Iwamizawa Kojin kai Hospital

Iwamizawa, Japan

Iwamizawa Kojin kai Hospital

Iwamizawa, Japan

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Kinugasa Y.,Shizuoka Cancer Center Hospital | Arakawa T.,Fumon in Clinic 4469 Mashiko | Murakami G.,Iwamizawa Kojin kai Hospital | Fujimiya M.,Sapporo Medical University | Sugihara K.,Tokyo Medical and Dental University
International Journal of Colorectal Disease | Year: 2014

Purpose: Fecal incontinence is a common problem after anal sphincter-preserving operations. The intersphincteric autonomic nerves supplying the internal anal sphincter (IAS) are formed by the union of: (1) nerve fibers from Auerbach's nerve plexus of the most distal part of the rectum and (2) the inferior rectal branches of the pelvic plexus (IRB-PX) running along the conjoint longitudinal muscle coat. The aim of the present study is to identify the detailed morphology of nerves to the IAS. Methods: The study comprised histological and immunohistochemical evaluations of paraffin-embedded sections from a large block of anal canal from the preserved 10 cadavers. Results: The IRB-PX came from the superior aspect of the levator ani and ran into the anal canal on the anterolateral side. These nerves contained both sympathetic and parasympathetic fibers, but the sympathetic content was much higher than in nerves from the distal rectum. All intramural ganglion cells in the distal rectum were neuronal nitric oxide synthase-positive and tyrosine hydroxylase-negative and were restricted to above the squamous-columnar epithelial junction. Parasympathetic nerves formed a lattice-like plexus in the circular smooth muscles of the distal rectum, whereas the IAS contained short, longitudinally running sympathetic and parasympathetic nerves, although sympathetic nerves were dominant. Conclusions: The major autonomic nerve input to the IAS seemed not to originate from the distal rectum but from the IRB-PX. Injury to the IRB-PX during surgery seemed to result in loss of innervation to the major part of the IAS. © 2013 Springer-Verlag Berlin Heidelberg.


Rodriguez-Vazquez J.F.,Complutense University of Madrid | Murakami G.,Iwamizawa Kojin kai Hospital | Verdugo-Lopez S.,Complutense University of Madrid | Abe S.-I.,Tokyo Dental College | Fujimiya M.,Sapporo Medical University
Journal of Anatomy | Year: 2011

Closure of the middle ear is believed to be closely related to the evolutionary development of the mammalian jaw. However, few comprehensive descriptions are available on fetal development. We examined paraffin-embedded specimens of 20 mid-term human fetuses at 8-25weeks of ovulation age (crown-rump length or CRL, 38-220mm). After 9weeks, the tympanic bone and the squamous part of the temporal bone, each of which was cranial or caudal to Meckel's cartilage, grew to close the lateral part of the tympanosquamosal fissure. At the same time, the cartilaginous tegmen tympani appeared independently of the petrous part of the temporal bone and resulted in the petrosquamosal fissure. Subsequently, the medial part of the tympanosquamosal fissure was closed by the descent of a cartilaginous inferior process of the tegmen tympani. When Meckel's cartilage changed into the sphenomandibular ligament and the anterior ligament of the malleus, the inferior process of the tegmen tympani interposed between the tympanic bone and the squamous part of the temporal bone, forming the petrotympanic fissure for the chorda tympani nerve and the discomalleolar ligament. Therefore, we hypothesize that, in accordance with the regression of Meckel's cartilage, the rapidly growing temporomandibular joint provided mechanical stress that accelerated the growth and descent of the inferior process of the tegmen tympani via the discomalleolar ligament. The usual diagram showing bony fissures around the tegmen tympani may overestimate the role of the tympanic bone in the fetal middle-ear closure. © 2011 The Authors. Journal of Anatomy © 2011 Anatomical Society of Great Britain and Ireland.


