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Kadota R.,Chiba University | Koda M.,Chiba Aoba Municipal Hospital | Kawabe J.,Chiba University | Hashimoto M.,Chiba Medical Center | And 7 more authors.
PLoS ONE | Year: 2012

Background: Granulocyte colony-stimulating factor (G-CSF) is a protein that stimulates differentiation, proliferation, and survival of cells in the granulocytic lineage. Recently, a neuroprotective effect of G-CSF was reported in a model of cerebral infarction and we previously reported the same effect in studies of murine spinal cord injury (SCI). The aim of the present study was to elucidate the potential therapeutic effect of G-CSF for SCI in rats. Methods: Adult female Sprague-Dawley rats were used in the present study. Contusive SCI was introduced using the Infinite Horizon Impactor (magnitude: 200 kilodyne). Recombinant human G-CSF (15.0 μg/kg) was administered by tail vein injection at 1 h after surgery and daily the next four days. The vehicle control rats received equal volumes of normal saline at the same time points. Results: Using a contusive SCI model to examine the neuroprotective potential of G-CSF, we found that G-CSF suppressed the expression of pro-inflammatory cytokine (IL-1 beta and TNF- alpha) in mRNA and protein levels. Histological assessment with luxol fast blue staining revealed that the area of white matter spared in the injured spinal cord was significantly larger in G-CSF-treated rats. Immunohistochemical analysis showed that G-CSF promoted up-regulation of anti-apoptotic protein Bcl-Xl on oligpodendrocytes and suppressed apoptosis of oligodendrocytes after SCI. Moreover, administration of G-CSF promoted better functional recovery of hind limbs. Conclusions: G-CSF protects oligodendrocyte from SCI-induced cell death via the suppression of inflammatory cytokines and up-regulation of anti-apoptotic protein. As a result, G-CSF attenuates white matter loss and promotes hindlimb functional recovery. © 2012 Kadota et al.


PubMed | Narashino Dai ichi Hospital, Matsudo City Hospital, Chiba Aoba Municipal Hospital, Chiba Medical Center and 2 more.
Type: Journal Article | Journal: Asian spine journal | Year: 2016

Retrospective case-control study.To determine whether kissing spine is a risk factor for recurrence of sciatica after lumbar posterior decompression using a spinous process floating approach.Kissing spine is defined by apposition and sclerotic change of the facing spinous processes as shown in X-ray images, and is often accompanied by marked disc degeneration and decrement of disc height. If kissing spine significantly contributes to weight bearing and the stability of the lumbar spine, trauma to the spinous process might induce a breakdown of lumbar spine stability after posterior decompression surgery in cases of kissing spine.The present study included 161 patients who had undergone posterior decompression surgery for lumbar canal stenosis using a spinous process floating approaches. We defined recurrence of sciatica as that resolved after initial surgery and then recurred. Kissing spine was defined as sclerotic change and the apposition of the spinous process in a plain radiogram. Preoperative foraminal stenosis was determined by the decrease of perineural fat intensity detected by parasagittal T1-weighted magnetic resonance imaging. Preoperative percentage slip, segmental range of motion, and segmental scoliosis were analyzed in preoperative radiographs. Univariate analysis followed by stepwise logistic regression analysis determined factors independently associated with recurrence of sciatica.Stepwise logistic regression revealed kissing spine (When a patient shows kissing spine and concomitant subclinical foraminal stenosis at the affected level, we should sufficiently discuss the selection of an appropriate surgical procedure.


Yokota H.,Chiba University | Isobe K.,Chiba University | Murakami M.,Chiba Aoba Municipal Hospital | Kubosawa H.,Chiba Aoba Municipal Hospital | Uno T.,Chiba University
Spine Journal | Year: 2012

Background context: Melanotic schwannoma is a very rare tumor of Schwann cell origin, which can develop in various locations, similar to conventional schwannoma. This tumor has a malignant potential and therefore careful therapy is required. Purpose: To describe a case of melanotic schwannoma with a histopathologically and clinically malignant behavior. Study design: Case report. Methods: A 64-year-old man presented with sensory changes in his arm and gait disturbance. Magnetic resonance imaging revealed a dumbbell-shaped tumor at the left C7 spinal root, which was hyperintense on T1-weighted images and generally hypointense on T2-weighted images in comparison with conventional schwannoma; however, the peripheral zone was relatively hyperintense, and the central zone was hypointense like a target sign. Results: The tumor was partially resected and diagnosed to be nonpsammomatous malignant melanotic schwannoma. The patient experienced local recurrence and metastases to the bone and lung and finally developed quadriplegia. Radiation therapy failed to palliate the symptoms. Conclusions: Some melanotic schwannomas present with an aggressive behavior, which thus leads to poor prognosis. We should therefore be familiar with its characteristic clinical imaging and pathologic findings to provide a correct diagnosis and appropriate treatment for such patients. © 2012 Elsevier Inc. All rights reserved.


