Matsudo City Hospital

Matsudo, Japan

Matsudo City Hospital

Matsudo, Japan
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Nakamura J.,Chiba University | Saisu T.,Chiba Childrens Hospital | Yamashita K.,Funabashi Central Hospital | Suzuki C.,Matsudo City Hospital | And 2 more authors.
Arthritis and Rheumatism | Year: 2010

Objective. To clarify whether age at the time of the initial administration of corticosteroids is a risk factor for corticosteroid-associated osteonecrosis in children with systemic lupus erythematosus (SLE), using magnetic resonance imaging (MRI). Methods. From 1986 to 2007, MRI was used to prospectively study 676 joints, including 72 joints (36 hips and 36 knees) in 18 pediatric patients with SLE (<15 years old), 100 joints (50 hips and 50 knees) in 25 adolescent patients with SLE (15-20 years old), and 504 joints (252 hips and 252 knees) in 126 adult patients with SLE (>20 years old), beginning just after corticosteroid administration, for at least 1 year. The followup rate was 100%. Results. In pediatric patients, osteonecrosis developed in 4 joints (6%; all hips). In adolescent patients, osteonecrosis developed in 49 joints (49%; 18 hips and 31 knees). In adult patients, osteonecrosis developed in 207 joints (41%; 95 hips and 112 knees). The rate of osteonecrosis was significantly lower in pediatric patients than in adolescent or adult patients (P = 0.0001). Logistic regression analysis revealed that adolescent and adult patients had a significantly higher risk for osteonecrosis compared with pediatric patients, with an odds ratio of 10.3 (P < 0.0001). The youngest patients with osteonecrosis in the hip and knee were 14.9 years old and 15.5 years old, respectively. Osteonecrosis did not develop in patients younger than age 14 years. Conclusion. Our results suggest that age at the time of the initial administration of corticosteroids is associated with osteonecrosis in pediatric patients with SLE. © 2010, American College of Rheumatology.


Uemura K.,Matsudo City Hospital
Neurologia Medico-Chirurgica | Year: 2010

For clinical assessment of motor disturbances, the motor system is better classified into the voluntary versus automatic motor systems than into the pyramidal versus extrapyramidal motor systems. The voluntary motor system is related to externally guided movements initiated by the premotor area while the automatic motor system is related to memory guided automatic movements initiated by the supplementary motor area and supported by an appropriate posture and associated movements. Among the pyramidal tract signs, muscle weakness alone is related to involvement of the corticospinal fibers of Betz cell origin while hyperreflexia and spasticity is related to involvement of the reticulospinal fibers running medial to the corticospinal fibers in the spinal cord. The earliest clinical manifestation of cervical myelopathy due to cervical spondylosis is always hyperreflexia and spasticity without any muscle weakness. The memory depends upon the 3 processes of encoding, retention, and recall, and must be classified into the immediate memory or recall lasting for only several seconds tested by the digit span test, the intermediate memory lasting for up to 2 years at maximum at the hippocampus whose disturbance can best be tested by the digit learning test, and the long-term memory which can last as long as one lives which can be tested by asking one's experience before more than 2 years. The classical dichotic concept of recent (short-term) versus remote (long-term) memories must be abandoned.


Miyashita T.,Matsudo City Hospital | Ataka H.,Matsudo Orthopaedic Hospital | Tanno T.,Matsudo Orthopaedic Hospital
Neurosurgical Review | Year: 2015

This study aims to describe the animated respiratory movement of a spinal intradural arachnoid cyst visualized by intraoperative ultrasonography. A 69-year-old man with a spinal arachnoid cyst of the thoracic spine presented with gait disturbance. Magnetic resonance images showed a mild anterior displacement and flattening of the spinal cord at T4–T5. We performed ultrasonography before incision of the dura during the operation and observed the movement of the cyst consisting of not only pulsation in accordance with the cardiac cycle but also rhythmic expansion and contraction in accordance with the respiratory cycle. In the inspiratory phase, the cyst gradually expanded and pulsated in accordance with the cardiac cycle. In the expiratory phase, the cyst gradually contracted with the same pulsation. After resection of the cyst, the patient’s neurological improvements were excellent. To our knowledge, this is the first report of animated respiratory movement of a spinal arachnoid cyst visualized by intraoperative ultrasonography. Although cine magnetic resonance imaging can detect spinal intradural arachnoid cysts preoperatively, intraoperative ultrasonography is useful for close analysis of their movement and pathology. Considering the dynamic compression mechanism revealed in this study, we think that an early operation should be performed for such cysts. © 2014, Springer-Verlag Berlin Heidelberg.