Hinata N.,Kobe University | Murakami G.,Iwamizawa Kojin kai Hospital | Miyake H.,Kobe University | Abe S.-I.,University of Tokyo | Fujisawa M.,Kobe University
Journal of Urology | Year: 2015

Purpose: We identified the cavernous nerve mesh that exists caudal or posterior to the periprostatic region between the bilateral slings of the levator ani. We also assessed whether nonnerve sparing radical prostatectomy could be modified. Materials and Methods: Using histological sections from 24 elderly cadavers we investigated nerve anatomy by immunohistochemistry for S100 protein, neuronal nitric oxide synthase, vasoactive intestinal polypeptide and tyrosine hydroxylase. Results: The cavernous nerve mesh formed a U-shaped column attached to the lateral and posterior aspects of the rhabdosphincter. It was greater than 10 mm thick along the anteroposterior axis and 5 to 10 mm wide from the lateral margin of the rhabdosphincter. Composite neuronal nitric oxide synthase positive nerves ran obliquely with a highly tortuous course. The anterior margin of the nerve mesh corresponded to the anterior margin of the rhabdosphincter. Nerve mesh left-right communication was seen at and near the anterior margin. Bilateral periprostatic nerves joined posterior to the urethra and immediately anterior to the rectourethralis muscle, forming a midsagittal nerve mesh corresponding to the base of the U. The periprostatic nerves also formed a mesh or bundle but it was much thinner and smaller than the U-shaped mesh along the rhabdosphincter. Neuronal nitric oxide synthase positive nerves consistently contained tyrosine hydroxylase positive sympathetic nerve fibers but there were few vasoactive intestinal polypeptide positive fibers. The pudendal nerve and its branches were negative for neuronal nitric oxide synthase. Conclusions: Bilateral resection of the neurovascular bundle does not remove all cavernous nerves because these nerves cover the rhabdosphincter and perirectum caudal to the level of the apex of the prostate. © 2015 American Urological Association Education and Research, Inc.


Kinugasa Y.,Shizuoka Cancer Center Hospital | Arakawa T.,Iwamizawa Kojin kai Hospital | Abe S.-I.,Tokyo Dental College | Ohtsuka A.,Okayama University of Science | And 4 more authors.
Diseases of the Colon and Rectum | Year: 2011

BACKGROUND: With the development and spread of surgical procedures for total mesorectal excision and intersphincteric resection, rectal surgeons have gained frequent opportunities to observe connective tissues around the anal canal. However, uncertainty remains as to the exact identity and location of these structures. OBJECTIVE: The aim of this study was therefore to identify and describe the morphology of connective tissue structures extending between the coccyx and anal canal. DESIGN AND SETTING: This was a descriptive study carried out at university facilities for anatomic research. The study comprised histologic evaluation of paraffinembedded tissue specimens from preserved cadavers of 20 elderly adults and examination of frozen pelves from 6 fresh cadavers. MAIN OUTCOME MEASURES: From each cadaver, we obtained a tissue mass containing the dorsal wall of the distal rectum and anal canal, the coccyx, and the covering skin. Most sections were stained with Masson-Trichrome solution for collagen and smooth muscle fibers. RESULTS: Dissection of fresh cadaver demonstrated the anococcygeal ligament extending from the coccyx to the anal canal between bilateral slings of the levator ani. Histologic examination showed that the anococcygeal ligament was divided into a ventral and a dorsal layer and contained abundant smooth muscles, elastic fibers, and small vessels. The ventral layer extended from the presacral fascia to the conjoint longitudinal layer of the anal canal. The dorsal layer was recognized as a bundle extending between the coccyx and external anal sphincter. The dorsal layer was much thicker along and near the midsagittal plane than the lateral areas. The levator ani was located independently of and dorsal to the anococcygeal ligament. LIMITATIONS: This study used cadavers from elderly donors; thus, the specimens might have had age-related degeneration. CONCLUSIONS: The anococcygeal ligament is divided into 2 layers: a thick ventral layer, rich in thin vessels and extending from the presacral fascia to the conjoint longitudinal layer of the anal canal, and a thin dorsal layer extending between the coccyx and external anal sphincter. The anococcygeal ligament is one of the critical structures for decision-making regarding rectal and upper anal canal mobilization. © The ASCRS 2011.


Hinata N.,Kobe University | Murakami G.,Tokyo Dental College | Murakami G.,Iwamizawa Kojin kai Hospital
BioMed Research International | Year: 2014

Detailed knowledge of the anatomy of the rhabdosphincter and adjacent tissues is mandatory during urologic surgery to ensure reliable oncologic and functional outcomes. To characterize the levator ani (LA) function for the urethral sphincter, we described connective tissue morphology between the LA and urethral rhabdosphincter. The interface tissue between the LA and rhabdosphincter area in males contained abundant irregularly arrayed elastic fibers and smooth muscles. The male rhabdosphincter was positioned alongside the LA to divide the elevation force and not in-series along the axis of LA contraction. The male perineal membrane was thin but solid and extends along the inferior margin or bottom of the rhabdosphincter area. In contrast, the female rhabdosphincter, including the compressor urethrae and urethrovaginal sphincter muscles, was embedded in the elastic fiber mesh that is continuous with the thick, multilaminar perineal membrane. The inferomedial edge of the female LA was attached to the upper surface of the perineal membrane and not directly attached to the rhabdosphincter. We presented new diagrams showing the gender differences in topographical anatomy of the LA and rhabdosphincter. © 2014 Nobuyuki Hinata and Gen Murakami.