Kawabe J.,Chiba University | Koda M.,Chiba Aoba Municipal Hospital | Hashimoto M.,Chiba University | Fujiyoshi T.,Chiba University | And 4 more authors.
Journal of Neurosurgery: Spine | Year: 2011

Object. Granulocyte colony-stimulating factor (G-CSF) has neuroprotective effects on the CNS. The authors have previously demonstrated that G-CSF also exerts neuroprotective effects in experimental spinal cord injury (SCI) by enhancing migration of bone marrow-derived cells into the damaged spinal cord, increasing glial differentiation of bone marrow-derived cells, enhancing antiapoptotic effects on both neurons and oligodendrocytes, and by reducing demyelination and expression of inflammatory cytokines. Because the degree of angiogenesis in the subacute phase after SCI correlates with regenerative responses, it is possible that G-CSF's neuroprotective effects after SCI are due to enhancement of angiogenesis. The aim of this study was to assess the effects of G-CSF on the vascular system after SCI. Methods. A contusive SCI rat model was used and the animals were randomly allocated to either a G-CSF - treated group or a control group. Integrity of the blood-spinal cord barrier was evaluated by measuring the degree of edema in the cord and the volume of extravasation. For histological evaluation, cryosections were immunostained with anti-von Willebrand factor and the number of vessels was counted to assess revascularization. Real-time reverse transcriptase polymerase chain reaction was performed to assess expression of angiogenic cytokines, and recovery of motor function was assessed with function tests. Results. In the G-CSF-treated rats, the total number of vessels with a diameter > 20 mm was significantly larger and expression of angiogenic cytokines was significantly higher than those in the control group. The G-CSF - treated group showed significantly greater recovery of hindlimb function than the control group. Conclusions. These results suggest that G-CSF exerts neuroprotective effects via promotion of angiogenesis after SCI.


PubMed | Jichi Medical University, Kanagawa Cancer Center, Chiba Aoba Municipal Hospital, Saitama University and 3 more.
Type: Comparative Study | Journal: Bone marrow transplantation | Year: 2016

Previous studies have suggested that tacrolimus (TAC) is more potent than cyclosporine (CSA) for prophylaxis against acute GVHD after allogeneic hematopoietic stem cell transplantation (HSCT). However, the target blood concentrations of these drugs in these studies were not consistent with the current recommendations. Therefore, we performed a randomized controlled trial to compare CSA and TAC with target blood concentrations of 500 and 15ng/ml, respectively, to prevent acute GVHD after unrelated HSCT. A total of 107 patients were randomized into a CSA group (n=53) or a TAC group (n=54). During the first 4 weeks after HSCT, more than 90% of the patients achieved a mean blood concentration of between 80 and 120% of the target concentration. The incidences of grade II-IV and grade III-IV acute GVHD were 39.6 and 7.5% for the CSA group and 33.3 and 9.4% for the TAC group, respectively (P=0.41 and P=0.76). Other clinical outcomes, including overall survival, disease-free survival and the incidences of relapse, non-relapse mortality, and organ toxicities, were also equivalent. We concluded that the combinations of CSA and TAC with strict dose adjustment showed similar efficacies and toxicities as prophylaxis against acute GVHD after unrelated HSCT.


PubMed | University of Tsukuba, Chiba University and Chiba Aoba Municipal Hospital
Type: | Journal: Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia | Year: 2016

Posterior decompression with instrumented fusion (PDF) surgery has been previously reported as a relatively safe surgical procedure for any type of thoracic ossification of the longitudinal ligament (OPLL). However, mid- to long-term outcomes are still unclear. The aim of the present study was to elucidate the mid- to long-term clinical outcome of PDF surgery for thoracic OPLL patients. The present study included 20 patients who had undergone PDF for thoracic OPLL and were followed for at least 5years. Increment change and recovery rate of the Japanese Orthopaedic Association (JOA) score were assessed. Revision surgery during the follow-up period was also recorded. Average JOA scores were 3.5 preoperatively and 7.1 at final follow-up. The average improvement in JOA score was 3.8 points and the average recovery rate was 47.0%. The JOA score showed gradual increase after surgery, and took 9months to reach peak recovery. As for neurological complications, two patients suffered postoperative paralysis, but both recovered without intervention. Six revision surgeries in four patients were related to OPLL. Additional anterior thoracic decompression for remaining ossification at the same level of PDF surgery was performed in one patient. Decompression surgery for deterioration of symptoms of pre-existing cervical OPLL was performed in three patients. One patient had undergone lumbar and cervical PDF surgery for de novo ossification foci of the lumbar and cervical spine. PDF surgery for thoracic OPLL is thus considered a relatively safe and stable surgical procedure considering the mid- to long-term outcomes.