Miyashita T.,Matsudo City Hospital | Ataka H.,Matsudo Orthopaedic Hospital | Tanno T.,Matsudo Orthopaedic Hospital
Spine Journal | Year: 2013

Background context: Although complete resection is the preferred surgical treatment for ossification of the ligamentum flavum (OLF), it sometimes results in the floating method because of adhesion to, or ossification of, the dura mater. It is difficult to anticipate the degree of floating, and if the floated ossification is large, decompression of the spinal cord may not be sufficient. Purpose: To describe a case of spontaneous reduction of a floated OLF after posterior decompression. Study design: Case report and review of the literature. Methods: A 70-year-old woman with OLF of the thoracic spine presented with gait disturbance. A computed tomographic myelogram showed a large ossification and severe spinal canal stenosis at T10-T11. It also showed slight spinal cord compression by ossification at T9-T10. Results: We performed a laminectomy with floating ossification at T9-T11 and posterior fusion with a pedicle screw system at T10-T11. After the operation, the patient's neurologic improvement was excellent. Five weeks after the operation, a computed tomogram showed reduction of the floated ossification. Improvement progressed up to 3 months after the operation, bringing a sufficient decompression of the spinal cord, whereas it was insufficient immediately after the operation. Conclusions: Our present study is the first report that showed OLF was reduced after the floating method. Reduction of the floated ossification was observed 5 weeks after the operation. © 2013 Elsevier Inc. All rights reserved.


Kashimura M.,Matsudo City Hospital | Murayama K.,Gunma Cancer Center | Kojima M.,Dokkyo Medical University
International Journal of Surgical Pathology | Year: 2013

Primary hepatic and hepatosplenic diffuse large B-cell lymphomas (DLBCLs) are rare cancers and form nodules in most instances. However, very rare cases can diffusely infiltrate the whole liver without nodules. The general clinicopathological features of these lymphomas have not been reported to date. In our current study, we attempted to elucidate the features of these lesions through our direct observations and by reviewing the current literature. We describe the characteristics of 2 patients with hepatic and hepatosplenic DLBCL by autopsy. The lymphoma cells showed diffuse infiltration of the liver, red pulp of the spleen, and bone marrow with intrasinusoidal and interstitial lymphomatous infiltration of the organs. We discuss our observations in relation to previously reported DLBCLs with a similar pathology. © The Author(s) 2013.


Nakamura J.,Chiba University | Harada Y.,Chiba University | Oinuma K.,Funabashi Orthopaedic Hospital | Iida S.,Matsudo City Hospital | And 2 more authors.
Lupus | Year: 2010

Systemic lupus erythematosus (SLE) patients are at high risk of developing osteonecrosis. This study utilized MRI to document the long-term natural history of asymptomatic osteonecrosis associated with corticosteroid therapy in SLE patients. Two hundred and one SLE patients treated with high-dose corticosteroids were prospectively observed from 1986 to 1997. The inclusion criterion was that patients had received periodic MRI examinations of all their hip and knee joints for ≥10 years. Joints that were already collapsed and symptomatic at the first examination were excluded. Five hundred and thirty-seven joints (251 hips and 286 knees) were identified in 144 patients, with a mean follow-up period of 13.6 years (range, 10-20 years) and a follow-up rate of 73%. Mean age of SLE onset was 26 years, and the mean highest oral corticosteroid dosage was 57 mg/day. Osteonecrosis developed in 238 (44%) of 537 joints. At final follow-up, 117 (49%) of these 238 joints demonstrated spontaneous repair in the necrotic area. Osteonecrosis completely disappeared in 21 joints. Enlargement of osteonecrosis was noted in 35 joints (15%) following increased steroid dosage because of SLE recurrence. Finally, 52 joints (22%) were collapsed. Spontaneous repair of asymptomatic osteonecrosis was observed, whereas enlargement occurred only after corticosteroid dosage increases. © The Author(s), 2010.


Yoshino A.,Matsudo City Hospital
Kyobu geka. The Japanese journal of thoracic surgery | Year: 2012

A 69-year-old woman had undergone a subtotal esophagectomy for basaloid-squamous cell carcinoma of the esophagus 2 years before (pT3, ly1, v2, pN0, pStage II). Right lung metastasis was detected by follow up chest computed tomography( CT). A partial resection of the right lung was performed. Histopathological diagnosis was basaloid-squamous cell carcinoma. She is doing well 17 months after surgery for metastasis.To our knowledge, no case of radical surgery for the lung metastasis of basaloid-squamous cell carcinoma has not been reported in the Japanese literature to date.


Miyashita T.,Matsudo City Hospital | Ataka H.,Matsudo Orthopaedic Hospital | Kato K.,Matsudo City Hospital | Tanno T.,Matsudo Orthopaedic Hospital
Spine | Year: 2015

