1.EVALUATION OF ELASTIC PROPERTIES OF ACHILLES TENDON AS A FACTOR OF APOPHYSITIS IN ELEMENTARY SCHOOL SOCCER CLUB MEMBERS
YOSUKE EGAWA ; SHINGO NAKAI ; MARI ISHIKAWA ; SUGURU TORII
Japanese Journal of Physical Fitness and Sports Medicine 2005;54(1):107-112
It is well known that extreme repetitive stress on the apophysis without considering the physical characteristics of children induces a growth disorder of the growing skeleton. However, only a few studies have evaluated the indexes of the muscle-tendon complex as a risk factor of apophysitis. The purpose of this study was to investigate the relationship between the elastic properties of the Achilles tendon, physical characteristics, muscle tightness (MT) and general joint laxity score (GLP), and tenderness from typical apophysitis (calcaneal tubercle, tibial tuberosity and iliac spine) in kindergarten and elementary school students. Body and lower leg size, and MT of the calf muscle increased ; while GLP decreased significantly with age. The Elastic index of the Achilles tendon and its standard deviations were greater among 5th and 6th graders than among 3rd and 4th graders. Point tenderness was more frequent in older age groups (4th-6th graders) than in younger age groups (kindergartren-3rd graders) and was greatest in 4th graders. When subjects were categorized into groups with and without point tenderness, no significant differences were found between GLP, muscle tightness of gastrocnemius, quadriceps and iliopsoas. However subjects who showed point tenderness had a higher Elastic index (p=0.07). Considering the pathomechanics of apophysitis, repetitive traction of the apophysis by a stiffer muscle-tendon unit lead to injury of the apophysis and growth plate. Tendon properties appear to be more sensitive to the pathomechanics of apophysitis.
2.Histological analysis of the effects of electroacupuncture stimulation on the femur fracture line in a rat model of hindlimb immobilization
Shingo NAKAI ; Shin UNAYAMA ; Masafumi OHSAKO
Journal of the Japan Society of Acupuncture and Moxibustion 2023;73(2):121-130
[Introduction] This study compared the effects of joint immobilization and concurrent electroacupuncture stimulation on fracture line appearance, which is indicative of differences in cortical bone structure, in the femurs of young adult rats. [Materials and Methods] Forty-two 7-week-old Wistar rats were divided into three groups: a hindlimb immobilized group (IM), a hindlimb immobilized group with concurrent electroacupuncture stimulation (IMEA), and an untreated control group (CO). IM and IMEA were immobilized for two weeks with a jacket-type immobilization device that immobilized the hip joint in extension and restricted hip joint adduction and abduction. Acupuncture needles were inserted into the femoral region during the immobilization period in the IMEA group, and continuous alternating current was used for stimulation. A low-frequency stimulator was used to generate electrical current (250 μsec, 50 Hz, 0.24 mA, 500 Ω load resistance), and stimulation was performed daily for two weeks at 10 min/day. The extracted femur was fractured from the anterior part of the diaphysis or metaphyseal end by three-point-bending under constant conditions with 10 mm between the fulcrum and a crosshead speed of 10 mm/min. [Results] IM showed significantly lower Stiffness, Deformation, and Strength values than CO. Bone morphometry parameters also showed lower values for IM. A cement line was observed between lamellar and non-lamellar bone in CO and IMEA, but was indistinct in IM. In CO and IMEA, minute bone fragments were formed in the deep diaphysis region sandwiched between the inner and outer circumferential lamellae, but no such fragments were found in IM. IMEA had less resorption than IM, and lamellar bone with a structure similar to CO was maintained. Moreover, cracks observed in CO and IMEA ran longitudinally in the vicinity of the cement line and rest line, but no such cracks were found in IM. [Discussion and Conclusion] These findings suggest that electroacupuncture mitigates bone weakening in immobilized rat femurs, and this affects the appearance of the fracture line.