Osanai H.,Sapporo Medical University | Rodriguez-Vazquez J.F.,Complutense University of Madrid | Abe H.,Akita University | Murakami G.,Iwamizawa Kojin kai Hospital | And 2 more authors.
Investigative Ophthalmology and Visual Science | Year: 2011

PURPOSE. There seems to be little or no information about the morphology of the fetal eye check ligament. METHODS. The authors examined longitudinal and cross-histologic sections from the large collection of human fetuses at Universidad Complutense, Madrid. RESULTS. In longitudinal sections from 20 fetuses (four at each of 12, 15, 20, 25, and 30 weeks of gestation), a distinct connective tissue band was found connecting the medial and lateral recti and the limbus of the conjunctiva (sites at and around the lateral and medial angles of the conjunctival space). Silver impregnation revealed that the muscle endomysium (type 4 collagen dominant) was connected with composite fibers of the band (type 1 collagen). The cross-sections from three fetuses (20 weeks) exhibited a site-dependent difference in the rectus sheaths: the orbital-sided sheath suddenly increased in thickness when it tightly attached to the muscle bundles. The attaching orbital-sided muscle bundles reached 14% to 15% (or 18%-20%) in the cross-sectional area of the MR (or the LR). CONCLUSIONS. Taken together, the distinct connective tissue band extending to the conjunctiva was "originated from" the MR and LR rather than from a part of the muscles inserting into the connective tissue band. This band was most likely a primitive form of the check ligament. The authors hypothesize that the primitive check ligament conducts muscle tension to the conjunctiva to coordinate growth patterns between the anterior and posterior sides of the eyeball. This hypothesis may support en bloc recession for infantile esotropia. © 2011 The Association for Research in Vision and Ophthalmology, Inc.


Rodriguez-Vazquez J.F.,Complutense University of Madrid | Verdugo-Lopez S.,Complutense University of Madrid | Murakami G.,Iwamizawa Kojin kai Hospital
Surgical and Radiologic Anatomy | Year: 2011

Purpose: The present study describes the venous drainage, especially, that via the so-called Serres' vein, from border areas between two different types of ossifications: the endochondral ossification of Meckel's cartilage in close topographical relation with the membranous ossification of the mandible. Methods: Frontal and transverse sections of 25 human fetuses between 8 and 16 weeks of post-conception development. All sections were stained with hematoxylin, and eosin and azan. Results: At 9 weeks, a distinct vein (Serres' vein) is seen originating from the endochondral ossification of Meckel's cartilage. At 11 weeks, the vein collects blood sinusoids from both the endochondral and membranous ossification areas. At 12 weeks the vein accompanies a definite bony canal, the Serres' canal. The vein does not extend anteriorly beyond a level of the deciduous canine germ that was located anterior to the mental foramen. Notably, up to 12 weeks, the vein becomes clearly isolated from the inferior alveolar nerve, artery, and vein. Conclusion: Serres' vein seems to be a unique drainage route of ossification, not of the tooth germ, and is similar to veins at the usual diaphysis of a long bone. Although the Serres' canal had been termed "canal of the deciduous dentition", there appears to be no topographical relation with deciduous germs. © 2011 Springer-Verlag.


Osanai H.,Sapporo Medical University | Abe S.-I.,Tokyo Dental College | Rodriguez-Vazquez J.,University of Tokyo | Verdugo-Lopez S.,University of Tokyo | And 2 more authors.
Investigative Ophthalmology and Visual Science | Year: 2011