Study Design. A retrospective clinical and radiographical study. Objective. To assess the clinical outcomes and fusion rate of facet fusion (FF) for degenerative lumbar spondylolisthesis (DLS). Summary of Background Data. On the basis of the long-term clinical and radiological follow-up studies of posterolateral fusion (PLF) - that is, intertransverse process fusion with pedicle screw instrumentation - for DLS, we recognized that FF alone would be sufficient for spinal fusion. Methods. Eighty-eight patients who underwent FF for single-level DLS were retrospectively reviewed after at least 1 year of follow-up. The control group comprised 21 patients who underwent conventional PLF. The operative technique involved a 5-cm midline skin incision, bilateral laminar fenestration, and FF with autologous bone harvested from the spinous process. Percutaneous pedicle screws were then inserted through the fascia. The fusion rate of FF was evaluated using computed tomography, and the change in the range of motion at the fused level was assessed on flexion-extension lateral radiographs. The Japanese Orthopaedic Association Back Pain Evaluation Questionnaire was used to assess the therapeutic effectiveness of FF. The results of the Roland-Morris Disability Questionnaire and the visual analogue scales of low back pain, buttock and lower limb pain, and buttock and lower limb numbness were evaluated. Results. The fusion rate was 88.6% (78/88 cases). Among 10 patients with inadequate fusion, the average range of motion significantly decreased from 14.4° preoperatively to 4.3° postoperatively. The Japanese Orthopaedic Association Back Pain Evaluation Questionnaire category scores demonstrated therapeutic effectiveness in 93.0% of the patients for walking ability and in 73.0% of the patients for low back pain. The average preoperative scores of the Roland-Morris Disability Questionnaire and the visual analogue scales of low back pain, buttock and lower limb pain, and buttock and lower limb numbness were significantly reduced postoperatively in the FF group. Conclusion. FF achieved good clinical outcomes that were superior to those of conventional PLF with a comparable fusion rate. It is useful for managing DLS and is a minimally invasive evolution of PLF. © 2015, Wolters Kluwer Health, Inc.


Ataka H.,Matsudo City Hospital | Tanno T.,Matsudo City Hospital | Miyashita T.,Matsudo City Hospital | Isono S.,Chiba University | Yamazaki M.,Chiba University
Spine | Year: 2010

Study Design.: Case series. Objective.: To analyze factors that contribute to the development of sleep apnea in patients with rheumatoid arthritis (RA) and upper cervical lesions. Summary of Background Data.: No large prospective study has analyzed the association between sleep apnea and upper cervical involvement resulting from RA. Furthermore, only 1 report in the literature describes a case of sleep apnea accompanying rheumatoid vertical subluxation of the odontoid process. Methods.: The authors analyzed 8 consecutive RA patients with upper cervical lesions who underwent occipitocervical (O-C) fusion. The patients were examined with all-night polysomnography before and after surgery. Patients with apnea-hypopnea index values ≥5 were diagnosed to have sleep apnea. O-C2 angles were calculated from cervical radiographs. Results.: All 8 patients were diagnosed as having sleep apnea, and most of their apneic episodes were obstructive in origin. Among the 4 patients with medullary compression, central apneic episodes comprised ≤5% of their respiratory events. Two patients with severe sleep apnea had negative O-C2 angles. Six patients who showed postoperative improvements in their sleep apnea all had positive changes in their O-C2 angles exceeding 5° after surgery. The differences between preoperative and postoperative O-C2 angles were significantly greater in the patients with improvement of sleep apnea than in the patients with worsening sleep apnea. Conclusion.: All our study patients with RA and upper cervical lesions had obstructive-dominant sleep apnea. Negative O-C2 angles may result in upper airway narrowing, increasing the severity of sleep apnea. O-C fusion with correction of kyphosis at the craniovertebral junction has the potential to improve sleep apnea in RA patients. © 2010, Lippincott Williams & Wilkins.


Miyashita T.,Matsudo City Hospital | Ataka H.,Matsudo City Hospital | Tanno T.,Matsudo City Hospital
Neurosurgical Review | Year: 2012

The purpose of this study is to investigate the clinical outcome of posterior stabilization without decompression for thoracolumbar burst fractures. Thirty-one consecutive cases of thoracolumbar fractures involving T11-L2 stabilized by a pedicle screw system were reviewed. Neither reduction of the height of a fractured body nor any decompression procedure was added during surgery. Twenty-two patients had incomplete paraplegia; one patient had complete paraplegia. Neurological recovery and remodeling of the spinal canal were evaluated. Neurological status was evaluated at the time of injury, just before and after surgery, and at final follow-up. The degree of spinal canal compromise was assessed using axial CT scan images. The duration of follow-up averaged 39.6 months. The mean spinal canal compromise at the time of injury was 41.6%, and no significant correlation was observed between the degree of canal compromise and the severity of the neurological deficit. Within 2-3 weeks, spinal canal remodeling had started in all patients whose spinal canal compromise was more than 30%, and canal compromise had decreased significantly 3-4 weeks after injury. Seventeen of 22 patients with incomplete paraplegia had already shown partial neurological recovery even before surgery. At the final follow-up, all patients with incomplete paraplegia had improved by at least one modified Frankel grade. This study suggests that the effect of decompressing thoracolumbar fractures with neurological deficits remains unclear and questions the need to operate simply to remove retropulsed bone fragments. Posterior stabilization without decompression should constitute appropriate surgical treatment for these fractures. © Springer-Verlag 2012.

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