3.Aortic Arch Aneurysm 7 Years after Aortic Root Replacement in a Patient of Loeys-Dietz Syndrome
Jun Hayashi ; Seigo Gomi ; Tetsuro Uchida ; Azumi Hamasaki ; Yoshinori Kuroda ; Atsushi Yamashita ; Ken Nakamura ; Daisuke Watanabe ; Shingo Nakai ; Akihiro Kobayashi ; Mitsuaki Sadahiro
Japanese Journal of Cardiovascular Surgery 2017;46(4):157-160
A 14-year-old women who had a history of aortic root replacement at 7 years old admitted our hospital due to dilatation of aortic arch aneurysm. Loeys-Dietz syndrome was diagnosed when she was 10 years old. Computed tomography showed 70 mm proximal arch aneurysm. Operative findings revealed brachiocephalic artery and left common carotid artery branched from aneurysm. Partial arch replacement was performed and distal anastomosis was made between left common carotid artery and left subclavian artery. Close observation by CT regularly is necessary and undergo aortic repair not to miss the timing of surgery.
4.Quality indicators for cervical cancer care in Japan.
Tomone WATANABE ; Mikio MIKAMI ; Hidetaka KATABUCHI ; Shingo KATO ; Masanori KANEUCHI ; Masahiro TAKAHASHI ; Hidekatsu NAKAI ; Satoru NAGASE ; Hitoshi NIIKURA ; Masaki MANDAI ; Yasuyuki HIRASHIMA ; Hiroyuki YANAI ; Wataru YAMAGAMI ; Satoru KAMITANI ; Takahiro HIGASHI
Journal of Gynecologic Oncology 2018;29(6):e83-
OBJECTIVE: We aimed to propose a set of quality indicators (QIs) based on the clinical guidelines for cervical cancer treatment published by The Japan Society of Gynecologic Oncology, and to assess adherence to standard-of-care as an index of the quality of care for cervical cancer in Japan. METHODS: A panel of clinical experts devised the QIs using a modified Delphi method. Adherence to each QI was evaluated using data from a hospital-based cancer registry of patients diagnosed in 2013, and linked with insurance claims data, between October 1, 2012, and December 31, 2014. All patients who received first-line treatment at the participating facility were included. The QI scores were communicated to participating hospitals, and additional data about the reasons for non-adherence were collected. RESULTS: In total, 297 hospitals participated, and the care provided to 15,163 cervical cancer patients was examined using 10 measurable QIs. The adherence rate ranged from 50.0% for ‘cystoscope or proctoscope for stage IVA’ to 98.8% for ‘chemotherapy using platinum for stage IVB’. Despite the variation in care, hospitals reported clinically valid reasons for more than half of the non-adherent cases. Clinically valid reasons accounted for 75%, 90.9%, 73.4%, 44.5%, and 88.1% of presented non-adherent cases respectively. CONCLUSION: Our study revealed variations in pattern of care as well as an adherence to standards-of-care across Japan. Further assessment of the causes of variation and non-adherence can help identify areas where improvements are needed in patient care.
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Uterine Cervical Neoplasms*
5.A Case of Ruptured Abdominal Aortic Aneurysm Induced by a Hard Blow to the Abdomen
Kimihiro KOBAYASHI ; Tetsuro UCHIDA ; Azumi HAMASAKI ; Yoshinori KURODA ; Atsushi YAMASHITA ; Syuto HIROOKA ; Shingo NAKAI ; Mitsuaki SADAHIRO
Japanese Journal of Cardiovascular Surgery 2020;49(1):35-37
A 77-year-old man was transferred to our hospital with a complaint of a sudden abdominal pain after receiving a hard blow to the abdomen. Contrast-enhanced CT revealed rupture of the abdominal aortic aneurysm with a massive retroperitoneal hematoma. Because of severe hemorrhagic shock, he underwent graft replacement with a woven bifurcated graft through a median laparotomy on an emergent basis. His postoperative course was uneventful and now he is doing well 3 years after surgery. Most blunt abdominal aortic injuries are caused by high-energy trauma, such as motor vehicle collisions and fall injuries. Although body blow is considered as a low-energy trauma, abdominal aortic injury could be caused in patients with an abdominal aortic aneurysm.
