERVIEW OF LITERATURE: The pain-related peptide expression was suppressed in the etanercept (100 µg and 1,000 µg)-administered groups in a dose-dependent manner. METHODS: The neurotracer FluoroGold (FG) was applied to the surfaces of L4/5 discs to label their innervating dorsal root ganglion (DRG) neurons (n=50). Ten rats were included in the nonpunctured disc sham surgery control group, whereas the other 40 were included in the experimental group in which intervertebral discs were punctured with a 23-gauge needle. Saline or etanercept (10 µg, 100 µg, or 1,000 µg) was injected into the punctured discs (n=10 for each treatment). After 14 days of surgery, DRGs from L1 to L6 were harvested, sectioned, and immunostained for calcitonin gene-related peptide (CGRP). The proportion of FG-labeled CGRP-immunoreactive DRG neurons was evaluated in all the groups. RESULTS: There were no significant differences between the puncture+saline group and the puncture+10-µg etanercept group (p >0.05). However, a significant decrease in the percentage of FG and CGRP double-positive cells in FG-positive cells was observed in the etanercept (100 µg and 1,000 µg)-administered groups in a dose-dependent manner (p <0.05). CONCLUSIONS: When a low dose of the TNF-α inhibitor (10 µg of etanercept) was directly administered to the rat intervertebral disc in the rat model of degenerative intervertebral disc from injury, no suppressive effect on the pain-related peptide expression was observed. However, when a higher dose of etanercept (100 µg and 1,000 µg) was administered, the pain-related peptide expression was suppressed in a dose-dependent manner.
Animals
;
Calcitonin Gene-Related Peptide
;
Diagnosis-Related Groups
;
Etanercept*
;
Ganglia, Spinal
;
Intervertebral Disc
;
Intervertebral Disc Degeneration
;
Models, Animal
;
Necrosis*
;
Needles
;
Neurons
;
Rats*
;
Tumor Necrosis Factor-alpha