PubMed | Chiba Aoba Municipal Hospital, Chiba University and Chiba Rosai Hospital
Type: Journal Article | Journal: Journal of plastic, reconstructive & aesthetic surgery : JPRAS | Year: 2016

This retrospective study reports 10 patients with closed mallet thumb injury treated with surgery and compares the clinical outcomes achieved with those of previously described patients who were treated with either conservative therapy or surgery.We report the outcomes of a series of 10 patients who received surgical treatment at our institutions. Due to the rarity of closed mallet thumb, a systematic review was conducted, and the results of a literature search were compared with our case series to strengthen our conclusions. The previously described patients were categorized into two groups: the surgically treated group (16 patients) and the conservatively treated group (10 patients). The following patient and injury characteristics were documented: age, gender, injured side, time from injury to treatment, mechanism of injury, extension lag at first visit, postoperative range of motion (ROM) of the interphalangeal joint, immobilization period, and follow-up period.Statistical analyses showed no significant differences in the clinical results, except for shorter immobilization periods between our series and the previously described patients involving conservative treatment (4.90.9 vs. 9.52.3 weeks, respectively; P=0.0053).This study suggests that surgery may result in more rapid recovery.


PubMed | Chiba Aoba Municipal Hospital and Chiba Cancer Center
Type: | Journal: Case reports in orthopedics | Year: 2016

A 63-year-old male consulted our institution due to worsening of right hip pain for approximately one month. The patient had no apparent functional disorders besides rigidity of the right ankle secondary to childhood poliomyelitis. Plain radiographs demonstrated narrowing of the right hip joint space. Magnetic resonance imaging (MRI) showed unusual findings in the right gluteus medius muscle, suspecting a malignant musculoskeletal tumor. Further examinations clarified acute inflammation caused by Staphylococcus aureus with no atypia. After treatment, serum inflammatory markers normalized and MRI showed homogeneous fat signal intensity in the muscle, which was consistent with poliomyelitis. Total hip arthroplasty was performed due to progression of osteoarthritis. Intraoperative findings showed flaccidity of the gluteus medius muscle, and histological examination of the specimen also was compatible with poliomyelitis. Postoperatively there was no hip instability and the patient has been able to resume his previous physical activity. To our knowledge, this is the first report regarding polio survivors combined with septic arthritis, and sole MRI examination was unable to lead to the diagnosis. The current patient demonstrates the possibility that the involved muscles in poliomyelitis exist even in asymptomatic regions, which will be helpful for accurate diagnosis and life guidance in polio survivors.


Nakajima A.,Chiba Aoba Municipal Hospital | Watanabe H.,Chiba Aoba Municipal Hospital | Rokkaku T.,Chiba Aoba Municipal Hospital | Koda M.,Chiba Aoba Municipal Hospital | And 2 more authors.
Journal of Arthroplasty | Year: 2010

Patellofemoral problems are the most common complications after total knee arthroplasty (TKA). We report a patient who had patellar subluxation twice within 7 months after primary TKA. Postoperative radiographs and computed tomography scans revealed a valgus knee with no evidence of malposition of the prostheses. To eliminate the recurrent patellar subluxation, we finally performed an Elmslie-Trillat procedure in combination with extensive lateral release and succeeded in achieving normal patellar tracking. At 1-year postoperative follow-up, the patient was satisfied with the results. The patella tracked well in the femoral trochlear groove during knee flexion after the revision surgery. This procedure, in combination with lateral release, should be considered as a useful surgical treatment that can eliminate patellar subluxation after TKA in cases without component malposition. © 2010 Elsevier Inc.


PubMed | Chiba Aoba Municipal Hospital
Type: Case Reports | Journal: Gan to kagaku ryoho. Cancer & chemotherapy | Year: 2016

We performed laparoscopic liver resection in a patient with synchronous liver metastasis from advanced sigmoid colon cancer after induction with S-1 plus oxaliplatin (SOX) plus bevacizumab (BV) chemotherapy. A 61-year-old woman underwent laparoscopy-assisted sigmoidectomy for locally advanced sigmoid colon cancer with synchronous liver metastasis. SOX plus BV chemotherapy was initiated. After 3 courses, the liver tumor was downsized, and metastasectomy was performed laparoscopically with R0 resection. The postoperative course was uneventful and the patient was discharged on the 11th postoperative day. She has been free from recurrence. Induction with SOX plus BV chemotherapy is considered to be not only effective, but also beneficial for maintaining the quality of life (QOL) in patients with advanced colorectal cancer.

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