6.Surgical Experience of Radiation-Induced Coronary Artery Ostial Stenosis
Kimihiro KOBAYASHI ; Tetsuro UCHIDA ; Azumi HAMASAKI ; Yoshinori KURODA ; Atsushi YAMASHITA ; Syuto HIROOKA ; Shingo NAKAI ; Mitsuaki SADAHIRO
Japanese Journal of Cardiovascular Surgery 2019;48(6):396-400
Radiation-induced heart disease includes various types of cardiac disorders that occur after thoracic irradiation therapy. The coronary artery has been known to be affected in this kind of pathological condition. A 37-year-old man diagnosed with acute coronary syndrome was referred to our institution. He had received irradiation therapy for mediastinal malignant lymphoma at the age of 10 and 11 years. An extended thymectomy for a thymoma via median sternotomy was performed at 18 years old. He also underwent thoracoscopic pericardial fenestration for a pericardial effusion at 26 years old. Coronary angiography revealed severe stenosis of the left and right coronary ostia. Considering the patient's characteristics, including a history of thoracic irradiation therapy, radiation induced heart disease was suspected as a pathogenesis for severe ostial stenosis of the coronary arteries. He underwent conventional on-pump beating coronary artery bypass grafting (CABG) on an urgent basis. Neither internal thoracic artery was suitable for bypass conduit because of dense adhesion. Therefore, the radial artery and great saphenous vein were used as free grafts for coronary revascularization. Furthermore, partial clamping of the ascending aorta seemed to be difficult and inappropriate owing to severe adhesion, so proximal anastomosis devices were used without a side biting clamp. The postoperative course was uneventful and both bypass grafts were patent. Now, he is doing well 10 years after the CABG without any other cardiac event.
7.Aorto-Left Atrial Fistula after Aortic Valve Replacement : a Rare Complication
Tomonori OCHIAI ; Tetsuro UCHIDA ; Yoshinori KURODA ; Atsushi YAMASHITA ; Eiichi OHBA ; Shingo NAKAI ; Kimihiro KOBAYASHI ; Mitsuaki SADAHIRO
Japanese Journal of Cardiovascular Surgery 2021;50(1):31-33
A 60-year-old man underwent aortic valve replacement for aortic valve regurgitation, tricuspid valve annuloplasty, and coronary artery bypass grafting. Postoperative echocardiography revealed shunted flow from the noncoronary sinus of Valsalva into the left atrium. The pathogenesis of this complication is considered to be uncertain ; however, it might be due to some kind of intraoperative injury. Three weeks after the initial surgery, we reoperated to repair the aorto-left atrial fistula. According to the intraoperative findings, small slits were found on the left atrial surface close to the posteromedial side of the mitral valve and the noncoronary sinus of Valsalva. The fistula was closed with transmural mattress sutures. Post-operative echocardiography showed no shunt flow. Although an aorto-left atrial fistula is a rare complication after aortic valve replacement, reoperation might be mandatory if the shunt flow is considerable. Surgeons should keep in mind the possibility of intraoperative injury to surrounding structures when performing aortic valve replacement.
8.Abdominal Vacuum-Assisted Closure for Secondary Abdominal Fascial Closure into Open Abdomen after Surgical Repair for Ruptured Abdominal Aortic Aneurysm
Daisuke WATANABE ; Tetsuro UCHIDA ; Azumi HAMASAKI ; Yoshinori KURODA ; Eiichi OBA ; Atsushi YAMASHITA ; Jun HAYASHI ; Ai TAKAHASHI ; Shingo NAKAI ; Mitsuaki SADAHIRO
Japanese Journal of Cardiovascular Surgery 2018;47(1):36-39
Secondary abdominal fascial closure by abdominal vacuum-assisted closure (VAC) therapy is required for abdominal organ protection and prevention of infection due to abdominal compartment syndrome (ACS) developing after the surgery. In this paper, we present our experience with abdominal VAC therapy for two cases that required open abdominal management after surgical repair for ruptured abdominal aortic aneurysm, with favorable outcomes. Case 1 involved a 72-year-old man who underwent endovascular aortic repair for ruptured abdominal aortic aneurysm. Abdominal VAC therapy was started after decompression laparotomy because he developed ACS immediately after surgery. Secondary abdominal fascial closure was performed on day 4 postoperatively, and he had no complications. Case 2 involved a 71-year-old man who underwent emergency Y-graft replacement for ruptured abdominal aortic aneurysm. We considered secondary abdominal fascial closure necessary because of prominent intestinal edema and massive retroperitoneal hematoma, and performed abdominal VAC therapy. We changed the VAC system on day 4, postoperatively and performed secondary abdominal fascial closure on day 7, postoperatively. Abdominal VAC therapy is considered effective and safe for patients requiring secondary abdominal fascial closure after abdominal surgery.