PURPOSE. In the human body, the orbital muscle is a limited smooth-muscle tissue extending between hard tissues. To provide better understanding of its function, the authors re-examined its development in fetuses. METHODS. Using 20 human fetuses (12-25 weeks of gestation), semiserial horizontal or sagittal paraffin sections were prepared at intervals of 20 to 100 μm. In addition to routine histology, the authors performed silver staining as well as immunohistochemistry for alpha smooth-muscle actin (SMA), vimentin, S100 protein, and tyrosine hydroxylase. RESULTS. Up to 12 weeks, the orbital muscle appeared as a plate-like mesenchymal condensation between the ciliary and sphenopalatine ganglia. Up to 15 weeks, the thick smoothmuscle layer provided an inferoposterior wall for the orbit. A notable feature was a difference in fatty tissue development between the ocular (anterior) and posterior sides of the orbital muscle. At 20 and 25 weeks, SMA immunoreactivity and the amount of smooth-muscle basal lamina were decreased, in contrast to an increase in the number of collagenous fiber bundles. Nerves for the orbital muscle are unlikely to contain sympathetic fibers until 15 weeks. CONCLUSIONS. The authors hypothesize that, in the early stage, the orbital muscle separates the orbital content from the surrounding loose spaces to maintain conditions adequate for the development of orbital fat and other connective tissues. Later, the orbital muscle is replaced by collagenous fibers and seems to provide guidance for calcification of the inferoposterior bony orbital wall. Vimentin-positive osteoprogenitor cells appear to migrate from the perichondrium of the sphenoid and ethmoid. © 2011 The Association for Research in Vision and Ophthalmology, Inc.


Hieda K.,Hiroshima University | Cho K.H.,Wonkwang University | Arakawa T.,Fumon in Clinic | Fujimiya M.,Sapporo Medical University | And 2 more authors.
Clinical Anatomy | Year: 2013

In the intersphincteric space of the anal canal, nerves are thought to "change" from autonomic to somatic at the level of the squamous-columnar epithelial junction of the anal canal. To compare the nerve configuration in the intersphincteric space with the configuration in adjacent areas of the human rectum, we immunohistochemically assessed tissue samples from 12 donated cadavers, using antibodies to S100, neuronal nitric oxide synthase (nNOS), and tyrosine hydroxylase (TH). Antibody to S100 revealed a clear difference in intramuscular nerve distribution patterns between the circular and longitudinal muscle layers of the most inferior part of the rectum, with the former having a plexus-like configuration, while the latter contained short, longitudinally running nerves. Most of the intramural ganglion cells in the anal canal were restricted to above the epithelial junction, but some were located just below that level. Near or at the level of the epithelial junction, the nerves along the rectal adventitia and Auerbach's nerve plexus joined to form intersphincteric nerves, with all these nerves containing both nNOS-positive parasympathetic and TH-positive sympathetic nerve fibers. Thus, it was histologically difficult to distinguish somatic intersphincteric nerves from the autonomic Auerbach's plexus. In the intersphincteric space, the autonomic nerve elements with intrapelvic courses seemed to "borrow" a nerve pathway in the peripheral branches of the pudendal nerve. Injury to the intersphincteric nerve during surgery may result in loss of innervation in the major part of the internal anal sphincter. © 2013 Wiley Periodicals, Inc.


Kim J.H.,Chonbuk National University | Kinugasa Y.,Sizuoka Cancer Institute | Hwang S.E.,Daejeon Sun Hospital | Murakami G.,Iwamizawa Kojin kai Hospital | And 2 more authors.
Surgical and Radiologic Anatomy | Year: 2015

Although several studies have reported that the peritoneum does not contribute to the formation of a fascia between the urogenital organs and rectum, Denonvilliers’ fascia (DF), a fascia between the mesorectum and prostate (or vagina) in adults, is believed to be a remnant of the peritoneum. Remnants of the peritoneum, however, were reportedly difficult to detect in other fusion fasciae of the abdominopelvic region in mid-term fetuses. To examine morphological changes of the pelvic cul-de-sac of the peritoneum, we examined 18 male and 6 female embryos and fetuses. A typical cul-de-sac was observed only at 7 weeks, whereas, at later stages, the peritoneal cavity did not extend inferiorly to the level of the prostatic colliculus or the corresponding structure in females. The cul-de-sac had completely disappeared in front of the rectum at 8 weeks and homogeneous and loose mesenchymal tissue was present in front of the rectum at the level of the colliculus at 12–16 weeks. We found no evidence that linearly arranged mesenchymal cells developed into a definite fascia. Therefore, the development of the DF in later stages of fetal development may result from the mechanical stress on the increased volumes of the mesorectum, seminal vesicle, prostate and vagina and/or enlarged rectum. Therefore, we considered the DF as a tension-induced structure rather than a fusion fascia. Fasciae around the viscera seemed to be classified into (1) a fusion fascia, (2) a migration fascia and (3) a tension-induced fascia although the second and third types are likely to be overlapped. © 2014, Springer-Verlag France.

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