9.Treatment Strategy for Leriche Syndrome Complicated with Ischemic Heart Disease
Jun HAYASHI ; Tetsuro UCHIDA ; Yoshinori KURODA ; Eiichi OHBA ; Masahiro MIZUMOTO ; Atsushi YAMASHITA ; Shingo NAKAI ; Kimihiro KOBAYASHI ; Tomonori OCHIAI
Japanese Journal of Cardiovascular Surgery 2021;50(4):283-286
Leriche syndrome is often complicated with ischemic heart disease (IHD). In such cases, as the internal mammary artery (IMA) supplies blood to the lower-limbs through a collateral network, coronary artery bypass grafting (CABG) using IMA is considered to worsen the lower-limb ischemia and use of intra-aortic balloon pumping prior to lower limb revascularization is not possible. Recent advances in endovascular technology enable us to perform endovascular treatment (EVT) even in Leriche syndrome. In 3 patients diagnosed with Leriche syndrome associated with IHD, tailor-made treatments were performed as one-stage or two-stage surgeries. Various techniques such as percutaneous coronary intervention (PCI), CABG, and open surgical revascularization or EVT of lower limbs were employed. EVT is a less invasive and more attractive alternative to open surgical revascularization, it led to new treatment options in patients with this particular circumstance. Considering the severity of pathophysiology, treatment strategy should be determined on a case-by-case basis.
10.Preventive Innominate Artery Transection for a High-Risk Case of Tracheo-Innominate Artery Fistula
Masahiro MIZUMOTO ; Tetsuro UCHIDA ; Yoshinori KURODA ; Atsushi YAMASHITA ; Eiichi OBA ; Jun HAYASHI ; Shingo NAKAI ; Kimihiro KOBAYASHI ; Tomonori OCHIAI
Japanese Journal of Cardiovascular Surgery 2021;50(5):337-341
An 18-year-old man with hypoxic encephalopathy was admitted because of recurrent minor bleeding a tracheal stoma, which was suspected as a tracheo-innominate artery fistula (TIF). He had undergone tracheostomy and gastrostomy 2 years prior and had mild opisthotonos and scoliosis. Although tracheal endoscopy showed no tracheal mucosal erosion, necrosis, or granulation tissue formation, contrast-enhanced computed tomography (CT) revealed a close contact between the innominate artery and the anterior wall of the trachea, and an equal height between the innominate artery and the tip of the tracheal cannula. Magnetic resonance angiography of the head showed dominant intracranial blood flow from the left internal carotid and vertebral arteries. Preventive innominate artery transection through the supra-sternal approach without sternotomy or reconstruction of the innominate artery was performed for this high-risk case of TIF. The patient's postoperative course was uneventful. Postoperative CT revealed that the innominate artery was transected and isolated from the site of tracheostomy. The preserved connection between the right common carotid and subclavian artery at the distal sutured stump helped maintain blood flow in the right internal and middle cerebral arteries. The patient was discharged on postoperative day 9 without any new neurological complications or bleeding from a tracheal stoma. TIF is a rare but fatal complication after laryngotracheal separation or tracheostomy. It is important to prevent the onset of TIF, however, there are no criteria for preventive innominate artery transection. Our preventive innominate artery transection through the supra-sternal approach is considered as one of the useful surgical treatment for high-risk cases of TIF accompanied by severe neuromuscular disorders.